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CAPE COD TOWN Of BAR��';'qTAIYIA at
INSULATION °
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FIBERGLASS SEAMLESS MAT I.A. 5G5iENGEG
RAT GUTTERS INSULATION CEILINGS
1-800-696-6611 DIVISIOMI
Town of Barnstable
Regulatory Services
Building Division
200 Main St
Hyannis, MA 02601
Date: /0/i / a...
Dear Building Inspector
Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. Performed&
completed the insulation and weatherization work at the property listed below. Cape Cod
Insulation did this in accordance to the specifications listed on the building permit
application. All work has been inspected by a certified Building Performance Institute
(BPI) inspector. All work preformed meets or exceeds Federal & State Requirements.
Property Owner Property Address Village
Awlle,l- y'klwz A/*c,' ,25-41clmM,915-1 e ¢. LC4L-01 44AA I
S
Insulation Installed: Fiberglass Cellulose . R-Value Restricted Unrestricted
Ceilings ( ) (jC) (3 5*1
Slopes ( ) ( ) ( ) ( ) ( )
Floors ( ) ( ) ( ) ( ) ( )
Walls ( ) 04 ( '1, W)
C'earl. CX) �0) X,
G Ad. p��� �NO d
Sincerely
He yWsidysident
Cape c.
5�eTOWN OF BARNS A E BUILDING PERMIT LICATIO
51 /� S
Map Parcel V ► V Application # ��
Health Division Date Issued 1 Z--
Conservation Division Application Fee
Planning Dept: Permit Fee 1
Date Definitive Plan Approved by Planning Board ���--
Historic - OKH _ Preservation/Hyannis
Project Street Address �� g�z�4v e
Village
Owner Address S
Telephone .f2j721� 4.2,-�,CC
Permit Request
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District _Flood Plain Groundwater Overlay
Project Valuation . Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units)
Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No
� --q
ER
Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other ..'
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq ft)!
Number of Baths: Full: existing new Half: existing a neG�
Number of Bedrooms: existing _new ==
Total Room Count (not including baths). existing new First Floor Room Count
Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other
Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No
Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_
Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes ❑ No If yes, site plan review#
Current Use Proposed Use
APPLICANT INFORMATION
/ (BUILDER OR HOMEOWNER)
Name apt ca ,�L�J�T�s,I� Telephone Number
Address ,L�/2� �.� License # /6 z�1
Home Improvement Contractor# �� 7
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE 1le, DATE `�
FOR OFFICIAL USE ONLY
APPLICATION#
1 DATE ISSUED
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER
'r
DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION
i
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
'.i
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
OWNER AUTHORIZATION FORM
(Owner's Name)
owner of the property located at
i Ln
L (Property Address)
l'T �S II
(Property Address)
hereby authorize
Cseiv e Co d(. �TKs J (CX 10^j ,
(Subcont or)
an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building
permit and to perform work on my property.
Owner's Signature
Date
IV
10 Park Plaza - 'Suite 5170
Boston, Massachusetts 02116
Home lmprovement Contractor Registration
Reqistration: 153567
Type: Private Corporation
Expiration: 12/15/2012 Tr# 206433
CAPE COD INSULATION, INC
HENRY CASSIDY
455 YARMOUTH RD.
HYANNIS, MA 02601 _.... __
:Update Address and return card. Mark reason for change.
L AddressRenewal . Employment Lost C
ard
JPS-CAI (i _10NI-04r04-6101216
Office• ( Sumer Affairs�iBu,ne'iRcgul•itiou Licewse or registration valid for individe! use
0. HOMEPf'b� �`Iff�`fF�C71t7fAC f19!"��c�aelGi before the expiration dale. if found return to:
E k Registration: 153567 Type: Office of Consumer Affairs and Business Regulation
I� Expiration: 12/15/2012 Private Corporation 10 Park Plaza-Suite 5170
z ;k Boston,MA 02116
S OD INSULATION, [NO
HENRY CASSIDY
455 YARMOUTH RD,
HYANNIS,MA 0260:1 Underseeretary t alid ith t si ture
' VASS 1ihusetts-:Dcl►artment of Public Safet%
Board of Building Regulation. anti Stan(I.u•d.S
m Qonstruction Supervisor License
License: cS 100988
HENRY CASSIDY
8 SHED ROW
WEST�ARMOLITH, MA 02673
Expiration: 1 1/1 11201 3
(ulnn i .i,nrr Tr#: 7620
,
4. Lv I L i I rlvi No. 1605 F. I
Client#:4597 CCINSUL
ACORD,,, CERTIFICATE OF LIABILITY IN DATE(MMIDDIYYYY)
INSURANCE
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.ITHIS2
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTrrul E A CONTRACT BETWEEN THE ISSUING INSURFR(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT:If the carilfiCate holder is an ADDITIONAL INSURED.the policy(ies)must be endorsed.If SUBROGATION 13 WAIVED,subJect to
the terms and conditions of the policy,Certaln policies may rugUlra an endorsement.A 6tatement on this certificate dues riot GOrll'er 6916 to(lie
certificate holder in lieu of such endorsement(s).
PRODUCEk
CONTAC
Rogers&Gray Ins.-So.Dennis NAME: Mar aret Young
PHONE 506-760-4602 F
434 Route 134 AIc Na Exl: AIC No: 677.816.2156
E-MAIL --
South Dennis, MA 02660-1601
508 398-7980 _INSUR�R(0)AFFORDING COVERAGE NAIC 8
wsURtRAtPeerlessInsurance 18333
INSURED` —'"---
Cape Cod Insulation Inc INSURERB:Evanston Insurance Company
455 Yarmouth Road INSURERC:Atlantic Charter Insurance
Hyannis,MA 02601 INJURERD:COminerce Insurance Company _34754
INSURER E:
I1,161ARER F;
COVERAGES CERTIFICATE NUMBER: T REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED hCl_OW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIRUMENT, TERM OR CONDITION OF ANY C014TRACT 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 PRAY HAVff BEEN REDUCED BY PAID CLAIMS.
R TVPE OF INSURANCE ADDL SUER POLICYEFF POLICYEiI
POLICY NUMBER WMIDDIYYYYI IMM10DNyvYwLIMIT&
A GENERAL LIABILITY COP8263063 0410112012 04/01/2013 EACH OCCURRENCE $1 00O OOO
X COMMERCIAL GENERAL LIABILITY �� C�ET ELATED $1000UO
IS a atturrence
CLAIMS-MADE
�OCCUR
MED EXF(Any ona person) - 5 000
PER$ONA4&ADV INJURY $1 OQO OOO
` GENERALAooReGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER; PRODUCTS•COMPIOP AGG $2 QUU OLIO
POLICY PRo- LOC
p auroNlaelLeuAe(LiTv
Ea auident 12MMBCKVMK 4101/2012 04IO1/101' COMBINED SINGLE LIMIT
1 00U 000
ANY AUTO - BODILY INJURY(Pcr i,cr:j) $
ALL OWNED SCHEDULED _
_ AUTOS x AUTOS BODILY INJURY(Per accidanl) S ^l
X HNON
IRED AUTOS X AUTOSWNED PROPERTY AM
(For ficcultifliL_
S
&
TB UMeRELLALIAB OCCUR XONJ453512401/2012 04/01/201 EACH OCCURRENCEOOOOOO
E)(C1=5y LIgB CLAIMS-MADEAGGREGATE �1 OOOOLIO
DEC) XRKERS COMPENSATION EMPLOYERS'LIABILITY WCA0052590230/2012 O6/30/201 X WGSTATU• OTIi.
ANY PROPRIETORIP 7' Off E�-
0PRCER/MEM99EE �p / (CUTIVfa Y I N
N/A G.L.EACH ACCIDENT 1000000
(hlandetory in NH) E.L.DISEASE_EA E ryee,daecnoa„Haar MPLOYEE $1 000 000
DESCRIPTION QF OPERATIONS bola. _r E.L.DISEASE.POLICY LIMIT 11,000,000
1 000 000
DESCRIPTION OF OPERATIONS I LOCATI DNS I VENICLES(Attach ACORD 1e1,AddllIcnal Remarks 6ghedura,11 more spgC91B requlrou)
"Workers Comp Information
Included Officers or Proprietors
Certificate Holder is Included as an'additional insured undor General Liapility when required by written
contract or agreement.
CERTIFICATE HOLDER CANCELLATION
Cape Cod Insulationjuic SHOULD ANY OF THE ABOVE DESCRIBED POLICIES OE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NoTice WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
®18B -2010 ACOAD CORPORATION,All rights reJerved.
ACORD 25(2010/05) 1 of 1 The ACORD name and logo are ragislered marks of ACORD
#S83849/M83848 MEY
I
The Common!! —'filth of Massac:.lnrsetts
Department,,/ /„dustrial Accidents
w oVicc i;( in vestigattotis
-__ - 600 V o. ,',irtgton Street
_
Y
L
l 0211.1
,y
Worker's coil►pelisatioti hisurattce. AftizJ_lI: Builders/Contractors/Electrici-ttys/1 ititi.tl►er
�Ilpli�attt luCttt'turttic►n Please Prillt Legibly
t
V;tutc: (I;ILsut�'.ss/Ord;atu.z.�ltioit/Individucll): cam_,.___• Q` .
P
"7 17
A v tuu an Ctu tlo cr'. Check, tt►t; al.►pruprirtle box:
`Type of pt•oject (re(Irtttcd):
I � l aut;:,r.utployc:r with .- 4. 1•u»a contractor and 1 have 6. � NOW construchun
cull,loyct;s (Ittll �lncl/ol- ( art-time) * hired Ihr 'id) ,:')Ill-actors listed on
7., F] hctuodcling
rr pro the attach,d .hc.�ct.$
`--� I ani a sc.,lt proprietor or partnershil:, These.uih , .•:uractois have 8. Q Dernol.ition
tnci have: nu ctrlployces working for employcc,:,i,,1 have workers' comp. 9. ❑ Building addit.iou
mt: in any capacity. [No workers' insufanr,. lU, l __I ,Electrical raptits or udditious
rtnnp iusurancr, rcilui,-cd.j 5. We aie a 1.01;;o1a6on and its
offlceis lim c r.xrrcised their right of 11. 1:1 PIUlrtbing repairs or acklittotts
L] I am a hunw.owuer doing all work exempiLoii j, i IVIGL e. 152§(4),and 1,2. Roof repairs
ntysclf. [No workrt:s' corlip. we have n,-, mjiloyees.[No workers' zcrp
/��ccr�lrl �t
uisuraurc rr.(Iutred.� � comp. uizui:ilir required.) 13. othe I.
\w;.tppli,ant Uwt c he:cha bux If I must also Fill out the section below shmk 11u:'ilia n workers'compensation policy information.
I I �whu submit this affidavit indicating they at doing 411 woil.jn,i ti,1)hire OutSidr COMA rdcrors mist subnutit a new affidavit imticatiog such.
it ,mm et,tis that cheek this box must attach an additional sheet showing tl w—I.:of the sub-contractors and state whether or not those ertlit'ies have enq luydr..; It
luc>ab�vunaetuu h.n,e cntpluy4es, they MUSE provide their wockcts'con,!- p ii,•, number.
l ant«n employer that is providing workers eompensation i;rs,n,mce for my employees. Below is the policy and job site
l.ortmuio rt.
t..'<tntparty Name: K_L_1h�Vle—e
!'obey tl of .1c;ll'-nts. l.ic. #; r Q `1 .5 L�
1 LL s�_a -...._ Expiration 1�211e: - _
City/State/Zip:
Auarh a cupy of the worlGers' compensation policy declaration pago i.-d-wing the policy number and expiration date),I dilwr to sccurc c:uvrragc as r'cduirtsd undar Section 25A of IvIGL c. I ).',.,n load to the imposition of criminal penalties of a fiuc Lill to Ili,500.00 autUvt
Ow-scat uulaisunnu.nt, as well as civil penalties in the form of a STOP 1wi)i(K ORDER and a fine of up to$250.00 a flay against the violator.Ht.;ulvisctl
th,tt,,,c,py of this stutetncnl stet c forwarded to the Office of lnvesti .0 , ,f the DIA for insurance coverage verification.
1 do here c if under the ) iris and penalties of p rl,r y that the information provided above is true and correct.
�1�IIillUrl'; � ---..-.__. Dati
1'h ulrtr
Ullitial use ,,lily, Dv rtot write in this area, to be completed i.,t,i iIk�or town official
l'irg or ToNrtt: ___._ t'crutit/Licensa#
kAliug:1,uthor-ity (circle oue):
t. Board of health 2. Building Department 3.City1'i u tii Clerk 4,Electrical luspector S.Plttntbiug l.t►spectot
o.Othee
Contact l'u,on: Phone#: _—_-
� Y
pFTHE.r Town of Barnstable *Permit#I-7�44I 6Cl, ,
�. �. Expires 6 nfhs torn-is
Regulatory Services Pee L J
t 6AMNSPARLE, ; Thomas F. Geiler, Director
y MAss. g
Building Division
''rFv ta't a
Tom Perry, CBO, Building Commissioner
200 Main Street,Hyannis, MA 02601
www.town.barnstab l e.ma.us.
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ON Y
Not Valid without Red X-Press Imprint
Map/parcel Number
Property Address 2_5 Soi'wj t S fdC L� �v`1►1L`�
residential Value of Work <?00 Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address Elezho
Contractor's Name C �e C.l� I C _Telephone Number 3 20—�'22
Home Improvement Contractor License#(if applicable)
❑Workman's Compensation Insurance -PRESS PERMIT
Check one:
❑ I am a sole proprietor AUG e 7 2008
❑ I am the Homeowner
[?J > ave Worker's Compensation Insurance TOWN OF BARNSTABLE
Insurance Company Name
Workman's Comp. Policy#
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box)
roof(stripping old shingles).All construction debris will be taken to j spc) a:,,
❑ Re-roof(not stripping. Going over existing layers of roof)
Re-side
❑ Replacement Windows/doors/sliders. U-Value (maximum..44)
*Where required: Issuance of this permit does not exempt compliance with other town,department regulations,i.e.Historic,Conservation,etc.
'Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Home Improvement Contractors License is.required.
\�
SIGNATURE. e�_16coo �k�
QAWPFILESIF0RM3lbuilding permit fornsEXPRESS.doc
t b
The Comrreonwealth of Massachusetts
Department of Industrial Accidents
Office of fnvestigaiions
600 Washingfon Street
Boston,MA 02111
` www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
A Brant Information Please Print Legibly
Name(Business/Organizatiowgndi Aduan:
• Address G�Ov�7L +�Gea -
City/State/Zip: UXVT- Phone.#: 'TPd'-:?60 '9eO I
Are you an employer? Check the appropriate bow Type of project(required):
L❑ I am a employer with 4• 54-Paag-a general contractor and I 6 0 New construction
employees(full and/or part-limn),* have hired the shh-contractors
2 ❑ I am a'sole proprietor or pa tner-
ese
listed.on the attached sheet 7. ❑Remodeling
• ship and have no employees Th sub-contractors have g, �Demolition ..
employees and have workers'
working for mr in.any capacity. 9. ❑Building addition
[No workers' .insurae comp.insurance.
nc
5. We arc a corporation and its 10-0 Electrical repairs or additions
required.] officers have exercised their 11.0 Plumbing re pairs or additions
I❑ I am a homeowner doing all work
myself [No workers' camp: right of exemption per MGL 12 ❑Roaf repairs
insurance requirralt c. 152, §1(4), and we have no
employees. [No workers' 13.❑Other
comp ms„rancc re-qui al
*Any applimnt that check=box#1 must also fill out the section below showing their workers'compa,st;om policy infmn-sation
t Hm=wncrs who submit this affidavit indicting drey am doing all work and then hire outside cant actors must rubrnit anew af5davitindicaimg wch.
lContraetr_srs that eb=V this box nuut attached an additional sheet showing the name of the sub-contractns and state whether or not those entities have
emplaycrs. If the sub-contractms have employers,they must provi&then wmi=I-s'comp.policy number-
lam an employer that is providing workers'compensation insurance for my employees, Below is the policy and job site
information.
Insriancc Company Na=:
Policy#or Self-ins.Lie.#: Expiration Date-
lob Site Address: City/Statelzip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as requfrd under Section 25A of MGL c. 152 can lea-d to the imposition of criminal penalties of a
5nr,up to$1,500.DO and/or one-year imprisomn as well as civil penalties in the form of a STOP WORK ORDER and a tv
of up to$250.00 a day against'thc violator. Be advised that a copy of this statrmrik may be forwarded to the Office of
Investigations of the DIA for insurance Myer-ago verification.
I do hereby certtjy under the a'wand penalties of perjury that the information provided above is true and correct
Date: 6�f^ a� _
Phanc#: ��'' ��-C32
p fzcld use only. Do not write in this area, to be completed by city or town of
fcciaL
City or Town: Permit/License#
Tsor ng Authority(circle one):
L Board of H'eAth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector
6. Other
9--farf Pprrnn- Phone#:
- ,p� ��ie �a�rim�rnuueaLC` a�� ac�uael�i ��-
Board of Building Regul'attons and Standards
- HOME IMPROVEMENT CONTRACTOR
Reg�tratwn' 147289 k
dxi anon -1,,24/2009 Tr# 131928
Type qBA`
CASABLANCA b €r r n
ERIC$SON TOftf'ES
% .
x` WEST YX410UTH,MA 02673 Admiu�strator s '
''' yam' - ue.:„ irs_vs�4tefi,`4z�r;,w•'1.3. :".,w
lk
�. ,� �h�,c a 4:7:of a ;...�r �,:'� x ;,:.•F+r� � d t�.�",�' '� .
� .
, . License or registration'valid'for individul use only R .
before the expiration date. If found return to: i
Board of Building Re
g
blat s and
;.
IRK ;_ One Ashburton Place Rm 1301
I, Boston,Ma.02108 4
M of valid Nyxfiout signature '
€'
f
r
Town of Barnstable
snatvsrnsc.e.
' � Regulatory Services
ATEor Thomas F.Geiler,Director
Building Division
Thomas Perry,CBO
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 .
I, B hp FAe4ee- , as Owner of the subject property
hereby authorize L'bMtk-+ 'A ',N7 c- to act on my behalf,
in all matters relative to work authorized by this building permit application.for.,
(Address of Job)
i e of Date
Print Name
QAVVTFILES\FORMS\bui]ding permit forms\EXPRESS.doc
Revise020108
I;
Town of Barnstable
Regulatory Services
BARNSrABLE Thomas F.Geiler,Director
MAss.
9� 1639. ,m Building Division
AjED N1A't A
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION:
number street village
"HOMEOWNER':
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
requirements.
Signature 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:\WPFILES\FORMS\bomeexempt.DOC
08/07/�2'00G 03: 1.9PM FAXCC M ])AGE 2 OF 2
y., 08/07/200K 12!2fi FAX 605 945 2049 BERKLEY ADMIN. PIERRE Z 1302/002
Acadia Iiisurance Company
Administeired by Berkey Risk.Administraiois Company, Lf_C;
P.C:'.Box 939, Flej,re, SIC) 5.7501.0930 2510 E. li,M, Ro.r rs, SO 57501
Phone(60 ) 946-2144 t"ax(606) 045-21748 Toll Tres-,800j e34-4581,4
Acadia ;i NCCl Carrier Code 3339"
ERTIF`ICATE OF INSURANCE
1.Theninvurpd' . WC11p 4 iiCv t�;r1�b�r:b�G92020n�E}1i�bF�UQ
Vapner,:Crapauia T;R iC{?i; E 204371841
dl7a,: r�rxtt�er�idnva�aii
Centerville,MA 02632 Pl:tYicy fleri;A4 From; 111101067
' T/3' �1i 1 r�tZ0st8
he C—Mifcate is issued;a a mattf;r of irai4lr 1at:Qn my a td confers no ri ahts'.;poi. th-, Certificate Holde.f.
This Cent,"tic::ate acc:S not arnend, extend or galt>•r ibe cone,--age afforded by the Pelicyt!Ist.ed
I .,s 1j to C:Bt'tVY tllaL It el Policy of Inaurance described herein has been iis:ded to tl'v� in', i edl!'icnned'abc,' a for
the?obey period incicated, NotWithV; tic91(g:attar!equ(rE went,!arm o condition of ny contract or rlit rF3i�t�Ji'ri6ii�:tll
!M1'kt'1 respect to which this Ce.if ate fl1 y Eiq,issued or may partain,the irsur:r'.ee affordecd., by tie,•'oJcj dav4,:ribAjd
here-in is su ji ct to all the terms,
r exclusions and c(.5n itions of s:_1rr; policy.
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i
i ECbli%ik=, 1 ', �t °3t��ak�yl4tl +��++7'1' +kH � r: �'P'.3 t! ,ityr „t. k 3•'`�aiA�
'�
1 omors'Cornpail.58tion Statutory
I; Part Iwo f3Adily njurf y A Clltf rrl $i vC,t7l.p a an:h e�cWielent.
I"rnpioYer 'LiaA Vi Y [3.^dity Ajuty by CkGa. o $900.,300 policy limit.
Bcdily Injury by r7ikeaSn $10.0,000 each Employee
Shuuid the buve Poliay be canoe:ed before the expiration date thereof,the Company
Mil.endeavor to mail 10 days written rlotide'o the Dzlovf rlarried Cerilflcate Holde e, bu'[ .
ictlli re t4 1T1&!li Sl?Gh{`iEYL'ICQ Sjlie]il impose nol'7CIla'ukiCtr o.�Iicil)illty of anjr kind UpG?1 the Carlil7 ly,
Cerfificaf;e HUIder's Name and Addross: SOLE PROPRIETOR NOT COVERED.
Town of sarm;tabla
11 Main Stream
Hyariis,DNA 426011
P��rtz�Nar�t;_arsd�d rem Cali l.s=,ur.�+: �ill2caUa
Marketing Aasociates fits Agency
T69emon Inn
I SU.Wells Ave
HA3140
08/07/2008 02:28PM
Property Location:125 SUMMERSIDE_ LAN_E MAP ID: 307/070///
Vision ID: 24613 L " Y Other ID: Bldg#: 1 Card 1 of 1 Print Date:06/29/2000
CURRENTOWNER TOEO UTILITIES:STRT✓ROAD 1'OCATION" _ CURRENTASSESSMENT „
PARKER,BRADLEY R Description Code Appraised Value Assessed Value
PARKER,FLORENCE RESLAND 1050 22,800 22,800 801
0 WILLOW RUN DR RESIDNTL 1050 70,800 70,800
ENTERVILLE,MA 02632 SUEPLEMENTAL Df1 TA. ..._ E DATA-Barnstable,A
ccount# 217633 Plan Ref.
Tax Dist. 400 Land Ct#
er.Prop. #SR
Life Estate I S I ON
DL 1 Notes:
DL 2
IS ID: Total §-3-,6001 93,600
RECORD OF OWNERSHIP. .;m BK:VUL/PAGE SALE DATE:, %u y SALEPRICE V C .: , PREVIOUS ASSESSMENTS;'HISTOR
PARKER,BRADLEY R 2776/225 Q 0 Yr. Code Assessed Value Yr. Code I Assessed Value Yr. Code I Assessed Value
2000 1050 22,800 999 1050 22,800 998 1050 22,800
2000 1050 70,800 999 1050 70,800 998 1050 70,800
Total: 93, ;,6001 Total: 93,600
:EXEMPTIONS...` . ._ ' ,. _ OTHER ASSESSMENTS :_ This signature acknowledges a visit by a Data Collector or Assessor
.. _
Year T e/Descri Lion Amount Code I Description Number Amount Comm.Int.
APPRAISED 1ALl7E SUMMARY
Appraised Bldg.Value(Card) 70,800
Appraised XF(B)Value(Bldg) 0
Total: Appraised OB(L)Value(Bldg) 0
NOTES . (Bldg) 22,800
Value
.. —:.
Special Land Value
1-2 BEDRM APT...
2-1 BEDRM APT...
Total Appraised Card Value 93,600
Total Appraised Parcel Value 93,600
Valuation Method: Cost/Market Valuation
et Total Appraised Parcel Value 93,600
BUILDING PERMIT RECORD VISIT%CHANGE HISTORY
Permit ID Issue Date Tvpe Description Amount Insp.Date %Comp. Date Comp. Com
ments Date ID Cd. Purpose/Result
4/15/88 ML
LAND L11VE VALUATIONSECTION. ..;.. ..
B# Use Code Description Zone D F Frontage Depth Units Unit Price I.Factor S.L C.Factor Nbad Ad'. Notes AdYS ecial Pricing Ad. Unit Price Land Val
ue
1 1050 Three Fam RB 4 0.14 AC 407,000.00 1.00 5 1.00 61AC 0.40 PCL(.14,U10)Notes:10 1BLD 162,800.00 22,800
Total Card Land Units 0.14 AC Parcel Total Land Area: 0.14 AC Total Land Value 22,800
Property Location: 25 SUMMERSIDE LANE MAP ID: 307/070/
Vision ID:24613 Other ID: Bldg#: 1 Card 1 of 1 Print Date: 06/29/2000
GONSTRUGTIONDET,9IL ;' SKETCH. .
Element Cd Ch. Description Commercial Data Elements
Style/Type 4 Cape Cod Element Cd. I Ch. Description
Model 1 Residential Heat&AC
Grade C Average Grade Frame Type
Baths/Plumbing HS 36
Stories .5 1/2 Stories ccupancy 0Ceiling/Wall AS AS
ooms/Prtns
Exterior Wall 1 4 ood Shingle /o Common Wall
2 Wall Height BAS 7
Roof Structure 3 able/Hip
Roof Cover 3 sph/F GIs/Cmp
CONDO/MDBILE HOME DATA
nterior Wall 1 5 rywall Element ode Description actor
2 2 all Brd/Wood 7
nterior Floor 1 2 Hardwood Complex
2 Floor Adj
Unit Location 30 3
eating Fuel 2 oil
Heating Type 5 Hot Water lumber of Units
C Type 1 one 14umber of Levels 2
Yo Ownership
Bedrooms 04 4 Bedrooms
Bathrooms 3 3 Bathrooms COSTIMARKET VALUATION
0 3 Full Jnadj.Base Rate 48.00
Total Rooms 10 10 Rooms ize Adj.Factor 1.01178
rade(Q)Index 1.02
Bath Type dj.Base Rate 49.54
Kitchen Style Idg.Value New 104,084
ear Built 1945 1 36
ff.Year Built 975
rml Physcl Dep 22
uncnl Obslnc
con Obslnc 10
iY1lYED USE pecl.Cond.Code
_....... pecl Cond%
ap
1050 Three Fain 100 verall%Cond. 68
eprec.Bldg Value 70,800
OB OUTB;UILMG&`YARD ITE:MS(L)%XF BU.ILDINGEXTRAI FEAT..URES(B)
Code Description LIB I Units Unit Price Yr. Dp Rt VoCnd Apr. Value
BUILD"O'SUB AREA SUMMARYSECTION
Code Description Liviniz Area Gross Area Eff Area Unit Cost Unde rec. Value
BAS First Floor 1,129 1,129 1,129 49.54 55,931
FHS Half Story,Finished 756 1,080 756 34.68 37,452
UBM Basement,Unfinished 0 1,080 216 9.91 10,701
ki di�kLiylLease Area 1,8851 3,2891 2,1011 1 104,084
e
°Ft Town of Barnstable
Regulatory Services
BMWSTABMAS&I'E� Thomas F.Geiler,Director
1639.
�ArfDMA'�p1� Building Division
Elbert C Ulshoeffer,Jr. Building Commissioner
367 Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
December 6, 2000
Mr. Bradley R. Parker, Jr.
60 Willow Run Drive
Centerville, MA 02632
Re: 25 Summerside Lane
Map 307,Parcel 070
Dear Mr. Parker:
Enclosed is your check for$81.00,which we are returning with our apologies.
It has now been determined that this property does not require inspections under the
multi-dwelling category. Multi-family dwellings are defined as three or more dwelling
units within a single structure with a common entrance and, therefore, these inspections
are not required for your property.
Sincerely,
Elbert C. Ulshoeffer, Jr.
Building Commissioner
Enclosure _
�//
I
-� t r Town of Barnstable
Regulatory Services
r
BAMSTABLZ Thomas F.Geiler,Director
Mass.
9`bAiEo;o�►``� Building Division
Elbert C Ulshoeffer,Jr. Building Commissioner
367 Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
MEMORANDUM -
DATE:
TO:
File
REGARDING: COI Multi-Family Use
Re: /✓V�
I
Certificate of Inspection is not required for this property--does not consist of 3 or more
units within a single structure.
Notes: W>
COMMONWEALTH OF MASSACHUSETTS
TOWN OF BARNSTABLE
APPLICATION FOR CERTIFICATE OF INSPECTION
Date Vim'. 3 V Z' (X) Fee Required$
( ) No Fee Required
In accordance with the provisions of the Massachusetts State Building Code,Section 106.5,I hereby apply for a Certificate of
Inspection for the below-named premises located at the following address:
Street and Number: / ,.
Name of Premises:
Purpose for which premises is used: -3 FAd,aL-
License(s)or Permit(s)required for the premises by other governmental agencies:
License or Permit Agency
Certificate to be Issued to: ieA n P14t1,J6 i _
Address: CCU L"• It*(" ku' Ty
Telephone: eG' r v:�tt, 444. 0
Owner of Record of Building: a �.
Address:
Name of Present Holder of Certificate:
Name of Agent,if any:
/0-Z
SIGNATURE O RSON TO WHOM CERTIFICATE
IS ISSUED OR AUTHORIZED AGENT
INSTRUCTIONS:
1)Make check payable to: TOWN OF BARNSTABLE
2)Return this application with your check to: BUILDING COMMISSIONER, 367 MAIN STREET,HYANNIS,MA 02601
PLEASE NOTE:
1)Application form with accompanying fee must be submitted for each building or structure or part thereof to be certified.
2)Application and fee must be received before the certificate will be issued.
3)The building official shall be notified within ten(10)days of any change in the above information.
CERTIFICATE# EXPIRATION DATE:
INE
The Town of Barnstable
BABNSTABLE,
9� NABS, �0� Department of Health, Safety and Environmental Services
'yEc 39. Building Division
367 Main.Street,Hyannis MA 02601
Office: 508-862-4038 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
September 12, 2000
BRADLEY R PARKER
60 WILLOW RUN DR
CENTERVILLE, MA 02632
SECOND REQUEST
Re: Certificate of Inspection
Multi-family Dwelling (5-year Certificate)
25 SUMMERSIDE LANE, HYANNIS
307 070
3 Units - $ 81.00 r
Dear Property Owner:
We have not received a response to our letter of May 15, 2000 requesting you to return
the Certificate of Inspection application with the required fee to this office.
The Certificate of Inspection is required by Section 106.5 of the Massachusetts State
Building Code, Sixth Edition. The fee must be paid before the Certificate of Inspection
can be issued.
Your failure to respond indicates that you are not interested in maintaining your multi-
family status with this office. Please submit the application and fee immediately or
contact Lois Barry of this office (862-4039)to clarify your situation.
Sincerely,
Ralph M. Crossen
Building Commissioner
RMC/lbn
j000906a
FtME l°�
The Town of Barnstable
'+ BARNSPABLE, • .
9� MAES, Department of Health , Safety and Environmental Services
ArEor,,pra Building Division
367 Main Street,Hyannis MA 02601
Office: 508-790-6227 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
May 15, 2000
BRADLEY R PARKER
60 WILLOW RUN DR
CENTERVILLE, MA 02632
Re: Certificate of Inspection
Multi-family Dwelling (5-year Certificate)
25 SUMMERSIDE LANE, HYANNIS
307 070
Dear Property Owner:
Attached you will find an application for a Certificate of Inspection as required by
Section 106.5 of the Massachusetts State Building Code, Sixth Edition.
Please complete the application and return to this office with the required fee:
3 Units - $81.00
The fee has been established by the State (Table 106).and must be paid before the
Certificate of Inspection/Capacity Card may be issued.
A copy of said Certificate shall be kept posted as specified in Section 120.5.2 of the State.
Code.
Sincerely,
Ralph M. Crossen
Building Commissioner
RMC/lbn
j990428e
L ] [R307 070 . � ]
•
LOC] 0025 SUMMERSIDE ANE CTY] 07 TDS] 400 HY KEY] 217633
----MAILING ADDRESS------- PCA] 1051 PCS] 00 YR] 00 PARENT] 0
PARKER, BRADLEY R MAP] AREA] 61AC JV] MTG] 0000
PARKER, FLORENCE SP1] SP21 SP31
60 WILLOW RUN DR UT11 UT21 . 14 SQ FT] 2209
CENTERVILLE MA 02632 AYB11945 EYB11975 OBS] CONST]
0000 LAND 19900 IMP 80600 OTHER
----LEGAL DESCRIPTION---- TRUE MKT 100500 REA CLASSIFIED
#LAND 1 19, 900 ASD LND 19900 ASD IMP 80600 ASD OTH
#BLDG(S) -CARD-1 1 80, 600 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE
#PL 25 SUMMERSIDE LN TAX EXEMPT
#RR 1559 0104 RESIDENT' L 100500 100500 100500
OPEN SPACE
COMMERCIAL
INDUSTRIAL
EXEMPTIONS
SALE] 00/00 PRICE] ORB] 2776/225 AFD]
LAST ACTIVITY] 12/06/91 PCR] Y
MR307 070 . op P R A I S A L D A T A• KEY 217633
PARKER, BRADLEY R
LAND BLD/FEATURES BUILDINGS NUMBER ZN/FL=RB
19, 900 80, 600 1 A-COST 100, 500
B-MKT 94 , 000
BY 00/ BY ML 4/88 C-INCOME
PCA=1051 PCS=00 SIZE= 2209 JUST-VAL 100, 500
LEV=400 CONST-C 0
----COMPARISON TO CONTROL AREA 61AC -----------------------------
NEIGHBORHOOD 61AC HYANNIS
PARCEL CONTROL AREA TREND STANDARD
101 10 LAND-TYPE
19900] LAND-MEAN +0%
1005001 74880 IMPROVED-MEAN +80 250
] FRONT-FT
] 100 DEPTH/ACRES TABLE 02
10001 LOCATION-ADJ APPLY-VAL-STAT 1
LNR] LAND LFT/IMP] ADJS/SB/FEAT STR] STRUCTURE ARR]AREA-MEASUREMENTS NOR] NOTES
COM] MARKET INC] INCOME PMR] PERMITS GRR] GRAPHIC
FUNCTION- [ ] STRUCTURE-CARD NO- [0 0 0] DATA- [ ] XMT [?]
R307 070 . • P E R M I T [PMT] ACTIOR] CARD [000] KEY 217633
000000001
PERMIT-NO MO YR TYPE VALUE CK-BY MO YR oCMP NEW/DEMO COMMENT
RESIDENTIAL PROPERTY
MAP tIO. LOT NO. 25 Summerslde Lane FIRE DISTRICT
STREET Hyannis SUMMARY
307 70 H 73 LAND ;
/ BLDGS.
l 'is"/t'�a.-.[.its-
OWNER t_r,_-r �C TOTAL 1 70-
_... .__ LAND
RECORD OF TRANSFER DATE BK PG I.R.S. REMARKS: BLDGS.
Of
B TOTAL
•14 a LAND
BLDGS.
Of
TOTAL
:Pdrker, -Bradley R.,Jr.. & Florence M. 9-1-78 2776 225 $40 0 LAND
�O 0) BLDGS.
TOTAL
LAND
BLDGS.
TOTAL
LAND
BLDGS.
TOTAL'
LAND
BLDGS.
TOTAL
_ LAND
INTERIOR INSPECTED: / i; - ? f' BLDGS.
TOTAL
DATE: y �/ ( LAND
ACREAGE COMPUTATIONS BLDGS.
ND TYPE # OF ACRES PRICE TOTAL DEPR. (VALUE TOTAL
HOU ? . /y / O•' J /o �O to/O LAND --
CLEARE FRONT rn BLDGS.
REAR TOTAL
WOODS 8 SPROUT FRONT LAND _
REAR BLDGS.
WASTE FRONT TOTAL
REAR LAND
0I BLDGS. -
TOTAL
LAND
A. uwa Hill
/ IV IT BLDGS.
LOT COMPUTATIONS LAND FACTORS TOTAL
FRONT DEPTH STREET PRICE DEPTH% FRONT FT.PRICE TOTAL DEPR. COR. INF. VALUE HILLY TOWN SEWER LAND
0 y ROUGH TOWN WATER BLDGS.
HIGH GRAVEL RD. TOTAL
LOW DIRT RD. LAND —
SWAMPY NO RD. BLDGS.
h(JUIVUHIIVw LAND COST '
cone.Waft Fin. Bsmt.Area Bath Room Base /� ��
q
� BLDG. COST
Cone.Blk.Walls Bsmt. Rec. Room St. Shower Bath 04
Cone.Slab Bsmt.Garage St. Shower Ext. Walls PURCH. PRICE PURCH. DATE
Brick Walls_ Attie FI.&Stairs Toilet Roam Roof RENT �(
Stone Walls Fin.Attic Two Fixt. Bath Floors
s FL r�ajS
Piers WINTERIORFINISH Lavatory Extra
Bsmt. C CT 2 3 Sink
% 'h 'A Water Clo. Extra Attie 4
EXTERIOR WA Water Only �� 4- 3 o ODouble Siding No Plumbing Bsmt.Fin.Single Siding Int. Fin. -- S"r'1 C1 R
Shingles AI TILING C4,f
Cone. Blk. G F P Bath FI. Heat / / 3%Z C I
Face Brk.On Int. Layout Bath.PK&Wains. Auto Ht.Unit U 3 0 '
cry 'J .
Veneer Int.Cond. Bath FI.&Walls Fireplace
Com. Brk.On HEATING Toilet Rm. FL
Plumbing 1.• �,.f _;
Solid Com.Brk. Hot Air Toilet Rm.FI.&Wsins. y�—
Tiling f—
Steam Toilet Rm.FI. &Walls 7`s -' — 3 6 ——
Blanket Ins. Hot Water f St. Shower
Roof Ins. Air Cond. Tub Area Total .
Floor Furn.
ROOFING COMPUTATIONS
Asph.Shingle Pipeless Furn. �U t (� S.F. JrJr
Wood Shingle No Heat 'G S. F.
/o. 3 o
Asbs.Shingle Oil Burner L S.F.
Slate Coal Stoker S. F.
Tile Gas S. F. OUTBUILDINGS
ROOF TYPE Electric
Gable flat S.F. 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 MEASURED
Hip Mansard FIREPLACES S.F. Pier Found. Floor `J
Gambrel Fireplace Stack Wall Found. 0. H. Door LISTED
FLO RS Fireplace Sgle.Sdg. Roll Roofing AT
-Cone. LIGHTING Dble.Sdg. Shingle Roof
Earth No Elect. DATE
Pine Shingle Walls Plumbing
Hardwood ROOMS Cement Blk. Electric 1/
Asph.Tile Bsmt. 1st f TOTAL - Brick Int.Finish ED
Single 2nd Z .} 3rd FACTOR
REPLACEMENT
OCCUPANCY CONSTRUCTION SIZE AREA CLASS AGE REMOD. COND. REPL. VAL. Phy.Dep. PHYS. VALUE Funct.Dep. ACTUAL VAL.
DWLG. •F F /1� �4'S ?cs �%C t:.• �7 c" ?3 / n
1
2
3
4
5
6 .
7
8
do
TOTAL
TATE PARCEL IDENTIFICATION NUMBER
iV ADDRESS I ZONING (DISTRICT CODE SP-DISTS.I DATE PRINTED(CLASS I PCS I NBHD KEV No.
0025 SUMMERSIDE LANE 07 R8 400 MY 07/09 5 105
LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS Y UNIT ADJ'D.UNIT
,"a ewoat. BN.Dme.No" LOCJVR.SPEC.CLASS ADJ. C P PRICE PRICE ACRES/UNITS VALUE ,ro.ro. PARKER• BRADLEY R MAP—
co. FF.De InlAues D 1 19.900 CARDS IN ACCOUNT
10 1BLDG.SIT 1 X .14 =10 407 34999.9 142449.9 ..14 14900 G(S)-CARD-1 1 80P600 01 OF 01
25 SUMMERSIDE LN DST 100500
BATHS 3.0 U X C= 100 10500.0 10500.0 1.00 10500 3 ORR 1559 0104 ARKET 94000
NCOME
SE
PPRAISED VALUE
100.50C
ARCEL SUMMARY
AND 1990C
LDGS 8060C
-IMPS
OTAL 10050C
_ CNST
DEED REFERENC T, DATE F,_— RIOR YEAR VALU
Boo• Page M( S...a P.c- A N D 1 9 9 0 C
2776/225� 00/00 LDGS 8060C
I' IOTAL 10050C
BUILDING PERMIT —2 BEDRM APT..
A"ro""' -1 BEDRM APT..
LAND LAND-ADJ INC ME SE SP-BLDS FEATURES BLD-ADJS UlITS NN.— :Dll* TTPs
19900 10500
Gass Cops. T*.a. Bese Ra.e AEI Ra.e Burl. Age N rm Ob- CND Loc %R D .pI Cost New AEI Rep.V u. S.d..s Hepnl Rodin Rms B.tna •Fi Pv ...FK
Unils Unn' A9.9 fly OeP, C-
03C 000 100 100 66.30 66.30 45 75 19 80 90 70 115106 30600 1.5 10 4 3.0 12.0
Desc r�pnon Spuare Fee. R,,1 Cost MKT.INDEX: 1.00 IMP,BVIDATE. ML 4/88 SCALE. 1/00.92 ELEMENTS CODE' CONSTRUCTION DETAIL
OAS 100 66.a30 1080 71604 GROSS AREA 2209 THREE FAMILY DWELLING CNST GP:00
FSF 90 59.67 49 2924 *---------------36---------------* STYLE 04 APE COD 0.O
--------------- --- ----------------------
815 42 27.85 1080 30078 ! 815 6 iS-1 N ADJM_T OG 0.0
- --- ----------------------
! EXTER.WALLS 11 OOD SHINu'LES 0.0
--------- --- ----------------------
! +--7--* EAi/AC TYPE 10 IL—H Y—ZONED 0.0
-------- --- ----------------------
! FSF ! LNTER.fINISH _O7 RYWALL/PANEL O.D
! 7 7 NiEi.LAYOUT 12 VER-_-NORMAL I- 0
! ! _NTER._]UALTY_ 02'AM_E AS EXTER._ 0.0I
*--7--* FLOOR STRUCT 02 D JOIST/BEAM 0.01
W 30 BASE 30 ELOOR COVER 01 ARDW00D 0.0�
------------
Td..A,.aa A.._ Base. 1129 ! 24 _0Of TYPE 01 ABLE-AS_PH-_S_H_...0.0
BUILDING DIMENSIONS 'L E C T R_-1 J 1 VE-RA-GY 0.01
BAS W36 N30 E36 S06 FSF E07 S07 ! ! OU�DATI04 Q2 ONCRETE BLOCK 99.9
W07 N07 .. BAS S24 .. 815 N30 ! ! ---------------
------------ --------
W36 S30 E36 .. ! ! VEtSHa6FH6 OD 61AC HYANNIS
! LAND TOTAL MARKET
! ! PARCEL 19900 100500
*---------------36--------------X AREA 2848
VARIANCE +0 +3428
STANDARD 25
1
TOWN OF BABNSTABLE
REPORT S LEMDNTABY/CONTIWETATI REPORT
4y
---
NAME (LAST, FIRST, MIDDLE) DIVISION /DEPT f'1 v JX t
L 1V�
NOTE DETAILS i OBSERVATIONS-ITEMIZE EVIDENCE, SERIAL IS ETC. <zLo
�` yam' �►-
{J off' - v�,,,` •
ovrf
PAGE'$
SUBMITTED BY �
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