HomeMy WebLinkAbout0310 LINCOLN ROAD jA/d 0 4 j4)
� � - - - ACTIVE
�
0
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Niap Parcel O -26 Permit# '7
Z�a h Division 4 a-00/- 32 6 1215 D, - Q• Date Issued 1�- Obi
Conservation Division I Z D NZ-04_�__- Application Fee f
Tax Collector 20 Q - a r N L" fal s- Permit Fee
Treasurer_(
I: �,m�".LLt�O IN COMPLIANCE
Planning Dept. YJITIi TITLE 5
Date Definitive Plan Approved by Planning Board ENVIRONMENTAL COOE'ANE
Historic-OKH Preservation/Hyannis TOM REGUUTIONS (0
Project Street Address
Village 4,1f IV,S
Owner 14 Em, Address
TelephoneS -i �� 77 %'° a
Permit Regst � r_ J t d'
ARE NOW LAW. EVEN THE ADDITION OF A
NE';i"d BEDROOLA WILL TRIGGER
t Y UPGRADE G. 4 tt_efi C—v"v K�E ID zr T
Square fee.FigfgorT&As Fr b 'pT6dSE• Yqr Afl�or! sing zsproposed Total new
PLAN ACOR IICAN�VE YO R
Zoning Distr c E -r-�,P�a� ;, -r-n[ Ioo�Pl irr ► E �=p(ny ;� a,tQ gndwater Overlay
Project Valuat � �
Lot Size .3: Grandfathered:: ❑Yes O No If yes, attach supporting documentation.
Dwelling Type: Single Family d Two Family ❑ Multi-Family(#units)
Age of Existing Structure o Historic House: ❑Yes ❑No On Old King's Highway: El Yes ❑No
Basement Type: Z Full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) CD Basement Unfinished Area(sq.ft) t .�
Y ``7
Number of Baths: Full: existing _ new Half:existing _ news
Number of Bedrooms: existing new Z
Total Room Count(not including baths): existing. new_� First Floor Room Countzf
Heat Type and Fuel: idGas ❑Oil ❑ Electric ❑Other
co F
Central Air: Ef-Yes ❑No Fireplaces: Existing - New Existing wood/coal stove: ❑Yes m IG
Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size
Attached garage:❑existing ❑new size Shed:0 existing ❑new size Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑ No If yes,site plan review#
Current Use Proposed Use
BUILDER INFORMATION
Name M A-A H uj 61 r T e. Telephone Number g -7 7 � 9 6 7(�`
Address -f4 o w IVP le 3 /0 `Q/Co�.c/ license#
47 ci_ Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
19
SIGNATURE W DATE i-L, z
` FOR OFFICIAL USE ONLY
t; 1
'PERMI-T NO.
r. DATE ISSUED
MAP/PARCEL NO. '
ADDRESS VILLAGE
OWNER -
DATE OF INSPECTION: 4
FOUNDATION
FRAME
INSULATION
r- L•
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH < FINAL
a
FINAL BUILDING 4j A
DATE-CLOSED-OUT, r:i f7 ,
ASSOCIATION PLAN NO.
y
t
�y�ptHE Tp��O Town of-Barnstable
Regulatory Services
Z B"NSPASLE, ' Thomas F.Geiler,Director
KASS9`bp g
E . e, Building Division
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 adjacent to
such residence or building be done by registered contractors,with certain exceptions, along with other
requirements. Q
Type of Work:
oo/� Estimated Cost O
Address of Work:3 O �� Co 1A
Owner's Name:
Date of Application:
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
❑Job Under$1,000
❑Building not owner-occupied
26`
wner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A.
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner:
Date
Contractor Name Registration No.
OR
Date Owner's Name
Q:forms:homeaffi dav,
Tabla Is ab
sm,�g�,ddsta3sl S aaL v$•�'a
. prsycrspz}rs P�tek�cid for d�asrd T�r�-F'
mmm
MAXIMUM F1ocr Ss� ' �a
C31�ng . GIJL E �-� �� R-vstu� WXU
A='(•!.) 11-vsluc R-vnlusa R•vsiva A
Psi° SN1 'ta 6500 He Dears*Dar 6 ?�Cs�
39
Q . 0.40 C j 9 19 t O d is f►FL1E
. R• 12`!: CSZ 11 19 10 ' �.(
�;, • —�� ?S �—r Ii�t�— Norms! _
• T
v • .1S'/. Q.46 3E 19 Z3 ?i/A 1 WA !S 1,FVE
t3
v Isi. 0.44 31
W 1SY, C3Z 34 19 u WA �A !ice
'3E I3
X ,l E Y• D�2 • 19 ZS ?YA N!A 90 AF{1E
0.42 3E' Ig 10 f gq AFM
13
IEY. CAT 3E 1 19 t0 f
AA 1 E•!. OJG 30
k D1l
T ADDRE55 OF PROPERTY
YO
Od
2, SQUARE FOOTAGE OF ALL FOR WALLS: f
3, SQUARE FOOTAGE OF ALL GLA.ZIN
#3 DrVMED BY#Z): '�
4 %a GLAZIN G AREA( :
• S; SELECT PACKAGE(Q— AA sec chart above):' ; • • : .
•
OLVED MEIH ODS OF D
N -FOR
G EH'ER.GY'REQLTIREMENIS .
OTE: 'OTHER MORE TNV
ARE AVAILABLE.•ASKUS FORT HIS TNFORMAT1021.
---- OVAL
$UILDING INSPECTOR APPR
YES:
q�farms•�gQ30]a .
a
Footnoies to Table•15.2.Ib:
! Glazing area Is the iatio of the area of the glazing assemblies Ctttlex uditiuding l opaque doors) to theg-class-doors, gross w d
basement windows if located In walls that enclose conditioned nedasp�may be eXcludea.from th'e U-value requirement.
area. expressed as a percentage, Up-to 1/a of the total glazing area.
ted by For example;3 frt gf*decorative glass may be excluded from a btulding drsig=t wthic manu ° j in afa cccordance wiEh
z After January 1, 1999, glazing U-values'must C test rocedu�re,1 or tikcz from Table 11.5.3a. U-values are for
the National' Fenestration Rating Council (NFR ) p
whole units:'center-of-glass U-values cannot be used.
a The ceiling R-.valdcs do riot assume a raised or oversizrd truss Rap�s°ctmlatina may b�5ub sed four R48
insulation thickness• over the exterior walls without compress a, of cayiry
iitsulatian and R-38 insulation may be substituted for R=49 insttlat16n- - rathiug be plat d between
Insulation plug insulating sheathing (if.used). F°r.ventilated ceilings,.
the conditioned space and-the ventilated portion of theyoof. sheathing (If used). Do not include
Wall R-values rcprescnt the sum of the wall eavity,iztsulatfoa plus -9 =.rcquir Grit could be Met EITFIER
exterior siding, structural Sheathing, and 1hterior'dryw-a1L For example, jhe.a&jr;g- Wall requirements apply to
by R-15 cavity insulation'OA R-13'cavity insulation plus K-6 lnsuT 9
wood=frame or mass(concrete}masonry,log)wall.construction,but do not apply to metal�frame construction.
The floor'requiretnents apply to floors'ayer unconditioned spaacts (such as unconditioned erawlspaces,basements,
or,garages). Floors over outside air must meet the ceiling requirer e=. '
�'Ct:e entire opaque portion of any individual basement wall with as average depth less than 50%below grade must
rs of conditio ad
rnc_; the same R-value requirement•a�above-gradeHa -ement doors must sliding
edoordV value requirement
bc,,emants must be included with the glazing.
d_scribed in Note b.
'Zhe R-value requirements are for unheated slabs,Add an additional R Z fcr heated slabs.
' If the building utilizes electric resistance heating use compliance approach 3+ , r 5. If equipment meat wiith the lowest'
than one picce.of heating equipment or.more'than one pieea of cooling cgWpm t, P
efficiency trust to act or exceed the efficiency required by the sele ated pazkage.
'Fcr'Heating'De&ree Day requiremdnts of the closcst;city ortown see Table JS.Z.la
KOTES:
a) Glazing areas and U-values are maximum acceptable.levels.Insulation R-values are minimum acceptable IeYels.
R-value requirements are for insulation only and do nqt include structural eamP==ts-
envelo a must bane a U-value no �than 03.5.Door V-vaIues must be tested
b O ue doors is the building ,P cdure or taken fr°m the door U-Value
P�
and documented'by the manufacturer}n.accordance with Tj-N�c�>f°r�door is not available, include the
in Table 11.5.3b. If a door contains glass and an aggrcg.
glass area of the door with your windows and use the opaque door U-value to determine compliance of the door.*
One door may be excluded fro this
wail slab edge,or ay spat wall component includes)two or more areas with
m
c) if a ceiling,wall, floor,b ,
different insulation levels, the component complies ifthe area-weighted avgragc R value is Utter than or equal to
e�R-value requirementlatiocel for that component. Glazing or door components comply for =A-weighted average U-
value of all windows or doors is less than or equal to the U-value requirement(0,3 )
- 43
The Commonwealth of Massachusetts
Department of Industrial Accidents
- Office oflnyestf98tfans -
. 600 Washington Street
Boston, Mass. 02111
/
Workers' Com ensation Insurance Affidav: /
naIIma:
location: i �' �q �: -_-
,n. hone# 5 �� �-4 0
Y1�
ci cC � i• el£ , • L,?�g 77 �
I a homeowner performing all work� ,
[] I am a sole ro rietor and have no one worlds in c achy
� /// e %/D/Gan�/�/�ob////%�%%��%/%%//%%//.Gl/%%/�/%%%///%%�%/%%//,.
a Sol
ensation for mp �.oy
COIIl {r• f. ,t,x•:'C r 7 hY L: {Y<r?:°?: 5,2;5 },QY ,:•c:.
workers' p u,axa;.h.:'t h r•;,v:nr,S:$?•is :,`.'%iA?i;�� ^, v t•y V Y:2• ?'•i{: •i{ ,, i{{,c?`•,.,•, 7}.7 .\${`r} a7 ::v
rovldia work :a:•Ye9;{YSf:•,4:Qfir::!•::::.rx•,...:�?{r,.}<'r:?,.:.::.{r{,. .:'•a ..,:L,f{:br•r.,,;a•:�.:,}•••.�Y.•YS:w`r'x2?9} ;�}i r:f 'r:•�{`t• :.�'{?:;..;o'>�£}{S�..,•
e 1�y D g . ?o:W:4 { i`.r}l£r:S?,'`:}`•i`::i#,;:}...;:.£?:,}};}, xy,•r of•$::},•: 4}}} p.} f•}3f}<s F?•,'}:Y: ,r.,Y;4 •.a..r,..,,.}.}..., )}Rr.S;7n :r.r; )r;K:;,{•,•i{,
am arl "J�F.. •::•:++:}`.`�•i.?•...:..,�5%'..«,•r.o:,....::s..{.ten,.:}. ;,".�:•:�:}r{...!,+:.::.,,.,r.�....{.}$::!:alt.,,l ..;a:}:.• .'#}%r .,•}r...:?.;,,.�;.K "�6,. .},{.!. :
I � ,v:.,::?4:oY.;vfrY,..,{{:.....;s,.x:...,.:•. :.,.�..n r•.i.• .r.:':Y:. .:..rn: . ...h. ..S:Y>::.J;;t4nrS'•.^.:'::.r..
..,...a,x 7:3:u•,•: :..v£.•:::.:a}:{?....:ti :•:}.}}y.}•;}:•?.^;.<t x{.:W. r 3�;YYs ...2.:::. •Srr :^�.txfi.Y.r}Y.:X�, ..>�
•.,•x:•.:?•Y}:.. ...,£'�:�';'s xY: ,.,;:�.7•. ,,:x;3+':}}:.�.•}i,Y:'+r}r:'t? ..rkb.•.•.rb•.2?t4...,..'a.•l:rw
.r.•rr. ..r. ....r.a•3:•7}{•... r....::,......:..:......:....},::•x•::•r:•}::.:..,.,,};:,.
,..s. �r.S,•.Y••Y.•:u 4.Y+r+W.xcr,V,t++i•+:+•$;:•••r, r•rr..:i ,:.)..{.:{.;l,S�:?,^•:}.,,,y,,f+�';:`+�xi:?:Y.r:4::}..r,r..:.
nrY.•x,+ SC:•:•x..; :}.rrl,•)..}..,.:.rrr.;ni;;Y:v' ::?ayr,Yh.•:.•x,:.r. x:�r: v.q,•?i•.vi`}.Y:....4..,.
..: !.•.....,:•.4:nv:+::::.. a,..n:.i..,:•.•.rY.:y};};'+-}+W'+??'.vs.:.,. ??W}:•'r::'Y• h '{::4:r...,.nC:{.wry}::{::2.... ..�... :nti{2'ww,•: :4\Y.??%J.�'i^^.
:... ..:. :v:,..v::•+a:•.•i::.v vr,.•;.: },+:.y:rr•:..,t:}v::::4:.OT::+i:.w;.S.4v+:}r•:?$a};4}!• tv:. {.w$Y:i{{:$:]v i''•?::YFL•.v:::r.n:•..:....... ... r•• 8.V':
.N ;r:.£r• r5, +$.•. '.. ..}[ a}x•: ^:.}}, {}Vx'tS;. 'Y::V,`iJ.•V?
:,v':�+,...;:;:xr;6„rr.;:...v,•:a::7..Wty .r v.....x•:v , :: 4,.vh•,,::•• n...i•2.y.•v+':1 .r:iv. .Y•<:t;'+ i$i'. •nr;;L'•\;,vr
,.,.v r.r•...•4 r:r ..,:,..r y] ::v.:.:n A.:Y.Y.n. w..,,..•r:..v. +:n, r v:.:t•:
..•f••n.}ir.. y..Lgvr}:.:f.•. fi fin{.ia4::•,:.::T:.•.. "!•{SYY;ti:/:'}^:b:•: �•:\,{.fi,�'iv }Yh,r.h:Rn'h:<:^+;
;i$y;•:.};..r:b:ii:ri:4:.. ..T:•:•t:n,..:f•:rb••W. .Y .bti ,'t•.}.,•,• .:.}'• :47:•::nb•x �:',::,
n},..r.r x.l YY�fv•...,:Y,..,:}.', :.+..;f..P,•.,{..... �::•::it r..r.:. r.., :...,,,t,•} :,'}.::::.' .........;.,<•:W:•..,•{+r.•}}:4]r•+':" ..:. Z•x•}:7: J "%��YYY::,,
.{•:x.,.:.. , .;.{, n.::::•r?4}x.,:;4... ..„,•:•:•.r...:.::.:..x7 •.:..... ::•:+:....:.}.. .a{••),.,>:. �•'••y,•:.}:ta.}:+•:;:$Y}:•,•;:4:: ,Sr.•x•:: �.r,};},.n �:nr.x!.]}'s{.r
e•.. .:•i.r•.t,..:{.x::: ..; .�.4}'v{}:4:•:{... ]};;;}�.: `..S:a}fx•::r)..,,.:,�:•::.�n.,J.}};#.Yx•'k:j#�'•r:•.S,n' ,S'.�,�'i;}'j+ .y.;{ .�:; 3�
SII•$•tiBIII Y.::s3 ti:.3kr7':. ;,r,Wr+h}L::$' ?•:+, Y::•:. ;.;,,}
?�;•{..;Y::fi}':!:•: .,,xr.. :,r:rr•:•. !..a:rd,.:•..}{f,:{:.••::;:.,• it ;,;•yS{}?7y':..:#•,:•Y.:yC{,a•. n;?�nr+':}:}r:.:4::•..........,•.vmx•:++:fi:::x::•?1}ii•^,Y:;:•v,{.;{;}....v•v.v..r.{... r...n}:......,,..v Zv.. yi.r•.::•a:$:'.5...!`n:.},, '.::
...... ..,.�....,... .:$ rf...,.v. v ;....... ... n;. ... ..n. ..n.•. •r:L+'•,..r..{v.•.•rY.:..Y;.. J..'f, �.S.y,;n,i+• •3k•:5�::}�•.£;ti.,. a.}x,.,s3r` �£'•k?.}:..:h•..
•r•r:.• t..r t...} .:L :{Y,. .i.:ws: •;x•f:+ ::.a.. $x•)r::•:.4:..... �
•:t+•.^:'fn+•: n...h••:.::: .....:4'•:rxbx r i}...:..:.. r..:.v ../i:•:r{,�:::.r. •y.�!}.{;i:•}'n,'�•:v:•:
..., Vr.i.... ,... ..::. t... ..r: .... ..... .:... ........ ., v .nL:.::.:.rT..:'vf%':,.r:}...}:L,•r:,,....:.:{ S•T.Y�`• 7S�$}..
..r.i}..,.�.... .,r....r.....rn... ..:. <..,: ..r:... ... ,:, r.. {{'::f:..n.+:r•x'.?Y•:+:....:.
...r. ... ...b..i ... ....... }..f rf. ...: .. ..r.. ......•!�'.:•.}..,::•:::::.•r..4, :.,.L:.,•..,..:::..:.:.....,....... . ..........,... .,;;}yr:y{.:.::5:{:: 't�Y:•:;•.ct:;hi .r.3`:'r>,?ahk3�h2Y�'r•o-....;rth:
t..:....! {,•. ....r•S...ts..:... .:.+..,. ...5: l...n•;.:. :•:r£..- .3}:..,.... ......::.•...}t.:•\••..•.r.:....:. .... •:�:}'{'y'r";:!' .,:. ...'{ ...&.•r }Y •} ;}\,}
.::1•,.l.4},.r.S.v.:.:h:•....v.v,•..\}F' .!.(y....,:?v:�...:;:x•{.. :Ar%.....n•Y.•.�':;::::.....}....r ...r.n ....: .}.+,.4x,{:3..,, •Yr•Y.Wrvt:,
...x::v: .. .}'•,Y>:+:iv! •v:.•:::': :r;{:i i.'$:.. i n `:}'+:{{•y •?T}:T}.r,• .Y}.Y.:f.^�$?--gg
n.h.;...x3v {...r.:•+.•Y:.: r.:x•.: $.; .+v.nr.,J•$;�,.,:•v::....r.r. .vv, :...<•n :.';{.:4::r..:,+fi.v.,:}'{ „nv ': :J.r :}�•.:.1.•. :•{f ...v }
.: .`Y..x,n. ..•Si: .l .. ,.n..... .xx•r ,.}.... .::'Y+i;•'7 .: +r.�Y..nf:,L+ x.:Y$• ..}:^ :;�rr:r !:}.{:'.:. ?7;'S:?4:•}'xi•}r:•;
...'h..n ;;;{.;}1.• „a:;;,
a:.: .•r:.v.vr,......, ,.:..r. .}: •.. •.r:b),••... 'i':3
.... ,:�.. ..... .. .....•::•.v::.+•:•{•rYr:'....:.: .....W:.,::::':.�.wy;v,:{.}Y}>.} :..::+.:rvv::r:v+rv. .•r Y':riyrn?;<?}S.n}.+.5:• •,4.$:}, yy�
.a+.•:....-.}... ....... .:•.:....:•:, ..r.,..{,...:¢f ...::'h:....:: .v;,2:+,:::.. : ..,:••...:•.:..i•:..:}.Y ..$,s-hr;: ,.a:r, +fi;:� •';•`....Y•a.�Y:YY:•'?{�i: {•}:?;:{..'r
ASS•., :s.., .,tn: .E .{W Y,.{.. r..Y. h•.v Q:iur:•Y]}: :r.•:•'. 3:a •.:hx•.:..:.:%>'J:. n: Y.nb �:
; r::•r. :• � ..3r. �4:^i.. {.>. ::.}:•::+•.
•$ir.v t• L,a
....r. .., .x. ...r.:... x. 7`0..:: .% ... ..v.... .,. v•;V•.....; }{.rv'4r.v$•:};v::i.r .:•:•:y:•: £ii}.•; }�:: .hY?v
....r....,.t.,.:.....,...... r„}..t...:{•.r...3...:::s...,.......,.....r..3...5.•. ..{•.},,.+..... •.h.h$... rt:::...:{:.,:•:.::{'•. •:• ,:..,::?''s+.i::a}.n.,.:•:.,':•
.:r.......:.n'....r.,•:x•... ..L.... .,,:h:•ra'... :a}:fi., .:.i... {,, :•:.{•r::r.. :•:•.'•';;}.:•i{:Y:
•{.}•.:.vW':t;• .,.,:.:,:vn••?{•. r:.'!.{•7n•y;.•+x>:,.:.:{;{{•,:}.r.:rv2•:. :+4.Y} Qb.e: €rfr
•::.};.:L.,{{•;•;:?:., „ :•:;Y.}:+ . a{r.;...:r:Yy{.:W:{;•:/•y::.•.,•x.:,.. '«!•t.};.•a-}:! .a;�::�.,{a•::�:..:.,f.,
., :. ,,.;.:{ n,:::••:,.:::'.'+bi+r..::,>r a•::y r,+?}..r .x•}}r: ;•:f;:e:'t••;:: .•.«•:4r;:•:rTi•.,:,rirSS'. ...xE::?`••S .,fi: •4:}�•rvw.x
'••1....../.:r}Y,}:!!.. ..}.}'•'•f,.;: !,}.•,.v.fi•.•..+Y,.:?•}.+v, :;:'}::ai�'•Y.•}:'J.W ..fat ><.n:.}..}. $•:•::+•i:• �...4
:b.. .{rn .,:}... ::;:Y:..Y.. •:•}}h+'•:£•}:•Sh�^£•.•Y,•.4::, yy a.•}•..,... v,.••+vra.{•}h'C...ai:. 't.. ..7e,.,;
::•}r:..r....;}Wiry•.::+:?•i '•: v!. •:.Lrt•W:i•f.• r}:r"•}iY:e+•?Y'.'{•...a h r?.. ..•}..Y. i'rA{. : i .�£.+. .:}.i:..v :Y
i {..{,.. ./...,c, :.:.,r•.},:ax}xi'?• ..iW:•{:..::xa4:Y'2}.`::s,. ;•:Yiar;{.}.r. r:{4{:.}.?}r.' .:3r•s}:•...a:..., rn'..{i>iiYh4 .:3:{•}:••r'• ,:b •rfi?:.v :a:{.. :rt::�;M.'• b..
Y.: ::.:i•.v.av:.::::rr.a.. ...o;.}+,.l. .{i.,rr;}•.: {v.}ty;r;Y+r'rr•.: : 4r,:.,..Y:}'•£:`•`•.,i2?':.W. .•;E<::a. ,.-S.::QC•.
...}.:.t.,..7+•<.+.:: };{•r.{:.r,`.<r.:$SS$S$•.r:. a:wY'^»::•S:r, S:r]•..+.-,. ..4••.•::,.,r}. ..:.h. ..,t•r.. .+. 't?Y:•,::. :.fil.... ,.o.{
:;•:a}x?:. TW•s:•. ,WS.:... t••S..r.Wt•,+.•.x• {:•+,..r.,}} : a,..:...F •::F;: :.vW
?41' ' :.cttie{+:}•.,fi^..:'f.'+X•.'::?:::.,..{r:: 4... S:ti::{,..: .}c{».. :r:}.. E•:r:.r. u,•. ..{...:'t. ...{... s.::..{.
•}'%+i l••:,. .t... .i{.:. ,.:Y..::Y.i,{,., .+t..• .•$,.t.....r'+ .}f.}',y.......:Y•••:f. f:{.,.. .;}.},.,k•}:x::•.,+..,,W.,.2;:
:Yhf•'+.i•}:':• v y.•.,r:'y:.}Y.^,'at.{?v.}x:.v W..r. v.,vf.:'v$}::W. •n r....•.,�+{:{a
•}Y"}'{'... r .J:;••{{•, •.{f rr!{.r..:r•LY}:4':.}}•4}}}.h Y r }. ,
r:.,:':•}:+•:;•:•?......7"v,r:$Y:.:^Lv:!:4::�r Lv.4, finvv:.�•..n.•!:t¢.};,} ..,,,,,::4.x:v;+::Nw.: vn+ '�$?:ti'i
r...:•.y,•r...;.•:.'...;,:...:. ;.,.:..):3:•:::lW,.:{•.:$>....:•:f..,.i,Y•}r?:•:5,;..,.::::•:• yt .: ;..+v,.'yY;x•;;?•^:5:. '}::4:•}.............
,v},•}x:;•WY:£:•::.}f;.},:•:{•i:••::: .:}.:!<.•..: •n4•n:•v:a,'}. vf''1,.;:;}i?:kvi:`.'�}•i•:}!}:';•be?}$r:%;!!:!•vW V�lf.:T. l
,;:..:Q.S?Gf:•:+•:•W:•+:.>:?i.'.•:7Wr...x,.:K;rSr:•.x.:•{.:+r•;:>,ri',.,:•;.•}••:.,:•,:W:+^:.W;,y�f#f::.;W:r•.,,,a:.,••:�?s•r.:..:W4.f•:
Yv$%i?i4'r,}:r..... f:•?}.::•.:::fi,;;:....{.-{r:b;;{•;.}i"}f]?•} '1,.:.i,.;:$},4,4,},•.{f:C} :i?.•{.r{.}:'v:Y n:v.,�...:.:.•:....
.
� nce::ta: f>:.?:{Y:%.i::Yf:.:Y}:.:}:...?L..... er circle oneJ and have hire d W __.
omeown d the contractors listed below
❑ I am a sole proprietor, general contractor, or h
havej 41:'fif.}}.,{.}W.{r.:fi}:Yr./i•..•r.}.,+{.,4..,,...Y•:....•:.a..•.r".t..:W.:.:...:}:.....r•rr.•...:�:....::,4.•.}.+.:{.i..,..,.r.}{..$•r....:.r}...!.x.:...•.•.,:::.......,3.:.r.4:£r.......,:.:•?::....4..:.:W......•..,v•.:c....f.rr,•r::..r.9..S.:::.t.:.n.�..ai.rfi.,rc..:.,•+.r.;.....•}.:...r.:.n:....}4Y..:n..r.:..•,.r.:.Fv.,..:v:.....:...:.Y 4..r•I..n..r:..v•.:..r..t:.?{}p.•s..•.i v.:.i•::....:..:,[.•:.{.,S...;Y:...:.n•T hn,..nQ.•F:.,'.n..},:.t..:r r.:;7r...•o.•...:.:.•,..r.;x...:Y2.,..}.:.:f!...Y••.xr...:..�.xn.,.:}}•N er..;.::.:..•e�.;{}:..•..:...rr..:r.:•.•'$,r}.>{..•..,{.v.;.{}.;':r-r...•.•.:.4...::,..r£..,::.x...y.•..•.:{..,.:.:£r:,,,+..:.•:!IY.'{.r.::x....:;v,r,:..r:r?..{:•.:..�:.•.:..l'...:.•:,'.•.:...:4...v:.:../:Tw{.:.4r.f./'.:•r:,b�a.S..L•,...t:{•'b.r.M:.:•{b.,..}..:.,r?.:r.:.r4:.rv:...}o w.^..::.}W•':.4...:..+.•,r•?Crr....:r r r2.M?v.rS'.r;,4f4:r.•..l:;i.r:r l:...•....i:},:.i..n...+.,:.•r nC...;v.,t.r,.{9•rr..r:4L.+:.e}4.4((.,.fi•.,•.:i.::{,:�}•.{..4.:r.::<....:t�.r.:::xV{•..W:.x x..!)S}:...n•.i,:..:....,•.:,n::.$.:....4.y,......:'$$...r..::i.;.Y{].r f.•..?.•t::..•,..,.;.b.i{,,,v.W{.W.....4:r,.i:'.r.•..:r;r..i.:,..'+W:)•4Y.r••.::.,rr:i.vv.i.;i:.:':.ir..ry...•.W Y:rv..:}.....f.v:W.+::�,.•'.{.•.;n••..•.:{•.:.,:,•r.:..:..fe.:$...t.:.•.r...r}}r4...v.f.r..{W.r};r.,....•},r;.;:.':.,..•.rv...l:..•.r.3N3n,4...F:..,•.4.r:..:.•..•n::.-:..•...f'v.,.;.;:,..v:..:n.,..}..:.}v;..:.`Y:.x...r•.:•,.:,.:S%;...::4.r:}•$..•........xh:,S•...,..a$:..v:..,..fr5.£.....•:,';.x.�.i.+j..S...:..•W,i,r:y,.rl:".�.r:•'{•::...•,:n..:...::.:•r:•,..W.r.}:4.:,.,.....••..i.{.Y:r.•;...:•'fi:£:'...f,..r..:'{}{..n:.•f.•:,.�n...£l:.,...,:•.r.?r.4:•.{.:r.r:•.r.•...:..:.:x:,,.r,�..i?,r}r:r..••+W...:,Y>n:+..,.or,.:r•.:.%,..W..::.n:.•.;.:...{.•.}•:x::.•..•v:..::.r,.v,.;,.n::.,.r::a r.:.&.•}e:....:%,::}.••.:•..Y.h.•.}.r.::}}W{{i.•.:,;t....},!..p:c:•..W:•...Y,...:\.{.::.^...tr..r'fi.•.:.}.fi;}..r;:.}:....,..;.:r..:.r:•x:•...r.,G:}..r.:?}.{..,'s,A<<,:!:..}...,.}.:W:}..:7.:?•n..r......•::r.'.?:•:::...:vrr{.•{4..k.....2 r.:..::•:,.,V:.}.,p.}+.rn.fh.Y•,•r.:..r,t:,•:>:r::l•.:::•-./..,•..:.::..,,Y.:•...�..:...:},}•,n.;.�.•.S'....o•.?:;.•.:r..,...SY.aY,h.:..4...c.fi•.�n.s:.,.y',n..••S::.F:5[+.•..:',.•...7...:....:x.v}•.%¢r 22.x•5..•Y:.i{^}r.:...4Q.r:•;....'.:.'{i,
r:^,hx r...::.{•:{.::r.t.f..;}••{.l.•:::;•.:Y..h}•:..:r//r.S}.{?i
}..W.n::::.i v•,ri..r:.�.:.':•;}:h....::�:{.r r�:.:{:+.r{::..F;:v;a.:.£:.•:,.}•,r,W.::ut..l.,.{,,.:r..'•�.:rx7.i..r.:,•.:r{:..+.w;:K}W.;::.{.'}.r•..:•.,,:.}.'....:�...?.•....W n:..n$r.£.:.,7,.:.,.,
:$.:.sf:..a:.;•s.r4::}..y{:•.:,.h.W';.{...,•r,.}.,`:,fi r}h nYx.••,•.}::4..;.!x..,.;.:4;.?.W•t•:Ysit i:;:}.`:.i.t}.•.•:r..:.:.:..:.::v•7.n..:.2..ut3•.,r.,.{,.,}.r•?1h..x..rS>n:i.x......::i....r<.{•W.<.,.v.,a:.,i:{':..•:.7.S,:•.W{L:rt:}r;,.:::..4,:..,.ut':.u...r{,•£..',r..f•:�:3.i.:}..•:.{:.}.•w,•.,`+..i r!,nY'•1�}:.r
�a•r7r':�i.:.:.:b•,:..{..::,•}•,,f.'"W•:..r•.::v+.•{.x.r:•tf.:.r..•r•.W:W•.:•x•:.ia}..!,...,r,.:Y:l.::.'•%:.,x>;•,:.:•:.:{.:r:.ri•,•ru}Y.•.,Y.{:.:r',.^4.xt:,.�..{r}:,•r,•..:
..••r,'}:.:h.`.}{i{.{,.h..•.:%.;rY....••.•...}{::::,:a:i4�:.:.•,£•n.v'}:,4.4...,af•xi:
{;']:,+•^•y.,{'}::r:+rhW?;.,..4a4}..:•r},)••...:Yy`.:,rWrQ,+.i.•.ra`:.:r,rW'•2{'.:rY.v.crh•ri$4+•..i.;,:...,f:x•`,h:+{;.t.S,Y.!r•.:::.r..:::•4.?Yn,�,.r•rW?;•.y.;}}•+t:.xy.4.:v•:•,,n+.,.$«c'{•£�}r,+:J;+r::f,...•i+.{..:.4 vi.}Yr4 7'%tv.rY,C.r•.,.:,:::•'4:;h.,.,??kY4::.s fvS:Y:L:4y:y 9:4.,•f,n;:y.$i::+:.
lC:::R,S}'fY:.s'•v..4:n}.r.k`.r'r•..•.}r+Y.r..{:.,�•:t.:r:r;:.S,:•i.•;?$;:..
:•';Y....?.G.}:;.+.W}::}.i i!t:.i,;r•.!}:,}n::!r''+v•!fi3{•l.:;:i+n'{.{.,,''h::•'}...:..•;i.•:;i{,?:.::;::.}:i;i•�..•••}..+:.$r.::f?:.,.:t.i;:vy,,.:.{iJ...::%Mf Vii.•:?:{}'{.rb{.•<;:,:r,}yr,..:.ii::?:a,::•.•.:,.''te.;:}{,..
W•:.•':,••.},:.•.•;:'•f.r..�
:<£'}iY..;.'•'.•:.i?}{':++;.Ya.^{.:,•w.:'.:}fif f:4
..�.•,+a..4;Y.:�::.,;..i{;::.5.{.t•x:.t4;?>;.,••':r....v::}.�:i.r:::{;:}.;•?:�{.r.r>.j...3..;..r;:+?;a:;r=3:{�}�i.:f.�:�{?Lk}r.{7'r.}Y}:.:.;.h..S},•...l.}��:'=?,,?;,;vq•r+^.{.,SY x
:�.v•..'.•`?::.;:K},.:..•
:•n:i:V>:£•1.:',f{'.?i:r:rc4`{,;yY+f';;r3Zn{k.f+^�77':.y•:a
•Y4j•''.:T,n;n}{.;•{::,.:f:.^v'W.#:r},r•r•;,•:.Y'.':}i.•;.h'C;t•`Y rer{•h:.<W;';:£:M:}y:.:Yr}�:•:�?�.�..r}.;
}•:}{.{':Y'}'i•n:;{•:W'r{.;:`$•�7HS...•rv.v?{.!$'}$�>'i:.v.•"?$.?'r.f::.S:r}i$%;33r;'':;�:..:#;'5$'{•Y.4!+{•:'Yb4Y+:tr y�:£..S+';.:,<'•;:..'''•::..::}{ro•F:,}}•:`'.+...:.}:x}'v}.•3L,r$.''a}:y.~iW`✓+e:%:r.r•.•.;•,:.:es:•.:<,:.•:kn{,;,.�:R:..•'�yr.?i+x..:},{'r4.:.t•:.S.;l:n•3l:t•x$ji�},r,Wr+i.��3 fi•r."3'{.n'5
�cS••.�•.%�:br..a7),+f.�•tWS 4:
�:}4{]]''�•:•V;•4{',i,'.Wnv.::'t{i'....•x:'.•};:+.:{N$.:'<F?;;+•'.a.�L:}?+r%,�Y;�•."�:Qv•W
icx^Yi.•':{•.4••{:f.i.:i',•i`9:hi•;',.•'}Y:..•3:;••..�''Y;g.'r;h?:Sr:•Y..,,.n'l.:..."3�,ix%.,r+`•,{<'.:•'.:�,:Y5rR?t
}}:
..,,�v3�.'•'.:s,rV•k.r}
^
Y{.,?�h:'�Y
+•Y::.',�N`r,rr'.;.Y
s:..54},...}L.•:�•.k.1.
..�}•>.
CO��en•saon Polices: a•, •:x.:}i `,{s,
the following
�`�
1 §Yti.
•.L ..r:{.,....•n n ;..::...W.;Ax:r.-
Gar.4...::r:..n :i$£':4 y} ;:•y.:•.%� ' <
:Y 3� >3:
.» qfi:1d :ee •f
�
n:A r{ / d' $.
{:r:.W•^+�::•}i•:}+
rr{%{%,.<'•Y•,{tr$�
tr's�:}r•.b+r:,;:r:,;•'}}:::;:.$•Yy;
.S:•
t
t{
•..
•,'•
fir.�,4..�{'r]l.•.n;•t.,:.n:3.;{.nJ:.;:vti:•.in:.}.rr.r.•4..'r:r>.:.:.',>::.;.:.L.r..,...,..:::.:.?}..:...rn.•../....n:...•:..;.:.r.n:.:t:•r:!•r•.;.n..•,..::..:{{:.{.a•5•..}'6+.r•{.:4.:..4,.ti'•.:tr`..•r.:rr•r•l.,r+i..:.W:.:.,:.:...{'r%v.r..:..,;........r...;{.;}5r+,::•.:..}•..Y'.:..:?f.v.$.S:..::.v.x S.:,?.<.......:...•...v..f:.?•:."•,•;'..}f'b..,:4:.{..�,•r,rW..,4.
r•.i,{:•.Ar.•W S••..hv:a:.^.:,:•.:?{.ry;.4,??t.S.:{lr..ir:W.:•a.,..na.,,r•.:..,;..•»:•'.•.r?.l::..>;:•a£.+{+.;•;:i-:?a-ri;rtl?�:';'n'+:rvi�r:1..,c:o.:a}3.•y,,n C v?,C�:•,x.w•:k..r::5':y•,.?+r.W;..t.h.;;..:?:,!,!:ra::S•Th't::r 7::xtt.�$:!!•.•.,%:fWiri:.,h.•;f.:Y'.kpr`..r:`.•.r.'f,:;�'i}},i}
c:..•�hy:';..x,y.:r:C}o•F«:`•}W,3r• •i.•Y ix. W v?
...... ;A !, .Y;h'6%+..vi f..':'W�••:-.•�•'bY!,i4'}f•�.'::3,7$o?�•br,i,:
r:
.3.
tt4••.{
i•x:'4�•:ah5c£yW:W.{:,}:{.........,:.
:::::;{4•:+•::r:::,.;•}:r:4:., /.b:•n:v•:W'•:x•,•/....::?£}l•.•:+$:•y:•W.4:y?:5.,.,{r•}?:.. .:f,,:•y},?:5.,$,.1•::.{;{,•:•a}}•.:..riit:r. , ' {..t{}r:yx;}:;.Sra:.E }
•'•YW4}rr'•.,.,:3s.,•::n+y:/••;:•.r?.::;.�}.•}::}S•i••.'45.,:,:{•:::.:n+,•4.rf,•r.+,:{:k. �:u:L:••vhr'k;S.;.. +.;„ax. n.af;•
.7.;�.';'.{;+...WW.�L.?:}.7•�l:.i W.,..,,n.'.aW.W:?ri.r:;•:.:.v......v.•.,.rr::.t••'..h•Q,^:.'.•:n:.,..:.;r.r.:h:}Y••:Fr:4.•::::}{:•;r:;,V.�y.?:..,'$.;..'4.,K..!h.;'.�..r}::l:•7f•.ir.Y.i...rjY5.?r:•.,:Lr?>{•S•r+rini:•;+W•Y'i+Wr•}•::{•.•v•Y}}:••.,.,.{.}..xr,r,:•::.:a?.t S.4:'Y.:}.:•,:7
•n.>v:.'.`}..:x•..:.....•:.,{:.•}?t:i{:.::+?L.r,}�a;.„:..u}Y:Y.:{••4.x.W,¢.,r..:.ir{:.�::•a i{:.C.r::.:.>:.'.+:.;.::.'.b;.:r.+.::.r.•:•.:.r.r•:..•S'r..
.;'ir.:,.rr.r`:,.•::::.!.::r%?.:vY::r::::f'Y.:.•.},•}}:;.,s•,'5.,•?•.•,:i?{••.:{xS.:S:.•?i'•..r•{::..::..:.•...'..•:.4.....1].'.R•...,•;:...yY.:•<Y$::::..:::.':•,?W'S•0ST},1:;'?3
..•:<fi£:: ...:........:.: w
•}.f4}•.7.:•7:+}.:7±l.}..�i.}v,}:s•%b":.;'r4.:.t;:ir:�.,v,::,••c,:.1Si.t•.{..::
:+..4}.:.3rvY f.�?}4yJ••».nr.;�'..{�:..�:.vr?i;i,$t'??
�YJrT�P;r tz`•'.i:•:s.:5T}.�r:3x.$:.}.{r i}S.}$.b.::?rif:!,r.4y:.,i!f.•Q}.S::+�{'.Yr.w.!..$:::.:}`S£f i•.:L:$:k}h,,;n5av•.�,:{{:r:.:'r:'4.:;.'..1..'.;{+9.,!$,L.}:A;.'.'%.''<rFiYy.r::•
ti'r:Wti'F,t?.,S,:•h+5•',;.t::W%.•?:4s•3n:W:•:r i•r.Y,vr.vY,v„r;.r.?M 4•t�•Y•£•••„,.f.:!:rY4Y.•;:;i.}vVM3;r�'r#�r•,�J'%cGL1117,
IIII ....n : �W�'�SrcY;�4>%/••�3°n'
<,/•:.:.•`.Y}:,A�}.�Y..
<}..F.r,.•,rt;
..r
:.r•{..+!!.?).:.}.•?'r::..;.S:+rr,.n:,::•.<•.,:.:::f...t{.::.•.Y:::.'::.r:.,..;Wl..,?•:}4•:. .,Lh:.•...:r:}.�::.:{.::$•W,;,...},.}:' a.r::r,•:W...:;..},.,..:..:•r:.•r:W.......... .::+..W
S4•:lrWb••WL:,v.:4::h,:,l.{n.•{w:r•+ O V••m:•.•w;:•A...,i};:{•....;;,r•..•:A;::; :.;..:,•;:,S.;}.... .Y.:::Wi.x•:fix•..:a.v v:W % Yt.. rv:r::r.,...h..in:....
}.•. •:r,v...r/.•r..:b..t:....,,:.,•.:.n{ :n•:r!•...r.:..:v...rv::.v.:.r,:.. ?4.....W,•t.•...£rx,...{....;}.,r.,.... .. ..?.Yi
.,•!' ...{:.......... .,.:f. ,i.. ].... r... ...$.:4:•,:L•:::.:v;.;:..,.:}}:•.:.
:r;..•473 p Cy.!t.:,'4•{...;...+.v....'!r,.-.b..;1..•.rr.r..rd3.:..e..r.L.::v•.x:...$.r:/.rW..'.t...W.S•:e.7..a..::.x};.{......sh•:.:r.r{}..+r,n?.•s•F..;n.•..:.,•v:.,.r•.:•.,,....:yr.i.:n.:..:.1..•.:v..IIr:..,n..:....•,.....:.I•.:Y.£..:r►.....�.,..:ry.....;.;...r::{..r..:..••;{.r......•.W4.:.....:.�...........�r..,..r4..y.r:(........,•....L:nr..l xx..:..,{...r.;........:.:.:...ir;....v......::�...�,.>r...v:.,3.•;r.'.....v.•O.;'.•.W..:r.{.:4..u.;.::,....,f 3.):{..r1:;t}...t:.•.::,:.:,,v._.•;.::..'{.b.....}.".r..,f:.n,:u..r...k,:}...:...}•....:..r.,:,;...r•i:::.x.7•r..{.:.:...n:.r•i.Y..:yn,.:,•nr..:..::+.r:nr.rJ•,..;r.,.:r.::.•..$..:..::r......:•:.....r...,.+...:frn.n..r t.,;...r.::.:.:S...•r;.:.:w.r:••..fi...:n:.x S.•l.•r..r.•..;.M.{:..•:.,.?r.•r\..:.••..fi.:..•L..r.,::,....•4.x...;.x::.....:..,?:.W:i....•....•:.:..):Y....£Y..::;..'.x:•..:y.....:.i..:.£.•'nr.,...r pl•:...:!.l...n.:..•$£...:...::..Siv.....•..,...:.i'..vr..}..ta,:::...•..:..;.$.:}r,,!�,.r.:..:•...:::....;:.:a.•:r f{?rv...:..r.{.:}.:?n•.:.::.;]'rW.:1..w.t:.;ut..:{•.:.:...nv.:.r..{:..,..•:..,.:,:..::.....r4.:.:r.•{.:....S.;..;..•..:•,..n{,..:}.S4;.W,•....:,...x..}•..:r.:.::?....•}.x:"t•...•.n.•..v'•vv...•rW,.:.'x.••...'..:.:.:,:.;t.,..Y..:•Y.:..{.x,,.:•:..h.Y•S t.rr...:::...'..•.V.•;:..:n..i:.,r.....:•:,.•:�...:'n...:h•.+...:.f.c.:..:•i.:..n,..4....:•f.:..r.•r r.,}.:•....:v.r•X....,.x:....:.!.....v..:r:.:..W.....:+.r,4:.a:........•:.:::$..:7:....m.5.W.,rf.:•.....:r.:..::.•r!_.{.....:.4v.v..rW.nW.v..r::....}...'...::...av?.vY..:W•.4:7W..rr...:..}..}A....:.i..�.r4v...r:S:..,•l..Y.vS.....F....::n,:...:.r..:::.....}.,...n W.,;}{.•..:n?...::•...h.•4:Y:n?{wr..:.*..':+.:/....:...:.•.:.:{..:.•....•:o.:}f•:}.,..;.r.,.•..}.r:.;:::...£:.;.:+r.,...,..".{•..:v.,..::W..{....?S�,.:.J...;::4..r....:.;a;...,.'•..:n::r:....,.rr;•a...r:+r..r,...}r...:$,..,.....}..}..•:.;r.r.:...{:vr.
..•n::$...,r:::..✓}n:}..r.,..;?.9.r:,.i•.•n'..h..t x?i..{:....Yn$.+...v..nx.r.>.?.:...ib..,.;..•{v•.,•::..:'..f.:.•..:..2..•..}�.x..,$:.....r....:.a:...,,,:.,:{W.
x.}v.WW:J•.,.£}...:':.:•sJ.r:`^•'m.••.:4.•..:::r:r+::rvv...^:):.•.:.,•:vr:.{...rv/$•{:,!+.r,.:.•:W:.•;:Y!vr•''v.}::4.?v,:,,..:..v•n}:v•:}rh,.:rv:7...:n.W:,v:;•..r•.'::,;YW+;:.{..•i.}:;.':•.{.:.r,rW::;:•.{.::.:./:.,':•r:f^•.�..i.t}:r'••+,...•},.£•,:}.'r..:,•}..::J•',..::,.k..+.:n..?Tw..}:•::..:...;.•..{.:7.....:$:•.•.:.•h.:.::::'}{
%.r...:S.::'n:•.+2.r.:...i:?;,•:.r{.4:.:..$:n;:•7v•...:xW r•,:t{.:'v...n.:;.:w.ti•.xn.i.:.r fir..+r•r....:.n..:.J...+.:.•.{
.n,:.}.{$f..l.:.,},•r{.....;.2:.E v::.::;•}:;.r.::.:<,:;.vF.s,:.�',•,^.'?\^.•S{W•::.::,t:;:}}W..'4++:}r;•s.$.,•v:},},i•.Y{.:,f{rYY:4:.•r•$.•').:r,:.•v•S:}}::r:v•?}}..::,:;.{:};.i.:W.h::.•::ney;�.;W>'•n•:..{:..,b:•�+"{,v::{:'.,::•}:,.•:.?.::r:..-.+a{%.frl...}%::v:r:+'....•+.fY:r..:....'.;:x;?r:.¢.•..Y..?:•?%;{v:�.::i3nA;.:'{,.{''i•:{,:•r•sf^rr:.r:;:va4:{•4Y{'{r•rr:;.]:x•}ri},.•.v:,+'i}:;::
•.+WS;'u r,:r�<
r.r:r,ti?"rr:i n!'i.Tw sn.:.C:4•v•{•.�.i:•.R{.,+:?"?:;,•.}.;{}S:•:•p�v,"::r�}•.•.:':$:.+4•�n{+.:•..�`:}...:
t?Yt
:x:..!..
...............
t { %.•?.}:.,••..,:.a.h•vva}•;?}dV{w
}r:f.{•:Y..:::;:?;.••ZnY.:{{•r'..,+'�{rf•.;;}4v:.'
r$rY
•:!Y.,...Y.t L?.';:•;::$},•r
}r 7n.h....,�..
...:::. s:•:y:.}.v's,'',..r{�i\fs,T.{a7,rc;•':r:'r;.$.?r.i+:'r•{.:i4 r•..}NA.'.'
.J{?4},in.t•s.h5,„r}y{,'h•vY}.•o'$.4.>•";^Y:r!4�;•I•!'.Y#^••'"Wyi:4`i;,:.�"�:.?Wg,•fa:v<:Sr.':77:•{:`'.r}..•}.Y?'..}•`?+.a•;.V.%}.'h.ra,v
;�{h::,,•r:'.C.{:rK::Q.::4wY::x,•v}+%.}.S':r
yf.;'{}L:.$i••;:ti•:{4i.':rn?rw4 siF;•v.•}r:•.•£;
•.:i•.y S`.,]•:,r•S.;c
,
]?.
':,?t y.. .. 7 d
.�. ........::.....n: •....r...n•.....v..:....n.x....,,•....:..............W......tvr.,i..,....:...:.W.:.,v.SW••.:..,.},:'•....,..:r 4.r:••..n....:•x•.•.......:t:v rXL,{?r....,.}n•'•vlS:•r rfxv:n+i;.}:{4`..:.v,}r:.,:.}Y:.
.........:r:n•::W4::• ::::Wv.?v:.•}:•::.v.:vn:•:::.r,.,:W:••;f.:?•:•:�:•.:.v:};nv v:r:•r•xfxr:n•.:;}+v}+.vw.v:r:.:.:•:::r:.vn};.h{:•:v............ !.,r::..}.. ...:.... .;.,,•:}.r
•,:::.,:.,•:,,.{••:...,...:+.{.....W,:::W..:.:,::....5,,:•:•....•{.,.,,•..W{3;,.....••}r....,to.......r•....:..;..:......5.,:::::.....:...:.....{.. ^:Ya:::.,•,.:.•+:.5'•: ::..•..w;.?:,{.....:...r.. ..,.,;r,,}•F••.r.
�::• ..n:.r. .:,+':.,..w:n.•:W...•:•:nv:.. ..rv.:....•:r:. .+•:•;:...•:v:Y::......:x.. :v.•W,•W:^v.r..:. , •::lW y ..'.•i +$£{:}WY.a�y�.
:....:n.r,,,•..n....:....r.r ...r..fi......{!••.W.....•:...r.}}...:...n:...•.•. ..:•W.:..?:4.. ..r.x...•.:r:'+::•::r;:.... 4.::rrrit?•W' �Qll¢.. •:•rr.•........ ..`....r..:.....:.' } :.):.
•..Y W?:••.....v.,.....,••.:..v:r, ..r::..:...•v:Y:,..••.r:.,•..•:::v.vn-Lr.;;{•::..h::v... :.2Y Y:•.d..:•;..;,.}. ..;W. ,,,+. : !.'r.':r
n.xr..r....: ...� .::.... :r}.. ..... ......r ..... ..... .,.. ... :•.rh- ..,.... x:W,{. ...n....• r..:. .,vrL•:L+.St•}+'+:$r:,r.•:?•:{•:•%$$'4'}'{:','�.••t�':5:;:.'r:?'4.:7•t.ry
r.,.. ..x...,.,Y:n.r.;f.....::+:v..{.;;u+•...W;..;,...•::v....•vx•.•.....v:.:.:.::•+..•...}h::.i..:.+v,•:::%...... .. :W'V /..;,Yy..n 'rvni:^:h+rri:'.
v .:.:r..,.n.4.r.,.v..v .....Wr. .W?,.:..,.:.v.n:ry .:.n....:.. :...:•:h..::v.,,....,v.......... ..:....
r...£• ...... ,... S. ... .. ....ur....r.. ».... :r.:. ...{... ':•}l:::•:•••;rw:;::,,.;c{':r7.:•Srx:Y:?S�Y::Y:+/.,4,6.}.:..,;y:•r??{1,:.}n::x•rv.:i r,
Y.r.�... ..r.....:.,.........i4..v:,...:... : .................•r.....: .:.......r..n... ........ . ...rr.. ..l.....}+t.`.....r..:n .:::.^,i.{}r;•r....r.:'.:::4:' ':i}}}:.}'r:{r.?{rr,.yi:•.r:•+}:� •n•.;5:.
{.::•....,•%+....:.:... :.:...r�:..:!•. :, ,...;..:•...i.4W+.•;.......,..• ,'•.W.::::x:rn.:..;Yb:ri...{::v.
..r.... .....:„.:. .. .:r: ... r.r..... .......;.;W:.�:},•,..... ....... .:.... r.}{{?....r::r:};{.:::•.::•}r•}::}.•,!}r.,::.,.:}•rut;:{�4+::::ry:}iS•;iiw}'.,.;.r.::..a_:i„+•,fit:a.y'?.
.v+.(•:....;•::{•...{w..::•:,.�.. r..,. .. .. .}•!,!•:r n ?r.....:...�;?L•....:Y.vx.•.r;..r,•.+:x4:. .•:l..r. rxv:••...,.�.,..{:v.:..:vv:::avt...,S.+.,rr:;v..•nv:A'-v.:.�.�{?iii�i r;�•;
r .:..,n•:•: .:.::+.....vrnv..:rr..F.. ...v:::.::x:r:{•:{L•'!?i.;.•+,..v....,{r......; �.;.......•:::v.......:rh.,?
........nfi•...rr.... .........::::•v .........:•:W.... •.:., .,:::•1...:......:r...•:v.. r:...... ...x,.;{.}$: :,,.;;,yy.y:.vT•xn x.•.v;.,,!_:•;:v;w.. p•r}•v:•ir:��•:],, •+£• '
..v::......... .... ........:...n:,.,.....v,,f.Y.•......::......;.t.....}r.. ..}::•:•n.!. :r.{v.:..T..: ;W. ..:r:•:::Y.r..:.:+:4. ••..
.L'k. :::ti:•.:4.t+r:•r.,:. : r. ..4.,..... ...Y..�•:•::.; :':;:1;.}:.?;h?':f'•?�$if,';''t+.;.,;:.t+y?;r••}i:.:,i,.s<rSi:r�?}�rF;'$•2.,yc
...:...,v.:•v.:•y,,.,...r•::,.:!•:c•:.;.,•::..:::•:•:::::.+r:,•:::}•:::.:.:•:.,:•W{7:;L?.:•:W_...,.., .r.W,•:rW..;. .};Y?}y'.o.,;.......'�..?'$.....7..WS.,
. .....:Wv;•+*..;,•+:W.;:^:r. .r{.r•,+,, .}r..S.W.n.•x:;::.t...::r::,...n:!v::..•r:x.,v.,..;:.. .v•.h:•::'•??$$}::..,..�}4{Y.i•?T;Y;:Y.•., n.,{. :v:J•{;:.i:3}y ,•:'•}:n.h..vl.•.\.r.:�.•:::::W+.•..x.,,:Ar{•:v:.,..., ...f..:'':•
rvvr;Ww'+.?+v.:v,$•.vn,•:••:!L:•Wrt:p:CJ'WrW{•1.+.�•r.4S}Wv:::::{.•::v.•Wr•rrr::rv:::.v:::W:7::v:xi:{hAi•,y;p:•:4.}S':,vr::• }3^.:'hv.?£;�.v ] ?h'r.•:r..#r}::{•:ir:}.{r:.:w:::}':_...
Y'•Yi'4'}:4;rr:v}}}:7:{!{•}i}:$r{a'r:•l:xi'+:.ijr:/,•:r,{{•::{rlrr}.ri:a'�•:},•}.v}$+:r v.•.t.v::?,..n;.;. ..:.A.:£:n.{L•:••{4:•. TT22�� ��yy,.....
.,:.}:":•::•.•,;r::::r} ::•:•r.,,.•.•.:•.}•},r<,.{.�.{:,..,,..•/}}::t•::?:.::WW:• ..-r.i•;:.,,};:s.i;{;•};fS:•}S?S;r"•%F;°•:.`. :..::rr �r{aa�•S:<•'r,•.5:.}%}:.•l3LiE.•,ir.••..
r}•air'..]:•^L;? •}•%}:: ;:$f:;.{•}x!•:•:4•.,fi..$:r{.;.t:•}r::}Sn:{Y}r:$i}$:.::.;$}t!r3}•.'r$:•}.?e{•:...;:•.......,.,....r r,::::4:4•Y:::....Y.•::::::.....
f ;;;;:}f:??.E:p<;,;;:?...}:yn;;:?;ar:;'`?{?,,.;•:'y,r7+:'•::,}i++%,•.:•,..,r•:::rW:r::{•:y.::,:::.,::.?!+W:c.:i:::::.:.:.
............
enalties or s ffine np to 51�OU. m ar ,
Failure to secure coverage is requirednnder SeetionlSA oow
f MGL 152 Caytlead to theisnposition of eiisninalp _
ors+iin rison7neat as tell as e1 penalties in the form of a o the 0 r�� gL theey oon,UO A dap againstma Itmdersfsmd thsit A.
one ye P {� be forwarded to the OMce of InvesttE ,• -
Copp or Phis statem y
--- Yrb �erti ndertk e�ains and penalties-of-perjury•that-the-information pro-vide�Labaue_islrsresd correct
I do here y f
Date
Signature -,'r - •,'. Phone# -
Print name
do not write m this area to be completed by City or town.
of8.cialuse only .' - 0Buaaing I)epariM-Td
p ermitRicense# ❑Licensing Board
city or town: - []C e1_ect;nea's OM",
"
Contact 2 era M.
.Information and instructions
c usetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
viassa h
ees. ..As_c�4fed fromtbe"law17 an employee is.defined as everypersoainthe service of another Y, .•
,f hire,-express or fin-plie or or
-- - ..
layer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of
An ern P
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&anthree apartrnents and who zesides 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 ontheroimds or
building appurtenant thereto'shall not because of such employment be deemed to be an employer. s
ocal licensingag
ency shall withhold the issuance 6r renewal
MGL chapter 152 section 25 also states that every state or
c uildin s in the commonwealth for any applicant who has
of a license or perrnit.to operate a business or to construct g
who
br the'
not produce4 acceptable evidence'ofdbmdpli one wi shall the
into any contract for the insurance coverage 1perforznance Additionally,ublicc work until
commonwealth nor any of its political
acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting
authority. ,•, , .• .. : _-. .. .• .` ,.. . . .. .. ., .' '". . ' ' . .:.: ..
Applicants � ..
P lease fill in the workers' compensation affidavit completely,by checking the boxthat aapnpe tall affidavits maybe
supplying company names, address and phone numbers along wlth a certificate o_uisur _.
snbmittedto 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 thee s��d u have any questions regarwn that the application for e perrnit,or ding the`7awcor if you
b requested,not the Department of Industrial Accidents. Y. •
eing ob}aiii a�torkeis' compensatioi polioy,please call`ttie Department atihe number listed below::
ed,-to . r;
are requu'
City or Towns
e that the affidavit is complete and prizited legibly. The Department has provided a space at the bottom of�he
Please be sur eat the Offi g the applicaat._Pleas e
affidavit for you to fill out in vent office of Investi ations has to contact you repar
ed as a refeieace numb'ei,�TTie affi' vits
b e sure to fill izi the.p ermzt/hcens a zivanb ei which wi1Lb a us
artai by grail'oz FAX unless,other arrangements have been made:' -ti
theDep .. .,,.•
vesti atiozis would like to thank you in advance for you cooperation and should you have any estions, .
The Office of In g. ,. _ .. _! . ...,
please do not hesitate to give us'a call. _
/MINIM NO Ol%////////////%%%///%//////%%%//////%//////%%%////%%%%%//////%%��/////////////////////////
The Department's address,telephone and fax number. v_,,... •.
- The•Commonwealth Of Massachusetts
_Department of Industrial Accidents
' - p�lce at 1nYestigatlana .
600 Washington Street
Boston,Ma. 02111 ,
far#: (617) 727-7749
RESIDENTIAL BUILDING PERMIT FEES
APPLICATION FEE
New Buildings,Additions $50.00
Alterations/Renovations $25.00
Building Permit Amendment $25.00
FEE VALUE WORKSHEET
NEW LIVING SPACE
square feet x$96/sq.foot= x.0031=
plus from below(if applicable)
ALTERATIONS/RENOVATIONS OF EXISTING SPACE
-342\5- square feet x$64/sq.foot= -3' j3O x .0031= /00J 0
plus from below(if applicable) '
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
The Town of Barnstable
Regulatory Services
Thomas F. Geiler, Director
Building Division
Tom Perry, Building Commissioner
200 Main Street,Hyannis MA 02601
Office: 508-862-4038 Fax: 508-790-6230
(
t
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE: Al -L
JOB LOCATION: /
number street / village"HOMEOWNER': S j S O �—. 6 O 7 �_-�T/lpp
D d
name home phone# work phone#
CURRENT MAILING ADDRESS: "
city/town state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or
less and to allow homeowners to engage an individual for hire who does not possess a license,provided that
the owner acts as supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is �.
intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or
farm structures. A person who constructs more than one home in a two-year period shall not be considered
a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the
Building Official,that he/she shall be responsible for all such work performed under the building permit.
(Section 109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and
other applicable codes,bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building
Department minimum inspection procedures and requirements and that he/she will comply with said
procedures and requirements.
Signa re of H 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:EXEMPTN
FLOORPLAN
Borrower: Mary White File No 01050117
Property Address:310 Lincoln Road Case No.:
City: Hyannis State: MA Zip 02601
Lender:Cape Cod Co-Operative Bank
t-- V, ,
I CIO �.
I ®cc
a
jw
C7
edroom Vqzso�
' w
Second Floor N 4� iL" W
ca
c m
Not to Scale
34'
Bath Bedro m
Kitchen
24 24'
First Floor Living Rod
Bedroom
')A�
FLOORPLAN
Borrower: Mary White File No 01050117
Property Address.310 Lincoln Road Case No
City. Hyannis State: MA Zip 02601
Lender.Cape Cod Co-Operative Bank
L4 K ACIO
f
DOX
m r' r- 0 -0 MMM ! 1
t00
aps, = � � 0 �
>innmmm �` '� Broom
Dn ® �.
z04. M
m m 09 Q Second Floor o
-r>I > 0 0 --1 0 m
T � r- � �1 h-
5j M 3 TTI
m0
m � 0 ��
vGs ,
Mz (nA M -_O
rrt ® M m --� 1a rig Not to Scale
z -u < O -Ij M 341
;-
� CymeM +0 � iot
O C O z
C (r, M --4 Bath Bedro m
� m Kitche
n
C. 24
24'
0
First Floor Living Roo
Bedroom
- O
rf A 1
1
� Y
��
.�
� � � -
�.
� n
-.
Y
1 ..
r C.
j
.. -t ` �,
t �
� .''
�,.
A 1 �
I
TOWN OF BARNSTABLE B ICATION
Map . 7l Parcel 0 7® UG 1 7 ZVI ermit#
Health DivisionV9 ate Issued
Conservation Division (9 TAO gY Fee '
�Ir of 4
Tax Collector `� / SEPTIC SYSTEM MUST BE ��
LED IN COMPLIANCroI'FP
Treasurer ' , INSTAL
WITH TITLE 5
Planning Dept. ' ENVIRONMENTAL C00- 5'
TOWN RECULAa V_ �•_
Date Definitive Plan Approved by Planning Board
�
Historic-OKH Preservation/Hyannis
Project Street Address t i n Ov bo
Village 040AI
�dEr��Y urroy p��
Owner Address !3 jn 11 n /to /� . /115
Telephone
Permit Request odQd " v r -h-l-k e-
down 4z) 5-4;u6 Aiv [ticJA cuLnc_7 I Ac?,eleLic . Nui
� .
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Valuation Q SO - 0 Zoning District Flood Plain Groundwater Overlay
® Construction Type
o Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units)
3--me of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No
O Basement Type: ❑Full ❑Crawl 0 Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: existing new Half: existing new
zi Number of Bedrooms: existing new
Total Room Count(not including baths): existing new First Floor Room Count
Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric 0 Other
Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No
Detached garage:❑existing O new size Pool:0 existing ❑new size Barn:0 existing ❑,new size
Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑ No If yes, site plan review#
Current Use Proposed Use
BUILDER INFORMATION
Name V Telephone Number
Address (o`�LS 7U icense# (20 -71-/O
Lt , Home Improvement Contractor# 7W
Worker's Compensation# W Cl3/ -0?
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO WOU i ) 'Alo�L
SIGNATURE ✓t.Q�'�CQ�:�{ - V DATE
FOR OFFICIAL USE ONLY 1 T
PERMIT NO.
DATE ISSUED
MAP/PARCEL NO.
ADDRESS VILLAGE!
OWNER
z DATE OF INSPECTION,!-
FOUNDATION
FRAME
t INSULATION i
FIREPLACE �- <
IEL-ECTRICAL: ROOD,It _ FINAL
t,PLILMBING: RODGIrl FINAL
GAS: ROUGH-* FINAL
FINAL BUILDING• ;" E '
DATE CLOSED OUT
ASSOCIATION PLAN NO.
: . The Town of Barnstable
• ,eaNsr�. •
9 MAM Department of Health Safety and Environmental Services
Building Division
367 Main Street,Hyannis MA 02601
Office: 508-862-4038 Ralph Crossen
Fax: 508-790-6230 } Building Commissioner
Permit no.
Date �o
la
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 adjacent to
such residence or building be done by registered contractors,with certain exceptions,along with other
requirements.
Type of Work: ild:b Estimated Cost
Address of Work: 3)o �tacrJl/'1 �- 11 n13
Owner's Name: Mago
Date of Application:
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
pJob 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 IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A.
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner.
IDD�
ate Contractor Name Registration No.
'Apt zi F6t"f, t V9Vf.MEut
OR
Date Owner's Name
q:fbnns:Affidav
The Commonwealth of Massachusetts
Department of Industrial Accidents
-- Office o//nvesUgaUons
600 Washington Street
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
/10 co
city ITC.( &.n c s phone# / /"Z6 7
I am a homeowner performing all work myself.
I am a sole proprietor and have no one working in any capacity
X�(( I am an employer 1.providing workers' compensation for my employees working on this job.
company name: � q,0J zz
(, tit/ al Ai
city_ CQ l -c T" Q �l03 5� phone#• 6�z)
• insprante co it C��rJO&15�M?tt :C7AJS �Q- policy tt C. P`I 5 tP 1 Q t,,5
I am a sole proprietor, general contractor,or homeowner(circle one) and have hired the contractors listed below who i'—
the following workers'compensation polices:
company name:
address:.
city..:. phone#.
insurance CO.:... oli #
company name:
a ress^:<>.:
city phone#
irisuranceso. policy#
Failure to secure coverage as required under Section 25A of N1GL 152 can lead to the imposition of criminal penalties of a fine up to SI.500.00 and/w
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and it fine of S100.00 a day against me. I understand that a
copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do hereby certify under the pains and penalties o,f perjury that the information provided above is true and orrect'l
Signature •/ nlLa P -� Date C�
Print name �LbC9 t UL 1/• K�S� �. [ t 1 ar d,/ •.L Phone# d
Ccheck
ly do not write in this area to be completed by city or town official
permit/license# I-(Building Department I
Licensing Board :
mediate response is required QSeleetmen's OfficeQHealth Department
n: phone#; (-)Other
(mvised 3195 PIA)
e,� Tie -(�anz�na�uuea[Gs� �•.�v��cfu4ett4 � I'
* BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
ie Worn-,nay:weal!!u�illaxac%rue!!a Number: CS 057032
HONE IMPROVEMENT CONTRACTOR 1
Registration: s , Expi�Qs 99/26/2901 Tr.Oo: 5742
a 100740 x ` R�strl' te�i To: 00 t
Expiration 6/23/02 '
Type: Private Corporatio THOMAS X CAPI7ZI JR i
280°PERCIVAL DR'
CAPIZZI HOME IMPROVEMENT, W=BARNSTABCE, MA 02668 Adr i. trator'
G� c o Thoeas Capizzi, Sr. {
1645 Merton Rd.
ADMINISTRATOR ,.,... -:.., •,.n.< ::.._....r
I
Cotuit MA 02635
-
✓tze �omvnw�u�eicCtl. a A.4J.04 etla
n i/cc Ca�wrrw�uuerctl�- n`�< Caaaao�zudeClJ j; " s BOARD OF BUILDING REGULATIONS
DEPARTMENT OF PUBLIC SAFETY License: CONSTRUCTION SUPERVISOR M1
r f Number: CS 007454
CONSTRUCTION SUPERVISOR LICENSE
# a'3
t Number: Expires:
I
I, Restrtcted;7o. 0Q I. II i Restricted To: 00
THOMAS CAPI711
FREOERI(K V:: .RRSCH III
I 1645 NEWTOWN RD
**� T+ r1060 BOURNE;RD COTUIT, MA 02635
Administrator
I
PlYNOUTH, NR 0236Q j l
RESIDENTIAL BUILDING PERMIT FEES
APPLICATION FEE
New Buildings,Additions $50.00 no
Alterations/Renovations $25.00
Building Permit Amendment $25.00
FEE VALUE WORKSHEET
LIVING SPACE
square feet x$96/sq.foot= x.0031=
plus from below(if applicable)
ALTERATIONS/RENOVATIONS OF EXISTING SPACES C1
q q square feet x$64/sq.foot=I 00 x.0031=
plus from below(if applicable)
ACCESSORY STRUCTURE>120 sq.ft. I
>120 sf-500 sf $35.00
>500 sf-750 sf 50.00
>750 sf- 1000 sf 75.00
>1000 sf- 1500 sf 1001.00
>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 ��n
(plus above if applicable) C d G \
Permit Fee
00
projcost