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Home My WebLink About0219 WIANNO AVENUE 0 a n o r r • 21 0 z No 3LR NABS 9i 6N -`^'ram. ,-�.r. -.—w...r—.�v......w�s+«.,-+-.y. �.rx..�.r.w• ..--..r.P� awri^r.�J#' o:.. ^+w��- Y+.�►- 'r,++w.._ - ..^+q*n:.�r o`^'_.... _ ��!` r ,- , .,... ...,,,,�.,..., .„�__..�,;,.5":3, _ .... .. yam:�..—�,_ .-„r-�r _ x3�"�S,i'•`.:"x"'.T�..-_ _ .. t — — 1.- Town of Barnstable Building t Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept MASS, Posted Until Final Inspection Has Been Made. Permit =bsw r, 1 Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-19-1648 Applicant Name: JEFFREY MORIN Approvals Date Issued: 06/10/2019 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 12/10/2019 Foundation: Residential Map/Lot:_140-140 � _ Zoning District: RC Sheathing: Location: 219 WIANNO AVENUE,OSTERVILLE F Contractor Name-.JEFFREY MORIN Framing: 1 L$'1� Adv— Owner on Record: MEYER, PETER&JEANNIE S Contractor License: 179299 2 Address: 219 WIANNO AVE _ -" Est. Project Cost: $9,000.00 Chimney: OSTERVILLE, MA 02655 • Permit Fee: $95.90 Description: Remodel Bathroom, put divider between toilet and laundry area. Insulation: (oI jig Fee Paid:r $95.90 Install new pocket door. Wall will be 7'6" long and 34" inside !�g Final dimension. Install new plumbling, lighting,flooring,trim __ Date: �� 6/10/2019 0 Project Review Req: REMODEL EXISTING BATHROOM. Plumbing/Gas Rough Plumbing: ��,BuildingOfficial f Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and the'approved construction docume nts for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. i �- Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing 2.Sheathing Inspection Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Building plans are to be available on site" Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: O Application Number............................................................. snaxsr, . = 4/ MAB& �, :3 _ ` 'lei.........q5 10..............................Other Fee........................ a639.. QY Tp Fee Paid............... ................................................ ...... �NpFBAR olY TOWN OF BARNSTABLE & pro valby....... . ......................on..... /f....l.......... BUILDING PERNUT NO I q 0 MV........................................Parcel.............................................— --— APPLICATION �y� s Section 1 — Owner's Information and Project Location Project Address s gle Village Owners Name . A yt�,1,11111_ Owners Legal Address InI19 aWle A111elf, City 1/ �Gr�/1 -G State 14, Zip Owners Cell# 5�'O C�6 y E-mail p� CVA Section 2 —Use of Structure Use Group ❑ Commercial Structure over 35,000 cubic feet ❑ `Commercial Structure under 35,000 cubic feet M, Smgle/Two Family Dwelling Section 3 —Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑+Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment ❑ Sprinkler System ❑ A 'lion ❑ Retaining wall ❑ . Solar IR Renovation ❑ Pool ❑ Insulation Other—Specify Section 4 - Work Description r e � 1 i J ' I i Application Number.................................................... Section 5 -Detail Cost of Proposed Construction�Z,� Square Footage of Project Age of Structure cl Dig Safe Number' e ` ' # Of Bedrooms Existing Total#Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics Wiring ❑ Oil Tank Storage ❑ Smoke Detectors Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom 9 Water Supply Public ❑ Private Sewage Disposal ❑ Municipal l/a On Site g sP P Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: /o�/�'I r ' �li I am us' a crane ❑ Yes P No S? � i Section 7—Flood Zone I Flood Zone Designation Within or adjacent to a wetland coastal bank? Yes ❑ No Z Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed d Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No i act —el.tnA- 11/1 gnn1 2 ...... . . ... .. ...... Application Number........................................... Section 9- Construction Supervisor Name �dG/✓� Telephone N ber �171 ^ s Address . i City /State Zip License Number -G / License Type , 6� Expiration Date � y , Contractors Email /1��7✓1j`/�/ i'�Gr� cj��C® Cell #�aXjP� t I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by CMR and the of Barnstable.Attach a copy of your license. _ k . Signature Date Section 10—Home Improvement Contractor Name Telephone Number Address o .City,1��Sl��` %f�S State�1�IC��, Zip a�o� Registration Number Expiration Date I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required 0 CMR and the wn of Barnstable.Attach a copy of your H.I.C... Signature Date Section 11 —Home Owners License Exemption Home Owners Name: Telephone Number Ce or Work Num er I understand my responsibilities under the rules and ations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I erstan the construction inspection procedures,specific inspections and documentation required by 780 CMR and the own of B ble. Signature Date APPLICANT SIGNATURE J Signature ' Date Print Name J' a Telephone Number E-mail permit to: jhoenll ,j G : .,.. Section 12—Department Sign-Offs Health Department ❑ = Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation ❑ For commercial work,please take your plans directly to the fire department for approval Section 13 —Owner's Authorization as Owner of the subject property hereby authonze to act on my behalf, in all matters relative to work With ed by this building permit application for: (Address of job) Sip of Owner date J� , `f�`1/1Mn e. Print Name i i } e 1� J •1 ._._ OdLSN�� dw . r° I1 /0 1/0Jp N® r4 BUILDING DEPT. MAY• 16 2019 ' TOWN OF BARNSTABLE Sb eL FF • ... e.• n .T.Lu.%dr.. � r..•of..,oes DS t FF i ... r. ------ M.2,NW. 11p ____L.............. b � �L$•. IL ---=�"—T-------- 1 IN woe, Mt y Ma a a [ICA S9 J-q"\PIP-lr-FLOOD PLAN .� wsoo hanla: /4" 1,_0.� �IM, �ko� S9 Fa �. ouwm�e me. • ra.s rbm Pl.n ;MEET NtIMBFiI A200 I� 1.1 4 w cv 1r u G K f d' SPR r :✓ S 'ruu w rw f 0• .. .• .,aP.. . r a - - D The Commonwealth of Massachusetu Department of Industrial Accidents Office of Invadgadons 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Bulders/Contractors/Electricians/Pinmbers AlpyUcant Information Please Print Leizibly, Name(Business o gganizatim/Individual)• �l Address: L!J r City/State/Zip: D / Z4�Plone#: " /llD�®G�✓'�� Are you an employer?Check the appropriate bog. Type of project(required): I.�F' pl'emp loyer with- 4. I am a general contractor and I (full and/or part-time). have hired tine sub-contractors6. ❑New construction a sole proprietor or partner- listed the attached sheet. 7. ❑Remodeling ship and have no employees These subcontractors have g. Demolition workingfor mein an act employees and have workers' y ty. 9. ❑Building addition [No workers'comp-insurance cemP.mstrance.Y . ram] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance ]t c. 152,§1(4),and we hava no employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hue outside conhactors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. , lam an employer that isproviding workers'compensation insurance for ray employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or ono-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify un pains and pe f perjury that the information provided above istrue and correct Si Date: Phone#: Ojj`icial use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.EIectrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person im the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insmance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation inmu•ance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for conformation of irmirance coverage. Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate lime. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit./license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would bike to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The CommonwWth of Massachusetts Department of IndusttW Accidents Office of Investigations 600 Washington Street _ Boston,MA 02111 Tel.#617-727-49M exxt 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 wwwr maw.gov/dia .Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only 7, E:.Individual Re ist_tio�_ Expiration before the expiration date. If found return to: �. 3299 10/02/2020 Office of Consumer Affairs and Business Regulation JEFFREY MORI,� �'' 1000 Washington Street-Suite 710 Boston,MA 02118 JEFFERYMORIN MOUNTAIN OU 55 MOUNTAIN MARSTONS MILLS,MA 02648 /J� /Not valr �w �� i signature Undersecretary ' 4 J Commonwealth of Massachusetts ®� Division of Professional Licensure Board of Building Regulations and Standards Constr�4ttj�6rj S-b"p�.rvisor CS-092132 Et-Pires: 10/03/2020 JEFFREY M MORIN':-`; T;; 55 MOUNTAIN' -ASH �C MARSTONS MILES MA 026!18 S Commissioner Construction Supervisor Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Call(617)727-3200 or visit www.mass.gov/dpl v t � t Ie+E'�y Application numb ............ ............................ wa� anR.usrAs -PRF..TPRO) Date Issued.......M/10-As MO'►�°`e� NOV 14 2018 Building Inspectors initials... ...................... Q .. T01�!�a iJE Rf�RC11S r�RLE Map/Parcel......z...q..... �0................................. TOWN OF BARNSTABLE �3f EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY MOR' ATION Address of Project: n n o Z e__- O4e�✓�'I� NUMBER STREET VILLAGE Owner's Name: Jea,•,,�,'e �e✓ f� Phone Number 5 o y- Ld_ 1 Z L( S Email Address: , 5 M e f/e r)3 qo/.C0 Cell Phone Number Project cost$ Z 3 8 8 — Check one Residential Commercial OWNER'S A>UTHORT ',AT ON As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: S e- -44a ck\a 06-4fr-4 Date: TYPE OF WORK Siding EfWindows (no header change)#' 3 F-1 Insulation/Weatherization Doors (no header change)#___�_ Commercial Doors require an inspector's review cr-1 Roof(not applying more than 1 layer of shingles) Construction Debris will be going to CONTRACTOR'S IINFORMATION i rI Contractor's name I�c�u,, ��n�,'su r, - So,. ��n 4/Pxj Fry 1CV4 J'/)JOW S Home Improvement Contractors Registration(if applicable)# 17 3 2-14_5 (attach copy) Construction Supervisor's License# S 7 07 (attach copy) Email of Contractor QSL,Jea 9 qS@ Ci'W; • C f rn Phone number q01- Z 2 R -1900 ALL PROPERTIES THAT HAVE STRUCTURES VER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS 11U A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. ,A APPLICATIONNUMBER............................................................ *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one:this event is a: for profit non-profit event Check one:Food served Yes No Flame Spread Sheet of each tent must be attached.Provide a site plan with the location(s) of each tent Iffood is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3.30 pm-4:30pm. Commercial events may require Fire Department approval *WOOD/COAL/PELLET STOVES x Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures;specific inspections and documentation required by 780 CMIZ and the Town of Barnstable. Signature Date PLICAI TT'S SIGNATURRIE Signature Date / 7 All permit applications are subject to a building official's approval prior to issuance. Renewal Agreement Document and Payment Terms byAndersen. dba:Renewal By Andersen of Southern New England Jeannie&Peter Meyer Legal Name:Southern New England Windows,LLC .219 Wianno Avenue RI#36079, MA#173245,CT#0634555, Lead Firm#1237 osterville,MA 02655 wi�oow aE 1110EMENr 10 Reservoir Rd I Smithfield,RI 02917 H:(508)420-1245 Phone:866-563-2235 1 Fax:401-633-6602 1 sales®renewalsne.com C:5086815484 Buyer(s) Name: Jeannie & Peter Meyer Contract Date: 10/27/18 Buyer(s)Street Address: 219 Wianno Avenue, Osterville, MA 02655 Primary Telephone Number: (508)420-1245 Secondary Telephone Number: 5086815484 Primary Email: jsmeyer23@aol.com Secondary Email: Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Southern New England Windows,LLC d/b/a Renewal By Andersen of Southern New England("Contractor"),in accordance with the terms and conditions described in this Agreement Document and Payment Terms,any documents listed in the Table of Contents,and any other document attached to this Agreement Document, the terms of which are all agreed to by the parties and incorporated herein by reference(collectively, this"Agreement"). Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job Amount: $12,388 By signing this Agreement,you acknowledge that the Balance Due,and the Amount Financed must be made by personal check,bank check,credit card,or cash. Deposit Received: $4,128 Balance Due: $8,260 Estimated Start: Estimated Completion: Amount Financed: $0 8-10 weeks 840 weeks Method of Payment: Credit.Card We schedule installations based on the date of the signed contract and secondarily on the date in which we complete the technical measurements.The installation date that we are providing at this time is only an estimate.We will communicate an official date and time at a later date. Rain and extreme weather are the most common causes for delay. Notes: TXS PD in Osterville MA Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there are no verbal understandings changing or modifying any of the terms of this Agreement.No alterations to or deviations from this Agreement will be valid without the signed,written consent of both the Buyer(s) and Contractor.Buyer(s)hereby acknowledges that Buyer(s) 1) has read this Agreement, understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO BUYER: Do not sign this contract if blank.You are entitled to a copy of the contract at the time you sign. YOU,THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT OF 10/31/2018 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. Legal Name:Southern New England Windows,LLC dba:Renewal By Andersen of Southern Nov England Buyer(s) Signature of Sales Person Signature Signature Eric Woods Jeannie Meyer Peter Meyer Print Name of Sales Person Print Name Print Name UPDATED: 10/27/18 Page 2 / 10 AZ FL Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement-Contractor Registration -- Type: Supplement Card Registration: 173245 SOUTHERN NEW ENGLAND WINDOWS,LLC. Expiration: 09/18/2020 10 RESERVOIR ROAD SMITHFIELD, RI 02917 - Update Address and Return Card. SCA 1 20M-05/17 .%fie �e»�innieeetiao,�e��/a�:�weld. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Supplement Card before the expiration date. If found return to: Reaisfhation. Expiration Office of Consumer Affairs and Business Regulation 173245 :.. . 09/18/2020 1000 Washington Street-Suite 710 SOUTHERN NEW ENGLAANb WINDOWS,LLC Boston,MA 0211 BRIAN DENNISON 10 RESERVOIR ROAD' U� SMITHFIELD,RI 02917 Undersecretary v . .a� withOUt Signature r Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construct-fib n °Supervisor CS-095707 __ Eap i res : 09/08/2020 J ./: BRIAN D DENNISON •=� 8 BLACKWELL-DRIVE CHARLTON MAiciv 01507 Commissioner The Commonwealth of Massachusetts Department of industrial Alccidents I Congress Street,Suite 100 Boston,M4 02114-2017 www.mass.gov/dia `Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERNHTTLNG AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/individual): J-1Aer.,1 k/ f S lalj &V,7,�dy /a Address: /p &5er✓o,'r' Rcl City/State/Zip: z'� 17 Phone#,: 4-10 I—1-2 f—gi'DO Are you an employer?Check the appropriate box: Type of project(required): L�I am a employer with ai O+'employees(full and/or part-time).* 7. EI New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required] 9. El Demolition 3.D 1 am a homeowner doing all work myself.[No workers'comp.insurance required.]' ]0 Q Building addition 4.❑1 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I LE]Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.r7 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractor have employees and have workers'comp.insurance.'. 1 Roof repairs / 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14..E�therW r�1C�lSWCr Z� 152,§1(4),and we have no employees.[No workers`comp.insurance required.] I'P�IQe-,--eil'> *Arty applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information.Insurance Company Name: f'`t-e r t 2J1 5 �/1 C CDM I)a t Policy#or Self-ins.Lic. /C A 3/ 5"S 72— r Expiration Date: Job Site Address: cC W 1 q I•Q tin o Ale— City/,State/Zip: e /,�/, 1 I—(A Attach a copy of the workers' compensation policy declaration page(showing the policy number and expira ion date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties:in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do Hereby certi under the pai;� and penalties of perjury that the information provided above is true and correct PIN r Sienatur Date: /— 7-4 Phone# �d —LZk—cI f�DD Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other , Contact Person: Phone#: ACC)R ® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 12/29/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT CoBiz Insurance, Inc.-CO NAME: 1401 Lawrence St, Ste. 1200 W NE 303-98840446 AlC No:303-988-0804 Denver CO 80202 E-MAIL ADDRESS: COMaiI cobizinsurance.com INSURER(S)AFFORDING COVERAGE NAICli INSURER A;Acadia Insurance Coma 31325 INSURED ESLERCO-01 INsuRER B:Firemens Insurance Company of WA,D.C. 21784 dbaRenewal by Andersen of Southern New England SouthernNew England Windows, INSURER c:Homeland Insurance Company of New York 34452 ba 10 Reservior Rd INSURER D: Smithfield RI 02917 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER:1252851165 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCEADDL SUBR ' POLICY EFF POLICY EXP LTR POLICY NUMBER IMMIDDIYYYYI (MMMDNYYYILIMITS A X COMMERCIAL GENERAL UA13ILFTY CPA3158728 1112018 1/12019 EACH OCCURRENCE $1.00D,000 dLAIMS MADE FTIOCCUR DAM-AGE" PREMISES a,=.ce $30D.D(!0 MED EXP(Any one person) S 1o,00o PERSONAL 8.ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2A00,000 X POLICY ECT LOC _ .PRODUCTS-COMP/OPAGG $2,000,000 OTHER A AUTOMOBILE LIABILITY N CPA3158728 1112018 1/12019 COMBINED SINGLE LIMB Ea accident $1 000 000 Ix ANY AUTO BODILY INJURY(Per parson) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS X AUTOSNON-OWNED PROPERTY DAMAGE $ Per accident) $ A X UMBRELLA LIAR X OCCUR CPA3158728 1/`I2018 1/12019 EACH OCCURRENCE $10,000.000 EXCESS LIAR CLAIMS-MADE AGGREGATE $10.000.000 DED I X RETENTION$ $ B WORKERS COMPENSATION WCA3158729-20 1/12018 1/1/2019 X PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER IA ANY PROPRIETORIPARTNERADMCLM OFFICERIMEMBER EXCLUDED? N/A EL EACH ACCIDENT $1.000.000 (Mandatory in NH) E-L DISEASE-EA EMPLO $1,000,000 Byes desafbeunder DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $1.000.000 C PDgution Liab17Ry 79300733400DO 1/12018 11112MG Each Occurrence $1.000,000 Claims Made Policy Retroactive Date 0620/2013 Aggregate $10.00.000 Deductible $10,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. For Informational Purposes AUTHORIZED REPRESENTATIVE Com . ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD L Do Town of Barnstable #�(,o kq i � Regulatory Services , 6hie da" MM Richard V.Scab,Interim Director Building Division Tom Perry,CDO,Building Commissioner 200 Main Street,Hyannis,MA 02 I \. www.town.bamstable.ma us Office: 508-862-4038 Fax:508-790-6230 EXPRESSPERI&M APPLICATION - RESIDENTIAL ONLY Map/parcei Number /�� /�b Not i�affd"*how IZ�I X,A+es$l . Property Address q WIAPPO Ayx u-E WesidentW Value of Work$ goZ31� ! Aginimum fee of$35.00 for work finder$6000.00 Owner's Name&Address Z! WIN € o srv�cc� m 6 a pipro ' Contractor's Name ou4herN Oet4 t /Aivd GUI0010cOs Telephone Number40/-ut—p&D0 Home Improvement Contractor License#(if applicable) /73 Z"IT Email: Consmxtion Supervisor's License#(if applicable) O Z57o "�.. rr = 1� a �Qe �Worknm's Compensation Insurance . \\ Check one: MAR 2 8 2014 ❑ I am a sole proprietor I am the Homeowner ~' I have worker's Coition Insurance I TOWN OF BARNSTABLE Insurance Company Name ,�Fl4�AAl-'T �iUS • . Workman's Comp.Policy# ff I t�Qa 78V-Y-3r2- 3 9 y Copy of Insurance Compliance Certificate mast accompany each permit. Permit Rau (check box) U Re-roof(hurricane nailed)(stripping old shingles) All construction tion debris will be taken to Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Reside Replacement Windows/doors/slidm.U-Value 3lS (maximum.35)#of windows #of doors: ❑ SmokelCarbon Monomde detectors 4 for plans marked with red S and inspections required. Separate Electrical&Fire Permits required. •Where reqwed_ Immme of this permit does not exempt compha=with other town dqm neat mplahms,i.e.Historic.Cowmvd wn etc. R•"Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Hoare Improvement Contractors License&Contraction Supervisors License is aired. 01 SIGNATURE: T:4MVD D%kt lding doc Revised 061313 Renewallicti EN byAndersen. � REWAL BY ANDERSEN �rUCOM'vat7Vtd5 WINDOW REPLACLYtar 26 Albion Rtrad • Lincoln,R102865 Wad rmn aI 37 Phone 866.363.2235•Fax 401.633.6602 rdmt r,s to aacv;ccW Southern New England Windows,LLC d/b/a Renewal by Andersen of Southern New England CUSTOM WINDOW AND DOOR REMODELING AGREEMENT 1 SUM(s)Ncmr �e e / eQq Yet l� Oxe ofAvee nt_ /h irh y Surer(r)Swm Addr mCay S=VL.d Trp Code 1P.tleou {_W ) AnILD 1)C&.L&0 1-It (ti o&- O-L&S 9 YW 1 ZyS cc E-tWAddn NaneTdephme VMDATetephane Number. Buyetis)hereby joindy and severally agrees to purchase the products and/or services of Southern New England 1\unclows,LLC d/h/a Renmal In•Andersen of Southern New England("Contractor"I'in accordance with the terms and conditions described on the front and the reverse of &s agrtemem and on the attached specification sheets;(collectivtih;this"Agreement"). ❑Historic ❑Condo ❑HOA? Total)ob Amount�ji38! linkmted Starting Data Method of payment: O Check ]Cash ]Financed Deposit Received(33%)./D�0_/ �j Credit Cods are accepted for deposit only—maximum 1/3 of the Balance at Start of)oD(33%r./" & �Compfttion Data p��( see oe*t and ftment Fern.)By string this Agreement,you acknowledge that the Balance at Start of job and the Balance on Substantial 311?3 ��w�� Balance on Substantial Completion of Job cannot be nude by credit Completion of job(33%): card and mint be made by personal check bank check.or cash. Buyer(s)agrees and understands that this Agreement constitutes the entire understanding between the parties,and that there are no verbal understandings changing any of the terms of this Agreement.Buyer(s)acknowledges that Buyers) (1)has read this Agreements understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellations on the date fin written above and(2)was orally informed of Bayer's right to cancel this Agreement.DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. (Rhode island Sales Only)Notice to Buyer(1)Do not sign this Agreement if any of the spaces intended for the agreed terms to the extent of then available information are left blank.(2)You are entitled to a copy of this Agreement at the time you sign it.(3)You may at any time pay off the frill unpaid balance due under this Agreement,and in so doing you may be entitled to receive a partial rebate of the finance and insurance charges.(4)The seller has no right to unlawfully enter your premises or commit any breach of the peace to repossess goods purchased under this Agreement.(5)You may cancel this Agreement if it has not been signed at the main office or a branch office of the sellers provided you notify the seller at his or her main office or branch office shown in the Agreement by registered or certified mail,which shall be posted not later than midnight of the third calendar day after the day on which the buyer signs the Agreement,excluding Sunday and any holiday on which regular mail deliveries are not made.See the accompanying notice of cancellation form for an explanation of buyer's rights. Bu%vr(s)received the consumer education materials provided by the Rhode island Contractors Registration Board. llkner°r initials) Renewal by Andersen of Southern New England Buyer(s) ^ Buyer(s) RV: �"fJ Sightture Produc Manager ' Signatur Signature: Print Name of Product Manager Print Name print Narse YOq THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT. NOTICE OF AN ELLA O X NOTICE OF CANCELLATION -x Date of Transaction Z&W -.You may cancel I Date of Transaction .You may cancel this transaction,without y enalty or obligation,within I this transaction,without any penalty or obligation,within three business days from the above date.If you cancel,any l three business days from the above date.If you cancel,any property traded in,any payments made by you under the I property traded In,any payments made by you under the Contract or Sale,and any negotiable instrument executed i Contract or Sale,and any negotiable instrument executed by you will be returned within ben business days following i by you will be returned within ten business days following receipt by the Seller of your cancellation notice,and any I receipt by the Seller of your cancellation notice,and any security interest arising out of the transaction will be security interest arising out of the transaction will be canceled.lf you cancel,you must make available to the Seller I canceled.If you cancel,you must make available to the Seller at your residence,in substantially as good condition as when i at your residence,in substantially as good condition as when received,any goods delivered to you under this Contract or I received,arty goods delivered to you under this Contrail or Sale;or you may,if you wish,comply with the instructions of I Sale;or you may,if you wish,comply with the instructions of the Seller regarding the return shipment of the goods at the the Seller regarding the return shipment of the goods at the Seller's expense and risk.If you do make the goods available Seller's expense and risk.If you do make the goods available to the Seller and the Seller does not pick them up within I to the Seller and the Seller does not pick them up within twenty days of the date of cancellation,you may retain or I twenty days of the date of cancellation,you may retain or dispose of the goods without any further obligation.If you I dispose of the goods without any further obligation.If you fail to make the goods available to the Seller,or if you agree I fail to make the goods available to the Seller,or if you agree to return the goods to the Seller and-fail to do so,then you 1 to return the goods to the Seller and fail to do so,then you remain liable for performance of all obligations under the remain liable for performance of all obligations under the Contract-To cancel this transaction,mail or deliver a signed 1 Contract.To cancel this transaction,mail or deliver a signed and dated copy of this cancellation notice or any other 1 and dated copy of this cancellation notice or any other written notice,or send a telegram to Renewal byAndersen of I written notice,or send a telegram to Renewal byAndersen of Southern New England at 26 Albion Road, 865, i Southern New England at 26 Albion Road,Lincoln,RI 02865, NOT LATER THAN MIDNIGHT OF / I NOT LATER THAN MIDNIGHT OF (Date) (Date) I HEREBY CANCELTHISTRANSACTION. )I I HEREBY CANCELTHIS TRANSACTION. X Buyer's Sitnau re ►rert Name Date Borer's sh111ature PAnt Name Data RbA Coov:White Buyer Coon:Yellow Buyer Co ..Pink Southern New England Windows d.b.a Renewal by Andersen of SNE (.10Massachusetts Department:of Public-,tafety Board of.Building Regulations and Standards Construction Supers°o—r• L.: License:CS-095707 r BRIAN D D,ENMSdN, 7 LAMBSPOND C'IRC - e' Charlton.MA-615i)7 " "` Expiration Commissioner 0 168/2614 I ` Office of C Irs pan Bess e ation 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improve menf Contractor Registration Registration: 173245 Type: Supplenwit Card EMIrad0n: SM212014 SOUTHERN NEW ENGLAND WINDOWS.LL-« DENNISON BRIAN 1137 PARK EAST DRIVE ? WOONSOCKET,RI 02895 Update Address and return card Mirk reason for change. SCA t a saw ' ❑A"ren p Renewal O Employment p Lost Card .Ei tare at Coonmer Mtein A Bod.en Reaelsdea License or mllistradon.valld for Indlvldul use,only E IMPROVEaIFJ1T CONTRACTOR- before the esplratlon data ufound velure to: Office of Coosomer Aff tin and Business Regulation 173245 Type: 10 Park Plata-Suite 5170 - EiPlratlon:�9HS2014 SupptemeM i:aid Boston,MA 02116 SOUTHERN NEW ENGL°AND WINDOWS Lm RENEWAL BY ANDERSONDEN ' ' PARK BRUIN 1137 - ` 11J7 PARK EAST DRIVEJl---- WOONSOCKE.RI 02895 Uedemecretery Not valid without signature The Commonwealth of Massachusetts Department of Indastrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers a A licant Information Please Print Led*blv Name (Business/Organizationgndividual): Aiw ^J lice. Address: WIDI.Al �p City/State/Zip: L lA1 e_n 1A1 ../e,r, W467 Phone#: YD/ ?YDO Are you an employee9 Check the appropriate box: Type of project(required): 1.[d I am a employer with 01 O 4. ❑ I am a general contractor and.1 employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. ^❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity, employees and have workers' q Building addition [No workers'comp.insurance comp.insumncx t ❑ g required.] S. ❑ We are a corporation and its ME]Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.[]Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.)t c.152, §1(4),and we have no 13. Other !,� employees.[No workers' _ comp.insurance required.] NP 1A62 .`Any applicant that checks box#1 must also till out the section below showing theft workers'compensation policy information t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractor must submit anew affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy umber. I am an employer that is providing workers'compensation insurance for my enrployeec Below is the policy and job site Information. Insurance Company Name: SlI aw aril) Policy#or Self-ins.Lie.A /p'�1 g_Q 7?f?3 SZ 3 7 � Expiration Date: cZ/ / Job Site Address: 01q (.VAl/d/(1 AUe, Cilyll telTplQ�P,111 IV Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of STOP WORK ORDER and a fine Df up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of [nvestisations of the DIA for insurance coverage verification 'do hereby cerfib under the pains and penalties of pedivy that the information provided above is a and correct signature: Date: 7 'hone o2 ;1 ;9 — 9 92:yn Offm use only. Do not write in this area,to be completed by city or town offww City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.Cityfrown Clerk 4.Electrical Inspector 5.-Plumbing Inspector 6.Other Contact Person: Phone#: I Client#:30124 SOUTNEW DATE(MUnmrfYY) -ACOW. CERTIFICATE Of -LIABILITY INSURANCE 8106P2Q93 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER..THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATr4ELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED SY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder In lieu of such endoreement(s). PRODUCER NAME; Anita Little Witlis of New Jersey,Inc. DNN 856 9144660 Arc N,;856-91141881 1015 Briggs Road,PO Box 5005 E ADDRESS: anita.little@willis.com PO Box 5005 INSOESMj AFFORDING COVERAGE NAiC: Mount Laurel,NJ 08054 INSURER A:Selective Insurance Co of the S 39926 INSURED ,N B Argonaut Insurance Co. 19801 Southern New England Windows LLC INaURERC:Beacon Mutual Ins.Co. 24017 D/B/A Renewal by Andersen INSURER D 26 Albion Road ' INSURER E Lincoln,RI 02865- INSURER P! COVERAGES CERTIFICATE NUMBER: i REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITIONOF ANY COISITRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN RELDUCED BY PAID CLAIMS, ON TYPe OF IXatIRAI�E R �' POLICY XUhlllER PDNID�Y i LIMITS A GENERAL LIABILITY S202945900 0811012013 08110/2014 EACH OCCURRENCE $1 000 000 DAM�ApGGEE ES T'r X COMMERCIAL GENERAL LIABILITY PREMIS ERaE m $100 000 CLAIMSAWE CXI OCCUR MED EXP VMane nson !10 000 f I PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE $3 000 000 GEPPLAGGREGATE LIMIT APPLIES PER: PRODUCTS•COMPIOPAGG s3,000,000 POLICY PRO LOC S A AUTONOBILE LIABILITY S202946900 8!10/2013 08M0/A1 JECT E°e ddE�DISINGLE LIMIT i,000,000 X ANY AUTO BODILY INJURY(Per pawn) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS MOt OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS Pe • - S A X ULUMLLA LIAR OCCUR S202945900 1180012013 08/10/2014 EACH OCCURRENCE $ 000 000 EXCESS I" CLAIMS-MADE AGGREGATE 85 000 000 DED i RETENTION I S C WORKERS Co11�ENsaT►� 0000066028-RI 9/24/2013 08/211201 X 91C sTATt> OTw KE AND EMPLOYERS'LIABILITY B ANY PROPRIETORIPARTNEWEXEC JTM�YrX AIC927818352394 81;1/2013 08/21/201 E.L.EACHACCIDENT S1,000,000 OFFICE EMBER EXCLUDEM t N. NIA I (M a ndatory In NH) I E.L.DISEASE-EA EMPLOYEE 61 000 000 DESCRIPeundar TION OF OPERATIONS below l E.L.DISEASE.POLICY LIMIT $1 000 000 I I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Ranarks Schedule,N i1m spare Is nqulnd) i • CERTIFICATE HOLDER CANCELLATION Southern NE LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 26 Albion Road ACCORDANCE WITH THE POLICY PROVISIONS. Lincoln,RI 02865 AUTHORIZED REPRESENTATIVE 0 IN8-2010ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S215109/M215068 AXL e+3 w Town of Barnstable F THE ip� do Regulatory Services Thomas F.Geiler,Director �xxsTnai.e, • 9�. : �0� Building Division AtEO Mp'1° _ Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 UV PERMIT# t"'o t _ / f FEE: $ 42 SHED REGISTRATION Cf 120 square feet or less Location of shed(address) Village. w SSA /�� 6 C A/ 2,45 Property owner's name Telephone number rf Size of Shed Map/Parcel# /! (D dJ Signature Date Hyannis Main Street Waterfront Historic District? /vOn , Old King's Highway Historic District Commission jurisdiction? 1 y y t_ Conservation Commission(signature required) 03 DA C PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR,DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg f REV:121901 6 96 30., �yWOOD f I �nTF-PL cE h•z es iq ; 4+/c 7, i o /"a /2.� i R ('p h p i 0 \O N 1 EI,GZ * A'G. N i I I . I I 40 V I q 7 00 ` oe 1 0 i e30 o TOWN OF.BARNSTABLE ZONING ' to. � gg N /�� "'acr BY-LAWS DATED SEPT 14 1987 ' s�9 FRA �� ° ZONE:: ` qC ° c NK y v_ r1 7 d , No TI G a SETBACKS DN AfCISTEaco��y� FRONT = 20' SIDE.= r o' 9/L4g REAR a 10' I PHOPERTY LINES SHOWN HEREON WERE COMPILE D FROM PLANS OF RECORD AND DO NOT REPRESENT PROJECT NO. 3.3283.0 1 AN ACTUAL SURVEY ON THE GROUND. THE STRUCTURE DEPICTED ON THIS PLAN WAS LOCATED I PLOT PLAN ON THE GROUND "BY SURVEY ON SEPT i9 i988 inAND EXISTS AS -SHOWN AS OF THE DATE OF LOCATION. I BARNSTABLE , MASS . THIS PLAN IS FOR PLOT PLAN PURPOSES ONLY AND SCALE: 1" 40' SEPT 20 i988 SHOULD NOT BE USED FOR ANY OTHER PURPOSE. THE BSC GROUP-CAPE COD INC 9 zi ROUTE 28 MADAKET PL +2 ACE 8 I Al - PROFESSIONAL LAND SURVEYOfi MASHPEE. MA "02649 E508)477-2525 ---.._.—------ 1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 3 //// Map � Parcel `-o Permit# V/ 7 Health Division 9 - 6 101 I 2 S ) Date Issued A9 2 a 0 2 Conservation Division e 'D/ pD 2- , ,y.)� ,7 j j: 25 Application Fee Tax Collector 00� U Pc� I\� ��- f© Permit Fee: -� ©� Treasurer — _ ____ _w_ __-- 1C SYSTEM BUST BE ;!\!SlOfd INSTALLED IN COMPLIANCE. Dept. MITI;TITLE 5 Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE AND TOWN REGULATIONS Historic-OKH Preservation/Hyannis Project Street Address ;Z n blj tam Ave_ Village O.S e'er V 1 6 e, Owner Re*r— mzgec Address Saw. , Telephone Permit Request ' �®01��a �, - Is X 4D Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 3!�OOD Construction Type Lot Size I. (� I Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure �d Vr:_� Historic House: ❑Yes t3No On Old King's Highway: ❑Yes ❑No Basement Type: 3 Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing 1 new Number of Bedrooms: existing_3 new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: YGas dbil ❑ Electric ❑Other Central Air: IR/Yes ❑No Fireplaces: Existing Z New Existing wood/coal stove: ❑Yes l�N0 lietached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name rl VA e cc,,, ��(� Telephone Number Address 54'0 Ar, ::CJe_ AUe License# f DDT.8 - S e. .DV--, ve, Home Improvement Contractor# Worker's Compensation# -WC_ OD ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ti/It SIGNATURE DATE Ib FOR OFFICIAL USE ONLY — • AJ r� PERMIT NO. t_ DATE ISSUED f MAP PARCEL NO: ADDRESS% — } -�� tILLAGE v OWNER _ DATE OF.INSPECT N:' ,s r —•.< FOUNDATION FRAME INSULATION r ,, FIREPLACE f ELECTRICAL: ROUGH FINAL,, , r PLUMBING: ROUGH `' FINAL s GAS: ROUGH:� FINAL FINAL BUILDING i ': t 1 s ' �� / ) 4.�• STD � � � �. DATE CLOSED OUT JL ASSOCIATION•PLAWNO: ; , � .. S j C �+1 . The•Corrcmonwealth of Massachusetts - Department•:of Industrial Accidents _ - Office alnyesti9atfans•. = - -- - 600 Washington Street _-• Boston, Mass- 02111 -�3 / Workers' Com ensation Insurance Affidavi� -- location: I am a homeowner performing all work rarel£ , I am a sole ro rietor and have no one wor]an in ca achy 0 o et)r andd hav ////%/// /% �/ //%//job%%%/%//%%////%////%/////�l/%///%%%%%/ com ensationfoz mp a9 �;: :?{;x ? 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Qins and penalties-of-perjury th�the-information-prouided abnue isscua.au I da hereby certi lit • Date � .. ' Signature ,p� • ..•: , :" ��,..•• • �� .�� '��IG�....:�D' '•' ..Phone# 'J ''Print name � . official w e only do not write in this area to b e completed by city or town OMdal • - ••'pernllflHcense# (3BufldingDepartment ❑Licensing Board city or town: contact person: � . Information and Instructions i Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their �s,._As quoted fromtbe"law", an employee is:defined as every mthe service of another under an contract _..._......_.._.. - _ _._._. Y. •nf hire,'mress or imp lie or or artners , association, corporation or other legal entity, or any two or more of An employer is defined as an individual, hip _ the foregoing engaged a joint enterprise,-and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner.of a ... dwelling house having not more than three apartmends and who zesides therein;-or the occupant of the dwelling house of another who employs persons to.do maintenance,construction or repair work on such dwelling house or oaths grouricis or building aFp enant thereto'shall not because of such employment be deemed to be an employer. MGL chapter section 25 also states that every state or local licensing agency shall withhold the is uanc i b who has of a license or permit.to operate a business or to construct buildings in the commonwealth y pP „ .• 6r the' not produced acceptable evidence of compliance with the insurance coverage cregeirod. A�dtienall of ublic work uutr7 commonwealth•nor any of its political subdivisions shall enter in y P acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authoaty' a .. .. .. r... _ applicants your Please fill in the wbrkers' compensation affidavit completely,by checertifccate of insurance as cking the box that applies all affidavitsmay be supplying company names, address and phone numbers along with a _... _ _ submitted to the Depastmn nt of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and be returned to the city or town that the aapplication ns re regarding permit or thethe"lam' being requested,not the Department o o date the affidavit. The•affidavit should r f yQu f Industrial Accidents. Should you have ny questions 8 obtain a�ttorkers' compensation polioy,please call the Depaitzrierit atthe number listed below:. are 1equired,66 City or.Towns •. e be sure that the affidavit is complete and printed legibly. The Deparfrnent has provided a space at the bottom oMe Pleas t the Office of Investigations has to contact you regarding the applicant. sel. for you to fill Dirt lathe even be used as a refeience num�er.�Tlie afFidavits maye'r a: affidavit y the •eunitllicens a niiulb ei which wi1L :: - be sole to fill , ,;p or FAX urllass other arrangements have been made: = , the Departmerztby., . The Offsce of Investigations would like to thank you in advance for you cooperation and should you have anyyuestions. . . ...�•.. .. :. .. ... ... _. . ,•r•- ,. .. Please do not hesitate to give us a call. The Department's address,telephone and fax number: ...... " The Commonwealth Of Massachusetts ;.Department of Industrial Accidents Gfflce of lu estigatlons 600 Washington Street Boston,Ma. 02111 fax ff: (617) 727-7749 • �F,nna ii• (617) 727-4960 eat. 406, 409 or 375 Town of Barnstable N Regulatory Services ]h16, STnBLe. ' Thomas F.Geiler,Director 9 04 Building Division rFD MP'� Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction, alterations,renovation,repair,modernization, conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements. Zd Type of Work: O X Estimated Cost 3�� Address of Work: �� `1`^� iq Ue Owner's Name: Date of Application: 1 (g A) L I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑ uilding not owner-occupied wner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. Date Owner's Name Q:forms:homeaffidav (D A > o D CD nU 'c a m D m @ Z D D � o m o 2 0 r K m o _ .. o w m o Z � T T 0 0 n � n F= °' o O fD R O 4- r i < TO N cn �.rn m go C) 4 q ,c m C;, < o A/ o Z Q 6 13 "r Z y f O•V o co cr) 3 m n m a' N 7 O Z U d I\�C Q m uc)N < O Z m W J < EL WOO 47 d fD n < YI RO S to . d ro ro 0 w e ti I n a a m rD a g d c � 0 0 •�--� The Commonwealth of Massachusetts - `_- , Department of Industrial Accidents t-- (_' Office of Investigations 600 Washington-Street Boston, Mass 02111 Workers'Compensation Insurance Affidavit Applicant information Please print legibly Name: Location: ... one : --..._.._. . _. . .....__. --- .. . ._ ... . _...._.......... Please check one. I am a homeowner peffonving all work myself. I am a sole prdpdetor and have no one working in any capaa s I am an employer providin workers'com ensatfon form Y em to gew workin ,on this ob:-- Cam an name: giC,41,4S Addnss: P S .. . . : ... . . .. hone# `"ET c Insurance co: i0l i ram a sole proprietor,general contractor,or homeowner(circle'one)and have hired the contractors listed below wih ha-, Me following workerecom ensation polices.- Company name: Address: hone# ............_......_. _._._. . . Insurance co: policy#-..__......__. . .........._.. .. Company name: Address hone#....... .. .... .... Insurance co. Attach additional information if necessary Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine:up.to $1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK..ORDER and a fine of$100.00*a da. against me. I understand that a copy of this statement may be forwarded to the Office.of Investigations of the DI:A for coverage verification. I do hereby certify under the gins and penalties of perjug that the information provided above-is true and correct Si nature: 1, Date: 8 I E Print name: AL P%1?6 L_ S1--1 4ck ___._.... ... ...... ..Phone#...... Official use only do not write in this area to be completed by city or town official: Gty or town: Permit# Bid De Check if immediate resoonse is re uired: License# Licensin Board: Contact rson: hone# Selectmen's Office:, Health De t: . ....._. OTHER: _ . ... The Town of Barnstable Regulatory Services Thomas F. Geiler, Director Building Division Tom Perry, Building Commissioner 200 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION //'' / Please Print C�DATE: � ! " 7,ob Z/ JOB LOCATION: 7 K_ ( o Ave, �Z J Oc V i /v(e 6_5126—ZZ5 number stre6t �j village / "HOMEOWNER'-: pd(f(- name t home phone# -work phone# CURRENT MAILING ADDRESS: �a✓�'1 city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner" assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said proced d requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." j Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. O:FORMS:EXEMPTN C • ND 011 4) - I 49'a f �WOOO j �ZCo 4AIVOuG II FIREW GE *16z, z 9 s 0"! /2.c'9 L/ KOEA / c'AR.Q 9S'� O CO ` • � �� S�F"a C 1 01 �p a I.lo F}G. �p I 1 t 1 I i " I I A 00 i Op I � � 00 1 Avg , ,3 N \o� 3s� TOWN OF BARNSTABLE ZONING ; \o es. OF Arc BY-LAWS DATED SEPT 14 1987 ' 1 d o a9 0 ZONE: RO FRANK V 7 1 ;, No WHITING29 •o SETBACKS D\ 9Fc!StER`SJ� FRONT = 20' 1 I, q�Lleg REAR 1p• .. - - ._ _. _ V i PROPERTY LINES SHOWN HEREON WERE COMPILED FROM PLANS OF RECORD AND DO NOT REPRESENT AN ACTUAL SURVEY ON THE GROUND. t— PROJECT NO. 3.3283.0 , THE STRUCTURE DEPICTED ON THIS PLAN WAS LOCATED PLOT PLAN ON THE GROUND BY SURVEY ON SEPT 19 1988 in I I AND EXISTS AS SHOWN AS OF THE DATE OF LOCATION. BARNSTABLE , MASS . THIS PLAN IS FOR PLOT PLAN PURPOSES ONLY AND I SCALE: 1" - 40' SEPT 20 1988 SHOULD 140T BE USED FOR ANY OTHER PURPOSE. —• ___ _ —_! THE BSC GROUP-CAPE COD INC ROUTE 28 MADAKET PLACE 812 L�A1 = PROFESSIONAL LAND SURVEYOR MASHPEE, MA 02649 (508)477-2525 L..._.___ — _.— -•__�. i � 92 Fv I w i v9,� w0o0 I ��u. u+NDuG FiREPI. cE e do. ef I 9 . 0"" 4 I , KMEA r7 I(7 FOs h ` 0 UPr C o o N I ' b I I I I I I r � � I I ` 40 I q''' 00 � O _ NON, )f N \p\ 3° I� TOWN OF BARNSTABLE ZONING 0° Mq c BY-LAWS D%TED SEPT 14 1987 ' ZONE RC 0 FRWHIN ANK ` 76 �9, 90 No 29009 ,o SETBACKS 1� A cO FRONT = 20' fCIS1ER SJ�� SIDE.5 to, REAR 10' IV PROPERTY LINES SHOWN HEREON WERE COh1PILE0 FROM PLANS OF RECORD AND DD NOT REPRESENT AN ACTUAL SURVEY ON THE GROUND. PROJECT NO. 3.3283.0 THE STRUCTURE DEPICTED ON THIS PLAN WAS LOCATED PLU1 PLAN ION THE GROUND BY SURVEY ON SEPT i9 1988 in i ARID EXISTS AS SHOWN AS OF THE DATE OF LOCATION. BARNSTABLE , MASS . ?�IIS PLAN IS FOR PLOT PLAN PURPOSES ONLY AND SCALE: .," = 40'--- SEPT 20 ?986 _ — SHOULD NOT BE USED FOR ANY OTHER PURPOSE. THE BSC GROUP-CAPS: COD INC � &6 - ,, �4 ,/,_ • • ROUTE 28 MADAKET PLACE B12 PROFESSIONAL LAND SURVEYOR MASHPEE, MA 02649 (508)477-2525 — --—- --- --•--....... —_.. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map /Y0 Parcel 1116 Permit# 39 -39 Health Division 7 / / ��✓J� 07� Date Issued 4 Conservation Division S� -�— Fee 5Ja-2 3 3,`13 Tax Collect 1' SEPTIC MUST BE Treasu'r C INSTALLED IN .. IUI®MPLIANCE Planning;Dept. - WITH TITLE 9 y, ENVIRO Date Ref,in tive Plan Approved by Planning Board "MENTAL CC J 7 7 Historic";OKH Preservation/Hyannis Project Street Address G+�%corn o Cc✓� Village co sA,, u v L, ' Owner CL-s fk�v y c- Address Telephone 2 0 1-1 ti Permit Request 1 25 Y 4 rb, La C ,rV% Lo-e-k -&u Square feet: 1 st floor:existing 1 14 0 v proposed PL N 2nd floor: existing PI)(xZ proposed -- Total new Estimated Project Cost 7 5 300 Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size I >L I A C . Grandfathered: ❑Yes ❑No If yes,attach supporting documentation. Dwelling Type: Single Family 0' Two Family 0 Multi-Family(#units) Age of Existing Structure 2 3 L/ Historic House: 0 Yes allo On Old King's Highway: 0 Yes &No Basement Type: &Full 0 Crawl ❑Walkout 0 Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 1 wvtp Number of Baths: Full: existing / new Half:existing / new d Number of Bedrooms: existing 3 new / Total Room Count(not including baths):existing D new 2 First Floor Room Count 6 Heat Type and Fuel: O'6as O Oil 0 Electric ❑Other Central Air: ❑Yes O'No Fireplaces: Existing / New Existing wood/coal stove: 0 Yes Q No Detached garage:O existing ❑new size Pool:O existing ❑new size Barn:0 existing ❑new size Attached garage:FA existing 0 new size Shed:0 existing 0 new size Other: Zoning Board of Appeals Authorization 0 Appeal# Recorded Cl Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name n PA nc c. Telephone Number -? Address L-I ti'L�^T� License# Ce v��-c ✓v��n.. iM A Ga C^3 z Home Improvement Contractor# 10 D 7/9 Worker's Compensation# 1w73 -2 311h /U ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO '7Rc coL c c Cunt C'u Q— S��0wVa SIGNATURE DATE _ FOR OFFICIAL USE ONLY , PERMIT NO. DATE ISSUED MAP/PARCEC NO. ADDRESS VILLAGE ' OWNER DATE OF INSPECTION: FOUNDATION 19 G FRAME (S' 2- INSULATION FIREPLACE - ELECTRICAL: ROUGH' -i FINAL i y , PLUMBING: ROUGH FINAL GAS: ROUGH FINAL, ` FINAL BUILDING - DATE CLOSED OUT + ASSOCIATION PLAN NO. , i . I , Building Division 367 Main Street,Hyannis MA 02601 ffice: 508-862-4038 Ralph Crossen ax: 508-790-6230 BuiIding'Co=issior e: Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERWr APPLICATION MGL c. 142A requires that the"reconstruction,.alterations,renovation,repair,modernization,conversion, improvement,removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of work: woup 0JQ Estimated Cost Address of Work: Q1 l,� ;a. •.v Owner's Name:<��c,r .t �e�„�„�; 1MP 14,e ,r Date of Application: S S I hereby certify that: Registration is not required for the following reason(s): Work excluded by law C3Job Under S1,000 Building not owner-occupied E30wner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME MWROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Date Contractor Name Registration No. OR Date Owner's Name q*mis:Affidav �x • —�►�__ ` trey m' i _= :z<. 600 Washington Street J� � ..' Boston,Mass OZIII Workers' Com�ensadon Insurance Affidavit name: L�'O� Y /l DG G.. location- city hone� ❑ I am a homeowner performing all work myself~ [1 I am a sole aronrietor and have no one warldng in any capacity ❑ I am an employer providing tivorkers• compensation for toy emplovets working on this job, comnnnv name: address: .. . .. citV: hone#: " insurance cn. niiev# ///��///.%///%//l///�GGi/��!//%!/!/�% e ❑ I am a sole proprietor eneral contract or homeowner(circle on and have hired the contractors listed below who have . the foIloi%ing workers' compensation polices: comnnnv name: M rocq C---%- V- (~ ��C,. address: L-I LI - L_,.`. dtv- Vv\/'1 i '..:..: °• '', y o<ieeeci.r. _ Diltlfle 0-•..-7'2 .., •w �V tom•••a::. `�aw.�. :i�"';".. :a••b insurnnce ca. `` G;' k'• comnnnv name: :.: ..• .:: :.:, : ;'.Ty ,. >«:,:;:v.•5w 'Lv;: address: Mane#- nsnrnnce ca. :::.. .^•.::: ;^..... .:: <:as:. nw: +. ..:••.• ;...... .'r.'...i�YT}>:•m•'•..W� /:•Ar.;•'•. :.: �{.:v.h'.vww•N::.w.v++ inure to secure coverage as required under Section 2U of MGL I52 can lead to the imposition oiabuinai penes ofa Qae up to S1.500.00 and/or ne years'Imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a Qua of S100.00 a day aSaimt me. I understand that a opv of this statement may be forwarded to the OMce of Invests;atiom of the DIA for cavenge vMQt:adon. do hereby certify under the pans and penalties of perjury that the information provided above is& :mud earreez: i�tature Date �/0A;S 'riot name 4,10 l O / Phcme 0�7 S 70 0 oincisl use only do not write in this area to be completed by city or town am-4-1 Sty or coven: p�caweti nC Department ❑ check if dnihtediate response is required ing Board mews once contact person: phone#, r Deparement . :. ........::At7C3 Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensatiM for emplovees.. As quoted from the "law", an employee is defined as every person in the service of another under=IV' t;—- of hire, express or implied, oral or written. An employer is defined as an individuaL partnership, association, corporation or other legal entity, or any two or mo:a c: the foregoing engaged in a joint enterprise, and including the legal represeatauves of a deceased employer, or the:ec� trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant ofthe dwelling house Of another who employs persons to do ma,— e , constiuc=or repair work on such dwelling house or on the building appurtenant thereto shall not because of such employmeat be deemed to be an employer. ,r. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renew, of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who ha: not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall eater into any contract for the performance of public work acceptable evidence of compliance with the insurance requirements ofthis chapter have been presented to the coszaac--== authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Deparaaeat of Industrial Accidents for confirmation offinum=coverage. Also be sure to sign and .date the affidavit. the affidavit should be returned to the city or town that the application for the permit or license is :being requested, not the Department of IadusaW Accidents. Should you have any questions regarding the"law"or if you 'are required to obtain a workers' compensation policy,please call the Department at the number listed below. ------------------ City-or Towns Please be sure that the affidavit is complete and printed legibly. Mk Deparuaeat has provided a space at the bottom of-the affidavit for you to fill out in the event the Office of iavestigatiams has to C=act you regarding the applicant Please be sure to fill in the permitlliccase number which will be used as a zefiaen=number. The affidavits may be==ilea io the Department by mail or FAX unless other anangemeats have bem made. The Office of Investigations would h1c to thank you in advance for you epoperation and should you have nay questions. ,lease do not hesitate to give us a call. the Deparaneat's address, telephone and fax number; The Commonwealth Of Massachusetts Department of Industrial Accidents 0MCC at ImtestlMBE 600 Washington street ' Boston;Ma. 02111. ••. fax#: (617) 727--7749 phone #: (617) 727-4900 eat. 406, 409 or 375 � r N; I I MAScheck COMPLIANCE REPORT Massachusetts Energy Code I Permit # MAScheck Software Version 2 . 01 . I I Checked by/Date I I CITY: Barnstable STATE: Massachusetts HDD: 6137 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 4-7-1999 DATE OF PLANS: 4/7/99 TITLE: Master Bedroom/ Den- Study Addition PROJECT INFORMATION: Peter and Jeanne Meyer 219 Wiano Ave. Osterville, MA COMPANY INFORMATION: Kenneth Sadler Associates P.O. Box 1149 Hyannis. MA 02601 508 . 790 . 3922 COMPLIANCE: PASSES Required UA = 209 Your Home = 189 Area or Cavity Cont . Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 916 38 . 0 0 . 0 27 WALLS: Wood Frame, 16" O.C. 991 15 . 0 0 . 0 76 GLAZING: Windows or Doors 108 0 . 310 33 GLAZING: Windows or Doors 40 0 . 310 12 FLOORS: Over Unconditioned Space 900 21 . 0 0 . 0 39 ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application . The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater t 12 °° of the d ign load as specified in Sections 780CMR ;Z2and J4 . Builder/Designer 4k b�'?0ZO Date-4 - MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2 . 01 Master Bedroom/ Den- Study Addition DATE: 4-7-1999 Bldg. l Dept . l Use I CEILINGS : [ ] I 1 . R-38 Comments/Location WALLS: [ ] I 1 . Wood Frame, 16" O.C. , R-15 Comments/Location I WINDOWS AND GLASS DOORS: [ ] I 1 . U-value : 0 . 31 For windows without labeled U-values, describe features: q Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location [ ] I 2 . U-value : 0 , 31 For windows without labeled U-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location FLOORS: [ ] I 1 . Over Unconditioned Space, R-21 Comments/Location AIR LEAKAGE: [ ] I Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. When installed in the building envelope, recessed lighting fixtures shall meet one of the following ,requirements: 1 . Type IC rated, manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2 . Type IC rated, in accordance with Standard ASTM E 283, with no more than 2 . 0 cfm (0 . 944 L/s) air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1 . 57 lbs/ft2 pressure difference and shall be labeled. VAPOR RETARDER: [ ] I Required on the warm-in-winter side of all non-vented framed ceilings, walls, and floors. i . MATERIALS IDENTIFICATION: [ ] I Materials and. equipment must be identified so that compliance can be determined . Manufacturer .manuals for all installed heating and cooling equipment and service water heating equipment must be _-____ J_J T_ _._1 _i __ r ___l.._- _.__1 -1 _-_.__ t♦ __ l.._ _. ....._.L L _ _.l _ _-1_. permitted . The HVAC system must provide a means for balancing I air and water systems. TEMPERATURE CONTROLS: [ ] I Thermostats are required for each separate HVAC system. A manual I or automatic means to partially restrict or shut off the heating I and/or cooling input to each zone or floor shall be provided. I I HVAC EQUIPMENT SIZING: [ ] I Rated output capacity of the heating/cooling system is I not greater than 125% of the design load as specified in Sections 780CMR 1310 and J4 . 4 , [ ] I SWIMMING POOLS: I All heated swimming pools must have an on/off heater switch and I require a cover unless over 20% of the heating energy is from non-depletable sources . Pool pumps require a time clock. [ ] I HVAC PIPING INSULATION:. HVAC piping conveying fluids above 120 F or chilled fluids I below 55 F must be insulated to the following levels (in. ) : I . PIPE SIZES (in. ) HEATING SYSTEMS:. TEMP (F) 2" RUNOUTS 0-1" 1 . 25-2" 2 . 5-4" Low pressure/temp. 201-250 .1 . 0 1 . 5 1 . 5 2 . 0 Low temperature 120-200 0 . 5 1 . 0 1 . 0 1 . 5 Steam condensate any 1 . 0. 1 . 0 1 . 5 2 . 0 I COOLING SYSTEMS : Chilled water or 40-55 0 . 5 0 . 5 0 . 75 1 . 0 I refrigerant below 40 1 . 0 1 ..0 1 . 5 1 . 5 [ ] I CIRCULATING HOT WATER SYSTEMS: Insulate circulating hot water pipes to the following levels (in. ) : I I PIPE SIZES (in. ) NON-CIRCULATING CIRCULATING MAINS & RUNOUTS HEATED WATER TEMP (F) : RUNOUTS 0-l" I 0-1 . 25" 1 . 5-2 . 0" 2 . 0+" I 170-180 0.. 5 1 . 0 1 . 5 2 . 0 140-160 0 . 5 f 0 . 5 1 . 0 1 . 5 I 100-130 0 . 5 I 0 . 5- 0 . 5 1 . 0 ( ----NOTES TO FIELD (Building Department Use Only)------------------------- , i _ OEPARTTNENT OF PUBLIC SAFETY CONS TRUGT_IOM'SUPERVISOR LICENSE Expires: Restri,c:ted if ee FRANCIS�:E=NOfiAN 442 BAY LN" CENTERVILLE, NA 82632 r HOME IMPROVEMENT C Registration �NTRACTOR 007 TYPe - PRIVATE18 Expiratin o CORPORATION , 06/?3/00 MOGAN CO. � � Fra cis INC. �MiNisTaaroR BaY Laneogan, Jr. . Centerville MA 02632, 4i g yi o d d ______— • 3 61 'P ----- --------- IA • - ...i'iaTlA.7c6Tla� lk . A PI�JT PLOO�PLAN =jgig � �Al lg� q - waoo t. Sb w iIO !. ouwmcTm: . rfr.k�bm Plwn ' SNFEf NUMB(N: A200 t oM �V si 1 ,.,.,.,.•-�.�..-..-. ... _.:_s.�-r..._.._-..._'....._...__....... ...... ._..�-:_—L._.9�Jm-. _ ••+tee ' nA L x •J _______ ___ --- --- --------- r 4 —______________ Fb --------------------� L { tf R •,0 0 A. PauNr��.TioN P�A.N de,�ppv�� i 3�$ wioo ZGale: 1/4" 1`-O" r .� V�^' f•oun.l.tion Pl.n _ {NffT NIM18fi1: A 1 00 4 m o Q d o Y+... J. �I Z w.r....4 ________ - V - 0 a.r rr YurA.u4MM r r .s. r pi _. 3 ,mm Vim OMWMG TYR MEUMMUR; O rm ®® a Q4 tl Fz I I -- --------- -'-- — ' oL r-------------___r__—__________________________t____-________5 Z ,� �IGHr��vanory � FFQ+ s -•yira ad p �o L _ a ® ® �Qj9AA ep � Ytn[yi O �e�p�a moo: j!-- -- --- ------ —--------- ------- I I g1 tn3 r----- ------- `-------------------------------i r LBFr CL&-YarloN u.rorr.F .. sncn wmeEa: Ag!70 5PI+J F-1 ��.Z� wf� d �ily sue= Gµ'nubu.r�wvrnF� � KN11.shYwlw.plWi.x'my. K+'/•shrwl..PlWr-hiMb- al, [l' I h•rwN/•'P'r •d Ih•r.Npprr `ro '�T oRwarr-e Nnrwbl l/a•.x.wM:w Ir'`� /t4�• � � > NArw+.e I/a•.l,.wlfibo ,/' raa 'me o 'Q 4 raV' dHo.In.W.bnRso I t•r4x•-•4�nnRse O"Nv.liwWrbnR>O - 01 r a•r4ti-WIbnR9D` OY � � C 6• •4 Prnpr v.+ Prayr aw�h / -\ � S m D 14 S,DGIiMYM.oIb•sa. - - D� - t.O 4.mM Je+..s 16•sa. tl ,_Pr.p�m4 pw km �I/!•4Yp•noxmre(yt•I I,_Prwp'm.d p'..r h:n `I/[•4YP•Onb.rd<yN Q � .f Gnrnnm..dfd a,n. Gwmuau.rlfd awM Z yyxy-� F w 4.rwx'•.N•.ro m.rn � wt.mhxyL.rom.roA � J 4 txwwTllvr 4 � � � O 401 NAu.rd I/C.Iw IF' 1 NM..N IIP.x.•rhry 7 J [,.w.e-rw.>lo•rd. � e..w.e..�e.[ibrod. � � ' _t7. +•Nnr...e rw 4...LILnr fx a >I/[•NO.e..W♦bn•Rly 141u.e.b rvLel 9 I/!•Hv.b.W.on. 9/I"NAb.wd T.14..dliwa 0.1 h (4uwrN ryLw I I I .•NAr.1.a Y..e jy:. I I/.•NAr...dx.nf ieu T/D•90brrW LPI/o'w..016 od. Q�4-� P.T.t,G tNu.11 W/aimpwn 'O•>O PT.t,m Ppd.11./Y'rM.an I I � 5'•_S g' >vowmxa-e['rw. rV.c.neha.a!'Fn. d'a - ml/.•r4.t.+�4rbn.RSI bl/.•r4.t••Wfroo.0.el .� �� 8. n.11W>Ie.nfw4bn..rJr _.+ n. �, tp..•Y.huf.•Ib os D•••'•Pmrwe nororvl'. -Y 3—_ buWlbn.�/1m••IC -�• - D•,ab•Pewweunxr+w pvweaeMrw.w R»riM t•Pmrwd nonvMw euN wp __8 • IP �l�a r�InoriM. I M.rcx.� Mxi.s,l _�S iaH-nOrY iauwr'an...Lr >•po.r.d vmr.rr.LL../rY.rm..F . I�� ar�iNg�eGriml�-ram Aa "` o a D lo,lo•vwrem[r.f.awl.,l f - '�€€�d f°E - pgnwnvc nro puildmq o.cFion A-A. puii}iy advhion P-P ' [Hlrt rawem ar€ ® ®® ® ® ®® OD u 4 d � c� -----------------------------------; i -- ----; + ----------------------- --- ----1 `-------- e — ' ------i 0 --- --------------- ----- ---------- ----�---—---—------- -------- z ----- 4 �A� �' oly'r�LCVA lor.► O S oo a 0 -$ mR$ ff1-4 a *to mull .X i ----- ------------- ---------- ---------------------—-------------------------- 3�fi s . OBAWMG IYYF: �r-GA�CI-GVAT-mil Gwwhbn. • - fyf!'f XLNtBFC ArvOO GENERAL NOTE5: - DIMEN51ONAL CHART 1.THI5 DRAWING SET HAS BEEN PREPARED TO OBTAIN THE REQUIRED BUILDING PERMITS, IT DOES 1 IN SCOPES OF WORK AMONG • • . •. :' 16' Z3 6' 32' 4'6" 6'�� 13E6" 8' 0" 7 0" 8' 0 3 6 4-6 NOT DELINEATE SCO E CONTRACTORS AND OWNER;SUCH LIMITS OF . 5.5. LADDER _ 18 x 36 18 36 -6 4 6-0 13-6 12-0 7-0 8-0 3-6 5-6 RESPONSIBILITY SHALL BE DEFINED IN THE , -�„ •, B - O E - - - _ _ _ _ - ' 0' 0' 0' S' 0" 7' 6" 3' 6" 4' 0" 9' 0" 8' 0" 3' 6" 5' 6" CONCRETE DECK—,, OR . ' ",• _ I` :, . C NCRETE DECK-\_ CONSTRUCTION CONTRACTS. ' ., SWIMOUT. . . , • O 20' x4 2 4 I I A I ' " 2.THE BOTTOM OF THE.POOL BED(AND ANY B CKF ll) • • • SHALL BE FREE OF: LARGE STONES,ORGANICUIRMWATER LINE FROZEN CLODS OF EARTH, RUBBISH,STUMPS, OR }' WASTE CONSTRUCTION MATERIALS. 16 l 3. ANY GRAVEL BASE MATERIAL USED SHALL / ' 4' 0" -- -------- --- T F AN COARSE SAND OR BANK RUN min '• ' ; CONS S 0 CLEAN, min GRAVEL,CONTAINING LITTLE OR NO FINES,OR ,- ••.• ORGANIC MATERIAL,AND CONTAINING LITTLE TO OPTIONAL DIVING NO COARSE FRAGMENTS GREATER THAN 51X INCHES , BOARD •' `� � ' I ' • • . . � � '� IN DIAMETER. THE GRAVEL BA5E MATERIAL SHALL A A ' " BE PLACED IN SHALLOW LIFTS AND COMPACTED. • N i '' I, I ' 4•THE FOLLOWING ASSUMPTIONS HAVE BEEN MADE PREPARATION OF THESE DRAWINGS: { FOR THE PRE NO SPECIAL CONSIDERATIONS ARE REQUIRED TO ACCOMMODATE HIGH SEASONAL GROUNDWATER CONDITIONS. INSTALLED ON A LEVEL ' - -THE POOL WILL BE I • •• COMPACTED BASE. -ANY REQUIRED LANDSCAPING AND/OR RETAINING • • .. . •, i WALL(S) 15 NOT PART OF TH15 SCOPE OF WORK. ' PROPOSED POOL AREA DOES NOT ENCROACH UPON . ANY: EASEMENT5, PROPERTY BOUNDARY LINES, I '-O" RAD '• t '•'� 411�. UTILITIES WETLAND OR ISD5s. • •. : �.TYPICAL • , ; . . _ _ �,• . • �S. . Y , POOL IS SERVICED B PUBLIC WATER AND .' - „•, •. •. . •. OPTIONAL.: • .• , MUNICIPAL SEINER. "�: .• •,' ; • • E r •. ,.• CONCRETE DECK , .., POOL SECTION B-B NO VARIANCES ARE REQUIRED TO OBTAIN _ APPROVAL. = r - — - ti . SCALE I/4 I 0 . -THE 501L UPON WHICH THE I'=WILL BE A A BEARING CAPACITY INSTALLED WILL HAVE B 4" CONCRETE DECK. EQUAL TO OR GREATER THAN 3,000 LBSJSQ. FT, POOL AREA PLAN -THE POOL, ONCE FILLED,WILL BE MAINTAINED AT 5CALE - 1/4" I '-0" A A ITS DESIGN WATER LEVEL ELEVATION TALL TIMES. PITCH AWAY FROM POOL -THE FOLLOWING OF PROPER WINTERIZATION PROCEDURES WILL BE THE RESPONSIBILITY OPTIONAL DIVING BOARD OF THE OWNER. WATER LINE ,•p 5. ALL UNDERGROUND PIPING SHALL BE INSTALLED " e a .•d IN TRENCHES WHICH ARE RELATIVELY SMOOTH WATER LINE AND FREE OF ROCKS. WHERE LEDGE ROCK, L 6x6 # IOWIREOR :HARDPAN,OR BOULDERS ARE ENCOUNTERED,THE 6" WATER LINE TILE 'e FIBERGLA55 ME5H b � _ (entire perimeter) a a „ ! TRENCH BOTTOM 5HOULD BE PADDED U51NG A N E 5" 6 COMPACTED SAND BASE MINIMUM OF 4"TAMPED EARTH OR SAND BENEATH THEPIPE. -- -- -------- ----- --- ------ ---------- - --- „�.:. 1/4" TO 3/8" WHITE #3 REINFORCING RODS - 12"C.C. MARCITE FINISH ' G. ALL PIPING SHALL BE 16 ig J :�;7CONTINUOU5 GRID PATTERN RATED SOCKET WELD FITTIN65. - e WALLS FLOOR ALL LINES SHALL BE INSTALLED AS SELF-DRAINING E a WITH NO DEAD LOOPS.:HIGH POINT VENTS AND LOW H - - POINT DRAINS SHALL BE INSTALLED TO FACILITATE STARTUP AND ANNUAL WINTERIZATION. e 1:.. 7. ALL UNDERGROUND PIPING SHALL BE 'Pi d. PRESSURE-TESTED 1.5 TIMES WORKING PRESSURE - PRIOR TO COVER . i�w�•' • • I 8. SAFE USE OF THE FACILITY I5 DEPENDENT UPON ' a i _ a GUNITE POOL SHELL i PROPER SUPERVISION, MAINTENANCE, AND STRICT a CONCRfTf TO DEVELOP CONFORMANCE TO SAFETY REGULATIONS AND 5TRENGTH OF 3000ps► CONSIDERATIONS BY BOTH OWNER AND USER5. a IN 28 DAY5 I C p E F • .a 6'y it 9. PERIMETER FENCING,AS REQUIRED, a •. a e .1► WILL BE BY OTHER5. a - .. .: NOTE: TH15 POOL FACILITY 15 DESIGNED CONSTRUCTION NOTES. B FOR 501L BEARING CAPACITY OF i, CONCRETE SHALL HAVE A MINIMUM i I ! 3000 In/5Q.FT. MINIMUM COMM551VE STRENGTH OF 3,000 P51 AFTER 28 DAYS. ALL REINFORCED CONCRETE CONSTRUCTION SHALL LONGITUDINAL POOL SECTION A-A I TYPICAL WALL DETAIL BE PERFORMED IN ACCORDANCE WITH THE LATEST SCALE I/4"= I '-0" EDITION OF ACI 318 AND DETAILED IN ACCORDANCE NOT TO SCALE WITH ACI 315. I 2. ALL REINFORCING STEEL SHALL CONFORM TO A5TM-615, GRADE GO. WELDED WIRE MESH SHALL AMERI AN SWIMMING CONFORM TO A5TM-185. C S G POOLS CORP. - • `��IIII111//// 3.THE CONTRACTOR SHALL SHORE OR BRACE AS REQ'D. �� //i� AR7NUR R.CRIPPS.JR. Rt.44 � of coNNF �,, `�H of 540 Arcade Avenue, AT ALL STAGES OF CONSTRUCTION TO ENSURE �i� ' STRUCTURAL STABILITY AT ALL TIMES. ��'r4N R/Ap o�� AaTM+uR R. � Seekonk, MBSSaChlISBttS yTYPICAL DETAiL5 OF 4• ALL WIRING TO BE PERFORMED BY A LICENSED ♦` cAo GUNI TE POOL CONSTRUCTION ELECTRICIAN IN ACCORDANCE WITH ALL { 4c�s� o '�ECISTEa �,� PREPARED FOR: STATE AND LOCAL CODES. ��T 15ti � E� i AL E�� REGISTERED ADDRESS: �NNO U ��%Ew)L. C . }°}� 5. BA A a b �- t � CKFI RI �LL MATERIAL n�AL A5 SPECIFIED IN EN �G E NO TE,.OTE rrratnl�� PRo�sslowu.ENGI SCALE: , #2,SHALL BE USED TO FILL ALL VOID SPACES BETWEEN A5 NOTED DRN. BY::IU15E DATE: UNDISTURBED EARTH AND POOL EXTERIOR. Job No o, IL,t Reosron: Drawing No: 51. 171 DIG SAFE NO. GENERAL & DETAIL SPECIFICATIONS S� Fm x�/O 3 b 6 i DEPTH TO AREA S FT. 5 �. L SHAPE 0 0�1 t4N REF. ! _ I EF. NO. � `( PERIMETER � FT COPING 3i1CI'_ i y^ TILE 6 TILE COLOR O Vf c 05 q POOL CAPACITY GALS. 6000 FILTER 3o 0 oF I L,7 ert PUMP I+4 W r, S P w..vv MOTOR H.P. - SKIMMER MODEL OTY Q RETURN LINES` — MAIN DRAIN > R � to - t + _ ►� b _ .. � BACKWASH TO 3 PCAD CHLORINATOR i �vwr- e r co �, 13-0 UNDERWATER LIGHT n 1 VOLTSISODWATTS I BOARD SIZE \ _ BOARDS PP RT 4 U O GRAB RAILS T t w� ` `t YPE 3� 7-0 LOT- t_t ' LADDER q CUP ANCHORS IN WALL � ROPE and FLOATS No r�F HEATER 6 SIZE 3 ' 3 3 BTU U INPUT 3 �. £7D0 t_ .. NATURAL GAS [Z, PROPANE ❑ OTHER FUEL GAS LINE BY. av,� 4�� r�. VENTED BY.lip Ott �ti_r� - TIME CLOCK + ELECTRIC BY: �u - To 5`i!1 r£.." LOTS(= b O - y b ELECTRICAL BONDING BY: 04,/ y�;o. I WATER FOR GUNITE 51 � DECKING 13 C'llS E7� t POOL CLEANER FOLAN S GRADING o POOL SETBACK Rear Side 30 c SWIMOUT 1 6 tS DFFP F,1 0 BfNC�+ KA_ Pt,tAp ` M SLIDE -' HAND RAIL - Nr a,. WATERTABLE CONDITION r n RAISEDB�hM 6 - f o 12 FIL L ❑ AWAY ❑ D.O.P. El POOL COVER TYPE Lov p t o c s PLASTER FINISH , HYDROTHERAPY SPA t v r Depth SIZE` JETS ti JET PUMP HP i SKIMMER MAIN DRAIN RETURN AIR BLOWER wntw� Y��•u � • LIGHT FILTER '. HEATER CHLORINATOR i NAME PF_ e n EIL , ADDRESS I CITY 05 7gr\_ a b � I PHONE S-0 JOB ADDRESS "UV Scale. 18 _ 1,-0" NO GRADING UNLESS SPECIFIED �w NOTES AMERICAN GUNITE OWN ER. To determine approximate elevation of Pool on or before day of A DIVISION OF AMERICAN SWIMMING POOLS CORP. excavation. Pool area to be fenced per state and local ordinance. Gates to be ! t �► 540 ARCADE AVE. self closing and self latching. P.O. BOX 248 OWNER: To wet down concrete structure at least two times daily fora SEEKONK MASS. 02771 0248 �� minimum of seven days. Do not use rubber hose to fill ool as it will mark the p (508) 336-7577 interior plaster. 1b �3 MA. REG. NO. 100284 R.I. REG. NO. 217 OWN ER: Extra charge for watertable condition. DATE DWN BY CK'D BY REF. N0. _. -