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0175 ABBEY GATE
�� J ��r.,.� ,. � ,�� ,�.�. � r..:rt:�� 41'4�..w a� .�Yti�..�i�+� �g� (jt� - �}..�ICfI� !.`,t rr i. '�% J�� %3.� ,:{,P �r� .. .. ,.. �- N'g, ..,_., .. ._ ,. .,: .. 4 .. .. __.._. _____�..�._ _.�._...—�..�..�. —._n_._._. ., ___ L . � _ . ♦ - ..u.-- �—r�'rra`.+,^..y"s:,�"wrsr+- '"�-,....�,..�--�•�ir..« � _ ....,.__:�i,—..-Y..•_...:,::re..� �... . �,.. IME o Town of Barnstable BARNSTABLE. Regulatory Services MASS. t639. Building Division 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection FzA)A L Location` 1-2 5 A Q Q E Y G NTF- Permit Number Owner Builder ' One notice to remain on job site, one notice on file in Building Department. The following items need correcting: R-P-ACS,-G NcrF)CD R2. 5u PR-"e i PDS 1 s Toss-r N i Please call: 5087862-4038 for re-inspection. n Inspected byr � Date AL S)I`J �j TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map �Q 1 lication # Parcel Pp Health Division Date Issued 3 Conservation Division �� '�2�5� OK Application Fee Planning Dept. Permit Fee lh Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation /Hyannis Project Street Addressor /1 Villaage Owner �-- �"�� Address �S Tele phone 6"09 40 A4+ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay CA r 'roje�t /aluation S �o�o Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, a72U portingdocumentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old Kind's H ighway70 Yes? ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other_ Basement Finished Area (sq.ft.) 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 new First Floor Room Count r 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—Pool: ❑ existing ❑ new size _ Barn: 0-existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # _ Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name :"" `�-�y Telephone Number aer W p?�1 Address .5� 6W License# AAA U `J- Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE - DATE � F i> FOR OFFICIAL USE ONLY APPLICATION# A .DATE ISSUED :�;,:ss - i MAP/PARCEL NO. n ADDRESS - VILLAGE OWNER DATE OF INSPECTION: FRAME INSULATION,'.. FIREPLACE ELECTRICAL: ROUGH FINAL r PLUMBING: ROUGH FINAL iGAS: ROUGH ?tt - k, FINAL "FINAL'BUILDING' ` ` ' DATE CLOSED-OUT ._ ASSOCIATION PLAN NO.,. �,E r T6?F.n- of B arbstable regulatory Eervzces i *. 4,.1tr• - Thomas.F. Geger,Director Building Division ' Thomas Perry,•CB 0,'Bm7diag Cam'r„i money 260 Mai a aft a4 Hyads,MA 92601' T".fc sfn.barn sEa b l�uta_u s 'Offices 508-8624113 S Pax: 508-790-6230' PLATS RF Yt /� Owner /yt Map/Parccl: D 7 l Builder. I PIL?jCCt AddLC55 /7J �iaW���� The following items were noted.on reviewing: ZN Z ' 16 tjo 7 av o1V G09-� G ReYieWed by. i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,MA 02111 .Y www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'bl Name(Business/Organ an�dividual): . Address.--'Ail,5 / Gt-4- Cil /S to/Zip: VO�Mrf" �- OA35. Phone.#: SM YJ0 ,Jq 4 �tre you an employer?Check the appropriate box: Type of project(required):. 1.❑ I 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' [No workers'comp.insurance comp.insurance. $ 9. ❑Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions �3.E 1 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 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. ZContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 'I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do�hereby certify underL tyhe pains and penalties of perjury that the information provided above is true and correct Si�gnatur /'V�C/IV Date: /� S iU. Pho ne##: c6 68 a 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 j . Contact Person: Phone#: . f 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 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, §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 oa 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 conpliance 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 o necessary, supply sub-con6actor(s)name(s),address(es)-and phone number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to 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 ofghdustrial 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 permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessarv)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 CommonwWth of Massachusetts Department of Industrial Accidents e . Office of Investigatlous 600.Washingtori Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax#6i17-727-7749 Revised 11-22-06 ' www.mass.gov/dia 1KE Town of Barnstable Regulatory Services r3MWffrAsr e, : Thomas F.Geiler,Director y KAM o 39. �.0� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.b arnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DA'TEE JOB LOCATION: n bW street village "HOMEOWNER": name home phone# work phone# i 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 l09.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,xules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. �� - k �� 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. I� HOMEOWNER'S EXEMPTION ` The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. . To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt i - THE Town of Barnstable Regulatory Services MASS Thomas F.Geiler;Director i639 �� 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 Usi_= A.Builder as Owner of the subject property hereby authorize to act on my behalf, in all'mattets relative to work authorized by this building permit (Address of job) Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled before fence is installed and pools are not to be utilized until all final inspections are performed and accepted. Signature'of Owner ? Signature of Applicant Print Name Print Name Date Q:FORMS:O WNERPERMSSIONPOOLS M ,Q �A' c ' '� -'.COT f-� -.�?1" q'i'✓ .�a'ryal�: -2�/ .�"G 8/ Tfl.�` t�'.��'/..;-'"�"�i✓.':�',1Gf. r:;:"�..;�`7fc�<,f may. � - - Ex:/:_ - .., :.7f�• .�.� ��=f 1��r. .G. �:%,/G' C /� , ter+ ,�`.`f�.. T/m'sw:t�:..�T%:7//.'r':'..T'.�-1�,ti;' .'� ,_.... .'.';•,s =• �G S/,T./"�/�1�� {✓'N4� �e .G...c�t'- ... i; f �4 � y n ..>' '�.-,'.ice ! _JP2•5 �p '' t J� .. . Tf.. .. �7� s..�..y��-'��-'� r�c .7'J•F.rrJ/�i/�5.� �.i�wE'a��f. oop Up Print, Page 2 of 3 s P I F - AsBuilt Card N/A Constructions Details -Map/Block/Lot: 021 /027/-Use Code: 1010 Building Details Land Building value $ 193,500 Bedrooms 4 Bedrooms USE CODE 1010 Total Improvements Value $219,848` Bathrooms 2 Full Lot Size(Acres) 0.49 Model Residential Total Rooms 7 Rooms Appraised Value $ 170,: Style Colonial Heat Fuel Oil Assessed Value $ 170: Grade Average Plus Heat Type Hot Water Year Built 1984 AC Type None Effective depreciation 12 Interior Floors CarpetHardwood Stories 2 Stories Interior Walls Drywall Living Area sq/ft 2,128 Exterior Walls Wood Shingle Gross Area sq/ft 4,020 Roof Structure Gable/Hip Roof Cover Asph/F GIs/Cmp . Outbuildings & Extra Features-MapBloek/Lot: 021 /027/-Use Code: 1010 Code Description Units/SQ ft Appraised Value Assessed Value WDCK Wood decking 828 $ 9,800 $ 9,800 w/railings FPL2 Fireplace 1.5 stories 1 $ 3,800 $ 3,800 FPO Ext FP Opening 1 $ 1,300 $ 1,300 BMT Basement-Unfinished 1064 $ 21,500 $ 21,500 . Sketch Legend ttp://Www.town.barnstable.ma.us/Assessing/printl2.asp.searchparcel 021027 5/17/2012 • 4 � / 1 17 V �� 1 �. ffl HM , __ -- ..i..,..-m:'* ^.t:!� . ..!."j,-1.�*.�,.I;.:.1�-",....,.,-..:.,:�."�o-'''l.i..lI..:!._.;I-...:;':tI!'�,".�..,..,;.���%1-. ..,t..":.x,,..�. ...I.,�'.:-1.'*..:,..k,._.I.:":..\*.....I_:'.\......,..—.-.1,..,,...-,.1-:,I 1j.,.....!..:...�9-.�..I..,-.....:...I�'..1.I...I,.,..../!,,',�.,:..�.q A . 1 . ' _ l: :Y ,.,.�'�;.-.;.-....1 i 1. ..,�...I1:,..:.......--;..:,"�...1:......;*......1.�.�:,. 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',.\ �� N4 f , ' :,1 1 t : . \:; \ qC c�1li T !3`a;t .IQ. , GII IV (�- A i.- i j \ 1 `iW f ,^ 1 1 , - , y ,r �y . - \ / , ' `. 1 1 / \, / 1: 1. i`r J. ,, . i. . e n N ,�. ti q: of 1f f , Ate 't r q / Ay I,"i 1 �, ,,'ifs , I / _ _ , 4 + I J i y O.I y r� { / `I [r ' I I 1 T. 1. \ '' 1 1 ./ 0 1 .mil N I 4. . 7 I \ , / J ' ,.1c1 . • - .� `'-j>. .. . rL'oTA / . ' : . I, - . + `1N OF y Oi O'r3`1:.RIC61ARp y �3`�p`tN M 4y r c O'HEwRN. iwis.: LEGEND suR� . aaiTaa\ EXISTING SPOT ELEVATIONS O,RO '/ �! .:..__.. .. ' ` ' EXISTING CONTOUR- - - 0 - - - - % !/ FINISHED SPOT . ELEVATIONS 0.0 . FINI:SME . CONTOUR 0 . .PROPOSED PLOT . PLAN . APPROVED: -BOARD OF HEALTH `,f ,' . . . - H.g2.1sr.913c , MASS. DA E ' : AGENT LoT L. ,9 - //�/�',s lzANT: .. 1 . ,GEEtTIFY THAT THE PROPOSED R. ✓. O'HEARN, /NC, RLS, A : BUI.LD1NO! ;SHOWN ON THIS PLAN 1348 ROUTE -. 134 CONFO,RM.S TO THE ZONING LAWS EAST DENNIS:, MASS:. Op. 3,gc�i�s:r ,tJc: .,.. MASS. DATE / � 8/ SICALE " 30 r !"j' ,/- --- J p 8 N O..�a-8E. CL'I ENT rib s v. 8/ D. TE R GISTE ED AND SURVEYOR DR. BY :__ !f- � �", SH.E E T � ,'..OF ._.z • s.� SO1L. T ES.T-. . . -. .. , .. f V.�f�:�.T.. . ELEM LONS.: .. IYQTE - -..-. DE OF- AT . �.. SOIL . TEST INVERT AT BUILDING /2'0 FT i .:ALL. WORKMANSHIP' lt-NESSED BY` P/Y'.: A;VD M"ATER�ALS D.E.:0 E. TITt_E::. .5 INLET SEPTIC` TAANK . . /4 S FT• SHALL:-CO.N.FORM= TO _PERCDLATI4A1 RATE FAIN./IN,CH.: OUTLET SEPT.IG. TANK: 3 . FT •: AND' :THE" - T . _ ,grsrg UL:ES _. CL 0 W N. OE ,B QBSER-NAT1`.�N� f"IflL.E [: ... :.� INLET:. D1 ` � ANO. . RfG�L. .. QBSE.Ri aTi.ON : HOLE ., Z : . . STRIgUTLON., . BOX .:FT. . R S!}BSU.RFAC;E .- ELEVATION.- //a :. :: . OUTLET .DIS.TR•IB ... ; D1.SPOSA L :OF SA F _ . : _. . ELEYATLON-f/..8. . . UTIO.N B.OX.. . /�. 2 FTII:TARY _:=SEWAGE .. INLET [.Fi9 .�ir/NG'..`7` 5,vC To Psoi�. T M oP g ' FT'/c sa . - jN. E.9 • .. _D`ES1�N.. 'CAL�..ULAT10�1:S-` .;. :•-.:N..... rND !Z NUMBER:-- OF:. .BEDR.00.MS'. .s GARBAGE'. DISPOSAL. UNIT. ;Sv�s�r TOTAL ESTIMA.TE.D FLOW ( /G- GAL /BR. . — .. 3 3� /0 .AY. x 1BR � ) � �GAL/DAY REQUIRED SEPTIC. TANK CAPACITY 4 9 5 GAL ACTUAL. SIZE _ Of.. SEPTIC. TANK 'TO:_BE- INSTALLED.:.:.' /a�J m��. s,9/✓D.: GAL'•..: LEACHING -AREA 'REQUIREMENTS. SIDE: WALL. AREA 2. 5 GAL../S..F. /zo ' BOTTOM AREA Ae GAL./S.F - i/:~ 96 " F�_ 3:.p L�%/aTE _ @`./o_S F�:=.: 2::� APACtTY (: BOTTOM +SIbEWALL ).. . ... . : . . GAL. LEACHING: E ?¢ RESERVE LEACHING: CAP`ACIT1 3.45 NOFy� TOP OF 20 r=T. 1,111VGAL. o s• - R1ct+� FOUND. Ame. RN C.ON�RETE.. 4 SGH. CQVERS: P:.VC PLP ITCH. ".lJa vi3�� R �.� - MI _ PE iZ co.2�TED E COS iSE;'Vt�T1 Q� g i R. F ; G �U�� 41 12 MAX OF FLOW LINE +�� ����p. G _. -JAW 897 S NJ> 1.p Z:.. ... 4�� CAST' IRON �. PIPE - MLN: I. .P:TCH. . - . 'P 6 � a� L - al ST:. _ : -.�.. ,;. - BOX .. a •qe /� WAsr/E..,� _ GA.L - • T�k:NK H iNC .r-77-j 4. •.. 13 4 R O t1TE 13 8:• T. EAS D N " E�. 3 2 W� No:. � o .. , ....:NOT.. 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I■ 1 11l�lI■ 11111■I Imal I■Illl ■I■III li��?Ir �� IC I■1111�11■I '� .I�i►! � _ I■IIIIII�I■11�11l�I�!�1����■I■�111111■I Im■I I■1111111■Ilill !! �1� ■I■�111111■I I�■III _ I■Illlli��■1l�lill�l�!'�: ��0■I■IOli�i■I I�[�L I■111111■I■Il�lli�l�'IE`�11�■I■IIIIII■I '� I�■It" IIIIII■I■111i1l�1I�11��E�■I■elllll■I I�■Ilj ■IIIIII■I■Ihlll�il111�■I■IIIIII■I Im■I[' I■IIIIII■I■IIIII■I11' 3■I■IIIIII■I Im■II I■111111■I■11 11l���ili �ll■I■Iillll■I I�■I _ _ I�111111■I■1��1� `�i��i �111■I■��l111■I Im■I : iilllll■I■IIIIII■I■IIIIII■I■IIIIII■I Imo■ '��- � �1�111111■I■IIIIII■I■IIIIII■I■IIIIII■I Im■I ��IIIIII■I■IIIIII■I■IIIIII■I■IIIIII■I ■I._ II111111■I■IIIIII■I■IIIIII■I■111111■I ■I■ II111111■I■IIIIII■I■111111■I■IIIIII■ ' I�■I■ I[IIIIII■I■IIIIII■I■IIIIII■I■IIIIII■I '' I ■I■ I■IIIIII■I■IIIIII■I■IIIIII■I■IIIIII■I MEN I[IIIIII■I■IIIIII■I■IIIIII■I■IIIIII■I li■Il I[111111■I■IIIIII■I■IIIIII■I■IIIIII■I IM■S I■111111 �■111111■I■111111■I■IIIIII■I IM■I I■11111!! ,■IIIIII■I■IIIIII■I■IIIIII■I IMEI I■IIIIII■if�il ill■I■IIIIII■I■IIIIII■I Im■I■ I■IIIIII■I■ E� AI■I■IIIIII■I■IIIIII■I oil, I■IIIIII■I■IIIIII■I■IIIIII■I■IIIIII■I Im■I I■IIIIII■I■IIIIII■I■IIIIII■I■IIIIII■I I��I I■IIIIII■I■IIIIII■I■IIIIII■I■IIIIII■I Im■I I■IIIIII■I■IIIIII■I�111111�1�111111�1 I�■I iii ii iiiiiilii����������■Mal I�■I I■IIIIII■I■IIIIII■I■IIIIII■I■IIIIII■I 'r T Commonwealth of Massachusetts SheetMetal Permit Map Parcel d�7 Date: G �' Permit# Estimated Job Cost: $ 0 Permit Fee: $ Plans Submitted: YES NO k Plans Reviewed: YES N Business License# 7 0 1 Applicant License# `\ Business Information: Property Owner/Job Location Information: Name: 94 Lt.404 T� Name: /�-6�- Street: tA:Aj.42 led. Street: ?AR.- City/Town: C: a�T`ti City/Town: l.0 ft L4 f Telephone: clo g �� � `�� Telephone: did-O d 44 Photo I.D. required/ Copy of Photo I.D. attached:- YES NO A C-7 o /j_1 Staffinitial t` /M-1-unrestricted license o . J-2/M-2-restricted to dwell* s 3-stories or less and commer ft.-cial up to 10,000 sq. 2-stories-or les Residential: 1-2 family. . Multi-family Condo/Townhouses Other ' Commercial: Office Retail Industrial Educational ' Fire Dept. Approval Institutional_ Other Square Footage: under 10,000 sq. ft. I,/ over 10,000 sq. ft. Number of Stories: i Sheet metal work to be completed: New Work: Renovation: HVAC Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes No ❑ If you have checked YM,indicate the type of coverage by checking the appropriate box below: A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement.. Check One Only — Owner ❑ Agent ❑ Signature of"Owner or Owne sr' Agent By checking this box ,I hereby certify that all of the details and information 1 have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General laws. Duct inspection required prior to insulation'installation:YES NO Progress Inspections' Date Comments- - Final Inspection Date Comments Type of License: iy 5dMaster 'itle ❑ Master-Restricted 'ityrrown ❑Journeyperson FSi@nature of Licensee 'ermit# ❑Joumeyperson-Restricted a License-Number: 'ee$ ❑ eck at vwvw.mass.govIdol ispector Signature of Permit Approval The Commonwealth of Massachusetts .UV `. Department of Industrial Accidents Office of Investigations -600 Washington Street- Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/FIectricians/Plumbers Applicant Information Please Print Legibly •=Nam`ns�ss/oga izat mllndividual):���t 9_z y,4- q,- dbc- "A ci-"n! ij KVAef ' •Acicliess:� �`�0 .�° c.rc,.e�i.l�..Q-r�L ��G^�-��- � . C %State/zi ty p el"GA, AA Q i53b Phone.#: 6_0 8 540 046Y Are u an employer? Check the appropriate box: a of i o ect(required):.'-Typ P J � 1. I am a employer with / -4• ❑ I am a general contractor and I ❑ . employees(fall and/or part-time).* have wed the sub=contractors 6. New construction . �2.❑ I am a'sole proprietor or partner- listed on the-attached sheet 7. ❑Remodeling (� slug and have no employees These sub-contractors have 8. ❑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 i 3.❑ I am a homeowner doing aIl work officers have exercised their l 1.❑Plumbing repairs or additions ' myself [No workers'comp. right of exemption per MGL 12.0 f r ai-s insurance required_]t c. 152, §1(4), and we have no 13. O�er employees. [No workers' u /u comp.insurance regrured.] *Any applicant that checks box#1 Est 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 hue outside contractors must submit a new affidavit indicating such. *Conhactors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have crployees. 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. Insiaance-Company-Name: � � • Policy#or Self-ins.Lic'# _ _ /� Expuatton Date: �"' " 7ob`Site-Addres /`'o a-� QR3VState/ZiFiaT �� �tk o�- Attach a copy of the workers'VoMpensation policy declaration page'(showing the policy number and expiration date). Failure,to.secme coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of'a fine tip 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 staternmit may be forwarded to the Office of Investi.zations of the DIA for insurance coverage verification. I do hereby certify under the pains-and penaltie of erjury that the information provided abov,is true and correct S ture /� Rhone_# 5�t0 0 g Official use only. Do not write in this area, tb be completed by city or town official City or Town: PermitUcense# -Issuing Authority(circle one): J.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: WE Town of Barnstable Regulatory Services ` ry �M ` Thomas F.Geiler,Director 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 as Ownet of the subject property hereby authorize to act on m7 be in all matters relative to work authorized by this building permit ( dress of job) Pool fences and alarms are the responsibili f the applicant. t3'o e app Pools are not to be filled'before fence is installed and pools. are not to be utilized until all final inspections are performed and accepted. y Sign e_of_Owner_f C afar of Applicant R_6S C4tAIZ4 M JA �� � �% -Print Name + Print Naine Date Q:FOR MS:OWNERPERMISSI0NP00LS 'THE Town of Barnstable Regulatory Services IMMSTAsM Thomas F.Geiler,Director MASS. ,!s CO. ��•� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 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 Dermit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and rcquirerncuts. i 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 person(s)for hire to do such work,"that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15)_This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt , 1 �_- COMMONWEALTH OF-AP SSACHUSETTS-, SHEET-NfETxrC- Rf tERS - AS A.:MASTER-UNRESTRICTED - /'e Tponpu[o9%roc /� 1"����c(ru�c/la Ofiice of l onsa ess egnladon ! ISSUES THE ABOVE LICENSE TO ME IMPROVEMENT CONTRACTOR _= egistration: 167149 Type: J O S.EP H B E N T O J R xpiration: 8/17R014. DBA _ yy '~P 0 BOX T k` FAL H CHIMNEY SWEEP _ �xn ~TEATICKET MA 02536-.0200. = JOSEPH BENTOJR.' 9017 O1/28/13 9.98416 . 440 LOCUSTFIELD RD,: E.FALMOUTH,MA 02536" Undersecretary Chimney Safety Institute of America Certified Chimney Sweep !«ITIM #361 , Massachusetts-Department of Public Safety rsw EP Valid Board of Building Regulations and Standards Thru December Construction Supcn'isor License: CS-024158 20 JOSEM BENT�O t,- PO BOX T �. o • TEATICKE MA+02536;' Bento IkA`� Expiration Falmouth Chimney Sweep Commissioner 01/01/2014 Teaticket, MA www.CSIA.org r - CONTROL# H 19 7-7 9 4 IMPORTANT - - If.this license is lostior destroyed,notify'your Board`At the: - - Division'of Professional Licensure,.1000 Washington St., Suite 710,Boston,MA 02118-6100. If your name or address shown is changed, notify your board of correct name or address to insure proper mailing of.:nexf Renewal Application. Always refer to your license number. This license is subject to the provisions of the General Laws a as amended.It is a personal privilege,and must not be loaned or assigned to any other person. Keep this license on your - person or posted as required by law.' W T X 3 00CUC,7Uz_�CT N-S CSIA Code of Ethics 1 tJy acirwvdedge lhat certification by fire Chimney Safety tnstitWe of America(CSIA)ca^eEs vidh it certain respons,,TIftsam calgations vdddr may hold nm to a tdow standard of Performance and pmfessional treimvW Man app&We tam."les or regu atiars. M Mlsregan.I ice: Unrestricted-Buildings of any use group which 1.To learn and,alit,al dbmey and ven**safety 2 To es.xf contain less than 35,000 cubic feet(991 rn )of Manner and to retrain from n udaa or dec a enclosed s�nn practices or en,"V a"unfair or deceptive "Yam• OvOdig W not tired to an%regard to use of Me CSIA IoWs. �codes in Me 3.To comply vr0h applicat0e . labon areas I service.wiM Bre - Mstnxtiva for Me pmmwtr kmtA and with mcogrumed dofflmy and vadvg practices. Prornote and edtmate cmrsuners about sate - - dumneY and ve"procbces- S.Tend t ednWes"aregard to cwrerd accepted chimey and venting sa}ety Practices' - Failure to possess a current edition of the Massachusetts 6.To conduct myseff m a decent tespec"and . profe54Wna,nq„ v&—senunginnncapacdy State Building Code is cause for revocation of this license. as a chvmaY sue;m when a6end*a ha�iwn m even of an o*ganoatiOn in the d*n ney or hearts �mducts,bv stn'• eIMeCSw For DPSlie� rn singiyrforationvisit www.Mass.Gov/DPS 7.To cornvfy w&fire proper usage Registerd Trams as defined in the CSIA Tmdenlek Use Gudefnne docuerents \ wwr.csla.mVeMrcs - Revised 5011 G V 1 G l . 1 V . 41 f IvI V/ 4 V W V L! V L DATE(MIvIlDDJYYY) CERTIFICATE OF LIABILITY INSURANCE 07/20/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE 1 DOES GOT AFFIRMATIVELY OR NEGATIVELY Ai[END, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES HOT CONSTITUTE A CONTRACT BETWWREN THE ISSUING INSURER(S), AUTHORISED 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 CDHrACT Lawrence-Carlin Ins Agency Inc FEE eN®e YAY 230 Jones Road 'A/` $ Emir B-IpIL Falmouth, MA 02540. WORMS: PRODVCHH CUST0H89 IDB. IesUREn ls) Ai[ORnYE6 CDP�B HAIC• INS°MD IRS/RER g.I.M. Mutual Insurance Co 33758 Joseph Bento Jr. I1611RSfi F: cma Falmouth Chimney Sweep IRSUM C: P O Box T-T INSURER D: Teaticket, HA 02536 IASUPER E: Insff R F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTn'Y THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE 19SVMM RAM3D ABOVE PO8 THE,POLICY PERIOD INDICATED. NOTWIIESTANDIBG ANY REQUDRIZENT, TERM OR CONDITION OF ANY COUTRRCT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED 08 MAY PERTAIN, THE INSURANCE AFP0808D BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE IMMUSDOBS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOHB MAY HAVE BEEN REDUCED BY PAID CLAffi_ xra POLICY NUMBER POLICY EFF POLICY En LSE Lra TYPE OF IDSURRHM 0-MATrr0 tmVDDRTrr) GENERAL LIESIL Y EACH OCCURARM 6 11CCC0IERCIAb Ge DERAL LIASI:In DAHASE TO REHTSD $ YR®f2&ES(Ze.aCCarce�rce) ❑CLA-— [:].CO. ea (e,y am Yers°n) 6 VERS®i.G WV ISO= r, GEWL AGGREGATE LIMIT APPLIES ER: OEN81=A80R6 BlUH ❑—ICY ❑PROaECT❑LOC PR®DOTS-C�/® ASS V AUTONXIBIIA LXABXLr1R CUKB=D SDXLE LIMIT (ea iaenil 6 nARY AUTO HUDILY ISOM (Per He m) S ❑ALL OROeD AUTOS eODI1T ITiIURT(Der am]Denil $ i sceeDDLeD AOYos eRDPEDTe nlRmss HIRED AO1V9 (Der amlOmi) �OOFddRED AUTOS . B B QDMHHeLLd LLB O OCCUR EACH OcC =Hm $ DEICESH LIAO CLABB MRDE AGGREGATE B ❑DEDUCTIBLE B EIRETEDTI07( $ 5 WORKERS GWHBENSATION ® Toar � OT)F AM EMPLOYEES LIAEIISTY ER THE PROPRIETOR/PARTlERS/ EXECUTIVE OFFICERS ARE E.L.EACH ACCIDENT 5 IOU,OOO A ® incl 0 excl 7027074012012 E.L. DISEASE-POLICY LffiY s 500,000 08/10/2012 08/10/2013 E.L. DISEASE-EA EIWLDYEE $ 100,000 C=MHTS DESCRIPTION OF OPERATIONS OR LOCAn OUS: JOSEPH HENTO IS COVERED BY THE WORKERS' COMPENSATION POLICY WORKERS' COMPENSATION COVERAGE APPLIES TO MASSACHUSETTS EMPLOYEES ONLY CERTIFICATE HOLDER CANCELLATION PROOF OF COVERGE SHOULD ANY OF THE ABOVE MSCBIEND POLICIES BE MA .Td>)88808E THE °.. MMIHATION DATE THEREOF, NOTICE WILL HE DELIVERED IN ACCORDAHCE WITH THE POLICY PROVISIONS: A7TNDA0Y®T1PP18:SERffi'IVE OR97 Building Detail Page 1 of 1 6Z26 l0 - - - 1 17 g uus t�etf :MASS `Opel 109�. Logged In As: Building Detail Monday, May 14 2012 Parcel Lookup Parcel Detail Building 1 of 1 r�K I' ?BMT r' Code Description Gross Area Effective Area Living Area BAS First Floor 1064 1064 1064 BMT Basement Area 1064 0 0 FUS Upper Story 1064 1064 1064 WDK Wood Deck 828 0 0 Extra Features Code Description Units Unit Price Year Built Value Comments FPL2 Fireplace 1.5 stories 1.00 4,300.00 - 1999 $3,800 FPO Ext FP Opening 1.00 1,500.00 1999 $1,300 BMT Basement-Unfinished 1064.00 23.00 1999 $21,500 Out Buildings Code Description Units Unit Price Year Built Value Comments WDCK Wood decking w/railings 828.00 15.30 1999 $9,800 F6� Z 60 http://issgl2/intranet/propdata/BuildingDetail.aspx?PID=1004&BID=103 8&N=1&NN=1 5/14/2012 i i ke4s Pe-rnw--F hog x K 'r :. t1;.1� .t j... k-. =. t w.-w,y�..�.... r't /-" � ..: ..-.Y max. .ti-h��t>1'�. ,,r:r.;:iy r-- I';':�-•i��!,w�,..�w:�"ti+v+�r-..-»r.w�-'.�...-..v-�.��.„'K+�... .�. t �i, 1 1K E'O�1' Town of Barnstable BARNSTABLE. Regulatory Services MASS a639 ,0r Building Division p�ED MAC a. - 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice T e of Inspection S T E - �D/�/� ��r{��l� T U� 1�� 7 YP P I Location/ 9,3106, C,,4r[ C�' Permit:Number Owner _ Builder. One notice to remain on job site, one notice on file in Building Department. The following items need correcting: 4 o c e- LD e6-JZ�k J 7- �� ?'t-1 12 7-10,v t)lo C-Pq7r -kk �PErroz Please call: �508�-86 2- for Inspected by Date Town of Barnstable *Permit#C ®Oo 061-7s- Regulatory Services Expires o /rsfromissrredate • BARM st.s, Fee 9 MASS 1659.A��� Thomas F.Geiler,Director 0 Building Division Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 Office: 508-862-4038 www.town.barns table.ma.us EXPRESS PERMIT APPLICATION - RESTDENTIAT ONLY 508-790-6230 Not Valid willrout Red X-Press Imprint Map/parcel Number Property Address ❑Residential Value of Work Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address T Contractor's Name Telephone Number4�� �G ,� Home Improvement Contractor License#(if applicable) Construction.Supervisor's License#(if applicable) orkman's Compensation Insurance PEMI Check one: ❑❑ 1 am a sole proprietor AN 3 2�12 I the Homeowner have Worker's Compensation Insurance Insurance Company Name jl/��{ TOWN OF BARNSTABLE Workman's Comp.Policy#_������� �� Copy of Insurance Compliance�ernttcate must accompany ch ermit.. 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) 6-side #of doors ❑ Replacement Windows/doors/sliders. U-Value (maximum .44)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department.regulations,i.e.Historic,Conservation,etc. ***Note: Property Ownei must sign Property Owner Letter of Permission. A copy he Home Improvement Contractors License&Construction Supervisors License is requi d. GNATURE: s The Commonwealth of Massachusetts Department of Industrial Accidents IL Office Of Investigations t :lid 600 Washington Street �v r Boston, MA 02I1I �~ WW.W.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ADDUCant Information Print Le ibl Name(Business/Organization/Individual):_� Address: City/State/Zip: (Phone #: Are you an employer?Check the appropriate box: 1• mm a employer with- 1 4. ❑ I am a general contractor and I Type of project(required): employees(full and/or part-time).* have hued the sub-contractors 6• ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. I 7. ❑Remodeling ship and have no employees These sub-contractors have working for me in any capacity. workers' comp. insurance. 8' ❑ Demolition [No workers comp. insurance 5. 9. El Building addition ' p ❑ We are a corporation and its required.) officers have exercised their 10•❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no insurance required.]t employees. 12•❑Roof repairs [No workers' ,, comp, insurance required.] 13•❑Other to 14/1 j *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 anew affidavit indicating such. t :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors'and their workers'comp.policy information. , I am an employer that is providing workers compensation insurance for my employees Below is the pplicy and job site 1'information. Insurance Company Name: Policy#or Self-ins. Lic.#: _ ""ZL Expiration Date: _ Job Site Address: City/State/Zip:4� Attach a copy of the workers' co pensation 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 airs nd pen es of perjury that the information provided above is true and correct ' Si ature: ate: Phone#: Official se only. Do not write in this area,to be completed by city or town official 1 City or Town: Permit/License# Issuing Authority(circle one): L Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other TRAVELERS J - WORICERS c®MPENSA4T10ti AND EMPLOYERS LIA.BILI'FY PO-rCY TYPE AR INFORMATION PAGE WC W, 00 01 t A POLICY NUMBER: (ESKUB-4861 P48-6.-' i ; NEW-11 trCi�F?rR' THE TRAVELERS INDEMNITY COMPANY 1. NCCi C 0 C00E: I14SUREI : PRODUCER: 0A'N'FORTH. vAMES DBA PAUL PETERS AGENCY INC ,JAME S, DANFOR T H REMODELING 680 F ALMOUTH ROAD PC BOX 973 MASHPEE MA 02649 CC T 01..7 MA 02648 insured 15 AN INDIVIDUAL Dther-troork places and identification numbers are shown in the schedule(s) attached. _. T h,e !in,lic',r period:is from 49-29 4 1 to 09-29-1 2 i 2:01 A.tvt, at the insureds mailing address. . 3. A, IMORKERS COMPENSATION. INSURANCE: Part One of the policy applies to the'01orke's Compensation Law of the state(s) listed here: B. EMPLOYERS LIABILITY INSURANCE: Part T,.A)o of the policy applies to work in each R,aie Jls e-3 tern ,;.A The limits of our liability under Part Two are: Bodily Injury by Accident: $ 100000 Each Accident Bodily Injury by Disease: $ 500000 Policy Limit _+— Bodily Injury by Disease: $ 100000 Each Employee C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any,. fisted here: COVE RAGE REPLACED- BY ENDORSEMENT WC 20 03 06A D. This policy includes these endorsements and schedules: SEE ISTING OF ENDORSEMENTS - EX_TE;JSION OF INFO.PAGE —_ The premium for this policy will be determined by our Manuals of Rules, Classifications. Rates and Razin �. Plans. All required information is subject to verification and change by audit to be made ANNUALL 1 . DATE OF ISSUE.:. 10-20-•11 RR 5T ASSiGiv• '`4 OFFICE: ORLANDO INDUS AFF 161 PRODUCER: PAUL PETERS AGENCY INC 28LBR p. '�f C� �s �L"�e�i License or registration valid for individul use only of rice o onsumer Attfarrs swess egu ation g Y HOME IMPROVEMENT CONTRACTOR" before the expiration date. If found return to: Registration: 1i4813 Type Office of Consumer Affairs and Business Regulation rg F = Expifa ion: 10/27/2013 Individual 10 Park Plaza-Suite 5170 Boston,MA 02116 JaNIES D DANFORTH REMOD JAMES DANFORTH t r 1105 OLD POST RD COTUIT MA 02635 Undersecretary \of " id witfiout signature �M,s its- I)'C1T:lT'#hti`ill'1►I't'ud)fiC 151kik� ;;( ,�...,....,.,.,..s,....•..��•-.----.^'-�. -.e-,a.-.-.....•�-...s.•....... _,.� .. fit3I:`ifint—, Re"tit ittiOft's aQd `stat daV,tI�s. #+.,�'. s}}� a1 y»•���, �; ' CLI.Sx>ttrT!Gi1 `s.�i>zCat'3tJY 10E>Y'Si2 � . °. License: CS 8267 $. t )a;� t-tireRe strioerl to: 00 ht of L,7t,or ' JAMES D DANFQRTH •'�a."" ,"•�• ,:lccugatxieasSsrefHa�tnnanw��tratiwi .lyres�BI!tsk fI PO'BOX 973 I C6TUIT, MA 02635 ,, , ` rtas a t essf� rx3+nFi¢racx stl ta4,+0 up¢+tz#YR�;t tN Haalttr, —� Expiration: 5/2012fk12 '{ ' ' i ,suri�.,..,n�•�• :'rT: 2fi1�4 "� � t _ ;' ��_� f c e t t"e n cv e._. it ifS a f e t y e '4 '' �i:tl>rlCtt?�3�t. :ciftl`2f to n i ARls�•��e z 00 i or 06 a Ia Satefy's b AUTROTKIIQa RAZE fN CQV ` . hefd`ai Spfey Wood Ru .' Ya►rnis. A , - ;Ali Wdvember 5.2008 Fmk ` C£� 'iy � w*tY:�xcA!to sate` ,cosz Training Date Construction Supervisor Home Improvement License Numbea#008267 Contractor Registration#114813 OSHA Approved Member of the Better Business Bureau Home Phone#508 420-5131 CELL PHONE#508 280-0802 ESTIMATE JAMES DANFORTH P.O.BOX 973 COTUIT, MA. 02635 Jack Dixie Abby Gate 175 Cotuit, MA. 02635 October 22, 2011 Work to be completed on the entire house siding as follows. Remove the existing wood shingles. Install Typar house wrap over the house sheathing. Install squared and rebutted white cedar shingle 5" to the weather. Removal of rubbish. Material and labor $13,800.00 All materials are guaranteed to be as specified.All work to be completed in a workmanlike manner according t standards practice.Any alteration or deviation from above specifications involving extra cost will become extra charge above the estim te. Our workers are fully covered by Workman's Compensation Insurance. DATE OF ACCEPT USTOMER SIGNATUR CONTRACTOR SIGNATUR / i Town of Barnstable ' *Permit#��� Expires 6 months from issue dale Regulatory Services Fee s swx�vsr�st�, v �nss. $ 1619- ,0� Thomas F. Geiler, Director �TFJ Mp`(A O Building Division �-,. -Ai Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstab le.ma.us \l�)V - f)i� Office: 508-862-4038 SOWN 01F6A5'p8.4VDp6.��0� EXPRESS PERMIT APPLICATION - RESIDENTIAL .ONLY Not Valid without RedX-Press Imprint Map/parcel Number 0 ZPro erty Address-1'7S Qz° e GQ Q esidential Value of Work 0� Minimum fee of$35.00 for work under$6000.00 Owner',s Nam e & Address t 1S,001 n Contractor's Narne J /jl e �G/1/ Telephone Number , ��'— fo � Home Improvement Contractor License#(if applicable) Construction Supervisor's License# (if applicable) 9� �o �orkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑. am the Homeowner have Worker's Compensation Insurance Insurance Company Name Bgv�.C(jIV. Workman's Comp, Policy#_ Copy of Insurance Compliance Certificate must accompany each permit. Permit Request (check box) ❑ Re-roof(hurricane nailed) (stripping old shingles) All construction debris will be taken to ❑Re-roof'(hurricane nailed)(not stripping. Going over existing layers of roof) ❑Zp *acement de l Windows/doors/sliders. U-Value �.- #of doors J (maximum .35)#of windowsi *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. SIGNATURE: Q:\WPFILESIFORMSkbtiildingpermii forms\EXPRESS.doc evised 072110 The iCommonivealth ofMassachzrsetts Department of lnditstr3al,4ccidenis 0 ice Of 1nvesfi afroTlS 6-60 Washington Street ` Bostoz JV4 02111 tiers w.rnass govldia Workers' Compensation Insurance Affidavit: Builders/+Con#a-.ictai-s/Electrici:ins/Plumbe.rs Applic Information 14 Please hint Le "bh• Name (Busme&.-Or anizati vidrtal): 0r 4 Assoc 4-4 c- Address: 3 7 7 City/S teJ�ip: 0/� 9 Phone #: O/ b �/ —COW Are tau an employer?Chec the appropriate box: T e of project(.required): �-. lam a general contractor and I 3P P {1_ I am a enp°lover witfi � ❑ 6. ❑remocdoling nstruction ertlpIoyees(fall and/or part-time).* have hired.the sub-contractors 2_❑ I am a sole proprietor orpartner- listed on the attached sheet_ 7. s and have no employees These sub-contractors have �'P Y S. ❑.DenwlitY�om working for me in any capacity. employees and'have workers' corn insurauce•.1 9. ❑Building addition [No workers' camp.insurance P retlttired.] 5• ❑ We are.a corporation and its i0•❑Electrical repairs or additions 3.❑ Lain a homeowner doing all wank affieers have exercised their 11.❑Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance:requincl.]F c_ 152, §1(4),and.rve have uo employees.[No workers' 11El Other comp.insurance required.] 'Any applicaw thst checks box#1.mast also fill out the section below showing ibeir workers'compensation policy informatian. I Howeowners who submit this affidavit indicating they mm doiag all wwt and then hire outside contractors mast submit.a new affidavit indicating sac1L 1Cactractars that cbeck this bear tgust smcbed=sddilinnal:sheet showing the name of the sub-contractors sad state whether or notthose entities.have employees. Ifthe sub-contcadors1ave emplayees,they.amst provide their workers'comp.policy cumber. I ant ail eniplo, z�r that is prom".edirtg nrorisrrs'ronrpertsntion 'rasa�r�cr�ce for r.�y'r����rpla,;aec�.x BetQn�is tt?te pzrlir.,y�r�n:rl,ja6:sif� informatiam ,A Insurance Company Mane: Pio-c gl Policy#or Self--ins.Lic.#: p Expiration Date:4) V Job Site Address: C. City/S,taWZip:CA Attach a co of.the workers'con ett .4'on oli -declaration Page(showing the policy number and i nation&te . S PY P P c} P g (• g P 3 �P ) Failure to secure coverage as required,under Section 25.A of lyfGL c. 152 can lead'to the imposition of criminal penalties of a fne up to$1,500.00 and/or one-year imiprisonment,as well as cizril 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 Inw-stigations of the DIA for insurance coverage verification. I do hone y certify under thapinns and pe-nalfies nfpn> ury fllat th information provided a.bmte is true and correct Signature: -.�' `- Date _/0 Phone#: L4�v -C7/-C4VO O, .... use:only. Do not.iirit-e in Otis area,io be completed by city or totem owe aC City or To-"rt: -Permit/License# Issuing.Authority(circle one): 1.Board of Health 2.Building Department 3.City/To-vim Clerk 4.Electrical - spector 5.PluEInspector 6. Other Contact Person: Phone# 6 " s - ME . . ..._1 y��, ^,��,yam ��•�'i> _ _-•..:,.-%' •- _ " 14Q ' - �,,(..vy �•I. _ :f:LjYi,2. ,�`'d C ;:i'ir 1�5.y,�f.(Q)'�q}.y�,�{.. i' ,�'{p.�."-fs 7 �c - ''•��7 -,, r,,, •! Z '� �q'yL' - sn��.• �. Ex Zi� ,s=�,:,`•;:,a,?g::.aa.nzzfmp^--yseT_Y-14.R..� ��"R, r � �¢ tip Sakti $ 5a:1 wZ$J5b 5@3�Y•�{ ,vre yy Z't iYL3. �' s3 c: vra3ba"S }3%��i � . F ➢ s�.�tFJ� ar + i.i r"i1 Ucein-se-: CS .A.M-E-S 4=113 48 FAiINaE ROB C LUSSR NNI . Rl 02864 I fc>7j tie CERTIFICATE OF LIABILITY INSURANCE OP ID SR DATE(MWDDNYYY) MOONA-1 10/05/10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ' ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Hunter Insurance, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 389 Old River Road, P.O. Box 1 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Manville RI 02838-0001 Phone: 401-769-9500 Fax:401-769-9502 INSURERS AFFORDING COVERAGE NAIC INSURED Moon Associates Inc. INSURER Hational Gzange_insurance Co 14788 DBA Gutter Helmet DBA Renewal by Andersen of RI INSURER B: Beacon Mutual DBA Gutter Helmet Roofing DBA Moon Works INSURERC: 1137 Park East Drive INSURERD: Woonsocket RI 02895 INSURER E: 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. LTR INSRC TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YYYY) DATE(MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 10 0 0 0 0 0 EU- A X COMMERCIAL GENERAL LIABILITY MPS26619 09/16/10 09/16/11 PREMISE-s'(a�urence) $500000 CLAIMS MADE X OCCUR MED EXP(My one person) s.10000 PERSONAL&ADV INJURY $ 10 0 0 000 GENERAL AGGREGATE $2 0 0 0 0 0 0 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $2000000 POLICY JECOTT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000000 A X ANY AUTO BIS26619 09/16/10 09/16/11 (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AITQ ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 1000000 A X-1 OCCUR ❑cLA1Ms MADE CUS 2 6 619 09116110 09116111 AGGREGATE $ $ RDEDUCTIBLE $ X RETENTION $10 0 0 0 $ WORKERS COMPENSATION X TORY LIMITS ER AI AND EMPLOYERS'LIABILITY B ANY OFFIER PRCOPRIE ORPARTNEE4w CUTIVE a 28586 10/01/10 10/01/11 E.L.EACH ACCIDENT $500000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $50 0 0 0 0 It yes.describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION MOONASS DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN 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' REPRESENTATIVES. AUTHORIZED REPRESENTATIVE�L,. ;1 !- ACORD 25(2009/01). ©1988-2009 ACORD CORPORATION. All rights reserved. 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MASSACHUSEM C MAY Solid Fuel Stove Permit QQ��ff DATE OF APPLICATION ....... ..Sl....l.'!.................................. I DEPT. I SUING PERMIT NAME (owner)A�-�.�!..o-l�l!L.ak&,...J. !.; (Installer) ...................................................................................................... ADDRESS J 1. .... ..��.- ............ ADD •ESS STOVE TYPE ...... .............................................. ........ CHIMNEY: NEW ........................ EXISTING ........................ / Manufacturer ................... ............................. ....... ........................................ CHIMNEY: Masonry ............................................................................................. Mass. Approval ................................ .. ........................................................................ CHIMNEY: Metal ....................................................................................._............ This is to certify that the above installer has permission t " insta a 'so uel burning appliance at the listed address in accordance with an application on file with the .,4 ....f................................ 1M. Department, and subject to the provisions of the Commonwealth of Massachusetts' State Building Code and regulations made .under the authority thereof. Issued By: .................. .... . ... .......................................................Title 4. ... ................................ Date......................... ..... .. Permit to install expires 60 days-after issue date Stove .......................................:.. .......................................................................................................................................................................................................................................................... StoveClearance ........... ...........................................................................................................:....................................................................................................................................... Floor .................................. .........................................................................................................................................................................................:............................................................. SmokePipe ................ ......................................................................................................................................................................................................................................................... SmokePipe Clearance ..........................................................................................................................:..................................................................................................................... Chimney ...................... 11 ....................................................................................................................................................................................................................................................... k� Smoke Detector ..........G � .......................................................... ................................. ..................... .................................................................................................................................. The undersigned hereby certifies th t the installation of solid fuel burning stove and equipment made under au- thority of permit dated ...... ............ has been made in accordance with provisions of the Commonwealth of Massachusetts State Building Code now currently in effect and pertaining thereto ............./ ................................ Installer INSTALLATION APPROVED .................�........�...1............... By:......... ..................... ........................................................ Title: ............. ate WHITE: FIRE DEPARTMENT - CANARY: BUILDING INSPECTOR - PINK: APPLICANT " o• ' TOWN OF BARNSTABLE Permit No- 25745 �. ---------------------------------- t Building Inspector »aam Cash ------------ -OCCUPANCY -PERMIT, Bond - _______`------ Issued to T'1dShaM CAMStmction . Address 1 Lot 13An 175 Abbey Gate, C otuit Wiring Inspector . �f.-'� Inspection date. Plumbing Inspector/ 0 f ' Inspection date Gas Inspector /u �� J Inspection date X Engineering Department w+ I °' -+ �. .Inspection date . qp: ev ''Board of Health , ) f �F Inspection date THIS PERMIT WILL NOT BE VALID, AND,,THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119-.0'OF THE-MASSACHUSETTS STATE BUILDING CODE. .......;�. ........._.._.................................................................`gam Buildin InsP ector FROM r' TOWN OF BARNSTABLE . BUILDING DEPARTMENT mr' Francis laahteine 67 MAIN STREET HYANNIS, MA 026M Tam Clerk +/� C ,' An.`s i�t$4Ft►awi`'S++!spa rqe� - Phone. 76-1120 SUBJECT: FOLD HERE DATE May 10, 1984 MESSAGE •.s 1'L�tl fys 6'4N4�1 Yf Work has been eopleted mder-F'er 4t t25745 ,ftShage,Cgq#ruction) . Please release Bond. i• i SIGNED# - \.,3 .DATE REPLY SIGNED N87•RMI •w RECIPIENT: RETAIN WHITE COPY,RETURN PINK COPY PRINTED IN U.S.A. SENDER:'SNAP OUT YELLOW COPY ONLY.SEND WHITE AND PINK COPIES WITH CARBON INTACT. 7Assessor's map and lot number .. ...... . FT Eage Permit number ...... a... . .......�... G / Z BASd9TAME, i ,House number ...................d. .......................................... r rasa OO t639. o APP �"+ TOWN OF BAR 1�N��,}4�' -.�$'/�//°qy\�, �dJ�Ji i� �O1S.i�b. �iW SQIBJECT T MOVABLE CONSE11" ' WITH TITLE COMMISSIONCO- BUILDING " . INSPEurr �T�L APPLICATION FOR PERMIT TO .............. rIV? ......75+11.......... ..... M.............. .......................... TYPEOF CONSTRUCTION ................w - X........ .................. ................................................................. ............... ?... ...................19.....4..J TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .......... .. ....1. ?... ............... i. r.......t ...................................................................... ProposedUse ........ . ...... .....:.........................................................................................I......................... Zoning District ........ .........................................Fire District ........... Name of Owner ... .lil. r/��-Q....... R.R.?�.�...Address .../ .....L.N.. :..:....:......... ..{..... /S Nameof Builder. ........... .................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ..............5�?...............................................Foundation ....... ....... s�...................... �Rt Exterior ............. ... .. ... .. ... .... ..............................Roofing .............. � . ........................................................ Floors ..........� . ... .............*:.........................................Interior ............c.?.! Z!4../..��tX_<`............................... Heating ..........t�� T...........................................................Plumbing ..........Z-..../�y4-(,K............................................... Fireplace .................Vice........ .... ..............Approximate Cost ............... 5. Q-C? ......................... Definitive Plan Approved by Planning Board ------------_____-----------19 . Area 1...v.. l :... .j.. a Diagram of Lot and Building with Dimensions Fee �.. ... .................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH N OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS i I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ........ !1 ...•..W.a..ls �'v ................ -.Jf6-*SHANE CONSTRUCTION No ,.2... .. Permit for 1 2...Story............... Sincfle Family 'Dwelling ........................................ .................................... Location ..Lot....1.3A 17 ....Abbey....Gate . ....... .... .... .. . Cotuit ..................................................... ......................... Owner ......McShane.. ....CoRst.ruc.t.i.o.n.............. .... .... .. .... ....... .. . .. .. Type of Construction .........Frame...................... .... .. .. ............................................................................... Plot ..... ...................... Lot ................................ . .. ..... Permit Granted .. November 7 ............................ 4. 19 83 Date of Inspection ....................................19 Date Co S34 mipleted ....... ................t............19 Assessor's m and lot number 7n �� o FTHET Sevyage Permit number � J....`. ..`.... ....1 j `House' number f �/.43 < STABLE. • v,............................................ Op t639. 0 MAI a' -,,TOWN OF BARNSTABLE BUILDIK INSPECTOR APPLICATION FOR PERMIT TO .............................r....::............................... ........�.......... .......................:.. TYPE OF CONSTRUCTION ................(��a S! �51........ .................................................................... ...................2........................19... S TO THE INSPECTOR OF BUILDINGS: The undersigned hereby // applies for a permit according to the following information: Location .......... ./� T.......� �... .............. ..e �........ .�t.A. 4-'E...................................................................... ProposedUse .......... .....74! �&(4 .....:............,................................................:................................................... " Zoning District ................ :��.....:..............................+ ....Fire. District /J. rS Name of Owner ....:' ! ...... "f;,:(,?.e�.���...Address ... �.. ,7.N....fd•� ��Qll�Cl�f!....� � r Nameof Builder" ......:.... c ..................................Address .................................................................................... Nameof Architect ..................................................................Address ..........................................................................:......... Number of Rooms ............. ...............................................Foundation .......�e..f ..................... �j J ................................. Exterior ............ ...........................Roofin ....� ..... Floors ............. Interior.......................................................Interior ............ i2n 2•, �; f .............:................ Heatingir� .`............. .f.... ..........................Plumbirig .................................................................................. Fireplace �� �� �+�[�af-A-4,C1 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 (, & '"UX :;1 e s� �I OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of.Barnstable regarding the above construction. Name ........... ............................ ........................................ , taane construction 21-27 No� .. 5,745' Permit for ...... Story........ . . 'Single Fami ..............I................ .............. 175 Abbey Gate Location „Lot 13A,...... �.................... O...t.....ui....t.............................................. Owner ..McShane Construction ............j................................................... Frae. Type of Construction .......................................... ............................................................................... Plot ............................ Lot ................................ ,,_ Permit Granted ....... November 7 ..............;..................19 83 Date of Inspection .....................................19 Date -Completed ........................................19 C af eyL "IV �r S� -2- • �1 00 w r Oleo 3,W9 .c1s� J!.�-sr• �9,�. i�� .e.���: o .o rs. ' q "D ) �•ur�•. /cam , T//.— .•s..�.ya,�.f.�.i ..ems Js -�i���- . .E3/9'.����5';7s�.�"'L�E -/�1i'P� rH.'cr1-Jr.�r�,.�/,,S ��G�r��� I��..S/5�.��.E C-,f�i�S'T. '�'C�'• • . ,�'.Gr?e.C.l.�/y`Ti''�/1/.'Vr �f • �w J. J�� �+. sr ,.+ � yy s y 1s ek" -