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0110 WHITE MOSS DRIVE
Application number........ OTMFee .............................d..............7........................... aAtMA-S& t � Building Inspectors Initials......... .... p`v bi¢ UC 'l5 Z i# 141A v!. Date Issued...........7.1sA... . ... ................................. ����i Map/Parcel.........IJJ��... a... ..dU�...... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: S (A)h t , d Sco r- 1 ' IQmika n STREET VILLAGE Owner's Name �V - y - :PRA44 Phone Number SOS- 8 61- 306 Email Address: W k&n D D '77 A a6 k. Co al Cell Phone Number 509•Sa l- 3694 Project cost$ Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK ® Siding IN Windows (no header change) # Insulation/Weatherization a Doors (no header change) # Commercial Doors require an inspector's review ED Roof(not applying more than 1 layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration (if applicable)# 1 a l0 U (attach copy) Construction Supervisor's License # J (A ` '4 (attach copy) Email of Contractor 1"� Phone number 568-3641 4 S ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. • APPLICATION NU *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does�e tent have sides?Yes No (If yes`please attach floor plan with exits marked) Dimensions'ofi each Tent X X X Additional tent dimensions can be attached on a separate piece of'paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location (s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am -9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval, *WOOD/COAL/PELLET STOVES* — GJ ,,�4WQi a ii1 :II%JU Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, `specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature r Date // (. All permit applications are subject to a building official's approval prior to issuance. • One 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): Baker&Associates, Inc. Address: PO Box 923 City/State/Zip: Centerville, MA 02632 Phone#: 508-362-2445 Are you an employer?Check the appropriate box: Type of project(required): 1. ✓ I am a employer with 1 4. I am a general contractor and I employees(full and/or part-time). have hired the sub-contractors 6. New construction 2. I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp. insurance comp.insurance.+ required.] 5. We are a corporation and its 10. Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 11. 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 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: Associated Employers Insurance Company Policy#or Self-ins.Lic.#: WCC-500-55y0�02454-201�A Expiration Date: Job Site Address: . W �r��ry 1 '1,0� l�� City/State/Zip: M a a 1/1 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby c tv der-thq pains apd pefries of perjury that the information provided ahave is a..o and"orrect Si ature . C Date: 6/1 -V4 Phone#: 508 362-2445 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#: s Client#:9 &ERAS ACORDr. CERTIFIC TE OF LIABILITY INSURANCE DAT 12912DI19 • 0412912019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: The Hilb Group of N.E.dba PHONE 508 775-1620 5087781218 A/C No Ext: A/C No Dowling&O'Neil Insurance Agy E-MAIL P.O.Box 1990 ADDRESS: Hyannis, MA 02601 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:NGM Insurance Company 14788 INSURED INSURER B:Associated Employers Insurance Company 11104 Baker 8 Associates,lnc.P 0 Box 923 INSURERC: Centerville, MA 02632-0071 INSURER D: 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 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS INSR WVD POLICY NUMBER MWDD/YYYY MMIDD/YYYY A X COMMERCIAL GENERAL LIABILITY MPJ7223M 4/19/2019 04/19/2020 EDACH�OCTCURRENCE $1 000000 CLAIMS-MADE �X OCCUR PREMISES EaE�uence $500 000 MED EXP(Any one person) $1 O 000 PERSONAL&ADV INJURY $1,000 000 r,OTHER: LAGGREGATELIMITAPPLIESPER: GENERAL AGGREGATE $2,000,000POLICY a JECT PRO- FX LOC PRODUCTS-COMP/OPAGG $2,000,000 $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ I I $ B WORKERS COMPENSATION WCC50050024542019A 4/23/2019 04/23/202 X PER OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N E.L.EACH ACCIDENT $500 000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEEI$500 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Baker&Associates,Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 923 ACCORDANCE WITH THE POLICY PROVISIONS. Centerville,MA 02632 AUTHORIZED REPRESENTATIVE ©1988-2016 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S235063/M235062 RPSW1 .... .w._..,� .,.� Office of Consumer Affairs&Business Regu on HOME IMPROVEMENT CONTRACT Registration valid for indivi se only TYP.E:.Corporation before the expiration date. *lf ..nd return to: Registration Expiration Office of Consumer Affairs and Business Regulation 1626000a 03/25/2021 One Ashburton Place-Suite 1301 BAKER&ASSO,CIATES`I f1/A. Boston,MA 02108 MARK L.BAKER`;'`.`_ 1 �.�� ,.kat 521 SHOOTFLYING:.HILL RD' CENTERVILLE,MA 02-632" Undersecretary Not valid without signature .%/te (9Gvirire%2[,'i'emlf�-'�.��¢JJu,[Yt[tJnllJ Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE::Supplement Card before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation ;1[626.00 03/25/2021 One Ashburton Place-Suite 1301 BAKER&ASSO.CIATES`ING +v—`' - Boston,MA 021108 ) —> 1 RICHARD GARNEAU=�• 521 SHOOTFLYINGMILL RD' �`` 'L� `_ 'U?✓i�� CENTERVILLE,MA 02632 Undersecretary Not valid without signature • i ommonwealth of Massachusetts Division of Profes.slonal Licensure Regulations st . r.. o Or t�� :•..,' � � - �� ; ' �,Jai`^ 3¢Kl m �J QJ�yej '•'' ,3 '' y'ST kr•Tf_t1".'dk� r,4 'y..,tsy y ,. i�IrJ't7ty-�j. i li 1 [ . 3$4 - I Ty�, f.. < 21±•3' tfx. 21'M 't if K� A y.'C_k at .5 � � 6 � u Y},�,K ',•�1 a r r'a e.,.. y r' [ r. •b,� * _:.ai<'k t,., �a �,,�� .�_ t. } 4 �.> 'fi 1•::'.� r "'� b 61 A ,r4. t t`• ;a;Y�"')i ,�4,,Y r'' Y"' a,5.t.�4�yr, r ,•1. ��. IC �yY -;<N'"" s' h ,•,�,o'^r v��< 8.f� � '2k€.1^. 5� '.5 j-A, k xa yNz ,c a I �t�y&t� •?K k. 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N. ^';K-r. .4' -e - ;'F1 2 a..•.s,.,,�, ,.:•�t e d. 1' t �;e-u ..a .Y, t. rlfii::- v.., [µ�?'. .u. 7. �:t5x ;:a. �9. -ee� d+. _ «f.s�.l,..k lY: Scz-_, 2 ••�}°' r>, :'���. M'�.. �?. a�, ,t..•, ,?5' �?s46'ic��;•a�' .'{,. s:,y ..'�'"- [:. ,a,S'1. ;7',7ek• rri. d�d,i A c _ ow er of the subject property, here y au orize Baker As ociates to action my behalf, in all matters relative to w authorized by this building permit application for Address of property: 110 White Moss Drive Marston Mills, MA I I .�:.:-,ii.f:2 ti.:i.d.•..v d.•Oil' -- •. �/bV�� ((l��N�JIT��� .. 74- 1 t Print N anie: /Yl �)10.k, I 4 i � � _ I .,•1�, i � � " ' �� TOWN©F BARNSTABLE BUILDING PERMIT APPLICATION TO Ma 3 Parcel 0 4 H'VSTAB Application— ��� � P � � L� pP Health Division Date Issued Conservation Division Application Fe Planning Dept. Permit Fee •V Date Definitive Plan Approved by Planning Board �w Historic - OKH _ Preservation/ Hyannis Project Street Address 10 ��►I} ' loss �a r� Village rs t-1 AS Owner S-k& t o Frank S Address S a eh e, Telephone 5pt SOL Permit Request Pdj (Z- S ce��a'oJP� r a e -t�►& k id ium Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation a d 0 Construction Type Lot Size Grandfathered: ❑Yes 0 No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ 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 I I jlcllft► In reC Im G g L /ra-t e S0.i- Itic.Tel eph one Number Address I +ree- License# S• ��,rn,�w� �, fn 01 b b Home Improvement Contractor# 1 U Email Worker's Compensation # W 3c13 �T ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE Z DATE i� FOR OFFICIAL USE ONLY' APPLICATION # DATE ISSUED - MAP/PARCEL NO. ADDRESS i VILLAGE OWNER. DATE OF INSPECTION: FOUNDATION r - FRAME INSULATION FIREPLACE i; {< ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL j GAS: ROUGH FINAL ;. FINAL BUILDING DATE CLOSED OUT ASSOCIATION.PLAN NO., '` ,� - �szooat�ozss�xa�.rcMo:sr,�xoaa i ?ICI �10'L�Z21 �( ��ada���i��paugo�ad�`ar�°saon�ad eazr",Re.FM11: 90 V-Say S"'PU4,1pjo9 .a n ra a , soo . auz�d aourcrsodsa� a Pare sauna tpa ,� _ Sill UOIT dual :20},IIO�jE�C��E:• �tIyp�.,SEI��?�:p2ZLi0i��tCe�, QddO�'31473'e�'dI':S;I211�CFi'nEIIi xa�. g•���:��x�rs�,�x ••0£G9-Q6L�$US�•'�3 - . . �8,:�Q�-Z98=8�OS-°=��30 sircur*gsufeq i09Z0'•�NI;`-S'?�H�a?�4S:�b�L.OUZ iauo�ssaaic�ia?r�iuPlTnS`mod Vi i r The Commonwealth of Massachusetts . Department of Industrial Accidents _ 1 Congress Street;Suite 100 Boston,MA 02114-2017 M www.massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contrictori/Electricians/Plumbers. TO BE FELED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual):Cape Save Inc Address:7-13 Huntington Avenue City/State/Zip:South Yarmouth, MA 02664 Phone#:508-398-0398 Are you an employer?Check the appropriate box: _ Type of project(required): 1.�✓ I am a employer with 20 employees(full and/or part-time).* 7. New construction - 2.[:]I am a sole proprietor or partnership and have no employees working for me in 8 Remodeling. any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.E]I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 0 Building addition . 4.O I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or*additions proprietors with no employees. 12. Plumbing repairs or additions 5.❑1 am a general contactor and I have hired the subcontractors listed on the attached sheet. 13.[]Roof repairs These subcontractors have employees and have workers'comp.insurance. 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.err Other Insulation 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number." I am an employer that is providing workers'compensation insurance for my employee& Below is the policy and job site information. " Insurance Company Name:Wesco Insurance Company Policy#or Self-ins.Lic.#:WWC3136274 Expiration Date:04/09/2016 Job Site Address: 110 White Moss Drive City/State/Zip: Marstons Mills Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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$250.00 a day against the violator.A copy of this statement may be forwarded to the.Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under th pains andpenalties of perjury that the information provided above is true and correct Signature: Date: 12/28/15 Phone#:508-398-0398 Official use only. Do not write in this area,to be completed by city or town official City or Town; Permifticense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ACORU® CERTIFICATE OF LIABILITY INSURANCE FDATE(MMIDD/YYYY) "#% 10/14/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In Ileu of such endorsements. PRODUCER NAME:WACT Colleen Crowley H� E.E (781)986-4400 FAC No: Risk Strategies Company P (781>963-4420 15 Pacella Park Drive AD�ss:corowley@risk-strategies.com Suite 240 INSURER($)AFFORDING COVERAGE NAIC* Randolph MA 02368 INSURERA:Selective Ins. of America INSURED INSURER Allmerica Financial Alliance Ins Co 10212 Cape Save, Inc P INsuRERc:Wesco Insurance Company 7 D Huntington Ave INSURER D INSURER E: South Yarmouth MA 02664 INSURERF: COVERAGES CERTIFICATE NUMBER:CL15101402127 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER MMI�EFF POLICY MI�EXP LIMITS LTR X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A 7 CLAIMS-MADE X�OCCUR PREMISES Es occurrence $ 100,000 91994480 10/16/201S 10/16/2016 MEDEXP Anyone arson) $ 10,000 PERSONAL BADVINJURY $ 1,000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY Z ECT I LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: 1 $ AUTOMOBILE LIABILITY Ea accident $ 1,000,000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED �AA(UJTTOSS SCHEDULED AWBA46796600 11/6/2015 11/6/2016 BODILY INJURY(Perexident) $AO NONOVWVED PRO ERTnDAAGEXHIREDAUTOS Per.cade $$ X UMBRELLA LIAB IX OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-WADE AGGREGATE $ 1,000,000 DED I I RETENTION Nil 91994480 10/16/2015 10/16/2016 $ WORKERS COMPENSATION Officers Included for X STAHUTE OR F� H AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNER/ CUTIVE YIN Coverage E.L.EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? N/A C (Mandatory In NH) VBC3136274 4/9/2015 4/9/2016 E.L.DISEASE-EA EMPLOYEE $ 500,000 Ifyyees,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more apace Is required) National Grid Corporate Services LLC d/b/a National Grid, Action Inc, Colonial Gas Company and NStar Electric are all included as Additional Insureds with respects to the General Liability coverage of Named Insured as required by written contract. . 1 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Housing Assistance Corporation THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 460 West Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE Michael Christian/CLC �� O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD I NS025(201401) r Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration - _ Registration: 171380 Type: Corporation Expiration: 3/14/2016 Tr# 249649 CAPE SAVE INC. WILLIAM McCLUSKEY 7-D HUNTINGTON AVENUE = — . SOUTH YARMOUTH, MA 02664 - -- - - Update Address and return card.Mark reason for change. scn, 0 20nn-05n1 Ej Address Renewal ❑ Employment Lost Card �T n�riniiu•-riuea.`C�oil/�l��JSnr�i�J�/1 - - - • Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: _ egistration: 171380 Type: Office of Consumer Affairs and Business Regulation Expiration:.—-3/14/2016 Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 CAPE SAVE INC. WILLIAM McCLUSKEY - 7-D HUNTINGTON AVENUE SOUTH YARMOUTH,MA 02664 Undcrsecretaary Not vali ithout signature I �{ Massachusetts -Department of Public Safety Board of Building Regulations and Standards U litruciion.Sunei visOT.3leciaiiv License: CSSL402776 WELLIAM J MC�U 37 NAUSET ROA6 JF West Yarmouth NA WWI " - Expiration Commissioner 06/28/2017 I AL Phu i i r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map a5g _Parcel n("q Permit# Health Division ? `� � 7 Tt�ti:�la! 0QAR�f ST,48LE Date Issued ��' -�� Conservation Division 700li J(;1_26 P,M 1: 58 Application Fee 1J0 Tax Collector Permit Fee Treasurer i -' IFU!S!0! r � Planning Dept. .S. = act-c 008MG SYSTEM Date Definitive Plan Approved by Planning Board 11%'t G.V to k rde<�,4 UMITE)70 OF BEDROOMS Historic-OKH Preservation/Hyannis Project Street Address 5o 1PV( yh �1Q G Village Mans_ m ►A,115 Owner Pau-I l"Qrie- < Anne b- Address " hid 11 Telephone Permit Request 14 X oZ o2 M_ oar Qoyou_ U_ "dam- 4b ' xts( !fives, / w 144% Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 7 0�. DDU` Construction Type Lot Size aub Grandfathered: O Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ®--,Two Family O Multi-Family(#units) Age of Existing Structure 15 (AYS Historic House: O Yes Q o On Old King's Highway: ❑Yes O No Basement Type: M Full 0 Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) 54& :�q -1^ 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 1-7 new First Floor Room Count Heat Type and Fuel: Gas ❑Oil ❑ Electric O Other Central Air: ❑Yes VNo Fireplaces: Existing U1�-S _ New Existing wood/coal stove: ❑Yes �%o Detached garage:46*44vw", Pool:0 existing ❑new size Barn:O existing O new size Attached garage:Vexisting Vnew size WX 22 Shed:0 existing O new size Other: Zoning Board of Appeals Authorization O Appeal# Recorded❑ Commercial O Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name Telephone Number Address 1116 TU�O t-nsef ��" License# c3),3 rA 6,3&Sig Home Improvement Contractor# /Dales 3� Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN Ter OaFz jL as SIGNATURE DATE FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS,; VILLAGE l ' OWNER. DATE OF INSPECTION: ` r. FOUNDATION FRAME INSULATION FIREPLACE t ELECTRICAL: ROUGH FINAL ' °PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDINGI� DATE CLOSED OUT - tea ASSOCIATION PLAN NO. Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 2/3/16 Thomas Perry CBO 1-Vv Town of Barnstable -0 Building Division 200 Main St. a Hyannis,MA 02601 : v RE: Insulation Permit 201508963 -0 Dear Mr. Perry This affidavit is to certify that all work completed for 110 White Moss Drive,Marstons Mills has been inspected by a third party Certified Building Performance Institute (BPI)Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey Town of Barnstable °PYRE P� ti Expires 6 months from issue dale Regulatory Services Fee ; RARNSTABLE,p• y� MASS. 0 Thomas F. Geiler, Director s63q. ,0 ArfD µP't A Building Division Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town:barnstable.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.Q /00 Ydo • I roZidential y Address .�f �iG�J 2 ry1c1SS° 1�J2• E� I Value of Wort. ��j fjt�,Qf9 Minimum fee of$25.00 for work under$6000.00 Owner's Name & Address [DUr'i �C? fg Use+ Contractor's Name_ � 1 G 62 L4� tlL���3� Telephone Number 7 f� d 2l I tome Improvement Contractor License#(if applicable) 1 ( 9 Construction Supervisor's License# (if applicable) 1(o Y-P 's',_'S3S' RERMIT ororkman's Compensation Insurance APR 2009 Chec one: am a sole proprietor TOWN OF BARNSTABLE ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy # Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) - U?"R'e-roof(stripping old shingles) All construction debris will be taken to 1AXI?0 L,,�Yvor«-L ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum .44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e. Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: �!. WPI-II.LS\FORMS\huilding permit forms\EXPRESS.doc Revised 100608 s The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia 'davit: Builders/Contractors/Eleetricians/Plumbers Workers' Compensation Insurance Af Applicant Information I Please Print Legibly Name(Business/Organization/IndMdual): Address: Ac-6-0•r eyt!4 i✓G= - City/State/Zip: jAO-= Phone.#: -c—eG- Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. �a general contractor and I 6 New construction employees(full and/or part-time).* have hired the sub-contractors ..2:0 I am a'sole proprietor or partner-• listed on the attached sheet 7. .�Remodeling ship and have no employees These sub-contractors have g.•Q Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers'-comp.-insurance comp.insurance.$ required.] 5. 0 We are a corporation and its 10-❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑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 . 13.❑ Other employees. [No workers' comp.insurance required_] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating tbey are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employ=,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 io secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a•STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce under the pains-and penal 'es of perjury that the information provided above is true and correct. . Signature: Date: — Phone#: Official use only. Do not write in this area,tb be completed by city or town offWal, City or Town: Permit/License# I 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 M Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their.employees. Pursuant to this statute,an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity,or any two or more - -- - of the foregoingg-engag in a joint-en rprise;and..lu3mgfitie legal-represenfa'tillTeb`-6f deceased mpioyezvirthe= receiver or trustee of an individual,partnership, association or other legal entity,employing employees.'However the owner of a dwelling house having not.more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not-because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL.chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall . enter into any contract fori the performance of public work until acceptable evidence of compliance v nth the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contiactor(s)name(s),-address(es)andphone number(s)along with their certificate(s)of insurance. Limited Liability Companies.(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Offidals . .Please be sure that the affidavit is complete'and printed legibly..The Department has provided a space at the bottom .CG J--_.r------.- =11 .:—aL- a au_r%s:;z.e iT....nnti..nt.nnn from to, mn t♦Inn rPonrriinV the anti!;'art, of the autua V 11 lUl y V U LU LAIL ULLL LLl LLLt.is r t uL lilts V Llat v ail ul•t u lib..... ...... . -- — — rr- Please be sure to fill in the permit/license number which will be used as a reference number. in addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address" the applicant should write"all-locations in - (city or town).".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A neRv affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not.related fo any business or commercial venture (Le.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would life to-thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Department's address, telephone-and fax number: The Commonwealth of IMassachuseM Department of lndustrial Accidents 4fftce of Investigations 600 Washington Street Boston,MA 02111 TO. # 617-727-49-00 ext-406 or 1-877-MAS-SAFE Revised 11-22-06 Fax# 617-727-7749 r www.mass.gov/dia � T��Zc'3 �`�'i�tX°e 1�IORKERS' °� OIVIPENS9�TiON,AND E,IUi�LOYEf�SL`IA:B,I ITY INSURANCEPO.L F , � waG '� r �. .: prS =S — w as Oka * �x�S' » , C t, 1 �, ���� �.�:� ,�� �� :��x�- :� � :��!?.for�at,�o�Pag��� � Rk Atlantic Charter Insurance Company VDAC NCCI Co. No.:29211 Policy Number: WCV00730202 1. INSURED: Prior Policy Number: WCV00730201 Tyndall Roofing, LLC Producer: 30 Jillian's Way _ Fredericks Insurance Agency, Marston Mills, MA 02648 Federal ID Number:204616445 Inc. Risk ID Number: 1046 Main Street Business Type: Limited Liability Osterville, MA 02655 SIC:9999 NONCLASSIFIABLE ESTABLISHMENTS Other Named Insured: Other Work Places: See WCE107 2. POLICY PERIOD: The Policy Period Is From: 7/1 1/2008 To 7/11/2009 12:01 A.M. Standard Time at The Insured Mailing Address 3. COVERAGES: A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states liste here: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 100,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease .$ 100,000 each employee C. Other States Insured: Part Three of the policy applies to the states, if any, listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06A All states except Monopolistic State Fund States D. This policy includes these endorsements and schedules: See WCE105 4. COVERAGES: The premium for this policy will be determined by our Manual of Rules, Classifications, Rates & Rating Plans. All information required below is subject to verification and change by audit. Code Premium Basis Total Rate Per Estimated Classifications No Estimated Annual $100 of Annual Remuneration Remuneration Premium See WC 00 00 01 Minimum Premium: Deposit Premium: $500 $500 Interim Adjustment: Annually Servicing Office: Estimated Premium (Minimum Premium) $500 25 New Chardon.Street Boston, MA 02114-4721 Issue Date 07/01/2008 ° Countersigned By: Date Copyright 1987 National Council on Compensation Insurance Form: 100m - i Iassachusetts- Department of Public Safety Board of Buildinit, Re!-ulations and Standards C.onstr.uct on Supervisor License License: CS 46189 Restricted_to;,.00 DAVID H ;WEBB 3 17 ACADEMY,'LN FALMOUTH,, MA Q2540 Expiration: 10/29/2010 Commissioner Tr#: 5826 �\ Board of Building Reg::latians and Standards License or registration valid for individul use only H314E IMPROVE:P"ENT CO:iITRACTOR before the expiration date. If found return to: Rgoistratt on:, 119766 Board of Building Regulations and Standards Eipiration:_=8 28/2009 Tr# 132550 One Ashburton Place Rm 1301 Boston,Ma.02108 Type_DBA WEBB CRAFT DESIGN DAVID WEBB l t� w �17 ACADEMY LN. FALMOUTH,MA 02540` - AdmialArator Not valid without signature n r Z try,, Town of Barnstable Regulatory Services 9BARN,ST"M Thomas F.Geiler,Director 16.19. 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, O) ct) FVI1 6G{stf , as Owner of the subject property hereby authorize bo tb W'5''8B to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) o Signature of Owner . ate 01gPrct) 16RBush Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. n.ono�rc.ntr n.ri=o nro r rr�crnwf zH�f ray Town of Barnstable N�� o Regulatory Services �P Thomas F. Geiler,Director Building Division �PrE° A Tom Perry,Building Commissioner 200 Mairi�treet;HyanniMA 026�1 _.._. . .. _._.._..... www.town.barnstable-ma.us Office: 50 8-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: numbs street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: cit3rAown 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. DEFTNON OF HOMEOWNER TII Persoa(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 com,Lance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned."homeownee'certifies that.he/she understands the Tpwn of Banpstable,Buildiug Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. SignatUre of Homeowner Appivval 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 -Ucensarg of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall ad as supervisor." Many.hornwwncrs who use this exemption are unaware that they arc assuming the respmsbrlities of a supervisor(see Appendix Q, Rules&Regulations*for L eeiuing Construction Supervisors,S=tion 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 uniicanscd 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 mquirc,as part of the permit application, that the homeowner certify that hUshe understands the responsbititics 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 sucb a fomr/certification.for use in your community. • Q:forms:hoinccxcmpt Assessor's offioe (-1st 416or),— STHE Assessor's map and lot number ........ ... ........ ono Board of Health (3rd floor): Sewage Permit number ........3.7'r. ....................... i EARISTLBLE. Engineering Department Ord floor): vo MAX& Housenumbei ..................................................... a........ 0 t639- APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00' P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO 7.c.4......... lw................................... TYPEOF CONSTRUCTION .................... .......... .............................................................................. ............................. .....1q.,67 ... ....... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ......./,O�... .......mkk.. ......00.5�.s.... M14 .........I............... Proposed Use .........-5i.n.e-V. ........77 ................ ....d-.... Zoning District ..... .. ..... ....................................................Fire District ......M ................................ Name of Owner C.P.'............Address .... W Nameof Builder ......... MQ..........................................Address .......... .......................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ............../-..................... .........Foundation ...... Exterior (A) . .................... j................. ......Roofling ...... ...... ..................... . ..... Floors 4n. .....�/.. d ......................................... ..................................Interior .... I -- .Plumbing ..... 7 .�3 ...........Y, .. . ............................ ................. Heating ...................... ......j Fireplace ......A0..................................................................Approximate Cost ......... ................. Definitive Plan Approved by Planning Board ------ --------—----------7-;---19 Area .......................................... Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH 32� X 24 Cil-f; 2-z- 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 .... ....A.... Construction Supervisor's License ........6.....0..../....0..... 10 GREENBRIER CORP. A=0 3 1 CL-,,--8- 31496 Story No ................. Permit for ...... ............................. .�ingle Family Dwelling ........ .............................................................. Location Lot #11 110 White Moss -Dr. ............................................v................... Marstons Mills ............................................................................... Owner ....Greenbrier Corp .............................................................. Type of Construction .....Frame ............................ .. .... .. ............. .....................................................I,.......... Plot ............................. Lot ................................ Permit Granted December 14, 87 - ........................................19 Date of Inspection ....................................19 Date Completed ...................................... 19 cc �i � � +- • . 1'- a: '{ -r` Ys•��,'Ott'"u..�+-+iS1u:iF"ir.C.f'^..�^tir'.., a..+r....,�y...r-.r-B^.^•'. .............. -.. -.. .. �_v. t ...— TOWN OF BARNSTABLE Permit No. ..31.496.,..'. r BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash Yl ' �suY HYANNIS,MASS.02601 Bond x.... CERTIFICATE OF USE AND OCCUPANCY i Issued to Greenbrier COrD. Address Lot #11, 110 White Moss Drive Marstons Mills, Mass. USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND.IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. JI Anrii..15........... 19...8$.......... !`� � r /. ........ ................ Building Inspector 77--7777777 NG" OF BARNSTABLE, MASSACHUSETTS BI / Greenbrier Co: AooREss 1= ' (). 3iJ. 5'10, Cei'li :'x'�.T.il].e= r'�� 001. �97 j APPLICANT � (NO,) (STREETI (CONT R'S LICENSEI NUMBER OF PERMIT TO F3uild Dwi lli:ug (_-Li). STORY M�1iCi� C- J�Ju111:1�DWELLING UNITS. (TYPE OF IMPROVEMENT) N0, - (PROPOSED USE) �`• +, ),�• ZONING tjr' Lam 11 110 6gjjit_t: iriL��F1S ) 1V'''j 1 r�i�i}ll�i 111 i DISTRICT AT (LOCATION) (STREETI AND BETWEEN (CROSS STREET) (CA055 STREET) LOT SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BYc FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: Sewage #f 87-246 c. _ ' 3b . 001 AREA OR 1076 sq. it. ESTIMATED COST � ��, �� �� MIT FEE 11) VOLUME (CUBIC/SO UARE FEET) Greenbr(ber Corp. / OWNER BUILDING DEPT. _.�%'r:.'3'••f /d )/,� U i I c,flL'C-r"rl1J t'� BY s ADDRESS Tf, r y r THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT. SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED 'BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR PERMITS ARE REQUIRED FOR ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN ELECTRICAL, PLUMBING AND A FOUNDATIONS OR FOOTINGS. MADE. .:IWHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 1. 2. PRIOR TO COVERING STRUCTURAL QUIRE&�k_ }�6 BUILDING SHALL NOT BE OCCUPIED UNTIL MEMBERS(REAOY TO LATH). FINAL, INSPECTION HAS BEEN MADE. ' 3. FINAL INSPECTION BEFORE OCCUPANCY. POST TH BAR® S® IT IS VISIBLE FR^Aii �TR��T BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS I ) 2 2 �C.Ir/'7 �f f� 2 3 _ t'GS HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT TL 4J j c — OTHER _ _ 2 W"��Z ° o �21�' BO RD OF HEALTH v V r i / j g 196 i WORK SHALL NOT PROCEED UNTIL THE INSPEC-' PERMIT WILL BECOME NULL AND VOID IF .CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE TOR HAS APPROVED THE VARIODUS STAGES OF I WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN CONSTRUCTION. I PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION. SEPTIC SYSTEM MUST EE Assessor's offioe (1st floor):-, - _F p�LLE IN COMPLIANCE- piTNElp Assessor's ma and lot number ......... ......... ........03/ QO p ITLE 5 B ard•of Health (3rd floor): `t'ARONMENTAL CODE AN70 Sewage Permit number .:...... .7^.. .y`�(�..:...................... i BAS34TABLE, TOWN REGULATIONS il Engineering Department (3rd floor): �o - 'oo rb9 39• \0� Housenumber ...........................................................�. c �0MaYa' APPLICATIONS PROCESSED 8:30-9:30 -A.M. and 1:00-2:00-P.M. only TOWN OF BARNSTABLE BUILDING ' INSPECTOR APPLICATION FOR PERMIT TO COA...7 r.u-.0....... ,.�. ...... ........ " . . . . . .... . /' 1 !� TYPE OF CONSTRUCTION .................... (/v ..... ... ...M............................................................... . • .............................. . .... 9 37 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: 1� . !" � � s.Location ....... � ....... ... .. J.... Proposed .Use ......... f Q....... (Y.I. ..I. i........................................I.................................................................. Zoning District ........PIT....................................................Fire District ..... � nJ�.... .�..'.!^�...................... Nome of Owner Aa T .e.(.......CO .:...........Address /?.Q....6X....5 �a.....(:.e.A./. .V1 /.IP ry v 1 Nameof Builder ........ ..I M:4�..........................................Address ..........,/a.!`.�x.......................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ............6..................................................Foundation ......�al.�r��.�......4..d.�.����................ Exierior . ....�JY.If; c........... .......�/1. ......Roofing ...... 40.C..1�� � .... �� ............................. Floors �.�... ..4.... ....... o f.............................Interior ...... 1...[e�� Q ......................................... 9 ..........................Plumbing 1.....? �. \, 'r�eatin /.�.�/� y. ..... /. ........................................... \`I�\Fireplace ......!••V•o..................................................................Approximate Cost ..........�l.��f ...Q�..:............................ Definitive Plan Approved b Planning Board _ _-- _--_ �1 PP Y 9 '---- -r--19-��. Area ..... ...5��7..— i (� Diagram of Lot and Building with Dimensions 'JJ ' Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH l 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 .... ...0 zr� Construction Supervisor's License ....L/..Cll .� GREENBRIER CORP. 31496- 11 Story No ................�, Permit for ......?............................. Single, Family Dwelling .......................................................................... Location ..,.Lot. #.1.1..........1.1 ...White. . ...Mo.ss Drive .. . . ..... .. .... ..... . Marstons Mills ............................................................................... Owner .......Greenbrier....Corp..... .. .... .. . .. .... .... .. .. . Type of-Construction ....Fr........ame.......................... .... ............................................................................... Plot ...... ................... Lot ................................ 4�. Permit Granted December 14.,...,9 87 ...................... ..... . Date of Inspection .........19 Date Co plet d .. ..... .I.........................19 F..-� r ?.';..r Y••L� C' !.:z � 7- tiy �: ;ru.7 .'�tr. S f ;`': FT. /Y07"E /F E/7rNtri? Ti/E SEpT/G TANK OR r _.. /iv T TH ot/V /2 JELO-W L,�ffCN G Pt ARE Ir/ORE �c,o�A. GRAo� 24'L�/A/✓lETE. CoIVCR.IET� C'O!/E�r !!� Irs'. /•'9/Ik scHFvuL�.gsO S.+ls'bLL BE $�ollGHT TO 6l�AOE.�A/V,EiYTieA P.V c. P/PE D U CON=RL`TE �E'`;vY CAST/RO/Y CO�/ R Sf/ALL BCE USED �G / q-— COVERS PER F7 /P'/IV DR/✓E .4 y o. 2 i� M1N. C�NC�•�T� q pg CO YE/R CL EA}N .SANG A r . r BAC/C,=/L L UQU/O LEVEL • q••D��• - - - �' , -'• ••�• 2 LAYER :: .p..u'C PIPE /DDO - GAL. o �o o �� f • • •e • b o � �` 1�8'--�/S" MIN.P/T'CN � %4 PER�►; S�PTlC• . 0 too ,TANK D/sT s • f . • • • • • 1YASHPD S7??/YE t • IEFFECT/�i/E • : • •y 3�4"- fp• _�; _ • P e f S APT!/ • • • • r e IVASNED S'?rdNjff • .�.'a•_. - • • � . • s o er • • • ••► � boo , s 41 O /S/ xZ.S=S7�.S�f;D o o • f • • •. • •• • op o PREG45TSEEPAGE" K /� d = /l3,D�/Pjp i a. a es • • s • s• • p ��p P.; 0 co • • • •. • • f • • a o P/T D /V_ R EQIJ 1AWIR7 erl-EVAT/ONS �9o. 5^C�fp Q s IV_- 8. /Nt�ERT AT ®l!/LD/NG . /� .F1w 6 F7 D/AM. INLET SEPTIC T.4/V K / •i_FT, . _L F T D/.4 A/• C(SSE TAHLLATJ ON� D U?L,ET'SEPTIC 7,o4/V K /iLZ L=FT- 1AlL, T DISTR/$UT/ON BOX/�FT, .SECTION aF GROuNo l7ER TABLE OUTLETDISTR/B[ITYON BOX/o3•/ FT. ' /NLET.LEACRINCr OIT 1S ,70FT. SE�!lAGE O/S®C�SAL SY.ST'�//�9 �ABULA?lD/V L�ACf'�ING PST D/MENS/ON A � 3 SCALE . %4~ DESIGN C/d/TERIA D/�y,HVS/ON 8_`.�—FT. lvVM,3ER OF®EVRoOMS 3 D/HENS/ON C FT. GA RBA 6EO/5,P0-S4I- UNIT NoN� SO/L. L.O& T0TAt ES7//�'iitT-ECG FLOpS/y�,3e G.4L.�DA�" SO/L TEST A/ So/L. T.EST*2 SLR/L TEST A/UNOBER OF LOAcmiva PITS / fEtEY.�117, 7 -FLAY, PATE OF SO/L TEST `��O Se-' S/OF LEACH/NG Pitt P/T 15-1 5S 9 FT. o-� P RESULTS I•VITNESSED aY BOTTOM LZACNING PL=R PIT /1 3 W. A7. SUFS�o/L f'ERCOAAT/ON RATE j*/ 2 M/M4IINCH TOTAL LEACHING AREA 2,6'4 SQ, FT. /-Safi PEITCOLATIO/V RATE fk2 MIN.f INCH R�sER!/ELEi4CHlN6AREA —SQ. FT. r; CLAY PA U L cy� S14NA LoT f A. LEVY A p No.10050�O tQ l LEVY & ELDREDGE ASSOCIATES. INC. 90 5T ��' �° EL, 9 889 WEST MAIN STREET CENTERVILLE.MASSACHUSETTS 0263 # FSS�GM �� �� NOGROUND YY,QTER EJF/CDUIyTL�REO CL/ENr y�zEenl /�,� DATE: f 8 . r y a GRo E/No yt/�TER Ar EL EY. _ JOB ND. L03Z SHEET OF 2 OPEN . S pAc� �(4.00 z l ,Slo S, F. ti �— OP )EN SOT �2 N � SPACF 0 N ZZ� Fovn,RPn otv. 43t R=_ y 2 op R'v �N1T� I' CERTIFY THAT THE SHOWN ON THIS PLAN IS u� p`jNocMA�'�� LOCATED ON THE GROUND PAUL A. AS INDICATED LEVY NO. 10617 S tj V L DATE R G I TE RED LAND .S RVEYOR LE & ELDREDGE ASSOCIATES,INC. CLIENT CERTI ED PLOT . PLAN ENGINEERS — LANDSCAPE ARCHITECTS JOB NO. 0 2 U`�'' ) ) w f rFE MOSS DR(y PLANNERS— LAND SURVEYORS DR. BY : �..T zo IN 889 WEST MAIN STREET CHKD. BY=pim 5A R)V STA P 1-F_ , M A. CENTERkLE, MA. 02632 SHEET OF-1- SCALE= N= ° DATE= y�� 87 ' -XNo T,LE - 4 L G��-1p vi oas l I + / 7;4/ L l fhe" �vv /o' S�YOA D To 6; q% .. cl 16A i00�DJ`Y� �,aT /2 op . - J N 1b'V 67 A+ L nls6; 0I N / '600 N N 1 1 A Mo . LEGEND EXISTING SPOT ELEVATION 0 �(N OFtijgs PROPOSED SPOT ELEVATION EXISTING CONTOUR ---0— —— P AU tirn OF PROPOSED CONTOUR 0 cl U E v NOTE: THE LOCATION OF ANY UNDERGROUND SIN No.10o5o p " b RO SEWERAGE, I OR OTHER LIERM ED �0 �/STHS PAN S APPROXIMATE MATEONLYASDETEN FROM RECORDS AND/OR VERBAL INFORMATION. F�SiO«ALEN� THE CONTRACTOR IS RESPONSIBLE FOR THE ' '�fc ti°�°�Q,� THE FICAT ON OF THE EXISTING LOCATIONS IN N GISTEEDR A I LEVY & ELDREDGE ASSOCIATES,INC. CLIENT-el PROPOSED PLOT PLAN ENGINEERS- LANDSCAPE ARCHITECTS JOB NO. f"' r_._0_T....1.L.��1 /Toss !'-,FIVE .PLANNERS - LAND SURVEYORS DR. BY=,d, IN �. 889 WEST MAIN STREET CHKD.BY: J 89RIV' '7r4Rl-,c HA R. CENTERVILLE, MA. 02632 SHEET-)-OF 2- SCALE ��` 4t�� DATE