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" 21 2008 Building Division oK f�J6 F ®�8 Tom Perry,CBO, Building Commissioner ARlUSTAgLE 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508=862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY {{ � ( Not Valid without Red X-Press Imprint Map/parcel Numbers' a, Property Address ? LaJ e E k lA C- ff /� ,,�l�. +��;.v c- �C n'rG/0 t - /C ErResidential Value of Work /d y 0 o 'D Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Contractor's Name jo s`40 r e Telephone Number LE® Y) Y Home Improvement Contractor License#(if applicable) 3 ( �� ❑Workman's Compensation Insurance Check one: Z I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name 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 stripping. Going over existing layers of roof) Er Ke-side ❑ Replacement Windows/doors/sliders.U-Value (maximum,1 *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: QAWPFILES\FORMS\building permit forms\EXPRESS.doc Revise020108 Board of Regulations and Standards Lic or registration vali ense Building d for indwadul use only before the expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR Board of Building Reg lations and Standards u j One Ashburton Place Rm 1301 Registratio�i:' 139619 Try 131937 Boston,Ma.02108 Expiration 7/28/2009 t=, TYpe DBA '+ 3f JOE POWERS HOME RENOVATIONS JOSEPH POWERS• i, �p �'°' Not valid without signature 130 FULLER RD Administrator CENTERVILLE,MA Q2632 r 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 A Iicant Information Please Print Le "bl Name(Business/Organizationnndividua): Address• p FKd c/ City/State/Zip: G n �G( J 11 A r /4 Phone.#: Are you an employer? Check the appropriate bog: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I # have hired the stab-contractors 6. El New construction �Iam ployees(full and/or part-time). Remodelin2. a'sole proprietor or partner- listed on the attached sheet 7• ❑ g ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers' comp.-insurance comp.insuuance.$ required.] 5..❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions myself[No workers' comp. right of exemption per MGL 12 ❑Roof repairs §insurance Iequired.]t c. 152, 1(4),and we have no 13.❑ Other employees. [No workers' comp,insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workms'comperuation policy infarr ation. t Homeowner;who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. h__Mtractors that check this box mast attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employces. if the subcontractors have mmployces,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and jab site information. Insurance Company Name: Policy#or Self-ins.Lic.M 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 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 statement may be forwarded to the Office of Investigations of the DIA for Insurance coverage verificatiom I do hereby ce ' unde e p and pe allies of perjury that the information provi7,770 is true and correct. /w Date: Si afore: �f Phone# Ll 51 / 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#• L - J 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 hue, 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 I Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone numbers) 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 Towa 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 onp 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 homeowner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum 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. 4 The Commonwealth of Massachuse#s Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston, MA 02111 TO. #617-727-490.0 ext 4-06 or 1-977-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia r oFZHEro Town of Barnstable Regulatory Services BARNSTABWW%M�" Thomas F. Geiler,Director $'°rf0.19. &� Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: .508-790-623 0 Property Owner Must Complete and Sign This Section If Using A Builder T, V�)G Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: lla- (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 OFYHE Tp� " Regulatory Services saxrtszegL9 Thomas F.Geiler,Director MASS. Building Division pTfD^OVA Tom Perry,Building Commissioner . 200 Main Street, Hyannis, MA 02601 wmv.town.barnstable.ma.us Office: 508-862-4038 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 supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on'which he/she resides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said 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 The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1,.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor.,, Many homeowners who use this exemption aire unaware that they are.assuming the responsibilities of a supervisor,(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Town of Barnstable Permit# 00&3(0C& xk :.A Expires 6 onths from issue date Regulatory Services Fee � Thomas F.Geiler,Director /06 0 � � Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 A ,. t:, rr www.town.barnstable 2r,9.ma.us ?? �j - Office: 508-862-4038 Fax: 508-790-623k76' EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint iap/parcel Number <A Cz 17 C roperty Address Residential Value of Work 1 C.pd 6 Minimum fee of$25.00 for work under$6000.00 )wner's Name&Address ;ontractor's Name d�®-a �� � Telephone Number S®is —!Q S9 — ®t4?S' lome Improvement Contractor License#(if applicable) ;onstruction Supervisor's License#(if applicable) ]Workman's Compensation Insurance Check one: I an,a sole proprietor I am the Homeowner ❑ I have Worker's Compensation Insurance asurance Company Name Vorkman's,COtnP•Policy# .opy of Insurance Compliance Certificate must be on file. 'ermit Request(check box)Re-roof(stripping old shingles) All construction debris will be taken to C�U V<) in ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Reside ' 'L ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) *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. 1IGNATURE: �- !:Forms:expmtrg '- .evise061306 ,4 mac:..... (� Inc L'Urritnurlwvu&,Tn VJ 1r1NJJNl nKJcuJ Department of Industrial Accidents Office.of Investigations 600 Washington Street Boston,AM 02111 �y www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers kpplicant Information Please Print Legibly Vame (Business/Organization/individual): ` �e% Address: `7.. Lc�e City/State/Zip: ci_ Phone#: ire you an employer? Check the appropriate box:. Type of project(required): ❑ 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 sub-contractors ❑ I am a sole proprietor or partner- listed on the attached sheet $ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in an capacity. workers' comp. insurance. g Y P tY• El Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its officers have exercised their 10.❑ Electrical repairs or.additions required.] I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself.[No workers' comp. c. 152, §1(4), and we have no 12.0 Roof repairs insurance required.] t employees. [No workers' 13.❑ Other, comp. insurance required.] ,ny applicant that checks box#1 must also fill out the section below showing their workers.'compensation policy information: lomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ontractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. zm an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site formation. surance Company Name: )licy#or Self-ins.Lie. #: Expiration Date: ib Site Address: City/State/Zip: ttach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). dlure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a Lie up to$1,50Q.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORD ORDER and a fine 'up to$250.00 a day against the violator. Be advised that a copy of this statement may forwarded to the Office of ivestigations of the DIA for insurance coverage verification. do hereby certify under the pains and penalties of perjury that the information provided above is true and correct ' afore: Date: \d hone#: 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#: Town of Barnstable *Permit# L6)l�t,7yj Expires 6 months from issue date Regulatory Services Fee t��; Thomas F.Geiler,Director -PRESS PERMIT Building Division APR 0 3 2007 Tom Perry,CBO, Building Commissioner V 200 Main Street,Hyannis,MA 02601 TOWN OF BARNSTABLE www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION .- RESIDENTIAL ONLY Not Yalid without Red X-Press Imprint [ap/parcel Number roperty Address `'7 L ck\(e, ]Residential Value of Work Minimum fee of$25.00 for work under S6000.00 iwner'sName&Address 4L \C �1�'s'i'��� d ►—i1 � L Y :ontractor's Name Telephone Number [ome Improvement Contractor License#(if applicable) bEnse�-{�f-aFPiieable) .. . ..... ]Workman's Compensation Insurance Check one: ❑ I am a sole proprietor I a3n the Homeowner I have Worker's Compensation Insurance asurance Company Name Vorkman's Comp.Policy# ,opy of Insurance Compliance Certificate must be on file. -ermit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side 1UReplacement Windows/doors/sliders. U-Value 'where required: issuance of this permit does not exempt compliance with other town departnentregulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property:Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. IGNATURE: � °\, 1:FoM:expmtg .evise061306 The commonwealth olmassachusetts Department oflndustrialAccidents : Office of Investigations n a ' 600 Washington Street Boston,.MA 02111 ,Y www.mass.gov/dia ' Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please]Print LeEibly Name(Business/Organization/Individual): . •Address: "t L<n,_\Ce_- City/State/Zip: �n`�"�y��-e�. 1 cM Phone:#:_ Are you an employer? Check the'appropriate boa: -Type of project(required):. 1.❑ I am a employer with. 4. ❑ I am a general contractor and I have hired the sub-contractors 6. ❑New construction . employees(full and/or part-time).2.❑ I am a'sole proprietor or partner- listed on the:attached sheet.. 7. ❑Remodeling These sub-contractors have ship andhave no employees 8. ❑Demolition • . ' workin for me in an capacity. employees and have workers' g Y •$• 9.-❑Buildmg addition [No workers' comp.insurance comp,msurance. 10.❑Electrical repairs or additions required.] 5. ❑ 'We are a corporation and its 3:�I am ahomeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. o workers' co right bf exemption per exercised. Y � �• 12. Roof r airs c. 152 1(4), and we have ❑ insurance required.]t ,§ no employees. [No workers' 13. Other l9)Wk comp.insurance required.] H s � *Any ipplicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then.hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees: If the sub-contractors have employees,they must provide their workers'camp.policynumber. 1 am an employer that is providing workers'compensation insurance far my employees. Below is.the policy and job site information. Insurance Company Name: Policy#or Self ins.Lic.#: Expiration Date: lob 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 ofMGL c. 152 can lead to the imposition of criminal 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 statement maybe forwarded to the OfF ce 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. Simature: o n �__Mll�_Cl Date: �'�10`7 1, Phone#: Official use only..Do not write in this area, tb 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#: Infor ati®n and In Atucti®ns Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Puns employee Pursuant to this statute,an em to ee 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 =eive. or trast=of an individual,Partnership, association or other legal entity, employing employees. However the owner of a dwelliug•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 rene*al•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-contcactor(s)name(s), address(u)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. Bp 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•oi-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 bum leaves-etc.)said person is NOT required to complete this affidavit. The Office of Investigations would hke to thank you in advance for your cooperation and should you have any questions,-,- ,please do not hesitateto,give us a call. The Department's address,telephone-and fax number; ate Commolwealth of Massachust�tts, Dgputment of bndtstrial A.oc ents Office of In-vestagat ons 600'waEshingta-6 Street Boston,MA 02111 Tel. #617-727-490.4 ext 4.06 of 1-$77-MASSAFE Fax* 617-727-7749° Revised 11-22-06 www,Mass.gov/dia r QFZHE, 'Town of Barnstable. yo y Regulatory Services 9 WUM Thomas F.Geiler,Director 16.9. Building Division prFD►�AA'�A Tom Perry, Building Commissioner 200 Main Street, Hyannis,NIA 02601 www.town.b arnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, z +� � n ` lc �i ,y as Owner of the subject property herebyauthorize to act on my behalf, in all matters relative to work authorized by this building permit application for: , (Address of Job) Signature of Ovner Date Print Name Q10RMS:01 WNERPERMISSION . SpWN OF 88H88?,88LZ ORTSV ICONM=jk;�XON :=I)ZVZSZON (sasr. rsAar. � �AIIS i OSSF.1[W1ITONS�iZZIIZZL EVZn -[ onus S=tl= /S =C.------------------ . i e 1 ' 14- RESIDENTIAL PROPERTY MAP NO. LOT NO. Lake Elizabeth Drive FIRE DISTRICT SUMMARY STREET 9 a W ©rt 73 LAND / 226 C-0 01 BLDGS. /6 �' SO OWNER TOTAL 3/ 174 LAND _v RECORD OF TRANSFER DATE BK PG I.R.S. REMARKS: �7 Lot 17 BLDGS. / y 6 TOTAL _. _ ..,...... ..~. 1 18 2 802 2110 / s yo3 voo. .2 i l ors .13 ac LAND U a) BLDGS. Re-Me -Frederick 33 TOTAL o? i �� LAND O1 BLDGS. TOTAL • • LAND BLDGS. ? TOTAL 1 LAND Wernick, Philip, Trustee, P & E R'ty Trust 12-18-78 2841 214 ( 32,30 BLDGS. TOTAL off/ 1�1��T��osTo oz/od LAND BLDGS. TOTAL LAND INTERIOR INSPECTED: rn BLDGS. TOTAL DATE: LAND Ak ACREAGE COMPUTATIONS OI BLDGS. ND TYPE # of ACRES PRICE TOTAL DEPR. VALUE TOTAL HOUSE LOT _13 LAND CLEARED FRONT O1 BLDGS. REAR I TOTAL WOODS&SPROUT FRONT HLANDREAR WASTE FRONT REAR LAND O BLDGS. TOTAL LAND 1,3 0 U BLDGS. 01 LOT COMPUTATIONS LAND FACTORS TOTAL FRONT DEPTH STREET PRICE DEPTH y{,:FRRON]TFT.]PRICE TOTAL DEPR. COR. INF. VALUE HILLY TOWN SEWER LAND ROUGH TOWN WATER _ BLDGS. HIGH GRAVEL RD. TOTAL DIRT RD. LAND FOUNDATION BSMT. & ATTIC PLUMBING PRICING LAND COST Cone.Walla Fin. Bsmt.Area Bath Room Base BLOG.COST Co...Blk.Walla Bsmt.Rae. Room St. Shower Bath Bsmt. • CJ O pURCH. DATE 'oni.Slab Bsmt.Garage St. Shower Ext. Walls PURCH. PRICE. ;tom Brick Walls Attic Fl. 8 Stairs A jn Toilet Room Roof RENT Stone Wells Fin.Attic Two Fixt. Bath Floors mere INTERIOR FINISH Lavatory Extra Bsmt. F 1 2 3 Sink . 3/4 Plaster Water Cie. Extra Attie EXTERIOR WALLS Knotty Pine Water Only Double Siding Plywood No Plumbing Bsmt. Fin. Single Siding Plasterboard Int.Fin. — Shingles TILING �'';.il., � / SO. .one.Blk. G F P Bath Fl. Heat , Face Brk.On Int.Layout Bath .&Wall a. 7 We Veneer Int.Cond. Bat(Fl. &Walls Auto Ht.Unit Fireplace 0 Dom.Brk.On HEATING Toilet Rm.Fl. plumbing 1 Solid Com.Brk. Hot Air Toilet Rm.Fl.&Wains. • -- Tiling Steam Toilet Rm.Fl. &Walls _ — .� Blanket Ins. Hot Water St.Shower j Total , Roof Ins: Air Cond. Tub Area ' Floor Furn. C S ~r ROOFING COMPUTATIONS �p Asph.Shingle Pipeless Furn. .5O S.F. a 3 Wood Shingle No Heat y f S. F. O Asbs.Shingle Oil Burner S.F. ' Slate Coal Stoker S.F. Tile Gas S F OUTBUILDINGS ROOF TYPE Electric S.F. 1 2 3 4 5 1 6 7 6 9 10 1 2 3 4 5 6 7 8 9 10 MEASURED Gable Flat ' Hip Mansard FIREPLACES S.F. Pier Found. Floor ` Gambrel Fireplace Stack i Wall Found. 0.H.Door LISTED FLOORS Fireplace Sgle. Sdg. Roll Roofing Conc. LIGHTING Dble.$dg. Shingle Roof Earth No Elect. -- DATE Pine I _►/ Shingle Walls Plumbing ---- Hardwood ROOMS Cement Blk. Electric _ ED TOTAL Brick' Int.Finish Asph.Tile Bsmt. 1st /�{ o� �J 7 ' Single 2nd 3rd FACTOR V 3 2 -LLQ(p L.;`• REPLACEMENT OCCUPANCY CONSTRUCTION SIZE AREA CLASS AGE REMOD. COND. REPL. VAL. Phy.Dep. PHYS. VALUE �Funct.Dep. ACTUAL VAL. DWLG. Up 2 3 _ 4 5 6 7 B 9 IO TOTAL . ROPERTY ADDRESS I I ZONING (DISTRICT CODE SP-DISTS.I DATE PRINTED(CSTATE LASS I PCS NBHD KEY NO. 0037 LAKE ELIZPTINTH D2I 12 nC 300 12CU 071G9/9.5 1041 JJ 4,5AJ K22 174 1 �FA73 LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS T Lantl BylDale Size D�men<,pn vP UNIT ADPRI E ACRES/UNITS VALUE Description I F£D E R I C O, J OS E P 4 & A N N A MAP- 1 FcDe mrAc,es BLOC./VR.SPEC.CLASS ADJ. COND. E PRICE PRICE J D 1 5 3�00� A CARDS IN ACCOUNT — 10 18LDG.SIT 1 x .13 =10- A=155 438 .59999.9 407339.95 .13 5:JJ0 43LDI(5)—CARD-1 1 76,000 01 OF 01 ' tt?L 9 LANCE EL'IZAdET4 DR OST 129000 iATHS _0 U x C= 100 7000.0 7060.00 1 .OG 70J0 8 li)L LCT 17 4ARKET �0C } — iVt) vJ,tiiT S K I C= 100 6.1 e 1 1.350 i 'Jt —;� �YR :)Yb4 iJl J6 IIvCGNE A !FIREPLACE U X C= 1 G 0 31C0.0 C 31C0 00 1 .06 31J0 ,} (USE D IEXT FIREPL U x C= 100 1.300.0C 13u0.0G. 1.00 13Ju d APPRAISED VALUE J i 129,000 I JI I ARCEL SUMMARY S AND 5300C T E3LDGS 76000 M j O—IMPS E I ITOTAL 129000 N _ i CNST DEED REFERENCE DATE YEAR rYpa Racy o.a PRIOR VALUE T I Book Page I"s' MO. v1Dl sma,Pr c. 4 D:0 53000 S I I I b:i5310247EI!03/89 A i I3LDGS 7600C 4362/061: 1:12/3.5 160000 TOTAL 129000 { i 4369/2.32: 1:06/85 112000 I' BUILDING PERMIT *LAND ADJUST-FOR ' I I Npmhe. Dale ryp. Amount L!0 C A T I C N I LAltiO LAND—.QDJ INC ;"E �1Sc I SP—tsLDS FEA7URESI ELG—.4GJSI U'lITS I S30C'0 1 3200 Glass Consl Tolal Base Rale Atll Rale Year Built Age Norm. OhaV. CND Loc 4y R G Re U's Un,ls A I Depr, [igntl. pl Cosl New AOI Repl Value Stories Height Roortrs Rms.Baths ♦Fiz. Partywall FaC. 02C 00 ) 110 110 60.80 66.88 50 75 19 80 100 5.0 95053 7 G uJJ 1..1 6 4 2.0 3.0 • Description Rale Square Feel Rep,.Cosl MKT.INDEX: 1-JJ IMP.BY/DATE. / SCALE. 1/UJ.90 ELEMENTST__ CONSTRUCTION DETAIL SAS 100 b6. 3 13.50 90283 GROSS A E S TWO FAMILY DiWELLING CNST Gp:; FEP 5 43.41 36 15b5 *----------------------50-------------------_* ST_YL'G _ 'UPLEX �e __-_____ 0.13 ! DEJIG) iAE4IiG_N ADJUST 10.17 + + -- --�--------tom -tXT r�. d.4LLSOnOCD FRfimI : J..J+ titATIAC TYPAJ --------------0.0INTER.FiNIS � 0.0 T<v1 _r2.LAY0U ---------"-tj.0 iNTc,F. lJALTAM� AS EXTER. .0 27 8ASE 27 IPL-0-oq Si.R11c - ----------------o:GI L w! ! EFLJiJR L'JVcsZ--[jo J0 ------------------ ff.OI E IT-1 Are lAun . �6 Base= 1350 ! ! ---- ----_____-- "� a2OJF-TYKE Ot; - BUILDING DIMENSIONS t ..- - _ _________cL'ci TRICP:L- - ---- tT.QI T AS W29 FEP 504 E09 NOG �109 6 + F01A0AT GN - JO ----------- A AS r 21 NZ7 E50 S 27 ._ + -------------- - -- ------------------q.9 L -----aEl - - - -- -- *--------21-------*---9---*----29-----------X ;Fii30R�10OL LAND ANO TOTAL TAE 4 FEP 4 AL MARKET PA2CEL 53000 129000 *---9---* AREA 14614 VARIANCE +0 +783 c STANDARD 20 V L ] [R226 174 . ] ' LOC] 0007 LAKE ELIZA TH DRI CTY] 12 TDS] 300 CO KEY] 136873 ----MAILING ADDRESS------- PCA] 1041.. PCS] 00 YR] 00 PARENT] 0 FEDERICO, JOSEPH & ANNA MAP] AREA146AD JV1291124 MTG10000 37 JUNIPER RIDGE RD SP1] SP21 SP31 UT11 UT21 . 13 SQ FT] 1350 WESTWOOD MA 02090 AYB11950 EYB11975 OBS] CONST] 0000 LAND 53000 IMP 76000 OTHER ----LEGAL DESCRIPTION---- TRUE MKT 129000 REA CLASSIFIED #LAND 1 53 , 000 ASD LND 53000 ASD IMP 76000 ASD OTH #BLDG (S) -CARD-1 1 76, 000 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE #PL 9 LAKE ELIZABETH DR TAX EXEMPT #DL LOT 17 RESIDENT'L 129000 129000 129000 #RR 0864 0106 OPEN SPACE COMMERCIAL INDUSTRIAL EXEMPTIONS SALE] 03/89 PRICE] 1 ORB] 6658/024 AFD] I TE A LAST ACTIVITY] 06/12/90 PCR] Y R226 174 . P P R A I S A L D A T • KEY 136873 FEDERICO, JOSEPH & ANNA 0 LAND BLD/FEATURES BUILDINGS NUMBER ZN/FL=RC 53 , 000 76, 000 1 A-COST 129, 000 B-MKT 85, 600 BY 00/ BY /00 C-INCOME PCA=1041 PCS=00 SIZE= 1350 JUST-VAL 129, 000 LEV=300 CONST-C 0 ----COMPARISON TO CONTROL AREA 46AD ----------------------------- NEIGHBORHOOD 46AD CENTERVILLE PARCEL CONTROL AREA TREND STANDARD 101 10 LAND-TYPE 530001 LAND-MEAN +Oo 1290001 91427 IMPROVED-MEAN -170-. 2006 ] FRONT-FT ] 100 DEPTH/ACRES TABLE 02 1000] LOCATION-ADJ APPLY-VAL-STAT 1 LNR] LAND LFT/IMP] ADJS/SB/FEAT STR] STRUCTURE ARR]AREA-MEASUREMENTS NOR] NOTES COM] MARKET INC] INCOME PMR] PERMITS GRR] GRAPHIC FUNCTION- [ ] STRUCTURE-CARD NO- [0 0 0] DATA- [ ] XMT [?] R226 174 . P E R M I T [PMT] ACT*T[R] CARD [000] KEY 136873 000000001 PERMIT-NO MO YR TYPE VALUE CK-BY MO YR %CMP NEW/DEMO COMMENT