HomeMy WebLinkAbout0069 CAPTAIN ELLIS LANE �,s� -ion
� � �a�� �_�'�� ���
-- - -
�i
'I
i
1
�'' _ - _s_
I `
J�
(AFf
L L �
j
J
.!J
fz� Town of Barnstable *Permit#
o Ta,,
Expires 6 m on( s from issue date
-� Regulatory Services
f i
BARNSTABLE, Thomas F.Geiler,Director
v MASS $
Building Division
®P �prFD tAA�E6' .
Tom Perry,CBO, Building Commissioner
JAN ?f1Uri 200 Main Street,Hyannis,MA 02601
www.town.barnstable.nia.us
( 1 ' F� � MARL Fax: 508-790-6230
EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY
( Not Valid without Red X-Press Imprint
Map/parcel Numbera O
' e _ � ` ftl/)tS
.Property:Address �� 'n, 1 `� -�� � � "
[residential Value of Work r V Minimum fee of$25.00 for Work under$6000.00
Owner's Name&Address n
Contractor's Name 1�`t1"fficn�L ����` I� Telephone Number �0
Home Improvement Contractor License#(if applicable)
❑Workman's.Compensation Insurance
Check one:
El I am a sole proprietor
❑. lam the Homeowner
❑ 1,have Worker's Compensation Insurance;
Insurance Company Name
Workman's Comp. Policy#
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box)
Re-roof(stripping old shingles) All construction debris will be taken to
I
Re-roof(not stripping. .Going'over existing layers of roof)
❑ Re-side
i
Replacement Windows/doors/sliders..U-Value (makimum.44)
*Where required;. Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Propjerty Owner Letter:of Permission.'.
A copy of the Home Improvement Contractors License is required. .
I
SIGNATURE:
QAWPFILES\FORMS\building permit forms\EXPRESS.doc
Revise020108 . - y
^ istration valid for individul use only
Gl I License or reg
Board of Building Regulations and Standards
Uefore the expiration nations and Standards
HOME IMPROVEMENT CONTRACTOR I Board of Building Regulations
H Place Rm 1301,
1 i n
qj
� � e>Ashhurto
�� On _
Registration 126480 Boston,M 10
Expiration 618f2010
Tr# 267766 i . a.02 8
Ind vidual '
I
MARK HERBST �t
MARK HERBST 1 Not valid withostt signature "1
35 PEEP TQAD RD ',
,.
MA 02632' Administ[ator
CENTERVILLE,
Construction SupervisorLicense I
: ,
ff License:.CS 48546..
f .
I Expi�aton.__ '
1/27/2010, 7r1R 14362 ,
�tRrR�r n �
�
t MARK D 4MERBST�`
35 P( T TOAD`RD h
CENTERVILLE,,.MA 02632 %' L d;Ail. . .
-
�.. - Commissioner I
r ,
s "
NOTICE NOTICE
TO TO
]EMPLOYEES y; EMPLOYEES
The Conunnonwealth of Massachusett's
DEPARTMENT OF INDUSTRIAL. ACCIDENTS
600 Washington Street, Boston, Massachusetts 02111
617-727-4900
As required by Massachusetts General Law, Chapter_152, Sections 21,22 & 30, this will'give you
notice that I(we)have provided for payment to_eiax-injured employees under the abov oned
e menti
chapter by insuring with:
ASSOCIATED INDUSTRIES OF MASSACHUSETTS MUTUAL INSURANCE COMPANY
NAME OF INSURANCE COMPANY
54 THIRD AVENUE, P.O._5OX 4070;BURLINGTON, MA 01803-0970
ADDRESS OF INSURANCE COMPANY
AWC 7016215012008 01/10/2008 - 01/10/2009
POLICY NUMBER EFFECTIVE DATES
P O"Box 494
Leonard Insurance Agency Inc OsterviAe MA 02655 (508)428-6921
NAME OF INSURANCE AGENT ADDRESS PHONE
Mark Herbst 35-Peep"Toad Road--- Centerville, MA 02632
EMPLOYER ADDRESS
`. 01/04/2008
EMPLOYER'S WORKERS COMPENSATION OFFICER(IF ANY) DATE
MEDICAL TREATI�J[ENT
The above named.insurer:is required m cases of personal injurNs arising out of and in the course of employment to furnish
adequate-and reasonable hospital and medical services in accordance,with the provisions of the Workers Compensation Act:'
A copy of the First Report of Injury must be given to the injured employee: The employee may select his or her own physician.'
The reasonable cost of the services provided by the treating physician will be paid by the insurer,if theareatment is necessary
and reasonably connected to the work related injury. In cases requiring hospital attention,employees are hereby notified that
the insurer.has arranged for such attention at the
NEAREST AND BEST MEDICAL FACILITY
NAME OF HOSPITAL ADDRESS .
TO BE POSTED BY EMPLOYER
k
� x
jA
Com
kP
PROPOSAL SUBMITTED T0. WORK PERFORMED AT s
b
Dawn Burt
338 Pleasant Pines 69 Captain Ellis y
Center_ville MA r
.� ` ' Hyannis MA
y 508-362--ig. 9'508=663-9467�.
l r
F
We herby propose to furnish the materials and perform the labor necessary forthe completion.of:
New Root
`r Remove 1 laver of existing shingles' ,k,
Install ice&water shield at edge:
Install 151b.felt paper
{ Install Certain Teed 30yr.Architectural shingles
i Cut ridge&install cobra vent
Replace plumbing boots `k '
s, Storm nail all shingles =w
All debris cleaned daily ' r
Price includes material,labor&dump fees $3 100.00(. J*check ki rafrf acceptable fif►ankYou ,.
a� 4,
Add-gutter clips awrox.2'on center to existing-gutters,material&labor $150 00( )check&initial if acceptable Thank=You
All material is guaranteed to be as specified. The above work will be performed in accordance with the specifications siibmittedr
and completed in a substantial workman-like manner for the sum of:.
As specked above&venfred with your initials
Dollars( )with payments as follows: full amount.due upon completion
a F ,q] x�s Na y x w c u t 3 separate written agreement and become an extra
RESPECTFUL SU IT
t G
.,. Y .r 211.7108 r
.. ...
Mark Herbst
r, f '
The.above price,specifications andconditions are satisfactory.)herby accept this proposal. You are authorized to d-the work mnd
{ z - payments will be as'specified abode j s
s ;{
SIGNATURE
y-'�G.f 9 } }3+f`£ .y. 7?,yy� � &,
,rr*4�4��.c
� '`-r,.+f�'P$4t...�'3. ,{ ry•'4. Y�'✓5,,YY'+F r. i:�✓F.'�r"z"`'�S i' �`r".�,3.z�ti�� �i - 9� � � s S �. � :s' �� a
,a-
c
,isl a F'x. ��• ?:-
kN.Y_"'SS'° R'. "t,`.�� "�b� .v `4�^,r'�:. , .. Y 's
-.,: a�� zrs" -a^` -f g;,f.'' " c- fi,r'S '" ' t T ' z;k '�,r ...4m;,,i -;,�^a i`ad .�''`-'
f3 6I�.*" y.�,7,., ';' `',_y�r� r 'k.e e*>+i'�" ?-?'..: tS``3?1- par }.».�..a r - , r; 'i Tea,, ! `,r rsr �ap <:
r yy.K ✓ i*t ,. ;Y 4A .. s::h'7�Nes`< $. ':� 'S .p^y La, A. 4gxr"b'�'?u-[�?s. % � ''� ;M
x:.,7�'r t,rfi �+'+`r.�":>;`�. e..�,jyr.u'-i+ C ,, .Y �k-.za ,F e, -'^,-. k .r.
-Jz "` t.., '''4 53Y' -�`v� t-k .'s * : .� I i`' - 1.. � }�..., j '+� t _ ..x
wyu .fix;-J'` x y`: �''�4'r:" �i k; a C. t r: �,,'c"14 .•E .-s ,4 I - ' '-� --k
t 7 u Y?yU :•' t x
�� rE _rl..�.,.v 4: ,ty--�?✓r'�`a ��✓�4 �' t :; '` - '' -r ., v:a°'...m t". �x
c.•- .->*. ,. 3v -+}"Fi., i .,�
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
5� www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Eleetricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual):
Address:
City/State/Zip: Cc V, /� Phone.#: L� 10
Are
�you
-an employer?Check the appropriate box: Type of project(required):
1.[ I 1 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
.2.0 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. 0 Building addition
[No workers' comp.insurance comp. insurance.
required.] 5. Q 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.[-�-R�`of repairs -
insurance required.]t c. 152, §1(4),and we have no
employees. [No workers' 13.❑Other
comp.insurance required]
"Any applicant that checks box#1 must also fill out the section below showing they workers'compensation policy information.
t Homeowners who submit this aff davit 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-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: V�l�
Policy#or Self-ins.Lic.M 7 D ) l vZ6 Expiration Date:
Job Site Address: b CT (24 t' 11'`} City/State/Zip: OJO 0 11 1
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 tip 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 in-suranco/coverEtge4erificatiorL
I do hereby certify u r t a n d pe ale f perjury that the information provided abovee�is
true and correct.
Si tore: Date: U
Phone#: L 6) (0O9
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#:
Information and Insttuctions-
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 fore om engaged m a omt-ente ns�mcludn`--the le all re een-li v`e-s of-edemas i or the---- ---
g g g g_ J rP � g g P ed-emp oar,- -...
receiver or tivstee 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-conti-actor(s)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 permittlicense 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 fo any business or commercial venture
(i.e.a dog license or permit to bum 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 1-977-MASSAFE
- Fax#617-727J70
Revised 11-22-06
www.mass.gov/dia
s �•
[ ] [R250 102 . ]
LOC] 0069 CAPTAIN ELL'IS LANE CTY] 07 TDS] 400 KEY] 160186
----MAILING ADDRESS------- PCA] 1011, PCS] 00 YR] 00 PARENT] 0
BURT, ALAN R & DAWN M MAP] AREA] 5 0 AC JV] MTG] 0 0 0 0
81 CAPT BELLAMY LANE SP1] SP21 SP31
UT11 UT21 . 35 SQ FT] 960
CENTERVILLE MA 02632 AYB11976 EYB11976 OBS] CONST]
0000 LAND 27200 IMP 51800 OTHER 900
----LEGAL DESCRIPTION---- TRUE MKT 79900 REA CLASSIFIED
#LAND 1 27., 200 ASD LND 27200 ASD IMP 51800 ASD OTH 900
#BLDG (S) -CARD-1 1 51, 800 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE
#OTHER FEATURE 1 900 TAX EXEMPT
#PL 69 CAPT ELLIS LANE RESIDENT'L 79900 79900 79900
#DL LOT 7 OPEN SPACE
#RR 0238 0125 COMMERCIAL
INDUSTRIAL
EXEMPTIONS
SALE100/00 PRICE] ORB13245/191 AFD]
LAST ACTIVITY110/22/91 PCR] Y
i L eY
R250 102 . t P P R A I S A L D A T KEY 160186
BURT, ALAN R & DAWN M
LAND BLD/FEATURES BUILDINGS NUMBER ZN/FL=RC- 1
27, 200 900 51, 800 1 A-COST 79, 900
B-MKT 71, 400
BY 00/ BY ML 5/90 C-INCOME
PCA=1011 PCS=00 SIZE= 960 -JUST-VAL 79, 900
LEV=400 CONST-C 0
----COMPARISON TO CONTROL AREA 50AC -- TREND EXCEEDS STANDARD
NEIGHBORHOOD 50AC HYANNIS
PARCEL CONTROL AREA TREND STANDARD
101 10 LAND-TYPE
272001 102000 LAND-MEAN -7306
799001 75048 IMPROVED-MEAN -310 250
] FRONT-FT
] 100 DEPTH/ACRES TABLE 02
1001 LOCATION-ADJ APPLY-VAL-STAT 1
LNR] LAND LFT/IMP] ADJS/SB/FEAT STR] STRUCTURE ARR]AREA-MEASUREMENTS NOR] NOTES
COM] MARKET INC] INCOME PMR] PERMITS GRR] GRAPHIC
FUNCTION- [ ] STRUCTURE-CARD NO- [0 0 0] DATA- [ ] XMT [?]
R250 102 . P E R M I T [PMT] ACT*[R] CARD [000] KEY 160186
000000001
PERMIT-NO MO YR TYPE VALUE CK-BY MO YR %CMP NEW/DEMO COMMENT
se UPC FI1 21
No.SF11 SAWW
'! HASTINGS,UN
744
5'.PROPERTY ADDRESS-� _• - ...,. - _o �~ I `ZONING I DISTRICT CODE SP-DISTS.I DATE PRINTED CSTATE LASS I PCS I NBMD Y`--� Cq�- — _�y�
0069. CAPTAIN-.ELLIS LANE 07 RC-1 : 400 _ 07HY: 07/09/95 1011ioD 50AC R250 1D2. '160186
LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS TY UNIT ADJ'D.UNIT
Le By/Date s�:e Dimanron LOC./YR.SPEC.CLASS ADJ. COND. P PRICE - PRICE ACRES/UNITS VALUE DeetnpbPP B UR T i A L A N' R Sr DAWN M ;MAP— M.
CD. FFAe ttVAcres #LAND 1 27 i 2 D O CARDS IN ACCOUNT =
L
10 1BLDG.SIT:1 _ X1 .35 =10( 194 39999.99 77599.99 .35 27200 #BLDG(S)-CARD-1 1 51P800 01 co -.01,
q #OTHER FEATURE 1 900 COST
; N BATHS 1.0 U X' C= 100 3500.0 3500.00 1.00 3500 u #PL 69 CAPT ELLIS LANE ARKET 71400 '
E) FIREPLACE
REC. RM S X C= 100 10.4 10.40 720 75OU B #DL LOT 7 INCOME
fIREPLACE U x C` 100 3100.0 3100.00 1.00 3100 B #RR 0238 0125 SE
pSHED S 8 X 12 1976 C= 85 10.55 8.96 96, 900 F APPRAISED'VAtUEr
D 79i900
A U ARCEL SUMMARY. 4
T .S AND 27200
'A T LOGS 51800 t
goo
I M
MPS
OTAL 79900 '
I F E CNST
E N DEED REFER ENc Type DATE „�,,,�, - R I 0 R YEAR -VALUE
- _ q- T Book Page Inst. MO. Yr.D SaIes Price AND 27200
I T S 245/ 30/00 LDGS 52700
U OTAL> 79900.'
IR
E BUILDING PERMIT '
S Number Data Typo Amount
LAND LAND-ADJ ': INCOME SE I SP-BLDS FEATURES BLD-ADDS UNITS
27200 900 14100
,. Class Const. Total Base Rate Ao'.Rate r B'It A e Norm. Obsv, CND. Lot %R.O. R.PI Cost New AE Rap'Ve'ue Stories Hei nt Rooms Rma -.1t. I F4. --I—. --
Units Units l A I 1 g Deer. ConE. 1 g
01C D00 100 100 60.20. 60.20 ' 76'76 18 81 90 71 , 72948 51800 1.0 5t 3 1.0 4.0
Description Rate Spuare Feet Rep'Cost MKT.INDEX: 1-00 IMP.BY/DATE: ML" S/9O SCALE: 1/00-77 ELEMENTS CODE CONSTRUCTION DETAIL
S BAS. 100 60.20 960 57792 bKOSS AREA
`
T FMP- 55 5.50 192 1056 *-----16-----*N
STYLE 032ANCH�I -------0.0
' FMP ! €SIGN ADJT UD ----------- 0.0
U 12 12 5 fT 4 DOD SHINGL ___ES D.0
! ' EATIAC-TYPE- -fl-3 AS-WAR(4-AIR----U:0
C ! ! NTER=FIVf9H 74 RYWALL ----------�.0 '
T *-----16-----*-40--------------* NTER:CAYDUT- TZ VEiF:7W6RMAL-----D:O
U _ hTE_fT_QUAUTY_ iJO.
------------------D.0
R _ � � .
CDtiff-STRZTCT JZ D--JOISTfSEAX---a:0
A W E! • ! OUR CDVER-- U4 AR PET------------U--0
L E'TPtalAreaa A..- 192 Saw, 960 ! ! ODF'-TTPE---_ UT AB—E=AEFR-�N---7-0
T BUILDING DIMENSIONS 24 - BASE _ 24' . CE-TRIL7lT--- UT VERAGE---------`U -0
AS W4 N24. FMP N12 E16 S12 W16 ! " ! OUWATIUW7-- UT DUfTED-_CONC-----9T1:4 _
A .. BAS E40 S24. .. ------------
----------------------
-----NEIvEfHORH 6 5UAC HYARNT
--
L ! ! LAND TOTAL MARKET
! - PARC
EL 27200 - 799 00
*------------ -40-- - -----X
- -- ---- AREA 102000 657
VARIANCE -73 +12060
STANDARD 25 ,
V ..
" RESIDENTIAL PROPERTY "
14
AP7NO.1 . LOT NO.
FIRE DISTRICT SUMMARY'-
STREET. 6CI
Capt. Ellis Lane, Hyannis LAND r
". OWNER .
.. TOTAL"
RECORD OF TRANSFER DATE BK' ;PG I.R.S.' REMARKS: LAND QO s`l
Lot 7 D
.: � ..BLDGS.
TOTAL
78; LAND e BLDGS. �885'0
Z.S9.s®,
3 � �r..
TOTAL
/ 44" �9_ LAND- ::e
BLDGS. Bop 3
TOTAL
- - , LAND
Burt A1Fan`R. & Dawn, M. 2-24-81 3245 191 ($39,9
f i-:..r. BLDGS.
IEf{Ml � 3 CoM r/,/7ry rn
h�1NL-, /7�j /IJi TOTAL r
A�Iv S v 7�o d
� _ - LAND
BLDGS.
" TOTAL
LAND
i
BLDGS: _
�..,,
TOTAL
LAND
INTERIOR INSPECTED: . BLDGS.
TOTAL
.;DATE /Z//7/76
LAND
ACREAGE COMPUTATIONS 6.1 BLDGS.
TYPE # OF ACRES PRICE TOTAL DEPR.. VALUE - ^ TOTAL
1"HOUSE;LOT .op.p LAND
2CLEA RONT s BLDGS.'
is .z,.' .EAR .JIOO TOTAL
f�WOODS kSPROUT FRONT LAND
' t REAR _ BLDGS.
a
WASTE FRONT TOTAL - I
- REAR
LAND
OI BLDGS.
TOTAL
s,#• LAND'
BLDGS.
LOT COMPUTATIONS LAND FACTORS TOTAL
FRONT DEPTH STREET PRICE DEPTH % FRONT FT.PRICE TOTAL DEPR. COR. INF. VALUE HILLY TOWN SEWER LAND
i ROUGH TOWN WATER BLDGS.
I HIGH GRAVEL RD, TOTAL;
LOW DIRT RD. a LAND
SWAMPY NO RD. BLDGS.
- ^ _TOTAL
I TOWN OF BARNSTABLE, MASS. UNITED APPRAISALCO.;°i EAST HARTFORD.CONN.
tVonc.•,Walls•-- - 61, 1 rrn.osm[.Area oaw nuow i v Dase / t!� - �j �,.
_. .. .i... — BLDG.COST - -. � - � - f+ r
Conc.`Blk.Walls Bsmt.Rai.Room $t. Shower Bath Bsmt.
iConc.Slab ?' Bunt.Garage St. Shower Ext. PURCH. DATE
Walls' PURCH. PRICE. -
�Brick Walls _ Attic FI.&Stairs Toilet Room
. Roof RENT. - -,
lStooe Walls Fin.Attic` Two Fixt. Bath
Prer ti INTERIOR FINISH" Lavatory Extra Floors
jBsmt. A7 - 1 2 3 Sink -N—s u t --lbv . Lj n
r : Plaster Water Clo. Extra Attic1/21/4
I.EXTERIOR WALLS Knotty Pine Water Only /Z
.Double Siding, Plywood No Plumbing Bsmt. Fin.
Single Siding Plasterboard Int. Fin. (�
.W.p Shingles /0 TILING Q
Conc. Blk. G F P Bath FI. Heat
Face Brk:'On Int. Layout Bath FI.&Wains.
_ Auto Ht. Unit y- Z rz�Veneer Int.Int.Cond. Bath FI.&Walls Fireplace
tom. Brk'.On HEATING Toilet Rm. Fl.
Plumbing
Solid Com.Brk. Hot Air W Toilet Rm.FI. &Wains.
Tiling
I Steam Toilet Rm.Ft.&Walls qt7
181aoke;1 ✓ Hot Water St.Shower
RpofJn. Air Cond. Tub Area Total
Floor Furn. x
( ROOFING — COMPUTATIONS '
f Asph.Shingle Pipeless Furn. S.F. �9�y00
lWood Shingle No Heat S. F� 3 p
jAsbs. Shingle Oil Burner S.F. '
f Slate ..:. Coal Stoker S.F.
Trle It""�"cp Gas ✓ S.F. OUTBUILDINGS
ti 't ROOF TYPE Electric ,
IGable=: :1- Flat S.F. 1 2 3` 4 5 6 7 8 9 10 1 2 3 4 5 b. 71819110 MEASURED
Mansard FIREPLACES S.F. Pier Found. Floor 7-1 ,yyyi
jGambrel Fireplace Stack ✓ Wall Found. 0.H. Door
*' LISTED~
FLO RS Fireplace ✓
Sgle.Sdg. Roll Rooting
li f,Conc. LIGHTING '
Dble.Sdg. Shingle Roof
Earth No Elect. DATE
fP.na.yV Id Shingle Walls Plumbing
f.Hardwood ROOMS Cement Blk. Electric /Z
:Asph:.Tits, _ Bsmt. -1st TOTAL Brick Int. Finish PRICED
!Single 2nd 3rd FACTOR f 2—9��
+'' J REPLACEMENT o y2 7 e
#,. rOCCUPANCY CONSTRUCTION SIZE AREA CLASS AGE REMOD. CONO.' REPL. VAL. Phy.Dep. PHYS. VALUE Funct.DeP. ACTUAL VAL.
DWLG. �. F%M S;,.t�t3 F s .- if% E x: o - 3 . .4.8*1v-7 l
i .. .
s 5
k 6
I
—7
-I
.I
1,•r.-
tt ��.. TOTAL.:`,,