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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
aim P �
Map Parcel Y•Application* # v
Health Division 'Date Issued
4y i
Conservation Division :Application Fee '
Planning'Dept: Permit Fee
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation/ Hyannis
Project Street Address SW 13 M A;54 s
Village Cr7-7E' -
Owner C L L-C. /c991_-t . Address 70 iV*// S'-° M"is
d��
Telephone
9 /
Permit Request &eA1®t1*r10 vs 7-0 Ale-,,Ls r�Kft�i
.a
Square feet: 1 st floor: existing proposed ;2nd floor: existing proposed _ TO
Zoning District Flood Plain Groundwater.Overlay '
Project Valuation %doyo Construction Type WWI'
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting do'�umefltation.
Dwelling Type: Single Family 0 Two Family ❑ Multi-Family (# units)
Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: 0 Yes elNo
Basement Type: ❑ Full 5Crawl ❑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 J new
Total Room Count (not including baths): existing v2 new First Floor Room Count
Heat Type and Fuel: Q°Gas ❑ Oil ❑ Electric ❑ Other
Central Air: ❑Yes O o Fireplaces: Existing-6 _New^0' Existing wood/coal stove: ❑Yes ®'No
Detached garage: ❑ existing U 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#
Proposed-Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name Me4e-cerz Telephone Number 7.-
Address A SSA eI2-vllle &1/-e, License # ZaElp
S Ctz�t lie M 04/13 Home Improvement Contractor# /',,, f Z 99
Worker's Compensation # Wersn�pDS¢6.Du&
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO -_ �uPS� /
SIGNATURE DATEX le%
4
e
' FOR OFFICIAL USE ONLY
APPLICATION#
F
DATE ISSUED
MAP/PARCEL NO.
,+y ADDRESS VILLAGE
"a OWNER
DATE OF INSPECTION:
FOUNDATION w
x
j
FRAME 16 lol D OQ 9 o i
r
INSULATION Qo�t�o5
FIREPLACE
} ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
s
GAS: ROUGH FINAL
FINAL BUILDING ��--
' DATE CLOSED OUT
ASSOCIATION PLAN NO.
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 LeL-ibly
N=C(Business/Organization/Individual): A/I 5'e v5-q t/5 Adore_ /Zc'-.r"010 e I/,4/6
Address: ;>6 9 So I lie- five?:
City/State/Zip: .�ex ef�ie j to , Wr,4 ��/I3 Phone.#: �?� 7' ta��` 23 7S
Are an employer?Check the appropriate box:. Type of project(required):
1.KI am a employer with .1_ 1.4. ❑ 1 am a general contractor and 1 6. ❑N w construction
employees (full and/or part.tim.e).* have hired the sub-contractors
..2.0 I am a'sole proprietor or'partner-' listed on the attached sheet. T. : Remodeling
shipand have no employees These sub-contractors have g, ❑ Demolition
P employees and have workers'
working for me in any capacity. 9. ❑Building addition
[No workers'-comp.•insurance comp. insurance.
required.] 5, ❑ We are a corporation and its 10.❑Electrical repairs or additions
exercised.their additions
officers havePlumb repairs or
3.❑ I am a homeowner doing all work11 ❑ g p .
myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs
insurance required.].1 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 scction below showing their workers'compensation policy'infomration.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
XContractors 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.
lam an employer that isproviding workers'compensation insurance for my employees Below is thepolicy andjob site
information.
Insurance Company Name: 45'f04iY`e.Q j C9 eAf �.
Policy#or Self-ins.Lic.#: LI/t SDt7 /;,60 Expiration Date: b /1
C
Job Site Address: /'�lf�I/✓ ST. 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 crimiriaJ 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
Ida hereby certify under the pain and penalties ofperjury that the information provided7,?
ve l true and correct
Si afore: Date: ' D —
Phone#• t!B _A�
Official_use only. Do not write in this area, to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health '2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person': Phone#:
Information and Insttuctions _.
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute,an employee is defined as "...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the
receiver or tiustee of an individual,partnership, association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or local Iicensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced-acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7) states`Neither the commonwealth nor any of its political subdivisions shall .
enter into any contract for.the performance of public work unto acceptable evidence of compliance vsZth 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-contcactor(s)name(s),address(es)and.phone number(s) along with their certificate(s)of
insurance. Limited Liability Companies.(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure.to fill in the permit/license number-which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address" the applicant should write"all locations in (city or
town).".A copy of the affidavit.that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or eitizen is obtaining a license or permit not related fo any business or commercial venture
(i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to,thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone-and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of In Vestigatians,
600 Washington Street
Boston, MA 02111
Tel. #617-727-4900 ext 406 or 1-877-MASSAFE
Fax # 617-727-7749
Revised 11-22-06 www.mass..gov/dia
._ . ENERGY CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR
ONE, ADD TWO-FAMILY DETACHED RESIDENTIAL-CONSTRUCTION (780 CMR 61.00)
Applicant Name: GA&I Site Address: ng-
Pr1rd Town:
Applicant Phone: 6/ 7- 6 R-41*3 76—
Applicant Signature: Date of Application: PA/d"y
NEW CONSTRUCTION:' choose ONE of the following twwo tions
780 CMR TABLE 6107.1
PRESCRIPTIVE ENYJELOPE COMTONENT CRITERIA FOR
NEW ONE- AND TWO-FAMILY BUILDINGS
MAXIMUM •MINIMUM
Ceiling or Basement Slab
❑ Option 1: Fenestration exposed Wall Floor Perimeter
U-factor floors' R Value R-Value wall R-Value R-Value '� HSPF SEEI
R-Value and Depth
National Appliance-Encrgy
R-10, ConscrYation Act(NAECA)of
3 5 R-3 8 R-19 R=19 R-10
4 ft.• 1997 as amcndcd,minimums or
, T * caicr es a licable
Note: This form is not required if you choose either of the two versions of REScheck as listed below.
❑ Option 2: RES check Version 4.1.2 or later variant software analysis must be completed
780 CMR 6107.3.2
REScheck—Web which can be accessed at http•//www.tnergycodes.goy/rncht rk/
ADDXaT :ORAL T ZAIXONS.`I'OEXISTING BUILD TNGS.OVER5YEARSOLD*
`-*)3uildings under 5 years old must use option#1 or#2 in New Construction section above.
(--Complete-tI1Ffollowirfg_formula'fo determine.the`�%�"oI='glazuig:
(a) Gross Wall & Ceiling Area equals Formula: (100 x b_ a)
SF
100 x - _ %,of glazing
(b) Glazing area equals SF 6 a
If •lazin isi<-40%.u9e the chart below. If Iazing is > 40 %prQce6d to "SUNROOM" section
780 CMR TABLE 6101.3
PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTING
LOW-RISE RESIDENTIAL BUILDINGS
MAXIMUM ATM
Ceiling and Slab Perimeter
Fenestration -
wall Floor Basement Wall R-Value
�-; Exposed floors
U-factor R-Valua R-value R-Value and Depth
.39 R-37 a R-19 R-10 R-10, 4 feet
a R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R-value over the entire ceiling
area(i.e. not compressed over exterior walls, and including any access openings).
'
SUNROOM—An addition or alteration to an existing building/dwelling unit where the total
glazing area of said addition exceeds 40% of the combined gross wall and ceiling area of the
addition.
Note: Owner to fill out Consumer Information Form found in Appendix 120T
Town of Barnstable
�^ Regulatory Services.
snxxsrAmE,
MAM Thomas F. Geiler,Director
'DTf1639.MA'I0. 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
If Using A Builder
X, CaA C� & , 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.
S-oi? 3. MAi�v VT ceivred-at lle- MA-
(Address of Job)
&ALL �
Signature of Owner Da
Print Name
If Property, Owner is-applying for permit please complete the .
Homeowners License Exemption Form on the re
...._..._,p._- F
Q:FORMS:OWNERPERMISSION
Town of Barnstable
o Regulatory Services
T
Thomas F.Geiler,Director
RAaxsrABLE,
HAS&
Building Division
TFn � Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
r
Office: 508-862-4038 N, Fax: 508-790-6230
` — HOMEOWNER LICENSE EXEMPTION
\ Please Print j
DATE:
JOB LOCATION: .
number street village
r
"HOMEOWNER":
name hb`e phone# work phone#
CURRENT MAILING ADDRESS:
city/town state zip code
The current exemption for"homeowners was extended to include owner-occupied dwellings of six units or less and
to allow homeowners to engage an individual for h e who does not possess a license,provided that the owner acts as
supervisor. \
}DEFI TION 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 t+�etched 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 erformed under e buildingpermit. (Section 109.1.1)
The undersigned"homeowner"assumes resp7nsibdity for compliance with the State Building Code and other
applicable codes,bylaws,rules and regulations.
The undersigned"homeowner"certifies thaflie/she u derstands the Town of Barnstable Building Department
minimum inspection procedures and requirements and at be/she will comply with said,procedures and
requirements. {
i
d
Signature of Homeowner
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubib.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 codstruction 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 ConstructionlSupervisors,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 full 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.
t
Q:\WPFILES\FORMS\homeexempt.DOC
The Commonwealth of Massachusetts William Francis Galvin-Public Browse and Search Page 1 of 2
�. The Commonwealth of Massachusetts'
William Francis Galvin
Secretary of the Commonwealth,Corporations Division
One Ashburton Place, 17th floor
= Boston MA 02108-1512
Telephone:(617)727-9640
PALAEMON, INC. Summary Screen
Help with this form
Request attCer�tlficate � ,-
The exact name of the Nonprofit Corporation: PALAEMON,INC.
Entity Type: Nonprofit Corporation
Identification Number: 000981823
Date of Organization in Massachusetts: 07/09/2008
Current Fiscal Month/Day:6 /30
The location of its principal office in Massachusetts:
No. and Street: 508 MAIN ST.
City or Town: CENTERVILLE State:MA Zip: 02632 Country:USA
If the business entity is organized wholly to do business outside Massachusetts,the location of that office:
No. and Street:
City or Town: State:. Zip: Country:
The name and address of the Resident Agent:
Name: UNKNOWN
No. and Street, NONE u
City or Town: NONE Stater MA Zip: 00000 Country:USA
The officers and all of the directors of the corporation:
Title Individual Name Address(no PO Box) Expiration
First,Middle,Last,Suffix Address,City or Town,State,Zip Code of Term
PRESIDENT JAMES R.O'CONNELL 508 MAIN ST.
CENTERVILLE,MA 02632 USA
TREASURER JENNIFER L.MAIOCCA 508 MAIN ST.
CENTERVILLE,MA 02632 USA
CLERK JENNIFER L.MAIOCCA 508 MAIN ST.
.,y
CENTERVILLE,MA 02632 USA
DIRECTOR JAMES R.O'CONNELL 508 MAIN ST.
CENTERVILLE,MA 02632 USA
DIRECTOR JENNIFER L.MAIOCCA 508 MAIN ST.
CENTERVILLE,MA 02632 USA
http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.asp?ReadFromDB=True... 6/10/2009
TOWN OF BAIRIMISTABLE
21 51 JUL 27 PM 1' 47
DIVISION
septic tank is required, however the discharge line going to it shall be visually checked at the
Carriage House to ensure the comiections are sounded and sealed_ After visually inspection if any
damage is found this is additional cost to the client.
Owner: ,� Contractor:
cas0ns laome emoctenn
Gary S. Mercer.President Tel:(617)628-2375
369 Somerville Ave Fccc:(6171
Somerville,MA 02143 628-3105
�vv- 9-1'1'Aggsomat-19M0-1a oq L_c rn
All work to be done to city and state codes. Price includes all labor and matel•ials except for all
appliances_ (other than gas fired domestic hot water and heating appliances). Any electrical service
upgrade will be an extra.charge to the client if needed. As design installation shall support the future
addition of air conditioning, without further upgrade being required. All plumbing, and sewer
systems are to be checked for appropriate use. Hard wiring for computers, phones and plenty of
electrical outlets are to be added: At this time no redesign of the existing shared 508 and 508B
septic tank is required, however the discharge line going to it shall be visually checked at the
Carriage house to ensure the connections are sounded and sealed. After visually inspection if any
damage is found this is additional cost to the client.
Contractor Owner:
All Seasons Rome Remodeling TJLC LLC/John Menzies
369 Somerville Ave. C/O P.O. Box 1223
Somerville,Ma, 021.43 70 Wall Street
Madison CT. 06443
Page 8 of 9
6 /6 # OU906L809 1Z :60:60-tip-LO
RE: 508E Main St Centerville
To whom it may concern,
We run a non-profit residential program for young adults living with learning disabilities. The
purpose of the said renovation is to house up to 2 young adults so they may attend our
program. We are committed to teaching this population and guiding them towards an
independent life.
Please call with any questions/concerns.
James&Jennifer O'Connell
1-774-289-1182
fM4 W
44
Ir-
a =
i�
Fir �
4lif
� �
3
r .: awe
c
� ,per hyy
{�.
Y+a £
#vY rs,'�s{
- .. g �ar •3.. 1R�3. ` � i
A
and day us h License or registration valid for indiVieul use only
I Boart(of B 1Idmg Regulations
tiOME.IMPROVEMENT CONTRACTOR before tlic expiration date. If found return to:
ti` Board of Building Regulations and Standards
Regxc trat n 1274/2009 Tr#; 261854,` # n tAshburton Place Rm 1301
125399-
O
i E�p �
Boston,A9a.'02108
}a " TYpe DBA
All Seasons Horn6T modelir t
x
L= j�
GARY;MERCEP
3�9 e Aver
Som rville / � "`Q'
�/ ot valid v t signature
i itho❑
SOPAERVILL(=,MA 02143 Y
r
Board of Biulding Regulatio sand Standards
r�
° Construction Supervisor License
I sY
License CS 70529
�1 Tt# 12957
Expiration 1/3112010 ;t 1
x i Restriction
t GARMERCERS' y r/r T
I 369 SOMERVILLE AUE yf/
Commissioner
SOMERVILLE,MA 02143-'
A CORD DATE(MMIDDNYYY)
,M CERTIFICATE OF LIABILITY INSURANCE 07/13/2009
PRODU fER (781)344-3200 FAX (781)344-1425 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Malcolm & Parsons Ins. Agcy. Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
6 Freeman St. HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P.O. Box 527
Stoughton, MA 02072 INSURERS AFFORDING COVERAGE NAIC#
INSURED Gary Mercer INSURERA: Associated Employers Insurance
DBA: All Seasons Home Remodeling INSURER B:
369 Somerville Ave INSURER C:
Somerville, MA 02143-2914 INSURERD:
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.
INSR ADD*L LTRINSIRTYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION QA LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $
CLAIMS MADE ❑OCCUR MED EXP(Any one person) $
PERSONAL&ADV INJURY $
GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $
POLICY PRO JECT LOG
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT -
$
ANY AUTO (Ea accident)
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per person) $
HIRED AUTOS BODILY INJURY
NON-OWNED AUTOS (Per accident) $ _
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
n AUTO ONLY: AGG $
EXCESSIUMBRELLA LIABILITY - EACH OCCURRENCE $
OCCUR ❑CLAIMS MADE AGGREGATE $
DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND WCC5005464012009 06/17/2009 06/17/2010 X WG STATU- ER
EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ 500,000
A ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? E_L.DISEASE-EA EMPLOYEE,$ 500,000
s If yes,describe under
SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000
OTHER - ..
DESCRIPTION OF OPERATIQNS I LOCPTIONS I VEHICLES I EXCLUSION§ADDED BY ENDORSEMENT/SPECIAL PROVISIONS -
Contractor, residential remodeling projects
Gary Mercer is not covered by the Workers 'Compensation policy
1.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL
John MenZ i s DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
1903 North Mohawk Street BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
Unit B OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES.
Chicago, IL 60614 AUTHORIZED REPRESENTATIVE
David Parsons
ACORD 25(2001/08) FAX: (617)628-3105 OACORD CORPORATION 1988
SMOKE DETECTORS REVIEWED
a
' aH•W.x br D. B'-1 1/2' s'-,1n" , ' 7
REMOVE EXIST.WINDOW- D '
r
RE-FRAME TO INSTALL REMOVE EXIST.DOOR
jam;`E T B UILDI DEPT. DATE
I NEW DOOR PATCH TO MATCH EXIST.
9 1R'T'P.J OTEMP. N
a
a a < Tq'4RU, E DEPARTMENT DATE �-.
•p UP,4R o l-9/4• U
FIR
' 00
SIGNATURES ARE REQUIRED FOR PERMITTING
T$' - -
4— 1l:. O 5'E O 3 X 6 RAFTBZ.0 16'O.O.RYPJ
36'x 96'F.G. ALIGN m _ F 2 X b MF'RAF'(ER
REF. I '0' --_ y - ... _ °
T'PJ
LNFTI CABIN Q 4 4 C-
Q
12 IN
m 5TRUCT.WOOD v
F
OOff(^(I f yyWyWy� L34•MLXB4'L. � WH �' ~ m U1m ___-_ _I-1 VANRY -
ry C O COUNT732 a o O p, �1 R - I I O --m BRACKET
o�asr Dom ' < m Bedroos c'- Bath !! R BELOW(rrn.) —oxRa^FASCIA Ertw �.
m
A --_—_ TEMP.bLAY' I-O �---- 4)—
REPLACE ---- i_I "_� (� Om n s'-a• 0
SHOWER OQ'JRI fe OF WNDOW BElOV/ O
A.3 —----- -- `z-v 12 H Typ.Roof Framing @ Entrances
EXIST.DOOR o ; I. - r CCOF
5 I WlNppy
�B+ Bath In - - CI.I , BELOw q
• r ,I. -p I o t: o SCALE:va„n 1,-p,.
F REPLACE m in - 2'-0• %"x 56•F.b. ..
m ,
' EX6T.DOOR •0 i j SHOWER • n
� LIN. it I I ....,,...... .... �__..... �
'A'YL z 19'D. C•
' O I UNION FEDE5TAL SINK
!LINEN GARNET !RRant -E !REPLACE TE 61
Dom
L 0
E.5T EXIST EXIST.
1. 5 '.,' LEGEND WINDOW SCHEDULE x
1H'-9'./- WINDOW MANUFAGT. MODEL
MkND01'i ROUGH OPENNb WINDC4N TEMP. _
(EXIT.) EwST.WALL TO RB4AM --. MARK INC'. TYPE (W x N) CiIANTTY 6LA56
• _ 400 SERIES,VINYL EMERIOR.NIGH P02FORMANCE
�_. •..-----.-- NEW 3 X 4 STUD WALL Y 16"OL. ^ LOW-E4 GLASS,PROVIDE E+cTBiSION-IAMBS IF
F1 Ate `'N TYV244Y DOUBLE HUNG YES 1/B"x 4'-4,/H° 8 3 LOCATIONS RB=.,,/5'5DL.GRILLES•NEECT SCREE". �1
First Floor Plan Second Floor Plan unuTYArovinbSEE PA5 NPRDYWRE SELECTED Sr OYQ et,EX ER OR
SCALE: 114"=1'-01, DOLOR-xe1rtE
SCALE: 1/4"=1'-0" 400 BERES.—L EKTBZ .NIGH PERFORMANCE
- - . _ LOW-E4 GLASS.PROVIDE FJC11_-T'SION JAMBS IF `p A C \ -
ANOBLEN AYt252 AWNING 2'-4,/H'x r4l/B' S NO RE13D.,l/B'5DL GRILLES,PISECT SCREENS, r^
NOTE: - # HARDWARE SELECTED BY OWNEREXTERIOR
COLOR-WH,TE �..
PROV T 92•W.X bb•L.INSULATED,TE ACCEY Q
PANEL TO CRAWL SPACE.C�RORu.TE LOCATION /
(RN OWN62 - O ,.•1 I�
` 1H•-5'./- ,-1/2'./-OA. ,B'�'./- ,-lY1"./-O.H. ' _ b" I O.H. 16'-11"
EXIST.) MATCH EXIST. (mX T.) MATCH EXIST. MATCH EXIST, MATCH EXIST.
' S'-,11/r 13'-91/2" ., 4-,1/2' } 4-1 1/r � B'-51/2" B'-9,/2'
• 0 W ._. ,
W Zj,O!10� 3 x 6 LOOK-OUr
tY j 13 0 16'O.C.fTYPJ - • 12 ! 12
• - -(x B D TO MTL.JOIST Q � MATCH EXIST.RAKE BPS. MATCH EXIST RAKE BDS. 4 < 00
\\ (RIPPED TO 51� NANbEFtS(IYPJ - = Z _ MATCH EXIST-RAKE BD5 - =MATCH EM5T RAKE BIDS,
16'OL. 6 CROPP.MLD6. <CROMi MLV6. Z <CROYWi MLDG. 7
m I mO I / I • m II BLOCCK�OLID DOWN 12)2xI1 _ C•`4 x i POST FROM UNpER-
SIDE OF RIDGE BEAM
_ ! , " -- TO FOUNDATION(TYPJ I DOWN TO HEADCR I I !
r x r •
(211-9/4'x41/4' I I I _______ O 2 x 8(RIPPED TO SIZE) U ( 1.9E LVL NEADBi I V _ III' _ --__
_________ ___________ ___________
I 3
- -----L------------I----------
` ^ ® --
m J{l
' I I—_____ ! _ m - ^m
. N „
ZN m______01
R - - U� 2 x/Y FDGB2 v I x 13 LEDGER I� U
I� - R NI I� !I ' - N N/ IL••iri�
I
A �_ - I m Ka I ' _ I I _
A.3 'rI'--- s I �, 1�I`; .'t A.3 p ! o ----- xI m ---- "Is-- �. ^'
r _ _ Q
x x
of AID X �I (2/,-9,4"x4„4• ---
m I - LVL NEADB2 l yl r-• w
m ------ ----'--
!I4x 4P05T. I 4 x4 POSTFROM UNDBt- _
OI "________ I IBLCGK 50Lm DOWW •� SIDE OF RIDGE@FAIN � h
N _ ^
1TOFOUNDATIONT I -DOYPI(O:2X 10 '' ___ _ ____ __ I F
'___________ iL—(m 21 ,ol�• (3�xloh I 1312x10 (�j2x to
_ o J
--I FL_J __L _J_-1__L_J__1__I MATCH EIST.RANI \ • -- I m � O �.� a .
. EXIST.RAKE BDS. E%6T.RAKE BDS. Uf L 2: CD 0 r
O <CROWH MLD'6.TO REMAIN CROI'gl MLD'6.TO REMAN q BDS. kMATC11 EXIST.RAKE BDS. O �O
WW a CROYP!MlD'b. CROIg1 MLD"' PPPWLLL
�1012
10� EXIST.LOOK-0UT ; Q4./- 4./-p w ,
Q a , 12 tY TO REMAIN
(EX15 r/_ 4-,1/3• 4-1 1/1' - Z H'-ri l/2' H'-5 1/2' ^ a
' (EXIST) •^�
MATCH EXIST. (EXIST.) MATCH EXIST. MATCH EXIST. MATCH EXIST. �F••i••'ll _
^mi�l •l�j I
Second Floor Framing Plan Lower Roof Framing Plan Upper Roof Framing Plan Z
P
SCALE: 1/4"=1'-0" SCALE: 1/4"=1'-0" SCALE: 1/4"=1'-0" ' o u
e - +'•
ICONTRACTOR SHALL REMOVE EXIST. _" .A.I
GABLE END WAl:c TO RBHAN.
N
0
A
' � a
CONT.RIDGE VEM • O ,
CONi.RDGE VENT
12 12 MATCH EMST.CROYPI
4♦/-t- Q 4./- RAKE BD.CrYj ICE I F�!ELD
Yl^J.L 1H'MIN,(TYP.) •�30 YEAR ASPHALT ROOF SHINGLES
v.
ILE 4 WATER SHIELD SELECTED BY OWN9t OJER
. OVB2 ROOF• S'-0•YVmC-STRIP
._. - ICE WATER SHiFi n OVER ENME • • _.
T.O.P. WALL 1B'MM.r1Yrr P.) ICE 4 YVAT6i SMIFID SHED ROOF_._ O EAVE$ -
EX6T.FaiP.c BD. 1%b CORNER BDS.(IYPJ
TO RBHAIN -- - CEDAR CLAP 5D5.rtY.) _-1___
EXET.CORNICE -- MATCH EXIST.EXP05UREJ L.G.G.FLA_MM6 frYPJ �..y.
4 - _ CEDAR CLAP Bm.rtYP)
TO REMAM r q _ t x 6 GORNCR Bps.ril'P.) • { ' THATCH EXIST.EXPOSURE) V _
T.O.P ;0 YEAR ASHPALT .
Y- .(✓a Knee Wall - LADE __ -- - -_-_ __ ROOF SNIN6LE5
(BX) __ �• _EXBT.---. EXIST.RAKE BOS.< MATCH Ex ST. -_- SELECTED BY O ER
LROYU�MLp'G.
FASCAA eos. e B e T.O.P.Q iCace wall
TO
REMAM (Exist)
h Sub Boom Second Floor
-174 4-r--12 ICE.WATml sHm.D 50 YEAR ASPHALT .
—_ 0162 ROOF s UP ROOF SHNGLES t2
(ExI6L) I'=- WALL 15"MN.rrYP.) 5E `rw BY OWNBi 4 p 12 - -
1 xTRIM W- —_-- _- a a Sub_Boor C1;Second Floor tv
EXEiT.CLAP BDS. _ ._._._ _._
_ L.C.G.FLASHING rTYP.J
_ MATCH EMT. --
EXIST.CLAP 5D5. II - 90 YEAR ASHFALT CROYU4 ML176. _ _---- f ---- MATCH EMST. - �1
\ - _-- GROWN MLD'G.
' TO RB-1AR1 - - ROOF SHMGLS 1 x TRM BD.
Li-jr
� SF.L.ELTED 1 x TRIM BD. O ,�
STRIIGTIRAL WO.TJ - MATCH EMST.CROM MLD6. BRACKET --_ _
TURAL YIOOD-�
BRFGKET frYP.J - —-' RYP.J _- `-BRACKET frYPD -
) V
. MATCH.EXIST MATCH.EX rr--��' iK
� TRM BD5.(IYPJ _ i`nrI tr ^y
EXST.CORNER BD5 _ iRIM BDS.(TYPJ N �r
•' TO REMAIN(lYP/ A I t A EXBT.CORNER Bps. —_---_rr
To MATCH EXBT.LANDMG 0
Fla.@First Floor —REPLACE -- RFMAM YPJ _— A A .
REP KE- _
(Exist.) __ 'EXLaT. --Mx T. rO REMAM fTYPG.) - -' _ E--- Fin.(al._First FtOar
M-T
1 - (Exist.) -------- -
• 2/8 x b/B POOR -
SEI J C Y OYplgt c
REPL.ALE EXBT. i
PATCH TO MATCH EXIST.
Front Elevation Right Side Elevation
a�
.SCALE: 1/4" SCALE: 1/4"=1'-0"
4-
con
Ir oPaA .J
i.
A 3
CANT.RXG Vp C4NT.RIDGE VENT _
WATER SHIELD
O • " 12 12 Q ATGH EX T.CROYOI e
... - .. 90 YEAR ASPHALT ROOF SNIN6LE5 ROOF x tP 4./-p fTYPJ AID Q4./- R BD.(tYPJ
SELECTED BY OYMJB2 OVER Y'NLL 1H'MM.
' ICE x WATER SHED ROOF--n OVB2 E1JTa2E s'-0'YE STR - ICE 4 WATER SHELD
TAP. �� ICE x WA'®TER SHIP ED ' G- OVER ROOF e-
_ - - O EAVES TOP ____ WALL 15"MIN.ffYj '
CEDAR B C
GLAD.E 5UPJ E-T.FR BD. 1 x b C siC BD5.(lypJ y.J
C
MATCH EXIST.EXPOSURE) ,i. TO REMAIN
90 YEAR._..PALT - , _ __ LG.G.FLASHM6(tYP.) EDAR LAP DS.rfYP.) �LJ
ROOF SHM6LE5 I ` Exi T.CORNICE (MATCH EXIST.EKPOSNiE)
.. 1 x b LORNBi BDS.rtYPJ TO SELC-LTED � �
LzL.FLASHMG rrYPJ 1�'r'
Q - T.O.P.Q¢Knee wall_._. _ r TexjET. .O._P.@ Kncewal] .TH./P. -REPLACE—(Exist) -- B B B B HA A BDS. ; (E ) _.___ EXEiT. F T.RAKE Bps.4 .
I GROI•PI MLD'6.
.. p .- - TO REMAtN y -
fI Sab}lour q Second Floor 4 L-T 12 90 YEAR ASPPALTF_I2 ij -_-—
____ _ _ ROOF`�INGLES n Sub_lloor Second Flaar ICE a WAtgx sH�j.p
(P usL) EXST.CLAP BDs._ d'4 SELECTEP BY OYPIBi _�._.__._._._ --�4�—�41 O�JBZtROOF<n PJ (V
_._TO REMAM (Exist)
C A EX6T. - 1 x T BD. - __ - In
GRggt MLD'6. MAC MQST. _ - LG.G.FLASNM6 r1YPJ N
1 x TRM BD. M� rT,ET
I TRM BD, To K GLAD BDS. _ 90 YEAR ASPPALT w
p 5TRUGTIRAL WOOD -- TO RB4PJN ---- _ _ _ _ 5ELP 5HM6LE5 ^ T/1
• BRACKET rrYPJ S 'M rr WOOD . m - _ - SELECTED BY GWOIB2 y
Q - -- J 9 5TR11CTU YVg7p MATCH BAST.CROY'M MLD6.
MATL
-- R BRAL rr Pj O .r
Dart /�T MATCH. >MATCH Er�T.LANDING T1iIM Bd.(TYPJ EX T-; _ M.sm-r1YP-)
DOST.CORNER BDr'.
A __ EYcST.CANNER BDS. ----
A TO REMAM rTYPJ TO REMAM fTW.) �
Fin. -F- Floor -.Mp,E_—. - A .•.y �N
_-REPLACE T.LAN N& Fin.Q First Floor
(Exi6t.) EXIST. EMST. - TO REMAIN rTYPJ - (Exist) ---�T.-
J - `wb x b/H DCYJR O N
SELECTED BY OY'P162
EP �I
RLACE By W
PATCH TO MATCH OasT-
Left Side Elevation Rear Elevation A
SCALE: 1/4" SCALE; 1/4"=1'-0" o O
CONiRAGTOR BHALL SCRAPE FLAKIN6 PAMT.P < W •,
SELECtFD BY
APPLY 2 SY OYEMlg2 GRADE AINT.DOLOR ' 2W ^ 00 PIER. �
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LVLRIDGE BEAM .• SHIN6LE5 _
ILE t WATER SHIELD OVBt
'BYRE SHED ROOF
S/H'LDX PLYWD SHEATHING
2 x 10 RAFTERS o IV O.G.
. - R-50L F.6.BATT INSUL.
1xS FURRING o 16"O.G.
.. _
. 2"CANT.AIR BAFFIF T•P.) 1/2'6YP.BD.LA SMOOTH
w�'L
SKIM GOAT PLASTER
_ - AWM GRIP EWiE T'P.) V+••,/ ����,
+ir GBLN6 CON5IRUGTION - �I O =' 1 .?
T.O.P. ____ ] H LLb.A5T5 0 16'O L MATCH EK15T.FASGA SM.T'P.)
11._. ._._._______._._. _
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_ tx3 FURRNG o 16'O.G. LONE.SOFFIT VBlT ITYP.) - .••I \
6YP.W.W/SMOOIN ?i•1
SKM GOAT PLASTER I HURRILMQ TI6 o EA _ O S t
RAFTER(TYP.)
. LG.C.FLASHNG rlYP.) 1f')
SCABBED-ON ROOF
q Bedroom Bath WNSTRucnoN
T.O.P_Q Knee wall WALL GONSTRIIGTION - 5HIN6LE5SO �PHAL .
._.__ CEDAR CLAP BDs. - MT.Wi1J_GONST. ICE C Y/ATER SHIELD O/ER a .. - _ ,
ti
(MATCH EXIST.E OEIRE/ • 1/2'GYP.BD.W/SMOOTH IJP WALL 18"MIN.
AIR NmTRATION SARRE3R SKIMLAOT PLASTBi 5/H'COX PLYWD 5HEATHING
- V2'CAX PLYWD.SHEATHNG EA 507E OF 2 x 4 5TVD5 2 x 10 RAFTERS o Ib'O.G.
0 IW O.G.W/BOUND
2 X 4 STVD�0 16'O.G. - - 00
- Q R-13 F.G.GATT IN511L ATTENUATION 1115UL W
1/7 GYP.W.W/SMOOTH Ix SOFFIT BD.(TYP.)
5KMCOAT PLASTER
_ Sub f)OOI Q SCCOnd Floor EMST.FRIEZE W.TO REMAIN v I
r�
FLOOR CONSTRUCTION -
BY OR FINISH SELEGTi7J
EXIST
SEA w
EXIST.SH iA T TO R EMM
. TRUE 2 x i JOISTS TO RERAN
55TB2-5(RIPPED TO SIZE)
TO EWST.JOISTS
_ R-SO F.G.BATT INSUL
1X5 FURRING a IV O.G.
1/2"GYP.BD.W/SMOOTH rV/11
SKIMGOAT PLASTER O R0'LAGE • - r
EXs Parlor Bath A EXST.
- - NT.WALL GONST. I• �✓ O
. 1 SK C OTB P5TER EA BVEOF EX .E5MT
GI
W SOUND ATTENUATION
fH x y
U1
. - NSUV.TION - WALL LONSTRLK.TICN -
. ' INSTALLNEW FLOOR FINISH EXIST.CLAP BD5.. �I O Q
(SELECTED BY SHEATHING
Or-BR) .WOOD N
SASE
B400 F'!P STUDS TO REMAIN. \'
DVH2 EKf5TN6 SHEATHNG INSTALL R-1B F.6.
AND FLOOR FRAMN6
BAIT INSUL a
Fin.Q First Floor G9 MO
OTH
'Ij�- KIMCAOT PLASTER
� / z is bA
fir, Gl.OSm LELL ICYNETIE Exist. Crawl Space � � - f •/�) O
SPRAYED INSUL. - "� OZ
. R•l PER NCH.MIN.5 INCHES
A Building Section o SCALE: 1/4"=1'-0" +••y o _
�i z i
L A.3
S
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