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1 I'OWN OF BARNSTABLE BUILDING PERMIT APPLICATION
ap / Parcel Q 93- 0®,Z Permit#
Health Division a- 204_03� Date Issued d 82—
Conservation Division 2 Application Fee 2J D
Tax Collect dL Wmit..Fee 4r?
SF�TOG a d:eia b�m
Treasurer "°�" INSTA'�D IN C®MPLIANCF
Planning Dept. WffgTM.E6
ENVIRONMENTAL CODE AND
Date Definitive Plan Approved by Planning Board TOWN REGUUT.IONS
Historic-OKH Preservation/Hyannis
Project Street Address r_�— AlTO en
VillageE,/�� Yt
Owner _��4lee,&_1 _J, de/ Cd Address ��,� /0 �,o,JE ��,itre411�
Telephone o '�7�-✓c�0 y --�-
Permit Request JX7-A L2 0:o�_n AAkAE 6-AtijvN0 AO L &)c,)
Square feet: 1 st floor: existin proposed 2nd floor:existing �.S�Q proposed ) To new
Zoning District Flood Plain Groundwater Overlay tt
,ProjectValuationlo��0 00 D Construction Type A50dE gRpy-w 64vc/-
ry !'
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Lot Size A c" Grandfathered: ❑Yes ❑No If yes, attach supporting documentat[n.
Dwelling Type: Single Family.A Two Family ❑ Multi-Family(#units) rrn
Age of Existing Structure ��'3 Historic House: ❑Yes ANo On Old King's Highway: ❑Yes No
Basement Type: ,Full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) A,
Number of Baths: Full: existing new Half:existing / new
Number of Bedrooms: existing_ new
Total Room Count(not including baths): existing 97 new First Floor Room Count
Heat Type and Fuel: )d Gas ❑Oil ❑ Electric ❑Other
Central Air: ❑Yes XNo Fireplaces: Existing I New Existing wood/coal stove: ❑Yes ❑No
Detached garage:❑existing ❑new size Pool:❑existing X new size� Barn:❑existing ❑new size
Attached garage:❑existing ❑new size Shed.'1$existing ❑new size Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes A No If yes,site plan review#
Current Use /=,tl M a4,y Proposed Use -
� BUILDER INFORMATION
Name �Da 1a+�`' 4066 kC-TelephoneNumber VT_7 _ 0"D
Address License#
1A Lh-)Qd ZjS G r Home Improvement Contractor#
C�2 f�, vd Low v+/7- o Q Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TOF/hsollJ
d .rQ -So I L I L L
SIGNATURE DATE / �J mac. o-Zopa
FOR OFFICIAL USE ONLY
I ♦ j .~ f
PERMIT NO. ,
+j r
DATE ISSUED
MAP/PARCEL'NO.
ADDRESS ^" �r• _ V''ILLAGE �' f
OWNER
DATE OF INSPECTION:
FOUNDATION
FRAME '
INSULATION Y!
FIREPLACE ,
ELECTRICAL: ROUGH 13.1 FINAL
PLUMBING: ROUGH 1 -FINAL)-
GAS: ROUGH„- V- FINAL
FINAL BUILDING
!! ~ ter•
DATE CLOSED OUT
ASSOCIATION PLAN NO.
!
The Commonwealth of Massachusetts r'
- - Department of Industrial Accidents
Office oflnyestigatioes • L
600 Washington Street
Boston,Mass. 02111
Workers' Com ensation Insurance Affidavit
name t�, 0�-C',�S' cJ GCSf `
location > ���1✓�/C�P !��¢ . . � -- ... ..
ci ` f11 � phone#
I am a homeowner performing all work myself.
I am a sole r 'gor and have no one workiu in ca achy
e 1 er_ rovidin workers' compensation for my employees working on this.job.:}:<-:i.}:-}:•}:•;}:<-i>}}:-:::}:•:;•}'•:•};y}}:,::: :}:}:?}}:.:<.:.;:?.;>:;;.;}:;.}:
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❑ I.am a sole proprietor,general contractor,or homeowner(circle one) and have hired the contractors listed below who
have .. . •;.r��,'::
the
following workers'
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Failure to secure coverage as required-under Section 25A bf MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.o0 and/or
one years'imprisonment as well as dvil penalties in the form of a STOP WORK ORDtR and a fine of$100.00 a day against me. I understand fliat a
copy of this statement may be forwarded to the Office of Investigations of the DU for coverage verification
--' I 0 hereby-certify-underthepains- d en -of-perjury-that the-information-pr-ovided_abvve`is-true-and-cvireci
Signature Date J P ® �
Priest name' /s� (" l �,Ri Ps0✓ . Phone#�,�r)
official use only do not write in this area to be completed by city or town offidal
•'
city or town: permit)Ucense# OBuilding Department
OLicensing Board
❑check if immediate response is required. - ❑Selectmen's Office
_❑HealthDepartment
contact person: phone#; ❑Other
Um
U-ised 9/95 PJA)
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees. As quoted from the"law", an employee is.defined as every person in the service of another under any contract
of hire, express or implied, oral or written.
An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of
the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or
trustee of an individual,partnership, association or other legal entity, employing employees. However the owner.of a . .
dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of.�:
another who employs persons to do maintenance, 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 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal
of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has
not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the
commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until
acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting
authority. -
Applicants
Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation'iaCf
supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be
submitted to the Departs ent.of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and
date the affidavit. The-affidavit should be retumed 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�fyou
are required,to obtain a workers compensation policy,please cal:ihe Department at the number listed below:.
City or.Towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottomf otlie
affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please
.aIw.
' " - The'affidavits ma .die'ieriz to
'ch willbe used as a reference aumlier. y .
be sure to fill in the:pain' tTlicense number which .. . .^ .. ., _ �.
the Department by�or:FAX unless other arrangements have been made:
ce of Investigations would like to thank you in advance for you cooperation and should you have any ci 06ons. .
The Offs ,.4.
o not hesitate to give us a call.
please d
The Department Is address,telephone and fax number:
The Commonwealth Of Massachusetts
Department of Industrial Accidents
018ce of Invesduatlons
600 Washington Street
Boston,Ma. 02111
fax#: (617) 727 A7749
phone#: (617) 727-4900 ext. 406, 409 or 375
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so offers plenty of space forIes' �I lr Kayak pool
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°me, kayak engineers have dour i d LIN:, ,,lr1t for years . ' �+•� t r t
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ABOVE•GROL1114D PLM SERIES Convenlence and virtually,
MODULAR M111*1A rtlaintenance•h•ee oDeraUon make this aboveground
FILTER SVSTEMJI� system a smart emolce.Featuring Ste-Rite's modular
M*dla technology"OW&D Sy3jerrla handle curt leads
of up to 1611Mw more than sand 111terg of equivalent
11124.Available with nmggedr large-capacity jWp was
pump or the now enorkwe Intagrai trapArolute At3G Own slh"M
aeries pump, with JWP pwr4h)
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27002.010gS S145.00 100 Sq.'FL Replacement 11
7-00 Module for PUN100
Vf ZM02-01 SOS 'S2(36.00 ISO SQ,Ft,Rsplacw 4nt 12
Modulo for PLM780
0 s +J78 820P S 3.20 E" 1.1/2"Pipe y
EI Maducer Bushln
27001-01303 S 7M Spring Gherk Valve 1
27001-0139 Ely50 Pled.Eitenalan 1
i, ll t� 27001-00325 t539.o0 Fletform Extensfcn with
1� canngclor 101 3
1 4 C3.13SP3 523.80 ACVlc Trep Ud for 4JWP 2
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11 ® 7T1172.0100 518.Od l-tW K eP Nose Kn-Includes 3
(2)hOA-4,(2)home adapters,
and(4)as band alenlps
Pump toAlle�ONMI)iny Omniatlam Pump dlachaMa moat Do smiled to
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P1,M100.JWAf388 i"2.00•�..-.�.�100 AB6
PLM1 oaJwAE-03 - 314 3.5 e1
PWIOQJWAE-04 $710 .._- -100 JWP 1 2.5 e7
5710.00 100 JWP 1
PLM100.nNAE-11 s727.00 lOQ 2 Be ,
PiM10s4lVyA8-12 5710.00 100 .JVI/ 1 _ 1,5 67
PL4100JWAJy57 100 - t 66
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lVWA6Ja AUG tC701.00 100 �p 1
PLM10G1WAF-03 . 1 3.5 62
57�1e.00 100 JWP- t-t12
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PLJAI SO4WAE-03 JWP 3.5 64
5804.0D 150 JWP. i P,3 PLN 1 g0,JW4 04 579g 00 150 70
PLlvt150JWAM-12 JWP 1 - 2
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PLM130JWAF-03 1 3,5 eie
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Kayak P*o,,o�l�s® Stainless S���sel Kayak Pools® SwinTUp Aluminum Safety Udder
irl Pal Ladder IBM The outside aluminum ladder being strong,but Ilght-weight,swings away
Won't ever rust = easily when not In use,making pool entry by children difficult,if not
impossible. It also contains a locking device to insure protection of your
Wide steps for comfort and balance pool when you are away(tom home.
����
Heavy duty structural Aluminum,Complete with all hardware plus 1
Easily placed...wherever aluminum Safety lock,1 aluminum handrail &2 ladder hinges.
desired...at any time 1:0'
0L.• Will support any weight - _ •:: � 1 , . ' � ,,.,t�sy, ,.3r i
Heavy duty 1.9" handrails,
3 polypropylene steps, -
Complete with hardware and
2 rubber bumpers. -.
Replacement Parts
ML124003 Step S9.99 ea. I Lying
MP134001 Flange $6.95 ea. Replacement Parts
ML124002 Bumper $2.99 ea. AA104054 Step
HS364030 Flange Bolt Kit $2,19 ea. $19.99 on.
MJSST-60300.150•HC Hinge $4,99 ea.
AA104051 Handrail $29.99 ea.
MH304001 Latch $9.95 ea.
a HS364019 Screw for(5 Req:for each Hinge) 9.19 ea.
Kayak Pools® e 2 000 N+�ml,9K,' STYLE (6 Req,for each Latch)
In Pool Ladder
Complete With two heavy duty hand rails,I urea wide steps(20"),two bumpers and hardware. Perfect for addlni. 9 second ladder to your pool. l
Flanges not included. *h Pools 5,
These unique stairs fit all above and f� r
on-ground pools.They provide
stability and easy access for i
II� swimmers up to 350 pounds, Large, f r
flat steps along with 2 molded
handrails provide safety for all your
Replacement Parts guests exiting and entering your
MLR124002 Bumper $2.25•a. pool.Water circulation openings
MLR124003 Step(20") $11.00 ea- Inhibit algae growth. Snap together
MP134001 Flange $6.95 ea. assembly makes installation easy.
0�0
Deluxe Resin Ladders
Durable construction,easy IIm
to assemble and Insta
Fll, Pool Entry Sy
Featuring Comforvead,a steA
broader,slightly rounded step. Steps are closer This innovative pool entering
�+nn
� 'I� system comes complete with a
together Making it easier self-closln self-latchln
to climb. Maximum , , g, g gate. It 4 �
chemical resistane®.
meets ANSI/NSPI
Includes ladder flanges, standards andsatisfies most
building Inspectors.
Gate height Is 58"• Xis
Non-slip step na
surfaces and
handrails allow ! i
easy access,
stability and a
convenience for
II� 1 all your guests.
"Denotes truck freight.Please call for quote.
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L-Deck
20'x 42' 16'x 32' 4' 13;493 gallop
16'Ik x 12 30' 'x 2017,000 gam
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Deck configurations may not be as represented:
P.O.Box 207
West Seneca,New York 14 2 24
1.900.639.5292
www.kayakpools.com
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And wall.studs
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ANUMO LAAE BAf�M1/STABLE— AIA
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CANAL LAND SIRYDYrnrs
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No.32448LAW
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The Town of Barnstable
Regulatory Services
Thomas F. Geiler, Director
Building Division
Tom Perry, Building Commissioner
200 Main Street,Hyannis MA 02601
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:JOB LOCATION:
number street village o
"HOMEOWNER": l/,GC Jc:� �0C:) 770—/,DOY
name home phone# work phone#
CURRENT MAILING ADDRESS: /lI j/G'O Z,6AJE
city/town state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or
less and to allow homeowners to engage an individual for hire who does not possess a license,provided that
the owner acts as supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is
intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or
farm structures. A person who constructs more than one home in a two-year period shall not be considered
a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the
Building Official,that he/she shall be responsible for all such work performed under the building permit.
(Section 109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and
other applicable codes,bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building
Department minimum inspection procedures and requirements and that he/she will comply with said
proced r e
Signature of Ho wn
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:FORMS:EXEMPTN
✓A 'cowl a "��,
�1KN� i ,:
oard of Building Regulati - Standards
One Ashburton- Place
Boston, Massachuse C11301OB
Hone Improvewent Contract i 3str.ation .
EXPIRATION; -9127',02
TYPE: PRIVATE
aoRPoRATlarr S�, � �••••r••1K,r.,l�',,.,.L�.,�
UK Mtllrt]i CMIN
Kayak Pools of NE,Inc/Sunatljit*jN -_ . XOGWRATM �s
Douglas Smith ZXPW► N"M
. 29 Eastbr-ook Rd Tfle. hlstatarw"
Dedham MA 02026hyd
E- ,
: 1:��•,.., In Stitt
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. Eajtml CiWhllty
325 Clonald J. Lynch 9oulevar4, Marlborough, Massachusetts 01752.4729
(NCCI Carrier 16942),
WORKER11.' COMPENSATION AND EMPLOYERV LIABILITY INSURANCE POLICY
INFORMATION PAGE
Policy Number WCV:C1300713 f Bureau File#: 260036Y
Federal Imo: W013246
1. Named insured/Malliti pI Address;
Sunshine P0018,119c. Legal Entity: Individual
DBA Kayak Poolo Of N.E.
29 East Brook
Dedham, MA 024116
Insui�dif tl�gi�, dr�+q��foaT•?
See attached Sch,Wule of Named insureds and Locations
2. Pq-WtP!qrdd '
The policy period ii,!u from 08/21/2001 TO .013/28/2002 12:01 AM.Standard Time, at the insured's
mailing adaresa. �. ; �,�� - - _ _ •
JJ•,y 'f;:. ,: „�r�( ' 'j' �aiti.-r:.u.'S�A(SsYY:S -ti _ a,N•---
rw
8,w Employ--ivs' Liability Insurance' Part Two of the policy applies to work in each state listed
In item:';.A. The limits of our liability under Part Two are:
Bodily Iri_jury by Accident 100,000 each accident
Bodily Injury by Disease 500,000 policy limit
Bodily IrGjury by Diselk a 100;000 each employee
C. Other:1,Aes insurance: Part Three of the policy applies to the states, if any, listed here:
See en0orsement WC200306 '
D. This pc! ¢.Includes these etidorsements and schodutes: Refer to Attached Schedule
Total Estimated Annuiit Premiuft $1,249.00
Countersigned: Aft a insurance Agency, Inc
P,Ct Box 322 Acord Station
Hini;iiNarn. MA 02018
By 1
?ate: 03I22J2(;00 o"repre wntathre)
PR
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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel 00 = o U � @ Permit# �9/ 70
SYSTEE �� q .�m
INSTALLED IN GOE F -,,",--,Rate
to Issued
Health Division. _ q���� �,, ,��,�
WITH TITLE 5
Conservation Division CI �_ WITH
COD- , �,:,Fee
S;TOWN RIEOLLIrb �..,
Tax Collector * r. o°
Treasurer
Planning Dept.
Date Definitive Plan Approved by Planning Board
�.1) � .2 R le<s e d CPO 5,0AeC -PEA.(
Historic-OKH Preservation/Hyannis
Project Stre t Address `
Village44
Owner Address
Telephone — S
Permit RequestILAD
Square feet: 1st floor isting proposed 9 6 2nd floor:existing proposed �3�0 Total new /jRZ.
Estimated Project Cost 6H Zoning District. Flood Plain Groundwater Overlay
Construction Type
Lot Size_/61 i Z Grandfathered: ❑Yes ❑No' If yes, attach supporting documentation.
Dwelling Type: Single Family D- Two Family ❑ Multi-Family(#units)
Age of Existing Structure—14_iAAJ Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No
Basement Type: Off l' ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) d Basement Unfinished Area(sq.ft) 9 3
Number of Baths: Full: existing new 3 Half:existing new
Number of Bedrooms: existing new 3
Total Room Count(not including baths) existing new b First Floor Room Count ,
Heat Type and Fuel: U Gas ❑Oil ❑ Electric ❑Other
Central Air: ❑Yes UKo Fireplaces: Existing New Existing wood/coal stove: ❑Yes 3'9-0,
Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size
Attached garage:❑existing _❑new size Shed:❑existing ❑new size Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑No If yes,site plan review# '
Current Use Proposed Use
BUILDER INFORMATION
Name ,,// Telephone Number
Address 3 (�Z.Q�G1 License# t/7�1� 34 7 q
Z!�6�464:p J)"'ki 42S 3 2 Home Improvement Contractor# .Z9S'7
Worker's Compensation# W C S'- =9 2 O el
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PR OJ CT WILL BE TAKEN TO
SIGNATURE DATE /ZJ/
t
FOR.OFFICIAL USE ONLY
PERMIT.NO. +'
' 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.
E f TOWN OF BARNSTABLE
.CERTIFICATE OF OCCUPANCY
PARCEL ID ..172.. 003 004 GEOBASE ID
ADDRESS 55 ANTICO LANE PHONE
- ZIP -
LOT BLOCK LOT SIZE
DBA DEVELOPMENT DISTRICT
PERMIT 45734 DESCRIPTION 3
PERMIT TYPE BCOO TITLE CERTIFICATE OF OCCUPANCY
CONTRACTORS: Department of Health Safety
y
ARCHITECTS: and Environmental Services
TOTAL FEES:
BOND $.00 THE
CONSTRUCTION COSTS $.00
756 CERTIFICATE OF OCCUPANCY 1 PRIVATE P . ,E-., ;
* BARNSTABLE, •
' MASS.
r BUI .D'W( V SI
DATE ISSUED 04/27/2000 EXPIRATION DATE
.,_fir�,�}, .t- _ _ � • „M - -, Q✓..:'i�b. ti
.' . �'f!4;r'iy{�¢.•'4: 'b. }q/y!�f� p�(. :.`K �y+Y/�.p �j .Z:S'C,l'' .� .,yam; � i ,
PARCEL ID 172 003 004 GROBASE TIC �I
ADDRESS Asa ANTICO LANK
p.
LOT --�' LOCH LOT SIZE
OT
PERMIT 43770 DESCRIPTIOR SINGLE AVI-DWELLI,NG 2 FL.COLONIAL U.200 03'I
PERMIT TYPE BUILD TITLE NEW RESIDENTIAL BLDG PMT
CONTRACTORS: J. SC OTT C;IM NC) ' Die 'artment®f- ealth.,`Safety
ARCHITECTS: and Environmental:se,rvice
TOTAL FEES: $335.92
BOND 00
CONSTRUCTION COSTS $108,�360.00.-
flZ'&A ..
BUILDIN ' IV�ISI(1�T
B�
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR-ANY PART THEREOF, EITHER-TEMPORARILY OR PERMANENTLY.„EN_
CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE-BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR
ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OFTHIS
PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS.OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. 4
MINIMUM OF FOUR CALL INSPECTIONS REQUIRED —•
FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED-ON JOB AND
THIS CARD KEPT POSTED UNTIL FINAL INSPECTION WHERE.APPLICABLE,'SEPARATE..
1.FOUNDATIONS OR FOOTINGS HAS BEEN MADE.WHERE A CERTIFICATE OF'DCCU_ PERMITS ARE REQUIRED FOR
2. PRIOR TO COVERING STRUCTURAL MEMBERS ELECTRICAL,PLUMBING AND MECH-
(READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS.
3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE.
4.FINAL INSPECTION BEFORE OCCUPANCY. '
BUILDI NSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS
L000
P eplo 0
��-
i bock ouCl, �°.
3 . 1 HEATING 1 PECTION APPROVALS ENGINEE I r T T
Cbc
2 ��,� B RD OF HEALTH
` OTHER: SITE LAN REVIEW APPROVAL
WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INDICATED"ON THIS.
.THE INSPECTOR HAS APPROVEDTHE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED.FOR:BY,:'
VARIOUS STAGES OF CONSTRUC MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA
NOTED ABOVE. - - [TINSPECT'ONS.
ION. - -
BUILDING �
PERMIT
JRN-25-2000 12:59 OLD CENTRE RPRLTY 1 509 9.33 6111 P.03iO3
SANDWICH CONCRETE FORMS
P.O. BOX 1.832
SANDWICH, MA 02563
(508) 888-4579
BRYDEN INSURANCE AGENCY
(508) 888-2244
POLICY #WC99-704103 6/12/99-6/12/00
JEFF WARNICA CONSTRUCTION
P.O. BOX 1278
MANOMET, MA 02345
1-800-623-7777
ALBERT & TONY & CO., INSURANCE
(508)588-1934
POLICY #WCV0016562 1/12/99-1/12/00
VIENS MASONRY
150 COLLIINS ST.
SO. ATTLEBORO, MA 02703
(508)761-9847
HARRY BOARDMAN .AGENCY INC.
(508)761-7371
POLICY #8P17009478 4/17/99-4117/01
MARK SHANAHAN, SHANAHAN DRYWALL& PLASTERING, LLC.
P.O. BOX 1126
PLYMOUTH, MA 02362
(508)224-6744
ALMEDIA & CARLSON INS.
(508)888-0207
POLICY#WC8119360 7/8/99-7/8/00
w .
T-OTRL P.03
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aOT PLAN LOT 4 aj,,�do
s ANTICO LAID AA
SULE .r' • AID �r ao�oro
CAAG4L LAAV SUMEMN6
306 LXD PL MJ7H ROAD, BUZZAAW BAY NA
cr mmw oa-,w
ME Mom Tray .vm CW nvrs PLAN Mils LOICAW `JN�PAUL��
or AN lA�T1�'�4E yr S�GRyEr ay ll�7/Oo A l�Yi ISTS � R. �
QV VE 6i%VV AS RYLL
No.32448LAW IqRMFYW
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EST/MATED PROJECT COST WORK-SHEET
Value
LIVING SPACE square feet X$55/sq. foot= V
GARAGE (UNFINISHED) square feet X$25/sq. foot=
/ 6 Ike,
PORCH r X square feet X$20/sq. foot 3/ 6
J
DECK square feet X$15/sq. foot=
OTHER square feet X$??/sq. foot=
Total Estimated Project Cost
For Off ce Use Only
lnc/usionary Affordab/e Housing Fee
Residential Commercial*
Property Owner's Name
SS- W
Project Location
Project Value , yj Permit Number �`377d
**Existing Sq. Ft. **Proposed New Sq. Ft.
Fee $
WI-1 co LN , REMITTANCE DICE 53-7147
2113
OLD CENTRE HOMES REALTY TRUST ;,-•N -.
P.O.BOX 635
WAREHAM,MA 02571 -
� . 2259
-
CHECK
DOLLARS AMOUNT
,< DATE -a-u, q
:;fita SOTHE ORDER,OF. 4 + .;:a. at t3 .,e ;,,:';DESCRIPTION E2r-'-+7F CHECK.NO. < �tiz a
COMMUT1M1i(.
BANK
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v00225911' 1: 2113714761: 5630 147
—- '•-°--- -- ••-^^-••SECURITY FEATURES.MICRO PRINT BORDERS-COLORED BRICK PATTERN-WATERMARK&CARBON STRIP ON REVERSE SIDE-MISSING FEATURE INDICATES A COPY...,,. *�--- °��•"'""-
OLD CENTRE HOMES
P.O. BOX 298
SAGAMORE, MA 02661
-SMOKE Cd OX
B NSTABLE BUILDING
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PRODUClR THIS CERTIFICATE 18 ISSUED AS A MATTER OF INFORMATION
ALMEIDA & CARLSON INS ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
345 COURT ST BOX 3255 COMPANIES AFFORDING COVERAGE
PLYMOUTH MA 02361 COMPANY
A GRANITE STATE INS CO
INSURED COMPANY
IRK SHANAIipN 'DAi.s.
MARK SHANAHAN DRYWALL COMPANY
BOX 1126 c
PLYMOUTH MA 02362 COMPANY
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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 166UED 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.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTNE POLICY EXPIRATION ��
LTR DATE(MM/DDITY) DATE(IAM/OD/YY)
GENERAL LIABIUTY GGJERAL AGGREGATE 8
COMMERCIAL GENERAL LIABILITY PRODUCT8•COMP/OP AGG 8
CLAIMS MADE D OCCUR PERSONAL 6 ADV INJURY 8
OWNEITS l CONTRACTOR'S PROT EACH OCCURRENCE 8
FIRE DAMAGE(Any one ere) 8
MED EXP(Any one paeon) 8
AUTOMONI E LLABBJRY
- COMBINED SINGLE LfM1T $
ANY AUTO
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per person) 8
HIRED AUTOS BODILY INJURY
NON-OWNED AUTOS
(Per eccWnp 8
PROPERTY DAMAGE S
GARAGE LIABILITY AUTO ONLY.6A ACCIDENT S
ANY AUTO OTHER THAN AUTO ONLY
EAC ACCIDENT 6
AGGREGATE 8
EXCESS LIABILITY EACH OCCURRENCE 8
UMBRELLA FORM AGGREGATI! 8
OTHER THAN UMBRELLA FORM 8
WC STAIU
WORKHIW COMPOKATON AND WC 81,19 3 6 0 7 0 8 9 9 7 0 8/0 0 X To ER
EMPLOYEW LIABILITY EL EACH ACCIDENT 8 10 0 0 0 C
THE PROPRIETOR/ INCL EL DISEASE-POLICY LIMIT 4 500, 0 0 0
PARTNERS/EXECUTNE
OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE 8 100, 0 0 C
OTNEA
DEBCRPTION OF OPERATIONS/LOCATIONSNENICLUMPECLAL ITEMS
DRYWALL
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..Rf;Yr /;: tn'i;•f::cf.x.w. '>; >.. .. 4:y:R:bx;:.x.a• c ..'?�'(i'^',° Lbww:.�x.n '?..3...:3
. ,.,. .. 7.... ,.:' :::Cv.'Y:J:.xa:,f;..•e::u x..o t'�f<:,'.'al.t;G.Y<..,.x. ............'a:%<�!t.'.e.f ef6h%k,:� ...................:.y:.,, :c:,r...•.....,..............r:2:4:4:L:'r.4:4:w:G... .'f.......4:.
...•.:..:......4 ,.owwwx•.:..v.,.:.........t��),J:.x�R...�:::...r....f!%R�Jns:• .. 4a;>::.:.....: .: ,.. �.;,,,. ..:
SHOULD ANY OF THE ABOVE DESCRIBED POUCIEB BE CANCELLED BEFORE THE
OLD CENTRE HOMES EXPIRATION DATE THEREOF, THE ISBUINQ COMPANY WILL ENDEAVOR TO MAIL
0 DAYS WRITTEN NOTICE TO TN!CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL.IMPOSE NO OBLIGATION OR LIABILITY
OP nNY KIND UPOR THE COMPANY ITS AGENTS OR REPReSENTATIVa.
AUTHORIZED ARPRESENTATIVE
L......... ::.:....,,,.,.. ..:e.,....:.:.::,: h.x.L.M he l •:::,., JM
Jose azzucc 1 C
.x.;:.,.� ...e.-r. •;.e.:...:: o.o.0.4.<.. .'f.:ti;y.l::ik:'.:.'
: .f r. :^:G4xr.: .J,r,t.'1.<:'�:xt:c,. .r.f t,<x�>.....;fie;4 a LMi:i2:;fi::�:a.>••r»rii� v':v.• ..
N�, c::4;<•p:•: t,y,,xa,yx.iv•:os>•:`caaijw:'J:G:4Ji'r::?:c::::::....: r.c„r..t4si>,?a,:•' x'xy<::b;,; ;a
.fi" xcY>;:1s>,oT4:.; t'f•.o;J.,x•, r.i.t '.t>.>.: ..xfr .<„f.,. )„M•>.<.4>j>,oo4 a.•!,'fl!';:"i;"�:?):'f:1;oy:.. i' .a
<: iFTe� xi:w:% ,.'Y4'�;:So-. ..(fix«• ;f:1,eta%. ':f^ra•„>t .:o.o.v.
_�. �. __-• �. ,�� � ,_,v,-,i.ui•iruy lives i-)Vuvl,i h-'HUt bL
CORr[ e
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" "^•���
PRODUCER O1/05/1999
(508)761-7371 FAX (508)761-4817 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Harry 1. Boardman Agency Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
679 Washington Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P. 0, Box 3269 COMPANIES AFFORDING COVERAGE
Guth Attleboro, MA 02703-0925 _.................................. . .....
.........._................................ .. ..._.............
i COMPANY Vermont Mutual Insurance Co.
.,ttn: Carole McMorrow,CPIW Ext: 12 A
_....... ..._.....
INSURED .......
ViensMasonry COMPANY
150 Collins St. B
:. .. ................. .................... .....................................................
So. Attleboro, MA 02703 COMPANY
C
.............................
i COMPANY ..... ...........
� D
... �:i>S!^%>�i:::i2� i? iti�9$ i?j?„ sa:':k`i`:`•ilEi:.:�..,:.•
....................:. ..J:....::......::s.�::s:s...:.ss;::ss.;sasssss:,ss>sss:as»>xJ.�.,..:::,::.,[:[..s:s:::.'.:;.::..�.o;::.,[.;:..:.::.:.�...�:;i;r;:::a::�r•r�::'::::::>:�;.::;:«p>::>;�:
.... .... .............�:::::•:.::.�:::;:ro:s<:.;;Sit:_;?^...._..;:.�...,..:.,:•,::::>:
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,
.......................................................:.....................................
CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION
DATE(MM/DDIYY) DATE(MMIDDIYY) LIMITS
GENERAL LIABILITY
"' GENERAL AGGREGATE i$ 600 OO
X COMMERCIAL GENERAL LIABILITY i "'""
;sss' CLAIMS MADE [ X :OCCUR PR _.........PLOP AG... $.......... 600,00C
ODUCTS•COM G
A BP17009478 _ PERsoNAL s a0v INJURY E 300
.....
OWNER'S S CONTRACTOR'S PROT: O /17�1998 i O4I17/2001 '• r 00
EACH OCCURRENCE $ 300,00
.•.•........•........ i FIRE DAMAGE(Any one fire)... E
50,000
MED EXP(Any one peroor)......E:........ 5 000
AUTOMOBIL11 LIABILITY
ANY AUTO COMBINED SINGLE LIMB E
'ALL OWNED AUTOS _ .i.................................. ..............
[SCHEDULED AUTOS BODILY INJURY $
(Pot paraon)
HIRED AUTOS
i :............................................:...............
NON-OWNED AUTOS BODILY INJURY $
(Per accident)
PROPERTY DAMAOE $
OARAOE LIABILITY
AUTO ONLY.EA ACCIDENT E
ANY AUTO
OTHER THAN AUTO ONLY:
....... .................................................... .......... .. .... _.
EACH ACCIDENT:$
............
AGGREGATE:$
EXCESS LIABILITY - EACH OCCURRENCE $
UMBRELLAFORM ;.............................................:.._........r..........
AGGREGATE $
CTHER THAN UMBRELLA FORM
....................... ......:.........
$
WORKERS COMPENSATION AND
4
EMPLOYERS'LIABILITY ; _,j,TORY LIMITS:
EL EACH ACCIDENT.... ......
THE PROPRIETORS E..DISEASE. ............................
..............................
PARTNERSINXECUTIVe INCI : L •POLICY LIMIT i E
CFFICER6 ARE: :EXCL'. ..
EL DISEASE•EA EMPLOYEE:$
OTHER
DESCRIPTION OP OPERATIONSILOCATIONSJVEHICLES/SPECIAL ITEMS
ob site: Various Project Locations
�'.
a... ... ,... 1. ,,
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF,THE ISSUINO COMPANY WILL ENDEAVOR TO MAIL
lO DAY$ BITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.
Old Centre Homes BUT FAILU O MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY I UPON THE COMPANY.1T9 PLOENTS OR REPRESENTATIVES.
AUTHOR EPRES NTATIVE
,S
d
yK
'i7'.:'.� V'•. .i nn. Q]nn
! � p�; ✓ire Lnommanivaa�/J�i n�,..-'7nvan�lrr�aeh�i
! DEPARTMENT OF PUBLIC SAFETY
! CONSTRUCTION SUPERVISOR LICENSE
NunDeh Expires:
' . Restrlltld To: 11
w J SCOTT CIMENO
11 NOREAST OR
BUZZARDS BAY, MA 12532
•
A' 4011 I,® DATE(MM/DD/YY)
01/21/99
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Albert J. Tonry & Co., Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Crown Colony Office Park 7ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
300 Congress Street COMPANIES AFFORDING COVERAGE
Quincy MA 02169-0907
COMPANY
INSURED A EASTERN CASUALTY INS. CO.
COMPANY
Jeff Womica Construction B
P.O. Box 1278
COMPANY '
Manomet MA 02345 C
COMPANY
D
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.
co
TR TYPE OF INSURANCE POLICY EFFECTIVE POLICY EXPIRATION
LTR POLICY NUMBER DATE (MM/Dbm*) DATE (MM/DD/YY) LIMITS
GENERAL LIABILITY
GENERAL AGGREGATE $
COMMERCIAL GENERAL LIABILITY
PRODUCTS-COMP/OP AGG $
CLAIMS MADE OCCUR PERSONAL&ADV INJURY $
OWNER'S&CONTRACTOR'S PROT
EACH OCCURRENCE $
FIRE DAMAGE(Any one fire) $
AUTOMOBILE LIABILITY MED EXP(Any one person) $
ANY AUTO COMBINED SINGLE LIMIT $
ALL OWNED AUTOS
SCHEDULED AUTOS BODILY INJURY $
(Per person)
HIRED AUTOS
NON-OWNED AUTOS BODILY INJURY
(Per accident) $
PROPERTY DAMAGE $
GARAGE LIABILITY
AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN AUTO ONLY:
EACH ACCIDENT $
EXCESS LIABILITY AGGREGATE $
UMBRELLA FORM EACH OCCURRENCE $
OTHER THAN UMBRELLA FORM AGGREGATE $
WORKERS COMPENSATION AND —��— �§T—ATU- TH
EMPLOYERS'LIABILITY X TORY LIMITS ER
WCV0016562 $ 100,000
A 01/12/99 01/12/00 EL EACH ACCIDENT
THE PROPRIETOR/ INCL
PARTNERS/EXECUTIVE EL DISEASE-POLICY LIMIT $ 500,000
OFFICERS ARE: EXCL OTHER EL DISEASE-EA EMPLOYEE $ 100,000
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS
Project: General Operations
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
Old Centre Homes EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
' Carl L Tralna
ACORD„V CER" IF CA"M" 0 �.JAgILNTY ]IVSUNIIC CSR MP 2 DATE(MM/DD/YY)
PaoDuceR - JONE S 2. 0 6/15/9 9
The Insurance Agency THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
of Cape Cod, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Route 6A, P 0 Box 838 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Sandwich MA 02537 _ COMPANIES AFFORDING COVERAGE
The Insurance Agency COMPANY ------ -- - --
Phone No. 508-888-2766 Fax No. A Legion Insurance Company
INSURED
COMPANY
B
COMPANY
Greg P Jones dba C
P 0 Box 635
Wareham MA 02571 COMPANY
D
COVERAGES -
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.
T TYPE OF INSURANCE POLICY EFFECTIVE POLICY EXPIRATION
LTR POLICY NUMBER
DATE(MM/DDNY) DATE(MM/DDNY) LIMITS
GENERAL LIABILITY
GENERAL AGGREGATE S
COMMERCIAL GENERAL LIABILITY — —
PRODUCTS-COMPIOP AGG S
CLAIMS MADE OCCUR PERSONAL&ADV INJURY S
OWNER'S&CONTRACTOR'S PROT - EACH OCCURRENCE S
FIRE DAMAGE(Any one fire) S
MED EXP(Any one person) S
AUTOMOBILE LIABILITY
ANY AUTO COMBINED SINGLE LIMIT S
ALL OWNED AUTOS —
.S
SCHEDULED AUTOS BODILY INJURY(Per person)
HIRED AUTOS
NON-OWNED AUTOS BODILY INJURY S
(Per accident)
PROPERTY DAMAGE S
GARAGE LIABILITY
AUTO ONLY-EA ACCIDENT S
ANY AUTO
OTHER THAN AUTO ONLY:
.EACH ACCIDENT S
AGGREGATE S
EXCESS LIABILITY
EACH OCCURRENCE S
UMBRELLA FORM
AGGREGATE S
OTHER THAN UMBRELLA FORM — —
S.
WORKERS COMPENSATION AND WC STATU- OTH-
EMPLOYERS'LIABILITY TORY LIMITS ER
EL EACH ACCIDENT $ 100000
A THE PROPRIETOR/ INCL TB
I 06/16 PARTNERSlEXECUTIVE /99 06/16/00 EL DISEASE-POLICVLIMIT 5500000
OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE $ 100000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS
Carpentry/Building Operations
CERTIFICATE HOLDER C
ANCELLATION
SANDW-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR L ILITY
OF ANY KIND UPON THE C PA ,ITS AGE S O REP ESE
AUTHORIZED REPRESENTATIVE /J ,
ACOFtb, 5(1/95)
The Insurance Agenc
25y
-.
ACORD.GOftPOFiATION.i988 '
/'9VV�\L/TM �`��.�'��..��r�r�.:� r�� L�ML��L,1�. YIR:•'1��V Vj � - {
_ .. ,. �.•. =w g�at3n b� rt:•� �V1� } ". '/ ati:tt.'. 11/23/199'
u.:..:...�._�..
PRODUCER (508)588-1260 FAX (508)588-7236 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
i se & Quinn Insurance Agency Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
449 Pleasant St. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Brockton, MA 02401 COMPANIES AFFORDING COVERAGE
COMPANY Legion Insurance Company
At 'aul Crowley Ext: A
INSURED
McDermott Construction COMPANY
Jon P. McDermott B
90 Oak Street COMPANY
Middleboro, MA 02346 C
COMPANY
D
COVERAGES
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.
Co TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION:LTR LIMITS
DATE(MM/DDIYY) DATE(MM/DD/YY)
GENERAL LIABILITY GENERAL AGGREGATE $
COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG $
i CLAIMS MADE OCCUR PERSONAL&ADV INJURY $
OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $
FIRE DAMAGE(Any one fire) j $
j MED EXP(Any one person) $
AUTOMOBILE LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT $
ALL OWNED AUTOS
BODILY INJURY $
SCHEDULED AUTOS (Per person)
HIRED AUTOS
BODILY INJURY $
NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE ,$
GARAGE LIABILITY i AUTO ONLY-EA ACCIDENT
ANY AUTO OTHER THAN AUTO ONLY: $,i'. .iF Z fv t'
EACH ACCIDENT!$
I
AGGREGATE; $
EXCESS LIABILITY EACH OCCURRENCE $
UMBRELLA FORM AGGREGATE $
OTHER THAN UMBRELLA FORM $
WORKERS COMPENSATION AND !+t P-'F �'-"'•'+-:
EMPLOYERS'LIABILITY TORY LIMITS• ER A
A WC5-0282394 09/30/1999 O9/3O/ZOOO EL EACH ACCIDENT $ 100,1000
THE PROPRIETOR/ INCL . f PARTNERS/EXECUTIVE ELDISEASE-POLICYUMIT $ 500,000
OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE i $ 100 OQO
OTHER
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/SPECIAL ITEMS
CERTIFICATE HOLDER - N' �� tea'
CANCEL"LA�QN ; a
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Old Centre Homes BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES.
P.O. BOX 298 O AN
Sagamore, MA 02651 ALITPORI ERRESE TATIVEACORD 25-S 1/95 V J.•. .�.; :::,;� CORD99RPORATION"�1988
Certificate of Insurance -
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON YOU THE CERTIFICATE HOLDER. THIS CERTIFICATE IS NOT
N INSURANCE POLICY AND DOES NOT AMEND,EXTEND,OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED BELOW.
This is to Certify that
'*AM NS��U L IfJ' 'SY `E `S
M.A.P. INSULATION CO., INC. Name and LIB R,�
PO BOX 1309 '— address of
165 OLD STATE ROAD Insured. MUT TAL®
SAGAMORE BEACH, MA 02562
Is,at the issue date of this Certificate,insured by the Company under the pOlicy(ies)listed below. The insurance afforded by the listed policy(ies)is subject t
their terms,exclusions and conditions and is not altered by any requirement,term or condition of any contract or other document with respect to which this
certificate may be issued.
:��TYPE OF POLICY EXP. DATE POLICY NUMBER LIMIT OF LIABILITY
WORKERS ❑CONTINUOUS COVERAGE AFFORDED UNDER EMPLOYERS LIABILITY
COMPENSATION ❑EXTENDED WC1-181-053991-019 WC LAW STATES:OF THE FOLLOWING Bodily Injury By Accident
®POLICY TERM r. $500,000 Each
+ ; v MA, ME, NH, NY, PA, VT Accident_
Bodily Injury By Disease
$500,000 Policy
Limit
Bodily Injury By Disease
$500,000 Each
GENERAL LIABILITY General Aggregate-Other than Products/Completed Operatioerson
Products/Completed Operations Aggregat
❑OCCURRENCE
Bodily Injury and Property Damage Liability
Per
CLAIMS MADE Occurrence
Personal Injury
RETRO DATE Per Person/
Organization
Other Other
AUTOMOBILE LIABILITY
Each Accident-Single Limit
B.I. and P.D.Combined
❑ OWNED
Each Person
❑ NON-OWNED Each Accident or Occurrence
❑ HIRED THER Each Accident or Occurrence
ADDITIONAL COMMENTS
""THIS CLAUSE DOES NOT APPLY TO NON-PAYMENT CANCELLATION
"If the certificate expiration date is continuous or extended term,you will be notified If coverage Is terminated or reduced before the certificate expiration date.
SPECIAL NOTICE-OHIO: ANY PERSON WHO,WITH INTENT TO DEFRAUD OR KNOWING THAT HE IS FACILITATING A FRAUD AGAINST AN INSURER,SUBMITS
AN APPLICATION OR FILES A CLAIM CONTAINING A FALSE OR DECEPTIVE STATEMENT IS GUILTY OF INSURANCE FRAUD.
IMPORTANT NOTICE TO FLORIDA POLICYHOLDERS AND CERTIFICATE HOLDERS :IN THE EVENT YOU HAVE ANY QUESTIONS OR NEED INFORMATION
ABOUT THIS CERTIFICATE FOR ANY REASON,PLEASE CONTACT YOUR LOCAL SALES PRODUCER, WHOSE NAME AND TELEPHONE NUMBER APPEARS IN THE LOWER RIGHT HAND
CORNER OF THIS CERTIFICATE. THE APPROPRIATE LOCAL SALES OFFICE MAILING ADDRESS MAY ALSO BE OBTAINED BY CALLING THIS NUMBER.
NOTICE OF CANCELLATION: (NOT APPLICABLE UNLESS A NUMBER OF DAYS IS ENTERED BELOW.) BEFORE
THE STATED EXPIRATION DATE THE COMPANY WILL NOT CANCEL OR REDUCE THE INSURANCE AFFORDED
UNDER THE ABOVE POLICIES UNTIL AT LEAST XX"" DAYS
NOTICE OF SUCH CANCELLATION HAS BEEN MAILED TO:
� scr<r _
OLD CENTER 825 � --
Kathleen M. Murty
CEi. CATE SCOTT CIMENO AUTHORIZED REPRESENTATIVE
HOLDER PO BOX 298
Rochester. NY (716)424-6050 11/01/99
�SAGAMORE, MA 02561 OFFICE PHONE NUMBER DATE ISSUED
This certificate is executed by LIBERTY MUTUAL INSURANCE GROUP as respects such Insurance as is afforded by Those Companies BS1501
Eavtern GvttakV
WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY
INFORMATION PAGE
(NCCI Carrier 16942)
Policy Number: WC99 704103
Federal I D#: 043161368
I. Named Insured/Mailing Address:
Sandwich Concrete Forms, Inc.
P.O. Box 1832 Legal Entity: Corporation
Sandwich, MA 02583
Insured Location,Addresses:
1. 16 Jan Sebastian Way Sandwich. MA 02563
2.Policy Period:
The policy period is from 06112/1999 to 06/12/2000 12:01 A.M. Standard Time, at the insure '
mailing address. d s
3.Coverages:
A. Workers'Compensation Insurance: Part One of the policy applies to the Workers'
Compensation Law of the states listed here: Massachusetts
B. Employers' Liability Insurance: Part Two of the policy applies to work in each state listed
in item 3X The limits of our liability under Part Two are:
Bodily Injury by Accident 500,000 each accident
Bodily Injury by Disease 500.000 policy limit
Bodily Injury by Disease 600,000 each employee
C. Other States Insurance: Part Three of the policy applies to the states, if any, listed her
All states except those listed above in item 3A and NV, ND, Off, WA WV, WY e'
D. This policy includes these endorsements and schedules: WC122B, WC128,WC242
WC332, WC367, WC369, WC441,WC57S
Total Estimated Annual Premium: $14,122.00
Countersigned: Bryden Insurance Agency, Inc.
125 Route da
Sandwich, MA 02563
Date: 07/15/1999 By
HP orized representative)
i
OEF�PrMrwT nE ouv� rr :%rsty '�`
CONSTRUCTION SU?ER'JT"OR 11(�'! E
Neer:
CS OS742� 01/11:';(O1 '�
Restricted To: pu
SLOW
GR'GORV P
(16 YHITING S► _?
PLTNOUT4, ":t
I I
MAScheck COMPLIANCE REPORT I I
Massachusetts Energy Code I Permit # I
MAScheck Software Version 2.01 I I
I I
I Checked by/Date I
I I
CITY: Barnstable
STATE: Massachusetts
HDD: 6137
CONSTRUCTION TYPE: 1 or 2 Family, Detached
HEATING SYSTEM TYPE: Other (Non-Electric Resistance)
DATE: 1-24-2000
DATE OF PLANS: 1/24/00
TITLE: SINGLE FAMILY
PROJECT INFORMATION:
LOT 4, ANTICO LANE, CENTERVILLE
COMPANY INFORMATION:
OLD CENTRE HOMES
P.O. BOX 298
SAGAMORE, MA 02561
COMPLIANCE: PASSES
Required UA = 465
Your Home = 461
Area or Cavity Cont. Glazing/Door
Perimeter R-Value R-Value U-Value UA
-------------------------------------------------------------------------------
CEILINGS 1256 38.0 0.0 38
WALLS: Wood Frame, 16" O.C. 2652 13.0 3.0 189
GLAZING: Windows or Doors 300 0.510 153
DOORS 42 0.510 21
FLOORS: Over Unconditioned Space 1256 19.0 0.0 60
HVAC EQUIPMENT: Furnace, 0.8 AFUE
-------------------------------------------------------------------------------
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 4.
Builder/Designer Date 2 y d V
A
MAScheck INSPECTION CHECKLIST
j-Massachusetts Energy Code
MAScheck Software Version 2.01
SINGLE FAMILY
DATE: 1-24-2000
Bldg. 1
Dept. 1
Use
I
I CEILINGS:
[ l I 1. R-38
I Comments/Location
I
WALLS:
[ ] I 1. Wood Frame, 16" O.C., R-13 + R-3
I Comments/Location
I
WINDOWS AND GLASS DOORS:
[ J I 1. U-value: 0.51
I For windows without labeled U-values, describe features:
I # Panes Frame Type Thermal Break? [ ] Yes [ ] No
I Comments/Location
I DOORS:
[ ] I 1. U-value: 0.51
I Comments/Location
I
I FLOORS:
[ ] I 1. Over Unconditioned Space, R-19
I Comments/Location
I
I HVAC EQUIPMENT:
[ ] i 1. Furnace, 0.8 AFUE
I
AIR LEAKAGE:
[ l I Joints, penetrations, and all other such openings in the building
I envelope that are sources of air leakage must be sealed. When'
I installed in the building envelope, recessed lighting fixtures
I shall meet one of the following requirements:
I 1. Type IC rated, manufactured with no penetrations between the
inside of the recessed fixture and ceiling cavity and sealed or
I gasketed to prevent air leakage into the unconditioned space.
I 2. Type IC rated, in accordance with Standard ASTM E 283, with no
I more than 2.0 cfm (0.944 L/s) air movement from the the
I conditioned space to the ceiling cavity. The lighting fixture
I shall have been tested at 75 PA or 1.57 lbs/ft2 pressure
I difference and shall be labeled.
I
I VAPOR RETARDER:
[ ] I Required on the warm-in-winter side of all non-vented framed
I ceilings, walls, and floors.
I
MATERIALS IDENTIFICATION:
[ ) I Materials and equipment must be identified so that compliance can
I be determined. Manufacturer manuals for all installed heating
1 and cooling equipment and service water heating equipment must be
I provided. Insulation R-values and glazing U-values must be clearly
I marked on the building plans or specifications.
I
I DUCT INSULATION:
[ ] I Ducts shall be insulated per Table J4.4.7.1.
I
I DUCT CONSTRUCTION:
[ ] I All accessible joints, seams, and connections of supply and return
I ductwork located outside conditioned space, including stud bays or
I joist cavities/spaces used to transport air, shall be sealed
I using mastic and fibrous backing tape installed according to the
I manufacturer's installation instructions. Mesh tape may be
i omitted where gaps are less than 1/8 inch. Duct tape is not
I permitted. The HVAC system must provide a means for balancing
1 air and water systems.
I
i TEMPERATURE CONTROLS:
[ ] 1 Thermostats are required for each separate HVAC system. A manual
1 or automatic means to partially restrict or shut off the heating
1 and/or cooling input to each zone or floor shall be provided.
HVAC EQUIPMENT SIZING:
( ] I Rated output capacity of the heating/cooling system is
I not greater than 1250 of the design load as specified
I in Sections 780CMR 1310 and J4.4.
I
[ ] I SWIMMING POOLS:
I All heated swimming pools must have an on/off heater switch and
1 require a cover unless over 200 of the heating energy is from
I non-depletable sources. Pool pumps require a time clock.
i
[ ] 1 HVAC PIPING INSULATION:
I HVAC piping conveying fluids above 120 F or chilled fluids
I below 55 F must be insulated to the following levels (in.) :
i
I PIPE SIZES (in.)
I HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-l" 1.25-2" 2.5-4"
I Low pressure/temp. 201-250 1.0 1.5 1.5 2.0
I Low temperature 120-200 0.5 1.0 1.0 1.5
I Steam condensate any 1.0 1.0 1.5 2.0
I COOLING SYSTEMS:
I Chilled water or 40-55 0.5 0.5 0.75 1.0
I refrigerant below 40 1.0 1.0 1.5 1.5
[ ] 1 CIRCULATING HOT WATER SYSTEMS:
I Insulate circulating hot water pipes to the following levels (in.) :
I
I PIPE SIZES (in.)
I NON-CIRCULATING I CIRCULATING MAINS & RUNOUTS
I HEATED WATER TEMP (F) : RUNOUTS 0-1" 1 0-1.25" 1.5-2.0" 2.0+"
1 170-180 0.5 1 1.0 1.5 2.0
I 140-160 0.5 I 0.5 1.0 1.5
I 100-130 0.5 1 0.5 0.5 1.0
NOTES TO FIELD (Building Department Use Only)-------------------------
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The Commonweaun of wtussaenuseus
Department of Industrial Accidents
-� 600 Washington Street
Boston,Mass. 02111
Workers' compensation Insurance Affidavit
name: rn CD
location: 335-
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city
❑ I am a homeowner performing all work myself.
❑ I am a sole p rietor and have no one worlds in anv ca aclty
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rovidin workers' co ensation for my employees working on this job.: ;:;:;: :;:< : . ;: , .,.
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Faflnre io secure coverage as required under Section 25A of MGL 152 can lead to the imposition o[crhninal penalties of a fine up to deist.00 and/or
one yam,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 understand that a
copy of this statement may be forwarded to the office of Investigations of the DIA for coverage verification
1 do hereby the pains and penalties of perjury that the information provided above is trap and carted
Date / -
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Phone# 3✓7 — 2S—/s— —
Print Ham �� --------------
official use only do not write in this area to be completed by city or town official
perruivitcense k ❑Building Department
7J
city or town: QLicensing Boerd
is required ❑Selectmen's Office
❑check if immediate responseq (--]Health Department
phone N,
contact person
— ❑Other
(tevued 9195 PJA)
` ACORD- CERTIFICA 1 t Ut- LIABILI I Y INtiUKAM;SR CT
l 12/01/99
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
The Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
of Cape Cod, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
480 Route 6A, P O Box 838 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
E. Sandwich MA 02537 COMPANIES AFFORDING COVERAGE
the Insurance Agency COMPANY
PnoneNo. —888-2766 FsuNo. _ A Legion Insurance Company
INSURED
COMPANY
B
J Scott Cimeno COMPANY
Old Centre Realty Trust C _
P O Box 635 COMPANY
Wareham MA 02571 D
COVERAGES
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 PLRTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TEAMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POUCY EXPIRATIONYY) LIMITS
LTR DATE(MM/DDrM DATE(MM/DDI
GENERAL LIABILITY GENERAL AGGREGATE S
COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG S
CLAIMS MADE C 1 OCCUR PERSONAL 3 ADV INJURY S
OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $
FIRE DAMAGE(Any one nre) S
MED EXP(Any one person) S
AUTOMOBILE UABIUTY
COMBINED SINGLE LIMIT S
ANY AUTO
ALL OWNED AUTOS
BODILY INJURY f
SCHEDULED AUTOS (Per person)
HIRED AUTOS
BODILY INJURY S
NON-OWNED AUTOS
(Per arGaont)
PROPERTY DAMAGE S
GARAGE LABILITY AUTO ONLY-EA ACCIDENT S
ANY AUTO OTHER THAN AUTO ONLY:
EACH ACCIDENT S
AGGREGATE S
EXCESS LIABILITY EACH OCCURRENCE S
UMBRELLA FORM AGOREGATE S
OTHER T14AN UMBRELLA FORM S
WC STATU- OTM-
WORXEAS COMPENSATION AND TORY LIMITS ER
EMPLOYERS LIABILITY
EL EACH ACCIDENT $ l OOOOO
A THE PROPRIETOR/ INCL WC5-0289809 11/23/99 11/23/00 ELDISEASE-POLICY LIMIT $ 500000
PARTNFASM XECUTIVE
OFFICERS ARE EXCL EL DISEASE-EA EMPLOYEE S 10 0 0 0 0
OTHER
DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLES/SPEGIALITEMS
Carpentry/Building
CERTIFICATE HOLDER CANCELLATION
SAMWI I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMP011 NO OBLIGATION OR LIABILITY
FAN KIND UPq*rECOMMNYj5Z8rkZ6 REPRESENTATIVES.
A ORl REP _S T
T nsur Ag cy
ACORD 25S(1195) " ACORD CORPORATION 198E
TOTAL P.01
NQTES
I.Water Supply ForThis Lot is Municipal Water. FG.71.0 Perc Test P-9150 Date 5/14/98
2 Location of Utilities Shown on This Plan Are Approx. i; n n � F.G. 0 SElnc. P.Sullivan Board Heath J.Dunning
70. e At Least 72 Hours Prior to Any Excavation ForThis TestH 1
Project The ContractorShall Make The Required r��68�. 0 2 o Organic MatteNotification to Dig Safe(1-800-322-4844) D-Box' 67.0 2"-14" A Vry Dk Gr Loam,Fn Sand 10YR5/4
67.$ s?500GaIlon i top i=f. 68.0 14"-28" B Yet BnFn Sand wLoam 10YR5/6
3. The Contractor is Required to Secure Appropriate 67 6
Permits From Town Agencies For Construction ' • Septic Tank 674 �:; Bot. E1.6 .0 2a"-12o~ c Fine Sand 10YR5/8
Defined byThis Plan. i. 67.2
• ••,+ +,
4. Install Risers as Requiredto Within 1211 of Bedding as Test Hole 2
5,
Finished Grade. Per Title 5
0-2" O Organic Matter 5YR2/2
10, 10.5 10' 10' 1 2' 2%16" A Vry Dk Gr Loam,Fn Sand 10YR5/4
5.All Structures Buried Four Feet or More or Subject' Bottom of Test Hole EL 60.0- 16^-26^ B Yet Bn Fn Sand w Loam 10YR 5/6
to Vehicular Traffic tobe H-20 Loading.
6 Septic System to be Installed in Accordance With 26%120" C Fine Sand 10YR5/8
310 � -
CMR 15.00 Latest Revision And The Town af
Barnstable Board of Health Regulations DEVELOPED:: PROFILE OF PROPOSE_ D SEPTIC SYSTEM Perc@50" Pre Soak 25 Gallons in less than l5Minutes
Bar
7. AI I Piping to be Sch. 40 PVC. .
Not to Scale Class 1 Material Less 2 minutes per inch
i
I
Finish Grade
Y
Filter _
M Fabric —*'_ ""-Compacted F10
12CIJ
1/8't I/2'o
M Pea Stone DESIGN DATA
i
tO .► Single Family-3 Bedroom
With no Garbage Grinder
Leaching ,� Daily Flow=110 x3 = 330 GPD
N Chamber 3/4 - 1 1/2 ' SepticTank:330 GPD x 200%=660 GPD
Double Washed Stone Use 1500 Gallon Septic Tank
4�-1d � LEACHING AREA �
12'-0" 330 GPD/0.74 =446'SF Required
SidewalI = 2(12't-25)2=148 S.F.
Bottom Area=12'x 25' = 30C S. F.
CI 446- .E Total Prov;ded
SEC70 +rtI BER LEACHING CHAMBER DESIGN
NOT TO SCALE_ All Pipes to be Schedule 40. Use
2 - 500 Gal. Leaching Chambers ina
12'x 25' Washed Stone Field as Shown
i
y
I '
fIEVISIf�NS.-
L,41116' a NO. DA TE V
A 52 50 r I'ETIV
SULLI NO.297�4
7oo* 44 12 +1JIv114- a
oQ I ��
FK'OApsr� 27 JP,u, �3r) -
TN-Z DA TE AqOr1,5,510NAL ENGINEER -TVIL
PA"L sq`yG° ► PLANSHOWING THE DESIGN OF A PROPOSED
�2 - « R.
o , RYLI +
,2 No.32448 SUBSURFACE SEPTIC DISPOSAL SYSTEM
P" 4
/ c - ,c LOT 4, ANTICO LANE BARNSTABLE, MA
TA N K
o �``` 4''� SCALE 1
Sum " 30 JANUARY 11,_ 2000
� �• � I -
CANAL LAND SURVEYING
LOT 4 _ _— i AD BUZZARDS SA Y, MA
PLAN VIEW ?6236f S.F. 'o z Dr, 306 OLD PL YMOUTH RO ,
NUMBER 00-004
Scale I"= 30' 173. 04 DA F2' S N L A S RrEYOR
PAOJEI;T