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0033 PILGRIM LANE
�� kP a i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION b3Map Parcels Application Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Address Q Village f a��IS OwnerIr1ilQ `IZ..t km 1y y_xi Address 332 �Y1M► �i ,s a `1 lath * 643v Telephone (.Q v Permit Request2� i�sr�rr ,ee �.9/haQc ,6y .��Mee Ace o//eu��,dacus Square feet: 1 st floor: existing IML proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project ValuatioT FAeM Construction Type 2 14 Lot Size 0, ly Grandfathered: ❑Yes ®'No If yes, attach supporting documentation. Dwelling Type: Single Family ® Two Family ❑ Multi-Family (# units) w Age of Existing Structure Ce l Historic House: ❑Yes �lo On Old King`is,; ighway: Ye6 o Basement Type: ❑ Full Ycrawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ffll 61�7 Number of Baths: Full: existing 1 new Half: existing new? _ Number of Bedrooms: �- existing A new Total Room Count (not including baths): existing $ new First Floor Room Count ) Heat Type and Fuel: ZGas ❑ Oil ❑ Electric ❑ Other F-4A Central Air: ❑Yes MNo Fireplaces: Existing I New Existing wood/coal stove: ❑Yes L1-?46* Detached garage: ❑ Qisti new size_Pool: ❑ existing ❑ new si e Barn: ❑ existing ❑ new sizen w size Shed: ❑ existin ❑ neM Other: Attached garage: ❑ ee g Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ 'Commercial ❑Yes U o If yes, site plan review # Current Use deny Proposed Use Val J APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name IkLC1 kAnd"'V, I'a-00L Telephone Number S0,i 41 &1 0&0 Address License t) 1( Ay k'Q 100n&YoIJ Je kA ft b7i Z_ Home Improvement Contractor# Worker's Compensation # �'r'41 3 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE /0lw5?Z/3 FOR OFFICIAL USE ONLY APPLICATION# - DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER 6 DATE OF INSPECTION: r .,FOUNDATION, FRAME INSULATION FIREPLACE C - ELECTRICAL: ROUGH FINAL Q PLUMBING: ROUGH FINAL GAS: ROUGH FINAL P - FINAL BUILDING a DATE CLOSED OUT ASSOCIATION PLAN NO. f 0 Town of Barnstable Regulatory Semces r . x�icxsrtist.� �x � � 'I'hDMU F.GeUerf.Directo.r 'Building 7aMsion Torn Perry,Building Commissioner 200 Main Street,Hyammis,.MA 0260, w�*.Eo�y¢.b arastabte.Fna.us Office: S08-8524038 Fax: 50 8--790-623 0 . Property 0V'g1Cr mus t CO MPlere and Sign This section If Usin .ABuilde.r z, .�� , as Owner of the subJectPoperty Eby at�x11ai72.e . \lC������-t-• '�� to act Qn my beb.alf, in all matters relative tozk authorized byrhs btdigpernit application for:.: (.Address of job) of C*mer af� • Print Name -- . If bra e C er Pexzn Is a- I ` for please comp ete e PP 3' 9 p H0meQV MCrs, L1ceiase Exem- t ou Orm-on the reverse side. Q=FUR3rtSrO VdNEX3'�W�fT5570N The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: -T hU rn-ho n—J)r I Ul City/State/Zip: S Phone#: �O °7'7 - // Are you an employe Check the appropriate box: Type of project(required): 1. 9I am a employer with 4Q 4. I am a general contractor and I employees(full and/or part-time). * have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees. These 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.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ R f repairs insurance required.]t c. 152,§1(4),and we have no 13. Otr- employees. 0 S �G�[No workers' comp. insurance required.] RQi *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. xContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have . employees. If the subcontractors 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: ij��Q�} N1a4innc-�l =rr-�(1YC=?r,f e�� Policy.#or Self-ins.Lit.#: .��- �1O C( 51 Expiration Date: .I j 2 ob Site Address: �G� city r1ti /State/Zip: }�t{Q1� �11t S w 6 O` 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 forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby cer116 der pains and penalties of perjury that the information provided above is true and correct . Signature: Date: 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#: Client#:23059 OCEAINCI ACORD. CERTIFICATE OF LIABILITY INSURANCE FDATE(MWDDIYYYY) 1/02/2013 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 Rogers 8r Gray Ins. Kingston PHONE 434 Rte 134 EMAIL A/C IL Ezt: ac,No): 877 816 2156 r South Dennis,MA 02660-3700 ADDRESS: mail @ ogersgray.com 508 746-0055 INSURERS)AFFORDING COVERAGE NAIC# INSURER A:Arbella Protection Co 17000 INSURED Oceanside Inc. INSURERB:Everest National Ins.Co 217 Thornton Drive INSURER C: Hyannis,MA 02601-8105 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR 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 ADDLSUBR LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DDY� MM/DDY� LIMITS A GENERAL LIABILITY 8500053796 1/01/2013 01/01/2014 EACH OCCURRENCE $1 000000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occTurrence $100,000 CLAIMS-MADE F—x1 OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY E a LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED F SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION CF4WC00045131 1/01/2013 01/01/201 X WCSTATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $SOO OOO OFFICER/MEMBER EXCLUDED? FN N/A (Mandatory in NH) - NO EXCLUSIONS E.L.DISEASE-FA EMPLOYEE $50U OOO If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT s500,000 N DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I ©198 -2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S92190/M92188 CJF 1 Massacf'usetts Department of Public Safety Board of Building Regulations and Standards Cl�nstructi6n Supervisor License: CS-073097 PETER A 1LAR04qI1E 18 CEDRIC ROAD ' Centerville MA 02632 t754,, t.J Expiration Commr!s sic ner 11/03/2014 ffice.of Consumer Affairs&$usiness'Regulation ME IMPROVEIYt NT CONTRACTOR A . egistraitlo _ �_�a Ty- Expira itit _ Su0016 ent OCEANSIDE, INC.{v PETER LAROCHE �-r 217 Thomton.Dr Hyannis; MA 02601 Unders,cretary License or registration valid for,individdl.die only before the expiration:date: If found return to:. Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 r•arci Boston,MA 02116 Not valid without signature TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION I2 —ApcMap Parcel iation #Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee tl? (v Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Address 5 3 ?1 Lit-12114 LA blf- Village' > y A N A11 S Owner L® 11K 4 AL) C 114 L 01 Address 33LAYKaer A 6 Telephone U 14 U347 IQ I I 6�1� t Permit Request ACV® o o!l it/1wae �nd&v=5 1'l0/�161f/'/ Sul /da,c eolleei;y!� , &Z4 /I2TWI1S �i� �S 'ULl '� 71) 4e Square feet: 1 st floor: existing L062-proposed 2nd floor: existing propos i 74tal r�nr Zoning District Flood Plain Groundwater Overlay 03 .Project Valuation -Construction Type Zx� Lot Size 0, 114 Grandfathered: ❑Yes l!t'No If yes, attach su porting.ocur3;ntation. c- Dwelling Type: Single Family Y00, Two Family ❑ Multi-Family (# units) %0 Age of Existing Structure Lt 11 Historic House: ❑Yes [W o On Old King's Highway: ❑Yes Basement Type: ❑ Full ®'Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing 1 new Half: existing new Number of Bedrooms: existing new Total Room Count (not including bath-,): existing J� new First Floor Room Count Heat Type and Fuel: YGas ❑Oil ❑ Electric E(Other r Central Air: ❑Yes e o Fireplaces: Existing i New Existing wood/coal stove: ❑Yes r3<o Detached garage: isting ❑ new size—Pool: ❑ existing ❑ new size rn: ❑ existing ❑ new size_ Attached ga existing ❑ new size _Shed: ❑ existing ❑ new i e ther: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ®'No If yes, site plan review # Current Use T61!1(Il1 Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name ! r yl a ko Telephone Number 60� _441 3110 Address 1111VX nb6y() License # CS—®-+srT= t1l ""\Sjift oluo` Home Improvement Contractor# 166 I LI 4� Is ajj c`10 mknll I k M P 6Z(A 3Z Worker's Compensation # C rq a S 1 S 1 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Yvx Co SIGNATURE DATE F _ FOR OFFICIAL USE ONLY E ' APPLICATION# I DATE ISSUED E a' MAP I PARCEL NO. f ADDRESS VILLAGE OWNER t r DATE OF INSPECTION: a----,FOUNDATIONS FRAME c INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL .PLUMBING: ROUGH FINAL GAS: ROUGH FINAL 4 FINAL BUILDING DATE CLOSED OUT s` 'V ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents ' Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): ncear -�!)d-NE Address: 12 7h0 rn-f7'j rL-3)r I Uie City/State/Zip: 5 Phone #: `jC. 77 - // Are you an employe Check the appropriate box: Type of project(required): 1.9 I am a employer with /112 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees. These subcontractors have 8. 'L, Semolition working for me in any capacity. employees and have workers' T [No workers' comp. insurance comp.insurance.: 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions. myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.�Other I rl-�wioY' 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. 1 r Insurance Company Name: �EV C �Q�7" Na4innca( Policy.#or Self-ins.Lit.#: Expiration Date: Job Site Address: �161 A Lau City/State/Zip: h yG4 n ri l S M n G&JO . 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 certi der pains and penalties of perjury that the information provided above is tr �e and correct. Sianature: . Date: � d 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#: Client#:23059 OCEAINC1 ACORD. CERTIFICATE OF LIABILITY INSURANCE DATDIYYYY) 1/02/202/2013 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 Rogers&Gray Ins. Kingston PHONE 434 Rte 134 A/c No Ext: FAX No): 877 816 2156 E-MAIL r mail South Dennis,MA 02660-3700 ADDRESS: mall@rogersgray.com 508 746-0055 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Arbella Protection Co 17000 INSURED Oceanside Inc. INSURERB:Everest National Ins.Co 217 Thornton Drive INSURER C: Hyannis,MA 02601-8105 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR 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 ADDLSU—BR LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD/YCY EYYY MM/DD/YYEYYY LIMITS A GENERAL LIABILITY 8500053796 1/01/2013 01/01/2014 EACH OCCURRENCE $1 000000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occcurrrence $1 OO OOO CLAIMS-MADE E-x1 OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/0P AGG $2,000,000 POLICY J`E j JEC LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ALL OWNED SCHEDULED Ea accident $ ANY AUTO BODILY INJURY(Per person) $ AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OHIRED AUTOS AUTOSWNED PROPERTY DAMAGE $ Per accident UMBREL A LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION CF4WC00045131 1/01/2013 01/01/201 X WCSTATU- OTH- AND EMPLOYERS'LIABILITYITS I ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $500 OOO OFFICERIMEMBER EXCLUDED? a N/A (Mandatory in NH) NO EXCLUSIONS E.L.DISEASE-EA EMPLOYEE s5000OO If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT s500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 0198 -2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S92190/M92188. CJF VE Town of Sa nstable t Regulatory F Semces 'nOmas F.Geiter,Director °rFD k Bui-fding b; ivision Tom perms,Building Commisdoner 200 Main Strmt,Hyannis,MA o26oI t�srw.Ea-fvn:h arnstabi e.ma.us Office: 508-862A-038 Fax. 509-790-6230 PropelOV erMLjst Complete and S &n This ,Section If USi.n.p A.Budder , as C'wner of tfiL subject Property hereby authorize 1� i all matters rAitive to y 3 wprk authot7zed by, binding permit appReat ott fC)r J � 55 Of�p�3 5 of Ownex Date k—K. 0 ORR Pizat Name If Pao e er'is-applying far permtplease cozxiplete the Homeowners License Exemptzoh dorm on the x��erse side.. Q;FORMS:OWJ7EK?ER.htiSSJON . Massachusetts - Department of Pubiic Sa fety , Board of Building Regulations and Standards Construction Supervisor License, CS-073097 PETER A LAROCHE 18 CEDRIC ROAD Centerville MA 02632 ; -r r `Xpirat1on Co:-nm ssi`ner. 11/03/2014 ffice:of Consumer Affairs`�c$us�ness Reguiation ME IAAPROVE' Y CONTRACTOR eglstrat10 _ Type, supplement OCEANSIDE, INC PETER UAPOCHEI� ' +iW • 217 Thomton Dr Hyannis; MA 02601 Unde�scretary license orregistration valid'for.individul:use only before the:expiration date. If found%return to: Offige of-Consume Affairs.and Business Regulation 10 Park Plaza-Suite 5170 hard Boston,MA 02116 Not valid without signature .._ - �� ���� ����. s ������ ��� r ■ r���� ���� �� rr����� ��� ��� ���r� ■ �r �� �����r� �� ��� r� � ��� �� �� � r�r�r � �r u � �. � �, rr �r ■ �� �: — _ ■ ,� r . . �. �� � ■ �r ■ ��► ., o , ■ ■ ■ - r � ti�� ■ ■ mac_ �..�,A.s q' � :si _ .ar .a�� ''44+Sc. � � sal x� .�.'.�.. 'fi'�,G:.�`y�;,'�. '.�';.to.. ...�.... 0' .R�FL�;� ��:*.±'-� �Sld':2'r"� fF' it, /� ".y/ 1 �� ��� �r� � � ■ ■���r� r� �� l i I { rt t I ! - -i-- - 1 i R310 102 . y P P R A ILS A L D A T KEY 226721 PEREIRA, DOMINGOS & LAND BLD/FEATURES BUILDINGS NUMBER ZN/FL=RB 17, 100 1, 100 26, 700 1 A-COST 44, 900 B-MKT 51, 700 BY 00/ BY ML 8/87 C-INCOME PCA=1011 PCS=00 SIZE= 780 JUST-VAL 44, 900 LEV=400 CONST-C 0 ----COMPARISON TO CONTROL AREA 63BC -- TREND EXCEEDS STANDARD NEIGHBORHOOD 63BC HYANNIS PARCEL CONTROL AREA TREND STANDARD 101 10 LAND-TYPE 171001 LAND-MEAN +0% 449001 61720 IMPROVED-MEAN -570 200-. ] FRONT-FT ] 100 DEPTH/ACRES TABLE 02 10001 LOCATION-ADJ APPLY-VAL-STAT 1 LNR] LAND LFT/IMP] ADJS/SB/FEAT STR] STRUCTURE ARR]AREA-MEASUREMENTS NOR] NOTES COM] MARKET INC] INCOME PMR] PERMITS GRR] GRAPHIC FUNCTION- [ ] STRUCTURE-CARD NO- [000] DATA- [ ] XMT [?] I -- R310 102 . • P E R M I T [PMT] ACT& [R] CARD [000] KEY 226721 000000001 PERMIT-NO MO YR TYPE VALUE CK-BY MO YR %CMP NEW/DEMO COMMENT I [ ] [R310 102 . , ] LOC] 0033 PILGRIM LANE CTY] 07 TDS] 400 HY KEY] 226721 ----MAILING ADDRESS------- PCA11011 PCS100 YR100 PARENT] 0 PEREIRA, DOMINGOS & MAP] AREA] 63BC JV] MTG] 0000 DELIAS, MARY P SP1] SP21 SP31 .POVIO, JOHN P UT11 UT21 . 14 SQ FT] 780 P O BOX 364 AYB] 1952 EYB] 1970 OBS] CONST] WARMINSTER PA 18974 LAND 17100 IMP 26700 OTHER 1100 ----LEGAL DESCRIPTION---- TRUE MKT 44900 REA CLASSIFIED #LAND 1 17, 100 ASD LND 17100 ASD IMP 26700 ASD OTH 1100 #BLDG (S) -CARD-1 1 26, 700 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE #OTHER FEATURE 1 1, 100 TAX EXEMPT #PL 33 PILGRIM LANE HY RESIDENT'L 44900 44900 44900 #DL LOT 232-5 OPEN SPACE #RR 1246 0060 COMMERCIAL #CL 41C INDUSTRIAL *LIFE ESTATE PEREIRA, D #UP FY98 EXEMPTIONS SALE] 02/90 PRICE] 1 ORB] C119842 AFD] I A LAST ACTIVITY] 10/10/96 PCR] Y . [ ] [R310 102 . ] LOC] 0033 PILGRIM LANE CTY] 07 TDS] 400 HY KEY] 226721 ----MAILING ADDRESS------- PCA11011 PCS100 YR100 PARENT] 0 POVIO, JOHN P MAP] AREA] 63BC JV] MTG] 0000 P 0 BOX 364 SP1] SP21 SP31 UT11 UT21 . 14 SQ FT] 780 WARMINSTER PA 18974 AYB11952 EYB11970 OBS] CONST] 0000 LAND 17100 IMP 26700 OTHER 1100 ----LEGAL DESCRIPTION---- TRUE MKT 44900 REA CLASSIFIED #LAND 1 17, 100 ASD LND 17100 ASD IMP 26700 ASD OTH 1100 #BLDG(S) -CARD-1 1 26, 700 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE #OTHER FEATURE 1 1, 100 TAX EXEMPT #PL 33 PILGRIM LANE HY RESIDENT' L 44900 44900 44900 #DL LOT 232-S LC11519G-S2 OPEN SPACE #RR 1246 0060 COMMERCIAL #UP FY98 INDUSTRIAL EXEMPTIONS SALE110/96 PRICE] 49000 ORBIC142249 AFD] I LAST ACTIVITY] 12/16/96 PCR] Y R310 102 . P P R A I S A L D A T A KEY 226721 POVIO, JOHN P LAND BLD/FEATURES BUILDINGS NUMBER ZN/FL=RB 17, 100 1, 100 26, 700 1 A-COST 44, 900 B-MKT 51, 700 BY 00/ BY ML 8/87 C-INCOME PCA=1011 PCS=00 SIZE= 780 JUST-VAL 44, 900 LEV=400 CONST-C 0 ----COMPARISON TO CONTROL AREA 63BC -- TREND EXCEEDS STANDARD NEIGHBORHOOD 63BC HYANNIS PARCEL CONTROL AREA TREND STANDARD 101 10 LAND-TYPE 171001 LAND-MEAN +0% 449001 61720 IMPROVED-MEAN -570-. 200 ] FRONT-FT ] 100 DEPTH/ACRES TABLE 02 1001 LOCATION-ADJ APPLY-VAL-STAT 1 LNR] LAND LFT/IMP] ADDS/SB/FEAT. STR] STRUCTURE ARR]AREA-MEASUREMENTS NOR] NOTES COM] MARKET INC] INCOME PMR] PERMITS GRR] GRAPHIC FUNCTION- [ ] STRUCTURE-CARD NO- [0 0 0] DATA- [ ] XMT [?] R310 102 . • P E R M I T [PMT] ACTO[R] CARD [000] KEY 226721 000000001 PERMIT-NO MO YR TYPE VALUE CK-BY MO YR oCMP NEW/DEMO COMMENT ` t -- 14 h% 96 UPC 68021 Now A NAGTINGS,MIN 'ROPERTY ADDRESS I I ZONING I DISTRICT CODE SP-DISTS.I DATE PRINTED I CSTATE LASS I PCS I NBHD KEY No. 0033. PILGRIM LANE 07 R8 400 07HY 07/09/95 1011 . OU 63BC R310 102. 226721 LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS IT UNIT ADJD.UNIT Lantl By/Date Size Dimension ACRES/UNITS VALUE Dlncriwion 1PEREIRAo DOMINGOS / CD. & Mpp- LOC./YRSPEC.CLASS ADJ. COND. P PRICE PRICE #LAND 1 17i1OO CARDS IN ACCOUNT - FFDe 10.18LDG.SIT 1 ' X INAcres .`: .1 =10 E 407 29999.9 122099.9 .14- 17100 #BLDG(S)-CARD-1 . 1 26.700 01 OF 01 q I #OTHER FEATURE .1 ' 1:100 Iv a THS. 10 U X` D= 100 2700.D 2700.0 1.00 2700 8 #PL' 33 PILGRIM LANE`HY MARKET 51700 NOBSMT. S . X 0= 100 7.2 5.61 780 4400-8 #DL LOT 232-S INCOME EPLACE U X 0= 100 2400.D 2400.0 1.00- 2400 8 #RR 1246 0060 USE q' HED S . 12 Xe 16 197 D= 78 9.81 5.96 192 1100 F #CL 41C APPRAISED VALUE IiD DI *LIFE ESTATE PEREIRA. D 44.900 4 PARCEL SUMMARY T S AND 17100 4 T I OLDGS 26700 I I (TOTALS E 44900 r � j _ CNST N I DEED REFERENC Type DATE R-d d R I O R YEAR VALUE A T I Book Page InsL Mo. Yr. Sala Price AND 17100 T S C119842 I IO2/90 A' 1 LDGS 27800 J C63865 :00/00 (TOTAL 44900 BUILDING PERMIT AmprM LAND LAND-ADJ ( INC ME SE SP-BLDS FEATURES BLD-ADJS UNITS Number Dale Type 17100 110 700 Class Const. Total Base Rate Adj.Rate B II Ago Norm. Obsv. CND. Loc %R.G Repl C-1 New Atl Re I Value Slorie9 Hei ht Rooma Rma Bathe afi:. Pany.a"Fa Uni15 Unal A u / Depr. Contl. / p g 1D+' 000 100. 100 51.85 51.85 52 70 24:74 . 90 64 41759 26700..140 5 2 1.0 4.0 Description R.I. Square Feet Rep.Cost MKT.INDEX: 1.00 IMP.BY/DATE: ML 8/87 SCALE: 1/00.82 ELEMENTS CODE CONSTRUCTION DETAIL I. AS 100 51.85 780 40443' _ FMP 55• 5.50 112 616 N *----14----* STYLE 03 ANCH 0.0 uU 8 FMP 8 E3TGN-AUJMT-. -00--------------------j=O ` ! !J XTE-R-W-WES-- -06 LlJM7vrNYL--------U:O_ *=------------34-*----14=---* EAT/AC-TYPE- - -tt AS=GA?FM-AID-- '- ! NTER:FTNISN- -05 IXSTEW----------UU.0.O r ! NTER.LATOOr -T2 VE_R 7NTffRMA1-----E J ! ! INTER.BUACTY -02 -AKE-AU-EXTEff_90 LD-UR-STWOCT- -02 V-JOI3'T/BE-Am U.O W 22 BASE E LDDR-C"ER-- -01 AADGU-06---------U.O D 112 780 26 OOF-TYPE---- "Ot ASCE=ASPfl- SN---U:O E Total Areas Au Base e T BUILDING DIMENSIONS LEC-TRI-C/�C 01 l/ERAIiE U.0 6AS WU8 N 4. W26 N22 E34 FMP N08 ! ! FOUNDATTO`N7-- -02 VWCRETE-BLACK-94.9 A W14 S 08 E14 OAS S 2b .. ! -------------- --- ---------------------- � NEI1aHB-0R OD 7i3BC-IiTARNTS------- -26---------* : LAND TOTAL MARKET 4. PARCEL 17100 44900 *--8--X AREA, 2325 VARIANCE +0 .+18311 �.... STANDARD . .'20 RESIDENTIAL PROPERTY , l MAR.-NO. LOT NO. FIRE DisY RIC T ;- �• STREET 33 Pilgrim Lane Hyannis RY i SUMMA 1 310 102. 1 3 3 ' V f LAND G S'D - 777, OWNER _" �Rv. } TOTAL LAND }J, RECORD.OF TRANSFER r. DATE _:' eic.: PG- I. S 'REMARKS L•L• < 232-s LC 11519GX '" BLDG S.. 1't e«T .O J, �� _ ; -. :":-(Sheet ' .TOTAL. ore it-a--Bolilinmoi " x LAND w - .. $1 r .00 consider tion �', BLDGS. Pereira- Domingos 2=14 75 tf. 3865.. L1475 TOTAL LAND 3 3; «P_I►;�' "- ' N. 1t �rvNes `/A.` O.a-�O I r' " L.C. 11: 1 -G i "zBLDcs TOTAL . LAND-. . • BLDGS. _ 'TOTAL % ....-.: `.LAND a) BLDGS. TOTAL LAND.. - BLDGS. TOTAL LAND INTERIOR INSPECTED: ^. ^ ') i BLDGS. ✓iVJ TOTAL. DATE: 7 ec.of Death Perr °.Pereira -- -LAND ACREAGE COMPUTATIONS 2-1. -75, Ctf. 59799 BLDGS. LAND TYPE OF ACRES PRICE. TOTAL - - # O AL DEPR. VALUE TOTAL; J ' HOUSE LOT 8 0 8�r�b 5/l� 3 G,S'-0 LAND CLEAR FRONT _ BLDGS. EAR TOTAL WOOD SPROUT FRONT LAND REAR BLDGS.- WASTE FRONT TOTAL REAR" LAND BLDGS. TOTAL ., LAND 4 , BLDGS. .. 3: LOT COMPUTATIONS LA D FACTORS" TOTAL FRONT DEPTH STREET PRICE DEPTH y� FRONT F7.PRICE TOTAL DEPR. COR. INF. VALUE HILLY TOWN SEWER LAND 0, ROUGH TOWN WATER BLDGS. t . HIGH GRAVEL RD.' TOTAL r ' LOW DIRT RDA X LLASWAMPY. NORD OS ,..... ,n•},..t g.�.. t. ;,. r.: �. - ;, � :..-. y..,/v ..f_.,, .. _:, � '.. r'3'Y X ap, r: 1 s._,.:. .., ::;.,r. ,...`....:.-k..._ ._.. ;TOWN�OFo,E3ARNSTABLE wMA"S,.S.:...:..,;6i+.+..:,,&,'„—:=+.: =fF,w.,,w+k;�wK.--„ UNITED:APPRAISAL..CO;EAST„HARTFORD,�:CONN. '` --!P IXT FOUNDATION; Bath Roo Base-.LUMBING X:Z` PRICING A' 1� 116�,66s�r "t'Will j'T'"m, ni�&�,77 T 4�7 Fin: �L6&60ST,-��t: PURCH DATE Conc.Blk. St J/` t.:Rec.,Room 1� "Silo.iF Bath 'k V ,, E�smt.,�,__l, t 4�_ -Gar-ge,, , ' ' t " Wells _'7 St..Sh w6rExt;1.��!j,!;*, j", lConi"Slab`� • _�'r Bisint. -RICE-:17-" -Brick Walli." Attic Ff.&Stiirs Toilet RoohiZ�k'� Roof RENT ,Stone Walls Fin.Attic s� Two Fixt..Bath isr% Flook !F,Plers INTERIOWFINISH, Lavatory Extra'A* smt. F 1 1.2 1 3 Sink Extra Attic % % Plaster Water-Cio. A EXTERIOR WALLS Knotty Pine' Water Only -Double Siding Qjj, Plywood Ho Plumbing Bsmt. Fin. �.'Single Siding Plasterboard_ Ant. Fin.r p- Shingles TILING ce Conc.Blk. G F P Bath Fl.- Neat 3 4,0- Int.Layout* Face-Brk.On. Bath ffl&Wains; Auto Ht.Unit Veneer lnt.!Cond.:`.- .......... I/ Bath Fl.&Wails' Fireplace Com.Brk.On HEATING,� Toilet Rm. Fl. Plumbing Hot Air ains. FSolid Corn.Brk. L,, Toilet Rm.FLA W Tiling Steam Toilet Rm..rFl. &Walls -Blanket Ins. Hot Water St. Shower .I.Roof ins. Air Cond. Tub Area Total Floor Furn. F^' ROOFING COMPUTATIONS i,,Asph' Shingle Pi;ieless Ftfrn. S.F.� 3 6 0 �.Wood Shingle No Heat S.F. Asbs. Shingle- Oil-Burner S. F. 1�.`Slatel. Coil Stoker S. F. Tild Gil • S. F.' OUTBUILDINGS ROOF r TYPE Electric S. F. 1 2 3 4 5 6 7 8 9,1101 1 12 1 3 1 4 5 6 7 819,11 MEASURE ,-"Gable Flat Hip Mansard.' S.F. Pier Found. �, F 00 FIREPLACES Wall Found. O.`H.Door Gambrel Fireplace Stack LISTED FLODRS Fireplace Sgla;,Sdg. Roll Roofing 1-,Conc. LIGHTING Dbla.Sdg. Shingle Roof 'Earth No Elect. 7- DATE Shingle Walls'. Plumbing Pine — Hardwood Cement Blk I Hardwood ROOMS ctric 4sph.Tile -TOTAL 0 Bsmt. 1st Brick t.Finish D 3.d FACTOR. , 77F. 171 2nd lel-- Single Ic -REPLACEMENT SIZEr' --REPL`. YS. VALUE- Funct.Del). ACTUAL VAL.-66CU�AN6Y:'- �CONSTRUCTION AREA, CLASS AGE REMOD. COND., VAL r' .1`14 7 b L G. -e- 27: 2 A - 7 [G 5 TOTAL ..... .. .. 49 � B ILWNG $ERVI.� 1�•� 310 10 2 :.. ... .. . : ::::::::D..•.MIN w::>::.... GOS EREIRA ::::::::: :PILti::i ... x.. GRIM:•LANE:::• % > W HYANNIS ; .:....:.................::... 1s::: : Z. E.—B.H.A. .............::::................................................... ................................................................................................. ........ ...:::::.........::..:::.:.>: ................ LEGALAPT. :. ....:.:::..........::. } 5r� n. ..c •4 u:Y .S.V. M:• r CZz SEARCH::. .r.. ; ':x;:;: NW'80NI1SVN • b$ 96 LE089 3dn O -mill,� r- 11-05=1995 12:20PM FROM BARN HOUSING AUTHORITY TO 979OS230 P.09 Barnst • AM o using uthorl 146 south street•xy M&mchw ttTTs M60101 ZONING VRRIFICATION TO: Gloria arenas FROM: Leila R. Bruce, PHM, Leased Housing Coordinator RE: Uerifying legal rental unit Date: wQveMbeg Address: 33 Pilgrim Lane Village: Hyannis Unit type: single family (?? Bedroom size: Map 8� Parcel No.: 310 102 The owner of the aboue listed property is entering into a contract with us for the rental of the property as listed above. Please uerify by signing below that the unit'is legal and meets all zoning requirements for a rental in the town of Barnstable. If it does not, please list reason here: Thank you for your assistance in this matter. Signature Print name 1 j Bate VIA FAX: 790-6230 MAC Equal Housing Opponunicy Agency Rev TOTAL P.09 FIR 3; 0 C DH LOT 232S 6000. 00 So FT S75 19 -N- 0. 138 ACRES p �0 � I 53 2q , C OH z EXISTING o RESIDENCE HED Soso OosoNo 0 '?1. 08 2 ' 10 oS0 OmSONO 4 p 35, 5010"SONO c• 0 �4 12"Sd12 ONO 1 0 11 . 37 ' co N�5 19 qg.. � 4 W o �N S� S9C o`er MICHAEL tiG CERTIFIED PLOT PLAN S. , LOCUS: 33 PILGRIM LANE, BARNSTABLE. MA No. 37560v PREPARED FOR: SPRINKLE HOME IMPROVEMENT, INC. �o P�.5. DATE: 1/9/12 F.`` SCALE: 1"=20 ' ° u NOTES: LADUE LAND SURVEYING 1 . EXISTING FENCES ARE NOT DEPICTED ON THIS PLAN. 2. DIMENSIONS ARE FROM CENTERS OF EXISTING SONOTUBES. MICHAEL S. LADUE, P. L. S. I HEREBY CERTIFY THAT THE STRUCTURES SHOWN ON 51 CAPTAINS VILLAGE LANE THIS PLAN T ON THE GROUND AS SHOWN HEREON. BREWSTER. MA 02631 508-896-6707 /t A TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION l Map Parcel 10 Application # Oel/ 16ST2 Health Division /G v� Date Issued l Conservation Division Application Fee C� . I a-o Planning Dept. Permit Fee a � Date Definitive Plan Approved by Planning Board Historic - OKH _Preservation/ Hyannis Project Street Address 3,, > Q r M L0.&L tiVCLAAl,S Village "u 5 Owner 1)2n(j. I't��C�G` 1�1f1o�n e r�.�n� Address �� a 5Q= 6_.,cJ Lxkt� �"�" a� Telephone o 1- 1 M q Oa t,3O Permit Request " i Square feet: 1 st floor: existing hO proposed 5C 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation -004) Construction Type Lot Size 0, 14- Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family >8 Two Family ❑ Multi-Family (# units) Age of Existing Structure I4 Historic House: ❑Yes 1I-No On Old King's Highway: ❑Yes No Basement Type: ❑ Full Crawl, ❑Walkout ❑ Other Basement Finished Area(sq.ft.) IV4- Basement Unfinished Area (sq.ft) 44 Number of Baths: Full: existing_ new 6:> Half: existing Cs new a Number of Bedrooms: existing 1 new Total Room Count (not including baths): existing newer_First Floor Room Count Heat Type and Fuel: AGas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes 2rNo Fireplaces: Existing 0 New 0 Existing wood/coal stove:rt,0 Ye. No Detachsd garage: sting ❑ new size—Pool: ❑ ing ❑ new size _ Barn: ❑ existting ❑ new size_ Attached garage: UJe ting ❑ new size _Shed: P-existing ❑ new size6,00ther: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ — ' Commercial ❑Yes Jdlo If yes, site plan review# Current Use ," vf, G Proposed Use de_- -r";l t APPLICANT INFORMATION (BUILDER OR HOMEOWNER) a Name ':-- °_...'- 46 I. Telephone;Nurnber Address L99 �th&Le6_ CA, License# 6 6q3 J iS mA c*6 l Home Improvement Contractor# 163 ? S� f-Lae-ta eA aA . Worker's Compensation # AWC 700 4 y L I ad l ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO{ SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# z. s DATE ISSUED; i MAR/PARCEL NO. ADDRESS VILLAGE OWNER `— r ` ? DATE OF INSPECTION: r FOUNDATION FRAME INSULATION,' FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS =- ROUGH FINAL ` o.'• FINAL BU_ILDINGj_ 7,:: �n DATE CLOSED OUT - ''w ASSOCIATION.PLAN NO. `Town- of Barnstable Regulatory Ser-�ices g Thomas F. Geiler, Director 'r 6 ;A� Building Division Thomas Perry, CBO, Building Commissioner 200 Maim Street, Hyannis,MA 02601' www.town.b arru to b l e.m a.us Offices 508-862--4038 Fax: 508-790-623C PLAN R-EW D$N FEQD14 f Map/Pamcl. Project Address 13; VI Builder: S'6`?�I UYK U!- The following items were noted on reviewing: S Reviewed by: ��A P-� Date: r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Mass. 02111 www.mas&gov/dia Workers' Compensation Insurance davit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/organizationandivi&w): Sprinkle Home Improvement Address: 199 Barnstable Road City/State/Zip:Hyannis, MA 02601 Phone#. 508 775-1778 Are you an employer?Check the appropriate box: Type of project(required): 1. 1K I am an employer with 9 4. ❑ 1 am a general contractor and I 6.)tVew construction employees(full and/or part time).* have hired the sub-contractors 7. ❑Remodeling 2. 0 I am a sole proprietor or partner- listed on the attached sheet. slip 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.insurance.t g required] 5.❑ We are a corporation and its 10. 0 Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11. 0 Plumbing repairs or additions myself [No workers'comp. right of exemption perm MGL insurance required]t c. 152,§ 1(4),and we have no 12. ❑Roof repairs employees.[no workers' comp.insurance required.] 13. 0 Other *Any applicant that cbwJm box 01 mint W o 0 out the seedon below showing thdr worken'compenudo polley latormaton. tHowwwnen wbo submit dhb a8klavlt Indk:a ft they are doing all work and then hire outside con&amn must sabudt a new affidavit indicating such. tCont wwn that check this box mot attach an additional sheet showing the name of the subeon&aeton and state whether or not those entltks have emP ioYem if the sab-eoatradon have their worker'co emnbvee% mmt rovlde� n ma aodky number. I am an employer that is providing workers'coeipensadon hmrance for my employees.Below is the policy and job site nsurance Company Name:rmoBo insurance Associated Industries of MA Policy#or Self-ins.Lic.#: AWC 7004943012011 Expiration Date: 01-01-2012 Job Site Address: el irl, City/State/Zip:_ &AA 4 S 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 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 $250.00 a day against violator.Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coveMe verification. I do herby7! and penalties of perjury that the information provided above is true and correct Si Date: PK&Nww: Brad Sprinkle Pho„e#. 508 775-1778 Ext.10 Official use only Do not write in this area to be completed by city or town offleial City or Town: Permit/Iicense M Issuing Authority(circle one): l.BoaM of Heath 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact person: Phone#• CERTIFICATE OF LIABILITY INSURANCE DATE11/24/2010 11/24/2010 THIS CERTIFICATE IS ISSUED AS A MATTER OF.INFORNATION 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 term- 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). PRaoaCal CONTACT Bryden & Sullivan Ins Agency NAM: PxoNE rAx Inc (A/C. a.. E.0: wc. as E-MML 88 Falmouth Road AM)I S: PRODUCER Hyannis, MA 02601 CUSTOMM IDS. INSURED(s) ArYCRDINo COVZRAOE NAIC 0 INSURED INsoaza A: A.I.M. Mutual Insurance Co Sprinkle Home Improvement Inc INSURER E: 199 Barnstable Road INSUMM C: Hyannis, MA 02 601 LNBURM D: INFORM:: INSURER r: COVERAGES CERTIFICATE NUMBER: 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. POLICY EFF POLICY EXP TYPE OF INSURANCE POLICY NUMBER aWooimr Inum�ritn LIMITS GENERAL LIABILITY EACH QCCVRAHC30 COMMERCIAL GENERAL LIABILITY _ DANAM TO RQR= -- PSUM"S IL..oa.r. I 0 O❑CLAIMS MADE 0. MD PCP MDy ❑ PERSOHAL i ADV INJURY 0 . GEN•L AGGREGATE LIMIT APPLIES ER: OzNzIAL AGGREGATE 0 ❑POLICY ❑PROJECT ❑LOC _ PRODUCTS-COMP/OP Am D ~ 0 AUTOMOBILE LIABILITY COMBINED sINOI.E LnaT ❑ANY AUTO (.....id—t) 0 []ALL OWNED AUTOS BODILY INJ to—P--) 0 r URY ' SCHEDULED AUTOS _ - BODILY nL=Y(p.s.oaidmt) 0 HIRED AUTOS AROP�TY DAMA(m to-...1d"t) 0 ❑NON-OWNED AUT.. '� "'• a ° UMBRELLA LIAB ❑ OCCUR EACH OCCURMCE 0 EXCESS LIAB ❑ CLAIMS MADE AOOAEOATE 0 ❑DEDUCTIBLE _ 0 El RETENTION S a WORIQ:RS COMPENSATION .t • - orx- AND EMPLOYEES LIABILITY Sam amT. ER THE PROPRIETOR/PARTNERS/ - - E.L. EACH ACCIDENT 0 500,000 A EXECUTIVE OFFICERS ARE ® incl ❑ excl 7004943012011 E.L. DISEASE -POLICY LIMIT a 500,000 O1/01/2011 01/01/2012 E.L. DISEASE -EA EMPLOYEE 0 500,000 C000=TE I DESGIIPTLO-or OPERATIONS OR IOCATYOaS: WORKERS' COMPENSATION COVERAGE APPLIES TO MASSACHUSETTS EMPLOYEES • 0 CERTIFICATE HOLDER CANCELLATION PROOF OF INSURANCE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AVTHOSIISAD iliPALSQRATIK ISM Town of Barnstable Regulatory Services 7Umaa F.GWw,Mrecter Building Division Thomas Perry,CBO Bnuding Commfsdoner 200 Main Street, Hyannis,MA 02601 wvvw.town.barnstable.ma.us o ffm SOS-862-M8 Fax: SW79"230 Property Owner Must Complete and Sign This Section If Using A Builder U106L a2 j i C�4 man ' r Jn% ,as Owner of the subject property hereby authorize Sprinkle Home Improvement to act on my behaK in all matters relative to work authorized by this building permit application for. f- ,fy) K Avran A LS (Abdraw of]ob) S*natm of Owner bate Print Name Owner applying for permit,please complete the Homeowners License Ezemptlon Form on the Revised072110 `Aar wm RBSSAoc do m%Tempomy Intmo FilesVCon t outlooldDDv87nnz� �1.i��.l�illt 11 Ilk liu,tt'tl � t htultltn I + E _ (lttii;cn((°un�umcr:�>`lieu-s�\ Rirrtirncss�2(t,ufxtton ' Construction SUpetf!•75yu',rr•` t „r•\Iryft� l.{r'ii�. ! `"t��-_ HOME IMPROVEMENT CONTRACTOR " 1 }? Registration: 103757 Type: i.r.:e, 5,• S 6643 _ t. Expiration: 7/9/2012 Private Corporati( SPRINKLE HOME IMPROVEMENT,INC. BRAD K SPRINKLE � 1 190 LOTHROPS LANE Brad Sprinkle W BARNSTABLE, MA 02668k 199 Barnstable Rd. Hyannis,MA 02601 I ndcrsccrctary t;,+t.ft„ 10,18!2013 6004 Liceww ur registration valid for individul use only Failurc-to possess a current edition of the before tile expiration date. If found return to: Massachusetts State Building Code Office of Consumer Affairs and Business Regulation is cause for revocation of this license. III Park Plaza- Suite S170 i Itoslon, ;CIA 02 116 Refer to: WWW.Mass.Gov/DPS Not N alid without signs tore ti 8' Edition.Massachusetts Building Code(� _ Mass. Version of the WFCM 110 MPH Exposure B Che cklist M c K E NZIE Summary of Construction Requirements ENGINEERING CONSULTANTS Project: Manferdini Addition, 33 Pilgrim Lane, Hyannis structural civil environmental a Per review of location,site is Exposure B • The Mass Checklist has been satisfied except for the following items requiring an engineering. solution: o The building is to be constructed on sonotubes so the anchor bolt spacing is non- applicable. Use ABU46 post bases with 5/8"threaded rods epoxy grouted into sonotubes a minimum of 10"deep. Standard framing;connection requirements: Table 2 from WFCM manual. Anchor Bolt Requirements: . Use Simpson ABU46 post bases to connect the framing to the sonotube foundation. Use 5/8"threaded rod epoxy grouted into the sonotube with Simpson SET epoxy or equal. The rod is to be embedded a minimum of 10" into the concrete. A Floor Construction Requirements: First two joist bays of the floor framing to be blocked with 2x lumber 4' on center for the length of the joist. Sheathing to be nailed in accordance with Table 2 (8d nails,6"spacing at the edges and 12 inch spacing in the.field).-Use Simpson H8 clips to connect floor joists to the low girders. Exterior Wall Requirements: All exterior wall studs to be 2x6 16"on center. The double top plates on the exterior walls to have a minimum splice length of 2 feet and splices to be nailed with 6-16 d nails in accordance with Table 6 in the WFCM 11 OB booklet. Nailing of plates to studs to be with 2- 16d nails. The bottom plate to floor box nailing is 3- 16d nails per foot for walls on all elevations. Full height studs are required at the gable elevation. For all door and window openings,multiple king studs are required. For openings up to 4 feet wide,2 king studs are required,for opening 5 feet to 9 feet wide,3 kings studs are required,and for openings 10- 12 feet wide,4 king studs are required. For shear and uplift connection of the sheathing,the sheathing is to be nailed 6"on center at the edges and 12"on center in the field for all elevations. All nails are to be 8d or equivalent gun nails(.131 x 2 ''/2"). In order to eliminate the need for steel strap ties and hold downs per the WFCM manual, sheathing must be installed and nailed in accordance with Note 4 on the Mass Checklist. This includes using full sheets of sheathing running from the bottom of the floor box up to the double top plate of the walls. Roof Framine Requirements: Rafter connection to the top plate requires Simpson H2.5A hurricane clips with 2x blocking between joist bays toe nailed to the rafter with 4- l Od nails per side. If blocking is not desired, Simpson H-10 or H-14 hurricane clips can be substituted and installed on every rafter. All clips to be install in accordance with 1279 Millstone Road Simpson requirements. Brewster,MA 02631 t 774.353.2144 f 774.353.2142 ' www.mckengineers.com Collar ties are required within the upper third of the roof height on every rafter connection or use Simpson LSTA 18 straps over top of roof sheathing across ridge on every rafter nailed in accordance with Simpson requirements. Roof sheathing to be nailed using 8d or equivalent nails 6"on center at the edges,6"on center in the field. The first two bays between rafters are required to be blocked 4 feet on center at all gable ends per the WFCM. Limitations and Contractor Responsibilities The contractor must refer to the Tables and Figures within the WFCM 110 MPH Exposure B booklet for illustrations and requirements discussed within this summary. All connections and nailing must meet the requirements herein and as illustrated in the booklet in order to be in compliance with the building code. The contractor is responsible to ensure all connections,nailing,and anchor bolts are visible to the inspector at the time of the framing inspection/foundation inspection. The contractor must reference the Simpson Strong Tie C-2011 catalog for all strap,hangar, and tie installation requirements and limitations. This document and the attachments as well as a copy of the WFCM booklet must accompany all sets of plans submitted to the building department and issued to the contractor/subcontractors unless the plans are updated with notes and details that reflect the requirements stated in this document and attachments. This review was completed on plans submitted by Sprinkle Home Improvement and was based on the floor plans and elevations provided. Any changes to these plans o es made may render the requirements outlined in this document null and void and coul An ian e with the requirements of the wind design. MARK A. t� •y ark A.McK' 2 P. res.,McKenzi nts,Inc. r' r"i Attachments: Mass Checklist AWC Guide to Wood Construction in High Wind Areas: 110 mph Wind Zone Massachusetts Checklist for Compliance(780 CMR 5301.2.1.1)1 33 pt`'ri*A Ln. RyAnrli S � Check Compliance 1.1 SCOPE I WindSpeed (3-sec.gust)................................................................. .................................................110 mph V/ Wind Exposure Category.................................................................. .............. 1.2 APPLICABILITY Number of Stories(a roof which exceeds 8 in 12 slope shall be considered a story)_!stories 5 2 stories t� RoofPitch ..........................................................................(Fig 2) ........................................... a 12:12 ✓' MeanRoof Height ..............................................................(Fig 2).................................................-ft <33' _!G" BuildingWidth, W ..............................................................(Fig 3)................................................ ft <_80' _tG BuildingLength, L ..............................................................(Fig 3)................................................. 9 ft <_80' Building Aspect Ratio(UW) .........2.:..................................(Fig 4)...................................... s 1........... � <_3:1 V" Nominal Height of Tallest Opening ...................................(Fig 4)................................................ 1.3 FRAMING CONNECTIONS General compliance with framing connections ...................(Table 2)............................................................... 2.1 FOUNDATION Foundation Walls meeting requirements of 780 CMR 5404.1 Concrete.............:............................................................ . ConcreteMasonry .................................................................... ............................................................... 2.2 ANCHORAGE TO FOUNDATION'.3 5/8"Anchor Bolts imbedded or 5/8"Proprietary Mechanical Anchors as an alternative in concrete only Bolt Spacing-general ................................. ........(Table 4)............................................... in. Ma Bolt Spacing from end/joint of plate ............................(Fig 5)....on3d!'IO.fi! &..... in.<_6"-12" Bolt Embedment-concrete.........................................(Fig 5).... ........ in.>>7" Bolt Embedment-mason Fi 5 Sew � ` > masonry..................................... ...( 9 )............. . .. ......................... m._15" Plate Washer...............................................................(Fig 5)......!'�..(?I:r......!�...................>_3"x 3"x'/<" 3.1 FLOORS Floor framing member spans checked ...............................(per 780 CMR Chapter 55)................................... ✓ Maximum Floor Opening Dimension............................:......(Fig 6).................................................. 0 ft:5 12' ✓ Full Height Wall Studs at Floor Openings less than 2'from Exterior Wall(Fig 6)....................................... -4/4� Maximum Floor Joist Setbacks Supporting Loadbearing Walls or Shearwall................(Fig 7).................................................... oft <-d ✓' Maximum Cantilevered Floor Joists Supporting Loadbearing Walls or Shearwall................(Fig 8).................................................... Oft <-d Floor Bracing at Endwalls...................................................(Fig 9)................................................................... Floor Sheathing Type .........:..............................................(per 780 CMR Chapter 55)......4?V$.1 t>QI'!4WTn*- v Floor Sheathing Thickness ................................................(per 780 CMR Chapter 55).......................0 in. V' Floor Sheathing Fastening..................................................(Table 2).. 4g:d nails at min edge/L in field t� 4.1 WALLS Wall Height Loadbearing walls........................................................(Fig 10 and Table 5)...........................-6 ft <_ 10, Non-Loadbearing walls................................................(Fig 10 and Table 5)...........................j7--ft <_20' _�• Wall Stud Spacing ........................................................(Fig 10 and Table 5)...................&in. <_24"o.c. [� Wall.Story Offsets. ........................................................(Figs 7&8)............................................jo ft <_d ✓' 4.2 EXTERIOR WALLS3 Wood Studs Loadbearing walls........................................................(Table 5)..............................2x�_&-11_I_in. Non-Loadbearing walls................................................(Table 5)..............................2xLa--LL-ft o in. Gable End Wall Bracing' Full Height Endwall Studs................I.............................(Fig 10)................................................................. WSP Attic Floor Length...............................................(Fig 11)............................................. ft>_W/3 AA Gypsum Ceiling Length(if WSP not used)..................(Fig 11)............................................_ft>_0.9W A-* and 2 x 4 Continuous Lateral Brace @ 6 ft. o.c. .. (Fig 11)............................................................. MA or 1 x 3 ceiling furring strips @ 16"spacing min.with 2 x 4 blocking @ 4 ft. spacing in end joist or truss bays VA- Double Top Plate Splice Length ........................................................(Fig 13 and Table 6).................................... ;?ft Splice Connection (no. of 16d common nails).............(Table 6)........................................................ L L/ M�h�vdiho f4d�dt�w. C��`+) AWC Guide to Wood Construction in High Wind Areas: 110 mph Wind Zone Massachusetts Checklist for Compliance(780 CMR 5301.2.1.1)1 Loadbearing Wall Connections Lateral(no. of 16d common nails)...............................(Tables 7)..................................................... 2. • Non-Loadbearing Wall Connections Lateral(no. of 16d common nails)...............................(Table 8).......................................... 70 11 ............. Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) Header Spans ........................................................(Table 9)................................... ft 4 in.<11' V** Sill Plate Spans ........................................................(Table 9)..................................0 ft A5—in.s 11' Full Height Studs (no.of studs).................................. (Table 9)................................. ._ . Non-Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) Header Spans.............................................................(Table 9).................................._Z ft_(e_in.:5 12' ✓' Sill Plate Spans...........................................................(Table 9).....................................a?ft Q in.:5 12" Full Height Studs(no. of studs)....................................(Table 9)....................................................... Z Exterior Wall Sheathing to Resist Uplift and Shear Simultaneously° Minimum Building Dimension,W Nominal Height of Tallest Opening SheathingType..............................................(note 4)...................................................... Edge Nail Spacing.........................................(Table 10 or note 4 if less)........................in. —� Field Nail Spacing..........................................(Table 10).................................................__�"Jn• Shear Connection (no. of 16d common nails)(Table 10).......................................................�'s L Percent Full-Height Sheathing.......................(Table 10)...................................................4k*% 5%Additional Sheathing for Wall with Opening>6'8" (Design Concepts).................... gip` Maximum Building Dimension, L Nominal Height of Tallest Opening2.......................................................................4'ba<_6'8" t/• SheathingType.......:......................................(note 4)...................................................... e,0V Edge Nail Spacing.........................................(Table 11 or note 4 if less)........................ in. C/• Field Nail Spacing..........................................(Table 11)................................................. /'Lin. ti^ Shear Connection(no. of 16d common nails)(Table 11)....................................................... 3 ,C' Percent Full-Height Sheathing.......................(Table 11)....................................................n2 /o 5%Additional Sheathing for Wall with Opening>6'8"(Design Concepts).................... Wall Cladding Ratedfor Wind Speed?............................................................. ..................................................... 5.1 ROOFS Roof framing member spans checked?.......................(For Rafters use AWC Span Tool,see BBRS Website) Roof Overhang ....................................................(Figure 19)................Q ft<-smaller of 2'or L13 Truss or Rafter Connections at Loadbearing Walls Proprietary Connectors Uplift................................................(Table 12)............................................U=_o'5plf y' Lateral.............................................(Table 12).............................................L=-4!M plf ✓' Shear...............................................(Table 12)............................................S=-77 plf ✓' Ridge Strap Connections, if collar ties not used per page 21... (Table 13)...............................T=JW plf Gable Rake Outlooker..........................................(Figure 20)............... O ft<-smaller of 2'or L/2 ✓' Truss or Rafter Connections at Non-Loadbearing Walls Proprietary Connectors Uplift................................................(Table 14)............................................U=4n lb. ✓' Lateral (no. of 16d common nails)...(Table 14).......................................L= Ib. t/• Roof Sheathing Type...................................................(per 780 CMR Chapters 58 and 59) .......C..pw �C Roof Sheathing Thickness........................................... ............................................. .40,in.>-7/16"WSP Roof Sheathing Fastening ...........................................(Table 2)............................... Notes: 1. This checklist shall be met in its entirety,excluding the specific exception noted in 2,to comply with the requirements of 780 CMR 5301.2.1.1 Item 1. If the checklist is met in its entirety then the following metal straps and hold downs are not required per the WFCM 110 mph Guide: a. Steel Straps pert Figure 5 b. 20 Gage Straps per Figure 11. c. Uplift Straps per Figure 14 d. All Straps per Figure 17 e. Corner Stud Hold Downs per Figure 18a and Figure 18b 2. Exception: Opening heights of up to 8 ft.shall be permitted when 5% is added to the percent full-height sheathing requirements shown in Tables 10 and 11. 3. The bottom sill plate in exterior walls shall be a minimum 2 in. nominal thickness pressure treated#2-grade. AWC Guide to Wood Construction in High Wind Areas: 110 mph Wind Zone Massachusetts Checklist for Compliance(780 CMR 5301.2.1.1)1 4 a. From Tables 10 and 11 and location of wall sheathing and Building.Aspect Ratio, determine Percent Full-Height Sheathing and Nail Spacing requirements b. Wood Structural Panels shall be minimum thickness of 7/16"and be installed as follows: i. Panels shall be.installed with strength axis parallel to studs. ii. All horizontal joints shall occur over and be nailed to framing. iii. On single story construction, panels shall be attached to bottom plates and top member of the double top plate. iv. On two story construction, upper panels shall be attached to the top member of the upper double top plate and to band joist at bottom of panel. Upper attachment of lower panel shall be made to band joist and lower attachment made to lowest plate at first floor framing. v. Horizontal nail spacing at double top plates, band joists, and girders shall be a double row of 8d " staggered at 3 inches on center per figures below:Vertical and Horizontal Nailing for Panel Attachment -MEN THE EDGE RESTS ON FRAMING ELSE&i NAiLS AT6b.c. 11 11 ll t! 1 1-1 rl 11 II 1 11 11 11 11 I r II 11 11 1 11 II 11 1 M 1•I IS= 71 11 11 O I 11 It 11 11 11 I 11 I_i, 1 l 1 iI 4 1 !i 11 a Zco n rl � Q if It 11 Ir � 1 a. 11 � 11 Ir 1 11 It 0 fl Ir 1 r 1,1 n • II W i; Il 1 ;1 d I I Q Ir i/ W 1 U 11 I r •• 11 II JI 1 IJ t1 1 fl �11 1 11 tt t MAILSPACWG See Detail on Next Page Vertical and Horizontal Nailing for Panel Attachment I AWC Guide to Wood Construction in High Wind Areas:110 mph Wind Zone Massachusetts Checklist for Compliance(780 CMR 5301.2.1.1)i Mp ; Q 1 1 1 �za � 1 1 , o I a a FRAMINGMEMBERS i I i ED&H RdTERMEDIAT£ e � ( 1 � 31 MIM. .1 1 r- STAGGERED 3"MW MAX PATTERN � P/WEL PANEI EDGE DOUBLE MAIL EDGE SPACNG DETAL Detail Vertical and Horizontal Nailing for Panel Attachment L f Town of Barnstable * �aFfHt Tpty� Permit# o E rpires 6 ruontlis j jiir issue dole Regulatory Services Fee - , Thomas F. Geiler, Director- Building Division Tom Per-ry, CBO, Building Commissioner 200 Main'Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 `` 'F' X?50'& 190-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid wilhoal Red r-Press Inrpriia Map/parcel Number ��� /D D,__ 4 Property Addresz" rt r "i/n Vesidential Value of Work b Mir imum fee of S35.00 for work under$6000.00 Owner's Name & Address Contractor's Name Iyl/ � CS Telephone NumberL,Og�—Y't Home Improvement Contractor License#(if applicable) i Cons ction Supervisor's License#(if applic able) _ �� '�, Workman's Compensation Insurance Check one: I am a sole proprietor I am the Homeowner I have Worker's CCompensation Insurance Insurance Company Name New ;tl'c- 6,11 Workman's Comp. Policy# 0 ��. Copy of Insurance Compliance Certificate must accompany each permit, Permit Request (check box) ❑ Re-roof(hurricane nailed) (stripping old shingles) AV construction debris will be taken to ❑Re-roof(hurricane nailed) (not stripping. Going over existing layers of root) ❑, Re role. /'; � #of doors Replacement Windows/doors/sliders. U-Value (/i , _(maximum .35) #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. IGNATURE: k . The Commonwealth of M assachatsetts Department of Industrial Accidents r ®/face of Investigations 600 Washington Street Boston,A 02111 r :. % •��i�JY3%.�?i3sS.�ii'V,�f�itt Workers' Compensation insurance Affidavit: Buaiders/Cont�'actots/�I ple se Pri laLegt -lrs P9ease print I.e�ibiv Name(Business/Organization/Individual): "�1 �'� 4"` � t=J Address: City/State/Zip: ifs Phone#: ,5 Are you an employer?Check the a propriate box: Type of pro' t(required): I. I am a employer with -0 4• ❑ 1 am a general contractor and 1 6 Q w construction have hired the sub-contractors employees(full and/or part-time).* 7, Remodeling - _,- 1 ;air 3.sole proprietor or partner- listed on the attached sheet. These sub-contractors have 8. El 7oci-I ship and have no.employees working for me in any capacity. employees and have workers'comp.insurance q Q Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its I0.❑ Electrical repairs or additions required.] s officers have exercised their I I.[] Plumbing repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL myself.[No workers' comp. 12.Q Rooi'repairs c. 152,§i(4);and we have no 13.❑ Other insurance required.]t - .employees.[No workers' comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing.their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing,all work and then 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. _ -IT— Insurance Company Name: 04.T Policy#or Self -ins Lc.#:' © ' J Expiration Date: 1 City/State/Zip:/State/Zi �1 Job Site Address: l :. �l 1y1 � y p number and expiration date). page(showing the policy num p P — Attach a copy of the workers compensation policy declarationp g ( g Failure to secure coverage as required udder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a tine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to.the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify unde pains and penaltie of perjury that t e information provided above is true and correct. Date: Signature: , Phone# 5 5Z �� COL Official use only. Do not write in this area,to be completed by city or town officiaG City or Town: Permit/License# Issuing Authority(circle one): LLContact of Health 2.Building Department 3.City/Town Clerk 4.Electricahlnspector 5.Plumbing Inspector Person: Phone#: ttom�,, ✓!ce �omimo.cu�ea� o�✓�.cieea�/ruaella ti Office of Consumer Affairs&Business Regulation t License or registration valid for individul use only before the expiration date. If found return to: OME IMPROVEMENT CONTRACTOR I - •• ' Office of Consumer Affairs and Business Regulation Registraion;wt26893 TYPe; 10 Park Plaza-Suite 5170 Exprra,ion ,8/3L241;2._. Supplement Card Boston,MA 02116 ' _ �.i. t The Home Depot'�t Home' ervlce5 DARREN DEMERS� ;b j 2690 CUMBERLAND PARKWAYS GA Undersecretary Not valid without signature I i r ® DATE(MM/DONYYY) CERTIFICATE OF LIABILITY INSURANCE ��. 02/19/10 i PRODUCER 1-404-995-3000 THIS CERTIFICATE IS ISSUED.AS A MATTER OF INFORMATION Marsh USA, Inc. ONLY AND CONFERS NO RIGHTS S UPON THE CERTIFICA E HOLDER_. THIS CERTIFIC` `E- DOES NO, AV!-_ND EXTEND OR r ,•! TCi< "IE CCA/ERAr�E �.r yR��D S �'! i-'OL C'F$ l.. 1 homedepot.cartreyu:es t`:narsh.com ---_—_--.---- T• o A;liarce Center: 3560 Lenox Road, Suite 2400 Atlanta, GA 3032b = , .i ! NSURER r„i IING COVERAGE NA IC a:_ ; . I !N; RED !MSuREn, L__ L adfas Ins- Co .3 2i3 I The Home Dezct, Ir.c r-..h American Ins Co _ i5 35 Acme Depo,. II.o.A.; _n_. - 2455 Paces Ferry Road NW INSURERC:New Hampshire Ins Co --_— 23d4i Building C-20 - 8 -- Atlanta, GA 30339 �INSURER 0:NATIONAL UNION FIRE IITS CO OF PITTS 19445 INSURER E:Illinois Union Ins Co I279660 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD'L - POLICY EFFECTIVE POLICY EXPIRATION LIMITS LT POLICY NUMBER M/ N T M /YY Y A GENERAL LIABILITY GLO.4887714-00, 03/01/11 EACH OCCURRENCE $ 4,000,000. —_ DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 1,000,000 CLAIMS MADE ❑X OCCUR MED EXP(Any one person) $EXCLUDED—____ PERSONAL 8 ADV INJURY $ 4,000,000 GEN ERAL AGGREGATE $4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS=COMPIOP AGG $ 4,000,000 _ ___ X POLICY - PRO- LOC B. AUTOMOBILE LIABILITY BAP 2938863-07 03/01/10 03/01/11 COMBINED SINGLE LIMIT (Ea accident) $ 11000,000 X ANY AUTO ALL OWNED AUTOS - .r BODILY INJURY $ SCHEDULED AUTOS (Per person) — --`—_ HIRED AUTOS - BODILY INJURY NON-OWNED AUTOS (Per accident) $ - - - X SELF INSURED AUTO PROPERTY DAMAGE (Per accident) $ PHYSICAL DAMAGE GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO- OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESS/UMBRELLA LIABILITY GL04887714-00 03/01/10 03/01/11 EACH OCCURRENCE $ 5,000,000_ _ X OCCUR CLAIMS MADE AGGREGATE _ $ 51000,000-- DEDUCTIBLE $ RETENTION $. $ WORKERS COMPENSATION 03/01/11 X WC STATU-" OTH- C WCO20342355 (AOS) 03/O1/10 __— AND EMPLOYERS'LIABILITY Y/N D ANY PROPRIETOR/PARTNER/EXECUTIVEa WCO20342356�.(CA) -03/O1/1Q 03/01/11 E.L.EACH ACCIDENT _ $ 1,0.00,000 —_ OFFICER/MEMBER EXCLUDE07 E (Mandatory in NH) WCO20342357 (FL) 03/01/10 03/01/11 E.L.DISEASE-EA EMPLOYEd$ 1,000,000 _ If yes.describe under \ SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 OTHER E TX Employers Excess TNSC46242373 (TX) 03/01/10 03/01/11 Occurrence/SIR 30M/2M D Workers Compensation WC0910566 (QSI) 03/01/10 03/01/11 C Workers Compensation WCO20342358(XY,M0,NY,WI, ) 03/01/10 03/01/11 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RE: EVIDENCE OF COVERAGE CERTIFICATE HOLDER a CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN THE HOME DEPOT, INC. HOME DEPOT U.S.A., INC. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL ,- IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND'UPON THE INSURER,ITS AGENTS OR 2455 PACES FERRY ROAD NW BIIILDZNG C-20 REPRESENTATIVES. ATLANTA, GA 30339 AUTHORIZED REPRESENTATIVE ,07 Ott USA ACORD 25(2009/01)Jthornton_hd ©1988-2009 ACORD CORPORATION. All rights reserved. 14481889 The ACORD name and logo are registered marks of ACORD - The Conrnioirrs'ealtlr ofAfassachusetis _ - - - Deyarfinent ofIndirsfrial-4cciderrts H — - Office of Invesfigafions 600 Waslrrnr torn�S'treet ' Bostort 1'�L� 02l'11" ii,rsnsr.nrn.ss.gon✓'dia 'Workea-s' Compensation Insurance Ufi.da-vit: Builders/Contractors lectricians/Plumbers Ap-pl>ican#Information _ Please hint Legibly Name (Business/OrgauLadollgIndividcial): OA r aT �C—S A.d sass: City/State/Zip. W. (J P1101-le Are you a.n emp.lo_.yer?tl4idck the approp 'ate box.: E project(required): 1..❑ I a --Mployei-Ivith 4• ❑ I am a general contractor and I avloyees(full and/or part-time).* ii<3 vZ ilix:2d ti1Z sii17-cvntfacit�f3 �Zodeh onStxdre.tion 2 I and a sole proprietor orpartrler- listed on the attached slr.eet. xlg ship and have no employees These sorb-contractors have xuolitioir working :for me in any capacity. employees and have Avorkers' ilding addition [No�tiorkers' comp,insurance comp_insurance. 5. We are.a corporation.and its ctrical repairs or additions xequired.] ❑ rP officers have exercised their 3.❑ :I am a.homeotivn;er doing all work mbing rrpair�s or a�dditaonsmyself. [No workers`comp. rigl3t of exemption periti-IGL of repairsinsurance:required.]i c- 152, §1(4),and.eve have noemployees. [No workers' er camp.:insurance required.] 'Any gppticaut du(chec}:s box#1.must also fillout the section below showing sheirworkers'courpenssb.on policy inforimtian_ t Homeoavmers who submit this.affidavit indicating they are doing all work and then hire outside contraciors tuust submit.a vew.affidavit indicating such kontracinrs that cbeck this boot miest attached au sdditionstt sheet showing the nsme of(be sub-con'tracinrs su.d stare twbether or not those entities have eVVIO ees. Ifthe sub-contractors:have employees,.1hey.must provide their workers'comp.policy number. I arrt nu eNiplo}ar dint is prof i'.clirrg rrrork rs':corrrp�risrat ort il:rslrrvrrr.c. or trly elrrpfoyevs. Below is t'lie policy and job site information. Insurance Company Name: Policy#or..Self-ins_Lic.. `: 1 e Expirntron Date: Job Site Address: t 1 /!/ Cit}1StatelZip:l ,�p,ti 1�7� l Attach a copy of.the 1i arkers'cc ensationpoUrT declaration page(shoirdng the policy nuizer and aspiration date). Failure to secure coverage as required under Section 2.5A of MGL c. 152 can lead to the imposition of cr.imirial penalties of a fine up to$1,500.00 and'or tnYe-year imlarisannlent,as well a.%ciT.41 penalties in the form of a STOP'jVORP'ORDER and a fine of up to$250.00 a day against the violator. Be advised that a cop),of this statement may be forwarded to the Of-rice of Investigations of the D.IA for insurance cmwage verification. 1F do TtFI certify rnr.de Pie prlins and penrzlfies n airy that the hr fortnation provide .bstre is true and correct Si ature.: Date: Phone#: F only. Do not trrita in this area,to be cauipltrted b}'cih'or town official n: Permit/License# hority,(circle one): Health 2.Buildin.g Department 3. CVY/Town Cleric 4. Electrical Inspector 5.Plumbing Inspectorson: Phone#: JuI. 13. 1'JU9 9:2UAiVI Charles G. rase Jr, 1u0. 4111 r. j � �fairKandu-s/in&essWegua ion ce o onsu�er A 10 Park Plaza - Suite 5170 Boston Massachusetts 02116 Horne Improvement Contractor registration Registration: 163528 Type: DBA Expiration: 7/7/2011 Tr# 285903 ERICSSON HOME IMPROVEMENT ERICSSON TORRES +� 16 HOOVER RD ---- ----- WEST YARMOUTH, MA 02673 Update Address and return card.Mark reason for change, Q Addross d Renowal n Employment [] Lost Card 7PS•CAt 0 40M•0108.068LIFORMCA108212008 Ad tbps"waril Alit-SY&'ilii#Offl icon lAcense or rogistratlon valid foi indiridul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Reglstrallon: 163528 Expiration: .7/712011 Tr# 285903 to park plaza- Boston,MA 02116 SI70 16 ERICSSON HOME'IMPROVEMENT ERICSSON TORRES .;..•:: t�l/ 16 HOOVER RD ---- WEST YARMOUT-H;MA-02673 Undersecrehry Not valid without signatu re Jul. 23. 2009 9: 20AM. Charles. C. Case Jr, i a®strietedlo:;No. 4717 P. 6 �= 11:>sxacl�u•ctts- Departmelit of Public Safet% IA- Masonry ,only Sword of Buildin. Regulations and SnindardN RE- Roof Coveting Construction Supervisor Specialty License 'WS-Windo4s anil Siding License: CS SL .100546 SF- Solid Fuel Burning:Devices Restricted W.S DM-Demolition only to:. ERICSSON: TORRES Failure to possess a current edition of the Massachusetts State Building Code 16••HOOVEI4 ROAD is cause for revocation of this license. W,EST'YARMOUTH, MA 02673 Refer to: W W.Mass,Gov/DPS Expiration: 811812012 ( uuuf+xbmvr Trg: 100546 HOME IMPROVEMENT CONTRACT • PLEASE READ THiS Sold,Furnished and Installed by: Branch Name: Boston Date: �J_-[-/_6 TIID At-Home Services,Inc. d/b/a The Home Depot At-Home Services 345A Greenwood Street,Unit 2,Worcester,MA 01607 Branch Number:31 Toll Free(800)657-5182; Fax(508)756-8823 Ncdcrai ID#75-2698460;ME Lic It C 02439;RI Cont.Licft 16427 '� �.,! CT Lic#565522 Home Impmvemt:rrt Contractor 1teg.#12689:1/ Installation Addres: ;5L f(_ r � — Q p (Sty State 'Lip Purchaser(s): J Work Phone: Home Phone: Cell Phone: Lq011y 1 l l L Home Address: — (If different from installation Address) City State Zip P:mail Address(to receive project communications and Home Depot updates):_ / ❑1 DO NOT wish to receive any marketing ema.ils from The Home Depot ,L a V I / Proicet lnfurnration: Undersilmed("Customer"),the owners of the property located at the above installation address,agree.;to buy; and Till)At-Hume Services,Inc.("I'he Home Depot")agrees to furnish,deliver and arrange for the installation("Installation")of all materials described on the below and on the referenced Spey:Sheet(%),all of which are incorporated into this Contract by this reference,along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders(collectively, "Contract"): .inh#; wl—d kar l Products: r�-- Saec Sheets)# !r Ject Amount `- Kontin - LJ - ❑ g ❑Siding Windows Insulation 0 *�2 ❑Guttcrs/Covers ❑Rnuy Doors ❑ 0 '{l _S Rrxrfmg Siding ❑Windows nnsulation $ ❑Gutters/Covers ❑Entry Doors ❑ _ �- Roofing ❑Siding Windows ❑Insulation ❑GullcIs I Covers ❑Hntr'y Doors❑ QRoofing Siding ❑Windows ❑hm ation $ ❑Guttcrs/Covers ❑N.ntry Duurs ❑ Minbnum 25%Deposit of Contract Amountt due upon execution of this contnut. Total Contract Amount $ 6 Maine Purchasers nrny rrut deposit more than one-third of the C'ontrad Amount. Customer agrees that,immediately upcni completion of the work for each Product,Customer will execute a Completion Certificate (one for each Product as defined by an individual Spec Sheet)and pay any balance due. As applicable,each Customer under this Conn-act agrees to be jointly and severally obligated acid liable hereunder, The Home Depot reserves the right to issue a Change Order or terminate this Contract or any individual PnxiUet(5)included herein,at its discyc:tion,if The Home Depot or its authorized service provider determines that it cannot perform its obligations due to a structural problem with the home,environmental hazards such as mold,ashestos or lead paint,other safety concerns,pricing errors or because work required to complete the job was not included in the Contract. Pavment Summary: The Payment Summary# ci [ �L _. included as past of this Contract, sets forth the total Contract amount and payments required for the depohiL%anti final payments by Product(as applicable), NOTICE TO CUSTOMER You are entided to a completely filled-in copy of the(contract at the time you sign. Do not sign a Completion Certificate(note: there is one Completion Certificate for each listed Product as derided by individual Spec Sheets)before work an that Product is complete, in the event of termination of this Contract,Customer agrees to pay The Horace Depot the casts of materials,labor,expenses and services provided by The Home Depot or Authorized Service Provider through the date of termination,plus any other amounts set forth in this Agreement or allowed under applicable law. THE HOME DEPOT MAY WITHHOLD AMOUNTS OWED TO THE IIOMK DEPOT FROM THE DEPOSiT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCU AMOUNTS. Acceptance and Authorization: Customer agrees turd understands that this Agreement is the entire agreement between Customer and The Hume Depot with regard to the Products and Installation services and supexsedes all prior discussions and agreements.either oral or written,relating to said Products and installation.'this Agreement cannot be assigned or amended except by a writing signed by Customer and The Ilona Depot.Customer acknowledges and agrees that Custom T has read,understands,voluntarily accepts the terms of and has received a copy of this Agreement. AC rat, 1 Su tied by: Custumer'a Signature Date / Sales onsullant's ignature Date J' X Telephone No. Customer's Signature Dale Sales Consultant'I;iccn%c No. _ CANCELLATION: CUSTOMER MAY CANCEL THI5 (en sl,pairaDle) AGREEMENT WITHOUT PENAi;Y OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME DEPOT BY -MIDNIGHT ON THE. THIRD BUSINESS DAY AFTER SIGNING THIS AGREEMENT, THE STATE SUPPLEMENT ATTACHFD HERETO CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRE,SCRiBED BY LAW IN (USTOMER'S STATE. NOFKT:ADDITIONAL TERMS ANI)CONDITIONS ARE STATP.D ON TrW..KKVER.SP Sl'lw AND ARE PART OF THIS COIw'RACT 11.30-09 CSC- White—Branchfile Yellow—Customer Pink—Salto f'nn4,'rant 2A d SHV 4oda0 awoN << ILLW_56905 3N0Hd'KGdX32L92 L£:£L GO-LL-OL02 v 6_5 3 Y C) TIKE r� Town of Barnstable *.Permit# b Expires 6 m194. ths i de Regulatory Services Fee . BARNSTABLE, Thomas F. Geiler, Director v MAss. g 1639• Building Division �-- prED Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www,town.b arnstab l e.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - ' RESIDENTIAL ONLY Not,Valid without Red X-Press Imprint Map/parcel Number Property Address 33 �C C S'' 41�U/ O� esidential Value of Work ` Minimum fee of$2S.00 for work under $6000.00 Owner's Name &Address_� 2'/��—�' �'7�• � �'��� �CJ Contractor's Name ��7 /` - L�j—t`'L 4/S Telephone Number 7 7 3— 0/0✓ Home Improvement Contractor License# (if applicable) 1— —3 �l ❑Workman's Compensation Insurance Check one: /' am a sole proprietor ❑ I am the Homeowner V-PRESS PERMIT ❑ I have Worker's Compensation Insurance Insurance Company Name SEP 2 4 2008 Workman's Comp. Policy# TOWN OF BARNSTASL. ' Copy-of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) side ❑ Replacement.Windows/doors/sliders. U-Value (maximum..44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. 'Note: Property Owner must sign Property Owner Letter of Permission. - A copy of the Home Improvement Contractors License is required. SIGNAT'URE: . Q:\WPFILES\FORMS\building permit forms EXPRESS.doc Revise020108 The Comrnonwe y1th of Massachusetts f Department o Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumberg AppHcant Information Please Print Le 'bl NaI]7.e(Business/OrganLation/lndividual): - • City/gtatdZip: �'7" �`? of i� /J`- Phone.#: Z. Are you an employer? Check the appropriate bole: Type of project(required): 1.❑ I am a employer with 4_ ❑ I am a general contractor and I ti ❑New construction employees(full and/or part-tiwc).* have hired the mb-contractors Z [�I aim.a-sole proprietor or partner- listed on the attached sheet [7. ❑Remodeling slip and have no employees These sub-contractors have g. Demolition working far me in any capacity. employees and have workers' 9. ❑Building addition [No workers' Camp.-hanmdnr_C cow incrsra�°�'$ 5. [] We an a corporation and its 10-[]Electrical repairs or additions rhirrred j officers bave exercised their 11-❑Plumbing repairs or additions I am a homeowner doing all work myself; [No workers camp_ right df exemption per MCL 12 ❑Roof repairs t c. 152, §1(4), and we have no insrrranCe r j employees. [No workers' 13.0 Other c,rop,T in=cc regvired-j *Any applicant that chxka box#1 must also fill out the section blow showing their wcnkrrs'cotnpcnsz4o.n policy infmmation t Hrnwnat who submit this affidavit indicafiag 6rcy am doing all work and then hire outside contractors must subm a it new affidavitindicatin om 9 svrh tC-Dvt Mctnrs that cbmic this box rnvst attatbcd as additional sheet showing the name of the mb-contracinrs and slate whetlra or not fhosd entifirs have employers. if svb{oniractars have rsvployees,tbey must pravi&their workcn,camp.policy numbcr- I am an employer thni is providing workers'compensation insurance for my emproyees Belaw is the policy and job site informatian. Inm ancc CompanyNamc_ Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/Stafc/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to sccurc coverage as required under Section 25A of MGL c. 152 can lean to the imposition of crisatial pcoaltics of a find Tip to $1,500.00 and/or ono-year in:j i onmont,as well as civil penalties in the form of a STOP WORK ORDER and a fi of up to MOM a day against the violater. Be advised that a copy of this statm=lit may be forwarded to tho 01�2-ca of Investi bons of the DIA for inerrramr'coverer o verification.. I do hereby certify un pams.and pen of perjrLry that the information Provided above is true and correr� ! 2 ~© F — Si e: P Phone# 7• D O facial use only. Do not write in This area, to be completed by city or fawn offcciaL City or Town: PermitrUrense# Issv7agAuthority,(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Phone#: Town of Barnstable Op THE rp� Regulatory Services saxxszescE Thomas F. Geiler, Director q,P 1639. awe Building Division Tom Perry,.Building Commissioner . 200 Main Street, Hyannis,MA 02601 nrmw.town.barnsiable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION C� y Please Print DATE: 6 JOB LOCATION: number street village "HOMEOWNER": // ' 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 m;n;mum inspection procedures and requirements and that he/she will comply with said procedures and requireme s. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the. State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1,1-Licensing of construction Supervisors);provided that if the homeowner engages a parson(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption aTe 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 unliccscd 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 hcJshe 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. .,ofIHEr 2 Town of Barnstable Regulatory Services s,lxx esrF- Thomas F. Geiler,Director .63p t tea. Are 639 Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the property roperty hereby authorize � eG' to act on my behalf, in all.matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name I£Property Owner is applying for permit please complete the Homeowners License Exemption Form on tb:e reverse side. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ^�C- f-02 Map 1 0 1 0 Z, Parcel Per it# Health Division gle 6k' Derte Iss ued 0f _.Conservation Division' � l 3 '" f �-f Application Fee Tax Collector Permit Fee Treasurer m4:t 11 #Qt . Planning Dept. CON NECWMACCOUNT Date Definitive Plan Approved by Planning Board # Historic-OKH Preservation/Hyannis Project Street Address 53 Pt L, i ✓h �yl e Village 1A,&A n't S Owner -)o V N No U to Address 118 IC�1 Telephone �--' �iJlarvh ► 5t�./ 1 9-7 7/ Permit Request 1- uk-_-% hayncLI e°i 1,Cr4;n A4 oAACe W�-'P Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new fl . Zoning District Flood Plain Groundwater Overlay Project Valuation $900 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes X No On Old King's Highway: ❑Yes No Basement Type: ©Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing AJ new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing tJ �' new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size AM Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal#. Recorded❑ Commercial ❑Yes N No If yes, site plan review# Current Use S,,n4)_1P Q 44A%L CI S.�e ACle Proposed Use ��,_ ,, A).�C k_ BUILDER INFORMATION I I r' 4 ; Name ' b�4Q,,"( w Telephone Number ` a `7 Z ~ Address e ` License# c 4f I ! ?10 . —A,)&A-r '/AMo c� , MAC 0 y2Z, 3 Home Improvement Contractor# Worker's Compensation# -35 7 k E70 7 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE /0-20"/f d FOR OFFICIAL USE ONLY o PERMIT NO. DATE ISSUED MAP/PARCEL NO. k ADDRESS VILLAGE ' OWNER DATE OF INSPECTION: FOUNDATION E FRAME N INSULATION FIREPLACE C� ELECTRICAL: ROUGH� FINAL m ' PLUMBING: ROUG FINAL GAS: ROUG FINAL t FINAL BUILDING n DATE CLOSED OUP ASSOCIATION PLAN1 NO. } RESIDENTIAL BUILDING PERINUT FEES APPLICATION FEE New Buildings $100.00 Residential Addition $50.00 Alterations/Renovations $50.00 Building Permit Amendment $25.00 ` FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x.0041= plus-from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0041= plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq.ft.= x.0041= 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.0041= 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 � �® •O d Projcost Rev:063004 1 The Commonwealth of Massachusetts Department of Industrial Accidents Mh ef/floswM F - J 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit-General Businesses name ^ address: city 11 Gvf tM OZ.�* state: zip' 67,67--3 -phone# Q�j ' -7-N� work site location(full address): 3 `La t✓v` L tAA Ae—"N 4 IS �A a< d Z1,,O 1 ❑ I am a sole proprietor and have no one Business Type: • Retail❑Restaurant/Bar/Eating Establishment working in any capacity. ❑Office❑ Sales(including Real Estate,Autos etc.) ❑I am an em loyer with etn l ees(full& art time). ❑Other I am an employer provliding vior/klers' compensation foamy employees worldnlgl,on this job, company IIemea YJ Cl h�l' 11/1' ic l/�l lL�k�L PJI'e address �0"5 � �`�• •it; �... -;. .'r .i ' city: �lLr �i FC�J�an'1U1��'►L Ubone#:-ffS. rrr///V `• insurance.cb: ,..; . . :., •.'. / / //% I am a sole proprietor and have hired the independent contractors listed below who have the following workers' compensation polices: coin en name city phone insurance co. g ///// company. neide address cite phone# insurance co:.:: '.;,•.•. : .. :...:: ` .,<,.• • ..: o7icV#':'•' Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that d copy of this statement maybe forwarded to the Office of Investigations of the DIAfor coverage verification. I do here ce under th_epains and en ties ofp jury that the information provided above is true and correct Signature Date /0 S Print name P i/1 t f i'A '//!C Phone# .�G,f• 7 7J ' `3` S77 •�-tea. .•:r�� •�`k�����-•,•'-,,,,�-,-x=�-,�r.=�•��r:�'€b�. '�i'�'�' = _. z official use only do not write in this area to be completed by city or town official city or town: permit(license# []Building Department IEIIAcensing Board ❑check if immediate response is required ❑Selectmen's Office []Health Department gar- contactperson: phone#; ❑Other �( (revised Sept 2003) r Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers'compensation for their employees. As quoted from the"law",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 on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 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 applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation. Please supply company name, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. .Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns 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. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents OfllMe of Imsugauens 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 7274900 ext.406 FINE roy, Town of Barnstable Regulatory Services ' MM "BIZ' Thomas F.Geiler,Director MAM Building Division -Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This'Section If Using A Builder l) ✓i 0 ,as Owner of the subject property herebyauthorize Habitat for Humanity of Cape Cod, Inc., to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) o;t-p o r Sig t6' 6'of'Owner Date �— R'dit (7- Print Name Q TORM&OWISM"ERMISSION Town of Barnstable Regulatory Services HARNSTAELE, Thomas F.Geiler,Director 7 MAN. fp 39. p`` 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. sQ Type of Work: JA Ar4 %r Ap_ a r ce sS 2AtAe Estimated Cost q Address of Work: 3 3 I.u,C I M - Owner's Name: Jei h n ►'60 J3 Date of Application: 1 D- Zo- O q I hereby certify that: Registration is not required for the following reason(s): QWork excluded by law aJob Under S 1,000 ied Building not owner-occup []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 he apply for a permit as the agent of wner: J 1, - -7o -6 1/ Q)AZ� Date —T Contractor Name Registration No. OR Date Owner's Name Q:fortns h omeaf8dav ...................................... ..... ....... DATE(MMIDD/YY) ............. .............. ........... ... .... . . . ......... ........ ...................... S: . .. .......... ... .. ...... ...... . ... ........... ............... .......... ... ..... ................ ..... ..... AN . .. .......... .... ............ ...... ...................... ......... 5/14/04 ............. .................... � "T ......:l: - .... R ]:'IN IN' . . . . ...... ...... ........ PRODUCER 800-824-9245 THIS CERTIFICATE IS ISSUED Ah A MATTER I ER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE Acordia Northeast DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW 1300 Mt. Kemble Ave. COMPANIES AFFORDING COVERAGE P.O. Box 1919 COMPANY Morristown, NJ 07962-1919 FEDERAL INSURANCE CO. A INSURED COMPANY MAY 18 2004 HABITAT FOR HUMANITY B COMPANY OF CAPE COD, INC. c 657 ROUTE 28 COMPANY W. YARMOUTH, MA 02673 .......... .... ....................... ................ ................. .. .... ......... 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. LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF. POLICY EXP. LIMITS Col DATE(MM/DDrYY) DATE(MM/DDfYY) GENERAL LIABILITY GENERAL AGGREGATE 20000 A X COMM.GENERAL LIABILITY 35781707 4/01/04 4/01/05 PROD-COMP/OP AGG. 20000 CLAIMS MADE �OCCUR PERS.&ADV.INJURY 10000 OWNER'S&CONTRACT'S PROT EACH OCCURRENCE 10000 X Hired/Non- FIRE DAMAGE(One Fire) int-hiript 1 Owned Liab MED EXP(Any one person) 0 AUTOMOBILE LIABILITY COMBINED SINGLE ANY AUTO LIMIT ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE GARAGE LIABILITY AUTO ONLY-EA ACCIDENT ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT q AGGREGATE EXCESS LIABILITY EACH OCCURRENCE UMBRELLA FORM AGGREGATE OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND STATUTORY LIMITS A EMPLOYERS'LIABILITY 71706899 4/01/04 4/01/05 EACH ACCIDENT 1000c THE PROPRIETOR/ INCL DISEASE-POLICY LIMIT 1000( PARTNERS/EXECUTIVE�/ OFFICERS ARE: EX CL DISEASE-EACH EMPL. 1000c OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS EVIDENCE OF COVERAGE .......... SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE TOWN OF BARNSTABLE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE 367 MAIN STREET LEFT,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR r655�7 HYANNIS, MA 02601 LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTHORIZE EPRESENTATIVE =7.7.77 BOARD OF BUILDING REGULATIONS ' License: CONSTRUCTION SUPERVISOR Number-;.CS 081130 Yl Bicthdate;01!02(1.997 Expires:.01/02/20b6 Tr:no: 81130 - - Restnc#ed 00- PATRICIA A TAY,R 46 BELLS NECK RQ (,,�,....* W HARWICH, MA 02671- Administrator 37 l ----- ...176 .........._.J; MAP 3 10 .......... i fpr 1 i c:\conservation.dgn 10/20/2004 1:29:02 PM lot rl or rro = SCALF) 3` lb© Dom �,k E Eta o RAttj bilk 0 Lb tf ! 1:lvc ix ET t T2o�1 R LAI FokN .► - ,-Z�Y2. F2otA L o vs LAG HOLY To HOLLSE 1f5 III } t M E:. CAS ST(LDE'fAILS rs sriS1,D IA A-6�T� tj ............ 74 Yi t - -- sw lb ;'mac.,;� ,'• •.+•�{YaJtf,..�� !� •@r �°s'�`'.��� •,..•'`'�s` � � �a I „, +s,= a ��•• s r4•,tea,.. ECI+ r+�"'•ti �" # pja[�' � f.. y: iF'':� ' . �i Mt �` 'fir ��i _«lam► f +� � �t`i •� � '� t .;c 'i� � .,�'f. .�I i TOWN OF BARNSTABLE REPORT SUPPLEMENTARY/CONTINUATIO EPORT NAME (LAST, FIRST, MID E) DIVISION /D'13HY7 ®�. � NOTE DETAILS 6 OBSERVATIONS-ITEMIZE EVIDENCE, SERIAL tS ETC. 33 tS e_ t- o Ad 'r-� 2 C� �.� SUBMITTED PAGE 1 CARBON MONOXIDE AL��fS . �4.' iL MUST BE INSTALLED PER ' MASSACHUSE)7S �; -��'„t (�•_ N i `�. �.. L S DKE DETECTORS REVIEWED-- \J J BAANSTbLE BUILDING DEPT. DATE .. - nAE DEPARTME 4 f DATE - &M VWV S AW fil OUIREDFORHRMIMNG IMPORTANT- UP ADE REQUIRED. � b STATE BUILDING CODE RE IRES THE UPGRADING OF SMOKE DETECTORS FORT ENTIRE DWELLIN '5W'EN ONE OR MORE SLEEPING AREAS ARE ADDED OR ✓ NOTE: A SEPARATE PERMIT IS REOURED` THE INSTALLATION OF SMOKE DETECTORS-THE ELECTRICAL ES NOT SATISFY o lkv -- 4 ` 042., �S Li I *6rJ2 �`� " Tl �• }-�L NW*99NILevii V$a® 96 M089 Odn �p�1/tit __...__._.I!`;;I:,I!I i,Iii►I!II: P____.r,.._.._II'I;I'1orI!i .p.._._o.1!�!I�iI!;II s_-be.�d_.�1_.6i,IIi�IIIIi!I1I'IrI .x... _1_6 Addition ddition .'a►--.�_.--a-.--.----'-r1irI!I!III IIII!i I(!IIiI':I!I�' iI elevations levation s__-_.r(I!I"__.-`----._rL�iiIiII•-,- e -_-n..iIiII�I_ n e_ r I-•�iIi i n--ij�!II—��!,•"--'_-y_-:a_•._-_-�!��:Ij'�Ii-_-__--.-�I;1Ilt; _! __-r_•__h__-riII1 IIIfI�iI I/4" ' Rd9e is double LVL see attachd oof frame z xto t�" OC with �ciu ceiling joist aR n 10 strappingL t is shingle vent z-It, r sp alf sW Cesoveutderlaymen framing with /: GDheathing yveK ouse wrap � _ ' Whits c ar shingles �II1rI I alce, _ with second member —. - " AzeK soffit with nCnous vent t5 Azeic freize, board� azeK fascia _10 Aluminium gutters with down Puts Windows are Vicon vinyl with Low a glass Internal grids (*/�4 f WWI r" Awning III1{� -------- -III _.--•--.. 6 AzeK window trim with PVC sill nosing Exterior wall insulated R 9 fiberglass F Wall board %_" blue board and sicim Plaster iI I --_----__-/----._-'��;I.'rI•Ir� ._ —S l►5�''!i.I Ii _-F L .-A eManferdim Residenc 33 Pilgrim L ane Hyannis Ma 02061 'i cG- �I u�i t!i Iit_! --� — -..-.. i D.-� � I-- jI -I I� -— -_- -- __ !jiiI! - !I'I; - I� -� I - -- - - _ � I j - i I I I I : I I _ _ t , r , : : ' I I ! I I : : : , I i I I • l - , : , , , r. r : I : I , Frame f�Footing Plan t xisting house 2x4 house T . r Ledger attached toe _ ! - , T- all on 8 concrete foundation with A" IL 5" �: } _. v'1 lags , ._ I _ `_.._ �. j • I _ _ - . ! .. _ , -- , 1 i 2*10 joist IV OG Simpson with metal LuS210Z hangers on both ends ,�C�_ r : j ' 1 Double 2xlo birder on4Xto post attached to i E a 10" sono tubes on big foot : -- - With AQV4 !. post base nth 5/S" anchorhor It _ I i i Floor joist connected to beam with r , _oor system Detail "G" joist (tYP) / MS clip per joi Flo i a E woo a r r detail P top ; � �2X10 joist , - See det ! • DecK to be '1/4"Tfr lr 1 ood glued and nailed with R 3o fiberglass - i t ; P Yw , '-,Nailer 2" 2" 9 F_._ .. _.-- S ring shanK mails Insulated with R 30 fiberglass , " X I ! i ! i I Base of de�K to be Y% PT plywood �: � ywood ,. . ... -- L Cleat nailed to and I ood dropped n' r inside of joists a _,i Pl _ ! ' J yW d piled i , ; e , r See detail G P � _ , i I st� ' bath Foom wall/base : (to enclose toilet plumbing move) =' - - - - -- Plumbing enclosure "A I I t i s ab b of de Frame 2xlo wall on side c from base cK � i # I i( to 18 below grade. Dover outside with Dura rocK and sKim seams, Insulate with R I - fiberglass f - 9 j See Detail A ! _ I 111 Footing Detail "6" 1 i t _.�___ I 0 footing U4lo post base AQ 51or anchor bolt -- Sono tubes to dia 40" - _�. _ _ _ _..___ . _r_ - ' 1 �T below rade 9 2 x2 6igfoot I t•'•jH OF Sys I I >`� 1 v M R A, y<% ff ' ---� _s _.. _ , M- _ a F _ i , E I , 9 , , • 1 n ,• r a� l : t , , _ -7-101 (J _. If`IQ�S .i. b . s 31 1 1 IO C:o Jo s .FLi __ f _ } w .__..._ .,_.,_.... .__ _ t japeop 91A-I Nti/ 11 X Ni/e I -Z a6p� uoltepuno} o} 190d S IA7 Y. NV/E N�1.6 HUM 6wJeaq peol anouaag i! i { 1 t � 1 I Town of.Barnstable Geographic Information System April 26, 2011 �s s ; 9170 tO 310104 , #A5 310106 41 s k 3.10091 # 176 310103 a 439 310110 ,: Ak >: #9 > H 310092 i S � O i ` AveJ r 310093 # 310101 i 310109 86 + ��`'�r1'',` - 'i b des �.IF Mn•. . 310108 I F'.. •10094194, 1+: 310100 r~ #94 Feet x ' DISCLAIMERS This ma is for planning u Ma 310 Parcel 102 p p g p rposes only It is not adequate tor.legaf F boundary determination or regulatory interpretation. Enlargements beyond a scale of Owner MANFERDINI DONALD R& ALICIA Selected Parcel N 1"=100'may not meet established map accuracy standards The parcel lines on this map Total Assessed Value S132100 are only graphic representations of Assessor's tax parcels They are not true property Co-Ovmer' Acreage 0 i 4 acres Abutters E such as budding locations boundaries and do not represent accurate relationships to onysical features on the map LoCaiior, 3 PILGRIM LANE Buffer AJ q . �iclsT- n6AI129tQ-,r- uhPs ��S ru2. I . _ •-� --- -. _ - . � .. �S fin i_ ��o�t - u - � / /1/ W Gle-c, Avi// ..- �' r.�e�`, fl�Q.c�vy ��/✓ •t�� 1 /G"_ / v UCI�IC�I'Td,c/ /QC� v / _ ` 'v // o'a°to �. �ir/e !� �c:� ,u.�u�o �r/Dosr—�6�%vT" r, 6X1ST?�iG rrx/ lock i I o DET ORS REVIEWED SMOKE E TO RE II I I E I EPT. DATE �. ZBARNSTABL BU LDIN CO FIRE DEPARTMENT DATE t i #! I BOTH SIGNATURES ARE REQUIRED FOR PERAA -~- _an"ow &7 I lip -- - ! �y I /r 2 e C`/��, ter/ �l�O�. o �'r r, Ft�cL-��-12��Q�,- .. -... . ./ - �( -- - - .._ ._O/ .. _..�, _..�el/9.Cf. f z-Y ILI , --- - .-eIt UrIL,/i\( Ili �cd,PiJ Ii d XG wer A/ i 0-9 I ii rr a� e i Livj new I , i i � . IV 44,V44" ec fu fX,4c1joL -217 ZIC dow bt a - 30" x s7 '/i Ro I. n 3 Po �JO b 2S , , ,;7 Grose 4110 7-1 elo 7_. i OL/6 r �1 - - EX/Sr/N 6 7-,WSS /,vS �Gc �� " .211 '� C/C. .2,2(A� P C04D / 6o,4i ,.cs ,vr/./Pc/�ay�s%�pc vo os� oo J PjiC�G�� �rrtt4 LLSrA i �XS RAF 33 Sill 14,5- 7X6•e•fltS.Ee /J2 To Plate- - 144 , SA) r`AJ 1 Zo i ��k A arm 7i // Ole Aig A116 eqA»u�e A1 iui ► O U QL-E -- - -- - jo' -bouu e wL �' Doi -LL LVL- Aleey See- - i- _i_ /VoRao� 2 3 x .I e , e - I 5 , _ LI C R60 ,�