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HomeMy WebLinkAbout0244 GREENWOOD AVENUE �Y�� �7`�I�c10a� 7�d� - — --- _ _ --- - 'i �, Town of Barnstable TOWN O �, �: ALE ,oFTHE> � Regulatory Services FN, , ' - Thomas F.Geiler,Director52 B"RHAS& " Building Division 1634• �� a Tom Perry,Building Commissioner 200 Main Street, Hyannis;MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 _ Fax: 508-790-6230 PERMIT#0 d 110, Z J I FEE: SHED REGISTRATION 120 square feet or less Zyd Location of shed d ess) Vi ag lb Property owner's name U, Telephone number f -` Size of Shed Map/Parcel# ig a Date Hyannis Main Street Waterfront Historic bistrict? Y - Old King's Highway Historic District Commission jurisdiction?: k. Conservation Commission(signature is_required) Sign off hours for Conservation 8a00=9 3"0T&=3 30=4:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A.REVIEW PROCESS AND APPLICATION FEE. PLEASE SEETHE APPROPRIATE COMMISSION FOR DETAILS, THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN` Q-forms-shedreg . REV:042506 .daft V Y! + it Town of Barnstable Geographic Information System March 11,2011 ? y° #88104 217 �d t� �288175 288172 #224 #35 / A' f 288171 #45 f w 288168001 #54 ' 288103 »a ' #229ji 288176 � t S #234 r u 288102 #237 w 288177 ZO ` R 288180CN D 288101002 Fc €` #160 #108 q tr 288178 288101001 1 f #254 tit * ! #126 :1 288179 t 0 ' 26 Feet #262 , DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:288 Parcel:177 a N boundary determination or regulatory interpretation. Enlargements beyond a scale of _ Selected Parcel Owner:MCHUGH,PAUL E&JANE F Total Assessed Value:$228500 1"=100'may not meet established map accuracy standards. The parcel lines on this map Wes: E are only graphic representations of Assessor's tax parcels. They are not true property Co-Owner: Acreage:0.41 acres Abutters - • boundaries and do not represent accurate relationships to physical features on the map Location:244 GREENWOOD AVENUE �`Lr such as building locations. - - - _ Buffer TOWN OF BARNSTABLE CERTIFICATE OF OCCUPANCY I PARCEL ID 288 177 GEOBASE ID 19277 j ADDRESS 244 GREENWOOD AVENUE PHONE HYANNIS ZIP I LOT 3 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT HY PERMIT 85465 DESCRIPTION CERTIFICATE OF OCCUPANCY PERMIT TYPE BC00 TITLE CERTIFICATE OF OCCUPANCY i CONTRACTORS: Department of ARCHITECTS: Regulatory Services. TOTAL FEES: $25.00 BOND $.00 pf TME CONSTRUCTION COSTS $.00 * BARNMBLE, MASS. � 1659. �FD MA'S A I BUILDINC.ADNISION BY I DATE ISSUED 07/15/2005 EXPIRATION DATE I TOWN OF BARNSTABLE CERTIFICATE OF OCCUPANCY PARCEL T,D'-bB 177 GEOBASE ID 19277 - ' 4DI5RESS 244 GREENW06r3 AVENUE PHONE HYANNIS ZIP. LOT.. 3 BLOCK LOT SIZE DBA , DEVELOPMENT DISTRICT HY. PERMIT 85465 DESCRIPTION CERTIFICATE OF OCCUPANCY PERMIT TYPE BC00 TITLE CERTIFICATE OF OCCUPANCY CONTRACTORS: Department of ARCHITECTS: Regulatory Services TOTAL FEES,: $25.00 ` BOND $.00 OFF CONSTRUCTION COSTS $.00 Ba)NErrABLE, . Mass. 039. FD MP'� 4 BU IN Ili ISION I BY ! ` DATE ISSUED 07/15/2005 EXPIRATION DATE THIS PERMIT CONVEYS NO RIGHT-TO OCCUPY,ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EW CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS I, PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE; SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE BUILDING SHALL L NOT E ELECTRICAL,PLUMBING AND MECH- (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS. 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. 4.FINAL INSPECTION BEFORE OCCUPANCY. I : oleo guej IM L�1:11 a g;uo UT N;1 I' BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1 1 2 2 2 3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 2 BOARD OF HEALTH OTHER'. SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON.THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. BUILDING PERMIT kTOWW OF BARNSTABLE,,1 7. j w" BdiLDING PER14IT PARCEL, T.D 288 177 GEOBASE ID 15277 ADDRESS 244 GREENWOOD AVENUE PHONE HYANNIS ZIP - LOT 3 BLOCK LOT SIZE DIVA DEVELOPMENT DISTRICT ICY PERMIT 81067 DESCRIPTION. REMODEL KITCHEN/BATH DOORS WIN- CABNETS PERMIT TYPE BREMOD TITLE RESIDENTIAL ALT/CONV CONTRACTORS: TANGER NEIL S Department of � ARCHITECTS: Regulatory Services TOTAL FEES: $255.00 BOND $.00 p1U CONSTRUCTION COSTS $50,000.00 434 RESI.D ADD/ALT/CONV 1 PRIVATE f1f.0 * BARNSTABLE, MASS. FD MA'S A 1 I BUILDINQ,,.DIVISION BY �r 1 / DATE ISSUED 12/06/2004: EXPIRATION DATE THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY::STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OFTHIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED f FOR ALL CONSTRUCTION WORK: APPROVED-PLANS,�MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIStARD KEPT POSTED UNTIL FINAL INSPECTION ; ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS HA_S'-BELWMAOE.WHERE A CERTIFICATE OF OCCU PERMITS x'SUCH BUILDING SHALL NOT BE ELECTRICAL,PLUMBING AND MECH- (READY TO LATH). ,PANCY IS REQUIRED, a 3.INSULATION. OCCUPIED-UNTIL.FINAL_INSP_ECTION HAS BEEN MADE^ ANICAL INSTALLATIONS. 4.FINAL INSPECTION BEFOREACCUPANCY. BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS DOC /� C' 5--� 2 'l g FAN K RED' - zy - vim c � gag tj Ore- 3 _c� 7_� HEATING INSPECTION APPROVALS. ENGINEERING DEPARTMENT OK 2 a BOARD OF HEALTH OTHER: SITE>PLAN REVIEW APPROVAL L;C®rp WORK SHALL NO ROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. .- I I I If I � M IL III .. .. I . 4 I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION it .�Lz Map Parcel `1 -7� Permit# ;z Health Division ►rli 1 1�� )3 Date Issued 0 s Conservation Division r S"s A, /� Application Fee Tax Collector Permit Fee ` Treasurer U � 'TIC �'trST� tsT B Planning Dept. f; � ,LL ®16d COMPLIANCE . WITH TITLE 5 Date Definitive Plan Approved by Planning Board ENTAL CODE A' Historic-OKH Preservation/Hyannis PF" ULAtN Project Street Address 2 q9 U—Ye eo lib d Village Owner �fGt L 1 Address ca q� 6Y_e&_vl wa 0 c.Q Telephone nl �1_7 3 Permit Request ; 10 - e h K 4 -{'v ,: - 1 lNfe(ilag Gdotgl<� -No o4fare �c Square feet: 1 st floor: existing"�R proposed " 2nd floor: existing proposed -4�)-- Total new -63" Zoning District Flood Plain Groundwater Overlay t4 Project Valuation 5, 006. - Construction Typed 1-4'2d��i�� Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family M"" Two Family ❑ Multi-Family(#units) Age of Existing Structure 90 VY5 � Historic House: ❑Yes Rio On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other r Q I Basement Finished Area(sq.ft.)- �G14'A Basement Unfinished Area(sq.ft) 730 Number of Baths: Full:existing new / Half: existing -8- new 44- Number of Bedrooms: existing Z new F�- Total Room Count(not including baths): existing new 48-- First Floor Room Count Heat Type and Fuel: UrGas ❑Oil ❑ Electric ❑Other Central Air: UKes ❑ No Fireplaces: Existing �_ New -49" Existing wood/coal stove: ❑Yes W to Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing O new size Other: Zoning Board of Appeals Authorization ❑ Appeal#- Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION W _5�� 737 7�2 5/ Name i Telephone Number 1-}- SDI 0177 SOS / Address PO 60y I-Z License# O 5 65 i -7 S IE2 rest- _ OX(O C Home Improvement Contractor# /1f 6 Worker's Compensation# 4WG -70 //l 7 6-0/aOdel ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO TI z D Y -wm S SIGNATURE DATE Pyo g/o_�5 FOR OFFICIAL USE ONLY PERMIT NO. - DATE ISSUED MAP/PARCEL NO. ' ADDRESS VILLAGE ! ; vi OWNER ~ I DATE OF INSPECTION: FOUNDATION - FRAME INSULATION f j i� _ ��L L; `0 {� , FIREPLACE - ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL - GAS: ROUGH FINAL I;w FINAL,BUILDING r��l Ole-" DATE CLOSED OUT ASSOCIATION PLAN NO. Q.1 r r i y r J L. r m D-P_-�ett, 1.5 91065' lam-- - L . __._...._. ._ -------- - -----�- . -- -- -- - - • 1 i- • _r 4 r I r I I r I I : _L ` Town of Barnstable FZHE Tp� . Regulatory Services sAMSMBLE, Thomas F.Geiler,Director 9 MASS. `bA 039' A,m Building Division TED MA'S Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. ff II r Type of Work:� �n� hQi-Vh✓no �� �1 P�l]� ted Cost�1 Address of Work: 02. V1 re U� C VI N S 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 E]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: -7 CE S n Date Contractor ame Registration No. OR Date Owner's Name QIorms:homeaffidav Town of Barnstable Regulatory Services �� # Thomas F.Geller,Director 9`b 163 ��� Building Division RFD MA'S A Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.b arnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize. P.t to act on my behalf, in all matters relative to work authorized bythis building permit application for: (Address of Job) Sign e o weer Date Print Dame Q:FORMS:OWNMERMISSION 790 CMR Appendix J Table JS.2-Ib(continued) Prescriptive Packages for One and Two-Family Residential Buildings Hated with Fossil Fuels MAXIMUM MINIMUM Glazing Glaring Ceiling Wall Floor Basement Slab Heating/Cooling Area'(%) U.valuc' it-value' R-value' R-value? Wall perimeter Equipment Efficiency' � R-value° R value' Package . 5701 to 6500 Hating Degree Days' Q 12% 0.40 38 13 19 10 6 Normal R 12% 0.52 30 19 19 10 6 Nor mal S 12% 0.50 38 13 19 10 6 8S AFUE T !S% 036 38 l3 25 N/A N/A Normal U 15% 0.46 38 19 19 10 6 Normal V 15% 0.44 38 13 25 N/A N/A 85 AFUE W 15% 0.52 30 19 19 10 6 85 AFUE X 18% 0.32 38 13 25 N/A N/A Norma[ Y 18% 0.42 38 19 25 N/A N/A Normal Z 18% 0.42 38 13 19 10 6 90 AFUE AA 18% 0.50 30 19 19 10 6 90 AFUE 1. ADDRESS OF PROPERTY: �1 r`e ell (00 h� 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 0 3. SQUARE FOOTAGE OF ALL GLAZING: l9'1 4. %GLAZING AREA(#3 DIVIDED BY#2): 5. SELECT PACKAGE(Q- AA-see chart above): NOTE:.OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-f980303 a 780 CMR Appe ndix J Footnotes to Table J$.2.1b: ' Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and basement windows if located in walls that enclose conditioned space,but excluding opaque doors)to the gross wall area, expressed as a percentage. Up to 1%of the total glazing area may be excluded from the U-value requirement. For example,3 ft of decorative glass may be excluded from a building design with 300 ft of glazing area. 2 After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for whole units: center-of-glass U-values cannot be used. The ceiling.R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. 4 Wall R-values represent the sum.of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding, structural sheathing, and interior drywall. For example,an R-19 requirement could be met EITHER by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. S The floor requirements apply to floors over unconditioned spaces (such as unconditioned crawlspaces, basements, or garages).Floors over outside air must meet the ceiling requirements. The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned basements must be included with the other glazing. Basement doors must meet the door U-value requirement &:scribed in Note b. 'The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs. " If the building utilizes eleotric resistance heating use compliance approach 3;4, or 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. . 'For Heating Degree Day requirements of the closest city or town see Table J5.2.1a NOTES: a)Glazing areas and U-values are maximum acceptable levels. Insulation R-values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b)Opaque doors in the building envelope must have a U-value no greater than 0.35. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table J1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. . One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c)If a ceiling,wall, floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with different insulation levels,the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). 43 The Commonwealth of Massachusetts :---- Department of Industrial Accidents — 4Ico KNAW09 s 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit-General Businesses VAN Erne' I .j address C1tV 1' / 1i5 'v it Ir Y�tl� state:' ziv'�y�yy phone# work site location fall address ❑ I am a sole proprietor and have no one Business Type: []Retail ElRestaurantBar/Eating Establishment working in any capacity. ❑Office❑ Sales(including Real Estate,Auios etc.) ❑I am an employer with gin ] ees(full 1 art time). ❑Other I am an employer providing workers' compensation for my employees working on this job. c'o'm snv name: , s'aa> ' bone# I VIA. poI am a sole proprietor and hoye hired the independent contractors listed below who have the following workers' compensation polices: come any nami: •'•,. .: .. a,.• .. . address: �.. hone#' ' citv:. :; r....• insurance eo. OEM. /%///'/�// /. / , // / /////// .. mot,. .f::•; .�•±:, C.{ •.. com on. ,nsriie ,a, address: hone# Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/IL or. one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me: I understand that copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify u er the pai s enalties of perjury that the inform ation provided above is true and cor rect Data Signature Phone#--1 -7 Z print name. ,�oofflicial use only do not write in this area to be completed by city or town official permittlicense# ❑Building Department. city or town: ❑Licensing Board ❑Selectmen's Office ❑check if immediate response is required []Health Department , � coataetperson: phone#; ❑Other e (revered SCI2003) �','�•.�,r"��_ .�Ft�"^'"�-'ec ,ter'-`�.'m.'m'P°�' �•__�_ - - 'e�.a�•[C34Z. Information and Instructions Massachusetts General 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,partners hip, association,corporation or other legal entity, or any two or more of e 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. Please supply company name, 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 perinit 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 listedbelow. City or Towns -- Please be sure.that the affidavit is complete and printed legibly. The Department bas 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 frill in the pern it/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.= The Office of Investigations would like to thank y"au in.advance for you 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 letrestlgatlens 600 Washington Street Boston,Ma 02111 fax#: (617)727-7749 phone#: (617) 727-4900 ext.406 RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE ; New Buildings $100.00 Residential Addition $50.00 Alterations/Renovations $50.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x.0041= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0041= plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq.ft.= x.0041= ACCESSORY STRUCTURE>120.sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0041= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 i (plus above if applicable) Permit Fee tJ T-,� 0 6 Proicost Rev:063004 07/05/2005 13:27 50B2553176 EAS-.r CAPE PAGE 01 r east cape engineerin& inn. 44 Route 28 P.O.Box 1525 CIVIL ENGINEERING Orleans,Mass.02653 LAND SURVEYING WATER RESOURCES LAND COURT ENVIRONMENTAL ,� ,�� ARE PLANNI NO frA RAN CERTIFIED PLANS 1rT9V9TVRA6 Fsx -a17�'6 WATERFRONT June 21,2005 Jane McHugh 244 Greenwood Ave. Hyannis,MA 02601 RE: Deck Review—244 Greenwood Ave. Hyannis,MA Dear his.McHugh: East Cape Engi raring,Inc.completed an inspection of the deck located at 244 Greenwood Avenue in Hyannis as requested by your contractor,Neal Tanger. Rased on our inspection,two items require to be addressed. I'h first is connection of the deck to the house. The ledger needs to be connected to the band joist using 3/8"x 6"lag bolts,one top and bottom, lb"an center along the entire length. The second item is the cantilevered section off the and of the house. The end needs to have a post(4x4)added along with a footing(b"sonotube mina to support the end. s�ofr�� If there are any questions,feel free to give me a call. MARK A McKENZiE a . Sincerely, CIV NA-3 8 �9Q t TER �8IONAL Eta Mark A.McKenzie,P . Treasurer-East Cape Eegineering,lne. MAM:jlo enclosures cc: Neal Tanger TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION x } Map $ Parcel 1 7 7 Permit# 4f G 6 7 Health Division � y� �►1w� Date Issued `a 6 0' Conservation Division ON Application F iLSO fax Collector Permit Fee os 0 0- Treasurer SEPTIC SYSTEM MUST BE Planning Dept. INSTALLED IN COMPLIANCE Date Definitive Plan Approved by Planning Board ENVIRO WITH TITLE 5NMENTAL CODE AND Historic-OKH Preservation/Hyannis TOWN REGULATIONS Project Street Address 0,2 4 rz e h c i O o d !-f Village 4 V a M h 1'S Owner 1_0 y) �A c avr Address y`f (ry-,e! ►rya®d ! lte Telephone ' 3 3 1 q;i_-7 (q;L3 3 , Permit Request I 4n ,.e F; �► �►� Gieu 7 ' eti..Se - L f?. A-d-GQ ra -fin � e_ C lase 1 'wdo vP ^ A-ew I-M w�s, 1-_d J S&ss k LW n e lm i►s o fa+e6L 1+,xy-ve, 1're p IGcew eK-r tin 1,4-S i dx quare feet: 1 st floor: existing! proposed_ L 2nd floor: existing .4;tproposed _Q- Total new_ AM4S Zoning District Flood Plain Groundwater Overlay Project Valuation 1Lo,DD®, - Construction Type k&Je,1 Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family 9 Two Family ❑ Multi-Family(#units) Age of Existing Structure D f 5 Historic House: ❑Yes la"No `On Old King's Highway: ❑Yes Wf4o Basement Type: ❑ Full ❑Crawl WrWalkout ❑Other Basement Finished Area(sq.ft.) -42�" Basement Unfinished Area(sq.ft) '7 87 . Ca I,L� Number of Baths: Full: existing I new -0- Half:existing -P- new Number of Bedrooms: existing_ new $ w f o >f to Total Room Count(not including baths): existing new $ First Floor Room Count } Heat Type and Fuel: ❑Gas Cia'Oil ❑Electric ❑Other Central Air: ❑Yes LWfio Fireplaces: Existing I New -C Existing wood/coal stove: ❑Yes r` Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION �o /44 row Name- I21 b . ' Telephone Number S O'�- 73 7'7 Z 7 4't) 1-770'" Address �D !�C?X License# to� e4e N30 Home Improvement Contractor# _-/1/0bc1 2(o Worker's Compensation# )+W C 70 l// 7,5 0.1 ,.Oo t ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO d}- I an Az /)arl-k 2)M454e1", SIGNATURE PA DATE /o2 Lot loy { ~ FOR OFFICIAL USE ONLY PERMIT NO. ; DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER ` DATE OF INSPECTION: FOUNDATION FRAME p"._ '.._ °� rC',. � % TV ; r' INSULATION ! t ©C.�_ 5; t Ps'/Z. _ '•,. FIREPLACE ELECTRICAL: ROUGH FINAL . ' PLUMBING: ROUGH FINAL- GAS: ROUGHi P FINAL' FINAL BUILDING ' �f.fz DATE CLOSED OUT ASSOCIATION PLAN NO. tS !- v � \ L ' The Commonwealth of Massachusetts Department of Industrial.4et idents 1 molts ofIMAIM ►M., ' 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit-General Businesses name: IV�t lV AW R address city C�l C I.e state:' n�'1� zip: t?2k 4 V phone# 426 -7- 7 1 Z C work site location full address I am a sole proprietor and have no one . Business Type: 0 Retail Restaurant/Bar/Eating Establishment working in any capacity. ❑Once❑ Sales(including Real Estate,Autos etc.) ❑I am an em loyer with em to ees(full& art timme). ❑Other I am an employer providing v�orkers' compensation foamy employees worlffng on this job, com any name: addressr • city phone#: . insuran ee.co:• �] I am a sole proprietor and have hired the independent contractors listed below who have the following workers' compensation polices: co in Pan name: address: 1. city phone insurance co. :.:.:••: ',. :••'::. •;.•... .....NOMINEE, //// //%/ // / / /%/// / come en.�name: •.''� - address city phone# t �:.L1.'SnCBl:Or-''.'.':.•:?. - �OlicV'#MEMO ins r '•'';:::::;.:.. .. .. .., .. . .. .a NO IMEMEN IMME Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that R copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby ce under ains and penalties of perjury that the inform ation_provided above is true and correci _ Signature Date 1 Z) Print name Phone#- V 0 -�i- -7 11 7 �.. - .�•`�'{ '•�''"4��+�`��`s' �'"':.�,^` 's��ai'�..�iesx3�� .�'�� '_�Fu 'r&�+�u'a,m �—���"�^,� _ official use only do not write in this area to be completed by city or tows official city or town: permAllicease# ❑Building Department ❑Licensing Board [Icheck if immediate response is required ❑Selectmen's Office J ❑Health Department contact person: phone#; ❑Other (revised Sept 2003) r Information and Instructions Massachusetts General 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. Please supply company name, 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. %%%%%////%////%%%//////%///O�///%%%%/G///%////O/%%////%%�%%%/////%%/%%%%/% City or Towns Please be sure.that the affidavit is complete and printed legioly. The Department has provided a space at the bottom of the affidavt 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. The Office of Investigations would lice to thank ybu in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. The Deparhnent's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Imsfigatfons 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 7274900 ext.406 oFt rot, Town of Barnstable y Regulatory Services 41 BARNSTABLE, ' Thomas F.Geiler,Director Mass. 0 3 9. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements.q New, fl„.late , o W G+I�C�S� Yler �D Type of Work: Tc 0,� Cti Estimated Cost �OLUUD Address of Work: q q 6 ,-e-e+^ CA OA rJ ►� ' Owner's Name: Date of Application: 1 1-1 01 0 I hereby certify that: Registration is not required for the following reason(s): FWork 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 the agent of the owner: DSSg 2 5- Date Contractor Name Registration No. Date O er s Ne Qhnns:homeaffidav c M CMR Appendrk Table J5.2.1b(continued) Prescriptive Packages for One and Two-Family ResidentW Buildings Heated with Fossil Fuel MAXIMUM MINIMUM Glazing Glazing Ceiling Wall Floor Basement Slab Heating/Cooling Area'(%) U.value= R-value' R-value' R-value' Wall Perimeter Equipment Efliciencyr Package I R-value° R-value' 5701 to 6500 Heating Degree Days Q 12% 0.40 38 13 19 10 6 Normal R 12% 0.52 30 19 19 10 6 Normal S 12% 0.50 38 13 19 10 6 85 AFUE T 15% 0.36 38 13 25 N/A N/A Normal U 15% 0.46 38 19 19 10 6 Normal V 15% 0.44 38 13 25 N/A N/A 85 AFUE W IS% 0.52 30 19 19 10 6 85 AFUE X 19% 032 38 13 25 N/A N/A Normal Y 18% 0.42 38 19 25 NIA N/A Normal Z 18% 0.42 38 13 19 10 6 90 AFUE AA 19% 0.50 1 30 19 19 10 6 90 AFUE 1. ADDRESS OF PROPERTY: Li 't C e ix Lu®ocJ Ci hh� s 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLSf b ZS 3: SQUARE FOOTAGE OF ALL GLAZING: I lei 4. %GLAZING AREA(#3 DIVIDED BY 92): 5. SELECT PACKAGE(Q--AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: _NO: q-forms-f980303a 780 CMR Appendix J Footnotes to Table J5.2.1b: ` Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and basement windows if located in walls that enclose conditioned space,but excluding opaque doors)to the gross wall area, expressed as a percentage. Up to 1%of the total glazing area may be excluded from the U-value requirement. For example,3 ft of decorative glass may be excluded from a building design with 300 ft of glazing area. 'After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for whole units: center-of-glass U-values cannot be used. ' The ceiling.R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. 'Wall R-values represent the sum.of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding, structural sheathing, and interior drywall. For example, an R-19 requirement could be met EITHER by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces,basements, or garages).Floors over outside air must meet the ceiling requirements. The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must mzet the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned b.,,sements must be included with the other glazing. Basement doors must meet the door U-value requirement &-scribed in Note b. 'The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs. " If the building utilizes electric resistance heating use compliance approach 3;4, or 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. 'For Heating Degree Day requirements of the closest city or town see Table J5.2.1 a NOTES: a)Glazing areas and U-values are maximum acceptable levels. Insulation R-values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b)Opaque doors in the building envelope must have a U-value no greater than 0.35. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table J1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c)l,f a ceiling,wall, floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with different insulation levels,the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). 43 RESIDENTIAL BUILDING PERK UT FEES APPLICATION FEE New Buildings $100.00 Residential Addition $50.000 . Alterations/Renovations $50.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x.0041= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= "t" 0 G 6 x.0041= d�' plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq.ft.= x.0041= ACCESSORY STRUCTURE>120,sq.ft. >120 sf-500 sf - $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as'new building permit: square feet x$96/sq.foot= x.0041= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) C Permit Fee Projcost Rev:063004 BIKE Town of Barnstable Regulatory Services MAMg` Thomas F.Geiler,Director E16. a Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.mams Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder. I, as Owner of the subject property hereby authorize se'; to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) c-� lip � � •�� gnature of Owner Date Print Name Q TORM S;OwNERPERMIS SION i f Board of Building Regulations and Standards JauoissIW WOO VI IN 31yQ1SB2i0 License or registration valid for individul use only p'8 Od/d l 1�1 99 HOME IM ,OVEMENT CONTRACTOR before the expiration date. If found return to: !I / Re 9ik—. 1069 C\ Board of Building Regulations and Standards J.N111 S II N One Ashburton Place Rm 1301 ' Jt i /2006 i r -— Boston'Ma.02108 idual I 0-tzLi7 :nu,jl 9 NEIL S.TANGE } , aq0, N 5L65S0 NEIL TANGER J�c � Y PO BOX 1291/66 R ' � 4 i 2iOSan?I3df1S NOIl�(1�I1SN00 asu;a�i� FORESTDALE, MA 02644 SNOIld`if1J321 OJNI(a]IA',3 SO QadM Administrator Not valid wi Cursiinature a j ; s i ■ s■■�wwrrir�r � ■��lifii i lei R� �RwR/ w MwM Prom I■ ■■■■ i■■I ..... l�r�°i■�l■■ MINES '�l�:■■■ 11■■■ ■ri ■ ■ice ■ 1"k,1192- MEN OWMEMES1 . ' ■ ill■■i'�� _ � �J■ ■ a.. r \ T d .. . ... ... ... . __ t.a_._ _� Boisw BC CALL® 2003 DESIGN REPORT - US Monday,January 03,2005 12:52 Double 1-3/4" x 6-1/2" VERSA-LAM® 3100 SP* File Name: N Tanger 244 Green.BCC: FB01 Job Name: Description: Address: 244 Greenwood Avenue Specifier: City,State,Zip: Hyannis, MA Designer: Joe Madera Customer: Neal Tanger Company: Shepley Wood Products Code reports: ICBO 5512, NER 629 Misc: 1 Standard Load-20 psf 11 psf Tributary 12-00-00 .gd%'�d,.i., </„Wi y.f..�. �/P.%rfi' ••, .MaT•• ,' emv. .a.,. ,x - � ,-\ BO 61 1755 Ibs LL 1755 Ibs LL 996 Ibs DL 996 Ibs DL Total Horizontal Length-06-06-00 General Data Load Summary Version: US Imperial ID Description Load Type Ref. Start End Type Value Trib. Dur. S Standard Load Unf.Area Left 00-00-00 06-06-00 Live 20 psf 12-00-00 100% Member Type: Floor Beam Dead 10 psf 12-00-00 90% Number of Spans: 1 1 Unf.Area Left 00-00-00 06-06-00 Live 25 psf 12-00-00 115% Left Cantilever: No Dead 15 psf 12-00-00 90% Right Cantilever: No Controls Summary Slope: 0/12 Control Type Value %Allowable Duration Load Case Span Location Tributary: 12-00-00 Moment 4470 ft-Ibs 57.0% 115% 3 1 -Internal Neg. Moment 0 ft-Ibs n/a 100% End Shear 2292 Ibs 45.3% 115% ? 3 1 -Left Total Load Defl. U368(0.212") 65.3% 3 1 Live Load: 20 psf Live Load Defl. U576(0.135") 62.5% `e 3 1 Dead Load: 10 psf Max Defl. 0.212" 21.2% 3 1 Partition Load: 0 psf Duration: 100 Notes Disclosure Design meets Code minimum(U240)Total load deflection criteria. Design meets Code minimum(U360)Live load deflection criteria. The completeness and accuracy of Design meets arbitrary(1")Maximum load deflection criteria. the input must be verified by anyone Minimum bearing length for BO is 1-1/2". who would rely on the output as Minimum bearing length for 61 is 1-1/2". evidence of suitability for a *Cut from: 1 3/4"x 7 1/4"VERSA-LAM®3100 SP particular application. The output Entered/Displayed Horizontal Span Length(s)=Clear Span+1/2 min.end bearing+1/2 intermediate bearing above is based upon building code-accepted design properties Connection Diagram and analysis methods. Installation Consult project design professional of record or BOISE technical representative for connection design of BOISE engineered wood Member has no side loads. products must be in accordance with the current Installation Guide Connectors are: 16d Sinker Nails and the applicable building codes. To obtain an Installation Guide or if a=2„ d you have any questions,please call b=3„ b (800)232-0788 before beginning c=1-5/8" a product installation. d=12" T • BC CALCO, BC FRAMER®, BCI®, BC RIM BOARD rm, BC OSB RIM C \ BOARD- BOISE GLULAM-, VERSA-LAM®,VERSA-RIM®, VERSA-RIM PLUS®, • • VERSA-STRAND-, VERSA-STUDS,ALLJOISTO and AJSTm are trademarks of Boise Cascade Corporation. Page 1 of 1 PATRICK J. DONOVAN ASSOCIATES, INC. Claim ane-lLoss.A dustments 71 Legion Parkway, Suite 25 Brockton, MA 02301 Tel. (508) 580-1475 - Fax (508) 559-9041 7/6/04 Building Commissioner Town or City Hall Hyannispewt,,M Insured : Jane F. Mchugh M Property`Address 244 Greenwood Avenue, Hyannisport, MA \ Insurer : Vermont Mutual Ins. Co. Policy Num.ber— : H012026308 Date of Loss : 7/2104 Type of Loss : Fire We have received a claim involving loss, damage or destruction of the above indicated property, which may either exceed $1,000 or cause Mass. Gen. Laws, Chapter 143, Section 6, to be applicable. If any notice under Mass. Gen. Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of the undersigned and include a reference to the captioned Insured, location, policy number, date of loss and file number. On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. pATRICK J.DONOVAN AASSOC. 71 LE SUITE 25N-PAR� BROCKTON,MA 02301" ' Signature