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��� � �� _,w �� ___. }. „a S i I� j ' �J I /' if i 1 1 I `i. �x �� �, i I r) go '9 Town of Barnstable *Permit# ,-70f���„ p� Expires 6 months from issue date ' Regulatory Services Fee BARNM9aMAS 1b� Thomas F. Geiler,Director .p ' BuR � 2Q12 din Division 1, 0 g OCT Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 0260 1 8����TAB www.town barnstable.ma us `T®W(� OF LE Office: 508-862-403 8 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcelNumber oo q 6/ Property.Address I\ I 1-®y*BA A. 9v .S. Rkesidential Value of Work 14'7c)c)o 00 Minimum fee of$35.00 for work under$6000.00 .Owner's Name&Address FrkjrvS-C 2, Contractor's Name TrILD Telephone Number Sol Home Improvement Contractor License#(if applicable)__A /S V30 ConstructionSupervisor's License# if applicable) 9c3 aPP ) Workman's Compensation Insurance > Check one: 0 I am a sole proprietor 0 am the Homeowner II have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# y 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 e d f ecsfin ❑Re-roof(hurricane nailed)(not stripping. Going over existing-layers of roo fl [] Re-side #of doors Ej Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows ' ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red Sand 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 j equire . SIGNATURE: Q RPMESTORMS1building permit forimsVDMRESS.doe i The Conunonrvealth ofMassachusetts ~Department oflnd cculenis Office of Investigations 600 Wdsliiiigfon Street Boston;"M.4 02111 www-mass.gov/dia WorkeW Compensation Insurance-Affidavit:-Buiiders/Contractos/EleA Grant Info ctricianlPlambers rmatio ... :::.::,;. Please Print Le 'bi Name(Businesstorgmization/Individual): _ Address:-is 75. _ ... City/State/Zip:fi� I.�- =- :, :1q : _ •__ Phone#: Are you an employer?Check the:appropriate a:= I.El i am a employer with- `` 4. I am a general contractor and I Type°f pra7ect(i'ecjuar ): employees(full and/or part tune).* have lured the sub-contractors 6 ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet t 7- 0-Remodeling . ship and have no employees-- , -These sub-contractors have forme in any capacity. workers comp.insurance. 8. ❑Demolition.- working - {No workers'comp:insurance: 3_ p tiondi 9: {�Building addition[�.We are�corporation and its _ :- required.) `_ '" : :officers:have exercised their 10.0 Electrical repairs or additions 3-0:I am a homeowner do' all w_ ork n t of eze - ':,, F ; ption per MGL 11.�`l?lumtiing rep�its or additions myself.[No;woikets.cairip. c.`132 i 4 'and we have no :' =:°--c 3, i• mstrrance re9�ed-). ' empl6Y'—';—jNo workers' 12.[ roof repairs _ rump:ii sivaiii a regiiiied j - 13:0 Other ,r °Any applicant that checks box 1 must also fill oat the section blow showing their workers 9" _ t Homeowners who submit this affidavit mdung they are doing all work and then hire outsidi com n ors must submitna nolL ew atdavit indicai -- tContractots that check thin bok music' ' m8 such.. . attar red as additional sheeEsK."' the iiarne of ttic sub-contractors'an.d thenwork&s'`com : li I am an employer the[is providing workers'compensation ursurance or Po P cY informatron information. f_ my employees.-Below.is.the policyand�ob site Insurance Company Name: --- - - Policy#or Self-ins.Laic.#: Expiration Date: Job Site Address: _.::. City/StatdZip: Attach a copy of the workers'compensation policy declaration page(showingthe.policynumber and.- Failure date). Failure to secure coverage as rag required under Section 23A of MGL`c l52'caii lead to`the imposition`of ciimirizal°penalties°ofa' fine up to$1,300:00 and/or one-year imprisonment-as well as civil Of up to.$250,00 a der penalties in-the form of a.STOP WORICORDER and a:fine y against theviolator. Be advised"that a copy ofthis statement mad be; uvvarded#o'the Office of° Investigations of the DIA for iitstirairc coverage verilac2tion - :; • - I do hereby cerBfy r the. P •~ Pen es of jeejj6,that the 1nforination'provided above is true and correct` Si v Phone# Official use only. Do.not write in this_area,tv=6e conipleled by'cuy oilown olciat City or To c'N° _'fermi t/L-icense# -Issuing Authority(circle one): 1.Berard of Health 2 Building Department 3.City/Town`Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other g P. Contact Person-. Phone#: f °PIKE t° Town of Barnstable Regulatory Services MAS& Thomas F.Geiler,Director .19. 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 Owner of the e ro subject ' l property. nY hereby authorize IDS ler to act on my behalf, in all matters relative to work authorized by this building permit: / 7 idk/ (Address of job) Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. 4Signature of Own r Ooant Print Name Print Name Date Q:FORM&OWNERPERMISSIONPOOLS 6/2012 �t r Town of Barnstable Regulatory Services s�xr►sresr,E Thomas F.Geiler,Director ass. 9�p 1639• A Building Division . rED MA'1 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, hall 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 ; „ cv • . 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 forLicensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community.' Q:forms:homeexempt 9 Ut?It�trtntettt nf'1'uHlic:ti;tl'ct� s` 13out'tlf3uiltlin� Rct;ulutit►ns ;nttl tirtntlurils • Construction Supervisor License License: Cs 83126 RON K FLOSER 14 COLDBROOK RD , MILLBURY,.MA 01527 nnmlktii��n.... Expiration: 12/10/2012 -, 6 • 7442 ` -N Of ti ce of�`on�u.rir�arr��ueal� ��//� x rf k�NOME IMP mcr All�airs Boinc sf` J �uPe�i ROVEMENT CO cg°,anon License or re �/Registration NTRACTOR gistration valid for individul use o. 154430 T before the expiration n Expiration: 3/7/2o13 s Once of only " DBA F Ype Consumer date. If found return to: Fib-"DELL BUILDING:& 10 Park Plaza_ Affairs and Business Re ' REMODELING Boston Suite 5170 Regulation ,MA 02116 RON FLOSER , 14 COLD BROOK RD a MILLBURY.MA 01527 Undcrsccrctary 0 10U aof r. 4. .. ` r . s IDDIYYYY ACQ n. CERTIFICATE OF LIABILITY INSURANCE DATE` S/20/12 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: P J Lombardo Insurance Agency PHONE 508 829-7100 FAX NO: (soB) 829-0689 789 Wachusett Street E-MAIL : Holden, MA 01520 ADDRESS INSURE S AFFORDING COVERAGE NAICft INSURERA:The Keatincl Group INSURED INSURER B: Flodell Builders Inc INSURERC: Ron Floser INSURER D: 175 W Main St INSURER E: Millbury, MA 01527 INSURERF: 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 AML SUBR POLICY EFF POLICY EXP - LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER M/DD/Y MM/DDIYYYY LINTS A GENERALUABILITY BAK 1001870 11/20/11 11/20/12 EACH OCCURRENCE $ 1,000,000 �[ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISE Ea occurrence $ 100,000 CLAIMS MADE a OCCUR ME EXP(Arty one person) $ 5,000 PERSO NAL&ADV I NJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATELIMITAPPLIESPER PRODUCT S-00MP/OPAGG $ 2,000,000 POLICY PRO- LOC $ CoBINED SINGLE LIMIT AUTOMOBILE LIABILITY a acciderd $ ANYAUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS _AUTOS eraccident UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESSLIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION W I.0 STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? N FA (Mandatory in NH) E-L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD101,Additional Remarks Schedule,if more space is required) Workers Compensation information to be forwarded under separate cover by assigned risk carrier. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE . THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main St Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE Peter J. Lombardo ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: (508) 790-6230 E-Mail: RightFax C1-1 6/29/2012 4 :54 :53 AM PAGE 2/002 Fax Server =� CERTIFICATE OF LIABILITY INSURANCE DATE(M29/201 YYY) IFICATE 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 WANED,subject to he terms and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: PHONE GLOBAL HELP CENTER INC {A1C,No,Ext FAX 19 MILL STREET 2ND FLOOR PRODUCER LOWELL,MA 01852 CUSTOMER ID#: 77SYH INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: ACE AMERICAN INSURANCE COMPANY CASTRO,LUI S POLINARIO TACURI DBA L&A INSURER B: CONSTRUCTION INSURER C: INSURER D: 19 OLIVER ST APT 1 INSURER E: MILFORD,MA 01757 INSURER COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIF7VAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVEFOR 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 OF—SCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MSR ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MMaDD1YYYl') (MMIDDIYYYY) LIMITS GENERAL LIABILITY ACH OCCURRENCE $ ' COMMERCIAL GENERAL LIABILITY AMAGE TO RENTED $ ! CLAIMS MADE OCCUR. D DREMISES(Ea occurrence) r ED EXP(Any one person) $ ERSONAL&ADV INJURY; GEN'L AGGREGATE LIMIT APPLIES PER: ENERALAGGREGATE $ + POLICY [3 PROJECT❑LOC RODUCTS-COMPIOP AGG $ AUTOMOBILE LIABILITY OMBINED SINGLE $ ANY AUTO IMIT(Ea accident) ALL OWNED AUTOSBODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ Per accident) NON OWNED AUTOS PROPERTY DAMAGE $ Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB. CLAIMS-MADE GGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND X WC STATUTORY OTHER EMPLOYER'S LIABILITY YIN UB-4621P825-12 04/2112012 04012013 LIMITS ANY PROPERITORIPARTNERIEXECUTNE E.L.EACH ACCIDENT $ 100,000 OFFICERIMEMBER EXCLUDED?. (MandatoryinNN) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIRESTRICT10NS1SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE THE WORKERS'COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR CASTRO,LUIS POLINARIO TACURI a CERTIFICATE HOLDER_.. . CANCELLATION FLO DELL EXTERIOR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES-BE CANCELLED 175 WEST MAIN ST BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL B9 DELIVERED �. IN ACCORDANCE WITH THE POLICY PROV AUTHORIZED REPRESENTATIVE MILLBURY,MA 01572 .xm _ ACORD 25(2009109) 1988-2009 ACORD CORPO rights reserved. Rightfax C2-2 9t21t2012 5:10:58 AM PAGE 2/002 Fax Server :.f CERTIFICATE OF LIABILITY INSURANCE09/21/ DATE(MMIDD/YYYY) TWW.Efa[FICATE 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 WANED,subject to he terms and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME. P J LONfBARDO INS AGENCY PHONE FAX 789 WACHUSETT STREET. (A/C,No,Ext): (A/C,No): E-MAIL HOLDEN,MA 01520 ADDRESS: 7837J INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: TRAVELERS INDEMNITY CO. FLODELL BUILDERS LNC INSURER B: INSURER C: INSURER D: 175 W MAIN STREET INSURER E: MILLBLTRY,MA 01527 - - INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: HIS IS TO CERT THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED KAM M ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAK THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICES_L@dITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MMDUIYYYY) (MMIDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY CLAIMS MADE Or-CUR. REMI CUR. ETORENTED S REMISES(Ea occurrence) WED EXP(Any one person) S ERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: EIdERAL AGGREGATE 5 POUCY PROJECT a LOC 21RODUCTS-COMPIOP AGG S AUTOMOBILE LIABWTY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY S SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY S 1•J0N-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAR 0 OCCUR EACH OCCURRENCE IS EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEDUCTIBLE S RETENTION S S A WORKER'S COMPENSATION AND X I WC STATUTORY OTI-ERI EMPLOYER'S LIABILITY YIN UB-4$56P976-11 11/20/2011 11/20/2012 LIMITS ANY PROPERITORiPARTTIERiE`CECUTNE NIA E L.EACH ACCIDENT $ 100,000 OFFICER/MEMSER EXCLUDED? (Mandatory in NH) EL DISEASE-EA EMPLOYEE S 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICYUMIT S 500.000 DESCRIPTION OF OPERATIONSILOCATIONSfVEHICLES/RESTRICTIONSISPECIAL ITEMS THIS REPLACES ANY PRIOR Cr1?TEETCATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE CERTIFICATE HOLDER CANCELLATION TOthW OF BAR-NI STABLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED 200Iv1AIN ST IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTVE E HYAN1,TIS,MA 02601 �n 1 , ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. 'r t ,.�'_ :ie r.s a N k O E:s 5k 4 100.S1 ' 't N 82.47.38-E O �f TIDAL Y GAS ► 42'z M u' LANE ,z 3 27 z LOT 105 M •M v p fo • op O m %' O� 4' z 7845 + S.F. `. 8 .W 2 5p••1 I S 75 x TOWN OF BARNSTABLE ZONING {` is�E jl 8 ZONE RC' TO THE BEST OF MY PROFESSIONAL KNOWLEDGE ' INFORMATION AND BELIEF THE STRUCTURE SHOWN SETBACKS : OPEN SPACE HEREON CONFORMS TO THE HORIZONTAL SETBACKS FRONT - 20' SIDE - 7.5' AS GRANTED UNDER THIS OPEN SPACE DEVELOPEMENT. REAR - 7.5' a Of PROPERTY LINES SHOWN HEREON WERE COMP I LED FROM AVAILABLE r© C' c� PLANS OF RECORD AND DO NOT v WHITING No.29869 REPRESENT AN ACTUAL SURVEY oe ON THE GROUND. ISTER�� 08AI LAU S� 3 THE DWELL 1 NG DEPICTED ON THIS �Jvr / PLOT PLAN PLAN WAS LOCATED ON THE GROUND Z�z4�je 1N BY SURVEY ON FEB. 23. 1996 AND BARNSTABLE. MASS. ,. EXISTS AS SHOWN AS OF THE DATE <° OF LOCATION. SCALE: 1'-40' FEB, 26. 1996 THIS PLAN IS FOR PLOT PLAN EAGLE SUIRKATING a ENGINEERING.INC. r ,x PURPOSES ONLY AND NOT FOR 92d Route BA RECORDING. DEED DESCRIPTIONS YarRorrthport. AU. 02675 OR ESTABLISHING PROPERTY LINES. (508) JCZ-8132 'y . (508) 432-5898 THIS PLAN IS VOID IF NOT STAMPED AND SIGNED 1N RED. 0 20 40 80 PROJECT NO. 96-210 !AA Engine4ing Dept. (3rd floor) Map �" °� t= Parcel QO r 61. Permit# ` 1,502 7490 House# .3 _ to Issued �/7 �� NN JIUsT 400 Board of Health(3rd floor)(8:15 -9:30/1:00-4r3t1) 'B►'CI 0NN p UB �. Conservation Office(4th floor)(8:30-9:30/1:00-`2:00) q mr�YpNDIj'ISIpNP&o TgE yy� _ $TO Planning Dept.(1st floor/School Admin. Bldg.) ! OpIME Defi ' we Ian Approved by Planning Board ' 19 k. _ RARNSTABLE. ` TOWN OFBARNSTABLE, Building"Pe��r//mit Application Project Street Address / TiGJA J.,4.11g5 /V.,Vl-S "- Village 639 hb lv Ni Owner _ 1't1://`t Address Telephone or t l Il � -. /r Permit Request �- b j / / SA ✓e- First Floor square feet Second Floor square feet Construction Type ' Estimated Project Cost $ 4"Oiy, ®D Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Struc ure Historic House ❑Yes �o 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: dGas ❑Oil ❑Electric ❑Ot er Central Air UYes ❑No Fireplaces: Existing t/New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) Attached(size) l44 Q X oV,a ❑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 BOB 'DU 8e Telephone Number Address L)e,(r� .4�� , , License# -/7 Home Improvement Contractor# /49Z 9�215 Worker's Compensation# 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 �d Nsr:7Z, vlv SIGNATURE DATE 9� BUILDING RMIT D IED FOR THE FOLLOWING REASON(S) V FOR OFFICIAL USE ONLY _ PERMIT NO. E DATE ISSUED t MAP/PARCEL NO. ADDRESS VILLAGE` OWNER DATE OF�INSPECTION: POUNDATION FRAME ; 'r INSULATION. ' • _ - = FIREPLACE ' ELECTRIGA. FINAL .ROUGH , ° PLUMBjNGy ROUGH ' FINAL GAS: ROUGH FINAL ; a• FINAL BULD#NG - its tz DATE CLOSED OUT. i ASSOCIATION PLAN NO. The Town of Barnstable MWM �$ Department of Health Safety and Environmental Services Building DivlSlon R 367 Main Shuff,Hyannis MA=01 u WE= SOS.790.= BBi Coco Fax: 308-790-6Z�0 uilldd ing For offl=use only Permit no.______--. Dau AFFIDAVIT SOME IlVfPROVEME iT•CONT1tACZ'OR LAW ySUPPLEMENT TO PERMIT APPLICA77ON MGL 14 .A requires that the "reconstruction, alterations, renovation, repair, mad conversion. improvement, removal, demolitfon, or construction of as addition to any re u=iti owner occupied building containing at least one but not more than four dweiliog puts to structures which are adjacent to such residence or building be done by registered contractors, with certain csccptioas,along with other requirements. Type of Work: ' , '•� Est.Cast DOS'�� Address of Work: / f— Owner's Name Date of Permit Appiicot!on: I hereby certify that: Registration is not required for the following reason(s): work mcioded by law _Job under S1.00L __Building not owner-occupied ✓' Owner pditag own permit Notice is hereby guest that:OWNERS .PULLING THM OWN PERMIT OR DEAIMG WITH UMMGLTrERED _ ACC=ACTT S�TION PROGRAM OR GUARANTY FUND UNDER MGL 142A � ACCESS TO TSE ARB SIGYED UNDER PENALTIES OF PER.IURY I hereby apply fora permit as the agent of the owner. Date Contractor Name Registration No. OR Daze ownees Ixacae �= ---_—= The Commonwealth of Massachusetts Department of Industrial Accidents - OIllce al/mre599211aos M« ' 600 Washington Street Boston,Mass. 02111 Workers' Comyensation Insurance Affidavit Q at a �%//%//11,17///%%//EM/10,��/////////// ► '�e:£814 NOr /'% name: location dri,phone I am a hdmccnvner performing all work myself. ❑ I am a so prietor and have no one world n in espy capacity /// /// ❑ I am an employer providing workers' compensation for my employees working on this job. comnnnv name: - address: dtv- phone#: insurance 2011CV# a sole propriet ,general contractor, ho �wner--- cle one)and have hired the contractors listed below who have the fo or compcnsation policcs: comoanv name. address: dtv T�1n tie ...: ::....: vhone#! ^�f—�0 /�1�'�°Y� .• insurance cn. ...... . ImIICV . .�•�:��.. /.(b^'ir!!lll6ll//,G/.t�w(//,l�'G%/!/,lff///.(%/%///,�//////.✓��lu.r"�lllllllC/////// eom any name. address- dtv- Mane#- .. .:..:.. 9011CV4 .. .... nsurance co Failure to secure coverage as required under section 25A of NIGL 152 can lead to the imposition of criminal penalties of a One up to s13o0Ao and/or me years'imprisonment as wail as dwo penalties tm the form of a STOP NORK ORDER and a One of 3100.00 a day against me. I understand that a copy of this statement may be forwarded to the OMce of Investigations of the DIA for coverage vedfiation. I do hereby jc-�adundcr the pains aad p es of perjury that the information provided above is trw and correct Date //V- ? signature (W�— - r #7 T6 Priest name e i phone /" �' 9�� e only do not write in this area to be completed by city or town olIIdal town: penuitllicense 0 ❑Building Deparemmt CLicenvng Board Blmmediste response is required ❑selectmen's Office ❑Health Department LCcontactpctson: phone ii• - ❑Other S P1A) 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 cow- 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 die foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the rec.—wer . rustee 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 ,..L ..d,n o.r+..le%,m++nrcnnc to do nmintenaace , construction or repair work on such dwelling house or an the grounds c: 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 anv 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. ow Applicants comp ensation ensation affidavit completely, by checking the box that applies to your 'smtation and Please fill in the workers p supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Departzneat of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and _ that the application for the permit or license is date the affidavit. The affidavit should be returned to the city or town app P 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 Town-- 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 permitlIicease number which will be used as a reference number. The affidavits may be remmed io the Department by mail or FAX unless other=angemeats have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions.• please ...3 not hesitate to give us a call. WIMMA The Deparmicat's address,telephone and fax mmmber. The Commonwealth Of Massachusetts Department of Industrial Accidents Oltice of Imtesdoallons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 eat 406, 409 or 375 TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB LOCATION T ye�_ f ' Number Street address Section of town "HOMEOWNER" 214/�/7 - Z94N Name f Home phone phone �CI PRESENT MAILING ADDRESS �� _� ��, - ' P-ea-6 ��. City/tow1w State Zip code The current exemption for "homeowners" was extended to include owner-occupied dwellings of six units or less and to allow such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Persons) who owns a parcel of land on which he/she resides or intends to re- side, 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 Officia on a form acceptable to the Building Official, that he/she shall be responsibl for all such work performed under the building permit. (Section 109. 1. 1) The undersigned "homeowner" assumes responsibility for compliance with the Ste Building Code and other applicable codes, by-laws, 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. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 0, Construction Control. ' HOME OWNER'S EXEMPTION The code state that: "Any Home Owner 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 Home Owner engages a person (s) for hire to do such work, that such Home OwnE shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix -Q; , Rules and Regulations for licensing Construction Supervisors, Section 2. 15) . This lack of awarene often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board 'cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home "Owner act- as supervisor' is ultimately responsible. To ensure that the Home Owner is fully aware of his/tier responsibilities, ma. communities require, as part of the permit application, that the Home Owner 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 to amend and adopt such a form/certification for use in your community. t, c� CUSTOM VIEW CYSTOMER -- PHILLIPS DATE 07/13/98 REF Deck98194 ABC LUMBER ROUTE 2 SCARBOROUGH, MAINE (207) 883 0012 .r w7'x BEAM LAYOUT ABC LUMBER CUSTOMER -- PHILLIPS ROUTE 2 DATE 07/13/98 REF Deck98194 SCARBOROUGH, MAINE (207) 883 0012 8' 1 1/2' D 21' 6 1/8" 8' E 4' 4" F 3' 1" 2' 2 7/16' G G 2' 6 7/8" 6' 2' 2 7/16' B A in co %o �o Cu u� r (U zj- (lJ BEAM BEAM POST POST LABEL LENGTH COUNT SPACING A 5' 15/16" 2 3' 8 7/16" B 4' 5 7/8" 2 3' 1 3/8" C 4' 5 7/8" 2 3' 1 3/8" D 20' 10 1/2" 4 6' 10 5/16" E 20' 10 1/2" 4 6' 10 5/16" F 2' 1 1/2" 2 11 10" G 22' 10 1/2" 4 7' 6 5/16" H 1' 5 1/2" 2 1° 2" Post spacing is measured center-to-center. Depth of concrete footers --- 48 inches. ;a r . r 1\O y . N 82'4 7'38 T 100. 31 b � 22.2 cs .p 40, ,,,,/ 0 ti n /// - /.3 4 5, 82 �5 5 y Q RES. ZONE- 'RC" This MORTGAGE INSPECTION Plan is eoO I FLOOD ZONE.- "CBank " TOWN: DIY I _ REGISTRY OWNER: COBBLESTONE L NDMG INC DEED REF: _,912� 1� _ _ _BUYER: SuzAyJVL FHILLIP� _ — DATE: 4/� F:— — — PLAN RE 425 30 _SCALE: I" _20_---FT. I HEREBY CERTIFY TO _ ARD S _____ S � \ dpe ______THAT THE BUILDING c� �UYANKEE SURVEY SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS ,L CONSULTANTS SHOWN AND THAT ITS POSITION DOES _ __ CONFORM o �EF�Ry TO THE ZONING LAW SETBACK REQUIREMENTS OF THE ` NO 32098 40B INDUSTRY ROAD TOWN OF ---BARNSTABLE-------------AND THAT ���,. �� MARSTONS MILLS, MA. 02648 IT DOES_ NOT _ LIE WITHIN THE SPECIAL FLOOD HAZARD '` Fs�.n�� �:�-;;,,�—•.!,� ,� TEL: 428-0055 AREA AS SHOWN ON THE H.U.D. MAP DATED 8f 9�� _ 11JR'� a ,. ;� FAX 420-5553 Co unit —Panel # 050001 0005 C �____ THIS PLAN NOT MADE FROM AN INSTRUMENT 20433 JF PAUL A ER. MITHEW, PLS SURVEY. NOT TO BE USED FOR FENCES, ETC. _ i f .r r TOWN OF BARNSTABLE CERTIFICATE OF OCCUPANCY PARCEL ID 27�2 6 4 012 GEOBASE ID 37577 ADDRESS 3Z TIDAL LANE PHONE Hyannis ZIP LOT 105 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT HY PERMIT 15683 DESCRIPTION SINGLE FAMILY DWELLING PMT.#13183) PERMIT TYPE BCOO TITLE CERTIFICATE OF OCCUPANCY CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: Im BOND $.00 1 � , CONSTRUCTION COSTS $.00 QA 756 CERTIFICATE OF OCCUPANCY nAxrisrABi.E. MAS& OWNER MARKWOOD CORP. , 039. 6 ADDRESS 110 BREED'S HILL RD. UNIT 10 BUILDING�D 6 8Ia HYANNIS, MA BY DATE ISSUED 06/07/1996 EXPIRATION DATE ., 2::��,-�'s;gv-.s.`..ia .:.: .�.:::it�:.a:.::i%.Latta.-2i,��.i:�:::::=::+:...i. '•..,;:::,"�i,]1J;:»:�..._.a..nas.t,i,:�wr.:�.,:.:..�•?+a�:ry.��...�..;__.:r:.,;..,.�_... ..,.,..a..._"X. .._.... �.,.�.,__wa�"'`_�..:;.:.- 1 Department of Health, Safet3 and Environmental Services o�TME = 1AMSTABM 0.19. BUILDING DIVISION BY THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF,EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OFTHIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- ELECTRICAL,PLUMBING AND MECH- (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS. 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. 4.FINAL INSPECTION BEFORE OCCUPANCY. VISIBLEPOST THIS CARD SO IT IS BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS )rr Ai • Vaal 3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 2 v � BOARD OF HEALTH OTHER: SITE PLAN REVIEW APPROVAL E K SHALL NOT PROCEED U TIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS NSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY OUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- . NOTED ABOVE. TION. Assessor's Office(1st floor) Map C2 /c °Par ��7 Permit# 13 Conservation Office(4th floor)(8:30-9:30/1:00-2:00) C D ate Issued "2 - O- Board of Health(3rd floor)(8:15 -9:30[1:00-4:45) Fee -2 t) Engineering Dept. (3rd floor) House# � � APMCANTMt13TOMMA 114E CONNECTION PBRMiT FBOM � Planning Dept.(1st floor/School Admin. Bldg.) R III ENGIIVEEBIIdaDlV�tpNPlliO$ URN • BARNSTABLE, Definitive ved by Planning Board J (INN Q t3 19P , MA9' f�- � 161 .0 � ri°�� 1 x--eole A TOWN OF BARNSTABL_ Building P Application Project St ree ress Village / Owner e Address f0 IWfl, Go., . Telephone 7*0��r/ Permit Request --*/CV C LJ 4mlc- h y First Floor square feet Second Floor A,.4�4,4-6- y square feet Estimated Project Cost $ `l z ooc> Zoning District "" -A Flood Plain Water Protection Lot Size Grandfathered ? ap Zoning Board ro"'T pp A thori tion Recorded Current Use Proposed Use x,Construction Type (ti Commercial Residential fsJ w Dwelling Type: Single Family PL4 Two Family — Multi-Family `4ge of Existing Structure Basement Type: Finished Historic House Unfinished (� Old King's Highway Number of Baths No.of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Q&JrM &" Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached to Barn None Sheds Other Builder Information Namelq6VLJ�41-7j—"o Telephone Number Address I fD License# , Home Improvement Contractor# 160fl7l Worker's Compensation# WCAVO 0 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBR S R$ULTING FROM THIS PROJECT WILL BE TAKEN TO U SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) (56 ?-3 FOR OFFICIAL USE ONLY -� PERMIT NO. DATE ISSUED MAP/.'PARCEL NO. f ADDRESS VILLAGE t , OWNER DATE OF INSPECTION: - - FOUNDATION FRAM E INSULATION FIREPLACE ELECTRICAL: GH FINAL _ z R PLUMBING: o UGH FINAL GAS: UGH FINAL s FINAL BUIl DI e +� a i DATE CLOSED OUT ASSOCIATION PLAN NO. s ; 23542 EPARTMENT OF PUBLIC SAFETY n 23542 1SIACE. P Q 0 ONE ASHBURTON PLACE, RM 1301 ,3 Z BOSTON wkk.O21O8-1618 W� 3.0 • -�- �a995 a CONSTRUCTION SUPERVISOR LICENSE # a o 0 Number: Expires: " 1 , _ Restricted To: 00 TIMOTHY PEARSON _ Detach bottom, fold sign on r b ck and laminate license card. POBX 519 , CENTERVILL•E, MA 02632 /Keep top for receipt and change -';of address notification. 23542 Restricted To: 00 \ - JFFARcUF.RT ;1F RUB='1C SAF"°'° ...1fT?fl} 31UP.', ;?S.;p .i nNQS �0 None .___.a _RJ_. ., __G .Q_ Ruscer; EYpires: 1G - 1 & 2 Family Homes Restricted To, '0 Failure to possess a current edition of the Hassachusetts State Buiilding Code 'IHOTHY PEARSON is cause for revocation of this license. Pngg D19 CIENTBRVU.T.•, HA 02632 COMMONWEALTH OF "SACHUSETTS + DEI'A.Rr NEWT OF LNDUSTRIAL ACCIDENTS 600 WASHINGTON STREET ames.: Carn=ei: BOSTON, MASSACHUSEITS 02111 Ornm-ssione' WORKERS' COMPENSATION INSURANCE AFFIDAVIT (licenscelpermi ttee) with a principal place of business/residence at: _U P al-gLIL'i, In i -M- 62, D I � (CirylSut �p) - do hereby certify, under the pains and penalties o perjury,than. [ l am an employer providing the following workers' eompensanon coverage for my employees working on this job. Insurance Companv Policy Number m [� I am a sole proprietor and have no one working for me. [� I am a sole proprietor,general contractor or homeowner eirde one and have hired the contractors listed b:? x g ( ) o who have the hollowing workers'compensarion insurance police~ Name of Contractor Insurance Company/Policy Number Name of Contractor . Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Numbs: 1 am a homeowner performing all the work myself. TOTE Please be aware that while homeowner$who employ persons to do maintenance,construction or repair work on dwdJing of not more than three units in which the homeowner also resides or on the grounds appwwnant thereto are not gcnerarh• considered to be employers under the Workers'Compensation Ae:(GL C 152,sect.. 1(5)),application by a homeowner for a licesc or permit may evidence the legal tutus of an employer under the Worker$'Compensation Act. . ' Al .-erstzid that a copy of this sucement will be forwarded to the Depar-.r::cr.:of lndustrial Aecideia'Office of lnsu.-anee for coverac: vcn-scation and that failure to secure eovcmge as required undo Section 25A of MGL 152 can lead to the imposition of criminal pc:-.!':a eo,:sisong of a fine of up to Sl 500.00 and/or imprisonment of up to one ye`:and civil penalties in the form of a Stop Work Ordc:ar,:: fine of S100.00 a day against me. day of , , 19 1_i<c_tsrc�l'crmiRcr � I:icc»or/Punrii7or � -- e TOWN OF BARNSTABLE SEWER CONNECTION PERMIT " OFFICE USE ONLY Assessors Map No. `� �AT£R ACCOUHT Zd0 :-... ....`: : ;ac:}` Assessors 2 ors Parcel 1 :. `..... ..:..`-';r:<:;:a ?=>`<'s»>: �::: :'<`.: No. �L'1 ,t�` ;1�'ATEI;,SI7`T'�'LII:It .. 1�5 Street: 31 -T&S Lme_ SEW&R AccouNrrlo ' , Village: <`:P.GRidIT. _ FI3E> _ - j PROJECT CONTRACTS. PROPERTY OWNER(Mailing Address) SEWER INSTALLER Name: Ir Name: Ad r ss 1 (V �S Address. Z t A- &Zbo i s 2(o Phone: 1IF:i rf_6. Phone 49 rl—(66`J OWNER'S AGENTIENGINEER M. I ADDRESS: rP 's s col PHO. — 1 PROJECTDESCRIPTION REGULATORY REQUIRaIEN 13 FACILITY 8 LAND USE DATA The installation of all sewer c onzecd nts must be done in �Y:•�N}.''}i::�)..?t►}.f>.Ty3;?E•::y;am:R.',i;}f q;:c{Ef<u•,N :R•::}:.'r:..iii;}.•.%:;:�:>n�5:':-.:r•:i:}:::;:;::r::=8a�_.8%nY+S-4.:v::...dfi;r}.�n,.}:a3%-,d`rr;�+::v;a>ffi':Sa:[b:��:ti}k�>�Iri::k::£r.;r;,:^•�;;,{k.'Y.•:•'�v,£'•s�"nv:t!:3.hc,.c.•i�Jr{:r:C.:.n{.--a; ace rda nee with the rw_lt ions a[ 1ricle XXXVI.Town ,:;�: •KfS:i}tiv ?:L�' •? ::r.j{;••rq?:{:;{.}i•:i}:Yr::•:"::'_' �y�i:::l.:.:r`-'•?::::v}'n•::}:Ji{}:•;:?f::?-.)::•'•y-:ix:r.}}f:t{}r?};rn ri,:{`,�.'-.}xy¢.??;:'i.{:F.:� ...... :} pf-:,,,.. :..,.•S£ £�::.�. �.v.,.r.:�<:?...,..;:: w,�,�:<�:,,:..... ?.. .�:,: ,�. r:.:: o[Banrstable.Genral Hy—laws.Before ezcavatinewithin a Town Way the sewer installer=st also obtain a Road RESIDENTIAL Opening Permit and must comp"cywkh the Construction Standards and Specifications outExd therein. At least 48 COMMERCIAL hours prior to the installation.dx ar,.itcant must notify the Department of Public Works.Eapncering.for the RESTAURANT purpose of inspecting the installation. The Inspector will complete the Compliance Sketc Totting the installed INDUSTRIAL lines and connection. By signing i:.e Application.the applicant acknowledges and unce-st=ads the regulatory • NUMBER OF BUILDINGS requirements and understands t-a,fzilure to comply with NUMBER OF BEDROOMS 3 them shall be grounds for rcvo=ion of the Sewer Connection SITE OF PARCEL. 'lZ ACRES Permit and the denial of any fmare permit applications ESTIMATED DAILY SEWEAGE GALLONS PIPING:LENGTIa DIAMETER i EXPECTED INSTALI-AT.ON DATE i NOII :A C:op ul a Scwa-Tic Rer-=tion is Attac'hcd i AGNATURF ON'iIAi> a T /ACiI_�'1' DAL'!. 2'g ! -- - - --— JI(,1�'ATURL (DPWA1'T-10VAI ) GATT T, LEAD FLA:NIN(i VLLUA•q ALUM C.UTfm Mars IMAM-., _ - --- A+.um.GurfEK u!p L �Lj-] IIry�Irnpry I (�I I i _.._ %• M A-C LLv.N. N.N 4.AN. _J 4...J I. H'•N 4LDK rya L,4L.yK. ._ __-_..—_._—___ MI N11E LMYDWIYY—• _ _ 9••7-Gv.RoK Woo9'3iL1"y —... t MUD p(y.an .. (yam ArKO-k FROUT ELEVA710u �;sTMI„°;f1"� . 5:+•i 0•rE 508.428.6 ALYNgIt r1111y LES -----� , W.UM.4u'I'feR I�evl in ( usto — �: `assigns i_ MU�UpN ALVM(avr+ER WNi+E LEOAR yNIW4LES��- �—+ ALUM DN,r+rovl C+rY) I----�-�----- JL,L�],,j J J 1xc�.uwe � �------ --..... ......... ... ................... REAR EEEVATIOf`! r'M � •w P,71, nary pf,nf ana ..yours oy DCO are for the use of Ineir CullOmerl only Any olner u%e ,1 nr,c nr pion,o it b UAn FLULANCI \\GOr)IGGHt.Q. atia+ut�.a. ILI OC,L\,Lw C.M. .LM�E NAhL... .. . ......... ALPw 6u1N4LL5 .....MT . • ,' +— '\Vw11(..Lfl�1fl;L{w<,LFS I >aL lwx A.4E.Rw. f ..7.Al�Yi4t.4-tua. NUILON Pp%2D an ,I r .4.._ Wus\L cEnAq bUI NSLLS —s•• I I, LEFT ElL\/hZ10N RIGHT ELEViRION i1 ,1 s➢ 8'f1YGP . q\v 11"TIM.WALLS ON hi't.B`TNM. / 5`7 - 77 508.428.6191 ilo � 1'I e v l i n listom D d 2�s -.cow-wl'..wlE+K•III ?designs COMC.FNLLn LALLY COL. I — :opynyni c 19r5 O N mil i.gntl N a �; its rrr ea I � I°LT�PRp•LCLINM.).tIL Q � y bMEC F P-FOUND• tip N� CdIAV.\CT TILL � . O n O > N I i Y Y"r P(DUwr)/1,7ioW PLAW --._...- -— °O o`o_._. .__ ar•o.. ♦'r• lo••OiOr ra•• x o ~o• .r.o Preliminary plans and layouts by DCD are for Int use of them CUltdmtrs only Any otner ule .t Il roc:Ij P:_ni Carr, 34b- �sLILN 1Y711MLN .. p•.. _._..---...------- Imo.— • 4':L__: svo' v , p ._MEDQAAI I4trc�, � .- JJ Le F N - - _ '-MONn FICOR PLAN 11.�D pKK • � - ..._...._._.._........ ...A.._. -_-___ --- o 7 t0• O ..___...._............__......__.._.—._lt•_0.. .___.._.. S sunL0. d I- --- O >o _ 0 _ j .t li•lo` �ItITCy1EN I - a`tr`lsr,�- 5gE•4Z8.6191 1� k••.�s co sNLLl�OCJ( r -t •' gustom o i designs I lo•O"GO• • N I A11 i,yntl WaGMY I,wE -- ntw _ p FIRST F=R.['L..,N - si• a"O ss• ao 'to- ske- To• ti ----� ---- �'o �t�cy••••• I'lehminary plans and Iayoulf by DCD.Jre for the use of their Cuslomefl only Any other uIe ,l Itn(Ily J I I R.C.C.LW%OARn4 ON TNCK - n - CLAn VWW',.(.Dm.4T)OV vl• -� +'e .-bCCWAI. ... _ I .KYw'b(41.091C114 mmwm) _w.GsuwcCC-6GT.TOC.CLXRs1 1:L.)vlurynxllslwu►tz:_ - .. - A uC•um itM�su Vs C.lw n)ON - LT' i . TYi>vATLILT4µ1(}S•CiJt) .. . - Wl lq���UP DETAIL. i5 to•) Ul.F.•1•SRC`!•L SCAIYR. • "P►TIOY AL:._.:..:.:•._ WATERTMLE-MTKIC CN-a-o") _.'..�.to unto--�----- �• • ..__II.10 tAFTLGL • . - •, ._."L`1CCwt40D_.._..._ ___. '..\ - _4aLOGR+AC4 t.IwFTLRi' .... . - •. • "�lL-:Tel 1�7 SSYntu`.., i V r^; �ri`slucrR.ocK s ca F _ 70 R♦.SlA.lv]'KpFCl:', r �1'T_ llll o YIGKf-Mn1:LW'YENS.:. I' -D4tiiLtA♦f.._ + J•� G 808.428.6191 (Levi In .l.t..6Di PT 00 .i Li•..e (5 m usto una 4U1b1VQ '- I 'I Pw Itac.l6._.. a 1 cs svcT•c t.ontan @ S 19 n 5 cognpnt p liol c AJ i,pnc, r� ifItry td -,fit }�I7FTICTL""f'1'•._efl-�..... I I 'Te G'IM_Ic cx.,") .. _ ❑6,1bCfTY. ' ......LYCT(tIt.RGOt1N` '•I q4 Vretiminary plans and layouts by RC.O.are for the use of the' Cu/tome11 only.Any other use :c Ctnc Ely p,oh,.mle r, • r � t ASYNA$.7 SL11NfjLES ALUM GuIrreR --I'F- O MF1 _� b N•frl 4L9 H. N N 4L.AH. � �� I. (w•l+�4L7K h'1•L4(��.'AK ..... - u�Jo _ r;� MAStu 11E LIJ.YDWNVI--'• ._ PLUM.�N.yYWf. _" ___—__..--.—_._�__ 7_. 9••7•aA yaoR 1 Mup p<aL n .. CGrC. APRO _ (ROUT ELEVATION5�1R�M l"� N 508.428.6191 ALUM C UTT£R l. • _. ��'lII � �faevl i n �Ustom signs - ��� MULuosJ WHI+E GE DAR SKIN4LES--... ALUM Du.4WVT C• LUI J Deco ur•le i Q \ REAR ELEVAT1Of I — 1 o „µ Prelrmrnary Plans and layout$ by DCD.are for the use of Inch customers only Any dtnrr �s< it it l'�.c by -�i on,.Cite u1 / om,wvull-. unn FLA W NCi won IGUYLG. NtW "7 KA171'6wINC.Ui --'- I _ 1 Ill I 1a+7n lw".4.0-w� 1j� ,i ..76LLI/i1.t.ea.c�y. MUUAON ep%2D GJf 11,E • .1.._ . '\vwsll C10nR 6w1 NSIt5 - 1 I. UI T El1_VnTIOW RIGHT EIEWMON RV y}V Ti ] 6 IthV OITiM,WALLS ON s'4•►S"T/M. S:..LE :.•rE. 1 508.428.6191 4"f TSK.CONG, Devlin 5ustom D .2�.i•.1•1N-.Cows.P14.W0.7v•0 -1 CO"-FILLI,rs LALLY cagy, .j e s i g n s i iJ Ad 7,y nll I°FfG,PP.W.CI•TNM,)Ml p y }1nU♦•'P.NVNO. y. Ww AGE FILL f O r -0 >T�1 i Y1 `r ==7, ===Tz FOUu0n7low PIN I -- --- °''a_._.. .__ Y•o aV vv o^paoP �y 3410 O- Pi N;mmary plant 7no layoulf oy D C D are for Ine use of heir <us comers only Any oiler ut<-,I I l r;c Hy p;zn,0.{r. -'- -- - - __._.4.._..._..._----- . U e 'r 'BEDP=M z' Lt� p N - Itr,o• Isrel ur,.uuz.. SEcc�Nq FLOOR PLAN 12.�0 OtCK IS �.�•� 9'�� I la O '0 J .� �i•�o` �It ITCi•ILN bl ^ hININCI I 50;8.428•6191 . 2, e)i W A \VK"&:CaG. I C V i I n •' Custom of i designs le t Ucopyngni C 199s MILGNV I.s►sC ° P�EI�RC�QM ' 4�a•.sOuw..ti FIT p � o T N I � A. i FIRST FL R,pL/,N - s`" a'•.° _ 44 _ •'o' Io t:r.-_ ty. i,o. Vo. .... lad• -�� Iva, Prcbm.naty plans and layout$ by OCO.ate lot Inc use of Int,customers only any otner ule,t+.••... 1 IL aL R.C. Lw%cn Ills,61 TYVlk IIAn VLAS 4•G CPNNT)ON vy . ...DC tall wt. .. —... 1 .PSYw'n L%LM 'q Ywaln) (RaTyGN u+nb) ._... ' I -I sill AVALWAlit.4"Ikmmx� '`N.GWWGl2 6TALTLR.CMM1bL ` •LunxAcstSCw-uT)wl I VMNAV CAP DETAIL.Q` als.) A.G:F.lmbsll'."•L-42AL1 R 'VAT LRTAhU-DETML CN-,y.o� • J _'_"::....III tcAFTOCT""• .... �•ouu. cuwLLLS:.._..-' ' , 20 WY .ri/•RIOKI:. r�otiff_. il'E a5 i - is AL uu.KS.STArQ[KvClJT.:. .- 1 II mIr 508.428.6191 _.--p..e.Jtx►u ,r� _ eV fl Custom I.a..bDF i1T t I I .a'YtALYt�-..._ •yT ..1411DI V 1 wLeTFD UG:.. _- p dDles 18 f 1 s Ct copynpnt Q liaa 1 Q All i,pnt-s 1 r rt , ies rtv rd cc _.�r3CFlT—nPT1crY"Y I'•.'_�r„o�..-.. - I ., ' I 'TI L-t1K11•t7Clr1 ' - ...:tlwTL�RDOF1N r1 ;c e s' 4 Preliminary plans and layouts by DC.D.are lot the use or their customers only.Any other u se is stncny pton.mte 5 T ;Assessor's offioe (1st floor): Q�) G n Assessor's map and lot number ... e...... .. la? �aEt°� Board of Health (3rd floor): � �/ MUST CONNECT TO TOWN SEWER Sewage Permit number ............... .../ Z EAUSTABLE, S Engineering Department (3rd floor): c 3 �O M6 9• 9 House number ................................................'........................ "�o Na3 d` APPLICATIONS PROCESSED 8:30,-9:30 A.M, and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ..construct „a single familX dwelling TYPE OF CONSTRUCTION ..W0.0d...fr.d le......................................................................................................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit a cording to the following information: Location .....Lot... MA #.105................................Ti.dal..Lane........:....................Hyannis►... ....................................... ProposedUse ............................................................................................................................................................................... I'I Zoning District .......... ....I.................................Fire District ....RydRTI.i ............................................I.......... Name of Owner G.a):?xic.o.T:a..Fe.alty....TrUSt............Address ...76.5...F.aIICtQ.uth... R4aa.,...HyannlS, MA Name of BuilderFrAn.CO....R...F......D.P,V.,.C.0....1n.0............Address ...7..6.5...Falmo.utb...RAda......H,yann S.... MA„ Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ..... Six .,.Foundation .......P.C............................................................... Exterior clapboard, and�or shingle.S....................Roofing ........asphalt shin Les g.. . x Floors .....qaYKpe.:t.................................................................Interior .........shePtY'OCk Heating .......GAp.-F.W...A...................................................Plumbing ......TwP-.Q9 P.9e :'.................................................. Fireplace .......Yes Approximate Cost $50, 000 . 00 ............................................................ . .................................................................... Definitive Plan Approved by Planning Board ----- Z ___-_ 9 Area 111.6.....sg.�......t....... Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Na , Construction Supervisor's License 0.0.0.9..8.9 ......... . .. . . ................ r No ................. Permit for .................................... .......................................................................... r Location ................................................................ ............................................................................... Owner .................................................................. �• Type of Construction ........................................... ' Plot.. . .............................Lot ................................ X I d� -Perm it,Granted ........................................19 Date of. Inspection 19 Date Completed ......................................19 c— r 1 � � e f'f E • I A offioe (1st floor): Assessor's map `and lot number ,;?.7 .D�: ��? �o*THE rot♦ . Board of Health (3rd floor);, Sewage Permit number ����..�f 4 3' Z SAUST11DLE, i Engineer'ingDepartment (3rd floor): 2 "6 9 House number ....L': J ^ �Fp yay a• APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNS,TABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ..construct,..a, single family dwelling ... ......... ... .. ... ..... TYPE OF CONSTRUCTION ..wood...fraane....................................................................................................... 19...._ . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit a•cording to the following information: 1-1� Location Lot #1.05...............................Tidal Lane .............Hyannis, MA ...................................... ................................ . ProposedUse ............................................................................................................................................................................. �Rr;B*.jA..P.,.....l..................................Fire District ....RyanniS Zoning ,District ....................... .................................................................... Name of Owner Capricorn Realty,,,Trus.t Address ...765•••Falmouth„ Road, Hyannis r MA Name of Builder Fran•co.. ..• ....DeyCQ,Inc..••.•.•....Address ...75..Fa1muth...Road ,•,Hyannis, MAR , ,. Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms .......SiX .............Foundation .......P C. ....................................... .................................................................. Exterior ?............................... ... ...... Roofing ...........r.�? . .. .... cla board and/or shin .les.... .. ... as halt shin les car t sheetrock Floors .P..,.,,.............................................................Interior ............._................ Heating .......GAS—F.W.A....................................................Plumbing $5 Fireplace/......Yes...........................................................................Approximate Cost 0, 000. 00 116 Definitive Plan Approved by Planning Board ____-03----------19_U Area ......................sq.................. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS r I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Cons-.ruction Supervisor's License 000989 p .............................. i I No ................. Permit for .................................... .......................................................................... Location ................................................................ ............................................................................... Owner ................................................. Type of Construction .......................................... ............................................................................... Plot ............................ Lot ................................ ti Permit Granted ........................................19 Date of Inspection ....................................19 Date Completed ......................................19 ` C F�IA1 a� ..j EQUflQUET• cy •9 q Q. .00 �9 F' 4` 1 � , S v w I 0 I / 5 pAC� ► / 1"' LOCATIOt\1 MAP scA z 000'• �/ / _ N 00' 19' 34"w --1 __ " p 88 . 36 I r l l _ Lo 7 s 4 - s �' N 0. Q 'n22 2 8�� lJ 13�* t°w i 6 b i 7CID 4 In t LOT 106 r T 10 4 I p3.4p \ .3B.41, . 2.50 Up - Ft 5 - k N FLo \Jr \ RENWICK N " 1N1/ERT �D� ♦ o� B. CHAPMAN y fl-•=��•5� ` \ o •p No. 27654,0 w� yF�G�ST����� FSS7pNAL ` The BSC Group-Cape Cod Inc 3236 Main Street BENCH MARK USED: Route6A 110C ELEV. - 75 .68 N. G. V.D. _ ` Barnstable Village MA ZONE RC-1 02630 SETBACKS: (OPEN SPACE) ' 617 362 8133 FRONT 20 ' K SIDE 7 .5 ' �r REAR 7 . 5 ' A PROPOSED SEWER J� of Mgsfq� CONNECTION FRANK FOR SEWER MAIN DETAIL SEE Pl-+,N S BY KALKUNTE ENGINEERING CORP. LOT 'DEC WHITING 1749 CENTRAL STREET STOUGHTON MA. 02072 y No. 29869 IN Fs rsrEa-° �� � BARNSTABLE MASS . (Hyannie, _ FOR: CONSTRUCTION NOTES 1. ALL UNDERGROUND UTILITIES SHOWN ,WEFE COMPILED ACCORDING TO AVAILABLE CAPRICORN REALTY TRUST RECORD PLANS FROM THE VARIOUS UTILITY COMPANIES AND PUBLIC AGENCIES AND ARE APPROXIMATE ONLY. ACTUAL LbCATIONS MUST BE DETERMINED IN THE FIELD. THE CONTRACTOR MUST NOTIFY UTILITY COMPANIES T2 HOURS IN ADVANCE SCALE : 1 "= zo, OF CONSTRUCTION. THIS MAYBE DONE BY CONTACTING THE DIG SAFE CENTER METERS 1 — 800 — 322 48 44) FEET o 10 Zo 30 4o so 2. ALL WORK AND MATERIALS SHALL. CONFORM TO THE TOWN OF BARNSTABLE DATE: J UNE ��-` 1938` DEPT. OF PUBLIC WORKS CONSTRUCTIOA SPECIFICATIONS AND STANDARDS`. ' COMP./DESIGN: T. A.W. /S.A.H.A-14-4 _ 3. PRIOR TO START OF CONSTRUCTION THEN CONTRACTOR MUST OBTAIN FROM THE TOWN OF BARNSTABLE A SEWER TIE — tV PERMIT AND A ROAD OPENING PERMIT. CHECK= c. t=: W. /tz.g.G. DRAWN= T. A .y�l. / L.H.Ci. FIELD= KEy /JYB FILE NO= DWG. NO= 13t5-toy JOB NO=3-3035.2o SHEET= I OF= �A ni 27 K Tts, ..... GFAIER"A L, NO PROPERTY- LI NES WERE C&PILED-FROM A VA I LABLE PLANS 'OF RECORD AND DO, AN �ON THE�'GROUND SURVEY. NOT,',REPRESENT, 'CONFORM . . ,'ALL WORK AND MA TER IAL S $HALL DEP T. THE, "TOWN OF'SA RNS TA BL E OF PUBL I C WOR 6 C ONS TRUCTI ON:'SPECIF CA TI ONS AND S TA NDA RDS.�3. ALL SEWER P IPE SHALL BE SCHEDULE40 , :OR 'APPROVED EQUAL . "DIG-SAFE". BEFORE, CONS TR UC T I ON CALL 8 0 0'-3 2 2 4�44 FOR . LOCATION OF UNDERGROUND'.UTIL-1 TIES, L OT 0 6 ,5. VERTICAL DATUM IS: NGVD CA) -75. 68 6. BENCH MARK USED: M. G. S IIOC. EL 100.-31 4 .38 7 TO TIN6 S 1�) U) VFWAY PR SgD opo IN. p 0 02 ... W 4 -a-27'k Rop 0 SA4H ao ZONE : RC- �SETBACKS: (OPEN SPACE) 67 ' SPA CE 'r OPEN 'FRONT - 20 -- S IDE REAR 7. 5 ' , 66 L OT 05 7. 845-t S.F. 82.75 50* 1 N 75, L OT 1 104 s TA .) 'A IVN S -OR A R.�ED IVA 'wo 0 10 S (:.-A L%iE �20 jE 49,R UA R ,v4t / o Cz 40 ez z 4a Z2 C KV ez z7 4 le Af ez: -5 0 a 0 :"40 /0 20. C'.1 SAP CHECK NO 9 R JOB "'R V81PDR w 6-2Io FlIELD. ..... .. ...