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0044 THATCHER HOLWAY ROAD
�._ i �. .. _...... oF'IKE Town of Barnstable *Permit# G• Expires 6 n the n' me Regulatory Services Fee BARNSfAB1 E. • X-PRESS MI v� 1639. `0� Thomas F.Geiler,Director '°rFc niw�a Building Division APR 18 2013 Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us TOWN OF BARNSTABLE Office: 508-862-4038 ' Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY ®� Not Valid without Red X-Press Imprint Map/parcel Number I 4,� / Property Address I I �y 2 {V 144 dResidential Value of Work 3l�y Minimum fee of$35.00 or work under$6000.00 Owner's Name&Address L aiLt/( f l rl�i I low Contractor's Name Libla a(.ttom / C'fi'jj/xW1ije Telephone Number ( jJ) 7��7 E)b7 Home Improvement Contractor License#(if applicable) 1433 5 Construction Supervisor's License#(if applicable) 12� nj [�JOGorkman's Compensation Insurance Check one: L ❑ I am a sole proprietor WIam the Homeowner have Worker's Compensation Insurance Insurance Company Name 1'1 V Workman's Comp.Policy# 0 Jr l 5�0_fl 1 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors (�Replacement Windows/doors/sliders.U-Value 93 (maximum .35)#of windows—L7-- ❑ 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 re aired. SIGNATURE: C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\QRE6ZUBN\EXPRESS.doc Revised 053012 A The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.Mass-gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ' Applicant Information Please Print Legibly Name(Business/Organization/Individual): L e )d Address: 153 CDmme rG l— St City/State/Zip: sash A O2(p4°J Phone#: Are. ou an employer?Check theippropriate box: Type of project(required): 1.71 am'a employer with 2 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors ❑Remodeling 2.El am a sole proprietor or partner- listed on the attached sheet._ 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 10.❑Electrical repairs or additions officers have exercised their exemption per MGL I L[]Plumbing repairs or additions 3.❑ required.] right of tion 1 am a homeowner doing all work g p myself. [No workers' comp. c. 152,§1(4),'and we have no 12.❑Roof repairs insurance required.)t employees.[No workers' 13-V Other W t aW S 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 their workers'comp.policy information. lam an employer that Is providing workers'compensation Insurance for my employees. Below is the policy and job site Information.Insurance Company Name: I� coC� Policy#or Self ins.Lic.#: CCP/� iSOb0S7)F31� Expiration Date: Job Site Address: Q-� City/State/Zip:m, Attach a copy of.the workers'compensation policy declaration pag (sbowing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify un er the pains and penalties of perjury that the information provided above Is true and correct. Signature: Date. Phone# (56- 5� -f7-7 —88-7-7 Official use only. Do not write in this area,to be completed by city or town of/iciaL 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#: sHErgyti RwRVSTADI.F.. 9 M69S. . Town of Barnstable CEO MA't A Regulatory Services Thomas F.Ceiler,Director Bididina Division '1'honws Perry,cBo lltaildinb{Commissioner 200:Main Sircet, Hyannis,iviA 02601 �v�vw.to��°n.irt rnsta iile.rna.us Office: 508-862.4038 tax: 508-790-6230 Property O,%,tTile.r. Must Complete and Sign This Section 1.1 Using.A. Builder l>_.-... �L��� � ���r��__.._.._._.__._....____- __..it Owner of the Subject propel-ty hereby atitliorize �u�i`� • �.,�tc-i �-1 ! ,> �io aCr.on my behalf, in all matters rcia lve to work authorivcd by this bnz,Idiril;permit application for: at (Address u.f job) Sign. ire of(--)wncr Date. Priat Narnc If Property owner is applying for permit,please complete the Homeowners License Exemption Form on(lie reverse side. C:ii)s�.�s';ifcciillikt,lp�Dz!atl,rani'�4licresroft`.l�1indo��.s�(emparury iniernetl�ite91C0��tet�t.Quttookle;)ltl:'I,LL!t3t��.t:XPftt�SS.ctac Revised 053012 9 Client#:51439 CAPEENT ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMDDIT ") 04/16/2012 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 terms and conditions of the policy,certain policies may require an endoisemenL A statement on this certificate does not confer rights to the certificate holder in lieu of such endomement(s). PRODUCER haecl Linda Taddia Rogers&Gray Ins. Kingston P �N ;508-746-3311 No):877-816-2156 63 Smiths Lane Ic n ADDRESS: Itaddia®rogeFsgray.com Kingston, 02364-3TOO INSURERS AFFORDING COVERAGE NAIC E 508 T46-0O55 INSURER A:Arbella Protection Co 17000 INSURED INSURER B Capewide Enterprises LLC J.P.Mecomber&Sons INSURER C• PO Box 763 ENSURER D. Centerville,MA 02632 INSURERE. INSURER P COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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 ADDL SUBA RUM POLICY NUMBER DM DWA MMOIUDD EXP LIMITS A GENERALLIABILITY COP8500050813 4/30/2012 04130/2013 EACH OCCURRENCE $1 o000O0 X COMMERCIAL GENERAL LIABILITY PREMISES ar ante s25O OOO CLAIMS•MADE a OCCUR MED EXP(My onePerson) $5 000 PERSONAL&ADV INJURY $1 00O OOO GENERAL AGGREGATE s2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2 000 000 POLICY PRO LOC $ AUT OMOBILE TOMOBILE LIABILITY 58944400004 4/20/2012 04/20/201 CO eBINED SINGLE LIMIT 1,000 OOO ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS N AUTOS NON-OIX HIRED AUTOS AUTOS mED PROPERTYrndd ) GE $ AUTOS $ A X UMBRELLA LUB OCCUR 4600050814 4/30/2012 ON3012013 EACH OCCURRENCE $5 000 000 EXCESS LLAS HCLAIMS-MAOE AGGREGATE f5 000 000 DED,I X1 RerwrIONS10000 I I $ A WORKERS COMPENSATION 0054370411 4/14/2012 04/14/201 WC STATU• OTH- AND EMPLOYERS'UAMUTY ANY PROPRIETORIPARTHER�ECUTIVE —N E.L.EACH ACCIDENT $500 000 OFFlCEWMEMBEREXCLUDE07 N/A (Mandatory.in NH) NO EXCLUSIONS EL.DISEASE•EA EMPLOYEE SSOO OOO rcye%descrbeunder E.L.DISEASE-POLICYUMIT $SOOOOO DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLE$(Attech ACORD 101,AddlVond Remarks Schedule,It more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 0 198 -2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S80369/M80368 CJF License or registration valid for individul use only Office of Consumer Affairs&Business Regulation before the expiration date. If found return to: OME IMPROVEMENT CONTRACTOR egistration: 143358 Type: Office of Consumer Affairs and Business Regulation xpiratlon: .7/6120'14 Ltd Liability Corpc: 10 Park Plaza-Suite 5170Boston,MA 02116 We CAPEWIDE ENTERF.#r RICHARD CAPEN i 4507 R RTE 28 g .� o COTUIT,MA 02635 Undersecretary valid withou gnature t Massachusetts -Department of Public Safety t hoard of Building Regulations and Standards Unrestricted-Buildings of any use group which (un%iruciinn Supcn i.ur Contain less than 35;000 cubic fed(991in")of License:CS48WI �. enclosed space. F$[G[iAhTl)ifrl trAiPEN. . 02; COT1TlT M� .; Failure to possess a current edition of the Massachusetts t Expiration State Building Code Is cause for revocation of this license. Commissioner 11/27/2013 For DPS Ucensina information visit: www.Mass.Gov/DPS CAPE COD TOV144 OF BAR ST.BLE INSULATION 1 !2 � � AM 9: 08 NRER OEASS SEAMLE55 SPRAY FOAM SU SVENDED RATT5 OUTTE RS INSUUTN)N CMt'NO* 1-800-696-6611 DI�II �f Town of Barnstable Regulatory Services Building Division 200 Main St Hyannis, MA 02601 Date: "71131)'�.. Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute (BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address Village yqu6a� Fvtwc�� �c2s�v�s M Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings ( ) ( �O (`10 ) ( ) ( X - --� K) ( ) Floors ( ) ( ) ( ) ( ( ) Walls ( ) ( ) ( ) ( ) ( ) 6L,Lt Sincerely He y E Ca sidy r, President Ca e Cod sulation, Inc. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION TOWN OF BaAR)"5 �� �. Map �. Parcel :Appel cation Health Division 201.7 1 AIbale Is-sued � Conservation Division Application Fe Planning Dept. ` -- --Permit Fee DI1d 1SI0r i Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address �¢ ,�G�q .�92hr/64 /2c� Village �f Owner /q/i,�r2N� ;9/ Address Telephone Permit Request _e 6 C✓� / C`�,��y�0,�� �G f�iQL� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay. Project Valuation d 1onstruction Type OZ 5j5>M"77r,0A✓ 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 2IVo On Old King's Highway: ❑Yes -6kNo 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 ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name il gj4e 4o, dul,� y�,� Telephone Number �D 77 �/ ZB Address s:�C License #/ Home Improvement Contractor# Worker's Compensation # V00P. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO v SIGNATURE DATE F f, f- FOR OFFICIAL USE ONLY ' APPLICATION# �:�DATE I$SUED_jJa���c �r. .�... .. ' F✓. , MAP-1-PARCEL NO. r r, ADDRESS. i r VILLAGE OWNER DATE OF INSPECTION: ',tFOUNDATION!'L, FRAME FIREPLACE I ELECTRICAL: ROUGH FINALr PLUMBING: ROUGH FINAL .• GAS:^ =—a{ ROUGH z-,• ° •r r FINAL �. =FINAL BUILDING q - DATE CLOSED OUT ASSOCIATION PLAN NO.-r r r •-^; +rr J _ 10 Park Plaza - suite 5170 . Boston, Massachusetts 02116 w" Home Improvement Contractor Registration Registration: 153567 Type: Private Corporation Expiration: 12/15/2012 Tr# 206433 CAPE COD INSULATION, INC HENRY CASSIDY - `. ' M a H 10 . . : 455 YARMOUTH RD. �:�{ .�... �� A HYANNIS, MA 02601 1. Update Address and return card.Mark reason for change. .�, Address Ej Renewal Ej Employment Lost Card DPS-CA1 0 50M-04/04-G101216 Office o umer Affairs Bus ne `ReguI tion License or registration valid for individu! use en!y HOMITf �H1C� before the expiration date. If found return to: Vj0_ Registration: 153567 Type: Office of Consumer Affairs and Business Regulation Expiration: 12/15/2012 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 D INSULATION;INC., HENRY CASSIDY 455 YARMOUTH HYANNIS, MA 02601': -q``-.,% Undersecretary t alid ith t si tune ' iV fts>Ytchusetts-J.)cp:u-tmcnt of Puhlic Safet% Board of Buitcling Re!-ulations and Standards'. Qonstruction Supervisor License � 4 0• License: CS 100988 HENRY CASSIDY 8 SHED ROW WEST)�ARMOLITH,:MA 02673 c— �"�'" Expiration: 11/11/2013 ('uumi>.i urr Trt#: 7620 f The Commonwealth of Massachusetts Department of Industrial Accidents.z � Office of Investigations a 600 Washington Street tia ym Boston, MA 02111 www.mass.gov/dia Worker's compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): t G . Address: City/State/Zip: ya P2 V7 (S- )WA 016 Z Phone#: 5�6 9- '7 7 5 " 1,Z f q Are you an employer? Check the appropriate box: Type of project(required): 1• rl lam a employer with 4•❑ I am a general contractor and I have 6. ❑ New construction employees(full and/or part-time).*' hired the sub-contractors listed on 7. ❑ Remodeling the attached sheet.$ 2. E] I am a sole proprietor or partnership These sub-contractors have 8• ❑ Demolition and have no employees working for employees and have workers' comp. 9. ❑ Building addition me in any capacity. [No workers' insurance.$ 10. ❑ Electrical repairs or additions comp insurance required.] 5.❑ We are a corporation and its officers have exercised their right of 11. Plumbing repairs of additions . 3 ❑ I am a homeowner doing all work exemption per MGL c. 152§(4),and 12. Roof repairs myself. [No workers' comp. we have no employees. [No workers' 13. Other erg Z � insurance required.] t comp.insurance required.] 'Any applicant that checks box#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. tContractors that check this box must attach an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees.If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees.Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic. Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.Be advised that a copy of this statement ma a forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do here c i under the ins and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: Official use only.Do not write in this area,to be completed by city or town official City or Town: I 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 oa Contact Person: Phone#: I Date: 4/19/2012 Time: 10:13 AM To: Cape Cod Insulation, Inc 0 1508.778-5735 Rogers 8 Gray Ins. Page, 002 • Client#:4597 CCINSUL ACORD. CERTIFICATE OF LIABILITY INSURANCE o4/1912O12YYY) 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 CUNTcT .NAMEA Margaret Young Rogers&Gray Ins.-So.Dennis PHONE 508-760-4602 FAX C No 434 Route 134 E:t: ac,No: 508-258-2102 �"AI` oun ma ro ers ra com P.O.Box 1601 ADDRESS: Y 9@ 9 9 Y PR DU R South Dennis,MA 02660-1601 CUSTOMER ID#: INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A,P88HOSS Insurance 18333 Cape Cod Insulation Inc INSURER B:Ohio Casualty Insurance Company Hyannis, MA 02601 Yarmouth Road INSURER c:Atlantic Charter Insurance Hy Commerce Insurance Company 34754 INSURER D: p y INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. N R 7ypE OF INSURANCE DDL UBR OLICY EFF POLICY EXP LTRPOLICY NUMBER MM/DDIYYYY MM/DD/YYYY LIMITS A GENERAL LIABILITY CBP8263063 /01/2011 04101/2012 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY DAMA E RENTED PREMISES Ea occurrence $100 000 CLAIMS-MADE 51 OCCUR MED EXP(Any one person) $5 000 PERSONAL 8 ADV INJURY $1 OOO OOO GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY PRO- LOC $ D AUTOMOBILE LIABILITY 11MMBCKVMK 04/01/2011 04/01/2012 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $1,000,000 ALL OWNED AUTOS BODILY INJURY(Per person) $ X SCHEDULED AUTOS BODILY INJURY(Per acadeni) $ PROPERTY DAMAGE X HIRED AUTOS (Per accident) $ X NON-OWNED AUTOS $ $ B UMBRELLA LIAB X OCCUR 0001254514645 4/01/2011 04/01/2012 EACH OCCURRENCE $1 OOO 000 EXCESS LIAR CLAIM$-MADE AGGREGATE $1 000,000 DEDUCTIBLE X RETENTION 10000 $ C WORKERS COMPENSATION WCA00525902 6/30/2011 06/30/201 X WCSTATU- OTH- AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE I NIA E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Workers Comp Information Included Officers or Proprietors CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 01986.2009 ACORD CORPORATION.All rights reserved. 1 ACORD 25(2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD #S80552/M68179 MEE f OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at , (Property Address) (Property Address) hereby authorize 12Ll CTiIJ (Subcontrac ) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. Owners Signature Date D MAY 2 5 2W TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION /I 31 Map 'T Parcel ©� I :'Application # _ Health Division Date Issued -4 I Z Conservation Division Application Fee S Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic OKH _ Preservation / Hyannis _ Project Street Address -14 Tyiatcl�r AaMw ?,A Village mrsiuns Hill's _ Owner T Ri�`f Pil Address Tha r Telephone GA Q P,'-+ U II-a455 Per it Request un I1 ny) 0 ►a _phoj= a-Q.ia Square feet: 1 st floor: existing proposed _2nd floor: existing proposed Total new Zoning District -1 Flood Plain Groundwater Overlay Project Valuationj�, Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach yorting dMi umodtation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) o Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway:Q Yeses❑ 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 nevus, 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: 44� Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILPER PR HOMEOWNER) Name Ch r�SZte"T'sr Telephone Number 5n Address PD License # ( Oc _ 75 /0 A 00 6 _ Home Improvement Contractor# I Worker's Compensation # KU6-4 I ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO >n4abk e TrQy�S�er S' Vcc�` SIGNATURE AYE ,r } FOR OFFICIAL USE ONLY APPLICATION# -,.DATE ISSUED MAP/PARCEL N0: .�:. ADDRESS VILLAGE OWNER DATE OF INSPECTION: -'°.FOUNDATION uA. FRAME n INSULATION)..: �. { FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS:;: ROUGH FINAL, -e'sFINAL BOIL^-DINGAx:." Z i `?%-1 DATE CLOSED OUT s - r . ASSOCIATION PLAN NO. - ,r i The Commonwealth of Massachusetts I P[intform ={I �----� Department of Industrial Accidents Office of Investigations I Congress Street,Suite 100 Boston,MA 02114-2017 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): U U 1 &Mr Address:0 zmX ?I City/State/Zip: C(9 V6 M H DD Phone#: (5 0 6-to t—E 4 4,-) Are y u an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.El I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have employees ❑ Demolition workingfor in an capacity. employees and have workers' Y P ty : 9. ❑ Building addition [No workers' comp. insurance comp.insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I I.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.�Other Sp I<Q� comp.insurance required] Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: 'raydeh� Policy#or Self-ins.Lic.#: lu KL( 4 l 2 O P R- o� Expiration Date: 319 9 Job Site Address:44-T—ha V1 H D Q City/State/Zip:pQ,�nS µI US, 1" z),Z&�fg Attach a copy of the workers'compensation policy eclaration page(showing the policy number and expiration date). T 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 ce der the paifis and . ge!g=that the in ormation provided above is true and correct Si Date N` Z- 12 Phone#: 77�( -S Z� -7(o 31 I 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#: ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM1DDIYYYY) 03/29/2012 PRODUCER (781) 312-7206 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND FERS NO RIGHTS UTHE Don Bunker Insurance Agency OLDER. TH SOCERTIFICATE DOES NOTO AMEND, EXTEND CERTIFICATE AMEND, 51 Mill St Bldg. F ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PO Boa 221 Hanover MA •.02339- INSURERS AFFORDING COVERAGE NAIC# INSURES INSURERA-Nautilus Inc Co. Cotuit Solar LLC INSURER B:Travelers 3800 Falmouth Road wsuRERc:Arbella Protection INSURER D: Marston Mills Mk.-02648- INSURERS COVERAGES ' THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT NTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AD LTR TYPE OF INSURANCE POLICYNUMBER POLICY 7�E EFFECTIVE DATEE(MMMU CY jN LIMITS A X GENERALuAnLITY KN026707 06/01/2011 06/01/2012 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PDE S $ 50,000 CLAIMS MADE a OCCUR / / / / MED E P one $ 5,000 PERSONAL SADVKILIRY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE UMITAPPUESPER: PRODUCTS-COMPIOPAGG $ 2,000,000 POLICY X PR JECED LOC C AUTOMOBILE LIABILITY 26916400003 04/30/2011 04/30/2012 COMBINED SINGLE LIMIT ANYAUTO � ) $ 1,000,000 ALLOWNEDAUTOS / / / / BODILY INJURY S X SCHEDULED AUTOS (Per Per—) HIREDAUTOS / / / / BODILY INJURY NON-OVOIED AUTOS (Per aoddent) S PROPERTY DAMAGE (� ) s GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO / / / / OTHER THAN EA ACC S AUTO ONLY: AGG $ A X EXcESSR1MBRElLALIABILITY AN001320 06/01/2011 06/01/2012 EACH OCCURRENCE $ 2,000,000 X OCCUR CLAMS MADE AGGREGATE $ 2,000,000 $ Rx DEDUCTIBLE / / / / S RETENTION $10,000 $ B WORKERS COMPENSATION AND 611D8-4988P86-8-12 03/26/2012 03/26/2013 R Ola LDS EMPLOYERS'LIABILITY ANY PROPRIETORIPARTHER0MCUTNE EL EACH ACCIDENT S 500,000 OFFICERIMEMBER EXCLUDED? / I I / E.L.DISEASE-EA EMPLO S 500,000 If yes,deserbe under SPECIAL PROVISIONS below EL DISEASE-POLICY LIMIT Is 500,000 OTHER / / —-------- DESCRIPTION OF OPERATION&LOCATIONSNBIICI E&E7CCLU9010 ADDED BY ENDORSEMHVTISPEdAL PROVISIONS Solar Heating Contractor installation of solar panels *Aggregate Limit Applies per project Additional insured: Massachusetts Clean Energy Technology Center, the owners S as applicable the host customer. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BIT Massachusetts Clean Energy FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE Technology Center I R REPRES ATIVEs. 55 summer Street, 9th Floor AUTIIO Boston MA 02110- ACORD 25(2001108) m ACORD CORPORATION 1986 INS025(010nos ELECTRONIC LASER FORM.INC.-(800)=41W Pap 1 of 2 O ffice o�Consumer air and Business Regulation .` 10 Park Plaza - Suite 5170 Boston,.Massachusetts 02116 — L N •:. Home Improvement Contractor Registration ' O ��jj '• Registration: 146276 Type: Supplement Card 10- Expiration: 4/8/2013 a COTUIT SOLAR — ' i CHRISTOPHER PETERSON I t ?r Z o �* 3800 FALMOUTH RD. n � �o ,Q o. ! MARSTONS MILLS, MA 02648EQ — 'L - �' I Update Address and return card.Mark reason for chiingC •_ :. W .k = J Address �] Renewal Employment �� Lost Card tY E. i' DPS-CA1 c� '50M-04/04-G101216 w U Z i �. ✓lac '�Do��vr�u»uveccll�. o�✓tlaaJrrJeCld I: 0 tO Office of Consumer Affairs die Business Regulation License or registration valid for individul use only L.... a before the expiration date. If found return to: IiOME IMPROVEMENT CONTRACTOR a U I - r'`'' Office of Consumer Affairs and Business'Regulation I �� r. Registration::: Type 10 Park Plaza-Suite 5170 j •`,;�> Expiration:.:gj Supplement Card Boston, 021E COTUIT SOLAR. CHRISTOPHER PETERSOtV ` P.O.BOX 89 �•�'-�'^��-- _ COTUIT,MA 02635 Undersecretary Not valid without signature 0 V u m C I S ASS 0 C I AT ES Structural Engineers LxlB Phyflumional sour Products,111111 1551 S.Rf�ae Atra.,Oxt�rd,� - Tel:50640 4Z00 SubjeM Static load test results for the#allowing. M �aatfmmn Frame Madintim Fraste toad EquivaleritWirid Spea1 tsmgth Ch) W11W(f>r,) 5WN5 {�P' Rouffrac - 65 40 55 135 TW; EW(as shown in-=died Three modules%as specified above,were.batted to 336 XIS&e1.5' pal Solar Products(PSP)patented m&suPport ras.usiitg an assembly of 5/16'Staff Steel(S S)Botts. SS lock washers and p fopdM- ly aluminum clamps and inseris.The RoptTiags support rail was attached to the PSP R�racs structural allac hme.adevice with a 3/8'SS nutand SS washer at six attachment points.The setup was attached to 2"z6' wooden iraRers using 5116'x 3-112'SS tag bolts The attachment spans consisted of 48'front to rearwith struc turat . attachments spaced 48"on center. 7ES T PROCEDURE(as dO Mn in aftclued drat ftditWrT.The best set up wastop loaded to 55 tb/W The setup remained loaded for an approximate period of 30 minutes.The maximurn deflection and anysigns of permanent deformation were recorded.The Lest setup was then Inverted and loaded-to simulate the uplift:.condition.The test set up was re-loaded to 55 Ib/ft?The setup remained loaded for an approximate period of 30 minutes.The maximum deflection and any signs of permanent deformation were recorded. TES RESULM The maximum top load deflection was recorded at 0.469.with no permanent deformation. The maximum uplift deflection was recorded at 0.31.3',with no permanent deformation. This documentcertifiesthe RooffracP mounting system used with modules,asspecifted above,withstands a 55 Ib/Wstatic pressure'load,equivalent toa wind speed of approximately 135 mph"'_The.mountingsystem performed as expected_ Sincerely, James R.Vinci.S.E. nft erop,mMg repartvedfksthatlfmd&/ls cbMsit m provided kHkii ndentoravadm:forbm testing asdesenIM irithis report.fie results of Utis losdWa,neixactuetdeft etbnvahresanidaregenerelyacwPte0asvmin&*Wstmdwdfor.testingrfiodirremo nftsymnm trod&AssocUtesdoes notfidd dredc arts orverr7ythat the momftsystem is tnstaaed as descrfbed in fits engineering report Toassmftbuadbt wepecfntufverrw)mgMeauu=Myofthispmpde Yffounftng"m m.aponmtemecteam, T j silver relaqwRoarraco,wa as show tnihe right Is placed on at teat one of the main support ra➢s or Roof pemrm+eredystemped with'Protee��t�rad_�retlf$350.483.'on the underside of ren. $tnrcbaalattachrrrefhf:Lagbotanaameasttwfdbeitr�using the pro;wp5Kholeforq*nurnzv A l+� 5/16'bgbdtr64L6 sa3/IWPdathdettistherespa rfityofthetrsWerto[rsuaeaproperai>adiment;smade totheslructr wmernberoftherwL Fa mewsemelyanadrtoftrD fsVucWnDff Fesuntndamagete eMAMML pWonatinpayorpmpergid8rna9P- Tnis offic does not eXpres+s an opWw a w the toad bearing draractWblks of thestn>cwm the mounting E system/modules are being installed on-cued Q testedsvw wal anadnrenis rr>arr dntsed by Pogewwai Solar Pmoducts QUO 9 p Nx ld-mg a laboratory VRththis� . ti¢i (rnc�gFast)adc°.Ti�TtaeM-FoarnladP)canbeferdraged to � � -- rn *Modules masnft%Wn Meted spedbogoes midlesteb to t111703.or equhratent are Induded In this ci mgvalws relative to defined toad values usMgwmd load eOue(13S mph nor S/32 roof pah or less`115 mph for WeStel i 5/12 roof pitch?aaa gustfactor eoetrident eaihosuie C'as U� defined in the2006(I 3Q/20D7(c? •w+Moduletested:84.6'x 39.1'x 18'(shrp) - •++•EsL snow load ratingof 30 i4flF besed an"a safetyfaaor 31324 VIA COLiNAS GTE 401 lIrESTLAKE VILLAGE, CA 91362 PSP Page 1 0T 3 - •�'%'i':a id;:i: 1 _a-. • -.rid,-„_!_ ` r ' NSUNTECH Solar powering a green future" 225 Watt POLYCRYSTALLINE SOLAR SOLAR MODULE Features High module conversion efficiency (up to 13.6%),through superior cell technology and leading manufacturing capability Positive tolerance Guaranteed positive tolerance from 0-5%ensures 1 power output reliability Suntech's TruPower" 10% Suntech's TruPower-process neutralizes the initial LID effect Excellent weak light performance Excellent performance under low light environments (mornings,evenings,and cloudy days) Withstand high wind and snow loads - —� Entire module certified to withstand high wind loads —� (2400 Pascal)and snow loads(5400 Pascal) Certifications and standards: Suntech current sorting process UL7703,IEC61215,IEC61730,conformity to CE i I All Suntech modules sorted and packaged by I I amperage,maximizing system output by reducing t:SPAS mismatch losses by up to 2% 0 CE Fol Trust Suntech to Deliver Reliable Performance Over Time Suntech modules are • World's No.1 manufacturer of crystalline silicon photovoltaic modules =,.-.rr, . _. - trusted and proven, • Unrivaled manufacturing capacity and world-class technology powering over 2.2 GW of • Rigorous quality control meeting the highest international standards: - -- solar installations all over ISO 9001:2008 and ISO 14001:2004 i the world. Industry-leading warranty • Warrants 6.7%more power than the Latest IP67 rated junction ® market standard over 25 years box improves module • 25-year transferrable power performance stability.High Mai output warranty:5 years/95%, performance connectors 12 years/90%,18 years/85%,25 provide low resistance �* interconnection to ensure ,M years/80% "* the full utilization of • Based on nominal power module power output. o • 5 years material and workmanship warranty i Please refer to Suntech Standard Module Installation Manual for details. "Please refer to Suntech Product Warranty for details. OCopyright 2011 Suntech Power r2011 STP225 I I Electrical Characteristics a, STC STP225-20/Wd /%krr.cbw box Draumon Optimum Operating Voltage(Vmp) 29.6 V .......................................................................................................................................................................................... Product label Optimum Operating Current(Imp) 7.61 A Open-Circuit Voltage(Voc) 36.7 V .......................................................................................................................................................................................... Short-Circuit Current(Isc) 8.15 A ......................................................................................................................................................................................... •P 1 Maximum Power at STC(Pmax) 225 W L1 Module EMciencY..................................................... _..................................1.3.6%.................................. .... Operating Module Temperature -40°C to+85°C ......................................................................................................................................................................................... Maximum System Voltage 600 V DC(UL)/1000 V DC(IEQ .......................................................................................................................................................................................... 2°1 Maximum Series Fuse Rating 20 A (Back View) ......................................................................................................................................................................................... PowerTolerance 0/+S% i STC:Irradiance 1000 W/m',module temperature 25 T_AM=1.5; Power measurement tolerance:t 3% Section nJ. NOR STP225-20/Wd Front lew) I M.aximum. .. .. .. Power.... (W) 165 W . . ..........9.......................................................................................................................................... J ...... ....... ........ A 2 , Maximum Power Volta a(V) 26.9 V .......................................................................................................................................................................................... 3s,. w, Maximum Power Current(A) 6.12 A Note:mm[inch] - ........................................................................................................................................................................................- Open Circuit Voltage(Voc) 33.8 V ................................................................................................................................................... Short Circuit Current(Isc) 6.65 A Current-Voltage&Power-Voltage Curve(225-20) NOR:Irradiance 800 W/m',ambient temperature 20°C wind speed 1 Ms; a uo Power measurement tolerance:t 3% e Mechanical Characteristics es so Solar Cell Polycrystalline 156 x 156 mm(6 inches) ............. ........................................................................................................................................................................ 0o No.of Cells 60(6 x 10) 3 . . . ......................................... ........................................................................................................................... ................ = so Dimensions 1665 x 991 x 50mm(65.6 x 39.0 x 2.0 inches) ..................-............................................_................................................,.......... Weight 19.8 k g s(43.7 lbs.) o s to is p 25 30 35 Front Glass 3.2 mm(0.13 inches)tempered glass Voltage(V) ...............................................................................................................................................................I.................. ... . . Frame Anodized aluminium alloy =l000wmr eooW/m• 6110W/m• ♦aoW/m' ]ODW/m• ......................................................................................................................................�................................................... Junction Box IP67 rated .......................................................................................................................................................................................... Exellent performance under weak light conditions:at an Irradiation intensity of U. . L 470. .3,T.U.V(2P.fg116.. .92..00.7) . . .. .. . ..... . .. . . ........................................................ 200 W/m2(AM 1.5,25-C),955%or higher of the STC efficiency(I Goo W/m2)is Output Cables 4.0 mm'(0.006 inches'),symmetrical lengths(-)1000 achieved mm(39.4 inches)and(+)1000 mm(39.4 inches) .......................................................................... .................................................................. . . Connectors H4 connectors(MC4 compatible) Temperature Characteristics Packing Configuration Nominal Operating Cell Temperature(NOCT) 45t2°C Container 20'GP 40'HC ......................................................................................_............................................,........... - Temperature Coefficient of Pmax -0.44%/°C Pieces per pallet 21 21 ....................... .......................................................................I.............. ......,......................................................................................I................ ............ ......................... ... ......... Temperature Coefficient of Voc -033%/°C Pallets per container 6 28 ............................................................................................................................................ ............................................................................................................................... .............................. .. Temperature Coefficient of Isc 0.055%rC Pieces per container 126 588 Dealer information Specifications are subject io change without further notification • • t2011 44 Thatcher Holway Rd Marstons Mills—Matthew Rittel Installation of 12 solar photovoltaic panels flush mounted to roof 2% lbs./ft2. oaP 00 o°q d '�Q Jrjf i. .., � � I SS4yt Moo PRe004,0L TOE D"M cut"P IKX Boo P-POs,r,.�aF�F tYs 1�L 4 9N6#7Yt�tJ4 . 3�t CAW. Vt6 z►vto' P��it ' TYPs AL- Me�NTse16 PV Pltaw/ i 04/06/2012 08:43 5087719555 EMERALD PAGE 03/03 P��F2►tErpr`'r Town of Barnstable Regulatory Services �1 t"OSTA Thorriox F. reiler, Dircctnr � T %`✓ Building Div isioxl �,cr,►tea Tom Perry, 3ttilciing Commissioner :40 Main Cirtet, Hyzwnis,MA 02601 wvrw.towr.11a rnsis hfe:.ma.t's Office: 508462.4038 Fax: 5os-790--w30 . roperty owner. AI'Llst Complete and Sign. This Section Tr Using A. B'LiAdcr as 0-\V;:r.r. of the asoject propert-y hcreb; attt,},e�ri�C_. CC�_IV t _Se6\Qv• - --- . _ er., a•Lt on my behalf, in 1+I t7,.1ti:rre rrlatxv r_ ro worts aut),orize.d bv rl,is be>;ldinf; q-011ir a.Yl*It7Oz, fnr. (Addrrss oE.jnl,� Sigmf,ure of Owner a rn.Narnr, t(Prvpr-cty OssMncc is applying for permit plea.5c: complete the Horricownc.m License Exemptiota Form on the reverse side_ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION, Map Parcel' ��"� - Application # O N sa Health'Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board - Historic;- OKH Preservation/ Hyannis Project Street Address �-� ( (''1 �-I t"1 C t 4 L Village 10,�U S M I l C ) Owner_ VV*1 I-VCw Address.. s v n C Telephone Permit Request V(,CM O✓J C L. CAb0— eeo P oc Square feet: 1 st floor: existing I L�proposed 2nd floor: existing ?Q0 proposed Total new Z �G Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type uJCk;>0 Lot Size • S S Grandfathered: &—Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family If Two Family ❑ Multi-Family (# units) Age of Existing Structure I a Historic House: ❑Yes �(No On Old King's Highway: ❑Yes &No Basement Type: 0 Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) 0 Basement Unfinished Area(sq.ft) Z O y Number of Baths: Full: existing new 1!�' — 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 XNo Fireplaces: Existing_New Existing wood/coal stove: ❑Yes W No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑-new e_ Attached garage:)Kexisting ❑ new size _Shed: ❑ existing ❑ new size _ Other: 71 _0 Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# _ Current Use Proposed Use APPLICANT INFORMATION _ (BUILDER OR HOMEOWNER) Name e A PE LU t 0 C (=-"jI C 1 Q4 t3CC Telephone Number 5` Z ti zg f Address —I � C-T 2 & License # V -I 2- � 3 1 k /Y)� - Home Improvement Contractor# P C( 33 Sq Worker's Compensation # C_ g 5 16 i �" Z ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO C'A'-Ss C LGA- SIGNATURE DATE (W Z �� -0 f t `Y • FOR OFFICIAL USE ONLY I APPLICATION# DATE ISSUED ' MAP/PARCEL N0, 1 'ADDRESS VILLAGE � 1 OWNER DATE OF INSPECTION: FOUNDATION FRAME !? r c lof�9 INSULATION F E 't = FIREPLACE . , J ELECTRICAL: ROUGH FINAL + PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ~FINAL BUILDING DATE CLOSED OUT. ASSOCIATION PLAN NO. - t L c• �1.a:� :tchttsctt.- I)tlt:trtntcnl nl l'ultli� nl�n Buartl ul i3uiltlin RCCul;rtinn. nntl ` t:u�rl:rrrl. construction-Supervisor License License: CS 89273 � Restricted to: 00 ` tl RICHARD M CAPEN 122 WHITMAR RDrz K ;.laFr COTUIT, MA 02635 # Expiration: 11/27/2011 uuni..i nrr Tr=: 9638 1 Restricted to: 00 00- Unrestricted 1G-1 2 Family Homes Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Refer to: WWW.Mass.Gov/DPS . ✓�eC::�an?rrrzarzure� O� �/�,aaaaC�..utP,tld- w _ Board of Buildi'ng9Regul'ations ariil Stander`d's HOME=IMPROVEMENT+:CONTRACTOR Registration: 1'43358 Expiration 7/g/2010 •Tr# 272627 Type :LtdLiability Corpot CA;PWIDE'ENTERPR SES_L L-E Cc RIC.ARD CAPEN 4507 R RTE COTUIT MA'0263 Adminrstrato5 License or registration valid for individul use only before the expiration date. fffound return to:, Board of Build'iritRegulations and Standards One Asl%burton Pl'ace-Rrn 13:01 Boston,MR..,02.108 9 i .LYalid without' ignature The Commonwealth of Massachusetts _ Department of Industrial,4ccidents Office of Investigations ;r�s 600 Washington Strect Boston, tb1:4 02111 ►vrv►v.titass.1a ov/diu Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. Anplicant Information Please Print Lefyih(v Name (Business/Organiza(ionilndi�-idual): CvO ;)C—W l OC C`',-J-CC-VI L(�tt S C�' �LC Address: �_0 2 City/State./Zip: C 07-0 17 qYV Phone m: (13 Are you an emplover'. Check the appropriate box: Type of project(required): 1.K I am a em to er with 4• ❑ I am a general contractor and [ P Y �— 6. New construction employees(full and/or pan-time).' have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. a Remodeling ship and have no employees These sub-contractors have S. ❑ Demolition workingfor me in an capacity. employees and have workers' Y P 9. ❑ Building addition [No workers' comp. insurance comp. insurance.+ ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] 5: officers have exercised I I. Plumbing r ;. 3.❑ I am a homeowner doing all work hv cied their ❑ repairs or additions right of exemption per NIGL myself. [No workers comp. 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 till out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have r _ employees. if the sub-contractors have employees,they must provide their workers.'comp.policy number. a": 1 am an employer that is providing workers'compensation insurance for my employees. Belory is the policy and job site information. /� Insurance Company Name: (4 AN GU&'L `�N S udt A Al CC Policy#or Self-ins. Lic. #: C Lf `T Expiration Date: '0 / z 0t o Job Site Address: U q T Hg-L1 "C—,�,_ �I ti'City/StateiZip: 0°V� (YJ L L Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date)., Faiiure to secure coverage as required under Section 25A of 1AGL c. 152 can lead ro the imposition of criminal penalties of a Fine up to 51,500.00 and/or one-year imprisonment. as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 3250.00 a day aeainst the violator. Be advised chat a copy of this statement may be forwarded to the Office of im•estications of he D[A for insurance covera<e verification. 1 do hereby c iji corder the pains and penalties of perjury that the information provided abut i true and correct. 10 t z 20� Si=nature: �' , ? 1 Date: — Phone 4: Ojficiu «s�welt'. Du not write in this area, to be completed by rin•or totrtt official .Cite or Town: Permit/License Issuing Authority (circle one): 1. Board of health 2. Building Department 3. Cil.'Tn%%n Clerk 4. Electrical InspectEPlunibin- Inspector b. Other Contact Persow Phonc =: .AC®RDM CERTIFICATE OF LIABIL- ITY INSURANCE 0411 12 9 PRODUCER (800)782-0251 FAX (781)261-2099 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Eastern Insurance Group LLC - Commercial ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE t HOLDER..THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 77 Accord Park, Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELLOW. Unit Bl Norwell, MA 02061 INSURERS AFFORDING COVERAGE NAIC# INSURED Capewide Enterprises LLC INSURERA: Hanover Insurance Co. 22292 PO Box 763 INSURER B: ACE USA Centerville, MA 02632 INSURER C. r INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH"THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. rA DD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS NSR GENERAL LIABILITY LBN5336555 04/.3012009 0413012010 EACH OCCURRENCE $ 1,000,0061 X COMMERCIAL GENERAL LIABILITY DAMAGE 70 RENTED $ -300,OO CLAIMS MADE a OCCUR MED EXP(Any one person) $ 10,00 PERSONAL&ADV INJURY $ 11000.100( GENERAL AGGREGATE $ 2,000,00( VGEN17AGGREGATE.LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00( POLICY M JERK LOC _ AUTOMOBILE LIABILITY TBD AUTO 0412012009 0412012010 COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO 1,000,006 ALL OWNED AUTOS BODILY INJURY (Per person) $ q X SCHEDULED AUTOS X HIREDAUTOS BODILY INJURY $ X NON-OWNEDAUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) ' GARAGE LIABILITY AUTO ONLY EA ACCIDENT $ ANY AUTO OTHER THAN .,'''•FA ACC $ .AUTO ONLY: .', '"AGG $ EXCESSIUMBRELLA LIABILITY UHN5336S45 0412012009 '0412012010 EACH OCCURRENCE $ 2,000,OO OCCUR, a CLAIMS MADE AGGREGATE-.- $ .00 RDEDUCTIBLE $ X RETENTION $ 10,00 $ WORKERS COMPENSATION AND C4576147� 04/14/2009 0411412010 WC s7nTl I- I OTH- EMPLOYERS'LIABWTY.r_._.._ E.L.EACH ACCIDENT $ 500,00( B ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 500,0O If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT 8 SOO,OO OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Evidence of Insurance. " CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, a BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE' Ronald Cl eaves/KC1. ACORD 25(2001/08) ©ACORD CORPORATION 1988 ,ofTMEr ti ToWn of•Bairn' stable o • Regulatory Services M Thomas F. Geller,Director Building Division Tom*Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.b a rn s to b le.m a.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section if Using A Builder as Owner of the'subro l Property hereby authorize CA PGW(cd C. 'V f C i e, i.S C— s to act on ray behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) Z,'1 (e�ignature of Owner Date Print Name • a If Property Owner,is applying for permit please complete the Homeo cvners License Exemption Form on the reverse side. r -M A�iia•tJ�S �cG�S d14�} . .:..:. . ::: { 0 I .......... -X . t -71. . It i yy sA j l`9 • ;t ,+ .. ............- f r:, 71 Tq 'Be-D eooM -bA (set k TACACr>11 to y Cco 5ebP— LA A==A A= OP�� c�� AA - 1, :.T:'�'r. CX S �.�., �' t'. ': is ..+. i: `!/y �� `. 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INSPECTOR APPLICATION ,FOR PERMIT TO ....... �m� / zi TYPEOF CONSTRUCTION ............................................................. ... .................................................................... ................................................ ........................ ��/9./ .19. ..... ......... .... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..... iC ?e..... Ci.W1}�0 /�� / � �... �`r/....s......... ?.. .:................................. Proposed Use ............................................................................................................................................................................. 12 ,f-r T Zoning District ................... D{n!T!��................................Fire District ......�..`............✓i��........................................... Name of Owner ... lG/,L!Q D........... !VZ..............Address Yy.7! � 'e.....!7���. .......�........� ...... �?// �� Nameof Builder ....................................................................Address .................................................................................... a p�. IA— Name of Architect ....... ...................Address °............................................:......................................... ...... .....Number of Rooms ..................................................................Foundation 6�.R:��...................................................... Exieriorv....... ....................................:...............Roofing ......... .J .. `'+t..l....................................................... Flqors \ Interior ........li � ��1........A'. . ......................................................... `-� .......... G.. .................... ................ Heating 4,L � C�1'�� (— g ............ ......................................................Plumbin ......... Fireplace ...........................�.......................................................Approximate Cost ......Gir .. .v.d.. .:... ................................ Definitive Plan Approved by Planning Board -----------_------_-----------19________ . Area ....Z., . . .Diagram of Lot and Building with Dimensions Fee � ...... .............................. SUBJECT TO APPROVAL OF BOARD OF HEALTH 22. y=-- OCCUPANCY PERMITS REQUIRED IJOR, 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 .................................... -TANZ, RICHARD No .?7D2..... Permit for DWELLING .................... Si��Cj.le..F.Family Dwellin.. .... .. ..........................._q........................... 44 Thatcher Ho Location ...................................IV�!y Road...................... Marstons Mills ............................................................................... Owner. ..... chard.. .................................. ............ .. .... Type of Construction ......FKar.w......................... .................................................................................. Plot ,-..*.......................... Lot ................................. Permit Granted ... .....April-...10 ............19 85 Date of Inspection .................19 ...Date Completed ........... .......19 7 TOWN OF BARNSTABLE Permit No. -------------------------- 1 Building Inspector»n� Cash 7op bYP P OCCUPANCY PERMIT Bona _________ "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Pjnlia ri Tiff" Address Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. ...................................................... 19......_ _ ............................................................................................._.._.._...... Building Inspector Ass sse 6's mapo and lot nu �� Q��.-�-8- ............... E� .�-mod OF TN E t0 � S "C SYSTEM Sewage Permit number ............ 9 E MU �NgT COMP. �/ 'N L STODLE, i House number �l�'T ENVIRO MN TITLE 5 4.900 "639.a�e�' ...... .. . ................................................. ENTAL COCA,.' a'M n TOWN OF BARNSTXvfl1T"AT';,` , BUILDING INSPECTOR J `'.� APPLICATION FOR PERMIT TO ..... .t.W. ..1�...... . 4ke.� c ....cJ r. . ............ .................. TYPE OF CONSTRUCTION ....... ........ ...............................19s p. TO THE INSPECTOR OF BUILDINGS:' The undersigned hereby applies for a permit tacncording to the following information: Location ..... f......7..�......Y.�:. /...6 /A1r... .{:t. .....J.� ............ L..: ��C :............. ��/ / ProposedUse .....fie.....A :. ....... . . ...... ........ .. ... .......................................................................... ZoningDistrict ........................................................................Fire District ....... .. ..0....................................................... Name of Owner�� }. !�(V(�I1 .. GJY1. Address 4� t�D F--C�. ... ..... Name of Builder .G1... �...........................Address �......... .............fW4?. 1r...�...li.:. ....... mob Name of Architect DaW.D c} .. Address ............ �...........OL-.J&.--t. ................... Number of Rooms .......5......................................................Foundation .... ........ 1..... C11. .............. Exterior 7AIA..... if ?!`^ ..... !`-..�...r�. \�. rRoofing ......aA..i. Floors —UA. .........................................Interior ..../..z........................................................................... W.. Q.5� .;Plumbing ...... Fireplace b p Approximate Cost ..."k.C77Sd.................f....Q........ ......... .. ..... Definitive Plan Approved by Planning Board ---------------—-----------19________. Area .......l...s!1.. ........ .............. Z - Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH —WOtiJ( , k7,6. 41 Q. L,4 1 t £'" C w � o I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .... ...... .. �. TANZ, RICHARD " 22 1 One 1 2 Stor No ......�.�...... Permit for .................1................1' ingle...F..amil ..Dw.e.1 .ixi9................. L' f��tcation ..Lai.. .2....4.4...Tha-.cher...Halw.ay Road ............Marsfons...Mills.............................. Owner ..Rir-haZCl...T.anz................................ Type of Construction ....F.rame......................... ................................................................................ a Plot ............................ Lot ................................ Permit Granted ......October 16 .....19 80 Date of Inspection ................/Z Z 6 9 Date Completed 19 PERMIT REFUSED y _ ,.. S ...... �..�............................ 19 ; ti . . ................................................ H ...... .N r... ........................................ . ..........f. -. �. � . Appr ed ... ....... ...... .�... 19 .. ..... .`................ The Town of Barnstable 9 9. �m�' Department of Health Safety and Environmental Services ` °rFa,,, • Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissions For office use only 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. ents Type of Work: C1014CP�t. Cost e Address of Work: Owner's Name Date of Permit Application: W " 7 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under 51,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Date Owners Name The Commonwealth of Massachusetts :ate- Department of Industrial Accidents � ��-__ t .�•-� � .�� Office al/nyestigatin�s 600 Washington Street 0 Boston,Mass. 02111 '— Workers' Con,3eensation Insura�nccee Affidavit VV name: �-!lI4 -11'f/D klAIC ' �Yh 4VAI location: C,LJ6f LbL M A- / city DUI lq' 3 M m 1U-5 nhone# ❑ I am a homeowner performing all work myself. ❑ I am a sole aronrietor and have no one working in any capacity VO/rUMME �:222: I am an employer providing workers' compensation for my employees working on this job. comnnnv name: 0 IN�JI�r llo�s AleijMdAI address: city: 0 Mir A& Aati .3S nhone#: C.S'0,0 �oZg- 9S/8 insurance Co. nolicv# W C uat ❑ I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have the follo«ing workers' compensation polices: comnnnv name! ... .::::.. .: address: dtv: phone#r ..... .. '. ..: ... Insvrnnce cn. vltcv#.. ,. .. :...... : : . comnnnv name: addresr: city- phone#' :.::;.....::.:... ..:::.. inuvrance co. : .::.•:;:::::.; . z;:.... olii:v# ...... ......... as fW8 Failure to secure coverage as required tinder Section 25A of MGL 152 can lead to the imposition of crtminal penalties of a tine up to S1.500.00 and/or one years'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 OMce of Investigations of the DIA for coverage verification. I do herebv certify under the pains anddppen/allies perjury that the information provided above it�trru�:and/correct Date "7 `� 7 7 _ Print name 1'R Et)Ft l Cx V. R A S C H.� Phone# q D g' /S/8� (contact tllcial ere only do not write in this area to be completed by city or town of ciai i or town: perntitlllcense# ❑Building Department ❑Licensing Board ❑check if immediate mponse is regeired ❑Selectmen's Office ❑Health Department person: phone#; ❑Other (trn+ea 9i95 PIA) 1 ✓xe -&W)t )1L nrueaCC/ v1,.11ajaac/ruaee6 CEYARi EYT Number ��ie �mnnna o�✓�aa,ac%uJeaa ;�eSCf1Ct?� T): •1�) HOME IMPROVEMENT CONTRACTOR � /"Ni�NAi` CnPI7: Registration 100740 'b=5 NE'WOWN ?L ' Type PRIVATE CORPORATION _0TUIT :yA EzpiTation. 06/23/00 CAPIZZI HOME IMPROVEMENT, INC G�• �o7� �h as Capizzi, S_T. ADMINISTRATOR 1045 Newton Rd. j Cotuit MA 02635 t r` ',��e -p�a�nrinn,nrueal(�. c/ Gl�ea.;ac�u�eC!' ` 'sue OEPAP,TNEHT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE Ex i 3ifthUate: Number: t..P res: CS '357332. 0912611999 09126ji962 Restricted Tb:_ a0 I ' iHOKAS X- CAPIiZI iR 280 PERCIVAL OR W BARNSTABLE` AA 02668 i j��� ��a .'� •J�e -1�0�)/LAC.09LlUP,aLCI P`vC��Gi3af.{f CCdP.�. OEPARTNENt OF PUBI IC SAFETY r'x 3 CONSTRUCTION SUPERVISOR LICENSE § 1 lumber: Eroires: Bir0eate: CS Oi27a9 021aaJ2aa2 a'r.iaal{9r Restricted To: a0 FREOERICK V RASCH III ia60 BOURNE RO PLYROUTH, NA 02360 i Town of Barnstable Regulatory Services San MASS. Thomas F.Geiler,Director �A 039. ♦0 lEo 39r A Building Division Elbert Ulshoeffer,Building Commissioner 367 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 ASHED REGISTRATION �CP.Y 120 square feet or less Location of shed(address) Village Property owner's name Telephone number Size of Shed Map/Parcel# n� D 6 - /3 6 / S ature Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? Conservation Commission(signature required) PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,.THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. caulk iq 1 o THIS FORM-MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg i - _ N54 38'55"E \ 26. 99' — OLD ROAD---� \ (12t UDE) \ `,,-LOT 7 OLE � BY PLAN \� NO W \ REMO VED ti ~ 2' 0 VERHANG BALCONY LOT 6 ;� ____ LOT 8 ---------=--- - zzf w Dts'Gk' ��• \ \ \ � I � �+ POLE LINE i 74. 01' — — L=51.00 S5731'31"W BY CALC. R=1 7 0 S57 51'31 "W BY PLAN THA TCHER HOL WA Y 1- _D. RFS. ZONE.- "RF" This MORTGAGE INS P FrTIO N Plan is For FLOOD ZONE.- "C" Bank Use Only TOWN: _AfJRST_ONS MILLS— _ _ _ _ REGISTRY OWNER: RICHARD & EVELYN TANZ DEED REF: _,3M41Z80 _ _ _ _ — _BUYER: OWN '_0137' N�'��1LS�1V I9.4Y-4L L DATE: _ — _ _ — — _ PLAN REF: _e871,,?7_ _ _ _ - -SCALE: I"= 30 ___FT. I HEREBY CERTIFY TO BLAZA_HQME MQE_TGJ_ E ______ `%w of YANKEE SURVEY _B_A-NK,_FS_B ------------- THE BUILDING SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS ?o` PAUL a CONSULTANTS SHOWN AND THAT ITS POSITION DOES ____ CONFORM a 40B (SUITE 1) 'FO THE ZONING LAW SETBACK REQUIREMENTS OF THE 3 MEARMEW H i TOWN OF ___BARNSTABLE___ --------AND THAT No. 39M INDUSTRY ROAD I IT DOES_ NOT _ LIE WITHIN THE SPECIAL FLOOD HAZARD "�' FCI �0 , MARSTOFS MILLS, MA. 02648 AREA AS SHOWN ON THE H.U.D. MAP DATED 8� 9�85 _ o�u u os TEL: 428-0055 Co i -Panel # 250001 0015 C FAX: 420-5553 ! _____ THIS PLAN NOT MADE FROM AN INSTRUMENT 14918 hJN PAUL A. MERITH 'W. PIS SURVEY NOT TO BE USED FOR FENCES ETC. 7 _ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION < Map b Parcel Permit# c7/ � Haab-Bivision Date Issued Qmfisa"on Division Fee Tax Collector , Treasurer Plaaai�Bept. , Date Definitive Plan Approved by Planning Board F�'s�'e--OKH Pces�ar�tienA-lyannis Project Street Address doll- )AV Village Owner VV60de 612-1HM,9-7dA1 Address :O"&Me Telephone Permit Request 1--c tf—gA 1(41 ;h bQ 14) ' e4p I afe/kr(141'f Ld/, Ail])64SeAl Square feet: 1st floor:existing proposed 2nd floor:existing proposed Total new Estimated Project Cost 41.`q QV Zoning District Flood Plain Groundwater Overlay Construction Type 0 r-tz- Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family QV. Two Family ❑ Multi-Family(#units) Age of Existing Structure - Historic House: ❑Yes D o On Old King's Highway: ❑Yes D<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 41140 If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name C AP`Zz 1' /Ivy), C_ 4�a,.eg O;T u£w>-Telephone Number %S`1T Address 16 4�,'5 , r�tjr-rr&W Pb-. License# CS d%.2 C 6 (35 Home Improvement Contractor# 100 % �- o Worker's Compensations�#yy U) GS 5Z2&QZ1 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO L A 1 z 1/A1�_���,5;� SIGNATURE DATE _ 9� J FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ' ADDRESS VILLAGE OWNER DATE OF INSPECTIO FOUNDATION FRAME --y INSULATION _ FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. + I � , � SrK Al S4 a STK 1T far � 0 a8 4G• W ry� Cr/5 r. N - 0 i ,3rK gm IR � f7a ° T.zr`4 r TNT [/�/Ga47"/Q�cl. .yoil��t l opt/ / 'L 0ff; 9N , cac/ � 86fl �j , oti � l.a " 7 ,7f,�,drGi,?�'QDCH!,4>'��'°• • ��t��� . /Y�"4��"r�hl5 /tom/.G� Lv- 5.a VI11kWiCK• t' r / )See::, .WILVA 5C.74e >.3 Y $e"!.`, Jam * 4 v;%� A1.4,.