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HomeMy WebLinkAbout0459 WIANNO AVENUE o a i P 1 = P //// QECYLLpOc UPC 12743 No.63LR moll ma iYa 0 mN - .... NOV/30/2020/MON .07: 48 AM COMM Water Dept FAX No. 5084283508 P. 001/001 Centearvitle-OstervnUe-Marstons Mill<.s Water Department P.O.BOX 369-1.138 MAIN STREET OSTERVI.LE,MA,SSA,CHUSETTS 02655 www.commwater.com � OFFICE OF MI — BOARD OF WATER COMSSIONERS WATER WATER SUPER TMNDENT DEPT. TEL.No.508-428-6691 'M FAX No.508-428-3508 November 27, 2020 Town of Barnstable Building Division BUILDING DEPT. Via Fax-508-790-6230 NOV 3 0 2020 RE: 459 Wianno Ave, OST TOWN OF BARIVSTABLE To Whom It May Concern: This letter is to inform you that currently COMM Water Dept. had a water service at the above mentioned address that has been disconnected for the purpose of demolition as of November 27, 2020. If you have any questions regarding this do not hesitate to contact our office Monday through Friday, 8:OOAM until 4:30PM. Thank you. Sincerely, '.ICL ��L Glenn Snell, Asst. Superintendent Centerville-Osterville-Marstons Mills Water Department GES/bf a% TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel. Application 01 Health Division Date Issued Z Z Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board ok Z�I/12 Historic - OKH Preservation / Hyannis Project Street Address TS`I Z')i/4-nJ N 0 (/L Village �S rle-/` ✓l Owner �f-�r/i �.� �'W01crt-t 'F- LU C#M 60 'T-74tZ i c� Telephone ° fl:'�' % N Dyol�'/1 0��� U O 3 Permit Request L�-S .�` 02 1�ef� .4cg.0,4�V r- V�0ors ' NsU/ -rd— r�C. Square feet: 1 st floor: existing Iroposed T T 2nd floor: existing AAproposed Total new Zoning District Flood Plain_ Groundwater Overlay Project Valuation o�5, Oo Construction Type 4Uooe A41 .4- Lot Size Grandfathered: ❑ Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family 0 Multi-Family (# units) Age of Existing Structure 1 to _ Historic House: ❑Yes ,-No On Old King's Highway: ❑Yes %6No Basement Type: 'Full 0 Crawl 0 Walkout ❑ Other Basement Finished Area (sq.ft.) 7 -�_U r/ Basement Unfinished Area (sq,ft) 04�0 Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing Onew Total Room Count (not including baths): existing _ new o First Floor Room Count Heat Type and Fuel: 0 Gas ❑ Oil ❑ Electric ❑ Other , Central Air: Yes ❑ r�No Fireplaces: Existing —New C.) Existing wood/coal stove•::i;CYes 0 No Detached garage: ❑ existing 0 new size—Pool: 0 existing ❑ new size _ Barn: 0 existing ❑°rbw s e_ Attached garage:�(existing Cl new size _Shed: ❑ existing ❑ new size _ Other: i Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) / Name ��6¢iy�' --�/�-"�— Telephone Number �o p 7 / 3 o Address Z j //� D� w-M License # � A..-'( `�� Home Improvement Contractor# LOD l Z r Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �730U/L / _ _/11110 47t SIGNATURE DATE__ i l/�" l a y 2,& 1 ?i if ` - FOR OFFICIAL USE ONLY APPLICATION# -DATE ISSUED ' MAP/PARCEL NO. ADDRESS VILLAGE, „t OWNER L } DATE OF INSPECTION: - E r� r FRAME el _—INSULATION q OL .. - FIREPLACE ' ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ' • GAS:- ROUGH " � FINAL - fl J -FINAL BOILDING'`w -DATE.CLOSED OUT a ' - ti .1 ASSOCIATION-PLAN NO--, i ti , • • `` I nem�rwnweabh ofMa�rachu�et� • . '.- bepartinerit of�ustrial. �4ccide.� Office VOrMa gadorrs, 600 #r=kb ton Sireet Bva�i;.M�i OZIII WWW masMgoV/da Workers' Compensation Insurance Affidavit: RMIders/Contractors ficant Information /IIectriciaa /Phrmbers . Namen Please Print Le (B�ess/or Crip/State%Zip: {��vivl S'�,,/�- Phone/ a ' Are you en euiplayer? Check I ke8p111'1 to arc 1.(9 I a e�Floy= ?/ 4. ❑I am a geneamI cmdrwtDr Md.I e° Project(req�e�; . 2.Q`Iffy=W and/or part t me}:* have hied fhe sub-cm tac4� fi. New oansizvcfion I am a sole pmgaetor or pa*tne. listed On the attached sheet 7. Remo tip and hs�+e no e�lDyees These sub-coattacton have working for mein any capacity, employ=and have worh=, 8. Demolition [No workers'coin,it s e c °mP•iusorence,# 9, ❑13uIdmg addiiiam 3.Qrequimi j 5. ❑ We are a corporafim and its 10.❑IIectIIcal ins -I am a homeownm doing aR work officers have exercised their rep or additions Myself P4e workers' cam• of exemption per MCU 1 l.❑Phmmbing repairs or additions insr c regii e j t c. 152, 91(4), and we have no 12•Q Roof repairs M3P1Dy=. [No work=, 13.❑Offer comp•iasrnmice required] ADY RPP�that checla bas#1 rest also fM ant the section belowhD feu t v,,_=,—V,=who sabmit ffiis dndavk-&-t¢g ti�c�,an wow'�P=-fMn Policy Win. $C1nM±rBCt=file Chert this boat mast attached as addritun� wow end then his h titi wha new d o d=or nit th ��� must sabmit n— �Inyocs If tho sub-contractoo;have 1 IdOR'�Vn m�e of the meting such P�rde their wad end state eese enes ave - �P�,�mast �=11P,poficy camber. I am an employer AF&isProvitffng workrrs compe=atioa insarance or mare fio,?L .f my etrployem Below is tke po&cy=d job xh5e hmLmm ce Company Name: Policy#or Self-ins.Lic. Expiration Date: Job Site Add=sg: Attach it copy of the workers° compensation o ' � ' Baihne to setae c P decFarafion page(showing the Policy number and expiration date). coverage regtrasd under Section 25A of MQ,c. 152 can lead to the m�ositinn of�� fine UP to$1,500.00 and/or one-year��omment as well as civi'1 Peres of a of r�to$250.00 a day against fhe violator. Be advised s Penalties in the foffi of a STOP WORK ORDER and a fine �'estigatians of file DIA for insazmmce coverage verification.Copy of May be wed to the Office of I do hereby cert�y and er and p fP�Jary that the�}' o rmation provided above true and correct Date: ( � �( hone# �� 1 a ------------- a a1 use only. Do not write in this ama, to be completed or town p�7ga[ City or Tom¢: pe+rmitUcense# ' Fsstrirztg Authority,(circle one): L Board of Health 2.BulfmgDepntment 3, City/T`own Clerk 4.IIectrical Impecimr S.P 6 Diher lnmhiag Inspector Contact Person: Phone#: n:Theresa Cahalane-Norkus To:Town of Barnstable, Bldg./Oceanside Inc.Cert. 09:48 01/18/12GMT-05 Pg 02-02 Client#:241369 OCEANSIDEIN DATE(MM/DD/YYYY) ACORD. CERTIFICATE OF LIABILITY INSURANCE 1/18/2012 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 endorsement(s). PRODUCER NAMEAC Christopher Hedetniemi HUB International New England PHONE 508-946-0446 508-945-9136 AIC No Ert: A/C No 265 Orleans Road E-MAIL ADDRESS: North Chatham,MA 02650 INSURER(S)AFFORDING COVERAGE NAIC IY 508 945-0446 INSURER A Everest National Ins Co. 10120 INSURED INSURER B: Oceanside Inc; INSURERC: S Clark Inc. INSURER D: 217 Thornton Drive INSURER E Hyannis,MA 02601 INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE DD SUB POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MMIDD/YYY MMIDD/YYY GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES Ee occ�urren_e $ 1 —•t CLAIMS-MADE 7OCCUR MED EXP(Any one person) $ v PERSONAL&ADV INJURY $ GENERAL AGGREGATE ! $ CD GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ •�'� POLICY JECOT LOC $ w "� AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ � ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS i NON-OWNED PROPERTY DAMAGE $ !17 HIRED AUTOS AUTOS Per accident R+� UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ TORYA WORKERS COMPENSATION CF4WC00045121 1101/2012 01/01/201 WCSTATULIMI- X OTH- ER AND EMPLOYERS'LIABILITY A ANY PROPRIETORIPARTNERIEXECUTNE Y/N E.L.EACH ACCIDENT $1 000 000. OFFICERIMEMBER EXCLUDED? NJ N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1 OOO OOO. If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1 000,000. DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) CERTIFICATE HOLDER CANCELLATION Town Of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE V C406- - ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S645521/M645518 TC002 A g pzvYsion To2wrerm c0=fL donar. top 2, Shrr 117=m; .MA- Prropetty OWnerMust aomplebe and.5ign maxis.Seciion ter - as Owne�_r-of tote subjexe property to act on atybe6A m Z maw toVolk °'arid bpi bmiaigP=Z3it! PP far, (Add==.of Job) ofam if Pro e ..00wncr is.a o-..for - . . . pp : permit�pleas�e �omplete.the ••.• • ora�er� �e�se: p on orm on t o reveise:sine, TO/T0 39dd S8S£669LT9 60:60. OTOZ/£0/80 Ali.rs ►es = e iu atton. Office o: onsn.rner g M` HOME IMP f tJV. R ON ACYOR I . Z E i. u. w Rtr2ltiibn � p.�,2:1 Type" is diratior �612: Private: Corporation ! SIDE INZ4­ Richard Ciark. :2�7 'Ilornton t .r Massa - Del��lrtment of Public -St, 4. B'��trd:.�of Bu 'Idi.ng Regulations and-Standards. Coh.strzucti:on Supervisor ' License License: CS 43 E Re Stricted lo.: .00 RICHAROW LARK 6 ACRE HILL RO BARNSTABLE, G 63- IVL , c Expiration.: 1/21/2012 -: = Commissioner - T.r#: 11887 M ,,$u21F .aru Seni'4! . a h'ifN`lai ... _ - -s.w •T1 VT i ' r License or registration valid for. vi.dua use o.n'ly is before*th-.e expiration date•... If fo:u:nd: r.etu:rn t.o: Office of Consumer Affai;rs. and Business Regulation 10, Pa'rk PFaza - Suite 5170 Boston, MA 02116 x Not valid wkho.ut s : atu:re 1 , S Restricted to: - 00 V . 90 Unrestricted 1G- 1 2 Family.Homes F. . f Failure to possess- a current edition'of the , j• Building Massachusetts State } .y g Code is cause for revocation of this license. Refer to: WWW.Mass.Gov/DPS lr , I i r , ! I � j I _ r ' ; � i , ' V I I � ,.-�' i ' ; nnp vJJI�''�• j � ,} 1 _ r I ' •. I � I � I i ; 6'� I � � ! � i I � � � i i I j- I` .._ I 1 I I I � ' � i { i j Nam' �Ar, UL r I I r i I r r - I � 1' ! ' ' I ._�! N}Q�✓"-d �'lAi r I - !_.. I { - ; - ! ' , I I ( ' r � i ' � � � ; � ' I 1 __� __;.� _ _ _ _ _ ; �i�• i I� I i \ I ' i � ' ; i t I � ' I ^' �f u/ `� I ) � yV -C l ; ' ► ' ' ' jv Gc.� L!.i4 � • � I I I i I I i I i I _ i I ! � i I i j i ��coo� � I i � ! , ! 1 ! ! ! ! I , r 1 i ► t I i I I I ' ; i i , I R i I � ' i ; r � ! � ; � C. I��lti� ���' j� }ll,f'g` � j ' i 1 j { I ! � i �� 1✓ _ � i � ; S�• i i I I ' i I rUc o OCEANSIDE, INC. Jr ( 217 Thornton Drive ; Hyannis, Massachusetts 02601 (508) 771-3110/800-464-3318 r Town of Barnstable t ut Ecpires 6 mart tsfrom issue date Regulatory Services Fee + HARN5rA61,E. + v� "t" 9 Thomas F. Geiler,Director163 Ot6D MA1 A Building Division Tom Perry, CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barns table.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 Property Address S U)I4,A NIV A I>-_ t/.iT��l"✓r � AA, r Residential Value of Work /0 7 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Contractor's Name:51 gC-5 M00(y Telephone Number, Home Improvement Contractor License#(if applicable) / 5S"3S Construction Supervisor's License#(if applicable) 9/ O / 0 Zworkman's" Compensation Insurance Check one: -P SS PERMIT ❑ I m a sole proprietor ❑ am the Homeowner APR I Z010 I have Worker's Compensation Insur nce Insurance Company Name l�el�C0A) ,IVA TOWN OF BARNSTABLE Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit.Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) VReplacement-Windows/(V side #of doors liders. U-Value 0• 35 (maximum .44)#of windows *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 copy of the Home Improvement Contractors License& Construction Supervisors License is /required. SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 090909 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/Organization/ ividual): Vim/U _](/C, Address: B�h ,✓ / ' , City/State/Zip: O Pnone#:, -�'7/- � Are you an employer?Chec the appropriate box: Type of project(required): 1.I_I I am a employer with / 0 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. FC�emodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers'comp. insurance comp. insurance.; required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions officers have exercised their 11. Plumbing repairs or additions 3.❑ I am a homeowner doing all work ❑ g p myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :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 'nsura ce for employees. Below is the policy and job site information. Be6an/ v Insurance Company Name: n�- • Policy#or Self-ins.Lic.#: Expiration Date: V � 9 �Job Site Address: / . Ulf#NNdPIVIe— City/State/Zip: �t'� 0 cz Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided }above is true and correct l�r Signature: .� `— + Date: Phone#: Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 1 law XPI Fit IP#t� i2 r# '2$ 438 wootioll xq AM 64 1�1O9€OCKET, R "b i. iln�er�ecr xat AA* iv�itt€5ss�i' a3;,!�t�'fii'i9� #ii ;z � . bw Ps. r +Od 43 j� 3 a Bra r - a Of L From:Shaunna Robinson, Hunter Insurance At:Hunter Insurance,Inc. FaxID: To:Denise Glode Date:923/09 09:45 AM Page:2 of / A4ORD CERTIFICATE OF LIABILITY INSURANCE OP ID S DATE(MMIDDNYYY) PRODUCER MOONA-1 0 9/2 3/0 9 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY.AND CONFERS NO RIGHTS UPON-THE CERTIFICATE Hunter Insurance, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 389 Old River Road, P.O. Box 1 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Manville RI 02838-0001 Phone: 401-769-9500 Fax:401-769-9502 INSURERS AFFORDING COVERAGE NAIC# INSURED Moon Associates Inc. DBA'Gutter Helmet INSURER A: Rational Grange insurance co 14788 DBA Renewal byy Andersen_ of RI. INSURERB: Beacon Mutual Insurance Co, DBA Gutter Helmet Roofing DBA Moon Works INSURERC: 1137 Park East Drive Woonsocket RI 02895 INSURERD: COVERAGES INSURER E: I THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. - LTR IINSR TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(M M/DD/YY) LIMITS GENERAL LIABILITY • EACH OCCURRENCE $ 1000000 A X COMMERCIAL GENERAL LIABILITY MPS26619 09/16/09 09/16/10 PREMISES(Eeoccurence) $ 500000 CLAIMS MADE FX I OCCUR MED EXP(Any one person) $ 10 0 0 0 PERSONAL&ADV INJURY $ 1000000 GENERAL AGGREGATE $2000000. GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2 0 O 0 0 O O POLICY JECT LOC AUTOMOBILE LIABILITY A COMBINED SINGLE LIMIT X ANY AUTO BIS26619 _ _ _09/16/09 09/16/10 (Ea accident) _ $ 1000000 ALL OWNED AUTOS ` SCHEDULED AUTOS BODILY INJURY(P $ er.person) HIRED AU TOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ 1 0 0 0 O O O A X I El OCCUR CLAIMS MADE CUS 2 6 619 0 9/16/0 9 0 9/16/�10 AGGREGATE $ $ P DEDUCTIBLE RETENTION $10 0 Q Q WORKERS COMPENSATION AND y EMPLOYERS'LIABILITY X TORY LIMITS ER B ANY PROPRIETOR/PARTNER/EXECUTIVE 28586 10/01/09 10/01/10 EL EACH ACCIDENT $500000 OFFICER/MEMBER EXCLUDED? If yes,describe under E.L.DISEASE-EA EMPLOYEE $5 0 0 000 SPECIAL PROVISIONS below OTHER E.L.DISEASE-POLICY LIMIT $50 0 0 0 0 O DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION BUILDIN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION _ DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Building Cont. Reg. Board NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Dept, of Administration One Capitol Hill IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Providence RI 02908 REPRESENTATIVES. AU D REPRESENTATIVE ACORD 25(2001/08) ©ACORD CORPORATION 1988 i 5� Col Cuatoruer Name Year Built: 'SO Roenc l by Anderson of Rhode island& Address: u "dN Cusronwr IDX: cod I l Park Err Drive 02895 {','.�7� newai Sales Agreement City Saar Zip: i,rs�t)y//-P I�6 J Order Number: Woonsocket,t rive wnraowr ni►uei�N-AodusmCkn p" CQ y PhonrHo ri sV P of f��U Phone-Work: agc:1._. �Datc: license a7 RI.30839 RI-12259 MA- ad. O _ S" 119535 CT-562725 UNITS ttdswol ' GRUES Oblsraslor � f? ; r�..Room y.� � A11 �•�, i1a,Description r �� E �• C N M •OQRIUI R T Fl, T 60 SubWal o w o YL•All u(rhv ohwe rtrs rnJ dr ur be wi.lal hxs P^ wml i PB"MM Method ppnr..wr.id..dd vdl rcrtrr.nU r,.lid fir. .red is dr x ruro M rhJ n.l . a+ s PNce SA TOLI(cs rrtwwm.wand n hfann , .th.* 3/3 �aalpr� � p�.¢.6CeIP rQ2T�� Sub Totd w►»»i t)rrc ndewn SJ&.tepwmurw ure Mla.craft or lspentet Customer tsneel Yrw.re lnrbT uahnei.ed ur furnbh.a oimbw..rwl rL..n rcytiral ro C.+nplcrc rhl. A/w gt "Ox s.r whKh r •txxkr.owd%;,M u.p.T the ururmt.sated in rhn.grerment.nd ma.nllryt to do nrma herent Total fkli11 k* See Reverse Sick for 7btrtu and Co"doru of Sala Xtw,the buyer,may wttcel this transacggn ar atry dare riot to midnight o�the third bvun4pa day Whet ,sp„ dwAs t .* the dare of this tranaactio �ienae see attach notice of eartce lots for an Nto� [ explanaign o;this right Taal Mhodhnnw Credits or Expenses �drdu MI"aplhl Aervpeal ,�7r�+j��- ti (w ova tut.l m arise.endlr I eWnw column u do)) A�ow mwf su o' �� ,• DAMr;usnxrxr Appnw.l sip taw *dd arch NotesTotalAMu6tcIAgre -M e I"Dwr rrrMw Aaeep,.:.l t>eposlt Re0uksd 9d�ry Nlsdow wArrgqpp�mIiryyqq rAere R nsv.l by A Wcr.xo At.r alsr 5fqururc J �pOM.O ivl �01moodbrAAulme rew"YddrrmrYppomw Mew as to wo we mekwa�wxwpYMq aaw'm DIN an Committ)on ��olnM lydtdtd #daVnJ*ur7orr~ rdYbA min toMda■bsailrtse. o11rMY old• ..w di.eh.ye1 Y rol.dsmr+new w4lYc.dn.Anr a+n1daP VAVM•RerMwal ter AtrdweM NAbrr-hrflitrllolr Pkd:•NfxseawM rLce 4Mwl+Ltbor.unrcahu.hnraWtun,Pf "raval.and depasoldi,"wcrs reOa� re= w �� .rswMg Corfelr custom tr... 411Ni: ^D fic hrMyy; tstlslL, n,al�G TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map �o� Parcel Oal " ESS_ Permit# 39 I (P q Health Division Date Issued Conservation Division Fee Tax Collector ` S 1 --- 4�­ . j Treasurer o Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address /VU LOT—, 0 k u.) ' Village 1� i Owner ulz Lp)S Address Telephone Permit Request A Square feet: 1 st floor: existing proposed 2nd floor:existing proposed Total new Estimated Project Cost 11 r Zoning District Flood Plain Groundwater Overlay Construction Type i Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family O Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No 'On Old King's Highway: O Yes ❑No Basement Type: ❑Full 0 Crawl ❑Walkout 0 Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air: O Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No _ Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:O existing ❑new size Attached garage:0 existing O new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial 0 Yes Cl No If yes, site plan review# Current Use Proposed Use UILDER INFORMATION I " Na Telephone Number Address y"d93A License# Home Improvement Contractor# Worker's Compensation# vl Q' ALL CONSTRUC ION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO i SIGNATUR DATE _ FOR OFFICIAL USE ONLY _ • r PERMIT NO. DATE ISSUED ' MAP/PARCEL NO. t ADDRESS VILLAGE ' OWNER ' DATE OF INSPECTION FOUNDATION J FRAME , INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH ' FINAL - GAS: ROUGH FINAL FINAL BUILDING ' DATE CLOSED OUT ASSOCIATION PLAN NO. 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Cressen Fax: 508-190-6230 - Building*Commission.: Permit no. ' Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building.be done by registered cons w=ms,with certain exceptions,along with other requirements. Type of Wo Estimated Cost Address of Work: Owner's Name: Date of Application: `e I hereby certify that: Registration is not required for the following reason(s): Work excluded by law C]Job Under$1,000 Building not owner-occupied Downer pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME MOROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I he by apply for a permit as the ag t of the Date Con Name Registration No. OR Date Owner's-Naune q:forms:Affidav —< L lie L,U//1//lunweUlfll Uj LV�UJ'J'UC/111J'L'IIJ' .. " .-^ — IDepartment of Industrial Accidents -_ Office o11HY05lMVITOMs ". , 600 Washington Street --.. Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit name: s V/ location: �LQ - city Phone# ❑ I am a homeowner performing all work myself. ❑ I am a sole p rietor and have no one working in anv capacity %%%/ %%%% ////%%%% l%// am an 1. emplo er providing workers' compensation for my employees working on this job. om n m .. 8dt ess ::.. :. :;; ....;..::. .:: ................. M., :........... .. ho 0.-..'�.'�!!!���::i:::i�:�:�:������!iii�ii""�:��i�ii--!�i �iii:.i:.i.:�i�i���:�iii��i:�i�::�-::i:l�ii. , I ..........���;�]�i������]��;�����;�����������]i���i�:;����;i�i�����������ne:#;:::;;; :.;:.;:.::.;:.;:.;.;:.;:..::.;s:::;.::::;::.;.>. ..:.:....:.:.::::::::.::.::.:::::...:. -: Moiicv: ;;..,.::::;:4. .;:.;:.;.;;::;.. ... . :::::; .. ..::::::...:::.: ..::.:::...:.:::..... . /lip, ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: ;..:.. . como nv ddr"CJS ? .": :`::. 1.1."12'%1'''1 '1"`± `' 11 " '1 ��' `if" ' ' ' .:: <, :.'. .:.".::: > `'::'.Y 2 ' `1 ±'':.'' `... ::i.. ..................................- ............................. ..............::.:::::::::::..:�::.::.::::::.�::::::.�::.:.:�:.:::>:�o:::::>:>:::>:> ::::::»:<•::>:>•.;.. :......�.... ::::::::::;.y:::�::::>::.:..............: ........................::.:::•::.... :::::::.:::::.:::::::::::.;::.....................................................................:...........:::::::•:•:•::::.:.::.....:.:::::.�::::::::::::::.:�::::..::::::::::::.:........;..�: ......................................................................... ..................................:::::::::::.:.:....::::.:.......:::::.::::.::::::::::::::::.:..::::::::::::::::::::.......................:..........�:.�;a:::`x::�::.:r.::i> ;.::i;:,.:... Ci uhone.#....... ::::. :::. ;,:> ............................:..:::......._......::::::.;.::::.;::.:::...::::.:..;............•::.;;; s�:;::: :>;:.::.;:.;:.:::...::..... ..:.....;;:.:;.;:.;:.;:.::.;:.;:.;:.:•;;:•:.:.;:.;:.:.;:;:.;:.;;:.;:.;:::.;:.:.:;......;;:.:- >::::;:::.:;.;:.:; .......................: 4::..:....�iiii--- ,.. ..........:::.....:,.:..:.:.:.:::.; ;;::;;:;..;: :.:.:---X.:.;::.;:.;:..>:.:;.;::.;:.;.:.;:.;•:::::;::.:.:::.::::.:.:::::::::..::::::;:::..:::..::;:...... ...................:..:.:..::::............:.:..:. .110///////, C;:)::p:>8(tV'1181i1 :::.'�< - .:; ':'::[5.< .. :; :-':.� ;':: .: :; ; : ::::: ::'+::<2 . ::' :::::: . `. :`: :;:'`:::' :``% `' ;:'':: ,>. ' > ''::>:X: --, arnn ........... :.. :...................::.:::::.:.........::....... sdiiresss ........ ................................. >s�wc:-- •::::.::::::.::.::::::::::::::::::..—.:::.::::.:..:::::::::...:::::•:::::::.;.::.::......::r.,........................ ::.:::.. nrsnce:co...,.. ...,.:..:::,:::.:.•::::::..::..::........:;•:.::<:::::::::::::::.:.:.::::::::::::::::::%::::::::::::::::::::::::.::::9. ::::::.::::::::.::,:•::. .:%...>:::::::::.:::::::::::::>::'...::::::.::::::................ % 1111A Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or one yeah'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understzmd that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification I do hereby certify the p penalties of perjury that the information provided above is tru:an cone SignatureE . )L, Date 44n , Print name -AZ3 1 Phone# 1 official rue only do not write in this area to be completed by city or town oMcial city or town: permit/license# . ❑Building Department ❑check if Immediate response is required ❑Licensing Board ❑Selectmen s Ofice contact person• phone#; _ O❑HOther ealth Department f Urnud 9195 PJA) 1 1�,' •S �rt t !%�� KI � .<�!•?i'"',.`,,.,y.,1,r,:!'' IF ,•!{1."�•ti; .,:r•,rr:°f::le1.J{i ,.1' ,� .(,��'i'G<:.'r'.•;i`':''. ti1[•7:F i�'., /' "l�Ge> ., •.,.+:y�.:,C. 7 � f'•� ''h:" !�:i.,.r �•'r; k O. Tx' %•- .ail,. .,tie-:.. 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( PAU a J•:� CAIEAULT,.�'SONS;ROOF OV",02653 I;re e�', :Oril:",5',i •.�:: .1 rt'f L•. :'ti .+- .3 vl 4 Y •�...� t,,:'�.`- {"..,y N=7d .di` 'r'.!•),ryw� ?l l.'...'caa i_,+J '.r•y1fm,� ':1.:, ... .'PaV 4� .i.p`••':f^\''Id;:,.-i.b.'•u�`I�c•� •;i7.' .�'+ a• .V: !C;.1• r.3,•(• 'r.,,;n3- A t- �. ,f.;.,xrl`,�r ;! �•':4�):• , �.:.f...r:T� . r :J-.•.fit.":,° .,;L St> .0�:, t ...::"'::�I�•� yt, ',T .. 'l�:i- ''�4+' :tr<-:•s•�t:,�,:= at,,�,�r�.�r, ,:n,a!� , ,r•-:�:::,I:G��:;a.r�K� iddialt"Rdv/,�tP O::Boz27,8 ;i y9 +•. v , G d.W,:r..:.,,...x -,gy�d•l.^ I ADMINISjRAATOfi, Orleans MA 026 , n: 'f1h I'i`11.P1 f 01:- 1)11R1. 1. 'I:f: I - (ip.11• r'•r5;llllllfl'I-UP•I I'I rt(:I., Iti+i ,1:;691 110 l'UN MI) 0. 1.08 CUI`'I';II?llf:"I-.it)N : Ill`F:-{�V.I::iOI? I_.f.Ck1`d!3t. - Ntu ilwr :: 1. Ilr?''i:f'1.+'I:r?LI l r,; ;�� I _ _r.•.._ 1,.1";.. .._... t y a I.1:3 FI I I I.I.1: , 111A 6):Ii!i!i Kr�r>I) i..t)I) for I t,r. r.i.(.71: Itrl iat,�itf.tr flol-J.'l i.c:,:tl.iutI r:, ;. ✓/re _,11.1 oweal!/r o�°vt�irav ((dellJ�I • F + DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE i Nuetben: 'l. Expires: I > Restricted ITo: • 00 ! :' •'Fi�lll J` CAZEAUL-T 1585 MAIN ST OSTERVILIE, MA 02655 r 03/14/2012 16:17 5087785731 CAPE COD INSULATION PAGE 01 HEAT" - Y'IP"Fl11 y,IRl I'wA Nf•!'OhM - 200 Installed Insulation Statement Location of Insulation Thickness Total R-value Approxlmat®Sq.Ft. Walls _x 7.0= i Attic-Floor or Roof Deck(Urtleonu) x 7.0= Cathedral Ceiling x 7.0= x 7.0= © x 1.0= R-value= 7.0 per inch Tensile Strength= 45.4 psi rho/O� vo,; Density= 2.1 Ib/ft 3 Compressive Strength= 20.6 psi DEMILEC Batch# O( oS' Cempn V Name p 'y,PhhOr*Numv+r 3 D ib4ZLI appotmar Name Applicator 51pn?lu p 1,44, hlo-oet--) d ` v ` U� a01a00P-102� r