HomeMy WebLinkAbout0111 WEST WIND CIRCLE l ��
1, /
J���i����"ec�/�1�� C%���
n
w
�i
c °
a �
e
o.
C{�
°
a
e
_ o a
a
a ^
^
c
a o p =
o E =a
V a
4 ,
a
°
a
a
c n
e
0
` v
:
X-PRESS PER IT
own of Barnstable *Permit I �O�iL (0 j
Expl" nths iron issue date
SEP 2 0 2013 Regulatory Services Fee
• BARMABU&
163 Thomas F.Geiler,Director
N ®F'ARNSTABLEB
uilding Division
Tom Perry,CBO, Building Commissioner
20.0 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-86274038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
of Valid without Red X-Press Imprint
Map/parcel Number u
Property Address )�. 1C4
[residential Value of WorA Iko O Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address
Contractor's Name Telephone Number n
,\ r
Home Improvement Contractor License#(if applicable) �L� Email: 1 nC . &Jfv\—
Construction Supervisor's License#(if applicable) CS Wo
❑Workman's Compensation Insurance `
Check one:
❑ I am a sole proprietor
VI
am the Homeowner
have Worker's Compensation Insurance
Insurance Company Name I/ Q A Aek 4D
Workman's Comp.Policy#�n�. ��
Copy of Insurance,Compliance Certificate must accompany each permit.
Permit Re st(check box)
Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to 9"
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows
#of doors:
❑ Smoke/Carbon Monoxide detectors 4 floor plans m/rkeSandi pections required.
Separate Electrical&Fire Permits required.
*Where required: Issuance of this permit does not exempt compliancp t regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property f rmission.A copy of the Home Improvement e s &Construction Supervisors License is
fired.
SIGNATURE:
C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Fil Content. tlook\8R76BDVA\EXPRESS.doc
Revised 061313
CERTIFICATE O LIABILI Y INSU ANAETE(MMr°D/VYTY)
THIS t ERT,IFICATE IS SUED As A MPON
08/30/2013,
CERT1 ICATE DOES NO AFFIRMATIVEL OR NEGATIVEL AMEND,EXTENt OR ALTER THE OVERYONLY Al�D CONFER RIGHTS UPON "HE ITHE UCIESEBELOW.H
THIS G ERTIFICATE OF J SURANCE DOE NOT CONSTITU A CONTRACT E TWEEN THE IS UING IRI2tCD PRESENTATIVE
OR PRO DUCER AND T CERTIFICATE LOER.
farmsIMpOR ANT; It the cent cafe holder is a ADDITIONAL INSURED, the policy)es)must bo end rsed,It WAIVE , subject to the
t nd conditions o the Policy, cart. policies may r quire an endorse enL A stBtem2 on th not con r rights to the
i!"Ii to holder In lieu such endorsem nt s).
P DO
-CONTACT
OLDE1 APE Coo INS GCY NAME:
2S6 WINTER ST PH E FAX
AIC,No E A/C No
IIII I I e+wa
YA I5': MA 02601 AODR963:
� I I � 'I i
IC II: !'', INSURERIS)AFF RDINO COVERAGE
II NAIC y
INSURER A:THE TRAVELERS I OEMNITY COMP NY
I11 III !I I;' INSURER B:
PI TA,'H R;, MSCHAEL A
I M�`Ai H. ,SRorwERS NSTRUCTION INSURER Q
9 FI�H, R�1LD!!STREET IN�uRt-Rp
I�>7 TI'M� M1 LLS MA 2648 INSURER Z.
INSURER F:
LO1! . GES i: ERTIFICATE NU BER: RE SIGN NUMBER:
j EMIlit I, SITO OERTIFY fl iAT THE POLICIE 5 OF INSURANCI LISTED BELOW 1AVE BEEN ISSU ED TO THE INSU ED NAMED ABO IE FOR THE
t IIP L. PIPER►.OD'INDIC tTED, NOTWfTHI, TANDING ANY R QUIREMENT, TERM OR CONDITIC q OF ANY CONT ACT OR OTHER OCUMENT
W 1,,1I i �'H RESPECT TO WHICH THIS CER IFICATE MAY B ISSUED OR MAY PERTAIN, TH INSURANCE A FORDED HY T POLICIES
pC RIBED'HEREIN I SUBJECT TO L THE TERMS, XCLUSIONS ANC CONDITIONS 0 SUCk POLICIE LIMITS SHOW MAY HAVE
I
1 IYI 39 b REDUCED BY P D CLAIMS,
LrR kIILL; TYP F INSUR CE INSR WVD OLICY NUMBER MMIDDIY Y MM1D N YY Li TS
s QEN RAL LIABILITY EA OCCURRENCE E
II
iI) 0 AGE TO RENTED —'
MMEROAL OENER LIABILITY PR MISES ee O=umnce S
II Clq►MSMAOE OCCUR M EXP' none eason S
ti P AL A AQV INJUk
IERAL AG REGATE S
kll
EPr.AGGREGATE lt4R A I PER: PR DuCTs-COMPA7P a c
OLICY PROJEC LOC 3
BINED SINGLE LIMN
6VC MOBILE LIABILITY v Cciden S
f�l BO LY INJ RY eI e�ffigS
ULED
fill
kNYAUTO BO ILYINJURY Peraacio t S
Li(MINED AV
PR ERTY O WAGE
i
I UTOS AUTOS P acciden s
i tI� IRaD RUMS s
!II EA OCCURRENCE 5
Lf II UMSREL A LIAR OCCUR a REGATE s
' II ExCE LIAR CLAIM&MADE S
I v *ATV- "
Ij )li OED I RETENTION 3 1 1-09 2 1 1-09-13 x TO Y LIMITS
A VVOI HERB CoMPENSATIO (6KUB-4 9P84—A—12) 100,00(
ANCEMpLOVER6'LIABILI E EACN ACCIDENT S
ANN PROpMETOR(PARTN /EX(ECUTIV Y E DISEASE—EA EMPLC E S 1001100
OFF GERIMEMBER D(CLU NI
(Ma IdoWry in NH) N001
E. DIS SE—POLI YL IT S 500
I�yE de°aibo under
E, IPTI N OF OP A NS be
i
DE8CR1 TION OF OPERATI S GCATIO SIVE IGLE. AttA h ACORD 101,AC Mona)Ramat,Schod le,IP moro space Is m sired)
CA CELLATION
LL
CERTI ICATE HOLDER HOULO ANY OF THE BOVe DESCRIBED PO IDEU BE DIN ACCE. BEFORE THE
XPIRATION OATS TN EFO,NOTICE WILL B DELIVERED IN ACCO DANCE WITH THE
OLICY PROVISIONS.
TO' N OF BARNST LE BUILDING ' EPT.
Al ORIZED REPR— THE
23) SOUTH SIRE MA 024011
HY NNI S ® 88.2010 ACORD ORPORATION, it rights reserved
E{COI D Z5(2090lO6) The ACO D name and logo are registered ks of ACORD
l•
0"
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
Construction Supervisor
License: CS402260
hHCHAEL S MEA,0HER JR
97 EMERALD LANEti1� s
Marstons Milts WA 02648.
Expiration
Commissioner 11105/2014
�Pomvrreoruacall/l o��caauc/tuaelld
Office of Consumer Affairs&Business Regulation
— ME IMPROVEMENT CONTRACTOR
egistration: 162938
Type:
xpiration 4/27%2015 DBA I
MEAGHER BROTHERS CONSTRUCTILN
MICHAEL MEAGHER,JR<Yr: %.
97 EMERALD LN
MARSTONSMILL,MA 02648 �--
Undersecretary .
Unrestricted-Buildings of any use group which "•
contain less than 35,000 cubic feet(991 M3)of
enclosed space.
Failure to possess a current edition of the Massachusetts
State Building Code is cause for revocation of this license.
For DPS licensing information visit: www.Mass.Gov/DPS
License or registration valid for individul use only
before the expiration date. If found return to:
Office of Cbnsumer Affairs and Business Regulation
s 10 Park Plaza-Suit 170
Boston,MA 0211
i
No slid Without signature
• i
• eaatvsrna�. •
MASS,
A,� Town of Barnstable
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
6t L ,as Owner of the subject property
hereby authorize ( ,LAM�(,, �-'-k4,= � 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
rint Name
If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the
reverse side.
C:\Users\decollik\AppDataV.ocal\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\8R76BDVA\EXPRESS.doc
Revised 061313
The Commonwealth of Massachusetts
Depaphnent of Indushial Accidents
Q,Q`ice of Investigations
600 Washington Street
Boston,MA 02111
n,mv.nrass.gov/dia
Workers' Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(B ssro aa&aNiaoal) (,(n s L r4t.rM—
Address:
City/State/Zip. �VL✓� 1�1 �d �phone 4-
Are you an employer?Check the appropriate box: Type of project(required):
L L2 I am a employes with _ 4. I am a general contractor and I 6. New construction
(full and/or pat"=).* 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 8. F1 Demolition
working for me in any capacity. employees and have workers'
[No workers'comp.insurance comp.insurance.I 9. Building addition
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 I LE]Plumbing repairs or additions
myself. [No workers'comp. right of exemption per MGL 12_❑Roof repairs
insurance required.]i c.152,§1(4),and we have no
employees.[No workers' 13.0 Other
comp_insurance required.]
'Any appticzar that checks box#1 must also fill ant the section below showing their workers'campmmdon policy informs ion.
I Homeowners who submit this affidadt in&ating they are doing an wank and then hire outside contractors rust submit a new affidavit indicating such
$Contractors that check this bu must attached an additions!sheet showing the name of the sub-caartracmis and state whether or not those entities ham
employees. If the mb•commaors have eokplayees,they must provide their warkeas'comp.parity number_
1 am an employer that is providing workers'compensation insurance for my engA7j eeL Below is Hie policy and job site
information
Insurance Company Name:
Policy it or Self-ins.Lic.#:1 vl `Yl��� ' /2 Expiration Date:11 `t l
Job Site Address: U ✓- City/State/Zip:a_�_t!!
Attach a copy of the workers'compensation policy ratio page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 2. of MG 152 can lead to the imposition of criminal penalties of a.
fine up to$1,500.00 and/or one-year imprisonment, s as 6 penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator_ Be a t&cor, of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage ti
1 do hereby c fy nKdff the pains and penalties v it Brat injonuation prmddedd�above is trite and correct
1 .
S ture: I te: /
Phone
Official nse only. Do not write in this area,to be mpleted by city or town gf'iciaL
City or Town: PermitUcense#
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#:
-' •+ ..+ix�u•i.�'�3-.��'_ _ .. `,."".}'"f.;,.;,.?".YFi._...�f^.:.�:JR �..!-'1 .�s't�`+....,_.L„r!` "4^rl� �! �...: • .- •.7,3 r"v:Y1 .�S" ...:
;� • ° a TOWN OF BARNSTABLE permit No. ---?$68S___-.•__
e
t Building Inspector
Cash ___---��_--
IL �
�
OCCUPANCY PERMIT Bona
---x -
1
Issued to Theo Construction Co. Address
Lot #29, 111 Westwind Circle, Osterville
Wiring Inspector Inspection date
Plumbing Inspector Inspection date
Gas Inspector Inspection date
Engineering Department \` Inspection date
Board of Health Inspection date
THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL
.SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN
REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE
BUILDING CODE.
..., 192�! r,��..... ........ ..4.........� ,.�„..._ r
l/ Buiillding Inspector
' F
i
5
t
..�' °• TOWN OF . BARNSTABLE ti
BUILDING DEPARTMENT
t sears = TOWN OFFICE BUILDING
rua
1639. HYANNIS, MASS. 02601
OIIpY ��
MEMO TO: Town Clerk
FROM: Building Department
DATE: IS P
An 'Occupancy Permit hasp:,been issued for the building authorized by
Building PermitA$ .. ...... .5,{ _�? _..........................................- .........................................
�
issuedto .... ..�. �. ...............r'......_ ................ �._...._........... ..._.. ...__
Please release the performance bond.
._ .ter„...s_... .. .. _.... .... .. ... ...�. f
''TOWN OF BARNSTABLE, MASSACHUSETTSPERIN 2
JOB WEATHER CA.RO_
GATE ' 19 PERMIT NO.
APPLICANT .`•� `?'•U �..t 1.^.�1Y iC j.' i9:.._ •,..a:•l:t.l
ADDRESS _ .
(NO.) (STREET) (CONTR'S LICENSE)
PERMIT TO STORY "r ' NUMBER OF
(_)• (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) DWELLING UNITS
AT (LOCATION) . - :•, 4 1 1 '"•'`^' • ' . ' s`' '' .•...... ZONING
(NO.) (STREET) DISTRICT
BETWEEN AND
(CROSS STREET) (CROSS STREET►
SUBDIVISION LOT LOT BLOCK SIZE
BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS:
AREA OR
VOLUME J ' •' ESTIMATED COST J PERMIT 7_.:.cJ
.(C USTISQUARE FEET),
OWNER
BUILDING DEPT. f '
ADDRESS BY
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY.OR
PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP-
PROVED 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 THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE
INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR
ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND
I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE— MECHANICAL INSTALLATIONS.
2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALLNOTBE OCCUPIED UNTIL
M IRE TO LATH). FINAL INSPECTION HAS BEEN MADE.
3. FININAALL INSPECTION BEFORE
OCCUPANCY.
POST THIS CARD SO IT IS VISIBLE FROM STREET
BU LDING INSPECTION AP O PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS
2
0
3 HEAT:-4G :NSPECTiNG APPROVALS REFRIGERATION INSPECTION APPROVAL
� m a L6
Z-17
2 � 0 � Tr
L 'NE PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION iNS�ECTIONS INDICATED ON THIS CARO I'
WORK 15 NOT STARTED WITHIN SIX MONTHS OF DATE THE CAN BE ARRANGED FOR BY TELEPHONE
_'AGc' =F =7VS"�4r',fir'• PERMIT IS ISSUED AS NOTED ABOVE. OR WRITTEN NOTIFICATION,
•
Mg
CERTIFY THAT 2nls LOT/S NOT LOCATER IN FEA,.:RAL F4000 HA.ZARP LONE
-" "AS .5wwN ON THE FEDERAL FL000•INSURANCE RATE MAP FOR THE TOWN OF '
COMMUNITY PANEL NO. EFFECT/YE AATE:....,�.
ROBERT E. RAYMONP, R.L.S GATE NOTE- NORTH ARROW NOT"TO
BE USEp FOR S0.(,.4R PURPOSES Z Z
' av
0 n
30• O >� •
V� 3 JN
ZL
�J 21740 SFN ~ may
(4
o�J O C �
— 1AT-4c�
310 31,E n � ~DIR ,ov
G •
n F� \
� O
QS
D
oho
TH/S PLOT PLAN WAS NOT MA Pe FROW FOUNDATION IGOCAT/Off-PUN . .
AN INSTRUMENT SURVEY ANG /S FOR THE
USE OF THE BANK ONLY. UNDER NO
CIRCUMSTANCES ARE OFFSETS TO BE Y1
USED FOR FENCEtiS, WA4k,5, HEDGES, � ,v l AII -
Erc. OWNED BY:
��A��H OF Mq�s9 AA /1 O ENG/NEERIN �► INC.
o� �y 60 EAST iAi mouTH H/GHwAY
ci ROE. °� EAST FALMOL/TH MA. OZ536
,o RAYMOND CASCA E% AATE' SH/EE�j '
9 0.21583 a y36
F FC'
o BY CyE Y APP BY: PkAN NO. '
r
dal_ 6EI� �.� I�9I S`1
Assessor's~map and lot number ............................��...3....e ti 0*TNETo
Sewage Permit number '..S. SEP I J SYST e�P ♦�
F 0qS e4LLeO IJ CO ? ,? S ,ASd9TODLE. i_.
Rouse number. ...........L/l.....�!.!!.!��,� � �ll/JTfi TITLELA 9,0• N 9
EN1/JRpN 5 �o
1�AEN- )07: ,Amo
TOWN OF BARNSTA�B- -,o;,
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO ..................... �. :....................................... ................................
TYPE OF CONSTRUCTION ......� . ......:L`�!�. ........ . je'
..................4, ....... .�,�....19G.'•�
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ....... .7........W.Cr ...A.../N.D.....e.4. ..........�.�. fL��.�if/..G.��......
ProposedUse ...............D... ................................................................................................................
Zoning District ........... .............
............................................ District ..............................................................................
Name of Owner ....TAM 0...��OA1.1.1Ir ,�..Q'L�......Address ..............�.�..��7r.iQ//J�J(.�L/...rt/�j�...................
Name of Builder .......�� RQ...: I f� .f �,�(f�./.Address ..............J..,...Y�18.j�!,1(,}� 7-/..... ...... ....7-//....................
Nameof Architect ..................................................................Address ....................................................................................
Number of Rooms ..3..1.�t.,�.�.,�../..I/r� . a ... .�.T...Foundation ......p.d.. ........ jv.f.�.Ir: .T .......
,p y� O/
Exterior .........W..I/). �.-...c�����..�.IfY'G��.Roofing ......./.a...1.��1T�-.7........ .......
Floors ......................�A.r .l:..�r..r�.........................Interior .......),D.A..�......W. .............................
r.`Heating .( .' ; .T. .. .Y... ..1.....Plumbing .......... " ...: .... .1., ...................
Fireplace ........................... Y . .....................................Approximate. Cost .... r... ....v.....................................
Definitive Plan Approved by Planning Board -----------------------------19--------• Area...............
Diagram of Lot and Building with Dimensions Fee �U
/ ........... .............
SUBJECT TO APPROVAL OF BOARD OF HEALTH
l
�6
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 ... � ,�1........t- -rG�E G
Construction Supervisor's License ......lCY../..�.�j.. ,�!
TEMO CONSTRUCTION CO.
Nd ...286$8... Permit for 112- story single
....................................
family dwelling
Location ...Lot 29 111 Wester Circle-
.............................................................
Osterville
............e..................................................................
Owner .....Theo-Construction-Co.
.......... ............. .... ........ .............
Type of Construction .......................frarre...................
... .................................................................................
Plot ............................ Lot ................................
Permit Granted ...................... .......1.'985
Date of Inspection ....................................1.
.9
Date Completed ie........................1.9
Assessor's map and lot number ......... ............. .... CL OfrC DL ���d/8'S/ ofT"Ero
r �
Sewage Permit number
Z BARNSTABLE, i
House number ..:...... ...�/ J 1A°a`..f...............;............................... 9p
pow s639. \0�
'FO wN d'
TOWN OF BARNSTABLE
BUILDING INSPECTOR
l ..���.APPLICATION FOR PERMIT TO ......ems,!..:...,.,.. ...................... .
TYPE OF CONSTRUCTION ..:..... y... ......... -�1:���.......:.,�... .....,�.. ,,.....
......� .....I q jW
t„
TO THE INSPECTOR OF BUILDINGS:
The—undersigned hereby applies for ar permit according to the following information:
Location ... • . �!!► ,�.�....F!?/'/��1��,....r y .�� r�...,�..Ft•�.�.:�.�!�.�<..
. �•• l R.i
,,Proposed Use ...........r ,,y .E :. .1 .. . ..............................................................................................................
cp
ZoningDistrict ........ rt ...................'.....F....................Fire District_ ..............................................................................
Nome of Owner .�"�'��"�;.�-%.�!i�'�. ��..� � .)U.(Address ................ �t• /� �f�, �I���f�',!faG� �>'..........
Name of Builder `!lt. an..''7�/r `2! '1 �IeAddress ......... �. ...Y f �1d 1 c�.�. ...............
r, . .
Nameof Architect ..................................f:...............................Address ....................................................................................
Number of Rooms ...Foundation ...... �.f ...� 0: 1 ......
Exterior ....... .2 ............. ff?!!^' .Roofing ....... ........ !.�<N� . .......
Floors t` ?. !.. �.'J'lG...-Z� .Interior . Qk .! ; .' .. ............................
Heating �. '.... !l` p' Z� .r ..Plumbing ............................ = ..............
F,irep'laceI ' L
.....................................Approximate Cost ...................................................................
Definitive Plan Approved by Planning Board -----------_------_------------19______. Area ..........................................
Diagram of!Lot and Building with Dimensions ` Fee
SUBJECT TO APPROVAL OF BOARD OF HEALTH
t �
A C
lP -
v -
�
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 ... .%,
Construction Supervisor's License
4
THEO CONSTRUCTION CO. /A=121-11-3W
[/ c?CQ
No „28688..., Permit for 1 z..story single„
family dwelling...........................
...... .... ...........
Location ....Ibt..29...........j1J..T^1.W�kWixld..CarCle
..................................................... ......................
Osterville
Owner ...........Theo Construction Co.
.......................................................
frame
Type of Construction ..........................................
i
i
Plot ............................ Lot ............................:...
Permit Granted .......................11/19......19 85
`. Date of Inspection ....................................19
Date Completed ......................................19
rD
S
P�OFtHE,�~G Town of Barnstable *Permit#
Expires 6 months o issue date
s
,,, �,�, : Regulatory Services Fee
v MSMS
M^ Thomas F.Geiler,Director
1a39. .m
Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601 X P R
Office: 508-862-4038
Fax: 508-790-6230 F F P o
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY 2004
Not Valid without Red%Press Imprint. TOWN OF BARNSTgBLE
Map/parcel Numb 21 D i l 63L,
Property Address S, 0
� �" � �"L
12
I
esrdential . Value of Work 3,
Owner's Name&Address la�14
Contractor's Name— ��,cf.v-`r �U� Telephone Number
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable)
orkman's Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ Jafia the Homeowner
I have Worker's Compensation Insurance
Insurance Company Name
Workman's Comp.Policy#
Permit Request(check box)
❑ Re-roof(stripping old shingles) All construction debris will be taken to
❑Re-roof(not stripping. Going over existing layers of roof) �c��
❑ Re-side
❑ Replacement Windows. U-Value (maximum.44)
*Where required: Tssuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
Home Impro eat Co actor cease is required.
Signature
Q:Forms:expmtrg
Revise053003
Town of Barnstable
y�..�FVE'O'�tio� Regulatory Services
Thomas F.Geiler,Director
r STS. _ Building Division
p�E1 �.p Tom Perry Building Commissioner
200 Main Street, Hyannis,MA 02601
ice:` 508-862-4038 Fax: 508-790-6230
COMPLAINUINOMY REPORT
Date-.2-2 4-�- p¢ Rec'd by' I- 1�,Q y cz 1
►mplaint Name: K S Map/Parcel
ication
Address• )2-cl LA >>
-iginator Name: ,-4 1 M 0_r)4 e C C, a
Street: / 2 �l' 1 A ) e c,-� f A>>yt
Village: State: Zip:
Telephone:
►mplaint Description: NI Q-104S -U
t y�ov� c, n P.v-yn-\A -
-� � l�Ss �
FOR OFFICE USE ONLY. i
pector's Action/Comments Date: 9:- 2 4 — � � Inspector•
CA
1Q e r
cil
ditional Info.Attached.
Providing Insurance and Financial Services •
Home Office, Bloomington, IL •• StateFarm
June 28, 2017
Building Division State Farm Claims
200 Main St PO Box 106169
Hyannis MA 02601-4002 Atlanta GA 30348-6169
CERTIFIED MAIL: RETURN RECEIPT REQUESTED
RE: Claim Number: 21-0528-1336
Our Insured: Peter M Ders
Date of Loss: June 01, 2017
Loss Location: 111 Westwind Circle, Osterville, MA 02655-1367
Tax Block:
Tax Lot:
To Whom It May Concern:
State Farm.Fire&Casualty Insurance.Company writes to provide notice as required by
Massachusetts law in connection with the matter referenced above. State Farm®received notice
of loss or damage in excess of$1,000 at 111 Westwind Circle, Osterville, MA,:i o
G7 nz
We hereby notify your office pursuant to General Laws c. 134, §36 that-State Farm; cD
intends to make a payment of$1,000 or more in connection with the above referer.►ced
insurance claim.'
la 7; can
Further, the applicable amendatory Policy Endorsement informs the insured of the —+
Massachusetts requirement by stating the following: '° w
M
"We are required by Massachusetts law that we must notify the local inspector of
buildings or Board of,Health at least 10 days before we make a payment.of$,1,000 or,
more for loss to a building or structure.
We must also give notice if there is damage which makes a building a health or safety
hazard or dangerous or unsafe for occupancy regardless of the amount of our payment.
If, prior to payment, we receive official notice of a pending or existing lien against your
premises, we must delay payment until the matter is settled. If we are required to pay all
or part of the amount of the lien, we will not be obligated to pay that amount to you.
Sincerely,
Mike Matheny
Claim Specialist
(844)458-4300 Ext. 2534395796
State Farm Fire and Casualty Company