Loading...
HomeMy WebLinkAbout0114 LINCOLN ROAD J - _� - NJ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION e�fs(o97 Per o'ZL�-T #ribb� / Map O t .5 9�P'I-:k Parcel c o-rS ag t 3L I Application # Health Division Date Issued Conservation Division j7j Application Fee ' Planning Dept. Permit Fee Iry Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 1 I 'i L I1g co&r_1 iZoAD Village 1--�Y A-rF N I S Owner_I-our5 -t- bouN/k A-a-t r Lv A- Address IyL-w i.K eSr1iEno it 1-7r"Li yC: Telephone 50&- �;Lg ,3L- 1 S' Lv FAT i/,Aszrt�u�r wtA 0_Z(-'7 3 Permit Request Qc,_,2Ia.cc w;�,d�ws, syw�e new o,�r,��s s1+�+,tir� c�ror new mo r- ba+kcoam re-i4o✓,4e Z ba+h rooms -FIOOr��g Glt7S� n��ti� ; s�f�. ,�s�+ awtd driliWa j -p —1V yw 5 JKAW i n r-e�adP i� a�a.s ►�env h ea:4,�+� - �� pgA-+wt'F. r 15fLv"09 APO I S.*T+ , 4-5rtoArE PAVCZ645 Square feet: 1 st floor: existing i�proposed G 2nd floo • � g=�5oposed Total-new--0_ Zoning District Flood Plain Groundwater Overlay Project Valuation -50 coo ,- Construction Type WvOD rZ4af;-',D Lot Size 0,3k Ac_ees Grandfathered: ❑Yes M9 No If yes, attach supporting documentation. Dwelling Type: Single Family d Two Family ❑, Multi-Family (# units) Age of Existing Structure &5 Historic House: ❑Yes LB/No On Old King's Highway: ❑Yes 53/No Basement Type: Cd/Full W C;rawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) 9 t(,, Number of Baths: Full: existing 91 new I Half: existing new Number of Bedrooms: existing U new - Total Room Count (not including baths): existing (o new 0 First Floor R,-Ogm Count"" -r Heat Type and Fuel: ❑ Gas ZOil ❑ Electric ❑ Other Central Air: ❑Yes 5dNo Fireplaces: Existing New O Existing woo (coal stove: ❑`des dNo Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing--O nem size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing 51/new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes MIN If yes, site plan review# Current Use fi,51 DF44 i-i,+L- Proposed Use Qfi-N iTI AL- APPLICANT INFORMATION (BUILDER O HOMEOWNER) Name �.v�clS •r �• �lLi-�L1�- Telephone Numbee Address j va W i M(3L6 Din( D1Z 1 V C License# �✓rSr YAP-Pourµ , MA D,-b7 Home Improvement Contractor# Email Jame-liar. I1ie`7 e�o"n Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE � J _ DATE webGdIS' FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION G FIREPLACE - ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT °' ASSOCIATION PLAN NO. The Comww7twealth ofMassar-hurettr Department oflndustrial Accidents Office of Investigations 600 washhwon Street Boston,MA 02111 www.murs gov1&a Workers' Compensation Insurance Affidavit:Borders/ContractorsMecfricians(Plumbers Applicant Information Please Print Leaib�' Name(Business/oiganizaticn&dividm i): /..0q i_s a Address:-)t7 z W I•M 6L-"o"I -7 P 1 v(z City/StatdZip: ti -rt0 wru KA a z t,-13 Phone#: 5Dk- 311,)L- Are you an employer? Check the appropriate bon ' Type of project re p J (required): .1.El I am a employer with 4. �I am a�°�contractor and I employees(full and/or pair time).* have hired the sub-contractors 6. El New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. [► Remodeling ship and have no employees These sub-contractors have 8. []Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers'comp.insurance comp.instnance.t ❑ � ed] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3. I am a homeowner doing all work of have exercised their 11.❑Plumbing repass or additions myself [No wormers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' I3.❑ 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 indicatingsnclL that 1 Contractors at check this box mast attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employ=& If the sub-contractors have employees,they rm;t.pruYidc their workers'comp.policy amber. ' I am an employer thaf 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/StaWZip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required uader Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,50.0.00 and/or one-year imprisonment;as well as civil penalties in the fora 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 penabiey of perjury that the information provided above is true and correct Signature: � � Date -r&b Phone#: 5 0 k- 9� Official use only. Do not write in this area to be completed by city or town offzciaL City or Town: Permit/License# Authority circle one . I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: -Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. pursuaat-to this statute,an employee is defined as"_.every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the - - dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or oa the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicantwho 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 ofpublic work until acceptable evidence of compliance with the in su anCO. 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 certificates)of inc=ce. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to cant'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 ofinsirrance 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 lime. City or Town Officials f 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 BE 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 p olicy 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 fixture 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 hike 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 Commcmwealth of Massachusetts Depa-dment of lndustial Accidents Office of fnvestigativas Goo Washivoa Strut Boston,MA 02111 Td.#617-727-4900 c�xt 406 or 1--a77-MA.SSAFE Fax#617-727-7744 Revised 4-24-07 www,m=_gov1dia Town of Barnstable Regulatory Services -ME r, Richard V.Scali,Director Building Division 4 4 sanrrsT"M " Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 QED NtAt A www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION _ • Please Print JOB-LOG�ATION: ,J L)J��G dLll( (�LO number street v l� village "HOMEOWNER":_k,-0 -:s (R• � i� Sam s3 y-Rsgs ��s'r d�9d t6s� name home phone# c ,�vrerkphDnc# {,t STD T�a S ti"""`"w- CURRENT•MAlI.ING ADDRESS:_)0Z W"Iv-b)e,&cn_Dri ye Ca ss `!CC owe G�. city/town state lip node 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"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures d requiyr/ements and that he/she will comply with said procedures and requirements. Si o .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,RuIes &ReguIations for Licensing Construction Supervisors,Section 2.1S) 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 formlcertification for use in your community. Q:\WPFMES\FORMS\building permit formslEXPRESS.doc Revised 061313 � ETti Town of Barnstable Regulatory Services �RAMSTABLU, Richard V.Scali,Director Building Division Tom Perry,Building/�ommissioner 200 Main Street,Hy/annis,MA 02601 www.town.baVnstabIe.ma.us Office: 508-862-4038 Fax: 508-790-6230 Prope ina wner Must Complete agn This Section If UA Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work au rite bythis building permit application for. ( dress of b) ''''Pool fences and alarms are the respo ibility of the applicant. Pools are not to be filled or tilized before f ce is installed and all final inspections are perfo ed and accepte Signature of Owner Signature f Applicant Print Name Print Name Date Q TORMS:O WNERPERMISSIONPOOLS MO.R TGAG-E INAS.P.E'C TIOIV FLAX APPLICANT: AMEILA TOWN.: HYANNIS O LOT 30 o�- �" o LOT 29 _____— \��i �� �.�_o'•T< !�'�J MAP & PARCEL ---- �tG� 270/071 LOT 28 •0� SHED MAP & Pa CEL e LOT 27 Gjl— y a STEPHEN 1p ® v J. ai i o�FQ s sib�N�S FLOOD PANEL: 25001 C 0564 J FLOOD ZONE: "X" DATE MAP REVISED: 7/16/14 1 HEREBY CMWY THAT 70 MORTGAGE IWWMON PLAN HAS BEEN PREPARED FM DATE: 2/19/15 SCALE: 1" = 30' DUBIN & REARDON DEED REF: 25642-44 PLAN REF: 58/99 THE LOCATION OF THE DMIXG SHt M DONS NOT FALL 7ATHIN A SPECIAL.FLOOD HAZARD ZOWE, PER TAPED INVECTION THE DWELLING APPEARS TO CONFORtA TO THE LOCAL.ZONING BYLAVS IN EFFECT THE STRUOTIJ1M.SH00 CN THIS MORTGAM IN93ECTION PLAN ARE LOCATED BY TAPE SURVEY AT THE TIME Of COLSTRUCnON VBTH;RESPECT TO HORIZONTAL.DIMENSIONAL SETBACK REMMEMENTS ONLY.NO INSTRUMENT WRVEY WAS PERFORWD AND LOCATIONS WAN ARE APFRO)OMATE. OR IS,Dom FROM viaLAIM ENFORCEMENT AcIM UNDER MA 000t&LAWS CHAPTER 40A AN INSTRUIMT SLRtYEY IS NECESSARY FOR POMISE DETERMINATION OF BUILDING LOCATIONS SECTION 7.REFERENCE DEED SUBJECT TO AND WITH THE BENEFlT OF ALL IWHM RIGHTS OF WAY, AND ENCROACtIAE M IF ANY EW,EITHER WAY ACIZ W PROPERTY LINES YANNKEE LAND EASEMENTS R%TE ATIOlS AHD RESTRICTIONS�RECORD. �ANY THERE SHALL BE AND BAR SURVEY COMPANY INC.SHALL NOT BE HEIR LIABLE FOR DNAAGE.S RESULTING FROM ANY USE AS TH#SAldE ARE CF LEGAL FORCE AND EFHTiCT. OF THIS FLAN FOR PURPOSES Olta THAN,MORTGAGE INSPE IIM, TELEPHONE: 508-428-0055 YANATE .LAND SURVEY COMPANY, INC 119 ROUTE 149, Marstons Mills, MA 02648 FAX: 508-420-5553 yon keesu rvey0com cost.net I www.yankeesurvey.net 1 83594 JM ? _ lli , OK 4z � - A r r . s z . � �6e•CpR t�l�, � � III ' ..-...�..-mw.+.n..�..n...n....y� nr.K.. v�ms. �.vnaMv�me+�a.Wrobtsaetm.'v�*N+erz4�<u�6TS:Ye,�lYAu4!LWfffAw.4S2Ti3$::... .,+.r..,,. ...i4 w�.....mx� w n....e........n.�«.....�...a.w.� ... ..._._w...,_ Oe. •.. ••,•�n.a.......mn.... 0 1 t Commonwealth of Massachusetts Sheet Metal Permit Map Parcel Date: ,/ h 3 4J Permit# , 24 Estimated Job Cost: $ .SQ d,PR 2 3 2015 Permit Fee: $ FS / Plans Submitted: YES NOq BARNSTABLans Reviewed: YES NO Business License# , �-LQ, 7 Applicant License# Business Information: Property Owner/Job Location Information: Name: o KN6 a Name: Street: 3� /ct o- fed/ -cieS-G Street: d ff ! i d1 c c 11 City/Town: u,--�e 54 1/c<cmoc._+-V-) City/Town: ✓�✓� trS dam- � Telephone: so, Telephone: Photo I.D. required/Copy of Photo I.D. attached: YES NO t/ Staff Initial J-1/M-1-unrestricted license t J-2/M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft. /2-stories or less Residential: 1-2 family Multi-family Condo/Townhouses Other Commercial: Office Retail Industrial Educational Fire Dept. Approval Institutional_ Other s Square Footage: under 10,000 sq. ft. over0000 q. ft. Number of Stories: Sheet metal work to be completed: New Work: Renovation: -HVAC Z ---' `Metal-Wateished Roofing 'Kitchen Exhaust System = _ Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: /V 15 4 � ke INSURANCE COVERAGE: I have a current liai insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes 61' 0 If you have checked Xp&,indicate the type of coverage by checking the appropriate box below: A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box❑,I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation: YES NO Progress Inspections Date Comments Final Inspection Date Comments Type of License: By ❑ Master Title ❑ Master-Restricted e Cityrrown ❑Journeyperson Sign ture of Licensee Permit# ❑Journeyperson-Restricted �® 3 —] Fee$ fur License Number: JJ ❑ e,G ►iA.CA, \ Q v\ Check at www.mass.govIdol u I() R� S.�t�G-� Email: Inspector Signature of Permit Approval ��°,COIVIIVIONWEALTH'OF M�$SACHIJS�TT� t A C ? f74I '�:T 1 9 WA t f C C t 1 1 LE E�.t t� � v " AS E RN YPERSov t!�lPiE,$TR{ Tc' 1 f . a Yt �'iOtiTH MA 02673272 � (j r q "COMMONWEALTH`OF MASACHUS�'fT� le, S I aE �T K3 F d +'� ' � ` ISStl�'S TFEc FO�L�►5�+�1�*�� LI;C�`��E r A A ,�E Alt hfi� YPERSON #r+lfzE t { .!glSk� F,EELEI` 71 4 zi i � J e Y ' i ACORO DATE.(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCEF4/14/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Lora FitzGerald NAME: Southeastern Insurance Agency, Inc. PHONE • (508)997-6061 FAX No (508)990-2731 439 State Rd. E-MAIL .lfitz@southeasternins.com P.O. BOX 79398 INSURERS AFFORDING COVERAGE NAIC# North Dartmouth MA 02747 INSURERAMerchants Mutual Insurance Com 23329 INSURED' - INSURER B: JAMES ROBERT FEELEY JR INSURERC: JR I S HVAC - INSURER D: 31 LAKE RD WEST INSURER E W YARMOUTH MA 02673-2724 INSURERF: COVERAGES CERTIFICATE NUMBER:2014/15 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL BR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence) $ 500,000 A CLAIMS-MADE Fx_1 OCCUR BOPI060553 9/8/2014 9/8/2015 MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ include GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO- LOC $ AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ REXCESS LIAB CLAIMS-MADE AGGREGATE E $ RED I I RETENTION$ $ A WORKERS COMPENSATION $ WC STATU-. X OTH- AND EMPLOYERS'LIABILITYCRYANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) CA9098488 /16/2014 /16/2015 E.L.DISEASE-EA EMPLOYE5$ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E1.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) -CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE Lora FitzGerald/LHL " ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD The CommounmM o►f Massrudiusetts Depar&umt ofindus&ialA mts Mice oflnuestrgations 6#0 Washing mt Street Boston,A4 02111 rw:masx gvv1d& Workers' Compensafiun htsw=ce Affidavit BuidersJ'f✓a dw-dDmfrician&Mun bee Apyhkant Iufarmafian Please Print lembiv Name �! A 31 GK P wes -�- _. e �� rn�1�? Phone# S O S'6 C G O l U Giiyl�#abel�p:�-r/ 5 ya r V.a Are you an employer?Check appropriate bo= Type of project(required): L❑ I asa.a loyer with 4_ ❑I w n a.genend contractor and I Ayes s 4 andlar part-tinle} * haZ*e hired the s 6. []New constzuctiou 2 am a sole or partner fisted on fine attached sheet slip and have no employees These sub-contractors have: g- ❑Demolitioa employees and havewodcers' wotldag fnrtae in any capacity- employees ❑Building addition . [N- a wanness'comp-insurance Camp.ins,Y.mce I 5. ❑ We are a oration and its 14�Electrical repairs or addittiotYs 3_❑ �d l I officers have exercised their . umn I am a homeotx�uer doing all wrtrlc ❑Plbi g;epairs or additions myself[No worlaers'camp- xi&ofexemption.perMGL 12-0 Roofnepairs ir+n required-]I c.152,§lQ%and we have no 13-❑other employees_[No wormers' comp.insuralle mired] ` Y APP��Sin rbeCla bM#I nest also 1�1 onf 15e 3ecfinn helve sharing flies vroaYe�'�Mmadmpalie7 infaansEiam- 1$p�7GaRrIIHS aho submt&3&sffida[ft indxmting they ae dom;al[VMk Mad&ea hae oats&crostm =mIISI59If427[i 2teti{i�ijiFl[inQIC3�IILo SnCIL h�0UUVCtMttlatcbeatdzboxmast aturhadanadditi—A 5hw6;�q�o inst1mumeaftEm xndAzftwhe&WWzMftM MMtMMbxM eniprayees. If the snbtoniractnrs baste moplaJees; mu5tp¢auide t WOrk—'-mp.pohcT manheL I am an employer that ispm*bi rg worker'coagreusathm&mrmce for my employees. Below is the policy and jots sits in,formrafra& lusumce compatry Name: Policy#or Self ins_Lic.#_ ExpitafionDaatr Job Site Address: City/Statelzir Attach a copy of the workers'€ompensatian policy declaration page(showing the policy,number and expiration date). Failure to secure coverage as required udder Sectim 25A ofhlGL c 152 can lead to the imposition of criminal penalties of a fine up to S UODOQ andior one-year imprisonment as well as civil penalties in the fonn of a STOP WORK ORDER and a fim of up to S250-DO a day against the violator: Be adrised that a copy of this statement maybe forwarded to the Office ar . Investigations of the DIA for insurance coverage verification. I do heresy undsF the pains an penal ter o.fpedwy d�atfhe anfornia#ian is lure and correct Date: C7 Phone#: official use only. Do n of wrife in this area,fo be completed by city or town official City or Town: PermitUcense# Issuing.Authority(circle flee): L Board of Heaths 2.Ending Department 3.C iVrown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone 9: r *. Information and Instructions ` Massachusetts Gen e-A Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pmsuanf to this sue,an w p&5yae is defined as"_..every person in the service of another under any contract of hire, express or implied, oral or written." An m ployer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartmenis 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 budding appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buddmgs in the commonwealth for any applicantwho 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 perfoffiaace ofpublic work until acceptable evidence of compliance with the incttr =. 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), addresses)and phone numbers)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to cant'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 fur the permit or license is being requested,not the Department of Iudtsizial 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 inked 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 obtamag a license or permit not related to any business or commercial venture (ie. 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 cooperaiion'a-ad should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number. ' The Commawealth-of Massachusetts Degartrnent of ludmtaal Accidents Girace of kv'est g-atious 600 Wasbingtan St=t BaAon,MA E1�111 Tel.#617 727-4900 ext 406 or 1--977- ASSAFF, i Revised 4-24-07 Fox 9 617-727-7744 w .mas.5_gov/dia �t r Town.of Barnstable #� ti Expires 6 mantlo issue e Regulatory Services Fee snaxsresM MAM 9 163ig. ,m� Thomas F. Geiler,Director �ArEa nu•'t° J�'� Building Division Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.bamstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not valid without Red X-Press Imprint Map/parcel Number Property 1_Address z/ y /1Vrj`_o_7 le 4 Residential Value of Work -S Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address J Contractor's Name_ Telephone Number_`_,5"df— 771- Home Improvement Contractor License#(if applicable)__ d Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance , .-PRESS PERMIT Check one: ❑ I am a sole proprietor 5 E P - ' l i I am the Homeowner I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. k Permit Request(check box) XRe-roof(stripping old shingles) All construction debris will be taken to •' ,� dCd /ems'�, ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders. U-Value (maximum .44)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License& Construction Supervisors License is required. SIGNATUREV Q:\WPFILES\FORMS\building permit forms\E SS.doc Revised 070110 f C� The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers licant Information Please Print LeLibly Name (Business/Organization/Individual): —//"& Address: ` D �_Ap Jc City/State/Zip: Phone #: Are you an employer? Check the appropriate box: 1.El am a employer with 4. ❑ Type of project(required):I am a general contractor and I ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 6. 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' comp.insurance.$ 9. ❑Building addition [No workers' comp.insurance P� 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 I I. 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' 13.0 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$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 p nalties of perjury that the information provided above is true and correct Signature: Date: 02-0// Phone#: Official use only. Do not write in this area, to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: �TME Town of Barnstable Regulatory Services w iAxtvsrasr e, * Thomas F.Geiler,Director y MASS. `bA 1639. A•�� Building Division rf0 MA't 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:B LOCATION: ,4number street1 ��, pvitlag/e OMEOWNER": ice' Pr hkwlte "�-_771- 419T(yname 7 home phone# work phone# URRENT MAILING ADDRESS: �:�, ,�0,W city/town Or 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. I DEFINITION OF HOMEOWNER tPerson(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 requirements and that he/she will comply with said procedures and -- requir ents. S' a ure of Homeown 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:forms:homeexempt 'I �IHE�jy, Town of Barnstable Regulatory.Services suuvsres[.�, MASS, �, Thomas F. Geiler,Director s6;q. p�,,,pr► Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-623 0 P r` p o exOwner M >rs"t 5 ty Complete and Sign This.,Section - If Us"ingxA Builder i a as Owner of the bject property hereby authorize to act on my behalf, in all matters relative to work authorized by this buildin rmit. (Address ob) **,Pool fences alarms are the responsibility of the applicant. Pools are not to be filled before fence is installed and pools are not to be utilized until all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date VE QTORM&OWNERPERMISSIONPOOLS �--� oFTHEr Town of Barnstable *Permit# Expires 6 months from issue date Regulatory Services FeeXAM Thomas F. Geller,Director Building Division - Tom Perry, CBO, Building Commissioner -PR E�zEi E R FM 200 Main Street, Hyannis,MA 02601 fN U V 2 2 O 91 www.town.barnstable.ma.us Office: 508-862-4038 `�'�ANN OF TARS T?§cli 8.2b EXPRESS PERNHT APPLICATION - RESIDENTIAL ONLY Not Vaffd without Red X-Press Imprint Map/parcel Number G?2,,)r Property Address 0 Residential Value of Work_ ��1/ _ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address <7'1 �//�C�1 3914 Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) - ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor , I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# 2opy of Insurance Compliance Certificate must accompany each permit. 'ermit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) Re-side #of doors Replacement Windows/doors/sliders. U-Value (maximum .44)#of windows _ *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. ` A copy of the Home Improvement Contractors License& Construction Supervisors License is r juired. GNATURE: // �'� ' 1 - i", /�//2� WPELESTORMSIbuilding permit fbrmskEXQSS.doc wised 070110 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumhers A_ pplicant Information Please Print Le�bly Name (Business/Organization/Individual): Address--:— ® 4Ci--ty/State%Z-ip:--w - ,,--� Phone#: -=�C7� 7 7/- t,/9.s FOEII employer? Check the appropriati employer with 4. a general contractor and IType of project(required): ees(full and/or part-time).* hired the sub-contractors 6. ❑New construction sole proprietor or partner- on the attached sheet. 7. ❑Remodeling ship and have no employees e sub-contractors have g Demolition working for me in any capacity, employees and have workers' [No workers' comp. insurance _ comp,insurance.$ 9. ❑Building addition required.] 5. We are a corporation and its 10.7 Electrical repairs or additions 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 insurance required, t c. 152 1(4), and 12. Roof repairs ] � § 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 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify der th pains and p n es of p fury that the information provided,above is true and correct - ` Phone Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: i "THE?I Town of Barnstable 4 Regulatory Services * a+xtvsresi E Thomas F.Geiler,Director. y �►rnss. . �p a 39. 1% 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 HOMEOWNER LICENSE EXEMPTION Please Print DATE:_ ��/ZZ C70B-LOCATION: /'/ l!. - Z l��/,'i3 f� Z& d number street village C'FiOMEOWNER": �� /�1, / �/•�/",�Pf c f� S�t�C'� name home phone# work phone; U�RRENT-MAILING ADDRESS: J��— C��C 116 9 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. DEFINTTION 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 ins ection procedures and req ' ements and that he/she will comply with said procedures and requireme 5 a re. -- eowner. 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:forms:homeexempt A �7HE Town of Barnstable Regulatory Services �.�►���. � g ry MASS Thomas F. Geiler,Director 1639. `fig a►r+Ay' Building Division Tom Perry,Building Commissioner 200 Main street,Hyannis,MA 02601 www.town.barnstable.ma.us. Office: 508-862-403 8 Fax: 508-790-623 0 Property Owner Must Complete and Sign This Section - If Using A Builder as Owner of the ro subject l p Pert7 hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit (Address of Job) **Pool fences and alarms are the ons res ibili of the responsibility applicant. Pools are not to be filled before fence is installed and pools are not to be utilized until all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date QTORMS:OWNERPERMISSIONPOOLS 1 i E } 1 4 } t a i WIO A Cat . t _ .—_M.—�..._.--.f 3 /r 1 v' I Pit ss �p{}✓i F.;• „ �..,°� �,3 ps� KE DET TORS REVIEWED NSTABLE BUILDING DEPT. DATE FIRE DEPARTMENT DATE If . FUR-PFRIDI a IMPORTANT- UPGRADE REOUIRED STATE BUILDING CODE REQUIRES THE UPGRADING 'OF SMOKE DETECTORS FOR THE.-ENTIRE DWELLING WHEN CARBON MONOXIDE ALARMS ONE OR MORE SLEEPING AREAS ARE ADDED OR CREATED. MUST BE INSTALLED PER NOTE: A SEPARATE PERMIT IS REQUIRED FOR THE MASSACHUSETTS BUILDING CODE INSTALLATION OF SMOKE DETECTORS-THE ELECTRICAL PERMIT DOES NOT SATISFY THIS REQUIREMENT. f f };:: 111 1 � i 1 71 ti i i ' r t r + lj� 0 a" t t Ni ' Pa cnin ID 4D ct.! .f, 0 p- - I' O e. ILs r { : I a NTT, Pi a. ro LA I• r. ; j A �r N N ® .r , �1 Aati! i4 ttce+Er.( p "t Z a G.B.a 1 tJ,Fit CY ow C—A AD, JL__ It oil Al- A- a w. 1-0 y _ dI1����.""" ..,•.-.,.ev,.,..><.,,:,W...-..u. ...•:.:>,.-..,,�....,..:�,..,.,,...: ..,.>,,.......e.,.::a..a6w..,.:.....«,.,..nr,... '.�..,,,-..w,.,w:>... a+u-,y-< . _> t °`• .t'a...o t. r 8 ?�° ?' v: e �Y,AtNOI s 1A. 02C6-'61 .P.c ttT W,d I 2 _ r , - _ I �t ►=fig,' .1: 3 o�� 3-®" •,, �. I j' —t:::. ..� •. �, j 1 L. :.' 'i 1 I �' j i _ r B {i ! 74- t . OZ � r _. � � 1 i t , t fi ! • . Y . . P16�-'�"���...�'_ G�Roo Vic: } ! >f • .f -�-- .+ f � .� i. —f — u•— j-- —s. .. � i j t �6`�.C3 r'i kn �. ply '"_—s ' .tom r' qJ^—.^ice 4,. 77. to / �.:— {•"' � - is r � I i I � �� I �. .. � � . - � 1:. i— �, � �-��.--•-•.._. i . ..,. o i 1 s ,. i �. .G 6:P9 i�€�I E � � I t ,� � t M � � ��� _L..- 7•. /11i.. - T ..M -t.. ---i.. _ _ - i. t .��. �s j 'I'a.�.fs•. t jr�_.i,._ -i r l......��..�. . #:.' ..:.�..___.. 1.__..��•.-�:>:_ <�—.._y.w-.�...,__.ice 1 .'. - -�--.-_.:::.�.._ { � •! � .. I i.: 1 ! �' 1 �.- € -�_,.i � t!.-",—"�. ., .. ..: .. . , .. .. .. �`' .. .. ... --^p .�:; ,.1 j, {. I 1 .II �� 3 I.N :�::. � � � �),:� of � � .A� :j.... � •1 .. .. � - :;1._.. a.... ... e , q r ! _ } L� , I l 1 1 ice?�j —� `-�-;-_ .��.«LLL..r_d- 3a.. •- _ i`,Y'-f.^.' ..�._.._.,t..._•e..h�r..�...L_.. •....r�..�.�.+r._ }...._:..1.... ._.J=-•--�«..,.•.ir.. a.lr � I~ ... ... ' s + SGo1-Y of t�0 K L OGttS -t• btJNNA AM(a-L.1 kf X?LACf- Wit4000S, wtit 4lt4At,,$iwW- Aw4& Gqt Gc-vputE �.33� s6► E. o?EkimrS AP-F- NE43 RF 1,41DVA-roo s -r SLcPVo►ZCtz9 wtTit SAcC-5; 4P 4- z� 2"��v" ftf-AOEZ. SOMF (dimOw-s3 lm,,T/AL.L-ao f5y p(Mvc&ws InISTR« NFtJ $LlDbrf£atG�Rb'-O~ �Cl����� WHI•tEVlnlyl., (i(•VAt-afsa0,3J _ - ���,t � ��_�,I �t ,� � , Qd�1t&l'� Olt esl�t��'tTf: Cour�tT�� Nfw f rHAwm tN mA-,i .Z sutTE, �-Aew Eea t i P-Vo2, LA-�,Lmp w dcoM tt�,nco�i�4-�F� '���rttR�r� �a.N��i.��€�. w►��, �w� tn.. ���p; ��t���� ��Ia" Fl���s.� ��ca��..�ncz�(� "~ t4 tit�ow S , GDr. �cti4c�t� � T , s A - � 1 i q { i i � t U. Fi cl Al t ` �_ — _ _ _ .._..._�t�:v •�';.W..._. _. -._.,.-:w�:-a.rTe�r 'co--.�_.-.tee=c..waw..�� _ _� __ _ �_— _ .. _ ....wm..�_..-gene.=s•-..sa�./v=c-_. a f ' i g ►, Fx)�-rtti•4� � ����` �M�.��Enc�oor't.��t.__��.�..�..m..� _.____ ���'4r�� 1-�o�as�.�..._sT.��._��.��_._-�!_�t __._._.___ G t2 Ac S 'P Ac-r-- r:f✓ �A S M �t T L©LAiS •f Vt' NN A A!PAEL--i/'k Poi y V NFO(- '0AgA46 M ' �Ek0VA`t'10P,45 -ro EXAST1,M6, CIE" OF1K. T1,k1 'AL%- FL-00e— .46 N& EE•tOtJ tF,. ft lr-*-T t t--Ar'f©P- f J,,j f 1 P-C P L/lGC, 5-i•Ai:f...M F40 (=ACT •,( �.t�6 Q\cAXV.-r�, Gd�O MA 0 ! C 13 t I12 'l. tCo Rf S,tv _,T,�-,nttsrtSS 5Tt't✓� Ft.atS �rP� .TE Pr`C� M►rrEuFActuuett`S Ss-4rc��,tS, .TNSrAcsL- 9fFGQ 6 W 5 tuft- 94, F2aQQ 19F-®� 8Yo" NE-W pRrg'��H C TMEATF-D WooD Df-C,(c Iv-0 '�te. - � � New ttF—A-T�►�(G �KD �z�cM6►r�(G- 'Jv �E. �Ns1'�I.t�r� �3��' c•t��•�t.��'�a . ��.s�A�t�'�'� - -�— T F� TV.ICt° s YITEM TD Z (,A E, F.C> 13y L�I4C (S$F,0 tsr4T, ( I M -t�(s t arks opt D 1 ` A r-6N 17--4`I t-oW-S AM tI A h. M Ry 15r, N n� 1 1DtSE.-�Plrr�t�.►�-i, t+auSC D�.�aaltT Corta�+At.��� Ni�'�'' A�6�s��.��6.��, i 1 A5 FRAt_T gooF ! a , TT- T—T-I t E i � F .-._-.....-._. HEW L.JI)k3pows I POOP- LEI r R.pt q- - T - :.. oTr--s717 i t + Sri M16- Cur. gt ►rtla► - I` - C>K p CC.t~- Ct.AF-W �. t, v r�,�► tic 4. 2-'lL•• •rMedwc� 3o�Ts _- � } -All { i��STS w(5►eeaptord T1=5 a'. G CMW ' 13LOr—C S CL) Q{,l T'V00(L. S I-tOW 4 C0,4 C2 CTF- s R- 4s. (,CV { io 14 -- -- -- - ......... --- ------------- -_ ._-_„__ _ ►(o(o"�/ Rou�.tm _ __—__ 1 Z FX IST) LMAtsrelt 'C��t3e��eatkt Laisetc AmeLA R E).10 dATIO WS rO 1114 =-t NGot iZ®P Q o ,, SRC CT Sol: -7 -" E , E , + cam, Q -4. [3R kSTaZ�+•� 1 3 p -ali /��p }� 3 l�llZ.4 �a. i �DAB 5ttAVf_(I- 1 / a P.a�oAt � ctl. lFA tZJ&KV S t A r L-C VAT t O N cot-ta=itcTr- L s Qel—b L.N E A u t ill hB9 MA 2-001 �— � � ( L)U 1r"AS a n y 5 R Ale—Co P4 - _ 5 � � I I —� r -Q � EtA..s v�.C.�. ,.__ -...... ..��. _t.T_ zi IZaauo ���1'jc+�v I r rvm!mod -4 AMCL14 PIC-NOVA--r IONS TO 14 L11�4COt_fA ?-OAO ; MA it 44 jor ? ' i (o M M RELY v'kc�on. T3�w� :` `"�•-•..., .� �,, t i I-1'Pi 1z�W �• �V d o R. ! ;, � � � �— �0^4 9 td��. i . �-r 1W . 2 x ai R Nf-rf� ° 1> 2"Kota" -- a N ,� �.s=l�r►s`aaags� s V13 FLdoi� ra i Z x4elorz `t 7 LfL/Lw f+ A ttAt t L.)Aw- e � O 'Z' J. N uu S �- ` / 1O Ga�1Tlo �D 1 ST.— - � 1� � � / I � t.TS � (/ LO IT-* 44 MM je'�.:'r1� j 2 x�?� STTZv+GT�eA}t— � "x 14.r g rl w l ►Dow s • , a.J ��• rt6nn Esc }Lo0YL 1 PO a , i ..��..//// � C.O7'4TI11 NOW /� 5a t� Ifs Pa{ OI S'r ���� �r�f5'rt rt Cs— �► : Gg-M rr-'N'1' '13 Locr- LD4etMof 1l4 _ `� D�'i"PrIC. @ N� Iof\( t-CDrseit PV, G cr4 ��a�A.►