Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0212 ANNABLE POINT ROAD
. �t ,�: . A _ ,, . ... � r . . . . . � .� .� � . . . � . ,: ., � ,, K . a t - - ., � . „ . ; v . .: . x 2 �� . . ,.. . z . _ . , .r .. - � � , .. _ r :. �. , � � , , � . . .. � : _ .� � n _ a . . � . .�� w . . :. . . r ` 4 A. _ r.. _. ... .. .._ c. � .. t 5 ,1 .. _, r: c c ., .. .. , ,. u ,. - .. ��. :. - �, � '.-. < ._ � may.. � � � '.�.T c - ��. � _ .. r .�' - �� _. .. o . .. - � - _ a �.. r ', � ,� �.. � -�.. ., ,. .. ., f r .. _ .. .. n .' �' � " .': r _. , a: - _ .. .. � - - � � ..., ,; 5 ,..; �.� _. .. .. .. F i - - -' � - i. .. - , v .. .•.. ... _ ,F �T. q -,...N ..�. O � ,, W .�. -. _ , �. � ,. , , � .. ._ t: � is .. ., � - � a + y _.'`. '.i n .. x " � � 9 ,: ,. r � ;, • v .,. ,. t �` .. ` J .. ., .. � _ , s ,. ;, :. �. .. ., .e. .. � � t ., - .. _. - .. � .. :.. ..y. .. E � ... .. 7— Town of Barnstable it 9MAW a a"WASS ' 200 Main Street, Hyannis MA 02601 508-862-4038, 463 Application for Building Permit 071 1 Co Application No: TB-16-3069 Date Recieved: 10/18/2016 —r Ln Job Location: 212 ANNABLE POINT ROAD,CENTERVILLE -77 Permit For: Building-Solar Panel-Residential i+ Contractor's Name: CHRISTOPHER J MURPHY State Lic. No: CSFA-083813 Address: NORTON, MA 02766 Applicant Phone: - (508) 683-9919 (Home)Owner's Name: FERGUSON,WENLEY S&HUGH S TRS +.Phone: (801)558-4268 (Home)Owner's Address: C/O WENLEY S FERGUSON,)CRANSTON,RI 02905 ` Work Description: Installation of a roof mounted PV solar system lagged to the roof rafters consisting of 12 panels Total Value Of Work To Be Performed: $16,904.00 Structure Size: 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G,S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: CHRISTOPHER MURPHY 10/18/2016 (508)683-9919 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $16,904.00 Date Paid j Amount Paid Check#or CC# ? Pay Type Total Permit Fee: $136.21 10/18/2016 $1.36.21 }iC3IX-70 -XXXX _ Credit Card 1327 ............. ......... ......... ...................... Total Permit Fee Paid: $136.21 Commonwealth of Massachusetts off `��t�jS Sheet Metal.Permit U Maid-it Parcel -PRESS O. Date: 4?tKc1, a 3 ?.0l S' Permit l MAR 3 0 2015 b w Estimated:Job Cost:$ 15 qA� _ Permit Fee $ VON Ur BARNSTABLE Plans Submitted: YES NO Plans Reviewed:: YES NO. Business License# Z Applicant.License# 13 y/ 3 Business.Information. Property Owner(Job Location Information: Name: M Q't rI'W StA-IJ I CL S Name: 06,j L rt✓ Tc s 1-� 'Street: 3`i W �-,� aT Street: 21 Z /-�-�IJ�S� Jp a City/Town: �A 017 w H, City/Town: C;9>J T-eA V 1 tJ_ - Telephone: S-o -7 b a L 6 a Telephoner- Photo I.D. required/Copy of Photo I.D. attached. YES ✓ NO W _ Staff Initial stricted license J-2 I M-2-restricted to dwellings.3-storie8 or less and commercial.up to 10,0.00 sq..ft. /2-stories or less Residential: 1-2.family ✓ Multi-family _ Condo(Townhouses; Other r i Commerciah Office Retail Industrial: Educational_ Fire Dept. Approval Institutional_._ Other Square Footage: under 10,000 sq. ft. ✓ over 10,000 sq.f t. Number o€§.tones: Sheet metal work to be completed:.' New Work: `� Renovation: 3 HVAC - Metal Watershed Roofing. Kitchen.Exhaust zsystef Metal Chimney.[Vents Air Balancing Provide detailed description of work to be done:: _jfJSitt V �� ti1 0 � l�t�u PVC f�J�ern Awn 2 nl,f y l n i e ZC 01/ /14- (,a�� i I INSURANCE COVERAGE: I have a.current j ebili insurance:policy or its equivalent which meets the requirements of.M.G.L Ch.112 Yes[Rko ❑ If you have checked Yes,indicate the type of coverage by checking the appropriate box below: i i A liability insurance policy d Other type of indemnity ❑ Bond ❑ I OWNEWS INSURANCE WAJVER.--I am aware that the licensee floes not have the insurance coverage-required by Chapter: 112 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement: I Check One Only Owner ❑ Agent. ❑ Signature of.Owner or Owner's Agent I By checkingthis box[,I hereby certify that all of the details and.information l have submitted(or entered)regarding:this application are true and accurate to the best of my knowledge and that all sheet metal work and.installations performed:under the permit issued for this:application will be incompliance with all pertinent prevision of the Massachusetts.Building Code.and Chapter 112 of the General Laws. I I Duct inspection required:prior to insulation installation: YES:-NO Fro=cs 10SPA Lions Date Comments Final TnaRection {{ Date Comments f I Type of Ucense: 3y P luster 3 the Q Master-Restricted r 'ityf Town ❑Joumeyperson Signature of Licensee 'errnit ; ❑J.oumeyperson-Restricted License.Number. 3 y/7 ee$ ❑ Y3 ` 13 Check at www.mass.aoWdol I I nspector Signature:of Permit Approval Tsae Co on.veah*,ofMassach=eM Deparlpnent ofln&stria Accddents r _ Office'of lnvestzgatiorts 600 Wash ngton.Street Boston,MA 02111 r wfe.mMs govAdia Workers.' Compensation Insurance.Aft davit: Bi&derskontractors/FIeciricians/Plumbers Applicant Information Please Primt.LedbIy rrurc p� Name(Business/Qrganizanonllndiviclua�: .. y 1 ��01 C�t . -Address: 3 w ,' TA D�L 6 - Giiy/Sfate/Zip s'+� �i `� '��'''�o?/ Phone_ .-o ?e-o A t y Ae:y. u an employer 7 Ch.eck the appropria.te box:: . �a of ro'ecf r 1, IamaemQioyetih. d '7 •4. Iama eneralcontractorandI 6. QNew construction- employees Have lured the=b-contractors . 2 ❑ I.azn a'sole grcpnetar:ar:parfaer- listrd on.t3 e-attacl ed sheet. 7. 2-Remodeling strip.and have no employees These sub-contractors have 8.. ❑Demolitim ' wor'cin>;_for me in arty capacity. employees and. _ - c n 9. [�Building addition[No;workers comp..msuzan. comp.Mmmi ce., 5. ❑ We are a c uporation and its 10.0 Electrical repairs or additions. rrquirel]-3:❑.I am a houzowner do all work - officers Have exercised their - 11.❑?1:umb ng repai s.or additions. myseu-(No workers'comp. right of exemption.per MciL 12:7Roof airs insurance reused]:t c 15;,§`I'(4),and we have no- - rep.' employees:.[MO workers' I3., C)ther ✓ �. Comp.m mra=required.] ` Y aPPlicaat t ia#ch=lm box A mustalsa-M otithe.secdon bdow.showing:9iei v7A)6 1.aamgeosation policy,boa. t Homeowners who:submit:tiiis affidavit indicating they=:doing.A work and th=:hite outside cantractom must submits=w affidav'stindicating,such. Iconnacton that checkthisbox,n=attached as additional sheet showing.thenazmethe sub,coub=t=1 and state:wbetber ornat'those eudderhave: �ioyees.If the:sub-contactors.bave=ployees,tkiey'mtstprovidt their WMi, s'comp,:policya®ba:._ ram an employer that rsproviding workers'compensation.bwurance fbr my empir�yees. Below is the:Po&7andjoh site: information. Tnsur-anceCompanyName:: A'r& 4j r%G C 427,e/L Io✓S'V/Lq!✓CP— Co. Policy# - W C.8' 00 Y a2,9 O0/ Expiration Dates_ 1 b S or.Self ins.Laic:.�. Jots;Site:Address: City%St drJZip: Attach a co of the workers'comp ensation:mpensatxan poficy,decisraSnn gagp'(shawii�g,the policy.number and;exprration date). Failure•to:secure Coverage as required under Section 25A of MGL c. 157 can.lead to the imposition of cdmiinai penalties of a: fne up to.$1,5M.00 and/or one-year:imprisonmeA;,ass well.as ci*A.penalties-in the form of a b i ur WORK ORDER:and a fine - of up to$250:t?o a.day against:the vioLdDL. Be:advised tbata copy of this statement may be forwarded to the Oface of investigations:of the DIA€or ins ranee.coverage verificatibm I ido.,hereby cerfi;fy under the pains-and penalties of-oajwy ihat'the informs on.provided above is true an correct Si — •Date- ,*7ij4--c4 21.• U/5—. Phone:# So -71 1 6 D Offzcia[use only: Do.not rw'ite:in:this area,to 6e cnznpleted°by city of town.oicirzL City or'Town: : Permit7License#' Issuing Authority(circle one). A.Board of_Health...Building Department.3.City/Town Clerk 4,Electrical Inspector 5.P.lumbittg;Iaspector 6.Other. Coirtact Person: Phone: Town of Barnstable s Regulatory Services 'AaRwa�'lAf� s 4 MASS Thomas F.Geiler,.Director ,u�a Biding.Division Trim Perry,Building Commissioner 200 Main Street,,.Hyaunis;IY A.02601 www.town.barnstable:nna.as Office: 508-862403 8 Fax: 508-790-623:0 Property Owner Must Complete and Sign This Section _ If Using A Builder T; ,"as.Owner of the.subject pxoperty hereby authorize to:act on my behalf. in 2E=atters:relative to work:authorized by thin building permit 02>z ,4AJe,4 /e- too IV 7— (Address of Job): "Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled before.fence is installed and pools are not to be utilized until all final inspections are performed and accepted,. Signature of Owner. tore.of Applicant Pitint.Natne" Print.Name Date Q:F0Rrs:0VR,MU ssrozPooLs: Client#:41999 2MURPHYSE ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYY`/) 3/30/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Dowling&O'Neil PHONE 508 775-1620 FAX 5087781218 AIC No,Ext: A/C,No Insurance Agency E-MAIL 973 lyannough Rd., PO Box 1990 ADDRESS: Hyannis,MA 02601 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Acadia Insurance INSURED Atlantic Charter Insurance Co. Murphy Services,Inc. INsuRERB: 34 White's Path INSURERC:Safety Indemnity South Yarmouth,MA 02664 INSURERD:Union Insurance Company INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:. REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTRR DDLSUBR TYPE OF INSURANCE NSR WVD POLICY NUMBER MM/LDDY� MM/DDY� LIMITS A GENERAL LIABILITY BOA039450613 6/16/2014 06/1612015 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY DAM AGE TO RENTED PREMISES Ea Occurrence $100,000 CLAIMS-MADE 51 OCCUR - MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY PRO- JECT LOC $ D AUTOMOBILE LIABILITY MAA039450813 6/16/2014 06/16/201 Eo a.l.id.Dsw lGCE LIMIT $1,000,000 ANY AUTO - - BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED -AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident A X UMBRELLA LIAB X OCCUR CUA500841713 0611612014 06/16/2015 EACH OCCURRENCE $1 OOO 000 ` EXCESS LIAB CLAIMS-MADE AGGREGATE $1 000 000 DED I X RETENTION$10000 $ B WORKERS COMPENSATION WCE00428001 6/16/2014 06/1612015 X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? � N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Division ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S148590/M148589 CBD I - JJ f r ; L r r .� �..•,,�` ' ���f� ������ �� A�r COi�ci�twraiir�g��= Heatmg���Plurb�ng��� ���� _ , �, � February 19, 2015 Mr. David Kerr. 212 Annable Point Road Centerville, MA 02636 Dear Mr. Kerr: We are pleased to propose the following air conditioning and furnace selections for your project at 212 Annable Point Road in Centerville, MA Selection 1: ■ Murphy's model GMVM97 variable capacity, variable speed, ultra high efficiency gas furnace 0bo3 QNA ■ Murphy's model ComfortNet CTK-02 touch screen digital thermostat- Single zone insulated and sealed galvanized sheet metal,duct system ' ■ Start and test system with factory trained technician. - ■ All required permits and inspections - Total price including tax is $8,800 (rebates of$625) Yes No Selection 2: ■ Murphy's model GMVC96 two-stage, variable speed, ultra high efficiency gas furnace ■ Murphy's model ComfortNet CTK-02 touch screen digital thermostat ■ Single zone insulated and sealed galvanized sheet metal.duct system { ■ Start and test system with factory trained technician " ■ All required permits and inspections Total price including tax is $8,500 (rebates of$325) Yes No Toll Free:800.292.1669•Chatham:508.432.1627•Falmouth:508.548.1669•Hyannis:508.778.1669•Qrleans:508255.1669•facsimile:508.760.1670 Murphy's Services,Inc.•34White's Path,.South Yarmouth,MA 02664•www.CallMurphys com. Selection 3: c ■ Murphy's model GKS9 single-stage, high efficiency gas furnace ■ Honeywell model TH4110D1029 digital thermostat ■ Single zone insulated and sealed galvanized sheet metal duct system ■ Start and test system with factory trained technician ■ All required permits and inspections _ Total price including tax is $8,100 (rebates of$25) Yes No System Upgrades Upgrade to above quoted system, please choose from the following selections: Air Conditioning Coil ■ Furnish and install one Murphy's model CAPF air conditioning coil with matched TXV for future air conditioning use. Total price including tax is 600 . Yes No Central Air Conditioning Selection 1 Furnish and install one new Murphy's Services model DSXC16 two-stage, ultra high efficiency air conditioning system. Total price including tax is $4,800 (rebates of$25) Yes No Central Air Conditioning Selection 2 Furnish and install one new Murphy's Services model GSX16, high efficiency air conditioning system. 03� Total price including tax is $4,200 Yes No Central Air Conditioning Selection 3 Furnish and install one new Murphy's Services model GSX13 standard efficiency air conditioning system. Total price including,tax is $3,900 Yes No Zoning Furnish labor and material to convert above quoted single zone temperature control system to a three zone temperature control system complete with duct,work, dampers, zone control panel and thermostats. Total price including tax is $2,100 (rebates of$25) Yes Ix No Filtration Furnish and install one high eiciency media air filter in lieu'of above quoted standard filter. To include required one high efficiency media air filter cabinet and media filter. Total price including tax is 300 Yes No Humidification. Furnish and install one Honeywell model HM5120A2000 high efficiency steam humidifier to provide humidification and increase comfort. .Total price including tax is $1,900 Yes No Wi-Fi thermostats Furnish and install one Murphy's model ComfortNet CTK-03 Wi-Fi touch screen digital thermostats in lieu of :above quoted Murphy's model ComfortNet CTK-02 touch screen digital.thermostats. Total price including tax is $100 per thermostat Yes No Qnty Hot Water Recirculation System: Stainless Steel Circulator Isolation Valves, Control and Copper Tubing Total price including,tax is $2,100 Yes No� .On Demand Hot Water System: Furnish and install one Eternal GU195S 199,000 BTU on demand modulating gas hybrid hot water heater with 98% efficiency. Total price including tax is $4,500 (rebates of$800) Yes No Please Note • The above pricing does not.include any allowance for electrical including low voltage. F Payment Terms ■ Customer agrees to a deposit of 30% upon acceptance of proposal. • Customer agrees to a payment of 30% upon start of work. ■ Customer agrees to a payment of 30% upon completion of rough. ■ Customer agrees ,to a payment of 10% plus the cost of any change orders upon completion of installation. ■ Customer acknowledges that all invoices are due and payable upon receipt. Late payments will be subject to a finance charge of 1.5% per month. ■ Customer agrees to reimburse Murphy Services, Inc. for any reasonable costs incurred with its collection of any invoice. Acceptance After making the desired choices as out fined in-this proposal; please sign, date and return an enclosed copy of th• p o o with your credit card information below or check for the required amount, igni n u,,`cceptance. Signature Date 3 Credit Card Exp. Date Thank you for considering Murphy's Air Conditioning, Heating and Plumbing for your project. If you have any questions, I may be contacted at (800) 292-1669, or visit our website at www.CailMurphys.com. Sincerely, Gary Thompson Gary Thompson Sales Manager tit MONW,EI�►LTH, EN., S �► :HUSETTS • • • , � � �.ti;�s '� / /: ' x' • • • - Z ( Commonwealth of Massachusetts a • �� i L WORKf RS',,. SHEET Department of Public Safely ISSUES THE FOLLOWING 1`'CCfiJSE W > PipcfitterJnurne)mrin I UNRESTR I CTCD License: PJ-030573 AS A :I4UR;NEYPE �4'I 'II' RSON I° (9 WILLIAM O HEAIT� }��(I i III ,I II I". I I AM 0 HE ATW II�II'In IIl{I ` 265 GREAT WESTE r rT , A. I3ARWICH MA:026451'�!�Ii Iy C� . VJESTER:N: �'. IIglb�{ MA 02645-24" $ HARW<I CH 1 262� Expiration: 12>7; .;":?srtrt' 0:4�25/..15>':;<;>"«>i Commissioner 04/04/2016 I.iU WALTFI.OF IViR►fllkA$ . ; * .�,,,W �m,�, y.n� _,,.,•>,z, - =.u,, _. _ - s • o • • I Commonwealth of Nlassachusel-ts �... R 'ARID Department cf Public Safety SHCCT 'FETAL WORKERS _ ISSUES THE FOLLOW.-' LfCE`NSf; 011 u 1 Tcc3nici:unCcrt ic.,tc ' D Llcense:iBU-02408G t �. . MASTER-UNR.ESTRI CTED z W II LIAM O ITEATH JIt ILL:LIAM 0 HEATH JF� I ', jI �? I1;i +I I; p , N 265 GREAT WE�TERPf RD tll F w HARWICH MA.02645'�I i 265. GREAT WESTE:RN. '! da' H�1fZW::1 CH f.1A 026/t5 /t2a3 ? J I �� Expiration: 1 tFl 0I 12626 CommiSsioi�er 04/04/2015 �1At�N�I1�,EALTH LOF�MA►SS �HUSE S' � �• ASS,Am, ie Commonwealth sa fi se is AL WORI(�R nenPublic a ornr � o �s�n h a l SHEET Deparll _ t of' eky ISSUES THE F0LLOWI;N _ iCENSE, r ' � W:' Pipcfitter Jnurne)main r A5 A< pURNEYPERSON-UNRESTRI CT Ep License: PJ 030573 !, J R l r li II' WILLIAM O HEAIH: i r 1, W{ L I AM 0 HEATW �1�iynt if "I r 2G5 GREAT WE 'I l (1�. HARWICH MA;026451.1:jp;, li„•�. t J VJ'ES'TERN �l r MA 02645-24` S ..... >2627 //r ,. ,; 1�, tWICH Expiration: 12�51. Commissioner O>t/2$L;•1..:5.:.. 04/041201 _ - ,.w.,b•NW'OE FI LE, aS(�rC:l1UIS�1 b`eM *,•�n� ,,�» �,,,«,,..,s,nu w - _.. s o OW Rai0 0 (. Commonwealth of Nlassachuselts SHECTBM TAL 'WORKERS Department cf Public Safety ISSUES THE FOLLOW(iS(G LICENSE, Oil Burner Technician Ccrtificatc I License: BU-024086 MASTER UNR.ESTRI CTL0 z W H LIAM O HEATH Jit 1 l L I AM 0 HEAI``wl' J 265 GRE,ATWE TERPiItDit;I� it t1 is Itl:;'•. ,'�I I iII.Y'II tt11 w HARWICI3MA=02G45{ I i 265 GCE AT` VJE STE:RN::::°R:U W ... ... .. J CH MA 02645-�� ��>;::>:: .,. J � —e-.1�� Expiration: Commissioner 04/z8/1 :::.:.:. ` LL7���772pp;;6�¶26 i 04/04/2015 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Z 1A Parcel 6,31 Application #CsO d d Health Division _ Date Issued Conservation Division Application Fee Planning Dept. Permit Fee l2`�Z telo P Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street Address Zl A?,Lz- ?T- u> Village C i2V ►GL Z-_ Owner I 2c-1 \-A g.\,k L1z Y P FW4�s®tA TYe ress Telephone , I Za(3 S." Permit Request d ousb ?,Y ►4,?L;2i©tl_ N g-w S %Di ac G TtsUUY—I Square feet: 1 st floor: existing roposed 2nd floor: existing A2 proposed GL Zk Total new l 4-(6- Zoning District � Flood Plain Groundwater Overlay Project Valuatio4— l90 a Construction Type RAt- Lot Size ®„ 2 1 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure W24 Historic House: ❑Yes 2 No On Old King's Highway: ❑Yes No Basement Type: "6 Full Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) ® Basement Unfinished Area (sq.ft) Number of Baths: Full: existing Z new Half: existing;-:,; mew,- Number of Bedrooms: existing 4terew f _ Total Room Count (not including baths): existing new First F oor Room Count S� Heat Type and Fuel: Gas ❑ Oil ❑ Electric ❑Other ' %1 '.v Central Air: �Yes ❑ No Fireplaces: Existing 1 New Existing wood/coal stove: Yes g No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ risen size_ r Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes,_site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 2�Ay ko )C.1 ek- Telephone Number !ate — 3 7 Address License # ('S '" `t' S 3 Isl— n3""c� ► '" �2Po 3S— Home Improvement Contractor# Email ��� f�(' 115 C fl CAASa,0A orker's Compensation # 1-4 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE ' FOR OFFICIAL USE ONLY APPLICATION# 'DATE ISSUED a � 1 MAP/PARCEL NO. i t ADDRESS i VILLAGE y r OWNER DATE OF INSPECTION: t FOUNDATION FRAME OK PR-O,,, 1 u-11 s Ii ` INSULATION 6K y't!{lrS - FIREPLACE k t ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL - GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUTS ASSOCIATION PLAN NO. r Me Commons ealth ofMassachmseffs Department offiulrrsa trl Accidents ice ofinvestigatilans 600 Washingtow meet f Boston,.MA 02111 wnnv.mass.gcnldia Workers' CompensatiouLLsua auce kffidavit:$uilders/Contra:ctorsMectricianMumbers - Applicant Information Please Print,Legibly Flame(Busm Organ tionlfndi6dna0_ Address: 24o 4- Ou> City/State/Zip: a C� Shane Are you an employer?Check the appropriate bo>r; T of: �- 4 I_ ants contractor sac I 3,� o Ject(required): 'L❑ I am a employer with ❑ 6- ❑New cons x ioa employees(full andlorpart-time)_* have b redthe 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 me in any capacity- employees and have workers' 9_ ❑Building addition. [No workers' comp_insurance comp_insurance-1 redntred-] ' 5_ ❑ We are a corporation and its 10-❑Electrical repairs or additions 3_❑ I am a homeowner doing all work officers have exercised their I1_.❑Plumbing repairs or additions Myself. [No workers'comp- right of exemption per MGL 12_.0 Roof repairs insurance required]T c_152,§l(4),and we have,ao employees_[No workers' I3_.❑Other comp_insurance required-] -Any appliumt that cbedcs boa r1 mast also fill out the section below c-li ring Their wol s'rnurgensadion policy infrrrmztior2_ i Homeowners who submit tbis aff�indEcating they are doing all beak sari then hire outside contractors mnst subffiit anew affidavit in�rst ne mcl *Contractors that check this box must attached an additional sheet showing the nmme of 8ie so conft3cton and state whether oriiot those a dities have employees. Ifthe mb{orxtmcturshxm employees,they must provide their workers'comp.policy number_ I am an employer that is praiidilig tnorkers'compensation insurance for my,anW&yees Beloty is thepolicy and jab site informatiom Insurance Company Name: Policy,;#or Self-ins-IAc_4-, Expiration Date: Job Site Address: CityStatelzip: Attach.a copy of the Tsorkers'compensation policy declaration page(shvNv#ng the policy number and expiration date). Failure to secure cm-erage as required under Section 25A of MILL c. 152 can lead to the irnpositidm of criminal penalties of a fine up to$1,500.Oa arWor one-year imprisonment,as well as citil 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 i sumce, i ge V cribcation_ T do hereby c;ertf&a th n marries ofp,erjury thatthe informationpraii&if abm� is h�ra and correct re i Signature: Date.: ` J Phone# C3SEciai use only. Do not sprite in this area,to be completed by city or form officiaL City or Town:. PrrmitUcense# Fss Anthorit� {rs cIe sue}::ng I.-Board of Health 2.Building Department 3.CitylFown Clerk 4.Electrical Inspector 5.Plumbing Inspector r 6.G-ther: r , contstct Person: Phone#c 6 Information and. Instructions �. Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant-to this statute,an errcployee 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 corrrmonwealth for ally 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-coatractor(s)name(s), address(es)and phone number(s)along with their ceri_ficatc(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 confznnation of insurance coverage. AIso 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 i1he 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`are number listed below. Seli insured companies should enter their self-insurauce license number on the appropriate.line. City or Town Officials PIease 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 add tion,an applicant that must submit multiple permit/license 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 rile 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 requ cd 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 Comm;onvycalth of Massachusetts Department of Ldustrlal.Accidents €office of kvestigatxons 600 Washington Stz(�et B aston.MA 02111 Tel,4 617 727-4900 W 406 or 1-877-1�LAS E Revised 4-24-07 Fax 61 ` 27-7749 www.mass gov1dza oFIKE * * * BARNSPAIRY, + '� Town of Barnstable Regulatory Services Richard V.Scali,Interim Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, kk)e/)tc.n qe-�I�a l25; C-)rl ,as Owner of the subject property IJ hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) l /] 72: Signature of ner Date L-2-so!�) Print Name If Propy`Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse sl& TAKEWN D\Building Changes\EXPRESS PERMMEXPRESS.doc Revised 061313 Massachusetts -Department of Public Safety Board of Building Regulations and Standards ConstI uction supel�IS10 x License: CS-045395 n DAVED F KERR 364 OLD OYSTER RIA . COTUIT MA 02635 !Z2y ,�i_.>r"`�� Expiration Commissioner 11/17/2016 i Consumer Affairs&Business n License or registration valid for individul use only Office of Cousumer Atfairs&B siuess Regulation g Y uk� HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: :-1.31833 Type: Office of Consumer Affairs and _usiness Regulation ; Expiration: -`9)26L2016 Individual 10 Park Plaza-Suite 5170 Bostonr 2116 ,. 364 OLD OYSTER COTUIT, MA 02635 Undersecretary Not va id without signature ? i I _ _...A'. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map.. Parcel Application # Health Division ' Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Address Village ,f (/L�[1L� Owner Ce)P�'J t hkv h Jam/" U.Sc�� 6TrUS Address c�a usJ Telephone C�.`ue1150rvp c�u - Permit Request Wes.OZVe- ,66, Z Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District R D— I Flood Plain Groundwater Overlay Project Valuation ®�� Construction Type 'y Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 2--' Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑Crawl ❑Walkout 510'ther Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new,,�{_ Half: existing � new Number of Bedrooms: existing,6ew Total Room Count (not including bath.,): existing new First Floor Flo. I Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other == CD 6entral Air: ❑Yes Lr'I o Fireplaces: Existing New 0_ Existing wooW oal stove' -3 ❑Ys�o ZZyj. size_ etached garage: ❑existin ❑ new size_Pool: ❑ existing ❑ ew size _ Barn: ❑ fisting D L� rfev ZZ Attached garage: ❑ existingn>]ew size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ °g' Commercial ❑Yes R No If yes, site plan review # Current Use [C [ Proposed Used APPLICANT INFORMATION -- — __ -- -- - -(BUILDER OR HOMEOWNER) Name �� A , LZi ROCIle, Telephone Number 77 s& Address C aA n G RA , License# � Cq 7 Home Improvement Contractor# G Worker's Compensation #CLy 10C 000 �Lz ALL CONSTRUCTION DEBRIS RESULTING FROM HIS PROJECT WILL BE TAKEN TO SIGNATU DATE r! Zl2/I'—I FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCELNO. a ADDRESS VILLAGE OWNER r DATE OF INSPECTION: ► _.FOUNDATION;- FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ' ASSOCIATION PLAN NO. ` '+' M. The Commonwealth of Massachusetts Departmentof Industrial Accidents Office of Investigations 600 Washington.Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: ]Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): 0c. e_n,_c>f LA 2 VTDhC ,a Address: City/State/Zip: (Ann i J Phone#: — �3/ / 0 Are you an employer?Check the appropriate box: Type of project(required): 1. !� I am a employer with 4. ❑ I am a general contractor and I have hired the sub-contractors 6 ❑New construction employees (full and/or part-time).* 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling shipand have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity, - employees and have workers' pomp. insurance.) 9•. ❑ Building addition [No workers' comp.insurance P• required.] 5. We are a corporation and its. 10.7 Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself, [No workers' comp, right of exemption per MGL 12.❑Roof repairs insurance required.]t : c. 15.2,§1(4),and we have no L employees. [No workers' 13. Oth I dt=M u-�=}0 comp;insurance required.] L - :' *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such,. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not_those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and jab site information, Insurance Company Name; r-\!-e ne2it N :I.L--1 'cy-d Policy#or Self-ins.Lie:#: C F 1,0 C� 0.0 U��1 Expiration Date: 1 } h Job.Site Address: lrC� 4 City/State/Zip: 4Z(0 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 inthe 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 certi u .er lh a*s and penalties of perjury that the information provided above is true and correct. Signature, Date: j o� j Phone#: n 7_7 I1 Official use only. Do not w to in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.]Building Department 3.City/Town Clerk 4.Electrical Inspector.5.Plumbing Inspector 6.Other Contact Person: Phone#: Client#:586925 20CEANSIDIEIN ACORD. .DATE(MMIDDIYYYY} 6'�i�,r6, RD.� CERTIFICATE OF LIABILITY INSURANCE 4E(MM/D414 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE.HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed,If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). . PRODUCER CONTACT _ - NAME: Dowling&O'Neil PHONE 508 775-1620 FAX 5087781218 AIC No Ext: (A/C,No Insurance Agency E-MAIL 973 lyannough Rd., PO Box 1990 ADDRESS: . INSURERS)AFFORDING COVERAGE NAIC# Hyannis,MA 02601 INSURERA:Arbella Insurance Company INSURED _ INSURERB;Everest National Insurance Comp Oceanside,Inc, - - - INSURER C: - - - 217 Thornton Drive Hyannis,MA 02601 INSURERD; - INSURER E: - . - INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSIR DLSUBR POLICY EFF POLICYEXP - LTR TYPE OF INSURANCE 1N R WVD POLICY NUMBER MMIDDNYYY MMIDDIYYYY - - LIMITS - A GENERAL LIABILITY 8500061423 0110112014 0110112015 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY PREMISES EaEeeurrence $100,000 CLAIMS-MADE F x]OCCUR MED EXP(Any one person) $5,400 PERSONAL&ADV INJURY - $1,000,000 - - GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER; PRODUCTS-COMPIOPAGG s2,000,000 - - POLICY jECOT L00 $ AUTOMOBILE LIABILITY - - - - COMBINED SINGLE LIMIT Ea accident - ANY AUTO BODILY INJURY(Per person) $ALL OWNED SCHEDULED - -AUTOS AUTOS BODILY INJURY(per accident) $ _ NON-OWNED - PROPERTY DAMAGE $ HIRED AUTOS AUTOS - (Per accidenl $ UMBRELLA LIAB OCCUR - EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE - AGGREGATE -$ DED RETENTION$ - - $ - B WORKERS COMPENSATION CF4WC04045141 1/01/2014 0110111201 X I we STATUE OTTH- AND EMPLOYERS'LIABILITYER ANY PROPRIETORWARTNER/EXECUTIVE YIN - E.L.EACH ACCIDENT $1 O0O 000 OFFICERIMEMBEREXCLUDED? NJ N/A (Mandatory in NH) - - - _ E.L.DISEASE-EA EMPLOYEE $1 00O 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.LDISEASE-POGCYLIMIT $1,000,000 - DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD iOl,Addltlonat Remarks Schedule,If more spaceIs required) Insurance coverage is limited to the terms,'conditions,exclusions,other limitations and endorsements. _. Nothing contained in the certificate of insurance shall be deemed to have altered,waived, or extended the_, coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,` NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-20i0 ACORD CORPORATION.All rights reserved,. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S1349821M134981 LS1 Office of Consumer Affairs f Business Regulation 10 Park.Plaza Suite 5170 Boston, Massachusetts 02116 Home ImprovemeAt-Contractor Registration Registration: 100121 Type: Supplement Card OCEANSIDE, INC. Expiration: 8/912016 PETER LAROCHE - 217 Thornton Dr - - Hyannis, MA 02601 _. Update Address and return card.Mark reason for change. sCA I Co 20M-05n1 Address Renewal Employment 0 Lost Card die�anarrrurrtaerr�ll.ry/'C��iirractic��e� Bice of Consumer Affairs&Business Regulation License or registration valid for individul use only n ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation egistration;+; Q0121':.: :. Type: 10 Park Plaza-Suite 5170 s Expiratio Supplement Card Boston,MA 02116 OCEANSIDE, INC. PETER LAROCHE 217 Thornton Dr Hyannis,NIA 02601 Undersecretary Not valid without signature ti L Massachusetts -Department of Public,Safety Board of Building Regulations and Standards k-onstructior.supe'visGi- License: CS-073097, PETER A LAROgft 18 Cedric-Road 71 'D CN, , `� Centerville MA 02632 3 10- Expiration " Commissioner 11/03/2016 Unrestricted-Buildings of- any use group which contain less t1an.35,000 cubic feet(991M3),Of enclosed space. Failure to possess a current edition.of the Massachusetts State Building Code is cause for revocation of this license. For DPS Licensing information visit: www.Mass.Gov/DPS A, Ce11SIdE'. i . .'IN HOUSE USB ONLY,' I I JOB NUMBER SMCC I I 1971...THERIGHT I CHOICE - , I 217 Thornton Drive,Hyannis,Mass.02601 77 I 5084714110 . 800-464-3318(MA,only),508-775-1848 Fax ------------ MASS.HOME McR0VEMENT CONTRACTOR REa.0100121 MASS.CONSTRUCTION SUPERVISOR RM.#000043 ASSIGNMENT OF AUTHORIZATION TO PAY . The undersigned, herein called claimant, has authorized and ordered from Oceanside,. Inc. , the materials and/or services requested. Undersigned hereby assigns to Oceanside, Inc. any unpaid proceeds. du or. to become due, under the claimant's policy with the insurance . e company to pay direct to Oceanside, Inc. or to include its. name- 'on a check or. draft, .'for all requested work. - In the event that Oceanside I s 'claim herein is not covered by, or paid.: by, an,insurance company, claimant agrees to pay Oceanside, Inc. within sixty .{60) days after work has been completed. Claimant understands that Oceanside, Inc. .is working for them and. not the insurance company or the adjuster. Payments remaining due and payable after the claimant has received payment from the insurance company shall bear interest at one and one-half (1-i/2*) percent per month. ; In the event that there is a breach by the claimant of any of the conditions .of this agreement, Oceanside, Inc. shall-be entitled to recover, as additional damages, attorneys, fees, costs and any other collection expenses reasonable and attributable to said breach. if payment 'is not received within. 60 days, collection action will commence wit out further notice .ta the claimant_ . DATE: -all CLA T S S GNATURE- PRINT NAME HOME ADDRESS . (BILLING) � `—" CITY STATE LOSS ADDRESS '�'�-' •�- I Print Page Page 1 of 4 Print this page • Owner Information -Map/Block/Lot: 211 /036/- Use Code: 1010 Owner Map/Block/Lot GIS MAPS FERGUSON,WENLEY S & 211 /036/ Owner Name as HUGH S TRS Property Address of 1/1/13 C/O WENLEY S FERGUSON 212 ANNABLE POINT ROAD CRANSTON, RI. 02905 Co-Owner Name 212 ANNABLE POINT ROAD Village: Centerville NOMINEE TR Town Sewer At Address: No GIS Zoning Value: RD-1 • Assessed Values 2014 - Map/Block/Lot: 211 /036/- Use Code: 1010 2014 Appraised Value 2014 Assessed Value Past Comparisons Building $ 145,800 $ 145,800 Year Total Assessed Value: Value Extra $ 18,300 $ 18,300 2013 - $ 607,000- Features: 2012 - $ 673,900 Outbuildings: $ 4,200 $ 4,200 2011 - $ 687,100 Land Value: $ 438,600 $ 438,600 2010 - $ 687,100 2009 - $ 695,300 2008 - $ 679,500 2014 Totals $ 606,900 $ 606,900 2007 - $ 679,000 • Tax Information 2014-Map/Block/Lot: 211 /036/- Use Code: 1010 Taxes C.O.M.M. FD Tax $ 916.42 (Residential) Community Preservation $ 166.05 Act Tax Town Tax(Residential) 5,534.93 Fiscal Year 2014 TAX RATES HERE 6,617.40 http://www.town.bamstable.ma.us/assessing/print 14.asp?ap=0&searchparcel=21103 6 12/2/2014 Print Page f Page 2 of 4 • Sales History - Map/Block/Lot: 211 /036/- Use Code: 1010 History: Owner: Sale Date Book/Page: Sale Price: FERGUSON, WENLEY S &HUGH S TRS 2013-08-30 27656/83 $0 FERGUSON, HUGH C TR 2012-10-01 26722/315 $0 FERGUSON, HUGH C TR 2006-12-20 21631/171 $1 FERGUSON, HUGH C 1978-09-21 2787/204 $13050 • Photos 211 /036/- Use Code: 1010 • Sketches - Map/Block/Lot: 211 /036/- Use Code: 1010 FV M s t a Y i As Built Cards:Click card#to view: Card #1 • Constructions Details -Map/Block/Lot: 211 /036/-Use Code: 1010 Building Details Land Building value $ 145,800 Bedrooms 4 Bedrooms USE CODE 1010 Replacement Cost $171,567 Bathrooms 1 Full Lot Size 0.21 (Acres) http://www.town.barnstable.ma.us/assessing/print l4.asp?ap=0&searchparcel=211036 12/2/2014 Print Page Page 3 of 4 Model Residential Total Rooms 6 Rooms Appraised $ Value 438,600 Style Conventional Heat Fuel Typical Assessed Value 438,600 Grade Average Heat Type None Year Built 1915 AC Type None Effective 15 Interior Typical depreciation Floors yp Stories 1 Story Interior Typical Walls Living Area sq/ft 1,846 Exterior Wood Shingle Walls Gross Area sq/ft 2,785 Roof Gable/Hip Structure Roof Cover Asph/F GIs/Cmp • Outbuildings & Extra Features - Map/Block/Lot: 211 /036/- Use Code: 1010 Code Description Units/SQ ft Appraised Value Assessed Value FPL1 Fireplace 1 story 1 $ 3,500 $ 3,500 WDCK Wood Decking 315 $ 4,200 $ 4,200 w/railings BMT Basement- 624 $ 14,800 $ 14,800 Unfinished • Sketch Legend Property Sketch Legend B2N Barn-any 2nd story area FPC Open Porch Concrete Floor REF Reference Only BAS First Floor, Living Area FTS Third Story Living Area SOL Solarium (Finished) BMT Basement Area FUS Second Story Living Area SPE Pool Enclosure (Unfinished) (Finished) BRIM Barn GAR Garage TQS Three Quarters Story (Finished) CAN Canopy GAZ Gazebo UAT Attic Area(Unfinished) CLP Loading Platform GRN Greenhouse UHS Half Story(Unfinished) FAT Attic Area(Finished) GXT Garage Extension Front UST Utility Area(Unfinished) FCP Carport KEN Kennel UTQ Three Quarters Story (Unfinished) FEP Enclosed Porch MZ1 Mezzanine, Unfinished UUA Unfinished Utility Attic FHS Half Story(Finished) PRG Pergola UUS Full Upper 2nd Story (Unfinished) FOP Open or Screened in PRT Portico WDK Wood Deck Porch PTO Patio i http://www.town.barnstable.ma.us/assessing/print l4.asp?ap=0&searchparcel=211036 12/2/2014 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION Two Center Plaza Boston,Massachusetts 02108.1904 (617)723-3800 Ma Only(800)392.6108,FAX(800)851-8424 1 1/412 0 1 4 Form of Notice of Casualty Loss to Building Under Mass. Gen. Laws,Ch.139,Sec.313 BARNSTABLE BUILDING COMMISSIONER 367 MAIN STREET 367 MAIN STREET HYANNIS MA 02601 ` Re: Insured: HUGH FERGUSON&WENLEY FERGUSON Property Address: 212 ANNABLE POINT ROAD,CENTERVILLE• MA 02632 Policy Number: 1266694 Type Loss: Fire(including Fire caused by Lightning Date of Loss: 11/02/2014 Claim Number: 327215 Claim has been made involving loss,damage or destruction of the above captioned,property,which may either exceed$1000.00 or cause Massachusetts General Laws,Chapter 143,section 6 to be applicable. If any notice under Massachusetts General Laws,Chapter 139,Section 3B is appropriate,please direct it to the attention of the writer and include a reference to the captioned insured,location, policy number,date of loss and claim or file number. MPIUA Claims Division �.a I GMA00021 j Centerville house fire under investigation CapeCodOnline.com Page 1 of 1 t s4 =., tl r4 < aw p Centerville house fire under investigation November 03,2014 2:00 AM CENTERVILLE—A fire at an unoccupied summer residence is under investigation, Centerville-Osterville- Marstons Mills Fire Chief Michael Winn said in a statement. At about 4 p.m. Sunday, rescuers were alerted to smoke coming from M Annable Point Road by a neighbor, Winn said. Upon arrival,firefighters found heavy smoke coming from the home, he said.After forcing entry into the house, firefighters were able to knock down flames in the living room in about 10 minutes.The home sustained moderate heat and smoke damage, he noted. There were no injuries, he said. Hyannis firefighters assisted on scene. ETHAN GENTER A Copyright©Cape Cod Media Group,a division of Ottaway Newspapers,Inc.All Rights Reserved. http://www.capecodtimes.com/apps/pbcs.dll/article?AID=/20141103/NEWS/4110203 l l/-... 11/3/2014 -7 J1 + cv 3X/r5W 1 e j. Engineering Dept. (3rd floor) Map" G Parcel-- Permit It House# J Date Issued b 3 Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) F ��°^.. /� a�^d Conservation Office(4th floor)(8:30-9:30/1:00=2:00) prove y ammn ' = ;19 NSTABLE. (�Aw � FMASS;"1 a TOWN OF B RNSTABLE ` � V y. on � 1 mild g rt pplicaho + Proi eet Address Village _ r �9 Owner (> )ce✓�"G`✓�� �V� Address 5 "& _ M l�' � &Z6 Telephone ► G'S Q 2, L Permit Request 2— First Floor square feet Second Floor � � square feet Construction Type -- Estimated Project Cost $ IV Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ;MNo On Old King's Highway ❑Yes IV0 Basement Type: ❑Full �Cra ❑Walkout ❑Other / Basement Finished Area(sq.ft.). Basement Unfinished Area(sq.ft) 1-1, Number of Baths: Full: Existing / New_� Half. Existing New No. of Bedrooms: Existing New Chi9 4c Total Room Count(not including baths): Existing . New First Floor Room Count Heat Type and Fuel: Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fire laces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) /V 6 Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes No If yes, site plan review# Current UselsL� ✓��L Proposed Use ` 9e_�_c� uilder Information Name �J� ! / Telephone Number .2,16 Z—3 � Address �j p �' License# ©!'A " / 3 6) Home Improvement Contractor# Worker's Compensation#11__� 5--"JOLOA. , NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESUL G FRZW THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 1,9 BUIL PER. DENI OR THE FOLLOWING REASON(S) 4 ei 9 FOR OFFICIAL USE ONLY 0 PERMIT NO. ' DATE ISSUED 3 MAP/PARCEL NO. ADDRESS I t VILLAGE 1 . OWNER DATE OF INSPECTION: — FOUNDATION FRAME INSULATION f-,�? 7 FIREPLACE ? ELECTRICAL: ROUGH FINAL PLUMBING: r^ ROUGH FINAL GAS: ROUGH FINAL , FINAL�BUILDING s q DATE CLOSED OUT ASSOCIATION PLAN NO. 6 MASTER 15'-1" p BEDROOM I f2XIO 26, C CLST2 0'-10" OBATH Q OFFICE - • I— 10'-9"— 14'-4'"— a r 24'-7". SECOND FLOOR 4T0' i0'-9"—II- BEDROOM BEDROOM ` 11'� KITCHEN . UP O 26 NTRY _9 �0 LiV1NG N �0 ! BEDROOM"I BATH .,. FRONT 8'-5" REAR FIRST FLOOR i FILUII LL111 HE M F-I IT IT LLHI M9 H Lc: . MASTER15'-1" BEDROOM 2x10 26). CLST CLST 2x6 OFFICE 0'-10 ' BATH O 2 x 10 0 0(] 10'-T -- 14'-4" - 24,-7„ SECOND FLOOR . .�'a.+.�r'y-.. a #' 'Sw'a^� � �� t ��*4. i'�� �+ c ,��S4�j, a L•�^�'c'K'�`•kr-r„c-'•L�°•w:. : t +� a ',-ea:x° •� s #a e+ '°' # L �'^tx'i,t�' ...,zi• q�'' •`s y,�: sy�Z`,n�rS.P+w+y, 1 - ., AN „.' :HOME '3MPROVEMENTONTRACT:ORS2EGISTRATION , � _ , �, .. Board "of Buy ldins�ReguT'ations and Standards , j 0'ne A`sbbu rton:,P1 ae 3oom LL`1301 , rt � Q ; Boston q#lassachusstts 021..08 �, k R "i`'t k $.fi# !���N,-w���� i� �%"`k p�p ��`�9 r.'6'N ��..tt��r4f5a'��'!Y'���':� iJ{{'eyy�yy,ygqaa��'�"+ $p�p �M�l�`Cc�d g„��°'�•, hv1� k 5 ,1 3 -,4 +! u'� 1 SI �:h ..$W f" �F +'1'S�.' F M'���Y'*��'�'FS h'S'4;n.^• .�h -4k� T �'1N^dL+S�.e4��}+" r �iOME IMPRONEAlENF aTRADTOR #'�'`�fi�;� ��,�Y' •�,°�� ����h � , _ - Registration100390 M �Exapiration 06/'16/98 to .a 4cF tt).Src3# 'x '-y7lt.t4 ice# r FS:Type� INDIVIDUAL h - -.k s t tv a,r 4.A }L S' g +� '�9 ytsr, Y r r, S+ ,,'aa• s m r R��`4Ir55* r ra•�t # 'c' •v` ,':T s .. - xT -,.... `-,' _ Q • . 7 s a".+• -..y>�3•t� } 3�4 a^}'sr� z'r �J 6 c s "i�'�'� F" `�s 'S u.` •�¢'� v.. 'f 2 } ;-d4�Yu S.STURG IS ST �TE,R4' r Y"N,`=� 3 1 r 65 .Cindy J,La.ne/ P.Q 'k-Box Barnstable MA '026303 °r .�" � M bf V-ijyy .'` ! .,S' c a "ay.K"` M i' ° 0 2,J 7 DEPARTMENT OF PUBLIC SAFETY-.----- 0. ONE ASHBURTON PLACE, RM 1301 BOSTON, `MA-02108-1618. CONSTRUCTION SUPERVISOR LICENSE Number: Expires: - Restricted To: 00 STURGIS STPETER Detach bottom, fold sign on BOX 372 = 4 = back, and laminate license card. BARNSTABLE, MA 02630 _."i E Keep top for receipt and change of address notification. lic- ;,=;i '' • - =f.�� Drpartnrclrt.of Industrial Accidents t� t pfcea/loyeSM21laas 61111 «aylii igwn Street `- �-;�►� Binum.-Mms. 02111 - ' Workers' Compensation Insurance'Affidavit .� nhnn•# sit` I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity, 1 am an employer providing workers' comp -tion for my employees working on this job. cmm�•Im•n•tmc• rLJA&ZC?*61 nhone 0: .31 inctlranc ca. (icv ll...*-•--^�...�"""�- _.. _._.._.... 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: m ann•na c• a idre inn phone#? inwrince CO. policy f! - .. - �• -•.. _. „rn•� •n�ss---fir -�+r�•«f-•. �. -ai�+•+na���'s�' cnm anv name: addre c• rip Rhone fl- i curance Co. _ .Attach additional sheet if nicessss - •"� '"�`� ""'""" i( i:ilC-O^:,...y,,,,f�rr�.:f!)ff _ _...r :•Y.i.�.� ..•..II..`�.rr,• il..�a�M IV Failure to secure coverage as required u r ce 25A of MCL 152 can lead to the imposition of criminal penalties of a fine up to S1SOU.UU and unc.cars'imprisonment a.c• s ci penalties in t e form of a STOr��'ORti ORDER and a fine of S100.00 a day against mc. 1 understand that c copy of this statement may onv tied to the Orr c Or investigations of the D1A for coverage verification. 1 do herebt•eery •p au /t 0 'urn•that the information provided above is true and correct. Si_natu Date `s Phone ame V Print n f rC0iftr:-ci2r` Ilse only do not write in this area to be completed by city or town official permit/licease# rlBuilding Department tn��n: Licensing Board c1scleetmen's Of6cc check.if immediate response is required C311ealth Department phones• n Other contact person: ' irevntd;:Q1 NAI Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for employees. As quoted from the "law-. an ennphot ce is defined as every person in the service of another under an% contract of hire, express or implied, oral or written. An cnyp/i►rer is dcf mcd as an individual. partnership, association. corporation or other legal entity, or an two or r the fore�_oims enunged in a joint enterprise.and including the le-al representatives of a deceased employer, or tiie receiver or trustee of an individual , partnership, association or other legal entity, employing employees. Howe►'e. owner of a d►►•ellina, house having not more than three apartments and who resides therein. or the occupant of the d►vcllin- house of another►►-Ito employs persons to do maintenance, construction or repair work on such dwelling or on the _rounds or building appurtenant thereto shall not because of such employment be deemed to be an empic MGL cha.pier 152 section '_5 also states that e,%-en-state or local licensing agency shall withhold the issuance of rencival of a license or permit to operate a business or to construct buildings in the common►►•ealth for anv applicant►►ho 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 chapt, been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to;your situation ar supplying company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that,thp application for the permit or license is being requested. not tite Department of Industrial Accidents. Should you have any questions regarding the "law"or if you are requ: 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 tite bottorr the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. P be sure to fill in tite permit/license number which will be used as a reference number. The affidavits may be returne 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 quest: 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. 02i i1 OF TME r, The Town of Barnstable Department of Health Safety and Environmental Services �019-r9' Building Division 367 Main Street,Hyannis MA 02601 r Ralph Crossen Office: 508-790-6227 Building Commissioner Fax: 508-790-6230 For office use only Permit no. Date AFFIDAVIT HOME MROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, an conversion, improvement, removal, demolition,least one but construction ottmoref than four dwelling unitsion to any ng to owner occupied building containing structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. r/ /( e m djP Est.Cost Type of Work: f _ ' Address of Work: Owner's Name v � C- sew Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under SI,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: UNREGISTERED OWNERS PULLING R ASP IRI OABLNE HOME MWROVEMENTERMIT OR G WORK DO NOT HAVE CONTRACTORS FO FUND UNDER MGL c. 142A ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. s ` O� z d /n� l Registration No. .Date �` , Co tractor Name OR RESIDENTIAL PROPERTY MAP NO. LOT NO. FIRE DISTRICT SUMMARY STREET 36 Off Annable Point Road, on Wequaquet Lake, Centerville 73 LAND _ 211 OWNER C-0 0) BLDGS. /'Q ;7 0 0 TOTAL RECORD OF TRANSFER DATE BK PG I.R.S. REMARKS: Lot 2 LAND . U O Lot C `J BLDGS /2 7 /-25/44-62 32- A ort. '78 FY B TOTAL z7 ?00 Lot 2 from _ -BC- �. LAND / yoo Ferguson,. Hugh C. 12-27-76 244 282 (gift) #211-8 10-11-78 ,21a �, BLDGS. /A 9-21-78 2787 204 (13,0 0. .06a TOTAL 3 / / 0 O ��©sro..� �7i� oa �.i /tea. •�7.28 L oT Z 'bEniou ivig-v q-7 LAND O) BLDGS. cg 'L TOTAL LAND BLDGS. TOTAL LAND BLDGS. / TOTAL LAND BLDGS. TOTAL LAND INTERIOR INSPECTED: BLDGS. AL DATE: TOT LAND ACREAGE COMPUTATIONS BLDGS. LAND TYPE # OF ACRES PRICE TOTAL DEPR. VALUE TOTAL HOUSE LOT 4000 O LAND CLEARED FRONT '16% / d 0 — /�y0 O '�hi2i cr )J - /o 4,o L BLDGS. REAR �o F /7� TOTAL WOODS&SPROUT FRONT _ Z �� 5 n" ND REAR s. -'/t - - rt 0) DGS. WASTE FRONT TOTAL REAR LAND 0) BLDGS. TOTAL LAND BLDGS. LOT COMPUTATIONS LAND FACTORS TOTAL FRONT DEPTH STREET PRICE DEPTH % FRONT FT.PRICE TOTAL DEPR. COR. INF. VALUE HILLY TOWN SEWER LAND ROUGH TOWN WATER BLDGS. HIGH GRAVEL RD. TOTAL LOW DIRT RD. LAND SWAMPY NO RD. BLDGS. TOTAL t;onc. 61K. Pans nsmc. K.C. rtoum oat.. ttsmt. .. . ��''`' PURCH. DATE Conc. Slab Bsmt.Garage St. Shower Ext. Walls -- PURCH. PRICE . Brick Walls Attic FI. &Stairs Toilet Room Roof RENT Stone Walls Fin.Attic Two Fixt. Bath Floors Piers INTERIOR FINISH Lavatory Extra — Bsmt. F 1 2 3 Sink _— a/ `/z '/� Plaster Water Cie. Extra Attic l EXTERIOR WALLS Knotty Pine Water Only Double Siding Plywood No Plumbing Bsmt. Fin. Single Siding Plasterboard Int. Fin. /•/ Shingles TILING Conc. Blk. G F P Bath FI. Heat - y0 Face Brk.On Int. Layout Bath FI.&Wains. Auto Ht. Unit Veneer Int.Cond. - Bath FI. &Walls r- Fireplace 7-- 5 U Com. Brk.On HEATING Toilet Rm. FI. Plumbing Solid Com. Brk. Hot Air Toilet Rm.Fl. &Wains. --- -- Tiling Steam Toilet Rm. FI.&Walls /o Blanket Ins. �;;; Hot Water St. Shower Roof Ins. Air Cond. Tub Area Total �. Floor Furn. ROOFING COMPUTATIONS Asph_Shingle Pipeless Furn. / S. F. / -5 6 t_ Wood Shingle No Heat S. F. Asbs. Shingle Oil Burner S. F. Slate Coal Stoker S. F. Tile Gas S. F. OUTBUILDINGS ROOF TYPE Electric Gable flat S. F. 1 2 3 4 5 6 7 8 9 10 1 1 2 1 3 1 4 1 5 6 7 8 9 10 MEASURED Hip Mansard FIREPLACES S. F. Pier Found. Floor Gambrel Fireplace Stack Wall Found. 0. H. Door LISTED FLOOR Fireplace Sgle.Sdg. Roll Roofing Conc. LIGHTING =/ _ Dble.Sdg. Shingle Roof Earth No Elect. DATE Shingle Walls Plumbing Pine Hardwood ROOMS Cement Bik. Electric Asph.Tile Bsmt. 1st TOTAL / /o J Brick Int. Finish PRICED j /ram Single 2nd 3rd FACTOR r. REPLACEMENT '1 OCCUPANCY CONSTRUCTION SIZE AREA CLASS AGE REMOD. COND. REPL. VAL. Phy.Dep. PHYS. VALUE Funct.Dep. ACTUAL VAL. DWLG. l ?/h 133 12 7 1 2 3 4 5 6 7 ` 8 9 10 TOTAL i J ,ROPERTY ADDRESS I I ZON114G I DISTRICT CODE SP-DISTS.I DATE PRINTED I STATE I PCS I NBHD KEY NO. CLASS 0000 OLD WAY 10 RC-1 300 loco 07/09/95 1011 0J 42WC R211 036- 131486 LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS ,, UNIT ADJ'D.UNIT Lana By/Da'e s�:e Dimenswn BLOC./VR.SPEC.CLASS ADJ. COND. P PRICE PRICE ACRES/UNITS VALUE Desaiplion F ER 6 U SO N i H UG H C M A P— CD. FF-De E 4 L A N D 1 76.,1 00 CAREJS IN ACCOUNT — 15 1WAT£RFNT 1 X .21 =1 OC 290 124999.9E 362499_9 -21 75 10 1 43LDG(S)-CARD-1 1 63,300 01 OF 01 Ai IP L 31 OFF ANNABLE PT RD ON a m v BATHS 1 _0 U x C= 100 35CO.0 3500.00 1 .0G 3500 3 .IDL LOT C&2 MARKET 96000 D — NO BSPIT S x C= 100 6.7C 6.70 1066 T1U:i -:t Zit 1179 i1JaS INCOMc A FIREPLACE U X C= 100 3100.0 3100.00 1.00 3100 i; USE PPRAISED VALUE D 1 139,400 A U ARCEL SUMMARY T AND 761 0C TLDGS 6330C j -IMPS E TOTAL 13940C E CNST N DEED REFERENCE Tye DATE R_'j-A R I O R' YEAR VALUE T Book Page Inst. MO. YI.D Sales P"c. LAND 7 6 1 0 C F S 2787/204, 00/00 &LDGS 6330C JTOTAL 139400 1 BUILDING PERMIT nt Amou LAND LAND—.ADJ INCOME SE SP—BLDS FEATURES BLD—ADJS UAITS Nembar Dale Type 76100 500- Class COnsl. Total Base Rale Atl Rate B 11 A Np Obsv. I Units L'ni's 1 A e I / 9e Dap,. C., CND Loc %R.G Repl Cost New Atll Repl V.1.e $brie_ Meignl Rooms FBO Rms Bama I Fis. Partyw.11 Fac 0 1 C 030 105 105 59_40 62.37 15 75 19 80 120 100 96 65985 65.500 1.1 6 4 1.0 4.0 Desc npnon Rale Square Feet Rep'.Cost 00 MKT.INDEX: 1 a IMP.BY/DATE: / SCALE: 1/0 C 61 ELEMENTS CODE CONSTRJCTION DETAIL 8AS 100 62.37 10615 66486 E W ,Y. — *------25------* STYL= 09 OTTAGE 0-c 1 ! ! 3 ESZ i119 A—JMT- _JT 1C5IGN--X03U-S-T----7-0 E XTc(?.—WA1LS-- -UT;r']QD-FR7IhE------- -.o TEAT/AC-TYPE JTVWTE-------------- tU-C I NT-i?F_IWISH- -JO--------------------LT=0 ! ' itiT"c:d:LAYOiIT- -JT ------------------- 1 ! ! rvT :4—,4V L"TY- -J2 's1WE-AT-EXTE7i=-- =0 40 BASE 40 LJJR 55,TTiUCT- -i70 --------------" D W ! ! = 'LOJZ C0_vFR -JU --------------- --0:0 E Total Areas Avr Base 1066 I ZGUfi-TY TE---- -.JU ------------------�.-0 � . . BUILDING DIMENSIONS —CEL TRItAL--- -J0 ------------------7-0 T BAS N06 W04 N40 E25 S40 W10 S06 F OLr.DAT11r,"i- - -IJ0 ----------------- A W11 BAS .. i -9 -------------- - --- ----------------------- I L ! ' -----'d3rHD--47ZWC -CE; TE'RVIL—E---CQN-W_E_�!TU *4—* *--10—* LAND TOTAL MARKET 6 6 PARCEL 76100 139400 x--11-* AREA 15603 VARIANCE +0 +793 STANDARD 20 c - g.1-'A V-R, �r f>£)C �St't�►l� 0 )'SL AKA. _ 0 - 5'S''AltT' 'l . __ _ Rdv_4tSG . I _ — 9� 3 a c a "30 C,L, S�oK -rw 2 t o4Z 9 c, i2 . -t'v�t 2cas2- p[�t'''SG52- T`w 2a►5� IW Se't�K R W Ua-L, ° ,t A W 31 3_0p z -4 Q � � 4 ,n Frcomr 1 R ST FLoolt . � I z- p�t�OA�3LE Pow—( R b 4 a, Cos j 90 r4 y aR 1 m wAi° x`!r~#y�"r= rx. t 4 � '�-��L- C���N •IZ�•f'1+�t 1 S� • { ..,..x..:u.:. .,,..a.to.aS..��CL}...,u�r,�.b.�.Yia.�.�..,..,.�a,s.,:..,...5..�,.:o...w.,.,e 1.:.w:.`�rx.+m+dl".',S`1...a�..' ,.. �.:,:.5,,.„u:u•n.re. .3e�,u.,� `:m"red' -�.4+G.,:r�u�.�.�.`t..$'1,w.;k.e.:�s,2�..:,e;w::.«F.S6e.:�s.S�`. ril f 4t Ar. u( vAcT 5 IAIM Loa IBIS / a5 i by.�. ,"1s a3� J jw ��. Al �4 �u.CJs sY � , LoGUS �'lAh _ _ a Cc 0 5� ' �� g - 3 33.8 So AA0 _ , 3s. A s S CSSoaJ MAP Z // 3 'one Al O i� 65g �� p rt . PARwEL /D ' OfppM- QNc / 7VvV *t.g p� 43 Pa DEL ,LAWN �, y /' a ilA+�vw I?.4Zt \ rprt f v .1r•r� Opp C.B. � Dui�rll./n1b FO D l�l~r or - 43.8 V � �.�w a� __EL-V7.19 tv wq y �3 F\. L COY g, ST1 Aj lA2 Zo 2S- /Yo PfeWm D 9-4 0 �' Y A NAtA Pvtj5 M. 0. Z14 c7 ©`�- �- �,P� -I.sp F4, 4/14 Por". LAXE7 CA C�SAT 0;�1J D -6.S' E1En/, 7, or (2- 2">I7'f Rev s7oAig S4.,� r LAt-� h/A1Y�t. �Y4y • il3.I / --- --- n'i TYAcAL 3r 7 7 TE PLA NI 3,3 ' 0 0 ' I x5 P�7 6v� SE ECK.1hl(7 ToP E�, 3¢,!o i /�^� (' (� /� I ` C�, /'� 1 iT. 2'x4' RT 2"x4 — I �" �.J r��V I T`1 C. 1--K G- U ..J C) Q �413ut.T --- + ' Ro�T Q.T. 2" �" SCAU-= As Qo-rCC E 3G ' 2 3 9 9� �. Lh1KE W!4Ti�t.. EC.�J, 33. I 1 REG-1'=.�TECZU 1140D 6QQN `1f ot2'S o� wi�tii,�M '\�* ---- C. NYE " p No. 19934 a C..\V 1 L C s._)Er I K) E E Q-t--) yNo 7 P'-A kl 2E r Lo`r 3' PL,PStC Z 3 PG, 3 7 Tt a �6� 5.Lq\IA-n o k3S BASED (!IQ J �1 U `0 v� C3cTl0tA Z9. 8 ' o ►J ,�- /� "SALE