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Home My WebLink About0169 WHITE MOSS DRIVE 4' ,� --_ d..,....t, .-. _. _ ..� ._._r.._. �. ._.. _ _ _�.�_..:.� �_.a.,..._,..�_. _.. _ - _,w ,� �� . _.. . Vie _ Town of Barnstable Building Post This Card So That it is Visible From the Street=Approved:PlansMust,be.Retained on Job and this Card Must be Kept 6'S Posted Until Final'Inspection HasBeen Made. ''A r ►� Where a Certificate of-Occupancy is Required,.such Building'shall Not`be Occupied;until,a final_Inspection has been made: Permit Permit No. B-18-1813 Applicant Name: SOUTHERN NEW ENGLAND WINDOWS LLC. Approvals Date Issued: 06/08/2018 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 12/08/2018 Foundation: Location: 169 WHITE MOSS DRIVE,MARSTONS MILLS Map/Lot:, 031-004-006 Zoning District: RF Sheathing: e . Owner on Record: DOHERTY,ALAN R&GINA K Contractor Namern.:`,,_BRIAN D DENNISON Framing: 1 Address: 169 WHITE MOSS DRIVE Contractor License: CS'-095707 2 MARSTONS MILLS, MA 02648 Est. Project Cost: $ 15,261.00 Chimney: Description: replace 11 windows ' Permit Fee: $77.83 i Insulation: Fee Paid: $77.83 Project Review Req: / Final: D ate: f 6/8/2018 Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and thevapproved construction documents for which th s permit has been granted. All construction,alterations and changes of use of any building and structures sFiall be in compliance with the local zoning by-laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. i c --� Electrical r The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work:(; Rough: 1.Foundation or Footing g 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: :'Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department 1r Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT yp6rIME Application number.sL.1/Y'.1.0. 879,41% 00&. Date Issued..............:l . ........................... BAMSrABLL MASS g a639. UN 0 6 , Building Inspectors Initials. �4 VS Map/Parcel.................. .............I.......Q....6............... /�� 2,, I TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: 16 A✓AA tp A a s NUMBER STREET VILLAGE Owner's Name:Alan 4 G•na T��e� � Phone Number , 5329'-1121(-O�v�O Email Address: Cell Phone Number Project cost$ '.2 ( —' Check one Residential Commercial OWNER'S AUTTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Sep ^-dQ ck\a 06-` -4 Date: TYPE OF WORK ED Siding ZWindows (no header change)# / / D Insulation/Weatherization Doors (no header change)# Commercial Boors require an inspector's review 17 Roof(not applying more than 1 layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name `j(�a JI-n Jow S Home Improvement Contractors Registration(if applicable)# 17 32-L 5 (attach copy) Construction Supervisor's License# 09 5 7 01 (attach copy) Email of Contractor Phone number 110/- Z 2-R -9 100 ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY/5 IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. 1 APPLICATION NUMBER *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X 9 X Additional tent dimensions can be attached on a separate piece of paper. 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 I of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. i *WOOD/COAL/]PELLET STOVES x Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles:front back left side right side HOMEOWNER'S LICENSE EXEMTTION Homeowner's Name: Telephone Number Cell or Work number I understand any 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'gown of Barnstable. Signature Date PLICANT'S SIGNATURE Signature Date All permit applications are subject to a building official's approval prior to issuance. • Renewal 61 luanse#3G079 F,.�/�� Cp RE Mnse NEWAL BY ANDERSEN MA a 0173245 Jill Iderr sen. CT UCMe#0634555 WINDOW avuaareMr rn An&—Coeoan, 10 Resenroir Road • Smithfield,RI 02971 lad lttm#1237� Phone 866.563.2235•Fax 401.633.6602 Fedtnl Tas ID#46.0566630 Southern New England Wiadows,LLC d/b/a .Renewal by Andersen of Southern New England CUSTOM WINDOW AND DOOR REMODELING AGREEMENT 6uyer(s)Namc _� A `} G a l [l /y� I'�,2/T//��,1 ( Da�a1 of Atreemarc /t7 &"r(s)SereetAddreu.City Sate.and Zip Code/P.O_Ikx / O / •"��!`� y J� I�I 1 ��yy NN ';;��)' y T y— E-MailAddrcn: V 't/61_✓(C017CR3T. Nif Homa Tel hoots NumFxr. Y'dlfl'Y/b.7V ep Work Telephone Number: Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Southern New England Windows,LLC d/b/a Reneh%ali by Andersen of Southern New England("Contractor");in accordance with the terms and conditions described on the front and the reverse of this agreement and on the attached specification sheets)(collectively;this"Agreement"). ❑ Historic ❑ Condo ❑HOA71 Esnmued Starting Date: Method of Payment: 0 Check Cash Financed Total f ob Amoune�� i Ym ,� C9--J6ly S Deposit Received(33%):�) J U 0 ,�y� Credit Cards are accepted for depositmaximumonly-maximum 113 of the Balance at Start of Job(33%): -� N�of) Estimated Completion Date: project cost.(Please see Gedit Card Payment Form.)By signing this CC agreement,you acknowledge that the Balance at Start of Job and the Balance on Substantial y�7SGJ Balance on Substantial Completion of job cannot be made by credit Completion of f ob(33%): � card and must be made by personal check bank check or cash. Buyer(s)agrees and understands that this Agreement constitutes the entire understanding between the parties,and that there are no verbal understandings changing any of the terms of this Agreement.Buyer(s) acknowledges that Buyer(s) (1)has read this Agreement,understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and(2)was orally informed of Buyer's right to cancel this Agreement.DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. (Rhode Island Sales Only)Notice to Buyer.(1)Do not sign this Agreement if any of the spaces intended for the agreed terms to the extent of then available information are left blank.(2)You are entitled to a copy of this Agreement at the time you sign it.(3)You may at any time pay off the full unpaid balance due under this Agreement,and in so doing you may be entitled to receive a partial rebate of the finance and insurance charges.(4)The seller has no right to unlawfully enter your premises or commit any breach of the peace to repossess goods purchased under this Agreement.(5)You may cancel this Agreement if it has not been signed at the main office or a branch office of the seller,provided you notify the seller at his or her main office or branch office shown in the Agreement by registered or certified mail,which shall be posted not later than midnight of the third calendar day after the day on which the buyer signs the Agreement,excluding Sunday and any holiday on which regular mail deliveries are not made.See the accompanying notice of cancellation form for an explanation of buyer's rights. Buyers)received the consumer education materials provided by the Rhode Island Contractors Registration Board. (Bgw's Initials) Renewal dersen of Southern New England Buyer(s) Buyer(s) By: ~ 1 ignature of Product Manager ignatur t lure Pri - he 44 nt Name of Product Manager Prin 'ame / Print Name YOU, THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT. - - - - - - - - - - - - - - -�- - - - - - - - - - - - - - - -�c- - - - - - - - - - - - - - - • NOTICE OF CANCELLATION Date of Transaction -- You may cancel Date of Transaction I .You may cancel this transaction,without any penalty or obligation,within this transaction,without any penalty or obligation,within three business days from the above date.If you cancel,any I three business days from the above date.If you cancel,any property traded in,any payments made by you under the property traded in,any payments made by you under the Contract or Sale,and any negotiable instrument executed I Contract or Sale,and any negotiable instrument executed by you will be returned within ten business days following I by you will be returned within ten business days following receipt by the Seller of your cancellation notice,and any l receipt by the Seller of your cancellation notice,and any security interest arising out of the transaction will be security interest arising out of the transaction will be canceled.lfyou cancel,you must make available to the Seller I canceled.lfyoucancel,you must make available•to the Seller at your residence,in substantially as good condition as when I at your residence,in substantially as good condition as when received,any goods delivered to you under this Contract or I received,any goods delivered to you under this Contract or Sale;or you may,if you wish,comply,with the instructions of I Sale;or you may,if you wish,comply with the instructions of the Seller regarding the returnshiprinent of she goods at the the Seller regarding the return shipment of the goods at the Seller's expense and risk.If you do make the goods available X Seller's expense and risk.If you do make the goods available to the Seller and the Seller does not pick them up within to the Seller and the Seller does not pick them up within twenty days of the date of cancellation,you may retain or twenty days of the date of cancellation,you may retain or dispose of the goods without any further obligation.If you I dispose of the goods without any further obligation.If you fail to make the goods available to the Seller,or if you agree I fail to make the goods available to the Seller,or if you agree to return the goods to the Seller and fail to do so,then I to return the goods to the Seller and fail to do so,then you remain liable for performance of all obligations under I you remain liable for performance of all obligations under the Contract To cancel this transaction, mail or deliver the Contract To cancel this transaction, mail or deliver a signed and dated copy of this cancellation notice or any I a signed and dated copy of this cancellation notice or any other written notice, or send a telegram to Renewal by I other written notice,or send a telegram to Renewal by Andersen of Southern New England at 10 Reservoir Road, I Andersen of Southern New England at 10 Reservoir Road, Smithfield RI 17,NOT LATER THAN MIDNIGHT OF I Smithfield,RI 02917,NOT LATER THAN MIDNIGHT OF Date) lHISTRANSACTION. .(Date)I HEREBY CAN EL 1 HEREBY CANCEL THIS TRANSACTION, Buyer's Signature Print Ham* OaH Buyer's Signature Print Nuns Cate RbA Copy:White Buyer Copy:Yellow Buyer Copy.pink i Office of Consumer Affairs end business I�egT:�lation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Hone Improvement Contractor Registration Registration: 173245 Type: Supplement Card SOUTHERN NEW ENGLAND WINDOWS LL Expiration: 9/19/2018 BRIAN DENNISON 26 ALBION RD :.. . LINCOLN, RI 02865 Update Address and return card.Mark reason for change. Address Renewal —. Employment — Lost Card -=-Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: Office of Consumer Affairs and]Business Regulation Registrations: 11324$ Type: 10 Park Plaza-Suite 5170 Expiration: 9il9120/8 Supplement Card )Boston,MA®'_'116 ;OLITHERN NEW ENGLAND WINDOWS LLC. 3ENEWAL BY ANDERSONj IRIAN DENNISON 16 ALBION RD .INCOLN, RI 02865 Q-Undersecreiary Not valid without signature De--n .bM n; ^r L:' r'^ v v _ i�N Q': L: F i r.i i� �V I 'L.'1.J:I �4- '✓'-- Qru.Ot Buildi c- Rec'Ularioi s and "^`+Iancia' S J _.c�,r��; CS-095707 b BRIAN D DENNISON 7 LAMBS POND CIRCLE CHARLTON MA 01507 �Girnm3SsIoner 09'081.'2018 I The Commonwealth of Massachusetts ' Department of IndustrialAccidents I Congress Street, Suite 100 Boston,MA 02114-2017 _ www.mass.gov/dia 11 orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERNIITTING AUTHORITY. Applicant Information Please Print Le gib) Name (Business/0rganization/Individual): o E e Lo Address: (p A&oz 1:A City/State/Zip: Li A P Phone Are you an employer?Check the appropriate box: Type of project(required): 1I am a employer with �O temployees.(full and/or part-time).* T.Q New construction 2.�I am a sole proprietor or partnership and have no employees working for me in any capacity.(No workers'comp-insurance required.] 8. Remodeling In I am a homeowner doing all work myself.f No workers'comp.insurance required.]t 9• ❑Demolition 4.n 1 am a homeowner and will be hiring contractors to conduct all work on my P PAY•ro I will 10 Building addition - ensure that aU contractors either have workers'compensation insurance or are sole 11. Electrical repairs or additions proprietors with no employees. 5.7 I am a general contractor and I have hired the sub-contractors listed on the attached sheet 12. Plumbing repairs or additions These sub-contractors have employees and have worker.'comp.insurance.! 13-❑,/Roof repairs 6. We are a corporation and its officers have exercised their right of exemptior,per MGL c. 14.L`_'J Gther n 151§1(4),and we have no employees.[No workers'comp.insurance required.] �e �&e relent 5 iArry applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this a5d2vit indicating they are doing all work and then hire outside contactors 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-contracctors 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 a�iid job site information Insurance Company Name: Ire me n S �M Policy#or Self-ins.Lic.#:+W C-A,3`-8"7 2 q — Z.V Expiration Date: / 1 Job Site Address: City/State/Zip: �nJ .4 Attach a copy of the workers'compensation policy declaration page(sbowing the policy number and expirati a date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation plIriishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORT{ 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 aims andpenalties of perjury that the information provided above is true and correct Sip,nafore: Nl-"- I D2ie: — —/� Phone#: QO t- 22, 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/To"Clerk 4.Electrical Inspector. 5.Plumbing Inspector, 6.Other Contact Person: Phone#: r AC& CERTIFICATE`� OF LIABILITY INSURANCE DATE(MM/DDIYYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON lvzs/zo17 THE CERTIFIC CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EX ATE HOLDER. THIS AFFORDED CERTIFICATE TEND OR ALTER THE COVERAGE AFF BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING ORDER BY THE POUCHES 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 014TACT CoBiz Insurance, Inc.-CO NAME: 1401 Lawrence St, Ste. 1200 PHONE -303-988-0446 iic No:303-988-0804 Denver CO 80202 EAIL DDRE : COMaiI cobizinsurance.com .INSURER(S)AFFORDING COVERAGE NAIC i INSURED ESLERCO-01 INS RER A:Acadia Insurance COMDany 31325 Southern New England Windows, LLC. INSURER B:Firemens Insurance Company of WA,D.C. 21784 dba Renewal by Andersen of Southern New England INSURER c:Homeland Insurance Company of New York 34452 10 Reservior Rd INSURER D: Smithfield RI 02917 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1252851165 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 ADDL SUBR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF IMPnaIDD E11P LIMITS A X COMMERCIAL GENERAL LIABILITY CPA3158728 1112018 1/12019 EACH OCCURRENCE $1.000,000 LiWMS-MADE I X OCCUR —DA—MGF TO RENTED -PREMISES occurrence) $300.000 MED EXP one person $10,OD0 PERSONAL&ADV INJURY $1.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000.000 OTHER: X POLICY PERK LOC PRODUCTS-COMP/OP AGG $2.000.00D $ A AUTOMOBILE LIABILITY N CPA3158728 1/12018 1/12019 COMBINED SINGLE LIMIT Ea accident $1,000,0110 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ A X UMBRELLA LIAR X OCCUR CPA3158728 1/12016 1112019 EACH OCCURRENCE $10.000.000 EXCESS L1AB CLAIMS-MADE AGGREGATE $10.000.D00 DED X I RETENTION$ $ B WORKERS COMPENSATION WCA3158729-20 1112016 1/12019 X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N/A E.L.EACH ACCIDENT' $1.000.000 (Mandatory in NH) If yes describe under EL DISEASE-EA EMPLOYEE $1,000,00o DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $1,000.000 C Pollution I iabLty 79MO73340000 1/12018 1/12019 Each Occurrence $1,000.0D0 Claims-Made Policy Retroactive Date 06202013 ==ga $ble 1l),000� DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if 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. For Informational Purposes AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD i ' otp40C0 6 a�� *'THE Town Teti Town of Barnstable *Permit# O Expires 6 mon hsfrom_issue date Regulatory Services Fee IARNSrABLE, + v KAsa. Thomas F. Geiler,Director �A 163;9• rE[);MA't ® a c� �. -S P � ' Building Division Tom Perry CBO Building Commissioner D F C 2 3 2009 200 Main Street,Hyannis,MA 02601 . (Q\nnir� F gARIVSTABL� www.town.barnstable.ma.us Office: 50�-8�2-4.038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Prope Address !o t/" e s A. I//s ® U Residential Value of Work �L•�ii 5 m fee of$25.00 for work under$6000.00 . Owner's Name&Address __j Contractor's Name J /rl 2S d�� Telephone Number '7�t`G e CJ C� Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) T v ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ Pam the Homeowner I have Worker's Compensation Insurance Insurance Company Name e lco Workman's Comp.Policy# J (� Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ZReplacement( i ide #of doors ndows/ oors/sliders.U-Value (maximum.4.4)#of window *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: c/ Q:\WPFILESTORMS\building permit forms\EXPRESS.doc Revised 090809 UoC� o7 / S Customer Name:��,�N_J��7—K Year 13uilr. Renewal by Andersen of Rhode Island& �ene�tat .,. Sales A reement Address: /i,�,,_UA17—�a PFOSS -4 CuscomerID#; Cape Cod ��i� City,State,Zip: 1137 P r c Drive Andn• g L Order Number: arkt,�i � � � � � �.- Woorisockece RI 02895 WINDOW REPLACEMENT anAmicrxrtContpiny Phone-Home n-Siii 4�b-063© � Phone-Work: Page.L of �_ Dace: / L— of license tt RI-30839 RI-12259 MA- " Email: 119535 CT-562725 UNITS Technical Measure GRILLES Dimensions 6 � {i0 "nn d x d i I C C D E� E' cg oN o a y@ �g ski ng o�, •p6 a e_+ v V o os y y y€� O 3� m aft F� 5 °'� c6 a t: a't c3 c e8 y8 :'E �e€8s .. cE oP ,t «°Ir e s E Room d $ 'e"5 N a'e •p 2 'g a b°' S ^t'dr° ^r^r b PRICE$ 9 E d to a�i $gg$ff o E Z ,y�3 is [ ar rn 3 ,n,� _ a gI Desolption 94 qps Z`Zd vc "a Qe a cc .a m � OE 1p 8 L� _ ._ =p .^n3 v+'3 W3 Nx N �p pg S o'c sic �,� og .¢3 0oG Vgt Vx o J: ^ p -p ... Gf€t! �S gym$ us! v V� 6t cE Ng Q �'J C So dL1 x o 0 �7 S2.< 1 1 )31 S 11 I 1 7 _ I I I a-7 Si 17 1 s i 64 rt 1 I I 9-7 37 Co tf PAY I ,-7 " a-7 r r ` Proposal:All of the aboce°•ind—.,and doors m 1,e p—ided inr nc�total amounr.stmed in the ay.-In-t-The Miscellaneous Credits or Expenses 1 Sub Total trap.n d'r S payment Method pm po will remain Mid(T30 -nd is ubiea ro acceptanee by Mnh fusa,ma and Nenewai M•.mlenen Jtany;cr as (Staining,Wmp,Rot Repair,Promu ,eta Y , Po'It Ixhnot t Sub Total peep.rageo � 1,, r Description I Notes / ( u✓�7) sp.r6 Sub Total wt�.0 Check by Aod--gales Rcprcsem.dreSiymatur< / t Credit Card Customer Accept Ce:You a c hnhy amhndaed w(urmsh all°•induws:nod do>rs rcyuimd us umsplete this 1 O MIX.Credits at EflpeRseS agreement(ur which Re ood-iyp..J ug—rn pay the--t-Wi m this agreement mat acamtinR to the tc<ms hereof. _ ❑ See Reverse Side for Terms and Conditions of Sale.You,the buyer,may cancel L T 1 Financing this transaction at any time pprior to midnight of the third business day after /�JJ� is LtX tr r the date of this transa tion.Yle. sce attached n ice of cancellation for an LVK(.)f4 fJR 9/yr Fv rvr4 0✓RcI yF S SalesT °rRCed6t6R0°ti explanation of this " ^ overt total rni eore Credits or Expenses u2tAdditional Okla rams Attached Accept Jt ( (carry over tool to mist,cerise f eapcnce column at right) Work Permit Cost /�C Dam I't:ti crApp—O•ilmam�—� +' _ please doorallthatDplyl Special Order Note.< Total Amount of Agreement Patio Door Storm Door :\cceptnl ��° aaY/aew Fntry Door Dam Renewal by Andersen afar h-S.gnture V/3 r? a Deposit Required specialty Window 2Y,painting sWNnga Renewal byAndenen Removal and reinstallation vleate note that we are u=fw bid on,epauing L04C kt11/ 60,5C,7 `a•S 7s 8alanee Due on Completion r. wallpaperhg IMIm nmy does trot�gw,aranter the o1 window cove IIp,are a,ry mseen dam'nge,Moweveell a,ry unseen damige De needed h tyros kwhided fit of arig(nal window solely dre respow{blllry of h dismveted rsaing tmtaNat[on we wtg comyleee t+ / `�•- 'P In Mb aaqgrrerment unless <overinq,her new unity Necmtomw mks, and charge you for the regain uponymrapproval. �• // GO 7 Price i.crodes labor,materials.insnllation, ,pedRcaltyrrotedabove are inwlled, orMrwisemM, A,Ine end of tl¢(ob ale construction deNis will be removal,spd disposal of producL<rcplacetl. removed and we wig treaty yom,net windows and White-Renewal by Andersen Yellow-Installation Pink-Homeowner Customer j ,T// Customer /y// Customer On,Installation area. Initials: -(/F� Initials:. -�tv/ Initials:, •x.,...JNa,dn,u'•na,M WnnAN,t�dnun lap ae u.6m.r,adMln<e up.0 0:.m Ndrt,en4�Pnnun.Atl r1{hu mmN.008pnade,iP:W]!A i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 11 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information A Please Print Legibly Name (Business/Organization/Individual): 00 V^) ssoc. kc L� Address: // 7 Or . City/lye/Zip:00090ckc. Phone #: ('� �0 '7� VD-0 Are 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 6. �rem construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. odeling ship and have no employees These sub-contractors have g• ❑Demolition working for me in any capacity. employees and have workers'comp. ❑ Building addition " [No workers' comp. insurance comp. insurance.$ 5. ❑ required.] We are a corporation and its 10.❑Electrical repairs or additions 3.,❑ I am a homeowner doing all work officers have exercised their l 1.❑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 anew 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.-ifthe"sub=contractors have em to ees-they-mustprovide-their workers'com i.policy number- - - - - -p Y Y P•P Y I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Befic'm f'` Policy#or Self-ins.Lie.#: l 6 Expiration Date:�� Tn, Job Site Address: / City/State/Zip: 7 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided 1above /is true and correct. Signature: Date: �0` /C� ` 67 2- Phone#• 110L 6,71— C�00 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6. Other 1 ' Contact Person: Phone#: Mgr r __ a. ®ns i s.$ 43� ziss �gulat v -� : ... i �.: TO --286438 on � ��i,9£h��rsi�7:31� .. :. . .:.j,., t:.r•.y: a� � f-'-- J ti'i � - & 11-37-PAR_. ,r ?.: WOOMPOC ET, Unt�er�ecr�xaiy 7 3 €€i ,,. i a l 4 •or. Si t- r&0tc ram. rr t DI . �i-,.�� ,tr"-.Pe�".. r., ". �"g � v `. '•>:�p�•-.�I -�'L't� �rT. �.�'�a�a r -rom:Snaunna Robinscn, Hunter Insurance At Hunter insurance,;,c. =-----dD: To:Denise Clode Date:923/09 09:45 AM Page:2 of ACQRDL CERTIFICATE OF LIABILITY INSURANCE OP ID S DATE(IA%'JDD/YYYY) MOONA-I 09/23/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Hunter Insurance,* Inc. HOLDER,THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 389 Old River Road, P.O. Box 1 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Manville RI 02838-0001 Phone: 401-769-9500 Fax:401-769-9502 iINSURERS AFFORDING COVERAGE NAIC INSURED Moon Associates Inc.DBA Gutter Helmet INSURER A: National .range Insurance Co ' 14788 DBA Renewal by Andersen of RI INSURERS: Se can Mutual Insurance Co. DBA Gutter Helmet Roofing DBA Moon Works ; INSURERC: 1137 Park East Drive I INSURER D: Woonsocket RI 0289S � ENSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOT`A ITHSTANDING 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 UPAITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I.— LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE Q'dI1/DDIYY) DATE(M(111DD1YY) LIMBS GENERAL LIABILITY I 1 EACH OCCURRENCE $ 1000000 A X COMMERCIAL GENERAL LIABILITY MPS26619 i 09/16/09 09/16/10 PREMISES (Ea oC urence) $ 500000 CLAIMS MADE OCCUR I MED EXP(Any one person) $ 10 0 0 0 FK� PERSONAL&ADV INJURY $ 1000000 GENERAL AGGREGATE $ 2000000 I GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP.4GG $ 2000000 POLICY PRO- JECT 0LOC AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT A X ANY AUTO I B1S26619 09/16/09 09/16/10 (Ea accident) $ 1000000 ALL OVVNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) ($ HIRED AUTOS I I BODILY INJURY $ NON-OWNED AUTOS I (Per accident) — PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY I AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EAACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY I EACH OCCURRENCE $ 1000000 A X OCCUR CLAIMS MADE CUS 2 6 619 i 0 9/16/0 9 I 09116110 AGGREGATE $ DEDUCTIBLE i Is X RETENTION $10 0 0 0 i$ WORKERS COMPENSATION AND X TORY LIMITS ER EMPLOYERS'LIABILITY B JUIH ANY PROPRIETCR/PARTNEWEE.CUTIVE 28586 10/01/09 10/01/10 EL EACH ACCIDENT $500000 OFF ICEWMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $5 0 0 0 0 0 It yes,describe under SPECIAL PROVISIONS beic++ E.L.DISEASE-POLICY LIMIT $500000 OTHER I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES J EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS I CERTIFICATE HOLDER CANCELLATION BUILDIN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Building Cont. Reg. Board NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Dept. of Administration One Capitol Hill IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Providence RI 02908 REPRESENTATIVES. AUT D REPRESENL TIVE�y ACORD 25(2001/08) ©ACORD CORPORATION 1988 rt �'. "►Y � +x^rY+Wtaf �' 7:1 ,y K�i .} ,.^`.a nx+ >< y • � .._w r,.'Cd+g ri 'L i:+; *' e4 SW� l'•-� '�C':.=^.y w..f• ?. ''�'• •1 f. '.:'st+�i' 4. ';i�, y .'di :ik'X�} "f�``"T'�?i+Y �• �.: f!�''G1` Ls�,*ry^ems I` `Oi1ME Tpk� Town of-Barnstable BARYSTABLE. • Regulatory Services MASS. - _• ,639•- Building Division "°�-- 200 Main Street,Hyannis, MA 02601 Office: 508-862-4038 Fax: ' 508-790-6230 Inspection Correction Notice Type of Inspection Location �6`1 �� Permit Number Owner, a Builder One notice to remain on job site, o notice on file in Buildi Department. j The following items nelled corrIle ecuaa .: 41 Please call: 508-862 for re-inspection. Inspected.by l k Ir Ai(r�/0"_" Date � r d� 1 I Q '�� pPe„�tiys `� ba�`�ti� 5',.cs , Q i BUILDER INFORMATION Name__ I ��'� eYT� Telephone Number s-d 8, Address U� j�/� 1SS License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE - DATE �� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 3 Parcel fo hC t 1 Permit# '7 I/ / ir tti.ttiT �.�rt1l�:5 J Health Division � o t��_, Date Issued Conservation Division 10�� i �'�/ ' { tii i a: 2b Application Fee G6 Tax Collector I (� Permit Fee F-12 7'77 Treasurer EXISTING SEPTIC SYSTEM Planning Dept. LIMITED T0.3.#OF BEDROOMS Date Definitive Plan Approved by Planning Board lv"2 ad M 1,1(',,lV," S.> C®. Historic-OKH Preservation/Hyannis G✓► �wt� �y /-0044 � '�A'ClfCP Project Street Address Village 4,iil.:::. Owner Address Telephone Permit Request IL g �I�Oi�,LIEE IE200d0044 Square feet: 1 st floor: existing proposed 51Z- 2nd floor: existing 5�6 proposed Total new 6 fro Zoning District Flood Plain Groundwater Overlay Project Valuation 5v, avo Construction Type VJQ0d - Lot Size 90 , &Z1 Grandfathered: ❑Yes Cl No If yes, attach supporting documentation. Dwelling Type: Single Family 2 Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes OTIo On Old King's Highway: ❑Yes 2KO Basement Type: &Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) _7(o c7 Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing 3 new Total Room Count(not including baths):existing -7 new First Floor Room Count Heat Type and Fuel: 2116as ❑Oil ❑ Electric ❑Other Central Air: ❑Yes 3 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:21"e"xisting ❑new size / X 7-Shed:�xisting ❑new size 6 Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑ No If yes,site plan review# Current Use Proposed Use 601 r - BUILDER INFORMATION rName Qn �� IQL-� S LLC- Telephone Number SO 94 Co 3 33 Address -7 License# y 57-7 1 38 Vy� ?4tf�k d ZCo(,0 0 Home Improvement Contractor# 1 a a, --!:)-7 Co • Worker's Compensation# ALL CONSTRUCTION DEBRIS RE LTING cIbOM THIS PROJECT WILL BETAKEN TO �-� � J SIGNATURE !� DATE f, • FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED a MAP/PARCEL-NO. - - ADDRESS VILLAGE OWNER f DATE OF INSPECTION: FOUNDATION FRAME `"t 1105- c " INSULATION FIREPLACE { ELECTRICAL: ROUGH FINAL r ' PLUMBING: ROUGH FINAL GAS: ROUGq FINAL FINAL BUILDING " ,f cr w. ► n rr DATE CLOSED OUT •• I N ASSOCIATION•PLAN.NO. _ J 0 rr, 3 N w 3�.95 SHED LOT 23 22,616.9 t S.F. r 44.38, v C9 C j ZZ j k y� 'O W � i goo�noN 6g W B L�Jc p tA PniN � �p3. al � )' oRI�E MOSS MILS 11.5 WHITERSTON L A TO THE BEST OF MY INFORMATION, "PROPOSED" PLOT PLAN KNOWLEDGE, AND BELIEF THE BARNSTABLE, MASS. STRUCTURES SHOWN ON THIS PLAN LOT 23, L. C. PL. 37857_8 HAS BEEN LOCATED ON THE GROUND DATE 9/18/04 SCALE 1" = X AS INDICATED JOB 6062-00 CLIENT CLANCY SWEETSER ENGINEERING 9 18 04 235(GREAT WESTERN ROAD DATE PROFESSIONAL LAND SURVEYOR PO BOX 713 SOUTH DENNIS, MA 02660 OFF. 508-398-3922 FAX.508-398-3063 C.• �S8\PRLJ�6062-OOIDWG\6062-CPP.DWG Permit Number REScheck Compliance Certificate Checked By/Date 2000 IECC REScheckSoftware Version 3.6 Release 1 Data filename:Untitled.rck PROJECT TITLE:Doherty CITY:Marstons Mills STATE:Massachusetts HDD:6137 CONSTRUCTION TYPE: Single Family WINDOW/WALL RATIO: 0.10 DATE:09/27/04 DATE OF PLANS: 9/25/2004 PROJECT DESCRIPTION: Addition DESIGNER/CONTRACTOR: Clancy Builders,LLc COMPLIANCE:Passes Maximum UA= 109 Your Home UA=96 11.9%Better Than Code(UA) Gross Glazing Area or Cavity Cont. or Door er' eter R-Value R-Value U-Facto UA Wall 1: Wood Frame, 16"o.c. 123 13.0 0.0 9 Window 1:Vinyl Frame:Double Pane with Low-E 12 0.350 4 Wall 2: Wood Frame, 16"o.c. 169 13.0 0.0 12 Window 2:Vinyl Frame:Double Pane with Low-E 12 0.350 4 Window 3:Vinyl Frame:Double Pane with Low-E 12 0.350 4 Wall 3: Wood Frame, 16"o.c. 123 13.0 0.0 9 Window 4:Vinyl Frame:Double Pane with Low-E 12 0.350 4 Wall 4: Wood Frame, 16"o.c. 64 13.0 0.0 5 Wall 5: Wood Frame, 16"o.c. 152 13.0 0.0 11 Window 5:Vinyl Frame:Double Pane with Low-E 12 0.350 4 Wall 6: Wood Frame, 16" o.c. 123 13.0 0.0 9 Window 6:Vinyl Frame:Double Pane with Low-E 12 0.350 4 Floor 1:All-Wood Joist/Truss:Over Unconditioned Space 352 19.0 0.0 17 COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications,and other calculations submitted the permit application. The proposed building has been designed to meet the 2000 IECC requir ents ' S check er ion 3.6 Release 1 (formerly MECchecl and to comply with the mandatory requirements li t d in th S the kIn ection Checklist. Builder/Design Date i I i tt RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings $100.00 G Residential Addition $ 50.00 �. Alterations/Renovations $ 50.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE O _7�square feet x$96/sq.foot= �1 x.0041= 77 plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq. foot= x.0041= plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq.ft.= x.0041= ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0041= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee Projcost Rev:063004 I , F -� r Town of Barnstable Regulatory Services ` saxiv 1% Thomas F.Geiler,Director 1639. p Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 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. Type of Work: AIWJ R11Z Estimated Cost -34,0-0-0 Address of Work: (o g y Ak--bt ;44 6 S S Owner's Name: C) p /o Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby ap ly for a permit as the agent of the o er: 3 o Date Contractor a e Registration No. OR Date Owner's Name Q:forms:homeaffidav I °f Town of Barnstable Regulatory Services ` RAJMSTABM Thomas F.Geiler,Director '°�ED► p`� 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, bow* ,as Owner of the subject property hereby authorize C OIL- I IS S to act on my behalf, in all matters relative to work authorized by this building permit application for. I (09 Ijk.,:� l/4ssIt (Address of Job) 0 Zfo 45 q z--7 0 Signature of Owner Date " f Print Name QTORM&OWNEUERMISSION The Commonwealth of Massachusetts urr. '= j De artment of Industrial Accidents 600 Washington Street Boston,Mass. 02111 Workers' Compensation Insurance Affidavit-General Businesses �//��0�� name: address: city state: ap phone= work site location(full address): ❑ I am a sole proprietor and have no one Business Type: ❑ Retail❑Restaurant/Bar/Eating Establishment working in any capacity. ❑Office❑Sales(including Real Estate, Antos etc.) ❑ I am an employer with em loyces(full&part time). ❑Other I am an employer providing��w//orkers'compensation for my employees working on this jeb. company name- address: city e, phone# insurance co. policy# ❑ I am a sole proprietor and have hired the independent contractors listed below who have the following workers' compensation polices: companv as address: city phone 9- insurance co. lice# company name: address: city phone#r Insurance co. poliev# Failure to secure coverage as required under Section 25A of bIGL 152 can lead to the imposition of criminal penalties of a tine up to$1,500.00 and/or one years'imprisoning as well as civil penahi in the form of a STOP WORK ORDER and a fine of S100.00 a day against mr_ I understand that a copy of this statement y>x forwarded to the ice of Investigation of the DiA for coverage verification. I do hereby certi der the s an pe • o perjury that the information.provided above is fr7 and c e 7 Signature 1 Date O Print name + Phone R official use only do not write in this area to be completed by city or town oirxW .�d<� �::. - - city or town: _- _. 5,.�.f P �0 agittldia�Department ucensing Board _ ❑check if immediate response is required ;_,_--�_ ,,, . ,::.�. __ _,...._:r _. __ Q$ei�en' Os tfiee --- - DHeahh Department contact person: . .phone#; (--W Sag_MO) 77 _.-.....• _. ... .. ..._w. _. � + ._ .r..r. ._-.....y ...y>.wM_+r�.Wr'.--�..+ ......-..+a.rn•w•w...li • .... .MM -.M.raW aK'.+.r .r._. .._n..... .:•+sir. Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers condensation for their employees. As quoted from the"law, an employee is defined as every person in the service of another under any contract of hire, express or irrzplied, 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 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 j building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 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 far any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the corrrnonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. i/�%�ioi//%%!%�/1//lam%%�/ /////,,,%%// /////�//r/,/:////��/,/,r/,... ,/,.,// , /�� Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation. Please supply company name, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accident 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 perrnit 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. City or Towns Please be sure that the affidavit is complete and printed lembly. 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 er which will be used as a reference number. The affidavit may be returned to be sure to fill in the perrrtit/license numb the Department by mail or FAX unless other atrangernesrts have been made. The Office of Investigations would lice to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call The De,-a. address. teleahone and fax number: _ The Commonwealth Of Massachusetts Department of Industrial Accidents 81ft N a 11 U181ft - 600 Washington Street Boston,Ma. 02111 fan#:(617)727-7749 phone:: (617) 7274900 eat. 406 �: .. ._. �.-,,.... .. ... .. :�:a- .r ..y ++':r«...a.__. ....- Y'^`i'W,- •-K�;.t - ...r>• ...r...-!_1..i_.l'.-..;.wt.�.S.rl:r...'�4Y•.n4 q . r.-i n:+y-:i�•n�sr3 ..- ... ,a•. � . k__. __ .._ . , .... .. ... .�,.— .., .... _ .:-5.'T•' -_.. ....-•�r".. _-...:_.,.,_«:P...,s^.,.�.. .... G ..,7:.....n.-..T..A"._t'n.;,r..1Cs1 air,. E ,was BOARD OF BUILDING REGULATIONS License CONS7RUCTfON SUF:ERVISOR f NumtSe � r CS: 05,7138. . �L �Exp 05/09/2k{005: Tr=no 12348 � ;Res�tricted�00yA�. �� 207SETUCKET S;DE_NNIS,`MA 02660`-`; Admimstrator.2 Board of Building Regulations and Standards.:. HOME IMRROVEMENT CONTRACTOR Registratlont :122376 _z_tl0Wff_-/23/2006 _ TYpe=DMI b CLANCYBUILDERS ° k MARK CLANCY ` �f 207 Setucket Rd S,y ->S'.-DENNIS,MA 02660 Administrator — _._.:__-- IMPORTANT AJ / - ANY CONSTRUCTION THAT INCREASES LIVING SPACE K'j r*L-I IQ09I!�V SEYGND 1200 SQ.FT.PER LEVEL MAY REQUIRE THE TO �(K� i.4LLATION OF ADDITIONAL SMOKE DETECTORS. :.')TE: A SEPARATE PERMIT IS REQUIRED FOR THE -A_LgTION OF SMOKE DETECTORS-THE ELECTRICAL :?rOES NOT SATISFY THIS REQUIREMENT. Ell a a. a tEl - <0 MR'sw silo gpWV �✓IOrf(an/ 0--4- fA I-S kt,M - ►b� ��+-� �� ,�z►ram ��ors �� SCALE: I APPROVED BY: DRAWN BY 3� DATE: K'p : REVISED S Y DRAWING NUMBER f�[s/eS¢4 �,�I�� koPDSe Eki6fiNlf �2o GuS��._..f�_�f .�do.�►�I_._`!�d"�D.-- fdLN ED�IS'fA•I✓ - � ¢wDa— 'Fi-oo� vJ,�Jouv+ To GIKEn ` DPEN�Ntr A �JQJ'1 EX,hf• GAs•,rG� o�ENlul� l IWEE Wkw tie"i' �I�sno� �o�n� �� rtit. + nnas � ,�b►�e�Y 1,{�S II� 1 11 DRAWN BY APPROVED BY: L BGALE: I v DATE: S D REVISED d DRAWING NUMBER �I ti El . i 1 a ol f:16,0v6iF2 AV0ir��7jN �2 L t-r��'l-yV4, Fh�kN- I�j V ' •PAPPRD BY: VF DRAWW D�SAN 13I SCALE: � I DATE: M o NS DRAW'NO NUMBER • G�'�NGY �,�iw�S k ryVdvA A_ *Air 21D&lg' t6a, �! ►IfE ,KIP p�P�ktf PaoF or(�¢. q>LIa II. OL I�jSr�ibf D►� 0 J� /SG(f 7J �OIYe 02 R G+/f T° rGX"gf' I' 6DX +, �V-1 IL vc P 4 �ANIIOL 39vr�, �o Gov 16' w Slbl. 5>rA1— kC � h ++ (noPaS2� "OITI oN r g—►^ t r iLS A-,,W Oo n SCALE: I - APPROYEO BY: _ DRAWN BY DATE: Ad [ /'I 31/2, GU •Ggo'Sri i- %o�JI�DATIO1 Q%�'X 16 �O✓I lI'1� DRAWINGN MBER ��il,7S . / Engineering Dept.(3rd floor) Map Parcel h Permit# q House# �lle5;, --L��d Date Issued Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) _1rV0,\Fee `� v Conservation Office (4th floor)(8:30- 9:30/1:00-2: 0) " f use. ✓L� Defim 1 19 - BARNSYA� ` n MASS. TOWN OF BARNSTABLE Building Permit Application Project Street Address q � ��G (S oc j Village 1 t 1 A es 7i1, yni t" " y_ Owner / l Address ` o q �h�le � Ib Telephone qZ k-- d bT,0 2- Permit Request0.2612A&r. ` sa First Floor 21 d' 33t (GAt�L quare feet Second Floor `f7-1 3 quare feet Construction Type W"-10 T-2nrnie- Estimated Project Cost $ 90,a-D i ( Zoning District Flood Plain u�� Water Protection 1J1� Lot Size r�a t L►1 Grandfathered ❑Yes ®No Dwelling Type: Single Family a Two Family ❑ Multi-Family(#units) tAge of Existing Structure (A Historic House ❑Yes S,No On Old King's Highway ❑Yes a No Basement Type: ❑ ra Full C& wl ❑Walkout ❑Other Basement Finished Area(sq.ft.) U 1 S Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New ►3 8 Half: Existing New t h No. of Bedrooms: Existing A New I - Total Room Count(not including baths): Existing 142 New �_First Floor Room Count 3 Heat Type and Fuel: Gas ❑Oil ❑Electric ❑Other s )gl 1Z Central Air ❑Yes Wo Fireplaces: Existing New Existing wood/coal stove ❑Yes EtNo Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) 1AAttached(size) ' 2-Z, ❑Barn(size) _°4 ❑None ❑Shed(size) j ❑Other(size) 'y Zoning Board of Appeals Authorization ❑ Appeal# �� Recorded❑ Commercial ❑Yes ` LNo If yes, site plan review# Current Use Proposed Use Builder Information NamelQ e Lo�ov� Telephone Number 4-19- 43too Address 116icense# ©`s o?4) So-%M fay I Q K. MA. b. w,\ e'-'Home Improvement Contractor# /dZ -?a6_ XVorker's Compensation# 7S/ 161 QS NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCtT`.ION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO r•�Q.wtC�t �`�1t.�- SIGNATURE BUILDING PERMIT D I FOR THE FOLLOWING REASON(S) _ w� FOR OFFICIAL USE ONLY PERMIT NO. ' DATE ISSUED MAP/PARCEL;NO ADDRESS %'1 ' VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION t FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. ....................... . :: : .11 :CaT : .. ::::::::.:.::.::::::::::::::::::::::::::::.:::::::::.::.::.::.::::.::.::::::::::::::::::::: :: rlhE.::.:.:::::::::::::::::::::. PRODUCER .... .................. 05-24- 96 cER ` THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIONONLY AND ... .CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS;CERTIFICATE FRANCIS M WALLEY INS } DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE PO BOX 469 POLICIES BELOW. DEDHAM MA 02027 COMPANIES AFFORDING COVERAGE COMPANY LETTER A THE TRAVELERS INSURANCE COMPANY � 22LTW COMPANY INSURED LETTER B GREATER HARWICH CONSTRUCTION COMPANY C CORP LETTER PO BOX 441 COMPANY LETTER D SOUTH HARWICH MA 02661 COMPANY E LETTER HIS ST O CERT•.�� IFY HA T TH......... E POLICI .ES�OF I NS........ URAN LSTE�� LOW>:H HAVE BEEN N ISSUED THE:N:::;::>: SURE ��- D NAMED••ABOVE•�FORTHE•POLIC�� • Y PERIOD , INDICATED, NOTWITHSTANDING'ANY.REOUIREMENT, TERM OR CONDITION OF ANY,CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY R'ERTAIN, THE INSURANCE AFFORDED,BY THE POLICIES,DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH.POLICIES.LIMITS S.H01NN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO f ,_ LTR TYPE OF INSURANCE POLICY NUMBER" POLICY EFFECTIVE POLICY EXPIRATION DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE $' COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. S CLAIMS MADE F-1 OCCUR. PERSONAL&ADV.INJURY $ OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE $ FIRE DAMAGE(Any one fire) S MED.EXPENSE(Any one person) $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE S LIMIT ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per Person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS S � (Per Accident) GARAGE LIABILITY PROPERTY DAMAGE S EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM A WORKER'S COMPENSATION STATUTORY LIMITS 857K8108 05-08-96 05-08-97 AND EACH ACCIDENT $ 000100000 DISEASE—POLICY LIMIT S 000500000 EMPLOYER'S LIABILITY DISEASE—EACH EMPLOYEE $ 000100000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. .......................... . ..NC STOP & SHOP COMPANIES INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE CORPORATE INSURANCE DEFT I LXX PO BOX 9227 EXPIRATION DATE THEREOF, THE ISSUING COMPANY' WILL ENDEAVOR TO - MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED'TOTHE BOSTON MA 02209 LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL'IM�POSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY„ITS AGENTS OR REPRESENTATIVES. S AUTHORIZED REPRESENTATIVE ..................................::..::::::::..::::..::::.:::::::::::::::.;:.;:.;:.;•.:.;:.;:;;.;:.;:.;:.:;::._::::::::.;:.;:.;;:;:.;:.;:.;;:.;:.;;:.;:.:.;:.:::::::::::::::.;;:.;. ..ACOlD>CQRAQRA�I:ON:? . >: tt= s.••.+1 S't:.. 4 r-r- 'mow' 'x•'ttt)".Yt. r-�j+k�ror:rm.-,nti , g '•w�.-�-�► ri'ter^-yd.• �.n -l.•... ,.� - r '�Sy,.i• �' ;� K �,z y-'"n: :• Y* .�. .. E:a. ;f_ ,' 4C :r "; N, ,i f`t,•.. 1 r 1 } et k s..,q ��'. E 1.1 ..° ''.r; `r+."' :Kk-`•i.. w#l,�: "' 's.�t�ri`+•N�a@ � rtj 1 4 ,01+ x T�(.� ia'�i� al:.a.:'�l i t� 7 ♦tT "k�� f f ��7F L e+'�,y t a-:• , \ �., '. (// .'� ,; Y ,. Y L, veyti y''.yi °`a rewc ?�." `, 'ri-✓ 'i� � :_ �'%>( Aal"Z} 4rE y+ k^'.t••,51�.+ rG , -,��• '{.�. '�� 4f.�,;•-.,'�• r+• Ste.'r.:i.gp' L�a T''F ' w;',l'�.'_ -._w r rp�Yt tY ,y .+. t ?�'• R +.} a]... r••l.F+/ .r.-'& � a--:+?w ..�:-(.. f yM�,y L �y}r- ,ih "4,4 ;HOME.-JMPROVEMENT REG1ST RAT.I _ �y!CONTRACTORS-•em•.ws:T .. ,t... tt rJ •r+ a}t'M' � �;dd h m�+t�,t+jFj, +,r.;s1 7r ' Board: of Building .RegutatOns ancF Standards t ` ; - l. 4ne'Ashtiurton" .1a6 .-,Room 1301 yl, P�.> ¢U� ';`� ;� to+�?YQS l � ��°��3,"� ,� 4� -c ,Klt S ,nm-: Si .+•pt«a: L , y1►'r ..�• '}:"`r,� ^r< Y•f..j gyp. . 3 Boston, Massachusetts 02108 r l.. r- ..t+ f ! _ A Y ...Cl w ra .''s�`'�'!y r1� -w. Iti.'r.� i• �i3,.aY.- k tAA i•" ♦ - ' -. Ci �rrF'. y3{ �, t ""`, L S � xads�hr TP� ♦ a .a•t}• w. .. ..i '` ,.�.+bc-..t .yr♦� - r�z V J_`.,t•' ,�Z°�i .� tom. ! d t '� �•1 a � u 4' �,3. -•+,cy,s. t6.. :++.., �{ _ r. r a �`.f iv;TX, "llf,r,d -.� tf'�„! ''�' rr'.t;.r iJir ..N* �•"•ti =#�iOME...I 1PR0 EMENT��ONTRACTOR " ,•^M t + =j•t add k`v,t�.RL4'3. }r¢x r ^�4 r .H • 1s- 2N .r ^Vy h,.1�L,•f nS _ Registration:1.00225 :: .�r"`ti`Exprratron O6/12/9& - .f R! '1.. �..'�. f � c, f r' ��! fKyG�.�„ : t,.ci ,.t� ,a• a�,'" :. 4 �, 4r.yi`,ts+r ::Type, #PRIVATE CORPORATION �. �. ,-� "��• �'�."s''•r'' ,� � '; `s;.~* �` "', ': ` �` 'HOME TMPROVEMENi:.COt1TRACTOR t s L y st,. - .i >,n c` i •'(j,•ai.>z -F+-, e Sfi1 r d •J y � e a} 0022 .r:• ` `t: .. .. �.. f„+ r "`• �' ,w.:4;�..�Y'�.,r'y k z .,:-'•"' i�L4�"Ik � '4 YY j..2l ri', � l F t�719918t�Y�IQ�,�:�WLLS •ice:e'� ,_ ;:; GREATER rHARWZCH .CONSTRUCTION '.CORP. Phi lip J. Fenne:1.L °sti,, ' = F `- M:ExpireticQ ; .06/12/9�- 4. ' 30''.Pleasant eay°`Rd E.xt 'i};� �yQa t �- ��r✓ 6 ;< , r �_. t � Yx r ; fi � iK; r t K ,� #L. e.s;ti�:r.a t•p Y Y v�ck t.`�.,:. E.. Harwich MA 02645 �` :7 3xr' 3 �t �y` = s0--: 1}.GREATER.MRYICWCWTRUCTIO! 'Y u:. t :.trw'-R 3 F `L.�,•r �:.. +.} ,AF.... q.-,•a. r a L n 4 ,* j .. e..r f +. " >' t }i,r•.."� 1 ;Ai ..,7 , i? flldp 2.�'Fennell ..�;.. QrPleeiant Bar Rd Ext:._.,. hl ', y c,. jt• r e ADMINISTRATOR Harrich-MA 02645 _ __ .... _.. _. ..._ ___._. -. .� -.-...-_._.. -. :a.ems-..v. — � -�_.. ._ �. •-... -x4 .. , .. .rn.., .. v*-'.- _.•�`_ �.. ✓fie �accecceacz<ueall� o`:.•llrJJuc�rc.rnlLi I _ I - -- Restricted To, 00 77803 a- DEPARTMENT OF PUBLIC SAFETY z CONSTRUCTION SUPERVISOR LICENSE 00 - None NUnher: Expires: iG - 1 & 2 Fatily Hones Restricted To: 00 Failure to possess a current edition of the Massachusetts State Buiilding Code PHILIP J PENNELL is cause for revocation of this license. BOX 441 @y14d0` S HARWICH, HA 02661 R 7,03 LeT 23 \ C \o o f RIvE -.. I CERTIFY.. THAT THE OF SHOWN ON THIS PLAN IS FIOBiN LOCATED ON THE GROUND W. AS INDICATED " (NJ o; AlC/ST[ LA0 Svr DATE REGISTERED LAND SURVEYOR LEVY & ELDREDGE ASSOCIATES,INC. CLIEN fN CERTIFIED PLOT CLAN '. ENGINEERS - LANDSCAPE ARCHITECTS JOB NQ O32 ( -` 2.3 Wf�I Tit MCLSS��/�[E PLARS LAND SURVEYORS DR. BY' A` IN ,. NNE; 889 WEPT MAIN STREET CHKD.BY, t3 �1�1ST'f}$L NIA}' CENTERVILLE, MA. 02632 SHEET.L.OF1._ SCALE, I it" ` 01 'OATEs - 8 FINE rq�,_ : . I,j• The Town of B arnstable MASMIDepartment of Health Safety and Environmental Services 'OrFo r�►t" Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner 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. Type of Work: -0,1NCbd V— I go quo- Est.Cost rVy Address of Work: 1601 MOS9 P2. i Owner's Name Date of Permit Application: 1 I Z") l q b I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IIVIPROVEMENT 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 theaffent of th ow Date Cdtttr)61ok Name Registration No. OR Date Owner's Name T11C CU111111011 N'CQI111 0f.4faSSQCf1 U.VClls _. �•�� jl Department ntldtlstrial.4ccidc�llts ••. s t. ;� . _�!� • OIIIcEaI/lryestlgatlaas r•w 6Ot1 11'asltitl�;tun Street y;• Btt tm. Alas. (12111 Workers' Compensation Insurance Affidavit ' '—" le•tse 1'R11+IT'le�ibly�, .®,�isiichnt reformation - - - c ' rite nhone 0 ❑ I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity ,^, I am an employer providing workers' compensation for my employees working on this job. ComnInv name: •tddrece• tits phone!!• incur-ince co policy f! 1......��rr..-.....�� •• 01 1 am a sole proprietor nera contrac r homeowner(circie one) and have hired the contractors listed below . the following workers' compensation polices: cmm�an nnmc Ce-7(?1;r41k e . Atzwk l t- lddresc IJ 4 1. etn dD RI� - -'phone It• 43 2 " 434OD insurincecn ��1��I;i�S _ �noiicc 1 K9Ia - rem nn%, nnmc• addre e- sin phone a• ' curt eii •B :Attach additional sheet if neeessa �: w-�'�- `-"`'"'" `' ""'' = `' �- F:tiiure in secure coverage as required under Section 25A of 51GL 152 can lead to the imposition of criminal penalties of a fine up to S1SOU.uU one rears'imprisonment as%well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. 1 understand copy of thin statement ma% be forwarded to the Otrice of Investigations of the D1A for coverage verirteatioa - I do herebt•cc •under dic pains and tallies of perjure•that the information pro►ided above is true and correct. D � Signature ate " )1-21 1 ''rr� 11 / m Print nae �l'�^'1 J • t-, e1` Phone>: 7� r O d rif�il �otlicial use only do not write in this area to be completed by city or toa official permit/license to Mfluiidin;Department city or town: �L!censing Board check if immediate response is required Selectmen's Office C311e21th Department contact person: phone#• rlOther f 'Information and Instructions Massachuac.tt.• s General Laws chapter 152 section 25 requires all emplovers to provide workers cndcr:.'i employees. As quoted from t he "1a\%•". mi c'nrphu►'ee is defined as every person in tile service sc tcc of suth er•uui contract of hire, express or implied. oral or written. An c•nrplurer is defined as an individual. partnership, association. corporation or other local entity. or au"e two r. or he the fore�_oimg, enanued in a joint enterprise, and including the legal representatives of ad in aeu� tovees. Ho��e•. receiver or trustee of an individual , partnership. as or other legal entut�, emplt y P oa-ner of a dwelling, house lizving not more than three apartments and who reside thes persons to do maintenance , construction or ein. or the pair work on such Of the d\v ellim` house of another who e1ttpl theretosl all not because of such employment be deemed to be in er.:-- or on the •_rounds or building appurtenant GL cha f ter 152 se�ion 25 also states that e�•er}• state or local licensing aancc bene�•shall ��'n'1mU'd;C1itli�for nn� u. M p renewal of a license or permit to operate a business or to construct buildinbs to the Lo applicant who has not produced acceptable evidence of compliance with tltcl; enter lecc coverage nto any o i raCtgfor uire tide Additionally. neither rite commonwealth nor any of its political subdivisions s a P crforniance of public work until acceptable evidence of cotnpiiance with the insurance requirements of this cl::: been presented to the contracting authorit, 77 Applicants ur Please fill in the workers* compensation affidavit completely, by checking the box that mated applies De to partment situation. Supplying company names. address and phone nee oerera^_ell Alsoavits may be be sure to sibn and date the affidavit. TI;: Industrial \ccidents for confirmation of insurance afida� it should be returned to rite city or town that the application for the permit ornicil;ee`la beionaif you are re. not rile Departing:tt of Industrial Accidents. Should you have any questions regarding - to obtain a workers' coii�pettsatioit police. please call the Department at the number listed belo��'. City or rowns Pl ease be sure that the affidavit is coinpiete and printed legibly. The Department has provided a space at the bo. rdinn the aPPlic n. the affidavit for you to fail out in the event tl�,'Officeich V �be used as a reference number.f Investigations has to contact The affidavits may be ref, be sure to full in the permit/license numb the Department by mail or FAX unless other arrangements have been made. Tlle Office of Investigations would like to thank you in advance for you cooperation and should you have an} q' please do not hesitate to `ive us a call. The Department's address. telephone and fax number. ».. V1 The Commonwealth Of Massachusetts Department of Industrial Accidents office of investigations 600 Washington Street .. _-- AR.. n9111 SINE:VFl-.NOWF -- Iml,VhtR XIJf� T r-L,rv�t1nt� iAµT �ib� e��VAT iaN NvMtAW 10 t't�f N�F,xl�Maj. 6 I _ yr DDITIDN vllr MAR�foNs:Miu� 'OZ�i�'P9. - l- 1 oNTM�C*`°pae�� I cola ra�nN� I I I FIK OaETM�rK -1? I ItH►g rJhW AND GEILir4( ' I _ PITCH TO MAIN rol^hK�aM.'t� • �?CI�I hl� _ Izo. ZI-q 11. 1 jLpll 151011 ��N ►ON p N MOWIED AMMION rOgr ��r%� rq�III II-oll ALAH f eoriNA .LZ�HFr<TY :. 1(o* HH116:M bKiVE 11AI�or N5 'MILLb . ;a _ A.Y:fV.aL�u�:%4!d/iSwye r'�.W'j�'�i�Y.r.o V..Y u_„6: •.....•._.-�;'.-...... __._.... " I n. .. a .. _..��+ .. .- .-�.��4 e'S _ A E.1� �` ..'xh• r P 'S2. �` - � .��.� (�•`-O II .. _ � Xel- 1-011 'a ON Gav�.RED `r ?t H. WK�: { tat-1G pVb IT ION aFIiT � r�oroy�b Aaart IQN: �a� : VOH:PIK h ^Llfl %ran I-D ICI NHlie'.0 'h..GFIV - i�67oN�. MA y �': [� ,_ V�.e ..•t' :'+`�i BeG:, .-w... r .. �/G".`i.1�Q1' ..,._..�_t J'_ i=Z..-i ..5:4- ip 3° 44 ADt7tTICN y. r/1 jai:. �2�o It • . i�bel T i o N c:��oN I-> �� • �l ►N # ►!NA ► ttT.Y tW-0fONro. tLb "oil r r _ . . . . c�.:k a++` �.'•. • , � �clz RIC?iB bD� III Ox+ .. �P I�t RCPP'<FIIN�iI. �'�'i M/+toFF NSW t�cMEK A.; _ TO TGFf rwtriw,, 9 F�. vVirlor! ,. -MATCH yruh HrI�HT ro. NGr W r�W F.�c1511NG1 -�:'. u Yn I�PGoMe,tRWA`(.. Ir oNd Ft.croR ,f `ry Jv2x l c ISM " (pro _ TO.,rM; Aly(0. � 15T N�a �fc �RtiNlo►��V., Y�i f'nl�Gk�, T'° 2�o ql-ol N_ 13_ U ENTt�`r ENll2(i�b ? 5V�6 01-1 GKApe'. i'llcspT FWVK - laR/rRG� �RnEP � 6XI5+t1NGl) La °' uN4r C;x YrcTFD tWl,yf�'+GB -O (OW rH�LNG.WAU.oN GiFi�D6 ° loll - coNG� �tIN�S . Pr=o��h nroplT.loN'. Wiz:. ��GtitiN � �eerrioN �: I6A WHit� Mom DKIvF.; Msq�toroNs MIP,6, OZ44IVILIP f7. .. ..... , .. _.. — q•II�ILp it 11/24/2004 11:56 5083852856 CLANCY PAGE 01 CLANCY BUILDERS, LLC PO Box 1397 • South Dennis, MA 0266o • 5o8-394.6333 • fax 508.394.6323 • g1palUbaildersCoveriaon.net FAX DATE: November 24, 2004 TO: Town of Barnstable Building Department FROM: Lynne PP (INCL. COVER): i NOTES: Please remove Clancy Builders from permit #78716; location: 169 White Moss Drive in Marstons Mills, MA. We have completed the contracted work. Please do not hesitate to call me with any questions. Thank you. 12/09/2004 11:37 5083852856 CLANCY PAGE 01 Town of Barnstable RAMMRegulatory Services '�0116 Thomas F,Geiler,Dfrector Building Division Tom Perry,Building Commisstoner 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 NOTICE TO THE BUILDING DIVISION OF WITHDRAWAL OF LICENSED CONSTRUCTION SUPERVISOR FROM PROJECT I, lq -7�- , Construction Supervisor License # 0 � �` 3``' ,hereby certify that 1 am no longer the Construction Supervisor listed on the application for the project under construction as authorized by building permit #_—7 -7 ,issued to (property address) fi,&ss on 2001' I also certify that on 200—�--,I notified the property owner,that the project under construction must cease until a successor licensed Construction Supervisor, is submitted on the records of the Building Division, o-blo ICENSE DATE q/form0lawomtr r4dwa R-S 780 CMR -' n of Barnstable e Tow Y", Reguiatory Services C C- 'U� Thomas F.Geller,Director B�sraBrs, T � . �pTFo 19�y,.0 Building Division ccn Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Fax: 508-790-6230 Office: 508-862-4038 Permitno. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERA T APPLICATION MGL c. 142A requires that the"reconstruction alterations, of an n addition ti any pre-existing mt�ng°�eo OO owner ion, improvement,removal,demolition,or construction btu7ding containing at least one but not more than four dwelling units or to strictures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. p n oQ i CA,_ /Estimated Cost '1 6 k Type of Work: �I�Y Address of Work: Owner's Name':' VL44 Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law []Job Under$1,000 []Building not owner-occupied [Owner pulling own permit Notice is hereby given that: GISTEBED OWNERS PULLING THEIR OWN.PERMIIT�OIlYIPROYEMEDEALING�N'T�'OltKDO NOT HAVE CONTRACTORS FOR APPLICABLE ERMGL c.142A. ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER -SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Contractor.Name Registration No. Date OR Date I� HPR 6' Owners e Q..fomis:homeaffidav i �Pv y~O - u Reguiatory Services .. . . �nrrsznsr.E�$ '. � �`!... �...•,-.��o�,s�F;•:�eIIer,•Dirsctar:�.-.�...._--•---�_:..._.,....,....._ . .. .. .•Building Division . . ._ _.. . . . DMA — •.:•. . . - •--.�.. .. :..'-Tom Per'ry;'BfiildingC"ornmissi'tiner '� .:: .. .. -.. . 200 Main Street, Hyannis,MA 02601 ' www.town.barnstable.ma.us Office: 508-862-4038 =- =' Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION 1� �� Please Print DATE: 1 G, t� JOB LOCATION: 6 l (,�L t (M dss (/r PA W-\, number 1 street village "HOMEOWNER rCth �dV��/✓ �Jdc� (a� CJ6c�/ name home phone# work phone# CURRENT MAILING ADDRESS: city/town 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 pot be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building"Official,thathe/she shall be responsible for all such work Performed under the buildinipermit. (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`Tovmt of Barnstable Building Department minimum inspection procedures and requirements and that he/she will c041y with said procedures and reMt,, Signs n 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 lastpage 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:foims:homeexenmt i - -� The Commonwealth of Massachusetts ., .. lv�r.. _, Department of Industrial Accidents Office of Investigations == : 600 Washington Street, 7rh Floor Boston,Mass. 02111 Workers'Compensation Insurance Affidavit. Building/Plumbin;/Electrical Contractors APp1'ican n#Orma'�°�""h'on .9 _ eas'�P.RI1T' e�i1'v �s :� i^.,..Ye' t'°�.tS?i` rep r+� ' wxe name: (� addressL M"�D" city 1"u',s l( i s state: phone# do /o2e t 255 work site location(full address): (� I am a homeowner performing all work myself. Project Type: ❑New Construction[]Remodel ❑ 1 am a sole proprietor and have no one working in any capacity. ❑Building Addition `".�:'.�:"r>l: '"��s'x� �5� �t�'•.'-'F.tV:'-�: }'r'.:;_" ." '_.,: ":�• �� .,. :` .._ ':-< . •. .•.`%r, -'+�i s";; ❑ I am an employer providing workers' compensation for my employees working on this job. company name: address: city" phone M insurance co. policy# ❑ I am a sole proprietor,general contractor,or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: company name: address: city: phone#• insurance co. policy# �r9cr+iRr�l.�Sia►,'�� 3�i" .aiL�`�'.�f #Sgh�"?+rJ�fe'Lgt�,iz�:�t:`�i�;!'s�ti�:�'�s.:.:�-:�`'c.�� k'S�314^+�.tx'3:�'�'y".G=a -?�=�3rs�*+:.'"*5!x�.�E'y�:srri' company name: address: city" phone#• insurance co. - policy# ?c,�idditi$nilaGal�.f nec��r�°�c°ra'rr ,�. .�r��s�rra�a_�_ ,.s�s4 .�;..� •h'`'�,�`�uc�t :�aJ�'' Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 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 Office of Investigations of the DIA for coverage verification. /do hereby cert• n e pai s and penalties of perjury that the information provided above is/true and correct Signature > Date 1d' / Print name /Ot V^ t�{'L e l Phone# �S-c �28 06 2el official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department ❑check if immediate response is required ❑Licensing Board ❑Selectmen's Office contact person: hone# ❑Health Department c nixed Sept.r oil P ; ❑Other Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", 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 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 section 25 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,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation. Please supply company name, address and phone numbers along with a certificate of insurance as all affidavits 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. City or Towns 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. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street,71°Floor Boston,Ma. 02111 fax#: (617)727-7749 phone #: (617) 727-4900 ext. 406 Assessor's offioe (1st floor): G �306 �NEr A� Assessor's map and lot number.................. /..-.0............ Q�o� o�♦ Board of Health (3rd floor): Sewage Permit number ...................... 2 SMUSTADLE, Engineering Department (3rd floor): 'oo Na IL House number 3 �e :...... : o ray a' 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 ........(.�.Q17VC TYPE OF CONSTRUCTION ...................A./0 -F. e740 .........19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: .. 0Location ... �...1. ...... ffi M T I vF �� NlS .... ProposedUse ....�u).61 ........EAM.�L- .. .................................................................................................. Zoning District ....................Fire District .....✓ - Q �......M, 445 Name of Owner 2G(`7e.—...Address j .....L Name of Builder ..✓ /l/�.....�.............................................Address ................................. Nameof Architect ..................................................................Address .................................................................................... Number of Rooms .......... / ..............................Foundation .... /),(,�t��r. .......CwV,/\c L....... Exterior ...!� .e..... ��1., �......... �1L/.?.i">.......Roofing ........... .�- .....J�_.. Floors 1/...I IV% .(..j/ ?.Al >.Pt=T l k)l...................Interior ............ .!�. r !�t/`r .................................... Heating .7 (/a)fl " g nn .............................Plumbin .......... . ........................................ Fireplace ..................................................................................Approximate Cost .......... �r �� Definitive Plan Approved by Planning Board _______________ _19________ . Area � l��(7 ----------- Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH i 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 ......... � J� .. GREENBRIER CORP. A=31-006 No ...3.0..5.6.2.. Permit for ............ Single Fc .............................. .....X Dwellin Location ..L.ot...#.2.3.1 16 9... Moss M s Or. ..................... ' Marstons Mills ............................................................................... . Greenbrier Corp Owner ......................................Corp. Type of Construction ...Frame.......................... ............................................................................... Plot ............................. Lot ................................ Permit Granted ..... March 26, 87 .......I...........................19 Date of Inspection ....................................19 Date Completed ...................... ................19 4/0 � 13L� ZZ Q�TNE�` TOWN OF BARNSTABLE Permit No. ..3056.2 .., m BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash ......... v HYANNIS,MASS.02601 Bond X.. CERTIFICATE OF USE AND OCCUPANCY Issued to Greenbrier Corp. Address Lot #23, 169 vdhit�. vioss. Dr. Aarstons A-, Lls. idass. 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. June ..1.�!...., 19..... �........ .. �4zZ .., .............. Building Inspector Ai ' I TOWN OF BARNSTABLE BUILDING DEPARTMENT aaaa�r TOWN OFFICE BUILDING rua t639' HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department DATE: An Occupancy Permit has' been issued for the building authorized by Building Permit $k... (O »».».». ...........................................................»........... »»» issuedto .....» c.....................»..................... . ...» Please release the performance bond. THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I A , m / �C(�`J' IL DATA TO`,^/?q OF BARN$,TABLE, MASSACHUSETTS BUILD NG PERMIT DATE_ 19 PERMIT NO. ' APPLICA7IT ADDRESS (N0.) J (STREET) (CONTR'S LICENSE) PERrAIT 10 NUMBER OF (_) STORY DWELLING UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE; ZONING AT (LOCATION) I` DISTRICT (NO.) (STREET) BETWEEN AND (CROSS STREET) (CROSS STREET) LOT SUSOIVISION LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE _ USE GROUP BASEMEN AL OR FOUNDATION (TYPE) - v- ARcA OR ` PERMIT V' (G"' - ESTIMATED COST $ FEE $ (CUBIC/SQUARE FEET) ADDRESS - _'o.i -`J LU / - _ _ ..- BBUILDING DEPT. T Y15 Pv_R:!IT CONVEYS NO RIGHT TO OCCUPY ANY. STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR A PF'?::='.�. 1'LY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- �„ P •._ .• :' '�Y THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED F'•':.:= c: DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS C !IC::BLE SUBDIVISION RESTRICTIONS. - Tr;REE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE I'• '•> Rc QUIREO FOR PERMITS ARE REQUIRED FOR uC TION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN ELECTRICAL, PLUMBING AND OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. - COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL ADY TO LATH), INSPECTION HAS BEEN MADE. �• �• •- 'cCTION BEFOREE FINAL ' _ POST THIS CARD SO IT IS VISIBLE FROM STREET R DING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS �a Lpa o� �. 715 2 2 f 2 " " AlF7 HEATING III NSPECTI N APP, OVALS ENGINEERING DEPARTMENT 1 2 �` BOARD OF HEALTH s '7 tki. .. •:ul PROCEED UNTIL THE INSPEC- PERMIT W!LL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE -� -i<, •• _^:LU"[HE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN -•'' PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION. f 2.Oly _ Pet S E T 94 c K SY Frl ,y�i3 . Lo T•2 N. s . s L T 9 b7ra3 X\qo I I,'t,, Lo T 000 - o :1 W� _ECEND :XISTING SPOT ELEVATION V :.'`� 'ROPOSED SPOT ELEVATION] Cr OF :X15TING CONTOUR ---0- -- WA,!. , ap� a IR OPO CONTOUR SED C NT UR 0 N r �`�,� Roam�Nrr 1Ft,�rao .OTE: THE LOCATION OF ANY UNDERGROUND �� CIVIL. EWERAGE,WELLS, OR OTHER UTILITIES SHOWN ON .��,, .�No.3111540 31 1 HIS PLAN IS APPROXIMATE ONLY AS DETERMINED '10 r ^/STEREO ROM RECORDS AND/OR VERBAL INFORMATION. i01 1 Q LAO6JQ H:E-CONTRACTOR IS RESPONSIBLE FOR THE --• 'ERIFICATION OF THE EXISTING LOCATIONS IN l • iE FIELD. t; ` REGI§S RED ENGINMR- 1 A aELDREDCE ASSOCIATES, INC. CLIENTI-IRE PR D ..OT ENGINEERS - LANDSCAPE ARCHITECTS JOB NO.� ( n� >:.'Z7� 41 T E MnSS QRIV�` J :PLANNERS - LAND SURVEYORS pR.•BYikK IN y 889 WEST "IN STREET CHKD.BY= C ENTERVILLE. MA. 02632 SHEET -�0F.;L SCALEt 1 o DATE, LoT 2 �. LET 2� LoT 23 S m. o h• o !n o m M� j so ,� s �03.02 Asp I doss t 4 I I I • f 4 I CERTIFY THAT THE FouN1)AUoAl ��`N of �'Qssq SHOWN ON THIS PLAN IS �o Rom LOCATED ON THE GROUND ti w. AS INDICATED '� o' N 1 e* E�ISTER�� F LAND Sv } 3 y 87 DATE REGISTERED LAND SURVEYOR LEVY & ELDREDGE ASSOCIATES,INC. CLIEN FN - CERTIFIED PLOT PLAN ENGINEERS - LANDSCAPE ARCHITECTS JOB NO 032 _L2T 23 WHITE MUSSD_ yc PLANNERS- LAND SURVEYORS OR. BY ¢} IN 889 WEST MAIN STREET CHKD. BY,_____ is4q)�N51r4BLE MA- CENTER�ILLE, MA. 02632 SHEET.LOF.L,.._ SCALES I �-`}•O ` DATE I 8 7f Ir Assessor's offioe-Ost floor):? � THE �..�.o. G:. �` rO Assessor's map and lot number ........ ... ... . - SEPTIC SYSTEM MUST B� Board of Health (3rd floor): - Sewage Permit, number �.Z .. T`L ee 9STALLED IN COMPLIANC,'` t BaHasTAXLE. Engineering Department (3rd floor): r /�L WITH TITLE 5 'oo House number V rb39� 9 N L CODE Ap.i •a0� APPLICATIONS PROCESSED 8:30 9:30'A.M. and 1:00-2:00 P.M. only. TOWN REGULATIONS TOWN ,OF B.ARNSTABLE BUILDING 1.NSPECTOR APPLICATION FOR tPERMIT TO ...:.....dW 6.n...... ......./�. �.1. TYPE OF CONSTRUCTION ....:............. ........: 1........................................... . ..............19 . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ... -5.......!!5/tT.1.1.6....... .......7.� 'v&�.........MAA4: 5!�...... ............ ProposedUse � ........ �1!! .I. -L................................................................................................................. Zoning District ............ell .............".......................................Fire District ......Mf icr!5 PO;;� .....)A f.�-4 5............. Name of Owner . `� � ......... .:...Address .......P..l,l:.. ... ��. ...... Gl�..��.�-�-(� Nameof Builder ��• . ..............................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ..........&....................................................Foundation .... r� AnD....... C��[V.l: .> ....... Exterior .. . -...�5 �N.. .4% .......... .....at.L/.f S.....Roofing ........... �T : - ....�.3.�.................... Floors .....V..�l�!t/ .Ci/-02- .� ��. .................lnterior ............ .?/..i�i �/ / ........................:.......... 'v ... 1 -y rtrt Heating jV.1/ ........ j........6.7t ...:.........................Plumbing ...........�..... �.1..�1...................... .....................,.. Fireplace ..................................................................................Approximate Cost .......... , ��..V. . Definitive Plan Approved by Planning Board ________________________________19________ - Area /..1 6, ti —.4................. Diagram of Lot and Building with Dimensions ' �7 Fee ........... !t.. ....................... SUBJECT TO APPROVAL OF- BOARD OF HEALTH ' OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . . � ... f. ..... .......... Construction Supervisor's License ........'��J .. GREENBRIER CORP. 301562' One Story No ................. Permit for .................................... Single Family Dwelling .......................................................................... Location Lot #23, 169 White Moss Dr. ... ........................................................... Marstons Mills ............................................................................... Owner .....G.re.e.nb.r.ie.r. ...Corp. . ........................ .... .. .... .. .... .. .. .. .... . Type of Construction .................Frame......................... ................................................................................ Plot ...............I............. Lot. ................................ Permit Granted ....kja:Kjqh...2..6...............19 87 Date of inspection ....................................19 �v Date Completed .... ... ........19 V