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HomeMy WebLinkAbout0038 ABBEY GATE y I� i q rt: � CIN Application numbe� Fee ......... ....... ..!..:. ............ Z Kam'$' = Building Inspectors Initials... ,,pp OCT 1 � 20.E ............................... s6s¢ ASP MAIN A 1• U I �� 1 AIN ' )F bAKI��S IABLF Date Issued.:....1�11.d . ................... ....................... Map/Parcel...........0. � I... ........................................... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION edAddress of Project: �, NUMBER STREET VILLAGE Owner's Name: /�i gi:112 0;4L Phone Number /SwJ oq— 7/-�7 Email Address: tA/ t1 b6 0 l 1 © C,0 r`c QS J,h e kell Phone Number Project cost S A/ Check one Residential ✓, Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize &-ofloy e S C- to make application for a buil a ac rdance with 780 CMR Owner Signature: Date: TYPE OF WORK ❑ Siding ❑ Windows (no header change)# ❑ Insulation/Weatherization ❑ Doors(no header change)# Commercial Doors require an inspector's review Roof(not applying more than 1 layer of shingle ) Construction Debris will be going to -'own e ya,,V-- -k D j5rosq 4 req /� CONTRACTOR'S INFORMATION Contractor's name 13 ►L roo l/ trh �✓�S�S /I-i C Home Improvement Contractors Registration(if applicable)# got`7 / (attach copy) Construction Supervisor's License # 114006 (attach copy) Email of Contractor Jft\3 @ �QO tJ0Ve NTeRP2 iSeS,C Phone number (509)695`006 ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTYES IN . v/1.•A A..frr AftnrA MI A nnn^%iA S nrr_i+nr A nL'nAA.r A-Aa ..P id-r-f rr.+ R 1 APPLICATION.NUMBER............................................................ *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a.site plan with the location(s) of each tent Fuel source being used LP tank 20 lbs. or>Yes No ,if yes, a gas permit is required. Natural Gas Yes - No , if yes,a gas permit is required. If food is being served at.your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand -the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APP 'S SIGNATURE Signature Date All permit applic ' e subj ct to a building official's approval prior to issuance. r� V 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 /��j Name(Business/Organization/Individual): f/✓ror"tAv Address: -72 c lkov- )n City/State/Zip: �� /w�G� Phone#: JtsgS -`� 06 Are you an employer?Check the appropriate box: Type of project(required): 1.9I am a employer with _�; 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' 9. ❑Building addition [No workers'comp.insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work r. 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 Ke- `V'00 _4- — 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. 7/ Insurance Company Name: / rr, V e/�ys Policy#or Self-ins.Lie.#: t� �6 9 / Expiration Date: 71312 t2 Job Site Address: �o 'e_ 414Q�� City/State/Zipfi /.,-I�MA026 3 4�-- 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 covers a verification. I do hereby certify under th and raffles of erjury that the information provided above is true and correct Signature: Date: Phone#: w J^ `1 /0- Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person iri 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,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permittlicense number which will be used as a reference number. In'addition,an applicant that must submit multiple permittlicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 4-24-07 www.mass.$ov/dia I Office of'Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts: 021:1& Homed',mproveMiAf�Ca tractor Rpegis,trati`on Type: Corporation Registration: 182479 06l25f2021 BRONOV ENTERPRISES INC t x XExpiration; 72A'1 CHtJR'LANE ya vt A COTUIT,MA 02635 Update Address and Return Card. SCA 1 A 20M-05/17 -- Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT,CONTRACTOR RegW4tion::daiid-for,indivnidual use:only,: TYPE Gorooration before.the expiration date'. If found return Registrptt�n it Qffice of Consumer affali's:an d Business KgguIa#0p. 'k824a9� O6I25�202�1 10()0 Washington Street Suite BRONOV ENT.ERPRISES_1NC1'5 Boston:MA 02118 72 ANCHOR LANE',?'-,. �, fGG.� - COTUIT,MA 02635 ' U�aderseGretary of lid M► out Signature I Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Cons VAA*Nisor CS-114006 S, �� Q "-pires: 10/25/2022 EVGENIY BR_UNOV, - r 72 ANCHOR LANE, COTUIT MA 0303&; Commissioner "'�-- i I ACORO® DATE(MWDD/YYYY) � CERTIFICATE OF LIABILITY INSURANCE F10/09/2019 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(Sj, AUTHORIZED REPRESENTATIVE OR PRODUCER,,AND THE CERTIFICATE HOLDER. IMPORTANT: If''the certificate:holder iS,an.ADDITIONAL INSURED,the:,policy,(ies);must be:endorsed. If SUBRQGATION.IS`WAIVED;subject.to,. the ter-msand.conditions.of the pelicy(,certain.poitcies-max requireartenclQ 5ement ArstaWrrkeato.h4hiscimtifieate*d0..ea7"t.cdaferrfghts.to the certificate holder in lieu of such endorsement(s)'. PRODUCER CONTACT NAME: Natalie Silva BENSON YOUNG & DOWNS INSURANCE AGENCY INC mac"o EXt; (508)487-0500 A/ No: E-MAIL natalie@byandd.com 56 HOWLAND ST INSURER(S)AFFORDING COVERAGE NAIC# PROVINCETOWN MA 02657 INSURER A: TRAVELERS INDEMNITY CO OF AMERICA 25666 INSURED INSURER%B .-BRONOV-ENTERPRISE'S INC ANSURERC-: INSURER D: 72 ANCHOR LANE INSURER E: COTUIT MA 02635 INSURER F: COVERAGES CERTIFICATE NUMBER: 458678• 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 AFFORDER+BY THE POLICIES:DESCRIBED HEREIN IS SUBJECT T,O<ALL'THE TERMS, EXCLUSJONSAND CONDITIONSOF SUCH:POLICIES:.LIMITS•SHOWN MAY HAVE-.BEEN REDUCED RY'PAID.-CLAIMS,. INSR A SUER POUCYEFF POLICYE•XF= LTp TYPE:Of.INSURANOE POUCY•NUMBEIR MM/DDL•YYY MM/DDN- UMITS;: COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES Eaoccurrence $ -MED EXP(Any one person) $ °N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMITAPPLEBflER: -GENERAL AGGREGATE $ POLICY❑ O-PR ❑LOC PRODUCTS-)COMPPOP AGG_ S JRO- _,OTHEf;` 3 JAUTOry1QBILE`Fl)QIIJTN •OOMBINED.SINGLEUMrr S Eaeoeident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ HIRED AUTOS AUTOS NON-OWNED PROP PERTY DAMAGE $ accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE' $' EXCASUAQ: CLAIMS-MADE N/A AGGREGATE. s DED I I RETENTION S $; WORI(ERSCOMPENSATION, ^ $RT UTE ER AND EMPLOYERS'LIABILITY Y/N TH ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBER EXCLUDED? WA WA WA 6HUBOG14209319 07/03/2019 07/03/2020 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 DE3s-describe-under CR PT ON OF OPERATIONS below E.L.DISEASE-POLICY LIMIT s._.500,000 N/A DESCRIPTION OF-QPI RATIQNSI LPcAT10NS,iV.EHICLES;(1ACORQ1011dAddttionel Remarloe:5l hedutq•may bp:attached if mvF615paoe(s cpquiced) '.Workers'Compensation benefits will be.paid to Massachusetts:employees:only.Pursuant to.Endorsement VVC 20'03!06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.goV/twd/workers-compensation/investigationsi. CERTIFICATE HOLDER' CANCELLATION. SHOUL'D'•ANY,OF THE ABOVE DESCRMED POILICIES•BE CANCELL'ED,BE•FORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 367 Main Street AUTHORIZED REPRESENTATIVE Hyannis -MA 02601 Daniel M.CroG�ey,CPCU,Vice President—Residual Market—WCRIBMA O t988=2014 ACORD>CORPORATION.•All:rights reserved. ,ACORD'25(2014M) The ACORD.name and Ingo-are,registeFed:marks;MACOAD Map, 4249.2 Parcel Permit# 13214 / Conservation Office(4th floor)(8:30-9:30/1:00-2:00) Date Issued 3 -.2-1 91v Board of Health(3rd floor)(8:15 -9:30/1:00-4:45) Fee Engineering Dept. (3rd floor) House# d.�NB Planning Dept.(1st floor/School Admin. Bldg.) ee: RNSTABLE.�` Definitive roved by Planning Board 19 SF_ EPTEC Ma3w �. I TOWN OF BARNSTABL ����MT H'r�i�Tl�'�.����a � vV6E Building Permit Applica n ENVIRONMENTAL CODE AND TOVWIREGULATIONS Proje Street ress � Village C�-N8ftNzlv Owner Address SD•,vs`G" `r Telephone 1..�.�.�— (A �2 Permit Request First Floor square feet Second Floor Q square feet Estimated Project Cost $ 1 O O© , Zoning District Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type Commercial Residential Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House Unfinished Old King's Highway Number of Baths No.of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds Other `` �s - Builder Information Name��v\ � . 1(��o.M.O,,3 --N-SO V S �AO z Telephone Number Address 0,V e icense# 96 fft5r a.,S o_ .0;Z-6 S�3 Home Improvement Contractor# Worker's Compensation# CL)CC-/9(,P 'S o 1,9z NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS-BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �G.4fYi96`� SIGNATURE ( o l�fi DATE �6 BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) i J r FOR OFFICIAL USE ONLY l YJ r Z PERMIT NO. DATE ISSUED i MAP/PARCEL NO. y ADDRESS ' VILLAGE OWNER . � r DATE OF INSPECTION: FOUNDATION ! FRAME ` INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL _ GAS: ROUGH `� �; FINAL FINAL BUILDING : ; /,4kg"7� DATE CLOSED OUT . er! Q >f ASSOCIATION PLAN NO. �� EA �; TH OF MA.SSACHUSETTS COMMO , i7EI't3.ItTMEN ' INDUSTRIAL OF INDUSTRT ACCIDENTS - 600 WASHINGTON STREET BOSTON, MASSACHUSEZ'Is 02111 � . fames J Carnooel' AFFIDAVIT �ornm!ssioner WORKERS' COMPENSATION INSURANCE I, PCr.�2 a C�ze AAA- 5©`A-5 (licensee/permittee) with a principal, place of business/residence err. (City/State/Zip) do hereby certify, under the pains and penalties of perjury.that providing my employees working on this [J 1 am an employer p g the following workers' compensation coverage for job. \ GC �A,- C. �A�ed---5 ��"'�'��'��`" Poli bcr Insurance Company [ ] I am a sole proprietor and have no one working for me- [ ] er (circle one)and have hired the contractors listed below I am a sole proprietor, general contractor orhomeown who have the following workers` compensation insuranee'poliaer. Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Number. Name of Contractor Insurance Company/Policy Number Name of Contractor 0 1 am a homeowner performing all the work myself. repair rk on a NO'I'E.:..Plcu c be aware that while homeowners wbo employ persons to do maintenance, grounds appurtenant thereto r are not Q nerally application by a homeowner for a license dwcliing of not more than three units is which the homeowner also reside or on the grow considered to be employers under he Workers, Compensation under the tWorkers'C Compensatioa)AePQ or permit may evidence the legal for of Indust"Accidents' Ofncc of cnalucc ce I understand that a copy of this statement will be forwarded to the Depa A f MGL 152 can lead to the imposition of mminal pera l 1 vcrifiation and that failure to secure coverage as required under Section 25 Work Order an consisting of a fine of up to S1500.00 and/or imprisonment of up to one year and civil penairia in the form of a Stop fine of S100.00 a day against me. n day ofL� , 19 Signed thisr���- Licensor/PermiCLor Liccr srrPerrm ec ,t O' e &mwwmweaa 23407 DEPARTMENT OF PUBLIC SAFETY P Q 23407 ONE ASHBURTON PLACE, RM- 1301 2 U ��C BOSTOt1;-T�� (A��;02108-1618 OCT CONSTRUCTION SUPERVISOR LICENSE 'tiM.'.Y` �e P. a. Number: Expires: .: == CS 026325 10/20/1997 Restricted To: 00 i 1 PAUL J CAZEAULT ��y` -�-- Vie4ch bottom, fold , sign on 1580 MAIN ST _ hack, and laminate license card. OSTERV=, MA 02655 `•.�.. " --' ,"K ep top for receipt and change '"of address notification. Restricted To: 08 23407 .D$ RTNENT OF Inue SAFETY , MIST$ffCTIbi=SOPERYISOR LICENSE 00 - None _- -_Expires: 16 - 1 h 2 Fasily NoDes F: AA Failure to possess a current edition of the ;. F; ==.- ;:. Massachusetts State Buiildiaq Code J CAEBANLT is cause for revocation of this license. I N MAID ST OSTEIMU, MA 02655 f i r .......:.._.,._. .. `' :: .�>::.:::. i....,.�......:iii'.....;FINi :.....:. .::.... ::::r,:;.........;.,.::;•:...:i M /YY c:y CERTIFtGATtNC DATE( M,DD ) PAULJ.:,2;:, 10/30/95 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Drake, Swan & Crocker HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 14 Lot's Hollow Rd. ,PO Box 429 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Orleans MA 02653-0429 COMPANIES AFFORDING COVERAGE Peter G Walther COMPANY 508-255-3212 A Assurance Co. of America INSURED COMPANY B American Policyholders Paul J. Cazeault etal DBA Paul COMPANY J. Cazeault & Sons Roofing C P.O. Box 2781 COMPANY Orleans MA 02653 D OVERAGES -... 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. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MM/DD/YY) DATE(MM/DWY) GENERAL LIABILITY GENERAL AGGREGATE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CFP25552812 05/01/95 05/01/96 PRODUCTS-COMP/OPAGG $ 1,000,000 CLAIMS MADE FXJ OCCUR PERSONAL S ADV INJURY $ 500,000 OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ 500,000 FIRE DAMAGE(Any one fire) S 50,000 MED EXP(Any one person) $ 5,00 0 AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT S ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) S 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 S AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ B WORKERS COMPENSATION AND STATUTORY LIMITS EMPLOYERS'LIABILITY EACH ACCIDENT $ 100,000 _ THE PROPRIETOR/ INCL WCC1861950195 08/09/95 08/09/96 DISEASE-POLICY LIMIT 5500,000 PARTNERS/EXECUTIVE OFFICERS ARE: EXCL DISEASE-EACH EMPLOYEE $ 100,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES/SPECIAL ITEMS Roofing `CERTIFI:EATE'HOLD > ;::::>'s ::::>>: <::;:::::>::::>:::>:>::»»»>s:>>:<:>:..:.. ER....: :::::.::......::.:>::;:.::.::.:::CANCEE E A7LOI�C:>::»>:>:<> >«>:is::>::......::::.:::.....:......::: . ... . .. ..... ... . nAGOZZ 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Peter G Walther ORD:26S;(3/9.31...... ;:::>::>;::;>;:...:>::::>::[:>:.r:.:>::::>:::::::::<>:::;:: r;;: a.�ACORD:GORPORATION 1993 A : . The Town of Barnstable KAMw�.$ Department of Health Safety and Environmental Services 65 `' Building Division 367 Main Street,Hyannis MA 02601 Off ce: So8 79o-6227 Ralph Croce Building mmissionc; Fax 5o8=775-3344 Co For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,con"' improvement,.mmo,%-4. demolition, or constriction of an addition to any pit:-existing owner occupied building containing at least one but not mots than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements- Type of Work: !C.� �'co 6 ot.� Est.Cost�� Address of Work: 3c? O%mer.Name: Date of Permit Application: a I hereby certify that: Registration is not required for the following mason(s): Work excluded by law Job under S1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: D CONTRACTORS OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH t7NREGI FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT. HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Date Contractor name Registration No: OR nnfe Owner's name 64, � 4,sse'ssor's offioe Ost floor): THE roiAssessors map and lot number .......d .......:.�� ecl Board of Health (3rd floor): Q [� R S T� ' '1kSewoge Permit number �. 1v C SYSTEM E g _ INSTALLED IN O Engineering Department (3rd floor): _ House number ................................................ ..... ......... 3 "t'i � L N ENVlgp WIC TRLE 5 APPLICATIONS PROCESSED 8:30:9:30 A.M. and 1:00-2:00 P.M. only MENTAL CODE AMP, TOWN 1113ULATiONS TOWN 'OF BARNSTABL BUILDING -!INSPECTOR APPLICATION FOR .PERMIT TO —� TYPE OF CONSTRUCTION ....................................................................:................................................................. 1.'.(�... .............I gr TO THE INSPECTOR OF BUILDINGS: The unders' he eb applies for a. permit according to the following infor otion: r Location ..... .......... . .........7� ... .............. .... .....�/l.v�/.. J pI -.a. .. Proposed Use ..................../\....................�✓.... ]... ... Mrn-G... ✓�.....: U11.. .................. v m f , �.... �� . .. 2. ...,e.n-1.. R. F......................................................Fire District ............V.JUC2�/I Zoning District .........a�7�)O . .... p VI Name of Owner . � ��......................Address .�0........g lea ...... .�!... ....S......,... ..... .Mote Nome of Builder .. olt{ P: �W�".k...................Address ..� Nameof Architect ..................................................................Address .................................................................................... Number-of.Rooms ..................................................................Foundation ............................................................................... Exterior ....................................................................................Roofing Floors ......................................................................................Interior .................... Heating ..................................................................................Plumbing .................. ............................................................... Fireplace ..................................................................................Approximate Cost ...../... .. ............ Definitive Plan Approved by Planning Board ________________________________19________ . Area ..... ...... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH ..ter:. OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I .hereby agree to conform to all the Rules and Regulations of the Town of Barnstable rding the above construction. Name Construction Supervisor's License .....D,iv��. . . HINES,', ELIZABETH No .................2 9 5 2 8 Permit for ....................................Remodel Basement Single Family Dwelling .......................................................................... 38 Abbey Gate Lane Llocation ........................................;....................... Cotuit ............................................................................... Owner .......Elizabeth...Hine.s............................ Type of Construction .....Frame........................... ............................................................................... Plot ............................ Lot ............ ................... Permit Granted ............ ............19 86 Date of Inspection ......... .19 Date Completed ................19 ....... ......... * (/..a Assessor's offioe (1st floor): ,p `THEr ++Assessor's map and lot number ....... 9,.......1J.3.............', e8 2& � Board of Health,(3rd floor): �Sewage Permit number .......;....... D.............Y ...... ......................j BAHd9TSDLE. . Engineering Department (3rd floor): + IN"°a House number - t 3 °°'°�'�a9 d�e� APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M.' . only /J TOWN OF BARNSTABLE BUILDING -INSPECTOR 1 . APPLICATION "FOR PERMIT TO ... IYxY !?1..::.. Q.3' .InPlh .................................................................... TYPEOF CONSTRUCTION ..................................................................................................................................... TO THE INSPECTOR OF BUILDINGS: The unders(g.ned h�en � b applies for a permit according to the following information: Location .......,. :. .................... ......... J /I . ....�) l-� G1 L YlJ �..Cl....Ll..... �................. . _- Proposed Use ..... .!.v..... m........... '-i. /!.!?....S7;qKn:7c...._:/.�..yn...... .....4ol noll2......1�'.�.:.......�.�f'OGrY� ti Zoning District .Fire District l/.7. ..{(/I /`( R...F..... .............................. ..... ..... Name of Owner �i °L .. ......./Vf.kli- .................\...Address I. ........1?' ?` ? '1.......�...?. ..... ... o�Vl Name of Builder f 0d 1'1 A`1 ................... �� q l i�j r S T /(/• I Y/ �.......... Address ,.......................... Nameof Architect .............................:.....................................Address .................................................................................... Number of Rooms ..................n........F ..........................,...Foundation Exterior .......................................:..................................,.....:.....Roofing .................................................................................... Floors .........................:............................................................Interior ...:.......... Heating ..................................................................................Plumbing .................................................................................. Fireplace ...................................................... �Approximate Cost ..... .../ . .......... ........................................... Definitive Plan Approved b Planning Board ______ ____________ ` PP Y 9 i -----=------19-----;-- . � 'Area . .. ............. . , /.............. !�. Diagram of Lot and-Building, with Dimensions; :S ~, Fee ......f!,............................... SUBJECT TO APPROVAL OF BOARD OF HEALTH - f OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS tl I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. Construction Supervisor's License .....69. v HINES, ELIZABETH A=022-113 No 2Remod . ..... ... Permit for Single Fami�y..D lliDg................. .............................. ...... Location .....M y.-A be Gte..Lang.................. . ......a.... Cotuit ............................................................... ............... Owner ..........Elizabeth Hines,,,..,. . . ........ .. . ................. Type."Of Construction EXAme........................... ......................................................................... Plot ........ Lot ................................ .................... Permit' Granted ..........June 19, ......1.9 86 Date of Inspection ....................................19 --Date Completed ............. ................. .......19 C6 �yq Asssor-,j map an��� number ..X,........... .... ...... ... ................ p P -7Z ;7 Sewage Permit number ....!L--2.......................................... *711 E TOWN OF BARNSTABLE MARNSTMILL 039- BUILDING . INSPECTOR APPLICATION FOR PERMIT TO .k�.l.. ...................... ...*..... ...... .......................................... TYPE OF CONSTRUCTION ... .. .../......� .............................. .............................................. . e.q ............. .............................19.....3 TO THE ,INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ............. .......... .............. . ....... 7 z ..... ..7....../ .... ProposedUse ... ...................................................................................................................................... Zoning District ... ......... . .............. ........................fire District ;............................................... Name of Owner ............. ................Address 26..... a..X ............ Name of Builder ......... ..<. ...............Address 24L347..,<.....-7/.�........ .. .. .... Name of Architect ...........1.z.7z...q..�.e.&kdclress .1774,41.:g... ........... ..5.................... Number of Rooms ...�..7!........ -.,v...........Foundation P.O.. ......F...... Exierior AW.'..r ...... ...................................Roofing ..................................................... FloorsA . Interior - .,........ .................................. Heating .......... ....................Plumbing Fireplace .. .2...........................................................................Approximate Cost 7....................... i��Ls . Definitive Plan Approved by Planning Board -----------—--—--—----------- Area ............................ ............ Diagram of Lot and Building with Dimensions Fee ...................j - -M-- ........................... SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .................... March, Inc. 16733. 1 1/2 story ............ .... Permit for ......................... single family dwelling ........................................................................... Abbey. Gate Locatio .. .......................................................... Cotuit ............................................................................... March, Inc. Owner .................................................................. Type of Construction ...........frame.................. ................................................................................ Plot ............................ Lot' ............A8.2............. Permit Granted ...........N.ovembe.r..13. 19 73 .. ............ .. .... .... .7 3 Date of Inspection Date Completed 14--......... d m � f� PERMIT REFUSED ...................................... .......................... 19 . ............. ... .......................................... ................................................................................ ...................................................................4........... ........................................................................... Approved ................................................ 19 ............................................................................... ............... ............................................................... �' _ t fa: • t r �y r a 1 Ffi t � 3 r- ,s yt'3 ir.1L�F�V.a.i}ti�A l��• yr a+ '`H aG r " ,�,. Y '-'t` ' � ' :,.t � t' r 'j',F'�,,.61T-477�0�1b •; � "�� t > � �nr: ¢ a f . r 1 P. ♦ I' 4 E' k'1n .. f y � �.- � t �.""S� 'r. f t 4 *.3. 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