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0022 ANSEL HOWLAND ROAD
I Ann 0 000ji, IRE "My—PA 1 1 TWO tit, UNNIV Uhl IS -Pelj HN g. Q SO Man J4 I Mi Wit 17 1"OF Not 0 MR" I I ,I tit ,1A7% out I i, U I g ply �q till Ij 1110" Ott INN 5 J J0, 0-140"WAIj fit fit�i�,W yj MIA til.11 J'i Elmo T JEW"' I NO vm`� mg', U'T AM- ij, WOW Los jf'rl , AD- TWO Il'i J l, WAS Q' Von lof ITWO,I iTMITTIR&K R "now: 6`101"1 t �1� T� � lid �W 'i QW WIN- YPI .1 tl '!vi'f q K j N110 v A-C K A ON ny, It- TO"I j HVII I ---nns-41 '' ) 0 NXI p Y'11 tqg��, " I I rM I it,INSWIMPIA 41 1 ri, W WIN, "WIN opus IN' B most it di�A`�i vji!,-�;4 loom 10 SANN ug 1 NPRINI gal 011 lot Ogg Qq ixo" Act PRE Wl" , ,,, . i It", ,I, law II� IWO, TI ,j)jIj'j it J-1ii;1 "AC P', - i`i"�f,, I 1 0 CAN! M51 'Pit 10A ALI fat 10 -Ell VPNI N, 06 PIT 'I - "Y MAC, 1 , hr4 Ofi,"'i Tij. OMNI` j:i� owl Bid tp, �A-qx� --p fill 'Y I-0 j'i-, vat i�`Ni Im wom qW I "MR a fay flV U gjl M' it INV to 0 of "°'`�o Town of Barnstable BuIlIl�IIl ,z •„.. Building " M pp h <,. "' t.be'Retalned on Job and this Cart) Must'be Kept Post This Card So That it.is Visible<From the Street=A roved Plans Mus Posted Until Final Inspection Has'Been made'.-: h�Fa Nay Where.a Certificate of Occupancy is Required,such Building shall Not-,be Occup ied until a Final Inspection has been made.. Permit Permit No. B-20-2143 Applicant Name: Steve J Spengler Approvals Date Issued: 08/11/2020 Current Use: Structure Permit Type: Building-Solar Panel-Residential Expiration Date: 02/11/2021 Foundation: Location: 22 ANSEL HOWLAND ROAD,CENTERVILLE Map/Lot: 172-226 Zoning District: RC Sheathing: Owner on Record: DEVER,EUGENE A JR&SUZANNE A Contractor Name""-STEPHEN J SPENGLER Framing: 1 Address: 22 ANSEL HOWLAND RD Contractor License: CS�-071546 2 CENTERVILLE, MA 02632 � Est. Project Cost: $31,460.00 Project Chimney: Description: Installation.of roof mounted photovoltaic solar systems,44 panels Permit Fee: $ 210.45 14.3kW Insulation: r Fee laid,+r $ 210.45 Project Review Req: Date: ,f 8/11/2020 Final Plumbing/Gas Rough Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized bythis—permit is commenced-within six months after i�� an tf Icia Final Plumbing: All work authorized by this permit shall conform to the approved application and the'approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Rough Gas: 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. Final Gas: The Certificate of Occupancy will not be issued until all applicable signatures by the Build ing_and Fire-Officials-are provided on this permit. Electrical Minimum of Five Call Inspections Required for All Construction Work: r' 1.Foundation or Footing Service: 2.Sheathing Inspection . Rough: 3.All Fireplaces must be inspected at the throat level before firest flue;,lining is installed . w _ g 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Final: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Rough: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Low Voltage Final: Work shall not proceed until the Inspector has approved the various stages of construction. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: I �Mq�L SCAT I - tt r Ap01i .......cation numbe . ....Z guILDTNG KEPT Date_•Issued ..L ..V J . �:a�Q.�'� s6rg.' i ng I speivv . Bu'Idi n ctors Initials.,... el ..... ap/Parc _- . o �p TOWN OF BARNSTABLE :-' x. % ..: t TOWN OF BARNSTABLE -02EDITED>PERNIIT APPLICATION.:': ROOF/SIDING/ INDOWS/DOORS/TENTS/STO.VESIWEATIIEWATION PROPERTY INFORIVI�TION ' Address of Pro ect:_ T . NUMBER STREET VII.IAGE Owner's Name�7,�7 4•- N G 1/l C.=� y Phone umber' v` 710 �. y Email Address: "CL,S&.q (a (2,tAn 6.cyn Cell:PhoneNumber Project costs J Check one, Residential Commercial v. As owner ofthe above . I hereby authorize. �f'' property Y � � ..oav. y to make application for a building permit m accordance with 78 1VIR 1 Owner Signature: to� Date: S b TYPE OF WORK Siding Windows(no header change)°# 5 x6p. Insulation/Weatherizahon E Doors(no header change)# Commercial Doors requare an anspector's review} y Roof(not applying more than is layer of shingles) Construction Debris will be.going: s ,r CONTRACTOR'S INFORMATION Contractor's name AA /1 • 1° ' Home-Improvement Contractors Registration(if applicable)# f �O �,3 (attach copy) 4 :.�?.-: .� 1.4 3r. !�a ^:^.:c ya � ^ .'GrW ��r:_j 7' Tr b`„4. k"��i�.i`.... *•} �..:.a' �`� Construction S,upervisor's License# AZA, f (attach coPY) Email of Contractor U.��"P1"�'l CL�7�1?G LyPQ�Z�71`rl�:Phone number ii'U�`��'�/01�� AtL'PR0PERTIES THAT:HAVE STRUCTURES;OVER;75 YEARS'OLD OR:IF.THE SUBJECT PROPERTY IS JN` A H/STORIC•DISTRICT, YOU MUST OBTAfN HISTORICAPPROVAL BEFOREA PERMIT CAN BE ISSUED` APPLICATION NUMBER............................................................► *For Tents Only* Date Tent`(s) will be erected Removed on number of tents total Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approvab *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number 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. Signature Date APP IC T'S SIGNATURE Signature (/ Date All permit applications are subject to a building official's approval prior to issuance. DocuSign Envelope ID:EA294ABE-4936-4412-ADCO-CO8E3CB920AD y�F SHE Town of Barnstable Department Service + RA AD Building De p s IH Brian Florence,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us - Office: 508-862-4038 Fax: 508-790-6230 u Property Owner Must Complete and Sign This Section If Using A Builder I, Suzanne Dever , as Owner of the subject property hereby authorize A/4vrGK Uie- U)a0ez-,2wh Uri Ito act on my behalf, in all matters relative to work authorized by this building permit application for: 22 Ansel Howland Road Centerville (Address of Job) D�o/cLuSigned by: - �- Signature of Owner Si ature of Kpplicant Suzanne Dever Print Name Print Name 1/22/2020 1 9:11 AM EST Date The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Auulicant Information Please Print Legibly Name (Business/Organization/Individual):ALTERNATIVE WEATHERIZATION, INC.' Address:2 LARK STREET City/State/Zip:FALL RIVER, MA 02721 Phone#:508-567-4240 Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 16 employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.�I am a homeowner doing all work myself[No workers'comp.'insurance required.]t . 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I L❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.t 13.❑Roof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.E✓ Other INSULATION 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :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 job site information. Insurance Company Name:LIBERTY MUTUAL INSURANCE i Policy#or Self-ins.Lie.#:XW058867158 Expiration Date:06/07/2020 Job Site Address: G -� /Ltd . City/State/Zip: i1iIle M4 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration dale). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under e ' ` s and al ti s of a ury that the information provided above is true and correct Si ature: Date: l Phone#:508-567-4240 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): .1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other 'Contact Person: Phone#: • �` DATE(MM/DD/YYYY) r CERTIFICATE OF LIABILITY INSURANCE 05/24/19 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 have ADDITIONAL INSURED provisions or 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 NAME: NE Anthony F.Cordeiro Insurance Agency AIC,No,E>tt: 508-677-0407 a/c No): 508-677-0409 171 Pleasant Street E-MAIL Fall River,MA 02721 ADDRESS: HSouza@Cordeirolnsurance.com INSURER(S)AFFORDING COVERAGE NAIC q INSURERA: Liberty Mutual INSURED INSURER B: Ohio Security Alternative Weatherization INSURERC: Ohio Casualty 2 Lark St INSURER D: Fall River,MA 02721 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR FkUUL POLICY EFF POLICY EXP - LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD/YYYY MM/DDIYYYY LIMITS ' x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR PREMISES Ea occurrence $ 300,000 MED EXP(Any oneperson) $ 15,000 A Y Y BKS58867158 06/07/19 06/07/20 PERSONAL&ADV INJURY $ 1,000,000 MT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑JET LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY Ea BIKED SINGLE LIMIT $ 1,000,000 ANY AUTO _ BODILY INJURY(Per person) $ Brx AUTOS ONLY AUTOS OWNED x SCHEDULED Y BAS58867158 06/07/19 06/07/20 BODILY INJURY(Per accident) $ HIRED x NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE Y Y US058867158 06/07/19 06/07/20 AGGREGATE $ 1,000,000 DED RETENTION$ $ WORKERS COMPENSATION - PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVEn E.L.EACH ACCIDENT $ 500,000 C OFFICER/MEMBER EXCLUDE[ NIA XW058867158 06/07/19 06/07/20 . (Mandatory in NH) _ E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Action Inc and NGRID,USA,its direct and indirect parents,subsidiaries and affiliatesshall be named as Additional Insured on commercial General Liability and Automobile Liability polcies. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN NGRID USA ACCORDANCE WITH THE POLICY PROVISIONS- -40 Sylvan Road r Waltham,MA 02451 AUTHORIZED REPRESENT / 1i ' ©19 -2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD - r Commonwealth o/Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Const�r�§fS, rvisor CS-105454 5toires:05/08/2021 TIMOTHY CA*R 2 68 DICKINS STREET FALL RNER 02721 niSS tAo , . Commissioner Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massa�, husetts 02118 Home Improveme"_ tCbritractor Registration Type: Corporation ALTERNATIVE WEATHERIZATION, INC. .•zz W Registration: 175683 2 LARK ST * ,- Expiration: 05/28/2021 FALL RIVER MA 02721 ° ✓1f r Update Address and Return Card. SCA 1 0 2OMM-0511177 .�e� l�pinrr<n,2tie2"�o-�/l��aJl�rc�iJe/lam _ ' Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE::Corooration before the expiration date. If found return to: Reaistiation Expiration Office of Consumer Affairs and Business Regulation 175683 - 05/28/2021 1000 Washington Stre -Suite 710 ALTERNATIVE WEATION,INC. ton,MA 02118 TIMOTHY CABRAL ANA 2 LARK ST \4 j/ � 'CL•�G�G(osoti' FALL RIVER,MA 02721 J of v ' withou signature • Undersecretary , Feb. 19, 2020 10:57AM ALTERNATIVE WEATHERIZATION, INC No. 5227 P. 1 ALTERNATIVE WEATHERIZATI.O.N Date; . 1� rpRpSs • ' • FEB ,� 9202p Town of Barnstable O� 200 Main St. �0 Hyannis,MA 02601 Re:Permit#�� 0�3 pillage: a. :The insulation weaq �ii 0 8rk at Viz! t�...�:�;u!1• has been com late ri ac o: ,a ce d. c xd n with"78 'NI P G �? Timothy Cabral, President CSL-105454 58 DICKINSON STREET FAIL RIVER,MA 02721 (508)567-4240 ALTERNATIVEWEATHERIZATION®.GMAIL.COM TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 9 ` j� Map _ Parcel �` r i v s plication # Health Division Date Issued .-2- b Conservation Division Application Feet Planning Dept. Permit Fee J Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Village Owner Ile -Z ` S-k �C_ to VL4- Address Telephone Permit Request i 0 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total ne Zoning District Flood Plain Groundwater Overlay Project Valuation "t ;00 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other n: = Basement Finished Area (sq.ft.) Basement Unfinished Area (sq =2! Number of Baths: Full: existing new Half: existing :2! new) Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Roo Count.0 CM Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other c s } .Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size = Barn: ❑ existing 0 new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# "Current Use Proposed Use- APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number SCE Address ;��- Y� ,,�,y� License# Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO v� - SIGNATURE , .�. DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH ! FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. xe Cominomittealth of 41assachusetts Departit exiFt of lidustr al Accidents - Office of-Investigations 600 Waykington,Street Boston,MA 4211I wfov.7nas&gat1dia Workeis' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant IlAhrmation Please Print Legibly Name akmke s! . nizafioudadividual)_ \ Address: Citylstate/Zip: Are you an employer? Check the appropriate b T : of: o ject r wire _ 4 am a contractor and I [ Fr I ` 1_❑ I am a employer with � 6_ ❑Zdeli-g Construction (full an•dlor part-ime)* have hired the sub-contractors. 2_❑ I am a sole proprietor or partner- listed on the attached sheet T. ' ship and have no employees These suit-oontractors have g- ❑Demolition w0a ng for me in any capacity_ employees and have workers' 9_ ❑Building addition [N(3 workers' comp_iusmanc-ee comp-insurance-, s t . e 1 5..❑ We are a corporationand its 10_0 Electrical repairs cr additions officers have exercised their I1_ Plumhin repairs or additions am a hrrmeou�ner doing all work ❑ g P lF myself [No workers'comp- right ofe a tioaper MGL. 12_.❑Roof repairs insurance required-] t c_152,§1(4),and we haim no I3_:❑Other ' employees-[Na workers' comp_insurance required-]. +tiny sppti E that cherf_s boa 91 mast also fill out the section below showing their wo%kets'compensation policy infurmatimi F_omeowners who submit this affidavit inmcsting dhey are.doing alI wcak and tbm hae outside contractors mnst submit a m-w affidavit mrii`ntinv snr,h_ !Contractors that clieclr this box mast attached an additional sheet shoteing the name of the!P a ca s and state whether ornnt thong eidities li4ve employees. Ifthe sib-contractors hose employees,they must provide their workers'comp.policy number. I am an employer iliatisprotidbtg tt,orket-s'compensation inrrrrarrce f'or rrry emrpiay-ees. Below is Ssepolicy ancd}ob site information- Insurance Company Name: Policy 9 or Self-ins-I r #: Expiration.Date: Job Site Address: CitwStatelZip: 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?'5A of MGL c_ 152 can head to the impositijim of"cnttrinal penalties of a fine up to S1,50Q00 and/or one-yearimprisortmeat,as well as citric penalties in the form of a STOP WORK ORDER-and a fine: of up to 5250.00 a day against the violator_ Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA far insurance coverage verititation_ I do hereby certi render tha pains and penalties of perjury that the irrf ormat&n prmrzdeil abm e is hub and correct siz atnre: Date- — Phone# SC -L i',� 0 C3ff-rcial use onl,}. Da riot sprite in this area,to be completed by civ ar gown o,fficiaL City or Town:. PermiVUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityfl`own Cleric 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 for 21iy 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 certincatc-(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than tLe 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 Deparment of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit 'I1:e affidavt should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industri.aI Accidents. Should you have any questions regarding the law or if you are requited to obtain a workers' compensation policy,please call the Department at the number listed below. Sell insured companies would 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 adctiou,an applicant: that must submit multiple permit/lice-rise 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 lice 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 Commonwt,�alth of Massachusetts Depaztment cif Tndustdat A.ociden Office of juvestiptiaas 600 Washington St=t Boston,MA 02111 TeL A 617-727-49GO ext 406 or 1-977-I ASWE Revised 4-24-07 Fax#617 727-7749 www.znass-gov1dia AC CERTIFICATE OF LIABILITY INSURANCE D (MMIDDNY 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), AUTHORIZE 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 o the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to I he certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Marshall K Lovelette Insurance Agency Inc NAME: PHONE FAX 396 Main St c o AIc No: West Yamouth, MA 02673 ADDRESS. INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:AIM MUTUAL A0089 INSURED William MCEwen INSURER 8: 2 Adams Rd West Yarmouth, MA 02673 INSURER C: - INSURER D: INSURER E• INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THI CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADD SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDD/YYYY MMIDDIY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY - - DAMAGE TO RENTED PREMISES Ea occurrence $ CLAIMS-MADE❑OCCUR MED EXP(Arty one person) $ PERSONAL 8 ADV INJURY $ GENERALAGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: _ PRODUCTS-COMP/OP AGC. $ POLICY PRO- LOCJEC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT _ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident,$ AUTOS AUTOS NON-OWNED PeOPERdTY�DAMAGE $ HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR - EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION VW C10060173182014A 03/25/2014 03/25/2015 V WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN Y . ANY PROPRIETOR/PARTNER/EXECLUIVEFN� E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOY E$ 100,000 It yes,describe under 500,000 DESCRIPTION OF OPERATIONS bebw E.L.DISEASE-POLICY LIMI $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES.(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Enviro-Clean Inc Insurance Reconstruction Services THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO BOX 46 ACCORDANCE WITH THE POLICY PROVISIONS. Forestdale, MA 02644 AUTHOMMD REPRESENTAT .2 (y- C _j ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Town of Barnstable Regulatory Services �aFzt�e TL Richard V_ScaIi,Director ° Building Division snxNSTnstE Tom Perry,Building Commissioner xus.� 1639- ��� 200 Main Street, Hyannis,MA 02601 ATEO 'y 0. www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION ii Please Print DATE: 1 `r�,Z ,,1 /� cyn JOB LOCATION:_a ,)- - (� -+-`CAS e l 6 Ackn U 2.6. l e a \` Q-, number street village r� ' HOMEOWNER": �()2 CLn `e 57D5S_1H6a 9' name home phone¥r work phone it rU-21 RENT MAILINTG ADDRESS: S(�VY�.2 Ci✓� C /�[�`1 Q, �v city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be, a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned`homeowner'assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. _ l The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection proced es and requir nIEUL and that he/she will comply with said procedures and requirements. Signature of H meowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules &Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems, particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities, many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFII:ES\FORMS\building permit f6 ms\EXTRESS.doc Revised 061313 �1HE r Town of Barnstable Regulatory Services sa s& E h Richard V.Scali,Director E139.E p Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 I Property Owner Must ' Complete and Sign This Section ` If Using A Builder 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. .j (Address of Job) '° Pool fences and alarms are the responsibility of the applicant.'Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date Q:FORMS:O W NTE RP ERM 1 S S I ONII P OO LS V Y z -... .. o .mow+.. "� vq.S U 4 ° � Y -•.'.ram , , ' — 1 � � t ,V k a' r �rs K ne n. + s s r _ r V s ' ,r w^ a F . a � r VVIV Tj . • tell N x e y i� r� z - . F a r • q p a'< ,+ r o e e �" d t. • - i _ - + k �^ _ � f`� i i s ,. I.rUS'#Otl'ler Information a:tt03'e Information Name: SUSIE DEVER HYANNIS 65 INDEPENDENCE DRIVE Address: 22 ANSEL HOWI_AND RD HYANNIS, MA 02601 l CENTERVILLE, MA 02632-2185 Store Number: 2612 i lhnCustomer Agreement # : 277691 It Noma Phony. 5084283621IV 9 I I Work Phone 5084283621 � Associate: EARL 100-1 200 Series Tilt-Wash Double-Hung 1 Was: $148.77 $148-7-7 19.5 x 35.5 Now: $133.89 $133.89 Standard Width = RO: 20" UNIT: 19 1/2" x ,w Standard Height= RO: 36" UNIT: 35 1/2" Save$14.88 (10%) until 1.0/22/2014 Frame Width = 19 1/2 S/O ANDERSEN Frame Height= 35 1/2 LOGISTICS-290067 Promotion until Unit Code =244DH1830 10/22/2014 Frame Depth = 3 1/4" t Venting / Handing =AA Exterior Color= White Interior Species = Pine Interior Finish Color= White - Painted Glass Option = Low-E High Altitude Breather Tubes = No Glass Strength = Standard m Glass Tint= No Tint Specialty Glass = None L( Optional Lock Hardware= None Unit 1 Lower Glass: None Unit 1 Upper Glass: Removable Interior Grille Unit 1 Upper Glass: Specified Equal Light RO.20 Unit 1 Upper Glass: Grille Pattern = Specified Equal Light Unit 1 Upper Glass: Grille Bar Width = 3/4" Unit 1 Upper Glass: Exterior Grille Color=White Unit 1 Upper Glass: Interior Grille Species = Maple Unit 1 Upper Glass: Interior Grille Color= White Unit'jr Upper Glass: 3W1H Insect Screen Type Full Screen Insect Screen Material = Fiberglass Insect Screen Color=White Exterior Trim Style= None Extension Jamb Type= None Room Location = None U-Factor= -1 SHGC = -1 Insect Screen 1 Part Number= 0833276 Search by Unit Code = No SKU = 290067 Vendor Name= S/0 ANDERSEN LOGISTICS Vendor Number= 60509030 Customer Service = (888) 888-7020 Catalog Version Date= 09/18/2014 t www.Homedepot.com Page 1 of 4 Printed By: EARL Date Printed: 10/19/2014 4:04 PM Jim r of Ole/ sd�. PC-RIA- P6 r a �t 1 r-- . d f � 'ji� O 1''1 i ° F V. .�. � . a ,.�. '. - �_: - . �.,;� ��� tS� � �� '`� '{gip § � i`�-� �.':�f�.�a .. � t;,c� � ��.�,�,;'� f TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 1 —7 ,Parcel=; C2?.-)4Q — Permit# 6 a 2 Health Division (//-7 tooq—7- Date Issued .2—37"6 Conservation Division F .5e 11',__� 63 - - Fee 4(, - Tax Collector SEP7! SYSTEM M E Treasurer I%,STALLED IN COMPLIANICE Planning Dept. YM TITLE 8 ENVIRONMENTAL CODE AN Date Definitive Plan Approved by Planning Board TOVIni REGUUTION' Historic-OKH Preservation/Hyannis Project Street Address 2 Anti Ho o f 'd QED Village �egkyyi(� , Owner - 4 AL l I A Tkff 9 S td-, L.an(1 e_ Address 191�t AY1Se1 jkW ahe4 Rj Telephone Permit Request ho'X i v addl. GYM eSL M Y tx)Yr _ 4-c- 'rear. of- kA�eh k�l IU`e. ON o b;=&x— Jtx_0 t?Ili l" and rnb-m e- emsbha h6wr'es ",Cd- olIIe5 Square feet: 1st floor: existing�'�Q proposed J15b 2nd floor: existing proposed Total new Valuation �� • J 7/Y vv Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size o 634 Acres Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family U Two Family ❑ Multi-Family(#units) Age of Existing Structu a �S Historic House: El Yes ❑ No On Old King's HXghway: ❑ s <C]No tCz Basement Type: Full ❑Crawl ❑Walkout ❑Othert erg co Basement Finished Area(sq.ft.) b U4 So 4 Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing �rrgw =.r Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: U'Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing ✓ New Existing wood/coal stove: ❑Yes ❑No Detached garage:Cl existing ❑new size Pool: Cl existing ❑new size Barn:❑existing ❑new size Attached garage: Wxisting ❑new size Shed:U4xisting ❑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`_FiM C'�fr-l Telephone Number _��� 477 '3L3 o7 Address 1_6 !Dloner \Sf License# Ha,<1l o�ft caugl Home Improvement Contractor# Worker's Compensation# tO C. O W/D,3 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN T4� wasit SIGNATURE DATE sjuu_ c)oo 3 FOR OFFICIAL USE ONLY -PERMIT NO. DATE ISSUED , MAP/PARCEL NO. a ADDRESS VILLAGE OWNER, 4 4 DATE OF INSPECTION: 1 r FOUNDATION At - /� �f'"t.'. Jcil A V b(z - t , FRAME C5 Z '�' 3 r INSULATION ) K\ x FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH j FINAL GAS: ROUGH FINAL to E FINAL BUILDING .Y _- ;' '` } DATE CLOSED OUT ASSOCIATION PLAN-NO. r E Jun 05 03 09: 37p Chip Dever 717 210 0263 p. 1 06/05i2003 19:48 , 5894283394 CHIP DEVER CN5 PAGE 01 low- �rQ/1'Vrr �y rl�► Road 1 B t I 1 stot°t� d�va�4Ci f �� . 2T 9 Mo. 46,043 Jl 5F 4I rtl/f But&br ref Cronit•t. °F 4 i®+ PAUL G J hlm&certify lhat t%s ttl tgcW 6xs�6_t0n. tva 4weP=v4- Or o T. rPrit& 9U(.y#,rs,'PC, $r p,�tir� f i�..a 'Ita.5t, for- C�taV- � *0 VEW » a wE.d'b am e*ctive S ^19-8u'Cit1.Gf.'dw tlonl aP a + $fit¢dwfi 4w dO:s mlfu °�11 u locat mreinq I y s t'Mgif ot 'tim ZlFcm,4tT1xz= lAyidL rv.S}'ea v hvt"��W dltfw"tvtYa� -_- setb" rltti� -or-is avm.�r�an 1"no' 11746Ct enfcc-mt1' rte fie: t" = Dtatd: 7. 4. 4-. oc,t► m - r Maw,GauraL Iam.'s Ctuc*W40 X•Uzftnrv'7. Fite No._2L2b'7 Q4 PLEASE NOTE: The strucevreq as shown oo this plot plan are approximate only. An actual Survey is necessary for a preetse determination of the building location and encroachments. it any euist. either way across property lines. This plan must not be used for recording purposes er'tor use in preparing deed descriptions and must not be used for variance or building plan purpef.ec. 'This plan must not be used tat locate property lines, Verification of building locwio45, property line dimensions, fences or lot configuration can only be accomplished by- an accurate instrument sixcvey which may reflect different information than what is shown hereon. Plesse not: that this is `NUT A 1300DARY SURVEY" and is "FOR MORTGAGE PUPMES ONLY". COLONIAL LAND SURVEYING COMPANY, INS. 269 Hanover Street Hanover. Mass. 02339 Phone: 617-826-7186 Nan: 617-826-4823 ,FILLER S 677241 . i_ , —=( Department of Industrial Accidents 600 Washington Street Boston, Mass. 02111 Workers, Compensation Insurance AMclavit < . ,,,, �►�Spa �-t�iay�i �� ,nhonc *i �V� / / ` ,J,3&Y1 I am a homeowner performing all work myself. [ I am a sole proprietor and have no one working in any capaciry am an employer providing workers compensation for my empioyees working on this job. cOmnanv ..ILI �` 1 (�l l �J I /iir �!: ; (=i'`r !% C1i i 1�1 i tJI C I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below• who the following workers compensation polices: comn;tnv name address: firs': lone#• insurance co. aolicv# Lgrno•Iny name' acidre•gs SL_ phone#• insurance co. policy# �iinc�s`nddlfiona s cet ii�ccssary..• _, .. . - _ - -:`.�<,_..:_-..... .. - Fuourc to secure coverage as required under Section 25A of MGL 152 can lead to the Imposition of enmtnal penaltin of a fine up to SI500.uo inu uric cars imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I unucntanu uu. .: culn of this statement may be forwarded to the Office of Investigations of(he UTA for coverage verification. i,rreot enif' under the Bails qna'penatries of perjure' rhui the informuiiun provided above is true and correct. 3tUrC Daic p 14 JfGc,al use only do not write In this area to be completed by ctry or town official •c,t, or town: permi0icen3e a f78uildinQ Department ? CDLiccns,ntc floaru _ meet, ,(immediate response a required Qjclectmcn's Ufr(cr (:]Ilcalth Dcparlrncnt f. .nmurt person: phnnr n r'1UIhcr i MAScheck COMPLIANCE REPORT Massachusetts Energy Code I Permit # MAScheck Software Version 2 . 01 Release 2 I Checked by/Date I CITY: Mashpee STATE: Massachusetts HDD: 5713 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 6-10-2003 DATE OF PLANS : 3-5-03 TITLE: sunroom 16x16 addition on cement tubes PROJECT INFORMATION: MR &MRS CHIP DEVER CENTERVILLE< MA COMPANY INFORMATION: TIMOTHY GRAY BUILDING & REMODELING INC NOTES: 16xl6 sunroom on 10"x4 'tubes 201xl2 'deck also on tubes COMPLIANCE: PASSES Required UA = 83 Your, Home = 76 Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value U-Value --------------------------------------------------------------------------- CEI.LINGS 256 30 . 0 30. 0 ,: WALLS : Wood Frame, 16 O.C. 368 13 . 0 13 . 0 GLAZING: Windows or Doors 141 0 .340 FLOORS: Over Outside Air 368 30. 0 30 . 0 --------------------------------------------------------------------------- -COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building«;. shall be no greater than 125% of the design load as specified in Sections 780CMR 1310 d J4 . 4 . r Builder/Designer Date ���ie �%oirci.urruc,�u /ir _ � K 1_ - _r;^""^`'�� ��te Vc O�wltto�uu�au� ✓�'GQdOacitW6�6� :A a----- — BOARD OF BUILDING REGULA?10NS. . Board of liuil iu(,Itrg;,latiuus anct$(��itluPils License: CONSTRUCTION SUPERVISOR i HOME IMPROVEMENT CONTRACTOR —> Number: CS O46234 Registration: 10?634 I Birthdate: 11/30/1959 Expiration: 7i2/200,4 1_ Expires: 11/30/2004 Tr.no: 3952 Type: D2A Restricted: 1 G ,RAY BUILDiNG 8 REM it ray TIMOTHY GRAY ,,( 15 TOBISSET ST r� MASHPEE. MA 026,49 Adrr"tratOr } '.A 02649 (Iministrutn( . 1 `, r - SAVERS Workers Compensation and PROPERTY Employers Liability Insurance Policy CASUALTY INSURANCE 10985 Cody, Suite 135 COMPANY Information Page , Overland Park, Kansas 66210-1224 A nu+ntrr Y MJuMnut3 In•urnnr Grvuy Policy Number Renewal Of Policy Period Agency WC0001031 WC0001031 10/15/2002 to 10/15/2003 0000750 Item Named Insured and Address Agent 4 1. Tim Gray Building & Remodeling, Inc Renaissance Insurance Agency, Inc. 15 Tobisset Street 981 Worcester Street Mashpee, MA 02649 Wellesley, MA 02482 FED ID Number: 04-3559727 NCCI Carrier Code No.: 31771 Risk ID No.: 311276 Other workplaces not shown above: None Entity: Corporation 2. Policy Period: 10/15/2002 to 10/15/200312:01 am standard time at the insured's mailing address. 3A. Workers'Compensation Insurance: Part One of the policy applies to the Workers Compensation law and any occupational disease law of each of the states listed here: MA 3B. Employers Liability Insurance: Part Two of the policy applies to Employers Liability Insurance for work in each state listed in Item 3A. The Limits of Liability are: Bodily Injury by Accident $100,000 Each Employee Bodily Injury by Disease $500,000 Policy Limit Bodily Injury by Disease $100,000 Each Accident 3C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: All states except ND, OH, WA, WV, WY and states designated in Item 3A of the Information Page. 3D. This policy includes these endorsements and schedules: See attached schedule. 4. The premium for this policy will be determined by our Manual of Rules, Classifications, Rates and Rating Plans. All Information below is subject to verification and change by audit. Adjustment of premium shall be made at: Policy Expiration Classification of Operations: See attached schedule Minimum Premium: $500 Expense Constant: $244 Deposit Premium: $3,521 Total Estimated Annual Premium: $11,738 Countersigned 09/30/2002 By DATE Authorized Agent This Information Page with the Workers Compensation and Employers Liability Insurance Policy and Endorsements, if any, issued to form a part thereof, completes the above number policy. i Date of Issue: 09/30/2002 Insured Copy RENCFWC 00 00 01 SV (12/98) L- + To" of Barnstable Regulatory Services - i snxxsres�, + Thomas F.Geller,Director Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 • Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMYROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion, tion of an addition to any pre-existing owner-occupied improvement,removal,demolition,or construc 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: Estimated Cost Address of Work: f�fi'�S F j wl a" d Owner's Name �L14 1�l e Date of Application:_ I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law ❑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 APPLICABLEON PROGRAM OR GUARANTY FUND UNDERMGL c ACCESS TO THE ARBITRATION 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: (Q 7 .03 ►�71u�N� &Y Contractor N Tr Registration No. . - Date' .. OR r,,fe Owner's Name 06/17/2003 09: 24 5084283384 CHIP DEVEP CN5 PAGE 01 FROM :TimotKU urav Builclin9 ►7eme�le FAX NO. :152WZ93714 Jur. 17 2993 09:49PM P2 Town of Barnstable 4 Regulatory Serdees Thine 1F.ofav,n%*dWr Buuding MvWon Tom Parry, $sat IftS C mnimi tr 200 Mors BtYG44 KYWW e,MA 02601 Offiee: 508-862.4058 PAX' S08 790-6= Property Owner Must Complete and Sign This Section If Using A,Builder ptopdm hersb�stiuthariaa lM U �N to wet oG 3:q behalf. is UU=Mts relative to vo*authodZed by this bWWkg p'enit appiieatkm for (Adams of job) ._ 17 K� Ng Date o t7oois Date PrintNarac sx�p�owtsx�s P`pp THE The Town of Barnstable '• BABNSTABLE. - Department of Health Safety and Environmental Services 9 MASS. f6M �" MP �0 ' Building Division pfFO 367 Main Street,Hyannis, MA 02601 Office: 508-862-4038 Fax: 508-790-6230 r PLAN REVIEW Owner: Dow C V, Map/Parcel: 1 2;' —Z 2— Project Address: =L Nn Se I t at v fc�,� Q .ilder: The following items were noted on reviewing: l� n - r � V-o C- r": C A C4 20 2d) ,021 {{ X Reviewed by: _ Date: q:building:forms:review I 4, r `RESIDENTIAL BUILDING PERMIT FEES .' APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 3 Z FEE VALUE WORKSH.EET I NEW LIVING SPACE __1` squaze feet x$96/sq.foot= x.0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE - square feet x$64/sq.foot= x.0031= ` plus from below(if applicable) ACCESSORY STRUCTURE>120 sq.f� >120 sf-500 sf $35.00 >500 sf-750 sf 75.00 .00 >750 sf-1000 sf >1000 sf-1500 sf 100.00 >1500 sf-Sarre as new building pelt x.0031= square feet x$96/sq.foot= STAND ALONE PERMITS x$30.00= Open Porch (number) a - x$30.00 Deck . (number) x$25.00= Fireplace/Chimney , (number) Inground Swimming Pool $60.00 $25.00 Above Ground Swimming Pool Relocation/Moving $150.00 (plus above if applicable) Perniit gee �' PROJECT NAME: Lp Sun r j ADDRESS: PERMIT#: lQ 4 3 PERMIT DATE: TWP: � - a LARGE ROLLED PLANS ARE IN: BOX 1►� SLOT Data entered in"MAPS program on: BY: /! -L�agineering Dept. (3rd floor) Map �,9 Parcel �v�.� �J� Permit# 3 fo House# a PJA Date Issued rBoard of Health(3rd floor)(8:15 -9:30./1:00-4:30) NQ rotes "JFee Z 0-b oor �2_'1 9 :Y„ 610 0,s,J,icF no -al gJeDOAS J OA BARNSTABLE. TOWN OF BARNSTABLE Building Perriiit Application j Project Street Address_ y w Village Owner f Address Telephone Permit Request ew First Floor squaJfeetSecond Floor square feet-- ' Construction Type Estimated Project Cost $ ®� Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes- ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes~ No On Old King's Highway ❑Yes ❑No Basement Type: ull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) � _ ,Basement Unfinished Area(sq.ft) e Number of Baths: Full: Existing New Half: Existing New No.of Bedrooms: Existing New r_ Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: �s ❑Oil ❑Electric ❑Other Central Air ❑Yes 10 Fireplaces: Existing New Existing wood/coal stove ❑Yes KO Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) X 2-0'r ❑Barn(size) ❑None M<hed(size) V- 1Z/ ❑Other(size) Zoning Board of Appeal20* orization ❑ Appeal# Recorded❑ Commercial ❑Yes If es, site plan review# Y Current Use Proposed Use Builder Information Name (� Telephone Number Address License# Home Improvement Contractor# Worker's Compensation#NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT).SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION RIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE BUILDING PERMIT DEN, OR THE FOLLOWING REASON(S) I FOR OFFICIAL USE ONLY .. PERMIT NO. _ DATE ISSUED i MAP/PARCELNO. ADDRESS: I_ VILLAGE ' OWNER DATE OF INSPECTION: FOUNDATION FRAME C"_'7-Uy atj >� r' INSULATION I r FIREPLACE + ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. , f_ TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print DATEz3o 191,1, JOB LOCATION Number Street address Section of town "HOMEOWNER" � ,Q _,bel/ ! / Name Home phone Work phone - - PRESENT MAILING ADDRESS2 � -1_r ... a 00 City town State Zip c de The current exemption for "homeowners" was extended to include owner-occupied dwellings of six units or less and to allow such homeowners to engage an in- dividual for hire who does not possess a license, . provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Person(sY who owns a parcel of land on which he/she resides or intends to re- side, on which there is, or is intended to be, a one to six family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building 2.ermit. (Section 109. 1. 1) The undersigned "homeowner" assumes .responsibility for compliance with the Stat Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department r4nimum inspection procedures and requirements and that he/she will comply aid proce . es and requirements. HOMEOWNER'S SIGNATURE f APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 0, Construction Controlq A HOME OWNER'S EXEMPTION The code state that: "Any Home Owner performing work for which a building permit is required shall be exempt from the provisions of this section (Section 109. 1. 1 - Licensing of Construction Supervisors) ; provided that if Home Owner engages a person (s) for hire to do such work, that such Home Owner shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for licensing Construction Supervisors, Section 2. 15) . This lack of awarenes often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed. Supervisor. The Home "Owner actin as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her responsibilities, . man communities require, as part of the permit application, that the Home Owner certify that he/she understands the responsibilities of a supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a P form/certification for use in your community. y� ' '0 he Town of Barnstable: �- _ �. T al Services .•NAM � Department of Health Safety and Environmental Building Division 367 Main Street,Hyannis MA 02601 Ralph Crossen Office: 508-790-6227 Building Commissioner kax: 508-790-6230 For office use only 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 ref an than fourn to any dwelling unitsxor'ng to ntainin at least one but n tors with owner occupied building co g ' tered contractors, structures which are adjacent ot her such residence or building be done by certain exceptions,along with .,, real Est.Cost r — Type of Work: s of Work: chi L Address Owner's Name Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000- Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWN PERwr OR DEALING WITH UNREGISTERED OWNERS PULLING HOME IMPROVEMENT WORK DO NOT HAVE CONTRACTORS FOR APPLICABLE FUND UNDER MGL c.142A IE ACCESS TO T ARBITRATION PROGRAM OR GUARANTY SIGNED UNDER PENALTIES OF PERJURY I her i for a pe as the a nt of the owner. Registration No. Contractor Nai6e Date OR. Owner's Name The ContinottMCallb of 4fassachusells •+cif _=-i;_� Deparmi ttl of Inditstrial Accidents ` ON=VUHMS11921lons �•.\ 'i i' = '' J f 600 11 a-vi nr tun Street Burton.Alas. 02111 Workers' Compensation Insurance Affidavit �nnlic•tnt Information• Ptense PR(NT'leb �,y~w'� name: � 04 Incition- hone g-fam a homeowner performing all work myself. OI am a sole proprietor and have no one working;in any capacity ta.._•^.�Tf^.'...�,.�.'.`a' ?]:'L7�"7Aeeams'-'aw1iT 71' `RA7�+!'.v. -. . .c..:.— ..•-n.ct �.11_..�.N�Or�*, w..e�..:r.!!�S+r�'..'..+.a.w. 0 I am an employer providing workers' compensation for my employees working on this job. company name: address: MI.: Phone#• insur•Ince co 1Lplicy# 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: company name- iddress• cirv- phone#• insurance co poliev# �. _ � _ ._... �rn•a •r�or:_••--�-r.•::�cr:.fr..e^'`_:;�:�-�•+,•.•��r.�.?.�;°-.sa r'+:�� f' `..' .-:cRq�''.Sr'r•'�'° `y""'.'`�.a.i..:s�s company name: address: rite- rhone#- incurnnee co 1nolicv# Attach additional sheet if necessary ,;:�:�� w_:P.>r+: srr..•F"' ''.� '^.''" ''"�"" ', s'"- "• ?''^`^'_ -�_ '�-.. ._.•_.at�7fo/ Cam' Failure to secure ctJvcrage as required under Section 25A of AiGL 152 can lead to the imposition of criminal penalties of a fine up to S1.500.00 andior one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. 1 understand that a cope of this statement may be warded to the Office of Investigations of the DIA for coverage verification. l do hereh► certij' u c ins and p rn/n of perjuty that the information provided above is true and orreet. Si_natur• Print name t � � Phone#, 'official use univ do not write in this area to be completed by city or town official city or town permit/liccnse# riBuilding Department Licensing Board O check if immediate response is required E3Sciectmen's Office [311calth Department contact person: phone#• riOther Irev:sed V05 P1AI Information and Instructions ' Massachusetts General Laws chapter 152 section 25 requires all emplovers to provide workers' compensation for their employees. As quoted Dort the law", an enrpl(�ree is defined as every person in the service of anotlf r under any contract of hire, express or implied, oral or written. An etnplorer is defined as an individual, partnership, association. corporation or other legal entity. or anv two or more the foregoing enLa`_cd in a joint enterprise, and including the lei-al 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 havin_ not more than three apartments and who resides therein, or the occupant of the dwcllin`o house of another who employs persons to do maintenance , construction or repair work on such dwelling hour 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 rencival of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant Nvho has not produced acceptable evidence of compliance with the insurance coverage required. n contract for the nor any of its political subdivisions shall enter into a C Add�uonally, nether the commonwealthp y performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter ha, been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names_ address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial Accidents. Should you have any questions regarding the "law"or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. _. __... w-w.._...Y,.• ..- ,..q°..i.,fur__.��t•�.+.++A11.T11.1.�� _- .. a ,��••ww •..yY.' ✓>.- City or Towns Please be sure that the affidavit is complete and printed legibly. Tile Department has provided a space at tite bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Pleas. be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of investigations would like to thank _you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address. telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 'u' phone #: (617) 727-4900 ext. 406, 409 or 375 Curcuit Breakers 0 Boiler Hot Water H ater Garage Unfinished �Q x is x ao fQfice playroom Sm oKe A�4Rm, ' aX � �71 tv room a /O x Unfinished hobby room workshop Bulkhead Insulated TOWN OF BARNSTABLE Permit No. _ Building 'Inspector tausr.r, Cash _. ------------ ------ 1wF `� "y OCCUPANCY PERMIT Bond - _-_____ - Is:=ued to A! ;r,- r- Srn.31 ? Address Wiring Inspector Inspection date t .r Inspection date Plumbing Inspector - Gas Inspector Inspection date Engineering Department Inspection date Board of Health Inspection date THIS PERMIT WILI. NOT BE VALID, AND THE BUILDING SMALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. /� :..-...................................................................... r Building Inspector 51►J GL.E F AM t t.Y � 6�ORoaM p R ►JD GARBAGE (�WNDEsIZ. � �, _. �oW m. ►lo X 3 = 33o G•Pp D At t..Y F - _ D .. SEPTIG TPw�K �•34ici"5 /•- �9l�,G.P.R . . - .. v 4� o � S v�! ►1 . N E 1.3 ot5P05A1_ PIT V4Es 10 oG GAS. 1 ". 5►D�.v�lAl.�. AttF.!► � 150 5.� . . ., ,*.,. ' � • I i \ , . g�; BOTTOM AP-F.Af �� SiF.' `d. •?r.S = -ToTA I- D S516N .',4.2 S (•,,P t7i. 16p ` -roT4A - IAA I�Y FI..Ovttl = 33a C.PR. . 40. CO�uNDAT 1o►.I 24, W pro PFLZC0"T.10N RATE; 1 ,IN WAIN fooOA6. TANK . n� y 7 ``•t ,r-:+" .. a ;:� '1 p0/I , M ASH OF 1p RICHARD �r ALaN. 9cy� t5• 4.3 V\, ' r 13AXlTR JONESNo. 24048 No. 251D0 ! .r auRN at . . i 4 .G• P- O ; TEST 4 TO P FWD-; G of o w� 4.ip 0 looa see soar. O15T (Nd, s`PTI A� 6RAYE\. t o00 1 NY. ; Go.t.. c, 4 - 1..EIs,GN PIT Mev►uM WASHca ' ` SAUD b?oN6 i G E-2T 1 F 1�•p p t.oT P l-A.W i � 'ti• PROFILE � I. 4g I� •', .. _� NO . SGA►l.E - SCALE �N a50 FT. T�ATE 12-1 I �'L•- No WATt=e, f ` e/lo /OI REF6>ZEN GEAM i 'I GERTIFYOMPt_ TNITN-THt� S DF:LNFsµ1N ,AWP SL-MBACK R.6R0I9-r-WA •N'M, oF-tµE. -TOWN. OF'&RNSTNSLMAN9 IS n"Kos s+hc:= i ', LOGp.TED •WITNI T �fz Ft-oop Pt�AIN _ .. � ; DATA 12 BAXT'E1Ze IJYE INC. i'ST tcQ6��LA11 S u i�.Y i'arols:S Tuts PL&W th NOT AN gASt�D ca os-rEe.vlt.t.� ►,55. I y 1)5.msj-tAr;,- r 5v2vGY 4THE 0FV5ET6 suoul� — ►.to-c [�sC- U�C'•t� �Cd APPLICANT' /�LNvA E. SMA�.i ���• Assessors map and lot•mumber ........ ..... Se� a Permi ... /Z-��l�L P�OfTMEro�` : fag t number ......;Cl, e� �jD"IST"L i House number : . t" •. k °'7 'S�'E�=Fi/i �sl�3 raga + INSTALLED W CORAPLIA#�°b,, OYpY T " WN I OF BARN CODE AN!) . TOWN REGULATIONS �UILbI 11 PECTOR ' APPLICATION FOR PERMIT TO ,® - � .. ........ ....... ... ..... .... ..... ........... TYPE OF CONSTRUCTION ......... ...................................................... .... . r ...... ....1 ... Pam, ........ j TO THE , INSPECTOR OF BUCLDINGS: The undersigned hereby applies for a permit according to,the following information: Location ............................. Proposed Use �"�`t/..............®II/i r!'................. ......... ....................... ........: . Zoning District ................................... .................................Fire`District ........................ :. . ........... ............. a ..Name of Owner . ............... ...........................:....................Address ...... . ...�:.......:....:"......� .?6,�! "�'........................ Name of Builder' : .........................................................:...:....Address ......................... Nameof Architect ............................ .............Address. ........................:.................:.....:................................... Number of Rooms ..... .: ......... .................Foundation ... !�� .. Exterior. .. .. ! !�. . �........... ....................Roofing .....9a �✓'� /'�!�/(!,( �'' Floors ........ .. .. .......................... .................................Interior .I!�.. :.. ...................... Hea.ting ............ Plumbing 5 (/,��<(-� �(p��(��s�"� /fop F !-. 4 ........, .......... ........- '............................... .. 7TP3'. Y.... .......................................' +. �j ry Fireplace %.ps ...........................................Approximate Cost ...f.. �/ " :............ ..... 01 Definitive Plan Approved by Planning Board __ ____________,__._________19_______, Area !•..•/.• ... ....... € ""Diagram- of Lot and Building. with Dimensions �' J ............................ - Fee ` SUBJECT TO APPROVAL OF BOARD. OF HEALTH. OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the`above� / construction. Name ` . . J SMALL, ALAN E. f . 2461. One Story R.No ...� ,.....!. Permit for .................................... q ' ` Single Family Dwelling ............................................. . .... ............. 71 _ Location „ Lot #26, 22 Ansel Howland Rd. Centerville ................. .................................................... I Owner ......Alan E.'...Small..............:........... Type of Construction ...1.".K0)AQr............. ; . .............................................................. .................. ...................... ............. a J Plot ............................ Lot•.. ... ................. December 2 Permit Granted ...................................1� Date of Inspection ................19 Date Completed *.: 4 e...--�. .19 r t s ue-!-ewl �--� s f 1 N I I ', I I I I f F I I i.i:'i.'L:S�:Lt:ia•i i�:i�:L`�:L'L'� I I NEW FOUNDATION WALLS I I I I O EXIST. FOUNDATION WALLS z I I N I 1 I I I I f I m OLLJ ' f 1 O 0 LL 1 I O 1 J I j Q— , , I 1 I , 1 1 I I 1 � ' ' Z (L 1 f I - _ ,--- --------------------------------------------------------------- --------------------------- -T ------------------------------, z ►► I TYP'5/8"ROD ►' _ p. , , c► , ,� 1L NEW I t I I I I CRAWL SPACE I I I 1 I I ---r I '► I I ► I - I 2XI0'6 i1 12" O.C. i °D _ el I I (above) I I Q 1 I I z 4" THICK 1Cal CONC,SLAB I 1 8" CONCRETE WALL e O _ DAMP-PROOFING CSA 4 APPROVED. / � - I o-' I ------------ ' I e -Q-_---�-�-Q----e ----------------------- " _ - - 4 POURED CONC.SLAB , S ----------- 16' oil Z X 4 KEY, -0" o _ C 10" X 20" ONC.FTG. P. o P / e ° ° COMPACTED GRANULAR FOOTING FOOTING DETAIL 8" CONCRETE WALL FOUNDATION PLAN � d I.PURCHASE OF DRAWINGS LEAVES PURCHASER RESPONSIBLE FOR COMPLIANCE WITH ALL 2.EXACT SIZE AND REINFORCEMENT OF ALL CONCRETE FOOTINGS 3,ALL FOOTINGS SHALL EXTEND BELOW FROSTLINE-VERIFY DEPTH. N LOCAL BUILDING CODES AND ORDINANCES.J B DESIGNS MAY NOT BE HELD RESPONSIBLE MUST BE DETERMINED BY LOCAL SOIL CONDITIONS AND ACCEPTABLE 4.VERIFY STRUCTURAL ELEMENTS FOR DESIGN 4 SIZE CJC A ` e ,'_Q n FOR SITE CONDITIONS OR FOR THE USE OF THESE DRAWINGS DURING CONSTRUCTION. PRACTICES OF CONSTRUCTION.VERIFY DESIGN WITH LOCAL ENGINEER. WITH LOCAL ENGINEER AND BUILDING OFFICIALS.