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0039 TOWER HILL ROAD (32)
tCn ; 4;- } '� F' ZZ., <� .� _� y _� .. -� ,i - .. - - � V i. ,.. _. Q ' .� .j`Ir [;,� .. �� Q ,� - �. -� j .n .. F.� � � - I.� .. - i '� , �"a Town of Barnstable Building _ Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept ',� Posted Until Final Inspection Has Been Made. Permit �t Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-19-464 Applicant Name: JAMES S PEACOCK Approvals Date Issued: 02/22/2019 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 08/22/2019 Foundation: Commercial Map/Lot`117-072-00B _ Zoning District: SPLIT Sheathing: Location: 39 UNIT 1B TOWER HILL ROAD,OSTERVILLE _ _u Contractor Name:"tiJAMES S PEACOCK Framing: 1 Owner on Record: FISHER, M LYNN TR f I Contractor License: CS-094500 2 Address: 2760 S OCEAN BLVD,APT 510 Est. Project Cost: $ 22,000.00 Chimney: PALM BEACH , FL 33480 } Permit Fee: $300.20 Description: refit bathrooms-new tub shower and vanities i Insulation: Fee Paid:f $300.20 l Project Review Req: NO STRUCTURAL WORK. ;� _ Date: 2/22/2019 Final: Plumbing/Gas ` Rough Plumbing: \Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months afte`r.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 - --f 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 ri - �, _ Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) l 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). Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: r Town of Barnstable Regulatory Services IIAPJMasiE Richard V.Scali,Director Fo rrw+' Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I t ynn Eisner ,as Owner of the subject property hereby authorize i Scott Peacock to act on my behalf, in all matters relative to work authorized by this building permit application for: 39 Tower Hill Road, Unit 1 B Osterville,MA 02655 (Address of Job) **Pool fences and alarms are the responsibility arr onsibili of the hcant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Sign e of Owner afore of Applicant /IZ1 A) '�Xpte-- S Ic— Print Wame Print Name i 3o v Date i The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Orgmizadowbdividual):-'�'"'Ff-PC(IXWCIIL &At af/i 1RC-M61d Address: Q. CD, 20K 12I - )C)4G- AWI n s , Syk- City/State/Zip:( -ef Vi I IP MA OQ(PS Phone#: SCf�-IJDL8- ty jo Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 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.: - 9. El Building addition ur required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner do' all work officers have exercised their 11. Plumb' re mg ❑ mg pairs or additions m sel£ o workers'co right of exemption per MGL Y (N comp. 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. tContrwwrs that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 1 am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information.Insurance Company Name: U=re m l f e, Skf _PS LA ra rl u: 0-e�. Policy#or Self-ins.Lic.#:KJ i� �-���3- �1-��'�c�� Expiration Date: , Job Site Address: 3a 16 kxc 4)tl RA, U-n if ( 0) City/State/Zip:yJ�'�rV� Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby c fy the p ' penalties of perjury that the information provided above is true and correct Si aturre: Date: �—/a — Phone# 0 > j 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 Commonwealth of Massachusetts Division of Professional Licensure ' Board of Building Regulations and Standards Co ns tructiori-Supervisor CS-094500 E,pires_07/22/2020 JAMES S PEACOCK 1046 MAIN St-UNIT 7 P_O.BOX 171 OSTERVILLE MA-026S5 Commissioner CI Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE::Corporation Registration .. Expiration 15195 ...`>-=07/0612020 SCOTT PEACOCK.BUILDING&REMODELING INC JAMES S.PEACOCK 1046 MAIN STREET SUITE 7 OSTERVILLE.MA 02655 Undersecretary DATE(MM/DDNYYY) ACC L> CERTIFICATE OF LIABILITY INSURANCE 07/19/2018 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: Germani Insurance Agency PHONE 508 428-9194 n c No): 508 428-3068 E-MAIL 908 Main Street ADDRESS: certs@germaniinsurance.com INSURERS AFFORDING COVERAGE NAIC# Osterville MA 02655 INSURER A: SAFETY INS CO INSURED INSURER B: Granite State-AIU Holdings Scott Peacock Building&Remodeling,Inc. INSURER C: P.O.BOX 171 INSURERD: INSURER E: Osterville MA 02655 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. ILTR NSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MMIDD EFF POLICY EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ❑X OCCUR DAMAGE TO RENT D PREMISES Ea occurrence) $ MED EXP(Any oneperson) $ A BMA0022118 07/05/2018 07/05/2019 PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑PR0- F1 LOC PRODUCTS-COMP/OP AGG $ JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 4 EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 B OFFICER/MEMBER EXCLUDE D? ❑ N/A W0005-81-5464 06/22/2018 06/22/2019 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Scott Peacock Building&Remodeling,Inc. ACCORDANCE WITH THE POLICY PROVISIONS. P.O.BOX 171 AUTHORIZED REPRESENTATIVE Osterville MA 02655 Fax:508-428-7625 Email:scott_peacock@verizon.net ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD - z TOWN OF BARNSTABLE • PERMIT CHECKLIST Sign off hours for Health and Conservation are 8-9:30 a.m. and 3:304:30 p.m. A complete permit application includes filling all sections 1-13 1. NEW STRUCTURES/REMODELING/RENOVATION/ADDITIONS ❑ Site Plan showing setbacks of proposed and existing structures [:] Comm ial—One complete set of full sized plans one reduced 11"x17"(plans may require a stamp by an architect or engineer). ❑ Residential - 5 Sets of floor plans no larger than 11"x 17" smoke/co detectors marked ❑ Worker's Comp. Affidavit and policy(if required) ❑ Res Check or COM check from the 2015 International Energy Cod Council (IECC) ❑Letter of financial Interest for new houses only(not required for rebuild after teardown) ❑ Performance bond made out for$4.00/foot of road frontage(new construction only) 2. DEMOLTION OF A BUILDING (NOT PARITIAL) ❑ Everything above plus shut off letters from following utility companies: ❑ Gas ❑ Electrical ❑ Water ❑ Sewer(if required) 3.-DECKS/PORCHES/GAZEEBOS/INSULATION/SOLAR/POOLS/SHEDS ❑ Site Plan showing proposed location ❑ Construction plans showing framing detail (if new framing), ❑ Pools—Barrier details,pool specs(engineers design) ❑ Workman's Comp Affidavit and policy (if required) FAMILY APARTMENTS ❑ Section 1 Plus: ❑ Family Apartments are subject to approval from the Building Commissioner. Agreement must be signed, notarized and recorded at the Registry of Deeds and returned to the Building Department. t Select Language( ♦j Assessing Division Property Lookup Results - 2018 367 Main Street,Hyannis,MA.02601 <<BACK TO SEARCH<< Q-Print Owner Information-Map/Block/Lot: 117/072/00B-Use Code: 1020 Owner Owner Name as of FISHER,M LYNN TR Map/Block/Lot GIS MAPS 1/1/17 2760 S OCEAN BLVD,APT 117/072/006 510 Property Address 39 TOWER HILL ROAD UNIT 1B PALM BEACH , FL.33480 Co-Owner Name M LYNN FISHER LIVING Village:Osterville TRUST Town Sewer At Address:No GIS Zoning Value:SPLIT BA;UB Assessed Values 2018-Map/Block/Lot: 117/07210013-Use Code: 1020 2018 Appraised Value 2018 Assessed ValuePast Comparisons Building $218,400 $218,400 Year Assessed Value Value: Extra $6,100 $6,100 2017-$256,900 Features: 2016-$256,900 2015-$262,200 2014-$262,400 2013-$288,200 Outbuildings:$10,100 $10,100 2012-$226,500 2011 -$231,000 Land Value: $0 $0 2010-$248,600 2009-$384,300 2018 Totals $234,600 $234,600 2008-$384,300 2007-$384,300 Tax Information 2018-Map/Block/Lot: 117/072/OOB-Use Code: 1020 Taxes iC.O.M.M.FD Tax(Commercial) $0 C.O.M.M.FD Tax(Residential) $377.71 Fiscal Year 2018 TAX RATES HERE Community Preservation Act Tax $67.64 I Town Tax(Commercial) $0 Town Tax(Residential) $2,254.51 f i $2,699.86 Sales History-Map/Block/Lot: 117/072/OOB-Use Code: 1020 History: Owner: Sale Date Book/Page: Sale Price: FISHER,M LYNN TR 2011-08-08 25608/204 $315000 LEBLANC,GORDON J&JANICE L2003-03-14 16571/179 $350000 LARSEN,NANCY SMITH TR 1994-06-15 9233/163 $1 LARSEN,NANCY SMITH TR 1994-05-15 9194/80 $1 SMITH,EDITH T 1973-12-17 1979/208 $0 Photos 117/072/OOB-Use Code: 1020 Sketches-Map/Block/Lot: 117 1 072/008-Use Code:1020 F_ -29 12 PRG PTO 1 1 BAS MT STORAGE NDER ADJACENTI NITS 15 AsBuilt Card N/A Constructions Details-Map/Block/Lot: 117/072/00B-.Use Code: 1020 Building Details Land Building value $218,400 Bedrooms 2 Bedrooms USE CODE 1020 Replacement Cost $276,507 Bathrooms 2 Full-0 Half Lot Size(Acres) 0 Model Res Condo Total Rooms 5 Rooms Appraised Value$0 Style Condominium Heat Fuel Electric Assessed Value $0 Grade Average Plus Heat Type Elec Baseboard Year Built 1972 AC Type None 1 � Effective depreciation 21 Interior Floors Carpet Stories 1 Story Interior Walls Drywall Living Area sq/ft 1,189 Exterior Walls Wood Shingle Gross Area sq/ft 1,642 Roof Structure Gable/Hip Roof Cover Asph/F GIs/Cmp Outbuildings&Extra Features-Map/Block/Lot: 117/072/00B-Use Code:1020 s Code Description Units/SQ ft Appraised Value Assessed Value FGR3 Garage-Good-Wd 240 $7,400 $7,400 Shingle PRG1 Pergola-Avg 144 $ 1,400 $1,400 BMT Basement- 165 $6,100 $6,100 Unfinished PAT2 Patio-Good 144 $1,300 $1,300 Sketch Legend Property Sketch Legend B2N Bam-any 2nd story area FPC Open Porch Concrete Floor REF Reference Only BAS First Floor,Living Area FTS Third Story Living Area(Finished) SOL Solarium BMT Basement Area FUS Second Story Living Area SPE Pool Enclosure (Unfinished) (Finished) BRN Barn GAR Garage TQS Three Quarters Story(Finished) CAN Canopy GAZ Gazebo UAT Attic Area(Unfinished) CLP Loading Platform GRN Greenhouse UHS Half Story(Unfinished) FAT Attic Area(Finished) GXT Garage Extension Front UST Utility Area(Unfinished) FCP Carport KEN Kennel UTQ Three Quarters Story (Unfinished) FEP Enclosed Porch MZ1 Mezzanine,Unfinished UUA Unfinished Utility Attic FHS Half Story(Finished) PRG Pergola UUS Full Upper 2nd Story (Unfinished) FOP Open or Screened in Porch PRT Portico WDK Wood Deck PTO Patio #��Print ,Contact Director Edward F.O'Neil, MAA i s P 508-862-4022 F 508-862-4722 367 Main Street f Hyannis,MA.02601 'Public Records Ann Quirk Public Records Request 0 s r ~O Application Number..........cU. :". .................... _ : BUILDING DEPT. BARNST MASEL `� 11 Permit Fee..........v.66..Q V..Other Fee........................ 5 • FEB 13 70 �:, �.� Total Fee Paid............................................................... ...... TOWN OF BARNSTABLE Permit Approval by... .................on.. z �9...... BUILDING PERNUT ..�...................Parcel..... .?. ..0 d.,c�........ APPLICATION Section 1 — Owner's Information and Project Location Project Address ',qq 1()o f t1 I I M . Lt0 l f I B Village Owners Name 4 (�k6r Owners Legal Address a (�f� S , Ctan 2) Api City Pa I >n 6en-c state 1= Ly zip 3 3 q 20 Owners Cell# 57 t A',)4'a WQ-)- E-mail '►'n\T S\ d , C.C> Vyi- Section 2 —Use of Structure Use Group ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet ❑ Single/Two Family Dwelling Section 3 — Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment ❑ Sprinkler System ❑ Addition ❑ Retaining wall ❑ . Solar ❑ Renovation ❑ Pool ❑ Insulation Other—Specify, ® Section 4 - Work Description 1 Last updated. 11/152018 '� Application Number.................................................... Section 5—Detail Cost of Proposed Construction 0---- Square Footage of Project Age of Structure Dig Safe Number # Of Bedrooms Existing Total#Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics Wiring ❑ Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom I Water Supply ❑ Publics ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: Va f MQV4-Vv Ltf n I ( I am using a crane ❑ Yes ❑ No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section;8—Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage # of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last updated. 11/15/2018 Application Number........................................... Section 9- Construction Supervisor Name . SC Q- Pe,a 0-0 C/�— Telephone Number 5M' Address R o, 20�- m l City N► l-e, State MA— Zip Od&ss- License Number CP) f�O License Type LA Expiration Date Contractors Email 3 CD +,PC C C UC-ke;Ve1"17 , Y1CCell # '3& - 3 I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Mass husetts State Buildm Code. I understand the construction inspection procedures,specific inspections and documentation quired 780 C d the Town of Barnstable.Attach a copy of your license. Signature Date c� �a- Section 10—Home Improvement Contractor Name_ 3a nit As A-b%&- Telephone Number Address City State Zip Registration Number 15 I c6 S-3 Expiration Date 7 I Stow I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C... Signature Date '1 Section 11 —Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work N er I understand my responsibilities under the rules and regu5lns for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. jyndeift—nd the construction inspection procedures,specific inspections and documentation required by 780 CMR and die-Town of Barnstable. Signature Date APPLICANT SIGNATURE Signature Date2- Print Name- S U L°(J( 'L Telephone Number 5 E-mail permit to: V(tr o , Last updated: 11/152018 Section 12 —Department Sign-Offs >� Health Department ❑ Zoning Board(if required) ❑ - Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation ❑ For commercial work,please take your plans directly to the fire department for approval, Section 13 — Owner's Authorization 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 j ob) Signature of Owner date Print Name 4� Last updated: 11/1kM oF� Town of Barnstable *Permit E ires 6 months from issue date Regulatory Services ee L wwsrABM NAss. Richard V.Scali,Director 039• Building Division)j'' SFP r� Paul Roma,Building Commis�ipp//v 200 Main Street,Hyannis,MA 02601'/I/ www.town.barnstable.ma.us /� Office: 508-862-4038 �I� -790-6230 MI EXPRESS PERT APPLICATION - RESIDENTIAL ONLY' Map/parcel Number � of Valid without Red X-Press Imprint I �� � '2I Property Address. 61,�PCT 411 Residential Value of Work :3 q Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address J-uhA ICU_%ee r(4 f( ya ,bIt.v t t\,O- Ulnt T I `5' . Dc.�ct�n�lyr� � ,� S►O��t c���-t,:�-¢��, `'�1 33� Contractor's Name U.�tl NUVIQZ Telephone Number A3-(j Home Improvement Contractor License#(if applicable) r Z // cj 3 Email: V4AC0 `Q_Q al1N UO 1� CGWJ Construction Supervisor's License#(if applicable) ta�© ❑Workman's Compensation Insurance Check one: &I—am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name q1J6 73�A_-_. C.® Ll!c l 1 Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side gr Replacement Windows/doors/sliders.U-Value IMEV Ot,Amaximum.32)#of windows #of doors: 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. , ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: C:\Users\decollik\AppData\Local\Microsoft\Windows\INetCache\Content.Outlook\L7U69LF2\EXPRESS(2).doc 01/25/17 usrtsrABIA ���,.� Town of Barnstable Regulatory Services Richard V.Scali,Director Building Division Paul Roma Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us j Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, ��VIVt tl 64` r— ,as Owner of the subject property hereby authorize V A-ZCo to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\Microsoft\Windows\INetCache\Content.Outlook\L7U69LF2\EXPRESS(2).doc 01/25/17 i i , r PROPOSAL c diN MA L.ic. =069680 D P,taytaif ( i Swslh l3eni�� ."AA� i-EY-0 GeseGldhirtdav:.eom H•f-C, =124793 (508) 398-1511 • Dennis. l'AA (866) 398.1511 Toll l r" i%D: Mt. 1.,1,-nn. Fisher- 3J8-246-28a7 ` 331 °_'Gtwer ail l Rd. _t-,r: ,A a.rt-.rc I l.`-i- 1 R .r-a1_� ;mderuon Mazrow l,i7G' 'Conversion, �`;_fc vil t. re c•quare �nndam_r_i'?�. r-de_®Pst Awning im-i_ou L'e:frrrille �s A?,668 J':e`L.MkR It r:;E. - + 2P,02 . ic::cove five _mIr of Atdez'..vTF "n3r?'rw�.i1C ° double h,ngy t Ln olei eae` I i,nd replace --,i-,h five P+L,'0rz,e-,-- GCn 6::—a,on }:_t5 _n *;ime lo:.aLior:x, Locaticas yrc, three in. !-.ring zLxrlt, one in c l;rs- bedzeom aynd one in m.,y,tc_ bed-room * Ncu, Andersen 1vi,rrtiRri:?IIe Ccnve SiOn k i r' ; -i �,g;r���� � •;__ a'i 1.♦:':_e eXte3:�nr N1th a 4Pi:1i.iG f:=1 .r-•c_ __ ''.i)twasjl an:3.7 t Sll_•?`� s - t._ th_ :_,Cite paUefn- atz the f3 l+..tt;ae a gars with tiy-� �- .g ,eimdcws•, ( 8'8 in. Cleauble mg t:r_rr a:wu j , =Lnd r1`-.^Gt1 .i.7.5lilclied g.!a o' :alf 3_Yerri:, T„=£' 'at• avellc.:3Le f'Ji `-'.iv 19 2 wlrtHaw, Convert;_G-t kits-do 4= exmitriC_ tri Gp-i iod or pa-nt'rig, i:f7 e,8etit any _:r_:; it._a'1'�' • Re=" ,C cms older r`.rdereen a-.,n.j i i ,I.7 M;_II=05:r rC_ g-uee !�r. :rCC,7i f:L� �.,Isfvil one new -Nndersen 400 zer4ft* al-Ming Wir•;:a*,; in same location- Nt-v' ._..%in'3 t:'inno h*i__ havr_ _he spec_fir. ctz ions as the •_0:1•.._.,.•iLyII en- -he ril:m* ail= be twttt.!wce= :lie .. - L r .i; -with a :ix 1 tiht _at�r_4n 1=ke - Supply any :late=1als, ( ocul:._ur , -.rim for awn:i.L- w_'_'ck Cn; c 1 t i= ,o;. _• re:v: GP_3EC r , r. �J rc'.-+ple_e 'i- Tai r_. .,,_d o =he tc:mn lan all' _3 5. Mztk-C a=Ya!1Cr_-'=rt for _e t ivc_ of _.�•,w ..T,_r t�3w: =t1ir, proposal do,!tr, not i^r•_t-(i - ALI Zrdorsen ` pre`uct dezc�i6: • cKr•ore 'will be __epary: _rf the home-o thiti arcpse_ L�i4:,Cr, must � , y n , , ..�e 3Tne _u o.>_--1--�7 a--�- ::cccpt?v+ •h Yf th_ Eiro�tisal 1$ Jallsfacho - •, p_ee�e _ r Lhe iEyG;: cep, aril _ , • . ;:= edu_,_•� .. lea!Rr_ -.ake a c_ex-:. -a 4,le -ei vasc.�� taj:tA C-grpeII<rs� t - -,e» :..rideise; „+g r,9Gr1.^'ed ah4at aII` ``_ear.- - _1 • ^r r'C 1 -l3dt ::.z chsC «.it:h �' c9 Allc de'. -YC'rY, `ice a3 :a:ci-ory or:;:r_-,r. We Propose!x:r:r.:'�hi'.T;;r rulc:roI I_.;r.!—::a rx:la's tf:ia1=C!•J::-;rc:•x 2:'v'n_��Ie;:fi; a i1 . icr tv!r::rr _-ve ^th^::'i:v.cmd one t-4:nc red _Zleyr n z nd �„'1!''r �lrl T l`L re - F:r.rrr- f,; >,._1 1.2,3 j ,e r':au:ar fnit-' _.ahc_": 5Q'* Down jiay IGn_ t•_ Start at :ime .5-art, LaSa__ 3�r$ r_pcn EGO 0111 numple-ion a:: -itte of lot_c•r. . - . . , . . . . . . . . EGO. 2'3.C C. it' ;r.�K*.:: ..rtta•;+•t...,13:r..y,.e.s^i��.. ��i a•,�It:i:r:,: .�r{e •:.r' - - rrTt Tr wfjz x a, Lr M1-r It '. •'•:�-�'a, .� /� :.7tL. rr,i2•.':2:::':'--f �?Tsf 1. , -I a�f.« ,+.xz—,- v , r - VL Cd• I — �rl. r tf .. .rc r-0;•.onj.-,r w 7..YsJ: ihA a:}w:.1 l T tm rT c-r rnar: .F.n.,,w.,. of fin_cr ,• Uri ♦ t r r r r fi n{ rj_ s r:, „s arr r..�.a r.r :cc: w.fts •{•P rf, _,A:S:.. :. - Tt7::('A,'.(1'c�11 17 si• r' r',•`+�f7:A7i .:'i LL:i-n';r'i::N_:'_'j'.q:�.in �r� ry,3 Yam• Acceptance of Proposal AL•sZ. _,TU.ri:::lut7 vM Ur!`LYP_-r,n.,;,:u t -,._ • _ :!I•::IItS:%.'.r.!:.::f. 1l 1�NCr+:t= .;f..:'ir'1 .,:�,rr:•i va[to r-:..�:.ti'.s<rw•.;tz.,c. au'::n,�t,: �, r f i 77Z�- ' y/ i The Conintoniveakh of Massachusetts Department oflndustrial Accidents Office oflnvesdgations IF 600 Washington Street Boston,MA 02111 n►vrv.inassgov/dia Workers' Compensation Insurance Affidavit-Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(BusinesstOrgmimhou Individual): VASGn con N EZ Address: SQUTH QENNI-79 �lua ror,6n NIS, City/State/Zip: Phone#: Sub 3 S b IS( 1 Are you an employer?Check the appropriate box: T of project 4. am a general contractor and I Type Iect(r��� 2.❑ I am a employer with � I g 6. ❑New oonstnuction Employees(full and/or part-time)-s have hired the subcontractors (j listed on the attached sheet. y- ❑Modeling 2_ I am a sole proprietor or parfuuer- ship and have no employees Theme sub-contractors have 8. ❑Demolition. working for me in any capacity- employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp.insurance required] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]T c. 152,§1(4),and we have no employees.[No workers' 13$0 Other t � comp.insurance required.] 'Any appticmt that chedm boot#1 mast also fill out the section below showing their workers'compensation policy information. T Homeowners wbo submit this affidavit indicating they are doing an work and then hire outside contractors mast submit a new affidavit indicating such TContrsctors'bat check this bmr must attached an additional sheet showing the name of the rob cmnacma and state whether or not those entities have employees.If the sabcontnaors have employees,they must provide their workers'romp.policy number. I am an employer that is providing tvorkers'compensation insurance for my employem Below is the poScy and job site information. Insurance Company Name: �J(r ILA -D11S Co Policy it or,Self-ins.tic.#:_ Expiration Date: C!�-' Job Site Addnw:`3 4A Fur il.Ql TO• Llsn l' 1 -3 City/State/Zip: (T�IO�W 6"q� 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 S1,500.00 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 inmrance coverage verification. I do hereby certify older thepains and penalties ofpedury that the information provided above is true and correct Si tore: Date: Phone#- S I S O cial 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.Cityfrown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 6 i Client#:647900 2NUNEZVA DATE(MM/DD/YYYY) ACORD. CERTIFICATE OF LIABILITY INSURANCE 9/20/2017 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 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 Dowling&O'Neil Dowling&O'Neil Insurance Agency PHONE 508 775-1620 FAX ac No Ext: ac No): 5087781218 973 lyannough Road ADDRESS: col@doins.com P.O.Box 1990 Hyannis,MA 02601 INSURER(S)AFFORDING COVERAGE NAIC ll INSURER A:N GM Insurance Company 14788 INSURED INSURER B: Vasco E.Nunez III DB/A V.E.Nunez Carpentry INSURER C: 79 Mayfair Road INSURER D: South Dennis,MA 02660 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTRR ADDLSUBR TYPE OF INSURANCE NSR WVD POLICY NUMBER MMO/LDIDNYYY POLICY NDDNYYP LIMITS A GENERALUABILITY MPOS117J 9/12/2017 09/12/2018.EACH OCCURRENCE s2,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea oaTurrence $500 000 CLAIMS-MADE a OCCUR MED EXP(Any one arson) $10 000 PERSONAL&ADV INJURY s2,000,000 GENERAL AGGREGATE s4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $4,000,000 POLICY PRO- LOC $ JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPER DAMAGE $ HIRED AUTOS AUTOS UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS UAB HCLAIMS-MADE AGGREGATE $ DIED I I RETENTION$ $ WORKERS COMPENSATION WC STATU- I OTH- ANDEMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE - E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? ❑ N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of Insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S198111/M198108 CBD 9 Massachusetts Department of Public Safety Construction Supervisor 1 &2 Family Board of Building Regulations and Standards Restricted to: License: CSFA-069680 Construction Supervisor 1 & 2 y Family VASCO E NUNEZ,III r w 79 MAYFAIR ROAD SOUTH DENNIS MA 02660 n Failure to possess a current edition of the Massachusetts Expiration: State Building Code is cause for revocation of this license. Commissioner 10/03/20,18 DPS Licensing information visit: WWW.MASS.GOV/DPS U/e.n. TpriJiainrlruveal/,�c��G�aOdac�r%9n.�/4 . _ Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only ^A TYPE:Individual before the expiration date. If found return to: e ,F(bg1stration Expiration Office of Consumer Affairs and Business Regulation •124793 08/24/2019 i 10 Park Plaza-Suite 5170 VASCO E. Boston,MA 02116 VASCO E.NUNEZ,III r - 79 MAYFAIR RD. `` -` " P% S.DENNIS,MA 0266Q Not V id without "ignature Undersecretary I 1 i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map P? Parcel 00 Application #ail J 730 Health Division Date Issued a3 7� Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis VVV Project Street Address 97ZP_y 7— Village Owner L�.v,✓ r7SN��- Address 397_,,7vv< 1h1_z Telephone 7— Permit Request ✓iv��, Ma)Akx 2— 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 Q40 On Old King's Highway: ❑Yes Flo Basemerit�Type: ❑ Full ❑ Crawl ❑ Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count--, -M Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other �-' � ® s Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/,'coal sto e: ❑Tes ❑ No Detached garage: ❑ existing ❑ new size Pool: ❑ existing ❑ new size _ Barn: ❑ ixisting 7a new! size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: W ►„ Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name � /7 �/ Telephone Number .S76 Address N"'�0 `l �D License # Home Improvement Contractor# 1,157W Worker's Compensation # -Z:2-77 2-2— ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE'ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION j FRAME INSULATION FIREPLACE - ELECTRICAL: ROUGH FINAL t' PLUMBING: ROUGH FINAL 1 GAS: ROUGH FINAL FINAL BUILDING 'Yi• DATE CLOSED OUT'- -ASSOCIATION PLAN NO. a i 77re Connnornvealth of Massadiuselft Department of Indristrial Accidents Office of Investigations IF 600 Washington Street Boston,MA 02111 fvww.rnass:gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information �— Please Print Le gib Name(Business/Organization/tndividual)- Address: /S— �&Vd N c itl City/State/Zip: A/1 &200 Phone#: Srf)$ Are you an employer?Check the appropriate box: Type of project re 4uired)= 1.L /I am a employer with 4. 0 I am agmeral contractor and I 6. ❑New construction employees(fall and/or part-time).* have hired the sub-camtxactors 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 w capacity- employees and have workers'°�� for me in any � tworkers' 9. ❑Building addition [No workers'comp_insurance comp.insurance.: required-] 5_ ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ officers have exercised their I am a homeowner doing all work 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' 13100ther 2�00-- comp.insurance required-] 404fce"""{ ;Any applicant that checks boat#1 must also fill our the section below stowing their wor$en'compensation policy informativb Homeownus wlm submit this affidavit indicating they are doing all work and then hire outside contractors Mnst submit anew affidavit indicating such_ Contactors that check this box must attached an additional shem showing the time of the sub-comre curs and state whether at not those enti*ies hare employees. If the sub-contactors have employees,they must provide their workers'comp.policy number. I am an employer that is protidittg workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: �A� �sJSd/Rn/GC UY�yP Policy#or self--ins.Lie.#: �f5-4,we ZL77 Z L Expiration Date: Job Sine Address: WW A o,iT City/StateJZip: G-lei✓;/lam lax Attach a copy of the workers'compensation policy declaration page(showing the polity 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 fie 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 cerfi&under the pains and nalties o itry that the inforazartion proWded above is tme and correct Si tune: -r '` �"��- Date: l0 30 /Zr Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/Ucense# 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#: - - - - 6 i CERTIFICATE OF LIABILITY INSURANCE 12f27/2011 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 be endorsed. If SUBROGATION IS WANED,subject to the terns 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 CONTALT Paychex Insurance Agency Inc PHONE FAll E.MAR 150 Sawgrass Drive c Rochester,NY 14620. am CUSTOMER 1 S AFFORDING COVERAGE NA1C0 INSURED INSURERA:GUARD INSURANCE GROUP James P Healy Jr INSURERS: 15 Annawon Road INSURERC: Mashpee, MA 02649-4946 INSURER 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. DR TYPEOFURANCE POLICYNUMBER MMYEFF MO LT INS POLICY Y LIMITS A GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 DAMAGE To RENTEU- IX COMMERCwLGENERALLMSILITY PREMISES ffa o S .-.-.---. _�•� CLAIMS-MADE �]OCCUR JABP201239 0124/2011 0124/2012 MEDEXP one rson S 5.000 PERSONAL&ADV INJURY S I== i GENERAL AGGREGATE $ 2MOAM GENL AGGREGATE LIMIT APPLIES Pelt PRODUCTS-COMPIOPAGG S zAaoaao x POLICY I LOC I S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S (Ea accident) , ANY AUTO BODILY INJURY(Per Parson) S ALL OYMEDAUTOS BODILY INJURY(Per eoddenq S - SCHEDULED AUTOS . ._ PROPERTY DAMAGE S HIRED AUTOS (Per ftedderd) I_-- NON-OWNED AUTOS S L UMBRELLA LIAR Q OCCUR EACH OCCURRENCE $ EXCESS LL A13 ❑ CLAIMS-MADE AGGREGATE S DEDUCTIBLE S RETENTION S tNORKETISCOMPE19ATI0N X WCSTATIY 0 , A ER ANDEMPLOYEFWLIABILITY ANY PROPRIEfORlPARTNEfUEU(ECUTIVE YIN NIA A E.L.EACH ACCIDENT S 100,000 OFFICEiIMEnBEREXCLUDI3Y/ _J JAWC227722 l�e�o✓2D11 H azolz (Mandatary In HH) EL DISEASE•EA EMPLOYE $ 100.000 II yyeess,desu(De under 500,00D OESCRIFnON OF OPERATIONS heiaw EL DISEASE•POLICY LIMIT S DESCRUMON OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Addithmal Remarlm Schedule,I more wace Is required) CERTIFICATE HOLDER CANCELLATION TOWN OF BARNSTABLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE HYANNIS, MA ACCORDAHNCEION DATE WITHTHEP THEREOF, NOTICE WILT BE DELIVERED IN AUTHORIZED REPRES ATNE 1 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD i O� • BARNSfABM ,` ,� Town of Barnstable '�Fc nle� Regulatory Services Thomas F.Geiler.Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street; Hyannis,MA 02601 www.town.barnstable.i-na.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, �✓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: /ems 7l n-e- (Address of Job) SignatZe of Owner D to Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\Appl)ala\L.ocal\Microsoft\WindowsVremporary Internet Files\Content.Outlook\I).DV87AA/_,\FXPPFSS.doc Revised 072110 i Village Square South Condominium Association P.O. Box 598 Osterville,Massachusetts 02655 February 9, 2012 James Healey 15 Anawan Rd. Mashpee, MA. The Board of Village Square South Condominium Association gives James Healey permission to replace windows and slider in Unit 1 B,located at 39 Tower Hill Rd.,Osterville,MA. Walter E. Bianchi Treasurer,VSSCA i '-' M!1Ssachusetts- Dep:u-tment of.Public S:tfet' Board of Buildin.- Regulations and Standards Costr`ction SupeTiisor License One-and Two-Family Dwellings License: CS 56765' JAMES.P HEALY' 15 ANNAWON RD:: . "..w,�: .. .. MASHPEE;:.MA Q2649 �` Expiration: 4/24/2013 Cmurnisvioner Tr#: 12802 i• . p _ . • . .-: 4—N• .,✓fie i!�a�rvnco�r :o�,./�aaaa�iuQetta Offce of Consumer Affairs&'Business Regulation HOME IMPROVEMENT CONTRACTOR Registrationw✓_1-15770 _ ExpiratioA° 2412 Tr# 293979 Type: i an�i'a�ar JAMES P.HEAL`l J.Fr_ DAMES .HEALY 15 ANNAWON MASHPEE,MA 02649''_' "? Undersecretary ;�h License or registration valid for individul use only ( before the expiration date. If found return to: { ±' Office.of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 r Not valid'w.ithoui signature i RE-ROOFING/RESIDING/WINDOWS (COMMERCIAL) ❑ If located in OKH or Hyannis Historic District- Certificate of Appropriateness required unless same color/same materials specified on application ❑ Map/parcel number Approval Sign-offs from: ❑ Tax Collector ❑ Treasurer ❑ # of squares of shingles or square footage of roof or sidewall to be shingled/sided ❑ Specify stripping old shingles or going over old roof. If going over ❑how many roof layers existing now ❑what size are rafters? What is span? /xwmer's name & address Project valuation must be entered Builders Information Signature Workman's Compensation Insurance Affidavit State form must be completed and a copy of Insurance Compliance Certificate must be submitted. A copy of the Construction Supervisor license is required. Effective March 1, 2009 ❑ Check expiration date, no restrictions ] Permit fee S160.00 / operty Owner must sign Property OvYner Letter of Permission;�.5`5 o e a��a n�e o� e.ede� ?rojects requiring the use of a crane must complete the forms issued by the Aeronautics Commission 1 mis/bldgpermits/permitcheckl ists ,.070610 i