Loading...
HomeMy WebLinkAbout0157 ABBEY GATE 1- 67 ys, FWA�T Town of Barnstable Building • 'Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept MASS, Posted Until Final. 01 Where a Certificate of Occupancy is Required,such Building shall Not Inspection Has Been Made. �6 Permit 3p �be Occupied until a Final Inspection has been made. Permit No. B-20-1500 Applicant Name: david richards Approvals Date issued: 06/30/2020 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 12/30/2020 Foundation: Location: 157 ABBEY GATE,COTUIT Map/Lot: 021-026 Zoning District: RF Sheathing: Owner on Record: ANDERSON RONALD J& IRENE M Contractor Name: Framing: 1 Address: 157 ABBEY GATE Contractor License: 2 COTUIT, MA 02635 Est. Project Cost: $48,000.00 Chimney: Description: Build pitched a roof over the right side of the existing flat area of Permit Fee: $ 294.80 the home and build a garage all as shown on provided plans. Fee Paid:` $294.80 Insulation: r Project Review Req: HEAT DETECTOR REQUIRED IN GARAGE Date 6/30/2020 Final: Plumbing/Gas Rough Plumbing: \Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing 2.Sheathing Inspection - Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy • Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT `''� Final: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ,Map DParcel v Permit# %Z q'7 f� Health Division loh->6 5 Date Issued /0—*21 7— 5� Conservation Division , �a Fee Be Tax Collector /��ZS'ld S 'INSTALLED I�N CCOOMPLIANCE pp A lication Fee Treasurer WITH TITLE 5 ENVIRONMENTAL COg�_AK�d in By Planning Dept. .:. TOWN REGULATI Date Definitive Plan Approved by Planning Board Approved By Historic-OKH Preservation/Hyannis Project Street Address 64 07zlC Village Cot 7l Owner Db w / Address jS Lei,JOS (�j� Telephone 50� " L LD _ Uzi �b Permit Request W olotA7&b � Nep by-db� , fltieS , Jed R, J bA4 RPoI.V) 6641 FndegAce IP012A 4JVo G174,AlEe,- -AQ foci-�12m/7") Square feet: 1st floor: existing /may proposed 5,0he 2nd floor: existing proposed Total new Valuation n ­NC (�Zoning District Flood Plain Groundwater Overlay Construction Type WdOG' lot Size o10.630 Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure go Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ClNo &Basement Type: Full ❑Crawl Walkout Cl Other Basement Finished Area(sq.ft.) -6 Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing to new First Floor Room Count Heat Type and Fuel: ❑Gas -VOil ❑ Electric ❑Other Central Air: ❑Yes 4 No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new,.,size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ ,++' l Commercial ❑Yes ❑No If yes, site plan review# c Current Use Proposed Use BUILDER..INFORMATION Name 1 � Telephone Number 500 Address� �� bhe License# CS 071� F � �AgMOA )q4, 096T Home Improvement Contractor# �aZ FOX Worker's Compensation# ALL CONSTRU N DEBRIS RESULTIN OM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE aS O� i FOR OFFICIAL USE ONLY PERMIT NO. e DATE:ISSUED MAP/PARCEL`NO. ADDRESS VILLAGE o r OWNER DATE OF INSPECTION: r FOUNDATION FRAME INSULATION' ca FIREPLACE O -� !r ct O ELECTRICAL. CROUGH' FINAL co PLUMBING: rRO.UGHj FINAL GAS: ROUGH FINAL FINAL BUILDING L 1 DATE CLOSED OUT ASSOCIATION PLAN NO. 4 V Town of Barnstable +. Regulatory Services Thomas F.Geiler,Director 9 Eow►y°`e� 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 Permit no. Date AFFIDAVIT HOME IlVIPROVEMENT 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. Teoo Type of Work: U Estimated Cost Address of Work: 157 AbheAf GA tv Owner's Name: U�C2t L r-. � Date of Application: I6�ask I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH.UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent o e owner: b A a&kjaz Da -a Contractor Name Registration No. OR Date Owner's Name Q:forms:homeafdav o&IME A. 'L Town of Barnstable ° Regulatory Services Thomas F.Geiler,Director 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 subject property hereby authorize � n- -L �'�- to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) /D . 61ginatLaute of Owner Date R,ober C Lewi,3 Print Name Q:FORM&OWNERPERMIS SION t r MN . ,p ITT Board of Building Regulations and Standards ' 1 HOME.IMPROVEMENT CONTRACTOR I I - RegistrAQ11s, 128086 22/2007 'dual JOSEPH A.BU a r JOSEPH BUT LE l 23 ALISON LANE W.YARMOUTH,MA 02 Administrator e ✓f%e.T�omvnao�u�ea��✓�aaaac�ivael7d j 'BOyAR©O"E�BUILDI_LG�REGULAbII:Q`NS kicense CONSTRl1'CT;I:®N SU'PERVfS'O'R N;u,m:beS 0714'88 I 7 Tr.no: 151.03 JOV50W A BUT I PQ BOX 61;6 - c SO'D,EMNd8, MA -- - Conimiss�oner � I ' 157 Abbey Gate COtult(Barnstable), MA SCALE: 1"= 46, Ociober 3, 2005 "ark P. Ryan P.E., P.L.S. 33 Pyurgan Place Norwood, AAA ► lot -+- l_o ►-q � �1 1 AAN 6c I the tirr►e Of emnsbuclfon vwthM�9e•MO.,that the butlftg(a)GhMM an#ft plan conform fs)to>tle Zonln laxs of Title VII,Chaffer 40A,Sec"On 7 erwIse nd�slorial requlremente ongr Or is=1 pt from vlolatlon mfuaem�On under M G.L� COUNTY OF:Barnstable DEED—Book 8160 Page 112 PLAN—Plan 800k 261 Page 62 'THIS PLAN WAS PREPARED FOR MORTGAGE PURPOSES ONLY.THIS PLAN WAS INSTRUMENT SURVEY AND IS NOT A PROPERTY SURVEY.THIS PLAN IS NOT TO BE NOT PREPARED FROM AN ON THE GROUND HEDGES,OR CONSTRUCTION LINES.TFIIti PLAN!S NOT TO BE USED AS A PLOT PLAN FFOR NNEW�CONSTRUCT16M AND/OR ADDRIONS.NO RESPONSIBILITY IB EXTENDED HEREIN TO THE LAND OWNEb FENCES, • OR OCCUPANT OF THE PRppo". V Town of Barnstable *Permit# 35 l� Expires 6 months from issue date d Regulatory Services Fee BAxxsTABi e � MAC'i639. Richard V.Scali,Director �FD Mfd s Building Division Tom Perry,CBO,Building Commissioner /C 200 Main Street,Hyannis,MA 02601 TD Fe j 8 c '� www.town.barnstable.ma.us "" 0� �O,v Office: 508-862-4038 8% 'Y�- 0-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY. �"�F n O l Not Valid without Red X-Press Imprint Map/parcel Number U ( Property Address 1 � NIJ residential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address�11e� � -1� n Contractor's Name—OA la I I)(_�6 Q11Y) Telephone Number QrC Home Improvement Contractor License#(if applicable)_ I LD Email: I QLp(Z) Construction Supervisor's License#(if applicable) ylJ ' � ZWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ m the Homeowner El Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# W C5- S -(:Ag - .o Copy of Insurance Compliance Certificate must accompany each permit. Permit RSVEst(check box) [!I Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to �SQ I ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum_32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *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 requi SIGNATURE: C:\Users\Decollik\AppData\Local\Ivlicroso Windows\Temporary Internet Files\Content.Outlook\2PIOIDHR\EXPRESS.doc Revised 040215 i • snEetvsTnsLe. , MM& Town of Barnstable 'OlFp�a Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO 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 I, rwi—\ �� , as Owner of the subject property hereby authorize T11 u A!11 (}��''(� to act on my behalf, in all matters relative to work authorized by this building permit application.for: (Ad ss of Job) ` � I '-ZJIS f kStature of 6rner Date Print Name If Property Owner_ is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\Dccollik\AppData\Local\Ivlicrosoft\Windows\Temporary Intemet FileAContent.0utlook\2PIO I DMEXPRESS.doc Revised 040215 i 'n INFORMATION PAGE V/ I N S U R A N C E Issued by LM INSURANCE CORPORATION 27243 175 Berkeley street Boston,MA=16 j Policy Number WC5-31S-382437-014 Issuing Office 016C RENEWAL OF: WC5-31S-382437-013 Issue Date 09-25-14 Account Number 1-382437 1. Insured and Mailing-Address Sub Account 0000 ALLAN WILLIAMSON DBA WILLIAMSON CONSTRUCTION 25 CORRINE DR RISK ID 000935788 EAST FALMOUTK MA 02536 Status 01 — INDIVIDUAL Other workplaces not shown above: SEE ITEM 4. PREMIUM- EXTENSION OF INFORMATION PAGE ?. Policy Period: The Policy y period is from 10-01-2014 to 10-01-2015 12:01 A.M. standard time at the Insured's mailing address. 3. Coverage A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation listed here: MA p Law of the states B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3.A. The limits of our liability under Part Two are: Imps Bodily Injury by Accident $ 100, 000 each accident _ Bodily Injury by Disease $ 500, 000 policy limit Bodily Injury by Disease $ 100, 000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: SEE END WC 20 03 06B D. This policy includes these endorsements and schedules: SEE EXTENSION OF INFORMATION PAGE Premium: The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Code Premium Basis Total Rate per$100 Estimated Annual Classifications Number Estimated Annual Remuneration See Extension of Information Page of Remuneration Premium nimum Premium $ 500 �nium will be billed ANNUAL ( Total Estimated Annual Premium $ 780 )ducer 0004-156933 tRRAY & MACDONALD INSURANCE AGENCY IC 0 MACARTHUR BLVD -URNE MA 02532 00 00 01 A ©1987 National Council on Compensation Insurance,inc. 07/01/2011 All Rights Reserved WC 00 00 01 B (NJ) Page 1 of 1 insured copy r�'r NOV. 24. 2015 7: 54AM HART INSURANCE N0. 213 P. 1 AC 0® CERTIFICATE QF LIABILITY INSURANCE °A11/2420115"' 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 D09$ NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If tho 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 ondomemont(s). PRODUCER " n EfICa H,O'Connor HART INSURANCE AGENCY,INC. PHONE 506-769-7326 x205 FAI 508.759.7356 243 MAIN STREET AIC No: PO BOX 700 MAIL ORBISS, eoconnor@ha:tinauranceagency.com BUZZARDS BAY,MA 025320700 INSURER s F RDING COVERAGE N IC P wsuaeR A: NAUTILUS INSURANCE COMPANY 17370 INSURED Anthony R Faris Jr wsunelta: AIM INSURANCE COMPANY 18929 18 Fordnam Circle East Falmoutn,MA 02536 INSURER C I INSURER 0: INSURER E I INSURER F I — 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, INSR APOL SVBR POLICY EFF POLICY E%P LTR TYPEOrINSURANCE POLICY NUMBER WDD D LIMITS A COMMERCIAL GENERAL LIABILITY NN558910 05/21/2015 [5/21/2016 EACH OCCURRENCE S 11000.000 CLAIMS-MA OCCUR DAMA T RENTED PR r poourrancol S 50.000 MEO EXP(Any one perM S 5,000 PERSONAL d ADV INJURY S 11000.000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2.000.000 POLICY n eCT `l LOC PROOUCTa•COMP/OPAGG S 1,000.000 I — OTHER 1 S AUTOMOBILE LIAIDUYY B 1IRGITLUMITS n ANY AUTO BODILY INJURY(Par porson) b ALL DINNED SCMEDULED BODILY INJURY Per aee�Cenl E AVTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS E . E UMBRELLALWB OCCUR EACMOCCURRENCE S EXCESS LIAO CLAIMS•MAOE AOOREOATE S D 0 I I RETENTION S E B WORKERS COMPENSATION ASSIGN201511230921504090 11/20/2015 11/20/2016 S' P _ AND EMPLOYER LIABILITY YIN A ANY PROPRIETOR/PARTNER/EXECUTNB E.L.EACH ACCIDENT S 500.'_ OFFICERIMEMBEREXCLUDE01 Y NIA (Mandewy In NH) E.L.DISEASE.EA EMPLOYEE S 500,000 It Yea.09ecnbe under DESCRIPTION OF OPERATIONS bela. E.L.DISEASE•POLICY LIMIT S 500,000 DESCRIPTION OF OPERA71ONSI LOCATIONS/VEMICLEb (ACORG 101.Addlllonol Romer%a SC nodule,mey be ellaahad II moro spar.•Is roqulrad) CERTIFICATE HOLDER CANCELLATION (508)457.7SB5 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Williams Construction THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD i Massachusetts -Department of Public Safety 3card of Building cicgulations and Stanca.os C'unstructinn Supra istir �Ys License: CS-050182 � ALLAN B WII.LIISON 25 CORRM LR E FALMOUTH MA 03536 �O � Ljs�_ � n��• E7l'Dtri210n Commissioner 07/26/2016 Office of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR registration: 112161 Type: ':x. ?kxpiration: 3/12/2017 DBA WILLIAMSON CONSTRUCTION ALLAN WILLIAMSON 25 CORRINE DR E FALMOUTH,MBA 02536 Undersecretary .-Feb. 12016 9: 09AM No. 5485 P. 2 37te Commomvedlth of Massarliusetts Dvivonmt of rAdrt o a!/!cddemu Offma afriauigadmu 600 Washvegttau Seed Boston,MA 02111 turves nlass4�rovr�dia Workers' Compensation Iwaratace Affidavit:Bu iider9/Contractors/EYectrklanslPhmbem AppIkMt InfermatioII k Please Print Leeffity Nat=qua;ae�aaAionlfn�j; L Addtress- CitylS.--- 601 Zig F, OA5 3 Phone#k Q Are you an employer?Chock the appropriate b Type ofpnaJecl(r��d): 1.❑ I eta a employes v4ith 4_ am a general contractor and I * bave hin d.thre sult-conaaza a 6. ❑New conshudion eallrloyees(flt11 andlbr part�imej. ' 2.❑ I am a sole prvpdaor or gartuer- fisted on the wached shaet, T. ❑Remodeling a and hne no 1 �eea TAem sub-contractam have � �� employees sad have �. ❑,Demolition wodaag for me in any capacitywadws' g Bnildin etlditiaa [1do'%Vdo!s'comp.iir unmce comp-insorat�oa.i _ ❑ g reygued] 5. ❑ We are a zorporatioa acid its to❑Elecwcal repairs Cr adcbtiom 3.❑ I am homeouzer doing tillrxoais ofkm have rxgreised their ILL] Zolf repairs or additions myself[No workers'camp. �t of ommoon per MGL l2. az?':iirs itaBtAetice fecfni:ed]i employ�<[No d no, 13.❑Otter camp.insurance rogwnd.) IAtay appHrsteot cLedt box Ml tenant elan tdl oume secdogtdowstwa arg fiahr wadrery cazq;;;ZI ol?cyiaEormation. 1 liemeowasn vU 96wh tfiis af5da,V indic:tta j&qY ere doigo ail w-k rod&-WM oatd&CMtrsc(nysz=oftatt a new afdaoi2 iodic gdng MdL kaauactotsthae Aeri tlds blot mug attad%d ant additinaal sbMi 0MVb6 tbs as oe df eLe sub-am=wa :and awls whether arnot tbore 61fitles Lane employees.lflho,sub-rbaftutorsim emplay"r,eL =wPmvtda their worker'wrap•Pollee curer. I am an eurplayar that prdvidirtg lr�ur&tars'eoertpartsrrhton irrsr�rartt:s fbr terp emplg�eev Below is the policy and job zfts ztrdr�at�t>, 1'nstaance�otnpri,>zy Platte: . 'Policy#or Sel€ m.lie-ik FxpirationDate: Job Site A4dnm: City/stawnp. Attach a copy of the l orlmrs'compensation Polley dedaration page(showing the Policy mrmbeir and,expiration date,}. Failum to secure coverage as required-under Section 25A of MOL e.W—can lead to tb imposition of crimical penshiea of a Ehu up to$1,50a,00 abdlor of-year imprf ao»memt,as well as civil pemalkea im the form of a SWOP W©RX ORDER and a fine of up m MOO a day against the violator Be adx iced that a copy of this sfttemcmt maybe forwarded to the Of ka of Invesiggatiam ofthe DIA fiar iustuance cmerage ver firatiom I do Iretraliy 7 er tk its r lilrur o�Pet jiuy thartlte rlaforwratror�ptrotRdlatl aboyat Due andcnrsect Sitmatnr // te- l5� .noneit �Zj 6(�56 07-3G Offs at arse enty. Dgr riot writ in this area,to be completed by city artomn aQS'teint EltJ or Tom-a: Permitl7bense# Imuiog Authority(cutle bnd); 1.Board of Health 2,Building Department 3,Qgffown Clerk 4.Eleetr Ical Fuapector S.PEiwpewcter 6.Other Cotltact Person: phi#- 6 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION J bt �- �6 Map� Parcel� Application # Health Division Date Is s ed Conservation Division Applica 'on Fee 1, Planning Dept. Permit Fe Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address XS7 ���� iG �� 'Y o21 Village Owner/`7�G`l'�6 DC RAI Addrewsy �jw�// .,r) / .eyell.)do l� Telephone,-'rdd'�' f Permit r_Req�uest t 1N GG .�1SU�:�o?ia.�' iD�4 .��i:�l/ZoG�C ✓ze L✓s9 i P4 Square feet: 1 st floor: existing 4,Zproposed 2nd floor. e 'pv< proposed Total new Zoning District Flood Plain Groundwater Overlay dO CProjectTValuatio5;/4 i19,0 Construction Type �� Lot Size �/�o Grandfathered: ❑Yes ❑ No If yes, attach upportin Flme tation. VI Dwelling Type: Single Family '� Two Family ❑ Multi-Family(# units) PQ'> Age of Existing Structure /`J�_r Historic House: ❑Yes ❑ No On Old King's Ri> j y: ❑UAL No Basement Type: mull ❑ Crawl ❑ Walkout ❑ Other O A 4 Basement Finished Area(sq.ft.) Basement Unfinished Ar c)� Number of Baths:, Full: existing_ new Half: existing Bq net Number of Bedrooms:13 existing ew TgeC Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ArOil ❑ Electric ❑ Other Central Air: ❑Yes ZWo Fireplaces:ExieMg New Existing wood/coal stove: ❑Yes ❑ No D Dached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: 1�. Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) NameAVCA 6 - �&Y�/ Telephone Number � ©�oz Address/x.5 ��•�/�ci �l License #Jr 9 GV'i .P,,,® &6LIP l d/� /`7,4 O� 5 Home Improvement Contrac 1 p �" Email Worker's Compensation # A CONST CTION DEB TING FR THIS PROJECT WILL BETAKEN TO 2V¢'�/� � ILL I SIGNATUR DATE O -:Z 0-3 l FOR OFFICIAL USE ONLY APPLICATION # ' DATE ISSUED MAP/PARCEL NO. I i ADDRESS VILLAGE s a OWNER I r DATE OF INSPECTION: - 'FOUNDATION FRAME INSULATION s FIREPLACE r ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING 1 Jzj e DATE CLOSED OUT r ASSOCIATION PLAN NO. 21 e Commo7nrealth o,f Massadiusetts Repa rhnerrt cr,f rrulustriat-4ccide dg Offl-cue of rnves rgatims. 600 Washington,street Boston,41A 172HI iviviv.viaSS.govIdia Workers' Camp ensation Insurance Affidavit:Bmlderm/C!iuntradGrs/EIectr cianstThmihers Applicant Inf umaiion Please Print Le�rly � A.d&esss- Citylstatel P}ion� Are you an employer?Cheekthe appropriate T of project r I a1n a Qeu��ral cofactor and I � P 1 ( ���'= 1.❑ I am a employer with o 6_ ❑New construct a employees(fiT11 andfor part�ime * ave lured.fhe sub-conb actors 2.❑ I am a sole pmprie�tot orpartner- listed on.the attached sheet. y- ❑Remodeling ship and have no employees , These sub-confractors have S. ❑Demolition wo king for in any capacity. a Tloyees and have wodcers' 9. ❑BBildinmg addition [No wrod2rs'comp.insurance comp.Msuranm required] 5. ❑ We are a corporation and its lb--❑Electrical repairs ar ad&fions 3.❑ 1 am.a homewmer doing all work of have exercised their I❑Plumbing repairs or additions ' myseli[No worlmrs•c amp. right of esempfion per MGL 13_❑ ofrepairs insurance requited 4 p c.152,§1(4,andwe have no ' n employees.[No workers' 13. Other G/A C�r-� �Ci'f��2�`• comp.insurance required.] 'Any WBcznt&st chedsboz Al mast also apoUryinformauaa fiHameaaraerswhysn6GmitThisaffida� ;r r�+*Tgtheyatedoi�sIfwool[sad&tenhaEoutsidecontiacta6mattsubmits.newafdastindir�na=rTi tCa sheer showing thenmme of the sub-cowzxc Drs.and state whether ar riot these entities have • enop9o3ees.IfthesnBtantnidasl�eemPloSers,tfieymorstpmvidrthea uorkrss'�amp.palicgaumisez . I arc[art employer Eliot is protririurg workers'coettperesrdfolt irtsur�cg,jor mS*¢azplay�ees $etoty is ribs pv£icy ruzd job site irrformatiatt Insurance Company Name: Poficy or Self-ins Iic.4L-�piratiauDate: Job ate Address I°S ,E, Q2 Tt Cityfstatel2sp: U ,T (/1/(� Z��3 6 Attach a copy of the worlrers'compensationpolicy declaration page(showing the policy number and expiration date}. Failure to secure coverage as requiredunder Section 25A of MQ.c. 15"2 can lead to the iznposi ion of criminal penatties of a fine up to$U.06OD indrar one-yearimprisoumeaf,as well as civil penalties is the fora of a STOP WORK ORDER and a B e of up to$250 00 a day against the violator. He adt}ised*drat a copy of this statement maybe forwarded to the Office of, Iavestr oMet DIA for insurance covers a vmriflcakion- Arlo hereby erhfy Utd9r the per s afgetjst ratfJte infarmtrtiortpratir£ed abm�a is hue adr[t correct S;onature Ixn� Date: Phone A- z- O o A OB&i L use a7ify. Do itat write is this area,to be camp£et6d by clip artonvi offw-ial City or Town.: PermitfLicense# j Issuing A flmrity(ccirdde one): L Board of Health 1.Buil mg Department 3.CityMowa Clerk 4 Electrical Inspector S.Pluinbing Inspector 6.Other Contact Person: Phone fl: Laformation and lastmefions, ' Ma�car�;,Tseits GehPaal Laws cbaptea M rap==all employees to provide woIkers`coraPeas�ion fortheir employees. Pmsaanttn this statnie,au ea.PIvyr�m&FMed as"—evaY Pe<sdn in.die service of another ffider airy co�ract ofIa express or implied,oral or vznm.7 An�Ivyer is de fined as"an indiyidng partnership,association;corporation or other Iegal etdify,or any two or more of th_e foregoing aJo �P .and including the legales�atives of a deceased empIopea,or the receiver or trustee of an individual,pa bimship,association or other Iegal entity,employing employees. However the owner of a.dwelling house having not more than three apar[meots and who resides therein,or the occupant of the . dwelling house of another who employs persons to do mainfE==,consErac i on or repair work on such dweIlmg house or orL the grounds or bm7dmg appl fl o i ierein shaU not becanse of sash employment be deemed to be an employer:' MGL chapter 152,§25C(6)also sites brat"every sfafe or local licensing agency shall withhold die issuance or renewal of a*ficen e.or permit to operate a business or to construct buildi ags in the commonwealth for any applicant:who has notprodnced acceptable evidence of complianceith w the insurance coverage required." Additionally.MGL chapter 152,§25CM states¢Idelfficr the ccamnonwealth nor any ofits poIiiical subdivisions shall enter into any contact for the performance of hr.wmkmrbl acceptable evidence of compliancewith the,msm-ance.. regim emus of tfiis chapter have been presented.to the confraclmg anfiioiity." Appli�an-ts Please fill.nit the Wo&.ers'compensation affidavit completely,by chm ng the boxes ffiat apply fin your sifnation and,if necessary,supply sub-contractor(s)name(s), addres (es)and phone nnmber(s) along with their certificates)of mmnamce. LimitedLiabilityCompanies(LLC)or Limited Liability Partaemhips(LLP)withno eznpIoyees othesthanthe mertlbers or parEae3s,are not requi ed to carry workers'compensation ins[ mcn If an LLC or LLP does have exnployees,apolicyisrequtied. Be advised-that this affrdayitmaybesnbmitindto the Depa-t-imentofIndustrial Accidents for confsmation of insurance coverage Also be sure to sign and date the affidavit The affidavit should be retnmed to!lire city or town that the application for the permit or license is being rDgnested,not the Department of Indmsiaial Acci dents Should you have any questions regardin g the IaW or ifyou ai a rcgni76d to obtda a wolkers' compensation policy,please call the Department at the m=ber listed below Self-insured companies should enter their self-;n su ance license number on the appropriate line. city err Town Offfcr:als The D atfinenthas Aided a ace at the bof= Please be sm-e that the affidavit is complete andprintedlegRiIy. ep Fro space afions has coufactyon t. the applicant of the affidavit for you to fM out in.the event the Office ofInvesta� itg Pleas e b e store to f0l is the permit/license,mmabes which will be used as a ref=mce number. In-addition,an applicant that must submit mirltipIe pem�llicealse applit;atiom m auy giveaa year,need only submit one affidavit indicating ensent p oHr mLo=at io L(if necessary)and under"Job Site Q_ddr'ese the applicant should wtif�"all Iacaticns is (�'or town)"A copy of the-affidavit that has begin officially st�ped or marked by the city or town may be provided to ffie applicant as prooftbat a valid affidavit is on fire for fut= permits or ricenses. A new affidavitnayst be famed out each year. Wh=a home owner or citi=is obtaining a license or permit not Ielafed to any business or commeazial venture (i.e.a dog license orpenuit to bun leaves eta.)said person is NOTreqah7edto complete this affidavit The Office of Investigation would hIm to thank you in advance for your cooperatiorn and should you have any questions, please do not hesitate to give us a call. The Dep iz enfs address,telephone and fax nunbm: Of �U&Cf1S Defiant Gf Indusfdd Aoadents �Q4� n Sheet . Tf,-1.4 617- --9W M t 406 or 147 lvi A T�-AM I Fagg 617 727 7M Revised 4-24-07 � ��� Feb 0216 07:25a p.2 Town of Barnstable Regulatory Services 8rr Richard V.Scali,Director Building Division ,• sAnrsraBl> Tom Perry,Building Commissioner 1659. �� 200 Main Street, Hyannis,MA 02601 CFO www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-7W6230 HOMEOWNER LICENSE EXEMPTION Plt2se Print DATE:'_w /1�1 IOB LOCATION: % 2 /� C�h-C V " J �•/J number skeet village -14OtE0vtq4ER^:/`'I�r�i�/,!!'1 name home phone 0 work phone 1t i CURRENT MAILING ADDRESS:/ t •S� /�✓(• city/town state Zip code The current exemption for"homeowners"was extended to include owner-occttl'ied 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 helsbe 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. i7ae u2ofEomeo%V= d"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection proced equir d that he/she will comply with said procedures and requirements. r natu Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor!' Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this rase,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. C:\UsetsOccollildAppDataV-oWa LMicrosoft\windows%Temporary Internet Files\Content.Outlookl2PIOIDHR\EXPPMS.doe Revised 040215 i • =OA'MYYYY;CERTIFICATE OF LIABILITY INSURANCE 15 AND CONFERS No RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE IN ISSUED AS A MA TER OF NEGATIVELYION ONLY AMEND, EXTEND OR ALt R THE COVERAGE AFFORDED BY THE POL CHE�3 CERTIFICATE DOES NOT AFFIRMATIVELY _gFLOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER{S), AUTHORIZE[ \EPRESENTATIVE 01 PRODUCER,AND THE CERTIFICATE HOLDER. Inust be endorsed. If IMPORTANT: If the certificate holder I certain 5'5 IO AmaySIURED,re n e the ndolr5(ies) A st temen on this certificate Ce does not co erDrl9hts ttre. the terms and conditions of the poll Y, policies certificate holder in Ileu of such endorsemen 6). coy ACT Lesley Oarrigus, CIC RODUCER PHONE (508)540-2400 (A CFAX Na.(606)299-4111 turray & MaaDonaLd in services, Inc. MAIL •iesley®siakadviee.com i 5 0 MacArthur sl vd. NAIL INSURERS AFFORDING COVERAGE 3ousne DQA 02532 INSuRERA:Arb. a Protection Insurance 41360 INSURER 0-NatiOAa1 I.Labilit & Fire Insurance NSURED - 201ony Insulat:icla Inc., D&R Realty Truat INBURERC: INSURER 28 Jonathan Boman Road D INSURER E MA 02559 INSURERF pocasset REVISION NUMBER: COVERAGES CERTIFICATE NUMBER;15-16 master OL THIS IS TO CERTIFY I STANDING OLICIES S OF INSURANCE SURANTERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH R SPA T TOLIWTiICH T IS INDICATED. NOTVVIT i CERTIFICATE MAY 81: ISS OED'OR MAY PERTAIN. THE INSURANCE NS OF SUCH POLICIES.L MITS SHOWN MAY FHAVE BEEN REDUCED BIY PAID CLAIMS. HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND _ su POLICY EFI POUCDY p(P LIMITS INSRR TYPE OF INSURANCE UCY N MBE EACH OCCURRENCE $ 1,000,000 $ COMMERCIAL GENERAL LIABILITY A p IS FAE E $ 100,000 e 5,000 A CLAIMS-MAI)E 1 X ,OCCUR 8/16/cols 9/16/2016 MEDExP An one ereon $ ^� Q590020.929 1100C.1000 _ PERsoNAL a ADv INJuav $ _ GENERAL AGGREGATE $ 2,001:1000 GEN'LAGGREGATE LIMIT APPLIES PER: 2,001,000 PRODUCTS,COMPlOP AGG $ X POLICY EJ j;?GT' 7 LOC $ MSIN SIN ELI $ 1,00l OTHE E cide AUTOMOBILE LIABIL TY BODILY INJURY(Per pere0n) $ ANY AUTO B/16/2015 6/1B/2016 BODILY INJURY(Per aaaidenl) 3 A ALL OWNED R SCHEDULED 1020005705 PR Per ER DAMA E $ AUTOS AUTOS r D NON-OWNED $ 2),000 X HIRED AUTOS R AUTOS Underineured M01068181 a h rl EACH OCCURRENCE $ 3,00),000 g UMBRELLA UAa X OCCUR AGGREGATE $ A EXCESS UA6 CLAIMS.MADE 9/le/2015 0/10/2016 $ 4600026929 TM- DEO $ RETFIITION 10 096 X 8E t WORKERS COMPENSATION 5t 01 000 AND EMPLOYERS'LIABILITY Y/N EA-EACH ACCIDENT $ ANY PRCPRIETORF,�RTNER/EXECUTIVE 14NRA 0/16/2015 ' 9/10/2016 E,L.DISEASE-EAEMPLOIi $ 5(0,000 OFFICER(MEMBER ECCLUDED? v9WC516109 $r Q 000 a (Mandatory In NH) EL.IZ(9fiA�SE-POLICY L'IMTT $ �- 1(YYea,descAbe under r -,1ZLI DESCRIPT ON OF O AERATIONS below :--. � � Q may be attached H more s ce Is roqulred) DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES (ACORD 101,Additional Remark3 Schedule, pa I7 W co M CANCELLATION CERTIFICATE HOLDER' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCI_LLED 8 EFORE THE ' John Nconan EleCtziC ACCORDANCE W TH THE POLICY PROVISIONS. WILL 8E DELIVERED IN TION DATE P O Boil: 6 9 9 Catiaumf!t, M& 02534 AUTHORUZEOREPRESENTATNE C Finigan CIC,CRM,CMI 01988-2014 ACORD CORPORATION. All rights rase ACORD 25(2014 101) I The ACORD name and logo are regletered marks of ACORD 2,1117 3IrI A- OL970 eel Lev- 4 Sl ,a-�•�1L MA �t lejx �r1�uR►N` f 1 i BUILDING DEPT. FEB 0 31016 TOWN OF BARNSTABLE CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)8/14/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. -THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Lesley Garrigus, CIC Murray & MacDonald Insurance Services, Inc. PHONE (508)590-2400 ac Not:(508)289-4111 550 MacArthur Blvd. pDDRIESS:lesley@riskadvice.com INSURERS AFFORDING COVERAGE NAIC# Bourne MA 02532 INSURERA:Sentinel Ins Co LTD 11000 INSURED INSURER B:Hartford Accident & Indemnity 22357 John Noonan Electric Inc -INSURER C:HartfOrd Casualty Ins. Co 29424 INSURER D: P 0 BOX 748 INSURERE: Cataumet MA 02534 INSURER F: COVERAGES CERTIFICATE NUMBER:15-16 Master REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDTYPE OF INSURANCE INSO WVD SUER POLICY NUMBER MWDDY� MMIDD� LIMITS LTR X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADERETED OCCUR PREM GE SES Ea oocu ante $ 1,000,000 08SBAIM3292 8/1/2015 8/1/2016 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO-POLICY❑JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 X OTHER: CBRFX $ AUTOMOBILE LIABILITY COEa aMBINED SINGLE LIMITccident $ 1,000,000 B X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED 08DECAX2066 8/1/2015 8/1/2016 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident Tenn Rider $ X UMBRELLA LIAB F1OCCUR EACH OCCURRENCE $ 3,000,000 A EXCESS LIAR HCLAIMS-MADE AGGREGATE $ 31000,000 DED RETENTION$ OBSBAIM3292 8/1/2015 8/1/2016 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN ANY PROPRIETORIPARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? C (Mandatory In NH) 08WECCN4111 8/1/2015 8/1/2016 E.L.DISEASE-EA EMPLOYE $ 1,000,000 V yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 1 000 000 DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION (508)790-6230 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Electrical Inspector ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE S Harrington, CIC/SMH ` i°"K- f�crRr.Lvr� L.st ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 01114m) 01/29/2016 20:38 15085647272 RIDER RISK PAGE 01/01 OP ID:MR DATE(MMMDTYYYY) ACORN" CERTIFICATE OF LIABILITY INSURANCE 02/021201, THIS=THISCERTIFICATE SSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRODUCER,AND THE CERTIFICATE HOLDER. AIVED,subject to IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,ure the policypes)must be endor,, an endorsement A statement on�this certificate does not N IS lconfer rights to the the terms and conditions of the Policy,certain policies may req certificate holder in lieu of such endorsemen s. cONTACT PROLUCFR NAME• F Rider Risk SPBCIBIists E44AIL PHONE �, Insurance Agency,Inc. _ — Ed4MIL PO BOX 115 Aongess: — Cataumet,MA 02634 ROWCER TOBEY-1 _ - JAMES W.RIDER CUSTOMER„ID_iE INSURER()AFFORDING COVIIRAGE_ _ _ NAIC A•, INSURER A:UTICA FIRST INSURANCE CO INSURED 7QBEY PLASTERING - -- - -- - '- PO BOX 223 INSUR BRB;TRAVELERS INDEMNITY _ SAGAMORE,MA 02561 INSURER C 1 PROGRESSIVE INSURANCE COMPANY 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 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 POUCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.--— MMMD LIMITS F TYPE OF INSURANCE POLICY NUMBER MMIDD MMlDDIYYYY EACH OCCURRENCE 3 1,000,00 GENERAL LIABILITY 1 00 00 X COMMERCIAL GENERAL LIABILITY BINDER#TOBEY-1-24 12/02/2015 12/0212016 PRE e , a• _ -_• + MED EXP IAny one person) 7 6,0 CLArMS.MAOE ❑X OCCUR 1.000,UO PERSONAL R ADv INJURY 1 —-- — GENERALAGGREGATE 2,000.00 PRODUCTS,-COMPIOP AGG 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: 9 X POLICY PRO0 I.00 COMBINED SINGLE LIMIT AUTOMOBILE LIAIUL17Y (Ea sw1danl) ANY AUTO BODILY INJURY(Pelt poraon) 50,00 ALL OWNFO AUTOS BODILY INJURY(Per accldrml) 3 100,00 TYDAMAGE .s 50,00 C X SCHEOUI.FD AUTOS 1806546 08/24/2015 00124/2016 PRDPER (PER ACCIDENT) X HIRED AUTOS -" X NON-OWNEDALrros —' UMeaeLLAuae OCCUR _EACHOCCURRENC_E :5 E F.XCESS UAB CLAIMS-MAD AGGREGATE __• _ .6_ —_ .-- DEDUCTIBLE - -- ------ RETENTION X WC STATU• OTH- WORKERS CO}fIPENSATION ORY_LN1L AND EMPLOYERS LIABILITY JUROG268988 08/22/2015 08/22/2016 E.L.EACH ACCIDENT b _ 1,000,00 B ANY PROPRIETORIPARTNER/HXEcunvE Y N I A 1 000 0 OFFICERIMEM13ER EXCLUDEW EJ,.DISEASE-EA EMPLOYEE 3 + + (Mandatory In NH) -•" '-" If nr,describe un&r E.L.DISEASE-POLICY LIMIT $ 1.000+( O S RIPTION OF OPERATIONS below I I I I.- F TTDEESCRIPTION OFF OORPERATIONS/LOCA'rM5/VEHICLES(Atleehh ACORD 101,Adel larol Remern Bchnd++le,if Moro Space le requln e) COMPELEMONRP� A AkRK �08��3�737ECTED TO BE COVERED UNDER WORKERS' 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. NOONAN ELECTRTIC JOHN NOONAN AUTHORIzEDREPReSENTATWE 12 MILENNIUM DR. JAMES W.RIDER CATAUMET,MA 02534 1988-2009 ACORD C RPORATION. Alirrights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD BUDDING DEP7; FEB 032016 7'OwN OF BAnNSTABLE OZ 1�1 IA A-5 r'� SC _. 1� \ l•�F��iKk.��l 5�ve � � � SMOKE DETECTORS REVIEWED 2f151lG Wc G DEPT. DATE FIRE DEPARTMENT DATE j BOTH SIGNATURES ARE REQUIRED FOR PERMITTING A � T BVI LDING pEPT FEB 03 2016 TowN SARNSTAB CE oc J •,.0/cc> � (gam! SMOKE DETECTORS REVIEWED zJ�9/r� A N LE JILDIN DE PT. DATE �,r�-�oKrNJ ARE DEPARTMENT DATE BOTH SIGNATURES ARE REQUIRED FOR PERMITTING It 02�/g sue° Act BUILDING DEPT FEB 03 2016 TOWN OF'BARNSTABLE �� � s vok i> SMOKE DETECTORS REVIEWED SF TWO BOIL ING DEPT. DATE FIRE DEPARTMENT DATE 34r'i SIGNATURES ARE REQUIRED FOR PERMITTING i BUILDING DEPT. FEB 03 2016 TOWN OF BARNSTABLE L � �T4 a 0/1-0 SMOKE DETECTORS REVIEWED T -2 . /'U'LDING DEPT. DATE ..,,pp FIRE DEPARTMENT �S'MQ/ee �U� / 7v M TE BOTH SIGNATURES ARE REQUIRED FOR PERMATTING Town of Barnstable Regulatory Services . RichardN. Scali,Interim Director • BABNSCABU& "t"9' 1639. Building Division A� �Fp Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 REQUEST FOR ELECTRICAL INSPECTION ELECTRICAL PERMIT NUMBER (Permit required in order to process inspection) Today's Date Requested Date of Inspection I,. hereby request an inspection under Massachusetts General (Electriciarx) Law chapter 143, section 3L and 237 CMR 4.02(3). The installation will be ready for inspection at (Property Location) Type of inspection requested: ❑ Temporary Service ❑ Service Re-inspection ❑ Excavation ❑ Rough Re-inspection ❑ Service Inspection ❑ FinalVRe-inspection ❑ Rough Inspection for ($100.00 Re-inspection Fee) ❑ Final Inspection for ❑ Other Owner or tenant Licensee's name, address, and phone G License number Licensee's.Signature This section to be completed by Barnstable Inspector of Wires Inspection date ❑Approved ❑Not Approved This work was not approved for violation of the following Articles and Sections of the MA Electrical Code Q:WPFiles:forms:electrequest Rev:1112013 n:4Rle 0�5 ._ / f 1 �g G - '8E.D f2..00A- vEw .S I a/„J e- Ya2o svT__G L•A P,Ci0ftr2. 27 UV/ l At1ND n-1(� lLoOat M.A•�'Y-�2 73E�2A OAn - 1 - 35/_atf a,/1G SI-// UG L EZO 5'7-'rw.-r- rVr/b!G O Vt2�a cnic PL%..-Y: e�-crS-r. s-I'•e r Dow r✓ 1 /JE r.� +_X Y /xS CaP S 'la WALL 1 a /xY T/'_//L/ WIG /c h FAfciA/y/L I s y i - '1 wA•LL AVo ja T ,fj r4T'I•.L �JSD(2r�t?M Df K17CWeN 17-0y•g6L V Try ayc/Co__aZ 7w a. l`L6 -��X6gs fix_ r. _ c - T Godv / Pr. ax 8 Lt"'b(!,E _ Iscg RAT-T_ - �xX P.•r- L-ED6 2 LA C� PE2 C-oD� /6 4�G Q FLoORz P Lf1 tit ATOP— t CA bq O _$UP_Po.2.T__ Gow/u.Nfj yrasucTtJoszrl-C p �. 00T. VX 8".<3r=Anet _ — — Bof�fLD C LG. 5 ATOP 4xrl to T. Posr5 A'QGH D ARG+1•E 1� s ATv P £x I S r• N Q -o:axs p_T l3ox A-7aP s LhO e G L $D/JA'S - y'AT/N. 73�LOw 5-7 37-O•• ro&wc> 1-770N/ Di=GIB/ J� NEw OLA+�r �tc� o✓-E2 P.T: axY P-Alu. 6AOOv-e-D pT, axa�Ars- �' 3sT �� SrDE ✓raw 1 P T- ��M E711-ST/NG - Lrt•G l3.o-GT PAR COF>� A"S P H AL,r /Lo F - - —��Dx PAY LAG PEr2 God - — — ceXB Pr LfDG'E2 Fl NO TC/-/6D T.u /d OL rV Ov)2 IX(o FASG+ A 8 P_T I1rF--�III�II�-I11 1IInIII rA --- ,r _GaaxUTI INSI Df TM SC Sb d I� u 1-1 3TRUC P&-tL L-1 DO 11 El Ixy PA F/OGA,�!j .DaGK rNb� Y'-✓<I�G D I A P T --- N-T"l�.y Fr2_ON i •EI.E �AT70 - Sc �E �S//,=/-p.' r.+"joNny-1/,A41n/, '$SLOW G AA•DE V/N 9f L- . L-�WIS P�•N5 6 / / APPROV ROVED BY: scALe: /y ^ v'=/,-O" DRAWN 9Y�i�0% GD wgSc �r2 .. REVISEDT x % 8°.xG �jc(o�.y .- 7- OR--ONUM—