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0116 TOWER HILL ROAD
-_ _.._� _ _, �. .,., ,.,.. ....gin.-��....,�._._.z -- — .,..�.r� .. .. r D I .� C 9 v f �'.re { f� I� .� .� L� '� o I� O �e� i• f !i- S` to Application numb ....1.1.:1.Iq. 1........... t1KEFee .��..Qa ................................�7 . .... NAB, Building Inspectors Initials................. ............ .� APR 26 2019 .,.._ Date Issued:...................... ���.... .1.!....1.................. TOWN Ta b�RI�I r ALE Map/Parcel...... . :. .. ... ... ........................... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: //G 7-6w--er QS c1- (1W1,e NUMBER STREET VILLAGE Owner's Name: Phone Number Email Address: Cell Phone Number Project cost$ 70,0 Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK © Siding E-1 Windows (no header change)# El Insulation/Weatherization 0 Doors (no header change)# Commercial Doors require an inspector's review oof(not applying more than 1 layer of shingles) Construction Debris will be going to t-0,—d / CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable)# / 0 (attach copy) Construction Supervisor's License# ( o ` (attach copy) Email of Contractor ` �ne number yz, y ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTYES IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER............................................................ *For Tents Only* Dat Tent(s) will be erected Removed on number of tents total Does the,,tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X. X. X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent Fuel source being used LP tank 20 lbs. or>Yes No_____, if yes, a gas permit is required. Natural Gas Yes No , if yes, a gas permit is required. If food is being served at.your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval: *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature Date All permit applicati s are subjeet to a building official's approval prior to issuance. AC40 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 04/02/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFE)tS 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 endorsements). PRODUCER NAME: Deborah Kell LEONARD INSURANCE AGENCY PHONE • (508)428-6921 FAX No: ADDRESS: DeborahK@Leonardagency.com 683 MAIN STREET SUITE B INSURERS AFFORDING COVERAGE NAIC A OSTERVILLE MA 02655 INSURERA: LM INS CORP 33600 INSURED INSURER B: RICHARD CAZEAULT JR INSURERC: INSURER D: 198 FIVE CORNERS RD INSURER E: CENTERVILLE MA 02632 INSURERF: COVERAGES CERTIFICATE NUMBER: 385233 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. INTSR ADDL R POLICY EFF POLICY EXP R LIMITS TYPE OF INSURANCE POLICY NUMBER MIDD MIDD COMMERCUIL GENERAL LIABILITY EACH OCCURRENCE $ DA CLAIMS-MADE OCCUR PREMISES Ea.rence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY Q JEST LOC PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accidentl _ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTYDAMAGE $ HIRED AUTOS ecl AUTOS Per a dent $ UMBRELLALUIB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMSMADE N/A AGGREGATE $ DED F7 RETENTION$ $ WORKERS COMPENSATION X I sTRTUTE ER TH AND EMPLOYERS'L1ABILr1Y ANYPROPRIETORIPARTNERIEXECUTIVE YIN EL EACH ACCIDENT $ 500,000 A OFFICERIMEMBEREXCLUDED? NIA NIA NIA WC531S620615019 02/04/2019 02/04/2020 (Mandatory In NH) E.L.DISEASE•EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space 1a required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in.states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was Issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/twdtworkers-compensabon/invesfigafions/. Sole proprietor has not elected coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN Of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 367 Main St AUTHORIZED REPRESENTATIVE Hyannis MA 02601 Daniel M.Cray,CPCU,Vice President—Residual Market—WCRIBMA @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD . The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ` Please Print Le 'bl Name(Business/Organization/Individual):: A Address: r�� (� /t/� CG�� �� I /ZZ City/State/Zip: �`e y"l( / " X Phone#: 17�0 Are on an employer?Check the appropriate box: Type of project(required): 711 am a employer with 1_ 4. ❑ I am a general contractor and 1 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' 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 1 LE]Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.❑ Other 4 comp.insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hive outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. ,! Insurance Company Name: Policy#or Self-ins.Lic.#: C �� ( -1 Expiration Date: ( �� / �} Job Site Address: �� �w{� City/State/Zip: 05 r 4 - /V-\� Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pa' and penald perjury that the information provided above is true and correct Signature: Date: Phone#: d' Sy� c*�-- Official use only. Do not write in this area,to be completed by city or town officiaC 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 Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 www.mass.gov/dia CA ZEAULT\ ROOFING & REPAIRS PROPOSAL Proposal No. 19-32219 March 22,2019 To: Scott Peacock Work to be performed at Re: Weglarz Residence 116 Tower Hill Rd Osterville MA We hereby propose to furnish the materials and perform the labor necessary for the completion of: NEW ROOF(Backside of Main Only) 1. Remove existing shingle roof 2. Repair and re-nail plywood as necessary 3. Install drip edge 4. Ice& Water barrier first 3ft, all skylights and penetrations 5. Cover roof with Rhino paper 6. Re-roof with Lifetime architectural shingle to match existing 7. Install ridge vent 8. Flash all pipes and penetrations 9. Remove all rubbish from project Labor and Materials $4,700 All material is guaranteed to be as specified, and the above work to be performed in accordance with the specifications and completed in a substantial workmanlike manner for the sum of Four Thousand and Seven Hundred Dollars $4,700 with payment as follows: Two Thousand Three Hundred and Fifty Dollars $2,350 with acceptance of proposal and Two Thousand Three Hundred and Fifty Dollars$2,350 Due upon Completion Res c 1Vitt Richard P. Cazeault, Jr. HIC# 168607 CSL#100393 198 Five Corners Road Workmans Comp and Liability with Centerville, MA .02632 Leonard Ins of Ost (508) 420-5482 Acceptance of Proposal No. 19-32219 The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment is outlined above. --------------------------- -------------------------------- Signature Date *Removal of additional layers of roofing not forseen with result in additional fees of$75 per Sq *All quotes are valid for 30 days r Commonwealth of Ma machksetts j Divisioq of Professional Licensure _ Board of 3uilding Regulations and Standards CS-100393 yapires: 02/03/2020 RICHARD P CAZEAULT;JR.' 198 FIVE CORNERS ROAD CENTERVILLE MA 02632 Commissioner •�� /jn/iril7GYI//../'!LC/�l. ���11:h30C�liG// ....,",�_r.-�•..�.•• .� -..�..__--.' Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Reglstration valid for individual use only TYPE:Individual befota the expiration date. If found return to: S Uo &Rkdiom Office of Consumer Affairs and Business RC9U)Ution , "164 0:7_--== 03/07/2021 10 Park Plaza•suite 517o i - _ Boston,MA 02115 RICHARDPCAZEAULTJR�;fs� . D/B/A R CAZEAULT_ROOFftj` REPAIRS RICHARD P.CAZEAUI?T_�JR 198 FIVE CORNERS CENTERVILLE,MA 02632 Not valid without Signature Undersecretary � • { . I J. t �i Department of Labor '. 'OcaipaUonal 5afety:and Heattti Administration W. r i Aas successfufy completed a lllhour Oea,padonal Safety arid:Health ' �-s� :Training Course in.C I, s Construction Safe Health`J ^Y r, �' t. '�•z ,(Date) ,��= I- � \ •1 1 1 Z7 V 10, o goi le , Q I certify -that this property is located - in Flood Hazard Zone C (outside the 500 Year flood) as identified by the Department 44.75' of Housing and Urban revelo t Oluc ) . 0�,.sf� Cr(271 FI f=D PLOT I'I_AN 4 -L ate \uNw /990- Dw R ,, - LOCATION q19!?�!-rlAB �osrEViLG45) fve Zo /ft of aEL1FkY-id ve or SCALE . .���: .. ,... DATE No. 26100 PLAN REFERENCE ,a�'`�C ff 9FCIS1tR�� �`'�'4�. L,.+►�b . S/�,tM�v i9S , !`9A2{E ,/a..SCuDDF.�', I certify to New Bedford Ins 1 -ution for Savings and its Title Insurance Company that there aro no visible oncr. oachmont.-i or casemento except as , shown and that -thin- plan was prepared' under my immediate ICERrIFY1'tIAI THE supervision. SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON AND THAT IT CONFORMS TO THE Tj,��,-� � j SETDACK REQUIREMENTS OF THE TOWN OF Property Address ----- - M� - `?fin '%�` t�.. ,,.. . , wIIEN CONSTRUCTED. Q jL - -- Petitioner -fl'v_ =s1= --" Dare iL�s�Rf i�l� REGISTERED LAND SUAVEYO 1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION P. Map Parcel Application # �� J Health Division Date Issued Conservation Division _ Application Fee X'f\ Planning Dept. -_ Permit Fee (D 6"> Date Definitive Plan Approved by Planning Board o©�l Jg1 tt Historic - OKH _Preservation/Hyannis Project Street Address Village Owner � Address )(-p �l/r Telephone J`1�" 6051 i �1� Permit Request � (it"�� P-W fit 60ML Square feet: 1 st floor: existing V6 proposed 2nd floor: existing_ proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 4010V" —Construction Type D- 1� � Lot Size r Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 'Q Two Family ❑ Multi-Family(# units) Age of Existing Structure 37 Historic House: ❑Yes & oOn Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing i new Half: existing new Number of Bedrooms: existing _new Total Room Count (noXas ing baths): existing new First Floor Room Count Heat Type and Fuel: Oil ❑ Electric ❑ Other o Central Air: ❑Yes Fireplaces: Existing New Existing wood/coal stove; ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: L existing anew ize_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes o If yes, site plan review # Current UseSi;,Ok c Proposed Use � . APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name�C �XJI I ��['�lC � Telephone Number r Address `T . 0, `1 License AA w- 020z Home Improvement Contractor# �' 7 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTI FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE / 6 ~ 1 T— I FOR OFFICIAL USE ONLY 7- APPLICATION# {- DATE ISSUED MAP/PARCEL NO. ADDRESS ' VILLAGE E OWNER t . DATE OF INSPECTION: FOUNDATION �I t FRAME _(2001.%4I h INSULATION; FIREPLACE r ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS ROUGH FINAL 'FINAL BUILDING DATE CLOSED.OUT . ASSOCIATION PLAN NO. - 5° , s The Commonwealth ofAlassachttsetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant information Please Print Legibly Name (Business/Organization/Individual) a Inc-_ Address: 8r, 11 1 City/State/ZipO p Phone #: q2,8- A 7(pDo re y an employer? Chech tl a 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.❑ 1 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' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.', required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their i I.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] ' c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] "Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy inforniation. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 'Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees.they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my emplovees. Below is the policv and job site information. NN Insurance Company NameNawl Unon Tire 1m5aw& �w&Am lrikPolicy#or Sell=ins. Lic. #: lam 58'24 Expiration Date: Job Site Address:I u IU City/State/Gip: AAA 1 0 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 tip 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. Ile-A I do hereby eertifi,rr de tl pains and penalties of perjury that the information provided above is true and correct. Si natt e: Date: /D -- G Phone Z Official use only. Do not write in this area, to be completed by cith 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 Aco CERTIFICATE OF LIABILITY INSURANCE DATE(MYYY) o7/o6/201sreoll 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 NAME: Germani Insurance Agency PHONE (508 Falc 30 908 Main Street IAIC-�Ex'I� 128 9194 Nu: 508 428 68) E-MAIL ADDRESS: Oslervllle,MA 02655 CUSTDPROOMER ER ID p: INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: SAFETY INS CO Srott Peacock Building&Remodelling, Inc. INSURER B: 11.0.Box 171 Osterville,MA 02655 INSURER C: INSURER D: National Union Fire Ins.Comp. 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 JMMiDDfYYYY1 IMMIDDIYYYY) LIMITS A GENERAL LIABILITY CP00001152 7/5/2011 7/5/2012 EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY AMA TO—REfV PREMISES_Ea occurrence $ CLAIMS-MADE OCCUR MED EXP Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO JECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULEDAUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNED AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ D WORKERS COMPENSATION WC 5815464 6/22/2011 6/22/2012 WC STATU- I OTH- AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION Scott Peacock Building&Remodeling, Inc. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Fax#"508-428-7625 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD N9assachusctts- Dcpar-ttucnt of Public Sufeh Board of Buildin- Regulations and Standards Construction Supervisor License License: CS 94500 - JAMES S PEACOCK,y- PO BOX 171 { OSTEVILLE, MA 02632 Expiration: 7/22/2012 Commissioner Tr#: 29233 I - l ' Office of Consumer Affairs&B sines Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: _ — Registration:;01.51853 Type: Office of Consumer Affairs and Business Regulation - Expiration: =7%7l2012 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 SC TT PEACOCK=I3UILDINGB-REMODELING INC JAMES PEACOCK'. `�=-.13�__; 1046 MAIN STREE15SUITE;y7`�� � ./ OSTERVILLE,MA 02655.i;=5 Undersecretary Not valid without signature 1 oFtK r ti ' Town of Barnstable • RA MsrABM 9� `0 � Regulatory Services Thomas F.Geiler,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 Property Owner Must Complete and Sign This Section If Using A Builder I, 6D f•C/V+V9!�1 ���L��G�, , as Owner of the subject property hereby authorize ¢����[,� 4 t�//' �/ - 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 Q:\WHILESTORMS\building permit forms\EXPRESS.doc Revise020108 BENCHMARK: CENTER OF CB RIM TOWER . HILL ROAD ELEVATION: 98.42' DATUM: ASSIGNED ® _ I 10.6ft 61 .73' �� PROPOSED INFILTRATOR _•8f-t- S 89°45'59=� CHAMBERS IN FIELD OO�p� ���� DTP#2 �4 CONFIGURATION ii`0.�1' �� °'�� ,°� �r_p# WITHOUT AGGREGATE EXISTING LEACHPIT PROPOSED PVC CLEANOUT o .3ft EXISTING 1000 GALLON TANK �Q 13.8ft ' TO REMAIN / SIJE GE! L f ////////,////////// 11 .0ft !/ NOTE #11 NOTE: EXISTING SYSTEM COMPONENTS ARE DRAWN PER TOWN OF BARNSTABLE AS—BUILT CARD.' OF N �P��N Mgss oo Z�ft /. DAVID ///, f' o B. G EDGE OF ROAD MASON . ,�.gSpti :,:�:/,///,///// 2i No.1056 EDGE OF SIDEWALK Fl1i� . "/""/' i' 10 0 26 : ft `, y cn 20226.2 SQ. FT. 0.46 ACRES _/ 0 70, oo., AS/LOT _lj Q 28 77 z o 44.75' -� AS/LOT o o ,> W "S 82 37 50 30 GRAPHIC SCALE 30 0 15 30 60 cp A c /I nT I I I Town of Barnstable *Per *16m7os r7 Regulatory Services weem issue date � BARNSfABLE, � y Mass. $ Richard V.Scali,Director A'F�'AP�p Building Division Paul Roma,Building Commissioner 260 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint 02q Map/parcel Number , `T /. / / Property Address_ / Le /Cowmr A /1 / oa ©�r yi f l e- i Residential Value of Work$J., SOd Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address j l t7GLr . D e-Lu.Ca-, `L— h-0"Ulf-se, vV /a r l I (P To"r /-W I Oad O g r Ville., Contractor's Name c9cc9 T, Pea—C-c;,c4 Telephone Number_5D9—Yo8—7&0O P ( applicable) 1510 6 5 Email:Home Improvement Contractor License#(if a licable Construction Supervisor's License#(if applicable) \AVorkman's Compensation Insurance Check one: ❑ I am a sole proprietor �Q ❑ I am the Homeowner have Worker's Compensation Insurance 70WIV SEP R,j?Q,, Insurance Company Name i J� VI((�� ®r ��� Q8APA,.- Vo 01 r �C Workman's Comp.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) JSae-side ❑ Replacement Windows/doors/sliders.U-Value (maximum .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 s' operty Owner Letter of Permission. A copy of the Home mp ovement Contractors License&Construction Supervisors License is requir SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc 01/25/17 ACCO O® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 07/10/2017 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 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 endorsement(s). PRODUCER CONTACT NAME Germani insurance Agency PHONE (508)428-9194 No: (508�28-3068 908 Main Street E-MAIL ADDRESS: certs@germaniinsuranoe.com INSURERS AFFORDING COVERAGE NAIC# Osterville MA 02655 INSURER A: SAFETY INS CO 39454 INSURED INSURER B: Granite State-AIU Holdings 000000 Scott Peacock Building&Remodeling,Inc. INSURER C: P.O.Box 171 INSURER D: INSURER E: Osterville MA 02655 INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW RAVE 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. OD S BR POLICY EFF POLICY EXP ILTR TYPE OF INSURANCEINSD POLICY NUMBER FOLIC MOLIC LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE ❑X OCCUR DAMAGE TO RENTED PREMISES Ea occurrence) S MED EXP(Any one person) S A BMA0022118 07/05/2017 07/05/2018 PERSONAL&ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY PRO- LOC PRODUCTS-COMP/OP AGG S OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S Ea accident ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED BODILY INJURY(Per acciderd) S HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS AUTOS ONLY AUTOS ONLY Per accident S S UMBRELLA LIAB OCCUR - EACH OCCURRENCE S RXCESS LIAR CLAIMS-MADE AGGREGATE S ED I I RETENTION S $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE WC 005-81-5464 06/22/2017 06/22/201$ E.L.EACH ACCIDENT S 500,001) B OFFICERIMEMBER EXCLUDED? N/A (Mandatary in It yes,describe under EL DISEASE-EA EMPLOYEE S 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 i 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. PO BOX 171 Osterville,MA 02655 AUTHORIZED REPRESENTATIVE -- Fax: Email: ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD i Town of Barnstable Regulatory Services RIUMMAMM WIAS& ` Richard V.Scab,Director ►� Building Division Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.mans Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the sub'ect ro � l P Pay 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# installed and all final . inspections are performed and accepted. Signature of Owner Onature of Applicant rnge-�, pe wed Print Name Print Name Date QFORMS:OWNE"ERNIISSIONPOOLS I Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-094500 Construction Supervisor A;r= JAMES S PEACOCKl PO BOX 171 OSTERVILLE MA 02655': `= Expiration: Commissioner 07/22/2018 I c� l_%�(. ((:/l irh77Gor�unCt�lfL o/�l✓��CXJJCFc�ccJe Office of Consumer Affairs&Business Regulation License or registration valid for individual use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration:,- 1151853 Type: Office of Consumer Affairs and Business Regulation 1 �- Expiration:_-=7--7/201;8 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 SCOTT PEACOCK BUILDING- REMODELING INC JAMES PEACOCK 1046 MAIN STREET SUIT&T.„4V OSTERVILLE, MA 02655- ' '� Undersecretary - Not valid without signature Town of Barnstable F1HE lq��O� Regulatory Services Thomas F.Geiler,Director BARNSTABLE. HASS. Building Division ,e�FD MA1 A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 PERMIT#y D FEE: $ � SHED REGISTRATION 120 square feet or less Location of shed(address) Village. 1 0 t13�..e dt�cl 00 Property owner's name Telephone number Size of Shed Map/Parcel# 3 Si tare Date Hyannis Main Street Waterfront Historic District? �0 Old King's Highway Historic District Commission jurisdiction? U Conservation Commission(signature required) ! 4� PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:121901 ' J �7 V do i g�i V � ' Q I certify -that this property is located in Flood Hazard Zone C (outside -the 500 Year flood) al-3 identified by the Department 44.75' of Housing and Orban r evelo , - I,• (HUE ) . �N OF' v�f CEftTI Fl f=n PLOT ('I_AN Late Dw R r J LOCATION Q.ggy-. ,gn.�esr,7 VF.L c:) Reg. of 1$E►jfLj ve or SCALE . .�. ,. �, ,,,, DATE fy9Za /9 No. 26100 FLAN REFERENCE C3Gri'�tG � 4/SL"p .E /a;SCuADF, I certify to New Bedford Ins 1 -u-tion for d'`! , . -8' •, .BZ . ': �,� Savings and its Title Insurance Company ihnt; there arc: no- vi.nible oncr. oachmen-ts or . casements except 'ab - r;liown and that .-this . . . . . . . . . . . . . plan was prepared- under my immediate I CERTI FY TI,IAT THE supervision. SHOWN ON THIS PLAN IS LOCATED ON THE GROUPED AS SHOWN HEREON AND THAT IT CONFORMS TO THE Az SETDACK REQUIREMENTS OF THE TOWN OF Property Address -=------ --------- BsDTiµs`y;ag�t - wIIEN CONSTRUCTED.Petitioner -�1'dv_ =S-'} =`}C ___. DATE Jam ,? REGISTERED LAND SURVEYO TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION. # p Map Parcel piicatioh ." Health Division 'Date Issued L �Conservation Division licatidii.Fe Planning Dept.: :-".-Perrilit Fee! Date Definitive-Plan Approved by Planning Board Historic - OKH Presiervation Hyannis Project Street Address Village Owner Address Telephone Permit Request V Square feet: 1 st floor: existing proposed :2nd floor: existing proposed Total new ZQ'n'* ing District. Flood Plain Groundw' ater'Overlay Project Valuation %000 Construction Type Lot-Size Grandfathered: Q Yes U No If yes, attach supporting documentation. Dwelling Type: Single Family >0 Two Family El Multi-Family(# units) Age of Existing Structure Historic House: Q Yes 0 No On Old King's Highway: Q Yes LJ No Basement Type: LJ Full U Crawl L3 Walkout U Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing —new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: 0 Gas Ll Oil U Electric L3 Other Central Air: Q Yes Q No Fireplaces: Existing New Existing wood/coal stove: 0 Yes 0 No Detached garage: Q existing Q new size—Pool: Ll existing Q new size Barn: 0 existing 0 new size Attached garage: C3 existing Q new size —Shed: Ll existing U new size Other: Zoning Board of Appeals Authorization C3 Appeal # Recorded 0 Commercial Ll Yes Q No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number q7- VT- ) 600 \J Address P0 13 5SI License # 6—al- Home Improvement Contractor# S t Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE Lek— DATE U - FOR OFFICIAL USE ONLY APPLICATION# - DATE ISSUED MAP/PARCEL N0. .. ADDRESS ' ' VILLAGE OWNER a1 -DATE OF INSPECTION: _ FOUNDATION 1 FRAME - F - INSULATION FIREPLACE �w ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL "GAS: _ ROUGH. FINAL 'S FINAL BUILDING , t DATE CLOSED OUT' E ' " ASSOCIATION PLAN NO. .. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 -* www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le iblSMITT5aL Name (Business/Organization/Individual): Address: Nn City/State/Zip:05k%Ak I A Q�� Phone #: �� qzp 0 - . `V�la Are you an employer? Check the ppropriate box: Type of project(required): 1.4 1 am a employer with 4. ❑ I am a general contractor and employees (full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g• ❑ Demolition workingfor me in an capacity. employees and have workers' y p tY• 9. ❑.Building addition [No workers' comp. insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. =Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my emplovees. Below is the policy and job site information. Insurance Company Name: 1 �� 2 Policy#or Self ins. Lic. �t J"I Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 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 D1A for insurance coverage verification. I do hereby c tri Y u the d penalties of perjury that the information provided above is true and correct: Signature: (l 4 /_ �l Date: Phone#: �f�D- (0 v V 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#: l CERTIFICATE OF LIABILITY INSURANCE DAT / 06/29/29/2012 Y) 012 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(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 NAME: Germani Insurance Agency PHONE FAX 908 Main Street AIC N E : 508 428-9194 A/c No): 508 428-3068 Osterville,MA 02655 ADDARESS: INSURE S AFFORDING COVERAGE NAIC# INSURER A:SAFETY INS CO INSURED INSURER B: Scott Peacock Building&Remodelling,Inc. P.O.BOX 171 INSURER C Osterville,MA 02655 INSURER D: Commerce&Industry Ins.Co. 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 SUER POLICY EFF POLICY EXP OMITS LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A GENERAL LIABILITY CP00001152 7/5/2011 7/5/2013 EACH OCCURRENCE $ 1,000,000 N1:011 MERCIAL GENERAL LIABILITY DAMAGE ( RENTED PREMISESS Ea occurrence $ CLAIMS-MADE 1-1 OCCUR MED EXP(Anyone person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ D WORKERS COMPENSATION WC 005-81-5464 6/22/2012 6/22/2013 WC STATUS OTH- AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Scott Peacock Building&Remodeling,Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Fax#508-428-7625 Scott_Peacock@verizon.net AUTHORIZED REPRESENTATIVE - I _OC2� ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-094500 ,_ '•;';.: JAMES S PEACO!Ix , PO BOX 171 ?� r OSTEVILLE MA70263 $'n` s r � Expiration Commissioner 07/22/2014 k CCofir: n•� Office of Consumer Affairs& Busi r/ess Regulation License or registration valid for individul use only _— — !< OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: registration: 151853 Type: Office of Consumer Affairs and Business Regulation xpiration: 7/7/2014 Private ate Corporation 10 Park Plaza-Suite 5170 SCOTT PEACOCK BUILDING& REMODELING INC Boston,MA 02116 JAMES PEACOCK 1046 MAIN STREET SUITE7- ��� Q �� OSTERVILLE,MA 02655 =a-= tlrrdersecret:rry Not valid without signature z` I ,vRE r ti Town,of Barn-stab le Regulatory Services • riIRNSTkBLF_ • ' . q nAB& g Tho... F. Geller,Director ��ED MA'I J'\� Buffding'Division Totn'Perry,Building'Coinmissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790 6230 Property Owner Mus t Complete and Sign This Section If Using A Builder r, ,.:as Owner of..the subject:property e, hereby authorize �j( " � o act on my behalf, in all matters relative to work authorized by this:building permit,apphca6on for. (Address o ro ,) /3 ignature of Owner 15ate - I Print Name If Property Owner is applying:for.permit=pleasetornplete the Homeowners License Exemption Farm on the reverse side. y,,,: I Vh,,.� Q:FORMS:O WNERPERMISSION Uj" �" ,: �IOUS67 ILL is'IY . 2n tl c^" ka13 d• L ti •�����■ Town Boundary O 55.07 7 123-456 Parcels 1Y2012 Gq(� � 142;:OQ7 #1234 Address Street NumbersED p0 #1419 F 142-006 Buildings �1 # 123 Approximate Locations of - �, L-a New Buildings from Plot Plans y ® Decks/Patios 1 0 44 C Above Ground Swvimmin Pools O QOIn Ground Swimming Pools m '' ' •'; ® Walkways Improved p 00 141-0e ___, Walkways Unimproved # 1 1 Paths 1 00 Stairways Paved Roads O 42:64 � .O 11 G^,Zr_j Unpaved Roads 1 Paved Driveways Unpaved Driveways Painted Lines O Paved Parking Lots \ / Unpaved Parking Lots _ \ - •'t �O ® Bridges ` \ Railroad ; -__ --- / X Fences �^1 - Guardrails ?1.41r028 1 --<C>— Retaining Walls aa0 Stone Walls 1117-068 QQ Sports Areas # 109 - Golf Areas 141029 Docks/Piers _ # 116 .. o Boardwalks Jetties ^—^- Streams - - - Drainage Ditches O r t Marsh Areas i 52.47 Water Bodies ,..••'•-• / •_; X X Spot Elevations(NAVD88) O Topo to ft Contours(NAVD88) j t-�J � oF�FII•`C nt lr$f�� � `--' •: _- ----I� � �� -, x Catchbasins I f O Monuments 117-157F ( - Lamp Posts ® Towers #99 Manholes O Utility Poles O Satellite Dish 1 ! 141-030 1 141-024 Signs 00 Fuel Tanks #98 # 15 Water Tanks l Flagpoles 1 Zuj Q Utility Boxes - _ ______ 0 0 Posts -- -- ------- Y • Pilings Data Source Human-made features, Disclaimer This map is for planning purposes only. It is 1 inch=40 feet N Town of Barnstable hydrogmphy,topography,and vegetation were Parcel lines on this map are only graphic not adequate for legal boundary determination Feet Conservation Division interpreted from 20o8 aerial photographs and representations of Assessor's tax parcels.They or regulatory interpretation.This map does no p 1 10 20 40 60 80 W may have been updated from more current are not true property boundaries and do not represent an on-the-ground survey. http://www.town.barnstable.ma.us snurrps. Parrpl lints wprp.dipiti-d from ��..r.+co.,r -,ro.ohr,.,..r1.;,.�r.,..6.,�,..�1 F„lo.�a..,P�rc h.,,,.....i�cro1.� r,^-,nn.,.�., TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Z Permit# 7 6 Health Division `'23�02 ./ �, .S�C Date Issued Conservation Division T"� �/ Application F.ee 1p� 00 Tax Collector 9 2 ,0.L QK Per i 3 a- 0 0 an ' Treasurer INSTALLED IN COMP MANO?; Planning Dept. WITH TITLE S 8WIRONMENTAL C001 AN11 Date Definitive Plan Approved by Planning Board TOM RE7 /Z, lQw� Historic-OKH Preservation/Hyannis , tl Project Street Address f 16 �- Village 0-sy Tiuli e-t,4L •- Owner J-2� �F, S Address l G °�`� 7 4/ Telephone Permit Request C N/,D 1 6,119.c�i J Square feet: 1 st floor: existing proposed 0 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Zo �� d2/Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family U51 Two Family ❑ Multi-Family(#units) Age of Existing Structure `/v w .V Historic House: Cl Yes 6M_0 On Old King's Highway: ❑Yes ldPl�. Basement Type: &cull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 1%�nber of Baths: Full: existing new Half:existing new ,Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: Cl Gas ❑Oil Cl Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑ No If yes,site plan review# 'Current Use Proposed Use �, f-BUILDER INFORMATION / q Name �a�� A /A5 6,524 �i Telephone Number 7 > o / Address 4� A.1 577r_- License# Home Improvement Contractor# ! 3 2- 67 2G 1-� Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO IX-AIS-2W IS SIGNATURE DATE "X3 b7 FOR OFFICIAL USE ONLY t r PERM.I•T NO. ---' 7 -: DATE SSUED MAP/PARCEL NO. r ( r r r � ADDRESSP _ i f r✓ ~t` , VILLAGE OWNER-,- DATE-OF DATE-OF INSPECTION: FOUNDATION FRAME r INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL r ' PLUMBING: RCMQ FINAL- ;� ddgl^tt �� r, .� ✓ it , GAS: ' ROD == FINALIn FINAL BUILDING/ a' =: s -i i s DATE-•CLOSED OUT ;7!04 ASSOCIATION PLAN NO.' r nle Commonwealth of Massachusetts R = - ,Department of Industrial Accidents - Offrce Offn0estiAFEWs . - 600 Washington Street - - Boston, Mass. 02111 - `3 Workers' Co ensation Insurance Affidavit m H S"911I11-6 location: L1 hone � d &.S_Z____ ;VV i mall workeelf. ❑ .I am a homeowner performing ❑ I am a sole ro rietor and have no one workii m ca achy %/% %%%%/ %%%///e//%///i%///%%S%//w%/o//I//%n//%n/// 'ob. ////////////%////////////%////////////% com ensation f mY �. {n}Y.YaY:<F:{:::G:•r v:• c:?h c;:?:»:::.;; {f!R;..^•.\,^.:k3:?:"•{;.. i`r'•: yvolkers P ?{.:•}::�{•t. f;.?`?'$:5f:!{2;$>:}:•: : ... .y #:C.;v::tiv:t:tn:•f:u•:%.'••}+{>t:iY}nx:,"!.�S;h;:�:.;::`.m em 1 er_ roV1d711.� ..]]cn:•rfft:�:i�ti�2f::t•::naf.{:>:::::x..}r:•4:,:.v:4{...:.n-ft,}:::r::f.^,.r:L:::Y•r•$:2��::.}{. .:..5:•}:'•:^•.:•:;•.Y::2.}+•,.•}nsY...:t�?., :.,av:.:. 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Failure to secure coverage v requirednnder Section 25A of MGL 152 cahlead to the imposition of criminal penaltles of a iblenp to 51,500.00 and/or one years' ecurc coverage onment as s recell as duff penalties in the form of a h OsYo the A DVR endd a� 00-00 a day again+tme Imtder�(smd that a' copy of this stat mentmay be forwarded to the Office of Inv tig ` ndertk ` ai and penalties-of-perjury that the-informatimpr-ovided.abnveisscr&an_d correct - I da hereby eertifyu p /01 Date AIA11 III Signature _ .�•., •• .. _ � 'Phoae# � •� • print name "' official we only do not write jn this area to b e completed by city or town official "pezmlt!licertse# [3BuIlding Department city or town: ❑Licewing Board ❑Selectmen's Office r.•_.__..�..- eontactperson: r .Information and Instructions Massachusetts General Laws chapter�152 section 25 requires all employers to provide workers' compensation for their `Law an employee is, ;defined as every person employees, As quoted from the in the service of another under any contract of hire, express or implied, oral or written. i Partnership, association, corporation or'other legal entity, or any two or more of An employer is defined as an individual, li �P _ 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 app�tenant thereto'shall not because of such employment be deemed to bean employer: MGL chapter 152 section 25 also states that every state or local licensing agency shall w withhold for an he i applicant who has of a license or permit.to operate a business or to construct buildings to the comma y PP , .. 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 autho#ty. rr. . . , .. r.• Applicants lies to ur situationand: Please fill in the workers' compensation affidavit completely,by checking the boxthat app yo phone numbers along with a certificate of insurance as all affidavits maybe supplying company names, address and submitted to the Department.of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and r'} date the affidavit. The-affidavit sh°uld'be returned to the city or townthat the application for the permit or license.is Accidents. Should you have any questions regarding the"law"pi iif yQu being requested,not the Department of Industrial are required,to obtain.a workeis' cpmpensatioapoliay,please call;the Depaitmerit at the nitmlierlisted below:. •• r: City or Towns •. Please be sure that the affidavit is complete and printed legibly. The Departrment has provided a space at the bottom o- ou to fill' out in the event the Office of Investigations has to contact you regarding the applicant. Pleas e affidavit o tlie.permrt"nicense iiii�nber which wilLbe used as a refeieace num��er: Tfie:affidavits may 'e'r ► . � , ' `mail'or FAX finless oth&arrangements have been iriade." ay the Dep ent b .., artm Y,�:,.,.. �. Investigations would like to thank you in advance for you cooperation and should you have any questions. . The Office of ,.s.. please do not hesitate to give'us a'0all. The Department s address,telephone and fax number. The•Commonwealth Of Massachusetts ._Department of Industrial Accidents office of 111Yestfgatiolls 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 eat. 406, 409 or 375 °FINE r Town of Barnstable Regulatory Services r • snxxsl'asIX. ' Thomas F.Geiler,Director • a � Building Division rE0 MA'S Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements. Type of Work: �C/d- N t�d t�C' Estimated Cost �i0 ad O , Address of Work: Owner's Name: ,_J_®HIJ Date of Application: ;✓ I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 OBuil ' not owner-occupied er pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. Y i^ OR Date Owner's Name Q:forms:homeaffidav f.. .. ;/he V�anvircootuiea�� O�/�G�?ac/tuGCt76 BOARD.OF$UI WING,REGULATIONS f ense: CONSTRUCTION;SUPERVISOR' l Num6eii..CS 038866 "i irthdate 04'/30/1949 y Expires 04/30/2004 Tr.no: 25167 °Restncted "00 FRANK J+.HEIDENRICH r 1.046 MAIN,ST-UNIT 8' OSTERVILLE, MA.•02655 'Administrator I ' fie Vovrvriza�ztuea��i d��il� �audelYb � Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 129372 Expiration: 8/20/03 Type: Individual Frank Heidenrich Frank heidenrich i - A 046'Main St. Osterville, MA 02655 Admitiisfcato It__�; � 1 � � 1 r I'• n7 • Ali It ; t a: �� •y ti fir: ��p 1 i a•. of� J •Y-. l+ .t.`.�: •.Y:}�' t' �1• v.• �. !,.. �r • -' rye`:.:lr' -.•1:\•- �•... , Nr �- ��.{� _ �.r. . . . ;;fix:: - .. • . fc% � � ! 1 - f C 0- 4 19 r �• -t, �t 4V.w... t�. t tAw o 0 ,� h.;. .,.• _�; �'�`P •+�(..__ 1' .�' it .. '.+t �`�� .�'j.. .�.�0':.1•. A 1 E LOCATION OF PROPERTY LINES MAY NOT BE ACCURATE STANDARD LEGEND NOTE:not all symbols will appear on a map => GOLF COURSE FAIRWAY EDGE OF DECIDUOUS TREES EDGE OF BRUSH -' ORCHARD OR NURSERY 7-1-v-� EDGE OF CONIFEROUS TREES ` r MARSH AREA -- • • ---- EDGE OF WATER DIRT ROAD DRIVEWAY �—PARKING LOT PAVED ROAD ' - --- - DRAINAGE DITCH + ----- PATH/TRAIL ............... PQ P"t PARCEL LINE .N � `� g �. ; •• tlsPito --MAP# '. ' ••..... __ 21 EPARCEL NUMBER. 41 818 E60 HOUSE NUMBER �0 MAP141 `+, 2 FOOT CONTOUR LINE ; 2 8 is 10 FOOT CONTOUR LINE ... � � # 134 Elewtion based on NGVD29 ` `X a.9 SPOT ELEVATION .. 1....�.......,`1 00o c r STONEWALL �JJ I Q -X—X- FENCE RETAINING WALL -F-�-F+ RAIL ROAD TRACK :.. .............. STONE JETTY SWIMMING POOL r PORCH/DECK ] 0 BUILDING/STRUCTURE oi- DOCK/PIER Q HYDRANT MAP 141 •• a VALVE o MANHOLE 1 0 POST oW FLAG POLE T O W N O F B A R N S T A B L E O E O O R A P H 1 C 1 N F O R M A T 1 O N S Y S T E M S U N 1 T o SIGN 'a STORM DRAIN ■ PRINTED SCALE IN FEET *NOTE:This map is on enlargement of a **NOTE:The parcel lines are only graphic representafions DATA SOURCES: Planimefiics(man-made features)were interpreted from 1995 aerial photographs by The James UTILITY POLE TOWER monummW 1"=I scale map and may NOT meet of property boundaries.They are not true locations,and W.Sewall Company.Topography and vegetation were interpreted from 1989 aerial photographs by GEOD 0 20 40 National Map Accuracy Standards at this do not represent actual relationships to physical objects Corporation. Planimetrics,topography,and vegetation were mapped to meet National Map Accuracy Standards O UGNT POLE O ELECTRIC BOX I INtN=40 FEET* enlarged stale• on the map. at a scale of 1"=100'. Parcel lines were digitized from FY2002 Town of Barnstable Assessors tax maps. �0, rpw� Town of Barnstable *Permit# h� p� Expires 6 months-from issue date iARNSTABLE, � Regulatory Services Fee MASS. Thomas F. Geiler,Director x Building Division Keys Pep V r- TomPerry, Building Commissioner OCT' 200 Main Street, Hyannis,MA 02601 7.OwN 3 1002 t Office: 50 38 OF B,gRNSTA�� Fax: 508 790 6 30 EXPRESS PERNHT APPLICATION - RESIDENTIAL ONLY / / Z Not Valid without Red X-Press Imprint Map/parcel Numb Property Addr /I6 Zy-zN Y/& ZVI 6/L esidential Value of Work Owner's Name&Address Wa //6 1?�vt2 /ficc d S f �Gi't � Contractor's Name_ 7�eA&:!�kl— `l ! Oya Telephone Number 4� I(� Home Improvement Contractor License#(if applicable) Z Construction Supervisor''s License#(if applicable) 0 U j1 ❑Workman's Compensation Insurance Check one: ❑ I sole proprietor !/�� Homeowner ve Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Permit Request(che ox) Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roo of stripping. Going over existing layers of roof) de eplacement Windows. U-Value +�d (maximum w ❑ Other(specify) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Coasery lion,etc. Signature Q:Forms:ezpmtrg Revised121901 _,►. _ �.. -.., ..:+.4, � r. � .;., `?� f � ��: i'ti' y 1'- /;�� w ��.f• i '���� r ,ta f � ' s �i 2 <� f:_ f jjJJ I 1 f K 4 S .yi Z ...f ems. •{�; 5 � . ,.fir.�,r� .. ( q" � • .' � �-� n w "'„ '..1p ��.1. /� F 1� jJ 1 i 1I1r1`1{l � '•r -�R Irl • R ROIDO;3,1N 01 5'4!9 0 5;1'0'3 6�.� liZ w POL'A �.' i I t, I I 1 A 1 ' I �C e i i _ j � � ; ` � ! � � � i . ' I ,I � � '' � i � i � p � � � .. � I ► � � ; f i ' .�. � _ . � . ' i i � i � __,—..— ----.�...--- — , i i i i ! i i I 1 � � i � . i � .-. �� � 1 i � � . .. - j 1�� I � � ,. . . 4 i + � � ( I ( � i i ; i i - � � . _. - � 1 } ! � . .� i � � � �. i � � � i i � ._.._ ._ , ...... ' i "• _ ,-�� . . � ! � ; �i . � ! ' i -- i �� ' ! j i �^ i � i , i � ...._,.___ I � � � � 1 i I � � � 1 i � � � � � i � c i '' E I � I j i i i i � � i � � , � � i � i 'i � . � � � ;i � � � I i ; � � � � i ! i � � � i � i i i I ' � ' � i i ; .� , � � i .I i i � � ( � •� 1 I i I ( � i �� . � J i sue.. i � I i I i . i ,I � � . _ � � i ; i. � i � .. ..� ....•_.. ... r .. ... r �\` `�� �� ��. /� `��\ _.. � � - � � �"�' � � _ �� � . �? -- s � a; • I i .. , � . I . � :,�� � . I�. � . � . . . c�' : � , r i d - i n � . � ,,--. � , ; TOWN OF BARNSTABLE BUILDINg PERMIT PARCEL ID .141 029 GEOBASE ID 7694 ADDRESS 116 TOWER HILL ROAD PHONE Osterv.ille ZIP - LC)T BLOCK LOT SIZE D'R.A DEVELOPMENT DISTRICT CO PERMIT 12817 DESCRIPTION REPLACE WINDOWS W SLIDERS INSULATE AREAS PE:'.MIT TYPE BL1'SMOD TITLE. RESIDENTIAL ALT/CONY ' �,fiN`:L'RACTORS: D1.V I NE, LA.WRENt, Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: $31.00 L30ND $_00 CONSTRUCTION COSTS $1.01000.00 434 REBID ADD/ALT/CONV 1_ PRIVATE P ABLE. MA89, OWNER SAVAGE,. i 0HA] F & MARY J �1639. A��� ADDRESS THREE FORD +:SANE FD Mfg FRAM__NGHAM MA BUILD DI ON BY DATE ISSUED 01 /,19/.1290 EXPIRA:iION DA`1'% THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2.PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ELECTRICAL,PLUMBING AND MECH- 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. ANICAL INSTALLATIONS. 4.FINAL INSPECTION BEFORE OCCUPANCY. A BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1 1 2 2 2 3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 2 BOARD OF HEALTH OTHER: SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVEDTHE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. �essor's Office(1st floor) Map ,.1141 Parcel dZ Permit#- Conservation Office(4th floor)(8:30-9:30/1:00-2:00) Date Issued Board of Health^(3rd floor)(8:15 -9:30/1:00-4:45) Fee ,,,,4ngineering Dept.(3rd floor) House# R MARPL rd 19 619. TOWN OF BARNSTABLE Building Permit Application / , ActS�Jreeddress /lfo W¢l tf village,_ J<_, -LAV-e Owner 4�'., �Ic3�►�._ i19vc'C e . 'Address . 116 �v �r /V G C r2®0._P v51• r Telephone Z;C� gZ'B6 ,.-Permit Request (YJ fsee e✓1k,0,1 .�.. `S - l7cx�✓s 1 �� � ones /y1 Sv�� -fi l�v r 5A n a: COM- - Cif k-/Ci, /a rY S r 44- First Floor square feet Second Floor square feet stimated Project Cost $ Z0- d- Zoning District Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type Commercial Residential Dwelling Type: Single Family. [/ Two Family Multi-Family Age of Existing Structure ®-t- Basement Type: Finished Historic House h! Unfinished Old King's Highway Number of Baths No.of Bedrooms Total Room Count(not including baths) ~First Floor Heat Type and Fuel Central Air Fireplaces �. Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds Other Builder Information me �Q—vc-i c be%j a dephone Number Sc'>Y3 a/Z% dress 1Z6 6V_�- 4 ce 1�r --,-License# cl�,e-10 8 j -I Iome Improvement Contractor# Worker's Compensation# )?_1J. NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE�/ -�•� DATE /cJ Q ti 19 /1 S BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) Q FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED ` MAP/PARCEL NO. + ADDRESS VILLAGE 1 OWNER DATE OF INSPECTION: FOUNDATION FRAME- INSULATION FIREPLACE ' ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL _ GAS: L ROUGH FINAL FINAL BUILDING DATE CLOSED OUT I 3 ASSOCIATION PLAN NO. t I ; #L W The Town of Barnstable Department of Health, Safety and Environmental Services • a,+PUNWABM r Building Division M¢� o 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Home Occupation Registration Date: / /6 9'/ Name: 'Yt+k� F Address: //b Ti e� lo�C/� /`�. Village: �2f 7 a✓!l�Q— Type of Business: "E u f�f Map/Lot: "I y/ZO INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance, provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor, no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit, located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings, and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton opacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • if the Customary Home Occupation is listed or advertised as a business,the street address shall not be included • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. Applicant: ELM Date: 116 The Town of Barnstable • 1�P Department of Health Safety and Environmental Services Building Division e, 367 Main Street.Hyaaais MA 02601 Ralph Crosses Office: Sob-790-6227 BurTding Commis F= 508 775-33" For office use only • - Permit no. Date AFFMAVrr HOME SwROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMr APPLICA71ON MGL c 142A requires that the"tee n=ction,aitemtions;reaovmiDN regal moderniMdOn,conversion, improvement,,=men- 1, demolition, or eonsauction of an addition to,any pre.=asdng owner oezIned building=training at least one but not more than four dwelling waits or to some==which-ate Aacent to such resideaoe or building be done by registered contract m with certain a=001M along with other tequiremmts. Type of Est Cost I� ,--,"Address of Work: /L6Gz-n� �'� vs�• ner.Namc: �`�a✓y S o.-c ' a v a c e_.. ate of Permit Applicauon: I hereby certify that: Registration is not reg4.aired for the following r=son(s): Work Goduded bylaw Job tmder S1,000 Budding not ownawoaUPied Ownerpuking atvu permit Notice is hereby gh=that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WMUN CONIRACPORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT GAVE .ACCESS TO THE ARBTiRATION PROGRAM OR GUARANTY FUND UNDER MGL c 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. S G Contractor name Registralion No. OR IThe Commonwealth of Massachusetts Department of Industrial Accidents ;,; _ Ofllce ol/nvesl/gaUotts 600 11'ashington Street Boston.Mass. 02111 Workers' Compensation insurance.AMdavit .A�lica�t nfnrmation: Please BURR', 1V' /name /_C� I✓1 -e— - /nratinn• f Z� /��1icr' AA ✓ ', //1'/ors }�ti; ✓Lt;[/c vii:A- o2=C! '. 1 am a homeowner performing all work myself. -� 'am a sole proprietor and have no one working in any capacity 1 am an employer providing workers' compensation for my employees working on this job. 4~ com��,y name• address: ci phone#• . insurance co. n(LSY# 0 1 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: ci Rhone#: ipsurnnc!CO. gip•# 7MIR;�'K!"nStif53r.� 'TJRF�A!J1¢'_J�j_._?yvtfRT:!�l�:r. �Fy."�;!!79Rir•7R_4!R?'-"' - - - - ctimpanv name: address: city: nhone#: InSUrnnce CO. :Atiach additional'sheet if rieeessary ;: Y.:= w ter;;t;, :- :.•Cc ..�� .•..�,�� -^�- - - ,�;; ;,; Failure to secure coverage as required under Section 25A of AIGL 152 can lead to the imposition of criminal penalties of a fine up to 51.500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORk ORDER and a fine of 5100.00 a day against me. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do��hereby certij•uWrler the pair s an Wallies ojperjuq•that the iajorntation provided above true and corrrct ,,9 cnature Date ✓Print name 0,P I,& ,Phone# r_ ottcial use only do not write in this area to be completed by city or town official cit, or town: permit/lietase# Building Department ❑Licensing Board ' O check if immediate response is required C3Seleetmen's Office Ofiealth Department contact person: phone#;. rlOiher Irevued IM PJA) '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 emp/gyee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An emp/i►rer is defined as an individual, partnership, association. corporation or other ;L-gal 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 1.52 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commumvealth for any applicant who has not produced acceptable evidence of compliance with the in 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. r:•-we.r!wY�!�-��R!�� _ ` .. <,. .1, •i�,;:�. \^.'�i-Y. 7 aC•:.•. �N�.. `'~�.i".:MrY;^ �i;_!".,'�,'-,::�`+� 'ti' : ci 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 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 afGdayit. 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 for regarding the"law"or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. T. 7 •.._;'. .. :. .' •: __ - '•�'1 ..j.di l�.N �\'q.-f'.�Ldi��'4 •.t(�7.f�•i:: ie•i�h.'s�.s '�ti .. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of'Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. • r;�,,..T..�.,...u-.•.!!�..--•v...ssv,• _ .... ..s ,:•u„�',• ..:gin:. �i �:: �'-r..-s..—,.�...r.+�•�• n4. .- ....1+ .. _ .11 .wr. • •�:fV i. ..f,iy�..P( .J!'+•.; '-'�' ��`3,:T M:'I•'••'• 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) 7274900 ext. 406, 409 or 375 31. f t} . NOME�IMP0ROVENENTiCONTTRACTOR-�; �a Registrati on41.407 . UPC INDIIFIDUAL: SS.��,yy�( ExP.irat�ion," ,06./25/96 � • PO B '7 Devine�1 ��. Peft, urn ed116 2 RtverRidg G� moN " s�Centerville':°NA02647 s{AAD�MINMTRATOR. covsTRU� U p�AQrnfaT of P TIpN SUP f $IIC SAf flr f _ =Restlj_034081._ :._:09iZ0i es: - • may._ thdete: e� Sir To '>�`Cp 1997 09/1p/19a p �. _ �fNTfRV1((f, dA D163 I p, ��.'.�, -y�...'y.#':��+�'�� I`i<-'�,.�y'.F`7'�."J{'-...::.ii�r'"'��^'Et`.�,.f"-'.�..`*.�'�•�'�_..�•'t�`a-r"f:K4..'ai�-�''"^,� :_i'.�"S.ti:f.s-,�I+i^.-=L.�'`%'`+�ysi'+"Fr--i'..�,•�'~ti� -::rrT✓` �.r--•--- -"� r 11 � ..... Assessor's and lot number Sewage.Permit number ........:....:............................................ T ?"ET°�° TOWN OF BARNSTABLE + Z BABHSTABLE, i M6 BUILDING INSPECTOR • pTt'p YPY Or• � ., ERMIT TO APPLICATION FOR P 14 /%�v�nn�✓ �.Y/srlsrl' TYPE. OF CONSTRUCTION ..... l9!J� . ......:........................................................................................................... r'..............�...................19•�/ TO THE INSPECTOR OF BUILDINGS: The-undersigned hereby applies for a permit according to the following information: Location ..�� .. /..JtLI_ '":............................................................... �j/.SILL!— !t' lssi� Proposed Use ............................ -...... .................................................................................................................................. Zoning District .....�.�................................................................Fire District ' �'•'' '•'� . .�/S!7r'................. ................................... �,•�� i3vc. Name of Owner .�1..�.11' ......I-S �'r''V� ,�� ....................................................Address .................................................................................... Name .of Builder .. G—%�G--2 C��✓i�S�' �......: ' ':......Address .......®5 � +?..................................................................... Nameof Architect ..................................................................Address .................................................................................... /"OD- /l39rii Y' / D.�' �-rr Numberof�Rooms ..................................................................Foundation ............................../..........................:.................... Exierior ....................................................................................Roofing ........................................... G::r' '-5"�..............................Interior 7hG- . .....G/C Floors .......................... ................................................................................. Heating�a TIIG...� �f �7 ... i.�1 �?` "........ !Plumbing :J �,....r/ C-rf�...� �{�..... .:..................' '.:.. .... .... ........ .. ........ .. .... :.... ...: ...... ................ ........ .. Fireplace N/1 K� ......................Approximate Cost ..... G+,/�i' /. ..................,........................ ............................................................. Definitive Plan Approved by Planning Board -------------------_-----------19--------. Area lit!?�s '-�1� �'' .. Diagram of Lot and Building with Dimensions i Fee ............................................. ` ! SUBJECT TO APPROVAL OF BOARD OF HEALTH -T � f' r�,.: •� /R'xz240 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ..........................'.................. ...../.... KD0BEIM, MATTBIASi9 ADDITION * No ���.����� Permit for ------------ Single Family Dwelling ----^-----------'^----- ll� ���e� Bill Doad ---.---------.--.------ � . Doterville ..............................................`..................... - Matthias I{ooheim ' ^ ~`~'~ -------------------~-- - Frame ` Type of Construction .......................................... ^ � ' ' Plot Lox � ^ ' l Permit" Granted" ^ Date � of ` ^ .. � PERMIT!REFUSED � / -----_--------------.. lV . . � ... -------- ----------. . _..\ . _______ � | � ............................... � i ----------~.~--------.----- � . ' -------.--------.--...-----,— � � |! Approved lg '----------^----- � ^ --------------------------' | ----------------------..--... | ' � ` LEBEL CONSTRUCTION BUILDERS - REALTORS '+{•� 32 WIANNO AVENUE SICcTc/�- F, OBTERVILLE.MA68ACRUBETTB 02866 S TELapsorru 428.8551 � 1 '�.. f. •tit ,�'�ft +'. r r)/ IJ`Ki t � / . 1 O d it non t� 1 . t 1 p r ' L.1+:131+:1., ('ONti'1'I:11( ;'I'1ON 1 1 f 1S'19:1t VI 1.1.I:. MAYNA/:11 lJri KT'1:`3 02055 '1'r:Lra•u���r:417 rt-N531. • n . 1. "vs� .n...wl•w..Y �/4.—'N1tiln +wwwr•�vi�r�`v".•+r"""'�. } s Assessors and lot number .;...... .. ...............,. .. . - `:. s-� �i� 9•�z SEPTIC SYSTEM MUST BE INSTALLED IN COMPLIANCE Sewage Permit number .......... .l.. ............................. WITH TITLE 6 ENVIRONMENTAL CODE AND yoft�ETa,�. TOWN - OF :BARN1RT5k0 s EJHBSTdDLE, i 03 BUILDING INSPECTOR APPLICATION FOR PERMIT TO /..!'` .......................... TYPE OF CONSTRUCTION ....!!!/O!>® •�/21�/YIL ..... ......... ............................................�...................G.�..........................p..... r.........f.....................1949/ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .���.../dZ,i 2 `71�G �/�� ti'.. il��f�. SQL—"2UlGlrL ...... ........................ Proposed Use .s�(if�GLG �Y..hj/,t �/ yc 'S�O�/��i✓��—.................................... ......................................... .................. ..... ........... ....................... G� Zoning District ,. ..........................................................Fire District T.............s .................................... Name of Owner / ! 5..../f�!it!� ..............Address ...........iS!iTL. .. '.1............................. �/ vL. Name of Builder G:���=L... l�?s ....... C.:. Address ...........-S Z2. 2t//ILG.../.. ss........................ r......A**'***........Address ....-.............s.............. :.......................: Name of Architect•.......................... ............ ................ Number of Rooms .......�:y�...�..h'�'¢'/�"�- Sl�?`�........Foundation .L.�!NLY2G/LG�' ........................ ................. ................................... Exterior ./.!..:e:.. /���L�/GrS Roofing ✓..�. r�T...S / �ZG ....................... .................................. .. . .. . .. ��,��T / 'G.Gr ...............................Interior ... /!`fir /� Floors �... ...�... .... ............................................ Heating ..............................Plumbing ....1,5 l ............................. Fireplace d.. p �GGt/ ................Approximate Cost ...��j.11..���.... s� . 9a Definitive Plan Approved by Planning Board -----------_______-----------19________. Area l>.yav� �ltJ.S` .. Diagram of Lot and Building with Dimensions Fee . SUBJECT TO APPROVAL OF BOARD OF HEALTH ov- DuN liePV 40 _ -Sol G 01 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. �. Name ... ........... ............................... � XDNHEIM, 2Q\TT8IAS � / �J�DI]�IO� `rNo -�������'Penni� {or -- ............................. . 3 ' Siu l ' Dwelling ' ! ' � . � ~ Osternille . ---.�----------------------.. . ^ . � Owner -M��tthi���_I{onb�e.i�_______ . � Type of Construction I ��� � -- � - -----. \ . ' ,- � --------------------------. � ' Plot ............................ Lot ___________ . . /\ - � , O�to�e� 37, 8l ~ Permit Gronu�] -------------.lA Dona of |nxpecion���-::?2........................lV , Dote Completed ------�����k.���]9 / . \ PERMIT REFUSED . ' .... 19 ` � . ............................................ ' . « -.----.---------------....--- / ----^----------''^-~----'---- ' . � | � Approved ................................................. TQ / ] / ' | J --------------------------' �. -----------.---------~-.--... ~ . , t � Assessor's map-and,.lot number �,..l y/. .... .. .. TOE OFT WE SA,woge Permit number . ..... .. .. . .. . ..... 123 Z STODLE, i l � 9 House number .................................. .....11.r.._..,..../............ . rnea 0 m a' 'TOWN OF BARNSTABLE BUILDING INSPECTOR'r APPLICATION FOR PERMIT TO ....... .C.-�,/..4:.0....... ....... �� -................................................. TYPE OF CONSTRUCTION ..... � ,�y.r...�. .'.............. /-�!',/.. ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ... : ........7.—,-..("Y„ .�i '� ...�)��Y............... .'. .` G`: :.................................. .........:Proposed Use .....................i. %oYl... .......: U/ ........:...................................... ZoningDistrict ........................................................................Fire District �........52...............................................:......... Name of Owner ; ?/1.,tT..l'. �..l�U�/../ry �:.....Address �...T(,: .! L:.HI'��.. ' ... ' G .. Name of Builder a.?!....5./.�'Yi �✓/� ....C��. f Address . ......... .... ... ..........,... �:.' �� Nameof Architect ............:.....................'..........................Address .................................................................................... Number of Rooms ',� /� .........Foundation ..... �V��. .............................................. Exterior ...................................�.� �..:................................Roofing ..............:..�/. ...:.��....'............................................ Floors ..................................../V. .�/'/�...................................Interior jV lf ,L.......+.......................................... Heating ....... � ...: ............Plumbing �,f x � ....... .... ... .. Fireplace pp.............................:�:...��...1..................................A roximate Cost .............� � Definitive Plan Approved by Planning Board -----------_______-----------19_______. Area .......................................... Diagram of Lot and Building with Dimensions. Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH f E I i , t f OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS .- I hereby agree to conform to all the Rules and Regulations of the Town of B,aFnstable regarding the above t construction. Name . .,... .�> ................... Construction Supervisor's License,.O' : 6:I3 KUNHEIM, MATTE H. A=141-'29 A202 Build No ................. Permit for .................................... Swimmincr Pool .............................................................................. Location ..1.1.6....ToNer....Hill;...Rog�d............ .... .. .... .... .. . ... Osterville ............................................................................... Matte H. Kunheifn Owner ...........v...................................................... Gunite Type of Construction .......................................... ............................................................................... Plot ............................ Lot ................................ Permit Granted .....�T!�]Mft... .................19 83 Date of Inspection ... ........19 Date Completed .......................................19 Assessor's map and •lot number ...../y!. .. T H E 1� Sewage Permit number 0.. .... Z BA INSTAM E. i House number ........................................ O/+f ........................ '�0,,�039 0� C MAI a TOWN OF BARNSTABLE BUILDING yINSPECTOR APPLICATION FOR PERMIT TO .. .C?.�. //.��` ....... ..... ................................................. TYPE OF CONSTRUCTION ... . yr..l,�.yl.�.7' ......... G!'✓...�YJ9...��.T/....,?� .d�..:.. ............. ...............................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .....114....... j::..../.1.�.�l....��d...............Q t. 7f f. A, ....................................... Proposed Use ..........l�C� .%..:..,P„..!... /...f?1 ....... G(! /... 1...?I?... +. f.... ...... ...........................:...................... Zoning District ..........................Fire District .... .........../.............................................. Name of Owner Address ...... . Name of Builder �i,�.�.. 5�)Y.. .�1�1../ .... 1�.:............Address Nameof Architect .......................I............................................Address .............................../.`..................................................... Number of Rooms /X. Foundation .......�Y ,�` '........... .�...............................................'........ Exterior ..................................: ..i................................Roofing ............../..1� ....�......1............................................... Floors ..............................Interior. ............./ ..... .1.............................................. . ...:... Heating .............................. ...,..................................Plumbing ..........sOL'�Gl Fireplace .................. A ..`..................................Approximate Cost zlr.. ..:C1-r- .�.........`.. Definitive Plan Approved by Planning Board -----------______-----------19_______. Area .......................................... Diagram of Lot and •Building with Dimensions Fee .. SUBJECT TO APPROVAL OF BOARD OF HEALTH 1 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of ble regarding the above construction. Name .. ... .................. Construction Supervisor's Li ense .ea<:: ?!3 KUNHEIM, MATTE H. No�-*................25202 ui Permit for ..B. ............. .... ............... SwimmincT Pool .............................................................................. Location ............. Osterville. ............................................................................... Owner ..M.at.te....H Ku.nhe.im..................... .. .... .... .... ....... ..... Type of Construction .....q14Ait.e..................... ................................................................................ Plot .....*"--*,*,** Lot ................................ June 16. ...........1, Permit,Granted ............................. 9 83 Date of Inspection .....................................19 60, Date Completed .................... 19 Q v� O 1 1 I 0�.i ice'. i Nk.�..2. •. 1' S o Atka 1 < F on z. a -77 �I �3 o• XNCC 91 - EM�O IN�G/•ti •' Esc i5.rl rIG ---_ 1 I . .... ...: ..: :. UA r ! I �,- OF RXHARD ANDEL. P. l.. RSON y vNO. .�Z/•o�F �:•rr. 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