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HomeMy WebLinkAbout0213 OCEAN STREET (8) A I V, NN 1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ,Map' Parcel ; , r R l Health Division Date Issue a��03 Conservation Division � ' ' FEB 2A PlCatio /- pp c Tax Collector 62 O� ��/ Permit Fee Treasurer G' �� �� '�, � Iti 1S10N Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Addressf� Village o Owner Address , � 7�ytyvn, F S;r Telephone (/S= 0 0 Permit Request f,��n Sj i—9!4 z r ��a� s/- Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Q Flood Plain Groundwater Overlay , Project Valuation / /, d0•°a Construction Type XOO Lot Size �7— Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. J Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes LkNo 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 / DTR L Proposed Use BUILDER INFORMATION Name ,T!v���- /�J ©D �wc, Telephone Number Address ^ ��� �1 0�7� License# Home Improvement Contractor# Worker's Compensation#4L)4 J e Plw ALL CONSTRUCTION DEBRI RESULTING FROM THIS PROJECT WILL BETAKEN TO %��4L Qi SIGNATURE DATE y� FOR OFFICIAL USE ONLY } ¢r 1 f PERMIT NO. � ` DATE-ISSUED i MAP/PARCEL NO. , ADDRESS VILLAGE OWNER 1 w ti DATE OF INSPECTION: FOUNDATION FRAME fi INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING. ROUGH FINAL GAS: ROUGH FINAL' FINAL BUILDING DATE CLOSED OUT f ASSOCIATION PLAN NO. 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Faimse w sacore eoeera�a as regateed Beeline ISA otMQ.1S2 ealaad to for 1 ds�ahot pms�ies oia!!aa up to S1Amw tailor aea�+tmptitaeo>smt m weft as eftII pmaltiea fn tba form ota b'i�P WOBR ORDFB ssd a ttaa OcnO 0 a dsq Rgzhwt ms:Iuadmitasd Ebat a toopT of tbL snsem��7�torttsadsd to tbs OIDsa otIattaaa ot�a DIAtar.at�R radsiaWoo. I do harby ca�ify PA P OJ PaIM7 thd the infi. Sdabase is tnra mid carted oin"nsa oah do'not wrtta in tbs asea to ba completed b7 cfty or town WTWA d!j o:town: Panswaceme 11 a CSC Bpardr ❑chwklf 1'..*:wdL"•response is required ❑Selectmen's QIDu ❑HealthDepw=wz' contact person• P�a ` UCaro 9193 PIA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers• compensation for thr:r emplovees. As quoted from the"law", an employee is.defined as every person in the service of another under any cq=--z of hire, express or implied, oial or written. An emplover is defined as an individuaL partnership, association, corporation or other legal entity, or aav two or more of or the-foregoing engaged in a joint enterprise. and including the legal reprzsentatives of a deceased employer,.or the rec°'t<'er trustee of an individual,partnership,association or other legal entity, employing emPIoyecs. However the owner of a dwelling house having not more than three apar=ems and who resides therein, or the occupant of the dwelling house of another who employs persons to do maix=na=, construction,or repair work an such.dwelling house or on the grotmds cr building apptuteaant thereto shall not because of such employmaat be deemed to be as employer. MGL chapter 152 section 25 also states that every state or Iocal,licensing ageney_sW withhold-the issuance or renewai of a license or permit to operate a business or to construct buildings in the conmianwealth for any applicant who has not produced acceptable evidence of compliance with the insmmnCe in required: Additionally,nettherthe commonwealth nor any of its political subdivisions shall eaoer.imo any contact for the performance of public woti:==l acceptable evidence of centpliaace with the insurance rtquir�tr of this chapter have been prescuted'to the corru-t��*T^ authority. - on -Applicants Please fill in the workers' campeaszdm affidavit completely,by checking the.bas that applies to Your situation and suPplYmB company names,address and phone mrmbers along with a certifitte of iasu-==.as all affidavits may be sabmitted to the Departmett of Industrial Accide=for ofinsm=ce�gz• Also be sure to sign and is date the affidavit 'Ilse affidavit should be.returned to the city ortownthat the application for the permit or license is being requested,not the Departo =of Indusaial A.ccidmis. SvauId yvu have nay questions g the haw„or if you are required to obtain a workers'camp=zdca policy,please call the Department atthe number lusted 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 thr affidavit for you to fill out in the eveatthe Office of -has to coact you regarding the applicant- Please be s to in the peimalliccas e number which will be used as a refcrmce ni 6bcr. 'Ilse affidavits maybe reimnea t^ ure fill the Department by mail or FAX unless other aaang have bemmade. Ile Office of Iavestigat?ions would like to thank you in advaace for you eoopezatiDa and should you have nay questions. please do not haitate to give us a call. FIR The Departnemt's address,telephone and faxmmrber. The Commonwealth Of Massachusetts Department of Industrial Accidents Otflcs of lmtestloatloas 600 Washington street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 7274900 ext. 406, 409 or 375 i Sent By: NE'WPORT HOTEL GROUP; 4018493721 ; Feb-24-03 12:31PM; Page 2/2 FROM : HYDRO—STOP ROOFING SYSTEMS PHONE NO, : 5086469992 Feb. 24 2003 12:36PM P2 Town of Barnstable Regulatory Services t a�nxAM F.Geer,Director ,� 1 Thomas , %6 A a Building Division Toms Perry, BuDding Commissioner zoo Main Street, Hyannis,MA 02601 Office: 508-862-4638 pax: 508-790-6230 Property Owner Must Complete and Sign This Sectic n If Using A Builder i 6 5 rwQww of the s ject property � r htreby authorize 6i A) . t act on pry behalf, in all matters reiaxive to rk authorized by tE bu Uiag permit pplica on for{address of job} ��r�rt.ttl �xa✓ r Signature of �J Die Print Nan-A Peter E. Cairns General Manager 213 Ocean Street Hyannis,MA 02601 (508)775-4420 Fax(508)775-7995 pecairns@hyannisharborhotel.com www hyannisharborhotel.com ,OFTHEtOj,� The Town of Barnstable O„ BAMISIABL- = Department of Health Safety and Environmental Services MA95- e Building Division plEO N1P'�� 367 Main Street,Hyannis,MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice IY4//G o/t Y/ ;7 w MO T-,-- L Type of Inspection fr Z!Sr/ c o?1 e 7— Location * /3 OC j',4 A/ Permit Number Co/jPcj.'aT der Ph'T,'n E Cog//t/v Tip f"10z T �206A-I. r' /V/17l One notice to remain on jobsite, one notice on file in Building Department. �^ y�kr-72 The following items need correcting: / W X,v T T o /¢/�!?6 o A V/,,,c l.-/ M o ZZ e- d 7 �/"/✓e:�- � Tao A " / c#'FA s -/ '0�1' rs`S oz.0 y �r,&: /✓L' '-e^ �9 /°40 GE 1 7-AK i S f3ai� Dim /-5 72 ��✓5 ���� i C/1,��� a W1ro fl�sTon/ c �aT/v 1�+o y k- la/ T 11 LOXLon Z'� F % c '9 x 'V W/7/" Please call: 508-862-4038 for re-inspection. Inspected by t2l Date Y/a 9/0 Town of Barnstable oFI"E, Regulatory Services {{ k Thomas F.Geller,Director ► BARNSTABL , 9 ass. g Building Division s63q• ♦� AtEp Mpr s Tom Perry Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 COMPLAINUINQUIRY REPORT Date: Rec'd by: Complaint Name: Map/Parcel 3a(e� Location Address: pay-6a,C- \f l e LO Moo P 1 Originator Name: p r acr-, r S Street: Village: State: Zip: Telephone: �� �3 77 Complaint Description: e e FOR OFFICE USE ONLY Inspector's Action/Comments Date: Inspector: Additional Info.Attached Q:forms:complaint d SENDER:V ■Complete items 1 and/or 2 for additional services. I also wish to receive the Z ■Complete items 3,4a,and 4b. following services(for an ■Prim your name and address on the reverse of this form so that we can return this extra fee): card to you. ai ■Attach'this forth to the from of the mailpiece,or on the back if space does not 1 ❑ Addressee's Address a . � permit. � ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2.❑ Restricted Delivery to ■The Return Receipt will show to whom the article was delivered and the date a e delivered. Consult postmaster for fee. 0 v 3.Article Addressssed to: i 4a.Article Numbercc d E I- 4b.Service Type 0 VJ J"QQ ) �00 L�AU4 s ❑ Registered Certified W of e ❑ Ex ress Mail ❑ Insured .S cc etum Reoeip for erchandise ❑ COD al h%5/�/f 0ZGG/ 7.Date of li w z rj�j q a. 5.Received By:(Print Name) 8.Addressee'd Addfasb Only if requested to _ and fee is paid) cc¢ t- 6.Signature: re or nt) a°. X PS Form 3811, DecqpIKr 1994 102595-97-B-0179 Domestic Return Receipt UNITED STATES POSTAL SERVICE First-Class Mail USPS9e&Fees Paid Permit No.G-10 i • Print your na • , ad r' s, and 1IP Code in this box 76 Sj� b Building Divisica 367 Main St. I Hyannis, MA 02601 203 WILLOW STREET SUITE A YARMOUTHPORT MASSACHUSETTS 02675 TRANSMITTAL LETTER PROJECT: Hyannis Harbor Hotel/Additions &Alterations ARCHITECTS 213 Ocean St. PROJECT NO: F DATE: 19 February 2007 1 TO: If enclosures are not as noted, please Tom Perry inform us immediately. Barnstable Building Commissioner If checked below, please: ATTN: ( ) Acknowledge receipt of enclosures. L ( ) Return enclosures to us. WE TRANSMIT: (X) herewith ( ) under separate cover via ( ) in accordance with your request FOR YOUR: ( ) approval ( ) distribution to parties ( ) information ( ) review&comment ( ) record (X) use ( ) THE FOLLOWING: ( ) Drawings ( ) Shop Drawing Prints ( ) Samples ( ) Specifications ( ) Shop Drawing Reproducibles ( ) Product Literature ( ) Change Order (X) COPIES DATE REV. DESCRIPTION ACTION ' NO. t CODE ' 1 ' 2/15/07 Field Report No. 1 (Allen & Major Associates) ACTION A. Action indicated on item transmitted D. For signature and forwarding as noted below unde7 REMARKS CODE B. No action required E. See REMARKS below C. For signature and return to this office *� REMARKS: y Tom: Enclosed please find Field Report No. 1 from our Structural Engineer, Brian Wals , for the subject project. Please feel free to call if you have any questions. r- COPIES TO: r ;• r' (with enclosures) t BY: Rick Fenuccio r w ALLEIN MAJOR ASSOCIATES. INC. 100 Commerce Way P.O.Box 2118 Wobum,MA 01888-0118 Field #ITel: (781)935-6889 Fax:(781)935-2896 Client: BLFR. Report Date: February 15,2007 Project: Hyannis Harbor Hotel A&M Project#: 1203-16 Location: Hyannis, MA Contractor: Builder Systems Inc. Weather: Clear Temperature: 18' Date of Site Visit: February 13,2007 Time: From: 12:00 am To: 1:00 pm Present at Site: Bill Daniels(BLFR) Mike Snow(BSI) ' Brian Walsh (A&M) Reported."by: Brian Walsh The following was noted: 1.1 The tower framing was observed. In general it appears that the existing conditions and new framing are consistent with the design documents. 1.1.1 The structural steel columns and beams have been installed and appear to be consistent with the design documents. 1.1.2 Demolition and re-attachment of adjacent deck framing is ongoing. All deck beams framing into the side of new framing require joist hangers. 1.1.3 PT side plates or nailer plates are in the process of being lagged to the nailers already bolted to the steel beams at the deck level. 1.1.4 Roof level demolition and splicing of the diaphragm has not yet occurred. 1.2 The interior tube steel beam is installed. 1.2.1 A clip angle should be installed on one end and lagged into the supporting wood post. The above items were reviewed with the project superintendent prior to my departure from the site. Brian A.Walsh, P.E., Project Manager Email: bwalsh@a[lenmajor.com y 1<Indsus E archilect5 �i�-il tCiruct lip[ez �znct + 1,�ticl:;��u�e cir •. envircziimct�t�tl cc?nu[tci, • t Zvi:w,a[I�nrrr�i)�n-.com I tv U. yo%TNEto�` TOWN ' OF BAR.NSTABLE Z SAHBSTAME, i 26 � BUILDING INSPECTOR 0 MPY a' APPLICATION FOR PERMIT TO .............3cci td A'ddZti vn .to 1�1,v, ..........:..................................................... ............. .... ..... TYPE OF CONSTRUCTION ovd f�cczrne, G)zi.cJz VeneeA .........................................................................................:..:.................... .......Al arch 6.........................19..�j.. TO THE INSPECTOR OF BUILDINGS: i The undersigned hereby applies for a permit according to the following information: Location ..............2�3..vce 1?.: ?, ,..11azura................: -3Z6—.35...............................:........:.....:.................................... ProposedUse .....MO ............................................................................:................................................................................ Zoning District 1- cr..uzp-o�.........................Fire District ..........RyaCtt't.<4 ................................ ............ .................................................... Name of Owner .............Address .................................... Nameof Builder ....................................................................Address .................................................................................... 2 6A (nelvote�c �`�l0 Name of Architect ?a cd �eacar? .. o (,fie •Address '...e.•......1. 6-6.................................................................... Number of Rooms gym . vtvted /vnate e; ...fie cad on Piieo p.... Foundation ................1,................................... .............. . q Exterior ............ �ch..✓.et2e2lic...............................................Roofing ..........��f7 �..,��.�`.4�. ............................................. 8 r Floors ..........�`9.�.. ..�J-P. .q cw t vvel[ .Interior Heating ...... eect�uc. .. ................... ......................Plumbin v oen Lc ;lnon , Fireplace ......YeA.....................................................................Approximate Cost .........�r q,X0• ....................................................... Definitive Plan Approved by Planning Board ________________________________19________. S' Diagram of Lot,.Q,,,d Building with DimensionsLa ' S U B J Q-qO PRbVAL OF BOARD OF HEALTH Im 4 W L?i F-- 71 lm�.I.. .wo., • g Q • c~ z U Z i w • 0 Li av~iaz- zc=� � � J WZ QW. N? -- Jx o o cU t I hereby agree to conform to all the Rules and Regulations of the ow f stable regarding the above construction. Name' ............................................................... � D&aeo^ Abe, IJ'mnl 8; Sanford ` / . , lAl6n - ^ No ..�����_. parmi� �v �o����mz.�m.�mte� _ ---------_________________. 213 /l-=,°� j�~ Location � -^^-~^ � —' ------------------- Hyannis ---------------------~----^ . �"^^ - Owner .�.'�� ----'' ' Type of Construction 4.Wd. --. _ \ ,era��a ^ . / . Plot ^- ~ . . � . | } � Perm 26 . 73 0 Dote of `�--.�-----..---lV ^- `} Date Comp|== ~^°� � --~.--.�------lq . � ~ �ERA&� REFUSE0 ` ---''---------------.. lV --------.—.---------------- —.--..----.-----------------.. . . � . . —,--------------------~---. . n ' —.---------.----.----------.. . t ,~ U ' Approved ................................................. lV ^ ` / -----------------.--------- , � . - ................ ` x ^ . . | ^ | � TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION a Map 0��PDParcel Permit# 9 Health Division Date Issued 7 02 3 Conservation Division Application Fee Tax Collector Permit Fee C Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address Village ALY&n n Q-4 ,,// Owner r-u10-Lo 117�-trid AjUtSTV&SLL-C-Address eZ/ 3 cr_-eag) Srz At,G 01 cS Telephone Permit Request 9 X ��� �D xAa / Cff U0�y Zj 4!r! '=h M 6KIST( O-ei�►'1GrnrnrT r4N� l yS�2a �yo RA(,cf4d lurr f L.,c.n uy e.y .fiu 11 6- 4sv Cc k At 4a A.,k/.T 1A)&CJ Q 1 t Tv tA4r+d l.owt -L � z. Q s D u"-4 rL4 /1"01, Sr o.v.C*,►e-- Square feet: 1st 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: 0 Yes ❑ No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other It Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half:existing ; twe,w Number of Bedrooms: existing new cj ct, Total Room Count(not including baths): existing new First Floor Ro m Counter :_z co co 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:O existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded 0 Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use 41t_um) BUILDER INFORMATION Name Duk is Telephone Number Address oZ t3 Dcx&, 5 ncC./-- License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATUR DATE 5 FOR OFFICIAL USE ONLY r . `PI{RMIT-NO`; DATEJSSUED s MAP./PARCEL NO. - f ADDRESS — VILLAGE OWNER r � . ` DATE OF INSPECTION: , " FOUNDATION FRAME INSULATION FIREPLACE - ELECTRICAL: ROUGH FINAL'' " PLUMBING: ROUGH FINAL " GAS: ROUGH FINAL - ~ FINAL BUILDING DATE CLOSED OUT x ASSOCIATION PLAN NO. l r r "' Jun 26 03 09: 10a WALTER SWANSON 1 -781-826-1628 p. 2 certittratt ut jflame .3aroWtallite A; REGISTERED I Dale LVor�"Pe fonrrecl 4 �� ,`m� APPLICA110H issUE®BY Qt s 010ERN No. HERCULITE PRODUCTS, INC. 1/16/99 P.O. BOX 786 F122.03 YORK, PA. 17405 This is to certify that the materials described on the reverse side hereof i7ove been flame- retardant treated(or are inherently nonflamable). I 0R ASTRUP COMPANY AT 2937 WEST 25th STREET ,l a CITY CLEVELAND STATE OHIO 44113 I Certificafion is hereby made that: (Check a or b the aaid2s described or the reverse side of this Certificate have flee`. 0 Pa:a:na; i^ J retardant chemical approved and registered by the State Fire,Aharshal ants n: at the applica-ja:'t 4 oil said chemical was done in conformance with the laws of the State of California and th` :s and Regulations of the State Fire Marshal. a Name of chemical used Cher;. Reg. �°�..------- Method of application s i b) The artiyaes described on the reverse side hereof are made from a resisiar e z. materiai registered and acsnroved by the State Fire Marshal for such use. Trade rarrne of flame-resistantfabric or material used ARCHITENT _ 'sled ,rr --F122.03 k¢ °I a WILL NOT r1 en7` +-. a•1e Hame Retardant Process Used Be Re1�r..veO (will or will not) i ROBERT MAXWELL 1$v ROBERT MAXWELL, QC MANAGER Name of Production Superintendent I � pA4� p��S � g .��.t��������� P�'.spa.��.a,�g,`•,�����;���:•.��'•;!, 4y`.1�.��`: 00'a tereby certify this t� ue original E� n L �l.�r -`•• _ be a tr. to of the®rigir�a ERT9FICA OF FLAME RElST'A�CE" :•Gy - _ at . C.M Ao 9y .. ':.�°R LC,'.':.'i h" ...�.. :� �y�:7<_ BY i r'onxrol/lat4. �.� Quantity 280 YDS ---_._...----- PO 4816 ARCHITENT BLKOUT 1607 61IN WHITE Customer order# Description 1'A:.3L R.rM1V ?r,�,fes9F: -r`• 961367 Product Code 973080 DORCHESTER AWNING CO. P.O. BOX 385 PEMBROKE, MA. 02359-0385 TENT PERMITS The following information must be included on the application form: 5 ::,-Map/parcel number L'. yroperty Owner information rpose of tent If use is commercial, plot plan showing parking spaces and location of tent �quired(if located in parking lot) 7Dates ensions of tent tent will be up .,❑ ign-off from Health Dept. Workman's Comp form tv e ��e Si 'ture on Application Certificate of Flame Spread must accompany the application ❑ Fee (minimum- either residential or commercial) Municipal Tents on Town-owned land or district-owned land $0.00 • Property Owner must sign Property Owner Letter of Permission. 2-5.1 Tents $25 A) A tent may be put in place on a lot used for residential purposes, for no more than 10 days,in connection with special family occasions or events, but not to be used for any commercial purposes. $25 B) A tent may be put in place for not more than 10 days, nor more than twice in any calendar year, in connection with a fund raising or special event by a public �-- institution or non-profit agency. $� 100 ./C) Subject to annual approval by the Building Commissioner, a tent may be erected and used as a temporary accessory structure to an existing permanent business only during the period beginning May until'October 31. The tent shall conform to all the parking requirements and Bulk or Dimensional requirements of this Ordinance. $50 D) Maintenance and occupancy of tents in an organized and supervised recreational camp subject to compliance with the rules of the Barnstable Board of Health. provided, however , a Special Permit is first obtained from the Zoning Board of Appeals.. (A-D,added and changed by Town Council vote on 2/22/96 as item#95-194 -by a 9 Yes 2 No roll call vote.) q-forms:permitsl rev.2/10/03 Jul 01 03 12: 29p WRLTER SWRNSON 1 -781 -B26-1628 p. 2 r —� Th e Common wealth of PVMassach taserts Department of Industrial Accidents �� - - �� Oflict oll�tsPi1a11ae�s 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit e� name: kSztion: City nhone R 1 am a homeowner performing all work myself. C] I am a sole proprietor and Gave no one working in any capacity C] I am an employer providing workers'compensation for my employees working on this job. se±nnanv name THE DORCHESTER AWNING COMPANY INC aslsltrie 2 3 0 . OAK STREET tits: PEMBROKErMA. 02359 nhnne�y 781-826-9001 insurance=o. GRANITE STATE INS.CO. aaticyN WC5343603 (] 1 am a sole proprietor,general contractor,or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices. �canvname; � i i ddress- city: �1t2lte N insurance Co. �olicv M toma�an.,name- address: f city; rUot#, insv��-ce co. ,goiiey•# Attu •a dtQOua S L_._____—_ , M 9 a�n�e.Fa�iraimm tit silurc to secure coverage as required under Settion 25A of MC.L 152 can lead to the imposition of criminal penalties of a fine cep to si soo.00 and/or cat years'imprisonment to well as eiyil penaities in the form of a STOP WORK ORDER mod a fine of Sloo.00 a day against me. I understand that a copy of this statement rosy be forwarded to the Orrice of Invtspga(ions of the DIA for coverage verification. 11 i do hereby certify under t ke pairy d penaltier of perjury drat the information provided obt,•e is true and correct Sigtz,eurc`;�" `~ � Date f Print name WALTER J SWANSON Phane# 1-82 6-9001 otrtcial use only do not write in this area to be completed by city or town otricsal city or t°"^; permit/license M nBuilding Depar,ment check if immediate response is re aired ❑Licensing Board C7 P q ❑Selectmen's Office { r`1[icalth Department i contyct person: phone tt; 00ther ;+e.e.d)A$PIA) 'ate• U ✓/ / �/ '1 0 MUIJWAL AWPOU b iZ� N 3'10 20'E 421A-l' is"U•.r o -..--" '- o —1 •. .S fV � Q w.p,:e•4.try Exit/Entrance T}" � cam• r a 3 a� Rpnem •fig *o ; Exit✓Entrance a O 1] ALI W.M4n. — — S.S. B av I �. / j //j%/// % •% 7 d9 rv9+c'° / a v �b b / / / !/ //.ice, °�' h LOCATION MAP (no scalp) m 0 Iz- b / view N�tel / ,; ' �! j% �/�' N Hr , ,�/ // � '::: //�. / � I ; ' / //%/:�, /i/ •. /,: // :ice: arbo f_ .mot �� /-., /�,.�34 4 f• � � J / Pit / j// a I 1/61 g`!�S �• \ )j ///i � i/�i ' > )),/jet,[ ..� l /� � W y _ �'{: _ i•a �. 1', i'i•�� `2 i al. _ _�_ !�/ / � c ICj 1 -Q ..0 .E�;3- ' -lY Main EMre+we Entrance Az 4 +u....a...... w.o ` ._.._.•_,._y meant -� ,/j:;. . PArking GAI6uIA+IOn�s for Tho HAr-@Or-,V1CW HoT01 HyAnni�.MA /` ?'' ---•_ G�y3 � </�! q _ cY.. ...�a.... W1P J,J` I Curran+I'A-!inq s pAaa+. t 9 4 S PAaas S, =_ C1 r d r < c Curran+NAnd'wnppad apAGat. Curran+Hotal PArkinq raq�.. 1 08 Uni+a o". I.4 rP AGaa/Unit- 190 41 A/.aa. 1 O a I au. 1 s Aas✓2 am 5 ev A a6a PAN m HAndiGArred( 1 0 1-s 00)tlea 9 91� i jl `5.s y I 19 y spAaca x 7'b- 4 hPAGaa ra�Ulrad �J a et cL o� I 1 No+e: DRAWING TYPE: E=xis+inq N,o+al PArkinq zpALe$:. 1 94�PAoe•s _ ..Proper+y from�4n ,.rad P pr-r PraPoaed�lii'e plan } (inalude.,to NAndiGAppad•pewee) 1 by Gwpe God purvey l7w+ad Nwr<I. aq uirad for Ha+cl: ( S''yp'a6" And from FLAnr w"ivy e,%Urvey Go..wul+wn♦� Yw� t;x+rA PArkinq:. SHEET NUMBER_ O Z5 50 "15 100 .,, f - ,fit O O t