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0150 BERKSHIRE TRAIL
a �Rtcyclf0�0 ZJ �z UPC 12543 No.5�3LOR `brr.corss°� HASTING , MN °acidCloici�faii@{■'v � '�'- �........-._... ....... _. ... ...—_ .,, - _ r a - _._.. W - ' -+�`n.:.:.lnY�vdAle9il.;w,tr..vW,:.4ai�.;L.ar;:n'L:s4:w,*.'2tir`Irrrl�Y,a�t"' .••,•spa,.�y,ia:-. ..:. -.r�.+aiim'L'.�.:.u`1:/ -5•_`�'�^e.:.t�'tJ::!,'.uv.:C:l.iti.w'�a.�..."._..e2v5:sa::e. r..:Wn. rea:.`.t.:::,e�..rL;.riCN�i�'V�"r�1� i �.�-���.,., d..:..,.� - _.. - ._ ,,..-m,.�:a'rr:..cs�.rdtr•.n:t.�;�.emic'-�.e,�;...:.'elumlP�e�3a.^aas�:•..�:.®.�.�eU.:'a. — �-tue�alCy.F11Ye�Y/ Town of Barnstable Permit# Expires 6 months from issue date Q, Regulatory Services Fee 13w214srnaM MAC' Richard V.Scali,Interim Director �� i6;q. A�� J Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 �ri i� 19 www.town.bamstable.ma.us Office: 508-862-4038 c A ��,",%�9ldl;�Fw�: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONI1`MALE �� D O Not Valid without Red X-Press Imprint Map/parcel Number ��/ o B Property'Address /SAD r Ks ki. Pe �ra I Q Residential Value of Work$ .17. 10 Z Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address A u tt '1`,C64 +4 Gt yC10✓- w /SO 3e,,K,5h i r-C. Trc„ I- (,J c M nz 6 BkgA.) Contractor's Name rVWIMWSZlS9/1j / Telephone Number<101-1Zr-f'SW Home Improvement Contractor License#(if applicable) 7�Z'j/J Email: Construction Supervisor's License#(if applicable) O S70 7 j A orkrnan's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner .I have Worker's Compensation Insurance Insurance Company Name� Vr&90A)Ata- Workman's Comp.Policy# 9 2 g'ZS ,33 QJ 9 y 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) ❑ e-side [vjReplacement Windows/doors/sliders.U-Value 3 V (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. 'Wheie required: Issuance ofthis permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. *`'Note: Property Owner must sigh 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 061313 r } re v Agreement Document and Payment Terms / ndersen _ A";Bcii.6wjl oy Am-ilmw¢!toF86-AIlhcrn NOW 6-4in1 Pad And Richard Hayc[on (Nil Name:%utN(n New E>'s nd Wr*vk+rs ILC 150 Beikshim M R11 N36074F MA N113145�CT WHOM Lead Run— �V1237 �S�sCGarnskaf�� hjat�2ti63 �;�wa c�ai�lep. 26?lb4n Pd I tincofo'0107805 tyC�dJ 62�n03� ��Ry.F;�6-2� a1��71.�c�:�`d�'1 ����6[F`G'I:.11f441f�nf•�11`JI3�l�.[RnI+ fln1 _ L.ifLSa itxt{�) rrla ci Paul Haydo:n and Richard Hoydon �:,i5iii.zi.�i. rasa_ 05102/ 16 _ t:.fil9monerti) Srteee Aldlda-c-sda 150 RarksNo Tull, W.ost earinstaWel'MA.01669 Iiiliiiae}i'C Iel;Fisile iitir,l er � 0$�362 0037 � Ie,3a�°L�It�9f4i�t��Fl�ciul�er jry E•'Ii:f�l_puts y��4Val1,d���4��1 Oil}�+r(sy lie.t*=riliitly ind scoef3tlty apccs w pwdju the pod►vs widlkw krvicca i+�yailt9'lierri! 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(�;i'1tigiciit chid, 1',aym d154 T4rfi'ix, NoI:iw i)r c uDme-o16awii It41ihkod 00nivr=R0"'ujzt",ctivi. tiiiiol)�fidlligeilm.g Li� le,.$nlcq C`�?*'$tittigfp p rsi_ut5 WiSM fl�I-4ry l—mm Gc11` MA I IYI port0itr Vf"OjIta I&L16�rdllE8t,imb,Si4i 0.fceIns y Di Expctt Vd.1r j 11d�15Y 5th�'d-ci xt.umk-i ri rf igcIied to dds A��rwroemt Doc- unit,the.krtm i�F whLeli are till igpee-d to 6y Ow Ql.i_ttio mbill Nwotporilud 15emisit by ack-twieu l$iim tXj ter tiftiii ;). ii ilfPrt9l lii:si 1k'age csi vali t if C3i]tjilel Inti et#1@i tii itrtet ixiiti:i i#id LU'61drij�ileted,511 wfk eiffitku diils Atstin-t itt. `I`'uial fob Alalp unt: $1'7',JO1 6y II]l �4Qi.l :ijyF4sif74'EiQ,�tijii if>ltigmVa{Ul ;t'alit dI_"I �:ilif V0i:-:iAA;ty Allnfipf ll' I�Iai ql�i 4dl ftiivast Ise fii:tila I ' rsi?Irl i 1 Tree.,bulk i:l l lc,c fVla.k,icdV,d71'gash= Li�j:n�ia: iiti•ci9: 51�,��1' Ilal:fine Dam �����1'. Eitlrluccd 5taeri &f:lii UTIJ C-mat1jj14ctlatfi: 1�iliif5ufi19.tHlfi:uii cd: 10.12 weeks, 10412 r eek.;s Si .902 M[ihud urvi.yfii.efit: PGnartdog '►gt 3�1i oil�5le'irim i'Ilttjwls I rased inn tlic date of the slipwd kCil anct Agid on,d'Arily klf t the dale In whi€Is,we 00iii j leic th te-d ilall lift ifurc i ul IN '111w IEiiiiallacmin tLm 91f 31' N'- N: 50% �dep 50 `�a bal paid by wc4cv pP vid-Ql1g lid rlias trlile"!�wily wite�ilint+es.�Jv will�i�iliil�`iim3f tic all ajI1i�iPJ is+rt Grct eislCy alul tI fi qc ii lhccr data. 1Um.slid-exlA1nic-wallies itee elte 'Clum for TA>Kcr��paG� I�n��arn��tibia� i1eLi.ys ILrm"'.-01 41grocs widl•w1dontlim—b- dial.dhlis Awmavit oomptuccs-the CI<0m.updurmut wAirAgA kii'weem ch1,putid`4 afudl flue diet-,my m)wrbal iJ19aI4Priifiid�lal �li�llijyllf fSP liiUdlEyl�i; 9fli ijf I':Iid i Ptit�.fYl'Blip �Pddliif:ti9 I�Ii1:9I1�5rllti➢fi5 to dIowhiams houl,tl`f3� f uriwi telic%4I.I tv Vnik1' w13th roues tlior saptEvlf'ewPrtP0ii 0-yisieE t(if both the Ct;+litd lt:iii-Mod i$Iiuyt I mporfq) 10 IWis kind) tj' J1pc ucritp tutdoiseirlds the cctfuis(iftMs Awmatnt.amd hug i j%,�NJ a comp[tied,. 11 ed, 7m I dm[cp� ci(601 .Awwri.ciit;huliidlrkg tlia tiwr.aitncft Not1w of cancelittlan.fiii dw dials ff;tw+;rh hire alsi a Aiiil )te'ix oli"Aly Itiftw aled of Man-,x otolt,ldt eatied OWN NOTIC19'1'O 0WN LA: LN)Halt';—t ch4" Ditima dl hInvi L You nue$1 idcdl toot tiutj of ific colicrivt 114:che°1:6140 mt 51jP�li. OUP TT EV R-,:MAY CANCEL THIS`r-MAN ACTION MT ANY- `-11ME�Y(`.E LAT I IR THAN MIDN'101-1T OF 051'0 12016 ORTHE`11[RO NSINESS DAY)WYER TF[F.:1 ATE,OF THIS Rr1NSAC'TIONN C ry{[tp11, �H�:rE'�1r�1�h� m�.A/�� IS LATER.SEE' U.L!4.e�'.1'g1;�vcmF'D':1,V4�°'rtcC O C.ANC:I�i�l�:j ON FORM FOR.AN _AC_ fEL�iiGt Sil45tP�dPii�lr±a Flow-itd4l"ur rlary:.. :0 iiCi;it2(9) 41ba:LRewtv.4114 ll•wtighod: .�Ilfliai4lge°%iI'�ilr:`�9 l�`PSl�li •.�51(�lisiel� �I�fliatelf`e 1C;an Ianneill caul Flaydfan Richard Hagdon (hint Mum of&ilG$ l'�:P om Min Mfaf a Ift1i15.Na-lie {15tQaP1� :PLi€It' � 1 1V Southern New England windows d.b.a Renewal by Andersen of SE I Massachusetts -Department of P!ab6ic Saieiy �!! Boa-,of Building Reguial;ons and Standards ` Const-uCtion Super+-isor 1 !;ce;fse: _y r. I 1$IBI,0 D DEPdPl)I�2N - - 7 IAMBS POND Charlton B�dA ®fl5�7 , r iti' rtt Expiration 09108=16 l 1 GO?iLceLfSSiDP.eT 4ac i woe r fn ce umer A ti5c1e ' o of Consffairso d Business Regulation 10 Park Plaza-Suite 5 170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Regtmabon: 173245 Type: Supple"Mrt Card Emiration: g/19l2016 SOUTHERN NEW ENGLAND WRgDOWS L! -.-- DENNISON BRIAN 26 ALBION RD LINCOLN,RI 02865 'Update Addrw and rewru card.Marl:rssaoo for ebnnge r i Address Renewal 17 E000a e"t r Lost Card SCA:a 2VM4W1 . � ema valid for iadividul me only 1Tirx ;;;:LENT Aft.!- beforeor the espuntion date.lrfound return to: rp E;;;:LENT CONTRACTOR OfEim of:.omamv:.ITain gad Bosiarss Regnlatioa egh;=Uon: 173245 Type 10 pari pLa=-Suite 5170 Expiration• 9J19=16 SumlemeTt-Ord Boston,MA 02t16 SOUTHERN NEW ENGLAND W1NXWS LLC- RENEWAL BY AND.RSON DENNISON BRIAN \ - - e UN OLN C2865 t}adasecretarr tiot valid without st rum . 77ie Commonwealth of lViassachu'etts Department of Industrial Accidents office of Investigations 1 Congress streeg, Suite��® Boston, MA02114-2017 •: � a u w.mass.gov1dia Workers' Compensation Insurance davit: Bualders/Contractors/Electriclans/Plumbers A pUcant Infoirmati )n Please Print LecF„,_.� SOUTHERN NEW ENGLAND WINDOWS Name (BusinessrorganiZation/lrtctividoat): Address:26 Albion Rd City/St ate/Zip: Lincoln, RI 02865 Phone #:401-228-9800 Are you an employer`? Check the appropriate bog: Type of project(required): �: : 20+ 4. ❑ I am a general contractor and I 6 ❑New construction 1.© I arrt a employer with employees (full and/or part-time}- have hired the sub-contractor Remodeling I2.❑ I am a sole proprietor or partner- listed on the attached sheet. ❑ These sub-contractors have g• ❑ Demolition ship and have no employees employees and have workers' 9. Building addition comp. insurance.+ working for me in any capacity. ❑ [No workers' comp. insurance and its 10.❑Electrical repairs or additions required.] 5. ❑ We are a corporation officers have exercised their I I.[] plumbing repairs or additions 3-❑ I am a homeowner doing all work right of exemption per MGL 12.❑ Roof rernairc myself. [No workers' comp. c. 152, §1(4).and we have no 13.M Other 01` insurance required.] employees. [No workers' comp. insurance required.] re go le,c ein S '*Any applicant that checks box n1 must also Fill out the section below showing their workers compensation policy information. r Homeowners who submit this affidavit indicating e they are doing all work and then hire outside contractors must submit a new affidavit intiti s es h h such_ ?Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entitiave employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. ensation insurance for my employees. Below is the policy and job site lam an employer that is providing workers'comp information. Insurance Company Name: ARGONAUT INS. CO. Policy# or Self-ins. Lic.#: WC 928058352394 Expiration Date:8/21/2016 n h` -(-ram�, ( City/State/Zip: �• �(e' /'� Job Site Address: 5 f7 <<s ' r� Attach a copy of the workers' compensation policy declaration page(showing the policy number and egpi GL c. 152 can lead to the imposition of criminal nalties of a Failure to secure coverage as required under Section s NA.. civil penalties in the foam of a STOP WORK ORDER and a fine fine up to$1,500.00 and/or one-year imprisonment, P of up to $250.00 a day against the violator. Be advised that a-copy of this statement may forwarded to the Office of Investigations of the DIA fbi insurance coverage verification. I do hereby certify under th gins and penalties of perjury that the information provided above is true and correct. ' Date: Signature. Phone it. 4012289800 FF6.Other l use only. Do not write in this area,to be completed by city or town official. or Town- Permit/License# g Authority(circle one): rd of Health 2.luilding Iiepartnnent 3.Cityf'Town Clerk 4.Electrncal inspector 5.plumbing Inspect©r Phone#: I SOUTNEW-01 SHETTYSHT DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 8/19/2015 IS THI�TIFICATE IS ISSUED AS A MAJOR IdEGATIVELYTAMEND ION ONLY EXTEND OR ALTER THE COVERAGE AFFORDED BY THHOLDER. POLICIES CERTIFICATE DOES NOT AFFIRMATIVELY IZED BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER{S),AUTHOR REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. SUBli IMPORTANT: If conditions on itioncertificate of the policy,certain polices mayNAL require INSURED,endorse the m endorsement A statement on thises)must be endorsed. certificate Adoes o WAIVED,confer rights to the the terms and c certificate holder in lieu of such endorsement(s). CONTACT Willis Certificate Center PRODUCER NAME (888)467-2378 PHONE 877 9$5-7378 �.No: Willis of New Jersey,Inc. Al c No E,:t ) c/o 26 Centurryy Blvd E-MAIL certifcates@�nllis.com P.O.Box 305191 ADDREss: NaC Nashville,TN 37230-5191 INSURER(S)AFFORDING COVERAGE INsuRERA:Selective Insurance Company of Southeast 29926 INSURED INSURER B:OneBeacon Insurance Company 19801 Southern New England Windows LLC INSURER c:Argonaut Insurance Company DIBIA Renewal by Andersen INSURER D: 26 Albion Road INSURER E t�. Lincoln,RI 02865 INSURER F REVISION NUMBER: COVERAGES CERTIFICATE NUMBER: ED To ED OV R THE CY 1-05-11 ISS IN DICATED.GATED. NOTTHIS IS TO IFY TH I THE POLICIES OF INSURANCE ANY REQUIREMENT TERM LISTED CO BELOW HAVE AtiTBEEN C0 I INTRACT OREOTHE DOCUMEI T BWITH RESPECT TOLIWHICHRTHIS CERTIFICATEAND CONDISSUED OR ITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEI�EN RE UCED BY PAID CLAIMS.BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS POLICY EFF PDUCY EXP LIMITS ILA TYPE OF INSURANCE NSD WVD POLICY NUMBER MY81DD MIDDIYYYY 1,000,000 EACH OCCURRENCE I5 A X COMMERCIAL GENERAL LIABILITY o 081,012015 08/1012016 PREMISES Ea oxurtence 5 100,000 ®OCCUR S 202945 10,000 CLAIMS-MADE MED EXP(Any one person) Is 1,000,000 PERSONAL-8 ADV INJURY 5 3,000,000 GENERAL AGGREGATE Is GEN•L AGGREGATE LIMIT APPLIES PER: 3,ODO,000I PRODUCTS-COMP/OPAGG S POLICY®JEC LOC I 5 OTHER: I EziaccideDtSINGLELIMIT I5 1,000,000, AUTOMOBILE LIABILITY S 2029459 06/10/2015 08/1012016 BODILY INJURY(PP'person) 15 A X ANY AUTO i BODILY INJURY(Par accident)I S ALL OWNED SCHEDULED AUTOS AUTOS PROPERTY DAMAGE 15 NON-OWNED I Per accident) HIRED AUTOS AUTOS i I S Ml 5,000,000 EACH OCCURRENCE 5 X UMBRELLA LIAB X OCCUR 5,000,000 S 2029459 08I10l20i5 08/10/2016 AGGREGATE �5 A EXCESS LIAB CLAIMS-MADE ;S DED RETENTIONS ER I STATUTE ER WORKERS COMPENSATION 1,000,00 AND EMPLOYERS LIABILITY 0000068028 0812112015 0812112016 EL EACH ACCIDENT 15 B ANY PROPRIETORIPARTNER/EXECUfIVE Y�' NIA 1,000,000 OMCER/rdEMBEREXCLUDED? u DISEASE 15 (Mandatory In NH) 1,000,000 If yes,OeSClsbe under' E1.DISEASE-POLICY ularr I S DESCRIPTION OF OPERATIONS below C928058352394 08121/2015 0812112016 See Attached C Workers Compensation DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101.Additional Remarks Scheduie,nay be attached if more space Is required) i CANCELLATION CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, p((?IICE WILL 6E DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED it A4 Evidence of insurance ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01} The ACORD name and loge are registered marks of ACORD TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map olk Parcel o z�;' / ob$ Application Health Division Date Issued c�-3 Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address % ts o ��t Zit 5N . o.• �. Village _��. Owner Address ;;�- o �o Telephone -soA - \--X �a N.J. ', w-�Pt nZU o I Permit Request e.w Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District � � Flood Plain Groundwater Overlay Project Valuation's\\ ec� .�c" Construction Type ==� Lot Size Grandfathered: ❑Yes ❑ No If yes, attach ?pporting-doc f-entation. '97 11 Dwelling Type: Single Family CH' Two Family ❑ Multi-Family (# units) Age of Existing Structure �gc.L Historic House: ❑Yes ❑ No On Old Ki7ng'UFHighwayy ❑Tes ❑ No V) Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other ry Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) "' .Number of Baths: Full: existing z, new Half: existing new Number of Bedrooms: 3 existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: 0"'G as ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size—Pool: ❑ existing ❑ new size — Barn: ❑ existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size — Other: Zoning Board of Appeals Authorization ■ Appeal # Recorded ■ I Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION -_ (BUILDER OR HOMEOWNER) Name c:_ h,4 -c_c.. Telephone Number sow- Address es "Zoe. -3 o License# o z ap �1�. e.�., r�`z� �'� Home Improvement Contractor# \ % 2 s Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 4 l FOR OFFICIAL USE ONLY APPLICATION# DATEISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER • DATE OF INSPECTION: „s:F,OUNDATLONv�.•:��:;.tis���.�cr;c,.cr�t�:�•r�; , FRAME ;INSULATI.ON-: �., FIREPLACE ELECTRICAL:,•• ROUGH FINAL., PLUMBING: ROUGH FINAL% GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION.PLAN NO. Ii, The Commonwealth oJ'Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 UT ►v►viv.niass.govIdia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Letribly Name (Business/Organization/individual): ConserVision Energy Address: 376 Route 130 Suite C City/State/Zip: Sandwich, MA 02563 Phone #: 508-833-8384 Are you an employer? Check the appropriate box: Type of project(required): 1.[3 I am a employer with 8 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- Iisted on the attached sheet. ❑ Remodeling ship and have no employees 'these sub-contractors have 8. ❑ 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 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work. right of exemption per MGL 11.[] Pltunbing repairs or additions myself. [No workers' comp. c. 152. §1(4),and we have no 12.❑Roof repairs insurance required.] ' employees. [No workers' 13.® Other Weatherization 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 indicaling they are doing all work and then hire outside contractors must submit.a new all-davit indicating such, tContractors that check this box mast attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. !am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: CS&S/WORKCOMPONE Policy#or Sell=ins. Lic.#: 6011316349 Expiration Date: 03/11/2015 Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a tine up to S1.500.00 and/or one-year imprisonment,as well as civil penalties in the fonn of a STOP WORK ORDER and a fine ol'up to S250.00 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. /do hereb #j t 2der th p 'its nd penalties of perjury that the information provided above is trite and correct. 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 f A�-oRO® C-E.RTI.FICATE OF LIABILITY INSURANCE DAT3117120`1 YYI 0311712014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS,UP'ON THE CERTIFICATE HOLDER.TENS 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 pol(cy(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 Ileu of such endorsement(s). CONTACT PRODUCER NAME CS&SM.01 )(COMPONE P"ONE_ fA7t PO BOX 946580 (A/C.No,En). tart"eic MAITLAND,FL 32794-6580 ADDRESS- Phone ADDRESS: Phone-877-724-2669 Fax-877-763-5122 INSURER(S)AFFORDING COVERAGE Nac r INSURER A:Continental Casualty Company 20443 INSURED INSURER 6: CONSERVISION ENERGY INSURER G- 376 ROUTE 130 Continental Casualty Company 20443 SUITE C INSURERO: SANDWICH,MA 02563 INSURER E:Continental Casualty Company 20443 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 C064TRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLtC.1ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. C NSAILTR TYPE OF INSURANCE tNSR WVD POLICY NUMSER MMIOD NN/DOM't' OMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $300,000 PREMISES(Ea occurrence)CLAIMS-MADE ®OCCUR MED EXP(An one person) $1 O,000 A Y N 6011316335 03111/2014 03/1112015 PERSONAL 8 ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN1 AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMPiOP AGG $2,000,000 PRO POLICY JECT LOC COMBINED SINGLE LIMIT $1,000,000 AUTOMOBILE LIABILITY (Ea acwent BODILY INJURY(Pot peson I ANY AUTO ALL OVMEO SCHEDULED BODILY INJURY(Poi aCdd*M) A AUTOS AUTOS N N 6011316335 03111/2014 0311112015 MIRED AUTOS NUh+UWN[0 PROPERTY OAMAGE AUTOS (Pet awdent) D IUMBRELLA LIAR OCCUR EACH OCCURRENCE 1,000,000 EXCESS LIAR HCLAIMS-MADE N N 6011316352 0311112014 03/11/2015 AGGREGATE 1,000, OEO RETEN-TION S 10,000 WC ST ATU• OTH- WORKERS COMPENSATION TDRV LIMITS ER AND EMPLOYERS'LIABILITY $1 00'000 ANY PROPRIETORIPARTNERIEXECUTIVE YIN E.L.EACH ACCIDENT _ E OFFICERIMEMBER EXCLUDED? N N 6011316349 03/11/2014 03/1112015 $100,000 (Mandatory In NH) E L.DISEASE-EA EMPLOYEE It yes.descobu uWat $500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLF•S(Attach ACORD 101,Adddwocul Rarna6A Schedule.d mire spaw M rwx4rw) Certificate Holder Is added as an additional insured as provided in the blanket additional insured endorsement. CERTIFICATE HOLDER CANCELLATION Ise Engineering SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1341 Elmwood Ave THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Cranston,RI 02910 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD caa865 t Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supen icor Speciolt` License: CSSL-102778 .�' CONOR D MCINEi2NgY 39 SIASCONSETDRWE? , SAGAMORE BEACiiThA1 ,02562 �,�..—�d�6[�c• r,�„ Expiration Commissioner 08119/2016 .Office of Consumer Affairs&Business Regulation License or registration valid for individut use only ME IMPROVEMENT CONTRACTOR before the expiration date. if found return to: �Registration: 171251 Type: Office of Consumer Affairs and Business Regulation Expiration: 3/1/2016 Partnership 10 Park Plaza-Suite 5170 Boston,MA 02116 CON-SERVE ENERGY CONOR MCINERNEY 376 ROUTE 130 SUITE C SANDWICH,MA 02563 Undersecretary Not valid without signature s' on ............ OWNER AUTHORIZATION FORM owner of property located at t�o ul' hereby authorize ConserVision Energy,to act on my behalf to obtain a bulld0ng perrnit to Oefform work on my pmpetty. Owner signature,— ®ate l� /d r. ,4 oF�t Town of Barnstable *Permit# v I 6 7 G Expires 6 nths from is a date PERMIT Regulatory Services Fee sexnts ABl e, 9�. 24 2014 Richard V.Scali, Director 1639. OF prFO�� T BARNSTABLE 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 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Map/parcel Number �� Not Valid without Red X-Press Imprint [' �l.�V � Property Address �✓O /JC�iClt S/ /�(3 Tj�/ /� l�/�S'j� d/3'pJ�/�L(r , /�//� Residential. Value of Work$_ 3,Q00, 00 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address l SO ac-RI(S;01126; Ti(2 c CcJ• ►2NS A0 ,L= Contractor's Name NUC 14k{ lew Telephone Number 5049- -79 Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name 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 StT &7ydo• ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *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:IWPFILESTORM wilding permit fo s\EXPRESS.doc Revised 061313 Town of Barnstable Regulatory Services Richard V.Scali, Director Building Division RAJRNs T7 Tom Perry,Building Commissioner Muss 1659. 200 Main Street, Hyannis,MA 02601 '°rEc Mom" www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-623 0 HOMEOWNER LICENSE EXEMPTION Please Print DATE: y "� _ JOB LOCATION: I S I.J d 6luLs'1m2G f R4f(- 02ft3Lc number street village "HOMEOWNER": P,4o I- dkgoo sob- 30- go37 - 508- 'Id 8 -la87 name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requiem gnaatuure of liom er Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems, particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require, as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. s • • BARN6PABI.E, • ,e$ Town of Barnstable A Regulatory Services Richard Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,'MA 02601 www.town.barnstable.ma.us Office: 5082862-4038 Fax: 508-790-6230 J. Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building perruit application for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit,please complete theHomeowners License Exemption Form on the reverse side. QAWPHLEMFOR Wbuildmg permit fomis\smokecarbondeteotors.doc Revised 050412 The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ApOlicant Information Please Print Legibly Name (Business/Organization/Individual): L .V Address: /J�� � i�fi�/�C /W/L City/State/Zip: eV-/�E (,gZW Phone #: 5OL9 79 Are you an employer?Check the appropriate fiox: Type of project(required): 1.❑ I am a employer with 4. 0 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. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' incrrrance$ 9. ❑Building addition comp.[No workers' comp. insurance P• required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3./y 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 employees. [No workers' 13.❑Other comp:insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this afdavit 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 thepolicy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under 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 ce i e the pains and penalties of perjury that the information provided above is true and correct Si afore: Date: �� L Phone#: �018 4 Official use only. Do not write in this area,to be completed by city or town official ... ..._ ._........... ..... ....__.. ...... _.._.._......__......._ ......_.... ........ City or Town: _......._.._..__..._----..._...._....__......................_.... __._...Permit%I.i cense#....... I 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#: Information and Instructions } Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials I Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the . applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. . The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel, # 617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 4-24-07 www,mass.gov/dia NjU"[e . Assessor's office(1st Floor): Q INSTALLED IN Co Assessor's map and lot number O/ �D/S ODS. "'t, W" �� VIR o� Board of Health(3rd floor): y EN �ME�� Sewage Permit number I C% TOWN EG U� 9T&BLL Engineering Department(3rd floor): � rua House number /�� i °° t639• Definitive Plan Approved by Planning Board — 19-- APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only F ' TOWN - OF , BARNS A L BUILDING INSPECTOR APPLICATION FOR PERMIT TO ,�U/LD O► STU/�I� �G�GC�L��(/ TYPE OF CONSTRUCTION TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following.information: Location for t 9 1,wA %1/,et:' 7,,E'xw 1, Proposed Use S//y/�z Zoning District Fire District GZ/ AW&SZWL� Name of Owner / U'� /77�0/� Address MX?6r6-5 AWN S-T 6� - Name of Builder�F� /LGIs/460&4--7050AU� MW-Address '30 aw 004�c"e 4,0 Name of Architect �,G�i�/'- GdiV � oC Address Ae& 70- �&7 � Number of Rooms 17 Foundation Aneey oolla 3Tec- Exterior C4041e 51"' Roofing Floors �� �� C1���GsT Interior Heating ���� � 'J Plumbing Fireplace Approximate Cost �'!p 900, 00 P� Area ,.'Diagram of Lot and Building with Dimensions � Fee �oZc�'• e OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable reV"gabove construction. Name Construction Supervisor's License C, l HAYDON, PAUL C: _ r No 34731 Permit For Two Story Single Family Dwelling Location Lot #29, 150 Berkshire Trail Ir r r , Wesi: Barnstable _ owner- Paul C. Haydon - - Type of/Construction Frame Plot r' Lot - -Permit.Granted December 5 , 19 91 Date of Inspection p -'19atedL- 1 mCr t I rl•,�x„�4ir�'�"v!'�h'IL..i �^^�+r''K�`�""�r7�N''�+'r �.�y"��-'�a Wr.+''��'�Y7'S''-/�'�IiY'.I'v7f•Y-Y*a . `'.+1.`.'J'�-/�"'�"'ti'.Y�'�i -K„'"f^�''` '�-'rav�'�`tF�'.��li'�t�Of�Y�t"L7ltr,. FF o�TM� TOWN OF BARNSTABLE 34731 Permit No. . BUILDING DEPARTMENT I "8"Y' I TOWN OFFICE BUILDING Cash �9 .679. X >ra,ur HYANNIS.MASS.02601 Bond CERTIFICATE OF USE AND OCCUPANCY Issued to Paul C. Haydon Address Lot #29, 150 Berkshire Trail West Barnstable, Mass. USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND.IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. March 5, , 19....9.......... .• .,.. ...................... Building tnspector.•••....•.•.. r x y _ { SACHUSETTS 3v,l7sl 3' a7 .L DATE_ th : !jal)o!: 19 Eli PER��'II/��/ AP' l Lei:: 'i;17.?:'.�:' '.;I,:f ADDRESS-3( E:CZ2- Road: Cant �3 (STREET) (CONTR'S LICENSE) 1 _ PERMIT TO bLli ( I STORY JWclil£1rT NUMBER DWELLN OF G UNITS (TYP IMPROVEMLwil NO. (PROPOSED USE) x ( 150 t.� - ;�,- . . ZONING RF AT (LOCATION) +' 1- ii � �r �:1"t..:?.1'.•.. :J_.i, iv [.j,0rr'�•'ta3V L! DISTRICT(NO.) (STREET) BETWEEN AND (CROSS STREET) (CROSS STREET) SUBDIVISION LOT BLOCK SLOT IZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT.;.(N HEIGHT ANq SHALIrCONFORM IN CONSTRUCT) TO TYPE USE GROUP o BASEMENT WALLS OR FOUNDATION !. .. J 1 ).3 )TYPE) REMARKS: Bond AREA OR VOLUME ESTIMATED COS 1L. •00U (�0" PERMIT ,�I2.5 5o[ T .� - (CUBIC/SQUARE FEET) , FEE OWNER. y�tli? �'• tlu .'tt�):'7 i I ADDRESS 1'tv`^i+Ei + +- •= ' , tJ�, !''? + BUILDING DEPT. }} BY / / M THIS PERMIT CONVEYS NO.,RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART T.KE'REOF,.EITHER TEMPORARILY'( PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE A PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAIN[ ,.FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITI ' OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. 4 M�1,,IINIMUM OF THREE CALL -APPROVED PLANS MUST BE R8TA1NED ON JOB AND THIS WHERE APPLICABLE SEPARATEf ALL CONSTRUCTIONRWORK R CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR 1. FOUNDATIONS OR FOOTINGSELECTRICAL PLUMNG. MADE, WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL,INSTALBLIATIONS.D" 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL 1 ME ALlINSRE TI TO BEFORE FINAL INSPECTION HAS BEEN MADE, 3. FINALIINSPECTIO/J BEFORE OCCUPANCY. POST THIS CARD SO IT IS" VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 :z 2If 9z 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 2 F HEALTH • OTHER SITE PLAN REVIEW APPROVAL • i VODRK SHALL NOT PROCEED UNTIL THE INSPEC• PERMIT W!LL BECOME NULL AND VOID IF CONSTRUCTION r ,,;s V TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE INSPECTIONS INDICATED ON THIS CARD CAN[ r0Nc"`)N. PERMIT IS ISSUED AS NOTED ABOVE. ARRANGED FOR•BYTELEPHgNE OR WRITiE NOTIFICATION.; y a SURVEYOR'S CERTIFICATION: ON THE BASIS OF MY KNOWLEDGE, INFORMATION AND BELIEF, I CERTIFY TO : RICK HAYDEN THAT AS A RESULT OF A LOCATION SURVEY.PERFORMED ON 'THE GROUND ON NOVEMBER 27, 1991 IN ACCORDANCE WITH THE NORMAL STANDARD OF CARE EXERCISED BY PROFESSIONAL LAND SURVEYORS PRACTICING IN THE COMMONWEALTH OF MASSACHUSETTS. I FIND THAT THE EXISTING POURED CONCRETE FOUNDATION IS SITUATED ON LOCUS AS DELINEATED HEREON, AND IS IN COMPLIANCE WITH THE CURRENT ZONING BY-LAWS OF THE TOWN OF BARNSTABLE AS TO DIMENSIONAL SETBACK REQUIREMENTS. DATE• PRdFESSIONAL LAND SURVEYOR o O ti ® JRLA. •. U CLAAK ��Q ® NO.35D21 Dy �l jr19 r 8 LOT ' J 429 POURED CONCRETE FOUNDATION #28 •os, ti T� �tl CERTIFIED PLOT PLAN OF LAND IN BARNSTABLE, MASS. AS PREPARED FOR RICK HAYDEN NOTES: SCALE: IIn.= 100ft. DECEMBER 2, 1991 1 . ZONING CLASSIFICATION: RF SCHOFIELD BROTHERS, INC. 2. FOR LOCUS REFERENCE SEE: REGISTERED PLAN BOOK 462, PAGES 30-34. PROFESSIONAL ENGINEERS AND LAND SURVEYORS 161 CRANBERRY HIGHWAY - P.O. BOX 101 ORLEANS, MASS. 02853 (508) 255-2098 COMMONWEALTH ' DEPARTM ENT'OF PUBLIC T OF ` 1010 COMMO SAFETI NWEALTH AVE. MASSAC14USETTS I BOSTON,MASS.02215 � I._1 I.':E N__FE- aG' EXPIRATION DATE 1 CTIQNS :1.;-5. i o EFFECTIVE DATE , { 0 7nCMTTHUMj3 FEE: HEIGHT: I NOT VALID UNTIL SIGNED BY , SIA MP�Z�RrTUREL CEN$EE ANDDOB; I OF THE C MI$$,ONER THIS DOC UMENI '/U$T 8E CARRIED ON 7uE RE=SON OF THE HOLDER 'HE'. E:�<G ' NATURE-OF I EO n; ,,.;S ON CENSEE 200M.2-87-81429 .. MetiSSIONER. v t. Application to ��ppy{oEpH�1!P'�pt� Old Kings Highway Regional Historic District Committee in the Town of Barnstable for a f CERTI FICATE OF APPROPRIATENESS Application Is hereby made, iri triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: ® New Building ❑ Addition ❑ Alteration Indicate type of building: ® House ❑ Garage ❑ Commercial ❑ Other 2. Exterior Painting: 3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other (Please read other side for explanation and requirements).' l� TYPE OR PRINT LEGIBLY DATE SCOT. 9 1 - ADDRESS OF PROPOSED WORK/,QTO` / 11��'(SAW P10 LVi /JAY ASSESSORS MAP NO. 109 OWNER 0&Aycencr) sE/y(lmt /ro � � �' , y�0'� ASSE SORS LOT NO. �J HOME ADDRESS lox / w ,_y/S TE NO. 36 a— Y ?87 FULL NAMES'AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). /lI/Cy�C �T: �,�itici��/�oC �cotivE/,C I�T�PS fjY,4ti•Yr �N S �( (0TS�_ 3i0 0tw1v srt r W eAOluE/C �ONS a701/ S AW 09660 Ca(oN 3 LOTS` i AGENT OR CONTRACTOR �C/UT�i U/�LG� /JI�JE J/�lA&UET TEL. N0. ADDRESS eJO C/W DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done (see No. 8, other side), including materials to be used, if specifications do not accompany plans. In the case of signs, give locations of existing signs and proposed locations of new signs. (Attach additional sheet, if necessary). o�v z APPROVED OKHRHDC Signed Owrier- ntractor-Agent Space below line for Co/,nme�euse. Received by H.D. �! RECEIVED D tsz» 0n The C irate is hereby Date' 4 ,9T OCT Time r OLD KING'S HIGHWAY B , •n��.�nfp,Y " Ap roved IMPORTANT: If Certificate is approved,approval is subject to the 10 day appeal period �� provided in the Act. Disapproved ❑ Ic t-4 ...... Iz.7 Z IJ7 lime N!" rr ILL] oo�..x t�rools-U.rEi-MA I Ll 7:1-T tiP le&i L. tL 1,�Z' T L- 1&7 AVMqOiH S,SNIN 010 7. ion 1661 G A 1 3 0 L!.1 ekv.ro mommawavop" I LF.4 LZF J':� f=.7 L F:�- 7 1 14�: