Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0208 FIVE CORNERS ROAD
a,L VIP x Cor= e•r-S` ' . F h , < y ° e e .y� , r m P. P. v i a ° „ , , 6 ° e ; v e `a a , .0 K' s • A � c u r ° „ 4 i ' ,V u 'peg , ,, _ •J .. o". , , r u , .. n a o � T Town of Barnstable ilding o saxvsrnaie, PoStThis Card So That it is Visible from the Street-Approved Plans Must be Retaine�d ob and this Card Must be Kept os' M"S& $ PPosted Until�Final Inspection Has Been Made -' @/—� a6;4• �� - - . r 1t fo►ruy° Where a.Certificate of Occupancy is Required,such Building shall Not Occupied until a:Final Insp�. eection has been madel . Permit No. 13-20-1600 Applicant Name: W. Ray Colwell Approvals. Date issued: 06/29/2020 Current Use: Structure Permit Type: Building_Insulation-Residential Expiration Date: 12/29/2020 . foundation; Location: 208 FIVE CORNERS ROAD,CENTERVILLE Map/Lot: 168-109 Zoning District: RC Sheathing: Owner on Record: GAGNON,STEPHEN&I:ORENA + _ `y Contractor.Name`"-.55C Energy. 'Framing: 1 Address: P O BOX 10221 :z Contractor License: 194390 2 VAN NUYS,CA 91410 Est. Project Cost: $4,019.00 Chimney: Description: Insulation;See Contract `, ' Permit Fee: $85.00 Insulation: �q. Fee Paid:` $85.00 - Project Review Req: - Final: Date 6/29/2020 f Plumbing/Gas Rough Plumbing: W `,Building Official _ Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six monthsafter.issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. ' Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction WorkA Service: 1.Foundation or Footing , Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: ell Town of Barnstable *Permit x7) /fi `T r ti Expires 6 m onths from issue date Regulatory Services Fee g� �p IARNSPABLE, Thomas F. Geiler, Director 7 MASS. q, -1639• , Building.Divisionr'Y('�/ prfd rAa�a Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 5087790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY q Not Valid without Red X-Press Imprint bpb Map/parcel Number,' 1 0 /1 Property Address jk C, 6cr,J`S Residential Value of Work `" L'/. Minimum fee of:$25.00 for work under $6006.00 Owner's Name&Address y' �j t'�. D Contractor's Name ( �� '�C'/� 11 rO v(�,, Telephone Number Home Improvement Contractor License#'(if applicable) `n ❑Workman's Compensation Insurance X-PRESS PERMIT Check one: ❑ I am a sole proprietor AUG 2 6 2008 I am the Homeowner TOVVN OF BARNSTABLE I have Worker's Compensation Insurance �' v�0 �✓ `fir. C Insurance Company Name 4A` MC( Workman's Comp.Policy Copy of Insurance Compliance-Certificate must be on file. Permit Request"(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stnppi7g. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders. U-Value a (maximum..44) °I0 *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e. Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is.required. SIGNATURE: Uv,� Q:\WPFILES\FdRMMuilding permit forms\EXPRESS.doc Revise020108 ` The Commonwealth of Massachusetts . Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors[Electricians/Plumbers Applicant Information Please Print Le 'bl Name(Business/organizalioaflndividud): �-f� GD�� /`°�t/►1�- ��!`1� 1 •s Address: y 5 3 • Po,_cq- S . `rep VV, fZ� �I/c✓ City/gtate/Zip: a.f1 l�C� Phone.#: 6 -7 �a Are you an employer? Check the appropriate bwc Type of project(required): LU I am a employer with 4. I am a general contractor and I 6 New construction employees(full and/or part time).* have hired the sbb contractors 2.❑ I am a-sole proprietor or partner- listed on the attached sheet [7. ❑Remodeling ship and have no employees These sub-contractors have g,-Q Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers' CZn3p.-mstn=r comp.insurance.$ 5 [] 10.0 Electrical repairs or additions . We arc a corporation and its rtgtured] officers have exercised their 11.[]Plumbing repairs or additions 3.❑ I am a homeowner doing all work myself. [No workers' camp. right of exemption per MGL 12 ❑goof repairs insurance regnired.]t c. 152, §1(4),and we have no 13.a Other IZ2►o)0,U M Zn employees. [No workers' , camp.msurance reguired.] *Any applicant flat chmks box#1 must also M out the section below showing their workers'conipauatim Policy infra -ation. t Homeownat who cult this affidavit indicating they arm doing all work and than hire outside contractors must submit a new aff davit indicating avch. tContractars that cbxk this box must attached an additional sheet showing the name of the mb-cantradvm and st tt whether or not those anti6cs have ernployees_ irthe subcont:actrns have eraployces,-thty must providb their workcas'comp.pobcy mmnber. lam are employer that isproviding workers'compensation insurance for my employees Below is the paUcy andjob site information. Ins>iranco Company Nzme: "VN. S� dl s Policy#or Self-ins.Lic.#: / / -7 S Expiration Date: C3 Q9 lob Site Address: �o� �t`y$ C01-a,ors City/Sb&Zip: C�z✓� y t�I�e � RW. 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 leak to the imposition of crimarial penalties of a fine tip 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 statcmcrit 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 aboove'is true and corrwL Si c. e�� �°. '� Date: UG Phone# 5 V�- I (Q ya OTew use only. Do not write in this area,tb be completed by Rsty or town offtciaL -City or Town: Permit/License# Isodag Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person• Phone#: oFzµEr Town of Barnstable Regulatory Services �anaxeBia� Thomas F. Geiler,Director $p 1639• TFo �a Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.ba rnsta ble.ma.us Office: 508-862-403 8 Fax: 508-790-6230 -Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my Behalf, in altmatters relative to work authorized by this building permit application for: (Address of job). Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Town of Barnstable mop 1Ht:.ty Regulatory Services Sty ? Thomas F.Geiler,Director MA S Building Division PrED '�a Tom Perry,Building Commissioner 200 Main Street, Hyannis, MA 02601 vrWWAwn.barnsiabl e.ma.us Office: S08-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: 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- superyisor. 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 procedures and requirements. Signature of Homeowner 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 homeowner erfomun work for which a building permit is required shall be exempt from the provisions e Code states that: "An hom p g g PmP The Y 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/certificat:on for use in your community. f AC®RDM CERTIFICATE Off' LIABILITY INSUR- NCIE 02/26/08YYYY) PRODUCER 1-404-995-3000 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Marsh USA, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR homedepot.certrequest@marsh.com ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 3475 Piedmont Rd NE, Suite 1200 Atlanta, GA 30305 Fax (212) 948-0902 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A:Steadfast Ins Co 26387 Home Depot U.S.A., Inc. - The Home Depot, Inc. INSURERB:Zurich American Ins Co 16535 2455 Paces Ferry Road Building C-8 INSURER C:Illinois Natl Ins Co 23817 Atlanta, GA 30339 INSURER D:American Home Assur. Co 193 00 INSURERE:New Hampshire Ins Co 23841 COVERAGES 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,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD'L POLICYEFFECTIVE POLICY EXPIRATION LTR NSRD TYPE OF INSURANCE POLICYNUMBER DATE MM/DDYY DATE(MMIDDIYYI LIMITS A GENERAL LIABILITY IPR 3757 608-02 03/01/08 03/01/09 EACH OCCURRENCE $4,000,000 X COMMERCIAL GENERAL LIABILITY LIMITS OF POLICY ARE EXC SS DAMAGETORENTED 1,000,000 _ PREMISES Ea occurence $ _ CLAIMS MADE aOCCUR °'DF SIR: $1,000,000 PER CC" - MEDEXP(Anyoneperson) $EXCLUDED PERSONAL BADVINJURY $4,000,000 GENERALAGGREGATE $4,000,000 GENI AGGREGATE LI MIT APPLIESPER: PRODUCTS-COMP/OPAGG.. $4,000,000 E X POLICY PRO- JECT LOC B AUTOMOBILE LIABILITY BAP 2938863-05 03/01/08 03/01/09 X COMBINED SINGLE LIMIT $1,000,000 ANYAUTO (Ea accident) ALL OWNED AUTOS - - ' BODILY INJURY. $ SCHEDULEDAUTOS (Per person) HIRED AUTOS BODILY INJURY $ , NON-OWNEDAUTOS (Per accident) X SELF INSURED AUTO PROPERTYDAMAGE $ PHYSICAL DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANYAUTO -EA ACC $ - - OTHERTHAN AUTO ONLY: AGG $ A EXCESSIUMBRELLA LIABILITY IPR 3757 608-02 - 03/01/08 03/01/09 EACH OCCURRENCE $5,000,000 X OCCUR CLAIMSMADE AGGREGATE $5,000,000 DEDUCTIBLE $ RETENTION $ $ C WORKERS COMPENSATION AND 1928757 (FL) 03/01/08 03/01/09 X roRY IMITS OTR D EMPLOYERS'LIABILITY 1928756 (CA) 03/O1/08 03/O1/09 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT. $ E OFFICER/MEMBER EXCLUDED? 1928755(AOS) 03/01/08 03/01/09 E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under - — SPECIALPROVISIONSbelow E.L.DISEASE-POLICY LIMIT $1,000,000 OTHER F TX Employers Excess TNS-C45197967 (TX) 03/01/08 03/01/09 Occurrence/SIR 25M/2M D Workers Compensation 1928759 (QSI) 03/01/08 03/01/09 E Workers Compensation 1928758 (KY, MO, NY, WI) 03/01/08 03/01/09 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS *FOR EVIDENCE ONLY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THE HOME DEPOT, INC. DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 0 DAYS WRITTEN,- . NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO$0 SHALL 2455 PACES FERRY RD., N.W. BUILDING C-8 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. ATLANTA, GA 3Q339 AUTHORIZED REPRESENTATIVE - USA C�� f7 41 ACORD 25(2001/08)datkinson ©ACORD CORPORATION 1988 8213215 Ill n- I-- 0 F- i�J ,f� ✓RC 7��`�RTt99249¢i �✓K.ladSRc�de� -` Board of Duilding Regulations and Standards License or registration valid for IndividuL use only v -- HOit9E IMPROVEMENT CONTRACTOR Before the expiration date. If found return to-. L Reblstratipq:. 126893 Board of Building Regulations and Standards �� Ex irt4ien:.;•aj y30 one Ashburton Puce Run 1301 Ey�Te: SOP fement Card Boston,Ma.02108 The Home DeNt AI-1•iorne'SeaviCe &TARK NIARA 3200 COBS GALLERIA PKWY.*20 XTLANTA,GA 30339 _.._-- -...__._ -...IAdministrator at valid signature F— J ' S W T W W I L J J W 3 rJ'I ED rn I I l_l � 08-26s2008 ` 13:35 FROM-THD AT HOME SERVICES +508 756 8823 T-084 P-004/004 F-495 110ME DIPROVEMI<ENT CV1N LKALL FLEASB RLADTMS - sold,Ftunished arse lnstailedby Brauob'Name: Bostoln Date, /'f°/ b THD At-Home Services,Inc. d/b/s The Rome Depot At-Home Services Branch Number: 345A Greenwood SavMa,Unit 2,Worcester,MA 01607 ❑North 33 South 31 Toll Free(800)657-5182; lax(509)756-8823 rederal ID 0 75 2698460;ME tic 0 C 02439:RI ConL Lid!16V7 CT Lie u 565522;MA home Improve..,Contractor Reg.s 126893 TnsWlation Address: 2av ;251LJ o A"n eel Q n f Ar �'-- Ciry State Zip Purchascr(s): Wort Phone: Homo Phonet Cell Phonc: Howe Address; (If difrcrent frorn jpstellation Address) City 5tatn Zip E-mall Address(to receive prajcet commuaicarloas and Home Depot updates): ❑I DO NO wish to receive any marketing ctnuils from The Flame Depot ,P_raidct Tnfbrrna6on.1 Undersigned(`Cus(omer),the owners of the propCCty lercatad al the above installation address,agrees to buy, and THD At-Home 5erAces,Inc.(`Tho Home Depot")agrees to furnish,deliver and arrange for tote installation(inaWlb►tioo')of all materials described on the below and on the referenced Spec Sheel(s), all of Which.ate Incorporated iDto this Coatmcr by this reference,along widt Any applicable Smec Supplement and Payment Summary a llchcd harcto and any Change Orden(collectively, "Contract"): .fob#_. 0.1-1 na ) p ducts: Spec Sheets tt: Project Amouht Roo&3z Sidln w•mdows El Luuladoa / pautters/coy= L3EAtry Door$ p Roofllllt LJ51ding 0 Windows 0 Insulation $ ❑0utten:ICovers []Entry Doors M ❑Rootlna Sidiae Windows insulatica $ ❑auuers/Covers QEauy Doom❑ Rooting Siding' Windows 0 105U1ad0a $ ❑Guticts/Coven[]L•attyDoor; [] Minimum TSPA Dcposltof Coutrutt Amourrt due upon execution oribb connect. Total Contract Amount Mahe P=h,tsars MY not lk-pa*morn thou oarthird of the ContractAmount Customer agrees tl,a% immediately upon completion of the work for each Product Customer will execute a Completiou Certificate (oac for each Produce as defined by an individual Spec Sboct)and pay any balance due. As applicable,each Customer under this Contract agraw to.bc jnietly sad severally obligated and liable hereunder: The Flotne Depot rcrervos the right to issue a Changc Ordcr or terminate this Contract or any individual Products(s)included bcrciu,at is discretion,if The Home Depot or its authorized service provider determines that i1 cannot perform its obligatious due to a structural problem with the home,environmental hazards such as mold,asbestos or lead paiat;other safety oonocrus,pricing errors or because work required to complete the job was not included in the:Coa=r. Payment Summary: Tho Payment Summary 1 O included as part of dria Contmot, sets forth the total Contract amount and paynaunts required for the depostu and fmal payments by Product(as appiicabla). NOTICE TO CUSTOMER You are entitled to a coalppleie�y tilled-in copy of the Contract at the time you Sign. Do,nut sigh a Completion Certificate(note: there is one Completion I'cttificite for each listed Product as defined by individual Spec Sheets)before work on lhat Product is complete. In the event of termination of this Contract,Customer agrees to pay The Home Depot the costs of materials,labor,expenses and Services provided by 7fbe Home Depot or Authorized Service Provider through tho date of termination,plus an yy other amou=set forth in thin Agreement or allowed'under applicable law. TI1'C ROM DEPOT KAY WITH11OLD AMOUNTS OWED TO THE HONM DEPOT FROM T11E DEPOSIT PAYMENT OR OTHER PAYMMM MADE, WITHOUT I:MITING TIM ROME DEPOTS OTTER REMEDIES FOR RECOVERY OF SUCII AMOUNTS. Aces At thorizatt Customer agrees And understands that this Agreement it the eadro agreement between Customer and The Homo cpot uvi t'e to the Products pad Ittstalladoo sotvices and Supersedes all prior discussions and agmenten%either oral or written,Tals4ng to said Products and bAullation.This Agreement cannot be assigned or amended exocpt by a vmlting Sigped- by Customer and The Homy Depot.Customer acknorMedges and agrees that Customer has read,understands,voluntarily accepts the terms of and bas received a copy of this Agreement Accepted by: Sub 'tted by: +/ X Cus¢itneC' Sjgna re 1]9r �y Sales onAultnni`s Sigpp[utie Date V, L G 0 Telephone No, Zor TZ6 Costahrees Siguar= Dam Sales Consultant License No, C1.NCELLAT QN: CUSTOMER MAY CANCEL TIUS (am opplimbla) AGREEMLNT WITHOUT PrNALTY OR OBLIGATION 13Y DELWE nvG WIdrrEN NOTICE TO TBE RoM DEPOT BY MIDNIGHT ON THL TUM uuSINESS DAY AFTER SICNTNG THIS-AGREEMENT. THE STATE SUPPLI'WNT ATTACHED HEIMTO CONTAINS A FORM TO USE I)F Orir r, SPECIFICALLY P1t1rSCRIBED lav LAW IN CTI5TOMEWS STATE, NOTICE:ADDIT10NAL'TFRMS AN u CONhriTiONS ARE STATED ON T&M REVgRSE SIDE AND ARE PART OR TMI CONTRACT_ "Us C.SC White—Branch Fllo .yellowy CLmtmmdw pinM - V98-d 900/f00'd UP-1 -lkoad WYM1.1 sane-al-sad '- TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 42 Map_.' Parcel /D C Permit# 0 . 3 4! 05- ° 5 ° Qt �:11i'r';, F� $ to Issued Health Division �� o� Conservation Division R 3! �� ��1 MAR 2 P Application Fee Tax Collector as L � (I Permit Fee - 00 � 1' EXISTI NG I � SEPTIC T surer a SYSTEM reas G�V'SIOXIMt _#OF BEDROO Planning Dept. I�S_k Date Definitive Plan Approved by Planning Board � � CIAL"A Historic-OKH Preservation/Hyannis Project Street Address 208 f=i ya co ati E�L5 26,A-D Village C F X i F(Lv,LL f: Owner 5 � LoyZ6_,AiA 4A -&_)p Iv Address 9v l? FLV Telephone (5,q ) +.L O <6 9 3 Permit Request N S; ;Z i 2 eV NO A /3 G 4 e2o v _o >�ao L._ Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Food Plain Groundwater Overlay Project Valuation t ©o Q Construction Type Lot Size 115 74-C., 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.) 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 BUILDER INFORMATION Name TE+r, R) t L� 5PA c(ooe Telephone Number (t�od) 457-796- o Address 4 3 5 License# 13066(s. F A 5i Home Improvement Contractor# 136666 Worker's Compensation# 8,369 2-7- 7 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO A I_1^V\,m M 'G iQkQJ , I SIGNATUR DATE 2 2-/ L0�6;_ FOR OFFICIAL USE ONLY � r PERMIT NO. - # DATEISSUED MAP/PARCEL NO.. ADDRESS VILLAGE - r OWNER l ' DATE OF INSPECTION: FOUNDATION FRAME INSULATION I Ir FIREPLACE ELECTRICAL: ROUGH; FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL k FINAL BUILDING �e136g1I_ DATE CLOSED OUT, a 0 v ASSOCIATION PLAN•NO. The Commonwealth of Massachusetts Department of Industrial Accidents ' afBca 17t1finutigavaas _ t 600 Washington Street Boston,Mass. 02111 r Workers' Cam ensation Insurance davit name Y"N fL S w r rn�n.r.e�.�� S F/� (,�'!L® i✓ l f'�� �•L���i�t'ca/�-� location: �► 8 �� v rz. c u�2,n�F S 6 A 0 . citv C�rLTr�2✓i L i..i� Qhone [j I am a homeowner performing all work myself ❑ I am a sole prwrietor and have no one worldng inany ca acitp %%%/%/%%%%/%%////%%/%/%/%%/%���%%/%//%%%/%�/%�//G%/%�%%%///%%�O/%%%%%%�% workers' 1 rovidin mP .......................:•::::::.:.....r.:...:...:?..::.}.:::•:.}:.}}::..}.}:'.:;.:::.:.:.:..:..:.;}:;::?4::>< :::.}Y... :.1..:..... .:.v•.:.h•:. ::. I am an era g :::............ .r..................,:,.:............:.:::::............ .. .............. ............. ... .. ... .... ..............: ..... .... ..... ....... .N.......... ......... � .:::::;4:•... :.?+i:^i n{i:?vi:•i.{{:4}}ti•irv::..;��.,.,K?:?J:v. :??.............v:..........•;•:•. ...... .::- ,.... .....:.v..r{.. ..:... r...: ... ...n.... :...............r...........•:n ........ n: .. .. :. '. r..Y........:.� .......: ........ ....... .v ... ::: ;: ::.:: ::: .:•v:,v: .:•$::•:•:::::.. ::::.•:::: .. ....::::•::::. :•. .;� ::•;;%jy::}::•i '.:ii':Y'r,} 7:•}::+?v:{::v..w:`::::::•.v::.v :..... .want :..,: ... '�,::.:,:•:'..;{..>}Y:•:;::ii{:�:..:: .,.:�ii;}:;: ::::>s .... . .. .....r...............r........,..............,.............,.............,...h:. ...........r... r:v}::•;:::::•..,......:r.,r..::..rh..:......... .,::{{:4::r;;:,}:{<r•�:^`•}i.;.<, ��::: . .t.r ....... .r..?. .... ..t,.... ...........�:::.. ...... :.............:.}:;,..:. ........:.t•::..., ..?...:•:•,:•.............t}...:..�.},:}>r,:<;::::.:.:.:,.::.r..::tir::•:::: ,•}€;;t.•r. .w••:«n: :::>::> •:.t•..,.....:::.::.:...... ..:::...h r.....:•.:::...... :�.�::...........�.. .3=.v;:.• ...........y.. .�. ......rr..:.:•: ...{...,r.?:•.;:....:,.r.::{:.:•:::•:::::;:r.. ..{.,.:.}:{.}}}:..:.........?.,:.}>�:.t :.::.:::r:;:.Y';<...,.,::.�.;}:{:.::••.�:::.,...,, .....t.r.:r:::::.;:•::•.:r... ,.v, .,�::.••?:?<.77':4::.�:...�:;::::. ,....:....:.....:.....r...r.,.r:••:., ...J .. .........:::.v{:}:•.••:•:.is;•:::.v:....r. .....::::.v:•+:v:rt•Y:•:}}i:::-.....r:}:..:r..... .:::.....:?: .... ....r J....v..... .}.... ..t .. .............n.... ...r... .......:.v....v.v::nv::.....•vnv.v:?••:::......;; .... ... .� .... :::::::::..:vx:.v:.y:•:v...w::: :-Y::rr:::.;...... {{t{:'.{tiff:{.};•;•w:; ... .....:;:;_••}:;:<•��'',•:.}:•:•::.:.;<:.,..:. .,:..�,.,•.,::: :: �.....�e�a'Y.:;�..}•:•::Y::.::•:. :. ..... ..:....::.........:.�..::..:7i:.r....::w...:...... Q .. ...::.:...:.'...n.:.:::::•}:v::::v::•:.v.::{t:•:ti?S;v:.,v}v::•4 vx:::}w: ::• ...::. r} ...r....... :....n........• ..... ....... .... r .}•.}::ya.. ..r.. .... .. ..... ...n..... .. ..�v.•w.:.:::•.::Y.' ?4?:{v:•}}.i.:.:.. }' ,•.::•'rv:`{::Y �•;?{.�':':;} r :{ivtiv::::.1`n,•:x::'•.•.:;•::{:v.:::•. •}}:{{w::::•:?i4?::{t•i:•h:v.v.`::•4, r, •.:{r{4:,v n.•,. ..... ..v:;v.v. :: ! .....,;....,. ..... .n ::... .•:a:••.s:t:::.�:;::}:77+�. •.:: ....:.: .... : ::::>:}:��+w•.. ,t�•.;;::a�'.::;Yi7 Q�I�N%#}•:•:r::7:.. . ME ❑ I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have ...•.•..:t..�..........w:....r.ow rr......:v.mr;r.....::..Y.....wthe following .:........v.r......v........n.:r..+.::....:.....:.n.v...r...:.......:.....•.::.......::.w.....::,....workers'::•...::.. compensation ...v...:.r•.v.:...:•..;..::v•..:..,..::.r.o.:,:.t..::.:J}...:::.v l::.:r:.:.'.::•i•.::}.:•.::.c:n?:.:•.:....}:.e..,..:.:::.•...}:..i:..s..:i..:.....}:..:...;......:....... ...•....:..................v....:•...,.:.............,........:.•.....:.-...v....:..::.r v...:::..:...;.,.:nv....•.:.:...:.;::.:.:••:.:.:....:.::.:.:.:-::::..v::,...v•,:..::.:.v::....::,:\:{.....:•.:?..:.•..:r.?:..:.tY.n.;..•.:•.•...:w..v}.:......:r.:::.....:.:::..:..v:.::n....:..:..}.....}:.:.n......w:::.......v:::.......:..::.,{.....:.:...::.':..�....:•.....::.•..:v.:...:..:.:..... :..v..:......:.:.}.r.r:.:.•....::.7.....•:..:.:.:..:.:.:..:. .::.:..•..:....v..v.....;n.....::v.r:.•.:....v...,.....:,.:..::.,..•:.....r,:v:.•.v.:.t{.:..::.:..+..y:...'{}t....v.t.::v..,,•.::..:.....:.:::.:x::....:.:.}.\t�.:.:..:••v.`.:r:...:.vh:}:.:...:.:.:::...Kr.:.}:....•.....:.?r..,vt.;?r...•::.:.•..v:}..t:.iv..;•.,..,::•:;,.:...•::...'.:...:.•:x:....:..:.:.:..r.:r:.:.v..:..:r.?.:..:r:.::.;..i.-.i..•...;.:r.:s.....r::.r.:....•:.}•.::r::.:...4.w.i,..J{r..h•.}:.:.v.r{:.t•..•:^ :..:.:?.::t.{•.::.:.:::.}.;:Y:.•:.:fct.::.,:..w....r r:}w:.{.:..::t}i.?.:::.•}.....::}:v::.}..i.4.::::.;{..?.::•::.:.:..:.:..::•::v;•:..;:?:::v:..;.;::.::4:..•.::..i:v.....:A::t::•..:.:..•:vv•..:;r,:.t.:..ar}..h::.:r•'.ti.t�.+.:::...•..v...4..:.,::4;. ,..::::.:•'•.`?.:::r.,:,..:.::::;:?:.r.:;.}4.vr..n}}:,....:.{;}v}....r..}{?:.}.C.•..:�.}xr•r.?..::<...:..•.:::?:.4L{.:{..{...{.4?a.}{..r..:.•x:}}4:::rn.VS��a},�.':.:{{.}.::;v.{.:v•i:r:..L;{.•::,i.wv:?:?:i:•••.v7::i:.:4v.�•h:::?.iY`:.••..,}r}:h•:.:}••}r:..:.w}}^e"} ...:. ........... ..... .... ......:......rr.. ............... .1 . }r}} }Y:::?.•};47 c4\v:,..}..:•t}•�:.:::..3:Y4,:�v.n:r.:•:.ry•\}:•.».... .•U.v+•t4.:;r.3..^vY.4}4-. •:..::.,:•:.:......,....•:..•:..:.:.:..........:..::w•:h:........... ......r h.��'':.t'4.F.•}.�vvh"`;t".v,�1>} , r:...4:•{Y:$>.vi•€{: .<Y• $..'•`�.{}.`.a•:}. :..S'.x�• ?.:. ,...,.....:v...••r.•:::v;r.•:i•}}:�:•::;..••7h.:.:?:,,r.•.: :ar:r•: S .. ...{... .:..r ...... ..........,........:::4:::::..:......•:vn:.....r..v:nv:•7:v:::::::...:{::::. :xv... :.:::.vyn....};.,.. t:•.. .ir......... ...n....:• ..r..t r..n v...n.., ........... :..:::::::::::::::•:::r::::.. ........... •.:::.v:..?.•::v:. . .. ....t.... .....}..r...• .v:r.............n}v.v::::x:::::;:•:v::.v:::.v::v;vi.:•.... ...vt::••::'.:.:i:{?:::::.::.:::::::�.. ... ......;y 'a}:•:;:4rii}ii:�i: i?. ..........:r•.v:::::v:.•}::::•::. ::?vv,,.:r v:nv::.v:.v:••Y::::.:..:::••:::v:,...... .. .. ... :•}:<: .r7y};i is r.•:�;•; v{:}i:i: • T:.....;w;}::::....v.,?:7:}C,•::w:::.:............. ,:{.}}'.::{'•}W}r.ai7;h?v:r.:'.}J•:•::•.i4'•<:::tiM1:j:ti;{i?r4}h.; • ..v:::::... .. .... bi:::;f�•}:;�.:. {.:4;.., w:'• y{: }x:J: ..•Y::'L>,qi rtb7,�{Yiiti '::•F ....................:::.............:...:•:::::::........:.:.v:::r:.,•::•::....,�:::<...,,.;r..:........?»,,:•.:......4.r•.:.,ts•. t:•::r••.,,•. }.:fr:.... c• •r:.x•:z::•{r. ................................................. ...................... ......v....... ...:::r..........,....7f............, :•.F.•.t.:v.i^.;{.}•:,••i:••':•;`•{•}s•:. ..•.:.{•.,•:..:v.r.,.:.:'x :{,w,r`;7:.�wr'••�{s. inJ:}C{;:a:� .. ........ .... .f..r. ............... ..... ...::v:?'n v....:::v:::v.v::...v:nv::::v.:.?: `rx.....n:.:,:{.:•;:r•;t:.h.:......?.v::x•.4. .. . ........ ... ... .........:i.....:...4.......:,..:•::.,....r.. ti.f..... ..........:::........:...?a............. ...,t....s '+�• Y�;r •fi•`.' .v}+y<}>:•i::i; .•r...: .. ::::::•:::.v::.•r....,,:<•:•rJ 7ti••r•::••:,...C.,•.::::•}.,,....:... r..............}.. ...r.t,...,. ..,..,......:. t••,•:::•:•.v?..t"r•:.: .. ..i`'t-:• i...•r. :r...:........ .......r.....,:..r:.: ........r..:..r.............r...... ...:....rr,.:r:.:.........., :,•:::::.:.. :.v:...?..4•;:t:::::....:. �y ....?r..:..:..................t...�... ..,.. :.......... ....r...... :......:.......:•::.......}..........r.y;...........:•:::::::::.... .:... ?,.•.. a•:.. •.J•.•.,.......}::.•:r:}:}:s•{•.,•J.:?;:�..�:`:r` }•• ?'':Y. ,.t??•#:r;:`•}>:: . .,. .::.............::....r...,........•r...J+.........n.,..........:7:..........r...,•r.•..t..........r....,....::• ..... ...::::::::r..Y.... ..^•..� ::.::.:::.>.•.,•.:.,:r..,.. .{.}.t r.;>. ..•r..x.$•R. :;�}:: .S. .H.,:r:.va...........r.. .....:}:::•?.vrvsr..,.r .};•:::?•r:....:.:.,:.:::::::......:.i:••::..•.:...............::::::..:•.r.,•r:::.}:.:•.v}::.........:::: ....,:......: .,5:.; , •r...3..•5:.. .. ..ar:;::::::n,r••:.,...,.........:?:t4....... .r..:•...............:...:.......:..:.:r..v::x.. ...........::.............:•::.-... .¢•.} ?•}:CvY t4Ft•. f,.}}n:<Ct:'i'f.}:: r .:..v{,.v,..v........•:::::::.......:...vw::h•.........•::}}v: ........t,:i•:?•::......:.:4 .....:r.:.:}..v?w......••::^::.v; •.:.. w w:: r�:•:::h..........r:.:..........•}r.v::....,.,.r......:, :...A....::::.............}:.:..,r,•}}}ii::•?•::......i:}:. .............:.:.....:.v:::.v. �Q'•Ci. v::r...r.:•:n .--fi..........:.:•:.........•:v; ........?..?•:.v{..nn....w:r.•..........r.....:. Y•:.v?:.v: ....:....... .r:r.•..:: r.•. ... ... ... .:. -:�..}::,:.}ri•:::::•.v.vJ::.}:;•:,•:7:.}:•:•,•;?:iiii^iiti c{^:}'t<:i::'t:} q;+ii:::?Sr:<3�:}::}:'�'.°Si?.v::.v}.:}.:. ::•••• :•tit, :...:.......... .......... .. ......... r.... ..r:... .v......v:.v.v::;:::.rr..r::.::::.... .::...... .tt...}:•::.•,,:.;.t,., .. 4w':t{:;;•{.:.. ::::r;::::•:,}` :•.:}}x'<7+•Cta:'•?y..,:..d•.:•. .......................... r...n.r...:r..: ............,,... .r.}.n.vi..t.. ......................:•.., r........7.}.......:v: r' r.n.J...S. ... r.;x.t•},vr{' : ....r......:..:.:t..............:•.:.......:............................ .•::::.,..........::::rr..t.{,.::�:r:a•{Gi...:•.v:•:.•::•...... }.{.. ;4•:k•r.::.:•/"r:4,:.:, .b aY . . .. .r.............:.r.......r...v... ........... ............ ..,.............. .....r.r..v.:....... r................r...{ .......v.....Y.,{.:....rh r....r.:r.+•.v, �... ...... .... ..n,.v..tiv ...... ........... :..r.r......n. .... ...�......n.•:•::..... .:. ( ,.<..?t?'v.{:?.;4.;?�;"•Y.v,.}r Jh., Y' +{4+,..i$".\??j {;:�}'.; .:. ..t.. ..r... ...r... .:................,..:+::.v::...,.,..•... ...r r......., x:.,•:{{•.+::::....}::Y}:••::::�,;;:.:::i+r}::..... r;{.yti.:;• ,�,a�;. ''.k�. r. .4.V.........:............... .... ........... ..... ......... ................:.,n.a..r.n.r. ...:........:::.v:•::::?...n..•;..i... ...... x.•x•,... ::{:y} •,7;r, .:C. .A.. v:........t.......,..... r..n..r. ..t. }:....:......: .:..rv.......r•.......r..,. .....n....:..Y•.r...• ...r.......... .......... �} ...?::... t.v ..n•,?•\:•?:?5. ...t`:7�::. .`•:�S:S:ii>: •: ...:....:::...........:::.:.... }.v,...4.........t..:.v........,v......;. r.....r{..v........ r.. .....v..< :v...f...... SS r,.....:. ....,.... ...{iv. ,.. ......nv v.......,........ r.... ....... ...}}..r..v .,•.}'{{•:•}:L•... ..:v7>:{.•.:.:`??.: ':f..: ?:.r.:..,.....v.4..$...... .h....,..r.7•. .{•.•.X...........v......r........... v......t..n.n... ..r... b�•.�:::... J :non cC ................ ..... .;.�;ir.;,: :•7}:•}w;?„4;<i: ...... ......... .......:::....:..:::::::.::.i77:4}:a:•:a};}::::Gii•.'.<,.{•:;•}}:?:::i?fi?•:ai•:aY•7•??•..vr.,:::.!`?:•::..•;:.h.::•:..:.}}'.. '<:S>.}•••:t, ..{•.:: ::.>.:.:..:?.:4::h.}r...iv:ki:}`:•({i{i,•.:,.. u�:aa;:{.::v. .......................:......... :.................. ...............}.r...v....,n.,.....• .r.,......:::r?..n......-:�?>.•:•:•}}}:ry?YY}:t<:`:•t:::??{{4X{::.}:: .......... ........ ........... :......... .. ......r..... .............n.. .:.v.:.v:•:::,v::.:. ..tr...... .::v:r....t.r..... :r.},.w::.'fr}:?{:.:r...:.,v,•:i?•k:•:;,x:v'4?'lvvxr.}7i'}ii'n.,4.}}}:{fir::$::r}ii} .......:•...............:...........:::: ..r.... .,.....r .....:.•.:: v........:. .......:::.v....,...•}••::•. .r•:.:..v•::::.t•:::: a:•}:•h4,•..,•••7:}.};{{a'.r:::r.{{•,r..};n{ ;;:.•. .::....r... ........... ....}...r... .....r... ..t............. ...n r........... ........ x.fi::;r.,.;......:•........::w::^:v:•,v.:•:•::} yr.. r.• r........ .......r :..:.......... ...r.....n .................:. ...n.n...........:r:::•.v;:•.:.. v.4:r h,V•X::.. `'•v,,.j+,•:?7';'-:?`??}. ..... ...... ..... ........ ...................:.::..........v............ ..v•:taY}r:x::.v.v:vv;•:??•}:v'• ,...:}{{:.;}.;.aY•:{;�.:r>'?{v..:...>.�t7:{}�:. v�:;{::ti::. Sn•:.r...:......v:.........•r•:n. .nt.....v:n:.............•:::•................... ::}:•::ivh:::::,. rx..... .........t.....,.........r. ..............:n{:v.v:;:v.v::v::{:.}:{t;•}::?::4:{•}.;........-::•v.v::•.. v....m..n•.v:v::::.77::::::v::r,t!.::•::::::.::::.v...::.v....... ........... •....v.,i....,•:................... ....:... ...............:•: ,v:: :}::.;;:.v.;.............:•:::::;....;.;, t.i<:6:::,;?..?t:,i:Jv:rJ,::.;v.�. Pw..... .:.. y..,.... WC•:1:r::'.. >.ay.4:h•.v t:.:,:'•:.•.}•y $� ...... ..::.}.;;.....r...........: :.7.::::}::r.:::C;.?}:?:•i:.:::::ri::}}. ..wvv:•i:•vxv, 1 ...•}:}::.:}}:• fin.� ............. ... ............. ......: v'•:}?}.v..:.r.:v:, .:.;??�'?..v.v: '' t v4:•}}:•.,},1.4:i:::�':l•.. i ................ ................:.:::::+v:::::?•.v:: n:...........v:v:::;{•}i.•......... ::. ,....::v:ntw: n•;xJ{:4.:}}':v:}}}}:::{.:}•::•.::"• •r,...., .. ................:..:.............:::.:.:.............vv......v......,.....••::....v...............;. r..........v:5„w••• t.r,..t. �:...,. :.;'.'i:�N:vx;i::y•'::•: ........ .... .... :.....r... ............. .................. ................ .::?:.::::::.:.. ....,...�'•.::•:^:•}r::::v.v:??•::v.n•:::?>.tvv:::.4.4 ..}r::'•:{;vv..}•}:h�l•:::�.}?N.fi.. ................r.............. ..,. .:....t.... .............r. ................ ................v....x:•.v:••r•:::::.;::rw:;...........:,:t•::.v:.v:.:...v........ v..:...;.. e r... ....::.r...............v7:v::.v•. .....::...n..t..r. .,.:::•:r,:•i7::J?4}}yr:•:4}?}:v:•}Y•:• •, rv`•:i'v}- {:....r. ............ :........ ....... ....r...r.......... ....r...... .:.................... v...t......M1•v?'•:::::....:.}}:$tv7:;:;.,•.,}•v4+':. vn ...,. ... ......:..:.....:...:..v:.v:::v::::.v:•i'4:•:}}:!?:•::::?:??;{i:ii::}:::CiiY:?i::i::::?:::^`:i47?'4:?•Y:•:�::?4;•}.:4v{.:•.;a:...,... ... �S. .............. ..::.::.n:.::::v.}}:{{47::;?•.{•ii:v}}}::?"}`,:C}r:i::i:t:ii:•i}:......:..5•i}:•}::n..v}:::v. ..r. •;{h;::,:r:•}:}•:x,.,n • .............:................... :.................:....................:. .............. ............ .............. .,..,.t:•.�.•:::::::::::::.�.,.{.;:.}•;.}';:::::rr}:•}>::>?Y{i•::x}:.......rt•r.}y.::.;::i,<>::.i•;;.;: .... . ... ............ ::..:..........,...:................,:.:.......r......::.:....:...............:.... ..... ....�... ....... ...... .........r... .... ....... n.•w:::.v::;.v ..........,..v::?:.,w:::?:.r......,...vrN::::.w:.v.v:::....•i.i{r4:•:?:,•r.v;:rv,,v.x•: ,r.... .......... ..... ......... ...,..... ..................:•:.v::::,v::,.......•••:•::::...:... ...........tv:.v:................ x.,v.v:..•:•:::w;...:.;,:...v:•:::•'!:}k:,N,:i';::itiY:}:4:?•:?;;i ::•.?}::•:7:4'::}::::•':???iii:%•...::::r.•..••::•:.:::.:::•:•:.}i::{.:?•};:?::i::ii:�::%�iii:i:•Y:::ri?;:i<::si<::issi•:;::}:-::.,•:::::.....:.,.: :...........r..... :......:.....:.....:.:::....... .... .... ... .. ......... ,•::.:.....t•::.v.v7;:i•:a}}};}'t;::i;•:i•:},}:•>:�i:Y:n4}:•:;:.Y:,.7•.•{•3..J.':Y,>•%:::%': .� .......... ,......... .................... ..................:....... ............t:•.};}>:.}x?•'.•••}:a:•'.::::ikt:;:}::;?•Y}}:•:{:•.r. r..}.{:.y..:-::<>:{•�}.a.•.;:}•:.,rr}r::•:-•Y•:.??:•{•:i•:i ....... .......... ......... .r...... ..................::::::.v:v..:......, t';4::•.•:•:?^:.n... .:reS:w:,..; ,•::•.4}::.; :a::7• ..... .. :r..... ... ... ................ ....r.............:......... :..::^.v?;:?:•`.,•.v•r:::.v::h....:.:::::::..:.....::......vr:•.,•.a+,.;:,;{:::{s.,:{•:>.{vn .iij:3;•:;fi;:�;::::2'+.:. ..:......... ........ ........r.... ..,v..... ......... ............... :.,..:... :....:::{v.}:•4?:...........r. :'..... 4:J:C'y:,v..v.v,•.v?ti;�'�;:?•}}:;v.^}:i::{:}Y: ..::.............w:•,r.:.....v.........n.,r.•.:...r....rv::.;.:....,...r...,.. -•:::•..::::rv::rr ... r• .......... .:......, ..r..r.... ...r....,.. ...........................n............;.:•:{4••}}:•...... J........ \v:. t....'.r.......,. .,..h:r..,.:.. ..:r::•........::•:::.......:{:.}.rr....?....:::.v:...r........:.,••:::....::::::•....••.......::::.:•::•.:•r:.....:.. 0 :#• :::....,..:,,....,.,....:.,{;:..::r.:•:}::J:??:;::,...... :••-•:..... riaYa't'ice XXX ind or gagm•e to secur-e coverage as required raider Section 25A of MGL 152 can lead to the tmpositlon of erimin0. 0 a lain ga a fine up to dens .00&at a one yam,bnprisonment as wen as civil penalties in the form of a STOP WORK ORDER and a 8ne of 5100.00 a day against me I mtderstimd that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification 1 do hereby fy under the pains enalties of pedury that the information proHded above is tnu and tarred Date i�-��t-� Z•�e ��� Signature tV Print name Phone#T5-®�� �l official use only do not write in this area to be completed by city or town official permit/license# ❑Building Department city or town: ❑Licensing Board response wired Selectmen's Office ❑checkif irnmediate q ❑Health Department phone#; Other _— contact person: . Unwed 9/95 PJAi } Information and Instructions ' or their de workers compensation f Mass achusetts General Laws chapter 152 section 25 requires all employers to prove P 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 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 ti Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying comP any names,'address and phone numbers along with a certificate of insurance as all affidavits maybe submitted to the Department of Industrial Accidents for confirmation of fimu nce coverage. Also be sure to sign and C,4- 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 a workers' compensation policy,please call the Department at the number listed below. are required to obtain City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the perm license number which will be used as a reference number. The affidavits may be rebamed to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a'call. ' The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 eat. 406, 409 or 375 °FINE TO�ti Town of Barnstable Regulatory Services SA NSrAHLE, ' Thomas F.Geiler,Director 9 MASS. g �prE16119. D MA'S A�� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 _ Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: AO&Vk- 090UP 0 AQQ 1- " �l Qoc.1,v0 Estimated Cost Address of Work: F 1 yr2 Cp 2yv&rL_S L2-aA-- 0 5 Owner's Name: Date of Application: 312-i / v 5 I hereby certify that: Registration is not required for the following reason(s): OWork excluded by law ❑Job Under$1,000 (Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agen f the owner: Pate Re istrationNo. Contractor Name g OR Date Owner's Name Town of Barnstable Regulatory Services 9$°' �'� Thomas F.Geiler,Director 16 ,19,9. 1% Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, Sr e p H r u 4 fu lv o FJ , as Owner of the subject property hereby authorize -rft Swim wlwa PooL +51pA GapiP to act on my behalf, in all matters relative to work authorized by this building permit application for(address of job) alas Five coasiao.s Roho . ca,+-,,rvtLv�Lt-o Signature of Owner,,-'- Date SrrLf#4&VV * Lo��ruA Csg� Ne�v Print Name i Q:FORMS:OWNERPERMISSION r E x P LoDED, °1k _ _-Nu M WAL3 ^�y _sd?(�FY r'RteER F r^tit4aX Rio x Wo g few i 31 WASHER .. � � Mz a WALL RAIL 30 7 COPING a K WI L L 6i-A 1 L S L FI""�.R s. .�� ;i i 1`�dw• •�<','. acoal & F � S:.iTTf�4� ':l.�jv.,.1 1•• y i 1� , BOTTOM STRAP �31t•3� ifil e-`-':�•. ts"r` F s: au1 �S!�s $ �{j f ° � �,F. i-'k�.°R,�s. `2!� .'•� �r�� COhAtEGTQRe � A 17 UNIVERSAL oG •°�y-jp'ii y.-Il h _ •y_�" WALL ne`:_::a SHEET i Jid i ii EJv SL 4 HOLD >ca<ET ! Fq EOTTCsMSi]J&?FE � \� CP'Rfltw.'EL s� 77UiSiiVEE9aa19 —19 BUT ml''ES-saSOPPOPT 22130TTOM STRAIGHT WALL RAIL 4.c t P.Al'eSNOLF MACKE Ti V� W .............. A 62 48a�Strome, Brooklyn, NY 1220 Tee- (7181.492_8991 ® FAX: 718)439-12 4`oill Free-* 1 a80- = s-659# T2 _ Bordure securitaire an resine de synthese. , ice, •Resin safety top seat. Montants en resine de synthese ou an acier. Ys „ Resin or steel uprigts.For oval pool,steel Pour une piscine ovale,montants ')? '�� uprights only. an acier seulement. + •Corrugated steel wall for greater sturdiness. Mur en acier ondule offrant plus de robustesse. 1 Polymer wall coating to protect against Revetement du mur en polymere, faw, z corrosion and oxidation. a 1'epreuve de la corrosion at de I'oxydation. Galvanized bottom track. ,. " •Rail du bas an acier galvanise. 12'(3,66m), 15'(4,57m), 18'(5,48m),J 12'(3,66m),15'(4,57m),18'(5,48m), 21'(6,40m),24'(7,31 m),27'(8,23m), 21'(6,40m),24'(7,31 ml,27'(8,23m), 30'(9,14m) 30'(9,14 m) 12'x 24'(3,65 m x 7,31 m), 12'x 24'(3,65 m x 7,31 m), 15'x 24'(4,57 m x 7,31 m), 15'x 24'(4,57 m x 7,31'm), 15'x 30'(4,57 m x 9,14 m), ' 15'x 30'(4,57 m x 9,14 m), 1 B'x 33'(5,48 m x 10,05 m) 18'z 33'(5,48 m x 10,05 m) Mur an acier ondule -- Corrugated steel wall ` ' The superior quality top seat,made of i it e Rail scurare De qualite superieure,Is bordure en resine de synthetic resin,features uniform calibration, �_ 'Blotto msafety tracksynthese,de calibrage uniforme,avec traitementUV treatment against discoloration and a 1/4")(3,20cm) UV contre la decoloration,est dotee dune molecular memory to prevent warping. In memoire moleculaire qui empeche la deformation. �, F, addition,the top seat is totally resistant to JL 10 En plus,elle ne s'egratigne pas! "�' i�,. corrosion and scratches. De conception unique a Trevi,le montant double Unique to Trevi,the double pool support post and ' Plaque de joint an ecier galvanise pour section droite de Is piscine ovale assure une Galvanized steel joiner plate stay assemblies are designed for superior grande resistance contre les pressions de I'eau strength as well as aesthetics(an the straight tout en offrant un design tres esthetique. I{ _. Montant an acier side of oval pool only). Steel upright Fait d'acier galvanise,Is rail du bas plus 1' Montant de support an acier galvanise The bottom safety track,made of galvanized securitaire,garantit a la piscine une plus grande Galvanized steel support post steel,guarantees the stability of your pool. stabilite. L:r4J tia►.:�..3 C�J� p � a Revetement plastifie SP. Plasticized SP coating. Couche de zinc fandu, Molten zinc coat. Couche d'appret. —- Primer coat. Application d'une solution alcaline pour — Application of an alkaline solution enlever lea oxydes. to cleanse the oxides. Revetement de polymere ultra resistant. i hl -- -- Ultra-resistant polymer. Motif incruste at durci a Is chaleur. — ; Heat-hardened inlay. Couche d'appret. ) — Primer coat. Couche de chromate antirouille. : -- Chromate anti-rust coat. Corps en acier. Steel wall core. Application d'une solution alcaline pour -- Application of an alkaline solution enlever les oxydes. to cleanse the oxides. r A�C']a - - .v 4 _ Bordure de 8"(20cm)an resine de synthese. °b - .. B"(20cm)resin top seat. Couronnement an polymere et en acier. Polymer and steel coping Couvre-joint an resine de synthese. Resin seat cap. Plaque de joint en acier. — Steel joint plate. Mur de 48"(1,22m)ou 52"(1,32m)an acier. Resin or steel upright. Montant an resine de synthese ou an acier. 48"(1,22m)or 52"(1,32m),steel wall. Syste•me exclusif de retenue � r' ' Exclusive liner locking system. de la toile. l f`f Prevent liner setback in case of movements Previent le decrochement de la toile an cas de caused by freezing or thaw,and increases overall mouvement occasionnes par le gel ou le degel at j I rs pool stability. accrot la stabilite de Is piscine. (Available only with"U-bead"liner) (Offert sur les toiles avec jonc d'acerochage Cb� 1A — "U-bead"seulement) I Piscine hors-terre - Above-ground pool T `w 207 4 Fr � }g, 4 . ►IS CI It IS SPAS •tlS U S I IS www.trevi.ca info@trevi.net Board of Building Regula ions and Standards One Ashburton Place Room 1301 '{ Boston—Massa 02108 Horne 1mpr®vemen$ Contractor Registration Registration: 130666 . ,---.-type• xpiration: 4!6l2006 The Swim Pool Spa Sale & Ser, MaketGrp Steven Senna P.O. Box 3612 E. Falmouth, MA 02536 -- Update Address and return card.Mario reason for chang 0 Address ❑ Renewal ❑ Employment Lost Card ✓Xe Ve 0.37tiLPYIZCG+E'.(XLt O�F../!/CCE't7SI.CCJB�IA Board of Building Regulations and vtandards License or registration valid for indiyidul use only (' HOME IMPROVEMENT CONTRACTOR before the expiration date. 1f found return to: Regis 6 Board of Building Regulations and Standards E*0Iration: '4!6l2006 One Ashburton Place Rm 1301 Type DBA Boston,Ma.02105 The Swim Pool p a etGrp Steven Senna 435 Waquoit Uwy µ E.Falmouth,MA 0253'6 - �� — It as'1� � .�•� Administrator Not valid without signature ReGenX'' Grid Element D . E. Filter Series ReGenX filters are also available as individual units to custom design filtra- tion requirements for new or existing pools.Choose the appropriate pump as enhancing accessor ies, well-as s stem e , 1 w� V 9 f _ such as optional Hayward automatic oh f, pump timer and chlorine feeders. r t HG450 Series ReGenX System RG700 Series ReGenX System Enjoy the benefits of crystal clear sparkling A high-powered,high-capacity ReGenX water for above-ground pools of all types system that is the ultimate in filtration for and sizes.System.come complete-with: larger above-ground.pools.System.come. o RG450 ReGenX filter complete with: a Power-Flo LX series ®RG700 ReGenX filter high-performance pump o Power-Flo LX series a Quick-connect union high-performance pump a Modular platform base ®Quick-connect union ®Deluxe modular platform base 0 FILTER TYPE: ReGenX Grid Element Extended-Cycle Diatomite FILTER TANK: Injection-Molded PermaGlass XLj'11 FILTER ELEMENT: Reinforced Spun-Bonded Polypropylene Grid Element FASTENINGS: Easy-Loklm Ring Assembly PUMP AND MOTOR: Power-Flo LX�'Series Pump—115 volts MOUNTING BASE: Injection-Molded ABS Energy Savings For proper filtration of residential swimming pools,your filter system should provide.a. Model Number Maximum Design I Turnover(In Gallons) complete turnover of the pool water once Flow Rate 8 Hours 12 Hours every 12 hours.Because ReGenX filters are RG450 Series 30—45 cPM 14,400-21,600 21,600-32,400 designed for high-efficiency;you may use the 8 hour turnover rate and save energy costs by RG700 Series 30-70 GPM 14,400-33,600 21,600-50,400 operating the system less hours. L.1 RG96 Americas # 1 Poo!Water Systems. r I1tVCl.,OSC;i I{'OP O-UTD I'tTA`fi� S. G I'�I. P ME CM,NSPI BOCA&-SBCGI BARRIER CODES LATCH s V9 9 IAN 5556� Gtf Y IAA t o • C,Q111�PLI"i l" A RiNCLOSURE '.. f TOWN OF BARNSTABLE Permit No. -------------------------------- { w Building Inspector 1 7W7TAUSUL . Cash OCCUPANCY PERMIT Bond ------------------____1f/ "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Smith Address RoUte 13P, !lyannis 1? Pl.ve C1orn/ere Wiring Inspector Inspection date f Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. .....................................................1 19......_._ ................................................................................................................_ Building Inspector Assessor's map and lot num ...... " O .... /• ►LAUST THE �) '7F J/D S-F$(I L YS`! M COl�A1 LIANCE ropy - Sewa e; Permit number ..g ............. '° !N v %NSA �! TINE S `` �' 6�R K = 33AUSTADLL i � WlT� TIC►- �0� House cnumber ............Zd .................................'............... SANITARY CODE pNC� 'oo,,�rb39 \0� T►ONS. .- o war Av :Y ;TOWN OF BART 'STABLE f- t�t RUILUNG INSPECTOR APPLICATION FOR PERMIT`TO ............................C.anstrLtct..AFwell.i-ng.......................................................... o _ TYPE OF CONSTRUCTION Wood Frame :LZ June 619.78.. r.a ................................................ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the, following information: Location ................L..ot.. ..F.. ve... Corners... Cntery ille.................................... ..... .."... .. .. ........"""". ... Residential ProposedUse ............................................................................................................................................................................. Zoning District ...Residential Centerville ....................................................................Fire District .............................................................................. James K. Smith Barnstable Nameof Owner .....................................................................Address .................................................................................... James K. Smith Address Barnstable Name of Builder ............................................................ .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms 6 Poured Concrete .................................................................Foundation .............................................................................. Clapboard & T 1.- Exterior ...............................................11.....................................Roofing ..............Asphalt.............Shingles......................................................... Floors ...........Wall to Wall Drywall ... Interior .......... ...............................................................:........ Heating .......F..H..W.....b..y....O...i..l.......................................................Plumbing ........1. .Bath.s .......................................................... .... .. .. Fireplace ......One.....................................................................Approximate Cost .......32,000. 00................................. .... . Definitive Plan Approved by Planning Board ---------------_--_--_ 9,% s• - 19 - ---. Area ............... Diagram of Lot and Buildingwith Dimensions ee��� 9 Fee .......... e.......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH B(j/Vo I hereby agree to conform to' all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name -...�R. Smith, James K. Y No`..20273............... Permit for ...........one...story...................... s single family dwellitg • .. ............................................................................... 208 Five Corners Road Location ....`............................................................. j Centerville } - ............................................................................... i e" 4 Owner James K. Smith I f > frame Type of Construction .......................................... u ................................................................ Plot ............................ Lot ....... 3.................... ` June 7 78 Permit Granted 19 " c Date of Inspection .......:.......19 ' .. l(� ' Date Completed .....<..... . ...... ..19 r PERMIT REFUSED ........................ ................ ....... 19 Y • ........................................................ ... .................. _ ............................................................................... y ............................................................................... c t t ` ............................................................................... ., C - Approved ....:........................................... 19 Assessor's map and lot number .....,./:'.7 ...:� �.%>./ f ...........0..... ?�Of THE tO�y e S/d Sewage Permit number ..:.................. Z BASHSTODLE, i House number ........... ?Q8................ oo Mb a O 39• �0 �t'p YFY a, TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ......... TYPE OF CONSTRUCTION ...................................Wood Frame........................................................................... June 6 19 7 P ....................... ................. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ............... -ot 4k3...F Aye, Corned Roa .. Cgntervi,lle...................................I............ .......................... Proposed Use Residential Zoning District Residential Centerville .............................................................Fire District .............................................................................. James K. Smith Barnstable Nameof Owner ...................................................... ..............Address .................................................................................... Name of Builder James K. Smith Barnstable ...................................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... 6 Foundation .,,poured Concrete Number of Rooms .................................................. . .................................................................... Exlerior .........Clapboard. . . . ... .. ... .& T 1. 11.. ....................................Roofing Asphalt Shingles . . ...... . ...... .. .. ..... . t1a11 to Mall Drywall Floors ......................................................................................Interior .................................................................................... i fPf by Oil „Plumbin 1� Baths Heating ................................................................... g .................................................................................. tno 32,000�00 . Fireplace ..:...............................................................................Approximate Cost .................................................................... Definitive Plan Approved by Planning Board -----------____---------------19________. Area `.. . .r Diagram of Lot and Building with Dimensions Fee Gr4"" ".. .... ............................ SUBJECT TO APPROVAL OF BOARD OF HEALTH .3t1! :s pie �t I hereby agree to- conform to all the RLIes and Regulations of the Town of Barnstable regarding the above construction. Name . .....: ..................Y............. ....... + .................. Smith, James K. A=168-109 U 20273 one story No ................. Permit for .................................... V m single family dwelli g ........................................................ ............ ........ 208 Five Corner. R d Location ........................................ ... .................. Centerville ............................................................................... James K. Smith : �sner .................................................................. frame ' Type of Construction ....... .................................. r ............................................................................... Plot ............................ .... .. Lot ................... June 7 78 Permit Grante ........................................19 Date of Inspectio 19 Date Completed ... ...................................19 PERMIT R FUSED ................ 19 .. ..................... ...... ........... . . . .. ...................... .............................................. � .. ............................ ............................................................................... Approved ................................................ 19 ............................................................................... ............................................................................... TCST HOLE MA RCM. . Z j /9 78 4'a ,,:, '' 'PRUL MURRAY - I N LoT 3 1 C?-aZ L©14M ANQ SUOSOIL i J rib C PROP. WATER +! RESERVE ,8+0 76 LINE 24 - 144 ME D7 uM o MIN DI ST., i C OAf f E SAND ( BOXLn ° 97 t �4 6ot3 i MA R1R1C K . `i`� i� ELEV 6..1 i j. TEST 8= 30 �-''�_` 4so j. HC3LE �y` _�� ND WATER ENCOUNT ER S pLLJ . w A?So�E GI?avND k PROPOSED a�'Ro�wo Pool , ,LOT 4 WAreR 15 9VV,4 h8,4 � r r3 u/L_D/n/G S ETL3AC� U/Q T,5 S CIA ;L:EF J - F20/V T Si DE 12at;E . �Q P2co�o SED F E3F_DIZOG9MS SEPT/C 5y5T M CcanfS7'2UC7101V SHALL CONF02M. Td MASS • . 0E5/Gw 4=*L0W GAL.. DAY ' E A,/v/,2 oAIP4Z- l7 AL CODe T/7-L — l AIE�4 7-AV L �'AG 97 :D.00 A sSuPf1Eb, ^1 AA11401- CO✓E� To �X rE_tea. Ta / I�}'tj, ✓so(-/s Co rrE/Z i+.#"')_ ZA �20M /A/V Z T/ ,G 7%ic/6, r I ,`'rO�hlE G A 6,0A f. Z : . / vl/'DEvr O/�2oN --�-•-- 3'M 47. AIOW - LIN� !M� ' . ti Q i S- -�Fa `'� O7 /a"Mi°V /4„ %4'/Fo o. "=.� Mrni �i rc��. a! •�%T ! , i DIA. a /� -//2' _Y_ n 4/AJ /4"/moor ,.. WAS HBO 00, /�iYf2T C,G1 P'.4 Cy'7`Y �` .4�DUnlO SE/�7-/G, TA A/� / 4 EL.EV. CWATG�T/GNT) /rVY�.e7- / $d f©M c�/= V6,07- �rpr- P17-* NO GARBAGE G,21AJD�k � /o./ c-� . — -- 20.'.�/wrtirUM / >� 6 k /� > S/ TL :�, h EFL nnrc E ; ' '_ OF E.aT/O TAN. /ST,0/BUT/ON 450X ,AlV� . E ACH/.VG X:>17- FO,�. AW1►1 R �3E o ,�'E/n/F�E'CED CO.vG/zG-T4 Gl{ FoF e" _ Nn,f,631 C iVG',24T"E S7�2EA/GT�/ .3000 P.s-/ M/A/. W/C: 4.0 L;LJ �-7-, -'�"� �o �,2/V�vVAY NOT TO �E- L OC,�i TE D y 2A'l0.0 I .+ 7 4 cov e sv T� uti. � ss �- zo �ya.v.T-.�.. i\ ES/Gib( LC).AD/NG /SON USED. Ttl 15. PLAN 15 LOeRTEIJ ©lv rt�C' °F 'cutfl !/ cec�Rc Low,•s. L to T. LD 9: .; • _ 601'891=y- r .J' .;.ry !p„L,, >., r...... ,3.�r .s"+. .aE x^^ ,;.. , i. ..,%e C :,j, '` _ s :...,- , = e 7..:_.rr+�^`'M:t+7rtcci "'t?3ej-,• a - .X TE T Ht' E MA RCN . zI - /978 P1RUL.. MURRAY = rNSPE.- OR o - LOT 3 E4.EV. /8-1 15746 O-cZ LOAF! ANb PROP. WATER Q RESERVE Is-toStJD.SQIL.. t— X t± } W Q -. " LINE , a � �- :4 - 144 ME D/UM MIN D/ST, © CDAITSE SAND Z r5 �o' BOX 4 LLJ 91tf w 4. Q r � �., 1846 /9i6 oCOt c I. LEACH U PIT ELEV 6.1 �. TEST .30,+ NO L�mreR NC t;IVT 'f D Lu HOLE ® ;8+/ I LOT 4 ' V -rOU .N+ GUt9T,'R 15 AVAf:G,A84,f MiAJiM U/1/J 3 u/L 17//vG S ETl3.�1 C� 2 U/, E. ,5 C.A L E J 0 � ME.t.%T'S , F2QA1 T P2o,a0 SED BE-Df20oM5 SE P T/C 5 y5 TE1►4 CONS T2 UC TLO1V SHA LL C'OA/FO/ZM TO MASS . ve5/G N FL 0 w GAL. Y ENV/,201VML—A17AL CODE. TITLE 'r V L.�t AJ S L G-,Gi. C,c! .,e,4 TE M/!v 7"nG' t�FAle �'��GJ T/C3 S 0LD,00 (�AssumEp) MAn/A/OLL NCO'✓E P- To EX TEnID ?O /�'1pC.RV/OCIS GoVE� bV/ Al OF F//�//S/1 ED GSA DEr To ,a2E✓eA-17- �20M /A/F/LT2AT/A/6 � STONE 15 za„Co✓r�zs /0 -� /sT. /Q ' I M, � . coV� Q�CiaST I BOx I Z/'N/iDG- O v97 j i E 3"MIN nn r A1 4,'D/A. ' UATFZ .. -x--- --�-- ---�— i�Nr 4' D/4 M/ty pl TC// �Q��FOOT /O"MItV �Zw Mrn/ / CAI � PiTe DiA. /4" �4 /jooT G, /I"/Poor �- WAS NEO Y L1 imlt-J M� /N(/E.ZT 1 oZOO. STONE GALLON/ /A/✓EeT /1v VE.2 T C A P.4 C/-T Y A 2 0 uN0 1Gt4 f�EV• G 93 �WA TGTd T/G,/T) /1V VE r BdTTOM OF ,v vEAzr No GA,e6AGE G,2]AJDE,P- C� /0./ C-- �` / Loc,aT/oti R IV 1' LE (alyTARi1�LC�� �1 _ 2 EF E I2 En/G E �E/NG L C?T ' i?f�}lt �." OF —�-- - - —_ >� P� S6 ` ,� Enr`ic TAn/:L, a/Sri/evTio.n/ Box RO)�ta�LD U= , OUTLETS AND LE�ICN/A/G X>/T AF?1'i 8E OF ,�E/NFO.E�CED CO.VCI2ETE c� GIFFOf to No,ft� C A1,CeETE ST,2EAJ,577/ 3000 ps/ M/!v. 7' `/L � C`URF'. �-l-/O LOAD//vG t/1>f/L w '7", - ►'" � 2/VEWAY N0T To �3E• Z-OC.aTED Y,� L JV1 O C./��L 7- /1�fJ -S. ti p O✓E,2 5 YS T��-� UAIL E 5 5 H- ZO ,. /fir\ ES/GAJ °LOAa/!v0 /S USED. S cER7'IFY ?`f/AT r//5 FOUN ATioN 5*00N' oar � . 4Yr�.G&ORCF SC � T H tS• ' PLAN /5 L.00R,TFD D!v T�€-6;R UNb f� LOw,'�.R. A- s tr l�l 14 N /i L �Q lYFta ti 4 TO 7�1E s,c oil, C�IJI .1?I11I!r ;L 1 � tlt� ? C7F srE¢`` o¢ Rv D 1c4?' e. 9 8 A ��teo V,4 z- , . t