HomeMy WebLinkAbout0216 GLENEAGLE DRIVE P ^,
�:'.f ; tt {i a4`� f*�' ,<t, 1, t ,}( t ,' t j+ i(!P�.I C tl d` `.� � �i� •{,
t p1i F� '};, t •' +I�?i t � .���� i:tl,.,� � ,d: �} t t. •t i:� 'i� �' 4. t� g1 �� I ;,{jlt t1 4� t��j ;ti, � �}r�� i{� �_
�( , u;i,�lv �'i 1},� }F j: ( t f}I , }V, t 1'', i :� e '}t �"�� s 4 "1{t�f 1�I}� � tFF�'tlf�4f ( � � l{;� '`i r`It.�• e 4:
i ei. �., } 'tl +.,�t N. f�,lt', ', �ty�P. '1 �y j ��,P. � },� f•.l, I ..�'
11 •'�Y t•� c 9r' ,f i ,� r
1
4 d t�i
p
'� ' .1 I•
,
I.: } 1.1 'P �. t, 1+ !t r A•
A i
[� }
J it'll f
P t
P
i � b
tP t s 8.
bt d
It t
t f
t �.h
a'
r ► t i �� �" t { : �9 I ! (I
n r i -J. i• r r t a 1
- r ,
!t4 I ! t K! ). , ? � ; r: �; r �i 1:#F ,��I ,f ...•ir i 1 t{ it;
.�, 'ir;' al L 4. �jt : t •i � : .a ra; ! },
I
1
I } I
E .•!
E {
t r••:b { �
t }
•,1,
� �� 1 : r P} ,, J �s rl y� � t' ,i ,, ,- { , ,•i` �' ' .x I� �; r a� ,= d� f ��.. .. 1 �! s�? ! t ,., t � ,. ,� r., ., � { ,
}t i ,' ,. { �: ,.,, 1! I ut t � ,Y .n. :. P ,, �!Yi� �: . t��+;� r it. tl r,• l: ���j t .: v
. � � ,•� ., , ,. l } ,: t' t � i .+� � � t{, ti .: Y, t'h ,� , , t 4 tl:; .� �. 1. y�i� ti� � f ,. ' � �
t t, ,. .. .. { t l r :1. ... E I r,�fh r :. - , • '..��..4 1. .r ,: ,, ,t,. ., � t , �, ,,�.,+. l�� d. . � �� � ,, t! ..:-,� �: f � j t. � ,
( i t .. �t.�. ., .. � , - , ',:.t • � 4 ,}I f1. 7 �.. , j. r,f I. ,; •. �,4 (t! �. 4 � F }. l$ {f
E f
i a F r ': , ' f 1 i, t r t ;r � p f," {} � �'{ �k t� a}:}: •:
} 1• 1 !'1 5 t ..# r 1 i I.. :�]/. H '1 1 �'j{t { {+y 'F-r'� x
6 r t li V-t r� f•1 r 't d �f (
i � t 1 s I ib� f ,tf �4 •, � ,�
t � tl tj
.I �• !
r � r,d
f� f'.j
t
b
L
1• r ri. 7 }
{ i 1- t
r A
'C"• M Y J, {
a
I -{ f ,," I'i" , 4 i �i� 4V � '� t } r,r tI' •: .}, f �, f
t ,
i F t �pkry .,h jj
1; { tt', �• 7'? R t�1. 1 { } � ,�N i �, r I f. ,.I �P I{.. t { r{ r�,t •.t�J t,. � t� }. { t {t`� � I }I
-
b
� .l •.'T, ,} - , fi f � 1 I �t 1. � `t �.. �t�'� i.. f +t" f + t, � Itr. t�. }', .r. •{i.
a� t
r 1
y t• '' t r .. ' .� � , I I� } ��{P .., ,. ,_� � '" '1` ti• t t� I P.:. .' �, � :. r1} , }, _ 1.
,a , k
} ! � i
�t M •n f
! { t i ! Pf•
jt
� 1 4 { � :r•1 ,fj{}
9 1
p
t t ,
} {
} i { }a ( }
' Sr P! F ,,`�ry¢�7}F�t,• „, } 1r[ �" i t[
�- � 'I 1 ',:• .f 7n�.f}F� I..'.. � i '1 i �. S II {!tV ,.
t 7. ry � ,. l,j ,. , .i ��•. �, : t � r � . . :} t' 11, ,1 r �.}.�f , � � 1! ( , � �� , t I
L1(
, Cu tr I' f ,V y . �, h l.t A •d• t:. , l r: ;�;+'' �IJ}I. ,
I
�� r rr�. � � > i, ,� i J,E, I •f,� 4 �1 i � �• .€
f ,
, � r � r•
t 9 �
,r t
t� l ,a
I( ,} {
( 1 tit. [i i ,r
,1
t , 1 ,. r
t l J,
t. j� i. f• tFf{[�rt- t} ✓` -1 ,t" t.(+4/ C `'}f t
F
1 't •f r , It � � , r f t } � frtl •i. �� 6.i I t d• i rr
I t' to •}i• t I M r t�
i •r` ,�� � id
1 M l� F!r f
a . f
,, r :' .' , tr. . , 4 , , .�, •' I, - '} .' :f. i � t � �Vi l � .} a. , tt ', i{ � t t , 3
{ d , } / A f to l.. �Y p t,• 1. t , tR E : ,, },- t X, f7fl, 1 4 r� t {. 3 � � C.. } .,1_.. 1�1 ! k. �,d,�r -}r � 1 � � .i
}.till,
'� r. ,. �i�fl +.,!}. ,}1 d� i. �.,t(,, Yt' � x � �y ,. :�• } P rf f. •y .�,.
- , •, �.�. , d < ! t�t (y/1.. ! Jd ., } �,�: , } ,r�, t., `t',� Ye1� � ,/�Yr1t L .. rr F`F�!t}� „ t , 1([ ,'t.. . ,. .. J , li k. .
: � . � .. ►t tl . � ,� ! :{ t fl ,� J,t _ ,r;, }' ( 1�� t t r f, fr '. 4 : . I , �t � ,G ,
, � �¢��'! ,, r'k a; , .r ,:.,} ,:, }�. , . .,• 4t :. ,. ; ,.. J ,I}. .. � ..�, ,. ,. ; � ,. � �,. :. •. � ,9. rr. t .>. , 4- Ff;� ., '.� �
, Pl t t } + , rl �, - i -� f :f} ! , } ,I •, . � gg t. .. � • . }c �i {{ I• � „
1.t; Y' V� r +' r r If r. P tq { �. } '.,f, ,¢ Fdy ti + � {V1 � 1., Jlt tE.. r 1 1: (p��pF',� � � •(
. i , f�tt ,�. .t.. ,.ti ,. .. :1 , . r _� }, 1P �., „ 1.1 ..; I � � r ..L • .��� 'f , �{ I ! tSt., � 1. �_ r,i. t I � ,,. ., .. l
, i ,,7 y , :. P 1 s , ., , ;��!li � ., =.V I rt t� t .� t+ l i, r � •1 ,4 ,a � i + + � � t k '
f. •. ;#r } '. r , q ,t �, fW1
{ .�' .. t d,::u t .. f. t --�i}` f - f '. r,�! tj r } rl t I t .,, � , . • i, � �1 : , 1.... fJ �}r? -,, : r�� t .. �. .1
.. V P. t• ., c - 1. ,, 1 , ,1 { ,, , t t 1. 1 (.,� hx t L.� � t {n sa(. ,i, of 4. � 1. t� Id•. i .
,d fly` b 1 1 1
Y' S,[ a y4• t i ( !P - 'E �t , {� � :'i}ty': S, .4. } t }, E, },.. ,:17 ['�1 .�{ F
tr ,
_ r ., i. _t , 6 °'•flt '. :� , �, tl' �. `, t� Ci ,. ..t �.� , r , � , �:, ... v I�� ,t of � '�t.
• ' � I ,, �, � „ •r � l �,1 i. . .,, `` r R , ,� 1.�} �, � ,. ,I ( 1 It , 4�1. tf t 1 Il,i j ,, i , . .
i. 1, , 1 ,, . t, 59 (, ci r e ,.I C , t # � .} 11 1 r J. • :- t,t , . 4 . � t t , l . i t' :�} .t ,,, t'��: � `
F �, e � . , . ,l , .,t ,f }� 77� t i _ ,. rr. } !.. �:t .. ,� tt #dt}:a . � }{4 � t . Ii► �,} ... { tt » �. r c 3 , , t :' i 4 ,1 � f r .. q{(d ;:I, i❑ , 1 t € ., � r r
, 1 } }} , � ,,. t � 1` a t 'f }., r i �`4 ,I ' a ,� Y E�, !F. i �[ , +f• �4f t' j
�jtp ..t. �� � , � {y tr} , , 7 r ,. ,t. r iE t ��•,, y ,� , . ; �tJ If
ILI
r , , l. I . >'� tf r ,:. �. 1 •I � _ I .., ��I �},� jj!i� 1 ,r r ��``! ,I } r M.kl }�. 1 , l
a } r; , , [[. � � } , ' � r , t , � t. r ut, .1'tt`ry1f1•r �t {:,1, {r{ 4 t�lY� ;, } , }fF. E `�,}t �t'�.tP� Y� { i , .: t, 3
.., :.. ppa 1,�� 16. } .rr :, . �, ,r{,.1 .. � ,,, ,jtyy,, f t. .j){,� .. t t :'�. I (ft, .,! LT r i. .f '� 1 r)' 1 ,, (:�... {�f,1 t :r. � (�.t •.
E : dt it t 1.. ¢!'' t ...t � ' � t �I� l,, ,, p t ,l {: a �' ( r 1 , •r .�.
• , ,: } t . , r, ,4 d P r ., .� � i a } } . �� f.. , .1. ,..!! 1 , 1 �, `I s u�, � � � 11 ,
j� • k • . ._ ! r.' � ) I f ,1 � } . ', tf T"7 r LAG d{ ,;.. , 9.� r. 1 :,.��.t
• ., ,� , { , r.) r d t � ! , ' •1 r „} I �{ �} .�'�,lt; �} i, :} � , #I� i`i �# { � �. �t. } k , } r �, t t . .. 1! ,. . !# 11. i
• ^. x. tF .. .�: Yil t a,��r d�yye . ,>� �f�(,, I .. � � ,1 .+c{i{ i.. �. . t. �{'a(t � r, ,[ !,. •�, t ,}��. �r .r t. dlt.. t}P. �Y S#. r ,, , (+'t/, t� (� ��_ }, a
,.1 _t 'T r}} r "�i' It -H" i 1 1. v �` p� F, .jG tlt,+}�rtT, E{ :�fE7�i ;51A�1 rkYu�tlf �,e i• rKY':. .�71 t .A.Y�t (''
, ,V.: �'., :i�'•! '.iy : r.Yrt.. .: ;�.klF!��',..J,. ,Ir !,. i v: f1
.„fit �, 1� '► y , t l � 'G �� ,,
:
P., ',1 V, i �. � .. r.r' # u �..' �. �.. e t{ f:•r .}. � } 'P i 't Ir j{F'
I ! - } � , t <{ i '�' �Yi '(' •I'rJs11Lt:�t� iri�il�l � ! �� ��ft1�'}t J ,s
i :
: 1a,9�
r v �
E �a
f'
����Is
��' '' �1�`�' �
fp {{ J�
1 1: apse.r y t j 7t' �fY
1`d'� ., p.. V .•I •.�, [::f'4. " r : J
N
( ,:P 'I+ ! �` k, 1 ,�".;Tr 'i �(�1' •eiP{ i' :th a'' r,i"„"�• " fit
P 9M� 1 li i{' �F `�, •) A 1 i {v1r }q 91}• � '1,: f INK
h h 9�, g 9'! 1 ! �► .' i9{,t ;)irtM,,
1 ar 1 i7iiur t. �. i i' 9; ir' g�'qy •'
v q
If
F 1 -,. i '.¢!,� ,.� .�h + , t III. -❑,1 I.. '4•� '.' �l $. "" }.,
« �
1 ,r•'
_gypAil
ii++qq Rai
i, j.. ,'!i' ! 1 nx ' C ��•�, i '-.� 'Efl�"Y ."t,i'i'- Y � �Si i�.;
'i
till
I 't{p, H f `i 1 i•(4 `1 Iy��
v �'if
,
,
�" a �, f. � tdi � s_ i t r'• j �
I 'f
t <#. � ,� �.1 y� r,ie;1� is .r p �� •i
�` •rl wi � v U
r i � 1. �•p;r �� t r I i!1 ��YS IE � .r, a jl�a ;,�,� 9'v,,
I
� •7 r r � y ,r+ ! >�; !'.�,m. `,a 9�r�9s. �rl�, t
1 1 1... f 'I i. 1 '� j i'•. :f yi... !, K(l; � >f.
.,tt',
r 1 7 ( i � r li "i gg� r �t •8, F � .tr'i .� j(
� y d. i '!i•
h'
�f �iyi I
,{�� I' �..•� :�Y 't �� � i,rot �- i. ��.. ^a� .�' � y P rr ��. t .r,iA y` h�h.7 i � 11(.-
'r t ri:
, r k !, ,r. '�: l, � !� 4 y: 9iffi'1�'7 •fl:l'^?iH' ai �±
i 77 � I f Y � r 7 �• a�� �: 9 fit'IF �'
�(
trs:1 -'�
., f I
P; y ' ^'a7: r, ,� � vt" '.tit ,
ill ,3 .a: a.. ,'a,r "f�! .. ..y kda r.�. ,.I,. ,v .
�' i�, � )q k .6 .raj.
g�� Cp,�
pe ,y. 4j tSF�?t�Fy;
t. .ill �,i � [/• �•.. r r ii'"r• i
�I �{ i ,t1 i �' Y '� g E V, 21 f, ��•!� 'i t. r •"tf:..Yh .'i�, df;•'„S t:
Amu -1 i �
j9t•r ,r { p fir: { t t:i y
7i F
A a i e
r',i�' �i'r,1• ,
�' a i� L r'II���- k ..I!,�;t' ,6 �,f P !��5,1'iE I r't ,ky Y�..'�1lP :,t,.} a i-i( +1 a�5 './ P• ;'iY>n � ,��' 9 ',. '�" A -
,��. (, i E ��«, 4 +u1 tr�,,i. ..� �� � pt, 1.. r.t 1 , t ri ! ,� .a .� ii'.f. }'jsPvt °4',,.� ��:Rirt. k'•_
;l,�f., �. Ic ' , ��, r , irk- ,�+►�, j �r' i. u d ,r � n ! �,t 'tp>,:q
I � t .,. � '� � d �. d �• � 4 ��YY 1� !t(!� a.: P �1ry�*m,,:,' ,11a , { �„ � as
�a -r� ;i�} i. � 1 �-�, 1 H'. � i:.' �i' a,r 3t" �r Ili.'_."'Pi•t 11.
, 1 .r.,r� Pt 1 �.(r„ a � r. � y � 'j ! '?. i• •i 4oa:'' .,' � � �. 'iA.,f
t' ,9 � !' I �! if! ,'�9f� Y °r! rM � r i,+� �y P E, t , ' , it f.wr •,.
1 s i'. x t 'n Vn
i {l� 4. f H' P � t FR Rrt1 i !S it d �1, 1f'
Rol
rwaFi F r a i ,�� "''� d ,jlf},+;{tpt�yt I r"• {`[F .i#'"+"9�4 fit. y ,r , Ft fu 1. "S: ! 't
�t
t t
t r
n
�� ._. ... .•.:.,, '. {�$j!S(}{jr`�'� I��ii7p (�.yI q$+! i .
:... ..,.. 3f.. .rl . .4.. „-- ,- £`" it {it'�^dp,� .�....... ��T�,'�'! �-L:f,c— T'"�.•q!'.� ' ., t ,. .... F 7 tc��
Ci) � 1+-
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map � Parcel Permit#
Health Division �-01 `. L Date Issued Z C/o -
Conservation Division �� 03 �` Application Fee
Tax Collector Permit Fee 9 9
Treasurer �{ !���I�q }/E
�i_"O IgN C�BiY�il(�WWY\1i11L.'
Planning Dept. �. T H TITLE 5
*.. 1r �3�a � NTAL CODE ANC
Date Definitive Plan Approved by Planning Board %—` I RF-GULATIONS
Historic-OKH Preservation/Hyannis
Project Street Addressdj&az
r�
Village (��i���►� � ;
Owner �,L �� %` - Address
Telephone �-02 �y 7.3 Y7
.Permit Requestiv 6�11
/C �
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new1=61
J:
Zoning District Flood Plain Groundwater Overlay `.
Project Valuation 5-U 0"0 Construction Type �l J
d
Lot Size . Grandfathered: ❑Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family ❑ nMulti-Family(#units)
Age of Existing"Structure Historic House:. 0 Yes ❑No On Old King's Highway: ❑Yes ❑No
Basement Type: ❑Full ❑Crawl ❑Walkout 0 Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 4 _
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 stover ❑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 r Proposed Use
BUILDER INFORMATION
Name ° `�. /a' - ephone Number 5 UG d2 //I
Address r �C -r - v License# 0
G1 Home Improvement Contractor#
Worker's Compensation# tI 1 5 .3 1 7 3,
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE Ll p ._
4 � A
FOR OFFICIAL USE ONLY
PERMIT-NO.
DATE ISSUED
MAP/PARCEL NO.
l
--ADDRESS VILLAGE ,
OWNER
DATE OF INSPECTION:
—A�
FOUNDATION
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH .,;-FINAL "
GAS: ROUGH. f s FINAL
FINAL BUILDING
a!' ez 'f
DATE CLOSED OUT
ASSOCIATION PLAN NO.
- I
f
The Commonwealth of Massachusetts
Department of Industrial Accidents
office 0110yestltlations
_ t 600 Washington Street
' Boston,Mass. 02111
Workers' Compensation Insurance davit
name. `
oration
ci �G Gar _ hone# �-�G ✓/
❑ I am a homeowner performing all work myself
❑ I am a sol r, netor and have no one worldn in ca achy
I ravidin workers' compensation for m�emla�ees worldng on this job..
am an om rrvpT g }}yh}}'4}%.}y:::: Y 7•'•:v:,%Y{;{.Sy: C::i;:$h:;v '.•.•ytY,.,v,QY^y, Sti}}}x^{^; rvr, :yn:•:;;
v•::•?,r.•r,.;?; ..2,fq•:${:;$': ..n.a::r :+:•Lo:;:. .::;k�h�'t:31:?: th:ti:.?.<,`:.'•t=.'•: i::::
❑ P........�...... t•.t r.rtt::rr•.tt :• y •;.}}xq:::?{;.}.R..%;�.;>.r;:;�:$:}••:..... ?{.:.:...... a<...,,:,Y:f•:3. .
.... ......... ,... .:.:n .n..rn.]. .:. ...,..;?.:?f.'.}A2,.....:..:.:. ,:}.... .... .♦. :..?..... .::•:J•:r-..n:...R-.t:.}%.n;,...:# :i..}7:•?.:`•?:}fi•77}:::rfi\.+:'••.,:.;}:,{:#•.}:.}}r,.\vCY::::.•SY.a2"}].••}::.:7::•}5
...3.'.. ..5... }:•}}C ..•}.a ...4.v..r }}}::};•i::J• }:?7}:;{+.;.;.:nv 4:'+t?'T•n}.x:::i:$n.i.v{'•}?:+, a'$i7:. n:•x^:
^''Y'::'':-••+.r'i •i .:,x•Tv}.vx,R$ :•TL? i'•:; ::h"::i:`>:'•:.•r. ..}r>:J•.}:}:S:v?: ...5. ,T�• ht�+•{•}:nT'+}....
f
..cur•:r{;}%;:{;:<fn?:^,{;;.:;+;':.}.:}::s: .,}T nY:J,.y: :.n:••. : ::?f•f .:,}:+.5:,4... $r:. ..Y{:p:•x:4:.:;a•t,•:{•:::.♦?,..'S" .}. .:n+!.n}:.. }:a.;..r.,. C•`.t4:r7, F},:n$:'.k:%•'.}v:fi;}a:tlk\}ls,t.:3,},.•�;{;$;
�,(i.,.n•4.yrv:v.•::v:.^::\:y<,:�i.7 .v.+. .,.v r v}, :: '
.:n
om anv;n
........................:•.v::•.... .:n. :: .:}::x•Fti:}:::::•J.• .t..n :{:4:t. ..^rv'vv..,•:q$�}:••:vv:,K}rir:• r}::?G}{:; ..
........ .. ... .... ..n.. .........J... .. ....?.......}..:...:..x...:.4... .. ...v.....r. ... .: A. t: .•:tr_ : :C•?:•.?• �'•^• .f�vR}':r?{:+{h+'J••,.`f�::i:•'.�i:
:\•lvn•w:•:•.t rr./.t.x..: .4 .• •:f.h :r.•:. .}a♦n..{+t'••At x•:t4.+n?`v:•$:i�:{....v,}n'CC;.i$S<x}h {!.v¢;{.;7xii.•7...
7:qq•++?•} .n fr..iY}.w:.4:}K•%•..}v fY. 7:•::i:K•:h:}::}+rn::4... .v.{}:�;. Y.tv.. .$.....r: nvMt. n}.xrt '{•Y'1\4:J;},v:}
+,.4?•Yr:•}]i;'}.y.:t!•.:.. 4tn i'::7::r•.n. ..§. n..{. ..'},¢?,r.••. .y .. T,::q•,,, +i:•. q.:K. .{... .TR.
•...x?.r. :Y.v'yr+•. ..n\:K{..:. v:.Kx.{4::...... v.{r.v 1.�:..nO:x•Jv r: .4•:4::::.::..... ..A : v
::-:vr•, :.'•...` } .. .. +i..{ ....v v+: v:i^:{'•:r4v.•.q:. n.. .{.n•,CS.,n.. k4.. `.{•$:''S i.'+.:R
:,v..{. ,» {..:.}{;,:}•{:;.;•T:^:'.'$::.{::•..�}.ti.r,i,t.x•:3•:..... i................. ....n$}::::y,}; ..,. yy
x.A S...h ...f. ..{.... v::H.'k•Yi 7f:^'•` ;..i}$...•v; ...\....{.Y.+....Kv^:Y• , ;.}.;••}}}x•:i,..+t{•x•'•a::;SS:�.;.. ,]Cf y:}.h5{rSR4.;:<<'}•.:
r.J}'+.G.a':•rn :r S..: :!t^:t;;.}:'h .?::K4. •.a..�k+;•r: :•T. a? mx'.:c:x..i.t @..n ;.:,•,� �}y�.}��h.:r;r, ar4'{::v: `}"•, S vn:4'4fY{i•:•' :v:;y.. :.r•v;,, :{t};tii: "}+ t1 ,.*Y:•"}:,:r:;•:., .:•. x,•}+:..,:..•}•?:}.:.:k..: ..:. 4...t..n,}r. ,::.;.,..;}}.t7y,.:.}'::;.' '}•{Yr7 '7,...•'}x;{.... r, •{'turn:
r{.:t....v^x?y.'Y; :a... �: J t< ...::yn•r:.. n :•+}:...., :. •.••. .♦{ .,•x•}{•YF•".•:^•.Y.\'<•bn, �t{.`C, :,it•. ?;.$:}:{%+:t.::•+t?'{2t'v':<• }.,
�f� .,.:.Kr.,t.}fy k.. r... }. }C•�x•}.:. ...t. {q•:.,}na ,..... :+Xq{.n.;?ar}.}:•}:.SYK;?;}:::£,.:;}.:.. .:r}r,:s;;{, ..Y,},,}....: .Tr:>:yy,'.t...
,. ...a:. ,t nr „r: n••:?:t}`:::•:{•}7.,r.G•.,:+:::5�}}.,.}:•T:•.::•:?•:•.rn:•:.n•:�....g}n,?:i:},.,r..
:: •-r:$+ : � ,• :, .•l<•.:.....:.....k..,.....:: .. .. '..•.:.....:.. •.v4`3:•}..}•n:,.}�••n; ,C`k;?[ I
{:.r:•}n:,fi.;.};;:{}},r•.da r:tq}:q+,Y3S•�:: :i':' :::uy.;.;y`;%':`}::::<f,':;{,{t",v 4�{�`t•?,,•,.3??}.r'�'xo.•..try,}
•::4: "•}•:Y$+" 'ia?yr r.}t:..,;.�':$vqa, nr::, :r`R?`ti .aY
....... ..:...... ... .....:•:.:•. .. r r, }r.... .:n....+:%f:': .... ...;•K.,..•.L. •:{$i'•i$?,G::.A�'G:"+fi.'iik:}•x}:u:::•}1Y..... +,•.}`.:.v.. .:<:•:}:•••....J. :•:;',. .,`Z•.•♦•:•!n:�'c.J•,
..J. .{ kr.{fiY{:.+.+....f•}:...:• } .i1 A...:.?.±:•J.3::•,.{...t<{ .:t....: .nY.'+.�•..a.4•.,. v.4 1 4 k....
t•.+:•: {wxarr.•n•,:,, ;}. :..C.. :•:+x.,........ 3 ....�,:,�.: ,{:•:7.. ,..,{{...::..•:•n• r,}..: C..x.}•y..y};:i �;
rrx{::::L%-... ..?:f...... 5....'£•.n..nY'•T♦• {•.r:r..t;..}.�r.:.. .}:{5....Y::•..;..., ..}: Y.+Efi.:.:,y
:f.. ••T.. } J?.'v:.•+»: vn•'v:•!.I•}; } r�. +${:$$$:•�4�i�:{.:�:�:`'i{ •.:••; ,+{•$:nA}}.:.::,:rtyl:r.:.:•::r».::4}.. { •:::C .n,.r n.v..0•}:::Y' r..y v ... J.� .vni?4•'J.i{{}.}}.:}.v+:<hr},:A}.•$:.};•..n.; ..{..,J.: .r).:tr:•::..n.n.••. ..r............ ..::n.f:>.r:;;{.•,,,K:.7,,.;,.::i::R'?•;<Ri. n..}.. :
.:...r}J.,.... ...:.n...r.. .:.....f.: r.:hn. .n:.%.$j•:. �.�.:::::n:4}:{{$;v.r:..:•..:+:•q:n:f w�•: �!v�,gy�� "}}yti, '-.:'r}•:• +�.••,' vutrygi:^$f:
•.C.... v}:}:{+•:.v.. v,..,{;+:::f.... v].. ..T.. `�'�vK•vt:.tiiCi: :x{Y :+�7:K thep•n•v:::
r.....:.v v:}•: .�i.v....r.:?.rn•:x?•:{r.?r::•:+ .+>t:{4:?•:?vnv:n ...v.... :.::v:..
.t. .:.Sr:n?•.v A}•�•:•:•;. ..... .n ...... .... •5:•v.v:.:,....,a{.{iti[::;y..•:•:rT:•.7:{tiA'.'•'^\:.' S.f$: t'•7+4 k .Sr'':a,....`:c�i�y 0.}:.v. ti.v
.;v:..n•:.Yt..y::{,$.:n+^+;.:•...i:v- .:r. •:vY %• w;:{••v}7•.x•}.:5:••:.0:•$5:44.v.v::.:.•}: .4.; ...4„aJ•.v. �:}�?4 �•QnP.:fiFi:•' ''N rJ;.....yf}.. $l�S:
.J.«.r...... 1.r: .v.: :;..., .• antJ.::�•...Sq ::{}.;q...,,•.?�w:•�::}, ..}y.J .:i}:'t+'•7+'•}..<}•.}}.,,{•};•.
.C::.v.n• :.:n. ..nn:4 '
•� ;+t::,t ?}:{::.k•R ••i},S {$:kyic.:Gi;:ir t$'r:'t}r.}'v+ ::t':.; .:?b:;;f¢±,;i,••.
... ;.., .. :.:. •-::• �-.::+t•}:}.i,•.r:.,•:•.::.::::::{•}Y .t....{...:.•,?: ••:LL•.•.r:.z•: w t•!,:'::{{ t?•R•.. .} .tc%�: •:?•.::�'.'�r+� ..T....
+r k•
.K••#!• Yti•Y{T}r r.21... r•h •:?•:•7}.h:::.
rt}Y:vn
� j� :t4F$:tip 'Y4"'?"••
yr•:•i:nt.ti:•}:..,:sirs}. •r.}. ?{}�' .' :: .¢.ry .,; ....:;•{.l,;;y: .:• :.}.{}fq: v.
yY+•:){•:•7:•nvi:i•�`r••:x,:�?4:C!::. /} ;: ,ty:` .S:r?v f'n... ... .. ':.•, !}.7}.}::;�;rj?•;••• •:7.:;r.L:n<'}^•••• :i '?.t,t
�tlSdsatiC�Ycls>.'{x :}:.{•}:a..t:?:•....: '++}• :}. :.•..
❑ I am a sole proprietor,general contractor, or homeowner(circle one) and have hired the contractors listed below who
have
following workers' co ensation olic es:
{ i4.,.
the Q m� ...........}y.......,..:♦•:rnx•:•:•.,r..•„• .,•::•o::{:.y}:q:+.:;•}:o}:.}::t't:q:a`x`.:.^•.xx;,xx<r%•Yry B.nK:•}•�S:.;s3�•":•�'::�::H;,}.i`;':,;fi;•q•;';.fi'°;Y•R. t+4;: ''•: •Tn+ t'•?"::?'>'};'ry
(7 ... +,..;.; .t.R v.v.}:..}.r v..vvv,•n•; .:.N,.,h..A.r ::.}vh::.::f.•:.+.!v.vr..;}•}.v:v:♦;hi:::::]Z•'.h{ ^...4:.; {.
,::hyxv}:.v.}.:u:1,.•:{•'}.•}:v... :.•}{::}:•:•♦.•:i?•:{h}:::+t;t}:•{4..: ..{ ..S:x .:Y�<.%}r,.::•:}:{: •t♦Y:?•.} ,-0,:%]`;}:{tix
rh;•yA+-.}}:•x<•.}. ..3 ...?...:.r:...t.x.r:t:v::!•.::.•.4•.:•n?...:t{v:h]:.:.•r ..iv... ...nK•:•v•. ::�•.S::.v:!•x}:n•:• ..C..x ^ %. .
.Yh:•. :.K:.v ..Y4n :R?• 'S ry. {•K•%
::4Y vR•.
:•:: r••$}3•} q vox
i.r::'}:Y:r .�}.,;•. .k..:...;a ♦.}.$S.....}r. ..:+r::••A..,$>•: ..:}+{:4+4$}::i;-t .n}4_'•;:3{#$:$X•n �•: t.
^:}n♦ q•-:t•,••} .:.. ut•, •:+a:♦.S. .rir?�i7::{•:S:• .. Qx��
.{{yv :.M�.
:"::?'ti•$?i •.:{n n .:'h}S ?{•raC•}'•t 'n:~S..
S}!+v 47'+{!•.{•• v.•}"R':.r•::;:}:.n♦ v.A�(r:. n•}Y}q};v» n� •.
v� ...::•;..vrti?::i;";::.:f}:v'+iQ!�SS;i:.::.;.,••yt '?:::':::.:n, h}
n,•.. :..n.....::':;:::•• .. ::. 4,;x•;.:•:n•+• •J,., ,...:.; ,,. R:.x .x2::;!h+•.:t}:}}:?%•• ..t.r ..7T:•f•`. .,T..
4..n. .::...:•..t4.:{:..n}y,.;?.Y+.:•i�:•:v}'?:•'34YSy�•}•C;tc%:•..... •. .S.n.•a: .;}..:,.. .>.:.♦t2£..,f.s n•::+,.}..rt....: .Sr. .}:;tt;�•f :?,£r:n::
.3•.yx•::•:v}•. q :nw:h:?h}:•xt•••.•r.••$:n».f$. .v?::{:}:.'fiJ.::::i w. Yn+:x..n..:,n:•:r.q.v :x:n..T .{f.:}.,x.:: :.::}i7.,T!x
:fir<....,..,.r�/.,.�:.;.... ...vt.::::v�n:?.w..:.. .,.::::.+.•:iv:}n•...'•:{..rx 4:n4+v..nn..].....�.. :>:}:w.v.:w::.,•n:•:r
• ; a:q'TY?•.,•::»•^.v:r}�.':n{J.:;}.{..:v:•:+v::::::::T•.x:...w....�.........:....R .v::... .;.;. J.....: .rw.. .... ... ;..
.. :. ew..,.v:}..n.:.4.:..:n....... .. :::::.v.;,.}::::•.:^'+}'r:v}'v,{:n•Y}}'+:Cq:C4•. vy.{.:;::•.•.yrn;
.rx�m .an .nam .... . .. .....:'..• .. . .. ,.....:.•r::.t•:.+....rr :J:{.; . r, y}
.. .. ...... ... .... .........:...::•::n...:...... •.•::r:x•Yr++•::•:::{•]•]7x•T.:::::»:.,•{?..;;: .. .S;S.y :•+$,:,: .::n'1t}+• �:';:'i��:cc',•'"i::?b t;;{; ::{2:tr`:
! ..5.. .Y}�•.•4..: .�..�'{..f.t't}.: .<;�:::.•.,h,.x:r ^.}.;.$¢:; :..74sTke•: .:�:•i,:r,:.,r:M. ..'r�'.k�t;:.Tt".k}}x,xticb}t�•.•°'�'%?`:� 4:t'at°•t,�:};.}:U.
vs h .>.•n,}::,y{Y:v.3T•: $:n {7.: t 'R£.a>%• xr•' R.
,ar;c pF.....'i a n �•�• •:.t.. .:'k:•.. u ...k;..;;::•.'i: Rt4. „r.:;,r :::{••71 r.: ,.L.:.iA•. :f,•�+: ^a•,fi..,
..;r. ..?�.x•r .. .n}.::n ..7n..R••:n:...♦. :.:x•:? ..ro•:Tt: •:t. nor; 4Y.•i�YY••r•}Y:•{$.; v:<. 4'+.ro .4. •Y•Y;:
a••r•$7:.• ..s• :}}•::}:+:•' n:T.. ?;'2:_ •6. r:}. .{i3+' ..4.•,�...%! r•.t: . •Y}< :r�+:•;4•••fi}3}•;{ .'!}yq..;:•. i:Y^i r ,�`:.;;a: .}.. •.
J. .. '+ •::?:}:-:.••:>. .::J.,•{ .t<. :•:.};.$?•$:.}:•.:.r ....,.. <:;.',,r.:Y.:a. Y9.f:• }. .Sa }r....tt:;•Y:
, ... :`.♦ .+.• '•}.:hK.};•:.x::q•:.r:r firR .,... .,r :•}:'�;n L.:?y;::•.y;•.}•.x•,,`.•.•;}}7:::� �$":J•?;t... .r.h /.e "••`•:�:;}.:.{:{.}•J rr
n�:.J:f.CV•:•J n.;::4; }:..�.,J.: ..��.i}r.v�$•:Y•.n'C n•:?•:::•r x,•:v.f7....fr:::Yn.M.t? R.4. 4:}•.•}:: vfr::-: Rn•A i'iv..y,, rt:4f',:.">..,`
t.:?nr.2,t•.4.Frr .•7:;.#;.:4K• rxtl, , ....$}:..,,f..:•::4:}yT..r. .,,....$v:::•a:}KnR,r.�:n:•},:$::tt•7.:•:.r..4•x..:::�:.:}'�::4:.�3.4�?<}:{3}k?»$?.••..:::y.S+.:. :n;.:!::{:{:'::.;:{;,,:
.. .........n.;.r.. C.:p......h ._jj``��,i??itll.P qr;+S L ,...h::;.�::; .t::.a.}:�.:.. ..h.
•:�,,]. ..♦:•:J n, w :. .... .......n:•. •. ,:?:,r•{♦};: :.,.. t •r:M4;:S•+'r,}}:.: .`�+♦•'+.ti:n.}x\?-0;:{
,iliLYf.C,7.7' ,;{i.;: tip•.: :i
4}x3v.}r.}iR'{{+:;}.;r,:} {7:r 52^•.Ri"{�; :i:•:•ti::yv: :.+t,%:iy (yKi{{a•.:K! �.t+^-:'Qti^.,• r':y;
......... ..... ......:.::••::•:•.. :••.vr.'•'{+•7':`{a]}.t}Y}:;:n::;q•{.ti:. ;:;:W;:;}:'LR::$$..;...}:.: .w\+.•; .':<.}'•:Sj,T .{♦.v•.• .?i•Yh YJ::S 'n}:•} {:Q.-K.'t':tJ�. R.
+u:... ty.y }}k♦.¢.r..;.. •} ..Y�dn ...<.:nt.Cx..t.;Ttt�.. ,c,,:;}2 4c-i.•.'•-r+:v•.r•.:L•{•::.•.,- � 20\ •�;T;twn:Y;'r.'.�..�::�?'R}:q,:;
•yy: .Ka.: 7:5}RL•r 7,'.;• �} +,$� +•R�:S r,{•}e�•,.•. •ns•.+n'�}U:}�L:�$..;fi'Lr,} ,,•l•+
'$fr qhr. :`•$<r.'$:: .-a •Y: •y+?;r .t,•?r:;•?� .{2':.}:. .>:. `•3•. tc• nK;}xh} :?,.•.}i. Rv...4.i, n$:$?•!'♦..J.. �F:4 G•':•f{i::rr•..J7•.•,..:..::: .4. ^sitar %-.:t..r.?•SQL:rn y{�'�;�•},7:iY-by}\tr: ..'•'+�.t'•;'•;;a,7y •::fi,. ''+air`'^:.{w:::i•�:;q:{.},:7.,ti i'S•:• .:••'r•}•:frti }�+.• pJ..y+: ...4::`::i.. 4.C:•:::::: $:{+, ..{.:v+::F•}",. + }�, p
T.?. v^J:Tv:%•..r... : C•.:.};q•.;{..nhvy,Y•.. Y... 5.... .} .t?.v. ..v>rn:•:^Si.':•}y}}; •h{$:Y tyCy:}•T'+yS$::}•t'•.hvni:'Ji'S'7'vti}S.vJ. .k'+;t ':1':L•?t•}hv3?•'w h}:},.f•,.••$;;•f.: .n,,r. ,%t,.:!. .i:: .;t•,.}4 .•�'.3.t: 2a•.a w:R.y.: ..L.yr.. y'•h .4+.?} �$R::i {L.r •T♦. ,..}., :x•;}C2$:
??3r'.h:}::; ... q., ,.,»q.?+{•'L:•:.. ;{., ,{•.,t}.$: R:T,::: .�+4..:,w�'+}: .y?`.:r: rt,} ..t;.} ••:b,'.n }:F': ,t{x: 3.3.t:
, .,:n:r., n, r• YKr+''..•'t4•:•:ak: ::S:'... !r>rR,. :•r'''.•: '�.'�.: > n :•R;t:+.tfS... va'!.•.:..;rt:.. •.r.:,
.{:. „q rr;..;:YJ;,?•�+' 7 l?.'�,: {,<.r;r ..}•:+ w.. •?.dsr.3...:n :{q::.• `,.�{;.•• .t,J:G:
f.}$n..L., •:<.!;5:•<:'+r .at;; .fi.,..w,tt.¢.. r.r.,:t n`f,:,{;!{}t't{} :.. .:,,;T}:r�•oT,:{`,•::ti:`$$:'k2;:3.h{,} x2P$} I1tIt1 •..r$' ..:,•a. �?.?
r.;..:••::.n:.:h:;::.}{{, ]:��r>7• Y•/ ,�{•.�.. +t};.{{.k:;:K•:%}::.,.:r.+:•r:.:::r...T;..:...t,:.... .....:. -ni<w:n
.L
•.l
• }Y.O}h:?•:• .:...:.T.:xiSv•+.y}.{•:{:+a.C..S,...
•. ...r.Y....T.r. .... v... ... .. .............. ., J::}}}'.}}•..:. $.:4i::i<+:h}:S}:v•YijY}:;:•}'+:+r:{$i ti{:::%'Y:v....`S}iS.T,}J..'1 .^....,.......Y..... ...... .............:.•y::�:�.•.:,.:.t•......;.,.; :,:.:;;:•.}r.;:.},:•}}...{a+.:}k's<:•:::>+•>}•••:$:'t.y v.�{;:,;.::5.};:•:J{•A••+::'x:{.i ;.t{f;{.r:�;},:.,xi:. 7 {•:'k`28:�:r•;{}.
............ ...........:::vr:::;:m:::..:v•:x•,;.••::-:r,}rr::q;•:}r..Tv rw.v:4 J.:y,':.q:v•:h •.•. .{�,v:}:v.f..;.t{.,n;r. ., :},y vv.h, fr :'•:4.; 4:,�{:j`,,�♦.,.v :.:A
.............:w-:n:... :...:»} .::••v. ..t v r•v: n•.,♦. n;.;{?.• r. .. n...�.:..;}n r{+4..�r .:;{<';,w..%:..:2 ...vr}..v:(( 44 }h�r. L.}., J.;.4..} 1.4.fr},}•�k•}Ca'iT+2'h}7.;3}.H.•.Yf�•{3'r 4:v. ..,
.:•f r.w:n? :n{}•t:,n :}, •, ++l:{•:•{:y.t?•:n!?{•.r...,.;v{$yr•,ln}:}.v•.S, ,.,i5v\:.J.!q .}n.,.q q.}.,..:{rr:.(%x .(�•{nv{w:.n• r:��i}} :•�•,}•, r �,'••••r +'RY•:n ,`:�{:{.•
;ri4;{;}ay:.Y..,: .R.$;<k+. fi}...:L•.JJr;.:+:r:.k.f. .:<y :n,krn n},3',tx ,'.•t,•;},:x};t-'•:•: ••n{.:?„4r}.•R,• '4:..•::n•,t�'Y:. .t rx, Y'' he.n
.,rT.,r}} ♦r.•,a•.;�:.♦: :!•f.Y. ...:r.:.;.h3:•:a.t•J. t4,,�41`?r{rR.. :<•:L}.!• ...r ..:t,?,.�:y.n ,..;..`i't;`••:::•,•.$};..... .:4...2fi;,•.�'•.;�+t �;;,L .k,°'y.{;.;}.+.{''t:::�^C; `'Ey 2'+'S`r.•..:':+4'`f�y�h.$}r'
7r'?,+.•:v}'!4••h•.4+Y:.: n•.+K•::•:•r.•.r x:::r<.?:7.:n.,i::4•Yy ::},%;L++$:v::n ::{•.•:}, :•�}.:••.a:};.•n r ;.4:y.vn r.: k K .. .{.,.�i;v ni% :l• {:•}u: v.»JY' :4r:4 4:y �,}Y�.�% .ri.Sv}
•,{•::+ ^�i$+ :?Y• ro-x.tn• :r.+ �.a,•.+•y{:.:: .z•k,$.+ .i:$ nau: fy,Y:t:}Y k;;.`-v,�:;kf 1:' :. �::•Y}.•".""r.. T.;.,.
��,.. .%.•n{r.r•'+.,n 4 ,•.:•{- ..,%{r T•v•,nv.,•:•,•x .,+•}'rf�'r,} .:>... C. bllCtf:FF:v'•t>. .� `7{'4:...q$$:4..
. r.24Y>.?`.xl,.•::$:w.<R{.:;�•.}}$;>:,•' '� 4u�#'' r.s,fi �•}{fig�fi{?#,;:{.,$,'.}, .�.{4n•t•:. f�.... �///�
n
•n•::n:?:ai4Y.;;; {,...J•}.R• fy ;•+:+:T.kvr.4.t2%}:R:•:.$.. �} a:. }..J:r,}
..............
.h3t(3`sitCe:CQ:}i:37::,::• .fi:..):•.' {,
y.}}:?•::+' rf{c;% }'}ti}:4:{•Y•'• }T:o't; t}ry';i:,}4`:?:+'f}.
:.yyr,:.xr.::.}}r:•::i'{+:::::.}�Y:::�.t. :':Sti.'r'i }:}t4:}'�<}., ..gyy'•.•,.h; K..}:.R:, y}............
'i'j:$$j
'4}.•xtnKtC{+•}}}�?.: 't;• '4. .Y f,.4•.%M4'..:t,.,.. A r�i:V+.::n r.T {4�:•:R•':}:: ,iv. ,j.:'K•4 n..L• .S•.Kf>:{::.Sri;
:::•.v:;•;•,
................. .n.;.;...:•:.•:::...:,•{::'4:Ch}Y.:.}:{•{•.•:{C.. •"vi']'•rr, x+•n+4:
:
............. ...........t+ .... ...n ..:.. :{••:-::•:::tqy... }{:;`r.Lr+:r;;•.,r}+,;}t}}$}„:$q;•}{••.:r,.}. .4.,n.,.....yn••}.>.:}�t}✓.'•},.r::::r.:t+•}:•n�'..{:>2yv+f♦rr ,•F✓.,t`3♦}:t.}n{},4•rn'•:..r:•:: +.
v:/n•.v?�•: :/.. .%•i4:.L•.-0R•.v..•J.Y+,....;.T4:rr..5.3::••r n:i�:t:.. nv{+.�. v.4.•:w:^ ..\vh^v i r nv.�i`:.{.:::$.•r:?a.i•. :Lti4}•}}}+S:},C,,n w>�r.h�,•$v:::•YYr7.}•}':••:Y+:•r•}'tn}•:.::'•:•... .. s .;{l. .. :•r.an.+n.i. ..t;•.....,r:}>:t.:....;4L:t••`4:}•.r.,.. •7.4..h.$..:..y?�,•..t..t+.. ..4+t,�txrn?,C•.•.}Y:•:;t.... ...5... +}:.tr;:;{
rd•:t•r.S.r.::4i:i•.fn....:. : }$:Y�.iL.•...L.{:•r.,},.v,{{:r......Y.......K•::.}.,.... .:..{.S,.v:J.... :•..,{.:0.'•h•: ..+;;:+}.?{,•:. ,:{•.t;, , �::tiv•:.:•::....t
...{f:}�+•:�`.. ..:J v ::.•:.0.. •LrKr,.. r::}.r:.r:n+{:•;}g:'$:':,.^:.y':+ .,:;•s:' 3.'.�'�..••:•R?
xn+::•C{v:nv:•}?.:.w:..;..:.... r : ..,:.:::v:.t,.. :Tv R47C :.......,q.
.fi r..Y... Jr,...t.. .Y':.r ..,{..}.4.+4....t....:�{{:!R 3}:. }::'•.n.x•}.•rn,• .,4a,b7'ithi:�•:i•.y:+{•r;{tx>'�'�r:n••r•: :a•. }..;.,{:$,: :vn,at•}:.:.•.}. :..Raa`e•.}::•.;•..
+f.: ,Z.+•.r.r• .J✓:hSR•:i•$x•}••. ,.\-.?}.::: ..}.:y.:$$t}-.h.. ..r: •,4 a+!?`v,• .:,r t•J n:•.,x:.3ti.`t'•'td.•:R.Rx$:>i..2..2r....
+•?,7;$r�::n•»{•::.fm%{i'r.:;•}}`::? ..xr:?•.::. r.?;.{.F{t,: :x.v...
:....n.::r-;:{.... +:•r.,•..:•...{•:::•,:...;,:{h ...:•:••:• .r::•:+\tLy}$rxo:.,, ,•. :;}.:}�!;:$•$:7,'c''r:;�4:{:S.+i?;:}aii}{:`2fL?•T!.f>r':i l'{i•T:? :r afiti.+fi:':?#,•$:•R.J
!,•.,•,�•,;:};:;..,.:,..:....,.}r.,r qff•��}.,,.r.;t:.n.?r.r-:{.$• :•:•n?•:•:.•}',•?2.:r:::W.•.-::w„:?$:fS.�.:t: t.,•,•::.\:y`ur,+�'}�::,:..r}.,.;${..: .....n....
...... ....:........ .:ra..`.Y, .,+:Y:•.r7k5,•:n•:.rY:>•t::.........;£...;»:fr.........nt".;{...}t.....:. ......::.. .:n.:.;:Y:
.........,..rn.,..• ...................:vnr,,: ,,'•Y:+'4}TY•:S:n}'•:{+:}'rrn}}7+}:$`v<:xti'{':!•?:+•:'}::,4'::•R:f?{;1;::q$::):•.+,C•:n;.jiC:'t'�rfi2a:}ri 'v:.••,p?fig
ah�.naIIte:. :.�q,:..<.•:r4.•!••?4:•Y+Y•R3:,^•:YT:za }.,z,. ,}:•K•;:q'.t tax •Y a,ft:r:y•. t-?}:
.... ........ ........:::::•..•.:••::+{+{h"•:i{{:.}:•.r'n1 :.....Jn,nv.,..:, .. •!•i$$SR::'•7{x.T.
.. ........•:.. , .. .v.....r...}.: ..:..h......r....v..,.........v4 :r.n.4•r{s.x:n+•.:}• ...nx:•.•::..:..w.}n•%• ^•:: ,4,;. •fir}.}•n•.}7::;:.v.,n.,v}•{.,!•{:. }.;}fi i:•K+,vJ, xY'.
........t...........: r:.+....... .a.vr.Yv.:+............ •S.Tn....r..t....r... v....n vn:,•:::•::..a.....,, t ,.rn h .:}'n•.'• •$
..n. {r..r.. .•? .. r..,r....: .......tr:t ... ....::•.,:v•r.:..3.. {..t..:: .. .,..,^,•}x.:•vrxt7•.•:R•.•.5.... •Yt:.y.,..}y.:•:�:.n..:. ,:.:..
..t...... r....v :. ....•}..x ....n.. .♦f'.,.. r.n......,.•. :•}.v::nry .v....... t .:r....xn...r..3,• .....h .. ...\.....^.•}.. r $ht•SY.v:<y+•ri}•Xi;:•:} hJ+;:..., ?: Y+sn:;n}}:;;:^:?i;:::
�:r:r••:.r.•..... .......•:..:....'t :..;,;ay.. ,........7..:}::::+•........n.}{a..r::•..,.,•.:•.•:r:{tr7?y:r{{{::.:.:::.:••:::,-::..,}.,;:;:t.}:• .+.,n:.-:r:.r,•. r•y• •:::.:.
..}. ..d . ,.,..+f..,.7}}•• 4:}:: :?•:}..q,+. .i.}:�-:.`••:w:<':?$}.t: {•}3}y}f::i:::.,;::.:....::?... .. •.::•::•::..v ..{•F. +�.:{�••:.f:f•:•,.::..n..x•:::::v.:.4::�:•:'•.•::.v.. ..:.:..r ..:•:, ♦:Y.♦i,^
L,{✓r.. n.iu A....J$.. n:,{.. �. ..1:>>.'?•:•:...} }:'+•:L. hv.{-:.n''Xv-}+. •Y,.y..>{.%v.}.�:?::4'i:......r:.},• ;?env:%. .:,,.... ♦ .:.::....... ....n::n}.;....x.:,..?:yAn:v,!n4.xv......n nv.r. :..{..:..{ :}RSY .., :w:.w.q�}'$Y,w•:. JJyy }•"•f:•':•:
�. ...J:.Y. �.. :,{v:]:•:}:.k. .r4:...::vv.:...': ...<..,..:.n:••4J:v:. ?:•h••':•♦•nw.•:::::}.Lx:::.�t.{:.{n:.,v,{.?:,:ryt}.y.}:!.{..:4}•x,:.{:�?y{.r;:.
•%•r....'S.hJ..,:}.,?:.k •::::{{{:�' %rr:C♦•:: :•i+a}:.•.;s:..;•;{.}{.,.,;,,{•:{•}}:•::••x{{:•n•::::n•.}:;•.r:•�{ .,•t...t.•:{r}'+t•:?+•.:r...t.:.C••r:,<tr•r::•:.........?....f. .n.r,.?},x,..J
ssv.v a••.v�}n+.w::ft tt::::.•..;?..,:ry'/•v:.�.$,, ..:yYT:Y::::}:?f1:•:v:,-vow:•n}'a}}:}:Tti.':i�ir}i:}S•,.,;y.T.{,..:: n......... +..h...r..t.......... x...{.,:k'�:.•:..;. .n :Y
Y.. 2, 4v:.• :.;r.n{...,.......:.. .r::!•::»:. t::,!v;:•:•}nn.. ...n.::.:.:. nn.•.}n.......... �•RY;}.44;\':S:S?ry);:�::.
..,. ...nJ..x .... S' .},Shun•..,}•}..n..•..:.$. •..vv:A.'?n:Y;,y. ', r{::;
S. i4Y7 ) }�+`$'$t':in•{.:•. C<: f! 'ri:;ti{;4\::" ••;' r:i�if' .-W
adt�'es 3}}:•+✓:•$... •}}:;.+i•. v'{':,.2�Q:..}r:.iT ��::a:::n r:%:v Y'r.>.'�.:�,r: ;..}}i�::}.}'•
♦?•.St:tr,{;}ij:}:}S:•:�� .ntY•::^}}ii:.+•$.. ...$. :J.+i:....}%•:�h•,tv:v' .•",�ii:
• ... � ........:.v:.::n:+...p...•:r::'•:v.nv,.::....,•.}:??•}::{.:}K•.ri%4:LxS, ::}?..., ...♦ +•xv'C}}}:•K:+•q;
.. ........... ............. ..:. ....r.... :.....r.a......:r:::::.:r.........n.........:.:::::!•::.. ..,...{{.:+•:•.+.i!r.:•.r...4......{.. •r'•F�,..:.. r.:n.L...S: ,. 'h
.r.... ....r.......r:rr.....n ..r. .... ............t..........:. :.... .....n ..:,•:...........,:........... ...... K!.:...,.+•::.:. ,}}}.ta•'.•}};:.} ♦;+L :•X.-
:::.......::•:::...:::::•.r...r. .. ... .......»....::... .:,..........J•.............::..:.... ..:,.♦.......:...........::,.. .t.tr....,Rr .}.. :•}'?k?'' :.•h'y!
•,.....r:.L.,... r..n.• ..:...AT r.:Tr. :.r...n.....• .:.... .... v..r. ...... ...:.... ..n., ....:i:.r:•:Y:7• :•?:{:r;v }:7$:
r ..n ..i{...v. : : n..\.n.vr .n...........: r }•:?:.........:n..•:•.::.w::.•r:!:. ,.♦:..:... .......n..n.T ...x\.... :.}.. : '�44': x,{{Y;<•i{
�„ ..r:... ,.T.n T}.}.. .r}:. ..<.:.. rt;/.. Y:R4,:.}r'�iy`!}::•is,••+•w. :v,;':: •rq•4
J ..:...nv.r.... .::•1.•:n,•........::v:?•T?4}r...:}}:: :i,^,♦..r:{•}%.}}.n♦:.n :,••x:•{a„ .v......y.}{:
.:.......»$.. ( :.r.......:..X ... ...... ........ :......:•>•:•n•t}.:......:......... ..:.+..:r.v...n }•kia C'riti«^:•.....}. ..'4`..
• .......... h'i.. .:...v r.n...r..rnK r:..:.n...::.•....rn....n....:,..... n : .... •+q:' }::�..
... ...... .r .. ....... ...\.....v: }.r:•.v.v:.•,.n•:f.{x.+?vf.••.::•...... .{;:•.}:.v:}:•... .. r.:f;r•{}.y7i?'viv :�}Ta{i
fi�rr..r....t....k.•S:':..... .... ...:.., rn.. ... :. ..a...:.....:}:,.......:,,..T. .. n ..%..SSh•:.,. ..... :•n:•.w:{•?+%?•:;...<r:::.:.}. :;::{nt" ;n:1•:iE
•y,r.;fi:•:: :v,.,r.v;:?:,:R}h,9,...v,J,.:::•:.?:r:.r{L•7:.:a•;}:r.:•:.•?.•r:+n?•+.:•.♦::.:..}:h:::.•.,•}:,.:vrK..y.M: :+.:v+
J.. ..r. ... •:J•n•,...z.:.& ..ty}.r...r...}..fi:;?•>}}:}}:•::::•:•:�•n:{?.$%::.r.r.;.,.•::•:n.•,•n..;r;,.,..•.. n.na•.•.!.......
f....::T•�I,.....,.),•n:•yY{•w::..:..,...�::::::n...............+..., .. ..... ...,y.. , n... •......:..
��{{ .n: ............ •n-. n..,.TB+::..:.,5;?';::}S-:•...w.:,i}}:y:•:y::vx:.}v:r.:•.:;':;Y'::.,:r...::::"n'v:i.;W'$T:Jv'\Y: +�':}.?%Ci.;.
.Gl.....:.n.:....r. ................:.•»•:nv: •:.:};.}}"::..KxT:w:A•.{..r...,vv::,Y,.••^n•::'-„d4i•:... ... 4{;x}+5.4'•}:$}'.$:h.y}:.{;:.••}:;.r+{.r{i ra:v by '
... .. .........:v:.•.:::-v.v.v4::::h:.+v::;:,,... .:vJ:,:v+ r:..;..4,.;•n:M1T. ....t• :r w::., r.:i}r:•%{{+.ry;%::•:» S}', r•S: :vit:R�4��,tr$in}'{�i':{:'`:}i$i
.. .. ..........:.,...:,•:. ♦•.. ,»:?v .v....:.....}}. •.r:...n.......:•x:::l}.t•}}�+::t7gf}•n<;......:..x.v.:•.t•:.K.n.....,•.;3•... :•:L?:.4:K{:titre.•::,vi}it:}•ti:•::},•k't,.NJy}?... ..T:•::.
+.✓r ,{t.;{}.r'S......�.:•{v ..}h...,. :4.. ,}:J.•T.A :.4 ,5.. Qai'., }
•:»r.,•:;..f•Tw:F.r,...:•:::r.}•r..:+.t?'rY ...>.. ..::<+a. •,.n...y, ,.;?.;;...,, .•-2:7•. •:i•+:�..t.: :.J.. ?. :ti,:t}y:.r •:t{{..}.}. ;;;r{.
J.....r ..{r%n nr! n.}'ii:'•}... 'hL::}:N::•}i•:' .v:7AK<?+i}R.v:.C.. y
.�.. :Y•.t:vt. •:.�: .#:r ...4.. ,`:n 4• ':vrk•`.Li{{,.:}•7 �fY...Tt n.;X:r•:{t v iQ: ^.•::S•;}:;:k;:ii' :;ry...
•Vr`:•+::.w:n{y••;v•:•h::?v:..n .y?.:•:r:4:}x: t...v.•?::4:•5:!n,;{{;i':$nvrT.v..t..{A:.. .3. A. ... :n4'
.:.i.... .:7...I..r.....f4::'�" •::•�Y.?w +r:tv, •:+.4:KR:^`.,. y.},1.}.:
?Wv... +n x..nr•:.n,....,.;r.:x•v•.rr;., ..}.::.. n.u.\n^:••:$:i:v::•:7,r?,Y:.. :.:4 +.sL rY.... ..a ...:4}%^.. .,Y. •ri.u.:J.ry:t:C}}. ?S•••Rb'•rr.•g4
}. x w:}:•.:v. :�4. � :h•fiT!}{t...r.',.. :Sot: }S{}•{C' Z...}§ .•.?7}li:}?vx.v?r..;,;...'$r•,Y+:tx:iT:y :Y6`.:i?{'ry.:•... •:yJ�S:..:.. r:•:•:{$}S$'{.:•}.rr}f:. ...n..4.::•:+.+v.:n. n:.z..4:.Y,.. ....,
.;.,:T.....;.,; .<:•...:rrnr$•w.rJ 7v:»:R {4:,+.<n,t.....f:•:•::::::.: ;{.:.::.•/'q}.,•:::,csr•.x •}:,•. t•]xgnt-itniq\%: 1t': .3Y .•.t•t+:Y:.}$:q} .:•.t•:YT•::.:j;:;:`:j:'•:%>:..,.•R•.ST r.>•.,; .,...
5+:?•{;;,•y.}�}Y}$;q$Yf•;.y:.$:^'•Rw::+�$xn+$}.'i3;.5'{;S�':r•}:\•1.}7}<G$<:}`+t:!}�r:•xr}i>clt,?Y n..}y:.t.,},•::.;.{:u M1h;�vz Y.::.,:.x•.:+n}ari•}:.: Ull .YtS}:a:::$7.t<?•}:Y}.,..:...
• x...n....%4{t+n.1�,}.Jr:;:y.'•}�::::::}:::Y.t•}:h::::.:.n../.,:....:::.v.:'h,}J.•.q.4.}:..Yi'+Q.}..,;{Jiy....... .... �j:II�Q�nL�i:�•biL..:::.:•.:C•.w:.::v.y 'S::• { •: �„'
YWhire to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of atanfnsal penalties of a tine Ap to Sr,500.00 and/or
one years'hnprisonment as well as dvfi penalties in the form of a STOP WORK ORDER and a fine of 5I00.00 a day against me: I understand that a
copy of this statementmay be forwarded to the Office of Investigations of the DIA for coverage verification.
1 do hereby certify under the pains and penalties of perjury that the information provided above is tru,avid tarred
SipatureSa� ��Print name -
h � G Phone# 5�0 e 3C 2 // a
(Jd�
official use only do not write in this area to be completed by city or town official
city or town: pera dt/license# ❑Building Department
❑Licensing Board
❑Selectmen's Office
❑checkif immediate response is required ❑Health Department
contaciperson: phone#; - Mother_
orv;.ed 9195 era)
RESIDENTIAL BUILDING PERMIT FEES
APPLICATION FEE
00
New Buildings,Additions $50.00 C)
Alterations/Renovations $25.00
Building Permit Amendment $25.00
FEE VALUE WORKSHEET
NEW LIVING SPACE
�e, square feet x$96/sq. foot= 3 2 2 5"(o x.0031=
plus from below(if applicable)
ALTERATIONS/RENOVATIONS OF EXISTING SPACE
square feet x$64/sq. foot= x.0031=
plus from below(if applicable)
GARAGES(attached&detached)
square feet x$32/sq.ft.= x.0031=
ACCESSORY STRUCTURE>120 sq.ft.
>120 sf-500 sf $35.00
>500 sf-750 sf 50.00
>750 sf- 1000 sf 75.00
>1000 sf- 1500 sf 100.00
>1500 sf-Same as new building permit:
square feet x$96/sq.foot= x.0031=
STAND ALONE PERMITS
Open Porch x$30.00=
(number)
Deck x$30.00=
(number)
Fireplace/Chimney x$25.00=
(number)
Inground Swimming Pool $60.00
Above Ground Swimming Pool $25.00
Relocation/Moving $150.00
(plus above if applicable)
Permit Fee
projcost
Town of Barnstable
Regulatory Services
s Hnxr�sxnet Thomas F.Geller,Director
KAM
9�pr16 µ;. Building Division _
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601
office: 508-8624038 Fax: 508 790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
the.subj ect property._ ........._... .:
hereby authorize (%Q o:act on=Y behalf,
in all matters relative to work authorized-by this building.pesmit-application for:
/� . f
Address o Job)
p .
$' a of er Date
Print Name
I -
�pFTM+Eroy, 'Town of Barnstable
Regulatory Services
9EssLE.$! Thomas F.Geiler,Director
1639. k.� Building Division
rFD►,M�
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038
• Fax: 508-790-6230
Permit no.
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion,
-improvement,removal,demolition, or construction of an addition to any pre-existing owner-occupied
building containing at least one but not more than four dwelling units or to structures which are adj scent to
such residence or building be done by registered contractors,with certain exceptions,along with other
requirements.
Type of Work: -� Estimated Cost
Address of Work: ;7-/ G �__ -e 'X 1
Owner's Name:_
Date of Application:
I hereby certify that:
Registration is not required for the following reasou(s):
[]Work excluded by law
❑Job Under$1,000 `
Building not owner-occupied
[]Owner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME EVIPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A.
SIGNED UNDER PENALTIES OF PERNRY
I hereby apply for a permit as the agent of the owner:
Date Contractor Name Registration No.
OR
Date Owner's Name
THE
The The Town of Barnstable
BARNSTABLL Department of Health Safety and Environmental Services
Building Division
367 Main Street,Hyannis,MA 02601
:e: 508-862.4038
508-790-6230 -
PLAN REVIEW
Owner: I V 0.S V1 Map/Parcel:
Project Address:`Zl(� Qevt Builder: A.
The following items were noted on reviewing:
�. 2 X 1 p 0 uy\nQ iJi ✓'
TII j
U-J �+ sZ1 I Y 2Y l
Q Qe
yQ.v� C\d1P P.�u, f o C1 y� bC,C-�2-v' e P 2 .r o?
_Q�bLY1 C� y@
112 fhlattD S LuA �6 z
ry
1 s
Reviewed by: 1 D
Date: 2 2 -D
,l
j
LOT 35
IN 4
QSJ
a.. o J, O
LOT 36
Lo 7' 37
RES ZOA'L•'• RC" This �qOR
TGAGE' INSPECTION Plan is For-
` o lY'� C'I;:17�;; 71. ..f _ Bank (se Onl • FLOOD ZOiV-' "C'"
I)I ':U IZ(A- ;'.� IG.. 11J� - - IZEC�( 'J RY Otti'VER:
DAJ F: '� •��,����.+ II('YER TODD.h' -
/T�SGC'CGSSD/ �`_h ��? 1 i /i >.,:.._l�arlr_.•ir%F_�11,+f/�a<Yl_ :1LF. 30 ( '(
— - _ �:.1c: _ __THAT TIDE BUILDING � } :1VIiE S�►I�V�
S 101h'�� ON THIS PLAN IS LOCATED 01\` THE GROUND UI AS
SHOIkN AND THAT ITS POSITION DOES _ '` CO NS U1,T�11�TS
TO THE ZOv(�G Lrtt1 -__ CONFORM ;�.: '�
ETBACK REC i � �
7( !t` 0(. `.. �l IRB F,N'fS OF THF. ( 40B
('f '>QF�_ :1Y�/_ �_. �. .. _....AKD '('FIAT '.r , 1
(stnTF L j
!.!. �1111.\ "I'lif` f'k:C1:11 I''.OUD HAZARD INDUSTRY ROAD
iFA :�� ,�;(nti�\ O`� AW?STUvt MILLS. MA. U2(idU
►:., .., _ �� rHe ii 1;:,' IA DA�rF:D jg.�1�._tf�__
TEL 128-0055
i;. ( _.. .. TL1I rt.AlN N01' t�lAllE FLlUA1. ,�.. FAX: .12(}-5.55*,I
A: 9!rS R.,1lEK'r
ru BE USED MR FENCG� <'1r)69 I)( If
I. fie
BOAWRI)OF BUILDMI
Lic-,ewe, MCI,
LATIONSGTS
rtLi gg7
yr 03 Tr.no: 12063
l Rekr 'f
AR,TH y,%R L D0." k i6
NSl'ABL'E; M`�2668 e �f� �
wu n
Ad'��mistrato'
Board of Building
Regulations and Standards ot HOME IMPROVEMENT CONTRACTOR
Registration .10449S
Exp�rateon -
7-4l2004
rYPe, PA,Wte Carporation
I ART DOLGOFF BUILDlNG�EMp
f Ar€hur Do�goff
19 McCormick Dr.
W.Barnstable,MA 02668
Administrator.
1
Permit Number
REScheck Compliance Certificate Checked By/Date
Massachusetts Energy Code
REScheckSoftware Version 3.5 Release lb
Data filename: C:\Program Files\Check\REScheck\Nash.rck
TITLE: Nash Addition Plans
CITY: Centerville(Barnstable County)
STATE: Massachusetts `
HDD: 6137
CONSTRUCTION TYPE: 1 or 2 Family,Detached
HEATING SYSTEM TYPE: Other(Non-Electric Resistance)
DATE: 12/16/03
DATE OF PLANS: 11/8/02
PROJECT INFORMATION:
14'x24' family room addition
c ,
COMPANY INFORMATION:
Art dolgoff building/remodeling
COMPLIANCE: Passes
Maximum UA=77
Your Home UA=68
11.7%Better Than Code(UA)
Gross Glazing
Area or Cavity Cont. or Door
Perimeter R-Value R-Value U-Factor UA'
Ceiling 1: Flat Ceiling or Scissor Truss t 336 1 30.0 30.0 6
Wall 1: Wood Frame, 16" o.c. 390 ;13.0 0.0 28'
Window: TW2446: Wood Frame,Double Pane with Low-E , 49 0.330 16
Floor 1: All-Wood Joist/Truss:Over Unconditioned Space 390 119.0 0.0 18
l .e
COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications,
and other calculations submitted with the permit application. The proposed building has been designed to meet the Massachusetts
Energy Code requirements in REScheckVersion 3.5 Release lb (formerly MECchecl and to comply with the mandatory
requirements listed in the REScheckInspection Checklist.
The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design
Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125%of the
design load as specified in Sections 780CMR 1310 and J4.4.
Builder/Designer Date l� G
_ �.. _ ..
Assess 's map and lot numly"e .......,,� .... V��'3 �✓C�"_ '7�� 7j
/7, SEPTIC SYSrTELA War 64
IAMCE
Sewage Permit number ............. � t9............................. I t „ „ r S"TAT'E
WI e H ,�� 1G �
SANITNly CCU .
OfTHE'TO�ye TOWN OF BARaST%]ffLE
,
BAHBSTA➢LE i
"6 9 BUILDING INSPECTOR
Opp1M a
�.. APPLICATION FOR PERMIT TO ...... 4 C�. 4�i� ..... ....................
TYPE OF CONSTRUCTION ................... ......61.Q`....... ........................................................................................
.................<P..:/.,?.............19.2j .
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
p /�. ...................
Location ........../'®. ' 34,........ �G?.. �.. . .ve .+.......
I
ProposedUse ............. c!'+ - ............................................................. ............................
Zoning District ............... ..�... .................:..............Fire District ...........................................
.. .................:.
..........
Name of Owner .......... ... ...... . ....... ........... ,....Address .. 2a Z..... ..... . . ..............
Nameof Builder .. .......... a........................Address ....................................................................................
Nameof Architect ..................................................................Address ......................... ......................................................
Numberof Rooms ......................9........................................Foundation ................ .. . . ..................................
Exterior ................... 10 10. ..................................Roofing ................ -t�C. (!.................... . . .. ................
Interior
Floors ................... . ...................................... ................I. ......1 C04
�.. .... ... .....�cJ.' 'Heating GlG . Plumbing ............... r...... .... .......:......................................
3f D
Fireplace ................. ..............................................Approximate Cost ................... ..... ............e.®......................
Definitive Plan Approved by Planning Board ________________________________19________. Area ................................. ........
Diagram of Lot and Building with Dimensions
Fee .........................................
SUBJECT TO APPROVAL OF BOARD OF HEALTH ?�
1 �l 12.0 0
2 47Z
3 yr, o
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name ... ...... .................
joseph
single family dwelling
�
' Centerville � �
� ...............................................................................
^ Breen ^
. Owner ..................................................................
�. .
frmoum
� Type of Construction --------------
`
................................................. �
^ �
Plot ............................ Lot ---..#.3.6............... `
. '
.^ '_~
' July 8 75 '
Permit Granted ------..------..l9
-^ Doha of Inspection
`
i Dote Completed ............
>
PERMIT REFUSED .
�
'
-----`---------------.. lA �� \
( .
' --------------------------. .
` ^.�----.—.-----------...-----.—
'
'-----'---'-----^----^'—^---'—''
,
�
'
. .-----.—.—.----------^—.—.----. . .
�
`
Approved _-----...................... -- lQ
'
---------------..----..-----.
�.
�
. ...............-- ........................................................
`
'
' Assessor's map and lot number �l
Sewage Permit number .......................n ...............,....,...........
P�O*THE l��I TOWN OF BARNSTABLE
i B98H9TAIfLE, i
M6 9 a• BUILDING INSPECTOR
`FO NPY
APPLICATION FOR PERMIT TO ..........ram!`....... .....rrf'....... ��.:.... .............+ ' . I•-111 r
TYPEOF CONSTRUCTION .......... I,h.�'. r r ,. .?....... .... ............. ................ ........... .............. .............
/ 7/ !�
.............................19........
r
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information: , b
Location ............! ..............{..:`'�'.... `...-. �.... .".........^ i f..,... ......... .G..... ........ ff
ProposedUse ............ .......:..... ...............!t"::....................................................,..........................................................
/ r
Zoning District 1 ......................Fire District �- . ...... . -g'
Name of Owner .............................._ ..- i. . ........ '.- . ...Address _, ,lr * f<c..:.......y'?............1 .. "
.... ................................
1►
Nameof Builder ......................................,...:........................Address ....................................................................................
Nameof Architect ..................................................................Address ....................... .........:....;......'.....................................
Numberof Rooms .......................,........................................Foundation .........................................�......................................
Exlerior . ....... .......................................Roofing P..,
. ... .
Floors f! .........................
. . / Interior .
Heating . V�.'a�...../t� lr+ /�.1.....:....Plumbing ......................... �a�. .................................................
r
Fireplace t ✓... ..................................................Approximate Cost
.........`,...............................................
Definitive Plan Approved by Planning Board --------------_-----------------19________. Area ............................ ...;:.......
Diagram of Lot and Building with Dimensions Fee ..............................``�.
SUBJECT TO APPROVAL OF BOARD OF HEALTH
_ e
3,4,0
�s
I hereby agree to conform to al the Rules and Regulations of the Town of Barnstable regarding the above
construction.
......Name ...................... ✓ ...... .. :a....:.....t............
Breen, Joseph A=192-153
�i
1 1 2 stor ,No'.s1J800... Permit for ....................................
single family dwelling
1- _:............... ....................................................
'L leneagle Drive
Location .................................................... ...........
Centerville
............................................................. :.......... ....
Owner Joseph Breen
......................................... .r .........
Type of Construction fra `e
................................................................................
#36
Plot ......................... .. Lot ..............................
YJPermit Granted ............. ..y.....................19 75
Date of Inspection ....................................19
Date Completed ........................19
RMIT REFUSED 4
..................... ...................................... 19 I
...............................................................................
..........................................................,. ..................
Approe ................................................ 19
r_
�=cam----
luadruple 1 3/4" x 91/2" VERSA-LAM®3100 S File Name: CALL Project:FB01
ob Name: Description:
address: Specifier.
:ity,State,Zip: , 'Designer. Joe Madera `
:ustomer. Company: SHEPLEY WOOD PRODUCTS
,ode reports: ICBO 5512,NER 629 Misc:
1 1 I I i 1111 f II
Sfandard Lead-40 psf 11,0 psf Tributary 01-00-00
11-00-00 11-00-00.,
BO B1 ; , t B2
4091 Ibs LL 11688 Ibs LL 4091 Ibs LL
2573 Ibs DL 8576 Ibs DL 2573 Ibs DL
Total Horizontal Length-22-00-00 -
2eneral Data Load Summary
fersion: US Imperial' ID Description toad Type Ref. Start End Type_ Value Trib. Dur.
S Standard Load,Unf.Area Left 00-00-00 22-00-00' Live 40 psf 01-00-00 100%
Ilember Type: Floor Beam Dead 10 psf 01-00-00 90%
lumber of Spans: 2 1 Unf.Lin. Left 00-60-00 ' 22-O -00 Live 810 plf n/a 100%
eft Cantilever No Dead 595 plf n/a 90%
tight Cantilever. No
Controls Summary
lope: 0/12 Control Type Value - %Allowable Duration Load Case Span Location
ributary: 01-00-00 Moment 22290 ft-Ibs 79.8% 100% 2 2-Left
Neg.Moment -22290 ft-lbs 79.8% 100% 2 1 -Right
End Shear 5497 lbs -42.8%, 100% 4 1 -Left
Cont.Shear 8965 Ibs 69.7% 100% 2 1.-Right
.ive Load: 40 psf Total Load Defl. U469(0.281") 51.1% 51 2
)ead Load: 10 psf Live Load Defl. U674(0196") 53.4% 5 2
'artition Load: 0 psf Total Neg.Defl. -0.037" 7.4% 5 1
)uration: 100 Max Defl. 0.281" , 28.1% 5 2
)isclosure Notes
-he completeness and accuracy of Design meets Code minimum(U240)Total load deflection criteria.
he input must be verified by anyone Design meets Code minimum(U360)Live load deflection criteria.
Ao would rely on the output as Design meets arbitrary(1'j Maximum load deflection criteria. '
.-vidence of suitability for a Minimum bearing length for BO is 1-1/2".
.articular application. The output Minimum bearing length for B1 is 3-3/8",, =
above is based upon building Minimum bearing length for B2 is 1-1/2".
ode-accepted design properties Entered/Displayed Horizontal Span Length(s)=Clear Span+1/2 min.end bearing+1/2 intermediate bearing
and analysis methods. Installation
if BOISE engineered wood Connection Diagram
products must be in accordance Beams 7 inches wide will be assumed to be either top4oaded only,or equally loaded from each side
vith the current Installation Guide Bolts are assumed to be Grade 5 or higher.
ind the applicable building codes. Member has no side loads. .
o obtain an Installation Guide or if
ou have any questions,please call Connectors are:112 in.Staggered Through Bolt
800)232-0788 before beginning
►roduct installation. a=2„ b d
=
3C CALC®,BC FRAMER® b 2-1/2"
,SCIG, _i
3C RIM BOARD-,BC OSB RIM c=5-1/2"
30ARDTM,BOISE GLULAMTM, d=24' a _
/ERSA-LAM®,VERSA-RIM®,
/ERSA-RIM PLUS®, \
/ERSA STRANDTM y \
/ERSA-STUD®,ALLJOISTO and C
WSTM are trademarks of
3oise Cascade Corporation. \/�
'age 1 of 1
v �x
Daniel E. Braman, P.E.
C,o �L6�.t �pG�.� �Qt\l� 189 Harbor Point Rd
rC wmsoq" MA 02637-0361
C a tsZ
DEstr,"
coop
'Ft--c�V. - 'D•L, t p s t,a 4O
Q cm.,ofir ^ V •1... (rj s L .L.0 30 �s
a {o �s
�P.�.,►.3 �.'Z.t
1IV (o
t�`�,,;• fie,` �L�,e-,c2�
wQ,L, s l�xt2 t tt>>c.to -t tSxb
a tao t tod + mc, k do toy wt 51: 5P-'� .
t.s L.L- a sa 2(m k.-Oro9o<. Jc--3� rc'1
---� USE w to x 4 5
L
Fc-e--Ct V14 s . ,#,\,-V k 4A43&Q-S E.vJ,
4ex"a"cq`s,`cs"S car
�} OF
d►1,1i�QM.Sltat�S t tAg���
t - ®� �IANIEL E.
� oV2 Trett� �5 e tv► ® BRAMAN ,
. ® v STRUCTURAL
® NO.M95
vwv
^ -off
RAMSBEAM V2 . 0 - Gravity Beam Design
%icensed• to': Dan Braman, P.E. ,
Job: 216 Glen Eagle Dr. Centerville Steel -Code: AISC 9th Ed.
SPAN INFORMATION:
Beam Size (User Selected) = WlOX45 Fy = 36. 0 ksi
Total Beam Length (ft) = 22 . 00
Top Flange Braced By Decking
LOADS: Self Weight = 0 . 045 k/ft
Line Loads (k/ft) :
Distl Dist2 DLl DL2 Pre DL1 Pre DL2 LL1 LL2
0. 00 22. 00 0. 595 0. 595 0. 000 0 . 000 0. 810 0. 810
SHEAR: Max V (kips) = 15. 95 fv (ksi) = 4 . 51 Fv = 14 . 40
MOMENTS:
Span Cond Moment @ Lb Cb Tension Flange Comp Flange
kip-ft ft ft fb Fb fb Fb
Center Max + 87 . 7 11. 0 0 . 0 1. 00 21 . 44 24 . 00 21. 44 24 . 00
Controlling 87 . 7 11. 0 0. 0 1. 00 21. 44 24 . 00 --- ---
REACTIONS (kips) : Left Right
DL reaction 7 . 04 7 . 04
Max + LL reaction 8 . 91 8 . 91
Max + total reaction 15. 95 15. 95
DEFLECTIONS:
Dead load (in) at 11. 00 ft = -0. 469 L/D = 563
Live load (in) at 11 . 00 ft = -0. 594 L/D = 445
Total load (in) at 11. 00 ft = -1 . 063 L/D = 248
. .. �. .;
Lm
RA,t- -G
_1-�=�•- �B� �1��-���,II�I:.all,� ��U:. :���I 0�1�:�_d. Il �•� I 1( �.�(=�11:��(��� � 01i � 11 ,1
FIB
�- TTII _ I I LI I-J I L
— � I
91&}I-(' i E-cc c�
vA7-1ti1 ----- �EA2 L,;myA-T'!en? _
� I � � __ r J I _ 1 •
I L
L I J Ll . 0 1 .
PI
Li. ---r�
T7 0,J
—----_
iVA�tI
_-
:
.SCALE
- ..
.[t.MI.
FMIH FTR
/,r ORAWN HY�I%Y
�.REYISEO rTo
�.
—
III
y ; .
ti < ,
III
ESQ{is r
i . i
rp
J:
P
'
k f 4
{
t I'.
SL
77
Nl-
i i to ma ;s r~—
i k
•c .
0� ��-
E
j'
y-O y 3 P'
Nmti
:ck�
i � z
91
d
0
- - - -
- t:.:
�f.
1
• r
r
'' i``. --.{� � t ' t '< `� ',• s .;, ? , i .�:; 4- off, r (
�? l
, t �
1 42
-
,r
•
5
..�f20wdT tixPgS Jr "'I -
limp
i'
1boom ,
) � z
>e E fi W lot Ws I bra i6i 2asua '< i
Fill
O
-
1,
Y:
tt
r G,�
t
v> S G e is
Z
E12.
�( A!
i � `:. GSsr{ 77.U6 o1:X8 1
t
TD R l
, *. t
K:
" +jtj -,
"Miami wavy
v m
ram, O { C s 3
4 r - r
:t.':• � � -
s,� o (1
t i� •i. �< Fl
pan maw
,o
fin,
R! �y
.. a 0.
0
w : -
C 'i
r '
7/
ih
r
.o,
to
"t 4 .
' i In
%9 N J 1 Z ti
a
_ Z40.S.—V I CERTIFY THAT THIS PLAN SHOWS
THE 'ACTUAL LOCATION OF THE
STRUCTURE ON THE LAND AND
THAT IT CONFORMS WIT►-! THE
BYLAWS OF THE TOWN
1 �L
o �
PLAW OF LANES
1 t�
CA/y TAR v/< 4�- MA!E
�s. OWNIZO 9C
_ OF
OF M��sT �,-cr M,jSs�� ,q
R 6 ,4 iRANq G: Z FRANK FRANK CONERY 5 VREN l Ot4 ;A .
H CONERY
CONERY
No, 6232 p No
fi573,�0 Q HYANNIS. MASS. U21Ot
�c*C ��oa � MmmTwwo aroaama a LA"a SupVEvrsR
4N1
Si1it`+�'� �FSSlONA�F'�6 SCALE t IN -H2O F T. ./u �c/ ��7•
(14
4