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0119 CHILDS STREET
. � w a . � H - o .. .. o o ,. �. a �.. � a .. a .. �- c r ,, � .. .'.,A ,. :. . .,, a -. ,..., ,, ,. ... ,¢ n .. .. .. a 0 _. .. .. _ �; j e R � � � .. ;. K � .. Town of Barnstable Building �.t";' •, ;. m.- .:,._ __" ,,"-'..""'�"`n"r"-'."y:r, t''"�',;,:;'� „��m"`•,n+r ,w, ^'=.,M',;,. rs. *. Y'F'a+1-"a»�,�'"g �" `°'"'�.:, ,Post This Card So�That�t is Visible From the Street ApprovedRPlans Must be.Retamed on Job"and this.Card Must be Kept �'`� ";,n :.ti, r .; fF �,.s#. W r Y:X. ,,,...R;.c G .� :.9 u'� r =. ✓. ro x M? • '"^`�• � � 1639, ��. 3 z.+,'m. ."•r'�=, ,�{Y..�-r„w ,�,��w„ .< ^'.y4:""� •e,��,:,' �«�",a `� � r f ft� �i „- ,:„d;,,w�� .nf ,� !;,� �` s+1�"� �" Where a Certificate of Occupancy;s,Required�such Building shall Not be Occupi d°,until:alinal l�nspecti�onyhas,been made��� 'Permit Permit No. B-18-401 Applicant Name: YERVAND GHAZARYAN Approvals Date issued: 03/01/2018 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 09/01/2018 Foundation: Location: 119 CHILDS STREET,CENTERVILLE Map/Lot: 249-005 Zoning District: RD-1 Sheathing: Owner on Record: THAYER;DIANE M&LYONS,LENORE P # ,r ' Contractor,Name: ADVANCED BUILDING SERVICES Framing: 1 �, LLC Address: <119 CHILDS ST + 2 . -Contract CENTERVILLE;MA 02632or License 182162 h Chimney: Description: Bathroom Renew. Coset,Remove, New Closet Built. New,Deck like '� =Est Projj t Cost: $58,680.00 to like dut to severe rot issue. m'"< .�Permit Fee: $349.27 Insulation: Project Review Req: _ � � � ��r� �� -� Fee Paid a $349.27 Final: Date 3/1/2018 Plumbing/Gas P �^"" ^✓ Rough Plumbing: �� � '. Final Plumb in m Building Official g' Rough Gas: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and theapproved construction documents for which this permit has been granted. Final Gas:- .All construction,alterations and changes of use of any building and structures shallrbe in compliance with the local zoning by laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Electrical work until the completion of the same. "s Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire.Officials are provided on this permit. Rough: Minimum of Five Call Inspections Required for-All Construction Work:, „, ` g. 1.Foundation or Footing 2.Sheathing Inspection Final: _ 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Low Voltage Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection S.Prior to Covering Structural Members(Frame Inspection) Low Voltage Final: 6.Insulation 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Final: Wo k shall not proceed until the Inspector has Approved the various stages of construction. �,�, Fire Department "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT CF IHE 1p� pApplication Numb'�.. ........ .. ...�............:.......... * BARNSTABLE, +" y MASS. $ Permit Fee................... .....Other Fee........................ 1659. Total Fee Paid`....F ................ ...... TOWN OF BARNSTABLE Permit Approval b ....... . . . .�!..........On..3. BUILDING PERMIT Map...... `'... ..... ..............Parcel....... .. APPLICATION Section 1 — Owner's Information and Project Location Project Address Village Owners Name ew 0,, e- Zyws 1 6 i6w �Le,- f f Owners Legal Address ' /l9 CA/?r City Can 7°e 11,:6� ` State 41 Zip Owners Cell# E-mail Section Z— Structural Use ® Single,/Two Family Dwelling ❑ Commercial.Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet Section 3 —Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment Sprivr System ❑ Addition ❑ Retaining wall ❑ Solar • _n C Renovation. ❑ Pool. ❑ Insulation 0 Other—Specify 00 Section 4 - Work Description C � w � BaAKonen Renew, Cos Rom©&V, Alew C OE eu/ � �4u T..+,,,,aarPA- 11/1R/nm7 Application Number.............................................. ..... Section 5 —Detail Cost of Proposed Construction 5'6 680, Square Footage of Project Age of Structure Dig Safe Number Total# Of Bedrooms (proposed) # Of Bedrooms Existing �/ � p ) 110 MPH Wind Zone Compliance Method ,❑ MA Checklist ❑ WFCM Checklist ❑ Design �I - i • -Section 6 —Project Specifics ® Wiring _ ❑ Oil Tank Storage _ E] Smoke Detectors Fire Su, Gas Plumbing "�-❑ Gt `u ❑ ppression ❑ Heating System El Masonry Chimney - y ElAdd/relocate bedroom Water Supply ❑ Public ❑ Private Sewage p a e Disposal El municipal [IOn Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: /�3� I am using a crane ❑ Yes ® No Section 7--Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units(on site) Setbacks Front Yard Required Proposed N r l Rear Yard Required Proposed Side-Yard' -Required Proposed i Has this property had relief from the Zoning Board in the past?. ❑ Yes ❑ No , Application Number........................................... Section 9— Construction Supervisor Name YP. p*d �y� Telephone Number L:7-7�') 836 .5-5-cur Address /3 Cdt,A?6�:n c�/a City YgrmW*fState Zip License Number ��—/20 License Type' CS Expiration Date 2 // o/ Contractors Email Q d y����S S (' 6 S-Yos— I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 d the Town of Barnstable.Attach a copy of your license. Signature Date 1 8/fB Section 10 —Home Improvement Contractor Name y�/I/�d 7�� �/y ai` Telephone NumberSStS— Address y/f,09 City Al wrOc/-4� State 0,61 Zip Registration Number l&,2/4 Z Expiration Date O5- -i/zz0/q I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation_ required b CMR and the Town of Barnstable.Attach a copy of your H.I.C... Signature. Date Section 11 —Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number I understand my responsibilities under the'rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand.the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT SIGNATURE Signature Date Print Name Telephone Number����� T E-mail permit to: k6r1j1,4AfCE v Last undated: 12/28/2017 r • r Section 12 —Department Sign-Offs Health Department ❑ Zoning Board (if required) Historic District tiw Site.Plan Review(if required) ❑ Fire Department ❑ ,, �..., ;#j ,£ Conservation �� ."a. ..-. ('e.... ; <' ^� °':1 For commercial work,please take your plans directly to the fire department for approvab Section 13— Owner's Authorization I, `k 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: a . - (Address of j ob)" t Signature of Owner ,ti t Vdate Print Name SNIP £ T net nndAtPA- 17/7R/?Ol7 1 _ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street - Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information J� Please Print Legibly Name(Business/OrganizationlIndividuaI): ktla�2aed Bcl ,%?r Seyo ceg Address: 400 2Y Z City/State/Zip: G. bWo;5 /114 Phone#: F ?el 83 6 Are you an employer?Check the appropriate bog: Type of project(required): L❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.® I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp.insuranceJ required.] 5. ❑ We are a 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 � 'o workers comp. right of exemption per MGL Y P insurance required]t c. 152, §1(4),and we have no 12.❑Roof repairs employees.[No workers' 13.❑Other comp.insurance required.] *Arty 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,,yhether 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 ng 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 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 c e verification. I do hereby certify under t ains a en .hies of perjury that the information provided above is true and correct: Signature: ¢¢ Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to&rfiaintmance,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." . r 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 coinmonwealth 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-contractor(s)name(s),address(es)and phone number(s)along with their cerlificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permitllicense 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 , Dement of Industrial Aeddents ' Office of Investaigation s 60-0 Washington Stet Dostan,MA 02111 TeL##617-7274900 ext 406 or 1-977-MASSAFF, Fax# 617-727-7749 Revised 4-24-07 wwwmm gov/dia -=�- Office of Consumer Affairs&Business Regulation - - HOME IMPROVEMENT CONTRACTOR TYPE:LLC Registration valid for individual use only u�-- ± before the expiration date. If found return to: IJ Registration Expiration Office of Consumer Affairs and Business Regulation s182a62 05/31/2019 10 Park Plaza-Suite 5 70 _ Boston,MA 02116 ADVANCED BUILQING SERVICES LLC YERVAND GHAZARYAN` �� `�`-- ' LY 15 CAPTAIN W RIGHT �- of V WIthOUt signature S.YARMOUTH,MA 02664 Undersecretary 1 t Massachusetts'- Department of Public Safety Board of Building Regulations and Standards Construction SuperN isor } License: CS-108653 YERVAND GHAZARYAN� 15 CAPTAIN MWGH -;RAQ D_- e South Yarmouth 1VIA 02Gfi1 � ` J,•�... JJ � Expiration ; 12/11/2018 Commissioner 5 Advanced Building Services LLC , ' �.. �� Estimate 900 Rte 134 South Dennis, MA 02660 US 888-979-4227 advancedbsllc@gmaii.com ADDSS :` SHIP TO RE ----.._--------- ----_--- -- - — - _ --_. Lenore Lyons Diane Thayer Lenore Lyons Diane Thayer 119 Childs street s 119 Childs street Centerville, MA Centerville, MA r K ESTIMATE# _ �DATE--- +— --- -- f l - 1001 10/24/2017 ---- ACTIVITY AMOUNT' 01 Plans and Permits:Plans and Permits I 1 600.00, File permits(building/electric/plumbing/health)with Town of Barnstable in accordance with MA State Building code 780 CMR, including plan review and inspections 02 Site Work:Dumpster - 1,200.00 Supply 15 yard dumpster or dump trailer for construction waste removal(based on 1 dumpster) Services - 45,380.00. Demo and remove existing upstairs bathroom vanity, sink, tub,toilet, closet,etc: Remove carpet from the second floor. (New Carpet and installation is not included in this Estimate) Remove sheetrock from the wall sharing the bedroom to studs: Remove the wall and move back into the bedroom. Details and plan based on the sketch pro{vided by the homeowners. ; Remove second floor railings with balusters. Build new walls for the bathroom, the closet and washer dryer room' Frame and build new door openings. No transom window in the closet wall. Install wallboard on new walls and patch the areas where touched. Includes tape and compound to prepare for paint, or - plaster to prepare for paint. Repair living room ceiling damaged areas. " Install new fixtures, Vanity($750.00),Vanity top ($300.00), Sink($200.00),Toilet($300), Shower valve ($400.00), Medicine cabinet($200.00), Shower Grab Bar(1X150.00)� excluding Tile Showers. Including installation and materials. Floor, shower wall, laundry room tile installation, regular pattern, including glue and labor'(Tile material - allowance$750.00) Install new doors on the openings. Door style to match existing. Install new small hand rail on the up of the stairs. ;. Install interior trims on new doors, baseboard,window trim in the work area. Paint bathroom walls,trim, door, laundry and closet and living room ceiling. Remove and replace first floor bathroom vanity and toilet. Remove existing living room bay window. Remove exterior and interior trim. , Adjust frame to achieve rough opening required for new window. f - Install new triple window (doublehung/picture/doublehung) Install new exterior trim to match existing. ' Install new interior trim to match existing. ' Apply foam insulation between window and frame. ~ i 'ACTIVITY ,- MOUNT:.. i Remove existing back deck. Including railings, beams and posts. Client will be advised of how much needs to be replaced. Frame new deck. Size not to change. New footings and new support posts. Deck material to be Azek decking and Intex Hampton Railing with flat top. Remove and install new slider in the second floor by the deck. Slider to be Andersen slider with white hardware. OTIONAL(NOT INCLUDED) - Existing interior railing upgrade with new style hand rail and balusters ($1800.00) OTIONAL(NOT INCLUDED) - Hardwood treads and pine risers replacement($2150.00) NOT INCLUDED - Painting entire house or the first floor '�vC A eS e i� iv S�4�'rc,� e i �P, 14 Plumbing 7,500.00, Plumbing- Relocate the toilet,vanity,washer/dryer hook up and tub/shower location. Allowance$7500 16 Electrical&Ughting:Electrical capping 4,000.00 Capping and removing any wires or fixtures that will need to be moved for new installation. New light/fan combo in the bathroom. Allowance$4000.00 Please note-our standard contract: TOTAL58 68��0� This estimate is valid for 30 days. No additional work is included in this estimate unless described in writing. Any extra work will become an extra charge over and above the estimate at$70.00 per hour plus materials. The property owner has three-day cancellation rights of this contract under M.G.L.c.93,48;M.G.L c. 140D, 10 or M.G.L.c.255D, 14 as applicable. All warranties and property owners rights are - under the provisions of 780 CMR 110.6 and M.G.L. Property Owners failure to make payments for work . duly performed may result in a lien against the homeowners property. DO NOT SIGN THIS CONTRACT IF YOU HAVE NOT READ THIS ESTIMATE.SIGNED ESTIMATE IS A CONTRACT. 5%deposit at contract signing 30%at the start of the project a 25%after rough plumbing&electrical complation 20%after wallboard completion 150%after the installation complation 5%after project completion Accepted By Accepted Date - 1 110 sono 4u& sp�o-�v� . i7 0 PT y ee10 Jer (2� 2X 10 P1 (� y x 4 PT II D'1 ion o a� Prop P - - Ce�4 erv;eee, r� - Pit 001 z Una f . el Z nn ttr o .. bed e - � _ _. ! i .. ^ ..• .. a - � ..' , . s Lo FT R� os- .2,,j f4o f C'jeViQe i� f s 119 too r T 6 V y t P 9 i i i i G $� 9 Q • r U , N o • � � N x c dO O ' a , V3y r .. • 3 X y ry - eX�sf 1/7 a k O r Y 4� . s � , � . . - _ s 4 . 0 r i .� ! '� �. � � I ' C$+� a �. � � � 3 � i � � � �.< ��n,' ' �' .i. V 9. �' � - � - � - . . . � � -'� � . �. � _ . . � . t � 74 - o ot G X , a 1 4d' 1 i r� •. i ((yyam� y , 3 a A sf t 1 1@1@� 1 Y Y • Ex S� MP a , 7 L(jo n Sc �_ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel I 605, ..Application, 'Health Division Date Issued Conservation Division __ Application Fee bl Planning Dept. Permit Fee �� Date Definitive Plan Approved by Planning Board 4/A/,/q;GL Historic - OKH _ Preservation/Hyannis Project Street Address _ �p� c 1 Or 57 Village fc/_i f 0°/ o Owner e ® ! d�v f / a+�,✓ � clAss_I k 0, Q d .�' Telephone 0 1-3 Y o f Z7 `Y —Permit Request Request e w i-f S`� i' Of e -,%ti r �. Square feet: 1 st floor: existing 0 proposed 2nd floor: existing--proposed Total new ©' Zoning District Flood Plain- Groundwater Overlay Project Valuation YN, _Construction Type tom.. o o 9 ?0 Lot Size V.7 Achk Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of;Existing Structure 1 Historic House: ❑Yes 211 No On Old King's Highway: ❑Yes ❑ No Basement Type: dFull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) �6 Basement Unfinished Aresq.ft) CD Number of Baths: Full: existing 'Z— new Half: existing 'hew t Number of Bedrooms: existing A new w Total Room Count (not including baths): existing new First Floor Room Count ` Heat Type and Fuel: C3-Gas ❑ Oil ❑ Electric ❑ Other CN Central Air: ❑Yes ❑ No Fireplaces: Existing_(_New _ Existing wood/coal stove: ❑Yes ®-N-6 Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ®-No If yes, site plan review# Current-Use- _------ - - — _ Proposed Use_- APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number f C J Address ?H OUA, e V-f/o License # 2 (o G I( re _ Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 1 /V �e SIGNATURE���� � DATE /y / L M1 FOR OFFICIAL USE ONLY APPLICATION# �} ' ,. _.,,DATE ISSUED ?�a s -MAR/PARCELNO._xj a ADDRESS VILLAGE OWNER t. - r ,! DATE OF INSPECTION: R f ^:sFOUNDATION:_' rS� tolls Z FRAME `i .INSULATIONY . r'. r r t FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ->GAS c:,A,.n. ROUGH w--1• FINAL ."iFINALBUIL=`"DING`' .! x 3r) ,L 101 1/1�/L R f-=DATE CLOSED OUT 'y ASSOCIATION PLAN NO. c The Commonwealth of Massachusetts Department of Industrial Accidents 02 Office of Investigations 0 600 Washington Street Boston,MA 02111 SV www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeLibly Name(Business/Organization/Individual): f t�,t Q a,1. I (J,¢� A C � !�✓ Address: 3 l+ P y 'A y City/State/Zip: C�.,v a f K%A t � 0.r 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 1 mployees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.0 I am a sole proprietor or.g - listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me ' any capacity: employees and have workers' [No workers'comp.insurance.., comp.insurance. 9. ❑Building addition required.] 5. ❑ We are a corporation and its -10.❑Electrical repairs or additions . 3.❑ 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' 1I©'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 fine up to$1500.00 and/or one-year imprisonment,,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$256.00 a day against.the violator. Be advised that a copyof this statemerit may forwarded to:the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: .�V�'t ��1 X-� . _ Date Phone#: 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): s .1.Board of Health 2.Building Department 3.City/Town Clerk4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: a� 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 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-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in _(city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related 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 Massacktusetts Department of Industrial A.ecidems Office of Investigations 604 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-977-MASSAFE Revised 11-22-06 Fax#617-727-7749 • www.mass.gov/dia �IKETown of Barnstable Regulatory Services • snaxsrA= • MASS Thomas F.Geiler,Director 639 w Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508=790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize I� (,N-2A to act on my behalf, in all matters relative to.work authorized by this building.pertriit. r (Address of job) Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled before fence is installed and pools are not to be utilized,until all final inspections are performed and accepted. Signature of O r Signature of Applicant Print Name ' Print Name Date Q:FORMS:O WNERPERMISSIONPOOLS THE Town of Barnstable Regulatory Services • saants'resU, * Thomas F.Geiler,Director Mnss. 9q'prf16.19. ' Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 R'R'w.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: s 4 city/town state t `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 log.1.1) The undersigned"homeowner assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(seeAppendix 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. 1n this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner actingas 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, :hat 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/cer ification for use in your community. Q:forms:homeexempt LOT IZ 2 :0[W S.F+ ` ddcK #119 — �Y2 STY �11-C 80 J 11rs.85 7 p RI vE � CHI LDS STREET I CERTIFY TO DUNNING, FORMAN, KIRRANE, & TERRY, FIRST UNION MORTGAGE CORP. , AND ITS TITLE INSURANCE COMPANY, THAT THERE ARE NO VISIBLE ENCROACHMENTS OR EASEMENTS EXCEPT AS SHOWN AND THAT PHIS PLAN WAS PREPARED UNDER MY IMMEDIATE SUPERVISION. THE LOCATION OF THE DWELLING AS SHOWN" HEREON A" IS IN COMPLIANCE" WITH THE LOCAL APPLICABLE ZONING BY-LAWS WITH RESPECT TO HORIZONTAL „ DIMENSIONAL REQUIREMENTS. � yi 24 f= EI I� �i:',1 FHE DWELLING SHOWN HERE DOES NOT FALL WITHIN A SPECIAL FLOOD HAZARD ZONE AS DEL I NEA rED" ON A MAP OF COMMUNITY #250001 -0005C DATED 8/19/85 BY THE F. I .A. ' Kenneth R. Ferreira Engineering, Inc.' 4'• 11.0.Box 1903 ......""•' New 0M11ard,NIA 02741-1903 Tr 1:508 992-nn2n• I-ax:508 992-3374- GENERAL NOTES: (1) The declarations made above are on the basis of ■y knowledge, information, and belief as the result of a mortgage plot, plan tape survey inspection made to the normal standard of-care of registered land surveyors practicing in Massachusetts. (2) Declarations are made to the above named client only as of this date. (3) This, plan" was not made for recording purposes, for use in preparing deed descriptions or for con— . structions. (4) Verifications of property line dimensions, building offsets, fences, or lot configuration may Lmm be accomplished only by an accurate instrument survey. SP11 t WS v . . Massachusetts -Department of,Public Safety Board of Building Regulations and Standards Construction Supervisor 1 Jc 2 Famih � License: CSFA-058266 CHAEL J RENZI AU -i 387 PHINNEYS LN CENTER VII3LE MAC i0�2632 IX Expiration 01130/2014 Commissioner: ✓fie i�arrvy+� � °�' dQC�!''Aa License or registration valid for individul use only, office of Consumer Affairs&B siness Regulation before the eXpiratiQn;date. If found return to: HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs andrsiness Regulation Registration ,A 11859 Type: ` 10 Park Plaza-Suite 5170 13 DBA 2 14/20 . . ;. � .Expiratwn:_ I Boston;MA 02116 ` MI EL RENZI C&V--RUCTION 1 , MICHAEL RENZI\,'. '� I 387.PHINNEY S LN;ti � - — CENTERVILLE,MA 026-2 Undersecretary Not val' thout signature ` 1 : , y L • F F p9' . !! 1 r _ k r a � t � i , x a6// 0 (Qi� r Town of Barnstable. *Permit# Expires 6 months from issue date Regulatory Services Fee ass Thomas F.Geiler,Director ll�10�!! Building Division I d ' TAT- Tom Perry,CBO, Building Commissioner",: 200 Main Street,Hyannis,MA 02601 NOV 7 2011 www.town.barnstable.ina.us _ Office: 508-862-4038 ,Fax± ,&4,,'09240 E �� EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number p2 77`© � Property Address ' Residential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address (P Contractor's Name( Telephone Number S/D - Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp;Policy# Gf/ Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to �J�` � �� �_ ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum .44) !Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Home Improve ent Contractors License is required. SIGNATURE: WA� Q:Forms:expmtrg Revise071405 rCERTIFICATE CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 11/4/2011 TIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Timothy Lovelette NAME: Y Marshall K Lovelette Insurance Agency Inc. a/c No E:c: (508)775-4559 �� No): (soe)775-9577 396 Main Street E-MAILADDRESS.timothy@loveletteins.com P.O. BOX 836 INSURER(S)AFFORDING COVERAGE NAICS West Yarmouth MA 02673 INSURERA AEIC 0006 INSURED INSURERS: Thomas Hilchey INSURERC: 82 Old Chatham Road INSURERD: INSURER E: Harwich MA 02645 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1111400889 • REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN.IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN9RR TYPE OF INSURANCE ADDL U8 'POLICY NUMBER MMIDDY EFF POLICY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE 0 RENT PREMISES Ea occurrence $ CLAIMS-MADE F—IOCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PROCT LOC $ JE AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT L_! Ea accident $ ANY-AUTO BODILY INJURY(Per person) $, AEL.OWNED•. SCHEDULED AUTOS Cw AUTOS BODILY INJURY Per accident) $ ` NON-OWNED PROPERTY DAMAGE $ HIRED AUTfJS AUTOS Per accident UMBRELLA-L:IAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ ,4 DED RETENTION$ :. $ A WORRIERS COMPENSATION WC STATU- I OTH- AND PLOYERS'LIABILITY YIN TORY LIMITS ER ANY PRIETOARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFIR)PMEMBER EXCLUDED? NIA (Mandatory In NH) C5009790012011 /13/2011 /13/2012 •E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) CERTIFICATE HOLDER CANCELLATION (508)790-6230 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE' THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Tawas of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 367 South Street AUTHORIZED REPRESENTATIVE Hyannis, MA 02601 John McShera/JOHN ACORD 25(2010/05) O 1988-2010 ACORD CORPORATION. All rights reserved. . INS025(201005).01 The ACORD name and loqo are reqistered marks of ACORD The Commonwealth of Massachusetts c ,; Department of Industrial Accidents ~`iJ� it Office of Investigations s; P / 600 Washington Street V__ Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organiz tion/ di idual): wo Address: c City/State/Zip: Phone #: �r����" %t��/ / � Are you an employer?Check th appropriate box: Type of project(required): am a employer with- 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-tune).* have hired the'sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. $ Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10,E]Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I L Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 1041:vaf repairs insurance required.] t employees. [No workers' 13.❑ Other comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my emplo ees. Below.is the policy and job site information. 7 Insurance Company Name: 4 ' Policy#or Self-ins.Lie.M. _ ® Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby c der the pains an en ie of perjury that the information provided above abovejs true and correct. Si ature: Date: Phone# �d`o�/l y Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: *. u Town of Barnstable '* lARNBTABId, 1639. Regulatory Services '°�fc►u�° Thomas F. Geiler,Director Building Division Tom Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: e . (Address of Job) Signature of Owner Date ��e Print Name Q:Forms:expmtrg Revise071405 Lenore Lyons Diane Thayer 119 Childs Street Centerville,MA 02632 508.221.0536 November 2, 2011 -_ Town-of-Barnstable - Please be informed that we have hired Thomas Hilchey of Harwich,MA to do repairs to our house. He has our permission to do the roofing job on the address listed above. Please contact us with any questions. Sincerely, Lenore Lyons Diane Thayer i f r Massachusetts- Department,of Public Safety Board of Building Regulations and Standards Construction Supervisor License y License: CS 34718 ' • J THOMAS A`,HILCHEY ,A2 OLD CHATHAM RD , "HARWICHi MA 02645 ' Expiration: 9/19/2013 ('onnnissione _ Trt#: 533 Office of Consumer Affairs&Business Regulation License or registration valid for individul use only L HOME IMPROVEMENT CONTRACTOR, before the expiration date. If found return to; Registration:��,`•10649 Type: Office of Consumer Affairs and Business Regulation I Expiration: -14 012 Individual 10 ParlrPlaza-Suite 5170 Boston MA 02116 THOMAS A.HILC, i THOMAS HILCHi — 82 Old Chatham RA HARWICH,MA 0264 Undersecretary Not valid Without signature 4 j TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Application # 02616I 6 Health Division `" Date Issued (� Conservation Division Application Fee Planning Dept. ;" Permit Fee Date Definitive Plan Approved by Planning Board Historic: OKH Preservation/Hyannis Project Street Address 1IA CIA i Village �'0.1✓1 � Owner e, LIAMS Address Telephone Permit Request U. tr-f> "� 5 tPA m ;9) Square feet: 1 st floor: existing a to proposed.tame 2nd floor' existing Z proposed 5tojr ,__Total-new O Zoning District Flood Plain Groundwater Overlay Project Valuation �� Construction Type i3 Lot Size Grandfathered: ❑Yes q1 No If es, attach su y pporting documentation. Dwelling Type: Single Family, Two Family ❑ Multi-Family(# units) uc Age of Existing Structure 2-*fJ e6,6 Historic House: ❑Yes Q&No On Old Kings Hi hway: r0 Ye!F*No Basement Type: ❑ Full ❑Crawl N Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing Z new ® Half: existing 0 new Q Number of Bedrooms: existing Q new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ®Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes W No Fireplaces: Existing I New Existing wood/coal stove: ❑Yes ® No Detached garage: existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garageexisting ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# J Current Use Proposed Use APPLICANT INFORMATION _ -- - ----(BUILDER OR HOMEOWNER)-- Name W a-iL i A m FogAgi)/ Telephone Number '.("50 - Address q 6 to F am ECe- C-r License# C 5 — 6 cl d q 5 ( J5 i F I-Vi w_E wZ656 Home Improvement Contractor# 15(0 907 w Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE a �� FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. , t ADDRESS VILLAGE OWNER DATE OF INSPECTION: r , FOUNDATION FRAME Witolds INSULATION o a)4sos 4 FIREPLACE r' ,r F ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING 01)03 DATE CLOSED OUT ASSOCIATION PLAN NO. �. r f The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,.MA 02111 www.mass.govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/El ectricians/Plumbers Applicant Information Please Print Ledbly Name(Business/Organizationandividual): �� 1 L!..A r AIM no Address ( 1 j F P_1 E r i= C-' - v • ity/StteZip 05iCe0S � hone M �1S �5- �I��" �6�� Are you an employer? Check the appropriate bog: Type of project(required): . general contractor and I 1.El I am a employer with 4 � I am a g 6. ❑New construction . employees(full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9 a Building addition [No workers' comp.-insurance comp.insurance t required_] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself[No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13:❑Other comp.insurance required.]. *Any applicant that checks box#1 must also fill out the section below showing their workem'conrprsrsation 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. I-_Mtracton: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 mmployces,they must pravidb their workers'comp.policy nwnber. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and jab site information. Insurance Company Name: - Policy#or Self-ins.Lic.#: Expiration Date: ' Job Site Address:, City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine iip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy-of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify e pains•a0enalties of perjury that the information provided above is true and correct Si ature: Date: it -0,F _ Phone 4- Official use only. Do not write in this area,to be completed by city or town offuial City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.BuiIding Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees: Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall nottbecause of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate_a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states`Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants 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 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 permittlicense 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 homeowner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to born 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 C6mmonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tet. #617-727-490.0 ext 4-06 or 1-977-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia ENERGY CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR ONE- AND T)YO-FAMILY DETACHED RESIDENTIAL CONSTRUCTION (780 CMR 61.00) Applicant Name: o A Site Address: 119 C�„� p� s print �- Town: C G of TE P_V 1 L L E M pt Applicant Phone: 50,q- 4 a�- 06 0, X Applicant Signature: ''/• �a Date of Application: NEW CONSTRUCTION: choose ONE.of the following two options) 780 CMR TABLE 6107.1 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA FOR NEW ONE-AND TWO-FAMILY BUILDINGS MAXIMUM MINIMUM Ceiling or l r Slab- Option O ton 1: Basement p Fenestration exposed Wall Floor Perimeter U-factor floors R-Value R-Value Wall R-Value AFUE HSPF SEER R-Value R-Value and Depth National Appliance Energy R-10, Conservation Act(NAECA)of 3 S R-3 8 R-19 R-19 R-1 O 4 ft. 1987 as amended,minimums or greater as applicable Note: This form is not required if you choose either of the two versions of REScheck as listed below. ❑ Option 2: REScheck Version 4.1.2 or later variant software.analysis must be completed (780 CMR 6107.3.2) REScheck—Web which can be accessed at http://N ww.enetgycodes.gov/rescheek/ ADDITIONS OR.ALTERATIONS,TO EXISTING BUILDINGS OVER.5 YEARS OLD *Buildings under 5 years old must use option#1 or#2 in New Construction section above. Complete the following formula to determine the % of glazing: (a) Gross Wall & Ceiling Area equals Formula: (100 x b _ a) SF 100 x — _ % of glazing (b) Glazing area equals SF b a If glazing is<40%o use_the chaff below. If glazing.is>40:.°%a procee .to "SUNROOM section 780 CMR TABLE 6101.3 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTING LOW-RISE RESIDENTIAL BUILDINGS MAXIMUM MINIMUM Fenestration Ceiling and Wall Floor Basement Wall Slab Perimeter U-factor Exposed floors R-Value R-value R-Value R-Value R-Value and Depth .39 R-37 a R-13 R49 R-10 R-10, 4 feet a 'R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R-value over the entire ceiling area(i.e.not compressed over exterior walls, and including any access openings). SUNROOM-An addition or alteration to an existing building/dwelling unit where the total ❑ glazing area of said addition exceeds 40% of the combined gross wall and ceiling area of the addition. . . Note:.Owner to fill out Consumer Information Form (found in Appendix 120.P) OPINE►� Town of Barnstable Regulatory Services RAMv MASS.� 'Thomas F. Geiler,Director G 0119. ate` Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-79076230 t Property Owner Must Complete and Sign This Section If Using A Builder I, D 4 , as Owner of the subject property hereby authorize O t G t A M Foa A 971.11to act on my behalf, in all matters relative to work authorized by this building permit application for: VKu's 1, (Address of Job) Signature o ner Date U4n ff� t Kn 6 -D'q vi e- e-Y-- Print Name If Property Owner is applying for'permit please complete the Homeowners License` Exemption Form on the reverse side. t ` t Town of Barnstable mop SHE tp�� Regulatory Services snxxsrwar.E Thomas F. Geiler,Director v Mass. q, 0_19. Building Division �TFD �A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Rrmv.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print F 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) - r The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. ' Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption 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. r, y ✓/e 7oaoriraarzcaea�o�✓�aa�aa/uael�a. '. Board ofBulld[rig Re�+i[ta`Uons andStanda ds f Construction Supervisor Oeerse Licese CS ..64245 B�rttiqa—lew.4,0128/1950'.' \` j - zp�ratrdn18008 Tr# 5256 ' Re` tr[cBor 1G1' . , rl(�ILLIAM J FOGARTY �36lERMEER CT - - �J i l MA t)2655 ` C-omm[ss[oner 'r � �_'-✓fie Voanvnzoauvep,�t/ a�✓!�'.,a.�aac�ruaelld � -,r ____ ( \ 11ilaCf�o�13udc6no itc�wr ,oStuf �r d ,s art i l d r is [t rei ac u� registrafi6u vah. nor[ndnic!ul use u ,� -: HOME IMPROVEbAENT CONTRACTOZc�p[raho[[date it found rctn�`nae r3egis[rabon 150807 Co irc of IZu�ldmg Regulations an�I;:StanGarit Explittion M/312008 ("AM3441 tan Place Rm 1301 Type li;�diwpual.. 4 c�asto`t,Ma 02109 # �F [AM F J ,i ' QGART(II n I i t OAT LLE to 0c s Dcp�t. i�u,�ni: N a6 )vil outs[ itttre i 2e��. yYb. .�` ,,�,,. _ '.. .:!.�-_. .."..-: t � �. 1- .�. g�J.,?. �� .. _ '�,. •.r . �!1;1,w� � e•:-s,i. .�• �•i,. t .r'oi ' f TOWN OF BARNSTABLE permit No. 25386"--" Bliumg Inspectbr. Cash - -- _ OCCUPANCY PERMIT '"`'Bond "".-"-_X""-:�//S �3 Issued to Bayside Building ,Co. Address ~ i Lot 1.2, ., 119 Childs Strut:, Centervi"Tle �i rT- Wiring Inspector le� �� f r: Inspection date Plumbing Inspectioor/ .�' �... � y 'Inspection date Gas Inspector Inspection,date' Engineering Department Inspection date Board of Health 6 •�ti- "Inspection date ell$�/3 THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON 'SATISFACTORY COMPLIANCE WITH TOWN i, REQUIREMENTS AND IN ACCORDANCE WITH SECTIONJ19.0 OF THE MASSACHUSETTS STATE BUILDING CODE. { , �,�l n.... �. 19� 3 ' � U Grti ..... _., Building Inspector nc- P ..,.; Tca�s ! L Q SN OF.b,� 4! �34$14 LP N� SJg��y 'L vi _ ,66 3 LL 4' G G: ► o i Lj Q L'o T / +I v} clo CERTIFIED PLOT PLAN IN Aga tAL : SCALE, DATE+ �' S</� C fyywi�ATiv� i CERTIFY THAT THE SSE RE®@gT�RCD SHOWN ON THIS PLAN IS LOCATED s: . JOB ��,'= . . �.:- ON T�lE AROUND AS INDICATED AND CIVIL LAND VIE .�Yy =` COWORM8 TO THE ZONING LAWS OF SARNSTASLE+ MASS. Tut 2 Mtl Ny� '9 Ta.429T *A -u.VIwW tlti i J, Y1vYi'O'ai. •,^ i t...,.: : �.. ATE ...._ LR:EO. LAND SURVEYOR .. ,. .. Arse*sor's map and .lot number .....99,. . ..../..�'..n.....}... F 7HE r Sew' a a Permit number ........ b /I I SEPT GSYSTEM SYS 8 E i UST BE // _ INSTALLEDIN COMPLIANCEs 33AUSTSDLE, House number ................. ............ ...... . .......................... Maea WITH TITLE 5 'moo 1639• �.r TAI. C ODE AND �ED NPY a. TOWN OF-, =fBAWNWNTk 1&T! is ' BUILDING, INSPECTOR APPLICATION FOR PERMIT TO ......�/..�I ..t°.........(�.!{:'1�. ..`�............. ....... '6 ................:.......:.. TYPEOF CONSTRUCTION .....1N.. .. ...... c..........._......................:..................................................... r ........ ... . 19..V ' v TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for as permit according to the following information: Location :....../�. .. _ .1 .......(...f?l.f. . 5.......01.�.................5. :!!YC.T eI{U.�!. .............. ............................... ProposedUse .....*31.5...e.............:............................................................................................................................ Zoning District ............ .... .�........................................Fire District ......( .riw ... .l..S� ............................................. Name of Owner ...... 51A/ .....Qlp14......6-2.ti.C......Address ................ ...................................................... Name of Builder ........ ..............Address ..............l f!!� 4.T �( ,/ Name of Architect ..... A.e4X :we .......3.4.'c' (.......Address ...............45.� ................................ Number of Rooms ...... ................:...........:.....:................Foundation ..... 0. �ll7rl.<..P�e... ...... �e.................. Exterior ....... .�..f b �Z.d.... ............ ................Roofing ....... �4 1... ............................................ Floors .....C! .. f..............v.A.yl..............................Interior ..........Sryl�j' .5.l.W....1.............. Heating .' ............ -.:fi ...? .:..............................:.Plumbing ............4..-?70 .......P U...................................... IR;Cr.�..... ......3..(.�..CV...Fireplace .........S ....................Approximate. Cost � ini iv Def t e Plan Approved by Planning Board _____________________________19________. Area ....f ............................... Diagram of Lot and Building with Dimensions Fee - 7...3... �.�.. ............ SUBJECT TO APPROVAL OF BOARD OF HEALTH 3; 3 1 It 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 : �sC BAYSIDE BUILDING CO. T j �9—25A6 Permit for 1 2 Story I` . le F ............ Sin g anvil Dwelling, 'Location ...Lot..12.i.... '.Cl?1 �dS... r�et . Centerville .............................................................. Owner ..:Bayside..Buildirlq,..�A............ .. s . Type of Construction ......Fr 3zp....................... • f _ ............ ..... ......................y'......... ........... Plot ............................ Lot ................ .......... August A, Permit Granted ...... .............QQ..................19 8 3 f Date of Inspecti .r"FAf .....1..�..............19V. / -. ' Date Completed .... �, ....�'r.�....19 OIL- - � y f t . x L Assessor's map and lot number Ll..!.......f;,................. ' O%THE tO r ro�'Qy �y�w Sewage Permit number ........................................................ / Z EAR33T/1DL8, i House number .......� '.�� w �� rasa ............................... 9 0 Apo,11639. �F0 MPY a� TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO 5i� /e �'lvv+l' 1 ` -� 0-66`.......... .....................n.. t. ....................... ......... ... TYPE OF CONSTRUCTION A.,//(......:f:......,-.........a`... ......(�.................................. ..... • ..... . ram%/ �-l?� ............................................... . 7 ............ ���,..`�...... .3... ....19.O TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location !� C 1, ........G�/,i/C! 7, �.,5 C ,Div ;/t1,;;i i�...................................................... ........... ............/....... .............a..................:. ProposedUse ..... '��P-•:.G•( 5� ................................................................................................................................................ . Zoning District j� ...........!.i .f....................................................Fire District ......r....°?1.. ... s..Sf ........................................ Nameof Owner ...... V ..... �. a.1.....Address ............. 1 f........................................................ 5��1:X .Address �.:�' 4 Name of Builder ........, //.. . . ....1l.................... ........... ..............s..... .................................... Name of Architect ....... f'.i.>' G!. �`........:'.) (`.......Address ..............lZ 24.......................................................... Number of Rooms ......-- ..............Foundation ..i < <` �r?�sr'^ f.tl.. ............................�................. (' f l ��y -- dv/ 1' Exterior .............. .......s......................%..... ... .................Roofing ......... .. ..' ..:.......:................................................. Floors .....:.......... A1 /...............................Interior ..t................�1. Heating `.:.........�...................................Plumbing ............ 11.. ..................................................... Fireplace ........ � !.C.��.......�� ( 5..!.f..�...��::......................Approximate Cost ........... r: �........ ) ............... r Definitive Plan Approved by Planning Board -------------------_-----------19________. Area ..._ ............... Diagram of Lot and Building with Dimensions Fee ................................ SUBJECT TO APPROVAL OF BOARD OF HEALTH U 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 .... l G r BAYSIDE BUILDING CO. A=249-5 .?5 3 t45 1 z Story No ................. Permit for .................................... Single Family Dwelling .......................................1.0................................ Location .,,Lot 12, Childs Street .................. Centerville ............................................................................... Owner Ba.ys.id. e....Building. . ...Co.. ................ ....... .... ....... .... ....... ..... . Type of Construction .....Frame..................................... ................................................................................ Plot ............................ Lot ................................ Permit Granted .....August...4..............19 83 Date of Inspection ....................................19 Date Completed ......................................19 I AWE A The Town of Barnstable • .�uvsrnsi.E. • . 1K6M J9. ,0�' Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner SHED REGISTRATION V. ✓ e-- Location of shed(address) e r —7 l -7 ( Z� Property owner's name Telephone number Size of Shed Map/Parcel# Sig ture Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? AN Conservation Commission(signature required) THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg • sc t� E) � V N V� " •Q 46 14.7 y 150 ST FIE ST i `N 154CD , c' 41 D 297 n 154 AVENUE ` 309 227 d •A N n tiG I ,. D n �� GG/ S I Ldfib e o d 04/04/98 Page 1 Address 119 Childs St Li rice C $177;500_ Town Barnstable# 8039177 List v ListType MLS Listing Status ACT Style Contemporary Rooms 9 FBaths 2 DescStyle Beds 3 HBaths 0 Nn r5.orr.Avails v YrBuilt 1983 Actual #Lvls 2 TBaths 2 Garage No Garage OccupBy Owner Leasbl N Fplce Y SepLivQtr No Separate Living Quarters Bsmt Y County Barnstable LotSize 0.59 YrRnd Yes Village Centerville LivSpc 1801 to 2200 MlsBch 5/10 to 1 Mile ConvenTo Shpng BchDsc Ocean Area Long Pond, Centerville Street Public, TMaint, CulSac 13ch0w Public Subdiv Dock NoDock OthAcc WView Zip Code 02632 Pool No DscAcc Pond Basement Full, Wlkout, IntAcc Floors WtoW, Tile, Vinyl EquipAppl Dish, ERange, Refrig, Hood Roof Pitchd, Asphlt InteriorFt Attic, CableH, EDryHk, WashHk SpclFnc NoFin ExteriorFt Deck, InslDr, InslWd, Screen, StDoor, StWind Siding Shing, Clap WtrSwr PriSew, TwnWtr, Gas, Elect, Phone, CATV HotWtr NGas, Tank HtCool NGas, HotAir Foundatn Main 48 x 27 Assoc No MshpReq No YrlyFee $0 FeeYear EL x Feelncl Irreg Y Pitchd, AdditSvc Asphlt LotWidth 147 Depth Irregular Yes LotDesc Inter, Level Ad Copy Wonderfully spacious and well-kept home in popular Long Pond area. Generous floor plan allows for 1 st floor master, if needed. Winter views of pond from deck. See'features'for full description of this lovely home. Directions Pine Street to Childs Street. House on left. Map# 249 TitlRef B 3923 P 009 LCx AssmtStat Assessed Parcel# 005 Plan LandAsmt $39,800 UFFI N AnnualBttr $0 PlnLot Improvmnt $113,200 Asbest U UnpaidBttr \ Zoning TotalAsmt $153,000 UTank U FloodPlain Unknown Use 101 -Single Family Taxes $ $2,084 LPaint Unknown Tax Year 1996 Room Dimen Level Features Living Room 19 x 13 1 Fireplace,Skylight,Closet,Wall to Wall Carpet, Bay/Bow Windows, Interior Balcony Formal Dining 15 x 11 1 Wall to Wall Carpet,Sliding Door,Dining Area Family Room 18 x 13 1 Skylight,Closet,Wall to Wall Carpet Kitchen 11 x 8 1 Built-Ins,Vinyl Floor Master Bedroom 20 x 11 2 Skylight,Closet,Wall to Wall Carpet,Sliding Door,Exterior Balcony O Bedroom 2 11 x 11 B Closet,Wall to Wall Carpet Bedroom 3 14 x 12 2 Closet,Wall to Wall Carpet (y Bathroom 1 6 x 4 1 Closet,Tile Floor,Fall Bath Bathroom 2 2 Full Bath U \� \ Den/Library 12 x 11 1 ('l \ O Laundry B Other 9 x 7 1 V p0 �t,1 day Real Estate-#8039177 / rmalion Deemed Accurate but not Guaranteed-printed by o � 7svv 1 5 L, I _ I '`&1.) �w ,4,,v�ig �1XGcJ -� P / o I L71-55 (ocfrs5 �� 14721) J71� a3�� � v/NL A44-Ae9 L 7t)6q F ' 5u3AtJ/ �� f ✓�. ' -05 _ 1 / �fW790 � ; /�iScn�-D r5 ss � � /Zs,c.� fps a•v � 75 LLD 31 F6W tsMN - _ �_-- - -_ Z� S 9"D ` 1D06if— li r Ifi i i f; i'l ICr I 3 " . y o� s S� it L _ s