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0061 WILLIAMS PATH
i I i /XO 1 I i j i APPLICATION NUMBER ° e. *For Tents Only* Date Tent (s) will be erected Removed on number of tents total Does the tent have sides? Yes No e4es 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. Purpose of Event 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 Fuel source being used LP tank 20 lbs. or> Yes No , if yes, a gas permit is required. Natural Gas Yes No , if yes, a gas permit is required. If food 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 Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: A, �k J0 A/1Sall Telephone Number 3 �—Q Z Cell or Work number fl _ 39-6VX 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 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE. i Signatu Date All permit applications are subject to a building official's approval prior to issuance. I, - NI maws yoJh • Town of Barnstable o�dccoProegre Planning LZ Development Department RAFLNgrABM Old King's Highway Historic District Committee g e' 200 Main Street, Hyannis, MA 02601 4iRv%y.tot"Vlnoll)arnstable.us/plamunganddeveloprnent Thank you for submitting your application with the Old King's Highway Historic District Committee. Your application is scheduled to be heard on at 6:30pm, at the West Barnstable Community Building, located at 2377 Meetinghouse Way (Route 149),in West Barnstable. WHAT TO EXPECT ertificate of Appropriateness and Demolition or Relocation Applications ■ The applicant and abutters will receive a copy of the agenda in the mail,approximately, two weeks prior to the scheduled hearing. ■ We are required to print legal notice in the local newspaper,at least one week prior to the hearing. Legal notice can be found in the Barnstable Patriot. ■ The applicant or authorized representative should attend the hearing prepared to answer questions that apply to the work proposed on the application. ■ The committee reviews applications in the order they appear on the agenda.Should the applicant arrive after the application is called, said application will be moved to the end of the agenda. ■ If the application is approved and an appeal has not been filed,it will be available for pick up, 14 calendar days from the date the decision is clocked with the Town Clerk. o While we strive to have all decisions clocked the day after the hearing,it is best to check the decision on the Town of Barnstable's website(see below for instructions). Certificate of Exemption &Minor Modifications ■ The applicant is not required to attend the hearing. ■ Provided the application is approved, the signed approval will be ready forpick-up at the Town of Barnstable's offices located at 200 Main Street,Hyannis,on Withdrawal-Should the applicant choose to withdrawal the application,please contact the OKH administrative assistant for directions on how to proceed. f` Bulletin- To access the Old King's Highway Regional Historic District Bulletin, go to www.townofbarnstable.us go to Boards and Committees, Old Kings Highway Historic District Committee, under the Resources heading you will find the OKH Regional Bulletin. All certificates issued will expire one year front the date of issue, or upon the expiration date of any building pennit ' issued for the work;whichever expiration date shall be later. The committee may renew any certificate for one additional year,providing.the_request for such renewal is received at least 30 days prior to the expiration date. Elizabeth/enkins,Director Planning&Development Department Erin Login,Admin Assistant 508.862.4787 N , N . The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations IF 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information `Please Print Legibly Name (Business/Organization/Individual): �l`y ,���(i/� 5� �/�/1/�Scs') Address: s City/State/Zip: - Le—/�?A Phone#: r7 3 7- ocl V Z Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. �1 am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers 9. ❑Building addition [No workers' comp.insurance comp•insurance.t required.] 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 required.]t c. 152,§1(4),and we have no 13.❑Other employees.[No workers' comp.insurance required.] *Any 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. tContractors 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-contractor;have employees,they must provide their workers'comp.policy number. 1 am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: 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 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. 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 certi der the pains and enalties of perjury that the information provided above is true and correct Si atur . Date: i Phone#: GZ 9 3 9—6 Official use only. Do not write in this area,to be completed by city or town off ciaL 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 1 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 in 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 insurance 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 insurance. 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 confirmation of insurance 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 line. 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 like 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 Commonwealth of Massachusetts Department of Industrial Accidents ' Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-2407 Fax#617-727-7749 www,mass.gov/dia i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / ,Please Print Legibly Naine(Business/Organization/Individual): f�L Address: - - L s 37 City/State/Zip:, cSrc, 66i Phone#: -S o 4? Are you an employer?Check the appropriate bog: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 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. RRemodeling ship and have no employees These sub-contractors have g, ❑Demolition workingfor me in an capacity. employees and have workers' y p �'• 9. ❑Building addition [No workers' comp.insurance comp.fimn nce.t required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.El officers have exercised their I am a homeowner doing all work right 11.El Plumbing repairs or additions myself [No workers comp. of exemption per MGL 12.❑Roof repairs insurance required.]t §1(4),and we have no 13.[1 Other employees. [No workers' comp.insurance required.] *Any 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 subcontractors 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 andjob site information. Insurance Company Name: 0Q6C5 ��,i( plc v Lj1,St�'�1Ce Policy#or Self-ins.Lic.#: / Expiration Date: Job Site Address: &/ W �I141�'tS City/State/Zip: Ct/it51� 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 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 ce der the pains and penalties of perjury that the information provided above is true and correct Si afore: Date:' +Phone Official use only. Do not write in this area,to be completed by city or town ofciai 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#: 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 in 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 insurance 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 insurance. 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 confirmation of insurance 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 line. 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 like 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 4-24-07 www.mass.govfdia CAPEABI-02 MVAUGHAN „ RQs T CERTIFICATE OF LIABILITY INSURANCE DA04E(MM/DD/YYYY) /19/2018 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 have ADDITIONAL INSURED provisions or 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 NAME: Rogers&Gray Insurance Agency,Inc. PHONE 434 RIB 134 (MC,No,E)d): (AC,Ne):(877)816-2156 South Dennis,MA 02660 n DR'ESs:mail@rogersgray.com INSURERS AFFORDING COVERAGE NAIC S INSURER A:Main Street America Assurance Company 29939 INSURED INSURER s:Associated Employers Insurance Company 11104 Cape Ability Construction,LLC INSURERC: 13 Fort Hill Road INSURER D: East Sandwich,MA 025V INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 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 SUER POLICY NUMBER POLICY EFF POLICY EXPLTR OMITS iA X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE �OCCUR MPK0264N 05/05/2018 05/05/2018 DAMAGE TO RENTED 500,000 MED EXP(Any one arson $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY j - LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBeaSINGLE LIMIT $ ANY AUTO BODILY INJURY(Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS Ep BODILY INJURY(Per accident $ A�TODS ONLY AU'NOS ONLY P erOacEcideTMid AMAGE $ UMBRELLA UAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE E DED RETENTION$ $ B WORKERS COMPENSATION STATUTE I I ER AND EMPLOYERS'LIABILITY Y/N E.L.EACH ACCIDENT $WCC50050090192018A 04/09=13 04/09/2019 100,000 ANY PROPRIETOR/PARTNER/EXECUTIVE ICERMIEMAT EXCLUDED? � N/A 10�,000 andatory In NH) E.L.DISEASE-EA EMPLOYEE $ It yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Certificate holder is additional insured per the signed written contract. -NOTE THAT DAVID ANDERSON IS COVERED UNDER THE WORKERS COMPENSATION POLICY—CERTIFICATE HOLDER IS ADDITIONAL INSURED PER THE SIGNED WRITTEN CONTRACT I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE , MacKenzie Brothers Corp. ACCORDANCE WITH THE O CYREOF P OVISIONSCE WILL BE DELIVERED IN 214 Cotuit Rd. Marstons Mills,MA 026U AUTHORQED-REPRESENTATIVE ACORD 25(2016/03) @ 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Application to g Jbfgbivap RegiottaY-�Ol:otoric Migtrilct committee, . �V In the Town of Barnstable B.'\hM' t-,BLE. 'IASS. . PIS vie *7r) CERTIFICATE OF APPROPRIATENESS Application is hereby made, with four complete sets, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings, or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior building construction: ❑ New ❑ Addition ❑ Alteration / Indicate type of building: ElHouse Elff Garage ❑ Commercial Other d -2L /' 2. Exterior Painting: ❑ 3. Signs or Billboards: ❑ New Sign ❑ Existing Sign . ❑ Repainting Existing Sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other TYPE OR PRINT LEGIBLY: DATE ADDRESS OF PROPOSED WORK _(o I W I II OJY\-S --Rk4 ASSESSOR'S MAP NO. OWNER LI\ and, 1 Gcy ASSESSOR'S LOT NO. ©3 Y HOME ADDRESS 61 U) i 1o✓hS Pcd-S TELEPHONE NO. G;2 FULL NAMES AND ADDRESSES OF ABUTTING OWNERS, including those of adjacent property owners across any public street.or way. (Attach additional sheet if necessary.) AGENT OR CONTRACTOR TELEPHONE NO. �33 ADDRESS Par DESCRIPTION OF PROPOSED WORK:. Give particulars of work to be done, including materials to be used. Please include locations of proposed signs. CO rre c-+ ( I'r\p ro J e ) eX►5+-,() C!ec_r, i. Signed Owner-Contract - gent For Committee Use Only ►, rs; .� Thi Certificate is hereby Date " a Approved/ enied _ I o ittee M bers' Signatur JUN 2 8 2011 k �IMN OF BARN SIB c a ' v .iH\N g [__ E_ �2 00 Town of Barnstable Old King's Highway Historic District Committee. �V SPEC SHEET FOUNDATION SIDING TYPE COLOR CHIMNEY TYPE COLOR ROOF MATERIAL COLOR PITCH WINDOWS COLOR SIZE TRIM COLOR DOORS COLORS SHUTTERS COLORS Lr !P � i�� 1U GUTTERS COLORS DECKS MATERIALS S-6i A. GARAGE DOORS COLORS �o SKYLIGHTS SIZE COLORS SIGNS COLORS V o P r FENCE COLOR NOTES: Fill out completely, including measurements and materials/colors to be used. Four copies of this form are required for submittal of an application, along with Four copies of the plot plan, landscape plan and elevation plans, when applicable. SPECSHT Revised 11/98 I; TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 6341 Permit# 5- 716 Health Division �� V7 Date Issued 31 Conservation Divisioni So I /. Fee Tax Collector I//1Ar U° C7 �✓' -�•d� ��, �y� / SEPTIC SYSTEM IMUST BE Treasurer -Zi C',1-4 47 0I INS7�ALLED IN COMPLIANCE Planning Dept. ENVIRONMENTALWITYLE 5 CODE AND Date Definitive Plan Approved by Planning Board 7'OWNI REGULATIONS Historic-OKH Preservation/Hyannis Project Street Address Ai c'-n-s ?k� 1 Village -BG ,s_J k_- Owner Agr-y �_&" 1i ,Gk LJ6 5 6 n Address Telephone SlJ St' - 3 G 2- - Q �2 2 Z ~/ ,, Permit Request�d������i CJJy 6?<— IAI t�af e/AIT_ Or Sfili�� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Valuation '7 Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size e-1 Grandfathered: ❑Yes O No If yes, attach supporting documentation. Dwelling Type: Single Family U/ Two Family ❑ Multi-Family(#units) IL 4 r3. � Age of Existing Structure Historic House: ❑Yes E No On Old king's Highway: O Yes ❑ No r Basement Type: Od/Full Ertrawl O Walkout O Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) I [ ; Number of Baths: Full: existing new Half: existing new u Number of Bedrooms: existing new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: 2 Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes Lf No Fireplaces: Existing New Existing wood/coal stove: ❑Yes O No { Detached garage:D existing ❑new size Pool:O existing ❑new size Barn:❑existing ❑new size ` Attached garage:O existing O new size Shed:O existing ❑new size Other: Zoning Board of Appeals Authorization O Appeal# Recorded❑ Commercial ❑Yes O No If yes, site plan review# tR Current Use Proposed Use -- BUILDER INFORMATION j f Name! � /2 -��� Telephone Numbe�'5 i� •-9,4Z:2=� - rAddress License# V:l �,Z�'��, Home Improvement Contractor# -2 ?z E. Worker's Compensation# i . ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE F(4' w FOR OFFICIAL USE ONLY I s w a PERMIT,NO. DATE ISSUED MAP/PARCEL NO.. ' l ADDRESS VICLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME 7/25kr INSULATION 4 FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ' fi DATE CLOSED OUTA > ASSOCIATION PLAN NO. F` y The Commonwealth of Massachusetts Department of Industrial Accidents fiflice of/nsestigatioos _ 600 Washington Street ' Boston,Mass. 02111 --`y Workers' Compensation Insurance Affidavit name location: Q nhone# X ❑ I am a homeowner performing wor myself. ❑ I am a sole proprietor and have no one workin inany ca am din workers' co ensation for my employees working on this job. an em to er rout g comp .... ....... ::.::::: : :.::::::::::::::::::.;:;.;:.;:;.;:.;:.;:.;:.;:.;;;:;: co :::::::::::: :::::.:.:.:::::::::::::::::::::....::::::::::::::::•:::.:::..:.:::::.::::.:.:::::::::::::.::::.::.:.:.:::: : :::::::::::.:..::::::::•:::::. .::.::......:::::::::::• 1:i: ..: .: ...... .::: ci...:..............::: :. ....... .:: :.>:.:;;::::;. hone• .: .::. :.. . : 9 W'*-%---4`::;::: --*'*-*'---`---`,`.` . nsuranc ❑ I am a sole proprietor, general contractor,or homeowner(circle one)and have hired the contractors listed below who have tto n po lices: thefollowing workers comp P.............:.::::::::.:::.:::::::::.;:.;:.>::::::::::::::::::.;:;.:::::::::::::::.::.:::.;:.;:.:..:.;.:<.:.:::.:::::::::::::::::::.:.; :::.::::::::::.;:.::.;:<;.;:.:.;;:.;:.;:.:>:::«: f g :::....::.:.....:::::::::::..::::::::::::::::::::::..::.::::::.::.::::::..::.::::::::::.:::.:::::.::::::::::::::::.:.: :::::::::.:::.::::::::::::::..:.:..::::::::. >:>;>::::;:::;.;'as .::::::;::>:;:::: >::>;:;::>::>::>::>: ::<:>:::•;::;.;:::»::>::»:::::25: com an na _ ... ......... . .......................... ............... s ....................... :v:r< : :::>:»>:>< .......................................................................................... ............................................................................................................. ...................... ..................:......:.......................................:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::........,,i is•.. .............. `'dares WIN/1111111111,0p. LOW tie ....... ..:... :: : .......... ....::::::::.....................:................... d "fii[Y' 33?' i'..: d oli ;eiurance Fafiore to secant coverage as regdred under Section 25A of MGL 152 can had to the Imposition of criminal penalties of a fine up to$1,M.00 and/or RK one yam,imprisonm�t beeffiorwarded to the Office of Inv oestigatlons oforrcR and a fiverification.er of 00 a day against ma I understand that a the DIA f000verage copy of this etstememt may I do hereby a the pains and enalties of perjury that the information provided above is true and correct ' ' Date 4 signature Phone# -0 i �/�_ Print name t1111111111g:111111INgg:!I!: official use only do not write in this area to be completed by city or town official f permit/iicense# ❑Building Department city or town: • ❑Licensing Board response� ❑Selectmen's Office ❑rheckff{nunediaterespo required ❑Health Department phone#; ❑Other contact person: Devised 9/95 P,N Information and Instructions •' Massachusetts Geneyal Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in 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 section 25 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,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 insurance requirements of this chapter have been presented to the contracting 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 Department of Industrial Accidents for confirmation of insurance 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. City or Towns 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/lieense number which will be used as a reference number. The affidavits maybe returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. ME The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Me of Imiestigatloos 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 °E 1ME Tpy,_ The Town of Barnstable . 9°ARNST"B`.Lg Regulatory Services cb 'bsy:'OrE059 ' Thomas F. Geiler, Director Building Division Peter F. DiMatteo, Building Commissioner 367 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. l ��C�1 �Ie_o C e�I P Estimated Cost 7 / �{ Type of Work: � I 'T Address of Work: 61 G✓ `�� CAMS 'P(A Owner's Name: Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied ❑Owner 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 t t of the owner: 01.1 Date Contractor Name Registration No OR Date Owner's Name q:forms:Affidaw re v-070601 lee �o�rvnzau�eal!!z o�✓�aaoac/u�aeka Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 124091._--- . Expiration: 5/12/2003 T /. DBA CAPE ABILITY David Anderson 7 Tupper Rd Sandwich,MA 02563 Administrator BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number.CS 069188 ) {' iEStp1 6105/2002 Tr.no: 25797 k+ Restricted To. :` DAVID J ANDERSON-`. 7 TUPPER RDA % 1, SANDWICH, MA 02563 Administrator Licensed*insured Supervisor License#100753 Remodeler License#124091 E Carpentry Home improvement CAPE * ABILITY David J.Anderson 7 Tupper Rd. Tel 508-888-2112 Sandwich,MA 02563 Fax 508-888-2112 I r ACORD CERTIFICATE OF LIABILITY INSURANCE D / - � 07/197/19/2002001 PRODUCER S08)888-2244 FAX (SO8)833-0680 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Bryden Insurance Agency Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR .12 S Rdute 6A ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. i Sandwich, MA 02S63 INSURERS AFFORDING COVERAGE INSURED David 7 Anderson INSURER A. Assurance Company of America Cape Ability INSURER B: 7 Tupper Road INSURER C: Sandwich, MA 02563 INSURERD: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L LTR TYPE OF INSURANCE POLICY NUMBER POUICY EfMEF�CTNE POLICY EXPIRATIONM LIMITS GENERALLJABILJTY SCP31300883 OS/OS/2001 OS/OS/2002 EACH OCCURRENCE $ 1100010 x COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Arty one fire) $ 300,00 CLAIMS MADE a OCCUR MED EXP(Any one person) $ 10,000 A PERSONAL&ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY M jEa LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND I TORY LIMITS I I ER EMPLOYERS LIABILITY E.L.EACH ACCIDENT $ E.L.DISEASE-EA EMPLOYEE $ E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS WORKERS COMPENSATION CERTIFICATE TO FOLLOW DIRECTLY FROM GRANITE STATE/ASSIGNED RISK CARRIER. COPY OF OVERAGE DECLARATION PAGE ATTACHED. CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILLENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Town of Barnstable BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 3 S 7 Main Street OF ANY KIND UPON THE COMPANY,]ITS AGENTS OR REPRESENTATIVES. Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE David Va'covec STACEY ACORD 25-S(7197) ©ACORD CORPORATION 1988 L� .. M °G`R� N I'1'E STATE INSURANCE COMPANY 64143-0000 wC 854-43-07 1102 --------------------------------------------- SEND CORRESPONDENCE TO: 0 1 3-66-0301-03 • . • P E N N S Y L V A N I A AMERICAN INTERNATIONAL CO. .. . . • P.O.BOX 409 PARSIPPANY, NJ 07054-0409 DAVID ANDERSON PHONE: 1-800-645-2259 7 TUPPER ROAD �n Member Companies of SANDWICH, MA 02563-0000 American International Group EXECUTIVE OFFICES: 70 PINE STREET, NEW YORK, N.Y. 10270 SEE NAME AND ADDRESS SCHEDULE - WC990610 I.D# MA UI#: •. .. BRYDEN INSURANCE AGENCY WORKERS COMPENSATION AND EMPLOYERS 125 ROUTE 6A LIABILITY POLICY INFORMATION PAGE SANDWICH, MA 02563-0000 INSURED IS _ PREVIOUS POLICY NUMBER INDIVIDUAL RENEWAL 001254187 OTHER WORKPLACES NOT SHOWN ABOVE:SEE NAME AND ADDRESS SCHEDULE - wc9go610 ITEM 2 POLICY PERIOD 12:01 A.M.standard time at the insured's mailing address FROM 03/26/01 TO 03/26/02 ITEM 3 A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA S. Employers Liability Insurance: Part Two of the policy applies to the work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 100,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 100,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: SEE ENDORSEMENT - WC200306A ITEM 4 The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Estimated Total Rate Per Estimated Classifications Code Number Remuneration S100 OF Re- Premium aAnnual 3 Year muneration N Annual 3 Year SEE EXTENSION OF INFORMATION PAGE - WC7754 TAXES/ASSESSMENTS/SURCHARGES $16 EXPENSE CONSTANT(EXCEPT WHERE APPLICABLE BY STATE) 107 MA MINIMUM PREMIUM QQ MA TOTAL ESTIMATED PREMIUM QO If indicated below, interim adjustments of premium shall be made: Semi-Annually El Quarterly Monthly DEPOSIT PREMIUM-- is ENDORSEMENTS(FORM NUMBER) SEE ATTACHED FORM SCHEDULE - WC990612 � .. i I 03/07/01 ASSIGNED RISK 66 I �' Issue Date Issuing Office Authorized Representative we 00 00 01 39967 1 PRODUCER'S COPY I I I WE do The Town of Barnstable—Historic Preservation Division Old King's Highway Historic District Committee BAMSTABM Mass. �, 230 South Street, Hyannis, Massachusetts 02601 .z6g9 �0 39 Phone (508)862-4684 Fax (508)862-4725 Public Hearing of July 18,2001 Summary of Decisions. Unfinished Business George &Lisa Simpson 75 North Winds Lane, West Barnstable (Map-Parcel 013-005) Convert Single Car Garage to Two Car Garage With Second Story Approved the Certificate of Demolition & Certificate of Appropriateness as submitted Markwood Corporation Lot#2 Abegail Snow Road, West Barnstable (Map-Parcel 088-001 & 002) New Single Family Home with Attached Two Car Garage Continued to August 1,2001 Agenda Items Thomas Butler 45 Briar Lane, West Barnstable (Map-Parcel 13 6-05 5-004) 8' X 12' Shed: Screen Existing Farmer's Porch Approved the Certificate of Appropriateness as submitted Christopher& Katherine Thew 448 Willow Street, West Barnstable (Map-Parcel 130-024) Replace Window with 6' Sliding Door; Construct 14' x 16' Deck Approved the Certificate of Appropriateness as submitted Spirits Realty Trust 3010 Main Street, Barnstable (Map-Parcel 279-021) I' Installation of Black Wrought Iron Railings at Three Entrances Approved the Certificate of Appropriateness as submitted 1 � ry Richard P. Morse& Betsy Newell 65 Sunset Lane, Barnstable (Map-Parcel 301-022 & 023) Demolition of Existing Single Family Dwelling; Construction of Single Family Dwelling. Approved the Certificate of Demolition & Certificate of Appropriateness as submitted Tales of Cape Cod, Inc. 3046 Main Street, Barnstable (Map-Parcel 279-071) Repositioning of Sign Approved the Certificate of Appropriateness as submitted J. Kevin O'Haire, Tre., Wing Farm Realty Trust 4 Great Marsh Road, West Barnstable (Map-Parcel 089-003) Construction of Single Family Home with Garage Approved the Certificate of Appropriateness as submitted Rick& Mary Ellen Johnson 61 Williams Path, West Barnstable (Map-Parcel 111-034) Correct(Improve) Existing Deck; Change Railing; Add Middle Section Between Existing Decks Approved the Certificate of Appropriateness As submitted Other Business Approval of the Minutes of the Meetings �l of June 6, 2001, June 13, 2001, July 11, 2001 &July 18, 2001 Continued to the Meeting of August 1,2001 ALL APPLICATIONS AND PLANS MAY BE REVIEWED AT THE OLD KING'S HIGHWAY HISTORIC DISTRICT OFFICE, TOWN OF BARNSTABLE PLANNING DIVISION, 230 SOUTH STREET, HYANNIS, MASSACHUSETTS. Dorothy Stahley, Chair , Old King's Highway Historic District 2 / J „o TOWN OF BARNSTABLE Permit No. ____2 = Building Inspector cash 'e w OCCUPANCY PERMIT Bond Issued to Richard Johnson Address Lot 5, ' .61 Williams Rath, West Bd nstable Wiring Inspector --'. - --� Inspection date Plumbing Inspector Inspection date Gas Inspector ,/�%� (/ /�� Inspection date '�CEngineering Department+ 9� �JII�� Inspection date�-21) ' �1 Board of Health �' Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. A - -- �1/12v /P�........ 19 M_ , Building Inspector TOWN OF BARNSTABLE BUILDING DEPARTMENT TOWN OFFICE BUILDING Nut 639 HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department DATE: June 10, 1985 An Occupancy-Permit has been, issued for the building authorized by. 27116 BuildingPermit #........................--- ......................................................................... ................ Richard Johnson issuedto ................................ ................................................... Please release the performance bond. 1� z f� ,/01 f• �j i J { S \ FouuDAroN OCR yr•. t.c.s.�,,.i.,.,.. •r Of MCHARO G \ l = , .tip I+� 4 o BAXTER �nw.s4oaeo 3v DH 85'86 �'ya SU lik ��+� _ tt ' toc�7-ioy U/CST l3AR�J57ri4rB�l-��." / CEe7/.c)oo' r-MA7' Ti/E FovND09TioN •.S'NO/J✓iV HE,2EC�l/CGti►�l l-YS W/Tf/ SCALE- ��- l0 i 7-X.E S/OE.0 44.4E AA/O SET�4 CA< �eE4!//.eEMEM''.s OF Tf+/E T22Wi✓G� PLaN 6AZVST,9 B L.0 ANO /.5' AIO T L07' �T ` , r • , PLAN Boo K. 29/ PAGE` f - L c� XT.E- A/YE /MC. : I JAT,C /D Z ,BA fs - I ON AA1 .2EG/STE.2E� •l �O S ✓�j'��I /�.s�-,e�.w.E.vrsvevEy� Tye asr��ic��o •ass. _...-. I •• �� D•--,&ZS'E7.r.SWy✓ySA"14Z> NoT g� . /G�1A**" S /SEp T4 OETE.�i�/�/E .LoT�/NHS. ��c N A 2!� APc.C. o N►J 5 0►`1 � y � Q .� • •As essor's map and lot number ..... .. .... ........ �� /C�:� � Cd1I �oF TN — S'PTIC Sit TEIM MUST Sewage Permit number ��. .0�� ^'` INSTALLED IN CWPL!A-! � �y P Z DA"STADLE, i House number .............! .../.............................:................... ' WITH Yl7L vo ruse ee� TOWN OF .;BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ...... .... .....��/......................... `................................. Oa � TYPE OF CONSTRUCTION .....G.S�.f........................ ................................................................................................. TO, THE INSPECTOR OF BUILDINGS: E The undersigned hereby applies for a permit according to the following information: nn Location L 0 l v,!,.�4 wi..S.......["cif ►.........we.S.f.,l,3.Gi.i�.47.sS 7t�s.f� ��....!�..:?.fl: ............ ........... ....... .................. ...... ,L ./ Y Q e/% ✓S :!. /u . Fay,.+ . w ProposedUse .......... ..G..... .......................................................�.................................................................... y .l.Q...i...........• r we-.:eY 91 9Zoning District .................................................Fire Distract ....................... ......... ....a.....!.�............ Name of Owner c 4 4,,-/ Tc .................Address .... S..... af.//. .............................................. 4/Name of Builder ...J.?:.":"'.e.s...........!...lG.y..................Address ... ..../Z e Cep•✓c �" �� '?'Y1 4S?�•,i`W��` -/S Name of Architect ...!Q.t'...`'"°^...'.. ....rti. ..�.v..!..s.T......Address .... °`v".'o�f ti pOc,v Number of Rooms 6 Foundation.................................................... PO V W e Co.-v cv e f .............................................................................. Exterior WoocQ F✓ate CG SJOXC-14 200 � • ....................................................................................Roofing .................................................................................... Floors CavOe cveo cl'....................................Interior ....... v a `.. f CV,._1 .. .. ( � e .t &;0ejHeating / ........ �e.... Q .�..................................Plumbing ..... ................� ......... ....... Fireplace ...... � ..................................... Cost ...........Approximate / G Definitive Plan Approved by Planning Board ___ ____ ___ _��_______19 _7 Area ��` ................f. Diagram of Lot and Building with Dimensions / Fee /91 SUBJECT TO APPROVAL OF BOARD OF HEALTH 30 2� aaa�2 yFy 1 Y c 6b` �° Or 13 zo OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. M Name .... ..................................................................... Construction Supervisor's License .(l..j ..../.".. ...... ;A-t JoHNsoN, RiaiAPD No'.271N..... Permit for ................ .......SJpgle..Famijy..1;:��i Sr...................... .... ......... Location ....Lpt..5�.....61..Wi.11iam..Pa.th........... .... ............. .... .... ............... .Q.%;..B.....�table ............................................ Owner ......Richard Johnson ............................ Type of Construction ....�qW.......................... .......... ................. ............................. . ..................... Plot .......................... Lot ................................ -Granted ...... ..................... .Permit, d ....October 19, 19 84 Date of Inspection/a .....................19 Date Completed .... .............19 . .............. 4 (7 Engineering De . (3rd floor) Map ' Parcel 3 y"FJJ Permit# ?-o 5 House# —�2l Date Issued 9 •'o?'J Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) - L1� Feem Conservation Office(4th floor)(8:30-9:30/1:00-2:00) cC �I Ailv%i� Planning Dept. (1st floor/School Admin. Bldg.) Definitivqa ved by Planning Board 19 �.`��'�'�'_-� ,� ✓i�� ,', �. BARNSTABLE'• �A C ^.., I s6.79�- TOWN OF BARNSTABLE Building Permit Application • U'S Project S n l ��>r vwc ��-�� 1% Dell Ldr S Village la) �i.►� s �,�� r Owner rL� ��� �„� y Address Telephone si b 12,Ci -7 ?,1 ' n Permit Request me-" .V-�_ 6-1 S:�N. 14, �„-� 6cQvas � ,�uQJc�v�►,. [JJC�y- -e.��3'� First Floor /,��/?� square feet Second Floor square feet Construction Type �Jyod1 Estimated Project Cost $93 1 U5 Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family 0' Two Family ❑ Multi-Family(#units) Age of Existing Structure 1 21 rs Historic House des 0<0 On Old King's Highway E3Yes ❑No Basement Type: ❑Full arc rawl ❑Walkout Q Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing oZ New 1 Half: Existing New No. of Bedrooms: Existing 3 New 1 Total Room Count(not including baths): Existing 6 New yZ First Floor Room Count (� Heat Type and Fuel: ff as ❑Oil Q Electric ❑Other Central Air ❑Yes ON o Fireplaces: Existing New _� Existing wood/coal stove ❑Yes U Ro Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) g_1 )c X`I ❑Barn(size) Q None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes. ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name E ryn Y1 I,-�` Telephone Number '77S R.700 Address_�1 1 �,,, (, ,,� License# 0 �2 C U c24 2 Home Improvement Contractor# ,ZhC2 7 223 Worker's Compensation# 6 R /U (,l 1 7 31 k� 1 OL-0 i NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO C. �,� l,iAr0CII SIGNATURE �� DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY t , .. PERMIT NO. A. DATE ISSUED MAP/PARCEL NO. ! ADDRESS y VILLAGE r OWNER DATE OF INSPECTION: - FOUNDATION FRAME INSULATION FIREPLACE' ELECTRICAL: ROUGH FINAL , PLUMBING: ROUGH FINAL GAS: ROUGH t FINAL ' FINAL BUILDING DATE CLOSED OUT i ASSOCIATION PLAN NO. o y) Le t � , t 4 The Town of Barnstable URNSTAeLE MASS p Department of Health Safety and Environmental Services . O tesv. .0 Building Division 367 Main Street,Hyannis,MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice Type of Inspection czM�L Pt I Location p , �,IV�l.l,l�k1�C �1 Permit Number �Q�� Owner ! ,t7 �8 Builder DR, bir(—K One notice to`remain on jobsite, one notice on file in Building Department. The following items need correcting: AA E `��" OILS A N NLO vin tx 0-11i � ► ( ,E w IRL A-64c.q4 Sv G Y L 36 e( Lai �d (E7 3t C61 rL ► Please call: 508-790-6227 for re-inspection Inspected by- Date °F FIE r, i ' •'Y°� The Town 'of Barnstable hima De artment of Health Safety and Environmental Services ,�59. P Building Division 367 Main Street,Hyannis MA 02601 Ralph Crossen Office: 508-790-6227 Building Commissioner Fax: 508-790-6230 For office use only 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 such h residence or building be done by registered contractors,ontra tors with structures which are but not more than four dwelling units or to djacent o certain exceptions,along with other requirements. Type of Work: n n_,1 y s� ���� Est.Cost Address of Work: f, Owner's Name Date of Permit Application: " I hereby certify that: i Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWN' OWNERS PULLING THEIR H PERMIT OME MTR0 MENT WORK D OR DEALING WITH ORNOT HAVE CONTRACTORS FOR APPLICABLE [ ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL G 142A t SIGNED UNDER PENALTIES OF PERJURY �1 F I hereby apply for a permit as the agent of the owner: Registration No. Date Contractor Name OR Owner's Name The Commonwealth of Afassachusctts � ii -___:=�;_� Department of Industrial Accidents ` office VIIHMS11921180S 6O0 11'asltingtun Street Boston, A1uss. 02111 Workers' Compensation Insurance Affidavit •,Apnlicanflnformafotic name: location: city Phone# I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I.`.`t:"•.•,'_.�o�'a�w.wL,"c:`7,rr*.,'..i:;a`A::�:+en..i.t" `�'>'zo�a.��R"� �"�°s+' � 4'Su:Y�a,'��'�:.."�a'i-A�n._ - r'.�.,- "^•ah�g�+'�",e�u,,..+��;•�'!�'!�r`-�•nr r•..•,= 01 am an employer providing workers' compensation for my employees working on this job. J company name: Y\vx 0!e r- C� A"— address: city: (_Z n V A L, O a- 3 L Phone#• cU• insurance co. I'C��iunc� � e C.,- -731 k 10(-'0—%f ,..... ,..- i •,�::. ..:art!!y... ,xr,v-. _ .!a!!+,*-•r+±�.!+aa.c:wr...�.��o.w_•Ss �eww•I„!Y.!,.,�,w..«.; 1 am a sole proprietor, general contractor,or homeowner(circle one)and have hired the contractors listed below arho have the following workers' compensation polices: ` company name _ i ' address city: phone#: insurance co. policy# '4�:.,... .a �!ra,:. -.7;�"�n.__<a;y.•.,"'T'�"�r-3r ;^em•"'T..4�T''_^,.,., m.a�?eyr.=•� company name• address- city: phone#• insurance co. polio'# Afiachedditional'shcefif`necess����:��'•-�;;�`•�r:+;a� ..�:__:�: ••��r�e�'� -,f::�•:��..:�d::+r�--y=- --- _�"'-?�����;a;.: Failure to secure coverage as required under Section 25A of 111GL 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 5100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certiJ'under the painsand penalties of perjury that the information provided above is true and correct. Sienature Date Print name ;ig-7 i /tea a n J r_ Phone# -7 00 n_r 7"ofricial do not write in this area to be completed by city or town official permitAicense q nlluilding Department pLicensing[Board pceck if immediate response is required 0Sclectmen's Office _ Health Department contact person: phone#; rjOther r -+r;-�+c.:rr-.r.^••^rr,.r!!o°ro�, - - ..rsnsR+-..•-•�• .••.-.s.a.•.�:t:�r,,. Irevised V95 P1A) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for tlieir employees. As quoted loom the "law", an cinpl(�vee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An einphnver 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 dwellino house of another who employs persons to do maintenance , construction or repair work on such dwelling house or on the urounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 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 tlic commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally. 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 insurance requirements of this chapter have been presented to the contracting authority. .t. .. ......_ .. ..�+Ji: _ .. :1. 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 as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. Tile 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. T .. ... ... - t?: +.3 t::t.1' ar>' '•cZ'V"i+;'�'-- 'Y 1e:,'Lly... - .. ... M1. Citv or Towns 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. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. Tile Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. .. _:-'-.--�lw-'.-••...,r...t•.�........s-r..cs.•... .....•vn.,; ,'4'a•,:,.;.'.-.r�,•^-.�:•Y'-•.-=!;�w�..,q, ;..'emf}=!�7rc'.^- The Department's address, telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 Application to `°' v 1 31 BUJ�N'N���,EtPv�N S SP pN`'�PP'BPS EP GN Old Kings Highway Regional Historic District Committee in the Town of Barnstable for a I ' CERTIFICATE OF APPROPRIATENESS Application is hereby made, iri triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed.work as described below and on plans, drawings or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior Building Constr ctiioon- ❑ New Building j'Addition Alteration Indicate type of build' g: [ House ❑ Garage ❑ Commercial ❑ Other 2. Exterior Painting: / 3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other t � (Please read other side for explanation and requirements). TYPE OR PRINT LEGIBLY DATE ADDRESS OF PROPOSED WORK �l�/��/�/ I if All H-1 1A). 1446ESSORS MAP NO. OWNER gll-420� 19 ASSESSORS LOT NO. QJ God' S� HOME ADDRESSzo—/��d1 is A /.J jP,4AVI1/ril1P_ /t'IA 0z664 TEL. NO. :2Q2 FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet-if necessary). 2 &S /�/1/1alsT✓9��P if� G Z��J✓ Le AGENT OR CONTRACTOR /�oG/��v �a.�I ����� �G - TEL. NO. 7 -7 V C13 7 ADDRESS yZ ��J aC�. �GcLCJi l�p GLC.Q G G 1 DETAILED DESCRIPTION OF PROPOSED WORK: .Give all particulars of work to be done (see No. 8,other side), including materials to be used, if specifications do not accompany plans. In the case of signs, give locations of existing signs and proposed locations of new signs. (Attach additional sheet, if necessary). CO)pn .� � ,4dd 1n .S�j4ce -fa eX- sfi�, aye nI . 62 . �'�Y r'Oo/<\ Ge// PJGl/'aa,n �'IOl G / O� Gv /1 Z al9e— c5�'�� ti D Signed l=D Owner- ontractor-Agent .-Pace-tie Qw lay a om ittee use. ce%edlb� D�C� Date ���r The Certifi to is hereby �n11''a�a Date �`o JUL % ��I-e, Time RN S T ABLs: TOgy ICINGS HIGHWAY Approved •IMPORTANT: If Certificate is approved, approval is subject to the 10 day appeal period provided in the Act. Disapproved WN ADDITIONAL INFORMATION FOR MAKING AND FILING AN APPLICATION FOR A CERTIFICATE OF APPROPRIATENESS The four categories for which a Certificate of Appropriateness is required are: (application for demolition or removal is a separate form). 1. EXTERIOR BUILDING CONSTRUCTION (new or existing buildings): An application is required for any exterior of a building to be erected or altered including windows, doors, siding, roof, light etc., that will be visible from any public street, way or public place. The following scale drawings are required in duplicate with application: plot plan (if addition — show existing buildings in outline), floor plan and elevations. Also required are snap shots of existing buildings, where additions or alterations are to be made. No plot plan is required for addition or alteration which does not touch the ground. 2. EXTERIOR PAINTING: An application is required for any portion of a building, structure or sign to be painted that is visible from a public street, way or public place. Color samples must be attached to these applications. An application is not required when repainting existing colors, changing to white, or using colors approved by the Town Historic District Committee. 3. SIGNS OR BILLBOARDS: An application is required for any sign or billboard to be erected within the District, with the following exceptions: a. Existing signs or billboards on November 27, 1974 shall have until November 27, 1977 to secure an.approved Certificate of Appropriateness. b. Temporary signs for use in connection with any official celebration or parade or any charitable drive as long as they are a. removed within three days of the event. Certain other temporary signs that the Committee feels does not detract from the Act may be allowed with the prior permission of the Committee. c. Real Estate signs of not more than 3 square feet in area advertising the sale or rental of the premises on which they are erected or displayed. d. A single sign of not more than 1 square foot in area showing the name, occupation or address of the occupant of the „r ; premises on which they are erected or displayed in a residential zone. 4. STRUCTURE: An application is required to build or alter any structure within the District which is defined by the Act as a combination of materials other than a building, sign or billboard, but including stone walls, flagpoles, hedges, gates, fences,.etc. GENERAL REQUIREMENTS 5. Work on projects requiring approval shall not be started until the Certificate of Appropriateness has been filed with the Town Clerk by the Committee. Approval is subject to the 10 day appeal period provided in the Act. 6. No changes shall be made from the original approved specifications without advance approval of the Commission on an amended application filed with the Committee. ;mil 7. A separate application must be filed with each project requiring a Certificate of Appropriateness. 8. Under heading of "Detailed Description of Proposed Work" 1.give detailed data on such architectural features as: foundation, chimney, siding, roofing, roof pitch, sash and doors, window and:door frames, trim, gutters —leaders, roofing and paint color. 9. Unless application is complete and legible and all material required is supplied, application will not be accepted or acted upon. Copies of the Act establishing the Regional Historic District may be obtained at the Town Hall. , n Town of Barnstable Old King's Highway Historic District Committee SPEC SHEET FOUNDATION S/S 94 SIDING TYPE //V o o _6 J 61i.- COLOR CHIMNEY TYPE COLOR. �� ROOF MATERIAL �r7/�Gf /�o� Woo COLOR � G`e PITCH WINDOW •Se�pF�,/1-C SIZE 7 X-N� SOS f TRIM COLOR DOORS �f '�//t-'� COLOR SHUTTERS GUTTERS cct/�'�� Lt :5;VS i . DECK GARAGE DOORS Gii d z L� � COLOR i NOTES: Fill out completely, including measurements and materials/colors to be used. Three copies of this form are required for submittal of an application, 1 along with three copies each of the plot plan, d landscape plan and elevation plans, when !� U applicable. "Certified",pp ble. Plot plan need not be Certified , I; but should show all structures on the lot to scale. SPECSHT 11� - f .49 v 0 �C�O ^ ••M Sr roe `po-� I► •e:� • V O eIt O 40 �• \• Set Z° '� � ma's V 3 •'e`l, a• O h 9 �°3 O vF ti i 111q r` , •1C ,yAci- cN 9 / s • eaa�ao,ti L24� • O `3� - i r 90 O I.00AC Z o n / v� per. Q' O b /• >g a 40 C Vt O 1.00 m 4c B6 /eo tie * e � ecqC eer 'so 2.87 AC OQ ♦� P qC Rio.W O� V v lot O %.Aet kc. .� O 22 ze 32 O s 'cam 41 h . A 1.ob AC 0 ®d r ee 14 N /9 9C �i N < , .04 AC ' „ az - ' /. CF .� t 240 8 �e 6y era . 71 6 q0 Ne /a0 ri �I a o 3; 61 A+G o d 5e Nw Q 94AC-5 I.o Cc 4 1 4, a" g 60 ..84AC. i.e Q f . J /ej z _ ^�ao Y // • ,S � �••. 3 'o o a '9C 84,AC. (e 8 34 1.03AC ry s a 81 AG 704 9c > .147Np N b .84At .81AC .84AC. w w te2 .'. c 84AG � TWO .84 AC, b ^S e SCALE w e. 07 w we 19 seo o OERu vA� -DR 1 VE 07 HOME' IMPROVEMENT CONTRACTOR: : .' - ;:RegistTation::'100118.��;'.. -Type.. 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N•.•.AdM•AW uM....o ��:� I ,OL n Hn.e..aAMR,o _p Fb K a m�� aaroT' —M Pllt ma,mN4 awwCoa'i „d �,• :& g s. f�ul�pING�GTIoN'G" aii��)� ggl3j 4 ��Saal ouwlnc nm p.fleim.-f-n•G• NoF•: AUHM.t.m.M.IDim.n,bM,r•Ye JMF[t NUnWFC b•.iY••Y8i•d by 4•nard GoMr..sia• •YYim.of done}ruaf on ^4 O 2 : o • a � I I I I { I I ?------------- -- -----------1! ��NO�TFfC�LYSLLVATION }�I �I i !Mtt�� =g!!a 1t .4d �If�dd� I I 1 1 1 pMM1NO iY1ff -------- ________________________l1_-__-_-------- Fit.. fNEFTNUMOFk Au w.o-.m.nt.tvim.n.io"..r.to . b�wit."!&W by 4—A&Vftf stc ` OO •t tim.of�on.truetian 1' 0 0 ox § o El IHIII "M � on MIMI !----------'----1-----------------r---------L-----------------i---------—----- -------1 y d-V �1�OLIT, G g 8 i III Ii _________________________________________r L__-_____________Lr-_______________-_________-______- -------------------—------------—------J---_-------------L----------------------------------- rOMY.]NG TYYF: gw�Han. wr-lWreT-LrCLOV +r1oN Not.: sHEErmWER: All 1-Itiu��m�r:h��Oim�ni:OM K�#O vwlrud by A—A GoMr. m A�O .r#im.or do�.+r�tion Assessor's map and lot number .....��m z/...... TNE- Sewage Permit number ......... .............. .......... T... . t BARN AXLE, MAII& House number ................................................................. ...... 039- Ar, TOWN OF BARNSTABLE BUILDING 11.D I NIG INSPECTOR ...................... APPLICATION FOR PERMIT TO ... ........X! ..... ........................;W.......... ............. TYPE OF CONSTRUCTION ......4...I.A0.47k -V-- ................................................... . . . ............................ ...........................19...... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .....f....... w ....... ............. >o, ... ......................................... ...... V Proposed Use .... ................. .........ir....... . ........ .......... ire I.,A.............. Zoning District ........................... ...... F.' .-District ......................... 4 Name of Owner ......F 4 c,,,/ .......... Tq.... h. .. .. Address .... ........ ....... .. ... 4 6""'c 5,V7 r'S Y01,1W Vs Nameof Builder ....................... .................. . L....... .......Address ... ......................................................................... Name of Architect ... ....... .... .. Iva..... ......Address ................—...6..........ee c n. .......... C Number of Rooms ................... ............ .........................Foundation ........................... ,.-.e...74.—C................ r............... .. . .. .... Exterior ..... Roofing ....... ................... ....................... .......... ..fro ...........;............................... Floors .......Ca 19-e............... ..................................................Interior ... ,,I................................ .............. Heating ... ......... Qj ......... ....H. ...................Plumbing ...................... Fireplace la e ......13 .................... ............................. Approximate Cost .......... ............... Definitive Plan Approved by Planning Board A 0)-------19011 Area .......................................... Diagram of Lot and Building with Dimensions Fee ........ ............... SUBJECT TO APPROVAL OF BOARD OF HEALTH yq 2 f 0#;o 0 V— 3 &, o 10/ S 10 .y S- OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby 'agree to conform to all the RUI,es,,,anc1 Regulations of the Town of Barnstable regarding the above construction. Name ...... ...................................................... ys, Construction Supervisor's License .0.1.5.0................... JOHNSON, RICHARD 111-34 27116...... 1� Story No Permit for .................................... .........Single Family Dwelling..................... ... ......... ......... .... ...... Location ..Lo.t.-.5 6.1..WilliarrtsPat-h .... .. .. . .. ..................................... West Barnstable ............................................................................... Owner Richard...John.s.on........................................... ........ . .... Type of Construction .....Fr .......................... ................................................................................ Plot ........ .................... Lot ............ ................... . Permit Granted .. October. 19, ................. ....................19 84 Date of Inspection .....................................19 Date Completed .......................................1.9 •�},, TOWN OF BARNSTABLE Permit No. _-_2-7116 1 . Building Inspector Cash ■ 0 `� ------------ Y OCCUPANCY PERMIT Bond -_---_--X r Issued to t2 x-r-1 a a rr Tni�x�cx� Address Lot 5, 61 Williams Patti, WeSt Barnstable Wiring Inspector I r '� .t - zt Inspection date Plumbing Inspector1 ; r _ ,` Inspection date 0 d Gas Inspector !". i Inspection date Engineering Department f �. � f`j. „� Inspection date,� X Board of Health �-`.:.^ s � � � t �✓�,,.� Inspection date - ' THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. x7 1�` Building Inspector J �4(tttT �, ` ��• Fir '* I-AP r�� � �t' . '+ � �P.LOG/�•TPD DhIY�v�/�Y is•; o r- � s � Q 0 17 17 A iT 1 11 } Cil Li v p1 OV J • may. �x:.,.�., � . _---,.- - -7 . � , I , � , "'. I , , . 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