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0055 HILLIARD'S HAYWAY
Ox�brdNO. 152 1/3 ORA ESSELTE 10% /�3�Sy "`1 � I I a t s� .. NO lO Application numberZ-.19 , . ...... Date Issued...........,� l'Z;Z 1 BARWSTABI.S, n r .....�....................... MASS. g (r AFC n i639• �0 Building Inspectors Initials......... . .MA'S A � .................... rw� Map/Parcel........!:Nj......��y,7 .. ..... .......... .................... TCJ�,���� 'a� kSARN�����. TOWN OF BA STABLE ` ` EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: S S �acc4 S +-Ixy IK V ("J 3a ter, NUMBER STREET VILLAGE Owner's Name: �A n G,;I ( Phone Numbers o _ _ /7� Email Address: Cell Phone Number 7 7,/--qq.1,,.O'og 3 I Project cost$ _____. Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: .5 e �-{{Q cha 00-7(-24 Date: TEE OF WORK ,0,��ding ❑ Windows (no header change)# ❑ Insulation/Weatherization U Doors (no header change)# Z Com mercial nYmercaal Doors require-an inspector Is review Roof(not applying more than 1 layer of shingles) Construction'Debris will be going to W.9 s4e-/na a I eoq� 11 1 C of,,i /� L CONTRACTOWS INFORMATION Contractor's name �t u� ire n.�,so✓� - �,,k�2�� �p / �� ( f rf'n c( S Home Improvement Contractors Registration(if applicable)# 17 3 Z.C{5 (attach copy) Construction Supervisor's License# 7 07 (attach copy) Email of Contractor Phone number V01 z 2 R 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. APPLICATION NUMBER *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 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-4:30pm. Commercial events may require Fire Department approval *WOOD/COAL/PELLET STOVES x Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEARTION 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 CAR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CM[R and the Town of Barnstable. Signature Date PLICANT'S SIGNATURE Signature Date Z- Z 7- /9 All permit applications are subject to a building official's approval prior to issuance. f Renewal Agreement Document and Payment Terms byAndersen. dba:Renewal B Andersen of Southern New England Y pl Patricia Cahill Legal Name:Southern New England Windows,LLC 55 Hilliards Hayway RI#36079,MA#173245,CT#0634555, Lead Firm#1237 West Barnstable,MA 02668 wiNoow NE L1ICEMENT 10 Reservoir Rd I Smithfield,RI 02917 H:(508)362-1799 Phone:866-563-2235 1 Fax:401-633-6602 1 sales®renewalsne.com C:(774)994-0083 Buyer(s) Name: Patricia Cahill Contract Date: 02/15/19 Buyer(s)Street Address: 55 Hilliards Hayway,West Barnstable, MA 02668 Primary Telephone Number: (508)362-1799 Secondary Telephone Number: (774)994-0083 Primary Email: packyc@comcast.net 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: $8,717 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: $2,905 Balance Due: $5,812 Estimated Start: Estimated Completion: Amount Financed: $0 8 to 10 weeks 8 to 10 weeks Method of Payment: Cash/Check 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: Taxes paid in Barnstable, Ma. 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 02/19/2019 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:Renewal B Andersen of Southern New England Buyer(s) Signature of Sales Person Signature, Signature Gino Montesi Patricia Cahill Print Name of Sales Person Print Name Print Name UPDATED: 02/15/19 Page 2 / 11 Fri / �/ZeC�/�'I/�. �CItBIGGGc CJ 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, LLC.:•" Registration: 173245 10 RESERVOIR ROAD Expiration: 09/18/2020 SMITHFIELD,RI 02917 scA , < 20roi•05/17 Update Address and Return Card. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:SuoDlement Card before the expiration date. If found return to: Registration_ Expiration Office of Consumer Affairs and Business Regulation 173245. 09/18/2020 1000 Washington Street-Suite 710 SOUTHERN NEW ENGLAND WINDOWS,LLC Boston,MA 0211 BRIAN DENNISON 10 RESERVOIR ROAD SMITHFIELD, RI 02917 Undersecretary without signature Commonwealth of Massachusetts Division of Professional Lioensure Board of Building regulations and Standards Construct-fon' ' ui pervisor CS-i095707 E P i res : 09/08/2020 CHARLTON MA.-,-0-1507 Commissioner r The Commonwealth of Massachusetts . ;g= Department of Industrial Accidents I Cone ress Street, Suite 100 a Boston, M.4 02114-2017 www mass.;o v/dia tiForkers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PER_Nl1TTLYG AUTHORITY. Applicant Information / Please Print Leeibly Name (Business/Orsanization/Indivtdua(): Oleo �j� ��•1Ar( n( r7 Address: IJ _U Ser UD/r �J `"��----- City/State/Zip:S m t-f�A e-J ( ,R1 ozq 1 7 Phone#: 40/—Z?Z-- � 9 Me yo an employer"Check the appropriate box: Type of project(required): 1. l am aemployer with 17`0+employees(full and/or part-time).* 7. New construction 2. I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.(No workers comp.insurance required.) 1[]I 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 m 10 D Building addition Y Property. l will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 50 I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.❑hoof repairs These sub-contractors have employees and have workers'comp.insurance. 6Q We are a corporation and is officers have exercised their right of exemption per bIGL c. 14. Other j?,0J i'o cf 0o r 152,§1(4),and we have no employees.(No workers'comp.insurance required.] ('l�(Q e--el,n *Any applicant that checks box al must also fill out the section below showing their workers compensation policy information. t Homeowners who submit this affidavit indicating they am.doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those endties have employees. If the sub-con t:actors have employees,they must provide their workers'comp.policy number. 1 am an employer that is p ro W&A Cr workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name:- !resellsT/76(,f 0 tY- Policy#or Self-ins. Lic.#: Wlf A �3 1 S 7 Z Sf1 c-f Expiration Date: —/2 D L.O Job Site Address: S 44, I �i Ard S �/wct y City/State/Zip: W � s-t l�l� Attach a copy of the workers' compensation policy declare on page(showing the policy number and expire on date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A.copy of this statement may be forwarded to the Office of Investigations of the D(A for insurance coverage verification. I do hereby certify under the paini penalties of perjury that the information provided above is true and correct Signature* Date: 2 Phone#: 47 2�9U Official use only. Do not write in this area,to be completed by city or town offciaL City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department J.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: f AC�� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) `.� 1 12/28/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT CoBiz Insurance, Inc.-CO NAME: PHONE 1401 Lawrence St., Ste. 1200 WC.No,Exc: 303-988-0446 ac Not:303-988-0804 Denver CO 80202 ADDRIESS, COMail@cobizinsurance.com INSURE S AFFORDING COVERAGE NAIC# INSURER A:Acadia Insurance Company 31325 INSURED ESLERCO.01 INSURER B: Flremen5 Insurance Company of WA,D.C. 21784 Southern New England Windows, LLC. dba Renewal by Andersen of Southern New England INSURER C: Homeland Insurance Company of New York 34452 10 Reservior Rd INSURERD: 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 ADDL SUBR . POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMIOD/YYYY MM/DDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CPA3158728 1/112019 1/1/2020 EACH OCCURRENCE $1,000,000 CLAIMS-MADE a MAGE OCCUR A PREMISES Ea occurrence $300,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY a PRO- ❑ JECT LOC PRODUCTS-COMPIOP AGG $2.000,000 OTHER: $ A AUTOMOBILE LIABILITY CPA3158728 1/1/2019 111/2020 COMBINED SINGLE LIMIT $ Ea accident 1 000000 X ANY AUTO BODILY INJURY(Per person) $ ALL OW AUTOS AUTOS NED SCHEDULED BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE X HIREDAUTOS X AUTOS PeraccideM $ $ A X UMBRELLA LIAB X OCCUR CPA3158728 1/1/2019 1/112020 EACH OCCURRENCE $15,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $15.000.000 DEO I X I RETENTION$ $ B WORKERS COMPENSATION INCA315872924 1/1/2019 1/1/2020 X PR OTH- AND EMPLOYERS'LIABILITY Y/N STEATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000.000 OFFICER/MEMBER EXCLUDED? ❑N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $t,000,000 I/yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 C Pollution Liability 7930073340000 1/1/2019 1/112020 Each Occurrence $2,000,000 Claims-Made Policy Aggregate $2.000,000 Retroactive Date 06/20/2013 Deductible $25,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be 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(2014101) The ACORD name and logo are registered marks of ACORD Town of Barnstable Permit# E� ir�esJ.6k.�ron# late RegulatoryServices e Richard V.Scali,Interim Director A,Fo��a APR 2 9 1016 Building Division TOWN1' Tom Perry,CBO,Building Commissioner OF BARNS1ry 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL, ONLY p p O Not Valid without Red X-Press Imprint Ma / arcel Number Property'Address l 1 1;Lz A-RdS Ay um-y 9)16 Residential Value Value of Work S ./01 b/ Minimum fee of 535.00 for work under$6000.00 Owner's Name&Address �Q7�/G{� , �J�fjll/l�-lt�s #A f IV AI &*W )6je/ m Bte,R,v Contractor's Name �V [ WS /Sot✓ / Telephone Number Ql)/-2Zr—f't Home Improvement Contractor License#(if applicable)_ 1 7-32- Email: Construdtion Supervisor's License#(if applicable) 0 IJ 7d 7 AWorkrnan's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name 4RQ10X)AL Workman's Comp.Policy# W t�iQa g'Q�g 9 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders.U-Value 60 (maximum3 #of windo s ` #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Mfheie 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: , QAWPFILES\FORMS\building permit forrnslEXPRESS.doc Revised 061313 �TS45 Renewal byArldemm RENEWAL BY AmERSEi y I n40 3SY°•7 26 Albion Road • Uncoln�RI 02865 �o/i}pl toad Firm e123 55 aMOnteCagrr r f1UH►■pMetYUT Phone 866.563.2235•Fax 401.633.6602 redud Taa m weastso Q q-7 Southern New Bagia&d Windows,LLC d/b/a (� Q Renewal by Andersen of Southern New England r ' CUSTOM WINDOW AND DOOR REMODELING AGREEMENT euyrr(,)SamAdita.clay Sem n,a za Curie I V.O.races , r MaaaAdd. - .I.�ai o ttameTekptom twmbl•�Zf/r L vakutepl a e ttwmt���7'y 2gy 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 descri on the front and the reverse of ! the agreement and on the attached specification sheet(a)(collectively,this Agreement"). Historic O Condo O HOA? Tonijob Amount j Fstimsted Surtlq Date Method of payment 06eck O Cash 0 Financed Deposit 0.aehred(33%p azv��arils ' .. Credit Cards am accepted for deposit only-nutdrnun I/3 of tM Balance at Stare of lob(33%): Esumatw completion bate P''0iect coat(Please see Oeds Card Popnera Fwm)By s�thls Ayeem«n.ym adutowledde dw'ihe Bahno at Stare of lob and rite Baance on Subsnrtttd Balance an Subsesmlal Completion of job aunt be nude by credit Completion of job(33%}_T07&co card and must be nude by personal check,bank check or ash. Buyer(s)&green and understands that this Agreement constieetes the entire understanding between the parties,and that there are no verbal understandings changing any of the terms of,this Agreement.Buyer(o)acknowledges that Bayer'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 Bayer's right to cancel this Agreement.DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. (Rhode ldowdSalr&oin&)Notice to Buyers(1)Do not sign this Agreement N any of the spaces intended for the agreed terms to the extent of then av&&ble information are ke8 blank.(2)You are entitled to a copy of this Agreement at the time you sign It:(3)You may at any time pay off the fidl unpaid balance due under this Agreement,and In so doing you may be entitled to receive a partial rebate of the finance and Insurance charges(4)The seller has no right to aalawfuny enter your preasises or commit any breach of the peace to repossess goods purchased under this Agreement.(S)You may cancel this Agreement if it has not been signed at the main office or a branch office of the seller,provided you"aotlly the seller at his or her main office or breach office shown in the Agreement by registered or certified mail;which shall be posted not later than midnight of the third calendar day after the day on which the.buyer signs the Agreement,excluding Sunday and any holiday on which regular mail deliveries are not made.See the accompanying notice of cancellation form for an eaplanadon of boyerts right,. Buyer(a)recei6thnsumer education materiik provided by the Rhode Island.Contractors Registration Board. (Boa's Inidab Renewal laythem N -England Bu ) Buyer(s) By: S; of at Si acuteSignaturc Print Name of Product Manager Print Name Print Name YOU, THE i llyER(S), MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT.. - - - - - - - - - - -x - - - - -- -k- - - - - - NOTiCEOFCANCE!eTtnw - - - -x Date of Transaction You may cancel . Date of Transaction .You may cancel this transaction.whiiout by malty or obligation.within �' this transaction,without any penalty or obligation,within three business dap from rite above bate.If you cancel,any three business days from the above date.If you cancel,any property traded n.any payments made by you under the I property waded in,any payments made by you under the Contract or Safe,and any negotiable instrument executed I Contract or Sale,and any negotiable instrument executed by you will be returned within tan business days following I by you will be returned within ten business days following receipt by the Seller of your cancellation notice.and any i receipt by the Seller of your cancellation notice,and any security interest arising out of the transaction will,be I security interest arising out of the transaction will be canceled.lf you cancel,you must make available to the Seller canceled.If you artcal.you must male available to the Seller at your residence.in substantially as good condition as when i at your residence,in substantially as good condition as when received,any goods delivered to you under this Contract or I received,arty goods delivered to You under"Contract or. Sales or you may,if you wash,comply with the Imtructlons of I Sale or you ma%if you wish.comply with de irtramcdons of, the Seller regarding the retum shipment of the goods at the k the Seller regarding the return shtpn Fit of the goods art" Seller^&expense and risk.'If you do make the goods available I Seller's e> mse and risk.If you do make the goods available to rite Seller and the Seller does not pick them up within to the Sel err and the Seller does not pick them up within twenty days of file data of tnncceilation,you met retain or I twenty clays of like date of caneetlation,you many retain or di of tlha goods without any further obligation.If you I dispose of dw foods without any further obligation.If u fal�maho the goods available to the Seller,or if you agree I fait to make the goods available to the Seller,or if you agree you to return the Roods to the Seller and fall to do say den you l bo return the goods to the Seller and fall to do so,then you refrain liable for perform of all obligations wader the I remain liable r parformanee of all obligations under the Contrwt.To cancel this transaction.mail or deliver as ed Cont mct.To cancel this transaction,mail or deliver a signed and dated copy of dab cancellation notice or any oth , I and dated copy of dds cancellation notice or any other written notice,or send a tal to by n of I written notice,or send a telegram to Renewal byAndersen of Southern Now England at 2 Albion R14 6S, I Southern New England at 26 Albion Road,Lincoln,RI 02865, NOT LATER THAN MIDNIGHT OF I NOT LATER THAN MIDNIGHT OF fDatel i �Du°) HEREBY CANCELTHISTRANSACTIOIC H 1 i EREBY CANCELTHISTRANSACTION. atryerra sin,. Pfto mum Close wee+ rrYs Nance Otte ilbA Copy:White Buyer Copy.Yellow Buyer Copy:Pink I Southern New England Windows d.b.a Renewal by Andersen of SNE '•. ( Massachusetts -Department of Public Safely Board of Building Regulations and Standards onstrucdon Supervisor L,rense: ffitTAN D 1DINK 90N 7 LAAAS POND L'iR Charlton FDA 919 7TIC z %C..e,.C • ,I ,5; Expiration CornTnissioner �R>8d2II16 I i � f Office of Consumer Affairs ind Business Regulation 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement.Contractor Registration Reg•Istratim 17M45 Type: Supplement Card Expiration: 9/1912016 SOUTHERN NEW ENGLAND WIIQDOWS LL DENNISON BRIAN 26 ALBION RD , —— LINCOLN,RI 02865 Update Addr w and remro card.Mark rtasou for cbsuge. Add. E Rme-A Employment [j I.au Card SCAt 0 mu45M ribs�6unue��.c��m+ a tLcr of Coareaar nftun 8 BMW—Rq 40"C' Uteme or registration vAd for iodlridal use onV BdpROVEMHtT CONTRACTOR before the expindion data Iffoand return to: wtpirallon: offs¢of:omnmer;drairs and Brr�Regulation tatlon: 173245 TYPe• 10 ParL•pl=-Suite 5170 9119=16 SuAPlem �n.:14 erd•ward BostA 02116 SOUTHERN NEW ENGLAND WINDOWS LLC. RENEWAL BY ANDERSON DENNISON BRIAN 26 ALBION RD 9_7 � LINCOLN.RI C280 u r. Not votid without siguamre I The Commonwealth of Massachusetts Department of IndustrialAccidents F Office of Investigations I Congress Street, Suite 100 Boston MA 02114-2017 `. ,° www.mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Ledb y Name (Business/Organization/Individual): SOUTHERN NEW ENGLAND WINDOWS Address:26 Albion Rd City/State/Zip:Lincoln, RI 02865 Phone#:401-228-9800 Are you.,pn employer? Check the appropriate box: Type of project(required): 1.0 I atn a employer with 20+ 4. ❑ 1 am a general contractor and I 6 ❑New construction_ employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor orpartner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g- ❑Demolition working for me in an capacity. employees and have workers' g Y p h'- 4 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 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t C. 152, §1(4),and we have no Window Replacement employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box 91 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit tins affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such- tdontractors 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 isproviding workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:ARGONAUT INS. CO. Policy#or Self-ins.Lie.#:WC 928058352394 Expiration Date:8121/2016 P Job Site Address: SJT �/'��� �' / 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�oT GL c. 152 can lead to the imposition 6f 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 surance coverage verification. I do hereby certifu under the ' s and penalties of perjury that the information provide;ah Tis �ue"and correct. Si afore: Date: Phone#: 4012289800 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#• SOUTNEW-01 SHETTYSHT DATE(MMMDM'YY) A`®�® CERTIFICATE OF LIABILITY INSURANCE8119/2015 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). coxracT PRODUCER NAME Willis Certificate Center Willis of New Jersey,Inc. PHONE ff87T 945-7378 �,Nc;(888)467-2378 y AIC No Ext J C/o 26 Century Blvd E-MAIL�( C ates@Willis.com P.O.Box 305 991 NAIC& Nashville,TN 37230-5191 INSURERS AFFORDING COVERAGE INSURER A:Selective Insurance Company of Southeast 3992266 INSURED INSURER B:OneSeacon Insurance Company 19801 Southern New England Windows LLC INSURER C:Argonaut Insurance Company DBIA Renewal by Andersen INSURER D 26 Albion Road Lincoln,RI 02865 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWfTHSTANDOVG ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO HE TERMS, 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. _ POLICY EFF FDUCY EXP LIMITS IIH.TR TYPE OF INSURANCE INS VND POLICY NUMBER MMIDD MMlDD/YYYY ¢ 1,000,00 A X COMMERCIAL GENERAL upai I Y EACH OCCURRENCE S 2029459 0811012015 0 1012016 PREMISES Ea occurrence s 100,nn CLAIMS MADE ®OCCUR 10,000 MED EXP(Any one person) S PERSONAL'&ADV INJURY S 11000,000 GENERAL AGGREGATE S 3,000,000 GEN'L AGGREGATE UMIT APPLIES PER: PRODUCTS-COMPlOP AGG I S 3,000,000 POLICY®JECTT ®LOC Is OTHER:— COMBINED SINGLE LIMIT Is 1,000,000 AUTOMOBILE LIABILITY (Ea arndent S 2029459 0811012015 0$11012016 BODILY INJURY(Per Person) Is A X ANYAUTO BODILY INJURY(Par accident)IS ALL OWNED SCHEDULED H AUTOS PROPERTYDAMAGEc S X NON-OWNED I (Per accident) HIRED AUTOS X AUTOS Is EACH OCCURRENCE S 5,000,00 X UMBRELLA UAS X OCCUR 5,000,000 A EXCESS LIAR CLAIMS-MADE S 2029459 08h 0/2015 08/10/2016 AGGREGATE i s IS DED RETENTIONS X STATUTE 0ER 1 WORKERS COMPENSATION 1,000.00 AND EMPLOYERS*LIABILITY 0000068028 0812112015 08/21/2016 E.L EACH ACCIDENT I s B ANY PROPRIETOWPARTNE RIEXECUTWE Y� NIA EJ DISEASE-EA EMPLO S 1,000,00 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) 1,000,00 If yes,describe under' E!_DISEASE-POLICY UNIT 5 DESCRIPTION OF OPERATIONS below C Workers Compensation C928058352394 0812112015 0812112016 See Attached Additional Remarks Schedule,may be attached If more space Is required) DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, t4pTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. A TTHOORR12FD REPRESENTATIVE Evidence of Insurance p 1g88-4p44 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD i P.D. Box s9 Cotuit, Ma 0263 , C®T U I T' SOLAR 5 508-428-8442 Fax 508-428-8441 t�Vtplbv.`C)t(j So��3r.COi?1 November 20,2014 . Town of Barnstable Regulatory.Services Building Division • I Go��� - � a Lam ' as Principal of Cotuit Solar officially request change the Construction Supervisor's License from Christopher Peterson Vreeland.#107947 on all Cotuit Solarprojects:This change applies to the folio q to 102975 to John building pets in the Town of Barnstable: lowing open solar 250 Windswept Way 4sterviIle 77 Winter St Hyannis 26 Little River Rd Cotuit 170 Capes Trail West Barnstable 55 Hilliard's HayWay West B j 51 ueen Barnstable Q Anne Lane Cotuit 32 Kimberly Way Cotuit U� 340 Vineyard Rd Cotuit . . M Please see attached CSL and supplement �y HIC Iicense for John Vreeland. Pi 'e contact the a Cotuit Solar office with questions or for more information. M Regards, Conrad.Gey set Quality renewable eneirgy systegns U[a,44 :.... ... _ Since IL988. �EnsYa�i€er6c .. CERTIFIED r m ���� D,60gn Installation • SeP'471Ce ..` .. .'... a ermaal �Wbid Conrad Geyser 4' Cert*031409-40 Photovoltaic SolarTh ° . CertAST032407-8 Conrad Geyser DEPARTMENT OF HOMELAND SECURITY-FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B.NO. 1660-0015 COMMUNITY ACKNOWLEDGMENT FORM Expires February 28,2014 PAPERWORK BURDEN DISCLOSURE NOTICE Public reporting burden for this data collection is estimated to average 1.38 hours per response. The burden estimate includes the time for reviewing Instructions, searching existing data sources,gathering and maintaining the needed data,and completing and submitting the form. This collection Is required to obtain or retain benefits. You are not required to respond to this collection of information unless a valid OMB control number is displayed on this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing this burden to:Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency, 1800 South Bell Street,Arlington,VA 20598-3005,Paperwork Reduction Project(1660-001S). NOTE: Do not send your, completed form to this address. This form must be completed for requests involving the existing or proposed placement,of fill(complete Section A)OR to provide acknowledgment of this request to remove a property from the SFHA which was previously located within the regulatory floodway(complete Section B). This form must be completed and signed by the official responsible for floodplain management in the community. The six digit NFIP community number and the subject property address must appear In the spaces provided below. Incomplete submissions will result in processing delays.Please refer to the MT-1 instructions -- -ror'addiiionai'information-about this form. Community Number: Property Name or Address: A. REQUESTS INVOLVING THE PLACEMENT OF FILL As the community official responsible for floodplain management,I hereby acknowledge that we have received and reviewed this Letter of Map Revision Based on.Fill(LOMR-F)or Conditional LOMR-F request. Based upon the community's review,we find the completed or proposed project meets or is designed to meet all of the community floodplain.management requirements,including the requirement that no fill be placed in the regulatory floodway,and that all necessary Federal,State,and local permits have been,or in the case of a Conditional LOMR-F,will be obtained. For Conditional LOMR-F requests,the applicant has or will document Endangered Species Act(ESA)compliance to FEMA prior to issuance of the Conditional LOMR-F determination.For LOMR-F requests,I acknowledge that compliance with Sections 9 and 10 of the ESA has been achieved independently of FEMA's process.Section 9 of the ESA prohibits anyone from"taking"or harming an endangered species. If an action might harm an endangered species,a permit is required-from U.S.Fish and Wildlife Service or National Marine Fisheries Service under Section 10 of the ESA. For actions authorized,funded,or being carried out by Federal or State agencies,documentation from the agency showing its compliance with Section 7(a)(2)of the ESA will be submitted.In addition,we have determined that the land and any existing or proposed structures to be removed from the SFHA are or will be reasonably safe from flooding as defined in 44CFR 65.2(c),and that we have available upon request by DHS-FEMA,all analyses and documentation used to make this determination. For LOMR-F requests,we understand that this request is being forwarded to DHS- FEMA for a possible map revision. Community Comments: p f,4ce P2,o/2 - D Com unity Official's Name and Title: (Please Print or Type) Telephone No.: Community Name: ccmmunit 0 cial's Si ature: (required) Date: 1�k 9 )-46 l2_ B. PROPERTY LOCATED WITHIN THE REGULATORY FLOODWAY As the community official responsible for floodplain management,I hereby acknowledge that we have received and reviewed this request for a LOMA. We understand that this request is being forwarded to DHS-FEMA to determine if this property has been inadvertently included in the regulatory floodway. We acknowledge that no fill on this property has been or will be placed within the designated regulatory floodway. We find that the completed or proposed project meets or is designed to meet all of the community floodplain management requirements. Community Comments: _Community Official's Name and Title: (Please Print or Type) Telephone,No.: Community Name: Community'Official's Signature(required): Date: ' DHS-FEMA Form 086-0-268,FEB 11 Community Acknowledgment Form MT-1 Form 3 Page 1 of 1 Sullivan Engineering Inc. I Parker Road,P.O. Box 659 Oste rville,MA.02655. Peter Sullivan P.Z.Mass Registration No:29733 phone 508-428-3344 fax 508-428-9617 peter(asullivanen " .com 1Vlarch 10, 2014: LOMC Clearinghouse..* 847"South Pickette.Street-' - Alexandria VA 22304-4605 ATTN LOMA.Mang# Re: . LOMA Request " 55 Hilliard's Hayway.West Barnstable MA 02668 Community.Name::Town.of Barnstable;.Barnstable'County.MA .. 'Dear LOMA Manger, Please find attached the following information for the above:referenced property. Property Information Form MT-1 (two-sheets) Elevation Form MY 1.(two sheets) :FIRM '250001.0011 D Portion of FRI1Vi 250001 001 I'D..showing locus. -Copy of Deed(attested) -Copy.of Subdivision Plan(attested) I trust that his.meets your present needs and if you have,any:questions please feel,free to call,fax or a-mail this office... Kyyours Peter Sullivan PE Sullivan Engineering, Inc. cc: Ms.Cahill Members of American Society of Civil Engineers and Boston Society of Civil Engineers Section DEPARTMENT OF.HOMELAND SECURITY-FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B.NO.166i-001S PROPERTY INFORMATION FORM.: ExPi—February 28,2014 PAPERWORK BURDEN-DISCLOSURE.NOTICE Public reporting burden for this data collection is estimatedto average L63 hours.per response.The burden estimate includes the time for reviewing instructions, searching existing data sources,gathering and maintaining the needed data,and completing and submitting the form. This collection is required to obtain or retain .benefits. You are not required to respond to this collection of information unless a valid OMB control number is displayed on this form.Send comments.regarding the accuracy of the burden estimate and any suggestions for reducing this burden toAnformation Collections Management,Department of Homeland Se rity,:Federal. Emergency'Management Agency,1800South Bell Street,Arlington,VA 20598-3005,Paperwork Reduction Project(1660-001S). NOTE:Do not send vour completed form to.this address. This form may be completed by the property-owner,property owners agent,licensed land surveyor,or registered'Professional engineer to support a request for a .Letter of Map Amendment(LOMA),Conditional Letter of Map Amendment.(CLOMA),Letter of Map Revision Based on Fill(LOMR-F),or Conditional Letter of Map Revision Based on Fill(CLOMR-F)for existing or proposed,single or multiple lots/structures. In order to process your request,all information on this form-must be completed in Rsenvrety.unless statedasootional. Incomnletesuhmiseinw�..,ru.a�..r.:. .... _ LOMA A letter from DHS-FEMAstatingthat an existing structure orparcel of iand that has not been elevated by-fill(natural grade).would not be inundated by the base flood. ❑ CLOMA A letter-from'DHS-FEMA stating that a proposed structure that is not to be.elevated by fill(natural grade)would not be inundated by base flood if built as proposed. ❑-LOMR-F A letter from DHS-FEMA stating that an existing structure or parcel of f land that has been elevated by fill would not be inundated by the baseflood: A'letter from DHS-FEMA stating that a parcel of land or CLOMR-F .proposed structure that will be elevated by fill ❑ would not be inundated by the base.fiood.if-fill is placed on the parcel as-proposed.orthe structure is built as proposed. Fi/I is defined as material from any source(including the subject property)placed that raises the ground.to or above the Base Flood Elevation(BFE).The common construction practice of removing unsuitable existing material(topsoil)and backfilling with:select structural material is not considered the.placement of fill if the practice does not alter the existing(natural grade)elevation,which is at or above the BFE. Fill that is placed before the date of the first National Flood Insurance Program(NFIP)map showing the area in a Special Flood Hazard Area(SFHA)is considered natural grade. Has fill been placed on your property to raise CA Ccpk ground that was previously below the BFE? Yes ❑ No If yes,when was fill placed? J.AAA / k9iMD. Will fill be placed on your property to.raise month/year ground that is below the BFE? ❑ Yes* No If yes,when will fill be placed? / month/year . `If yes,Endangered Species Act(ESA)compliance must be documented to FEMA prior to issuance of the CLOMR-F determination(please refer page 4 to the MT-1 instructio.ns). 1. Street Address of the Property(if-request is for multiple structures or units,please attach.additional.sheet'referencing each address and enter street names below): S AA o ZAGS 2. Legal description of Property(Lot,Block,Subdivision or abbreviated description from the Deed): Lo i 5 314 Sa AS 500W-J-sA or..k SulSo\VtsliD�q c�e.l.,� 13�C�ow pY4o� y�riS�-9 Jes,_� 19—pj 3. Are you requesting that a flood zone determination be completed for(check one i^tQ� Structures on the property? What are the dates of constructi ?V AA I.M (MM/YYYY) ❑ A portion of land within the bounds of the property?(A certified metes an ounds escription and map of the area to be removed,certified by a licensed land surveyor or registered professional engineer,are required.For the preferred format of metes and bounds descriptions,please refer to the MT-1 Form 1 Instructions.) ❑ 7-he entire iegaiiy recorded Propertv? 4. Is this request for a(check one): KSingle structure ❑ Single lot ❑ Multiple structures(How many structures are involved in your request?List the number. _J ❑ Multiple lots.(How many lots are involved in your request?List the number:' ) DHS-FEMA Form 086-0-26,FEB 11 Property Infonrnation Form IYT-1 Form 1 Page 1 of 2 i - In addition to this form(MT-1 Form 1),please complete the checklist below. ALL requests must include one copy of the following: Copy of the effective FIRM panel on which the structure and/ocproperty.location has been accurately plotted(property inadvertently lomted in the NFIP regulatory floodway will require Section B of MT-1 Form 3) j Copy of the Subdivision.Plat Map forthe property(with recordation data and stamp of the Recorders Office) OR Copy of the Property Deed(with recordation data and stamp of the Recorders Office),a—mponied by a.tax assessors map or other certified map showing the surveyed location of the property relative to local streets and watercourses. The map should include at least one street intersection that.is shown on the FIRM panel. AForm 2—Elevation Form. If the request is to remove the structure,and an Elevation Certificate has already been completed for this property,it may be submitted in lieu of Form 2. If the request is to remove the entire legally recorded property,ora portion thereof,.the lowest lot•elevation must be provided on Form 2. Please include a map scale and North arrow on all maps submitted. For LOMR-Fs and CLOMR-Fs,the following must be submitted in addition to the items listed above: Form 3—Community Acknowledgment Form For CLOMR-Fs,the following must be submitted in addition to the items listed above: ❑Documented ESA compliance,which may include a copy of an Incidental.Take Permit,an Incidental Take Statement,a`not likely to adversely affect" determination from the National Marine Fisheries Service(NMFS)or the U.S..Fish and Wildlife Service(USFWS),or.an official letter from NMFS or USFWS concurring that the project has"No Effect"on proposed or.listed species or designated critical.habitat Please.referto the MT-1 instructions for additional information. Please do not submit original documents. Please retain:a copy of all submitted documents for your records. DHS-FEMA encourages the submission of all required data in a digital format(e g.scanned documents and images on Compact Disc[CD)). Digital submissions help to further DHS-FEMA's Digital Vision and also may facilitate the processing of your request. Incomplete submissions will result in processing delays.For additional information regarding this form,including where to obtain the supporting documents listed above,please refer to the MT-1 Form Instructions locatedat Processing Fee(see instructions for appropriate mailing address;or visit the most current fee schedule) M A. Revised fee schedules are published periodically,but no more than once-annually,as noted in the Federal Register. Please note: single/multiple lot(s)/structure(s)LOMAs are fee exempt. The current review and processing fees are listed below: Check the fee that applies to your request: ❑$325(single lot/structure LOMR-F following a CLOMR-F) F ❑$425(single lot/structure LOMR-F) ❑$500(single lot/structure CLOMA or CLOMR-F) ❑$700(multiple lot/structure LOM1R-Ffoila,r:? a,a�M3-F,or�4iuitip!e l_t%structure CLQiUA) ' ❑$800(multiple lot/structure LOMR-F or.CLOMR-F) Please submit the Payment Information Form for remittance of applicable fees. Please make your check or money order payable to: National Flood Insurance Program, All documents submitted in support of this request are correct to the best of my knowledge. I understand that any false statement may be punishable by fine or imprisonment under Title 18 of the United States Code,Section 1001. Applicant's Name(required): ��'['P,%e.w% A, 01. ;k (L;E. . Company(if applicable): N A% Mailing Address(required): Daytime Telephone No.(required): E-Mail Address(optional):aBy checking here you may receive - F correspondence electronically at a: tional):the email address provided): - Date {(required) 'R CZ�E o 'Z b\4 S. nature of Applicant(required) DHS-FEIVIA Form 066-0-26,FEB 11 Property Information Form 116T-1 Form 1 Page 2 of 2 DEPARTMENT OF HOMELAND SECURITY-FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B.NO.1660-W15 :ELEVATION FORM Expires February 28,2014 PAPERWORK BURDEN DISCLOSURE NOTICE Public reporting burden for this data collection is estimated to average 125 hours per response. The burden estimate includes the time for reviewing instructions, searching existing data sources,gathering and maintaining the needed data,and completing and submitting the form. This collection isrequired to-obtain or retain benefits. You are not required to respond to this collection of information unless a'valid OMB control number is displayed on this form. Send comments regarding the accuracy of.the:burden estimate and any suggestions for reducing this-burden to:Information Collections Management,Department of Homeland Security,Federal Emergency Management Agency,1800.South Bell Street,Arlington,VA 20598-3005,Paperwork Reduction Project(1660-0015). NOTE:Do not send;your completed form to this address. _ This form must be completed for requests and must be completed and signed by a registered professional engineer or licensed land surveyor. A DHS-FEMA National Flood InsuranceProgram(NFIP)Elevation Certificate may be submitted in lieu of this form for single structure requests. For requests to remove a structure on natural grade OR on engineered fill from the Special Flood Hazard Area(SFHA),submit the lowest adjacent grade(the lowest ground touching the structure),including an attached decf:or garage.,For requests to.remove an entire parcel of land from the SFHA,provide the lowest Int aIpigtinn• =-•`=`'=-=c�==��_c.-�c:bra ��+rue.:-sy`r�-e-�aru-i;ounus',=pro6ioeinelowes elevation vrithm e metes andbounas description.All measurements are to be rounded to nearest tenth of a foot In order to process-your request,all information on this form must be completed in its entirety.description. m submissions wilt result in processing delays. .1. NFIP Community Number. Property Name or Address: 'S S "•.I<Li 46c-0 x`,V AX,N f -.T sAarosm 2S000 KA- . oZCv4.6 2. Are the elevations listed below based On existing o.r ❑proposed conditions? (Check one) .3. For the existing or proposed structures listed below,what are the types of construction?.(check all that apply) ❑crawl space®slab on grade basement/endosure (�]other(explain) �A LK�+t+ 4. Has DHS-FEMA identified this-area as subject to land subsidence or uplift?(see instructions) ❑Yes gJ No If yes,what is the date of the current re-leveling? / (month/year) S. What is the elevation datum?X NGVD 29 Q NAVD 88 ❑Other(explain) If any of the elevations listed below were computed using a datum different than the datum used for the effective Flood Insurance Rate Map (FIRM)(e.g.,NGVD 29 or NAVD 88),what was the conversion factor? Local.Elevation+/-ft.=FIRM Datum 6. Please provide the Latitude and Longitude of the most upstream edge of.the structure(in decimal degrees to the nearest fifth decimal.place): Indicate Datum: ❑WGS84 ❑WD83 .;S NAD27 Lat.4 J 11M.1k Long. "t O 3a(oa7 Please provide the Latitude and Longitude of the most upstream edge of the property(in decimal degrees to the nearest fifth decimal place): Indicate Datum: ❑WGS84 D.NAD83 NAD27 Lat.4` 7. 307SLong. 70 .38.`.'r 3 Lowest Address Lot Number Bloc Lowest Lot Adjacent, Base Flood Number Elevations Grade To Elevation BFE Source Structure. .... -.... - . _. . . S�N.iu.� As 31 32. �3 .o \\ •a0 F M11A zSct� W thA sMg -6 I"104 This certification is to be signed and sealed by a licensed land surveyor,registered professional engineer,or architect authorized by law to certify elevation information. All documents submitted in support of this request are correct to the best of my knowledge. I understand that any false statement may be punishable by fine or imprisonment under Title 18 of the United States Code,Section 1001. Certifier's Name: �� License No.: '26 3 Expiration Date:d G /3b Company N me: Tele hone No.: Email: �� Fax No: exec- v� cewl - 28-94p 1"7 =r,� Sig e: Gate: m� ry. i r I dr�d.`q :i' TO t{�� �t� �. :at kth fl' •For requests involving a portion of property,include the lowest ground elevation within ' the metes and bounds description. 3 Please note:If the Lowest Adjacent Grade to Structure is the only elevation.provided,a determination will be issued for the structure only. DHS-FEMA Form 086-0-2GA,FEB 11 Elevation Forth MT-1 Form 2 Page 1 of 2 Continued from Page L Lowest.Lot Lowest Adjacent . Address Lot'Number Block Number Grade To Base Flood Elevation' Structure Elevation BFE Source ' This certification is to be signed and sealed by licensed land surveyor,registered professional engineer,or architect authorized by,law to cerijfi+chvatiea -info!ratianc Albdc_-uments submi-Lted.ie Support of£5is request are iio ect to ihe'best cf my knowledge."I understand that'any false statement inay be punishable by fine or imprisonment under Title 18 of the United States Code,Section 100E Certifier's Name: License No.: Expiration Date: Company Name: Telephone No.: Email: Fax No. Signature: Date: `For requests involving a portion of property,include the lowest ground elevation within the metes and bounds description. �I ccnl I-pt; n I[N Please note:If the Lowest Adjacent'Grade to Structure is the only elevation provided,a 0 Ma determination will be issued for the structure.only. I OHS-FEMA Forth 08"-2oA,FEB 11 Elevation'Form MT-1 Forth 2 Page 2 of 2 �n •\ \ ;' _ 7 i L fix.' '•�. ATl0NALFU0D_INSURAN4E_PR06RARI FIM :FLOOD INSURANCE RATE MAP \\ \\ ,:TOWN OF - - RM22 .BARNSTABLE,. 0,0 x ; M,A:SSACHUSETTS BARNSTABLE - 9AV�q - T� 9 0 L PANEL 11OF25 q �C p �SPE IYFIHOEII FOP I�t1EL6 Not%11NRD1 ` O . ,QO� _ �! o •rw.ur wmsoutu unman ouonm a - • • - . �®woueva nr�w•srs� COMMUNITY-PANEL NUMBER 250001 0011 Q ' MAP REVISED: ZONE E C JULY2.1992 LO�'V5 'r� >> _ F > � =t ELEVATION REFERENCE MARKS 2ii '��`' RFFFRFnIr:F EI_.EV4TION _ - - _ � i _ . ,z ..r•sue-.r���, MARK• IN FT.(NGV.D) DESCRIPTION OF LOCATION w RM 19 <_. _5.74 Chiseled square_In co ppaoximately 350r.b t east 2 feet north of CONRAIL.'ttacks-anda of CON RAIC crossing at' tate puts 6A "` RM 20 21:64 Chiseled s-quare'on"stone header on Parker Street atBfidge'Creelc, gxw yy ' adjacent to pole 91/11. --- - - RM 21 • 23.32 Corner of,Massachusetts,highway bound on south side of State Route 6A-at intersection with Willow Street.-'- - - - RM 22 33.26 Chiseled square on top of granite boulder,20 feet southeast of cen- terline of Sandy Neck Road at intersection with Leonard Road and . - 40 feet-southwest of pole 4: RM 23 15.67 Chiseled.square,in granite header on north side of State Route 6A 50 feet east of junction with High Street. RM 24 10.25 Chiseled square on top of boulder 8 feet west of stone monument at northwest corner of the intersection of State Route 6A and Howland Road. 'National Geodetic Vertical Datum of 1929. Bk 1741B P9328 �91671 08-07-2003 a 1 1 2 20m QUITCLAIM DEED Property Address: 55 HilHards Hay�yay:West Barnstable,Massachusetts 02668 Barnstable,Massachusetts 02668 _ ._�_.._... .:_ ... r ...•_ .., _J.._ C__.__— -',''-.-__-,._,.1 AA/1 AA IQQ^N► !Vl(1 M\ r,%-11.— Ior consideration paid of V inc niuiu►vu Sevcrtty 1 ttvuJatiu vv/,vv vv>r v,vvv.vvJ ✓vAAa O Grant to Patricia A. Cahill, individually,of 212 S.Monroe Street,Denver Co. 80209 With Quitclaim Covenants The land and buildings thereon in Barnstable, Barnstable County, Massachusetts, bounded and described as follows: Being shown as Lots 31 and 32,containing an area of 75;230 square feet;more or less, on a plan entitled"Subdivision Plan of Land in West Barnstable,Mass. and East Sandwich, Mass. Designed for Point Hill Realty Trust, Petitioned by Crowell &Taylor Corp.,Yarmouthport;Mass.,Scale: 1 100',July 1971"said plan being duly recorded in Barnstable County Registry of Deeds in Plan Book 249,Page 107. Said Parcel is now known as and numbered 55 Hilliards Hayway, W. Barnstable, MA 02668 Said Parcel is conveyed subject to rights;easements and restriction of record insofar as same are in force and applicable. For title reference see deed recorded June 19, 2003 Barnstable County Registry of Deeds _ Book 17.1.15, Page_ 160...___. _ Executed as a sealed instrument this 7th day of August, 2003. Z� Mather ® o Deborah A. Mather T1 O O I C+.3 1 CJ CJ CJ O 1 -A 42 ! CJ rJ CJ Y� ~ VJ� �11 O O 0 8 C3 E;lc 174'1$ Ps329:` �9ifs71 C0lV M0NVVEALTH OF MASSACHUSETTS August:7;2003 Bamstable,ss: — --. d§45h:all-y,appe_ared-t�e.atio�e_narried.Ietlzey�. Mather.and veaoran� rviatner ana -- acknowledged•the foregoing°instrument to be their free-act and:deed;;before me, 0 -' ssion Expires ' r- . _ Riilkiwatraotc bsyUPv REGISTRY OF DEEDS.- A TRUE COPY,ATTEST ` - JO HN R MEADE,REGISTER,. BARNSTtABlE REGISTRy.Of DEEDS � > Town of Barnstable *Permit# Expires 6 mouths from issue date Regulatory Services FeeRAMSTABIA d Thomas F.Geiler,Director Building Division �j Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERNUT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address Residential Value of Work /P-0,Ono Minimum fee of$35.00 for work under$6000.00 i II -- '. Owner's Name&Address P a4a ict4_ Gi/ll-i/ o9- Contractor's Name £ AL4 s C+42p A,-'2 5 Telephone Number Home Improvement Contractor License#(if applicable) �(p ®�� �* In c o m m. fr- Construction Supervisor's License#(if applicable) —7�a :�Ll MAR 0 7 2012 ZWorkman's Compensation Insurance Check one: ❑❑ I am a sole proprietor TOWN OF BARNSTABLE I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name A/17 7-0n 46Ze1A q E; t)&-4Ue_1 ZT vt s&eZ4 n< Workman's Comp.Policy# W G 1 331v 9 0*7 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side c� n / #of doors J�Replacement Windows/doors/sliders.U-Value/�NdI25£N (maximum.35)#of windows /3 *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: C:\Users\decollik\AppDataEocal\Microsoft\Windows\Temporary Internet Files\Content.0utloo DV87AAZ\E)PRESS.doc Revised 072110 f i ti 1 - The Commonwealth of Massachusetts Department of Industrial Accidents i' Office of Investigations 600 Washington Street a Boston,M4 02111 Workers' Compensation Insurance Affidavit: Builders/Contractors Electidcians/Plumbers Applicant Information Please Print Legibly Name Musuiess/Organi ationquilivi luai): Address: l t 1 P- M og4,k) Sf. U K) 1-T 18 City/state/Zip: S7i_(2Vt LL Phone Are you an employer?Check the appropriate box. Type of project(required): lX I am —[ a ern to er with /� 4. ❑ I am a general contractor and I 6_ ❑ P y New construction employees(full and/or past-time)s have hired the sub-contactors 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have S. ❑Demolition working for me in any capacity. employees and have workers' 9. [:]Budding addition [No wm1mrs'comp.insurance COW.insurance. required-] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LEJ Plumbing repairs or additions myself[No workers'Comp. right of exemption per MGL 12)KRoof repairs insinance required.]' c.. 1.52,§1(4),and we have no employees.[No workers' 13.0 Other comp-insurance required_] •Any applicant that checks bum#1 nmst also fill our the section below sbawing their wwkers'compensation policy information- Homeowners homeowners who submit this affidavit indicating they are doing all want and then bite outside contractors mast submit a new affidirm indicating sum - kontmcrors that cbech this box must attached an additional sheet showing the name of the sub-conmctors and state whether at art those entities have employees. Ifthe sub-contractors We employees,theymust'provide their workers'comp.policy number. I anal ata eutpheP that is prot4ding tverkers'corrtpettsrrtion iarsairnnce jot iriLs erttpinTees. Below is Htepofac> rind job site informa don. Insurance Company Name: 6 aa-Nrr S MJAJSu/LArIJC`t Polity f,or Self-ins-Lic.#: (,J C-s Expiration Date:. S /� s �` w rl Ci FStatelz- : & I� /', t A. Job Site Address: c � � - ty, �= t�9�tl� '�_ ��t 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$1,300.00 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 cerrhfy anderr�the pains and penalties ofpet,ury that the informa&n proWdedabetv is ime and correct Signature: -.-- Date: �O Phone#- S� ' L -- 3/6 S Official use only. Do not write in this area,to be completed ky,city or town off City or Town: PermitfLicense# 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 M - _ - 6 Client#:12032 2BISHOPRICST ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 02/29/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CtRTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Dowling&O'Neil PHONE E�rt:508 775-1620 5087781218 Insurance Agency E-MAIL ac,No 973 lyannough Rd., PO Box 1990 ADDRESS: Hyannis, MA 02601 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:National Grange Mutual Insuranc INSURED INSURER B The House Carpenters, Inc. 1112 Main Street, Unit 18 INSURER C: Osterville, MA 02655 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE"ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUB LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS A GENERAL LIABILITY (MMMPJ3369M 3/09/2012 03/09/2013 EACH OCCURRENCE $1 00O 000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea NT D nee $500 000 CLAIMS-MADE a OCCUR MED EXP(Any one person) $10 000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 PRO- POLICYEl J CT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ UMBRELLA LIAB 11OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION WCJ3369M 3/09/2012 03/09/201 X WC STATU- OTH- AND EMPLOYERS'LIABILITY OFFICER/ME BER EXCLUDED? ANY PARTNER/EXECUTIVEa N/A E.L.EACH ACCIDENT $500 OOO Mandatory In If yes,describe under E.L.DISEASE-EA EMPLOYEE $500 OOO DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1 s500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) Operations performed by the named insured subject to policy conditions and exclusions. CERTIFICATE HOLDER CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL -BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE, ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S92900/M92899 LS1 6T' �o„�,wouaealllz �✓t �l Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration-4168461 Type: 10 Park Plaza-Suite 5170 Expiral�o 3- Supplement Card Boston,MA 02116/ THE HOUSE"CARPENT;ERS=SIN. ; WILLIAM SCHMITrZ 1112 MAIN a UNI'Tr18 OSTERVILLE,MA 0 Undersecretary Not vali thout signature +� Massachusetts - Dcpurtment of PUliliC Safctl Board of Building Rc�gulittions and Standards Construction Supervisor License License: f�S 76571 WILLIAM L SCHMITZ 66 CARAVEL DR HATCHVILLES,MA 02536 Expiration: 9/9/2013 (l nunissiunci Tr#: 3843 �{,1lIE HAN'�STABL$ `down of Barnstable .Regulatory Services ft Thumas F. Geilcr;Director .Building Division ThoiTIas ferry,CDO Building Commissioner 200 Nfain Street, Hyannis. MA 02601 ��`N'RaO K'1!.bur 11 s 18IT I e.�n a.tl s Office. 508-862-4038 Pax: 508-7W-6230 Property Owner Must Complete and Sign This Section. If Usino A Builder 0 7 , w4 ()weer of the -ubpect pxoperty :1uThorize__LAJ L 1> tee act on i11; be atf, in all rna hers rclarivc to work authorized by !.dais b ilding pertnir aj piicatlon for. (Addt.c-sg of job) S� 1ature of.Owner rJahe lffrojwrtv.Owner.is applying for permit,pieasc complcte the Homeowners License Exemption Fore on the reverse side. C:=tiUs•:r�r!eccllik'v'apt+Cata�.t.n:ate,llierrr�,f11C1���aJa�vs1'L�mpucen�Int:mceFil Con►cn..Q:cclrMk',hn�'�;,�,`a1�V�K�SS.Joc Revised 072110 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 3 co Parcel NIT. , App lication # 1 a Health Division Date Issued It Pd Conservation Division Application Feed Sy8 Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis �m Project tre t Address —bn NM.Yd�� �CJAL I Village tltsi I v�s Owne ICI ( I r . Address � fbh(otroi(s H01V Q Telephone ,�?' Per it Request (a `'� �Al Ck r Q �� M' fe F Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuationl5i c6onstruction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. 'D Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No I Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new p 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 22 O Central Air: ElYes ❑ No Fireplaces: Existing New Existing Wood?o ,l stove:c YeJ�7 No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ r�Qw e_ .� Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: � r � o Zoning Board of Appeals Authorization ❑ .Appeal # Recorded ❑ , m w Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name V�I l/�� Telephone Number (503— Ad ress License# /®a9 76 - l�< </ 35 Home Improvement Contractor# �TC9 7 (a Lin Worker's Compensation # 003 %' < 5 (n ALL CONSTRUCTION DEBRIS RESULTING QM�THIS PROJECT I,9 BE TAKEN TO �-i 11 SIGNATURE DATE, / FOR OFFICIAL USE ONLY 'APPLICATION# -DATE ISSUED MAP/PARCEL NO. �-- ADDRESS VILLAGE OWNER " DATE OF INSPECTION: FOUNDATION FRAME INSULATION - FIREPLACE ELECTRICAL: ROUGH FINAL f f PLUMBING: ROUGH ;.' FINAL GAS: ROUGH FINAL - FINAL BUILDING • � t DATE CLOSED'OUT, - { ' ASSOCIATION PLAN NO:3� �Y f The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations .600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information 0=4 1 Please Print Le ibl Name (Business/Organization/Individual): Address: City/State/Zip: 6L� Phone#: - `fo�K—E Are yo an employer? Check the appropriate box: Type of project(required): 1. 1 am a employer with 1 OC 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition workingfor me in an capacity. employees and have workers' Y p �'• 9. ❑ Building addition [No workers' comp.insurance comp. inswance.t required.], 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself ' right of exemption per MGL Y �o workers comp. 12,❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13. ther uCJ C comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information, t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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 isproviding workers'compensation insurance for my employees. Below is thepolicy andjob site information. Ora 3fa�� Tos W ^^ r) Insurance Company Name: // -- / (yidL JCS Policy#or Self-ins.Lie.#: � 9 / 62 I Expiration Date: o� Job Site Address: 65 Al I i a IL64City/State/Zip: !gryi /1, 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$250.0.0 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 co erage verification. I do hereby certify u e pains an enalties rjury that the information provided above is true and correct. Signature: Phone#: Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: ' 1 i 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-contractors)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 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 burn 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.gav/dia i ACORD�, CERTIFICATE OF LIABILITY INSURANCE1. 06/(16/2010 ' 1 PRODUCER (781) 312-7206 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Don Bunker Insurance en ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE. `a'g HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 51 Mill St Bldg. F ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PO Box 221 Hanover MA 02339- INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERiCNautilus Inc Co. Cotuit Solar LLC INSURERB:Aibella Protection 3800 Falmouth Road INSURER C:Granite State Insurance INSURER D:. Marston Mills 'MA . 02648— , INSURERE: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L„R NgRp TYPE OF INSURANCE POLICY NUMBER �DAUTE(MMIDCY�D�DATE(MMIDP EXPIRATION LIMITS A X GENERALLIABIUTY NK026707 06/01/2011 06/01/2012 EACH OCCURRENCE $ 1,000,000 X COMMERCLAL GENERAL LIABILITY DAMAGE TO RENTED 5O OOO PREMISES Ea ox aww $ , CLAIMS MADE Fx_�OCCUR / / / / MED EXP Any one pmon $ 5,000 PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AL $ 2,000,000 POLICY JECT LOG / / / / B AUTOMOBILE LIABILITY 26916400003 04/30/2011 04/30/2012 COMBINED SINGLE LIMIT ANY AUTO (Eaa��) $ 1,000,000 ALL OWNED AUTOS / / / / BODILY INJURY (Per person) $ X SCHEDULEDAUTOS X HIREDAUTOS / / / / BODILY INJURY $ X NON-OWNED AUTOS (Per aaddent) PROPERTY DAMAGE $ (Per a=der t) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANYAUTO / / / / OTHER THAN EAACC $ AUTO ONLY: AGG $ A X ExCEssruMBREI LA LIABILITY AN001320 06/01/2011 06/01/2012 EACH OCCURRENCE $ 2,000,000 X OCCUR CLAIMS MADE AGGREGATE $ 2,000,000 $ DEDUCTIBLE / / / / $ X RETENTION $10,000 $ C WORKERS COMPENSATION AND WC 003-49-5161 03/26/2011 03/26/2012 X I VYC TATU oTH- EMPLOYERS LIABILITY TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICERJMEMBERIXCLUDED?, E.L.DISEASE-EA EMPLOYEE$ 500,000 If yes,downbe under SPECIAL PROVISIONS below EL DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONSIL.00ATIONSNENCLES/EXCLUSIONS ADDED BY ENOORSEMENTISPECIAL PROVISIONS Solar Heating Contractor Installation of solar panels *AGGREGATE LIMIT APPLIES PER PROJECT Additional Insured: Massachusetts Clean Energy Technology Center, the owners 6 as applicable the host customer. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES.BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT Massahcusetts Clean Energy FAILURE TO DO SO SHALL IMPOSE NO OBUGA71ON OR LIABILITY OF ANY KIND UPON THE Technology Center INSU ITS A R REPRESENTATIVES. 55 Summer Street, 9th Floor AUTHo. . Boston MA 02110- ou'4& ACORD 25(2001108) 0 ACORD CORPORATION 1988 T,:INS025 pioa).w ELECTRONIC LASER FORMS,INC.-(B00)327 W Page I of �I E, 'Town of Barnstable • Y Regulatory Services Y �an MASS. Thomas F.Geiler,Director Eo;p. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 568-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, GZ , as Owner of the subject property h eby authorize—L�'!ir� Cc /�- r' to act on my behalf, in all matters relative to work authorized by this building permit application for: S (Address of Jo o 617Z /C Si ature of Owner Date . i Print me If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. QTORMS:OWNERPERMISSION Town of Barnstable - OF THE T� Regulatory Services " Thomas F. Geiler,Director » aAMITMBLE, « 9� 14`A s9. Building Division i6 �0 ' ArFO MA't A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 10B LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town ? state , r zip code V. The current exemption for"homeowners"was extended to-'include owner-occupied'dwel'Iirisfiof six units or less and to allow homeowners to engage an in2lividual for hire,who-does'•noj,p�ssess 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 inla two-year period"shall not be considered a homeowner. Such "homeowner"shall submit to the Building Offcial on"4,1 rrn asceptabl�e'to the.Buitiding Official,that he/she shall be responsible for all sucli'work performed and""er[he buil'dmQ permit. (Section 1'09 1:'1) The undersigned"homeowner"assumes responsibility for compliance with the State Building•Cbde and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she undefttands tlje'gown of'Barnstable Bu iding Department minimum ins JV pectiori procedures and requirements and tl�atehe/ e wi11,c omply w.ttaim oa`ed&r eY andi requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from'lhe 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. Q:\WPFILES\FO RMS\homeexempt.DOC 55 Hilliards Hay Way—Patricia Cahill 2 (4' x 10') panels flush mounted to back roof. F^ 'tire 7' _ fir' THE OEM SERIES UP GLAZER COLLECTORS HHTHI�[, Models ECand P FLAT TS EOCIFICATIION SHEET THE VALUE LEADER I IN SOLAR WATER HEATING TECHNOLOGY { i {I Stainless Steel Fasteners 4 I Riveted Corners Low Iron Tempered Glass -• - Low-Binder Fiberglass Insulation - Rigid Foam Insulation i Secondary Silicone f Glazing Seal i `� � ., ,,',� ' ��'. tom•.,,, • Black Chrome or Moderately Selective Black Paint I Absorber Coating I Copper Absorber Plate .—�y� _ = v = � Integral • Type M Copper Riser Channel g Tubes and Manifolds Extruded Anodized 1 Aluminum Casing and • EPDM Grommets Capstrip Vent Plugs Primary EPDM Glazing Seal • 15% Silver Brazed Joint Aluminum Backsheet 1 PROTECTING OUR ENVIRONMENT-SINCE 1978 r 9UP[HRIH101. EMPIRE SERIES SPECIFICATIONS c�, D r C -C �Q-C y �i Q�i 5.1 y' V n1 C C� ,J.Cn,C ac � 't Z � �..C �• �• �,C oz �\u m\emu �\ `o�,o• Q yo• �� a C� ��� y",om"y �`D� .S'°�4`' a• •c• a• �of aa'c p o EC/EP21 40 76 3 1/4 21.12 18.70 70 0.72 0.54 0.003 12 160 43 3/8 1 71.25 EC/EP24 36 1/8 98 1/4 3 1/4 24.61 21.88 80 0.78 0.62 0.005 12 160 39 3/4 1 93 5/8 EC/EP32 48 1/8 98 1/4 3 1/4 32.79 29.81 106 1.00 0.83 0.006 12 160 51 3/8 1 93 5/8 EC/EP40 48 1/8 122 1/4 3 1/4 40.81 37.33 141 1.20 1.04 0.009 12 160 51 3/8 1 115 5/8 EC/EP40-1.5 48 1/8 122114 3 1/4 40.81 37.33 150 1.61 1.04 0.006 25 160 51 3/8 1 1/2 115 5/8 MODEL EC THERMAL PERFORMANCE RATINGS* MODEL EP Btu/ft /Day Btu/ft2/Da Category CLEAR MILDLY CLOUDY Category CLEAR MILDLY CLOUDY (Ti-Ta) DAY CLOUDY DAY DAY (Ti-Ta) DAY CLOUDY DAY DAY TI-inlet quid temp 2000 1500 1000 Ti=Inlet fluid temp 2000 1500 1000 Ta m ambient air temp Btu/ft2/Day Btu/ft2/Day Btu/ft2/Day Ta=ambient air temp Btu/ft2/Day Btu/ftz/Day Btu/ft2/Day A(-9°F) 1,332 1,005 680 A(-9°F) 1,284 971 659 B(9°F) 1,218 890 1 565 B(9'F) 1,169 854 542 C(36°F) 1,040 720 1 402 C(36°F) 984 677 372 D(90°F) 699 405 127 D(907) 619 343 89 E(144°F) 390 137 - E(144°F) 280 62 A-Pool Heating(Warm Climate) B-Pool Heating C-Water Heating(Warm Climate) D-Water Heating(Cool Climate) E-Air Conditioning/Industrial Process Heat. Thermal performance is obtained by multiplying the collector output for the appropriate application and insolation level by the total gross collector area. *Collector ratings are derived from the Solar Rating&Certification Corp(SRCC)Document RM-1 and Standard OG-100. ENGINEERING SPECIFICATIONS (Performance specifications subject to testing error of+/-3%) The following shall be the specifications for the solar collectors. Collectors thermal isolation of the foam from the absorber plate. Total thermal resis- shall be SunEarth Empire model , and shall be of the glazed liq- tance shall be a minimum of R-12.The sides and ends of the collector shall uid flat plate type.Collectors shall be tested in conformance with ASHRAE 93- be insulated with a minimum of 1 inch foil-faced polyisocyanurate foam 1986 and SRCC 100.81.The collectors shall be certified by the Solar Rating and sheathing board. Certification Corporation(SRCC)and the Florida Solar Energy Center(FSEC). ABSORBER PLATE AND PIPING GENERAL The absorber shall consist of a roll-formed copper plate of no less than.008 The dimensions of the collector shall be inches in length, inch thickness. Risers shall be a minimum of 1/2 inch O.D. Type M copper inches in width and 3 1/4 inches in depth.The collector casing tubing on no more than 4 1/2 inch centers continuously soldered to the shall be an anodized aluminum extrusion (alloy 6063 T5), minimum thick- plate utilizing a non-corrosive solder paste with a melting point of 460OF. ness .060 inch, with an architectural dark bronze finish. The casing shall The risers shall be brazed to 1 1/8 inch 0. D. Type M (1 5/8 inch O.D. on have notched framewalls for ease of plate removal and reinstallation.Sheet EC/EP40-1.5) copper manifolds utilizing a copper phosphorous brazing metal screwed fasteners shall be stainless steel (18-8 #10). The backsheet alloy with no less than 15 percent silver content, and conforming to the shall be textured aluminum not less than.014 inch thickness.A 1 inch vent American Welding Society's BCuP-5 classification. EPDM grommets shall iso- plug shall be installed in each of the four corners of the backsheet to min- late the manifold from the aluminum casing. The absorber plate shall be imize condensation. designed for 160 psig maximum operating pressure. GLAZING ABSORBER COATING AND PERFORMANCE CURVE The collector glazing shall be one sheet of low iron tempered glass, with A)Black Chrome(EC Series):The absorber coating shall be black chrome on a minimum of 1/8 inch thickness (5/32 inch on EC/EP 40), and a mini- nickel with a minimum absorptivity of 95 percent and a maximum emissivity mum transmissivity of 91 percent(89 on EC/EP 40). The glazing shall be of 12 percent. The instantaneous efficiency of the collector shall be a mini- thermally isolated from the casing by a continuous EPDM gasket. There mum Y-intercept of 0.714 and a slope of no less than-0.7271 (BTU/ftz-hr)/F. shall be a continuous secondary silicone seal between the glass and cas ing capstrip to minimize moisture from entering the casing. B)Moderately Selective Black Paint(EP Series):The absorber coating shall be INSULATION a moderately-selective black paint with a minimum absorptivity of 94 per- The insulation shall be foil-faced polyisocyanurate foam sheathing board of cent and a maximum emissivity of 56 percent.The instantaneous efficiency a minimum 1 inch thickness,siliconed in place to the aluminum backsheet, of the collector shall have a minimum Y-intercept of 0.682 and a slope of covered by low-binder fiberglass of a minimum 1 inch thickness, providing no less than-0.7995(BTU/ftz-hr)/F. Due to SunEarth's policy of continuous product improvement, specifications are subject to change without notice. MANUFACTURED BY: AVAILABLE FROM: SUORThi. m 8425 Almeria Avenue•Fontana,CA 92335 °¢0 " to (909)434-3100 • Fax(909)434-3101 • t � www.sunearthinc.com RECYCLED PAPER-SOY BASED INKS+roN,r N , FIr�Sl� ov N,%- F R-0 M TP ' TOP O F C_01.lr�GQ'o K -T-o S c�-t-•E 4 r r r6 G P v jPoI X?--'FAD C.hr / Mou ►JG rAovmNx-J6 t C L T G Row E Structural certification Collector Manufacturer and Address: sun Earth, Inc. 4315 Santa Ana Street Ontario, CA 91761 Collector Model Number: Empire EP-40 Gross Area: . 40 .8 Sg Ft Transparent Area: 37 .3 Sq Ft Type of Glazing: Low Iron Tmpr Thickness of Glazing: 5/32 in (4.Omm) The undersigned., an engineer registered in the state of Fiorida does certify that, having used generally accepted procedures, he/she has determined that the wind load that may be sustained by the solar collector identified in the heading above without structural damage is at least 207 Pa ( 30 psf). Signed: --. - f Date May_ 3, 1994 -- -- --- _ -- -- Typed Name .Henry M. Healey, P..E. Registration No. __. 35056 SEAL r FLORIDA SOLAR ENERGY CENTER TEsting & OpErations Division 7�Arr 300 State Road 401. Cape Canaveral. Florida 32920 Air Vent Pressure Relief Fiat Plate Valve Solar Sensor Collectors � f Outside Glycol Solution in Loop - Int Expansion Differential Tank Controller 000 Cold in ftom House axing pn=k�f =� "' Valve. T&P Hot out F1 Flow Gauge A Valve V&a House Glycol Fill y�. Check Sensor' Valvew Glycol Drain A, _ Glycol ' ll Pump I t rt�- VALVE KEY Glycol Loop - -- ---- ----`' Solar Tank isolation )rain Solar Storage Conventional Drain =:lV open Tank Water Heater Closed n A-Temperature activated fan switch to provide dehumidification when solar " - fluid is sufficient temperature . Va Olt —_ — O f Consumer fice o Affair and Business Regulation _ 10 Park Plaza - Suite 5170 N Boston;Massachusetts 02116 Home•Improvement Contractor Registration Registration: 146276 Type: Supplement Card Expiration: 4/8/2013 COTUIT SOLAR CHRISTOPHER PETERSON 3800 FALMOUTH RD. MARSTONS MILLS, MA 02648 4 Update Address and return card.Mark reason for change. Address ❑ Renewal Employment Lost Card DPS-CA1 0 50M-04/04-G101216 Office of Consumer Affairs&Business Regulation License or registration valid for individul use only before the expiration date. If found return to: OME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation ` Registration::-146276 Type- 10 Park Plaza-Suite 5170 Expiration:';4/8/2013. Supplement Card Boston, 02116 COTUIT SOLAR CHRISTOPHER 'PETERSON P.O.BOX 89 COTUIT, MA 02635 Undersecretary Not valid without signature Ntassachusetfs: Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License License: CS 102975 Restficted to: 00 CHRISTOPHER PETERSON 41 THATCHER HOLWAY ROAD MARSTONS MILLS, MA 02648 . o-- ��- Expiration: 10/7/2012 Commissioner Tr;: 162975 e • rimml 0 1 a 11 t3i VJ 134. . GRANITE 'STATE' INSURANCE COMPANY 0072808-00= WC- 003-49-5161 13102 ---- -------- -- o�3-66-0311 10 -. COTUIT SOLAR LLC 'C H A R T 15 PO BOA( 8.9 _ 64 OLD SHORE RD COTU I T, MA 02635-0000 A Chartis company EXECUTIVE OFFICES: SEE EXTENSION OF ITEM 1. OF THE INFORMATION PAGE - WC990610 175 Water Street 1 New York, NY 10038 I.D# MA U#• •.. . ... DON BUNKER INSURANCE AGCY WORKERS COMPENSATION AND EMPLOYERS PO BOX 221 LIABILITY POLICY INFORMATION PAGE HANOVER, MA 02339-0000 INSURED IS PREVIOUS POLICY NUMBER LIMITED LIABILITY COMPANY RENEWAL 003495161 OTHER WORKPLACES NOT SHOWN ABOVE: SEE EXTENSION OF ITEM 1. OF THE INFORMATION PAGE - WC990610 ITEM 2 POLICY PERIOD 12:01 AM:standard time at the Insured's mailing address FROM 03/26/11 To 03/26/12 ITEM 3 A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to the work in each state listed in item 3.A. The limits of our liability under Part Two are Bodily injury by Accident$ 500,000 each accident Bodily Injury by Disease $ GOO.000 policy limit Bodily Injury by Disease $ 500.000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: SEE ENDORSEMENT - WC200306A D. This policy includes these endorsements and schedules: SEE EXTENSION OF ITEM 3.D. OF THE INFORMATION PAGE - WC990612 ITEM The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject.to verification and change by audit. Premium Basis Rate Per Estimated Classifications Code Number Total Remuneration $100 OF Re- Premium aAnnual 3 Year munerat'on a Annual1:1 3 Year SEE EXTENSION OF ITEM 4. OF THE INFORMATION PAGE - WC7754 TAXES/ASSESSMENTS/SURCHARGES $800 EXPENSE CONSTANT(EXCEPT WHERE APPLICABLE BY STATE) $338 MA MINIMUM PREMIUM S 5OO MA TOTAL ESTIMATED ANNUAL PREMIUM S12,311 If indicated below.interim adjustments of premium shall be made: Sdmi-Annually Quarterly Monthly DEPOSIT PREMIUM 03/22/11 ASSIGNED RISK 66 Issue Date Issuing Office Authorized Representative WC 00 00 01A 39967(Revd 04/08) I • , a.1HF Barnstable Old Kings Highway Historic District Committee 200 Main Street, Hyannis,MA 02601,TEL: 508-862-4787 Fax 508-862-4784 1659. APPLICATION, CERTIFICATE OF APPROPRIATENESS Application is hereby made,with four(4)complete sets,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 all categories that apply, 1. Building construction: ❑ New ❑ Addition ❑ Alteration 2. Type of Building: ❑ House ❑ Garage/barn ❑ Shed ❑ Commercial ❑ Other 3. Exterior Painting roof ❑ new roof ❑ color/material change,of trim, siding,window, door 4. Sin : ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign 5. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Retaining wall ❑ tennis court Other 6. Pool ❑ swimming ❑ Other man-made pool Sear m V al l Type or Print Legibly: Date: 5 Address of proposed work: House# 55 Street: \�\1 ar S M0,\j Wav Village�. � 0,rn AQ Ie Assessors Map Lot# 1,3�- 041 Description of Proposed Work: Give particulars of work to be done: lh al 4% a : q'xio' Iar ii,ermOLI p0nelS _ D z T l II p '/ -1 Agent or Contractor(print): CD UA So 1 ar Telephone#: 50 8-1 a 0-8�7 2 Address: ?)bX Sq ; MA oab3'5 r 0 Contractor/Agent'signature: co NOTE AU appficabons must be s' ed by t current owner Owner(print): j Telephone#: 5 0-3(o a` 11q Q-1 Owners mailing ad ess: W Owner's signature: q RE I` /� or committee use only. This Certificate is hereby APPROVED/DENIED V [t ate 5 Members signatu MAY 0 3r 2011 TOWN OF BARNSTAEt HISTORIC PRESERVAI ION Any ndi on roval: MAY own of Barnstable O Committee 1 C:(Documents and SettingsldecolliMocal SettingslTemporary Internet FilesIOLKI IOKHCert Appropriateness 07.doc Town of Barnstable Geographic Information System May 6, 2011 13\, MN 136038 �L 136034 #91 W #51 #74 136020 136040 136039 $1,36035 #109 136041 #17 #31 #80 #100 136037 #88 136021 1360' #127 p� #.81t Q *1136045 #68 136044 136042 136043 #48 #124 #32 �136022 H`t.1'1p jx1D Np'�WAY 136053 #141 #105 *0 ® 136047 #55 #55 336050 ® 13�C 6049" 136048 #148 #23 #39 135003 #0 135005 #160 0 71 Feet DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:136 Parcel:047 boundary determination or regulatory interpretation. Enlargements beyond a scale of Owner:CAHILL,PATRICIA A Total Assessed Value:$1047900 Selected Parcel 1°=100'may not meet established map accuracy standards. The parcel lines on this map � t- ,E are only graphic representations of Assessor's tax parcels. They are not true property Co-Owner: Acreage:1.72 acres Abutters boundaries and do not represent accurate relationships to physical features on the map Location:55 HILLIARD'S HAYWAY f such as building locations. Buffer cif �JflJ!f 55 Hilliards Hay Way—Patricia Cahill 2(4'x 10') panels flush mounted to back roof. a f r APPROVED MAY 2 5 2011 '� Town of Barnstable RECEIVED Old King's Highway Committee MAY 0 5 2011 TOWN OF BARNSTABLE HISTORIC PRESERVATION Patricia Cahill—55 Hilliards Hay Way Installation of 2 (4' x 10') solar thermal panels to be flushed mounted on south roof facing out toward marsh, not visible from road. �y �k Yeathervane� � ti o ua,?o 4 s, o {i3 Last Me G T�ia 0"a`L„ �dway 4 6A MnarC' HaY WeY N d C 6A S ��Ln Z 6� APPROVED RECEIVED MAY 2 5 2011 F MAY 0 5 2011 TOWN OF BARNSTABLE Town of Barnstable HISTORIC PRESERVATION Old mmittteeway Panels to be mounted on back roof not visible from street A' MAY 2 5 2011 Town of Barnstable Old King's Highway Committee RECEIVED MAY 052011 TOWN OF BARNSTABLE HISTORIC PRESERVATION r THE EMU SERIES GLAZELAR COLLECTORS Models DEC and P FLAT TS SPECIFICATION TIION SHEET THE VALUE LEADER IN SOLAR WATER HEATING TECHNOLOGY Stainless Steel Fasteners i i Riveted Comers Low Iron Tempered Glass T Low-Binder Fiberglass Insulation Rigid Foam Insulation Secondary Silicone Glazing Seal • Black Chrome or Moderately Selective Black Paint Absorber Coating • Copper Absorber Plate - I Integral Mounting i • Type M Copper Riser Channel i Tubes and Manifolds Extruded Anodized I Aluminum Casing and • EPDM Grommets Capstrip Vent Plugs Primary EPDM Glazing Seal • 15% Silver Brazed Joint � Aluminum Backsheet APPROVE MAY 2 5 2011 Town of Barnstable Old King's Highway Committee - PROTECTING OUR ENVIRONMENT-SINCE 1978 / 1 9UP[HRIHIHI. EMPIRE SERIES SPECIFICATIONS o O` S' JE 4�ti I'd, i rah ac y� ¢� h �a F Q � ci m S G J° `•.c° �• �• a s�'\c, �\mac, p\ o yo• Q yo• o ;� �, a" � � a, 'o m ate, r, a, F aa, a, -,�o O =a, pc'+ j r.,• O°i�� C` p � �Q`° �� y a y F°i=o yc�Qc EC/EP21 40 76 3 1/4 21.12 18.70 70 0.72 0.54 0.003 12 160 43 3/8 1 71.25 EC/EP24 36 1/8 98 114 3 1/4 24.61 21.88 80 0.78 0.62 0.005 12 160 39 3/4 1 93 5/8 EC/EP32 48 1/8 98 1/4 3 1/4 32.79 29.81 106 1.00 0.83 0.006 12 160 51 3/8 1 93 5/8 EC/EP40 48 1/8 122 1/4 3 1/4 40.81 37.33 141 1.20 1.04 0.009 12 160 51 3/8 1 115 5/8 EC/EP40-1.5 48 1/8 122 1/4 3 1/4 40.81 37.33 150 1.61 1.04 0.006 25 160 51 3/8 1 1/2 115 5/8 MODEL EC THERMAL PERFORMANCE RATINGS* MODEL EP Btu/ft-/Day Btu/ft2/Day Category CLEAR MILDLY CLOUDY Category CLEAR MILDLY CLOUDY (Ti-Ta) DAY CLOUDY DAY DAY (Ti-Ta) DAY CLOUDY DAY DAY Ti-inlet nuid temp 2000 1500 1000 Ti=inlet fluld temp 2000 1500 1000 Ta ambient air temp Btu/ft2/Day Btu/ft2/Day Btu/ft2/Day Ta=ambient air temp Btu/ft2/Day Btu/ft2/Day Btu/ft2/Day A(-9°F) 1,332 1,005 680 A(-9°F) 1,284 971 659 B(9°F) 1,218 1 890 1 565 B(9°F) 1,169 854 542 C(36°F) 1,040 720 402 C(36°F) 984 677 372 D(90°F) .699 405 127 D(90°F) 619 343 89 E(144°F) 390 137 - E(144°F) 280 62 - A-Pool Heating(Warm Climate) B-Pool Heating C-Water Heating(Warm Climate) D-Water Heating(Cool Climate) E-Air Conditioning/Industrial Process Heat. Thermal performance is obtained by multiplying the collector output for the appropriate application and insolation level by the total gross collector area. 'Collector ratings are derived from the Solar Rating&Certification Corp(SRCC)Document RM-1 and Standard OG-100. ENGINEERING SPECIFICATIONS (Performance specifications subject to testing error of+/-3%) The following shall be the specifications for the solar collectors. Collectors thermal isolation of the foam from the absorber plate. Total thermal resis- shall be SunEarth Empire model , and shall be of the glazed liq• tance shall be a minimum of R•12.The sides and ends of the collector shall uid Flat plate type.Collectors shall be tested in conformance with ASHRAE 93- be insulated with a minimum of 1 inch foil-faced polyisocyanurate foam 1986 and SRCC 100-81.The collectors shall be certified by the Solar Rating and sheathing board. Certification Corporation(SRCC)and the Florida Solar Energy Center(FSEC). ABSORBER PLATE AND PIPING GENERAL The absorber shall consist of a roll-formed copper plate of no less than.008 The dimensions of the collector shall be inches in length, inch thickness. Risers shall be a minimum of 1/2 inch O.D.Type M copper inches in width and 3 1/4 inches in depth.The collector casing tubing on no more than 4 1/2 inch centers continuously soldered to the shall be an anodized aluminum extrusion(alloy 6063 T5), minimum thick- plate utilizing a non-corrosive solder paste with a melting point of 460OF. ness .060 inch, with an architectural dark bronze finish. The casing shall The risers shall be brazed to 1 1/8 inch 0. D. Type M (1 5/8 inch O.D. on have notched framewalls for ease of plate removal and reinstallation.Sheet EC/EP40.1,5) copper manifolds utilizing a copper phosphorous brazing metal screwed fasteners shall be stainless steel (18-8#10). The backsheet alloy with no less than 15 percent silver content, and conforming to the shall be textured aluminum not less than.014 inch thickness.A 1 inch vent, American Welding Society's BCuP-5 classification. EPDM grommets shall iso- plug shall be installed in each of the four corners of the backsheet to min- -- late the manifold from the aluminum casing. The absorber plate shall be imize condensation. designed for 160 psig maximum operating pressure. GLAZING ABSORBER COATING AND PERFORMANCE CURVE The collector glazing shall be one sheet of low iron tempered glass, with A)Black Chrome(EC Series):The absorber coating shall be black chrome on a minimum of 1/8 inch thickness (5/32 inch on EC/EP 40), and a mini- nickel with a minimum absorptivity of 95 percent and a maximum emissivity mum transmissivity of 91 percent(89 on EC/EP 40). The glazing shall be of 12 percent. The instantaneous efficiency of the collector shall be a mini- thermally isolated from the casing by a continuous EPDM gasket. There mum Y-intercept of 0.714 and a slope of no less than-0.7271 (BTU/ftz-hr)/F shall be a continuous secondary silicone seal between the glass and cas- ing capstrip to minimize moisture from entering the casing. B)Moderately Selective Black Paint(EP Series):The absorber coating shall be INSULATION a moderately-selective black paint with a minimum absorptivity of 94 per- The insulation shall be foil-faced polyisocyanurate foam sheathing board of cent and a maximum emissivity of 56 percent.The instantaneous efficiency a minimum 1 inch thickness,siliconed in place to the aluminum backsheet, of the collector shall have a minimum Y-intercept of 0.682 and a slope of covered by low-binder fiberglass of a minimum 1 inch thickness,providing no less than-0.7995(BTU/ftz-hr)/F. Due to SunEarth's policy of continuous product improvement, specifications are subject to change without notice. MANUFACTURED BY: AVAILABLE FROM: SUflEflflTNm�. m 8425 Almeria Avenue•Fontana,CA 92335 "P"" W (909)434-3100 • Fax(909)434-3101 www.sunearthinc.com RECYCLED PAPER-SOY BASED INKY/oN♦� IO TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map I :l0 Parcel '• O �' 6 I 'Application# Health'Division `Date Issued 3OEL Conservation Division Application Fee Planning'Dept. ;.;Permit Fee Date Definitive.Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address 55 � /I ! r ,'Y 1 M Yo_- (: Village W z S 8 ov n s4a.b 1 e Owner Q 1 C ON) A. Address 5 Telephone Permit Request S+Q 1(, 2 -P hA s k m o u n h CAP va1+01C: POflez) s Square feet: 1 st floor: existing proposed .2nd floor: existing proposed Total new Zoning District; Flood Plain Groundwater.Overlay Project Valuation 2 Construction Type Lott Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family .❑ Two Family ❑ Multi-Family (# units) v Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft)} r Number of Baths: Full: existing new Half: existing nevw ;- Number of Bedrooms: existing _new E c Total Room Count (not including baths): existing new First Floor Roorbl ount :;-t Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other GO Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove:q3 YesP0 No Detached garage: ❑existing 0 new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existi g ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # -Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name coiu -1A 5©� Qy_ Telephone Number 501a_ `C 2 t7—8 Y q Address -Po 1p)©X 6 / License# ft A I I ) c 0 f u l I1, !`�' 4 0 2 (o&5 Home Improvement Contractor# 4 Z CD Worker's Compensation # '[Z ` ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO � ns� SIGNATURE DATE L( 2 7 9 i • FOR OFFICIAL USE ONLY E APPLICATION# ' DATE ISSUED f MAP/PARCEL N0. ADDRESS - VILLAGE OWNER r DATE OF INSPECTION: FOUNDATION FRAME _ INSULATION FIREPLACE , ELECTRICAL: ROUGH FINAL .f PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ' mNty Cots�O do A- P�•RYiRC� _ .. FINAL BUILDING Ex,-&uoje—A6 Zl remoj 4MMAS_ - - DATE CLOSED OUT ASSOCIATION PLAN NO ' f r 9 b\11 �oFrttu r 1. ` 'own of Barnstable ` Regulatory Services tiA,RNSTAA4.F . Thomas F.Ceiler,Director ��0rF0 Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnsts ble.nmus Office: 50.8-862-4038 Fax: 508-790-6230 Noperty Owner Must Complete and Sign. This Section If Using A BuRde.r G ICE ,as Owner of the subject property hcrcb�authorizc to act on my behalf, in all//utters relative Co work,authorized by this huddling permit application for: " �Vizz- 1191-Qos (Address of fob) _ IVAss, 9L( $' aturc of Owner. _ ce // -ZX cif CAI/ ILL P»nt Name I If Property Owner is applying for per_ruit please complete the Horne owners License Exemptiou Form on tt a reverse side.. bo d' COTUIT SOLAR P.O. Box 89 • Cotuit, MA 02635 • 508-428-8442 • Fax 508-428-8450 • www.cotuitsolar.com 24 panels to be mounted on back �'� !� roof 2 '/2 lbs/sq ft. f evergreensolar. Think Beyond. I I E S-A SERIES 200, 205 & 210 w photovoltaic panels Best power tolerance available A range of high quality String RibbonTM solar panels _ offering exceptional performance, cost effective 1 installation and industry-leading environmental credentials made with our revolutionary wafer 1 � technology. ' a No power below nameplate Never pay for power you're not getting e Get up to 5W more than nameplate* For enhanced field performance a Industry's lowest voltage per watt rating } Delivers the most cost-effective installs a UL4703 certified cables For use with the highest efficiency transformer-less inverters e New extended length cables Eliminates home-run wiring e New lockable connectors** Complies with the latest codes for accessible arrays a Most extensive range of mounting options Allows installs virtually anywhere and anyhow I a Smallest carbon footprint of any manufacturer iFor the greenest of the green je 100%cardboard-free packaging Minimizes job site waste and disposal costs e 5 year workmanship and 25 year power warranty*** Born in the USA *Maximum power up to 4.99 W above nameplate rating;—Locking sleeve not supplied with the panel. ***For full details see the Evergreen solar Limited Warranty available on request or online. This product is designed to meet UL 1703,UL 4703,UL Fire Safety Class C,IEC 61215 Ed.2 and IEC 61730 Class A standards. String Ribbon is a patented technology and registered trademark of Evergreen Solar,Inc. Electrical Characteristics Mechanical Specifications Standard Test Conditions(STC)1 PANEL ID LABEL ES-A-200 ES-A-205 ES-A-210 �•° -fa2* -fa2* -fa2* 2.2 4.9 , Pmp2 200 205 210 W ° Ptolem°ce -0/+4.99 -0/+4.99 -0/+4.99 W i JUNCTION BOX i_ T (IP65) 8x 0.16 PANEL GROUNDING Pmp,max 204.99 209.99 214.99 W SERIAL NUMBER HOLE Pmp,min 200.00 205.00 210.00 W ° 0 T)min 12.7 13.1 13.4 % ° Ppu3 180.6 185.2 189.8 W CABLES 0 (10 AWG,UL4703, Vmp 18.1 18.4 18.7 V PV-WIRE) Imp 11.05 11.15 11.23 A a \+ V« 22.5 22.8 23.1• V ° Al ui t0.0.26 Isc 12.00 12.10 12.20 A PANEL MOUNTING HOLE ID LABEL FOR Y'BOLT Nominal Operating Cell Temperature Conditions(NOCT)4 ° MC-LOCKABLE TNOCT 44.8 44.8 44.8 °C71 ° CONNECTORS ° (TYPE 4) Pmax 146.4 150.1 153.7 W N a 0 (-) (+) 0 Vmp 16.7 16.8 17.0 V o� R ANODIZED - Imp 8.76 8.93 9.04 A o ALUMINUM FRAME 0 12x FRAME 7-°; DRAINAGE HOLE V. 20.5 20.7 21.0 V o 0 ° tom- 3(+/ Isc 9.60 9.68 9.76 A 1 8(+0.02/-0) 37.s5.i o.1 1 1000 W/m',25°C cell temperature,AM 1.5 spectrum; All dimensions in inches;panel weight 41 Ibs i Maximum power point or rated power 3AtPV-USA Test Conditions:1000W/mz,20oC ambient temperature, Product constructed with 114 of alline silicon solar cells, anti-reflective 1 m/s wind speed poly-crystalline 4 800 W/m2,20'C ambient temperature,1 m/s wind speed,AM 1.5 spectrum tempered solar glass,EVA encapsulant,polymer back-skin and a double-walled f-framed;a-low voltage,2-matt blue(textured)cells anodized aluminum frame.Product packaging tested to International Safe Transit Association(ISTA)Standard 213. All specifications in this product information sheet Low Irradiance conform to EN50380. See the Evergreen Solar Safety,Installation and Operation The typical relative reduction of module efficiency at an Manual and Mounting Design Guide for further information on approved installa- irradiance of 200W/m2 both at 25°C cell temperature and tion and use of this product. spectrum AM 1.5 is 0%. Due to continuous innovation,research and product improvement,the specifica- tions in this product information sheet are subject to change without notice. No Temperature Coefficients rights can be derived from this product information sheet and Evergreen Solar assumes no liability whatsoever connected to or resulting from the use of any a.PmP -0.45 %/°C information contained herein. a Vmp -0.43 %/°C Partner: a Imp -0.02 %/°C . a V. -0.32 %/°C a IX -0.003 %/°C System Design Series Fuse Rating' 20 A Maximum System Voltage(UL) 600 V s Also known as Maximum Reverse Current. ELECTRICAL EQUIPMENT ES-A_200_205_210_US_010908;effective September 1n 2008 CHECK WITH YOUR INSTALLER P Worldwide Headquarters Customer Service-Americas and Asia 138 Bartlett Street,Marlboro,MA 01752 USA 138 Bartlett Street,Marlboro,MA 01752 USA Evergreen Solar,Inc. T+1 508.357.2221 F:+1 508.229.0747 T.+1 508.357.2221 F:+1 508.229.0747 www.evergreensolar.com info@evergreensolar.com sales@evergreensolar.com � PFo 9elAtt 7T'•�. . ' DowN Cc.ha� p PRO-ULAR. ' tl ' \54 �, � _ fly' lJi�i4c-� �...•�t.. .. i'�1;-r,w.�'�L s+v��i1�i1%.• �i/•.'. �... (;. �ci ., '�,...„�.. Board of Building Regulations and Standards on. Place _ Room 1301 't .. One Ashburton Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 146276 Type: DBA Expiration: 4/8/2009 Tr# 131107 COTUIT SOLAR CONRAD GEYSER P.O. SOX 69 COTUIT, MA 02635 Update Address and return card.Mark reason for change. (� Address Renewal Employment Lost Card )PS-CAI 0 517A1•05i0&PC049Q �, ��a 't'��u��tuur[aenl(�• V,.,.' I�t13�zr. adr7J Board of Building Regulations and Standards License or registration valid for Individul use only before the expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR P Board of Building Regulations and Standards Registration: 146276 One Ashburton Place Rm 1301 Expiration: 4/8/2009 Tr# 131107 ' p Boato�Ma.03105 Typo: DBA COTUIT SOLAR / CONRAD GEYSER 3800 FALMOUTH RD. Not valid without signature MARSTONS MILLS,MA 02648 Administrator VINCI & ASSOCIATES Structural Engineers CUENT: Professional Solar Products,Inc. 1551 S.Rose Ave.,Oxnard,CA 93033 Tel:805486.4700 Building Department Note:NOT TO BE SUBSTITUTED WITH STANDARD STRUT OR COUNTERFEIT PRODUCT. Subject: Static load test results for the following: Module Maximum Frame Maximum Frame Minimum Frame Load Equivalent Wind Speed Mounting System Manufacturer Length*(in.) Width*(in.) Height*On.) pbs/ft2) (mph)** Rooffrac® Evergreen 65.0 37.5 1.80 55 130 TEST SETUP(as shown in attached drawing detail):Three Evergreen modules,as specified above,were bolted to 136"x1.5"x1.5"Professional Solar Products(PSP)RoofTrac®support rails using an assembly of 5/16"stainless steel bolts, lock washers and proprietary aluminum clamps and inserts.The RoofTracs support rail was attached to the PSP TileTrac® structural attachment device with a 3/8"nut and washer at six attachment points.The setup was attached to 2"x6"wooden rafters using 5/16"x 3"Stainless Steel lag bolts.The attachment spans consisted of 48"front to rear with structural attachments spaced 48"on center.- TEST PROCEDURE(as shown in attached drawing detail):The test set up was top loaded to 55 lb/ft2.The setup remained loaded for an approximate period of 30 minutes.The maximum deflection and any signs of permanent deformation were recorded.The test setup was then inverted and loaded to simulate the uplift condition.The test set up was re-loaded to 55 Ib/ft2.The setup remained loaded for an approximate period of 30 minutes.The maximum deflection and any signs of permanent deformation were recorded. TEST RESULTS: The maximum top load deflection was recorded at 0.438",with no permanent deformation. The maximum uplift deflection was recorded at 0.250",with no permanent deformation. Building Department Note: This document certifies the RoofTrac®mounting system used with Evergreen modules,as NOT TO BE SUBSTITUTED specified above,withstands a 55 Ib/ft2 static pressure load,equivalent to a wind speed of WITH STANDARD STRUT approximately 130 mph**. The mounting system performed as expected. COUNTERFEIT PRODUCT.. Sincerely, James R.Vinci,S.E. This engineering report verifies that Vinci&Associates has provided independent observation for load testing as described in this report resu f this load test reflect actual deflection values and are generally accepted as the industry standard for testing module mounting systems. vinci oc t does not field check installations or verify that the mounting system is installed as described in this engineering report To assist the building inspector in verifying the authenticity of this proprietary mounting system,a p ane adhesion,silver reflective"Roof rracG'label,as shown,is placed on at least one of the main su rt ra Structural attachment: Lag bolt attachment should be installed RVVf Ta using the proper pilot hole for optimum strength.A 5/16"lag bolt requires a 3/16"pilot hole.It Is the responsibility of the installer to insure a proper egi attachment is made to the structural member of the roof. Failure to securely attach to the roof structure may result in damage to equipment personal injury or property damage. ;��,�'• `�` �;',:=;:`. This office does not express an opinion as to the load bearing characteristics of the structure the mounting system/modules are being installed on. ICC accredited laboratory tested structural attachments manufactured by Professional Solar Products(including,but ""'• not limited to Fastlack®,TileTrac®,and Foamlack®)can be interchanged with this system. :�• r?t *Modules measuring within stated specifications are included in this engineering **Wind loading values relative to defined load values using wind load exposure and gust factor coefficient 'exposure C'as defined in the 2006(IBC)/2007(CBC) 31324 VIA COLINAS STE 101 WESTLAKE VILLAGE, CA 8136 Page 1 of 2 PSP:RT_EG 2 4T --s 37.5- _�I _ XX I 1XV , \kX 136' Building Department Note: NOT TO BE SUBSTITUTED WITH STANDARD i STRUT OR COUNTERFEIT PRODUCT. 5/16°Stainless Steel Hex bolt Top Load Deflection: 0.438" 5/16"Stainless Steel Lock Washer Aluminum ProSolar i Inter-Module Clamp C R LA IT Aluminum ProSolar �.� Channel Nut Aluminum ProSolar Up lift Deflection: 0.250" I RoofrracO Support Rail �---� 3/8'Stainless Steel Hex Bolt and Flat Washer Aluminum ProSolar FastJack®Roof Attachment 5/16"Stainless Steel Lag Bolt and Flat Washer Professional Solar Products Roofrrae Patent#6,360,491 RoofTrac® Photovoltaic mounting system Evergreen Solar odules Static load test illustration Page 2 of 2 PSP:RT EG_2 f The Commonwealth of Alassachusetts ,Department of Industrial Accidents Office of in vesfigations 600 Washington Street Boston, JIM 02111 www.mass.gov/dia Workers' Compensation insurance Affidavit: Builders/Contractors[El(-,ctTiciaas/Plumbers A licant InformationUW1. Please PrzntLe "bl Name (Busincss/OrganizaEc5nlIndividual): u� �o o•� L LC �r Address ` f City/State/Zip:Cdi\!, MA DZ 0-�-f) Ara you an employer? Check the appropriate box: Type of project(required): 1.[V I am a employer with _ 4. ❑ I am a general contractor and I 6. ❑NcW construrtion etnployccs(full and/or part-time).* havc hired the Sub-contractors 2.❑ I am a'solc proprietor or paztncr- listed on the attached shr-ct 7. ❑ Remodeling Thcsc sub-contractors havc 9. ❑ Demolition ship and havc no employees employees and have workers' working for mom' aay capacity. $ 9. ❑ Building addition [No workers' camp.•imsurancc comp.instuance. 5. We arc a corporation and its 10.❑Elec ❑ trical repairs or additions required] officers have exercised their I I.❑Plmnbing repairs or additions 3.❑ I am a homcowurs doing all work myscLE [No workers' comp- right of exemption per MGL 12.❑Roof repairs incnrancc rcqu]:L d] t c. 152, §1(4), and we havt no 13.❑ Other employees. [No workers' comp.insurance rcgturcd] Any applicant that cheeks box#1 must also fill out the section below showing their workcrr'eorvcaso4 on policy inf rrmbDrL t Homeovmc-r who rubroit dug affidavit indieafmg they arc doing all work and thrn bin:outside cantrectors must rubrmt a new affidavit indicating such. XCvntractors that ebmicthis box mugt attacbcd an additional rhect showing the name of the sub-cant aetur s and slain wbetha or not thosd rntNrs havc artployecs. If the sub-eonhaetor=havc mnployccr,tbcy must provi6b their workers'comp.policy nrunba. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and jab site information. lnsuzamcc Company Name: ��aV 1��1� lJl IVA I - Policy#or Sclf-ins. Lic. #: � —I 2 l 4 Expiration Date: to 30 1-2 00 Job site Address:55 �i1V�a.Yd'S 4/M W Mr cityi5tatc/zip:� . Q��S�I�,! Jl�I"l D�l9l�g 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 tho imposition of rri irial penalties of a fine tip to $1,500.00 and/or one-year iroprisonmLnt, as well as civil pcnaltirs in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the`'iolatDr. Bc advised that a copy-of this statrmcrit may be forwarded to the Office of Investigations of the DTA for M' n -ancc eovcra c verification. Ida hereby e under the pain d penalties of perjury that the information provided above is true and correct Si attire: Dato 2`t 0 q OJfzcial use only. Do not write in this area, tb be completed by city or town offtciaL 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 #: Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees: pursuant to this statmtc, an employee is defined as "._.every person Lathe service of another under any contract of hive, express or implied, oral or written_" An employer is defined as "an i idividuA partnership, association, corporation or other legal entity, or any two or mart of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the rcceivcr or trustee of anindividual,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 swelling house of.anothcr who employs persons to do maintenance, construction or repair work on such dwelling house )r on the grounds or building appurtenant thereto sball not brcaust of such employment be deemed to be an employer." v1GL chapter 152, §25C(6) also states that"every st Ltp or local licensing agency shall withhold the issuance or -enewal 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." ldditiona l),MGL ohapter 152, §25C(7) states `Neither fhc commonwealth nor any of its poNdcal subdivisions shall :rater into any contract for the performance of public work until acceptable cvidcacc of comphahcc with the in--ura-rice cquiremenfs of this chapter have bccn presented to the contracting authority. ,pplicants lease fill out the workcrs' compensation affidavit completely, by chccking the boxes that apply to.your situation and, if DccsSdry,supply sub-eontraetor(s)wime(s), addresses) and phone numbers) along with their certificate(s)of isurmcc. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP)with no-employees other than the icmbers or partncis, are not required to carry workcrs' comps sation tnsura- ce. If an LLC or I L.P does have nployccs, a policy is requirctL 13e advised that this affidavit may be submitted to the Department of Industrial ccidcnts for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should returned to the,city or town that the application for the pcmait or license is being requested, not the Department of idustdal Accidents. Should you have any questions regarding the law or if you arc required to obtain a workcrs' ,mpcnsation policy,please call the Department at the nurghcr listed below. Self-insurod companies should enter their :lf-insuranGo license number on the appropriate,line. ity or Tow-R Officials case be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom 'thc affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant case be sure to EM in the permit/liccasc number which will be used as a reference numbcr. Iii addition, an applicant rt must submit multiple permit/license applications in any given year, need only submit onF:afSdavit indicating current Lacy information(ifnecessary) ami under"Job Site Address" the applicant should write "all locations in (city or ern)."A copy of the affidavit that has bccn officially stamped or marked by the city or town may be provided to the pliranf as proof that a valid affidavit is on file for future permits or licenses. A new affidavit.must be filled out each ir.Wherc a hDme owner or citizen is obtaining a license or pcim..if not related fo any business or commcmial venture a dog license or permit to burn leaves etc.) said person is NOT required to complctt this affidavit ike to thank you in adva.ncc for your cooperation and should you have any questions, e Office of Investigations would l ass do not hcsitatr.to give us a calL Department's address, tcicphonc•and fax number. Thn Commonwealth of Massarhuset-is Dg3artment of Industrial Accid=ts Offim of Investigations 600 Washington Street Boston, MA. 02111 Tel. # 617-727-490.0 ext 4.06 or 1-V7-1vMASSAFB Fax# 617-727-7749 11-22-06 WWW.MaSS.gov/dia JJ�ANN/—��27/-09 12:16 PM TALANIAN BUNKER INS AGCY 781 659 2499 P. 03 :.. 3DUCER M .::;.': ...... ....w ...... ...: ... :!!. ".�• �11✓'�.�v� {�',j'� ':ii:: ..DATE MY/DD.�I'YI. . TIFICATE !s ISSUED AS A MATTER OF INFOflMAtI r. .,, 1/26/0 pri Burlkar THIS CER I surance Agency ONLY AND CONFERS NO RIGHT$ UPON THE CERTmAll �0 IFIC Washijingt• n Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, WEND phi ALTER THE COVERAGE AFFORDED Bv.THE POLICIES BEI.OYY, y orWel l I I MA 0 2 O 61- COMPANIES AFFORDING CbvERAGE 7 659 ;-04 I I •3 $l, 0 COMPANY -- '�--'- '-- If A Scottsdale Ins. Co. I _ ' ! Qtuit 'So ar l LLC COMPANY -±o. Box I e Arbella Protection Insurance Co. 4 old Shore Rd. : COMPANY " t}�it C MA 2 02635— I COMPANY 0 •428 $4 _... ram,; D T THE POLICIES O N E LISTED BELOW I .GATED;NO ITN T W HAVE BEEN ISSUED "�'=•_ , ANbINO ANY REgUIREMENT,TERM OR CONDITION OF A D 70 THE INSURED NAMEb ABOVE FOR THE POLICY PERIOD TIPICAtE M�Y BE SSUEb OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIIBEDD0 HEREIN S SUBJECT TO ALL WHICH 1$I:.. �LUSIONS AND CO DITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. :• ••� -, -• -. CT TO ALL T E E ' -- - �, I! NP9 OF NSURA CC POLICY NUMBER 'POUOY EFFECTIVE.POUCY EXPIRATION• 1 DATE(MMiDD/VY) I OATE(MM:DD/YY) LIMITS ERAL UABI :X C_bMMKRCIACENEF AL UAHIUTY I CLS 3 8 4 O 5 6 ;GENERAL AGOREGATF. S2,000,000 t : FFF 0 6/01/0 8 0 6/01/0 9 Pr:oDL!cin-COMPIOP Acme s 2,0 0 0,0 0.0 CUUMg AOE I IX,OCCUR PERSO' NAL&ADVINJURY 91 OOO OOO X OWNER38 ONTRAI-TOR'SPROT: ! , . ,__ ,EACH OCCURRENCE S 1 0 0 0,0 0 0 j FIRC DAMAGE(My are the) s 5 0,0 0 0 ' AliI�OMOBILe LIA ILITY i MED EXP(Any one pernn) s 5,0001 6 ANY AUTO I26916400003 p I 's All OWNED 10 4/3 0/0 8 0 4/3 O/0 9 I COMBINED 61NGI,E I IMIT ! 1 O O O O O O i UTOS I /.. . ..l. J._._- t• �t SCI IEDULED UTOS j 'BODILY INJURY •>n .HIRED AUTO ' I (Par pecan) S •NON-0WNt:D�gUT'08 : i BODILY INJURY i•S. ,.-.--- i (Par PROPERTY DAMAGE ;9 t. V"GELIAMUTv -VI ANY AUTO ! I - / / :AUIU ONLY-EA A_CCIDFNT •S _•-__ - •" i j - / / i OTHER THAN AUTO ONI Y: , .:.—.— .. ..._- .... .. .. EACH ACCIDENT;3 L plCRss UARILITY; AGGREGATG!S I EACH CA'rURRENCE $1, 0 0 0,O O 0 i �UMBRELIAFCIRM ! .xz+50055077 10/24/08 .06/01/09 'AGGREGAIE _ ,GOO,000• :X OTHER THAN MB FORM _sl W CAOMPE SATIO AND 10 000 5 WG 6TATU- �... !M DYERS'J.1AB ITY X ;7UHY UMITS.j_... ER A. IPROPfgLTL�RI� .FI EACHACCIDENT — t, �yAFVE INCL: EL DISEASE-POLICY LIMIT S ?. ARE: ! EXCL ! - -- I%F EL DISEASE Eh CMPLOYFF'S q I ON OF OPER!{ ONS CATIONS/YEHIClE3/SPECL4L ITELIS ' Liab.l)) coverage applies on a primary & non--contributory basis & includes .;as� Techrlolo y Park Corporation & The Rebate Recipient as add'1 insureds.I; �: ` i n ludeS Coverage for inde endent/sub-contrac & Residential t ......,.b..• �.�..... ors :.......... .......w...,,.....,: ..,..... ..,Nc i - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISPUIN0 COMPANY WILL ENDEAVOR TO MAIL A' ,3 0 DAYS WRITTEN NOTICC TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, s"gachli q1e tts� TeChnology Park Corp. BUT FAILURE TO MAIL SUCH NOTICE SMALL IMPOSE No OBLIGATION ORLANAJT1' 7. North Eriv C ANY KIN UPON THE COMPANY, ITS AGENTS OR REPRE3ENrgnyEg- )•` tgstbara A O` S 81 t!!�5�11D E6ENTATIV! i: :M.,. .......... AiRD• ORf'd0A>7°lOe � �..;.... 10(, � sS 5 i `pFSHETp o Barnstable Old Kings Highway Historic District Committee- • � 200 Main Street, Hyannis, MA'02601, TEL: 508:862-4787 Fax 508-862-4784 KASS 1639. APPLICATION, CERTIFICATE OF APPROPRIATENESS Application is hereby made,with four(4)-complete sets,for the issuance of a Certificate'of Appropriateness under Section of Chapter 470,Acts and Resolves of Massachusetts, 1973,for proposed work as'described below and on plans;draw or or photographs accompanying this application for: Check all categories that apply; _ 03 1. Buildin,construction: ❑ New ❑ Addition `-' � � Alteration � :r cr. 2. Type of Building: ❑ House ❑ Garage/barn ❑ Shed ❑ Commercial ❑ Oth'& 3. Exterior Painting,roo El new roof ❑ color/material change, of trim, siding, window, dooms :X 4. Sign : ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign N 5. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Retaining wall ❑ tennis court ❑ Other 6. PooL ❑ swimming ❑ Other man-made pool Type or 1P'rint Legibly: Date: l - C - Address of proposed work:. House# Street: t'f lL-.L 1 l4 g--0 Village dl/ . t✓STT}dL1.�Assessors Map Lot# t 5(a 14g et7 Description of Proposed Work: Give particulars of work to be done: -41>n !rj2L.43 Q PV 04YV& a � Agent or Contractor(print): C C77-V t T Telephone.#:. �O 8 Z$ B' ej/�'_Z_ Address: P0 AO 0. C07Z/l7' 0 26 3J Contractor/Agent' signature: NOTE All applications must be signed by the�jtrr,ggn�t owner Owner(print): P$TZA l L.l R-- C/ �Et7C-f'._ Telephone#: 5;C>,% 5 6 2— Owners mailing address: _3-5— HI L.L i Ave_17 j:t jjy k4,111 (i✓CST S,4,t Q/�C l` 44 Owner's signature: For co mittee use only. This Certificate is h APPROVED DENIED Date Members signature ..� D EC � � dC JAN- 0 7 Z009 TOWN OF:BARNSTABLE A i ' s appro HISTORIC PRESERVATION ti a o�gaNgr�a�l e C:(Documents and SettingsldecollWLocal Sellingsl Temporary Internet FU&IOLKI IOKH Cert Appropriateness 07.doc 1 :4M4r evergreen Solar Think Beyond. H �i Cj� is erES-A SERIES 200, 205 & 210 w photovoltaic panels Best power tolerance available A range of high quality String RibbonTI solar panels offering exceptional performance, cost effective installation and industry-leading environmental credentials made with our revolutionary wafer {: technology. • No power below nameplate Never pay for power you're not getting •Get up to 5W more than nameplate* For enhanced field performance ' ? •Industry's lowest voltage per watt rating Delivers the most cost-effective installs •UL4703 certified cables a' For use with the highest efficiency transformer-less inverters • New extended length cables Eliminates home-run wiring f • New MC®Type 4 lockable connectors** Complies with the latest codes for accessible arrays • Most extensive range of mounting options Allows installs virtually anywhere and anyhow .. •Smallest carbon footprint of any manufacturer For the greenest of the green cw • 100%cardboard-free packaging S Minimizes job site waste and disposal costs r�r �� • 5 year workmanship and 25 year power warranty*** Born � ( a. r d I ... F-HISTORIC TOWNOr tsNHIvSTABLWE,�'Maximum power up to 4.99 W above nameplate rating;—Locking sleeve not supplied with the panel. PRESERVATION -For full details see the Evergreen Solar Limited Warranty available on request or online. This product is designed to meet UL 1703,UL 4703,UL Fire Safety Class C,IEC 61215 Ed.2 and IEC 61730 Class A standards. String Ribbon is a trademark of Evergreen Solar,Inc Evergreen Solar's wafer manufacturing technology is patented in the United States and other countries. Electrical Characteristics Mechanical Specifications Standard Test Conditions(STC)' PANEL ID LABEL ES-A-200 ES-A-205 ES-A-210 ,b o -fa2* -fa2* -fat* u I 9.' Pmp2 200 205 210 W ° ° ° ` ° ° -0/+4.99 -0/+4.99 -0/+4.99 W i JUNC`nON BOx P�Iemnc� _ (IP6S) ax 0.16 PmP,max 204.99 209.99 214.99 W PANEL GROUNDING SERIAL NUMBER HOLE Pmp,min200.00 205.00 210.00 W ° ° 1'Imin 12.7 13.1 13.4 % ° ° .Pptc3 180.6 185.2 189.8 W CABLES ° (10 AWG.UL4703, VmP 18.1 18.4 18.7 V Pv WIRED Imp 11.05 11.15 11.23 A 4 Voc 22.5 22.8 23.1 V o o ° 10x 026 Ix 12.00 12.10 12.20 A PANEL MOUNTING HOLE ID LABEL FOR Y.'BOLT Nominal Operating Cell 0 Temperature Conditions(NOCT)4 ° MC-LOCKABLE TNOCT 44.8 44.8 44.8 °C ° CONNECTORS o (TYPE 4) Pmax 146.4 150.1 153.7 W N o 0 (+) ° VmP 16.7 16.8 17.0 V o� Imp 8.76 8.93 9.04 A ° ALUMINUM NUM FRAME 0 12x FRAME T o? i DRAINAGE HOLE V. 20.5 20.7 21.0 V I 0 o n 1 35.9 Ix 9.60 9.68 9.76 A 1 �B(w.021.0) 1_. -37.5(+/-0.1 =1000 W/m',25°C cell temperature,AM 1.5 spectrum; All dimensions ih inches;panel weight 41 Ibs Maximum power point or rated power 'At Test Conditions:1000 W/mz,20°C ambient temperature, 1 m/s/s wind speed constructed with 114 poly-crystalline silicon solar cells, anti-reflective in 4 800 W/m=,20°C ambient temperature,1 m/s wind speed,AM 1.5 spectrum tempered solar glass,EVA encapsulant,polymer back-skin and a double-walled f-framed,a-low voltage,2-matt blue(textured)cells anodized aluminum frame.Product packaging tested to International Safe Transit Association(ISTA)Standard 2B. All specifications in this product information sheet Low Irradiance conform to EN50380. See the Evergreen Solar Safety,Installation and Operation The typical relative reduction of module efficiency at an Manual and Mounting Design Guide for further information on approved installa- irradiance of 200W/mz both at 25°C cell temperature and tion and use of this product. spectrum AM 1.5 is 0%. Due to continuous innovation,research and product improvement,the specifica- tions in this product information sheet are subject to change without notice. No Temperature Coefficients rights can be derived from this product information sheet and Evergreen Solar assumes no liability whatsoever connected to or resulting from the use of any a PmP -0.45 %/°C information contained herein. a Vmp . -0.43 %/°C Partner: a Imp -0.02 %/°C a V. -0.32 %/*C a L -0.003 %/°C System Design Series Fuse Ratings 20 A �� Maximum System Voltage(UL) 600 V S Also known as Maximum Reverse Current 7 00 eat�gh��a'y ELECTRICAL EQUIPMENT CHECK WITH YOUR INSTALLER ES-A_200_205_210_US_010908;effective September 1r 2008 Worldwide Headquarters Customer Service-Americas and Asia 138 Bartlett Street,Marlboro,MA 01752 USA 138 Bartlett Street,Marlboro,MA.01752 USA Evergreen Solar,Inc. T.+1 508.357.2221 F:+1 508.229.0747 T.+1 508.357.2221 F:+1 508.229.0747' www.evergreensolar.com info®evergreensolar.com sales@evergreensolar.com AGBP { ,0W, QW, 4 � a7.04.f * 00 ' Jy.=. �' - ^� t 1.•� ,gam `I �,1- so 2 1 • 1 •.1 4 w Y • Y View from the road PP r P_. Yive. N � of Gacngay Od K�co m ee G r NI0*1KE Town of Barnstable *Permit it �P p Expires 6 months from issue date BAMSTABIA = Regulatory Services Fee 9 Mass' Ift Thomas F.Geiler,Director �A i6J9• ��0 � Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 X-PRESS PERMIT Fax: 508-790-6230 EXPRESS PER.NIIT APPLICATION - RESIDENTIALi INL� 2003 Not Valid without Red X-Press Imprint Map/parcel Number / 36 b OF BARNSTABLE Property Address 31}sLt,A �S4AWi J T Residential Value of Work Zweig Owner's Name&Address EMU& I L Contractor's Name— Q1S oPR�� Telephone Number o u Home Improvement Contractor License#(if applicable) Gg99� Construction Supervisor's License#(if applicable) cr ZWorkman's Compensation Insurance :) �a Check one: ❑ I am a sole proprietor ❑ I am the Homeowner n m have Worker's Compensation Insurance Insurance Company Name C- Workman's Comp.Policy# wcc' 6W3 1,6-0 1 a Permit Request(check box) e Re-roof(stripping old shingles) All construction debris will be taken to � ❑Re-roof(not stripping. Going over existing layers of roof) t Re-side ❑ Replacement Windows. U-Value (maximum.44) ❑ Other(specify) *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. Signature 4 Pam, Q:Forms:expmtrg Revised121901 Board of Building Regulations and Standards HOME IMPROVEMENTCONTRACTOR Registration: 106141 i Expiration:' 7/22/2004 Private Corporation t STEVENJ.BIS HOPRIC�INC� ;,=t'• Steven Bishopric�;�t `` `' ' :.✓ .: 1112 MAIN.ST UNIT 1t3��a"t i OSTERVILLE.MA 0265-5 Administrator :J �,�, ,���� x �„t �i�e -tOhirmra�u�,�y �✓�aaaaduaeQ2�� t rya t BOARD OF BUILDING REGULATIONS Cr,ONSTRUCTION''SUPERVISOR F p� _� : N"betrGS, 047928 Se'_ /29119,/48_. 09/ig �4 03 Tr.no: 12189 E 110- STEVENJ � I l BISH(4RRfG° 00 PO BOX 656 \� � %° ! 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I �' CM of fhb Cummme m y beta to the am"of Iavectiptlom of Me DIA tar ca"Mr I do hcreby t atify slanff the pain= p0=1da ofFal3u7 prvrided trbosie it rroa and earrcd DateSipaz -- Ph=¢ omcw use only dome wwrita is thb area to be eampleted by ctty ar tools Ontad city or town: P QLo mint Board ❑Sdseoaea's OIDu ❑ChseicitlamssdiaticeaPonuisregtaeed ❑HmLthDeP'� Contact person: (ts�ws 9193 PIN �tHE Town of Barnstable Regulatory Services snxtqAe[.EMAM Thomas F.Geiler,Director �EO1A0r� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation, repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements.Type of Work: Qe koO - Estimated Cost UU Address of Work: S7 9)�LUwyS uyw Owner's Name:_ ekR a Date of Application: I hereby certify that: Registration is not required for the following reason(s): ]Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: %- J64M Date Contra for Name Registration No. OR Date Owner's Name Q:fom slomeaffidav f Town of Barnstable Regulatory Services BARNSr"BM Thomas F.Geiler,Director y MA4& �pr16 39. a` Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A: Builder as Owner of the subject property hereby . authorize 'A- tV�n T. ?D 15110QriG r 7r-CC: to act on my behalf, � in all matters relative to work authorized by this binding permit application for (address of job) Signature of Owner ^� Date PavNCO, Calk\ Print Name I Application to: uPNE4 0`E�N .. fY Old King s Highway RegionarHistocic District Committee in the Town of Barnstable for a CERTIFICATION.OF EXEMPTION Application is hereby made, in triplicate,for the issuance of a certificate of exemption under Section 6 and 7 of Chapter 470, Acts and Resolves of Massachusetts, 1973, as amended for proposed work as described below and on plans, drawings, or photo• graphs accompanying this application. . TYPE OR PRINT LEGIBLY DATE ADDRESS OF PROPOSED WORK ASSESSORS MAP NO, 1310 OWNER ASSESSORS LOT NO. D7� HOME ADDRESS TEL. NO. AGENT OR CONTRACTOR ADDRESS TEL. NO.� �Q ✓� This application is for exemption of proposed exterior construction on the ground that: ❑ (1) It will not be visible from any way or public place. ❑ (2) It is within a category declared entitled to.exemption by Old King's Highway Regional Historic District Commission: (Check applicable box) PROPOSED WORK: Describe and furnish plan of proposed work,showing location on lot,and, if an addition Is involved, show• ing location of existing building. SIGNED l Space below line for Committee use. . Owner-Contra r-Agent Received by H.D.C. The Certificate is hereby Date Time By L✓ Date Approved ❑ The categories of work entitled to exemption are listed on Disapproved ❑ the back of this form. ' 1999 193 I Application to .. Old Kin is Hi Historic 8 8�3'A�S� L}jstrict Comm>tttr`c in the Town of Sarnstable for a CERTIFICATE OF APPROPRIATENESS Appilusan Is hereby meter id triplicate, for the imance of a Cartitieate bf will aas under Seatlon s of Chaptw 47A Acts and Resolves of Manschusett% ISM for proposed work as described blow and on plans. drawings or photoRapfp a t:oornparlying-this application for: N CHECK CATEGORIES THAT APPLY: t. Exterior Building Constnhcthm: ❑ New Building- ❑ Addition C1 Akeradceh Inckate type of bulldinq: ® Mouse D Garege D Conmtns;ino p other 'z Exterior Painting: 3 Signs or Billboards: ❑ New sign D Existing sign ❑ Repainting existing sign 4. Stnicu e: ❑ Fence ❑ Wall Q Flagpole ❑ Other (Please read other side for otplanation and nhquirarnwits). TYPE OR PRINT LEGIBLYDATE ADDRESSOF PROPOSED WORK SS �.�s 1 4 Al"__„�,ASSES90RS MAP NO. OWNER �`1 >4�/iwr- t \44,ff-o44 L /lfo",a,,. ASSESSORS LOT 1*1 HOME ADDRESS X6�s/ �1.4 0233___ TEL.NO. 7Si 93Yc 7.7S? FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent proper" owners lam why public street or way. 1Attach additional sheet if necessary). A E L&t1dov /y� a -15i"04 ube� _N1�•�f/fA C�A�� !o�' /�,//.a��1s_ flay lvA3.. Cu..D�.ns�b.� /lA. �6�- - t//�niC� �rnC•�iP� � /{i//iArd9 /lA3r LUAy W. ���s<.sb/e/y/1. O�(o��^ Rahn /�://iAMs �/ No/a,yw.o�Y 2sPi vie. AV- /Bata s li b/r /l/1 D�b68' AGENT OR CONTRACTOR Smolt TEL NO. ADDRESS .SAme I43 blovt'� "o DETAILED DESCRIPTION OF PROPOSED WORK: Give sll particulars of work to be done{see No.K other side),indudin; materials to be used. if specifications do not accompany plans. In the case of signs.give locations of existir�g signs and-proposed locations of new signs. (Attach additional sheet. if necfessaryl. ;.—' laini,n9 Clnpboards .t T,e/m on h0U-S,12� :A � �1,J � Signed 0,ner Contractor-Atpnt Spae*below line for Committed use. ' 11 Date t f The Certificate'#hereby Date q�( 2 9 S9 E T iV OF t3ARiVSTABLE Aowaved ❑ IMPORTANT: It r`.wrtHtr•.ato 1a,%nnrr.__ -� ..._...--•-- .,. ,- - Town atHanwhdAe Oid KWX MSMM7 Ebb rk Dhb id Gamines SPBC SST lO TIOZi ace �x/STin,9 Cab,-� /J�tv Ccl/o r; "Je cx�ar- c�/�n COLOR ye�r� r�iv BID� TYPRti C8num TYPE S&cro COLOR ROCr l wuuCAL iezl COLOR �r PITCB C/! WII4DM COL01 8288 eVS)t//).g Co%/' 17e(V TRnt COLOR Leah i)-er cuh.fP� ex�s n� anus co/ar- C.u/ art ,brt�wy DOORS 1 man N_ COLORS Lf u6�0 : aaorrsRs�2Q COLORS — eK/macLAv C.o%r'GUTTERS /9cGl� h//. COLoas �f�,/� DScas P 7 ' ' ?re y new cu/or GARAW DOORS_ COLORS LSGaTs nine a X38" COLORS 6wty SIGNS �Q COLORS 1 In X-11 i i k PB3TCE /�U COLOR 1 um$ rill out Cosfistely. lnolndinp mw u wlm.nc• and, satars"M/Colors to be used. Four copies or thii foes ors revired ran a mittal or m application. aleaq dtb roar copies of tas plot plan. landscape plan and alevatim plans. vbaa applicable. • BpIC� M e�P J. I 30.62� i.02 i►C., r... pomp* t qNw+►� Nrw ems` 1 40 39 38 90AC 80AG 6 2 nc 35 a44 8ZA-CL $-9 g r I►t 1iK�''� 47 46 1,12 AC �i •wtr n 80A,C ' .• �11R dr - .. . ,.ram.. pINMI� 'i 273 - �..�.. ,a D 136 � �Rtl� SIP - ML: 8047209m St:ACtive Cat:single Family LP: S532,f Address:S5 HILLIARDS HAY zip:02668- Town: BARN Barnstable subdiv:POINT HILL Map#:136 village:wBA w Barnstable County:BARNSTABLE Parcel#:47 ----------------------------------------------------------------------- waterFront: Acres: 1 water ACcess:Marsh Rd Frt: waterview: Depth: Beach: Miles: .S-1MI S-1MI Public ----------------------------------------------------------------------- Bedrooms: 2 ROOMS: 5 Year Built:1986 APPROXIMATE SgFt:2,701to3,, Full Baths:2 Levels: 3 Year Round:Y Fireplace:Y Half Baths:l Sep Liv Qtr:N None Garage:Y #: 2 under Room Levels / Dimensions and Descriptions: Living: 1 x Fireplace,wood Floor Baths Bsmt: Family: 1 x Fireplace,Closet wood Floor Baths Levl: Dining: 1 x Fireplace,wood Floor Baths Lev2: Kitchen: 1 x Fireplace,Closet,wood Floor,sliding Door,Dining Area Baths Levi: Mastr BR:2 X Pvt Mstr Bth,Firepiace,Closet Bedroom2:2 x X Laundry: 1 x Fndtn-Main: 28X 76 wing: x Bedroom3: x x Foyer: 0 x Bsmt:Y Full,walk-out,Gar. Access Bedroom4: X X Flooring: Interior:Attic Stor. ,HU-Dryr Elec,HU-washer,Pantry,whirlpool ---------------------------------------------------------------------------------------------- ---------------------------- style: Cape Contemporary Pool :N _ r siding: shingle,tlapboard Fndatn:Concrete Irr :N Dock:N No Dock Roof: wood Shingle Closet: ` Street: Paved Lotoes:view,Cleared,Marsh Hot wtr:oil utils:Priv sewer,Priv water Ht/Cool:of 1 ` Appinc: r' Exter: Deck FeeIncl: f OptSrvc: ------------------------- ---- Tot Asmt: 318,600 Ann Taxes: $4,371/1998 To Be Assessed: TitleRef:B 5141 P 044 ASSOC:N Mbr Req:% Land Asmt: 78,300 Ann Bettrmt: SPEC Assessment: Zoning: RESIDENTIAL Ann ASC: SO/ Impr Asmt: 240,300 Unpd Bettrm; PIan:B P LCO Mass USe:101 SINGLE FA --------------------------------------------------------------------------------------------------------------------------- Remarks: Panoramic views of Great Marsh, sandy Neck & Barnstable Harbor. Custom designed and built Cape with open floor plan on 1.72 acres, Three fireplaces, jacuzzi, cherry kitchen, builtins, alarm system. Directions:Route 6A to right on Sandy Neck Road, right to Point Hill, 3rd left to undgrnd Fuel:U UFFI:N showing: Appntmnt Req,Call Lstg of,Yard Sign Asbestos:u Lead Pnt:U Documents: Flood zone-unknown Cert/Trt: --------------------------------------------------------------------------------------------------------------------------- LO:KINLIN GROVER PROPERTIES I (508) 420-1130 Ext: List Date:12/04/1998 sP L (S08) 999-9999 Ext: Exp Date : Original LP: $532,000 Owner:LUci e Coz SAC:3 BAC:3 DDAC:3 oth Comm: DOM: 141 SA: Ext: Terms: Concessns: ----- In: ,rmation Deemed Accjrate but ri_-t Guaranteed. ----- _p,y'rLght : 999 by Cape Cod & Islands MLE, Inc. r)9/ '� 311999 16 : C1 THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) Im ^xC�J41C DATA PLMCgASXANDSAIX a tt�e day d:tW lei Qs!�bps tl t�1'1!tM�■!� 1W er"Opw swan n sail Brest esaN4 1. 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Im ULLU iW16 at do 1w ol 1r dogf star&K Yw<6 arlMUW&M On Ass�wt�[Mrd�werwsi wlir wr wrMder sew Mre add b"bm oft qps"r ludo Owp- dwiE Eft wli A 1M MIWM niw%ran*womi0d mow,m bodo by A[drowL am aMid ea AMsmh stW"l.sf.a her" you im Ima b s boa a.d. mm tas aeon ii/e&.wiptl.r.nr"t a I a..eeAt..�rrws. Ledh °qbowl SdIa a.er. Lew ter: 024�o.s�- am o a99S' Ld Wd9T:S8 666T 9Z AeW •pN 3NOHd WOad 1999 193 Application to .. Old Kings Highway Regioad Historic Distrx Committee in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS Application Is.hareby made` id triplicatk fbr ft Issuance of a Certifiem bf APPr%MAW wWw Sect g of(spur 470, Acts. and Resohin of MmUdwsettui, 19M for proposed work ere described below and on plans, drawings or photograpfp accompanying-this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior Building Constriction: ❑ New Building ❑ Addition Q Alteration Indicate type of building: ® House ❑ Garage ❑ Commercial ❑ Other 2 Extirior'Painting: Mr 3 Signor Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sigts 4. Structure: ❑ Fence ❑ wall ❑ Flagpole ❑ Other (Please read other side for explanation and ra luine,tnnt�t. / TYPE OR PRINT LEGIBLY DAB (01"/FY ADDRESSOF PROPOSED WORK SS y 11.4y Z Al,Rd" ASSESSORS MAP NO. 1-36 OWNER `J �` /1147F�ie� t �/.4�►e�� L. 4/or—n ASSESSORS LOT No. 17 HOME ADDRESSX6a,-s/ /11�i 023�/ TEL NO. fig/ 935'17S'9 FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjawnt property owners across any public street or way. (Attach additional shoat if necessaryll- G/g/Ql7okAll _Nl;rM,9 Q,9-r1b 11,4y Cv.4y Cy.A&W-51-VA& /yA. A:U,68- • ���iCe /,�rrc�E�P� yD /f.//�A�d9 /lA3r ui�1 y ltJ• i3��nSfi�b/e/lll. O�lo� —^�� Ric M /ice; 6,4AJs �/ //n/awAfY / - !u- ARMS-tab/r AW, O.264V AGENT OR CONTRACTOR g4-1 TEL NO. ZP/'041"9?5y cam. ADDRESS ,5wf"a 7) DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done(see No.IL other sids);induding 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). )PaInfin 9 Clnp boards f- Te/m on h out - Signed Qwner Contractor-Agent Space below line for Committee use. FNI " 13 Date :� The Certificate jl hereby Date __)/V 2 91999 OA �! 8 T N OF BARNSTABLE Approved 13 IMPORTANT: It Certificate is approved,approval Is sublect to the 10 day anneal nerind Tows of Banwbd le OU10 !'s7 SPRC SHEM D�O�ITION rUllCp� . pi�75T/N9 Ca�c►'� /1�'c� ca/o r SI3)ZP9 TrM,, 4yhjJe mar- P COLOR CHDNB! TYPE S/Unc o COLOR Row xn=xAL ted cLda✓ COLOR PITCB 42, Cc �n�awsc�blr `Jun 5c COLOR SISR evs)//).q Co%/" TRIG[ COLON! W h(Ae. cvh.fe, e'XfS C.u/ Deus co/ar- dart ,brvwY DOORS flan P-1 COLOAB yfuO�) SNUTTZRSo COLORS eY/�o slew Color OOTTBRB AILG/� / /�I a Ir COLORS While DECKS Y'CS )0, T Qtt'Y /�CGtJ CUIO/� VV c�J►RAaR DOORS �/�5 Flush CCOLORS, Wh;Ale-, SMIGRTs S e=ss X 3B' COWRB wry SIMS AQ COLORS I I L__j-11 76E), 0 pa,�� rMrca O' COLOR dill ouc eaipl.c.ly. ia.ladiaa .rasusa.rat. .Da Saearial./solaro to be o..d. four eopi.. of t" toss ar required tar subuLttal or as anxieati.a. alma..ica pow copies of the plot plan. landscape plan and sl..atloa plans. vhm applicable. eQ� a 1 m .qZ� O® 0 AL 3i ti .30 �17AG 1•��G 3 3 © ' 64 8^C. 40 39 39 90AC SOAG 62OG 35 `��te ;'sA� Jci9�j� 44 •w_ e�A� ,� CUlR1C'. IL •AC .8 Z At. $ . CL a.) Air t 47 t 46 t .wir N .80^0 .• �E1t ev `„ �NI • i ---- .......� w •-� 273 »...... �� � • �r I>t1 IM •�a 136 -- - - -- ML: 8047209m St:Active Cat:single Family LP: S532,( Address:55 HILLIARDS HAY Zip:02668- Town: BARN Barnstable subdiv:POINT HILL Ma #:136 ..::..:..::.... . ....:...::.....:. .:.:.........:. village:wBA w Barnstable County:BARNSTABLE Parce #:47 ----------------------------------------------------------------------- waterFront: Acres: 1. water Access:Marsh Rd Frt: watervi ew: Depth: Beach: Miles:.5-IMI .5-1MI ,Public ----------------------------------------------------------------------- Bedrooms: 2 ROOMS: S Year Built:1986 APPROXIMATE SgFt:2,701to3,; Full Baths:2 Levels: 3 Year ROund:Y Fireplace:Y Half Baths:1 Sep tiv Qtr:N None Garage:Y #: 2 under Room Levels / Dimensions and Descriptions: Living: 1 X Fireplace,wood Floor Baths Bsmt: Family: 1 x Fireplace,closet wood Floor Baths Levl: Dining: 1 x Fireplace,wood Floor Baths Lev2: Kitchen: 1 x Fireplace,Closet,wood Floor,Sliding Door,Dining Area Baths Levi: Mastr BR:2 X Pvt Mstr Bth,Fireplace,closet Bedroom2:2 X x Laundry: 1 X Fndtn-Main: 28X 76 wing: X Bedroom3: X x Foyer: 0 X Bsmt:Y Full,walk-out,Gar. Access Bedroom4: X X Flooring: Interior:Attic stor.,HU-Dryr Elec,HU-washer,Pantry,whirlpool --------------------;------------------------------------------------------Paol:N----------------------------nl----------- Style: Cape Contemporary , Siding: shingle,Clapboard Fndatn:Concrete Irr. N Dock:N No Dock Roof: wood Shingle Closet: Street: Paved LotDes:view,Cleared,Marsh Hot wtr:oil Utils:Priv sewer,Priv water / Ht/COOl:Oil Appinc: Exter: Deck 1f Feerncl: m r OptSrvc: Tot Asmt.: 318,600 Ann Taxes: $4,371/1998 To Be Assessed: TitleRef:B 5141 P 044 Assoc:N Or Rep Land ASmt: 78,300 Ann Bettrmt: mc Assessment: Zoning: RESIDENTIAL Ann ASc: $O/ Impr Asmt: 240,300 Unpd Bettrm: n:B P LCO Mass Use:101 SINGLE FA --------------------------- Remarks: Panoramic views of Great Marsh, Sandy Neck & Barnstable Harbor. Custom designed and built Cape with open floor plan on 1.72 acres. Three fireplaces, jacuzzi, cherry kitchen, builtins, alarm system. Directions:Route 6A to right on Sandy Neck Road, right to Point Hill, A left to Undgrnd Fuel:U UFFI:N Showing: Appntmnt Rtq,Call Lstg of,Yard Sign Asbestos:U Lead Pnt:u Documents: Flood Zone:Unknown Cert/Trt: --------------------------------------------------------------------------------------------------------------------------- LO AINLIN GROVER PROPERTIES I (508) 420-1130 Ext: List Date:12/04/1998 SP : L (508) 999-9999 Ext: Exp Date : original LP: S532,000 Owner:Lucl a Coz SAN BAc:3 DDAC:3 oth Comm: DOM: 141 SA: Ext: Terms: Concessns: Information Deemed Accurate but not Guaranteed. ----- Copyright : 1999 by Cape Cod & Islands MLS, Inc. 04/23/1999 16 : 01 THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) I A , m / �C(�J LI DATA nMCMASX AN1D SALZ AG�lBRM�iT as" dq Ormw lift tila—r Qan1a a wt hrldt bmbwm*Wt r Oft swum t Moran ub stm l Name fAwwsr i. !AN= l�ed�a/'.ntt[iT6.li�4Hq�fit4r�lihU IptwttNiarit■ttbat�iat+eltalt� ears tlt e'ttii'it.Marts•a�•rt�4 C Irlstitr srt t�s�-Mares� ��t�fat�itwtMt,ilerlttes atiss tr�JYI�f.•�'�w�1Y,t*ais Aa tt+�sa�raMr/lrr art tb�.l�s MaMa�Merisi/r�Ma s ria wlb do beams do -4 NSWIM1y WI-M aprrs Erata/iasi,mane w tw,laaatsf aK is�i�4�aitt MAtt:+iia►Mtttttl�wttt•t aan ptAtali�t'b�ttet�ai ilt **W tt lw mw=fidla Cwstl !at;tllts�.tMak i149,VIVA ttM As"M O1eNtrrttllt Atttttai�t�att��tstral A irela�e!ttt3l nbm apettlttli N Who ttstitb�/rtp, t� trw t�rrwn.tdi>M i a tit 3ilLLitR oet yad sa awtelws 1MtttMi opow"s t4,i MA04"wpm drnwy m ft aNrrlkNtapiw—iii,loom wakwlofawes"MIN%itewr mm idwom f uA dIta�tlld�,*ANW r lM!'ltaNr ittlo�ittllyN f Now"49miir ban"Uditm tgs+rtt t,N.cwtwr iew+•rs. mdaetw.ftkvmpfiMpoil ,I I'll',awe NW edw styttgttr,aMh •ir ei�a..aMtasted was r.eoms pw4.rmMuIs . ®ttopno"atd w iewtr 14 6Y I*PM rash go lea•tfYl1R arts tiiw ateMleNa�ttiptb!b!•titre tittilli�r!wrMl..■atia�ts e!a li:iiARatlintaa�fl!�itMea+�rdttrR��wi�wM/rtiwalt p�rlit�, �sus rtaiiattaaa�a pas atserar�swi ar rrMNtM.tills tlMes,Qre hem aaM (s) ft"m ms semi"Miry and No"lnwt (r) 4it vf$n av e11%t1 m M parq waa*W&me wa Vw a Ol l "Of wrl��aanea>3 tN �bdtss lief �et�eat7�r tre rai iu aas//�aDiaaw Aa date d !M Mrw�r�ataaei M�t� (4 Aay*W ar vm@§*d y aitt�a/at#�r tit iwa�Wt a/nfe ase (y Sirtit�1R ettf mart�!r+ttw+it.lt aiq��s f�r tle+sor �a sttiRslilttr iltstlttt�jr itle'l�+t��t Ntrt n1a add prlitattt Y all I at 0 d l9 aNY pts�aar r0i►t;w tldt seta. 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' i!t !1�QT.�.���al�lbat�f Ir ilk!����r d�•�MsMe M!f� b�d�sllwt 4gI a 4 ft ar"Win wao o"pmmW a WwOW obda Mat 80 jrasia��. Ma4l�sft oppm"d smbe dea t"n u line wllb �0. Tu a l"W 80%igloo out&"bwgft,as' b wis by AtruL as mO W Arwda GUM"bawr M an" "OUM 1fir1�a blpLi�st Est�r 1�6i� ��ssieatwr, o�swMt ss Mrerl. Logm Cd Wd9Z:SO 6661 9Z pW •0?4 BNOHd . W02id FROM TOWN OF BARNISTABLE Town Clerk BUILDING DEPARTMENT Town of Barnstable 367 MAIN STREET HYANNIS, MA 02601 Hyannis, MA Phone:775-1:120,. SUBJECT: BOND/55 Hilliards Haywaq, West Barnstable FOLD HERE •. DATE ; NOvember 20, .19 9 MESSAGE Obligation to Town of Barnstable under bond issued for building permit has been completed. Please releave the bond. SIGNE�Ve W0 . a uz Bui R Commissioner DATE REPLY • - H ' SIGNED - N87•RMI , RECIPIENT:RETAIN WHITE COPY.RETURN PINK COPY SENDER:SNAP OUT YELLOW COPY ONLY.SEND WHITE AND PINK COPIES WITH CARBON INTACT. f�. 4 . N 1 f - 1 31 III 1 e&rogiAll vG w�u. 78 f 0 s�,,v/�' /7Z 0 N I' ' o ti� 67 I A� cu�Cq�D s 39,.s'3o Sq.Pr-t �cb' of H�3N V i CERTI FI ED PLOT PLAN LOCATION .War,•� irLn!sr�98«. , SCALE . .�.��-5. �.... DATE aGT ZZ /�84 FLAN REFERENCE e�//VG. .. . . . . . . . . . . 4,7s 3/ $1 3Z EG1 �I v LLEY Bo.26100 vs 9�G/gTEP�'o +p�3UP�Ev CERTIFY THAT THE G !Sr�^/G �ou.� 4't °`�• SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON AND THAT IT CONFORMS TO THE SETBACK REQUIREMENTS OF THE TOWN OF .WHEN CONSTRUCTED. DATE OC7 ZZ /jB¢ _ .y . . . . p �L1 e,l 5,6"zL $'DpA/NA ' I�/.t�/CAS — /�E7777Oi✓c`%� REGISTERED LAND SURVEYOR FROM Mr: David Allen & Mr. Donald Currier l ,,F'TOWN GP BARNSTABLE d/b/a Decoy Realty Ltd. BUILDING DEPARTMENT c/o Dinius 367 MAIN STREET HYANNIS, MA 02601 P. 0. Box 40 Phone:775-1120 East Sandwich, MA J SUBJECT: 55 Hillards Hayway, West Barnstable FOLD HERE ' DATE . May 29, 1985 MESSAGE ' i Please contact this office immediately re your open foundation located at 55 Hillards Hayway, West Barnstable. i SIGNED Alfred E. Martin, Asst. Bldg. Insp.. DATE REPLY SIGNED J M87-RMI ' RECIPIENT:RETAIN WHITE COPY.RETURN PINK COPY SENDER:SNAP OUT YELLOW COPY ONLY.SEND WHITE AND PINK COPIES WITH CARBON INTACT. s, MAC NEILL & FITCH ATTORNEYS AT LAW TUDOR HILL HOUSE ROUTE 6-A POST OFFICE BOX 549 •. SANDWICH,MASSACHUSETTS 02563 JAMES R.MAC NEILL TELEPHONE(617)888-2453 JONATHAN D.FITCH - TELEPHONE(617)771-1929 File No. R-2781 July 26, 1985 Mr. Joseph Daluz, Building Inspector Town of Barnstable - Hyannis, MA. 0.2601—- - -— RE: Richard W. Anderson - Lots 31 and 32 Hilliards Hayway, W. Barnstable Dear Mr. Daluz: Please be advised that the purchase of Lots 31 and 32 Hilliards Hayway has been concluded: Russell J. and Donna L. Dinius sold both of these lots to Richard W. Anderson of 507 Route 6A, East Sandwich, MA. 02537. We have enclosed a copy of the deed from Dinius to Anderson. If you should need any further information, please contact our office. Thankyou. Very truly yours, MacNeill & Fitch + /hrc enclosure } I t fp. �!.'o ,� � . / .1,C� Ass' sor's map and lot pnumber .4.../...........f......l.................. 4-s r , l/ Q���f. — / —/0 ^ THE T��t f >Q H age Permit numberasn� �"`....... ., y� a�� House number `.............. J............................... , .t ��r 71 o,03g. 'EU M;k 4 TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ..... . .. ... ..... ............ ..... .............. ... ( �GL.... ... ..................... TYPE OF CONSTRUCTION ......1. ..... ....... ............ ... .............................. 006.........................19Z .T TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following/ information: Location ... .,2 .. .... ........ . .. C� ......... ............ ...................................... ProposedUse ........ .. . . ...................................................................i ... %........ .. .,4/ Zoning District ..........�.!..!.. .... ....Fire District ... 4-4/� �...<. .................... j .ale, � .. .. . Name of Owner ... .......... .. ... . dress .. . ............... Name of Builder .................................. . ...............Address .... .. ... Name of Architect . . ..........1�.. :/.4.5!i....Address ................................._.. ....._.............................................. Numberof Rooms ....................7.........................................Foundation ...! i ......................................... Exlerior ............ ........................... . ........ . ..... ..... .........Roofing ......... ...... ................................................................... Floors .........................Interior ... .. .. ...... . ......................................... Heating `..`.......... L........r .....................Plumbing ..... . ....... ............................................................. Fireplace ............f....................................................................Approximate Cost ...........g.0t... ................................ Definitive Plan Approved by Planning Board _ ___________________19________ . Area 1 / b........../...... . ................... Diagram of Lot and Building with Dimensions Fee . Q ar SUBJECT TO APPROVAL OF BOARD OF HEALTH �IL OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of Z..Tn of rnntabl Bard' g the abo e construction. Name .... ............................................................ Construction Supervisor's License ..... .............................. ANDERSON, RICHARD W. -* 1Mo ....Z$29.0.. Permit for ....1... Story............................ ....................... Location ......aa..HzL11ar-d!.s.-Ha.yway................. ......................................West Ba�!�.sA... ..............................le OOwner .. ....R.i.cha.r.d.. ......viderson wner ................................ rl Ty of ons, on .......................... ........... ..... ......Oi................................................. Plotlot ....... . .................. Lot .............................. Permit' G led .....August.�!!&us 2...............19 85 Date of Inspection ....................................19 Date Completed,, ...).............................19 Assessor's map and lot number .l1..../ ...d�7...Z� /, t� 3 6411 (� _ I�LVtr/ /�� yp TNEt��I Sewage Permit number ......................C�... ...J...... .). �� v` EPTOC SYET � T 1 F0'z13T,q MCOA, . Housenumber ......... .. ............................................ ERVIRQNM�E TITLE 5 0,�= AL CODE A"aY 781 toleC PROVE WN OF BARNST�M uLATI onservat,01 T ssiorl ONS ed Date D uILDING INSPECTOR APPLICATION FOR PERMIT TO ....�:.Q ;!k7.!Lew!....R S'/ c t- rpr��i`�„l�GvE�c�i"�� TYPE OF CONSTRUCTION ........... 0 0 v.... ! !4' .f:....................................................................... ......................... ,3......190. 1 a TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..fR.T.. ....53f... ..Q�......tT .. LN N G^r Proposed Use ....�/�'.:��...�?,'�.��:Y.....................................................+...'..I.............�.................................................... Zoning District .............. ..�............................................Fire District .......�N.4ffai..!,l�2wS11!3La -.................... Name of Owner ../..`as ^'cc�F.4: ...�.�.................Address ��.�L�..��4't.��...��1!!�LUtGEf�Y" Name of Builder -77442 CYVU-1fY .....�.......I .... ...............Address ............�?.:'...............���....5,...... .�.... Nameof Architect ................ -..............................................Address ................................../................................................. Number of Rooms ............... ...............................................Foundation �.!�/ ° .................. Exterior :5........Z ....... ...Roofing ......2-c?..C-c. ?, 1�`/i�''F���`.................. . AZT CJ�oi9'i�'.Ceuq•�i3a/�'z� Floors ......... ......................LL./...................................................Interior ......f�L'��4//STB. ...................................................... Heating ....l..f7-- 1... .........Plumbing ......C//.. ... !gTh`5............................................ Fireplace ......Q`v Q�� C /Mn.! `'�...........................Approximate Cost .............[..6Uj.va ............................... ....... ................ . / Definitive Plan Approved by Planning Board ___ __ --------1971_____ . Area Quo!.—� Diagram of Lot and Building with Dimensions Fee �,.......... ". SUBJECT TO APPROVAL OF BOARD OF HEALTH Q j,Q OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable re rding the above construction. Ne .......... ......... . .. ....... .................. C Supervisor's License ..... .... .. . 91.. ......... o Q m -a O r �L • 'f c� N Q �' m ~• H Q n A4 :00 n rt :wi4d;I "_ �- � ' 'it03� kr"�omtt'► ' " .,d oCs���nYeM :N o o rt :O n ;ln 44 F 0• : Fj. 00ON :P ka tv �+-r�...-.�....q,y•"7r�---=—..r�.�..�_ ,.—. -..- .�.�.,y�..f .......�.`r^+w�'nwr� E`..;3,:_.':�7�.�Y.'aMw.t' '1y��Y>A7%Ji°'Y`*v6�:.•.+i:.;v...v.+ .- ... .-...�_ .. o.THE-r, TOWN OF BARNSTABLE 30187 � Permit No. ................ BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash ■... .• HYANNIS.MASS.02601 Bond ......`....1�.. . CERTIFICATE OF USE AND OCCUPANCY Issued to Lucille. Cot Address Lot #31, & 32, 55 Hilliard' s Hayway Kest 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. 19................. ................................ Building/inspector TOWN OF BARNSTABLE BUILDING DEPARTMENT _ »°T TOWN OFFICE BUILDING HAM t639' �� HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department yQ DATE: An Occupancy Permit has been ' issued for the building authorized by BuildingPermit $k........��.-_`�..../. .................................................._......._................................»................ issuedto .V..�/. .......Q`1 -�� ...... _ ........................... . ......................................._._... ..» ..... ». ......__�. _ » Please release the performance bond. TOWN OF.BARNySTABLE,'MASSACHUSETTS B I D N G ;PERM 1 T A=136-047 DATE Nov,!rnber 14 19 _ PERMIT �'q{M/ �Q ` APPLICANT +•'• tl� � .. dnhn R Curleyto ADDRESS T�l�A • •.n,�•,)4�� . '-. (NO.) R f C'ONTR=S-LICENSEI,. ., PERMIT TO (_2) STORY NUMBER OF(TYPE OF IMPROVEMEN 1 No. DWELLING UNITS 1 (PROPOSED U E1 AT (LOCATION) lnta �1 £ �� 55 Ni 11 iarll f T7 n LTA RA ZONING; =.:`.':, •. :. (NO.) (STREET) In table o1sTRlcr BETWEEN AND != (CROSS.STREET) (CROSS BT REETI SUBDIVISION LOT LOT BLOCK SIZE �L *-_•^!•' BUILDING IS TO BE FT. WIDE BY ' ; � ,..:;::•'.r:'�!'::"'; FT. LONG BY FT. IN HEIGHT AND SHALL,CONFORM.IN'C-ONSTRU. G!f I'ON' TO TYPE. USE GROUP BASEMENT WALLS'OR FOUNDATION ' (TYPE)'; REMARKS:. Sewage 984=901 AREA-OR s`. VOLUME.— e PERMIT :Q ESTIMATED COST y�_ 1'6n 000 FEE (CUBI /SQUARE FEET) f OWNER LQf3-119 1209 ADDRESS kill l BUILDING DEPT. «a OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE' SEPARATE INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING • AND I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MINAL INSPECTION TI TO LATHE FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 2 2 2 3 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT OTHER BOARD OF HEALTH WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT 'W!L L BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE TOR HAS APPROVED THE VARIODUS STAGES OF I WORK IS NOT STARTED WITHIN SI;: MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN CONSTRUCTION'. I PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION. i ` OF BARNSTASLE, MASSACHUSETTS TOWN . _ N.G��:��P:E�NI•IT�j.. DATE NICIV,:(Oi1iJl" �j. •. ... .;•.•.:•... :. �:':,.1"7ie,a.<r�,• �;�lS�. !t,— 19 �`Mv 1 APPLICANT T.}. 1, PERMIT 'iti X►/ .:.- • /� !rle y ADDRESS K` R. •�yy1CONTRlS':C1,4ENSEl:y:,aw•j. PERMIT TO ,.17r, '•,-, .,- STORY NUMBER OF::' �I'•_,. ..: ^,�%.a:,::?: ITYPE of IMPROVEMENT) NO. ` DWELLING'UNITS AT (LOCATION) ..... ...•i:: ..`. 'r,.?. •• .,; �� 55 Ri l l i aryl NaywgV. W RntnQt' ZONING:.,':: . (NO.I (STREET) ------.....—able �oISTRIGT_:�.':.';�'Da ..•... BETWEEN ;i,:••;,,':.._.:,,^ (CROSS.STREET) AND ' (CROSS STREET) ':. :.''ai%�:'`•i�'::''„�`.i• 5p- SU BID.IVISION LOT LOT BLOCK S1ZE "' %• :::a.: ::%;' BUILDING IS TO BE FT, WIDE 8Y .". '..•:.': . :•P,:.,:._':.:c•,;i�'/: :. .. FT. LONG BY FT. IN HEIGHT AND SHALL'.CONFORM`IN:::'CONSTRU Itebk-':-- TO.TYPE. ... USE GROUP BASEMENT WALLS"OR FOUNDATION ' I'; REMARKS: (TYPE ESTIMATED COST (jnn': "PERMIT $OND (CUBI /SOUARE FEET) FEE .n' .Sl••:? OWNER a:: ✓,; ADDRESS J.,•:< Y.r<t.•,y;Y�' .. rast BUILDING DEPT, OF ANY APPLICABLE SUBDIVISION RESTRICTIONS, *,* ---' '� 'j•i-••n "'��''° �3f.'..��. MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AN O THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR ALL C P r NDATIONS OR FOO TING5. n 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MINAL INSPECTION TI TO LATHE FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE OCCUPANCY. _ POST THIS CARD SO IT IS VISIBLE FROM STREET � BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1997 •� 7 2 2 — — 1 2 l of 6 - HEATING INSPECTION APPR LS ENGINEERING DEPARTMENT t OTHER —' BOARD OF HEALTH 1 1/2Z ' WORK SHALL NOT PROCEED UNTIL THE INSPEC P E RM;T 'N!L L BECOME NULL AND VOID IF CONSTRUCT ION INSPECTIONS INDICATED ON THIS CARD CAN BE TOR HAS APPROVED THE VARIOUt:S STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONC OR VVRITTEN CU•ISTRUCTION PERMIT= ISSUED AS NOTED ABOVE. NOTIFICATION. ` T Ah i.<r.e a s �/�� w•9y 40 w,a� 3Zo. o o —T- 3l' I \ W/9 c.C- 78 f 0 0I ` N Ar.3o.y S t IV. Ayer-�9 �`i<Yizs/1 3.Ss76o sp,Ar,/40 &--Dcs- op- HAraSN 1: CERTIFIED PLOT PLAN LOCATION SCALE . .�.��=5.�.... DATE oc7. z.Z /j _ PLAN REFERENCE .S! !n/G. .. . . . . . . . . • . L,TS 3/ $/ J Z. . . •S A wti � N ll� Na 261�0 v� 'D �4 FCISTEP e� AhDsua4t I CERTIFY THAT THE SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON AND THAT IT CONFORMS TO THE SETBACK REQUIREMENTS OF THE TOWN OF _ . . . . . .WHEN CONSTRUCTED. DATE ,GUSS�2L �vDOA/NA ' h/.t//US REGISTERED LAND SURVEYOR U 77X low �' ` 47 �Assessor's map and lot number ..../.�� . ........... s�,_ D THE . (C�-�c r•>�. i� -. �f Sri X. ,. J,Y.'�i Sewage Permit number ...........�!�'to� : ..............:..... �` d�' �� . BHB A9TADLE, . use number ......:.......... C� rasa ionrA a' TOWN ;OF 'BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO . �{ r TYPE OF, CONSTRUCTION ......1..kt* .....A.........,. /..:........ .. �/...................... .fqA. :19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ... � ..�y ✓��i C1J..\- l! ....t /......... :...... ................ . cz.c� J y� Proposed Use' ........ ... .��<C Cr....................... .......... ��..... Zoning District ............!..!^C�/U1. .1. ... .. .. .. !./.•�r ....Fire District ...,. 5/.,. :. ...............:....................?.... Name of Owner . . . ....... ....... ...... .. ................. . . _. ... ..address o.;!(��. IJY.��1�1. a-............... l.!/�, �?G��S:rr) L'�".. ,•G•,���-emu:-c.z�=-=.�_�---__=_--. Name of Builder ..............................:...... ....... ...................Address .. r��.. �`� Z .�.. .......>. _-__-:.-' ...... Name of Architect .� .... ..L ( (!�.J...Address .................................................................................... 7 Number of Rooms .........................Foundation .... ......................................................................... Exterior ............ ........................... '�! !.. ..`.. ...... ...........Roofing .....:.......... ................................................................ Floors ..... .........................Interior ... ......................................... Heating !' 0... � .....................Plumbing .....r'.2...//�............................................................. Fireplace ...........(................ r...............................................Approximate. Cost ...........!?..t.�i... ................................ 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 thDri n�& Bnstlle eegat:ding the�bove construction. � NameZr .GZf �.......... ~.`...................... Construction Supervisor's License . ......... i(7 ANDERSON, RICHARD A=136-46-- & 47 40t 47 28291k 1j Story No ................. Permit for .................................... Single Family Dwelling ............................................................................... 55 Hillard's Hayway Location .................................................................. West Barnstable ............................................................................... Owner Richard W. Anderson .................................................................. Type of Construction Frame .......................................... ................................................................................ Plot ..... ...................... Lot ................................ Permit Granted .....A!4Ms. ..2..................19 85 Date of Inspection ......................................19 Date Completed ......................................19 0 I't 0 Z-4 Assessor's map and lot number .7T-.f`- ?... .. tot TNETp�O t �7 Sewage Permit number ......../.......... ......... o.).. d BASBSTODLE, i enumber ......... ...................................................... r MASK 0 �� t639•Or,9� TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ................T...:.....................�1:......:......,....... TYPE OF 'CONSTRUCTION ......................... L3......190ot. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies fpr a ermit according to the following information: Location ...... �Grc,i •iZvs y Proposed Use ....} /n!Gc .... 14i`.!'... leu.,' `!. .................................. ..... .......... ......................... ., Zoning District .... �.�.. � ....Fire District ..:....� Name of Owner r .... .Z.................Address FL!...� .4 .. ........ !.L?uJd! &f. .&,4 1 . Name of Builder -40HA....... .C. ......................�.......................!.Prr.•.. ................Address ............f.�:..................f;�..... .�........ ....................... 6A4-57- Nr-�t�criG�� Nameof Architect .................�.�.......................................Address .................................................................................... Number of Rooms ................0...............:...............................Foundation .... 2tF�... ,r •C•,a2�r� . ...................... Exterior 2... t G- ...Roofing ......!:......T�..�� A.. i?. f.�'.!<r.'.......�................ .zz . i Floors ........E....7.................... ...........- .. ........................................Interior ...........................................................................,........ Heating !Q 1 . ... ! .1 . r. ........ � ..........Plumbing ......Cf...�[ ...��Th' .................... 1 3a� , c �� Fireplace .............. ...............ffl.............`�...........................Approximate. Cost .............1•Ga...../...................,........................ Definitive Plan Approved by Planning Board —� - - 19�1- Area � �................... Diagram of Lot and Building with Dimensions Fee o SUBJECT TO APPROVAL OF BOARD OF HEALTH T • OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS 1;hereby agree to conform to all the Rules and Regulations of the Town of Barnstable. regarding the above construction. Name .....WMI.+a. ! .. ....... .................... ConstcuSEi/nS' upervisor's license ............ ......... COZ, jXCILLE A=136-047 30187 Two Story No ................. Permit for .............................. ..... Single Family Dwelling ........... ................................................................... Location Lot #31, & 32, 55 Hilliard's Hayway ..... ............................................................ West Barnstable ............................................................................... Owner .......Lucille...C.o.z..................................... ...... . . .... Type of Construction .....Frame..................................... ................................ ............. ............................. Plot ............................ Lot ................................... Permit Granted ....November} 14, 19 86 ...... . .... . . 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