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Home My WebLink About0171 SETH GOODSPEED'S WAY I?l Se�h GooQl sPeec�s lc7 `� Q_�,�iled Town of Barnstable RECEIPT ` a"HAS& ' 200 Main Street, Hyannis MA 02601 508-862-4038 & Application for wilding Permit Application No: TB-17-3453 Date Recieved: 10/5/2017 Job Location: 171 SETH GOODSPEED'S WAY,OSTERVILLE Permit For: Building-Insulation-Residential Contractor's Name: WILLIAM J MCCLUSKEY State Lic. No: CSSL-102776 Address: West Yarmouth, MA 02673 Applicant Phone: (508) 398-0398 (Home)Owner's Name: TAYLOR,MARGARET E& KENNETH R Phone: (508)292-3187 TRS (Home)Owner's Address: 171 SETH GOODSPEED WAY, OSTERVILLE,MA 02655 C:) Work Description: Add R-37 cellulose to the attic. Add R-19 fiberglass to the basement. Air seal the;attic planand basement with expanding foam. General weatherizaiton. ' k Total Value Of Work To Be Performed: $5,000.00 Structure Size: 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: William McCloskey 10/5/2017 (508)398-0398 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $5,000.00 Date Paid j Amount Paid Cheek#or CC# i Pay Type Total Permit Fee: $85.00 10/5/2017 $35.00 XXXX-XXXX-XXXX- Credit Card 0299 Total Permit Fee Paid: $85.00 -�10/5/2017 $50.00 XXXX-XXXX-XXXX-$ Credit Card 0299 THIS IS.NOT A PERMIT i Cape Save Inc. 7-1) Huntington Avenue , South Yarmouth, MA 02664 �; Tel: 508-398-0398 Fax: 508-398-0399 , � 12/13/17 Thomas Perry CBO Town of Barnstable Building Division 200 Main St. Hyannis,MA 02601 RE: Insulation Permit 17-3453 Dear Mr. Perry This affidavit is to certify that all work completed for 171 Seth Goodspeed's Way, Osterville has been inspected by a third party Certified Building Performance Institute(BPI)Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, • William McCluskey e TOWN OF BARNSTABLE BUILDING PERMIT APPLICATiQNr-'• Map I22 Parcel Application # Health*Divisiono Date Issued. Conservation Divisions Application F Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board ! Historic - OKH _ Preservation / Hyannis \�/ M, P� Project Street Address 1-1 1 Sam C_ed6e•" Wav . Village (SSA-e. vi II.P Owner e r►e "A( ev�av1`t"a�.l Address -9-4' Gi•I-w► 1QA c SwunA elx,. , T�T� M R G251o3 '� Telephone_gog_ :2 j4 2. •- Permit Request k4ckl n oebWA4,A1 r_6g*k04 k ocAhm W a,!- 01 1n a9oLI1r / Q�'T M �e�nnov er4- o t c t=�rv, yn t Square feet: 1 st floor: existing 1t q3 proposec�N �oor: existing WA proposed Total new Zoning District- "''t Pft_ Flood Plain K n Groundwater Overlay Project Valuation-11 i -Construction Type ;/No ( ��Lot Size 6,,3S �1�� Grandfathered: ❑Yes If yes, attach supporting documentation. Dwelling Type: LSingle Family V/ Two Family ❑ Multi-Family (# units) Age of Existin(StrudMre Historic House: ❑Yes W(o On Old King's Highway: ❑Yes &r�o Basement Type: Vull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) ® Basement Unfinished Area (sq.ft) 1.0 ZeS� Number of Baths: Full: existing new d Half: existing a new 6 Number of Bedrooms: existing 0 new Total Room Count (not including baths): existing _ (a new fl First Floor Room Count (� Heat Type and Fuel: ❑ Gas Oil ❑ Electric , ❑ Other Central Air: ❑Yes U No Fireplaces: Existing New Existing wood/coal stove: ❑Yes U40 Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: Vexisting ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # MIA Recorded ❑ Commercial ❑Yes ®'No If yes, site plan review# Current Use 1_to Proposed Use Spmq�,& N1 DC 64M 01 ,. APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name N owl t4 t,ScWe y— Telephone Number SjnS—:7(gyp—,a 43 Address 13,5�g 13--L f License #��7� VOt"4 be.,~i5 , KA d{270 Home Improvement Contractor# afo�7 Email f Worker's Compensation # ICY I rg 7 101 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO AA l�W,,V aA 'S t� SIGNATURE CLA&c,_L , DATE 41 2!0 11(, r r - FOR OFFICIAL USE-ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION , FRAMEr INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL ' PLUMBING: ROUGH FINAL (SAS: ROUGH FINAL "_FINAL BUILDING r DATE CLOSED OUT ASSOCIATION PLAN NO. , . n Jhe Conirlioyrivealth of-V rssachuseits Departhrrerrt of lrndustrial Accideidg 600 Washinoon S`ireet Boston,MIA 0- � n,vv11irliasS.gaVldia Warkers' Campensation Insu -auce Affidavit:Bcdlders/CantractGrsM.ectrictianFJO ---,� Applicant Inf n-motion Fleas G 1f Name�_,�;,,� �} Box 521 West Dennis MA��2g70 J•®- 50&7604534 Ad&ess:�i��l City/Sta&Zi s Phone 4',"- 506— —a.53 Are you an employer?Checkthe appropriate bo=: O-J,6-7 D Type of project(requii�e�t 1.❑ I am a employer with 4 ❑I am a general contractor and I Ioyees(full anrc3torpart timed* 'haveluredtfze sub-contractors 6. New consfiuctioa 2. I am a sole proprietor arpartner- fisted on the attached sheet, 'I- ❑Remodeling ship and have no employees. These sub-contractors have 8. ❑Demolifion working for me in any capacity: employees and have wodcers' 9. Buildingadditia>p. [Nan-�orkers•'camp.insurance comp.insurance-1 rewired J 5. ❑ We are a-corpomfion and its 10:❑Electrical repairs or additions 3.❑ I am.a fiomeoumer doing all work officen have exercised their l 1.❑Plumbing repairs or addition, myself[No-workers'comp- right of exemption per MGL 12. Roafr c.152 §l(4h and we have no ❑ eF� ;nc,�,�nce required-]� • employees.[No workers' 13•❑Other cone-insurance required_] 'AnyR"ica ff lchedcslms#1mastalsafillmlthesectionbeTowAwningtheywor3sers'ca®p reensatioupoRUi�ormadan_ I3amFaamers who submit his ai#ida�ir indiczting they s =g O wa l=4 then hire outside contractors nmst submit a new affidavit inEmii�sacTi TCan=ctorsthzt chea this bmt must attached as adelitianal shxet showing the nave of the sub-comtmc�a.and stgte whether or not Pose entities hzve e�ioyees I€thesub-am-tnutoshwe mnployt�s,they mustpmtVidetheir worker"MMp.polity mmeber. I am att eutplo}�rr tleat isprot�tiirrg wark¢rs'+:an>pertsah'ort insrtrarrce for art}*¢ncptoj�ees $eIoav is flrepoiicy�a�¢d ja7a cite it formadom Insurance Company Names Policy#or Self--ins.I.ic.k- Expiration Date: Job Re Address: CitylStawzip: Attach a copy of the workers'couapensationpolicy dediration page(shotriug the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL m 157-can lead to the imposition of criminal penalties of a fine up to$1,500:00 andrar one-year imprisonment,as well as civil peualties.ia the form of a STOP WORKORDERand a fne of up to$250-00 a day against the-aiolator- Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DFA for insurance coveragei-raffication- I Jo herby cetlifjr iluder the pabis andpenaWks afperfurp fJlatthe infornzadoupror-i-&d above Zs bwe acid correct Sisnature: v k4A L .re I AAAA-Az4-,9AYL,- Date: 41761 l0 Phone ik �O�s"1(ot)— 3LZ� Offs al use anly: Do not errke in tleb.area,Air be completed by city ortnnan ofjrcdaL • I City or To-um: PernritUcense 4 Issuing kulharity(chide one): 1.Board-of Health 2.Building Department 3.City1rown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Oth'er Contact Person: Phone#: - formation and Rnst-uctiolis Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation far their employees. Ptusaani-to this she,an enplayee is defined as"_.every person m the service of another under any contractofhire, express or implied,oral or written" An ernplvyer is defined as"an mdividnal,partnership,assocralmafn,corporation or other legal entity,or any two or more of the foregoing engaged in a Joint entrrprlse,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 dweIling 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 dw6 iag house w� or on the-gromlds.or building appurEenaIItthereto shaIlnotbecanse of such employmentbe deemed-to be an employer." OngAn lie s►�-� ..( " §2SC((]xalso sfes tizat"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 arrp applicantwho has notproduced acceptable evidence of compliance with the nisnzance.covearage required" Additionally,MGL chapter 152, §25C(7)states-Neither the commonwealth nor any ofits political subdivisions shall enter into any contract for the performance ofpublic work uniml acceptable evidence of compliance with the.insuranc6.. requirements of this chapter have been presenind to the contracting ani oiV.' A-ppUcauts ' Please fib out the workers'compensation affidavit completely,by checking!me boxes that apply to your sitaation and,if necessary,supply sob-contractors)name(s), addresses)and phone numbers) along with their certificates)of h=amce. LimitEd.LiabOity Companies(LLC)or Limited LiabMty-Pa taD='hips(LLP)withno employees other than the ' members or partners,are not regimud to carry workers'compensation insurance. If an LLG or LLP does have employees,apolicy is required. De advised that this aflidayifmaybe submith--dto the Department of Industrial Accidents for contrmation of insurance coverage Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that time application fur the permit or license is being requested,not time Departiamt of Eadustrial Accidents. Shovldyou have any question regarding the law or ifyou are regoaed to obtain a workers' compensation policy,please call the Department atthenumberlistedbeIow. Self-ins�companiesshouldentertheir self-fi sarance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed IegibFy. The Department has provided a space at the:bottom Of the affidavit for youto fill out in the event the Office of Investigations has to confactYonregardmgthe applicant. Please be sure to frill in the peiit4icense number which will be used as a reference number. In addition,an applicant thatmust submit mul4lD pem itlIicense applications in any given year,need only submit one affidavit indicaihmg current policy ij ration(if necessary)and under"Job Site Address"the applicant should write"an locations in (c'ty or l 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 proofthat a valid affidavit is on file for fatnm permits or licenses Anew affidavit must be filled 0i1 each. year.Where a home owner or citizen is obtaining a license or pe=it not related to any business or commercial venimse (ie.•a dog license or permit to bzun leaves e�.)said person is NOT regoimdto complete this affidavit The Office of Investigations would bke to thank you in advance for your cooperation and should you have anY gnesfiaos, please do not hesitate to give us a call. The Department's address,telephone and fax number: The ammwwe althE Of Mas chnaetts Depaz mt of ludustcial AocZen:t Qitce of I,vestgatioa$ fQl� asbintan Street Boston,MA W11F Tt,-L 4 617'27-490()Qxt 4-06 or 1-977-MA SSAFE Fax 617` 27-7749 xevis ed.424-o7 Amass-gagf�'a 13'10 87 �!� _ 5►3 2'10 2'5 01 CL "a. 1 co � i I 1'11 1'11 21- _ _ - !-ta� WPA,fs A-0 2 8. -- 310 41 3 3 13'10 13'10 3'7 5'3 I 2110 - - 215 71 C\j ve-6 LI �i 11 Ns!-2tr W - o- - ; I-- (r i 221 — Z .- E 2'8 -- 310 41 I� 3 3- ►v, s�a9e� r� �r 13'10 i ,�Ld �an7v�. 170a 24„ 27" , 27" ,' 37a„ 27" 27" 82B„ 30B„ 577" 4 „ 49 e„ 72'--e„ , 36" 2 '—�18" 37 27" 27" 23 24 25 26 N Legend -4 _N 1: 3/4REP27X90L N fh y r;; .�.� 2: 3/4REP27X90R M 24:DISHW 19 20 21 3: B12FH_ORGSC -�� / `W 6• W361524 RLS „ I LAZY----- 5: W361524B N ��C— �� SUSAN CUTLERY 2-PULLOUT 2-PULLOUT BRICK WALL 6: W1233L DIVIDER TRAYS vl BASE ONLY TRAYS 8: W1233R —�I DW 24" 9: WD2433L 10: B15 RDU2L 2-PULLOUT 11: BF3-34.5 -ro t7" z TRAYS 12: S8278_TOT N 2-PULLOUT 13: BF3-34.5 ro co I i I� " TRAYS 14: B15 RDU2R I j SPICE 15: ER3L/36 3RLS PULLOUT 2-TRAY DIVIDERS 16: W1833L LAZY 30"RANGE LEFT SIDE '17: W1833R ao - SUSAN 36"REF 18: WD2433R�- "ai I BAS ONLY 19: 3DB18 E, N 1 20: B27B_RDU2 \� 0-GAS-RANGE. 3 L 1 21: B27B RDU2 ih 22: BF3-34.5 v 5 23: W2733B N I 6 24: W2733B 9 B I 7 25: W2733B 26: W2733B 27: FS3-36 Iq 1„ 45'3,I� 9 118" All dimensions_size designations Cape Islands Kitchen This is an original design and must Designed: 2/2/2016 given are subject to verification on Designed By: not be released or copied unless Printed: 2/9/2016 job site and adjustment to fit job Kevin T. Schlosser applicable fee has been paid or job conditions. Kevin@capekitchens.com order placed. C: 1-781-291-6184 Taylor Ken ��+ �, r�Bq�•� All Drawing#: 1 No Scale. i 170 4" ��" mY- ��rvwCr � 24" 27" 27" 37;" } 27" 27" 1: 82a", 30, 571" 48 49" 72;e' 36" �2 '—r18" 37„' 27" I 27" Legend 23 24 - 25 26 - 1: 3/4REP27X90L co N .,_ �� 2: 3/4REP27X90R M / 2 DISHW: 19 20 21 N 3: 812FH ORGSC Hvi �Y_ _. -- -. .... .. .. _ - 5 W361524B "� �`� I SUSAN CUTLERY 2-PULLOUT ?-PULLOUT BRICK WALL 6: W1233L a DIVIDER 7: W3015B al BASE ONLY TRAYS TRAYS 8: W1233R -• DW 24" 9: W02433L (CcLoi 10: BF3 RD52L 2-PULLOUT - 1 - TRAYS 12: SB27B_TOT to CM) N (i 2-PULLOUT - 13: BF3-34.5 .I 14: B15 RDU2R TRAYS SPICE 15: ER33L/36RLS I` PULLOUT 2-TRAY DIVIDERS 16: W1833L LAZY 30"RANGE LEFT SIDE 17: W1833R co �� SUSAN 36"REF 18: WD2433R�- 19: 3DB18 " BASE ONLYt_ Ii ... .. 20: B27B_RDU2 �'•t 0-GAS-RANGE 3 / 1 21: B27B RDU2 g , �� 22: BF3-34.5 N M _3�_E_ 5 23: W2733B 9 M�� 6 24: W2733B 25: W2733B 26: W2733B 27: FS3-36 36" 3 ,-12 3 NI 2 , 118" All dimensions-size designations Cape Islands Kitchen This is an original design and must Designed: 2/2/2016 given are subject to verification on Designed By: not be released or copied unless Printed: 2/9/2016 job site and adjustment to fit job Kevin T. Schlosser applicable fee has been paid or job conditions. Kevin@capekitchens.com order placed. C: 1-781-291-6184 Taylor Ken All Drawing#: 1 JNo Scale. O,P i 6'� __.... . P�posed Utility Close Laundry Closet �xrs� f�osed� Pv�o pad, Utility ClosetLaundry Closet i MISCH R BUILDING & REMODELING Box 521 • West Dennis, MA 02670 • (508)760-2534 Owners Authorization Date: March 23,2016 For: Town of Barnstable Building Department 200 Main Street Hyannis,MA 02601 Statement of ownership and address: Kenneth R. and Margaret E. Taylor are legal owners of record of the property located at 171 Seth Goodspeed's Way, Osterville,MA. This property is also referenced or identified on Map 122 and as Parcel#079 Authorization: I/We authorize Noel Mischler/DBA Mischler Building and Remodeling to: Build an 8' laundry/utility closet in the existing family room. Remodel the existing kitchen. Remodel both existing baths. Name of authorized agent/contractor: Noel D. Mischler DBA/Mischler Building and Remodeling P.O. Box 521 West Dennis,MA 02670 Owner(s)Signature: Date: 3 Z3 � - Massachusetts Department of Public Safety lug Board of Building Regulations and Standards License: CS-072467 Construction Supervisor t NOEL D MISCHLER 29 BAYBERRY RD W DENNIS MA 02670 C—A—_ Expiration: Commissioner 08/10/2017 L//LC "�7JIAN.(YJU�/CCG��O�V��(IJ9CLC�lIJCIIJ Office of Consumer Affairs&Business Regulation Wx ME IMPROVEMENT CONTRACTORgistration: 126874 Type: piration: ;8/3L20:16 DBA MISCHLER REMODELING' NOEL MISCHLER - 29 BAYBERRY ROAD WEST DENNIS,MA 02670 Undersecretary I ce--4 74 mot:. G<.�G- :>>•?,+�=` Sv S r x 2. S = t.5't S � v•.Tj. � c M� �' S !'�..i,� ECTTOM 42 EA N. r C ; ST tO 6F Al /.G WILLIAtri - e`v / t •��".�► n Q / N Y E 19334 O Cs 5.�- tx �• � 'r /EST /000 i - Z o D- Q�5SL cn A rill r r7i T , , ! , j�''fL• :v/ / � aZ 2 �/U SWAG t'� Ct=eT1 lEL7 7- PLC) PL.l�,1rl; LOCATIC)" Oc, t//f.L #-�A4 .. T , C6RTt F�{ T{-(AT TNTvbA�U� �Ee a� LG�MPL�Fs vv,IT" THE 'gl Dom.Lt G o r 70 /J ND SETS�CtG V-Zf4ut2EMe"TS OP THE -ro w v 09:: 6:>57S't,/144— DATE Ptt�.�1 � �' 1,, xTEtz �. u�E �•..tG_ tl�J A�►i OSTCV-v%L..L.G o �rtAS�ilz 12U¢va'l 'T1�� ua�'r+:rS >�•1e,wln ApPL_1 rA.NT �/4� ' t/�/�G� �..- �r• t'� �1 t\11=- ,.fi'�� t!-lip.r r iisorAssessor's map and lot number ..1 �..�.. :... ..... — L f� 1� j"m i�_ - a ��"' ( 5 - 7 7 > �4 N COMPLIANCE Sewage. Permit number .................................. E+A AND E J �,a w �t T r TOWN OF BARNSTABLE �v r O �•, t7' O" L Z BAW STABIA, • `T „� 131.1`11DING INSPECTOR O i639• 6 t� �A YPY a'.. 6S �'7 O ;-+ /!S Eo u APPLICATION" FOR PERMIT TO . ....... TYPEOF CONSTRUCTION 4 � ./............................................................................................... E� .....................a�....3..........1.9.�7> TO THE INSPECTOR OF BUILDINGS: The undersigned reby applies for a permit according to the following information: Location .. .... ..... ...... Q..... . . .. � . ................. ......... ProposedUse ................. ......................................................................................... ................ ....................... e2l- ...Zoning District ...... .......................................................Fire District ....... . ............. . . ................... Name of Owner .... �. . ...... .. ....................Address ............ ...�.... ....... : . .. . ........................................... Nameof Builder ...........................:........................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................. ................................ Numberof Rooms ..........j.....................................................Foundation ... ................................................... ................................................... Exterior ............ ... `/....................................................Roofing .............. Floors ..........1�(. ��1/!..�....................................................Interior ........... ,%.. . .... ..... ....................... . .................. Heating ......../...r:. vvr... .....,Ll/.... ......:...................Plumbing ..........jt2................................................................... Fireplace ..........Approximate Cost ....... � Definitive Plan Approved by Planning Board -------------------_------------19________. Area .../6,01 ................ .... .............. . ....... ... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH I .hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding t e above construction. Name . ................... .......... Capewide Development . ' _ ' one story No ,�" Permitfor -----------.. ingle fmuu -~�� dnn�� - -.~ ' .—..^. ..................................................................... / � ' Location ---�m��. «�.��___.. . 1 � - Omterville � —.--.-----.---..--..---------. ~, � ] Owner � -----~---^-----=------'' ' Type of Construction .........��Y��.------.. � , ---.--^—.---------.---------' � #70 ' Plot^...--------. Lot ---_------.. . � i � ` . � ' August 24 77 Permit Granted ---............------.lg ' '15ate of Inspection --- -----l9 � �� ~bate Completed .�^��=-m�...^—�----l9 - ` ^ PERMIT REFUSED . . ' —.-...—,_—.--....—.------.. lQ � � ...—.--_---,-.----.~--.—.------- ' . ....-..-.--.........-----.------.--. - ^^'-'~~'--'—^--^^^^—`^^^--^^'--~---^ ` .-----..--.----..—.^...~.—,...---... � � Approved ................................................ 19 � ' -------.--------------...—.—. | � � ! � ----.---------------...---.... ` � � Assessor's map and lot number ..... .?......... ..... q rJ Sewage+Permit number .......................................................... t . OFTMET� _ TOWN OF BARNSTABLE B9HHSTODLE, i .6 9 BUILDING INSPECTOR . O NPR A,. n + APPLICATION FOR PERMIT TO / TYPE OF CONSTRUCTION ......./�/ .!s y-.f,.,...�... ................ :::-............................................................... ................................................ ...' TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a/permit according to the following information- Location ......................................... .................. y Proposed Use ......t:;...:a.+:! :..........................................................................................................y........................................ Zoning District ........................................................................Fire District �-�:�....:�?�.....;.�..:.............................:-'P'...... Name of Owner �< � ��*gip s' � ter:.-a.. ...................Address ........... ........................ .....,.. .:...................................... Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms . .....................................................Foundation /--»�--A�'t'"" ............. ..............................:................................................ Exterior ..............:.......... .........................................................Roofing ....... r .................................... Floors ..................................................................Interior ........ Heating / if,/. i ..... ... ..........................Plumbing ............-2................................................................... Fireplace -.................................................Approximate Cost :�� ................ ........................................... Definitive Plan Approved by Planning Board -----------_______-----------19________. Area /�°`�........................................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH r I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above .construction. Name ..:............. :.... ,. ......................... Capewide Development 22-79 .� sl -No ...19538... Permit for .....one.... t...y.....:.... single family dwelling ............................................................................... Location Beth Goodspeed's Way Osterville I .......................................................... .................. Owner C.apewide. Develo. . pment .. .......... ........ ...L Type of Construction ftrame Plot L #70 ................... August 24 77 Permit Granted . .. ... ..................19 Date of Inspection .....................................19 Date Completed .....................:................19 PERM EFUSED ............ ............ ................. 19 ...................................................... ....................... .................... ............................................................................... Approved ................................................ 19 ............................................................................... ............................................................................... U 0/19 ha zo 06 v oFTHMET Town of Barnstable *Permit# Expires 6 monfhsfrom issue date Regulatory Services Fee +' STABLE, + 1' MASS' c� �659. Thomas F. Geiler,Director pTFD MA't e . Building Division , Tom Perry,CBO, Building Commissioner 200 Main Street;Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTLkL ONLY Not Yalid without Red X-Press Imprint Map/parcel Number 1�� 0 P G(� eW , le, Pro e Address >/ Residential Value of Work nimum fee of$25.00 for work under$6000.00 Owner's Name&Address Contractor's Name J,9-/✓1 es /,610AI Telephone Number_ q01 71�//''��d� Home Improvement Contractor License#(if applicable) Cons ct orkion Supervisor's License#(if applicable) (/ Wman's Compensation Insurance XGNPRESS PERMIT- Check one: ❑ Ia3A sole proprietor S E P 16 2010. ❑ the Homeowner El"I have Worker's Compensation Insurance `SOWN OF BARNSTABLE Insurance Company Name (� O � r Workman's Comp.Policy# s�j k 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 r000 VReplacement-Windows/doors/sbders. de #of doors U-Value 0 �� (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: ,• ._ QAWPHLESTORIAMuilding permit formsT-XPRESS.doc The Commonwealth of Massachusetts Department of Industrial Accidents - Office of Investigations 600 Washington Street Boston MA 02111 � '' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): I/Y l 0-07U j�j 50 e,lq,1 , 1 Address: �l J� �7 Pt_`lt 90.-5 ' Dr-!V�- City/State/Zip: K Phone#: `(Ol (a 7/ 6 l Are you an employer? Check the appropriate bog: TyVemoodelting (required): 1.X1 I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. truction 2.❑ I 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 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1"must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. =Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: C'i,,Ct:�t� A, � .s c-D ^ Policy#or Self-ins.Lic.#: Expiration Date: % bo Job Site Address: w City/State/Zip:0 E �S Attach a copy of the workers' compensation policy declaration page(showing the policy number an 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 $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided bove is true and correct. Signature: ram— Date: Phone#: Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: I i t q�,r �q ji Q .J r# 2.8 ,1_ �3�ka k6��.E�F-�� •1. '�[]i' '�LCl��'f�8 AAM PA t ,.,. ,b L iJrix�erecr #airy rar d of Building Regulatiops and Sitan&W- Construction Supervis<w Speckifty L Lire : CS SL 99840 Restricted : Rf.W$ J MES 48 PANE KbAD CUMSERLMD, R1 02864 •�[3iLD4f vCp:l6BCi Tr#: 9 I. i � I �c1� a1i ut:K { iriuA i C ur LIAMILI t T 1N VKA1N1Ut: MOQT3A 1 05/07/10 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 r4ld 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 NAICTM IRISURED Moon Associates Inc. i1MSJRERA: trational Grange Tssurance Co I 14788 DBA Gutter Helmet DBA ReneiTal bV Andersen of 'RI INSURERS: Seacon tdutual Znsuranca Co. D$A Gutter Helmet Roofing INSURER C: DBA Moan works 1137 Park East Drive INSURERD; Woonsocket RI 02895 I !NSllREP,E: COVERAGES THE POLICIES OF INSURANCE LISTED SELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD MICATED.NOTWIThSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE-MAY BE ISSJED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES D=SCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE(MMIDDNYYY) DATE(MWDDIYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $1000000 A IX COMMERCIAL GENERALLIABILITY IvIPS26619 09/16/09 09/16/10 PREMISES(Eaoocurence $500000 CLAIMS MADE X❑OCCUR MED El(P(Any one perem) $ 10 0 0 0 PERSONAL&ADV INJURY $ 1000000 GENERAL AGGREGATE $2000000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2 0 0 0 0 0 0 POLICY El jRCT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT A X ANY ALITO BIS26619 09/16/09 09/16/10 (EDaccident) $1000000 ALL CAVED AUTOS BODILY INJURY SCHECULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NO"WNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABMY EACH OCCURRENCE $1000000 A X OCCUR ElcLAmsMADE CUS26619 09/1.6/09 09/16/10 AGGREGATE $ $ DEDUCTIBLE $ IX RETENTION $10 0 0 0 WC 51-ATLV- $ WORKERS COMPENSATION X ITORY LIMITS IQ ER AND EMPLOYERS'LIABILITY B ANY PROPRIETORIPARTNEPjE*CUrIVE a 28586 10/01/09 10/01/10 E.L.EACH ACCIDENT $500000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500000 U yes,describe under SPECIAL PROVISIONS belowE.L.DISEASE-POLICY LIMIT $500000 OTHER I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS 1 1 i I r i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLIt16S BE CANCELLED BEFORE THE EXPIRATION R}:NEWAT, DATE THEREOF,THE ISSUING INSURER WRL ENDEAVOR TO rd,Idl 10 . DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO$O SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENT'S OR Renewal. By Anderson REPRESENTATIVES. 1137 Park East Drive AUTHORIZED REPRESENTATIVE Woonsocket RI 02895 ACORD 25(2009101) c-319M2W9,ACPRD CORPORATION. AD rights reserved 1 Al.Reg.0 17159174839(Moon Maocvlea tic.1 1137 Park fast Drive Conn.Kc-owm(Mnon As iates Inc.l Woonsocket,Rhode Island 02895 �""O^a Mass.it a 119535(Moon Assocy:es tin 1 (aW)975.6666 �p p Purchasers)Name:4-vA7% < J� <v 11 Installation Address: � f L— 00 r3 �'` Mailing Address, /J Q S2' I� Co Home PRtSt A/'u 2JV`-' Cell Phone: E-�d' w �Le Year Home Built: Customer Tatter Pao In Totwl�� •_J t I/We,the above purchaser(s)("Purchazer(s)")an the r(s)of the property located at the above installation address,hereby j irrtly arid s� i",gee to contract with Moon Associates,Inc("Mocinworks")to furnish,deliver,and install of all materials as described in this agreement("Age attached Spec Sheet(s)and diagram(s)which are incorporated herein by reference and made a part hereof.A Completion Certificate wgl be executed for all Sobs at the end of the installation. i Order Number, -� � � Order Number: Order Number: � ��yt1Op Project Type: Project Tye: Project Type: � I I D_ Agreement Amount S Agreement Amount S i Agreement Amount S Less Deposit# $�/ Less Deposit# $ less Depositt S I Balance Due On Completion $ �/ Balance Due On Completion $ Balance Due On Completion S Ob tMinimum m of Agrtemee Amount due uW eoecntnn.33'It of 4gteemem Amount due uppneaecutlon. itNinirnurn 33%dAgtednent Ameuxt due upon eccul7°r'' I, Indicate Payment Method For Balance Indicate Payment Method For Balance Indicate Payment Method for Balance Due at Time of Installation: Due at Time of Installation: D�S-- Te of Installation Est.St rt te: Est. mpl n Date: Est.Start Date: Est.Completion pate: . ate: (Est.Completion Date: 9i io /aiS /D POSIT/PAYMENT OPTIONS(su*dtohmdverificationand/wueditapproval) 1.Chec shlees Check or Money Order Ck sl 192 3•Financing gable to Moonworks) Acct x Approval Code 2.Credit Card'(circie) Visa MasterCard Discover Acct# Approval Code •I/We agree m albw Moonroria to charg Me referenced credit card for the deposit amount Acct N Exp O ite Security Code indicated.aakance to be charged to oretm card upon completion 01 instauation d noted atim" h a agreed by and between the parties that this Agreement constitutes the entire understanding between the parties,and there are no verbal understandings changing or modifying any of the terms of this Agreement.purchasers)hereby acknowledges that Purdoaser(s)1)has read the front and reverse of this Agreement and has received a completed, signed,and dated copy of this Agreement,including the two accompanying Notice of CanceBadon toxins,on the data first written above and 2)was orally informed of his/her right to cancel this transaction.DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLINK SPACES. Purchas Purchaser Moonworks 2S nature Signature Signature Print Name lee Print Name 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 NOTICE OF CANCELLATION FORM BELOW FOR AN EXPLANATION OF THIS RIGHT. N E F C E ON NOTICE OF CANCELLATION Date of Transaction d Daft of Transaction You may cancel this transaction,without any penalty or obligation, You may cancel this transaction, without any penalty or obligation, within three business days from the above date. if you cancel,any within three business days from the above date. If you cancel,any property traded In,any payments made by you under the Contract or property traded in,any payments made by you under the Contract Or Sale,and any negotiable instrument executed by you will be returned Sale,and any negotiable Instrument executed by you win be returned within 10 days following receipt by the Seller of Your cancellation within 10 days following receipt by the Seller of Your cancellation notice,and any security interest arising out of the transaction will be notice,and any security interest arising out of the transaction will be canceled.If you cancel,you must make available to the Seller at your canceled.H you camel,you must make available to the Seller at your residence,in substantially as good condition as when received,any residence, In substantially as good condition as when received, any goods delivered to you under this Contrail or Sale;or you may,if you goods delivered to you under this Contract or Sale;or you may.if You wish,comply with the instructions of the Seller regarding the return wish,comply with the instructions of the Seller regarding the return shipment of the goods at the Sellers expense and risk.If you do make shipment of the goods at the Sellers expense and risk.if you do make the goods available to the Seller and the Seller does not pick them up the goods available to the Seller and the Seller does not pick therm UP within 20 days of the date of your Notice of Cancellation,you may within 20 days of the date of your Notice of Cancellation,you may retain or dispose of the goods without any further obligation.If you retain or dispose of the goods without any further obligation.If You fail to make the goods available to the Seller,or if you agree to return fail to make the goods available to the Seller,or if you agree to return the goods to the Seiler and fail to do so,then you remain liable for the goods to the Seller and fall to do so,then you remain liable for performance of all obligations under the Contract. To cancel this performance of an obligations under the Contras. To cancel this transaction, mail or deliver a signed and dated copy of this transaction, mail or deliver a signed and dated CM of this cancellation notice or any other written notice or send a telegram to cancellation notice or any other written notice,Or send a telegram to MOONWORKS, 1137 Park East Drive, W et, Rhode Island Moonworks, 1137 bark East Drive, Woonsocket, Rhode Island 02895,NOT LATER THAN MIDNIGHT OF D (Date). 0289S,NOT LATER THAN MIDNIGHT OF (Dante)• 1 HEREBY CANCEL THIS TRANSACTION. 1 HEREBY CANCEL THIS TRANSACTION. Consumer's Signature Date Consumers Signature Date b�� O"olutber li t REP W E R o r a