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HomeMy WebLinkAbout0105 WHISTLEBERRY DRIVE �� Cod 1,�h��s-�1e� � �� �,_ _ _ .� { TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION" Map Parcel Application # c21Vli 2 717 Health Division III Date Is$ued Conservation Division Application Fee Planning Dept. Per, it FeeIN7 C0-O Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address W Village e1� MH,�7 1 / • I F a`� gays?• Owner SIU E g �0 I Nv �C Address 6� 1l)gk.9 4 a". U 4 Telephone 77 o?9S 11 , I 1 Z Ig56 I.7 9 Permit Request - -V.`' �, U fig t'T b- Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 2,00 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other. Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ 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) �} Q Name ©fit/ Telephone Number d b 13 ,� Address �I ��5�� S N License #C S (9 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE I` 'I FOR OFFICIAL USE ONLY y rr APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE ' lid OWNER 1 ; DATE OF INSPECTION: ufFOUNDAbTIQIi swwu t� aE:> t I FRAME r INSULATION,L A- it, ;:iiii;•I. FIREPLACE ri ELECTRICAL: ' ROUGH FINAL I , PLUMBING: ROUGH FINAL , GAS: ROUGH FINAL FINAL BUILDING'= >;x DATE CLOSED OUT If q ASSOCIATION,PLAN NO.- ',ts : Town of Barnstable Regulatory Services MAS& Thomas F. Geiler,Director Building Division Thomas Perry, CBO,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: .508-790-6230 p7I PLAN REVIEW S o l `� 7 Owner: ois EiLra �o c Hrn Map/Parcel: 4963 D�g Project Address /OS"l f E ,2it. Builder: !Toa Win( _ The following items were noted on reviewing: �.J��X!na!.�/K �G Go l�A•d cSi°� ��ll�E�—�t/�i4 LLB S7�yZs . �J y " �g Az.o rl°ie r Reviewed.by: Vic. Date: // Y Q:Forms:Plnrvw . 1ne t_ommomveaan gimassacnuseur Department of InduvhW Accid=& Office of brPaWgations 600 Washington Street Boston,MA 02111 www.mamgov/dia Workers' Compensation Insurance Affidavit Builders/Contractors/Electricians/Plmnbers Applicant Information Please Print Legibly Name ghnineWommization/lndivich4: Address: ► (� �fL� L�� City/State/Zip: c9 Phone Are you an employer?Check the appropriate bow Type of project(required): L❑ ❑I am a employer with 4. I am a general cofactor and I # have hired the sub-contractors 6. ❑New construction Ioyees(fan and/or part-time-). - 2:Lff I am a sole proprietor or partner- listed an the attached sheet 7. ❑Remodeling ship and have no employees These sub-�6 have 8. ❑Demolition working for me in any capacity. employees*and have workers' [No workers'comp.insurance comp.insrr>$tx 9. El Building addition required.] S. ❑ We are a corporation and its 10.❑Electrical repairs or additions officers have exercised their 3.❑ I am a homeowner doing all work ' 1 LE]Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL 12.❑Zer7&nLkkQ-L, f insurance regrtu'ed.]t c, 152,§1(4),and we have no employees.[No workers' 13.❑ comp.insurance requuirel] C *Amy-applicant that ohecka box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they arc doing all work and then hue outside conrctors mast submit a new affidavit indicating such. #Coatracmrs that check this box must affichcd an additional sheet showing the name of the sub-contractors andstatr whether or not those entities have employem If the sub-conitacinrs have employees,they must provide ihcir workers'camp.policy number. I am an employer that is proving workers'compensafon insurance for my employees Below is the policy and job site information. {� Insurance Company Name: Policy#or Self-ins.Lic.M. Expiration Date: Job Site Address: City/gyp: 1 #4 Attach a copy of the workers' compensation policy dekration 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 weIl as civil penalties in the fora 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 DU for ins more coverage verification. I do hereby a the p d p ties of pedwy that the information provided above is true an correct s C Dale: —/ Phone# Official use only. Do not write in this area,to be completed by city or town offidal City or Town: PermitlUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone# Information and Instructions' Ilassar-hncettS General Laws chapter 152 requires all employers to p¢ovide Wor3ceas'compensation for then employees Pursuant to this stabile,an employee is defined as"_.every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of.a.deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than tln-ee'aparments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repairwark on such dwelling house or on the grounds or building appurtenant fhereto shall not because of such eniploymem be deem d 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 confrad for the performance of public work until acceptable evidence of compliance with the insui:m- ce requirements of this chapter have been presented to time contracting authority." Applicants PIease fill out the wozkers' compensation affidavit completely,by checking the boxes that apply to your sitntion and,if necessary,supply sub-contractors)name(s),address(es)and phone numbers)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or arts are not to c partners, required any 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 confrmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be retired 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 in.anber listed below. Self-insured companies should enter their self-insdrrnce license mImber on the appropriate line.' City or Town Officials 1 Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submif 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 tmwn may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture '(i.e.a dog license or permit to bum leaves etc.)said person is NOT required to comnpleto this affidavit. The Office of Investigations would like to than 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 nmmban. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Ixivestkations 600 Wasbingtan Street. ' Boston,MA 02111 Tel,#617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749. revised 4-24-07 .ma -PV1dia Town of Barnstable Regulatory Services swuvsr,�ar�. MA-C& Richard V.Scali,Director 0,19. �0 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, Jkil"IgA "(aX to ,as Owner of the subject property hereby authorize "20- y�, ly"*,kj to act on my behalf, in all matters relative to work authorized by this building pernut application for. Kw\ms n (Address of Job Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. tore of Owner Sig tore of Ap cant Print Name Print Name Date Q:FORM&OWNERPERMISSIONPOOLS\ Town of Barnstable Regulatory Services ��oF ratyy Richard V.Scali,Director Building Division t Tom Perry,Building Commissioner 16 ��� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: cityhown state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems, particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities, many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page. of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFHM\FORMS\buildmg permit forms=RESS.doc Revised 061313 i Massachusetts -Department of.Public Safety Board of Building Regulations,and Standards -Construction Supen-isor License: CS-052945 ' JOHN LJORDAN-` - 1 GREEN ACRES`LM r FORESTDALE NIA OZ �� Expiration Commissioner 11/19/2015 _ �/iC ZJOI77/h24QG�/E�/L p�p�� Office of Consuiuer Affairs&Business Re6u6 i HOME-:IMPROVEMENT CONTRACTOR,. I Reg stration: 64543 Typp Expiration.ja69&0j 3 :Individual JOHN JORDAN . —_ JOHN JQRDAN v i} .1 GREEN ACRES L�, MA 0 E A FORESTDL , . rr:.t,,t — ' ��'�%` . Unde!rsecretary •• � - Office of Consumer Affairs & Business Regulation - Mass.Gov Page 1 of 1 The Official Website of the Office of Consumer Affairs&Business Regulation(OCABR) Consumer Affairs and Business Regulation vw ' Home Consumer Rights and Resources Home Improvement Contracting HIC Registration Complaints S, Registration # 164543 Home Improvement Contractor Registrant Registration Home Page Name JOHNJORDAN Address 1 GREEN ACRES LN. City, State Zip FORESTDALE, MA 02644 Expiration Date 10/19/2015 Complaints Details No complaints found for this registrant. You can also view arbitration and Guaranty Fund history. Back To Search http://services.oca.state.ma.us/hic/licdetails.aspx?txtSearchLN=66345 11/5/2014 0 2l�o nT �.i .._/��c�.�./.�.G4._w r 7�L �{x` Cori H ost Vic, !�Z D� � r x fT �� d�►2 s�R�� f (10xC MiTA ' FR-STe _ �Zys�wort� ¢s: b�, I gX`�nal S`T(�•ifLS � f EX 1 S 4 _ ' 1 _._ CXOMM SUE- 4, E- N gu A- r on : oy,'rarT�o TOWN OF:.LBARNSTABLE Permit No. ___.___ 6057 , Building Inspector r a�nsar►m Cash x OCCUPANCY PERMIT Bond Steve Pickul & John Elacqua Issued to Address lot #10 105 Whistleberry Drive, Marstons Mills Wiring Inspector L_ 45� � ��� Inspection date t� /1/ �" ` Plumbing inspector �.�a.,� ��f� \� Inspection date / Gas Inspector �A/10 ( 1 Inspection date 6 Engineering Department � 1v-'`'"l _ Inspection date / Board of Health .s"A,. y �e� -1 3_ Inspection date L/ THIS PERMIT/,WILL WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY,'T'HE BUILDING INSPECTOR UPON S.ATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND.IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. s......�� .-�........... - ............ `". Building Inspector + f 4` FROM TOWN OF BARNSTABLE BUILDING DEPARTMENT Mr. Francis Lahteine 367 MAIN STREET HYANNIS, MA 02M TownClerk Phone: 775-1120 L SUBJECT: FOLD HERE DATE July 2, 1984 MESSAGE Work has been completed under Building Permit 426057 (John Elacqua & Steve Pickul). Please release Bond. i I SIGNED I ,,,,,,d DATE REPLY /N SIGNED I N97-RMi RECIPIENT: RETAIN WHITE COPY,RETURN PINK COPY • PRINTED IN U.S.A. SENDER: SNAP OUT YELLOW COPY ONLY.SEND WHITE AND PINK COPIES WITH CARBON INTACT. assessors map and lot number ........ `3 '�.. ........... ..�Z lt3T V �i�/_ 2 / ��/ t• �-• �1�i�:�� �:a Sew a Permit number k...l. �✓ /i�i�1l VV '"� t " FINE '• g ... . .... ...... .,,•,�t�Lt=0 IN GOB,: �,: :,�D, r , Z PASB-nSTADLE. House number �.........` .................... a� ���w8 vo a 039. TOWN OF BARNSTABLE BULLDIHG INSPECTOR APPLICATION FOR PERMIT TO / G / C!. 'ilC���' .4��yYG< TYPEOF CONSTRUCTION .......... ... .. .:..... .......... ................................................................................. .................... ............I91? TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information- Location ....... jar..... /`' ......... ..... .. .................................................................................. ProposedUse .................................� ............................................................................................................................ Zoning District ........... ................................................Fire District .... f'Ko... ........................... Name of Owner A�Oec.a�. ...y ..2Q": �cldress ! 6 ......... ... :.(. �,p Name of Builder ....•................ ...... ........................Address .lL���r. ���F4A .�t.,.1e ..�� �Ziac� V �. Name of Architect ....................................... t/.................Addressj� I. /(�� "'! ... .....All....C.I•!..................... .�................ Number of Rooms ...............7................... ...........................Foundation �� ������ ........ ✓ Exterior .... .......................... �!.` ..................Roofing .................................................................................... Floors ..1 ........................Interior .... .. ........ .. ................................................. Heating - .....................Plumbing .......... �a �'D D U D Fireplace ... C-L.. .... . ...................... ......................Approximate. Cost ..... ......,........................................... .. Definitive Plan Approved by Planning Board ---------_- 1--R_ ! ' 19 /. Area o...k?.�.......... .. .. Diagram of Lot and Building with Dimensions Fee ................... SUBJECT TO APPROVAL OF BOARD OF HEALTH �&-o 1 i Q� • 3/cSr. �3 D 1 0� o" ti OCCUPANCY PERMITS EQ RED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. .; Name ..0 ... . ................................. t Construction Supervisor's License v/yA D TEVE PICKUL & JOHN ELACQUA IUA riwo story No .... Permit for ................................ .... Si le - ............��g -.......kkoily..Wpa I i rig....... ....... ...... stlebe; Drive Location ..Lot..10'.1 .......... . ....... .... ... Marstons Mills ........... ................................................................... Owner Steve Pickul. & John..Elacgua .............................................. ... . ... Type of Construction .,..Frame........................... ............................................................................ Plot. ........................... Lot .............. ................. ebruary 8, Permit,,,Granted ......F..................................19 84 Date of Inspection ....................................19 -Date Completed ..........19 P41, Town of Barnstable *Permit# ' C ;76d/q Expires 6 months fraa issue date Regulatory Services Fee Thomas F.Geiler,Director Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.b.amstable.ma.us Office: 508.-862-4038 Fax: 508-790=6230 EXPRESS.PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number CJU� Property Address 10S Qw.\bgLk, 1 �1 RResidential Value of Work 6= Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address V,)j rV L tv Contractor's Name to ti,), 2_ �� Telephone Number—` SOq '-1 lo lL-U Home Improvement Contractor License#(if applicable) 19,j601 S Construction Supervisor's License#(if applicable) �Workman's_Compensation Insurance Check one: ❑ I am a sole proprietor❑ �( w�-PRESS PERMIT I am the Homeowner �I have Worker's Compensation Insurance I �� Insurance Company Name DEC 2 0 2007 L�3�� Workman's Comp.Policy.# WC231 S-2306% 0 (A Q 2V TOWN OF BARNSTABLE Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to lr g�t ❑ 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 regular o,-i-d-H?gteac. onservation,etc. ***Note: Property Owner must sign Property Owner Letter gf�P sion. A copy of the Home Improvement Contractors License rs ded0Z 330 L901 SIGNATURE: � !` tr (t..:l�l ,I J. Q:Forms:expmtrg Revise061306 r OLIVER KELLY 9 PEREGRINE LANE SOUTH.YARMOUTH MA 02664 PH/FAX 508 775 4498 MA. REG.# 128957 December 10 2007 IS Proposal submitted to Mrs. Kunin of 105 Whistleberry Drive Marstons"Mi is M ED We propose to supply all materials and labor necessary to remove and replace the existing roof at the address above. All debris to be removed to town trans-fer. Aluminium drip edge to be installed on all eaves. P , -Ice and water damage protection membrane-to be installed on first tYuee feet of eaves and in any valley areas Remait6er of deck to be covered with#30 felt paper. 30 year liriited warranty Architect style shingle to be installed. Bathroom vent pipe boots.to°be replaced with new. Cobra ridge.vent to b 'installed oh,entire length of all ridges with hand nailed caps. Protect all walls;`.windows, decks, plants and shrubs etc. during roof strip Obtaining of town permit. At a total cost of$6coo Payment Schedule; 40% with signed contract, balance upon completion. Respectfully submitted, Oliver IWy Proposal accepted b _� j. Y� /2007 If acceptable,please sign and return one copy and keep one fdr your records. This propel is valid for 45 days from date above i 1W "0 Wi.slbfi AUR&red Boxow,MA 02111 Workers'Compensation Insurance Affidavit: Baden ContrsctonMectntdansMkMbom AnnHcmd Information Please Print Legibly Name 5-r;& Address: City/State/Zip: Go, Phone#: 5©t SC>Ql t,G.4 0 eapioyer!C'reeik thtappr�aprlate bow" Type of Project(rcgdreM: 1.Fl"amsna employer with 7-- 4. ❑ I am a guall oontraclor and I employers(IA and/orparttin** hang hired the sub-oontrapon � ❑New comatroction 2.❑ I am a gob proprietor m partner- listed on the attached ghat t 1 ❑Ren odeling ship and bave=employees These sub-contractors have & ❑Demolition warffiig for me in any capacity, worYaas0 CMW. , 9. 0 a&wm [No workaa'eot*mamaae s. ❑ We we a cogwstros ad im r'e4uire •] ofg=have emci:ed their 10.0 Mectrical repairs or additions 3.❑ I am a hommser doh g A wak right ofc memptiou per MGL II-El Plambing or additionsms myself[No workers'comp. a 152,11%god we have no 12.[�' f r nranee r'eq�.]t ®Qbyem[No woalkers' 13.E Other epgM cam.inwrance nq�ed.] • ePP art cbeeb loss#1920"IM Outdo r Cdit bdow dww%@ tieir.vxwbd OOGqoMW=�►berm tioa t Homrowrneta wrho sarrsk Us maWk t�t�,gas doss sii.Ya k Md o r.tiro atria.oordagar.mut wbmit.aav sffia�vit s ,�tCowdsetors dW drk Ob boa mad WNW s.saMo.d dwd dww*do Hams Of do fob 001hack and bait wits u caelp 1OIL7 kfonvotim t7iat Ltd wionksrs cowfdr a1 S Bdm ls Mrs lwfo►sat�dia. /sAlj►srwalJob sth Insat'aaa Comipaoy Name: ��''3 �`� �'! ✓�v rvr¢L Policy#or Selgios.lk t 3 3 3 S O g*ndn DM- 42 -$f` Job Site Addraa: Attach a copy tithe workers'eompeasatlon PoNey deftmtlow pqp(fig the po&y nw*w and UWattom date). More to secure coverage as required m da Section 25A of MGL-e, 152 can lead to the iooposition of ahniaal penalties of a fine cup to 50. d 00 a d 00 and/orono-yearay agaua$t the vioLdor. Be a 0 well as civa penalties in the form of a STOP WORK ORDER and a fine of alp 1D$250 dvised d at a copy of dds statement may be fa7 war"so die O>$a of Invest4atim of the DIA for fiMw=oe covenge verification. I do har by ceno nadir dwpabs=dpswsMa of Aw Me Jiitfwsratlsw PvA&d&bow b loss and urreft w Phone#: Sn s Sc,q[ Lt L,y'C7 t�'Iclai ante� Die wet wrl�e lw drb s►�eS h bs aoatp�edbp clip M hwsa o�elsg City or Town: raeene# Issning Authority(chvie one): I.Board of Balch L BNldIng Departmtot 3.City/Town Clerk 4.Electrical lam. S.llmanbkg Inspector 6.Other• Contact Person: Phone 0: • Board of Building.Regula ions and Standards One Ashburton Place - Room 1301 Boston. Massachusetts.02108 Home Improvement Contractor Registration Repietration: 128957 w Type: Individual Explmoon: 8/M009 T101 131109 bliver Kelli't Oliver Kelly 9 Peregrine lane : . . S. Yarmouth, MA 02664 Update Address and return card.Mark reason for change. OP8-CA1 Q 60M-08 0"C8490 C] Address Renewal [] ftployntent Lost Cal , a ;JR@ TDOOJt47t4�u1/eR[s/o O�✓6ZQd6Q.pt . Board of Bullding Regulations and SmndZ Unmoor registration valid for ladlWdul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. U found return to: �.n. 128957 Board of Building Regulation and Standards Expluatloii: '6/14/2009 UP 131109 One Ashburton Place Rm 1301 Type: Individual Boston,Ma.OZ108 011ver Kelly ` Oliver Kellyrn 9 Pereodne lane �yw14.�.•.. South Yarmouth,MA 028M Adodoistrator Not valid without signature Liberty Mutual Group Liberty P.O.Box 9090 mutual® Dover,NH 03821-9090. Telephone(800)653=7893 Fax(603)-245=5330... ... November 26,2007 TOWN-OF FALMOUTH .. 59 TOWN HALL SQUARE FALMOUTH, MA 02540 RE: Certificate of Workers Compensation Insurance Insured: OLIVER KEI-LY 9 PEREGRINE LAME S YARMOUTH, MA 02664 Policy Number: WC2-31S-338804-026 Effective:, 12/28/2006 Expiration: 12/28/2007 Coverage afforded under Workers Compensation Law of the following state(s): MA Employers Liability(I..imits� _ Sole Proprietor/Partner Coverage Election: Bodily Injury$y Accident: $100,000 Each Accident The workers'compensation policy does not provide Bodily Injury_by Disease: .:$.100,000 Each Person, coverage for: Bodily Injury by Disease: $ 500,000 Policy Linfl OLIVER KELLYts 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 document*th 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.—T-O'eerdfv*%-is--not-airinsuranc-e-policy--and-does-not-amend—extend;or-akerthe-Eouera 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 Certificavis executed by LIBERTY MUTUAL INSURANCE GROUP as respects such insurance as is atlorded by those companies. cc: Insured: Producer of Record: OLIVER KELLY SANDPIPER INSURANCE AGENCY INC 9 PEREGRINE LANE 12 ENTERPRISE RD S YARMOUTH, MA 02064_ HYANNIS, MA 02601 Assessor's map and lot number e<?'` � tr�4` F.:...:............:...:..... ' P �Q�piTHETp�O Sewage Permit number ........................................................ d �� 1 BAWST"LE, i Housenumber ........................................................................ 900 NAM } e, �9 �F0 MO a TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATIONFOR PERMIT TO ............................................................................................................................. TYPEOF CONSTRUCTION ..................................................................................................................................... ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....................................................................................................................................................................................... ProposedUse ............................................................................................................................................................................. ZoningDistrict ........................................................................Fire District .............................................................................. Nameof Owner ......................................................................Address .................................................................................... s Name of Builder ........ . .. .. `.' s' �.........................Address Nameof Architect ..................................................................Address .....................................:....................I......................... Numberof Rooms ..................................................................Foundation .............................................................................. Exterior ` :: Y..1:A.....................Roofin Floors .......................................................................................Interior .................................................................................... Heating ..................................................................................Plumbing .................................................................................. Fireplace ..................................................................................Approximate Cost .................................................................... .................... Definitive Plan Approved by Planning Board __________�__._�____________19_______ . Area .. ......................................... Diagram of Lot and Building with Dimensions Fee " SUBJECT TO APPROVAL OF BOARD OF HEALTH '/0 e t'1 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .................................................................................. Construction Supervisor's License .................................... STEVE PICKUL & JQM\7KQUA A=63-89 No26057 Permit for Two Story ................... .................................... Single CAF)- n-dly Dwelling. .....................?......................................................... Location .... 10.5...Wh.i.s.tleberrv. ...Drive .... . . ............... Marston Mills ............................................................................... Owner ......Steve Pickul & John..qc�(pc .......................................... .... Type of Construction ..Frame............................. ........... ................................................................................ Plot ............................. Lot................................. February 1, 84 Permit Granted ........................................19 Date of Inspection ....................................19 Date Completed ......................................19 f s ' Qv 4d7 �;W9 S It art a ry , N � W N Y c o��b Y I-s//T.x/ ?h',4E7 .4/IOP' / f3�4,2 ST9Q ,4AI-P /...5 IV-lnT;-44kedT�",Z> W1,v 1A-" /.�£ 77�'r..3MENT`Sv,2✓, j/ A VZ> 77'V.= 0. X&F� �iA7-X:; �J�4K�.0 ,Siy©�LSD �YoT 8etr !/SE'a 7