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0010 COTUIT BAY DRIVE
T56q -N. f 1 t 1 1 i s 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 v *'" Posted Until Final Inspection Has Been Made. Permit rvr" Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-19-3728 Applicant Name: PETER J SAVARY Approvals Date Issued: 11/05/2019 Current Use: Structure Permit Type: Building-Sheet Metal-Residential Expiration Date: 05/05/2020 Foundation: Location: 10 COTUIT COVE ROAD,COTUIT _Map/Lot: 005-014 Zoning District: RF • Sheathing: Owner on Record: BRUGGER,B ELIZABETH Contractor Name: ' PETER J SAVARY Framing: 1 Address: 154 HICKORY HILL CIRCLE Contractor License: 4557 2 OSTERVILLE, MA 02655 Est. Project Cost: $0.00 Chimney: Description: (2)System HVAC using 96%eff furnaces,A/C,�related ductwork �y Permit Fee: $85.00 Insulation: Project Review Req: DUCT WORK ONLY. Fee Paid:: $85.00 Date: 11/5/2019 Final: t Plumbing/Gas 3 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. j 1 -_�-------- - ` 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 Rough: 2.Sheathing Inspection i3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: i 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 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). Fire Department I Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT ��. ! ►' T', ,4 c L S Ys ` ' �� • ' Commonwealth of Massachusetts t Sheet Metal Permit I l�s�lg Map UOJ Parcel UI I Date: Permit# Estimated Job Cost: $ Permit Fee: $ Plans Submitted: YES NO Plans Reviewed: YES NO Business License# `S 7 Applicant License# s 7 Business Infomsation: Property Owner/Job Location Information: Name: Street: /y 3 Nec-It /f Street: /0 C o 7-v r` 7— Co c iZ City/Town: 1.y4 m r, 4 a--m-- City/Town: C- n To ivL df Telephone: s6� Z 9L 7 6 Telephone: 0 3 Z 5"S Z Photo I.D. required/Copy of Photo I.D. attached: YES NO J-1/restricted license J-2/M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft /2-stories or less Residential: 1-2 family-,Z`Multi-family Condo/Townhouses . er ` Commercial: Office Retail Industrial Educational as. Fire Dept.Approval Institutional_ Other �j Square Footage: under 10,000 sq.ft. ✓ over 10,000 sq. ft. Number of Sto es: 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: 5 yso� ��c �yit c,e-,F A I - [1have SURANCE COVERAGE: a current liabilifi[insurance policy or its equivalent which meets the requirements of M.G.L. Ch.112 Yes No ❑ you have checked , indicate the type overage 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 goes not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application}�jxes this requirement Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box[], I hereby certify that all of the details and information I 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 Uws. Duct inspection required prior to insulation installation:YES NO Pro�r'ess Inspections Date Comments jEmal Inspection Date Co_= is F ❑Type of '�ense; By Master Tile Master-Restricted Cityrrown E]Joumeyperson Signature of Licensee Permit ❑Joumeyperson-Restricted s License Number. —7 y Fee$ ❑ Check at www.mass.gov_Tl Email: 'Inspector Signature of Permit Approval �9�3I7FtOIWea19,�md�SeS Departmentc��eFi�sfrir�tAccz s GB 00, �FfTJ1� 600 Wa&bigton&reet Boston,MA 02111 mvmmmmgvWdia Workers' jCm1p n �h�,bers ensa�ran Ias�s��ffi�avi�$��rslt�irhract�rsfElet-�*� - a„s/R In E'arma �Ts Please Print E Y • �� _ - �, l i r c lam.. S S' AMr ws: / 3 Nz(,4,e n citgIS u, c Z S- Phone-, 08 Z q l `/-7 Are ru an c=ploger?Checkthe appropriate ba= ' Tyre of3'rdea{x eared}: L��=a�1 •-7 � El am a general=fract=and I •6 esa c=x Ter lJ 1 6 yees{�a�fa:pastime}-* havehiredthe suer-comtc-a�rsemiA ' Z. I dehng [� am a sole groprie#as orgartaer- Fsfed outixe ached sluff �- ❑g�1O shFp and have no empkyee-s These sees mad have=6wn' g '�DemnlifrozF woddng �e is auy avac ty. ° 9. []Building a Vrz e CO�p-ir,�M�# or adcinns d1 gyp: 5- 0 Weareatasparaaudifs 1��IIec�icalsepairs do- allzeor3c afficershave cw=edfMw ILE]Flumbmgmp�Qrgdaih� 3-❑ I ama h ligbL cF f==Pf%on per MG .. L ElRoofrepaim. mysdf[No w66=e COmP c.IS?.,g I(4�andzae have no nc iM=: e re4aired_j employees[No l3❑flamer carp.insure r£qaiMAl •gay8pp tcbedsb=R alsoSIlor�thedertinabdaws rwadse�®�a5aapeycyi � # ,�s�aas�s ��������a,����5�ta��a�•-art � I Sctr�m�i rho -ci1isb=must xc msd�sl sbe-q doudngIN ,�a of tt�e sab-ca�chazs sa3 sh6evdselLc;�nattbnse e�tesbage Ift�esoh cm•���xse�� `tp��drt�s .�.���,eL I am�srrrpioysr f7i�pravirlirg�v�risers'cazrn i�rmrartca�vr m}suzpIoyees $eiraov isf�ispaficy�join sda . fu,�orra�n, . bike OompaayName: �tjAjq Me it c h� •P��¢��i�.s�� � ss 1D C o lob TAe Addre f v r Cove . 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J[■ Y.. ■low■.1 •1 i t.t...tiuu• Im �■ �� s• aa_■ ' ! - • ' all :aa ' !• t ; ►i ' ti► ' 3 ' �VE Town of Barnstable Building DepartmentServices r np .� � 4 $ri= anFlorence, CBO xnsa E 63 ►`0� Building Commissioner 200 Main street,Hyannis,MA 02601 www.town.barnsfiable.ma.us , Office: 508-862-403 8 Fax: 508-790-623 0 Property Owner Must Complete.and Sign This Section - If Using A Builder (�-v c�z � / _,as Owner of the subject property hereby authorize �G �� K J v Pf to act on my behalf; in all matters relative to work authorized by this binding permit application for: (Address of Job) **Pool fences and.alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are pet=fopned and accepted Signature of Owner signature of Applicant l vecti` i/ 141:e' 7�� Print Name Print Name Date QQFORNB:OWNERPERMISSIONPOOLS ReP 09/16/17 i Town of Barnstable Building ]Department-Services Brian Florence, CBO o Budding Commissioner 200 Main Street, Hyannis,MA 02601 KAM www.town.barnstable.maus s639. 1 Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXXMMON Please Print DATE: JOB IACATION: ' nnmbcs strtet. village ' "HOMEOWNER": name home phone# work phone# CORREIgr MAILING ADDRESS: . c4ttawn• stye zip code The current exemption for"homeowners"was extended to include owner-occupied dwelEm"of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,vrovided that the owner acts as supervisor. DEMMON OF HOMEOWNER Persons)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or fan structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Bulding_Official on a form. acceptable to the B uu�dmg t1i$Vi21 he/she sh311 be responsible for all such viork pe 6a pea imdgr&- lac ng_pernf. (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 ofBamstable Building Department minim>mm inspection procedures mmdTequirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Appcwyal of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger wM be required to comply with the State Building Code Section 127.0 Construction Control - HOMEOWNER'S ECEMTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this sectian'(Section 109.L1-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." ]luny homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appends Q,Runes&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 personas it wound 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 this issue is a form currently used by several towns. You may care to amend and adopt such a formlcertification for use in your community. Q_\WPFII.ES\FORMS\building pemut frowU XPRESS.doe 081i6/17 i �•'� "OMMW 'EALTH`OF MILS ACH[ SET S SHEETaiALRTAL WORKERS X.:, ISSUES THE FOLL E1�}SE 1111/�iSTER UNRESTRICTEDS`� PETER J SAVARY 143.GREAT KIP::RD MA2571 2426 r z 45 2812020 t i y ' S r ACCMV CERTIFICATE OF LIABILITY INSURANCE DATE 08/14201D NYY 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 poiicy(ies)must have ADDITIONAL INSURED provisions or 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 NAME Margaret Viera Morse Insurance Agency,Inc. PHONE zt, (508)748-9577 FAX fAIC No): (508)748-9579 INC,No,F354 Front Street ADDRESS:S: maggieviera@morseins.com Suite 4 INSURE S)AFFORDING COVERAGE NAIC 0 Marion MA 02738 INSURER A: Main StreetAmedca,Assurance 29939 INSURED INSURER B: NGM insurance Company 14788 QUALITY MECHANICAL SYSTEMS LLC INSURERC: 143 GREAT NECK RD INSURER D: INSURER E: WAREHAM MA 02571-2426 INSURER F: COVERAGES CERTIFICATE NUMBER: 2018-2019 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. LTR SR TYPE OF INSURANCE INS AUULbUdK POLICY NUMBER MMIDD MMIDO LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE �OCCUR PREMISES Ea occurrence s 500,000 MED EXP(Any one on) s 10,000 A MPM25432 11/07/2018 11/07/2019 PERSONAL&ADV INJURY a 1,000,000 GEN'LAGGREGATE LIMITAPPUES PER: GENERALAGGREGATE 5 2,000,000 X POLICY JEc LOC I PRODUCTS-COMPIOPAGG s 2,000,000 S OTHER: AUTOMOBILE LIABILITY rEa accident) NED SIN S _ „•_ ANY AUTO BODILY INJURY(Per person) s 250,000 - B OWNED X SCHEDULED M9M25432 11/07/2018 11/07/2019 BODILY INJURY(Per ooddent) s 500,000 AUTOS ONLY AUTOS HIRED X NON.-OWNEDER s AUTOS ONLY AUTOS ONLY (Per delitl s UMBRELLALIAB OCCUR EACH OCCURRENCE s EXCESS UAS CLAIMS-MADE AGGREGATE s DED I I RETENTION S PER WORKERS COMPENSATION FFl- AND EMPLOYERS'LIABILITY YIN STATUTE ER E.L EACH ACCIDENT s 500,000 A ANY PROPRIETORMARTNER/EXECUTNE � NIA WIM25 OFFICER/MEMBER EXCLUD 432 11l0712018 11/07/2019 ED(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE s 500,000 It yes,describe under 500,000 DESCRIPTION OF OPERATIONS below EL,DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Peter Savary is included for coverage on the workers compensation policy CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE +• t z745 � Uc�..r 01988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Application number �L....1... 46-�— Fee .............................P......................................... . • �� R�' Building Inspectors Initials............ ................... t6s9. ��� J MAY02 2019 Date Issued.*................,5 ?J,............................ T IJ 14/� 0k L'AH1V81 t Map/Parcel....©� .............I...v v.. ................ TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SID1NG/WINDO W S/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: CA! Tfz ale NUMBER VII.,L E Owner's Name: Phone Number ��8 Email Address: � ll Phone N er Project cost$ Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK �&S�iding �indows (no header change)# 0 Insulation/Weatherization M-""Doors (no header change)# Commercial Doors require an inspector's review 03-Roof(not applying more than 1 layer of shin es) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable)#HV-i t331SG(attach copy) Construction Supervisor's License# (attach copy) Email of Contractor M sY-e-05-� ' In". co, number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER.................................................. ........ *For Tents Only* Date Tent(s) will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent ' X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s)of each tent Fuel source being used LP tank 20 lbs. or> Yes No___, if yes, a gas permit is required. Natural Gas Yes No , if yes, a gas permit is required. If food is being served at.your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire"Department approval, *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: `/� 9&�6 Telephone Numb Cell or Work nu er I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection rocedures, spectfic inspections and documentation required by 780 CMR and own of a table Signature Date APPLICANT'S SIGNATURE Signature Date 3111k4 11 permit applications a resubjecVa building official's approval prior to issuance. r � The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass-gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Print LedW Avgficant Information Ni me(Business/OrganizationMdivid `Address: ' City/State/Zip: Phone#: U Are you an employer?Check the appropriate Type of project(requited): l.❑ I am a employer with 4. l :m a general contractor and I 6 =odeling construction employees(full and/orpart-time).' -��iave hired the sub-contractors listed on the attached sheet. 7. 2.❑ I am a sole proprietor or partner- These sub-contractors have g. El Demolition ship and have no employees employees and have workers' w for me in any capacity. 9. ❑Building addition workinginsurance= [No workers'comp.insurance comp. and its 10.❑Electrical repairs or additions l 5. ❑ We are a corporation officers have exercised their 11.[]Phimbing repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 12.[]Roof repairs myself.[No workers'comp. c. 152,§1(4),and we have no insurance required.]t 13.Fl Other employees.[No workers' comp.insurance required-] 'A"applicant that checks box#1 most also 511 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 tCanows m that check this box must attncbcd an additional sheet showing the name of tie sub conuedors and state whether or not those entities have employees. if the subcontractors have employees,they must provide their workers'eonW.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Instn nce Company Name: policy#or Self-ins.Lic.#: Expiration Date:: M Job Site City/StatelZip:! ��1.� ��. Attoch a copy of the workers'compensation licy declaration page(showing the policy number and expiration date). Farltae totaae se coverage as required under Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a fie op to S1,500.00 and/or one-year imprisorr new,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of lnves44dioas of the DIA for insurance coverage th verification I i ierr8j the pen j that e information providede' cored Of/idd ttl:+e only. Do not write in this area,to be completed by city or town o leW Clty tar Tewn: Permidlieense# booing Aai>tority(circle one): L fiend of Health 2.Building Department 3.City/fown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Orer Chad Pt�n: Phone#: The Commonwealth of Massachusetts j Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: City/State/Zip: Phone#: U Q' ArVIam an employer?Check the appropriate bog: Type of project(required): 1. a employer with 1 4. ❑ I am a general contractor and I employees(fiill and/or part-time).* have hired the sub-contractors 6. ❑N construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp.inanrance,I required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or.additions 3.❑ I am a homeowner doing all work officers have exercised their I L❑Plumbing repairs or additions m sel£ ' right of exemption per MGL Y �o workers comp. 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. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that isproviding workers'compensation insurance for my employees. Below is the policy and job site information. ((�� Insurance Company Name: D1 Policy#or Self-ins.Lic.#: b Co 0 22 0201'expiration Date:—) Z 0 Z ) -;zd Ici Job Site Address: O CO�U �J 2V � City/State/Zip: C1EV I rq A t Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi under thepains andpenalties Ofperjury that th information provided above is true and correct Date: IJ l b Phone Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector. 6.Other Contact Person: Phone#: 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 applicant who has not produced'acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to-your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required,to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The,Deparlment 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 necessary)and under"Job Site Address"the applicant should write"all locations in (city or ' town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusdts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel,4 617-727-4900 ext 406 or 1-877-MASSAFE Fax##617-727-7749 Revised 4-24-07 w w.m=,gov/dia i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Tf—nu"j '?A-, I Jt� ItJ Address: S f CO ci 6 i�r Ci /State/Zi : Y �'IP,fl 6 ZI -�( ty p TI 2-T-1'`')A Phone#: ,�-69- 3 Z- 61 6;2z Are you an employer?Check the appropriate bo Type of project(required): 1.❑ I am a employer with 4. am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑Ne o"nstruction 2.ElI-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' con insurance.: 9. ❑Building addition [No workers comp.insurance P required.) 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I L❑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.] *My 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. trontractors 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 thepolicy and job site information Insurance Company Name: ,1 t jT yt2Ai 121 i?_tg- Policy#or Self-ins.Lic.#: �y ©Pia- Expiration Date: _L I I U / .7 / J I � IK_ Job Site Address: Cl City/State/Zip: r{�-� t Attach a copy of the workers' compensatil 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 un pains and - erjury that the information provided above is true and correct. Signa Date: Phone#: Offccial use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector. 6.Other Contact Person: Phone#: Y 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 grotuids or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced'acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone numbers)along with their certificate(s)of insurance. Limited Liability Companies(LLQ or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to cant'workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The•Department,has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please;be sure to fill in the 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 necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Depm tmeat of Industrial Aecidents Office of Investigations 600 Washington Street Bosfian,MA 02111 Tel,#617-7274900 ext 406 or 1-977-MASSAFE Fax#617-727-7749 Revised 4-24-07 w w.rnass gov#dia CORD Client#: DATE TM CERTIFICATE OF LIABILITY INSURANCE 05/02/2019 :ERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHT UPON THE CERTIFICATE HOLDER.THIS FICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES IELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED MPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. MPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the erms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the :ertificate holder in lieu of such endorsemen s. 2RODUCER CONTACT Guilhemle Camossato PHONE (978)726 9830 DISCOVERY INSURANCE AGENCY LLC EMAIL guicdiscovery@gmail.Com %8 MAIN ST UNIT AADDRESS: -IYANNIS,MA 02601 Phone:(508)771-4600 -aG haeldiscovery@¢Tnail.com INSURER(S)AFFORDING COVERAGE NAIC INSURED INSURER A:Atlantic Casualty insurance Company INSURER B: ELITE BROTHERS CONSTRUCTION INC INSURER C: 720 PITCHERS WAY 52F INSURER D:AIM MUTUAL INS COMPANY HYANNIS,MA 02601 INSURER E: INSURER F: OVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO JVHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO TALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSRL ADDLI SUBR fR TYPE OF INSURANCE NSR YYVO POLICY NUMBER mmlo LIMITS A GENERAL UAEJuTY EACH OCCURRENCE S 1,000,000.00 DAMAGE TO RENTED COWIMERCLAL GENERAL LIABILITY PREMISES IEn onuraKe) S 1, ff.00 .y F f� NED EXP I"one Pawn) t0 LLA9d5�AADE I X OCCUR S .00 L261002752 12/8/2018 12/8/2019 PERSO &ADvtUURY 5 1,000" .Do g Z GENERAL.AGGREGATE S 2 .00 "j 0 t � GENL AGGREGATE LDdR APPLIES PETL PRODUCTS•CONP/DP AGG 5 2. .00 X POLICY PROJECT LOC B COM GLE ULgT AUTOMOBILE LIABILITYLIABILITYIEe amtleN.cid-tl AM'AUTO BODILY INJURY(Per Palm) ALLOY/NEO AUTOS AUTOS SCHED LED BODLLY W JURY(Pa r,ruEenQ 11O__ NONAWNED PROPERTY DAMAGE V, HI AUT09 AUT09 IP—ddmd C UMBRELLA LIAR I I OCCUR EACH OCCURRENCE EXCESS LIAR CLAIMSNAGE AGGREGATE DED RETENTIONS D "'mm"NScORPENSAT10N BTAMORY OTN AMD EMPLOYERS'LWBRITY YIN LILBTS ER ANY FROPRIETORJPARTNER/Ef CUTrVE OFFICERMIEYISER EXCLUDED? ENIA ElEACHACCIDENT N/A VWCf0060227642016A 12/2/2018 1?l2/2019 5 l000,00D.oO ,Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000'OD0.00 Oye,,desert,Mader DESCRIPTION OF OPERATIONS Inbs E.L.DISEASE•POUCYLIHJT $ 1,000,DDO.OD DESCRIPTIO OF OPERATIONS/LOCATIONS I VEHICLES Wtach ACORD 101,Additlonad Remarks Schedule,it more space is required) Workers'Compensaffon benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 8,no authorization is gwen to pay claims for benefits to employees in states other than Massachusetts if the Insured hires,or has hired those employees Outside of Massachusetts. This certificate ofinsurence shows the policy In force on the dale that this certificate was issued(unless the expiration date on the above policy precedes the issue data of this certificate of insurance).The status of this coverage can be monitored daffy by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.govAwd/workers-compensaUoriFnvestigations!General Liabdi7y:for regular and usual/obs. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE IT IS THE CUSTOMER'S RESPONSABILITY TO INFORME ANY TOWN OF COTU IT CHANGES OR CANCELATIONS. 10 COTUIT BAY DRIVE, MA FAX: (508)790-6230 GUILHERME CAMOSSATO 1 1 ®1989-2010 ACORD CORPORATION.All rights reserved. Assessor's map and lot number ....... `' OFfNETO Sewage Permit number Z 33AUSTAZLE i House number .............................................................: � 'oo MM6,e39. , �QYP�a�� TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ................��? 1..`? .rz l�s i'........... ! V.�T 10 a1............................. .�,j... TYPEOF CONSTRUCTION ..........................:.►....�. ................................................................................................ 1 ............. �.Z V.................19.1 :: TO THE INSPECTOR OF BUILDINGS: The undersigned-hereby applies for a permit according to the following information: �' Location ..........) ��.,.c77.a ! T 1=�>.t+J �. C �c>7 7 W� ProposedUse ................L...6.. �. ..1....... !- ..................................................................... ZoningDistrict ........................................................................Fire District .............................................................................. Name of Owner .<��rLG Cho rz.a...... !..C.iQ..Y. .........Address ....�U..... �.t T...�A"HI.....t::l,.3...... Name of Builder" ►�o� .. �t?.vV�l+�f.;!�..I....��t7.bG..Address .. 5..... ��r�►,l vv .... .L?.:. j-(�I s��1��,..��A i..... ..... Name of Architect u/A ............................................... a Number of Rooms ..................................................................Foundation ..... �...... �Or•)C �G Exterior a Q.!... � �� �- �.......: N �`>..Roofing .........1.t......................... L:..!............................ Floors ......... A?. T..... . ..Interior .......... �. %- .�TLC' ',.:.................................... i I Heating ............................ ..................................................Plumbing ..................................................................................... Fireplace .........................V1A..................................................Approximate Cost .............../.....�............................................ Definitive Plan Approved by Planning Board -__--____-_---,___ - �p... ...... 9 -----. Area ........... nop j Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH { i i OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS 0 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name gb"� ��'.. .. for`:,�.. kA X;'11 fil"'I� s . G/�.:;;)L•�-�dl�`�S�G� '. LaCAVA, GRE\GOORY A=55-23 24690 V ADDITION No ................. Permit for .................................... Single Family Dwelling i 10 Cotuit Bay Drive Location ................................................................ Cotuit ............................................................................... Gregory LaCava Owner .................................................................. Type of Construction" Frame ............................................................................... Plot ............................ Lot ................................ t December 30, 82 Permit Granted ........................................19 Date of Inspection ...............:....................19 Date Completed 0 Assessor's map and lot numbe ....J ........................ BEPTIC SYST c .,. INSTALLED 7� IN COMPLIANCt 3 7 WITH ARTICLE;,II STATE r 7' Sewage Permit number ...................-...................................... ld1ll )�RIY CODE AND TOWN THE.T°�° TOWN OF BARNSTA"JU BARNSTABLE, i " 9° 039. MAS ' �UL'LOING INSPECTOR 'Fa MAR A, • , r • APPLICATION FOR PERMIT TO .. � Cc✓a-C TYPEOF CONSTRUCTION '...................................,........:..... .......... .... .. ....................................... .... ....J.........19 . ' TO THE INSPECTOR OF BUILDINGS: The undersigned bereby applies for a permit according to the followi g information: Location ........ .. (/v Ile) �� - ` ............................................................ cyL.�iL....�......... /...... ProposedUse ....... �..... ............................................................................................................................................. ....... �� Zoning District ..................................................... .............Fire District ........��..�......... ........................... (� ....... Name of Owner .. ............ ..... ... �'.........Address ...... ........ ��a ' . ......................... Name of Builder ...... . .....:. .................Address .(.. ....1.... /C.. .......... Name of Architect .:.......... ....................Address ................................ Numberof Rooms ........... ..................................................Foundation .......C..�V`c-C12 .......................................... ` Exterior ......... ./ ......�... �` �" ..'.....Roofing ......... :"':........•............................................ Floors .......... .........................................................Interior ........ ...... ................. ... . Heating Gl.. . .. ��.... G. ..Plumbing .................................. ............ �.-:.......... Fireplace ........ .....................................................................Approximate'Cost .. .� ................. .................. o q6a � -Definitive Plan Approved. by Planning Board -------------------_-----------19________. Area .72,k ....)...5ro )r........... Diagram of Lot and Building with Dimensions Fee ....'...1.................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and ,,Regulations of the Town of Barnstable regarding the bove construction. Name . .. .. .............. ........ .... ... ....................... ..... 55 ~ 23 Cmtoit BayLhorem Sewage 327 ` . 18544 '� �p�m1� No .--.. -- Permit for -----. ^ ' ---'`'' ' ' — ' � Lw*�W Cotuit Ba� Location ...—__—_______^..^_������_. _ - —'' .ao*�uit............................. . Owner —..C �)�. �..����m��-------. ' ��o B� ~- ' f Frame ^ Type of Construction .......................................... ^ '. � ---.—~---..---------.------.. Plot ........ Lot ----------.. , ^ Pe'rmh Granted Jo�� �� -^ lg �8 ' '� � " — ^ —. . e, . Date of Inspection —,lV Dote '— Como|a�a6 . .. lA � ' . —`—,—'_.`---� �. . ' . IN PERMIT REFUSED / . _ -----_—^---~—~----.--.. . . .-..�,.-----...--------.--'�--.--. -.----....----------.��----...—.` —....�----.----- ...—_—_—___~,__,_ ' ` °,---.`..`---.--..—.------....--.~— . � . . . . . | Approved lA | ^' r, . r°--------------- . . ,_ . . ' . �� --.—'�.. ---------.---------- | ____.`_____.________,_..__.__,. - | �� Assessor's map and lot number ........................................... Sewage Permit number ' `�° .`�. ............................... 'THE T°�♦ TOWN OF BARNSTABLE 1; 33MUST"LE, i 9. BUILDING INSPECTOR O•�`0 M 0r APPLICATION FOR PERMIT TO ... ......... TYPE OF CONSTRUCTION ... ...................... ......... ......... ......... ........ ....: ............19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information:. Location .... ......... ................................ ......... ........ .................................. .............. ProposedUse ....... .!:. ......................................................................................................................... ....1........................... ZoningDistrict ........................................................................Fire District .............................................................................. Name of Owner .. ......: ' ........Address ......... ... . ....... Name of Builder ......................... .:..................Address ........ ...... . , ..... ........................................................... Nameof Architect ........................................... ....................Address .................. ......... ......... ......... ............................ Numberof Rooms ........... ....................................................Foundation .............................................................................. o o Exierior .................... ......... ......... ......... ......... Roofing ................... ......... ........:. ....................................... Floors Interior ........ ........ ............. ............................................... ......... ........ ... ...... .. ..... Heating .........................::.......................................................Plumbing .................................................................................. Fireplace .. Approximate .. ........................................................................A roximate Cost . ...... ................ Definitive Plan Approved by Planning Board --------------------------------19________. Area . :.:: :;:.. .' Diagram of Lot and Building with Dimensions Fee .................. ....................... . SUBJECT TO APPROVAL OF BOARD OF HEALTH I I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the/above construction. ; Name .... ......... ' ..... ..................................................... 55-23 Cotuit Bay Shores Sewage 327 No 18544...... Permit for Co,�,Uit Bay Shores .... .............. ............. ............................................................................... Location Lot 110 Cot)U Bay Shor........................................ .............e.$...... ...............Old...Post.M.:./Co..t.uit.......................... ...... Owner ...........Co.tuit.'4y..Slhorels.................. Type of Construction .....Frame........................... ............................... ................................................ Plot ...55-...23 .... L. ................................ Permit Granted ...�q!Y..21.....................1976 Date of Inspection ..........................:.........19 Date Completed ........ ............................19 PER/MIT REFUSED .............................../................................ 19 ........................... .......... ................................ . .... .. . .. . .... ........... . ...................................P........... ............................ '!z....�. .......................................... Approved, .............................................. 19 ......................................... 10 ............................ �FTNE Tp� Town of Barnstable *Permit# Expires 6 months from issue date ' LARNSfAHt.E..• Regulatory Services . Fee 0,;?'s- Thomas F. Geiler,Director �A s6J9• A�0 Building Division Tom Perry, Building Commissioner X-PRESS PERMIT 200 Main Street, Hyamus,MA 02601 Office: 508-862-4038 J U L 3 0.2002 ! Fax: 508-790-6230 T� EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY OF BARNSTABLE iNot Valid without Red X-Press Imprint ✓lap/parcel Number -j� 'roperty Address CO+U4R I • R<esidential Value of Work of 300 . db owner's Name&Address CLrw La, Q V / ( JCLMe) p :ontractor's Name!0 i.? I y1/1e rc)1/Q M ILA4 Telephone Number Some Improvement Contractor License#(if applicable) construction Supervisor's License#(if applicable) GL� 05 7 03.� orkman's Compensation Insurance Check one: ❑ I am a sole proprietor i ❑ I the Homeowner have Worker's Compensation Insurance [nsurance Company Name /1 ).t.ky I Cta d— Workman's Comp.Policy# C LU(' a�62a CC? Permit Request(check box) ❑ Re-roof(stripping old shingles) ❑ Re-roof(not stripping. Going over existing layers of roof) �Re-side ❑ Replacement Windows. U-Value / (maximum.44) 2-10ther(specify) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. Signature mtL -) I-•rms:expmtrg scd121901 t . } TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Maf Parcel ; Permit# 7 gadg Health Division Date Issued td 0 0V Conservation Division 1 Fee Tax Collector a41 —& (�?i� Cv wi(►�v Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board - Historic-OKH Preservation/Hyannis Project Street Address Village C�� _� V(Y) ft ' Owner rn A-Q G 0 Lz� h`ec 0"i A Address ` Telephone r Permit Request PCB _ 3 a t` i Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Estimated Project Cost g000 ' Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes , ❑No If yes,attach supporting documentation. Dwelling Type: Single Family Ad Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new JNumber of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air. ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove:, ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name FRASER CONSTRUCTION Telephone Number Address 71 Ta�RAGON Cliff• License# COMIF MA 35 Home Improvement Contractor# V Worker's Compensation# /U6u ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO � 6 SIGNATURE DATE /y / � (i FOR OFFICIAL USE ONLY PERMIT NO. IT' x DATE ISSUED e MAP/PARCEL NO. � ADDRESS VILLAGE t OWNER DATE OF INSPECTION:': FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING 3 d 1 DATE CLOSED-OUT 3 JI ASSOCIATION PLAN NO. The Town of Barnstable AM 6"3 ��' Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Permit no. Date 1) h, AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires thaf-thi"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing.adeak one but not more than four dwelling units or to structures which are adjacent to such residence or building-be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: 2 Ron4Estimated Cost Address of Work: �U rp,61 f ✓7 '1 �� a Owner's Name: r���el I --. Date of Application: r o I hereby certify that: Registration is not required for the following reason(s): 0Work excluded by law 0Job 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 permit as_the ag owner: 11� Date Contract o Name Registration No. OR Date Owner's Name I q:fb ms:Affidav aM1• ^s, 1•.. •.... .r,.. w Miv... r - w..re. � axe., r. •�... �a.! a:. - ., ,,►�Iyi,, . �.» .. yx a n..�,rrl�^sv _aft_ t- .. - • ...I.urs!-�. v�oit wa,v'a.r�'!s• r.+��e• ..-,►,.. r.a✓• .e.m l.�w'W"'h +w.i ;,l. �""'�'"Y`'1r.'C.: '." '�'... Yh+'►.',S""'""'�i'=°2'7*p;{.,,,.. �.' T.•�,�.'�.`�F•e S. y...�w... ,yw.l...,.i.�.�w s�.i,» !'""°fiN.Fw�.' -� '.it... i..i,./y//]//� � 1! W. . �•wJy9{y�%y.�y r�sM-. ! y Iy�Yv^. .4w�anF, +y,. kV R`+r,•V V ..� 4 t�iF+ .; .M.Fefl1" ' -4.-1 vl. V-lilk�W.+U.� N'f Yl .i�'. ^.... 1.,. - •1 .!V I JYAr ,17r,.. oc�M.,. ,✓ HOME IMPROVE1ENT CONTRACTORS REGISIRA'rION w 'Board c-)fig, BtJ I ii.na Roal.,lr�.t..ions and Standards , One Ashb trton Pla.cP — Room 1,301 i. N R Rc� i.c�r1 Ma.S sachl.!setts 02108 HOME IMPROVEMENT CONI-RACTOR Registration 7.a 5?% I EXp.11 a1.a.On 04/0E,/01 - - .. . . . . . . . . .- TypF=; - pBA I "� HOME IMPROVEMENT CONTRACTOR Registration 112536 FRASER CONSTRUCT ION Type - OBA DEAN C FRASER I 71 TARRAGON CIR Expiration 04/06/01 }i ( OTOIT MA o;> :, I j FRASER CONSTRUCTION co ! OEAN C. FRASER � 1t�1 TARRAGON CIR ,ADMINISTRATOR COTUIT MA 02635 t r i .� Vv......v....v_--._ j ..--------__---- . 4 == Department of Industrial Accidents -• -- _ OlDceolladestlAa�lons 600 Washington Sheet - - Boston,Mass. 02111 Workers' Compensation Insurance Affidavit rJ C 2 y) S-e- nalnC location I �� Y-�6 O Q > 1z city 4-v► Yn ►) mhonr# (s�81 y�8- 9'� ❑ I am a homeowner peforming all work myself Iam a sole Drouriet"and have no one working is I am as 1 ............ working .. .:.. .......L.r}:%v::"«:•:::•. ii\f•:.v .::.......... .•.............::•.:.:...................r........:•.:.......................... .............. ....::•.v:::::::nt•::.,....r::::,:...;�., y.••r:•...:• ..............a.....( °• . y Nrx.•n... �333#333 ................:::::::::::::'.............:.v.. r r:..:::v.v::: .............: :v:}:••:{v}:.. ..};:;::.;y" r/•'. /:tt r.v;4YJ� YJ} '?:� r{%Yri'3#y:#: f. .::1. :t .... ... ,Y.. :A':?•Y}; ::, , �r .ntF..b .v:�,. oaf r y •Y;•$ 3+i. �} . .:::.::..........:.�:••.........:•::.�::•::...... , ::.. •::.:�:•:..:::.}:: :r.�:: ''?•: HIM• . ..t.. r•3}Y 3• •Y.! `!:t:2�r}x• �;z.%x}n.., a F m e a IIv n m II e , F ♦ r W ro i Y♦ :Yi♦ i.. 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Yii4l�h:..a�v .:::....... ,.{ ...Mt r: Faflure to seenre covuW as ngahed under Section 25A of MGL 152 can Ind to the Wpoddm of paumes of a fine ap to 31,5MM and/or one yam,,imprhomnemt as weR as civil penalties in the form of a STOP WORK ORDER and a One of 3100.40 a day against me. I mWentw d that a copy of thh statmtent msy be forwarded to the OIDee of Investigations of tha DIA for oaveraV va'ftmd . 1 do hereby exrii the p ' penakm olpalr!'tbat the Wornmimn provided above is hw and comet Date Si�ature Print name of8dal use only do not write to thh area to be completed by dry or town ofil" city or town: - P q 011censin Dowd ❑chedclf immediate response is required Osdeehnan's Omce _ Mealth Depart contact person: 1hor"' ofhev' x . f /20.00 ' �?T r r 1 y_ (•, 1,CO •- .. 1 n p1G :.,.,. .b..v i.i 4 i ,f \J ;1. �-.;�J , a. 6 • JZJ - N 1 . Iz,4�,a l' ; Seale 1"- 40' - �EttTlF160 PLOTy?LAN 14 ,` ( Being lot shown on a subdivision ,pplar} -entitled _ Y'Cotuit Bay Shores" located ini I, hereby certify_ that > Cotuit Masi.-s Da_t-ed Jm.-.3 ,197:5 the existing'ToundAion and recorddcr-.in B-qLrnstable locator-,is correct as � �. � 4 Registry of :deeds; in book sh6 --aiid°•does conform ; 292 page 2�p.�' wi the building setback or re ` fre\rilehts of they Town ` July 6th, 1976 °y of Barnstable. Thomes A. f JACYMN Builder:, 1 g Wo.8937 y Charles F.` Stanley t9 cis Tea�° �- - _ - _Qenterville, Mass. o _ S"i-gned ` --- As'Sessor's map and lot numb ......�J d....... ............ .............. . TM E Tp�` Sewage Permit number . . .J.. ...... Z 13 STAMBLE i House number 7� M6 IL \0� ............................................................ ... ....... 39 - 0 MAY d' TOWN OF " BARNSTABLE BUILDING JASPECTOR APPLICATION FOR PERMIT TO :....��,F.��:1. .j..��.ti? ...........A k�.I {dAd............................ r , i TYPE OF CONSTRUCTION ................ ...... ............................................................. ............. .../ ........................19.g7i TO THE INSPECTOR OF BUILDINGS: The undersign ereby ppl�s for a permit according to the following information:: Location ... ......1... ..... ..�.� !�.I .......O A 1.....14.1�-............(!. - -_u-!: .......�!!.11�................................................. ProposedUse ............../ .�..�l.c .. ...... V !k,..... 6 .l ... . .................................................................. ZoningDistrict ...................................:....................................Fire District .............................................................................. Name of Owner ...Address ....�v..... .t.T.... ?P..!�.... .... ?l'��J.� Name of. Builder- Nameof Architect ............. jt`.�............................................Address .................................................................................... Number of Rooms ........ ...................................................Foundation .. 4.!?� .... !��G' -T:......... Exterior ............ .X. .!.J)�.r.Clr-, A!Z...`�N:.!yrc?tr ..Roofing ........... v�........ 7NIW1............................ Floors U� �z7ZUa.! . �. ....�,�.�.(.... z`.(J.....C.Interior ........... Tl- 0. ................................... Heating ............................ ........................................ ..Plumbing .................................................................................. an Fireplace ................ ............:..............Approximate Cost ............... .... .y ...... ...................... 7, . .. ................................... Definitive Plan Approved by Planning Board -----------__------------- 19 Area CO........... . ....... ............ • o� Diagram of Lot and Building with Dimensions Fee .e SUBJECT TO APPROVAL OF BOARD OF HEALTH DV�rLt%bra . f �ZS- �� Gave OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable rega ing the above construction. ' Name .. . .. ......,... LACAVA, GREGORY 24690 ADDITION Igo ................. Permit for .................................... Single Family Dwelling ............................................................................... Location 10 Cotuit Bay Drive ................................................................ cotuit ............................................................................... Gregory LaCava Owner .................................................................. Frame Type of Construction ........................................... ............................................................................... Plot ............................ Lot .................I............... ............... 2 �Permit Granted .......19 82 bate of Inspection ............ ..................I.......119 .......19 Date Completed ...........Z-9..... I op 0,00 Iz ! o V 7' i ► i I 00 CO - a Scale 1" 401 i CEaTIFIED PLOT rL1�N jBeing lot #110 as shown on a ' subdivision plan entitled I, hereby certify that "Cotuit Bay Shores" located iri the existing foundation Cotuit Mass. . Dated Jm:.3 ,1975 location is correct as ; and recorded in Barnstable shown and does conform : Registry of deeds, in book with the building setback 292 Page 26. OF a4rs9 requirements of the Town : July 6th, 1976 or °yam of Barnstable. _�- ! i'A" N Builder: 5 m.B937 Charles F. Stanley j G,STEP`°o� Centerville, Mass. Signed . * tT+'1lx iE -t t flC M bent ti Ccs NR4 AIRS GIU'60k'l L ogCAYA M Carutr SAY Rb. C; cSTAi f T rA A&L MaW s " 12-21-R2 ' rryt EVtSfrh-6 AS .rt. w As f O�1e i MPitt�UE'ntft SPectAtrs;�, ti 97 `;t �' A�•-�' C�.�X."fh fit. k 3T`C1it'f� ,��l� A� - _.- - .._..�.��,.,.._.__,---- �". 171 _ ��� Etu�a1L Af tL�. t_�e+•� r .s�s�t,L.S +ce.IL�+v� E teC-RlC P,C R f't.A*i a,.0•.,e 4k TO S4.1#VLY ALL F f Yr a"I fwa�r 3 - Lsi>mTS I mime -cal? S"TTCp_! FLML C+f^+W L tc.,N T_5 IN Ci-0 ,*T S Q C oSS S�`TI t;frV '� �- I MSTt�LL tJt{i►�tt .S 2�fL i rt 4%/fY {141 13A+? 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