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1692 SOUTH COUNTY ROAD
/� 9� � . ����� �� s t � � a - — . . ,.. SEPTIC SYSTEM MUST 87 Assessor's office (1st floor): THEt D l3 I�YSTALLED IN COMPLIANCE of o Assessor's ma and lot number .... �`♦ p�; �� WITH TITLE 5 e�Q�� o„ Board of Health (3rd floor): r_ ���ENVIRONMENTAL Sewage Permit number ..........................................:............. �'®��IIUI C®®� c':' t BABBST&BLE, N REGUL_ATIO,hi a 9 raea Engineering Department (3rd floor): G� , /JL 00 ,639- \0� Housenumber ............................. .. ............. ..... ................... o gar APPLICATIONS PROCESSED 8:30 9:30 A.M. and 1:00-2:00••P.M. only TOWN OF .". BARNSTABLE BUILDING", INSIPECTOR APPLICATION FOR PERMIT TO .......� :...6•. t.,. .I................................................................. TYPE OF CONSTRUCTION ....... .;0 X.... ................................ . M. 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .....�5?.��i.... .. .'............ . . .:�.. ......... ............... log ProposedUse .....Yu .. `..............................`..................... Zoning District ..�f ' � ....Fire District .. . Name of Owner . /t� ... •/1� ...................Address .../ � ......................: � ...,�� � Name of Builder ... . .. Address .... ............................................... Nameof Architect ..................................................................Address .................................................................................... ....../........................................................Foundation .... . ........ ...... .. .............................. Number of Rooms �,�!��"�'"'� d��E�'�/"� Roofing ..... .. ........... .. ................................................ Exterior ...../� �� / % .............................. g . . Floors . ..... .. ... ... ..........................................................Interior .. . . . Q..........................:. Heating ...,/ .........................................................Plumbirig ......... Cl?!` `.�..........................:...... ................................................ Fireplace .. ...................................................................Approximate Cost .....k5....O'r?� J Definitive Plan Approved by Planning Board _______________________________19________ . Area ..C)........ ................. Diagram of Lot and Building with Dimensions Fee '• 1 5.......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Nam .... Construction Supervisor's License .................................... BROWN, EARL T. A=98-013 V I No .... Permit for .....B.u.ild...Addi.t.i.on .. . ...... ........ . . .... Single Family Dwelling ........... .......................... Location .....1692 South County ................................... ...Road........... 'Marstons Mills ............................................................................... Owner .......Earl T. Brown ................................................. ......... Type of Construction ............Frame.............................. . ................................................................................ Plot ............................ Lot ................................ Permit"!Granted ........................April '22 86 ..............19 Date of Inspection 11.7 .7 .... 19 Date Completed ......... ........ ...19 . ■IIl■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ICI■■■■■ ■Ill■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■���■■■■■ ' ■lI�■■■■■■■■I■■■■■rrfi�■■■■■■■■■■■■■Ill■■■■■ ■11■■■■■■II■■■■iiiiiiii7■■■■■■■■■■■[IIl■■■■ ■11■■■■■■II■■■■■I■■■■■■It■■■■■■■■■■■[III■■■■ ■11�■■■■/■��-iiiii■■■■■■1�■■■■■■w��■■[III■■■■ ■11■■■■■►I■III■■■■lTl�:Rf■■1,■■■f�i■■■i■[II■■■■ ■III■■■■�■■f'■■■■■■■■■■■1_I■■■I■■■■■■■■■i11■■■■ Ellin ■ ■ f■'�fiilii'i ■i'�IiL�®■■■■■■ ■■■■■■■■■III■■■■ molls MIN, �■a�■■�■■■■■■■■l■..■■_■■■!�■■■■ '■[III ■■■■■■■■■■11■■■■■■■■■■■■■■■■■111■■■■ ■■I11■ ■■■■Ill� � a�����■�■■ ■■■■■■III[■■■ ■■111■ ■■�'i�■i�id��■R"M■■■■:■s��■■■■■■III[■■■ � ■■:11■■■■■■■■■■ ■■■■■■■'L!��1' ■■■■■■[III■■■ ' ■[Il■■■■■■■■■■it■■■■■■■■■V■■■■■■■■■III■■■ ■■it■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■[III■■■ ■■III■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■���■■■ ■■III■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■Ill■■■ ■■ill■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■Illlli■■ ■■III■■■■■■■■■■■■■■��■■■■■■■■■■■■■■11�■■ ■■ill■■■■■■■■■■■■■�[�■�f■■■■■■■■■■■■■■1.1��■■ ■■ill■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■[III■■ ■■111■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■III■■ ' ■■il�■■■■■■■■■■■■■■■■■■■®■■■■■■■■■■■ III■■ ■■11■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■nil■■ ■■�I■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■nil■■ ■■II!■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■III■■ ■■[II■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■loom ■■[II■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■Ilia■ ■■ill■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■Ilt�■ ■■[ll■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■MIME ■■■Il■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ III■ N Assessor's map and lot number ....... .................................. SEPTIC 5Y ° ET'`'t CIU—T CE I J/ INSTALLED IN GO .PLIAN.CE r r . LII H.r--� Sewage Permit number -. �:.. �A417M ANTI+��-E II S .°.TE ", SM11TARY COD} XM TOWN TOWN . OF BARNSTABTL�E yp*TH E T� N 4rp ♦O1 n �' i BAR RTODLE, =i0 BVILDING INSPECTOR A'gc war a' C.i ✓ U` c el �p -9 L� ooNt ���C -, A0PLICATION FOR PERMIT TO .... . .. ..�............M .............�. ............... ' .. ....U.LY ................... ..... TYPE OF CONSTRUCTION ........... v°.v..... .!' -........................................................................ r. • ...................19.L.,0. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: .�!.. � ........ ��.. ........ U. ..............(.1. :...!....�.................. ...............`............. Location ..... ProposedUse ....................... ...... ........................................................................................................................................ Zoning District Fire District .fir ram'............................................................. .............................................................'...... �a T Name of Owner ��J.� Q (.f/...........Address �0..P tA.....160knc.. �1\........d.S.r oz v l�e Name of Builder ........r............. ..... Address .�✓... j2.!vS. j�.pj L 1=........... /Y.t..A!.� ...... .... . .. .. Nameof Architect ........... .ZU. G. /2.............;.............Address .................................................................................... Number of Rooms Q N .....................................Foundation a.N.C.� . ....'.T..............�3Lv . ............ ........ .............................. I Exterior .... d O 1' Ste/fvG,�Z�S .........Roofings 1�Ir .................. ...... . . ........................................................ i Floors /'-�L ,C_ Q f ... �.!�.c.t....lnterior ......�/7' � `/.,., n t1 G ... .. .. ...... ..... ... ...... ,/•`•........................................... Heating <../ v W 4 r. .�2`...^ .�..�. ... .....Plumbing .................. .............................................................. Fireplace ..................................................................................Approximate Cost .... v. }..... ................................... Definitive Plan Approved by Planning Board ---------------____-----------19________. Area ......./....�a........r........ . . Diagram of Lot and Building with Dimensions Fee lR.� .'.�.r SUBJECT TO APPROVAL OF BOARD OF HEALTH I a �5 CKsSp� 0 7 A /3 1' so 1 c.r f I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ........... .. ..'..... 1....... Brown, Earl � No -----.. Permit for' — add. to single------.� ^ .. fa�i ^ ` --- . =^ ` ---------- - South Road ----'_ ----------~----------. , � ' ` ' ^ ll ----..`--��������..��-----------.. . Owner ............Earl.�Brmnmn________.... .. _ . Type ofConstruction --. -------.. , ----.---------------------.. Plot ............................ Lot ---________ ' ' . . ' Permit Granted ---..Smptambwer .10.]g 75 ~'Dote.of | ...... --'lg Date Com� o��e6 �� --''19 ' —'~7^»;+' — PERMIT REFUSED ' . ` .-------.------------- lg ` ~ ---------------.-----------. ^ ' -------..._—.--.---.—.—.------.. . ' ~.—.---..�...--......-------.—.---. ' ^ . . ' ^ --------.-----.—.....-----~—. ` ^ . '- 'Approved | | ^ Approved ---------------.. lA ---------------.---^----.--. ' -------`-----------------... -- Nis Assessor's map and lot. number ........ .�...1..(2....-.!.v „�� 1i J11 er 1-7Z,7'40,# . �� dal ���v +�4,:,�i�CO . L sI f 3 ✓ LC! ry(Jl��........,/..�G1Ccli It� of CAA �,O�s 4. tN f Sage Permit number .... i�� r °FT"Er° TOWN OF BARNSTABLE B9SHSTs1fB, : Y1 "639 0� _ BU�LLDIHG INSPECTOR . ,.^ ...� .... ........ �° APPLICATION FOR PERMIT TO ...... .................................. . .. c �d TYPE OF CONSTRUCTION ................ ... . .R! ................................................................................................. u� P.02..e.............�9.?'7 TO THE, INSPECTOR OF BUILDINGS: The undersigned//hereby applies for a permit according to the following information: /f Location ........ �[�.,9. .................... ..... !!!..:.........� 1.�' L�t`,r.C.��..................................... . ProposedUse .......�..0. . .... ... . . . .......................................................................................................................................... Zoning District .......f l/^ ................................................Fire District ..(J'..................... - ... ........... Name of Owner ... ®ll ..................Address ....��P.:. ,...✓�-��,9... . Nameof Builder ............ .......................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ..................................................................Foundation .............................................................................. Exterior ....................................................................................Roofing ...................................................................................: Floors .............................................................:........................Interior .................................................................................... Heating ..................................................................................Plumbing .................................................................................. Fireplace ..................................................................................Approximate Cost ...... .'.®......................................... Definitive Plan Approved by Planning Board -----------------------------19--------. Area4 /�Q S' - ...................................°.�...... Diagram of Lot and Building with Dimensions Fee J SUBJECT TO APPROVAL OF BOARD OF HEALTH - . x 16 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. ,, Name .,, .�(F!1/!...J..... . ................................ ' Browo* Earl T. ' ^ ^ ^ ` l9�]4 ' No -----.. Permit'for .....�����������--.. ^ . � . . ` ^ ---------_._--'----.-------. l69Z South ��a� Location --'^--------..���'.��----- < ' Omtexvillm ........................................................... O ...................................�a�l � .`_______ �� -- �—.— Type of Construction -------------- ° . , ' -----.--------------------. Plot �� ---------� ----/------� / � July 26 ' 77 Permit Granted ........................................ Date ofInspection ...... -. .' - - -.—. �1V ' Dote Como��a6 -------..������..l9 ��� . ' -�� . . PERMIT REFUSED . ' ...................................... 0!.................... 19 —^—^----'.r'�'^'—^~'^^---------~— —..---.--.-------.—.—.,.:�.----~- - ___.____...`__,~',`______._.__~^ ' .......................�_~----.—.------.---.- ^ . Approved ................................................ lQ ` ---------------~------^'—'-- -------------------.—.---..� | it I � 1.. -� F0,.U-JT A.tl i j I ��•n„ TttwO Y/4`MAr RIDE -_,_,,. a. V � P.T.cI. _! L UfW Yul, P POJ Tf U pw0 G •D, 4.4 YO yT 0Wr BELOW r�l O o4 D�4 T21H ' - NE:J .:Yw LB+ aaa � AODVF .la"y }1A WOt 4' -NtW TV1M1ty/ I L00.i !i � t LV, p I 711 ' �Fi NkwI.W ')j h v I LI SH7 Ct✓TfiCED �` I TV ac Tt�E. 1ALK -,•yI,j OC OPT. D LEIE DOOR. 1 O< D � • �__ Fy) Oh,�/p,J I FtA AA 1 J L PI-�L_ JL/c, Glwyy i wag-�lda--5.� �/V I�—I-�„ �O� I y n SLALc J4•-1'O° . ` I vll.�,E yL W A�QII AL., ROOD• /SOI Jb'LT UVE(<��Y-C>Pty ' I�Ip6E• LON'I. joFPIT' VENT \ ' AL VM. f>v,7'E'� +5P0 V15 (WI'I ITf Ix(, Ix, RAPE nliTtj A✓- TC/n LIKE 6ADWOE )x.O RIDE+=• .i�� '(AF TE Ry •O C. l IC 11>V - W'C SH IN4Lfy $'7LSfD"T11J4-n.a,TC}/Ix5 DO' - F+TE2IOC 7D tE Iwo 712210-1 _ Ix4 OD bLA I.ITE __ '� Id 1 SNU TTE ae) A>VM W6 RO. SS AN,UvJAP OVEN' �o"Lcr•Fl.y, i:- _ `S Iw,6S CFF'IT•r- IN E Li.,� O. L '1� W/I C'b NN4L t SOFFIT 0� TOP An, f�I VZOACl) ALL Gu 6�0?, .. . ILODF L. Z iI:11:5VL.YIEb I I�Ti•y'CC RE4u:.AieO Q i` ,. ...vy a rt>'O[. �' a c.L I16. `_ •�' `T `)-Y'•STVD�-" 9'i RE r/ASLl IM1 LX:.�I w C- 7 L-A +-iY :.x4 sIIOC I3 AT 5jV 5VO FI. ROOT A` p�qiIa` 9"Y- C zEGolAco IVY yf Al Ry. v, ? HIP AI.1A T0.-1 bA11 E, ` i.-) Vv♦ P.T. P S7) 4 ? wllaac R OUI LtD _. TPAM ItJ f l 3i�LEit al�l�L—+SDI TI I g a4w/J am['3_ KA4ll M.wOVlO nt MAWIIR {'.LAC E4•Tt L..L lAbNT I 'rDNNSeN T7Y•a67�_,-•.... NOTE- TILE TD dE L6ViL eke OV.Sro AAt-L - TILE 21 o1JV6z LA7Ce 4oZP- S jd\_ I \ I i ' R JI b n I t , A !Z I3 S A P (1 N� f GMQ e r�,jl'n,.uac�iriae!/a 1�.�.,+a e. . �• F... , ..�.,_...: .-7.J.s?�".�"' •I . NONE IMPROVEMENT CONTRACTORj �" j �omrmzoozcuea/C/ o���� uceelra y' Registration: 10074p °"" 4 5;': 'I BOARD OF BUILDING REGULATIONS Expiralion: sr iYPe 6�23/p1 4;< ; License: CO SUPERVISOR 1 Prival-e Corporatio >. Number CS 057032 CAPIZZI NONE ` I Ihoeas Ca it 1nPROVEMENI, `i`3 Explrgs 09/26/2001 Tr.no: 5742 I ADMINISTRATOR 1645 Nev ion ' Sr' ' ' ) i j ton Rd. -" Resticted,To: 00 Co l ui t ✓!A 01635 THOMAS X CAPIZZI JR r- _.: 280 PERCIVAL DR '• �`�'•� s;l W BARNSTABLE, MA 02668 Administrator j:l �I • . . i` _ 6/7 l � -J •./� ueella 5 F' .` � f',s ¢ �zc '�omv�rea�uoeall� o ! a�vac�iuveCld I � �Fa` `' BOARD OF BUILDING REGULATIONS n ' Yrk y i License: CONSTRUCTION SUPERVISOR DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE is , Number: CS 007454 I Yfi , I h 4. Number: Expires; ; G,, I, Rest 00 OB I, I I Restricted To: 00 THOMAS CAPIZZI FREOERItf, V. RASCH III 1645 NEWTOWN RD + 1060.BOURNE.RD i COTUIT. MA 02635 Administrator t PLYMOUTH, MA 02360 ' - - - The Commonwealth of Massachusetts ^•+ __-= --: Department of Industrial Accidents ...... — Office 0111 MBSMM9,M91S 4 600 Washington Street Boston,Mass. 02111 Workers' Compensation Insurance/ee Affidavit Yam/ name: location: city ❑ I am a homeowner performing all work myself. ❑ I am a sole aroDrietor and have no one working in any capacity �Q I am an employer providing workers* compensation for my employees working on this job. comonnv name: No,' l-Fb')'Y1E address: l60#!�r /ILe&J7ZJW AI city: 0 77�/ r , A4 Iola 3S phone insurance Co. / /'TG policy# WC Spot&iP 8 l /////////////iAN///1„ ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors Iisted below who have the following workers' compensation polices: company name: ::. ...... address: city phone#: insurnnce cn. PORV camnanv name: :. ;•:::. ;... .;.....:;:;::...:.: address. cih: phone#: ......::.:.. . insurance co. .....•... o icy " ' •' ark.#1�i ,�%%%%/%%////////%%/%/�///%%%%%/%/ /// / / � / / / % /// / %/%�//%//i. Failure to secure coverage as required under Section 25A of MCL 152 can lead to the imposition of crbninal penalties of a line up to S1,500.00 and/or one vearn'Imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 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 veriilcation. 1 do herehv certify'under the pains anddppen/alties perjury that the information provided above is trap and correct SialaturaC� �G l/' Date LD Ll Q Print name rp,,rb FxjeK V. RA S C H.IM rp - nAPI zZf Phone#�c�g' /•S�t� o[ncial use only:d,, n this area to be completed by city or town oMcial city or town: permitilicense q ❑Building Department ❑Licensing Board ❑check if immequired ❑Selectmen's OMce ❑Health Department contact person: phone#; ❑Other (mwec 9l95 PJA) . y��pf TF1E Tp��O : . The Town of Barnstable • snxtvsrnsi.e. Department of Health Safety and Environmental Services OIEp Mph Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 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. 11V T YPe of Work: C 4 Estimated Cost h /7 7-3 led Address of Work: —/4 91� _Z64 Je Owner's Name: i�� Date of Application: (9 ! Q� 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: '7 zM Date Contractor Name j*g_ 6,4PiL2. .ikm,g Id, egistration No. OR Date Owner's Name q:forms:Affidav 12 STANDARD LEGEND 72� NOTE:not all symbols will appear on a map / ,' GOLF COURSE FAIRWAY EDGE OF DECIDUOUS TREES EDGE OF BRUSH % ORCHARD OR NURSERY \s .............. ....._...._ .'. EDGE OF CONIFEROUS TREE r i • S MARSH AREA ......... EDGE OF WATER DIRT ROAD DRIVEWAY E / \ / \ < PARKING LOT PAVED ROAD DRAINAGE DITCH PATH/TRAIL P HE PARCEL U 21 I E ' PAR El NUMBER i % MAP 98 01860 E HOUSE NUMBER /:•' 1 ..... \ --- 2 FOOT CONTOUR LINE/ ' \ /. �Eaas( � � � 1 692 \ —Te— 10 FOOT CONTOUR LINE Elevation based on NGV029 �_ `,•�4.9 SPOT ELEVATION �" E / cx= � STONE WALL P. F . -X—Y.— FENCE y m RETAINING WALL -1-F E•--I-- RAIL ROAD TRACK STONE JETTY SWIMMING POOL PORCH/DECK MAP 98 [�3 0 BUILDING/STRUCTURE 64 11,41.._r_r...r_ DOCK/PIER HYDRANT 6 VALVE O MANHOLE 0 POST 0" FLAG POLE T O W N O F B A R N 5 T A B L E O E O O R A P H 1 C 1 N F O R M A T 1 O N S Y S T E M S U N 1 T o SIGN a STORM DRAIN M PRINIED SCAEE:IN FEET *NOTE:This mop is an enlargement of o **NOTE:The parcel lines are only graphic representations DATA SOURCES: Planimelrics(man-mode features)were interpreted born 1995 aeriol photographs by The James I'=100'scale mop and may NOT meet of property boundaries.They are not hue locations,and W.Sewall Company.Topography and vegetation were interpreted hom 1989 aerial photographs by GEOD W UTILITY POLE m TOWER "�(e0 30 60 Notional Map Accuracy Standards at This do not represent actual relationships to physical objects (arpomtion.Planimrhics,topography,and vegetation were mapped to meal Nnlional Mnp Aamacy Standards O ELEORI(BOX r I INCH=60 FEET * enlarged scale. on the map. at a scale of I"=100'.Parcel lines were digiti+ed from 1000 Town of Barnsloble Assessor's tax maps. IIGIIT POLE \sltemaps\Pub Ic m98p13.dgn Jun. 05, 2000 11:27:28 FILE No.047 06/05 '00 AN 09:51 ID:BORTOLOTTI CONSTRUCTION FAX:508 428 9399 PAGE 2 G i too TOWN OF BARNSTABL LOCATION / z �du SEWAGE 11 VILLAGE_ /{'1 l" /15 gl 113 ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. o���� 'r`S ? SEPTIC TANK CAPACM 042 64 f LEACHING FACILITY: (ty ) (Size) ,f I^� NO.OF BEDROOMS PERMTTDATE: 9!3 _2 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Not Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(if any wetlands exist Fact within 300 feet of I hi facility) Furnished by ��T• CD 3 f �- -v N / CT co w z 2 972. 3 p IVe AA 00 O A � � 3 p s n Nj CO .,.. p o^`C a T \ ji /v aoa J� o V c o p p o o T LA O 14 o O ... � r i �+ i� vefV ..i VI S Y1 p J 1 II .. •.' V p_ � � _,c'� T z O _ T O iC CD Vt p m N O =•� O O ^ r p ❑ 0 OO p Z o D n o o crDAi �o a aao o cmciT 3D ^ A o ^O £ A CD m O A \ N \ m D Z 2 m r = 2 2 0 2 m A OT = m A CD O m C G7 ao o �•' ti fA•� nOi ���oOOO !` m n 'n..� O Cn• A `� = A O Z p A ➢S m �ii A •-1 � O � � r r = G='f A r A A M r = G Oy< O A n N H = N A � x 2 ~ p m N m m A < A < 3 H � Q-3/ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Q p Map v-i 0 Parcel 0 /3 Permit# "2!�lIzI997-zl Health Division -1 r -9/ 0l ,r ff av�� . Date Issued Conservation Division sae C//9 4f> Fee Tax Collector adw Treasurer l� SEPTIC SYSTEM MUST BE ` INSTALLED IN COMPLIANCE 2Ianmiag-Dept. WMi IME 5 Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE AND TOWN REGULATIONS Histexic-OKH Pfessatation/Hyannis w Project Street Address /�n�f cS�Gi oeu,127Z 'R) Village LL i ,, / Owner J��IA4 6%� j5, �QG�/l6 Address Telephone m Permit Request &) D Al S �1 Square feet: 1st floor:existing proposed CTO 2nd floor: existing proposed Total new Estimated Project Cost V�oning District Flood Plain _ J Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes U44 If yes,attach supporting documentation. Dwelling Type: Single Family Ck-� Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes M110 On Old King's Highway: ❑Yes Or�o 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:❑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 Milo If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name �/ZZi L-&22 6_��1.�/�� Telephone Number Address /(a f�!5— License# 0 0 7,7? 7T�ln C6 � � Home Improvement Contractor# 00-1 9yW116/,6— Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO . SIGNATURE c DATE FOR OFFICIAL USE ONLY - G P MIT NO. DATE ISSUED ' ' MAP/PARCEL NO. 'VILLAGE ' E ADDRESS ��., . " OWNER ' ' � ' ' ' � � • .- _A;- DATE OF INSPECTION' FOUNDATION gbylb FRAME 30 2 . INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL - t11 PLUMBING: ROUGH} N _ FINAL GAS: ROUG,Pj + pwn FINAL 'J� Ifm ixFINAL BUILDING ' +� 40 _ .� DATE CLOSED OUT �r � r \ `, /', t ASSOCIATION PLAN NO WWI U 4 oF� r 'Town of Barnstable *Permit# s Expires 6 months from issue date BARNSTA8M = Regulatory Services Fee �tZ5 ,t6 1639. �e� Thomas F.Geiler,Director ATE0 Building Division Elbert C Ulshoeffer,Jr. Building Commissioner 367 Main Street, Hyannis, NIA 02601w X-PRESS PERMIT Officc: 508-862-4038 Fax: 508-790-6230 SEP 1 4 2001 TWA EXPRESS PERMIT APPLICATIOL�IQ � OF �ARNSTABLE . Not Valid without Red X-Press Imp rint Map/parcel Number J VP Ap Property Addres v Z_11� csidcntial OR ❑ Conunercial Value of Work /,f7J J Owner's Name &Address j .&_n�24,2-2 ( T" //, 9� o��� you �� /�, �� �ut Contractor's Name�/� . / T_(:2 7e7 _e ci- �� ,�. Telephone Number, -Op y'g p J j,7/j Home Improvement Contractor License #(if applicable) i,,9_3 7/j Construction Supervisor's License #(if applicable). G,-ZZ,,r t� [✓Workman's Compensation Insurance Check one: I am a sole proprietor I am the Homeowner Q have Worker's Compensation Insurance Insurance. Company Name. Woikman's Comp. Policy # (•� /9� y/�r�yy Permit Request(check box) Rc-roof(stripping old shingles) Re-roof(not stripping. Going over existing layers of roof) Re-side Replacement Windows. U-Value (maximum .44) Other(specify) *Where required: Issuance of this permit dots not exempt compliance with other town department regulations,i.c.Historic,Conservation,etc. Signature �( expmtrg. v .. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Permit# 3 Health Division Date Issued 0 V_C� Conservation ' ision _ Fee ��Y... �( Tax Collector�`'- ��.-n ' tL �{ ✓ w„V I7 tgWZS7 �J Treasurer'<=:7�- 16 c (o ' Planning`Depf. J i Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis r Project Street Address 7NL1 Village Owner VWA) Address Telephone 'Permit Request _1e60 / P4 Square feet: 1 st floor: existing �5 proposed 2nd floor: existing proposed Total new Estimated Project Cost 0-0— Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: 0 Yes 0 No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ 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 Number of Bedrooms: existing new Total Room Count(not including'baths): existing new First Floor Room Count Heat Type and Fuel: O Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:0 existing ❑new size Barn:0 existing 0 new size Attached garage:0 existing 0 new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization 0 Appeal# Recorded❑ Commercial O Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name 2U/44 Telephone Number Address Licenseidi "bi 124A /26- dfhtl Home Improvement Contractor# Worker's Compensation# 1;7�ZV ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 7 �� l 1 1 FOR OFFICIAL USE ONLY f PERMIT NO. , DATE ISSUED - MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION i + •FOUNDATION - FRAME ' INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL - GAS: ROUGH FINAL - E FINAL BUILDING DATE CLOSED OUT c ASSOCIATION PLAN NO. t The Commonwealth of wjassacnuseus m - = Department of Industrial Accidents office ot/otresdoom#Hs 600 Washington Street Boston,Mass. 02111 Workers' Co m ensation Insurance Affidavit name:m / location: — �1 J-,�.1— hone# U city ❑ I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one working in any capac1 %%% %%%////%/ �'�/,�//,0/'�////////�'��/////.l�/ ���'�, em to er roviam an din workers' compensation for my employees working on this job.::{ com anv name. addreSi.. - •. :: { i •i ; .: _ :. ;::::�{::i;>: ;;r:;:;:;.';•%•Co-:»�::>;::>: ::;;> ..... , {, insurance co. ❑ I am a sole proprietor, general contractor, or homeowner(circle one and have hired the contractors listed below who have n workers' compensation polices:the following ..........mPsa .... .:. . P .... - com anv name: address::-: :{::•,};•::•:::•: ,:,::':;.•,. J. t 5................. ...................... . ........................:...................:............................ olicv . .................. ................ .................................................................. Cam MEE= anv name:• address: { a ::.:>;:•}::.;:.:.};.: :.:.:.:.:,;.. •{.;..: ::•::.•::.. ..:... . .. hone#. .......... ;...} .... .. ..... .......................... ..............................:....... ....... !•::....A::•::.:::::...:. .::.::.�:::.:.:..Ufa*:::.,::}{..:c}:;;:{•:! ::::::::.....::::�::> ::S.,,.:.,,•,...,:..;r..;•:: .:...........:::•:::...i.....:::.; ..:........::::::::•:::::.•..........:-•::::.ter:.:...;:..... ................................................................. ....... ........ :......n... ..................... ......,.... ..... 7$i::j::•:+<:::'viii:G{:;Y�?:i:�iii`:':..•:.-:::::.�4i:�}. ...........:..............:::::...............:..:.. .:.......... J :............ lily :,::..:::..:.........._. ._..._ . . iasnrancc co:. Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penaltes of a One up to$1,500.00 and/or one yam'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a One of$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, the wins and penalties of perjury that the information provided above is tru.-and correct. Si lure Date n Print name PAU, C "/� a1Q 014- Phone# official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other OrAud 9/95 PIA) . . : The Town of Barnstable BARNW� "UL � 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. i �. Estimated Cost Type of WorTc: '" s�Il/ l��rnl�. i�� /r /C� tc.A�-�_. Address of Work: Owner's Name: 1 &2-� ' Date of Application: 16 Zip () 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 IM[PROVENIENT 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 o r. Date Contras r Name Registration No. OR Date Owner's Name q:forms:Affidav _..__.... ..._.... ........ _ ?/X -� U(.G jac1'I�tG� el Board of Building Reg 1301 f,` tiT One Ashburton Pace, Rm 02108-1618 Boston, Ma License: CONSTRUCTION SUPERVISOR LICENSE Restricted To: 00 . CS 026325 Expires: 10/20/2001 Number. PAM J CAZGAUI;1' ISSS MAIN SI MA 02GSS O5'I'IRVIL,LI.., Tr.no: 7665 Keep lop for receipt and change of address notification. "`�� r/JLG V��17'LllLfJ�)LCUE'CZGGIL O, J✓�'LC(d JCLGJ?.f(i1GC�1 (:I - - 14� I' oa d ('-)-f Building Rr<Iuaa.t:ions and S dr�rcl:: - -/ Once Ashhw l-on P:l.acc - Room 1301. 13w;ton . Masr.;achu et.ts 02108 Ilci�iie; 1:mprovernent Contra( i:.oT- IRe Gi. l-.ra.'t•.i-�;r� 103714 . Exp.i.ral..ion: 7/9/0_'. -fyPr: - Private Corporation HOHE IMPROUENENI CONTRACTOR _ (1. Registration: 103114 I .. r;A'I__AI,JLT & 01\1;> , INC . _ ?-_ J Expiration: 119102 zC.au..11 Type: Private Corporalio :_: a:i]h Ind . P .O Box 781 0 .I.r-_a ri'� NIA 02653 PAUE J. CAIEAUEI 8 SONS, I Paul Caieaull Grh�«, t' •r'a�.•L�/ 22 Giddiah Rd. P.O. Box 2 ADMINk;1HA1013 Orleans Hp 02653 I. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel p is io ' Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee i Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis Project Street Address /Gi 92 ,� � i e� �cc,��,� . ^9 02,L55 Village Owner Gdawhne-.- Address /b92 Telephone 33 9- - o 2!o Permit Request /,Y&a.yyc 1&Z Zct.Cc 19 G� _c.Lc�r7-c__ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 7 Q.Of Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) _ Age of Existing Structure Historic House: ❑Yes ❑ No On Old Kinp ighwayw0 Ymi 0,No ZE Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other On Basement Finished Area (sq.ft.) Basement Unfinished Area (sq fl) c� Number of Baths: Full: existing new Half: existing new —a Number of Bedrooms: existing _new (?? c Total Room Count (not including baths): existing new First Floor Room Count w M Heat Type and Fuel: ❑ Gas 90il ❑ Electric ❑ Other Central Air: 0 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 0 Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name t Telephone Number 0 7 7 L Q//f Address 79 Mid l 2C,� �� License # jZJ, (IdA 17 a Zt�4 &A a&V 3 Home Improvement Contractor# Worker's Compensation # ��(� 500.5.593012d/2 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Mid SIGNATURE DATE �'�O" s ' FOR OFFICIAL USE ONLY k APPLICATION# r DATE ISSUED - Y • MAP/PARCEL NO. � ADDRESS ^ VILLAGE OWNER ' DATE OF INSPECTION: ' z=�_FOUNDATION _ FRAME INSULATION s FIREPLACE x ELECTRICAL: ROUGH = FINAL ;a ,.. i. PLUMBING: ROUGH FINAL r GAS: ROUGH 1 FINAL r FINAL-BUILDING k DATE CLOSED OUT , ASSOCIATION PLAN NO. i r - j OWNER AUTHORIZATION FORM V (Owner's Name) owner of the property located at Ct Z— d (Property Address) 1-e,11-y . (Property Address) hereby authorize L)( L � -. UG -xi (Subcontr t ) ' an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. Owner's nature Date � t �s a eumuII1R9 tiEwummANce tN:f1`iiUi INN ;Massachusetts Department of Public Safety (' q}�Y x ' 107 Honor Road Suite.110. s —.Board of Building Regulations and Standards Matta;NY 12M (877)274-1274 C'bnsh uctisrn�unet r i���r ticenset CS-069058 www' i ;3 »ti red,, Ys i tF t RICHARD S TUPPPR., t x i 79 B MitJECH"DR WEST' VAR Mtti 02673 a Richard Tupper .° :.:. E T .'.'. i f� ' SION ,rii sst t. Expiraiian t.z `Commissioner "12/31/2014 (.Suat:vEnsE SIDE,FOR ts>;srGrurrarrs Hilo txwsano»oarts) : `�`(•'� a, F {k 7 :. r11011N!/�O'!tt[J60 ✓rfui�Y4 {. + x f � Ofliee of Con surnet Amairo&Il alaes :Regulaftoo gp� HOME IMPROV NTRACTOR itegi8 121 5 Type p E ra4r'o 6/'19l20 Individual Cjppi RICHARD T PER 8 s ma ti 29 Roberta Cleve a W.YARMOUTH..MA 02 I�rc nderaecrctary The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.govIdia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name.(Business/orga,uzation/lndividual): Tupper Construction Co. , LLC Address: 79B Mid Tech Drive City/State/Zip: West Yarmouth, MA 02673 Phone#: 508-778-0111 Are you an employer?Check the appropriate box: Type of project(required): 1.0 1 am a employer with 4. ❑ I am a general contractor and 1. 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. % Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity, workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 1 I.Q Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12.Q Roof repairs insurance required.]t employees. [No workers' 13.0 Other comp, insurance required.] °Any applicant that cheeks box it I 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: AEIC Policy#or Self-ins. Lic.#: WCC 5005593012012 Expiration Date: 10/0 3/2 013 Job Site Address: 3. &u City/State/Zip Attach a copy of the workers'compensation polic 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 du hereby certify de the pains and penalties of perjury that the information provided above is true and correct. Si nature: Date: - Phone#: 508-778-0111 i Official use only. Do not write in this area,to be completed h y city or town official. i 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#: eC. 19. 2012 4:31PM No. 8524 P. 1/2 A66mun CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 12/19/2012 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(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terns 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 endorsementls►. PRODUCER Co CT NAME: Lora Lowe Southeastern Insurance Agency, Inc. AIC Nu E (508)997-6061 AtC N,; (508)990-2731 439 State Rd. E-MAIL ADDRESS: P.O. Box 79398 CUSTo ID/: N. Dartmouth, MA 02747 INSURER(S)AFFORDING COVERAGE NAICI INSURED INSURER A: Arbella Protection Insurance Tupper Construction Co LLC INSURERS: AEIC wsuREac: CNA Surety 27 Roberta Drive ---........___._.----.._._...__._—.__._....._•._._--.--._.__— INSURER D: West Yarmouth, MA 02673 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 12/13-2 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 INSR WVD POLICY NUMBER MMIDD MID LIMITS GENERAL LIABILITY 850000874311/0112012 11/0112013I EACH OCCURRENCE s 1,000,00 X COMMERCIAL GENERAL LIABILITY i aREMiSGS E occ rarer ce S 100,000 I CLAIMS-MADE I X OCCUR j MEO EXP(Any one person) $ 5,000 A PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GERL AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OP AGG $ 2,000,000 17 POLICY JECT LOC $ AUTOMOBILE LIABILITY 56662400002 121D112012 12/01/2013 COMEINED SINGLE LIMIT $ (Ea accident) 1,000,000 ANY AUTO --- - , BODILY INJURY(Per par50r1i $ I ALL OWNED AUTOS BODILY INJURY(Par accident) $ A X I SCHEDULED AUTOS -- �— PROPERTY CAMAGE - $ X !HIRED ALTOS (Per accident) INC X ,NON-OWNED ALTOS $ UMBRCLLALIAB OCCUR i EACFIOCCURRENCE $ --— -- EXCESS LIAR CLAIMS-MADE I AGGREGATE - $ DEDUCTIBLE REFENr,ON 'WORKERS COMPENSATION i WCC100159301200 10/03/1012 111*112013 X I TA'ky"�iMITg i X ER I AND EMPLOYERS'LIABILITY YIN i I — ANY PR()PRIETOR/PnP NE�XECU7ffE ; j RICHARD TOPPER I r_L.EACHncCIDENr is 500,000 B O=FICERfMEM6EP,EXCLUDED? nI NIA; I ELIDED FOR WC COVERAGE E L DISEASE•EA $ SQQ QQ (Mandatory in NH) ; !; II yes,descr tis under 1 --�--- DEcCRPT10N OF OPERATIONS Dclorr E.L.DISEASE-PCLICY LIMIT IS 500,00 C ,Oond for theft of money & Ior � 71068913 0212812012 02128/2013 Limit of $10,000 property. DE CRIPTIO OF OPERATIONS I LOCATIONS VEHICLES(ACachACORD 101,Additional Remarks Schedule,If more space Is required) i l.ju�io@csgrp.com CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Conservation Services Group Attn: Bill luli0 AUTHORIZED REPRESENTATIVE 50 Washington Street We tborough, MA OIS81 Lora Lowe O 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD 06/08/2011 15:49 5087785010 TUPPERCO PAGE 01/01 ro?SNITUPPER CONSTRUCTION CO.uc. 795 MID-TECH DRIVE,WEST YARMOUTH,MA 02673 PHONE: 508-778-0111 FAX., 508 778-5010 L11fW.TUPPERCO.COM Date: C 7 Town. of Barnstable _ Thomas Perry CBO a' 200 Main.Street 01 Hyannis, Ma 02601 Re: Insulation Permits Dear Mr. Perry This affidavit is to certify that all work completed for permit application # 01 Issued on has been inspected by a'certified Building Performance Institute (BPI) inspector. All work performed meets or exceeds Federal and State requirements. Si y, Richard Tupper I °FTHE> Town of Barnstable *Permit# v ti Expires 6 n ntlis fran issu d` Regulatory Service-PRESS * awRxsTAsr.E, 639. 10$ Richard V.Scali,Director A,Eo A NOV 0 61015 Building Division �-n Tom Perry,CBO,Building CommiT�i8 Vh OF BARNSTABLE 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number. 098 f V /3 Property Address q2 5 . Cpv N T Y j2o A D 10 5 - m esidential Value of Work$ 3r26a Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address P i-J ' Po Znx ��-� D5'�Yz.vl �t✓L "A 07_6 SS Contractor's Name A L J. CAZCAU L+'' -I- Sc-,Ns Telephone Number 569- `�2 G—�1�� Home Improvement Contractor License#(if applicable) 0-2 �l-{ Email: 0 41 C 2 9 C_c�-Z_e(1_LJf.. [drl-1 Construction Supervisor's License#(if applicable) S tog ( 5 - ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner lave Worker's Compensation Insurance Insurance Company Name L+ I D.l_s Lo P---P Workman's Comp.Policy# (/�/G J"^ — 3/ 3 . 3 4 to 6 -4-6" 0 2 SE Copy of Insurance Compliance Certificate must accompany each permit. Permit Request heck box) e-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to VAtMQU174 ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: C:\Users\Decollik\AppData\Local\lvlicrosoft\Windows\Temporary Internet Files\Content.Outlook\2PIOlDHR\EXPRESS.doc Revised 040215 DATE(MMIDDIYYYY) ,acofzo® CERTIFICATE OF LIABILITY INSURANCE 8/11/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER DOWLING & O'NEIL INSURANCE AGENCY INC NCONTACT AME: 973 IYANNOUGH RD PHONE FAX PO BOX 1990 E MAIL [' AIC No HYANNIS. MA 02601 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: LM Insurance Corporation 33600 INSURED INSURER B: PAUL J CAZEAULT& SONS INC 1031 MAIN ST INSURER C: OSTERVILLE MA 02655 INSURERD: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 25918664 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE AODL SUER POLICPOLICY NUMBER MM DDY/YYYY MMIDD//YYYY LIMITS LTR COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGS TO RENTED CLAIMS-MADE DOCCUR PREMISES Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY a JECT PRO- F-1 LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accldenl ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accldenl $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTIONS $ A WORKERS COMPENSATION WC5-31 S-386670-025 8/10/2015 8/10/2016 �/ STATUTE ERH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1000000 �N NIA OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1000000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1000000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) WORKERS COMPENSATION INSURANCE COVERAGE APPLIES ONLY TO THE WORKERS COMPENSATION LAWS OF THE STATE OF MA. This certificate cancels and supersedes all previously issued certificates,only as they relate to workers compensation coverage. CERTIFICATE HOLDER CANCELLATION PAUL CAZEAULT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1031 MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. OSTERVILLE MA 02655 AUTHORIZED REPRESENTATIVE LM Insurance Corporation VVU UU Q j ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 25918664 1 1-386670 1 15-16 WC I shankar.gadaleolibertymutual.com 1 8/11/2015 4:45:09 AM (PDT) I Page 1 of 1 ` Office of Consumer Affairs and Business Regulation 4 I -_ >t 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 103714 Type: Supplement Card Expiration: 7/9/2016 PAUL J. CAZEAULT & SONS, INC.: : :: : ':`. RUSSELL CAZEAULT ------- --' 1031 MAIN ST - - OSTERVILLE, MA 02658 Update Address and return card.Mark reason for change. SCA 1 0 20M-05/11 Address n Renewal ❑ Employment Lost Card �n�rznzurzu�n�ilC/r,o�'pi��cd:ra�.c�selY:i Office of Consumer Affairs&Business Regulation License or registration valid for individul use only QOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: VON • Office of Consumer Affairs and Business Regulation Registration::)bD 71.4, Type: 10 Park Plaza-Suite 5170 "'� Expirations:?/gj20.16:: Supplement f1lard Boston,MA 02116 PAUL J.CAZEAULT&SbNSINC: RUSSELL CAZEAULT. C`•r:'` 1031 MAIN ST _ v OSTERVILLE,MA 02658 Undersecretary Not valid witho nature IBM Massachusetts -Department of Public Safety Board of Building Regulations and Standards C.'nnstru�tiun SupOri isur License: CS-108157 RUSSELL CAZEet VLT, - i 2071 MAIN STREET Brewster MA 026-31 Expiration Commissioner 1112312018 l4.> f Property Owner Must Complete & Sign This Form If Using a Roofer / Builder. (print) U owL/- as Owner / Agent of the subject property hereby authorizes Paul J. Cazeault & Sons Roofing Inc. to act on my behalf, in all matters relative to work authorized by this building permit application for: Address of Job /6 q Z S. Cvu ,j Tti Po etc,( t 0 5-+-cy✓t 112--� Signature of Owner Mailing Address of Owner 120 00X 6_ d s+ei,-vi tic kA. CD 26 S S Telephone # 3 3 — 9 9- — 6-2-6 Date Please return this form to Paul J. Cazeault Roofing along with your signed contract. It is needed for us to obtain the building permit required by your town to complete your roofing project fax#508-420-4555 office@cazeauIt.com r l The Commonwealth of Massachusetts - Department of Industrial Accidents Office of Investigations 600 Nfashington Street Boston, MA 02111 www.nzass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print I.,eaibiy Name (Business/Organization/Indivi dual): Ad-V , .-, 6A 7�L—�{'Vl�l '� S o� Address: Gb S A-iAI/U J j City/State/Zip: 6S U--E MA Phone#: 9S /V 3 4 re you a -employer?Check the appropriate box: Type of project(required): 1. am a employer with /d �-n" 4. ❑ I am a general contractor and I 6 ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and haveno employees These sub-contractors have g. ❑ Demolition employees and have workers' 9 Building [No workers'.comp. insurance working for in:any capacity. ❑ �addition comp.insurance.t required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.El I..am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions right of exemption per MGL myself.[No workers comp. . 1.2.❑ Roof repairs insurance required.]t c. 152, §1(4),and.we have no 13..�'Other t< �2UU employees. [No workers' 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. f am an employer that is providing workers'compensation insurancefor inji employees. Below is the policy andjob site information. Insurance Company Name: f- A-1 FN S C.0 Q Policy#or Self-ins.Lic.#: wG Expiration Date: �I O�/ Job Site Address: a? Cc)y N T 7-1 20 AJD City/State/Zip: 0ST1_'%2-v 1 L-L MA 0�55 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that thhe• information provided above is true and correct. Signature: R_e,��� 9 Date: l I Lt I 5 a Phone#: �� Official use only. Do not write in this area, to be completed by cio)or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/To-,vn Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone fr: - .• - ''r^ice_\ Q^ _• �, ^ " 6A r 1 Assessor's map and lot number ..... ........ ............ 4 7 7 A4;,T'lil f f Yl7/ a Sewage Permit number ..:arllic�J '/ec /��'/�' G fr Of r ......................................... 1M t FTMEt0 TOWN OF j BARNSTABLE Am"a MILL "b q: 0� ; BUILDING INSPECTOR, a A APPLICATION FOR PERMIT TO ,Lr TYPEOF CONSTRUCTION ............... :......................................................................................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ........ .........r(�!? ..................... ... �.:......... 0>iif.P ....................................... ProposedUse ..... ............................................................................................................................... Zoning District .....y�......^ .................................................Fire District ....'. .................................. Name of Owner ....,.....! ...... J~G 9 ou J3�... i?;fi?��...................'.Address ..��........../. ............ ...�.���� f S��Name of Builder •...........................:.........................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ..................................................................Foundation .............................................................................. Exterior ....................................................................................Roofing .................................................................................... Floors ...................................................................................4.Interior .................................................................................... Heating ........:=A.Plumbing Fireplace ° Approximate Cost ' W Definitive Plan Approved by Planning Board ---------------____-----------19________ , Area .......................................... Diagram of Lot and Building with Dimensions FeeO ............................-." ................... SUBJECT TO APPROVAL OF BOARD OF HEALTH Ile d h � t n I hereby agree to conform to all the Rules and Regulations of the Town.of Barnstable regarding the above construction. Name .............. Brown, Earl T A=98~l3 19434 Qrmeubooae ~ ' No ................. Permit for ------------ � � .-------------..-----.�-----.-. ^� � . �' 1692 South County Road »' � ' Location ---.---_----.---..------ � Oaterv1lle ----^---------------------'' Earl T. Qrmvmz Owner ............................. ' Type of Construction � . ' . � � \ ' \ r�,""/ �""".�� ' - � Date of Inspection ` uo,e Completed - ' � . ^ ` . . ^ CPERMIT ................... lQ � '- �'�F) ' ��----''.-'--' \~~ � / - ^'-----"- -----^^--~----- ' � -.--,.-.-.- ---....-~.-.----.- . .----.~--... ....-..-.-.—~---.-. Y ` ^ ' lQ � k Approved ''----- ---------. --------.----------..-~.-..-.. � ' -------------------.—...--.-. � u� _ Assessor's office (1st floor): �Q— 013OFTNEtO Assessor's map -and lot number .................................... Board of Health (3rd floor): Sewage Permit number .....:.................................................. t BARESTODLE, i Engineering'Department (3rd floor): � p 90o M639. House number ........:. �l.. m Ky� " '�o OR a` APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00•2:00 `P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR a t APPLICATION FOR PERMIT TO ....../� '�"`.:. ....( - 1 ✓d'?�................................................................. TYPE OF CONSTRUCTION .......... / .................................. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...................... .. ...�U.............. ................................ ProposedUse ..... ....................................................: ................ ....................... ... ........... Zoning District 'j.. .......................................Fire District ... .........✓........ Name of Owner ...................Address ... r.................................................:..... .......... 0 9 '' .................Address Name of Builder .. (/�..... -a b ���� !/ .............:........................................... Nameof Architect ..................................................................Address ...........................................................................:......,.. Numberof Rooms ......1..........................................................Foundation .............................. ............................. Exterior .....1./!.. ....., ......J...............................Roofing ..... ..........`.: .:......... ........................................ Floors ..................................................................................Interior ............................ Heating .... ...............*..........................................Plumbing Fireplace ..�../...Y....� ........................................Approximate Cost ......� .............................................. Definitive Plan Approved by Planning Board __________________________ S ...f.?�-. z 9 Area ....... . . . Diagram of Lot and Building wi,fh' Dimensions Fee .............../ff\J v .............................. SUBJECT TO APPROVAL OF BOARD OF HEALTH 1. OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name�� �.. ............. .......... ................. Construction Supervisor's ,License .................................... BROWN, EARL T. =98-013 No Permit for ....Build Addition ............Single Family Dwelling................... Location ....1.692...Sou.t.h...County ...... . ........... .. ............ Marstons Mills ..................................................................... ......... Owner ......Earl T. Brown ............................................................ Type of Construction ......Frame.......................... ................................................ .............. ........ ........ Plot ............................ Lot ............................... Permit Granted .......April. 22.. ........19 86 ........ ............. Date of Inspection .....................................19 Date Completed ......................................19 Assessor's map and lot number /3 Y Sewage Permit number .!s•.. �. t��!.� ��a. .:?../..... °`T"ErC f : TOWN OF BARNSTABLE BABH4TODM i ° o Yae�° BU ['LDING INSPECTOR q T� APPLICATION FOR PERMIT TO .......... ............................................................................................................... a TYPE OF CONSTRUCTION '.k! ° !) � rn .. . ?. ..�0.f........ ...........19..f.,�. --Td-THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .... !.. ........ �t..u..!V .�!....... � U. .��.........:..." .: (:...f-.1Z 1/1. .L.: .................. ...... f�.L= �.. l) C I►✓ � ProposedUse .............................. ............................................................................................................................................ ZoningDistrict ........................................................................Fire District ................................................................. .... L Name of Owner l /R Q.G!,/.&�.......Address ,�4.41 t 4 " I da U A/ � l� 3 � '.... . ............. ........ ............. . ..................................... Name of Builder ...... ..J...... ... .:.......... .........R... Address .. /c�d/� ! .p.!�......... .... ....................... S'S /y.1 A-- 7� �r Nameof Architect .......... .. ( Lz.�`�...........................Address .................................................................................... Number of Rooms ........... . ............................... Foundation ✓ /2aT � ...............G......v....�.................. �NG �..lJ.....^ ! {UG��~S ..Roofing ...,, 5 ;�1 .2� Exterior ....._........... .... .................................... ..�..-.^.................................................... Floors 5� ... r�-^ � .�. rL. cS 111 ...e.e9.41 C.F....Interior' ,/V R 1,,, .- .v G. ............................. Heating- ....'At irU r� T,6: /c_ Plumbing .............""" .......................................................... ........� .........................� ............. Fireplace ..................................................................................Approximate Cost . r�!-�...................................................... .- r• ' Definitive Plan Approved by Planning Board -----------_-._--_-----------19--------- �; Area `'s 1 / i a Diagram of Lot and Building with Dimensions ttjy Fee ... "77 '7 . � S SUBJECT TO APPROVAL OF BOARD OF HEALTH Crsspj •' t '� ,� 3o 1 �jo, . t v I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. 11 Name-:.r;-...�..... :....... ." � g%s &.!...... T/ .Brown, Earl 17933 add to sing 14?' No ................. Permit for..................................... family dwelling ............................................................................... mRead Location ................................................................ Osterville Earl Brown Owner .................................................................. fwame , Type of Construction ........................................... .......................................... ..................................... Plot ................. Lot ................................. P&rmit Granted ....19 75 Date.of Inspection ........................ .... .......19 Date Completed ................. ...................19 PE IT REFUSED ............... 19 ........................ .................................................... ........................ ........................................... .......... .... ....... .......... ......... . .......... .................. r.. ......... ....... I. . . ... .. ..... ... .............................. . ... ........ Approved ............................ .................... 19 .......................................................... ..................... .................... ....... ..................................................