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HomeMy WebLinkAbout0065 WATERFIELD ROAD e �� a y� .. _ .R /tin. �, .rt w-'r'. .C+ f. ,�"'\F►'!I"w+�+'r� ^'...?, �_./'w.�.M�"'�sv����.� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map I Parcel I Application Health Division Date Issued r2 3 0 �- Conservation Division Application Fee Planning Dept. Permit Fee AQ k) Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Village G31 -IrIll lc Owner AI c4, 7 w Address Telephone Permit Request 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 Ql_� Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) BUILDING DEFT.Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new DEC 2 7 2016 Total Room Count (not including baths): existing new TO yjrp Floor Room Count �� Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑Other 0 H RNSTABLE Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Mike McCarthy C®ffista-aaeta®n Name Telephone Number P® B®x 52 A2 � ?� £6£69g-L)IH ££9SS-'� a�,__� ,rt,___is' Address V969-OSZ (SOS) HaD License # Cell (508) 280-6964 OL9ZO YID `SffUua(1 $saw -5 Zs; x®9 ®d Home Improvement Contractor# a ouzaan.14SU03 Ag1.11193;3 I angw Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE 404 DATE )'2d131t( FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ' ADDRESS VILLAGE OWNER . I DATE OF INSPECTION: + FOUNDATION FRAME INSULATION " FIREPLACE _j .ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: - ROUGH FINAL r FINAL BUILDING Ix DATE CLOSED OUT. ASSOCIATION PLAN NO. ELM., 8 - 90- oa r Town of Barnstable Regulatory Services ' 8AJLS Richard.V.Scali,Director t63A `0� Building Division 1bm Perry,Building Commissioner 200`Main St,eet,Hyannis,,MA 02601 www.town.burnstable-ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Ramer Must Complete and Sign This Scction If Using ABuilder Alexis Zou as Owner of the subject propoat;y hcreby author'7.e to act on my behalf,. in all matters relative to work authorized by this billing permit application for: 4 _�. (Address,of-job) "Pool fences and alarms are the responsibility of the applicant;. Pools are not to be filled or utilized before fence is installed and.all final Mspecuons are performed and accepted- E-SIGNED by Alexis Zou Signature of Owner Signature of Applicant Alexis Zou Print Name Prim Name. December 05, 2016 nµrw Q:FORMS:O%NTFRPF-'UAISSIONPOU!S i Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration =—} Registration: 169393 Type: Individual tN ~> C Expiration: 6/16/2017 Tr# 264961 MICHAEL MCCARTHY — 't MICHAEL MCCARTHY ( i > P.O. BOX 52 �<< �" _ ►:; WEST DENNIS, MA 02670 �'A W. f �titi ; r = i + date Address and return card.Mark reason for change. ` r SCA 1 �� 20M-05/11 Address ❑ Renewal [-j Employment E j Lost Card V lL6 (QO�I7/J9207LCUCCCLGI O���JJCLC�C7/J� License or registration valid for individul use only Office of Consumer Affairs&Business Regulation OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: _ Registration: 6,'`j'69393 Type: Office of Consumer Affairs and Business Regulation 12 10 Park Plaza-Suite 5170 _ Ex iration_-=efi14fi%20:1:7 Individual • •,-II,, Boston,MA 02116 MICHAEL MCCA04',Y2 MICHAEL MCCARTHY=-_--.�-,�`,�.-P0=-'i=''1 f 6 RANGLEY LN. SOUTH DENNIS,MA 02660 Undersecretary Not lid with t signature Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-058633 Construction Supervisor MICHAEL J MCCARTHY— P.O.BOX 52 ' WEST DENNIS MA 020; 4-.. `"'"� vim— Expiration: commissioner 04/10/2018 I The Commonwealth of Massachusetts Department oflndlistrialAccident$ 1 Congress Street, Suite 100 Boston,MA 0211472017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE.FILED WITH.THE PERMITTING AUTHORITY.., Applicant Information Please Print Leeibly Name (Business/Organization/fndividual): Mike McCarthy Construction Po OX 52 Address: west Dennis, MA 02670 City/State/Zip: Cell 08)#280-6964 _ UIC-169-93 Are you an employer?Check the appropriate box: Type of project(required): l.Iqfam a employer with 5- employees(full and/orpart-lime),• 7. New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in $- Remodeling any capacity.[No workers'comp.insurance required.) 3.[D 1 am a homeowner doing all work myself.[No workers'comp.insurance required.)t 9• ❑Demolition 4.n I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10[]Building addition ensure that all contractors either have workers'compensation insurance or are sole l l.0 Electrical repairs or additions proprietors with no employees. S.Q I am a general contractor and 1 have hired the sub-contractors listed on the attached sheet. 12.❑Plumbing repairs or additions. These sub-contractors have employees and have workers'comp.insurance.= 13•❑Roof repairs 6.❑We are a corporation and its officers have exercised[heir right ofcxemplion per MGL c. 14.1:3/Other ".f ,-«/,,` 152,§1(4),and we have no employees.[No workers'comp.insurance required.] Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy inforrnalion. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 1Conlractors that check This box must ellached an additional sheet showing the name of the sub-contractors-and state whether or not those entities have employees. If the sub-contraclors have employees,they must provide their workers'comp,policy number. I am an employer thnt is providing workers'cornpe»sation iiisura,rce for my employees. Below is the policy and job.site information. M Insurance Company Name: Al'/ 1 Policy#or Self-ins.Lic.#: 721- -(93 I ) Expiration Date: )a 4- 1/( 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 MGL c:152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify tinder t a- ;$p7lties ofperjury that the information provided above is true and correct. Signature: Date: i Phone#: L500 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 S.Plumbing Inspector 6.Other Contact Person: Phone#: DATE(MMIOD/YYYY) , CCM" CERTIFICATE OF LIABILITY INSURANCE f 12107/2015 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 01962-001 N�IACT Bryden&Sullivan Ins Agcy of Dennis Inc W.I.Ext: (508)398-6060 M.No.: (508)394-2267 PO Box 1497 : So Dennis,MA 02660 INSURER AFFORDING COVERAGE NAIC 0 INSURER A. A.I.M.Mutual Insurance Company INSURED INSURER B: Michael McCarthy Construction Inc IN RER C• P 0 Box 52 INSURER D: West Dennis, MA 02670 INSURER E: 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 TYPE OF INSURANCE 1 yp POLICY NUMBER M � MM/D[j LIMITS GENERAL LIABILITY EACH OCCURRENCE $ AMAGE COMMERCIAL GENERAL LIABILITY PREMISES a occurrence) ccu e e $ CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ OLICY E OT OC AUTOMOBILE LIABILITY EOMBIN'dEBDLSINGLE LIMIT $ c ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPE tle DAMAGE $ AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS MADE AGGREGATE $ yyQRKDEEDg CpM EREgTEpTNTIONN $ AMA TH $ AND EMPLOY0 CULBI% Y X TORY L"I s °ER A AOFFIpROPR UJWPARTNEf3/��LECUTIVE NIA VWC-100-6017656-2015A 12/15/2015 12/15/2016 E.L.EACH ACCIDENT $ 1,000,000.00 (Mandatory In NH) EXXCCLLll1lDDttuu tt E.L.DISEASE-EA EMPLOYEE $ 1,000,000.00 D9W'CRIPTION OF 9PERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION Cape Light Compact PO Box 427 SHOULD ANY OF THE ABOVE DESCRIED POLICIES BE CANCELLED BEFORE Barnstable,MA 02630 THE EXPIRATION DATE THEREOF,1 NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROYISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010106) The ACORD name and logo are registered marks of ACORD TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel t)6Q Permit# 4 1 2? _ Health Division, bvl' // Date Issued Conservation Division bIi� Fee , `Tax Collector Treas4herr INSTALLED IN COMPLIANCE Planning Dept. Chec �Ij�V r TH TITLE 5 Date Definitive Plan Approved by Planning Board Approver REGULATIONS Historic-OKH Preservation/Hyannis Project Street Address ` Village �— Owner ,P , � �l�J/ 1Z Address Telephone c Permit Request 1 0 � Q C. Square feet: 1 st floor: existing / ®�j Q proposed 2nd floor: existing :g1V proposedJ wotail n"�ew Valuation fido,Qa Zoning District Flood Plain oundwatEOver r Construction Type X -0 N Lot Size Grandfathered: dYes ❑No If yes, attach supportin docum6itatior� o r / — m Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure f Historic House: ❑Yes XNo On Old King's Highway: ❑Yes ❑ No Basement Type: Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing_ new — Total Room Count(not including baths): existing Y new First Floor Room Count S Heat Type and Fuel: i4s, Oil ❑ Electric ❑Other Central Air: ❑Yes )4 No Fireplaces: Existing New Existing wood/ oal stove: ❑Yes t (No Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing Cl new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial Cl Yes No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION / Name r, Telephone Number 6 Address License# �5 b661Y7 Home Improvement Contractor# W Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 1 ZZ SIGNATURE DATE FOR OFFICIAL USE ONLY ,1 V PERMLT°40. DATE ISSUED MAP/PARCEL NO. ADDRESS=., VILLAGE OWNER DATE OF-INSPECTION: FOUNDATION r FRAME INSULATION '. FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUdH Ts FINAL t� GAS: ROUE I O FINAL FINAL BUILDING ® Fo ,r -- DATE CLOSED OUT N : ASSOCIATION PLAN a 7W CMR Append!:J Table J5.2.1b(continued) prescriptive Packages for One and Two-Family Residential Buildings Heated with Fossil Fuel MINIMUM MAXIMUM Glazing Glaring Ceiling Wall Floor Basement 31ab Heating/Cooling g perimeter Equipment Efliciency' t Area'(%) U-Val R-value' R•value' R-values R Walu e it-value? Package 5701 to 6500 Hating Degree Days' - 6 Normal Q • 12% 0.40 38 13 19 10 6 Norma! R 12% 0.52 30 19 19 10 6 85 AFUE S 12% 0.50 38 13 19 10 38 13 25 N/A N/A Normal ..---.--.. ---T—-------IS%.------.-..-_036.---- ------ U . 15% 0.46 38 19 19-• 10 85 AFUE N/A V 15% 0.44 38 13 25 N/A / 85 AFUE W 15% 0.52 30 19 19 10 Normal X 19% 032, 1 38 13 25 N/A N/A y 19% 0.42 ' 38 19 25 N/A NIA Normal Z 18% 0.42 38 13 19 10 6 90 AFUE AA 18% 0.50 30 19 119 10 6 90 AFUE 1. ADDRESS OF PROPERTY: L 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: „(' �•v 3. SQUARE FOOTAGE OF ALL GLAZING: 4. %GLAZING AREA(#3 DIVIDED BY#2): 5. SELECT PACKAGE(Q--AA-see chart above): ` NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q4otms4980303a 780 CMR Appendix J Footnotes to Table J4.2.1b: a Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and basement windows if located in walls that enclose conditioned space,but excluding opaque doors)to the gross wall y area, expressed as a percentage. Up to 1%of the total glazing area may be excluded from the U-value requirement. For example,3 fe of decorative glass may be excluded from a building design with 300 ft of glazing area. }C 2 After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for whole units: center-of-glass U'values cannot be used. ' The ceiling.R-values do not assume a raised or oversized truss construction. If the insulation achieves the full -- insulation thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38 insulation and R-38 insulation"niay be substituted"for-R-49-insulation: Ceiling R-values-represent-the sum of cavity---- insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. 'Wall R-values represent the sum.of the wall cavity insulation plus insulating sheathing(if used). Do not include exterior siding, structural sheathing, and interior drywall. For example,an R-19 requirement could be met EITHER by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. 5 The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces,basements, or garages).Floors over outside air must meet the ceiling requirements. 'The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned basements must be included with the other glazing. Basement doors must meet the door U-value requirement described in Note b. The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs. ° If the building utilizes elebtric resistance heating use compliance approach 3;4, or 5.• If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. 'For Heating Degree Day requirements of the closest city or town see Table J5.2:1 a NOTES: a) Glazing areas and U-values are maximum acceptable levels. Insulation R-values are minimum acceptable-levels. R-value requirements are for insulation only and do not include structural components. b) Opaque doors in the building envelope must have a U-value no greater than 0.35. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table J1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c)If a ceiling,wall, floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with different insulation levels,the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). 43 —_- The Commonwealth of Massachusetts JI Department of Industrial Accidents Office of Investigations 600 Washington Street, 7th Floor 3' Boston,Mass. 02111 Workers'Compensation Insurance Affidavit:Building/Plumbing/Electrical Contractors 41 r• .e`$ a+o`6.� €- ��'atA ly h�,,', u u4f.{r h^*: > .-ta.. �tr. L1('J k f! as-w 1 F�' d" 7 s 75 A�1plicanf�<�tfor,matton:,�� >h�� •�Aw,.�. .'�!,� �.a '§�'��2> 'I�^,`le!?t�l.�a�_.:, *��?, '��,���5 ,.;,r �.��,� yr ,�.�y.- ,,w,,����,: a. name: address: city state: zip' phone# work site location(full address): ❑ I am a homeowner performing all work myself. Project Type: ❑New Construction❑Remodel ❑ I am a sole is proprietor and have no one working in any capacity. ❑Building Addition [[�c�, ;.r,+.. •' a.,,C.E,l,y'-, y:.< ->: �;::ls>- _v.::r,n,•s. sr�'p ...i,;u:�i:• Y^"G ;L...G'�!�7,�.1' -'G:E' �Ar:�";��;-:"1� -:Kc:.�_... n• -:. ,E.. ...> ✓;. ..,i :....,• .: '..;�,.yr::,'.;;,,.:7';3,:,;":.^?'i,'.' -t s, -. �, 'aY+r:.ti-:::�:,.::+^^S.a-;u: [� I am an employer providing workers' compensation for my employees working on this job. com an name t ` address:" 55 city: phone#: d` ,el insurance co. Poliev# .e."�.. e..-ad.0,e u.14 lA.Y.Y+z....l,.k v.1U n.M ...•r_.. i.... .. L... .s .:. .. i. !;5•;:;.a M __. „'c... .+•L.,..�5.9,.b,>...- � .. .... < Gi;'a:^a......:+-i:iG`..J. �:'^ .J=1i"�'c:�S :;3f':., ..... .-o r.. ...,_,:.`a'F. ❑ I am a sole proprietor,general contractor,or homeowner(circle, one) and have hired the contracic2tors listed below who have the following workers' compensation polices: company name: address: city: phone#: insurance co. policy# r.�s•`.`% ;h; ,.:T.>Ex'.�.�:'s a,:-�. .:K'9��.�>''�'x;'.,t wti > �''"�`r::'� :3~. ...,..-�`: 2..-i'!.,.. .f„'.2.:... ,..`+. 3:�+'�.. . �.: .... +'s:;' ... - ;;i,l; "company name: address: city: phone#: insurance co. policy# •4Fx E. - r Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. do hereby certify un er lte pai an penalt' ofAer• that the information provided above is true an cor•ect Signature Date Print name ! A + Phone official use on] do not write in t area to be completed by city or town official city or town: permit/license# ❑Building Department ❑check if immediate response is required ❑Licensing Board ❑Selectmen's Office contact person: phone# ❑Health Department ^(rcviscd Sept.2003) ° ❑Other r. Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their ! employees. As quoted from the "law", an employee is defined as every person in the service of another under.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 bean employer. MGL chapter 152 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 commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. 'P f a s ��._ .z�^. .,;-�'a.,. Hr��::N 'nt"i: ��.:.::�a:.^::i'?"''.��,: ':�f•'.' '.t'�:r>•y, � b eR�p'L_;::'•�tia•.r.':e;.;;',�:.�e.'.2 �'?'=+i:'d7v' .. r ' ',y,-:' °?:.phi:r..tn: �- ::;n':+:r'ls;F-,e `ZA e,,-u,.� 5 "'i`v��`' •,es?.7'.rs9o.�.. ° t'... k`:;.'S�::,,+ .W: 4 �.., 'a{+#.���f4YtLk'•E'1�n.,Yw's3+v= 3� t'qy(y.isj:4i'',, + �.r+.}nJ..fl''�5� 'Stri�s�"".T+'1�.=f�'U k�7dS F�,@'Y" ii'2�.�'� .i%is(kfiiT.l�:d�:`rt!;ril:i::��•r'a:: ;:�i:'��:-.H I�i .:�. u1.#�l'li . Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation. Please supply company name, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the"law" or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. :.r..,-,,.r-. -'rs.ru:_ ^R^a.r - -:a;�s�vc r:�9c: '�o'.,N':;rt'ti.7.^. ^r.F"_-e? rti�e -:sfi:;.i:'.•;1'�.:,cY.:r�i•..;;r `.u.,:.rpF;gyr,.F :,:,W.:f r^ !�.+.' s:.'�.�i�;�F!•.'.:,'4§,r td. �?F -C�'?;�:�fi��1m`.a.^35"i` -'.`�.: s..�' � �.:o ,+� t� �..r�l�i'i���,r".` er.t ^�1 s .�....:�. b.,� .- .�'1 ry aaL 5t r..-Y-.fie_ t. r •.+'l<.. .:31'.!-':9 ..�2. 3`� F+ '1 �6f-c sr..>� ? ..rny:it,�';F•. ,.i a � _4R.::j is fro�.�'d`'i��� "�t kt wl�d.y,� '..ye"JYe rxAih �,i.�:.�p"y����Y rSan�t�`.e:s,. s _' •}s* n r`. ?.:i 3.� 3.r�{.`;A.-j_ f � .E�(4.:5:.��-�.:t...r.:,:.: 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•,,.ar:m.:- `>•- ar "GC nr..;, ss��r, •+sv; •,H=rR^',<r..'7i%:nl - a.?, •u"..:. c .:r..�' -�i+'r�'.:J�:'r'rY.,� y^t. -r::F.-'c5y:;x�- r. -;.-�3i8 y .�;r.:�?�r�::.,�i .:,�.. ,..•;ey�!.jte.. f_j`�zt t, 'S�'!.ye rCt!a..1 �, d �ie6. t _$ i t{}t -.r�4�`t"..ei,.x�;sy&,gr `•7�;3�h+,ar1�-'f�at,,y..rw j.r�. '-x�,: .5;ci�'...�;F.,v,{t.:r'f%.::s,ati l- r4� + _ �Y 7�a 2 4 � + '2Y5+ e av �x✓ e N-+� rr S•.riti45 to�� e 6 �F- or vR:.Y`+.nir..�t... s+'r. rft�kW t -w. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street,7`h Floor Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406 °F'WE r� Town of Barnstable Regulatory Services " r a MASMS.erg; Thomas F.Geiler,Director iOrEO na't 16 Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 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: D Estimated Cost Q ,DQIJ j Address of Work: J 0, �! D V faof Owner's Name: A 4 Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the o er: A�5 P,)� / AA K/ 5 Date C tractor Name Registration No. OR Date Owner's Name Q:fon-mhomeaffidav • 'I'o�vn.ofBarnstable Regulatory Service ... . .... .. . . . s anRrrsr�� - - TpomasF:,Geilers°Director q�b ����' Bititding Division v�►'� oraP stoner ., _.. . . .. Tefy;`Blinding Commis . . 200 Main Street, $Yaaais,.MA 02601 =. - :•. .town.barustable;ma.us Fax. 508-790-6230 office: 508-862-4038 Property Owner Must Complete and Sign This Section if Using ABuilder I �U� A4?1 ,as Owner of the subject property hereby authorize: to act on mybehalfs in all rriatters relative to work auth rued by this bu�diag permit application for. dress of ob • , Signature of Owner Date U�SQ Print N=e RESIDENTIAL BUILDING PERMIT FEES • APPLICATION FEE New Buildings $100.00 Residential Addition $ 50.00 Alterations/Renovations $ 50.00 Change of Contractor/Builder $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE �1 2 () square feet x$96/sq. foot= x.0041= p usl from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE / O square feet x$64/sq. foot=�y2 1,4 U x .0041=- plus from below(if applicable) JS Pop J7 7 / 2- GARAGES(attached&detached) square feet x$32/sq. ft. = x.0041= ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $ 35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq. foot= x.0041= STAND ALONE PERMITS Open Porch x$30.00= (number) s Deck x$30.00= L (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) r Permit Fee /3-SI , Z Projcost Rev:063004 i O N " O P RO P 1 S M Y N OT B AT" STANDARD-LEGEND NOTE:not all symbols will appear on a map / GOLF COURSE FAIRWAY \ 330 P f_ 9 __ .-_ -""""'"""" "'1 EDGE OF DECIDUOUS TREES EDGE OF BRUSH / ORCHARD OR NURSERY \ 0 7 \ '7....._'...._G V EDGE OF CONIFEROUS TREES 0 2 i �' r-•-! ,� ; -".. MARSH AREA l - - EDGE OF WATER DIRT ROAD \ / I DRIVEWAY _ �-PARKING LOT 1 q 2 PAVED ROAD ------- DRAINAGE DITCH ----- PATH/TRAIL ' PARCEL LINE** MAI I \ MAP0231EE PARCEL NUMBER �-'" #367 —HOUSE NUMBER 1 I —<� 2 FOOT CONTOUR LINE � 05 0%. -- \ 10 FOOT CONTOUR LINE Elevation based on NGVD29 \. 0 `,•�4.9 SPOT ELEVATION 300 i .... oc-�o STONE WALL -X—X- FENCE RETAINING WALL ` -I-F-1-I- RAILROAD TRACK P c STONE JETTY SWIMMING POOL \ / 38 ;_! PORCH/DECK 0 / ] 0 BUILDING/STRUCTURE DOCK/PIER 7---- HYDRANT e VALVE OO MANHOLE 0 POST 0"' FLAG POLE T O W N O F B A R N S T A B L E G E O G 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 ® STORM DRAIN N PRINTED SUIT:IN FEET *NOTE:This map is an enlargement of a **NOTE:The parcel lines are only graphic representations DATA SOURCES: Planimetrics(man-made features)were interpreted from 1995 aerial photographs by The James 1"=100'smle map and may NOT meet of property boundaries.They ore not true locations,and W.Sewall Company.Topography and vegetation were interpreted from 1989 aerial photographs by GEOD 0 UTILITY POLE ❑ TOWER " e 0 20 40 Notional 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 0. LIGHT POLE O ELECTRIC BOX s 1 INCH=40 FEET* enlarged scale. on the map. at a scale of 1"=100'. Parcel lines were digitized from FY2004 Town of Barnstable Assessors tax maps. °•TM" The Town -of Barnstable BAHNSTA6LC ASS o m Department of Health Safety and Environental Services M t639• `0m `'E�►��' ' Building Division 367 Maim Street,Hyannis,MA 02601 ipe: 508-8624038 c: 508-790-6230 i PLAN REVIEW OwneZ: Map/Parcel: I �� Projecf'Address: � L a�Ql-- t e � � �� Builder: The following items were noted on reviewing: / . 0 0 o LU 114 X I Reviewed by: Date: �5 2 D �� 1 , Assessor's map and lot number, .��..9.-..dS<)• ��-- . S Qyo* rot♦ T E 4 Sewage Permit number A ....5.3 EASHSTADLE, i House number ........ . .. y NAB& 1639- �. .......... ..............................:, . Ni a. TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR i'� ... / ��/L r:....................... OR PERMIT TO ..:.... ......................................................... TYPE OF CONSTRUCTION ..... �?d��....../.,,,/�iy1/.� ............................................................... . .....P .................... . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for ��a��permit according to the following information:: Location !a' ................. �lf--t•'� �/`��........................................................... y/z /'•........................ ProposedUse .......................................:................:...............�:..........: C'. ��,�/:if_'/1S/r�..,6.• Dl% .l <,.1` ZoningDistrict ......... ................................ ..F_.......................Fire District .....................................`:.:.....................y Name of Owner .......Address iName of Builder ........................./..........fi................�..J..............Address .....................................................................n../..�........:. Name of Architect yil. ............./•����/t'�..........Addr s� /i��<✓��/t�xl/ /�/Ll � 6 .^.. .......... .ice'............................. ..... Numberof Rooms ................................................:::...............Foundation .............................................................................. Exterior �� ®° i9Jc�/J 1/Doi> �'� ./ ...... ..i����... ...................... ........:. .................................................Roofing .................... ,�F /�e� von . i Floors .. .... ..... ....�......Interior ............Q................................................................ �d..::........Plumbing �, 1✓ ....1'� • .. ... .......... Firepp ......................Approximate. Cost lace ...............����.:...................................... .............................:......................:. Definitive Plan Approved by Planning Board -----------_______-----------19_______. Area .......................................•... -Diagram of Lot and Building with Dimensions Fee f SUBJECT TO APPROVAL OF BOARD. OF HEALTH I. OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name s;/.e r ... 11j:6...:... rn •./................. Construction Supervisor's License,_ .... �/%. �j............. FB 2 BRIODY, P. OLIVER A=119-050 28029 13� Story No ................. Permit for .................................... 0 Single ingle Family Dwelling ........................................................................:...... Location tiol Location Road... ...... .... 0 .....................*.tervale....................................... Ow r Owner ....Oliver. ......................... l� Type of Construction ...Frame............................ ................................................................................. Plot ............................ Lot ................................ Permit Granted ......June...1.4.11..................19 85 Date of Inspection ....................................19 Date Completed ............................... ......19 t: A s sesibr's map and lot number .11.5.1.7..52 65V.............. sTHE + Sewage Permit number ..............................5 . .................. SEPTIC SYSTEk"t ft-­: 0I INSTALLED IN C­_, 13AANSTAMLE, House number. .....................4....................................I...... MAO& 1639- & r TOWN OF BARNSMA91 Zk, i 1,t ET%r; BUILDING INSPECTOR APPLICATION FOR PERMIT TO .... ky ...........Z . ................................. ....................... TYPE OF CONSTRUCTION ......4�!9.�........ ................................................................................. ..........................................I gf- 5. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the fall wing information: Z ........... .....4.�.......... Location .... . .................................................................................................................................... ProposedUse R/ ................................................................................................................................. ZoningDistrict ... .......................................................Fire District .............................................................................. Name of Owner ........................... .11, ..................Address 4r�. ............................................ �/fe1/l/�/Gf3/h/� Nameof Builder ...............................................Address ............................................................. Name of Arch itectcrlllm� ......Al */Y/...........Address . ................ 4%*ezl�I/ ........................................... Numberof Rooms ..................................................................Foundation ............................ .......................................... rl Exierior .........Roofing ............................ Kc....................... ........ ..... .... ....... Floor�s 44....4...0,.o.E... 'ior ..............................................................Inter ...................................................... -7- MAZ' �:,r4 2­7 .................................................... Heating ....................... .2 /..;11_0� . ...... .........Plumbing .., Fireplace ......�W./.............................................................Approximate. Cost .................................. ....... Definitive Plan Approved by Planning Board ----------------------------- Area .... ...... Diagram of Lot and Building with Dimensions Fee ......................... ........ SUBJECT TO APPROVAL OF BOARD OF HEALTH 6' ��, � o OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. 1A �e P,/ Name . ../1-1-1111-11,11 , Construction Supervisor's Licensef 10�'19fp............. BRIODY, P. OLIVER No .28029..... Permit for .... Story ............... ...... . .. .. ........ Single Family- Dwelling . .................I............................................................ Lot 1, 65 Waterfield Road Location ................................................................ Osterville ............................................................................... Owner .....Oliver P. Briody Type of Construction .....F.........rame.......................... .. ............................................................................... Plot ... ................... Lot ................................ Permit Granted ........June...14...............19 85 Date of Inspection ....................................19 Date Completed ... ............. 19 3`T .81 0 3a CQ=�L T/F/A-Z;P pL oT A:PL,AN EFEE'�,c/cE: 2 f,/E,L�EBy CEE'T/FY TN�4T TL-/E 6C//LD/�cl6r SNON/.V cml TN/S PL.4.V /S LOCATED OA/ THE _. _ OF M,psf ARNE sc� H. OJALA HI wn cam en9ineerir�9 � �zss.s o . G/V/L E�c/G/.t/EEc3 o��Jf/q T i Gsa.va sc�av6Yoea �� �1/��� AM 120c/TE 6!a^-Y1peMOC/TNi M1,i53, a�a� �e�. L�i�va c/ev�tiroe TOWN OF BARNSTABLE Permit No. .28029 BUILDING DEPARTMENT I ""'> I TOWN OFFICE BUILDING Cash ,6)V X HYANNIS.MASS.02601 Bond CERTIFICATE OF USE AND OCCUPANCY Issued to Oliver P. Briody Address Lot #1, 65 Waterfield Road Osterville, Mass. USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND.IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. August 16, 19....91........ ... ........glnspector............. Build I ��.,� °•. TOWN OF BARNSTABLE BUILDING DEPARTMENT _ RAREST � TOWN OFFICE BUILDINGMAIL � tg .63q. �o1uY►��� HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department DATE: 6"1� —9 1 An Oc"cupancy ,Permit has -,'been issued .for the;,building authorized by , Building Permit #.. .. • ............................................................................................. _ .._......__. ...�.._ . . . issued to .... /LLQi1.R11..3-4i ll P ................................_..................................................»..........._.................__ Please release the performance bond. i ` THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) m A DATA :PINK-DEPT FILE COPY/WHITE Z O-FIELD COPY/YELLOW- APPLICANT COPY ) ~ ( r Ir ( ,fie BUILDING a TOWN.OF.BARNSTABLE, MASSACHUSETTS a y PERMIT -mo o V.A. (TIQN 85 D s D9/ Owner ATE 19 PERMIT No. '#r APPLICANT ADDRESS n�1¢;'.,%j PA - i (ND•) (STREET) (C.ONTR S;;LICEN'SEI PERMIT'TO•' :. Build•dwelling �-). .;:li rle Tamil dWellin NUMBER I (_) STORY ' y g .. �:.,�;.`:•t,�',:.. '-(TYPE OF.IMPROVEMENT) N0. 'DWELLING,UNITS:?•''^ �`':'u:' (PROPOSED USE) ' "" _ AT'(LOCATION) of b_) L"Cr._�.. :,: [:Oqd Osterville zoN)Nc ' (NO.) DISTRICT 'RC`'j (STREET) • I BETWEEN .r..... AND .. '• (CROSS STREET) "' "�r (CROSS:ST REET),�; ,':�•.. SUBDIVISION LOT LOT BLOCK SIZE j. �::• BUILDING •IS:TO.RE FT, WIDE BY FT. LONG BY FT, IN HEIGHT AND SHALL'CONFORAI•IN:'CONSTRUCT.IC i? .. TO TYPE USE GROUP BASEMENT (HALLS OR FOUNDATION (''�•.( `''' REMARKS: .'�' . .�...'._.J '.�'..,.•. ,�: own°E 1476 Sq, f t. ESTIMATED COST 40 f 000' PERMITr r (CUBIC/SQUARE FEET) •'FEE qt •, 83�,00,:'e Vx P. Oliver Bri0dy Fky .•D RE �"j' k •,..'yt7 BUILDING.:OEPTti crnn iIHE�p�rUgZ-T'C':^w7yR 5: 7Ht ISSUANCE OF TH'fS p BY A 12 >'..r� sa.y5�),j�•Jk�, `�`�___�T OF ANY PPLICABLE SUBDIVISION RESTRICTIONS. ERM`IY�Q�S N '- ELE.AS .. HE APPLIC N FROM THECON DIT IO MINI CALL INSPECTIONS REQUIRED FOR APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICCA L AL�I PLUMBING INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL i 3, FINAL INSPECTION BEFORE FINAL INSPECTION HAS BEEN MADE. I OCCUPANCY. ' POST THIS CARD SO IT IS VISIBLE FRO IV� STREET BUILDING INSPECTION APPROVALS PLUMgIN(i INSPL(,IION APPROVALS ELECTRICAL INSPECTION APPROVALS z -- ox L . 3 .- HhAfIMr,INSPLCfION I\PPlTUVAL$ ENGINEERING DEPARTMENT OTHER 1 BOARD OF HEALTH WORK SHALL NOT PROCEED UNTIL THE INSPEC• PERMIT '+J! L BE,TOR HAS APPROVED THE'VARIODUS STAGES OF EORK IS NOT STAROTEDNUL WITHINN$DjX o0NTH5 OFID IFSON DATE THE ARRANGED FOR BY.':.TELEPHONE OR WRITT RE ~ CONSTRUCTION. E R M I T ;5 ISSUED AS NOTED ABOVE. INSPECTIONS WDICATEp ON THIS CARD CAN NOTIFICATION. ✓fie (oomvn)�ruueaC o�./�aaaar/uraslld BOARD OF BUILDING REGULATIONS License:1190NSTRUCTION SUPERVISOR Number:-CS 066147 Expires;02/05%2007 Tr.no: 9402.0 n Restricted 00a1 _ r CRAIG J RILEY PO BOX 382 /f OSTERVILLE, MA 02655 Commissioner ✓1Z6 ZdOO7UlJl(YIZUJeCG(,[/L d�✓!/LQ6JCLC/Lp4P,�b ^� .- - .. -_ Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 125799 Board of Building Regulations and Standards Expiration: j/30/2006 One Ashburton Place Rm 1301 Type: Private Corporation Boston,Ma.02108 C.J.RILEY BUILDER INC CRAIG RILEY 1322 MAIN ST, OSTERVILLE,MA 02655 '� ''• ,Administrator t"Oor�e Date: 5/10/2005 Time: 2:46 PM TO: ® 7,15087780268 Page: 001.002 ACORD. CERTIFICATE OF LIABILITY INSURANCE 0SM0 s°""Y' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling&O'Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Agency ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 222 West Main St.PO Box 1990 Hyannis,MA 02601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Western World C.J.Riley Builder, Inc. INSURERS: Associated Employers Insurance Compa P.O.Box 382 INSURER C: Osterville,MA 02655 INSURER D: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POUCYEFFECTIVE POLICY EXPIRATION LTR NSRE TYPE OF INSURANCE POLICYNUMBER DATE(MMIDDIM DATE IMMfDOrCn LIMITS A GENERAL LIABILITY BINDER230004 05/02105 05/02/06 EACH OCCURRENCE $1 QQQ QQQ X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $1 OO O00 CLAIMS MADE a OCCUR MED EXP(Any one person) $ 000 X BI Ded:500 PERSONAL 8 ADV INJURY $1 000 QQQ X OCP GENERAL AGGREGATE S2 00Q 000 GENt AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG S1,000,000 POLICY F PRO- FLOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO Me accidenQ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY S NON-0WNED AUTOS (Per accident) PROPERTY DAMAGEH1 $ (Per aoddent) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG S EXCESSAIMBRELLA LIABILITY EACH OCCURRENCE S OCCUR CLAIMS MADE AGGREGATE $ S DEDUCTIBLE $ RETENTION $ S TH- B WORKERS COMPENSATION AND WCC5001 S91012005 06/05/05 05/05/06 WC sTATU_ ER EMPLOYERS'LIABILITY T P ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $100,000 OFFICERIMEMBER EXCLUDED'/ E.L.DISEASE-EA EMPLOYEE $100,000 SPes,desce under ECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500 000 OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS RE: 65 Waterfield Road Osterville,MA 02655 Operations performed by the named insured subject to policy conditions and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Bamstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL ILL DAYS WRITTEN 367 Main Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO 50 SHALL Hyannis,MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORRED YPRESENTATIVE V� r- ACORD 25(2001/08)1 of 2 #38205 MAK o ACORD CORPORATION 1988 -�� - SMOKE TECTORS REVIEWED IMPORTANT � ANY CONSTRUCTION THAT INCREASES LIVING SPACE BARN ILDING DATE BEYOND 1200 SQ. FT. PER LEVEL MAY REQUIRE.THE - INSTALLATION OF ADDITIONAL SMOKE DETECTORS. NT TE NOTE: A SEP�TM PERMIT IS OKE DETECTORS-THE ELECTRICAL CAL BOTH SIGNATURES THE ARE REQUIRED FOR PERMITTING INSTALLATION OF S ---- - PERMIT 0 S 0 SATISFY THIS REQUIREMENT, r' :aC. t ` : : t k , • n" _ : YA �10 ,, .._. _—_-_��Ljig ~�• ye`�:. ?r c"J" L e CC v c.t�j l S� a c_ .P 'LcCeSS m "'� I X24�! i ......_.-----.....--'.'..._.y.._._....__..._.- I : r �^•`•._.wa.�..�,a:r� ---�.�-�+-.�...�•...�.eo.�.� �.a.--.�s.�ws.�.rv,u,.,.,w,�...•.� — — .�...�..�..�r_x�._+.s.se...+�..r�.�...:ma._+.n.s..,�,.���v..e_e,.�.�_ r�.6�mr_�,..m..�-'«no��r��-.rw._C'h__.k___-"�..u:an.w v i ! ! it it Aid 4. y II f f! ;� I I � ,I jf .. I '' � I ... '�'.,.� I—r----•—� :,. i I` n4 1P Ay IIi; i I li I , : f 't I 1 i I I t i NA r I • iiJl� Cti _AJ il! Lip �r= i �t �I I '^"'a-'...:••�•.�..�.....��.�.�..,..a.....�«.e..a�....,..........�,o„�.�am�•...�,•...e..��..�..aoe.•e-.�,..m..«.._..�.......-�.......+.�......e-.o,.,,....�.....-..:q'..a...,�.. .,,.........-,-+.,......+..�.«...._....:,�w........._..- -_,_...-.....«...�.a:_e.,��-......-.o...a...................._....._..-.,:...._...._......_.._..._....,—,�.�.......e-...o...,..,.....e.,.w....:4�.-......................,...,....�.�,•-��..--.,..�......_._�.o......� _..n.._..I!! �. • I M I • I � �r (I�'�-5 I-= --;..'.�::':����-�_° !.\��. Ili-,. ! •I , lip ,r.meat:c,, `q V� I E, I , r y. -.. --- _-------.............. ...... .... I • Ip i . I r i ;li!II 3.ksvx r�_dfi i I � �_..._._-°I i�o T' t�i I�I I I. y � � � { .� ,t��acy�ii� C.,a..:,a;•;l �, !IF I . 14 ............._....-..,.,_.......__. mua._yp:.•�l$].`.;�..Seri ,: - aisaro ei.