Loading...
HomeMy WebLinkAbout0011 ELLAS LANE 4�. jot s .. a :.., •., •. l . , .,n . .. , a ; �. .,:7c 4 C. �. �e ai*' a, •e. .+t ,,t � { v r �, xNt} �.aa-V .�c, '.� _,r .,. ;.�+ ,: ,j. �. ,,.. .e ,..... 't . ..:a.A:' :c. •�-,> ,.e a�.., {'".;. "..,..'ii` A trey 'L- '1 T�. `�... .¢� `�+�.til '' e.��.t^Yxia 4� f t=��4l`, �- .; .. -, ,. ..._,. ,:,..,,, „ ,q,�x,av •�;.., diy ' � r. ,z' � et': rr, f. :.�'J.�y,', ,�t,� x' - LL y• .. � •' .�� h� i h,11 f 64=n �a r F ,r"�t .f a , o-• n a i� e, d G t r. 4 t 6 } 4 r Y 1 r ' H _ S� � as ®� � , d -©y � � } ►' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 2 3 D Parcel Application Health Division Date Issued Conservation Division Application Fee Planning Dept. t Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project ect Street Address EL,.i orr ST. Vill+age C,iEwrE►ty 1,LLiE Owner ELI t yTr 4Nn9?t50N Address it ELlar r ST 0s NTEALnue Telephone C42 2- 77 71 - l(Y3 Permit Request ✓3oVE [72yu+Nb 1400L Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new NO Zoning District Flood Plain Groundwater Overlay Project Valuation f—l890 Construction Type w "; Lot Size Grandfathered: ❑Yes ❑ No If yes, attach sup l orting cdume ation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Ai ighway:ti 4 Yes ❑ No b Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 6­ 1_ _I oTr 4K,pr''(1,SON Telephone Number - 7 & Address it SELLto7r ST License # I E NT-E&V I LL.� M14 D2 6.8.Z Home Improvement Contractor'# Email . Con Worker's Compensation # A�L CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE (' DATE D A©1 FOR OFFICIAL USE ONLY APPLICATION# :j DATE ISSUED v ~ 5 MAP/PARCEL NO. ADDRESS VILLAGE OWNER ' DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING; D'ATE CLOSED OUT ASSOCIATION PLAN NO. 1ne uommoaweacnt ojmassacnuseus Deparbnent of Industrial Accidents Office of Invesfigations _ kTJ 600 Washington Street Ile Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit- Builders/Contractors/EIectricians/Plu fibers A-P cant ,Infor ation n Please Print Legibly Name(Bussines/OrganizationdndividuaD: L"t,,l oTr, I'1 /�n tE►2.5©l� Addr/ess,: It Cut O fC State/Zi TLrLV(1LE Phone < 197 — 'Ar'•e you an employer?Check the appropriate bow Type of project(required): 1h I am a employer with 4. I am a general contractor and I employees(full and/or part-time).* have hired the sob-contractors 6. ❑New construction 2:0 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. D emohtron working forme in any capacity. and have workers'Y�capacity.� I 9. []Building addition [No workers'comp.insurance comp.insurance, ed] 5. 0 We are a corporation and its 10.❑Electrical repairs or additions 3Lf I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions / myself-[No workers'comp. right of exemption per MGL 12.❑Roof repairs ( insurance required.]t c. 152, §1(4),and we have no n employees.[No workers' 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 hue 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$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. t r� I dolherreby certify under the pains and penalties of perjury that the information provided above is true and correct Signature' - Darn • Phone#: �v � �� Z� �—��,�� - . Official use only. Do not write in this area,to'be completed by city or town official City or Town: Permit/License#__ac Lo s Xz D Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4,Electrical Inspector S.Plumbing Inspector ` 6.Other bContact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to ffiis 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 m'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(57 also states that"every state or Iocal licensing agency shall withhold the issuance-or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced.acceptnble evidence of compliance with the insnranee 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 perfoffiance of public work until acceptable evidence of compliance with the insur-a ce 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 Fine. 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 submif multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents ofiec of Investigations 600 Washington S=t. ' Bostou,MA 02111 Tel.#f 17-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749. www m ,gG-ddia LAB ME ..il a Q T✓ , EjO C..S6.g� _ l< t t \, GARHEAU ET UX • , N. t ; PIPS z e 1 ry �y WILLIAM ti o . 0e ET UX moo. i6 PTF 2�ael p OF A I FR E D 'O Y i4 Lg.: to cz Ld s'`UIVr�Lsc '`t PLAN OFIAll ND OF. 'L ELL.�C�TI" �. end J� A1Viel E. , L� � t0CAT EQ IN CEUTERVILLE MASS. .: - SCALE r." a 40 ��� DE D.'E2 EGO RDEpr9/;29/72 "tR! BA STABLE REG19tRY bF DEFn ' . Town of Barnstable Regulatory Services ��oF tOiy,� Richard V.Scali,Director °^ Building Division 4 � • H►xxsz'AsM Tom Perry,Building Commissioner 16 �m� 200 Main Street, Hyannis,MA 02601 ATE° �A www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE JO;OCATION: `l LCL LI a� �Z" (;r�' E tz.V(a,6. number. sheet village "HOMEOWNER': name home phone# work phone# CURRENT MAILING ADDRESS: �r Nl 4 �1 city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license, rp ovidf�j that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be,a one or two- family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. _ The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and re wire nts and that he/she will comply with said procedures and requirements. P� q PY P q S 02,1 re of Homeowner r. 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. . ITo ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit fomis\EXPRESS.doc Revised 061313 4! r 1 l Town of Barnstable Regulatory Services BAMSTABM Richard V.Scali,Director Building Division. Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section M1 If Using A Builder 4 as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date Q TORM&O WNERPERMIS SIONPOOLS ABOVE GROUND ROUND FRAME SWIMMING POOL OWNER'S MANUAL To order aT'SV,-118c"""c,eosso4rMies,ro"0'f answers to fre uentl asked a"Auestlons about yor roduct 4 lease ISIt UV1N111% P a rt y N q It p p OLYGRO PSTOREtCOM k Customer Service '"(888)�°91"9 '0070 r� ToFwatch howto,setup*-yourproductplea +Nt',., W O YGROUPCOIVI ` IDEO . ,�• a ` - _ _.4 ,z DO ,NOT RET�U, RN PROD'U'CT� ,�O 7&� STONRE� , � ' .„ . . DISTRIBUTED BY: POLYGROUP LIMITED (MCO) Avenida Man Xing Hai,Centro Golden Dragon,11 Andar M,Macau ` "Splash Guard"Technology 'r _ . L f re > f 4 For Round Frame Pool of all sizes and depths. POOL SIZE 2 18'x52" PUMP TYPE F 1500C GROUND CLOTH YES3 APPROX.G AL.CAP. 7700 LEAF COVER YES SOLAR COVER NA 14 • - I MAX. WATER DEPTH 47" MAINTENANCE KIT YES 4 FILTER SYSTEM SFS 1000 LADDER YES !8 WARNING: DO NOT overfill the pool and/or allows' people to layover or sit on pool wall- DOING SO CAN CAUSE PERMANENT INJURY! DRAIN pool to the proper level after a heavy rain. NOTE:DO NOT attempt to assemble this pool in adverse weather conditions,windy conditions or when the temperature is below 60°F. NOTE:This is a storable pool,which should be disassembled and stored when temperatures are expected to fall below 32°F. / Should you encounter a problem with your Polygroup Product,please do not return the product to the place or purchase. All Warranty claims must be made directly to Polygroup. Prior to con- tacting Customer Service,please first review the Troubleshooting Guide in the Installation Manual,or review the FAQ at www.polygroup.com. Please review setup instruction videos on www.polygroup.com/video. If you are still unable to correct the problem,please contact Poly- group customer service at (888) 919-0070.Have the product type and your purchase receipt ready. Our Customer Service Representative will assist you in resolving the problem. You may be -. asked to return all or part of the product for inspection and/or repair. Do not return any product to Polygroup without a Return Authorization number. 084-120462-2014 1 Read and Follow All Safety Information and Instructions. Keep for Future Reference. Failure to follow these warnings and instructions can result in serious injury or death to user,especially children. A DANGER A WARNING PREVENT NO DIVING! DO NOT SIT ON AVOID DROWNING NO JUMPING! OR LAY OVER ENTRAPMENT Watch children POOL WALL Stay away from at all times. Shallow Water-You can You can be permanently suction fi ttings- Observe all Safety Rules. be permanently injured. injured You may drown 1. Children,especially children younger than five years,are at high risk of drowning.Drowning occurs silently and quickly and can occur in as little as 2 in.(5 cm)of water. 2. Keep children in your direct sight,stay close,and actively supervise them when they are in or near this pool and when you are filling and emptying this pool. 3. When searching for a missing child,check the pool first,even if the child is thought to be in the house. 4. Very Important:Swimming pool barriers,which restrict access to the pool by small children,may be required by law.A barrier is necessary to provide protection against potential drowning and near drowning.Barriers are not a substitute for constant supervision of children.Check state or local laws and codes before setting up pool. 5. The use of artificial pool lighting is at the discretion of the pool owner.Lighting,when installed,should be in accordance with Article 680 of the National Electrical Code(NEC)or its latest approved edition and in consultation with a licensed electrical professional. 6. During nighttime pool use,artificial lighting shall be used to illuminate all safety signs,ladders,steps,deck i surfaces and walks. 7. The floor of the pool shall be visible at all times from the outside perimeter of the pool. 8. Local building codes may require obtaining a building or electrical permit.Installer shall follow regulations on setback,barriers,devices and other conditions. 9. Post a list of emergency telephone numbers such as the nearest available police,fire,ambulance and/or rescue unit.These numbers are to be kept near the telephone,which is closest to the pool. 1 10.Toys,chairs,tables or similar objects that a young child could climb shall be at least four feet(41[121.92 cm]from the pool.The pump filter system shall be positioned so as to prevent it being used as a means of access to the pool by young children.Do not leave toys inside pool when finished using,since toys and similar items might attract a child to the pool. 11.Basic lifesaving equipment,including one of the following should be on hand at all times: *A light,strong,rigid pole(shepherds crook)not less than twelve feet(121[365.76 cm]long. *A minimum one-fourth inch 0/41[6.35 mm]diameter rope as long as one and one half(1-1/2)times the maximum width of the pool or fifty feet(501[15.24 meters],whichever is less,which has been firmly attached to a Coast Guard-approved ring buoy having an outside diameter of approximately fifteen inches(15'1[38.1 cm],or similarly approved flotation device. 2 12.Entrapnient Avoidance:There shall be no protrusions or other obstruction in the swimming area,which may cause entrapment or entanglement of the user.If a suction outlet cover is missing or broken,do not use the pool. Suction can cause body part entrapment,hair and jewelry entanglement,evisceration,or drowning.Repair or replace the suction outlet cover before allowing the pool to be used. 13.The pool is subject to wear and deterioration.If not maintained properly,certain types of excessive or accelerated deterioration can lead to failure of the pool structure that might release large quantities of water that could cause bodily harm and property damage. 14.Above ground/onground residential swimming pools are for swimming and wading only.No diving boards, slides or other equipment are to be added to an above ground/onground pool that in any way indicates that an above ground/onground pool may be used or intended for diving or sliding purposes. 15.Never allow horseplay,diving or jumping into or around the pool.Serious injury,paralysis or death,could result when this rule is disregarded.DO NOT ALLOW anyone to swim alone without supervision. 16.Safety signs shall comply with requirements of ANSI-Z535 and to use signal wording. 17.The pool is to be assembled by an adult,care should be taken in the unpacking and assembly of the pool,this pool may contain accessible potentially hazardous sharp edges or sharp points that are a necessary part of the function of the pool. 18.Become certified in cardiopulmonary resuscitation(CPR).In the event of an emergency,immediate use of CPR can make a lifesaving difference. 19.Keep all electrical lines,radios,speakers and other electrical appliances away from the pool. 20.Do not place pool near or under overhead electrical lines. 21.Remove pool ladders before leaving the pool.Children as young as 2 years have climbed up ladders and into pools and drowned. NOTICE: CUSTOMERS THAT PURCHASE POOLS MAY BE REQUIRED BY LOCAL OR STATE LAW TO INCUR ADDITIONAL EXPENSES WHEN INSTALLING A POOL,IN ORDER TO COMPLY WITH STATE OR LOCAL LAWS REGARDING FENCING AND OTHER SAFETY REQUIREMENTS. CUSTOMERS SHOULD CONTACT THEIR LOCAL BUILDING CODE ENFORCEMENT OFFICE FOR FURTHER DETAILS. CONSUMER AWARENESS BOOKLETS Contact:U.S.Consumer Product Safety Commission at www.CPSC.gov/cpscpub/pubs/pool/pdf,Pub.#362"Safety Barrier Guidelines for Home Pools". Contact:ASSOCIATION OF POOL&SPA PROFESSIONALS(formerly NSPI)at-www.apsp.org/l 64/index.aspx These titles are now available:'The Sensible Way To Enjoy Your Aboveground/Inground Swimming Pool","Chil- dren Aren't Waterproof,"Pool and Spa Emergency Procedures For Infants',Layers of Protection",and the"ANSI/ NSPI-8 Model Barrier Code for Residential Swimming Pools,Spas,and Hot Tubs". DANGER: Competent supervision and knowledge of the safety requirements is the only way to prevent drowning or permanent injury in the use of this product! Never leave young children unattended. DANGER: POOL SET-UP Do not attempt to assemble this pool in adverse weather conditions,such as in high winds,strong gusts or when the temperature is below 60°F. Should you encounter any problems,contact the Customer Service at(888)919-0070 from 8 AM to 5 PM Mon.thru Fri. EST.Extended operating days and hours during peak season requirements. 3 FRAME POOL SETUP INSTRUCTION SHEET 1❑ SITE PREPARATION WARNING-VERY IMPORTANT.SITE MUST BE LEVEL,STABLE,COMPACTED SOIL. • The pool must be assembled on a smooth and level site of firm soil that is free of stones,gravel,sticks,blacktop or other oil base compounds.Do not install pool on a wooden deck or any type of wooden surface.You can not use sand and/or uncompacted soil to provide a level surface for this pool;it will only wash out. •FAILURE TO FOLLOW THE INSTRUCTIONS BELOW WILL CAUSE POOL TO COLLAPSE AND WILL VOID THE WARRANTY! A. Select a level area,and completely remove all debris,twigs,stones,etc.DO NOT select an area under overhead electrical lines,trees or within 15 feet of a house,building,etc. B. The pool shall be located a minimum distance of 6 ft(1.83 m)from any electrical receptacle. C. All 125 volt,15 and 20 ampere receptacles located within 20 ft(6.0 m)of the pool shall be protected by a ground fault circuit interrupter(GFCI). The 20 ft(6 m)distance is measured via the shortest straight line distance the supply cord would follow without piercing a floor,wall,ceiling,doorway,window,or other permanent barrier. D. Contact your local utilities,checking that no underground cables,telephone lines,gas lines,etc.run beneath the area you have selected. 21 POOL INSTALLATION WARNING:DO NOT overfill the pool and/or allow people to lay over or sit on pool wall doing so can cause permanent injury.DRAIN pool to the proper level after a heavy rain. TIP:It will be much easier to install your pool if you unfold it and let it lay indirect sunlight for about 2 hours prior to installation.This will help to insure a wrinkle-free fit because the pool material will be more pliable allowing it to form into shape during installation. Z Pin&Grommet(with 2 Pre-installed Round Frame Pool Horizontal Beam Vertical Leg T-Fitting Leg Cap extra). V-Shape Spring Pin (w/1 extra) Pool Model Pool Size Part# Qty. Part# Qty. Part# Qty. Part# Qty. Part# Qty. Part# Qty. P20-1030 10'x30" 090-380015 x10 090-380020 x10 090-380031 x10 097-080008 x10 097-080029 x22 097-080004 x11 P20-1130 I VOW 090-380015 x11 090-380020 x11 090-201301 x11 097-080008 x11 097-080029 x24 097-080004 x12 P20-1230 12'x30" 090-380015 x12 090-380020 x12 090-380032 x12 097-080008 x12 097-080029 x26 097-080004 x13 P20-1236 12'x36" 090-380015 x12 090-380021 x12 090-380032 x12 097-080008 x12 097-080029 x26 097-080004 x13 P20-1239 12'x39" 090-380015 x12 090-380126 x12 090-380032 x12 097-080008 x12 097-080029 x26 097-080004 x13 P20-1330 13'x30" 090-380015 x13 090-380020 x13 090-380034 x13 097-080008 x13 097-080029 x28 097-080004 x14 P20-1333 13'x33" 090-380015 x13 090-201223 x13 090-380034 x13 097-080008 x13 097-080029 x28 097-080004 x14 P20-1339 13'x39" 090-380015 x13 090-380126 x13 090-380034 x13 097-080008 x13 097-080029 x28 097-080004 x14 P20-1436 14'x36" 090-380006 x14 090-380021-1 x14 090-380024 x14 097-080002 x14 097-080030 x30 097-080002 x15 P20-1442 14'x42" 090-380006 x14 090-201249 x14 090-201250 x14 097-080002 x14 097-080030 x30 097-080002 x15 P20-1452 14'x52" 090-380006 x14 090-380075-1 x14 090-380024 x14 097-080002 x14 097-080030 x30 097-080002 x15 P20-1533 15'x33" 090-380006 x15 090-201404 x15 090-380033 x15 097-080002 x15 097-080030 x32 097-080002 x16 1 P20-1542 15'x42" 090-380006 x15 090-380005 x15 090-380033 x15 097-080002 x15 097-080030 x32 097-080002 x16 P20-1546 15'x46" 090-38000E x15 090-201405 x15 090-380033 x15 097-080002 x15 097-080030 x32 097-080002 x16 P20-1548 15'x48" 090-380006 x15 090-380012 x15 090-380033 x15 097-080002 x15 097-080030 x32 097-080002 x16 P20-1552 15'x52" 090-380006 x15 090-380075 x15 090-380033 x15 097-080002 x15 097-080030 x32 097-080002 x16 P20-1642 16'x42" 090-380006 x16 090-380005 x16 090-380055 x16 097-080002. x16 097-080030 x34 097-080002 x17 P20-1648 16'x48" 090-380006 x16 090-380012 x16 090-380055 x16 097-080002 x16 097-080030 x34 097-080002 x17 P20-1652 16'x52" 090-380006 x16 090-380075 x16 090-380055 x16 097-080002 x16 097-080030 x34 097-080002 x17 P20-1748 17'x48" 090-380006 x17 090-380012 x17 090-201244 x17 097-080002 x17 097-080030 x36 097-080002 x18 P20-1752 17'x52" 090-380006 x17 090-380075 x17 090-201244 x17 097-080002 x17 097-080030 x36 097-080002 x18 P20-1842 18'x42" 090-380005 x18 090-380005 x18 090-380056 x18 097-080002 x18 097-080030 x38 097-080002 x19 P20-1848 18'x48" 090-380006 x18 090-380012 x18 090-380056 x18 097-080002 x18 097-080030 x38 097-080002 x19 P20-1852 18'x52" 090-380006 x18 090-380075 x18 090-380056 x18 097-080002 x18 097-080030 x38 097-080002 x19 P20-2048 20'x48" 090-380006 x20 090 380012 x20 090-201406 x20 097-080002 x20 097-080030 x42 097-080002 x21 P20-2448 24'x48" 090-380006 x24 090 380012 x24 090-201407 x24 097-080002 x24 097-080030 x50 097-080002 x25 P20-2452 24'x52" 090-380006 x24 090-380075 x24 090-201407 x24 097-080002 x24 097-080030 x50 097-080002 x25 Should you encounter any problems,contact the Customer Service at(888)919-0070 from 8 AM to 5 PM Mon.thru Fri. 4 EST.Extended operating days and hours during peak season requirements. ® Locate a level and flat area to setup the pool. Make sure the ground is free from sharp objects as it may puncture the pool. ® LIFf the pool liner across the ground.DO NOT drag the liner from one location to another location. Q Locate the pool so that the pump opening is 10 to 21 feet away from the electrical outlet. O Put on the leg cap"C"in each vertical leg"V". Q Lay down all parts on the ground as shown below. a O ' 0�0 Carefullyslide the horizontal beams"H"into the sleeves of the pool. '4 Q Connect the T-fitting'T"to horizontal beam"H". e i i a e i Q Insert the Pin"P"down through the top of the T-fittings until the Pin snaps into place on the lower side of the fitting. 1 1 � a r � a ' r I � Should you encounter any problems,contact the Customer Service at(888)919-0070 from 8 AM to 5 PM Mon.thru Fri. EST.Extended operating days and hours during peak season requirements. 5 Q Carefully slide the Vertical leg'Y down through the reinforcement belt. (For pools bigger than 12'x30'j (For pools equal or smaller than 12'x30') t f i Look through the hole in the fitting as you insert and rotate the pipe until the buttons align with the holes and pop out,locking the leg in place. ® Go around and check all fittings,legs and beams are properly installed and secured in place.Make sure the drain fitting is plugged securely and the cap is in place. t .Q' 1 Should you encounter any problems,contact the Customer Service at(888)919-0070 from 8 AM to 5 PM Mon.thru Fri. 6 EST.Extended operating days and hours during peak season requirements. (D'Start filling the pool with water until 1-inch of water is on the bottom,stop filling and smooth wrinkles out of the bottom of the pool. Push outward from inside the pool removing all wrinkles so that it fills evenly and flat. IF MORE THAN 1-2 INCHES OF WATER COLLECTS ON ANY ONE SIDE BEFORE THE POOL STARTS FILLING IN THE CENTER,THE POOL IS NOT LEVEL ENOUGH,AND MUST BE CORRECTED,SEE SITE PREPARATION ON PAGE 4. 31 DISASSEMBLY AND STORAGE GENERAL INFORMATION:Pool must be stored if temperatures are expected to fall below 32°F. A. All parts should be cleaned with a mild soap and lukewarm water only-DO NOT use detergent or hot water. B. Make sure all parts are dry before storing to help prevent mildew from forming. C. Store all parts in a dry heated area where temperatures do not go below 32'F or above 125'F. D. Failure to follow the proper storage instructions could cause damage to pool parts and void warranty. E. YOU MUST FOLLOW THE ASSEMBLY INSTRUCTIONS TO REASSEMBLE YOUR POOL NEXT SEASON.Pool site must be cleared and leveled again before setting up your pool. DRAINING THE POOL: A. To drain the pool,locate the drain plug on the outside of the pool wall and remove the drain cap.A standard garden hose will thread onto the drain fitting.Extend the hose to the area where the water is to be drained. When you have placed the garden hose where desired,the drain plug on the inside of the pool can be opened. B. Remove any remaining water as you wash and completely dry pool using a soft cotton cloth.Push the drain plug into the fitting and replace the cap. C. Frame Pools:If your pool has metal frame work,disassemble those pieces by depressing the plastic buttons sliding those pieces apart or by removing the plastic pins holding them together again sliding those pieces apart,clean them and wipe them dry.If in doubt of proper disassembly refer to the pools set-up sheet and reverse those steps.Place them all together in a safe storage place for reassembly next season.Order replace ment parts for any damaged,broken,or worn parts. D.Solar blankets,leaf covers,ladders,etc.,should be cleaned and dried before storing. LIMITED WARRANTY Polygroup"L meted(Macao Commercial Offshore),(he reinafterpolygroup)warrants to the original purchaser only,the Metal Frame Pool £(frame and liner)against defects in material and workmanship for 90 days from the date of purchase Original Purchaser,must retain proof s Win' �3:»,.,:, ��"-� �,d:;—m' �' �' ��.�.5: .�^:���ar ; i„G+i �.e_ of such purchase in"the form of an original store sales receipt and must produce such upon request by Polygroup or its designated agent)_ Warr anty cla s cannot be processed without a vaali proof of.purchase� ; This Lmited Warranty appl es only tothe original purchaser of the'product and s limited solely'to he repair or e'place' nt' f th product to be deaded m Polygroups solediscreUon.;Consequential damages,including claims for loss of water poolychemicals,damage, Por labor are not covered under this L�mrted Warranty '�` g �� This Warrantyw�lt be declared mval�d should the Purchaser modify or repair the product themselves or,by unauthorized persons;use on-Polygroup parts or.accessories with the product;use the product rn contravention of the Manufacturers Instructions;use improper volts e,abuse the roduct m any way orµth ougti accident or;negligence. Normal wear-and tear is not covered under this Warranty,nor are`acts of God outside the control of Polygroup IN NO EVENT SHALL POLYGROUP,THEIR AUTHORIZED AGENTS;•RELATED ENTITIES OR EMPLOYEES BE LIABLE TOTHE BUYER OR ANY �� ..,� .�h �...� b... �r �.�,�� � � � �,�F� we _ V F nsdictions do not allow the exclusion or a q g y : . � OTHER PART{Y,FOR DIRECTOR CONSEQUENTIAL DAMAGES:Some states or countries or others'u mIfitation of;ni cidentat orconse uential dams es so the above limitation oexclusio�n ma nofapply to y ��� t Should you encounter any problems,contact the Customer Service at(888)919-0070 from 8 AM to 5 PM Mon.thru Fri. EST.Extended operating days and hours during peak season requirements. 7 i POOL COVER SAFETY IF YOU ARE GOING TO USE A POOL COVER,SOLAR COVER OR SOLAR BLANKET, PLEASE READ THIS INFORMATION. POOL COVER WARNING SOLAR COVER WARNING SOLAR BLANKET WARNING WARNING A WARNIN G AVOID DROWNING RISK AVOID DROWNING RISK STAY OFF COVER-WILL NOT SUPPORT WEIGHT. STAY OFF COVER-WILL NOT SUPPORT WEIGHT. KEEP CHILDREN AWAY.CHILDREN OR OBJECTS CAN KEEP CHILDREN AWAY.CHILDREN OR OBJECTS CAN NOT BE SEEN UNDER COVER. NOT BE SEEN UNDER COVER. REMOVE STANDING WATER-CHILD CAN DROWN ON REMOVE STANDING WATER-CHILD CAN DROWN ON TOP OF COVER. TOP OF COVER. REMOVE COVER COMPLETELY BEFORE ENTRY OF REMOVE COVER COMPLETELY BEFORE ENTRY OF BATHERS-ENTRAPMENT POSSIBLE. BATHERS-ENTRAPMENT POSSIBLE. NON-SECURED OR IMPROPERLY SECURED COVERS NON-SECURED OR IMPROPERLY SECURED COVERS ARE A HAZARD. ARE A HAZARD. FAILURE TO FOLLOW ALL INSTRUCTIONS MAY FAILURE TO FOLLOW ALL INSTRUCTIONS MAY RESULT IN INJURY OR DROWNING. RESULT IN INJURY OR DROWNING. j THIS IS NOT A SAFETY COVER. THIS IS NOT A SAFETY COVER. l TYPE OC COVER CLASSIFICATION. TYPE OC COVER CLASSIFICATION. INSTALL COVER WITH LABELS FACING UP. INSTALL COVER WITH LABELS FACING UP. USE DRAWSTRING TO SECURE COVER TO POOL. LAY COVER ON TOP SURFACE OF WATER. THIS COVER MEETS REQUIREMENTS DESCRIBED THIS COVER MEETS REQUIREMENTS DESCRIBED IN SPECIFICATION F-1346(ASTM). IN SPECIFICATION F-1346(ASTM). ;i VERY IMPORTANT DO NOT USE A POOL COVER,SOLAR COVER OR SOLAR BLANKET ON THIS POOL IF IT DOES NOT HAVE THIS TYPE OF WARNING LABEL ON THE COVER. DANGER: Competent supervision and knowledge of the safety requirements is the only way to prevent drowning or permanent injury in the use of this product! Never leave young children unattended. Should you encounter any problems,contact the Customer Service at(888)919-0070 from 8 AM to 5 PM Mon.thru Fri. 8 EST.Extended operating days and hours during peak season requirements. I MANUAL DEL USUARIO PARA LA ALRERCA I DE MARCO INFLABLE REDONDO I Para £ edlriezasaccesorloso ` ara�cor �''p p p sultas�sobre�el producto �. por favor dlrijase. WW .POL CO ! GRO. PSTORE Tel de atenclon al cllente: )�' Os(8y88 9007 Por favor,vislte WW.W POLYGROUP COW/VIDEO1para aprender 'er '�+'ate" k+,? ^W^ rur, ^+ �, w, .�.. P -. ," lk',. ' , m � ycomo con figurarksu producto NODEV ELVA�E PROD w CTOAALNIACEN'A�R 'tfl DISTRIBUIDO POR: POLYGROUP LIMITED (MCO) Avenida Man Xing Hai,Centro Golden Dragon,11 Andar M,Macau { —z) lash Guard"Technolo • N A � o�y,xayp�gg� l Para piscinas circulares de todos los tamanos y profundidades TAMANO DE LA ALBERCA 18'x52" TIPO DE BOMBA F 1500C LONA PARA EL PISO YES .1 CAPACIDAD APROX.EN GALONES 7700 CUBIERTA(DE HOJA) YES CUBIERTA SOLAR NA PROFUNDIDAD MAXIMA DE AGUA 47" JUEGO DE MANTENIMIENTO YES SISTEMA DE FILTRO SFS1000 ESCALERA YES l ' a� ADVERTENCIA: NO Ilene en exceso la alberca y/o permita que la gente se recargue o siente sobre la pared de la alberca- HACER ESTO PUEDE CAUSAR DANO PERMANENTE! DRENE la alberca al nivel apropiado despues de una Iluvia fuerte. NOTA:NO intente ensamblar esta alberca en condiciones climaticas adversas,con viento o cuando la temperatura este por debajo de 60°F. NOTA:Esta alberca se tiene que desensamblar y guardar cuando las temperaturas esperadas sean menosres a los 320F. Si surge algun problema con su producto Polygroup,por favor,no devuelva el producto al lugar o la compra.Todas las reclamaciones de garantfa deben hacerse directamente a Polygroup.Antes de ponerse en contacto con Atencion al Cliente,por favor,primero lea la Gufa de Solution de Problemas en el Manual de Instalacion,o revise la section de preguntas frecuentes en www.polygroup.com.Revisa los videos de instruction de instalacion en www.polygroup.com/video. Si aun asf no puede corregir el problema, pongase en contacto con el servicio al cliente de Polygroup al (888) 919-0070.Tenga el tipo de producto y su recibo de compra listo.Nuestro servicio de Atencion al Cliente le ayudara a resolver el problema. Quiza se le requiera devolver todo o paree del producto para su inspection y/o reparation.No envfe ningun producto a Polygroup sin un Numero de Autorizacion de Devolution. 084-1 20462-2014 I Lea y Siga Toda la Information de Seguridad a lnstrucciones Conservelas para Futuras Referencias Ell no seguir estas advertencias a instrucciones puede resultar en ser_ios danos o muerte para el usuario,especialmente ninos. A PELIGRO A ADVERTENCIA PREVENGA EL PROHIBIDO LANZARSE _ NO SE SIENTE O RECARGUE EVITE AHOGAMIENTO CLAVADOS!NO BRINQUES! SOME LA PARED DE LA ENTRAMPES Agua A Poca Profundidad- ALBERCA Vigile a los ninos todo el tiempo. Usted Puede quedar Alejese de las aberturas Siga todas las reglas de seguridad permanentamente invalido Puede herirse permanentemente. de succion-puede ahogarse 1. Ninos,especialmente ninos menores de cinco anos,estan en alto riesgo de ahogamiento.El ahogamiento ocurre silenciosamente y rapidamente y puede ocurrir en tan poco agua como 2"(5cm). 2. Mantenga a los ninos a la vista directa,permanezca cerca,y superviselos continuamente cuando esten dentro o cerca de esta alberca y cuando este Ilenando y vaciando esta alberca. 3. Cuando busque a un nino perdido,revise primero la alberca,aun y cuando piense que el nino este dentro de la casa. 4. Muy Importante:Las barreras de la alberca,que restringen el acceso a la alberca de los ninos pequenos,son requeridas por la ley.Una barra es necesaria para porporcionar la protection contra el potencial de ahogarse o poder ahogarse.Las barreras no son un susitituto para la supervision constante de ninos.Revise las leyes y c6digos locales o estatales antes de instalar la alberca. 5. El use de la iluminaci6n artificial de la alberca esta en la discreci6n del dueno de la alberca.Prenderla,cuando esta instalada,debe de estar con el Articulo 680 del C6digo Electrico Nacional(NEC)o su ultima edici6n aprobada y consulte con un profesional electrico con licencia. 6. Durante el use de la alberca por la noche,la iluminaci6n artificial sera utilizada pra iluminartodas las senales de seguridad,escaleras,escalones,y los pisos en que camina. 7. El piso de la alberca debe estar siempre visible del perimetro exterior de la alberca. 8. Los c6digos de edificio locales pueden requerir obtenga permiso electrico y de construcci6n.El instalador seguira regulaciones sobre las distancias,barreras,dispositivos y otras condiciones. 9. Ponga una lista de los numeros de telefonos de emergencia tales como el de la policia,bomberos,ambulancia o la unidad de restate disponibles mas cercanos.Estos numeros deben de estar cerca del telefono,el cual este to mas cercano a la alberca. 10.Los juguetes,las sillas,las mesas o los objetos similares que un nino podria escalar deben de estar por to menos cuatro pies(41[121.92 cm]de la alberca.El sistema del filtro de la bomba debe ser ubicado de tal manera que evite ser utilizado como acceso a la alberca por ninos pequenos.No deje juguetes dentro de la alberca cuando terminen de usarla,ya que los juguetes y objetos similares pueden atraer a los ninos a la alberca. 11.El equipo salvavidas basico,debe estar siempre a la mano: * Un tubo fuerte,ligero y rigido no menos de dote pies(121[365.76 cm]de largo. * Una soga minimo de cuarto pulgada(1 AVI[6.35 mm]de cuerda de diametro no o uno y medio(1-1/2)por to maximo del ancho de la piscina o de cincuenta pies(501[15.24 metros],cualquiera es menos,que se ha unido firmemento a un aro flotador,aprobado por la Guarda Costera de aproximadamente quince pulgadas(1 YJ[38.1 cm],o cualquier otro tipo de flotador aprobado. 2 ` 12.Evite que se Entrampe:No habra salientes u otra obstrucci6n en el area de la nataci6n,que pueda causar que quede atrapado o que se enrede el usuario.Si la cubierta de una Salida de succi6n esta perdida o rota,no utilice la alberca.La succi6n puede causar entrampamiento de alguna parte del cuerpo,entredo de cabello o joyeria, destripamiento,o ahogamiento.Repare o reemplace la cubierta de salida de succi6n antes de utilizar la alberca. 13.La alberca esta expuesta a desgaste o deterioraci6n.Si no se le da mantenimiento correctamente,ciertos tipos de deterioraci6n excesiva pueden causar que la estructura de la alberca falle y puede soltar grander cantidades de agua podrian causar danos corporal y/o propiedad. 14.Albercas Residenciales sobre piso solamente son para nadar o caminar.No utilize trampolines,resbaladeros o I cualquier otro equipo que se pueda agregar a su alberca que se pudiera utilizar para lanzarse o resbalarse. 15.Nunca se deben jugar caballazos,saltar o tirarse clavados dentro o alrededor de la alberca.Davos serios, paralisis o muerte pueden resultar cuando no se siguen estas reglas.NO PERMITA que nadie nade sin ninguna supervision. 16.Los senalamientos de seguridad deben de cumplir con los requerimientos de ANSI-Z535 y utilizar la frase de acuerdo al senalamiento. 17.La alberca debe ser ensamblada por un adulto.Se debe tener cuidado en el desempaque y ensamblado de la alberca,la alberca puede contener los bordes potencialmente peligrosos o los puntos filosos que son una pane necesaria de la funci6n de la piscine. 18.Certifiquese en resucitaci6n cardio-pulmonar(CPR).En el caso de una emergencia,el use inmediato de CPR puede hacer la diferencia al salvar una vida. 19.Mantenga todas las lineas electricas,radios,bocinas y otros aparatos electricos lejos de la alberca. 20.No ubique la alberca cerca o debajo de lineas electricas superiores. 21.Retire las escaleras de la alberca antes de dejar la alberca.Ninos tan pequenos como de dos anos han subido las escaleras dentro de la alberca y se han ahogado. "ISO: USUARIOS QUE COMPREN ALBERCAS PUEDEN SER REQUERIDOS POR LA LEY ESTATAL 0 LOCAL PARA INCURRIR EN GASTOS ADICIONALES CUANDO INSTALEN LA ALBERCA.PARA CUMPLIR CON LAS LEYES LOCALES 0 ESTALAES EN REFERENCIA A CERCAS Y OTROS REQUERIMIENTOS DE SEGURIDAD,LOS USUARIOS DEBEN CONTACTAR LA OFICINA LOCAL DE CODIGO DE ASEGURAMIENTO DE EDIFICIOS PARR MAYORES DETALLES. F ` FOLLETOS PARA EL CONOCIMIENTO DEL COSUMIDOR F Contacte:U.S.Consumer Product Safety Commission al www.CPSC.gov/cpscpub/pubs/pool/pdf,Pub.#362 "Safety Barrier Guidelines for Home Pools". I Contacte:ASSOCIATION OF POOL&SPA PROFESSIONALS(NSPI)al www.apsp.org/l 64/index.aspx. Estos titulos estan disponibles ahor:"The Sensible Way to Enjoy Your Aboveground/Inground Swimming Pool", "Children Aren't Waterproof,"Pool and Spas Emergency Procedures for Infants","Layers of Protection"and the "ANSI/NSPI-8 Model Barier Code for Residential Swimming Pools,Spas,and Hot Tubs". PELIGRO: El conocimiento de los requerimientos de seguridad y la debida supervision son el unico camino para prevenir ahogamiento o lesiones permanentes con el use de este producto! Nunca deje ninos pequenos desatendidos. PELIGRO: INSTALACION DE LA ALBERCA No intente ensamblar esta alberca en condiciones adversas de clima,como vientos altos,rafagas fuertes,o cuando la temperatura este por debajo de los 60°F. Si encuentra problemas,contact de Departamento de Partes al(888)919-0070 entre 8 AM y 5 PM Luna.a Vier.Tiempo del Este. Requerimientos para la operaci6n en los dias y horas extendidos durante la temporada pico. 3 HOJA DE INSTRUCCION DE LA ALBERCA 11 PREPARACION DE LA INSTALACION ADVERTENCIA-MUY IMPORTANT I EL SMO DEBE ESTAR A NIVEL,ESTABLE Y CON LA TIERRA COMPACTA • La alberca se debe ensamblar en un sitio liso y suel firme que debera estar libre de piedras,de grava,de palillos, de black-top ode otros los compuestos abase de aceite.No instate la piscina en una cubierta de madera o ningun tipo de superficie de madera.Usted no puede utilizar arena o tierra suelta sin compactar para poner a nivel la superficie para esta alberca,pues solamente se desvanecera. •LA FALTA DEL SEGIMIENTO DE LAS INSTRUCCIONES DE ABAJO PODRIA CAUSAR COLLAPSO EN LA ALBERCA Y PERDIDA DE LA GARANTIA! A. Seleccione al nivel del area,y remueva completamente todos las ramas,piedras,etc.NO seleccione Lin area bajo Ifneas electricas de arriba,arboles o a 15 pies de una casa de Lin edificio,etc. B.La piscina se ubicara a una distancia minima de 6 pies(1,83 m)de cualquiertoma de corriente electrica. C.Todos los receptaculos de 125 voltios,15 y 20 amperios ubicados dentro de Lin rango de 20 pies(6,0 m)de la piscina deberan estar protegidos por Lin interruptor de circuito con descarga a tierra(GFCI).La distancia de 20 pies (6 m)se mide a traves de la distancia mas corta en Ifnea recta,el cable de suministro iria sin necesidad de perforar el suelo,pared,techo,puerta,ventana,u otra barrera permanente. D. Contacte sus utilidades locales,comprobando que ningunas lineas subterraneas del cable,telef6nicas,lineas de gas,funcionamiento del etc.debajo del area que Listed ha seleccionado. 21 INSTALACION DE LA ALBERCA ADVERTENCIA:NO Ilene en exceso la alberca y/o permita que la gente se recargue o siente en la pared de la alberca,hacer esto puede causar danos permanentes.DRENE la alberca al nivel apropiado despues de una fuerte Iluvia. ' TIP:Sera mucho mas facil instalar su alberca si Listed la instala en la luz del sol directa por cerca de 2 horas antes de la instalac16n.Esto ayudara a asegurar Lin ajuste libre de arrugas porque el material de la alberca sera mas flexible permitiendo darle mejor forma durante la instalaci6n. I © o 0 0 0 Conector En Forma Perno/Arandelas Pre-instalado Perno Albercas Circulares Vija Horizontal Pata Vertical De"T' Tapedera De La Pata (con 2 extras) En Forma De V (con 1 extra) Modelo De Tamano De Alberta La Alberta Numero De ID Qty. Numero De ID Qty. Numero De ID QtY• Numero De ID Qty. Numero De ID Qty. Numero De ID Qty. P20-1030 10'x30" 090-380015 x10 090-380020 x10 090-380031 x10 097-080008 x10 097-080029 x22 097-080004 x11 P20-1130 11'x30" 090-380015 x11 090-380020 x11 090-201301 x11 097-080008 x11 097-080029 x24 097-080004 x12 P20-1230 12'x30" 090-380015 x12 090-380020 x12 090-380032 x12 097-080008 x12 097-080029 x26 097-080004 x13 P20-1236 12'x36" 090-380015 x12 090-380021 x12 090-380032 x12 097-080008 x12 097-080029 x26 097-080004 x13 P20-1239 12'x39" 090-380015 x12 090-380126 x12 090-380032 x12 097-080008 x12 097-080029 x26 '097-080004 x13 P20-1330 13'x30" 090-380015 x13 090-380020 x13 090-380034 x13 097-080008 x13 097-080029 x28 097-080004 x14 P20-1333 13'x33" 090-380015 x13 090-201223 x13 090-380034 x13 097-080008 x13 097-080029 x28 097-080004 x14 P20-1339 13'x39" 090-380015 x13 090-380126 x13 090-380034 x13 097-080008 x13 097-080029 x28 097-080004 x14 P20-1436 14'x36" 090-380006 x14 090-380021-1 x14 090-380024 x14 097-080002 x14 097-080030 x30 097-080002 x15 P20-1442 14'x42" 090-380006 x14 090-201249 x14 090-201250 x14 097-080002 x14 097-080030 x30 097-080002 x15 P20-1452 14'x52" 090-380006 x14 090-380075-1 x14 090-380024 x14 097-080002 x14 097-080030 x30 097-080002 x15 P20-1533 15'x33" 090-380006 x15 090-201404 x15 090-380033 x15 097-080002 x15 097-080030 x32 097-080002 x16 P20-1542 15'x42" 090-380006 x15 090-380005 As 090-380033 As 097-080002 x15 097-080030 x32 097-080002 x16 P20-1546 15'x46" 090-380006 x15 090-201405 x15 090-380033 As 097-080002 x15 097-080030 x32 097-080002 x16 P20-1548 I 15'x48" 090-380006 x15 090-380012 x15 090-380033 x15 097-080002 x15 097-080030 x32 097-080002 x16 P20-1552 15'x52" 090-380006 x15 090-380075 x15 090-380033 x15 097-080002 x15 097-080030 x32 097-080002 x16 P20-1642 16'x42" 090-380006 x16 090-380005 x16 090-380055 x16 097-080002 x16 097-080030 x34 097-080002 x17 P20-1648 16'x48" 090-380006 x16 090-380012 x16 090-380055 x16 097-080002 x16 097-080030 x34 097-080002 x17 P20-1652 16'x52" 090-380006 x16 090-380075 x16 090-380055 x16 097-080002 x16 097-080030 x34 097-080002 x17 P20-1748 17'x48" 090-380006 x17 090-380012 x17 090-201244 x17 097-080002 x17 097-080030 x36 097-080002 x18 P20-1752 17'x52" 090-380006 x17 090-380075 x17 090-201244 x17 097-080002 x17 097-080030 x36 097-080002 x18 P20-1842 MAT 090-380006 x18 090-380005 x18 090-380056 x18 097-080002 x18 097-080030 x38 097-080002 x19 P20-1848 18'x48" 090-380006 x18 090-380012 x18 090-380056 x18 097-080002 x18 097-080030 x38 097-080002 x19 P20-1852 18'x52" 090-380006 x18 090-380075 x18 090-380056 x18 097-080002 x18 097-080030 x38 097-080002 x19 P20-2048 20'x48" 090-380006 x20 090-380012 x20 090-201406 x20 097-080002 x20 097-080030 x42 097-080002 x21 P20-2448 24'x48" 090-380006 x24 090-380012 x24 090-201407 x24 097-080002 x24 097-080030 x50 097-080002 x25 P20-2452 24'x52" 090-380006 x24 090-380075 x24 090-201407 x24 097-080002 x24 097-080030 x50 097-080002 x25 4 Si encuentra problemas,contact de Departamento de Partes al(888)919-0070 entre 8 AM y 5 PM Luna.a Vier.Tiempo del Este. Requerimientos para la operaci6n en los dias y horas extendidos durante la temporada pico. ® Localice un area plana para montar la piscina.Asegurese de que no hay objetos punzantes en los alrededores que puedan perforar la piscina. ® ELEVE la Iona de la piscina por encima del suelo,NO arrastre la Iona de un sitio a otro. ® Posicione la piscina de tal manera que la apertura de la bomba se encuentre a 10—21 Q Coloque la tapa de la barra"C"en cada barra vertical"V". Q Coloque todas las panes en el suelo,tal y como se muestra mas abajo. Q Deslice cuidadosamente las barras"H"en las Ilamadas mangas de la piscin. r � Q Conecte la parte'T'en la barra horizontal"H". e I Q Inserte el pin"P"a traves de la pane superior de los encajes en'T hasta que el pin quede ajustado en su sitio en la pane inferiorinsertthe Pin"P". a I Si encuentra problemas,contact de Departamento de Partes al(888)919-0070 entre 8 AM y 5 PM Luna.a Vier.Tiempo del Este. Requerimientos para la operacion en los dfas y horas extendidos durante la temporada pico. 5 Q Deslice cuidadosamente la barra vertical V hacia abajo a traves del anillo de refuerzo. (Para piscinas de mas de 12"x 30") (Para piscinas de igual tamano o de menos de 12"x 30") M t U Mire a traves del agujero mientras inserta y gira el tubo hasta que todos los botones encajen y queden alineados con sus respectivos agujeros y sobresalgan,fijando la barra en su sitio. Gamine alrededor y compruebe que todos los ajustes, barras y tubos estan correctamente instalados y asegurados. Asegurese de que el drenaje esta bien asegurado y que la tapa esta en su sitio. t Si encuentra problemas,contact de Departamento de Partes al(888)919-0070 entre 8 AM y 5 PM Luna.a Vier.Tiempo del Este. 6 Requerimientos para la operacion en los dias y horas extendidos durante la temporada pico. r ® Cornierrce a Ilenar la piscina solo hasta una profundidad de 1 pulgada (2,5 cm),interrumpa el proceso y alise las arrugas del fondo de la piscina.Empuje hacia los bordes desde el Centro de la piscina alisando todas las arrugas existentes para que la piscina pueda Ilenarse de manera homoge- nea y nivelada.SI SE ACUMULA MAS DE 1 -2 PULGADAS(2,5-5 CM) DE AGUA EN CUALQUIERA DE LOS LATERALES ANTES DE QUE EL CENTRO DE LA PISCINA COMIENCE A LLENARSE,ENTON- CES LA PISCINA NO ESTA LO SUFICIENTEMENTE BIEN NIVELADA,Y DEBE SER CORREGIDO,LEA EL APARTADO"PREPARACION DE LA LOCALIZACION"EN LA PAGINA 4. 30 DESENSAMBLADO Y ALMACENADO INFORMACION GENERAL:La alberca debe almacenarse si se esperan temperaturas por debajo de IDS 320 F. A. Todas las panes se deberan limpiar con jabon y agua tibia solamente-NO USE detergente o agua caliente. B. Asegurese que todas las panes esten secas antes de guardarse para ayudar a prevenir la formation de moho. C. Guarde todas las panes en una area Seca y donde las temperaturas no Sean menores la los 320 F o mayores a los 1250 F. D. El no guardar correctamente las partes pueden danarlas y la garantia no es aplicable. E. USTED DEBERA DE SEGUIR LAS INSTRUCCIONES DE ENSAMBLADO AL REENSAMBLAR SU ALBERCA LA SIGUIENTE TEMPORADA.La ubicacion de la alberca debe despejarse y nivelarse de nuevo antes de instalar la alberca. DRENAJE DE LA PISCINA: A. Para drenar la alberca,localice el conector de drene en la pane exterior de la pared de la alberca y remueva al tapa de drene.Una manguera de tamano estandar entrara en el drene.Ectienda la manguera hacia el area donde de drenara el agua.Cuando haya colocado la manguera donde desea,elconector de drene de la pane exterior de la alberca puede abrirse. B. Remueva cualquier emanente de agua mientras lava y Seca completamente la alberca usando un trapo suave de algodon.Presione el conector de drene dentro de la abertura y coloque la tapa. C. Albercas de Marco:si su alberca tiene un marco de metal,desensambae esas piezas aflojando IDS botones de plastico,deslizando esas piezas aparte o remviendo los pasadores de plastico,sosteniendolos juntos de nuevo, limpielos y sequelos.Si tiene dudas para desensamblar,refierase a la hoja de ensamble y deshaga los paso. Coloquelos juntos en un lugar seguro de almacenaje para reensamblarlos la proxima temporada.Ordene los repuestos de cualquier part que se haya danado,quebrado o desgastado. D. Los panos de Sol,cubiertas,escaleras,etc.,deben limpiarse y secarse antes de almacenar. GARANTIA LIMITADA �. . ,. Polygroup Limited(Macao Comercial Offshore) (de aqua en adelante Polygroup)garantizarunicamente al comprador original,los tipos _ ,�.;,«�,�, �w, �*��� ma a . ,�° r¢ a,��+ . .,f v 0isdna con'b a�e metal(horde y revestimiento)'contra defectos en matenales y mano de obra durante un periodo 90 dias a partir de �Ia fecha de compra=EI comprador debe conser' a el comprobante de compra que podr'ser el recibo de la tienda y debera mostrarlo, x=ar m..w MIMV414 �mr•::, .ix M w „., � w. .v, a W;ram a a m cuando Polygroup o sus agentes autonzados asi to soliciten Las reclamaaones de garantia no pueden ser procesadas sin una prueba KAHJa de co"mpra �,, � � f " w. ro + t � g � � � k IEsta garantia limit�ada se aplica unicamente solamente al comprado me' a Ia reparaon o W J ; .. sustitucion del pro ducto,decision que sera tomada por Polygroup a discretion.Aquellos Banos consecuentes incluyendo reclamaciones por rdida de agua;productos qu micos para piscinas,o mano de obra;no estan cubiertos por esta garantia w�0w g m -° ._ .. fir, .., _ ,�,,..;fix a�v„ „' µ.� Esta garantia sera declarada nula si I comprador modifica o repara el producto por si mismo o se Ileva a Cabo por"personas no t8nz'a �das;si se utilizan partes o accesoriosque no Sean de Polygroup se utiliza el producto en contra de los que especifica el fabncante en sus � �, .Ts-a ,rrr>k;"rvlAX;kAln4u`�+"+'s;'''1M'rSMnnd ;..;. :"q?.xr rMism,.rva�ua , . .' 4aM'iC' ""nwi""% N,", , o-x�ts,vlkFrve'4vasr,�; f;a? instrucciones;se utiliza voltaje incorrecto;se abusa del prod ucto en cualquier modo;o en caso de accidente o negligencia EI desgaste n' � -; f qu14 w cubiertopo�rEesta garantia rn cualquierAproblema de fuerza mayor�quuu�e fuera del control de Polygroup_ ! 71 EN NINGUN CASO POLYGROUP,S U 5 AGENTES AUTORIZADOS„EMPRESAS R_E LAC 10NADAS O EMPLEA DOS,S E R A N RESPONSABLES DES DATOS DIRECTOR 0 INDIRECTOR ANTE EL COMPRADOR O CUALQUIER OTRA PERSONA:Algunos estados o passes o lunsdicciones no permiten la exclusion o limrtacion de Banos mcidentales o consecuentes;porlo que la limitation o exclusion puede no aplicarse en su I; J. I Si encuentra problemas,contact de Departamento de Partes al(888)919-0070 entre 8 AM y 5 PM Luna.a Vier.Tiempo del Este. Requerimientos para la operation en los dias y horas extendidos durante la temporada pico. 7 , 7 SEGURIDAD DE LA CUBIERTA DE LA ALBERCA SI VA A UTILIZAR UNA CUBIERTA PARA LA ALBERCA,CUBIERTA SOLAR 0 MANTA SOLAR, POR FAVOR LEA ESTA IMPORTANTE INFORMATION. ADVERTENCIA DE LA CUBIERTA PARA ALBERCA ADVERTENCIA DE LA ADVERTENCIA PARA CUBIERTA SOLAR LA MANTA SOLAR A ADVERTENCIA A ADVERTENCIA EVITE EL RIESGO DE AHOGARSE EVITE EL RIESGO DE AHOGARSE LA CUBIERTA-NO PODRA SOPORTAR EL PESO. LA CUBIERTA-NO PODRA SOPORTAR EL PESO. MANTENGA ALEJADOS A LOS NINOS.LOS NINOS 0 LOS OBJETOS MANTENGA ALEJADOS A LOS NINOS.LOS NINOS 0 LOS OBJETOS NO PUEDEN SER VISTOS DEBAJO DE LA CUBIERTA. NO PUEDEN SER VISTOS DEBAJO DE LA CUBIERTA. REMUEVA EL AGUA-EL NINO PUEDE AHOGARSE ENCIMA DE LA REMUEVA EL AGUA-EL NINO PUEDE AHOGARSE ENCIMA DE LA CUBIERTA. CUBIERTA. REMUEVA LA CUBIERTA TOTALMENTE ANTES DE LA ENTRADA REMUEVA LA CUBIERTA TOTALMENTE ANTES DE LA ENTRADA DE BANISTAS-POSIBLE TRAMPA. ' DE BANISTAS-POSIBLE TRAMPA. LAS CUBIERTAS NO ASEGURADAS O INCORRECTAMENTE LAS CUBIERTAS NO ASEGURADAS 0 INCORRECTAMENTE ASEGURADAS SON UN PELIGRO. ASEGURADAS SON UN PELIGRO. LA FALTA DE SEGUIR CORRECTAMENTE TODAS LAS LA FALTA DE SEGUIR CORRECTAMENTE TODAS LAS INSTRUCCIONES PUEDE CAUSAR LESIONES Y AHOGARSE. INSTRUCCIONES PUEDE CAUSAR LESIONES Y AHOGARSE. ESTA NO ES UNA CUBIERTA SEGURA. ESTA NO ES UNA CUBIERTA SEGURA. CLASIFICACION DE LA CUBIERTA TWO OC. CLASIFICACION DE LA CUBIERTA TIPO OC. INSTALE LA CUBIERTA CON LAS ETIQUETAS HACIA ARRIBA. INSTALE LA CUBIERTA CON LAS ETIQUETAS HACIA ARRIBA. UTILICE ELLAZO PARA ASEGURAR LA CUBIERTA ALA ALBERCA. COLOQUE LA CUBIERTA EN LA SUPERFICIE DEL AGUA. ESTA CUBIERTA CUENTA ON REQUERIMIENTOS QUE DESCRIBEN ESTA CUBIERTA CUENTA CON REQUERIMIENTOS QUE DESCRIBEN ESPECIFICACION F-1346(ASTM). ESPECIFICACION F-1346(ASTM). MUY IMPORTANTE! ' NO UTILICE UNA CUBIERTA PARA ALBERCA,CUBIERTA SOLAR 0 MANTA SOLAR EN ESTA ALBERCA SI NO TIENE ESTE TIPO DE ETIQU ETA DE ADVERTENCIA EN LA CUBIERTA. PELIGRO: El conocimiento de los requerimientos de seguridad y la debida supervision son el unico camino para prevenir ahogamiento o lesiones permanentes con el use de este producto! Nunca deje ninos pequenos desatendidos. Si encuentra problemas,contact de Departamento de Partes al(888)919-0070 entre 8 AM y 5 PM Luna.a Vier.Tiempo del Este. 8 Requerimientos para la operacion en los dias y horas extendidos durante la temporada pico. r tHE Town of Barnstable BARNSTABLE. ' Regulatory Services MASS. 039. Building Division prFD MA'S a, 200 Main Street,Hyannis,MA 02601 Office: 508-8624038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection F" -'1J:4 L- Location LA Permit Number Owner Builder One notice to remain on job site, one notice on file in Building Department. The following items need correcting: /�nJ1) . ,Tip,-`,wWA Please call: 508-862-4038 for re-inspection. Inspected by Date J, TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION,.- Map el, ;Application # Health Division Z� -767� Date Issued Conservation Division ' ' ' "Application Fee Ai Planning'Dept; ='Permit Fee L,20 Date Definitive Plan Approved by Planning Board Historic OKH Preservation / Hyannis Project Street Address Village Qe�-Icrvi%% Owner ��f%� aT���i Address Telephone POW Permit Request .c6 a J" , Square feet: 1 st floor: existing proposed .2nd floor: existing proposed Total new Zoning District: Flood Plain Groundwater Overlay Project Valuation'Var000' Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes A No On Old King's Highway: ❑Yes 91 No Basement Type: ❑ Full ❑ Crawl Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) C , Number of Baths: Full: existing new Half: existing new �J Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count L- Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No ' Fireplaces: Existing ,New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size 9 — 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 y APPLICANT INFORMATION (BUILDER OR HOMEOWNER) , Name C!2 kZ4 AAnJGyer74 Telephone Number Address License# 41OT-60 a411i:r, ,!!�tC , 0,9604 Home Improvement Contractor# 'Y7.S- Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �.�, �% SIGNATURE�JLz�'/1 50.� z�t�,�rz�e? DATE r 1 �i FOR OFFICIAL USE ONLY i - APPLICATION# DATE ISSUED MAP/PARCEL NO. n ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION (o aid{o`t FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL t PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. i Vie Commonwealth of Massachusetts Department of Iridusti ial Accidents Office of Investigations 600 Washington Street ,Boston, MA 02111 . www.mass.gov/dia Workers' Compensation Insnrance Affidavit: Builders/Contractors/Electricians/Plumberg Applicant Informadoli Please Print Legibly Name (Business/Organization/Individual): f��Bi/1lGyc�d��� ' ✓ E'�7�✓� Address: 16.3 3 &C C kW,.,J 4-Awt City/State/Zip: Phone.#: Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ 1 am a general contractor and I 6. ®New construction . employees (full and/or part-time).* have hired the stab-contractors 2. 1 am a•sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors hive g, ❑Demolition employees and have workers' working for me in any capacity. $ 9• Building addition [No workers' comp.•insurance mmp• insurance. requirnd] S. [] We are a corporation and its to. Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I L E]Plumbing repairs or additions myself. [No.workers' comp. right o£exemption per MGL 12.❑Roof repairs ;na,,,ance regnired]t c. 152, §1(4), and we have no 13.❑ Other employees. [No workers' comp.insurance required.] *Any applicant that checks box#1 roust also fin out the section below showing their workers'Compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors trust submit anew affidavit indicating such. tConiractnrs that check thin box must attached an additional sheet showing the name of the sub-conh—tors and state whether or not those entities have employees. Uthe sub-contractors have employees,they must providb their workers'comp.policy numbcr. 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/StatdZip: 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 rti_m_ir_ial 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 tine 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 bIA for insurance coverage verification. I do hereby certrfy under thepainsss-andpenaLdes of perjury that the information provided above is true and correct. Sitrnature �G � �Z�i.� �.��� Date' Phone# y! " d SryA Of use only. Do not write in this area, to be completed by city or town officiaC .City or Town: Pernit/License# Issuing Authority(drde one): 1.Board of Health 2.Building Department 3, City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspecfor 6. Other Contact Person: Phone#: s✓® Information and. hiss 'u.eb ons Massachusetts General Laws. chapter 152 requires all employers to provide workers' compensation for theiremployees: Pursuant to this statute, an enxployee 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 forcgoing.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 not more than three apartments and who resides therein, or the occupant of the owner of a dwelling house having n dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grouudse er building appurtenant thereto sha'1 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 commonwealth for any strict buildings the m renewal of a license or permit to operate a business or to con g aired.„ • applicant who has not produced acceptable evidence of compliance.with the insurance coverage re q Additionally,MGL ohaptcr 1.52, §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(cs) and phone nurnber(s) along with their certificates) of ed Liability Paxtnershi s LLP)with no employees other than the insu rance. Limited Liability Companies(LLC) or Limit ty P members or partners, arc 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-insuranc�c license number on the appro2riato line. City or Towp 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 Invcsb.g ations has to contact you regarding the applicant.' Please be sure to fill in the permit/licensc number which will be used as a reference number. In addition, an applicant that crust submit multiple pe mit/licensc applications is any given year, need only submit onF affidavit indicating current or policy information(if pecessary) and under"Job Site Address" tho applicant should write"all locations in—(city town)."A cbpy 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 permaits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a liccns c or permit not related fo any business or commercial venture (ic. 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 besitatc to give,us a call The Department's address,tclephone.and fax number: Tha COEamouwt,-4th of Massachusetts DcpzztmeAt of ludusf riO A c-cidonts Office of Izavesstipti.ans 600 Washington St-cet $Qstan, MA 02111 Tcl. # 617-727-490.0 ext 405 Qr 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 WWW.Ma_5;S..gou/dia -'� IVlass.lchusetts- Department of Public Safeh Board.of Buildim,- Rel,ulations'and Standards 4,54/.FF Construction Supervisor License License: CS 45009 Restricted.to: 00 CALVIN B-FARNSWORTH. } 57 ROCK AVE PAWTUC KET;,R 102864 t; Expiration: 9/3/2010 ('ummissiinrer Tr#: 9875 �lze i�anvrreoozuse o��/ aclucaelt ;j Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registratwn `156475 Ex 'ration P 7/5/2009 Tr# 256026 t� Type DBA I r PRECISION CARPENTRY V J�, T CALVIN FARNSWORTH .ff 57 ROCK AVE. PAWTUCKET,RI 02861 Administrator ' i 51►.�G�C FAMILY DA►L.� F►-OW s IID A 3 - 33OG.Pp ` � ZZ SF_p-r%a TAWK a 330x150% 2-495b.PR USE— l000 D15PO5AL PIT V4E lvoD GAL• �"CppSow.. SID�h/p�L 2RGA. Is 1!5,06.F �RD i 15G BOTTOM REAs 3p'l�F. . -roTA1 DE51GW 1 4z� -TOTAL pA 11."( FLOW = 330 G.Po 30. 1 FWD -� PEpLcoLATIOW RATE+ iIN 2MIN oP-Ltz55 c z4 tH OF M 1 ittCFiJ1FiD o AL A. / JI ..�AkTER I N 2 I 1 v WL TEST P-13Z�j /C� � 1�21 'TOP FNO� + ` '. Nolte• 8-�`-ez �G '4Z. �,�,�'cv� 6Z. 4-Z.o �fY9`r ILhI. Gopl� IOOp INV.. P►5T: sueso�l. INV. 56PT►G 4 '8 i ,Z' 94K. ¢O•G .TANK 1Oo0 1NY SANOY Goy.. 4o.v 6�q�EC. 6"' wIT INV.. INV. N .Qo;z 4,04 1'��/q•I Yi -wAsuco � 1 I 670 N MED 6 : A•v�``��"" GERTIF1G.p P1.oT PLAID • PRvFILt~ ��. � - — 1 Ic Mo� SCALE 5 ALE< <o' V A 9-. zZ-SZ wA p>~At� RED EIZEN GE G E RT 1 F Y T H F►T T N 1~ Foc7u D�k-n coo :5vto WN N;q_r=o►.1 GoMPLYS WITN'f HE S I P56L-IN r= LoT 77 _ AWD S67VQo►GK R-r=Q0%9.et&SNT'p ®F "TNc— I ZA W N O F 8A RN sTH BLeE AN 1;a l�7oT- _zAa vD 35 s I.00ATED_'WIT_NI.1J_T._13G .F1.O17D PLA11.! 1 1 I eta 1 i a l ry I y .NIA x � ,,� qu sc oFCHeroy Town of Barnstable � y Regulatory Services BABNSrABLE, Thomas F. Geller, Director �prFo ta`� Building Division Torn Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property ®wrier Must complete and Sign. This Section If Using A Builder 1, �lae- d as Owner of the subject property hereby authorize La,lk � &4S&&1 /� to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) lgnature- of Owner Date Print NamE If Property Owner is applying for permit please complete the Homeowners License Exemption Form on th'e reverse side. Town of Barnstable THE y T Regulatory Services Thomas F. Geiler,Director • BARNSTABLX v MASS. $s679. �� Duildiug Division � AlFcD A Tom Perry,Building Cornmissioner .. 200 Main Street, Hyannis., MA 02601 IIw3v.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOA4EOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: village number street "HOMEOWNER": work hone# name home phone k P . 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 possess a license, provided that the owner acts as to allow homeowners to engage an individual for hire who does not p supervisor. DEFINITION OB HOi14EOVYNER 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 tyro-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 buildingpermit. (Section 109.1:1) The undersigned "homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes bylaws,rules.and regulations. Y p1? • rtment e uildin De a The undersigned "homeowner"certifies that he/she understands the Town of Barnstabl B g p 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. HONMOWNER'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 lo9.1.,1-Licensing of construction Supervisors);provided that if the homeowner engages a persons)for hire to do such work, that such HDmeo\Vner shall act as supervisor,", y homeowners who use this exemption arc unaware that they are assuming the responsibilities of a supervisor(see Appendix Q. Man Rules&•Regulations for Licensing Construction Supervisors;Section 2.15) This lack of awareness often results in serious problems,particularly is case our Board cannot proceed against the unlicensed person as it would With a licensed ties unlicensed persons. In this , when the homeowner h P Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/hcr responsibilities,many communities require,as part of the permit application, that the homeowner certify that ha'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 forrrVicertification for use in your community. I Town of Barnstable Regulatory Services . SARNBrAH[I�. nc�ss. Thomas F.Geiler,Director Building Division Thomas Perry,CBO,Budding Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnsta ble.ma.us Office: 508-862-4038 Fax: 508-790-6230 PLAN REVIEW Owner. Map/Parcel: lee 16 7 Project Address// EL-44t 4J. &T- Builder: -�XYER14J-C WOX?-1h' i The following items were noted on reviewing: i !-j et S'r 'q E 1 x 8 Con 5T-&4cc ticAf f" 'PrW5 eyoz E, 2 �f/Crr �l.fY - /Ltt%f Sf J�{tiz � cq-�ct ��2c P - �7F�rc,Ffr�tJttr !?' T� GlfeT, 3 oS/7-/C/6 OVA,A) Fri-r.! �ON R '�"E !IU Sr�N6S OS�S /F 4r6*Ese 7*--o 1 . � FEt•r' oFF Gl2R-A�• � ' • Reviewed by: Date:... 07- IIVI Q:Forms:Plnrvw mot , '` vn of Barnstable *Permit# - Expires 6 months from issue'date Regulatory Services Fee � �r + BARNSTABLE. 9 MASS $:, � 163 �0 �,s } � �� ,l ,�, ��ri �,�'homas F. Geiler,Director , ��^*�qq pTf� IA a, � � rLJ �.. I /Zpjlag at Building Division Tom Perry,CBO, Building Commissioner d l� �, 200 Main Street,Hyannis,MA 02601 ARNSTABLEwww town.barnstable.ma.us Office: 508-862-4038 Fax: 5087790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY - Not Valid without Red X-Press Imprint, Map/parcel Numberg 'l07 EJ /' j. Prop Address �l '. � C�G/v � V I, 2. Residential Value of Work �/Mi imam fee $25.00 for work under$6000.00 Owner's Name&Address n � Contractor's Name AWN, Telephone Number ( (p /.(� V Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable)-. q0 � ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑Xm the Homeowner I have Worker's Compensation Insurance Insurance an Comp Y .Name Workman's Comp.Policy Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re- ide - Re lacement Windows/doors/sliders.U-Value �, maximum .44 +N00'U/ p ( ) � w *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note` 'Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. ,' .SIGNATURE: V Q:\WPFILES\FORMS\building permit.forms EXPRESS.doc, Revised 100608 12/23/2009 13: 11 FAX 002/002 is o � P+�00rI�d S)a)X poyley�Eulso) .n N p010WI1/B �7 �1 �` V1 M iC 14 topim Fingwilra to rn iii 555pp ZI a 46ln s4in►oe S � C 3 �ptM ES sES ►o x } \ `v 3 8 4 ` EMS 5 epUA ee111!o tl o \ o ti Mks IL NWEa NI1gyfNlYr ` Y' 9 2 I alddd�IIP7 N p Rr 1►Yl w MW muomW) W ' u►ellod ellli9 ` B MU Nti�fLiMw�/ e� a iw pro�i ti1 aa� B ' y�Wq• Mrll'rMPWr «�irvw. uopdp�o+eMploN 1n h � � N � � �7 halSrr1. 0 4"S $ •rA r Me r0A•YAP 9W ycoS lad q361 yces r . - _ ope-i apo.e w.mo•m '4 �§ I sll^d Ju s7►Il 4c05 a N A o�iai� tr1 M x x x mlulul�olo� -s g s s 'a '.� 3 0 imp y (rvImrNUAe/AO i T ro.,Wwr.m �� � 5•� �u��ty� � J �u0^ha5u0111^W Qoe.d en � .9lll IBe►eBu e1P 9lll lea►Bau 1 of • lev+ut w hvw+l�v � dw s�,yrQy7«�� Cp � �a�� V v!no;M IAQ ldd PgNoub fO YIilY1N �MM/ \ . q 6 adtiQ0 Owolj N - .rar_ �'W ap^pnrd Cdl ��. �� U �° �• v �� C Iw d A0014 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600=Wash-ington-Street Boston,AM 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lelzibly .ter Name (Business/Organization/Individual): Mom) ' Ssoci Jll C a , Address: .5 % ✓f _ Ffr City/St to/Zip:00O N-1,oJe IZ- 0),*� Phone #: /—/CJ /'. 60 7l 6GL/ Are u an employer?Check the appropriate box: Type of project(required):. 1. I am a employer with O 4. ❑ I am a general contractor and I employees(full and/or part-time). * have hired the sub-contractors 6. ❑Ne construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. emodeling ship and have no employees These'sub-contractors have g- ❑Demolition workingfor me in an capacity. employees and,have workers Y p tY- 9.:. ❑Building addition. [No workers' comp. insurance comp,insurance.1 - 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. [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 41 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 -emp ogees.-rf-Ife sub-con rac ors have emp oyeeTthey-musrprovido-their w-orkzrs'comp.Toticyn-amber- -,- - - - - - - - — - - - I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. an `` Insurance Company Name: t:�li.0'J!! C� / �7 — Policy#or Self-ins.Lic:#: � Expiration Date: lo / V Job Site Address: / /�/5 �� ' City/State/Zip: h Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP'WORK.ORDER and a fine of up to$250.00 a day against,the violator: Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification: I do hereby certify under the pains and penalties of perjury that the information provided above is,true and co r ct. Sii znre: Date: f� Phone#: C 0 Official use.only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# :" d 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#: From:Shaunna Robinson, Hunter Insurance At:Hunter Insurance,Inc. aAD: TO:Denise C-lode Date:9123/09 09:45 AM Page:2 of ACORP' CERTIFICATE OF LIABILITY INSURANCE OP1D S DATE(MM,DD,YYYY) MOONA-1 09/23/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Hunter Insurance, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 389 Old River Road, P.O-Box 1 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Manville RI 02838-0001 Phone: 401-769-9500 Fax:401-769-9502 �INSURERS AFFORDING COVERAGE NAiCY INSURED Moon Assoc iates Inc. - - - DBA Gutter Helmet INSURER A: National Grange insurance Co I 14788 DBA Renewal by Andersen of .RI I INSURER B: seacan Lattual Znsuxanca co. DBA Gutter Helmet Roofing DBA Moon Works INSURER C. 1137 Park East Drive INSURERD: Woonsocket RI 02895 ` INSURER E: COVERAGES 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 SUBJECTTO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE(MMIDDNY) DATE(MM/DDIYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 10 0 0 0 0 0 A X COMMERCIAL GENERAL LIABILITY MPS26619 - 09/16/09 09/16/10 PREMISES(Ea occurence) $500000 CLAIMS MADE a OCCUR - - MED EXP(Any one person) $ 10000 - PERSONAL&ADV INJURY $ 10 0 0 0 0 0 GENERAL,AGGREGATE $2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $.2 0 0 0 0 0 0PR - - - POUCY JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT A X ANY ALTO B1S26619 09/16/09 09/16/10 (Ea accident) $ 100-0000 ALL OWNED AUTOSBODIL — SCHEDULED AUTOS (Per person) on) $ .. (Per person) HIREDAUTOS - BODILY INJURY � $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) ' GARAGE LIABILITY. AUTO ONLY-EA ACCIDENT $ ANY AUTO - EA ACC $ • OTHER THAN _ AUTO ONLY: AGG $ EXCESSAIMBRELLA LIABILITY EACH OCCURRENCE $ 10 0 0 0 0 0 A X OCCUR CLAIMS CUS26619 09/16/09 09/16/10 AGGREGATE $ $ DEDUCTIBLE $ X RETENTION $10 000 WORKERS COMPENSATION AND - S - EMPLOYERS'LIABILITY - - .X TORY LIMITS ER _ B ANY PROPRIETORIPARTNEWEXECUTIVE 28586 10/01/09 10/01/10 EL EACH ACCIDENT. $500000 OFFICERIMEMBER EXCLUDED? — If yes,describe under ' E.L.DISEASE-EA EMPLOYEE $5 0 0 0 0 0 SPECIAL PROVISIONS below - E.L.DISEASE-POLICY LIMIT $5.00000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS t VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION BUIhDIN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION R Building Cont. Reg. Board DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Dept. of Administration One Capitol Hill „ IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Providence RI 02908 REPRESENTATIVES. ALIT D REPRESENTATIVE ACORD 25(2001108) ©ACORD CORPORATION 1988 I r Pw jo . .09535 • - . e. R } �i� ttt.` itio .G1 I�i. .. •i LYf "L�CsYU al on OON XET+ U �rsecre#aty V -UPON Df PAI. IKE r Tart wn of Barnstable *Permit# pExpires 6 months from issue date i M Regulatory Services Fee • BARNSTABLE, + Thomas F.Geiler,Director MI Clz/Z l Building-Division DEC �' Z009 2 :� Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 T®�✓ 4 OF BARNSTAF3LE www.town.bamstable.ma.us Officer. 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY i� Not valid without Red X-Press Imprint Map/parcel Number ®C' o6A rRe Address i.N ? (.�� Cx1t/1- 1� Lential Value of Work 1V .mum fee of$25.00 for work under$6000.00 n Owner's Name&Address (J ,/ i A Contractor's Name ` �/�n') e— AOM/7/ Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) (7,9 NV ❑Workman's Compensation Insurance Check one: ❑ I am sole proprietor ❑ I the Homeowner have Worker's Compe(nssation.Insurance Insurance Company Name L J C(/✓� 1 p Y Workman's Comp.Policy Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re.-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of r000 ❑ Re-sod Replacement Windows/door /shder�s. -Value Q, C . (maximum .44) a� *Where.required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy,of the Home Improvement.Contractors License is required. ' SIGNATURE: Q MPFILESTORWbuilding permit formslEXPRESS.doC Revised 100608 The Commonwealth of Massachusetts Department of Industrial Accidents: Office of Investigations 600=Washington--Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): f.��!V S�OG: Ci , a Address: �% 32 KW' Mfrs City/St to/Zip:iiUoofi)-Oc tc�_ �:� ( �� Phone #: Are Y4u an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 6 V 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. modeling ship and have no employees These sub-contractors have g, ❑Demolition workingfor me in an capacity. employees and have workers' Y P �'� 9: ❑Building addition , [No workers' comp. insurance comp. insurance.$ 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 [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no ` employees. [No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $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 em to ees.-If c subcontractors have�o eel th-e must-rovrdu-th-eir w rkery-mourn . olic number- -- - - - - - - - -- - - P Y employ h P P� Y I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Y Insurance ComP an Name: efial/) n4w Policy#or Self-ins.Lie.#: Expiration Date: / Job Site Address: �k LV City/State/Zipd i �d-�3 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 certify under the pains and penalties of perjury that the information provided above is true and co eet. Si nature: Date: L ^ . Phone#.. ©/ �co 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#: � s • � r�Aft�au-line, Rio � 0.210.0 � F°,�e+�s t g:#1� �,'t-9ry�yq.f Rio" ;S�3,O * _ _ TF# Lt3 "tJU MOONAS f �P J.l�11718 No K O �� fi, U#ir� rserretary �. .11 olp 8-� 'av Aa < 1 cum �` � rr.c � cam . srsr t # From:Shaunna Robinson, Hunter Insurance At:Hunter Insurance,Inc. =axID: To:Denise Glade Date:9123109 09:45 AM Page:2 of ACQR® CERTIFICATE OF LIABILITY INSURANCE OP ID S DATE(MMIDD/YYYY) MOONA-1 09/23/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Hunter Insurance, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 389 Old River Road, P.O. Box 1 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Manville RI 02838-0002 f Phone: 401-769-9500 Fax:401-769-9502 INSURERS'AFFORDINGCOVERAGE INSURED NAIC� Moon Associates Inc. 14788 DBA Gutter Helmet INSURER A: National Grange Insuruace co DBA Renewal by Andersen of RI INSURERB: sear_an tiutual Insurance co. DBA Gutter Helmet Roofing, DBA Moon Works - Y INSURER C: 1137 Park East Drive INsuRERD: FWooasocket RI 02895 INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. . LTR INSRE TYPE OF INSURANCE POLICY NUMBER TTVIE DATE(MM DI DDNY) DATE(MMIDD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A X COMMERCIAL GENERAL LIABILITY MPS26619 09/16/09 09/16/10 PREMISES(Eaoccurence) $500000 CLAIMS MADE OCCUR MED EXP(Any one person) $ 10 0 0 0 PERSONAL&ADV INJURY $ 10 0 0 0 0 0 GENERAL AGGREGATE $2 0 0 0 0 0 0 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG. Is 2 0 0 0 0 0 0' POLICY jc LOC - AUTOMOBILE LIABILITY - COMBINEDSINGLELIMIT A $ 1000000 X ANY AUTO BIS26619 09/16/09 09/16/10 (Ea accident) ALL OWNED AUTOS , SCHEDULED AUTOS BODILY INJURY(Per (Per person) HIREDAUTOS BODILY INJURY $ NON-OWNED AUTOS - - (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY - ., AUTO ONLY-EA ACCIDENT $ ANY AUTO _ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE _ $ 1000000 A X OCCUR O CLAIMSMADE CUS26619 09/16/09 09/16/10 AGGREGATE $ DEDUCTIBLE FORETENTION $$10 0 0 0 f$ WORKERS COMPENSATION AND S - B EPAPLOYERS'LIABILITY XTORY LIMITS ER 28586 ANY PROPRIETORIPARTNERIEXECUTIVE 10/01/09 10/01/10 EL EACH ACCIDENT - $500000 OFFICERIMEMBER EXCLUDED? -- If yes,describe under E.L.DISEASE-EA EMPLOYEE $5 0 0 0 0 0 SPECIAL PROVISIONS below - - _ E.L.DISEASE-POLICY LIMIT $500000 OTHER - DESCRIPTION OF OPERATIONS t LOCATIONS!VEHICLES!EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION BUILDIN SHOULD A14Y OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Building Coat. Reg. Board NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Dept. of Administration One Capitol Hill IMPOSE NO OBLIGATION OR LL4BIL(TY OF ANY IUND UPON THE INSURER,ITS AGENTS OR Providence RI 02908 REPRESENTATIVES. AU T D REPRESENTATIVE 'ACORD 25{2001/88} ©ACORD CORPORATION 1988 w V.y;c) ' V .� •ti'�y` � Customer Name: +�s `D� Year Built: Renewal by Andersen of Rhode Island& Address: 772 �'9! T /1Y FootL L-N Customer ID#: Cape Cod Rye al ���g. Sales Agreement City,State,Zip: C f+A.7+�1-t MR o2C3I Order Number: 1137 Park East Drive byAn en, - ?y�_ C S.9-3 'y Woonsocket,RI 02895 Phone-Home: r� , 1 WINDOW REPLACEMENT�an Andersen Company �3� vl_lj��. ,833 � �-[. ,'L L—�S111f. Page: /./ � license#RI-30839 RI-12259 MA- Phone-Wo g :�of-�Dace: Email' 119535 CT-562725 Technical Measure, GRILLES UNITS, Dimensions C rs-1 s Bas 8 n' a �_'` 3 o,! wno �,+,E« � 0n arg`.: c< E E-t-0 6 O d W❑ _ '" $PRICE$. 9a� Room $ ¢Y. �`m o,to �c.5 t� W� cZ ran mu �w "yF L g=E —3Nv' 'n � `c_'^Qs'Description vmE o z }-c a N o c `oS- `2 mo @ `orn �OOn � N � u o m =53 a u x a '' x _ yy V x = EQa Q - f jol/y ' o Dlvt Miscellaneous Credits or Expenses Sub Total(Page l) 3 1JU Payment Method Proposal:All of the above windowsand doors to be provided for the total amount stated in the agreement.The - - (Staining,Wrap,Rot Repair,Promotion,etc.) I. . proposal will remain valid for 30 days and is su jeer to acceptance by both Customer and Renewal by Andersen Manager as Sub Total(Aldo.Pages) prowd<d below. M c - - Descriprion/Notes $P'e Check J 6- ()0/ �/I �v! is qt� is eU lhzS R PPLiE� Sub Total(AIIPa9es) 3 i�� ❑' ate y dersen S <s Representative Sig—rare - Credit Card j Customer Accepts e:You are herby authorized to furnish all windows and doors required to complete this - ,j Misc.Credits or Expenses ^TS^ r agreement for which the undersigned agrees to pay the amount stated in this agreement and according to the terms hereof - - pe•✓ I�I financing - See Reverse Side for Terms and Conditions of Sale.You,the buyer,may cancel Total SV Y this transaction at any time pprior to midnight of the third business day after _ the date of this transaction.Ylease see attached notice of cancellation for an Sales Tax office detail only explana•oq of�s right. / Total Miscellaneous Credits or Facpenses 3'S' - 6 O �n V Work Permit Cost Additional al orderforms Attached Accept< f� Y A` (carry over tonl w man credit/arpensc column at right- ,n (pleas circle II that apply) - Date. »stonier App Sig-t re�^ Special Order Notes Total Amount of Agreement Patio Door storm Door P � �� Bay/Bow Entry Door Accepted Date Renewal by Andersen Manager Signature Deposit Required ® Specialty Window Any painting,staining or Renewal by Andersen Removal and re installation Please note that we are unable to bid on repairing Balance Due on Completion / wallpapering which may does not yvaramee the of window ar.ringgs are any unseen damage.His verif any unseen damage be needed is not included fit of original window solely the responsibility of is discovered during installation we will complete - Price includes labor,materials,installation, In this agreement unless coverings after new units Me customer unless and charge you fw the repairs upon your approval. +. spxifica y note are installed. otherwise noted. /,. At the end of the job all co S�rhon debris will be White-Renewal by Andersen Yellow-Installation Pink-Homeowner removal,and disposal of products replaced. ,/','--J removed and we will clean your new windows and Cu Omer Custom Customer the installation area. Initials: Initials: Initials: •a.�.,l I,r Ana .a s.ae,��.m er A�dr�loge ua Hdrn,era,erA„ar,.=e ee,po�ao,,.o zoos a,ar,m,u,p�.uw�.Au,;d,o,«,.�_von xro,ae araooaw oFz► r Town Of Barnstable *Permit Expi 6 mo t fro is e date Regulatory Services Fe 1 ! R swaxsrnBLE, Thomas F. Geiler,Director v Mass. .6 1639• A,� Building Division rFn ana� ^� Tom Perry, CBO, Building Commissioner pr 200 Main Street,Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 5087790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number I �� Property Address i residential Value of Work t U� Minimum fee of$25.00 for work under$6000.00 wner's Name&Address m 1*joejehy ILI-ell"Il d 1 r M4 ..-� hone Number�icJJq Contractor's Name d < � Home Improvement Contractor License# (if applicable) ❑Workman's Compensation Insurance -PRESS PI hec one: am a sole proprietor AUG "' $ Z��B ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company.Name Workman's Comp. Policy# /'/171-1 Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) e-roof(stripping old shingles) All construction debris will be taken to: ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town departmen =lIl igoric,Conservation,etc. ***Note:' Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors Licensh' �7fla{1 t.��V4 V,;.� i SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revise020108 David Sawyer Construction 318 Meiggs Backus Road Sandwich, MA 02563 (508)-539-1992 1 Prop sal Submitted To: Work Place: Date r Strip, Remove, and Haul Away all old roof and'or sidewall sh�' gles. SUPPLY AND INSTALL: COLOR: w-�,(i Pit(/tJ ob , oul�d nv 30 vu/�" "/R " �;, " ,- ds��' Mks 0- � rLuaWl( 14- 6a OX, (U.,t P Veltlj— ( �Z CLEAN&RE OVVE AL DEBRIS FROM WORK PLACE AFTER JOB IS COMPLETED. ALL DEBRIS TO LANDFILL. G) TOTAL INVESTMENT FOR MATERIAL& LABOR.$ , All materials guaranteed to be as specified,and work to be performed in th6 accordance with the specifications submitted for the above wor and completed in a subs 1ntial workm ike manner. Payments to be made as follows G Any alteration or deviation from t e work specifications involving extra co is will be executed only upon written order,and will become an extra charge over and above the estimate. All agreements contingent upon strikes,accidents or delays beyond our control.Please remove and/or secure any fragile household items. Not responsible for broken or damage household items. 10YEAR LABOR WARRANTY/PLUS MANUFACTURES SHINGLE WARRANTY. Thi4 oposal r9ay he withdrawn by us if not accepted within 30 days. Respectfully submitted ACCEPTANCE 6F PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above. Date Signature I The.Comrrzonwealth of Massachusetts Department•of Industrial Accidents Office of Investigations 600 Washington Street' Bostoft, AM 02111 • - www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/ContractorsfElectricians/Plumbers A licant Information Please Print Le 'bI Name (BusinGss/Orimiizarionindividuan: /� Addre55: J ckx tY Ci /StatdZip: Are you an employer? Check the appropriate box: Type of pioimt(required)_ I.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction have hired the shb-cou ractors employees(frl11 andlorportrtint).* T�a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling 2 'Q ship and have no employees These sub-contractors have g,,❑Demolition employees and have workers' working for me in any capacity. $ 9: ❑Building addition . No workers' Gomp.-insuranre We a i a aurnce. 10- Electrical re airs or additions rtq�,�] 5. [] We are a corporation and its ❑ P. 3.❑ I qt a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers' comp. right 6f exemption per MGL 12 ❑Roof repairs insurance requimd..]t P. 152, §1(4), and we have no thrr employees. [No workers' camp,inarrance required.] "Any applicant that chmks box#1 roust also fill out the section below sbowimg their workers'cornpmsztion policy infmToation- t Horncownas who.subnut this affidavit h 6catiag fbey an:doing all work and thrn hire outside canbmctors must submit anew affidavit mdicatmg such t'-ont mctors that cbcck this box must attached an additional sheet showing the name of the sub-contractors and stdc whether or not those entities,have . cmployc s. If the sub-contractrna have employees,they must pruvi&their wMimn;'comp.policy number.. I am an e - layer that is providing workers"compensation insurance for my employees Below is the policy and job site information. lncrira rce Company ldamc_ — Policy#or Self-ins.Lic.#: Expiration Date- lob Site Address. City/Stafc/Tip: 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,lip to$1,,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fv of up to$250.00 a day against the violator. Be advised that a copy of this statcmtrit,may be forwarded to the Office of Investi ons 6Mc DIA for incTtranr_e coy=ge verification. I do hereby c der the pains•an enalties of pe ' that a ircfor 'on provided above►-s and correct Phone#: O ftcial use only. Do not write in this area, to be completed by city or town offtciaL City or Towa: PermitrUrense# Tsm ngAuthority(circle one): 1-.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other (-nnfnr Phone#' , S ��e �� •u Board of Building RegulatKos and Standards ` - kj-,A s1-&11,rtnn Pjce Room 1301 Boston. Massachusetts 02109 I Home Improvement.Contractor Registration Registration: 134313 .. Type: DBA Expiration: 10/24/2009 Tr# 259907 DAVID SAWYER CONSTRUCTION DAVID SAWYER 318 MEIGGS BACKUS RD. _ - --------- SANDWICH, MA 02563 - Updat dress and retu card.N ark reason for change. Address [I Renee .! [I Employment Lost Card IS-CAI r 50M-05/06-PC8490 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map_ Parcel !� ;A licatior .. pp Health Division Date Issued Conservation Division ; ;Application Fee Planning;Dept: Permit Fee Date Definitive Plan Approved by Planning Board �k F1zo f pg Historic = OKH Preservation/Hyannis Project Street Address Village kf a:ra,ayeale Ce-A Ar4Wd a Owner AddressVff Telephone v 68- '7`7 /�G 9 Permit Request Od f s�&d J `d�i X 6��' . ccx fit---m ' ,r ooeCIO e ` ain KKK„ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Tonal newer Zoning District Flood Plain Groundwater Overlay 6� E uJ y: Project Valuation Construction Type u Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ff Two Family ❑ Multi-Family (# units) Age of Existing Structure Y/ds. Historic House: ❑Yes XNo On Old King's Highway: ❑Yes 1 No Basement Type: &Full ❑ Crawl )MrWalkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing U new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing U.new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Z Commercial ❑Yes ❑ No,__ If yes,,site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �.lc.,�,d �' Jos.��r Telephone Number --'16f- as8--Qy6, Address A9 3 ffoc,/leoa go Ae, License # 0-!S-Gb Home Improvement Contractor# -T. Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE ( G� dU ,���� DATE .Z8-a 1 t FOR OFFICIAL USE ONLY APPLICATION# I DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: 7 i FOUNDATION r FRAME INSULATION ' FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ;. DATE CLOSED OUT ASSOCIATION PLAN NO. I .- ie _ , Office of Consumer Affairs and/Business, Regulation 1.0 Park.Plaza Suite 5170. Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 156475 Type: DBA t Expiration: 7/5/2011 Tr# 286760 , PRECISION CARPENTRY CALVIN FARNSWORTH 183 BUCKWOOD DR HYANNIS, MA 02601 k4� Update Address and return card.Mark reason for change. Address 0 Renewal Employment Lost Card DPS-CA1 0 50M-04/04-G101216 Te eoanvnv mzeaLC! Office of Consumer Affairs&Business Regulation. License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: *1' Office of Consumer Affairs and Business Regulation Registration "'156475 10 Park Plaza-Suite 5170 Expiratigri /512011 Tr# 286760 Boston,MA 02116 lug Type Y '�72 DBA� 3 PRECISION CARPENTRY ; CALVIN FARNSWORTH 183 BUCKWOOD Undersecretary HYANNIS,MA 02601x:.Ny =" Not valid without signature I �1K�%� Town of Barnstable { { Regulatory Services + BAMErrABLE, 0 Thomas V. Geiler,Director MAM Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis, MA 02601 . www.town.b arnstable.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 (' l,,,� gr,,,.'6yoWA to act on my behalf, in all matters relative to work authorized by this building permit application for, (Address of rob) � III ignature of er Date Print Name If Property Owner is applying for permitplease complete the . Homeowners License Exemption Form on the reverse side. O:FORMS:OWN ERPERMIS SION s 0`. Town of Barnstable " Regulatory Services • Thomas F. Geiler,Director + BARNSTABLE, vq16. i6�9, Building Division j `Q� prfD Tom Perry,Building Commissioner .200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": hone# name home phone# workP CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be,considered a homeowner. Such homeowner shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"nomeowner"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. Q:\WPFILES\FORMS'\homeexempt.DOC ,1 The Commonwealth ofA assachusetfs .Department of Industrial Accidents _ Office of Investigations' 600 Washington Street Boston, MA 0211 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print I.,e ibl Name(Business/Organization/Individual):_ /-/2/-7/r ,�'�1 �Q Address: A:� _ c, luav� �City/State/Zip: Phone.#: ' Are you an employer? Check the appropriate box: Type of proi6ct(requir'ed): 1.❑ I am a employer with 4. ❑ I am a general contractor and I * have hired the sub-contractors 6. ❑New construction employees (full and/or part.tim.e). Remodeling 2. I am a soleproprietor or'parMcr-' listed on the attached sheet. T. ❑. g These sub-contractors have 8. '�]Demolition ship and have no employees working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers'•comp.-insurance comp. insurance. required.] � 5. ❑ We are a corporation and its '10.0•Electr� ical repairs or additions " ' 3.❑ 1 am a homeowner doing all work officers have exercised their 1 L❑Plumbing repairs or additions myself.[No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required-] t c. 152, §1(4), and we have no employees. [No workers' 13:[]Other comp.insurance required. *Any applicant.that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have cmployecs,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 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 crimfii4l 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 statemei tmay be forwarded to the'Office of Investigations of the DIA for insurance coverage verification I do hereby ce . under the pains and enalties erjury that the information provided above is true and correct. Si ature�//`� Date: ✓ CJ 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 CIerk 4.Electrical Inspector S.Plumbing Inspector 6. Other f nnfarf Per.cnn r Phone#: information and 1.ustructions 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, eicpress 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 buster,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 construction or repair work on such dwelling house dwelling house of another who employs persons to do maintenance, 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 Iocal licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in_the commonwealth for any mpliance with the insura coverage required." applicant who has not produced-acceptable evidence of co nce 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,%zth the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contiactor(s)name(s),address(es)and_phone numbers) 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 ired to obtain a workers' Industrial Accidents. Should you have any questions regarding the law or if you are requ 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 painit/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: ,. ��4 bt Commonwealth of Massachusetrts ,. _ i,,• Bepazfinent of lnclustri.al Accidents Office of lnvestigat!Qns- 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MAS.SAFE Fax # 617-727-7749 Revised 11-22.06 Krww.mas,-.gov/dia - ,� �'lassachusettti _ BO'trd ofquit ,,, "tment nstr -► 11 Re:ulatio 01 Public Sat. �� ucti n S to Restricted. CS 45009on uAer�ispr St:tnd:ti•ds* ted.to: 00 License CAL ON g.57 .. ROCK A�ERNSwORT H PA WTLjC KET 102864 , EXPiration; 9/3/20j 0 -- -_ Tr#: 9875 r - Y 4♦ ' • ryas � �y 1 G1� V � e a o� sor's ma and lot number �1�/l� / d' ......... pr3 �2 THE rO� UU :1 I Sewage Permit number a..... ... . .� _ 1,. BAR33 LEL House number ... ... . . �! . ....:.?.. ... .... j/" 314STALLF-D IN C�t�'?.�'l.i C�. �� ra39 � TOWN OF BA-N "A V' It,,vv + . -. BU1141ItS ]JIS P E C T 0.R Construc APPLICATION 4OR�PERAMF#'iTQ � , t Dwelling. ................................................. ... ll YYPE OF CONShIlICTIO4 t " W®od frame .............:.............................:.................. C �,/ , a..� .... . ...... ........ ........ , Dec. 16 1982 i �,:• ,. ... . . . .......................19........ o-4 TO TF E INSPECTOR QF BUILDINGS: The undersyigned hereby ap 1'es for` permit acco`din ....to the.following information:. Location hOt 27 Centerville I, 9 ............................... .�.... .......................................................... ................. Vingle Family � l ` Use ... .. .. .. . ........:.................Proposed ... ..... .... ........ .Residential Centerville-Osterville ZoningDistrict ........................... ................... ......... .........Fire District ... ........... ....... ............................................. Name of Owner ...jAm.QA..X .:............... ......... .Address ..... Barnst"abl.e..:....................................:.... Name of"Builder. _James, K....Smth:.....:. Addressy ......:.....Barnstable Name of Architect _ ......... „........ ......:.Addi s, .aq.......a. ........................ Number of Rooms . 6..... ~,.��,' .....moo. I. Fou ;'er,� ...Poured...concrete Exterior ...C1apb0a� d & w.c...s,�.. ' Roofij;g� ,. asphalt .... t Floors o..:k...... �.e. ... ..: ..... ...":..... .... ..Interior e.. .dr l�il ._. a :...... . 4j �a Heatin hotair b gass .......................................� Plumbing ...2:.baths .... .. g .. ................ �. .. i ..4.. Fireplace ... OT12 .. ... ..... ... ............................Approximate Cost .... Definitive Plan Approved by.Planning ` nnin Board � , vv V Diagram of Lot and Building w1i 7`DT 6ff ' Fee SUBJECT TO APPR6VAL 69"IC*kD OF.:HEALTH AJAO i OCCUPANCY PERMITS REQUIRED FOR NEW'DWELLINGS r I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. OName .:... ....... ........... SMITH, JAMES K. J a :: is ' , 24,650 O e' tort ........ Permit for ...... .............. Single Family Dwelling .... .... .. .. .................................................. ' Lot #27 , 11 Ella' s Lane s Location ................................................................ Centerville , ..... . • ...K. Smith. ... ... .................. James Owner .. ............................................................ - t' Type of Construction ......Frame... ............... ....... ................... ............ ........ .. ........... -Plot ............................. Lot ............................. u ` i Permit Granted ... ...1.6.......19 82 -Date of Inspection .................................... ' Date Completed ?�.r,105. ...................1 9A---1-5:7 " . .drat,, ` - .. ,` � . '�`!".`"'^ ' • i .. t /� 1 � 0 -{ rn Z p D N Nin C (N A F Cr 0 m m H a Ncm r � � !; �� 0 r � � fir{ `^ � r � -n O � Zr z ��g w '� � So $ v dD a Two 1> lp m z �-C m `'D D � m C N si ' I r 0 — D �,,D � �z z r D -� A -n ' ;\nv C 0. �� o . a£ � , �: . IZ m. V i m jw a m GAO '` D v1 . �-CV mOD G "� m � �il �n _= -lnrp = Npp4N T-G Is pO N _ Z , �., Z .n h 0 0 A zm � ll Mdz ID rr ji IP In c m o a i1 o z v o o 79 NfpmIQ N [Z m m r EL1A'S ZANYTO 3 1. ". . TOWN OF BARNSTABLE 2 4 6 5 Q Permit No. .----------------------------- .ten Building Inspector cash -----------------— OCCUPANCY PERMIT Bond ________ _____ r3 Issued to James K. Smi-th Address Lot 2 , , 11 E11a's Vane, Centerv-J-11e Wiring Inspector {� .� ��"^ - Inspection date Plumbing Inspector -y/ y` Inspection date Gras Inspector ,� ,� , Inspection date ?{Engineering Department-_ Inspection date,, f f Board of Health 1p,.• i Inspection date THIS PERMIT WILL NOTfBE 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. i J .............................» 19 1 Building `Inspector Assess or'ssrf'ma and I - ., u /, r!...... + �'b�� ��.� / G p of number .. /t -- _ Sewage Permit number .................................�` _� _ ��MEro�♦� 1I. IA23ST/18L House number ....... i i ...................... r.ed .. ..... ..: �0 YAy a' 039. TOWN OF BARNSTABLE BUILDING INSPECTOR Construct Dwelling APPLICATION FOR PERMIT TO ............................................................................................................................. TYPE OF CONSTRUCTION Wood frame .......Dec. 16. 1982 t9........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit acco ding to the following information: ;cE fit_..f-A S tr t= Location ........S'o ...27 V �:� e- Centerville ...... ..... ............ .. ........................................................................................... ie ProposedUse ......... 72g1 ...Family.................................................................................................................................... Zoning District ....Residential Fire District .......Centerville-Cstervill@ Name of Owner ... AMIR Ki....awUh..............................Address .............$, ,;MatkL;A............................................ Name of Builder' �'ames..K....Smith..............................Address .............Barn.@table............................................ Nameof Architect ..................................................................Address .................................................................................... Number of Rooms .........................................Foundation ........K o.ured. ...Concre. . te ............................... .. ....... .. .. .......... ....... Exterior ...4. RbOard...L.`'rdt tS......................................Roofing .............aspilalt.................................................... Floors .....QWik........................................................................Interior ......... dzV3J41.................................................... Heating slaOt...ei:�"..bv„bass.........................................Plumbing .....,.....2..baths.................................................... ... .. .... . ... .............. Fireplace .......qAe....................................................................Approximate Cost .....5�.?.000 ...........................................C.. Definitive Plan Approved by Planning Board ________________ ________19_______. Area s c - -- Diagram of Lot and Building with Dimensions Fee �,.,.......... ... SUBJECT TO APPROVAL OF BOARD OF HEALTH. � C� 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 .......: !,.: 1. �.....��w.,..... f !. ........... SMITH, JAMES K:" l A=188-4 1F�-167 24650 One Story No ................. Permit for .................................... Single Family Dwelling ............................................................................... Location „Lot #2 7 , 11 E.lAia' s Le ........................ .r.. .................. Centerville ......... .................................. ......... ...... Owner ....James................. '...Smthr....... . ......... Type of Construction ,Frme ......................................... ... ... .. .... .......... i Sy Plot ............................ Lot ..... ................... December 16 , 82 Permit Granted .......... ..I. ... ..........19 Date of Inspection ...... .... .- ............19 Date Completed ........ .......?..I.............19 t 1 . Ca�P a F Assessor's maps n st Floor): :r � ���_ SEP ������ �o -THEToo Assessor's ma and lot nu er c MUST 8 P ` Conservation(4th Floor): � � `'a 0�� �3INSTALLED e„ Board of Health(3rd floor): WITH TITLE 5 • '4 Sewage Permit number / / ( ;ENVIRONMENTAL CODE t DsaNAS& D rua Engineering Department(3rd fl39. oor):' �'-, ATI®NS °�to Der a��� House number Definitive Plan Approved by Planning Board 19 ; APPLICATIONS PROCESSED 8:30-9:30 A.Wand 1:00-2:00 P.M.only TOWN ` OAF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO a TYPE OF CONSTRUCTIONpp cL( R 19 1 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location // 'Ea AS 4- A ill,F ('2AJ-1'kVh1l .E'. Proposed Use "o z-C Zoning District ,,II Fire District Name of Owner A&—Ws Address' Name of Builder Address Name of Architect / Address Number of Rooms l Foundation Exterior LRoofing Floors Interior Heating Plumbing Fireplace Approximate Cost -fl 0 a D i Area C �S Diagram of Lot and Building with Dimensions Fee —5 Qom, 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 1/7 61 Construction Si ipervisor's License �✓1�'-per CHIULLI , ALFONSE J. ADD ROOF No Permit For TO DECK. Single Family Dwellinq Location 11 Ella' s Lane Centerville } Owner Alfonse J. Chiulli ! Type-of Construction Wood Plot -. Lot Permit Granted October 12 19 93 Date of Inspection: Frame 19 Insulation _ 19— FireplaceJ _ 19 Date Corrpleted 13d� �Y 19 .tr. 7+ y` gFv i E i E y, f t • ,, t 1 Building Sketch 24' 16' 12' Deck 6► Brick Patio I 12' I hoover 6' I 26' 1 Car Garage 26' 1 Story Basement 28' t r S 16' 24' 2' 26' .it t i t t//(�J�/I/lf)���/ �/�/{��7 �I�iJ C((/ ✓VJi1</li[ill�(.�l.�J.i � _ TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE / _ ; JOB LOCATION 11r Number Street Address Section Of Town "HOMEOWNER" .t° ' Name U Home Phone Work Phone PRESENT MAILING ADDRESS /S -Q' f,�bT 6- ,Q 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 such 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 to six 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 s.3"u "ding perm %. (jec iIl o 109.1.1.) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements HOMEOWNER'S SIGNATURE 00, APPROVAL OF BUILDING OFFICIAL � Note; Three family dwellings 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0, Construction Control. MISC5 HOME OWNER'S EXEMPTION The code states that: "Any Home Owner 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 Home Owner engages a person(s) for hire to do such work, that such Home Owner shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming see supervisor Appendix Q, Rules and Regulations the responsibilities of a supe ( PP for" Licensing Construction Supervisors, Section 2. 15) . This lack of awareness often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the unlicensed person as it would with licensed supervisor. The Home Owner acting as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her responsibilities, many communities require, as part of the permit application, that the Home Owner 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 to amend and adopt such a form/certification for use in your community. a COMMONWEALTH OF MASSACHUSETTS DErART.NIT-IT OF I?-FDUSTRIALACCIDENTS 600 WASHTNGTON STREET BOSTON, MASSACHUSET"I'S 02111 fames Carnooei �e- :ss�one WORKERS' COMPENSATION INSURANCE AFFIDAVIT (licensee/permictcc) Nyah a principal place of business/residcncc at: (Gry/State/Zip) do hereby certify, under the pains and pcnalries of perjury, that: [ ] l am an emplovcr providing the following workers eompcnsazion eoveragc for my employees Working on this job. Insurance Company Policy Number j ] I am a sole proprietor and have no one working for me. j ] I am a sole proprietor, general eontraaor or homeowner (circle one) and have hired the eontraaors listed below who have the following workers' compensation insurance politics: Name of Contractor Insurance Company/Policv Number Namc of Contractor Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Numbcr 4--fam a homcowncr performing all the work myself NOTE: Plcuc be awarc that while boracowncrs who employ persons to do maintenance,eoastruaion or repair work on a dwelling of not more tban three units in wbicb the bomeowner also ruides or on the grounds appurteaaot thereto arc not generally considered to be cmploycrs under the Workcrs'Compensation Act(GL C. 152,sect. 1(5)), application by a bomcowncr for a license or permit m2y evidence the legal sutus of an employer uoder the Workers' compcnsation Act i unocrstanc that a copy of titis statcmcnt wiu ix forwarded to the Dcpa:tr.,cnt of IndustriaJ Accidcnu'Ofiicc of Insurance for.covcraec verification and that failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition ofsaiminaJ pcna]acs consisting of a fine of up to S1500.00 and/or imprisonment of up to onc year and civil penalties in the form of a Stop Work Order and a finc of S100.00 a day against mc. Signed this day o /2 . ]� 93 f Lice n1cc/pCi4nitice Licensor/Pcrmictor