The URL can be used to link to this page

Home My WebLink About0077 GEMINI DRIVE 77 I .� ,.� 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 • �ARN$fABI$ • - Posted Until Final Inspection Has Been Made. Permit t Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-19-4184 Applicant Name: SOUTHERN NEW ENGLAND WINDOWS LLC Approvals Date Issued: 12/20/2019 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 06/20/2020 Foundation: Location: 77 GEMINI DRIVE,WEST BARNSTABLE Map/Lot: 131-038 Zoning District: RF Sheathing: Owner on Record: BOOTH, KEVIN T& DAWN M Contractor Name: SOUTHERN NEW ENGLAND Framing: 1 WINDOWS LLC Address: 77 GEMINI DRIVE \1 2 Contractor License: 173245 WEST BARNSTABLE, MA 02668 Chimney: Description: 1 replacement door Est. Project Cost: $4,293.00 I Insulation: Permit Fee: $35.00 Fee Paid: Project Review Req: { Final: Date/ 12/20/2019 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. w f Final Gas: All construction,alterations and changes of use of any building and striuctures shall be in compliance with the local zoning by-laws and codes. IF 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 The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit.The 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. 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 i r TKE AG DEPT -8— Iq - 14193 �Ofr � uu Application number.................I.............................. DEC 19 2019 Date Issued..................1.1r ° BARVSTABLE, ° MASS. A F&39. AN TOWN OF BARNSTABLE Building Inspectors Initials........... Map/Parcel...../ ....rv. . .............................. "OWN OF BARNSTABLE EXPEDITED PERiUIIT APPLICATION: ROOF/SIDING/WINDO WS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY MORMATI ON Address of Project: 73 2 5'..4-k I'�ar� �f. �r✓r,��e NUMBER STREET VILLAGE Owner's Name: Gomti r?oc%r;CA Phone Number Email Address: /or/�o r�P�,�/(�L Q rya .-� Cell Phone Number Project cost S -7 &/Z /— Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building perinit in accordance with 780 CMR Owner Signature: See A- 2 ckN!0� OT+A"c Date: TYPE OF WORK 17 Siding lr Windows (no header change)#__11 Insulation/Weatherization 17 Doors (no header change) # Commercial boors require an inspector's review ll Roof(not applying more than I layer of shingles) n Construction Debris will be going to UI c s4e- �M,' �`' ri / r CONTRACTOR'S INFORMATION Contractor's name (fit an �, nn�So✓n - -2Ae rn AV P�J Home Improvement Contractors Registration(if applicable)# 17 3 L K-� (attach copy) Construction Supervisor's License# y9 S`7 07 (attach copy) Email of Contractor $LJee�9 q S C bm Phone number �(0/- 2 Z 9 -9 go() ALL PROPERTIES THAT HAVE STRUCTURES VER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMiT CAN BE ISSUED. z APPLICATIONNUMBER ............................................................ *For Tents Only* Date Tent (s) will be erected Removed on number of tents total Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X 7 X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached.Provide a site plan with the location (s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pin. Commercial events may require Fire Department approval. *WOOD/C®AL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HONEE®WNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for]Licensed Construction Supervisor in accordance with 780 CNM the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 ClV R and the Town of Barnstable. � Signature Date PULL Y 9S SIGNATURE Signature Date /Z All permit applications are subject to a building official's approval prior to issuance. Renewal Agreement Document and Payment Terms by d rse dba:Renewal By Andersen of Southern New England Lorna Roderick Legal Name:Southern New England Windows,LLC 832 South Main St RI#36079,MA#173245,CT#0634555, Lead Firm #1237 Centerville,MA 02632 wiroow aE u...... 10 Reservoir Rd I Smithfield,RI 02917 H:(508)775-7645 Phone:401-349-1384 1 Fax:401-633-6602 1 sales®renewalsne.com Buyer(s) Name: Lorna Roderick Contract Date: 12/02/19 Buyer(s)Street Address: 832 South Main St , Centerville, MA 02632 Primary Telephone Number: (508)775-7645 Secondary Telephone Number: Primary Email: lornaroderick52@gmail.com Secondary Email: Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Southern New England Windows,LLC d/b/a Renewal By Andersen of Southern New England("Contractor"),in accordance with the terms and conditions described in this Agreement Document and Payment Terms,any documents listed in the Table of Contents,and any other document attached to this Agreement Document,the terms of which are all agreed to by the parties and incorporated herein by reference(collectively,this "Agreement"). Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job Amount: $7,421 By signing this Agreement,you acknowledge that the Balance Due,and the Amount Financed must be made by personal check,bank check,credit card,or cash. Deposit Received: $3,710 Balance Due: $3,711 Estimated Start: Estimated Completion: Amount Financed: $7,421 7-9 weeks 7-9 weeks Method of Payment: Financing We schedule installations based on the date of the signed contract and secondarily on the date in which we complete the technical measurements.The installation date that we are providing at this time is only an estimate.We will communicate an official date and time at a later date. Rain and extreme weather are the most common causes for delay. Notes: 50% deposit by bank balance on completion by bank. 24 month 0% loan Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there are no verbal understandings changing or modifying any of the terms of this Agreement.No alterations to or deviations from this Agreement will be valid without the signed,written consent of both the Buyer(s) and Contractor.Buyer(s)hereby acknowledges that Buyer(s) 1)has read this Agreement, understands the terms of this Agreement,and has received a completed, signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO BUYER: Do not sign this contract if blank You are entitled to a copy of the contract at the time you sign. YOU,THE BUYER,MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT OF 12/05/2019 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. Legal Name:Southern New England Windows,LLC dba:Ren By d n of Southern New England Buyer(s) Signature of Sales Person Signature Signature Paul Sandrey Lorna Roderick Print Name of Sales Person Print Name Print Name UPDATED: 12/02/19 Page 2 / 10 r - Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Card SOUTHERN NEW ENGLAND WINDOWS, LL-C: - Registration: 173245 10 RESERVOIR ROAD - Expiration: 09/18/2020 SMITHFIELD, RI 02917 - SCA 1 0 20M-05/17 Update Address and Return Card. ..Te �cvni�zenrrea,�/jt��m:-icc�euelG� Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Suoolement Card before the expiration date. If found return to: Reaistiafion Expiration Office of Consumer Affairs and Business Regulation 17.3245= 09/18/2020 1000 Washington Street-Suite 710 SOUTHERN NEW ENGLAND WINDOWS,LLC Boston,MA 0211 BRIAN DENNISON 10 RESERVOIR ROAD u SMITHFIELD,RI 02917 Undersecretary tiv� -" dVithout signature Y Commonwealth of Massachusetts Division of Professional Licensure Board of wilding regulations and Standards �,onstructfbn 'Su pervisor CS-095707 _ Ea p s res : 09/08/2020 SRIAN D DENNISON 8 RLACKWEL.•L-DRIVE ; CHARLTON MA 01507 - Comrrdssioneir CIL t I. Me Comawnwealtla®f Massachusetts Department ofIndustrialAccidents I Congress Stree4 Suite 100 Boston,M4 02114 3017 www mms gov/dia R urkers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERM=LYG AUTHORITY. Anolicant Information Please Print Leaibiv Name(BusinesdOrganiration/Individual): Address: 'y City/State/Zip-5 t-HiA e-U ?l DLg / 1) = 7 Phone#: 40 -ZZ,9-- Are you an employer'Check the appropriate box: Type of project(required): 1. 1 am a employer with ;40"1`employees(full and/or part-time).' 7. []New construction am a sole proprietor or paruurship and have no employees working for me in any capacity.(No wtirk s'comp.inH�� required] S.' Remodeling 3.01 am a homeowner doing all work myself(No workers'comp.insurance required]* 9• ❑Demolition 4.®I am a homeowner and will be hiring contractors to conduct all work on my property.ro [will 10 Q Midin g addition ensure that all contractors either have workers'com pensation insurance or are sole 1!_[]Electrical repairs or additions proprietors with no employees. • 5.a I am a seneral contractor and I have hired the sub-contractors listed on the attached sheet 12 Plumbing repairs or additions These sub-contractors have employees and have workers'comp.insuance.r 13.Q Roof repairs / <3 We are a eorporahon and its officers have cxereised their right of e:remption per MOL c. 14. Other �✓//� (� . 152,g1(4),and we have no employees.[No workers'camp.insurance required] /. 4- 4--g *Arty applicant that checks box.Rl must also fill out the section below showing their workers'compensation policy information Hameownets who submit this affidavit indicating they are doing all work and then hire otaside 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. Ifthe sub-coanactm have cmplayexs,they must provide their workers'comp.policy number. 'am an enrpinyer that isproWdtng workers'compensation insurance for my employees Below is thepo informatiolc licy Qndjob site Insurance Company Name: Policy#or Self-ins.Lic. Expiration Date: !' 0—2 0 ZO Job Site Address: rf 3 Z ,44 1-f,:--;,, Si 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 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 penaldis in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violatof.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce under the p ' A penaldes of perjury that the injormaeion provided above is t�rrre and correct Si re: Date: Phone#: d n l 7 24r— 9 � O curI use only. Do not write in dds area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health L Building*Department J.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone(#: AC CPRa� CERTIFICATE OF LIABILITY INSURANCE OAT 12/28/2018 O//28/ 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 O AC CoBiz Insurance, Inc.-CO NAME: FAX 1401 Lawrence St., Ste, 1200 W N o Ex • 303-988-0445 (AIic No:303-988-0804 Denver CO 80202 EMAIL AODREss: COMail@cobizinsurance.com INSURE S AFFORDING COVERAGE NAlc tt INSURER A:Acadia Insurance Company 31325 INSURED ESLERCO-01 Southern New England Windows, LLC. INSURER B:Firemens Insurance Company of WA,D.C. 21764 dba Renewal by Andersen of Southern New England INSURER C:Homeland Insurance Company of New York 34452 10 Reservior Rd INSURER D: Smithfield RI 02917 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:787175890 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 ADDL SUBR . LTR TYPE OF INSURANCE POLICY NUMBER MML/DD/YYYY MPOLICY/Y YY LIMITS A X COMMERCIAL GENERAL LIABILITY CPA3158728 1/1/2019 1/1/2020 EACH OCCURRENCE $1,000,000 CLAIMS-MADE a OCCUR PREMISES Ea occuffencel $300,000 MED EXP(Any one Person) S 10.0m PERSONAL 6 ADV INJURY $1,000,00D GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2.000.000 X POLICY JECT LOC PRODUCTS-COMP/OP AGG S 2A00,000 OTHER: $ A AUTOMOBILE LIABILITY CPA31SB728 1/IJ2019 1/1/2020 COMBINED SINGLE OMIT $(Ea1 0 00D X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per ace dem) g X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ b A X UMBRELLA UAB X OCCUR CPA31SO728 1/1/2019 1/1/2020 EACH OCCURRENCE $15,000,OOD EXCESS LJAB CLAIMS-MADE AGGREGATE $15,000,000 DED I X I RETENTIONS $ B WORKERS COMPENSATION WCA315872924 1/1/2019 Vt/2020 K SPg-TATUTE ER AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1.000.000 If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT S 1.000.000 C Pollution Liability 7930073340000. 1/1/2019 1/1/2020 Each Occurrence 82,000,000 ClaRetroactive to 06 Aggregate $2,o00.0D0 Retroactive Date 06120I2013 Deductible $25.000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule may he attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. FOR INFORMATIONAL PURPOSES'ONLY AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Jr� �I ASS'- o f f't q_p FD i,VORK -7 6-in Ley in.Fi'• W.F�'�►RA15r-AS�.c M.- ).,itSr /�4ss>css0RS- Mkt N i-' 1— 0:3r_C-'y L,ss svRs L o7 /Ko, old A�D��ss-- 77 GEM►N1 17'R. 1N. PA MIA•gL E MA- Od bW iRAcTo9 7-# isrj.47 C0Ns1r1rcTlvtr Co AadEss - !.�_ ___kE t� Rd rat an= 3y-b� , A ofJ4 ouS�' _. SLIDING 1�oGR br� -- WX , LyRoom wa FA Cal L LAP, �----T 11 ........y .. ._. 'SLIDINCr Door - -- - t 3 r Assessor's map and- lot number• ..'..!..:�-.��.f....../.3 ... � 7 7 70 G SEPTIC SYSTEM MUSTBE Seage.Permit number ...........................................:.............. INSTALLED IN COMPLIANN CE w WhrH ARTICLE II STATE �v (-OnF q(�? TOWN TOWN OF :BARNS�TA-1BL Z ID STADL'•i L iAB& =. BUIt:LDING INSPECTOR APPLICATION FOR PERMIT TO ......&14,D........................ ,?../... .......................................................... C TYPE OF CONSTRUCTION .........'V0..120.... .. 4i4 Ic................................°......................:................................... ............................. ..............19.... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: ' Location .......... ............................ ....f.�Y/..�Y......?��u...(...................i116-ST..... .... ..!Y�.........Grr............:................................. Proposed Use ...�\.�� G�.... f�/n'1�LI!.... f�(/ELL/ ......................................:..................................: Zoning District ��E.SI.�?.�!VT/fJ�r......./...................................Fire District .............................................................................. Name of Owner gN. ,Q.G.`.{'VF� .. ! 1 ,$.Address ..... .C�f�P ....�1? ...�� ' ..,t..!.:l. F-�... Name of Builder .NgV'1... 0A(/. .4v1''w...619.............'......Address .....1.6/1I.° ..a2..:�..4/4CC�...�!�/'�?'EGs. Name of Architect gwz'c�c ! /��E�G�M.... :...Address ....1.. /7'� ... . ..1�... ,G. �E.y...(.. .... ... .............. Number of Rooms ............. ..................................................Foundation ...4 P14"L'2.ga.................................................. �E. ..........Roofin .......... �T.....�J•! /itlG��.S.......................... Exterior ... ... 'D.!/�"�....�!��I.�('LF...S........................:. g Floors ............h!4®,Q................................................................Interior .........., !��Gv!9� ........................ .......:........... Heating /v�C.E2t..../..!. ..1!V.�TFIL ...........................Plumbing ........I` 4.4....!T77ZOL-..74)....QE...C'BPP /tom.... Fireplace ......... .......................................................................Approximate Cost ........./ ......................................... Definitive Plan Approved by Planning Board -----------_______-----------19________. Area ....../0 7 ............... Diagram of Lot and Building with Dimensions Fee / SUBJECT TO APPROVAL. OF BOARD OF HEALTH �D 1,dL4r l/ K z s�' I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. //� Name ...5� U.- . ................... Barnstable West Associates No 18953•••••. Permit for .,one••stor aty ... .......... ..........s iagie...£awi.1y...deajjJAg.................... Location. ...... ' i ...temini..A!ziYB............... ...............Wes.t..B am s tab l e............................. Owner ....Brixms table.-West.-Assor-rates..... } Type,of Construction' .....frame..................:........ ......................... Plot .. �....................... Lot ..........5 ....�5...................... Permit Granted ...Fabruary..l7•............1977 Date of Inspection ......19 Date Completed ................19 , PERMIT REFUSED ........................................................ ..... 19 ` ......... ............................ ..........'r................. , V ...........................................................:................... f Approved ................................................. 19 ............................................................................... { Assessor's map and lot number ............................................. Sewage Permit number .......................................................... THE TOWN OF BARNSTABLE 33MOSTAMLE, &0" A$ 1639. BUILDING INSPECTOR 0 M APPLICATION FOR PERMIT TO ....... ......................................... .................................................................... TYPE OF CONSTRUCTION .............. . ............................................................................................................. ................. ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ........................................................................................................................................................................................ ProposedUse ..........I..,.'......................... ............................................................................................................. ......................... ZoningDistrict ................................................................Fire District .............................................................................. ............... ... ... ......Address ..... .................................... Name of Owner L... ..... ............................ ....... Nameof Builder ...............�..Y............ ......... :................Address ....../............................................................................... ti Name of Architect ................... ............/........ Address ...... ...................... ....................... ........... Number of Rooms .............//,, Foundation .... ........................................................ ..................................................... Exterior ........ ...................................................................Roofing .................................................................................... Floors ................. ..............................Interior ........... ..................................................................... Heating ................... ....................... Plumbing ........ .................... .......................................... .. ................................................ Fireplace ..................................................................................Approximate Cost .................................................................... Definitive Plan Approved by Planning Board -----------—--—--—-----------19---------- Area ........... ....................... Diagram of Lot and Building with Dimensions Fee ......................... ..................... SUBJECT TO APPROVAL, OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ................................................................................... Barnstable West Associates A-131-38 , No ...... Permit for .Q0P—At.Q.r.y................ w . ......s.tagla.1ami.l.y...dwell1mg........................ s Location Gemini-Dri.xe................... ...............Veat..)iarustahle............................... . Owner A-Arns.table..wes.t...AssQ.QLAX.ea...... Type of Construction .....frame.....:.................... � N " ............................................................ .............. �� N 0/5 Plot ............................ Lot ........4...................... F � \A Permit Granted .F.ebrjaary...17 7.............. 77 ((�� Date of Inspection .......:........................../19 �J N -Date Completed ..........:....:......:...::.../ 9 N 4RMIT REFUSED J' ....................... . .............. 1... t ls9 .. .. .. ................. .......... ..4... ..... - 1^ �`.1 tN ..... ..I.., 1........... n .......... ..` ............ /i Approve ................ .. 19 . � j t�v av IL or -6" LoT l � G,e5--1v11v1 CERTIFIED PLOT PLAN L O C A T I O N% ,�5L- 3CALE� 1 DATE: ISZd A/->,- REFERENCE* S/70t,JAI AS L o 7-46`5"04/f.e q Al Z� 77 I HEREBY CERTIFY THAT THE BUILDINGkwl LAND SURY � YOR SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON AND THAT IT '2l,ES' CONFORM TO THE aF1<9assr ZONING BY — LAWS OF THE TOWN OF 3�`` JOSEPH M. G7 WHEN CONSTRUCTED . - MONAHAN,JR. H v 13660 1� C M S ASSOCIATES, INC . ��C,STV-\" � REGISTERED ENS-IWEERS a LAND SURVEYORS psutr��{ MID -CAPE OFFICE BUILDING - 1265 ROUTE 26 SOUTH YARM O UTH., MASS. 02664 " -SEPTIC SYSTEM IVI4lST BE Assessor's ma and lot number ..�13/:-...t�. ........... p INSTALLED IN COMPLIANCE P p&INE?p`` I ` '`�-Sewage Permit number .................. ........................ ... WITH TITLE 5 ENVIRONMENTAL CODE AND t BaSaSTeDLE. ,,'House number ........:::04- ..7 ........................................... TOWN REGULATIONS g000�MU& 0. -. t' TOWN 'OF ,17BARNSTABLE BUILDING% INSPECTOR , -APPLICATION "FOR PERMIT TO ....al.�DD.....:1..S ;*,.1771.4x. .)....... — 2.-:r..................................... TYPE OF CONSTRUCTION .................'fZ.. ...X....1.2............................................. B Q�.... g c!. ...... .........19.{.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ........R ...........�j.......... %ry!. .. ...... 1e�4�...........................................:.......... ProposedUse ............�'TM.a........... ......................................................................................................................... Zoning District ....... • Fire District ...Y.`!... �R I1�ST/ �k ......................................... Name of Owner ..........y11/} i-.R.U.T...ffi..............................Address ........... ... .' ....N.............,.............................. CIO Name of Builder .d..1 .IL...........��®N...�T�.U..�.T..�U11�.....Address ........................................... ........................................ r r - Name of Architect ..................................................................Address d ` Numberof Rooms ..............1...................................................Foundation ............ ................................................................. C L Exterior ................DA .........AN ....� ..................Roofng .............................................................. Floors .............'�.......��..l.......W.°...� ...............................Interior ................. ..�G�: Heating � C j7glc.......................................................Plumbing /�' A../........... ... ..,...�................................. Fireplace .............N.V ALE.......................................................Approximate. Cost ................. !.J.C/.�1. !.f^.:........................... Definitive Plan Approved by Planning Board -----------_______-----------19_______. Area `5. ... ' ,,,, Diagram of Lot and Building with Dimensions Fee .... !.li................................. 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. T# Go . srucTiaw Ccs Name .. ...... ....... . . . ........... ....................,• . C'GWS'7t11sc�`lo4 Construction Supervisor's License ®a�� ..... gALLR0IB, EDWAR} G. & M\DY A=131-038 131 - 28351 ADDITION ` No Permit for ------------ / Family Room/Single Family Dwelling . --'."--------.-.------------.. ^ � Location ....Lot...5 77 �—.. _Gemini Drive .. ___ . . / West Barnstable -------`------------------- Edward G. & MaryF 'gallrntb Owner —------.�-------�------- Type of Construction --—�rume----------- ----------.-----------..---' ^ ' ` � p|o* ............................ Lot ............ ^ ^ ' � - August 23, 85 Permit G,on+e6 ........................................ . � Date of Inspection ....................................lP _ � Dote Completed ------------'lg ' ` ' ' . ' ' ` ` ^ ' ` . ^ . . _ � ' . ` ' ~ ' ' ' ' ' �~ ' ' ' | Assessor's map and lot number ... ..........--- 4:� Sew IP&mit number ............................................... STA-BLE, 77 MNAB& House number . ......... ......................................... 039, Up,,j TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ........4, ..... Vr.; .............................. TYPE OF CONSTRUCTION .................. ......................................................................................... . .. .. ... . ..... .........................19.6.A. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: 71 Location .... ........ t...........4611�. .. ........................................ ............. ProposedUse .....FAM/L Vo 0.......M ......................... ..................................................................................................I....... . ...... ...........Zoning District ... Fire District A.4......R.A.. N: .l ............................ Nameof Owner ..........W.A.k1-;.R.QT)t:...............................Address .................................................................................... V < . ..... ..Address ..................................................................................... Name of Builder Name of Architect ..................................................................Address .... ......4.14.:........ ....... Numberof Rooms .............. ..................................................Foundation .............................................. L Exierior ......... ...................Roofing ................................................... ................R.........lr:�........................... -'AW.a. PL o a Floors ................................ ......................................................Interior ................ ............................................ Heating ..4.A%....C............................................................... ....Plumbing .................................................................................. Fireplace ............. h'ib.11.........................:...............................Approximate. Cost ................. 'a,7a-6 0?............................. Definitive Plan Approved by Planning Board -----------—--—---—-----------19 Area .......................................... Diagram of Lot and. Building with Dimensions Fee ............................................. 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. CC) 1 STUG f/0A1 (fo Name ...... ......... ...... Construction`Supervisor's License .......0.0.*40...... WALLROTH, EDWARD G. & MARY No ..... Permit for ADDITION -> ....................... Family Room/Single,jpmily..AFelling Location ......7.7...G.e.min.i...Drive............ .................We.s.t...Ba.r.n.s.tab.l.e............................. Owner .. .Edward...G.....&..Mary..)�,...Y�lKo.t.h ....Edward . . .. ....... Type of Construction JxAlAg.................. .......... ................................................................................ Plot ............................ Lot ................................ Permit Granted .....Aj4p.s.t.. 23. Date of Inspection ............ .................19 Date Completed ........ %6.....................19 Cape Sav6U,'g 01: 7-D Huntington Avenue South Yarmouth; "D24fit'l (a' 06 Tel: 508-398-0398 Fax: 508-398-0399 10-6-14 Town of Barnstable Thomas Perry CBO Q,1' Building Commissioner I 200 Main St. Hyannis,MA 02601 RE: Building Permits Dear Mr. Perry, This affidavit is to certify that all work completed for 77 Gemini Drive,West Barnstable has been inspected by a certified Building Performance Institute(BPI)Inspector. Ceiling: R-38 cellulose main house; R-30 cellulose rear addition Basement: R49 fiberglass box sill Floor: R-30 fiberglass front cantilever All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years]. A business certificate ONLSI REGISTERS es on must do by M.G.L.-it does not give you permission to opera this form at 200 Main St., Hyannis. you te.) You must first obtain the necessary g Take the completed form to the Town Clerk's Off ice 1st FI., 367 Main St., Hyannis, MA 02601., (Town Hall) and get the Business Certificate that is required by law. DATE: 5 Fill in please: YOUR NAME/S: APPLICANTS INMI . ile;ti BUSINESS YOUR HOME ADDRESS: �rt '�J •''/ni4 ti: l 'i' l UJIaxy�S �lrz r�> � '`'' ' `u'° Home Telephone Number �� ` TELEPHONE # E—MA I L: S 3 `Lov dt�. �JivL4J5 �1 E I N #: NAME OF CORPORATION: TYPE OF BUSINESS � CLQV V`ft I — NAME OF•NF.W BUSINESS �'n ��er� IS THIS A HOME OCCUPATION? ✓ YES y NO MAP/PARCEL NUMBER I� U� `-' (Assessing) ADDRESS OF BUSINESS. . q`Z v rl rv\ When starting a new business there are.several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in pbtaining the information you may need. You MUST GO TO 200 Main St. (corner of Yarmouth ' S Rd. & Main Street) to make sure'you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSION 'S OFFICE MUST COMPLY WITH HOME OCCUPATION r This individual has bee in ad of an e mit requirements that pe in7to this tp of b !nLAND REGULATIONS. FAILURE TO COMPLY MAY RC-6VLT-IN FINES. Authorized Si ature** COMMENTS: _ S L f 2. BOARD OF HEALTH. - This individual has been informed of the permit'requi rem ants that pertain to this type of business. Authorized Signature** COMMENTS: 3. CONSUMER-AFFAIRS•(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: Town of Barnstable- I.1HE Regulatory Services )pk o Richard V. Scali,Director sexrts�+si.E. Building Division KAM� Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.as Office: 508-862-403 8 Fax:. 508-790-6230 Approved: Fee: Permit#: HOME OCCUPATION REGISTRATION Date: Name: Phone#: t�' Address: "M avy)w tw i illage: 1/y- V\1*�04 Name of Business: Type of Business: P"W%P-YCR -+ wN vLAA__, Map/Lot: INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling. there shall be no increase in noise or odor,no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,.glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment • There are no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • Ifthe Customary Home Occupation is listed or advertised as a business,the street address shall not be included_ • No person h be employed in the Customary Home Occupation who is not a permanent resident of the dwelling t I,the undersigned,ha a re d agree 'th the above re lions for my home occupation I am registering. Applicant: / Date:' r Homeoc,doc Rev.06/20/16 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ' z Map 3 Parcel 038 Application # i Health Division Date Issued l 5/ Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Ge M 111 i r I V,e Village OwnerTA WA11a±, Address Z-0. 41, 335 'Denny rn 8 Telephone 5 0$ a 15 4 oaT Permit Request NJ R-38 ce16,1r se -N 'f e Lc. �� R'3D �LrS14;u to '14 bwS e nl �• 1 r * 0 Jq A d �[S'C � Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 4900 Construction Type Q 4 w Lot Size Grandfathered: ❑Yes ❑ No If yes, attach s pporting d©cume5tation: Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) a _ Age of Existing Structure Historic House: 0 Yes 0 No On Old King's;Highway 0 Yes ❑ No Basement Type: ❑ Full 0 Crawl ❑Walkout ❑ Other r Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) T Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes W,No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name c, Telephone Number 50 8 Address c—a n License# ,�'o �-��Qrr�►��'�'h , 1'�t7 D� 6 W Home Improvement Contractor# Worker's Compensation # Glwc .3o8 5 6 33 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO KoSMOA SIGNATURE DATE VAul FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED. z MAP/PARCEL NO. ADDRESS VILLAGE OWNER r r l DATE OF INSPECTION: FO_U,NDATLONvu _ Z;t � s o;F,N u FRAME r INSULATION.-L;-, = i,,a_t.,,r:..�Lt:,,.•, 'i FIREPLACE l ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING". DATE CLOSED OUT ASSOCIATION PLAN NO. w r, 400 westo2so�l�e _ AssistaHousinnce LINTel:(508)771.5400 Fax(508)775-7434) Co ration CW M on All lines � � , Free Weatherization ! Your tenant has requested and is eligible for weatherization of your rental home through government funding. This will be provided at no cost to you. Program regulations permit us to spend around $2,500- $7,500 in materials and labor per dwelling unit. I. and caulk doors and windows; insulate Program regulations require us to weather-strip � attics, sidewalk and floors. All work is professionally done by established private contractors. We will conduct a final inspection to make sure that all work Is completed to specifications. If you request, you will be informed of the estimated measures before they are done i and provided with a list of the actual measures and costs following the completion of the work. We also need proof that you own the property. A copy of a'CURREISITT 1lC IBIL DID t, D listing you as the owner will satisfy this requirement. Please fill in all blank areas of the enclosed agreement and return with the proof of ownership as soon as possible. If we do not receive the enclosed form within two weeks, we will do a basic energy audit of the home, but no weatherizadon work can be recommended or done. i If you have any questions please call Suzanne Smith at 508-771-5400, ext. 123. '. LANDLORD,• !/�n�(d �_ WG!`(rvt TENW: 2-4 MA eme16• Wai_bilk dCam�;I v G emaih PHONE:(home) PHONE:(home) (Ce, '9D .-640-go13 (cell) TgNANT/PROPERTY OWNERlAGENCY WEA'THERIZATION AGREEMENT 1. The Pales to this Agn3emerrltt are the fallowing: a grrn roY1 (hereafter known as Tenant), (print your tends name) l�al'fatet (1�a1 l oar (hereafter known as Property Owner) (print your name) and Housing Assistance Corporation (hereafter known as Agency). in consideration of the mutual promises hereafter stated,the Parties agree as follows: ' 2. The date of Agency$signature will be the effective date of this Agreement 3. Property Owner and Tenant consent and agree that the Agency may do the following with respect to the property located at(street,town) o � N.Prick W. 9Arr 514 0A unit# ,and currently leased or rented to the Tenant: a) Enter the premises for the purpose of performing a Weatherization Inspection. b) Enter the premises to perform Weatherization work which the Agency determines In its discretion Is necessary and appropriate as a result of the Agencyrs inspection of the property and In accordance with the appropriate priority list for the type of dwelling. The Agency and the Agency's contractors may also enter the appropriate common areas of the building for ttre purpose of accomplishing the Weatherization work. The Agency and representatives of the Commonwealth of Massachusetts,Department of Housing & Community Development (DHCD) may further enter the property to inspect any and all work hereunder. The Agency will provide reasonable notice of the timing of the Weatherization work and Inspections. The Weatherization work will be performed In accordance with the Property Owner's consent as further specified below: I i "•-INfnAL Y ONE OF THE FOLLOWINCI i consent to performance by the Agency and its contractors of any Weatherization work determined necessary and appropriate by the Agency as a result of Its inspection of the property. I understand that the Agency will provide a detailed statement of the actual work performed and the associated value at the completion of work. i i will provide a separate consent to performance by the Agency and its contractors of Weatherization work following my receipt of the Agency's Inspection report and a statement of the estimated work and associated value. Thle additional consent will be sent under separate cover as Attachment A. i understand that the Agency will provide a detailed statement of the actual work performed and the associated value at the completion of the work. 4. The Property Owner understands and agrees that any and all work, Including related repairs for which the Property may also be eligible,will be performed at the Agency's discretion. The Agency estimated completion of the Weatherization work by the end of 2013. S. if the Property Owner is required to make repairs to the property prior to the commencement of Weatherization work by the Agency,the Property Owner will be notified by the Agency and will be required to make the repairs as soon as possible. Except where the Property Owner receives a written extension from the Agency,time Is of the essence in the performance of repairs by the Property Owner. 6. The Puberty Owner and Tenant authorize the Agency to raosive a statement from the fuel supplier/utility supplier as to the quantity of fuellutill8es used at the above address In each of the past three years and the future three years. The information is to be used orgy to determine the cost effectiveness of the Weatherization Improvements. 7. The Property Owner agrees that the rent for the dwelling unit will not be raised because of any Increase in the value thereof due solely to the Weatherization work performed. 8. .. In consideration of the Weatherization work hereunder,the Property Owner further agrees that upon the effective date of this Agreement and during a period extending through 2013/2014, approximately one year from the time the work is completed, howavu -far 04vt� vw�s t-ab�alc a) The present rent$__1600, per month will not be raised for any reason (The rent amount must be filled In).Heat Included In rent?Yes No V However,this Paragraph(86)will be waived by the Agency In writing If,and only If,the premises j are leased under a state or federal rant subsidy program, in which ease the actual rent charged by the Owner shall conform to the standards of the rent subsidy program. Please state which Housing Subsidy program your tenant is on and through which Agency. b) The Property Owner will not Institute any summary process action for possession except In the case of non-payment of read or other good cause related to the Tenant(or any successor Tenant). c) In the even the Property Owner decides to sell the premises, Property Owner shall comply with one of the two requirements below. The Property Owner shall not sell the premises unless the buyer agrees(with a copy forwarded to the Agency) In writing prior to sale to assume all obligations of the Property Owner set out in this Agreement;or j The Property Owner shall pay the Agency an amount equal to the cost,as certified by the Agency,of j the Weatherization materials Installed and labor performed in the premises as of the date of sale. Said amount shall be paid to the Agency Immediately upon sale. 1 9. (Applicable only If Tenant's hest Is Included in rental payment and blanks are filled in) At the end of the period set forth In Paragraph 8 above,the rent shall not be raised more than %per for an additional period of one year, and the provisions of 8b and 8o above shalt continue in effect for such period. However, the rent provisions of this Paragraph 9 may be waived by the Agency In writing 1, and only If, the premises are leased under a state or federal rent subsidy program, In which ease the actual rent charged by the Owner shall conform to the standards of the rent subsidy program. 10. The Parties agree that the berms of this Agreement are incorporated Into any other lease or agreement between the Property Owner and the Tenant,and between the Property Owner and any successor Tenant,and If there is any conflict between the provisions of this Agreement and the provisions of such other lease or agreement,the provisions of this Agreement shall govern. However,If such other lease or agreement,Including without limitation a lease or agreement under state or federal rent subsidy program,contains stronger protections for the Tenant, such stronger protections shall apply. 11. For breach of this Agreement by the Property Owner, the Property Owner shall reimburse the Agency In an amount equal to the cost, as certlfwd by the Agency, of the Weatherization materials Installed and labor performed on the premises,as well as attorneys fee and court costs. The Property Owner may also be liable for damages to the Tenant In accordance with applicable law;in such Instance,the Property Owner shall reimburse the Tenant for attorneys fees and court costs. Without limMV the foregoing, the Agency may at its option terminate this Agreement,by providing written notice to the Property Owner and Tennant,in the event of breach by the Property Owner or Tenant. 12. Performance of the Weatherization work hereunder by the Agency Is contingent upon the availability of funds to the Agency from the commonwealth of Massachusetts and the federal govemment,as well as the eligibility of the Tenant under WAP program requirements. The Agency may terminate this Agreement, by providing written notice to the Property Owner and Tenant,If the Agency determines that the unavailability of funds or Ineligibility of the Tenant warrants termination. i I& The Parties acknowledge that this Agreement is under seat. It Is Intended by the Parties that the Tenant or any successor Tenant is the Intended beneficiary of the Agreement and shall have a right of.enforcement. P e Owner's Signature: ��( �o� pere ` � 16 201 y mp �y -�� Phone: Y0 - 'go 13 n Q" Pa I w, (. .e Al Address: .� . a7-660 Tenant Signature Date Agency Approved Weatherizatiwrt Company lti s ,C . All Cape Energy / Adam T.Incorporated / Cape Cod Insulatlo / Cape Save / Frontier Energy Solutions / Lahr .&Sons Inc. ! Resolution Energy Agency Signature Date The Commonwealth of Massachusetts Department of Industrial Accidents -=� Office of Investigations _ , 1 Congress Street, Suite 100 yVA" Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Cape Save Inc. Address: 7D Huntington Ave City/State/Zip: South Yarmouth, MA 02664 Phone#: 508-398-0398 _ Are you an employer?Check the appropriate box: Type of project(required): 1. ✓❑ I am a employer with 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 g. ❑ Demolition workingfor me in an capacity. employees and have workers' Y p tY• 9. ❑ Building addition [No workers' comp.insurance comp. insurance.* required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their I LEI 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 N-vorkers' 1J•❑✓ Other Insulation 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 Nvork and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet shoving the name of the sub-conuactors and state whether or not those entities have employees. If the subcontractors 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 infor►nation. Insurance Company Name: Wesco Insurance Company Policy#or Self-ins.Lic.#: WWC3085633 Expiration*Date: 04/09/2015 1 Job Site Address: 7� G m i1 n 11 IJ f j v e City/State/Zip: W. 8 a rt►S+ab�$ 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 S 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$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DlA for insurance coverage verification. I do hereb certi under the eains and penalties of per that the information provided above is true and correct. S ianature: Date Phone#: 509-399-039$ Official use only. Do not write in this area,to be completed by city or town ofciat 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#: Aco CERTIFICATE OF LIABILITY INSURANCE DATE(MMMDI YYY) 11% 4/14/2014 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 endorsements. CONTACT PRODUCER NAME: Colleen Crowley Risk Strategies Company PHONE (781)986-4400 FAC No:(781)963-4420 15 Pacella Park Drive .ccrowley@risk-strategies.com Suite 240 INSURERS AFFORDING COVERAGE NAIC i Randolph MA 02368 INsuRERA:Selective Ins. of America INSURED INSURERB:Safety.Insurance Company 3618 Cape Save, Inc INSURERC:Wesco Insurance Company 7 D Huntington Ave - INSURERD: INSURERE: South Yarmouth MA 02664 1 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1441475243 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. LTRR TYPE OF INSURANCE POLICY NUMBER POLICY MI�EFF POLICY E P LIMITS GENERAL LIABILRY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY 000 PREMISES Eaocwnance $ 100, A CLAIMS-MADE Q OCCUR S1994480 0/16/2013 0/16/2014 MED EXp(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEWL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 POLICY X PRO � �X LOC $ AUTOMOBILE LIABILITY COMBINED Ea accident SINGLE LIMIT 1,000,000 ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED 208200 1/6/2013 1/6/2014 AUTOS X AUTOS BODILY INJURY(Per accident) $T X HIRED AUTOS X AUTOSO\MJED F r..dT DAMAGE $ I X UMBRELLA LtAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAR CLAIMS MADE AGGREGATE $ 1,000,000 DED RETENTION NIX S1994480 0/16/2013 0/16/2014 $ C WORKERS COMPENSATION Officers Included For riCSTATU-. 0 7H- AND EMPLOYERS'LIABILITY YIN X R ANY PROFRIETORIPARTNERIEXECUTIVE overage E.L.EAGHACCIDENT $ 500 000 OFFICER/MEMBER EW'LUOED? FIT N I A (Mandatory in NH) 3085633 /9/2014 /9/2015 E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes describe under ' DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IAttach ACORD 101,Additional Remarks Schedule,It more apace is required) Issued as evidence of insurance. Issued as evidence of insurance. Thielsch Engineering, Inc._ is listed as additional insured as respects General Liability as required by written contract. CERTIFICATE HOLDER CANCELLATION msong@capelighteoupact.org SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Cape Light Compact ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Margaret Song PO BOX 427/SC}i AUTHORIZEDREPRESENrATiVE 3195 Main Street Barnstable; MA 02630 chael Christian/CLC ACORD 25(2010/05) O 1988-2010 ACORD CORPORATION. All rights reserved. INS025(2e1005)ot The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs and Business Regulation -- 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 "Home Improvement Contractor Registration Registration: 171380 Type: Corporation Expiration: 3/14/2016 Tr# 249649 CAPE SAVE INC. _ WILLIAM McCLUSKEY 7-D HUNTINGTON AVENUE SOUTH YARMOUTH, MA 02664 Update Address and return card.Mark reason for change. SCA 1 ti 20M-05/11 Address Renewal Employment Lost Card , CJJ/LC 1�07I[77ta72[IIQCI��O�V'l/CCtJdfG0111CJE�1 Office of Consumer Affairs&Business Regulation License or registration valid for individul use only 0ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 1713g0 Type: Office of Consumer Affairs and Business Regulation Upxpiration: 3/14/2016 Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 CAPE SAVE INC. WILLIAM McCLUSKEY 7-D HUNTINGTON AVENUE SOUTH YARMOUTH,MA 02664 Undersecretary Not vali lthout signature Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor Specialty License: CSSL-102776r WILLIAM J MC C-LUS 37 NAUSET ROAD West Yarmouth AU 0 `N Expiration Commissioner 06/28/2015 THE TOWN OF BARNSTABLE MARNSTLBM NAM 1639. 11 NO BUILO.'ING . .- INSPECTOR APPLICATION FOR PERMIT TO ........13.V.! JAvoo;e......Eiylr .............................. TYPE OF CONSTRUCTION ............\MPA.......Eg.�m.e....................................................... .. ........................19 Eq.... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: 77 6 ....... ............./(-, .. Location ........� .... .................. 4 'L 1 ProposedUse .......1.4 AL2s.1. .................................................................................................................................................. Zoning District ...... .....................................Fire District ...................................................... Name of Owner ......W?Ief ........Address st ...... . ....... .. .. . Name I of Builder J.4d.k.1....C0*44:..... Address ......W).-. W.-.Ao ...bu*ry, Name of Architect ... ...............Address .... . ...... ................................. Number of Rooms .............Lt.. C......................�F�/� oveire-�C— ...............................................Foundation ....... ..... ). ..... .. . . 56' Exterior .................V16.0.).......................................................Roofing ...... .......... Floors ................Vie.0.1............................................................Interior ........ ...... .. .. Heating ..........!49T....... .......................................Plumbing S ..................... Fireplace ...............................................................A pproximate Cost ...........;jc) .................................................. Definitive Plan Approved by Planning Board 9 Diagram of Lot and Building with Dimensions SUBJECT TO APPROVAL OF BOARD OF HEALTH 1 0 f -se F4,*e- 5.11 s4z o ,)00-(. %�e) Ic 00.r Cw— I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. ...... ......... ...................... .................... ....... ... . ' No ................. Permit for .................................... . .—.---~--.-----.---..—.------. � Location ---.--_______^__.______ . ' ^ ^ � . _.—.—.---,...---.—,---~—.--..--- Owner ---_.________.____._____. _ Type of Construction .......................................... � � —.----.—.—.--.---.----.----.--.. � � Pkt ---------. bm ----------.. Permit Granted -------------]9 � � Data of Inspection ----------'—.lR ' Dote Completed ...................................... ` `- � � PERMIT REFUSED � . . Y � � -----'~--'--..---------.. 19 ' � ~~—..---..,...--.—..-----.---.--. ^—~^'—^—^^~~---^~^'---'—^^'---``--' ...................... � —.—...--.~.-.--..----.,—^--'--.—' � ^ Approved � ,-----------.---- lQ � � ' ----'-------------^----^^--- ` , ----------^-------~^—^'—'—^—'- � ' T"E.T°�� TOWN OF BARNSTABLE • BABB9TOIILB, i "�` i639 BUILDING INSPECTOR I 9� `��0 APPLICATION FOR PERMIT TO ................�uild..,Single Family..Dwelling... TYPE OF CONSTRUCTION Wood Frame ................................. ............May ...2.2.....................19�2... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Lot # 5 Gemini Drive West Barnstable, Mass. Location ....................................................................................................................................................................................... Housing ProposedUse ............................................................................................................................................................................. Residential ZoningDistrict ........................................................................Fire District .............................................................................. Welby Const: Co . Inc. - 210 Willow St. W. Roxbury, Mass. Nameof Owner ......................................................................Address .................................................................................... Welby Const. Co . Inc, 210 Willow St. W. Roxbury Ma ss. Name of Builder ........................Address .................................................................................... John Danielson Lexington, Mass. .. . ..... .. ....... .. .... ..... Name of Architect ... . . ... . . . . ..........................Address .................................................................................... Number of Rooms 6 Foundation ....C...oncrete. . . ........(.Full. . Cellar) .. ..... .... .. . . .. .. .. .................................. Wood ........Roofing Asphalt Exterior ................. ....................................................... .. ..................................................................... Floors Hardwood Interior Sheetrock ..................................................................................... .................................................................................... Heating .............Ho t Water ..,,_.....plumbing Copper & Cast Iron 1 1/2 Baths . ........................................ ......................................................:........................... Fireplace ................Brick ......Approximate Cost $20 000 ..:............................................................ :.................................../.............. Definitive Plan Approved by Planning Board -----------__________-_______19 Diagram of Lot and Building with Dimensions • SUBJECT TO APPROVAL OF BOARD OF HEALTH W - 4" --1 Q m DO.. d = � t_n N J Z WELL PF ; WLU IXW ¢ 29.0 � m2 J C> ;s- WLL O .n :E �4 7 (n Q Z. .? H o � Q� .� � CL p m� ul _ z :Lu- •�' 6 o <�(D _ .5FPt1c_ ' r t11 I-- = 2 z rn Q I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construdiori. Name ......... ....... ...................... W�lln/ Co. , Inc. ` | . . . , , ' I l /2 story No —� 3.. Per 'it for ---..��---..-�—.. � � -----...^�--.---.:------��~—.----.Gemimi | D~�,~` > �^`^,= v --6-._. —.--.-------.---------, _.___.___�ent. __----.— � ' Owner C~.� I��o, . i ----'�rr�—.�'��._z _.. . ` . ^ ' Type ofConstruction .............1�?��-----.. ` ' ^ -----.---~---.------------.- � Pk �* � ------.___ Lot _^_�,�______. ^ � � . / i . � Permit �ronh�d May 26 lq 72 � ~ ' � Date of Inspection . /� .. x ' Dote Completed -------------lg . ` - � . / / PERMIT REFUSED ` x --^--^-----...—..------- 19 ` . . � ---.-------------.---------. � . ~ i ^—_—.—.---,—.---.~-----..--~— ...—._—..—.---.—.—,--_—.~~--.—.. ' . ~ ' ` .--------.—..-----.---.—.-----. , Approved ................................................ lg . ` . . ��'��''�'�,��,' � - ------------------------'~'— ' . . . ` |