HomeMy WebLinkAbout0024 ELIJAH CHILDS LANE � ,
���2____
r
.,
Town of BarnstableBuilding
':..< �Via, 3 .,':'... ...:' ,� ,,��'. ':` i;; 4 �, < ,a.
PostTfiis Card So That rt rs Visible;From the Street Approued,;Plans Must be;Retained onfJob'and this Card MusRARIMA
t;be Kept z
Permit
6 "` Where a Certificate of Occupancy is Required,such Building shall Not be�®ccupied until a.Final�lnspection has been made
Permit No. B-20-802 Applicant Name: Douglas Mullen Approvals
Date Issued: 03/16/2020 Current Use: Structure
Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 09/16/2020 Foundation:
Location: 24 ELIJAH CHILDS LANE,CENTERVILLE Map/Lot: 171-257 Zoning District: RC Sheathing:
Owner on Record: PETERCUSKIE,JERRY S&KAREN JO Contractor Name ;^ DOUGLAS W MULLEN Framing: 1
Contractor LicenseW081995 2
Address: 24 ELIJAH CHILDS LANE gg
6�y i - -
CENTERVILLE, MA 02632ro—1st..? Cost: $5,000.00 Chimney:
Permit $35.00 ,
Description: Replace kitchen window like for like ,F Fee:
,.; Insulation:
i g Fee Paid: $35.00
Project Review Req: _ n Final:
Date: 3/16/2020
F `577
r Plumbing/Gas
y
L[1s��trv�
Rough.Plumbing: _
. . ... Building Official,
Final Plumbing:
This permit shall be deemed abandoned and invalid unless the work authorized'b`y this permit is commenced within six rhonths afte'r issuance.
All work authorized by this permit shall conform to the approved application,and'Athe approved construction documents for which this permit has been granted. Rough Gas:
All construction,alterations and changes of use of any building and structures�shall be in compliance with the,local zoning by laws and.codes.
g Final Gas:
This permit shall be displayed in a location clearly visible from access stye eto road�and shall be maintained open for public inspect n for the entire duration of the
work until the completion of the same. V F
Electrical
The Certificate of Occupancy will not be issued until all applicable signatures bythe Bwldmg and Fire Officials are provided on thi permit.
Minimum of Five Call Inspections Required for All Construction Work 'F Service:
p " � ;4'
1.Foundation or Footing ti
2.Sheathing Inspection ; .. ..� t�� Rough:
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed
Final:
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection
5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough:
6.Insulation
7.Final Inspection before Occupancy Low Voltage Final:
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health
Work shall not proceed until the Inspector has approved the various stages of construction.
Final:
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A).
Fire Department
Building plans are to be available on site
Final:
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT
Town of Barnstable
L
�
�A REC�IPT '
;
200 Main Street, Hyannis MA 02601 508-862-4038
163
Application for Building Permit
Application No: TB-17-3983 Date Recieved: 11/15/2017
Job Location: 24 ELIJAH CHILDS LANE,CENTERVILLE
Permit For: Building-Sidi ng/Windows/Roof/Doors
Contractor's Name: BRIAN D DENNISON State Lic. No: CS-095707
i
Address: , Charlton, MA 01507 Applicant Phone: (401) 714-6399
(Home)Owner's Name: PETERCUSKIE,GARY&JO ANN Phone (774)217-4166
(Home)Owner's Address: 43 LAZRUS LOVELL ROAD, CENTERVILLE,MA 02632
Work Description: INSTALL( 1 )REPLACEMENT PATIO DOOR NO STRUCTURAL
Total Value Of Work To Be Performed: $4,564.00
Structure Size: 0.00 0.00 0.00
Width Depth Total Area
I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before
he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568).
1 understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by
filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to
accept coverage.
I hereby certify that I am the owner of the property which-is the subject of this application or the authorized agent of the property owner and have
been authorized to make this application. .I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the
Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and
specifications. All information contained within is true and accurate to the best of my knowledge and belief.
All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24
hours in advance.
Signed: BRIAN DENNISON 11/15/2017 (401)714-6399
Applicant Date Telephone No.
Estimated Construction Costs/Permit Fees
Total Project Cost : $4,564.00 Date Paid Amount Paid Check#or CC# Pay Type
Total Permit Fee: $35.00 11/15/2017 $35.00 XXXX-XXXX XXXX- Credit Card
t........... 7716
........ ........._...._ ....................... _.
Total Permit Fee Paid: $35.00
`r� ` A THIS IS i�TOT A PERMIT
- Town of.Barnstable
i in
PostThrs Card So That`it=is Visible From the Street-Approved plans,Must be Retained on,Job ands;#his Card Mustbe Kept
BAfLN31'A13LB, ' .�;_ .. ,,,s. �•:, a -h. _ a _
6 Posted Until<Final Inspection Has Been Made. `
..
r: b P •
3A :;. ASs er It
Where a Gert�ficate_of Occupancys.Required,such�Buildmhall�Not be Occupied until a Final�In'spect�onhas been made
_i �.a ..
Permit No., B.47-3983 Applicant Name: BRIAN DENNISON Approvals
Date Issued: 11/15/2017
Current Use: .,: Structure
Ex iration Date: 15 2018 Foundation:
�05
e: Building Siding/Windows/Roof/Doors. P / / ,
Permit g
ICI .
Location 24 ELIJAH CHILDS LANE,CENTERVILLE Map/Lot: 171-257 Zoning.District: RC Sheathing:
§` Contractor Na"me „BRIAN D DENNISON Framin 1
Owner on Record: PETERCUSKIE,GARY&JO ANN a g:.
V
Address:i -. 43 LAZRUS tOVELL ROAD G Contractor License: CS 095707
2
CENTERVILLE,MA 02632 `, „., Est Project Cost: $4;564:00 Chimney:' .
Description. INSTALL'( 1) REPLACEMENT PATIO DOOR NO STRUCTURAL ' Pe�mrt Fee.:A $35.00
Insulation:
t n
F
Project-Review Req: ee Paid 5 35 00
t :Date 11/15/2017 Final:
I
Plumbing/Gas
.. . Building Official
,
RoughPlumbing:
�'
This permit shall be deemed abandoned and invalid unless the.work authorized by this permit is commenced within sa months after issuance. Final Plumbing:
i
All work authorized by this permit shall conform to the approved application and the approved construction documents, or whichthis 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. s Final Gas:
ee
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials:are provided on this permit. Electrical
Minimum of Five Call Inspections Required for All Construction Work -
1.Foundation or Footing Service:'
r
2.Sheathing Inspection `
Rough:
l before it I imn .i an 11
'3✓ N
I y
3.All fireplaces must be inspected at the throat leve be o e f est f ue I „ g s sta ed
4.Wiring&Plumbing Inspections to be completed prior to frame Inspectiona¢ a �tiy�
•
Final
5.Prior to Covering Structural Members(Frame Inspection) .
6.Insulation ;.
- iow Voltage Rough:
7.Final Inspection before Occupancy
Y
P P
r .
E
L w V �e Final:l 0 olta
II x
a' #a3w: g
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Ins tallations._ '_
C4 „
Work shall not proceed until the Inspector has approved the various stages of construction. Health'
a-
"Persons contracting with unregistered contractors do not have access to the guaranty fund'j'�( s set odrth In€MGLc 142A). Final:
Building plans are to be available on site Fire;Department
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT final:
Town of Barnstable low
c 200 Main Street, Hyannis MA 02601 508-862-4038
Application for Building Permit
Application No: B-17-3983 Date Recieved: 11/15/2017
Job Location: 24 ELIJAH CHILDS LANE,CENTERVILLE
Permit For: Building-Siding/Windows/Roof/Doors
Contractor's Name: BRIAN D DENNISON State Lic. No: CS-096707
Address: Charlton, MA 01507 applicant Phone: (401) 714=6399
(Home)Owner's Name: PETERCUSKIE,GARY&JO ANN Phone: (774)217-4166
(Home)Owner's Address: 43 LAZRUS LOVELL ROAD, CENTERVILLE, MA 02632
Work Description: INSTALL( 1 )REPLACEMENT PATIO DOOR NO STRUCTURAL
Total Value Of Work To Be Performed: $4,564.00 1
Structure Size: 0.00 0.00 0.00"7
Width Depth Total Area`
I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before
he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568).
I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by
filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to
accept coverage.
I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have
been authorized to make this application. I understand that when a permit is issued, it is a permit to proceed and grants no right to violate the
Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and
specifications. All information contained within is true and accurate to the best of my knowledge and belief.
All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24
hours in advance.
Signed: BRIAN DENNISON 11/15/2017 (401)714-6399
Applicant Date Telephone No.
Estimated Construction Costs/Permit Fees
LProjectost : $4,564.00 Aate PaidAmount Paid Check#or CC# Pay Type
ee: $35.00 11/15/2017 $35.00 ?XXXX-XXXX-XXXX- Credit Card
7716
ee-Paid: $35.00 .........................._......_......................................_.1..................................................................._. ..................................................................-
e
• TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
y
Map Parcel Application #
Health Division Date Issued 7
Conservation Division `3 pp
A lication Fee
Planning Dept. N0 ���•� Permit Fee
Date Definitive Plan Approved by Planning Board 10
Historic - OKH _ Preservation/ Hyannis
Project Street Address
Village Cf_—"T V?LL&- 02-0z,Z
Owner !V I:XneU�r'- k l Address f_-- L-I$INA C,,('h 457 �
Telephone t Cl'$1 q CA V
Permit Request M(DUB OtJ 5C_sbP '10 '13&° ?W&A-)I—
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation M6 P90,VOConstruction 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
Basement Finished Area(sq.ft.) 6 TL_ Basement Unfinished Area (sq.ft)
Number of Baths: Full: existing new Half: existing new
Number of Bedrooms: existing —new
Total Room Count (not including baths): existing new First Floor Room Count
Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other
Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No
Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_
Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes ❑ No If yes,'site plan review#
Current Use Proposed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER) -
Name 'IQ)(1h"4-5 M"rf,� Telephone Number !RF - 73 7--y3�
Address 'Po IZ?`/ License # /!M
A44 Mr V0 l M IVA 07-&T7 Home Improvement Contractor# 1 7 53 7
Email U2VO 9 t-0 !11 Worker's Compensation # l y Cd660b 50►'z, JOY�IL/t
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO - '11W440a7_4
w`7IAI
SIGNATURE DATE Za%'
\s" FOR OFFICIAL USE ONLY
' APPLICATION #
DATE ISSUED
MAP/ PARCEL NO.
n
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.
77ie Comniorrivealtrh o—Vassachusetts
Deparhrrerit o,f'r"ndush ial Accidents
- -- O,ffice o,f In tigations
600 Washingion Street
Boston,M4 02111
Workers' Compensatian Insurance Affidavit.BudlderdCantractnrs/FlectricianslPlumhers
Applicant Infa~imafan ' 1 Please Print Legibly
lvaffieB7]SfIIec3IIj2a}jgnl�n
Address_ r(J �L alL{
Are a a employer x�ith_� ❑I am a�n employer?Check the appropriate box: ' Type of project(required):
I.L� I azg
�� eneral coufmctor and I 6. ❑New construction
employees(frill anNor part-time).* have hired.the sub-contractors
2.❑ I am a sole proprietor orpartner- listed on the attached sheet., 7. 0 ling
ship and have no employees. These sub-contrac#ors have g-,❑Demolition
woddng for me in any capacity- employees and have workers' 9. ❑Building addition
0 Na i4ofkem. comp.insurance Comlp.tasurani�
required-] 5. ❑ We.area cotparatian and its lU:❑Electrical repairs or additions
3.❑ 1 am.a homeowner doing all work of have eaercised thek 11-❑Plumbing repairs or additions
myself [No workers'comp- right of exemption per lwl GL 12.❑Roof repairs
ir�ce required,]1 : c.152,§1t4k and we have no
employees.[No workers' 13.❑Other
camp_insurance required:]
*Any sppKcam2 tbatcbecksbox AEl— also fMmtthe sectionbelawshwvdng ih&woAeroe eompevsatiaapCHUi#bMMff-ioM-
1 Mmeowners who submit d m afUnn;in citing they an=_daiag zU waft sad their hap autside rAatractors omit submit a new affidavit is iestiag SUCE
fCaatractoistbatchecki�isboxmustSttErhafi additinoslskeetdiovdng the nsm,eof&asub-contwbotssndstatewhetherornmtbasee2tkshave
em Iwjees.If the sab-ccm=ctmslure etapIU-9,thegmustPivi.-ide their Wurk—'rump.palfCY MIMber.
I arrt an eetpia}�crr tltrrtis pratzrirrt��t�arkers'contpenrsaliart innsrirarice�vr at}*empFay�ee.s Selo�v is fhe paliry arrf jnh she
information
IttsuranceCompanyName:
policy#or Self-ins.Uc: : Expiration on Date:
Job SiteAddmss: City/State Z p:
Attach a copy of the workers'compensationp.olicy declaration page(showing the policy number and expiration date).
Failure to secure coverage as,required under Secdon.25A o€MGL c 1527 can lead to the imposition of eziminal penalties of a
fine up to$".OD 00 an&fGr one-year imprisonment,as well as civil penalties.in the form of a STOP WORK ORDERand a flue
of up to$250-00 a day against the violator. Be advised that a copy of this statement may.be forwarded to the Office of
Investigations.of the DIA for insurance covera;e verifrcaticm..
I do hereby certE ider the pruns aced periafties vfFerjitry fJtaffJte irzfbrmafimt provided abm� bare artd correct
Sitntature: Date:
Phone
O,Oacial use aptly. Do not unite in this area,to be co-inpteted by dty or town official
City or Tomv.: PermitUcense#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.Cityffown.Clerk 4:Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
- Qrmation and ast-uctions
hfassacbnsetts GeheaalLaws chapter 152 recces all employers in provide workers'compensation for their employees.
pUrS`Mnf7-tD this fie,as eVIayee is defined as."_.every person in the service of another under any corftact of hire,
express or implied,oral or writtEn"
An errrployM is defied as"an individual,partnership,association,corporation or other Iegal enfify,or nay 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 au individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling horse having not more three apartments and who resides therein,or the o=paat of the -
eiii g house of another who employs persons to do mainf�CM,consfruction or repair WOlk on such dweEi house
dv
or on_the grounds orbuildngappur[un�themto shaHnotbecanse of such employmeutbe deemed to be an employer."
l�LGL chapter 152,§25C(6)also sues 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 cdmpliance with the insurance coverage required."
Additionally,MGM chapter 152,§25C(7)sues"Neither the commgnwealth nor gay of ifs political subdivisions shall
=ter inin any contract for the performance ofpublio wow utI acceptable evidence of complian.cevr th the insm d ce`%
regtm-emeuts of this chapter have been presented to the contacting aufiioi�ty"
Applicants
Please -oirt the woricers'compensation affidavit completely,by checl the boxes that apply to your situation and,if
necessary,supply sub-contractors)name(s), addresses)aadphonenumber(s) alongwith.thea certificates)of
insurance. Limittd Liabdity Companies(LLC)or LinritedLiability Partnerships(LLP)with no employees other than the
members or partneas,are not required to cauy workers'compensation insoraa= If all LLC or LLP does have
employees, a policy is required. Be advisedthat this afddayit maybe submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the afjidavit The affidavit should
beretumed to ffi(-,city or town that the appficafion for the peanit or license is being requested,not the Department of
r A_ccid=-ts. Should you have any questions regarding the law or if you are reqused to obtain a workers'
compensation policy,please call the Department at fhe nrm.ber listed below. Self-insured companies should enter their
s elf-insu=ce license number on the appropriate Ime.
City or Town Officials
Please be sere that the affidavit is complete and prhted.legibly. The,Department has provided a space at the bottom
tie applicant
' the event the Office ofinv �ons has to Co7�3Ctyouregarding agp
of the affidavit for you to till.out m ��
Please be, ure s to fill in the pem en iit/licse number which will be used as a reference number. Ia addition,an applicant
that must submit multiple pemlitUcanse applications in any given year,need only submit one affidavit indicating current
policy ij ljmation Cif necessary)and under"Job Site A d,—Jress"the applicant should writes"all locations in (may or .
town)-"A copy of the-affidavit that has been officially sipped or maimed by the city or tows maybe provided to file
applicant as proof that a valid affidavit is on file for future permits or licenses A new affidavit must:be filled.oirt each
year.Where a home owner or citizen is obtaining a license.or permit not related tQ any business or commercial venue
e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit
The Office of Investigaiions would hke to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call-
The Deparinimf s address,telephone and fax number
Tha C-G-MmawmME of Massrhnsz#
Dq-pa tnmt of lndustzal AccidCD:tst
Q�it�e of�.�e�f?g�tio�
�Q4�arsbin�tan t
Bastauz MA 01 11I
Tt,-1.4 6 1 7-727-49OG Qxt 406 ar 1-977-M&&3AFE
Fag 617-727-7M
Revised 4-24-07 imaz-gavidia
i;a ur rc;;istr:►tion valid for ind Jittul use only " Otttcc orC onsumer A aliF III ne�s 1
+u��,iir3Non.date.>j F6und return to: .. � QME IMPROVEMENT CONTRe+C iOF 5
w ,
� onc,,n:Fr fairs and Business Rcl;elation � f ngip.tration. 1T5311
i ` r'tn[r Suile 5170 xplration 51'(6047 LLt'. '
Ic�i ,N A :ll t6 MU�L,?N BUILD{PJG&,REMCICF�#NG; LI:r
_ q
A
t QOUGLAS MULLEN
8%HICKORY HILL GFt'' w ^,
OSTERVIL#;E,M O2655
7ot uli�t ylthout sigc.turo'
. M
a' tulassttiusetts"O Fee Uiatip Stand Standards
ofi 6uiiding �_
n e: CS-081895
6on5tt4fliP U� rria_ CA
r r< OOUGLAS W MULI ENr
8T HICKORY HILL CiRj x t
pSTERVILLE MA CIS
oU2312018
. 1�;ornrtzEss"tohde -
t
B _
a
h
to
:
..
e .
PT
77777
f p
: �6
:
-
d
•
eQcj
!ti!O GA2ssdaG� �sRe+.tL7>EtZ. eut R
s laa �c 3 •> ��,�;�o+: ,.
a - SF—nC -rtsr.iic a :a—,roe lSo A-q5 6.Pa
ooeo 4Ae.. F too- ry
15PD�,DL. 'PiT - t locc 4AA.•.
}XUr..w.w
ion SF' :�` � 2.5• • 3?S G,.P.Z7. /r# �„ �--:�:.r.».• -
'EIOTTOM i7$
TCT'AL• "L76S1GW _.425 -�`T•w=
-MTo t_ •C,pat,L>f I=Low?
— 1p
PMr-DLLiTtOQ VATE.: �t"'W 2-Mt&J.' K. - �, p• Pop .
f area
MMChAA r r �,n ' • ric Z.S�
too.
- To*_F4.,•woo.o
e
49�
s
'3e
S�?lsors.. 4 &,e L.
130x 46.G SAC toICCO s.
tl
Fee. Sis« ( Ls�acN 5 4�•Z aa.•� ;.
FIT � fl
x VviT'&I wo
r " STO�•i� OrO " C - - .
N,ev f;EQTtr--%so PLbr OLA$J_
s oazi - PCol='t LS- l-OCATI O14 .J iimv �c.L� {
So 32
! o WATex
I TkAr TNr-- �nvat�ATt��i gtaorvN
WIC rsZ�sjj Cr ,tiP1_�s w Y� tom: �yr1a1=s�1�••l>~ crl'. 3
A► r.> ie-m' AC-4 K'C4t�1�CMc�tTS Gt= 1-b•i1~
'Tovjw op- -$A;lz A`3LS $.1fIVL.t'3 Ie E�adp,4
DA'1'C I s :st CA �:XTIr�Z. u�� t •1G.
RGCtS+LLD LA'1.1t`7 5t�•�v�?.Y�t=-;
t l=tJ i•o {W,C�,:J!✓� - i�� u�rc::tic`ue- � T' Ap�LCA."IT,
u"e LAi1 CVILL !
-vr-,O r 1t ..�
Co v CERTIFICATE OF LIABILITY I naTE(�owwyYrq
NSURANCE
11/10/2016"
THIS CERTIFICATE IS ISSUED AS AMATTER OF INFORMATION ONLY AND;CONFER$ NO;RIGHTS;UPON;THE CERTIFICATE'HOLDER: THIS
CERTIFICATE DOES;NOT::AFFIRMATIVELY.OR NEGATNELY;AMEND, EXTEND._OR.ALTER:THE.COVERAGE:AFFORDED BY THE POLICIES
BELOWr;Tklg CERT(FICATE;OF.:WSURANCE DOES:NOT CONSTITUTE A:CONTFIACT BETWEEN'.THE ISSUING INSURER(S), AUTHORGED
REPRESENTATIVE'OR PRODUCER;AND THE:CERTIFICATE HOLDER: . .,
IMPORTANTs>n the:certlecate holder:is an ADDITIONAL INSURED,the pollcy(lee)must:be endorsed. If SUBROGATION:IS WAIVED,aub)ect to
the;t. .. . and Condltlons ofahe policy,Certain policies may require an endorsement A statement on this Certificate does:not confer rights to the
certificate holder In Ileu of such endorsernent(s , :- ;; ,;
PRODUCER t:
Ashley Paiva .::
.Southeasters Iasuraace:Agency, IIIo: PHONE': (5.08)997-6061 F (308)990 2731
439 $tate;ltd. �IL'' apai- is iitheasterniaf3.com ;
P.O SOX 79395 M8URE S AFFORDINOCOVBRAOE NAK 0
North Dartmouth MA 02747
:;'..:: 0BUREo .'.
lN8URERA31rh@11a Protection Iasuraace 41360
INSURER 8.AEIC;
Mullea Building ;& Remodel3 ng LLC < wsltREe c.
:
PO Bt)B 127I ' INSURER D.
INSURER E
IIIarI3.I . . Mills MA 02648 uR F:
COVERAGES::: - CERTIFICATE NUMBER:2016
REVISION NUMBER:
THIS.IS TO:CERTIFY::THAT THE POLICIES OF INSURANCE LISTED.BELOW NAVE BEEN ISSUED.TO THE:INSURED NAMED ABOVE:FOR THE POLICY PERIOD `
INDICATED:: NOTWITHSTANDING ANY:REQUIREMENT :TERM OR.CONDITION OF ANY CONTRACT;OR:O.THER DOCUMENT WI TO.WHICH THIS:'
:CERTIFICATE MAYBE ISSUED:OR MAY:;PERTAIN,THE INSURANCE AFFORDED BY;THE PQLfCIES;DESCRIBED,HEREIN IS;SUBJECT TO ALL:THE TERMS,:: I.
.;EXCLUSIONS AND CONDITIONS OF SUCHWOLICIES.LIMITS SHOWN:MAY HAVE BE EN:REDUCED;BY mb..:CLAIMS:;:
I R •TYPE OF.INSURANCE bows
EF L Y EXP
.. LTR PO . .NUMBER ::
X' COMMERCIAL GENERAL LIAatLRY
1,000,000r
": LRAITS
A CLAIMS-GAADE;�$ OCCUR
.
EACH OCCURRENCE .S
<, 300,000`
S
95200032. 9/8/201. 9/8/2017 MEDEXP one n S 5,000
PERSONAL:&ADV INJURY $.:' 1;:600,000.
GEN L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 2:1 000,000
X;
POLICY a LOC
PRODUCTS`9COMP/DPI S 2:�000,000
OTHERi:,
. ...:
AUTOMOBILE LIABILRY:
S
E t S 1;0oo,000 ,
A ANY ALRO % BODILY INJURY(Per person) $
.. ALL OWNED SCHEDULED
gtmpg:..:. Ix
:A/rOS. 10700262.. . ,. : 11/17/.Z03,6 11/12/]017 :90DILY INJURY:(Per:ecddanq S:,NON-0WNEDx` HIRED AUTOS . ..
AUTOS:
PR PER GE :.:
, e derd S :.: ,
Uninsured motorist 81 k lki* .:: 280,000'
::, UMBRELLA LUIB
OCCUR .... ..
EXCESS LIAR
EACH OCCURRENCE S
CLAIMS-MADE
.. AGGREGATE: S
DED RETENTI N S
..
WORKERB COMPENSATION % P
ANDErdPLOYERB LU181.LITY Y/N
ANY PROPRIETOR/PARTNERIEXECUTIVE E:L EACH ACCIDENT S
8 OFFICERIMEMBER EXCLUDED? N/A 1 000 Ooo:
(Mandatay.)nNH) NCCSOOSO1S3082916A 0/90/1015 0/30/2017 `E
rc yygegg descrth under
DESCRIPTION OF OPERATIONS below
L DISEASE EA ENIPL S : 1 000 000.
• E.L.DISEASE POLICY LIMIT .S: : 1 666 000:
DESCRIPTION OF.OPERATKINa/LOCATIONS/VEHICLES(ACORD 101,Addldonai Remarks Schedule,maybe."ached if mas speee Is*ulietl)
.CERTIFICATE HOLDER i .
'CANCELLATION :: ::
SHOULD.ANY OF THE ABOVE DESCRIBED;POLICIE8 BE CANCELLED.BEFORE':
THE EXPIRATION DATE .THEREOF, NOTICE WILL BE DELNERED IN
1. `; ., I. AC
- . . ..
CORDANCE:WITH THE`POLICY:PROVISIONS.
-. . . ..,E.
AUTHORIZED REPRE8ENTATNfb
.:. A ahley Paiva/AMP
101988.20U ACOR.D CORPORATION All tights reserved
ACORD 25(2014/01) The ACORD name and Iogo are reglstered marks of ACORD
: :INS0266ntann><
s .
Ttt�r. a o
Town of Barnstable' *Permit#
"� 'a Expires 6 months froi issue date
gam. Regulatory Services Fe '
ARNSlLEh
� M^ Thomas F. Geiler, Director '
STABLE c
T®WN Building Division V�7
TomPerry,CBO, Building Commissioner200 Main Street,Hyannis, MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax ,
EXPRESS PERMIT APPLICATION• RESIDENTIAL ONLY
Not Valid with out Red X-Press Imprint
✓r
Map/parcel Number _
Property Address 1 �/. / ",l `.e-)e 11`L 16 .IQ
'
Residential Value of Work-3 �� 'Minimum fee of$35.00 for work under$6000.00
F A.-
Owner's Name& Address�5-'51
Contractor's.Name �C`( LJiL�j» �;e>�✓:S% t/�l/�� TelephoneNumber �� -��U
Home Improvement Contractor License# (if applicable) ',
Construction Supervisor's.License#(if applicable) 7 9I rt{
❑Workman'sCompensation Insurance,
Check one:
I am a sole proprietor
❑ I am the Homeowner
:I have Worker's Compensation Insurance
Insurance Company Name 'f;(`;L
Workman's Comp. Policy.#
Copy of Insurance Compliance Certificate must accompany each permit
Permit Request(check box)
- ram.._--- ---------- �-- =---- '---___--_ •.
Re-roof:(stripping old shingles) All construction debris will be takento
Re-roof(not stripping.'Going over existing layers of roof)
❑ Re-side
a - #.of doors
- maximum .44 #of,windows V lue• Re Iacement Windows/doors/sliders. U a
P
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e. Historic,Conservation,etc.
*Note: Property..Owner must sign Property Owner Letter of.Permission
A`copyof the Home Improvement Contractors License &:Construction Supervisors License.pe is
quired
SIGNATURE:
QAWHILESTORMS\building permit forms\EXPRESS.doc
Revised 070110
DATE(MMI°D YI YY)
CERTIFICATE,OF LIABILITY INSURANCE
106/01/2010.
THIS CERTIFICATE IS'ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS .NO RIGHTS UPON THE CERTIFICATE HOLDER.- THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT, CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. _
IMPORTANT: If the certificate, holder is, an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION 'IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require, an endorsement.'A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
RODUCER - NAME: -
ichlegel & Schlegel Insurance Brokers Inc PHONE FAX
(ac,No,Exq: '(508) 771 8381 (ac No).(508) •771 - 0663
34 MAIN STREET E-MAIL.
ADDRESS: - ... .. -
- PRODUCER_.__.____
CUSTOMER ID p:
Best Yarmouth, MA 02673 INSURER(S)AFFORDING COVERAGE NAIC#.
- .. . . ,•
dSURED INSURER ANGM INSURANCE ! -
Ldilson Segolini Dba Segolini Construction ;
L17 Minton Lane
INSURER.BGRANITE STATE
-
- INSURER.C:- -
INSURER 0: i
Test Barnstable, MA .02668 INSURER E:
-INSURER F:. .. .-. -
:OVERAGES 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 T0. ALL THE TERMS,
EXCLUSIONS AND CONDITION F S O SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS:
ISRoDL�S➢BR - - - POLICY EFF POLICY EXP.
TR TYPE OF INSURANCE < INSR I WED POLICY NUMBER -
-(MMIDD/YYYY) (MM/DOM'YY) LIMITS
L GENERAL LIABILITY _ EACH OCCURRENCE S 1 00 OOO .0
X
. -- MPT8486II 05/0T/201005/07/2011 r r
[ DAMAGEETORENTED`-COMMERCIAL GENERAL LIABILITY- PREMISES(Ea occurrence) S 5OO,OOO -
.CLAIMS-MADE CIOCCUR - MED EXP(Any one person) , S;lOi000
- - I - - PERSONAL&ADV INJURY S 1',000.,OOO-
: GENERAL AGGREGATE $2,000,000 -
GEN'L AGGREGATE'LIMIT APPLIES PER: - - PRODUCTS-COMP/OP AGG 52,000,000
POLICY.' PRO- - -
JECT n LOC .r S,
�.
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT - $
ANY AUTO + - �/ (Ea accident). .
r BODILY INJURY(Per person) S -
,:
!ALL OWNED AUTOS -
t - - BODILY INJURY(Per accident) S
i SCHEDULED AUTOS - - - - - -
- PROPERTY DAMAGE : .S
HIRED AUTOS `' - -
,. (Per accident)
I:NON:OWNEO AUTOS - - 5.: ..
UMBRELLA LIAO_, OCCUR - EACH OCCURRENCE.
..t S
EXCESS LIAO - - — -
CLAIMS-MADE - - AGGREGATE $
- ,..
DEDUCTIBLE .. S
RETENTION S S
3 AND EMPLOYERS'
YERS'LIOM ABILITY
A ILIT WC-007-648-4368- 05/23/2010 05/23/2011 g we sTATu-AND EMPLOYERS'LIABILITY - ,Y�N � - - _ TORY LIMITS - ER„
ANY PROPRIETORIPARTNERIEXECUTIVE E L:EACH ACCIDENT S 100,000
OFFI
It yes,describe under CER/MEMOER EXCLUDED? - a NIA. - -
(Mandatory.in.NH).___,.__- .-.-�.:_._.. ,.�_-.�—� ____^ _,-,+._. .. - _,. ,. _-_ ..•;r-_, -E:L:DISEASE-F.4 EMPLOYEE----,S--ZOO.J.0 S O'-- -
DESCRIPTION OF OPERATIONS below I - E:L.DISEASE-POLICY LIMIT - S 500,000
SCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) - -
_�DILSON SEGOLINI HAS ELECTED COVERAGE FOR HIS WORKERS COMPENSATION POLICY .
ERTIFICATE HOLDER 'CANCELLATION d„
LONE ON FILE
. - SHOULD'ANY .OF THE.ABOVE DESCRIBED POLICIES BE. CANCELLED'BEFORE _
- THE- EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZ REPRESENTATIVE - -
1 8 09 ACORD CORPORATION. All right
CORD 25(2009109) The ACORD name and logo are registered marks of ACO
I.
Massachusetts: Depa-tment of Public Safet%
Board.of Bu►Idiny Regulations rnd St tnd.bl dti
t onstructlora Supervisor Specialty Eep}se
L S C 99907
icense S L
Restricted to RF WS PM .
ADIL-SON :SEGOLINI
117 MINTON;LANE 2
WEST BARNSTABLE MA 02668
�J- °mayj Expiration: 10/14/2011:
_ C'bnnussi :"" , Tr#:,:99907'
fie i�o�rwnzooN�re������
Office of Consumer Affairs&B siness Regulation_ License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration 1;59597 Type:. Office of Consumer Affairs and Business Regulation
: Expiration. 5L15)2,012 DBA' 10 Park Plaza-Suite 5170
Boston,MA 02116
SM LINI CONSTRUCTION
{
ADILSON SEGOLI.NI �,
117 MINTON LANE V,
WEST BARNSTABLE WA;A2668 -
y� Undersecretary No alid without signature
The Co'nimoirwer lth .of Massachusetts
T
Derrrirrterrt of lrulrrsrirzl_Acc irlerrts
Office ice. of Investigations
600 Waslrirzgto'rr Street
Boston, 02111,
ft nww.rrr?rss,govIdlirr
Yorkers' Compensat on.Insurance_Affidavit:Builders/Contractoi•s/Electi cians/Pinmbers
Applicant Information Please Print Legibly
Name,t13usinews/tlrgaIli..ationrindividual)
Address- L/? �f�%✓Td� �N
City/State/Zrp: �. /1/vlTd� .WY 6 Y nion #_ �9
Are You an employer? Check the appropriate box, Type of p0ject(required)`
1. I am a ern to er vath 4. ❑ I arm a general contractor and I
p � .6. ❑Near construction
employees(full andJ: art-titrve .* ' ha`•e:hired the sub-contractors
I❑ I am a sole proprietor ar parEner listed on the attached sheet 'T ❑Remodeling
ship and have no employees These sub-contractors have $_ ❑:Demolition
working for me in an c ci employees and have workers'.
Y. t5' 1 9. ❑Building addition
[No workers' comp.insuuance comp_tnsurance.
required] 5: ❑ We area corporation and its 1D.❑Electrical repairs or additions
afftcea-s have exercised their 11.. Plumbing re. airs or additions
3'.❑ .I.aru a hameowiier doing all vrork .. ❑ g P '
No workers'c might:of exemption per NIGL
�"self � �• 12.0 Roof repairs
insuuance required.]r c. 152, §1('4),and-i;fe have no
employees.[No workers' 11 El Other
comp.,insurance:required.1,
•Any appkicant that checks box#1 must also fill one the:section below shoariug their workers'compemsation policy information
1 Hotneo. ners who submit[his affidavit indicating they are doing all wink and then hire outside contractors must submit sinew aff da-vitindicating such.
°Contractors that check this box mina attached an additions!sheet.showing Use name of the sub-contractors and state whether or not(hose entities hate
employees. Ifthe sub-contractors have employees,they mast provide their Workers'comp:policy ntnnber..
I at"art employer that is providing 1porikers'coijtperlsadvit insi4rance for lrly etttployees. Bel?w is the policy"and fob site,
infornzadolL
Insurance Company Name: �C/f� 6��cez`
Polity A or Self ins_Lie. : 4' 0 U 18 Expiration Date`
Jab Site Addressr' '1 t-// f� P G•'!' city/State/zip:
r '
Attach a copy of the Work
compensation policy declaration page(showing the policy number,and expiration date).
Failure to secure coverage,as required under Section.2.5A of I41GL c. 1.52 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or ane-year imprisonment,as well as ciNril penalties is the form of a STOP WORK ORDER and a fine '
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the,Office of
Investigations of the IJIA for insurance coverage verification.
I do hem bt certify r der tFte s atirleltalties of*duty that the informationprorrirletd ab rxzism and comet i
. Signattire
Phone#:
Official use oltty,. Do not ivrite in this area,to be c4inpleted bye city or totvrt orioat:
City or To-Aim: Perrnit/Iaicense
Issuing Authority(circle one):
1.Board of Health 3.Building Department 3.City(fomm Clerk 4..Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
OF ZHE rp�
. BARNSPABLE, ' - -
MASS'
i63q• Town of Barnstable
Q7 ��
al fD MpV A . -
Regulatory Services
Thomas.F. Geiler, Director
Building Division
Thomas Perry, CBO
Building Commissioner
200 Main Street, Hyannis,MA 02601 ,
www.town.barnstabie.ma.us
Office: 508-862-4038 Fax: 508-790-6230
t.
Property Owner Must
Complete and Sign This Section". "
If Using,A Builder
csi �ILr �A
1, , as Owner of the subject property
hereby authorize t-� I�n��: 1 CzQti, S TW 67-i n 0to act.on my behalf,
in all matters relative to work authorized by.this building perrnif application for:
a�� C L0At4 ChI L 0
(Address of Job)
S" nature of Owner Date J
Print Name
If Property Owner is applying for permit, please complete the Homeowners License Exemption Form on the
reverse side.
Q1WPFILESTORMSIbuilding permit forms\EXPRESS.doc
Revised 070110
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel / Application #060906 73
Health Division - nn Date Issued Z 3
Conservation Division �J� Application.
Planning Dept. " Permit Fee
Date Definitive Plan Approved by Planning Board �2J3109 U
Historic - OKH _ Preservation / Hyannis
<--ProjecStr eet Ad-des L1 G CJ, �fit.+ ��5 cON"-t-
,Owned:, e SS i q LA c t 11 -�t, , , cAddress S c -
Telephone
Permit Request e , 1' Cr- o,e.
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Projec-t=Val_ ua` t f41 r)c)<n,00 Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attacrEs61 pportingdoci entation.
Ri -�
Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) z l _ o +
Age of Existing Structure Historic House: ❑Yes ❑ No On Old King' Highwa ❑)�s ❑ No
Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other
�o
Basement Finished Area (sq.ft.) Basement Unfinished Area (sq. ) w
Number of Baths: Full: existing new Half: existing new
Number of Bedrooms: existing _new
Total Room Count (not including baths): existing new First Floor Room Count
Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other
Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No
Detached garage: ❑existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_
Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes ❑ No If yes, site plan review #
Current Use Proposed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER) s®k /V 72-
Name'=4"4-05 S i e c,PAs rTelephone.Number__5 eAS-/-/a y y & 7
Address p=-q !,i J, S License#
J Home Improvement Contractor#
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
"-� -
SIGNATURE .,C:<zfu-�- � DATE-�ltI-�c+ CS
FOR OFFICIAL USE ONLY
APPLICATION#
DATE ISSUED
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
FOUNDATION
FRAME
x
INSULATION
' FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
I' 600 Washington Street .
Boston, MA 02111
47
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
y
CNam (e B siness/Organization/Individual):
Mddre- s�s:— ' S c41V
City/State`/Zip Nye 0 2. Phone #: - IP6 0 S P/6
Are you an employer? Check the appropriate box: Type of project(required):
1.❑ I am a employer with r ]`I�_g eral contractor and I
employees (full and/or part-time).
* haverhired'the,sub=contractors 6. ❑ New construction
2.❑ I am a sole proprietor or partner- listed-on sweet. 7. ❑ Remodeling
ship and have no employees t These=sub-zcontractorrs have g. ❑.Demolition
workingfor me in an capacity. employees=andyhave workers
Y 9. ❑ Building addition
[No workers' comp. insurance comp, insurance.
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ 1 am a homeowner doing all work officers have exercised their 1 I.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.]t c. 152,,§1(4), and we have no
employees. [No workers' 13.0 Other
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.
tContractors 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:
Policy#or Self-ins. Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section,25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
-Sim natu eQb
Phone#:
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#:
f
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "...every person 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 local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required." .
Additionally,MGL chapter 152, §25C(7) states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit.. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete.this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Revised 4-24-07 `
Fax# 617-727-7749
www.mass.gov/dia
Town of Barnstable
�oI'VE ray
O Regulatory Set-vices
BA STAB Thomas F. Geiler,Director
LF-
11 . ,� Building Division r
PrEn►,gay�
Tom Perry,Building Commissioner
200 Maid-Street, Hyann M is, A 026.01
wwwAown.b zrnstable.ma.us
Office: 508-962-403 8 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Plcase Print
'—JO-B=ICA-TI0.T1: ��.�F 6 i It- ` GL O S
number street villa'gc
=`fOMWNERY��!
name p home phone# ygrlion #
�CURRENT-MAtI1N:G=ADDRESS� tS R 2 r�[rJ C� fe--- n j
eity/tovrn 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 HOMEO'SWER
Rergou(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 Biu7ding Of6cial 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)
7
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/sbe understands the.Town of Barnstable Building Department
minirnum inspection procedures and requirements and that he/she will comply with said procedures and
remrirements. °.
5i�ature of-HoTnwwria -
vU '•
Approval of Building Official
Note: Three-fauOy 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
.(Sectian 109.1.1 -Uccnsing of construction Supervisors);provided that if the homeoryncr cngages a pason(s)for hire to do such
work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they an assuming the rcsponnbilitics of a supervisor(see Appendix Q,
Rulcs&Regulations for Licensing Construction Supervison,Section 2.15) This lack of awarrness bflrn 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 responnbilities,many communities require,as part of the permit application,
that the homeowner certify that helshe understands the responnbilities 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 forrn/ccrtifieation for use in your community.
Q:forrns:homecxcmpt
� ro�ti Town of Barnstable
` Regulatory Services
• sAxHsrAs[
KAB& g, Thomas F_ Geiler,Director
1659.
0 a Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis, MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-621
Property O 6er ust
Complete and Sign his Section
If UsingA� uilder
as Owner of the subject property
hereby authorize to act on my behalf,
in all matters relative to work autho d by this building permit application for.
• e
dress of job)
Signature of Owner Date
Print Name
• e
Owner i 'n for pen-nit leas
If Pro e (awn r s applying P PP � g P P
Homeowners License Exemption Form on e reverse side.
NOU-18-2009 09:02 MARK T. VOKEY I.NS. AGENCY 5089459368 P.03
KENN= IsstlFDATE 1111812009
F PRODUCER
THIS CERTIFICATE IS ISSULD AS A MATTER OF INFORMATION ONT.v.awe
Mark 7'Vokey Ins Agcy hic CONFERS NO RIGHTS UPON'THIi CL••RTIFICATE ROI-DER.THIS CERTIFICATE
P O Box 1?.q7 DOES NOT AMEND,EXTEND ORTO CyLRn I�•ODI D BY THE
POLICIES5 BELOW,
Jcst Chatham,MA 02669
COMPAMS��WOWIZ CM%6Gk
INSURED
William N Fiero
dba Fiero Masonry ! CONVANY A A.I.M.Mutual InsII_r_ancc
�t99 Harwich Road LETTER 1 1 S N
rewster,IVA 02631
•
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAh4ED ABOVE FOR THE POLICY
PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDTTION OF ANY CONTRACT OR OTI-IER DOCUMENT WITH RESPECT
To WHICH THIS CERTE-ICAT'E MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED 13Y THE POLICIES DESCR18ED HEREIN IS S UBIECT i
TO ALL THF.TFTRAMS,EX6LUSIONS AND COND17IONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE DEEN REDUCED BY PAID CI.AIIVIS.
CD TYPS OP INSUFANCE POLICY NUMBER JIOLICY EFFECTIVE POLICY EXPIRATION LIMI'TR -
LT8 DATE(MMID7IYT) DATE:MMIDDrYY)
GE71ENAL LIABILITY CEIJERAL AGGREGATE 1 - -
PR0MJCTB-17OMPCP AGC�.:.... I
�w—_�r,.ONMERCIALI`•P.N£RAL L:A81L2TY - PEMNAL&ADY:NIURY 1
=C,LANS MALL=OCCUR
C.71OWNER'S&CONTRACTOR'.TROT. FIRE DAMACC(AR9uIIG Yvr) - 1
I_ - .,...•.,. MED I•XPFT96=(A.y.:., nyeuI ___.............,..--_
—
AUTorymBILE LIABILITY COMBINED SINGLE
LIMIT
kA11YAkJT) - I NODIL'!IN.NRY
ALLOWNEDAUTO:i - - - - (Perp-mij >
SCIISDULED AUTOS - _ _ .__....__....,...
F:RED ACTCE - - -
NON•DWREDAUTOo 8GO1S7IN;I.FY - 1.
(Vrr
GARAGS LIAOILITv
. YRIII'C7CI'Y QAMAC-' ! - -
EXCESILIABILITY EALTfUGCUkftEJJCL 7
IINRR£I_A FORM - ACCRECATE 1
QTNCR THAJI U143111AA FORM _..w,....
W0RAF,XSCOMPENSAMNAND 5TATLTM)-r5 S'IA'1I? OTIrER
}ZIP AVERS LIABILfrY C MA
E VftODRI PI DY/ EL EACH ACCIDBNT I 1()0,000
A PARNERs,LXECUTI/E
PPICIERIARF 7020892012009 04!l1/2009 04/11/2010
FL I:15l A5f•-DnTA YI.IMn` I 500,000
�L DISEASE--EACH I 100,000
EMPLOYEE
COMMEPnr l DESCRIPTION OF OPERATION'S OR LOCATIONS:
ILLIAM N FIERO IS COVERED BY THE WORKERS'COMPENSATION POLICY
SHOULD ANY OF TIME ABOVE DESCRIBED POLICIES BECANCL•LLED BEFORE THE EXPIRATION DATE
OWN OF BA RNSTA BLR TROL?OF,THE ISSUING COMPANY WJ U,ENDFAVOR I O MAIL I5 WRITTEN NOTICE TO THE CI ArmCATk�... ,
r%OL.DER NAND TO THE UF,,BUTPAR,URE TO WJL,-ULH NOTICE SHALL IMPOSE NO OBJGAnON '
BUILDING DE PT- PR LUOT.LIYV OFANY IUND ITON THE COMPANY,ITS AGENT N S OR MRESENrA7ES,
00 MAIN STREET l�
iYANNIS.MA 02601 .AUT-HOIULb•UREPRESENTATIYE
. , - TOTAL P.03
ems'
Rio GArraA�� GR�a.tb>�z. :i tl.'D � �r
Di�.t��! FLbw = 11 O � � • '3�C> G�.P•L. F _ E • t - '. E`
i
USA iOC� CAL-.
SPO�AL� PiT - uSE IC»n� G,'`l�L-.
1tewQ AeF a _ 150 s l !
15o SF I� .c 2.S • t7r> G.P.D. Y :
CJai •V \ �1L c—.f�4 mil—. I.� t. , :b .r✓ . M.Y:
SO Sim. :�,• 1 .0 SO C- .
AIL -1 >es-16 1 - h.RD"• S .._ -I- T'Ns "' z 4,
ToT d25 �• r
ToTQ t- �QI L�f FLDW - PD. oz
Q- O
Gr-f1GDl.QT OU SZeTE . 1 u 2Mi ui�otz LESSIXTEW
r
. t
P P
fvc,.AR6 Vr j/x�f is
�g.„ij � 5�34:�ti Sri iCt kn '
F 1 ,
t
�or4a,j� .� p,Pe Icoc iuv :;� fit:
Svf� O/G. 4��P6 IW. Grl. (. g .r
Zit -Box 4�•� Sync Iti 9� " '
.' 1►JV TANK y : } _ 4 ��.
1000
1 1C. rhYd Cs�L. q&'1
^_( G
LwaH r r ,A
!' WASHED € i
eu
•'' - Saar , ;� • � �: �,:
t PR.Q1c'1 L� I bCA.TI C7tJ � /ll-l-�
91951 113 UoI
j
Grr2'T'I,r { Tt-lAT TNsr t-oviJ>54TIoN _ S�Larcrt i i PLA�.1 R��cRE
f t,
t-1F.t't=L��.� 'Gc�1PL�lS WIT1-t T4-1 SIDfc.Ll►-�t�: "` Lp-r �73 �
AWE> Sc7-�nclC �:'cgLs,s`�titGuTS of THt~ G.
"Co w u oc-`} -$A�►J A131.E '(2!
`./C-.iV�G'�.V��.lPCir �.•••(.�p�I LA N Y�f ��.�4s t 's.,
�JAJ.
- ,; �, � RcGtS•ccrerD t�a.Ne� S�ev�.Y��� ':
T1415 PtTl�►►.•t I�, ►-,IoT t A-,c"co v►-.i AN oSTEev�u� o �ttAs�,.
I�J,f�:-1�✓�t_W: - :tJc_.�te� ;� T��E.. c3F� T�, S��Ge�ts�'
T °� w
trJc;r c:r.. u��c�> rc, >�tirc:ctit�a�: :Lour LIN`5
° be TORT OF BARPTSTABLE Permit -No. -2---C3 7�'--3
t 3AWTU .
• Building"Iii`spect or.
DAGIL
OCCUPANCY PERMIT- Bond.._ _ �'x
s
No building nor structure. shall be erected, and no land, building or structure shall be
used for a new, different, changed, -or enlarged,,.u'se'. without a Building Permit therefor
first having-been obtained from the"Building Inspector. IVo building shall be occupied until a
certificate of occupancy has been issued by the Building Inspector." '
Issued-to Alan .Small Address Centerville
Lot- #53 24 E1.*hjah Cl il*cjg; Lane ' Centerville
Wiring Inspector Inspection date
Plumbing Inspectors =: (_ °, . Inspection date
AtU
Gas Insp
ector �/ Inspection date
Engineerin De //
g Department date
p ""7/2�`lid2 -ram i�GCL��� G�--�.Inspection•
THIS PERMIT WILL NOT BE VALT,.;AND"THE BUILDING SHALL NOT BE OCCUPIED UNTIL
SIGNED BY THE. BUILDING 'INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN
REQUIREMENTS. =
ti � ....... .., 19».»._... .----....a.».......Building/Inspector .».....»...»..».».» `
["W
Assessor's map and lot numb ............. ....
} €• x �ti
, ,
. �+ SEPTIC SYSTEM M,US
w. o
L T Er
Sewage Permit number ....... V.. ...........................
I�IS�TALL$D'IN COMP
' .BASBSTAMLE, i
House number ........ WITH TITLE 5 rnea
... ........ ...........................
ENVIRONMENTAL CAD ° 0MPY \e� ,'•
a•
, W
TOWN OF BARNST ' "`�'TION
OUILDIHG IN.SPECT:O,R
'APPLICATION* FOR PERMIT TO .. .. I�5 1`� ............. ..... .... ......... ......... ......... .j...... .......i. ...
TYPE OF CONSTRUCTION. .... —`?��:........... y........ .........t ........ ......... ......... ......... .............
r .L..............?
TO THE INSPECTOR OF BUILDINGS:
# tri •4
The undersigne/d� hereby applies for a permit, according to the following infor`.'mation:
Location ..... .,. ..�? ��...........�z lJ1-3/w ..G /.......S.... .:...0 ............................. ....
ProposedUse . . ............ ........................................... ......... .................................................. r
Zoning District ........ ..............:....:...................Fire District .............................................................................. +.
Nameof Owner ............. ......... .............. ....................Address .......... .. . ..... .. .. ..... .................................. ` t
< Y
Gt C
Name of Builder ....................................Address
Name of Architect .......... ..........................Address `:.....:.: ..... ...........
Numberof Roo s Foundation ... 2...... ......._.... ....... ....... �< ................ ........................'..`. .....t r
Exierior ... ... ... . .... .......... .........Robfing
`• " . t Floors " lrterior.
Heating ��L ....:': ..............` " . ..... :.Plumbing ......................................................- „Li
Fireplace .................I....................Approximate Cost ..`'� r?r 4 ....... ,
..... ... ;
Definitive Plan Approved by Planning Board ---------------_---------------19 i ` Area .........................................'
,�L,�
Diagram of Lot and Building with 'Dimensions ' 'Fee ..... �-? 1 .....................
SUBJECT TO APPROVAL OF BOARD;OF "HEALTH
t
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
*w�
Nam ............................. ......... .....................................
SMALL, ALAN
No or .... ........
.....S.iP.9;�q...K-2Mi...y..PVg.j ji.ng................
Lot #53 24 Eli 'Location ........................................ S Lane
Centerville
...............................................................................
Owner Alan Small
............:...........0..........
Type'-of Construction ....TX4MP�........................
............................................................................
Plotf..:!........................ Lot ................................
Permit Granted ... April 16. .........19 81
......................... ......
Date of Inspection ....................................19
Date Complet d ............ ........ 19$�
PERMIT REFUSED
............ ................................................. 19
............I S.....................................................
..................
. ..........
.......... . ................................................
Approved ......... .............................. 19
................................ ...................
............. ........................................................
Assessor's map and lot`number ...
Sewage Permit number ...... ......................-::'........................
BARESTAXLE, i
House number / `
1 1 MAO&
t............ ............................................ 90� 1639
'eTE p OR a�
TOWN OF BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO .... /....................................................................................................
TYPE OF CONSTRUCTION ........ e: <................................................................... .. .
TO THE INSPECTOR OF BUILDINGS: i
The undersigned hereby applies for a permit according to the following information:
Location ....... (1,,-f ... ..' -'............'. .f,./��1��1.....`:.�j.�.L' .......... !=::L fr..................................................
ProposedUse ............................................................................................................................................................:................
ZoningDistrict ........................................................................Fire District .................................................
Name of Owner .. k:. '.:........ s.. ? :��: ..................Address .......... .•' '... •:`. ` .: f...................................
Nameof Builder '` ° ........Address............................................................ ....................................................................................
Nameof Architect ..................................................................Address ....................................................................................
Number of Rooms ................Foundation ....... ...... t `1...... _........................................
Roo Exierior F ' r.. .............................................. fing a. .
.......... .....:........................ . ........................
r� _
Floors '.........'....`......................................................................Interior ........`.... !� ..r............
f-ram- -
Heatingeating ...............r ... '..`..`"" -,.......................................................Plumbing .............................:...................................................
Fireplace .. ....}/t CF 'L Al L e. !..:'......................Approximate Cost ..!'�r .r�.• ,/j �.` ....................................
Definitive Plan Approved by Planning Board ________________________________19________. Area ..........................................
Diagram of Lot and Building with Dimensions Fee
SUBJECT TO APPROVAL OF BOARD OF HEALTH
1-2
f
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction. „ r
Name .............................................................................
SMALL`, ALAD
No ....�-..I`gyprmit for ....9P9... ........
.. ....... .. ................
Location ...Lpt...#.5.�...2.4...Zlij.all...Chi.lds Lane
.............QQ.-n.tex.vi.11e.....................................
Owner .....................................
Type of Construction ....Fr.ame........................
................................................................................
Plot ............................ Lot ................................
Apr' 1 16, 81
Permit Granted ........................................19
Date of Inspection ....................................19
Date Completed ......................................19
RMIT REFUSED
.......................... ................................... 19
...............................................................................
................................................................................
... . .........................................
I.0,
P....... ........................................
Approved ................................................. 19
...............................................................................
...............................................................................
GQIGI 0 QEMODELING'.
PHONE-508-7381905 PO BOX- 2705
HYANNIS—MA. ,
Job name: 21 ELIJAH CHILDS LN-(MRS WILLIAMS).
DESCRIPTION OF WORK: "
*replacement of 3 windows(30 x 52). `
*replacement of exterior door(32 x 80).
TOTAL COST:$2,650.00.
f-o LOG,
Total cost include:labor,material andFosol.
Jr(
FLAV/O GR1G10, 0610411
t a
IJ-
®0
f
Roll,Shelf I I t
Y WALK-IN
w
I,I 1
'E.
tl
(5)12"Deep
Shelves EA . R f ,
HIGH BOY
IVIIetST�z DRESSER
® BEDROOM ? II
r'
ON
s /• II
II
70
�f ` D W ('
--- ———
24" EEP
LINE
IN ABOVE
Z
w t
to
g
`- N a•, 0
rm6 ' x32".
ermount
E
'DRESSER w/MIRROR — �• _�;; , p S08k1
ogle
O O
1 I Rod&Shelf
—Jl------ ----------
--------------
I I _ 48"X3
WA0IN Al
r I I <__ t
.Y cLos�T /, sed KE DET CS REVIEWED
_ how NO.. REVISION DATE
` BARNSTABLE BLI DING DEPT.. DATE
CLIENT:
d ---- PETERCUSKIE Residence
FIRE DEPARTMENT DATE 24 Ell,ah Childs Lane
' _ •Centerville MA 026329 ,
BOTHSIGNATURES ARt R=QUIRED FOR PERMITING
SCA
LE:
4 TITLE: EXISTING COND
ITIONSI TIONSPiopsod � VF� orPlar FLOOR PLAN -
DATE:MARCH 15,4017
MICHAEL A.:RMERSON A.I.A.
ARCHITECTURE&INTERIORS
- 193 Horseshoe Lane
Centerville,MA.02632
508 775-4264
majuch@comcast.net
i
al �
t °
{
-
FAMILY ROOM
$ILL HT 31' SILL NT.31.5'
SILL HT 86'I f SILL HT.80"
II ,
6EDROQM#2 I I {
r BEDROOM##3
I. j.
e J II LIV
II � f
II
/' II } {
t II k
----- ------ DN -
II I t
-
L I F .
NIASTER I I I I I
EDROOIifl ® I I _ DINING ROAM FA`Ni1LY R(3(?M
I I ` L---1 KITCHEN Q O
I Al
P II I NO. REVISION DATE
SILL HT.31.5" $11-4 HT 41..t^ IL°JL°JI
$iLLUE.80" Hi 80'' ��----��.
�,
PETER CUSKIE Residence
24 Elijah Childs Lane
} ,. .. }} Centerville MA 026329
ExfSting .l sl Floor Plan SCALE:3/16"=1'-0"
- r - • - ', - TITLE: EXISTING CONDITIONS
.FLOOR PLAN
DATE:MARCH 24,2017
MICHAEL A.JIMERSON A.I.A.
- ARCHITECTURE&INTERIORS
193 Horseshoe Lane
Centerville,MA.02632 .
508 775-4264
' majarch@comcast.net
i .
t
i'*
8'34l
•� A .�, + ":• � ,,. " i �: A. A: °�`.�' •��:.yf 'Ary' ♦ '�' �'-°' J. � N•.a t •,7. ^' '3R, ::. �,V, i. "S ..y•M�: �y� -
FLAT SCREEN I
WATER /
2"x 4"INTERIOR WALE r SHUT Q[ F `
W/R-21 BATT INSULATION, CLOSET
Y"BLUE 60A9b,AND!y/
sa .
RCREATION
y"SKIM COAT SMOOYH
PLASTER• RQQM .
21-9"x 12'-6" i
14
I
._ 2
0
• '3�rr�i Er'ivc .-E•u�'� m• r`, .-'s{4 <s4 Kr. {✓✓iY' '�+fzk>R a +4 y .
s. ti.RIBATH S i O ':. e..,.. ,.o..,,.+r<:,...,;.:.t- .. :y,j 4:.v "�'<.',a3 �.y +l ax.. ''P'.a: crri
R.
DF
s _ II /' ELECTRIC �.:•
II PANEL
I s,; MF-CHANICAL F.RNACE
Cn Rbb
�• m �:�� &STORAG "
a'
; •> �'•� `'
B I I ROCK INSIDE
6,
TYPE X RATED SHEET RO._ 4
STORAGE � 21'- f � WH
'� .L�" j j WALL OF I�Ar�HANI�AL RpQM. ' •
UP
('11)9'`T�2EADS, \ 3,'x 48"
(1.2)7 71$.RISERS OASEMENT \V1
EGRESS -I I
SEWER PIPE WINDOW
SILL HT 67"
. !.l.. 'r 1!1 fff rr! i l:fr/ / lr. 11 1 - fff✓ �r f . �: / !!1 l 'S K— B
py. ,. . .: ,. .- +,++ .., ,. r,ti e. ... dy ..,GS•. 6: ,.-:,t. r. .. `x .:q', "r" !„ `d j' ,k s„$" fl,. u a ot, - '$r' S y,•
.. :9 ,,. . � .,..� .4.,, y ,. :. ,,,. .. - y ., -..,", � ,,-ty„ ,a,N,'. w<,y .a*. " d. j,p, :a, s„§.• d 'r". + 't'a+� ''Y'Fn
i•'a. - - NO. REVISION DATE
BAStMENT OV—RIMETER E)(TERIO
WALLS TO ESE 2 x 4"METAL TUp
+;h W/OPEN CELL INSULATION'AND °', CLIENT:
s,r GYPSUM BLUE BOARD w/X"SKIM PETERCUSKIE Residence
COAT OF PIASTER,' 24 Elijah Childs Lane
Centerville MA 026329
n�s /-if�sV�/'!l� ITJjI�V WILCO ' capeWE1' SCALE: 1/4"=V-0"
B S o •`•,j n A . PlanDEEP WEaE_L EGRESS - - o TITLE; REMODELED BASEMENT
d �'* e V v ? 4. Floor, WINDOW WELL W/ _ FLOOR PLAN
'SfakWEL'DOME COVER. DATE:MARCH 21,2017
-10" j
MICHAEL A.dIMERSON A.I.A.
E ARCHITECTURE&INTERIORS
• 4" - 193 Horseshoe Lane
- _ Centerville,MA.02632
" 508 775-4264
• majarch@comcast.net
�a ?
!
y1�y i
}
!
. a
04
-
1 si > L + _ ' :. yr. - x' { _ b 'a F . .♦ l- • I •_ Y.,i.. .. t'' ... 4
r
40,