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HomeMy WebLinkAbout0039 EAGLESTONE WAY . - y ,... .,, , �� z�70/-�Z-z .Av TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map G Parcel q � •Application #0��f. Health Division Date Issued Conservation Division �✓ Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address nz, � u�f Village Owner �i2¢�' /d FiG� � Address / �iG � f �144 Telephone ® 7oZ g- 67-73— Permit Request M `�'c� ®km O�f.�d2 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain ZOAJ4 L Groundwater Overlay Project Valuation �{� OeD Construction Typel� � Lot Size 1141,y�1a' /,Dl&W Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure 016 Historic House: ❑Yes >rNo On Old King's Highway: ❑Yes ONo Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new 0 Half: existing new Number of Bedrooms: existing Onew Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas XOil ❑ Electric ❑ Other Central Air: XYes ❑ No Fireplaces: Existing 1 New Existing wood/coal stove: ❑Yes No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn;: existing; ❑ S6 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 # w Current Use Proposed Use 00 APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name t" �t / �Av� Telephone Number." qzo 0 �� Address �� License � 0,49g), W4i) &A• fobO Home Improvement Contractor# Zs�°29 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO � � G1 2,SIGNAT R DATE Z_ �� G R FOR OFFICIAL USE ONLY APPLICATION# a DATE ISSUED MAP/PARCEL NO. } ADDRESS VILLAGE I ¢ OWNER , • DATE OF INSPECTION: FOUNDATION Argo FRAME $_6#r4i,Y/od s'AACA- wo'co- INSULATION blAJ5(V7V)dzyhL AWX4 FIREPLACE ELECTRICAL: ROUGH FINAL . PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. I•' Y "i The Comrnomvealth of Massachusetts Department of Industrial Accidenft Office ofInvesfigafions , r 600 Washingtpn Street Boston,MA02111 - www.mass goyMa . Workers' Compensation Insurance Affidavit: Btrilders/Contractors/Electricfans/Plumbers Applicant Information Please Print LeZtbfy Name (Business/Organizahonlln&vidnaI): Address: 12 ttiv J4,;i' City/state/Zip: S4 !� -------------- F2.E e you an employer?Check the appropriate box: am a employer with • 3 4:•[]'I am a general contractor and IF ject(required): employees(full and/or part-time).* have hired the subcontractors construction I am a sole proprietor or partner- , listed on rite attached sheet deling ship and have no employees These sub-contractors have lition working for me in any capacity, employees and have workers'[No workers'comp,InsuranCe comp.mgurance,t t ag addition required] 5. [] We are a corporation and its' cal repairs or additions 3.�]"I am a homeowner doing all work r officers have exercised their ;" 11.El,Plumbing repairs or additions myself- [No workers' camp. right of.exemption per MGL insurance required:]t c. 152, §1(4),and we have12. no 0 Roof repairs employees. [No workers' 13.El:Other. comp.Insurance required.] *Any applicant that checks box 91 must also fM out the section bolow showing their workers.'compensation policy iafocmatioa t Aume tDrs t who k this this affidavit indicating they-doing aIl work and then hire outside contractors roust submit a new affidavit indicating such, xContractors that check thin box mast attached ea additiOnal sheet showing the name of the sub-contractors and state whether or not those entities have employees, rf the mb-contractors have employees,thy*most provide their workers'c o �P•P oy cumber. am an employer that in is providing workers'cotnpensakan insurance for my employees: Below is the poficy and job site formation, a Insurance Company ISame: / s Policy#or Self-ins.Lic:#: f A 6 oc 31 Is 3 51 F.xpira$on Date: Z ' c?-O/ Z— Job Site Address: ` .. t City/state/zip:= �� �' W" OZ 63,5' 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 MCiL c:152 can lead to the imposition of criminal penalties of a fore up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in t]ie forest of a STOP WORK ORDER and a fine. of up to$250.00 a day against the violator. Be advised that°°a copy of thus statement may be forwarded to the office of luvestigations of the DIA for ir,ermmcl',coverage verification 14 hereby ce fy nder the peons and penalties o `` .fPe7�';�the information provided above is true and correct Si tore: . , �li Phone#: Official use only. Do not write in this area in be' completed by city or town offzciaL City or Town: Permi:t/License'#. Issuing Authority(circle one): I.Board of Health 2.Building Department 3, City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: 1/24!2012 12:08:C17 FN_ PST (GAIT-8) FROM: insurancevisions. _ Page: 2 of 2 "'"� ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYI7 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. 9 SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemen s. PRODUCER DOWLING &O'NEIL INS AGENCY INC CONTACT NAME: 973 IYANNOUGH RD HYANN IS, MA 02601 PHONE IA,c-ft.ExD-(508)775-1620 C.N : E-MA0_ADDRESS: INSURER S AFFORDING COVERAGE NAIC 0 INSURED NSURER A: tJ J DELANEY INC INSURER S: -20 RASCALLY RABBIT-ROAD UNIT 2 INSURER MARSTON MILLS MA 02648 NSURERD: INSURER E: NSURER F: COVERAGES CERTIFICATE NUMBER: 12240074 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT Wrm RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. D SUBR POLICY EFF POLICY EXP '- LTR TYPE OF INSURANCE POLICY NUMBER IMIDDIYYYY WM0D/YYYY LUNn'S GENERALLIABILnY EACH OCCURRENCE ; COMMERCIAL GENERAL LIABILITY. DAMAGE TO RENTED PREMISES Ea occurrence $ CLAMSaAACE OCCUR MED EXP(Any one person) $ PERSONAL&ACV INJURY $ _ GENERAL AGGREGATE $ GENLAGGREGATE LIMIT APPLIES PER: PRCDUC_T_S-COMP/OP ACG $ POLICY F PRO- LOC $ AUTOMOBILE LIABILITY air ant I GLE LIMIT ANIv AUTO BOCILY INJURY;Per person) $ ALL AUTCS OWNED SCHED8 AUTOSULED SOMLY INJURY{Par acceient) NON-OWNED $ HIREDAUTOS AUTOS P NONWPED rP AUTOS �gtDAMAGE $ $ UMBRELLALUIB OCCUR EACHOCCURRENCE $ EXCESS LIAaH CLAMS-MACE AGGREGATE — DED RETENTION$ $ A WORKERS COMPENSATION WC2-31 S-318101-011 — 11/2/2011 WC STATU- AND EMPLOYERS'LIABILITY Y/N- 2J TORYLIM S O ANY PROPRIETOPJPARTNERIEXECUTNE E.L.EACH ACCIDENT $OFFICERIMEMBER EXCLUDED?^� -� .N I A�. 500000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500000 N yes,descrbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY L MIT $ 500000 DESCRIPTION OF OPERATIONS(LOCATIONS 1 VEHICLES(AtlachACORD101,Addilbnal Ramarks Schedule,If more space N required) Workers compensation insurance coverage applies only to the workers Compensation laws of the state of MA. CERTIFICATE HOLDER C NCELLATION �y SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF BARNSTABLE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BUILDING DEPT ACCORDANCE WITH THE POLICY PROVISIONS. 200 MAIN STREET --- -- HYANNIS MA 02601 3e(:- 0- o REPRESENTAINE r Jeff Eldridge ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD CE3T 10.: L2240074 CL:ENT CODE: 1315596 :essica Eirck 1,2412012 12:05:20 PM Page I of 1 This certificate cancels and supersedes ALL previously issued certificates. :., .I j � Nlxs�ach tictts-Department of Ptjltlic SafctN Board of Building Re!-ulations ;in( Standar(Iti Office ofConsumerAffairs&Bu mess Regulation Construction Supervisor License HOME IMPROVEMENT CONTRACTOR Type License: CS 9961 Registration -A1 5529 Restricted to: 00 Expiration 1/..�15/2014 Individual ti � r JOHN J DELANEY Jp J.DELANEY r �t 271 PLUM ST t W BARNSTABLE, MA 02668 ..y JOHN DELANEY 271 PLUM ST, E 1� W.BARNSTABLE MA 0266$ vf` Undersecretary I c--�- �yj� Expiration: 4/14/2012 ('ummisinncr Tr#: 20469 Lice hefo use or reb'is ",��- the trati Office of expirati on va/i � 10 Co on d for• —�_ loosto P/al$sUn�erAM te• If fo4 nd iviaUq us 1 02116Ite51�0 andBLdnesSRety only go/at/on NOt�a/id withour oFE r Town,of Barnstable Regulatory'Services 9MASS&'►sr'E$ 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 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 building permit application for. (Address of Job) 9 lure of Owner ate Print Name If Proerty Owner is applying for permitpleasecomplete the Homeowners License Exemption Form on the reverse .side. Q:FORMS:O WNERPERMISSION oFs T Town of Barnstable Regulatory Services saxxsTasrs Thomas F.Geiler,Director Mass. s639. a.•� Building Division , FD MA'1 Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.b arnstable.ma.us Office: 508-86274038 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 dwelling of six units or less and to allow homeowners to engage an individual for hire who does not possess a license provided that t 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 fee_t or larger will be required to comply with the State Building Code Section 127.0 Construction Control. . HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in our community. Y tY Q:forms:homeexempt v 1 MIDI na TP I I �exlvw<.. 'FRONT El£Vn1[ON._. t - _ I i __ _ dab• I .. +_ —_ ._— —, SMOKE DETECTORS ECTORS REVIEWED ,N z OARNSTF9LE B ILDING DE PT. E FIRE DEPARTMENT DATE . ' fi1B':GC6h$EE - ;�— F/C.I�ILV QOOMI L BOTH SIGNATURES ARE REQUIRED FOR PERMITTING I_ 4 4 TN NFNK3 • FIRST R-06R PI/.til I Nvam� Devi* ^• 7742380773 I - sn.f� mx ,� .• . ---- - I r - ,.. � voaw«.iem wv.neaJ J Ef Raof3pma9: Be-a-Mdb Ofmmerom mmch and ofbcvdm 0".) 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FvrcoofeMeWingaimb6tm pfinepmimmer Wgd pfmvrmf,""uv�-If nn cenR , ' Bruce Devlin .�..�.•:Ta .,.m,®... ------ . ng wHBwlaT BgT Design e"m�w.,.n 1009 7742380773 i �q.: 1 . —..FIRST'fL27OAXK/JNA,—(•�•_.♦.b•) -P-R)fII9£1'�F[6`- ♦ —E%IbTl c - � ..v,d9.•,r says - -�nstzzie�am•.nea "�c^AaFabxaS�:yen., � �•:m c Z,-axndi-mc�+cc y 1 I UNn�T[Ol V - «0— ..a«.eemr tune a Bruce D!evlitim r_ -- . �* Design* swratwr._:_ om.aID "py66:9 >«.. 77423"773 .. .. .. .. tl i �Poms ti Bruce Devlin Dee ® 774-23"773 •"lib9:0.M<6 - fiian'fi��` � \ I :mauslri nr.sw - �iFe4aa�.Kp'�.. .•b�w�x..aivasa•. a ��tfl3��l Cam_^_-) _ • a° .'h.rae.`c,d NSSFL:. ms.ie ' _ ryunxtw oemwevn3y. _�uswsx'Sw � P%Ge!it''I •Kw o3 -_ Syu�/a_.glxxs. - ssranEeia4 aeMO3.w•.fa.�,x.w , -q� m� v�r�,x. d„ .��.: >�-- ' i:asm.suuxcwar.o.. .. I � "c-alvKOti'rML ' _SECTON 6.B Cx.-.i e•) SEGfrON cc Cam.•.o-) .. Bruce Devlin ••m D—ignA xc 774238.0773 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 7 Parcel Application Health Division u Date Issued Conservation Division -' Fee Planning;Dept. Fee Date Definitive i Plan Approved by Planning Board Historic OKH Preservation Hyan his. Project Street Address F_A9Lf_ STOVE Village Owner A&41Etk� 111 F41,94 Address 30&94,i�5 ' : WALI Telephone 2-9'- 0 TS_ Permit Request CbA1V6k7_ 1)QgTf PA I I' &'qp <qqPAqr k-UP q6k 6 AL/ add 2v_Y/A\2J:�q i Z-6A/Z 96P.65" F_ V V : Ap 7,13 )4A RM ROOM Square feet: 1 st floor: 'N_04proposed�*,2nd floor- existing proposed existing os d Total new ot Zoning District' T_ Flood Plain AIQ Groundwater Overlay Proj ect Valuation Construction Type Lot Size )k,Q Ls Grandfathered: d Yes U No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family LJ Multi-Family (# units) Age of Existing Structure /7 LAf Historic House: D Yes >(No On Old King's Highway: Ll Yes Basement Type: )(Full Ll Crawl LJ Walkout LJ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing Onew Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: LJ Gas Oil LJ Electric LJ Other Central Air: A Yes Ll No Fireplaces: Existing I New Existing wood/coal stove: LJ Yes )!(No Detached garage: L3 existing L3 new size—Pool:Xexisting Ll new silowe Barn: LJ existing D new size Attached garage:X existing Xnew azmShecl: LJ existing Ll new size Other: Zoning Board of Appeals Authorization L] Appeal # Recorded LJ C) -:n Commercial- -LJ Yes- U-No­- -If-yes,`site-pla_ n review# Current Use Proposed Use Co APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name JOA AJ 1�,D IiW)eU Telephone Number ,�69> qZ0 6&Y, Address D K ,A 6 S .9% &661411U PAY, 1� License # D Home Improvement Contractor# 115D 9 Worker's Compensation ALL CONSTPAJCTION DEBRIS RESULTING FROM THIS PROJECT WILL TAKEN TO &4 SIGNATUR DATE Y 17-00A f, FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF-INSPECTION: ,� r FOUNDATION'"' i ..- 4 r FRAMES y oV ltAo4 Poi lakes- 4fm .3 Z3 i INSULATIONIIUS ZIZ Rl+kAJC, FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ;F f DATE CLOSED OUT ` ASSOCIATION PLAN NO. The Commonwealth of Massachusetts ,Department of Industrial Accidents Office of Investigations' 600 Washington Street Boston, MA`02111 t• ''y wwlv.mass.gov/die Workers Compensation Insurance Affidavit: Builders/Contractors/Ele'etriciaus/Plunnbers Applicant Information Please Print Le ibl Name (Business/Organization/Individual): � Address: V . 1`7"� Z City/State/Zip: A RZ& Phoae.#: ��" �' Are y an employer? Check the appropriate bog: Type of project(required): 1.Axe a employer with_• 4. ❑ 1 a a general contractor and I 6 0 New construction employees (full and/or part-tim.e).* havee hired the sub-contractors 2'.Q listed on the'attached sheet. T. Q Remodeling I am a Soleproprietor or'parMer-' ship and have no employees These sub-contractors have g•'(�Demolition working for me in any capacity. employees and Have workers' 9 [wilding addition [No workers'•comp.•insurance comp. insurance. S. F] We are a corporation and its� 10.0 Electrical repairs or additions required.] � ' 3.❑ I am a homeowner doing all work officers have'exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no 13.0 Other employees. [No workers' comp.insurance required.] *Any applicant.that checks box#1 must also fifl out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. Iam an employer that isproviding workers' compensation insurance for my employees. Below is the policy andjob site information. Insurance Company Name: . Policy#or Self-ins. Lic. cl�c) ��� 6 �I I o Expiration Date: Job Site Address: City/State/Zip: LZ IL. L 10 Attach a copy of the workers' compensation policy declarad n 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 crimui4l penalties of a fine tip to S 1,500.00 andlor one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine. of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby eery er t in and enalties of perjury that the information provided above is`true and�cyo�rrect Si a e: Date: 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 S.Plumbing Inspector 6. Other r Infor atxon 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 i.a 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 tiustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelltgg 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 oron 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�crith 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-contiactor(s)name(s),-addresses)and.phone,number(s) along with their certificate(s)of insurance. Limited Liability Companies'(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the nurrlber 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 and under"Job Site Address" the applicant should write"all locations in (city or policy information(if necessary) 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 fo any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to.thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone-and fax number: Tha Commonwealth of Massachusetts }department of lndustrial Accidents Office of layestigatians. 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 11-22-06 www.mass.gov/dia ENERGY CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR ONE. AND TWO-FAMILY DETACFIED RESIDENTIAL'CONSTR'UCTION (780 CMR 61.00) Applicant Name: �� �' Site Address:. print pp, Town: Applicant Phone: 668 Lno Applicant Signatu ddA 4 Date of Application:tZ NEW CONSTR C ION: choose ONE of the following two'o tions 780 C.M TABLE 6107.X PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA FOR NEW ONE- AND TWO-FAMILY BUILDINGS crhrUM MINIMUM Ceiling or Slab Basement ❑ Option 1: Fenestration exposed Wall Floor Wall Perimeter AFUE HSPF Sl U-factor floors R-Value R-Value R-Value R Value R,Value and De th National Appliancr-Encrgy R-10, Conservation Act(NAECK .35 R-38 R-19 R-19 R-10 4 ft. 1997 as amcndcd,minimum cattr as applicabIr Note: This form is not required if you choose either of the two versions ofREScheck as listed below. ❑ Option 2: REScheckVersion 4.1.2 or later variant software analysis must be completed 780 CMR 6107.3.2 REScheck—Web which can be accessed at http-://www.t--ncrgycodes.gc)v/rrsrht- ----------ADDZX OIVS OR A T�RATXONS.TO E)aSTZNG)3 DZNGS,.O ER•5 YEARS.0LD' * *buildings under 5 years old must use option#1 or 42 in New Construction section above. Complete the following formula to determine the %o of glazing: (a) Gross Wall & Ceiling Area equals Formula: (100 x b=- a) ii S SF in x I I _ Si l ,, of glazing a (b) Glazing area equals_SF. le If glazing is<�0%.use the chart below. If lazing is } 40 % rocee.'d to "S•UNROOM" section 780 CMR TABLE 6101.3 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTING LOW.-RISE R.ES7DENTLAL BUILDINGS MAXIMUM M1NZMUM ❑ Ceiling and Slab Perimet Fenestration Exposed floors -Wall Floor Basement Wall R_Value. U-factor R-Value R-Value R-valuo R-Value and Depth ,39 R-37 a R-13 . R-19 R-10 R-10, 4 fee a R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R-value over the entire ceiling area(i.e, not compressed over exterior walls, and including any access openings). ' SUNROOM—An addition or alteration to an existing building/dwelling unit where the total Fglazing area of said addition exceeds 40% of the combined gross wall and ceiling area of the addition. Note: Owner to fill out Consumer Information,Form. found in Appendix 120.P THE Town of Barnstable Regulatory Services BARNBrABLE, Thomas F. Geiler,Director 16.3 � � 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 t� 1 as Owner of'the subject property hereby authorize Zi-MUKIV to act on my behalf, in all matters relative to work authorized by this building permit application for, (Address of Job) Si�Ifatureof er , ate PkName If Property Owner is applying for permit please complete the . Homeowners License Exemption Form on the reverse side. Town of Barnstable Regulatory Services r Thomas F. Geiler,Director 3ARNSTABLE, 16.3. Building Division ATED MAS a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Fax: 508-790-6230 Office: 508-862-4038 — HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: village number street "HOMEOWNER": hone# name home phone# workp 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) t 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." re that they are assuming the responsibilities of a supervisor(see Appendix Q, Many homeowners who use this exemption are unawa 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 belshe 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. O:\WPFILES\FORMS\homeexempt.DOC • i . r N" _.._, anvnta�uueau� a��/�addac�iueP,�6 � I € •}� Bbard of 960*Regulahofis and Standartls I I 'Construction Supernsoe License_I *�` Lice se: CS 9961 � E I. Ex iraf�oni-4214/2010 Ti!# 21680 . �� o"f estetcti JOHIa<,J JELAN\EY1 j271 PLUM ST W BARNSTABLE MA 02668' Coinmiss�oner A!t ✓_fie �arrvnzoouaeai o�./�aaaac�iudPlta Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registrif oR;\125529 Exp ration 1/15/2610 Tr# 262720 1= =� In 3 irr T p� In ivdual JOHN J. DELANE! r f IOHN DELANEY �E (. 271 PLUM ST l 4 � I `tr\Y W.BARNSTABLE, MA 02668 Administrator I g y ! License or rep..-. i .n valid for mdrvidui use onl j before.the expiration date. If found return to: 1 Board of Building Regulations and Stand.,ards l e One Ashburton Place Rm 1301 j ! Boston,Ma.02108 E Not valid without signature Dater 6/18/2009 Timer 10*43 AN Tbr 0 9,15084206056 "' Pager 002 cllenM 7813 2DELANE JJ 4OOR& CERTIFICATE. OF LIABILITY`INSURANCEFRODU HIS CERTIFICATE IS ISSUED AS A MAMR OF INFORMATION Dowling&O'Neil Insurance ONLY ANQ CONFERS NO RIGHTS UPON THE CERTIFICATE L. TI"Ib.COMFICATE DOES NOT AMEND,EXTEND OR Agency ' I 'rE TNt COVERAGE AFFORDED BYTHE POLICIES BELOW. 973 lyannough Rd.,"PO Box 1990 Hyannis,MA 02601 INSPRERS AFFORDING COVERAGE NAIL* INSURED NSURERA7 .be' " utual J.J.Delaney,Inc. Nsiilt�iLe: 20 Rascally Rabbit Road NSURERC. Unit 2 NSURERD: Marston Mille,MA 026" I NSURERE: COVERAGES THE POLICIES OFN8URAWCE4ISTOD:Fl�O ��,,.,,y�,,� TOT IfYSUFDNI}iflEOATir7�1IEFOR:THEPOLICYPERIODINDICATED.NOTWITHSTANDNG ANY REQUIREMENT,TERM OR CONDITION OF WIt I to r.OR OT H o6cbM rWrfH I�PECT`to%vHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAN.THE INSURANCE AF=ORDEDSYTPOLICEB bEscRIOEO 4EREIN IS sUO.EGT TO ALL THETERMS,EXCLUSIONS AND CONDrrioNS OF SUCH POLICES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLABAB. NBRI TYPE OF INSURANCE POLICY NUMBER LIMITS GENERAL LLABIUTY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABIL TY DAMAGE TO RENTEDCal $ DLAIMS MADE p OCCUR MED EXP Wy ore person) $ PERSONALBADVINJURY $ GENERAL AGGREGATE $ GENLAGGREGATEL101TAPPU PEIi. ' I I PRODUCTS-COMP!OP•AGG $ PCUC" Loc 11 + AUTOM ILELIABLiTY COMEINEDSNGLEUMiT 3 ANY AUTO (Ea eoddant) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per peBon) HIREDAUTOS BODILY INJURY NON-GWKED AUTOS Fw acddeN) 3 I PROPERTYOAMAGE (Pw acddwd) $ (iAR11GELUIBLRY 1! ' �' ! AUTO ONLY-EA ACCIDENT ANY AUTO li i1 OTHERTHAN EAACC $ AUTO ONLY: AGG $ EXCESSMIBRELLA LJABiLrTY EACH OCCURRENCE $ _ OCCUR p CLAIMS MADE AGGREGATE i s CECUCTIBLE s RETENTION A woR1awcoMPBiBATWNJMD WC231s3161a1018 11/02108 11/02109 X WCSTATU FR EMPLOYERS'LIABRITY ; ANY PROPRETORMAR HERID11CUTNE•• i . . :1 ' :; .' I E L EACH ACCIDBdi $1 OO OOO CFRCEIUMEMBER EMIMED7• NO 1 { r E.L D SEASE-EA EMPLOYEE 81 OO O00 If .eeaod6e ardor D EL D SEASE-POLICY LIMIT $500 000 OMER ❑r DESCRPDON OF OPERATTONB I LOCATM I VEH CM I EACLUMM ADDED BYENDOI MIT I MPEC-1 PRDV1810N5 Insurance coverage 1s limited to the terns,conditions,exclusions,other limitations and endorsements. Nothing contained.in the certlflcats of insurance shall be deemed to have altered;Walvsd;.arextendsd the coverage provided by the policy provJai ' . CERTIFICATE HOLDER CANCELUMN SROILD ANY QFTRE ABOVE DESCRBED.POLJCIES BE CANC U EO BEFORE THE E UWTION Town of Barnstable DATL;TFIEREOF THE BSUN I M URERWLL ENDEAVORTO IAAL _jL DAYS W MN Building Division NU=TG:TiECBMWATE HDLMNAMEDTOTIELEFT,eUTFALURETODO sosHALL 200 Main.Street IMPOSE NO,OBLIOATKIN OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGWrS OR Hyannis,MA 026(" I ENTATBIEa AUTIMMI)gFOMIOAME C. - ACORD 2b(2001106)4 of 2 aES iM58$B3 Ls, ®ACORD CORPORATION 1988 i � a //SMOKE DETECTORS REVIEWED ' B��iLDING DEPL DA - FIRE DEPARTMENT .,rc ES ARE 07H"S/GNg7UR REQUIRED f DATE 1/0 OR PERM/171NG / \��\ - _ -- li. "°" -%j `\\\ - ,,,,.,.,•�n,a "'BONMONOXIDEAL MUSTBE /j A•'�r { i �� ��, a..�.,..<,.: MASSACHUSETT INSTALLED ER S •�j - � �: i /„/ � ,,�; S BUILDING CODE I I . rt"/•{�ELE inTiOV - �. _. - _ _ _ __..-J- I I__ _ _ __ _ _-. _ _ _ _S - ItFT r_.t.•i••�40N Lf, - e^5 a I o 0 I , v _ I -- .-vbturrtG�wr<L NtP •.I rPOFrt EIE�IA'i1QN_. • - , .. .. « -C,ARAC,E_/flt7 ff10N i/•l'i i;1:•`1i Bruce Devlin Designs Chatham MA 774-238-6773T.eav �.c�esTol�e n,�,cr t•. .7- r I • Arr2'r+�flvW Gw.••.c�.b ausxEi uire issaEr eritauA�,•f AxC fer=..n•..mG..x••n:..:.xia rr..Aw.rz:ala..rx.xasL..e ' MassclluseM C:Ireeld isE for C irnal pi is ce Rw ca n'.ze�.u.n, MasSacl,usclls Cllecldiv foT Co...pliar,cefrwerns...i..o em _-_. n.__.a..v .ue.__� ✓ nm mrW Erxvouoa0 u....xa./z ..>n� rcm•m� wm vm.m=rw,w-.._.__ ______.__._Iw.,. ..ra..,w.o,�::o.rm.....•v..wm..m.•.vrrr.;,,��r...n.lr rm r� wv�l•wrrweeaee+e.nmm.arrm•.ewa.r.n� ,/r wrqu�v.wam.r_---R.�u.ei-- — �—L •�� ____ �f rr x�wr 4a�i+Nrrm•ommn%om emaww./:rms _ �:,[h ✓ S .: is • a_._.___-.._.. .._.L a sw...____.---- =I__._-__2ags,.� amrF...aw { °.."�°Iw""""=�..� —_____.-a•,l_.:==—__ Y w:.,'..���.wl"`°" meum°w.aew`u:,.eh.n.m zlm slm wm m,a � - r e�ran u .x..•�w.r...mw=•-. ._..__m n�•,rw,•s ._.p,o.�4.ar � �wa,ueCpxrecrwxs wx.e1 � tw n:sza:u zuavwcw.+em�' w.r[mmmm.w.Kmx•OI_ a r.r�i:+nr wan..Ca•w+•rw•.+r Eeouwsw.. � zsn.�.w aernawa a.am•r•vrwP%n re.vet__ iA M.......���ar _ _ _._.___.._____._.___._'•(i�rr � wo Fn:.mp.. cvem Roe.ut:mfF91.1+ spa e m • •w:r+n raw.�..e.;._._.---_.--__.,«rw,ere.w •'rm�_ pm..n _—�I. awaimm.anR.+•noel _ - .. 90.w � r.� °r`i�:--- �y eba.mc savrm vmfrw.nu,el � - fm �es a w a.oxr.z•mlearb comma - Up Lwpm SWp mBawmeeamlFsuxmwm wapr aw. . —�__Ievm~—_____1i.rcr. � rur,.w _ � ma�b•.m fE:.ee.awl(Fs 1.1 .^pd esm wrema••e•>s+mr.e•mee__._.__.mr Ewanuraasm_._—_—__ ✓ - •�^'"z,^^'Om'^�^••'^c+`Or---���°iqp jtl•''�^"'reywBmswwasl .y� esw mT r,ar..rar•oarWf^..r..--._Fm.___...—_.. _.Jla[rz 7 pOmo.Omwp_____._—__—py:m wr--._ .m.r•.wTs.n _�/ _ ^^^'S^!r!^??—_�__.._..—e__ .___ ... ........ ..p•mm s,er.nyE..nvquyw�ran..:..w.____�Fn r4..._.__...___......__a[e = .a�a_—_______—R�,EI.—..—__vyyj{y� � �mmmuuaaw wuaewmis•ee. cee/rIC4m ' s�.:ne:I�p�wrmiv wew__.�zz.—__._____a[a � �>•— —Ir�.•Rmr----s•�1N nlwambuaz[wrw wer l6ac - z'zapel.'sea �En--_—..-- �awEramms.,.ef _ _rEftlw � p[Ws anc.all nksanFe vwE ab Brtle owraM` e•m4s19'frJe ��srm----._. CW a:awss________ � R.xa _—���f•9.em1-- r m Im �aema..a=.xm.s ___�r+o a..3>�' - rerr�msw y rxne��.<a.+bw JI:•mwv wtMmtabM•Ww lae�•emwW WOW m rm .•N/rwm r r . .r_a ./. W ertnilnMmn uwa ee /.• u wuzs wc.—_ _""1 Rs xL—_— :dpi. �•, Y c - nmrakae.oF,mexq_ - ' .w.mmra+fw -cvasa� . _ r .:. ..�.�'w'�r.r�r+=e'.r.`�..'.:Om.a..e..•m - .. _ zra..'�--_ag-ae_:. wm.�w.enao' _—�rrosa—_----E•s-.:i•� .m"wswwvo Iz weamF.erw.m __ _ •';On �eaxn - m�..ss.nm.a...v.m+m+v.y.,.ae _ 1 r O.s.mlaes _ . - - �.`s�.xa•E�mre•®mm.��'r,i.`."Oewv._.__. >u.., .x m.mOO.uvr.dm..mmv.ww.wammE..•m:.aO .,:.. n amrls o.nm�•a:m ewr�' "'°°la E... rwp./Iz•a.m ems,w� — Iro o.:.r.r.m--__� � ......:.•..e.r az. :.r...mwa ... m.wm w .ww,.w..p� I ��. 7•`+ .r k iI•<� ac-o m,oa - I ..._.._.. ..... ._' IOUNnnTION PthiJ G1%ACE gnn.TlnV..E�iFRnTIO NS -.ee: Bruce Devlin Designs m - w Chatham MA .'.LL wa 774-238-773 ZI FASLESTO!4k COTUIT - - .:1_ FL.. — — --- ii�-- prL11 • W�..S titi..__ i I-e.<�.4 i / •�II __- 9 IL . I Kc,CF O.4.I)[7AIL(•`•• o� C.,vwc.�i--�5 � ;�.� �I.e uu,�.+5.car '.\ _... - a•r.<a.E a�Tw5 we - � ._— 3I I I I � - - L1 -- - Sl-f2]�n FlD'1R 1l.•.l ulucl �+*s:.._ .. .. �. - _ - Gn:nP.:nnu Tnl_a�Tc'.•n—inw5 _ Bruce Devlin Designs -.c..r 774-2J81177J b9 E.=t~SY.vE,,.,.I cuTJ T.n.n, t G•.t I � j ± aa� "" a• —_ - ...n�nwn arcs . "I - .,•.,•,. - I�.aw...vt..,sb.,n..G `I. �—.— -.uG,.•.a°/.w•..,�.,r . } er.z�LLw/1ut+na Sn - - I o�l h.•EM1tn f--..1a•Y Rxo4 � �t t� SECUNI')rLOp PLAN .. -77 i - i a- waa*ca.G ; xa.�aam it ,�(,i li I aF iae •.�s.^wa i SEC-Tl(JN n./.U..-�o•.). SECTION 6�H C••.,,:o-) - . a � � , •. - �GARAGE A+I�RION f n�-�Lf:tiTlil•1•. __ ..^m� Bruce Devfin Designs .. ."... ^�^ Chatham MA wCIESTCtNE\•/Av Cp-rI iT�+ ... 774-23fl-n77} <•as e i Common wealth of Massachusetts � Sheet Metal Permit Map dsy Parcel O o ab y Date: 71. [Z Permit 4v /o9- l al V Estimated Job Cost. $ /G a�o — Permit Fee: 5 $ Cab Plans Submitted: YES NO Plans Reviewed: YES NO Business License# /5 Applicant License.# �cl Business Information: Property Owner/Job Location Information: Name: �ob�c� I�v�jU4 e�A o� Name: .e- Street:.n ae Yhvk&-� w ,[2l. Street: 31R City/Town: &An�n (b City/Town: -e-. /44. Telephone: Telephone: Photo I.D. required/Copy of Photo I.D. attached: YES, NO Staff Initial J-1 - '..W,`estricted license J-2/M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq.ft. /2-stories or less Residential:4-2 family 'ol Multi-family Condo/Townhouses Other Commercial: Office Retail Industrial Educational Fire Dept. Approval Z",Institutional_ Other Square Footage: under 10,000 sq. ft. V over 10,000 sq. ft. Number of Stories: z. Sheet metal work to be completed: New Work: ✓ Renovation: HVAC Metal Watershed Roofing Kitchen Exhaust System a Metal Chimney/Vents Air Balancing ` J , Provide detailed description of work to be done: NSURANCE COVERAGE: have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes 2"No ❑ f you have checked Yga, indicate the type of coverage by checking the appropriate box below: k liability insurance policy [ Other type of indemnity ❑ Bond ❑ )WNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Aassachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent ly checking this box hereby certify that all of the details and information 1 have submitted(or entered)regarding this application are true and ccurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be i compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation: YES NO Progress Inspections Date Comments Final Inspectiion Date Comments Type of License: - y Master itle ❑ Master-Restricted ityrrown ❑Journeyperson Signature of Licensee ecmit# ❑Joumeyperson-Restricted License Number: 1�� :e$ ❑ Check at www.mass.govidol tspector Signature of Permit Approval I - i COMMONWEALTH OF MASSACIiUSETTS ' SHEET METAL WORKERS AS A BUSINESS ES,THE ABOVE LICENSE TO JUHN R _ROBICHAUp= ROBIES REFRLGERATIbN',iNC 279' YARMOU.TH R I D HYANNIS = a MA 02601 0000 r 07/29/12 970015 -f .' The Commonwealth of Massachusetts ;►� Department oflndustrial Accidents Office of Investigations :600 Washington Street _ Boston,MA 02111 www.mass.govAUd ' 'Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians%Plumbers Applicant Information /_ Please Print Legibly Name(Business/Organization/Individual):_ �O Y�1 P C �4 c1Address: City/State/Z P: 4W aAi Q Phone.#: [Are you an employer?Check the proprieaoe boa: I. I am a employer with •4• ❑ I am a general contractor and I -Type of project(required):; employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction . 2.❑ I am a'sole proprietor or partner- listed on the'attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me fir any capacity. employees and have workers' [No workers'comp.incirrance comp.insurance.$' 9• Building addition required] 5. ❑ We area corporation and its 10.❑Electrical repairs or additions 3.❑ 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] *An y applicant that checks box#1 must also fin 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. tCoutractors that check this box must attached an additional sheet showing the name of the sub-cont ucturs and state whether or not those entities have employees. If the sub-contractors have employees,they must providt their workers'comp.policy number. I am an employer that is providing workers compensation insurance far my employees. Below is the policy and job site information, Insurance Company Name: ��%Q.e�Z:�I�C �l�/��✓ �'vtsLl !� Policy#or Self-ins.Lic.# (il)�S f>p b '�'7 y�fj ExpirationDate: Job Site Address—City/state/zip: Attach a copy of the workers' compensation policy declarafion page*(showing the policy number and expiration date). Faihire.to secure coverage as required tinder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of"a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify rcnd ains•and penalties of perjury that t e information Provided above is.true and correct; -�_ Si afore: - _ at t ri Phone#: 5 OP. 7 7 S = 36 F3 — Official use only. Do not write in this area,to be completed by city or town official i I City or.Town: PermitUcense# -Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: I ,acC)R& CERTIFICATE OF LIABILITY INSURANCE DADD/YYYY) 12/23/23/2011 THIS CERTIFICATE.IS ISSUED AS A MATTER OF:INFORMATION ONLY AND CONFERS NO'RIGHTs.UPON THE CERTIFICATE HOLDER: THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Ann Pell CIC CISR Rogers & Gray Ins Agcy Inc PHONE FAX 434 Route 134 HONE No EXt: A/C No South Dennis MA 02660-1601 ADDRESS: iDellan@rogersqray.com PRODUCER CUSTOMER IDp:ROB IREF INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A:Selective Insurance Co. of S.C. Robie's Refrigeration, Inc.279 Yarmouth Road INSURERB:Atlantic Charter Insurance Hyannis MA 02601 INSURERC: INSURER D: INSURER E.: INSURER F COVERAGES CERTIFICATE NUMBER:1728781311 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR - D L SUB RI POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD/YYYV MM/DD/YYYY LIMITS . A GENERAL LIABILITY S1880333 12/31/2011 12/31/2012 EACH OCCURRENCE $1000000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES(Ea occurrence) $100000 CLAIMS-MADE rx-1 OCCUR MED EXP(Any one person) $10000 PERSONAL 8 ADV INJURY $1000000 GENERAL AGGREGATE $3000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $3000000 X POLICY PRO LOC $ A AUTOMOBILE LIABILITY A9091920 12/31/2011 12/31/2012 COMBINED SINGLE LIMIT $1000000 ANY AUTO. (Ea accident) ALL OWNED AUTOS BODILY INJURY(Per person) $ X SCHEDULED AUTOS BODILY INJURY(Per accident) $ PROPERTY DAMAGE X HIRED AUTOS (Per accident) $ X NON-OWNED AUTOS $ A X UMBRELLA LIAB OCCUR S1880333 12/31/2011 12/31/2012 EACH OCCURRENCE $2000000 EXCESS LIAB CLAIMS-MADE AGGREGATE $2000000 DEDUCTIBLE $ X RETENTION $0 $ B WORKERS COMPENSATION WCIO0077902 12/21/2011 12/21/2012 X WCSTATU- OTH- AND EMPLOYERS'LIABILITY T RY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $500000 OFFICER/MEMBER EXCLUDED? N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $500000 If yes,describe under F OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500000 ERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) cate holder listed below is an additional insured for ongoing operations when required in contract, agreement or permit for bodily injury and property damage on the general overage described above. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. TOWN OF BARNSTABLE REGULATORY SERVICES BUILDING DIVISION 200 MAIN STREET AUTHORIZED REPRESENTATIVE HYANNIS MA 02601 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD t v Town of Barnstable Re Mato g ry Services m+es 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 Property Owner Must Complete and Sign This Section If Using A Builder ice)' �k as Owner of the subject r • J property hereby authorize �(�'J1 CS to act on my behalf, in all matters relative to work authorized by this building permit (Addr ss of Job) . *Pool fences and alarms are the responsibility of the applicant.are not to be filled before fence is installed and P to pools are not to b be Pools utilized until all final inspections are performed and accepted. S 4 tore of Owner Signature of Applicant Print Name Print Name Date Q:FORMS:OWNERPERMISSIONPO'OLS �t Town of Barnstable Regulatory Services . IMMSr,mU, . Thomas F.Geiler.,Director ueea n 9. �,�� 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 HOMEOWNER LICENSE EXEMPTION I� Please Print DATE: JOB LOCATION: number I street village "HOMEOWNER": t-a� 6R&5 a S 33 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'a7building 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. i 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. i Q:for ms:homeexempt pp tHE ip� Town of Barnstable BARNSTABLE. " Regulatory Services 9 MASS. g 1639 M Building Division prFO AC h. 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection ��� �°� Location 3 ���LST6,ZJ� �/ j permit Number Owner Builders ��►- One notice to remain on job site, one notice on file in Building Department. The following items need correcting: ,J /Uf4/L ��4/P q�� �.0 G{J�9 L c / C� (.tJC - -4- 0 Please call: 508-862-4638 for re-inspection. Inspected by` ✓ �/ Date `{/0 G-/ /2f = PROJECT NAME: 1-�up ADDRESS: -tea PERMIT# PERMIT DATE: I (� 0!* M/P: 0 5 L4 OCR LARGE ROLLED PLANS ARE IN, BOX '- r SLOT - Z Data entered in MAPS program on: BY: q/wpfiles/arch.1ve �INE'�w TOWN OFBARNSTABLE , Building Application Ref: 200904522 • BARNSTABLE, Issue Date: 10/08/09 Permit 9 MASS w. .. .. �ArF1339�- A Applicant: J.J.DELANEY INC Permit Number: B 20092055 Proposed Use: SINGLE FAMILY HOME Expiration Date: 04/07/10 Location 39 EAGLESTONE WAY Zoning District RF . Permit Type: RESIDENTIAL ADDITION/ALTERATIO Map Parcel 054009004 Permit Fee$ 1,239.90 Contractor J.J.DELANEY INC Village COTUIT App Fee$ ' 50.00 License Num 009961 Est Construction Cost$ 243,000 Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND CNVRT EXIST 2 CAR GAR TO MUD W 1/2 BATH-KEEP 1 BAY ADD2 X24rHIS CARD MUST BE KEPT POSTED UNTIL FINAL 2 CAR GAR(3 TOT),2ND FLR OFF/MED/PLAY 1 ST EXT EX 10/8/10 INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: FAIELLA, ROBERT A&KELLIANNE - BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: 39 EAGLESTONE WAY INSPECTION HAS BEEN E. COTUIT,MA'02635 Application Entered by: RM Building Permit Issued By: THIS,PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLY OR SIDEWALK OR ANY PART THEREOF;EITHER TEMPORARILY ORPqprANENTLY. ENCROACHEMENTS ON.PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY.TH RISDICTION. STREET ORALLY GRADES AS WELL'AS DEPTH AND LOCATION OF,PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS,PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONTSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. `• 3.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 4.PRIOR TO COVERING STRUCTURAL MEMBERS(READY TO LATH). 5.INSULATION. ' 6.FINAL INSPECTION BEFORE OCCUPANCY. , WHERE APPLICABLE,SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS. WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION. PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A). BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 2 2 2 3 1 Heating Inspection Approvals Engineering Dept Fire Dept 2 Board of Health I J.J. DELANEY, INC. BUILDING 8y REMODELING cv L y f /12/q�0 �F aowA-zof Barnstable Building Depart ent Attn: Tom Perry, Building Commissioner 200 Main Street Hyannis, MA 02601 Re: Permit Extension Request 39 Eagle Stone Way Cotuit, MA 02635 Dear Tom, Please be advised that I have not started an addition at the above referenced property. The reason for not starting is two fold. #1 -My schedule has been very busy, and we were unable to start before the winter weather set in. #2—At this time I do not believe I could thisproject and t the footings b start get oot ngs and foundation walls up by April 7th,the deadline date of existing permit. Therefore, I am requesting an extension of the existing permit. We should be starting this project in the second quarter of 2010 and completing same in the fourth quarter of 2010. Sincerely, e i r (:Jac elaney,President Delaney, Inc. 20 Rascally Rabbit Rd, Unit 2 Marstons Mills, MA 02648 Office: 508-420-6855 • Fax: 508-420-6856 • Cell: 508-410-0750 info@jjdelaneyinc.com R-12-2010 13:59 Fr°om:J.J. DELANEY,INC. 509 420 6856 To:5087906230",. P.1/2 J. J. DELANEY, INC. - "TOWN OF ,B R STABLE BUILDING & REMODELING 7010 RR 12 PP1 2- 02 20 RASCALLY RABBIT ROAD, UNIT 2 71 MARSTONS MILLS,. MA 02648 608-420-6855 PHONE 508-420-6856 FAX I IS I FAX COVER PAGE FAX TRANSMITTED FROM: 508-420-6856 FAX TRANSMITTED TO: 5-0 J - '1,q o d, F DATE: 3 ba 10 T TOTAL PA438 02, ATTN: I Q rrn t e r 13.cc. d FROM: a MESSAGE: . kaAp U 4. Ie S- Cr le L'O" rd� c 0 ' I l If you,had any difficulty"receiving this fax or received this in error, kindly ca11508-420-6865.���Thank you. IMAR-12-2010 13:59 From:J.J. DELANEY,INC. 508 420 6856 To:5087906230 P.2/2 J.J. DELANEY, INC.. BUILDING• & REMODELING TOWN OF BAINST BLE 7010 MAR 12 P14 2 02 3/12/10 DIVISION Town of Barnstable Building Department Attn: Tom Perry, Building Commissioner ; 200 Main Street Hyannis,MA 02601 Re: : Permit Extension,Request 39 Eagle Stone Way Cotuit,MA 02635 Dear Tom, 3 1.., ro Please be advised that I have not started an addition it't the above referenced property. The reason for not starting is twofold. #1 - My schedule has been very busy, and we were unable to start before the winter weather set in. #2—At this time I do not believe I could start this project and get the footings and foundation wails up by Apri17`,.,the deadline date of existing permit. Therefore, I am requesting an extension of the existing permit. We should be' starting this project in the second quarter of 201 0 and completing same in the fourth quarter of2010. Sincerely Jac Blaney.President r Delaney Inc. 20 Rascally Rabbit Rd, unit 2 Maretone Mille, MA 02648 Offlca: 508-a204855 • Fax: 508-420-6856 • Coll: 508.410-0750 info@Udolanoyinc.com ` ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION;; Maps' Parcel DQq ®� Application# , 0b `1 8� Health Division Date Issued Conservation Division Application Fee Z5;' Mo Tax Collector Permit Fee fib 30-7 , Treasurer Planning Dept. � Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address �39 srp mi Lo6q Village Owner Address Le L),i td& a t..T Telephone n — '7 Permit Request41Z 6L,✓�60 UM A Alq Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new g � i G�� Groundwater Overlay Zoning District Flood Plain Project Valuation v Construction Type U Ilk— Lot Size ` l ��7. 0q6 C1 Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑ � ❑Yes o On Old King's Highway: Yes A o Basement Type: XFull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sgeft) � Number of Baths: Full:existing__new Half:existing new D Number of Bedrooms: existing_ �' new_0 Total Room Count(not including baths):existing e? new First Floor Room Count Heat Type and Fuel: teGas ❑Oil ❑ Electric ❑Other ,2kDoQAAIL. o Central Air: ❑YesNo Fireplaces: Existing New Existing wood/coal stoe: ❑Y N Detached garage:❑existing ❑new size Pool:❑existing new sizeDX Barn:❑existing7 ❑net sizev Attached garage:>(existing Linew size Shed:❑existing ❑new size Other: ca `' cr Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ a Commercial ❑Yes ❑No If yes., site plan review# Current Use Proposed Use BUILDER INFORMATION Name Telephone Number a�Ocl 72d t���J Address License# �� q%l . - Home Improvement Contractor# ZS�q Worker's Compensation#(JGoR 3 1 S 3/S 16'dZ 6 ALL CONSTRUCTION DEBRIS ESUf�fING FROM THIS PROJECT WILL BE TAKEN TOJ �j SIGNATURE 414 DATE —7k 3 \ FOR OFFICIAL USE ONLY . / • ` ` \ APPLICATION* . DATE ISSUED ' MAP PARCEL NO. ADDRESS VILLAGE OWNER • ' . ' . . ' % DATE OF INSPECTION: . . . / FOUNDATION ?! / FRAME 4� W b� fsl . ^ / INSULATION l� FIREPLACE ƒ � ELECTRICAL: ROUGH FINAL ƒ PLUMBING: ROUGH FINAL ' \ / GAS: ROUGH FINAL FINAL BUILDING � . . \ . \ \ DATE CLOSED OUT { ASSOCIATION PLAN NO. ~' , , The Commonwealth of Massachusetts Department of Industrial Accidents = r'. Office of Investigations _ 600 Washington Street Boston,MA 02111 ' www.mass.gov/dia Workers S Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers-- Applicant Information Please Print Le 'bl Name(Business/Organization/Individ al): . Address: City/State/Zip: /M, Phone.#: qzo LMA Are you an employer? Check the appropriate box: Type of project(required):, 1.( h am a employer with 2- , 4. ❑ I am a general contractor and I - 6. ew construction employees(full and/or part-:time). have hired the sub-contractors 2.❑ I am a'sole proprietor or partner- AKq listed on the-attached sheet. 7. �Remodeling ship and have no employees These sub-contractors have g, ❑Demolition workingfor me in an capacity. employees and have workers' Y P tY• $• 1 9. ❑Building addition [No workers' comp.insurance comp.insurance. required] i 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions •3.El I am a homeowner doing all work officers have exercised their 11. Plumb' repairs or additions ❑ g right df exemption per MGL myself [No workers comp. 12.❑Roof repairs insurance required.]t c, 152, §1(4),and we have no employees. [No workers' . .13.Q'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. $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'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information.Insurance Co any Name: �� &L,41 � i Policy#or Self-ins.Lic.#: "93 15 3 I �U6I101'6 Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the or rs' compensation policy eclaratiou page(showing the policy number and expiration date). Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK.ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DU for insurance coverage verification I do hereby ce der; p ins•and penalties of perjury that the information provide ab7e;4 ae and correct: Sienature Date:? Z3 Phone Official use only. Do not write in this area,tb be completed by city or town offciaL 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two.or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee-of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the' dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to bean 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 in.�Aance 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-contiactor(s)name(s),address(es)and phone number(s) along with their certificate(s)of insurance. Limited Liability Companies'(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. 'The affidavit should be returned to the city or town that the application for the-permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete•and printed legibly.'The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant, Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all-locations in (city-or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related fo 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:. Thy Commonwealth of Massachusetts Department of lndustdal Accidents Office of Investigations 600 Washingtofi Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Revised 11-22-06 Fax#�617-727-7749 www.mass.gov/dia E,�y Town-of Barnstable yP Regulatory Services * B !STAZIXx Thomas F.Geiler,Director 9 MASS. ib3q. .0 Buildinor Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 509-862-4038 Fax; 508-790-6230 Permit no. Date • AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modemization,conversion, -improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work- 4— U�k U �L Estimated Cost-7 A.ddress of Work: / Owner's Name: G Date of Application: I hereby certify that: Registration is not required for the following reas on(s): []Work excluded bylaw []Job Under$1,000 []Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS To THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES.OF PERJURY I her y a ly far a permit as the agent of caner: - 3 7 14hy)AV1 5�� to Uontractor NJne Registration No. OR Date Owner's Name Q:fm=:homeaffidav Tama dsSxa(eosRmne� . • Iz premaiptiya Paaksgei farfla°mad T'wo•al;Lmw RaldentwBaildlggz Hsatsd it' gyp° ' }iIAXfhitT141 ' 1►ffi+IIMU1Vi 4Iaung Glazing Ceiling WaII Floor . Ra=ad r Slab 'SeatiaglCoolimg '(',e) U-vatuex R-va1 R•valuel 8,yaluLA Wall I'airad=r F.qulFmeat Et6cieac ' Pa 'tea B-v3luef R-��t . • '.f'/DI to 6500 HrstlagltegrsrDmys' � 1Z%. 0140 33 13 19 10 d Normal i 12% 0-52 30 19 + l5 10. d Plorcnsl FC • 6 8S7tPUE 12% "0 39 I3 19 l a If's a36 31 13 25 WA NIA. Normal •� Normal V 15°1e 0,46 31 I9 I9 19 d Y 15% 0.4.4 311 13 23, NIA NIA U AFM W 13% am 30 19 19 la U AFUS MA03Z 31 - 13 25 NIA NIA Normal 13 . a.47 31 19 23 NIA NIA~ Noasnl 2 11% G,41 33. 13 19 I $ 90 ARM 32% GSC 30 19 19 10 d 5t7AFVz Annxllss OF pROFinay. t SQUARE FOOTAGE OF ALL.EXTERIOR WALLS: 3, SQUARE FOOTAGE OF ALL rTLA=NG: 4, °�a aLAZIN4 AREA 03 T IVMED BY"n2): �. SELECT PACKAGE(Q—'AA sea chmt wave); ; 9 c OTHERMORE Itv�IOLY�sD IYMTHODE OF DEi dG ENERGY REQUMEME`NTS ARE AYAILA.BLE. ASK,US FOR TM MQRMATIONb EMDINCITNEPECTOR AMOVAL! YEE: NO: q i"vtt ts-f�cQ303, . aoF,�' ti Town of Barnstable r � Regulatory Services MAR-WAISIX Thomas F.Geiler,Director ArE �b1` 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 authoriz ,/'W�l to act on mY behalf, in all matters relative to work authorized by thisbu.ilding permit application for: AOL 41 (Address of Jo S' afore of Owner Date Print Name QFOF.MS:OVR RPERMISSION A. ' BOARD-0F BUILDING,REGULATIONS Licensb.: CC.IS-.W4jjw T4W WP.ERVISOR Number CS009961 Bir16dfite 04/14/1952Y Expires 04114/2008 Tr, to: 21505 1 Restricted 00 =r it JOHN J DELANEYY 271PLUM STY r r i W BARNSTABLE, N, 02668 Commissiorier Boni* oflRu egulatidns an tan arr s fi. 1 icense;QrEXegis ration Valifl.f HOME IMPROVEMENT CONTRACTOR { "be foreabe exp�ratton date .If {' t3oardbff#uddiog�2egulation: Registrat off: 125529 One Ashburton Place Rm 130 Expira ion_ 15/2008 Type Individual Bo§ton,Ma-02108 JOHN J. DELANEY ai — , JOHN DELANEY 271 PLUMST W. BARNSTABLE,�A-026 8'� Not alid without si Deputy Administrator� € i r, l t _ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION: .a Map (-),S _Parcel ©®q OOP Application Health Division Date Issued 4�> Le Conservation Division Application fee ` Tax Collector Permit Fee`'"' f12 .L� Treasurer Planning Dept. �GU Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 3q r ,AqlF 6-1—o1Lg WA Village // Owner �� �i f� � LL,4 Address 3q Telephone Permit Request COVLMACTI 61uptAlk L Lf Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District�Q_ Flood Plain A& Groundwater Overlay Project Valuation Construction Type a i Lot Size !�A® �� Grandfathered: 0 Yes ❑No If yes; attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure d 14& Historic House: ❑Yes XNo 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 /vA new & /4' Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths):existin 1A new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other ��i� �J� Central Air: ❑Yes �o Fireplaces: Existing / New Existing wood/coal stove: ❑Yes O o Detached garage:❑existing ❑new size Pool:❑existing Xn"ew size2d'XL/D Barn:❑existing ❑new size Attached garage:❑existing ❑new size jkA Shed:❑existing ❑new size J Other: _ _ Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ ; ' Commercial ❑Yes �(N o If yes, site plan review# N) Current Use Proposed Use _ _ BUILDER INFORMATION el Name AJ Telephone Number� � � `�' Address L License# 6S D 6l r 07_f, Home Improvement Contractor# Z 6�o? Worker's Compensation# to 6o13`,5� ?10(Qi ALL CONSTRUCTION DEB S R ULTING F OM THIS PROJECT WILL BE TAKEN TO SIGNATUREn-V44, M DATE 3 PL uV 1 FOR OFFICIAL USE ONLY APPLICATION# rti DATE ISSUED - i M'AP/PARCEL NO. ADDRESS VILLAGE . OWNER 1 DATE OF INSPECTION: ti FOUNDATION lo? VIA_ FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ' GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 19 i �C o� tag Town of Barnstable Regulatory Services ,,AM Thomas F.Geiler,Director Eo Building Division Thomas Perry, CBO,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 PLAN REVIEW Owner: q leU X Map/Parcel: Project Address 07 64te-s-C°�e Ulf ( Builder: 157 G _ The following items were noted on reviewing: ett- oo&s . ZI IIJ6 AV �Qoc- /9wq-RW'g Reviewed by: 2 c /-c Date: Q:Fomis:Plnrvw The Commonwealth of Massachusetts Department of Industrial Accidents • Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers'. Compensation Insurance_Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'bl Name (Business/Organization/Individual):. Address: City/State/Zip: Phone.#: � � �lZ�'��� Are y u an employer? Check the appropriate box: 4. I am a eneral contractor and I Type of project(required):. 1. I am a employer with_ ❑ g employees(full and/or part-time).* have hired the sub-contractors 6. El New construction . 2.❑ I am a•sole proprietor or partner- listed on the-attached sheet. 7. ❑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. 10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ P officers have exercised their 3.❑ I am a homeowner doing all work 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' . 13.0 Other comp.insurance required.] . *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ;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'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is.the policy and job site information. Insurance Company Name: / Policy#or Self ins. Lic.#:W Q315 1 O /O I0I L Expiration Date: IWV 2, Job Site Address:_R41/&gOot, um City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure_to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy-of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby c fy' 7Z9,7ains-andpenalties of perjury that the information provided bo7r, is true and correct.Sienatur . Date: �� _ Phone# �bAlzo 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#: Information and. Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity,or any two.or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." mGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to*opera te 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( )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-conti-actor(s)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies'(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage.. Also be sure to sign and date the affidavit. 'The affidavit should be returned to the city or town that the application for the-permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the peimittlicense 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 like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number: The,Commonwealth of Massachusetts Departanent of Industrial Maidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 11-22-06 www.mass.govldia I °FTME,�y Town-of Barnstable yP °� Regulatory Services * BARTISTABLE, Thomas F.Geiler,Director _ 9 MASS. $ . �pl 1e.19. Buildincr�D1V1$lUll ED MP b Tom Perry,Building Commissioner 200 Main Street, Hyamus,MA 02601 Office: 509-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT ROME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c.142A requires that the"reconstruction, alterations,renovation,repair,modernization,conversion, -improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building contain g at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractgrs,with certain exceptions,along with other requirements. Type of Work: pZ Estimated Cost J Address of Work: '40q&67_ _&h Owner's Name: Date of Application: a'J o�2 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law ❑Job Under$1,000 QBuilding not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBTIRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES.OF PERJURY I here;pp for a permit as the agent of thee�owner: � � l Date Contractor N e Registration No. OR Date Owner's Name Q:foms:homeaffldav ryoFr�,y Town of Barnstable } Regulatory Services Thomas F. Geller,Director �ATFcA1� Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www-town.b arnstable.ma.us Office: 5 08-862-403 8 Fax: 5 0$-790-62 3 0 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 bythis building permit application for; , 4(mz v (Address o Job) " �Z ature of Owner 0Da Print ame QFOP MS:0INNFRPERMISSION 01/10/2007 12:.39 FAX 508 778 12.18 rf7J002!002 LMG 1/9/2007 5 : 16 PAGE 002/002 LMO Amutuy $bertx Liberty Mutual Group m LPO Box 7202 . Portsmouth, NE 03802-7202 Telephone(800) 653-7893 Fax(603)431-5693 January%2007 TOWN OF BARNSTABLE 200.MAIN ST HYANNIS,NU 02601- RE: Certificate of Workers Compensation Insurance Insured: J J DELANEY INC 20 RASCALLY RABBIT ROAD UNIT 2 MARS'TON MILLS,MA 02648 Policy Number: WC2-31S-318101-016 Effective: l 1!2 2006 Expiration: 11J2 2007 Coverage afforded under Workers Compensation Law of the following state(s): Employers Liabitity. Bodily Injury By Accident: S 100,000 Each Accident Bodily Injury by Disco= $ 100,000 Each Person Bodily Injury by Disease: $ 500,000 Policy Limits As of this date,the above-referenced policyholder is insured by Liberty Mutual Fire Insurance Co under the policy listed above. The insurance afforded by the listed policy is subject to all the terms,exclusions and conditions, and is not altered by any requirement,terra or condition of any or other documents with respect to which this certificate may be issued. This certificate is issued as a matter of information only and confers no right upon you, the certificate holder. This certificate is not an insurance policy and does not amend, extend, or alter the coverage afforded by the policy listed above. If this policy is cancelled before the stated expiration date,Liberty Mutual will endcsvor to notify you of such cancellation, AUTHORIZED REPRESENTATIVE LIBERTY W)TUAL rNSURANCE GROUP This Cerdleals is eseculed by LIBERTY MUTUAL INSMANCE OROLT as seapeclssuchirrsumMs as Is affirded by those eompWas. cc: Insured: Producer of Record: J J DEIANEY INC DOWLING&c O'NEIL INSU&,INCE AGENCY 20 RASCALLY RABBIT ROAD UNIT 2 INC MAlARSTON MILLS, MA 02648 P O BOX 1990 HYANNIS,MA 02601 1191VO7 Assessor's Map: 054 Parcel: 009/004 Baxter Nye Engineering Community Panel, Number. 250001 0018 D N Rev. 7/2/1992 Registered Professi F.I.R.M. Map Zone: C Engineers and Land S Plan Reference: Lot 2 0 Plan Book 465 Page 73 78 North Street, 3ra Hyannis, MA 021 Deed Book: 15,501 Page: 278 Phone (508) 771-7502 Fa Owners: Robert A. & Kellianne Faiella Job Number. 2006-059—PPP Scale 1 " = 40' Dot LOT 2 PLAN BOOK 465 PAGE 73 44,046 SO. Ff. 1.01 ACRES N/F JAMES F. & NICOLE D. PICCIOTTO go. �. f oW SAS IN FRONT OF BUILDING SEWAGE # 6— 7-02 OQ P SUBSURFACE SEWAGR DISPOSAL W 51.6' QUO SYSTEM FORM: 6127-02 r •'! �� GP 1 w c'r O z 81.6' EXISTING 2 STORY •v WOOD FRAME -o # 39 �G1 I 0 N CB/DH FND 1 f %P tO�GARAGE Ic N 88'01'00• W Bit• oR`�wAY N/F SUSAN M. & LARRY F. WHEATLEY g CB/DH FND WLO •� � a 188:98' N 89'5355' W Y .- O ►7 0 tD m Q z N N/F JOHN T. & DORIS G. n. TALMA W I fD $ CB/ o N o O. \ Z RUG-01-2007 14:25 From: To:508 420 6856 P.1/3 UISCo. INCORPORATED 133 UPPER COUNTY ROAD SOUTH DENNIS,MA 02660 (508)394-4800 FAX(508)394.6735 13"STAINLESS STEEL GATE SPRING NW198-SSB/Buck NW198-88W/White 00 y 20 -. 400 p e Marine grade powder coated EACH e 3-series stainless steel e#14 x 3/4"pan-head Phillips stainless steel screws included THE PROTECTOR TM/ MAGNETIC POOL LATCH NW276NE-26/Black NW276NE-56/White •$tandard profile height of 19.6" overall height 20 • Key at 45"angle for easy operation and protection from the elements EACH • Reversible mounting(right or left handed) Easy grip release knob *Stainless steel attachment screws included SELF-CLOSING STAINLESS STEEL ADJUSTABLE HINGE STANDARD T8 STANDARD NW38952SCR-BCP/Black NW38952SCR-WCP/White 12 +Flange dimension:3"(H)x 3"(\M x 3"(D PAIR e Mininimum gate frame or post size:3.5"(W)x 3.5"(D) e Horizontally adjustable e#14 x 3M"pan-head Phillips stainle".-=ews included a s RUG-01-2007 14:26 From: To:508 420 6856 P.3/3 RUG-1-2007 13:33 FROM-.PRO �-Ek4cc co 15084328715 T0:15®83946735 9.2 CQ 1 N C O A P O N A T 9 4 133 UPPER COUNTY ROAD • SOUTH DENNIS,MA 02M • (50 )394-4600 • FAX(5031394-6735 POO PRO PICKETS Bottom Holes On top Rail Enlarged For Racking please I Pvo 1 #booGAP a l y„ HEIGHT 4' l PICKET SIZE 1 3/8"x l 3/8' W x l/2", 7/S"x3" 3" TOP OPEN Straieht TOP RAIL 2"X3 V2"X96" g• .. RIB BOTTOM RAIL 2' 96_X 96" 3 V POST 5"X5"X 7' POST CAP Molded GothicElpt GATE 29 W, PICKET TOP pointed Doaear QRQER .SECTIONS 6" POST ENDS CORNERS LINES BLANK CAPS GATE r I` I BOARD OF BUILD ING,REGULATIONS r 4 ' Licensfa CQN$T 4„r 4WS*JPERVISOR Number,CSn 009961 , Birthdate 04/14/1952 - , 1 Expires 04/14/20,08 Tr, o: 21505 4 I Restricted 00-i j i JOHN J DELANEYt 271 PLUM ST r`. iJ 1 1 W BARNSTABLE, fR 02'668 Commissioner i Bo��A.- g1egulatidns an tan dare .l�cense6r`xegts ation valid f� HOME IMPROVEMENT CONTRACTOR i before fhe expiration date .if Registration: 125529 :�3oard of$uitding- 6gulatiow -.:.One Mhburton Place Rm 130 Expiration 1J15/2008 ON -- Boston,:Ma 02108 }r15�IITIMOCI,dividual JOHN J. DELANkEY= g JOHN DELANEY� i f,kz_4( 271 PLUM STi � 8- — Not alid withoutsi W. BARNSTABLE, MA�©2668 Deputy Administrator•i� € I FF _w TOWN OF BARNSTABLE Permit No. ..3522 9..... BUILDING DEPARTMENT 1 TOWN OFFICE BUILDING Cash 6y9 '>rOVA HYANNIS.MASS.02601 Bond ......x......... CERTIFICATE OF USE AND OCCUPANCY Issued to William & Mary Everitt Address Lot #-2, 39 Eaglestone Way Cotuit, Massa USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. November 18, 19 92 .......... .......... .....: 4. ....... ................ LiI ing Inspector IL ��� °•` TOWN OF BARNSTABLE BUILDING DEPARTMENT BAUSTAU S TOWN OFFICE BUILDING HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department DATE: ///i?` �?2- An Occupancy Permit has been issued for the building authorized by BuildingPermit #.. 9»....... ............................................................»...............................»».».._.............. »..».»..»»»». issued to ./1�� _ / C?i1.!�1...&e!�.._......................_.........._..»........»»»».....»»...... »»..»»»» Please release the performance bond. 1� 44 04 S V N fou+J�� �-�o►J ,CaC.47-iCIC/ TL2I-r S /OWiV f/E.2E0�C/COA I.dL YS Gr//Ty ,5'CA L G- I w 7`.y� O.q�- L�r ;C�C.4TE� r Ltd/T/-//�✓ ,T�/E ,�,�oar�L�4/y, .. BA Tyis. .�,�.�,v/s .voT aASE-o //1/ST.eU�/�it/T,$'U,21%�•}Y.� T.Y�.. •��/l-� SU.eY6•Ya.t�. �tlaT 8,. .4F1.�� /C,Q/t/?� /�!/&.S. . vl,i I L L L v E Z'Tr rtJSI6►,1 v TA ._ SING. �Mt�JIL`( 4 Bmmmw4 klMt (GARAGE 609vav. 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V J IR {yIIM _r i T / :. •` CRYI L eL la � CGTIoN d&W lu Ij 0 H 1 ' rr�.w � 1 e• w j i .. j I ... ��� - -. ._. �.:: � CGTIvN -•GCt IoN � ®r�p"q'� , f"• r.. �j. TOWN OF BARNSTABLE, MASSACHUSETTS - Bull DING PER_, I' A-054 OU9.001 DATE AuguF7 C 7' 92 0. APPLICANT, Will Everett I-bia--FO8E UIL ADDRESS 01295% (NO.) (STREET) (CONTR'S LICENSEI PERMIT TO Build dwelling 1$ Single. family dwelling NUMBER OF 1 (TYPE OF IMPROVEMENT) �_N0. (PROPOSED USE)_) STORY DWELLING UNITS AT (LOCATION) lot #2 39 EaglestOne Way, COtult ZONING (NO.) - (STREET) DISTRICT BETWEEN AND (CROSS STREET) (CROSS STREET) SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL;CONFORM.IN CONSTRJ)CTh TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: Sewage #92-277 BOND VOLUME 2692 6q. ft. T 225,000 FEE $ 169.50 $ (CUBIC/SQUARE FEET) ESTIMATED COST OWNER. William & Mary Everitt ADDRESS O::L Road, uOLUIE, 1 BUILDING DEPT. BY ^ ' r I - THIS PERMIT.CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY C PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE A- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINE FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIOt OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL INSPECTIONS REQUIRED FOR APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE PERMITS ARE REQUIRED FOR ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PLUMBING I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL ELECTRICAL�INSTALLATIONS D 2. PRIOR TO COVERING.STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL FINAL INSPECTION TI TO LATH). FINAL INSPECTION HAS BEEN MADE. 3. FINALINSPECTION BEFORE - OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1n,/7 T�iaw �� ij''�l : 2 3 HEATING INSPECTION APPROVALS EN ERI G D PARTM T 1 �� D BOAR HEALTH OTHER SITE P EVIEW APPROVAL WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT W;LL BECOME NULL AND VOID IF CONSTRUCTION TOR HAS APPROVED THE VARIODUS STAGES OF WORK 15 NOT STARTED WITHIN SIX MONTHS OF DATE THE INSPECTIONS INDICATED ON THIS CARD CAN CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE. ARRANGED FOR BY TELEPHONE OR WRITT: NOTIFICATION. Assessor's office(1st Floor): A'ssessoVs`map•and lot number �`` o�TH E ro Board of Health(3rd floor): ����T'A�,LFEDft COMPLIANCE Sewage.Permit number �t.. L_ ,. WITH TITLE erj 2 Beaa9TduLc ; Engineering Department(3rd floor): 9 y,Jf ENVIRONMENTAL CODE AND � toss Hquse number Definitive Plan Approved by Planning Board c 1T�N REGULATIONS �0Mar d APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only ���p 11M� I ' TOWN OF BARN STAB �, BUILDING INSPECT ORION)!; APPLICATION FOR PERMIT TO LO A),5—T7?— �'� W6Z-4W 6:— TYPE OF CONSTRUCTION ®Q� �✓� � �tJ 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: t Location � y � u)-N i cjo—\V Proposed Use �ll,�C�1.� �+'��i4L� �ul�Fc��' Zoning District '� Fire District (1 ET' 't Name of Owner VJA- --k E VL—,P�Vr\ Address As Name of Builder 1�--t-- �`^t Address Name of Architect Address Number of Rooms Foundation Exterior � � /��/ _��' Roofing ���'� Floors � ��' `� �0��-L- Interiors Heating Plumbing Fireplace 00E- Cal ms - Approximate Cost e0o 4 '� Area ,/ Cy Diagram of Lotand ui�g with Dimensions Fee 2y s l4 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name " I Construction Supervisor's License (N 2 9 56 EVERITT, WILLIAM & MARY "` r d .., No 35259 Permit For 13 Story Single' Family Dwelling 14 ' Location Lot #2 , 39 Eagl one way Cotuit Owner ' William & Mary Everitt Type of Construction Frame Y- " Plot Lot Permit Granted August 7 , 19 92 Date of Inspection 9 -4�2 19 �r t ted 19 r I [ProQosed New Construction Plan . in Cotuit, MA Prepared For: Robert A. & Kellianne Faiella Assessor's Map: 054 Parcel: 0091004 Baxter Nye Engineering & Surveying Community Panel Number. 250001 0018 D N Rev. 7/2/1992 Registered Professional F.I.R.M. Map Zone: C Engineers and Land Surveyors Plan Reference: Lot 2 0 Plan Book 465 Page 73 78 North Street, 3rd Floor Deed Book: 15,501 Page: 278 Hyannis, MA 02601 Phone — (508) 771-7502 Fax — (508)-771-7622 Owners: Robert A. & Kellianne Faiella Job Number. 2006-059 Scale : 1 ' = 40' Date 01-26-12 LOT 2 PLAN BOOK 465 PAGE 73 - 44,046 SQ. FT. 1.01 ACRES N/F JAMES F. & NICOLE D. PICCIOTTO S0. S 7 4 52 226 55, N h . SAS'IN FRONT OF BUILDING w j SEWAGE # 6-27-02o N �P SUBSURFACE SEWAGE DISPOSAL v w .. w GP�P SYSTEM FORM: 6-27-02 o to LP rn o z ' EXISTING 2 STORY WOODD 39 FRAME o r CB/DH FND UN a' GARAGE 149.23' 1. 22. N 86'01'00" W 15.3 m N/F SUSAN M. & LARRY F. b PROPOSED M WHEATLEY o 24' x 42' CB/PHr FND LO 24, GARAGE x w a . . CB/DH FND ,n 168.96 N 89'53'55" W _ Y LA to o m co J N N/F JOHN T. & DORIS G. Li TALMA co Q o 'co N CB/FND 0 z - - _ W ZONING DISTRICT: RF I a MINIMUM CURRENT ZONING REQUIREMENTS � 3 . m LOT SIZE: 43,560 SQ. FT. o o 001 FRONTAGE: 150' z ;n to o FRONT YARD SETBACK: 30' o `� SIDE AND REAR YARD SET BACK: 15' v� ,CB/DH FND i I CERTIFY THAT TO.THE BEST OF MY KNOWLEDGE THE EXISTING STRUCTURE AND PROPOSED o NEW CONSTRUCTION SHOWN HEREON ARE LOCATED IN RELATION TO THE MONUMENTS SHOWN AND ARE NOT LOCATED WITHIN A SPECIAL FLOOD HAZARD AREA. �`�� OVI }'� L. `' THIS PLAN IS NOT TO BE RECORDED NOR IS IT TO BE USED TO ESTABLISH PROPERTY R. LINES. E _S - 29E74 Ln co O REGISTERED PROFESSIO AL LAND RVEYOR N BAXTER WE ENGINEERING & SURVEYING DATE �► cat -IL co O O O • Pro2osed New Construction Plan in, Cotuit,, MA Prepared For: Robert A. & Kellianne Faiella Assessors Map: 054 Parcel: 009/004 Baxter. Nye Engineering & Surveying Community panel Number: 250001 0018 D N Rev. 71�11992 - r Registered Professional F.I.R.M. Map Zone: C Engineers and Land Surveyors' Plan Reference: Lot 2 0 Plan Book 465 Page 73 78 North Street, .3rd Floor Deed Book: 15,501 Page: 278 Hyannis, MA 02601 . Phone — (508) 771-1502 Fax — (508)-771-7622 Owners: Robert k & Kellianne Faiella Job Number. 2006-059 Scale 1" = 40' Date 08-27-09 LOT 2 PLAN BOOK 465 PAGE 73 44,046 SO. FT. 1.01 ACRES N/E JAMES F. & NICOLE D. PICCIOTTO SO' 226•SS, r • SAS IN FRONT OF BUILDING w j . J SEWAGE # 6-27-02 N # SUBSURFACE SEWAGE DISPOSAL J `` pw QOP SYSTEM FORM: 6-27-02 .. o •(0 0) � O 4L z , EXISTING WOOD OFRAME o # 39 c or CB/DH FND 0 GARAGE 0 149.23' 161 N/F SUS_AN M. & LARRY F. . WHEATLEY O PROPOSED °CB/DH 'FND GARAGE <L+ < Q l a 168.96' CB/DH FND LO N 89'53'55" W o m O N J N N/F JOHN T. & DORIS G. $ �! TALMA 4 c I CB/FND N ' M ; O Z ZONING DISTRICT: RF w' MINIMUM CURRENT ZONING REQUIREMENTS LOT SIZE: 43,560 SQ. FT. o b FRONTAGE: 150' Z wino FRONT YARD SETBACK: 30' c N SIDE AND REAR YARD SET BACK: 15' I r ti CB/DH`FND I CERTIFY THAT TO THE BEST OF MY KNOWLEDGE THE EXISTING STRUCTURE AND PROPOSED NEW CONSTRUCTIONSHOWN HEREON ARE LOCATED IN RELATION TO THE MONUMENTS SHOWN AND ARE NOT LOCATED WITHIN A SPECIAL FLOOD HAZARD AREA. �t< Of c THIS PLAN -IS NOT TO BE RECORDED NOR IS IT TO BE USED .TO ESTABLISH., PROPERTY LINES. _ ti 2o�9c,siE ° , . ' ` REGISTERED PROFESSIONAL D SUR OR N BAXTER NYE ENGINEERING & SURVEYING DATE Ora o:\700.6\7006-059\SIJRVFY\worksht\2006-059C;—garoge.dwg,'flj27j2009 4:41:26 PM, 1:1, MTPA r g BIZ �o�t�w 4\,L-� l,bcFw �lt�� _ c -cam; , n can k(o»x;tY? lt,t, ptCcH tT , • Am- C 8 Pik 23.E _ � - N - p �• t tto can, - iE .......... 1 6.6• tit .. �,6.. , f��,. .1�6a _ .t•41, 1.�.• 'OcXvl`��V- gb(� v �� C'et}�n� �pRr • I i ' I� f 1 Pl i IG" 3.2" g.0` , two" 4.0` Q .p•• b.ayy" NN, �- i21q f ~ANC S'tCzvy� MIM ?H tiFw tZ�H ' E2/4 C. ,r as ,n O �21w �� .- I � � 12- LO ' • Eroposed New Construction Plan in C.otuit,� MA Prepared For: Robert A. & Kellianne Faiella Assessor's Map: 054 Parcel: 009/004 Baxter Nye Engineering, & Surveying Community Panel Number. 250001 0018 D N Rev. 7/2/1992 Registered Professional F.LR.M. Map Zone: C Engineers on_ Land Surveyors Plan Reference: Lot 2 0 Plan Book 465 Page 73 78 North Street, 3rd Floor Deed Book: 15,501 Page: 278 Hyannis, MA 02601 Phone = (508) 771-7502 Fax — (508)-771-7622 Owners: Robert A. & Kellianne Faiella Job Number. 2006-059_PPP Scale 1 = 40' Date 07-23-07 l T-11.61' 1 LOT 2 PLAN BOOK 465 PAGE 73 44,046 SO. FT. 1.01 ACRES N/F JAMES F. & NICOLE D. -- PICCIOTTO SO# 74 o S ??6??3 E , r- M 4$ N o w SAS IN FRONT OF BUILDING C: SEWAGE # 6727-02 �OQ�P SUBSURFACE SEWAGE DISPOSAL W 51 6' G�P SYSTEM FORM: 6-27-02 r a� N Z 81.6' EXISTING 2 STORY o WOOD FRAME -00 # 39 G1� r N CB/DH FND s `0 zo 4 GARAGE 149.23 N 86'011005 W Y g�( DR1WP 0 N/F SUSAN M. & LARRY F. WHEATLEY $ CB/DH FND e. l n � w c� a 188:96' CB/DH FND. 0 � Li (D N 89'53'W W m t(0 11N a a N N/F JOHN T. & DORIS G. $ w�- a Lal ;� TALMA ro � $ ' N CB/FND o � , � M o 0 d- l W X EL ZONING DISTRICT: RF l �i MINIMUM CURRENT ZONING REQUIREMENTS �' 0 3 Ln LOT SIZE: 43,560 SQ. FT. FRONTAGE: 150' Z o o FRONT YARD SETBACK: 30' SIDE AND REAR YARD SET BACK: 15' I - CB/DH FND 0 N N } I CERTIFY THAT TO THE BEST OF MY KNOWLEDGE THE EXISTING STRUCTURE:AND PROPOSED w NEW CONSTRUCTION SHOWN HEREON ARE LOCATED IN RELATION TO THE MONUMENTS SHOWN �N OF N AND ARE NOT LOCATED WITHIN A SPECIAL FLOOD HAZARD AREA. THIS PLAN IS NOT TO BE RECORDED NOR IS IT TO BE USED TO ESTABLISH PROPERTY Is o LINES. 8 2M74 g nn �o l4L �Ey ` o REGISTERED PR SSIONA LAND SURVEYOR N BAXTER NYE ENGINEERING & SURVEYING DATE 0 N r r' i t - - _- Q _ CVrLk: m5.--.CL`.aG115� 1 i ; i \I , ---- ��4'� .C_CL•/%•�C� . .. ._ _._. -.. .._. •... .. ... ___ - - i ..�d _. ___....- --- ---- -- __ __._ - --..,i Al = -l.cJ::�' ---— ___ --'. _ _ .. ... _ _ .. -. Ls,Ci`s'—�L:cr�!�r.S�l.. _—. --_ - - 1 : il; � I 'wI � 1 i �•s: r� t. 1: O( _ j _; .t �^rt' ,_.c.�. cicL co• ' < �: ��i I ._�.in•,I7s::; Ii.. i '\ , s a..r':v.•.�ix�:��c\C .: 4�:o Tur-c �.. � '. - iI p U e"vf:�.,/Su-S tJl: 1-Q'�3• TWA.K�*-f;?I:FPG'S If g�ue�DEvttN aESr/+�us N eumfmM, MA. _ _ __ __ _ __ _ __ _ T - _ ­,.I I-II:I."1�II�II� ..1-�,",.:I�,I_,.11.�I 1.�.�II�I, :_I-�-1`I��I-� %1�EI.­ - - --- . . _ DIG SAFE NO. GENERAL & DETAIL SPECIFICATIONS '" I. y. ►, l ,i : r �� I1I I- . , SIZEAt� 1tc7 DE T 06=� REA FT - 30� . .. - n �7`I u4 : I. II I. 11 POOLS APE G 1= /1 REF: N - . . .. PERIMETER j � FT COPING . . ,►.. . . . STD,-Aa7 AQ CO t 0 T,S . . TILE TILE COLOR :. . - . , . - - .. , -, .POOL CAPACITY' GALS: d� DD ''• , - 14� iti b S_ C- h7'0ti ;0 G rc FILTER /1 (lid y� t�} - i . . . . PUMP w�tom, 50eil— MOTOR H.P. •. - . , , _ : 1 N- �iA-\Q QTY I I , . SKIMMER MODEL . . . I� - , .,. . I RETURN LINES : MAIN DRAIN- P- - - . . - oi� r� . BACKWASH 1"O . I ' ._ . - . . , . _ . CHLORINATOR ., t-T`�. r , ��h �3 ` „GG t. >:.i r+ . I.��,:-�I.;�,.,.,�..�1 1�L:.-,-I I�6�.�.L�.,1,'��,.1��,I Ij�I0,,.-.-,�I)-I-,I,.�,.-"..,I�_; . . . . . UNDERWATER>LIGHT VOLTS S�i7 WATTS .... . . . . - . B _ OARD SIZE . . . . BOARD' SUPPORT: . :: . . - . , .. - , . . -: GRAB RAILS , . ; -_-: ;-; TYPE, o : . . , .: : . " :: _ . - — . . . � .' LADDER: . .- :`CUP ANCHORS`IN�INALL. . - _ . - _ : ROPE and FLOATS. . . . . ,• �_. . ar��. NLFS` .N:Lf.1 , ; . . . , �� IZE . :.BTU INPUT ,7.S ,VaD . : .- , , {';: . : :,: ATE . , . , 13 � . N. ��� .. . _.,.,,��,, ATURAL\GAS ❑ " PROPANE.� � OTHE .FUEL ,�,, r- �. , . ' '� , a ..:.:. . , . : GAS LINE�BY. '. . VENTED BY:: ,. ' . EL, ECTRIC BY: 6 G+l�lt' ' TIM E�CLOCK t - . O , :. , . ELECTR C AL BONDINGB. , -,. : ; WATER:FOR"GUNITE �' 5 1 , y�- ,� , - . . : :. ._...._.. __ DE CKING"­ !1 5 ,. . . . Y , - , . : , ; - I' LEANER . .. �} ..' P -. : y, ,.; :' '. �.vi :. . .DING - - , < . , cb , , Ll cht POOL SETBACK Rear Side - - r{L . . ,, . : . - vk'r'. n r «r � Ir: �3 , . , ., F : MOUT . SWI DV r _. _ n vr. ..�. .. �4 .: : ._:�. ,. SLIDE u7_ , v D RAIL -: ,��."�,.,1�I II I 1�I�",,I 1I��1 I.I�..l.�-1 II.I�I1�I 11.I-�I�I.I I.�.��.1 1-.,II.�11­II����,.I­.I��.�L�I.-I�S�I�1I'­I I-I.�I-I.�I7..I..,..�I.111;I,.I)I I—1Ic,I�I�II I4�I�1-.I�.I5-�:.�-I 1I�­.I 1.�I��1��1t\1_.1>I",.1I1 1_I.:.L....,�.,1-1I-..I�....I',,,1�­,�I.I.�;...,/�.1�,I�-.I I-r,.II1I-._-,I.�I­1��',.I�­I..-I-,�1,""1�1,II�I.I—LI�I.-.,,-I..11I I I���..I'1 1I�1,.,�I':"I,��I.�I1I�..�"�.I,LI� yeti "e°1 . I WATERTABLE CONDITION /`/�?�� :. . I,"-�.,I I.II,�,�I.r.1.:.I.I,II1.II-�.I I61�-I�II�'.I-.I�.�I1rI�"I,0,I�I_D[.��I II�'1 I I��I I1 I��II-II.I.I I�I'�%�II',.�I,IIII�I�I"� ", „ . , RAISED BEAM p�1r_ FT 6 FT12 . . -" - . . FILL 11 AWAY ❑ LrT` 014 D.O.P. ❑ 5.� _ , O��E� . . " POOL COVER TYPE 1`� . , ,. _ t _ .. _ PLASTER FINISH G TL,y9 . . . . . .. 1 . - .. .. :: . " . o Depth . . HYDROTHERAPY SPA � /�/QN . ; . M . SIZE JETS . . JET PUMP"HP SKIMMER . MAIN DRAIN " . RETURN <o<L - - . ' - . ' AIR BLOWER: , LIGHT . LL . FILTER " , . HEATER . , , c,c _. CHLORINATOR' of " - , : .:" - ', -" . , i - I ot. c x . . AME ,d �: , , . . . : , , , ADDRESS 9L��-Sc�Lzy P - f3�3i" 171-1iT a .: : I . . . L�h c 4 . PONE u w.- _.._ , ._ , JOB ADDRESS �1 >=L(��: , . , _. ps ,� L. - Scal e Is- 1 -0 OTJ - f'j? � b - pE tFIED R DIN UNLESS S C N _,G A G. AMERICAN GUNITE POOLS . , - . _. _ a �o f--C—_�-�r ' DIVISION OF AMERICAN SWIMMING POOLS CORP.: , . A . . UWN ER :To determine:a roximate elevation of,Pool on or before.day of PP . VE. f n er state and local ordinance. Gates to be , „ _ _ . excavation: Pool area to be a ced 3 �, . ., . a - 5 f t m ,. __ .:.: __ . : . . � . P.O. B.OX�248"� . self closet and sal la ch . . c , NK,: MASS. 02771 0248 - i "for a- a ttwo Ames da I n to structure at e s . OWNER. To wet down co cre # . . . ' 7577 ` � I ark the . , . . . er se to fill ooF as �t w l m (508) 336 . mirn , of seven da s. Do not use rubb ho Y p , . . , int r or`: taster.en. . .p , , M, . , , ,� - :,. . _ MA. REG. N0. 100284 R.I. REG::,NO. 217 . - . ) ..p:, 1I ,. 13. b, :" :: ;. .: y ,. . ,. , _. , it1 n. EF.'NO.:;. OWNER. Extra char a for vvatertable cond o DWN BY . 9 DA E CK. BY R - -- — _ -- - --- - . - , . .