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0025 SOUTH STREET
'e.�o�J' SDu�-! ST"re,e� =f � Town of Barnstable Building b."n�e,stT iVFrom the Stre 4ARTABL6 *AS& Posed UntilFinal s BeenMa 63 uilngsNbeW d ` Permit ie , :�. Permit No. B-18-3000 Applicant Name: Henry Cassidy 1. Approvals Date Issued: 09/12/2018 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 03/12/2019 Foundation: . Location: 25 SOUTH STREET, HYANNIS Map/Lot 326-120 Zoning District: HD Sheathing: 77*777777,— Owner on Record: THOMPSON GLEED JR&MARIAN G `r Contractor'Name: HENRY E CASSIDY Framing: 1 A Contractor-,License CS-100988 Address: 1413 HOLLOW ROAD 1 2 CLINTON CORNERS, NY 12514 �o �' a �- Est Proj act Cost: $3,600.00 Chimney: Description: 12" R 38 to 80 sq.ft damming, 10" R37 cellulose to 880 sgft open Permit Fee: $85.00 attic space. R 13 to 44 sq ft kneewall, 14 hours air se rili Insulation: Pa $85.00 Feeid a Final: Project Review.Req: - f��; Date 9/12/2018 I 'r- �k Plumbing/Gas, w r ,` Rough Plumbing: { -• `4, ,,Building Official Final Plumbing: Rough Gas: This permit shall be deemed abandoned and invalid unless the work authonzei by this permit is commenced within si months after•issuance. All work authorized by this permit shall conform to the approved application'and the:approved construction documents for which this permit has been granted. Final Gas: All construction,alterations and changes of use of any building and structures"shall be in compliance with the local zoning by laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Electrical work until the completion of the same. Service: it fficials are covidednon this permit. The Certificate of Occupancy will not be issued until all applicable signatures by the Building and F e O p Minimum of Five Call Inspections Required for All Construction Work:l u ;; g 1.Foundation or Footing Rough: 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low.Voltage Rough:, 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy V� Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. �� PP P P q g ,�/� Final: Work shall not proceed until the Inspector has approved the various stages of construction. �' "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department. 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I' __,— � _______. k„ Ago ' a t .I/4..a;-8'3I'} ,1/2%,� loan +. yr fi J J i t r ... ., s �{ .1M• a OY,..i /'♦ rT�� fg1�Y 4 ,sy,� �i 'Y Any �.rro y - v !1 ^. :.., r 1y- t �•^, !"�i+ a+"} a tw: k.... t -• 't �. 'y _,y: ..�.u..y...yr,.,+er.x. .tea...yew.,v..v. �.i»..w<�...4..•.w.+ "."*'rr.s,e.�,- .".':M,N�e..n�. �M ,.J'::C• {.. :.x Cap . t ®' r 7 Z7-15- Town of Barnstable .*Permit# o c L504 c� Expires 6 Mhsfir's e Regulatory Services Fee 1639 ,��' Richard V-Scali,Director t r^ Building Division JUL Tom Perry,CBO,Building Commissioner. 200 Main Street,Hyannis,MA 02601 �U�ttJl' B ;Vb - www.town.barnstable.ma.us r - Office: 508-862-4038 ( Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 3a Property Address Residential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address U U Yl OVi' P 0 , Contractor's Name _ KQ O'Y)1f Telephone Number v50S �7/ ' Home Improvement Contractor License#(if applicable) `�a5l? Email: �� Construction Supervisor's License#(if applicable) 0 IF/113 ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Ar,S,oy ei W b'Iyloya'ki l�iU�Sfi�C�•e.[ [.d Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ' ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris Will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side A•S ,Vj eb j1Waz c Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate:Electrical&Fire Permits required.. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. �. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Q:\WPFILES\FORMS\builds p it forms\EXPRESS.doc Revised 040215 r 13 Jul 2015 9: 32AM HP LASERJET FAX p. 2 Client#:43622 -2MJNA ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDlYYYY) 07/10/2015 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 - Dowling 8 O'Neil AJC No E,1:508 775-1620 AIC No): 5087781218 Insurance Agency EMAIL . ADDRESS: 973 lyannough Rd., PO Box 1990 INSURER(Si AFFORDING COVERAGE NAIC# Hyannis, MA 02601 INSURERA:National Grange Mutual Insuranc INSURED M J Nardone Carpentry,LLC INSURER a:Associated Employers Insurance 299 Whites Path INSURER C: South Yarmouth,MA 02664-1214 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR 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. TRR TYPE OF INSURANCE ADDL SUBM POLICY EFF poo``11CCyy EXP INSR W POLICY NUMBER MM/DD/YYYY MMlDD7YYYY L6JI1T5 A GENERALUABIUTY MPT1209E 3/26/2015 03/26/201 £ACH��(xE:7CURRENCE s1 000000 X COMMERCIAL GENERAL LIABILITY PRRISESIEaENocaurrenoe $500,000 CLAIMS-MADE a OCCUR MED EXP(Any one person) $10 000 PERSONAL&ADV INJURY S1,000,000 GENERA-AGGREGATE $2,OOD,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY PRO- LOC $ AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT Ea acadant I g ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident S AUTOS AUTOS ( ) NOWOWNED PROPERTY DAMAGE HIRED ALTOS AUTOS Per acd Olt $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DIED RETENTION$ g B WORKERS COMPENSATION WCC50050119792015A 12512015 04l25/201 X WC;TATU- OTH- AND EMPLOYERS'LIABILITY IFR ANY PROPRIETORIPARTNER/EXECUTNE YIN E.L.EACH ACCIDENT $500 00O OFnCEPJMEMBER EXCLUDED? a N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500 000 If yyes.describe under DESCPJPTIONOF OPERATIONS below E.L.DISEASE-POLICYUMIT s500,000 )ESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) _"? nsurance coverage is limited to the terms,conditions, exclusions,other limitations and endorsement Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the :overage provided by the policy provisions. 'ERTIFICATE HOLDER CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 - AUTHORIZED REPRESENTATIVE 01988-2010 ACORD CORPORATION.All rights reserved. 4CORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S154399/M154395 LS1 The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 svE�� www mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): MJ Nardone Carpentry LLC Address:299 Whites Path City/State/Zip:South Yarmouth, MA 02664 Phone #:508 771 9927 Are you an employer?Check the appropriate box: Type of project(required): 1.[D I am a employer with 8 employees(full and/or part-time).* 7. ❑New construction 2.7 I am a sole proprietor or partnership and have no employees working for me in 8. bd Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.F_1 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 E] Building addition 4. I am a homeowner and will be hiringcontractors to conduct all work on myproperty. I will ❑ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. • 12.Fl Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 6.❑we are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other 152,§1(4),and we have no employees.[No workers'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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:Associated Employers Insurance Co. Policy#or Self-ins.Lic.#:WCC-500-5011979-2015A Expiration Date:04/25/2016 Job Site Address: t2,,� 'S6(J+t, (f3t City/State/Zip: _ Attach a copy of the workers' compensation policy declaration page(showing the policy nu ber and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00 ' and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify undeerUk thepa/i�n�s an penalties ofperjury that the information provided above is true and correct. Si nature: i t0 Date: Phone#:508 771 9927 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/.License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 4. s Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supen-isor License: CS-081139 MICHAEL J NARHONT I 299 WHITES PATH ( ?I,i P; South Yarmouth MA 02664,;', 2L Expiratior Commissioner 09/16/201f Q '. Office of Consumer Affairs and Business Regulation l� 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 135887 Type: Ltd Liability Corpor Expiration: 5/16/2016 Tr# 250229 M J NARDONE CARPENTRY LLC. MICHAEL NARDONE 299 WHITES PATH SOUTH YARMOUTH, MA 02664 Update Address and return card.Marls reason for change. Address Renewal Employment Lost Card SCA 1 E; 20M-05/11 // C�Xe: ((.'CII[7ll(l i[[C'BClIC�L�C% L(UJC(C�(!J C'(FfJ Office of Consumer Affairs&Business Regulation License or registration valid for individul use only .MtJOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: �- �� egistration: 135887 Type: Office of Consumer Affairs and Business Regulation ;expiration: 5((6/2016. Ltd Liability Corpou 10 Park Plaza-Suite 5170 Boston MA 02116 M J NARDONE CARPENTRY LLC. MICHAEL NARDONE 299 WHITES PATH SOUTH YARMOUTH,MA 02664 Undersecretary of li without signature Town of Barnstable ` Regulatolry SeMces RAMMBLEMAE& � Thomas F. Geiler,Director � i63g. ti0 �16.39.�° Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 _ . . Fax:.508-790-6230 Property Owner .Must Complete and Sign This Section If Using A.Builder as Ownet of the eto subject r l p .p rtY heteby authorize A) to act on my behalf, E in all matters relative to work authorized by this building permit. (Address of job) Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled before fence is installed and pools. are not to be utilized until all final inspections are performed and accepted. i `S�gnattiie of OwIlet S a e of Applicant Ptnt Name Print Name Date Q:FORMS:OVJNERPERMISSTONPOOLS z 7f ` q Commonwealth"of Massachusetts Sheet Metal Permit Date: rmit# 4 �, 03 Z �: Estimated Job Cost:$ b J_ ESS PERUP ,Permit Fee:$ Plans Submitted: YES NO 25 200ans Reviewed: YES `NO Business License# 3(0 ` OWN OF BAR�NSTtMLE Ir App icant icense Business Information: Property.Owner/Job Location Information: Name: Aarmcdof+ R e: Street:A1 L ..uff, Ul t1�l Street: 7, City/Town: 4y.(I� -RY City/Town: Telephone:��C ) ��� 't �� G� Telephone: T Photo I.D.required!Copy of Photo I.D.attached: YES NO �(� Staff Initial J-1/M-1-11nrestricted license �o J-2/M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq.ft./2-stories or less Residential: 1-2 family k Multi-family Condo/Townhouses Other Commercial: Office Retail Industrial Educational Lnstitutibnal Other Square Footage: under 10,000 Sq.ft. over 10,000 sq.ft. Number of.Stories: Sheet metalwork to be completed s New Work: Renovation: HVAC X Metal Watershed Roofing >Kitchen Exhaust System z Metal Chimney Vents Aix Balancing Provide detailed description of work to be done: r INSURANCE COVERAGE: have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch;112 Yes No❑ If you have checked Yes,indicate the type of coverage b checking.the appropriate Y g box below: A liability insurance policy 1 Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑- Signature of Owner or Owner's Agent ` By checking this box❑,I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metalwork and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation:YES NO Progress inspections Date Comments - ]Final inspection, Date Comments' Type of License: BY _ . ❑Master Title Master-Restricted City/Town OJourneyperson Permit# Signature of Licensee liJoumeyperson-Restricted License Number: Fee� El Check at www.mass.gov/dpf f Inspector Signature of Permit Approval ir The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): ru, C Q`f Q Qt1 �Q h�LU �(� Address: ' l L-bWfjCCUyk4q RocJ City/State/Zip: 1 Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1. 4 I am a employercontractor with �Q 4. ❑ I am a general and I 6: ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. # 7• ❑Remodeling ship and have no employees These sub-contractors have ' 8. ❑ Demolition working for me in any capacity. workers' comp.insurance. 9. ,❑Building addition- [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions q ] 3.❑ I am a homeowner doing all work right of exemption per.MGL l LEI Plumbing repairs or additions myself. [No workers' comp. c. 152;§1(4),and we have no 12.❑ Roof repairs insurance required.]t employees. [No workers' 13.V1 Other 4y6 b 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 checicthis box must attached an additional sheet showing the name of the"sub-contractors and their workers'comp.policy information. I am an employer that'is.providing workers'compensation insurance for my employees. Below is the policy andjob site information. , nn r Insurance Company Name: rl rP-0meavLq d c v �Itcx_ Policy#or Self-ins.Lic.#: N W�°1`73(2 142 Expiration Date: OG a015- Job Site Address:a � �11Y I � $Q City/State/Zip: 4 03(Li/1 Attach a copy of the workers' compensation policy declaration page(showing the policy-number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the Doi and penalties of perjury that the information provided above is true-and correct. Signature. Date: 113hq Phone#: D�` 02 Official use only. -Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: > OMMOnIWEALTH,OF,MASSAHUSTTS.:<: rf' ...B...OARUs0: .. .: �►. ::> ..:>SHEET':;F ETAL WORKE:R,S <;<< ; ISSUES THE FOLLOWING<;:L I GENSE,;::::.;<>:: :;;:ASA"T1ASTER—UNRESTRICTED HAR:V;E>CH PORT HTN'G' `CLNG ` ;ANOREW.M -L-Eu`E>S: UE a HARWI CN:::P`012T 461.. LOWER COUNTY` «:,HAW`I`GH PORT.; :;:<.:<NIA 02646-183>t`> <>> 28/.;:1.<6;: =<: : 180482 9..:.. ..... ...... .... ..::: e a o :COMMONWEALTH OF M�96btr HUSETTS:< ; BOAHUMt- <>:>SHEE`fMETAL::>WORKE,R.S;> ;.>> ISSUES THE FOLLOwlo-:L>KENSE,<;;.>..; AS A BUSINESS F AN;DREW M LEVESQUE :;.. HARWICH PORT :N EAT ING AND.,-,COOLIN 461 LQWER> COUNTY>,:>RD::;:<;: : NA'RWV'CHPORT::>,:::..,-.NM 02646 12630 0 4� ACHELT9AWT A, ER - - LICENSE :SSA V& 4a END 4d NUMBER - 031 01,3 NONE 5,6Q4 $ 3 n I JGr�- v �u� �5a2o�>302�?5-��96g M 11 ANDREW MI_MEL s 36 WHIG STREET DENNIS,MA 02638 . * ;- 5 DD 03.73-2013 Rev 07.152009 a 1 a � � a v v a v ► e, a 380arb of Re i.5tration of *beet Aletal N)orker,5 r 30abiug .5atiMieb the requiremeut.5 of ,l.a.5.5arbu.5ett.5 Oeueral law Cbapter 112, *ectiou 237 tbrougb 231 arbit" rb a tttl oo t1� Inc i!5 berebp grauteb tbi!6 certificate no. 361 a.5 ebibeuce to practice a.5 a ce eb *beet fRetal Bu.5t" ne.5,5 on tbi!6 91b bap of J.ap 2011 In Te.5timoup �WYjereof, io bereuuto affixeb the name of the (Executibe �Birertor of the 38oarb all U (Executibe director Mate HARWPOR-02 CLEDDUKE DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 11/13/2014 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: Ann"Pell,CIC,CISR - - Rogers&Gray Insurance Agency,Inc. - PHONE FAX 434 Rte 134 A/c No Ext: A/c No): (877)816-2156 South Dennis,MA 02660 ADDRESS:apell@rogersgray.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Selective Insurance CO. of S.C. INSURED INSURERB:SELECTIVE INSURANCE COMPANY Harwich Port Heating 8 Cooling,Inc. INSURER C:NorGUARD Insurance Company- 461 Lower County Road INSURER D: Harwich Port,MA 02646 INSURERE: INSURER F: - COVERAGES CERTIFICATE NUMBER: 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 TYPE OF INSURANCE ADDL SUER Y LTR POLICY NUMBER MM/D/YYYY) (MM/DDfYYYY1 LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 S1899080 09/01/2014 09/01/2015 -DAMAGE (RENTED 100 OO CLAIMS-MADE OCCUR PREMISESS Ea occurrence $ MED EXP(Any one person) $ 10,00 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,00 POLICY JEC LOC PRODUCTS-COMP/OP AGG $ 3,000,00 OTHER: . $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00 Ea accident B ANY AUTO A9099766 09/01/2014 09/01/2015 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILYINJURY(Per accident) $ AUTOS AUTOS XX NON-OWNED PROPERTY DAMAGE AUTOS P $ HIRED AUTOS er accident $ X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 5,000,00 A EXCESS LIAB HCLAIMS-MADE S1899080 09/01/2014 09/01/2015 AGGREGATE $ 5,000,00 DED I X RETENTION$ 0 $ WORKERS COMPENSATION X PER ATH- AND EMPLOYERS'LIABILITY STATUTE ER C ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N HAWC536127 09/01/2014 09/01/2015 "E.L.EACH ACCIDENT $ 500,00 OFFICER/MEMBER EXCLUDED? "N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT .$ 500,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required). Certificate Holders are additional insureds under General Liability when required by written contractor agreement. CERTIFICATE HOLDER ..: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable THE EXPIRATION DATE THEREOF, .NOTICE WILL BE DELIVERED IN 367 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE " ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01)% The ACORD name and logo are registered marks of ACORD. � g11nNMAaAgi� 'rown of Bay nstable Regulatory Services Richard Scab;Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street; Hymnis,-MA 02601 . ivww.towo,barnstable.ma.ns Office: 503-962-4.038 Fax: 508-790-6230 Property Owner Must Complete atd.Sign This. Section If Using A Builder . s Owner of the subject subj to f1 t ' l Fop heteby authorize tl4fw=Cl� 01 + e4 4 ` r to act on my bebaH, yin all mattets relative to tvotk.authoriz:ed by this binding permit application for: (Add-tess of Job) S atttt o ex Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Eiemption Form on the reverse side. • 1. QAWPPn &\FORWbu11ding permit fort 1smokecarbcndetectors doe Revised 050412 T 'd Xd3 13rN3Sd-1 dH Wd10 T b102 AoW S2 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # Health Division ^, Date Issued Conservation Division _ Application Fee Planning Dept. Permit Fee . Z' Date Definitive Plan Approved by Planning Board Historic - OKH _Preservation /Hyannis C P�� Project Street Address Village ' Owner . Address__42ir Telephone s -77 J /50 Permit Request Z4,s*14) �//AO&I /:Z-7 ,�,aeV Square feet: 1 st floor: existing proposed 2nd floor: existing &00 proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation `d� �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 ,0414o On Old King's Highway: ❑Yes ,9-No Basement Type: ull ❑ Crawl ❑Walkout ❑ Other_ Basement Finished Area(sq.ft.) _ Basement Unfinished Area (sq.ft) A?-3D Number of Baths: Full: existing new Half: existing new Number of Bedrooms: XxZst7ia 6 new Total Room Count (not including baths): existing new &9 __First Floor Room Count Heat Type and Fuel: , Gas ❑Oil ❑ Electric ❑ Other Central Air: des ❑ No Fireplaces: Existing -t— New ._� Existing wood/coal stove: ❑Yes a-No Detached garage:'Cl existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing q new ,size_ Attached garage:JW�existing ❑ new size Shed: ❑ existing ❑ new size _ Other: t= g Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ 0 Commercial ❑Yes .2-Mo If yes, site plan review # T> un --g Current Use � � Proposed Use r�s+ APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name U" Telephone Number ' Address � 9Li•� License AW dZ4_ Home Improvement Contractor# I3"6 7 Worker's Compensation # 4/y&;W_zo ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO A M SIGNATURE , DATE //°o��✓'' 7 f t FOR OFFICIAL USE ONLY APPLICATION# -J _,DATE ISSUED • :i MAP/PARCEL NO. ADDRESS VILLAGE 4" OWNER DATE OF INSPECTION: x , __`FOUNDATION, r` FRAME INSULATION e FIREPLACE f ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL -- -GAS: ROUGH FINAL ,,FINAL BUILDING w t DATE CLOSED OUT ASSOCIATION PLAN NO. 1 The Cornrnonivealth of Massachusetts Department oflndtistrhTlAccidents Office of Invesfigations 600 Washington Street Boston,MA 02111 W1yminass govfdia Workers' Compensation Insurance Affidavit: Mders/Contractors(Electricians/Plumbers Applicant fnformatiou )n A Please Print LegibTY Name(Business/Organizationitndividuai): Address: _901 1�1 G1 City/State/Zip:_ �/{^^� ,./yfll- ®2-C L 1( Phone Are you an employer?Check the appropriate box: Type of project(required); I,&am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I atn a sole proprietor or partner- listed on the attached sheet$ 7. VRemodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity, workers'comp.insurance. g, ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required,] officers have=exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL I LEl Plumbing repairs or additions myself.[No workers'comp. c.152, §1(4),'and we have no 12.]Roof repairs insurance required.]t employees.[No workers' comp.msurancerequired,] 13,❑Other *Any applicant that checks box#1 must also fill oat the section below shoiving their workers'compensation pollcy information; t Homeowners who submit this affidavit indicating troy are doing all work and then hire outside contractors must submit a new affidavit indicating such. IContmetors that check this box must attached an additional sheet showing the name of the sub-contractors and the",orkers'comp.policy information. lam an employer that Is providing.workers'compensation insurance for niy employees Beloty is the policy and job site lrrf6rmaflon, Insurance Company Name:45 so C.i > KIVII,f`G Policy#or Self-ins.Lic.#;L61M 06,S`lf %!?'?Cr201 V If ExpirationDate: Job Site Address: 25--4fA tom" City/State/Zip;Z/ .�kf Attach a'copy of the workers' compensation policy declaration page(showing the policy number and explraflon date), Failure to secure coverage as required under Section 25A ofMGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500,00 and/or one-year Imprisonment,as«ell as civil penalties in the form of a STOP WORK ORDER and a fore of up to$250.00 a day against the violator, Be advised that'a copy of this statement may be fonvarded to tho Office of Investigations of the DIA for insurance coverage verification. f do hereby certoy under the pains an penalties afperjury that life information provided above is true and correct. Signsfore: Alev( .-�-�' Date: Phone#: S _ e Offleial use only. Do not tvrlfe in this area,to be cmgleted by city or totvn offlclaL City or Town; Permit/License# Issuing Authority(circle one): 1.Board of Health 2,BuildingDepartment 3.CityMwn Clerk 4.Electrical Inspector 5.Plumbing Inspector 6,Other Contact Person; Phone#t Client#:43622 2MJNA DATE(MMIDD/YYYY) ACORDT. CERTIFICATE OF LIABILITY INSURANCE 1 0511412014 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). NTACT PRODUCER NAME: Dowling&O'Neil P"o"E(A/C.No Ext:508 775-1620 AIc No): 5087781218 _ Insurance Agency E-MAIL ADDRESS: 973 lyannough Rd., PO BOX 1990 INSURER(S)AFFORDING COVERAGE NAIC# Hyannis,MA 02601 INsuRERA:National Grange Mutual Insuranc INSURED INSURER B:Associated Employers Insurance M J Nardone Carpentry,LLC 1 INSURER C: 299 Whites Path INSURER D: South Yarmouth,MA 02664-1214 wsuRER E INSURER F COVERAGES CERTIFICATE NUMBER: 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 EXCLUSIONS AND BE ISSUED OR MAY SUCH PERTAIN. HE INS SHOE AFFORDED BY THE POLICIES DESCR CLAIMS. BEIN IS SUBJECT TO ALL THE TERMS, POLICI MAY EN LTR ADDLSUBR POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE R POLICY NUMBER MMIDDIYYYY MMIDD/YYYY A GENERAL LIABILITY MPT1209E 3/26/2014 03/26/201 EACH OCCURRENCE $1 OOOOOO POEM, Ea occu ence $600 000 X COMMERCIAL GENERAL LIABILITY MED EXP(Any one person) $1 O OO CLAIMS-MADE a OCCURO PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE $2,000,000 PRODUCTS•COP /OPAGG s2 000,000 GEN'L AGGREGATE LIMIT APPLIES PER: $ PRO-� LOC COMBINED SINGLE LIMIT 1,000,000 A AUTOMOBILE LIABILITY M9T1209E 8125/2013 081251201 Ea accident BODILY INJURY(Per person) $ ANY AUTO BODILY INJURY(Per accident) $ ALL OWNED X SCHEDULED AUTOS PROPERTY DAMAGE AUTOS NON OWNED Per accident $ X HIREDAUTOS X AUTOS $ A X UMBRELLA LIAB X OCCUR CUT1209E 3/26/2014 03/26/201 EACH OCCURRENCE $5 000 000 AGGREGATE $5 000 000 EXCESS LIAB CLAIMS-MADE DED X RETENTION$10000 WC STATU- OTH- B WORKERS COMPENSATION WCC50050119792014A 4125/2014 04/26/201 X TORY I IMITS AND EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $5OO OOO Y/ ANY PROPRIETOR/PARTNER/EXECUTIVE N OFFICERIMEMBER EXCLUDED? a NIA E.L.DISEASE-EA EMPLOYEE $500 OOO (Mandatory In NH) If yes,describe under E.L.DISEASE•POLICY LIMIT s6OO,OOO DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CANCELLATION CERTIFICATE HOLDER SLD ANY OF THE ABOVE DESCRIBED lEBCANCELLED BEFORE HE TEXPIRATION DATE THEREO NOTICE WILL BE DELIVERED N ARDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD LS1 #S130451/M130450 t f Massachusetts -Department of Public Safety ! Board of Building Regulations and Standards Construction Supenisor � License: CS-081139 MICHAEL J NARBONE,t_-<.-. ' F " i 299 WHITES PATH zN h �A.,' - " South Yarmouth NIA OU4 :s i Expiratior Commissioner 09/16/201; &XIS f04)")1W1)?1(Ve1(Z1b111?11 a"— (11jJC1C11?1((1jeffi q Office of Consumer Affairs and Business Regulation �—� 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 135887 Type: Ltd Liability Corpor Expiration: 5/16/2016 Tr# 250229 M J NARDONE CARPENTRY LLC. MICHAEL NARDONE 299 WHITES PATH SOUTH YARMOUTH, MA 02664 Update Address and return card.Mark reason for change. Address Renewal Employment Lost Card SCA 1 ES 20M-05/11 ` r✓�`Consumer Affairs ss Regulation License or registration valid for individul use only Office of Consumer Affairs&Business Regulation g Y I �_M—Fgffi 10ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: I, _ e istration: Type. Office of Consumer Affairs and Business Regulation I_ -_•- � 9 135887 Yp l , Y CorP Ex ration: 5116/2016 Ltd Liability of 10 Park Plaza-Suite 5170 . _'` p Boston,MA 02116 M J NARDONE CARPENTRY LLC. MICHAEL NARDONE 299 WHITES PATH g �o SOUTH YARMOUTH,MA 02664 Undersecretary lloj li without signature � a�nxsreSta,, 3 Towi n of Barnstable Regulatory gervices Richard Scall,Director DuDding Division Thomas-Parry,CBO Buildiag Commissioner 200 Main Sheet; Hyannis,MA 02601 ivrv�v town.barustalsIe:ma.us Office. 508-862-4038 Fax; 508 790-6230 Property Owner.must Complete and Sign This Section If Using A Builder t MwOwner o£the subject xo�— •--- i-- --�-- 1 P P 9 hereby authorize KT oqe- 65"t 44r' to act on my bebA ua all matters relative to work autho&ed by this building permit application for,. (Address of job) Signature of er Date me-- A .,L.a Phut Name HProperty Owner is applying for permit,please complete theHomeowners License):exemption Form on the roverse.side. Q:tvrPPlt.B55T+ORMglbnfiding permit Rnnulamok�carbondoDeotorsdao Revised 050412 i Mass. Corporations, external master page Page 1 of 2 William Francis Galvin Secretary of the Commonwealth of Massachusetts Corporations Division Business Entity Summary ID Number: 001147591 j Request certificate I 1 New search J Summary for: FAE 45312OR THOMPSON, LLC The.exact name ofAhe Domestic Limited Liability Company (LLC):. 'FAE 453120R.� THOMPSON, LLC , Entity type: Domestic Limited Liability Company (LLC) Identification Number: 001147591 Date of Organization in Massachusetts: 09-23-2014 Last date certain: The location or address where the records are maintained (A PO box is not a valid location or address): Address: C/O HAYES & HAYES 23 EAST MAIN STREET City or town, State, Zip code, WEST YARMOUTH, MA 02673 USA Country: The name and address of the Resident Agent: Name: rSTEP_HEN P. HAYES` Address: 23 EAST MAIN STREET City or town, State, Zip code, WEST YARMOUTH, MA 02673 USA Country: The name and business address of each Manager: Title Individual name Address MANAGER MARK A..BULLOCK 215 S STATE ST, SUITE 380 SALT LAKE CITY, UT 84111 USA In addition to the manager(s), the name and business address of the person(s) authorized to execute documents to be filed with the Corporations Division: Title Individual name Address The name and business address of the person(s) authorized to execute, acknowledge, deliver, and record any recordable instrument purporting to affect an interest in real property: Title Individual name Address http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary... 11/20/2014 Parcel Detail Page 1 of 4 iL a STAB -{ MASS 'QUA}ffiNt E Logged In As: Parcel D2tc�I I Thursday, November 20 2014 Parcel Lookup Parcel Info Parcel 326-120 ( Developer ID Lot' _ Pri Location'25 SOUTH STREET Frontage 205 Sec - Sec, Road I Frontage ............. Fire Village HYANNIS JHYANNIS District Town sewer exists at this Road - --- �— -� -.._...-.... -------------_.... ..... 1511 address ;Yes Index' Interactive ' � Map3 A 11wY�: Owner Info .... _ ._._. Co Owner IGODDARD,ALLEN C&THOMAS A& Owned%FAE 45312OR THOMPSON LLC f Streetl r215 SOUTH ST SUITE 380 Street21 City SALT LAKE CITY State[ Zip 84111 Country Land Info Acres 0.65 Use EMulti Hses MDL 01 Zoning'HD J Nghbd o110 TopographylLeveh Road Paved Utilities [All Public Location'Waterfront,Excel View Construction Info Building 1 of 2 Year, Roof ROOfi Gab le;Hip I EXt'Aluminum Sidn Built' Struct I Wall' Levin ------- Roof ---- --_ AC _ 9 2064 �Asph/F GIs/Cmp None i Area' Cover Type' -- - Int -- - - Bed _ Style Conventional Wall Plastered Rooms'4 6earooms - - Int - -- _. .- Bath E- Model;Residential Floor Pine/Soft Wood ROOmS,2 FUII+ 1H Heat Total http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=27412 11/20/2014 -zs opIKErgk, Town of Barnstable *Permit Expires 6 month from issue date d Regulatory Services Fee * BARNSfABLE, v Mass.1639. � Richard V.Scali,Interim Director �fD MAC a - Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Map/parcel Number 3 Z A/?Z 6 Not Valid without Red X-Press Imprint Property Address O2 ,5- 366T 4 g� Residential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address L 044-k—_ Contractor's Name w4 A)AR-06A 67- Telephone Number Home Improvement Contractor License#(if applicable) �.3� � Email: VLt 1�-t a (/►il (/sq/,Ct�lrlrti Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one:ElI am a sole proprietor OCT 20 2014 ❑ I have the Homeowner TOWN ®F D/1 RNSTt1 BLC I have Worker's Compensation Insurance ®t�9 i�'U 1 ei C Insurance Company Name �5 ( �� Workman's Comp.Policy# WOL's- j q ? 4— Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box)Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to �t�(NM&.4- Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is re wired. SIGNATURE: T:\KEVIN D\Building Chan s\ RESS PERMIT\EXPRESS.doc Revised 061313 The Coninionivealtli of Massachusetts Department of lndustri r1 Accidents Offlce of Investigations 600 Washington Street Boston,M4 02111 lmminass govhlia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LegibTy Name(Business/Organizatiordrndividual):_ r`�(e v X14VWe076r_ �in z—d Address: C L2xxies City/State/Zip:J' //M?*Pl ,AV4- ®2e L'( Phone Are you an employer?Check the appropriate box: Type of project(required): I.d6:I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-ti=).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet,I 7 emodeling ship and have no employees These sub-contractors have S. ❑Demolition working forme in any capacity, workers'comp.insurance. g, ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their l0.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself.[No workers'camp, c.152, §1(4),'and we have no 12,0 Roof repairs insurance required.]t employees.[No workers' comp.msurancerequired,] 13.❑Other ;Any applicant that checks box#1 must also fiti'oat the section below showing their workers'compauation policy information: t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new of idavii iridiceang such. lContraeturs that check this box must attached an additional sheet showing the name of the sub-contractors and theirwukers'comp.policy information. I am an employer that IsprovIding iporker, 'compensa(lon hisarance for ruy employees. Below is the policy and job site irrformailorr, Insurance Company Name: -so 0-i ) 4/ Policy#or Self-ins.Lic,#;L 1d&0d,-/'10?C12_0/4f If Expiration Date: Job Site Address: 02'� S66-M ill - City/State/Zip; t, a2�0 Attach a'copy of the workers' compensation policy declaratlan page(showing the policy num er and exl4atlon 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 Nveli as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator, Be advised that'a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certoy ander thepai//ns an penaliles ofperjury that the informationprovidedabove is true and correct, Sig Listure: Date: Phone#: S Official use only. Do not sprite in this area,to be completed by city or town offlciab City or Town, Permit/License N. Issuing Authority(circle one): 1.Board of Health 2,Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: i 2MJNA DATE(MMIOD(YYYY) ., Client#:43622 ` CERTIFICATE OF LIABILITY INSURANCE .0611412014 ,. fRnFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS rGE-AFFORDED BY THE POLICIES W C HIS CERTIFICATE OF INSURANCE DOES NOT CO STITUTE A CONTRACT END,EXTEND OR LBETWEEN THETER THE ISSUINGISSU NG INSURER(S),AUTHOR ZED O EPRESENTATiVE OR.PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTS and conditionis of the policy,certainCate holder is an DpoliiciesL ay(requiiire an endorsement.nt A statement on this BertOif cafe does notconDfer rights to the the term certificate holder in lieu of such endorsement(s). ONTACT PRODUCER NAME: 5087781218 PHONE 508 775-1620 a/c No Dowling&O'Neil Alc EXt EMAIL Insurance Agency ADDRESS: NAICO 9731yannough Rd.,PO BOX 1990 INSURER(S)AFFORDING COVERAGE Hyannis,MA 02601 INSURER A:National Grange Mutual insuranc INSURER B:Associated Employers Insurance INSURED M J Nardone Carpentry,LLC I INSURER C 299 Whites Path INSURER D: South Yarmouth,MA 02664-1214 r7 wsuRERE: INSURER F REVISION NUMBER: COVERAGES CERTIFICATE NUMBER: THIS I TO 1-- INDICATED. ICY PERI VE FOR THE PO NOTWITHSTANDING ANY CREO�IREMENRA TERM I OR DCONDIOT ON OFHAVE BEEN ISSUED TO H NAMED O ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO LWHICH THOIS 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 LI Y EFDF B POLACD AIMS. XP LIMITS TR R ADDL SUBR POLICY NUMBER MMIODIYYYY MMIDDIYYYY - TYPE OF INSURANCE N R WVD 312612014 03126/201 EACH OCCURRENCE $1 000000 A GENERALLIABILITY MPT1209E pAMA�E T RENTED $500 OOO PREMISES Ea occurrence X COMMERCIAL GENERAL LIABILITY MED EXP(Any one person) $10 000 CLAIMS-MADE a OCCUR PERSONAL&ADV INJURY $1 (100-000 GENERALAGGREGATE $2,000,000 PRODUCTS-COMPIOPAGG $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: $ PRO- LOC COMBINED SINGLE LIMIT $1,000,000 POLICY T M9T1209E 8/2512013 08126/201 Ea accident A AUTOMOBILE LIABILITY BODILY INJURY(per person) $ ANY AUTO BODILY INJURY(Per accident) $ ALL OWNED X SCHEDULED PROPERTY DAMAGE. g AUTOS AUTOS per accident NON-0WNED g X HIRED AUTOS X AUTOS GUT1209E 3/26/2014 03126/201 EACH OCCURRENCE $5 000 000 A X UMBRELLA LIAB X OCCUR - AGGREGATE - $5 000 OO EXCESS LIAB CLAIMS-MADE $ DED X RETENTION$10000 WCSTATU- OTH- B WORKERS COMPENSATION WCC50050119792014A 4/2512014 041251201 X AND EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $5OO OOO ANY PROPRIETORIPARTNER/EXECUTIVE Y I N E.L.DISEASE-EA EMPLOYEE $500 OOO OFFICER IMEMBER EXCLUDED? N FA (Mandatory In NH) E.L.DISEASE•POLICY LIMIT $500,000 If yes,desc' under DESCRIPTION OF OPERATIONS below If more space Is required) DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD101,Additional Remarks Schedule, tions exclusions,other mitons and endorsements. Insurance coverage is limitedlficate of insurance to the terms, lshall�be deemed to have llaltered,waived,or ext nded the Nothing contained in the cert coverage provided by the policy provisions. CANCELLATION CERTIFICATE HOLDER. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE �?- ` ©1988-2010 ACORD CORPORATION.All rights reserved: ACORDof 1 The ACORD name S1304511M130450 and logo are registered marks of ACORD LS1 1t Massachusetts -Department of Public Safety Board of Building Regulations and Standards _. Construction Supen-isor , License: CS-081139 MICHAEL J NAR#ONE�,� 299 WHITES PATH r' South Yarmouth.A1[A 02664 S.G ` Expiratior Commissioner 09/16/201! Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 �~ Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 135887 Type: Ltd Liability Corpor Expiration: 5/16/2016 Tr# 250229 M J NARDONE CARPENTRY LLC. MICHAEL NARDONE 299 WHITES PATH SOUTH YARMOUTH, MA 02664 Update Address and return card.Mark reason for change. Address Renewal n Employment Lost Card SCA1 0 20M-05/11 d/e`Fo„r1jrancoealf/r c f C%ll1jic(dw,:eCfr Licerise or registration valid for individul use only �. Office of Consumer Affairs&Business Regulation g y SOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: registration: 135887 Type: Office of Consumer Affairs and Business Regulation Expiration: ._,5_/16/201-6; Ltd Liability Corpo.. 10 Park Plaza-Suite 5170 >� Boston,MA 02116 M J NARDONE CARPENTRY LL . MICHAEL NARDONE 299 WHITES PATH g �a SOUTH YARMOUTH,MA 02664 Undersecretary of li without signature r�asF� 116; Tows n of Barnstable Regulatory gervices Richard Scall,Director • Building Division Thomas Parry,CBo Building Commissioner 200Matu Stcee� Hyaa KUA 02601 i Ww town.barnstableana.us Office; 508-862-4038 Fax: 508 790-6230 Property Owner Must Complete and Sign This Sectioti If Using A Builder f MAV-VA'?S�W ti A l�Owxter of the subject property � 1 heteby authozsze N►.1 A?�,r�onc �af Q L-t- to act on uzy behalf, in all matteiis xeJabive to wo�s authorized by this budding pwnit application fox: 5ou4 K S4- r nn.s M A (Address ofjob) L/ U%AL6jkYE:: — Signature of bivnet Dane Print Nsme HProperty Owner is applying for permit,please complete theHomeowners License Exemption Form on the reverse side. Q:iWPP7L1f51t�QRM3lbnfldtng pnnr►(t R►rm4ls�nokec�bondeteotorsdoo . Revised 050412 I if _ s 3 Corporations Division Business Entity Summary ID Number: 001147591 Request certificate f ,New search Summary for: FAEt453120R THOMPSON, LLC The exact name of the Domestic Limited Liability Company (LLC): FAE 45312OR THOMPSON, LLC Entity type: Domestic Limited Liability Company (LLC),. Identification Number:001147591 Date of Organization in Massachusetts: 09-23-2014 Last date certain: The location or address where the records are maintained -(A PO box is not a valid location or address): Address: C/O HAYES & HAYES 23 EAST MAIN STREET City or town, State, Zip code., WEST YARMOUTH, MA' 02673 USA ' Country: The name and address of the Resident Agent: Name: STEPHEN P. HAYES Address: 23 EAST MAIN STREET City or town, State; Zip code;. WEST YARMOUTH, MA 02673 USA Country: The name and business address of each Manager: Title Individual:name Address MANAGER MARK A. BULLOCK 215 S STATE ST, SUITE 380 SALT LAKE CITY, UT 84111 USA In addition to the manager(s), the name and business address of the person(s), authorized to execute documents to be filed with the Corporations Division: Title Individual name Address The name and business address of the person(s) authorized to execute, acknowledge, deliver, and record any recordable instrument purporting to affect an interest in real property: Title Individual name Address http://Corp.sec.state.ma:us/CorpWeb/CorpSearch/CorpSummary... .11/2Q/201 I.i �u t , Logged In As. Thursday, Pa rcel ®eta 16 November 20 2014 Parcel Lookup z ® Parcel info ParID 326 120 —._-__-._ Developer,_w____ Lot Pri Location 25 SOUTH STREET Frontage' Sec--------- - - _--- --- "—_ -- " Sec------------ ----.._ Road � � Frontage' ------ ------� Village;HYANNIS Fire HYANNIS District Town sewer exists at this Road _.._.__.__.._._.__ address Yes — ( Index;1511 Interactive` F, y Map 1 - a Owner Info .... ...... _ __ ... ..... _ Co -. Owner.GODDARD,ALLEN C&THOMAS A& /oFAE 45312OR THOMPSON LLC Owner Streets+215 SOUTH ST SUITE 380 Street2 I SALT LAKE CITY — ---- - --- Y; State;uT Zip841i1 Country; City !SALT Info , Acres :0 65 Use Multi Hses MD Zoning!--- OnlnL 01 'HD g Nghbd20110 Topography!Level _- Road.Paved Utilities ;All Public Location'Waterfront,Excel I v Construction Info Building 1 of 2 Year1942-__.. M__..__' RooffGable/Hip -_--I EXtAluminum Sidng Built Struct Wall Living - - - Roof -_-- AC - 2064 ;Asph/F GIs/Cmp 1None 7 7 �. Area Cover TY PC; ' - Int-- --- -----.._.:.._. Bed --- , Style;Conventional Plastered 4 Bedrooms Wall. Rooms _ Ir :_. . Model;R nt ;Residential Floor Pine/soft wood` Bath� Rooms 2 Full+1H Heat Total http://issgl2/intranet/propdata/Par(,,elDetail.aspx?ID=27412. `11/20/20.14 Map �3 S v�-z Parcel Permit# j a,;P,40 _ House#- AS Date Issued oor)(8:15-9:30/1:00-4;6) Fee: 1�s 0Z Co oor)(8:30-9:30/1:00-2:00) _ - 1 Admin. Bldg.) TNE 'ng Board 19 BARNSTABLE. - /1/�_ . �.. � /J MASS /KO,�•^ir__v 21 �VIOWN YB TABL ° O ARKS E Building Permit Application , Pr ddress 25 South Street , V lage Owner X La.nsdon Jaddard Address camp Telephone Permit Request RP Roof R.. S ' r .First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ 2 ,000 ' Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No 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 No.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 Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name John A LeBoeuf Telephone Number 7 7 8—5 0 0 4 Address 35 Princess Pine License# 01061 Hyannis Mass Home Improvement Contractor# 117 8 7 2 Worker's Compensation# 8 9—7 5 0 9 7 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES.ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ya rmouthk SIGNATURE DATE 7— f BUILDING PE T DENIED FOR THE FOLLO ING REASON(S) �N. • FOR OFFICIAL USE ONLY PERMIT NO. L - - , _ - DATE ISSUED' , MAP/PARCEL#NOt` a .s •t i ADDRESS VILLAGE OWNER DATE OF INSPECTION:. FOUNDATION r r FRAME r 'INSULATION FIREPLACE r ELECTRICAL: ROUGH _ FINAL - s PLUMBING: ROUGH FINAL - GAS: ROUGH FINAL '- - FINAL BUILDING DATE CLOSED OUTf ASSOCIATION PLAN NO. . t r - i dtlre - . ° The Town of Barnstable �$ Department of Health Safety and Environmental Services Building Division 367 Main Stteet,Hyannis MA 02601 Office: 308-790-=7 mph Crossen Building Commission. Fax: 509-790-6230 For oorce use only <i Permit no. Date AFFIDAVIT HOME mWROVEMENT'CONTRACTOR LAW SIUPPL MENT 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: ReRoof Est.Cost 2,000 q Address of Work: 25 South Sreet Hyannis Mass 02601 Owner's Name Langdon Goddard 7-21-98 Date of Permit Application: ' I hereby certify that: Registration is not required for the following reason(s): _Work ezciuded by law Job under SI,000. _Building not owner-occupied _Owner pulling own permit e 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 SIGpM UNDER PENALTIES OF PERJURY I hereby apply for a.permit as the agent of the owner. 7-21-98 John A LeBoeuf 117872 Date Contractor Name Registration No. OR Date Owrter°s Name _- The Commonwealth of Massachusetts Department of Industrial Accidents - --.. .r Office eflnlyesaffloaos 600 Washington Street Boston,Mass. 02111 Workers Compensation Insurance Affidavit �''�"u'ii'�✓'a'"" mat '"€1�/"'///////////////�%%�%%%�%%%%%%�%%i� �"��"��('�'�/%�%////%//////�%�%//////%�%/���%///////���%%�%�/O/��%' name: location: city phone ❑ I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one working in anv capacity /%///%/// %////%%%///%//////%%//%/%%%///%%//%%/%////%%////////////%%//%///l/%/////%/%%%//%//%%//%%//%//%%/%%///%/%////////%//%/////////%///%%%�/%////%%%///%%%%%/%/%/%/, ® I am an employer providing workers compensation for my employees working on this job. compnnvname The Rentator Building Company • address 35' Princess pine r city uVANNTc M Qp phone#: 77R snn� insurance co. Sentry olicv# 89-75097 ❑ 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: com any name: address: city phone#: msurnnce co ROIJ&# ' ///////////i%////%//// cam anv name: -. address• cih,, phone#: .. insurance co. RON&# Failure to secure coverage as required under Section 25A of NIGL 152 can lead to the imposition of criminal penalties of a fine up to SI,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Ofnce of Investigations of the DIA for coverage verillcation. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature Date - Print name John A LeBoeuf Phone# 7_ 8-5l1Q4 ofIIccial use only do not write in this area to be completed by city or town oflicfal city or town: permitAicense tt ❑Building Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑Health Departinent contact person: phone#t ❑Other (mmsed 9195 PIA) , ' 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 contaac 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 . 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 o: 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 renew of a license or permit to operate a business or to construct buildings in the commonwealth for any,applicant who ha 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. PRIMP MR 111IN In 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. 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 returned 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 _ Office of Investigations 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406,409 or 375 it'll il HOMEINDROVENENTCONTR`ACOR (+ TYpe.�J;IHDI IDUAL•` ' ; �`t2/12798 rt j��•ca; BOEUFt : yY` '' r JQlNxf LEBOEUFr ' v 5 o !dt ;Z " Q RINCES`PINE RD 'r "� r}' �ao� rs�ato �,y �AN�FISl�A2601 r, : RE-ROOFING If located in OKH or Hyannis Historic District-Certificate of Appropriateness required unless same color/same materials specified on application Map/parcel number / Sign-offs from Tax Collector #of squares of shingles or square footage of roof to be shingled specify stripping old shingles or going over old roof. If going over how many roof layers ex' 'ng now ` — -- - - what size are rafters? f . What is span? Complete dwelling inform n for the essor's Dept.-if known Workerman's Comp. form / Home Improvement Contractor Affidavit(RESIDENTIAL ONLY) Home Improvement Contractor's License + OR Homeowner's License Exemption(RESIDENTIAL ONLY) Check expiration date on license COMMERCIAL WORK-No License is required. Fee q-forms-PERMITS I Rev 6/2/98 MR ARCHITECTS,INC ARCJB'[¢CI8•1M131L101tI1Pffi@iW19•sTmnmLR 299 WHITE'S PATH SOUTH YARMOUTH. MASSACHUSErtS, 02884 tW (508) 382-8883 (508) 760-28M fax(5W) 780—WW i DINING WWW.ERTAROIITECTS.COM EXISTING r---------------' r-- ' CONDITIONS AT: 25 SOUTH ST. HYANNIS MA I I I I -- I I 1 ,REMOVE WALLS _ STAND UP SHOWER STALL PREPARED FOR: Y EXISTING WALL iI KITCHEN 1 REUSE L F HAF II E F FROM EXISTING REMOVE WALL AND DOOR. GLEED & MARIAN -COULD BE KEPT IF DESIRED i. BUMP WALL TH O M P S O N I 3'-0" i ON BATH 1413 HOLLOW RD CLINTON CORNERS — — NY Aal NEW CLOSET I 3'-0' TNESE PLANS ARE NOT TO BE USED EXISTING WALL O S ESE'Mrn OR CAFONSTR E.E.I UCRON FU MTNAN gN TAE CCT STAMP AND 4GNAIURE 4:MARKED RI - AS"PERMIT SET"OR"CONSTRUCTION SET". LINE OF SEWER PIPE g�LOW © ARCHITECTS.INC INC DRAWINGS AND 1 U LINE OF FOUNDATION WALL BELOW 2oM[RT RANCEMENTs({ AL T IDEAS.AR DESIGNS.AND BANSHE IND GATED THEREON OR REPRESENTED X 1HFRERT,ARE OWNED BY AND REMAIN THE PROPERTY - --- OF ERT ARCNTECTS.INC NO PART THEREOF SHALL SECTION � PROPOSED STAIR BFORTµEY MRPOSE.EXCEPT WTM��`IC W'TE" F PERMISSIONa E ERT CWTECiS,INC SHOWING DIMENSIONAL EXISTING MAIN HOUSE 1 ST FLOOR PLAN REQUIREMENTS SCALE 1/4' PROJECT N 321014 : = 1'-O" DATE ISSUED: ------------------------------------------------------------------------------------------------------------------------ REVISIONS: I Y 1 '-8, 1 '-4" 8'-9 1 3'-0" PERMIT SET PROGRESS SET • j PRICING SET CPROGRESS SET el } REGISTRATION I ' s TI f 7'-4'+LI r1l I 5i 0 3'-4 1 2 4'- 1 4" 3'-8 3 4" 3'-9 1 SCALE: 1/4'-1'-0' r2 0 1 2 4 8 UNLESS OTHERWISE NOTED. • 99 qjIvi 4 SHEET NO. Ill Si 7 T-a 1 4" 3._B.. g,-T" 1. �_D TOTAL NUMBER : SHEETS {t� IN SET: I _________________________________________________________ __________ ----------------------------------- THIS SHEET INVALID UNLESS ACCOMPANIED BY EXISTING MAIN HOUSE 2 N D FLOOR PLAN A COMPLETE SET OF SCALE:t a'=P-o' WORKING DRAWINGS t i