HomeMy WebLinkAbout0012 STALLION WAY kA4
a•
01/30/2009 10:14 5089937877
} SERVICEMASTER FHVN PAGE 01/02
'Town of Barnstahle *Pe�����
• Regulatory Services V�er6 ><(kQMAM f '"�"'�d°=
swnrrtrrss� t
6�19- A Thomas F.Geiler,Director
Building LDiViSion env/
Tom Perry,C80, Building Commissioner
200 Main StrccL Hyannis,MA 02601
6
www.town-barnstable.ma us
Office: 508-862-4038 ,
EXJPSS PERMIT APPLICATION - RESIDENTIAL ONLY 508-790-6230
�NM Volid wiihnui Red E=Frees!»tprFvt(
Map/parcel Number
Property Address S� `o. ' 0
5-Residential Value of Work 951' . (� Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address '
c/
Contractor's Namc
t Aft ()i/Loo �j 1 i 2?�j� 3'elephoneNumber c
Home Improvement Contractor License#(if applicable)_��� (y
Construction Supervisor's License#(if applicable) f 13 /1�s,
PV-orkmh Compensation Insurance -PRESS ���v" A
Checec k one: �®
❑ 1 am a solcproprietor �UN _ 1 2009
❑ lam the Homeowner
1 have Worker`s Compensation Insurance
Insurance Company Naine TOWS! OF BARNSTABLE
4_ � G
ic-
W
orkman's Comp.Poli: �p
Copy of insurance Compliance Certificate must be on file.
permit Request(check&ox)
Re-roof(stripping old shingles) All construction debris will be taken to
❑Re-roof(not stripping, going over existing layers of roof)
❑ Re-side �� �u�
Replace,;,cn Windows"doors/sliders..Lr-Value
(maximum.44)
°Where required: Issuance of this permit does not exempt comptianec with other town deportment regulations,i.e.Historic,Canwrvntion,etc,
***Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Home Improvement "tractors
License is required.
StGNATiJRE: -
C:IUsersldecollikW 1 �IlMicrosoftlWindowslTempomy ntemetFi c oaten-outlookl'�fY7NB4n,1,8,(p S-doe Revised 100608
The Commonwealth.of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
s. www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
'Applicant Information Please Print Legibly
Name(Business/Organization/Individual): Lo w c s,
�r Address: S� , (6
City/State/Zip: A)Cp"CA,nn MA- Phone.#: .77 `' " G g, -(",Od 0
Are you an employer? Check the appropriate box: Type of project(required):
1.❑ I am a employer with .4. NZve
a general contractor and Iemployees(full and/or part-im.e).* hired the sub-contractors 6. ❑New construction
.2.M I am a sole proprietor or"partner-- listed on the attached sheet. T. 0 Remodeling
ship and have no employees These sub-contractors have g, "0 Demolition
working for me in any capacity. employees and have workers' 9. ❑Building addition
[No workers'-comp. insurance comp. insurance.*
required.] 5. We are a corporation and its '10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers'comp_ right of exemption per MGL 12.0 Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.0 Other
comp.insurance required.]
*Any applicant.that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tdontractors 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: P
Policy#or Self-ins.Lic.M Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine tip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine.
of up to$250.00 a day against the violator. Be advised that a copy"of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby cenA under the pains and penalties of perjury that the information provided above is true and correct.
Si afore: 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#:
r
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 tiustee 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
of 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 arith the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if
necessary,supply sub-contractors)name(s),address(es)and.phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies'(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The 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 permittlicense 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 fo 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 11-22-06
www.mass.gov/dia
_ The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Invesdgations-
OF ° 600 Washington Street
�. Boston,MA 02111 r
www.mass.gov/d1a
'Workers' Compensation Insurance davit: Builders/Conte-actorslElectricfans/Plumbers
A PPlicaut information Plea§e Print LedblY
Name(Business/Organizationflndividual): t
Address: C��('n � —
Ci y/State/Zip: rGl��i"h(l(�2,� /�/� Phone.#: e5M-8 9S?
Are you an employer? Check the appropriate box: Type of project(required):
1.VI am a em-pioy er with.— 4. I am a general contractor and 1 6. (E]New construction
employees"tali and/or part-#rne).* have hired the.sub-contractors
2. I am a sole prepiietor or partner- listed on the attached sheet 7. .E]Remodeling
Ship and have no employees These sub-contractors have 8.��Demolition `
working for me in any capacity. employees and have workers' 9. ❑Building addition
[No worker;' cornp.-lnsurance comp.rncnrance.t
required.] 5. � We are a corporation and its 10.❑ Blectrical repairs or additions
3.0 1 am a homeowner doing all work officers have exercised their I1.❑Plumbing repairs or additions
myself: [ o workers' comp. right of exemption per MGL 12.❑Roof repairs
insurance required.] t a 152,§1(4),and we have no
employees.[No workers' 13.❑ Other
comp.insurance required.]
4zy applicant feat Checks,boxi must also fill out the section below showing their workers'compensation policy information.
t 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 r ast attached an additional sheet showing the name of the sub-contraciors and state whether or not those entities have
employ.;,.s. If the sub-contractors 1•ava 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. rn
Insurance Company Name:
Policy r or Sel ins.Lic. =: � ) 0��( 170%11�1 0 Expiration Date:
Job Site Address: J ` city/State/zip:. CA O /�i��_S . A1� p "( �
Attach a copy of the workers' compensation policy didgration page(showing the policy number and expiration date).
Failure to secure:,overage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal pe=ahies of a
fine up to$1,500.00 and/or one- ear imprisonment,as well as civil penalties in the form of a-STOP WORK ORDER and a fine
of up to$250.00 a day agains a viola . B advised that a copy of this statement may be forwarded to the Office of
Investi ations of thoOIA f Ins coverage verification.
I do hereby cer*§Vund, the penalties of perjury that the information provided above is true and correct
Date:
Phone
Official use oniv. fro not write in this area,to be completed by city or town offwW
City or Town: Permit/License#
Issuing Authority(circle one)-
1.Board of Health 2.Building Department 3.CitytTown Clerk 4.Electrical Inspector 5,Plumbing Inspec4or
6.Other
Contact Person: Phone#:
06-01-'09 10:01 FR011- T-330 P01/01 U-278
flc UKUTU
CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
DS/01/09
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Paul D Labonte Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
I 41 Alden Rd HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
I Fairhaven MA 02719 INSURERS AFFORDING COVERAGE NAIL#
INSURED Additions Plus INSURER A! MWCARP
181 Green St INs RER s: PRl:FERRHD MUTUAL INS
INSURER C: PILGRIM INSURANCE CO
Fairhaven MA 02719 INSURER D:
COVERAGES INSURER E:
7 THE POLICIES OF INSURANCE LISTED BELOW HAVE.BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE'TBRMS, EXCLUSION$ AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE 13EEN REDUCED BY PAID CLAIMS,
INSR D'
POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIIypTS
OENERAL LIABILITY EACH OCCURRENCE 5 500 000
FS
B X COMMERCIAL GENERAL LIABILITY CPP 0100596939 02/18/09 02118/10 DAMAGE TO RENTED
IR
CLAIMS MADE IK OCCUR
MED EXP(Any one arson S
—' PE SONAL&ADV INJURY S 00,000
GENERAL AGGREGATE 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS- OMPIOP AGG S 500.000
X POLICY PRO-
LOG
AUTOMOBILE LIABILITY
C X ANY AUTO PMC6941939 01/14/09 01/14/10 (a aooidanni)INGLELIMIT S
ALL OWNED AUT06
SCHEDULED AUTOS BODILY INJURY S 100,000
(Per person)
HIRED AUTOS
NON-OWNED AUTOS PODILY INJURY $300,000
( yr acatlent)
PROPERTY DAMAGE ; 1 OO,000
(Per acddent)
GARAGE LIABILTN
AUTO ONLY-EA AG IDEI4T
ANY AUTO
OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE
OCCUR CLAIMS MADE AGGREGATE 8
DEDUCTIBLE
RETENTION $ 8
WORKERS COMPENSATION AND x WCSTATU --[Or—H-
A EMPLOYERSLLABILIT TORIPAR MAWC914336 07/13/08 0113/09
ANY PROPRIETORlPARTNERIEXECUTIVE E.L.EACH ACCIDENT 100.000
OFFICERIMEMBER EXCLUDED?If yas,desonbe Under E.L.DISEASE-EA EMPLOYEE VS 500,000
fiFeEL1 L PROVISION,;tsar E.L.DISEASE•POLICY LIMIT $100,600
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES I EXCLUSIOUS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
"Lowe's Companies,Inc.and any and all subsidiaries are named as an additional insured
as respect to General Liability and Automobile Liability"
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL BAYS WRITTEN
Lowe's Companies,Inc NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
REPRESENTATIVES,
AUTHORI¢Eb REPRESENTATIVE <DC>
ACORD 26(2001l08) 0 ACORD CORPORATION 1988
litt9{ :� ,� IZr�:t�,tll itli.sY3� �l �t lt1ll ?-ii" .
d.•_.d r.F"-_1Si 1.:.'.;r'3(� S t,i erdiso( 1Jce,
Z,:...Lir..ense: CS 77520
Re!4 icted to;.Ob 'Y �;
� {.h.V.
MANUEL A CRUZ -
131 GREEN:ST ,`. s
FAIRHAVEN',.MAt72719 �t , .
P
Expiration: 8/13/2010 ,a
l nnuni.3i,m..r Tr,!!: 1505
M� Board of Building Regulatiofis and Standards License or registration valid for individul use only
HOME IMPROVEMENT CON
before the expiration date. If found return to:
TRACTOR Board of Building Regulations and Standards
Registration: 128654
= r '1 9 One Ashburton Place Rm 1301
Expiration: 5/3/2011 Tr# 284089 Boston,Ma.02108
` Type: DBA
ADDITIONS PLUS
MANUEL CRUZ r
167 SOUTH MAIN STREET 2N
Not valid with t nature
ACUSHNET,MA 02743 Administrator i
5069937877
SERVICEMASTER FHVN PAGE 02/02
' S
. Town of Barnstable
Regulator
y Services
Thomas F-Geilcr,Director
Building Division
Thomas Perry,COO
Building Commissioner
200 Main Street, Hyannis MA 02601
www.town.ba rnsta ble-ma.us
Office: 508-862-4038
Fax: 508-790.6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
T
as Ownet of tlic subject property
hereby authorize �
to act nn my behalf,
in all matters reladve to work autborized by this btuldin
g permit application for:
(Address of Job)
Signature of Owner
Date
Print Name
Tf propertY Owner is applying for permit,please complete the Homeowners License Exemption revOrse side, p on Form on the
C`U,nm"""'iklApppa"'LOcRI%Micro3oftlWindo%vmTemmy py]ntemct Fi1eslComem.p„tl� IMY7PtBart, (p S•
doc
Revised 100608
i
To whom it may concern:
Additions Plus is a licensed installer and certified sub-contracter for Lowe's Home
Improvement Stores.
;
The following names are approved installer's for Lowe's.
Manuel Cruz
Robert Chase
Alan Gregoire
Daniel Allende,
Sales Manager
i
�l a
Q ,
✓lie -�anvmomcueal/.li o�✓�aaactucaella '�•`
�\ Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR 1
Registr_;ation 148688 a
Ezpiationj 0/18/2009 {
�—_
=Type:=Supplement Card
id
i�
�r -
LOWE'S HOMES:OENTERS'A.
JAYMI RODRIGUE2
1000 LOWES BLVD ."`
i
MOORESVILLE,NG 81�7
Administrator5�^
r
individul use only :
or registration valid for return
License If found
iration date. Standards
before the exp ulations and �.'
:<<. of Building Reg
Board 1301
one Ashburton Place Rm
02108
Boston,
Ma.
`
' ;• of val►d w�thouts�g .
N9 .�r
tip
I '
r
I
Town of Barnstable *Permit# �
Expires 6 months from issue ate
Regulatory Services Fee
Thomas F. Geiler,Director
Building Division
Tom Perry,CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-8U-4038 Fax: 508-790-6230
EXPRESS PEPART APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press imprint
Map/parcel Number
Property Address
[Residential Value of Work t—S . Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address �}
Telephone Number S d� e 4 6 LC-
Contractor's Name P 'f
Home Improvement Contractor License#(if.applicable) I'2.b• l -5-1
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance XoPRESS PERMIT
Check one:
❑ I am a sole proprietor MAY
I am the Homeowner 5 2008
I have Worker's Compensation Insurance
TOWN.OF BARNSTABLE
Insurance Company Name
Workman's Comp.Policy# w c-2 S 1 s 2)-Z-,C6, % oLE O m
Copy of Insurance Compliance Certificate must be on.tile.
Permit Request(check box)
dRe-ro.of(stripping old shingles) All construction debris will be taken to
❑Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows/doors/sliders. U-Value (maximum..44)
'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Home Improvement Contractors License is required.
SIGNATURE: y
Q:Forms:expmtrg
Revise061306
l
c .
The Commonwealth of Massachusetts
Department of IndustrialAecidents
Office oflnvestigations
600 Washington Street
Boston,MA 02111 ,
www.mass.gov/dia
Workers' Compensation Insurance.Affidavit: Builders/Contractors/Electricians/PIumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual):. za_ lS.��t
•Address CA:a A
T ,
City/State/Zip: 2:0 . �_ Phone.#: sO% o c l{6 q, L
Are you an employer? Check the appropriate box: -Type of project(required):.
1.[Z I am a employer with_S 4. I am a general contractor and I
. employees (full and/or part.time).
* have hired the sttb-contractors 6 ❑New construction .
2.❑ I am a•sole pioprietor or partner- listed on the'attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have g• n Demolition
working for me in any capacity. employees and have workers'
insurance.$' 9• ❑Building addition
[No workers' comp.insurance comp.
required.] 5. 0 We are a corporation and its ME]Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself [No workers' comp- right of exemption per MGL 12.❑Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees, [No workers' . •13.0 Other
comp.insurance required.] ,
'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submmt 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 additionalsbeet showing the name of the sub-contractors and state whether ornot those entities have
employees. H the sub-contractors lave employees,they must providt:their wort mrs'comp.policy number.
lam an employer that is providing workers'compensation insurance for my employees Below isihe'policy and job site
information
Insurance Company Name:
Policy#or Self-ins.Lic.#: �)l^_� 3`� g O`{ Expiration Date::/� VL Z� 0g
4 Job Site Address: 2 & 4V City/State/Zip: t+�/b4 _S�Ms AAAAIS
Attach a copy of the workers' compensation policy declaration paa(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 cr4ninal 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification
I do hereby cerY :ender the pains•and penalties o erjury that the information provided above is true and correct
Signature: Date: S �j.
Phone# 3 0'�< C O Oyu c�
Official use only. Do not write in this area,'tb be completed by city or town of lciaL
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town CIerk 4.Electrical Inspector 5.Plumbing Inspector
6, Other
Contact Person: Phone#:
THE,p Town of Barnstable.
Regulatory Services
anxNsreBr�.
v MSS. Thomas F.Geller,Director
ArED MPI A Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601
"vr.town.b arnstable.ma.us
Office: 508-862-4038
Fax: 508=790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
L �` �JLG� . as Owner of the subject property
hereby authorize Ouw Z`Q__ to act on my behalf,
in all matters relative to.work authorized by this building permit application for:
(Address of Job)
Signatur of er / ate
Print ame
QTORMS:OwNERPEWIS SION
1
Board of Building.Regula(ions.and Standards
One Ashburton Place - Room 1301
Boston. Ma$sachusetts. 02108
Home Improvement"Contractor Registration
Reglelmilon: 12M7
Type: MdMdual
" Ekpiratfon: 8/1A/21309 TWO 131109'`
Miller. Kelly" •.
Oliver Kelly
9 Peregrine lane
S. Yarmouth, MA 02664
Update Address and return card.Mark reason for change.
ova-cA1 Q 60M.sroe�rce4 0
❑ Address ❑ Renewal ❑ Em ❑Lost Car j
p,�I, a•�'o9�a�xa� o�✓��oaaa� � . .
Board of BuIlding Regelatloas aad Staada Lkase•or rgfttmtlon valid for Indhidul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. Tt found return tot
Board of Buitdlog Rcgalatiow and Wandards
RealafiattQn::128957 _ One Ashburton Piave Rm 1301
Eliplratlon: 9/14/2o09 Tr9 131108 Boston,Ma.02108
Type. Individual ;
011ver Kelly
Olivet Kelly '
.9 Peregrine lane.
South Yarmouth,MA 02684 Admlatrtrator Not valid without sfgaetnre
Liberty Mutual Group
Liberty P.O.Box 9090
MutuR Dover,NH 03821-9090
Telephone(800)653-7893
-' Fax(603)-245-5330
Febniary 4,2008 "'
TOWN OF YARMOUTH
ATTN:BLDG DEPT
1146 ROUTH 28
SOUTH YARMOUTH, MA 02664-
RE: Certificate of Workers Compensation Insurance
Insured: OLIVER KELLY
9 PEREGRINE LANE
SOUTH YARMOUTH, MA 02664
Policy Number: WC2-31S-338804-027 Effective: 12/28/2007 Expiration: 12/28/2008
Coverage afforded under Workers Compensation Law of the following state(s): MA
Employers Liabi4 _tslT: Sole Proprietor/Partner Coverage Election:
Bodily Injury By Accideni: $100,000 Each Accident The workers'compensation
policy does not provide
Bodily Inj'uky'by Disease: $ 100,000 Each Person coverage for:
Bodily Injury by Disease: $ 500,000 Policy Limits OLIVER KELLY
i
As of this date,the above-referenced policyholder is insured by Liberty Mutual Fire Insurance Co under the policy
listed above.
The insurance afforded by the listed policy is subject to all the terms,exclusions and conditions,and is not
altered by any requirement,term or condition of any or other documents with respect to which this
certificate may be issued.
This certificate is issued as a matter of information only and confers no right upon you,the certificate
holder. This certificate is not an insurance policy and does not amend,extend,or alter the coverage
afforded by the policy listed above.
If this policy is cancelled before the stated expiration date,Liberty Mutual will endeavor to notify you of
such cancellation.
AUTHORIZED REPRESENTATIVE
LIBERTY MUTUAL INSURANCE GROUP
This Certificate is executed by LIBERTY MUTUAL.INSURANCE GROUP as respects such insurance as is afforded by those companies.
cc: Insured: Producer of Record:
OLIVER KELLY SANDPIPER INSURANCE AGENCY INC
9 PEREGRINE LANE 12 ENTERPRISE RD
SOUTH YARMOUTH, MA 02604 HYANNIS, MA 02601
2/4/2W8
r
oFt Tot,, Town of Barnstable *Permit
)6�-
Expires 6 months from issue date
RAMSrAB1.E, Regulatory Services Fee �5^
y MASS.
i639. `0� Thomas F.Geiler,Director N
atEo�,t s b
Building Division
Elbert C Ulshoeffer,Jr. Building Commissioner
367 Main Street, Hyannis,MA 02601w X-PRESS PERMIT
Office: 508-862-4038
Fax: 508-790-6230 JUN .3 e 2003
EXPRESS PERMIT APPLICATION TOWN OF 13ARNSTABLE
Not Valid without Red X-Press Imprint
Map/parcel Number f Zf
Property Address
esidential OR ❑ Commercial Value of Work �y
Owner's Name&Address
�� .S%�2.1✓r�a�
Contractor's Name Telephone Number`>
H
cpme Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ I a e Homeowner
have Worker's Compensation Insurance
Insurance Company Namerz,0
W orkman's Comp.Policy# -57 r 37S - F
Permit Request(check box)
❑ Re-roof(stripping old shingles)
❑Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
eplacement Windows. U-Value (maximum.44)
❑ Other(specify)
Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
Signature
expmtrg
�- HOME IMPROVEMENT INSTALLATION CONTRACT.
' Branch Name: /V r Date; /7 O 3 sofa,Furnished&Installed by
t� The Home Depot Installed Sales
Branch Number: Job#: ! t/U-Z� 345A The
Street,Worcester,MA.01607
Toll Free(800)657-5182; (508)756-6686; Fax:508-756-2859
Federal ID#75-2698460 ME'Gc#C 02439 RI Cont.Uc#16427 CT Lic#565522
Installation Address: /� `�
MA Home Improvement Contractor Reg.#126893
%O!il �pj[/ �fA6-r /L�//f1 4y e�;,
i
tY State Zip !d
rchaser(s): Work Phone: Home Phone:
i
Home Address: =�Q in P
(if different from Installation Address) City State Zip
Proiect Information I/We("Purchaser"),the owners of the property located at the above installation address,offer to
contract with The Home Depot("H9 a Depot")to furnish,deliver and arrange for the installation of all materials as described
on the attached Spec Sheet# 49 ,incorporated herein by reference and made a part hereof.
Home Depot reserves the right to cancel this contract if,upon re-inspection of the job,Home Depot determines that it
cannot perform its obligations due to a structural problem with the home or because work required to complete the job
was not included in the contract.
DEPOSIT PAYMENT OPTIONS
(Subject to fund verification and/or credit approval.)
1. Check,Cashiers Check or US Postal Service Money Order
CONTRACT AMOUNT $ / u (made payable to The Home Depot).
*LESS DEPOSIT $ 2. Credit Card*and/or other payment options-Circle One Below
Visa Mastercard Discover American Express
BALANCE DUE ON COMPLETION $ 3,9 a Home Improvement Loan Home Depot Credit Card
'25'90 of Contract Amount due upon execution of this Available Credit:$ d�7c' (HIL&HDCC ONLY)
q
contract.One-third(1/3n0)of Contract Amount is required Acct#:f7//l 7/707 9 Ezp.Date:
for MASSACHUSETTS RESIDENTS ONLY
Name as it appears on card: 7
Indicate Payment Method For By my/our signature below 1twe a to allow The Home Depot to charge the
BALANCE DUE ON COMPLETION above c c c r posit indicated.
S O3
a to ..
If this is a finance transaction,the agreement for financing is contained in separate document,which is incorporated herein by
Reference,and made a part hereof. At-Home Services Credit/Loan Application Ref.#
Purchaser agrees that,immediately upon satisfactory completion of the work,Purchaser will execute a Completion Certificate and pay any
balance due(unless the job is financed,in which case,upon submission of the executed Completion Certificate,Home Depot will be paid in
full by the lender). Purchaser also agrees to be jointly and severally obligated and liable hereunder.
For Mass.Residents Only: Contractor,at owners expense,shall procure all permits required by law as follows: Owners who
secure their own permits will be excluded from the guaranty fund provisions of MSL Chapter 142A. Unless otherwise noted
within this document,this contract shall not imply that any lien or other security interest has been placed on the residence.
Entire Agreement: This agreement and its attachments,including any financing agreement,contain the complete agreement
between the parties and can not be amended or modified unless in writing in a separate agreement signed by both parties.
NOTICE TO PURCHASER
Do not sign this contract before you read it. You are entitled to a completely filled-in copy of the contract at the time you sign. Keep
it to protect your rights. Do not sign any Completion Certificate or agreement stating that you are satisfied with the entire project
before this project is complete. Law prohibits home repair contractors from requesting or accepting a Completion Certificate'signed
by the owner prior to the actual completion of the work to be performed under the contracL
You may cancel this transaction at any time prior to midnight of the third business day after the date of this contract. See Notice of
Cancellation for an explanation of this right. There will be a service charge equal to 25% of the contract amount if the job is
cancelled by Purchaser-AFTER the third business day.
BY MY/OUR SIGNATURE BELOW,I/WE AGREE TO BE BOUND BY THE TERMS OF THIS CONTRACT. 1/WE ACKNOWLEDGE
RECEIPT OF A COPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATION.
BY MY/OUR SIGNATURE BELOW, UWE UNDERSTAND THAT THE AGREEMENT IS SUBJECT TO REVIEW OF MY/OUR
CREDIT HISTORY AND I/WE AUTHORIZE HOME DEPOT AND RMA HOME SERVICES,INC.,A HOME DEPOT AUTHORIZED
CONTRACTOR, TO VERIFY AND REVIEW MY/OUR CREDIT RECORD WITH AN INDEPENDENT CREDIT REPORTING
AGENCY AND RELEASE THEM FROM ALL LIABILITY INCURRED FROM INADVERTENT OMISSIONS OR ERRORS.
SUBMITTED BY: �— ��
Date: 05-1 h-03A!Jy:05 1'Ct%•,
s i Pi/
/
i ACCEPTED BY: Date: O 95-1 F-03A09:43 f,Ff;1
Homeowner Date:
NOTICE:ADDITIONAL TERMS,CONDITIONS AND WARRANTIES ARE STATED ON THE REVERSE SIDE AND ARE PART OF THIS CONTRACT
White-Branch File Yellow-Customer Pink-Sales Consultant
9-18-02 C-SC
Bri3nch Ofc: SIDING SPEC SHEET Spec Sheet#:1 O 419 5
Branch#: DESCRIPTION OF WORK Job#:
Customer Name: ACI/yl w QNi f e y Home Phone#: 2 $ — O
Installation Address: /.2 S'A flj'c�,+, y Work Phone#: /t
Street ddress
U2 6fj Siding Drop Location: /jf Sr Ve OT YC
Gty State Zip Code
Dumpster Location:
AREAS to be SIDED PRODUCT PROFILE r
CORNERS 'COLOR'
Front Select Siding Gr/ i/r
Left Basic Clapboard Standard 0 Outside Corners
Back Beaded
Right Triple 3" Dutchlap 6" Fluted 1Q INSULATION
Other Other +White
a
Only 3/8' or 3/4"
-Tuck Fascia
d L6 _ f ^.r
AREAS to be COVERED Under Gutter
Soffit& Fascia Front Left Back Ri ht Other Area OLOR' Yes No
Deluxe Crown "White Only"Frieze Board 2 y" - New Gutters
W%/Y-lf & Down Spouts 3
Soffit Only Yes No
Fascia Only `
z Cover Frieze Board with: PVC Alum. Coil 3 11 or Vert. Soffit,� 'Color"
New Gutters and Down Spouts to be installed in existing locations, unless noted otherwise below.
Qt •CO OR• _ E Os. N ?4 :
White Only" Ot rt Qt
Windows/Doors �
Qty Storm Windows Awnings up to 8'
Garage/Patio Door Flat Storm Doors Awnings Over 8'
Double Garage Door Fluted Burglar Bars ' Existing Shutters
Build Out Frame 'In certain markets,Burglar Bars can be removed,but not reinstalled.
Remove Existing Siding° Yes No
If Yes: Vinyl/Wood Aluminum
° Only where new siding is to be installed. Home Depot will NOT remove as estos material.
Double 5"Soffit a Color: GABLE VENTS
Front Beaded Soffit 5 Location:
COLOR,
Left a White or Canyon Tan Rectangle /t �/ '
Back Y/N 'COLOR' Octagon
Right Wrap Porch Beams
Wrap Porch Posts SHUTTERS
�• " Y/N 'COLOR' #of Pairs 'COLOR'
Knee Braces Louvered
Triangular Gable Vents Raised Panel
a 01.1 Specify the locations:
SPECIAL CONSIDERATIONS: - /
I �
and agree with the job specifications described above.
If r ood is discovered AFTER removing th xisting siding, or if it could not be identified at the time of sale,
there will be an dditio �re . Ft. for Plywood and$5.00 Per Lin. Ft. for Dimensional Lumber.
Customer Signature: ' S 3 U
Date:
70-18.02 SA•S•SD
.T �
r y CT
Board o�./�aaaac�cuaelld
Board of Building Regulations and Standard; "
HOME I VEMENT CONTRACTOR
R tFa 26893
8/g004
g � ! t o
plement Card
Home Depot A
ra
MARK AUDETT QY
3200 COBB GALL E `#26
ALTANTA,GA 30339 Administrator
i
► � �� /tee- ��� -,.o eti � r roZ./`e�-�.li (J`� _
Assessor's office(1st Floor):
Assessor's map and lot number mac►T"I toy
Conservation __�-• to—?- �? ,,. SEPTIC SYSTEM MUST BE ��°�•w Board of Health(3rd floor): , ;- INSTALLED IN COMPLiANC •
g -�� WITH TITLE 5 ;ssaMAO&
Sewage Permit number v
Engineering Department(3rd floor): <<;ENYIROINMENTAL CODE AND o�DwAY W,
House number TOWN RECULAI IO6S
Definitive Plan Approved by Planning Board 191X
APPLICATIONS PROCESSED 8:30-9:30 A.M.and 4-2.W P.M.only
TOWN . OF BARNSTABLE
BUILDING ,INSPECTOR
APPLICATION FOR PERMIT TO X,>Z
TYPE OF CONSTRUCTION
,9 93
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit 40cording to the following information:
Location 4�
Gl/
Proposed Use
Zoning District— Fire District —® /71
Name of Owner /✓&qU e.,4 4,e cy✓ Address
Name of Builder Address
Name of Architect Address
Number of Rooms p7 Foundation
r
Exterio ( -� 0 9` _�L X� Roofing �1�T
/Floors Interior 1441V y- =!S ?/�2.�1-1/1wl
Heating Plumbing P C a e4
Fireplace J�l YJ�"'� ��/% Approximate Cost
Area
Diagram of Lot and Building with Dimensions Fee
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 Qd 6 yy
® BAYSIDE BUILDING, , INC.
No 35933 Permit For 12 Story
Sincfle Family Dwelling
Location Lot #13 7, 12 Stal lion Way
Marstons Mills
Owner Baysid'e Building, Inc.
Type.ofnConstruction Frame
6
Plot Lot
Permit Gra ed June 8, 9 3
�xAUJG:
Date
QDate pltd ?Z/3 3 19
G
yJ r n
T.8.. J
L
I gZ I� \
= -i n �i
I � ONE :L mZ ;0 i
DT(n x n< d L \ tpa D,
a _
I oj,
r
TvOS c7=By,"
r \
All
nb
i b5 d�. rJ I N m CrI
4 1 h {
♦ I I �* _ Z
Ir D
N
/ z
ME z
0
Lmcc➢
ao? -n
0 (q G
c
i 00
DZ cr N0LP� n Lcm �(P� P c
-77a s _ s rn m
v � vp ��
o 0 ➢ a 0�
ZN 8� C
-a N r
N Iq
< p(9
a C rl A
t i
i
4
IT,
�• 9 0�
D
z
FF
LO
� � I
�!.
@ �.-
�� R
z
--
�
- - i
i
p - p r-o
r
8r h p �0(1
pZ'
r �
U
D \ i
� - I
I
• , iJ �- y i
r o^ I
e
o
Lj
i
Of. Val
111 0 !0)
•(�: Qua LrnrEr.J. I
rr, I Cm°Z
a.B�to'c n:' 0 oy' 0•V A' r iW
i d
�s A �
' o m ;o
tp
-
-T
24 0..
12'• o-'
3o s-7
- -- -- - — .......... —b—
p
p p nIZ a ( 1
� r
n P� l0
r 0
dL ,F�jj
,
I
�,cy 57 - -. �- ` o I
T
if
s - �o F g•o•` � I ,
N
n f
..�.-'..... I p j I -
I
i
• r � I I,
0 z j 6101
(� loy
I
7'•6'/4x 3'-I-
I I
i
a
� I I
II
I .
i
M- 111
E
s
in I-M
i.
D
D n
� N
r L
� L
s c
r
N
� I m
�i
,
! � I
� D
I -ti Z
E- L L*4tA
o
i F
t
, C
I, r_
-
I
C /11J�5161.I -DATA�I'} , , . I --- -- - - ----...---1
. • ` 511J6LF— FAMILY - ?: �f...✓Fi.�J/Y{I ! '• i ri Y I i I`� I ��r.+ '/'/� /-�y
flo
FLOW .SXIio-s'30 : "w 7W
5EFT'IC TANV—•
-OVA,44,
�% fir 6
51DEWA L: AREA.=:Ig$5F • . ��$;. . �'�{��' Pao ?
1138 5F x n. - 1 r �: a
VOTTOM
le, z2r o I
1( I:.O �
136
TOrAt_ DA I t, �,
?E160C-A oN
,sue. Tgr 4" :3Y 'CCA4&e9 :p.p;� �ti�° - --V
Xa OF
PETER
�. t:..rsa.� SULLIVAN ; y t\ i
'ttt No:29733'
qq
NAL DO 1 I
4�l,7TEST- la�l . ; . . .• I
4oc_t
Eta I� TF" IGo
--�rT
{ P v e
Iw
4! ' T :�' (doh IN✓ 1
a+✓ 6-AL Is;cB
� . � � r •'IU ISC'c S ric
Moo
�s Wmt1t I ' �i5revcTy; s. e'cr
2 6,.... f .WIT;
1-74
PMZCUL
:.,..� :.� •.. ' - - �-? � ; . . .. :.�._� . • :. Ceti i�►® pc�- PCd N
• �I O SGp.L� • • �' w i LOc.�'1'ION � W� ►7�'�7�$�a
i�o Ala a-�5 i : ' . . ; 6GALI:-, Ili �o� DATE:
1 CFYTl PLAN 2E' rzajc6-
FY ''T�IdT:.T ;::.pw�uaNb
yNn:<1'q NE2EDN CoMrc.YS..tivlTµ ' "51 UtJE Lor 137
TDWN O
AEID—�1�11LL veep. O� '[��� F-BAO'i7-4", PL �!L L�?� `PL l7
S IJd(' l-OC„4 f�� WI'i'I�Itt ilE _.SOD ;fZ'-Al fl;,
jA
rNIS F7.dN 15 NOT- ?MED ...oN ' tiIJ' l�tiT�c?ME 't- zw I l_ c-�.I01 N rc5
`_uf Vey MD THF_ -°FF5ETIS. � 40u .IJvY'� I'QE o 5'(�Etz�ttlE MA
Uscn ro STAB 5N- ,:FIZOrE$2:r�/ we
i : APPLICANT; �8Ay51�t� UII�It,>G
137
0
loll
� � 1
� o0
5,-A�►o N w,4 y
R OF
x ?
114XTEl� "tip'.
r �C L*:D
i
' c L 2T/.may 7-A,�47- 7-,4/E
:�inGr/iV yE.2E0.C/CD�'1.dL YS 2 9.3
13A1-2,v sr4 a Z-E A.vo /s 167-
Lor /37
W17'y/1V 7-1-125
/3/�, 43� �� 7
TiSi/S G.CA�t//S i(/aT BASSO Git/,4it/ � � i2EG/STE.eEp /mac/p �cU.�li6yar_�/
AF�.�.0 /C,4t/T
lr '>�.}F"`� tg�-`Ff,+Jt:�¢, „".;;:�-,1r£ ?" .::, oay�) � n�;;+i�. t 4 'A � .. ✓"�� :4 v"'. _`=;,;.�`,.:,> ..-xy.��••,+y,i._y •r. — .- .. ... ...,�?:.� -;. -
,. UILDING PERMif
f TOWN OF BARNSTABLE, MASSACHUSETTS
A=174--001.043 DATE .;ull(-- 8 19 N9 35933
APPLICANT OwnerPERMIT NO.ADDRESS 7705045
IN0.) (STREET) ICONTR'S LICENSEI
PERMIT TO guilt' Cat..El.lfl Z ]�_i-q,1. -- i"1v CiW;2l«;?L� NUMBER OF
( t STORY ' DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
1.O'�_- 7,;137 ZL Stallion ei 'V :_i:11 :' OI1S �`�11�.0 ZONING i(h:
AT (LOCATION) DISTRICT
(NO.) (STREET)
BETWEEN AND '
(CROSS STREET) (CROSS STREET)
i
SUBDIVISION LOT BLOCK LOT
SIZE
BUILDING IS TO BE FT-. WIDE BY FT, LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR'FOUNDATION
(TYPE)
REMARKS: Sewage i"93-259
AREA OR sq. it. _44,Ai0 PERMIT �.3.).3U
VOLUME ESTIMATED COST $ FEE _
(CUBIC/SOUARE FEET)
OWNER ,�• ide i Luildiiig, inc:.
� BUILDING DEPT.
ADDRESS f'. U. G• t.tt'_:t'll�'r, _ ^vJ.•32_
BY
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR
PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP-
PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED
FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS
OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE
INSPECTIONS REQUIRED FOR PERMITS ARE REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN
ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND
1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS.
2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL
MINAL INSPECTION
TI TO LATHE FINAL INSPECTION HAS BEEN MADE.
3. FINAL INSPECTION BEFORE
OCCUPANCY.
POST THIS CARD .SO IT IS VISIBLE FROM STREET
BUILDING INSPECTI N APPR VALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS
lip,(1/z
2 - 2 �NS>/ / � z
AW�3
3 TING INSPECTION APPROVALS / _NG RING EPARTMENIi/
1
` 2 n//� ^ / '�`3�O.g;jLOF HEALT1
7 �/y 9.- y a
OT ER SITE PLAN REVIEW APPROVAI
p 1 q 3
WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT W!L L BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE
TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN
CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION.
��..� °•`ew TOWN OF BARNSTABLE
BUILDING DEPARTMENT
= sans %rug TOWN OFFICE BUILDING
'679• HYANNIS, MASS. 02601
�o rur►�
MEMO TO: Town Clerk
FROM: Building Department
DATE:
An Occupancy Permit has been issued for the building authorized by
BuildingPermit #...... �� .........................................................................................................._ ._. ... .......»._ : .__.
issued to 0 �LJ/',L/ a..i.=-rT..,............._..............................._. . _.. .� ....._ . ......_�_._
Please release the performance bond..
_,.t. .. .�.. y - r '.; s . .,a ` ..:.s;0.<•',.'�,.,✓"'�. R:`F.7�,:�,'.M•.. y tii .'.!4'r➢�,;L 4.
i
*M� TOWN OF BARNSTABLE Permit No. . 3.3
.....:. .......
BUILDING DEPARTMENT
TOWN OFFICE BUILDING' Cash
ego•
''tour► HYANNIS.MASS.02601 Bond .................
CERTIFICATE OF USE AND OCCUPANCY
Issued to Bayside Building, Inc.
Address Lot #137, 12 Stallion Way
Marstons Mills, Mass.
USE GROUP FIRE GRADING OCCUPANCY LOAD
THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL
SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN
REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE
BUILDING CODE.
September 14, 93
... ... .... ...... ..... .......
19................. ................ ...............
Buildin�nspector
f
t