Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0035 FULLERS MARSH ROAD
r a1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map_ ©�S� Parcel D 4 t Application # Health Division Date Issued 2,11taby Conservation Division Application Fe Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Fct I l e r_5 4k q Village -�D�ui+ Owner VAMPS AmD 16rsfeA) Frbvs Address 95- Fu /lens 14AasH Telephone 8 ' E E /e q I g 9 Permit Request 3AYS room 2-ei&)c)41 i i oAJ Per(nit Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 142f_37e,P.1 Construction Type Lot Size 1. 0 5 AC. Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 2-11" Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes &Flo On Old King,'s Highway: ❑Yes ❑ No Basement Type: UQ Ful ❑ Crawl ❑Walkout ❑ Other L Basement Finished Area(sq.ft.) Basement Unfinished Area Number of Baths: Full: existing Z new D Half: existing O new s:�uo Number of Bedrooms: existing new - 0 Total Room Count (not including baths): existing 9 new 0 First Floor R om Count do Heat Type and Fuel: pas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes cc� Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑-No Detached garage: lt�'a5xisting ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: xisting ❑ new size _Shed: ❑ existing ❑ new size — Other:.p Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use NMLICA.NT INFORMATION (BUILDS R HOMEOWNER) Name !\Cylw- III w i Telephone Number' J� 3 �a 9Y ~ Address �7`� �CiJ/I S �11� �C License # /M,&7 i24' k L4f 6215,3o?_ Home Improvement Contractor# /,?03020 Email )(4)_ l.u.//i N I (:Ve_ri Zrra. tur-7- Worker's Compensation # 990/f 5yg ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO C§ a-re It1wSAC /ttle SIGNATURE DATE FOR OFFICIAL USE ONLY 4 APPLICATION# DATE ISSUED MAP/PARCEL NO. w • ADDRESS VILLAGE OWNER t" DATE OF INSPECTION: FOUNDATION FRAME r INSULATION 7 FIREPLACE ELECTRICAL: ROUGH FINAL r PLUMBING: ROUGH FINAL 'a GAS: ROUGH FINAL FINAL BUILDING 9 L� 1( i t3 DATEXLOSED OUT ASSOCIATION PLAN NO. � t W 1, - J Thiff CtJhTnvro3Zfv= of Massrlc us-elYs Departwmt of ladmftialAccidents -- - ��TCe'[T��ii4T�stlgga`ttoTlS 600 Washington Street Bostozz,14 02111 Warkers' Campensati fn Insurance Affidavit Builders/Contractor �tricianMumbers A Plicant Information Please Print Lep_ibly Name gkRineasr0rpnizziou&&vid=0: I&J ry tiFess: �D ��/I t.I Ci lC fC , City(StateMp: 141 A.O/S32 phone. Awe you an employer?`Check the appropriate bom THm of project(mired}: L I am a employer with 4- ❑ I am a general caaffractor and I 6_ ❑Ne w employees{full and/or part-ime)-* have hired-the sub-Conira�tors ,--, ^�-deling fin 2_❑ I am a sole proprietor or partner- listed on the attached sheet �- ship amd have no employees These sob-oontractors have g_ ❑Demalifion woddng for me in any capacity. employees and have warmers; 9_ ❑Building addition [No workers' comp_iumm re comp_inmwance l 5.❑.We are a corporafimand its 10-El Electrical repairs or additions 3_❑ I am a homeowner doing all work officersbmeexercisedffiek 1$F]Plumbing repairs or additions myseM [No workers'vamp- right of eimmpfionper MGL 12-El Rnaf repairs fizur nce requred]f c.152,§1(4),and we have no 13-El Other employees-[No workers' comp_innsuranm required:] *Any aggliamrtluc checks box-91amstalsosnouttthesecaaabe7owckrta duEirvalenT'mimpemsadonp*ULTinkmmidmi- TT I Hnmeowne s uha submit this atyidavit in Ho tag they am doing sII uc*and then hf a om commcmrs=sMIM3[a M-w aft idavit i"Er—tM soC tCsakRctoxsthst check this bwc mast zttached hoe additi rmst sheet showir g the name of t he Alt-ooiltradots and sbie whether onmit those maidipes have Employees- Iftbe-Vchrnt mcto-bay employees,they tmst provide tIt'wank-0 camp.policy number I am are empZajw that is prm ieURg warkeis'cot gwnsa an inurance for my employees BeLotr is thegoucy and job situ infor mach& Instnimce CompanyNa ne: 244,ri C 4— 4/77 t/j e9 A-) In j Policy#or Self ins:Lie.#:' 7` '` D/1 - e Exgiration Bate: `1,9^/3-1 5- Job Sii#e A d&,ss: ,�5 �u t✓1 I fI�S`( CiWstawzip: CoTui r,, ,V A o ed b3s Attach a copy'of the krorkers'compensafum policy declaration page(slwvkg the policy number and expsation date). Failure to secure coverage as reT iredunder Section 25A of IUL r 152 can lead to the i upositian of'erimsnal pmalties of a fine up to S1.5OQ00 andlor one,-yearimprisonmenty as well as chit penalties in the form of a STOP WORK ORDER and a fine of up to S250-00 a day against the violator. Be advised that a copy of this stet maybe forwarded to the Office of ImresEgations.of tiie DU for insurance coverage verification - I do hemby e>erli the panes andpenabies ref penury lhatthe inf or-rn'ahon pronaded abaue is true and correct Sitmature: l� p Bate: c Phone 9: 4WEdaI use only." Da not faits in this urea,to be compLeted by ciO7 or town offiC&L City or Town-. PerazibMicense# Is mina A uthurity(drele one L Board of Health 2.B Uding Department 3.CityHown Clerk 4.Electrical Inspector 5.Plumbing Faspeetor 6.Other - Contact Person: Phone#: 6 . Information and .Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an ernployee 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 appurtenaat thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also sia�s that"every state or Iocal licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance.coverage required.- Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), address(es)and phone number(s)along with their cert..ncate(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;ins,raace. 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 confirmationof inset-ance Coverage. Also be sure to sign and date the affM2vit 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. Anew affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Department's address,telephone and fax number. Thy CommQaweala of Mnsachusc�tts Department of 1ndustrjal Accident& Office of kvestipt oas 6Q0 Was du Street Boston.,IAA G2111 Tel.A 617-727-4M W 406 or I4 MASSAFE Revised 4-24-07 Fax#�617-` 27-774r w.ma -gevfdia I-;��t-�t.i���,.t--i--..._..-,.�-�.���.�,i,�--:�.�.��..���.:����.'.�...�,tt�i�;�t�,!.1tt::l-;.ti:,.-�`:":����"�..�:t��,1-.-�.��:t*.��...�t=.�.��-.:.��,..�:t:i..��:.-*�..�t�:,....I�.:�....��;,:��..����*-,.,.:�.-t:,-�.i..-.:-p�:,-.-:.::��:.y��*-::,.t�.�:,...�.;,...;--�.:-.:.::�-.:-.*.,t.;..,-�t�.':�1t',.:��,.,�,-.--.�..:��.*��;::,�..,.'-::-,:,-",:.��..,,�-::.:����::*i��.,:�,K��..-�:,.:..�t.'.�.:.:t.1I.,�.-�:..,�,'%,.�.,�,.;.-":!-:.,�:.:,.�,,:�--.-�.�.�'-.t.-,�t�-*:�t..:.�'..i�:'.I:p,,-�:,1-.;�,-.�.1�-1��.�-:i..�-;��--.'.�,:,..��:_.....�.:�..�..t_!i,%::*....�.:��.-..:�.:.�.�1..�1:t:�i.*..-.�.�-..`��..t-�:�-.:�.:,.:....!",.t:�-.�.:.�.��,,��.,.��..�:t.:,l.%,.��,-�..,..�--.�,���l:-.E�...-,1_.t_�...--.:,�i�����:'��-.��i:.,:�...�-�t:-..-,:.�,��K�,.��..�%:_�.-:,:.�..:.�%.�%.-...`::--��.��;,'�.�:,:::-..,i��.�..:�J�-,..�::::-::�..*.1.-i_--,.:.:��.2--��:"�:,..�,-.:-..wj::--,,��,I-.-_.�:..'.��:�:�:-:-.'.-:*i�-:...�.-...�:.�;1:�-�::.-:,-:%....--.�.�i�t:-.",.:.�.%�:�:-:.��l�ii.:�t7:-...,�.1-_�,.-.:.-:!!.��.-.�,-:��,:....�.,-.��:.�,i;*..�..�.;�,.�.t��,��-,-�,'�..,-,-:i,:��,�-..��,i,...:--..�:.�:���.,,�*:,.-�.:,��:�:�.�;.I.:��...�.:-.-,1.t::::�,,�tt�.!�ll�::..�*i.:.,,.���.��"�.,*��t.:,.,�..t.::��::.:�t��....-�1%--'t.,.�,:t.-.!-�:����1;..�.-�!�--:��:-�-�..�.-.:�_�.t:.i.�:.t..�..�.:..�.t.��.�::,.......*,!.�.-.�.:-..�tt..:-,.....,*..�.�'-.��-,t::,��.�_.,�-.-..::��.-.�.-..-�.,�.,��-���,i���:.:-.....,,�...:".,-;.�.��...�j.....-�,�.�,.�-t..-:.........;�.*,.:.,..-��:�.�*...�l..%.,������.:-...:--..!'--i�:-.t�.,..,*:,..-�...1..��;..:i:,._..��i.��-..-:-......-,'��..,.!-..':-t-:.,,`.�:-:.._:.-:.:...-*..:.-�,.,��.�,.*."t.,.:I-���.*,�..-*-.-.��j:..-t,,.....�'�',..�*..-:.--...-�.,'.,'-..-;t�.,...",�.�:��.*:.i��.�;..:.�.:�-,:.,�..-.-.i�.-�-....�,..:.t-.,,.:.*tz-,.,�:.:-j.,-.,..:�:-,..�-���:**.�.�-:*i,.�-":.t.�,..�:�:'t��.--.�:..��-...-l�.:.:'j.�.:-,...--:..-�.-t.�.:--...�"���t-..:: Ril6tfax z 2 11/19/2014 1y 00�.:.-I.wI�-I...-.��� 27 PM OAWt.' 2LObt, Fax 'Server ::,-.".:*-.-�-d..�I1�,..�,�.._.�..p�:-;..-.�:-.�:.I.:.�.�:t��..;;.::...:..�!.,.!.:,-."�....-�m.t�,�:....-'�,.—,-;:.p��:.J.,:.:.::,...-;�i:..,..I.-�,:.w:.,.�..,��:::..-,�.-:..:-..-�.�.;:ttm.%.-_.,.:...�..,.:::�1...�::.�..-.:...1�.-,....l.�...:.:..�.,--.�...,,,..I"�..1.::.I�..;,��:��.,.,�-.-��,.-.���I.:-,..t:�.I.-�,�:..::I".;:.�..--.,�I�l�,�.�.�t,,.--',WI:.,it:�.--.::��..�':".i:1-q�.:,I.,,.:�!,�,W:,.�,�._.,.�.:,I..�.m.,-�,.�".,...,toI..�1-�;-:.-:.-,.%.-.,..I-�-.i�,1,..l,:.:--..-..t:�..�..:-��...:.��-..�...:..i,.:;-..�t,t.i:t*�..,-.�.�..,,.:!::..t%%.-:.,:.:j,t.�8;�l-.�t.�.-:7�1�..��%�..��"tI-�-.�-�.�,�.�.-:.:�:-t.�:p.,�,,.:.I�:�...�..::.:-.�:.:-,...�:!..,::..-��...�.%.��,,,�-1.,:.:...*�.-�.-:��..j.m'r!-l-,.:t:1-.,�:'";...-.�:-O.7-..,��-1,,.�..�.-�.�I� .�..,.�.',.:.::�:-;..,.I-..:t...,�.��-��..'.t,�:...::.'�_..�::....�.-!:.'::��,..-�.'�-1,�t:.,a.:....:.,:..-...".,.%,..:..-,-.::_L�,.-....1'--,.�...:.v.-.�t�:::,�:t,�.:.-.�,..-,!�..�:.!.��....-.,.-*.,..�t.�-i,�.:.��',.,�:a:::..'..::...:*_,.:�. .�.��.��.:-.I-t11.",1.:'-.�.1..:-i.�.'..:..���.�,.,::.:�m.�.l--"�.,--..1� A� ""'A DatE«rasrDnmrYn :�..�.::;�,,�I.�%.---:..1R.1:..9..-..�.j.���,-,::-,t�.t-���,::�-:..�-!..i-,-�-�..-:.:".:.,..�..�.:.:.:,�...:,.1AI�.::.%�i:..1.�i-.:..��..::,i:�---..mI...:.,, u-:.,,I-:.�- ..'.�.,,',W--,-:,--..W.-.�.-'i.;.II�:i..-::��-,-I.I:-I.,.I.:.-.:-.1�l..-.:-:�.I��---------�,:-::-'-�:t.::::tI-:-.:�:,. -�..-..-�....:,:.L.'.t..�-.,i-.I. .�:":I.p�.:�:"::1.�:,.�.-�t.::.�.�:-','.I,-�.�:1�:�1:-,..1.0.: ,�.4-:...�.:��ff:�.,,:�., ,-.,-.1:—.-,:t.�i.�.-�.-,,.'-...,-..�.--:',-::i!:�,��t-I�-..::..,�,,t�.g.,:�.�...1.�:,::-,.,:,,�,0�. :...:.,,m�:,�t:1m..I..-�::,:.:...,...t-:,4,N..*''t.�...,-.�..:.j�--q��.-..�!.,I:J..-t_-:.:,,,'.%..*.."-:.:..�;-.,.—.���.:_:I.�-.��::.-�,",:,..-:i�..,..:..,-�.,,,,,..-�-.�:..::,:�... ,..�....,....,,,%i�.j 7:�-:i.:T-�..�n--.�-.�1.:7li!I-tt':..-.�.-:.,:,...:,t:1'.'I,� ,�:�.:::r.;m,..,---.-..t:--..��...--.:...� �-:...-!�.-;t-.�.-�,.::..:,....:.�..-1-,I1.:.:1:W,..:..t:-,_.I�...�-%��:.:�.......��...,��..:t.-m--:.-.:.t-�.:.�:�..�,�.: -.'.--.. 1. CERTIFICATE. LIABILITY INSURANCE ATE IS ISSUED AS A:. ATTER OF INFORIMATION ONLY AND CONFERS NO RIGHTS UPON THE GERTIFICA H L.DER Ti118 GOMPICATE DOES NOT AFFiRMAT VELIf OR;NEGAIWELY AMEND.EXTEND OR ALTER THE COVERAGE AFFORbED;BYTHE POLIdES.BELOW. HIS CERTIFICATE`OF INSURANCE DOES NOT CONSTiME A CONTRACT BETWEEN THESUMG tf�URER(S),AU1NORiZEp:REPRE$ENTATIVE MPORTANT if t 06ft loft holler is an ADDFIIONAL INSURED`ttNl pogcyftes)must be egdoraed. N SUBROGATION IS WAIVED,subJece to the arms and.condlNons of W.-pay,certain poll.,, may;require and endorsement. A statemelt on thk dartHidate does not confer rights to gIa dateUMer ingeu;ofatuch'eedorsemed s PRODUCER CONTAC3 NAME. NORTHSTAR INS SVCS INC PHONE":: FAX: job'FIRST AVE tAiC,No Exy fA�;�k : E-rwtAlL NEEDfiAM,MA 0249. ADDRESS .i �PNT Ir�URE.R(S)AFFORfACOVERAGE: NAICB_' 91SURED.'. INSURE R:A AMHRICANZIJRI(qlNSURANCBC0l1PANY I. MUL[1N ICEVTIV! INSURERS : INSURER;C. 40 DENNIS CIRCLE .. INSUAER D INSURER:E. . IiBOROUGH MA 01532 INSURER;F COYERAOES CEgTIFICATENUM6ER fiEYIStONNUMBER `:i .. . HA NBUREDNANW.ABOVEFORTHE➢OLICYPERIOO;NDCA.. H ANDNO ANY REOIbRfiII@Ir,TEIBI OA CONDRIDN OI;AHY CONTRACT OR OTNgI D Ir 1VIIF1 RESPECT TO..YINICH TNS CFRfFICA7E YAY BE BSUED OR W1Y PE1IiA M NBURIWCE FORgED:BYTHEp0G1®ESOESL HEf.: N&1BJ6CITOALLf1�TEFIMB,EI[CU1 omANDCPt— -- OF9UOIPWICIIMLWS8HcWwMAYHAVE.E REW1 BY :PADCLAee$ _ ;: NSR ADD B POLICY ffP DATE POLICY EYP DATE LTR TYPE.OFNSl1R NCE L: R VOLW.IAANM f1BI1001YYYY) P �Y1'YYI !lwlR, GENERAL LIAIt1UTY OGCURRENGE $ COMMERCIAL GENERAL LIABILITY AMAGE TO RENTED S CLAOAS MADE OCCUR REMISES(Ea ocdarerroe) .: ED EXp(Arty m pomm S ERSONAL&ADViRLiURY S GENT.AGGREGATE L�41R APPLIES PER ENERAL AGGREGATE S POLICY PROJECT IOC RODUCTS-COMP/OP AGG. S AUTOMOBILE UABIU,. BUIED SWGL. S aNY auro mnrr(Ea a�xlaara): . ALL OWNED AUTOS -. BODILY:WIURY '': E SCHEDULE AUT06 + perms) . HIRED AUTOS NON ONfNED AUTOS' BO DILY;INJURY E er acaderd ROPERTY DAMAGE S Per aa3dent) UMSREU A11AB OCCUR EACH;000URRENCE $ EXCESS LIAB CIAaAS MARE RELATE S DEDUCTIBLE E aETENnorl s s A WORKERS OOtiPEMSA710N Atm x YJC SfAMORY OIHER EMPLOYER'S LIABILITY YM UB 989pM54814 11/02IZ014 11/02Y101$ pugs ANY PROPERITOWARTNERIEXECIJrIVE D NIA E L EACH ACCIDENT S 100 000 OFFICEfVL1EMBER EXCU�ED4 (y��„y ti ) E L.DEASE Elti_EMPLOYEE $ 10.0 000 tl res Ceaame arelel 1 E L DISEASE POLICY LIAAIT S S00 OOD DE9CRIPnON QF OPERATIOtbelow DESCRIPTION OF OPERAIIOW14 .. ''ndiWVEHICLESRiESTRICTIO EGAL ITEMS 14i1S RHPIJ�CBS ANYpRIOR C6RIYFSCA 1�tLSSU6D 110'IHH COYRFICAIB AOLDSR AbFBCf1NG WORRBRS COAiP COVBRAGfl ., r:: ..-. .- TRBWORKERSCOMPBNSAT[ N 6LICYDOESNOTYROVIDECOVBRA&SI MUItiW ItBVINJ;; IOBSflB:35.FULLBR$MARR ROAD COTUIT MA 02635a. CERTIFICATE HOLDER CANCELLATION TOWN OF BARNSTABLE.BULDING DEFT SHOULD ANY OF THE ABOVE OESCRIBEO POLICIES BE CANCELLED ATTiV:TOM PERRY CBO BUII DING COMMISSIONER BEFORE THE EXPIRATION DATE THEREOF,NOTICE WMLL BE DELIVERED IN,ACCORDANCE- H.THE POLICY PROYI;HOKS 367 MAIN STREET IiY,4NNIS MA 02601 !. AtlrnoalzED REPR => NN7777ACORD name end logo are registered marks ofl ACORD` 1.9aM-ZO10`ACORD OORPORATIOM Aitirlghts reserved° `: B TO" N OF ARNSTABLE � � `oaf r•., �'' E' tj. �'. DIVISION Re dl jk-d ^-o,0 4IN /-1 ' ' ? �j � j q F Nr m - L e✓ir�t-�,s�owr� e�a`L \� a • � �; �� rStiK�i oaf,- _; „off n L _ g'L `J T/ 1 N iC 0 A,9/N a— F ➢ 5.4 ya1 �fr tfrrrzrrr,7rui-rr�/lt ('�ffr;1(rr/uul/ 4 �V12ssaCh4154�3#S bep1t"tr6l 1 t*oi.Ptd7t1G df61y lI �,".I�I,,..�r,-.I,�;,-.,�,��-I,,*I..�,,�,I,I.)1-:,"4';�`,";,I,.;�P,�,,-�..�,.',,�.("�.,I,,f;-4,��I,:�-.*',.I 1,,1.I;�,�.:f,��,',),1-1 I-',.1,I 1 1��,,:'-�,i I"I.��'.�,�,l�Ie,..I�!,,I�i,..�,��,k,I..,.01.��,,;.I�.I,,IW�1,,."1 I1�"II1"�;I.;,,1.1b.I,J.—r I.-:,-".-I.,,I,I".,.:�,,.�.-,k,I,,-�,,,I,�,-.�I,:,",.,.I I I I,�.�1�..�:,..-.I..1,,-,...'�,I�,�&&�-�.-,I��,,I%�,,.�,�.,11"f,i,.;'I�;�.,I��.,I"r1A,4I,,I:1�,�..,%I�.",I'll�.�6_I 1;q,..,;-.11.�-,:,..1:..J..,.�,'. t-4-,", .Of7icc of Consumcr Affairs&Business .egulation �✓ Board Of Building IRC6&1BtidYl�Ahd St6ndards ' I. III „ i1OME IMPROVEMENT CONTRACTOR ,>n7att�iiif'rtu9,+ �4tittr ,. T "e E3egistration: P :.CS-030125 e f 'I,r. ..r'., '"� F% fir._: ..` , .�: ...,'..• -')A Y',t,- ,�,. k� .n�$ . 180320 7, Expiration. .11/3/2016 ' Indiwduai;. 11Ce13 �..i" a : xs � �r i t - c: ICEVIPI J MULLIN-. f : r* x i ", w; rs °KEVIN J:MULLIN ..tp.:x r:. .t� � v. � `' I"..�>, r r i 40 Dennis Circle t 1 " W•' ,' Northborou h MA,01532 C�.' .r 1. KEVIN MULLIN ` dktt#' r } l; ` 40 DENNIS CIRCLE `" Y" y, 4r �' NORTHBOFOUGH;MA0;1532 Undcrsecret r" '` s,11 '< �i"�7ilc'1tiC�i : a: Y b'J.!�v.�� Cta: n i s e 01/08/20;16 ,r Y i2 i y^l;ot r xi v a, pa .v, 5e ,� :t xl a e t ti r'd� K a '.-r "ti �. hr k [, ag, ,* H :� '� "W , :,, t ,r'+ g Y t a,f '.t Y ? 1 l �➢ P4 7� i. t �'T �: r 1, Unrestricter� ,:$uildink s of an';use rou which r „ g Y. 9 P_ , G ,. �-,. e.._,. °a ,r' ,., .,,�.e . ' .., ,:,,, 1, , ,,,,. ,. tr - ,:. � License or iegfstration valu fbc�uidrvidul ase"onty contain less th` 35,000"cubic feet(991rr►` off v . before the'ex iiration bate.,)f foinui ,r, . . y return to �. t ri'�' - fi i�, a " :%`t e s:. 4a`' CnCIOSeCI,,space.. F 1'�. -�`i r""r ? x�, Office of Consumer affairs-anif'6usiness'Re(vTulahon :"�.-.�,.,.'j',��,I,...-,,I.��..,-�'.1.t,'.,I��!.'.,,,.,�...�,.1.I.,,:�"I.�_.1.�4.'�;.k�.41�,-g,.;��l_�,'i-��,�I�.:��,�.,:,,1�'I�-,.'..�.-.,F�r.,I I,,�,k,.'1,i.I...I.'.��.*�-t,�....1I,,l.I -.:�.;''.�,,N.,-,�r,'�,�1I,,,:I 7�-����,,F,..II,-...-,,.�-,,,Z..,I.1�'.I�.�I,�,.,,1-�,�.�- J a-0 Pant$1�i a':=Suite,5:17 >. r> Boston A1A 02116 0 e i 'G / �' + ,+ ;s 'f .,'; a 'i, ", c '� ;:.`d x..r 'x :. .r:.ri.n�'"' ' ,..r:{3 ,,,; :h:a,5 , n•w• liS 9f 4` t _ �J,.7 P , [,' -4 S v. , � '` , y` Fail to ossess a current: di i h P e t on`of t o Massachusetts M } �; o " -;,; .� -V,, ,�: ,..I. y " �',' State Building Code is•causefor,.revocation of his license 9 .F p. '1'.. C, «l ,4:4. li .. .( i4S. F I,.. -.# .,. .,T•� - �,)� r, y . 7.- , t �,,d„wrth�if,si nature, . s..,=r ForDPS Licensin inforrrati n.vi'i`." 6v .` � r''. 6 g o s t ww,Mass Gov/DPS { k L 1 L., t L a ...r 1 t 1f➢ i r f�, ( 1 .� Ns .+� ;+.p '.-ti ..a 5� a'. ' '..:.;:.N -� ,; i '_f. . ,tR_,':,. (,j( ^'IS `r r, Q i t; Ar ♦.I , :;F"�,. i ,::.Y n3. :.,Y�•, *-.'; ':;. ,. �; L 1! x:K;;.. ..41.�j;., :,:, r :.'; ,,;• y:. i, IYr,I' ).2.1.:.a. ,.,r�:'4 " � r .7. 1 4 a 1 A', r f, ,�., ,�. ti,,., 1 t .,. . r e , . :'3 r' -fi :r� t r l. 5' t v ...t `:, .7 41 1 . .. .. -C, " ,.,`' - pis d ). ':.Pr - •�:� -, , ,.,t.r r ."h�{, s "r s➢ �' }i aid a h r : ,?r':^! r '.t u�,„� y s: t >. re -, , er .",1V e F... SF .+,: + .^aa S, 3:'' 1 ;i i l' .,i.S• r 'k s t� 1 4 aF ",, 4,..t,: A i h II`�.. vt, krj,." _, r''°.` n p .i. ," F:.';' k di 9 fir': { �'.'R' a j 7 , ,4 , wA?. i( ' 4 R.',�t ➢.� `d 9 - fI'+ 4 _r f7.• .f Y.i:- M MKS d a k,iq: i e,i i yam, i - f rr Sa x e.,, a'''� x• u ', ';t 2 L,•""r ' l ,', s .. :q, _',f: .. . , e,l C, �' >r". ,9 . . , - ;I Y , t (! . .. . } , k:' l., E Ali r� _ r II .. ... . ,' ,? }. UWETown of Barnstable Regulatory Services Richard V.Scali,Director Building' ►� uildin Division Tom Perry,Building Commissioner 20.0 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property 0wner Must Complete and Sign This Section If Using A Builder - l�rS If'S��l'� , as owner,of the subject property J P P riY hereby authorize f- "IAI J 4L4 ti to act on my behalf, f in all matters relative to work authorized.by this building permit application for. (Address of Job) I ---",-Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are.performed and accepted. S' a of Owner Signature of plican Print Name Print Name ; CZ Date Q:FORMS:O WNBRPERMISSIONPOOLS Regulatory Services oF1HE Toh Richard V.Scali,Director Buflding Division • RdA,,�eRLs Tom Perry,Building Commissioner �MAR-3 200 Main Street, Hyannis,MA 02601 ��D a www.town.barnstable.ma us Office: 508-862-4038 - Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner" shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. - The undersigned"homeowner".certifies that he/she understands the Town of Barnstable Building Department minimirm 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. HOMEOWNERIS 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 &ReguIations for Licensing Construction Supervisors,Section 2.15) This tack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor_ The homeowner acting as.Supervisor is ultimately responsible. , To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\bmlding permit forms\EXPRESS.doc Revised 061313 Assessor's map and lot number .:....... :`..`�..... ........... . r THE Wj Sewage Permit.number �'�1�..;......! ......�.�: % �) w{ � BJHB9TADLE, i House number .................................................:..................... .. _ rhea 9 Op t639. `00� �FQ YPj A, TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ............. 1/ f� TYPE OF CONSTRUCTION ..................... ......................................................... .... ........................ ..� . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to ,the ,following information: Location .. .................. i Q•�.... .. .G! :••.-------- �.. _..,1 .................................................. Proposed Use .............: .................. ,..., ...,,.. Zoning District .................... .. . ........... .....................Fire District .................... ! ............................................. . . . Nameof Owner .. .�*1....... ........... .........,...� A- ............................................... Name of Builder ,.... Address ��. .... ... !�+ ,. ........... ....... ..................................................................................... Name-of Architect .............::. .. ............................Address .................................................................................... Number of Rooms ...............:..!...!' .. .................................Foundation ............� t!?..•!.... ..—r�r ..... rD.-_............................ Exterior .......:f".....�.%5.�.... 2............................Roofing .. . s(!`?............. .................................... �i ,--�J- Floors �! .!- '.........................................................Interior ...:.....! .,/.'...........:....�............. :'�. ...... Heating .............................................Plumbing ............. :........................................... Fireplace .....� . ..Approximate. Cost � © O - Area ....Definitive Plan Approved by Planning Boa _1 Board _____________________________- 9________. '_ .......... .F ..... / ................. Diagram of Lot and Building with Dimensions Fee zlz SUBJECT TO APPROVAL QF BOA.RD--GF"H'EALTH y _- 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 .... ............ .......... .... :...... ,. ..... Construction Supervisor's License ... ........1. ....... ASHLEY, HARRY A=6-41 No ... Permit for ..............................ENCLOSE P0QR C • Acc ............. ................... Location ... ........ .................. ......................... .................. Owner ......U4rKY...&$.11 I.P-y............................. Type of Construction .......Frame....................... ............................................... ............................... Plot ............................ Lot ................................ Permit Granted ...Apr11 6.,................19 84 Date of Inspection ....................................19 Date Completed .......................................19 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 00 6 Parcel og / Permit# 0®(,7 i t Er �J IABLE Health Division-��t �' gf 3 ' Date Issued 21003 Conservation Division V I3 OM W U-1 Application Fee CV 'Tax Collector �' Permit Fee ' 106 A Aa r ; Treasurer sID , SEPTIC SYSTEM MUST DE Planning Dept. INSTAL=IN COMPLIANCE 11YIT1`s TITLE S Date Definitive Plan Approved by Planning Board 'ENVIRONMENTAL CODE AND Historic-OKH Preservation/Hyannis TO REGULA. ONS Project Street Address. 35 /- V L-LEg S /4AX5H� J0A�D Village 0— 07U Owner 9055a _ y-1SRE1 0,4 C42-L_)'4Jb7_ Address 1,0S .m --IN ST S 0 ll.N�46wr Telephone (509) 92t)- L4[)5r7 Permit Request 8EmODEL k ruiEA I V-5gmlL WOOkI RepugCE ROD /AI i-TH DECK Square feet: 1 st floor: existing proposed_ 2nd floor: existing'/O Q proposed �_ Total new Zoning District Flood Plain Groundwater Overlay Project Valuation /®, DO C) Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family U 'Two Family O Multi-Family(#units) Age of Existing Structure /q 7/ Historic House: ❑Yes Up Xo On Old King's Highway: ❑Yes Z<O Basement Type: 2'Full ❑Crawl : ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) /0 30 - Number of Baths: Full: existing new 0 Half: existing new Number of Bedrooms: existing_ new y Total Room Count(not including baths): existing new First Floor Room Count_�__ Heat Type and Fuel: 01, as ❑Oil ®Electric ❑Other Central Air: ®Yes Ilo `'Fireplaces: Existing �_ New Existing wood/coal stove: ®Yes 34110 Detached garage:O existing ❑new -size Pool: 0 existing ❑new size Barn:0 existing ❑new size Attached garage:LYexisting ❑new size Shed:&,existing ❑new size' Other: Zoning Board of Appeals Authorization' O Appeal# Recorded❑ Commercial ❑Yes U1 o If yes,site plan review# --_. -Current Use m Z---S-111�-�C-t�-_�� __ Proposed Use BUILDER INFORMATION Name vsS L G 14 Telephone Number S��" 7 3 9/9d Address ./sP!!5— /1-7esll y S/ License# �o9 Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO `a'AZZ a-/7 f7- SIGNATURE DATE 1 F FOR OFFICIAL USE ONLY PERMIT NO. ' 1 DATE ISSUED MAP/PARCEL-NO. y 7 t ` - ADDRESS —` VILLAGE OWNER .. - t i DATE OF INSPECTION: FOUNDATION. FRAME INSULATION J t FIREPLACE ELECTRICAL:' ROUGH FINAL i ; ; PLUMBING: ROUGH; FINAL Y r ti i �i✓ f GAS: ROUGH rV-$s p3• : . . FINAL ; r; FINAL BUILDING t DATE CLOSED OUT ASSOCIATION PLAN NO. { r i R I AUG 14 2015 VE TTovm of-Babas - N 0F t3�R�5� LE Reatt} Se sGn�aa7ujrvmw-Lelmc r , a I'PIC�S Fee - $ 1639- �$ Thomas k:C�ex,Dixecfar / / - Badt gDivhion Qaaz3'e xs CBO, Ea¢!cM,',COMWi siomer 206 y �H� ,M9 02601 a'�'Sa�abarnsrablezmas Office= 508-862-4038 A-p-tyrricc7 t11J1�7 - R SID ''Y _A T.ONLY MzP/oaceIXuwber® l�orYa7rzTsvlhmrrRed7f�r slr an Vale ofwork S. D mnfee ofSSS 00 forwozj,'xm lerS6D00.Q0 Owmgt's N2 --&A&r--= f l Fome:3*rovrmextCox=cr-oaic, =C�fzgplicab7�) CO3S 7 •��yT� f///''. CAM iwr's1, seT(s�appFable} v1 /1� r RasCom�e�na -1--L� 11 f0rec&arse: , 0 lama SOL.LO Q�amtbe Homeow� I bavewo=-ees smensatwn� Cazrman rX2=-- [ 6 5 ��,C Co r Worksrnzt's Ca±xn.Po?cyT tlj q q-lot V f copy of rms=mce Coraip]rssaco Cer6ficase n msr acca ---mpanc each pezmit Prn�Re9uPsr Cc�eckbos} Re-r�Of(hm-caaenaQed)fCspFj,o'dshi }Agca � I]era7c :o �I RE-57C e `�DcSL�.764 b �7'031�OY7Gz a•} ESS f1bC a �P��iRiadows/doorJs'�aers_T7 V'a�� 4 of dcos= 9=ke/Caib,:Morta:.-ide detec=s 4:Qoorpb=mimed wM,, Sepanxe Mecc aad iuspec?sozu xaq cL aaaT S Fue 1'exmi�s � �4z:serea+urci:Iz�,ma£ih"sp�asoc���e�p�-clrzho�rovaa zc$atot�Cotscv.�,,� '"Tore: aropS' rxsss_ e MpyaFt edome 4"ener7etLexofl'e sston. xeq�rea 1r. �Pr�uECanrractozs T,iceiue�ConsdcnchouS�menzsols License is stc�r�rv� c�isasldxo�'•� om�ur` I "� ReviseQ.061313 �a�es�T�,myyzsa�_T��eata�?ooldSc2:CiBDlTg�y,P�FS5.aoc FRASc'ox-04 PAAS �....-- CERTIFICATE OF LIABILITY INSURANCE �AT�(G96VDp1YYYn THtS CEIR17FICATE(S ISSUED AS A MATTER OF INFORMATION O)4LYAND CONFERS NO RIGHTS UPON THE CERTIF1CAie FI9129/2.14 BELOW, —I S DOES NOT AFFIRM ATIVELY OR NEGATIVELY AMEND, EXTEND OR A?-Tr_R 7HE COVERAGE AFFORDED 5Y THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES 140T CONSMTUTE A CONTRACT SHEEN T1;E I REPRESENTATNE OR PRODUCER AND THE CERTIFICATE HOLDER SSUING INSURER(S) AUTHORIZED MPORT_AN T; If the certificate hoofer is the te an ADIDTIONAL INSURED,the p0—3ri esj must he endorsed, if SU BROGAMON IS W.ArVED,subject to trms and conditions of the policy,certain Policies may require an endorsement A statement on this certiliicate does riot confer rights to the certificate holderinfieaofStich endorsement(s). PRODUCER - Vivefros Insurance Agency,Inc. (508)676-d3U5 NCOAM Asfife P2[vE 375Airport Road H0 N 508 639-2?93 FaII River,MA C2720 (u:•D,Nol: a0"24-4553 PboRess:APaiva Vnreirosinsurance.com 1NSURE`a($)ArFORDING COVERAGE NAIC; wsuRw Fraser Construction LLC I INSURE;zA:Granite Sfate lnsurance CO PO Box I= wSIIRt•Dter: Cotuit,114A 02635 INSURERC: INSURERD: R'iS(iR^cR6 COVERAGES CERTIFICATE NUMBER INsuRERF: � THIS IS TO CERTIF!THAT THE POLICIES OF INSURANCE LISTED'' HAVt REASION NUMBER. INDICATED. NCSTWITHSTANDING ANY REQUIRSMEN T.TERM OR CONDITION OF AN CONUieRDATO THE INSUP`D IV.MED ABOVe FOR T#i POLIGY PeRIOD CERTIFICATE vigY BE [SSUED OR MAY PERTALV•THE INSURANCE AFFORDED AN CT OR OTHER DOCUNwNT WITH RESPECT TO WriJOH THIS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAlO CLgICIES MBI D HER IS SUBJECT TO ALL THE TERL4S, LTR mEDF INSURANCe < MR WVp POLICY NUM1d6E2 (Ar0.p00 1 hi100rryYY1 L GENERAL LLASIUT( @ARS t COW-4ERCIALGENERAL LIASLffY _ ' EACH OCCURRENCE- S t CLAIh4S 4ADE OCCUR. f PSE?AISES Jaocaursr.cs) ;S :,,FD W(Any me oer=n) S r P°.R.SONAL&ADVINJURY S GENLACGREGATEUWAPPi1ESPFR GE14`ULAGGREGATEE .c POLICY JEC' LOC PA.ODUCTS-COMPiOPAGC- S AU TOTICeI`E L QLny S CLr V Lwllt ANYAUrO � Ea acaden8 ALL OWNED �ULE) 5ODLY343URY(Pe psr5an) AUTOS NON-OVYtdr;O I - - BODILY tN3UR.Y(Po•acidctt; 5 _.I:RE:A'JrOS AUTOS ( I (PZRAOaOENTI n UN3FTclU,AL103 OCCUR c EXCESSI.JA2 C-AMTSNADE sAaiOCCURRENCE S DED RErEN7ON $ A2GRECATE 'g WORKERS 0OhtP.EN6AT oN AND BRPL01,E25'LSABR.iry YIN 'A/C�ATU. 'OTf-F A ANY PROFRrzToRtpA��CUr WC0099Sa601 X Tome peers OFACEt yI N6ERExCLLiDFD� a NIA9(2&201a 9i26rza15 E( EacxACCwENr s 500 060 (rtandarArylnNFt) I , IfyyeS,QeSajSeUnder EL➢ISFpSE.?Ar"ALO:' S. - 3oa,a00 DESCWFION OF OP...... NSt afore LDsaASE-FCUcrLnwi S 5a0,000 I DESCPBTION OFDP"RATIONS/LOCATIONSiVc"]-I{GEES(Altsc7AC0RD901,Add�Ionol Rer;nda Sehedulc emarespace6regt8tLd). CERTIFICATE HOLDER CANCELLATION Town of Barnstable Building Division IHESHOULD EXPIIRRATON DAIE�IHER DESOF E�D10T10E pOLICI NSECAi1C3LLC-DBEFORE 20D Ma-In Street ACCORDANCEVVITft'ntE POLICY?RoVISiONS. ILL 62 17ELNk^'i t;D 7N Hyanzlis,MA 02WI- AUT1i0R¢EO�SEMATNE ACORD 23(2010105) O 1388-2010 ACORD CORPORA-nOXN Ail r'Dhts reserved The ACORD name and logo are registered marks ofACORD f The Commonwealth afMassachu,setts Deparmient oflndusnialAceidents —, Office of�nvestations �--�= 600 Washington Street - Boston,.MA 02111 , www.inass gov/dia Workers' Compensation Xnsmance Affidavit: Builders/ContmetorslElec ricians/Pluim7z)ers Applicant Information J �t Please Print Legibly Name(Businessiorgani an/Iadividual): Address: r,'• City/State/Zip- ML r E Phone;: � `.�lrr��~ 9� Are y rr as employer?Check#he appropriate box: I-E I am a employer with 10 4 0 z am a general contractor and I Type of project(required): employees(fv11 and/or part time).* have hired the sub-contractors 6. ❑Newconstruction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. L]Remodeling ship and have no employees These sub-contractors have 8: ]Demolition wo&ng for me in any capacity. employees and have workers' INo workers'comp.insurance comp.insurance?-1 biding addition required.] 5. We are a corporation and its I O.0 Electrical repair;or additions, 3.❑ I am a homeowner doing all work of$cem have exercised their I I.0 Pl=bing repairs or additions myself ONO workers'comp; right of exemption per MGL 12.[]Roof repairs ins aaoe recrlired]t c.152,§1(4),and we have no employees.[No workers' I3.0 Other comp.insurance required.] *_4ny applicant that cheeks box*1 must also£Rout the section below showing the workea'compensation policy ado=tini �omeownets who submit ibis at£davit indicating that'are doing all work and then hire outside contcactots mast submit anew affidavit indicating such �Contr=ors that check this box , attached an additional sheet showing the naate e,the svh-oontrzc}o s and,state Wnether or not those cutiiits have employees. If the sub-mutraetors have employees,they must provide their worsens'comp.policy uumb-r. X am an employer that is provedvzg worker'compensation insurmzcefor my employees Below is the poacy imd job s''e informatiarL Insurance Company Name: ! �L � � h15U,(-ao(_ of Policy#or Self ips.I,ic. :/ (!) Expiration Date. • L(1. _ Job Site Address: City/Stateaip_. Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required larder 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 e of up to$250-00 a day against the violator- Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage vezt£tcation_ I do herebv certify under the pains and penalties ofperjury that the information provided above is true and correct. Sienature: Date: / Phone Official use only. Do not write hz this area,to be completed by city or town offzciaL City or Town: PermitLicense# [1ss¢iug A uthority(circle one): 1.Board of Health 2.Building Department 3.C ity/Town Clerk 4.Electrical Inspector 5_Plumbing Inspector 6-Other Contact Person- Phone f. f�7aasnoh►�setta•rJep:u{mo�El of f'uY/riL Si�tL{y at f 8gwri of pirlld),10 fro latlons an(? �S (1 tAntlnr<rs �' CgI15ff71Cltl►{t Stiphri•itwt�. " . � l.tcanSey C8"4By0QB �"` Ti7 jlltsQEV��)v fQ4 s44iiA ~ ErppitliUo,i 1 � gurnmtasionor �.QS(07(20�5 _ - � W0171 Office of Consumer Affairs and Business Re�atzan 10 Park Plaza- Sure 5 170 Boston,Massachusetts 021 1 5 Home lmprovemezz Contractor kegisfta-tion • Regisaauc•n: 9'[2536 iyge: DBA F.-pirafon: 3MI201 i ra 26MC-7 FRASFR CONSTRUCTION CO. DEAD FRASFR P.O. BOX 1845 CO T UiT, MA 026-3-5 Update Address zad r emm card_Mi a:k mason for change. Sca" Address 7 Renewal -nualoymeat 7 -ost Card C��ie�pam:me�xcuaaCU arPC�/�•a.xr/auaed7. Office aY Conso=er fairs S Bess Ped.ilaSon I imnse or registration sm Ed for indi ridul use only '- OME MPROVEMEY i CONTRACTOR before the expir2Fion date fo=d return to: �On- 112536 Type: OMce of Consumer Affairs and Business Regulation - - E;pirat:om -3/2312017 DBA 10 Parkpla= suite 5170 Boston,MA 02116 FRASr'�CONSfRUC•i�CN CO. DFIAN FRASER 104 TAIMN%4r--W LANE e rALMOUTH MA 02536 Undersecremry Not valid without signature f ' illas5Gchiusar,S Lisp am".21t c> uc:;ic .Sc1--T`•i Construction Super kor _,ce-lse: CS-097668 DEAN C FRASER 104 TWINN VIEW LANE:_`:`:':: _ EAST FALMOUTH-MA:02536 06/07/2017 r Aug, 14. 2015 12:49PM Fraser No, 9459 P. 1 Fraser Construction, LLC 31 Bowdoin Rd. Mashpee, MA 02649 Email: infogfraserconstructioncapecod.com www.fraserconstmctioncapecod.com FAX 1-508-428-0123/ PHONE 1-508-428-2292 flICL#112536 CS#97668 RUBBER ROOF PROPOSAL �C. Date 6 22 15 - Name Kristen Forbush / Email k4bush charter.net Phone 508 380-8107 Job Address 135 Fullers Marsh Rd, Cotuit MA 02635 GJ FRASER CONSTRUCTION hereby proposes to perform the following services in a neat, professional manner in accordance with the manufacturer's specifications and local building code. / Rear Rubber Roof: - Remove existing rubber roof, siding above roof line, and all sheathing and dispose of in onsite dumpster. -- Install new 5/8"plywood on entire roof deck. — Install Y2" Structo rigid insulation board using 3" plates and mechanical fasteners. — Lay down new black EPDM rubber roofing using a contact adhesive. - Install all termination patches and cover tape on rubber roof. Re-shingle rear wall using 1 coat SBC Cape Cod Gray shingles (color is closest to match and may need to be painted). Rubber Roof: $4,000 ` Plywood: $1,200 w Sliding: . $875 Aug, 14. 2015 12:49PM Fraser No. 9459 P. 2 • b Skylights: - Install new Velux curb mounted skylights during process of rubber roof install. Manual Venting VS: $1,650 each- $3,300 total Solar Powered VSS: $3,000 each- $6,000 total ` Skylight Selection: Initial: $6,000 skylights $6,075 rubber roof $12,075 total X 30% fed tax credit $3,622 federal tax credit for solar powered skylights $6,000 skylights -$3,622 tax credit $2,378 total ($1,188.75 each after credit) 1/3 initial payment before start of job, remainder paid upon completion- Payments accepted are- CASH- CHECK-MASTERCARD-VISA-AMERICAN EXPRESS Any payments not immediately paid upon job completion will be charged 0.005%for every day after the given 5 day grace period upon day of job completion. Possible Ewtra-Any rotted or otherwise deteriorated trim boards, plywood sheathing, lead flashing, or other carpentry needing replacement will be done and charged for as an extra at the rate of$110.00 per hour, plus.,20% mark-up materials. Possible Extra-If ice &water is found on current roof sheathing-removal of plywood will be needed as the existing ice &water cannot be removed. Due to its melting to plywood. Price is time and material at the rate of$11.0,00 per hour, plus 20% mark-up materials. Any deviation or alteration from above specification will be executed upon written orders and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays are beyond our control_ Owner should carry fire, tornado and other necessary insurance upon the above work. We, if not accepted within thirty days may withdraw this proposal. r [23 FRASER CONSTRUCTION, LLC: Carries Workman's Compensation and Public Liability Insurance on the above work, certificate available upon request. DATE OF ACCEPTANCE: J Homeowner F er G traction, LLC L ' _ t y � . - r 1t+E r Town,Of Barnstable . *Permit o/o D��'G�.� �0f Eby Expires 6 nionths from issu date Regulatory Services Fee •- y BARNSTABLE, " y� MASS. 9 Thomas F. Geiler,Director Building Division ' Tom Perry,CBO, Building Commissioner cmha L-de 200 Main Street;Hyannis,MA 026.01 . . www:town:barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address (OLS 'fit�t ❑Residential Value of Work 1(j- Minimum fee of$25.00 for work under$6000.00 t Owner's Name&Address C G � -Telephone Number Contractor's Name �Sl�Y Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) �q W1 ❑Workman's Compensation Insurance "P IT Check one: 0. 2�1� ® I am a sole proprietor JUN 1 ❑ I am the Homeowner f ® I have Worker's Compensation Insurance. TOWN OF BARNSTABL , Insurance Company Name . J ` e Workman's Comp:Policy Copy of Insurance Compliance Certificate must accompany each permit. . t Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be to - , Re-roof(not stripping. Going over: existing layers of roof) ❑ Re-side #of doors ® Replacement Windows/doors/sliders.U-Value( r ju (riiaximum.44)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property.Owner must sign Property"Owner Letter of Permission: A.copy of the home Improvement Contractors License& Construction Supervisors License is requirQ`ed, SIGNATURE ` n:\WPFILES\FO S\buildi s permit forms\EXPRESS.doc The Commonwealth oflVlassachusetts Department of Industrial Accidents �`� i Office oflnvestigations t500 Washington Street Boston, MA 02111 wwm mass.govldia' Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): �d. t r Address: 1` 0. y(/x !�aH 60 1Nat9- K�JO City/State/Zip: CV*Yf(LUo0-P,-_ fJafo3a Phone #: Are you an employer? Check the appropriate box: Type of project(required): 1 ❑ I am a employer with 4. 1 am a general contractor and I employees (full and/or part-time). have hired the sub-contractors 6. ❑ New construction 2. 1 am a sole proprietor or partner- listed on the attached sheet.. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. Demolition workingfor me in an capacity.' employees and have workers' Y 9. E] Building addition [No workers' comp. insurance comp. insurance.t required.] 5. 0 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. Y right of exemption per MGL 12.[ Roof repairs insurance required.] t c. 132;§1(4),and we have no employees. [No workers' 13.❑ Other yV<<r comp. insurance required.] "Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees, if the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy andjob site information. n -Insurance Company Name: Y C{ �C`-'( u Co S Policy# or Self-ins.Lic.M � 4WOCA ckx 1 Expiration Date: qLan hyj__((_j Uai��S Job Site Address: _6S `UU ezz `Ii City/State/Zip:04 rkVa 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 MOL 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 here certify under the pains and penalties ofperjury that the information provided above is trite and correct. Si nature: ice-'' e Date�U� f C� Phone# s__b� 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,,,f—f Phone#: f Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the, dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer.' MGL chapter 152, §25C(6)also states'that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL.chapter 152, §25C(7)states"Neither the conunonwealth 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-contractors)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 pen-nit or license is being requested,not the Department of regarding the law or if you are required to obtain a workers' Industrial Accidents. Should you have any.questions rega g y q 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 fature permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e,a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: . The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.mass.gov/dia I1 NOV-19-2009(THO) 15: 33 KALCOLM & PARSONS INSURANCE (FAK) 17813441425 P. 001/002 ACORN,, CERTIFICATE OF LIABUTY INSURANCE NCE (781)344-32W FAX (791)344-142S THIS CERTIFICATE IS ISSUED AS A MATTER OF IMFORMA710M Malcolm & Parsons Ins. Agcy. Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERDR(ATE HOLDER.THIS CER7IRCATE DOSES NOTAMEMD,EXTEND OR 6 Freeman St. -ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW_ P.O. Bout S27 Stoughton, MA 02072 INSURERS AFFORDING COVERAGE NA1C r+Iutm 3oht Dunn INSURER A: 'Associated Employers Insurance P.O. BOX 924 INSURER B: Carterville. MA 026324924 INSURERC:' INSURER 0: INSURER E: NERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWtrHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANYCONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IIIIW!AUM T%w0Fl1.961RANW POLEYtilmSt: POLICY POII V8NM7DN LEM 6EWFAILVA®.I1Y r EACH OCCURRENCE $' COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE OCCUR MED EXP(Any one person). $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GENT AGGREGATE LIMIT APPLIES PER: PPiODUCTS-COMPIOP AGG $ POLICY jEO LOC AUI0I/0MILIE A _ COMBINED SINGLE LIMIT ANY AUTO s '' - . (Ea accident) $ AL L OW NED AUTOS BODILY INJURY $ SCHEDULED AUTOS s (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS , (Per accident),, PROPERTY DAMAGE $ (Per accident) GARAGELMMIL0Y AUTO ONLY-EA ACCIDENT $ ANY AUTO- EA ACC $ OTHER THAN AUTO ONLY: AGG $ JLARRBO.LIY EACH OCCURRENCE $_ OCCUR CLAIMS MADE .i AGGREGATE $', DEDUCTIBLE /000,0 $ RETENTION $ r $ WORIOBCDIVEN3 MAIND WWSW4653012M 09/29/Z009 09/29/2010To WRYTAT�S OTH- BrPLOrBB tJY1�IlY A EL EACH ACID DENT-: $. 500 ANY PROPRIETORIPARTNERIEXECUTIVE s OFFICERIMEMBER EXCLUDED? EL.DISEASE-EA EMPLOY E $ SOD, If yyes,describe under SPEgALPROVISIONSbelow E.L:DISEASE-POLICYLIMfr $ S00 07l6t D13SCRgqmONOFOPERA71 MILOCR7WMtVBKUBIEX=M BADMBYBNDOISERE31riSPECWPIMMM Carpentry contractor - Donn is covered under the rrorimmis ooBp policy 91WiDANYOFIMAOME POUMBBECAMMLLFD TM', BO'Qn171�IDIgE7F6igF,ilEBSi�MS1l�1ABJ:BDC,t<WRTDWLL J] Delaney Inc_ DalnSVMffTMNMM7DTM M HMM WJKDTOTWLEFT, Building & Rewdeliru4 EWF aTDUWSLCH NCEg iMWOM-:NDaWMTEMORLMOLny 20 Rascally Rabbit Road OFAl KMLF 1TMWSLMEgITSACMMORRBqUMBRABVM - Marston Mills, MA 02649' AUDDa® David Parsons AGORD 25 PM AM r CORPORAIM IM 0€J0St�'E�2 1E�:�t 1818111 2Ciwid�ikiIsT' F' ��i :J t DLtAq ALLRIl�ik.�"i R 508771�i Y TO:17E� '�ic3:.' P. ' Regui tury e ves Tom Bua inz Comsigsiaacr 200 hi=Std67 jj}{azmis,MA 02601 .towfi.baras#abIt-ma.us office., 508-8624038 Fax:: 5 -7-90-6230 propercy owner Mwt ampletr, and Sign T s Section _If Using-AB-gilder A _ cnvmer of the 3-ub'ec prope to RCT On- Y.b k-a " au nnatmra relAve to-work aWj:Dri7Ed'by tMs buMicig a Ai_ sign is exneiC }fig br pP�t leas crr Home wncrs License Exemption FOM On there eve Side. A} �fze �ooavrreo�uveas:!l� a�� aaaacfucaeha_ License or registration valid for individul use onl Office of Consumer Affairs&Bdsiness Regulation g y _ . HOME IMPROVEMENT CONTRACTOR 'before the expiration date. If found return to: TOP. Registration. .A.101149 Type: Office of Consumer Affairs and'Business Regulation Expiration. -6/2562012 Individual10 Park Plaza Suite 5170Bo ston,MA 02116 DUNN John Dunn a m 80 MARIE ANN TE q� i - CENTERVILLE,MA 02632 Undersecretary Not valid without signature _ Massachusetts- Depiallment of Pullic_S ttet� Board of Btu ldin« �r Re,�utation:s and Standards £ConstructtonSupewisor License License: Cs 14007 Resfticted to 00 " r ' t 3M4,k £F I' ;.JOMN P tDUNN r$ 3 ........r" ' t ;. rr tF BOX 924/80 MARIE`A`NN:TER CENTERVILLE MA,02632 Expiration: 5/25/2012 C��nuniss l 14, Tr#: 24061 The Commonwealth of Massachusetts G. -- _-- Department of Industrial Accidents Office aflayesti9atians 600 Washington Street Boston,Mass. 02111 -T Workers' Com ensat�on Insviance Affidavit name, S LL Alf (l(7 h} � ovation: 35 Ul.l.� 2 o U Z one gram �PO��� myself a homeown I am a sole rietor and have no one workiv in ca aci .nn}afi:fti•...r.�.,:•r...G.}:.y V..:.•fr.':}S.x;.f"`r,+r.:,I}:+r::v>4:t.%:..R'.:1%.:.x 874.:4:•,.:^.n•...r..rv^.r••.{}.:.rn•.{.,.,.•...}::,.$:.,Y y.ary:•v.r•nx}$..x}.IIy.r.,ma..+..4S.;...r:r...},,'n:.v1..,::.•fivr+f•..xi.C:fi.j,•.f:t.•+x;:v.:.r.r.,raI,r,?....'x`{',;.I.\r.n.-•:a}.•.B.:.2.•}•.:s:r.,...lr•:,+.>..:.•v..}I...::...::r:..•.f:%..::.•II.e..::r.::....•.:x{:.'.cr....m?.•e-.{.::f...?...>rr.i.{Y.^:�::+.f•x•:...:.;..•.:•.f.:::}.+}.:t r.:r•.:x.}...x:..:0'.r.�.,i:•fa.�4..•.{•:.•:.•.•..:;.$.}.;..,..r.%.•.:..:;S.%...'..r y:.•}..S.{}C:,?...4.x,gr;rLr.u.,Y..f"t4.}3+,v.r::4:,;.{:n:•.:r::::x{n•+%...t.,:.,:.':;•..i•r..n�.nJ.{:t}:;%::?:••}..-iGL;••{.,.3:..:••.r...•r.•".r.}v.r'.+.�.r.!.•:.}rrr,v.'v4xY.r:.t.:x.:`..:x•r.r.:.•A:.:✓u,?:.-.r.r%.;r},wr....•..•`:,w;fn.4...n:.+:r..frwY'...,:�..n.+ni r,+.ttrn;r•4'.?.r••.vaa;::;.,v.:n.:nr r4•r.:•;..:3::vf:rn..•h,v:na.4I i,,.,:+•.rn•::}-.'.:.,k�i 4Y?,•.,:4':.::Y.•.;r+n••r.^,#;e.:..?)..F,.,...a•x:..7...IS r,{.:4r.;,r:.`G:,..:S%{:..f::r{}a..4,)•...`n.:{{.•::4'i>:C{.�"CN...�i:.r.;r...4rviw4.f•:O'...i.3f+•+v:.••'%m.:i-n.:•-:.:;:}.v•j}<....:{,.}T:{..i:x.:�v.}�nr:.••....].Ar{}'....•':.er,:.,+..++::,•.,.,}ra:./nr.n{}f..%;•r{:•.n.•:•;:s;:n::•:.•.::x:::n{.•.t::.:,air:•a:..::{."••.•;}:.:::::.n?r%;:a:.:%r-+:..:+:•:%•.:.:r••:.::'%:}.o,.::...:.�:..::::...t•..}..,.'.::::.{.n<:}.:,•..}:::.:.tn{•..{.:,,h.:;),f•�.:...i.::{.}.::4`.{..•.,{'f.••:;^'• es .:{,.{•.%•!.r.:C:+.:::.o.:•�,.xi•'•!..x{::.+r:::::%.r3::,f:.;�••.:•:.:t..}:i{:.•}4:n:::.�..::.;r:::m'•-.+•:.n...::,'l;:f nh{r:••.)+r ft:{...:,,:.1%r.::.•:....:yY,::#;:{::::i{Y.:;}.:?�:+.+.:•..•;{.`:..:S;:r:.ty;f...;{{i...•:;.;:•:4�S:,;.{..•.r+,iy•£{.i.r.:•.::..:.:f.Y•..:}}::':t...F?..:;�...v:'f;. on this lt::::{;.?:.•..%of.!•:v.•.{.`:Y::}'r.•::;f••.'+{:•yni3i::t:e:}n.•••.,}%.F:e}..r;.}•:4;+..}{t .::.}:,•nf2:•.y%,+::.}{f.fi.:•r.:•l:}..i':r;•'::;:.,;r•ffv�r::3•nf•:i'.::!:•iwoxldng �:ft.y4''}�,r,i;;+.£}.r;�•�;.;:.•.,>C{,..,:`,.:...?:.}r>tr%,...;,.".::;.:L•{}l.F+,..••..K4' ,.:3.;l,r•{?,::{::vS4n-U�N+.t,{,,;::;':»'+.:.?+"Yav!+t..;{4.•;tv,.�,}{•.••^:}.{i,}Si•.oan{+•�.{,naf;:Y{lf.ff:3•:{ {.}i..'..•}::r..:.{r%rc.�,ft,4%+.`{ny::.+A,:,.+..n S,�.,rYiw••,.>;,:,•,;::'}r+;S t.:•L'v.Y irt%,•Z,•rr%}.}x'.r,,k:rinkY...•.S :ht.:.v,•tL.+r;f rhf,.£.f..:�;•%rL.:,4^aglqppeInrovedin6awO r,r{•'y.,.3%.�+}.'hi�':a}.?4r.^+•,:i' #:•,r•.;f£+;;'S';`�}�k<.y•k,•r::.w%•+v':f..�}.f:Y:r}:'.Y'i•r3r,,r w.'e}::a>i R''•'+r•,i,:.>!}r.:rti.,.i'fi.)�:•N+}:ffi:n,•r4.4.:�n}4.{{e. '+fiyaI.r3<:,.^.,:9'+:i•..•,:;...i: !fff•r�^..Lx.�3 r•'�<;f;?•rtt..:,::n:;•+#. rY4"Aty{G•r.fi;..::..•:�4�-y'fa#n+}..i•v••Y•',}{y�,•}?i.',,C�#{+#:+�'Z, h.ia%,:;:k.}C:•Li{.r � h3•'.,:�'f4:..3r:s.%}.�f::r....3.Y,,r Y}:.,�f{t Y4:•F•)h.::?Sz'%'\`,ri 4C.,`•,,�'i:.'' � ^4:.a.a:+•�,S,.•:}4";:}k f„}S.r}ti):�••hx>,?`•>S^,{f•:^:r:4•}4.y:.£{`v+•{.4%}-••.}.{.S{:x'wa:.r4.4?�C•;.'.'+vFvQ^:�vbv.C,.�..:ra. �;"q•{}ra:r4a:r fixa'.+l•r:'r;-"•ti,..''.t�,.•,:.{a�Y::A:?vf'f/t;;4>:r}{:ti`':,{"n.'.•;•<.:•a}."':r L.%:''•':4}•,:.';•r'.;:}';:,:,vc.r.:•�•�} '3::?n•.ti; 4I •f rY {: r:C, q U. ¢ a{+ b•LO r% iv C 4.7 r : x :'.n ,:;:.•• : , .?„x:y, .s:•:T•+. rr:�,� .f,,,;�.. ,5:::.;. r.+a, `-2.•.:•t.}.r:r::+.:.,.r;.,r+f.?Yr+n.r•.:•,:.,:.r}aC.{.ti::}•r.:.?:.Y.k.,}:^r.%:at4..{:,x....:•.::^;.•r.::,.i.{:.:,var{.,...>;Y.,.:.^.4.::.•.:.Y:.!.:,.•.v.:..,:,fa+.,?•:::.::fi:•..{,•:...:.}'f.'.,•{f£3n;%...%..:+...:{:n:.4a.8.::.S}.::i//f..?:r•}..4l;,;.4:t..{s t,{.:a•.4#::aY.:/t..::+,{.4::'{r:r{,.•:.^5.:rtrv...a y.s Y•::,}•,{y'�vKv•.y r.4r.:}..{}T.^...,::I�.:n,.r;"{r.v.:;•:i:'•:.f n::a.{1.%Y.:rt.Y}%,•..r:.r i{Cv'':�.{.tKn,4.::.:.:.,.£4�n,t/i•:�J•.::::fi4,r4..',7.•%:k.?+£4:%?3:•a:`•:f:?:L£Sn}f:nr}..-•f.:,i+x;:•:.{;::�,•.+.}:>,::},.fY:}?•rv;:hn•f:+:axf:{•i4}::,}::+•Y..::.f:;;.•{:::%.;.,:;;:}4,.{x Y,a..}..;.;;:.\r}{.•4.�.•:}x:v:.`.{.r�:•R':;n•:`> •,::.#w;.•..r'.:.f<a.v.•;.•;:?N.:••rx}:...;;::.aa.x{...::.f.n:•!.}:.wi.%..'{,x'f:•�S:;''fv.::.•:+::•:.':i•?:;•{v:a!:�fiS`<•frti;i"}N r:}:':}%h:+-:.,;3.•aY.::.}'<.Y,.;a)rr[£:.•`,1.4:'CQWt..a.I:}r:3n}qh::E:.+:r5.!Y�'.7::}t�..ti+aff,.,{x.._irt•'rk•f:thq}r:':Y:{:?�•l4'�x£r it:r;.Y}}'`+'••a,..?'`£{,•f'?:.i:k,ti":•�?.4 yk.'f4n{fh L{•,'?'';:�}r}.'�{iY:,y3;r;:n�:\t}.•r.aF'?4r;f n.{.3q3:;i f;f<{,f<.•`;.`.:{i�ti4:aY•:.::„}...,•fr%.f�;fi.•:':`}.ti,:::.,�4.,{).f;,i:::�Y,.',..p..r;;%.•,,�•t};,.w+. ')�::�•`'..•+;�.'y •l Rat�•:f4;.S\.b,rr i.^';r��.S''.``,%%+:•y,fi•bt.Ar h}+'%,\ tic, :{ :).>a•:}; .:r t;;.°•;,•r;. , ;.:. ,•a ;t^}:4...:..:::::f:+ �;}� •;:%4};{:•{;};:;;qf;•%f`::'}.�.. x./ {S'{+ :n4•}+••::•i}:•f�%:.:.r. ..{%:?:•:i>i}>n::...:. :xx4x+{''t•:'<$St�•.:%)'it.Yn%Y\{h.S{.h�'ai•r?,f:,::a%•}fi:'w�:.Lr+4c /N.•FC}}r}.f:::l..:.•....,.1.;.;,f.£;i:r4r C'✓r.x'•>,'•+.:.,f;.;;ft'%xii�:�rr;:a:�:}%:4);}v:>a:•+::.}Yr;:i:•a.4:ff:t�x:x::f':i�:t•.,+:r.t;{+.;•.Y4.: 3:4v.';;+%':!%%>£.,Yi:?:'!;•.i:�3!,::;<?•+• :;Y t'f?;ckt_','{' r''.L`�';f;::a:{3?.y.:`:`>rf:�;£�'4':;:};?i??'•.•{:2i2y%4r:{<.+YxY::•::•`.�i'£'t%�:•:;e+%{.}:rr �/ W k. ..rr ...:. H.r.:,.•.r.r... +{4'•::4.,•4�rr:t•;:.rrt•::?:. :L.•r. . ..:.:...:.:. fi•+4y;24,.:fr:.::.•........ r• ':' lR•.t,;>�)^+tt.tn.:.. .,.. Stu atc'ce Ca r.:frif :,?:^::::•. ❑ I am a sole prorprietor,general contractor, or homeowner(circle one) sad have•hired,the contractozs listedbelow who have olives: x hy{ CO ensatioa aYb }�G tf.Yx:r'�`�i y } {�t ,eY••g. workers mPP. �?:. rhi.„ `: ' } S •.�€�: +�, following .r:::r:4:r4r^:<hr...:.::#: r ££<£#z::<>:f:•:;; ..}:>.}::<}£#:r,..`-r:;;.y;:%,}:k•..C.% .{ ':a.?E%•'• •h We b .•n•::r^^r}>Y.}}f:,• ...3,.. :.::.:. +.}.}r{,•.�C n.N{.,{r .f,a",`r.`:�` '^ ` •+•ro:}... .r.k. }Y:4:•:::{::a.: ;:}.::{;•:v•.. ..t• '` :'f .2{••. r lt:'ki't%•: :•::•:•::.:tix{a::4 a^'•.:. '^,..;...r, :•.v .;yt`::}if:4}i{r'F:>r'. �( ..::•.,•n,•.. r...,. .:.... ..+r.,.,.;.t...;,,tr...r.r.....r.:f:;;:•{n,••v>:•::::...;:•.::e{:•:;•::•.^•.{.4,.%.f••i•�f::f?:xi}:c�;e};;<+{>S. ,,.r+;t •:} :+:r#�`•:�S 'r. .'¢,.r�""•�'•:�`..•r ,.+...w:::.•v:::;;:•. .t-. f'x r• •r.% : ::ir.•:..:n+.tah.. r+:.4�r�::...;<:.::::-::::::,. {.;�.%}:-.: `{'i„'+<:•ra.?::r" :t fviy •��5S,,: ,.; Y��.^�:•....L.,S.•x: .YY• ?;>:{++f{fyv.•fii}.rr r°r:r.�:+x'•'4fS'•r}C,>+"4•:+.t S:•:n-.,;•.,:•:;k4•.:ff{.$:} :•:Y::::••}} •::"r•%:n.:n:,. 'yrlYY{`�; 5.t: ),.at, �i)...%}{ •ram{.:r... f•{{r.rY}>'.••:;:.}.;.:#+l{,.r..rrw�:'E rr. .f..n:•...,.n:..:r.t :+:1^:�. n•:•:•. .,.,.xf.;• ,r..;::'x+•rr..,i.;.. .N,.;�`;h: •.,. r:<+; ..n:lv}?•l::r.x:..{:•+.n„y3;•;,., '..F.{•,..U. ..rt•. :{v::h•.n:v,{{:;}f...tr.r.•.:':^,:t?rf:;:;:is%i<C�'�f.::if:ti:{>{n:•:•}..;:••r.•.,,..};;•,r,..✓.a.X'..,. •v ... ....... .; 'i'•'i4:};£'{ ..•:+naw:V:ur'Sr•.;rfi•::•'.•:{•::>.,,:}yv y 44x{Ll: :••. .:{:•rr.'•k•:•£tt:•:n?•{a{f^.t:::••:4.?{{•}••:a:::•:Y+.•':•x",:{::!.;}..::.:.r:....... •:.r.�::�.�r v•::y..: '•'ar^... r;>y,}Sy} ;,,5:%.:•:.#:•:•r:.f;•;{.f:;...:f:.Y:•+>.::{{,;..t.!r�'••nl.%r,.: if`.{;� •.}•n+r v)••k,v.::•r.r..;.n4::•:ar::.. ......... r.• ..Y34 YYnfae::.2 yx?;r.{,,.,.... .;,;r;S;.:.,;..,r•; .^ :,,t•:::•.t......n n,......'- ::r.,•.•t.Yxa::a$•};;:fa i>.}r{r$ '': r.y 5f£S 4 ¢v° £n:.L•a4 }!,f F { �£y`: r. Y {. ..e. :r*.:::.+r:.�h,{•:.x'{r'fc.` •r;}:;:x}•r,.}:4}•{.;�:::.YrY r::rta.:::: •v'i•�+ {. ::IIBTnC. ••x� xa•:;,}•} ::{{'{;:#3;^:##.'<? n,: ...%r; ..;•S.::"'.. . .f£}a^?•v;ar :r�,:,�+,,{'•;'•b,�:;; tx",:ry•�{}% f+X+,y�, ', :•f";{a:'<;: etpLB SII •+,�•e4k„w•:}+r +#`v}:'o:::.:•:.., rh•Fr::u:ti£.}}}'k•Y:fft:.. .e::A'::n�4�;4t:•S•�. ;,:.�,h•'.;,,.•4,o .fi %v°' •'�•. .''h�':';:�'t:+: .......::::.. .. r:+•nr.;, ;.:. { •+r.., }f r .vrr::.a. +:xixr...:;+ :.v.� -�{o , •M �•l }}5+tf-'wS,; {f{;£af'rr:;?fi.;..5:.':?+3+snl::.�a.:':f. •+• }•:.x.,:•':.: ..f .f. } r'f•.f' �22.3!ntx!dr. +r. .t:,.4?'.•.,;• •;+>r:?rY•{!{{'r.'G.%f�.�,,+CG r•r/.S'r,•,•ir.t. ,.... .•a.°1,::•+, is{•r,: :{la• 8 ;a. .,t*a^two.`,r�,,,}c:.frfK^.i�3 .t v.cif.;}f.4v� �-f. .,9•;ni , ,:..:r. •n:. ••;;r.+,•:v: 3.'< rrt Y. .....:n .r.. y•. r ,.��ss 4',.n.•.:,.¢,:;.£»,;.;'�:'''ia.'a: fn:;;n}}.•:;£.>}:,:t..::.x.%£xf:'r+{;Y.}f%}.•:<•{?:•:•':'r:£?..: „Y.:o-.Yx+.''f}x`,L�3,?%rx.�,... �.n.(rF�`J.;, .;.6 x•+f:.• .4r ♦•x�.3X.•+}•{., ::3•r:.w',e.+•4....,:.• •f..'•r?.�t;: ?txn,.y+,{{v...v,.::)r.:::v.d%>:l'%F`i.'a'++u:::fr..:%C.. ,';4:;T"'ofiif+f:�f:t' 9. i:•.: :. + '{;+',; ;+.4:f�?Yr:• ..�,. .:i+h,;•!:;!?}.i'.vi••, r v;+1...�v:v •%:•x: ,:i t•,k,:{:>:;rfn•.}k}.:.}::•%.;.tea:�'•3�:U' Y;'�:a.,,'.}..,r.!' '++�S',:{G:+2; •+vr•'+�••L:�:'y;t;..�, -;tfr•.,..r r• •'Wx?' ,�4;t. ,.i�?<�?r,L.;£:} :.. r:.n•.}: :?:'a' rc#ah::.,,,:•?h{,•+n..}}t!th.;r{.... " %;}:f:Y:;a+.f.:Yif;.;;;: kkdS;<'?7`,� `�:':+' r 4 S• +• .:5.....r Yr:::•+f:ti��{r n.:-�nrr,.}fr'�`•.•. �+�' .. ..:- �'s�'y}r�'.:v.,• !:'- )Fix � :4+ ;::}'4..}, �}.t;.::•. F'.,:•.:.:•... .;;;r{y,:•.,:w. ..w,. :,:4;:•'r:,,..}fYft.;:fSj '4:t•:{,.;ix�}{.t;fxr S: .Y�•:r;i�•, ti'::::`•: :$f1tkL: Su,:r,.' •t}!2<ir%rtr.}? ..r,.. {:v,::; £':•r^n., ;N>kY�g+::::;:4,,i•Y;t;:f} r.:bw%:.+r'f>r{f'S t.r:•;:4�, r%•si:}, r fiy'' C'' '`�S-�Cx+r+'4f::>• +xa: x:..:,+hY+ •:? rtr •rx•x:•}'4xf+,:iil.•I,: r•:4rtf:}:4...}:SOrry.r•n+•r+. :%21,.k� 4+�v:•}.::,+i.. ,'r:{f,• ;r.,•{•}:••,• .:•::•.•h•:•..:.i�+}y,:.},.;;:'£`C{Y;;y;.y..,..{.... v....:6Y•� i,�, `{i•.:th.•R'r•.:)+>.; ..hi:+,. .{..:::+.;•:rt;rr.'f:;}4+:Gx,}:r:'•.`•:{4i ••3•:h .fs£•:•y'•.F•:4fF$!,�r,,.. {.:Y{t/.'>:S} f.':;;n}xF{J,}-, fhv, w}.rfi15���F'�� hf}•.r .#. Sfrta:• .v}.:,' :;::ar•.r:.,:•�:?'4:r.,{:•::.^.ti}�;:3;:{•{•3?rf,?:f;'. '4 �'LO'I1C�, � t� S '<'•Li!: •f •- f�l?^'aY}•r.)f<f' :.. •r+.:h'+h �':?{�7°4.:.:•id ' {:•kt .: .:r....,•r.,G ... �'.•'..•.. u2'.,� ., .. .. }::.r}:�>:;t}}•.,r`.•}r:r.•i.•..•::..,,.,...,:.,.. 4•.r.:{:: ... y.;., �:S..rffi. f:,:r. y }�rrw•: , ��.3: ,:)}. ..,..a:%.:.3r..r.e,.lar t'•4rrr{•;;} xr+,Y.M:3•:. Yj}r•.r}^x-}'�,• ..�y`. ;:;�{x,�e�N'::2; <,<•r •.t,. �.�Yr.'%:;;.4. :k {,...>:ll ff::;}•S{!^,8 f{£Yr: .rr,.:,:. :i,•:::.,•r,.l..:.L v:.,. }r' �tA # w., i r•:Y.rt#:}Jt{ ;,:.{..:.v. :.t•.i...4.{.{:.:.•. vn..,lrrrr {•;'••:{x',•:::<;-+t33 %fi3•.'+.'.9f;ai 2 f,3:a5}+?.;' �`•#'f +. •'i.:.�'R ;'gy. a ,.• b. �r:. • :'{?fr:n•:`t•'•?K:r::.f.n. :{.:i:;f::{6::{if}:£#+f} ti?ri +^?{]h•::.v{}::?} ::;Y::f•"r?,:,t{.Sa,/ •%. �ri:•f}'+,v.`:):..+f...... i':Yi!L}it;}::;?L•:v.•rf�}.:W'r.,.r.{:. r✓ti•{:!r •Y}`fl;:r:,•r:�:yy f T ;'3!:`"' w r: }:}{%,::.r... :+:•f}.i:fir:;#,..:.:,:>•;a{.;:{.;{,.,::ya..f fa>7:. f%4++ .1. •.>'::i{}.,::.3••);•. 'i.`o#''�'%2ti'r. ,...:a^:: .a�,i/`,R:x4•{:f.....::#•::+n 6'4h.,;. ,:};:•. 5;a. r,,;•:, �f�:+� �i,%: .. •„f', nr:...+,y'4fF{3'+•:.it{cr l:F'+ ':•r,.'{3.^^.:5:•.fi:�';£fr`i:?:{f•Y::xa:x'.�;•. •.,;�.,..a';fj` ,r .,rr:.4£Y•;.;4 .+f•:' .}..rn:+r..,•+..�?:+:..filar �fr• �:}. rYx. �+•.+.+.•:":t•.'.: h.,•.:,....,::. ., >,... +},3;M�`{ ),.,f:?f%,.':•'•y•:?';{};,.,.,::: v6r.4+.;"••"•:{.,:f''''#::n,yr£3,;,.t%lt"•frr' :+: fir,. rn;, f•4;'+,•:af.•f ?fs"+{x3}.3; > '•4:-1,rY•3£:g:�L •4. 4• Y'• rf /�% ��'v')r�•f:Y'<•f:h%:%;?:::fcyx•3,C;i�`:aN�43f•:h :•.•r�fS'far..4�,i.,3�;:. ,to;;;.^•;%f>a',•'!:::';.'••'�y3'+'^'iCff:•%:P`.::{tw::x.::rv.}:r,.:, 0 C�+ra'"rS}}�f{};f:,tx.:•;ai t:.a., •rfi r},• ,.•:cf+•.tir' .: .9:.. rk'Y�r.•,:q:.,r,.. r.:Y.fk•:•r.{'a •n�`l.,?G%$t:{r•; r a v {;:"' 'ar:r', �fa�• '.f. '�:.^. II$IIitCet'O•.:•: :t;r,)%xy+'f:'{'{'Y,yi}}, hvlt} :iS!igg) {?{<£ 'Y. :}L'r.. }•yo-ly h`� {e : v::i• +:+},+;N:<}:.%?f£: is{v5 :Yft,}yv;}.{.:Sly'.}y.,,::;.,.f,{.f{ `: 't4 .,a. .;+:+1•. :d" ` 4: f X +rw•Y.t:•ly •.:rn>X.;:r,:'x•3}> r .;7;r..:. .,f>x :R,?r...r.#� {',trrr+"•�A• � t r ,}'£';: xi;$�:i+i,'iifr{`•?'•. ..{:'•i:••'•fnif}:•'•:f:•:'A?; ''1 r}{ v. f': 5� {•....,fFYC}t$.fiy�, 4isi. •.l:f•,r�.',...:.•:•• ,r.r:r' :}:.4.. X'+„••Y::••,kr:•.' r,•::. "`'}:£'ii+}tt,•• .,a'n`t":Y,{.�"a ��•; .... .....:.:•:,•:•;{:. ."..:,i,:.,•nw'4}:x;fv}.•ifs:�:x;+.4; ...,.}:•: r::.��4'r{.r•{#x;:, 0•.. ••:a......::n.i.Yi i kr r,r "s„r ^,G•4?�{'£'4:%'• +�•'}V'j't`3 •:fi,•..r..:?•+.. 7i:{,.fxfrn•:r''4!'rr ....44,,. r.f�a.r:n{•.,....:6;}:••..:.%:.}:•>.a;;:Y,.;a:;:ra>}}:•:•:f.: :;:,.y',+:,'r':a'�i. �. A r%};}'R{ .< ,}.�an�`.,,t�aur'.'� ,,aa4'S :�+i�e•,Y,..•..h�•:n v:4}i+"+ftifh':a'�..:/,.:•: :•.4 n• r..;ivr. .n {n:?? r...::. Y...;}}} .:rr. 'xr : .r. �: ,:#�x•:n..a„r>F:••r..,;{2 n :>..�.r.,,asi�f:s:•..n:n+•:.;•:{{.,:,.;.•..:}xf}::•rr:•a::::,...}i}:i%a•.:•..5.::•n+:+'.y2at%}y}ws��Y.•�rv.�a:° :s?u:{�frfin:.3:,....v/...{+r +,`+n r:f:::v{.rna.r^:t•:..:'::{L4.•.v: :.•, +r..,.'y .r.#x lfi vn+4:t.n.;}}::.T,.•{.;j.rr.::::^:{•kw::v.v:.:::,r.; .h. }.itu n.J.'n. .:.•{:r ..t.r �•:4:....r... .k'F.}•.: .l!,•i..i.r .fi..;:nZ... •Y}%%f:'.;.+.}:%•;f}}?c{ :,x;;;..t{„%;..i?•4i3%' ,are`., '%R;`h,:S?�? :a'r:•.. .$rr)'f%%.•. '{i';}'.. .•{,.. l.:'•1.+. ,..}r,:.:•;•;+}}n^;:fr•:•,i;f[•}}Y:'`iiti{:::vv:,b:•:}i :n• ..:.•yl�'r.;4' Y ti ^n \ '' ;i{•ir'r, t r.. . x:.}f:•}.,:::<'4f{..:.}. •,<3?•ffa: r .,.}, ••{s% .: z.. :...n.... r:,•::.t.a:..........., ::.,.:4. .:r..:). Fr, ..fj., 'rTC t,+:.,{:.•r,•rL,%;:.1....... :r•.•rr{;rn•.,g S.nr .r....: ... . .. ...: bn +h) ...? ...{.x•::>.•{::+nf•Y:f:Yt.;.x.•?{{{?•' ^r++ +.,rh`'t';wi:�'.'t�}::t•!r..,.yr..,.�,�+{H:?,,,^'#•;+„�4f';r,•':'�f':�Fd�{.,�„A;6f ., f.,.:!•.•n.......... :+n{•,•: .xr 'Y:t�:G....:.,..r:::}:.....r, r,.•{.. „f.;:•:, {r.,:Y{.••:+r?.yYfr-g.,. {"�•• r r. .:,c}/d...r...•, ,•::.;..;{;;{.:;:.:,}..;,r'+' >•.f:`:;fr:;n...::..•,JY}'•.`.{+r,•v.a.va?H t,}a;%ti�:r":g htv;4�4'•f :+Yr:{,vr,Y :11$IIIe.`...w .r:.,^:{.{%..:4:w:,t{•:::Y,;{}.hv•:4...;.4..;x:.: ;.>,;r•, •%.: Y:;c... .#:l; ;t.t• < ,.•:# y v'xNOX-1 <•: ut++f°:'f`,< : tff:YYiz:..va,x),.:Yr,•:::r::r..::, :.:ff.::t+:•:}}: :{;£{.>,+r}S•{f).. },.2,: : t•}., :•.{l,. t<•;:f...f{3. e...:...:}{.v.{.:•n•:•:.: {.}.. .,a'+.: ff}'y. ,if.; :.o•.•r.a#aV'�{4.. 4,•aaYrr�s :... ....;r.•:....,.xr{.tx'r%!:tii'<:Yf3�h{{'•f+4,•:V•:^.�'• .... ,(trx•. ':. ., •.::ffa;{.;:{.:.:Y+;xa•!f`,':?ffff.i>xiifi}i':}�•�:£>.'Cx`'.:4+:•1x „,...)..,.xt4:f..4::•:.:.::rf•• :-ra{.,r vr,.;:C„Yr,.• f•.SF.,•.+}::t•::::. n::•:•r:..}..:.{.L.:r.+:::•:::f::r.,::.:::Y'•}. :+• ., -.,'>L'�2�`'tr.+a.., n. '';tr.r• ,ac{:rrr.S;.Lt+nn9., 1 •.h.x{r..rr\:::n:•+:i•:• pqq•:{. .v} .,'4..•fv+fv•.: •rn{w:::.+.t:,...r.;}{;r•:C.::..,..,:f:..,•{^v {a,7,{••t•d�„•.2a`t4w:rrr.:,4tr�.:a:%.•n• r.,::'�•Y:+'..). ra..�%,...,;C:{•;irt}vi: r •:.fl•• :fiq.,lf,.:.;f) .:r.•.lniv;,r{;a,,.i t;:i•{%'•ix•:••:.w.y; i?•?Jii•..}rfi•. .7C4'. {f.''S' ++ YYr; {'ti4•?.•:^Y,f:yY::. ::vf.•?4 x: n.).::r:.4'•r}:>{;•}x}:::''a:•%:•r C!:v,'fa:;%:•:':Y:a:• $YartY:�.n,.4 ....n.}:•f,:..:x. ..4•::+.v:.ry..{:•::.,;..,;;:,,.{:flf•Y}:'•i:i-.:v.....:.::£:•::::. r...r...r...4./....:n.,.r:;n. yr Y•r..:.....;, „f,..;. ..}.>,,.•..:...:,... •... :... ...... ....:,. •.v }xn:x%)'r•'+-•trr:r%?4'{•}'?4v`%is�i•.i{}L,•���v'•;},ti{}`i' `•r..•/r•• .'f^'• rti{:4••...;iP r.Y:r.,:4}:^r�v::::•:n.4:•:r.}nah{{a.xy.}.::•{:Sa v,:};. •ii4 ..: n;:yf%•;?t;:+:v;+.%r}:;�;r;`.:?..rN.•.{r.;v.{;;3+:`'fy��:::�ry�.han:r•..•;,k x:t� Ya. f`}y•.••7�,,3r;+»:1;:;?;;: : ..:...:n•......... .. .......n•::::•r..:.•:..:. .: :.r.rr:dYf>f: ;:ti?:}:rii•;:;:•. n•.+•.:3:•;i..vr:%•r�:rf,;4:}%. ;$. 5..... , ..... .. ..., ...:..:.,•:• ..Y;::.,•. :.,...r....:}h:!r...,:•n•:••::..::n':�»:+•>::.;>:2%�:::::{•:r.,t•x:}:•.•,tis:rn a..)a:.•C+. f4.,;'f.. .4Y)'r}+'+,4';r„ {,•:}�4.:,,{�c}+ ;�l`•`;' .addre3 r{�. .K.t..v ....::.,...::.}::•:... ..;{,.;hx,} " ,,.}••':aw':o^ra•x•f{+.. .;�:..F:.;, a�'��.�3?t 4x+.4r{•C:•:. v..::4ra.;::}:}+:%}:.:: .:rq:.}.,.}}:.,: .n{.-:+•,•r. .r.' R..?�,lC'•+F�. �:.. .v.++:\ Y....v.�.urn,r+. : ........ -..�.....:...,:•:x}:�•;:{.;''r}:•:+{:}} .;•:.\;:+nr{..:.::.:�%•:�:::f:{}:Y..{.}.a.::....:..,:.::•::;{S f:}a..:r.:..•::..,•:.• n•'y::Sr, ...F4.r..r ,"w;;. ..J:'. }:•%%:;:{;+}fL}:•;{;<••}.. ...t,. w,n.v.cya:•J r't '+Y•xYr`.{: ^..t4".•3?.,.,an.}C+.:.:.x,... F'�•r},fy.,a}::.: .r••;•}:'.'rr:•;i4},:•:a:;i+{•::;...,..n••r.n.r..,t•:, ,..;..,::f:. n.r....... .::.}ir::•., ..,,.:.. :..... ...:.... .:. r.. .rrx•Y•}i+••}:::. ....?•.,•+.•S:•}:`•:;3:•}}:?+ef{3:Y:{{•>}:•}}:•::.;;tf:f4%}:•::?•:: r..r.r::i' .. :•4 .~<fi:.:.r:•hn•.....n{. :•f.�:,r •...;•.-fY. �flC:ifrx..r•}:}x^.:{..,.a}++i�,.:.....fc:'•: < a>..;.; :•: :.x.: .t. {:•;}:fr:::•a}:•}}x:{:•+:x:+a',+. •.t>•}}r{c:•>:S}::.r. O. ,•n••' ,>,:�LrYY: ::" .J•G ..r:rf. ;a+;.}:::x•: ....R:n•...r ::;:...,•:r..,,•.v:: ...}....a:t•.!:++r}!•3:;::.•...,;.;.,,+,•........:•}::::..:'•S:f.�,.r.•..:..:.:•.. . r... ,tf/•.,..f..�:....,.:.,, .r {. x,..�. ..:.}•;,:,..:•n•. .}:r....r:.},>,.n•:...,.....::.:.f:..........:.....Y.`.`+..., ...::..•r .... ...: .......... .. .:. ,ar'. ..Grr:•+xiv+iP r r:-.x... ..........r .:•.•,..... .t .. ...rr..,, t.,,...... :......)r..... � rx•x{+a•:v,.f}<?<{n.4%.�+};;�.^•.:{,•SSR,tiff;;�Sr.�:rt.L�ie:£y;;:<i;�r.Y,.:�4,{�<4..:.h,>,•r..%•-, :^Sf'•t`:>2:':y;:�:.; :�...:}:.Y;r.:::a•:;-{•:•.::.-.Yh•+:•.•/, 3;,'�.}..,{2,,�r^,•:;•:::%:'.,:•....,.� .;.;.>:•Yxr::,:;a•%i::s•;�::•.r s..{..+•.,: -,xr..;.;{r,.na,� .;fir, r}.• f�,` 9' :4.4•::•..,!'?•r.•'S4f%:::•:.., :.,k.. .:a>.r.r..r...:::•:?,v,.•{r:}:::.{Yri{;fz;�`:.i.;,n} .; +.x`S:;+a;v i..r:.,•,• rt;:;kri,•} •: 4'tY .;Y ui.4:,Y Y. .n.....a:........• .....;..rr... a:. .::%::f:tr.•.,.:..:::::..r:.,,::n:••::.:t'}:h•:;•..t•: :rtiS'r'•'�'rd:•^:+{.+•,f4•„X {�i;}�':r.•.a r�•','.r:%3.4•.>;.�s;•a�',:.:Zn+, ¢{.S:'r'X; ;�: •tit•' ).wf•}ff}:.fi',.... :fif`f;x:+ ..rr•: %S{):f;:;}Yx!:.^..a.t;h••>:E•.}:;}t•).?>:;�:"::;.',3'•C+.}.},{..,.. ..+}.;t�'4<:•.:'>.::++,.;"Y'f.ynr4r�4',h`'a?Yfiu%'a.`�•Cl.•4h4,:.;,.}:.:.�. f.••fa?.Y�•v:Yr^•.:..J.C•t>`6?�•;f ..;}.•:• r%". nna::f.:S:it• ..re;.'s{, .nr+::;{�•.::.:. .v.,^r}'a,.•.%•�ti';,%,{�� :,.Y;', „{�;,:4.3h•�',•rr+.afi ,... 4•r{4}}:{Q:R'f$?$?•rfi:Y ::N: :y l;:i}r;•y:,f}r:1:ar.,.,.,.;.,} r.`?ii{{{ ,vfxt':?�?t'.vd T,).t,.�,..h. . },v,.,•rh.;yrr}};?+.�..v:•.•r:.,•......::....{r'+7��•:+ ;i{hkr:r,.;tn.fi)%Y:}}•..:.. Y.S+.j}?'•+{Yvffa> ''.: 't •:-Grit%tCfa4%:<f� 5r:: }}.:•::•::r::•:4:wn•. :.:f a• ,+a:nc. . . r'f::r,.:{;:?,{%..'•:.}:+:nt..r..,y.:.n. Qi7j.r} :ff',.7f:•:•:.•.u,.r:,.•F:•.::•:,$?:./,.a fi#;.. . ,::+,••;:t":t+;:y: ;�`; `.`•�fSt:�::'v••:.{.:.a.•b.4.;i.;:•:{:.}},..,.;} ':')•: rr '�3S?4.''}:.•.}?:{,{fffi4{.;;:?xf7f;1}f�^;g;t•>;{'?`,.rr.,"i,,a::rn'f:"r.,;f:!i` ••r•.:Y:}if:•t}.:£ia:%£t{{rl.ut;•:x4:Yha::}:::4r..,r}<:£`t ':•°n•�i: �/ {,.)in,a:�:•h....; '••ti%'t?h%.s:.k?c„!:;n:.t.:..a.. tt3ara�ce?ro.iiii>!•r?:.3}} 00 and/or osition of csfasinalpenalties of a tine to$1,500. Faihn-e to accuse coverage su required under Section 25A of MGL 152 can lead to the imp a Qae of S100.00 a day against me.Iumderstmd thst a out y J prLsonment as wen as chg penalties in the form of a STOP WOE ORDEiZ'uui a veriticatian• copy of this statement may be forntardea to the Oice of Investigations of the DIA far coverage and enaIti ofPeTJ that the i .,on providedci above is truce ancarred I do hereby certify under t p P Date ISO E2 SignatureAJ, - II -- L?- Phone# 5,O V LI " Print name MUSS L�- afflcLel use only do not writs in this area to be completed by city or town ofadal ❑fig Departttunt perndt/licease# (JjAcuaing Soars city or town: ❑Selmimews Office • C3 �k�i„tatedlate rnpanse is required ❑HealthDepartment phone#; contact person• • Information and Instructions t Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the `law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. artnershi association corporation or other legal entity, or any two or more of An employer is defined as an individual, p p, 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 ll not because of such employment be deemed to be an employer. building appurtenant thereto sha MGL chapter 152 section 25 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,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work nan it acceptable evidence of compliance with the insuuance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and 'address and phone numbers along with a certificate-of insurance as all affidavits may be supplying company names, eats£or confirmation of insurance coverage. Also be sure to sign and submitted to the Department of Industrial Accid 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 ruired_to obtain a workers' compensation policy,please call the Department at the number listed below. areCity or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out is the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the perrnit/licensel number which will be used as a reference number. The affidavits may be retained t^ the Department by mail or FAX unless other arrangements have been made. The Of of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. Pay The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Me of tnvesugauans 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 �ofIME, ti Town of Barnstable Regulatory Services »NSTA S, ' Thomas F.Geller,Director KAM 9� i6J9 °� A Building Division pjF p�.t Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal, demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements. LL 4g_2gy:'_CVType.of Work: 1�)TC_d C� Rk)rg &*AL/ Estimated Cost o 00(� Address of Work: c?S F L_L&W 5' NhyffY) ROAD Owner's Name: gimaj-_ -A-I\rp &trPJnA C�Z c yL7 Date of Application: Z�DSO I hereby certify that: Registration is not required for the following reason(s): 0Work excluded by law []Job Under$1,000 E]^,B�ding not owner-occupied er pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. d v3 Date Owner's Name or 780 CMR: STATE BOARD OF BUILDING REGULATIONS AND STANDARDS i THE MASSACHUSETTS STATE BUILDING CODE Manual Trade-Off Worksheet Permit q Builder Name Date Choyed Bj :.• >: . Builder Address_ A"� Site Address FuuETZ MAesH T-cft COiyITT Zone 12 013 014 Date 1 �^ Submitted By Phone •;� M:. PROPOSED REQUIREDU• Ceilines:SkviiAts.and Floors Over Outside Air Required Insulation x lit Area U-Value Dmription R-Value U-Value UA (Table J6.2.2h) x Area UA Flour over outside Air Rr (Table J621a) - c u&PS Z-7 4 1 p A2 :F.. . . = ..Tow Area 1 U Waf%,Windows:and Donis ` Tas+mta:loa z Net. >tequ+mcd D=ri don •• R-Value- U-Valve Ara UA U-Value •x Area -UA Wam Rabte,c>.26.Ge) qr! 4:4- - (NFRC orTabk J1S3a1 .�� �7 �`• Z ;; Doors. _ d' (NFRC or Table J1.5.9.b) ej, ((NFRC or able JI.S3a) ` �� —+ fe 1c Total Am & Floats and Foundations tawtuioa tamtatioa R- x Arcs or • ° Required .Dc=Won Depth Value U-Value Perimeter -UA U-Vaku x Area -UA FloorovorUsco"doaod (Tabk fe Sp— J6 2 2e) iiamma1t Wan (Fable J6 2 2Q Uabaaed Slab abk J62.2 ) sa Tod Aropowe UA SUK be taa Total • • Tor ! pF due or aqua(to Twd(wA�Q Xc fWrdd VA JWposed Ut c�I U.3 q� Rt trfird UA 3 e � 1 Q Stae mm ofComprmanoc the p Wowd bAuae chip Wouded in l�:Adjrtsred Owe daewwna&cassWeM w*k pit buMVPbm *- amd other eal udons mbmiaed with the ueatiaa RegptJrrd UA G701 i� D ��J 7 3! D 8mr1ldm/Derrgna' Coarparry Name Hare 76022 780 CMR-Sixth Edition. 1J20/98 (Effective 3/1198) i ENERGY CONSERVATION APPLI CATION FORM FOR LOW-RISE RESIDENTIAL NEW CONSTRUCTION and ADDITIONS 780 CMR Appendix J (effectiue:3/1/98) A licant"Name; Site Address: t-.�c.c.clZt"Vt�SN PP Ci Applicant Address: ty/I'own: _ . ( '6tit T. /L!A - Use Group: Date of Application: Applicant Phone: Applicant Signature: Compliance Path(check one): [) Prescriptive Package(Limited to 1-or 2-family wood frame.buildings heated with fossil fuels only)- Package(A f rough KK from Table J5.2.Ib): Heating Degree Days(RDD6S)from Table J52.1a: (For items d.through i., fell in.all values that apply from Table J5.2.1b:) a. Gross Wall Area sq:ft f Wall R-value R- b. Glazing Area' sq.f L g. Floor R value R- c. Gla2ing%o:(100xb+a) % h. Basemcntwall R d. Glazing U-value U- is Siab Pertmeter R C. Ceiling R value R- : t J Heactng AFUE CompoaeatPerformance: "Manual Trade=0.fi"(Limitedao goad or metal framed baildings only) Cli c Zone(from Figure J6.2.2) k�j one i2 : Zone 1 Q Zone 14. Attach Trade-Off Worksheet from Appendixd C Trade-.Off FYorksheet if applicable) MAScheck Software Attach Compliance Report and Inspection Checklist printouts: (] Systems Analysis OR 0 Renewable Emergy Sources Attach Mass Registered Architect or Engineer Analysts ALTERNATIVE FOR ADDITIONS ONLY: a.Gross Wall+Ceiling Area sq.ft. b.Glazing Area' sq.ft. c.Glazing%:(100x b+a) C] ADDITION with Glazing% (c.) up to 40% may tee 780 CMR Table J1.1.2.3.1 below; hIAXIMUM U-value 141NIMUM R;values Feacsirxtioa. Ceiling Wall Elooc pisetrient WWI ;:. ;SIabTeriateter.Depth 77 0.39 R-37 R.13 R-19 R-0 :IZ='IQ,4 fit "SUNROOM"addition (greater than 40% glszlag-to-wall and ceiling.gross Area) Attach."Consumer information Form"from 780 CNMAppendix`B. Official's Name- Official's Signature: Application Approved 0 Denied 0 Date of Approval/Denial: Reason(s) for Denial: (provide additional details as:neecded on back side) 'Glazing Area may be either Rough Opening or Unit d'unensiolm BBRS 06n2 ns TOWN OF-BARNSTABLE BUILDING PERMIT APPLICATION Map D 6 � 1 Parcel v� Ud-78 2 Application# Health Division Date Issued= 02 3 Conservation Division Application Fee vV Tax Collector Permit Fee'. y Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board F �, Historic-OKH Preservation/Hyannis .s Proje t Addre`ss---, > ` 044 fru MIMsCa ! p Owners Address Telephone 76l� CPerm�uest t 6 rri lPoc m w Square feet: 1st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay (-ProjectzValuatio n 3 Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing t now ` f -�, Number of Bedrooms: existing new M Total Room Count(not including baths):existing new First Floor RoomaCount�, yy< IZZ Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other cl Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: UYes ❑No M Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑exi ting ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use - '�� BUILDER INFORMATION Telephone Number Cdress�I1�� �e�rlYu� License# •�es U,LZ4~r�i� nth o-a-/4j�, Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE , DATE l r s FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME _d9 z flz�j�/L�G �c INSULATION FIREPLACE ELECTRICAL: ROUGH .FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL O G " FINAL BUILDING DATE CLOSED OUT f ASSOCIATION PLAN NO. The Commonwealth of Massachusetts - Department of Industrial Accidents Office of Investigations ' d 600 Washington Street Boston,MA 02111 ..........., 5� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name' (Business/Organization/Individual): C /State/Zi �� Phone. #: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I * have hired the sub-contractors 6. ❑New constructionemployees(full and/or part-time). , 2.❑ I am a sole proprietor or partner- listed on the:attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g; ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp.,insurance comp. insuranceJ 9. ❑Building addition r ired.] 5. ❑'We are a corporation and its 10.0 Electrical repairs or additions 31 L1,T I am a homeowner doing all work officers have exercised their l l.❑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' 1311 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. #: Expiration Date: - Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fore 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 fore 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 certifyP Ider the pains and pen ies of perjury that the information provided above is true and correct r signature: Date: Phone# Official use only. Do not write in this area, to be completed by city or'lown 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#: "' Instructions Information and 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 g gJ receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into an contract for.the performance of public work until acceptable evidence of compliance with the insurance Y P 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-contractors)name(s),address(es)and phone number(s) along with their certificate(s)of 4 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 w 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 pernut(license number which will be used as a reference number. In addition,an applicant that must submit multiple permit(license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-72774900 ext 406 or 1-877-MASSAFE Revised 11-22-06 Fax#617-727-7749 www.mass.gov/dia , � oFVE r Town of Barnstable Regulatory Services _ Thomas F.Geiler,Director BARNMBLE, 9 MASS 039. Building Division TED �s Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 , www.town.b arnstable.ma:us Office: 508-862-4038 Fax: 508-790-6230 HH�ON WNERLICENSE EXEMPTION Please Print DATE: /'Z � �R OAS JOB LOCATION: • E_u/.A 1F 12:3 14 �p • number street village L✓I rc FR 13. f*-,9 "HOMEOWNER': o rqdi M• 7;ew SoH 7,c I 3 3 7— G 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 r' 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 buildinl?permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State.Building Code and other applicable codes,bylaws,runes and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department _r minimum inspection procedures and requirements and that he/she will comply with said procedures and yeqylrements. Signatur f Homeown Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor.,. Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often,results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed . Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as,part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the 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. Q:forms:homeexempt oFjHE Ta,, Town of Barnstable Regulatory Services * a yBAMSTABM MAM. Thomas F.Geiler,Director �A i639. �� rFn.19 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 7-=Pr-opertyAOw er Mus=tom Complete and Sign This Section 'if Using_A Bu>der 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) Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORM&OWNERPERMISSION eel � r� I c ............... _ � .vY BUYER: Russell and Brenda CazeaulL LOT 59 LOT 57 147.99' Shed El LOT 55 N U ID co LOT 60 Shed01 a O� . ('AT'2 re O1 flood 1�2 StOry Wood LOT 58 47,300 S.F. LOT 56 sy �o To THE (-_ Greenpark Mortgage Corporat;on MORTGAGE INSPECTION PLAN AND ITS TITLE INSURERS. I CEPTIFY THAT THE BUILDINGS SHOWN DO ( CONFORM TO SETBACK REQUIREMENTS LOCATED IN I.E. (FRONT. SIDE, & REAR SETBACK ONLY) OF Mdrtldable C 0 T lI I 'C N4iEN CONSTRUCTED, OR ARE EXEMPT FROM VIOLATION ENFORCEMENT ACTION UNDER MASS. G.L. — TITLE 141, CHAPTER 40A, SECTION 7, UNLESS OTHERWISE NOTED. MASSACHUSETTS I FURTHER CERTIFY THAT THIS PROPERTY IS not LOCATED IN 1}IE ESTABLISHED FLOOD IIAZARD AREA. COMMUNITY PANEL NO.: 250001 0021C - DATE: DEED f3-19-85 1}iIS COMPANY IS NOT RESPONSIBLE FOR ANY INDENTURES MADE SUBSEQUENT TO THE RECORDED BOOK _--.-- DAlE OF TIDE LATEST DEED OF RECORD.' 1;17 PAGE ..- MIDIEVER BUILDINGS ARE SHOWN LESS THAN ONE FOOT FROM THE PROPERTY LINE IT IS ADVISED TTTAT A MORE PRECISE SURVEY BE MADE TO VERIFY.THESE MEASUREMENTS. CERT. NO. I101E: 1.�I 7II THIS CERTIFICATION IS BASED ON THE LOCATION OF SURVEY MARKERS OF OTHERS,-AND DOES NOT PLAN BK. _.--_ PACE REPRESENT A PROPERTY SURVEY. VERIFICATION OF SURVEY MARKERS USED AND .-AN ,DOES SHOWN, MAY BE ACCOMPLISHED ONLY BY AN ACCURATE, INSTRUMENT SURVEY. ORIVI.W�yo ARE N0T'%PICTED PLAN N DATED Iql IIIC I'LAtJ. �. .. MIS CERTIFICATION TO BE USED FOR MORTGAGE PURIM N i ''� 1 -------- ------ —— -- ���� ONl„`Y. j Sel�Lctnbl�r 6, 20O_) OFFSETS AS SHOWN ARE NOT TO BE USED FOR THE ESTABLISHMENT OF PROPERTY LINE 6 SCALE: I'= fn �s BRAIDF® RD l ?. r1} `LEPJGINEE.RING CO ,. P.O. 13OX 1244 HAVERHILL MA. 01831 JAMFS W. F)OUGIOUKAS --�t.l #9529 071 111,u) , . ,,,, THE Town of Barnstable �F Tpw ' Regulatory Services snxrtsznei.e. : Thomas F.Geiler,Director �4, .•� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: J 3 JOB LOCATION: 3`� ��/L����5 /� �}✓Z S� C-m T li/ I number street village . "HOMEOWNER!': .06 y s5G L L Gl�l Z ric�l SD `��o yo 5 �o� w r' 117 7 name home phone# work phone# , CURRENT MAILING ADDRESS: d 5 /''7 sue/ti 5% O 5J '/2 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' on procedures and requirements and that he/she will comply with said procedures and require nts. Sign H meowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger.will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require;as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the 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. Q:forms:homeexempt RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x.0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot 9'5q x.0031= plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq.ft.= x.0031= ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf m 50.00 >750 sf-1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: " square feet x$96/sq.foot= .. x.0031= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck / x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee projcost Assessor's map .and lot number. . .......yr . �.... .......: ti o�*THE To 4 h Sewage Permit_number l .:... . ... .. .. .: '. ' ` / �♦� 33AUST4DLE, i '.5 House number -.......:... .............'.......... t MAB6 :.e.e................r' 163 9� 9 ,. 0MPYOr 4: TOWN OF -BARNST•ABLE r BUILDING -4 INSPECTOR - jAPPLICATION FOR PERMIT TO ............... ....................... ........................ TYPE OF CONSTRUCTION ..............:.............. GI ......:: ...... .................. .............19........ :TO THE INSPECTOR OF BUILDINGS:. .The undersigned hereby applie for a permit according to the followinC�'nfor' ` tion: Location . . ..� .. ........... ........ `. .................:.....:......................... Proposed Use ...:.... .......... ...`.. ..... , ... ...... / ... p Zoning District ..:...........: .......... ........:............Fire District ............... .... .......................:........................ Nameof Owner ...... . ............ ... ..... . ...........Address ......... 4.��................................................ Nameof Builder .::. .. ............ . ........... ............ ................Address . .....: ................................................ Name of Architect ...Address ......... .................... Number of Rooms .: ,.. . .�^ !t.. L1. .................. . Foundation �'Y /''�4�L'�•....1. .. '..Roofing. ....... ........ .t��.. Exterior .......... ..................... Floors ............................... .................:Interior ... '�" .......... .. .... " ......... Heating ` Plumbing . ................... .. .................................... t .................. Fireplace ...1/114i 'yll-k Approximate. Cost ........... .. . .. ............................................. ............ ................, ............. ........ ...... .. ... Definitive Plan Approved by Planning Board ________________________________19________. Area ..........3.4 .... ............a .. Diagram of Lot-'-and Building with Dimensions< Fee ...... .............:... SUBJECT TO APPROVAL LTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby 'agree to conform to all then Rules and Regulations of the Town,of Barnstable regarding the above construction.' Name ..., ... ......... .. ...... Construction Supervisor's License 1.. ......... � 2........ ASHLEY, HARRY . No ..26262... Permit forEN Accessor�'...to...?W��..J ................ ri r _ L Location ......35..Full-r.K..Maxsh:--Road...... ....................Cotut...................... - j r Owner ..:HarrY...ASxZ�ey........................... . i s r I rr` W Type of/Co►tistruction ....F.rame.......: ............. Plot ....' ..................... Lot ........................:....... f Permit Granted ....'April :6...:..••, .....-19 84 r •-Date of Ins ection ......... ......°19 _. Date Completed ......... .........19. r r r , ..ram ♦ �'� a; - - - • r r' }�.a %*"E.r°��� TOWN OF BARNSTABLE ii . i BABB9TAUX OMYa`e� BUILDING INSPECTOR APPLICATION FOR PERMIT TO ,�rc � r: ........... ............................................ TYPE OF CONSTRUCTION ......... '..� Gs. . ......I92 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby ap lies for a permit according to the following information: Location ........ .... ................................ �!�. ................... ........................:..................................... ProposedUse ............................................................................................................................................................................. ZoningDistrict ........................................................................Fire District .............................................................................. ...G% .:............:�................ ...................Address Name of Owner Name of Builder ... .... � ... .......... :...............Address d��. U' L.-a.� .. ..�. Nameof Architect ..................................................................Address ................................. ................................................. Numberof Rooms ..................................................................Foundation ...�I�F���...... . .................................................. Exierior .............. . .. ... ..............:../x'1`..............(................Roofing ............. :.. .......:........................................... Floors ........................ ......................................Interior .................................................................................... Heating ..................................................................................Plumbing ........................ ..../.... ............................................ Fireplace ..................................................................................Approximate Cost ............. ... s..1�.��........................ Definitive Plan Approved by Planning Board -----------______—-----------19________. �O Diagram of Lot and Building with Dimensions / SUBJECT TO APPROVAL OF BOARD OF HEALTH I00 Lu � � • . o.>: y tatcrn a 1 M,rr,g C MCC itz r 4.. of �'r,a I D , t�,1:t�••4a I-hereby-agree to norm to all the Rules and Regulations of the Town of Barnstable regarding the above constructs 'J 'h. Name ..................... ...............a".............. . ...................... Ashley, Harry 15302 garage �;`��•�(�,' ". . � � ';- a.,;'i� r� "' '` No ................. Permit for .................................... ............................................................................... 1 Fuller 1"'ia.rsh Road ; Location .................................................. Cotuit ............................................................................... ` - - . _i; 7i• �! !+. Owner Marry Ashley ................................... ......................... Type of Construction ..............frame ............................ ................................................................................ i . Plot ............................ Lot ................................ , Permit Granted .........Jlax..26...............19 72 + Date of Inspection ............ .......... ............19 1 - 1 Date Completed .... ... . . ...7 Z-....19 i PERMIT REFUSED ................................................................ 19 � ............................................................................... �` ........... . Approved ................................................ 19 ........................................................................... -{�- p ff'own of Barnstable "Permit 0"Onthrfi a axwoswtats. Regulatory Services Fee r639 �� Thomas F.Geller,Director ° Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 �3 Office. 508-862-4038 'APR 2 2 2003 Fax: 508-790-6230 EXPRESS PERAUT APPLICATION - RES Not Valid without Red X-PreaaImprint STABLE . Map/parcol Number v` (,/O Proporty Address . CJ ' �t � �I er s �jY l - residential Voge of Work Owner's Nara&Address c- Contractor's Name C c,"o J l Ci.ZeGc��+ �} '80ns '�3�"n Telephone Number�5 0� Home improvement Contractor License#(if applicable) �U3 Construction Supervisor's License#(if applicable)__ 5Worlanau's Compensation Insurance Chock one; ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name I ra\j e_�4 rS T-nde m -t y .Coo, Cf workmen's comp.Policy AL -IPJ U g-Q'aa X Ce 5 3 - 502-. Permit Requost(chock box) [)qe-roof(stripping old shingles) All construction debris will be taken to J4W ❑Re-roof(not stripping. Going over existing layers of roof) �e-side ❑ Replacement Wiadows. U-Value (maximum.44) P Other(specify) •Where required: Issuance of this pirtrrit doe:not exempt compliance with other town deputrnent mgylationo,i.e.Historic,Conservatim etc. Signature pan Q:Forrm:nTmtrg Revised 121901 DATE(MM/DUIYY) ACORU. CERTIFICATE OF LIABILITY INSURANCE —_I PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION McShea Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 749 Main Street, Suite#H ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Osterville, Ma. 02655 — 508-420-9011 INSURERS AFFORDING COVERAGE INSURED Paul J Cazeault & Sons ROOf ing Inc. INsuRER A: -- ------ ----- Roy�l Roofing, Inc. INSURER B: ___._-_Tra_v__ehr& Indemnity_Co__.of_-Illinoi_ 1031 Main Street INSURER C: ----------------------------- sterville, Ma 02655 INSURERD: — — — - COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING I ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. " LTA TYPE OF INSURANCE POLICY EFFECTIVE POLICY.EXPIRATION - ---"----"-POLICY NUMBER DA"fE MM/DDlYY DATE MXPIRA LIMITS GENERAL LIABILITY L=ACI-1 OCCURRENCE $1�-0-0 Q-�_Q Q 0-_ }{ COMMERCIAL GENERAL LIABILITY —`— — � FIRE DAMAGE(Anyone lire) $ -.--I CLAIMS MADE I x l OCCUR MIZI:>EXP(My one Person) —g_--------- A PAC5912908 04/30/02 04/30/03 PERSONAL&ADV INJURY $1�000. 000 GENERAL AGGREGATE S 2�0 O OJ_0 00_— GEN.L AGGREGATE LIMIT APPLIES PER: — — POLICY1-1 PRO PRODUCTS-COMP/OP AGG $ JECT F- LOC —1 -�-�0 0_.- AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ (Ea accident) ALL OWNED AUTOS --- — — _.— SCHEDULED AUTOS BODILY INJURY $ (Per person) HIRED AUTOS NON-OWNED AUTOS - BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY ANY AUTO AUTO ONLY-EA ACCIDENT $ OTHER THAN EA ACC $ EXCESS LIABILITY AUlOONLY: AGG $ --_------I EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ —_ WORKERS COMPENSATION AND - WC STATU- OTFi- EMPLOYERS'LIABILITY 7{ TO:Y LIMITS ER 7PJUB-922X653-502 08/10/02 08/10/03 E.L.EACH ACCIDENT ✓ E.L.DISEASE-EA EMPLOYEE $1_0 0,�-0 0-0--- OTHER E.L.DISEASE-POLICY LIMIT $ 500, 000 DESCRIPTION OF OPERATION S/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1n DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS Oft REPRESENTATIVES. AUTHORIZED REPRESENT TIyE � ` r ACORD 25-S(7/97) O ACORD CORPORATION 1988 One Ashbur u..,;=iLivi tOC1.CP� cc: I:t 1 10 1 Boston ;GI; .0 1� ,� ..Ma�rvsrr;uc-riory ;uP�h�✓I i_Icr_r`l,,l.. 02C' L-X1) l.:;: 10/'l_0/;'00 N . .; :Ir I, Ir iin',i:l.,:ilrl .nil,.i .ru•; : t,i .ulilrc .: nrrliln.,�lu!n. t OARD,;01 uU1Lt,INr:: I(I GUI_i1 rlUri:;Lit onsu: COJV;;'fI�UCf10W Nuiwlur:'.C;; L3irt4iUa:q:.i�pC.O/10:,:1 Expiru,:::10l20/'OG:, Tr. rr: Iu Rustrictud:.00 I'AUL J CALLiAUUr 1!335 MAIN ST OSTERVILLE, - i Board of Building Regula ions and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Reqistration: 103714 Type: Private Corporation Expiration: 7/9/2004 PAUL.J. CAZEAULT & SONS, INC. Paul Cazeault P.O. Box 2781 Orleans, MA 02653 -----._--- Update Address and return card. Mark reason for change. Address I Renewal Employment L,osl C:nd ✓/. Gf„J,,J)tu,u,.ea&11- Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. if found return to: Registration: 103714 Board of Building Regulations and Standards Expiration: One Ashburton Place Rm 1301 p 7/9/2004 Boston,Ma.02108 Type: Private Corporation CAZEAULT&SONS, INC. zeault ah Rd. MA 02653 -- —- ----- ----- -- - Administrator Not valid without signature .wa.+... .n.W. .....orwr .y_b,. ;.. .:,:, .+ICv, ._ _ '. s+ir,..iew+o+ . .�''a -?" ... -.xt4:3�stat_ l6'+tli4k"_ gvrurtiand........_srt• a5., srlFw ,,.; .was.s..».,:,;,a+.n _.. W I C4A5 F p, wi owNEU�. � Q �� AT 241 r x 24(6 WkVOWS W pC] Y) W CV �NTV ON WALL.MIMN �' w Q, BOOM ,- w 0. CY5 — L — Pl k� ' "FALL Wi 2-2 x 6 00 coo ol N�`vU 21 x6 � rwp >�o 110— t.�W,. _ . - r. I i r; I �X151", i 0 E-" ' '��NING (VWrYKJTl0tN ° GOON XIS • • Llhy ff W/ OW%ER; I MUbh00M �-+ x � O n ll�c N Y �XI51", I 5L05 I CC/) DIVING WA IaO5, pfv�ING I �k5� �X151 : 06 I w I $� SCALE : � a G DATE 7/31/2003 }�� I }�� P!I,.,AN CON'p,PC'OC; IS '0 V�t?I�" �XIS�ING CON✓I'101\15 PN� DIMENSIONSJOB NO.FII\5f FL001\ IN '-�� FEL( ) TIOp '0 {?' 5WI!"01 WORK CAZEAULT � 2,) CON'TAC'Or? 0 p�MOV �X151NG D00F:5, WINDOW5, WALL5, WOFING A5 P\�O IPF,5D For, NSW CON5TLk:l()N, _ DRAWING NO. : I 51 ALA NEW CON5` UC'ION !0 MA C, CXI511 % IN W TIAL, _ DPAII,, AND FIN15 IN5L1LAlON IN '-'E ilLIN6, & �' 1N '-� UJPLl.S, ' ! :9 5"! s.. 7�F.Y•'✓ ¢ M� -----�-►fW kvG C�GP � cD Ll an c� W cat w 1 W C)cn z _ F\,FAF\ FLFVATIO�- Z N w t�41�L "RE.�^M W 7 M 4. E SCALE : -- 1 /4„ _ 1._0„ --- — DATE : 7/31/2003 new w,!'- 5HNCA,�90% — r©WflrH�XI511Nu — ----- - --- ------ --- — JOB NO. : CAZEAULT ! L�Ff SIP ���VAVON DRAWING NO. : � zoo ¢ N c) p o i15 J R-1 � . c,�^^ ® ® 00 +I UJ O C ) LO 11'.diT' h g or a. Ell C�r.Sfra. r y a. — — NEW W.C.Sill 5i ING -- — t0 WTCrI C011 G SA NEW 4. P,16K 51P� �L�VAIO� 10 W _R , N rm, io'' VIA.SONoUt p,r.2 x to LEnCZr?PDXCJBoLr>;n ro ~' o t0 4'O" BELOWG�.AG 50-IF BLOCKING W/ 31 4" 5.5.SAG BOV5 �2F`O? ALUM 10's 2'0" oc. 5tAGGEKEt7.5EA+L L3OLT kf* w V - �t 2 x 9'5 a IFS W ;' A\W5 20 0Z,&uM, StLp FI A!IWG G/Wc: (D :D IEM6E�BOAPT A.i.01N 1"Ate — — — — — — — — — — — — — — — — — — — — — SPACEBErWEENLE(7GE�8AI7EP ,.y 06 .05'N aPa ON P05T W 15 5 5!-4 CAA BO r5/NAMM C�Otu l Nn5 a J01515 C Nt.�x P.r,p05r Fr500 I6 a ' `:VP50N,04 i I I Q J01 �SIL'2 x rO 13Aivn 6 705'3A5E w N rTl STEP w 1: -�3 O PIA.CONC SCALE : �. 7. 2 PTA F Op PACK & 5T�l5 � o 1/4" = 1,_ON I �LENGrN� �tIGW Nor ro`SALE; DATE : x � W,' 7/31/2003 I I 1 JOB NO. : CAZEAULT \-�X!5TM COW-FouNn wA���, � M�N� s �t?Ct�!GSr1N DRAWING NO. : n FOUNPMON PLAN_