The URL can be used to link to this page

Home My WebLink About0121 OXFORD DRIVE / l Gxj'6fecC :Drfoe r \ � l Far / Town of Barnstable RE EitPr NAM" p" 200 Main Street,'Hyannis MA 02601 508-862-4038 `"t"0iA Application for Building Permit PP g Application No: TB-17-4177 Date Recieved: 12/4/2017 Job Location: 121 OXFORD DRIVE,COTUIT Permit For: Building-Insulation-Residential Contractor's Name: Carl J Rebello State Lic. No: CS-084358 Address: , Swansea, MA 02777 Applicant Phone: (508) 567-4109 (Home)Owner's Name: GIARRUSSO,THOMAS E& MARK W Phone: (508)981-3671 (Home)Owner's Address: 23 WACONAH ROAD, WORCESTER, MA 01609 Work Description: Insulation& Air sealing. • -� 'tea tl Total Value Of Work To Be Performed: $5,598.00 Structure Size: 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers'Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: Carl Rebello 12/4/2017 (508)567-4109 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $5,598.00 Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: $85.00 12/4/2017 tt $35.00 ' Paypal Paypal Total Permit Fee Paid: $85.00 12/4/2017 I $50.00 Paypal Paypal s Assessor's map and lot number .....� ..........? ....:.. ;k THE I 'Sewage Permit number ....................... House number .. :�'./z.. :...................................... '�aaa}eHr s • 6 a 1 TOWN ., OF BARNSTABLE BUILDING INSPECTOR APPLICATIONFOR PERMIT TO .............. C? ....'.�)......... ......... ......... ......... .....�... .............,.......................... TYPE OF CONSTRUCTION 00 ).... > .. ................D1....I................ 19..�;�. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .......�.la..........`a� [ X k ...�.e I c,t. .t.....f A!n!1... .1��i.4 1. .... ............................ ..... Proposed Use $ S I.��' Aj :.... Zoning District ............:. ....... ........... ......... .... .........Fire District .......Ql) . .... ... ................ Name of Owner l�f.`T9-t 1�1. �_i1 t1 .t6�ll' O� '1�� ............. .. ...........l., . . ................ ......Address .................�...... .......... ............ �: .............. Name of Builder' l .t?. .. . . T. �S. Address .... :�,:r ........ Name of Architect .................. .Address Number of Rooms ........� ..... .. r1.. ...........................Foundation ..... �.ut ....... wtC.14 rv.................... a �i . ,.. ......... ......::.............:......Exterior .......... ......... a.......:............. .Roofng ...... � �A ; Floors ........... �: ................................. .......... ................Interior ........�' ........... Heating ........ � ?� .. �f.'4. Plumbing /x �c-... .i r; ................ 1 . .. .... .. .... ... vet fL�c�J' ............... > . .... � .,..-r" Fireplace ....._ ................... . Approximate.Cost ... Definitive Plan Approved by Planning Board -----------___-_-----------19_______ Area .. ...................... Diagram of Lot and Building with Dimensions. Fee . :� �... SUBJECT TO APPROVAL OF BOARD OF HEALTH 17c� 75 ... J 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 ............................................................................. r VAITKUS, WALTER A=21-59 t. No ..�262.... Permit for ......?...Story............. Single Family Dwelling ............................................................................... Location ....Lot 58A, 121 Oxford Drive ........................................................... Cotuit ............................................................................... Owner Walter Vaitkus .................................................................. Type of Construction .....Frame ..................................... ............................................................................... Plot ............................ Lot ................................ Permit Granted .....July,,.3Q...................19 85 Date of Inspection ....................................19 Date Completed ......................................19 !t > Afsessor's map and lot number F. SEPTIC SYSTEMMUST 't"E'o�` P Sewage Permit number ....:.:.............. ••u••••......0 INSTALLED IN COMPLI y House number .......`��z.�.... ............. ` WITH TITLE 5 t Basal a°�E . "'`-" ENVIRONMENTAL COD 9fb39. OWN REGULATION `'Fc�aY°'� TOWN ' OF '.BARNS ABLE 1 BUILDING INSPECTOR , Ip APPLICATION FOR PERMIT TO ........... ................ .... vS ,....................... TYPEOF CONSTRUCTION ...:..... .......0 ........ ....... ........................:................:... ......................... ' ........ l n................19.S5 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ......... l�..� ..... ?. .. ..... 1��A1 .... .1,1,! ..... ... .�--y. .. �. � UJ... .... le ProposedUse .........� 5.►. !tr...........................: ....................................................... ....................................... Zoning District ........ ...... . ..............................'........:.........Fire District ....... Q.I��? tQ-'.. Name of Owner .... T1 -......�.Qj .? !. ...........Address ..:. yG .w100 ......!�!d!+t' „. ............. Name of Builder' 5 �' .Address ..... .� Je—l—tJ.L:�( ..:......... ' Name of Architect ............................... .............Address .......... ...................... .......... .............................. Number of Rooms ........ ...: .... ....... Foundation ... Exterior ..........!: 0.,P ....� .................. . ...Roofing .................., !¢!J ...:�............................................... Floors ...........OA9 ......�.... .........................:....Interior ...........1X04, .. ...................:.......:..............:.... Heating ........)VO.�....o`Y..��...........................................Plumbing /'.i��..!'� �...!�V� .............. Fireplace .........t . ML�........ . ' .. Du°•• .....:.....Approximate Cost .1Z. DCXa,.' .............. Definitive Plan Approved by Planning Board --------_-------—------------19_______. Ared ,...��1..�!....................... Diagram of Lot and Building with Dimensions a .. .Fee :........: •. SUBJECT TO APPROVAL-OF BOARD OF HEALTH 7� - y 1, 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. S /. .Name`��r L�.................. ........ .. YAITKUS, WALTER '28262 11 Story .................. Permit for .................. Single Family Dwelling ................ ..I.............. .................4& Location ....L.o.t...5.8A.......1.2.1...Oxford...Drive .. . I .. ..... . I . .... . ...... ............. Cotuit ..............................................................................I Walter Vaitkus Owner ................................................................... Type of Construction ....Frame.................................. ................................ .............. ............................... Plot ........................ ... Lot .............................. Permit Granted ......J.U I.y..30. ....... l9 85 Date of Inspection ...... r. ..............................19 Date Completed ......19 > M r", 'AM IR 7A ,C�Z=-5/G/V Z , r4 S///GL E F<!1J/L-Y A,-O G-4,2B.445E //O X.3 = -730 (S. _l/.SE /,OUO GAG. /.S�QS,4L P/T--- 7a l�aTToti1.4.P�.d = So 5..� , cxl. �,•� IZ TO T.4.4 vE.s/Gi(/ 'j��S•��.P O, t G�,r ,p OES/G•c/ P.E.�co.L4Tia�.,2�1T�:� �r� G ,,� o ��'" _ /w ZN UF. `.�. U EiaxTF? rti'° No..29i,3 .. Il 4, QNA 91 s 452: Fp. /yl/. BOXr- v 277 W-/ '.�/y" TANK //VV //vf. -�/..1�� : . .sTGNE � ��•� /�./ G'E.2T/F/EO PLOT �L,q.t/ Y 73. 7 /Z.4) fj 7 / GE2r/,Cy T///lT T�/E <5 .- .yE�EoSioerl-Iile A/vo�ETI/aGv .eEQv/�E�IENr_S o.� Th'� /2EGifrE2c�.G4N0.S/i,2riEya,�S Tox%v OF . %%•��+/,.57*'.� �C� 11N� /S NdT' G�STE.2Y/LL.0 a G 4C.QrE.0 (�I//Thy//1✓ T,�,�E .CL aapvL..4/if/, .st - 71 L.,,e.v /.s V aT .13A--C�1:-nAl,4.V i" Sl,2- ' -!/ti1FiYT�SU.2l/�Y�1it/O T.SiE OGFS�T,S S l�l/if/fyE,e�4N.Si��UG IJ A07-a,!-f U_SEQ 134o ai J V. !9-eOR9E 4 ATTORNEY AND COUNSELOR AT LAW , 776 MAIN STREET HYANNIS, MASSACHUSETTS 02601 617-775-5366 July` 26, 1985 Bowden Enterprises P. O. Box 183 Cotuit, MA, 02635 Re: Lot 58A Plan Book 281, Page 82 Gentlemen: At the request of Walter Vaitkus, I am writing to advise that at the time I certified title to him, I was of the opinion that Lot 58A was a buildable lot. I am still of that opinion. I base my opinion on the following: Vaitkus' sellers, Francis W. Smith and Ann V. Smith bought the lot in 1975 within the eight year life of the plan. See deed enclosed. Smith owned no abutting property from 1975 to date of sale in.1984 so regardless of any change in zoning or lapse of the 8 years, Smith had a good single lot despite any upgrading which may have occurred from 1975 to 1984. I do not know, but presume Vaitkus secured a building permit before the recent Town Meeting which upgraded zoning to one acre. If you have any questions, feel free to call me Very truly yours, mas N. rge TNG:cm enc. cc: Mr. Walter Vaitkus • TOWN OF BARNSTABLE Permit No. 28262 Building Inspector cash - —-------- — /IT 039. X OCCUPANCY PERMIT Bond ----_----------__---------- Issued to Walter Vaitkus Address 20 Lynnwood Lane, Worcester, MA � lot' #5AA 191 n-vfnrd T1rr4ya rn_t_+vit Wiring.Ins�p tor_ +`V Inspection date Plumbing Inspector Inspection date Gas Inspector `^� Inspection date Engineering Department liftectio_d ate Board of Health Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. ...........Al .....�'2 19 .......... .......... r..........�-► ....... .......... � Bu/ilding Inspector TOWN OF BARNSTABLE BUILDING DEPARTMENT »ST % TOWN OFFICE BUILDING r rut i639. HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department . DATE: v q/�t�a An Occupancy Permit has been issued for the building authorized by BuildingPermit #.. .. _...... .................................................._.. ......_.. ....._ _._...... ......». .. ._»_ issuedto ................... .� f '/.�.....V........._.........:.................................................. ._...__..._._..». »»» _.........».»»..».» Please release the performance bond. r. TOWN OF-BARNSTABLE, MASSACHUSETTS PER" MIT A=21-55 JOB WEATHER CUD— July July 30 85 N9 a.2826N • DATE �19 _ PERMIT NO. APPLICANT Roden. Enterprises ADDRESS OC.0 , t'!� V1L64 INO.1 (STREET) (CONTR'S LIC .tENSE) Build dwelling ill Single family dwelling NUMBER of 1 PERMIT TO �' (_I STORY DWELLING UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) lot :E� A Oxford Drive, COtuit ZONING FL" AT (LOCATION) DISTRICT (NO.) (STREET) v BETWEEN AND (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE c BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) Sewage #85-680. REMARKS: B11d�J AREA OR 1596 sq. ft. 125,000 PERMIT 83.50 VOLUME ESTIMATED COST $ FEE $ ( BIC/SO AR F ET) - W6�tez �vat�us -- OWNER � B F'fL eT .-�C BUILDING DEPT:n '22 t ADDRESS BY THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR PERMITS ARE REQUIRED FOR ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN ELECTRICAL, PLUMBING AND i. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MEMBERS(READY TO LATH).3. FINAL INSPECTION BEFORE FINAL INSPECTION HAS BEEN MADE. OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS - PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1• 1 3 HEATING !NSPECTiNG APPROVALS REFRIGERATION INSPECTION APPROVALS N ERING OOR OF HEALTH 114- WLRK -_AL'_ NCT -P.00EED UNT:L THE PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD uE=ECT F SAS APPROVED THE VAZ,c.s WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE CAN BE ARRANGED FOR BY TELEPHONE STAGES OF CONSTRUCTION. PERMIT 15 ISSUED AS NOTED ABOVE. OR WRITTEN NOTIFICATION. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION `Map l Parcel Permit# Health Division /"�®3 Date Issued Conservation Division T° ,�o -z� o� Application Feey 5& Tax Collector Ele— 24E/A13 Permit Fee * T, ►c a. Treasurer 4!!�5 e- ��0 Planning Dept. SEPTIC SYSTEM MUST BE iNsTALUD IN COMPLIANCE- Date Definitive Plan Approved by Planning Board W=TITLE S ENVIRONMENTAL CODE AND Historic-OKH Preservation/Hyannis TOWN REGULATIONS Project Street Address 17 -t Village C v � Owner ki A-a ,e rc fi ✓}g J Address I Z t 6A•I- -h Telephone 4 Zk °- 9-4 1�- Permit Request V7-crt974 f2'e?,ID A—i-torl —( a t ►mot C•c- J c-41jo &J Square feet: 1 st floor: existing 10 c/0 proposed - 2nd floor: existing `l 0 y proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size '��- Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family �r_ Two Family 0 Multi-Family(#units) Age of Existing Structure t S Y 2S Historic House: ❑Yes WNo On Old King's Highway: ❑Yes �Mo Basement Type: Xull ❑Crawl 0 Walkout ❑Other Basement Finished Area(sq.ft.) oa = Basement Unfinished Area(sq.ft) San Number of Baths: Full:existing Z new Half:existing new Number of Bedrooms: existing new �s Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: 0 Gas 1210il ❑ Electric ❑Other •-_ Central Air: ❑Yes )11�No Fireplaces: Existing New Existing wood/QFI stove: 0 Yeses NO cn Detached garage:O existing ❑new size Pool: 0 existing ❑new size Barn:a- isting &new ,size Attached garage existing ❑new size Shed:0 existing 0 new size Other: Zoning Board of Appeals Authorization O Appeal# Recorded 0 Commercial 0 Yes �*No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION 'r Name 2aV7,Z_ T �t Lcc y �� `? � Telephone Number •�zo •- Address _ 74t ic 1 C 8'o License# C74-7 69s Co TL4,T Home Improvement Contractor# 1 Worker's Compensation# WC-6 0 0 0 'S a o - c,o ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO O eIKlC^tom �� ►�>P z<- SIGNATURE V "' C DATE `i FOR OFFICIAL USE ONLY 1 ,9 PERMIT NO. _. DATE ISSUED MAP/PARCEL NO. ADDRESS 4 .r VILLAGE - OWNER ' f Y DATE OF INSPECTION: FOUNDATION tI FRAME 6 I4 INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH $` i '` FINAL GAS: ROUGH` ' FINAL + FINAL BUILDING r.4 C'! . . DATE CLOSED OUT;' • '' ^ . ASSOCIATION PLAN NO. - �r k . The Commonwealth of Massachusetts ' - -=- Department of Industrial Accidents , — Office OflQYestfff8 ions 600 Washington Street - _ -Boston,Mass- 02111 Workers' Com ensation Insurance Affidavit / / name: . ovation v, A hone# Z o ` S�� 3 ❑ I am a homeowner performing all work myself: ❑ I am a sole r rietor and have no one worlds sole /� %%�/%//l//•�r;x/•t,/$.xq'.v:%iO.a+.x,if.v 7.{/,::II:a.../�.a..,/.rva:I1:a•..%.r.S•,tn.••�}'f.%,}}?:•.$..:,•?!aAr:%••,:•{,:t.n^:{.r/r..y....%%,...;n...1.}k.;.%}n.C%:•..{i/.k:g:/r.:.r�.x..1:rY.:?.i..f:.,n,..I...}r:,:rf,xII.r..;r.i r.:L:.•E.••:.•••:Yx:.l.$i.:....}i.:•.•.:<r•.r:>.,.r:c:f,:?:::F:..}.{{.,'?t.;:i..••>.},n:c•a#.::::;•>:.r 4+.r•r:;i..::r¢v•'+:v...a.:...:}.�.+:,.."..$..;c.:.cv}.:.h3.},:•,,:v..;;:}.��•::t':..'•••'.-}:...}.a a.•r•.':r Yn''.�.::�,.n,}•.;::4+:+�..,•r:Y,.•a�.-..+:n,.:,Lr..r{w•,rL,.:\.v:.�n..;.?..v:..r....,.,:,..•,n:'.`.�,y?v:..'t,•.r::•.n.i.•:+,.:}.r s.y:,."...c;,y•r.:'ot r:.•.n{`}4vv::fira.:,fw,..1•.)..:.n,,.<••.:{.m.r:x{..••;:•rnw:.v..r•{n...i•.•:•r,•r.v}vr^•.::}:•:.•:#{.:::.•r::..:,:$.`,:•..r::...�.'y;.•}..ny:..}.n•;:}.^t,n:;:::kL<i:a:'r v:r•r+{^:^.r•?.:•tlr:m,{::..+.•':., eyX'::.:4•.:v:Y.:.,$:..e•},$.L..i.;�...m '.•:•}:.:::>.••:2wp:/hi./,<°•.i%::..{••:r%:y:r.r:..:>:...•./?Sir$.ei ./:.•$/.r.',e w:S./.::a'£%$r.'•'.S...:,+/>$v'�.%•�:7r}l.:r,n•3#.,:t'.ir::,?:1;gr �.'<v!Yr t';r%`.•.}g':.va}„ag/w/•}.y;oEf•v:,ra .%r4`v.,if.Y:.t%`•this /a•,�n/Y.b•2"/n.'r•v v}/}r.v/Y•�•.`,o/?}�r'� job. b workers' <xr3•,•:k}.{,<<'{•Z\k•k'yr,}%}^}Kr{:..%s};:x{;'•:%r:v;.•:i;./:%;' 44,%:h?,'.1•`.v;•r+%?x:r,;tF Sr':+s•;,'.%H:y:�r,'x/i•t•G$}:•,$r.'.t Y:Y¢f#/.C4r':;:/..:•.,,:,}F{.�/h$}}../i.:yb.t Y%i�w.}.;}.`yN%y•r.r v n,•,/'�3:.:..o./}4k/Z•.-}.i%,•t.YxY;,Z��}/';}4aK.,{/•v1r•.4q/::,t.,;r,%,,.u,a?F�.i,.`t,;: .%.:•}.;.^;.^r}.,Y.••a•/xiQ}Ar,F/�ua../v1.".�F,a/:•ro/�f}K. %"qt.�3 v%:..},•4.y},S,,`/y. S�n/�...r/4,,�°�.lr�.ifi iGa/f?/r y,./Ct•.n',..•23/n•'vY.` rh? :``a'y{rhc%.:{:{',.•';rv,;;.%..,/;.{��-ir,.:%t•'£v.,.,:M k a ensa I mahemPto p�providing #:^ "4G } r; iR: r sn n }•o; M : : x :n:i{ri}'}. .uy + v 2 aR........ .. . A .ri5}}:::. . ./ ";•;.:•::: ;., .. ,; r.n r. ... .:..rr. .r r. r.+ r. ,gs, .n .. ..v...+.. .. .. r::. •:.•:a' v v v.r F^,<�y' ••q• }^: •'+vim•{:::: '�y:,. r'%', ,•i^,;Q•.{}• :h1.. �•..Y..rY•':y: r rt'v:r�...,V:•?::vn.t:✓.•,•,}.;,kv:f '$ytC,•A:; �.• '� .ti da9 F,F:`x.. ...,..... ...:£t• .:}.::r::.. .... . .::: :x••::{•}:•>:{,••rn•}.::;};•:;v.»f.,.:tJ`:!{yC.}};?i•Ys. .4./('yr{?C'rf:.ta7,•.i } ,y #:k...,,. .•hi+{.#�r••'S}"gvrf•';,•..k •% ..xtq:,.•:c•::x:::rr......: .,,... ... r ...n•:•,,.,•.,•:L:•.}x•r::•.v:•:.>}r:rff:.,.s};. x. 6 .,:!:„fit v..;}tY'; }:M-%*%,a�Y'3,v :;5,}f+r}•?'is iw:Y,.•}yp;.�tb.;'L'i.'{ , $S�•:••::.• - .. •..:.: ....: r.,••:t:n•-::f, ,.., }.•:.Y:•}>,:';:3%fi<}Y$:::Sf{'+;+,},$r,},,:n,:.tti{"'42?�.T�t; y' � .t+•i<4:•>}}i{••}..F?x}:.. ...{ ::}}:^•}:{t?•x. .:fi '^r:^+4 + :a;.: •.v,F•:i2•>..f,.?},••R•3\Cy •.k?:rt,t#f• .tom �;_y;c,:%{^: 31 :.•:i:}>• •;n.4:.. n.4 r:v:7:!...F... r::::T{:v Y'•:{:v:•:4:•.;•T{f.�i .ahE.}!^fi^•'•.v{.:••. ^x:.fi...}.. n..afr.. ,.:}•.}•:?::'i•.x:.{.;.:.}.?.;;:;:;i,;i.:.•;•ia}:::} „k•.•,`+}.,: .:w •,•v#>,•}Y, %••:;•}}}r•+cif>$:'t?r{%. r.wbv:v...4:..t,.... .v,}:}:xr: ,....,::. ,•.}:4v' A •tar♦ ,•.},.. gvi;n•^:t•:r• :+:f}f.<'.. ;+;•}. :}+.n�'t .!.....r::. .x:}:+r. ::q:..:::..}r :•:r.r.:;.•. +?$!:F:4$ i+'••^ ..t';Y.n ,`ir:•a::.,:..r,.;.,},Y,+'%•+a•�:".�:''fi:'':,. .'#'` ,}.}};:,• :`,•,}.2Y$: ••.:•. :+;.nc..y x'•h:r..::.v,}?nr::::;:::.:hv?•Kr%f•.a'a..v yr;:: ..;•.;•.. n.. {....r.nx ... ,}. ,.•.a.`.•nr ,+n•�•}: ;;.y}y. :tFaftf...,;• !i.:f :::}: }}},v:::{..$,aa}i•::r.fi [iQil�' nka t $rr r,•:,:} .tr.t .......n•}.};.;+:.f ...: •.i!i:'i;:;;;}:::,.:::x•:c;:$;.?;,.••;{;•,.•.,... .,}: .�:ar{��`..,Sy; { ...F: L?.?ry;kL$}::u:S'l.•.r�'::;4}}:•{f.^r::rt .:... •r,.. .r:• , rv$:..$ '�F'} .. n.. yr.. r.:.:•:•:r?•{:.;:,+..:{:; .,..t.; r. •} !{.r:•�a;:}:^�,.v,. •?,}::::..:...., ... .... ... .: .:.,}:}r:r• jyn ...� 3,,..,,:.>,:t•r;,i:?Yb; ��:•:'�.}'^^�-": ?o',7{a, f.i};:�;:.},is .,y{�.,;.:rn•:::k,..r,•..:$:..,..r::.•..�ra^trn +. �^. }.....,... ...:.:. ,.:r:t;•:'+ gr r.,•:.a>:•:x:}r}•:,:•',•'•:::.....,:.yt:}.rr.i„{..<t:,,,v^S'':;r!#':a��'k`•�.�,'•::�•tr:6'i`'.f''•�:%i°}�r^{r}; ,r`•��,;E'�{+::>}•.•,,;£•,�,5 :£.:..;r ::.•b:};:s:; ::%# }•;:�.}:LC i:`,$fi:;;+.:`•`:..: :a:r'.'�+T:x9xa'r�t:ty :�t'a �{y7,�7�. ::re•�y' :,a}.v•:• {.}rnv v.4:C $}:•:'{.i...:. {%:rr:;:;:v%y:$$}.}•.. •:.O} ,..J... •+%r. �yS:q?. �]SY..n'{;;..,v { '+;{�L7.}}v.'4S,i'}'fig}:^. :;•?::<:: ,•r: �'. a�a.•}}'{{..::"v','r::{v.,:::••'ti•!ti{i:•i:•{?•..}..:}.,x{rryr,...:., ,..va.,.. .:r,.;; {: ,r•`{•........ ,..:}v, r .}, �+x�:., vr..1 v fi:7:.:;,+:::•r.•.:n,h �g;.�� `i{}�^:i"''' i ,y.,i%•:. � j•" .•ri $: ;K;;`•;ta?/;'•$}rr 4Gf::'r.�i:+�:�$•.F• f•{'•]��!jfr .q'•+'{.��';�ry{�}:A, ,�p7j( i�#S!'{3t::;,.:$�yti f'• ••� Y,.w::�•.v::•}>.?{v:tri;;v.•R{v.vr}'F, :. •rt.'':{Mr'•r.,.ar',',�^,,,trn4;'y:4T:r�.,f{a,'y,,µi;�i ',v.';}Y;{•,`y::SS:•:4:•!•;•}.•''•'}'; r:p4}. ❑ I am a sole proprietor,general contractor, or homeowner(circle one) and have hired the contractors listed below who :r a ationnn011Ces: �$'•n:k{';.° ar ' `9+ay?v•f y%c'w�'�w?''. : . ,nLKs..RZ� 'On ✓}SA�s{f rkers co ens F:. ?:{yyw ::{ r#:v::?•y`;•,f!n}}};ip,}:,+}g 3?n.}{s% .v. •:,• , . }s: % WO .,•:::...;4.nxa:n•{: xt.^•.Y.S%,i{:f<p,:$^•.,,.3y•.::•::::{...i$•:{.::;.;•.:;a::;;:}sib?a:.:::r"}.k}: . k: r$.. nr.:•rNOUN : n•#a/LY@{,a'.�e' {t -5' .thefollowing . :a�: •4.r'. rt ; ?. t} ,5,, . r.+.,,{,•�e:r? :. .�a}a}'•:! r t; .1,'v, b.4. •.-y 'i?n r..L?: atr r a.r.....v ...r:r a Y. bn,. a. ✓ Y-f 41.1 § .}.. .•\ {t:•r,iw:.•r.;?••,}.•'•. i��!Y}:#•F?vfi �•+. ai•.}i+t: n {rnr r 4..{ •:Ya:..n{:;.4;r;•rv{•$}:{?Lv'4:{ti}� :.{ r 4:i• .Z.{ v :f.:{.r{r.}4;+.F}}i iyr$:ai'+:••v r.., S�'•S{,'+i.4..nff,•n... lr.. '•'}F:;?::;}:`• . ,�.. :/. .n.• n..}.. x. :.r '+ .q.:+:v;.tif•4:aa•. ` f..r.. •:.:::'{•.Fn+::v7.4n•vinv.:•.^,`.4/,�,.? .. ...r..l.•r+•nr}: r.... .:4.. ..S•. .?{..n;v..v:�.,� .,n:v\. a.:,Lv;!:^•:•:.;;?.:^r^nor:1:3':$::j;:••{$fiF:t�C:•::•::{;•:•Y:}:• xn +.y.::•i'. .. :f�;{.::•.v,.4::+..r..;;..}<..,.{•:}•1.• a44Yt::.;.:.: �v. .. ...:.+..{r:,r,+. ..• .;% <:...... ,..,n•::::.yv}}:...x:n:..n....., rr:},n$:::•:...;.x:nF:.•.n:••v: rv4 }.; L.l rr•.'. h`\•:•.v.n•:}Q•:•,S;3}:?:{v.v::•:S}:t;:• :. q.. vr•'•'}'.^i•'';'lr,fry}'•'F;}:'na.'{r y,. :r•:}L::•.{yY.•:r;r:':a}S.a,rr..{t ....... ... n•'h7}:}•}+'{ xiL�•:•'r.�:.:.,,•};}fn?...v......v... +.}:•:r•::S•".'O':4:4}.... • :,%a'},3na,:r6v. : .{.'••}:.w:{\xFrnt,F:k•.:v.......}.. -:.s:+S$:i^if!^3:?.;#•'^:#:'yiiji:t:$rfn%&;,`•r•`,3y,{�;:,};'�:' {�• ...•/.•:3,w,F:'zrt'#'rc•••. Sww"Im 0.4 nI1$Ine...7..... tr•,•q•:.}y,,i,,n;ii:i:•:N$$;i?`Ak'•:## 'c4:F:.,:.{}}{ :.}, a rY?;}. i .L ;; :rr r^4 •,;y :s°ia 8R :::.{:.f^•. wY r{.nn;^r, v F#4rtF+i.C,r?;...n... );:.r...., r•,;{,v., ;,.;., r '' :G �C. E tr,>,faq:.. ' ,ri. }}}.a:+.+{ :x.n •ir:}h?�';+;r}<ixf;r,kfi;r.• :s.•3:$'f�+:� ..,•{ , .v ,�tii?"•. y{^ ..%f:.h+r'':F? � r:•.:..,^r>. : ; ; ,, a. at t n�•i!?fi$..%..^+:{t `.fx}}% ...Y t•.+. ::•<:•,•,,inv::;t{.$Y::a'•; v#v r a.a:.•:.•• 1 ,, ..•$Yk ?F}. fff'!;< ::+•;iEt:l..:.... , ..r'{'.''::,., !.•:.::t,.. .., :. rr n.••:.:,ii•r}{t.:.x.r..... :.•Y:bR':{.}.r:f...,r.;:.y r}:a. •r .y,.`?�d$,,::fst�:�frq;,�.;r.{:.Cr} n ':.91y!i;.:, ,,.t::•.a:'.',rr,'a. •:', tt:••vf:tv..rnF:•{t: ...2.:;::!:' ::iG.{.,r,,.,}.'S,yn:r .•r,,:,.xx;2,;{:;;}4.. .:. . :;+:k ...' t i/,•,.::>r. �r•:?.,'.$L;:}}.o•.a•vr::•$ L$i7r' }fi',:;f:;.. v:rrL'gf n;,./{43:a✓;t,.i}r::r....;:,v :,.,v,.:,:;c{.};+:::oa,.}{,L,..r:, y•..c• ; dt;...,.},.., {.•..9r,£••::v .,,1;}Y, .t tif?r 7..;,;a:;;..:h:Y•t,>:L.`:?•}::.}x:•>:•:.a:.}}:•:::•::.i.,:. " �,U,. .•c.,!F}t}•.Y}•::..L#•: :+:+?:. >3 a:•. ?�.i.�..,.``a•,2.y„pi}Ex�r:,..,.:rr...... r ;:•... r'w• JLf::....r..r..?•::. �+% : :?:rr:•`:1'?•}?:•t•.,+•..,.. .. {K: rtit + Y +fi7..•4:Cr�r :•;:3?:±;•;'ri.}<te.}x,: r:.�ty, �EMCNE ' ' k R{ ' {. Xfiy '',� ' '+r!c^3 ?3>r;:,.'�.•::$;,na,.:•n.::•. :. ii:•$#:;.•:.:: '{.}a:{i3.a$.'{•;:•:: .ns }:, ' : iir: •��+:�•'.r•:+Y ' ..::, : >t': k . y.v.}}. }.• } : i + ' " . ;!3Y•rn:r• ..• ..# . ,: %: f.}• f:tn v •:r. .{+•:. :., +:•.}•# a}•:}}}:` . v..i {,�yr •3'ty$$ekiY ?.•:>,::r�.:r:.:r.•:^•::•:$•::, ,rr}::r.�'�'.' +:�.l'$.q ...r.}vvit•.'��.a!v}.�S}.•:.n. .,,wa:i<;c,•:i::,:+•,+.•it'•:{r iiG:h.jj t ;':Xtnr,:q.• kt$• + �{} : G.::..^: ..X:•a.:.;f.,ro::,}>....:•+t.;,?n^f.>'4F�• ..}:.::F'•Yr.+,.,• .r}x^•::•:att:f}}•,:ttq$;;;:,•:•}:., :r,{.;E..r?Y•q,.,y„ ..}.,L•rfr •:S�r� ,. v t+y r 'r?��?ie #::•:;„•r•:}!s::{:.Yr}:vY:}y<.Y#r,,,. : .xrx. : •>•+, +{4?� •••• : .v'fx'winr�vfr•�44. £•. .:r. arq�a,,, :if}�,�•.>,<•+a' �' �.. ;•:;y::+F^•3^$'+c:!F,}'•i: ? •"•xr•v.n-..,.ry:•, a:r4 .L:, C3;. : '7.:•3.+1 n 'r''Ir.' ,'•{'x; .•:L. ...r•,••" ::`;$b`;;e.•Yh•tr{dt•:r..ti:ry#-R:;.}+.;,;....xy.}tvY.:..•..}}{{:?•.;•:}wi:`004 }' . fan r..w ;, ! 2o- +.;: •�fti.^•. .;ry 3.. } ,%a;�,c,p: a':•:x:.rir• {��f f' `• ; .x; :,::••£ •:a:F :a ..{:;.., 3 :•Y'{+.^af!'a^T:•SriiSS�:::$f,.;:..1...:. ',:+•fit%?,fY�,vr v.�:R;r.F:}.f':•Cf,•,3 .?.r}.,,r. 3na: i>Y•:. �y+;;.,d,.Y;•y4,s:+.,.?.,br.. d:}3C•'•+rr:>:+fi}}•:}: v,•:4;,'n';:r •r.E}57+:•#:nx"'•.t:f•:#'{.::!•'}:•;rr L; J.•.'.:::.•ry:•"^.",}jx :.}:•}.....,...!.?::.:: .•:+F,`'i}:}a. ,L:;#:,w„r.ti,.:?.r...%1r'IX•.'.+i. 'ELF/�.;%.Y}.n;a;{::••+`:::r5#:r$#••'.i7ti:f¢{{:•+ :�Y,rw,+r,F'.rr:v•!r,#}r5,y;.,retafan,.fag;.::;:a•::::{.;;:};,:4E#Y,•-:{c^iY<q;•;. •r,.o{#i}:t.��:';32.:.. b /�� ;4:!'3Y.rv.?:�::�i'f.v:$}•::G3:;.,.J;v... � 3. n..fi•.;`�.:...q.Nr+y;::,rr q n,.,:.., r::>i:`::•#:.}}. . ',::F:%v,a{.+r'::}}v.x..r•;a{;•.'.,j 4F?dc $`+,'•?•<t:!, 'v .,+:p,y,{:;.xF.,::,<dG.s..'•::^:a:Y.,}.}xr:a::::,:,.,..:}.. .. :.r. ,}.v...v.::!.n. y...y:• }xK°`o a.,?,...;{.:?';`+:r'i p•`iti'`'` +y }:G t 31LAitCesCQ••: ;;!c:S:,ayr r f!a%:c{~Tf} z'/:Si pI .:.;}•L:$:r:!Ftv.•{$::•<?�#•'i`:##:3:;{•}Yv:.+•.,,f,.;}(,}},:.vr,S:!,r.,�{{:Yy}. .i: x{+A.^F.v':n•'.•,'.7•`�F:finr.K:. -q,` ',,•na '} i• •.+ay'..•:+r{.•'r;{•i •tii+f.:'+c:}:#r;;#%:;+}:'::?v7:::Y,.p•:}•n{,•: {<^S:••r: n.:..,;.:y'},r?: wr•,4•:r:.' tt'u ,rk},,,,,,5, ;..::•.::,.;: ;:;:v :•.ar:::•a:•„-a•.v yr .,+•{G};•;?.:::a:;}:<ifi:?h i?}: ,• {rn .i,a .;+r,.. .F.. } .:r:' t}'3'+•i,`:y`'tv:... >i,:} }:•:'f};.v?:.,.: n••,+... :'#yci}, r:: .;h'r ;.. +•{a3 .• Y .:9.•k7...k:a•K r:r}:;^r:, k•': i•• .7;. :..+W„ ,`•:%`,•%•:x-..rE.;j: i:.}'<r:i,?;i{.:L-:^t:•::..n i:2t$}:•}<.:•J4'{;}{,<i<$`>:fv ..#t}` ,.x%S'.. r•a£^4 a.{,a •`MI z:{t•E.. Y.r}}:•?+.•::;v.;k•F::?;:,!:n:+:rF•<�:${+v Y:.h1'�f.,q{. ..;:. .} r•::F.u•.+•:...;, ....n•:.•; ,....:}:::..••.. + +., k,{ ?,•} ..•F3rfi•}{•; .:r<? .: .. },t v,..::...is Y'..,?.:#!:.: :•:{:�:..:. r..t•.,,4.v{.r.x r,.$.k•:+ia:'::a..t. ,.r:..}..:....,.,}}2;:}'•:v:n•}33:•.t�i•}.., :...:•• ,. r F':ar....r.x . :rrx:xq•:n•:?;.4::;.:ra:+„•.••'•Y•vsa+:.vn2,J,.:v•f,+::•r.:+x:r.fi.r.,�:.;.;r,::•v:�::t::{...,vq.}:,...7.o-}}•'+c$#,.},:...•.:.a•.:. a..�`•r:, .,r r:.v�r.�. .:....i,Y....n:�:rr....}.: ..r}.}+.4.$.,/... ..:n•:.:,..;};:n....,{.+:.:..:....,r.}:..,.;:•Sn:.:..r,.;.;L.tiY:{•.�•i4:..... ...'.v +{{i••{f+f�',:? MINES' k:?:F:• x#':.'1.•^;v::;:+.}'.;•::4.i':••}r::•{;r..E4.•n:r.•: f.• r:::^}....vr:vt,y:{}..r:•}r.•iv:f::::.an�v.fi;.}r}r.r:>.•r.•..,...... J r.yr:. ...nor.:...;r.:r..4..w�a�..n..r.: ..,t<:.t>. r. Y'•:\::••........ ..... ....... •:.v, ; v x::qf;•?n ti?. ::+tr::t:.+'Z' :�St�' v:,}r !$�3,:: LLq� .F.. fi4t„kn::;r,.•�„!..... .. ,.,.r...t r ',}$,;L,•$Y,. t;4}.,}...r...... ::,•:+ r::•.. K^'a3��:.i«•'.}i'F.'Ff i}.;rY.g:;a•.Y�, ::$vf+:•,.;L a...y.; jj;.,4,;,•,.,,}.4SYR.. :.::•:.}..:,}...x,.}.f}:+}z: xir3 } :.•{r::>.}:•{. s. ,{, .y a {{$ �•...fn,..i4"+i ..An:h.vr....}::•:Y. r::r{•..\.}v,.;:}b}rpv:•'•S��}:N:•;nv:?'.•ti'?' }`',�'tSn},q•$:`}f ::M i, •`ti�•j;'•3 �y`t`'a,{ v:;:',v,`f,•if4$v{ $IISE3T�III 7:a:{.v :: Y•,rv::aFtt} ":r{;;:}:?:: :.::f•;f r,. n.s i .. af:y.a{.,F.n, $: ,:.y,.•. }•3a •$. 3Y q.,:•?}:.,•:}. CL` r•y.;. .; ,, 4Cr.•.arr,r.uJ,.:..+r:•::,.;...;.,.;Fa}y:}}gi..,.,.....a.;i:?t?}}:4f•:,y:.�,,+aY+•r.v.itiE v: ;.ar :;,h :.'. 'X'vt a. { fit.•. :.i.. .........::•:n.,.,} .,r.};...y., ..,r.,.}Y r,.. ,5.,,.rryr.$,}•y r..,•rfr..{.,:..;;;.:.n::..vya;•rv}f{? •w•..v,.:;.•'4}::::Y. .{t\,.,.v.}.;4}+.a MORE }:,:r5;.r.,;..L•r.+.1f 2{N �'rn�O'.,:r,}...} r. .> .:s.+.r...v:r,wr.v;k...?rxt..if'qn .fii,.:F.:r:S,.y,•t;,./:•<:.'•.. qn.c?r ,: f;,•,{.:r.t+t:•r.:::::::ti:i+•+ ;.q;.:}: q,�.;. .,.a{qn•+.:,v.:G'i.r$:.vru `, r>YF;Y;.:A}}•:::........f,...r.. x .• .. +}u b,..+;,.. :.:'t.;•.y:•'.',tlL-•..?c,/.•:.:}iyr;;` ,.$... ftty+.`•:;.}7:.v.r ,;.a#x+:fta.x.n.rF.'.a«.... •+$Y?::::;:;i ..J.f ,:{: r" ',+�;:} :'+<...,:•S}}.}r,.r n.:•,}.,:•}•:.. ,:.t.:::n..r7.a,.%. ..•.: 'Yi,•'•.a.;.:•:. '•:•�+ {a}�t:'rri:•:F}Y.. :}}.fi. ., .<...5.�:{;t•i+',•.:fi. }yr } •S..v• .. .:.x%v. .v::{tv}$'•^•r: :n f{ti.... r..L.vn...r.. :{•.!Y':•,:,^.,r•Yfi;#$::,;'{i;:$3$jJ .,•q xi{N^?Y',^.,:i�:..✓.• .C:' i4. •�w},:+xr.<.a}x^•}:a:iif:!�:.•^yt^•.:•�.,. .vn••.:.r:,R;:r�:::'vri!..+t`.:;::;;:+.;.,., L•. r''•y.GY.n.....:}.a:,... ....:::;•.:.••!••::,.a?n:•.'•'•J��'5S2..:,.:x. .....,r•,' .:a: }. .•{s;:` }a:.. .s.+at $,vi{ ;S.v.}%: •... .:•...}.....xr::;,...:...:.,...r. .:.:. .X.+:+.,,...:.}S r.:'•.....,••.. n.;.t+t!tY}- +{}"•r,:r;•:}%tp:Yvfi;^ary!'{+f ?.?t' {�{of • ^' Yq .Bch„}:•: .tf.'r=Y .:q:^+r;.;ar:rn•nYL.:... ..;{..3}7}, •r,.t::ri.f:3gt i,a ',{;rn•.,'!+::k.•y,:;v,<•af,r, ..!r.••.•:•i.y, :':h .7?).. • ::•:••.:.. .. . ........ .. � ..n:.;;}•{{.;:;.;:.;?..n......:...:y,•;:;:.:.:ri%•::•:•::;:.{.::•::...::}.,•:•::•}Y'r }'+,+rCt•i•::•v;y�.e`}!• :.;Y,{.. .,};,:^rfy..r;•: .� :' ••. f✓✓ {l�IJcL�5. :.v,+'4•?:.•r ::4:h:v.vSn'{?:..•::•{?v.,• .. ., , ''�+;v .v 11 ;.,Y'i•FaY+?a^ ::•}tiuvr# yL?:'srn4x+R r} ,4.':>).::„E v,S^ .. .r.:.:r r...aa ..::. .•: ..v.::}}:+•:S:h•::.} :•::{i•}}:•"v:.?•::?{?•}}:•.:.;•.'•?:•i'•i$•• .r:::::?L•:::...}{:; ;{..' NAL}''iCv:;£ $..}:. :. .,..:::.,...,.r..:,.{a.+,..,.•v$:.. ..;.E. .v..:::. ., •,•:•::.r..:•::nvti......•:?.::nL......tn•.:.,...•:::x.,..:: :..r... . r.......y:c•. $ fix:?a�y:a?> .r:rv... ,r%}�fi ...F; ..Y. ...n•. ,Y�i,••.';,...y..t;.,. •:}.• .. .,),...t .v.?•:.: �n: Ck'vr..`ZL+tr? �i:}Xf^i?:3?LY'�i.;#:g2.y:• .?.� •r<••.: ` n}..;+..r....:nvy::'+;:{i.}'a'•:^4S:•}:;{.<;:?`;v+•}:v:.:,v:t.:::::.:?•:i<?L?�::•. {�yy`,e,� h`r rf� r:+.nr •:ar.t.:.y:•::.:.,•,2•:n.n::+•::xr.}:n•+:,•:r::;a.tru,•.i,v••a{.}:..:.•::.r..,,:o•.:..i.;•:Y•,•r •vn:?:•.v..+.::.......>:• +..:{.. L1YII {ta;.:..,......,i, .. :..:•/r•:.....r:.}.r......;....tx•:.,r..:r.;n•• .n„•:..f. .t.....:.q.... ...,... ` ..v •..4r,.:.}:a}}Y... t•r:. ..... r} ••} ra}�kr•;'CF:ii '?„F${t.,:,:•: .}.,n. ,:r;.,•..r..v::,•:•...::r..:fi.v•n r.:..,.:r. .,::+•:X•.,:,. •: .:?+..?F$r..::.•:+;}.•:?t:c;.::•>•..�...:.......E.::rr.}...,•:••..:•:... r r:r..•.r. :::..r..r.�... .,:.... .:.::....F}:...n.....f.:.,,,•,,.,....::?•.........:::::.:..:::•. r}.,,;a.,',+••>"{+ ... ...>:•::•.v:. .. r: .................. . . ............::.::{.x•>'S'';+r4:s;'f{{'{ni{.r,',t •x'vrY{r.?y 3:, ..''t SY+'t`'•'n� 't:?;;rw�:<:#;�::.t•;3!c., .Y�#g•:r}..:}:;..,.}.•:::.;.:•.::.}>;Y}f,•;.ir�$3,:q,.nY}+:.:•:^..to:::::>.•rn.. { ....::rr..•::.•:..:.v:;;.{.,Y,;r.::t:..::{•.}'•a+•...:a•i'f .};{x.;;v..y:�.:,r..:•.a.}'.nYt.q.: ,.h: xk :^•.a�•ur:"Y••+,,??•.Y + .v•:.i•.a..rr:: rr .•n:':..t....•^ .:.L•r L•:;:::;.. p yy"�X .nt; + ..,... n.....+. .. :•r{+}}}::.4: :L$j ri:{'{•f<:{::}:.w: ....rr vri•, :tiYt•.v.{;.n{., n.a.; < 'tnti.n,:S ,.5. •:ryhr:• .;'.R{' vWl,x .CS.. . :..fi ..t:. r°F:v •••.t..r •::•x•,:i•.'•:<�ir:•:}:a}Y3:.... ,t::{•}:t:.}}f ..n�:..n{ay,+:;.;a�,r,;''� ,,.ralr;+a:+•a•'r}!n•,'t:^.:S•�`'?r"'�r• k''` rrir,.{S#ii::i!::: .... ..,..; •.v•,y;•:etkai:k..L,.y.•;`.•rtr::.•.•f^C...a.•.:.{.•r{.:•r.,{.}%•a:rr•`.:<if::r::••,:.,v::v:,..}nv•v:.:vr:n,}.,;r;:h.$,.; :%:,,.wry !}.,,%' '?,•. ,,<,::r:y. 'CSb}}.,.., .. .nv•-x::n{n:v:•.a!^. /�}a,.a.,f, ...fx>;.a .rk ,.}q•;.•.acvv.{,.;;;,•.,.:. +r:w..•.:'$:^ .•:•.wr ;..r.i .,;rr ,a. svC{ ''�i:;r'''fi`r'.,}r'.f:,}:w.,rY.Ff:Sry> ,ni.^••.%{vnq}.xi:n,4;f};•...v;i:r:qj r,r.}Y.4}}.v::}i:h •..FSr:{:,-q•;,j:}r.rrf , f.:::n;:{{.}4:+i}:`:r:{n;.}:ytq{:::.; +t: :..,:... {.. }>. +•'•rn<u•#7r :tir: f,:•Y•..{,}.......... y. r.........v.:,,..,, nrx•: ,.., .y..q.,r,.•t•:•:,•`,••,r:?x+`##:3•}F;:i;..t;.:: { }::4.}v,•}•:.::;tiff i.}•:;:an x'•: ffs?P.!F•vy:•:q•$::,•.•:v<;i!.pr:.f;R�{�4 a+;.,`?'•',t;,a.,q :, n♦ }.•,.n++ ,,.,{.nn "^ r:,y:t;.c.�+k�:'•^'+rr!�.%�t?}+•;-fy�it•HR'f,,y:;}:`•!#. ti!av +..?. y; ..:':�:}�•.:::>}}::.'}::r.S}.•:t., ...04�33]11. ....r r Q�• r}ft:na+n..a.:vn.a:.nf, ••rt ,. 6 tUQ•rsave:co.�$}:>+>.•A.}.•^:!^:y;.::.,,•'�;n•}: .. . ...Y.. of crfminslpenalt3es of a Saes to 51,500.00 md/or Fyffe toMCWCcverate as reg�xd ceder Section Z5A a[MGL 15Z csalead to ° P Sae of S100.00 a day against ma I� �that a one years'i L n erXg as j a+civil penalties in the form of a STOP WORK ORDLR and a veriffcation copy ea of thi+statement may w n as d ded to the Office of Investigations of the DIA for coverag tutder the muss and penaltc °f perjury that the informati°n P1°vcded above is try mcci corral I do hereby certify P Dad 2 S � a�- ^ c Signature Print name �7 Phone# do notwrite in this area to be completed by city or town offidaI oiSdaluse only • C2g nepartment perudt/licewe# �Idc g Board city or town: C]sd=tlnen?%Office clieckif iznmedlitz resPormisregnired C3E1W thDepartment Other phone#; contact person' II (wised 9195 NA) Information and Instructions ir Massachusetts General Laws chapter�, an employee is defined section 25 re employees. As quoted from the quires all d as emery ployeersonpinthe serviceers' compensation for of another under coentract `law of hire, express or implied, oral or written. artuershi 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 building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the 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 until acceptable evidence of compliance with the insurance 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 ce 5 all your siWits maybe supplying company names, address and phone numbers along with a certificateOn and of,,,�,„-�„ submitted to the Department of Industrial Accidents for confirmation of msurance coverage. Also be sure to sign and date the affidavit. The affidavit should be retumed 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 ' atioil oli lease call the Department at the number listed below. ens are required to obtain a workers comp p c5' P City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the peimit/license number which will be used as a reference number. The affidavits maybe retained n_ the Department by mail or FAX unless other arrangements have been made. i The office of Investigations would Like to thank you in advance for you cooperation and should you have any questions.. please do not hesitate to give us a call. The Department's address,telephone and'fax number. The Commonwealth Of Massachusetts . Department of Industrial Accidents Office of lavesdgaugns 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 ofVE, , Town of Barnstable At Regulatory Services BnBxsrABLE, ' Thomas F.Geiler,Director - MAss. 9`b 1639• °� g Buildin Division prfD MA'S A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which.are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type.of Work: i� t i� r(z^J '-,2g,se,,-j A'!Z10 s-A Estimated Cost Address of Work: l Z 1 C )rl rV-X `> �.G `Z` ti` A Owner's Name: Date of Application: I hereby certify that: Registration is not required for the following reason(s): - []Work excluded by law ❑Job Under$1,000 []Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: ' 117-5( Date- Contractor Name Registration No. OR Date Owner's Name RESIDENTIAL BUILDING PERMIT "ES ' APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $Z5.00 FEE VALUE WORKIMET NEW LrMG-SPACE ' squarex.0031= feet x S96/sq.foot= Pius from below(if applicable) A.LTERATIONS/RENOYATIONS OF EXISTING SPACE g jP 64/s fa 11` x.0031= �g square feet x$ q• ;It;fmmmbelow(if applicable) ACCESSORY STRUCTURE>120 sq.f >120 sf-500 sf $ 50.0 0 >500 sf-750 sf 75.00 >750 sf-1000 sf >1000 sf-1500 sf 100.00 >1500 sf-Same as new building permit: x.0031= square feet x$96/sq.foot= STAND ALONE PERMITS x 530.00= Open Porch (number) x$30.00 Deck (number) _x$25.00= Fireplace/Chimney (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25A0 gelocation/Moving SI50.00 - 3 (Plus above if applicable) permit Fee 7Zo CMR Appendix! Table d3.1Ib(contiaAed) Fossil Fuel ' pmeriptive paekaga for ace and Two-F=4 Residential Buildiegs 99, e'i - MAXfMUM MINIMUM Slab Heating/cooling ent Glazing Glazing Ceiling Wall Floor 13aseall ls paitneier Equipment Elliciency' Area'(%) U-valus3 R-valua� R-yaue R-valuar R valu l R velour p$ckage 3/Q1 to 6500 Besting Degree Da 6 Normal Q I2'/. 0.40 38 13 I9 10 6 Normal 19 19 10 R 12% 0.52 30 6 85 AFUE r12•/. 0.50 33 13 19 10 Normal 13 25 NIA NIA 15% 036 38 6Normal I S'/a 0.46 3 a 19 19 10 NIAas AFiJE 15•/4 0.44 3a !3 25 NIA a5 AFUE 0,52 30 19 19 10 6 15/. N/A Normal 3( 18'/. 032 38 13 25 NIA Normal 19 25 N/A NIA y 19% 0.42 38 6 90 AFUE Z IS% 0.42 31 13 19 10 90 AFUE AA 18•/. 0.50 30 19 19 10 6 1. ADDRESS OF PROPERTY' 2- SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING: 4, %GLAZING AREA(#3 DIVIDED BY#2): g, SELECT PACKAGE(Q--AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION, BUILDING INSPECTOR APPROVAL: YES: N0: q4orms-580303a 780 CMR Appendix J Footnotes to Table J�.2.Ib: lass doors, skylights, and d Glazing area is the ratio of the area of the glazing assemblies (including sliding-g basement windows if located in walls that enclose conditioned space, but excluding opaque doors) to the gross wall area, expressed as a percentage. Up to Mof the total glazing area may be excluded from the U-value requirement. For example, 3 fl of decorative glass may be excluded from a building design with 300 fl of glazing area. 2 After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table 11.5.3a. U-values are for whole units: center-of-glass U-values cannot be used. The ceiling.R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation•thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. 4 Wall R-values represent the sum.of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding, structural sheathing, and interior drywall.For example, an A 19 requirement could be met EITHER by R-19 cavity insulation OR R 13 cavity insulation plus R 5 insulating sheathing. Wall requirements apply to wood-frarhe or mass(concrete,masonry, log)wall constructions,but do not apply to metal-frame construction. s The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces, basements, or garages).Floors over outside air must meet the ceiling requirements. The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must maec nt as the same ra st be included withethe otheroglazinge s Basement d orsmust m ett th door U and sliding glass doors of conditioned base -value requirement basements described in Note b. "The R-vafue requirements are for unheated slabs.Add an additional R-2 far heated slabs. ' If the building utilizes elebtric resistance heating use compliance approach 3;4, or 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. For Heating Degree Day requirements of the closest city or town see•Table J5.2.Ia NOTES: a) Glazing areas and U-values are maximum acceptable levels. Insulation R-values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b) Opaque doors iri the building envelope must have a U-value no greater than 0.35. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table J1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c)If a ceiling,wall, floor,basement wall,slab-edge, or crawl space wall component includes two or more areas with different insulation levels,the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- -value requirement(0.35 for doors). value of all windows or doors is less than or equal to the U A'1 �' urael�a • BOARD OF BUILDING REGULATIONS License: CONSTRUCTION'3UPE,Vf8OR Number.,iCS' 041,,693 �%p9/23l195$- B.rttttlate.: Exptn :?09/23/2QQ3 Tr.no: 5442 —Ado,rictd '1 G .STEVEN P MCEL4111w, ! PO BOX.282 COTUtT, MA 02635 Administrator �T. _ ........ .-..ter-.- �..... . ._ fie -�oorrmcanwea� �`/ua�ac�ivaella Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR lug Registration: 110485 Expiration: 10/2012004 1 7ype; Individual I C t `J R r4`�CLIEGIY Bi.WER -\V,,6vt1-I�1dY �A,- ��'�� l �,vl�►,tvov�. ' 1 11 1.A5��-`�`S • .U� �I [�'-0'• I�}Zi:��DV,�`, t7C . ►Jo►J -7vc:��2it�C� �r��-- !' L1 - I I _ ----I L.--- -.-_._. .-- I i?-' : .oGA _ of 7aof-Bairtable Regulatory Services 9'A ABM MASSS. Thomas F.Geiler,Director 039. Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must_Complete and Sign This Section If Using A Builder I, W-A Z-kir-'C I'A as Owner of the subject property hereby authorize `f to act on my behalf, in all matters relative to work authorized by this building permit application for (address of job 1 Zl Ox�v�2J Z� CJ < < "".4 ei Zt-3S Signature of Owner ate Print Name