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Home My WebLink About0391 WIANNO AVENUE�- �� ._z ��., _._,� . . . .�. ...� y S i f r i f i !1 1 1 I i 1 1 J� J „ � a 5 :� Town of Barnstable �. Building HAIRWN�� Post This CardiSo That it is Visible From the Street 7 Approved Plans Must be Retained on Job and this Card Must be Kept c M^E& Posted Until Final Inspection HasBeen Made.1639, Permit Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-19-42 Applicant Name: GARY J SOUZA Approvals Date Issued: 01/16/2019 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 07/16/2019 Foundation: Residential Map/Lot: 140-173 Zoning District: RF-1 Sheathing: Location: 391 WIANNO AVENUE,OSTERVILLE Contractor Name_-`, GARY J SOUZA Framing: 1 Owner on Record: PACKWOOD, RICHARD J&MODAHL,MARY Contractor License: 6-102999 2 Address: 205 COMMONWEALTH AVENUE APT 6 I -- Est. Project Cost: $85,000.00 e Chimney: BOSTON, MA 02116 ; Permit Fee: $483.50 41 Description: REMODEL/RETILE 5 BATHROOMS s Insulation: .Fee Paid: $483.50 Project Review Req: Related permits still open must be closed - � Date: �`` 1/16/2019 Final: Plumbing/Gas Rough Plumbing: uilding Official Final Plumbing: Rough Gas: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within siz months after issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Final Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Electrical work until the completion of the same. � �..- f ✓` Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on.this permit. Minimum of Five Call Inspections Required for All Construction Work:) '` Rough: 1.Foundation or Footing 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Final: 'cork shall not proceed until the Inspector has approved the various stages of construction. "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department , Final: Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT DATE ACOD R ' CERTIFICATE OF LIABILITY INSURANCE 01/02/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: ' Applied Risk Insurance Services, Inc. PHONE (877)234-4420 FAX (877)234-4421 10825 Old Mill Rd A/C,No,Ext: IAID,No): Omaha, NE 68154 E-MAIL ADDRESS: PRODUCER (877)234-4420 CUSTOMER ID# INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Continental Indemnity Co. 28258 INSURER B: Rogers S Marney, Inc. INSURERC: PO Box 310 Osterville, MA 02655-0310 INSURER0: INSURER E: CTL 1273 1505727 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I ADD SUB POLICY EFF POUCYEXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD/YYYY MMIDD/YYYY GENERAL LIABILITY EACH OCCURRENC tGEWCCAGGREGATE MERCIAL GENERAL LIABILITY ❑❑ DAMAGE TO RENTED $ CLAIMS MADE OCCUR -RE occurrencP1 $ M D EXP n one person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ LIMB APPLIES PER:ICY F ECOT F LOC $ AUTOMOBILE LIABILITY ANYAUTO ET-1 ❑ COMBINED SINGLE LIMIT $ ALL OWNED AUTOS BODILY INJURY Per erson $ SCHEDULEDAUTOS $ HIRED AUTOS PROPERTY DAMAGE Per accident $ NON-OWNED AUTOS $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE FIF-1 AGGREGATE $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'UABILITY YINEEL ANY PROPRIETOR/PARTNERIEXECUTIVE N NIA❑ 3 7-5 8 5 3 3 2-01-0 1 01/01/2019 01/01/2020 E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBER EXCLUDED? (Mandatory In NH) I E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT 1 $ 900,000 II DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach Acord 101,Addition7l Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION Rogers S Marney, Inc. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED PO Box 310 BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED Osterville, MA 02655-0310 IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 1783118 ACORD 25(2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved i 1HE Tp� Town of Barnstable Regulatory Services 1AENSTABLE, 1M6A399S `0� Richard V. Scali, Director 'Tfo Mai�' Building Division Tom Perry, CBO,Building Commissioner 200 Main Street, Hyannis,MA 02601 www,town.barnstable,ma:us Office: 508-862-4038 Fax: 508-790-6230 Building Permit Procedure for Residential Addition Or Remodel Or Dock ❑ Determine map and parcel number and enter it on application. ❑ Historic District Commission,200 Main Street, approval rdquired'prior to construction/demolition for any properties located in a Historic District: • Old Kings Highway Historic District(north of the Mid Cape Highway) • Hyannis Main Street'`Vaterfront Historic District(See map for boundaries) • Historic Preservation (if applicable). ❑ If ZBA relief(Special Permit or Variance is required for Project): ❑Copy of ZBA decision ❑Documentation proving that decision was recorded at the Registry of Deeds w/in one year of ZBA decision date ❑ Approvals from the following departments are required and can be obtained at 200 Main St.: ❑Health Department (8:00—9:30 A.tM&3:30—4:30 PM {as of March 2°d, 20051 ❑Conservation Department (8:00—.9:30 A.DI&3:30—4:30 PiY1) [—]Tax Collector {can be obtained from Building Department} ❑Treasurer {can be obtained from Building Departmentl ❑ w Permit must contain complete owner information, full description of project, correct square footage of project, valuation of project (do not include hvac), building detail for Assessor's Office, complete builders information, including signature and date of application. ❑ 5 sets of reduced house plans measuring 11"x 17".scaled 1/4"= 1' & fully dimensionalized are required. Plans must include a foundation, cross section, framing schedule, insulation detail & floor plan showing location of smoke detectors (located with a Red `S'.) ****** IF USP i G ENGINEERED LUMBER ANND/OR STRUCTURAL STEEL,EN GliYEERLNG DATA MUST BE PROVIDED****** ❑ Plot plan or mortgage survey required for any addition. ❑ `Vorkers'Compensation Insurance Affidavit form must be submitted for any workers hired. In the event the homeowner takes out the permit, subcontractors hired must supply this, Copy of Insurance Compliance Certificate must be submitted. ❑ Mass Compliance Checklist ❑ Construction Supervisors License&Home Improvement Contractor's License OR ❑ Homeowner License Exemption Form must be submitted if homeowner is acting as general contractor or builder for the project. ❑ Property owner must sign Property Owner Letter of Permission. ❑. A NON-REFUNDABLE Application Fee must be paid upon receipt of application number. All checks should be made out to the Town of Barnstable ❑ CHIlYL�1i EYS: Need Home Improvement License,no plot plan required ❑ PIERS AND DOCKS:Need Construction Super License AND Home Improvement License. OWNER CANNOT PULL OWN PERMIT. ❑ Projects requiring the use of a crane must complete the forms issued by the Aeronautics Commission ACC) CERTIFICATE OF LIABILITY INSURANCE =(MMIDDNYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement,A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Teresa Van R sw00d ROGERS & GRAY INSURANCE AGENCY INC PHONE N. 508)2582111 RAiXc No: AfAIC REss, tvanryswood@rogersgray.com 434 ROUTE 134 INSURER(S)AFFORDING COVERAGE NAIC# SOUTH DENNIS MA 02660 INSURER A: HARTFORD UNDERWRITERS INS CO 30104 INSURED INSURER B: ROGERS & NIARNEY INC INSURERC: INSURER 0: P 0 BOX 310 INSURER E: ' OSTERVILLE MA 02655 INSURER F: COVERAGES CERTIFICATE NUMBER: 240064 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, TERtbI OP,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. INSRI ADOL SUER LTR TYPE OF INSURANCE I I I wv I PCLICY NUMBER POLICY EFF POLICY EXP (MMIDDIYYYYI IMMIDDIYYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE g DANIAGE TO RENTED CLAIMS-MADE OCCUR PREMISES IEa occurr=rce) S MED EX?(Any one oerson) S N/A PERSONAL&AOV INJURY g GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE g POLICY nJPE'c'r 7 LOC. PROOUCTS-COMPrOP AGG I g OTHER: g AUTOMOBILE LIABILITY COMBINED SIPlGLE LIMIT �a ac^ident S ANY AUTO BODILY INJURY(Per person) g ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) S NON-OWNED PROPERTY DANIAGE HIRED AUTOS AUTOS IPsr ec^idertl S IS UMBRELLA LIAB OCCUR (EACH OCCURRENCE S EXCESS LIAR HCLA.IMS-.NAAOE TN/A AGGREGAT= S OEO F RETENTION S S PER ANDRKERS COMPENSATION EMPLO ERS'LIABILITY YIN X I STT!JT_ I ORH ANYP RO PRI ETORIPA R TN ER'EXEC UTp/E A OFFICE(Mandatory in NH)RrNIENIBEREXCLUDEO? NIA N/A NIA 6S60U84977P25218 01/01/2018 01/01/2019 ='L.EacH.accloE�1T s 500.000 If yes.describe under E.L.DISEASE-EA EMPLOYE_ g 500.000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT g 500.000 N/A DESCRIPTION OF OPERATIONS 1 LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B, no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of i'vlassachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at wNw.mass.gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 367 Main Street AUTHORIZED REPRESENTATIVE �)_� �Ls Hyannis MA 02601 Daniel M.Cro ey,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD ROGER-1 OP ID: MP ,�coRo� CERTIFICATE OF LIABILITY INSURANCE DATE(M5/20 8 101212018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Matthew Paharik Northwood Ins.Agency,Inc. PHONE FAX P.O.Box 187 .508-393-2455 Alc No: 508-393-2955 Northborough,MA 01532 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC q INSURER A:General Casualty Insurance Co. 24414 INSURED Rogers&Marney, Inc. INSURER B: Gary Souza INSURER C P.O. Box 310 Osterville, MA 02655 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD/YYYY MM/DDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE a OCCUR CCI0395621 0312012018 03/20/2019 DAMAGE TO RENTEU- PREMISES Ea occurrence $ 100,00 MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 M'OTHER: L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00POLICY a ECT PRO- FLOC PRODUCTS-COMP/OP AGG $ 2,000,00$ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident A ANY AUTO CBA0395621 03/20/2018 03/20/2019 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 A EXCESS LIAB CLAIMS-MADE CCU0395621 03/20/2018 03/20/2019 AGGREGATE $ DIED I X I RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE I ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION TOWNBAR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE ,L 4�w��•cr,.r'l ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD I I dlIx (P� t ' , Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home Improvemer ' \\ Tractor Registration Type: Corporation ROGERS AND MARNEY, INC. ; Registration: 164688 Expiration: 10/29/2019 P.O. BOX 310 m OSTERVILLE,MA 02655 a 4 a A (C C a 1 Update Address and Return Card. SCA 1 0 20M-05/17 CF21e cpam�n wavallXi �lottac/zuvel t Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corporation before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 16468 U— 10/29/2019 10 Park Plaza-Suite 5170 ROGERS AND MARK -Y=�N= Boston,MA 02116 . N. i GARY SOUZA - 445 WEST BARNSTABLED.� U OSTERVILLE,MA 02655 a t Undersecretary ° NOt valid itho Sig ture r 1' Commonwealth of Massachusetts Division of Professional Licensure !`r'J Board of Building Regulations and Standards Construction Supervisor CS-102999 Etc ires: 08/16/2020 ' GARY J SOUA P.O.BOX 310 OSTERVILLE MA�026.5 r j Commissioner �xp��e.5 81 i�.1 a� • r The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, IYIA 02114-2017 ivww mass.;ov/dia Workers' Compensation Insurance Affidavit: Btulders/Contractors/Electricians/Plumbers. TO BE FILED IVVITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/individual): Rogers & Marney, Inc. "Address: 445 Osterville West Barnstable Road City/State;"Zip: Osteniille, MA 02655 Phone#: 508-428-6106 Are you an employer:'Check the appropriate box: Type of project(required): I.M I am a employer with % 1 employees(titll and ur part-time).`" ], ❑ New ConStrUCt1011 '_ I and a sole proprietor or partnerhip and have no employees working for tie in o ❑ S. © Remodelin_ am capacity.(Nio worken'comp.insurance required.) 9. ❑ Demolition 3.❑1 am a homeowner duin_all work myself.(NO Workers'comp.insurance required.]' 10 ❑ Building addition q.❑I am a homeowner and will be hi[in_contactors to conduct all wort on nry property. I will ensure that all contractor either have workers'compensation insurance or are sole I I.❑ Electrical repairs or additions proprietor with no employees. • 12.❑Plumbing repairs or additions 5.0 I am a general contractor and I have hired the SUb-contractors listed oil the attache(sheet. These sub-contactors have employees anti have workers'comp.insurance., 13.❑Roof repairs 6.❑We;ere a cotpoa[iun and its officer have exercised their right of exemption prr\di:rL c. l4.❑Other I i'-.S I(-t),and we have no employees.(No workers'comp_insurance re(µured.] '`Any applicant that checks box'I ['lust also till out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicatinQ they ar,doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractor that check this box nuts[attached an additional sheet showing the name of the sub-contractor and state whether or not those entities have employees. if the sub-contractors have employees,they must provide their'workers'comp.policy number. I tern an employer that is providin;workers'compensation insurance for my employees. Below is the policy trod job site information. insurance-Company Name: 'JC30�% L Ja��nA14/Y"1► MAC Policy_or Self-ins. Lie.-:6560UB4977P2521� 3� `sY�33L"fl E•cpiration Date: I�I�yp2,p Job Site Address: M %& I-wt4o A*tG City/State/Zip: .attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to SeCLIi'e coverage as required under tMGL c. 152, §25A is a criminal violation punishable by a tine up to S1,500.00 and/or ogle-year Impriionmenc, as well as civil penalties in the form of a STOP`CORK ORDER and a tine of up to 5250.01)a day against the violator. A copy of this stntel;hent may be forwarded to tl,e Office of Investigations of the DLA For insurance Coverage verification. I do herckv certify under th reins I rrttltiA perjury that the inj'ormution provided above is true and correct. Signature: Date: 1,2 l� lg Phone#: 508-428-6106 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing [nspector 6. Other Contact Person: Phone#: E Town of BarnstabIle # Regulatory Servkes Thomas L efler,Director � Building Division , Tom Perry,Building Commissioner 200..Main St;.=e Hyannis,M `02601 www.town.barnst ible.mtLus Office: 508--862-4038 F= 508490-6230 . t Trope rtv 0'1�_I1er-must K Complete and Sign TI i.s Section If Ud &$u alder ' as Ou raex of the subject hereby al1%Iloxdze„ -__.-...__ ------.-to Act ogl xny behalf. in.all ina.ttem rcla&e tb,*otk autboxiztd by this:bLrilc ng putt. 3 Q 1 - tJ lDr.�3� 4i�Cy F.r (Add-tens of job) M1 **Pool fences and al -as are the respons biRtp of the' applicaw.. Pools are not to be fiIl d before fence is installed a=d pools are not to be' � utilized until all fin.a:l inspections are performed and:accepted. 4 t .at'tl2e OI QwLIE:T__..-...._.._..___.-___..._... -- C3 �a�.�3$�1�?.t):� Pti t:Name P=:t:NaIlle Date THE ......... .— ...... Application Number...... . ....................... BU11-DING DEPT. So ELAMSTABM Permit Feel.39.31.....................Other Fee........................ MASS. ..... ... 16 JAN 0 4 2019 TOWN OF BARNST ABLE Total Fee Paid........................... ........... ...... TOWN OF BARNSTABLE Permit Approval by. .................On.... .... BUILDING PERMIT APPLICATION Map...:........(............C7 ...............Parcel............17�.................... Section I — Owners information and Project Location Project Address A 1 U3&A^"G k%/C- Village- 0 rrmjqt�y Owners Name. 0"944ALO Owners Legal Address • City. State MN, zip 02%t Owners Cell# E-mail 9v1A&-fA.%,)moo Section 2 —Structural Use Single/Two Family Dwelling F] Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet Section 3 — Type of Permit F] New Construction ❑ Move/Relocate F] Accessory Structure F] Change of use E] Demo/(entire structure) El Finish Basement El Family/Amnesty El Fire Alarm Rebuild El Deck Apartment El Sprinkler System R Addition F] Retaining wall E] Solar El Renovation El Pool El Insulation Other-Specify Section 4 Detail 0 Cost of Proposed Construction m:om Square Footage of Project 0 Age of Structure K -Dig Safe Number # Of Bedrooms Existing Total#Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method [] MA Checklist [] VVTCM Checklist ❑ Design Last updated: 11/7/2017 Section 5 - Work Description jZ�cpCl. �'S� t�T7.1�Aa.S a i Section 6—Project Specifics ❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom Water Supply s .,a [].-Public. ❑ Private Sewage Disposal ❑ Municipal On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway N Debris Disposal Facility: I am using a crane ❑ Yes ® No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland,coastal bank? Yes ❑ No Section 8 —Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed' Rear Yard Required Proposed .K Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last updated: 11/7/2017 Section 9- Construction Supervisor Name_ ,y -T ►ram, Telephone Number Cob �VZ _ Address 6Sr W o06W ao City_OL`''uatjState MA Zip o2�ss License Numbers j 99 License Type 6*sj Sd. Expiration Date TcL 6.Qaa Contractors Email Cag W 44 C-f Cell# "UX U. CAM I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your license. Signature Date Section 10-Home Improvement Contractor Name_ R-b4.4V_S+MA�L.1C`! 1.4 C. Telephone Number So% �6t4_ 6t,p(o Address_�}�}g 037 mil . 11 p City o kA.1c State ywA Zip oZ�S Registration Number 1 q b8 Expiration Date Al i9 ibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 I understand my respons CMR the Massachusetts State Building Code.. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C... Signature Date Section 11 —Home Owners License Exemption Home Owners Name: - Telephone Number Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLIC T SIGNATURE �hignature Date 1'0 ,a t• Prinf Name 5%: UZA, Telephone Number &,og 4.z.g_6101L E-mail pErmit to: Ga S @_ -1L .WDQ4X C t. `, Last updated: 11/7/2017 Section 12 —Department Sign-Offs Health Department 0 Zoning Board (if required) El Historic District El Site Plan Review(if required) El Fire Department 7�4, Conservation-. For commercial work,please take your plans directly to the fr e Wepartment for,app movaL Section 13 — Owner's Authorization as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of job) Signature of-Owner ate Print Name Last updated: I IM2017 Town of Barnstable Building Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept • /ARNSYABIE. • - MASS Posted Until Final Inspection Has Been Made. Permit 1639 p�� t Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been-made. Permit No. B-18-4055 Applicant Name: Eric Whiteley Approvals Date Issued: 12/12/2018 Current Use: Structure Permit Type: Building-Sheet Metal-Residential Expiration Date: 06/12/2019 Foundation: Location: 391 WIANNO AVENUE,OSTERVILLE Map/Lot: 140-173 Zoning District: RF-1 Sheathing: Owner on Record: PACKWOOD, RICHARD J& MODAHL,MARY Contractor Name:-,,ERIC T WHITELEY Framing: 1 11-1 Address: 205 COMMONWEALTH AVENUE APT 6 Contractor License: 15920 2 BOSTON, MA 02116 - Est. Project Cost: $5,000.00 Chimney: Description: Duct work 1 Permit Fee: $85.00 Insulation: �. Fee Paid:' S 85.00 Project Review Req: DOCUMENTATION TO BE PROVIDED AS REQUIRED. Final: Date: 12/12/2018 �C� Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open fo public inspection for the entire duration of the work until the completion of the same. l — . t[ Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT 6wLa;41c �GnAu S E�+r' Town of Barnstable Building 3 Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept &MM Posted Until Final Inspection Has Been Made. Permit 1 Where a Certificate of Occupancy is Required,such Building'shall Not be Occupied erm until a Final Inspection has been made. :~ Permit No. B-18-3977 Applicant Name: ROGERS AND MARNEY INC. Approvals Date Issued: 12/05/2018 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 06/05/2019 Foundation: Location: 391 WIANNO AVENUE,OSTERVILLE Map/Lot: 140-173 _ Zoning District: RF-1 Sheathing: Owner on Record: PACKWOOD, RICHARD J&MODAHL, MARY Contractor Name.` ROGERS AND MARNEY INC. Framing: 1 Address: 205 COMMONWEALTH AVENUE APT 6 ' Contractor License: 164688 2 BOSTON, MA 02116 Est. Project Cost: $12,300.00 Chimney: Description: replacement Windows Uvalue.31(17) i Permit Fee: $62.73 replacement doors i Insulation: f Fee Paid: $62.73 ' Final: Project Review Req: I .�I Date: ,f 12/5/2018 f. c.� Plumbing/Gas '`- Building O Rough Plumbing: Official i Final Plumbing: Rough Gas: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within siic months after issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Final Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. "'"— - "�- Electrical f Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Rough: 1.Foundation or Footing ` 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Final: Work shall not proceed until the Inspector has approved the various stages of construction. "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Final: Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT DIME Town of Barnstable *Permit# 3� Regulatory Services ee 6mont/is from issue date = ��,lA1ZNtSTA91E " ik� J Mass Richard V.Scali,Director /� (J i639• `� �C.ls D1A0�°i Building Division C/� V 4 201i9 Paul Roma,Building CommissionegIft) 200 Main Street,Hyannis,MA 02601 ' Pius i�g�l www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 1�'0/t'13 _ Property Address 'Ict Il W tArJh10 Ar.*./E ❑Residential Value of Work$ 110,100 Minimum fee of$35.00 for work under$6000.00 -- Owner's Name&Address fLkC"4&Q PArC1C.L"CAN0 Contractor's Name GCA 644w312/ Telephone Number Svc �2$ _ 61 O(e Home Improvement Contractor License#(if applicable) t1n4+ L$$ Email: Wt ` Q.0QwU 4WO AnAWIk( Construction Supervisor's License#(if applicable) C.S. r02049M ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor Vam the Homeowner have Worker's Compensation Insurance Insurance Company Name ZoGc5 lj t.Z f, AL4Pa=Ks c.& Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ® Replacement Windows/doors/sliders.U-Value (maximum .32)#of windows #of doors: 1 'Where required: issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A of the Home Im006vement Contractors License&Construction Supervisors License is equired. SIGNATURE: C:\Users\decollikWppData\Local\Microsoft\Windows\1NetCac e\Content.Outlook\L7U69LF2\EXPR.ESS(2).doc 01/25/17 f = 'ME tom, Town of Barnstable Reguhatory Services 9 Thomas F.Geiler,Director ram" Building Division Tom.Perry,Building Commissioner .200.Main Street,ll'yanms,MA O2601 i yYww t[}Iryn.b1.T1u'tc ble_ff a. us Office: S(18-862-�'�035 . i*ax: 508-790-5230 Property Owner.Must Gornplete and, Sign This Section. If Us%zag A Bb ilder � T, _P.1.eG1k-p1.—m—QgLC.r v.L ,._�,as O—imer of the subjectpra,a" s hereby autl�.abze, -Q sFa11�.d -1- �1� _ m _to act on my behalf, F in all rua_ttets relative o words au_-thoriGed by tiz±s build ing pc-sxr.,zL , (Address of job) Pool fences and al:anyis are the responsibility of the applicant. Pools are not to be filled before fence is installed and pools are not to be � utilized until all final inspections are perfiozxlaed and.accepted. � 4 e of C�vt nex Sz a z e 0 p l;.ca* - plint Name p.rin:i:l`Iazr.r Date . F Q:FOR2��;:�JT�'l+l�.,�t�'�.ttNsTSSiEJs'S'$CJOI�..` r s i r The Commonwealth of Massachusetts Department of Industr all Arcidents Office of Investigations 600 Washington.Street Boston,AL4 02111 nmtmass.govldia Workers' Compensation Insurance Affidavit:Bmiders/CnntractorsAElectricians/Plumbers Applicant Information Please Print Legibly Name(Businesslor *zafionandividnaly GAdLs i- qdbJe^( 4.1G Address: e*f O Cr,tu1. 2ltW 1c-^A1L LO City/State/Zip: O USS Phone#: 5&1% %k,.4' -L l a L Are you an employer?Check the appropriate box: Type of project(required): 1.M I am a to with 1 4. ❑ I am a general contractor and I ffiP — —s have hired the sub-contractors 6- ❑Neva construction employees(full atsd/orport-dime)_ 2,❑ I am a sole proprietor or partner- Iisted on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g- ❑volition working for me in any capacity_ employees and have workers' 9. ❑Building addition [No workers'comp.insurance. comp.insurance:+ required-] 5. ❑ We are a corporation.and its 10_❑Electrical repairs or additions 3 ❑ I am a homem mer doing all work officers have exercised their 11_❑Plumbing repairs or additions myself. [No workers'comp_ right of exemption.per MGL 12.❑Roof repairs mod.]1 c- 152, §1(4),and we have no employees-[No workers' 13.❑Other comp.insurance required_] 'Any gTbcm that checks box#1 must also fill out the section below showing their wo3ters'compensatsnn policy information- 1 Homeowners who submit this affidavit indicating they are doing all wa t and then hue outside contractors mast submit:a new affidavit indicating sach- ZContractors that check this box must attached.an additional sheet showing the name of the sub-contrKtors and state whether or not those entities have employees. If the sub-contactors bane employees,they must pm ade their workers'comp.policy number. I am an employer that is providing workers'congmisation:insurance for my earpleyem Below is the policy and job site information. Insurance Company Name: _ - tLOGCa�I.S 4r G—ttlAL`4 14 f. O4GGIPY>� Policy#or Self,ins.Lic_ft- (0 S( tZ 11? ICE I$ Facpiration Date: 1 ' 1 ' � Job Site Address: ' 11a110."b A6JC City/StatelZip:05—sZ&ds S�2� Attach a copy of the workere compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required unties Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this sWement may be forwarded to the Office of Investigations of the DIA for immrance coverage verification. I do h ere iiy cirrhfy pffft,the poi d penalties of pe n:ry that the information pro ded above is ante and correct S e: Date: Phone#: !S • --- -- - - 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.Budding Department 3.City/rown Clerk 4 Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: I ACo® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 10/25/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this'certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME. Rogers and Gray Processing ROGERS &GRAY INSURANCE AGENCY INC PHONE (508)398-7980 A C No: E-MAIL mail ma@rogersgray.com ADDRESS: g sgray.com 434 ROUTE 134 INSURERS AFFORDING COVERAG E NAIC# SOUTH DENNIS MA 02660 INSURER A: HARTFORD UNDERWRITERS INS CO 30104 INSURED INSURER B ROGERS & MARNEY INC INSURER C: INSURER 0: P 0 BOX 310 INSURER 2, OSTERVILLE MA 02655 INSURER F: COVERAGES CERTIFICATE NUMBER: 330248 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE AODL SUBR POLICY EFF POLICY EXP LTR POLICYNUMBER MMIDOIYYYY MMIDO/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE1-1 OCCUR DAMAGE TORN ED PREMISES(Ea occurrence) $ MED EXP(Any one person) S N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S PRO- POLICY JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ _(Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAfvIAGE HIRED AUTOS AUTOS fPeraccident $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X SPER TATUTE ERH AND EMPLOYERS'LIABILITY Y I N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 A OFFICERIMEMBEREXCLUDED? NIA NIA k/A 6S60UB4977P25218 01/01/2018 01/01/2019 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 367 Main Street AUTHORIZED REPRESENTATIVE Hyannis MA 02601 Daniel M.Cro ey,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD .�� ROGER-1 OP ID: MP CERTIFICATE OF LIABILITY INSURANCE DATE(M5/20 0/2 /20 8 118 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Northwood Ins.Agency,Inc. NAPH.ME: Matthew Paharik P.O.Box 187 _(A N Extl:508-393-2455 FAX No),508-393-2955 Northborough,MA 01532 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# --INSURER A:General Casualty Insurance CO. 24414 INSURED Rogers&Marney,Inc. Gary Souza INSURERS: P.O.Box 310 INSURER S. Osterville,MA 02655 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILNSR TR I TYPE OF INSURANCE DDL SITBR-J----' POLICY EFF TOLICY EXY j IN SD IWVD I POLICY NUMBER I MMIDD/YYYY MMIDD/YYYY i LIMITS A X COMMERCIAL GENERAL LIABILITY I I EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE l -- I OCCUR iCC10395621 03/20/2018 03/20/2019 UAMA ETORENTED PREMISES ea occurrence $ 100,00 j MED EXP(Any one person) $ $,OO i I PERSONAL 8 All INJURY $ 11000,00 GEN'L AGGREGATE LIMIT APPLIES PER: j POLICY rGENERAL AGGREGATE $ 2,000,00 ;JE0 ,�LOC j PRODUCTS-COMP/OP AGG $ 2,000,00 OTHER: I I $ AUTOMOBILE LIABILITY ( EO aBINE�DtSINGLE LIMIT $ 1,000,00 A ANY AUTO i CBA0395621 103/20/2018 03/20/2019 BODILY INJURY(Per person) $ ALL OWNED y SCHEDULED I I AUTOS AUTOS BODILY INJURY(Per accident) S I ' X HIRED AUTOS NON-OWNED j PROPERTY DAMAGE I�AUTOS Per accident $ $ UMBRELLA LIAB I X!OCCUR I + EACH OCCURRENCE $ 10,000,00 A EXCESS LIAR j CLAIMS-MADE �CCU0395621 103/20/2018 03/20/2019 j AGGREGATE S DIED I X I RETENTION$ 10,000 I I I I $ WORKERS COMPENSATION OTH- AND EMPLOYERS'LIABILITY Y/N I STATUTE ER ANY PROPRIETORIPARTNER/EXECUTIVE i OFFICER/MEMBER EXCLUDED? ❑N/A E.L.EACH ACCIDENT S I(Mandatory in NH) If yes,describe under i )�E.L.DISEASE-EA EMPLOYE $ I DESCRIPTION OF OPERATIONS below I I I E.L.DISEASE-POLICY LIMIT S i � I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION TOWNBAR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN To To Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD IQ Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home Improvement"Contractor Registration } w Type: Corporation ROGERS AND.MARNEY,INC. € - � ' it,. Registration:' 164688 , � / - # f Expiration: 10/29/2019 P.O.BOX 310 OSTERVILLE,.MA 02655 Update Address and Return Card. SCA 1 t5 20.j(M��-00�5/17,,61f6 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Porooration before the expiration date. If found return to: Realstratlon'% Expiration Office of Consumer Affairs and Business Regulation 164688:.:::. .:::.::::. 10/29/2019 10.Park Plaza-Suite 5170 ry ' ''' -' Boston,MA 02116 ..ROGERS AND MARNE'Y; .... r� Ei:....c a ri GARY SOUZA 445 WEST BARNSTABRD OSTERVILLE,MA .02655_...,�"� Undersecretary Not valid itho sip ture { Massachusetts- Departine"t of Public:Safety Board of 3udc-ing RCgUka ions and Standards License: CS-102999 s GARY JSOUTA P.t _80X 310. Ostervillc MA. 02655 XPIration Commission.e:r 08/16/2016 New eq a s:. rr--.^!" _ 's T.'• F ..�.�.-+. :.. j ►.0 t Y. T.c:^-" t - yC�y.. .-i..�w�;s..�,'7 �" tt i Commonwealth of Massachusetts ®sDivision of Professional Licensure Board of Building Regulations and Standards Const\;qyetion�Supe_rvisor J CS-102999 E Aires: 08/16/2020 GARY J SOU1:A P.O.BOX 310% ° OSTERVILLE ML> O'2fi55 ,�' 1'01 i 1� Commissioner ; re S 8A i%a l av s Town of Barnstable Buildin'g .. �,°��,�� : �Post This Card So�That�tTis'Visible`From the Street •Approved Plans Must beIRetain'ed�on Job��and':thisxCati!Mustbe Kept • M"�'• Posted Until Final.lnspection Has;Beeri.Made.• : bs� ro M Permit -? ram+" W<here aCertifcate of°O,ecupancy is Required;sueh BuildingshallNot be Oceupiedu.ntil'a Final Inspettionjhas been made, Permit No ,.:• B-184268 Applicant Name: ROGERS AND MARNEY, INC. --Approvals- -- Date Issued 05/21/2018 �. Current Use: Structure Permit•Type: Building-.Alteration INTERIOR Work_ Only Expiration Date:_ 11/21/2018 Foundation: Residential Map/Lot: 140-173 Zoning.District: RF-1 Sheathing: Location: 391 WIANNO AVENUE USTERVILLE ly g n ntiu Contrattor Na e' GARYJ SOUZA Framing: 1 Owner on Record: PACKWOOD,RICHARD J&MODAHL,MA RY,� �� F� � Contratto�L cense. CS.102999 2 Address: 1410 MONUMENTST JeCt .00 Chimney: CONCORD, MA 01742 _ ;� -� {: �X 30000 Permit Fee: $.203.00 Insulation: Description: masterbath renovations-retile and relocate shower, P �� FeePaid $203.00 Final: ' Project Review Req: 5/21/2018 -,. Plumbing/Gas Rough Plumbing: 3 - �. — ,� � Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work-auhorizedby'L s permit is commenced sixmo the afterkissuance. ` Rough Gas: All work authorized by this permit shall conform to,the approved appl ci ation in,,Ahe approved construction documen•t�sfort ifi'.iKis permit has been granted: g Allconstruction;alterations and changes of use of building and structuresshallbe in compliance with the local zonings ningby-laws=and codes,. Final Gas: This permit shall be displayed in a location clearly visible from access street or,.road and shall be maintained open for pubho,mspection for the entire duration of the work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by he Building and Fire O,ffcialsnare p ovideaph this permit: Minimum of Five Call Inspections Required for All Construction Work: �" �� ° Service: I� 1.Foundation or Footing Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed, Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) tow Voltage Rough:+ 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting,with unregistered contractors do not.have access to the guaranty fund" (as set forth in MGt c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel TOWN OF BARNSTABLE Application # Health Division Date Issued "y _ I AM 9. 34 Conservation Division Application Fee Planning Dept. Permit Fee ��3 Date Definitive Plan Approved by Planning Board y c I O N Historic - OKH Preservation/ Hyannis Project Street Address 3`N,k Village Owner Address /-Y/10 X_o"0L1ENr e�Lcce /AA Telephone o Permit Request Square feet: 1 st floor: existing proposed Z K 2nd floor: existing / proposed IK Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 50, O00 Construction Type iZ=�D Lot Size ' 3 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-FaYNo units) Age of Existing Structure GO % Historic House: ❑Yes On Old King's Highway: ❑Yes ;d`No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Otherr �T+�� _— Basement Finished Area (sq.ft.) c7 Basement Unfinished Area(sq.ft) � Number of Baths: Full: existing_ S new 01 Half: existing new Number of Bedrooms: b existing O new Total Room Count (not including baths): existing new o First Floor Room Count Cn Heat Type and Fuel: AGas ❑ Oil ❑ Electric ❑ Other Central Air: , Yes ❑ No Fireplaces: Existing / New o Existing wood/coal stove: ❑Yes,,�4No Detached garage: ❑ existing ❑ new size_Pool:9existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage existing ❑ new size Shed: ❑ existing ❑ new size — Other: S�osvc' . Zoning Board of Appeals Authorization ❑ Appe # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan r view# Current Use Proposed Use i APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name sue► lephone Number is"015 8 6010(o Address�o, rho K_ ZLO License # ©bNvEZ,.nu-F_ n',4 ozcosS' Home Improvement Contractor# IL04(,89 Email o�� ,Qoe�s�..n,/•.Azr►e�� u, s Worker's Compensation # coscan% ) C'7 218 I ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE. - DATE �� k Mr. FOR OFFICIAL USE ONLY ' APPLICATION # DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE r OWNER " DATE OF INSPECTION: FOUNDATION ' • FRAME ' INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL r PLUMBING: ROUGH FINAL k GAS: ROUGH FINAL - FINAL BUILDING = I - N DATE CLOSED OUT ASSOCIATION PLAN NO. 15.84 ft � I ;HEATED TOWEL R ------- - --' _ `HEATED TOWEL BAR' Shower 'E f u 00Al ' f Y. y 21 jt.�.>IJ1.Qi�.. `l<f•'�C t,'.`i}::�r•hS; �•Cfa fr`; ' 1 ' _ I ___— DEMO EXISTING WALLS - o>MAST CLOSET STUDY M A 200' Ll II I II . I i I I I I , I — I MASTER BATH I — L , CQ 1 � Fx�J <�� 7�- �\<�Az.o1/� TRIM I d I i DEMO PLAN PROPOSED PLAN A 1.O ..e:va•.i a' --` A J 1.Oro- SOPACKWOOD MASTER BATH DATE:30 = '0 Ai . — SCALE:1/4" 1 -O" 0 f THE %�IIART'STAIILE. Town of Barnstable Ea r�,t Regulatory Services Richard V.Seali,Interim Director Building Division Thomas Perrv,CBo Building Commissioner 200-Main S(rect. Hyannis.,fA 03601 w��w.rnwn.barn3lublc.n;a.us 011ice: 508-36'-4033 Fail: 50$-;90-62'0 Property, Owner Must Complete and Sign This Section If Using A Builder („ ^�C �►��c.WOp� ''IS 0\Vncr of the subject.Property hereby aLIffi.rri.•Le ROcre.rs and Nld-rn:e'_i Fli:i 1 derS • to:1Ct on n1V behalf, in all matters relative to work ourhorized bG this buildin',hermit application.tor: (Address of Job) �_ Signarure of 0,,vner Date lCW,A PAc--kv./oo Print Name If Property Owner is applying;for permit,please complete the Homeowners License Exemption Form on the reverse side. �� Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home Improvemenf'Contractor Registration Type: Corporation S Registration: 164688 ROGERS AND MARNEY, INC. Expiration: 10/29/2019 P.O. BOX 310 ltk OSTERVILLE,MA 02655 _ Update Address and Return Card. SCA 1 20M-005/17 ��/I,P�QIYGIIt4i1,LGiv(GCLi1,Q�.-ni000LdJCL1.'liLLilv�J Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corooration before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 164688 . ..- ;10/29/2019 10 Park Plaza-Suite 5170 ROGERS AND MARNEY,_INC. :' Boston,MA 02116 GARY SOUZAC -- 445 WEST BARNSTABLE RD. OSTERVILLE,MA 02655 Undersecretary Not Val wi signature I Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-102999 Construction Supervisor GARY J SOUZA P.O.BOX 310 OSTERVILLE MA 02655: N Expiration: Commissioner 08/16/2018 i Ago CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 02/15/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Teresa Van R sw00d ROGERS & GRAY INSURANCE AGENCY INC PHONE 508 2582111 FAc No: ADDRESS: tvan swood ro ers ra .com ADDR 434 ROUTE 134 INSURERS AFFORDING COVERAGE NAIC# SOUTH DENNIS MA 02660 INSURER A: HARTFORD UNDERWRITERS INS CO 30104 INSURED INSURER B: ROGERS & MARNEY INC INSURERC: INSURER D: P O BOX 310 INSURER E: OSTERVILLE MA 02655 INSURER F: COVERAGES CERTIFICATE NUMBER: 240064 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY LTR TYPE OF INSURANCE INSO WVQ SUER POLICY NUMBER MMIDDYY IYY) (MMIDD/YYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S DAMAGE TO RENTE CLAIMS-MADE F-IOCCUR PREMISES Ea occur ante S MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S PRO- LOC PRODUCTS-COMP/OP AGG S POLICY a OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S Ea accident ANY AUTO BODILY INJURY(Per person) S ICI ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE S HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE N/A AGGREGATE S DED I I RETENTION S �/ $ WORKERS COMPENSATION /� STATUTE ERH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNEW/ XECUTIVE YIN E.L.EACH ACCIDENT s 500,000 A OFFICER/MEMBEREXCLUDED7 NIA NIA N/A 6S60UB4977P25218 01/01/2018 01/01/2019 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE s 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT s 500,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 367 Main Street AUTHORIZ/IED REPRESENTATIVE Hyannis MA 02601 �"'r Daniel M.Cr y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD i The Commonwealth of,111assachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/ilia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Or.aanization/Individual): Rogers & Marney, Inc. Address:445 Osterville West Barnstable Road City/State/Zip: Osterville, MA 02655 Phone#: 508-428-6106 Are y an employer"Check the appropriate box: Type of project(required): I. I am a employer with 1rmployees(full and/or part-time).* 7. ❑New Construction ❑I am a sole proprietor or partnership and have no employees working forme in v S.�$emodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 31_j I am a homeowner doing all work myself[No workers`comp.insurance required.]' 10❑ Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I I.❑Electrical repairs or additions proprietors with no employees. I2.❑Plumbin-repairs or additions 5.Q l am a general contractor and I have hired the sub-contractors listed on the attached sheet. ]').[:]Roof repairs sub-contractors have employees and have workers'comp.insurance. 6.❑we are a corporation and its officers have exercised their right of exemption per NIGL c. 14.❑Other 152.§1(4),and we have no employees.[No workers'comp.insurance required.] *Airy applicant that checks box 91 must also till out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I are an employer that is providing workers'compensation insurance for»ry employees. Below is the policy rrnd job site ell/o rill atioll. Insurance Company Name:Hartford Underwriters Insurance Company Policy#or Self-ins. Lic.#:6560UB4977P25210 Expiration Date:01/01�4- Job Site Address: 1 tp City/State/Zip: 0_50�I LLZ, /^A oL(oS.s 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 ill le p s and pena 'es o pea jury that the information provided abolitsZera correct. Signature: Date: 8 Phone#:508-428-6106 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: ROGERS & MARNEY, INC. Subcontractor Workers Compensation Page 1 Insurance Policy Report System Date: 04-11-18 Vendor Name WC Insurance Co. Policy Period 150 ANTHONY GERACI HARTFORD CASUALTY INS CO 04-14-2017 - 04-14-2018 08WECE07531 820 ELITE WOOD FLOORING INC NORGUARD INSURANCE COMPANY 01-23-2018 - 01-23-2019 ELWC975604 1530 CARLOS DEANDRADE, INC NOM insurance company 06-05-2017 - 06-05-2018 WCP3999V 1879 W. VERNON WHITELEY, INC. 'AIM MUTUALK INSURANCE CO 10-01-2017 - 10-01-2018 MCC-200-2000518-2017A tom- SS Town of Barnstable Perini kepires 6 mondMs from issue dare Regulatory. Services Fee BARNUMBIF, • ® �9f�y v� M eea Thomas F.Geiler,Director . n.73a�`) 06 f07q. � Building Division ��-- Tom Perry,CBO, Building Commissionte11-3 16 2C`. `1 200 Main Street, Hyannis, Nfol !�! ``ii 1' ww.town m .bamstable. a.us OF 8ANIVS'Ala Office: 503-862-4033 w a E08.790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY . Not Valid without Red X-Press Imprint Map/parcel Number 0 Property Address � y W i d no n le F�J`Residential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Alcblaj 1 a k Uj l L/ l D M DryV,0 z Contractor's Name _ ��_Telephone Number Home Improvement Con ractor License#(if applicable) — —� Construction Supervisor's License#(if applicable) .__ Q_��_L_L-- - 2/workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I m the Homeowner have Worker's Compensation Insurance � Insurance Company Name )4��[(d �-- Workinan's Comp.Policy# 6iS(0 0 VLd"7 -- Copy of Insurance Compliance Certificate must accompany each permit. Permit RequesC(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to__ ❑Re-roof(not stripping. Going over existing layers of root) ❑ Re-side #of doors replacement Windows/doors/sliders. U-Value o3 1—(maximum .44) #of windows •Where r requited: Issuance o this permit does nut exempt compliance with other town dcpanmcttt regutatinns.i.e.Historic.Conservation,etc. ***Note: Property Owner must sign Property caner Letter of Permission. A copy of the Hot a Improveme C ntractors License& Construction Supervisors License is require . SIGNATURE: — C':\Uscrs\decollik\AppData\I-ocal\Microsoli windows\'Icmp ry 1 ternct Files\('ontcnt.Outlook\7S'fGItSQU\GXPRIfSS.duc Revised 090809 T6wiw of Barnstable RcgrtWery.Services - Richard V.Scali,Director Building Division. Tom Perry,Building Commissioner MOM&Sftee4 Hyannis,MA 02601' www.town.barnstAble.maius Office. '.508-862,4-038 1-�a 508490-6230 Property Owner Must Complete and Sign T his Section IfUsihkA Ruilder- .as Ownerlofthes6jectfftoputy hereby to,acvbn my behalf, in all matters relative to work authorized by this building permit application for: FM Wiam-wo A-nue,oiterv'ille **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 inspections are performed and accepted. Signature 6fOwner an SWNA- Print Name Print Name .2-11't-1 I Date The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 ' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/OrganizationAndividual): Rogers & Marney, Inc. Address: 445 Osterville West Barnstable Road, P.O. Box 310 City/State/Zip: Osterville, MA 02655 Phone#: 508-428-6106 Are you an employer?Check the appropriate box: Type of project(required): 1. ✓ I am a employer with 15 4. I am a general contractor and 1 6. New construction employees(full and/or part-time).* have hired the sub-contractors 2. 1 am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity. employees and have workers' insurance.+ 9. Building addition comp.[No workers' comp. insurance p' 10. Electrical repairs or additions required.] 5. We are a corporation and its P 3. I am a homeowner doing all work officers have exercised their 11. Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. Roof repairs insurance required.]t c. 152, §1(4),and we have no 13. Other Windows employees. [No workers' 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. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Hartford Underwriters Policy#or Self-ins. Lic.#: 6S60UB4977P25219 Expiration Date: 1/01/2019 Job Site Address: 391 Wianno Avenue City/State/Zip: Osterville, MA 02655 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify It pains d penalties of perjury that the information provided above is true and correct. Si nature: Date: 2A mS Phone#: -"Ll l UJ Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: r ACC> CERTIFICATE OF LIABILITY INSURANCE FDATE(MMIDDIYYYY) � 02/15/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Teresa Van RySWOod ROGERS& GRAY INSURANCE AGENCY INC PHC.o Ext: (508)2582111 FAX (AtA/C No E-MAIL ADDRESS: tvanryswood@rogersgray.com 434 ROUTE 134 INSURERS AFFORDING COVERAGE NAIC# SOUTH DENNIS MA 02660 INSURER A: HARTFORD UNDERWRITERS INS CO 30104 INSURED INSURER B ROGERS& MARNEY INC INSURERC: INSURER D: P O BOX 310 INSURER E: OSTERVILLE MA 02655 INSURERF: COVERAGES CERTIFICATE NUMBER: 240064 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE iNqn vrvn POLICY NUMBER MMIDD/YYYY MMIDD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES Ea oxurrence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ JECT POLICY PRO ❑LOC PRODUCTS-COMPIOPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION /\ SPER TATUTE ER AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBEREXCLUDED9 I NIA NIA N/A 6S60UB4977P25218 01/01/2018 01/01/2019 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 367 Main Street AUTHORIZED REPRESENTATIVE ' -o v�`oW�e� Hyannis MA 02601 `-" Daniel M.Cry,CPCU,Vice President—Residual Market—WCRIBMA @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD � (29 G,��wte� ollgAzwa�� Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home Improvement`Contractor Registration = Type: Corporation Registration: 164688 ROGERS AND MARNEY, INC. Expiration: 10/29/2019 P.O. BOX 310 - , OSTERVILLE,MA 02655 lac v. Update Address and Return Card. SCo,i .; 20NI-05117 (J�n,�bIYGI%Ga/I,cL'eCG�IL o��Clii�::ac•�uaelG3 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corporation before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 164688 10/29/2019 10 Park Plaza-Suite 5170 ROGERS AND MARNEY,INC.==:: Boston,MA 02116 GARYSOUZA 445 WEST BARNSTABLE_RD. . OSTERVILLE,MA 02655 Undersecretary Not vai WI signature Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-102999 Construction Supervisor GARY J SOUZA � ter, P.O.BOX 310 OSTERVILLE MA 02655�--,--,, Expiration: Commissioner 08/16/2018 tiff: 6Ae i !as Town of Barnstable *Fermi # Exp! rrralr s jr issue d rr ,�. . Olt ReguIatory Services F' C9G IC Thomas F. Geller, Director QE) 1015-1lr Building Division OF BARNSTABLE Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 308-862-403 8 Fax: 508-M-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Nor Valld witlrorrr Red X-Press.lnrprint Map/parcel Number Property Address zzwx 3+,Jy X/, — Residential Value of Work_ 7-_/}��_ Minimum fee of$35,00 for work under$6000.00 Owner's Name A Address ��,zj�k' OJ,p-r0A) Contractor's Nanie_ �. !/ �'.r� ' Telephone Number kyL- y� Home Improvement Contractor License#(if applicable) l%D � Construction Supervisor's License#(if applicable) ❑Workmen's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ("I have Worker's Compensation Insurance Insurance Company Name Z9,wz5?6z Workman's Comp, Policy# /,//Q �? Copy of Insurance Compliance Certificate must Accompany each permit, Permit Request (check box) VRe-roof(hurricane nailed) (stripping old shingles) All construction debris will be taken to h/ ❑Re-roof(hurricane nailed) (not stripping. Going over existing layers of root} [] Re-side Replacement Windows/doors/sliders. U-Value #ofdoors (maximum .35)#of windows wwhere required: Issuance of this permit does not exempt compliance wish other town department regulations,i.e.Historic.Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License & Construction Supervisors License is required, SIGNATVItE: 0AWPFILMFORMSVbuilding permit forms4FXPRGSs.doc License or registration vauu'u. ■■■�•••�--_-___-, Office o oosumer a'rs` I loess egu ahon before the expiration date. if found retain to: ,HOME IMPROVEM Type: CONTRACTOR office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Registration: --_,100497 Private Corporatic� Boston,MA 02116 Expiration: /125/2012 4 DAV1b• COX,INC. � - David Cox �__ 19 LAVENDER LN '''s'' `-= Not valid without signatur W.YARMOUTH,MA-U2fi73':`.: Undersecretary Niassachuscttx- Departmcnt of PuhliC Safcth ' Board of Building Regulations and Standards Construction Supervisor License License: CS 6353 Restricted to: 00 DAVID R COX R, PO BOX 401 S YARMOUTH, MA 02664 i Expiration: 1 011 51201 1 i (•ummi-o Tuner Tr#: 5022 DAVID-2 OP ID: KG A�No CERTIFICATE OF LIABILITY INSURANCE 706/29111 (MMiDD/YYYY) 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(les) must be endorsed. If SUBROGATION IS WAIVED,subject'to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsements . CNTACT PRODUCER 508-771-1632 NAME: Northwood Ins.Agency,Inc, PHE FAX 540 Main'Street,Suite 9 508-393-2955 ,uc ONNo ct). C. Hyannis,MA 02601 E-MAIL INSURE B AFFORDING COVERAGE 1` NAIC k INSURER A:Travelers Insurance INSUR -- DaYId COX, InC_ — INSURER B: ED P.O. BOX 401 INSURER C: S Yarmouth,MA 02664 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. r ___......_.......-........-. — ... ... - - --..__..........._.. 0" POLI O�XP TN_TR I TYPE OF INSURANCE POLICY NUMBER MMIDD/YY Y IYYYY I LIMITS GENERAL LIABILITY I 1PREMISES H OCCURRENCE $ _ 1,000,00 ( 6801481 M7B8 03M4/1 1 03/14112NVCEt2S R�at�� A I COMMERCIAL GENERAL LIABILITY LEa occurrence 300,000 CLAIMS-MADE I OCCUR D EXP(Any one person) S 5,000 X Business Owners RSONAL 11 ADV INJURY. 5 __ 1,000,000 — GENERAL AGGREGATE 5 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG f 2,000,00 — POLICY PRO.jpr.TLOC S AUTOMOBILE LIABILITY Ea accciCOMBIdentSINGLE LIMIT LANY AUTO BODILY INJURY(Per person) S'— --- - ALL OWNED r�SCHEDULED BODILY INJURY(Per accident) S AUTOS NON OWNED PROPERTY DAMAGE HIRED AUTOS __ S � AUTOS Per aedde�iL.___..'----•— -.__--. ... -._..—. UMBRELLA LEAS ;OCCUR EACH OCCURRENCE _— EXCESS LIAR CLAIMS-MADE I AGGREGATE S DIED RETENTIONS WORKERS COMPENSATION WC STATU• OTH• AND EMPLOYERS'LIABILITY X A ANY PROPRIETOR/PARTNERIEXECUTIVE Y�/N 6KUB91QX742211 07115111 07/15/12 E.L EACH ACCIDENT __ s_ 100,00 OFFICER/MEMBER EXCLUDED? I L J --- (Mandatary In NN) I I E.L._DISEASE-EA_EMPLOrEE f 100,000 It Yea,describe under E.L.DISEASE-POLICY LIMIT S $00,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Addlttonal Remarks Schedule,if more space Is required) - CERTIFICATE HOLDER CANCELLATION TOWNBAR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 230 Main Street Hyannis, MA 02601 AUTHORVED REPRESENTATIVE G�p2 • ab ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD i h h •e Tlie Corninompealth of Massachusefrs �.\ Department oflidustrial Accidents Office of Investigafions 600 Wash-ingtorr Street Boston) AN 02111 �pfYri+.raass.gvw'dia Workers' Compensation Insurance Affidal it: Builders/Coutractors/Electtici:tns/Plumbers Applicant Inferinatioa Pease Print Lei ibly Name (Btisinew/Orgnuizo6on/lndividual): -�,V Addre-ss: Z5241A � City/State/zi : Phone#: FEII rest employer? Cite&the approprinte box: Type of project(required): a employer with �4. ❑ I am a general contractor and I p � �� have hired.the sub-caatra�ctors 6. ❑.1�few constnrc.kion loyees(full and/or pnrtrtitne). s sole proprietor orpaat=- listied on the attached shier. 7. ❑.Remodeling rind have no employees ��stib-coutracSors hateg, ❑.Deawlitioaking :for;tine iu auy capacity. employees and liatTe tr Luke's' 9. ❑.Building addition wo kers' comp.in an-awecamp.insurance..ired.) 5. ❑ We are•a carporatiouandits 10.❑Electrical repairs or additions officers have exercised their 11. Fluattyin t ai s or additions a.homeowner doingall wexrk ❑ g EP 'lf[No workers'comp. right ofercetnptiisnper i�fGL12�.00frepairs ance required.] t c. 152, f 1(4),and.we have no employees.[No workers' 13.❑Other coop.insurance required.] 'Any fhpptkant abe(checla bbx#I.moat also fillout the section below thawing theirwwlem'compensation policy inforruati= I liomeeawom w1w submit this•affidavit int kitting they are doing aft wat and&ea Itka outsideconmWitin must mbasfit a um affidavit indicating suclL ICoutradars thatcbeek tbit box tfaust attached as additional sheet showing the'oimeoffbe sub•crartracmrs sad state srbeth-er or not tbose entities have employees. Ifthe sub-caAtactomhave emplvywri,they must provide their warken'comp.policy number. I serf ail tTHlplOydr tlarrt'ts p117f�%1 lTtg fJ�aJllerS COi?f�TBTLMIZQtt rld56tJY[1tGe for tray errrp2a}°ees. BeloV is the policy and job site information. Insuntace Company Name: lee"llZ Z-)C Fxpirntion Date: Job Site Address: s} /////,�1�?/ 1/� City/State/Zit) Attach a copy of the workers'eompwiiatioo policy dreiarntio.m page(showing the policy uuw6er and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 mWor 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 shtement may be forwarded to the Office of Itme dptioas of the DIA for insumace coverage verification. I de lasreby c ?,ft,+w er thapains mid pturaai'h:es Qfparjswry Neat the iraforntation proy7ded.aboyre is trus and corner S' Date; 17 ' h Phone M 00aci'nl rise only. Do trot sprite In tidy urea,la be cosipltrted by city'or town QfciaL City or Town: Permit/License# Issuing Authotity(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4,Electrical Inspector 5. Plumbbig Inspector 6.Other pp HE y n URNerAVU, MAS�A 'Town of Barnstable rEo Hv►'i" Regulatory Services Thomas F. Geiler, Director Building Division Thomas Perry, CBO Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.ba rns to ble.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize �LI �� to act or my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner ate Print Nacre Ir Property Owner is applying for permit, please complete the Homeowners License Exemption Form on the reverse side. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION u � , Map l 4o Parcel A lication # . pp Health Division Date Issued 1 Conservation Division Application Fee c Planning Dept. Permit Fee n Date Definitive Plan Approved by Planning Board P71fhL 40 Historic - OKH Preservation/ Hyannis Project Street Address Sg 1 �►P�+.»o hV Village o S�1�� `.�e , rvyk. Owner T OkN i GE C- Noti-MP3 nt . Address t 7 CArtTAjm RrA. 1Bw1:Pte,J se- Telephone ZY1 t c Permit Request CWi-,4-Q T oJ04. Grt_JN-_,rr Ooo2. kp La Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new O Zoning District Flood Plain Groundwater Overlay -ao Project Valuation��o Construction Type ►.� Lot Size -1 s ArcAcx Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family N Two Family ❑ Multi-Family(# units) Age of Existing Structure (oS Historic House: ❑Yes id No On Old King's Highway: ❑Yes V No Basement Type: ❑ Full '® Crawl ❑Walkout ❑Other _ 1?4VU-%1AL RASar.ewt Basement Finished Area (sq.ft.) O Basement Unfinished Area(sq.ft) 142 Number of Baths: Full: existing 4 new o Half: existing 1 new O Number of Bedrooms: G existing O new Total Room Count (not including baths): existing 12 new o First Floor Room Count 8 Heat Type and Fuel: W Gas ❑Oil ❑ Electric ❑ Other o a o Central Air: Id Yes ❑ No Fireplaces: Existing 3 New o Existing wood oal stoke: ❑ es No U CD Detached garage: ❑ existing ❑ new size_Pool:V existing ❑ new size _ Barn:;Cl'existing " ne n size_ Attached garage:$4 existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: w -a ;M Zn / Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ a �- Commercial ❑Yes ❑ s X No If ye , site plan review # m Current Use. Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name _ ROC k_ C 4- K\C . C`l ►.I c.. Telephone Number 19-01% 42.8 -(e1 W. Address ` 45' c>S-r %z --r k ctjoAk_r_ Ro. License # 10-2g0,9 l rbtia/�11.L. . 1vO, Home Improvement Contractor# ► (.4 bQ 8 Worker's Compensation # (o S 1.o yR-4911 ►�z:5-2 i2 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN-T-9 (Zc SIGNATURE DATE 3 %2 FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED 1 ' MAP/PARCEL NO. - ADDRESS VILLAGE OWNER"" DATE OF INSPECTION: ; FOUNDATION FRAME t INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL ' PLUMBING: ROUGH FINAL _ f GAS: ROUGH FINAL I FINAL BUILDING f , t ` DATE CLOSED,OUT f ASSOCIATION PLAN NO. } r . The Commonwealth of Massachusetts �j 'k Department of Industrial Accidents Office of Investigations q r 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibllv Name (Business/organization/Individual): Address: 44S aer sz City/State/Zip: 6 kan(L _L% C. AAix- Phone#:' 56% Lfz17 - (.t a L Are you an employer?Check the appropriate box: Type of project(required): 1.M I am a employer with t�- 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet t ?• ❑ Remodeling ship and have no employees These sub-contractors have S. ❑ Demolition working for me in any capacity. workers' comp, insurance. 9, ® Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their lo.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 1 l-El Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12,❑ Roof repairs insurance required] t. employees. [No workers' comp.insurance required.] 13.❑ Other ur 'Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they ara doing all work and then hue outside contractors must submit a new affidavit indicating such. 11—Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. ram an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: a.!CILT A%A3q as I4ae C,1 Policy#or Self-ins.Lie.#:- (e S L OUiS -4T7*7 R 2.5 -Z.-12 Expiration Date: 1N-u- Job Site Address: 39 1 U%4^zw1b City/State/Zip:_ 01TJpW1L4_C_ Mq OZfoSS Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cerd r the p pen s f perju that the information provided above is true and correct Si orate: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town offw" W City or Town: Permit/License# Issuing Authority(circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspe7EbingInspector 6. Other Contact Person: Phone#: ROGER-1 OP ID: KG DATE(MMIDON YYY) CERTIFICATE OF LIABILITY INSURANCE 01118112 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsements. CONTACT PRODUCER 508-771-1632 NAME: Northwood Ins.Agency,Inc. 508-393-2955 P cN E 540 Main Street,Suite 9 AIC No Hyannis,MA 02601 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC 0 INSURER A:General Casualty Insurance Co. 24414 INSURED Rogers&Mamey,Inc. INSURER B:Hartford Insurance Co Gary Souza INSURER C: P.O.Box 310 Osterville,MA 02655 INSURER D: INSURER E INSURER F: �d 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 POLICY NUMBER MMIDONY MMIDDIYYYY LIMBS GENERAL LIABILITY EACH OCCURRENCE tu S 1,000,00 A X COMMERCIAL GENERAL LIABILITY CCI 0395621 03/20/11 03/20/12 PREMISES Ea occurrence S 100,0 CLAIMS-MADE OCCUR MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY S 11000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,00 riPOLICY PO- LOC S COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Ea accident) S BODILY INJURY(Per person) S ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE NON-OWNED per acatlent S HIRED AUTOS AUTOS $ UMBRELLALIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTIONS O $ WORKERS COMPENSATION WC STATU R AND EMPLOYERS'LIABILITY Y I -I B ANY PROPRIETORIPARTNERIF�CUTIVE Y❑ 6S60UB-4977P25-2-12 01/01/12 01/01/13 E.L.EACH ACCIDENT S OFFICERIMEMBER EXCLUDED? NIA E.L.DISEASE-EA EMPLOYEE 500,00 500,00 (Mandatory In NH) S It yes,describe under ' E.L.DISEASE-POLICY LIMIT S 500,00 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) CERTIFICATE HOLDER CANCELLATION TOWNBAR . SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 23D Main Street Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE O 1998-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD x Office of Consumer Affairs and Ausiness Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Q4W for Registration Registration: 164688 Type: Private Corporation Expiration: 10/30/2013 Trek 217452 ROG-'S AND MARNEY, INC. GARY::S:OUZA =r " _== P O :BOX 310 OSTERVILLE, MA 02655 -= Update Address and return card.Mark reason for change. —r~ Address 0 Renewal ❑ Employment Lost Card - OPS-CA1 0 50M•04/04-G101216 T/e License or registration valid for individul use only Office of Consumer Affairs&B siness Regulation g y - _ HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: . 164688 Type: Office of Consumer Affairs and Business Regulation Expiration: 40/30/2013 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 RO RS AND MARNE`F 1NC.. GARY SOUZA 445 WEST BARNSTABLE'RDi. OSTERVILLE, MA Ot655 Undersecretary of vali thout 'gnature ,� �•�;: ..,�._�'�__ - __ -�==tea �: I Massachusetts- Department of Public Safet% Board of Building; Regulations and Standards Construction Supervisor License License: CS 102999 ReSfticted.to:.. 00. GARY SOUZA P.O. BOX-271-4 COTUIT, MA'02635 Expiration: 8/1&2012 ('nnmisri�mer Tr#: 102999 i Town of Barnstable Y°t Regulatory Services OARMAM Thomas P.Ceiler,'Director, v NYM ayo. ,e$ �°reoru Buiidirtg Division Tome Perry,Building Commissioner ' 200 Main Street,Hyannis,MA 02601 wrvw.town,ba rnrlable..ma.us OfE= S08-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Usin ABuilder, f, _�jy` r� O Yi6 t.,l• as Owner of the subject property hereby autholi-I l �2S - MI to act on my behalf, . in all matters relative to worts authorized byrhis building permit application for,I 3�t I �'Jo A& DS e-MV t `(G (:Address ofJob) Signature of Owner Date �A►St �E __�_�Or2Ty+�. Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Fonn on the reverse•side. L conc 6owdd �nL Conc. 2 17-3 Pam/ � y_•,_r -__ __ V N j 32./a a5 o � � New Govg�O o p. .d o �" d�. P6�•N. • Ou �U„v c 4� � � f O a 3Z 3 0°. .. . mAP 4b Pcc: 173 WIA i A. .� G6,27%, /E1J ocOT o�A,v_ / G'E2r/.cy T.U�IT Tf-/E Sr�euc7vzcs �C�T/O.V OSTE2V'�CLt� S'f/OWN f,�E,2EO.1/�O�-1 oL YS WI;9V -5C,A L E- /! 17, 95 SZQ,6 4 iC/E ANO SETBACA:: 2�/ S ??•95. .�E4U/.2E�E�t/7'S Ors T.�.�F 7'�wit/G7F /�•L.4 it! 2. Ec"6.2E�G"� G•9a95 BA¢�Jsr.4$c .4.vv is �c%T- «� Ate; ��CAT�l� j.!/�T///N TyE F.LOGlaPG4/� D SGL�f� 71o�7Q PAGE ZG3 OATS= S��• 9� � ,B.4 XTE�.26�l/yE /NC. /N.S7.2l,1,4fEit/T,S'U.2VEY f'. Tye 0•�.�sETS Ss,�ow�V S/ vim �t/oT 8� • Aff-4A442/G - 4 VAIJ AvG A1� U.SEO 7"� OETE.�isf/.t/E .LpT /it/ S. NEW ROOF CONST. - a,eaoov aAs+Fx^®+e•vd . xEw Ruw•Ewvr 3,e.®19-on.use -srtr cox P�rn°oo aooF slPAnolo - . S+De NNIS EACN END -ASPHALTROOF6HWGlE9 -16iR.FELT PAPER _. .3,10 RRWE BONA I -A—R PTCRNURPoVI�CL➢S NEW A$I(R/J�BOM0.9 NEW A6P+ULT RDOF 3 AT ALL PAFfFA EH09 NATCH� TO SIATOI EASfPA SgNGLE4 TO MAICN MATCH� .a,F/WATER S+OeDATBOTTON Ex+Si. EJUSIiNG 13 F108T. R Oi ROOF � -R WGe a soFFrt�EMe NEW W46gNGIES5IDINO ' MST. TO—TCNF]eSnNG NEW AZEx FA.YJAe 1 5+K.T VIM MATCH FALSIWO 3,6,®16 nn WIBEADDOMD e RECEWE0 FASTEN BFAM9 TO POSTE 116+a4i0 WlbWG50M LCT POSH "NEOG NEW COVERED KEx ClSINO86 FJOSTYiO Buvrense XO1� $ PORCH NEwP.r.aevasrs .� uP°re'F'ns`Ee�1Oea 0 0I $ NEW P.T,610 POSTSON 4 1S OIA CONCR6R SON0. ' NBE9 W13,•W BIGFDOT NEW FROM ODOR 65H)ELTJR9 GOp1 WG9 UNOERNFATM FRONT ELEVATION SIDE ELEVATION stMvsoN ueAx oa as ABU60 il EXISTING EXISTING n PORCH SECTION @ HOUSE HOUSE NEw3Tr wwoonnr F�om+A1MNDaws aooa x6slDeAN+s ExLanNo vnxowrs Bnsr.Fourm wAus A A A A EXIST. A7 I NEW I 1 NEWP.T.9,6POSSON Al 1 DECK } I COVERED I } +zoucoxcaEresoNo } 4 a EXIST. TNeED wi:v ou elcFoor PORCH FOOnNGS UNOERNFAM 1 ' 1 a d&EEPREP RRffPIA " DECK FOn—UNORAOEUSE 0 -— �� REMOW--OE—O 51UPSON IIeAIl OR SS I 0 POST BASE I I. EASnNO RARWG FJUSnNO WHOA =Q' LcwzZF° FOOTING PLAN VERDY ALL OEfAM1S FOR NEW P.T.6,SPOSi6 OEC AV ExImNO PFAGO+AON WIAZEK CASNG66 RENWALOR TO BTAY �� W P ACE ISOz FLOOR PLAN WALLWI4IYPSON HIT® PACE MOUMNANGER Da Posr wWN W E,Im. HousewAu NOTES: 4 4 1.)CONTRACTOR IS TO VERIFY ALL EXISTING CONDITIONS I , 8 DIMENSIONS IN THE FIELD 2.)CONTRACTOR TO VERIFY ALL INTERIOR 8 EXTERIOR MATERIALS, A A DETAILS,8 FINISHES IN THE FIELD WITH OWNER 3.) ALL CONSTRUCTION TO CONFORM TO 780 CMR MASSACHUSETTS } } STATE BUILDING CODE,8TH EDITION AMENDMENT 81RC2009 a ill I 4.) ALL AZEK TRIM TO BE PAINTED WHITE&ALL JOINTSMAIL HOLES SEALED. 5.) 110 MPH EXPOSURE B WIND ZONE 6.) TIMBER FRAMING TO BE SPRUCEIPINEIFIR NO.2 GRADE S+N'x1 1(I'E� aAFfEa66 CELLINDJOISTS TrAulEO To eEAMsvR 7-) ALL LVL LUMBERIBEAMS TO BE 1.9e U480 LOAD,VERIFY ALL SHOWN. slMvsoN+no3Tle6 SIZES W ALL SUPPLIER FASTEN BeAMSTO F05Td ROOF FRAMING PLAN eJ FOLLOW ALL MANUFACTURER'S SPECIFICATIONS FOR INSTALLATION OF ALL vnsMPsaN ice,cosrw SIMPSON COMPONENTS.ALL PIECES TO BE ZMAX FINISH +zu: Q COTUIT BAY DESIGN, LLC NEW ADDITION/REMODELING FOR: SCALE: DRAWING NO.: 43 BREWSTER ROAD 1!4"=1'-0" MASHPEE,MA. 02649 .JANICE NORTON DATE: Al FAX(�08)�279-940 391 WIANNO AVENUE OSTERVILLE, MA FAX 508 539-9402 3l19/2012 ' TOWN OF BARNSTABLE Building OF tHE Tp� 201202010 * BARNSTABLE, * Issue Date: 07/05/12 Permit y MASS. QUA i639• Applicant: ROGERS&MARNEY INC rFC MAC a Permit Number: B 20121556 Proposed Use: SINGLE FAMILY HOME Expiration Date: 01/02/13 Location 391 WIANNO AVENUE Zoning District RF-1 Permit Type: RESIDENTIAL ADDITION/ALTERATIO Map Parcel 140173 Permit Fee$ 61.20 Contractor ROGERS&MARNEY,INC Village OSTERVILLE App Fee$ 50.00 License Num 164688 Est Construction Cost$ 12,000 Remarks i APPROVED PLANS MUST BE RETAINED ON JOB AND j CONSTRUCT COVERED PORCH OVER FRONT DOOR AND REPLACE THIS CARD MUST BE KEPT POSTED UNTIL FINAL FRONT DOOR-RESURFACE REAR DECK INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: NORTON,JANICE G TR BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: 57 OAK TREE RD INSPECTION HAS BEEN MADE. BLUFFTON,SC 29910 Application Entered by: JL Building Permit Issued By: THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF,EITHER TVAPORARILY EN ENCROACHMENTS ON PUBLIC PROPERTY,NO SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION. STREET OR ALLEY GRADES A L AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 3.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 4. PRIOR TO COVERING STRUCTURAL MEMBERS(READY TO LATH). 5. INSULATION. 6.FINAL INSPECTION BEFORE OCCUPANCY. WHERE APPLICABLE,SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS. WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION. PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A). 1 • M MT91&a MMA"W.ff, BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1 1 2 2 2 3 1 Heating Inspection Approvals Engineering Dept Fire Dept 2 Board of Health ` .. FRONT ELEVATION SIDE ELEVATION <....... i _--__----- ___ _'e>,. __ 1 a...,._ a ryl .ay�a• h�._. .ea .r. El1' ......: ....._.._�: �lA„Il,ry.l _.. . .._I:i/5tit 1415} .t. ' _ ,<r FL. Is r FLOOR PLAN 2"D FL 00R PLAN 'IYl:16 R.A. D>N>r>5 :f A•. `_iO fi•.+...�___._ __-��.••D :- / ( ,..,..a ..., a •... 1.,`.,..,< o.>. I~ :,% ...•_..._<s � -- ..._+_ __ -__ r - ,.,.•e,n. lX� -- - - --4- F BCD D'^Am a>..e A FAM Am. IV ° . ......<. �r P .. ! L •' I. cm. A i 1 'I A >r10N rC KAVANNAUGH RESIDENCE ------- 39/ WIANNO AVE. io•o- r..�r.r. ROGERS MARNEY ISM KE DETEC BARNSTABLE 6ULDING W P ,y Tw E 33057 i T, TOWN OF BARNSTABLE Permit No. ................ BUILDING DEPARTMENT l "a" I TOWN OFFICE BUILDING Cash ................ •••• N/A ''ra.rY HYANNIS,MASS.02601 Bond CERTIFICATE OF USE AND OCCUPANCY Issued to Robert Allen Address 391 Wianno Avenue, Osterville 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. �� -�--•June 26 19...90.......... '.......................... ........ ...Building inspector. .......... � I °*TMC 1° TOWN OF BARNSTABLE permit No. ., 33057 . { BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash :.......:.... N/A 9'rouT► HYANNIS,MASS.02601 Bond { i CERTIFICATE OF USE AND OCCUPANCY Issued to Robert Allen Address 391.W'ianno-Avenue, Os.terville 7 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 OFTHE MASSACHUSETTS STATE BUILDING CODE. x; June 26 0 � �^-� .......................... 19...9............ f '............... Building Inspector . .S Assessor's offioe (1st floor): �[ Assessor's map and lot number ....'..:.7.0.......173......K' �Qy�FTNE>p`O Board of HealtK-(3rd floor): Sewage Permit number s....3....... .. ............... BAHIST&BLE, i Engineering Department (3rd floor): M"°IL ♦� O i639• House number a c. � •+ ..,t... ....c ... ........................................ 'FO VA a' APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00.2:00 P.M. only I � TOWN OF BARNSTABLE 1 BUILDING INSPECTOR A- APPLICATION FOR PERMIT TO ................ �! .l��l..� <a ,{ ��4.cc�c Q ............ W-t.................................. ................................................. ................................. TYPE OF CONSTRUCTION ....�A!..soa.. .¢U... ............................... TO THE fINSPECTOR OF BUILDINGS: a The ur dersigned hereby applies for a permit according to the following information: �� i 4 t�Q � s C .. Location � u Q............ ...`�.p:��i.......... ............r............:................................................................... Proposed Use S I(Q pc�4.S. .......................................................................................................................................... Prop Zoning District / `r.......................................Fire District ............�......................................................... • Nome of Owner l�rl�?.Q( ..�'fi.I .Q.`n.................................Address P.,.....0...r T,(Cv� t�P...... . .............. INome of Builder .G ....`Q(l„(lid •(tCl.�.✓�............Address j. ........ Name of Architect 0 .. ...........�.�.'Q.....:...........Address .......:.... . ........................................ n dd i ff Number of Rooms d" ..............Foundation ..Pb:4,r..P.U.(O K f 2 I� �........................ ............ Exterior .t,!.).0� 1!�`�.Lp.................................................Roofing ....R.��. ., 4�. ......................................................... ................... Floors �.._� .S:n. ... C!... o. ..:........................................Interior ..... .� vr`l .......... ... .......... . ` Heating �1.�5......!f"1�.�.:....................................................Plumbing ............ � ��• S ' I va Fireplace pp..�,S;ScS.�.�.-t.......................................................A roximate Cost ..........P..�C��QOa i Definitive Plan Approved by Planning Board ________________________________19________ . Area `., .. .fin............................ Diagram of Lot and Building with Dimensions Fee .%.............................. SUBJECT TO APPROVAL OF BOARD OF HEALTH Y OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS a I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ,.�,. . . . . ..�.�� . ,.a., Construction Supervisor's License F ALLEN, ROBERT A=140-173 I No ... Permit for .[ADD. TO................... Single Family Family...Dwelling i ................................. ...R9.............. Location ....391...W i.ann.o. Avenue . .. ....... .. .................................. Osterville .................................................................. ............. Owner .....R.ob.e.rt...A1.1.e.h.............................. Type of Construction .....Frame......................... Frame ............................................................................... Plot ............................ Lot ................................ Permit Granted .........July 13,................................19 89 Date of Inspection ............................ .......19 Date Completed ......................................19 PERMIT COMPLETED 1/1/ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map /1-'/0 Parcel 17,E �'6 Permit# Health Division - 3 3ff <<-Z Date Issue Z" �' Conservation Division Fee 3 Tax Collector .J,C V/1� 4;.j SYSTEM MAST DE ` G 1 Treasure/ t 2,�/ j INSTALLED IN COMPLIANCE Planning Dept. _ W"TE= CE Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE AND TOWN REGULATIONSHistoric-OKH Preservation/Hyannis Project Street Address 39 Avg: Village 0s-re-9-yt tka- Owner Mctrk 1K q 0C4_X,ha.LJcs)M Address S OLDA e Telephone q 2-9 • o6 Permit Request Go rN ue r} exus-r i x a P4 rom 8ft Q.I l re\ncaAe aAA4 crn wIi A �►u tymc moot ce10 c a-� e ge r-onm l Square feet: 1 st floor:existing proposed 9 A n 2nd floor: existing proposed ss_ Total new t o 36 Estimated Project Cost SCE .980."Zoning District l2F• 1 Flood Plain N I. n Groundwater Overlay Construction Type eod Fco. ee Lot Size ,'23 AEG.. Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure 6 54- Historic House: ❑Yes ❑No On Old King's Highway: 0 Yes XNo Basement Type: gull 'Crawl O Walkout ❑Other Basement Finished Area(sq.ft.) — Basement Unfinished Area(sq.ft) Number of Baths: Full:existing 'q new Half:existing I new 0 Number of Bedrooms: existing 6 new n Total Room Count(not including baths): existing II new l First Floor Room Count �7 Heat Type and Fuel: 2Mas O Oil ❑ Electric ❑Other Central Air: a'es ❑No Fireplaces: Existing 3 New_I Existing wood/coal stove: ❑Yes P1 No Detached garage:❑existing ❑new size Pool:O existing ❑new size Barn:0 existing ❑new size Attached garage:O existing ❑new size Shed:O existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# NA4 Recorded❑ Commercial ❑Yes Qlgoo If yes,site plan review# Current Use S Proposed Use .Sa...��, BUILDER INFORMATION Name t2 0 o e cs a,.rev 5�.& , Telephone Number 4 Z P5 • G l OCo% ,I Address x at o License# C_ o r U21 na-t-c-eut 0-4 t4 Home Improvement Contractor# (ao t,2,!J 2 S S" Worker's Compensation# We, 1 S11 Q 8 00 3 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKENX �)u SIGNATURE DATE l( - 24 •1 ? 4 r FOR OFFICIAL USE ONLY PERMIT NO. - 2 �'. '✓t DATE ISSUED43, , , •, ��. - W MAP/PARCEL NO. ADDRESS " f; VILLAGE, if - `+ 14 lk OWNER DATE OF INSPECTIOI�f 4 FOUNDATION FRAME 4 +. INSULATIOND✓ 1 '• FIREPLACE .y •A ELECTRICAL: ROUGH FINALivy! fz PLUMBING: ROUGH ,' > �... FINAL; GAS: i ROUGH 1 S FINAL - FINAL BUILDING } mHIR Al Yl DATE CLOSED OUT ; C3 0 ASSOCIATION PLAN NO. i r , Assessor's Office 1st floor Ma Lot 1 3 c Permit# �0�0 Conservation Office 4th floor Z �s Date Issued (o / 3 — 9S . q � Board of Health Ord floor / 33 4.eZ�� Eng-incerik Dept Ord floor House# � '``lei Plannin De t. • Ist floor/School Admin.Bldg.) NAM : v 6�94�' S aARNB[AB1l. _ Definitive Plan Approved by Planning Board 19 A lie irons roeessed 8:30-9:30 a.m.& 1:00-2:00 .m. I ®.► TOWN OF BARNSTABLE -� Building Permit Application Protect Street'Ad` ess, 09 t f Village � Fire District A /—� �� /,g�f/✓�D �' O (hvncr 1K � �I�1V/4E Address'n Telephone ram©©6 Permit Rcquest: P019 Zoning District 'JC" / Flood Plain C Water Protection Lot Size Grandfathered Zoning Board o A is Authorization Recorded Current Use Re.5 Proposed Use "( Constru6ion Type tN r9� inn-. Eaistine Information Dwellin .T e: Sin le Family Two family Multi-family Age of structure Basement Historic House Finished Old'Kin s Highway Unfinished Number of Baths 7 No. of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Qa Central Air f'a ��g Fireplaces Garage: Detached Other Detached Structures: Pool l� Attached Barn i None Sheds Other Builder Information Name ieB q/ Telephone number Address O License# Home Improvement Contractor# f CEO 13 Z Worker's ComDensation # P� cc..5 9- 7y r NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN (AS BUILT) SHOWING EXISTING, AS WELL AS PROPOSED STRUCTURES ON THE LOT, ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO C-e �?C' Fee <66•Ga SIGNATURE DATE /,/ 4Z BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) BPERM`l' FOR OFFICE USE ONLY e ADDRESS VII.LAGE C OWNER DATE OF INSPECTION: FOUNDATION .FRAME INSULATION FIREPLACE ELECTRICAL:. ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING: DATE CLOSED OUT: ASSOCIATE PLAN NO. r ............. F e COMMONWEA ,TI-I OF 2\�5..�1.SSA.CI VS - � Or• rNDUSI-1U-AJ-%ACCIDENTS 600 XII'/,S1-11'114.11 JaTcs Ga��acr. BOS7 ON, W6SAC1-1 USLI 1 S O21 1 1 WO)U I1S' COMPBl�SATION INSURANCE AT ODIXIT 1: ROGERS & MARNEY , INC . (liccnscc/permiacc) with a principal place of business/rrsideneeac 445 OSTERVILLE-WEST BARNSTABLE ROAD , P 0 BOX 310 , OSTERVILLE MA' 02655 . ' ,, •.. (City/State/Zip) do hcrcby ccrcify, undcr the pains and penalties of perjur)•, char. (� 1 am an cmplovcr providing'6c following workcrs' compensation covcragc for my cmployccs u-oik;ng on thic job. EASTERN CASUALTY INSURNANCE COMPANY 95 798003 Insurance Company Policy Numbcr am z sole proprictor and have no onc working for mc. jc 1 am a sole proprietor,gcncr2l conmaor or homeowner (cirdc onc) and have hircd'fhc contnaois lisccd bclow w•ho have the following workers'eompcnrauon insLL=ce policies: to �.ao3o7 s�fll�i cirn�riirtJ� pyol� -/��°/° l Nimc of Contracror Insu=cc Company olicy Numbcr 151g6M 7,-;?62 3 u 1A)suew-10 ez- Nzmc of Contractor Ins=ncc Company/Policy Numbcr Namc of Contractor Inmmncc Company/Policy Numbcr 0 1 2m a homeowner performing all the work myscIE NOTE- Plcasc Ix iw;.Tc Sat Wb ilc Lorzco-rmcn wbo c(nploy perwas to C!o ruxiotc-azz c,coottrvctroo or(Cparr--064 on a 1wclling of not roorc tlsan ttsrcc uoiu in Sc bomcor ucr aJso residci or oo the grouods appurunaat tSc(cto arc not£cocral)y <onsidcr<d to 6< eroploycrs uecr the'Wor:•crs'C;oropeositioo/.a(GI-C. 1 S2,eee1.. 1(5)).appliutioo by( bomco-mcr for a Jieeose or permit r..:y cvidcccc ut c 1<[.,1 st:ttr c(:_::cr- loycr uodcr tac GorLcrr'Corolxosstion/ut. i cnccrstanc trs:t 2 copy of ti-is st_tcncnt•-ic o:ior-.vdcd to ti,c Jcp' -cnt of Industri:J/,codcnu'Oft-,cc of lasc::.nu fors-o-cr;c verification z-nd th=t f:.ilure to secure eo�cr-.,�c_s required under Section 25A of MGL 152 c-,-n lead to tlsc imposition of f_Uminal per.aJues consisting of a fine of up to SI500.00:ndor inprionmcnt of up to onc year and evil pcnaluu in tic form of a Stop work Ordcr and a i fine of S 100.00 a day a£:.inst mc. S'.,,nc this day of /I'V , 39 �— is see/Per ircee Licensor/Permircor TOWN OF BARNSTABLE BUILDING DEPARTMENT COMPLAINT/INQUIRY REPORT Date b rzl.�,� Rec'd B Assessor's No. NU., t?3 Last Name S_�S> First Name b ORIGINATOR Street Village State Zio Telephone: Home Work Description: 'Fo „v Y_ ✓ COMPLAINT Sew Vvi S ' e o 0 Y wr,� !�k e INQUIRYA77— VV�V • 1�sg C�SZM c�Y�Ad, � � - `-� Requestor's Signature COMPLAINT Street Address l o- LOCATION ` OFFICE USE ONLY INSPECTOR'S Date Inspector ACTION/ COMMENTS FOLLOW-UP ACTION ADDITIONAL INFO. ATTACHED COPY DISTRIBUTION: WHITE - DEPARTMENT FILE YELLOW - INSPECTOR PINK - INSPECTOR (RETURN TO OFFICE MGR.) „ISCI v � I �f�r`9•a.r Y ;.� I ,�41 r ,.a ,�,�:,'t. $r 3,. a' a°S�* 7 U' �`_'� +J�. � I Y �A: wi..:...� , , y,1i.,�..d -t t ! �• ,. .,yt�q'''�W Jr �B :�. 77'- ' •* ! i !� I.�Nr Ilhi ':I� ��' ' 'I '•' -�.. "��' r(6ji 1 'k�i' II r-- , r 1 li Z i I II I } ,:� - I r `y�l pu��, •N• yY i � 3:. i �y. 1�1`I'I� !il{I a p! t. 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HOME IMPROVEMENT CONTRACTORS REGISTRATION Board of Building- Regulations and Standard•:, One Ashl:)urt��n Place - Room 1301 Boston, Massachusetts 021 OE3 HOME IMPROVEMENT CONTRACTOR Registration 100134 Expiration 06/09/94 Type - PRIVATE CORPORATION HOME IMPROVEMENT CONTRACTOR Registration 100134 'Rogers & Marney, Inc ... Type - PRIVATE CORPORATION Charles R��gers Expiration 06/09/94 445 W. Barnstable Rd Osterville MA- O':655 Rogers & Harney, Inc. Charles Rogers 445 W. Barnstable Rd ADMINISTRATOR Osterville MA 82655 v. COMMONWEALTH. 1 DFPAR.TMENT OF PUBLIC SAFETY _ I 1:41forato poss ®� OF ONE ASHBORTON PLACE ` 4ret?a saourraar , �® AtasaachasattaStateBolldleg ,� MASSACHUSETTS BOSTON,MA 02108 Codalscsuaalorrav LICENSE oltA/sl/uAs ocat/on EXPIRATION DATE CONSTR. SUPER`IISOR L`AUTION 09/0 5/ 19 9 5 EFFECTIVE DATE LIC NO. FOR PROTECTION AGAINST RESTRICTIONS 0� ,1�t2 THE PUT F�1G O ' UMB NONE 06/30/1993 030148 � PRJ' IINA�j�ROP�E o BOX ON LICEW" JOSEPH C MOREAU D z 241 RACE LANE _ �T(NKq TORS SS 4 028-34-6154 m MARSTONS MILLS MA 02-64 MUSTINC U HOTO. ` PHOTO(BLASTING OPR ONLY( FEf.0 .00 .-_. NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY I I HEIGHT: -STAMPED•OR-SIGNATURE OF COMMISSIONER ' DOB: 09/05/1947 , THIS DOCUMENT MUST BE I SEE « SIGN NAME IN FULL ABOVE SIGNATURE LINE CARRIED ON THE PERSO 1 THE HOLDER "HE' HE 1j�C�/ OTHERS-RIGHT THUMB PRIM GAGEDINTHISOCCUP T�EN COMMISSIONER 3 y I I ' I - I ' THE TOWN OF BARNSTABLE BARNSTABL& 1639- MAG& Fb BUILDING . INSPECTOR a MAI .................................. APPLICATION FOR PERMIT TO ... Ld... ..... IQ TYPE OF CONSTRUCTION .... ................................................................................... ....... .. .........................19-74ZI TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit acc'ording to the following information: Location ......15f/.....a.ol.&....... r................03 .......................................................... ProposedUse ... . ......................4.......................................................................................................... , A Zoning District .... ..................................Fire 'District V.. .............. ..... ......... Name.of Owner Address Nameof Builder ... ..............Address...................... .. ............................................... Nameof Architect ....................................................................Address ..................................................................................... Numberof Rooms. ..................................................................Foundation ....................... ....... ....................................... Exterior .................................................................Roofing ......... ...................................... Floors ... ........................................................................Interior .................................................................................... Heating ...................................................................................Plumbing .................................................................................. % 50-dv Fireplace ...................................................................................Approximate Cost .................................................................... Definitive Plan Approved by Planning Board ---------------—------------ Diagram of Lot and Building wi Dimensions te".. SUBJECT TO APPROVAL OF BOARD OF HEALTH 0 Ui U- 0 U) -Caj CL < > LLJ 0 > Lj--0 O Uj >: < X90 LLj 3--D L y\&,A(N U) X L LLJ. LL u LLJ (D 3: LL] 0 zq L L j ca X I hereby agree to conform to all the Rules and Regulations of the Town of Barns ble regarding the above construction. Name ........... .................. .............................. ................ Connors, Mra. .Jbho J. � , I�3�q too' shed ~^ ^ No —��.�—. Permit for ---.—~------.. ' . ---^~—.-------.�-.—.—.—.------. ' � 391 Wiazouo Avenue v | Location -----._______,______._..` y � Oate ! ^—~'--^---^—^.'.'.'��---'-------' � Mr John J s | `^ Owner ^ ^ ' -"^ '^ ---`—^---^-------'---'--' . { . frame ^ ` Type of Construction .......................................... ' ' � \ -----.---.--------.--__,,___.. i / ` Plot ............................ Lot ................................ ( i ^ Permit Granted -- ............. 72 . ! ' � Dote of Inspection ----- Dote Completed --- --]9 ' | ' | ' PERMIT REFUSED ' i/ l� ` --'--'----^'--^----~----- ..—~---..,..._---...--....................... ' —'~^—'—^^^'~~—'--^---'—^^^^`---'—^'- � —.-...---..,—.----....--^_.-..,..--. .! i \ . .-----~.--.--..,..-_---.,..—.--.--' . ` Approved ................................................. 19 ' -------------,.------.---..-. -------`-----~-----.—.--.—~.. ' �� ` 1 ESTIMATED PROJECT COST WORKSHEET Value LIVING SPACE 1 036 square feet X $55/sq. foot = C6, 9 80, GARAGE (UNFINISHED) square feet X $25/sq. foot= PORCH square feet X $20/sq. foot = DECK square feet X $15/sq. foot = OTHER square feet X V?/sq. foot = Total Estimated Project Cost 6-61 9 VO• 1 g990915b 9 9 2 M . DEPARTMENT OF PUBLIC SAFETY 176992. ONE ASHBURTON PLACE, UM 1301 CONSTRUCTION SUPERVISOR LICENSE MAY 1 2 SO Wgroms MILLS, MA 02U48 Keep top for receipt and change of address notification. . . ' � --------- -`- -----��- -r--�-��-'- - -- -- -- � �` � � _ �`` '� ' ' '� .`��' .}' ' � � ' -� 7 �y�u� 0«� i - '�-- '----'-' �/ ~ ' ------'---'-- ! � \ ! HOME IMPROVEMENT CONTRACTORS REGISTRATION | | Board of' R�ild�Dg Regulations and Standards | ` | One Ashburton Plaue - Room 1301 | � � Boston , MaoaaChUSoLto 02108 | | ' L. . HOME IMPROVEMEK1 CONTRACTOR '| - -.' -' Registration 100134 Expiration 06/09/00 | o�, ��,=,�_� � Type - PRIVATE C0RP0RATI0N | ' | I0N[ lHP8OVR8T CNDNUO8 | KoViobodoo 00134 Q0GERS & MARNEY ' INC ' ' lyoo ' PR[\NH CORP0NDOH | | Charles D ' Rogers, [xyi/oiioo 06/09/00 | 445 0STERVILLEpO BOX 310 / | Oatorville MA 02655 i RM[KS & Hum, lHC. | 8oOom Og0VlLLIP0 BOX 3N | ""°=^"=Ul' 0oiomiiio HN 0265 . ' ' ' | f MAScheck COMPLIANCE REPORT Massachusetts Energy Code Permit # MAScheck Software Version 2 . 0 Checked by/Date CITY: Hyannis STATE: Massachusetts HDD: 5973 CONSTRUCTION TYPE : 1 or 2 family, detached HEATING SYSTEM TYPE : Other (Non-Electric Resistance) DATE : 11-23-1999 DATE OF PLANS : 10-28-99 TITLE : Addition to Kavannaugh Residense PROJECT INFORMATION: 391 Wianno Ave Osterville, Ma 02655 COMPANY INFORMATION: Rogers and Marney Inc . Box 310 Osterville, Ma 02655 COMPLIANCE : PASSES , Required UA = 179 Your Home = 167 Area or Insul Sheath Glazing/Door Perimeter R-Value R-Value U-Value UA -------------------------------------------------------------------------------- CEILINGS 582 30 . 0 0 . 0 21 WALLS : Wood Frame, 16" O.C. 863 11 . 0 0 . 0 77 GLAZING: Windows or Doors 138 0 . 330 46 FLOORS : Over Unconditioned Space 480 19 . 0 23 HVAC EFFICIENCY: Boiler, 86 . 0 AFUE ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design represented in these documents is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code . The heating load for this building, and the cooling load if appropriate has been determined using the applicable Standard Design Conditions found in the Code . The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in sections 780CMR 1310 and J4 . 4 . Builder/Designer Date j�• 29 p� uMAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2 . 0 Addition to Kavannaugh Residense DATE: 11-23-1999 Bldg. Dept . Use CEILINGS : [ ] 1 . R-30 Comments/Location WALLS : [ ] 1 . Wood Frame, 16" O.C. , R-11 Comments/Location WINDOWS AND GLASS DOORS : [ ] 1 . U-value : 0 . 33 fti.1* For windows without labeled U-values, describe features : # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location FLOORS : [ ] 1 . Over Unconditioned Space, R-19 Comments/Location HVAC EQUIPMENT EFFICIENCY: [ ] 1 . Boiler, 86 . 0 AFUE or higher Make and Model Number THERMOSTATS : [ ] Adjustable thermostats required for each HVAC system. AIR LEAKAGE: [ ] Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. Recessed lights must be type IC rated and installed with no penetrations or installed inside an appropriate air-tight assembly with a 0 . 5" clearance from combustible materials and 3 " clearance from insulation. VAPOR RETARDER: [ ] Required on the warm-in-winter side of all non-vented framed ceilings, walls, and floors . MATERIALS IDENTIFICATION: [ ] Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R-values, glazing U-values, and heating equipment efficiency must be clearly marked on the building plans or specifications . DUCT INSULATION: [ ] Ducts in unconditioned spaces must be insulated to R-5 . Ducts outside the building must be insulated to R-8 . 0 . DUCT CONSTRUCTION: All ducts must be sealed with mastic and fibrous backing tape . Pr2ssure-sensitive tape may be used for fibrous ducts . The HVAC system must provide a means for balancing air and water systems . TEMPERATURE CONTROLS : [ ] Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: [ ] Rated output capacity of the heating/cooling system is not greater than 1250 of the design load as specified in sections 780CMR 1310 and J4 .4 . MISC REQUIREMENTS : [ ] Refer to 780 CMR, Appendix J for requirements relating to swimming pools, HVAC piping conveying fluids above 120 F or chilled fluids below 55 F, and circulating hot water systems . ----NOTES TO FIELD (Building Department Use Only) ------------------------- I The Commonwealth of Massachusetts ' - Department of Industrial Accidents Office offnrmfgal/oas - 600 Washington Street -- Boston Mass. 02111 Workers' Compensation Insurance Affidavit •,. flame: location: city phone# _ I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity Sa-Tarn an employer providing woikers' compensation for my employees working on this job. comoanyname• LhQ C ISN a �c-�^� V k .L.ht" address.::. x` 31``O city:_ OS &,V phone#• S'Og qZ8 61O(-� Z of O I am a sole proprietor,general contractor,or homeowner(circle one) and have hired the contractors listed below who h::,.- the following workers' compensation polices: c` _r ctimnanv nae e �. �e 4. CXdC� 5�2;� m -5 address• city:.; " phone.#.-:...: ..:.:. msurance::co ..< policy# comnany:namt city•. phone# insarano co policy# r Failure to secure coverage as required under Section 25A of A1CL 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/ur one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. l understand that a copy of this statement may be forwarded to the Office of investigations of the DIA for coverage verification. /do hereby certify under the ains and penalti ojperjury that the information provided above is true and correct Signature Date _ 11•Z4 Print name &046V Phone# 2 (o(O 6 Ccheck ly do not write in this area to be completed by city or town official permit/license it f 1Building Department ❑Licensing Board mediate res onse is re uiredP Q ❑Selectmen's Office ❑1lealth Departmentn• phone N; 00ther (rwi.cd 3/95 P)A) i [nf'ormation 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 be an 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 hav been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to'your situation and supplying company names, address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the 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. City or Towns Please be sure that the affidavit is complete and printed legibly. Tile 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. Pleas 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,laesitate-to..give us a call L �y. The Department's address, tele phe c: and :1 .r. The 1)C(1:�rr'TC1`.' iti ?._^.(IL•Ei!'_:� �1C:._:.. 'i'_=5 Aiec of tfauestioatious 600 Washington Street Boston, Ma. 02111 faz_. ',#`'(617)727-7749 '. . . . _ i Issue date: it/11/9g Prndncer; I This Certificate is issued as a spatter of irlfnrrnatinrl orlly and rnr,far5 i I nn iluhfs uf`f,on the rartlfl ,tP holder ThIs rertihm e A clot a(perirll SOUTHEASTER!! INS Aff'Y I evt"A or alter the c"erqe of fnrhd by the policies below, PO BOX 7610 i-------------------------------- --- -- _.... -- - ------------ - f,Mt MAIN ST I COMPANIES AFFORDING COOERAGE HY01HI S PIA 02601 i-------------------...---------------------------------------------------•------ CorlP; Soh-code: I f_.p I tr A: ARhE11 A PROTECTION ---------------------------------------------------------------------------------------------------------------------------------------- Insmod: I Co I tr P: HOI COMB POMF k HTNh I Co I tr f; 11A0HO COMG � I-------------------•------------------=P-.._......--•----------------------------- P n BOX 170 I Co Itr D; GREAT AMERICAN OSTERUIILE MA 02-0170 i----------------------------------------------------------------------------- I Co i tr E' C 0 V-T.!'R AGES This is to rertifv that Poliries of irlsu.ranre li:tei below have been issued to the inslrrerl named ahnl>;{nr the pnhav oerjnd jrrllr,t_r; ,ntwit� t f.' rlv ;erp.IINgPTt l�.ry rnlirlltinrl of _ , rnilll_;t ntller Irrrrmant vI I 'recoar+ to whir{1 EhiS f:ejtlfi AtP rnnV tN is,II•er Jnr rl a.Y fNrt li,l +!IG I I:Ilr a•iis ✓ nffl-Y�w,� hY ttfe �rl lr.i ec, described OWN jllhlPrt to ,.II the terriis, ,_. e.trlli•i,-p;r 9•11j _nndf'-inris r ;p.rl-, Pyl iCA0 Lim shiwn n_r Fla.up bean rPhed 4 rain rl„M• -----------------------------------------------------------------------------------------•--------------------------------- fn 1 I I Pnliry I PnIiry Itrl Type of Ins�iranre I F'oliry rin•ulher effer.tiue date IPvniratinr, '.�. PI All I rIilr in thousands ----------- -- - ------ --------------------------- ....------ -------...------------------------------ A IKERAI O!Aril ITY - --I 07005E-47MA I 17018 I i% _$/99 !G?neral a•ooregate; II I Goon , I�! �erleval li.;bility I I I IP rin i rla/ yrr e�; I� 1� fl in rnarle [XI Ilcrp•r f ! IPercon I/nluertl ire irl ' Ilwnel's °, cnr;trarlrp's p,rnt ! I I IE�rh occurrence: MOO IC 1 I I I !Fire darnaar' 50 I` I I I li^erlica.I exoarrse; ------------------------ ---------- ------------ ------------ ------------------------ ----------- ----------------- IAIITOMORII E LIABILITY ITY I I I Combined I I II 1 Anv nfr. I I I 1Sinnle limit; I J" I hQ hAd autos I I I 19n li l r in iurr I If 1 -Che p•lpd e.p.to.. I i IIGar oursOCl}; I IC 1 Hired auto,., I I I I�nriilr jrljury I If 1 Non-nwned b-, to:.n i I I I(PPr a•criden�l' I 11 1 r.9',•aoe !iail��; i 1 i j,. .. . . 1 -------------------------- ------- --•---------------------•------------------------------....------•------------ !EXCESS LIABILITY ITY I I I I I Each If I I I I ! I Occurrence Aoyreyate 11 1 Other than o.f(,f,rell.a for!rI 1 I I I ------------ - ----... -- --.... --- -------- ----- -- ---------------------------------------------- D 1 POUTS C(AVEN';AT I ON WC90F1 M'_OM I 1%/1 AR I 1%/101q I rh at p.t o r s I----------------------------- I MI i 1 i.... tu0 fEach arrirlPrrtl I EMPLOYERS' LIABILITY I I I I I i«litl I � I I iQ(I �Dice.,sP-pacl-I anlnlnvea� I i ITHER I I I I I -------------- - .._...--------•---------------- -------- ------------------------------------------- Des0ption of opera.tin'adnati"Mew 0es,res+rirtin'nc/coecjal ite!(!'•' ApiY AND ALL PLUMBING AIIp HEATING_, OPERATIONS --------------------------------------------------------------------------------•--------------------------------------------------------- C2RTIFICATE TT(1T,T;ER CANCELLATION 1 S60 I.," of the Me decrrihed polirjes. be ra.pelle�l hefo('e the I PYnlr lnl date ih,.ralf. 1{,: I Ilur nrnr nv III e'IidYaunr to I a'. 10 days wl lily not lie to .1 Ierrl fl +- t �1�1✓Y' na!fod to the R_16FRS it i'IOKY MC 1 IPftl but failure to mail such notice 011 impure no nhlQatinrl or P (I BOX 00 ! IIat-r1it f kind upon the Company, Its agents r r ,re �n} dues, OSTERV!LiE MA 02655 j------- - ---- ------------------------------------------------------------ A!ltC!gri�r• representative' i .. 1 SCFT W I NE .A I f 24, 14 :24 EST by: A M EIR ary .L . Brennan ( 14 : 25 ) Page 1 of 1 r , .........................:::::.. ;:::::::.;:•.::::.: ;::. ::::.;r:.;::.•.;:::..;::.;;.........:::.::::::•.•:::::.:•. :.•:.:::::.•.:•::.:•:.::::::.•::•:.:•:::::•::........................................ ::i� DATE(MM/DO/YV) ACORN ':::(�,'F'j,�'. .. ;} •::{t. :':gy : ...: : : ..::?: >: :;: :; .;;: :: : ;:.: :i::::':'::::':;•>:•:;: ? ::•:::::.:.. ........>::?I!r. R, /1 ;: :i .A ! ::.i '.p'r. ':•:•i:•i:•i::it i:•i:ii :i PRODUCER FALTER HIS CERTIFICATE !S ISSUED AS A MATTER OF INFORMATION OLDS CAPE COD INS AGENCY, INC. NLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE OLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR THE COVERAGE AFFORDED BY THE POLICIES BELOW. l� 435 MAIN STREET COMPANIES AFFORDING COVERAGE HYANN I S MA 02601 COMPANY A C G U INSURANCE IMSURED COMPANY DAVID BRODD B LIBERTY MUTUAL INSURANCE CO COMFANY 116 ST CATHERINE AVE C HYANN I S MA 02601 COMPANY D :tIE?1i.....•......:::: :• • • •::.•:•:::::: ::::::::::::::.::: :::•.:•:::.: ::::::::::::::. ::::::::•::::::::. .•::::.: ::::.: :::.: :::::•::::::.::::•:::::::::•.•:::. •::::. :::::.: T:•. IS S O CERTIFY THAT THE POLICIES:•LI I .......... 0F INSURANCE LISTED•BEL 1 ••OY HAVE BEEN''%ISSUED TO.THE•INSURED NAMED ABOVE FOR•THE•POLICY •PERIOD•.• INDICATED,NOTWITHSTANDING ANY REOUIREMENT,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. LTR POLICY NUMBER DATE(MMOD/YY) DATE(MMIDD/VV) TYPE OF INSURANCE POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY NBFB 4 O 6 8 8 O 1 01 9 9 O 1 O 1 0 0 GENERAL AGGREGATE 11,000,000 X COMMERCIAL GENERAL LIABILITY PRODUCTS•COMP/OP AG $1 0 O O 000 CLAIMS MADE�OCCUR I PERSONAL 6 ADV INJURY $ 500, 000 OWNERS 8 CONTRACTOR'S PROTI I EACH OCCURRENCE S 500,000 i FIRE DAMAGE(Any one Are) $ 100,000 MED EXP(Any one Parson) S 5,000 AUTOMOBILE LIABILITY COMBINED SIIR)LE LIMIT '$ ANY AUTO ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS i I i I(Par P"MI, S HIRED AUTOS BODILY INJURY �NON-OWNED AUTOS -I I (Per actiderdl $ P ROPERTY DAMAGE S GARAGE LIABILITY AUTO ONLY-E4 ACCIDENT S �. ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE S EXCESS LIABILITY ( EACH OCCURRENCE S UMBRELLA FORM AGO RELATE $ OTHER THAN UMBRELLA FORM i $ WORKERS COMPENSATION AND WC131S492127039 2 18 99 2 18 00 X TORYLMRs ER EMPLOYERS'LIABILITY EL EACH ACCIDENT $.....10.0. .000 THE PROPRIETOR/ Net. i EL DISEASE-POLICY LIMIT $ 500,000 PARTNERSIEXECUTNE ' I OFFICERS ARE: I EXCL I EL DISEASE-EA EMPLOYEE $ 100. 000 OTHER 1 DESCRIPTION OF OPERATIONSA.00ATIONSNEMIGLES/S►ECIAL ITEMS r LIBERTY MUTUAL WORKERS COMPENSATION CERTIFICATE. OF INSURANCE TO FOLLOW. ::•:::::::::::. ::::::. :::. .:•::::::•:::. :::::. :::::::•:::::::::•:._:...... . C :mil*i K?�:E#QE3hER :;•: :•;:•::::•:•:::•:;:;•>:•;:•:•::: :.>::<•:•>:•:::;•:•::;•::....•::.:;•:....>:;• . ..................... .................. . IC+�NCP✓<f!!kTJ4N:::r: :: ;::: i':; 5:<: ?: ::;:;;:::Hsi::: >>: ::?>::ic;?::::: ::;. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ROGERS & MARNEY INC EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, P 0 BOX 310 BUT FAILURE TO MAR SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR UABILRY OSTERVILLE MA 02655 OF ANY KIND UPON THE AOMPANY, 5S AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Martha...J.....Findlay :..:......::.M.B..A. i .... ............ .......... DATE(MM/DD/YY) A o _D. CERTIFICATE OF LIABILITY INS`LIRANC�P�� 02 BARGER1. 10/04/99 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Burlingame Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Robert Burlingame HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ?�'D Post Office Sq ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 1 `/ nterville MA 02632 COMPANIES AFFORDING COVERAGE Robert Burlingame COMPANY A Vermont Mutual Insurance Co Phone No. 508-771-0105 Fax No. 508-771-1258 INSURED COMPANY B Kemper Insurance COMPANY James C Barger C PO BOX 219 COMPANY Cotuit MA 02635 D COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSU TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CON ACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE PO IC DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN RE UCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EF ECTIVE POLICY EXPIRATION LIMITS LTR DATE(M /DD/YY) DATE(MM/00/YY) GENERAL LIABILITY GENERAL AGGREGATE $ 1,000,000. A X COMMERCIAL GENERAL LIABILITY BP17013142 09 26/99 09/26/00 PRODUCTS-COMP/OPAGG $ 1,000,000. CLAIMS MADE ❑X OCCUR PERSONALS ADV INJURY $ 500,000 OWNER'S&CONTRACTOR'SPROT EACH OCCURRENCE $ 500,000 FIRE DAMAGE(Any one fire) $ 50,000 MED EXP(Any one person) $ 5,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY $ / NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ WORKERS COMPENSATION AND WC STATU- OTH- TORY LIMITS ER EMPLOYERS LIABILITY - EL EACH ACCIDENT $ 100,000 B THE PROPRIETOR/ INCL 704946593 10/09/98 10/09/99 EL DISEASE•POLICY LIMIT $ 500,000 PARTNERS/EXECUTIVE OFFICERS ARE: EXCL 10/0 9/9 9 10/0 9/0 0 EL DISEASE-EA EMPLOYEE $ 10 0,0 0 0. OTHER DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/SPECIAL ITEMS Masonry CERTIFICATE HOLDER CANCELLATION ROGERS 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL I Rogers & Marney 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, FAX#508-420-3550 PO BOX 310 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY Osterville MA 02 655 OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Robert Burlingame ACORD 25-S(1/95) " ACORD CORPORATION 1988 X ........... .... ............. .................. ................. . ..... . ... . ........... ....... .. ... ... .. .. ............ ............. .......... ........................ ................................ .... .................... .... ...... -.-.-.-.- %::::::`.............,:,;::;::-':.................... ... * , ...:;:::::. ............. ... . .......... ...... ..... ........ ....... ISSUE DATE I ...................... .... ......... .......... MMIDD/YY) .... . ...........1: .... ..............R .. .. . ........................... ............................. ............... .......... .... . ..... ....... .... .......... ............ .... ....... . .... .... RT : . ...... .............. ................. ........... .................... . . . ..... 07/29/99 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND The Fair Insurance Agency, Inc CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE Box 430 619 Main Street POLICIES BELOW. COMPANIES AFFORDING COVERAGE enterville, Ma 02632 (508) 775-3131 COMPANY A LETTER AIC COMPANY B INSURED LETTER ESSEX INSURANCE CO Shoreline Construction, COMPANY c 87 Pond Street LETTER COMPANY D osterville MA 026SS LETTER 428-SS29 COMPANY E LETTER ........................::::::'1'............ ...................................... ..................................................... ......... :*... ........ ............. ................. ............. ........ x-1... ... ...... xxxxi.......... ....... ..........:............... .... ................... .................................... ............................................................. .......... .................... .......******.............. .... THIS IS TO CERTIFY. .THAT THE POLICIES OF INSURANCE.LISTED.. BELOW. * *'HA'V*E**B'E'E'N'I'S'S'UE'D 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. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MWDDIYY) DATE(MWDD/YY) B GENERAL LIABILITY GENERAL AGGREGATE s200, 000 X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $200, OOO CLAIMS MADE —]OCCUR. 3CA1972 05/01/99 OS/01/00 PERSONAL&ADV.INJURY $100, 000 FX OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE $100, 000 -FIRE DAMAGE(Anyone fire) $50, 000 MED.EXPENSE(Anyoneperson) $51000 AUTOMOBILE LIABILITY COMBINED SINGLE ANY AUTO LIMIT $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ GARAGE LIABILITY PROPERTY DAMAGE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM STATUTORY LIMITS WORKER'S COMPENSATION WC1 50169 07/25/99 07/25/00 EACH ACCIDENT $100, 000 AND EMPLOYERS'LIABILITY DISEASE--POLICY LIMIT .6 00, 000 DISEASE--EACH EMPLOYEE 1$100 , 000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHI ES/SPECIAL ITEMS ...................... ...... ............................ ...... .......... ............................. ........ ........... ........ .......... .. . .... ........ ........ ....... .. .. ........... ....... .............. ......... . ..... ...... . ............................. ............. ...... ......... .. .......... .......... ...... ............ ....... ......... ....................................... ....... .... . ...... IBM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO -�-qers & Marney MAIL 15 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE 310 LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR Dsterville MA 02655 LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. :i::`AUTHORIZED REPRESENTATIVE .. ... ............. ....... f v... ......... ... ........... ... .......... ... ............ ........................ . ......... ........ A'-b., .......... ........ .......................... ................... .......... . ................... ......... . ...................... ............ .......... . ...................... . ....................... ...................... RA ..N 99 ......... 0FSHE Tp� .�� The Town of Barnstable • aAnNsrna1.e, MSTADepartment of Health Safety and Environmental Services �A i639. ♦0 lfo,,9- 16 Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MCL 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: AAAACerN Ak�.&%4AZ,cry1 Est. Cost Address of Work: 3 q 1 L,)t,cL C%o aYe Owner's Name TAO,ry.� 1C ei%.O a e%r%o ue Date of Permit Application: 1 l• 2.4. 4 9 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: tt� Z4 q9 x4arnev �_.r Date Contractor Name Registration No. OR Date Owner's Name I , ------------ =..;.... � 163 roe 62 •• '•. 115 139 1 166 Nt —01 i 161 O / ,_`? 1 , "-... - it !; •L; '; •tt Z 146,r 147 ,'.`210 � I � LU CL - \ / LU cr / 149 9 1150- 38\.• t Z07:;i// �' �•' it ``{'I ',, cr i U 129 \ \ \ m ,' 155� ti LU 133 128• ` i':/ ..;'' 2ti i \\ -= / 1 /' 6 Z v ?/Of _ 134 `Mt. O ' 152't ,'' 1L�.. / uj 190 a w ^��\121 125./ •` 153 [2 J\�) 122 98 123 p. 99 1, 120 /r, 177Lij 100 �� 174 \: ��"•` Z 16 115 178 10 180 25 1• Z 10 10Lij 216 c VV 183 J 187 104 170 ^ 31 O 33 �4 r 50 / '!i: Q � r• �,j _' r CD`1 35 .:25 O- 28 30, j \ 49 — LL i 9 1 � I • � f j l � I � f III l Il I l _... _ -- I HOW TO USE THESE TABLES 1. Determine the live load deflection criteria(MINIMUM CRITERIA PER CODE- 3. Select the on-center spacing you prefer. L/360 or IMPROVED PERFORMANCE SYSTEM -L/480)and locate the 4.Scan down the column until you meet or exceed the span of your application. appropriate table. 2 5. Scan left in the row to locate the TJIO joist series and depth which satisfies your Z. Identify the loading condition(40 PSF LIVE LOAD/10 PSF DEAD LOAD or condition. 40 PSF LIVE LOAD/20 PSF DEAD LOAD)and move to the appropriate section of the table. MINIMUM CRITERIA PER CODE IMPROVED PERFORMANCE SYSTEM L/360 LIVE LOAD DEFLECTION L/480 LIVE LOAD DEFLECTION DEPTH TJI®/Pro'" 12" o.c. 16"o.c. 19.2"o.c. 24"•o.c. DEPTH TJI®/Pro'" 12"o.c: �,16'o.c. ' 19.2"o.c.- .,24"o:c. 150 18'-8" IT-l" 16'-2" 14'-11" 150 16'-11" 15'-5" 14'-7" 13'-7" gN 9'z 250 19'-6" 17'-10" 16'-10" 15'-8° O N 9'/z" 250 17'-8° 16'-1° 15'-2° 14'-2° 150 22-3 20-4 18-10 15-0 "'e inr ' " ' " ' ° ' ° o 0 0 150 20'-1' 18'-4° 17'-4° 15'-0° 250 23'-3° 21'-3° 20'-0° 18'-8°('1 s�a 117/8" co 250 21'-0' 19'-2° 18'-1" 16'-10"(1) a 350 24'-10' 22'-8" 21'-4° 9'-11°('1 a t- 11/a" 350 22'-5" 20'-5' 19'-3" IT-1 I" o a 550 28'-2' 25'-8" 24'-2° 22'-6' o 0 550 25'-6° 23'-2' 21'-10" 20'-3' c Q250 26'-5" 24'-1° 22' D 18'-11°('1 c 250 23'-10" 21'-9" 20'4"0) 18'-11"('1 O c 14" 350 28'-2" 25'-8' 1'-4'(') O e 14" 350 25'-6° 23'-2' 21'-10" 20'-4°(1) >p 550 32'-0" 29'-1" Q 25'-6" >c 550 28'-11" 26'-3° 24'-9" 23'-0" U. 250 29'-3° 26'-00 18'-1 l°(0 N U. 250 26'-5" 24'-1' 22'-9°('1 18'-11°('1 N L C. 16" 350 31'-2" 28'-5"( 26 '1 21'4'0) c 16" 350 28'-2° 25'-8" 24'-2'('1 21'4"01 550 35'-5° 32'-3 -4" 26'-9"(0 P 550 32'-0" 29'-1' 27'-5" 25'-5" Q c 9'/z" 150 18'-8° 16 ° Q '-3° 12'-6° 0 0 9'/z" 150 16'-11° 15'-5° 14'-7" 12'-6° O 250 19'-6° 16'-6' 13'-5' ON 250 IT-8' 16'-1 15'-2' 13'-5" o'0 150 22'-3" - 15'-8° 12'-6" CIO 150 20'-1' 18'-4° 15'-8" 12'-6" o® 250 23'-3" '1 19'-1'(') 15'-9"('1 O0 250 21'-0" 19'-2' 18'-1°(1) 15'-9"(1) N F 11/s"a Ua_350 24'-1 20'-8"(') IT-9"(U 350 22'-5" 20'-5' 19'-3"(1) 17'-9'(') s- o¢ 550 27' -4' 23'-11' "22'-3°('1 N o 550 25'=6'.;-i 23'-2' 21'-10° 20'-3" N Q d ¢p 250 23'-2'(') 19'-9°(') 15'-9"(1) 0 250 23'-10' 21'-9"(1) 19,-9"(1) 15'-9"01 %O o 14" 350 2 2' 25'-1'(') 22'-2"01 17'-9'(') O c 14" 350 25'-6° 23'-2'(1) 21'-10'(') 17'-9'(1) J 0 550 .31'-7° 28'-9' 27'-1'(1).` 22'-5°(1) >a 550 28'=11 ;26'=3'. r ;`24'=9°.';'C. 22'-5°(1) J" U. 250 28'-11'('1 23'-8°('1 19'-9"('1 15'-9"('1 U. 250 26''5" 23'-8°('1 19'-9"(') 15'-9"(1) �c Nn N 16" 350 .31'-2'(!) 26'-8'(') 22'-2'(') 17'-9°('1 N 16" 350 28'-2°i'^ 25'-8°('1 22'-2"('1 IT-9"('1 550 35'-0°. 31'-10' ' . 28'-1'('1 22'-5'('1 550 32'-0' ,"'29';-1 r ;27'=5°U1.:x • Long term deflection under dead load which includes the effect of creep,common to all wood members,has not been considered for any of the above applications.'Shaded spans reflect initial dead load deflection exceeding 0.33",which may be unacceptable.For additional information,refer to our TJ-Beam"or TJ-Xpert"'software or.contact your Trus Joist MacMillan representative. (1)Web stiffeners are required at intermediate supports of continuous span joists in conditions where the intermediate bearing width is less than 51/4"and the span on either side of the intermediate bearing is greater than the spans shown in the following table: TJI®IPro" 40 PSF LIVE LOAD,10 PSF DEAD LOAD r' 40 PSF LIVE LOAD,20 PSF DEAD LOAD" 12" o.c. 16 o.c: 19.2"o.c. '`24"o'c.' 12" o.c. 16" o.c. 1 19.2"o.c. 24" o.c. 150 Web Stiffener Not Required Web Stiffener Not Required 250 Not Required 24'-3° 20'-2" 16'-1° 26'-11° 20'-2" 16'-9" 13'-5" '?=R(oRtiatCi 350 Not Required 27'-8" 23'-1" 18'-5" 30'-9" 23'-1" 19'-2" 15'-4' �•. 550 Not Required 25'-8" Not Required 26'-11" 21'-6° 12 PSF Dead Load at TJI v/Pro'"550joists. "22 PSF Dead Load atTJl=/Pro"550joists. GENERAL NOTES Tables are based on: WEB STIFFENER REQUIREMENTS • Assumed composite action with a single layer of appropriate span- • Required if the sides of the hanger do not laterally support the TJIO joist top flange or rated glue-nailed wood sheathing for deflection only(spans shall be per footnotes on pages 20 and 21. reduced 5" when sheathing panels are nailed only). • End Bearings: Not required j ✓ • Uniformly loaded joists. • Intermediate Bearings:Not required at intermediate bearing where joists are • Increase for repetitive member use has been included. continuous in span and the intermediate bearing is at least 51/4"wide. For • Spans shown are clear distance between supports. intermediate supports less than 51/4"wide,web stiffeners may be required • Most restrictive of simple or multiple span. (see footnote 1 above). 0 For loading conditions not shown,refer to PLF tables on page 11. Asses offioe Ost floor): Assessor's -map and lot number .....L.T ..�r...I 7:3.......!� �mpMC Sy=-M MUSS'BE �O�THE TOE Board INIUALLED IN COMPLIANC of Health (3rd floor): , Sewage Permit' -number ...........�,1 ��........�..�3... .... �II�I�'I LE 5 Z EABdSTABLE, S ENVIRONMENTAL CODE AN MASa Engineering_Department (3rd floor): '°o 1639• ♦� House numEi r ... t.........................:............. TOWN REGULATIONS APPLICATIONS PROCESSED 8:30-9:30 A.M. and' 1:00-2:00 P.M. only { TOWN OF BARNSTABLE BUILDING ' 1NS,PECTOR APPLICATION FOR PERMIT TO � !t�lt y.. 1!f .. �T4.S 4sv ................................................... ..................... . TYPE.OF. CONSTRUCTION ....V�J.S�C�41`...... ��X'�............................................................................................ �.�.1: ...�. .......... 19 ••d TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 'I u S' t'ui R �s�.!.�".J..........................Proposed Use ..... .. ................................................................................................................ ZoningDistrict ...........................!.r.......................................Fire District ........................................................ Name of Owner Address . ...C�,S�-L°CZ/� �(:Q...... .............................. `..... Name of Builder �G�/ `�T.�.\..C�� .t4C`7� .!1...........Address ......... .... .... Q d C.�,.�. ...�,1 e-h0�.�.'�.I-........Address ..Q. c�.r.. .�.....r c. Name of Architect .. . . ........................................ Number of Rooms ..rL'. ...........................................................Foundation ..Pv.C�c.P .CUK( 2 I�- . ......................................... n l Exlerior .lnJ.60CxS !� in .++. .................................... '\\..N ....................................................... 3I Roofing �.......F?.Q Floors ...C.. .fin. ..t..4N.t�U. ....................................:......Interior ..... .......................................................... Heating Q:``5 Plumbing�?` g ......Q�W_.................................... Fireplace .. M4'..4`r- .......................................................Approximate Cost .......... .. ................................ Definitive Plan Approved by Planning Board ________________________________19-------- - Area.4.4.0 ......................... Diagram of Lot and.Building with Dimensions Fee .....Ral........................ SUBJECT TO APPROVAL OF BOARD OF HEALTH 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. A"J. '�'juia,4. Name . ................ Construction Supervisor's License ..4. `[..... �- ALLEN, ROBERT 33057 0 Permit for ..:�DD TO Single Family Dwelling .......... Location .....3.9.1....W.i.a.nno...Av.en.u.e................ .. . .. . .. ....... ..... .... .. .. . 0:§terville .................................................... ............. Owner ......R6.be.r.t...Allen ................................. .... .. .. .. .... .. .. Type of Construction ...Frame......................... ............... ............................................................... Plot .... ........................ Lot ................................ 'Permit Granted ...J.11l y. ... 89 Date of,Inspection//....... .......19 Date Completed .............Yg.................19 L I CON E3 % �Jp L 1 _— I , III Fein 0 .. � ��1 To au I O O i- I ^� 1 • WfT E LPG S�OI�D FI,kw 54.rwrgf,- g355f OF BARNST BLE TOWN wFf •rE_3!0 sF . Bli9a • o �llt .PrAl- 1I6W 50.fW(AGE =t 199USFr 1 _ sEcvrly �Loo�, �wJ _ DOREVE NICROLAEFF ARCHITECT, INC. �a 6 c S 0 :U b �If� I oc I. --- RAM?1:12 IZA ts i I-Q 1 I — i 1T'� —, S I T» I o e 4'-.ac..a�::,n.��e.• gC 'V :!fin$ '� - :` -''. .. Z _ n O ` ' r �n m ,• ail,; �: �• � ;- o fi� 77-77-7-77-7 UN t cn �'itil I;I� i a FS U Oc `• I� I •� i�. �o D ILTi f � UN Lt '� o . —. O • o Li TF d I I I III I ..................................................................... GpY J .L. TT�1 _ 1 II . � IIi I � I � I I Ilj lil tt a - i a' I _ �o z I� I� 0 I • 7 tj __-_ - �_ '�, '��% ,�•, '-I' - i 'fig I�i!'i 77 ij '' I i i i ' \ FEII HI f ' {I _ It . 0 1 , III ,.. ! _ .i'Il•,1'� 'Ill'I, / I i R NEW ROOF CONST. -2 x B ROOF RAFTERS @ IW O a. NEW RIDGE VENT 2 x 66®16.0 C..USE -SW COX PLYWOOD ROOF SHEATHING 5-10a NAILS EACH END -ASPHALT ROOF SHINGLES F -15LB.FELT PAPER -2:10 RIDGE BOARD I -SIMPSON H10.2 HURRICANE CUPS NEW AZEK RAKE BOARDS NEW ASPHALT ROOF 1 12 AT ALL RAFTER ENDS 12 TO MATCH EXISTING SHINGLES TO MATCH 1 MATCH -ICE/WATER SHIELD AT BOTTOM MATCH EXISTING ' I EXIST. 70'OF ROOF EXIST. j 12 -RIDGE&SOFFIT VENTS NEW W.C.SHINGLES SIDING 1 EXIST. TO MATCH EXISTING NEW AZEK FASCIA& I 5 Ile x 7 1/4'LVL SOFFIT BOARDS TO I 2 x 66®+6•o.c. MATCH EXISTING 1 W/BEAD BOARD &RECESSED FASTEN BEAMS TO POSTS z LIGHTING �TF W/SIMPSON LCE4 POST CAP UTUNE OF W NEW ® ® ® ® ® ® NAPISAS 6x6POST5 COVERED z WI AZEK CASING&8' EXISTING o CAP/BASE HOUSE � PORCH u) .I STS W/AZEK CASING B S Ulu u CAP/BASE 00ig EXIST.DECK JOISTS 1 Peva d NEW P.T.6 x 6 POSTS ON -- I? IZ'DIA CONCRETE SONO- o TUBES W/24'CIA BIGFOOT NEW FRONT DOOR&SIDELIGHTS FOOTINGS UNDERNEATH FRONT ELEVATION SIDE E L E VAT I O N SI BELOW GRADE USE SMPPSS ON ZMAX OR S.S ABU68 POST BASE EXISTING EXISTING nSECTION @ PORCH HOUSE HOUSE NEW 37 MAHOGANY EXISTING WINDOWS DOOR W/SIDELIGHTS EXISTING WINDOWS EXIST.FOUND. 4 WALLS 4 § < o o ! 1 A A A A EXIST. Al I NEW I 1 NEW P.T.6x6POSTS ON Al * * 1 DECK q COVERED 1, 12•DIA CONCRETE SCNO- Y y EXIST. TUBES W/24•DIA BIGFOOTFOOTINGS UNDERNEATH PORCH I DECK TO 47 BELOW GRADE USE / / REMOVE EXIST.DECKING MAXSIMPSON OR 5.::ABU66 R/REPLACE AS POST BASE NECESSAY I i EXISTING RAILING EXISTING RAILING —————————— ———I L VERIFY ALL DETAILS FOR +Y.O't LDECK ABOVE OF EXIST. FOOTING P LA N EXISTING PERGOLA ON NEWP.T.CASING - DECK ABOVE REMOVAL OR TO STAY W!PIBA CASING&B' IN PLACE AV— AV CAPlBASE 1Y-0t FLOOR PLAN FASTEN BEAM ENDS TO WALL W/SIMPSON HU68 FACE MOUNT OR POST DOWN IN EXIST. HOUSE WALL NOTES: r 1.) CONTRACTOR IS TO VERIFY ALL EXISTING CONDITIONS I ¢ b &DIMENSIONS IN THE FIELD b 2.) CONTRACTOR TO VERIFY ALL INTERIOR&EXTERIOR MATERIALS, A �1 A DETAILS,&FINISHES IN THE FIELD WITH OWNER Al 3.) ALL CONSTRUCTION TO CONFORM TO 780 CMR MASSACHUSETTS In STATE BUILDING CODE,8TH EDITION AMENDMENT&IRC2009 N olo +la N 4.) ALL AZEK TRIM TO BE PAINTED WHITE&ALL JOINTS/NAIL HOLES SEALED. N 5.) 110 MPH EXPOSURE B WIND ZONE - 6.) TIMBER FRAMING TO BE SPRUCE/PINE/FIR NO.2 GRADE s t/a x7 1/4 LVL RAFTERS&CEILING JOISTS ATTACHED TO BEAMS W/ 7.) ALL LVL LUMBER/BEAMS TO BE 1.9e V480 LOAD,VERIFY ALL SHOWN SIMPSON H10.2 TIES SIZES WITH LUMBER SUPPLIER =FASTENAMS TO POSTSROOF FRAMING PLAN 8.) FOLLOW ALL MANUFACTURER'S SPECIFICATIONS FOR INSTALLATION OF ALL N LCE4 POST CAP SIMPSON COMPONENTS.ALL PIECES TO BE ZMAX FINISH 12*-0'* THE i Q COTUIT BAY DESIGN, LLC NEW ADDITION/REMODELING FOR. CONSRgTION.TlLBELDNOTEO IF TRAC AW SCALE : DRAWING NO.: ERRORS OR OIASSIONS ARE FWNDON THESE ORAWhV S PRIOR TO START OF 43 BREWSTER ROAD coNsrnRcnmN IBLEHE FO THE II 11 YALL BE RESPONSIBLE FOR T/¢CONfclR 1/4 1 -0 IN THESE DRAVANGS IF OONSTRUCOCYA - ( C07AIAENCES`MTHOUT NOTIFYING TIE JA N I C E N O RTO N THESE FRAWNOS ERRORS OR FOR THOUS DATE : MASHPEE ,MA. 02649 I THESE OWNER E PH. (508))274-1166 THESE ORAWINGSREOUIRES THE WRITTEN 3/19/2012 FAX (508) 539-9402 391 WIANNO AVENUE OSTERVILLE, MA CONSENT OF THE DE5 THE lAl ARCHITECTURAL fgPYPoGM RONTMO PROTECRON ACf OF 1590 77 415 -te. C> .....t., -FT KIN. 2 OP 9,1 �_q DATE, `T0 MIN.- EL.,4 ',FT - id, Jim, TNESSE0 ONCAETt Z-8-" UK/ INCH PYC ERCOLATION RATE 'COVERS.._� z 7 tAND P � CLEA ,SCH 40 PIPE OL T E I -.08SERVAT 'M IN �PITC I H PIE ION i ON,,:,.H "CO NCRETt EL E V.:% ;ELEV LAYE.R �)D COVERS '-CAST 'IRON, If: 4 E f4TCH, S ONE /4"PER ,LF To S a I Z WA AED FLOW LINE 10" M16 EL.,= EL 2b �O _ E E L L s 'Di T EL ATER' "Jo- -N WATER AT" _EL -BOX 3/4 -1 1/2 LCULATIONS , ON DESIGN CA' VASHED� STONE GALL .2 SEPTIC SER F SEDROOMS-�� ' Num 0' TANK ACHING T E 61SPO SAL EQUIW,:, GARSA6 UNIT TOTAL . ESTIM T ED, -FLOW 7?ttD. DAY 6 DIA M. A GAL. OAY"-'��r_i 'SEWAGE, 'DISPOSAL . Y T E GAL, SR.) S m PROF1 E Y ED CAPACIT 15 0 C_'y �GAL REQUIR NOT -ACT M,SCALE PTJC',,TANX AL' AL" G NG AREA ,R S17 EQUIPEMENT'S; OTTO M 0 F TEST MOLE U S GS.�', PROBABLE, WATER TABLE D R 1ASL L S.F E'--' EWALL REA 'C &F LEACHING L: GAL CAPACITY.(BOTTOM 4 SIDEWAL '�AREA-' '778 BOTTO GAL LEACHI VE N EX STING SPOT TO AEkR OC�O LEGEND, tLtVA DO I T"Y' D EXISTING CONTMA U F E L E'V4 1 INALSPOT CON NOTES� ERIALS SMALL, ORM 10,� E 4 L--TEST INAL' TO AT ALL'�WlOkkMANtHiP 'AND RULiS,_A N ND SfO =a ZMW Z0=MvrXCm= �SA'NftAR "UNITS LLrl SHA 6A�IN, ITHIN -OF FINISHED�.GR DE -BE WA ER W -7 NE USSURI ACE' Of SAL �Of SEWAGE VTOTY OF_R;A v b T HE E I'�T B "E REG U LT 10 14 S FOR:,j TOWL'L;� COVERS y 'y A E ENTS �OF,,THE GW Sk& 'RE IN'EMENTLAUY THE. XISTIGA ES �OF WITH 100ING .:UNLUS STANDING :'H- E ARE U1400 i'bR A -F, OF I)RIVES_ 5 �DRIVE -10 FT WI, MIN LCIADING AA :'4REAt .:P KING,L SHALL, BE, USM�VNDER'OR T 'ANY- 0_ BRING C'OV RS TO'�,GRAOE -A OF -7 E MORTARED N�'PLA. S APPLICANT. DEEDEU "At 6�'CdMPL IANCt `0E,TE R A AMROPRIATE,`AUTMORITy.r OSTAJN :SUCH DETERMINATION, R T 17 T N :,,AGE T y 1'�H FD iBOARD"�OF�HEALT 7 to P ROV �'A A il D El�pob Ls E L C PAOAV UXATI(* g Acr y U N 'pt Pi"A fj IL Z0Lfi:AkT t 'A_L-L_F I' 'T z iTA R iA W I?VCEI EQ R GIS, TE Rs s,".. SPUP�-LANEA", A L