The URL can be used to link to this page

Home My WebLink About0036 SHARON CIRCLE J �Y �. h4r'✓'drl C�� ' .. ,� , �, � o., „ � � �� o i � � �, ��- - � � �, . ._ ,. �. o � , , � , i � ,. - � .. i, � , �, .. _ , r� � � .. ,. - � - ' p - ` �, �r .. � � � � - v .., � .,� � � � li ., ,.� ' � � � , �, �'; ,,�,. � ,. .,. *r ,, � � i�- � � � , i, .� ,. ,/� ��i 0 a.....-,.... .-...ra.. �.,..� ..�.r.. _..�_ �} Town of Barnstable Building_ aAwmAam? Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept MAS& Posted Until Final Inspection Has Been Made. Permit ' Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-20-208 Applicant Name: Jared Reeves Approvals Date Issued: 02/20/2020 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 08/20/2020 Foundation: Residential Map/Lot: 122-149 Zoning District: RC Sheathing: Location: 36 SHARON CIRCLE,OSTERVILLE Contractor Na e''-,�ARED A REEVES Framing: 1 Owner on Record: COPPLESTONE, DAVID W& MARGARET T Contractor License: CS-092058 2 Address: 6 SHADOW LANE j Est. Project Cost: $50,000.00 Chimney: WELLESLEY, MA 02482 s Permit Fee: $305.00 Description: We propose to finish a recreation room and a bathroom in theInsulation: Fee Paid:. $305.00 existing unfinished basement. Date: 2/20/2020 Final: Project Review Req: A /� Plumbing/Gas Rough Plumbing: i-------- - -�^ \Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and the'approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. I I /1 Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing 2.Sheathing Inspection Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Carter, Jeff From: Jared Reeves <jared@reevesbuild.com> Sent: Wednesday, February 19, 2020 9:13 AM To: Carter,Jeff Cc: Jared Reeves Subject: [ Probable SPAM ] 36 Sharon Circle - Osterville Hi Jeff, Here is the framing detail and insulation we plan to use in the basement project at 36 Sharon Circle. The basement partitions will be framed using 2x4 pressure-treated shoe plates and studs and wall cap plates will be 2x4 KD stock. There are no structural headers. We will insulate the exterior wall cavities using 3" of closed cell foam insulation (R-21). I will have my insulation contractor supply you with a report upon completion as well as manufacturers' specifications. The basement ceiling rim and blockers will be insulated with R-21 kraft faced fiberglass insulation. Thank you, Jared Reeves Reeves Fine Homebuilding & Remodeling 774-836-0961 CAUTION:This email originated from outside of the Town of Barnstable! Do not click links, open attachments or reply,`unless you recognize the sender's email address and know the content is safe! i JJ —p5zo 0� j(p S I --rvyY CIJARE D 01 '4f�vRo CERTIFICATE OF LIABILITY INSURANCE DATE(MhVDD/YYYY) 11/6/2019 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(lee)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In Ileu of such endorsemen s. PRODUCER J&ACT ROpemGlay,Inc. PHONE FAX 484 Rte 134 aC No Ern): 800 563-1801 aC No; 877 816-2156 South Dennis,MA 02660 Mass.mail@rqgeregray.com 1 8U S AFFORDING COVERAGE NAIC# INSURE •Main Street America Assurance Company 29939 INSURED INSURER a:Associated Employers Insurance Company 11104 Jared A.Reeves&Daniel Reeves INSURER dba Reeves Building 340 Queen Anne Road INSURER D Harwich,MA 02645 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL BURR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTRA X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000 CLAIMS-MADE FX OCCUR MP029769 10/7/2019 10/7/2020 DAMAGE TO RENTED 500,000 MEO EXP(Any oneperson) 10,000 PERSONAL&ADV INJURY 11000,000 GEML AGGREGATE LIMIT APP IES PER: GENERAL AGGREGATE 2,000,000 X POLICY D imr LOC PRODUCTS.COMP/OP AGG 29000,000 OTHER: . iji Hier, 4 l+^►•' AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ne ANY AUTO FEBO O f BODILY INJURY Per Demon) AU�T�OpSONLY AUU�TNNOS��ULNNEEEDpp ED BODILY INJURY(Per accident) AUTOS ONLY AUTOONLY �O�V�v v+ v •' V PPe�MRklent AMAGE UMBRELLA UAB OCCUR EACH OCCURRENCE EXCESS LAB CLAIMS-MADE AGGREGATE ��DpEEDg RETENTION$ B AND ENIPLO YEMRSLIABIILOIINY OER TH• WCCS0050084972019A 11112019 104020 ` 0,000AANYPROPRIIETOR/PARTNER/EXECUTIVEY E.L.EACH ACCIDENT ppp®nd N/ARyqMW)EXCLUDED? E.L.DISEASE•EA EMPLOYEE $ 500,000 It yyeess describe under 500,000 DESCRIPTIO OF OPERAT NS be E.L.DISEASE•P LICY LIMIT DESCRIPTION OF OPERATIONS LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule;may be attached It more speoe Is required) SCANNED FEB 2 0 2020 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE "'FOR INFORMATIONAL PURPOSES"* THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ®1980-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 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. NIS 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 the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Select Department E: Eastern Insurance Group LLC PHONE . (800)333-72341A C'No:781-586-8244 233 West Central St ADDRESq;SSo electwork@easterninsurance.com INSU S AFFORDING COVERAGE NAIC 0 Natick MA 01760 INSURER AArbella Protection Ins. Co. 41360 INSURED INsuRERBStar Insurance Cc 18023 Gary C Jones INSURERC: DBA: Gary C Jones Plumbing & Heating LLC INSURERD: 12 Yeoman Drive INSURERE: West Yarmouth MA 02673 INSURERF: COVERAGES CERTIFICATE NUMBER:19-20 CERT REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LTR POLICY NUMBER D LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 A CLAIMS-MADE a OCCUR _ - - p�M Ea occurrence)- $-- 100,0 To 00 "— 9520042951 9/1/2019 9/1/2020 MED EXP(AM one person) $ 51000 PERSONAL&ADV INJURY $ 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER o F r GENERAL AGGREGATE $ 2,000,000 X POLICY❑JPERC LOC Ry\1Lj PRODUCTS-COMP/OPAGG $ 2,000,000 v OTHER CYBER $ 50,000 ,.,,,;ti. AUTOMOBILE LIABILITY w O �tJ L.0 COMBINED D SINGLE LIMIT $ . ANY AUTO BODILY INJURY(Per person) - ALL OWNED• SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED �UY PROPERTY DAMAGE $ HIRED AUTOS AUTOS UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION $ ME ER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 B OFFICER/MEMSER EXCLUDED? N I A (Mandatory In NH) NFA0867872 9/8/2019 9/8/2020 E.L.DISEASE-EA EMPLOYEE $ 100,000 IF yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 ,' M•" DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached N more apace is required) PLUMBING & HEATING CONTRACTOR SCANNL77 FEB 2 11 MR • CERTIFICATE HOLDER CANCELLATION ' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE INFORMATION PURPOSES ONLY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE John Koegel/KH3 ©19M2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025 r7ntanii A'C- ® 7E,(MMIDDNYYY) IORDO CERTIFICATE OF LIABILITY INSURANCE /31/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER CONTACT NAME Colleen Ormsby Safe Harbor Insurance Agency, Inc. PHONE 508-896-3771 FAx 508-896-9276 2450 Main Street Arc No Brewster,MA 02631 ADDRESS: info@sh-Ins.cc INSURERS AFFORDING COVERAGE NAIC 0 INSURER A: Norfolk& Dedham 23965 INSURED Richard T.McKenzie INSURER B: 55 Barque Circle South Dennis,MA 02660 INSURER C INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER LIMITS A COMMERCIAL GENERAL LIABILITY R1295234A 05/14/2019 5/14/2020 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE V OCCUR DAMAGETORENTED occurrence)PREMISESfEa S 500,000 MED EXP(Any oneperson) $ 5,000 trj PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: ` �I "1r GENERAL AGGREGATE $ 2,000,000 POLICY❑ PRO- JECT LOC )\(- PRODUCTS-COMP/OP AGG S 2,000,000 OTHER: $ AUTOMOBILE LIABILITY Q M COMBINED SINGLE LIMIT S ANYAUTO v ,. BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) S HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY Per accident S UMBRELLA OCCUR EACH OCCURRENCE S EXCESS=1 HCLAIMS-MADE AGGREGATE S DED I I RETENTION S S WORKERS COMPENSATION I STR UT ERH AND EMPLOYERS'LIABILITY Y/N ANY PROP RI ETOR/PARTNERIEXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S If as,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) SCANN�C Operations performed by the Named Insured as provided by the terms and conditions of the policy. FEB 2 0 2020 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Reeves Fine Home Building ACCORDANCE WITH THE POLICY PROVISIONS. 340 Queene Anne Rd. Harwich,MA 02645 AUTHORIZED REPRESENTATIVE 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD RICHI-1 OP ID: DE ACOR�O 701/242020 (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER COPFTACT LIA CIC AAI Rua-Dumont-Audet Ins.Agcy.In jar( 'NH a Jason Rua, 155 North Main Street � �� Arc No Ext:508-673-5808 A/FAXC No):508-677-4828 Fall River,MA 02722 E-MAIL LIA,CIC, ADDRESS:AAI Jason M.Rua, FEg O 6 LULU INSURER(S)AFFORDING COVERAGE NAIC g INSURER,C:Liberty Mutual Ins 23043 INSURED Richie's Insulation Inc. INSURER B: 111 Old Bedford Road INSURER C Westport,MA 02790 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR I SD POLICY NUMBER MM/DD MMIDD A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTED CLAIMS-MADE N OCCUR BKS60778611 0123/2020 01/23/2021 PREMISES Ea occurrence $ 300,00 MED EXP(Any one person) $ 15,00 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 X POLICY a JE T LOC PRODUCTS-COMP/OP AGG $ 2,000,00 OTHER: $ MBINAUTOMOBILE LIABILITY Ea a.der»SINGLE LIMIT $ 1,000,00 A ANY AUTO BAS60778611 01/2=020 01n=021 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED AU TOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PeOPE dentDAMAGE $ AUTOS X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,00 A EXCESS LIMB CLAIMS-MADE US060778611 01/23/2020 01/23/2021 AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N SPER ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ tf yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached N more space Is required) Subject to actual policies term,conditions,definitions,coverage& SCANNED exclusions FEB 2 0 2020 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Jared Reeves ACCORDANCE WITH THE POLICY PROVISIONS. 340 Queen Ann Rd Harwich,MA 02645 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD �1 BRIAKBO-01 MMA ,4cof20" CERTIFICATE OF LIABILITY INSURANCE D 02/20TE(M /2019DNYYY) ov2o/2o1s 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 pollcy(les)must have ADDITIONAL INSURED provisions or be endorsed. It SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsements. PRODUCER C ACT Rogers&Gray Insurance Agency,Inc. PHONE FAx 434 Rte 134 aC No Ext: 800 553-1801 A/c No: 877 816-2156 South Dennis,MA 02660 .mail@rogersgray.com INSURERS AFFORDING COVERAGE NAIC* INSURER A:Western World Insurance Company,Inc. 13196 INSURED INSURER B: Brian K.Bolton INSURER C: 63 Barnacle Road INSURER D: Yarmouth Port,MA 02675 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTRTYPE OF INSURANCE ADDL SUBR Vp POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE CLAIMS-MADE ❑X OCCUR NPP1489672 02/18/2019 02/18/2020 DAMAGE TO RENTED $ 100,000 MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: � GENERAL AGGREGATE $ 2,000,000 X POLICY❑jpeT LOC `��` PRODUCTS-COMP/OP AGG S 2,000,000 OTHER: �� AUTOMOBILE LIABILITY O •' COMBINED SINGLE LIMIT $ ANY AUTO 4v ' BODILY INJURY Per arson $ OWNED SCHEDULED J. AUTOS ONLY AUTOS BODILY INJURY Per accident S AARE NN ��yyNNEEpp I, P e�PER'�dent AMAGE $ UTOS ONLY Z SV8NLY �Vv $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/NPR ANY PROPREIIETBBOEERRR/PARTNER/EXECUTNE E.L.EACH ACCIDENT $ a SER/Mgn NH)EXCLUDED? N/A storyE.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) SCANNED FEB 101010 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE es Construction THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Reev 340 es Co Anne Road ACCORDANCE WITH THE POLICY PROVISIONS. P O Box 663 Harwich,MA 02645 AUTHORIZED REPRESENTATIVE I I c 7 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD b . q--I SEP 09 2016 Town of Barnstable *Permit�� Z Expires 6 months from issue date HAHNSTABLLRegulatory Services .Fee - • r MRNnAEM MAE& Richard V.Scali,Director 1639. Building Division Tom Perry,CB.O,Building Commissioner 200 Main Street,Hyannis,MA 02601 -- .w..ww.town.barnstable.ma-us -- -- Office: 508-862-4038 Fax: 508-790-6230 EXPRESS P PJVHT APPLICATION - RESIDENTIAL ONLY '^ 2 Map/parcel Number Not Valid without Red X-Press Imprint U�/ �j Property Address S H11A 01 q C!/(b C ©-S T lL(R V )U V— []' sidential Value of Work$ t YO0 r 0 0 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address /l E f L 6-1-A i C1/e — 6 A-_S -it- 3 ( S tt/}-tz otu C r'R C- 0-5ak Contractor's Name Dyo Z>` � Telephone Number Home Improvement Contractor License#(if applicable) ( � I 1 Email: D l+W -7313.0 4C Ik e e-d-"A- Construction Supervisor's License#(if applicable) C> & ❑Workman's Compensation Insurance Che one: am a sole proprietor ❑ I am the Homeowner ❑ I 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) 9?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.32)#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 Home Improvement Contractors License&Construction Supervisors License is requir SIGNATURE: QAWPFILES\FORMS\building permit forms=RESS.doc Revised 040215 aruueaCC/o�C�oacl ccaeC� T 'airs&Business Regulation License or registration valid for individul use only. :NT CONTRACTOR before the expiration date. If found return to. I 766 Ty0e: Office of Consumer Affairs and Business Regulation ' 117 DBA 10 Park Plaza-'Suite 5170 'Boston,MA 02116 'l Undersecretary Not valid without signature Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construcfiion SupeT"iisor License: CS-046189 DAVID H WEBB 32 YR Ullie Road Woods Hole MA 02M5 Expiration Commissioner 10/29/2016 J d forindiv License or registration ate' If found return toidul use�nly. Regulation irat►on Regulation before the exp Office of Consumer Affairs&Busioe CTOR HOME IMPROVEMENT CONTRA Office of Consumer Affairs and Business eg Y Type: 10 ParkPlaza 'Suite 5170 Registration:1 119766 Expiration:;'_812812017 pgq Boston,MA 02116 WEBB CRAFT DES',. AVID D WEBS =-= ' ~= ` Not validw►thoutsignature 25 MEADOW VIEW EAST FALMOUTH, MA 02556 Undersecretary ; The Commonwealth of Massachusetts s Department of Industrial Accidents I Congress Street, Suite 100 Boston,MA 02114-2017 M www mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: 11 0 (Dow City/State/Zip:,F. `'-f-L ec•1 Phone#: S'08 33 2F Are you an employer?Check the appropriate box: Type of project(required): 1.❑I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition I[]I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5. am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑ p Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. iContractors 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.Lie.#: Expiration Date: Job Site Address: * 3 �Si�A-20/� Cixe_ City/State/Zip:QS yl'af,/ylJ}, Oa2(nSS Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi un er the pain and penalties of p ju that the information provided Bove is tr/u/e'and correct. Signature: Date: Phone#: 511flo S111fle � `33 P_ff_ 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#: 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 permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 02-23-15 www.mass.gov/dia IE Aug, 1. 2016 3 : OOPM _ Dowling & 0'Ne i l No, 8993 P. 1 ' v, Fk� Rg"COi P'ENSATI.ON AND EMPLOY9RS.LIABILITY'INSURANCE POLICY Iforrh�'tiorr Pape Atlantic Charter Insurance Company VDAC NCCI Co. No. 29211 Policy Number WCV01243701 1. INSURED: Prior Policy Number WCV01243700 Robert Tyndall Producer: Tyndall Roofing Miller McCartin, Inc. DBA Dowling & O'Neil PO Box 1093 PO Box 1990 Forestdale, MA 02644 Hyannis, MA 02601-1990 Federal ID Number 999100972 Business Type: Sole Proprietor Risk Id Number: SIC 9999-NONCLASSIFIABLE ESTABLISHMENTS Other Named Insured:See WCE106 Other Work Places See WCE107 2. POLICY PERIOD: The Policy Period Is From: 07/15/2016 To 07/16/2017 12:01 A.M. Standard Time at The Insured Mailing Address 3. COVERAGES: A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here:MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 500,000 each accident Bodily Injury by Disease $ -500,000 policy limit Bodily Injury by Disease $ 600,000 each employee C. Other States Insured; Part Three of the policy applies to the states, If any, listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 OBB D. This policy includes these endorsements and schedules: See WCE105 4. COVERAGES: The premium for this policy will be determined by our Manual of Rules, Classlficatlons, Rates& Rating Plans. All information required below is subject to verification and change by audit. Code Premium Basis Total Rate Per Estimated Clesslflcatlons No Estimated Annual $100 of Annual Remuneration Remuneration Premium See WC 00 00 01 Minimum Premium; Deposit Premium: $650 $7,894 Total Estimated Premium $9,702 Interim Adjustment: Annually Surcharge(s) 533 Servicing Office: Total Premium and Surcharge(s) $10,235 25 New Chardon Street Boston, MA 02114-4721 Issue Date 07/16/2016 Countersigned By: Date opyNht 1987 National Council on Compensotlon Insurance Form:100mvnt4 oft tqy. � 16.59 Town of Barnstable sos¢ �� prED Ml� Regulatory Services Richard V.Scah,Director __...._:_.._Building Division - _ ___.._ Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 P operty Owner Must Complete and Sign This Section. If Using A Builder . ,fir � f . I, t L V/�e , as Owner of the subject property hereby authorize �� I 1 � J� to act on my behalf; m all matters relative to work authorized by this building ermit a licadon for: � g P PP S d A( ' 26 C( GsT �dl (Address of Job) 6 q l Signa of Date V S Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the . reverse side. i QAWPFa,ESIFORMS\buBding permit fonuslEEXPRESS.doc Revised 040215 i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map d2L Parcel (4 Application # I Sl0 V Health Division Date Issued Conservation Division AWE: Application Fee - Planning Dept. Permit Fee Date Definitive Plan Approved:b_y Planning Boa d-=a /�- �� Historic - OKH Rrese qi n/ Hyannis 'b Project Street Address _ 3b S WFt_Ord Village 05T g_q LA,E Owner A.,t 1. Aw_D 7PT V�W Address 36 S1I ARot-� a 2ck,& 0'v l L. M A Telephone �qj 46o �6Qo i Permit Request FRONT fA�FO s I?o 2c,N ZI X j �1/I fII' WRAP AP-o aP 571S Square feet: 1 st floor: existing proposed 2nd floor: existing Z"' proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 17. 000.00 Construction Type WOO Lot Size o•3 S Grandfathered: ❑Yes No If yes, attach supporting documentation. Dwelling Type: Single Family Ul/ Two Family ❑ Multi-Family(# units) Age of Existing Structure l 1Aq( Historic House: ❑Yes No On Old King's Highway: ❑Yes �No Basement Type: dFull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) I JAB Number of Baths: Full: existing new Half: existing new Number of Bedrooms: 3 existing —new Total Room Count (not including baths): existing 6 new First Floor Room Count 6 Heat Type and Fuel: ❑ Gas 3/0iI ❑ Electric ❑ Other Central Air: ❑Yes C2(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: iexisting ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes IKNo If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) I Name AIJIL A4 FaT V�h Telephone Number qu 46041a Address 36 00o d CA VU License # Home Improvement Contractor# Email U R.VAA•G cmyr,L • C0 A4 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 6AP►351k9(& 'DUMp SIGNATURE DATE "DCc- Lo 15 4 f FOR OFFICIAL USE'ONLY APPLICATION # f' DATE ISSUED `t MAP/ PARCEL NO. ADDRESS VILLAGE OWNER : J r } DATE OF INSPECTION: FOUNDATION FRAME INSULATION { FIREPLACE ? ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL e FINAL BUILDING ; . r DATE CLOSED OUT ASSOCIATION PLAN NO. y 7lie Commorriveafth of 1Hassachusetts Deparbxent of r4drrstriaf Accidads Offire a,f.£nve€trgaticfns �y 600 Was irigtorr Street Boston,AL4 02111 mini}masagovfdia '"rorILers' Camp ensattan Insurance Affidavit:BuildersrConfractarsJEIecfricians!Plumbers A13pl%c2Mt Infcsrrmatian Please,Print'Lem tiv Tame(SusiQ anizati fffldt deal AN Ark s pnru�vrA V�1a�5 Address: 36 5 kl%P-00 ct a.c L-f- CitytStatetZig OSIT-P-/t wt ,MA 0t655' Phenei 111 460 Mo Are you an employer"Check the appropriate box: T of project r 4. I am a general contractor and I Type P ] ( e4��'= 1.❑ I am a employes with. ❑ 6- ❑New construction employees(full andfor part-time)-* Have hired.the subcontractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet;. I ❑Remodeling slop and have no employees. These sub-contractors.have 8. []Demolition worb for me in anycapacity.Q employ and ha;,v a woricers' 9. ❑Building addition [No n,-orl ' comp.insurance comp.insurance.l 10 Electrical r or additions requred_] 5. ❑ We are a corporation and its ❑ q a, 3. 1 aura homeowner doing all work officers have exercised their 11.❑Plumbingrepairs or additions mysel€[No workers'comp. tight of exemption per MGL l2❑Roofrepairs insurance required-]Y c.152,§1(4),and we have no employees.[No workers' 13.❑Other comp.msuran.ce required-1 J 'Any appticaatthat checksbox r.`1 rnb5t also Moat the section belowshauiag their warkes°compensatio-apayey infnn3ts6ML l nmeou mers who submit this af#"idavu iadiratm_q they are doing&U wait sad then vie autside contractors—st submit anew affidarst iadic=ng sac'h_ fCan=Rctors tbst check this boat must attached an additiaad sheet showing the name of the sub-comUzctar r and state whether or not those eatittes ham e=p4oyees.Ifthesub-contactors have emplayees,theymastpimidetheir workers'romp.p.olignumber. lam an elripiay�er that is prmadurg tvarkers'corrrperrtsafiort i�tsuran a for mS*employ es: Seloov is the policy and job site friformadan. Insurance Company Name: Policy,41'or,self--ins.Iic-4k / Expiration Date: / Job Site Address: CityJStateJTp: / Attach a copy of the workers'compensationpolh;v declaration page,(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c~ 152 can lead to the imposition of criminal penalties of a fine up to$15.0U.Oa andfor one-yearimprisomeff,as w611 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 maybe fi nwarded to the Office of Investigations.of the DIA for insurance coverage verification. l da hereby cgdify us. the pacts arrd psrtah es ofpetjW y that the info rtrrctfiartprmi&d abm a is tutus and correct Signature: Bate: -Dw-, 20 201 S Phone ik ill.460"S 6 0 OB&ial rise only. Do itot avrke in this area,to be caruipleted by c4 ortonm af)rcfaL City or Town- PermitUcense 4 Bsuing Authority(circle one): 1.Board of Health 2.Building Department 3.fitylTosrn Clerk d:Electrical Iuspectoe 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Iast'ucfions ; Massachmetts General Laws cbap� 152 reguires all employers to provide wormers'compensation for their employees. pamum tto this stye,an mnplayee is defined as.--every person in the service of another under any contract ofhim, express or implied,oral or written." An employes is defined as"an individual,,partnership,association,corporation or other legal entity,or any two or mom of the foregoing engaged in a Joint mt gzise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individnal,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 mainfra,ance,construction or repair work-on such dwelling house or on the grounds or building appmtenanf 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 not the commonwealth for any applicant who has not produced acceptable evidence of cdmplianr-,with the insm-ance_coverage required." Additionally,MCrL chapter 152, §25C(7)states'Teithes the commonwealth nor any of its political subdivisions shall enter into any contract for the perfoIance ofpublic wont until acceptable evidence of compliance with the iumiran ce._ regua-emeuts of this chapter have been presented to the cunt w mg anthozity." Applicants Please fill o-at the wo&='compensation affidavit completely,by chec is thLe boxes that apply to your situation a act,if necessary,supply sub-wnt ctor(s)name(s), address(es)and phone numbers) along with their certificates)of ins -a ce. Limited Liability Companies(LLC)or Limited LiabUffyParfneaships(LLP)withno employees other than the members or partners,are not mquired to cant'workers'compensation insurance. If an LLC or UP does have employees, a policy is regaued. B e advised that this affidavit maybe submitted to the Depa.-iment of Industrial Accidents for confamafion offi=ance coverage. Also be sure to.sign and date-he 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 Loll sir al A ccidm-ts. 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 nrnnberlisted below. Self-insui d companies should enter their self-insurance:license number an the appropriate line. City or Town Officials Please be sure that the affidavit is complete and primed legibly. The Department has provided a.space at the bottom of the affidavit for you to till out in the event the Office oflnvestigatious has to contact you regarding the applicant - Please be sure to fEU in the peunit/licrose number which will be used as a reference number. In addition, an applicant that must submit multiple permitllicense applications in.any given year,need only submit one affidavit indicating CMrent policy information(if necessary)and under"lob Site Address"the applicant should wa-e"all locations-ha (city or town)-"A copy of the•affidavit that has been officially stamped or m aOLed 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 Anew affidavit must be filled oiat each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial veutnre (Le. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit t 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 mess,telephone and fax number_ _111a f�a W!eS&of Massachuselt-, , Depa3:tment caf 1adustdal Aocideni� FQ��ashin�tan�`tz� &ogtov,MA 0�111 Ta 4 617' -4 c-xt 4-06 or 1-&77-M aSAFR Fax#617`27-7M Revised4-24-07 ,Masg 9CM/dia. oA1Z8AG� vRl�JU�1Z �! FLOW a 11q ►c 3 t -S30 G.P.V. —�\,`. •WIG -r4"v- = 330.r ISO % + 4-95 6.P.o. u5�- IOOC> 6AL.. jPOSAL RIT - USE l Ooo SUX-U/AL:L AZEA = l50 �N-� : /'� 1 Ioo•oo t: i sue. ► .o = 5o 6.P v. I *� 4- T� i := TOTA L_ �ES16KI - 425 G..P.tO. roTA L- v,dl L�-f 33D b PD. �'. �/71 12COLQT100 O&TE J°IQ 2MiIJ 02 Lr--%.. 17- y` �r/a. 6 Ll 'ti'A= r 01 P XT[R v S�fd:t :C40 EST g��f 74 - ,.. rG s� Tor Fwo s 4-7 . � - r7.• C- i I--o Ati1 �'� luv• s � 4'PP� 'Box 41 G SEPTIC iuv l o Z'Iz. � To�K i loop GI Iwv. ►� .', ; i LpE,a�N :o 'PIT 7A WASNBD I I STo.�fc 3C, Ap • C6QTlF1ED pLbT PL_./.��] � LOGATIO:,J ►.�o SaAt`�- SCALr � :WZTIF�{ T64AT T14� -t-ov1`1bATtot- S"oww Pt-AQ TZL-PEzE►JGC Q t3 DI1 GovVLPL�lS W 1 TI-1 TI-�C 51 D'E..LI►-1tr � d.9 o SETL;�,ACV- Wr--4UIQEMZ7wTS OP T'4 C-Z, i Li 01- B,4�CT6tiZ �. u�E 1�1G_ y. i Town of Barnstable - Regulatory Services -. oFE roiy,� Richard V.ScaIi,Director Building Division Tom Perry,Building Commissioner MASS.� 200 Main Street; Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 'DEC . 73 1-®if JOB LOCATION: 36 S HAR01' number street village °•HOMEOWNER••: Aw I L A tl) PRT V 9 A S name home phone# work phone# CURRENT MAILING ADDRESS: 36 S&+wiLo jj.CI g-CA6 ----- ------•--•—•----- OS'PF.1ZV6wE� MA pZ6Ss------------- city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned`.`homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. - The unde igned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedur and requirements and that he/she will comply with said procedures and requirements. ignatam of Homeo Approval of Building Official •.Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,RuIes&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisords 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 formlcertification for use in your community. Q.XWPFILE.S\FORMS\buflding permit fmmslEXPRFSS.doc Revised 061313 �THETp� Town of Barnstable Regulatory Services BKMSUSIE� Richard V.Scali,Director i639• �0 plE1639. 16 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder L ,as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for. (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 Owner Signature of Applicant Print Name Print Name Date Q:FORMS:OwNERPERMISSIONPOOLS �Rupos�7Fp-wr►Y po" Town of Barnstable Geographic Information System 36 S N R-0 1� 01 V l LA-C, ( M A 0 76s"S December 21,2015 �t 122146 122144 f °5 #21 `^ 122145 #12 let #20 0 g# f'aF 122148 #35 49� r r 'ar rl_ti^ �W< 122147 #26 122151 #47 q. y.r '4 . �122149 I ma 122047 #2800 122150 Y, #46 122153 #50 122152 #48 0 20 Feet DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:122 Parcel:149 boundary determination or regulatory interpretation. Enlargements beyond a scale of Selected Parcel 1'=100'may not meet established map accuracy standards. The parcel lines on this map Owner:WAS,ANIL&PATRICIA CARROLL Total Assessed Value:$251600 are only graphic representations of Assessor's lax parcels.They are not true property Co-Owner: Acreage:0.35 acres Abutters W+ v boundaries and do not represent accurate relationships to physical features on the map Location:36 SHARON CIRCLE t such as building locations. Buffer j;;'. t� � 9 <. ✓�� a COMMON4, oel a T q vI �` ••`C°-�j� C^..� � "5/ �,9�o ta0 0 ®e tl sN - 'q�l ..r-•. 0 .7 :. I TT' �N X rZ LA d � . M C�NFFR S iL�'S(\ `�� N Szo 74 ao I J- 1 _.,,:�•-, � � ... � it ,M•r.re....... •-.ter-+._. K'...�.n.r.w+..�... aa'..�+.n..n�:.c... _ ._.,...- ......a..n - _1 • y�� Ginn o - � � � � o Fn G'iyFF 1�Sp� �:. y � �,a, _ k . , Cn . t T14 a 21,11 { Town of Barnstable Geographic Information System �6 S N 2 d 0 l v vL M to 0 Z"b�s December 21,2015 is i �t f`t c 1#�46 f "" 122144 122145 #12 #20 t4 4 x - 122148 ,... #35 � FT • � F 5 F«. 122147 �< #28 elk1>22151 #47 y a��^�f•�. �.t i� 122149 #36' 122047 r . #2800 122150 #46 122153 #50 122152 #48 0 20 Feet DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:122 Parcel:149 boundary determination or regulatory interpretation. Enlargements beyond a scale of Selected Parcel Owner:WAS,ANIL&PATRICIA CARROLL Total Assessed Value:$251600 1'=100'may not meet established map accuracy standards. The parcel lines on this map are only graphic representations of Assessor's tax parcels. They are not true property Co-Owner: Acreage:0.35 acres Abutters boundaries and do not represent accurate relationships to physical features on the map Location:36 SHARON CIRCLE such as building locations. Buffer '�•','' COMMOH6y LA a q Q 04 AID _ oof re ra elm 6 9 i dx - �pMM 1p �,� — vLl AOcn y . 9F�1-7 ws tM - , 1 A_i� .'-- o c�NFFR SiL�'S r 4 :�J f y ' r Town of Barnstable Geographic Information System 36 (�A Rukl 0 t V I U" FM'..A,, 0 2"6s-S December 21,2015 ` 122146 ^�. 122144 #21 122145 #12 r » 122146 g'�• �'"��j♦t�! �� tr #35 122147 #28 122151 #47 '. , 122149 ...z .Y`#36 c Wk 122047 #2800 122150 r F s #46 122163 450 122152 #48 0 20 Feet DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:122 Parcel:149 boundary determination or regulatory interpretation. Enlargements beyond a scale of Owner:VYAS,ANIL&PATRICIA CARROLL Total Assessed Value:$251600 Selected Parcel 1'=100'may not meet established map accuracy standards. The parcel lines on this map « :E are only graphic representations of Assessors tax parcels. They are not true property Co-Owner: Acreage:0.35 acres Abutters boundaries and do not represent accurate relationships to physical features on the map i such as building locations. Location:36 SHARON CIRCLE Buffer 0-1 ` P CC NBC G= 6 r � cmi O 31 CM _ N �'y X �6 a� o► Q- n d• 4 c �! s a � c — _ I -'L4jrL- v � N X Jh)' n d 1 oLA a, s ! l q "i 9 o o dx Is 8 r �OI�h4O/V lam y o pos, . zNam." ` c o T .y G'�tiFFR S1 .N _ . .1„►... '. .:. � � ..... - ... - �," III Is la a'=Z • o o ;.:e4, .. , 00J��a- --7T - ' t`� 0 y Q? o GGa S.n T %c co it IL _ O v H a . o `-'� _ . a� Tt, N V CAPE COD VAIN OF BARNSTABLE INSULATION 7 Ai! 8= Lltr cam ®®® Mn 0"SS SSAMU$$ SPSATMAM SYSPSNCSU SA"I oumAS 'NSuunoN CSIIINOS 1-800-696-6611rVIb;}N Town of Barnstable Regulatory Services �� Building Division �S� 200 Main St C., Hyannis, MA 02601 Date: 3_11 _,,?o j 5"- Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute (BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address Village L VYA 5 3G S�-14ko,-r /& Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings (x) Slopes ( ) ( ) ( ) ( ) ( ) Floors ( ) ( ) ( ) ( ) ( ) Walls a °1,�ewe ( ) ( ) ( /y ) ( ) (K ) Sincerely I byE ssi r, President ns ation, Inc. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # Q P 00 q,3 . Health Division Date Issued Q 61 .Conservation Division Application Fee b Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address rD 6V1, _,tU Village �Vu AV Owner k)4� Address Telephone qfo 0 r Permit Request l(Z 11 -V ; r' 0 wif, .,Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation • 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' ghway:`;' Yew❑ No Basement Type: ❑ Full ❑ Crawl ❑ Walkout ❑ Other �v Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft �. Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new rn 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 A'ihorization ❑ Appeal # Recorded ❑ Commercial ❑Yes Q No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number Address License#4--7% 1 L Y Home Improvement Contractor# Email Worker's Compensation # 0 5 2CA(I ALL CONSTRUCTION DEBRIS RESULTI g ROM THIS PRO( CT WILL BE TAKEN TO mvlma httf 1, // i SIGNATURE DATE ( 0� i f FOR OFFICIAL USE ONLY t APPLICATION# fi [-ATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: . I_ FOUNDATION _ r FRAME INSULATION FIREPLACE ` r ELECTRICAL: ROUGH FINAL 1� Y PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO: 1 r w Massachusetts - D6partment.of Public Safety ..:Board of Building Regulations and Standards Consh•uction Supers ixtir License: CS-100988., r HENRY E CASSD)V 8 SHED ROW WEST YARMOiFfH D " '" Expiration Commissioner 11/11/2015 a Office of Consumer Affairs and Bu/siness Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement C6ntr `ctor Registration Registration: 153567 Type: Private Corporation Expiration: 12/15/2016 Tray 259188 CAPE COD INSULATION, INC HENRY CASSIDY 18 REARDON CIRCLE -- SO. YARMOUTH, MA 02664 Update Address and return card, Mark reason for change, sCA 1 {i 20M•05r11 Address Renewal 0 Employment Lost Card -- - — _......._._... _._..... (_J�7/&e tp m w?m,&on,uec,.ZC%_1G CIddac/veraeM C\ Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 1.53567 Type: Office of Consumer Affairs and Business Regulation xpiration: ;.427:15/20:1:6 Private Corporation 10 Park Plaza-Suite 5170 _ Boston,MA 02116 CAPE COD HENRY CASSIDY 18 REARDON CIRCLE'-'. 30.YARMOUTH,MA 02664 Undersecretar y N valid wi ut sign e I 4 The Commonwealth of Massachusetts Department of IndustrialAccidents W Office of Investigations Y a d 1 Congress Street, Suite 100 cy Boston, MA 02114-2017 www,mass.gov/dia Workers' Compensation Insurance Affidavit; Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/Or zation/Individual); GZ Q w Address; 40 V wu V �` City/State/Zip; 1,�,�L ` 0l N 0, Phone #; t�(�l�'•'�� `'�' �i Are you an employer? Check he appropriate box: Type of project (required): i.5;�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. New construction 2,❑ I am a sole proprietor or partner- listed on the attached sheet, 7, [] Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity, employees and have workers' [No workers' comp, insurance comp, insurance,t 9, ❑ Building addition required,] 5. ❑ We are a corporation and its 10.0 Electrical repau-s or additions 3,❑ I am a homeowner doing all work officers have exercised their 1 1.❑ Plumbing repairs or additions myself, [No workers' comp, right of exemption per MGL insurance required.] t c. 152, §1(4), and we have no 12,❑ Roof repairs employees. (No workers' 131[ Other �( comp, insurance required.] // +Any applicant thai checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit thisl'ff ddavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the subcontractors 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, Li44� Expiration Date; 1Job Site Address; v614. City/State/Zip c 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 ui 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 ofthe DIA for insurance''coverage verification. I do hereby certify n r pains and penaltles of perjury that the lnformatlon provided a ova s true arrrl"correct, Si nature: Date; I[ ( L) Phone#: Offlclal use only, Do not write In this area, to be completed by city or town offlclal. 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 c V r ` 1 7 CAPECOD-27 KLIGETT d...� CERTIFICATE OF LIABILITY INSURANCE ffDATEiMMIDD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE H LDER. 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 pollcy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER CONTACT Rogers&Gray Insurance Agency, Inc. NAME: Barbara DeLawrence 434 Rte134 PHONELA FAX South Dennis,MA 02660 E-MAIL a/c No: 877 816.2156 ADDRESS: bdelawrence@rociersgray.com INSURERS AFFORDING COVERAGE INSURED INSURER A:Peerless Insurance COm any INSURERB:COMMERC8 INSURANCE COMPANY Cape Cod Insulation Inc INSURERC:Evanston Insurance COm an S Reardon Circle INSURER D:ATLANTIC CHARTER INSURANCE GROUP South Yarmouth, MA 02664 - -- INSURER E; —"----'--- 00 ERAGES CERTIFICATE NUMBER: REV T IS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NIAMOED ABOVE FOR THE POLICY PERIOD IN ICATED. 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. .ITR ;;7! SURANCE n POLICY NUMBER POLIC EFF POLICY EXP a X COMNERAL LIABILITY MM/DD/YYYY MMIDD/YYYY LIMITS i E OCCUR CBP8263063 EACH OCCURRENCE $ 1.000,000 04l01/2014 04/01/2015PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 5,000 GENT AGIT APPLIES PER: PERSONAL&ADV INJURY $ 1_000,000X POLIC • GENERAL AGGREGATE $ 2,000,000 T LOC OTHE PRODUCTS-COMP/OP AGG $ 2,000,000 AUTOMOB $ -- I COMBINED SINGLE LIMIT ANY AUTO 14MMBCKVMK (Eaaccidenl _ 1,000,000 ALL OWNED X SCHEDULED 04/01/2014 04/O1/2015 a0DILY INJURY(Per person) $ $ AUTOS AUTOS X HIRED AUTOS X NON-OWNEO BODILY INJURY(Per accident) $ AUTOS PROPERTY DAMAGE ----"—' Per accident $ X UMBRELLALIA9• X OCCUR $ EXCESS LIAB CLAIMS•MAOE i XONJ453514 ' EACH OCCURRENCE $ 1,000,000 04l01/2014 04/01/2015 AGGREGATE DEO X RETENTION 10,000 $ ORKERSCOMPENSATION Aggregate $ 1,000,000 •ND EMPLOYERS'LIABILITY PER 'R NY PROPRIE70R/PARTNER/EXECUTIVE Y/N WCA00525904 STATUTE OT FFICatoMEMBER EXCLUDED? ❑ N/A 06/30/2014 06/30/2015 E.L.EACH ACCIDENT MandatorylnNH) $ 1,000,000 f yes,describe OF O E.L.DISEASE-EA EMPLOYEE $ 11000,000 Eer SCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT $ 11000,000 SCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) rrkers Compensation Includes Officers or Proprietors. dltional Insured status Is provided under the General Liability and Auto Liability when required by written contract or agreement with the Cortlficato Holder. I _R IFICATE HOLDER CANCFI I CTInN -- �bRp mala mass save CONTRACTOR wow•Wdw► PERMIT AUTHORIZATION FORM I, PATRICIA WAS ,owner of the property located at: (owner's Name,printed) 36 Sharon Cir OSTERVILLE (Property Street Address) (city) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. X 1A GW4 V Owner's Signature I L30 Date FOR CSG OFFICE USE ONLY Conservation Services Group has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: ►�oD C 6A-27011 Participating Contractor Date 01 �'• For Office Use Only Rev.12132011 SIQGLLE PAM U4 - 3'�3t�2vc>M V 1,10 GA2'BAGt: �RI�JC�SL �.•j 2aat U-e $rLovv _ I tq We S t 33o Se:F-rlG TA>,t1C = 33o.r ISO % • 4-95 6.PD. USte- I.000 6Q.t_. 2?ISP0S4L PIT - USE (000 Gam. V / SCGa`-WQ.1� AeEA = Cc /T-Z.S + 37S G.P.D. So TOTAL 'C>ESl6Kl = 42S G.P.D. ti + TO oT0 t_ 'DA"L-( s c T Flow 330 6.PD. 1/71 Mizcc>L&T%o&.) zwre : Ctw 2"m w 02 Lrr- s.' /'7- �••'' Pao b� N �� 0 f:• � PAP - t}�k:� ►° ,/� "`4:,. Nr o�%�cP �'r N -- chi p,ARD �..;; y i .. PAXTE4a 4g rG Tor F'wo a:47 . E�- �- LoAnt �' "8ox • 41•G SEvnc l o 1 Vz- INV. To�tK Oop 4t Iwo tW. .', GAL. LH A PIT •.; i / Vj; a ; /a/d"l��z • 7A� WAS,+.IEfl i . 1 STOw1i= 'js I. t < CE1ZTlt✓IED PLbT PL. y ij 31 toc/�T'{oty MALs7oo , AA I c.c.s r � ►J o sc Q..ti..�- dag=n IZ�d I8o i 1 G61ZTIFl-{ TkAT TI'-1r-- Pl -AQ RGFEREt11cC i-•�E:Q t�b�J GOrN1PL�lS W 1 T1-� Tl-1� 51 D E..LI fir Lcrr t9 Aua SE7M3AI:IG Vr-4Ul2EAA&- ITS OF TNT. t 'ro w►.1 0 Aft 1��1'A IS PL . -f��1L 3-z PG . E DATE � � �G � • REGIS t-c-tZ�D "Wo 5uzva%(0 z,; � TI-11.5 FLAW 1'S UOT SA->GV Vi,-4 /'.64 OSTE2V1l_LG o MASS. If4,9r(Z JAnEt TNL-- ' UFc:,[=C'�, <i11GwlD U�"CO APPI.I GAt- l T flIbr ec-. o �r ra nr. 'rc�Mtw� t_a-c' LINES " C,?IFoe, �v+�T"_• co • �` .09 TOWN OF BARNSTABLE Permit No. "" � • Building Inspector Cash __-- 'eo !e 9.. 00CUPANCY PERMIT Bond _ XX ' No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Spiros Balodiiaas q Address hyannis Lot i;49 35 Sharon Circle Ostarvill�i Wiring Inspector f s� lit �m.- Inspection date Plumbing Inspector �/ Inspection date Gas Inspector Inspection date k`Engineering Department Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. ZZ 19 ......�..... µ. .. .�, ........ .....�: . Building'Inspector .5sor's map and lot number .. �........................... . ypi THE Sewa a Permit number f�.. ...->�,3............................ INST 77C SYSTEM 6 g � .ALLEOIN MUST / C�MPL�,gA� •_ BAHBSTABLE. i j House number ............ 1N Is s EISETr,�L CODE YF TOWN OF BARN,!;1Aff E10NS ' y BUILDING INSPECTOR APPLICATION FOR PERMIT TO ..........�4 IP.G.7...................................................................................... TYPE OF CONSTRUCTION .......... ....�0©QJ..f 2E}1yd .................................................................: ................................................19........ TO THE INSPECTOR OF BUILDING. -• >. - - The undersigned hereby applies, for a permit according to the following information: Location ........J,0.1'.........` -5......511,42..,9,&.....cltz Glr- .........oszefwulc......k4os................................................. ProposedUse ........,/A.M.'z.................................................................................................................................................... Zoning District ...............Fire District Name of Owner. ZY. 11PO. .-A140,01MA,6...........................Address a$-.6#&A k0#V../Iyf!t? Ah?,1',S:................. Nameof Builder .............5/9MC...........................................Address .................................................................................... Nameof Architect ..................................................................Address ....................................:......`.:::.:.:....:..:..........:.............. Number of Rooms ........:Kv............................... .....Foundation ....................... Exterior ....af..AR.R.. S r:..................... .... �i'........ .............Roofing .��f� G.d.S�/.��.�..:........................................ Floors ... .............................. Interior 'I C.. r - , Heating .... ......... .,.. `,4..........r...........:.........:........:..Plumbing �f .'1 ,q�, .n.. ::.......'...... ................,f-.°....... Fireplace .................................................................................Approximate Cost ........3 aq.q........................................... Definitive Plan Approved by Planning.Board ------ �_ -_____-_ ,��,�G•••. 19 Area ..................... �y ov Diagram of Lot and Building with Dimensions Fee. ...................... ...................... SUBJECT TO APPROVAL OF BOARD OF HEALTH 9D I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Nam/.........Q1�i14�1..\........... .`1. i ......... F..2.2.7.4.5.. AS, SPIROS Permit for ...Qae...Stcary.......... ......Sin. le. cftmmil• . Dwel.l.in Location .Lot...#•4.9:...3b••.Sharon•••Circ•I.e Osterville ............................................................................... Owner Spiros Balodimas . i .................................................................. Frame Y, Type of Construction .......................................... ` ........ ................................................................... JlPlot ...•........................ Lot ................................ nt1{- S> � y • r Permit Granted .....D.eaember..s9;;.... s19 8 0 r Date of Inspection ....................19 Date Completed ...... .......... .:19 r PERMIT REFUSED ......................................... 19 . ...................................................... s ....... ..-. • • ..••.••••..••••.••••••............................... •••••.• V•,'r •...............•...........••.............................• 1� .............v .............................................................. .. Approved ................................................ 19 �� sl✓ Assessor's map and lot number .,n... ............................... . . IN U, Sewage Permit number .7............................ ABLE, House number ..............................SaG................................ MASI,1639. a MPS a TOWN. OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .......... ..................................................................................... TYPE OF CONSTRUCTION .......... WOQ&amm.l...................................................................... ................................................19........ TO THE INSPECTOR OF-BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .........4.10.7..........Y.5......54.W.12W..... ..........0-5744?WW6...... ................................................. ProposedUse .........�Q.M. C..................................................................................................................................................... Zoning District ........................................................................Fire Districtce&!ApWah.6... ......................... Name of Owner ...........................Address Ir5ce(&IIIAINO.Axe? ................. Nameof Builder ............S1912,t...........................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ..........(......................................................Foundation ......................................................... Exterior ....Cxt.1.1.4.1?..Syl!IV,6.4.t...............................................Roofing ax........................................... Floors ...AQ4.4A.77,).WA4.4... (......................:..........Interior ..... .................................................... Heating .... ..............0/4............................................Plumbing ..... .............................................. Fireplace .............. ....................................................................Approximate Cost ........ .......................................... Definitive Plan Approved by Planning Board -—-----------19 2 Area ...../0K........................... ..... .... 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 the above construction. Name......... &............. . `..'............ BALODIMAS, SPIR. OS �� A=122-149 No .22.7.4.5... 40ermit for .Qne...St0X.y............ 5.ixlgLe...Za' mity..DWelling................. Location ...Lctt..#.4.9...3.6...Shaxan,..Cixal.e ...............O.s terms il le...................................... Owner .....Spiras...8al.odimas................... Type of Construction Frame ....... .1.............................. M Plot ............................ L%ot ................................ Permit Granted .....`ece- ..�........19 80 �. f Date of Inspection .............. ..........k...........19 Date Completed ...................:... ..............19 t PERMIT REFUSED .............................. 19 ............. J.. .I. . ........... ................ .. .. �,. ......... ... ............. 6 l ............................................................................... Approved ................................................ 19 ............................................................................. ............................................................................... Map Parcel Permit# 33733 House# �� Date Issued Board of Health(3rd floor)(8:15 -9:30/1:00-44W s^`j,K�� Fee 0( Conservation Office(4th floor)(8:30-9:30/1:00-2:00) 1 r Planning Dept.(1st floor/School Admin. Bldg.) SEPTIC SYSTE BE Definitive Plan Approved by Planning Board 19 INSTALLED ALLED I �CE Wi T aLE 1 N® f= 1fi�?OSt"MEN t6 9. QED MPy s �, TOWN OF BARNSTARE Building Permii Application Project Street Address ,5 `p SA a f.J- p h (f") C /R Village © S—I-P), V 1,/I� Owner /�G A S S e�b u�-. Address Telephone ,� 3 / Permit Request p �� old L- Z�:, RP cc �`l d First Floor square feet Second Floor square feet Construction Type LL` ,(`� G k// d ' Estimated Project Cost $ l (O to 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 I No On Old King's Highway ❑Yes ko 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) /,(P o o Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information p /_ Name P da / Telephone Number '-- 0 7 l to Address & a License# 1 R V 2 } CCO/I k- C/i%l(yp / .,/� Home Improvement Contractor# O D / D ' 3 Worker's Compensation# _3 9.2 I 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 BETAKEN TO A kA3-704e lzat'(4 SIGNATURE C>L� DATE �„ G I BUILDING PB&ITDENIE FORT FOLLOWING REASON(S) FOR OFFICIAL USE ONLY - PERMIT NO. � DATE ISSUED - MAP/PARCEL NO: ADDRESS VILLAGE t - r OWNER t DATE OF INSPECTION: - FOUNDATION ' FRAME INSULATION' FIREPLACE - i • ` } _ ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL• - a FINAL BUILDING' ' DATE CLOSED OUT: ASSOCIATION PLAN NO. 1 f . The Town of Barnstable "'M $ Department of Health Safety and Environmental Services .`° Building Division 367 Main Street;Hyannis MA 02601 Ralph Crossen Office: 509-790-6227 ; Building Commission.- Fax: 309-790-6230 For otrce use only I Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW i SUPPLEMENT TO PERMIT APPLICATION MGL c 142A requires that the "reconstruction, alterations, renovation, repair, moderni2=don. conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least ..one but not more than tour dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work: ' w �.� C k Est.cost 31 l a t- -o1-, �f � l� Address of Work: Owner's Name Date of Permit Application: �C— I hereby certify that: Registration is not required for the following renson(s): Work excluded by law Job under SI,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS .PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a.p:Zacou e owner. G Gwa-, / o D o Date or Name Registration No. I OR Date Owners Name -.- _ The Commonwealth of Massachusetts Department of Industridl Accidents 600 Washington Street ry �:. Boston,Mass. 02111 Workers' Com tion Insurance Affidavit name: location: city phone# ❑ I am a homeowner performing all work myself. ❑ lamas ole ro rietor and have no one working in any capacity ///%%////%%%%%/%%%%%////%//%/%///////%%%%%%%/%%/%%%%%%%%%%/%/%/D%//%%%%%////////%%%%%/%%%//%/%%%%%%%///%%%%%%%%/%/%/%/%%%%/O%%%%%////%///////// QQ I am an emplover providing workers' compensation for my employees working on this job. com anv name: d P Sla/i( a address- phone insurance co. k )- tic 4 l� to C `� ti olicv# Z S U 3 A, ❑ I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: company name: address: .::..:.:. ..........:.:.:.. . .... �.:: ;. .. . . . ..:.: phone :: ::::::::;:.:r;:;::;.::.;;.:,. ..... .,.: . insurance co. cam anv name: address: :: phone#: •;.:.:.:.;::::::;;:>;::<:;::;>.,.. city' :. in�nrance co:. Failure to secure coverage as required under Section 25A of NIGL 152 can lead to the Imposition of criminal penalties of a tine up to 51.500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and aline of 5100.00 a day against me. I understand that a copy of this staterhent-may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify un he pains and pen es o erjury that the information provided above is truo and correct Signature �e.L Date Print name tz P 4�-- I`G1 Phone# /4 ofticial use only do not write in this area to be completed by city or town official i city or town: perrrdt/license# ❑Building Department ❑Licensing Board ❑checks bTanedlate response is required ❑Selectmen's Otiice ❑Health Department contact person: phone#; C]Other (revised 9/95 PIA) 0 Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under anv contrac 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; 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 o: building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renew of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who ha not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the "law"or if you " are required to obtain a workers' compensation policy, please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the peirn t license number which will be used as a reference number. The affidavits may be returned fe the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number: �� < The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston; Ma. 02111 fax#: (617) 727-7749 . phone #: (617) 727-4900 ext. 406, 409 or 375 y ��• / o � •�d �'U`i'...�3�� •vim • • � ,'. �Dd.ad. 1 1 ., •tom � � f�� ■■■■■■■■■■■■■■■■■■EE■■■■■■■■■E■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ I■■ P..■■■■■ ■■■■■■■■■■■■■■■■■■■■� N__ o�r�. ■■ ■■■■■■■■■■■■■■■■■■■■■■t.�imo■■!■■!■■ ■■E■E■N■■■■■■■■■■■■ ►., . . Ili■■■■■■■■E!■ ■EE ! m■■ ■■I l ■■■■■■■ a ■E■■■■■■■■N!I_■■■■■■ ■■Ill ■■■■■■M!■ ■■ ■■■ IIE■■■■■■■NIIII■■■■■■ MIEN■■ lm■■■■■■■ ■■ pll■■■■■■■ I■■■■ ■■■■ ■■EMI■■■■■ ■■ ril■■■■■■■■■ ■ENE■ WE l ■■■■■■■■ ■■Illl■■■■■■■!�N■ ■■■■O!!■U■ *I ■■■■OMEN ■■Ill M■■■■■■Cy7■ ■■■■■ `■O■il■■■■■■■■■■■■Iill■■■■■■■■I■■ ■■■■crI■■■■l■■■■■■■■■■■■1!1I■■■■■■■■I■■ ■■■■■tR■�\■■1■■■■■■■■■1�� liii�■�RI■■ ■■■■■MPA.MMOMMEMMMMIMMMmillimmmmoommim■ ■!■■■■r■■■© ■■■■■■■M,,.. �m=mm_!li■ ■ ■■ ■■ ■NM■■1! OMEN ■N■■11 IE■■■■■■■I!■ ■■■■■■■H■■10—MMMM■II!■ t■i■■■t■i�■■ ■■■■■■■O■E1i�■■■■II■■■■■!■■■■■■■■■■ IMIMMMMMMIQ. mOtrl■■N■■■■i!■■■■E■■■■■■■■■■ ■■■■■■■Ir■■1! ■■■■■1■■■■■■■■■■■■■ ■■ ■ ■■■■■■■■■■1I ■■■■!Il■■■■MEC- i.".■ ■CT:■■■■ NOON • ,:� ' Mmommm umm MMMISMISES InMMISM 11 ■■■WAMS■l.11■ A ■■■I _ffiiEO■■■■Zm mlm■■■ INE Elm!NOON ■0ammm■mu l ■EMI ■�NINEONES ■ . ■ENE■■EMI► r �� E■■■} ■ ■EN ■EN■ ■EN■E■■■■■■■■MIN■ S■■■ ' _ _!!1■ MEN■ ■E■■■■■■■■E■■O■■■■■■■■■■■■i■EON■■ ■ ■■■■■■■■■■■■■■■■■■■■■,_ ■ENE MEN ■. ■■■O■■■■■■EEO■■■■■■■ NOON ONE ■■ ■■■■■■■■■■■■■■■■■■■■� ■■■■ . NOON IN ■E■E■E■E■■■E■E■■■■E OMEN ; NOON NOON■ lmmmommmmmmmmmmmmmmmmmmmmmmmmmmm imimmmmmmmmmmmmmmmmmmmmmmmmmmmmm immmmmmmmmmmmmmmmmmmmmmmmmmmmmmm immmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmimm IMMMMMMMMMMMMEMMMMMMMmmmmmmmmmmmmm immmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm immmmmmmmmmommmmmommmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmm �mmmmmmm mmmmmmmmmmmmmmmmmmimm immmmmmmmmmmmmmmmmmm r mill,m Emmmmmmmmmummmmmmmmill mm mi mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmommmmmmmmmm MMMMMMMMEMEMMMMMMMMMMmmmmmmmmmmmm mmmmmmmmummmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmummmmmmmmmmmmmmmmmmmmmommmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmummmmmmmmmmmmmmmmmmmmmmmI MMMMMMMMMEMMMMMMMMMEMmmmmmmmmmmmmI iii��i�iiiiiiiiiiiiiiiiiiiiiiii�ii eiimi�ii�ii�iii■iiiiii�iiiiiiiiiiii SEEN MOEN ■■ir ■ -- . ■■■■■■■■■■■■ICI■■■■■■■� ■ ■ ■■lml■■■■■■■ ■■■ ■■■■■I®m■■■■■■ ■�■■■ie■■■■■■I�l■■■■■■■ ■■■i■■■■■■■■1!11■■■■NEE ■ ■■■■■ • ■■ ■■■INl■0■■■■■ �■■1■ ■■■■■ill■■■■■■■ ■■■i 11 ■■■ I ®■ i■ I • _�'�■■i■G'�■■■QI ■�� ■�� r.