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HomeMy WebLinkAbout0140 DOLPHIN LANE (2) -- ' Town. of Barnstable Building Department 14 tq," Brian Florence, CBO Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.bamstable.ma.us Pre-application for Business Certificate '. Date b— U 2 Cj M Parcel _ Applicant Information Applicants Name rf 6 u w db L C r7 Z 6 C tj Zfj b Applicants Address Doje14% 1,r/1-Email Address Ca Ue S C6uA.dz,Cj Telephone Number q3 -7 O O 2. Listed Unlisted ❑ Business Information ° BUILDING DEPT. New Business? _____ ----_. Yes No Business is a registered corporation? Yes No JUN 18 2020 If yes Name of Corporation TOWN OF BAR � . S IAuLE Does business operate under the registered corporate-name? Yes No Is the business a sole proprietorship or home occupation? �U'`__"_ Yes.'' No If yes then a Home Occupation Registration,is required—See Building Division Staff Name of Business c l}L69 E,4 Business Address C) ol,!.'- Type of BusinessIU ��'�• ��'� y Buildin Com iSgsioner=fl6 e Only Co do - / �✓t Building CommissiotI2 Date Olt Clerk Office Use Only � J _ y Town of Barnstable Building Department �oF TOkt, Brian Florence,CB0 o� Building Commissioner aAxNSTME, _ 200 Main Street,Hyannis,MA 02601 163 www.town.barnstable.ma.us . �,,rFD N►P'��' Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: Permit#: HOME OCCUPATION RIGISTRATION Date: Name: C-P ro tjoCv�-0 L C 14Z- Phone M S702 ' 7E b 2 !� `4 b 2 6 Address: o f :ry z� r*vA-w SY 'Village;SA J2s'-t;k Name of Business: 6 c E a At,rL� rti Type of Business: -0- ' A2 ,' Map/Lot: U/ I INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discerm'ble from outside the dwelling:=there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater.pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust oT other particular .matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment • There are no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as'a business,the street address shall not be included. • No person shall Lbe employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and ee th the above restrictions for my home occupation I am registering. Applicant: Date: '_16 i OWN NX ro I SL 5� 44� 40- -7�. 7 7r ew IF w • iv- • r. v. iA,V 0-I Wl - 01 -y 4w to '�'y �.+I'•,. _ tea � � miff lk- F, �K r µ tea. o:��^.. ',\ � ,. �,..- '.t �''3i °°fit- G � ,... � � 4�• �� l'L M nhF d v- y r r , r aV r � �e r a r r gym„. r. .Y Ve r - ,� E .. 1 .� .� "• '} .an,a..p� *'i 'w» y4' • V '^ �. F 5 �V p � '°�� � r^ ",...JI.. yw i! i d s Y n. a M • r i�� T ✓ �t~ Pa lM as iVY a t � .v , r a 1- 0 DoC ihP- ne Hya7/24/1ns i �. .,. � r Cape Cod Court Reports Page 2 of 15 ' ,.r--re""""'�""::wwe�r� "' e'. ;.o,. - �ADALI aria,23 o D'olphm.Ln,_Hyannis,larceny over:$2_50 uttering'a false;check;forgery of check,May 3 ins v _ Barnstable.--Pretrial'conference-scheduled,-for July 25. AHART,Guy W,48,15 Brenton St;Dorchester;larceny over$250,June22 in Barnstable. Pretrial conference scheduled for July 21. According to police reports,Ahart placed ten items of clothing into a plastic bag at TJ Maxx, then attempted to leave without making payment. The store notified.police and Ahart was.arrested. JACKSON,Marjorie R,46,6 Bourne Bridge Approach(E Apt#14(sic),Buzzards Bay;two counts,larceny over $250,September 30 2010 in Sandwich. Dismissed. OBRIEN,Lawrence M,51,7 Circuit'West Rd,Yarmouth;assault with a dangerous weapon,a tomahawk, November 10 2010 in Yarmouth. Jury trial. Not guilty. VIERA,Russell, 20,32 Gen'l Patton Dr,Hyannis;Class B.drug possession,cocaine;June 22 in Barnstable. Pretrial conference scheduled for July 26. DISPOSITIONS MILLER,Melvin R,54,410 Bearse's.Way;Hyannis; Class B drug possessionVith intent to distribute,January 29 in Barnstable. Dismissed: ORLEANS DISTRICT COURT g June 24,2011 In court June 23,2011 ARRAIGNMENTS ADAMIAK,Edmund G,58,53 Nutmeg1nWorcester;OUI liquor,negligent.operatio*n,of a motor Vehicle,marked lanes violation June 23 in Dennis. Pretrial conference scheduled for July y. r BEAULIEU,Robert, 64,33 Church St,W.Dennis;larceny under$250,May 14 in Dennis. Pretrial conference scheduled for July 22. HOYT,Thatcher V, 19)211 New Canaan Rd,Wilton CT;-OUI liquor,negligent operation•of a motor vehicle,' marked lanes violation June 23 in Chatham. Pretrial conference scheduled for July 8. DISPOSITIONS HAMMER,Jennifer E,,26,169 Great Fields Rd,Brewster.possessing a counterfeit note;larceny under$250; uttering a counterfeit note,March 10 2010 in Dennis. All counts dismissed. MAHER,Christopher B, 60,29 Elinor Ln,W.Harwich;OUI liquor,-negligent operation of a motor vehicle,June 13 2010 in Harwich. Both:counts dismissed. Defendant discharged:' MARVELLE,Robert S, 58,98 Hathaway St;Wareham;larceny by check under$250,June 16 2010 in Harwich. Dismissed: . FALMOUTH DISTRICT COURT June 24,2011 In court June 23, 20i1 ARRAIGNMENTS X - http:Hwww.capecodtod4y.cbm/blogs/index.php/Court 6/24/2011 Town of Barnstable Regulatory Services S�P�esPosTq� Building Division AS 200 Main'Street PITNEY ROWS �. Hyannis, 'MA 02601 02 1A ` 0004606238 OCT 29 2010 MAILED FROM ZIP CODE 0 2 601 Theo Adalis 140 Dolphin Avenue Hyannis; MA 02601 stable R �A�esa0,9" . I yet 5- - PITNFV HOWES 02601 7008 3230 0002 5178 -3029 s 02 1 A $ 05.540 0004606238 5EP24 2010 ' MAILED.FROM ZIP CODE 02601 � . ;< - Theo dalis 140 D hinAve NIX - • Hyanni Ma , r 00 .16/26/10 TaUUg NDER UNABLE ;0. FoRj,)A1=3Ie1, DC'; II.�i: GJ�1Rr4jj�CY {3JC71 11jj :y�1� i4)—t17 +a}}*r.� -:2tt511- 3� i7r�c�f?10400 1�773"1t/12�1��til�itJlll.Iif�11tJ7iJJ�tlIJ7711�1 JYJ}�SIJI�Fii7 jUD m WIn1L`WMIT Er paw. .- � to !! ((A.Ls' m Postage $. . ./ Certified Ree 9� 0 Return Receipt Fee (Endorsement Required) S O Restricted Delivery Fee r-I (EndorsementRegWed). C Total Postage&Fees 9,5 'Sj Q Sent To � Imo- Street Apt No ] ------------- or PO Box No. State,ZIP+4 � , n ,1.6 :,, rr �t Certified Mail Provides: (es,anab)goo?aunf'009£w,oASd in A mailing receipt p A unique identifier for your mailpiece _ q A record of delivery kept by the Postal Service for two years Important Reminders: ® Certified Mail may ONLY be combined with First-Class Mail®or Priority Mali® to Certified Mail is not available for any class of international mail. a NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail !a For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is .required. is For an additional fee, delivery may be restricted to the addressee or addressee's authorized anent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". D If a postmark on the Certified Mail.receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. -IMPORTANT:Save this receipt and present it when making an inquiry. Internet access to delivery information is not available on mail addressed to APOs and FPOs. NAME OF OFFEN l - 4lAR ?0 r9 6 TOWN OF ADDRESS OF OFFEND ER_ C T pI'll-' B A RNS I ABLE CITY,STATE,ZIP CODE 1NE I - - MV/MB REGISTRATION NUMBER OFF SE y/�) (\' ! ,(�9 nAN\SIAXI.F..� / -'I.1 �.,.•s f,',' V f' V O Q MASS. ya' (rC� LLJ 1 NOTICE OF °° E OF 7wDLA(A.M. P. ON - 20 o TIpNOF ;I�y ���' w Q SIG AT E F EttFOR G ERS ENF IN DE T.1 BADGE NO W VIOLATION P o W OF TOWN 1 HE Y ACKNOWLEDGE RECEIPT OF CITATION X "' Unable to obtai n u of ff der ORDINANCE � 9 If �' THE NO FINE FOR THIS OFFENSE IS S �} ! LU � J Date mailed LL1.1 OR YOU HAVE THE FOLLOWING ALTERNATIVES WITH REGARD TO DISPOSITION'OF-THIS MATTER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL. w DISPOSITION WITH NO RESULTING CRIMINAL RECORD. to REGULATION (1)You may elect to pay the above fine,either by appearing in person between 8:30 A.M.and 4:00 P.M.,Monday through Friday,legal holidays excepted, w before:The Barnstable Clerk,200 Main Street,Hyannis,MA 02601,or by mailing a'check,money order or postal note to Barnstable Clerk,P.O.Box 2430, d Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. (2)It you desire to contest this matter in a noncriminal proceeding,yyou mayy do so by making written request to DISTRICT COURT DEPARTMENT,FIRST RNSTABLE DIVISION,COURT COMPOUND,MAIN STREET;BARNSTABLE,MA 02630,Attn:21 D Noncriminal Hearings and enclose a copy of this citation for hearing: (3)If you fail to pay.the above offense or to requests hearing within 21 days,or it you fail to appear for the hearing or to pay any fine determined at the hearing to be due,criminal complaint may be issued against you. ❑ I HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature t TOWN OF BARNSTABLE BUIL NG PERMIT APPLICATION Map a g Parcel 1 ?3,Y � Permit# - Health Division �' � s�Z"7� Date Issued Conservation Division l t" ,% Fee Tax Colle �d SEPTIC SYSTEM MUST BE, Treasur INSTALLED IN.CONJPlA{VCE Planning Dept. WM ENVIROHNIM, BODE AND Date Definitive Plan Approved by Planning Board TOWN REGULATIONS Historic-OKH Preservation/Hyannis " Project Street Address ,�o �0 Q6—J L Village ;Z; •,, ,.,�,� �� ' Owner v� Address Telephone ' t 0 r �� Permit Request � � �Sct�r✓vo rr�,v oa�c/ �t?irr S Square feet: 1 st floor: existing proposed �� 2nd floor:existing . proposed Total new . Estimated Project Cost eocyo y Zoning District Flood Plain -14 Groundwater Overlay Construction Type - Z Lot Size Grandfathered: ❑Yes ❑No If yes,attach supporting documentation. Dwelling Type: Single Family�wo Family ❑ Multi-Family(#units) Age of Existing Structure .3 Z Y-- -e 5 Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No r Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Fi ' hed Area(sq.ft.) - Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half: existing new Number of Bedrooms: isting new Total Room Count(not include baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air: .❑Yes ❑No Fireplaces: sting Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size ol:❑existing ❑new size Barn:❑existing. ❑new size Attaghed garage:❑existing ❑nevu She . 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 AIWAI-4,1 Telephone Number Address /Oc C License# (176 5 r Home Improvement Contractor# Worker's Compensation# G 75/ ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE _5 r_A7 r . t FOR OFFICIAL�USE ONLY _ z PERMIT NO. � DATE ISSUED - rt MAP/PARCEL NO. r ADDRESS r i VILLAGE OWNER i r � i ' i 3♦ _ r• f DATE OF INSPECTION: FOUNDATION -- FRAME INSULATION i FIREPLACE ELECTRICAL: ROUGH FINAL03 PLUMBING: ROUG FINAL - .. GAS: ROUG ', FINAL'fn i Vc FINAL BUILDING �, t DATE CLOSED OUT N .:. _ r, ASSOCIATION PLAN NO.rn A 7 WE r� The Town of Barnstable 9�awa0 . Department of Health Safety and Environmental Services TEo '' Building Division . • 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 ` Building Commissioner For office use only Permit no. Date , AFFIDAVIT t ` 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. Type of Work: Est.Cost 4e 600 Address of Work: ^�® ©1'a�4 Owner's Name /,4,/ hlyww— -,Vo Date of Permit Application: I hereby certify that: Registration isnot required for the following reason(s): Work excluded by law Job under S1,000. 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 the agent of the owner. Date Contractor Name Registration No. OR Date Owner's Name . __ -- - _- 1 X STANDARD LEGEND _ --- --- note:roluD symbds MD Spam aiumop L 6 ® GOIJ COURSE FAIRWAY �//� -,---- o DEODUOUSTREES P 26 8 ED6E OF BRUSH \ / F.^J OROIARD OR NURSERY MAP--- -68 # 150 EAXURSHAEROUS TREES MARSH AREA `� EOGEOFWATER E---DRIVEWAYS I PAP.gN6 LOi 151 aD RS Q-' MA 8 DITOIE$ -sT- PATH/TRAIL -1 PBoeEmruxEs �,E—�PaRQiNUMBER Y 9 O<�H01 NUMBER �-- 2 FOOT CONTOUR LINE # 221 ,. TO FOOT aRTroLIRuxE SPOT ELEVAMN STONE WALL FENCE MAP 8 x RETAINING WALL �� - --- -- - - RMLROADTRACKS SIONEJETTY ! � �.' SYYUNMX6 POOL 268 , � � -• POR01/DEER r V- BUIWM/SERUMR.ES 140 �{/ • F44i DOER/PIER/JETTY ------ t ��----X� L[ ASSESSDRSNAPBOUNDART 141 � T o POST so FVBOI O ® $IDP IMI IR 0 PDH o N AYER X3 d UBHf o EUt�AOE - - � MAP 268 SITE MAP I / \ -SCALE: in% SYSTEMS UNIT \\�///)Aj S E:1. feet T.O.B.6E MAP 68 # 13 0 20 - 40 1 INCH=40 FEET ' MA 268-- 4Q W E 2 # 130 ODYXxfl IxPPL6 OHODA�IRI�x II%fI9®AFWxdNA�1 x,D�9x-SO9x5Fo9 LY 7 51 131 _ __- _ " " -- - AIXNONSFNOIOftAxHM,•=eOR.EWNNIPI�NI•_tW. PAxD.0AA0xIi®FXW 1'mIW pB�X6M5�OBYAK I99T. 'RDANIREOMI'a IOO.AmlRlp'OFNIP519011EDATA NflQBII Isifemaps%public1m268p173.dgn May.27,1999 11:39:14 HOME IMPROVEMENT—CONTRACTOR . f Registration (125168-=-cj TYPO PRIVATE CORPORATION i Explratlon 10/21/99 .PATIO ROOMS OF BOSTON INC �- ANDREW MALONE r ' 1Fe�RoT, "/OTTS ST ADMIMSTMTOR : NORTHBOROUGH NA 0.1532 . (T; �1 r��f7 f001JJ»rA»rCfrfl�//1 r� •/(`rJJ/lr•�uJr•//1 - OEPARINENT OF PUOttf SArE1y f I CONSTRUCTION SUPERVISOR tICFN;E Number: Expires: •�`. Restricted ANA(W T•.NAtONF r r 11 uASHINGION'ST Ar► ;:�1.... :; �'��:e..:'NAIICK•_ MA Rf1f.P: .. � - ter:: ... - .• - - p# r iv f,? %i' { 9'd' 171C(C0111/11O/1 ove(tith oI tl,fi SS(1(.•!r((S/ills i• rc Ft a I f` ��+ �'t'�,ti111 :L � �Je /)rr1JllPl/11l!/11 t)f.�ll(llLf/ff(I(.'ICCfL�rlllS �' +'t`�;' � y< S Irk 0111ce o/lnvesUgal/ohs r , t } .,�•''^_��7�Cz— %=� 60/1 [Vusltiltwon S(ro f } w }4 �r, , filar t g : =•� Boston, Mass. 01111 r fig AM �{ r t Ltl•.'•'" f, Workers' Compensation Insurance Affidavit j y /`tsy�Geza Ue— V + F � ,,,���'�fasttl.on /GYM. 6 ` �-�•�'`� '',. ;1�3k,� K'r �a, J4r/` Nl!!'���%r1/tf / i�i4 O ���Z ^hone .Safes 393—CTYGa a �a°Y'' ZIS, 1atn .homeowner performing all ' ork,myself. ?='e sole pi�oorietor and have no one working in any capicirl rmplover providing workers' compensation for my employees working on -his job. nany name. �oa- 5 �D�S'Eo'�/ o i c � 'S - r f t {•t i 4 F r�," '3�ItsiL. /06 c�� -� _ lJ� i, <'�,2s :Ire+ur�nt:e co `T�i�''��a�U � '7oiicy,� c.�V—� J�C�� � L�5 Q7S�•[ 'F tf: l>artl a sole proprietor;general contractor,or homeowner(circle one) and have hired:he contractors listed below,who.hav- ;f 7 �};5, a�4 EEte following workers',compensadon polices: a `h S.ODjganv name• r , U. ddrets, a L ;�•(,r r 5 `aiY ,}ingur1nr!Co. policy 3 INit :3 y r �,F�� rs�,f L4�1tt3.nv n•tme• _ _ i { � ' � e- i k v t 5 phone 1• - —`s� �ass. e�rk ar Z L a a�'"fnSk[arice go, nolifY ,� ynZt'tAcb-,idat ooA1 Acit if iicmarr idur!to.lecurt eovera!e at required under Section _SA of.%IGL IS-can lead to the impontios of tnminal penalties off(tat op to S 130t1.00 and/or stillensifirs �•�34 tf fhif ffattmen ma: he for-ardcivadr o nt OrTeehoff Inin tSiont�OPofthe�OROK ORDER enge�Cnfi�SioOn�a dav,a�aieul me. t uedenned leer� x' S sa y dal�i r3 f Y 1 Jo!►arfby certtft•under the paint and penalties of perjun•that the irr!ormarion provided above it(rut and correctNP , o Yd ^ r sF FAR etc p ' t Fir r ('►lnf rtArTle � �ljr/- '`J1�i�COti� ` Phone Sa tr +� %Klw Sj+ .i _ St r1y y�. IIr 11l me+)"I%.r do sim itrlte In thi!Jrea IJ be tOmpleted by city Ur town ofPcl]l i t xYr 5 r L3 Y 5� y urmlvliccn+c t Siff Orpartmcnl f; CLlcenttnt BoardOfne Heil,f immrdrtlt re%lurntt 14 required y ❑ (]lltallh Dtpartmenl- '• {r ,� ' it ii�f�Y S+ry }„ �L4' � � .1r._� -- �• - •nOthtf. - .; •�+�„ � 'St'�°11�'�� O ,YO, a ORViS b UP, (CMS ti .. e� to �ng� �o ie 80 1VI" e` action. . i �,a The Massachusetts State Building Code (780 CMR) includes provisions to ensure that houses and house additions meet energy efficiency standards. This supplemental CONSUMER INFORMATION FORM is to be filed as part of the building permit application when a builder/contractor or homeowner, constructing/installing a house addition with very large percentage of glass to opaque wall, seeks to utilize a special energy conservation exemption option for "sunroom" additions to an existing house (780 CMR, Appendix J, Section J 1.1.2.3.1). This FORM is not intended to prevent a homeowner from selecting a "sunroom"of any size, configuration, orientation, form of construction'or percent glazing, but rather is only intended to assist homeowners in becoming aware of some of the important energy conservation and year- round comfort considerations involved in selecting and utilizing a"sunroom"addition. The connection of "sunroom" structures' to residential buildings may create comfort and energy consumption issues due to uncontrolled solar gain or uncontrolled radiation cooling of the main house. In the selection and construction/installation of"sunrooms", included below is a non-required, open-ended list of product and design considerations that a homeowner may wish to consider before. actually constructing/installing a "sunroom". It is recommended that consumers carefully review these options with their designer, builder, or contractor, in order to minimize potential energy consumption and/or house discomfort issues. In addition, the qualifications and reputation of the company or individuals to be hired are important considerations. PRODUCT AND DESIGN CONSIDERATIONS RELATED TO"SUNROOMS" • Solar Orientation and Natural Shading . • Type of Glazing - • Insulating value • Solar heat gain • Frame materials • Glazing to frame sealing and gasketing materialsfseal durability and/or weather tightness of the sunroom • Adequate ventilation-Operable windows and fans • Applied Shading Systems • Insulation level in floors,walls,and ceilings • Possible Sunroom isolation from the main house via a wall and/or door or slider • Heating and Cooling Methods: Efficiency,Zoning and Controls Homeowner Acknowledgment The Massachusetts State Building Code, Section J1.1.2.3.1, requires that the actual property owner(not the owner's agent or representative)acknowledge receipt of this CONSUMER INFORMATION FORIA prior to issuance of a Building Permit for a project that includes "sunroom" additions to an existing residential building. In accordance with this requirement, the undersigned hereby acknowledges that she/he has read the information in this document concerning sunroom comfort and energy conservation. Signature of Actual Building Owner Date Print Name Address of Permitted roject Owner Address(if different than project location) Owner's telephone number d �tiautoT1 - s ...., .. ,a..� .. w, Exception:Sunroom Additions/Consumer Notification: Sunrooms; as defined in 780 CMR ' Appendix J2o0 DBFINITION%'shall be exempt from the c6md Lance°requirements set forth in 780 CMR J 1.1.2.3.1 and J 1.1.3 provided thii,e'a tuatl rope y owner(not the owner's agent or representative)of the smaure onto which the sunroom addition is being made,provides a signed copy of the Sunroom"CONSUMER NFORMATION FORM"(found in 780 CMR,Appendix B) to the Building Department. This signed"CONSUMER INFORMATION FORM" shall be submitted to the building official as a requirement of building permit issuance,and shall remain as part of the construction documents. If such sunroom additions are separated from the main house by a wall and are conditioned spaces,then a readily accessible manual or automatic means shall be provided to partially restrict or shut off the heating and/or cooling input to the sunroom addition space. That portion of a wall that separates the sunroom addition from the existing building/dwelling unit, if an existing exterior wall, shall be allowed to remain and neither that portion of said wall or any fenestration within said portion and common to the sunroom addition, need comply with the thermal envelope requirements of Appendix J. ri t0 D Se: pro, a as yno 0 780 CMR J2.0 DEFINITIONS SUNROOM: An addition to an existing building/dwelling unit where the total area(rough opening or unit dimensions)of glazed fenestration products of said addition exceeds 40%of the combined gross wall and ceiling area of the addition. �► ,�aft�► o e, n �o,��,�, . �mme�at� S" O O n •' t R t k 7 Y ( six .. w .. .� 1 •#-... •t. i r = . Property Owner Must Complete and Sign This Section If Using a Builder - Y I (�t,tAA A-) J A&O .IL h n,I L �A9 N��, as Ow�—r of th, bject property f 7 '= hereby authorize A T' CA.,f i 0-fus �_ '� on my behalf, in all matters relative to work authorize by this building perrrut application for (address of job) �'�. � 9AT TDB OA l ue.� Mic n11t11 (� Zt,d/ Signature of Owner Date ` F W = , Owner or.-Builder(as Agent of Owner) Must Complete and Sign This Section as Owner/Authorized Agent hereby declare that the statements andifor ation n the foregoing application for � (address of job) Acts 6' `s are true and accurate, to the best of my knowledge and belief. rFA3AF tt�C , a ' Signed under the pains and penalties of perjury: ' n #� p Print Name t ri ' tr Date 1' VN ;Signature of Owner/Agent n { .; A TYPICAL OPENING EXISTING o n HOUSE WALL 12 o W (n 1 F� (n =IA VI Z 2 �7 4 a i o- h� n � n 3" SEE NOTE 3 A SEE NOTE 3 3" 5TUDI0 ROOM FLOOR PLAN RAIN GUTTER _ ALUM. PANEL HANGER CONNECTS TO WALL STUDS EXISTING J HOUSE Q U ALUM. SLIDWG DOOR Q. TEMPERED GLASS co SLIDING DOOR ON SILL 4" CONC. SLAB W/ SECTION W/ DOOR FLOOR EXPANDER FIXED TO CONC. 6x6xW2.9xW2.9 TYPICAL EXP. JOINT FLOOR . APPROX. GRADE 8" THICK POURED CONC. FTG. decl yo%rJ BOTTOM OF FOOTING TO REST ON - - UNDISTURBED SOIL BELOW FROST LINE . • 1 5TUD10 ROOM 5ECTION A-A(CONCRETE FLOOR) .l SEE NOTES ON F AGE 5.0.2 Betterliving P A T 1 0 R 0 0 M 3 studio4a-f2.dwg studlo4b.dwg enp11 u-�''``2++ EV T05.1 7 ,�� A- th,; v'• 4.2 ...- ALUM. ROOF MOUNTING RAIL CONNECT TO RAFTERS RAIN CUTTER ALUM. SLIDING DOOR TEMPERED CLASS .1/4- EXTERIOR PLYWOOD ' iO 2.10' JOISTS AT Ifi' I SLIDING DOOR ON ;ILL O lid, . DLOCKING PIECES AS SECTION W/ DOOR FLOUR I EOUIREO FOR ATTACINMENT EXPANDER FIXED 10 DECK i- F ROOM TO DECK AS PfQ ANUFACTURE•S SPECIFR...IONS FLOOR __ 2K10' O) 200" GIRDER TYPICAL BRIDGING ��•4� PRESSURE TREAT � 2E.1U LEDGER W JOIST HANGERS - AT MIDSPAN SECURE TO HOUSE-WALL TYPI6AL E[I POST TECO POST ANCHOR BASE . II^O MAX. CONC. FOOTING BOTTOM OF FOOTING To REST ON UNDISTURBED SOIL DCLOW FROST LINE t' '• '• STUDIO ROOM 5ECTION A-A(WOOD FLOOR) NOTES FOR FIGURE 50-1 AND 50-2 1) STRUCTURAL MEMDER5 SHALL COMPRI5E6063T6 ALUM INUMEXTRUSIONS SUPPLIED BYCRAFT-131LT MANUFACTURING COMPANY 2) -ROOF PANELS SHALL CON515TOF CARDBOARD HONEYCOMB(HC)OR EXPANDED POLY5TYRENE(EP5)PANELS SUPPLIED DYCRAFT 13ILTMANUFACTURINGCOMPANY. 3) MAXIMUM SPANS OVER DOORS SHALL 13E 67'. 4) ROOF PANELS SHALL HAVE A MINIMUM FACTOR OF SAFETY OF 2.5 AND SHALL DEFLECT LE55 THAN 5PAN/120 AT THE DESIGN LOAD. 5) ALL 5TRUCTURE5 SHALL 13E IN5TALLED ACCORDING TO THE MANUFACTURE'5 COMPANY RECOMMENDATIONS. 6) LOAI2IN�S: ROOF: SNOW LOAD 35 P5F WIND LOAD 20 P5F DEAD LOAD 2 P5F WALL: WIND LOAD 20 P5F DECK: LIVE LOAD 40 P5F ESTIMATED DEAD LOAD 10 PSF 7) UMBERDE5IG.N_5ff-5-5-E : SPECIES SOUTHERN PINE NO.2 BENDING 5TRE55 Fb 1400 P51 (REPETITIVE) COMPRE55ION PERPENDICULAR TO GRAIN Fc 565 P51 5HEAR PARALLEL TO GRAIN Fv 90 P51 COMPRESSION PARALLEL TO GRAIN Fc 975 P51 MODULUS OF ELASTICITY E 1,600,000 P51 ALL TIMBER SHALL BE PRE55UKE TREATED 8) -501LB-EARING_CAPA_CLTY- FOOTINGS SHOULD RE5TON 501L HAVING A MINIMUM BEARING CAPACITY OF 2000 P5F. FOOTINGS SHALL 13E LOCATED BELOW FR05TLINE.FOOTINGS SHALL 13E 51ZED ACCORDING TO THE APPLIED LOAD AND LOCAL 501L DEARINGCAPACITY.CON ETE f ' 15 TO HAVE A•MINIM TH OF 3000 PSI AT28 DAY5. Betterliving F A T 1 0 IT 0 M s sludlo4c.dwg eng*nsostv-i �t t Engineering Dept. (3rd floor) Map a C, 8 Parcel ("13 1-;7 J5^ Permit# d3,-q 73 House# d qdJ Date Issued 4 7 Board of Health(3rd floor)-(8:15 -9.:30/1:00-4:3 4 4 e Conservation Office.(4th floor)(8:30'- 9:30/1:00-2:00) r1� t�' Planning Dept. (1st floor/School Admin. Bldg.) SEA'TIC ����WE 7°ALLED NE Definitive P n A oved by Planning Board 19 WI.I.w�T ENVIRONMENTTD TOWN OF BARNSTABR N REG .. rr Building Permit A plication - Project Street-Address ry l�?' Village /L Owner w Address Telephone Permit Request �d�'L �'�e/La1 Owl qn, 15�ro 3 eocm5 fr) ead 0 ti e First Floor 4 0 i lare feet Second Floor square feet Construction Type Woq ): �t Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure a,S� Historic House ❑Yes ko On Old King's Highway ❑Yes �No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other . So✓✓av� Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No. of Bedrooms: Existing vF' New 6 Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas O-Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑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 Telephone Number Address License# Home Improvement Contractor# Worker's Compensation#W G 3 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING, S WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO VS (i Se 2I * e s 4 ►� �, ► e SIGNATURE DATE BUILDING PERMIT DENIED OR E_FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED - MAP/PARCEL NO. ' ADDRESS VILLAGE '' OWNER F DATE OF INSPECTION: FOUNDATION• FRAME �� 7 F INSULATION FIREPLACE ELECTRICAL: ROUGH; � FINAL PLUMBING: FINAL 1 GAS: :IQU'LiI FINAL r + � l y FINAL BUILDING. x: DATE CLOSED OUT;i- k l ASSOCIATION PLAN NO. Xt i , � �� �� `'=gym~�� / ,�•��/►� �.r.���r',r-' � �+ - , �� • 'I� jl, � � /�1 ♦ t . � Bap, � ��'�'.'�� � ��`'�; • ��r �t ♦ �1 ..• ♦ �� � `�. .�' 6 ► : �� - �, . it war ► 1/ ',• •+ � • ,. ,. ��I � � �l _ � ,� �� ��`��•��.�` �'�—�_ : � � Imo'.;�''`�,��� I ��I� !��. ♦ •�1 �'�5�� �r .�; �• • � �I � �I � '8� �i� i� his �: .�C>� � � ,�.��,,�,�; t r. ter+ 9 � � � •aI�= � - �1/ - �w,..i/;� �i� ~�• , � �, _r_.r.._ .., , � •� �..� it 1 � '• e ,� r � �� �. PLOT PLAN FOR LOT # Indicate location of garage or accessory building Additions with dashed lines -------------------- Sewerage disposal (cesspool) Well I I 1 (lot. . . /-0---0- . . ... . . .ft. rear) I A uttor s Abuttor s Name Name Lot # I Lot # REAR YARD If this is a If this IScorner lot, . . . . . . . . corner lo- write in name write in of street. name of other b street. SIDE YARD • HOUSE S YARD/ I ~ : SET BACK : . ., � o ( 19 (lot.. . . . ,f l,U . . . . . .ft. frontage) \ / (NAME OF STREET) / �\ Information �� / \ Supplied by MARK NORTH POINT Assessor's map and lot number �a � ......... '4"�. SEPTIC SYSTEM MUSTS of THE rot♦ g . . �.�.}�- -✓..0�; BoR�NSTALLED IN COMPLIA o�Sewage Permit number Q�.:C..�xw.... / House number .. �� WITH TITLE 5 Z BARNSTABLE, ENVIRONMENTAL CODE "6 a TOWN REGULATIONS amid TOWN OF BARNSTABLE BUILDING INSPEC APPLICATION FOR PERMIT TO .................. ................. . .. ...................................................................... TYPEOF CONSTRUCTION ........................................................................................:............................................ �. ) .r� .........("-.)...........19 TO THE INSPECTOR OF BUILDINGS: The undersigned herebyhereby applies for a permit according to _the following information: Location Jrrr f...i:t' -3 !.........�OL hLi-) .Lane......I.00sl............ Ql»�5P-"+ p .. .. . . .. ......... ... ProposedUse .Lm .......'i. ao.1...................................................................................................... Zoning DistrictG-. .... .. .. �a.r�.n. . S...PbYFire District ...� 0.1'�Y�LS .:............................................................. Name of Owne ,QG.U..1 ,2... ......... a-`�tSM lV...Address ........................... T..��( �5 p6ot Name of Builder4J �. ��C1EP,I ��s �a uSE Rd � ClY ott O Address Q.:.... .......................... . ............................................ . . e.r�F� .... Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ..................................................................Foundation ............................................................................... Exierior ....................................................................................Roofing .................................................................................... Floors ......................................................................................Interior .................................................. ................................... Heating ..................................................................................Plumbing gg Fireplace ..................................................................................Approximate Cost ........ .. ®�......................................... Definitive Plan Approved by Planning Board ---------------____------------19________. Area .......................................... Diagram of Lot and Building with Dimensions Fee ........./.0............................ SUBJECT TO APPROVAL OF BOARD OF HEALTH N1 `e h'GYDir/G S fTP Ti G Tra2 H/< O � � Ile as a- I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name.. . ... ... .......................................... ` PRUSS14AN, CALVIN J. ' r� 1 Y _ 1 No .2.2.24.8... Permit for ....ZK.iV• t;e............. 4. Swi?lln?ilg...P.a0.J P.00.1................................... .Location ... ...Dolphin...I..ara,e ...............We.,9t,...0 anal.sport...................... -- Owner Sc IVAII...J......PX:U.9SS.ICan................ e of Construction ...... ............... .. �' - �J •' . 4;4. . _~ 2 � �.r'� Type ...................... - I ................................................................................ Plot ............................ Lot ................................ Permit Granted ......June 5,................19 80 M.r� Date of Inspection .......................... .....19 Date Completed . ?.....19W i $ PERMIT REFUSED M.. .................... ... �" . 19 ............................................. .. Cr .��.�^.. ............. ..................................................... y-� � �••� � - 'yam APpfbJecl ................................................ 19 ............................................................................... _ ............................................................................;.. _ The Cminitunit•callll Uf Afassacltutictts Deparinzent ojludustrial. • 4cciflents A � lin Office affilzestlgallons _'; h tJlhington Street ' � ` •':,-'• Busttr»..lfass. (1?lll Workers' Compensation Insurance Affidavit , tirilicant information•• PliFie PRINT Ie�• ly"�""T'�—•"`�—•" —" ""� ' m (! /U e— pt nhnne# / L0—U T I am a homeowner performin_ ail work myself. f I I am a sole proprietor and have no one working_ in any capacity I am an emplover providing workers' compensation for m}'employees working on this job. rnm tam• name: 7M. EInP� addrecc• NQ�- � � ' cin' N I hone#• incurnnce co °fit 0.N1 1 �t�iict # ��C ���� �� 740 G 1 am a sole proprietor. general contractor. or homeowner(circie otre) and have hired the contractors listed below who have the following workers compensation polices: companv nntnc• nddrecc- - shone tt• incur tort rn policy# ��r.�+r+`��^• � - - ' - � � -fir.-' ...��� cnnlnany n-itnr- ;tddrecr itv phone#• ncurnnee co policy a Wach additianai sheet if necessar �-�� may. ___ _••r. •i• '++..+.• ...�.w: :�...m"' allure tit secure coveriec as required under Scetion Z5A of 11IGL 152 can lead to the imposition of criminal penalties ot•a line up to 51500.00 andiur nc cars'imprisonment:t.% ell:ts civil penalties in the form of a STOP WORK ORDER and a tine of 5100.00 a day against me. I understand that a opy of this statement mac be forivarded to the Office of Investigations of the DIA for coverage verification. rto hereht•cerrif•tinder the pains and pcttal'ies ojperjurr Ilia'ME information prorided above is true and correct. _raturc Datc 'rint name T AO ��y��/.l��/ Phone ��•�J-� official use unit do not write in this area to be completed by city or town olTcial '• R�City or tmrn�-.=.,. permit/license# i"'tl3uiiding Department C3Uccnsing Hoard L. check if immediate response is required 05electmen's Office ► C3I1ealth Department contact person: phone#• nUther_� i. Information and Instructions Massachutictts General Laws chapter 152 section __ requires all employers to provide workers' compensation for 1 .em loyees As c from tile fro the "la++". an etnplgree is defined as every person in the service of another under an, P contract of hire, express or implied. oral or written. An emplt rer is defined as all individual, partnership, association. corporation or other legal entity. or anv two or thc ''orcgoina cn-gaged in a.joint enterprise,and including: the le al representatives of a deceased employer, or the receia•er or inistce of an individual , partnership. association or other legal,entity, employing employees. Howeve owner of a dwelling house having not more than three apartments and who resides therein. or the occupant of the dwcllin`_ house of another who employs persons to do maintenance , construction or repair work on such dwellings- or on the ;,_rounds or buiiding appurtenant thereto shall not because of such employment be deemed to be an empi, MGL chapter 152 section _5 also states that cvcn•state or,local,licensing agency shall withhold the issuance o. 1 l renewal of a license or permit to operate a business or to construct buildings in the commonwealth for anv applicant who lies not produced acceptable evidence of compliance with the in coverage required. Additionally. nc'ithcr'tl,texcohiniol wealth nor any of its political subdivisions shall enter into any contract for the performance of public work tintii`acceptable evidence of compliance with the insurance requkements of this chart been presented to.the contracting authority. > i Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation ai 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. lire 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 requ: to obtain a Nvorkers' compensation police. 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 botton the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. I be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be return, the Department by mail or FAX unless other arrangements have been made. Tiie Office of Investigations would like to thank you in advance for;you cooperation and should you have any quest please do not hesitate to Live 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 fax #: (617) 727-7749 Phone #: (617) 727-4900 ext. 406, 409 or.375 dFTMe rq� The Town of Barnstable KAM• e�sreac� • �0�' Department of Health Safety and Environmental Services Eo g. Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner t For office use only Permit no. { t Date F 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. Y Type of Work: Q41r 0 4�eWIA-I d n/ Est.Cost 10 Address of Work:— Owner's Name Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. 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 the agent of the owner. r� Awe/ Date Contractor Ame Registration No. OR n.�o Owner's Name J Assessor's map and lot number ......l. .g f..j Ali TH E T0� Sewage Permit number ...!► .:-ts.<.;.. r 4.,..... �. ,% ...!..�l5/Bv R'>' d�P R .yam Z 33AHB3TSIILE, i House number � / � ' .............................................................. MAM •gyp 0}q• TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ................. :5. . TYPEOF CONSTRUCTION ........................................................................................................./............................ (��(.La�, �.........(.! ..........19 .J TO THE INSPECTOR OF BUILDINGS: I The undersigned hereby applies for a permit 'according to the following information: i Location ..t:- ....�...3...J......... ~ (3 .��.hL ..... Ct.( ) .......t l)G Sj.....4oc( j-,)'i. ..... d... ....... Proposed Use ...ti a L ;�,(.ry (}^j 1 .. ... r.l.�. ......r ...................... ............ ................ ..... ..... Zoning District J. fir? ).611`� t;L.tFire District .j� .. Name of Owne fl.C. &Z-5.`3f?�� .Address lr� ��:.... AJ.��. . ........................................... Name of Builders.. .—O?h%?............ .. J !„/) f�E .....AddressG1Y" (Y?UtC-� h'/�V �T . ....��....k�lJ.:..f ... ......... ) Nameof Architect ...................:..............................................Address .................................................................................... Numberof Rooms ............N.....................................................Foundation ....................................................:.......................... Exterior ....................................................................................Roofing ..................................................................................... Floors ......................................................................................Interior .................................................................................... Heating ..................................................................................Plumbing .................................................................................. Fireplace ...................................... ........................................Approximate Cost .......4..`a l ..w;{.... ................................... Definitive Plan Approved by Planning Board ________________________________19--------. Area .......................................... Diagram of Lot and Building with .Dimensions Fee ........... .................. t SUBJECT TO APPROVAL OF BOARD OF HEALTH f J r A h'�vs I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ::::' ....: .:'Iju1,-1................ �.- a "..�.....r..__. --....>: .....±,::. A.�,..u,., v.u....r:.... i.:.. ._.•....�....:- . r - -7 3 PRUSSMAN, CALVii-i J1.' A=2Z248 No -2.2-248... Permit for Swimmincr..........Pool ................................. ................................... Location W;....U.�.t....14.9...P91Ptiin..Lane .... ........ ...............West...Hva.n.ni.spqK:�..................... ..... .. .. ...... .. .... .. Owner ..Calvin...J.,.....P.r.us.sma.n................ .... .. .. . .. .. .. .. .... ....... .. Type of Construction .......................................... .......................................N..................................... Plot ............................ vlo t ................................ Permit Granted .. ....June...5.................19 80 Date of Inspect-on ....................................19 Date Completed ......................................19 PERMIT REFUSED .................. ................. .... ..........r....... 19 6�11A) -................I.... .............. ..... . ............ . .. ........ fs.. ......... ................................... . .............. .................... .......... ......................... .. ... ......... ............... .......................... ....... ......... Approve ................ ............ ... .... ... 19 ....................................................... ....................... .......................................................... .................... �Iie r�om�nonuira/,pE�./l?!aau�c�iu,re!/a HOME IMPROVEMENT CONTRACTOR Registration 101014 Type - PRIVATE CORPORATION Gg Expiration 06/24/98 CAPE COD HOME IMPROVEMENT SPE Bert A. Madaughlin ADMINISTRATOR Iyanough Road Hyannis MA 02601 ° ✓!LC �0�I77/l77,0�YI.II1CQtiUt d�.i%/(.2JJ2CJ2LL.IB�J I � _ - DEPARTMENT OF PUBLIC SAFETY j CONSTRUCTION SUPERVISOR LICENSE Number: - Expires: ` Restricted To:.• 08 ROBERT R NACLAUGHLIN 25 HARVARD ST S YARMOOTh. MA 02664 ' GRANITE STATE INSURANCE COMPANY 13102 71109 SEND CoRitzvommAKSW 1-34-6o AMERICAN INTERNATIONAL CO. P.O.BOX 409 PARSIPPANY, NJ 070544409 HOME IMPROVEMENT SPECIALISTS OF CAPE COD I Nt PRONE: 1-�'64s-2259 . 25 I YANOUGH ROAD Member Consnies of HYANNIS MA 02601-0000 y Americarftntemational Group KKKUTM ORICES: L0+/ 70 MNE MEET. NEW YORK,N.Y. 10270 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ROGERS b GRAY INSURANCE AGENCY INFORMATION PAGE P 0 BOX 1601 434 ROUTE 134 SOUTH DENNIS INSURED IS MA 02660 CORPORATION OTHER WORKpuCE8 NOT SHOWN ABOVE PREVIOUS POLICY NUMBER NEW miM= POLICY PEI1100 12:41 A.M.standard time at the insured-s mailing 41"ress MIN A. Workers Com FWM 07/02/97 To 07/02/98 Wnsatlon Insurance: Part Ono of the policy applies to the Worker Compensation states listed here: Law of the MA �. Employer Uabllity Insurance: ►art Two of the The limits of our liabilityunder pOiity applies to the work In each State listed in item 3 A. , Met Two an: Bodily Injury by Accident S 100 000 SubBodily Injury by Disease a S00 000 Uddent Bodily Injury by Disease a 100 000 � limit C. Other States insurance: Part Three of the employee SEE ENDORSEMENT WC 20 03 06A Policy applies to the states, it any, listed hen: 1f"a The premium for this 7 All Information policy will be determined by our Manuals of Rules, ClassHicatlons, Rates and Rating Plans. required below Is sub subject to verification and change by audit. Classifications Estimated Total Rale Pe► Estimated Code Number mm Ramunersti N00 W M, .�fta1111Y111 27,� � P t f ° S M rc- V►kiY L 5t o 1 Ufa { /L7 F,(- ZKL p.T. SoIS'S i4' a.�, i�- Z1�(P i21C, IIJ k ti i tNome Improvement specialists of Cope Cod r� SCALE ° APPROVED BY DRAWN BY DATE' �I18 o I�"� �...�"'� 1 �,� !�• �u. �'{��..� ��}^„s�� OMYYING N'JAABf� a l NEW ENGLAND REPROGRAPHICS&SUPPL Y CO ��� alp ��tDt��y S•� ��, i� ��t>,Ge �1= `,� \ � � :17 rw . ..... we'w 414i 1 1 r_ i r s I � �Jta� Sa2lSt�i i }! IZ JP - \ / t--�-- -- -- K i � _..__.._ __ . —..L.___.____._._._�.._____________ � 6 X t S T 2►•.i asx�:�i.- ►�c Li 14 Ila t �R I i e � � _ ------. � _____ l Z !;to� ,•-i 1 v N � �� �_ k Home - improvement ►z� = i 2i1 ` �� at r Specialists of Cape Cod LE 'mil �Liz—AT (�- ..� 1 1� C. V `y I SCALE APPROVED BY ORAMNI BY x . DATE<S .5 KEvIF.1 K41-R4C t, ! 140 � 1 tom, �{�4t�u; 7 onAwa+c3