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HomeMy WebLinkAbout0125 SMOKE VALLEY ROAD �ZxS� C�rYlofSe Gall �.� _ �, t .... . Application number..............y.l. �.l�. Fee............ ............................................................. SAWWMAM xs �Bilding Inspectors Initials.... MAY Gr Date Issued... r19 511.3115 l rQWnd � _ .... ... ....................................... !! IV ap/Pa rcel.............:... ... ................................. TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO W S/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: Id, J- J ta lkx d s��-,-y; 14> NUMBER STREET VILLAGE Owner's Name: d1 C ere h Phone Number Email Address: Cell Phone Number Project cost $ Check one Residential y 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 ❑ Siding ❑ Windows (no header change)# ❑ Insulation/Weatherization ❑ Doors (no header change)# Commercial Doors require an inspector's review PB7Roof(not applying more than 1 layer of shingles) Construction Debris will beg going to G�✓ /"`od g CONTRACTOR'S NTRACTOR''S INFORMATION Contractor's name /1/G �/ CIC Home Improvement Contractors Registration(if applicable)# �(� 0 6 Cj (attach copy) Construction Supervisor's License# �� G �3 (attach copy) Email of Contractor Ck 2 e6- rt� 7 7 (d�'� Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER S YEARS OLD OR IF THE SUBJECT PROPERTY IS/N A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER............................................................ r' *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 approvab *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CAM and the Town of Barnstable. Signature Date l APPLICANT'S SIGNATURE Signature Date All permit applicati s are subject to a building official's approval prior to issuance. 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 Lezibly Name (Business/Organization/Individual): �� Z � l�Ard-) ;e,�rc/rf /C(Address: idrr 6r,n crl City/State/Zip: �� ,� rP Phone#: J�w Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 4. 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 workingfor mein an capacity. employees and have workers' Y P h'• x 9. ❑Building addition [No workers' comp.insurance comp.insurance. required.] 5. ❑ We are a corporation and its 10;❑Electrical repairs or additions officers have exercised their 11. Plumbing re 3.El I am a homeowner doing all work g airs or additions P 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' 1 ther 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. tContractors 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.#: p Expiration Date: Job Site Address: ��✓ 5��� U� y /" City/State/Zip: (951 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 oriminal 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 under the #ns andpenalties of perjury that the-information provided above is true and correct Si mature: Date: Phone#: �« � �� Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 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-contractor(s)name(s),address(es)and phone number(s)along with their certificate(p)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the 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 Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 4-24-07 www.mass.govidia f A��® DATE(MM/DDNYYY) CERTIFICATE OF LIABILITY INSURANCE 5/6/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(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 GUNTAUT NAME: Maria DeOliveira Help-U-Insure A/C No Ext: 5059963934 A/C,No): Insurance Agency,Inc. ADDRESS: marra®helpyouinsure.net 2148 Acushnet Avene INSURER(S)AFFORDING COVERAGE NAIC# New Bedford MA 02745 INSURER A: MUSIC INSURED INSURER B: ACE American Insurance Co Father&Son Enterprises,Robert DeMello DBA INSURER C: 73 Russell Street INSURER D: INSURER E: New Bedford MA 02740 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MWDD MM/DD LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE E 1,000,000 CLAIMS-MADE OCCUR PREMISES(Ea occurrence) E MR 100,000 MED EXP(Any one person) $ 5,000 A BIN050619 05/06/2019 05/06/2020 PERSONAL&ADV INJURY s 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO ❑ JECT LOC PRODUCTS-COMPlOP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY UUMUINEU (Ea accident $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS ONLY AUTOS ( ) HIRED NON-OWNED $ AUTOS ONLY AUTOS ONLY (Pr acddent $ UMBRELLA LIAR OCCUR EACH OCCURRENCE b EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION E $ ORKERS COMPENSATION ND EMPLOYERS'LIABILITY YIN STATUTE I IER NY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 B FFICER/MEMBER EXCLUDED? NIA LID5221327 05/03/2019 05/03/2020 Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 500,000 f yes,describe under ESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT $ 100,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD JOJ,Addrdonal Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN cazeault77Qcomeast.net ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD r rr - R CA ZEAULT\ ROOFING & REPAIRS PROPOSAL Proposal No. 19-4119 April 1 ,2019 To: Jane Cronin Work to be Performed at 125 Smoke Valley Rd Osterville MA 02655 We hereby propose to furnish the materials and perform the labor necessary for the completion of: NEW ROOF (All Back side facing only) 1. Remove existing shingle roof 2. Install drip edge 3. Ice&Water First 3 ft,valleys and penetrations 4. Cover roof with Rhino paper 5. Re-roof with Lifetime architectural shingle 6. Install ridge vent 7. Flash all pipes and penetrations 8. "Remove all rubbish from project Labor and Materials $7,100 All material is guaranteed to be as specified,and the above work to be performed in accordance with the specifications and completed in a substantial workmanlike manner for the sum of Seven Thousand and One Hundred Dollars$7,100 with payment as follows: Three Thousand Five Hundred and Fifty Dollars $3,550 with acceptance of proposal and Three Thousand Five Hundred and Fifty Dollars $3,550 due upon Completion Respectf Ilib ------------ ------ RichardfP. Cazeault, Jr. HIC# 168607 CSL#100393 198 Five Corners Road Workmans Comp and Liability with Centerville, MA 02632 Leonard Ins of Ost (508)420-5482 Acceptance of Proposal No. 19-4119 . The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment is outlined above. Signature----—�---- �te--- _g --------- f *Removal o honal layers of roofing not forseen with result in additional fees of$75 per Sq *All quotes are valid for 30 days I . Commonwealth of dtassachpsetts f> t Duisiora of Frofiessionai Licensure Board of Building Regulations and Standards ;-'o.ns'i'usti01.1 supe.—VIBOr CS-100393 Expires: 02/03/2020 RICHARD P CAZEAULT;JR 198 FIVE CORNERS ROAD .. CENTERVILLE MA 02632 Commissioner C,,L , •- Office of Consumer Affairs&Business Regulation ' HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE1. :Individual before the expiration date. If found return to: e ift2hLqrj Office of Consumer Affairs and Business RegWation 1`ti$60:7.`_= 03/07/2021 10 Park Plaza-Butte 5170 1 RICHARD P CA'ZE9gCt1R Boston,MA 02116 I D/(3/A R C'4ZEAl1LTROOFING_$REPAIRS i RICHARD P.CAZEAULT`JR 198 FIVE CORNERS rz. �`- :,,'`f CENTERVILLE,MA 02832 undersecretary Not valid wltqout signature 4-1 r J.{ * US Department of Labor } i Occupationai5afety and Health"Administration k y i��r a .. � •r . Y .�1 �} .has'successfully completed a tOhour l]ccupationai Safety and Health l u =Trainmg Course in' i i} Constructtan .HeaRft.•: �Sy��;�rtetner} "a �' i � .'.Y• i�et9i�ta k�„�" Asses'sor's map and lot' numb ..`....��...... 9 2 J —7 0�- - ��� SEPTIC SYSTEM MUST BE ....... INSTALLED IN COMPLIANCE Sewage Permit number ............ .............. VVITH ARTICLE 11 STATE D TOWN �FTHETO� TOWN O TILU�Irxjy F BARNtV t r •BASBSTeDLE. ° 1639a�•� r D-011DING',. INSPEC.TOR.,. RFD YPY �y APPLICATION FOR PERMIT TO .... �1 ....1`FQW.....>a4!!�.k............................................................ TYPE OF CONSTRUCTION ........`4.a6F��............. ................................................................................................ S/.........................19.2.6�. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....... .11�!\S9�c:�...�SJ1 iL ...1�zk............1.0 ...........................:................................................................... ProposedUse .......\�Q,.(.................................................................................................................................I.......................... Zoning District \ �L�...........................................Fire District ............ ......... .. ©........................................................... Name of Owner ..�(�j +�,......:`.'�C`•tl .............................Address ...... 41 . ............................................................. Name of Builder ............Address ... ....... 95� ................................... � Name of Architect l�fl ...61YU................Address ...00.. .... ` ` '4........... Numberof Rooms ..............1.�'�..............................................Foundation ........................................................... Exterior ..... :.......................Roofing .....t 1 .........................:.................................... 'n Floors ......6. ...................Interior ....�. ? v.` ®Heating �,......� .. , 4...................................Plumbing .......4r*3...........................00 Fireplace ........1�.@ ...............................................................Approximate Cost ....1.a' �. moo................ 1 fs�"' Definitive Plan Approved by Planning Board ___________________._________19________. Area r .. R ..................... Diagram of Lot and Building -with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH cD, I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . L ........... . � Tww, Jw6m � ^ � No .....10679.. perm for _1_&/2..� � � --'__� � � � , a I ... ami � ' . �»~ � Location ~un6���_Smm»km.. e� �a�� ..�sm�_____.. } �� �� 1^� ` . -------.��������.� --.���.` .��--- ] ' ' J��� ' ^ ' � Owner --------.���-----------'' ^ |/ Type of Construction .........fra.me...................... .' --------------------------. � Plot ---------. �� ................................ ` ' � . . ' Septembmr 2O 70 - Permk Granted ................. � Date of |nopection/%/� --//'..�--lV Date Como��e6 .������'�< ..�.��----]V ' ]. .' � � PERMIT REFUSED � � -----_--------------. 19 ' \ . !.' --------------------------. ` , ^ � ` ^—_----------------~------... . � � '` .--------------.—.-----.---- � ^ \ ---------~------'--^------... ' , Approved ................................................ lq � ---------------------.-----. ---------------------'^^'^^^^'' � ` � .' � - ^ � --^---- As�e��o/x map and lot ------- ~ ' . x. ' . Sewage Permit number .................. ....................................... ������7�J ���� �� � �� �J�� �� � �� �K �� | TOWN�� |� ��_� BARNS TABLE ���� ���� BUILDING � NN 0 0 �� N �� INSPECTOR 1639. �� N0 N 0-N0 N ���� ` �� ~� � ���� � �� �� , APPLICATION FOR PERMIT TO ........... TYPE OF CONSTRUCTION ,` ----'--'------------------------------------' � ~ ^ � ............. .........--------]V........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for o permit according to the following information: Location ---.���'-----�.�.=-.-_—''�'-------'��r---------------'''--------------- . � � ProposedUse ............................................................................................................................................................................... Zoning District .............�.�—.�'-..-------------.—FireDisthct ..� . '�-------------------.. '- � Name of Owner ' ............ --z_'-..'..'..---------.Address -----------------------___-- Name ofBuilder `--_�-�'�`��i.--'��_---'A66,mu --�............................................................................ � Name of Architect . .-_—_--''--' —` -----A66reo ' ....................^ � ------^—'--'.�x--'' v Number of Rooms ------.'---------------Fuun6otion -'--------------------' � � � / Ex/erior -- ............................................................................ ----�'-'--------------------._ � Floors ............................... .......................................................Interior —'_..-'_'..x`...------------------ ' Heating ..........------._—.'.--------------..F1um6ing -----.---------------------.. , . Fireplace ---' ...................................................................... [nm —.^^i....—...'..=..-----_----__. � Definitive Plan Approved by Planning Boon] 19---- ' Area ', �—,� ..------- ', . Diagram of Lot and Building with Dimensions Fee /��' v'�----- --_---� SUBJECT TO APPROVAL OF BOARD Of HEALTH � ' ~ ~ � ^ � � . ~ ° | hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. - | Nome .................. =-{l',----' � Tew, John -,' A=1-84--W No J§�.... Permit for .....il I!..........&..ry, ........................... single family dwelling . Location f o. Smoke Valley..��9�4............... c ........................ . Ql-tprxille 14 M ...................................................V...... .......... Owner .............John Tew .......................... .......................... Type of Construction ...............,,a... ....................... ..................................................� � � ... .... Plot ............................ Lot ... Permit Granted ........P. ber 20 76 .......!Pep."...... ..........19 Date of Inspection ................ ...................19 Date Completed ............ ..........................19 PERM11REFUSED ...... . ........./........................... 19 .... .................................... .—IF...... ...... .... . ..... ... .......... . ..... .. ............. A................................ ................ . .. ..................... /-�*�/*"7.7.................... ............ .... . ......... ................. ...................... o Approved ................................................. 19 ............................................................................... ............................................................................... I =o- TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map_ n a:i Parcel Permit# Health Division F Date Issued Conservation Division • Fee 4 ' -. ' Tax CollectX4Ln Treasurer Planning Dept. f Date Definitive,Plan Approved by Planning Board Historic-OKH . Preservation/Hyannis Project Street Address Kko6_ Atr1-g(r Village .�,57, �/� Ad Owner VALUX,F— Address 1a��7i � 1�,= ( .Lr7 _ Telephone Ll� Permit Request Square feet: 1st floor:existing 0C�_O proposed J-2nd floor: existing ,� proposed Total new Estimated Project Cost aEy Zoning District Flood Plain Groundwater Overlay Construction Type ; I.ot Size Grandfathered: ❑Yes ❑No If yes,attach supporting documentation. t Qwelling Type: Single Family 0--__',Two Family ❑ Multi-Family(#units) Age of Existing Structure oZ® Historic House: ❑Yes Olb On Old King's Highway: ❑Yes 3-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 Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other - Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:El 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 ���� Telephone Number Address Yp �30 �c 62 5��7 I � License# Z_nTU TT_ Home Improvement Contractor# Dep_`3 ro a Worker's Compensation# 61 o-d�7:5Z0 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �7 T SIGNATURE DATE �� `� FOR OFFICIAL USE ONLY l PERMIT,NO. DATE ISSUED i MAP/PARCEL NO. r ADDRESS • VILLAGE t OWNER - DATE OF INSPECTION: = FOUNDATION - FRAME INSULATION FIREPLACE r ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL k GAS:' ROUGH FINAL FINAL BUILDING DATE CLOSED.OUT + ASSOCIATION'PLAN NO. The Town of Barnstable BSBxsrxaz.e. a �0�' Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-8624038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction'of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. ; Type of Work: Estimated Cost i Address of Work:—'. Owner's Name: e Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law Job Under$1,000 ❑Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Date. Owner's Name q:fbr ms:Affidav . The Commonwealth of Massachusetts Department of Industrial Accidents _T = ONCO o11,7Fe5ft2 ions .• 600 Washington Street Boston Mass. 02111 Workers' Compensation Insurance Affidavit name: location �-�7 � �{ _�� city /n 1 V l 1 phone if ❑ I am a homeowner performing all work myself. ❑ I am a sole pro netor and have no one working in any capacity ❑ I am an employer providing workers' compensation for my employees working on this job. companv name: address: city: LC9 b>TV- phone#: insurance co. olicv# ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: company name- address. city phone#� ... ..:.:..::. insurance co. l / /aiaii /ii /i /i / /%%%%////%//.0' company name: ;:;:,;>:.;::•:. address: city- .:..:: - phone#: :.:::.:•.:.:::«.:..•:::;:.;:... Insurance co. :............ tilii v# Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to S 1.500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S 100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification I do hereby certify un a pains and penalties of rjury that the information provided above is true and correct Signature ^' Date Print name"r T '��l'�� �f��G\ Phone official use only do not write in this area to be completed by city or town official city or town: permit/llcense# ❑Building Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other (mvea 9/95 PIA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any corm 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 receive: trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work'on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold.the issuance or renews: of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until ,� acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting MR authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names,address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be reined io the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. Ell The Deparunent's address,telephone and fax number. - The Commonwealth Of Massachusetts [ Department of Industrial Accidents Ofifce of lovestlMons 600 Washington Street Boston;Ma. 02111 fax#: (617)727-7749 phone#: (617) 727-4900 eat 406, 409 or 375 • j ` ��? An- • �rfi.Mh.� ��,,,,gg"�`�4i ?tSr"M : tom :HONEPIMPROVEMENTjCONTRACTOR • Registration��120362� rTyPe -Y&INDIVIDUAL S; ����;, •- �;' EzpiT,nation`����.il%3�0y/99 �. k „� �+y3 3 r wbW�•w `5T/PO BOX 16 ^ r, ADMINI �t s'� R" COTUIT NA 0263.5 ' ,�� LR�i � o ✓�aaaczc/zuaelta. .. � ✓lre anvnaaruueal!/ z Restricted ToI iG 4 J'� DBPARTMBHl,OF PUBLIC SAFETY ' -" CONSIRUCTIOH SUPRRVISUR LICENSE 00 - Hone Nuaber: -=. _. Expires: 16 - 1 6 2 Faaily Notes Restricted To: iG Failure to possess a current edition of the Massachusetts State Wilding Code ` Z`PBTIR D FIELD is cause for revocation of this license. PO BOI 16 COTUIT, MA 02635 TOWN OF BARNSTABLE BUILDING1PERMIT APPLICATION Map OQ? 'Parcel T01?74 0P 'RRNS_�r,ABtE' Permit# —(? 60 Health Division — 1-1 S )(0 03 Q ��`� O-rV L-Y Date Issued " 5 29 Conservation Divisioh 03 Fee Tax Collector. Treasurer / DIVISION SEPTIC SYSTEM MUST 11366 Planning Dept. F WSTALMD IN COMPLIANCE V=T=a Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE AND Historic-OKH Preservation/Hyannis TOWN REGUI.R1'10NS Project Street Address P, Village Osrc lZvI F_ Owner _DAgteL CeoNt w Address h'T 10 PgLxc_AIg PA a3� y D 39 Telephone Z34 - S'&6 • tZ 8S" KAPVszS /. FL 34f%08 Permit Request 1Z E N n)4 T f= Clct ST►>l /5, \AT- M AGns P cu MM I uta -r-W n BI T"1-4 S G 'PL XC E 7VW n Square feet: 1st floor: existing 32- proposed O 2nd floor: existing proposed o Total new 0 !t Valuation to, 2.1io, Zoning District R Flood Plain Groundwater Overlay �P Construction Type Wepo a Eg8j£ , Lot Size AZRC5 Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Q Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ®-No On Old King's Highway: ❑Yes O'ITlo Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 30(n=> Number of Baths: ' Full: existing 3 new I Half:existing ( new 0 Number of Bedrooms: existing new b Total Room Count(not including baths): existing R new O First Floor Room Count Heat Type and Fuel: A Gas ❑Oil ❑ Electric ❑Other Central Air: U[Yes ❑No Fireplaces: Existing 2_ New O Existing wood/coal stove: ❑Yes 81q_o_ Detached garage:❑existing ❑)new size Pool:❑existing ❑new size --c' Barn:❑existing ❑new size Attached garage:;d existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes $i No If yes, site plan review# Current Use S L94&�_e_ 'FAm.&% Proposed Use SHrcc- BUILDER INFORMATION Name rAA,"C—c?1 -TKC-. Telephone Number _T0- B • 12-6 • G I o 6 Address lox 3 10 License# CS o t h t11 0_c--t'EF.yt tM,A c5269s Home Improvement Contractor# too t3�j Worker's Compensation# ute- 6 29'1 y�2. ALL CONSTRUCTION.DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN 9c? '1M Ago wt,esE 2 ►A 2 — Co SIGNATURE DATE 1 16 . 03 t FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSOED MAP/PARCEL NO. ADDRESS VILLAGE OWNER r DATE OF INSPECTION: FOUNDATION FRAME r v INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL VA GAS: ROUGH FINAL FINAL BUILDING 1 . c or. DATE CLOSED°OUT �? ASSOCIATION PLAN NO. - 1 L i RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x.0031= plus from below(if applicable) AL,TERATIONSIRENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= l O� ?_�i O_ x.0031= plus from below(if applicable) ACCESSORY STRUCTURE>120 sq.f� >120 sf-500 sf $35.00 - >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 . >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x S96/sq. foot= x.0031= STAND ALONE PERMITS Open Porch x S30.00= (number) Deck x S30.00= (number) Fireplace/Chimney x S25.00= (number) Inground Swimming Pool S60.00 Above Ground Swimming Pool S25.00 Relocation/Moving S 150.00 (plus above if applicable) Permit Fee " projcost Board of Building Regula ions and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 100134 Type: Private Corporation Expiration: 6/9/2004 ROGERS & MARNEY, INC. _ Charles Rogers P.O. BOX 310 Osterville, MA 02655 Update Address and return card.Mark reason for change. p ;__.Address E] Renewal u Employment Lj Lost Card ✓2" el zlman�ueald a�.11a�ac�iuteC�t Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: ` Registration: 100134 Board of Building Regulations and Standards Expiration: 6/9/2004 One Ashburton Place Rm 1301 Boston,bla.02108 Type: Private Corporation ROGERS&MARNEY,INC. Charles Rogers •445 WEST BARNSTABLE ROAD � � Osterville,MA 02655 Administrator Not valid without si ature _ 'V/LG Loorimaow�eal,Ut a�✓iLQ�ja�{tILQCaf BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 016174 E Expires:05/07/2004 Tr.no: 24057 - — Restricted:'00 CHARLES D ROGERS PO BOX 310 OSTERVILLE, KIA 02655 Administrator Permit Number MECcheck Compliance Report Massachusetts Energy Code _MECcheck Software Version 3.2 Release la Checked By/Date TITLE: Bath Remodel CITY:Barnstable STATE: Massachusetts HDD: 6137 CONSTRUCTION TYPE: 1 or 2 Family,Detached HEATING SYSTEM TYPE: Other(Non-Electric Resistance) DATE: 01/16/03 DATE OF PLANS: January 3, 2003 PROJECT INFORMATION: Cronin Residence 125 Smoke Valley Rd. Osterville,Ma 02655 COMPANY INFORMATION: Rogers&Marney,Inc. Box 310 Osterville,MA 02655 COMPLIANCE:Passes Maximum UA=50 Your Home=41 18.0%Better Than Code Gross Glazing Area or Cavity Cont. or Door Perimeter R-Value R-Value U-Factor UA Ceiling 1:Flat Ceiling or Scissor Truss 160 30.0 0.0 6 Wall 1: Wood Frame, 16"o.c. 304 11.0 0.0 26 Window 1: Wood Frame,Double Pane with Low-E 15 0.034 1 Floor 1:All-Wood Joist/Truss,Over Unconditioned Space 160 19.0 0.0 8 COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the Massachusetts Energy Code requirements in MECcheck Version 3.2 Release la. The heating load for this building, and the cooling load if appropriate,has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125%of tWd-esiad as sp ified in Sections 780CMR 1310 and J4.4. Builder/Designer � Date l6 ZOV3 MECcheck Inspection Checklist Massachusetts Energy Code MECcheck Software Version 3.2 Release la -DATE: 01/16/03 TITLE: Bath Remodel Bldg. Dept. Use Ceilings: [ ] 1. Ceiling 1: Flat Ceiling or Scissor Truss,R-30.0 cavity insulation Comments: Above-Grade Walls: [ ] 1. Wall 1:Wood Frame, 16"o.c.,R-11.0 cavity insulation Comments: Windows: [ ] 1. Window 1: Wood Frame,Double Pane with Low-E,U-factor: 0.034 For windows without labeled U-factors, describe features: #Panes Frame Type Thermal Break? [ ]Yes [ ]No Comments: Floors: [ ) 1. Floor 1: All-Wood Joist/Truss,Over Unconditioned Space,R-19.0 cavity insulation Comments: Air Leakage: [ ] Joints,penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. [ ] When installed in the building envelope,recessed lighting fixtures shall meet one of the following requirements: 1. Type IC rated,manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated, in accordance with Standard ASTM E 283,with no more than 2.0 cfm(0.944 L/s)air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled. Vapor Retarder: [ ] Required on the warm-in-winter side of all non-vented framed ceilings,walls, and floors. Materials Identification: [ ] Materials and equipment must be identified so that compliance can be determined. [ ] Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. [ ] Insulation R-values and glazing U-values must be clearly marked on the building plans or specifications. Duct Insulation: [ J ( Ducts shall be insulated per Table J4.4.7.1. Duct Construction: [ ] All accessible joints, seams,and connections of supply and return ductwork located outside conditioned space, including stud bays or joist cavities/spaces used to transport air, shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. [ ] The HVAC system must provide a means for balancing air and water systems. Temperature Controls: [ ] Thermostats are required for each separate HVAC system. A manual or automatic means to nA partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. Heating and Cooling Equipment Sizing: [ ] Rated output capacity of the heating/cooling system is not greater than 125%of the design load as specified in Sections 780CMR 1310 and J4.4. Circulating Hot Water Systems: [ ] Insulate circulating hot water pipes to the levels in Table 1. Swimming Pools: [ ] All heated swimnung pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. Heating and Cooling Piping Insulation: [ ] HVAC piping conveying fluids above 120 OF or chilled fluids below 55 OF must be insulated to the levels in Table 2. Table/: Minimum Insulation Thickness for Circulating Hot Water Pipes. Insulation Thickness in Inches by Pipe Sizes Heated Water Non-Circulating Runouts Circulating Mains and Runouts Temperature(F) Up to 1" Up to 1.25" 1.5" to 2.0" Over 2" 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 Table 2: Minimum Insulation Thickness for HVAC Pipes. Fluid Temp. Insulation Thickness in Inches by Pipe Sizes Piping System Types Range F 2"Runouts 1"and Less 1.25"to 2" 2.5"to 4" Heating Systems Low Pressure/Temperature 201-250 1.0 1.5 1.5 2.0 Low Temperature 120-200 0.5 1.0 1.0 1.5 Steam Condensate(for feed water) Any 1.0 1.0 1.5 2.0 Cooling Systems Chilled Water,Refrigerant, 40-55 0.5 0.5 0.75 1.0 and Brine Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD(Building Department Use Only) The Commonwealth of Massachusetts Department of Industrial Accidents offlce 0/117Y.PS&9171/afts 600 Washington Street Boston,Mass. 02111 Workers' Compensation Insurance Affidavit name: location? city 12hone T I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity 7 1 am an employer providing workers' compensation for my employees working on this job. companv name: .':::ROGERS & MARNEY address: -P.O. Wi 310 city: OSTERVILLE.: .:MA:'.0-2655 phone 9: (5081 428-6106 insurance co. AMERTCAN TNTERNATTONAT, .......... C3 I am a sole proprietor, general contractor,or homeowner(circle one) and have hired the contractors listed below who have the followinc, workers' compensation polices: company,name: SEE ATTACHED SHEETS address: -phone 0: insurance co. policv cornninv name, address: city: phone�i- insurance co. policy ? '7Attich additional she"t if rt'i =. Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition Of criminal penalties or a fine up to S1.500.00 and/or ' imprisonment as-Cll as civil penalties in the form of WORK ORDER 2 fine e or SI 00 00 a d2%.against me. T understand that a one years . b copy or this statement may be for-'A 2rded to the Orrice of Investigations of the Dl.-% for coverage verification. I do herebi•certify under the p irts art pena1tieiofperjuiy that the information provided above is true and correct. Sienature reOGEP—S VL4AR—KF (—Date `YA t. 2003 Print name P-0 COOK- —Phone = -19'bA Y2,49 G l O 62' official-- 'use only —do,-:not -r i r e in this area to be completed by city or town OM621 Department m�nt 02�d cir% or town: permit/license d Building o .Department olLicensin;Board C] check- if immediate response is required oselectmn-,orric, C]Hc2lth Department contact person: phone 9; 00ther— P)A1 C E R T I F = CAT E O F = N S U R A N C E Issue date: 12/16/02 ------------------------------------------------------------------------------------------------------------------------------------ Producer: I This certificate is issued as a matter of information only and confers I no rights upon the certificate holder, This certificate does not amend, SOUTHEASTERN INS AGCY ext-end-- - or a-lter- - - - - - - the coverage afforded by the policies below, I--- -- -- - --- --- -------- -------- -- --- -------- ------------------ 641 MAIN ST I----------- COMPANIES-AFFORDING-COVERAGE HYANNIS MA 02601 --------------------------------- Code: Sub-code: I Co Ltr A: CENTRAL MUTUAL INS ------------------------------------------------------------------------------------------------------------------------------------ Insured: Co Ltr B: ARBELLA PROTECTION '------------------------------------------------------------------------- HOLCO DAVID B LPLMBCOM 8 HTNG Sj ? I Co Ltr C: P 0 BOX 170 I Co Ltr D: CENTRAL MUTUAL INS OSTERVILLE MA 02655 I------------------------------------------------------------------------- I Co Ltr E: WESTERN SURETY CO ------------------------------------------------------------------------------------------------------------------------------------ COVERAGES This is to certify that policies of insurance listed below have been issued to the insured named above for the policy period indicated, notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate may be issued or may Pertain, the insurance afforded by the policies described herein is subject to all the terms, exclusions, and conditions of such policies. Limits shown may have been reduced by paid claims, ----------------------------------------------------------------------------------------------------------------------------- Co I I I ;Pol icy I Policy I ---- Ltrl Type of Insurance I Policy number leff`ective date (expiration datel All limits in thy.Znds ---------------------------------------------------------- ---=-----------------------------------------------Z ------------- A IENERAL LIABILITY I ORDERED I 12/19/02 I 12/18/03 (General aggregate: .2,000 Commercial general liability Products-comp/ops ( ] Claims made (X) Occur I I I (Personal/advert�a�ng inl: wner's 8 contractor's prot I I Each occurrenn 11000 (Fire damag , 100 Medical �ense: 5 -------------------------------------------------------------------------------------------------- --------------------------------- B IAUTOMOBILE LIABILITY 1 80035400001 1 12/18/02 1 12/18/03 IOad,91ily 'ned I I An pp auto I I I le limit: I I All owned autos I I I injury I I Scheduled autos I I I I�Per person): 100 I I Hired autos I' I I I odily injury I Non-owned autos I I I (Per accident): 300 I Garage liability I I I I I I I I I (Property damage: 250 I -------------------------------------------------------------------------------- --------------------------------------------------- ! XCESS LIABILITY I I I I f Each I I I I I I Other than umbrella form I I I I Occurrence Aggregate ------------------------------------------------------------------------- -----------------------------------------------=---------- D I WORKER'S COMPENSATION I ORDERED I 12/18/02 I 12/18/03 StatutoryI----------------------------- AND 110 Each accident) EMPLOYERS' LIABILITY I I I 1 500 (Disease-policy limit) I I I 1 100 (Disease-each employee) ------------------------------------------------------------------ -------------------------- ------------------------------------- E ►OTHER 1 68943790 1 12 7/02 1 12/27/03 I LI 10 DISHONESTY BOND I I I I i - --------------------- ----------------------------------------------------------------------- Description of operations/locations/v icles/restriction /special items: ANY AND L PLUMBING HEATING OPERATIONS ------------------------------------------------------------------------------------------------------------------7----------------- CERTIFICATE HOLDER CANCELLATION I Should any of the above described policies be cancelled before the I expiration date thereof, the issuin company will endeavor to I mail 10 days written notice to 4e certificate holder named to the ROGERS 8 MARNEY INC I left, but failure to mail such notice shall impose no obligation or P 0 BOX 310 1 liability of any kind upon the company, its agents or representatives. OSTERVILLE MA 02655. I------------------------------------------------------------------------- Authorized representative: ----------------------------------------------------------I-------JOAN-----M--MARTIN---------------------------JA --------------------------------- 4/89 f , DATE(MMIODIYYI a_RA CERTIFICATE OF LIABILITY INSURANCE'° S 1 04/09/02 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION PRODUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AMEND,EXTEND OR `TorthTaood Eshbaugh Ins. Agency ALTER THE COVr.RAGE AFFORDED BY THE POLICIES 6ELOW. 605 West Main Streel: Hyai7nia MA 02601 IS AFFORDING COVERAGE Phone: 508-771-1632 Fax:508-778-1789 IN3vRERA. MA331aPEST INSURANCE INSUREV INSURER B: M�C.ARP �� INSURER C: Harmon Painting, Zn INSURER D: Ostervil e'& 0265 INSURERS: COVERAGES PERIOD ) POLICIES Of INSUCE LISTED BELOW IIEEN IOSVEDTO THE INSURED NAMED ABOVr FH I Ar WI-y y REQUIREMENT.TERRMM OR CONDITION-F ANY ONTRACT OR OTHER DOCUMENT WITH RES ECT TO WM/CH THIS ERTIFICATETMAY BE ISSUED OR N MAY PERTAIN,THE INSURANCE AFFORDED SY THE POLICIES DE30RIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AOGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. WMIT5 TYPE OF INSURANCE POLICYKUMBER TE M DIYY DA EACH OCCURRENCE $1000000 GENERAL LIABILITY FIRE DAMAGE(Any ene fire) S 50000 A T'tCOMMERCIAL GENERAL LIABILrrr ART036057102 I MED fJIP(AM one Peraonl s 5000 CLAIMS MADE 17 OCCUR. X Business Owners 04/01/02 j 04/01/03 PERSONAL&ADVINJURY $ I GENERAL AGGREGATE 4-$-�000000 I PRODUCYS-COMP. GOjS (OWL AGGREGATE LIMIT APPLIESKk CSL � 1000000 P i POLICY PEC 1 AUTOMOBIL6 LIABILITY COMB[ D SINGLE LIMIT S A ANY AUTO CA0082603 i 04/01/02 04/C1/03 (Ee iden1j ( ALL OWNED AUTOS BODILY INJURY S SCHEDULED AUTOS HIRED AUTOS BODILY INJURY I S (Per ecclaet>t) L NON-OWNED AUT08 i (Per rPROPEAMAGE I s i �R ,! OARIIGELIANLITY ALTO ONLY-EAACCDENT S ANY AUTO OTHER THAN EA ANY S AUTO ONLY: AGO 3' EXCESS LIABILITY EACH OCCURRENCE S OCCUR G CLAIMS MADE AGGREGATE S I S DEOUCTIBL'e I S RETENTION 3 s V4AKERS COMPENSATION AND I TORY LIMRS ER EMPLOYERS'LIABILITY I B 822X567-4-02 01/04/02 01/04/03 E.L'.EACH ACCIDENT 4500000 E.L.DISEASE-EA EMPLOYE A.500000 E.L.DISEASE-POLICY LINT S 500000 OTHER - I * jCommorcial Applioa ` ART036057102 OA/01/02i 04/01/03 PROPERTY 25000 A 1property Section ART036057102 I 04/01/02 04/01/03 0E6C4IPTION OF OPERATIONSILOCATIONSIVENICLESIEXCLUMONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER N 'ADDIMONAL INSURED;INSURER LETTER:_ CANCELLATION ROGERS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL -2.9—DAYS WRITTEt: NOTICE TO THer CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO 86 SMALL Rogers s Msrney,, Inc. IMPOSE NO OBLIDATION OR LABILITY OF ANY KIND UPON THE IN6URER,ITS AGP.NT3 OR P. 0. Bag 310 Oaterville MA 02655 REPR63lNTATIVES AUTHORIZED REP THE ACORA 25-6(7197) CACORD CORPORATION 1988 i ACO D CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YY) ,M 12/03/2002 PRODI!. R (508)994-9688 FAX (508)991-5461 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION RUTKOWSKI & KESTENBAUM ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 414 COUNTY STREET , ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. I BEDFORD, MA 02740 L. INSURERS AFFORDING COVERAGE , INSURED.Randa 1 C Agnew Electrical Contractors Inc INSURER A: OneBeacon 381 Old Falmouth Rd INSURERB: American Home Assurance Co Unit 32 / / INSURER C: Marstons Mills, MA 02648 / INSURERD: 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER FOLK EFFECTIVE POLICY EXPIRATION IMITS i LTR DATE MM/DCAV DATE MM/DD/YY GENERAL LIABILITY LW59141 11/16/2002 11/16/2003 EACH OCCURREN $' 1,000,000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAG y one fire) $ 300,000 CLAIMS MADE M OCCUR MED EXP ny one person) $ 5,000 A PER NAL&ADV INJURY $ 1,000,000 NERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO- LOC JECT AUTOMOBILE LIABILITY CBXE04239 11/16/2002 11/16/ 003 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY (Per person) $ A X SCHEDULED AUTOS X HIRED AUTOS BODILY INJURY (Per accident) $ X NON-OWNED AUTOS ' R—) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR El CLAIMS MADE AGGREGATE $ . $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND C568-21-85 06/23/2002 06/23/2003 TORYLIMITS ER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ 500,000 B E.L.DISEASE-EA EMPLOYEE S 500,000 E.L.DISEASE-POLICY LIMIT S 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, �I Rogers & Marney Inc General Building Contractors BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY PO Box 310 OF ANY K THE COMPANY,ITS AGENTS OR REPRESENTATIVES. Osterville, MA 02655 AUTHORIZED RE NITATIVE� ACORD 25-S(7/97) FAX: (508)428-6106 ©AC D CORPORATION 1988 r °F114E�° Town of Barnstable Regulatory Services B"NSrABM ` Thomas F.Geiler,Director 9 MASS. g 039. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: p-yA:- 6!.k Estimated Cost 10 �240 • Address of Work 12�5 S L�1 O 1�E �lN l -3_.C' `r 1-p Owner's Name: 14 k t!—= L., C.9_0 t L% N Date of Application: Z—Aj L, , t 6 . &=3 I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 []Building not owner-occupied El Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: 1 • 1(0 • o m_ NG, . k o o k 3y Date Contractor Name Registration No. OR • Date Owner's Name Q:forms:homeaffidav . 4 .. -. _ �.� � � �.L rx:fa•xf4�R-.'+�.r-r ?.�F' � '* ."'� .i", � `t -4.: i r, .. - •i.�- � f X; •Y�.w s it• L .Y � ' • i i Q i P � «� �� �r ,i+:. °s .Ta:s ✓� �!"•; ��, '� .� .t 3'�{"¢ �' -;;;���,y �'. 3i � �i� j`€a Z ffi.� � �t� r Kj yy 091 006 09 033 The .Town of Barnstable BARdSTABLE.MA Department.of�Health Safety and Environmental Services y SS a 039. `0m "' Building Division 367 Main Street,Hyannis, MA 02601 office: 508-862-4038 Fax: 508-790-6230 PLAN REVIEW Owner: Map/Parcel: Project Address: - &,—vl r Builder: y a The following items were noted on reviewing: / .�i�11'ReGN,�Ti�� znaT Una OrrL LR f3 r & !I"D/& 1624)1-a z/t1a-, w�*V/,t/ 1� Oe- f/ 7- 99E -r 44 A-Z 1 �/LdU/D ' /✓ Tp/Z G ,Y/5T/ti!� 41V /,0 X U�vrL -Reviewed by: Date: a _fx L 1 0 _ o z E c ILA pv i � y� • cn Nm �+cu Cnp m Z IN. Ei z ^➢ - AA fx — p i — 0 Fc • �I till o0o joati z �7so�8ro R it ` Z 131��srp �f2�y • i Z, "F70 P �m0°y3���t� "TI1L r rmf mPa o � m� c• np� £ mnopuoi�rgD r- y�Apro, i o wr.!� n m N • O y N in 1 ------- • O m / i ill b Z /p o 9 Z / o A T o [Fol QD "1 m r^rl a o p O m �z o i o 70 m u r L O IY k, r 14-