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0216 SEVENTH AVENUE (HYANNIS)
216 �dve, l l ! F r r I I I i I ! TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION a©® .Map Parcel Application# Health Division Conservation Division Permit# Tax Collector S�5�d �s = Date Issued Treasurer t Application Fee Planning Dept. Permit Fee , Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address !I` 7 A IWIVW-ee--'- Village r�/�s " N�/ti�yn.�c a;• " Owner 0 n �,� �� l?. i//� = fi��� �;��► Address �15.��i��)an 1e04 i4- l��iT,, Ole,& Telephone Permit Request w f�P�/� )07A f e Square feet: lst floor:existing /o© proposed 2nd floor:existing proposed -?1 Total new' " 3 Zoning District Flood Plain Groundwater Overlay " c0 Project Valuation � 000 Construction Type _ Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting docrmentation ; Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) tt Age of Existing Structure AcU o`v r- V/a e ,;Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Ge-)y-Ag c-e 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 ST new First Floor Room Count Heat Type and Fuel: A Gas ❑Oil ❑Electric Cl 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 O - - Commercial- ❑-Yes t7`No�"If yes, site plan review# Current Use Proposed Use 0 BUILDER INFORMATION Name 14biliPs A, Telephone Number, y, Address `2 Y 6 t k Alle t,v, 1 �` 7 f - License# Home Improvement Contractor Worker's Compensation# �� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 1 SIGNATURE F DATE Jf _ FOR OFFICIAL USE ONLY r ¢ h ,C 4 r PERMIT NO. DATE ISSUED MAP/PARCEL NO. ' ADDRESS• VILLAGE OWNER DATE OF INSPECTION: FOUNDATION O X— ('_a FRAME INSULATION FIREPLACE i ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL S / 4 g FINAL BUILDING [ DATE CLOSED OUT ASSOCIATION PLAN NO. j i �DFTHE Tpk� Town of Barnstable NP Regulatory.Services sARtvsins Thomas F.Geller,Director 9q, 3MASS .�� Building Division ' ATFD MA't s 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: r9,'�/D 6� JOB LOCATION: loillwe number street vi age "HOMEOWNER": i h ivt a S T Z G/l��1 J �� 5^ 1 ;7- --- name ( home phone# /• / work phone# CURRENT MAIIdNGADDRESS: a,ille d,e Inp ozz, yY, 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 of 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. ignature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. , 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 The Commonwealth ofMassachusetts Department of Industrial Accidents Office of Investigations 600 T3rashington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Pluxu hers Applicant Information _ Please Print Legibly Name(Business/Organization/Individual): Address: U.e Aj City/State/Zip: • Phone#: �o �•��� 3% Are you an employer? Check the-appropriate box: Type of project(regaired): I.❑ I am a employer with 4• ❑ I am a general contractor and I 6. ❑ New construction employees(fall and/or part-time).' have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet $ �• ❑ Remodeling ship and have no employees These sub-contractors bave 8: ❑ Demolition working for me io.any capacity. workers' comp.insurance. . 9. ❑ Butding addition [No workers'conip.insurance 5. ❑ We are a corporation and its officers have exercised their 10.❑ Electrical repairs or additions required,] 3. I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself.[No workers' comp. c. 152, §1(4),and we have no 12.0 Roof repair' s insurance required.] t employees. [No workers' l3.❑ Other,4di D e c1c comp.insurance required.] *Any applicant that checks box#1 nrust also fill out the section below showing their worlcers'compensation policyinfotzaetioa.' ` t Emneowim who submit This affidavit indicating they ate doing all work andthen hue outside contractors must submit a new affidavit indicating such tCoatractors that check this box must attached an additional sheet showing The name ofthe sub-contractors sad their workers'comp.policy information. ram an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and jab site information. Insurance Company Name: Policy#or Self-ins..Lic.#: Expiration Date: lob Site Address: -�>-/ City/State/Zip Attach a copy of the workers' compensation p.uUcy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.90 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 kgainst 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. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct, Sienature: Date: D �� /� Phone#: Official use only. Do not write in thu area,to be completed by city or fawn ofiecaL City or Town: Permit/License# Issuing Authority (circle one): 1.Board of Fealth 2.Building Depart I City/Town Clerk e.Electrical inspector 5.Plumbing Inspector 6. Other Contact Ferson: Phone#: i-ni®rmaza®n. anti instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees, Pursuant to this statute, an employee is defined as"...every person in the service of another under'any contract of hire, express or implied,.&-A or written." An employer is defined as-"an individual,partnership,association, corporation dr other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal repre=tatives of a deceased employer, or the . receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to bean employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence.of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states`Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to yeuu situation and, if necessary, ly sub-contractors name(s ,address es and hone numbers aloe with their certificates of DPP ( ) ) ( ) P ( ) g ( ) insurance. Limited Liability Companies.(LLQ or Limited Liability Partaerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure.to sign and date the affidavit. The-affidavit should be returned to the city or town that the application for the permit or license is being requested,•not the Department of . Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensationpolicy,please call the Department at the number listed below. Self-insured companies ffliould cuter their. self-insurance license number on-the appropriate line. City or Town Off cials . Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom. of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. = Please be sine to fill in the permit/license number which will be used as a reference number. In addition,an applicant that mast submit multiple permit/licens a applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job.Site Address"the applicant should write"all locations in - ; (city or town)."A copy of the affidavit that has been o$icially stamped or marked by the city or town may be provided to the applicant as proof that.a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year.Where a home owner or citizen is obtaining a license Or Permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax umhber: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ent 406 or 1-877-M-ASSAF'E Revised 5-26-05 Fax#617-727-7749 ur,�w.mass.gov/Cia Town of Barnstable Regulatory Servides ' ' seRrlsi'"HIA Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion, -improvement,removal, demolition,or constructfon of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: '7)&c k Estimated Cost 00 „ Address of Work: —�/( 61 V 41 OeCl_ ya-h Owner's Name: 0 Date of Application: D �D I hereby certify that: Registration is not required for the following reason(s): OWork excluded by law ❑Job Under$1,000 Building not owner-occupied ZOwner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME MROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Date Owner's Nam jr Qftmu homeaffidav U" OpfNE T Town of Barnstable Department of Health,Safety,and Environmental Services IARNSrABLE, + "�; � Conservation Division 200 Main Street,Hyannis MA 02601 Office: 508-862-4093 Robert W.Gatewood FAX: 508-778-2412 Conservation Administrator MINOR ACTIVITY REGISTRATION Property Owner Telephone number LI -ec'br t-jv a-C w pb1 01 G Mailing address 2 l Cm S'tZ�� Project location Map/Parcel# -De,& &4L GD Project description The following minor activities will be reviewed,under Art.27,by Conservation staff instead of the Conservation Commission,as long as they are constructed at least 60'from a wetland resource area or top of a coastal bank. * Pathways 4'in width * Fencing that does not create a barrier to wildlife movement,6"above grade * Conversion of lawns to decks,sheds,or patios that are accessory to single family homes,as long as: -house existed prior to August 7,1996 -alteration within the buffer zone is less then 250 sq.feet. -sedimentation and erosion controls are used during construction * Stonewalls(this does not include stonewalls for retaining wall purposes,grading and/or fill) Suture Date s S' u Reviewed by Date _GIS Plan Attached(fee charged for plan) Q/WPFiles/Form/MinorAct I it Town of Barnstable Conservation Commission 200 Main Street �°r ;�,•`° Hyannis Massachusetts 02601 eOV� Map Parcel: 245081 /' 7 Property Loc 216 SEVENTH AVENUE GILLIS,JAMES R&SUSAN L 45 MEADOWVIEW RD Date: Saturday,April 22,2006 HOLYOKE MA 01040 2 Our computer records indicate that an Order of Conditions- File# SE3-4070 issued to GILLIS,JAMES R.&SUSAN L. on 3/28/2003 for the following activity on your property: ADD.,UTILITITES,SEPTIC SYSTEM&PLANTING has expired without a Certificate of Compliance from the Conservation Commission having issued. Please check your records.If a Certificate of Compliance or a currently valid extension permit has already been issued,please contact us at(508)862-4093 and we will gladly update our file. If neither a certificate nor a currently valid extention permit has been obtained, please initiate the compliance certification process within 1 month of this notification by contacting your engineer,surveyor,attorney or consultant. Please call us should you have any questions on the process. The Certificate of Compliance is a necessary and final aspect of the wetlands permitting process. It,like your order of conditions earlier,will be recorded against the deed on your land. We thank you in advance for the anticipated cooperation in the closure of the wetland permit presently in force at your parcel Sincerely yours, Fred Stepanis,Conservation Assistant 4V F�J5 � 7 \ 14.5 _ — —7 � I I y ar+N+Ytngyy .IY e!J5 C J1 1 N i \e,Y ri�t�'�l .•.�.s_ i*..pL�F('Y'! �y,.`' � I � • NI 12 fnd S � '�` Tie '+ . •.^ •�' I . R!I` \ y � INIowl- If Y \ 50 Buffer Zone I 100' Buffer Zone .Landscaping Plan scale: 1"= 20' tl Show Septic Reserve Area, Add Woter Line, & Septic Notes. Modify Retaining Wall, & House Footprint. Date: 02127103 Reduced Septic System to T Bedroom *Zoning Setbacks Include Overhangs. SM1 < \ _g_ some nd/dh I I tIG� SM2 \ ��� r `� ,:,.�^` /IS/_.` I_,I ,tee. 4�c\Oa �; sf83!fit a's a u ..r e I+. >,.Y•l °' ..y ata'l r ,Yu w, s7 Buffer\ X' n `' k20 '' j ISM3 r v 4 Solt Marsh \'' 20 ` ar r �f \ !SR (8127102) F4F,' 1 \ r t'bj N�\'y^✓+ � !�ttF+I, . i fi N \ 812 dh. k\ t+w \ \ fnd Fine from FIRM Map � � �•��w \ � 'aRel # 250001 0008C July 2, 1992 \ �� \ 1 \ O 50, Bu ffer Zone 100' I 1F e `s G e { e47 _ F .. TI@ t z ` a o i nx.n.n�..a. i o - f El - R Y t t f f1 r' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 7 Map Parcel lo t A ROLE Permit# f health Division ILI/ 11(26fC 3 3 Date Issued o ; L Conservation Division `- .17id . Application Fee 47 Tax Collector _.__. -- Permit Fee �� f Treasurer l 3 f . SEPTIC SYSTEM UUST OE. Planning Dept. INISTALLED BN COMPLIr►M: WITH TITLE 5 Date Definitive Plan Approved by Planning Board EWRONFAENTAL CODE ANL Historic-OKH Preservation/Hyannis TOWIJ REGULA Project Street Address Z4i Village `/A f, `v/ x Owner�f 41Vv s Address V 5 Telephone �d-/,L'Z % OAya/<e ��/a o/® r Permit Request D b I f-1 0 N , 2_q K 3® 2 S{ Square feet: 1st floor: existing.2f proposed 2 e 2nd floor: existing proposed *--2,o Total newer. Zoning District Flood Plain 1 Groundwater Overlay Project Valuation 12- 0,o o B Construction Type Lot Size z,9 mod Grandfathered: ;W Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure 3'/ Historic House: ❑Yes 'P No On Old King's Highway: ❑Yes 6d No Basement Type: P Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) D Basement Unfinished Area(sq.ft) 'ff � Number of Baths: Full: existing 0 new Half: existing new Number of Bedrooms: existing new _ n 1 /n /nQltilad LI It? Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other ?Z/J 0i1iw %�D f �h�e{, Tf�N/C Central Air: ❑Yes V No Fireplaces: Existing New�_ Existing wood/coal stove: ❑Yes ®No Detached garage:❑existing ❑new size 01-� Pool:❑existing ❑new size A119 Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: �9_A?�� V_ uti� Je a (2) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION - 3 `a9�( Name- JAmvs �? ��"//t Telephone Number S GS / 'AddLALL r`ess L,�,vClajo& ,�,�u. /ZJ License# Ay m., •e— h'�/3 0/0 Yn Home Improvement Contractor# Worker's Compensation# ONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TOTURE DATE r ` y FOR OFFICIAL USE ONLY f r , PERMIT NO. DATE'I SUED MAP/PARCEC NO. ADDRESS VILLAGE OWNER " DATE OF INSPECTION: FOUNDATION— a } FRAME A k/!3/�' INSULATION /./�f VS U 0 FIREPLACE. ELECTRICAL: ROUGH FINAL l PLUMBING: ROUGH FINAL i; GAS: ROUGH ' = FINAL FINAL BUILDING DATE CLOSED OUT : - + y= ASSOCIATION PLAN NO. t!o r , Town of Barnstable o� Regulatory Services « 1 Thomas F.Geiler,Director BAMSTABM 9q, 9. �. Building Division Arlo Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: lOk�2.�G JOB LOCATION: 2/!0 number street / village "HOMEOWNER': J/am e S /2 �A l " name home phone# work phone# CURRENT MAILING ADDRESS: 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 re ' ements. 1-2 S. ture of Homeowner Approval of Building Official 4 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." I 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 personas 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. y Q:forms:homeexempt _ The Commonwealth of Massachusetts Department of Industrial Accidents OfffCg OffoYestfgatiaos _ 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit location / !o �' A !/Plti�/ GynS f �61,//�!zlyl� i0a L./7` l phone# I am a homeowner performing all work myself: I am a sole rietor and have no one workii in ca achy � //// O�////G� �////%%/!////%%%%%%%/ ovidin workers' co ensation for my employees working on this job. ... em 1 r mP Xam an .'anz .:................. 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Riftm :•::}Y'•?•::}..•:Y:}•:..:..:::.:.::;:•..:}}::::::•••}::::JJ:ij6:�:;}?ivv:vy.;jy-:::;•i:.:?>}v:'}rr:?:'.v:.::v::;:::;J}:•::4::4:ri;•iii:v::... .-rr:.Yi:;•}:•iJ':J;::.}:nyv}:::;:}i:�'•iiiJ:4::�}}i:;:i}::j::i:{:.v::n•. ....v:v...............::v.v;..•:w:::::::.•w::::;;v.�}:::v:ii:•ii:;•}:;•i:!•}:v:::;?•ii::::•ii::::4:•:;•i::iii::?i$is«i:}j;:j4:;{..;• :i::4}}J:iJ}:w..........";hi:;v::•.v:??}{}:{;;;4:•:i•%::v::.:•is•}:•}}JY}}:::.v:.;:::•J}:;•i}};;?.•�:.}:?;;?i:;?;4:n}J:4:?•i}:;;;•:}J:4:•:::o secate coverage req�r ed mtder Section 25A of MGL 152 cartlead to the imposition of ctimbnal penalties of a fine up to$1,WO.00 and/or +imprisonment as sreII a,dvfi penalties in the farm of a STOP WORK ORDER and a Sae of$100.00 a day against me I msderiGmd that a copy of this statement may be forstarded to the Ofce oCInvestigatians of the DU for coverage verification. do hereby c fy under the pains and penalties of perjury that the,information provided above is tarp and correct Date Signature /� J - print name �1�l�r S /�7L�' Phone#!� official use only do not write in this area to be completed by city or town oMdal din artment city or town: permii/license# ❑Bull g De P ❑Licensing Board response is required ❑Selectrneres Office ❑checkifimmedlaterap q —.❑Health Department contact person: phone#; Other (jcviaed 9/95 PJN Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. partnership, association, corporation or other legal entity, or any two or more of An employer is defined as an individual,p p, i the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,Partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or'renewal of a license or permit to operate a business or to construct buildings;in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neitherthe commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. +: Applicants '? Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and phone supplying company names, address and phone numbers along with a certificate of insurance as all affidavits maybe . submitted to the Department of Industrial Accidents for confirmation o'f;ncurance coverage. Also be sure to sign and �:. date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the'law' or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be ret®ed io the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Me of InvestlDauOns 600 Washington Street Boston,Ma, 02111 fax it: (617) 727-7749 phone 4: (617) 727-4900 ext. 406, 409 or 375 FROM FAX NO. 1802G505023 'Aug.` 19 2003 11':43AN- P1 ACORD, CERTI>"ICATE OF LIABILITY INSURANCE, . oa 1�%200� THIS CERTIFICATE IS ISSUED AS A MATTER HF INFORMATION �poouceR ONLY AND CONFERS NO RIGHTS UPON TH1 CERTIFICATE Cooper Insurance Servi oea, Ltd. —ALTER THE CI S CERTIFICATE OVERAGE AFFORDED BY DOES THE PPL CIES BELOW.E ND OR 595 Dorset Street . P.O. Sax 9230 INSURERS AFFORDING COVERAGE ; I go, Burlin ton VT 05463- INSURED .. . ! .- &UR CZtiCinriAti ansuxaacs Co. Vezmont Frames and Foam Laminates of V'6 ►ont F.O. Box 10Q . V'P �.05461=• ,. .. COVERAGES x , NAMED ABOVE FOR THE POLICY PERIOD INDICATED. THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NOTWITHSTANDING ANY RE4UIREMFNT;TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. PoucvFEcnvE POLICY fixP1RA71DN POLICY NUMBER LIMITS , IN9f: TYPE OF INBU RANEE � DATE IDD DATH MM Y A GENERAL LIABILITY _ '" /.. ./ I . / EACH OCCURRENCE $LTV 1,000,000 X COMMERCIAL GENERAL LIABILITY - - FIAE DAMAGE(Any one q± $ 100,000 C LAIMS MADF. OX OCUR C>pp0659425' 06/15/2003 06/18/2004 mroup(Any ono Oeraon- $ 5,000 - - - PERSONAE B ADV INJURY - S- 1,000,000 • / / / GENERAI-AGGREGATE $ 1,000,000 OFN'L AGGREGATE LIMIT APPLIES PF,R; PRODUCTS-COMPlOP AGG a 1,000,000 POLICY JLCOT LOC A AUTOMOBILE I,IABuTY CAP7662745 06/15/2003 06/15/2004 COMDINEO$INOI,F LIMIT ' ANY AUTO (Ea accident)_ $ 500,000 ALL OWNED AUT08; s - / / ./ / DODILY INJURY SCHEDULED AUTO � - - _ • (perpr+r+on).• $ HIRED AUTOS / / BODILY INJURY NON-OWNED AUTOS (Peraccident) $ .r - - .. / PROPERTY DAMAGE • .(Per accident) - E. OARAOE LIABILITY - _ AUTO ONLY-EA ACCIDENT. $ . ANY AUTO OTHER THAN -" EA ACC 5 _ AUTO ONLY: -AGG S EkCE88 LIABILITY - _ - / / I / - EACH OCCURRENCE- -$' OCCUR CLAIMS MADE - - AGGREGATE . . r:. $ RETENTION WORK!RSCOMPINSATION AND C S . u •, EMPLOYR S'LIABILITY X 4�tYIJm1_C8 E.L.EACH ACCIDENT $~' 100,000 WC 8957369-09 06/15/2003 06/15/2004 E.L.DISEASE.EA EMPLOYEES 100,000 E.L.DISEASE•POLICY LIMIT $ 500,000 OTHER bE8CRIPTION OF OPRRATIONWLOCATIQNBfVEHICLESMXCLUSIONS ADDED BY ENDORSSMENTISPICUIL PRDVISIONB CERTIFICATE HOLDER ADDITIONAL INSURED-INBURER LETTER: CANCELLATION SHOULD, ANY OF THE ABOVE DESCRIBED;POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE 1881.11NO INSURER WILL ENDEAVOR TO MAIL 030 DAYS WR)TTEN NOTICE TO THE CERTIFICATE NOLDFR NAMED TO THE LEFT,BUT Jay G711ia FAILURE TO DO SO 814ALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE - 290 High -Stz'®et INSURCA ITS AGENTS OR RAPIllfgrNTATIVEs,. AUTHORIZED REPREBEHTA Hol `oke MA 01040- - _ ACORD 25-S(7167) ~ INS028S(gp1d;.0� ELECTRONIC LASER FORMS.INC.-(eool3zT.o6 . �ACORD CORPORATION 1988 Pepe 1 of 2 - I FTHE F, Town of Barnstable Regulatory Services " WtNSTABLF, ` Thomas F.Geiler,Director 9 Mass. g 1639. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: &//-0,g/— Estimated Cost l e a DDl1. Address of Work: /� /J(/� /�S ..;1 w� s n �2 & f G1l U 3 2 Owner's Name:�J ,0 mCS 0 G, Date of Application: 0 E12 "07 3 I hereby certify that: Registration is not required for the following reason(s):. ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied XOwner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE' ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Date Owner's Name Q:fomis:homeaffidav N NIF Torres Family Nominee Trust Sherman'&Susan M. Eisenthol Bk.6460 Pg•226 Bk.12190 Pg.36 N87-21'36"E 100.04 Retainin Wall ce/en \ Ind - \ ` REFERENCES: New#216 Assessors Map: 245 \ Buffer zone Concrete Parcel: 81 \•�� \ Foundation Plan Book 218/23 ,r N \21.0' ; Farmer ,i m\ `Y Dwelling . c L 7 ONE.RB 14.0' y Setbacks: \ \ 0 CD Front 20'min \ \ NNE Side: 1 O'm in \ \ Rear: 10'min mod/ all, ,il, � /�1 \ '�• F` ZOOM Edge of Salt Marsh Flagged by ENSR (8127102) \ \ all, \\ \\ all, \ \ \ S87'21'36"W \ 72.63' RK:H 1Q4 l certify that the foundation ARD .\ shown hereon conforms to the \ tHEWREvx y setback requirements of the 231312 Zoning Bylaws of 'the` town PLOT PLAN °was+�`'� Barnstable. IN Zv wd 3 BARNSTABLE Professional Land Surveyor D to (We st Hyannisport) MASS. NOTES: DATE: 201AUG103 SCALE: 1"=30' 0 15 30 45 60 FEET 1.) The foundation shown was located on the ground by conventional survey methods on 18/A,UG/03. PREPARED FOR: 2.) The property information shown .hereon was Janes & Susan Gillis compiled from available record information and 45 Meadowview Road does not represent an actual on the ground survey. Holyoke MA 01040 3.) This plan is not for recording and is' not PREPARED BY: to be used for construction layout or deed CapeSury description purposes: 7 Parker Road Osterville MA 02655 DWG #: C479_1pp FIELD BY.. MDH WHK (508) 420-3994 ,/ 420-3995fax RESIDENTIAL B �,. UI D L ING PE _RMIT FEES *„ APPLICATION FEE n " New Buildings,Additions $50.00 a G 0 0 h Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq. foot= 13 d YG x.0031= plus from below(if applicable) t ALTERATIONS/RENOVATIONS OF EXISTING SPACE a square feet x$64/sq.foot= x.0031= plus from below(if applicable)' GARAGES(attached&detached) g. 7 o2'G square feet x$32/sq ft. y® x.0031= 7� ACCESSORY STRUCTURE>120 sq.ft. , >120 sf-500 sf . $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 " >1000 sf- 1500 sf 100.00 ; >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS y y Open Porch p w x$30.00= (number) - Deck — (number) _ Fireplace/Chimney.` x$25.00 (number) " Inground Swimming Pool ,;"� -,� $60.00 r r x N Above Ground Swimming*Pool -$25.00 ry Relocation/Moving `. $150.00 r (plus above if applicable) A . F Permit Fee � IN • projcost g ` } N T� � •q �' ,�h � .� �- e 1 4A B4 ;tiPb REVlA -• � � .. � � ".'SCALE. %�3HEET AF'A,� LLJ .. - - .. m FTT iliar-H.S', 2r�C 5 E ]D iB OMStNO 1ELT snAn:D n.wE�ox�-� ��• TO.:Top a[.vOA,iiCwuc - .PLATE. . i xMB'SUBiACY��ItJ. :. BOAPD - - � 1/Y[LOOP SNUINWC � z - xxe Tw.aaoPWc ' . ...; .T.O.:BEAM ' aoa+eew :irtc rASC:Errs W pAUEt BPEAIf OP p"Swi Y SPIKES AT-".°.C.. - - .. PRo,�Ecr poogss: cf trip) PANFI NS :i[P EN .NN�v.,FDII�. i WC D-wJl6 uR �f PANELol.6,W[L�TO 4°+IOE.R :. . _ wwxc afaiNn.>- sxcc�.r.,au I.IW NUIs BENT A CRAM4 BY BENT .B gQP-Ea Nre : HPc YEC�V( ..'FIRST ... FLOOR "R�YJ4ON d'N 0.5AT, O.C. ... • '- . B/e'q Y & '..� l' RAt 1[gp1E [m . x E:iREARD., 'eJ xArtS - [EiEPbn pOSR,:UJF ' M.x'NMulO�pATifPBE: - ' - nnr mnxw'BDsu - ' _ _ rwxDAnw DRsu u. - . b - —DAnoN N„rPpPeoNPo - - o SE CAB a �YM+OREB. O p.0 O TOP OF ' B SrxE 9 C oI f0011NG + tnrzP wPtC OOp 7 poi lEP K CAUN6 O'xx1HrCENCPErz r00 J 5 a _ �irrz°0°an°�° c�i PODE au�sa o i a TYPICAL SHEAR WALL SECTION C� - SCALE: ,.._1.-0" - . ImrzxiE'P., s u nra+wore FWE R m e[mv uxa arm Dx wAx. �bAUG TE >. x u pms a wn¢ x'.Er+m ]/'mtim xumwom.. - _ 1 3 S ] u vupxs ABE anie'xBimwwn A 5 40tl3;{ BENT C 5CALE qj� �e 42 .:, ROeFLT dD9RE9s e 1 3 5 C B A FRONT ELEVATION URAxtI ; .. - �•: - RIGH:T_ELEVATION. �trrc n s tt, REAR.ELEVA.TLON r LEFT.EtEVATION s < F;4trl t�i3:S4 � x5'rs ' ,. _.; -_:, f. •Y Fos -FAt ost w; 6 Asp star • A 77 i �/r�/ --------- --- ---- --== _ —' ---- ,HiE I,neca;mu. I �sm�uciuno PFOJEgT M Zvi E! , as ROOF FR_A.M(NG PLAN SECOND.40)OR FRAM PLAN. DAIS ; AU¢5 200$; , J h ;! i TOWN OF BARNSTABLE BUILDING PERMIT PARCEL ID 245 081 GEOBASE ID 14867 ADDRESS 216 SEVENTH AVENUE PHONE W HYANNISPORT ZIP - LOT A BLOCK LOT SIZE _ DBA DEVELOPMENT DISTRICT NY PERMIT 68417 DESCRIPTION MOVE HOME ONTO NEW FONDATION PERMIT TYPE BMOV TITLE BUILDING MOVING PERMIT ' CONTRACTORS:- HAYDEN, ROBERT- F.. Department of - -- ARCHITECTS: Regulatory Services f' TOTAL FEES: $150.00 BOND $.00 pf CONSTRUCTION COSTS $30,000.00 752 ALL BUILDING MOVES 1 -PRIVATE * lARN3TABLE, MASS. 1639. Al FO MP'� -- BUILD G D 'ISION BY �� DATE ISSUED 04/28/2003 EXPIRATION DATE �:v �2/ �G y `� �.�cv�a�-�� 3 "� i a . . TOWN OF BARNSTABLE . , � BUILDING PERMIT, � s PARCEL, ..ID :245 081 GEOBASE I ID 14867 ' 'ADDRESS, 216 SEVENTH AVENUE PHONE '' ' W HYANNISPORT ZIP LOT .. .A ALOCk ' LOT SIZE, DBA DEVELOPMENT DISTRICT HY i I, PERMIT 68417 DESCRIPTION MOVE HOME ONTO. NEW EONDATION PERMIT TYPE BMOV TITLE BUILDING MOVING` PERMIT CONTRACTORS: HAYDEN, ROBERT V. Department of ARCHITECTS Regulatory Services TOTAL FEES: $150.00 BOND $.00 dry -�CONSTkUCTION COSTS $30,000.06 752 ALL BUILDING' MOVES 1 PRIVATE ' Ksnxt`vSTnsi.E, y mass. BUILD MG DIYISION . _ BY -DATE ISSUED 04/28/2003 EXPIRATION bATE THIS,;PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,'ALLEY OR SIDEWALK OR ANY PART THEREOF,EITHER TEMPORARILY OR PERMANENTLY.I CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION-STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OlUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS "PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION.RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED I' FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- ELECTRICAL,PLUMBING AND Ml (READY TO LATH). PANCY I'S REQUIRED, SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS. 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. 4.FINAL INSPECTION BEFORE OCCUPANCY. Hamm ( BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS is i 2. - 2 2 �P 3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT. �I. 2 ' BOARD OF HEALTH OTHER: SITE PLAN REVIEW APPROVAL I WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVEDTHE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS. TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. E I I j I I I I I I I I I .. I I I I h, v.•.¢IES 2_�_z3-I 22O_VeE1��T S,QE ,._ TO L El. Ili o2' OR Ib._M 14n _ - - - - s Wlwnll.L. fON. -IG�GaJG.FAH. Al Z-nG TIP GOKf• ON 3'-O"W. .VV/ �V r h7T K�l'CO 1 r csi- T�rl pzVO N4 T P / _ 1i P6 Ao of Ton.-Tor Ton.TOALIC H pwSH. / A.—ION F T rtb FLR F 4JIH0 MILL F uL Sr Flooa (bY CIc.HL-rt^L.Ce'cru�cly V i i emnl Fro Z4)c24 maL OCR t7 I I FI I 1�- j �'ti I I-LI LLJ__I J I �ro.rt o 'a T•o.G_ pp�T i' N 1 i t1_12'.0i ERaLnN{CI ;F � Olu n i � �IOX'b30R ZK ZG s I� I 0e Itl c>rz _ I R-FR. I l f _S1>LEL Bn FU-7vN'fC'1.+71® _ Iluf I q1N� 0I --1l C\ t)D i 01w �I5I) olf_�F�_m _ _ IS EL-14.SZ I _ ' W IDx89 UFL I tX a.5 m xL�m 6nwT am, rTS (—Nate: JlNenlu WALL RGR. 'T'lP•fT Fla' 6L 12.0 r WIHOYIIL.L ( Tc-1, I4F1J 7x10 •" j - W I V - R�.rleo'F12dTZLf I THE C if"At�:ONTHAC I UH SHALI VERIFY ALL Q 4'cow_6UF EL.5.6' � I I IF rJ0 NCw TiR6T -` - V O LI/ 4-6 Ia 10 WWII - �Pi1rl I L✓,1S IF, - SiIE CLNDCIi,,T1. AND ALL OIMFNS IONS AND UI Q - $DNTEOSATRIECT,N OOEFRN A OANFL\'IO11.1.1Y NG IN;HIF-SE T VRpR9'-4' r' S7AT ALL OU G- ��} f-- NOTIFY S PINYDS;;{:I{gICIF T O 10 CpNC 9JN. x Q - i ' W/2-4.5 T!B ` N I I ,j - I THE GENERAL ONTRACTOR SHALL INSURE THAT 4,.0w,3-0 W. ��- FLFY L 4cL I ___-- _ - _�2_O'_Vc ScI ALL WORN CON ORMS TO IHE;AIEST MASSACHUSETTS X 12D AOHT Rt-ICD I 5 CA.END/-T G�--9R5 _ M4M�CYCO; i -F�ib�BOI'rcrl —_ __ 'Dv_ap TOC fd Bc.aH _ STATE ',A:RI CODE I DING CODF.REQUIREMENTS. �nvRN'Pi LlG� Z'��" 91-(•' ®TM 1TY7 - - TOR E-GIIN,c WALL TO G{Fc.._oe--YP Toc. -_ 9'G° ZES EL-7.6' eTi.e-.3 F�Fc' I ALL- UI,,�-TiDN IE.J YTtON 14E1HTS 1 14.72 I. ! j.t-L FR)rLOATTON VIrICNSI0N6 if . 24-5" ZI Af-�+` .. CONDITIONh �9f•{ALL ESE.vciztvlgz;'IIJ ..flCY7K To Aw WoRK.Connewc,NCI . - No srz'LtT.lI L FDN.PLAt, ALL 40Nc4-f6 i�:i-w.L z�E f7' ab dal. CIIu.I�i 6cPEWc£ ConPLICTw-f rk"-rO e.w.l!.nccv ?"Plm-, f to f►.75 ZIL��tN/eNTH I�vE W..H UNNLs�r Vctn..Jr Fa.LH!! I Wfo.fTEon \,/EK T'LONT.'fKAnrS.Foe WOOF LOL. AL.L RE Bat fY=4,:a�P61 'F1L1LL fLXgvjt:W.*XW_+4oe.u,cla 7[CR FDIC• CONS. R,,,tOM L166 Ih14ANGHOc EOl_T5 C6�O.G.f"1.a1C, l 14I'_pl .....o.ao n. ^vo FfIIJ. TOP CL,EVA -44, Nar 6 ALL 1i�7nNA-,,etpL. i!lkv,9Olq Tb'•T1BULL FDN. ,T't'cj L,L CV• NOT G -r By:C Fc Su xv TO ScTALL ELEv.LTLo µs GaPI.6L�OF 5L nN4 I I/2 TON4i/6F .. WD LvL 611 f- PUGIGeTS TO auto" LjINDP-IIL_L �u��� TO CIGOE y -10 =�TG•fAGE .. NEL-1 �UN+-IN:'�'ED E'ysEnEl-T�� Ci CxkauE i EL: S. m: I. r�-PELC Ge-i,E) 1 - 1'HC-OF NERAL CONTRAC fOR SHALL VERIFY ALL SIf[CONDITIONS AND All nIMENSIONSAND .: �- •� I T:•)TC r N At I n IAWINCS IN I1IIS SF,PRIOR It',S�Afll OF ANY WORK AND SHALL NOTIFY 1 I I DklSI;NEII OF ANY DESCHEPANCIES PRIOR TO I .. '.:I AHI OF ANY WORK . I HE GE NF IIAL CONTRAC I'OR SHALL INSURE THAT AU WORK CONFORMS TO THE LATEST MASSACHUSETTS STATE BUI_':IiNC LODE(SIXTH EDITION)AND ALL OF ? -.!)(:AI.DUIL.nING CODE PEOUIRFMENTS ,i1.�.15 KESi 61IGE . Z!L �JEVE h!`Fi �.VE•� Imo.HYJLNNIsT�KT . HEW GA2.d_F,Ti hW gi/.6ErlEN1 —7 I—" I vck'H �- C•+. � SR�jR "¢ H _ ��---vv Ag 6[LGC.FiT"GY'1H[Q r. ISFelo FisaaeS « - G 9 _E>(IST. fXtSf 1 L2 COLO L,v./KIT) . -7 5"; - bw Joy j. V. sII I l/ I I GENERAL.NOTES _. OI GENERALCONiRACTOA SHALL VERIFY ALL 7f SITE CONDITIONS AND ALL DIMENSIONS AND Fwc 1e04B NOTES ON FLL DRAWINGS IN THIS SFT PRIOR 'O SI AHi OF ANY WORK AND SHALL NOTIFY �1L G DESIGNER OF ANY OESCNEPANCIES PRIOR TO <-,xq•, START OI�ANv WORK 'fIF G'ENEIIAL C:ON7 HAC10RSRALL INSURE THAT L ALL WORK'ONF ORMS TO THE LATEST MASSACHUSETTS 'f ,, CODE(SIXTH EDITION)AND ALL OF F:PI--DING CODE RECU:REMENTS. GILL!5 RESIDENCE "ZI(c 6e\/EIJTN JC\/EyW.HYXIJNISQorT NEW flVf3f,4 EXIST f'RST 'rLP?iS o••A-2-•� `�4Jr v Esv. Rn - 2/t SECOIJO'fLR . S .1 7.- _ Up fff - t sy r.zs atc _ G �4 O i II WIL ylA. ,6u11m I,'TE -UP TO � � I� a n.eo.¢-n. al" / fie v .i ri; .I4GUL. E'.'B __.._.GENERAL.NOTES -_ HEGENERAL CONTRACTORSHALLVERIFYALL SITE CONDITIOh7 AND ALI.DIMENSIONS ANO NQ7F5 ON ALL DRAWINGS iN THIS SET PRIOR ' wa� "n START OF ANY WORK.AND SHALL NOTIFY .DESIGNEROF.AV'D SCREPAVCIES PRI9I7 70. .;I API OF ANY WORK C;ENERAI CON I FbtCTOR SHALL INSURE MAT AI+I,W'1R✓.(C\I C•R61S TO Mr LATE Sl MASSACRUSETIS -� --� •i D:I'LD'NO CODL(SIX.7H EDITION)AND ALL OF - l i�f.:.•':S':OC_AL DliI1.DING CGnE RLCUIREMEAITS. Gill�LlLi ��S117ENGE Z16 SEEVE NTH rICVE.�I..I..HTANNiS'.�O>4r LSE. �.. . Bo. Rn Z0'1x 20' \..._ cl : I (karma f ro GENERAL NOES •tiL GENERAL CONTRACTOR SHAI,VFRIFY ALL '!L CONDIT IONS AND A 1 DO 'N ONS AND _. _ ...._ NOTES ON All'1RAWIN(- AI.HI'- :PRIOR _ � • 'OSTARlr)LANY:WORKANt1SI'AlIN0TIT'i. 7?E.S10NEfl OF AM'DES(:RE E•ANGiES PRIOR 1 O - S TART QF AW iNORI( THE GENFRAL GUNTEtACTOH SHALL INSURE THAT ALL WOAK COW-IRMS TO THE IAiEST MASSACHUSET'S / c-Al E:::L'LC'NG CODE(SIXTH i'DI f;(-I AND ALL OF NE LOr.A!FtUIt DING CO:-L�`'.)t IIRt MrN I S. Gill.E_lS ?ZcSIl��IJG6 A—E i W..H r-IJ NIZ-(7v�"r . :8-20-00 �-4 _:THIry -fL'000z r-� -I L 11' 7��u _... I � I I I I • �l . �_I UIJFt N ISHEf7 IZ.QI El._S5_ �_I-R.SLAB/3�SE!'I�yT SA6Y I I _ 1 - 7l IF CAN El.S.o� - --—-__ - 1+---• — —�_. ''!TE.CONDIFIONO LL AND LLU NIFT•SIONS ANU I - - '401F.S ON ALL DNAWINGS IN 1HIS SET PRIOR 1 O SIARf OF ANY WORK AND SHAI I NOTIFY DESK;IIER OF ANC MSCRU ANCIES PRIOR 10 f! ._ __. ._ - - SIARTOFAN•...QIIK - .1 HE GENERA;''„ON I RAC'I OH SF!AL L INSURE THAT ALL WORK CUNFORM_M 1nE iATEST MASSACHUSETTS E-(A!E S11!LOING CODE.(SIXTH F.DPION I ANDALL OF T!If!.A rES'I LOCAL 9lI:I.01NG COUC Rf 0;::1EMEN1 S. GIl A5 F 1Uc=Ncr 216' ty NTH ANIC.,WFA5T FhCNNISflb�r 1A - � - � � � �JoIJ'T?•i ELEVATION °"•J4-5•••" ill F] P i igg F sYO.-c }'YZL poSEf� 24>.3p rL - - j PStb6 crr' E` EL-5 c' .,.Y!:: :Ai:. ._ zl(a ILVE.ty-H�`:JE - �! "YAV�J.Sj=OG"r -_.. WEST 1 .1 i LLLJJ EL:6.5• t. 4 - : - 1. iME GENE: < \ :14i: R r ci so SITE OOK N-4NI)A r.N F .0 Nr AND 'r..!n At I.lMWrrv(; IN S 'T PRIOR J-ANN.',( NO,:TY OF AN,D� '..0 '-s OliOR TO C:I'.SHAIIIN;iURETHAT C.11,IA.F,S'TMASSAZHUSETTS S I AT[Dl"::`!Nt:_'.01)I.(SIXTH-F UMON r AND AU OF r.,....�11: cMFf:15 .. ;p 72. r -j j61 tt Ell wi I . I f Iq v"'flAIjCON HA(-:r7Fl sim. VRWYAU .. — IL C.NI);I,ON:,AND AI i M.P.9I(•1!.ANn 'JOIF::ON A, VRIC:F+IU - A_` a t:Ni.;i,\r;,tJf:t�Ai.'fi•+ i.A:;INSU'!i.I:.A7 .. av l::•+":'iM5 -'.AI!"MASSA.r:•::5:.!.S :,)At JSU'i'\r,,r,OnF^V IN H r:ti;'ION)Ae.O AL 0r 4.14 4.9 r 4112 r 1/2 1/2 . 1 ,a.14 I` .-_ '�,.•a9 1' t 7 a 11� '_�i' F.-� r { 4.9 9 9 A.9 4x9 49 i 9 - •.10 4.10 4.10 j 4x10" 4.10 1110 x101 f 4J0 .' 1/7 4.16 J.� 4a10 4d0 4po 4.�0' 4 4x10 4.10 /x10 4x10 4.10 4.10410 400 a 10. FRONT ELEVATION . DRA�R!6Y RIGHT ELEVATION RRU .. .. _, 4,14 4x9 ' -I 4.t2- .. _-Ij2 I 2 0�10 -_ 4.12 i4.12 404�l WI 4.9 40 4.9 9.9 - 4x9 4.9 1/2 4 4.10 10 \�.0' 4.10 4,10 I ' a 1/2 I. _ CL . 4.10 112 -- 4.B 1/2 1 W 4.10 1.10 {.10 4.10• �•l 4.10 '. ; 1/2 i 44 4.10 J00 4.10 - 4.10 ... - .. DUNE 1@,2003 1.14 -o.. REAR ELEVATION - LEFT ELEVATION Ma.jerial Safety Data Sheet U.S. Department of Labor ' May be used to comply with Occupational Safety and Health Administration OSHA's Hazard Communication Standard, (Non-Mandatury Form) 29 CFR 1910.1200. Standard must be Form Aphruved consulted for specific requirements. Otv18 No. 1210-0072 IDENTITY (As Used on Label and list) Note: Blank spaces are not pernimea It any,rem is not applrcebte, or no PUR FILL 1 G and NF information is available, the space must be marked to indicate that Section Manufacturer's Name U.S. Distributor: Ernorgen_-1'elephone Number TODOL PRODUCTS INC. 508-879-7741 Address (Number, Sireot, City, Siato, and 21P Code) 1 elophone Number lot Inlormalion 20 Charles Street 508-879-7741 Date Prepared Natick MA 01760 Se ttber 18 1990 Sign reparer(oprione Section II — Hazardous Ingredients/Identity Information 01her Limits llnunulnun Cnrntunrnnln (Strn<'ilic Clmndrrtl hlnnt�: r:rrrmmuur Nnnrn(n)) nni1A rf'I AC011I 11_V rtnr:mnumt.n.tnrl i;. tnt.ln.nnQ t.�Er:1 j'.^�� :hicF. the rc`on inn nm�iie-t of Ant vcthc�T *Yll Vnl And ---- --- diphenylmethane 4,4' diisocyanate Not of CAS # 5967.5-6.7 1 Reported Reported Reported G4 68% Monomeric di hen lmethahe 4 4 ' diisoc ante (MIDI) CAS # 101 68=8 0.20 .PPm: 0.005, ppm Reported 4-6$ Chlorodifluoranethane CAS #. 75-454 _ 1000. pPm 1000 ppm Nonnrt�l 18 1 toroethane . Not Not Not CAS # 75-68-3 Reported Reported Reported 12% Section III — Physical/Chemical Characteristics Boiling Point Specific Gravity (H20 - .1) N.A. - 1 .15 Vapor Pressure(min rig.) Melling Point N.A. N.A. Vapor Density(AIR - 1) Evaporation Rate (nO,v!c2c2�^ - n Neal.iaible N.A. Solubility in Water � Not snl ublp, reacts to produce CO2 gas Appearance and Odor Liqht tan foam, no odor Section IV — Fire and Explosion Hazard Data _ Flash Pant (Method Used) Flammable Limits LEL FUE Non-flammable not determined Non-flammable in air Extinguishing Media Water spray or fog, dry chemical, carbon dioxide Special Fire Fighting Procedures Wear self-contained breathing apparatus. Unusual Fite and Explosion Hazards - This is an aerosol product - cans will burst in fire: Spray water to cool cans. (Reproduce locally) 0SHA 174.Sept. 1985 PUR F LL 1 G and NF' Section V s Reactivity Data Stability Unstable Conditions to Avoid Slable X !ncornpaliblllly(Materials to Avoid iazardous Decomposition or Byproducts monoxide oxides of nitrogen, MIDI aerosol components I,Uardous May occur Conditions to Avoid 'olymenzation Will Not occur X ection VI — Health Hazard Data oute(s) of Entry: Inhalation? Skin? Ingestion? Unlikely Possible Unlikely sallh Hazards(Acute and Chronic) Can cause skin irritation — itchinq and burning sensation of mucous tissue when exposed to very high concentrations of MIDI. Non-specific discomfort such as nausea, headache and weakness rcinogenicity: NTP? IARC Morvyga?As? OSHA Rzgulated? No No No ns and Symptoms of Exposure ..Asthma like, symptoms. with. very, high :concentrations of MIDI vapors Skin irritation ,.]rcal•Conditions ►erally Aggravated by Exposuro Asthma and other- respiratory disorders. :--Skin :al.lergies, eczema. Isrgency and First Aid,Procedures - Remowi`to fresh air- if'breathing difficulties occur:.` ,Wash promptly with soap-and' water if there has been skin irritation. -lion VII — Precautions for Safe Handling and Use )s to Be Taken in Case Material Is Released or Spilled Cover with hoist absorbent material - after cure pick up and discard as solid waste. ' le Disposal Method - F til l y emptied cans may be di gpQsed of as solid wast e autions to Be Taken In Handling and Slorin PUR FILL IS 'M BE LIS' TS 5 ,'y�l'. iv.,i ji'ntlz AS A I L1ATtNG. DOES NOT M1AKC AIR-BORNE PARTICLES. . r Precaullons This is an aerosol product, store below 120°F. Do not puncture cans or put in a fire. tlon Vlll — Control Measures oratory Protection (Specey TtPe) Not required in normal use. , lation` • Local Exhaust Special Mechanical(General) Othor X clive Gloves FEyo Protection Disposable plastic or latex Goggles or face shield Protective`Clothing or Equipmeni . Not Required IHygieruc Pra tices Wash contaminated clothing before reuse, Wash hands before eating. Page 2 . usnpo 1964-491-$29/65115 ' • TRADE NAME: NORSORD OSB PRODUCT IDENTIFICATION: Oriented Strand Board (OSB) DESCRIPTION: This panel product contains hardwood and/or softwood wafem bonded with resin (phenol formaldehyde copolymer) and wax. Manufacturer's Name: Norbord Industries Inc. Contact: Environmental and Technical.Services Address: 1 Toronto Street, Suite 500 Toronto, Ontario M5C 2W4 CANADA Telephone Number 1-800-387-17,10 or(416) 3G5-0705 Date rroparcd: to-:y 31, 1996 - r • r r . - 1 Principal Components ACGIH Tl_V OSHA PEL (Chemicalm n N mR TWA :STEL Soft Hardwood (e.g.. aspen, % :595 NVE:NVE sweet gum, etc.) Southern Yellow Pine (SYP) % S95 NVE'NVE Hardwood dust(aspen) mg/M I': NVE . 5 : 10 Softwood dust(SYP) mg/m� 5: 10 5 10 Resin Solids mg/m' . _ 1 _3% 10: NVE (phenol formaldehyde) Paraffin wax rriglm� 1 _2% 2'::NVE NVE:NVE Free Formaldehyde.-.-. ': .pRn? Ceiling 0 7fi 2 NOTES ACGIH=Amehc.3n Conference of Govemment Industrial Hygienists _PEL=,Permiss(ble l=xposure Limit OSHA=Occupational S fety d Health Administr;ition TWA=Time-wrilr)htodrAJemgc rl..V ..l;hrM�hnA Llmlt Vol C� 'TR.— Short tT,rm Cxv- urc_Gmi' NVE -.No Vnlue Estnblistied ction III PHYSICAL IDATA Boiling Point" ;. Not Applicable Specific Gravi water-1 - 0.7 Vapor Density _ Not Applicable %Votatiles by-Volume 0 Melting Point Not Applicable Vapor Pressure Not Applicable Solubility in Water(% by wt) 0.2% Evaporation Rate (Butyl Acetate=1) , Not Applicable pH Not Applicable Appearance; and Odor Crown light to d-.irk with slight aromatic wood Odor(n!�per,) .;troncy.r when wet. SectionIV FIRE AND EXPLOSION DATA Flash Point Not Applicable Auto Ignition Temperature 400-500"F or 200-260°C (will depend upon duration of exposure to heat source and other variables). Explosive Limit; in,Air Not AP'clicable Extinguishing Media Water, carbon dioxide, sand Special Fire Fighting Procedure,.,,' None Unusual Fire and Explosion Hazards Sawing, sanding or machining can produce wood dust as a by-product which may-present an explosion hazard if a dust cloud contacts an ignition source. An airborne concentration of 40 grams of dust per cubic meter of air is often used as the LEL for wood dust. Hazardous Combustion Products Not Applicable Explosion Data Not Applicable r Rate of Burning , Not Applicable Explosive Power Not Applicable K ensitivity to Static Discharge Not Applicable } "`SNote: LEL c Lower Explosive Limit , Norbord Industirlas Inc. P390 14 of 2 b Instability Stable under normal conditions. Incompatibility Avoid contact with oxidizing agents and drying oil. Avoid open flame. Product may ignite in excess of 400'F (204°C). Hazardous Decomposition Products Thermal and/or thermal oxidative decomposition can produce irritating and toxic fumes and gases, including carbon monoxide, hydrogen cyanide, aldehydes, organic acids and polynuclear aromatic compounds, Hazardous Polymerization Not Appliczble. Condition to avoid Storage of material in hot.areas. -HAZARDSection VI HEALT4 INFORMATION Exposure Limits (See Section II) Routes of Entry: Eye Contact Gaseous formaldehyde may cause temporary irritation or a burning sensation. Wood dust can cause mechanical irritation. Skin Contact Both formaldehyde and various species of wood dust may evoke allergic contact dermatitis in sensitized individuals. Ingestion Not likely to occur. Inhalation (Gaseous Formaldehyde) Gaseous formaldehyde may cause temporary irritation to eyes, nose and throat. Some reports suggest that formaldehyde may cause respiratory sensitization, such as asthma, and that pre-existing respiratory sensitization may be aggravated by exposure. Formaldehyde is listed by the International Agency for Research on Cancer(IARC) as a probable human carcinogen. The National Toxicology Program (NTP) includes formaldehyde in.the Annual Report on Carcinogens. Formaldehyde i' regulated by OSHA as a potential cancer agent. In studies involving rats, formaldehyde has been stloWn YO(' use,nasal.cancer after long-term exposure to very high concei trations` =`> 14-"` m 'far above those'normal) found in the work lace sin this rodud. The:NationaI Cancer Institute(NCI)conducted an.epidemiological study of.industrial workers exposed to formaldehyde(published June>1986).. The Cl conckid' that ' _. the data provides little evidence that mortality from;cancer,is associated with "formaldehyde exposure at the levels experienced by workers in the study. (Wood Dust) Wood dust may cause nasal dryness 'irritation and obstruction Coughing,wheezing and"sneezing-sinusiUs and prolonged colds have also been reported. ; Depending on species,wood dust may cause respiratory sensitization'andkir irritation.,Prolonged Iexposure to wood dust has been reported by some observers to be assodated with:nasal cancer. IARC classifies wood.dust as a.carcinogen-to._humans.i� (Group 1). This classification is based'on IARC's evaluation of increased risk in the o=rTence of adeno-carcinomas of the nasal cavities and paranasal sinuses associated.. with exposure to wood dust. [ARC did not find sufficient evidence to associate cancers of the oropharynx, hypopharynx, lung,lymphatic and hematopoietic systems, stomach, colon or rectum with exposure to wood dust. - Emergency & First Aid Procedures: Eyes Flush eyes with large amounts of water. Remove to fresh air. If irritation persists, get medical attention. Skin Wash affected areas with soap and water. Get medical advice if rash or persistent irritation or dermatitis occurs. Inhalation Remove to fresh air Get medical advice if persistent irritation, severe coughing or breathing difficulty occurs. PRECAUTIONS'Section V11 • Wood Dust Avoid dusty conditions and provide good ventilation. Handling Avoid skin and eye contact Wear appropriate personal Protective equipment Avoid generating dust Section Vill CONTROL MEASURES`% Ventilation Provide adequate general and local exhaust ventilation to keep airborne contamination concentration levels below the OSHA PELs. Pengonal Protective Equipment Wear goggles or safety glasses when manufacturing or machining the product. Wear NIOSH/MSHA approved respirator when the allowable exposure limits may be exceeded. Other protective equipment such as gloves and other garments may be needed depending on dust conditions. Work or Hygienic.Practices Follow good hygienical housekeeping practices. Storage Store in a cool, dry area, away from open flames and any other source of ignition NOTICE: Data contalned herein Is provided In good faith and,to the best of our knowledge,represents accurate Information. There is no guarantee of any kind,expressed or Implied,concerning the accuracy or completeness of this information. Norbord Industries Inc. Page 2l of 2 780 CMR Appendix Footnotes to Table J�.2.Ib: lass doors, skylights, and ' Glazing area is the ratio of the area of the glazing assemblies ('including sliding-g basement windows if located in walls that enclose conditioned space,but excluding opaque doors) to the gross wall area, expressed as a percentage. Up to 1%.of the total glazing area may be excluded from the U-value requirement. Far example,3 ft=of decorative glass may be excluded from a building design with 300 fF of glazing area. 2 After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from. Table 11.5.3a. U-values.are for whole units: center-of-glass U-values cannot be used. The ceiling•R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation.thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38 insulation and R-38 insulation maybe substituted for R-49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. 4 Wall R-values represent the sum.of the wall cavity insulation plus insulating sheathing(if used). Do not include exterior siding, structural sheathing, and interior drywall.For example, an R 19 requirement could be met EITHER by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to woad-frame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces, basements, or garages)-Floors over outside air must meet the ceiling requirements. The entire opaque portion of any individual basement wall with an average depth less thaan 50%below conditioned must MeeC the same R-value requirement as above-grade walls. Windows and sliding glass Basement doors must meet the door U-value requirement basements must be included with the other glazing. described in Note b. 'The R-vafue requirements are for unheated slabs.Add an additional R-2 for heated slabs. ' If the building utilizes elebtric resistance heating use compliance approach 3;4, or 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. For Heating Degree Day requirements of the closest city or town sec Table J5.2.Ia NOTES: a) Glazing areas and U-values are maximum acceptable levels. Insulation R-values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b) Opaque doors in the building envelope must have a U-value no greater than 0.35. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table JI.5.3b.If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c) If a ceiling,wall,floor,basement wall,slab-edge, or crawl space wall component includes two or more areas with different insulation levels, the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). j Tea CMK Appends 1 Tible J3.2,Ib(eoatlnued) prneriptrve Pseicsga far Qae aAd Two.Fjw4 Raldandal Enildtuga Hated with F°:'0 Fue11 � MAXIMUM MINIMUM •HeatinglCooling Gfig Glaang Ceiling Will Hoar Basemeat order Equipment Et dcncy' Area'('/.) U-value' R-valuer R-value' A-value' A-ws l R valuer Fa�aBe 6701 So 6500 Seatiag Degree Days' I9 6 Namw Q 12% 0.40 3S 13 10 6 Nannal 10 30 19 19 15 AFUE 13 19 10 6 g 12% 0.50 38 N/A Normal T 15% 0.36 3E 13 25 NIA 6 Normal U 1Sy, 0.46 38 19 19 10 N/A 15 AFUE v 15% 0.44 33 13 25 N/A 6 95 AFUE W 15'/. 0.52 30 19 19 10 N/A Normal X 19% 0.32 38 13 25 NIA Normal 19 25 N/A NIA. LzAA 18'/4 0.42 38 6 90 AFUE 19% 19 19 60.42 13 19 l0 3890.AFUE 18% 0.30 30 10 1. ADDRESS OF PROPERTY: 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING: S 9 4, %GLAZING AREA(43 DIVIDED BY#2): 7. 5, SELECT PACKAGE(Q--AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL' YES, NO: q.foans-f980303 a ' From: 413.534-1053 To:Faxk15087906230 Date:4/23,121D?D2 Time:8:56:02 AM Page 2 of 2 RTC-CENTERGYL:LE IRi'0M Fix:i�",�i�nuUS? Rp r 22 2CO3 x` U 4 Town of BRrIlstLble Regulatory services ,sm Thomas r.Gager,Meetar o Building DIVIBIOU Tees Perry, 3UCdgaE Commltslocer 200 Main Stseat, HYI;=iA,NIA 02501 Waco: S08-B62-4#038 Fsx; 08.790.6290 Propeity Owner Must.Complete and Sign This Section If Using A Bandar I / A �,�,O%+tser of the lajjact pmp®rty bmtrby 0.Ll4hOrias t"4 a W act on my behalf, in all=nera zelaave to WWQ authorrju g permit app ation for(address of fob) Owner lets OIL- TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION X( �rJ Map � Parcel �l Permit# J—/ � 7 Health Division � �"�_ �,..,�(L �•��� "' t '� 6LE Date Issued o Conservation Division�/703 ��3 bl (? � Application Fee -^, A FH : (*J Tax Collector �e1 7�`IC (��-- " D(p��a� Permit Fee ISO _ Treasurer -- L ® SEPTIC SYSTEM MUST DE h LI f S f OFF LLED IN COMPLIANCE Planning Dept. WITH TITLE 5 ENVIRONMENTAL CODE ANC . Date Definitive Plan Approved by Planning Board TOWN REGULATIONS Historic-OKH Preservation/Hyannis Project Street Address Village G� Owner Address O P� Telephone JJ Permit Request Square feet: 1st floor: existing proposed vZd 2nd floor: existing proposed Total hew Zoning District Flood Plain Groundwater Overlay R Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes - ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ull 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 y .. 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 plari review# Current Use Proposed Use B ILDER INFORMATION = Name Telephone Number' Address License# f Home Improvement Contractor# &Z 0� Worker's Compensation# f670� ALL CONSTRUCTION DEB ESULTING FRO THIS PROJECT WILL BE TAKEN TO /1 I i SIGNATURE DATE r FOR OFFICIAL USE ONLY i ` PERMif NO. ;k DATE ISSUED I MAP/PARCEL NO. ' J ADDRESS r VILLAGE -1, OWNER DATE OF INSPECTION: . n FOUNDATION O �j O /� 7/2 FRAME " INSULATION FIREPLACE i ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH: e FINAL GAS: ROUGH I F- : : FINAL FINAL BUILDING l `DATE CLOSED OUT ASSOCIATION PLAN NO. u b. A License r; w AM RTF MAi -' +c •m� `n 1 f6 s _ T Rc n R�F4 _egrnstable Water Company I 47 Old Yarmouth Road rnst�a�el�U�ter P.O. Box 326 Hyannis, MA 02601-0326 A SUBSIDWATERARY OF CONNECRCUT SER 7CE, Office:508.778.9617 Fax:508.790.1313 Customer Service:508.775.0063 April 8, 2003 Town of Barnstable Building Inspector Town Hall Hyannis, MA 02601 RE: Service#5255 216 Seventh Ave., West Hyannis Port Dear Sir: Please be advised that the above water service was shut off and the meter removed on November 20th, 2002. The owner has informed us that he intends to raise the house to for a new foundaton and addition to his property. Sincerely, Jane Morse, Clerk Barnstable Water Company ' rrCM: �IQI-;)='--.VJ 10 CVo M•TVcn• UaTs: 1//,CQ-jj Inns::1:V3:iL AM 'rageY CtZ 04/17/2003 TO 09:49 FAX RJ001%003, ' NaTAR Electric&Gat Company,tors.AW200 N AR ON N$1'AR%Iwj,WeAtwo 1,MAIIA htlOM U2090.5230 8L�C TA/C OA i April 17,2003 To Whom it May Concern, The cloetric meter at 216 7 h Avenue in W Hy muueport;Mu, meter 0 1001492 has been Shut off and mnoved by Nstar. ; 3inc=ly, ethy o Cuatoe Rcpres entative Nstar Electric r APR-08-2003 TUE 10:20 AM KEYSPAN ENERGY DELIVERY FAX NO. 5087607611 P. v KoV f' Q,,o� „. 201 Rivn Energy Delivery KI 701 Rivermoor Street (CN:I'fly DG;b't!'y West Roxbury.Massachusetts 02132 Tel 617 723-5512 t April 8. 2003 s rc: 216 70'Ave, W. YIyannisport,MA To Whom It May Concern: This letter is to confirm that all the natural gas services to the above referenced property have been cut and capped at the gatebox. This work was completed by us on April 1 2003. If you have any questions, I can be contacted directly at $08-760-7503, t Sincerely, ... Sally Sinclair Cape Operations ` ai it , The Commonwealth of Massachusetts Department of Industrial Accidents �---- Office offimestiystions 600 Washington Street r Boston,Mass. 021<11 AV�� Workers' Compensation.Insurance Affidavit name: ` location: ci hone# [] I am a homeowner perfqffning al ork myself. I Ole proprietor and have no one working in any capacity I am an employer provid workers' com ensation for my employees working on this job ar r tip "t",�"^ jU P. x .: x a}t yi p.. Y"Sf r� .,F { "Lc"'Yr=�t'-:1, .,�'"�c atwrt, tk„ �`� <+�" >: t ,a fi r 1 ">S. '1S ? - ..F' - I Ecom an.m-ame _.�� 3 ttu ':i7 c-� j�...r > •i,.« GFuh, '[r�,,,St •. "",} t i. 'Y"',r' 'i ,r�rT -� '�iw �?( yy it-iL sSpPo�W,.3+ r 'u<.:d''', i, 'L t-u >r S;tA 3n ~�tt_ 'yMY . ,address s.ti�rf� .,r• i `7-�{t�9,E"fV��F � .�-�,� = a b: cr+•.�'r�i+1tF.fit}o�L:+'`�.. .c fit- t xC ,3 tr h�.r LSI. f�n�.,-'s '' i4..:^4 t y� 3 xx�u'C�`°'�+��'• e ! �%'F�,{�r4: .ki�.ln�'a+',�7�yr's+r 4��. `1 E�' a ^�.''� •} �S�'i t .Sj t7 re�r'..���h�/r,ec,< s�'fd# <z; � 1 `,E".�+ - �tl:�,�,I ONt� v scl �.��s jc 2t" - uTi"11,,''4M�- 3:•'t,•I'�.`.;4•v.`"� t �.� -J y -z KtY.k d'rt's`�ai1r �� �y ITT �_.,. °".�-y�* A '��;..T K; i t [] I am a sole proprietor,general contractor,or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices y ��t .st' ai^'A �t~''��`C i ,.T�'r" k2,t`P' 4• `^ � '•�'�ry, t+� >n^'ru,7;4 P"4>, n� k.4` t; wM.,,:r �� *F y!` I t �^r. r .:..' f : i K,a*l` { z''f'"=sF�.,r�'�t t .. "n "6tfF. k'�M 4 F° N�'`� i.2 •""U r ) F i 6 F 3'<f}i�' iz.,'''"- he a ! J. •r b?'tl 'q £-t+`+� 2. '�...k ..A �'.,h. 4i - a .] Y f : y}1 rj., f '4 -t•-a 't e.-`y 4' 'c aR,' u•-.. ,7i '� R,,ya-ItE1i4°"'J ."WIN, i�•4hi NO, r `?F>n :yF 't tx•r s x tit �- nt'i .c''.' X.'rr� 'LLl3�;r �'ty t01 t U"yr -, ,".};+SZ"ri, xl IPL, #y:+ ( t.. k .Cx t.xtt',z:x.r a"f� i r7 i 'C. vta4.nrt.?v-`".ti`.§` '•) _ a�dre�s ��s r c J- t e"SY6�t "„'�W— IN 5} lwaYn r n x3j 3 i t y, k s l 1 Y�f�s��"� r � Pay$ �" 'N i"� yFkxx C arc ?�� � a tgg dr u .iC IN*v�-X«�nr T cr' '�M 'C" "x t .) .d ? sr`yH.�tark r•.ui...j f,,, ti....ems. y " 3s,.+irS" C'- >YF,..:`���5�t-,� `.�r� 4 E yis'�r •YI?' S ">) u.0 F..r".9�.e �art �,�-.``Y Lr - r,^".�"at"9 -�-+� t�� t 6 t � $3•", r, .e. n t ,�y .y L"EL'`�� '^, �R`Y�vF-'E.�c A 1 +0. I 4 A y� �� ..l��.l� +F J`i S--YF`y •SU� Y q# {F r�;'�s i11lSUt'anC�O�^rt<'r�,rs�,. i'zSet��,s- 3 it�•,3` <•+,r f -r,s �1 _ ;N M t�"+. 44 ❑ ? •t t4v'"-�.r '�'` s 'fi•I{ (,s ^rr r-` f & yC + 7s4 p v' i tS. tt �. r '`- � +;. t "F �.. ' t� Y t x rn I... T` ✓� ar ,µ s�c4 `i Y:tr} 5 r utY � �'.N"�+i Fi*u.�'f�1 �ifi.r-� t . r,<=4$'iy...5, ?.tar ',^,e6t`-px'rr ,�$r•.�,.i {,�+,F'„�'x rT 'E''Y"t `�.. i t �},n 3 ,�. et i .t tk .s t .;; ..,.,5".des t� i,•�<* 6y',y'Njy6T p t„ ,"1l' 'i+,S-'S++r �!�a*s+,-y,1f'.a�•-y-,F'�''>'hdiksr,7VF � fd rt'!! '` Cy I t+Fri z r Ft t �"`'Y<' M �w 7 v `;E t'q'.f�,�"}t„N f4+�rai ef' pL.lkq r trr�'i$- r* h n'}iy3t5. � ?2. .t C C i!'1d S �S 7f4' i (. 3 S/ 1 h rtl� .°t.*✓1 tM1 "`..V f� l y�address ++�h^J� 'r s`t +•�"xtY P�v � +? d s eS , � � n� e �. L Yt �. � 4� 'h .v G .f iiu �. r �` ,?��x�-�'�»•'Fu2�.5iy F�. I *�} -ey'. .r;.{ 't'(�d`'dy.d� *� �i§y.. f..^3''�t} 4'1' - U 5� r��'rt ytl-..YF r;ni •s t3-j'' ,r '*'.0 Y :,ii v �`.J�i'..iCF*4�• - ry f 2: �+fd`�w'�tLvt�✓"�CF_'�.^S. ��x edN X �a�,>ir f.r- � Ei 1 f-�- P rY, � '; -r �X vw �,��m}�� Ir.{.tjt`��*§ fry:ii x+a -s.. 'w. '"h`"'Ex� Kc,.�Ytr,.,,,.s fa 1 s ..-• .y `t z� .,t -..tf 4 s z .f.. x :! Y��,'-•�`�=+y '''fi',t'"'u^' ti .p011QY�iri ...r.«S.r. '>„ Smsurance co � x i Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarde the Office of I es t' lions of the DIA for coverage verification. I do hereby certify under the i pen p ' ry that the information provided above is true and rrect. Signature Date JT C (� Print name Phone# V �� O (/ official use only do not write in this area to be completed by city or town official city or town: permit/license# FIBuilding Department [)Licensing Board []check if immediate response is required ❑Selectmen's Office []Health Department contact person: phone#; (-10ther r (revised 9195 PIN Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual , partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of'a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. IM III Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you'have any questions regarding the"law"or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. XM City car Towns •Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us'a call. 11 IN The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406 -FCI C 9�4 ell, oe 1 C.'F*�Lp 0.6 I-Vtlp-1 VIV -fT Ly 7—t j j 14��l 4j j t: j > w fmt>"f IT 00 PROGREPASPRINT'' 4� .......... -A 03 EL e.> JZK vi �CAL* L 0 ski �;*7 NUMDER -4vi.4��,',V.1-0,vm --,�'��, - -, --I--- -- -- -------,----,----,- -,--, ----, ---- -,-,'-,- ,- - ----.,, --- -,--, - -,----- ------,-- - --- -,-,- I I - I-1----�I I- . I I-1 I I-- -- 11-1. - - - - t ,,v,,�,Wl-iiw-;� ... 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