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0176 WEST WIND CIRCLE
176 Z:9V 417 d6 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map `� Parcel 1l _ �� Permit# Health Division S)Z , al a �003—I6 I Date Issued U Conservation Division SA D' Q3/t/, Application Fee �50' dU Tax Collector Permit Fee "3 U Treasurer Planning Dept. vasmite SOMM sy LIMRED TO� OF BEDROOMS Date Definitive Plan Approved by Planning Board f d c/c��f Historic-OKH Preservation/Hyannis Project Street Address Village V, hf vI I LQ — Owner I V ' S J D bin I ch Address ���0 W�S� W i WJ G �t Telephone 66 0— � a s ` nabcP Permit Request gvnov.c b 1 al ck a/AJ �..F� tol�T fi Square feet: 1 st floor: existing proposed 2nd floor: existing proposed To tal,new�' 1 DZ ti Zoning District Flood Plain Groundwater Overlay S2I ,*-Project Valuation l 00Q . OD Construction Type p I Lot Size Grandfathered: ❑Yes O No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family O Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes U'No On Old King's Highway: ❑Yes vfto 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 new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: O Yes ❑No Detached garage:❑existing ❑new size Pool:O existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing O new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial O Yes �o If yes, site plan review# Current Use Proposed Use Non ( � BUILDER INFORMATION Name 1 Ho 601MAPKI Telephone Number Jd Address License# 6UQ3� Home Improvement Contractor# 100—170 Worker's Compensation# &l A l 0 6 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO mo DATE SIGNATUR - 14 o� FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. > 3 ADDRESS • t' VILLAGE Y r OWNER DATE OF INSPECTION: FOUNDATION A50N ©P 02/644f!!� FRAME INSULATION 1 FIREPLACE ELECTRICAL: ROUGH FINAL > PLUMBING: ROUGH FINAL GAS: ROUGH V FINAL A FINAL BUILDING CA ! DATE CLOSED OUT ASSOCIATION PLAN NO. ,� r7l , emwyCERTIFY THATIH/S LOT/,? NOT �,OCArirp /N FEpzf,44, FI-06,P HAZARDZZWFAS SHON�N ON THE F£OE�PA�. FLOOD /NSURANCE RA re MAP FOR THE TOWN OF ' 9 T 8LG C N/Ty PANEL NO,Ps000i'°O�St3EFFECT/VE O.ATE�O'O�"83 LA6 Z�� Y NO, R.4.S OATS NOTE. NORTH ARROW NOT TO BE USER FOR 804,49 PURPOSES. � y 0 X55TWIND CIPCLE //8• ,2.2' a (A y � ZOT 23 LO T-J 7" 0 9 'ExrST _ OCR � C61-- o v� � zLOT ° V�74'.A5 o � : ; n O � yZ y0rn � TH/S R,GOT 04AN wAS NOT mAOE Ffom FOUNPA.VON ZXX TION PUN 4N /NS7*ff41hfeNT sz1RvEY.4Np /S FOR rHE LOT 55, � ,I E ST�( QC) C f Z. !/SE OF THE QANK ON4 Y. LINER NO C� 1� ,,1RC4YMSTANCES ARE OFFSETS TO BE X54-P FOR FENCES, WALLS, HEpGES, ,670. . OIVNEO BY: . PC' Q+,11, STAje. � -r .• 50. \/AQ.Md OT"H MA OF Mgsf9cy .4 MON ENGINEERING INC. ROBERT G, 60 EAST FAA AfOUTH HIGHWAY RAY.MOND y EAV AALMOUN MA. OZ536 9 No.21583 0 SCALE: GATE 01STEQ� JS ""3�' 1%5RE-Er-1�i �NqL. p•HO% DRAIYN BY: aYeCA.rPBY APPR BY. Pk,4N NO. °ZVE�� Town of Barnstable Regulatory Services - -- vBARNaBLE,g! Thomas F.Geiler,Director MAn �p i63p. �0 �Eo,rp�p Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 509-862-4038 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: , ►`v�l.r tGt(X 1�CX I I'X Estimated Cost ��� Address of Work: Owner's Name: 1't l m �YJ��►1 ki c Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH-UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: a� 16020 Date 4tracttNank Registration No. OR Date Owner's Name Q:fo=homeaffidav CAPIZZI HOME IMPROVEMENT INC . SPECIFICATIONS AND ESTIMATES PAGE 6 OF 6 STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT OWN THE PROPERTY LOCATED AT IN � �U I l lX, MASSACHUSETTS. ' I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO `BI ZZ I� my LESSEE TO APPLY FOR A BUIL ING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. I SIGNATURE OF OWNER: OWNER'S ADDRESS: OWNER'S TELEPHONE: LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: G9rtIC� 1 / r APPLICANT'S ADDRESS: 1645 NEWTOWN RD. , .COTtTTT MA 02635 APPLICANT'S TELEPHONE: 9084428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: ACCEPTED BYv":9iJ- THIS PAGE IS P F AND IN CONFORMANCE WITH PROPOSAL # 1 - The Tower of Barnstable ;. epartment of Health SAfety and Enviro Building Division W Main Stmtt,Her=e , 'NIA 02401 Fax; 508-790-6230 &�_ .EIS The fullOWIDg !tames-vt�re Revkewed by: -_�_..._.._.....___ _ � _. I I � � I I I I � r\ l • Xi -4A r-� I I ! IL S I NJ r , I i • � I i Pan _ i 1 17 - - - -- -- 70 Iry)�o 'OD s p sY 3,4�'�7 yg x -- ='.� - �/ice?/--w01C 4�j --hX Z--- � -- J - -- --- --_ - - •- ---- JA r ice✓ v ._ _-_. _�.. ._. -« _ 01075i9fh ® 57tV-.Z00d nlcnVos�,�� _ StSo6 9X/7 .79 W/7 '7 1 d '77$'] 71&-4. 7Q' IV rl o0.�l l i oCt A From- T-610 P.002/002 F-551 ACCOMMENDED MAXIMUM SPANS FOR FLOOR JOISTS 60 PSF LIVE LOAD PLUS 10 PSF1)EAD LOAD Normal Duration Loading* Dead Load—10.psf Lave Load--60 psf Fb= 1000 psi E= 1 z30Ur000 psi I (Typical Values for'Pressure.PreseEvafive Treated saEn Pine#�2 used under exterior conditions, e.g. decks) Yellow � Joist- Joist size . Spacing W 2xI0 2x12 12" 8-9 11 14-8 1061 1061 10G1 1061 16 7.11 10-6 13.4 ' 16-3 1167 1167 1167 . 1167 20A 7-4 10-0 ' 12.4 1a-1 1242 1.254 1248 1262 ZV 641 • 9-2 142 • 1336 1336 1336 1336 Design.Criteria;. Deflecctm. 'For 60 Psf live load tirnited to span In inches divided by 360. Strength: Live load of 60 psf plus dead load of 10 � ps#determiryas fiber stress shown. * Note: Design values adjusted for normal duration foadmg.. . ]�.(•t�]�;1rv�iOl7 . , ,. •• f�ss)isliaiion: 1f)[)74D �• ; . �'• l)q.ir:: 3•'tiUaie Corhoralioli Expiraliurr 6/23/2006 CAPIZZI HOME IMPROVEMENT, INC_ Thomas Capizzi, jr: ----- -- --- - 1645 Newton Pd_ Coluii, IAA 02635 UpdAic Address and return rnrd. M204 re2son for clean EI Address M }tcncw2l D Employment E] Lost 330a1-d of T9uildinE Rcdulaiions and Standards Lieenscamgisiration valid for individu) use only '. X .. HOME JMPROVEMENT CONTRACTOR before ilieeapiraiion dais. If found return io: Board ofBuDding Regulsiions and Siandards �• Registration: 1007.40 Expiration: 6/2312006 One Ashburton PlnceRm 1303 Type: Privaie Corporation Bosinn,M2-02108 CAPJZZ)HDJOE 110PROVEMENT,) Tilmas Capi,,i,jr. 1645 Nevdon Rd. _ o Caiu.1,IOA 02635 Administrator loot va)id withou b hnr I II irnsc>'i� o ' - --- BOARD OF BU)LDING.REGU_LATI.' J License: CONSTRUCTIONS ::, Numb er_:.CS 057032 j Birfldate=39/2fi1-163 Expires;�D %2fi12Db7 =i i Resin ec7 THO it I. MASX 45 NEWTOWN Rp. % 4� .....-• MA 02635 _ Commissioner TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # �� Health Division - Date Issued Conservation.Division Application Fee Planning Dept. Permit Feb Date Definitive Plan Approved by Planning Board 69 77 f 24'f a s Historic - OKH Preservation/ Hyannis Project Street Address rs t LI/ o 0 Village Owner Address i ? Co d Yf tolm o6 1 Y c l e Telephone Permit Request \A-C_<- eja:,K PGS C_ c< r o P + i Square feet: 1 st floor: existing proposed 2nd floor: existing - proposed Total new Zoning District¢ Flood Plain Groundwater Overlay Project Valuation Z o o Construction Type ZS Lot Size S l�z'�``' 2 J,g60 S f— Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: El Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ZSFull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes -❑ No Detached garage: ❑existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage:1, ,q existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ d rCE -Commercial ❑Yes ❑ No If yes, site plan review # o' a, Current Use Proposed Use Co APPLICANT INFORMATION r i (BUILDER OR HOMEOWNER, Name 4-4 <�_t f /'c-'! L 0f P r.-st die4 *Telephone Number 5-0 Address "?� RC i e-Lr (3 A l-c R c License# (5 -3+C r^ u G Q C S"J' Home Improvement Contractor# l y C G l Worker's Compensation # 6 2 6 14' 6 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 0 SIGNATURE DATE _l Y FOR OFFICIAL USE ONLY _ a _ APPLICATION# `. DATE ISSUED MAP/PARCEL N0. ADDRESS VILLAGE j OWNER DATE OF INSPECTION: i ' FOUNDATION -'FRAME INSULATION ! _ .FIREPLACE ELECTRICAL: ROUGH FINAL s PLUMBING: ROUGH FINAL GAS: - ROUGH FINAL FINAL BUILDING o DATE CLOSED OUT v ASSOCIATION,P�AN NO. K r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance davit: Builders/Contractors/Electriciatis/Plumbers A licant information Please Print Legibly_ Name(Business/Organization/Indivi dual):��� S _ eu`= k 6`P y-'-'' A C Address: <2 2 ,_«� CA yv� City/State/Zip: 6S�{�'�✓ i l�c { 6 2 r f�' Phone.#: ds �— 3 'a --A Are ou an employer? Check the appropriate bog: Type of project(required): 1. 1 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 ole proprietor or partner- listed on the attached sheet ' modeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition comp. insurance.$ [No workers' comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required_] 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. rigbt 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#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 1contractors 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 providt their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: e� e.� b Expiration Date: S7- r 6 Job Site Address: t'7� C�EilC...1 0 �? lc �C City/State/Zip: 6�iL-Oy���r ��•��� 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 cri nal penalties of a fine tip 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 pains•and penalties of perjury that the information provided above is true and correct. Signature: 2 �S`� s t e/ e%t Date — Phone#: Official use only. Do not write in this area, tb be completed by city or town officiaL I 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#: A I 1111f®rmation and his' tructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. I 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 RZth 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-contractors)name(s), address(cs) and phone number(s) along with their certificate(s)of insurance. Limited Liability Companies.(LLC) or Limited Liability Partnerships (LL.P)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. $e 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 nurrtber listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Towli 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 permil:14censc applications in any given year, need only submit one affidavit indicating current policy information(if necessary) and under"Job Silt Address" the applicant should write"all Iocations 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 (Le. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Oiiee 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 C6mmonweaM of Massnhuse-M Department of Industrial A•cciddezts Office of Investigations 600 Washington Street Boston, MA 02111 Tcl. # 617-727-490.0 ext 406 or 1-M-MASSATE Revised 11-22-06 Fax# 617-727-7749 www.mass.gov/dia h • . 1 �0pYHErp Town of Barnstable r r Regulatory Services RARN� STABLE, Thomas F. Geiler, Director 4'ArFo;�,�a Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.ba rnsta ble.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder r � ��G� , as Owner of the subject property hereby authorize ,c c + * H 0 S to act on my behalf, in all matters relative to work authorized by this building permit application for: J�� wd�1'%w�•rD G'/�tLL� O._C'�i?v�Ccc� �'J.0 �'�.f�� (Address of Job) _ tore of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on t1fe reverse side. Town of Barnstable Epp YHE Tp� Regulatory Services saxrvsTAs Thomas F.Geiler,Director MASS. �� i679• Building Division lEn nar Tom Perry,Building Commissioner 200 Main Street, Hyannis., MA 02601 vt,ww.town.barnstabl e.ma.us Office: 508-862-4038 Fax: 508-790-6230 ----+-- HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFIINITION OF HOMEOWNER Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building.Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1,1-Licensing of constivction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors;Section 2.1�5) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would Writh a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. 7C'E9;rjFy TN,4T IH/S LOT 5 NOT 40C4TEO /N FEOERA4 F40017 HAZARD ZZIVE S90WIV ON THE F£OEi'M, FLOOG /NSURANOE RATE MAP FOR THE TOWN OF ' T $LC C N/TY PAN44 NO,.25-0001- O°1 EFFE(;T1YF O.ATE Lo-o1-e3 ! BE ,T E. R Y NP, R.,l,.S DATE NOTE: NORTH ARROW NOT TO BE USEP FOR 50k,49 PURPOSES. y X55TWIND CIPCLE a a is oC b s ! )5.)!t ST y a Fookao.Yio�l co � � . ° HQ) LOT �- , L y N 1J0 l t'9p <n D tet 5/5/2008 Timet 11r44 AM Tot @ 9,15064201936 Page: 002 ClIenIM ACORUM CERTIFICATE OF LIABILITY INSURANCE Osro51( PRE 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. 973 lyanough Rd., PO Box 1990 Hyannis,MA 02601 INSURERS AFFORDING COVERAGE NAIC 9 I INSURERA. A.I.M. TRI-S Development Corp. INSURER B: 72 Briar Patch Road IrLsuRERC. Osterville,MA 02555 INSURERD: 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 POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Nmm POLICY POLICY EXPIRATION LTR TYPE OF DISURANCE POLICY NUMBER LIMIT'S GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DMIAGE S i RENTS L CLAIMS MADE OCCUR MED EXP pe are on $ PERSONAL&AOV INJURY $ GENERAL AGGREGATE $ GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ POLICY PRO- LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea 80CMm) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per Pe—) HIRED AUTOS BODILY INJURY NONED AUTOS (Per eoddent) $ -0WN PROPERTYDAMAGE $ (Peracddent) GARAGE LJA9LnY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLALL BRM EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ RDEDUCTIBLE $ RETENTION s $ A wae�RscomPENsATLDNAn BINDER267690 05/01/08 05/01/09 X WCSTATU OTH- EMPLOYERS LIABILITY E.L.EACH ACCIDENT 1500 000 � EXCLUDED? NO E.L.DISEASE-EA EMPLOYEE $500 000 n ,desa®e uroe< S tow E.L.DISEASE-POLICY LIMB swo= OTHER oESc rnm—OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of Insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions.Officers are included under the workers (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OFTHE ABOVE DESCRIBED FOIJaEs BE CANCELIUM BEFORE THE EXPIRATION Town of Barnstable DATE THEREOF,THE ISSMG HNS NEE waL ENDEAVOR TG NWLL gyp_ DAYS mvrTm 200 Main Street NonCE TO THE CERTFCATE HMMM NAMED TD TNB LEFT,BUr FALIIRE TO DD SO SHALL Hyannis,MA 02601 IMPOSE NO OBLIGATION OR LIABBM OF ANY HOND UPON THE IINSLIRtit ITS AGENTS OR REPRESErrATNES. AUnKRMR PMMSEKATME .wo N:e--- ACORD 25(2001108)1 of 3 #51926 LS1 ®ACORD CORPORATION 1988 I I Boa7rofflu SpingVe g u I a ons an tan Rars One Ashburton Place -.-Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 148601 Type: Individual Expiration: 10/11/2009 Tr# 262957 SCOTT S. SHIELDS SCOTT SHIELDS 72 BRIAR PATCH RD. OSTERVILLE, MA 02655 - -- - -- Update Address and return card.Mark reason for change. Address Renewal n Employment Lost Card -CAI Ca 50M-07l07-PC8490 ,per ✓fie 'Vomrmr�uaea�l� a�./Glaaaarlu�aeCld 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: Board of Building Regulations and Standards Registration: 148601 One Ashburton Place Rm 1301 Expiration: 10/11/2009 Tr# 262957 Boston,Ma.02108 Type: Individual SCOTT S.SHIELDS SCOTT SHIELDS 72 BRIAR PATCH RD. OSTERVILLE,MA 02655 Administrator Not va d witholirt signature k' _ �✓�aooac�euaella ' I, .Board of Building Regulations and Standards I. Con6tr4cfi1 Supervisor License n I. License.,.CS 6$898 1011968 I yratinn. /i /2009 TO# 576 SCOTT S SHIELc -_ 72 BRIAR PATCH RD°� `•4, �"�'" �/J i'' OSTERVILLE,'MAD 2655 Commissioner T 1 ( II �e e B IAC 1 G6 D oc X (6 Fr► -4, c-' rarq n tk Vv .>�c=;:- 'q- ;I;a-•y,—._....-� ..�`rC��,A-;'Sc.a a._' tsn.;,h,•r.t��i �,'St•",-�„":�r+ (:*t� .f^x'"w'yy,,•',r=:Y`'ShT;,b.:�h:it':.•r:..-..-�:+:..a „_,:y,..;�.:a#.:<'�*1%..�s"r:.. F • "� TOWN OF BARNSTABLE Permit No. ______ 28148__._____ U"n Building Inspector _ V_ Cash • 1MI t OCCUPANCY PERMIT Bond i Issued to Dennis Star Construction Address lot #5B 176 Westwindl rirrlQ. nrtPryillP Wiring Inspector f'f�l �r�2i 'L� Inspection date `s Plumbing hmspectoOn.d _ Inspection date " � � i Gas Inspector Da Ps7/ PfTn �� Inspection date 30 067 345, /Engineering Department,. �'�ir � ! Jar/ Inspection date�� Board of Health t y in n r, i Inspection date�.� m t 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. -- ....... .......... 19. � i .. r Build g Inspector . _y� _ � ,. > a . � ., 1 C..�.�vY � ;',�. ._.r •Fl 'ti`I� 't l+"� .. ., _.(i _,.;'�'.:TT" tr s m'��••: TOWN OF BARNSTABLE BUILDING DEPARTMENT seslSr =a TOWN OFFICE BUILDING ru t639. �� HYANNIS, MASS. 02601 MEMO TO: Town Clerk 'FROM: Building Department DATE: An Occupancy Permit has been�issued for the building authorized by Building Permit #_ » x ��_.....»..— ` issued .to Please release the performance bond . f /HEREBY CERTIFY TNAT IH/S LOT /J NOT ZOCATEO /N FEOERAZ F4000 HAZARD ZONE AS ShOWN ON THE FEOEeAl. Fk000 INSURANCE RATE MAP FOR THE TOPYN OF G�9 T S L GX2 C N/T y PANE,G OATS/O-oc n aho/8S CBE T E. RAY IVA R.4,.S PATE NOTE: NORTH ARROW NOT TO o BE USER FOR 804,49 PURPOSES. O O Oo - WEST WIND CIPCLE a ZDT 23 to Fau�0A7106 01 CS 21800+ s,F, (J, e LOT 53 . Iy� Gy � , i7Z4 y o co 6o n yca O O THIS P40T P4AN WAS NOT MADE FROO FOUNDATION 4X4TION P4AN ' '/_ I AN /Ns. fzl.MENr SURVEY ANP /S FOR THE LOT 58 W t STIL/( Q o I�. USE OF THE BANK OVL Y. UNDER NO CIRCUMSTANCES ARE OFFSETS TO BE USED FOR FENCES, WA Gk%Y, HEDGES, pC Uht 6 ST 2 CG xi 5T". Cc ETC. OWNER BY: 50. \/A -M0 OTi-4 MA / A OF M4s�9C ARMY ENGINEERING INC. RDBERT yG�� �' 60 EAST AA LMOUTH HIGHWAY RAY.E. EAST F.4�C.MOUTH.. MA. OZ536 9O No.21583� ah/a SCALE:,, , RATE: .SHEET: / 9FGISTEQ�Q�� / -30 61Zo1BS" /or I PRAWN BY: CNECKEOBY APPP BY: PkAN NO. ® 0114- n /0- 1c-a y okDPB, / ` SEPTIC SYSTEM f�' k�E ENE �< Assessor's map and lot number ...lWl..�. ',lam r of.... 51 '-)INSTALLED INICIJKI�PUXA, Sewage Permit number ............... .:. ............................ �/lIITh d p� WITH 5 // �eP" �1�4/�ROitlIVAE9W!.� t SAWSTLUE, i House number G lO `' ��'� `� ' a T�'9�96I9-TjLGULAT`IbNS o Y aye SP TOWN OF BARNSTABLE . BUILDING INSPECT R APPLICATION FOR PERMIT TO ...................le. TYPE OF CONSTRUCTION ......:.: � ... ,.f Pf ..... ..fr C41-1../..1-1.49.... . ................ . ...........19.4.Y TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: 6 Location ..... J g......I,rI�. ..........�r.. ..T r�t Y...�.lr.G. ........ ProposedUse ..........Q. .� 1,/ ........................................................................................................................ ZoningDistrict ................ ...................................................Fire District ...........................................................:.................. Name of Owner D./.VT4!:! �. ddress ...........z.....Y. .1�YY�.(�.�I ............... Name of Builder P.u.!?dAddress ...............° ....YA'AiVa ..rA. ............. ------------ _�... Nameof Architect r� ..............................Address .................................................................................... Number of Rooms ,I.�� .,.. �.1�... �j .c... .I..�.,Foundation ..... �9. .��. ....1f,0,V.6.l-� ....77. Eicierior .... C� g .�7f `��./�:�:............�`./ .C�..C.�... ...Roofing ......... Floors ..................C.I -.AplEr-i..............................Interior ..........19 ... .y....W. lT4A&Z............................. Heatin ....... .......... . 9 �4�..T�n�/�%/..l...r�..��...��... .....�. . ..�.....Plumbing ...........�...� . ....7.�J.... . ..................... Fireplace ....................0..J...[.A ..........................................Approximate Cost ...............3.��(�`0.&.-,o.................. Definitive Plan Approved by Planning Board ---------------____-----------19________. Area � ..�1'G.. .. Diagram of Lot and Building with Dimensions Fee /...... ......... .. .. SUBJECT TO APPROVAL OF BOARD OF HEALTH / \Q\ r 1D r 1 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 .... d!......... Construction Supervisor's License .....,��6�:�.,�.1...... WNNIS STAR CONSTRUCTION xi Nfo ..... Permit for ....One..Stqxy............ ...........S.,i.ng.l.e...Fam.i.ly..Nft��ing..................... ...... . .. ..... dd 1A Location ..... D ..Q;Lr.r-le Osterville ............................................................................... Owner .......D.e.n.n i s...S.tar. ...Cqn.s.t.ru. . c.t.i.9.n........ . . ...... . ...... ...... Type of Construction ...Frame............................ ................................................................................ Plot ............................. Lot ................................ Permit Granted ........4uly..3.!..................19 85 Date of Inspection ....................................19 Date Completed ... ..........................19 Assessors ma and lot number ) � J / /U'- p: er ... �:..../� ,�/7.... iINE r�i► Sewage Permit. number ...................................................... House number' -�3i°� 9 B�aaAGa LE, .................................................:................. 6 39. 'Ep,YPY a. fML TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATIONFOR PERMIT TO ...............f' %".. .. .</..... .............................................................:.......... TYPE OF CONSTRUCTION ......... .�..�-n �?..n... 4.J?., .....��� ,�T!-. :!.,ll4.. ....................... VL .L r r. ..`.' ................... ....... ...........19. 1i TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...../140-. ...:... f`�, i/ tE..........(�� T .r .l./../.. .�.r. ........ ProposedUse ..........,.....�.....�.........../.................................................................................................................................... ZoningDistrict ...........�............................................Fire District ...................D....................................................... Name of Owner r .Fr/iV�.e..: . .... ./.!�.�. !YAddress ........... \..... vz .. ���.tz �`4............... Name of Builder .4.pF.g.o... If .i . .! .�../�.��Address ............... .. ./�'�1.?.1.�.. z`.� .............. Nameof Architect ..................................................................Address .................................................................................... Number of Rooms .:.... .,..I..l..f�........./............ L.7.,Foundation �(�. .... Yam/. _ �.. ... .... .,.. ................... . . .... Exterior r—0-612 ��,........�.�..F..� Roofing ...........x...,..........1!•:-.. ........ ............................. . ... Floors .. .. .. ...............................Interior ...........•f-2...9.V....tll/..�� f............................. Heating .. ,.........................Plumbing....................... Fireplace ..................::0.../.Y..��...............................................Approximate Cost .............:.� l�}�,D �9'� .r•......... .............................. a Definitive Plan Approved by Planning Board -----------___-----------------19________ . Area .......................................... Diagram of Lot and Building with Dimensions Fee' ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH t� 1 y 1� L 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. ar. Name ....... $ Construction Supervisor's License ......1�46( !I ! E t DENNIS STAR CONSTRUCTION A=121-11-17 tar - �1� ? • 28148 Permit for ,,,_ One Stor y Single Family Dwelling ............................................................................... Location Lot 58, 176 Westwind Circle ................................................................ Osterville ............................................................................... Dennis Star Construction Owner .................................................................. '9'• Type of Construction ,.Frame i i Plot .............................. Lot ................................ Permit Granted July 3, - 85 Date of Inspection Z19Date Completed .............................. .......