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Home My WebLink About0061 WHIDDEN AVENUE ��l cvH1� �r " 6 ! �- �j�\� � 'mil �llr�r sSfsLC.C✓�' /� I i I I +� I I Town of Barnstable BuIll�IIl � xo r � " �. �� ° ° n9 oeaiasras�.e. t Post:This Card So That it is.Visible From the Street Appiroved Plans Must be Retained on Job and'this Cartl Must be'Kept "AASS. Posted Until Final Inspection Has Been Made t ° 16sQ. ♦� ro- .7 , ,n ',,t�1 a.:^�F�"w•xT3.�',�y;n rat.:.„ a� �.. ;,a'�e � nK �x,'' ��r„u5$,;` ,. ,ya!°": �:7 4. ru•+• Where a Certificate of O&i pancyis Required,such Building shall Not`be Occupied until a Final lnspectionihas been made: Permit Permit NO. B-20-747 Applicant Name: Craig Bishop Approvals Date Issued: 08/07/2020 Current Use: Structure Permit Type: Building- Insulation-Residential Expiration Date: 02/07/2021 Foundation: Location: 61 WHIDDEN AVENUE, HYANNIS Map/Lot: 324-103 Zoning District: RB Sheathing: Owner on Record: KVARTUNAS,JOHN&DEIDRE Contractor Name ' CRAIG P BISHOP Framing: 1 'l. Address: 7011 HUNDSFORD LANE Contractor License: 109,777 2 SPRINGFIELD,VA 22153 Est. Prole,Ct Cost: $ 10,781.00 Chimney: Description: Weatherization/Insulation Permit Fee: $ 104.98 Insulation: Project Review Req: ALL REQUIRED DOCUMENTS SUBMITTED. Fee Paid $ 104.98 Date r 8/7/2020 Final: F Y �all— Plumbing/Gas Rough Plumbing: =- �,,Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within sixmonths after issuance. All work authorized by this permit shall conform to the approved application and the approved construction documer-ts for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road a d shall be maintained open forfpublic inspection for the entire duration of the Final Gas: work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this p rmit. Minimum of Five Call Inspections Required for All Construction Work: " Service: 1.Foundation or Footing Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed ^ Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Building plans are to be available on site Fire Department Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT (�Md�—, ,sE1✓T Town of Barnstable _ 0 Building grp Post This Card So That it is Visible From the Street-Approved Plans Must be.Retained on Job and this Card Must be Kept SAMN" Post UM Final Inspection Has Been Made. ° i61W�� Permit t Where a Certificateof Occupancy is Req;uired,:such Building shall Not'be Occupied until a'Final Fnspeeton has been made. Permit No. B-20-1053 Applicant Name: Timothy Johnson Approvals Date Issued: 06/03/2020 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 12/03/2020 Foundation: Location: 61 WHIDDEN AVENUE, HYANNIS Map/Lot: 324-103 _w Zoning District: RB Sheathing: Owner on Record: KVARTUNAS,JOHN& DEIDRE Contractor yNme: -TIMOTHY P JOHNSON Framing: 1 p Address: 7011 HUNDSFORD LANE Contractor License: CS=101696 2 SPRINGFIELD,VA 22153 4 Est. Project Cost: $ 10,000.00 Chimney: • � Description: Construct a 14'x 16'deck on front of house using p.t.framing and i Permit Fee: $ 101.00 slate gray decking Insulation: Fee Paid: S 101.Oo Final: Construct a 32'x 16' deck on the rear of the house using p.t,,_,_ _ Date: 1, 6/3/2020 framing and azek slate grey decking l ' Plumbing/Gas Project Review Req: Note: Front Beam support spacing to be checked on site. No Rough Plumbing: support of Joist on left side of front deil k required. Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for Public inspection for the entire duration of the Final Gas: work until the completion of the same. w, Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing . " 2.Sheathing Inspection Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy . Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: - 1 Town of Barnstable Building ' e a CCeard iSao l ePermit -'his d lM"� n- 039 rtifcat ,Whir of Occupancy,is Required,such Building shall Not be Occupied until a Final Inspection has been made Permit No. B-20-240 Applicant Name: Timothy Johnson Approvals Date Issued: 01/27/2020 Current Use: Structure � Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 07/27/2020 Foundation: Location: 61 WHIDDEN AVENUE, HYANNIS Map/Lot: 324-103 - Zoning District: RB Sheathing: Owner on Record: KVARTUNAS,JOHN & DEIDRE Contractor,Name°' TIMOTHY P JOHNSON Framing: 1 Address: 7011 HUNDSFORD LANE Contractor License. CS401696 2 SPRINGFIELD,VA 22153 Est` Project Cost: $ 20,000.00 'Chimney: � y• Description: n: Replace a11 windows usi ng existing openings � Re rmi,.t Fe_e: $ 102.00 Insulation: _ _ FeePaid $ 102.00 Project Review Re : AJ102.4 Replacement Windows Final: Date 1/27/2020 LUt ��crn Plumbing/Gas Rough Plumbing: ; e Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months af ter;issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be incompliance with the local zonmgby laws and codes. This permit shall be displayed in a location clearly visible from access street�or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. - u Electrical n The Certificate of Occupancy will not be issued until all applicable signatures by he Building and Fire Officials are.provided on this permit. - Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing 2.Sheathing Inspection a Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: . 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy .Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: e -Town of Barnstable Building R Post This Card So That it is Visible From theStreet-Approved Plans Must be Retained on Job and this Card Vust be Kept ; �WASIVSTABI.E; � 03 Posted Until FinalInspectionHas Been Mader,, - �' Per " Where a,Certificate of Occupancy is.Required,such Build ng.shall`Not be,Occupied until.a Final ln`spection'hat-beeh.made.� 1 �l mm 111it Permit No. B-20-5 Applicant Name: Timothy Johnson Approvals Date Issued: 01/23/2020 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 07/23/2020 Foundation: Location: 61 WHIDDEN AVENUE,HYANNIS Map/Lot: 324-103 Zoning District: RIB Sheathing: Owner on Record: KVARTUNAS,JOHN&DEIDRE Contractor NamTIMOTHY P JOHNSON Framing: 1 Address: 7011 HUNDSFORD LANE `' Contractor Li-tense:GCS=101696 2 SPRINGFIELD,VA 22153 �" E Est Project Cost: $8,000.00 Chimney: I ,. Description: Bathroom remodel. Frame in Back entry door and hallway to create Permit Fee: $90.80 Insulation: larger bathroom and new shower space. Frame in new 36`x18" 1I a ! Fee P,aid:• S 90.80 window opening. Install double 2x6 header. Install ne- ,insulation / Final: i Dater 1/23/2020 Project Review Req: Need full floorplan showing location of Work per discription �- Front desk Plumbing/Gas �- Rough Plumbing: - �. �... � Buiiding.Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorizedl`by this permit is commenced within six months after°issuance. All work authorized by this permit shall conform to the approved application and the£approved construction documents for'which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-lawsrand codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for publi( inspection for the entire duration of the Final Gas: work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by�the Building and Fire Officials are provided on this Permit. Minimum of Five Call Inspections Required for All Construction Work: ' Service: 1.Foundation or Footing 2.Sheathing Inspection _ Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). ' Fire Department Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: 10'-4 3/16" 31'-10 15/16" 32'-5W Remove exi.tfn�t Ent y Door Install(2)2xIO KID Header - nstall 6068 Pella French Do 1- --- - - Bathroom R5unroom Bedroom 1 Bedroom 2 a W Remove Exlsting Ceiling - sister up existing rafters with 2x10-KO Install new collar ties at 2/3 up from top of wall r-a• 2 s - to create a vaulted celling - Q O _ H 11 11 O n Remove existing Double Slider a e Install(2)2x10 KID Header Install 9068 Triple Pella 511 door _ Bedroom 3 Q H 12'-0" 6'-I I/I6" 12,-0%" - 22'-215° 10'-4 3/16" - .F MAIN FLOOR SCALE: 1/511 = 1l—Oil -02VIANIVS,A0 NMOI Town of BarnstableBuilding Qn ..» ,........,x.;M.r•r..y.F,•wws.a-,�„.«.,,„ ...,,.„,,«. _.....-........:.....,_...�..._,...,.. ,,. ,.,..a,-.—...,.,.mow...._ _y._......., .,..... - .. ......— -.r.— _ ^«w�.". .AxsrAeL& gTost This Card So That it is Visible From the Street-Approved Plans Must be Retained on'Job and this Card Must be Kept M^S& $ Posted'Until-Final Inspection Has Been Made.039. A ta�xx�" Where a Certificate of Occupancy is Required,such Building shall Not be Occupied untila Final Inspection has been made. Applicant Name: Timothy Kelley Precision Pools& Patios Permit No. 6-19-3269 Approvals Date Issued: 10/29/2019 Current Use: Structure Permit Type: Building-Pool-Inground Expiration Date` 04/29/2020 Foundation: Location: •61 WHIDDEN AVENUE,HYANNIS Map/Lot: 324-103 Zoning District: RB Sheathing: Owner on Record: GIBBONS,MARY JEANNE TR ET AL Contractor Name:,; Timothy Kelley Precision Pools& Framing: 1 Patios Address: 24 WHITNEY FARM PLACE 2 ` Contractor License: 178149 -- MORRISTOWN, NJ 07960 Chimney: Description: rennovation,of an inground gunite swimming'pool and addition of Est. Project Cost: $95,000.00 6x8 hot tub concrete Permit Fee: $ 175.00 Insulation: Project Review Req: " Fee Paid: $ 175.00 Final: Date:'. 10/29/2019 i Plumbing/Gas Rough Plumbing: 4Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Final Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. --- -- Electrical = Service: The Certificate of Occupancy will not be issued until all applicable signatures by.the Building and Fire Officials are`provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: • 'F Rough: 1.Foundation or Footing - 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons con with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: c, 11 Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Office of Consumer. Affairs and Business.Regulation One Ashburton Place -'Suite 1301. Boston, Massachusetts _021.08 Home lmproverneav ontractor Regis.stration Type: Individual ` # ; Registration: 178149; TIMOTHY KELLEY Expiration: . 03/16/2020 D/B/A PRECISION POOLS&PATIOS 20 BUCKWOOD DRIVE s YARMbUTH .,MA 62664 ., Update Address and:Return Card: scA' :o::zoM-oaMZ Olt-, cJJtu u9eG Otficevf.Consumer Affairs&Business Regulation HOME,IMPROVEMENT CONTRACTOR Registrationvalid for individual'use only TYPE Individual before the expiration date. If found,return to: R EWstratlon'• Expiration Office of Consumer Affairs and Business Regulation 1,781149 63/16/20201 One Ashburton Place-Suite-130T TIMOTHY KELLEY ,d i Boston,MA 02108 D/B/A PRECISION POOLS&PATIOS TIMOTHYW.KELLEY" 'X'2' GGPx -- 20 BUCKWOOD DRIVE```0r S.YARMOUTH,MA 02664: Undersecretary Not Valid Wit out slgtlature - � � NOTICE m NOTICE z TO r TO EMPLOYEES EMPLOYEES O,M Sve The Commonwealth of Massachusetts L a, DEPARTMENT OF INDUSTRIAL ACCIDENTS N 1 Congress Street, Suite 100, Boston, Massachusetts 02114-2017 617-727-4900 - http://www.state.ma.us/dia As required by Massachusetts General.Law, Chapter 152,Sections 21, 22 & 30,this will give you notice ZZ that I(we)have provided for payment to our injured employees under the above-mentioned chapter by insuring with: CONTINENTAL CASUALTY CO NAME OF INSURANCE COMPANY 151 N Franklin',- Chicacro IL 60606 ADDRESS OF INSURANCE COMPANY WC 6 11382271 04/08/2019 POLICY NUMBER EFFECTIVE DATES CS&S/DOWLING & O'NEIL INS AGEN PO `BOX -1990, 'HYANNIS, MA 02601 877-724-2669 NAME OF INSURANCE AGENT ADDRESS PHONE# Tim KELLEY 20 BUCKWOOD DR SOUTH YARMOUTH MA 02664 EMPLOYER ADDRESS EMPLOYER'S WORKERS' COMPENSATION OFFICER(IF ANY) DATE N r o . b O r ' N MEDICAL TREATMENT ON O The above named insurer is required in cases of personal injuries arising out of and in the course.of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Worker's-Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring,hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS TO BE POSTED BY EMPLOYER WC7506h(0&10)Wolters Kluwer Financial Services I Uniform FormsT'A �U1`D\NG D 111019 o C h e m �FFe&e E AUTOMATIC CHLORINATORS AND BROMINATORS o The easy, economical way to sanitize your pool automatically Hayward®automatic chlorinators and O v brominators are ideal for in-ground and Q c above-ground applications during new pool x construction or aftermarket installations. Models are available for in-line and off-line configurations to accommodate all capacity, plumbing and space considerations.These units incorporate a durable ABS body along with a high quality Viton®seal and an a > _ ergonomically.designed cover to allow for safe and simple lid removal. VOW I Y7 4- f r • .y {i � F, h,mn ^ /'..:}x��y 4s'�'�� "�•,� .r', ( Tk hY+....-M...a. �.c e r x W ftm 0 MW 0MINo 0 0 Agnam oa"" 0 aft 0mmem Hayward®.In-Line and Off-Line"Feeders ALTER RETURN ,. W _ I 4 `anmo�ae:;w,wew.v: u.orcarorarw , TO POOL Optional Union Connector Kit - �;T FLTKR SP1500t1NPAK2' i ..� , FRdM r 3 i POLL TOPM AS ° CHEMICAL FEEDER PUMP I _ �, t�f�!!>rl1LFEED�i „ I CL100 and CL2001n-Line Feeders CL110 and CL220 Off-Line Feeders j I CL 100 and CL200 in line.feeders are built with 1 lz"FPT CL 110 and CL220 off-line feeders install next to the filter system I I threaded inlets and outlets For serviceable PVC piping and work on system pressure differential.They connect easity with installations,optional 1 Yz"socket flush union connectors are compression couplings for new or existing systems.All necessary available.to provide an easy and professional installation. connectors and tubing are fumished::with each feeder. . Hayward Automatic Chemical Feeders Hayward automatic chemical feeders are sized to handle the sanitizing needs of most pools and spas. The product line consists of 9 pound and 4.2 pound chemical capacity units which feature a large dial control valve for easy and accurate adjustment of the chemical feed rate. • Models available for.chlorineor bromine sanitization • 9 lb. and 4.2 lb.chemical capacity configurations for in-ground and above-ground pools and spas of`all sizes • Uses large or small;,slow dissolving,chlorine or bromine tablets � � g •:Simple installation for new construction,aftermarket or..replacement. , } applications with multiple in-line and off-line configurations available • Large dial control valve allows for simple feed rate adjustment x° • Easy-Lock threaded.covertfor safe and convenient access to tablets, CL220 Off-Line • Corrosion-resistant components and high quality Uton®seal for extended Feeder durability and easy lid removal CL110 Off Line Feeder To take a look at automatic chemical feeders or other Hayward products,go to www.hayward.com or call 1-888-HAYWARD. 620 Division Street I Elizabeth,NJ 07201 IF O.B aarI trademark of Hayward Industries,Inc. 0 Hayward ndusme Yron is a registered trademark of OuPoft LITCHEM12 ISWGs048COC Rev D 09HAYWAREY ' CERTIFICATION OF COMPLIANCE Contains: WG1048E, WG1048EBLK, WG1048EGR, or WG1048EDGR Description: 8" Round Suction Outlet Cover Ratings: Floor: its 6PM_Wall: 72 GPM Open Area:- 8.1 s -in Certified to Comply with Section 1404 of the Virginia Graeme Baker Act (VGB) Pool & Spa Safety Act codified at 16 CFR part 1450. Initial Certification May 2011. Manufactured: After September 10, 2009, by a Division of Hayward Industries, Inc. at K4-A, 214028 Block K4- A, Export Processing Zone Wuxi New District Jiangsu Province PRC 214028, China; or at One Hayward Industrial Drive, Clemmons, NC 27012. Certified by Hayward Pool Products, 62o Division Street, Elizabeth, NJ 07207, Phone 9o8-355-7995 Contact at www.haMardnet.com Record Custodian is Customer Service at www.haywardnet.com. ' Hayward Pool Products P.O. Box 5100 Clemmons, NC 27012-5100,Phone: 336-712-9900 httD://www.hayward-pool.com/pdf/literature/8inroundCOC.pdf Date of Mfr:The Lot Number shown on the product label contains the Year&Month of manufacture. The first number represents the year(ex 1= 2o11) and the second character the month (A=Jan, B=Feb, H=Aug, I is skipped,J=Sep, etc) Tested to:ANSI/APSP 16 (ANSI/ASME 112.19.8-2007 (addendum 9b-2009)) per Section 1404 of the Virginia Graeme Baker Act (VGB) Pool &Spa Safety Act.Tested by NSF International, 789 Dixboro Road,Ann Arbor, MI 48113, Phone 734-769-8oio in April 2011. Certificate at: http://info.nsf.org/Certified/Pools/Listings.asp?Company=21600&Standard=ASME1go8 Date of Installation: Suction outlet components have a finite life,the cover/grate should be inspected frequently and replaced at least every 7 years or if found to be damaged, broken, cracked, missing, or not securely attached. Hayward Pool Products acknowledges that it is a federal crime to knowingly and willingly make materially false, fictitious, or fraudulent statements, representations, or omissions on this certification. 6„ SPACING BETWEEN -MOUNTING HOLES USED ON FOLLOWING SERIES: .0 00 WG1030AVPAK2 SP1030AVPAK2 000000 WG1048AVPAK2 SP104SAVPAK2 000000 IWG1049AVPAK2 SP1049AVPAK2, 07`3/4" 00 0000000 0000 0000 WG1051 AV PAK2 SP1051 AV PAK2 SUCTION OUTLET 0000 0000 IWG1052AVPAK2 SP1052AVPAK2 0000 0000 COVER WG104BE 0000000� WG1053AVPAK2 SP1.053AVPAK2 000000 W61054AVPAK2 SP1054AVPAK2 00. 00 WG1153AVPAK2 SP1153AVPAK2 WG1154AV PAK2 SP1154AV PAK2 A Warning—Suction Entrapment Hazard. Suction in suction outlets and/or suction outlet covers which are installed in a small area and/or below the surrounding surface can cause severe injury or death due to body entrapment hazard. To reduce the risk of body entrapment,installation of the Feld fabricated sumps must be such that the top of the mounted cover is a minimum of 1 1/2"above the finished pool surface over an area larger than 40"on a diagonal. s tNE Application Number. .....................................................I BARNWABIX MASS. c)on Permit F �j ' ....Other Fee..................:..:.. TotalFee Paid............................................................... TOWN OF BARNSTABLE Perm t dal by...,. `lL.. ....On...� X:7/z?� 0C1120, � ll BUILDING PERMIT Tp(/V/V ......Parcel.......... . p Map.................................. . ......:.................. APPLICATION AB Sectional -Owner's Information and Project Location Project Address r A � Village5 t.S Owners Name 0 n K V G �"(� n S Owners Legal Address City t1 V at n� ►S State- AA Zip 0 a G 0 1 Owners Cell # -7 0 3- 50-7 L93z4 S E-mail�O� n k-'t/a, +m n a S@ a4- Section 2 -Use of Structure �0M _ Use Group ❑ Commercial Structure over 35,000 cubic feet , ❑ Commercial Structure under 35,000 cubic feet 0 Single/Two Family Dwelling Section 3 - Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement '❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment a Sprinkler System ❑ Addition ❑ Retaining wall ❑ . Solar Renovation Pool ❑ Insulation Other-Specify Section 4 - Work Description �e 0 ft�tc ev d an � r LL rid cu rn ` f S w i rn m. a 00 .0tnd Oi ton 0� G' X 8' he 'b KJJW con r4t, 12 04 td Tact nnAateA• 11/1 VIM R ' S Application Number.................................................... Section 5—Detail Cost of Proposed Construction Square Footage of Project -7 SO Age of Structure SO t 90413 Dig Safe Number # Of Bedrooms Existing Total#Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics ❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑ Add/relocate bedroom i Water Supply Public ❑.Private Sewage Disposal ❑ Municipal On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: yaU wmk` a I am using a crane C Yes No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last updated: 11/15/2018 SEE APPROPRIATE REMODEL NOTES: MAR fm MOO p.at SPACINDETAIL G B GUNITE �P r sus ,� 1.EPDXY TO BE SNPSON STRONGTIE INSTAL EPDXY ADHESIVE OR EQUAL 8'C.M.U.,TYPICAL 03 BARS 0 8'O.C.E.W. THICKNESS INSTALL PER MANUFACTURERS AND DOWEL INTO FL00R& N SPECIFICATIONS(ICC REPORT ESR-2808, SIDE WALL WITH 3 1/2' L- RR 25744). MIN.EMBEDMENT FILL E0. E0. FW 2.BONDIN TO EXISTING SURFACE PLASTER WRTIi EPDXY. — afgMe�D a EXISTING SOD,FREESURFACES OF DEFECTS,CLEAN, OVER C.M.U. / AND FREE OF BOND INHIBITING TYPICAL —— MATERB'MIN.GUNIIE o B.EXISTING SURFACES SHALL BE s o OR 8'C.M.U. r- �� ROUGHENED BY CHIPPING OR /3 BARS 0 (fm-1500 p.B.iJ 51� OTHER SUITABLE MEANS TO ALL PROVIDE w i' 3 12'O.C.,EACH WAY. i I �p64 E. LOOSEOPEN PCRACKED.OR DETERIORATED0: a ' GUNITE WALL 1�N NFw MATERIALS SHALL BE REMOVED. " a'• I 0 8'O.C.EA.WAY OR $ C.CLEAN EXISTING SURFACES BY f- E a C b C.M.U.WALL USE 03 0 1, WATER BLASTING. 3 1/Y EMBEDMENT&FILL EXISTING POOL FLOOR. + DOWEL INTO FLOOR& '`�p1E D•SATURATED THE SUBSS'TRRFATESHAALLLCBE CONDITION o WITH EPDXY TYPICAL PLASTER OVER TIDE WALL WITH 3 1/2' S' MAINTAINED PRIOR TO APPLYING LY LL 6 CUNfTE OR C.M.U. MIN.EMBEDMENT FILL MATERIALS. WITH EPDXY. E.WHEN APPLYING MATERIALS OTHER EXISTING SPA OR POOL THAN -MIX SHOTCRErE OR DRY-MIX (GUNITE), /3 BARS 0 12'O.C. p CEMENT PASTE OR OTHER BONDING AGENTS SHALL BE BRUSHED ONTO C C THE SUBSTRATE FOR ABSORPTION •C 3 1/2'MIN.EMBEDMENT SEE NOTE/2. - ,j• INTO PORE STRUCTURE. OX &FILL WITH EPDXY TYP. 3 1/2'EMBEDMENT AND _ EXISTING POOL �Q� F.RECBONOMMENDED MATERIALS FOR ARE NOT d d FILL WITH EPDXY TYPICAL FLOOR. RECOMMENDED FOR WET OR DRY C MIX SHOTCRETE. NG_ DOWEL INTO POOL 0 EDGE OF CL SEE NOTE OZ 4.IF REINFORCING 3.USE GRADE 40 SHOWS SIGGNS OF SEAT WITH 3 1/2'MIN. c REMOVE(UNITE OR CONCRETE TO EXPOSE THE FOLLOWNNG'THIS DETAIL r 8E USED FOR EXISTING REEXCESSIVE I NFORCING w8N'pASTUTT),CUT EMBEDMENT&FILL WITH EPDXY. 2P OF REINFORCING STEEL(EXISTING) 1.REMOVE AND REPLACE FLOOR. DETERIORATION SECTION&LAP WITH NEW EACH SIDE OF REMOVED AREA FOR 2e NOT 01 - FOR.LAP SPLICE WITH NEW REINFORCING. 2.REMOVE AND IONREP O WALL STEEL 24'MIN. SEE NO 3.MY C0MBINA110N OF 1&2 ADD STEPS, BENCH OR SHELF A ADD A DAM WALL (GUNITE OR C.M.U.) B LAP SPLICE & REMOVE AND REPLACE GUNITE DETAIL EC EXISTING POOL REINFORCEMENT&WALL THICKNESS PER STANDARD SPILLWAY TO PROVIDE WATERFALL EFFECT TO MFILIZE POOL STRUCTURAL PLAN DETAIL J7. r � LEAKING THROUGH COLD JOIST. l\ ALTERNATE DPW Ile MIN.OF DISIING OPTIONAL REBIF.AND LAP 24'NTH NEW PORTION OF EXISTING STEEL&BOND BEAN - Z0 z I" BENCi \ NOW pIX DETA C' MAY BE REMOVED TO PROVIDE MIN.SPA F g _ WALL THICKNESS(NO STRUCTURAL SPA MAY BE 18' to L)a MAX RAISED OVER CONNECTION BETWEEN NEW SPA&POOL). EXISTING POO .j' CL I I I I ��O za zIr o DOWEL INTO jL OpVFLOOR&9UEW /3 BARS 0 12'O.C.W/ NEW SPA DAMJ 1/2'MIN.EMBEDMENT& /3 BARS 0 12' WALL MUST LAP Z w UNDISTURBED SOIL `. a NTH 3 1/2' FILL W/EPDXY. O.C.EA WAY. OVER EXISTING POOL WALL TO FACILITATE S BEARIN1,500 G VAIMUE &FlW�1M 1D WATER-PROOINC. Z w a PROVIDE FLEXIBLE MASTIC iZ _ EPDXY. O TIlE OR GROUT NE. O? o REMOVE IXSTINC SEE NOTE 0. POOL WALL,BEND d BACK-FILL N BARS SEE NOTE a. SEE STANDARD STIRUCTURAL EXISTING POOL > a SP IXISTING WALL RESIDE. -INTO NEW SPAa O 1Y O.C. PLAN FOR SPA WALL. \S I5 FLOOR,LAP 24'MIN. VERTICAL EXISTING GUNITE POOL o d� DATE: 01/05/11 CL z7 N SEE NOTE 12. - W BACK-FILL TO BE COMPACTED C CALCS BY: C.J.B. TO 90%3 SLURRY MIX OR PEA GRAVEL CREATE HOLE FOR _ /� CHECKED BY: R.LL. RECOMMENDED. DRAINAGE. HORIZONTAL BARS TO HAVE 3H MIN.EMBEDMENT INTO 3%'MIN.EMBEDMENT - POOL & SPA SIDE POOL WALL,TYPICAL &FILL WITH EPDXY TYPICAL O � REMODEL DETAIL ADD SPA OR SHELF PARTIALLY INSIDE POOL D RAISE FLOOR OF EXISTING POOL E ADD A SPA .- (OUTSIDE EXOSn ) F DETAIL#640 4r- 8E7J(k1 AND STEP OPTIONS EIa4 EARN SWAM 1/4'.Pla N°rD '� TABLE ND,i It'ElldtAl.NOTES - - WNER 1,t"OSSI m(ARM UY BE tW N RAM W TOM M MEPa aR BrOJ ai R9aCRmW Elea - Iaa eI UK Mato I/r m NNW�pl ra�Ru aW4 VAT� L pqpMpaE��Mgqarm Po1Ky�elrklay r.W WSr x rmPll®It A aU1 r�I e/e Mreo IO.rm lefa(aNa�pop MRMriir Irl r Gr Mip aErAwIDa 111 m AA®ARtAAW Oa ERP a Eiml dLrLO(AAd(Y am RW11 GR➢� 1/4 PR FM Aur rRa M i°jpgaq� �malt IRAP�rAI♦OK mA1mK m�1 er. man rarW99 L mLCalwr.o Na�xr@�W1a�rG'�wYirf ry np day A1D iOrCRKL Lm mT ABN a half tld 10a a aVa. a a¢SV=arRmICRW ND®Race Am T 2 ar RPE dS.Aw (aa y11r1 A B 19[[aD a2 aR• ed a Lm rtt U4 rAa a®aIlaa rpfxor ICR OtaaenNOW tW ERaWiald PEEL d(IL mla'omsm AT i1a aArAa Q Ra®le�.Am EaP1 r gR¢UI_ ]EIaIV Ci p EaaLd1�N a1w®Er p!mulwna a OYWI ro aaa0a n til,um r a}�au APEraID aNAYT idmaORD hm arAlWvr Pea aRaRrA1 AAu riu n ALTw iR mmaan MPlep as malde *121 0-QMBJ ftV"HAZARDOUS JACAIIONS mlr Nea AUr M➢M f WrlEa rin BMICRAA Rxe a e e[Ia»BaMlr WI STUARTra M n rRar CAM aau MRT IN a SMIN NSTU . t U B M!1c� Im�P 1�Wa - �pPl REaYO a/ma�E 9u. q�_ � �.- aln�w ro POOT P0' wrma n a�wE01� +sir wR •r�ima r�reur.WUlm�ea em xr afmoa mErr riot xW an ��`'-�'�• l\"♦'E(F I}16T# r'3'^me"'m1Otaar¢a° Ium rwaao xd°p° r�r rc a0¢Eo'a�nut n' Raara aeeRl A Twit rAst ilrE: aAla dance .--- MAN Ip•Pt 1�,-.}}�. .aiu arrmWo mwr A mu xo au ra¢r�a nL rauorm axrm wE r�pp mM ICI tOCLL Atraml r eapl 1 _ ],u I oe Ri mr IpEga AmAgµndr�py➢N eWy➢rri➢a 0egp u k.n Earla m3 v E[aAmr a al qd a aA mE a lm suR m BASE teEMl atAt�WIY men. �q1 Im1�AM�(Ip m �1aYL Ip A01[A rYPW■R/Q a1➢(rice a aA a na aAalq xa Ill It wa ( mn xn. . wn. 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PAAArw tWe e e Ia' ltalamia a AaLtW io iWa W�m mrA o M xlOeuadlL roan m ,� ui.Wa malt Am T Jq. 00 pmWAla TRIat RAa6 t Ma[WVAtaI'm lra YArall�xrAN a ar4 rMma¢Pmp. ra lOareflLAmNPntm en➢OA PIrIQ(W AWFVamI APYL91 aun Pa PW : XDAWSfARC'VYW AIO mR (ACmw RWIa i.� L■ae ERE a dpiTElalrp•M A amlraD YI➢1 AWAam At s�r fa u r a�/6p1n�p 0agaaPL RL ArAlollr Alriw i:PARAt IWr Pa11t :i((!MM MAt'.rRmrAIWRm ADre0xA1 Era all AT Sd.nfW:de mP V9e Puce wr art.as EamcRtN pmE Pp L➢i Ma yE1;r ni IY W rgplW ➢°AmarMOIS MVMIn a IArR°t': aml i yW[fpR r+AmpumE 16ren m dwA¢aLWa a m,aam AE9•pmAmlr an1R lul An MaErarNtr agAY Ea®I OA OAlral WALL (MISW M wT Rr5® • .. wai,aW¢mT t III RErOl�ipr loll afaW ATMI'QOI POW r Ice m1E}rr 8<ImMm P WOW dWOn e0a Oar®Am ArlaRallr Anam E■mM 7 'i` .eWl 00a IWTHr■a ) V a gala om ntrR aae oWL EE Oa•m M 1!tat r f r ICd Ral Itplt Oaa NOT.OiRW Yd aEil m Am1mlAL Thal la M PCa.BALL MINIMS G OP 9a unm maim mma o na wEMu da9rx Np7 0 ar afar Warty AM AIArIq Mat EtaOamE r fdrAE rc RtlRm OW Im APPLY m!VINT RaRD x OEamn rm t arJrm rn m AAmm a p¢raa. t dEll�: W ZMmImU)R rM Nom—aC rCNl rroamau xAaA WYn TYPICAL LONGITUDINAL;SECTION N r S 2 STANDARD WALL SECTIONa,,m;L"ri Dew ro mPme aOltlaE a a➢O gWmM qRT rr IarL Tqa U Ul palace¢Q/®W K[0r,tln IwrM a Inen oWerA aMl M 9Fblt PETAL Bala® R tR a ow I NISI am - - r A�OA1a■m n nl mw� on M.0"M 81a( dFOaaC(advma •' m ACWL>R malnw @dD`. 1. • '"•w:=� •- •. Z tanprl W M t1 rNwmW ti4!�Yppplf yapµj ' �a arrolAL mrm P) SIT nArya mr a mpeuL Paa1a Amaurz aAaNR TABLE N0.$RAND.BOND-BEAM m° xaea°�°'m aK mE°�I°n�ueutA�^i+� m w NL } ,rAWNNO epl mmee M llm 04D RNI Aa EDYD PaaRNL pMRp W .. ' .�. f .AA■xl[ARpI�Amimw::.. ,.Ol1Aa8 116 Pt,: e(WIAErI m. - oae■¢ ra@l rm Puvw x•Lan mami a boa d a. .rrOW[E ataL Aa K¢Mm:. 9. 1 4'PER WIFmAI®K mNIMa �imxlomWlr rW¢n"a' Wm(n ae•� • Yl WI m MAaell mlq lma ama Rua uaRaa ?` _P E F '.:G L mWlr Ma OMW■1 W W YCML O ID W rCM1 V!. .M P.ar... a rAr. cell►AP L ¢M q¢CI EIM(>S ratl w■AtaamLa rw u N[cam W rd IEt9 MM Par aePd;a W4 •�•' D:P•>m - mR EWER m A.r0 a daCC4D M ICEAL rtar eIWLL - . a[d1 a(TAl , hA r1t.Yl/Q , mom mim aJ�m 0 C. w1e0'LL C ` C ��++ b ;rwlar wu i mlap IN A amI-Pm aeJ2 .rar,uaE RLW lU _ ;t: .. �r. °m nm eIm .a mumwon Em wr our a # IY dd :a ax .r pppR ( Ice. RAMS - pma P•Ir •TY 'Y' •IY ` rmK a M °B A mWamu%•r;na sv r r n -.4.. a:rNA ra mmru� ailaa�°ii EMxw"'Ok" .. A11W01AW14/eW f - _ A{Eaq oar aTeo mn na 3E65f na n➢a lwurc. PER LB.C,SECf10N 180&T� .= BPNI IaCAtIPr Q i 4l• r •' ►u ■ wuamaa lace Jawm .`. aklt A¢ B01W aAr. aVf a• Por ]R• Or r •a' rIltl wue NAml®l -au�b alr ermm wr r WRL ARL IQ2 ."i `''_m1aAl SIDI•/ - -- laai Me Fora ►MAW N AAala•ep-a a mml, SURCHARGE CONDITIONS -''ADaTwNu'sPEaJroErAns N rs" Y' tarAraq M IrLDem ° — REg1WEDFT)ItOGmI=8ABOME 3 ,mmRo tGrao,.. ^: ra.�iaa.�slm � aw ]R• -- r r - -- .. rr 4• - - -- - r REm m Axdaux wmuL ET AIrrW rm - a�iau x-RaaW armaw tor]PEelam er as . AmmJ11 wma ETAl0A1W Rt7111UR Am Tb• '-r. - - (ALE9 ME ASSaaAIOI a Paa Am IaA NIat390aI9(AP91) aA' +' p•_V r Se r RE�IFMID7f @}AeLAr'91a1 - :YAS0IRY TW164':. ,`J 3 :. 1 .rp• ea• r ea• _-__ - ' .•r...w.. rz vrt ,. L mnal[raa mw M aba M igemp trM ooamar , ■r Ta' r smmAc .aMraW xrrN maT aaa f �4riWr m a Ial rw rd ar -- - 4SeICAlti ar0[R aaAr BWI wYAamarmaa M:neD pl ab• !• r tar• .L vm mr4alM1•IWa6am•AEr OarE OI M1.3Mp,PL.Qi ' E'e• •• Ir ila'. . arP°4rdvle°Om"m,mtW ,-J 'waewn warEra®awapWla,; lar r ^• _ _ Ir _ __ . aHR9,UlER®M .:, L lOat aWl E(maYrr r..ImP/Am lal�Olela To�t 1¢rm •'n' ::. '°• .' - • a Ad walODefl}W W IReE•laa Alt t■emr ab' r l r IaR• aaRWNaw rpm P •. ' - .. SHALLOW FEATURES - IR7d5N D,ORR OUC A SOL N r s; '4 RAISED BOND BEAM N.T.S. g. NOTES By nIE USE OF THIS PUN TIfE usm Af7D1aMILOfSs flat HE HAS REM d UNIMW. NDS ALL Or�THE ROTES WCU)=HERIX � 6.- mm ma arri im;Ara area lWm•n0L1mrlr•nr3•M v®At da 1•Rol L 1 1 '.INS Gi t mA91:.. iMl'aa AL■e ID w ma®m rRROAILarix , :'.JV A eAq teia w a• u " 'm auffm'ae a Qu wT asun 1/Y l�`rmW miM Mp�mmwrmwr�n �rW V at m®i Tj 4 aWef•AAR 'I} WAN91a SOaa b ` aT YART m lvml L�Atlpayay�l .T mm o mr ew a mT R I IL ROCIm maWA V WN ama"a 1 I rLaa. v,R a(tAL P Pmw(E I/Y aK adMt w qa Ara a®14 .AmAp N' - r Ice aA EET'Qil m0 nal[a m IT■ra epltp a Amm n pp ALL- CaaD MCK a aene w taA dC.� Mr WNT a p . Iqm➢ aamEAaa wr ar aAV.-. .IrK i eAla IA• -`A (-la[a IlaeOlaa Yml 1!1 °aal m a a, eAie PAArIa elaiIN r ( LmIeI'mO11®gler raE®1 veR RrAL sawn a trReaaA mAx •)p - Pan wMnura V a d.la as nrE fA 9aafl'. . .... :b as n➢ml" u mm MAr W we w @ u mR la@gtA pl a n Ir¢e slam IAaII R@adm0 Pa ORK/w I)� ro10.' A01arC WAY R mCAlm eeW emr PEA ilaa•a L S'. rpr 10 P eAle _ _ °s, . REFMO• r B¢D BFAY lams maD RNl eafQalai.. CALLS Or. A.G'•awl lrmmla.. RNldol I'of m.mW.,�: eAR3 wr R aml aR. DRAWN BY: TLL y a'ia w p`. W A_LL� a.W; -�P ( q 'uZIaRq'r8R1a.IL eARs pa"m CROLLA%_� Wt ae7AAm1 MAN,Ace 111q• CR V m�LL r irar S � um. .� •� 6 `� � ® - _ COCIfED V. R.4L Ope7®wM rg10rD AAYa Mn ORA G fAr (TJ P 7 a0 90a6t ,1pe 1 PRECABt CDPWa di MY AM ttWmW WrLT auAxen Am SrWaigCALLr:. 3 aePD! ,�. 8. 1 (TJ p era MA®llawld T A1rWa I _ ta R/Aa R awt wA :r pw'.� \. rAu -w alfo w v. .. L I \ , sfPAwmr eT ....CnON AT SKIMMER 'M@ k16a1rAl rW PUArxa ram 7.OPEIlL 6a S. �� IY mll:'-.w 1!rA0 rice bPA Ricer:" K lOOYL .Tema ,. �� -b MRr.Slm . ::. _ .1 ..IRO SPA DETAILS FM SPAS SMIT WT�POOl�S NrS: .7 Z''°°If w mraAB"ra mum rmeW ImL ter aE " d..�. IM.17P. r Ew aePM APEgrO SULMY - pL ffi: # A F PAA OmL1 RDOf aR 8Po(]E NO701 E 4 Maeaa ��IJ'r 1/C .51TNL To WMAarwa '' ]I ;. eplr t o • P•r of '. b VAX RAa♦IM IOW.am e.• 4830E M P'":`. m® rd ear'.ea•t a' 4. I Iata�a Tom Eno L IadLL t a Calms Ram!ffd TOR ace[W iflom K aRFl ROM a 8010 \ �� reA7ERAE01 vmlmiWW[damn nilN T as ',Rai aomar W EaOI ROW,R OFI/TAM mas•IY QC T.. WLV.mrsail vmt eAr< I FELT�m M9amf R I"•,IamllomW i'rRa AAIIWNEA2; TnrJt raWa - - RlRar CAN R 1!aM I♦UID 1A a COPPER! P - to a mm BPAY.. umbR y Arnpan wlRo ae•vao PEt1 x amSold)eaAaW aenc x L'aRR110 Pace IRIrzD Iemaa eRu:ml•LVt]M Y01D AIe®W'!mm L' aASR PUN"AT'SWNAIER !r"irL o R�uv. 4' IK ilr.aata ENAPRaR a a fl ammroW a APPIICAIII I1aRrNaY IaIRAmI®Imo! `L �[moEf® dOol m UIDAAL temmm SIaLL iR 1Rirr PEfafe7llA.VAMAN)V& wr mad maw mW aAr R> PLAN VAUD ONLYY O MET d rR mAll9W rat '�aumrt aaamW+a. ' CAleTIlE1Em f>ONfatETE STAND$ 8 SINNATt1AE EXPANSIVE SFi OIL DETAILS IAm La t �soa�wa tars ,8, SKIMMER:DETAIL N TS EZ DRD 0ac ON°� 8 SECTION,�AT.UGHT N•T•% 10 FREESTANDING POOL,WALL 11 BOND BEAM DETAILS N.ts. 12 u ' M r- UDI N.Taaan Ave. . .. ` STANDARD POOL .PNBVARED IN ACCORDANCBINITN' pool All h bl% Wmrlle a280T OO 2012■NMNATIONAL BUILDING CODE engineering FaE:hlg03"114 . STRUCTURAL'PLAN - Inc. 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I 4__________.a,- -_.i t i n¢r rd umem roue m,mowmrm eww.umc em.r uoenYa cwloa. •�w nw�c. oa�o •alarm } ¢eam,aII.a.ue.rod-.aw.m.¢..n.mrD.l,a mYsmD w.c mrm.m.I. s m eau Wmn mnnl,waa anew¢mlm, me we mwn.omm.ID m.ul _SWIMMING POOLAN�PL VIEW .u.�° i•K" 1a Sucse, .,a menm ww-am nw{m m,mr¢n¢wcneYl A Xl IwY,m.�p�ryp M .•e 0 COR¢1a>wta¢m¢Y•[ia.YYl.an M 0 .. •mlEar..II•rY O<.ql.i.m ' ¢[wawb�Nr6 P uw"iWm Im,l m�1D.m"0tl'i�n u.r f ae..c• iain.we uva¢aal..m nw n¢>...an..am mew¢uYman°`e�rxnm. r.avmwc wa w¢waawm w n..ao n eo.lrm uwrAme.w.Isa.Y ar w - MDs•rr as m, �[ - �mMr Mm _ .G¢m mTattc ud.a'• �g u-f r. _ .n me a slmwmn rm em�ra• ..Vr . � Walb TOIGl1[mIilW�rtfNullmi' .a.wnl Y fw Y [ n n1u'°'r o nonl SEMON .a Cn N in •d Im uw �w.mrvo.o a+m ¢rwm :r�'s°.nml ww. r m�acm acre.nwJ t s wD�o�..oennm,.•d v� � L.rf 1 0 um0 it{N SIOD 1 y W ad nn.l Y fIfina.J [Nn..w�T 6�a Yp.if�O —-------- _ t �mrow i w SIiOa aAfle'Yw _ m"'mm'H4. rYoe"'e1c� ava Imcul w m p .o`wa �pqr.y wa+w mwuwmm r.�...�s .aWII4 wwe>O.n moWwt YM 6RW _ m�'.Ow"Ym¢w'amm am'i...b].OVite rt.II S-100 FOUNDATION SECTION-SIDE V - r ""`�" -10 "ISSUED FOR.CONSTRUCi70N" � �W J wa,. "" utneaaD PUSH PUSH DOWN DOWN SQUARE GATE FRAME SQUARE GATE INSERT I I POST V O O Fw4W►E Align SELF-LATCHING ridge i with POST inside O groove. ALLOWS GATE Tb --O_ TO SWING IN�R _-__ BOTH WAYS ®- -- p � (B) CAN BE Align PADLOCKED ridge with inside groove. 3'opening between Drill —_—_ FROM Q gate and gate post D Whole EITHER SIDE and attach collar. AUTO-LATCH for ORNAMENTAL FENCE <__2-4 SQUARE SQUARE PRODUCT FRAME SIZE POST SIZE AUTO-LATCH No. 2015 . . . . . .1" . . . . . . . 11h" for CHAIN LINK FENCE/ GATES No. 202 2" 5 . . . . . 1" . . . . . . . PRODUCT FRAME SIZE POST SIZE No. 2215 . . 1'/a" . . . . . : 11/2' No. 1500 . . . . 13/s" . . . . . . .13/e" No. 2220 . . . . 1'/a/a n . . . . . . . 2" No. 2225 . . . . 11 . . . . . . 2'/z No. 1502 . . . . 1%. . . . . . . . /2 2" No. 2515 . . . . 11 " . . . . . . 1'/2" No. 1525 . . . . W'" . . . . 2'/2" No. 2520 . . . . 1'/2" . . . . . 2" No. 1527 . . . . 13/e' . . . . . . . 3" � No. 2525 . . . . 1'/2" . . . . . . 2'/�" No. 1562 . . . . 15/a" . . . . . . . 2" No. 2529 . Adapter Kit No. 1565 . . . . 1%. . . . . . 2'/2" No. 1567 . . . . 1%. . . . . . . . 311 No. 1572 . . . . . 2" . . . . . : . 2" 1-800-888-9768 www.dacindustries.com No. 1575 . . . : . 2" . . . . . . . 2'/2" AUTO-LATCH INDUSTRIES No. 1577 . . . . . 2" . . . . . . . 3" — JOB/PROJECT DATE OF 980.355.2749 EN POLY.GQM Your Fencing Professionals . Vw- T1iE FENCE PROS FOR OVER 20 YEARS ..�.1..- -- Style B Residential Aluminum Fencing.- Smooth'Top Material:6063-T5 Atuminum•72"Section length•Pickets:511 .x:OSU"Wall•Rails:i"sq.x.055 Wall*PPG C3 IGIC Palyester'Powder rating Screws:Hardened 610 Stainless Steal With Crb_Elating&Colored Heads�All Sections Are Qf fend Pre' sembled Orlin=Assembled+Fosts Sotd:separately Available Heights � Tl- 4b_, F _ r 36"Neight °. : �68"18eight s 56"Nyht k F a "60 Neight , r d' lterght.._a F , Style B.Pool Code Approves Heights:Standard Picket Qesign 54 Flusb Batiom,60 R 72 i Qooble Picket Oesign 49" 5b &71" -• Please Note That 36"Height&.Any Puppy'Picket Design Fence.Sections Do Not Meet Pool Cote ti� Auaitable Colors Available Picket Styles = w ;72"(Ali WdeM atSectfoF,$ ._ 3 13/16" Prwe. 1111 11� illoul White Standard Picket Doulde Puket Smooth top Puppy Picket - Spear tap Puppy Picket,- „ .�. ., x.. .'N", V I a, �o z .� k, t*.: �. ., ,T v Q 174 t6 (36}&48"Heights► 20"fws" 60. &;72"Heights) optional Product Upgrades _z , ;Sutterfty Scrolls: R!" note Rogs Pmmt sections from Racking ., a •��*°.^w"`�. . ""` -.-... Jk ht ....;;-,F � ..:,..m �' `avx x #% ':� wszpch. ' _ d6. 1 r.: y, aT *a..., 'o M«n!tf ",. . ». . _ •.. ,. _ .. .. Additional Specifications, Rail S n ? t„ :055 T _t 7" f. 51" Raft Oetail 60M 46 72 68' 72 35~ b7"� . . ) Picket Detail' a - �0~ ~ 7tf 7 7~ ,.,.(� _._. �� wa.�1.. t r-}v � s #% P.F-i 11F £.4 - . {> Sectmnscan:raclt30"tos�_ . 307 Height: 60"Height 56 f i3 Height; 5 .Height 60:Height 7-r Height n Height 6 Rail accommodate hitly terrain; - _ Note. Rie3sPttt$ecii�is Fianf Rx►3�g PUSH PUSH DOWN DOWN SQUARE GATEaE SQUARE GATE INSERT '"� o(FRAME Align POSE SELF—LATCHING rige with groove ALLOWS GATE o a TO SWING INSERT -i BOTH WAYS ®— -- { D Fgateand ) CAN BE Align0 edge with PADLOCK ED inside groove. en Drill O =.• FROM st VW hole EITHER SIDE and attach collar. AUTO-LATCH for ORNAMENTAL FENCE SQUARE SQUARE PRODUCT FRAME SIZE POST SIZE AUTO-LATCH No. 2015 . . . . . .1" . . . . . . . 1'/2" for CHAIN LINK FENCE/ GATES No. 2020 . . . . . 1" . . . . . . . 2" No. 2025 . . . . . 1" . . . . . . 21/2' PRODUCT FRAME SIZE POST SIZE No. 2215 . . . . 11/4. . . . . . . 1'h" No. 1500 . . . . 1%" . . . . . . .13/s" No. 2220 . . . . 1'/4.. . . . . . . . 2 No. 1502 13/e" . . . . . . 2" No. 2225 . . . . 1'/a . . . . . . 2'/2. 11 _ . . . No. 2515 . . 1'h" . . . . . . 1'/a" No. 1525 . . . . 13/e"" . . . : . . 2'/2" No. 2520 . . . . 11/20 . . . . . . . 2" No. 1527 . . . . 13/a' . . . . . . . 3" No. 2525 . . . . 1'/2" . . . . . . 2'/2" No. 1562 . . . . 1%" . . . . . . . 2 No. 2529 . . Adapter Kit No. 1565 . . . . I% . . . . . . 2/2 - No. 1567 . . . . 1% . . . . . . . 3" No. 1572 . . . . . 2" . . . . . . . 2" 1-800-888-9768 No. 1575 . . . . 2" . . . . . . . 2'/2" AUTO-LATCHACINDUSTRIES www.dacindustrles No. 1577 . . . . . 2" . . . . . .'. 3" — JOB/PROJECT DATE OF The Commonwealth of Massachusetts Department of IndustridAccidents Office of Invesdgations 600 Washington Street Boston,MA 02111 wKw mass gov/dia ' Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): p(J C\S10 0 ?Cas Address: a O &A f,� w oc6 Ur T - City/state/zip: S 'I 6,/&VO tAVN Phone#: l a S 01 Are you an employer?Check the appropriate box: Type of project(required): ' 1.Q I am a employer with• L) 4. ❑ I am a general contractor and I ti.`❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7• ❑Remodeling ship and have no employees These sub-contractors have g• ❑Demolition working for mein an capacity. employees and have workers' Y aP tY z 9. ❑Building addition [No workers' comp.irm nnee comp.insurance. required.]. 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I I.❑Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy iitrmation. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors mast submit a new affidavit indicating such. tConttactors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have - employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.. , lam an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. R T0�I C Insurance Company Name: C 0 In `r10, a S tn,a $ 1 Expiration Z C9 Policy#or Self-ins.Lie.#: lA�. (o��3 �� Date: q Job Site Address: 1 W.M t o Ave' ' City/State/Zip: 'q V Q Yyn t S Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment;as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify un thq&Wns and penalties of perjury that the information provided above is true and correct. Si atum: Date: 1.012 601 Phone#: S 0% Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.EIectrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person hi the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public-work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation kmrra+ce. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permittlicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call: The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 - Tel.#617-727-4900 ext 406 or 1-877 MASSAM Revised 4-24-07 Fax#617-727-7749 wwwv maw.gov/dia V .� y f { 4, I Y J . r R `'f;r 't t exit i a s�: w,ai t l f ' ,_} ,.. h f{ k:a 4 M F �, t za` r 11r r.y. t fit, .� .4 s - t -' f i r 5 . , c 1YX it 1 Y > ',} , , of � / Y +r7 5 t s \ 3r - t 1 y s J 1 -, - rr t 9r t Irv, ;�... a '.t rt Arlr, , r 1j _� ? a+ 11 �' 447 s X f. r L '_ 3 l - 1 x t - 4 f S '' ,� S_Y s. d its t- -c 's,f. + ar _1. J 3- t 1J )J 7 '' i "'t r 5 _i� i . tr{ i ' ✓ t...1 r.. J i s { �u. p? q ti 'ia d S `� �')�' 'Y v ..Vy : J 7 P,1 .r ; 5 .� _" , / r i f r q ,u r.. y f rr 't� .F ` Y { y.' 4 j d it. \iW��\.T Im"i � x } ` ,Z r! `° § .J.. :4 �. v t� .r x!{ ( Y t i ''ty 1 Y- ) r T:LY +r 5 �, .,,� 1 i .'�,- h `� f.ilt 1 p - a - a 1 { f y;_ 4 J 4 f r i 1 F r E J b 1 t R, 1'.'4 , f .X 1 !_ g.F } ` \. z_^ I 2 F r r a.} '. y ( r J 1 , i f t rr - r s\ ,y A rJ1 t r r' _. i ,. R tY .' t, S Pe `I ✓ r �.. i - r i• - t - t `s s S g fi This.confract entered into tlus 'ITH {d, ,,, � JU1<. 26t9,, by andrbetween SO T`KYARTUNAS,`o`f " , } 61 WIDD N AYE, MA$SACAUSETTS, 02601 ('hereinafter referred t0,j as "O VNE i' ar(d I OTAY" t KELLEYf: of PRECLSION POOIy$ 'AND rP TI<flS, p O $OIL 1082,J CEN E�2VII.LE,,, > .,- r`Y MASSAIrHUSE TS,0 632(hei°ei' 'After deferred to s"Cfl1aTTRACTOI�'�,Y Witness,thatbthe'OWNEI�and n ' t 1J ,iS A �'S {,. t h r� },C i� , r, , T.} ,1 4 - y ,, .co fqr consideration hereiiiaffer named„agree asfollows f t :3 t , 1 3..- 2 r� x a F 1 S k z - , r.' ° 9 -s r t—c.i zr t z :r i iT,y Zt f t t {, ,,J Y .ti i r , {. F -:} ti x ..t § t rr - ' SCOPE OF II WbRK.x slSemolitiori a[id tecotnstriiction of aii 18°X 38';giimte swimmnig pool' , , ; ' r with an attached`8' X 7' Splll over gtitlite hot titb Work mchideSrremoVal of exis nglcQncrete deck , S. . 7 Y-'v x., i )t 9 , j f - r 5? ; X r F,5 r Demo material will be used as sold Dili to fill tii the bottom off eistxng pool far the Purpose of racing r *x1 _ Elie - floor,bottom.1 a depths of 6'„ Additional details are.uidicated on e-I'll,<#127,:? a—, duly' .r r :. r ' , ' : -_20I9;wlueh will be,sO& . by"� �R at�d C( NTI2ACT Rand si}all batcoi dered patt'of this ' ' 4 J contract W} r ,t; � € < ' ` , t ' r � .)" R ., �,� a 1 } r, , f t Y f 1 .\l 3 _ `.f't f i t T 't ar, £ y �,P1�x ' r ft} ;, J r w_- !. s r ,� 4 Nd ti .� 1 yJ; r, r r ,n rt f t t j GENERA ,,&DETAIL SPECII�'ICA ION r °' 1 ` r. ,. tF .}, }, O Yd L i f t r1 f i L ', \ x' '"; 'ik+",., t. J 1 Pbol Size t $'X t38',r "P6"i l3eptli 4 '3 5'T©-6' t` i. K ` r ,r x P 61,Shapte I t R C')fANGLE r j 1'o.li,ii a ' 68� 4 sgfft y F } r a Psiol Capacity'; 23,0��GALL(JN'Sr �, Poal Perin3eter<j '` r�112X ti ' ;f t yCoping�1 CANTIYE ED CONCRETE ' 1, Coping by �t;r -CObII'RAC1 R "- ,"N 1 , s ; ` i a PuYnp r t OVM— 'S-.EX153LING�HAY�VARD PUMP .' t'A ,- 5 , 4 3y ." s s ,` Filter OWNER'S EXI$p�lG-)EIAY. SAND FYLTER ' ;Inle#'F` r 15" t ; r , T; { ; ' , Chlorulator r, ,; `HAYWARD A':QUARI` E SAl<,T GE�IEITOR �' �: ' `�' ' ° `, r i ; ,..: Haater s d HAYWARD 35flBTU NATT7�RAL'GAI , rat{ f` 1 1 q ( �/t��'rl r��vy�y� yyyy__}___. + ? i Returns S r 2 :Y t-4 K }r i,1�++i Ll Gull - t 2• ._1 I r F S 1�1 VI - "{2 r iC,. i Y f,i 4 'i~3 rt "-i. YrZ r$ 1 `� 'T'tY t..l+� Underwate -Aghf', , t �.r'Y }tJ.n4 f L? S:^ ,'1� 0; } 1. Y�it WayW Y f� �t'.h�OV _y. X �. ,.. , A r.. ` Elecfic By ,, OWNER Bonding by , OWNER ;Tuner by{ EXIST ,G' M 't,' r , , , Watea'For'Pooi OWNER Steps'`'' STRAIGIl�TsCORNER 4 Y` , , y h ,% "' 4 T y L '' y'` I andrail�r 1 r YES Ladder Y;ES y F 4 P� ;' ' S Oecfcing STAMPCRETE SEAIVILEySS FATrTER�l } "a ,, ;' `?` z ; y;" .- Coibr T B/D, r b ; ';,1,Release T/B/D,`1 fDec ing ByT i,tCONR� CTOR , " ' ' ,{° "';} J, - y S ?j r f + x '"s s 6 } fi r ra s -� �, ,z Witate Cgver YES a TTile t TB[D{t Plaster, , �. Vt'_,H3TE t s y `'' Fend 90'OF 4':HiGH BLACK ALLUM>�TUM OI AlVIE1VTAL 1WITTlNCUP4'_ENTRY GATE ._ice - r Jr p r Hot dub 9 X 9'WITH 5 3E3'S,2I,: Dl<2AIlYS 1 SRIMIVIER,'SPlIII,Z OVER TO POOL : , Y p j t ,S f { J• - f f- t d 7 SL�{ _ `,:. rr t e ! £ ' i4 >wv as yo? r : [ 5�`Js , �2 .. TIm OF COMPLETION t r fihe work to be performed^tuiciet this'co�tr-et shallf> a corm fenced on r g` J s" ' or aro"a .AUGiJST 15 2019 iid shall be sutistai�tially completed by OCT08ER�26 a,2019 ' ` f 6 , t � mot : r �'Aa 7A F ti r z i. t � - s S �'ry } r k e � cF ys>. n 1* r { s . t * t 1 :i 1 Jt 'a t :� -: j ( H { tJ J /.: t - 2 >k ,tl ... 3 CONTRACT STJIVI The OV NER shill pay the co racYor,for the pe ormak of the corn ac r } 1 ' sub}ect to acdihons and deductXons hereinafter provided or subsequently agreed tbrin Wfltiilg,fhe sum ` } , of A deppsit+of. shall be made ate tune this cement is executed with the i h J' 1 J :t' 1 J } { y'' J J k, (, ) J y 'l balance paid`in accordance With Paragraph 3 rt z a` o r # :y r t r t P 1> t '' ' E f nr '. f A {�, �. t` :Il S 3.. } ty r " 1 rFl y i' ' l f "t ` M t $ ,1 S �V' 'f J r ` 1;r t 4 t 7f y s -',, / " J r J r4 { PROGRESS PAY.IVIEN,.TS 'lie OWN'Ek shall mike pa�+mems on account of the balance due:on {, ` q yt. , rJ s. r .'S i x ' J` the contract of J as col-ows when each step is complete OWNEttragr'ee that l OWNER` 'F J ,A .`t z s 7 fails rtotmake a payment,COiTRACTQt has the right to stop,wcirktiltpaymeiit has beenvmade 4i y ft i il ' h r t J r s i t o ;tit$ } :.r t S i ` X�'S Y i t t + .{ s ti x 5 t r a J a- 'k 4 y, .f 4 $9,57�00 when work`begi, J}t><l 1 ! -r 3J 4 j L Y i S i I t 94 "L 9'y "�i 5 ty t f 4. {' ` , J ; , $6_`_,00. ' when demo is complete ,J t ; ,r ' }fi_ $5,000 OQ' J - when rough plumbing is complete,(p�c white ite0s1 1` " i r 5 2 , i wj x a p r F J t' " c r ,1 r t t i 7 } t ,r ,°. l ,.* ) r . i F r, , :t h, sti L i f 4 i 1 ... tm N! s F / + \ > ' :, > I. z t.. +. Fr t<..rre s 1}r air 3„r } J ..x t ry. Y 1 Y Tk 4 '�` t/- :1t # ,-_ �r s 1 a T t s y 1 2 't 5 ` y t , s� i ,. f 31 r Y A k r } 4 t f " ` aS ...k r ..,,-_r.r ....�. ... . .,.1 t.L .. �..:. .. ., ..e ...x:.'�• ..v.. .. .l}' ..e.. .. 4.{. .. ..al_i.S .. .r+.. .. { } 1 J 03 Awn q-t F whan. Qo""lwlk/�' "?KTOMM Q-",--"Von OWNERS any and any �e e e.,,,pp n6fikely'as th avm- ay, 'if cuftm, rlt thwater,th4P#y_; C 4 W the va er -a I Ine-he e, 6 t nearest operatesthe,. ool;;the 0"nj. .......... :AGREEMENT' WThto NSA Bementcontainsa m,gsi:;an 4e0 s-Ma by'the a no,repres nfifion agreement;-wanarity or OtOot"Stte fa agents 0 ahw�zis,jinc i e., ,gr 0 0 shall m eerqenj1, valyd unlessJ'n J000A Qsms Ams to C qjX 11.01nv MAY. =20, S8-V: EROD hereto have above I e ey X A"Jawally; jean, aqw., ify No "Tenn. IV -Qtf Too? Ok My no To Woe M, 101. ;lqtr Pow K"A".jz Wmato jr-gay vw mwyn ano Awl IWO igpw T"ns--clamp M"vv.. A-wow...,RM"and: Q,ya v"Nvnt jjn saw SM",,-WON so"I"Inn,w-o"n Q ita T nv 0 norms,to AW T Al L Jul W-SAY-MY 100-Oft- wow 0,4001 40=01&on too SM, Application Number........................................... Section 9- Construction Supervisor Name Telephone Number Address City State Zip License Number License Type Expiration Date Contractors Email Cell # I understand my responsibilities under the.rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your license. Signature Date Section 10—Home Improvement Contractor Name_ �fjt US Ic n P00\5 Pot (vS Telephone Number So$- `7 -1-7- a S L-l Address 30 ?IA t I W00d flf City S VA/ rn0w+k State I\A A Zip ORGC4 Registration Number 1`12 1 Lj Expiration Date 3/f6�2 O I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 80 C and the Town of Barnstable.Attach a copy of your H.I:C... Signature Date Section 11 —Home Owners License Exemption Home Owners Name: o h n ` )(w a r�k.nog,S Telephone Number 70?- 50'1- 33q S Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts'State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. r Signature Date APPLICANT SIGNATURE Signature 41 Date 1G a I Print Name Ti m c4k c f" 6 11 t Telephone Number SOS' `7 3`7 - I a S q E-mail permit to: Oft C is t o n p oo�s l V'k , Coal Last updated: 11/15/2018 Section 12 —Department Sign-Offs Health Department © Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation ❑ For commercial work,please take your plans directly to the fire department for approval Section 13— Owner's Authorization i as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of job) Signature of Owner date Print Name i i t Last updated: 11/15/2018 Town of Barnstable 'Post This Card So That it is Visible„From the Street Approved Plan"s Must be Retained on Job ad this Gard Musi<be Kept Building n �. *+"� �$ Posted Unt1lFlnal Inspection Haas Been Made a 4 6 Mesa , Permit here a Certificate of OccupancysRequred,such Build ng shallNot be Oc upied until a Final Inspectionhas been madeM Permit No. B-19-2933 Applicant Name: Timothy Johnson 'Approvals Date Issued: 09/18/2019 Current Use: Structure Permit Type: Building=Addition/Alteration-Residential Expiration Date: 03/18/2020 Foundation: Location: 61 WHIDDEN AVENUE, HYANNIS Map/Lot: 324-103 Zoning District: RB Sheathing: Owner on Record: John Kvartunas Contractor=Name: TIMOTHY P JOHNSON Framing: 1 Address: bl Whidden Ave Contractor License: CS=101696 2 Hyannis, MA 02668 _ Est Project Cost: $23,000.00 Chimney: Description: Remove existing Ceiling in Living room and kitchen Sister up ; Permit Fee: $ 167.30 existing rafters with 2x10 Kd. Install new collar ties6at2/3 to create Insulation: a vaulted ceiling. Remove existing Slider and replace with�Triple Fee Paid: $ 167.30 Final: 9068 slider,install double 2x10 header KID. Remoue existing single 9/18/2019 Date doo entry door to sunroom replace with double 6068 French Plumbing/Gas. install double 2x10 Header KID Rough Plumbing: Project Review Req: ;x.Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work autl�onied by this permit is commenced within six m'onths,a. er-issuance. All work authorized by this permit shall conform to the approved application and the�approved construction documentsfor which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by laws and.codes. b m This permit shall be displayed in a location clearly visible from access street or r`,oad,and shall be maintained open for pullic� spection for the entire duration of the Final Gas: work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by,the Building and Fire"Officrels are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: " Service: 1.Foundation or Footing a Rough: fi 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest-flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons- ontrac ' with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). �c Fire Department Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: �I KIEr Town of Barnstable *Permit# -�f � Expires 6 mop jr n issue Regulatory Services Fee * BARrrsrnai e MASS. $ Richard V.Scali,Director 1639. �0 Building Division . Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXP S PERMIT APPLICATION - RESIDENTIAL ONLY /o -5 Not Valid without Red X-Press Imprint Map/parcel Number Prope Address �I i�elN/DDE / � l��WlS, IV,4 O24g,0 Residential Value of Work$ �S� Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address KV)997Uq+S o COI Contractor's Name Tj-,b �.U$",�'1rJ ?U114: °°�6, /At Telephone Number_ 7 74 1 5-7 Home Improvement Contractor License#(if applicable) Email: keWe &&�e-eod, co dh Construction Supervisor's License#(if applicable) C.S 7&3 3 2- .❑Workman's Compensation Insurance P •c,,• Chec e: � e y Llj'l am a sole proprietor ❑ I am the-Homeowner MAY 2 ❑ I have Worker's Compensation Insurance 2Q14 Insurance Company Name 710ki n Workman's Comp.Policy Copy of Insurance Compliance Certificate must accompany each permit. Permit Regu. (check box) g Wh bm)PSI6< Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken 7 ❑ Re-roof(hurricane nailed)(not stripping. Going over existing jayers of roof) ❑ side Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt'compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of he Home Improvement Contractors License&Construction Supervisors License is requir SIGNATURE: ' Q:\WPFILES\FORMS\buildin ermit forms\EXPRE .doc Revised 061313 J;� The Go7n71 or€ytwa�h ofMassacli use is Deparhnent ofl`irdiu&ial Accidents Office of investigations 600 Washington&reet Boston,MA 02-U1 wn w.mass.govIdia Workers' Compensation Insurance Affidavit:Builders/Contra:ctorsMectricianslPlumbers Applicant Information. Please Print Legibly Name(�usme�slbr�ni�tionllndividnai�_ `�j�� C%U��Tl/1'�'1 ?(&06Z lAIC Address f O &X 2-1 City/Stat&Zip: �lr- Ing Phone 4� j_?4-9 f4—135 Are you an employer?Check the appropriate box: Type e of o ltt• 1—t(r eqnired)_. L❑ I am a employer with 4. ❑ I wn a metal contractor and I t5_ ❑New construction gVroyees(full and/or part-time)-* have himdthe sub=contractors. 2_ I am a sole proprietor or partner- listed on the attached sheet: 7- ❑Remodeling ship and have no employees These sub-oontractors have g_ ❑Demolition. w for me in an c ci employes and have workers' orlang y apa. tl- 9_ ❑Building addition [No workers'comp_insurance co comp-insurance-1 recNired] 5..❑ We area corporation and its 10-]Electrical repairs or additions 3-❑ I am a homeowner doing all work officers have exercised their I I-❑Plumbing rapairs or additions myself[No workers'comp_ right of exemption per MCL 11-0 ltoOrepairs. insurance reglu reti]1 e.1.52, I(4},andwe have na employees-[Naworkeis' 13_ Offierr��-/�� comp-insurance required.] *Any appHowt that checks boa-1 mast also fill out the section below showing their waakers'compensation policy infiormaticm T Homeowners who submit this affi k=iuffcstiag they are doing all t'rotk and dreg hire autside contractors mass submit a new affidavit mdusting such ZCuntwctors that check NE boor mast attached an additional sheet shateiag the mane of the sutF-conftictoa and sts whether ornot those enflies have employees. If the suV contmctars have emplbyees,they nntst pmvide their policy aumbe r lam art employer that is prm i&kg t►�orkers'compenmtinn imurance for my emplayem Beiaw is the policy and job site information. Insurance Company-Name: Policy 9 or Self-ins-Uc.a Expiration Bate: 5 job Site Address: to 1 WttjpL old 109 City,'StateiZip: C 2-(go Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c- 152 can lead to the imposition of criminal Penalties of a fine up to$1,500.00 andlor one-year imprisonment,as well as civil penalties in the fors.of a STOP WORK ORDIR and a fine of up to$250.00 a day against the.violator- Be advised that a copy of this statement maybe faswarded to the Office of hnestigations of the DIA for insurance coverage veriEcation- I do hereby certify r1 the pains andpenaTties ofperjurp that the information provided abiwe is true and correct S,i tune: I3at+~: I Phone#: 02W&I use only. Do not write in this area,to he completed by ciO7 or town ofjiciat. City or Town: PermtitUcense# Issuing Authority(drele one): ' 1.Board of Health 2.Budding Department 3.Cityfl`owu Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 6 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written_" An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or Iocal licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth far arty applicant who has not,produced acceptable evidence of compliance with,the insurance.coverage requ.ired." Additionally,MGL chapter 152, §25C(7)`states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants , Please fill out the workers'compensation affidavit completely,by checking The boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s), address(es)and phone numbers)along with their certaficate,(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance_ If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of in urance Coverage. Also he sure to sign and date the affidavit. The affadavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self insured companies should enter their self-ins; rance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permittlicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy`of the affidavit that has been officiaIly stamped'o?raarked by the city or town may be.provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number. >> \`The ComrmonWF,-ala of Massachusettsl;\ A` Department Qf Industrial Accident office of Tavestigatiaus 640 Washington Street Boston=MA 02111 Tel.A 617-727-4900 W 406 or 1-9 -MASWE Revised 4-24-07 Fax# 617-727-7-749 www.mass`govddia �r �iHE T M2.m noun u,' � ABC RAW! MAE 4a ow oastaile e u 110 ry et ces x Rtctard Y peaty Director +` �'� 4 am onto �Thvmas Per CBC) s r.p.. �1: ,If l +y.� 13ui1dtng�Commessloner S � � 200 Mdlt3 Street,.wHy3tyzllSy'3�4A.02601 Psi �4 W 14'tPV4 tl t?41TnSt�bI ma us Office. 50 86203$ �y tt+ `08 790 6230 IOpe, yW1�2' USt: t Cbmptete an 5xbxx Tkus ectxor aY �� sVON r N. COMMON rKY T � (RP ,as Qvcnet caf the susuITS MA jcct Zaropetty v � hexehy authotze l' a144 Z SWO1, to act ou to he}aalt , Away in all�nattels rh�e ti �vcaxk aurtiaied h �h15 Uulc�at%E cruut� l�caticii� " E (Addr�ss I � if Property z Owner is a pl3 mg ifir permit,please cnmpiete the tlaM66 ers License Exeroptrott Fnrm # 1¢ ,_;' z ¢s ,Y ;-: ay 4 � z IWP I?rS1FOK�,1�lbv+3#ian;,pcmvt oims,EXPRFSS.+iac:; n .. .. awn' d 06131,4 + VITRO _.. - A � �t Massachusetts -Department of Public Safety �✓ Board of Building Regulations and Standards I! Construction Supen isor License: CS-076332 ia6;IN BOYAR r, PO BOX 716 West Barnstable 1 028 !, )I i41 Expiration J,•�•� 09/05/2015 -- commissioner C��e (��arwncarrcvecc�f�o�C_/i'%lcot:�ccc/uaeCZ`a Office of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR eegistration 162,150 Type: xpiration 126/2015 Private Corporatic B&D CUSTOM BUILDERS INC KEVIN BOYAR 1050 MAIN STREET WEST BARNSTABLE MA 02668 Undersecretary j. License or registration valid for indiviclttl use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation { t0 Park Plaza-Suite 5170 4 Boston,MA 02116 Ntvid withou gnature o i Town of Barnstable F O Regulatory Service Thomas F. Geiler,Director + RAMSfABM 9 XAS& Building Division i639• �� 'O�Fc►ru`y Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 . www,town.barnstable,m a.us Office: 508-862-403 8 Fax: 508-790-623( PERMIT# FEE: S CZ) G SHED REGISTRATION c 120 square feet or less ci. a � Ca Location of shed(address) Village w r,7 e7 � ��hs 0 Property owner's name Telephone number Size of Shed Map/Parcel# L /v Si e Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction9 Gonser_v,ation Commission.(signature is required) Sign off hoursfor Conservation,8c00 9.30'&'3:304 30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. i THIS ]CORM. MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:042506 Map Page 1 of 1 Town of Barnstable Geographic Information System Parcel Viewer I Custom Map Abutters Map Size 1300 Zoom Out U, n J n J J J J j In "', ' r �IY A� ® o- 3PG Map: 324 -r[ �L !A W,I f _ Location: 324069 _'rr 324068 NJ it 34 �� -• Owner: _ N 46 �324068 f+ 4 48 J k22 {_ iLoca� tion In Map & Parce y Location Acreage { -f 324076- �r _ fJ `� N23 '' t t !Current 0,A Mailing Addi 324103j, f 324071 r _ i t14N62 `+ �� AL ppraised Extra Featur Out Building �-324076 '• _ 1 324072j�j ' N.66 t� tr�f Land 7 Buildings Total Apprai 324077 324102 t iu 64".-.___I N 60 33 34073' 324074 f !Assessed V __0 1 G4rFeet 33D F Extra Featur Out Building Land Set Scale 1" = 64 I Aerial Photos I MAP DISCLAIMER Buildings Copyright 2005-2008 Town of Barnstable,MA All rights reserved.Send questions or comm( BarnstableMA v1.2.3083 [Production] http://www.town.bamstable.ma.us/arcims/appgeoapp/map.aspx?propertyID=324103&map... 6/30/2008 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map _Parcel ` 93 Permit# 50 31/7 Health Division Date Issued fo? /P 1 oro Conservation Division Fee Tax Collector AL-2wti Treasurer0�L� ' Planning Dept. • Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis t Project Street Address 6_14 1�411.1 Village�d rt a`.5 Owner t��y �r�li(�y�> Address LcJ Telephone 4 � Permit Request �O d[r�l.,/c,P �./�� C�—o�� r4��s/�— ZJ`— Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Valuation Zoning District Flood Plain. Groundwater Overlay 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 0-Wo On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count , Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other a. 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 / BUILDER INFORMATION Name 4 / e-l�f h Telephone Number 00 Address DO' /tr Sf License# 114y �.� J1a Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ,� SIGNATURE Opp • f - FOR OFFICIAL USE ONLY PERMIT NO. - DATE ISSUED ' MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF-INSPECTION: FOUNDATION FRAME _ INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL ' PLOMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING_ DATE CLOSED OUT ASSOCIATION PLAN NO. VE v The Town of Barnstable awRxsTnsc.s. * . 9 'MAM Regulatory Services �'OrE1639n. ` Thomas F. Geiler, Director Building Division Elbert Ulshoeffer, Building Commissioner ' 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: J(�� Estimated Cost la Uc/D Address of Work: ri�� Owner's Name: Date of Application: / /;,- dam/ I hereby certify that: Registration is not required for the following reason(s): OWork excluded by law E]Job Under$1,000 ❑Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as t ent of a ow �-- Date Contractor Name Registration No. OR Date Owner's Name q:fonns:Affidav The Commonwealth of Massachusetts Department of Industrial Accidents ti ,� -_ �_ , __-_ Olfice of/arest�gatioos 600 Washington Street ` -= Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit name: of &'4 ell"' location: Awl CitV / hone# ❑ I a homeowner performing all work myself. [am a sole netor and have no one workin m* capacity ❑ P Y to e I am an em r providing workers' compensation for my employees ........... ,working on this job. . . mom anw.;name:. :. address... ::::: . a -p hone#. :::.. insurance ca: of ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: com an name:. .....:::::.:::. .....::::: ............:..... address:::' ..... ......... . .. §>i :.:.::::......... . ... M. . :...... "hon e ri ± ...... .?C r•::::f::i4:J:vJ:::•:::•. i.:•:•.C::.:J:vi:.iv:•::::.:::i::::isi:v.i:.:::::::•::v:i:i::i::i::<.:}:.;.;v::............................ . ............................................................................................................................................................................. XX ..::n.................. h:•. , ...... ;:..%;i:?;<::;i ri-r.%:::::i' .`'.?.::i: haritarr X. ;.....: :.::.::.:....: :address.. :<: li iyntraace:co.. 0 Fafime to secure coverage as required under Section 25A of MGL 152 can lead to the impostion m criminal penalties of a fine nP to 51,500.00 and/or one yeara'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fime of$100.00 a day against ram. I understand that a . COPY of this statement may be forwarded to the Office of Investigations of the DIA for coverage verifleatiom. I do hereby certify the enalti perjury that the information provided above is trw.and correct Signature Date �r 710,C, print e _ . 191/ 71/ vl Phone# official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department ❑Licensing Board ❑checkif immediate response is required ❑Health D Office e a ❑ ealth Department contact person: phone#; ❑Other (revised 9/95 PJla Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein., or the occupant of the dwelling house of another who employs persons to do maintenance, constriction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. r,� ; Applicants »Please fill in the workers compensation affidavit completely,by checking the box that applies to your situation and Y� supplying company names,address and phone numbers along with a certificate of insurance as all affidavits maybe ¢ E.resubmitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the`9aw"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the peimit/license number which will be used as a reference number. The affidavits may be retained t� the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Me of Investigations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 eat. 406, 409 or 375 o� s-71. �omvina�z o��aaaac/ucaelta. ; BOARD OF BUILDING REGULATIONS License: CONSTRUCTIONSUPERVISQR I' Number CS 022567 , Birthdate 07/1 t/1:9.55 j Expires 07/11/2001 Tr.no: 2164 -Restricted To: 00 RALPH E BERGERON: 500 ELM ST �'. :� KINGSTON, MA 02364 Administrator { Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: k, Board of Building Regulations and Standards74 Registration: 110412 Expiration: 10/20/2002 One Ashburton Place Rm 1301 Boston,Ma.02108 Type: DBA t i D.R.&SON CONSTRUCTION CO RALPH BERGERON 5 500 ELM ST � � KINGSTON,MA 02364 Administrator of validdwifhout signature