Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0151 IRVING AVENUE
/ S� Ziry i n �-dc�, - - -- - -- . Application Number..... �.........v.............. ..... :.................... * BAANBTABLE, *� MAS& $ Permit Fee........._........Zoning District........................ 1639. CEO MA'S A TotalFee Paid ............................................................... ...... TOWN OF BARNSTABLE Permit Approval by.....F-a....................On...... 1.f.1 ?..... BUILDING PERMIT '') Map............. -� .7.........Parcel........ ...................... APPLICATION Section.l — Owner's Information and Project Location Project Address %42 Village .l '' � ®r Owners Name I46k, Owners Legal Address / S/ City m State , Zip e:�?A60 l Owners Cell # E-mail Section 2 —Use of Structure- Use.Group ❑ Commercial Structure over 35,000 cubic feet 0 Commercial Structure under 35,000 cubic feet LV--Single/Two Family Dwelling Section 3 — Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment © Sprinkler System ❑ Addition ❑ Retaining wall ❑ Solar 0 Renovation ❑ Pool ❑ Foundation Only Other—Specify G k w Section 4 - Work Description B I III whir, T. SC OCT 19 mfi 91.7—D 1 VUI I QE BARNSTABLE Last updated: 1/31/2020 i Application Number.................................................... .. Section 5—Detail Cost of Proposed.Construction 6 00.,`f Square Footage of Project Age of Structure Dig Safe Number # Of Bedrooms Existing Total# Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6 — Project Specifics ❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑ Add/relocate bedroom Water Supply ❑ Public ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: /3q-,, , I am using a crane E Yes Q—No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8 —Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last updated: 1/31/2020 s a The Commonwealth of Massachusetts u_ Department of Industrial Accidents Office of Invadgations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. Applicant Information Please Print Legibly Name(Business/Organization/individual): (ALI q iP0AJh6rA ) Address: G. eZCs9ad- lQ=E6 6�,ya City/State/Zip: Phone#' Are you an employer?Check the appropriate bog: Type of project(required): 1.❑ I am a employer with- 4.;❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors employees ❑New construction 2.I� I am a sole proprietor or partner- � the attached sheet. 7._ odeIing - ship and have no employees - These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' _ 9. ❑Building addition [No workers'comp.insurance CIOmP.insurance. 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their I L re 3.El I am a homeowner doing all work id h ❑Plumbing or additions P myself,[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance requh.A]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 their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration.Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify nder the pauis andpenalties ofperjury that the information provided above is true and correct Signature: I Date: X3' � Phone#• 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 Instructions V, Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and'including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to constrict buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to cant'workers'compensation insurance. If an LLC or LLP does have employees,a policy is required Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Mamchusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Bostart<,MA 02111 Tel.#617-727-4900 ext 446 ar 1-877-MASSAM Revised 4-24-07 Fax#617-727-7749 www:mam.gov/dia s. Application Number........................................... Section 9— Construction Supervisor Name Telephone Number 50? F 3- -00 Address 10el 4-le City s State _Zip A >61 m License Number C_S 09/,,"5q 1 License Type IrAExpiration Date Contractors Email c. _61 (-jo emU.- Cell # $� 7 3 ®/G� I understand my responsibilities under the rules and regulations forLicensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation re ire by 780 CMR and the Town of Barnstable.Attach a copy of your license. Signature Date /0� — Section,10—Home Improvement Contractor Name 6 Telephone Number^ � :Z3i - t Address /o !K (4v-(b 4�r City °f State 0j,* Zip Registration Number ��, °,�J Expiration Date /0 I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation req d by 780 CMR and the Town of Barnstable.Attach a copy of your H.LC... Signature Date jb .. 2 I Section 11 —Home Owners License Exemption Home Owners Name: a p l,� 0 a r/>` Telephone Number -7n S75 Pell or Work Number - I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR nd the Town of Barnstable. Signature Date APPLICANT SIGNATURE Signature ' Date�/V— /,% a0 Print Name � f� / �& ,j Telephone Number i, o c oloo E-mail permit to: /A to d?- / C_n2 ' e►�4 . nLast updated:updated: 1/31/2020 Section 12 — Department Sign-Offs a Health Department C Zoning Board (if required) Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation ❑ For commercial work,please take your plans directly to the fire department for approval. Section 13 — Owner's Authorization a _ r I, ('>� , as Owner of the subject property hereby authorize Timm k t�, to act on my behalf, in all matters relative to work authorized S by this building permit application for: � i (Address of job) Signature of Owner date i Print Name 1 I i i Last updated: 1/31/2020 Town of Barnstable ilding t sPo`st This Card So Thatf�tis V�s�ble-From the Street :A ,,�lroyed Plans•MustbeRetamed on,lob and this Card Must be Kept x dARh'3'CAB3.lw- 8 9n �A" vl;:iF °et • ,..: �,, pp. �, { � r x'' `i r d S � :' Permit s� +° Where a"Cert�fic�ateof Occupacy�issRequired,such Bu�ldmg shall Not becu�p�ed unt��ati�Fina!Ir�spection'has been rnad'e^� y, Permit NO. B-19-3485 Applicant Name: MARK MCNICHOLS Approvals Date Issued: 10/17/2019 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 04/17/2020 Foundation: Location: 151 IRVING AVENUE,HYANNIS Map/Lot: 287 0688 Zoning District: RF-1 Sheathing:.'. Owner on Record: WILSON,JOHN B&LESLIE Q TRS Contractor Name £ MARK J MCNICHOLAS Framing: 1 3$ r < � Contractor License CS 063090 Address: 155 IRVING AVENUE g, 2 HYANNIS PORT, MA 02647 V0, � Est Potct Cost: $22,000.00 Chimney: Description: STRIP AND RE-ROOF ( Permit Fee: $ 112.20 ( Insulation: GL INSTALL( 24)SQUARES ASPHALT ROOFING SHINES Fee Paid_ 5 112.20 NO STRUCTURAL �~ Final: n Date 10/17/2019 Project Review Req: i t Plumbing/Gas � � � � � �� � � �—.:�•�rill __ .. .. Rough Plumbing: Building Official. mT Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authonied,by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved appl cation a d the'approved construction documents fo wh ch this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be incompliance with the local zonmg;by lawsand codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for Oibblipjnspedtidfi for the entire duration of the Final Gas: work until the completion of the same. ) Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and',Fire Officials aresprovided on this permit. Minimum of Five Call Inspections Required for All Construction Work: �'R� - Service: 1.Foundation or Footing n Rough: 2.Sheathing Inspection , tea.:. .. :::.... ..� m,.. .. 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) tow Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final` All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT . .� Town of Barnstable Building Post This Card So That-it is Visible.From�the.Street App oved�Jans Must be,�Retamed,on Job and this Card Must ybe Kept 46 Posted Until Final II specton Has Been Made 3A , a er a Where a Certificate�of Occupancy isaRequ red,such Buuldmg shall Not be Occcped until a Final Inspec#ion has been emit Permit No. B-19-3485 Applicant Name: MARK MCNICHOLS Approvals Date Issued: 10/17/2019 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 04/17/2020 Foundation: Location: 151 IRVING AVENUE, HYANNIS Map/Lot: 287-068 Zoning District: RF-1 Sheathing: Owner on Record: WILSON,JOHN B&LESLIE Q TRS Contractor-Name'::,MARK 1 MCNICHOLAS Framing: 1 Address: 155 1RVING AVENUE Contractor License:` CS-063090 2 HYANNIS PORT, MA 02647 Est. Protect Cost: $ 22,000.00 Chimney: Description: STRIP AND RE-ROOF ` " Permrt Fee: $ 112.20 INSTALL( 24)SQUARES ASPHALT ROOFING SHINGLES :' Insulation: w NO STRUCTURAL - Fee Paid $ 112.20 a Date 10/17/2019 Final: Project Review Req: k Plumbing/Gas t Rough Plumbing: ,Building Official x Final Plumbing: This permit shall be deemed abandoned and invalid unless the work auYho ized;by this permit is commenced within six mgri hs after issuance. All work authorized by this permit shall conform to the approved application and the.,approved construction documents for which:this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall 66 in compliance with the local zonmg:by-laws'and codes. This permit shall be displayed in a location clearly visible from access street,or.road.and shall be maintained open for pi5tilic inspection for the entire duration of the Final Gas: work until the completion of the same. ,r Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Buildmg and Fire Officials are pro3ided`ori thispermit. Minimum of Five Call Inspections Required for All Construction Work f;` f t Service: �' 1.Foundation or Footing , N 2.Sheathing Inspection Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection final: 5.Prior to Covering Structural Members(Frame Inspection) LOW Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final`. Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). TT_' Fire Department Building plans are to be available on site �1 All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: c� ' � rt7 Town of Barnstable Building io?e snxB+lDas.M"r'wA��t,n��$ WP�.�o hs,eterf,e d aU nCet.i nlx,st F fin.ca.waaltr eIn os_pf"eO;�c c'yt cti.'ou-"np`"aHrn acs y B'se:.;eRne`'.�M.uat,"r.:deed su�c'h- Buildr�m sEia.;ll No�at">be Occ•u?pgiredr u�n,;til�.,a.Fin;z<,al.Insxpection,.;has bsetesb'tan .sC n made" . Permit eo e PM M h b3p Permit No. B-19-3114 Applicant Name: MARK MCNICHOLS Approvals Date Issued: 09/20/2019 Current Use: Structure Permit Type:,, Building-Siding/Windows/Roof/Doors Expiration Date: 03/20/2020 Foundation: Location: 151 IRVING AVENUE, HYANNIS Map/Lot: 287-068 Zoning District: RF-1 Sheathing: Owner on Record: WILSON,JOHN B&LESLIE Q TRS 1 Contractor Name "-.,MARK J MCNICHOLAS Framing: 1 j' t' Contractor Ucense: CS'-063090 Address: 155 IRVING AVENUE :, -, >, 2 r c HYANNIS PORT, MA 02647 Est' Project Cost: $ 18,000.00 < Description: STRIP AND RE-ROOF Permit Fee: $91.80 Chimney: INSTALL( 22.)SQUARES ASPHALT ROOFING SHINGLES Insulation: NO STRUCTURAL ' Fee Paid: $91.80 Da,e. 9/20/2019 Final: Project Review Req: Plumbing/Gas Rough Plumbing: iJ Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authonzed by this permit is commenced within six months after,issuance. All work authorized by this perm itshaII conform to the approved application,and the approved construction documents for whidh�this permit has been granted. Rough Gas: I z nm ''b -law :and codes. h h local o s ' n changes of use of an building and structuresshalPbe in compliance with the All construction,alterations and c g y g p g. Y This permit shall be displayed in a location clearly visible from access street orQ road and shall be maintained open for public�mspection for the entire duration of Final Gas: work until the completion of the same. ..sff Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work ¢ Service: 1.Foundation or Footing i 2.Sheathing Inspection i_ Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installedb Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund11 (as set forth in MGL c.142A). Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: i Town of BarnstableBuildin �' ", „, ;.t r'g xi 3 "�°'"""'" '., °�."'; "° .. s•v- -.;<zza- kc u "�„a °` f J PostTh's4Card So That..'t-isVble,From the Street-A r-oYed.Plans Mwst,be.Reta'ned,on Job and,th's Card Must„be,Kept �- ,;° v ABIL ` n t 'y - 't� z pp , c a r t7 D g, f'd ��r ,3; - iMAS&ego �` Posted Unt'I F'nal Inspect'onHas Been�Made , y It Permit °such Build'n rsh`aIL.N�ot be'Oc u' ied iar t'I a F'nal lns'ect'on as b�e n made Whe�re�a�Certificate of Occupancy s 9 g t p P Permit NO. B-18-3561 Applicant Name: Tom Swensson Approvals Date issued: 11/09/2018 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 05/00/2019 Foundation: Location: 151 IRVING AVENUE, HYANNIS Map/Lot: 287 068 Zoning District: RF-1 Sheathing: Owner on Record: WILSON,JOHN B&LESLIE Q TRS x Contractors Name Framing: 1 Address: 155 IRVING AVENUE Contractor license' 2 u a HYANNIS PORT, MA 02647 'p Est: Project Cost: $300,000.00 Chimney: Description:. Construct new wood framed Garage addition�(23'x 36-) w/deck Permit Fe`e: $ 1,580.00 r Insulation. above,add Mudroom Entry and enlarge 1st floor,Sitting Area,and Fee Paid $ 1,580.00 enlarge 2nd floor Office. Install new windows�to match existing Final: w windows in style and manufacturer(Pella).The ne construction, Date y 11/9/2018 will require removal of the west wall on 1st&2ndfloors The roof of the 2nd floor office will also be removed and replaced with a'4 Plumbing/Gas gable roof. Existing double hung windows on n north and�south o Rough Plumbing: walls of 2nd floor office to be removed Picture w£mdow,W`/double --, Building Official hung flankers in existing Sitting Area to be removed;=s,new window M. Final Plumbing: to be installed to match window in in Breakfast Area:exi`stng A ; Rough Gas: double hung window at west gable of attic floor to be removed. Final Gas: Project Review Req: AS BUILT REQUIRED q . Electrical Service: � ,. Rough: Final: Low Voltage Rough: Low Voltage Final: Health Final: C Fire Department T ��� ' Final: ' TOWN OF BARNSTABLE BUILDING.PERMIT APPLICATION,. Map Parcel Application # FLO S 34 Health Division "Date Issued `3 Conservation Division '- Application Fee 21 PlanningDept: Permit Fee Date Definitive Plan Approved by Planning Board Historic -:OKH Preservation/ Hyannis Project Street Address 41 11t(/i Village dl !�1 5 ` /� YI Owner Address eat/ Telephone -77r� Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District, Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No 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 UseFri j all :r V0 APPLICANT INFORMATION v (BUILDER OR HOMEOWNER) —� r Name - ` nn� / Telephone Number 77 ) r Fq Address 12,- License #J 4V Home Improvement Contractor# 1/.3 3 7D 1 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO tr SIGNATURE,-- ;" DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE ` OWNER DATE OF INSPECTION: FOUNDATION FRAME o(e- 13 1 ►-' INSULATION FIREPLACE I ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL >r GAS: ROUGH FINAL y FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. ,per T,he Commonwealth of Massachusetts _ Department oflndustriarAccidenty Office of Inve,s6gation9 600 Washington Street Boston, AL4 02111 www.mass.gov/dia Workers' Comp msadon Jusurauce.Affida-vit: Builders/Contractors(EIectriciansMumb erg Applicant Informatioxl Nam �n Please Print Le 'bl e (Business/Organization/IndividuaI): "v yl/�, J� �/ 1,�1U lUt� Address: ' City/State/Zip: Phone.#: Are you an employer? Chec the appropriate box. Type of project(required): 1.J�r,croploycr with 4. ❑ I am a general contractor and 1 6 ❑Ncw constrixtian oyees (fill and/or part-time).* have hizcd the Sub-contractors 2.❑ I am a sole proprietor or partncr- listed ou talc attached sheet 7. ❑ Remodeling ship and have no employers These sub contractors havo S. ❑ Demolition working for Mn in amy capacity. employees and have workers' 9 ❑Building alMition [No workers' comp.- ctrrancc comp.insurance.t m 5 10- Electrical repairs or additions zCgtnrecL] . ❑ VTc arc a corporation and its officers have exercised their lLE]Plmnbing repairs or additions 3.❑ I am a homcownrs doing all wozk myself [No workers' comp: right of exemption per MGL 12.❑Roofrcpairs incrtranee required...] t c. IS2, §1(4), and we bait no •13.❑ Other . eMployces. [No workers' comp.insurance required-] *!wy zpplicant that chm)a box#1 murt also fill old the section below showing their workrzs'eompmnlion po}cy inforrmtim t Homcowncn who rubmit this affidavit indicating they am doing all work and than 1 irz outside contractors must rubrmt anew affidavit indicating such. $Contractors that cbcck this box must zdzcbcd an additional rbcct showing the name of the sub-etmtratturs and clam W'hetha ar not those entities have employers. If the sub-eonhaetors have anployeea,they must pro-vi db their workers'comp.po}iey ntunba. I atn an employer that is providing workers' compensa6un insurance for my empfoyees. BeLaw is the policy and jab site information Immnancc Company Name: nation D atc: u Policy#or Sclf--ins. Lic. #: 2� � Job Sitc Address: City/StatdZip: a n date Attach a copy of the workers' corapensati po 'cy declaration page (showing the policy numbe ,and exptr h ). Failure to secure r-overagc as required vndcr Section 25A of MGL c. 152 can lead to the imposition of crim_iiial penalties Of EL fines lip to $1,500.00 and/or one-year impnsonmcnt, as well as cii it penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Bc advised that a copy of this sta r=re t may be forwarded to the Office of lavcsti ations of the DIA for in urancc coverage verification. Ida her erti under the pairts•and"pen ' afperjury that the info rmadon provided abo 'is true and(d cbrracf- Si ED Dats: �V attrrc: — Phone 2 Ofzcra!use only. Do not write in this area, tb be completed by Ofy or town official City or Town: Permit/Licenge# Issuing Authority(circle one): I..Board of Health 2.Building Department 3. City/Towu Clerk 4.Electrical Inspector S. Plumbing Inspector 6. Other Contact Person: Phone#: Massachusetts General Laws cb-aptcr 152 requires all employers to provide workers' compensation for their cmployccs., Pursuant to this statute, an employee is dcaccd as ,._.every person in the service of another under any contract of hire, l- express or implied, oral or written" An employer is defined as "an individual, partncrsbip, 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 croploycr, or the reccivex or trustee of an individual,partnership, association or other legal entity, employing employees. However tha owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the iwalling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on tbz grounds or building appurtenant thereto shall not because of such cmploymcat be domed to be an employer." viGL chapter 152, §25C(6) also states that"every state or Iocal licensing agency sha-U withhold the issuance or -enewal of a .license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has notproduced-acceptable evidence of compliance with the insurance coverage required." UdditionaIly,MGL chapter 152, §25C(7) states `Neither the commonwealth nor any of its poligzal subdivisions shall aster into any contract for the performance of public work until acceptable cvidcnce of compliance vs ith the in e equiremcats of this chapter have been presented to the contracting authority." applicants lease fill out the workers' compensation affidavit completely, by checking the boxes that apply to Your situation and, if` ,rc sary, supply sib-eontractor(s)namc(s), address(cs) and phone numbcr(s) along with their certi_frcatL(s)of ,surance. Limited Liability Coropanies•(I LC) or Limited Liability Partnerships (LLP)with no�cmploycca other than the Lcmbers or partucM arc not required to carry workers' compensation insurance. If an L.LC or 11 dots have mployets, a policy is required. Be advised that this affidavit may be submitted to the Dcpu mcat of Industrial c c cidcats for confirmation of insurance covrago. .Also be sure to sign and date the affidavit The affidavit should returned to the city or town that the application for the pcm:iit or license is being requested, not the Department of idustC-W Accidents. Should you have any questions regarding the law or if you arc req uircd to obtain a workers' gmpensation policy,please call the Department at the number listed below. Self-insured companies should cuter their If-iumn-anr,o license number on the appropriate line. ity,or Tow- Officials ease be sure that the affidavit is complete and printed legibly. The D cpartment has provided a space at the bottom 'tare affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant case be sure to fill in the perm it/license number which will be,used as a refcrcnce number. In addition, an applicant it must submit multiple permitlliccnse applications in any given year, need only submit cup affidavit indicating current Iicy information(if necessary) and under"Job Site Address" the applicant should write"all locations in (city or xn)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the plicant as proof that a valid affidavit is on file for fit me permits or licenses. A new affidavit.must be filled out each jr.Where a home owner or citizen is obtaining a license or permif not related to any business or cormncrcial venture a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit e Office of Investigations would h]cc to thank you in advance for your cooperation and should you have any questions, ase do not htsita-t.tc give us a call Deparbnent's address, tcicphonc•and fax number: Tha Cammonweal.th of MassaGhusetts Dg3paz Dot of Industrial ACCidrrnt5 Offce of Investiptians 6.00 Washington Street Boston, MAf 02111 Tel. # 617-727-490.0 ext 4-06 ar 1-V7-MASSAFB Fax # 617-727-7749 11-22-06 www.mas,-.gov/dia f ENERGY CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR ONE- AND TWO-FAMILY DETACHED RESIDENTIAL CONSTRUCTION (78.0 CMR 61,00) Applicant Name: 7,7J--^may _ Site Address: r,�r„r ` . Town: Applicant Phone: l 0. Applicant Signature: Date of Application: NEW CONSTRU I choose ONE of the following two options) 780 CMR TABLE 6107.1 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA FOR NEW ONE- AND TWO-FAMILY BUILDINGS MAXIMUM MINIMUM Ceiling or Slab 1: Basement -Option Fenestration exposed Wall Floor Perimeter U-factor floors R-Value R-Value Wall R-Value AFUE IISPF S131R R-Value R-Value and Depth National Applimice Energy R-10, Conservation Act(NAECA)of .35 R-38 R-19 R-19 R-10 4 ft. 1987 as amended,minimums or greater as applicable Note: This form is not required if you choose either of the two.versions of REScheck as,listed below, ❑ Option 2: �. REScheck Version 4.1.2 or later variant software, analysis must be completed 780 CMR 6107,3.2 i RE'Scheck--Web which can be accessed at httn://www.energycodes.gov/reschccld DDZTIONS'OR ALTERATIONS TO`EXISTING BUILDINGS.OVER 5.-YEARS OLD* *Buildings under 5 years old must use option#1 or#2 in New Construction section above. Complete the following formula to determine the % of glazing: (a) Gross Wall & Ceiling Area equals Formula: (100 x b _ a) SF 100 x — _ % of glazing (b) Glazing area equals. 'SF b a If glazing is <.40%o tise.the chart below. If.glazi0 :is:> 40.% proceed to "SUNROOM" section 780 CMR TABLE 6101.3 PRES RIIP IVE ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTING LOW-RISE RESIDENTIAL BUILDINGS MA- MINIMUM Fenestration Ceiling and Wall Floor Basement Wall Slab Perimeter U-factor Exposed floors R-Value R-value R-Value R-Value R-Value and Depth .39 R-3 7 a R-13 R 19 R-10 R-10, 4 feet R-30 ceiIin insulation m e used in place of R-37 if the insulation achieves the full R-value over the entire ceiling area(i.e.not co ssed over exterior walls, and including an access openings). ❑ SUNROOM An addition or alteration to an existing building/dwelling unit where the total glazing area of said.addition exceeds 40% of the combined gross wall and ceiling area of the addition. Note:. Owner to fill out Consumer Information Form (found in Appendix 120,P) Eli d '�OYY!/I72O'JZIIICQ�CIZ dL s' oard of$uildi �/�aaaaclivarCta "ding Regulations and Standards '' L Board of Building Regulations and Standards x Construction Supervisor License I Lice e. CS } M CONTRACTOR ME IMPR OVE ENT NT 98120 on Registrati \ 133704 O ; Exp adon 9/1'0/2Oil E piration Tr# 98120 I i X -7/31/2009 Tr# 264053 t' g 1e t ct (a( r Type DBA JAMES- € I • MCMORR�tJ�j/I/ x'' f/=. � � JFM CONSTRUCTN IO 17 CIRCLE DR, le, t � j JAMES MCMORROW� fiYANNIS,MA 02601 �_ 17 CIRCLE DR HYANNISPORT1 /"t Commissioner , MA 02601 Administrator • -" _.-_�__.a..a.sv.�..-:+r, _ .' � ..-rtox.i .. -f'.✓.f - -t�%.,s.aLS-G �-��=- -+;fix s£�-� ,�.^1C-�.,; _•`iT---•... - r �a License or registration valid for individul use only a before the expiration date. If found return to: a Board of Building Regulations and Standards One Ashburton Place Rm 1301 + Boston,Ma.02108. s. Not valid without signature a AUG-25-2008 09:45A FRON:SCHLEGEL SCHLEGEL IN 15087710663 T0:15083980836 P.1 ACORD r, CERTIFICATE OF LIABILITY INSURANCE 08/25/2008 PAaau eIT THIS CERTIFI A t UED AS A OF INFORMATION SCUT GEL INSURANCE ONLY NO RIGHTS UPON THEA 34 1-%IN ST HOLDER THI1,101E 1FICATE DOES, NOT AMEND, EXTEND OR ALTER THE AFFORDED .BY THE POLICIES BELOW. �IE8T. YARL�DUTEI, MA 02673 INSURERS AFFOR OE NAIC1lialRm .. - INSURER A COLONY GE ' James rrow DBA JITM CONSTRUCTION INSURER a: ZURICH 17 Circle Drive INSURER C: - INSURER D: - Byannia, HA 02601 InsuRERE: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FO THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT O:-WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERON IS SUBJECT TO ALL E TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICYIEFFWnVff POLICYImRATION UYTa L111 eiAllo "T:YK OF OtaIAANCE POLICY IrlfaO OA= OAfG wuQRlw) A GAMEMUAMUTY GL3326473 05/01/2008 05/01/ )09 EACHOCCURRENOE 11,000,000 X COMMERCIAL GENERAL LIABILITY PREMSEB(Ee oceuenn) !1 OO,000 CLAIMS MADE a OCCUR - MED EXP(AIq on9 PON=) !5,000 PERSONAL A ADV WURY S1,000,000 J GENERAL AGGREGATE 12,000.,000 GENL AGGREGATE LIMIT APPLIES PER: _ PRODUCTS-COMPIOP AGO s2,000,000 POUCY JEC7 LOC AUTOMOULN UJARILITY - COMBINED ANY AUTO - (Es etldeA)SINGLE LIMIT S ALL OWNED AUTOS - ----.--- BODILY INJURY SCHEDULED AUTOS - I (Pow Psnen) HIREDAUTOS - i BODILY INJURY ! NONwOWNED AUTOS I (Per seddele) PROPERTY DAMAGE ! (Per ecddwd) GARAGE IHWUTY AUTO ONLY-EA ACCIDENT ! ANY Aura OTHER TUN E11 ACC 1 AUTO ONLY: AGO 1 - ElCEyhUMARS"UANUTY - I - EACH OCCURRE WE 1 .. OCCUR CLAIMS MADE - - i AGGREGATE 9 _— LLLJJJ 1 DEDLenBLE RETENTION ! !- H vlolluRacaRFw�AnaeAND 6ZZLTS-7982S18-1-08 06/28/2008 06/28/ 009 X roRGy5 IT- ER 9w1ROYERT LIARLRY ANY PROPRIETOIWARTNER/EXECVTIVE - EL EACH ACCIDENT 1100,000 OFHCERIMEMBER EXCLUO601 - EL DISEASE-EA EMPLOYEE 1 100,000 fT yes,describe user YE$ SPECIAL PROVISIONS Eeloer - ! E.L.DISFASE•POLICI'LfMTT 1500,000 OT1P,A - - ; 1 OC"FnON OF OPERATIONS/LOCATIONSU VENICLET/EKCLUSMW ADDED BY fiNDORNMOff I11PaA1 FRwacks- THE WORKERS COMPENSATION POLICY DOES.NOT PROVIDE COVERAGE FOR DAMES 5 .. CERTIFICATE HOLDER CANCELLATION TROI§w STARR 9*1" ANY OF THE • DEWMBED FOUCIO SE CAANCE L ED SWORS THE EKRRATIOH -17 TODD RD - OATH THEREDF, TW I INAA R WILL DIOEAVOR TO ML 21 DAYS VWUTfm .8. YAMVUTR, NA 02664 NOTIM TO TM COml,u NDLLETI NWED TO TIae LUST, WT FAWRE To DD 30 ISIALL IMMSE NO OiSUGAT= OR UANUTY aP aN THE INaAIPJL ITS AGENTS eS . - - REFRSIIB�RA iFM# 508-398-0836 AUTHOR EnRMMEM3" r ACORD 26(2001l08) Z ACCAD covoRATRW 1 I� ItEMODEUNG 17 CIRCLE DRIVE ® Iri1kAN -IS, MA 02601. -Date 9110,008 p77�-160� i'ngoif;e # 307 john When 55 Irvin Ave Hyannisport MA Ternis Due Date 911111TO08 NO% I'MI-IMNt ' y. .;. - aF r•�rt�r S Durn ter Disposal Fes arvi Dumpster Eli Cost (I. Painting Drywall Repair and Painting;install Sticky P'llasbc on All Rugs(537 Per Man Per Hour) Ptus Materials III Cast Carpentry Time jW Per Man Per Roar); InstaN Crown in Kithen iI.QQ Gi Build Frame For Counta�p and Laundry Machines; Remove and Replace RoBt n Nymd Found DuriN Instfatlat.on of Wi6dovm Carpentry install Pella Replacement Winch's $150 Per Window Carpentry Install LM. a pelt.a New Construction W lndowss $500 0.00 000 Per ftndow Unit Permit At Cost C 00 . 0 ,9l, Rayrrter:?.�,�t�r�dtµs x0.n_0 `.ra. w�J. t Town of Barnstable *Permit# _ 1,� peaiw 6'monthsfrom issue-date lor Regulatory Services Fee ems' Thomas F. Geiler, Director aartnsrn ass 4 2008 Building Division PrEn �F?NSTABLE Tom Perry, CBO, Building Commissioner. 200 Main Street, Hyannis, NIA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 5087790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint, Map/parcel Number C26 d(09 Property Address [VResidential Value of Work Min rnu m fee of$25.00 for work under M00.00 Owner's Name & Address ItSvlA/ Contractor's Name_.� G( � C yr, _Telephone.Number_ 'K 7. d LO, Home Improvement Contractor License#(if applicable) 133 3� — P<rkman's Compensation Insurance Check one: ` ❑ I am a sole proprietor Vmthe Homeowner ave 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 ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders. U-Value (maximum .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 Property.Owner Letter of PermiI�t`� a: �-- A copy of the home Improvement Contractors required. , SIGNATURE: Q:\WPFILESTORMSIbuilding permit fornsEXPRESS.doc Revise020108 RUG-25-2008 09:45A FROM:SCHLEGEL SCHLEGEL IN 15097710663 TO:15083980836 P.1 A'CORD CERTIFICATE OF LIABILITY INSURANCE 108/25/2008 �00 A 1 UED AS A MATTER OF INFORMWON SCHIEGEL INSURANCE ONLY AND CONF NO RIGHTS UPON THE CERTIFICATE 34 HAM ST HOLDER THIS C •IFICATE DOES NOT AMEND, EXTEND OR ALTER THE OE AFFORDED .BY THE POLICIES BELOW. WEST. YARMOUTH, MA 02673 - INSURERS AFFORDING OE NAIC* ut1LAID INSURER A: COLONY IN CE James McMOrron DHA JFM CONSTRUCTION INSURER 0: ZLIRICH 17 Circle Drive INSURER C: INSURER D: Hyannis, MA 02601 INSURER E. COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE F THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREEN MT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT O WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL E TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIM11B SHOWN MAY HAVE BEEN REDUCED 13Y PAID CLAIMS. Lim siwRD 'TYROPDWMNCE IbIILV MABO FouE EFFernve !DDATO OW TION LRRs A GOIDALUATUTY GL3326473 05/01/2008 05/01/ i 09 EACH OCCURRENCE $1,000,000 X Comma ma a GENERAL LwalfTY CAWIZI PREFAES(Ea oeaa.an) 1100,000 CLAIMS MADE a OCCUR HIED EAP(Arty an PMM) 35,000 .. PERSONAL B AM INJURY 31,000,000 GENERALAGOREGATE s2,000,000 OENLAOOREQATELIMR APPLIES PER., - - _ PRODUCTS-COMPIOPAGO $2,000,000 POLICY j;& LOC AUTMWMISLUWUTY - - - COMBINED SINGLE LOHTT s ANY AUTO (Ea ttdtlers) ALL O1AMEO AUTOS BODILY INJURY 1 SCHEDULED AUTOS (pwDaraae) HIRED AUTOS . BODILY DYURY s NON•ONMED AUTOS I, (Par aee(drd) PROPERTYRA/MCE s . (Par aeditt) oAlUloB�AUTO� AUTO ONLY-EA ACCIDENT s ANY OTHER THAN Es:Arc s Aura ONLY: .AGO $ ECCFIII&ARHRILLA W W Lm - I EACH OCCURRENCE s OCCUR CLAMS MADE f� AOOREOATE 9 II s DEDUCTIBLE RETENTION B ss mm c wpv,.A,mmo 622US-7982918-1-08 06/28/2008 06/28/ 009 X TORYLIAAITS ER rn 1YEWROPRI�I ANY PROPRI EL EACH ACCIDENT 1100,000 ETORIPARTNER/ELSECUTNE OFFICERIMEMBEREXCLUDED? - ELOISEASE-EAEMPLOYEE 1100,000 B yea.aasam tMr YES - SPECUIL PROVISIONS below E.L.DISEASE-POLICY LIMIT 1 500,000 OTIM I DFaCIwFTIM OF OPERATION I LACATt=I VBRCLES I EEDLUSM ADDED BY STDOwtalE r I iFWAL PRWROM THE WORKERS COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR JAMES CERTIFICATE HOLDER CANCELLATION THOMA3 STARR SHOULD AW OF THE DEr I%ED FOUCI0 U CANCELL® wlOw THE SPIRATION 17 T(mD RD DAT6 "UNUMP, M I 12UM MULL VIDFAVOII TO PAIL 21 oAYs WRITTis1 S. YAM40UTR, MA 02664 tlOnCE TO THE COMAGATE NM= NNEO TO TW LET, WT FAILIM TO W SO STALL IIM'Osi NO OLIYCATON OR NAAWW OF TM DisuRER, ITS AQW3 Ow REMHwBJTA FARM 508-398-0636 AurNOIwTfDREFItE!@Ir ACORD 26(2001109) VACORD CORPORATION 110 l� fl -, r .. �'!e viariawmusect/.li o�� aaac�uieel7a IL Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR l Registration,; 133704 Expiration 7%3l/2009' Tr# 264053 `4# r JFM CO NSTRUCtTION . JAMES McMORROW�� ��•t 17 CIRCLE HYANNISPORT,MA 02b01'"f Administrator op— Y - �• -.�1 '�R 'tit - License or re H� before gistration valid�+ the eX it for individ Board ofB P ation date. Iffou ul use only. Building Regulations and return to: One Ashburton Stan ' Boston place Rn,1301 dards Ma.02108 Not valid without si gnature g � ✓1ze 'C�ammeovuvegl� of i,/�q��daeQa Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR RegistraUon�133704 Expiration 7/31/2009 Trlt 264053 ype DBA JFM CONSTRUCTION t JAMES McMORROWx 17 CIRCLE DR. HYANNISPQRT MA 02601 "Administrator y�. License or registration valid for beforde fe expiration date: Ifndividul use only ti4 Boar One Building Re found return to: Boston,shburton Place R►n 13ps and Standards . Ma.02108 1 �i Not valid ��✓ without signature r 93;23f 2008 '8:8G e 7 =:SCE [15 r R(N�FING s SIDING a ItEMODE NG 17 URCLE DRIVE ° HYANNIS, MA 02601 Date 9111'2008 �m77�-t6tl� €€ZitsJ4f.� # 307 Jahn Wilson 955 Irving Ave Hyannispor°, MA Terms Due [date 91,<:7008 DurnWer Disposal Fees and Dumpster At Cost .obi) Q,'0 01 Painting Drywall ®pair and Painting.Install Sttcicy Plesbe on Ali Rug6(337 Per Man Per Noun) PIUS Mstvials 4 Cast Caroantry Time($48 Per Flan Per How); Install Crown in Kit n- 0 Build Frame For Countm and Laundry Machines; Remove and Replace Raftn Wood Found During Installation of W mows Carpentry Install Pella Replacement Window Q$150 Per Window 01jo 0'G0 Carpentry Install Large Pella New Construction Windows $501) 0.00 000 Per VV!ndcw Unit Permit At'Coat C 00 1.}�K) ,r 1 otaI Balance Due 524.240:50 17°d LGZ9 'VC099 djC):i,' qCj t,-O d3 l I a• PERMIT PAYMENT RECEIPT TOWN OF BARNSTABLE BUILDING DEPARTMENT 200 MAIN STREET HYANNIS, MA 02601 DATE: 09/23/08 TIME: 16:34 ------------------TOTALS----------------- PERMIT $ PAID 25.00 AMT TENDERED: 25.00 AMT APPLIED: 25.00 CHANGE: .00 APPLICATION NUMBER: 200805327 PAYMENT METH: CHECK PAYMENT REF: 444 },V The Cornmonwearth of Massachusetts Department of Industrial Accidents' Office of Ilrnvestigations 600 WashineDn Street Boston, MA 02111 - www.rrzass•gav/din Workers' Compensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers A_ licant Informafion Please Print Le�bly Dame (BusinesslOrkanization/Individual): �antiA Mtl, City/State zip: �J Plione.#: Are yo n employer? eck the appropriate box: Type- of project(required): 1. I am a enoploycr with 4. ❑ I am a general contractor and I 6 ❑New construction employees(full and/or part-time).* Svc wed the stb-contractors 2-❑ I am a sole proprietor or partner- ��on the attached sheet 7. [�.R modeling ship and have no employees These sub-contractors have S. ❑Demolition employees and have workers' working for me in any capacity. 9. ❑Building addition. . [No workers' comp. msrrtanl c comp-insurance.# S. [] We arc a corporation and its 10.0 Electrical repairs or additions rtgnrt--]I] officers have exercised thr:ir I l.❑Plumbing repairs or additions 3.❑ 1 am a homrov=r doing all work mysr-LE [No workers' c 'rap. right of exemption per MGL 12 n Roof repairs mcrrranCe Ic c_ 152, §1(4), and we havc no qd_] t employe workers' es. [No 13.❑ Other comp.in urancC required.] `Any applicant that cheers box# Mar ,ust also fit out the section below showing their woiicrrc'comprnsat?on policy inf—atimL t Hrnnwwnert who submit this afdavit indicating fey arc doing all work and then hire outside contractors must mbnit anew af5 av-itisdicating avrh IC-=trac1nrs that check this box umst attached an additional shoot showing the name of the sub-contractors and stdtt whether or not thorn entities have anployccs. if the sub tontract�rs have ccuployas,.th y must providh�cir a rni rss'comp.policy nwnbcr. I am an employer that is provilLng workers'compensation%nsurance far my employees Helary is the poUry and jab site information. Tn urar,cr.Company Name: Policy#or ScLf--ins.Lic. #: CQ 2 Z� "' / / 11 /'1 �— b�ahon Datc: �. Job Site Address: City/5tatc/Zip: .O. Attach a copy of the warkers' compensa " n po 'cy declaration page(showing the policy n er and expiration da Failure to sccurc coverage as required undzr Section 25A of MGL c. 152 can lca:d to the imposition of crinlirial penalties of a 5nn rip to S 1,500.00 and/or one-year i :iprisonmcnt, as wc11 as civr1 pcna-ltics in the form of a STOP WORK ORDER and a fir of up to$250.00 a day against the violator. Bc advised that a copy of this statc=Tit may be forwarded to the Office of Investigations of the DIA for ineT7ranr_e coves e vcrtfi.cation I dv her certrfy under the pains-and pena dzi of perjury th.af the.information provided above is true and correct Si c: L 2 Datc: r� — Phone#: O tidal use oily. Do not write in this area, to be compl*ted by city or town officiaL City or Torun: PermitlLicense# Isstung Authority(circle one):. 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Phone#: . THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA 24 08 09:34a H PC 6503475017 p,1 l � • i � l 330 Primrose Road, Suite 504 FAX TRANSMITTAL Surlin.garne, CA 94010 - 650.347.5757 office 650.347.5017 F,uc DATE: 650.270,5757 Cell TO: Fax Number: Phone: Ref: Number of pages including corer: ' FROM: L�- ,�� Fax�Number: . Phone: ' -L�1:.- �.i/-Z� Lc/�'. _.•�. j�•�..� ,ice; e_, �/.. �-+�: �. _r. C� ,�C' _���_> - •_ E i Jun 24 08 09:34a HPC 6503475017 p.2 Jul] ru %10 ru.wra nr-%, uaw4rwi r N.c Town of Barnstable �� dAFlISTBE.E . Regulatory Services ZQO� JUN 25APB 9: 47 Jaws. Thomas F.Geiler,Director Building Division Thomas Perry,Building Commissioner ------ GIV -- t 20D Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 June 6,2008 Mr.John Wilson Hyannis Port Capital. Inc. 330 Prim--rose Road- Suite 504 Burlingame, CA 94010 Dear Mr. Wilson, I am returning your Express Permit application for 151 Irving Ave.Hyannisport since it does require a Historic approval. I sent you a fax memo in January and have not heard back Gorr you. If work is going on at your home now,it is being done without a permit. Should you require additional information,please.do not hesitate to contact meat (508)862-4026. Thank you, Jennifer Engelsen Division Assistant Fax Memo to: John Irving From: Jennifer Engelsen Town of Barnstable,Building Date: 1/8/08 RE: 151 Irving Ave, Hyannis Please call me at (508) 862-4026. I am in receipt of your Express Permit Application and unfortunately you are in a Historic area and an approval is needed from that Department. They will just want to be certain that you are changing like for like. You need to speak with Patty Mackey. Also, where should the permit be mailed after it is approved. Thanks. Y oFTME rati Town of Barnstable Regulatory Services * snxtasTaa[.�, y MASS. g Thomas F.Geiler,Director i639• 039 ° Building Division Thomas Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 June 6, 2008 Mr. John Wilson Hyannis Port Capital. Inc. 330 Primrose Road, Suite 504 Burlingame, CA 94010 Dear Mr. Wilson, I am returning your Express Permit application for 151 Irving Ave, Hyannisport since it does require a Historic approval. I sent you a fax memo in January and have not heard back from you. If work is going on at your home now, it is being done without a permit. Should you require additional information, please do not hesitate to contact me at (508)8624N6. Thank you, Jennifer Engelsen Division Assistant M I Town of Barnstable *Permit# Expires 6 months from issue date Regulatory Services Fee. Thomas F. Geiler,Director Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number c 0 :7 0 L 72� Property Address esidential Value of Work �V Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address �� , Soy\ Contractor's Name V "` Telephone Number Home Improvement Contractor License#(if applicable) l J� Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check q a sole proprietor -PRE SS IT ❑ I am the Homeowner S EP 2 4 20�7 ❑ I have Worker's Compensation Insurance Insurance Company Name TOWN OF BARNSTABLE Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) i I ❑ Re-roof.(stripping old shingles) All construction debris will be taken to (�j�t ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ? Replacement Windows/doors/sliders. U-Valued *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note Property Owner must sign Property Owner Letter of Permission:-' ` ? ;,,- A copy of the Home Improvement Contractors License is required. c SIGNATURE: Q:Forms:expmtrg Revise061306 � 3 IL The Comanonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 , ' www.m ass.gov/dia Workers' Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organize.tioa/Individual):. ()'�i yy1 -` S G �✓t/l s Address: i✓� City/State/Zip: Phone.#: Are you an employer? Check the appropriate box: -Type of project(required):. I.❑ I am a employer with 4• ❑ I am a general contractor and I employees (full andlorpart.time).* have hired the sltb-contractors 6. ❑New construction . 2. m a'sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g• (l Demolition working, forme in any capacity. employees and have workers' insurance.$ 9 []Building addition co [No workers' comp. insurance �• required.] 5. [] We are a corporation and its 10.0 Electrical repairs or additions '3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL ' 12.❑Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' ..13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their wcrkers'compensation policy information. t Homeowner;who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional'shect showing the name of the sub-contractors and state whether ornot those entities have employees. If the sub-contractors have employees,they must providts their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name:_ Ca z:Zt� �. !^ iJ .i YS I <i� -- Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip. Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date), Failure,to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification I do hereby c fy;ruder the pains•and penalties ofperjury that the information provided above is true and correct Sienature. Date: Phone#: FOther only. Do not write in tl:u area,'tb be completed by city or town official n: Permit/License# hority(circle one): Health 2.Building Department 3. City/Town CIerk 4.Electrical Inspector 5.Plumbing Inspector l son: Phone#: 09/24/2007 09:22 007 PAGE 01 J M t;ONS'1RIA"JITION II(K)FING - SIDIN(I'l - REMODELING 17 CIRCLE DRIVE • HX,ANNIS, M.A.02601 Date 9/20/2007 508-771-1608 Invoice # 157 John Wilson Irving Drive Hyannisport, MA Terms Due on receipt Due Date 9/20/2007 010 �s:�B lam. ��,� �.�,i Q40 Carpentry Remove and Install 37 Windows With Anderson 400 38,650.00 38,650.00 Series(Pre-Finished White Interior)With Screens and Grilles; Replace Exterior Window Trim and Interior Trim Where Necessary; Apply 2 Coats of SW"Duration"to Exterior Trim;Apply Two Coats Of SW Semi-Gloss to Interior Trim; Dispose of All Debris Carpentry Time($48 Per Man Per Hour) Plus Materials: Remove 0.00 0,00 Shutters and Hardware-, Repair Any Rotten Wood on Shutters; Install New Galvanized Hardware and Re-Install Shutters; Any Extra Labor on Bathroom Window (Surrounded by Tile); Remove and Install Cedar Shingles Where Necessary Total $38,650.00 Payments/Credits $0.00 /i% Balance Due $38,660.00 I Board of Building Regula ions and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement:,Contractor Registration Registration: 133704 Type: DBA ~ Expiration: 7/31/2009 Tr# 130177 JFM CONSTRUCTION �' a JAMES McMORROW ' 17 CIRCLE DR. a _ HYANNISPORT, MA 02601 ' Update Address and return.card.Mark reason for change. DPS-CAI is 50M-05/06-PC8490 ❑ Address Renewal 0 Employment Lost Card f . J— Eti t ' r h lC Mr , a Q ki 77 Assessor's map and lot' number .: .. ...�r��`.. ��/_ C�� f- L�- '• SEPTIC SYSTEM! MUST! BE IN STALLED' IN COMPLYANCE c Sewage Permit number .........�� . .. . . . .�P�./! ...... `, WITH ARTICLE it STATE �.y ' �``✓ / ' SANITARY CODE AND TOWN, �o`TNETo TORN OF BARN19fvAOB•LE Z 2 STADLE, i w aY -BUILDING INSPECTOR APPLICATION FOR PERMIT TO 604.'j?04�p�....../1 c!�.� !�4.f'6 t�Y c?.......:...... .. : ...................TYPE OF CONSTRUCTION !1 ...�.«li - c?z ......:.................. ................... .. ..............:.. ...............19..�. TO THE INSPECTOR OF BUILDINGS: _ The undersigned hereby applies for a .permit according to the following information: Location ..`...... ia nJCrts :....:�� ! ��......................... � .......................... ProposedUse ...... ......X......................................................................................................... 1r ZoningDistrict ........................................................................Fire District ;......... ....... ........................................... Name of Owner ...... 2�°"�' (( � ` � .... Address �. %...��n ...... ..-c P-� ........................ .............. :...........4'� Nameof Builder ....................................................................Address .................................................................................... Name of Architect ........... f z u�....... Us f{........................Address .......4.E... a 1- Y1..... &/ t - Number of Rooms � .Foundation ..........:......................................... y G • Exterior ,...............:.................................Roofing ......... ...................:................................. Floors U ...................:.............................,..........Interior ........... ��tc `.. . ..... �w Heating ..........j.....................:......................:..........................Plumbing '.......s .. , G �� Fireplace ........./.O.� . .........................................:..................Approximate Cost ...1 ........ ........................................ Definitive Plan Approved by Planning. Board ________________________________19________. Area `f- .-' �.......... jj Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnsta le re rding the above construction. Nara .......... . .... ......�.. . ............................... Bruso, Bernard R. 18916 remodel frame No ................. Permit Pori .................... ........... dwelling - I , .. wt Location(/ ...IrvingS .... �./• .......... ` Hyannisport .................. Owner ...........Bernard R. Bruso ..... .... ....... .................. frame Type of Construction Plot ......... Lot ................................ "^ January. 24' -• 77 - Permit Granted ...............................:.........19 � iz..Date of Inspection ... .. .. ..................19 Date 'Completed krz .L....+ . ..........19 t PERMIT REFUSED ..................:.............................................. .19 . ................................................... .....r................. _ r r r .............'.................... �...................1 �' ¢ i ` ........................ .............. ....:..... `................ F F , } .......................................................... .................. •��` ! Approved ...................................f .. 19 .........................................:................................... ............... ................................................. .... ♦.. _ .!' .. � ....... , n . � .. .� � , T �- .. �r-l�.r+.'"�,�.y�l.. ,1 f.t , n.i ry•,�.' v'Z'�.r^.Jri'TM 'CT' - ♦ ti.�. Assessor's map and lot number ......... ...... ......................... L.__ Sewage Permit number ........ ............�� .�.t�-, T"ET , TOWN OF BARNSTABLE Z BAHH9TADLE, "6 BUILDING : INSPECTOR am a' �-1'1.��. "�0 ... .�' n.. ... •r ii . APPLICATION FOR PERMIT TO ...............:...................:........................................ , TYPE OF CONSTRUCTION ... - .?.........{.....r..: ^............: .:. ............................................ C/ � 1 ..... ................... 19._ TO THE INSPECTOR,OF BUILDINGS:, The undersigned hereby applies for a permit according to the following information: Location r . .. ./..... . ProposedUse .............�......:!...'............. ................... .................................... .................................................................... /r 1 ZoningDistrict ........................................................................Fire District ..........,..............:..................................................... r Name of Owner ..... `::.:�''='_trs� /l .�{r— Address ........./2.9 r�.n.r.< . .�<� ........"'?�.�:...... .................................. ................ t/ ............. Nameof Builder ....................................................................Address .................................................................................... Name of Architect ..'t `�•�,� S'A �f �r n yrn /i�r .................................................Address ............... ........:..... ........... .......... Number of Rooms �'�� .....................................Foundation .......:^ ..................... .................................................................... Exterior >>Dctr.�_ .............. .:..: :.: ' '...................................................Roofing .......... Floors `. ..............................................................Interior ��! Heating -v?. ............................................................Plumbing ...... h.:':... ..:.. 9J...................................................... U i Fireplace ......... :. . 1..........................................I..................Approximate Cost ►'G- .................................:.:.. Definitive Plan Approved by Planning Board ________________________________19________ . Area`......................................... Diagram of Lot and Building with Dimensions Fee � SUBJECT TO APPROVAL OF BOARD OF HEALTH / �f I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ................ ...... ...................................... Bruao, Bernard R. 87 � 18916 ^ ame remode No ------ Perm� {co��..����.�� .............. ` .dwalliog -------.-------.----.—..--.—.. . rvin ^.~.. 'r�� .~' ~-----.-.,--~—'-."------ - dymonl t ... ......----------.—. . ��vvne, ------- ' ��------- ^x,~ of Construction/ . . . ^ ,"° Lot . - J/anua 24 77 ' ` Permit Granted ' Date of wq/e Completed ' . ~ . , ' PERMIT REFUSEd ^ ' — . . ........................... ....... ' ' . . g / . . ----.--,....�—^—..—.---.-.' . ~ App,oVed .............................................. lA ' � ' � -----^---.�----.......---~...--�. � . -------`-------------~.^—.~.,. . ' � - � . L_ � ` I I-v L-"A'ssessor's offioe (1st floor): � THE Assessor's map and lot number ..... G1.`./ ......!/.(V�... �' I� ��ST�� ���T °F T°�♦ hoard of Health (3rd floor): (!5j,-,STALLED IN COMPLIANC'_ Sewage Permit number .................................................:...... WITH TITLE 5 t EASd9TADLE, MAX Engineering Department (3rd floor): NWIRONMENTAL CODE AE'�n '00s�039. House number 'Fp�pYa�e +............................:.... TC N REGULATIONS APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00"P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .........Inter.............ior...................................Renovations..............:....................:.............................:.. TYPEOF CONSTRUCTION .........................................................................................:..............:............................ February..2 0.,.--..--.._19...8 7 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....155...Irving...Avenue ...Hyanai p.ax t..,.:.MA.:..:................................................................................... Proposed Use .................. . .......... ................... ... .:.... ZoningDistrict ............ ..........................................................Fire District .............................................................................. M4A¢ C OA,M A4 4'g P0&^j t« Name of Owner Hyannis Po.rt. ....Trust.................Address .................................. .... .. . ....... Name of Builder ....Michael F. Burridge ...Address ........97 North Street , Hyannis , MA Name of Architect .,Julian J. Borowko 10 Industrial Park Rd . Hingham, MA .............................................Address .................................................................................... Numberof Rooms ..................................................................Foundation .Br,ic.k................................:................................ Exterior .......C,lapboards...................................................Roofing ......Asphalt.....................:...................................... FloorsWood...................................................................Interior ............... Heating ......................................... ............. .............................Plumbing .......................................................................7.......... 0 Fireplace .................................................................................proximate Cost ........ld..600".Q�400%e( � ................................. Definitive Plan Approved b Planning Board ________________________________19________ . Area pP Y 9 Diagram of Lot and Building with Dimensions Fee °................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations:-of/thhe wn of Barnstable regarding the above construction. Nam .... .... ........ MICHAEL F BURRIDGE r 004376 Construction Supervisor's License M.ACPHA-i-L -HALCOLM '.3JYANN--1.S POR`T� TRUST No Permit for ..!NTERIOR RENO'JATION.................................. Si ��Milv Dwelling ......... ..... ..................................... Location .....:A5.�.,.Jrying Avenue ..................................... H y an n i s or t ......................................................... Owner Malcolm MacPhail, Hya-nnisport .Trust',.� .............I.............................I....................... Frame Type of Construction .......................................... ................................................................................... Plot ... ..................... Lot ................................ 87 Permit Granted .........................................19 30 . .........19 ......................... Date of Inspection ....................................19 'Date Completed ......................................19 M C J W r-1 U."Assessor's offio,e Ust floor): /7 ', THE Assessor's map and lot number ....� .,/......1� ��.....:. Q°� Board of Health (3rd floor): d� o� Sewage Permit number t 33AUSTADLE S ..................................................: Engineering Department (3rd floor): . 'oo rb 9. 0� House number ........................................................................` 0�0�aY d* r APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR" PERMIT TO .....Interior Renovations ........................................................................................................ TYPEOF CONSTRUCTION ..................................................................................................................................... .......February...2.0............19-- $� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....1.5.5...lry _n..cx...A:�r.An.ur'...,....?1.va.n.1?.i.s.s.).c.r.kt..y.N(.,??.MA........................................................................................ Y. � , .... ................Propoed Use ........... ... ..... ........................ o ZoningDis 4trict ....................................�................,.........Fire District ....................................................................:......... /1i114�cdA,AA Name of Owner ... Hyannis Po. rt...Trus.t.:-:. .. .. ....... ..... .............Address .................................................................................... . Name of Builder ...Michael F. Burridge ..Address ......297 North Street , Hyannis, MA ........................... Name of Architect „Julian J. Borowko ..........Address .......1.0....Industrial. . . . . . . ...Park. . ...Rd. . Hingha. . .m, MA ....................................... .. . .. .... .. . .. .. .... .. .. .... .. .. ............... .. .... . Number of Rooms ..................................................................Foundation Brick................:. Exterior ......Q!4P)?9 girds.....................,.........................:.'..Roofing ......Asphalt...................................................... Floors Wood .,,,..,,Interior`` ................................................................... . >................................................................................... Heating ..................Plumbing Fireplace .......................................... .................................... Approximate Cost ...�...........!.............!. Definitive Plan Approved by Planning Board _________________________ - ------�9-------- . Area ................... .... .............. Diagram of Lot and Building with Dimensions Fee ............................................. \ SUBJECT TO APPROVAL OF BOARD OF HEALTH t . 1 F OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. � r Name ... MICHAEL F. BURRIDGE 004376 ..Construction Supervisor's License .................................. MACPHAIL, MALCOLM HYANNIS PORT TRUST =287-068 30585 I TERIOR RENOVATIONS No ................. Permit fo .................... Single Fami' Dwelling Location �...Irvin. . . . .g...Avenue. . . .......... ...... ......... . .. .. . .. .. .. .... .. .... . Hyannisport ........................................................ Owner Malcolm MacPhai1 (Hyannis Port Trust) . .................................................................. Frame 'i Type of Construction .......................................... E ............................................................................... z . Plot ............................ Lot ................................ y March 30 , 87 Permit Granted ........................................19 Date of'Inspection ...........................:........19 DRee Completed ......................................19 poa e R 2 81 7 1 Q 6 81 A F P R A 1 S A L D A T A KEY 190144 ENT a S 'fi FEDERAL -AVINGS BANK LAND BLDIFEATURES BUILDINGS NUMBER ZN/FL=FF- .1 1 ,576.,500 16000 1 .15515,800 2 A-COST 3.,4148.,600 S-M K T 1 ,788.,300 BY 00.11, B Y R f4l 8 C-INCOME FCA=1,,j.1.', F C.5, 0 SIZE= 7924 JUST-VAL 05148,600 LEV=406) CONST.-C cl FAR 1_`�Om TO CONTROL AREA 5%IA --nAY NOT BE COPIFARAE.L-P-- NEIGHBORHOOD 590A HYANNIS FARCEL CONTROL AREA 2REND STANDARD 15] 15 LAND-TYFE i 5 76.500< L",AND-r'2E AN 31486,00-, IMPROVED-MEAN .4-0% 5 J .J COCATION-ADY TAT 1 - Q AFFLTY �.-VAr-�j LNR'AND LFT/'I MP]ADJSISB/PEAT SIR ISTRUCTURE ARR,';.ARE,!M�-nEA�-CREr�EliTS NOR]NO-ES j L. - A COPJAARKET FPIRTFERPITS GRR]GRAPHIC FUNCTION-f 'I STRUCTURE-CARD NO-F0007 DATA--F J 111'r 77 T FFPTl ACTIONf Rj CARI)f-000j REyr.' 190144 R 21 0 6 E 000000m] FERPIT-NO NO Y 9 TYPE V A L U CpK-BY NO YE -CNP N Er N DEMO COMMENT n [B3051 F03:j CE71 FAVI j 00000 ;-GR 1 1-011 [88' F1003 f NEV j f HP REMOD,L f i f i J, I r I I f J f 7 L f I J J ,f( L J L I f f J f j I I f f f -i J L f J L TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION . ���''bj� fK�"j d •(/'�T"•��� /�C�-a/,ez/s/✓t� . Map a 0_? Parcel U69 PS 'IKGGTA .L -77.` ` - Perml# Health Division 25 -9ro �9 a a ra �Dafe.lssued Conservation Division F'ee, ., Tax Collector ' Treasurer Planning Dept. ' Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 15f Irving Avenue' Village Hyannis Port . Owner Mr. John Wilson Address ' 155 Irving Avenue , Hyannis Port Telephone 7 71-4 498 ' Permit Request Interior Remodel work — Change wi.ndow8't'Db6✓S Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new AY Estimated Project Cost#In ,onb Zoning District —Flood Plain Groundwater Overlay -Construction Type ' Lot Size Grandfathered: ❑Yes O No If yes,attach supporting documentation. Dwelling Type: 'Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No,. On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl , ❑Walkout ❑Other , .,,, Basement Finished Area(sq.ft.) ' Basement:Unfinished Area(sq.ft) Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing new- Total Room Count not including baths): existing new First Floor Room Count ( 9 ) 9 Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑ekisting ❑new size ' Other: Zoning.Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Residential Proposed Use Residential BUILDER INFORMATION Name B. J. Jaxtimer , Puilder., Inc. Telephone Number 7784911 Address 48 Rosary Lane , Hyannis License-# 003251 I Home Improvement Contractor# 110609 i Worker's Compensation# WC97-695028 ALL CONSTRUCTION DEBR)p RESULTING FROM THIS PROJECT WILL BE TAKEN TO comber' s Dumpster SIGNATURE DATE _ 5 ee-j y < FOR OFFICIAL USE.ONLY PERMIT NO. DATE ISSUED _ MAP/PARCEL NO. - • - t E _ ADDRESS} VILLAGE OWNER' DATE OF INSPECTION: I - FOUNDATION FRAME. : INSULATION FIREPLACE t r ^, f �.s ILL ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL = a 4 GAS: . — _ ROUGH . FINALr 1 ' FINAL BUILDING DATE CLOSED'OUT r ` ` i • > ; ASSOCIATION PLAN NO. " { t y - A Proposal PELLA WINDOWS INC. o y BELL TOWER MALL 1600 FALMOUTH ROAD SUITE#9 CENTERVILLE, MA.02632 a Phone:(508)771-9730 Fax:(508)771-8270 I r r V Cust-imer Project I Ship-10 roposa m . . x mier-Milder a e WILSON RESIDENCE No. WILSON I 48 Ra.ary Lane 155 Irving Lane Alternate No. 1 awe Hyanris,MA 02601 HYANNISPORT,MA 02647 Need Date Barnsable 13ARN Sales Rep.Name Tom Moran Prepared by D.O'Regan E.J.J.rxthner Owner: Payment Terms 20/. 15/Nel 30 � _Rile 14innp•(50Rl 77R-d91 1 A Bus. Rx:(508)775-4909 , Horne Phone. Cellulsc( ) - Or VALL) u si4e�iew RemQfy. ---Descrlpfion--- --" UnLTTrjce`E—wfeitde - Ttcnr#7 QTy--:10--- 2971�1=Egoal•Sash3g.-3u-Top�sbQlit�o�u le 73ung,�rame:29— �92.02 5"9Z Loealion:A X 71:Archilect Series,Clad,Model 2,White,5/8"IiisulShld Temp IG R.O:2'5-3/4" X 5' 11-3/4" Glazing,Full Screen,Brass Hardware,7/8"ILT Trad Special(muntin pallcm: Jamb Depth: 3-11/16" 3Wx2H13Wx2H),Fins(perdesi6u) WallCoud:3-11116" Notes: Item#2 Qiy:4 Fixed Double-Hung,Frame:77-1/4 X 71:Architect Series Classic,Clad, 798.28 3,)93.12 F71Location:B Model 2,White, 1"InsulShld/Clr Temp 6mm Glazing,Fins(per design) R.O:6'6" X 5' 11-314" Jamb Dep1b:3-11116" 1Val(Cond:3-11/l6" r Notes_ 0 P e1of4 4 Q Proposal for Customer E.J.Jaxtimer-Builder Project:E.IJAX11MERAVILSON Quote No.:WILSON Alternate No.: l a sl a 1ew diem - p o escri ton nit rice x enn eel W Item#3 Qty.4 3-wide Casement 1,794.14 7,176.56 c Location:C A:2559 Right Hinge Casement,Frame:25 X 59:Architect Series,Clad, R.O:6'3-3/4" X 4' 11-3/4" Model 2,White.518"hmLLIShld IG Glazing, While Screen,Brass Rardware, � UI B j C i Jamb Depth. 3-1 1/16" 7/8"ILT Trad Special(muntin pattern:2Wx4H),Fins(per design) WallCond:3-11/16" B:2559 Right Hinge Casement,Frame:25 X 59:Architect Series,Clad, ~' Model 2,White,5/8"InsulShld IG Glazing, White Screen,Brass Hardware N 7/8"ILT Trad Special(muntin patlern:2%4H),Fins(per design) o� C:2559 Right Hinge Casement,Frame:25 X 59:Archilecl Series,Clad, Model 2,While,518"InsulShld IG Glazing, White Screen,Brass Hardware, y Notes: 7/8' ILT Trad Special(muralinpatlem:2Wx4H),Fins(perdesign) _ U N Item#4 Qfy: 4 Fixed Double-Hung,Frame:77-1/4 X 59:Architect Series Classic,Clad 759.16 3,036.64 Location: D " --� Model2,While, 1"InsulShldlClrTemn 6mm��la7ir+o F:.,�(..,,.ao..:....� ' w R-0.G 8" X 4' t 1-3/4" a•-._. �r_..._ .b.., V Jamb Depth:3-11116" o WallCond:3-11/16" Notes. Item#5 Qty: 1 Fixed Double-Hung,Frame:109 X 71:Architect Series Classic,Clad,Model Location: 899.32 D 899.32 2,While, 1 IusulShldlClrTemp Gmrn Glazing,Fills(per design) R.O:9' 1-3/4" X 5' 11-3/4" Jamb Depth:3-11/16" WallCond:3-11I16" Notes:Note Confirm size this is are max on frame width. Item#t 6 Qty: 1 Pielure Window Finked by Double HiAnoc 1,405.76 I,405.76 Location:F,G 2171 Vent-Equal Sash 50:50 Top:Bat Sash Split Double-Hung,Frame:21 B c R.O.7' 11-3/4" X 5' 11-3/4" X 71:Architect Series,Clad,Model 2.While,518"IasulShld IG Glazing,Full Jamb Depth:3-11/16" Screen,Brass Hardware,7/8"ILT Trad(muntin patxem:2%--x3H/21'Wx3H) I l WatiCond-1:3-11/16' 5371 Fixed Double-Bung,Frame:53 X71:Architect Series Classic,Clad, J WallCond-2:3-1 1/16" Model 2,While,5/8"ImulShld Temp IG Glazing,Fins(per design) W21lCond-3:3-11/16" 2171 Vent-Equal Sash 50:50 Top:Bet Sash Split Double-Httng,Frame:21 r X 71:Architect Series,Clad,Model 2,While,5/8"InsulShld IG Glazing,Full l Screen,Brass Hardware,7/8"ILT Trad(munlin patient:2 Wx3H/2Wx3H) Notes: 1' r: 0 Proposal.Page 2—of 4 N7 ti Proposil for Customer li.l.Jaxtimer-Builder Project.KLIAXTIMER/WILSON Quote No.. WILSONl Alternate No.-. 1 l u s' a ew em -�—t}•. escrlp ion Item#7 nrt rlce`Ext e Qh' Z 2557 Vent-Equal Sash 50;50 Top:Bol Sash Split Double Hung,Frame:25 448.69 Location:H X 57: Archilect Series,Clad,Model? While,518"InsulShld Tenrp IG 897.38 R.O:2' 1-3/4" X 4'9-3i4" Glazing,Full Screen,Brass Hardware,7/8"IL.T Trad(rnunlin pattem: Jamb Depth: 3-11/16" 2Wx2H/2Wx2H),Fins(per design) WallCoud: 3-11/16" v N NOC@S: m Itern$8 Location:J Qty. 2 2977(E)Vent-Equal Sash 50:50 Top:Bol Sash Split Double-Hung,Fraeoe:29 X 77:Architect Series,Clad,Model 2,'W%ite,5/8"hisulShid IG 561.31 1,122,62 Cn 0 R.O:T 5-3/4" X 6 5-3/4" Glazing,Full Screen,Brass Hardware,718"ILT Trad Special(muntin pat len1: I Jamb Depth:3-11116" I p 3�Ux2Hl31Vx2I3),Fins(per design) � -� Wn1lCond:3-11/t 6" � �� w ry No l es: . Item#9 Qty.- 1 nixed Double-Hung,Frarne:77-1/4 X 77:Architect Series Classic,Clad, = Loention:K Model 2,White, 1"InsuiShld/Clr Temp 6rrmt Glazing,Fins(per design) 817.83 817.83 R.O:G 6 X G 5-3/4" Jamb Depth: 3-11/16" I I WallCond:3-II/l6" Notes: — — Item#10 Qty: 1 Custom Elliptical cirelelread Frame:77.25 x 19.31 R1,14.4S.R2 77.4 Location:Above K 1,670.40 1,670.40 Notes- Jamb Depth: 3-11/16" ------------- Itern#11 Qty: 1 3682 Right Hingc Ia-Swing French Door,Frame:36 X 81-112:Architect �— Location: Series,Clad,Model 2,Brown,5/8"InsulShld Temp IG Glazing,Aluminum I,441.17 1,441.17 R.O:3'0-3/4" X 6' 10" Hinged Screen,Brass Hardware 718"ELT Trad(Muntin pattern:3Wx5H),Fins WallCond:6-9/16" (per design) ' Notes:Liz , t� 0 rapasal- age 3 0 4 � w Proposal for Customer E_J_Jaxtimer-Builder Project:B.J.JAXTA'IER/%7n SON Quote No.:WILSONI Ahen iate No,: 1 IDats-Be view ttem Qty. -Ifescr pi�-ion - - �m rice x ea ed r Ilem#12 Qty: 1 3682 Left Hinge In-Swing French Door,Frame:36 X�81-1/2:Architecr f' Location: Series,Clad,Model 2,Brown,5/8"InsulShld Temp IG Glazing,Alurninum 1,441.17 j�44 j I > i R.O: 3'0-3/4 X 6 10 . Binged Screen, Brass Hardware, 7/8"ILT Trad( P mundn atlein.3NVx5I),Tins . We1lCond:6-9l16" (per design) r V Motes_ -- m Thank You For Your Interest In Pella Products y THIS QUOTE IS VOID AFTER 60 DAYS.Ternis and conditions: This order is made especially for you. No caucellations are possible alter order is placed The Scheduling Dept will call you with your delivery date. We provide tailgate delivery ou window and door orders only nip!m- a.-ra,,.,o A r 116YG(UJ1Jlg11tiLUll.�11tL"6L LLM'C Vl Udive1y. V u U1 civat QAP;;,ctSpaymen[for u.U,U, orders and is not authorized to leave your order withoul it. o Cancelation ofdelivery must be made 24 hours prior of confirmed Delivery date. For Delivery and Service call the Distribution Center at 1-800.888-7355. On C.O.D.orders a 25%d s required. Thank you for considering Pella . r stoner nature -- -- We- �_ L axab�e Subto al — �--- g P11a a resents a igna re (M�► — z�1,0221'71 N —e `--tat 'Uocoo — — —__T4Si:IT —at 00 To `-0:110� lion axaTile�u Tota7 O..001 .0OI Dtv =��_— oral ---- ----- 3a;47381 Date �- eposa eceroe —J1. r Noposa - age 4 0 4 0 r THE r � The Town of Barnstable • ` �nxiysrAat:E -� .. 4 Department of Health Safety and Environmental Services '�Fo rvr A Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner 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. Type of Work: Interior Remodel/New Windows Estimated Cost Address of Work: 155 Irving Avenue, Hyannis Port Owner's Name: John Wilson Date of Application: 4/17/00 I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law []Job Under$1,000 ❑Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: 4/17/00 E#J.Jaxtimer 110609 Date Contra r Name Registration No. OR Date Owner's Name gl6mis:Affidav . 1 The Commonwealth of Massachusetts Department of Industrial Accidents -_ Office 91111 esGgatfons 600 Washington Street Boston,Mass. 02111 Work ers' Co/m�ensation Insurance Affidavit ZITI7fl name: E. J. Jaxtimer, Builder, Inc. location: 48 Rosary Lane city Hyannis MA 02601 phone# (508)778-4911 ❑ I am a homeowner performing all work myself.. ® I am an employer providing workers' compensation for my employees working on this job. comaanyname E J. :Jaxtimer; Builder ,' Tn address :: 48 Rt sa;ry Lane city Hyannis MA 02601 phone#: (qos)77R�acai Eastern Casualt olicv# insurance co. — ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: comaany name• addresst city.. . phone#: #. .<:>:: ,::;<:ii3<i ohcv insurance:cm, coinaany name- .. address: city phone#. >. in�arance co.:.. .. :::.:::.::::.;...::.;.:..:. ;.::: :.....:.::......... Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a tine 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 S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Ofilce of Investigations of the DIA for coverage verification 1 do hereby tern. the pains and pen perjury that the information provided above is true and correct a s * Sigtlaturelf., Date _ Printnatne 47J. Jaxtimer Phone# (508)778-4911 official use only do not write in this area to be completed by city or town official city or town perndt/llcense# ❑Bufiding Depardnent ❑Licensing Board ❑checklf immediate response is required []Selectmen's Office ❑Health Department contact person: phone#; ❑Other Oevued 9/95 PIA) Board of Building egulations One Ashburton Place, Rm 1301 Boston, Maw02108-1618 - License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 01/14/1956 Number: CS 003251 Expires:01/14/2002 Restricted To: 00 ERNEST J JAXTIMER h 48 ROSARY LANE HYANNIS, MA 02601 Tr.no: 13740 Keep top for receipt and change of address notification. x .. ,r .x�ny 2 .•I rt3n r , -s y _ , HOME . IMPROVEMENT CONTRACTORS REGISTRATION 1 'f k , '' • °Board `of Bu`ildi ng Regul'ata o.iis aricl�lS`t'andards: x ,- 44 One ,Ashbur..ton Place Room 1301 �� 4 °t BOs'ton Massach�ise,t.t 02108 ; �W�. aa'�t<. HOh1E`"IMPROVEMENT CONTRACTOR%,. Yr� `+-� -L -- -` ..s;.�:,•..' r YK , % err ` ,_ Rega strati:on110609,. : . Expzra,tion 1 1/.03/;00 , '. IMop , F tv _ N v. >: rr _ - e •s u .bk TOofxmeo�eulealdL•o�./l TTY,Pe PRIVATE CORPORATION` $; zi #x< 3 s E HUM MPRUVEME[dTCONTRACTUR �d. � Try, .v 'r�•-`-Y 7' '�":''� �f,.M - y'.rf�"Sr sc 3,ra .4 b�:.-.�' id`� �A'��3.�„Y'E'Y ° _ �� "'" �"sr.e�r .S` ,�' �6*T',xra.'= - � a 5 j:.� .l ks .""•„Y,y ' .�a�,. x ""' �"w ac3-.,, - t .;1?t k,^ gistration 1I.0609 �. ?,•} ,,i, `r- ;" ,-,;1 ar -# _e s ''a '''7'�,k > k�.^ k ro , :� � _ *ra"agi`th ,[� E J JAXThMER € . " � a �. ,• BULLDER`., SI.NC :.- �' -,� ,�4 :Ty; e FRI�A-TE CORPORATION .e� s� N} .-�_��', �Y,� ��:W,=� ,S€ 3"•2- �- ,, ti. I°,'�i'',A. '^i�' ''a :."�"k•�h.���',�•«,� k'y��d';rt. ' eE:RNEzST � 7AX+TaIMER -;� • yrN, ...,4;:, � .',«�•s- . `�'. a"�' T,a �y�� ..::'sa "�,�:; rrs p•��d��'� yxn.•. ate; ,�- ,�y�.:•. 'n �.1'1:/�.3 .A'?�'�� :7'� ,�a � �. : .--4 . " ",a .5.�.'sF <.� L,s y i r. .�e.:" !`...• •.:r j":*,� ,a .,. r q��k"� ROSA Y rLN �� ._:�� . . ,,�r4T s� ,�$yx 1. a�.... ..a.. >..:,��rrX „- Y ate.``r 3.r n: -�. ,,r •,..� ,ett,�'.. _r, .y-.s. . �..., x.:�uS�i4 _�Y;�, �`�"• -! .:F '`�ix•,T<$ - ...;Sy S ,u 3.4 ! j, vL vk�"s'✓�.. HYA:N:NIS MA, 026 K r � �. k. 0 R, „,� E JJA ME��p i��(,3UIlDE . ,.� ,F .. :':t"+a.,< +i�±..w,•s. "w. --!, .:'�G fir. _ ,?'"Kx- }«�FW ,r�.... a+x '^ t'"#,1; +Yr;'"?` �1G 1..'b,Yx r:a�` �`�:x3 ?. �Y,'4�•.�# t,..i'. s=� ;K ,u.* y^ ,� x m,Y� aS STt J, JAXT' g. r, ` yy., �y. f _ �� ! r• k-' '1 i r"R-F' .n-r, ..�CQ)✓!2p d t d - .A '-*+ a .ce s:. 1 r ADMINISTRATOR '; s, ';" y" 'x '94Y'_ , l 'T 'x h"t,° �`au.. '� - wy R.-' ems'`• � ». 2 iy'.7 r S➢ *S�r`t•. fi Y >I: , � rNl'-ANNIS MA 026013 u. t h. ; Assessor's map and lot. number P( '7` `�.K J��/ �C _ f 0-7` 7 �► l ... ..,.. Vh SEPTIC SYSTEM MUST BE o _ l? SE10yage Permit number ... ... ....P. . .Q.y. ..k_�xf ..,. INSTALLED IN COM .. .... ....... PLIANCE �✓ =; / WITH ARTICLE II f STATE 4 S Y �Pypi 1Nf r0 TOWN OF BARN k _ "°. TOWN "1 61 [i t; ' = 89S89TLHLE • Q . ` 39 BUIaLDING ; INSPECTOR 9�0 16 - \0� 'E'p;�pY a• � -' APPLICATION FOR PERMIT'JO ... ..... . ............................. ........ . .......:................... v TYPE OF CONSTRUCTION <........:........................... ... .... ..................... .. .................................... ........................................ .19........ ti TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according' to the following information: Location ....... 1l'. •.......ti ��.......L �..........�V.... : ^. . .!! .......... ................................ ProposedUse .. ..................................................................................................... .............................. Zoning District ......................... ..............................................Fire District .......................:..... .. . ......................................... . W/Name of Owner .24 '................Address e?! .. .... .:..... ul Name of Builder .......... ....... / �....... ..Address .�... �..� ,.wf �lYl? .` ............... .. lti Nameof Architect .. ........ ............... ...........Address ..................:...:............................................................. Numberof Rooms ..................................................................Foundation .............................................................................. Exierior ....................................................................................Roofing .................................................................................... Floors ......................................................................................Interior .................................................................................... Heating ..................................................................................Plumbing ........................../........................................................ Fireplace ..................................................................................Approximate Cost ......1... /...............`................... Definitive Plan Approved by Planning Board -------------------_-----------19________. Area Diagram of Lot and Building with Dimensions Fee —^.................... ........................ SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ./.. .. . ...... ...... :. r Bruso, BeruArd Accessory to V No j6�...' Permit for ...1....A441A.W.elling ................... ............................... Location ....... ...ITYUS.AVA9......................... ..................... ......................... ....... Owner .............Be=ar.d..Arus.o........................ Type of Construction ....................:...................... ................................................................................. A 287 68 Plot ................ ........... Lot ................................ Permit Granted ..........Oct........7............19 77 Date of Inspection ........ ........19 Date Completed ... ... .....................19 PERMIT REFUSED ........................................................... .... 19 .......... .................................................... ......... ....................................................................... .............................................................. 00 --�, oo . ......... ....................................................... Appr6ved ...... .... 19 .................................... . ............................................................................... ............................................................................... Assessor's map and lot number ...... ........ 6i, lo- 7 7 7 ..... ... ... .. .. .... - Swage 'Permit number ...........'i....ji.flo,..............Z... "If N E TOWN OF BARNSTABLE 63 ARNSTAILE M , AU& 9' 1 BUILDING INSPECTOR APPLICATION FOR PERMIT TO ............. ................................................................................................................. TYPEOF CONSTRUCTION ..................................................................................................................................... ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...................................................................................... ................................................................................................. Proposed Use ....... ....................................................................................................................................................................... Zoning District .........................6� ...............................................Fire District .............................................................................. Nameof Owner .................Address.. .. .. ....... ....................... ....................................................................... Name of Builder ..../.1; 1......................... .................................Address zl:� Name of Architect ....... 6p, ..............................................................Address .................................................................................... Numberof Rooms ..................................................................Foundation .............................................................................. Exlerior ....................................................................................Roofing .................................................................................... Floors ......................................................................................Interior .................................................................................... Heating ..................................................................................Plumbing .................................................................................. 1 1,71 Fireplace ..................................................................................Approximate Cost ........ �/"e-1 .................................................... Definitive Plan Approved by Planning Board --------------------------------19--------- Area ....... ........... ............ I j/ c') --- Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .................................................................................. � ���7 - � Brmmo° Bernard / -/�� ~ ��6�O No ----- ... Permitfor ........... . � Dwelling —----- '-'T--'- -----------'- - �-�l Locution I�' .J�%................................ .............. .'....................................... Owner ..... ----------- Permit Granted .............. Net....7...19 77 ...............................................i............................... | � . � Date4 | � ""= PERLIT REFUSED | � | A '--------- ---' -'------ ' ----' '--''' � . ----.-.. �� ' '. ---'Vr' 'r - V........... ....--.-..........x'......zc..-..-.--...- App,oved ................................................ 19 ^ '----^--'-----^--^^^^~-'^^--~--'` ----^--------------^-^^^~'-^^'` � �� R SID ADD/ALT/CONY 68290 04/22/03 126 047 434 RESID ADD/ALT/CONV 68292 04/23/03 032 010 434 RESID ADD/ALT/CONV 68294 04/23/03 030 057 434 RESID ADD/ALT/CONV 68296 04/23/03 077__007 434 RESID ADD/ALT/CONV 68343 04/24/03 101 098 434 RESID ADD/ALT/CONV 68421 04/28/03 101 129 434 ,IRESID ADD/ALT/CONV 68589 05/06/03 057073 434 RESID ADD/ALT/CONV 68672 05/12/03 064 002 003 434 RESID ADD/ALT/CONV 68694 05/12/03 047 056 434 RESID ADD/ALT/CONV 68710 05/13/03 061 010 005 434 RESID ADD/ALT/CONY 68728 05/14/03 149 031 004 434 RESID ADD/ALT/CONV 68736 05/14/03 064 021 434 RESID ADD/ALT/CONV 68738 05/14/03 042 027 434 RESID ADD/ALT/CONV 68848 05/19/03 124 017_003 434 RESID ADD/ALT/CONV 68973 05/22/03 079 050 434 RESID ADD/ALT/CONV 68975 05/23/03 060 025 434 RESID ADD/ALT/CONV 69051 05/28/03 080 021 434 RESID ADD/ALT/CONV 69060 05/28/03 043 014 434 RESID ADD/ALT/CONV 69091 05/28/03 098 023 005 434 RESID ADD/ALT/CONV 69139 05/30/03 081 026 434 RESID ADD/ALT/CONV 69188 06/03/03 046 008 434 RESID ADD/ALT/CONY 69233 06/03/03 102 181 434 RESID ADD/ALT/CONV 69245 06/03/03 046 070 434 RESID ADD/ALT/CONV 69250 06/03/03 028 062 434 RESID ADD/ALT/CONV 69281 06/05/03 047 162 434 RESID ADD/ALT/CONV 69307 06/06/03 102 044 434 RESID ADD/ALT/CONV 69317 06/06/03 043 007 006 434 RESID ADD/ALT/CONV 69323 06/06/03 028 082 434 RESID ADD/ALT/CONV RUN DATE 09/29/03 TIME 10:32:26 �+ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION xe�a Map Parcel Q Permit# 7/ t? Health Division -=v )Q 'f �S(_ Date Issued q 00 3 Conservation Division o ., ©� Application Fee ` — Tax Collector e�4 � /Old 3 Permit Fee 66 � SEPTIC SYSTEM MUST EE Treasurer ���— D 0 11'1 Iof + . ."�--------__., I�5TALLED IN COMPLIANCE Planning Dept. VWTH TITLE S EIN11RONMENITAL CODE ANTE Date Definitive Plan Approved by Planning Board TOV1111 REGULATIONq Historic-OKH Preservation/Hyannis Project Street Address 14 Tiyi n A v- f ' Village NVAUNIS po" Owner T No l s Laos WA L-Gon Address 3060-Fpi,STan AV-6 e J)1Lj.40�Rk iq4010 0 '! Telephone r Permit Request XED IACc I nQ fLp Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation SS 000 / Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure E Historic House: ❑Yeses ❑No On Old King's Highway: ❑Yes ❑No Basement Type: El Full ❑Crawl ❑Walkout ❑Other Vs raL Y348401- Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) ALL Number of Baths: Full: existing new Half:existing Z new Number of Bedrooms: existing new . Total Room Count(not including baths): existing �J� new First Floor Room Count Heat Type and Fuel: W Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ENo Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:Cdexisting ❑new size Pool: W"existing anew sizeA 4Z!� 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 -' .T1067nm BUILDER INFORMATIONG' lo� Name l /6% i 00voo Telephone Number Address 5` 0 of n V1 License# es 011091 Home Improvement Contractor# f 00a8 Worker's Compensation#)/ �; ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �l( CA 2C C � � �zrnOv�fl - SIGNATURE .0 DAT y FOR OFFICIAL USE ONLY fi PERMIT NO. DATE ISSUED - MAP/Y4CEL NO. " v f - - ADDRESS VILLAGE ., - i OWNER ' a - t s DATE OF INSPECTION: Tj / J FOUNDATION - f o 0 � ��8 3 , �,,„„ i �y�c, �( FRAME INSULATION= _ FIREPLACE . ELECTRICAL: ROUGH FINAL • PLUMBING: ROUGH FINAL GAS: ROUGH FINAL . FINAL BUILDING r w DATE CLOSED OUT ASSOCIATION PLAN NO.• _ ~ i The Commonwealth of Massachusetts -- ---- Department of Industrial Accidents - Office oflarestigations 600 Washington Street Boston,Mass. 02111 i Workers' Com ensation Insurance Affidavit / / r�<Qrl , 155 t?��n AvE • ovation �.`�71 =Zb 2-4 Cit, enn�s � V � all work m elf-ahomeowner performing 3's LJ 1 am a sole rietor and have no one wo'JIM in ca acitp %%%%%%/%%%%/%/%/%%%%//%%%///e/S%//......///n///g//o////%/%//Sh////�G���/��� %%% ensationformyemp aye Hv;>w} ,;4.: ::: . nay}::,: ••r.{#+.v.N..:• gaS'c}":',••'<•::•.fi,•fi}N•:L.v.S#Sk., orkers co w:;$: yLr,.�•.,. :.i..,.:�:r?Ny,•,,:$;. .4`:Sn, rovzdun w .. :;>:i::SS.`,ty ,.#x,: 4:.iru.>? ?uy}.t:, c:F•:•J:..y 4. s;r:J . i• to er g 4:<:,;>: uva:. •<. ,'• em >. I am .. .�. •{.:4:,;:?.}):n•::.r.,. r,�::rr.:...f:,. •,•:..........r}}:Y.:.n n.x.. {!�,.: .{�.., ^a�.•.. ax :�..}..?:<�:. ...........:....::.v.Y; n . .,....ry:.:r..:.: }:.}..Y�'+:. ,y� ..........:,........:.......�'.t.. .... :.:..:...... n...:...;.;::•:}r.. n........•::::.:.x,..:.... }.•''::.. ...,.....:4}.•n.ri.Y{. :i 4}^ 4 {4••;}! .......r...-.,.........r.. ....... f ...r,.•aX. ..:f n: .... 4. .. n•{$•::1•{ ....• ...r.............n.-........+. ... :. .. xv...r::...ft:^:::::..?.::}nv:l:r.•:w:x:k.v:::v.:.n•:7v:rn.,..::v:+: ., • y.: ; ^t{y',:•;�}}n•} }P:S}4.:v. rv}}..,.f.r:• ta:/.: ..fr: •.4:. ..!y ...a^. .:.a::•.f v.4.}:+.•:;{in•.�+:{ •.: a:::. :::r,•}:'•::.v:x:•}:::.v.::v:a}:!i:+v:::•:v.44•}„'4 t:}.... .>•n•:}:•::•Y.}y..•::.vr {.•... x..,{,!: .. ...n•.5... ........ ......... .r.... ,.S�4.n..v........... n n rf.....kv:} }}::::•.. 7:Y?•}::.. r.•$:•}}:v..::::ti+i}}:•...:♦..J:.:. �v7:....•:w..a...w::r.•n•::,v:.:.an,+v:••:.x•v n: .nw:•:.•. ....,}n??•: ..t ....?.•.}...:.... ... 'va r..,.....:............:.......r.. .r.. a:.}. ...,:........n .v.}fv?•:4Y'.;...::r:{::!:?•:•:;•., ....: :.:•:,. ++':+ :':}k+}}J:':;: :.{;}iY}h�!{':$nyx.f,.rr•{.}••7va t_:}}:r::. •wf:::::•:. ::•.^:::.::•'•::f•.-r•:.;.:4:•.:t•+.,r.•:.,�.{..,,.:r:•4�v:..,::.;}..a...::..:,.,}.:n.......:..t..... ... ...:: ,...v:••...x; :ra:r•+'J c'•:: .}.},C}:: .3..w„ ,,.Sv >:..rS: .:.t:.•: w.•p:.::::},:,....;.. �..:„r,•:•v/.•::,!::X•:};•Y v:}::A:v:.,n,n Q ...;;.. ..::r.,:v:iii:•N.:;•'f+;}:.S{ ::•:S. ... ........v.,...v:2•........n+. � ,v: ., '..x•;4,M":} ••lt:v,{, ......... ... :::..:.:..n:-:'•}:4!::'t•. •i}:r.4xvY'•Y ::.... {.. {•n,ti•} ]4.fi{ r {. i„•,;'y+?,.$? . t#;i,ra}r}.4• >,• S.`++c'ak+;a.?-;.c,{.;:e3X}}:$•:: III :$:}.•`:.;., •fin •`.<}i:}:;::SSF:` .............v::.yr a•'u+-L:" .:r Sa'}:':.•>:r:+.x.:..;n},{r?•}:•i}}:•...,};•:;:w:, }}.,?{r;.;:. .}..f. .ar/. r.< .f:. •tf{}i{•{.'v::#;aJ:� x{.:•h:S:{r ';hvt\, ^:.{• S?w;• -'+•1'i•$:• :}.;a. . .....:::...:.:,{•..•t,.. ....r+.t ... .., :?•}:S:tt•: r.,. .r.rf:?•:.....y: i!}..::•;5:;: .'?:. .........:..:... •.... .: .}.rrr..,,{. .: � ...S)... ....... ..,:.ia:.•• ..... .. vx .. ,..xri r..i.,.x{, ..... .... .. .,.r. r .£S+":... .4 .. ,r{SiY•:+•7:.5.:;•:..:•..yn•{r.•.{:•.,..;,ti k:;, ..},... ,..£s.• '•.,i< .......,.:....:...:.........,....a:......-c..t.{.t,...,x...:...... . ...^ .,}..,}-:n3........,?}}:•}4+•n•. ....,:... .. ..,,r}xx.::... nx: }c4•} 3�':�4t4a•..:.4�.'•.:...:::..- .+.. ...:n.....:..t•:.....r.n?:....,}::.:........:....}.?... :?,.•f�i ,y.•..c•. :•rn•t•:.,•....,•.k.:t:•}.....?•.w: •:':,., .:'•}:+•.aY,•`• •w•�^}'�;,�,'<. }}}�::�r�+'i.£•:}+...S.i^,�'•y:a...'y,;:4;;:: v°t :}:a•:•a+•. i{. .;Ff.. ..•:,..fr•:/.••:x::.r. ..4. ..G::: ^$$}• a:4}•• {:k4r:r`.{�tt..w ,"rr,..}x•. •'.•>>:r.•::.:• ....+......r.4 .. ?....,...2?•.5..::.r....:.. ...r.r:... . ....a:••:::}:i':?•:4::.},}; ..•,•r::•}'<•.}::r::•.?:..:•S}::::>.'•S•• a7�•.. :::j•.•.::•xa•::t. va::: }-::.+.r..}.f:••;.;,..,,•::•..}.:4:?•.. .,....,:.;•.:r. ..:•::::}:::••..,}:::...}....:.:...:... .. .. .- :-;(.r.{.:yr.'•xia�:}•#:S:i `,":$•• .`ISi}�•::: • ;•,'Y•:::n•::::•::•:::•:t!::•.,r.•:.•3i}:r:,x>,{{.,S:•!r••r:: r:,,;..;{.::!.a..,..,., .}}rt?:•r:•::.:•.,4......::.. ...,... - K.;.O.,...... t:rx?J•. :}:C:,•:::n;n.S ?•!}}}'i-K•}:•;^,.Qti: •'${a{;lr..}$Y;+r$,w:'::'?£f}::,C4'n.t,ii��^}fir:vr�x'n,•:4}::.':•y`{•i {-,?:i:'v.n•.Si:^•,}v,.K:,•. :a}::}?,.}};!<•yr .,5.: .,.;.$::: w.:.t•4:.,•.t.:•$3.•..,•s} r:fa ,y4'+va +,;•.a: ^.xr. max:F•:.,::}:..,•{r.••:+.....;:?..,.... x..::•y::,,}:L•y ^ .v,.<k!;}•v..a.. ...... :.. ......::•}v;..v.v v:?•.^:•.::•::•4:•; ,,:.;. x t v:., fi,:}:•.'.. :�'Y:1: i' :{,; k•{ ,1'• 'C• �`::r\...,...:.....:.... .. ....::•: :......r..:::. .:,....n..r.:..# £la i:,`.;}}:;•>:Ss...?•:.:::•Yx...h. +'�., -Sxa}x•}•n'?ae,n{tt,: :+c.+'2+ .,{. tti#•? ,fi{.S{:<;$,}\5:: t�f•CSS.. ::.!•:;7{::v..:.,.,;a.rn..t:.,•::•:::4.•;::..,:..>•:.{•:.?•::•>}:•:::::...::::c•.�:::.,.. .•,}+..c;,+.:G., ,•::}„�:,,..,,t�;�..:. a.•5:�'�:•}••:y�.� r ':r :{.4.::•,...:. .:}.r,a.•�`'a}•:r;.y..v `;:y,5,}}::::r�'.::>.:.a `5:xi.. .t r :..r.} .:t. ,•..#. ..} , ,fNs..n.. rr<, "h. .... ... .r:r.. :.. ...,.....r:::::x:?n•.X•:::•!::•?:?4:•. r......t••...,.... •:..:• .:..:r.•.r.;{........t.: . .r :. C. ,r.:. rrr. .,... ,:.... ... .... .. .....,...........:........:..::!?:•:a:.,.,...;,',.vL::•. .:.... ;af.::.+,�?$i:^}:;�'•:J.,,tc:�."?};:}:S•`.hxc`•S::S;{J.S;�,a:..;y�•.y:.:t„•::>:a.a, ,.�r"}.!�#;S r:,r �.:: t y:..;:•.:.::::::::•.,:,-::n•:::.:::+.},•.�.,.,�;G.•.ri•....:::7+.•. :?•.,-::.:•:L}:f.,.,}.S:•::.:.:.r::f.. :•.,,•.r..:::::::•,::•::.•::.+t•:}::. ra...!.::...r•n.4.Y4:}:4•.,r'Y ..: ..}.. .r...rf7.4{.}:.{•r<t:•:::::::}:,+:•.• $>.;:r..:.a.�..r�.�.,..•:. r„•.,vn.•:::.;•..;.,.. .::..:::..:.::::.•:•.5:+::::::J�-::}::<4:>{•Y:.>.•:x.?. xr?4$:..vv::,,......:{...:..:y:}i:;};,{....:.�•::n,.S ,r.}::S?Y?Y:SSYv......;},.v,:•.}}}:k v::•...:.:.}.:v).^......:.:.vf..........- 4... ,•S•.,.......;rr: n v. A 4.r.. ;.x.,:•:S.•. :..<..�f:•Yrt•:;•,t;::. .;..:•:•.:.. .... •.:.....•n,••..;•,:{iY.••:::::,•. .;,>ti}.�::?';p":?KK <• a",��'}•'•<'YC°ar`,`:f` {:;+:3>':+� :+:.,..:-:::::{•}:••:::;::;.YF..;:•:..:r..+4::.•:.•.,d?air.•:,44:?•::.:•.L:•k).,.n.......v. .Sc.. ..... ....... 4..... :..r.F.•.. .n.rr.... ,,.}}}:•:}:.>::•}:}:•::::: ?.., ,.yx.;SsS. S�k•S}.aa:� Y{C<•.'�+•' i•,}•.:$;r fy�;�. 4�.•$. •:........:.,.......,...�r:..:.........r. t#:a.}S:?:ic'<,a:•},;t f?nr:.r•. \ '�.4•.�Q r7.•�1:•y�,: .,.yh.}yS�.. ....:............+. ... . .........:•.�•:..•:.,.. ....,n....:..:...t.r....;?.}:•}:}:••r.::..r;.;.::;?.� ..,• �r: .«^•,vr�.t•.•,�'�,{•a:t{{•z; `;` .};S;#'cS::r.};ti",F:.{x t•�y,y$•yc,:,, .vn..,..• .......:........n,•.:v;.+.•r.•::vv.•n:+f:!•::::::.......::nv)n..•,:•::'{•:....;;�•„•:r..:.,v.. ,.Ynx+w,{.. '+•.{•:t+i.•nk} k' i ..•....:. ,•:•+ ;:. :,...h... .... .: .::::..,. ....?.:;.......n..•:....,.,:•:.....t......::'.•...<•::.•.ol....Y,..x',}• ....•. +4', .{,. ,f:•j,.x:?•£4?:F :�'.•'•: ..A .{..;ar?.,. .:/::fi,•....i.;.:f•:•::.... a.v .:}f+..v.}.I+{t•.,:v^Yt•:?�':'•:' r:a::}'r. 11 i•. �.. �. ..........:w.:.n•}}:::.vr:r.a.•y..;.{...'{^�..nS.v.xr....L.{r••??+.i• ...:..... n.....n r:::•:.v:.r+..,µ. fa:r:::::::?!•;?,•;}:::: n. Lf .............v...:.:..••::,.....:!..v.. ::�,{'., s�...: .. ..:i•.x.....a..�.........:::......:.....::.,:v::::.:}#.........:v......v.;n. :4 x.t,. : ia:5•{::U� .rya} '4aC'�tr:;i,•ti' {••.'•:•}�n,.???•?:r:vi':•:: .V.: ..::::•.....?.:::::...:•:?•:....,::•!fS n.,.;Y}, !+•.ti.. .:}•:•::...::::..::?•r......,•:•::::4?....:•:::::x•:,...,. :.. .::•:' .?.,.''+{tn'•::2Y,...•:. •f?,;`),::::.•.f...:x..,....y.u... ;�::.:::?•::::ry:x.v:::•:4::.?•r.:•.;:r.Y:^•1•.}':N.1?-}. .}yr.,..✓fJ:•-.44::?}:.s.{x:::x•:••r:..•^v•:;:x•:•:••,. ,):4:$i F.v:.,•.:..n;, i+.n•. .xv:.!v..;;r.:::•:w:::r: v:::••:t vt .{,•A fi..;r icy v:.:.•^::::.v.:r•:::::Y:.+.v:::::; w:Y;v::.• :.n.�.- y,.;,•::..:•::::r•.•:n•r::rf+,4•:.?rrr.s•.r.5.::}::. :f.<;G,•'{'c•4}?c.:}r{t..F}.,,. •rrr:•:::;•:•:::::..,•}r.�:;:•}rS}:•}:t:•.t;.,•.,•.�:::..Y�::is:;.:::.:., aL`'�.':•�{•'•.a1S:•::.4}.....t}...::3.. S:}v h},.:>.',a+:::S+a7:+?i•?.'•:{4$?;arr$.•�x•?,5.r}}::•�;�:?�';w,r<,:25`:Y>•}>:y 7,.SS:?CS?••:.�.a5'•:::,.r.?{;.n..;.x:?r:?!.,;;:::. �ti's'er�n�e>c�s<:;::::;::a;::?,}:�:>,}{?•:::i::f... . . ,.:.�,.t•:n-:::::. I am a sole proprietor,general contractor, or homeowner(circle one) and have hired the contractors listedbelow Who hVe .. :4:N:Y{i4}w:x..c.S:::S:}:{r}::>}:a:;F}>:•?;;:;:?;.c.,.,., ;;<:8.'•:£: }:•};.}wti};}:s}::5a}:;i}♦,"ix'.{.'a:�4 S...{,v�J c}'x:...•.#}AY.Nv,..Sfi.�:'..¢o-?.}•.:r.nf...y!1'.,.{'..r iC?s;?:.?;a}{.<�4:';}^Y:.�?;?r :}v ti the following WOIkers CO ensation POlICeS; x ..a.:��,•fi:.yv}�.r >,t rc!yx,4}aa;5;;,;:4#'t.a:t:•:{s x:� ,y}fiu't^:'y S{S;'x a`!r{S,:a;:z:x> •./�rag':4}h ..��•• � .. ......y..v.v:+..:}:•;Y4tv:;; :..fa: v,a n.•::.. rv.,.w•.:. -.:.n.:•{?.,Y:w•. :::•:..:...;:Y:. }:.??•t} .. ..... ..... .. .A r:. .. :.. a....r ... f:.r:...:..:.::}::•.. �}?v::•$•Y?::ivY'•r v iiii.4}x'}n.,y.}.?v....{''' $}.4, 4.•4r }.ri` :.i r:•.•.:.: a.::n:•r...::::x:•.. r..t..:� rr[y. s .: J•,N:•r. .:}•?4•:..f L.:., t fi xr�.;:,{��t,�� }: :t t.:.r.., ..5.. ..r.•...y.f 4 },�:.. ..?,. Y?.v:••}••}>}:;::••:::.:•ix•.,..••:•:•:::::,:..},.?Y;::.,-.:.}••:{$r;73+{a.Na...trr,, :k ?•}v.. •.,:��L}xRa}'X�aax,{{,r.::iC�o.{} :Yr•...rr:f!v r;}.::.:::::•:...};., ..r/..n•::r :•,fr.4. �?:hnNvS:•:'•}:L:.:.:}.S••: •.:x••:v}:::.•r.•rn•..., Wx}.:?v;}}Y.:},•:� ::v:$4•$:•. .,......:..f;f,•$:a}•...:....r.n•:...}'• ..i. i.?'};4.t,.-..}U•}:•iS+{- :::.:•....... b.:.:..?.....ir.... f...:••r.y}:}.}:::...... .^.:+...:..a...v.Y r:.:•......::......:..r:...r...::.....3.F..•r.:.r-. ..i.. ...n•:.....,..w.,f...Y:.::i.++,......:s:::. :.•::;::::.:.::.. .f ....S.: k } .:.,....:.:..::.;•.v:.v:...... r x,r•r......::::}::::::n:x:.r.v:..n,r.:y;f••fi ...:.v:$'r;Lti'?:x.........;x4.....,.i.. ; n;4•:}:"v'{,i{:$4'j?'?::'ifi;^i#7r)7::^}# k$F:.r:}..•{ }'''' }v,?F•f?:n C:::::......:.... :r...x•?;}+:...\.Y�vv;7,.,h..:............. ....::.. :,b aS;:.. �k.n r• i ��ss �- a .: eb:•..::y{ f••nt,,,•f•:.:••• .:...rn•:.,: .::..;::.,4;?+}• :S r •f"y. fi :+: Y :;t'f}` :?R`6i• �'f �k.. rSr' e.....:.....,...•.. c {$a = }^S• SI12 :}„r.... v,{.;{.:}::..,};.;;:?}:!:::,.}••}' , ,-,,?iS;{.y:S<,i Y•nr:;'�:2y<''i•'•>'S?,. ,';a' .}rh: .y ..Y, $II ,.fl �:• ..t..{•:+}:e:,. .,4ia` ,..{„ ..�:.r.iY.:'at;.4r ..�x „? .` •}�•+>.�%i •LQ1I2 :•Si? {•r4:•., ..S •3fi, •idY} }.f•� .ra. n.S'+. $ui7r• 6 •.•: ..f: ....:n::,..:•?v.::.•• r. Y ..{ „•..t. :a:..A•:nt{•}}F.a:;,...•:4}::••x::.v'4}::?•?'{{v: ..:{?•}:•::...7::�:•X:i4:+?'r!:;.,.. : .. .... ...........r:.,..•.....fi...f 42;•r.. ..,..x.:.^S+t. ...•.. ....:..r......x......,:.,. ,..x:b.:....::,:•...?•:v:{:;:.}:+: '�:; {'.-}}•�..:;s,:t 71::. •,?ra':.'>•;i't;<i�":2a��.'f;4::�•t�;:n•.},. 1•S?.}�Sx• fi�r....tk. Sy.•.4::4f x.N.x•Y r.•::.�::r.:y.,r•v:•:.,,r: ,:•y.,:SS£,f•;{.r•. r{.:^:+r2::i•:,:}5:..,}r:r{t•.•}::.t:•:::::.}:y:::?4•. :. ,,4.:.:.t..,; ., '0}•. .n. ..:...F...:•::::•:.r••..n..Y.Cy.r. f. .� ;.y. ::.$.. ..S•:•:•......, },.}.xo}:f.t:::::.:.: xff.:�rt4�}3.rYt .:f..•}x^....:•:•::......:,,..f.,•::yr r..�:? ."}r..;iP r..v n::n,.v v.;N..�-.� 4�.'??::+.. ....:r:•:.v..::.}$:v vn2•}:a}):•:;C.:?•i?F:4::C ••,:,v..:r: }%:^2.,:>:.. `',•........ G•r:.+•. ..::•.,•..n:.:•a:•:.i:;•.:r......,.r:.,..:?k.!},...r..:f.;.;a....:>.:::^ ..,{.:.sa...:?.:::•.:,>.ia:.?.r.•::;•::..: r{s•::'-•4: ;+tfcr;....i?n,:g:t,{:a•aW}y,Y;YL•�i' :'$.'•. +af,.:4?v.v:Sv: ::.:v.vx Y...:.^y, f;,.•;.;.v,.:••{..,�. x,,:vdv f:^ .}::•:.•:?M:.}.:.?.:.::.;.,. 'y;.M'{'{{'f,+:?}R;if}:irr: r 4'Y:i.+ 4 •^•{"> r •'av:. YS<+tY.;..s.,,};::.,.;{.r::ra•r:}:i•}.SS,t:}{9'::::`.•a'i c S S.a:•{Fn+3.:S•#<,}};�.;.?}.n?f�.:?.....,.... .. .: ... -::ir•,;•{:•:::+ ..?F'tt;:'f• wx.:,•;••f# .;h;'. �!4J: ',.: a,•.^?,.,y, K.,,y.,,; t n•,r,...4..... ....:....... ..:}..}.&}?.y r a4 },:.} . ... ti.`;'t.;;.;}; ::.}:n.:.....:#•:::.:5...� ....,••..::r:.:.: .,:..:.::.,<$i•?fi<: ••.• , •j 5�1�•.iaw.,,:d,t�'SJyP4}�'$S.M,;flrw2lfb{S��.S{::f ��.y,4..+,•L•;.� �}� :.i�% j. SS.r.v. iixtiv+-t•.v:y.;p.,-:v# :,.,' :y;. a;}•^ ;a..T`}:•.a'{h.y. v.{,ya}: :r�/y,� yY 1.; '4++ '}:'.%�$��5 :$.; :sdtlTe 1{t{;:; ::N;?: f;. :•}}}: n vy}. :F'fs.. 3. :•}S2?�$t ,: :;r?4' .art., }:,a {•f •S• :i/�'y+�:� .:$. y h::L'S:•`^t' bt•• r.K•f"'.. r,•} :4� .{nY fit•`.• >)fQ: .:�. .an7+.. rrr r.•.{+. {1}'F.A•}....:C r: }}lj{:S:'!• •:}:v v'.,•G••.$ x'�• rt;' v:.f{•a•}':,. v}.4,^)f: N.•:M1• vy��rl.•:{ .r....v �S• }},}+.:i•:}tin#J;+'y •., :• ::}: ..#..n..... •,v:-:aS:{n!F-•::v'::<`:'v:•$i>':'riti:'.;::`y?•:•:i:f.:v.y:.-••n ..r:n} :}.v .i .: .,:•n:{.:.:r:,r,..Y^•,�.e}7.5.:.,., r.i. •a}} :.+tr.•ffS•J ':ri:^v:•:4+c£••}:r•:5;::•,:.}:;,•r::•4•r3.},}:.c:•:.:,•:•:4::•::•r•::-.:.J%4:r f)11C: $w};:4#,c: ,?:.a2a.?},. i���•T+'Yi,a. #fiF.:x.:::n•:•::.::.}....::..;c r,•:,. S; •a?.;: :r :.afb :.:.{.,., .; 1 .fi. ...,.......rr ..r 5..:.... .. .,c. ..5., .. .. +?+Y: ?rc.£•.:r ........v..nS}:•:{•.}...e.;,r.?,•:?ri•::}::::.,.... .. :.....r..v.....N {,.r $: .+x• .• f.} n:rfff..?+.,':�."'wr .:.. ....,..:•::......5........x:+:?:.G.^ ......... ..... .:..:.... :• :+f'}/•}:•:::v,:{;Y;{;J:;.;.Y•:L$•;.ild.:i,iy�''nYf.}iA+�':•2;F'yil•• 7fi�•• r r-�t,!{3.::}:N{.:;:rn•:+.:n•3`.#{.1..,3,:,Mi ..;tyr:r.,y..:?•:{••r:•::.4:Y. ..:r.{:...}....... ::., }a: »6'r.":•,•3 }y •n?:a},n4•r,.n:> J a... r?:a 4N .}:•; :•.{?•:.+.,•:::::::.a:x:•.v.Y,.:::::•f.!C?,f.?•;r..:4•fr:x.?.a:.fx...y. + v.,.:.... 44r ...............t.... ...A..a:.aa.. Si••:;: 'L.`.:f?'<S::}x•}^}tt,`{.x..!{~2,•1; :#^•. `:k•.r w y7,•S:•}?+a ••4'#':$:: ..•• •0..f4 ''f{}}'[•y: . ,:•n•......Y.:,,..... ..........;.r•._.:�..},•vr•,r:!.•:ac ....:?r,:•.,�r.:a•?`,'•:4';:F>x.'+:•::..t.:.}:.x;.ya}y;,.4�;;�•!',••t!.'4,rk:^^t; .{$.{:tri+rS.,;•.1t•,,}„4:•+£F'Y ��{• }�,r y.,>:?..•:};5:+:^r:,+.+!.:•:S4�?`'+„•:r.•: •:r.�;?}}.•::rx.•?•<•a.,r>;?v::,..rn.,,.t}a?7.+4r,x..f4 �,.{s'2;�: •YS.{S S. .:a.,,,rx):• •{.4�F .c•.a.,•kv4'•}:iuM£?r.�';�'•;: .;k}}'iS#}2)•fn+'.i .5,.,•4.4+.:.: v?n.:.n.}.y. •. :•.r:!=r•3`i?:ffi.::}w.,,.v:n:,,,.:+n,?:••,•:., ,.,,..yn 1•ti{ fn.}.}Yka{$,,. iri;•}}Y k R`4}'• ..� a,Sa:} t.........nrr........ t, r rrR :....} ..4..tti !• r:•,:?Fc:.?.....:-•:•: t:^••}`a^:n•:i•}r.: v.vt??:n•::ant• .,}•Ftry� ::i. 1.•::a.•r:..g:{a.::rfr: }.•,•. A.r,•;.:.i Evil t!•.tkL•::•:r::•:•:::•:::.••n+n:{:r.;7n!yYv:.4.:f'v,t• f4}::::•:^f:.,.;.,4.,5#:;iyry?.;r.;g:•:r:}�^:i4>. ;.;{,r�.,.ta;.;x•},:}.+w•.;.,>.::,'f{<2:?}w. �5. ft'.'.:.a'�:4.?`,f"K �,•+ 4'S;. 4n.:.•f,,',,:LQ�aw.w„eiS •rvw:•.v::r.}}:•?:{>:•):?•:-}:•5::::: {••::'!•Jf}L'V}.,i<,'r••:,{M''ryfiY f$�.fan}F?•.i..r...:4?..vf .n,'r'a;i',?::{::••4:;a:;,,;.,{.{v}?n{:•:$S}}}}:i:•.:n..}. Ql.[+: ,•,,F:,:,+:::Yx• :�r:S}•xv}ri:;+::;$:x::n1:{ryi::r,:.h:!•n;,:?f,`i,:jr,•,ij.,,;.•••$i:,.f.};•}:rti::. vf., i;F;Y,• ^ S?+n+.4• .,....!.. .•fr::}k•xn N'.•.'.,• x.+ Dr;*N I.........3•x.•r {.>.2•'::SS:•r:;::t;;S;.?::S';c Y•.:):::.::: ........ r. if/� •rS:•.a£:}y'}•R+;>. r}4. yS,..�r �/ M�1� x...... ... :::..:.....r.., , }: ......:. ,..i.,..�:/..a...n.. .. ::•$:..... :f•......... n:y. r..+.v:):..:::• ,h:}�+s.Uf.....rY.L•.,.3i}�::.. r .<,,rnv.,•{4:$:::?.nx::r f.'•-.v:: r.;.;4:}..,.;.:$�rf+.X•. f:n•2a.+i:.a:v:r.•:<^:•Y:;•:???v:• x.....: ::ay. .... +.,..5.... ..?............ ...,::t,:.S.....,...#....v. n, .... ... {•........ :.:.}.........4<r, ..:•:.,.. < a^+C? 'a+y 'at.{>w :{}'{}•' S):>: ..,,..n......:,. ..... . .:.d.., .,..... .. .,,a....#n,.>:.....n. .......,r.rf.....,...... ..........:...::......... ......r:r •::::?c•!:ti?+•}.,•4:r: a:r:,,•+•;k>. YS}'.S•`S':;•`''#:S?}n}..•`••}:?:fir;<?<ya••.r. 1'n�:w.t•.:.r. •. ... :::::.;:•.... .:•r..:,•:•.?:a'r••Y'fS?taS?:<.:...t....... .... ,•y,,. Sr•:.,•.• }?:A., a.,:+.x.,:•4;,•+.• .... $... :.S+L: .:q.}:,v.I4hS$.,a';•.. ;:4Y:• 'x rt;{{ FtF..S•:: ,r,;,C•.y }.;};?y4.7a. ,:,x'�,„'•: HLII ?:{:?.t• ?•:FS;rr;:: }}.:• ::}S:a:?:::•:.v;:}:} ::w :5: 4.,.x ¢{? S.S;` 7x,r Qc�• h• .Ya{'.}.?^`.i:�ti;t $n{�•31 n:a:•}Y:}•r:a.}:.}}+:..:.,:•:2i<:i'•:.r ' :4:::•.:. ?S<,::`::., 4 .::•}.}}: a•: ............:.r.••:•?+rY•:a}:r.,;Ftf ..,-Y..}r::..r.,.:•:r•:r.....n:•.,•:.�.. ::}:+?.}.••::;-:.+.•.{..,:.a}4••.}...$•}, ..•�•:: �r/.r,n`... }.: ..f•x... .:...t....::.::.. ...�.. : :{1•..:Ct•}r; }::{}y?..},,;y.:} '+.S'..'••:;4 r. }}:.;�'}r{{{??},,ir,+L}�;;f, . :>}6':?.5.:. ............::::::n!?•7:vv•::vNh'Lr r n..{:.ar.+�i +.v.n+.,•..::. "i.}:,:••:•• r $':•n.::•4.:�`:a:.xn, {•.iv.n,v.rxx,....�."}.. � i`� '..K.Y+'#,S:,tr.�. .... ..... ...r:..:.....,..:+....,rr�r{i,:• .:..,. ...r.:f:•}:...}}•.,r:•.{..+t,...$.r.:.}.:.:S:;;r:}•{?.Y:S^;.f:$.a::?:•}:`.�?:•:•:::.:,:...:•i::::'i.i.n.....,... ..,• �:r.. :•^..av7x:,r3. 'SS }.<..r. r•:{:.. .•7.Ra,. : ..,Lka•.•., .:./,•:nr!r...{.n?,a:::•.• i•.i}y.•}.,•}�'J.;:+'.v l..::n}}:••: r..}•' '.r'. vt;•}^:'. .}.'S:•r:.v{.v:x.,}r.x:.:..,.... .f ..r....•:...... r..: .i....// .,w...2•.:Y;•. n:;y:v:{;rq;.}•xt:;•:,.}}•{:'f+<QY¢#'2•F:...+nv}::x}y}:a:.vr:va.v:}:�a:: .}??.... •.f. nY:CJ,+CJ;;•r. .{ •:;}.4:•r::?. v:,•$....,.{t. •i'•Y{:i•Y;•i{$:�i..4• ..r..::r..:::v} .:n4.+:r..... .y;,•;:;:•.:r, n}:ti:rv:•':4:•.,.;:.x,}v:•:vv:•}:::$w:.:.. r .nrr...y }: .n.;.};{Yin r.{... .,.. .....,5$F,'Lt:}i: :i{SY:•x:na.f.v ...v. ?r•%v•rn....t...r.....r.:{:•..,r••.{...:.vnL..n.n..{. ..n.r....xi+.•:�•�•.f•:•L$:ii:,... n...:.,.... +,$i};a.^}}:.;v:. .......:.. ' .........r...:.. ........ ....::.. ..r.......r ... ...:x..yy..v. .,.+ f...vn�.•:, :....r n.M.x f•:i:.v:, Y:v}; {:;;#•. ..:.-. .........r.:..n.•....x..•± .....f.. ..n.$.?• .:ii.. f..W:.-M i:Rri!.;'}:.x^}y::,: .:J+�: .:.{v.,yt $`�G+? :;•:fif+j:��?$; .L..:•::•.....:•::...,..:{•,}.....;:••n.......t•.,......, .. v.v!:•.N.. .., '}:..:?x^•:{4'•xn•a6}r ^';t•::f�.'•};5�,}.•t';•'{%i:.a..6',r1 •�a'Y rf�r {t ::.}t:n{;:..:.4. ?tt$}:•..;.r)..r..;..{...:.x iv.f•.'':}.}.: ::.$}{.::::r:. r.}••�i:, .•:.art{:�''%• �:L:�r .;j';: ..... .:..,......:... .............:w:r:v;::::-:..;}:::•Y}'-:,,?:?v:$$:it•?+'$#:{}:;i.v::}:!vvn::+•:..:: .Snv%•}}}'4::-^nv.r..ta'.4.... F:^:::v,.. 5..... : ::....::•:.:..........:......::a.:;•::;{{.::.....;;...::•:r..:::::?:•..t:.:::::::....:•::::...:'•:.a::. ::f vl.•n .,,.. ..5.:} }?,.::tS '4.L:Y• }}:•.:,,r<k+cy{;tdS:#} a.s.:.. , :'�'} •,' ....:.....i:.}}:•:••:.,•:.•:..,{:.?+i•:•?i•::. :.. .}•.:•???•:?:...v:}:?•:::.....}::v••.......... i v. :.•=:+:.{}?.:r{i:;:};,{.Y;a}..:•.vr)}r+,:• •1•:,t:7.., .. ....... ......r r r....,n... :..::r.....r....:w:;;t-.+:a::;:.:::......n...x......A•:v::•...:.Un•;;...;{,}.. :.:;}.,..:r,r+•.:•}.G^r::.?•Yv >> ......... ...............n:..r,..+.v F.... .-,,..r.. ...........,...r....:............. .......,....,..........:.. wnv;r.•.. ...i. { f t:.:{ ,;$v; ..'�'•,t.r ..{;; ,):i yy.{.:y ..... ... ...... .... .... r. .,.:. ...r. ..... :............ ...,......:,,r.;... .,•.;•:...., ...} ,:+.•N.:} yyff v'.tt#i4 i'• +?:fYf }.>t:•.. $%•.\ ....r................... .:. .....n.. : ...:., ......,n..nr.n...• :.........r ..vx.v:.....::.. :.:.:• •..n:�4 +...:.. ..... -..4n. .-.... ....+.... .<.. ... .. :rr.r....:•:::.�•:.......r;::+::•:•:::.:•:....•::r.-.. •. t::.'}:•;:;t?F�::o?:•:F; +:"........,•:�•:}}:. {:t�:}'#'Y�';+�oi}'•$3 rY:...?.::- ...L?•:::... ...�....i??.:•.a...r:y..� ..}.:•.�:.:::•:}.,:. htiise.'#.. .. .. v :.. .: ... .. :i....\�:iS•}.v:.t,.::::r•Y::}:a::i+..}...n.......n.nv:.v?•}:+:w..,...... .. :... .... .... .... :..r.. .... ..x. .. ..... ..:..v:•::.{v........::: .... yr ..;....;,:S•:aT:'+ra,v•-:r,:$:••!' •.a:•:•}7:•:t•x:;";'{.4fii'•'�4SvF~~Z° 2 a......v....�....:::::::-..::r::...:•S.r., ...t•:.?:..:.:.t.::•rr.. a:;:+•:.{•n.....::•:::.:.:•:::.;.,.:.•.. ..:. ., ......... ......... :::.::...f}}x4... ,•,S.,,r,.::r.k...::.4>{•.y?•.'•:#•::fr •{•}}c i'.'v,�: r44.:.:..,r,•.,;••: >rf.}:r••::::•::::.....::.�:+...::::r.:,.nt;.:}......hrrn•r...r.;;.:}}....:..::::::•....+....-. ,; .r :..:x).. x. : .{.::}....f.,:.:.!+•::•n•�':><?`?+h::+• }. r v£.S•na'•r•.. ,. ,r..:....•.•::....rr.::....:•::n .....:::.v.... ::::..:..... ., .:...:•::::•::}}}::..,•}::;•}7}:•}7:•::+... {...;}::#:::y..,?.,,{,+,..::.,o:. r.. �. �,y• .,.:..:......,.:::: ...i:•....w:::.•..........r: .............:....::.:ia:.Y...:•r.•.-........:•:.......::::••::,:{t•.;::t...r•:: .}:..•Yti}r:•:4Y^x• L.• y tic'rx`n•i:}? '+ ^;$$�< .:::t•::::x•::a::.:.. ........ ......,,:::•.•::rY:}:a}::::;+ {•}:•}:{;•>.t•)f.t•}}:•:.::•?:•.,..:::• .,{.;:•t'?,Y n+.a?S:• , y.?•::y}. .a• .v.....,..... .. ..,:-:.v.. .:v:i...........?K. .:,.:...r:•..:.�•:4:i:Sr:•?{:rr.}}:•7:v:J,.:;•f..... �rL . .. .. .....,•v.:. ...n•..r•....,x.• ......... :.,•::•::::a....n .t.:> �7r.'::•# nv...S;}1:{Y.•x f.,r.y .,:{?.?a.,{;ti+�?.:t+';•t.;t:A, :C•},x ;`;5,:+>}xS�,•-:{•{{::•Y:. 4.:t.R.: :•{,¢t,{.....rr..o......:.k:n, •.tifS•r•.b :.{a:?<v^:•�x.} •vi?T.,{iv}:t�i$ ' ..-.....-::::.•r.•v}i'•,:.v.: ....... ... ...... ......... .4 v}?4:.,,..,••v:::J•t:r..v::v:J:?ri}'r.:v,vr.v..rv:::•'::'':$: ¢:+r}.,;{...;..,y� ,..,,}•:.• .vf.� .........................r.. .: xv.., ...r ...,Yr......;.-. .:...+,,G....r:!::•:v::::....n.:}....,:v...::•:•.}:{:'a}::v::i}::'{. +..... :.yy.:w.3: nixyi �y,?�: } .:•rxr... ::::::.i...::r•:...:•:.•x,3 r.:::r:.:r,,: ::,..:;...:.:•. .,t•}):••.5.,•.}.r::.i?:....4•:•::::•r r;:..:•:.r....•;.;}.}....:...•:::....,.,n•:;:., •--�5';•^'1' r,;n:fSn...Sk}:{.., ;i,+,{'S•.•:,}S}}',•c.•}}fivr::!>.a�w,......` .{•::.•;•::?:•:::•:::•..;,•,:.::..;{,.::.:./ ......::r.r:hS�+n.,>;.:x?{.,•..{•f.#,:•:::},..?:;,:•.•::r:}::fr!)::•:r::•:+t?•.:}.+.L•::••::.:!::•:}:•:::.}}h•r:::.-:.a•.:. '. •:$�'.•Ytf},::a�.../.v?: :}}iYt<•::::;t;:.}?..a;;:.}:•x4+}; .•{r.;r?YV).n•,•?{..;:?•: :::nv,•.::........:.. ;.....,.... n...:...r...r....:•:,vf a:fi?w.:i:.:rr:rL•:•wv:^:•.}'- nli::ar4{$,-;}:v:i}•.... ,•-ii?}F::.}•y:rv,•}:a}f.{v•x:{?•Y:4r{.:::fi'.i!:•$:•:t{:}:•}..:{r.v .{:>.,Y QLI }C' ....n-.a::.::::v..;•:'v;, >r?•?{•n�+ ra'{ �';:$::;C!;�{i.Y$:•nvii?t'f•'i:{4:•:vn:?•:.v. . E 1�1ATa�ce:co�:s>$<?ia::;?:::r:,•a,{>:,$..?+.. enaltin of a�e�rp to SI,S00.od and/or e sus required under Section Z5A of MGL 152 can to the Imposition of ertmin0.P g�rQ'e to secure coverag e,�slflea the form of a STOP WORK ORDER"�a 9ne of S100.00 a day against ma Iunderstaad that a one years'b nprisonme d as wen as ctvU p copy Ora i s statementmay be forwarded to the Office of Investigations of the DIA for coverage veriflcatton. the and penultias of perjury that the information PrO��d above is irt�artct carted • I do ' ebY c a003 Date ef if N�► 13= 1��,ao-h _ name oMdsl use only do not write in this area to be completed by city or town offidsl perndt/license# ❑Bsnilding Department ❑Licensing Board dty or town: ❑selectmen's Office ❑checkif immediate response is required ❑Health Department "" ❑Oth phone#; contact person' i3i ;I lrevuad 9195 PIA) • J 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 j another who employs persons to do maintenance f such employment or repair work be deemed to.such as dwelling employer. house or on the grounds or building appurtenant thereto shall n o MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or'renewal of a license or permit to operate a business or to construct.buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation,-and supplying company names, address and phone numbers along with a certificate 'of insurance as all affidavits maybe submitted to the Department of Industrial Accidents for confirmation ation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are'required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the petcense number which will be used as a reference number. The affidavits may be retarikb the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Otffce of InvesugauOns 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 a. fK17) 727-4900 ext. 406. 409 or 375 yOFISE rp�y Town of Barnstable Regulatory Services - ram, t Thomas F. Geiler,Director Buildinp•Division ''TFD MA'S w b 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. 1 / i Type.of Work: FIV idCt�u (LOv�tCf T.` Estimated Cost �60 0 Address of Work: /55 LKq_in I'VE d�� Owner's Name: J_HN ? CES 11 f oLSon Date of Application: ��� I hereby certify that: Registration is not required for the following reason(s): OWork excluded by law ❑Job Under$1,000 OD ' ding not owner-occupied er pulling own permit t Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME EvEPROVEMENT 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 nmm�r !N9m P. Town of Barnstable OFSME Tq�, Regulatory Services Thomas F.Geiler,Director snatvsTaer�, = , 94, ' AM .•� Building Division AtE�MAC a Tom Perry,Building Commissioner 200 Main Street,`Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: /D/ 7oQ3 JOB LOCATION:. 55- /✓1/1.. ✓E number d(LS<M streLet village.1KOMEOWNER": cL HNE 5C�Q -7"I1`2412 L name home phone# work phone# CURRENT MAILING ADDRESS: /;5 J�V l n� Av"" 8V617nQ190 27 . � 9 0W�7 city/tovd state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who.does not possess a license,provided that the owner acts as supervisor. - DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm.structures..A person who constructs more than one home in a two-year"period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable-to the Building Official,that he/she shall be responsible for all such work performed under'the building Permit, (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with.the State Building Code and other . applicable codes,bylaws,rules and regulations. - The-undersigned"homeowner"certifies that he/she understands.the Town.of Barnstable Building Department ... minimum inspectio procedures and requirements and that he/she will comply with said procedures and regt' ents. Sign re of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger"will be required to comply with the State Building Code Section 127.0 Construction Control. HOMKOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. . G Q:forms:homeexempt TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION �l Map % 929 Parcel 0(P b `� Permit# 2 1� e e �9 o t k r 3E y e�RNS(ABLE / Health Division — 5-To /1 �.3 Date Issued 1 f era Conservation Division 61 I��� C? � Application Fee Tax Collector Permit Fee 3/C. ® 6, -�---------_ SYSTEM Treasurer I V 1 S I ON SEPTIO1�+SPALLSD INARJcE MUST BE U Planning Dept. Eflll/i�O�WM TITLE 5 Date Definitive Plan Approved by Planning Board TO01V R NTAL CODE ANt OvS Historic-OKH Preservation/Hyannis Project Street Address 1511 Irving Avenue Village Hyannis (Port ) Owner Mr. John Wilson Address 155 Irving Avenue, Hyannis Port Telephone (508)771-4498 Permit Request Construct (6) Dog House Dormers Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation $100,000 Construction Type Wood Lot Size Grandfathered: ❑Yes ❑No If,yes, attach supporting documentation. Dwelling Type: Single Family ® Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of.Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:0 existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing Cl new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name F. J Jaxt imer, gui)der., lnc Telephone Number (508)778-4911 t Address 48 Rosary Lane, Hyannis License# 003251 Home Improvement Contractor# 110609 Worker's Compensation# 5000672012002 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO comber' s Dumpster ' SIGNATURE DATE 74 f 1�0 3 k •I FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. - ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME / /L m O h //AA 3 �� INSULATION //!a ZG / BEY A k, FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH- FINAL J FINAL BUILDING ! DATE CLOSED OUT '* ASSOCIATION PLAN NO. RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE IS, o , 00. New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSAEET NEW LIVING SPACE square feet x$96/sq.foot= fQ0 D 40 x.0031= 3�0 � O O plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.-foot= , x.003 I= plus from below(if applicable) ACCESSORY STRUCTURE>120 sq.1 >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: x.003 1= square feet x$96/sq.foot= 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) permit Fee projcost S• The Commonwealth of Massachusetts Sl'..i n< y Department of Industrial Accidents F - Office of/nsestigatiam - 600 Washington Street ' Boston,Mass. 02111 �k' . Workers' Com ensation:Insurance Affidavit name: J . J �va 1-1�er—. C . location: 1 l USA Z 7 city 0 2-(0o phone# g 1 2 -`1"/ I ❑:I am dhomeowner performing all work myself. I am,a'sole proprietor and have no one working in any capacity ❑ I am an employer providing wlorkers/compensation for my employees working on this job. companyname CJ x� 5GI � - city )1.Vl rl ►�t i�l I S rn 6� hone � I p insurance co. �. . .. -� olicv# 5,h14 i!a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have' the following workers' compensation polices: comoanvname• address::. cite - phone#:... ,.. ,;:: ohcv insurancelco.. { company-name. .:. .:•:..::;.: ........... address: city phone# :: :::... zan�tirance.co..;, ,_ <:.;; .;: .: `olicv#.:>. Fafiure to'secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or one year,'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 a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification I do hereby certify un t pains.and penalties of perjury that the information provided above is true an corre Signature Date I 3 a I Phone# Print name AT official use only do not write in this area to be completed`by city or town official city or town: permit/license# ❑Building Department ❑Licensing Board ❑check if immediate response is'required ❑Selectmen's Office ❑Health Department contact person: phone it; ❑Other (wnsed 9/95 PIA) �oFtNE, y Town of Barnstable Regulatory Services Thomas F.Geller,Director MASS 94ipTE16jrq. " � 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. Type.ofWork: Construct (6) Dog House DormersEstimated Cost $100,000 Address of Work: 155 Irving Avenue, Hyannisport Owner's Name: John Wilson Date of Application: 9/16/0 3 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 a the agent of the owner: 9/16/03 E. J. Jaxtimer 110609 D ate Contractor Name Registration No. OR Date Owner's Name -�e &mmowawald Board of Building Regulations and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 110609 Type: Private Corporation Expiration: 11/3/2004 E J JAXTIMER, BUILDER, INC. ; ERNEST JAXTIMER t w 48 ROSARY LN --- HYANNIS, MA 02601 ` ,, --- -- - ----- Update Address and return card.Mark reason for change. Address, I I Renewal ' Employment r_.-i Lost Card Board of Building a ulations One Ashburton P ace, m 1301 Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 01/14/1956 -K Number: CS 003251 Expires:01/14/2004 Restricted To: 00 ERNEST J JAXTIMER _48 ROSARY LANE �k HYNNIS, MA 02601 Tr.no: 14213 Keep top for receipt and change of address notification. 1. Sep 16 03 08: 38a p. 2 05/16/2003 10:47 508775490E PAGE 02 Town of Barnstable Regulatory Services # ' 'Thomas F.Geiler,Director Building D3visioxi .Tom perry, Building ComiWesloner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4638 Fax: SJ8-790-6230 Property Owner Must C.omplete and Sign This Section If Using A Builder as Owner of the subject property htrebyaudmrize �' .v._; �lv �),%iF to act on raybe}ia�f, in gn matters relative to work authorized by this bukkg permit application for(address of Job) �l ruse of Owner JDate j�J �h� L.�)LS IY-� Print Name �... .. .,.....:..n -..;e" -.r,._.:.,,,.;,.t..,.r as. ,. r..:•.:�:. ....._.;.� ,i*,=.y,.� r.,:..w.,n ,.,..v=rnravm v,;..:.ne.^ .:::..`w`?.,r:' assn-rs ��.�.:. I� MR r77774 71 _ r j r'! lj t I Iltli s '. I REAR:E'LEVATION aen¢e ie.r-o• < ? A 3 q I cl 7 I 7 77S :av7y DATE os/z! oz f y _ REVISIONS DRAWN BY DRAWING No yy I }3RO. :.LINDQUIST � RlrNO�?AT[ONS,'EOR - C - _ t 155 lRyltvc AVE : EENUCCIO & RICH 0NI7 1#kT +s I,° h HYANNISPART MA ! s , IOHN WILSON ROS-16EN�CE. iei�eoe ssiea3ez yAwauuxx�c�t:; �j dfaas k a�:. PHASE III _ ... __. ......_.__... -.,.n...:.. .. __,':.,,. �.`_..�_. ._.. .:�.. ..........:.._.. ...... .. ._ _._ J ..._._✓_n....�� __.. _ _._ __ _....e...__—. .._i�...- __ - _-r_ems.. ._..i_. .._ _.v..—u.. _n...... __�. __.._.._a.. ... ..._r-. ... '�{ mq,spnga[pme .. .'.•+' s::,.,. ._�.a..._ ,:.:s... ..5..: ,:. a_+e_.,.. ...: ...L.t ...-w..-.,..v.. .•.n..... '�. K....=wAwr.,ae ...* c.,�.+. _ Y a,K +5 :�.+.. ., ..,,..•,<.. ..... .rs!.„t.�a., ... ... r ......,.: xx. � srso R': F•a✓iwi:Fvn'i^' -u-v_•.rv' av:..u.,�:' usv�unsc ,.w v..:w. ,..•,.•• .. �•rrt 'l•aF.. ..gym- v „:.•v .' O " -ceriT@�E New,WtNoow .. '-' � •� . WALIGN 00�9R AIL BELOW TTP. BTRUOTURAI - y� °U V POK KN@E WALL 8�,, LocAT oNs T 9RA TTI ETQRA -A fiE •!p •Cr' \� '.'t O T4R.y�r pORtYER OV@R" ' ATTJc/5TORAGE PiRBT FLOOR wtNpoN ae[.oW �R'v B@DROOf4 h \.. HALL :C@NTlR NeW DORI'1eR OVF�R". OCNT@R N8W CWW.1eR'.OVER '� PIRBT PLOOR.WtNOOw BlLGw• PI¢BT PLCOR HINOOW DP10W ' . .. . S. a' 3 5.3/e NI SS-- gOrtoy/SlLit 1FuPfREU Gt55 S: 'BEDROOM NO E PE4A JAL"�i[Cf SF•5 E5 1- ' 2 K�'iVAO MC t6 9E 9R �N : Ivy DYahwCtDA D0 :N000 0�`F 0:/M10Q 2��'t • WN{H RD84CP D':.UBsmUS! IXIP P fCn-ACCAT{ '. DACE D5121102 REVISIONS _ DRAWN BY .. 1 : x k P DRAWING No. THIRD FLOOR PLAN BCALen/+•.r-D• . UIST ' F NEW RENOVATIONS FOR 73ROW'N LINDQ _ 165 INVING AVE FEN-UC`CIO & ;:RICHM:QND e1T:C 11 T t ING HYANNISPORT MA. TO'FIN W`I•LS0'N RESIDENCE 9ga aALx s tesT SANNOE74ltF1110. f4 Da p �rc 'T�L 600 3BD:,698@ RIS. GiN AUd 2ti:.A ., PRASE III �- „....=�,,.... .::.....,�: s-.,4= .r..c.. :... m. -:...: ..:s.:;.-.,,.....-.,......-: .. �,«....._..I.,�,.a,sa... 'mnr-.,,...,:��a.. w-,-,.-,w,-,_.«,.,... .... .,x�..,,s.. r s.�. _.�.�,.,. .. e 1 ,. ewe.,,,, .-:,w�«,. ,K... ........... �-. ..*,., ,b ,. ✓'` ... �z u. 8 t (1118)fltlBRTiLO,11.TT 77 ' AGPNAGT.;gNING B9�'1.rto f:�ATGN-. ... ' ��,r/.-PVCpT1H�/gKOM Pu`�J ]W RAfT t3iGGH VHNT ISl-:PLTNODD @AG[IN4 .. ' � 'a 1DOe.. , vH BGI/T uI l HGffIT.VHNT IA.,RI[iGe- :TOa , a TIfS'O'16'O.C. 'A9PyAlT gNIN6LEB TO I'IATGN' WNT B%4l.H-MJ PRI!IjC'P�:” .. E% 71 I� Na ON IBp�PCLT PpPGR �.'3'-O L.C� •OVLR q/e CDY.VLYINDOO'DN �'li{RAATBRH•.l{ O.G. \ ✓ OF DETAIL ® PORI IER .':;HggLHqe Id 9t 11(9 (RGID:NW 4.. y fIB[RGL SAT-T '.•� .. .,,. 7 e B,:GRONN:GIN: ` RLT�'DACkING ..'ll9 HO/PIT /I•:.:9OFPIT'VENT l H I I 11II I . I� .• INeuLAlgN 1 Va a1Wo iNHU ,` 1.r ;... �. -... .-... u ,�'. .. .`EON'T 4/A.>aB;1/Y•'fR1FZE @D. -' 1-'K[<T._•6AFYL,1?5 2 X(c 7_SL I() r5 al I �'/i1ut FA. �3L5 tiYD L .. ,eip ccX PLTi'+cop ..S K. '.'� `.,1"AT�'A`�a` -:a'vd BTUDB•�^u O.G. I �.' P>aNPeD) .KNee NAL r : X :eEE BTR�TURp1 I TI . - „H..In: RIUPieeRGL GATT .P d '4 a1 h]�E W" NeuLA ioN �.4 /. ATTIC/9T0RAGE 'ON TT4HK NWHBW0.AP �� TQ IIHMA�I PRbA�A@ N�DHD'' .k y .- :'' :L fN18N PLOQi}PER:'OWNeit PCYB.. - '1•'.4_, '•.. `, ' 11 -71 (TO mAT _ �6X PLOOR':PRA1Y NG ; - r : . - SEGTLG?t^l THRU AfiTIG - - - ' DDRt'hER DETAIL "ALHi^.r_o• A DATE 651241O2 ..REVISIONS DRAWN BY t 5 ; 'DRAWING No. F 'D NEW RkNOVpTIONS FQR BROWN.I.INDQIIST t ? I':55, tttvitvc AvE FENU.CC10 & RICHM ly1� Div; i l E t i INC HYANNISPORT MA: f—Y JOHN WII SO1V RESIDENCE eza IdA1R srRaai y�xyv i`tAqta d p. PHASE III:. / .: -. .... i ^ r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map v Parcel D Application# M fo Health Division Date Issued Conservation Division Application Fee Tax Collector Permit Fee JL Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address ✓/ 4L-C Village WInIm n 15!J om,'f" Owner 7o �A)d50-n Address 457 ,�via4 Telephone M - 7 37- 7q7a• Permit Request ?'O �R�e a. x g�' ao X3y' /��i.c�oRo�v Y'i d 0 c� 4 Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 1.3� (P&T-01 Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 5`a Number of Baths: Full:existing new Half:existing nevV ca Number of Bedrooms: existing new -7 Total Room Count(not including baths):existing new First Floor Room Count6 x Cal Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other 'n E0 Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: lZes No; Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning rBoard of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Aw� , • .. w..... ._ BUILDER INFORMATIO Name,&&k % o Telephone Number,2:r/ 7029 -YOM Address // l✓Q License# �, S OCaIl�L 9 "t- It es 4ex, /12�f Gd/gr0 Home Improvement Contractor# Worker's Compensation#647,"617- W ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO/ Tbc.+n cif 41KMA SIGNATURE DATE O l FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL N0. ADDRESS VILLAGE OWNER r DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE E` ELECTRICAL: ROUGH FINAL ,' t PLUMBING: ROUGH FINALle GAS: ROUGH FINAL L ' FINAL BUILDING > ;y DATE CLOSED OUT ASSOCIATION PLAN NO. Jun 30 09 08-.54a WILSON 6503436757 p.2 aoF ►� Town. of Barnstable Regulatory Services Thomas F.Geller,Director Building Division Tom Perry, Budding Commissioner 20D Main Street, Hyannis,MA 02601 www.town.barnstable maxs Office: 508-9624038 Fax: 50B-7904230 Property Owner Must Complete and Sign This Section If Using ABuilder - ` n 3k I, 'U i'�n l.� S C�i'� ,as Owner of the subject property he authorize �eT�ie.S arl /a/[i7�y /I 7�/Z to act on m)r behalf, in aII matters relative to work authorized bythis boil.ding pejTni:apPE tion for. , , (Address of job fa ' 3C DU 5ign� of Owner . Date • 2) C1 Print Name • l QFORM-S:CWNERFERMISSION I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information /f Please Print Le 'bl Name(Business/Organization/Individual): , 7e, /CS407 Vk N Address: City/State/Zip: z2z2 )e �0s !�,� Phone.#: ydrT� Are you an employer? Check Lie appropriate box: Type of project(required):. 1.[ I am a employer with ,?�— 4. ❑ I am a general contractor and I employees(full and/or part;time).* have hired the su'b-contractors 6. ❑New construction . 2.❑ I am a'sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ' ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp. insurance.$ e e 10.❑Electrical repairs or additions required.] 5. ❑ W are a corporation and its P officers have exercised their 3.❑ I am a homeowner doing all work 11.❑Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no -4— employees. [No workers' . 13.[jiOther /iPLX , comp.insurance required.] . *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provi&their workers'comp.policy number. Iam an employer that is providing workers'compensation insurance for my employees Below isthe policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.M lcC Od s- Expiration Date:`ftJ 9 O y' Job Site Address: s .GdJA► City/State/Zip: Attach a copy of the workers' compe Ration policy declaration page(showing the policy number and expiration date),,; Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and,a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains-and penalties of perjury that the information provided above is true and correct: Sienature: Zf Date: hl � Phone#: Official use only. Do not write in this area,'tb he completed by city ar town offeciaL 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#: I},;t►art file nt of Public afct Boil'-(] 44 Btfildin.1 Re-tilatio►n. an(f Standaudx C<:AstruCtiori Supervisor P License License : CS 9:0219 Restricted to: 00 .;-,, MARK TRA IiNA 33 HANFOF'O RO STONEHAN'., MA 0:!?18O ExpiratioC- 4/27112011,�,) ( ummiai Hoer' Tr#: 14425 15�''+ '".Jx�'.'rsw�'`s,t•..ar' K r xi+< , -�anc+ .`-'�"ae- t`ti^'fA ..., .: . ; Y e F'- IMPORTANT DOCUMENT 5 S 5 Certift,rate of Otame 'Rem"Maurr C5 5 REGISTERED ISSUED BY 5 5APPLICATION Q�'c �o CNOR. Date of Manufacture NUMBER H a . INDUSTRIES INC. 3/06/98 j 5 5 5 F121.4 ��fi ET�a�r EVANSVILLE, INDIANA 47711 Order Number 183326 5 CU K MANUFACTURERS OF THE FINISHED TENT PRODUCTS DESCRIBED HEREIN k. 5 5 This is ' to certify that the materials described have been flame-retardant treated (or are inherently noninflammable) and were supplied to: 5 5 5 5 PETERSON PARTY CENTER INC 5 5 5 5 139 SWANSON ST 5 5 WINCHES TER ' MA 01890 5 5 _ 5 5 Certification is hereby made that: 5 The articles described on this Certificate have been treated with - 5 h aflame retardant approved 5 chemical PP 5 cal and that the application of said chemical was done in conformance with California Fire 5 � 5 t Marshal Code, equal to exceeds NFPA 701, CPAI 84, ULC 109. 5 5 The method of the FR chemical application is: 5 5 Serial #: ----- 8001800 (0001) 5 5 5 Description of item certified: 5 5 FI TOP 20W X 30 VL W W 5 5 Flame Retardant Process Used Will Not Be Removed By 5 55 Washing And Is Effective For The Life Of The Fabric S �1. ►������ ? Signed: az 5 Name of Applicator of Flame Resistant Finish TENT DEPARTMENT—ANCHOR INDUSTRIES INC. r��PrPrJ��PrJ��PrJ�rJ�rJ��PrJ��1�rJ�rJ�rJ�rJ�r�rJ�rJ��rJ�r�rJ�rJ�rJ�rJ��PrJ�rJ��rJ�cJ�rJ�rrr�rJ�rJ�rJ�r�rJ�rJ�r��PrJ�rJ��PcPrJ�rJ�rJ�rJ�rJ�rJ�r��PQ03PrrJFrJ�rJ�rJ�rJ�rJ�rJ�rJ��P�PrJ�rJ��PrJ�r��Pr�rJ�rJ�rJ�r�rJ�r�r�rJ�rJ� 5 k,.;ertJ[ teatc or ' t r e leesistapee r 5 REGISTRATION ISSUED BY 5 � Date of Shipment 5 S APPLICATION Q S 5/10/2006 S NUMBER '> tw� DUSTHIE INC 5 S � r EVANSVILLE, INDIANA 47725 Tent Identification 5 1 I la.ub MANUFACTURERS OF THE FINISHED 04263446 5 TENT PRODUCTS DESCRIBED HEREIN 5 SThis is to certify that the materials described have been flame-retardant treated 5 S (or are Inherently noninflammable) and were supplied to: 5 5 657150 5 S PETERSON PARTY CENTER INC 5 5 139 SWANTON ST 5 5 WINCHESTER MA 01890 5 S S 55 5 Certification is hereby made that: 5 5 The articles described on this Certificate have been treated with a flame-retardant approved 5 chemical and that the application of said chemical was done In conformance with California eS0 S5 Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. 5 5 Serial # S 8123315C 1 5 � > S 5 S S 5 S Description of item certified:P S LOSBERGER MIDDLE 20MX5M WHITE 5 S 9702 FERRARI 13LOCKOUT VINYL r Flame Retardant Process Used Will Not Be Removed By 5 5 Washing And Is Effective For The Life Of The Fabric 5 5 ccnonor rcvrrr cc r n nrro nri prri 1'DnN99 Signed: —`� S Name of Applicator of Flame Resistant Finish ANCHOR INDUSTRIES INC. 5 O rJ��Pr.PcP�PrJ�rJ�rPr�r�rJ�rJ�rJ�iJ�rJ�rJ�rJ�rJ�rJ�cJ�r��Pr�rJ�r�rJ�r�rJ�rJ�rJ�rJ�rJ��.PrJ�rJ�r�rJ��P�Pr��.Pr�rJ��Pr�r�rlrJ�rJ�r�cPrJ�rJ�rJrJ��PrJ�rJ�rJ�c.PrJ�rJ�tlr�r�rJ�rJ�rJ��PcPrJ�cPrJ� t] 1 rRi k�.eraneatc oY WCslspCC 5 5 REGISTRATION ISSUED BY 5 � Date of Shipment S APPLICATION v � 5 ri CR R. 5/10/2006 5 5 NUMBER 5 5 '' ti tifi t Ide ntification C r EVANSVILLE, INDIANA 47725 5 S MANUFACTURERS OF THE FINISHED 04263446 5 r444.o8 5 5 TENT PRODUCTS DESCRIBED HEREIN 5 SThis is to certify that the materials described have been flame-retardant treated 5 S (or are inherently noninflammable) and were supplied to: 5 5 5 657150 S PETERSON PARTY CENTER INC 5 5 139 SWANTON ST 5 5 WINCHESTER MA 01890 5 5 5 5 S 5 5 Certification is' hereby made that: 5 ; 5 The articles described on this Certificate have been treated with a flame-retardant approved 5 5 chemical and that the application of said chemical was done In conformance with California 5 5 Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. 5 5 Serial # 5 5 8125315C(1) 5 5 5 Description of item certified: C 5 LOSBERGER MIDDLE 20MX5M WI11TI: 5 5 #702 FERRARI BLOCKOUT VINYL 5 5 Flame Retardant 5 a t Process Used Will Not Be Removed By 5 W 5 ashing And Is Effective For The Life Of The Fabric 5 5 T r_cnon12 xRyTrr FS: 614,TOAD DU trni FnnP4(;g Signed: � � Name of Applicator of Flame Resistant Finish ANCHOR INDUSTRIES INC. S !] rJ�cPcnrJ�cPrPrJ�r��r-rJ�rJ�rJ�u�rJ�r.1��r-�l�rJ�r�rr�rPr�rJ��PrlrJ�rJ���nrJ�rJ�u�rJ�rP�r�rJ�rPrJ�rJ��rJ�r�cfrJ�rJ�cPrJ�u�r�r�r�rJ�rJ�rJ�rJ�cP�nrJ�cPrJ�rJ��PcP�PrJ�rJ�rJ�rJ�rJ�r1��PrJ� o 5 REGISTRATION ISSUED BY Date of Shipment 5 APPLICATION 5 5 NUMBER Nou�sTE 5/10/2006 ti tifi t Identification 5 r EVANSVILLE, INDIANA 47725 Ten 5 5 Id1a.08 MANUFACTURERS OF THE FINISHED 04263446 5 TENT PRODUCTS DESCRIBED HEREIN 5 5 This is to certify that the materials described have been flame-retardant treated 5 5 (or are inherently noninflammable) and were supplied to: 5 5 657150 5 �j PETERSON PARTY CENTER INC 5 5 139 SWANTON ST 5 5 WINCHESTER MA 01890 5 S 5 5 Certification is hereby made that: S 5 The articles described on this Certificate have been treated with a flame-retardant approved 5 5 chemical and that the application of said chemical was-done in conformance with California 5 5 Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. 5 �j Serial # 5 CC5 8125315C(1) S Description of item certified: , 5 LOSBERGER MIDDLE 20MX5M WHITE S #702 FERRARI BLOCKOUT VINYL C, SFlame Retardant Process Used Will Not Be Removed By 5 5 Washing And Is Effective For The Life Of The Fabric " 5 5_j cco Signed: Name of Applicator of Flame Resistant Finish ANCHOR INDUSTRIES INC. rj o 'Oil 5 k. -erti_t leate o - ' ttl 1W `teesistapee S 5 REGISTRATION ISSUED BY APPLICATION a ' � Date of Shipment 5 _ riouse " 5/10/2006 5 5 NUMBER 5 5 5 5 r r EVANSVILLE, INDIANA 47725 Tent Identification 5 5 MANUFACTURERS OF THE FINISHED 04263446 5 F4�4.o� 5 5 TENT PRODUCTS DESCRIBED HEREIN 5 5 This is to certify that the materials described have been flame-retardant treated 5 S (or are Inherently noninflammable) and were supplied to: 5 5 657150PETERS 5 5 SWA ST ONTON PARTY CENTER INC 1139 5 SWINCHESTER MA 01890 5 5 5 5 5 5 5 5 Certification is hereby made that: 5 5The articles described on this Certificate have been treated with a flame-retardant approved S chemical and that the application of said chemical was done in conformance with California 5 5 Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. 5 5 Serial # 5 5 sI2s31;c cl� S C 5 Description of item certified: c5 5 LOSBERGER MIDDLE 20MX5M WHITE 5 9702 FERRARI BLOCKOUT VINYL 5 Flame Retardant Process Used Will Not Be Removed By 5 5 S Washing And Is Effective For The Life Of The Fabric 5 SCCD )ADf TCVTII T C i A T IIJ lll D1� Signed: 5 Name of Applicator of Flame Resistant Finish ANCHOR INDUSTRIES INC. a �r-r��Pu��Pr.r�r.Pr��rJ�rPrJ�rJ�cPr�r�rJ��Pr1rJ�cJ��1�r�rJ�c1��i-r��n�PrJ�r..J�u�r��.Pr�r.�rJ��.PrJ�r�n�Pr�rJ�rJ�rJ�r�rJ��PrJ�cJ��rJ�rJ�rJ�rJ�rJ�rJ��r-�PrJ�r�rJ��.n�.nr�rJ�rJ�rJ�rJ�rJ��r-r� � d. S k.�eruj legs of ' �� l `tvZesistanee 5 5 REGISTRATION ISSUED BY 5 a � � Date of Shipment APPLICATION 5 5 r�ousEi 5/10/2006 NUMBER 5 S 5 r , EVANSVILLE, INDIANA 47725 Tent Identification 5 5 F444.Os MANUFACTURERS OF THE FINISHED 04263446 5 5 TENT PRODUCTS DESCRIBED HEREIN 5 SThis is to certify that the materials described have been flame-retardant treated 5 5 (or are inherently noninflammable) and were supplied to: 5 5 5 657150 PETERS5 1 SWA ST ONTON PARTY CENTER INC 39 5 5 WINCHESTER MA 01890 S 5 S 5 5 5 5 5 S S 5 Certification is hereby made that: 5 SThe articles described on this Certificate have been treated with a flame-retardant approved 5 chemical and that the application of said chemical was done In conformance with California 5 S 5 Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. 5 Serial # S C5 8125315C(1) 55 SDescription of item certified: C5 5 LOSBERGER MIDDLE 20MX5M WHITE 5 5 #702 FERRARI BLOCKOUT VINYL 5 Flame Retardant Process Used Will Not Be Removed By 5 5 5 Washing And Is Effective For The Life Of The Fabric 5 5 ccoknoi i n 4:99 PU D� l ronni Signed: 5 Name of Applicator of Flame Resistant Finish ANCHOR INDUSTRIES INC. 5 teatc oYk, talpe S REGISTRATION ISSUED BY 5 � Date of Shipment 5 APPLICATION v SNUMBER 's INDusEi1` 5/10/2006 5 5 ~ Tent Identification 5 EVANSVILLE, INDiANA 47725 S 5 17444.08 MANUFACTURERS OF THE FINISHED 04263446 5 5TENT PRODUCTS DESCRIBED HEREIN 5 SThis is to certify that the materials described have been flame-retardant treated S 5 (or are inherently noninflammable) and were supplied to: 555 S657150PETERS 5 S SWA ST ONTON PARTY CENTER INC 1139 S 5 WINCHESTER MA 01890 5 5 5 5 - 5 5 Certification is hereby made that 5 5 The articles described on this Certificate have been treated with a flame-retardant approved 5 Schemical and that the application of said chemical was done in conformance with California 5 5 Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. 5 5 Serial # 5 8125315C(1) 5 Description of item certified: 5 CS LOSBERGER MIDDLE 20MX5M WHITE 5 5 #702 FERRARI BLOCKOUT VINYL 5 5Flame Retardant Process Used Will Not Be Removed By 5 Washing And Is Effective For The Life Of The Fabric 5 5 5 Signed: - - W � � 5 rconnoI i - ---t cc r n rniic nri PIN,snnrirr Si L' �j Name of Applicator of Flame Resistant Finish ANCHOR INDUSTRIES INC. 5 (] cJ��PrJ��P�PrJ�r�rJ��J�rJ��Pr�r�cJ�rJ�r�r�r PrJ��Pr�r PrJ�rJ��Pr��PrJ�rJ�rJ��PcP�Pr�rJ�rJ�rJ�r��PcPr�r n�PrJ�rJ�rJ�r1rJr�r�rJ��PrJ��l�rJ�rlrJ�r�rJ�rJ�rJ�rJ�rJ��PcPr PrJ�rJ�rJ�rJ�rJ�rJ�rJ� O 5 pertitteatc or ' tmW wes-ist pee 5 5 REGISTRATION ISSUED BY 5 � Date of Shipment 5 APPLICATION o- 5 s Uk 5 E ft 5/10/2006 5 S NUMBER � 14, 5 EVANSVILLE, INDIANA 47725 Tent Identification S S ° MANUFACTURERS OF THE FINISHED 04263446 f 444.OS 5 5 5 TENT PRODUCTS DESCRIBED HEREIN SThis is to certify that the materials described have been flame-retardant treated 5 S (or are inherently noninflammable) and were supplied to: 5 S657150 5 5 PETERSON PARTY CENTER INC 5 139 SWANTON ST S SWINCHESTER MA 01890 5 5 5 5 5 5 Certification is hereby made that: 5 5 . . 5 The articles described on this Certificate have been treated with a flame-retardant approved 5 pp 5 5 chemical and that the application of said chemical was done in conformance with California 5 5 Fire Marshal Code. All fabric has been tested and asses NFPA 701-99, CPAI 84, ULC 109. 5 5 p 5 5 Serial # C5 8125315C(1) 5 SDescription of item certified: 5 S LOSBERGER MIDDLE 20MX5M WHITE 5 5 #702 FERRARI BLOCKOUT VINYL 5 5 Flame Retardant Process Used Will Not Be Removed By 5 5 5 S Washing And Is Effective For The. Life Of The Fabric 5' 5 5 ccoonor rcvrrrcc r n rnrio nit on�nnrrQr Signed: - --- ^�j 5 Name of Applicator of Flame Resistant Finish ANCHOR INDUSTRIES INC. 0 This certificate is executed by Liberty Mutual Insurance Group as r ,xets such in urame as i!.afforded by those companies... - ill IOOGH Ccttt6cate of insurance This eerti6ute is issued as a matter of information only and conic.no rights ups.n the certificate holder.This cmificate is not an insurance policy and does not affmiatively or negatively amend•exto d,or alter We covcragc:(forded by the policies listed below. Policy lin its are no less han those listed,although policies may include additional sublimits not listed below. Policy limits may be reduced by,:aims a ahtt cots._ This is to certify that(Name and address of insured) - Peterson Patty Gntcr Inc 139 Swanton St _ j 1bert,Y Winchester,MA 01890-1918 - (1 Mutuc,::1. is,at due issue date of this eenif+cate,insured by due. ....Cn icy(ie: listedbelow. The insurance afforded by tlm listed poliq{ies)is subject to atl their trnns,exclusions and conditions an[ s not altered b an ra uirement lemt or condition of an um nt with ree.f.cct to which this eeni(icate may be issued.Ex iration Ty a MJEz olie—\umber(s Limits of LiabilitContinuous` 10/09/2008 WC '-111-25'1617-028 Coverage afforded under WC 12W of Employers Liability �—' the following Extt:nded Bodily Injury By Accident X Policy Term MA $500,000 Each Accident Bodily Injury By Disease S500,000 Policy Limit Workers Compensation Bodily Injury By Disease $500,000 Each Person 10/03/2008/10/03C 009 TBi 111-259,'M-038 General Aggregate-Other than Prod/Completed Operations General Liability - $2,000,000 Claims Products/Completed Operations Aggregate Madc S2.O%^.�00 X1 Occur;cn Bodily Injury and Pr;,perty Damage Liability Per S1,000,000 Occurrenc: Re tro Date Personal and Advertising Injury Per Person f S1,000,000 Other Liability Other Liability 10MY2008/I0/03/< :09 AS2 1 I 1-2 596 1 7-01 8 Each Accident-Single Limit-B.I.and P.D.Combined Automobile Liability $1,000,000 —� Each Person X Owned `� Nc:n-O• act Each Accident or Occurrence X Hired —_� Each Accident or Occurrence Excess 10/03/20 88/10/03/2 'i)9 TH2 i1 1-2596 1 7-0 88 $5,000,0o0 B1/PD $5,000,000 Products/Complctcd Ops C — $5 000 000 General Aggregate O M M r E N T S IMPORTANT if the unifcate holds is an ADDITIONAL IT'SURFD �I>e poficy(ia) must be en re A statement on this eatiGcate dues not confer right to the anifirare holder in lieu of wrh endasenwty,,i If SUBROGATION 1S WN Vr-D,wbjcci to the forms and conditions of db po ::r,certain poli_ies troy rcquirc N mdors-MnL A statement on this certificate does rat confer rights to the cenificate holds in teen of such endorsem�arts. The following applies mdy with respw to imumce for motor carriers re& i rd in Florida: is pmvided fix in Fla Sr t.i 320.02(5)(CL the listed insurance policy may nut be cancelled on kss than 30 days wnaen notice by the o 1:urtt to the Dcpartrrxmt of Hwy Sa(ciy 4 Moor Vehicles,such 30 days notice to c nuncnce from. it notice is received by the Department. Notiu of anal Wion:(not appliublc un{css:number of days is entered lost).Before au stated eapicdion dale the company will nd r nut or reduce un the insurance afforded do t1K above policies until at least 30 days notiu.i:of such wtccllarion has loom mailed ro: N list of Carctll:.ion does no aPPly whenolit(ies) ancel py :rc ced due to non-paymcm of premium. Office: Glastonbury CT Phone: 860-652-( 104 Cer11f1Cale Ilolder: AAtI'SIiA\Y Authorized Rc resentalive Date Issued: 10/14/2008 Prepared By: Et{ i IKE Town of Barnstable � `t�e Expires 6 monthsjrom issue date y Y Reglulatory_Serviees Fee-4-16�J, v MASS.9. $ Thomas F. Geiler,Director 05 Building Division Tom Perry, CBO, Building Commissioner, 200 Main Street,Hyannis,MA 02601, www.town.barnstable.ma.us : Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION y - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint ` Map/parcel Number Prop A' �/ / �' A& Address ' �}/U/l✓'A�f'CI� �C 4 Residential Value of Work d Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address .� ( /� �/�/. ke d 0o !C �O'4✓ G' Contractor's Name U in' e it? Telephon Number 05 �1' 6 (7/ Home Improvement Contractor License#(if applicable) -TV) Constr ction Supervisor's License#(if applicable) •,�' _ ZWorkman's Compensation Insurance Check one: MAY ." ❑ -I am a sole proprietor ❑ Jim the Homeowner �� C gARI STABLE -TOI have Worker's Compensation Insurance Insurance Company Name F't' ^ ' $ J Workman's Comp. Policy# 10 3 q2 ( Y Copy of Insurance Compliance Certificate must accompany,each permit. Permit Requt(stripping k box) old shingles) All construction debris will be taken to l'n e�Ie, � fi 1 f �/�r�_ K ❑Re-roof(not stripping.- Going over existing layers of roof). ❑ Re-side #of doors Replacement Windows/doors/sliders.U-Value (maximum .44)#of windows *Where required: Issuance of this permit does not exempt compliance with other-town department regulations,i.e.Historic;Conservation,etc. ' x - **•*Note: Property Owner must sign Property Owner Letter of Permission.. A copy•of the Home Improvement Contractors.License& Construction Supervisors License_ is required. T SIGNATURE Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc r Revised 090809 , The Commonwealth of Massaehatsetts Department of Industrial Accidents ®ffice of Investigrations y''I —r' 600 Washington Street Boston,AM 021.11 `y fvww.tnass.gov/(1irt Wort ers' Compensation Insurance Affidavit- I3laiI.ders/Contractor-s/Eleetrici<ans/Plunibea s Please Print Legibly Applicant Information Narbe (Business/Organization/Individt al): Address: ; City/State/Zip: �ewok 6t Phone#: ' � � Are you an employer?Check the a propriate bo Type of project(requia ed): 4. m a general contractor and I. 6 New construction 1. I am a employer with_nyb have hired the sub contractors ❑ employees(full and/or part-time).* 7. Remodeling listed on the attached sheet. ❑ 2.❑ [am a sole proprietor or partner- These sub-contractors have 8. Demolition ship and have no employees employees and have workers' • working for me in any capacity. 9. ❑Building addition comp. insurance.t [No workers'comp.insurance 10.❑ Electr' repairs or additions 5. ❑ We are a corporation and its required.] officers have exercised their I l.❑PI bing repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. g p p 12. oof repairs c. 152,31(4),and we have no l3.❑ Other insurance required.]t employees. [No workers' comp. insurance required] . *Any applicant that checks box#i must also fill out the section below showing their workers'compensation policy information. ating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. t Homeowners who submit this affidavit indic 'Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: ,3 Expiration Date: Policy#or Self-ins.Lic.4: (�d Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. I52.can,lead to the imposition of criminal penalties of a tine re to secure and/or one-year irr:prisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine y be forwarded to the Office of of up to$250.00 a day against the violator. Be advised that a copy of this statement ma Investigations of the DIA for insurance coverage verification. 1 do hereby certify under the pains and penalties erjury that the information provided above is true and correct. Date: Signature: Phone# Official use only.{Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: r � ✓fie Varrvinairusea�i �v��a�tacfzu.JeC�a Board of Budding Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registrattg[t. 126893 , x .$J3/2010 W0ement Card The Home Depqfll,AE€Pome Berv�ce 6ARREN DEMERS ' 3200 COBS GALL9R}A PtC lll(420 q a.. ATLANTA,-GA 30339v ' Administrator 3 License or.registration valid for individul use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm`1301 Boston,Ma.02108 .. e f E . Not valid wttl:ou#flgnature a 4 The Commonwealth of Massach.ttsetts t.. Department of Industrial Accidents Office of Investigations �! 600 Washington Street Boston, MA-02111. www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organizaticn/I di al)* Address: City/State/Zip: (J Ajq.. a ® Phone #: ` V7` Are ou an employer? Check the appropriate box: Type,of,proj ect(required): 1. I arri a employer with 4. ❑ I am a general contractor and I Y 6. ❑New construction employees(full and/or part-time),* . have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sUb-contractors have g• EJDernolitibif workingfor me in an capacity. employees and have workers' Y ❑ Building addition [No workers' comp.insurance comp. insurance.# required.] 5. ❑ We are a corporation and its 10.❑'Electrical repairs or additions 3.❑ 1 am a homeowner doing all work > officers have exercised their 11.❑Plumbing repairs or additions _._.__ .. ,_._ ,.myself,_[No:_w-orkers'_comp. right of exemption per MGL' P ....: .r ,.:,.12 -._...Roof,re airs ._..,_:. 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 their workers'compensation policy information. ' t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am,an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site . information. Insurance Company Name: I"�r>✓/j? /,VSl//✓e�' S �© - Policy#or Self-ins.Lic. #: w c 20 Expiration Date: Job Site Address: .0 �/ City/State/Zip: /Nil/ry _o 'Y7 Attach a copy of the workers' compensation n on policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP.WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi under t pains and pen Ities of per' ry that the information provided above is true and,c"orrect. Si nahire: Date: Phone# 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/Torun Clerk 4.Electrical Inspector 5.Plumbing`Inspector 6. Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as "...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(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 permit/license applications in any given year,need only submit one affidavit indicating current P policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may'be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to 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 1-877-MASSAFE Fax# 617-727-7749 Revised 4-24-07 www.mass.gov/dia AC®R® CERTIFICATE OF LIABILITY INSURANCE1 05/27/2009 PRODUCER THIS CERTIFICATE IS ISSUED A MATTER OF INFORMATION JC;it BERGONLI INS AZENCY ONLY AND CONFERS NO RIGHTS UPON . THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 75 Z' STREET I3ULI,, b]PL 02045 INSURERS AFFORDING COVERAGE NAIL# INSURED - INSURER A: .. ............. —�- michatl Viola INSURERS; GRANITE STATE INS CO ® $eldaaaah Way ."Su FIREbOWS I'= INS CO INSURER 0: Hull, MA 02045 INSURERE: COVERAGES TIIC POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MSR.. .-._ ..... ._ ... CYEFFEC POUCY Pb UVRO61F UMITS . LTR IU8RDI TYPE OF INEURANCO POLICY NUMB2R DATE MMIDD/YY DATE(MM/DDrM CINERAL LIABILITY EACH OCCURRENCE DAMASB'TO-RENTED—' E COMMERCIAL GENERALLUSIIITY PREMISES(Ee occur* nte) •.I CLAIMS MADE u OCCUR _ MED SXP(Any one parson) •. 7 _ PERSONAL SA 114JURY S __ -- GENQRALAGOREOATE s - OEN•L AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMP/OP AGO. f R POLICY PRO JECT LQC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT s300000 C R ANYAUTO VZA12508407 11/25/200B 11/25/2009 (Eearddent) ` ALL OWNED AUTOS _ BODILY INJURY 5100000 SCHEDULED AUTOS (Per penion) HIRED AUTOS BODILY INJURY S 300000 NONOWNED AUTOS (Pet ewdenq - PROPERTYDAMAOE 1100000 IPer acclasm) .. GARAGE LIABILITY - AUTO ONLY-EA ACCIDENT S ANY AUTO P. S OTHER TII w _.. AUTO ONLY: AGO S EXCE.681umamELL4 LIABILITY EACH OCCURRENCE - 1 OCcuR CWMSMADE AGGREGATE Y 1 -.._ / --' DEDUCTIBLE _ ._ S •-- RETENTION S •-_ - $ B WORKERS COMPENSATION AND WC-742-79-20. 5/26/2009 5/26./2010 X TORY . ITS ER EMPLOYERS'UASIUTr E,I.EACH Accr0EN1 6 100000 ANY PROPRIETORIPARTNERIEXECUTIVE ... .. _.. .. OFFICE"EMBER,ALLUDED? E.L.DISEASE-PA EUPL.OYEE 1500000 It Yes,deeMpe under .. ... .- .-.. SPECIAL PROVISIONS Ww E.L.DISEASE-POLICY LIMB 1 100000 - OTHER ' DESCRIPTION Of OPERATIONS I LACATIOND I VEHICLM I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS THD AT-ACME SERVICES, INC. AND THE HOWS DEPOT ARE INCLUD19D AS ADDITIONALINSORID WITH RESPECT TO GENERAL LIABILITY INSURA*TCE. CERTIFICATE HOLDER CANCELLATION AID AT'$C1NIZ SERVICES, T.NC. SHOULD ANY OP THE ADOYC DESCRIBED POLJCI,-1.8E CNICSLLED BEFORE THE EXPIRATION DBA TRZ HOI-M DZVO!' A•r TIr4M5' SEAVI(:ZS OATS THEREOF, THE ISSUING INSURVA %ALL ENOFAVOR TO MNL OAYS WRITTS:'1 2690 CUbTBERLRND pKt.vAY SUITE 300 NOTICE TO THE CERIVICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL ATLANTA 6A 30339 IMPOSE NO Od LIGATION OjLIA01F ANY KIND UPON T116 INSURER, In A0BNT6 OR RYPRESENTA AUTOO REP �11TATI�VE r A ORO 25(100 108) N�p ACO CORP RATION 1888 v3 60:80 600Z/SZi50 - ( w �� / .................... Office of Consumer Affairs and usiness Regulation 10 Park Plaza - Suite 5170 i. Boston, Manachusetts 02116 Home Improvement Contractor Registration Regisbation: 140993 I Type: Individual T 291832 E)M i ra Wn: .12/17/2011 MICHAEL J. VIOLA _ MICHAEL VIOLA 8 t.-IADASSAH WAY HLILL, MA 02045 : ' ----- Update Address and retnrn.eard.Mark reason tortost Gard ' Address [I Renewal (] Employment ❑ DPS(;tl Q1 itV-04/D4-Gt0t216 Jlre toovrc License or registration valid for individol use only } - r s'>>.^ �.., ®tfice o6 Cmosumer Af'[ain&13rssiotas 6trgulatioa before t.ltie eat.picatson date. If found return to. iy, p1 1., CONTRACTOR office of Consumer Affairs and Business Regulation ROME IMPROVE9AENT 90 Park Plaza-Suite 5170 ` a 1� i Registration: 140993 I I Try pg1832 Bostnn,MA02t>i6 Ex�peration: '12/17/2011 �1• Type: Individual. y PJIIGNAEL,9.VIOLA MICHAEL VIOLA. a HADASSAH WAY Not veffCwithovt sigoatnre MA 0�20+45 Ut+dcrsccrctary n,ttn�rt{R�( i`aiiylk rl�it, (3�e t tlsi+t lirx`+Jtli%? It� crl tirk�it� uiii"�Ixtntl ty1* .5 � .'�Ut :'ytl ►z�alti�tect for F WS � � x �r M kft L1 tu Ol:gb,�� 1 4. s`wadAssal�`wA r ' �R !-� r 1-��[e:�, .. .. .. .. �y .. • .,:�v .4�� �?^"S•^:.7�t zs as f ,',a'5i�t�ti`���` „ .. ✓ 4t it 7 .. _'i r � '�.•.3�" ::awx: s i�`:;wY s w a t;r a'�j .,,.}� � !777 I -2810 19:31 FROM-HOME DEPOT T-351 P.001/007 F-346 HOME XMPROVEMENT CONTRACT PLEASE READ THIS Sold,Fun4shed and Installed by: Branch Name: Boston Date: 3 ,4.26 _ THD t-Home Services,Inc. d/b/a he Home De of At-Home Services 345A Greenwood Street,Unit 2, orcester,MA 01607 Branch Number*31 / Toll Frcc(1 0) '57-518 Fax(508)756-8923 Federal TD#75-2698460;ME Lic#C 02 39;RI Cont.L.ic#16427 CT Lic#565522;MA Home Improvement C ontractor Rog.#126893 Installation Address: �°�r/l�vL ` `f n,57- L City State zip Purchaser(s): Work Phone: Home Phone. ') Cell Phone: n/ Home Address: i n� P,ro�/ A U lm nrey,�� J24 L ,c:;�s2 AIJ CJ (If different from Installation Address) City Sta to Zip E-mail Address(to receive project communications and Home Depot updates): []I DO NOT wish to receive any marketing emails from The Home Depot Project Information: Undersigned("Customer"),the owners of the property located at the above installatio address,agrees to buy, and THD At-Home Services, Inc. ("The Home Depot") agrees to furnish, deliver and arrange for the install Lion("Installation")of all materials described on the below and on the referenced Spec Sheet(s), all of which are incorporated in o this Contract by this reference, along with any applicable State Supplement and Payment Summary attached hereto and any,Chan c Orders (collectively, "Contract"): ,lob d: antertm,norommo) Products: Sec Sheets #t: Proieet Amount _WR_oofingE]Sidi_ng__0 Windows LJ Insulation $ / f y22 9,- ❑Gutters/Covers QHntry Doors ❑ t4 93 4 2 ❑Roofing LISiding ❑ windows ❑Insulation $ ❑Gutters/Covers []Entry Doors ❑ []Roofing ❑Siding Windows ❑Insulation C]Gutters/Covers []Entry Doors❑ - Roofing ❑Siding ❑Windows Insulation $, []Gutters/Covers DEnuy Doors El- Minimum 25%Deposit of Conti rtet Amount due upon exeeution-of this cOntrack Total Contract Amount Maine pare uims may not deposit mom[lean one-third of the ContractArrwunt: Cuustoincr agrees that, iiiimediately upon completion of the work for each Product, Customer will execute a ompleLion CertiGeaie (one for each Product as defined by an individual Spec Sheet) and pay any balance due. As applicable, cat h Customer under this Contract agrees to be jointly and severally obligated and liable hereunder. The Home Depot reserves the right to issue a Change order or terminate this Contract or any individual Produc t(s)included herein,at its discretion,if The Rome Depot or its authorized service provider determines that it cannot perform its obligations due to a structural problem with the home, environmental hazards such as mold,asbestos or lead paint, other safety concerns,p cing errors or because work required to complete the job was not included in the Contract. Payment Summary: The Payment Summary # /_7kEJ' included as part of this Cont.ct, sets forth the total Contract amount and payments required for the deposits and final payments by Product(as applicable)- NOTICE--.TO CUSTOMER You are entitled to a completely filled-in copy of the Contract at the time you sign. Do not sign a Comple ion Certificate.(note: there is one Completion Certificate for each listed Proariefas defined by individual Spec Sheets)before ork on that Product is complete. _ In the event of termination of this Contract, Customer agrees to pAy The Home Depot the costs oC tnat rial5;labor,expenses and services provided by The home Depot or Authorized Service Provider through the date of termin tion, plus any other nmouuts set forth in MIN A.grecment or allowed under applicable law. THE HOME DEPOT MAY WIT OLD AMOUNTS OWED TO nXE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOVS OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Accentance and Authorization: Customer agrees and understands that this Agreement is the entire agreeme-nt between Customer and The Home Depot with regard to the Products and Installation services and supersedes all prior discussions utd agreements, either oral or written, relating to said Products and Installation.This Agreement Cannot be assigned or amended exce t by a writing signed by ('nctnmPr onA Tha YY..--...T..-..-• r''.--•----- •-' ' i << _r G_EN_ERAL._ SPECiFICATIOJNS DATE I C? t,�i �- i �` -• I :x4�zz DRAWN BY - SIZE x � AREA>>� D DEPTH TO s SHAPE PERIMETER jam. b TEMPLATE NO. .. CUSTOM r C.j � TILE COLOR --- - t COPING POOLCAPACITY �, ,( ��t; GALS. tA,c MOTOR H P i �".. H.P. P ±' TER SO. FT. ---- f 1 ! r" 1 V A U U M �N E & S K I�.�h�E RETURN LINE - , MAIN DRAIN ;y _SKIMMER -_MODEL BACKWASH TO SEPARATION TANK YES ❑ NO I t HEAiER SIZE x �,� BTU I ie, GASLINE 8Y: ,r'�I=.�. VERB 6Y ' NATURAL GAS a PROPANE OTHER FUEL -..._.._._.- DRArT DIVERTER YES NO r LIGHT -- - - --0_OW ---- �^-(-�-(7-w P �f�. CONDUITs � ,. SHORT LONG � - .. CLOCK { E ELECTRIC BY I ELECTRICAL BONDING BY w� .. c.� { � POOL CLEANER BOARD-SIZE COLOR BOARD SUPPORTS- Tile: fL._ � LADDER-Model , Tile: T___ . _ ROPE R f NGS W/ROPE & FLOATS GRADING DIRT WALK STUB PLUMB ?) Yes RNo TRACTOR SIZE I TILE & COPdNG C?rASAP L7 OTfv OWNER: DECK BY �*,t 'e, TO DETERMINE ELEVATION OF POOL 0� SCALE 1/8 — 1'0" JOB NAME AND ADDRESS 'SALESMAN h___ TREES,ETC. ' ; _NOTE DAYWATER FOR GUNITE OF EXCAVATION. - -,v REAR fi. JOB NO.OwNfR: POOL AREA TO BE FENCED, PER COUNTY OR CITY ORDINANCE. GATES TO BE SELF LATCHING. SWIMMING POOL BY OWNER - _— OWNERADDRESS ; _ WET DOWN CONCRETE SHELL AT LEAST _ TWICE DAILY FOR 7 DAYS. DO NOT TURN ON POOL LIGHT WHEN POOL CROSS STREETS, IS EMPTY. W DO NOT ALTER DECKING SPECIFICATIONS. —.___.. _ f'tES. PHONE.. _ . ____$t5, PHONE.'_ : .. _ NO GROIADING EAUTH:CM:IZED ANaRE � r GUNITE NC. PM 6 REPUBLIC RD., NO. BILLERICA, MA 01862 � UNLESS SPECIFItu' — (617) 272-Q27$ -. iGenstructi<m (617) 273-2675 • Sales r; DIG SAFE NO. GENERAL & DETAIL SPECIFICATIONS SI E25x54"D TH3- ':::AREA Q.- FT. l350 [POOL SHAPEG'�'� G'4REF. N PERIMETER FT COPING _ TILE ��` TILE COLOR TO 1�lf ��1��`� POOL CAPACITY GALS. FILTER - 33J PUMPY`.x/A>� ' SUP� v10TOR H.P. Z '�2 SKIMMER MODEL '�`v QTY RETURN LINES MAIN DRAIN ► 2 BACKWASH TO CHLORINATOR co UNDERWATER LIGHTI i0 VOLTS500WATTS Now BOARD SIZE � .71 l BOARD SUPPORT N GRAB RAILS `-4=�t + TYPE LADDER NO~*-CUP ANCHORS IN WALL ROPE and FLOATS HEATER'- ' 'tea K SIZER`0'E5ABTU INPUT NATURAL GAS F* PROPANE ,'-] OTHER FUEL GAS LINE BY: VENTED BY: TIME CLOCK 1l�'`* ELECTRIC BY: ELECTRICAL BONDING BY: WATER FOR GUNITE = = I , 4 DECKING POOL CLEANER _ o GRADING %. ,rt. CJr*1 i"�i -y ��� _ ,r POOL SETBACK Rear Side 3' SWIMOUT C �j`tX •- "',��;� p �✓ 1 y SLIDE r.;! � , 1 �✓� 1 `VWtt, �," I�Owh HANDRAIL iH t'�o✓ y i WATERTABLE CONDITION RAISED BEAM FT 6" FT12" h FILL 54, AWAY D.O.P. POOL COVER TYPE WOI' ✓OC GJST�Jf�-r t;' ?I PLASTER FINISH 'qM �rfF- J I HYDROTHERAPY SPA Depth I l I =, . . �____ may`-+,-, ►2 SIZE JETS I JET PUMP HP _ I SKIMMER I MAIN DRAIN RETURN AIR BLOWER LIGHT I ail s 1 - - FILTER --- -_----�-------_, �-----�--- --__ _------�------_� HEATER � �i CHLORINATOR TAR 26 ,i. NAME ADDRESS 155 I R,f 1,''t G 9"'. CITY }— PHONE JOB ADDRESS i — Scale: NO GRADING UNLESS SPECIFIED f { � �► OWNER: To determine approximate elevation of Pool on or before day of NOTES AMERICAN GUNITE POOLS A DIVISION OF AMERICAN SWIMMING POOLS CORP. excavation. Pool area to be fenced per state and local ordinance. Gates to be 1 - --- ------ ------- -- — __,. �;� :.�. ; F self closing and self latching, 540 ARCADE AVE.----�-__.----------------- P,O. BOX 248 OWNER: To wet down concrete structure at least two times daily fora y 1. Ir - _ �,,� , ,�; � }- - SEEKONK. MASS. 02771 -0248 minimum of seven days. Do not use rubber hose to fill pool as it will mark the ., .� x, v� (508) 336-7577 nterior plaster _ r.- -..� - - MA. REG NO. 100284 R I REG NO. 217 OWNER* Extra charge for watertable condition — — DATE DWN BY I CK'D BY I REF NO j GENERAL NOTES: DIMEN51ONAL CHART .THIS DRAWING SET HAS BEEN PREPARED TO 51ZE A B C D E F G H J K OBTAIN THE REQUIRED BUILDING PERMITS,..IT DOES 1 1 1 1 1 1 I 11 1 N 1 1 I 11 11 1 11 NOT DELINEATE SCOPES OF WORK AMONG . : •` • . _ , , • 16 x 32 16 32 4-6 6-0 131418-0 7-0' 8-0 3-6 4-6 ' 1 1 1 1 1 11 1 " 1 " 1 „ 1 N I N 1 " CONTRACTORS AND OWNER;SUCH LIMITS OF • . '•' • C� p. • •.• � •, • •• • , . - • . • i 8 x 3 6 18 36 4-6 6-0 13-6 i 2-0 7-0 8-0 3-4- 5-6 5.5. LADDEf� 0 1 1 N 1 „ I II 1 11 1 1 N 1 " RESPON5181L(1Y SHALL BE DEFINED IN THE ; OR . ' -' .` •�-=CONCRETE DECK 20' x 40' 20' 40 5-0 7-6 13-6 14-0 9-0" 8-0 3141 5-6 CONCRETE DECK—,- •, �• , . -"'�. !CONSTRUCTION CONTRACTS. ' , . . SWIMOUT, • ' f '' . : . . 2.THE BOTTOM OF THE POOL BED(AND ANY BACKFIW . • • • WATER LINE SHALL BE FREE OFi LARGE 5TONES,ORGANIC -..— FROZEN CLODS OF EARTH, RUBBISH,STUMPS,OR WASTE CONSTRUCTION MATERIALS. • ' ♦ - . .ANY GRAVEL BASE MATERIAL USED SHALL ` 8�'0" ♦ /' 4'-Ol • - -- -- -------- --- 3 -- , / I min ' CON515T OF CLEAN,COARSE SAND,OR BANK RUN min . . ` - • , GRAVEL,CONTAINING LITTLE OR NO FINE5,OR ORGANIC MATERIAL,AND CONTAINING LITTLE TO :OPTIONAL DIVING �-- --� NO COARSE FRAGMENTS GREATER THAN SIX INCHES BOARD • A,.. � ' � •A•''': , '� '� IN DIAMETER. THE GRAVEL BASE MATERIAL SHALL '• H BE PLACED IN SHALLOW LIFTS AND i r ~ COMPACTED. 4.THE FOLLOWING ASSUMPTIONS HAVE BEEN MADE ' FOR THE PREPARATION OF THESE DRAWINGS: . , •� ••r -NO SPECIAL CONSIDERATIONS ARE REQUIRED TO ... • -- --—• I = 1s... ,,,.::'� ;�.,,, s ACCOMMODATE NIGH SEASONAL GROUNDWATER CONDITIONS. -THE POOL WILL BE INSTALLED ON A LEVEL, I COMPACTED BASE. ` -ANY REQUIRED LANDSCAPING ANDIOR RETAINING �� G WAW5)I5 NOT PART OF THIS SCOPE OF WORK. ' -PROPOSED POOL AREA DOES NOT ENCROACH UPON '• ANY: EASEMENTS:,PROPERTY BOUNDARY LINES, . I '-O" •RAD , ' . • `• •' UTILME5,WE mo,OR ISDS's. TYPICAL,. . . • •_ ,' . 5.5. HANDRAIL , -Pool Is sLv1cED BY Pusuc WATER AND ' . .. L. .B 1 E OPTIONAL. POOL SECTION 6-B ,.• , MUNICIPAL SEWEi� : y CONCRETE DECK- . . , . .:. _ ' ' . • d N ' • . -N VARIANCES ARE REQUIRED TO OBTAIN , , . • - • t •. �, SCA 14 APPROVAL -THE 501L UPON WHICH THE POOL WILL BE 4" CONCRETE DECK INSTALLED WILL HAVE A BEARING CAPACITY POOL AREA PLAN EQUAL TO OR GREATER THAN 3,000 WSJ% FT. -THE POOL,ONCE FILLED,WILL BE MAINTAINED AT SCALE - I/4"= I '-0" ITS DE51GN WATER LEVEE.ELEVATION AT ALL PITCH AWAY FROM POOL TIMES. -THE FOLLOWING OF::PROPER WINTERIZATION Ismail a; a PROCEDURES WILL BE THE RESPONSIBILITY OPTIONAL,DIVING WATER-LINE! ENE - W_ BOARD . : • OF THE OWNER. —Le .. 5.ALL UNDERGROUND PIPING SHALL BE INSTALLED ' • �� IN TRENCHES WHICH ARE RELATIVELY SMOOTH 18' WATER LINE 6 x G #I 0 WIRE OR AND FREE OF ROCKS. WHERE.LEDGE ROCK, 6" WATER LINE TILE • FIBERGLASS MESH HARDPAN,OR BOULDERS ARE ENCOUNTERED,THE (entire perimeter) �.' 5„TRENCH BOTTOM SHOULD BE PADDED U51NG A 6" COMPACTED SAND BASE N • MINIMUM OF 4'TAMPED EARTH OR SAND BENEATH THE PIPE. ; . I/4" TO 3/8" WHITE 11 ;;• = �= MARCITE FIN15H #3 REINFORCING RODS - 1 2 C.C. 6:ALL PIPING SHALL BE I GOIAIg U CONTINUOUS GRID PATTERN RATED SOCKET WELD FITTINGS. '� `• j WALLS * FLOOR •� b a. • ALL LINES SHALL BE INSTALLED AS SELF-DRAINING - - - - - KN •: E .:. •:.�.>� Y;zil.::y�: a •s WITH NO DEAD LOOPS. HIGH POINT VENTS AND Low H .:•+. ....�,�. HALL BE INSTALLED TO FACILITATE I RAINS 5 _4. POINT D , 1 L STARTUP AND ANNUAL WINTERIZATION. 7. ALL UNDERGROUND PIPING SHALL BE ,� , '� . ., PRE55URE-TESTE0 Q 1.5 TIMES WORKING PRESSURE PRIOR TO COVER. . s� 8. SAFE USE OF THE FACILITY IS DEPENDENT UPON ' •e GUNITE POOL SHELL PROPER SUPERVISION, MAINTENANCE,AND STRIC ( . CONCRETE TO DEVELOP. • STRENGTH OF 3000psr CONFORMANCE TO SAFETY REGULATIONS AND IN 28 DAYS CONSIDERATIONS BY BOTH OWNER AND USERS. C D E F 9. PERIMETER FENCING,AS REQUIRED; WILL BE BY OTHERS. •� ° -i . NOTE: TH15 POOL FACILITY 15 DE51GNED CON5TRUCTION NOTES: B FOR SOIL BEARING CAPACRY OF 1.CONCRETE 5HALL HAVE A MINIMUM 3000 Ib!%GQ.FT. MINIMUM COMPRE551VE STRENGTH OF 3,000 P51 AFTER 28 DAYS. ALL REINFORCED CONCRETE CONSTRUCTION SHALL LONGITUDINAL POOL SECTION A-A TYPICAL WALL DETAIL BE PERFORMED IN ACCORDANCE WITH THE LATEST SCALE - 1/41l 1 '-O" EDITION OF ACI 318 AND DETAILED IN ACCORDANCE' NOT TO SCALE WITH ACI 315. 2.ALL REINFORCING STEEL SHALL CONFORM TO A5TM-615,GRADE 60. WELDED WIRE MESH s"All AMERICAN SWIMMING POOLS CORE CONFORM TO ASTM-185. �111111111/p� �i, ARTHUR FL CRiP venue Rt.44. ��� CONN rfi, 540 Arcade A 3.THE CONTRACTOR SHALL SHORE OR BRACE AS RM. �����OF. F@j� �,, ���H °f Seekonk, Massachusetts AT ALL STAGES OF CONSTRUCTION TO ENSURE c;.cAv ' i ��' STRUCTURAL STABILITY AT ALL TIMES. a .� *? ARTHuR�' E1 TYPICAL DETAILS OF No- ION 4.ALL WIRING TO BE PERFORMED BY A LICENSED GUNK TE POOL. CONSTRUCT _ * a ELECTRICIAN IN ACCORDANCE WITH ALL • �,� a PREPARED FOR: STATE AND LOCAL CODES. '�i ENS�� ``�� �i ZONAL E RE ADDRE 55: ---- A RAr. R1 MATERIAL A5 SPECIFIED IN GENERAL NOTE ��i�11 ;��� j I ssto�� SCALE: A5 NOTED DRN. 8Y:�IUISE DATE: -- -- ns,1oh N ' __ _ - - Rev►s►on. Drawrng No: 5P 1 of - Conservation Notes: 1) D.E.P. FILE #SE 3-3906 2) EXISTING POOL/PATIO AREA = 4,055 SO. FT. PROPOSED POOL/PATIO AREA SHALL NOT EXCEED 4,055 SO. FT. 3) POOL FILTER SYSTEM SHALL BE OZONE INJECTION jll� , x z2 s IRVING AVENUE x'�o.l H.P.Y. / C -N83'55-�00''aIIF----------------' � t' _cT r r / , , x r , , PROJECT DATUM : NGVD i r� '' 11 - .-��`` /00 ;, COMMUNITY PANEL NUMBER 250001-0006-D THE FLOOD INSURANCE RATE MAP DEFINES THIS AREA AS ZONE A13 FLOOD ELEVATION = 12 NGVD ro o ,' ; o/ ZONING DISTRICT : RF-1 do AP FRONT YARD = 30 SIDE YARD = 15 REAR YARD = 15 )( 6.4 LOCUS PROPERTY IS COMPRISED OF I` ,5 N J o 2 �\\ ASSESSOR'S MAP 287 - PARCEL 68 i , r I , , / �I �\ —�'' J x 6.3 - I I I / 1 0 / LOCUS DEED REFERENCES Jill ,� 1 ` \ i ! /' i i / CER17FICATEI 122117 , , ` 5'6 PLAN REFERENCES N82-38'OO)M'- 5 \ i i x 1.9 f r'r N7�10 40 V ' i l 4 :�0' �� m� i ♦ LAND COURT PLAN 4223 1 �,' \ II • n� 8 --'�' ,00 321'f ; ; / LOCATION OF UNDERGROUND UTILITIES ARE APPROXIMATE AND ti , ` r r SHOULD BE VERIFIED IN THE FIELD BY THE APPROPRIATE x 1 ` I I I ' / o' r' 11 1� i p • -- ------- / -10 - - - - �, r ' @ �.`, ,T UTILITY COMPANY PRIOR TO ANY CONSTRUCTION. o / ��� I th To Beoch_(4 Wld�- - ! 1 N� I ► P a _ _ — , , / THIS PLAN IS BASED ON AVAILABLE RECORD INFORMATION k �� N , EXISTING ; � i1 � x / � �\ , x 5,4 � ,'�r // PLANS, TOWN OF BARNSTABLE CIS TOPOGRAPHY AND BOARD /DW ;TING 9.9 OF HEALTH RECORDS. R DOES NOT REPRESENT A FIELD SURVEY ' - -- - - � FOUND. EL 17.91 I♦ J l Q�s� ' ! SEPTIC SYSTEM LOCATION TAKEN FROM "AS-BUILT" CARD PREPARED BY, INSTALLER Permit 87 447 '15/ •97 r _ r / � I 1 r r r , / r � .--�, / � ' RUNOFF FROM PROPOSED POOL PATIO TO BE DIRECTED T , � r , / 0 A DRYWELL � ! r' 6, /, x 4,8 ,' / AND/OR STONE TRENCHES. EXISTING DWELL•ING �`� � / ,�o �, �\ � � � FOUND. EL.=11.88 / O 1 20' � , , / ,/ O of r / r U777 \tK Co ►� �! Q /� I I / r 1 POOLoe ro 6,4 , PROPOSED WOOD DECK W/AWNING Exis 151 Irving Avenue ting Pool ' Filter Shed '•°°" � ,' ;, ,� Hyannis Port Massachusetts _------ ,'� PROPOSED POOL PATIO i �C 4,3 i rr r- r Y PREPARED FOR I ' r r r / . . / John & Leslie Wilson I r x 6.7 it x 6.3 11`` / s�,• 1 r�/ l TfTLE CIV ? PERMIT PLAN - POOL RELOCATION �1 r , BAXTER NYE & HOLMGREN INC - 1 Registered Professional x 7.1 r � ! / Engineers and Land Surveyors } ! x 9.1 r' / 812 Main Street, Osterville, Massachusetts 02655 `�"oMgss�c a TEPHEN yG — — — — --- 1 Phone - (508)428-9131 Fax - (508)428-3750 AL 40 0 40 80 Gs7ER� �\ - - - - - -- - - - _ J ; ` ! SCALE IN FEET ssfaNAL -- ----- � I ;� I I , _ � ,i ,. 1 SCALE: 1 —40 i -- - - - - -10- - - - - - - - - - - - i ! -— -_` --------- -----8----------------------------------' �,/ DATE: 11/15/01 — r ! — — — ---- --------- REV. _ _____________ DATE: REMARKS - -- — — — — -- — — — --------------- -------- __---___--___-- --s----------------------------- 1 — 1— 12112101 Mod. Patio Add Notes ------- --------- ' 2 8 5 02 Add 2nd. Path e — 3— 8 04103 Modify--Pro Pool -----------2 -----------------------------------_— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — ——o — — — — — — —— —— — — - 1 — — Modify Pro Pool _ _ _ _ _ _ `''- &26 03 Modify Prop. Pool DRA*ING NUMBER / 0: 2001 -097 Civil Desi n 2001 -097w 5.DWG - - -- -- - 2001 -097