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Home My WebLink About0198 NYE ROAD ., i i p Y V 0 Town of Barnstable (0/)U q THE Regulatory Services TON OF Rfkru-� Richard V. Scali,Director 0 0 BALMSTAB M MASS. Building Division J P 4 1639. Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 PERMIT# FEE: $35.00 SHED REGISTRATION RESIDENTIAL ONLY 200 square feet or less �2W 4 Location of shed(address) Village Property owner's narAe Telephone number Lr7 01� Size of Shed Map/Parcel Signature Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? If over 120 square feet,you must file with Old King's Highway Conservation Commission(signature is required) Sign off hours for Conservation 8:00-9:30&3:30-4:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:040914 aWn of Barnstable Geographic Information System New search Home Help I Map Size Zoom Our I I I M I I Q .Parcel Viewer Custom Map Abutters ® In -- In Elq (a c 7PG Map:"147 Parcel: 098 Full Property Location: 198 NYE ROAD Info Owner: NOVIKOV,ALEXANDER&MARINA - 147ooe A 200 — Location Information ; Map&Parcel 147098 14710D .Location 198NYE ROAD s€ fig Acreage 0.34 acres y: �� Current Owner * Mailing Address NOVIKOV,ALEXANDER&MARINA ' ��✓/� %NOVIKOV,.ALEXANDER TR s; 14709e 77"POND AVE.,APT#1102 A 190 BROOKLINE,MA 02445 O Appraised Value(FY 2014) , Extra Features $73,400 - Out Buildings. $300 �6 Land $105,100 " a Buildings $126,900 Total Appraised $305,700 147005 147007 _ Assessed Value(FY 2014) - .�. k100 - 0 k0 3 F Extra Features $73,400 " .Out Buildings $300 7 Land $105,100 - Buildings $126,900 Set Scale 1" = 34 : s I Aerial Photos I MAP DISCLAIMER - Total Assessed $305,700 Copyright 2005.2010 Town of Barnstable,MA All rights reserved.Send questions or comments to GIS - BarnstableMA v1.2.5122(Production] i http://66.203.95.236/arcims/appg6oapp/map.aspx?properryID=147098 5/30/2014 F Town of Barnstable 'THE OF 3ARINIS,7Ar�ijr rO Regulatory Services Richard V. Scali,Director BAMSTABM MASS. Building Division p-0 , Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 0260-4,-. www.town.barnstable.ma.usD1 Vi-'�1 a Office: 508-862-4038 Fax: 508-790-6230 PERMIT# FEE: $35.00 SHED REGISTRATION RESIDENTIAL ONLY 200 square feet or less lg ti I y �� L13 4 o Location of shed(address) Village /V®V oe r �47-�P31 Property owner's name Telephone number 7x 7 A Size of Shed Map/Parcel# Signature\-7-'-' Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? If over 120 square feet,you must file with Old King's Highway Conservation Commission(signature is required) Sign off hours for Conservation 8:00-9:30&3:30-4:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:040914 Mp Page 1 of 1 Town of Barnstable Geographic Information System New Search Home Help Parcel Viewer Custom Map Abutters Map Size ® Zoom Out In (a .-JPG Map: 147 Parcel: 098 Full Property Location: 198 NYE ROAD Info Owner: NOVIKOV,ALEXANDER&MARINA 147099 0200 Location Information Map&Parcel 147098 147100 Location 198 NYE ROAD 019 Acreage 0.34 acres ' ` c Mailing Address NOVIKOV,ALEXANDER&MARINA �... ✓/ %NOVIKOV,ALEXANDER TR 147098 �c 77 POND AVE.,APT#1102 x, 1 u199 BROOKLINE,MA 02445 k ] - .,-, C3 Appraised Value(FY 2014) Extra Features $73,400 Cr In Buildings $300 b Land $105,100 Buildings $126,900 4 4 Total Appraised $305,700 147097 -' Assessed Value FY 2014 147005 01a8 --------( ) .,} 0 so 3 F Extra Features $73,400 % t, Out Buildings $300 V'$ Land $105,100 , Buildings $126,900 ; Set Scale 1"= 34 I Aerial.Photos (14 I MAP DISCLAIMER Total Assessed $305,700 Copyright 2005-2010 Town of Barnstable,MA All rights reserved.Send questions or comments to GIS BarnstableMA v1.2..5122[Production] http://66.203.95.236/arcims/appgeoapp/map.aspx?propertyID=147098 5/30/2014 . � Li 03`� � t THE rp Town of Barnstable Permit# Expires 6 months from issue date Regulatory Services Fee t I ABxSTASLE NABS, $ Richard V.Scali,Director �A 1639. tED MAC A Building Division . Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X--Press Imprint Map/parcel Number A Property Address �� /v�t� `.-rGn4c.I ! U ❑Residential Va-lue_ofiWo k-$� '00-0 Minimum fee of$35.00 for work under$6000.00 Owner_'S,Name,&Address C'� / /(/�!/! lvv Al W Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Email. Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Ye Check one: MAY 3 0 2014 ❑ I am a sole proprietor ��- am the Homeowner ❑ I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side D tM;—'Replacement Windows/doors/sliders.U-Valuer Rolf(=59$,-(maximum.35)#of windows #of doors: _ ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *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 H e Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 The Comworrnw—i of Massachusetts Departtt t of bt msfrW Accidews - Q017ce o,f'Iresiorrs 600 Wayhirrgt€w Street Bostaqt M,4 02111 wrtmr.rxzasmgm dia f� Workers' CompensaticanInsuranceAffidavit:Builders/Contractors/FAectricians/Rumbers Apl*c,-mt Information Please Print Leeibly �1�1aIn�'(1�tafiiirP' ni�atiDu/lndit�ittual): '�L��(7./i � C 1� (l v� �f�V �A,9 9—W e�/Y� �� c� �� tat ?- U, �l>< � �6 z Phoneme Are you an employer?Check the appropriate box: Type of proiect(reqmredy 1-❑ I am a employer with 4. ❑ I am a Vital contractor and 1 6- ❑Ne;w construction employees(full and/or part-time).* have hired the sub-contractors.- 2-❑ I am a sole proprietor or partner- listed on the attached sheet y- ❑Remodeling ship and halve no employees These sofa-contractors have g- ❑Demolition wonting for me in any capacity employ and have workers' 9- El Building addition [No workers'comp_insurance camp-tnsurance_l � ed] 5..❑ We are a corporation and its 10_❑Electrical repairs or additions I am a homaarvsmes doing all work offices have exercised their I -.R Plumbing repairs or a3ditions. U myself [No workers'comp- right of e3Tmptiou per MGL 12_.❑hoof repairs insurance required-]1 c-1.52,§1(4),and wehan1eno employees-[No,workers' 113_0 Other camp-insurance required-1 *Any appbcat that ched s boa-#1 must also fill out tthe section below shouting their workers'compensat ou polity inEbrmatiob T Snmeowners who submit this affidavit i bEcating they are doing all wort[ewd then hire outside contractors— submit anew af6da*it infficatmg such --FC.anumcturs that cliedc this boa must attached an arldrbonal sheet shoutmg the mmne of the WV-omxft3cbos and state whether ornot those entities have employees- If the sub-contractors ham employees,they must provide their warken'comp.palicy number I am an employer meat isprrmiding workers'compensation insurance for my emplgyem Beloit is fate poTicp and job site in,for madam Insurance Company Name: Policy 4 or Self-ins_Lie.tk Expiration Date: Jots Site Address: � City/StaWZip: Attach a cop} of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to semre coverage as required uude Section 25A of MILL c 152 can lead to the imposition ofrri inal penalties of a fine up to$1,500-00 and/or one-year impnsonment,as well as ciTrii penalties in the foam 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 fire Office of Imestsgations o€the DLkfw insurance coverage verification- Ida hereby certify r fhepains andpenaWes p f`p dw that the information pren ided abonre' hue an correct 2,6 oj&ai use only. I)o not write in this area,to be completed by cil!'or town offic&L City or Town: F PermitUcense it Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/1`own Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 6 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto this statute,an employee is defined as"-..every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the forego' engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or e of an individual,partnership,association or other legal entity,employing employees_ However the owner of a dwe. g house having not more than three apartments and who resides therein,or e occupant of the dwelling house o other who employs persons to do maintenance,construction or repair work such dwelling house or on the grounds o bung app', enant thereto shall not because of such employment be deg to be an employer." MGL chapter.152, §2 C(6)also that"every state or Iocal licensing agency shall with Id the issuance or renewal'of a license o permit to op rate a business or to construct buildings in the co onwealth for lay applicant who has not roduced acc table evidence of compliance with the insnranc .coverage requ.ared. Additionally,MGL chi er 152;§25C( states"Neither the commonwealth nor any of i political subdivisions shall enter into any contract fo the performan of public work until acceptable evidence of ompli.arce with the insurance requirements of this chap r have been p sented to the contracting authoiity_" Applicants — Please fill out the workers' mpensation davit completely,by checking the xes that apply to your situation and,if necessary,supply sub-contra tor(s)name(s), address(es)and phone numbers) ng with their certificate(s)of insurance. Limited Liability ompauies(LL ) or Limited Liability Partners s(LLP)with no employees other Aran the members or partners,are not r ed to workers' compensation If an LLC or LLP does have employees, a policy is required- advised at this affidavit may be submi ed to the Department of Industrial Accidents for confirmation of� ce cove e, Also be sure to sign date the affidavit The affidavit should be returned to the city or town that e appli on for the permit or licens being requested,not the Department of Industrial Accidents. Should you ha e any qu ons regarding the law o if you are required to obtain a workers' compensation policy,please call the partme at the number listed be w. Self-insured companies should enter their self-insurance license number on the ropria line, City or Town Officials Please be sure that the affidavit is compl e d p led legibly. The epartment has provided a space at the bottom of the affidavit for you to fill out in the ev t th ffice of Investiga ons has to contact you regarding the applicant Please be sure to fill in the permitllicense n ber hich will be us as a reference number. In add Lion; an applicant that must submit multiple permitllicense app atio any given ar,need only submit one ah3davit indicating current policy information(if necessary)and under"Jo Si Address"the pplicant should write"all locations in (city or town)."A copy of the affidavit that has been offic, stamped or arked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for tine permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a li e or pe not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said pe o � INTO required to complete this affidavit. The Office of Investigations would like to thank you in vance r your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's`dress,telephone and fax number: 'fie Commnnweat f Massachusetta Depaztment cif Ind -al Accidents' Office of f av tip tiom 6O0aslungt n Street Baston2 MA 22111 T61.9-617-727-4900 ext 4-06 or 1-9 MASWE Revised 4-24-07 Fax# 617-727-7 749 www.mass-gov/dia Town of Barnstable Regulatory Services i P�oFtru jOsiy Richard V.Scali,Director Building Division BARNSTABLE, Tom Perry,Building Commissioner MASS. 200 Main Street, Hyannis,MA 02601 prED ICY A www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION GPlease Print DATE:4^✓� U(� Q�/��'r /�- D rjJ � �f J-OB COCAT-IO__N' y z d 32- number street J / / village "HQNffiC WNER' �` �� E �[�✓ name home phone# / work phone# CURRENT MAILIN. ADDRESS- -7 7 �'/� b xve (1�� 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 undersi homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection proced requirements and that he/she will comply with said procedures and requirements. Sign re-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 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 Iast page of this issue is a form currently used by several towns. You'may caret amend and-adopt such a form/certification'for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 t r * aaxNsrnsc.E. ,' ,�� Town of Barnstable '0>En Mt•'�a Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02 1 www.town.barnstable.ma s 3 Office: 508-8 62-403 8 7 Fax: 508-790-6230 Property Ow r Must ' Complete and Sig This Section If Using uilder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this uil g permit application for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit,pleas complete the Homeowners License Exemption Form on the reverse side. R Q:\WHILESTORMS\building permit forms EXPRESS.doc Revised 061313 A 1—t Town of Barnstable *Permit ol)/a D ql Regulatory Services �ee 6 ��eu. • i SARNSTABI.Fw s-- M^S& Thomas F.Geiler,Director s639• Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXP SS P RAUT APPLICATION - RESIDENTIAL ONLY 147 Not Valid without Red X-Press Imprint Map/parcel Number Property.Address i g IU t �� n'�` y�V t / v/�,, 'c, [Residential Value of Work S 15 , V l'1 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Ake x '7 `7 Pon no hoi 11b2 -ilrb&000 `tla, oz:y yS- V I b Contractor's Name � o�� I� Telehone Number P Home Improvement Contractor License#(if applicable) l Construction Supervisor's License#(if applicable) V q cl qQ SS PERMIT ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor DEC 2 0 2012 ❑ I am the Homeowner I have Worker's Compensation Insurance MO+ ETOWN OF BARNSTABLInsurance Company Name ,�I V� Workman's Comp.Policy# �70 2 7 5D 1 '2 l Z Copy of Insurance Compliance Certificate must accompany each permit. Permit R quest(check box) A U4 Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ✓"! 4�h ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows. ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *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&Construction Supervisors License is required. SIGNATURE: Q:IWPFILESTORMSU l ing perm .fbrms\FMRESS.doc Revised 0.53012. r, The Commonwealth o,f Massachusetts �t-of�itel'r�strial�4�- eats Office o,f Invest4ations 600 Washington Street Boston,MA 02111 . www mas&gov/dia Workers' Compensafion Insurance Affidavit: Baidders/Coiat-actorslElectrici-ans/Pl hers . AApphcant Information Please Print Lei b y Name Musi O: A Mc Address: a 7 s Pa City/State/Zip: �?`} I a^t)�, c,C, cl Phone# Are you an employer?Check the appropriate box.: Type of project(required): 1.❑ I am a employer with 4. X1 ate•a general contractor and I � have Hired the sib--cont�ctaus b- ❑New construction employees(full and/or part-time)_ Remodeling 2..❑ 1 am a sole proprietor m partner- listed on the attached sheet 7. ❑ g ship and have no employees These sob-contractors have g_ ❑Demoliti:ont- working for me in any opacity. employees and have workers' 9 ❑Building addition [No workers'camp.insurance comp-insurance-1 required 5. ❑ We are a corporation and its 10.❑Flectrical repairs or additions 3_❑ I am a homeowner doing all wont officers have exercised their 11.❑Plumbing repairs or additions myself [No workers'camp- right of exemption per MGL 12: Boaf repairs insurance required.]T c. 152,.§1(4).,and we have no employees_[No waakers' 13;❑Other comp.insurance required.] 'Any apph am that checks box gl mast also fill out the section bebpw shotring their araakers'compensation policy infoT=ti= I Homeowners wbe submit this affidavit in&csting they we doing all woof and then hie outside cofactors mast ew ast submit a.n affidavit indicating such. tQmtractors that check this ban must attached as additional sheet showing the name of the sub cxanrwtm and stare whether or not those entities bare employees. If the sub-contmams have employees,they must.provide their workers'comp.policy number. lam an employer that is providing worknn cor gwasaden insurimc-e for niy employees, Below is the policy and job seta informati'vn. c /� lustuance Company Name: k uj r C to' S v ' Policy#car:Self iris.Lic.#: l/Il C d 6 S` Expiration Date: J Job Site Address: ( '1 y r Ra cityfStawzig: Oe,1 (J�`�c �4l' Attach a copy of the workers'compensation policy declaration page(showing the policy number and f3piration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500-00 andior one-year imprisonment,as well as civil penalties in the form of a STC3P WORK ORDER and a fine of up to$250-00 a day against the violator:. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the.DIA for insurance coverage verification- Ida hereby ceiWfy under the pains andpen5bliffs of �that the information pratided above is true and correct �7 1 S 0,.\.11 t. _ Date: P. L� 2 G 6 Phone �� 9y2- O,fcial um only. Dv not write in this area,to be completed by duty or town official City or Town: Permitfl icense# lssuing Authority(circle one): 1.Board,of Health 2.Building Department 3.City-frown Clerk d.Electrical Inspector 5.Piymbing Inspector 6.Other Contact Person: Phone#: �1�9�pmr/ryLdlLfOQQGCIL 0��Lll4P.�b ftice of Consumer Affairs&Business Regulation' License of registration valid for indivii before the expiration date. If found ret ME IMPROV ENT CONTRACTOR Office of Consumer:Affairs and Busine egistrati Type 10 Park Plaza-Suite:5170 VExplra%!i Supplement armed ".-'Boston,MA 02116 The Home Depot d MARK NIADNA =� 2690 CUMBERIAND.' S Eg" GA 30339 Undersecretary _ o�vlid with ut signature .f y f - JUN-05-2012 08:33 THD-AT HOME SERVICES, 'INC P.001/001 r CERTIFICATE OF LIABILITY INSURANCE106/04/2010 i THIS CERTIFICATE IS =UZ0 A8 A MATTER OP INFORMATION ONLY AND CONFERS NO MGMT9 UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE_ DOHS NOT AFFIRMATNELY OR NEGATNELY AMEND, EXItNO OR ALTER THE COVERAGE AFFORDED 9Y THE POLICIES i MOW. THIS CERTIFICATX OF INSURANCE -DOE$ NOT CONSTPPUTE A CONTRACT t3€TINEEN THE 160UING INSURICR(5), AUTHOR eb RTOMONTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. I!A a tt holder Fs an ADDITZNAL INSUK_FQ,__rn' pv muat be e11Ao W sub wt to- -tee tome and coadMM of the pot(py, saMIn CoIk"m my mgafra an antloTsement A statomera on this s®PtlaCate pos not 06nfap olohts t0 the cortHfrala Wdey in Ilea of such andorsMnont(s). MIOOYC{R NAIM: jow p B)hFtt~,wZYTw DEA JOW P SERRCMIZI DM AGENCY 7S F STREW — - _....... _. ......__.._ cvarORnelve ' 8C7L7f., WX 02045 -____-- INauRe�LelArw�!ngcoYlRAalt WA19a NnNtltu •• •-•^ - — CtauRSRA r A.I.M. xVJr 7118IIRA1CCE CO Mich"I Viola , nleuaeRa: dbu vy.ola CoatraCtj>.+gr +NsrinRnc: F 0 awC 43 i Hull, MA 0204S IraaRSRa: WSURLe F i COVERA095 CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY HAT THE„PO4CIES OF INSURANCE LISTED BELOW HAVE WN I NYD MrrWED ABOVE R ME POLI OD INDICATt:O. NOTWIIWANOING ANY REOUIRt:mENT, TERM -OR CON151TION OF ANY CONTRACT OR Gn4;R DOCUMENT WITH RESPECT TV WHOM TTQS CERMICAN MAY BE 13 M OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLIGIE3 00=80 HEREIN IS S11C40T TO ALL THE 'I(:RIAS, E%CLUMONS AN0 CON011IONS of BUCH POUOIM UMITS r3HOWN MAY HAVE ISM R601JCE0 pY PAID CLAIMS. 1191117 LTR I W iWVD MMYNUUM (M miaw i LIARTII. .....—_..._.. 9MALUAGUM EACH OCCIIRItErx E S _ COMM ACIALGENMVLLIABllJTY , I PRBhhEIE(eaxe�nMleel ! _ I 'CLAIMs.TrAOs OCCUR Mpo E%P(Any one perm)— i. r'lReeNAI,4ADV et.IUnY GHNLnoaReaAY/,LutlTAPWJtaieJx ' ;PR00LICTa-cOMPADPAGU 7 I VOUO Y F7 May1 1 am .s..._...._._ . .: AUTOROBaELIARLITY I :00VOINEOWNULEUMITmwro ,! I f �YOILYWJURY(Prr"� ) S ALL C*WrDAUT08 I _...._...-.. . eODILYINJUR'r(reraeevpns '! i w.mROULEOAUtoa I I pROP6RTraurAOa -' — WMINAUT0a 1 I (PoraopQrnq NONAmT16pAUr05 - UuaRRUALNa =kA 'EACH000URUNCe I! aXCFAaIUa l 1 C AIMSMAW ` AOGREGAT& ! Dc0U0TOLC � � ! ItCTanrnON ! I ..._ s•. ANoeRaWY/Il!'Wsl(Trr 010`o1eCOMFUA r10r' 7926049012012 -5/26/20125/25/2013IR YIN� .....NRY,LIRrrs ) Elt ... ...._. E AMI VROhaatoRrrARrnsRrptECunve r_ IN/A \ G,L.UON AC W4r ! 100009 i of Iceluue�aw axowOtlpT J pAenAdrrrInfoo e.LGIRGAOF IbNaMPwrl;� s 500000 i Ir yer.aee .-. MWAIPtwMOF0MRA UCY T30Wbokm EL CASEAW-POLMIT - f TWO 600�- DeaeRlrtroel0►01CRAt10Ma1 wGtgRs f KWIC(ls(AseW ACORO 101,AtllfoaY RemiyR�lseearl.,rmoh yWR.b npninal TFM AT-RCM SEMC29, 1tiC. AM 1PNE 10M DiAOT An =LOW AS A00TTZONALZN3UA%D WITg i �f;PECT TO MNMM LZABILM ZNSO UQ=. i CERTIFICATE HOLDEN CANCELLATION TNO Ai'-ME AILf CES, DE. � ATT: �iBTALLBR RYLATZONB DRP'r.. 9NWLD ANY OF THE ABOVE DE>I XGEO POLICIES BE CAmuLED at?PORE ' THE GXPIPA71ON DATa TWERROP, NOTICE LAlLL 114 CCUV PAD IN 2590 COIfMRRbWO ZMy Sol= 900 ACCORDANCE WITH THE POLICY PROV00Nt1, ATLhM G>rGsll= 30339 AUTHorr1�77a l 0 118 -2909 AGORD CORPO N.A11 flahm rteetYOd. ACORO 26(200 M) The ACORD name and lop art Itgfaterad Of ACORD Z00[j Si)t3trzmsxI izKoDusla 999C996TOL T'd3 92:9T,ZTOZ/DO/90 TOTAL P.001 �r c saf*et Board of Building Regulations and Standards Cun.n•uctinrt Suhcri.ur SliciiatC+ Lltense_CSSL-099403' MICHAEL J VIOLA 8 HADASSAH WAY HULL MA 02045 : miS3i0nEr 02/24/2014 �0'LIO- 1L l7U:tAJ rnun-inL !1fVLUVl1Vl `• -+uu .J •.•••4••, - � - ---` ---- - -' August 17, 2012 Barnstable Building Dept. The following is a list of our approved sub-contractors for The Home Depot: Ericsson Torres—CSSL#100546 HIC# 163528 Robert R€posa - CS#60526 H IC# 147080 �Timo by Thomas=CS#51899 HIC# 152121 Joseph Duarte - CS#70077 HIC#132349 Douglas Szynal - CSSL# 103950 HIC# 146142 Brian Laroche- CSSL#100478 HIC# 152612 Joseph Mckeon - CSSL#98863 HIC# 132614 If you have any questions please contact Mike Bedard our permit coordinator at 508.962-6942 or myself at 617-438-9017. S cer y, ussel Jo t Branc stallation Manager TH®At-Home Sorvicsa,Inc. 908 Boston Tumpike- Unit 1•Shrewsbury,MA 01545 Ph9ne:774.275.2130•Fax:508-845.6076•Toll Fred:800.657-5182 —a HOME IMPROVEMENT CONTRACT + PLEASE'READ TH IS Sold;Furnished and Installed by. Bra[1'ch/; ume: Boston Da�c • TI ID At-biome Services,Ina dibra The Home Depot At-Home Services 908 Boston Turnpike,Unit 1,Shrewsbury,NIA 01545 Toll Free(800)657-5182;Fax(508)845-6017 ti Branch Number:31 Federal ID Y 7 2698460;ME Lic#C 02439;RI Cont.Lic4 16427 CT Lis#II1C.0565522;N1A Home IImprovemen,t/Coonttractor Reg.ft 126993 Installation Address: 1' /11�� Jlt�T ��A3 City Stat6 Zip + Purchaser(s): Work Phone: Rome Phone: Cell Phone: VIA Home Address:7� �r/T�' /��lL rQ/JT/Y� �✓�OeJ /�r1q t� o� �Y��j (Ifdiffe.rent from Installation Address)i 'j City Staler Zip Xt�ail Address(to receive project cot�ltnunications and Home Depot updates): lJ/ Yi¢/I�DD��DIYj DO NOT wish to receive any marketing emails from The Home Depot Project Information: Undersigned("Csustomer"),the owners of the property located at the above installation address,agrees to buy. and THD At-Home Services. Inc.('T e Home Depot")agrees to furnish,deliver and arrange for the installation("Installation")of. all materials described on the below Ind on the referencedlSpec Sheet(s), all of which are'incorporatcd into this Contract by this reference,along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders(collectively; "Contract"): u 's Job#: p"m n,i u.r,„a.i I Products' Sec Sheets #: Project Amount Roofing ❑Si in ❑Windows ❑Insulation / /D n $ �!'/—7 ❑Gutters i Cove s ❑Entry Doors ❑' _ / d !� ❑Roofing ElSit ing ❑Windows ❑Insulation D�—71 F Gutters i Coves ❑entry Doors ❑ _ (p ❑Roofing ElSic ing Windows'❑Insulation $ ❑Gutters i Cove s ❑Entry Doors❑ fs ❑Roofing ❑Si ing ❑Windows ❑Insulation $ „ ❑Gutters i Covers ❑Entry Doors ❑_.,._.___ Minimum 25%lhepositofContract Amo nt due upon execution of this contract. Total Contract Amount Maine Purchasers may not deposit more an one-third of the Contract.Amount Customer agrees Thai. immediately up n completion ol'the work for each Product, Customer will execute a Completion Certificate (one for each Product as delined by individual Spec Sheet)and pay any balance due. As applicable,,each Customer under this Contract agrees to be jointly and severally obligated and liable hereunder. } The Home Depot reserve,the right to ssue a Change Order or terminate this Contract or any individual Product(s)included herein,at its discretion,i f The Hone Depot or it. authorized set-vice provider determines that it cannot perform its obligations due to a strucwral problem with Ulu home,environtncnta hazards such as mold;asbestos or[cad paint;other safety concerns-pricing,errors or because work required to complete the job was not included in the Contract.`n Payment Summary: The Payment unrntary ft included as part,of this Contact, sets lbrth•the total Contract amount and payments require I for the deposits and final payments by Product(as applicable). NOTICE TO CUSTOMER„ " You are entitled to a completely fille -in copy of the Contract at the time you Sinn. Do not sign a Completion Certificate(note: there is one Completion Certificate I or each listed Product as defined by individual Spec Sheets)before work on that Product is complete. In the event of termination of this Contract,Customer agrees to pay The Hume Depot the costs of materials, labor,expenses and services provided by The Home Depot or Authorized Service Provider through the date of termination, plus any other- amounts set forth in this Agreement or allowed under applicable law. THE, HOME DEPOT MAY WITHHOLD AMOUNTS ' OWED TO THE HOME DEPOT FROM THE DEPOSIT-PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOT'S DTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acceptance and Authorization: Cu comer aprecs and understands that this Agreement is the entire agreement between Customer and The Home Depot with retard to tl e Products and Installation services and>upersedes all prior discussions and agreement,,either oral or written,relating to said Produc s and Installation.This.Agreement cannot be assigned or amended except by a writing signed by Customer and The 1-ome De ot. C tstorner acknowledges and agrees that Customer has read, understands,voluntarily accepts the tents of and has n:c' d a of Ihi Agrecmcnl. Accepted x b•• /�� / Submitted by: � 3 f /� ' - j X Q f .. r tstomer's ignature I e Sales Consultant's Signature / Oatell X Telephone No. Customer's Signature Da e Sales Consultant License No, i 16 CANCELLATION: CUSTOMER AY CANCEL THIS usapphi al)lol _r AGREEMENT WITHOUT PENAL Y OR OBLIGATION 4 BY DELIVERING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS - k "t DAY AFTER SIGNING THIS AGREEMENT. THE T ,• STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE. NOTICE:ADDITIONAL TERMS A ND CONDITIONS ARE STATED ON THE REVERS;SIDE AND ARE PART OF THIS CON'1'11ACT 05-10-12 White-Branch File Yellow-Customer l,'d 0088-189 809 L peat' sug0 13ll C0 Zl, Cl, AoN TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map f L/ 7 Parcel 4 �' ::Application #,967/6L 3 94!�Q, Health Division Date Issued Z O Conservation Division Apphcatign Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project--Street-Address f Owner � �'� �>� V I Address Telephone 9 — 6 0� ® b Permit Requestt r-o o tv, Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay a� Project Valuation w Construction Type J Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name U� °" V ! 1� Telephone Number Addre s �" 0� License # v �V) (C.- V ept—Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRI LT OM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE } FOR OFFICIAL USE ONLY f APPLICATION# DATE ISSUED -f E ' MAP/PARCEL NO. IR � r r ADDRESS _ VILLAGE OWNER ` DATE OF INSPECTION: f r FOUNDATION. = �.. FRAME Arlftk n3�Ia?Y%0! l�h I. INSULATION:C��IVS ,y FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL- ,. , r GAS: ROUGH vRQV.S',� i ' FINAL .FINAL BUILDING;` 6k ,0,eo� XIZ7 /Z DATE CLOSED OUT ' ASSOCIATION PLAN NO. t The Commonwealth of Massachusetts r. Y ,Department of XndustrialAccidents 14 Office of Investigations 600 Washington Street c� Boston, MA 02111 yy www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ib1 Name (Business/Organization/Individual): 'e Ir ' Address: - P64 14kf 4eC ( �v Ci /State/Zi /`�l V 0//� i Vim—.+ / -97hone 42 �S. W_7-6904� I b h' :P Are you an employer?-Check the appropriate box: ' Type of project(required): ❑ I am a employer with 4. I aina general contractor and I 1. � 6. ❑`New construction have'hired the sub-contractors.. employees(full andlorp--art-time). - -.- -- -.-..--._.... ......... .: 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• ❑.Demolition, working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers' comp. insurance 'comp.insurance. required.] 5. ❑ We;are a corporation and its ' r 10.0 Electrical repairs or additions 3.;94 am a homeowner doing all work officers have exercised their 1 l.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.E] Roof repairs insurance required.] t c. 152, §1(4), and-we have no employees. [No workers' 13.❑ Other comp, insurance required.] ' *Any applicant that checks box#1 must also fill out the section below showing+thcir workers'compensation policy information. t Homeowners who submit this affidavit indicating they arc doing all work and then biro outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number, I am an employer that is providing workers'compensation insccrar'ce for my employees: Below`is the policy anti job site information Insurance Company Name: Policy# or Self-ins.Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal"penalties of a fine up to $1,500.00 and/or one-year imprisonment; as well as civil':penalties in the forma of a'STOP WORK ORDER and a fine of up to $250.00 a day against the lator advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for i c ov age verification. Y I do hereby certify under in a penalties ofperjc+ry that the information provided abo e ' trz and correct.—Bi " ate. Si'nature: Phone# 'Official use only. D'o not Write in this area, to be completed by city or town official . City or Town: MPermit/License# IssBoauing Authority (circle one): k 1. rd of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: - information and Nstructzons y, Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees, Pursuant to this statute, an employee is defined as ".,.every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, ass n, corporation or other legal entity, or any eT poo�eore of the foregoing e❑ aged in a joint enterprise, and including ih legal representallves of a deceased employ receiver or trustee o n individual, partnership, associalion or- other legal entity, employing employees. However the owner of a dwelling ho se having not more than ihree aparlm nts and who resides therein, or the occupant of the dwelling house of anothe who employs persons to do maint ance, constriction oY.repair work on such dwelling house or on the grounds or buildin appurtenant thereto shall not b cause of such employment be deemed to be an employer.' MGL chapter 152, §25C(6) also ales that "every state or I cal licensing agency shall withhold the issuance or. renewal of a license or permit to erate a business or t construct buildings in the commonwealth for any applicant who has not produced acc. table evidence of ompliance with the insurance coverage required." f Additionally,MGL chapter 152, §25C( stales "Neither t e conunonwealth nor any o its political subdivisions shall enter into any contract for theperforfriance fpubhc iwor intil acceptable evidence of compliance with the rnsuurance requirements of this chapter have beenprese ed to the c trading authority." Applicants Please fill out.the workers' compensation affidavit co Ictely, by checking the boxes that apply (o your siteiah on,and, if necessary,supply sub-conlractor(s) name(s), addresses ; nd phone nuunber(s)along with their cerlificate(s) Of insurance, Limited Liability Companies (LLC)or Limi ed Partnerships(LLP) with no employees other than the iability members oPpartners, are not required to carry workers' co p��cation insurance. if an LLC or LLP does have employees, a policy is required. Be advised that this of idavil may be submitted to the Department of lndusti-a Should Accidents for confirmation of insurance coverage. Al o be Sure��o sign and date th•e affidavit. The affidavit be returned to the city or (own that-the application for e permit or`l�iicense is being requested,not the Departmen't of Industrial Accidents. Should),ou have any questions r'garding the JAV or if you.are required to obtain a„workers compensation policy,please call the Department at th number listed be ow..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 pnnte legibly, The Departmen as provided a space al the bottom of the affidavit for you to fill out in the event the Offic e of Investigations bas to contact you regarding the applicant. Please be sure to fill in the permiVl'cense number whi h will be used as a.reference umber. In addition,an applicant that must submit multiple permiUlicense applications i any given year, need only subbrpit one afffdavit indicating current policy information(if necessary)and under"Job Site ddress" the applicant should wri�e�"a]) ]�caiions in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or to may be provided to the applicant as proof that a valid affidavit is on file for fu re permits or licenses. A new a,ffidavi ust be filled 0 teach year. Where a home owner or citizen is obtaining a li ense or permit not related to any busineso �ominerci a 1 venture (i,e, a dog license of permit to burn leaves etc,) said p rson is NOT required to complete this affiidavil. The Office of lnvestigabons-wou137ikeTo-1h�n -0 d shoui►d ouhave a questions, please do not hesitate to give us a call. The Deparlment's'addless, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street B oston, MA 02 11 1 Tel. 4 617-727-4900 ext 406 or 1-877-MASSAFE Fax 9 617-727-7749 Revised 4-24-07 www.mass.gov/dia y. Town' of Barnstable •oe ' �44 1%�, Regulatory-Services Thomas F. Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street,_Hyannis, MA 02601. www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOV NER LICENSE EXEMPTION l � 0 Please Print DATE: JOB LOCATION: ( Al G ��t V_V" nus cct/ village C_ ;"Ltvald. "HOMEOWNER": �r ®V ��' C�11 ` ( -690—Y? l9 name home phone# !/ work phone# CURRENT MAILING ADDRESS:_777 P �t t4 V ? * /109, &xvLl) k- 11 VLA__ r_j city/town state zip code T c 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. DEFINMON OF HOMEOWNTR 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 constrgets more than one home in a two-year period shall not be considered a bOmco-viner. 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 undcrsigne omeo r"certifies that,he/she understands the Town of Barnstable Building Department MIIU UM• e on o ures and requirements and that he/she will comply.with said procedures and requir . Signer re 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 pemvt is required shall be exempt from the provisions of this scction.(Scction 109.3.1 -Licensing of construction Supervisors);provided that if the homeowner engages a persons)for hire to do such work, that such Homeovma shall act as supervisor." Many homeowners who use this exemption an unaware that they an assuming the responsibilities of a supervisor(see Appemdix Q, Rulcs&Rcgvlations for Licensing Construction Supervisors,Section 2.15) This lack of awareness bftcn 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 responsrble• , To ensure that the homeowner is fully aware of his/her rusponnbilitics,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 SCVeral towns,,You may care t amend and adopt such a fom�/ccrtifrcation for use in your community. N Q:forms:homacxcmpt ti 3 THEr, Town of Barnstable Regulatory Services slE?t67ABI.E, • . r MAss $ Thomas F. Geiler,Director °TEo► 16 Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as er of the subject property hereby authorize to act on my behalf, La all matters relative to wo authorized by this b ding permit application for. (Addre o ob) 5i.gnatvre of Owner Date Print Name If Provertv is applying for permit please complete.the . Homeowners - icen ' omeownersLicene Exemption Form ion the reverse side. Q:FORMS:0 WNERPERMISSION 0 N ... ............. ............. ............ ti _.. ..................................._.... „b,6 e 64r- • N,. � CV C = 1 z ,4 t4 _ 28' p b T 04 13 8` E . - --- 2' 0." T T I o "- 8' 6" CD M 7"0 / co I� EO Coll) I CV I I �YIKE'r-, Town of Barnstable *Permit#`2 3� s Expires 6 nionthsftonf issue date RAKNSTABLX Regulatory Services Fee p�13 Mans.� Thomas F. Geiler, Director 163 9 Mpi�,�� 1 �� / /e {� G Building Division Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 ��c www.town.barnstab le.ma,us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number N71 y < Property Address (( A Residential Value of Work /Soo Minimum fee of$25.00 for work under$6000.00 wner's Name& Address � C2C�c� C�� ontractor's Name Telephone Number Horn mprovement Contrac r License #(if applicable) Construct nSupervisor' License#(if applicable) P' 'rLna. & � ; ❑Workman' Comp nsation Insurance AUG '8 2009 Check ❑ I a sole proprietor TOWN OF BARNSTABLE H I th Homeowner ave ker's Compensation Insurance Insurance ompany 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} ❑ Re-side Replacement Windows. U-Value 0-2 (maximum,.44) -Where required: Issua6t ' mit does not exempt compliance with other town department regulations,i e Historic,Conservation,etc. 'Note: r must sign Property Owner Letter of Permission,vement C s icense& Construct Supervisors License is required. SIGNATURE: Q:\WPFILES\FOR S\Express\EXPRESSPERM IT.DOC Revise06O4O9 y " The Commonwealth of Massachusetts Department oflndustrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers -Applicant Information 1V z (Please Print Le ibl (NSIne(Business/Organization/Individual): e? & 6� v'- ov/ l p Address: l Come-. City/State/Zip: Phone.#: � 1 l Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction .2.❑ 1 am a sole proprietor or partner-' listed on the attached sheet. T. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp. insurance.# required.] 5. ❑ We are a corporation and its '10.0 Electrical repairs or additions 3�g I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required.] *Any applicant.that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 1Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. Iam an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one ear imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day aga olator. Be advised that a copy of this statement may be forwarded to the Office of Inve ations of the DIA e coverage verification. o h reby certify r �s and er jury that the information provided abo a i, ,tue nd correct. S' afore: Date: 07 _ Phone#: 07 Official use only. Do not write in this area, to be completed by city or town of lciaL .City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town own Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: o Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as "...every person in.the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or dustee 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 to shall not because of such employment be deemed to be employer." or on the grounds or buildiitg appurtenant there MGL chapter 152, §25C(6);also states that"every state or Iocal licensing agency shall withhold the ' suance or renewal of a license or permit to operate a business or to construct buildings in the commonwe th for any applicant who has not produced acceptable evidence of compliance with the insurance cover a required." Additionally,MGL chapter 152� §25C(7)states"Neither the commonwealth nor any of its politi 1 subdivisions shall . enter into any contract for,the persormance of public work until acceptable evidence of comph ce 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 boxe at apply to your situation and, if necessary,supply sub-contractor(s)name(s),address(es)and.phone number(s)alon ith their certificate(s)of insurance. Limited Liability Companies(LSLC)or Limited Liability Partnerships( P)with no employees other than the members or partners,are not required to carry workers'compensation insurance. ` an LLC or LLP does have employees,a policy is required. Be advised , at this affidavit may be submitted the Department of Industrial Accidents for confirmation of insurance coverdge. Also be sure to sign and to the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is ing requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if y u are required to obtain a workers' compensation policy,please call the Department at;the number listed belov Self-insured companies should enter their self-insurance license number on the appropriate li�. City or Town Officials Please be sure that the affidavit is complete"and printed kegibly. The D artment has provided a space at the bottom t the Office df Investi ati`o s has to contact you regarding the applicant. of the affidavit for you to fill out in the even g r Please be sure to fill in the permittlicense number which will be used s a reference number. In addition, an applicant that must submit multiple permit/license applications in anyXgiven.y r,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Addres I.he�Ppliant should write"all locations in__(city or " town).".A copy of the affidavit that has been officially stampe ortr rked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permi licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or pe 't not related fo any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is N1O�T quire to complete this affidavit. The Office of Investigations would like to-thank you in advance for yo cooperation and should you have any questions, please do not hesitate to give us a call. t The Department's address,telephone and fax number:Ir %J The Commonwealth of Massachu etts Deparkment of Industrial�Acciden ti Office of Investigations. 600-1Washington Street r Bostan, MA 02111 Tel. #617-727-4�00 ext 406 or 1-877-MASSAFE Fax#617-72777749 Revised 11-22-06 www.mass.gov/dia ✓ t .. i TT�ti Town of Barnstable ' Regulatory Services BARNy MiA s°&M$, Thomas F. Geiler,Director en jq- '` Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using.A Builder as Owner of the subject property, hereby authorize to act on my behalf, in all matters relative to work authorized by this adding 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. . c Town of Barnstable tt'IE tf1_�T Regulatory Services asrtNsrnane. ; Thomas F. Geiler,Director Building Division prfD Tom Perry,Building Commissioner _. . 200 Maiii Street,—Hyannis;MA 02601 -....... vi".town.barnstable_ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print (URRENT ATE. J /,� B LOCATION:- , /� V number street village HOMEOWNER": name -7^ h me phone ff work phone# //0 MAH-ING ADDRESS: /J / 44 I® e s-� 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,byla rules and regulations. The undersigned o e ' ertifres that.he/she understands the Town of Barmstable.Buildiug Department minimum�Sp ti o and requirements and that he/she will comply with said procedures and requirements xiignt 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 ad 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 oficn results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicerhscd person'as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully awaie 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 fonn/certification for use in your Community. Q:forms:homccxempt I f: o /� �-'!.fN T ...•.rw1V yy•sit.. � 13 m :-A i No.2410 9 .�D(.a/�. /�CG� CGYVI�� 5 I,✓if L�' C ..; . ,r /. �--c,;;;��/''T � — 17— C% TWA r , 4c,7-'&;/6 �� Z�1 /�9 ��'^-G�•1�.�._.C. � l`...� �,� <.a f'�~' ....r ��f��l:�ld�-•--- !r, /�P�"' „r t ,� i r �� ,eye l�✓� . A � l t `. Aseslgr=s'offioe (1st floor) FTHEr )� ,Assessor's mop and lot numbei g...1.'1'.� o................ . { Board of Health (3rd floor): ZI.... `S��.� � IN 0%0 L.Sewa.ge,P_ermrt number ...... . . .. . E. Engineering Department (3rd floor): Housenumber .........................................om.f................. APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .....5/.ti '1 ..... �/11 L. ep L.G/�/� .... ........ .... .................................... ........................ TYPE OF CONSTRUCTION ...... ®.......:!� . ........................... ....t.................... ................. ---------------- { TO THE INSPECTOR OF BUILDINGS: ' The undersigned hereby applies for a permit according to the following information: g /,� /gyp e / LocationL®.7.....o.70....,� ..Y. .........'�/...�...........4,..4. ram. �s 4. ................................................. Proposed Use 6/...e......1-7wlllt64....... .�,. ry. ............................................................................................ Zoning District ..... .........................................................Fire District ...... . .......�..71y/................................... Name of OwnerNrl� ,gLJ/1/el� � f�'® . .d-�e� D .... ��5. ��5 ...... . ........................Address ...................................., ...................... S Nameof Builder .....5'/ f 2..............................................Address .............. ................................. Nameof Architect ..................................................................Address .................................................................................... Q t( Aboi-m cmucrw� Uw l noFcait6G Numberof Rooms ..........��7.................................................... � ........ ................................................................... 1 Exterior L/.. ..............�...........�ft/ ................Roofing / 1 ..../ // .......... .... ' Floors 01�.....................................................................Interior ...... ../,z ® !Ce ..................................... .HeQT.ng- .7f'JT..��'G....-../�.�, ,. b.�S..................Plumbing ....r.....3 {.717. ............... ...... f .. s i e Fireplace ..,,�. 5�j.li.IC...... ��.................Approximate Cost .....fer -04).00............................. Definitive Plan Approved by Planning Board _ -A - 19___ ____ . Area ' _ N�' ti - Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH 4 e-3 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the ab v construction. Name .. ......... ... ..................... ..................... onstructio, upervisor's License .d.o...�.'.M......... f 3ALDNER, JOHN J. JR. ;, NQ 33432 Permit for One• Story ` Sin le Family Dwellin 'Location ...L9t•••#670, 198 Nye Rc)aa,: I............ enterville ......... ............................................ , Owner ......John Jr Ba-Idner.,...J ........... . ... ✓- ' a Type of Construction ..F•r•amE............••••••.•.••••• rn ^I . ............ ................................................................. Plotf........................... Lot .............................. _ January...3'........ `3 Permit-Granted ! 19 %w Date of Inspection ...... %' �� 1 (,.........19 Date _Co lete ... ..Q.. .r'. a!!. .....19 w ; `�•` � ' r ,ice p ��` Y,, .,• -•' % •� ` .. }'. . $ 3R C'S ,- qbb S14 goo 3 a: Yip •T�g� �' •: {�.,� 1.1 ��Lii �@ .. _� /1. ' TOWN OF BARNSTABLE BUILDING DEPARTMENT _ »iar TOWN OFFICE BUILDING Nut t639• HYANNIS, MASS. 02601 �0 MAY b' MEMO TO: Town Clerk FROM: Building Department DATE: An Occupancy Permit has been issued for the building authorized by BuildingPermit #......-3..3_..13�.�Z.-. .:...................................................................................... .. »..................... issued to ...... ............' ! ..L C n/ c............................ 1 [` �C D,t�..�!..... �.......! !P! Please release the performance bond. ��i�, ,s ,.-; c;. . .. �.,,,; +.• .d -^z ♦ 4' ns s La '�1±�'„'' 3', N- . 'v Yw-..:,, �.. �x� D�THE TOWN OF BARNSTABLE .Permit No.334.32....... BUILDING DEPARTMENT 4 ""n TOWN OFFICE BUILDING Cash V .Ma x HYANNIS.MASS.02601 Bond CERTIFICATE OF USE AND OCCUPANCY aM Issued to John J. Baldner .Jr. . Address Lot #6 7 0, 198 Nye Road s. Centerville, Mass. USE GROUP FIRE GRADING OCCUPANCY LOAD ' 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 AND.IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. August ..13.'..... , I9....g�. `* ......... � ! ••.• �.. .. Building Inspector r H\JE►.10. _GatzaAG� G�rI .. �olab ?�tt_� Flow = tto �c 3 • 33o G•Pv �E>?t-tc T�ttc. = 330,E two % • 4s�S 6.1=D. . a2 Sao �` � � -._- uS�- t000 GAL-. 4, 'UN DISPOSAL. PIT . USE locao GAA-. �� C�.Ic%d.LL AV-eA = l5o S.F. 1�jo SF 2.S Borro/A ,azeA,. =A sr--. j TOTAL 'r-> 11 fit ESIGIJ = sj25 G,Qp, �cSE�i I` TOTo L rD,A.t I-�f t=LoVe = 330 6.PD. !-�v s PMCM&Ttoo tzeTE _�� I0 TAWL - y.., ;.� 44- r RICHARD .<�; P;A. h R ;�;• _ ` PAP 3 T A ' @/lXTEFt ]r' SU!._iVAPI IT v. ry.`) Vi S A(r- No.24048 oc �'; M1o. '2 733 �CJ CISTt 00 UO,oU " eig R4171 rL,-d5 Top F.+o IL4G f-�oL ��3-$5 1=G=dd 4. .LvAw �.. �aiin• ,ii�n � 4�•Pive f' SOM7011 r t! PPe IOao IIJV 'a1 4 p1'� alSt'. tw. GAL. A2.3 d2 l0 f ScQriC Ir"ty Tia�tK 1000 4+•5 INS, I,ti • , GAL. 7 419 t• LAN Man. PIT' •'� SANp` w�•;;�.t w s; Wi . WAS�iED , CEtZTt1=1ED PLC>-r LOCATIC)V-4 �TL-lzv)u-e 1NATt �AT1= Iv-�o-8y - Rz o Fcsal� Ct-IZTtt=*-4 T$4A7- TNG 9-ov56 5Na4/tJ PtAI`1 Rr--iz t�IGE Wtzzm—ow Cc:>&tt9LYS Wl"rP Tt-t SIDC.t_t►-tom �or. �ro--��' A.W > 'SCTUAC4 VcQUlQG A&.WT.; OF 'TowU or- BA4-2-►llrA 3C.G ANt» is NoT Lve-ATE IN C�uT"c L_"//t t tf GhlL.,<4 r rj5 't H E 1=t o o'D PLAW 0 r. 3v,19Oct • RCGIS't'cRicD 1.A1JG SU2VcY0c�� Tl-�l5 . hl_AtiJ 1�, 6JOT Zb,-e>C•p Ui,_4 A.&j OSTE2VtLt G o MASS• r Af�P L_t 1 L5� c, ter rec:MlalL Lo�C' l_tt.t�S A Lint L� L or l � ! e 1 , '• i _ y ., - .. -•� - ,• ,~ n \l Iil_' ,',r.('+\ 1'Ol r-II t t _ -T - -.7F T 'J C- i J it., I , _ I I i 4 r•,� f•' l I CIA .14 it i crlkrzt[ r NE.&nrrN'10L4 sl[rc Ilf /yam 1 �_� I 't' _2 (' 0_-�� _..1_L�'(�I'�:l_f 1.-)'(.)I}(., l f 1• � I,�) � '�\�1 r\t C } � � - « f ` ,411• lllrlrllr.�1'.:i 'Ct'.\ _ .r�'."• �rz.o� I i.'` r .. U.IE7 Crii�.+nJl �,EC=TION CEIAII Ir•'� � ,___ 2 '_ "�- I i�.�';- ! � ��` .. .: ,� 1'.�.��. i � 1 i O � J }j � 2. , �~t�.1'i=`�—�l yl.� �_�:; J1 I r - v � AC ' pw "BAPM AB C ET , E MASSA HUS TS 11 B DATE v'.niru<.ri. ✓.�.._-.. 19`. r PERMITNO, � * , L3CANT UWIIk,Y ADDRESS L l�a t 6�C�r BGa CIL� a.\. Y� w �rOn�fJJ 3# ,4,7 - - - IN (STREET) 4 (CONTR'S LICE F,1 f 1 1 ' MIT T0, _ }illi_C� i)W •]. '1 11C�' (�) STORVitl:'f ter' Y'1]TI112'J �P1C�1] j tI NUMBER OF ayl a#rq xp DWELLING UNITS'`"E A (TYPE 0I IMPROVEMENT) NO. (PROPOSED USE) of n (LOCATION) Lot #670, 198 Road Cont..;,_ville zoNING r ati;RC ; s .Rq r.v p.. • (NO.) d (STREET) ` DIST�RI�s..T��" l �+ e P r ,WEEN ' c ;w :ET) AND ins STR .,(CROSS:STREET•)' r OI SION l" "i9rw. a asF: LOTre LOT BLOCK SIZE ;rb k s4 k. DING l' TO BE FT. WIDE BY FT. G LON BY i FT IN`HEIGHTcAND 1HALL'C0NFORMrINC NSTR YPE` USE GROUP 4 �y OUP BASEMENT WALLS OR FOUNDATION 4, i'x rtrt+• 1. (TYPE) '? �i cf ¢G ARKS. '"-wage 089-569 t �.-q° •w(?.K �., ,�'"�'�3 +..,. n�� 5 rr 2 _ .r'S` t!N'4r Y.*rL,vs.• t,. : a �'t5" 2'a+ t� ��' ` r�Tt ��} •"� Y• w �w` 7^`��/ r•�+.rrt +jt•,�ii-� ViZI.C £ i A"OR x � Ate. tL.S� t�ap zP' 4:t u r t uME" r.. 2.098 � Yt P �T�� ESTIMATED COST•".� �. ':.M ��'0• (CUBIC/SQUARE FEET) FE- Ee • Y-r fi a1.• Baldjiur. or. i. g �1 BUILDING DEPT 11 4 RESSr - 180 LtV�TCt3.'een L7,:iy , 1`1cLYbL`r77' llZ'' T N rr7*y;, xr tr i BY> r�• -r y(v+ .41 ER PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARI Y.`C ERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFIC-ALLY PERMITTED UNDER THE BUILD; d:_R DE, MUST•I :!C Q,1�VED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINS r PROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIOr OR ANY APPLICABLE SUBDIVISION RESTRICTIONS. �MINdMUM OF THREE CALL `''' F w kL ECTIONS REQUIRED FOR APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE ¢ s n 'AL CONSTRUCTION WORKI CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN, PERMITS ARE �R.EO.UIRED FOR rr OUNrDATION9 OR FOOTINGS. MADE. WHERE 'A.CERTIFICATE OF OCCUPANCY IS, ; &MECHANICAL4lIN.TALBLIATIONS 8l` ar RIORYTO''COVERING STRUCTURAL �k c EMBERSIRHAOY TO LATH) QUIRED,SUCH BUILDING SHALL NOT BE;uI.; PIED LINT,ILt $ TBs# INAL00P'I IN CTION AN BEFORE. .',. FINAL INSPECTION HAS BEEN MApE N Rt0CY. I +f. " a y✓r $ � t* sir '` '' '"wr'(I.aMA `ur,.,•,*'h, 'r'MAd `" '�I.y A,�'�, r POSTw:ITHIS CARD 4SO IT IS VISIBLEFROMSTREET 3 kBUILDING INSPECTION APPROVALS -PLUMBING INSPECTION APPROVALS w, �,71; CECTRICAL INSPECTION`APPROVALS " `I i r 7 yyw 1�6 v'8 P�b• 1' r:. rt 'w 41. wRr§' ,� p e �f.- kf'Oar aTx{ �;�•�$ 2`.� '',vy' y✓ ..rR 1 o y 2 { HEATING INSPECTION APPROVALS „ENGINEERI G.DEPART ENT A. try �1HER v ? BOARD OF HEALTH r l lyres r 4a � SHALL NOT PROCEED UNTILTHE'INSPEC• PERMI-T WILL;BECOME NULL AND VOID IF CONSTRUCTION3i 'r ` AS APPROVED THE VARIODUS STAGES OF WORK IS NOT'STARTED WITHIN SIX MONTHS OF'DATE'THE INSPECTIONS INDICATED ON THIS CARD C r TRUCTION ARRANGED FOR BY TELEPHONE OR WRI t PERMIT IS ISSUED AS NOTED ABOVE, t n s NOTIFICATION �� r t � x:.rn`2•R...� .r...-3r k•u.. ... . ... �...,. ,. i�^,.'m °,��+r�xM�6��r i("�, .a9�xz�,{a`[ r�n7 �4 .� �)�'i, ;� St��• ��nlL�f - 3 �3>�eao�vc � . uo.. GArrs.cG� G�t�.rn� (VYE 4��oX\T� `ti-1 c TAr�t tC = 330,, (�iO % • 49 5 USte- tool 6AL. 41. ti 'LA z C _t)15Po5AL PiT - U5E loco GAL \m_ _I o S;MGac ALL AZSA = V5c> S.F. Bv-rrO,IA A MA= -a--. T d GRn 14t ��Za�e;i='�� i Ut OTA L �ESIGr.! z--- ToTn t_ \ O PE2GlDl.QT1oU CZ,&TEZ�SrtIQ'0lzLF_ S.. 0 t o fe.Cp \ Q 1 F 0 - o fi1CKARD - _ t =R Aeak �Ut� oU _rest- P-417I .— !-�oL r-& Tor=d5 Fuo a 4l0 •.r. LvAvA -�Y S�solL �'PP� loco ►ud. ;� tuv•az•� Lf RRA �fST IW- 6AL. 2 r==_ 'Box d2I SE nCtolDO0 l T"n ht K GAL. �' All Lt�N PIT SaN, •i%a%4'li WASHED STOWC- t1 ii CEQTIFtEt7 PLC>-r 12 3�•S W o SC4L - . . . LOCATI01-4 rzv« ScAL C— "- hl� WATt-rL Rz D pasaI I GGIZT(l=`{ TI4AT- T14E l�ov5t✓ SltowlJ Ptt�l�! RBI=�Rc�CE UFRP_t_n1,1 <f':Vv%PLgS W ITIA TI-1` SI DC.t_t►-�� "�" A.ua ':CYL•�cl< �GQ:�1�:ENtcl.1Z'y o� rNt; �-aT- �IG s rOv-/Ll ot= P_A7-Kli7 AF3La Arab is OoT LvLATE iIJ 0CT. 30, Ila! - tzc�tSrc.lz�� t..ANr, 5uevc�fc�r;� Tt-Al5 C7I_Al�l ! lJOT eASGO 04-t Aa,l QSTE2V1Lt.C- o �r(ASS 1Sf�J!✓�C-?t.1, ;u,c•_.i�t_�' � T+�L. U1=c=5�r�, 51�1�wLD Tc�_l�r__1_ec�Mt►�L LOB( l_1Ni=s A{�Pl_l l_t�.lJ 7-� I. I 1.1 N n 1