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0114 WILLIMANTIC DRIVE
0 �WE Town of Barnstable *Permit#ao " ` v3z;�L O Expires 6 m h'fr iss date Regulatory Services Fee BAMSTTA - v �ffl_'ch:Ird V.Scali,Interim Director RFD MA'I a Building Division MAY 2 0 2014 Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 ��� N AjL9 www.town.barnstable.ma.us Office: --88622'-40388' • L� Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number l�/ Property Address M� `�141 411�� A/W A�)X Residential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address `J F-✓fiA-) Contractor's Name Telephone Number 7 lf'sal �SS�� Home Improvement Contractor License#(if applicable) 7 l tl Email: �/'���— '�'/�2���1(/ia/�yr�� • �sLr Construction Supervisor's License#(if applicable) 106 c 9? �Workman's Compensation Insurance // Check one: ❑ I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# 6 R611304�,74/0 3�Z Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders.U-Value ° �� (maximum.35)#of windows / #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the o e Improvement Contractors License&Construction Supervisors License is equired. SIGNATURE: T:\KEVTN—D\Building Changes\EXPRESS PERMITEXPRESS.doc Revised 061313 s A�Rom CERTIFICATE OF LIABILITY INSURANCE 1/7/2014 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 cartific4lte does not confer rights to the certificate holder in lieu of such andorsemen s. PRODUCER Judi Nash Risk Strategies Company PHONE 781-961-0325 ?il-aac-c- 15 Pacella Park Drive ADDREL .Jmarcherisk-ntrategies.cam Suite 240 MSUIRERMI AFFORDING COVERAGE NAIC0 Randolph MA 02368 INSURERAMravelers Indemnity Co 25658 INSURED INSURER■: Marine Lumber Operator, Inc. Cora INSURERC: Marine Home Center INSURER D: 134 Orange St. INSURERS: Nantucket MA 02554 N R RF• COVERAGES CERTIFICATE NUMBER:CH41771302 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. NOTVNTHSTANDING 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. ILTR TYPE OF INSURANCE PO Y NUMBER N5R ADDL SUER POLICY�FDOM LIMITS OEN ERAL LIABILITY EACH OCCURRENCE i COMMERCIAL GENERAL LIABILITY i CLAIMS4AADE OCCUR MEO EXp am S PERSONAL i ADV INJURY 6 GENERAL AGGREGATE 4 GEN'L AGGREGATE LIMIT APPLES PER: PRODUCTS-COMPIOP AGO S POLICY PRO LOC 3 AUTOMOBILE LIABILITY SINGLE 01 ANY ALTO BODILY INJURY(Par pemon) $ ALL OVVNED SCHEDULED BODILY INJURY AUTOS AUTOS (Paraccidwi) S NON-OVVNED HIRED AUTOS AUTOS PR AMAOE i i UMBRELLA LJAa OCCUR EACH OCCURRENCE S EXCESS LIAR HCLAIMS-IMADE AGGREGATE i DEO RETENTION IIIi A WORKERS COMPENSATION U- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN E.L.EACH ACCIDENT d 500,000 OFFICERIMEMBER EXCLUDED? N I A I r (Myyaeenssdn"13�) 0167HO3513 2/10/2013 2/10/2024 E.L.DISEASE-EAEMPLOYE i 500,000 DESCdw RIPTION OF OPERATIONS Daluw E.L.DISEASE-POLICY LIMIT S 500.000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Mtach ACORD 101.AddlUonal Ramrks ScIndu►a,N more apace 1s r*Wb*M CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Marvin Design Center ACCORDANCE NTH THE POLICY PROVISIONS. AUTHORED REPRESENTATNF Bernie Gitlin/JMI '- ACORD 25(2010106) m OW2010 ACORD CORPORATION. All rights reserved. INS025 aoloo6).01 The ACORD name and logo are registered marks of ACORD The Conrntonlvealth ofMassaclusetts M Departntertt of Indrtstriad Accidents Office of Investigations 600 Washington.Street Boston,ALA 02111 tivn t .niassgm}/dui Workers' Compensation Insurance Affidavit: Builders/Contractors/Electiicians/Plumbers Applicant Information , r,, ��Q�2Please Print Le gib Name(Businesslorgauzationllndividual): /C�'►f�G/✓� /_G/i�'y� vi/�``'1 -2) . Address: /J ( /04w— City/Stat&Zip: /u G / ltt�� M�� Phone#: Are ou an employer?Check the appropriate box: Type of project(required).- 1. I am a employer with 130 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. y- ❑Remodeling ship and have no employees These sub-contractors have. g_ ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance. comp.insurances 9. ❑Building addition required] 5. ❑ We are a corporation.and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing ail work officers have exercised their 11.0 Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]1 c. 152,§1(4),and we have no employees.[No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box;#1 must also fill our the section below*showing their workers'compensation policy infotmatim 1 Homeowners wbo submit f3as af5dnit indicatige they am doia all wcA and ilhen bire outside contractors must subznxu a new affudavit indicating such. $Can racrors that check this box must attached an additional sheet showing the name of the sub-conttscmis and state whether or not those entities bare employees. If the sub-contractors bare employees,they must pro-nde their workers'comp.policy number_ I rem aee employer that is praridfng workers'conrperesalioet itcsrtratere for ney e:rrpWees. BelowisthepoM07 and job site inforrnaliom Insurance Company Name: Policy#or Self-ins.Lic.9 a `WI_�01&AI o5,�� Expiration Bate: 11 ld Jab Site Address: " "�� / C [�'VV /'�s7'ei' 5-/4VCitylstate/Zap:/-I� /4A� 14 1645- r 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 farm 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 cov a verification. I do hereby rtr r liter th pains a en 'es t19at tlie irrfornrttlion prmzrler!abor.is trr reel!correct Si tore: [� / Bate: �J s� Phone#: / l^7 t. ©fjFcial use only. Do not write in this area,to be completed by rat}'or town of ciaL City or Town: PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityrrown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 6 40 , . Ofrk of C00SW P 7r.n� Aftaiss.Sc' usInes ReguSa L — OME lMPR01/pE T CONT Cl OrR� j J �Reg�stration 2:. '.Expira 7120 g :« MAM E'LUMBE� > �.._ /n r v gP►em n RICH PETsERS ., ^ ♦ 3 `, �. 134'LOWER: RANGE - .,.NANTUCKET�MA 0255 �„ �t���` p' Uan�de s�crk�tiryl;�• , I i `l�l/ •Massach setts -Deparutment of Public Safety I l Board of Building Regulations and Standards ' Construction'Supervisor License: CS-1U6987 RICHARD PETE4$3 f 36 IIVDIAN TRAIE - Duxbu ry NIA 023§2, . ,ria C Ex pi ration-' `. Commissioner 0,7/24/20.16. MARVIN DESIGN GALLERY a complete window and door showroom by MHC Permit Authorization I, ge- V L CJe�I�-�e: , as Owner of the subject property understand that Marvin Design Gallery by MHC is a department of Marine Lumber Operator located at 134 Orange St., Nantucket, MA and hereby authorize Aae-"�o .Q���;��.-P'06- to act on my behalf, in all matters relative to work.authorized by this building permit application for: i lily s:,,V- (Address oflob) a"__40'� Signature of Owner Date Print Name 73FalmouthRoad 'Hyannis,MA02601 I(508)771-6278I(508)771-6279(Fax)J'wwwmarvin f designgallerybyrnhc.com TOWN OF BARNSTABLE BUILDING PERMIT APPLICA" Map 4u � Parcel Applibatiop # Health Division Date Issued v Conservation Division Glk!Application Fee ' j S� Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis •. �" Project Street Address ,Tea ki n i e e I/—t ey W0 AG(VYIC�rf 77� Village tic n 40-" Owner T2ayt aj t J e-V Address __1`y �l`�fMefV1�1C Telephone 56 • ??G ' 3 6S*L Permit Request C� c�/ ��� ' l✓S� l®O �— Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 1 (,000 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing . new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name LO r14,eS K rs Telephone Number t 3 y Address !U ke7d;amin-e l Lam- License # d-5 7 6 S Home Improvement Contractor# 5 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO e�c'o 6•e��tl SIGNATURE DATE 0 //e7 //5 u FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. r ADDRESS VILLAGE -_ OWNER t t ' (' DATE OF INSPECTION: 4 . E _ FRAME i-A 3 $R�lcs INSULATION. .�V �. FIREPLACE _ ELECTRICAL: . ROUGH FINAL A t PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING.'_ DATE CLOSED OUT ASSOCIATION-PLAN NO. f - 7 The Commonwealth of Massachusetts Department of IndustrialAccidents 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/Oro nization/Individual): (/v 10d 4414/IV e &—ne AV t/Qr//1Gj -f AW&411 Pi�i zz Address: &)1MC -P4 Ll�L City/State/Zip: VjZ�OVlk_ u ® Phone#: §169 ° f®C • IV 3 4 Are you an employer?Check the appropriate box: Type of project(required): 1.[Tam a employer with 5 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. modeling ship and have no employees These sub-contractors have g. ❑Demolition workingfor me in an capacity. employees and have workers' Y P h'• 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 requited,] *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: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,50-0.00 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 cer#fLunder the PP' and alti ofperjury that the information provided above is true and correct Si afore: Date: All l 3 Phone#: 5,d 901 el 3 6 Official use only. Do not write in this area,to be completed by city or town of City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.PIumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant-to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as."an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer;or the receiver or 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 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 out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permitllicense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of 1iavestigatiwks 600 Washington Street Boston,MA 02111 Tel,#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax##617-727-7749 www.mass_gov/dia CERTIFICATE OF LIABILITY INSURANCE DATE 171809(MM/DD111 IFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. T IS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to he terms and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to he certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: LOVEQUIST MURRAY INS AGC PHONE FAX PO BOX 38 (A/C,No,Ext): (A/C,No): E4VIAIL WEST DENNIS,MA 02670 ADDRESS: 75SCH INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: TRAVELERS INDEMNITY COMPANY OF AMERICA . WINDJAMMER HOME BUILDING&REMODELING LLC INSURER B: INSURER C: INSURER D: 2 WINDJAMMER LANE INSURER E SOUTH YARMOUTH,MA 02664 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: HIS IS TO CER HE POLICIES OF INSURANCE LISTED BELOW HAVEBIEEN 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 CLAM. INSR ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER Me=D1YYYY) (MMU7DIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE �OCCUR. REMISES(Ea occurrence) ED EXP(Any one person) $ ERSONAL 8,ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: ENERAL AGGREGATE $ POLICY �PROJECT F]LOC RODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSA71ON AND X WC STATUTORY OTHER EMPLOYER'S LIABILITY Y/N UB-0112NO36-13 02/082013 02/082014 LIMITS ANY PROPER ITOR/PARTNER/EXECUrIVE N/A E L.EACH ACCIDENT $ 100,000 OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE I$ 100,000 Dyes, under E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTIONIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION BARNSTABLE BULDING DEPT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 200 MAIN ST BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTOVE HYANNIS,MA 02601 1. 1�.�:t, .C„y-+:-,,. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. i Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supen-isor License: CS-096548 `�� JAMES M BIRE r. 2 WINWAMIGIER°LANE, SOUTH YAIjdVIOUTHMA 02664-- ,cam, Est Expiration Commissioner 01/26/2014. . _................................... �e wpomvrnoancuea"o'1 a4"1.0.6 a License or registration valid for individul use only Office of Consumer Affairs&Business Regulation before the expiration date. If found return to: OME IMPROVEMENT CONTRACTOR Type Office of Consumer Affairs and Business Regulation egistration: :1.76599 10 Park Plaza-Suite 5170 Expiration:c=-=919120.1;5r LLC Boston,MA 02116 . ;fir';• WINDJAMMER HOME Bl)ILDINGg REMODELING LLC. JAMES. BIRD 2 WINDYJAMMER SOUTH YARMOUTH,MA 026fi4 Undersecretary of valid withou s nature Town of Barnstable o� Regulatory Services • a+axsrAISM BUS& g Thomas F.Geiler,Director 16.19. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 509-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder A-K—L��-J ,as Owner of the subject property hereby authorize J A-vn e-S . —i3 ( to act on my behA in all matters relative to work authorized by this building permit 11 it 4-AJ77C-7DA. MA-iLS-Maus 41.,e-Ls, NA (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Ownet ' Signature of Applicant Print Name Print Name Date QFORM&OWNERPERMMSIONPOOLS 62012 I Town of Barnstable Regulatory Services • RaR fF NCPAR • ia&4ss Thomas F.Geiler,Director •``� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable-ma.us Office: 508-862-4038 /Fax: -790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAII,ING ADDRESS: city/town slate 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 license,provided that the owner acts as supervisor. DEFINIT IYchtuse F HOMEOWNER Person(s)who owns a parcel of land on which he/she resides ends to-reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to 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 buildingermit. (Section 109.1.1) The undersigned"homeowner".assumes responsibili -for compliance witli the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/ a understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwe ' gs containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Coatr 1. HOMEOWNER'S EXEMPTION The Code states tha�, "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this ction(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a persons)for a to do such work,that such Homeowner shall act as supervisor." Many homeoY ers 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 personas it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor.-On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. C:\Users\decollikVlppData\Local\Microsoft\Windows\TemporaryIntemetFiles\ContentOudook\QRE6ZUBN\EX MS.doc Revised 053012 z22' 37'-- 78 Id 62,.- 4B11 vv.y p Boxh epp=24'beseboerd Recessed Light New glass shower N _ door y $ O Fan/Light a o O 3 Linen To wall mount medicine cabinet and light Wa8 23 she ` 38' 113 S If Wall 38 rant Hamper/Linen tower I 38 2�" n Y BaciBnon Fa•. K Y PAN FI WTH—BASEBOARD THIS IS AN ORIGINAL DESIGN AND ALL DIMENSIONS @SIZE Job A-1-1 MARSTONS MILLS Jot Nv' DESIGNATIONS GIVEN ARE SUBJECT n MUST NOT 8E RELEASED OR autokitchC't; 1q7 D..IV..By, MicroCAD SOftworO Ovte 7/5/2013 COPIED UNLESS APPLICABLE FEE TO VERIFICATION ON JOB SITE HAS BEEN PAID OR JOB AND ADJUSTMENT TO FIT Brain By, SIMPLE ELFM N(; TS R_I.; . ORDER PLACED JOB CONDITIONS ml��ur.nl S.O., / I TOWN-OF BARNSTABLE 2013 SEP 19 AM 10: 2 6 DIV,SION e Ll cl c 2 a 3 n,�T4 o. \ c � 0 s i TOWN-OP BARN' STABtE 7013 SPP 19 M 10 26 DIVIS ON '3 i �I Town of Barnstable yQY o„n Expires timo frox issue date R atoxT Set( ces Fee anxxsrisr� ; . s1�m' Thomas F.Geller,Director Bnildilig Division „�v Tom Perry,CBO, Building Conimissioner ru 200 Main Street,Hyannis,MA.02601 www.towm.baxnstable.ma.us Office: 508-862-4038 Fax:508-790-6230 ]EXPRESS PJEAtNUT APPIACATI©N - RESW ENT AL ONLY Not Vaud without Red X-Presrlmpnnt Map/parcel Num Iber l 0 -2- G Property Address ///-/ l[�L'�'l sr'li�/�� i 1q111,3 z-4f V /residential Value of Work Z� Minimum fee of M.00 for work under$6000-00 Owner's Name&.AAd.--ess Q 2id& Contractor'sNxme r��r�� -,s,,� LC C Telephone Nupm�ber C.�o �/a8-���la Home Improvement Contractor License#(if applicable) ( 1 , 5,s�o �Q� S S P E R IV I IT Construction Supervisor's License#(if applicable) 8 ✓dWorkmaa's CompensationInsmmoe MAY Check one: ❑ I am a sole proprietor I am the Homeowner TOWN OF BARNSTABLE I have Worker's Compensation bsurance Insurance Company Name e,+d o a1 U tl o n h lr e, l Y-Is o r- n G2 C o- Worlman's Comp.Policy# W C-Od P 9 1!2 0(C�0 f Copy of Insuranee Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re•roof(stripping old shingles) All construction debris wiIl betaken to ❑R .roof(not stripping. Going over existing layers of roof) e-side #of doors ❑ lacement Windows/doors/sliders.U-Value (tnaxirr a .44)#of windows *Where regaQod Lauaace of this permit does not exempt compliance with other town depa=ttm regulation,ie.Suroric,Conservation,ctc. **"Note: Property Owner must sign]Property Owner Letter of Permission. A copy of the Home"Emp vement Contractors JLicense&Construction Supervisors License is requ r. Q.XV1?Fff-ES\F0PWSV=9dingp rms S.' Revised 090809 I . r The Connnonweda of-Vassachrtsetis . ®ffiee of grcresttigct�otts 600 FPashington sfizd Boston,MA 62M I r �Woxke&Comtpensaiion b�aace svwry t v�ov/din Iicxtrt lformatian A a �erslCo c�rsfElectlieiansi mbers riutL Name�Q �)_ rase Y PleaseP Ca n5�f Addtsss: �- "r CitylSiate/Zip: u�'c�s-F � Q3�,3 S P - —� Are ea M etn I er? hone Ste— y.28 �d2`�a P oy Check the appropa"rate Ica I. I am a emplcyercf 4 0 lam a gcuerai mar aad I Type of proms Ems): l 2.0employees(full aat�Jarpart-time)* have imed the saber 6 [ New consftlxdon I am a sole propn�'ai pa mer- listed cathe affached sheet 7. shipaud have noemplayees These sob-coaizacfnrshae Remodelama 1 wig forme is any capac y employ=andbavevmdkeas' 8 ❑Demolikion ! ji+Foworiters'com�mse=ce. D cmp iusuraucex s, 0.Bmldingaddi m J 5. We area corporation and its 10.�>lei�Grlc21 reps or additions 3.0 I am a homeownerdoing an work offices have esescised th= v uryself;jNo wozl Ze°°Mp, ugltt of exempti�per MC 1l'El irmabi�repfrs or additions ins�►auce req T ' c 152,§1(4),and aye have no of rep= I [No workers' 13.0 Other _ cautR insurance zegrured « o:ueoRaeawhosubmS�is lmns:alsoIM*= cse=.ube&wshvwmSth=svc*=, b� r ? a�idavitiadie poury boa 1 =Cauftaet=d=lrhe:ktidsb=m= malsk ersbmtIglbo beabiceotriddecott�tnzsmestSiBMkaaawafada itmdkift ac§ �zddiaooal sheetS+�awiRgthe aaa¢c of t8e employes Ifthesztb c�rs3aveemployas,�a9 rpmvidetheirwadcas"wmo ffiC�mMdse',-,WjMff r0r=fu0seent6eshavc I 1 f as�Floyer8zut i�pmriding workers'cor safwx nonceJbrmy=Floym•Be&v fS the,Folfcy and job site i to ornsatmn, b=ance Company Name - DY1Q f U , ! Policy#or Self-ins.Iic.#: F�cPiratioa late: O�j 2�f, as/� I Job Site Address G �// City/StaxlLip � b��[� AA� U Attach a copy of the workers,eomueasa&on policy deeiaration 15;/vlll t . FaBm-to seem ao FdSe{cm 1eag the a imp ztanrher snd expiration date}. �easse�imed.emder�SecdoaZSAofMGLt 1�2canleadhotheirQ fine vp to S 1,500.00 aud/or ono-year imprisonment;Ps vyeII as civ>Z Position of cfmhai penalties ofa ofup to 5250.D0 a daJ'agamsttite violator.on a ut as-th n a of m'dse form of a SI OP WORK ORDER and a#fire InvestigatiomoftbeMk for iasurarrcecoveaapoevezf�adon st�emeatmaY fadedtotheOfficeof ide JterrLy cer rr d pe�IS-93aix}ormaBonpavruledabove is true arrdconrct t?,jcciaZuseMay. Do not wZL'11Jhisarea,fobec°mpkfedby ortoxmoffuzai City or Down: PermittUeeme kst&g Aul tority(circle one): L Board of Health 2-Bading'Departmeut 3.Cify)Towa Cleric 4.F.jeeWes➢ 5 oe=r Yns tec#or 5.Plmmbinglnspecto, Coafactersanr. ?'bane#: l • I I FRASCON-01 MOSU CERTIFICATE OF LIABILITY INSURANCE DATE(Mn 1 ors1201YYzal2 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 INSURENS), 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 WANED,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 ofsuch endorsement(s). PRODUCER CONTACT (508)676-0309 NAME: Suzette Moniz Virv375 Aios rport Road Agency,Inc. PHONE.E:d,508-676-0309 ,Me):508-324-9'147 375 Airport Road Fall River,MA 02720 MAIL ADDRESS:SMOniZ Viveiroslnsurance.com INSURE AFFORDING COVERAGE MCI INsvRmA:National Union Fire Insurance Company INSURED Fraser Construction LLC INSURER B: P.O.Box 1845 INSUREtC: Cotuit, MA 02635- INSURERD: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCWSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_ LTR TYPE OF INSURANCE A L POLCY F POLICY DCP I vwD POLICYNUMBER NMlDD FOLIC UNITS GENERAL LIABILITY EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY PREMISES E2ocurrence $ CLAIMS-MADE OCCUR MEDDIP(Anyoneperson) S PERSONAL&ADV INJURY S GENERAL AGGREGATE S GEN'L AGGREGATE U MIT APPLIES PER: PRODUCTS-COMP/OP AGG S POUCY j COT LOC S AUTOMOBILE LIABILITY COM3INEDSi GLELIMIT Fa accidents ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) S HIRED AUTOS AUTOS NON-O�� PROPERTY DAMAGE S Per aeddent S UMBRELLA LLAB OCCUR EACH OCCURRENCE S EXCESS UAB CLAIMS-MADE AGGREGATE S DED T RETENTIONS S WORKERS COMPENSATION WCSTATU- OTFF AND EMPLOYERS'UABILr1Y YIN X TA R A ANY PROPRIETOR/PARTNEWEXECUnve C009930601 9/26/2012 9126/2013 E.L. ACHACaDENr s 500 OFMCER/MEMBER EXCLUDED? ❑ NIA ,OOO g6 describe under(mandatory NH)If EL DISEASE-EA EMPLOYE $ 500,000 If yyes, OESCRIPTIONOFOPERATIONSbelow EL DISEASE-POLICY umrr I S 500,000 DFSCRIPMONOFOPIFAlIONSILOCATIONS1VEHICLeS(Attach ACORD101,Addffonal Remartas Schedule,if moll space Is requtred) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Fraser Construction LLC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 31 13owdoin Rd ACCORDANCE WITH THE POLICY PROVISIONS. Mashpee,MA 02649- AUTHORIZES REPRESENTATIVE ©19M2010 ACORD CORPORATION, All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs and Business Regulation k�v 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 112536 Type: DBA Expiration: 3/23/2015 Tr# 237059 FRASER CONSTRUCTION CO. DEAN FRASER P.O. BOX 1845 COTUIT, MA 02635 Update Address and return card.Mark reason for change. Address Renewal ❑ Employment Lost Card SCA 1 to 20M-05/11 (glee, rpoarUnzowevea/// License or registration valid for individul use only Office of Consumer Affairs&Business Regulation g y yo OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 112536 Type: Office of Consumer Affairs and Business Regulation xpiration: 3/23/2015 DBA 10 Park Plaza-Suite 5170 Boston,MA 02116 FRASER CONSTRUCTION CO. DEAN FRASER 104 TWINN VIEW LANE E FALMOUTH, MA 02536 Undersecretary Not valid without signature i W1,35itt it CM-Depngfiiuent or PUblic's. BOnrd of-Building Regulations and Standat 0.0hatrubt'itm Supervisor Llcense -License:•GS 97668 Tj EAST t�AL �I?Ui ( A�2536 :� Expiration: 617/2013 f:oairnissimlor•' 7r#: 46692 I Vpr 16 13 09:24a Oakley,G&J ■ Y, 508-428-6773 p.1 r 19n RTL ME Fraser Construction, LLC �CONSTRUCTION P.O. Box 1845, Cotuit MA. 02635 ROOFING Email: fraser_construction@verizon.net SPECIALISTS wtiti-w.fraserroofcng.com FAX 1-508-428-0123 508-428-2292 HICL#112536 CS#97668 WHITE CEDAR SIDEWALL PROPOSAL DATE: 3/28/13 PHONE: SOS-776-3632 NAME: Jean Oakley MAIL ADDRESS: JOB ADDRESS: 114 Willimantic Dr. Marstons Mills MA. 02648 EMAIL ADDRESS: nursejeannie402@.comcast.net FRASER CONSTRUCTION hereby proposes to perform the following services in neat, professional like manner in accordance with the manufacturer's specifications and local building codes. i *****WHITE CEDAR SIDEWALL**** Supply and Install 16" WHITE CEDAR R&R Shingles Supply and Install TYPAR HOUSEWRAP Synthetic underlayment Supply and Install Galvanized Fasteners, Stainless Steel last course Clean and Remove Debris from work area daily PRICE:$ 4650.00 Initial 7�f�o�-3 Price for southern exposure gable and first floor above deck same side TRI1 WORK Remove and replace 2 rake boards right hand side main gable Supply and install: AZEK PVC trim boards to match existing fastened with CORTEX hidden fastening system PRICE:$ 895.00 Initial Apr 16 13 09:24a Oakley,G&J 508-428-6773 p.2 1/3 initial payment, remainder due upon completion Payments accepted are: CASH—CHECK—MASTER CARD—VISA—AMERICAN EXPRESS—DISCOVER Any payments not immediately paid upon job completion will be charged 0.005%for ever,•day after the given 3 day grace period upon day of job completion. Possible Extra - Any rotted or otherwise deteriorated trim boards, plywood sheathing, lead flashing, or other carpentm, needing replacement will be done and charged for as an extra at the rate of$75.00 per hour, plus 20% mark-up materials. Anv alteration or deviation from above specifications will be executed only upon written orders and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays are beyond our control. Owner should carry fire, tornado, and other necessary insurance upon the above work. FRASER CONSTRUCTION, LLC carries Workman's Compensation and Public Liability Insurance on the above work, certificate available upon request. This proposal may be withdrawn by us if not accepted within thirty days. DATE OF ACCEPTANCE: �lc �IEOVT ER FRASER CONSTRUCTION,LLC For company use only Date Received Date Started: Date Completed Job estimate: Dean/Mike # of squares: Billed Material ordered DXtraS Paid Available Discounts Assessor's offioe (1st floor): THE�� (� o 0 � r Assessor's map and lot number ..................................j..::..... �o Board of Health (3rd floor): � SYSTEM �� 8� �.��3 -A rkAi�LED IN COMPLI 9TSDLE Sewage Permit number ............... ..... .., • NAM Engineering Department (3rd floor): WITH TITLE 5 'o •6}9• House number ................... . .y........................................... ii-NIVIRONMENTAL CODE APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN REGULATIONS TOWN OF BARNSTABLE BUILDING _INSPECTOR APPLICATION FOR PERMIT TO .... D ..... S��O ry ...................................................................................................... TYPE OF CONSTRUCTION ........40Q.0 0 —2ph1 C........... ............................................................................................... .............3...a...............--.....19... .! TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ��.............w/•L� /mi/`A-).T.�.c...... .� ' .....hA. .5.?. .''..5....... !!..?......5................ f Proposed Use v� 1 . Ya L ......................................................... Zoning District .........../1� :..'.................................................Fire District ....... S.J. .. .M....................................... aa Name of Owner .7. .��5..:...AF?rQy....G 4 K 4 L./......Address ....���..�t/i/f.��'la�!v.�?�-.......7.�..........1?!�; wl. Name of Builder ! .�..13,Lel (cr......0,C°f.� w�o.c�,=,.��%ciclress .l � S9• ? uc��' ................. ........ ............ Name of Architect .....A1(.x)..�F..............................................Address a Number of Rooms ..........J....................................................Foundation ��....Z�1`�.KIH�'..£-^................................... �°�l4� b tt �f+'o,.�? � �.5 �.'? ^�LS Roofing .......�� S�itll4 —' ! c4 S S Exterior ......... ........................................... �........... .1...........��/��.....J1..................... Floors /� 1`, fCvt�C,�f'�G ..'K.�................................Interior ......P!rv.Gv a�l ......... .................................................. Heating ..J.... ..............................................................Plumbing .... (D r'l p ..............................................�••............. Fireplace .................................Approximate Cost �D po0 .............. ...... Definitive Plan Approved by Planning Board -------------------------- ,-. O••,�� .19__-___-- • Area Diagram of Lot and Building with Dimensions Fee ........................... SUBJECT TO APPROVAL OF BOARD OF HEALTH yg q:c . 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. -"G=truction Supervisor's License Oakley, Mr. & Mrs. GAry No ...305.9.0... Permit for ........add...grid...f.loq.r to dwellinR .................... .................................................... Location ..................:L4...WX.1.1imaA.t.iq...D.r.ive.. ................ ............... ................. Owner ............. .Mr Mr..... ...&. .... QAx.Y..Qqxlu...... Type of Construction ..............f r.avlp.................. ............................................................................... Plot ............................ Lot ................................. ...... Permit Granted � March 31 .........19 87 ..................... Date of Inspection .19 ......... Date Completed ..........1. ..4.7 19 V1, 14 Assessor's offioe (1st floor): q L—,, c'Assessor's map and lot number �..'2 �°.........: ..jam.......� .,r" THE Board of Health (3rcl4loor): Sewage Perm it'/number "! 3 r' Engineering Department (3rd fl raes .. pe,t6}9. House number .................................................................... 'FO YPY d APPLICATIONS 'PROCESSED 8:30-9:30 A.M. and 1:00.2:00 P.M. only TOWN OF BARNSTABLE z: BUILDING INSPECTOR APPLICATION FOR PERMIT TO ....14D� S�d U tv D F L ............................................................................................................ TYPE OF CONSTRUCTION ........ G.� 1.. (=2l9Iv� C .................................................................................. ................................................ A.. .. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location �/Y . V. CC........................�.�.r�S.�.°."�5.......f�?.t � 1 rr...................................................... .... ....................... Proposed Use ... ..............................................................................................:............. ....... ..................................................... 4e t Zoning District ........... . ...................``....................................Fire District ........... i'// r Name of Owner ?5........ y....G!`?.K 4 E�......Address Gr/i//(wln�r� �1� � ►�.. �. ►n. Name of Builder ...rj t �.,L°, �CFt+�c�d, ' �OAddress .ld.i...... �lPy S.9 �Ewt f-rCut�� . . ............................ ....... ..... Name of Architect ......Al.0 ................................:....................Address .................................................................................... Number of Rooms ..........13 ..........................Foundation ..... � 4.14.4Alt £-- Exlerior C4 � b K ,.i? . � ��re\ .. S...Roofing ....... 5/��S/K1 L.l.........5 / ter (1F S ...................................... L f ....... ........ ... ....I C....................... Floors` /.� /c7 ...... >' `N ! .Interior ............ y GvIQ�! Heating (.CJ..............................................................Plumbing ....�...13 ATE -9f>01-=Q> i ,p !�............... Fireplace �V .....................Approximate Cost � 7d mac' Definitive Plan Approved by Planning Board __________________________ t� �.. ------19:------- . Area ... ........`�Y�f':��.d.. .. ....... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL Or BOARD OF HEALTH W 20� f 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. ame .... ........................ ;`-..Ggstruction Supervisor's License .C!.Q.�..�.�..!......... Oakley,, Mr. & Mrs. Gary A=102-189 . No ....30590, Permit for .......4Ad..2n.d..f I.Q.Q.r. ...to...dwelling............................................... Location ............... .............................. .................. Owner ............. Type of Construction ...............fxame................ ............ .................................................................. Plot ............................ Lot ................................ Permit Granted ..........Mar.c.h...31.............19 87 ...... . . .... Date of Inspection ....................................19 Date Completed ......................................19 - - - - --i s r.A L E w --f --- /�DivT ELE%/+T --- - -- i _ ...... - �� is i-go. — -- - — — EEI EE EL _ I — IT it<4w?KiPn'tmA'°A?3" is=:ca;�JlSn'tRT'.•K+Sm_cm5}Lxx-ti:.�:Yl'C 'rLd'&-`_-?r •r 1renru.G raYr-' :E U:vs �.: 48°,` 'iYct r a +�.'t�m x: ,A-1:54i'- '.....ems - _- ,_.,-_...,; r„ �-da •J . m., .n•"tcy"3�z -'^,'.?'�^; v T`."^;� "'—�,-•.." �.. y; ..+fat t 4. €�; °_ay.� :7+1 :. n •_-; • ','s.* .via .z '.,. p°" `'q`, ..y,... �y;�-!S'rr't•-".'7 •. Y, a',°� -} { t... +. `C.s. .$,. M.._e.rZ�..,S .n.,.X .�!- N• ". .•. SCALD �v � . ,. LEF'T END - _ .. - .• _ - .' - • ... EKE" _ .. . _ ._ ... . � �.+,.-. ... ... ..mow. w . _.....+.... ..._. _ ---- ' � ..fi.`..r.A:�.::...,,.. .- .....:..... ..w, •'is :,...�,ci.s:9F+^i-�._.end..,.-.. ...,....::�r���.,:'+:.r��..„..,....i....,....d:�::c... ,,...�.....u.,.,�.., .K......�.,........�. .,>«- ' -.._._..-..---.. SCAL E_A__- .......... ..a-;"r,. ";3v�.«s. �.u', ,,.,:n.a ;h?',^. .;� '•ke`��s��_:r�.�'..,:._ '�..:s�,F..�7.;,.;;. e'er`'.- �°'�y�F nri.'r. ��'. ,�. `�`.�' r. r?'1•en'L�'+'3�e��ts51 ',aY_'�''r.'��`t��-�""'�.�',�u�.ri��� �i� „irnsm .� .'..:. s ,. ..- .. .. ".;}`-,m, � .,,�,� - 4�ts3�L" � � I .. � - u•5..�.-. �. �.,- •- n. ... ..._' .. ,fit:' _ .. 16. 3 Tab i •,x - Gr�lar TiC� ti� �� :ZX6 /6"o•c• CElOw 3oisT 0odB/E .eZXH P147- • � �y/� rN Tyv6X NEW L� / �,, cv//Nc- jry rM,/y %�. , o o��° .0,vSu/,.*;✓-;.� bvN,'rc C=-�. s��hYl S y/ST/N!r F,'RST F/ao/' C F/aoP �jo To ra Ja%sue :open' £/.:r,>� Uw�si-Pe✓►. �X1S7"/NG 13aS•e'm.rn,7 wA � --- _t °Ett , Town of Barnstable *Permit# P ti Ecpires 6 n ndhs front issue date ° Regulatory Services Fee �' • BARNSTABLE. # r� KAss �' Thomas F. Geiler,Director 1639. ♦� �TFD MA't a Building Division Tom Perry, CBO, Building Commissioner / 200 Main Street;Hyannis,MA 02601 www.t o wn.b arns table.m a.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address /�J� W i /�.1�/✓� /(/] l�� �y' �/�SC1•t/S �' S /r/ 0���'�`r�" (2'�esidential Value of Work ! Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Contractor's Name )AM Cg. .Al/0,A/ Telephone Number `t�� -�?/�G Home Improvement Contractor License#(if applicable) /za \� Construction Supervisor's License#(if applicable) X-FKLSSPERNT [�J*orkman's Compensation Insurance Check one: APR 14 2010 ❑ I am a sole proprietor ❑ I pn the Homeowner TOWN OF BARNSTABLE have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side #of doors Replacement-Window do /sliders. U-Value J (maximum.44)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License& Construction Supervisors License is required. SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc RPvi.cPri noomo The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organizatio Individual): i so� Address: � 0 City/State/Zip: Ud/ll. VO', .Phone#: VL Are yob an employer?Che&the appropriate box: Type of project(required): 1. I am a employer with 10� 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. El construction 2.El am a sole proprietor or partner- listed on the attached sheet. 7. ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its I0.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work ofcers have exercised their 11.❑Plumbing repairs or additions myself o workers' com right of exemption per MGL Y � p• 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $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'compensationran for my employees. Below is the policy and job site information. Insurance Company Name: &L,_461 cc� /VoT Policy#or Self-ins.Lie.#: Rc Expiration Date: 0 / t% Job Site Address: I IY atI141VILVPC ()l_- City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date) O 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 andpenalties ofperjury that the information provided above is true and correct. mature: ��Ly� Date: — — Phone#: Val— ckr� 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#: i ;19535 �(j..;j��y}. .. .•j!��,(�.� .(.j . �r# L8W on prAt •' MOONAV Wit. '': � - s s Uu�er�ecx�.�atp Pelf. #z koarce aogL �tot Rf.wa - ' ' And RMA, - From:Shaunna Robinson,Hunter Insurance At:Hunter Insurance,Inc. FaxID: To:Denise Glade Date:923/09 09:45 AM Page:2 of ACORN CERTIFICATE OF LIABILITY INSURANCE OP ID S DATE(MM/DD/YYYY) PRODUCER MOONA-1 0 9/2 3/0 9 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Hunter Insurance, Inc. ONLY AND CONFERS NO RIGHTS UPON-THE CERTIFICATE 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 INSURERS AFFORDING COVERAGE INSURED Moon Associates Inc. NAIC 9 DBA Gutter Helmet INSURER A: laational Grange insurance co 14788 DBA Renewal by Andersen of RI, INSURERS: DBA Gutter Helmet Roofing Beacon Mutual insurance co, DBA Moon Works INSURER C: 1137 Park East Drive Woonsocket RI 02895 INSURERD: INSURER E: I COVERAGES � THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHST ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH ANDING THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJE POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH LTR NSR TYPE OF INSURANCE POLICY NUMBER 77MW LIMITSGENERAL LIABILITYA X COMMERCIAL GENERAL LIABILITY MPS 2 6 619 H OCCURRENCE $ 10 0 0 0 0 0MISES(Eaoccurence) $500000 CLAIMS MADE � OCCURD EXP(Any one person) $ 10 0 0 0SONAL&ADV INJURY $ 10 0 0 0 0 0ERAL AGGREGATE $ 2 0 0 0 0 0 0 GEN. AGGREGATE LIMIT APPLIES PER: POLICY PRO- LOC PRODUCTS-COMP/OP AGG $ 2 0 0 0 O 0 0 JE AUTOMOBILE LIABILITY A X ANY AUTO BIS26619 COMBINED SINGLE LIMIT $ 1000000 09/16/09 09/16/10 (Ea accident) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ HIRED AUTOS (Per person) NON-OWNED AUTOS BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ (Per accident) fEXCE:SS/UMBRELLA ABILITY TO AUTO ONLY-EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: qGG $ LIABILITY PA ❑ CLAIMS MADE CUS2 6 619 EACH OCCURRENCE $ 10 0 0 0 0 0 09/16/09 09/16/10 AGGREGATE $ RDEDUCTIBLE $ RETENTION $10 O O O $ WORKERS COMPENSATION AND - $ EMPLOYERS'LIABILITY X b $ � TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE 28586 10/01/09 10/01/10 EL EACH ACCIDENT OFFICER/MEMBE $500000 R EXCLUDED? If yes,describe under E.L.DISEASE-EA EMPLOYEE $5 0 0 0 0 0 SPECIAL PROVISIONS below OTHER E.L.DISEASE-POLICY LIMIT $500000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION BUILDIN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EJAN�IR DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYSBuilding dmi. Reg. Board NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO S Dept. of Administration One Capitol Hill IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENT Providence RI 02908 REPRESENTATIVES, A D REPRESENTATIVE ACORD 25(2001/08) � ©ACORD CORPORATION 1988 q -7 Cuslotlict, 0 '!A ......................... ........................ Addrts-i: Lly L- �,.hnb.Tec-k— ("It'stolliel-101"; —.1.1............. Cape Cod' Rene�g Sales Agreement ...................... I t37 Park IMIT Starr,lip: -4 Order No �1704t4LS V(loollstwket,Ill 02895 byAnd n. Ciry lolne:-S3VJ-1 �t'.2-.%lP--.-CM2-,-- tj Wj,,ox,W REPLACIEMIEN7 mAm!",en('�-mrl. Daw: 30839 W• 1-1259 MA 63LI I ------!?7 ii,en-wo w 11 9.5.,j5 C,-I'-5 62 7 2 5 ............ technical Measure GRILLES UNITSD'roensims ....... ................. -------------------- .......... .................. a: Eji 88 0. 01 _b N Room .Z — 2: ,I .t -5 -5 ,.g S PRICE S J JR. -5 1 z4 Is Description Al 8 i-z 76 % v -q It ............ ...... 44. e .......... ...................... ............ ............. ........... ...... ............. + ------- Oft' ...........IFy-,-j; -7......... ................ ................. .................. ................ .......... ...................... ------ ....... .......... .......... ................. ................ ........... .......... .................. i --- --............... ..........L ..........- .... .......................... .......... __Po_rr,_le_n_m—v_—dl rc..�u.r.a.u,._v.a.i._M.:._�.,.r_ ;.Yi syn a uf'u hip'r fit JYccPwnr hp iai:l+fhu;�mrrw!_Rcv_—_....-.-...�.__..__. ........ _ __E-_��_1$iala_ht \r;ap Rut Rtait P.nvu_t_on c_lc.l _ _ ................... .............. ..................I .................... Mi�,ccljz eous Credits or Expcnws Sub Total mw Payment Method I.the IK to t S3 Ab,,f dix J o, -x; i11"' Sub Total t4am f,,.) NI—jwr j—�.dt OL.,�:rirl Ion Note., S Sub Totol i-o P") X, Check I • mnaiwr isc Credits or Expenses Ce.dii Cwd hen, ........... ......................... Al.-tOrner Acce it metwIt", ....... ...... Financing ,,qijIj:fot'rertns and Conditions of Sale.You,the III Total -Y ... ........... ............. .1.. ...................... ,K-c Reverse buyer,1113Y i this transaction at any tiple vor to Illidnight of the third btisincss dAV it let Ofka dw.ij owv I lite date of this transaction. lease see attached notice of calwellatiOti for all Sales Tax ......................................... explan ion t f I Work Permit Cost Additi—I 016V 10fl-Attalf"A J (PI....4,41t RO'lln APP41 at Paso Data stoon Door ......... .................................... ....... ...... 1hj, Total Amount of Agreement Spr,W Oe'.,.,Note, O.Visor Entry poor .................. ....... ....... nurpr ..................................... ...... Deposit Required W-Iv� ................ ......... .......... Balance Due on Complatioll in A,4�� pwout m�Ou: .................................... I Sal ........ atw 1h,(01w ...At an; custornet\' Cwtot-f custotoo�� Initiall: Initial.,. r. r Assessor's office(1st:Floor);, G 7^ -�� B�S��LL�® ��rkmp �t T Assessor's map and-lot number / / IN C®�f1P p` Board of Health(3rd•floor): : Q _ "T"TITLE Jr d� •e= Sewage Permit number t `. �" `�-, � � R ENVIRONMENTAL Co 4renLE . Engineering Department(3rd floor): // �J� � riu's House number Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30:-9:30sA.M.and 1:00-2:00 P.M.only , TOWN --' OF BARNST C. _ p _g f BUILDING ANSPECTOR APPLICATION FOR PERMIT TO Avg? TYPE OF CONSTRUCTION 19 d� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: r Location ( LL- ✓` � ��/✓c L�� LOT � Proposed Use Zoning District Fire District 4C /,/ „/ Name of Owner ©n/L�I� y Address II � � / //' Name of Builder aAel 2� Address 4S� O W-Fnwtij C�T'(J I T Name of Architect Address Number of Rooms I Foundation 2At�J L Exterior ��G S 41f, Roofing A 6 p"A-LT �( �J GAS Floors 1/ t �— Interior � �� = Heating N X Plumbing j c Fireplace Approximate Cost Q Od Area Diagram of Lot and Building with Dimensions Feed O � I TaT��t� OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstabl reg rding a above constructi n. Name Construction Supervisor's License ® � OAKLEY, No 35144 permit For ADDITION to - Single Family Dwelling Location 114 Willimantic Drive J Marstons Mills Owner Oakley . -t7 Type of Construction Frame Plot Lot 4 Per it Granted June 2 2, .19 92 ate of Inspe ion 19 Date Completed -19 -• a, W' ngineering Dept. (3rd floor) Map l D a7 Parcel Permit# O House# �{�' Q. Date Issued a Board of Health(3rd floor)(8:15 -9:30/1:00-4&Kn '7- e 2 -1 v O Lew Conservation Office(4th floor)(8:30- 9:30/ 1:00-2:00) Planning Dept.(1st floor/School Admin. Bldg.) SIN Definitive Plan Approved by Planning Board 19 SEPTIC SYST E INSTALLED IN CE TOWN OF BARNS T��� �►IITIi s ,, ` 'B60NMENTAL �►I�D ;•w Building Permit Application TCi IN �n '. Project Street Address f/� f�LGI/�i¢�I/T!G 2—)/z Village • ./'G4S Owner Address // v Telephone Permit Request �/ L=a 'i�'+�p� QLc� /�'! ,14-11, eF First Floor square feet Second Floor square feet Construction Type a� Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No 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 No.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 Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes 5144ro If yes, site plan review# Current Use Proposed Use Builder Information Name pPi Telephone Number Address lc efS' License# �cSr��g2 Home Improvement Contractor# `00 r7. 0 Worker's Compensation# 060/39 Z NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATES 3 9� BUIL AN PERMIT DENIED FOR THE FOLLO NG REASON(S) F , FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO'. ADDRESS ' ► A. VILLAGE OWNER DATE OF-INSPECTION: r s FOUNDATION FRAME INSULATION ' FIREPLACE ELECTRICAL: t ROUGH FINAL PLUMBING: ROUGH FINAL ` GAS: ROUGH ' ' FINAL` - r 1 G 1 4 v _ FINAL BUILDING -IN i ` ' � DATE CLOSED OUTS ASSOCIATION PLANrNO. F r i I Y: X�{� i�R__..c- I'.��w�:.7•.�,_.� s ./-��..--"'�: ��•".;ems=?�y�.j,,�, � +=_ �. ..- = ��� .T?'`cr;GV�?'`�� CC't`{ir�'iC� F="'�L:�:i:C:`• T . V� t c CQ�=G��TTGh ( t=- Mom: r:- _ . � ✓�t liGN19)[(iliflY./7�F� GI�,.��,�- fj�%CCL' - DEPARTMENT OF ?US!IC SAF;TY • COHS dUC�IOK SC?:_�1ISu1 UCEY:c musber: E:Pires: . .. •- ResGict:d Tc: IE TROAAS I CAPIi2I ?P. MA I ' I The Cumnionivealth of Ahzi.vachusetts •�i: ►'' . _._ I yf Deparnizent of Industrial Accide.,as Office oflnvestigilims 600 Street •�' � = �' Brtstorr.,1lass. 0?I11 . Workers' Compensation Insurance Affidavit i la in inf•rnt in _- _ Pl�T--I' jjlv naMC7 -"-'� V ----- -- � -Ill/ GT7�� Incnrion• _131*Jr_ city 6'�I—nlT_ phone 0 I am a homeowner performing all work myself. [1 I am a sole proprietor and have no one working in any capacity [� 1 am an employer providing_ workers' compensation for my employees working on this job. emmvan+• name: add rest city. nhone i!- ins Trance co.--�—��T �� nnlicr if 611flaI/35 Z Zeg Z41 r I am a sole proprietor. 'general contractor, or homeowner(circle arc) and have hired the contractors listed beiow who have the following workers compensation polices: cmmpariv nnmC: adriresc� car. phone 0, insurance rn. nnlic+•0 cmmnariv name, nddrecc• rir+- nhonc tt: insurance co noiicy it __ •Attach additional sheet if nice s_sacv •:�_ _ --+% ';;;;:�--- — � ''•' -"-'" "�" �..,":;,. Failure to secure cu+craee:ts required under 5cction 25A of 1%1GL 151 can lead to the imposition of criminal penalties of a tine up to s1.500.00 andiur unc+•cars' imprisonment:ts++•ell:rs ci+•il penalties in the form of a STOP NVORK ORDER and a fine of S100.00 a dap against me. I understand that n Copy of this statement mai be fur++•nrdcd to the orricc of Invcstig2tions of the DIA fur cavcrare verification. 1 do hereby cerrift•under the pains and penalties of perjury that the information provided above is true and correct. Si�aaturc �% L� Date Print name C --- J t'—��� Phone 9 omciat osc unh do not write in this area to be compacted by can or town o(Ticial city or town: permit/licensc it ritluilding.Department Licensing Board L I2 check if immediate respunse is required aScleetmen's office I '. C111calth Department EE F•. contact person: phone#: r"Other 4 .. ............... 0:.... A60 RD Am PRODUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE NORCROSS LEIGHTON INC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR HTTP: //WWW.NLINS.COM ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 437 STATION AVE COMPANIES AFFORDING COVERAGE S YARMOUTH MA 02664 COMPANY A MARYLAND INS GROUP INSURED COMPANY CAPIZZI HOME IMPROVEMENT INC B THE HARTFORD COMPANY 1645 NEWTOWN RD C COTUIT MA 02635 COMPANY D .. .............. ................... .. ........ .... ... .......................... ... ................. ................ .... ......:...:.. .*::::., , ::. .:.:: :0, .. .... ... .......... ........ ........................ ........... ... .......... .......... ..... ... ........ ........................ THIS IS TO CERTIFY. THAT THE POLICIESIDF-1�;U-R-ANCE 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. CO LI TYPE OF IN POLICY EFFECTIVE POLICY EXPIRATION INSURANCE POLICY NUMBER LTR DATE(MM/DDNY) DATE(MM/DD/YY) LIMITS GENERAL LIABILITY RGP28192822 04/01/98 4/01/99 GENERAL AGGREGATE s2, 000, 000 x COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG s2, 000, 000 CLAIMS MADE OCCUR PERSONAL&ADV INJURY $1, 000, 000 OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $1, 000, 000 FIRE DAMAGE(Any one fire) S 50, 000 MED EXP(Any one person) $ 10, 000 B AUTOMOBILE LIABILITY 08MCP399948 04/01/98 4/01/99 ANY AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $1, 000, 000 —HIRED AUTOS BODILY INJURY $ X ,NON-OWNED AUTOS (Per accident) 1, 000, 000 PROPERTY DAMAGE $ R 500, 000 GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE S EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE S OTHER THAN UMBRELLA FORM $ 1 WC ATIJ-I JOTH- WORKERS COMPENSATION AND 08WBBZ AN 2826 04/01/98 4/01/99 ITO YSLTIMITS ER EMPLOYERS'LIABILITY EL EACH ACCIDENT $ 100, 000 THE PROPRIETOR/ INCL I EL DISEASE-POLICY LIMIT $ 500, 000 PARTNERS/EXECUTIVE OFFICERS ARE: EXCL! EL DISEASE-EA EMPLOYEE S 100, 000 OTHER DESCRIPTION OF OPERATIONSALOCA'nOHSNMCLES/SPECUL ITEMS FOR VARIOUS CONTRACTED JOBS 4�0 ....... . . ..... ... . .................... ...... ...... ............ . .. .. ............. ... ...... . ............. ....... ...... . ......... ......... . It ... . . .. ::: . . . .......................... ....... .. .MR . . ................... X., .................. .............. .. .........EEi ........... .i. .. ..............i........i. ......... SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED En BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORCMD, REPRESENTATIVE Michelle Connors C ..... .... .................... ....... . .. ........ Y W The Town of Barnstable MASS• snaivsrest� • 9� ���' Department of Health Safety and Environmental Services ArE&659�- 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 y—Z3---� 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 oth r requiretyents. Type of Work: ' Est. Cost gnf� Address of Work:`/fd, 2 A_ Owner's Name Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under 51,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGaAM OR GUARANTY FUND UNDER MGL C. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the weer: 2 z /tea Date Contractor Name Registration No. OR Date Owner's Name D6 : Engineering Dept. (3rd floor) Map ��a Parcel ' Permit# y House# Date Issued A Board of Health(3rd floor)(8:15 -9:30/1:00:4:30) o� Conservation Office(4th floor)(8:30- 9:30/1:00-2:00) Z Planning Dept.(1st floor/School Admin. Bldg.) �� � ,otiHer� Definitive Plan Approved b Plannin Board 19 •C M ' PP by'Planning �€iSTALLED ON & �� ABLE. WITH T .� TOWN OF BARNSTAMEONMENTA AND Building Permit Application TOWN REGULATIONS Project Street Address ��GL/M /G Village /7�"_s�v S /d/l LS Owner Z5�lez Address Telephone 61,zr9 1773 Permit Request /1r/S1—Wz,& 8Xg o&A, cY,2- VD68 ELC� L_i'ml6 �G f/�n/�7 zr/12 6s D 1�t/O�✓�Dl� First Floor square feet Second Floor square feet Construction Type iE7- 1 Estimated Project Cost $ 3�'pP� ✓ Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family p Multi-Family(#units) Age of Existing Structure Historic House ❑Yes No On Old King's Highway p Yes 1i0 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 No.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 p Yes p No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No - Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) p Attached(size) p Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization p Appeal# Recorded❑ Commercial p Yes If yes, site plan review# - Current Use Proposed Use Builder Information Name p T,,z- Telephone Number Address ,' -1--wJ7ZJA1A1 0 i J License# �Id'`J e � ZZ/ Home Improvement Contractor# / el�7 4,"0 Worker's Compensation# 48 W J.3 3 Z zZ,9 02" NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS;R2EULTING FROM THIS PROJECT WILL BE TAKEN TO /yJ4'r/J7 A SIGNATURE _ DATE /—27— a` BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) I c FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. n ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH N FINAL .-c °e 1 PLUMBING: ROUGH p FINAL GAS: ROt i,g FINAL FINAL BUILDING 15t -� Pro � y ; DATE CLOSED OUT " _ z w i ASSOCIATION PLAN NO. I . C777- -At-7- - - I T-MP QVEt`��- CO ►r. C�C�FS E_eCrSTF.P�TiQ� - �_o�-� c= Eu:Lcirs sesLatLc= zra - �r,� F+s`cu—ter. Race -�cc.- 134t '- .• i - tts GZ08 t . -a`_ic� ZOa74O Ex�_ E2�- /T6 i ��E �D))19Jtd1tll/EQII� pJ ,.I(�J�Q,�/1��•. DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE MueDer: Expires: Restricted To: It THOMAS X CAPIi1I JP. + 280 PERCIVAL DR _ W BARNSTABLE. MA 12666 i f The Commonwealth of Massachusetts Department of Indccsfria!Accidents 01IICd o fIMS iffolS 600 Washington Street Boston, Mass- 02111 Workers' Compensation Insurance Affidavit n�m •� location G 5<�� �uTlJyll� i1 /y /�/� 02. G � � oho � �Z•�^C1S�l� cir' v9 .,C] I am a homeowner performing all work myself. Q 'I am a sole proprietor and have no one working in any capacity I am an employer pro%iding workers' compensation for my employees working on this job. om anv name: nddrcss- nhone insur•tnce co. z- �r� � oolicv L, _e3- L3 7_7 SZ� [I I am a sole proprietor. general cbntractor.or homeowner(circle one) and have hired the con-,ac.ors listed below who have the following «'orker_ :ompe^satien polices: m nov name: address- h n e t' itti•• oiicv� insurance co. om anv name: insurance co. n p m and/or 3A of 41GL 1S2 can Ind to the imPOsitsoa Failure to attars coverage as required under Sccaou of criminal penalties of a Qne+s to 51,500 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' N copy of this statement may be forwarded to the Office of Investigations of the DU for coverage veriticatioa. do hereby certify under!, ains and pen a of perjury that the information provided above is true and correct Signature Print name � �'¢'L-� A- Phone k -774!n2r' ofricizl use only donot w rite in this area to be completed b7 city or town official permiNicense p -Building Department city or town: _ �ucensing Board 261 OSdertmen's OMce check if immediate response is required C3Ee2lth Department phone p:_ (508) 398-2231 eat. -Other contact person• : (rev,ud 3.03 P)AI mEr �♦ TTown ®f Barnstable he � ��� Department of Health Safety and Environmental Services 1"9— Building Division 367 Main Street,Hyannis MA 02601 Ralph Ctns.:e.r- Office: 508-790-6227 Building Co= Fax: 508-790-6230 For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION GL 142A requires that the "reconstruction, alterations, renovation, repair, modernizztion. M q re conversion, improvement, removal, demolition, or construction of an addition to any pre--e=ting owner occupied building containing at least one but not more than four d coagiract is or to th structures which are adjacent to such residence or building be done b registered certain exccptions,along with other requirements. Type of Work: /,04 6 Est. Cost c��?�O Address of Work: Owner's Nome"4�1w— Date of Permit Application: �— I hereby certify that: Registration is not required for the following renson(s): Work excluded by law _Job under 51,000. Budding not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITIi UNREGISTERED CONTRACTORS FOR APPLIC�ROGRAM OR G�iJARAN'I'Y FUND UNDER MGLoVEMENT WORK DO O 14ZA � ACCESS TO THE ARBITRATION SIGYED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of a owner. rrnr NamE• Registration No• PLOT PLAN FOR LOT # Indicate location of garage or accessory building Additions with dashed lines -------------------- Sewerage disposal (cesspool) ED Well I I (lot. . . . . . . . . . . . . . . .ft. rear) I Abuttor s Abuttor s Name Name Lot # I Lot # REAR YARD If this is a If this is corner lot, . . . . .:. . . .ft. corner la write in name write in of street. � �5 � _ name of jj II 04 other v �1 ) street. SIDE YARD SIDE YARD HOUSE • �J-- - -- FT. [� � -- - - - FT� : Q SET BACK . . . . . .i . .ft. o (lot. . . . . . . ... .. . . . . . .ft. frontage) ZZX 1 i�/./ VO*v 7-le � /44�-)V s%ems \ (NAME OF STREET) / Information / \ \ Supplied by MARK NORTH POINT i 1 O2 I Ect *THE E e�Q TOWN OF BARNSTABLE BAWST"L& i mum 1619. �0� BUILDING INSPECTOR APPLICATION FOR PERMIT TO ...../ Vr aa� ? ......� -� TYPE OF CONSTRUCTION .......... ....... ... .` *,.... 4-::. . ................................................................... r .................7�., ....ol` ...............19.�s . TO THE INSPECTOR OF BUILDINGS: The undersignedQ hereby applies for a permit according to the following information: ,p Location ......... 'tom`.. ° .•7.......... /,�.......... M :... �:.t �.:..al:��e,/��..................... ProposedUse ..... -c. !1,+4..... ............................................................................................................ ZoningDistrict ........................................................................Fire District .....................:........................................................ Name of Owner ... . ..Address ..... .; •.�.�... .h Nameof Builder ................... ........... .................................Address .................... ..................'..:........................................... Nameof Architect ..................I...............................................Address ..................................................................................... Numberof Rooms ...............0 ...............................................Foundation ...... .&....................... AV Exierior ..........Roofing ...........&A ........................................... Floors .�) ....... ...✓,;-.. ..........Interior ..............51�` �....� �G��........................... Heating ..... .R-a?...rt.... K *i`t ,,N! Cs+�s t.�!...Plumbing ...... I...�......Ads'............................................... Fireplace ................... k4...................................................Approximate Cost .....: r..Ar d..e...... Definitive Plan Approved by Planning Board -----------_______-----------19--------. Diagram of Lot and Building with Dimensions �e SUBJECT TO APPROVAL OF BOARD OF HEALTH OLL- U') Q3 U, IL O z cn N Moo Z Lj `� � aORW � ¢ 0 Ll- m0 LL- a O Q , OcnQ w Lj Ld � U) _ Qa o � L � d1Q � � d � Vz / O Q cc 3� o � Q c ¢ 0- < X, w � LdLd )a < G � a I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .., :;.. .. . Yt ............. Mason, .Thomas H. No .................10564 P-erm- it for ............one..............story..........single family dwelling ............................................................................... Willimantic Drive Location ................................................................ Mars tons tons.Mills ............ ............................................................... Thomas H. Mason Owner .................................................................. frame Type of Construction .......................................... ................................................................................ Plot ............................ Lot ...............#9 ................. Permit Granted .......Kay 22 ..... .....19 72 Date of Inspection Date Cbmpleted ......................................19 PERMIT REFUSED ................................................................ 19 ............................................................................... ................................................................................. ............................................................................... ............................................................................... Approved ............................................... 19 ............................................................................... ............................................................................... Y Gq� BIZ � • 7-0 W/C 1 � �2 � , sot. ►2-� I r VIE- 2 x tic -� .• ► SCALE: APPROVED BY: DRAWN BY: 4 DATE: CJ REVISED DRAWING NUMBER • `� � � i•� 1. - — � i� 1 � ----- __� I !: ----.._— �• ai P 7 , ,lu � ;: I �� a - It ME C3, 1w ;1 7 t� �- UL _ c — SCALE: APPROVED BY: DRAWN BY: �"— �—� DATE: REVISED 4 DRAWING NUMBER VT`�..