Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0042 SCHOOL STREET
jv I�XD o L M s �V M V V O - _ �il��h tfa�sen ���- �a� - s�� p�oP�,-,�y:.��:��Pd Ste,���fs!ffi` �� , FAME tati Town of Barnstable Regulatory Services BARNSPABM + MASS. g Thomas F.Geiler,Director 039. Ten►�'�" Building Division Thomas Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 March 26, 2007 Gail Hanley, Clerk Cape Cod Commission 3225 Main Street P.O. Box 226 Barnstable, MA 02630 Re: Development of 3769 and 53 School Street,:Hyann-s w Dear Ms. Hanley, Pursuant to Section 168-8B of the Barnstable Code, Regulatory Agreements enclosed is a proposed project. This project is located at 37, 49 and 53 School Street. The project was approved by Site Plan Review on January 31, 2007. This project is in the Growth Incentive Zone and therefore is not a Development of Regional Impact. Please do not hesitate to contact me should you require further assistance. Sincerely, Tom Perry, CBO Building Commissioner cc: Ruth Weil, Director Growth Management Attorney, John W. Kenney OF IHE 1p� yw� The Town of Barnstable * snxivSrABLE 9$ 6►9 ,�$ Planning Board iOrED MA'S° 200.Main Street,Hyannis,MA 02601, Office: 508-8624786 Fax: 50.8-862-4725 JURISDICTIONAL DETERMINATION FORM for.Proposed Regulatory Agreements Hyannis Village Zoning Districts Pursuant to Section 168 of.the Barnstable. Code, this Jurisdictional Determination Form establishes whether an applicant may enter into a two-party Regulatory Agreement with, the Town , of Barnstable. This form shall be submitted to the Barnstable Building, Commissioner. The. Barnstable Building Commissioner shall, at his or her sole discretion, determine when a Jurisdictional Determination Application is complete and will contact the applicant when a determination has been made. The Building Commissioner may request additional information if necessary. A project proponent may seek to enter into. a Regulatory Agreement WITHOUT the Cape Cod Commission as.a party if the proposed project is ,NOT the type of project excluded from the Hyannis Growth Incentive Zone cumulative threshold (see attached Worksheet)_:_..-As-re.quired by .Section 168, a copy of this Jurisdictional Determination.- Form will be forwarded to the Cape Cod Commission. REQUIRED SUBMITTALS Submit three (3) copies of the following to the Barnstable Building Commissioner: ❑ 1. This Jurisdictional Determination Form, a completed Worksheet: Regulatory Agreement Jurisdictional Determination, and .the Required Filing :Materials set forth. below. Please note that Jurisdictional Determination Forms do not require the. submission of an abutters list. The undersigned intends to file a Regulatory Agreement Application with the Planning Board of the Town of Barnstable.for a Regulatory Agreement, in the manner and for the. reasons set forth below: Project Location Assessor's Map/Parcel Number(s): Map 327/Parcels 145, 146 and 257 Applicant Name'`Alan Granby and Janice Hyland Phone:508-771-3070 Applicant Address: 91 Harbor Road, Hyannis, MA 02601 ' The Applicant Name will be the entity in whose name the Regulatory Agreement will issue. 070308 Project Name: N/A Property Location; 37, 49 and 53 School Street, Hyannis, MA 02601 . Property Owner: Alan Granby.and Janice Hyland Phone: 508-771-9300 Address of Owner: 91 Harbor Road, Hyannis, MA 02601 Deed Recording: Book 12674, Page 023 Book 20289, Page 170 Book 20289, Page 170 Book Page Book , Page Book , Page Plan Recording: Plan Book 73 Page 129 Plan Book Page Plan Book Page Plan Book Page Plan Book Page If applicant differs from owner, state nature of interest:2 Same Zoning.District: Medical Services (MS District) Number of Years Owned: 37 School Street-7 plus years; 49 & 53 School Street-1.5 years Total land area subject to the Regulatory Agreement: 40,721 square feet ± Gross Floor Area of all existing buildings: 6,373 ± square feet Gross Floor Area of all proposed demolition: 6.78 ± square feet Gross Floor Area of all proposed buildings: 10,838 ± square feet If more than one land use is proposed, Gross Floor Area of each proposed use: N/A Gross Floor Area of all outdoor commercial space: N/A Total number of residential unit r — s proposed: Sixteen (16) Eight (8) Existing, Eight (8) New Construction 2 If the applicant differs from owner,the applicant will be required to submit one original notarized letter authorizing the application, a copy of an executed purchase&sales agreement or lease,or other documents to prove standing and interest in the property. 070308 Was any part of this structure constructed prior to 1960? Yes No ❑ If yes, is the project located within the Hyannis Main Street Waterfront Historic District? Yes No ❑ If yes, explain .what, if any, part of the structure is proposed to be demolished or substantially altered: The cottage located towards the back of 53 School Street is proposed to be demolished. The cottage.contains 678 square feet ± of gross floor area, and was built in 1978 according to the Town of Barnstable Assessors Records. Regulatory Agreement Requested: Demolition of a 678±square foot cottage located on 53 School Street, Hyannis and construction of 4 new duplex units totaling approximately 10,900 square feet of gross floor area. The duplex units will contain'a total of 8 new residential units on 37,49 and 53 School Street. The 8 new units will be in addition to 8 existing residential units (5 units on 37 School Street and 3 units on 53 School Street) bringing the total units to 16. Four of the units (25%) are proposed to be work force housing. There will be ancillary and associated infrastructure improvements as per the plans submitted. ►� 2. Existing Conditions Plan. If requested by staff, submit an Existing Conditions Plan that . illustrates existing site characteristics, including man-made and natural features, following Plan Size Requirements and General Requirements listed in 3(a) and 3(b) below. 3. Proposed Development Plans. If requested by staff, submit the requested plans together with this forma Three copies of proposed development plan(s) as follows: (a) Plan Size Requirements. For each plan submitted, provide each of the following: ❑ Copy of plan(s) sheet size 24" x 36" ❑ Copy of plan(s) reduced to fit sheet size 11" x 17" (b) General.Requirements. • All site plans should be drawn at a scale of 1" = 40'; however other scales which provide sufficient detail are acceptable. • If the plan requires more than one sheet, a cover,sheet at the scale of 1"= 200' showing the entire property must be included. • Include a locus map at, 1:25,000 scale with the outline of the entire property clearly shown. • All building plans should be drawn at a scale of 1/4" = 1'. 070308 • Legal Data to Appear on ALL Submitted Plans, as appropriate: 0 1.. Name and address of applicant and authorization of owner if different from applicant: ❑ 2.. Name and address of owner(s) of record, if different` from applicant. ❑ 3. Name and address of person or firm preparing the plan. ❑ 4. Current zoning classification of property, including exact zoning boundary if the development site is in more than one.district. ❑. 5. Property boundary line plotted to scale. Distances, angles, and area should be shown. ❑ 6. North arrow, scale, and date. ❑ 7. Property lines and names of owners of adjoining parcels. 0 8. Location, width, and purpose of all existing and proposed easements, setbacks, reservations, and areas dedicated to public use within and adjoining the property. ❑ 9. Date of plan(s) and subsequent revisions. ❑ 10. Plans must be stamped with original stamp of registered architect, landscape architect, or professional engineer, as appropriate. ❑ 4. Where there is.a reasonable argument that the project is one that was intended to be excluded from the GIZ (see attached Worksheet), provide documents and analysis supporting the proposal that the project is NOT the type of project that is excluded from the GIZ. 0 5. Copy of application(s) for any development permit(s) filed with Municipal. Agency(ies)with filing date of such application(s). IMPORTANT NOTE: Please contact the Growth Management Department at (508) 862-4725 if you have any questions or require assistance in completing this application form. 070308 WORKSHEET Regulatory Agreement Jurisdictional Determination This Worksheet is provided to assist project proponents in determining whether the. Cape Cod Commission must be a party to a`proposed Regulatory Agreement, In general; projects located within the Hyannis Growth Incentive Zone (GIZ) do not require the Cape Cod Commission as a party to a Regulatory Agreement. However, certain types of projects are excluded from the GIZ; as such, the Cape Cod Commission must be a party to any Regulatory Agreement involving the following: (a) .An addition or.expansion associated with the Cape Cod Hospital that meets or exce,;ds a DRI threshold; Yes ❑ No (b) A proposed demolition or substantial alteration of an. historic structure or destruction or substantial alteration to an historic or archaeological site listed with the National Register of Historic Places or Massachusetts Register of Historic Places, and located OUTSIDE the Hyannis Main Street Waterfront Historic District; Yes ❑ No T . (Note;'substantial alteration or demolition within the Hyannis Main Street Waterfront Historic District will be addressed by the HMSWHD through the regulatory agreement process.) (c) A project providing facilities,for transportation to or from Barnstable County, including but not limited to ferry, bus, rail, trucking terminals, transfer,stations, air transportation and/or accessory uses, parking or storage facilities, and any auxiliary or accessory uses are not greater than 10,000 s.f. of Gross Floor Area or 40,000 s.f. of outdoor area; and Yes ❑ No (d) A project requiring the filing of an Environmental Impact Report under.MEPA. Yes ❑ No T 070308 aem Pnntetl On3/27/2019 y Com aunt CaII l �;porgy µO r fdMUrABLIL PR 42 SCHy®OL�STREE , Hl(A.NNIS � /+ n p 3 ' Case#: C-19-218 Address: 42 SCHOOL STREET, Date: 3/26/2019 HYANNIS Owner Info: Property Info: ROZZI, PANFILO E MBL: 87 CLARK STREET 327-236 BELMONT MA 02478-2450 Owner Notified?.- P Complaint Details: Type of Complaint Classification of Complaint Method of Complaint Building Code Medium Priority Phone Complaint Summary: Building jacket reveals a building code problem with the exterior staircase in 2002 (found after a tenant complained of-work being done). The stairs were then permitted in 2004 and show no inspections. See building jacket for photos and inspector's notes. Action History: , Action Taken Date Description Fee Inspector Close Case 3/27/2019 $0.00 mckechnr Inspector Assigned to Complaint: mckechnr Filed by: sheas Comments: i Comment Date Commenter lComment ('LD � o LIP l' sa F P ,,:< z,ado, ,A ..,. ';�a. :`�,:s�.L,. „,,..... ., .'k'S> . •`.'� w„ ., ,., .,�aA.„ � _. .,.. .. . ,�<h a. .. �i�,..>..,�a,. .. i . .v at Ad UZ *Za" • "� �a �* 3 + ��a4 ;��xp'F t �� vow n IN7w d\t r + } •a Y �ra�Ml ���(,' i "k'41 ' �}`l•^e�` ^}•R?1%9 �•7•�Y,'y N' sl'v.� �Tl �44, T F e'• r �r � nj �� ; v��� A, �p, 1�' AS ` tic�4, ;, r crq 3�4`���.s 1 trr�" j` f ' .y* ,�3i- •r'' " t !'g r '!1 '�r` qe` ! g . ��� ,.r-� '�.r,esc.,4��a`���"t �,"';.�'��Y'�����r �'�`"�,��q ,.e' `M' x .��t!"'��,., €ar�g'�''1:"• ---- • t A Ip � r ....r. IN' '-5t AIR h t � •�w„ 1 �`d • . �, Y ;�', ,- � �Y � ����//.r ''"� :fit. �..� _.'•,.w` �irry,.��r e , � •� `i ,�,� f , M , a +tcn f:Y q �J a A zSr 5��� 3' r aF ' f '',,."r�s�•. �r.,.._y,Cc�".� -??7 �J� *S xt} �l.»„ t g Wit• .a �' ! .� r,�• .-� �w +!' ;�. � is 4- '�•: vti" •ii:*il [ -�y n"' re'3 7 _ + ..,r.,a+..��4 '' �.�� � yki r , `•` 'k �'!�"� •jt" �t pid�.. Jy"`. t �;`>• -�;J �� ,�,�. s" -� >�cyf�'�,•,. !fiats �t 4�j x, �., � ,� 1_w i� ` ', t �jtv�V .,,.� -� �` �>.' r E.St�� 1.'rr .'�,�,ay '�..,'k�yr i'� > �^6 a•fgs���tt�;11' . ,> S. wt. r�t� .t �,r� 1� „ 'sr+..-^p+'�� '.t J � .J' '�_ ��" �,- - '" *:S. j• ��t:� nY "V"���l�Ey� �. ��7%'�,��j"�'' 3� +����� �` .s�.�,. i �t f3..� -�v... �'�� /. aS ;3'• r� � 4� ���,� � [� 7 '� 7. t `� gt> ti-S�"1�"�•tide/*?�^A�� t i+{� - ' � _ .?s,lR+y�1" c ea l7 �' e e �{y,� J?t�,� r� r gay r ;� .,��;• .��c ,{ ��, " �' • .-- ';i ' +1$�w 'SY�Sh:3" ���� :r .;►:M t,,< 'Ise_ ..;.L'i�i�i.'tt�fq �����te{��y�i�,.}�,1"� t��"�,C(ra lv,�;'�r `•�.:I'� t.:t. ^.{�.` i i I I ••I ter.:. �.... �Ma:. �J i A � 1 � L. � -•r� t� �n . � . �� � _� i,� � .., ! '. . .ter.. � + � 1 � s 1 +.�, _/!� A..ter .. �_ ��..:.� � • I ► � � �I I I i I ' s � L 1 r � • i i t�' L � _ter �• � � FORM B—BUILDING Assessor's Number USGS-Quad: Area(s) Form Number MASSACHUSETTS HISTORICAL COMMISSION 327.=236 Au 5�2 MASSACHUSETTS ARCHIVES BUILDING' 220 MORRISSEY BOULEVARD BOSTON,MASSACHUSETTS 02125 Town: Barnstable Placer(neighborhood or village) Photograph Hyannis -Address: 42 School Street Historic Namei Capt. Robert Bearse House Uses: Present: Multi Family Residence . Original: Single-Family Residence =. Date of Construction: c1848 Source: Deed'Research. ' StylefForm: Greek Revival == '� Architect/Builder: Unknown Exterior Material: Foundation: Granite i Wall/Trim, Wood Clapboards Topographic or Assessor's Map Roof Asphalt Shingles } Outbuildiings/Secondary Structures: nt on. Garage nn' Major Alterations(with.dates): •31 .. .. Fagade.alteration(unknown)_ '1 story.shed addition-east(after 1949) s '6' Attached.barn demolished 1924-1,932 W1.6� O 1 „1 l s 719 m Condition: Fair mt m ��, t. Moved: no l .x ] yes l;1 Date Acreage: .3,acres Setting: Located.on a relatively flat lot on".School 7t44=141) - Street in an area characterized b small sin le famil PoO �. ----"f00 a am�e y 9 Y " `) Un residences and,residences converted to professional offices: Recorded.by: :Julie Ann Larry,ttl-architects Organization: Town of Barnstable Date.(month/year): September 2008 Follow Massachusetts Historical Commission Survey Manual instructions for completing thisform. INVENTORY FORM B=CONTINUATION SHEET. BAPNI TAk 42 School Street. MASSACHUSETTS HISTORICAL COMMISSION Area(s) Form No. 220 MORRISSEY BOULEVARD,Bosrom MASSACHUSETFS 02125 512 Recommended for listing in;the National Register ofNtsiori&Places If checked you must attach a completed National Regrster Criteria Statement form, Use as much space as necessary to complete the following„entres,'allowing text to flow onto additional;contnuationsheets. ARCHITECTURAL DESCRIPTION: Describe architectural features.--Evaluate the characteristics of this-building in terms of other.:buildings;within the community. The house at 42 School Street is a one-and-a-half story nine by two bay multi-family dwelling.The building is<Greek Revival in style with some later modifications, including 111 replacement ash windows:and three entry doors to the three living units.The building is located on the east side of School Street in a neighborhood of Greek Revivals.The side gable:faces the street and features two gable roof dormers,each with a sash windows.The rectangular shaped building sits on a granite foundation.The exterior walls are clad in painted wood clapboards.A centrally;located brick chimney pierces the ridge of the roof,which is sheathed in asphalt shingles.The front portico is-supported by:-one square post and Queen Anne Style columns,the portico:has no other ornamentation.The deep cornice features a,dentil,pattern on the lower part of the cornice.The comer pilasters have a central groove design. The house:at 42.Schoof.Street is similar to other Greek Revival style homes in.the area south of Main Street near School and'Pleasant Street. It has been slightly altered by entry modifications, replacementwindows,and its multifamily use. It makes a moderate.contribution to the.district. HISTORICAL NARRATIVE Discuss the history of the building: Explain its associations with local'(or state)history. Include-uses of the building and the role(s)the owners/occupants played within the community. The house at 42 School Street was once..part of a larger lot with 38 School Ztreet. The lot'was divided in 1946 Captain Robert Bearse(181*1899)bought a Iotof cleared land on School Street in 1847 from Captain Timothy Baker Jr. His Greek Revival residence was likely.constructed c. 1848.CaptainBearse commanded-both coastal schooners and steamships. Schooners include the Lacoon and the Nereus. Early,;in his career he commanded sailing packets between_Boston and.New York:Later, he commanded ships for the.Metropolitan Line_ Captain Bearse married first in 1837 to Eliza Pitcher(d.1841)1hey had one surviving son,'Francis. Captain Bearsemarried again in 1843 to Betsey Crowell(c 1820-1863),they had one surviving son Elliot. Captain Bearse married a third time(1863- 1870)to his wife Augusta Crowell..Captain Bearse, his wives,,and their infant children are:buried'inOak Grove Cemetery in Hyannis.After Captain Bearse's death in 1899, his widow.Augusta lived in the house'.until_it-was sold by herestate in 1913 to. Robert and Eliza Berse's.son"Frank B`Bearse In the 1920 census Frank Bearse it lodging in the house with Etta Smith and her husband Zelota[Zelle]. In 1918, Bearse sold the house to the Smiths. Etta Smith died in' 1928°and the house was held by her estate until 1929 when it was sold to John and Esther Glendon.The property was resold in 1930;to Nellie Anderson,wife of Ruben Anderson.The Anderson's divided the original'lotand sold the 38'School Street.in 1946 o Thuriow,and Parna'Bearse. The Anderson_kept 42 School Street.until1971 when Nellie.Andersonsold the house.to Philip Buckley,of`West Hyannisport. The building contains three apartment buildings. t United States Census. 1900. f Continuation sheet l INVENTORY FORM B CONTINUATION,SHEET BARNSTABLE'42 School,Street MASSACHUSETTS HISTORICAL COMMISSION .Area(s) Form No. 220 MORRISSEY BOULEVARD,BOSTON,MASmmusETTS OZ125 512 BIBLIOGRAPHY and/or REFERENCES Town of Barnstable.Assessors Records. 1880 Map of Barnstable. Published by G.H.Walker&Co.With inset:details of Hyannis Village.available,online at histohcmapworks 1905 Map of:Barnstable. Published by Walker Lithograph and Publishing;Company.With inset-details of Hyannis Village. available online at historicmapworks 1910 Map of:Barnstable. Published by Walker Lithograph and Publishing'Company.kWith inset detailsi of Hyannis Village. available online at historicmaaworks Sanbom Fire Insurance Maps..May 1901 ;4anuary`,1906;,_September 1912; September 1919;>November.1924;October 1932; 1949..available online at sanbom.umi.com , Poole,A. F.:Bird s-eye view of the village of Hyannis, Bamstable County:;Mass A. F:Roole, � t , e v r .mv Continuation sheet'2 . .i� ' ARCHITECTURAL SIGNIFICANCE (describe important 'architeetural features and- evaluate in terms of other buildings within community) This home, Like -many of_ the others in this area. of Hyannis is of Greek Revival style. The facad'e ;of the house now, has ,three doors, one for each apartment that now make up this structure..,A portico in the front is supported by one square post and. two smooth columns. The port .co, has no other ornamentation. The -windows are: 2/2. A. central chimney Is present in the left ell of the structure., as well as a doghouse dormer. A dent l pattern is pre ent on.,the lower part of .the cornice. The exterior is. of wood shingle. Corner pilasters have a.'central groove for a design. HISTORICAL SIGNIFICANCE -(explain. the role owners played in local or state history and how the building relates; .to: the development of the .communit.y) Captain Robert L. Bearse (1.814=1899) bought cleared .la:nd form Capt., Timothy Baker Jr. on July 20,, 1847 for $15.0.00v Soon after his residence was constructed:. Captain Bearse commanded both coastal schooners. and steamships. Schooners included the LACOGN ann the. NEREUS.. Early in his career Captain Bearse commanded . sailing packets on voyages between Boston and New York. Later;, he went on to command one of the first ships built by the Metropolitan Line and reMained with that: company for the duration of his career. After his death, the 'home ,was .owned by Augusta Bearse`. Her estate: settled in 1913 empowered the executor, Edward L. Chase, to sell the house. He d-ld.. so to. the Bearse`'s son,,; Franklin B. Bearse. Bearse sold the house to Etta Smith in 1920., Today the building house's three apart- ments. BIBL`IOGR4PHY .and/or REFERENCES Harris, Dr... Charles E. , Hyannis .Sea 'Ca tains,, 1939 Deyo. Simeon, .History of Barnstable County, Massachusetts, 1890. Barnstable County Atlas 185$0 1880; 1907 Hegi.stry of Deeds �Barnstable .County 20M72/8.0 November 29, 1990 J� '� atrn�tb ¢ �ri0� 111 NOW APARTMENTS—The Captain Robert L.Bearse home on School Street,Hyannis was built about 1847 on cleared land bought from Captain;Timothy Baker Jr.on July 20,1847 for$150. It now contains three apartments. } RAM. U M, rm' st of'B ka-w-no-b homlas Captain Bearse.(18'14-99)commanded both coastal schooners and steamships including theschooners Lacoon and Nereus. Early in his career the captain had commanded sailing packets between Boston Wand New,York. He later commanded one of the first ships built by the Metropolitan Line and remained with that company for the remain- der.of his.sailing career. After-his.death,.the home-was owned by Augusta Bearse,whose estate settled in 1913 empowered-the executor,Edward L.Chase,to sellthe homer .Bearse.'s son, Franklin $. Bearse, purchased the homestead and in 1.920 sold it to Etta Smith. t Like many, of its era,.the wood shingled structure is built in the y, Greek Revival style. The.facade currently has'three doors to ac- • commodate the apartments..A front portico is supported by a square post and two smooth columns.-The windows are two over two and a = central chimney.rises from the left ell as well as a doghouse dormer. A dentil pattern is present on"the.lower part of the cornice and corner j,pilasters have a central'.groove for a design. Photo,information courtesy Barnstable Historical Commission 6'_t6 ui •----- -_ __ - �-_ f�.... - - - - - _� , i �v 1� � �c� �, TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION L a F FIA- STABLE Map Parcel Application D i.q 7 Health Division �.`' r '" ''� Date Issued -i0 Conservation Division Application Fe i PlanningDept. p ;t 3 3 Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street Address Ll 2 - G d o 1 S -�— r Village_ h c• S n Owner Q [ `(�� Address 1-7 LI c� kA S 0.R.1 Telephone n Permit Request SA_ �1 O Cy O a C � G Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning:District_ p Flood Plain Groundwater Overlay Project Valuation O S 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 Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) �-- Name n M�.Telephone Numbed 2 6_ � Address 20 W icense# c, 2 Home Improvement Contractor# 2 S^6 5_ LY Email Wo rker's,Commpe scion#-_::1( C-6 3 '-1,2 Z ALL-CONSTRUCTION DEBRIS�RESULTtNG FROM'THLSwPROJECT WILL BE TAKEN TO y r—C /1 S 7;:'�c �- SIGNATURE---- r"= FOR OFFICIAL USE-ONLY APPLICATION# DATE ISSUED MAP/PARCEL N0. ADDRESS VILLAGE OWNER 4 } DATE OF INSPECTION: FOUNDATION FRAME INSULATION ' FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING w ` DATE CLOSED OUT ASSOCIATION PLAN NO. 21-e Commomwealth of-Vassacliruetts Depivhment of Industrial Industrial Accrdews l�•f re off 1m...estigadefis 600 Washington Street Boston,AL4 02111 , nwiv.wass gov1din Workers' Compensation Insurance Affidavit:B.mldersiCiontrac.tors)Elecfrlcians/Plumbers ApplicantInfia-matictu Please Print I.e "bI Na=(B.0 MME [Organiudffnadi idaal}. ` 1 d l 1) Address: 2,10 �, c City/stawzip Are yo plo}*er?Cl eck the appropriate bay: Type of project(required): 1. I am a employer unth_� 4 ❑I am a general contractor and I employees(full andloA part-time).* Have hired.the sub-comttactms 6- ❑New construction. ' 2.❑ I am a sale proprietor orpartner- listed on the attached sheet. 7- ❑Remodeling ship and have no employees. These sub-contractors have g_ ❑Demolition woAling for me in any capacity. employees and have waikers' [No workers, camp_insurance cep-insurance. 9. ❑Building addition. workers,required_] 5. ❑ We are a corporation and its 1�El Electrical repairs or additions officers have exercised their --•3.❑ I am a homeoumer doing all wa�rlt 11_[I Plumbing repairs or additions myself-[No workers'comp- right of exemption per MGL 12_❑IZoofrepairs insurance required.]T, C.152,§1(4k and we have no employees-[No,wormers' 13.0 Other comp.insurance required.] }`Any L"bcaa3tdatcbectsbox�l emzsi also finoutth,suctionbelawslruwiug theirwn ers'campensationpoRuin5nnsao3 1 j omaw ers who submnt this affidstat nbff==g.theY are doing all wsair sad then lie outside Contractors mast snbm]t anew aifidxvk mdiczdng SCICIL fContractoas that check this boa must attached an additional suet showkag the name of the sub-cantwtos and state whether.or not fhose entities ham employees.I€the sub-canuactaeshave employees,they masrgmvide their warken'comp.policy number. I am are enepLger that is pra��ding workers'corrrperesrrtiorr iresrrrance for niy*crrrpLgj�ees Below is IhepvUey and jab site informatiom w P Insurance Company Yuma: t4 /V\ V/�,(4 � ✓1 S Policy#or Self-ins.tic.# 2 W C�J 3`-i Z Z Expirat on Date: Job Site Add..s: �f � `l � L �n 00 � S'�'—. City/State/Zip: Gv► ✓1 // Attach a copy of the workers'compensatioapolicy 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$1,54D OD andlor one-year imprisonment,as well as cixil penalties.in the form of a STOP WORK ORDERand a time of up to$250-DO a day against the-violator. Be ads9sed that a copy of this statement maybe Forwarded to the Office of Investigations of the DIA for insurance coverage verffication. I do hereby certtfjr under the pains andpenabirs ofped wy that the information-prmidedaboire is trer8/artCd correct Si7nature: F Date 1 1 ) Pliare i;� . Ofjfcial we only. Do not arrete in the area,to be completed by city ortonrn of ciat City or Town: PermitlLuense# 'Issuing Antho circle one 1.Board of Health Building Department 3.CityrTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other . Contact Person: Ph-one it: Information and Instruefions r. ` hfassar_husetts Gelzeral Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pin saantto this stare,an MPIayee is deEaed as."_.svery person in the service of another ffider ally coact of hir , Mpress or implied,oral or written.." An Vnplvye-is deft ed as"an individual,paiinmrship,association,corporation or other legal entity,or any two or more of the foregoing engaged ina joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnmrship,association or other legal entity,employing employees. However the owner of a dwrellirg house having not more than three apartments and who resides therein,or the occopaDt ofthe - dwelling house of another who employs persons tD do maim ma ce,consttucfion or repair worm on such dwelling house or on the grounds or budding app thereto shall not because of such employment be deemed to be an employer." MGL cbapter 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 witlr the insurance.coverage required-" Additionally,MGL chapter 152, §2SC(7)states`Neiffim the commonwealth nor my of its political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance.. to file co autho._ " requirements of this chapter have been presented contracting zrty_ Applicants Please fill or t the workers'compensation affidavit completely,by cht-,c�the boxes that apply to you situation and,if necessary,supply sub-contractors)name(s), addresses)and phone numbers)along with their certifrcate(s)of in mance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not regLdmd to carry workers' compensation h s<n-mce. If an LLC or LIT does have employees, a policy is regaired. Be advised that this affida:yrt maybe submitted to the Department of Industrial Accidents for confirmation of in sui-an ce coverage. Also be sure to sign and date thhe affidavit. The affidavit should be retried to the city or town that the application for the permit or license is being requested,not the Department of Ii�,�irial A ccidmfs. Should you have any questions regarding the law or ifyou are reed to obtain a workers' compensation policy,please call the Deparment at:the number listed below. Self-red companies should enter they self-insurance license number on the.appropriate line. ` City or Town Officials . • t - Please be sure that the affidavit is complete and pried 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 regrading the applicant Please be sure to fill in the permit/Iicrose number which will be used as a reference number. In addition, an applicant that must submit multiple pennit/Ucense applications in any given year,need only submit one affidavit indicating current policy inffbrmation('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 maiked by the city or town may be provided to the affida must be flied out each applicant as •rooft3lat a valid affidavit is on file for future p ermits or licenses_ Anew vrt aPP P entLxc e owner or citizen is obtaining a license or permit not related tQ any business of commercial v year.Where a tom wn taming P - (Le- a dog license or permit to bun leaves etc.)said person is NOT req�red to complete thus affidavit The Office of Investigations would at,to thank you in advance for your moperafion and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number_ Tilt CG=QaWL-181a of Massachuttts , Depari meat cif Iudnstial Agents mce ref esfigatio-- �Q4�ashin�tan � B.astan..,YA G� I I I Tf,-L:#617 727-4900 cxt 4€6 or 1-a -MA-S F, Fax#617-727-7M Revised¢24-07 mass-gavldia �I A RDO DATE(MM/DD/YYYY) lV� CLRTIFICATE OF LIABILITY INSURANCE 05/05/2015 i THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). (PRODUCER CONTACT NAME: KERRY INSURANCE AGENCY PHONE —-- FAX PO Box 1945 (A/c No E><g_._ E-MAIL North Eastham, MA 02651 ADDRESS: —�—,__ — ' INSURERS}AFFORDING COVERAGE NAIC# INSURED INSURERB: AmGUARD Insurance Company — 42390 I All Roofing &Contracting Inc ---- -- - -- ------ f INSURER C: PO Box 517 INSURER D:--� Eastham, MA 02642 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: i THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD I 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. (IN�SRI TYPE OF INSURANCE ADOL SUBR POLICY EFF POLICY EXP^I - '— — I LTR I I POLICY NUMBER MM/DD/YYYY I MWDD/YYYY I LIMITS GENERAL LIABILITY I EACH OCCURRENCE _ $_ 0 r j + j DAMAGE TO RENTED i COMMERCIAL GENERAL LIABILITY i PREMISES(Ea occurrence—_I 5 0 }— 4 {( LI CLAIMS-MADE OCCUR M_ED EXP(Any one person) L$ __ 0 PERSONAL&ADV INJURY 1$ -`— 0 GENERAL AGGREGATE $__ 0 i II—GEN'L AGGREGATE LIMIT AP(P_LIES PER: I PRODUCTS-COMP/OP AGG $ O 1 POLICY I PRO- ----- -------'- EC AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT ANY AUTO ` BODILY INJURY(Per person) S ALLOWNED SCHEDULED ( — -- - AUTOS AUTOS ( I BODILY INJURY(Per accident- )�$ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS ( I (Per accident) I f UMBRELLA LIAR OCCUR I I EACH OCCURRENCE S EXCESS LIAB r _ CLAIMS-MADE AGGREGATE $ _ _ — _ —-- I ��DED RETENTIONS _( I ! � �—_----- $ — WORKERS COMPENSATION I WC STATU- OTH AND EMPLOYERS'LIABILITY Y/N _ TORY LIMITS _X�_ER ice___—______ ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S SOO OOO B OFFICER/MEMBEREXCLUDED? N/A R2WC634221 1,05/17/2015 05/17/2016 -------- —}-- -- (Mandatory in NH) E.L.DISEASE-EA EMPLOYE S 100,000 I If yes,describe under i — i DESCRIPTION OF OPERATIONS below I' E.L.DISEASE-POLICY LIMIT $ 500,000 IDESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) i I Exclusions: - Andrew Williams; j .. i CERTIFICATE HOLDER CANCELLATION j SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. I AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD r f \'��' .��/1(' ���>r��l tr7�rri!��'rl,/l�l t'? ��lr`[fC1,3.1f%Cyl-G��,���f�• =� Office of Consumer Affairs and Business Regulation r ` Z 10 Park Plaza - Suite,5170 Boston, Massachusetts 021. 16 Home Improvement Contractor Registration Registration: 125654 Type: Private Corporation Expiration: 2/12/2016 Tr# 247893 ALL ROOFING & CONTRACTING, INC ANDREW WILLIAMS _�---------- ------210 WEST WEST RD 2-9 ------ WELLFLEET, MA 02667 -- -----�--- --- Update Address and return card.;Mark reason for change. Address Renewal i .� Employment j Lost Card SCA 1 C., 20M-05111 Offce of Consumer Affairs&Business Regulation License or registration valid for indiv idul use only " :�I—[,SOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: l" egistration: 125654 Type: Office of Consumer Affairs and Business Regulation `"' 10 Park Plana-Suite 5170 Oa ,,Expiration: 2/12/2016 Private Corporation y Boston.MA 02116 ALL ROOFING&CONTRACTING, INC ANDREW WILLIAMS 210 WEST RD 2-9 WELLFLEET,MA 02667 Undersecretary Not valid without signature Massachusetts - Department of Public Safety Massachusetts -Department of Public Safety Board of Building,Regulations and Stta+n�dards Board ;f Building Regulations and Standards �vr�ir:uitluriSurper�iii,r ��rrsiiTiiciit�iis4i/ci�i�+ii'�ijicii�iii�' License: CS-102258 -License: CSSL,-102355 - : ANDREW WILLWKS ANDREW WILLI�IVIS. `r .. 210 West Road 2-4 210 West Road 24 , Wellfleet NIA 02667 Wetlfleet VIA 02667 Ex iration o.. a P ./,.ta.�-�..f�- Expiration Commissioner 02/02/2017 Commissioner 02/02/2017 r • *,,, 'aft�®����Y Page# of pages ANDREW WILLIAMS- ALL , '- ROOFING _ & TRACTI .ivGP.O. BOXS EASTHAM, ; MA 02642 PROPOSAL SUBMITTED T0: ^� JOB NAME JOB# L o—c) L ADDRESS � JOB LOCATION DATE DATE OF PLANS PHONE# FAX# ARCHITECT Zxye reby submit specifications and estimates for: aa r C L ------ — •- _ _ oo c s--- - - - ----------�- -Cam _ - - ---�`y--��- - ---- ---- -- --__- -=--- _____ .-------=— —=---=-- -- — ------------- -- J- — --Q e -- Uj Gc_!' C/c-- _ --C Gr1 tjj 7zye propose hereby to rnis al.a r— fete in accordance with the above specifications for the sum of: }� Dollars with payments to be made as follows: 6 1 Any alteration or deviation from above specifications involving extra costs Respectfull _ __...__ will be executed only upon written order,and will become an extra charge submitted over and above the estimate. All agreements contingent upon strikes, accidents,or delays beyond our control. Note—thi roposal may be withdrawn by us if not accepted within days. Acceptance of Vropoq r The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above. Signature Date of Acceptance ' Signature A-NC3619/T-3850 09.11 s r Cape Save Inc: 7-D Huntington Avenue South Yarmouth, MA 02664 22 , Tel. 508-398-0398 Fax: 508-398-0399 , / �Vv 5-20-2013 Town of Barnstable Thomas Perry CBO Building Commissioner a 200 Main St. Hyannis,MA 02601 RE: Building Permits Dear Mr. Perry, This affidavit is to certify that all work completed for 42 School Street,Hyannis has been inspected by a certified Building Performance Institute (BPI)Inspector. Ceiling: R-38 cellulose; Walls: R-13 dense pack cellulose Floor: R-19 fiberglass blanket ' All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application do 9ST,7 ©� Health Division Date Issued C l Conservation Division Application Fee J Planning Dept. Permit,Fee 3 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Address 4 5, ,S c 00 1 S+ceefi Village 4,4 a no i sIt q Owner 7.7-1 Address Ckark S`t gelM11r+ rn1' Telephone 6t-4 - 3 63' IN Permit Request P4a R-33 &n+ R- Ir� ceNkosc to t4 A6. LINdd bre :k% At W0,16, 0, 11 - 1 9 �N'V U +0 t4a 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) .,.. w Age of Existing Structure Historic House: ❑Yes ❑ No On Old i 's High\;Fty: I 4es 0 No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other ra Basement Finished Area (sq.ft.) Basement Unfinished Area (s .ft) Number of Baths: Full: existing new Half: existing 'caw 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 X No If yes,.site plan review # Current Use Proposed Use APPLICANT INFORMATION M1 (BUILDER OR HOMEOWNER) Name vwNow 1 Yee kyo�ve Tnc' Telephone Number 508 - 3 4g- a3qR Address ; --p WWA- 11l i�n Awe License# T C � o a g T 6 Home Improvement Contractor# Worker's Compensation # 'T w C ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO \�af ftxOAA SIGNATURE N' DATE 3 ` FOR OFFICIAL USE ONLY M APPLICATION# ` DATE ISSUED - -. MAP/PARCEL NO. ADDRESS VILLAGE s . OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION 4 FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING - DATE CLOSED OUT L '� ASSOCIATION PLAN NO. r jr ' c 460 West Main.Sheet Hyannis,MA 02601-3698 Housing T.(508) 771-5400 F (508)775-7434} �S§�§����� - 'I`IY on all lines ®�`�®rati®t� haconcapecodorg Cape Cod Free Your tenant has requested and is eligible for weatherization of your rental home through government funding. This will be provided at no cost to you. Program regulations permit us to spend around $4,000- $10,000 in materials and labor per dwelling unit. Program regulations require us to weather-strip and caulk doors and windows; insulate attics, sidewalls and floors. All work is professionally done by established private contractors. We will conduct a final inspection to make sure that all work is completed to specifications. If you request, you will be informed of the estimated measures before they are done and provided with a list of the actual measures.and � .. costs following the completion of the work. We also need proof that you own the property. A copy of a CURRENT TAX BILL OR DEED listing you as the owner will satisfy this requirement. Please fill in all blank areas of the enclosed agreement and return with the proof of ownership as soon as possible. If we do not receive the enclosed form within two weeks, we will do a basic energy audit of the home, but no weatherization work can be recommended or done. If you have any questions please call Mitzi Holmes at 508-771- �� r 5400, ext. 123. LANDLORD C�6'} 9G " &22t� TENANTS ? 61r�1 K , rIVj PHONE _ fart P --K- PHONE 0a +J TENANT/PROPERTY OWNEWAGENCY WEATHERIZATION AGREEMENT 1. The Parties to this Agreement are the following: (hereafter known as Tenant), (print your tenant's name) (hereafter known as Property Owner) (print your name) and Housing Assistance Corporation(hereafter known as Agency). In consideration of the mutual promises hereafter stated,the Parties agree as follows: 2. The date of Agency's signature will be the effective date of this Agreement. 3. Property Owner and Tenant consent and agree that the Agency may do the following with respect to the property to at(street,town) un it # unit# and currently leased or rented to the Tenant V a) Enter the premises for the purpose of performing a Weatherization inspection. b) Enter.the premises to perform Weatherization work which the Agency determines in its discretion is necessary and appropriate as a result of the Agency's inspection of the property and in accordance with the appropriate priority list for the type of dwelling. The Agency and the Agency's contractors may also enter the appropriate common areas of the building for the purpose of accomplishing the Weatherzation work. The Agency and representatives of the Commonwealth of Massachusetts, Department of Housing&Community Development(DHCD)may further enter the property to inspect any and all work hereunder. The Agency will provide reasonable notice of the timing of the Weatherization work and inspections. The Weatherzation work will be performed in accordance with the Property Owner's consent as further specified below: INITIAL ONLY ONE OF THE FOLLOWING**k I consent to performance by the Agency and its contractors of any i Weathenzation work determined necessary and appropriate by the Agency as a result of its inspection of the property. I understand that the Agency will provide a detailed statement of the actual work performed and the associated value at the completion of work. ' I will provide a separate consent to performance by the Agency and its contractors of Weatherization work following my receipt of the Agency's inspection report and a statement of the estimated.work and associated value. This additional consent will be sent under separate cover as Attachment A. I understand that the Agency will provide a detailed statement of the actual work performed and the associated value at the completion of the work. 4. The Property Owner understands and agrees that any.and all work, including related repairs for which the Property may also be eligible,will be performed at the Agency's. dirgn The Agency estimated completion of the Weatherization work by the end of � 2012. 5. If the Property Owner is required to make repairs to the property prior to the commencement of Weatherization work by the Agency,the Property Owner will be notified by the Agency and will be required to make the repairs as soon as possible. Except where the Property Owner receives a written extension from the Agency, time is of the essence in the performance of repairs by the Property Owner. 11. For breach of this Agreement by the Property Owner,the Property Owner shall reimburse the Agency in an amount equal to the cost, as certified by the Agency, of the Weatherization materials installed and labor performed on the premises,as well as attomey's fee and court costs. The Property Owner may also be liable for damages to the Tenant in accordance with applicable law; in such instance,the Property Owner shall reimburse the Tenant for attomey's fees and court costs. Without limiting the foregoing,the Agency may at its option terminate this Agreement, by providing written notice to the Property Owner and Tenant, in the event of breach by the Property Owner or Tenant 12. Performance of the Weatherization work hereunder by the Agency is contingent upon the availability of funds to the Agency from the commonwealth of Massachusetts and the federal government, as well as the eligibility of the Tenant under WAP program requirements. The Agency may terminate this Agreement, by providing written notice to the Property Owner and Tenant, if the Agency determines that the unavailability of funds or ineligibility of the Tenant warrants termination. 13. The Parties acknowledge that this Agreement is under seal. it is intended by the Parties that the Tenant or any successor Tenant is the intended beneficiary of the Agreement and shall have a right of enforcement. Property Owner's 4 > Signature: Date '�We'l� —3 c 7 061 � .Phone: io ,� � � y' -- 'Address: �_ t Al Tenant Signature Date Agency Approved Weatherization Company _P. r.vQ� A pe Energy Caliber Building &Remodeling Cape Cod Insulation ape Save Frontier Energy Solutions Lohr&Sons Resolution Energy Agency Signature_ Date V `' - The Conlntoinvealt1i of Massachusetts Departnnent of Industrial Accidents Office of Investigations 600 Washington Street Boston,It14 02111 wwiv.nnnss.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lembiv Name(Business/Or;anization/Individual): C p &v f n G. Address: D Hmti,mO-on Nve11H,C City/State/Zip:s fl,i,4 (aj-M �-t-h, (�A 02�44 Phone#: 50$' 3 4 $ - O 3 q Are you an employer?Check the appropriate box: Type of project(required): 1.fR I am a employer with t-1- 4• ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-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 mein:any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp.insurance+ required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.❑ Roof repairs insurance required]t c. 152, §1(4),and we have no employees.[No workers' 13.X Other 7—r-,S U,,&t 't on 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 subcontractors 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 isproviding workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: T e-P�n o 1 0 G n Policy 4. or Self ins.Lic.r —t: W C 3 3 1 Expiration Date: (4 t ( / 13 nn ` Job Site Address: Ll _�f, cl� City/State/Zip: kffach a copy of the workers'compensation_policy declaration page(showing the policy number hnd 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 2Hainst 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 certo,under the pains and penalties of perjug that the information provided above is true and correct Sienature: Date: _ Phone=` J 8 3 9 - O3 t7 EL Official use only. Do not write in this area,to be completed by city or town offrciaL City or Town: Permit/License_: Issuing Authority (circle one): k 1.Board of Health ?. Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6:Other Contact Person: Phone.-: AC0 0 CERTIFICATE OF LIABILITY INSURANCE 11//2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. .A statement onIthis certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER NAMMTE CT Shannon Sperrazza Risk Strategies Company PHONE ('781)986_4/i)00 ( (781)963-4420 No: 15 Pacella Park Drive E-MAIL :ssperrazza@risk-strategies.com Suite 240 INSu S)AFFORDING COVERAGE NAIC0 Randolph MA 02368 INSURERA:Selective Insurance INSURED INSURER 13:Safety Insurance Company 3618 Cape Save, Inc INSURER C Mechnology Insurance Company 7 D Huntington Ave INSURER D: INSURER E South Yarmouth MA 02644 INSURER : COVERAGES CERTIFICATE NUMBER:CL1211954576 REVISION NUMBER: THIS IS TO CERTIFY THAT THE 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR D S BR POLICY EFF POLICY EXP LIMBS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD MIDD GENERAL LIABILITY 1 EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) S 100,000 A CLAIMS-MADE X❑OCCUR S199448001 0/16/2012 0/16/2013 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY JFCT PRO- RO LOC $ AUTOMOBILE LIABILITY ERa��ntSINGLE LIMIT 1,000,000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED 6208200 1/6/2012 1/6/2013 BODILY INJURY(Per accident) S AUTOS AUTOS { NON-OWNED PROPERTY DAMAGE S X HIRED AUTOS M AUTOS ++{ Per accident X 1 Underinsured motorist BI split S 100,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE S 1,000,000 A EXCESS Lms HCLAIMS-MADE AGGREGATE S 1,000,000 RED RETENTIONS 199448001 0/161/2012 0/16/2013 $ C WORKERS COMPENSATION Officers excluded X WCSTATU- I OTH AND EMPLOYERS'LIABILITY ' RY ER ANY PROPRIETORIPARTNERIEXECUTIVE❑ NIA from coverage E.L.EACH ACCIDENT S 500,000 OFFICERIMEMBER EXCLUDED? C3318007 /9/ 12 /9/2013 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE S 500 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach.ACORD 101,Additional Remarks Schedule,It more space is requlred) Issued as evidence of insurance. Issued as evidence of insurance. National Grid Corporate Services LLC d/b/a/ National Grid, Action Inc. , Colonial Gas Company and NStar Electric are listed as additional insureds as respects.General Liability as required by written contract. CERTIFICATE HOLDER CANCELL ATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Cape Light Compact - I PO Box 427/SCH 3195 Main Street AUTHORIZED REPRESENTATIVE Barnstable, MA 02630 Michael Christian/SMS %% - - -- ACORD 25(2010/05) , ©1988-2010 ACORD CORPORATION. All rights reserved. INSn25 nMnnm nt The aRnpn name anel Innn arc renietcrcel mm-*-of,&rr1Ph 1lassitchtisetts- Depart"Ient 6t Pul)lic Si11et% Board of Building, Rc3ulations and 5r<tn(1ard• Construction Supervisor Specialty License License: CS SL 102776 Restricted to: IC .41 WIL•LIAM MC CLUSKY 37 NAUSET ROAD r-- WEST YARMOUTH, MA 02673 _� Expiration: 6/28/2013 (' nuuissi nci Tr=: 102776 •-,�. (571-77. �r� �£:/'cN ✓ ��✓ Jr��r/ if� y�'L'��lh=icCL J�7/r�,.��'� ����' - h. Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite'5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 171380 Type: Corporation - Expiration: 3/14/2014 Tr# 222184 CAPE SAVE INC. WILLIAM MCCLUSKEY 7-D HUNTINGTON AVENUE _ SOUTH YARMOUTH, MA 02664 Update Address and return card.Marl:reason for change. Address _ Renewal _ Employment = Lost Card PS-CAI 0 5011W/04-G7072So J,/e ewitwtc-2two-a d-of;�lr uselG License or registration valid for individul use only Office of Consumer Affairs&Bdsiness Regulation _ HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: ` Registration: -: MEET Type: Office of Consumer Affairs and Business Regulation L' 71380 10 Park Plaza-Suite 5170 c, d WL,� Expiration: :31141201. Corporation Boston,l'LA 02116 CAPE SAVE WC. WILLIAM MCCLUSKEY 7-D HUNTINGTON AVENUE SOUTH YARMOUTH.MA'02664 Undersecretary Not valid wit signs . fv1,1 f� { 5(.�,.�aK Town of Barnstable Planning Board E, Notice of Public Hearing Monday,April 9, 2007 at 7:30 p.m. LWi New Town Hall, Second Floor Hearing Room 367 Main Street,Hyannis, MA To all persons deemed interested in the Planning Board acting under Chapter 40A, Section 9,and all amendments thereto of the General Laws of the Commonwealth of Massachusetts and the Town of Barnstable Zoning Ordinances, specifically Section 240-24.1 Hyannis Village Zoning Districts you are hereby notified of a Public Hearing to be held on Monday,April 9, 2007 at 7:30 PM in the Hearing Room of the Barnstable Town Hall, 367 Main Street,Hyannis,MA to consider Regulatory Agreement Application 2007-01 under Chapter 168,Regulatory Agreements with relief for density; front,rear, and dumpster setbacks; driveway width in excess of 20 ft; and waiver of 25%impervious parking area in a front yard. The project includes the demolition of a 678 +/-square foot cottage located at 53 School Street, Hyannis and construction of 4 new duplex units totaling 10,900 sq.ft.+/- gross floor area. The 8 proposed residential units are in addition to the 8 residential units which exist at 37 School and 53 School Street,Hyannis and situated on a total of 40,721 sq.ft. 25% of the traits are proposed to be work force- housing. Ancillary and associated infrastructure improvements are proposed. The applicants are Alan Granby and Janice Hyland. Properties are addressed 37,49 and 53 School Street,Hyannis,MA and shown on Assessor's Map 327 as Parcels 145, 257 and 146 in the Medical Services Hyannis Village Zoning District. Copies of the applications and plans are available for review in the Office of the Planning Board,200 Main Street;Hyannis,MA between the hours of 8:30 AM to 4:30 PM,Monday through Friday. Cape Cod Times Felicia Penn, Chairman March 24 and 31, 2007 Planning Board 1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION � a Map .% Parcel- 3 o Permit# ? Y1 7 Health Division k i ��� t�� Zvver. cc �r�3 Date Issued !-5 6 Conservation.Division 26 ' Application Fee Tax Collector Permit Fee rt. Treasurer,- Planning Dept. APPLCANT MUST OBTAIN A SEWER CONNECTION PERHIT FROM TIM Date Definitive Plan Approved b Planning Board ENGINEERING DMON PRIOR TO PP Y g CONSTRUCTION: Historic-OKH Preservation/Hyannis Project Street Address 7 a 5 CHU 0L j �£ Village N y A m l / S Owner M 0 y 0/y9 / Address Telephone ( dgj 7 9 Z 7 1 - Permit Request Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation &ZO - Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. 1 Dwelling Type: Single Family ❑ Two Family Cl Multi-Family(#units) Age of Existing Structure g 3 '17eS• Historic House: ❑Yes [if 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: 0 Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes __ ❑No Fireplaces: Existing New Existing wood/coal stove: 0 Yes 0 No'Y Detached garage:O existing ❑new size Pool: ❑existing 0 new size Barn:0 existing ❑new size Attached garage:❑existing 0 new size Shed:O existing ❑new size Other: Zoning Board of Appeals Authorization ❑, Appeal# Recorded 0 Commercial 0 Yes (3 No If yes, site plan review# Current Use Proposed Use .. BUILDER INFORMATION / j~ Name-' �� �y �" KD/��1 Telephone Number S�o Address 5.rA S� License# J h �y � 'y d "CIO l Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATUR DATE l 13 `1) P - J J FOR OFFICIAL USE ONLY j � h } PERMIT NO. DACE ISSUED c . MAP/PARCEL NO. t ADDRESS VILLAGE ' OWNER i Z `z 1 DATE OF INSPECTION: FOUNDATION a FRAME ' INSULATION a FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH s FINAL Qs FINAL BUILDING s DATE CLOSED OUT s ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents -= = Office oflasestltlatlaos _ 600 Washington Street Boston,Mass. 02111 Workers' Com ensatiott insurance Affidavit name j'Yl(� /�y � 110 Ct<{OOL S7 5 _ ovation: o� / - N �/ A n () ��0 0--7qj city / ICj I am a homeowner performing all work myself~ ❑ I am a sole r rietor and have no one worlds in ca achy rtxvidin workers' compensation for mp empl es working on this job. , I :'S+:• {n,;{:x4r :;•YJ.4?}:•'!,.}•}:{}}y{•?:lri:::tij}';;4:.+y'•?}}}}}?t}:?'}�•'•„ti'{:?C�M S-�,�5�•'}'++M''•;�''jfN�};:;•$:h I am an em g .... ...,.::r::r::.n.,:•n.n•:•.,•... ��.::r::L ... °.�:.+!«.} .•"` .,,}::.:?...T•n•: ❑ P QY�' r...s;?•>??�' r.�.:{?T:?;,ra. r,.$.,: :<�x::?�Y:�:{,.}h,.}:. ...{{:....... ?:%s:,•. .,7J;.y+�::',..{:n...... y..:.,yx... .r..Yr:.Y..:sy.::•..,,•:.5...:•........:::••:•:r.:{•:•}:;•:h::...:'.... ,. .:,?:.:•:::. n.n•..;:•::+.,••:•:}:.,• :••:.}4•?••rti}:{}+ :'+`r`o:. :�.. :;r2K:.:r:••} '??:v:?.} {?.?,:• JC v}it$:' {{r$^fir }$Wh;.e{ri?• n• r. 4nran...•x.::v;, .. .. }?:w.vv-+}},+. •++:. .:`{: .Nn. :.yy.•:•+:.v:e:x... n ..f?,•{: :;:,v::r•%:,•$:j:.:•. :Yv.,v.. R +•n.. ....: ....: ....... .. .. .:.5: .. r......t•.a•.v}Yh:.;}+:;;:;}%v ,.,..:. vy n:..n.. :...:,:. .�+tt••.+•r '"5? {. :: • , ...,. n.Y. ... : ..,. nY:::.:r:4'••<?}vfk?:ii$q,{{;. .yy,.'t>.;w:u'?} •`.?`i'.•Y`::f8:i22•.ia,i.,v\.},..;4. ..a. r.d!6+.:!%.,:.,•n•}::r:.:•,+•:+.{,•.. a,F.. ,u.,Y:.:•::::::::.a:::.r.,,;{.n{•?r:•::.y+:?:.:Cr.},. ..{..:}r. :•}:{5:aY7 ..t?.. .,2!�:. r:.Y.: .:::::Sr::.....x .............:..:r...:a::}.: n.},,r•:...a,r.{:+:•:.yh•:•:. .... ;••.:{., 4• ...4}:•x.}••.: �..ri.nv:n.....::+;va{.r4,+••w•:.?•.•.w::•:}:,::.v..:.,,vv.::n•::.,:.:.:?:. ?-nv:.,..... � ..:.... .....:.•n. .. ... ' :. [{J::::::v v::::Mn,,.:.:..:.. ..:Y:4;•:v.:+F..,.':•?i.v J.,l•rnm.,.u:.t•....,4::•..((h..t...o•..:..}8...{...::y.;II...?4...:�Y..:.:..•..+Y•.„fII..r..a•::...::B:7.t xt:r.:.::.m.r:,,:.}::.r:n C}e.;•t+.,,:?.nr••:::}:,.n..•..,•....•.,S:.}:..:an....,,?.a...:4:},..•�'•,.:.,.',.r.:.n...;...?.....?:.{,,..5•:.;..:.:.+.....;r..?.n:.•,y.t,.,.f{...}r..,,?..r Q,..h.4.:,.}.•,.:.a,.;:...{a.r a.y..x.;.n...:..:,S•r,.�:..:.n,.y.n•.v:+?::{•.S:.:....r.r.....{.Y�...........J?r.{.,a.?.•fi;.::Y;::.}..?.,:;...r:.•}...{%..:...,8.•}};.•..••....:..Y,.y:.:::.•f•.:!:}......:Y:.•..•..?..:.?...r.:...r,:t..•.,}..5.:.:n?ty.,r•rt:..4•.;:+.+W;..a.?++..v:..;Y;:.:J.a.•.J}.:y.a:...:.J}aY+:•..:..:}.•.x r:•.•:Y•.:;},.::.:...�.n:r,::+;.::.�:�•;•,..y.;:S.:a::,.:•}.i.::x}..a},;,::{.4 rt,,.}..:.}�:{�'.a•.'..:}:a::Y•:...a•4.vr:.Y�{a�:,••'+t4.n{..•3."}.srS;h.h:}'.;.:{.•Y.:.�+3#y:'.:a}..+e.:n•.{.a::.S�,vv,:$S.}.t..{:r}{i$r •..}.r':.t•,}.a.$:?•..,{Y,�.?}rix•:'..;:..v.h},...r n'+,.,,Y+.;,•?S,.:::{}•.i:.;:..,:.::{;,:rSf>:h'}.tJ}F.:{.,}::yvS$..R•}.}•:.}.{;••t:•n..::,3n••.•x.}?.,•,.2.?`;;n:S•.:{i?.}.':,}.r.i�y 4#•n'?{}';n^::;+.�?.)..LF.:::<?: £.7{..r.::?..?::.:..'r:n?;}.tn••}7S,,..•i+}}:l,,r;,::.?rf.�Y i{.4;�:.':.,.a?,,}r.:yi.%•v4i..;£•,..:..;x}f.{{r.{}}{t:..:.,;,ya•,.:.3 S,:•.i}.Srn-?'-.}•i:A!i:�.?ti'••:..•2?}::..,.?}.:ra`'•}:y:••h;,,n.:•,�:w.•}•:vx:£5?t�3n:,}.)•.x}•;.Y}:.!:•;:}?•;++:•..'.a}:a:S<,,?r.,:i•.:`}}vi3+T•;}�::.i}•Y%�.,4..:a,y:;•+T+rJ{..:.}•.`:.}2'•{.::::,h.rn2}::;:}y?.•y.4+Y,•Y.•,.4�"4s#.}n n'.;:�}:a:4•Y:...%,w,,l.:a••.•h.+},;;k..X•}'}s,t;'h�4 avr::h.?•:;.? ;Yt•, �if 4 •:'`:Y':�,,+-::1 h;•,43.?E;?,•{;•s•4.w,"�4x••`!G.•v.;ah,i.'a:.3.'4c,x:c$.•f.;-•}+}gt,):q�a4:a--.,r:fir,.n?{'}••,:,r}•,}.•Y.: :•.i:.+ •yv::.?2,.. :n}...a...r........:.. ;;l�G•, +.,.:LSn.,yY;;{:}}}r!��.::}•:, }r{•}{{an:'•}.'•}::nW�;:nt}•n%;iy:.+•:.,,;7.;};:?.}�•:`•<:}:.:R,�c}}`.$i•a•:.}:Y::}.y ..xtS:,., ..�:ti{{.:.:: .,:S,i4;:r{:�;:;}}.;,hw• .:Sr........Y.•,:\•::::.�n:••:?a•r....:..3.:?•F..... .v......::. 7 y �SY:x:.{Y:nv+•....:x..{n.8.,;}::•,.:h•+.... ......... :v•:.:v..:.;:•,.{::{k iv,}•y.;,:;{:...}}:•W .;4.;34:x•;:rn;nyr.•::irf:\I;}'{r.'?;};}{:v;a• •,}n;S}:++£+hY��`%t'.;;}CJ�4?•:.: .. ..:..:..: .:......:.:..�r.••::.,,•:;:,+7x4}}}' •:{•rra:,,.:.i n.. .:n,;}.�{?:4�':<{.;;}6;}29.},;.s.;,:::?<:2i.;?}•:^•::;??:raa•.,.L.S Jr��,},c:..;y+.,{,'.�:Yy�';:}��•if? ;..kM;•��:c, nN: •.ir. .:$4:4•{. £#04: ..4. <:., .Y:.•. ::.�`{i..i'ma.}i.n +':W.4;{ •%r + ' M:vw:.w;;• .v7a}.•.. £`'•}+: : :}.J:::f.. }}}•}w.v, .{.. .4.2?^+::•}:•. •':,,.I, ..:...N v':Tx:'•:}'v:.r\'f.•Y+f. .'•}:K.i,;.{ ,.:v. ;,v}::in•}..;;•:-:..i� +`�ai:{x......•n. ,< ...}: $C.x.Ya,••x::Y., }:?c..: ?{.:'•:•..�:£r ,4.?t:.:}:.. +r;ik{: .+,,4}}Y:,:{:;;?::h {l..•:?�SS$.'rti}:y. :•:h•+:•::r.,n t4f:..Z :.•n.7fnk:ri! .....,.,• •r,....'k. :....{,... ,.}.•::.:..an:£v , •r...... •:::...::::::.•..::?,,...: :h+•.:..ar..••:-::n•{::;,,�.,. 7:,•::••..;r,... r.n+c•+.\}+ail:+:,;.:?:+:i,+?.. {.. .h4:•:);£}•,:•<;}�£�: nyf.,+•.i�r{ ,..�. , :.: .u:;�9;.::r:C,.. ,,a. .x y. {.r.:•:•:. , :+:}.4::�h..:. .,,4.,{..:•a::tn.�l.r. v;:'i{;{{•+•a};.::,.n-:•+ ,:W.•:x. ,: .:,...}....,5.t •.4:: •..Ct:: v h...n??{?:'{{}4:•Y.•:AS?v:::•.. .v£ ., ..h.. .}:•:+?•':•:ia'•: ..:t.n..:. n:W:t?•v`.??-'::n.n ...M{.. A. Y .a}r:$:}vn:+4.4•;v.?<;';,.x{:.}n r:.,.,..,iv.:•.r..v.n.x.,...•:.v.. .:.. .n.., {'•�::•a.�v�:;r::?•:•..:,:.. :.. .., :v.4.v..2 •+nv'C.:{y.,}.r,. h..�'..v:;•5.,.}.,;{•:::•....f:.• ........: +:.x:: .,.r.•{., ,�' ,.{.: ,.{ •.....n.....•.... ..,,..r:. .:.n..r.. .: :t,•r!.,......::..y:r?r....:..•.}:::.....,:..d.. ..#.a,r......... 4.,f:•�t•:.::•: ..,:...:.,24::,Yn}?$•'•;•,:�+$:`£�?2`.?S?<4�'•4�'.2,:i•. ,i7v,`?r•'�.i:•a,.::.y. �i :.... :rnv:rh:a;}•;.v....:•v;{.},vf.;..,v}wr�n...,a:v:7::?::.•.+..n:.r.::h:$;v'?,.......,..f•ym:••n:.7. x•U:•7:•}h• +r;:~L }h n}., •}?{,M1. h. .,.,,{:;. .....:!+,••:::::.,••..:......J.v::•r.,•:•::••,•. ....: ...,:•:•::r......i•::.::.•:::•.:• +..... :.;.,.•:J:!�:••..}.n r.}:£.Y::•... QII>±���?:.'•:<:gt ;•;'a,.,: {r.i;•{ .{?., ::},;.y ..7.. 3'r.•.. •.,•.`4�..g:ax•r }}:..i.?.{.}}•:}}••::•r.#}..:::?::•:<?•+•r{:Y.-::.!... .;.r.;�;a ..rn.4.. ,,..:..,•:..{?,.:;.,r.,:}::.y:•$:::,5,;.4.,..,t}:r:..}r... . .?..::.yr:fi:.i..,. . .. ,r...:rn:+rn,.:.tfi:..,.,?..tC...y...... :•:-;-• •}:t:�::'f,?�S`.`^'4L�:7?2:� ..... .. .... ..i';+;t,::.r...,.,:•,:}•:�${:4t,.•}.r..•..: { .. }:. .: g'?'?9.•';r�.:".^;R;{i:+::: 'il`?k`:::+:':.S.r`rw::�`:t-`'•"'awf•';•:''• ' ...... .. ...... :•.y•:•..........,,..;....•rn....... ,}::::.:.r:r...., }. .}::•..r .....:;.}k......, .}}.:•::rY? ...y..:•..7h+,:}.,t�:-{7::2£�:}•S}:•: '. .,..Ic.{}#}4C.}:h�.n.r'{ .k•Y.•:\ ,••::,:•..,...,.::....:r}::..:..,ns•;, y:.r...... #•:.+'•:.+ .{.$,:::+v.}. ..:k.,•k.::,t...:•:}�!r,{: ,:.; }•:::�:.,,•.:.y:,..::a,•..:::r.y::x:,:rr.:.::. ....... .......,.,•:•.?:;......r.:::.::•,:f .n.:::. .,f..n•,.. .r...... ... 4 :{.....,+..).. a, Q.r a:u:'#£''t?i .:2;:n;..fi}},• :.yi..;}.;+5. ..rgha.. r:.}.. ;:r4•• 4n .,}.�::••c?. •Y{Jh �•:o a::4•..:::••::+•::rr.Y?•}::•,. xr.aT? .rh,•. •:?x}}:. .}..,h.}.a}... :a:,:•y\ }:#k~t4 ya.• ;$,.hn, x.{.;•T:.}:{;•}`:.,}$::...a. ?:•}.:?•}7:?•}}:ar... :y;{;:.} :+r%•.:v.£'�c•?•.r. , a•.. :.n:•:•:•.? ..+a.\..pp ..{..:.JW:•}•:J:•}:.:. ':•:!rf•.•r::n::+':•r:•/.•;:fr::•::+f(!S::n:>Y•'Y':?{rvv.. n.}nv}Y.?S:{}:+... ..4}.:. �•?$}r.?•.,ri {..}...,{.nn;.; ..}}. ..l.v,}�n,Y .4.n:. r •.....n...x.. ..r..f...v.}r..?..n.f.: ...r.:...,+,M::v:r•:.}•t:•:.:.•,'•..... .x\• .:n:•:.vnv:+•..n.Y.S'}+�S::h.a4.. ::?ka. .+,•.?�::: ..? .{ •+h::v.: ..f:: ...}.. ..v{'.{v..: ,.r}.n,r. ..a}... .']...v..:n., 2t;:Sr}'.}n h+>,. W.a:;.a.:..+ 4:,5:•.v ..'?a 2.4,•4•.v:•.+}•W:v. . .;....,xx::.{$ r•v.v:rw.. •. rh: :..::+.•.+, ...n,r.x.vfii::+2}Y{?{,. .... ••, ..t x.a4,.. ?:..�,. .;h}::•r••x{t:•:•...ra:})�•h4:•:.?... :.:;z:?••?„ 9.•G+.b •Y:£C''•r'??�;#?•r':hy?:;a}}:;:�:xi..�..,ti ,:i•:?v:m .w•$"':rn^4:::r:•.a: h..}:r}:•::•h•x.r.:..•.,.?J+};ti••::.nv:•:.::.:;•,}.WY}h }}rx. .....:}:::.R. n...........v..C:r.,.. ..r.... f.....:.....hn.{.ni.....::}:.}.r..n......{.:::}!};v::.$•nr•:•:{'n{::,frrr:::•n,{; }}.w?:v::. !• r :�•}:L2•:vi:'•.•::.{•.4:... .a{..y,h•::•:.:v•.s?:.,.•:J}:<te:i+:;,•7{}�;},,}.}$:?n,:,}..,..?y.,;:r;- ,+r•?`:.:y:r,:4:n}}}?{}r}.}}:n;.{:a:.,,n}n.vyx4{;•n-::.{:• tf11'C{£: ❑ I am a sole proprietor,general contractor, or homeowner(circle one) and have hired the contractors listed below who have following workers' co ensation olives: ti:;•}::: ; tJ: :;%>?.$,:•.. 'ak.;';{. :} a:.:xNc fi4::y, 2 ?�. . :; h:s.:.: the f g ...�...... .n•.�.. ..... .... .......•:::vv:...r.:;y,:,r.,::}}:ia}yx•}::.:•},+v,:.....: ........ •:•.. r}.}:x: +:?. ivh;h}:.r:;?k:•?.>:::7.n•:K:5::}•aY•.]+:•:i�v.�}r'•?^r qS h{}{.,,••.�}ki:i:??2 ,rn}rn.}ay.+: ...};:.;;}:;,v:.:.;... :•.iv}..••+:•:nh•:v}.•}:Oh•;+,,..+nP,r.. ..:5,•{vrn•::.}.....5., .r;:'{?n•;24.., ••, •nvx.•x:::;•.,•:'::4::•}}:S:;+Sti{{nyM.h:.r.....n..:?+•+:�... :.,..n.....,n.xa:}{'S••;:J}:x••{:??{•3�a.+S:v?:.$r.... .3..4. .,+. •y,,{r? +':•.1.x........ ..,•:x?:v........,..F .v:v}:••.•... ...rnx.r••.......... .v .•.n......K+..... :. .n..4..v....:a}:..}:}::v:Yh•{{}....yxyy .}}.:•n •,•{.Y:.?:.LSv}a4.;^Y�?,i::?`^}<;{:::}`.:+t:�.., .}Y+'`{}'•?},++Jtiik :,,f,.y +•J:;, ..3. ,,..Y,. {?r:?•�.,. }.•::• ::W•::{•$h4•..{ ..,;:`?n3i•.v.R•T+t2•: `'•.,�{}: .hL }•.�,�?:t'+'i`?4 .L .;?ia{Y}+} :•3{}} ::4;};4; ;f:.. Y;;•}}}:}S:.r•::}}J{w:..:i::,}2}.},.t n•.}+} r # .^•.?}A v.•;n.....::.},'• .;•}:}+.{:..:.::!?ii$3$'i?}•i}:•r:•$:$:•. :n• .:;.}:... ...: :,h: }.%.. fr{ Y::.:.!: W:. .{•. .r.....: .+'•25:...�.....n ,`?£$.: �:5•?1+.:r,: .,2}• n}f,•a+. {••,s•?•++:£•.;: .. Y h.L.••42.. :•+•<•k:Sxa%•.. :..n., r 4 yn. :.a.... :w}.J?:n ::t a x• ...... :yt.:}£C?4 ft:. •f$ a+:+:.r;} 4.a £{.r.,•:h}.., '?a:.• r:•:+{.yY:.•:•: ....:.... .f•.:x^:?;'•}�?;:};.;;.::,:,..?•.�{•}:•}:;•+.. :,...:h::.,.:,, , •:::.. ..}r....r....:• ..tS....a:+, ..r...•.:•.,h,;.,:.:......h.y+yva t•:•4....r.�.{'•E'•4{ir......y...%..+•:••:.rat.,..:::::,o..,.:.};•.•'�;:. n:4i.• ;�L:�#;a{•n• ri�:.;••}S�Ca$ 4.::} ... :.,.....::.+.-n rr.....r.}:.. .....,?•r:. y.... ..r.:..:...,.,a.....k.:..: ax.55:�3'•h.E•4�f„?x,^.,•':.r::;`�i<.}$:•,•:{.3•`.£t.. .:.:..:,h.rr'....a+..;....a... ......:::%ix:':.. .v..::$n:.•vn4...n.a•rfrnnv,a } .. .rj...J.•: +•4..,:v r.v x:.:.,.. .. vn •:}•,+.a..x:..• :.,•n•h++:r.. :.i::..::i;4}::;::x::r.O...........v'•::a}:•:.....}. :... .. .. ..:..v w. +if,.{•: v;}};?{v}};^Y_.tii .. .: e. .vn:!.n.•b,....... ... .. ....:... .........:...vi•r'•`::w:...;;.•.. +Y::':;•:}{?!{:$4.;}}C'}:?;}7}ytiti::•�$'i?:!isti{::$•}}Yi'J`.isk}:'{{'3:•{.`rS{.{hR''.'`•.}Q•}},. ,fti121 .ttII .II'82n .., :........:...:........... .,...;.,}••:4}:•.•{•:r:.r.,,:.;,..,yy.+... .;.;{..;;r,:,, .+}, r,^.{,• .....:............. ...,...:,... ......:•:.., .. ...:•::n•. •:�: r ...Y...:'.'..}.}.:.. .•:••.,+.v '�}�:•:. L.$3••{•' a;;{$S.W,: `•:;{s"SKO�afii'+a`w^.a ;�v',•:}:•; .......... .....:•::.:..::....... r..,,• r.yyn+r., y. ,•.;...::+.,.. ...a.Y yiC,<.%,,n....:4.t.,a?•'+rr,:+. �! .+.:.., kn:ti::. !•'.#�.:�:,,...•.: •s`'5+:,•.:. :fit.. :`::';i}:.}aw ?. ,a,.T:f,,.: ....5:.{.:{.n ..{;..:::.:•r..,••::.,,.fix.fT:b}:,??•?n..n:?:n;{:.£$:,, f •••?:�.,. ,,.,).t.c?. .r??}:t::5,'f.• .,�{•;�2•r:.;fr..;,�•;:.::s'aT•?:a{•:c,{tih..ya- ti}:•:}.�g;•: :':s$rrxnY:%.+•:n^.aa);<. .Y,r+,r.;.%4• .,h..n:.}.}:Y,.}?:•.w ,.e;2�}}•: ..{,y.:t;Yry. y �C;..n ...hd•.r C��2 .,:}:•. yrhr.. .Ji.;h.. ..{r:4,...2^••'"s!+i$'i:J'.•:<:i :.£:Y`.{$:F... .5...+C,•:..,f.. ..a...::;:,.. ...•$::}::}::.v::+:.?a.,}•.a:.,:.;-•{:ay:.;.;{,,{{ .;,f,: :nit•..a.:v.. }Wr{•:}. ri}a.rS. ak•.4rS S:.$.. ,.f.:•. •:{?:}'•x•+. r:.i•::w, nnfn•n:4!•.{{•t}:•:;tiy}C#::?:'!•Y:•..r +}.•h}}•. }:.y, .k ::•::f r,Y•':$:£J^^.•}.. .:. ::r,•.:•ra .,•YifT�r.•tn+J.a••:.,•.....•....$ •.:•n,�:nYt+.?•::+•.}:x.}:•,n,.. .. .. ,.k:•. 3 .:,J 'YY{:+v: k�4:}n•:.•:ay+,? :h.;;.,Y�,'i: �3:•• ;. .w .,a.-y. ..; ..}:.: ..:i•. ..?;rrt.•;:;$cGr.:}:•:.:•:.{. .•�:n.yn .?.+%ti}.::a.-•.•t.; •,x• }$<;ya.y.;,::t''3•+•$i•:•4•. t"-;' rrN r+ .,,, .. n1}i+r`bnr�si�}{Sa•{�::+;}..�R.:::h x•,'J� :.:.rr: r.. ,...::}M.•.4. ':AC:J }.,.,y :yi•4.£µ ;!,9 v}``.a•+.;..J ,4.arL,.r .:'\a..i<i.. ., .....,•%'y;J'i/+c$r, ... .^:-:•aa}r:'Sn�?:�.^.?,•vh,?.a�Y ...r:G•x, .'tt„•:.}?{i:y :S. fv':?ta{.y ;?Y;.,, -:SWf,;•}5.,•.l;}}'?2?•.:,.1.•:<?}Y'n'ii:S:;. r-.Fr ;a,,?.:.r.,t.a•.a.. .�y,. :,:........,..y,» .tY'in: .... , ;y.t•{a,•::a:::�:'}:r, .:... ^+'Jt •# •irf` .R<it.V.@n:$:'vyx:;:•.::••:.��.'•.,:r{•'.....:ir:n..t.}•:7}:i{;....4+`�•.::»..,vaaW.:.:. ..: fiT::..:... ..;;f,,>?'ivt:t.,+,r".,x.?$l.N�::.r.:.rx....••.ft>tY`'+.•..5�. ::,..'w: ..,a•. •.xr: ;,0,}}h:riC{' -$.+�.`.??::i „+:'Y++'•?y.; �IIt�'.es� '::.?.:;++?t;.{. ..<.�;.5•<,?.aa,,�((a.? ��{{���, £,?,,;?:tat; { .:?''t':' p4� v• $4•,q .......... ....,•:::::. •::.. �.::::{;.x{;,:;.,:.}:!•.4}yf..:.'{}..}:• :; :.,•.n:•;'3`+{.;..yy., .+t. . yr+ rnFi.4:,..^.C?: :r,3,..£T�y�ay.y'?Y.'f•9:'?::j•n.x..n}+.+�•,y a,:irS{.:4.§.v{}a..r rr.'C.x4..:.k^.;..••J?.\!,.:.,}...:{l.:..r.;.iaC.yF.a.{..:4,-:..{.44,L+.f:}•.:i::,.r•••,:..l:,'•..rr{::.,:.r••.rh•..,•T?.,xr:...'p.:;�:x.?::3..:•:L:.?;.??...y{':,.:.:..•.tJr y...�.:v.t.::�+.w;w.r�{}:::'.4.%`x;:.:".::...•:?:,.?:..{.,r•.,r{.r..n::,.S{v:;a•�.a:n.:.:y ai.•:..•;:.::.:?•,•x•^.;n:yx..:..i:.•k$.,.:..ti::?v.•,}..::,..vv....:y.}:1 i,:R:.?<+,:n}:n:�{.y.i:,.;;.:.,.+.3;.•u..-,;t ha..t'r':•..••i..:,..:^3r.ri..7.th.'}..•:..lY..:i;?..a'..:':.7;�:.+rr•;..:.4.:...,{.°•.,l.�.•...:,.J,:t.7:.r.:.{'.t••xS:..?,.•..:`.:..rt t'n 4,:.`+::..fJ•d{1.`.:`}:..°.....i:..:.}.,/'.::•,.+.nr.;.:.,;�.•?..•Q+?r5.y;y:3.'.a,..C,.?,.wf:4•.$.:}hr^;.S.;.,.n••.•//t.?:}.x.+,a4v:�<.,:a:.}:,.�n�}..+•Kti,r`W•".},4•.:rY',:+:..:S�r::a.{+i.r.:+r,.r}r'.•:.::...f:£{v..;:}...r.?.k.},v,::vv r:}..,+:h}+(.}.4:•}.{,;::,�.ix:•:•4,}..1:t?.{..a,?,.y 4,.,:y�c;r+:;?.•'.:;'..Y{w•.y•nry4:{:,,r.!:••r{.7•?v...};r•x'?;••••:::..::,.•�V:�+y'.::;::�':.i.•.^:{.?r.t.:4.4•.<S�...v:.'fr},,r.n'\r'.}r:+S..•it•.Y'$h;:t,?r;..4}f,..�:S•.y..%:•..i?r{..Yy...!,;••.;.:t:...?•?.n,,.!'.:,:;.�{;{::{?,•/.:'n:?..fk,•'•::..'4:.,<:}.•.�•'a�h;...?:,.`:-r...�.'`•a.;•v r:Y:.7,:a.,a}y;..,ri•.,.?;..'r.:•h.+y-.'}?:r.+}:,}•.S rr?}.}n t}r.R.}�•,.•}.,.�t•r•y,:,:x•�.i,.,,:,a'}.io•.:T.•::+::}.`Sx.,{:•y.,k`•r:•?.n.?:rrr9,;v.:n:•::•n':4 jY:•.:Zi•:t-v:,Yi-3.;.:n:};::h�.{.n.•5}•,v'.+a.:i.;.,?:(',,.•':i...�.a{,...?.,„.{'^,.t,.t h�J{ai4.:+.•r+Jx,,?;•4.{},^a:':;•�.••..{,4:}"r.;r.r'�,�•i..n$?�h:.i;�•...:7•i.?.n}a.,..ik t:.?•..,A�;�.+.x'$r.`4,..}-?i:?;.r:{f.n:.,a..}hf<�.{..::+.}.;.'..t;..F4'ray.£.+.,��r.{,,�w'.}6,:•``r•..:.;'r:i,r:•tf.}..:,'.ati aa}..•?.',ati,?{:::',R>•.�:yv n;I,.,.C,�r:� :•:•2 J.'^•�R:++t}.r.`.it•S•},:.x;�.,}•}C%...4{.i,Sr:,{•}.:,.ri rr;£.+.aHy.x.`.,'.+frL••i.?:::..•$•.S y::.{a.:.�;•..r}d:Tn.:.:x;r}{.i.:4.:'+.?•y•i+?:?,.•=:ti!$:Y3i.•...}'t...::r.;`a:.r..?i.:..aS;}.:.�b.;.:ru�?th..\,.#,i,:,+"f.R.4,�.?r;•}.,r},.'':.,�i{x:i,.•::.}2`..•.:;.}.,Y.:{vy:y,.?n.v:•{Jt�?}ry,n..J;a+.,.::r•.:}?;•n.»,{?.•}:;}S::,�}Y 4,4„..$•..;•.t Srti1n..�;}yVa;�5•4 xC...o-{y�r•'i�•`r}C,.�.11 r::a•�;.:}II}..,a��..rx'.,:}a:w..i•:,t;.Y�L.±xF t?}y".;?..•�ar?:'n;.�+,:�;H::..a:,]•'\.^.:n•n.fi;rv}tn4•na�:,..•`Fra.,?.4:£�. ;�s.t,,v.�.{•?•?2.,,:G.:,'tL\,,+:�J."a;.3 t}r,v•,Yk.;'Yrr.M}vniA2{iY�•,s•:.'/:StL,i.'C..?.`}�,•%r.:n•+4'yr.i2k'{4.•.�,',n�'':•,,r`•','�•..r.}f 4•.i:$rTrv:l.+}.CJ�,•::x.nr?`r,?Jv..4�:.<x`'}.�::,'?;;;}$a.??•.�?:•}riC;•Y.{.}.� ra•,{tf;`•s;s'�r''•'{$,'a+?r'Cra;'7?'};!'••'::£Y.v:?�,';{.:%}4,3::::.q:+r.6}::l.::Yr,{:}•<�a:.:'�,:r$"..t.a:.t`2'r4..av+.;:•,s.?$h7"•`'$:.'J°4Wi.•Y�;:.}.r;Tt:.}•:}h%#:rS•�•w?x n+.`;.[t:�?i:r.�h:oa;?4-n:4'}ai.r 3'+•,w+.?}$'s•."•�r.^',r.}:.;{x.?�'?"?.•.2'�!;k:E.?}Y:f,}}t;••?}::•v'.+�t.M..}a�;:}:h::.:?,44.3::3�.}'}::.J:r!2#•'.••: ,;'•3:--.4?x`k�•::•}4••.4a4�:r4.�•�'t�.C,�:4. f �2'!,T•,;..3+b.+c.ty.};-fix3;Sr�>hY'.'?�}`,(.,.}•}f.•. y�,<•":<.,,,.�.\.h;�,�h%:,+�.a.?'•{f2,t':#�3 ,W;+;•..+: ?xwwn•`}h.ti?.}••:r;nS.;r:•.,4 v••::k�.)r n�4',w.~,•x.•.�G F:. ?•q.2{Y"Y •":.a+ ............. •a•:,. :,;;',?.;•n{4n;4.r4t :•,'�;:v•Y.f.,}`v;.}?•,{'ti.;^ :.}•`}'.'}:.r 2.••:} AY;•{ •:r•�;i'O n}J.., ::i•. y}•}:,t:;•}.?:.. :.;x;.. •xa4"�'K423S3S•yiS}t;:?#•F."??gti„�: 5:.${?'3?i; .a:{+Y{,{}?;v::} •vrrx:•y..::::}:• ••r' ,...:.v{:`:::xS•:{:{a''?j7}:•}i $%}:''•';+$'t}':y.y{{,;.?.: rxv'}t?.S9?C�:•1*,•,;y4a:}i."'r.{?'r,:!:.}+:;Y,•:+v"Z•, {S+}?:.i{.h:•+t$v••?J.aj+F,?Cn't;??}: :\ ham`•:%��'�'r. . .................... .y•:r. •..::•ci<'}{:•{.}•.:: •.•::•::?q:}:r.;+'•:::5:?^:?}.y`,•;$.rY+'�+ n {.n+ '.,•.,::• ,• ay•.v�v:... .................•:........ ....:. .! ..:..t ... .... rr.. .....,,•.x... ..:..a•. a••.�`::: .:a,•,t;.o-;n.,:r,,v::��}.Yr°''2t•.'.J?....,..:•f:.i}.i4rYr:?•:;{{>$•,+:.Wd..a?.•a:��ti n•2••aY ti}:}#'T'•ai y4o+l;?�•:,;�a•{.:a}`.•S:ky2:•::•:}:. :;J r yW`+. .,),�•:.? Y.s.::..,.w,/.,.::. :•+art••:::}•S.ha.}:•$$.�n�+'.� ,•w.2..::,•x•.a:n,.. :.:J?. :r{•.y: .r}:ln;,.4a�:.L:ynn.i .,.o;;,kw'}o-., :: :•f,4::�}} •fi:f;?,n }?;f•'r: fi��C .,;�,•.F...!l. :,+.,•Y....},. ,r...2{,: ..,c?rn n.}t.n ,a., }'}.� .r::., :.5...3:x..,}...;<..:c.... .,J.t ±:Q`•.. Y :..f. .,+;):;a'??Y::v x.::i-:}h}.{:{..... .-$x:.•;:•nr{:tr,},S'}+x\:: .,.{Snw:.,.. ...2•:nx,.. , .r:}. .:a....:vy.;•:::"•}:{.;};?.:n y,.;}}}::;{:$i; ::??;•S};'r+:'n'{•i,, .h.y.y..r.}'fr y,}•.}:• ,.}..:....h •. n.4 •:?nF.•:r ^.}:•• .f'a;4•.:•a, ..3.n•,:} ::{•;} n?Y££:a.•.tr.. }:S}n ..h.: r t F. ..s,•• :f. .a;{�;:;- .,+.. .:}.{x y{tx:,�;:?:0:2; ::. :xrx:.:h't•Yt':2:::::,+:::..4;�f.�i{rrn.. 2vv::;•:..... rv.v+....;:.S{}'•.n....h.}i.4,..rri'•{4•a{ .:{{{Stir$?::ri;...,•{.:$iit�:?•... .:ir•.n•:.:.4.v:tn:•:::•.,).,.,. .fir;...,.{.4.;.:.ar.+?.:.a45$y:ti:..:....,..,••,•::4. ., }:.•. .,+ 4:•:.:.i?} :+.:}}S}'a. .4, .r.......a:.....1..: ....:: ..,:,h,n..:• •:: .,:..¢:,\•:.,? .x.. :•W{°"rf:"`•tr 1:$'{,:...n••.t•+t'....y:rvrxr.•k,'f•�ik:-i'�.;:$Trti..Yh'!JS;.],.}h?�>.�k2£h�^.?S'�v'r :t?'•}�tS.^.,`•,�S$x}?•Y:.y:�i:Cr\}Y.�'+\....3•R ...{,:... •4t�„r�Yii:<..;;.....,::•::•.}+.},+.t`yn`rt, ,....:?.Y{..:+{}:^hr...r• ? ••n,.{....".?J.:a:.>, ,. S.4y.,:.:�•.•n:#,it::•s.�.;•,{..... ! •. :•.v::.!,vr.h...M...,4h:a•...n..:::::....... �• r;.y {,a+.' C}>;CY-{. {r,. e:..........,.....,.... .....y..:::.y•:n•:•:,':•::<aYto:J:r:?{a}••x;,^:'$;;:•}`i•'Y}}u;?�t�i+'';%}v'�£;?.'.'.r{iYy'}''`.•`?':£v:S•'%`�?x:;t}'..: 4 3 y-tx•}:�y�;•`•;a�}:?'; s s h�.IIata }:}}}%:t•%:•a: 4:::y,. ? ' r•:4+'?•}r'{.,...h. :a•:4}:$}r:•h, .C::7{-•n:,:,�•+.`a.•b;},•{,}.{;et6:+C3;`$,:;.n :?,+D•:.ti{• T n ':••.h.4wY:;:2{;Way Jk? • ............... .....::::v:•v.•;+:p'•T'+{�'•:J:S,a:•?'':v:�}:?rti;}:'•Y:L:r..r,..:. hn....nw.n. .r,v:ah'Y •.?n?4.. .}..•...•.. •.Jr}}}}:rr\. n.?.. ..}rr nhh.3:.y., .,}:r. ..$:•S:; ;{a•., :n%t}3.,!:.}..,t:.r.fa:.y t?p:} a:?i?•:•x +:wS+ xr,•}}r?,.S.nti•:}'x•.y-2...Y r:•Ft•`:h:• •+•.W"J.::h�;iS^'•}2�i?$2.$5?•:; •.,•.t•:}}... .+:$.., n`ar•+:•}:,:'t'......: r.•r.•..•}:...xx.v:;.;..-::+ :..i... ;.Y.... ••}::$ir.;}:;Q;;..},. ?r.}:. r.:x.n;..... .i•rvn• .. +.n r::.:. ,.:. r..t.....Y.:$'+.}.... • r..c. .r. 9 .'R. .:a:. r.:sJ:•aa:4!•£•+;}r,.:?c\•:.'•{':'.}:'•$}+i•{}:4.,•.•.. ..t •a%}:•+,>;':.::::}::'t<:•`.�•2?:,,.;{. {.:#,. .4.}{•.••y::;.hJ+,r•:••.`h,};i}•. Y{;n. }..,fn; ! ..!,.:}?44?S,$ 4:{} .n.?{•,v:f:n..x.}^.,n+}4,?.}'v$i'`:$r$..:.•a',y::? , ..:v..}+r.»•:4• v•Yn?v n.Y.,•. h.n.r.�{;.}:•':•Y'}k •{•S ,:.}`n a,,r$;�1.i..•rt;:4; r.:x,•} ..x.. :;;:}fir,;. •:.rnv.::; .. r•%:-.+v.., ryr'.y ,..{ :,{•n.n. ,;.;44 TY?Z..'2}�:r4::Sx::Sn•.r.... :.:r:..;....r..t...a4::••i;.;.n{...,.n£.?:•}:.....nr:....}3},{.•:• ..S:2xy:;{.:•:::.+{ :YFa,;.x•}:{t-:.na.•h..... .. .:•�,avc4:43CW:r.r.?,:r::,...Y•.,... ••nnv.�ri;..vn}{}•:.++•;}•::.•}•.;{„Y;n/{ n{•n..•.,,...:•.vn•:,v..}n......r:^"^:::}:x::...:..v..,:;y•;• 2 ,,••n•;}'f.•::w•:. ... Y...,r.:$:::r:x:!•• �in,:£•,::.r.,•:+'?.!:...v:{.;.Sb,{r �:F:4:{,:4,i,+4.vn:•S!.{:nnA:t;w:::n;n;r}}•.;.;...::•n••n•:•.�'..}.,.:.;;:<}:•:$?a• ..;.?.;.{.:�:.t?S`.�.':�:2tar..: k.r::..ah:: n•Y.w •:} 3:::•. •.y.:n{•rr::?.;nry..r:5.:;?•.v.n:..r r:}n:r,..,,..u: n.}.y:v..:•}:4:ia' ,:v..v. ': {•::•....v.,,, xn. : ....:x.. ,,,. x•:+ •:. •.'Y?1�'•� }\"?;};rnv .:}:•.�.+,•$?Y'{yrv:n•rn•:w:i},}}+:4C+$:,•..v.Y .....n. .:?:•:...::n•.: ... .. :. i•7x is{: {^: n{y ,:+%•'. .;;C:a}:r:.:,r,:S++' .,r.�: :'S,.w?:;2.i'?''••;<k•;rv'ah}✓rl�R;i'+'a{ r:;;:$; �illrC3 S. :J»:ua:'+•++•ai}}}}.:•x•:•}... .{r}r.; £:S$}+;';.}: 1?•:: S4'ri C 4;c}f y{..a:...#,,:t w.<at '?}' .. y.}•{r :iva ..}..,, ..J.. n+y.:. .a•::•f•:• •r..tr... :�}{. :.}r ,yh ..n........• .......... .....n.r. +:.... ...}.nn..,•}:....}.... n.......r..r ..........:......... ::..t:Y...:x. ..... ... {.n •'3$i ti::t/... ;r,4r•:+Y'+Q??f,`+{"`•$4': :.$},. .:}. :•t::tn. ,}r ..3... .:.<. :,.Y ..i.. h:••. :,'J,. ::•. ..k. ...J' c%'y# `•i,...r::r:n•• ..}::,,• ,..nnfyn:,•y....•}:::%•::.::,,:.?! }:::r ....:.,,..:n,a,. .}:•., •:,::, y{::.;••}ran J:.},}:••9J:•:•.,::''•%; ,vi......a....Sf. ..v.....x ......r..�.. ............ .r.::+•..nv....n. ',.n ..n...h S..a....v.vt{a:•}rr.:..n..w:....n,:r•..v.T.4::: ,.......n...:...:...:r.h.., nrn.....r....•...... .. , ...',. ...,.......:.... ...,..:.............T..r...... ...: ..fi.::::: •:!;F n•t:•i43w{y::} :.�.:SS£S;{;<�ii,..;a1}.;,�.:••;�4 ,ryK•<..,.;^n3:;; r::{+•}:till$+;•!�i{.r..}$:JY?h}ii: .},i::iY;•n•.a:v?v ... ;.;,}.,+ Y$:{ :: .•h•..''• .h+:•}}i:'hr �..2+..r }r'... .. ../ ..r. .. }... ....v:•:v:•::.}}}7ha .:..vp:';:v..n•::;. ....?•v$:••r.;}�.v:•W}Y.SJ:;+{{ ^.:S}xtirx.. :i'?,ri•}v ,:,J.. •�}.... ..r.r:•:?+:£..?:! ....:;y.: ....r:..,...r.:•r,...::..n..:n•:};:......::::•:•:•+:•::::..}',. 7. ...:Y:••:..a.rt,tir.:•::. r�,,/xx/�� !•:5:�:,•'; :•L�•'.^-:•:.. •,�'c•`;' nw:£} •r:'•r:::Y ,..a..n?':.v:?:• i�r�£?Jy:•::::+:.a....y; n..v....•?•v:v:•r;:.;}..:.v.....:.{.rv+;i x!.v r.r:: �IIII�ilri;?a;.vtit$�$:::.. �..f xlv...... v:....}:?? v;}.{.. r..rnn...t•:.:::•Y:•:J'?•:A•:}:::.vr:::x}:::::v;.w:•:vW.;4;:...4?.<.L,...v:•:4:y.an:•?.....? ...r..,...n....r...:..:...$$,,+7.r.?................. ry v:•„v:J}Y•}..•r...y.• ,..r,"• .W{r,+C 'M^ +r:-.`v'`7,-.ti•. :.:.......... .......... v.• •:•... '..'r n. r:v;.. ,,•'Wi:.•{•Y'•hv\�,. iAJ.'h}:'q'L (.1 h :.'Y:F':,:'a:?4:C{}:i�C:r.•.Yv?v:i�.•::T{::}i:}::v'. a. !�..:$ �•.S+v:.v. Liu }r� :n'}, ,;44{�$•{£4•;Y�4:?C..•.:. ' .. .. .........vw:..:::vnwr:SY:?a'O:•r::•:r:::nr: , .... ny:.i}:.,}.; }}:w:::•r• :%{{:•.: .............. ... ., .,.,...,:....,. ....... ..,..n.....:r,.tfn:.•t$$3.2�<.:.,t ::r:n.•r�... ...t,+:+•..n :.,;�: n;}{•;. .{,:?' :.\.h?nT. }.{;., u+4•.. .rF. :.'i L, .;:.rxf., •.4:{ h, :7'$7tt<fi}$? ::?:i.v. .}•{} $pv ;¢`+}` . .....w;::.::.vv•..v•::.a:.vn :.J^ }.tt:: ...v::;:i•v:.4+.vn•.•.....v.:vn4.•:•: +.v,:v:An.•r• ,Sv•. '::£? SY:?f..i. .?,:?• t$n :'],t$;• + .•�.}?,..}..f,....t..r.}..y.......ra. .t}}r;{i}.:n•,r.. .::Jr:y;e{..:: $?{:t�:.. .�.. :yt{.} ..{.�:r.,}r:n. `.Y:�:�?a .•:1.•:�:s}Y:y e! ..:.. ..:. :......:..,.:�.. r,....... :a!x;:.a::.y::t?::•:::•:•• :•:.•:}::••;•.•. :•n,:.••%:�}:•r.,+:.:.n:.y...�n.{.:.,.,:.} .:.:Y.::....r..,,.;?:........:......n:x:,•n•.:. ro.r:::r•:n....:...•.:..:t}:}}y•a:{•;h;n}.;y:.%.;a.:....v:.ynnn••.:.,.....r.. .,•.. .'�:.;}.... :� ...•,y.;:.?;t,n:• {.}a�^^•.:,. •n,,,�•;}S:.a,.,•:' ..... .,,vn., ........:•:?•:n,•.•.4....r:.}n}hn r .:•r:r•:x+.,..: .;.:••Y.v::•...:... ..: ...:,yr. .:•.;?•::....n.Y..:T K:.:. . ..r ......1., ....::. ...,r...... r; ..n +....4,..:....n. ..,..:r..rt, ..U.v4r.4.. ... ..... •.•t2•. <.?•,• +.ya;? ?:•k$•:t;3S;>Lt•4y $:??'^' S}>r!.-::,•. ?..•ri$3. .::...r.,,•4•a.4.. ..t..h:,�.., •t .{.:,.:..t.:.r.:.i.n.......a......:..n. :n.% .., ...:... -n�i.. ....: � :•2•...}o.G:?•y ;:?%:•.,.<4J .:snYx�n4.a•.SS3...:Yr 2 },n.$..:..f•+na• •::•.J.::n,y;{!.:,..•:r:yx.,, i?{�.., .v::::•n::n4 F:y.•?•n v}.vv?.{4:`•%{•:}a:H.•hn+. a..Y-.irn;. :....,1� k;..n h{•v.:.a.. •}};;, {.j.YrY?fi,••..{•::,!du„aan:4.::::.r...,:n{.. .25. a¢9{:4p,};�5:$:Si:+;a;•:3:::2:n:n:r::.}::4::rn?:,:..ik.. ,� r.?:y.,4}?;.Y.a.nn4?hY II�� :/fa:,•;Jr:x.YSi�,:nY:^}�'• ?:e .?.....:SS•.'•y{}..... ;t......x....n.:..,..•'•;y:;;::•Yi{•,..y.};kyS:r.,ay}•;aa;:•}r.G•... r< ,,{{ f,,,, r r. v:,/•.+}.''�.•;{:}:\;.::: :.:4Y.2•x4:::.4:v,vf.•w:ni•x:n:?vn•.;?S}+J}.'.Y v�}}{;... Funare to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to 514500.00 sndlor one years'imprisonment as weR as civfi penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me: I miderstmfl that a copy of this statement may be forwarded to the OMce of Investigations of the DU for coverage verification. 1 do hereby certify under the pains andpenalties of perjury that the information provided above is irtu and correct signature m �y A0�� Ph=# Print name_ ofuciA use only do not write in this area to be completed by city or town offieW city or town: perudt/license# ❑Buflding Department ❑Licensing Board once is required ❑selectmen's Office ❑checkif immediate resp q. ❑Health Department contactperson: phone#; Ucyl ed 9195 PJla I t� Town of Barnstable oF r� Regulatory Services BAMSTABLE, : Thomas F.Geiler,Director 9 ass. 1639. Building Division ♦0 �ArFD MA't A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOBLOCATION: 17LA SC#UlfLS- number street village «HOMEOWNER":p t9 R-' F, O t D name f home phone# ! work phone# CURRENT MAILING ADDRESS: 0 5- r7)/9 z) city/town 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 inspection procedures and requirements and that he/she will comply with said procedures and requirements, Signatur .of Homeowner a 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. . HOMEOWNER'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. Q:forms:homeexempt ~� SCt/oo4- S T r S m CE ,.,rr� 5T , �., g �j_ PZ TRr- AD 3 �/ S r iZ r N �;E2 +L)4Vc Ll iZ�.ytii,�,v � , �vi-LL %1Q:v/ 7-9 2,(X/Z lT ou - 1.� ST9'I S Barnstable Assessing Search Results Page 1 of 2 14 K fr et t r Home: Departments:Assessors Division: Property Assessment Search Results 42 SCHOOL STTREET Owner: KOMAR, MARY E Property Sketch Legend Map/Parcel/Parcel Extension 327 /236/ ' " , 0 1 Mailing Address _ �e 8— r KOMAR, MARY Eop'�'W+ ` r < 23 LENOX PL _ MT KISCO, NY. 10549Al _ 2004 Assessed Values: Appraised Value Assessed Value Building Value: $78,900 $78,900 Extra Features: $0 $0 Outbuildings: $2,000 $2,000 Land Value: $ 139,100 $ 139,100 Interactive Property Map: ap requires Plug in: it C or Totals:$220,000 $220,000 1 have visited the maps before E Show Me The Map ; r April 2001 photos available Sales History: Owner: Sale Date Book/Page: Sale Price: STILL, DAVID B&LINDA C ;,, 3015/58 $0 KOMAR, HUGH S&MARY E 11/24/2000 13385/ 139 $259,000 BOSWORTH,WARREN C JR 9/28/1999 12568/ 178 $ 165,000 KOMAR, MARY E 11/18/2002 15935/021 $0 k 2004 Tax Information: Tax Rates: (per$1,000 of valuation) Town Tax $ 1,454.20 Town Fire District Rates Other Rates 6.61 Barnstable 2.01 Land Bank 3%of Town Tax Hyannis FD Tax $446.60 C.O.M.M. 1.10 Cotuit . 1.52 Land Bank Tax $43.63 Hyannis 2.03 West Barnstable 1.36 1 J http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeS ervices/Finance/Assessin... 10/3 0/2003 Barnstable Assessing Search Results Page 2 of 2 Total: $ 1,944.43 Due to rounding differences these values may vary Land and Building Information Land Building Lot Size(Acres) 0.3 Year Built 1920 Appraised Value $ 139,100 Living Area 2068 Assessed Value $ 139,100 Replacement Cost$ 157,842 Depreciation 32 Building Value 78,900 Construction Details Style Apartments Interior Floors Pine/Soft Wood Model Commercial Interior Walls Plastered Grade Average Heat Fuel Gas Stories 1 1/2 Stories Heat Type Hot Water Exterior Walls Wood ShingleClapboard AC Type None Roof Structure Gable/Hip Bedrooms 6 Bedrooms Roof Cover Asph/F GIs/Cmp Bathrooms 4 Bathrooms Total Rooms 12 Rooms Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value FGR2 Garage-Avg 288 $ 1,400 $ 1,400 SHED Shed 80 $600 $600 Property Sketch Legend BAS First Floor, Living Area FST Utility Area (Finished Interior) UAT Attic Area(Unfinished) BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area(Finished) UST Utility Area (Unfinished) FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story(Unfinished) FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfinished) FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) T . e http://www.town.barnstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessin... 10/30/2003 f Town of Barnstable .' Regulatory Services ■ r r B" MASS. Thomas F.Geiler,Director v Mass g c 39. Building Division Elbert C Ulshoeffer,Jr. Building Commissioner 367 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 MEMORANDUM DATE: i TO: File REGARDING: COI Multi-Family Use Re: Certificate of Inspection is not required for this property--does not consist of 3 or more units within a single structure. Notes: _r EY.2- I - 14 6 0�� The Town of Barnstable • a�rrsr�t.E, . 1N6¢ Department of Health, Safety and Environmental Services " Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner CERTIFICATE OF INSPECTION CAPACITY INSPECTION MULTI-FAMILY DBA M&P LOCATION OWNER ADDRESS ZONING NO. OF UNITS/FEE GLORIA URENAS APPROVAL DATE INSPECTOR DATE OF INSPECTION J980309A r 1� c-2 oFt Ta,. Town of Barnstable BMMSTABLE. : Regulatory Services v 039. Thomas F.Geiler,Director prF0N1°rA Building Division Ralph Crossen,Building Commissioner 367 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 September 13, 2000 Warren C. Bosworth, Jr. PO Box 685 Centerville, MA 02632 Re: Certificate of Inspection Multi-family Dwelling (5�-year Certificate) 42 SCHOOL STREET, HYANNIS 327 236 Dear Property Owner: Attached you will find an application for a Certificate of Inspection as required by Section 106.5 of the Massachusetts State Building Code, Sixth Edition. Please complete the application and return to this office with the required fee: 3 Units - $81.00 The fee has been esta blished by the State (Table 106) and must be paid before the Certificate of Inspection/Capacity Card may be issued. A copy of said Certificate shall be kept posted as specified in Section 120.5.2 of the State Code. Sincerely, x Ralph M. Crossen Building Commissioner d j000424a Ftt+e tom, The Town of Barnstable # BARNSTnsi E 9q, M a �0� Department of Health, Safety and Environmental Services ArFo,,,ora Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner September 12, 2000 DAVID B & LINDA C STILL PO BOX 323 W HYANNIS PORT, MA 02672 SECOND REQUEST Re: Certificate of Inspection Multi-family Dwelling(5-year Certificate) 42 SCHOOL STREET,HYANNIS 327 236 3 Units - $ 81.00 a Dear Property Owner: We have not received a response to our letter of May 15, 2000 requesting you to return the Certificate of Inspection application with the required fee to this office. The Certificate of Inspection is required by Section 106.5 of the Massachusetts State Building Code, Sixth Edition. The fee must be paid before the Certificate of Inspection can be issued. Your failure to respond indicates that you are not interested in maintaining your multi- family status with this office. Please submit the application and fee immediately or contact Lois Barry of this office(862-4039) to clarify your situation. Sincerely, ' Ralph M. Crossen Building Commissioner I RMC/lbn I j000906a oFIKKE Town of Barnstable snuvsznsLE, Regulatory Services MASS 9 039. Thomas F.� Geiler,Director ArED MA'S s ' Building Division Ralph Crossen,Building Commissioner 367 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 July 26, 2000 Warren Bosworth PO Box 685 Centerville,MA 02632 Re: Certificate of Inspection Multi-family Dwelling (5-year Certificate) 42 SCHOOL STREET, HYANNIS 327 236 Dear Mr. Brackett: Attached you will find an application for a Certificate of Inspection as required by Section 106.5 of the Massachusetts State Building Code, Sixth Edition. Please complete the application and return to this office with the required fee: 3 Units - $81.00 The fee has been established by the State(Table 106) and must be paid before the Certificate of Inspection/Capacity Card may be issued. A copy of said Certificate shall be kept posted as specified in Section 120.5.2 of the State Code. Sincerely, Ralph M. Crossen Building Commissioner j000424a DIME The Town of Barnstable ■UWSTABM 9� " Department of Health, Safety and Environmental Services 039. Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner vv May 15, 2000 DAVID B &ILkA C TILLPO BOX 323/ W HYANIS , 0 672 Re: Certificate of Inspection Multi-family Dwelling (5-year Certificate) 42 SCHOOL STREET, HYANNIS 327 236 Dear Property Owner: Attached you will find an application for a Certificate of Inspection as required by Section 106.5 of the Massachusetts State Building Code, Sixth Edition. Please complete the application and return to this office with the required fee: 3 Units - $ 81.00 The fee has been established by the State(Table 106) and must be paid before the Certificate of Inspection/Capacity Card may be issued.. A copy of said Certificate shall be kept posted as specified in Section 120.5.2 of the State Code. Sincerely, Ralph M. Crossen Building Commissioner RMC/lbn j990428e I' 1' �� �® o, � � , /; � I, ;;� � � / � �� � �I� I /, d=�[�. �� O � , � Commonwealth of Massa zDepartment of Fire Se ^ BOARD OF FIRE PREVENTION R APPLICATI ON FOR PERMIT All work to be performed in accordance with t (PLEASE PRINT IN INK OR TYPE ALL XFORMAT City or Town of: 2NST By this application the undersigned gives notice of his or h Location(Street&Number) Owner or Tenant Owner's Address Is this permit in conjunction with a building permit? Purpose of Building Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical work: No. of Recessed Fixtures No.of Ceil. No. of Lighting Outlets o L ] LR327 236 . ] • LOC] 0042 SCHOOL STR* CTY] 07 TDS] 400 HY KEY] 243383 ----MAILING ADDRESS------- PCA] 1051 PCS] 00 YR] 00 PARENT] 0 STILL, DAVID B & LINDA C MAP] AREA] P015 JV] MTG] 0000 PO BOX 323 SP1] SP21 SP31 UT11 UT21 . 30 SQ FT] 2670 W HYANNIS PORT MA 02672 AYB11920 EYB11975 OBS] CONST] 0000 LAND 23400 IMP 127600 OTHER 1400 ----LEGAL DESCRIPTION---- TRUE MKT 152400 REA CLASSIFIED #LAND 1 23 , 400 ASD LND 23400 ASD IMP 127600 ASD OTH 1400 #BLDG (S) -CARD-1 1 127, 600 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE #OTHER FEATURE 1 1, 400 TAX EXEMPT #PL 42 SCHOOL ST RESIDENT'L 152400 152400 152400 #RR 1434 0076 OPEN SPACE COMMERCIAL INDUSTRIAL EXEMPTIONS SALE] 00/00 PRICE] ORB] 3015/58 AFD] LAST ACTIVITY] 05/22/91 PCR] Y +f RJ27 236 . •P P R A I S A L D A T A• KEY 243383 STILL, DAVID B & LINDA C LAND BLD/FEATURES BUILDINGS NUMBER ZN/FL=PRD 23 , 400 1, 400 127, 600 1 A-COST 152, 400 B-MKT 159, 700 BY 00/ BY /00 C-INCOME PCA=1051 PCS=00 SIZE= 2670 JUST-VAL 152, 400 LEV=400 CONST-C 0 ----COMPARISON TO CONTROL AREA P015 ----------------------------- PROFESSIONAL ZONE PARCEL CONTROL AREA TREND STANDARD 101 30 LAND-TYPE 234001 LAND-MEAN +Oo 1524001 IMPROVED-MEAN +Oo 500 ] FRONT-FT ] 100 DEPTH/ACRES TABLE 02 10001 LOCATION-ADJ APPLY-VAL-STAT 1 LNR] LAND LFT/IMP]ADJS/SB/FEAT STR] STRUCTURE ARR]AREA-MEASUREMENTS NOR] NOTES COM] MARKET INC] INCOME PMR] PERMITS GRR] GRAPHIC FUNCTION- [ ] STRUCTURE-CARD NO- [000] DATA- [ ] XMT [?] v J R327 236 . P E R M I T [PMT] ACTO[R] CARD [000] KEY 243383 000000001 PERMIT-NO MO YR TYPE VALUE CK-BY MO YR %CMP NEW/DEMO COMMENT RESIDENTIAL PROPERTY MAY NO. 's LOT NO. FIRE DISTRICT 1' �"�' SUMMARY STREET SchoolSt, (42-44) Hyannis 73 LAND / O o0 OWNER H � Blocs. TOTAL 3 9 0 0 RECORD OF TRANSFER DATE BK PG I.R.S. REMARKS: 7 LAND Z 2404040 0 BLDGS. 2-1 !F p 0 __ TOTAL 3 940 trs.- �.... -- - LAND I} BLDGS. _ O) o/ TOTAL Vwtt- LAND vAZ'8' 44- de a ua a; r z .. .;a a e��a v at O1 BLDGS. Still, David B. & Linda C.. 1-15-79 015 58 ( 40 ,0 0 TOTAL LAND f. ,+ .�.J W ,4 VA�I / O1 BLDGS. n -.._ d.A 6/�j^ TOTAL LAND Z Q p BLDGS. TOTAL LAND BLDGS. TOTAL LAND INTERIOR INSPECTED: BLDGS. r _ TOTAL DATE: oZ 3 7.? � �CyL/N. . !�!r �-�_ LAND ACPEEAGE COMPUTATIONS BLDGS. LAND TYPE # OF ACRES PRICE TOTAL DEPR. VALUE TOTAL HOUSE LOT LAND CLEARED FRONT D O D O D o U 2 Z a p O BLDGS. REAR TOTAL WOODS 8 SPROUT FRONT LAND REAR BLDGS. WASTE FRONT TOTAL REAR LAND BLDGS. TOTAL LAND ' 30 �� I %.j BLDGS. LOT COMPUTATIONS LAND FACTORS TOTAL FRONT DEPTH STREET PRICE DEPTH% FRONT FT.PRICE TOTAL DEPR. COR. INF. VALUE HILLY TOWN SEWER LAND ROUGH TOWN WATER BLDGS. HIGH GRAVEL RD. TOTAL LOW DIRT RD. LAND SWAMPY NO RD. BLDGS. TOTAL �-r-,.n��.l i^.'- n ••...ir-•r.�� F MAC,G rr.r�rr. ........ rn FACT HARTFORD,CONN. y- sm. ROC. K00111 St. 311ower a Bsmt. _ 5,30 PORCH. DATE Walls Bsmt.Garage St. Shower Ext. / -- PORCH. PRICE Brick Walls Attic FI. &Stairs Toilet Room Roof RENT Stone Walls Fin.Attic Two Fixt.Bath Floors Piers INTERIOR FINISH lavatory Extra Bsmt. F 1' 2 3 Sink Attie Plaster Water Cie. Extra EXTERIOR WALLS Knotty Pine Water Only �p Y Double Siding I Plywood No Plumbing Bsmt.Fin. Single Siding' Plasterboard Int. Fin. y /S f( (od J _ii i/ ,:, Shingles TILING e!}'lt,.tl� /7.1,d .S •2 �7 Conc. Blk. G F P Bath FI, Heat 3(0O c face Brk.On Int.Layout Bath Fl.&Wains. Auto Ht.Unit Fireplace Veneer Int.Cond. Bath FI. &Walls, 1' / _ ! Com. Brk.On HEATING Toilet Rm,FI. Plumbing .2 t! O Solid Com. Brk. Not Air Toilet Rm.FI.&Wains. ---- -- Tiling Steam Toilet Rm.FI.&Walls Blanket' Hot Water St. Shower .of I7V Air Cond. Tub Area Total , Floor Furn. ROOFING COMPUTATIONS Asph. Shingle _ Pipeless Fur'e. �� S.F. U , Wood Shingle No Heat �� S.F. S U Asbs. Shingle Oil Burner(' V 3 S.F. S O 7 y Slate Coal Stoker S.F. / qo U Tile Gas S.F. OUTBUILDINGS ROO TYPE Electric Gable Flat S.F 1 2 3 4 5 16 718 9 10 1 2 3 4 5 8 7 8 9 10 M Hip Mansard FIREPLACES S.F. Pier Found. Floor C U Gambrel Fireplace Stack / Wall Found. 0. H.Door LISTD FLOORS Fireplace Sgle.Sdg. Roll Roofing Conc. LIGHTING Dble.Sdg. Shingle Roof Earth No Elect. DATE Pine Shingle Walls Plumbing Hardwood ROOMS ---T Cement Bik. Electric 3 7 Asph.Tile Bsmt. 1st TOTAL cf 0 Brick Int. Finish PRICE Single 2nd 3-} 3rd FACTOR /U•� REPLACEMENT OCCUPANCY CONSTRUCTION SIZE AREA CLASS AGE REMOD. COND. REPL. VAL. Phy.Dep. - PHYS. VALUE Funct.Dep. ACTUAL VAL. -,-"k s. S — o.�H _�:r- _ o2 .1-177 'f oZ 3O s� oGoo 2 3 4 5 6 7 8 9 10 TOTAL ,2� yad IROPERTY ADDRESS ZONING I DISTRICT CODE SP-DISTS.I DATE PRINTED I PARCEL IQENTIFICATION NUMBER CSTATE LASS I PCS I NBHD KEY NO. LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS T L a�tl ey/Dale Size D ryenswn LOC./YR.SPEC.CLASS ADJ. COND. YPE RICE ADPRIC ED. NIT ACRES/UNITS VALUE Description S TILL P D A V I D 6 8 L I N O A C M A P— CD. FF.Oe I /Acres #LAN D 1 23,400 � CARDS IN ACCOUNT — L 10 "1SLDG,SIT 1 x .30 =10 217 50 71999_9 78119.9 .30 23403 #BLDG(S)—CARD-1 1 127,600 01 OF 01 A #OTHER FEATURE 1 1,400 COST 152400 N HS 3.0 U x I C= 100 10500.0 10500. 11.00 105UO B #PL 42 SCHOOL ST MARKET 159700 D DETGAR S 18 .x 16 � 192 C= 26 A 1 19.3 5.01 288 1400 F #RR 1434 0076 INCOME D USE D D APPRAISED VALUE J A 152o400 PARCEL SUMMARY A S � I AND 23400 4 T I BLDGS 127600 0—IMPS 1400 F EI TOTAL 152400 �1 I N CNST .4 T I I DEED REFERENCE Type DATE Iq RecortleG PRIOR YEAR VALUE .7 Page Mo. vr.DI s"a'P"" LAND 23400 r S I 3015/58 :00/00 SLOGS 129000 J TOTAL 152400 j BUILDING PERMIT *LAND A D J U S T.f C R 23LAND 400 LAND—AOJ I INCIME I Sc" SP-6LDS FEATURES BLD—ADJS UNITS Number Dale Type Arnoant RES. U S E 140 10500 C,a Consl. TOt al Base Rale Ad.Rate eY ear Built A Norm Obsv. V nits Vnils j A 1� 1f9 ge Depi. Contl. CND. loc. 4b R.G. Repl.Cost New Ad, RePI.Value Stories Meignt Rooms e0 Rms Batns I Fiw. Pertywell Fec. 000 110 110 66.40 73.04 20 75 19 80 100 80 159443 127600 1 .5 12 6 3.0 12.0 cripl,on Rate Squa a Feel Repl.Cost MKT.INDEX: 1.00 IMP.BY/DATE: / SCALE: 1/00.71 ELEMENTS CODE CONSTRUCTION DETAIL SAS 100 73.04 1026 74939 GROSS AREA 2670 THREE FAMILY DWELLING CNST GP:00 FEP 65 47.48 40 1899 *--10--* N STYLE 00 0.0 FSF 9 0 65_74 4,50 2 9583 ----- ----- - --- --=------------------- I ; ! ! *— --14---* DESIGN ADJ AT 62DESIGN ADJUST 16- FSF 90 65.74 168 11044 10 -------------- --- ---D FRAME -- --- - ! FSF ! EXTER.WALLS WOOD fRAME 0. 615 42 30.68 1026 31478 ! ! 12 12 HEAT/AC TYPE 040IL 0. --------------- --- ----------- I ' *----15----* ! ! INTER_FINISH 00 --------0." � 24 ! ! � --TER__. ------- ---------------------- *— * INTER.LAYOUT 01— t 5— *—---14-24*------* --- ---- -- - ----- - ------- --�'- --- • INTER.OUALTY 02SAME AS EXTER. 0. \ ! ! 14 ! ! FLOOR STRUCT 00 -- - 0. ----------- - - ---------- ---------- --W 8FEP8 FSF 9 ' EfL00R COVER 00 Q. • ------- E TolalA:eas Au• = 40 .Base= 1644 ! � � � � ROOF TYPE---- UG --��- TBUILDINGDIMENSIONS *-5—*--------25-------*--* ! ELECTRICAL--- Jo ------------------99" W54 N15 FEP W05 N08 E05 S03 ------------"- A 24 FOUNDATION 00 FSF N24 E10 S10 E15 S14 W25 ' BASE � -----------""" --- ---------------------- SAS1 E30 N09 F S F N12 E14 S12 15 - - -- - ---- - L _ _ ! ---QRvFESSION-- ZONE W14 BAS E,24 S24 B15 N24 ! ! LAND TOTAL MARKET W24 S09 W30 S15 E 5 4 . . ! 815 ! PARCEL 23400 152400 *------------------54-----------------x AREA VARIANCE +0 +0 STANDARD 50 c TOWN OF BARNSTABLE REPORT S LEMENTARY/CONTINUATIOREPORT NAME (LA FIRST, MIDDLE DIVISION /D37 NOTE DETAILS i O SERVATIONS-ITEMIZE EVIDENCE, SERIAL OS ETC. 7-0 2 G v s If7 JU 244p -J J !t 4 V r iv i o P SUBMI PAGE TTED BYi � >: LDIN 327t•236••ii 'Vi:L:•:�:vv:4:iG:G:i^i:Gi:G}}}}y: ...:::::::�::N:::::::.::.vx.:txttx.;xt.v ::•.:.:•.:::.::.:. ..:::•.::.:{.,v+•i:•:;tv••i'•i•i:•i:::.;::;.:;:•{i::�'L'vivvv::"::iiL}}tY,t:•}:;:::>.�:�:'v:i>X::::•:;:�iii:}}: DIN :::.:...::....................:..:::::::::.::.:::.:::.....:..::...:..: ...:......... ...................:::.:::.::::.....:.::.::.. DAVID STILL RAMT .......................... ��ttt ...�x«:SC OOL.STREETt't HYANNIS <€ .......... ....... :.:.::.tt.:::::. l ZONING .:::::..::..::..:t.:.ttttt..tt;:::.::.::.:::.:::>;;;;:.;:::.>:::.tt. t..t.ttt,......:. ..:..t..t.:.::�::.tx.:.�::>t.._::.::... :..:.:.:....... ................... ........ . .»>......................................... :::::::::::.:::...........................:::.:.... ....................................:: .... ...... . <' LEGAL?????????? aaaaa tea:::>::>::>:.. ::::;::: �.t: ... . . ;. ....................... ....... ................................. ....... . ......................................:.:...::........... .::.::.:.::::. :::.::<:::.> � : : fir: :SEARCH :: ;'..:.>;::::