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0126 MEADOW LANE
UPC 12543 �a No 'n, `' Ha STINGS. UN �-- ..:::.-..r.-�, _.... . ..: �- .<..-':,rye rr:. -� .. .,.,r. ......�...r : �� ....,�+..�.y.r•�.- - - - - - - -- _ - _ R-r.� :e!�!.T•. j Assessor's map and lot number Sewage Permit number •t *THE tp�♦� TOWN OF BARNSTABLE i BAWSTADLE, i "6 9. BUILDING INSPECTOR APPLICATION FOR PERMIT TO ....................... .................................................................................................. TYPEOF CONSTRUCTION ..................................................................................................................................... ... ........ .......................19..E .. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ProposedUse ...................................................................................................................................................I......................... Zoning District .....................................Fire District Name of Owner .. .....:.. Address .. .:... .............. o> ............. ...... . ..:.. .... ......... ................ Name of Builder '........ ...............................Address .......: ... .... ......... ......... ................. Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ..............: .................................................Foundation .............................................................................. Exierior ....................................................................................Roofing .................................................................................... Floors ....................................................Interior . Heating ..................................................................................Plumbing Fireplace ..................................................................................Approximate Cost .................................................................... '..:Definitive Plan Approved by Planning Board -----------_------_-----------19_______. Area .:.c........:.'. ................... Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ............................. Lilly, Robert A=133-25 remodel 2nd No .................. Permit for ................;................... floor ............................................................................... Meadow Lane Location)Z(V......................................................... West Barnsthble Robert Lilly Owner .................................................................. Type of Construction ....................frame....................... ................................................................................ Plot ............................ Lot ................................ Aril 14 77 Permit Granted ........ ...............................19 A Date of Inspection ....... ..........................19 Date Completed ......................................19 PERMIT-4-EFUSED ..................................................................I........ .. ............ .. ... 19 ....... .. ......... ..... .. .. ... . . . ...... .. .............. ............................................... ............................... Approved ................................ ..................................................11'*-********" 1 9 ............................. ................................................................................ Assessor's map and lot'number ../v..3..� `�T . . �iC, � / I—_ � 77-+ o SEPTIC SYSTEM MUST BE y - INSTALLED I N' COMPLIANCE ' Seyvage Permit number ....11�u �:�...............y°�........... WITH•ARTICLE II STATE SANITARY CODE AND TOWN -TOWN -OF 'BALM-9TABLE Z BISHSTABLE, i 9 1639. M�a �0 BUILDING ' INSPECTOR oYPYa' .i a� APPLICATION FOR PERMIT TO .................. .. ............. .... 0®2.................................... TYPEOF CONSTRUCTION ................. ............................................................................................................... ......�3..................19..7...� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: f�l e�' � a G� Zl�6d' Location ....... ... .. ........................................y...........,.�......,�.............�....!".:T..:...�.......................................................:......... �es�dey f? ProposedUse ....... . ...................................................................................../...,..................L....`............................................... Zoning District ........................................................................Fire District .....�'!!.:...&4-<k�J,l,,,��•... Name of Owner ... �'�'�%�.!.........LIGI ...............................Address ..f.'f. ... !'!'K......... �✓.:.........hS/,kr!`...f............ • Name of Builder ..... .... � ........................................Address ... ........... ...................... . Nameof Architect ...................................................................Address ........................................................................:........... Numberof Rooms ............ 3................................................Foundation .............................................................................. Exierior ....................................................................................Roofing ...................../................/.................................................. Floors .Interior `S'`.�•� `�C ........ .�-!o£T................................................ .... ................................... Heating �C1md �U! .��..........................................Plumbing ...................................... - .. ...............................:.... �a .7A I p Fireplace ........... ................................................:................Approximate Cost ..... ...... /..v ......... -Definitive Plan Approved by Planning Board ________________________________19________. Area :................. Diagram of Lot and Building 'with Dimensions Fee �— SUBJECT TO APPROVAL OF BOARD OF HEALTH • I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .... ........ .... D� ............................ Lilly, Robert Rmbert . . . . . ' No .................................... mo »del 2nd ' . floor ----. —..---,------------. ' ' ���e ' Location ---.������------------- ' ________..geot_ l��__.___.. . . . ��l Ovvner ----.X�ber�___.~��_________ ' . Type of Construction ---���P��------- -----.--------. .. —. --.`------- / ^ . Plot ��� ' ---------. ----------' ' ' 77 ' ' Permit Granted --'�����—�—�ll4-----l9 ' Dote of |n --.---------.lq/29 ' Dote Completed -----. ---lg ^' . ` PERMIT REFUSED ' . —`~--'^-----,-- ...................... lV . ' . . . ' . .—^----------------..'------.... . —_--.----------...----------. . . . | ^^'--^--------'------^—^----- � ....--.--------.----..------.— . . Approved ................................................. ln ' ' ' ------'---------`----''r----' ' ^ ~ ----------------------...--. ' | i Cape Save Inct��r�, ��� ��; ce) ('4 Vd" 7-D Huntington Aveuue y South Yarmouth, N16- 40�641 ^: 0 6 Tel: 508-398-0398 Fax: 508-398-0399 9/29/14 Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main St. Hyannis,MA 02601 RE: Building Permits Dear Mr. Perry, ' This affidavit is to certify that all work completed for 126 Meadow Ln.,West Barnstable has been inspected by a certified Building Performance Institute(BPI) Inspector. Ceiling: R-42 cellulose Kneewall: R-7 FSK Basement: R-19 fiberglass blanket on box sill Crawlspace: R-10 on foundation walls All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey —Asseij:,or's map and lot number .......................................... SEPTIC SYSTEM MUST BE I"'STALLED IN COMPLIANCE Sewage .eermit number ..... .. ...................... V :N A: TICLE II STATE a......... SANITARY CODE AND TOWN TINETo�♦o TOWN OF BARN§ IJft1' � • ems : � - BA"STMILE, i 1639. BUILDING INSPECTOR �ley M APPLICATION FOR PERMIT TO .... �4.. ....(A.....:0\,k.. ...��.�Z c� l� V, O�-La .............. ...... ..... • TYPE OF CONSTRUCTION ........V).0 �.b............................................................................................................ �a .....!... .............19../. .�? TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: l r Location ..........(.1 .......... ....... L�... C? ... �.C' .L�..C............. ..a .. i�. .�!�. ..`�JL ... (( ff ProposedUse ... .`.! .............................................................................................................................. Zoning. District Fire District I • '1.��l ..................... ...... ...W .............. ..... ........ Name of Owner 4� , "..!� �:��1. `84?.. fi...!...1 a........... Address .... . ............ �......4... ........'E?0 lA.d.�.sA. �IAddress ...... ,E,..................:....Name of Builder .. .... �...... . Name of Architect ..1.��. e .....�1.40.. .!'✓�...........Address ........ C'�,J...1... .�k .. .�`� -.... � a Number of Rooms ............ ..I/..Pe.................................Foundation .......... . c!!Q. .....r.�lr. l..2.:�..... °. Exterior ...c1.1 .Q.a ...................................Roofing ..... .!��.1... ........................................... Floors ��. ... ...1..}.I.' ......� e.+ .......-Intericir .....�.�.PP. ®C ...................................... Heating yy , b ® lJ l, /�1 a i/ ....1.�...:............Plumbin . .C�1T............�.�.....4.......!... Fireplace ....Ye—'s................................................................Approximate Cost /... .............................- .1/4 .. ' Definitive Plan Approved by Planning Board -----------_-------___ - ------- �Area 5 �.��.�.!..�. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH APeclVAL *-0't 9M0D u t Rel0 SAP /Gq AT7-#te(4 c--D PLA,,,3 . I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. M,-Gurl, Dr. Thomas J. r 16566 two S No ............... .. Permit for. ...,,. t017 single family dwelling .............................;................................. ... .......... X0 Location Y........Meadow Lane ............................................ West Barnstable . ............................................................................... Owner D..r........T..h..9m. ...Ma..G.u..r..l ......... Type of Construction .............tr .................. ................................................................................. Plot-..:.......................... Lot ..............0............. Permit Granted ..............Sept mber 12 73 2.3 Date of Ins pecti Sept ..... ........... ...........19 'r 11 17W 0/-r Date Completed 19 PERMIT REFUSED . ......................................................... ............. ..........7?. .... ....... ................................................................................ ............................................................................... .............................................................................. Approved ................................................. 19 ................................................................................ ............................................................................... TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application Health Division Date Issued 2 Z ll Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board / Historic - OKH Preservation / Hyannis Project Street Address q., �✓ u Village Owner i-Q14 4 V /C d 4 Address �S-a ets a U yP Telephone a. 13 Permit Request `✓ a C jo te tf w el qiI oweq e 4w f n ate, Cr fft, Al, C1�1 d C Q IQ► ,..� �`�s w t� ; v fo EfP lit° 4 eqq �J1 i�,f� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation J �O 06 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) 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) I Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Roc Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other w z Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood al stove; Ye's-1❑ No 00 Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ e ting ❑gew �ize_ � cn Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: co —i co M Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION ( UILD(E'R OR HOMEOWNER) 2 G Q q Name i {/�M / '`C /i�f�e (' G�(� h�Telephone Number —03 Address `I u w , �1 &e License # ` Oa ,S Q dt.� Ya.e-1)1' ati ��C Home Improvement Contractor# ! /� U 0 Worker's Compensation # / ku6 3 3s-3 g 6 U ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO a SIGNATURE !� DATE h oh � i FOR OFFICIAL USE ONLY APPLICATION# - DATE ISSUED �. MAP/PARCEL N0. - I r -: ADDRESS ' ' VILLAGE OWNER DATE OF INSPECTION: FOUNDATION ' FRAME 2 INSULATION I � r , FIREPLACE ELECTRICAL: ROUGH FINAL. ' PLUMBING: ROUGH - FINAL GAS: ROUGH FINAL J - FINAL BUILDING DATE..CLOSED OUT ASSOCIATION PLAN NO. i c I u IM Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supen-isor Specialt}• License: CSSL-102776 Y. WILLIAM J MC CLUSICEY:,.. 37 NAUSET ROAD West Yarmouth NIA 02673: ,: `J..L..�.�� • �r+,1�' -xpiration Commissioner 06/28/2015 CI Office of Consumer Affairs and eusness Regulation HMO- 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 171380 - — Tvpe: Corporation Expiration: 3/14/2014 Tr# 222184 CAPE SAVE INC. WILLIAM McCLUSKEY T D HUNTINGTON AVENUE SOUTH YARMOUTH, MA 02664 Update Address and return card.Mark reason for change. j 1 Address (j Renewal (7 Employment 17 Lost Card )PS-CAI 0 60M-04/044101216 � ✓lie i�arwnzontuea a�..lLaaaacfivaea Office of Consumer Affairs&Bddsiuess Regulation License or registration valid for individul use only .R i��HOME IMPROVEMENT CONTRACTOR before the expiration date. U found return to: Registration: .--171380 Type: Office of Consumer Affairs and Business Regulation 9 Expiration:`-3/14/2014 Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 CA E SAVE WILLIAM McCLUSKEY= 7-D HUNTINGTON AVENUE t" SOUTH YARMOfJTH MA 02664' Undersecretary Not valid it o signa Building Permit Authorization I• .'Diane 0-Conn:eil as owner hereby give my permission to Cape Save, Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Office: 508-398-0398 to take all necessary steps to obtain a building permit to perform work at my property located at 126 Meadow Lane West Barnstable, MA 02668 Signed , Date G j I . f Massachusetts- Department of Public Safct% Board of Building Regulations and Standards Construction SuperVisor Specialty License License: CS SL 102776 Restricted to: IC WILLIAM MC CLUSKY 37 NAUSET ROAD . WEST YARMOUTH, MA 02673 " Expiration: 6/28/2013 Tr: 102776 lvg�I q- tJ'.��ir� �� l���a��v�'✓-.�.I��i'1.i✓���✓ �:%fJ� 7 �? �������E�r/cf�'.s� Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration - _ Registration: 171380 Type: Corporation - Expiration: 3/142014 Try 222184 CAPE SAVE INC. _ WILLIAM MCCLUSKEY 7-D HUNTINGTON AVENUE = SOUTH YARMOUTH, MA 02664 Update Address and return card.Mark reason for change. Address _? Renewal ; Employment _ Lost Card PS-CAS 0 sah,, N-G101215 ✓1re�r'a„wnc�icceald el llQ::ac/u rely License or registration l valid for individul use on Of of Consumer affairs&BtWness Regulation b Y tice - before the expiration date. If found return to: R13 HOME IMPROVEMENT CONTRACTOR = .... , .,_a- Office of Consumer Affairs and Business Regulation RegistratiOn: .:171380 Type: = 10 Park Plaza-Suite 5170 Expiration: 3/142014 Corporation Boston,lVL,02116 CAPE SAVE INC.. WILLIAM McCLUSKEY 7-D HUNTINGTON AVENUE- ' SOUTH YARMOUTH.-MA dl664 iinde:secremr} Not valid w' o sign "rnn�rui n,- ;11 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations > I Congress Street, Suite 100 Boston,MA 02114-2017 ' www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EI please Print Legibly ARplicant Information Name (Business/Organization/Individual): Cape Save,Inc. Address: 7D Huntington Avenue City/State/Zip: South Yarmouth, MA 02664 Phone#: 508-398-0398 Are you an employer? Check the appropriate box: Type of project(required): 1.❑✓ I am a employer with 17 4. ❑ I am a general contractor and I 6 ❑New construction have hired the sub-contractors employees(full and/or part-time).# 7. Remodeling listed on the attached sheet. ❑ 2.❑ I am a sole proprietor or partner- These sub-contractors have g. ❑ Demolition ship and have no employees employees and have workers' working for me in any capacity. y 9. ❑ Building addition comp. insurance. [No workers' comp. insurance 10.❑ Electrical repairs or additions required.] 5. ❑ We are a corporation and its officers have exercised their 11.❑Plumbing repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 12.❑Roof repairs myself. [No workers' comp. c. 152, §1(4),and we have no Insulation insurance required.]t 13.0 Other employees. [No workers' comp. insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. iContractors that heck this box must teee ` g workers'com the ps pol cy number and state whether or not those entities have employees. If the sub-contractors have mploys,they must provide ihe I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Technology Insurance Company TWC 3353968 Expiration Date: 04/09/2014 Policy#or Self-ins.Lic.#: L �A Job Site Address: P (0 / ' �a� '�"` City/State/Zip:iV 9 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and enalties of erjury t at the information provided above is trueand correct Signature: Phone#: 508-398-0398 rFQfficial only. Do not write in this area,to be completed by city or town offciaL wn• Permit/Licensessugthority(circle one): 1. Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: ..�"� DATE(MMMD A�& CERTIFICATE OF LIABILITY INSURANCE1 4/9/2013 m 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). CONTACT PRODUCER NAME: Colleen Crowley PHONE Risk Strategies Comany E . ( ) AIC No:(781)963-4420 ARLO- 15 Pacella Park DriveADDRESS* Suite 240 INSURERS AFFORDING COVERAGE NAIC9 Randolph MA, 02368 INSURER A Selective Insurance INSURED 1NsuRERB:SafetV Insurance Co=anV 33618 Cape Save, Inc INSURIERC--Technology Insurance Company 7 D Huntington Ave INSURERD: INSURERE: South Yarmouth I-SL 02644 INSURERF: COVERAGES CERTIFICATE NUMBER:CL134960509 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 MAYHAVE BEEN REDUCED BYPAID CLAIMS. INSR TYPE OF INSURANCE ADOL SUB POLICY NUMBER PMMOIMY EFF POLICY EXP UMfTS LTR GENERAL LIABILITY EACH OCCURRENCE $ 1,00 -DAMAGE TO RENT lOO OOO X COMMERCAL GENERAL LABILITY PREMISES fEa occurrence S r A 1 CLAIMS-MADE a OCCUR S199448001 0/16/2012 0/16/203.3 MED EXP(Anyone person) $ 10,000 PERSONAL 8 ADV IN.IURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICYACT LOC S AUTOMOBILE LIABILITY Ea accider¢COMBIN SNGLE LLNIT S 1 000 000 ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED 6208200 I/6/2012 1/6/2013 BODILY INJURY(Per aocidenl)AUTOS S NON-OWNED PROPERTY DAMAGE S X HIRED AUTOS X AUTOS Per accident X Undennsured motorist BI s W $ 100,000 A X UMBRELLA L1AB X OCCUR 199448001 0/16/2012 O/16/2013 EACH OCCURRENCE S 1,000,000 EXCESS LIAR CLAIIAS.AIADE AGGREGATE $ 1,000,000 DED RETENTIONS $ C WORKERS COMPENSATION fficers Excluded from X 11 RVTIAMITS OTR AND EMPLOYERS'LIABILITY ANY PROPRIETORrPARTNE c�ECUTIVE Y f N overage EL.EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? ® (CIA /9/2013 /9/2014 (Mandatory In NH) 3353968 E.L.DISEASE-EA EMPLOYEE $ 500 000 If yes.describe under E.L.DISEASE-POLICY LGAIT $ 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES(Ausch ACORD 101,Addldenal Remarks Schedule,if more space is required) Issued as evidence of insurance. Issued as evidence of insurance. National Grid Corporate services LLC d/b/a/ National Grid, Action Inc., Colonial Gas Company and NStar Electric are listed as additional insureds as respects General Liability as required by written contract. 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. Cape Light Compact PO Box 427/SCH AUTHORIZED REPRESENTATIVE 3195 Main Street Barnstable, MA 02630 chael Christian/CLC ACORD 25(2010105) O 1998-2010 ACORD CORPORATION. All rights reserved. INS025(2010051.01 The ACORD name and logo are registered marks of ACORD f �TME Town of Barnstable • � Expires 6 m nths rom.due date Regulatory Services Fee g • ,�Rtvs-r,►at�, • M"S& Thomas F.Geiler,Director MKt Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address CJ LC./\r, J Residential Value of Wor Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address mC* . n(C p,^eyA (,c Ir'�eov L✓� Contractor's Name 9 IL�C C ) ✓�!L" Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance X Check one: JS I am a sole proprietor MAY —4 2012 ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name TOWN OF BARNSTABLE Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side Q #of doors �] Replacement Windows/doors/sliders.U-Value u (maximum.35)#ofwindows '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 sui� ed. SIGNATURE: �/" 1 UV C:\Users\decollikWppData\Local\Microsoft\Windows\Temporary Internet Files\ContentAutlook\DDV87AAZ\EXPRESS.doc Revised 072110 wN o� 400; TD l A ZNM (2- ( i Vt l ore OfV1)7 C The Courntonivealth of Massachusetts Department of Industrial Accidents Off ice of Investigations 9 600 Washington Street Boston,MA 02111 ivivinniass gov/dia Workers' Compensation Insurance Affidavit: Bmlders/Contractors/Electricians/Plumbers ApplicaBt Information Please Print LeAub Name(Business/oiganization&dividoal): c7✓�SAY�.- � VC iL�•Cf� lT�r V►Q- Address: C�v-e 5 $-6-3 City/Stat&Zip: t4ec-, M4 t>ZZ3 Phone o. '331 222 8SL{T Are you an employer?Check the appropriate box: T project I am a general contractors and I ��e of ject(r.�� i.El I am a employer with 4 ❑ g 6. ❑Neu'construction employees(full and/or part-time).* have hued the sub-contractors 2_PQ I am a sole proprietor or partner- listed on the attached sheet_ 7. H Remodeling ship and have no employees These sub-cofactors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9_ ❑Building addition [No workers'comp.insurance comp.insurance required-] 5_ ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c_ 152,§1(4),and we have no employees_[No worker-'' 13.0 Other comp.insurance required.] *any applicant that checks box Al nmst also fill out the section below showing�workers'compensation policy inforffiation. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such =Contractors that check this box trust attached tm additional sheet showing the nHme of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'camp.policy number_ I am an employer that is providiiW workers'couiperisidion itts irairce for my employees. Below is flee policy and job site information. Insurance.Company Name: Policy 4 or Self-ins.Lic. yamt;' 4: ,, Expiration Date: Job Site Address: IrZ6 1 aAa w City/State/7ipiJ-o�J -QrA MJ4 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby c under the pains and penalties of perjury that the information provideda bbove is into and correct Sienat re7 Date:� //"T Phone#:) —EZ2.-' M�5 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#: q ✓t1 varwnziuea ; o �%/� a�T,,;1�,'��License or reg►strat►on vaua'tor►narv►aw use omy, o ousumer a:rs h rness.►e,gu ahoy before the expiration date.'If found return to: - HOM.E..IMPROVEMENT CONTRACTOR �. Office of Consumer Affairs and Business Regulation 1C'G� � :•' Registration:;-1.54433 TS%oe: 1' 10 Park Plaza-Suite 5170 a Ezp'Iration: `3%7,l013 Individual `;. __ i toston,'MA 02-116 I R RD M.GARNETT 3 = RICHARD:'GyRNETT 78.WOOD AVE SANDWICH,MA 02563 Not valid without signature Undersecretary L INI issachusctts- DC�artniCnt uf.PuhliC S:,lfCt..N•c`.. - Board_uf Bu��di►1��'itt„ulaiion:� a►id Stand.u'.ds�p�� '. :. Construct?off S,upervior License License: CS 951'42 R I CHAR D::GAR N ETT 14,OUEENS.WAY;' .:SANDW.ICH MA 0�563:'''': •':...' , tzpiratipn:: 9/28/2012 �' ('ununissiitirer Tr#: 2682 i >NatvsrABM MAW 619. Town of Barnstable Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 'Co Pi'l'L I ,as Owner of the subject property hereby authorize R I L arU G-crhe-f� to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) i �Si&*tnr of-Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 7_01 ( G Coll 0*1HE Town of Barnstable *Permit# P� ~O Erpires 6 in r rom issue date Regulatory -Services Fee BARNsrm LE,MASS + v� 1 Thomas F. Geiler,Director ''rEo Mai" Building Division . '_ �4 f r� •� yTom Perry, CBO, Building Commissioner 1 �' j� "" ��' `' E dot 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 ' Fax: 508-790-6230 OVA CIFFNERESS PER+MIT APPLICATION - RESIDENTIAL ONLY / Not Valid without Red X-Press Imprint Map/parcel Number V ZC7/ Property Address 1 Cl esidential Value of Work Minimum fee of$35.00 for work under S6006.00 Owner's Name&Address W i•v�i ��G <«/ Li Contractor's Name 1011 c9h S��v ,��9,�✓ Telephone Number 7 76- 5_�3 d(�, Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable).. -7 c ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I -he Homeowner 2-f1have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to y 4e,/ ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side #of doors Replacement Windows/door sliders. Value (maximum .44)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of t Home Improve ent Contractors License & Construction Supervisors License is required. j SIGNATURE: Q:\WPFILEST0RMS\building permit form XPR SS. oc Ravic.d n7nl iti The Commonwealth of Massachusetts I ^ I Department of Industrial Accidents I I Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): l 1�e jJ 51uv,r.i L tg h e— c Address: 902 62 y l �7 City/State/Zip: I-e�4 k4 _ v �l t'l Phone #: A,rVlam an employer?Check the appropriate box: Type of project(required): 1. L a em to er with y 4. ❑ I am a general contractor and 1 p y 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. # 7 ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their ]0.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152, §](4), and we have no 12.❑ Roof repairs . insurance required.] t employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. (Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. nn / Insurance Company Name: ram.-6z 1 Wv A, y Policy#or Self-ins. Lic.#: ill 7 7 Gj Vf0,1-9/0 Expiration Date: Gi /C Job Site Address: /a L icd H� �N� City/State/Zip:_ u )i Attach a copy of the workers'compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u e e pai and penalties of perjury that the information provided above is true and correct Signature: Date: :3� L l 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. Cityrrown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: f Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver-or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or.to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s),addresses)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. i 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 bum leaves etc.)said person is NOT required to complete this affidavit. i 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 Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia ® DATE(MWDDIYYYY) -4C oRo CERTIFICATE OF LIABILITY INSURANCE s/ 0 0 0 'PRODucFk FRANK L HORGAN INS AGENCY INC THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 44 BARNSTABLE ROAD ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HYANNIS, MA 02601 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 508 775-5830 508 775-6i688 INSURERS AFFORDING COVERAGE NAIC# INSURED CAPE& ISLANDS CONSTRUCTION COMPANY INC INSURERA: L113ERTY MUTUAL GROUP PO BOX 210 INSURER8: CENTERVILLE MA 02632 INSUREtQ INSURER D: INSURER E: 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. INSR ilm TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL I1ABRJTY DATE(M EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PR EM ES a occurrence) $ CLAIMS MADE F—IOCCUR MED EXP(Any one person) $ PERSONAL&AOVINJURY $ GENERAL AGGREGATE $ GEN-AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/0P AGG $ POLICY PRO LOC jFc AUTOMOBILE LIABILITY COMBINED SINGLE LIMB $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ I HIRED AUTOS BODILY INJURY $ NOWOWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per amdent) GARAGE LIABLITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABMY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION WC2-31 S 377540-010 5/712010 5!7/2011 ,/ TN Oe IATI oTH- AND EMPLOYERS IL'UABRY IM Y/N EB— ANY PROPRIETOR/PARTNFJLEXECUT VE E.L.EACH ACCIDENT $ 100000 OFFICERIMEMBER EXCLUDED? ❑N (Mandatory in NH) E.L.DISEASE-EA EMPLOY $ 100000 I yes,describe under SPECIAL PROVISIONS bebw E.L.DISEASE-POLICY LIMIT 1$ 500000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Workers Compensation Insurance:Part One of the policy applies only to the Workers Compensation Law of the State of MA CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BE-FORE THE EXPIRATION TOWN OF BARNSTABLE DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN 200 MAIN STREET NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL HYANNIS MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ' Jeff Eldridge • � ��- ACORD 25(2009101) ©1988-2009 ACORD CORPORATION. All rights reserved. CERT 00.: 8086013 Anne ChandLer 8/20/2010 10:10:53 AN Page 1 of L L Depal'tillent of Public IS1110% T& - '✓/1' 011ce of Consumer Affair;..fXl - Board of Btjildin-, Re-ulations and Standm-ds Business RCgUlaL;nll HOAE IMPROVEMENT CC;.4TRACTCiR Construction Supervisor License Re giLitration: ;,c165936 Type: License: CS 74660 Expirwon: 4/9/2012 Private Corporat!o- CA &ISLAND CTION o k.--C. JOSHUA X KOURI PO BOX 210 j()SHUA KOURI 55 ELAA.AVE CENTERVILLE, MA 02632 HYANNIS, MA 02601` ";-'�%� U-4.rSecretary Expiration: 211212013 Tr#: 12106 License or registration valid for individul use only. before the expiration date. If found return to: Office of Consumer Affair's and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 f r j of alid without signature :tt i 1 1yi ROOFING 1 COD FOR 22 YEARS....WE'VE GOT YOUCOVERED Eat ,e 1, ,Islq. c°Ns7,RUC1I014 C'° o 0 3/02/11 To Whom it may concern: I authorize Cape &`Islands Construction Co. Inc.to re-roof my home and install a new sliding door located at 126 Meadow LnnW.Ba stable Ma. i `'ram arry Horgan, wner� P.O. Box 210 • CFNTERVELa, MA 02632 • PH: 508-775-ROOF (7663)' W W W.CAPEANDISLANDSCONSTRUCTTON.COM ce) /ol( Ll Cape Save Inco .-, - r 7-D Huntington Avenue South Yarmouth, N"A-j02664, , Tel: 508-398-0398 Fax: 508-398-0399 9/29/14 Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main St. Hyannis,MA 02601 RE: Building Permits Dear Mr. Perry, This affidavit is to certify that all work completed for 126 Meadow Ln.,West Barnstable has been inspected by a certified Building Performance Institute (BPI)Inspector. Ceiling: R-42 cellulose Kneewall: R-7 FSK Basement: R-19 fiberglass blanket on box sill Crawlspace: R-10 on foundation walls All work performed meets or exceeds Federal and State Requirements. Sincerely, ; William McCluskey I 0/X .- /v - -1A-,-j TO Irz,/7 rt 3q ;or's map and lot number .../... ... .........� 'PTIC SYS TEM MUST BE IN COMPLIANCE Sewage Permit number ..... . .. ............ 'I A.-TI-C'_E 11 STATE ....X.................. S^"'ITAZY CODE A `"'`'' AND TOWN FTMET��o TOWN OF BARN9Y)O L _._.. i BAWSTADLE, i "6 ,e0� BUILDING . INSPECTOR a' APPLICATION FOR PERMIT TO .... ..�a.:..l ..k.4.......aA.e... .... TYPE OF CONSTRUCTION . :'1./.Q.o. ..... .�....... .. .................. .... ......................................... ....................... ........ .� ->�'......�..a.............>i 9./. TO THE INSPECTOR OF BUILDINGS: The undersigned)hereby applies for a permit according to the following information: Location ........../.Q. '. �1......../ .e..z. .Q a...�,.a.v..�......... ProposedUse ..... .`\.. ........................................................................................``..�4.,................................. L3VE. Q (�Zoning District .......... ..........................................Fire District . ' !�. ........ Name of Owner .J�. I� C. .�"1'. .4....f.....tLU.Address ...5 /. 85' 4�........✓..fi...!...1 ..`/Q Name of Builder . .. .G�`.o �.0 b.c�lC�...l�l..:. �.1.eL1Address �1�.. ... C .. CS. ......................... ...... ... ............ 1,� Address ........Name of Architect .. .. 1�. Pl ..... C . .`✓j . �!t:.....G�. Number of Rooms �. P--.L... .................................Foundation .......... Exterior ....�.1.C�. .. .Q..�.� ...................................Roofing .....A5.t21-1 1Lal...1............................................... �- Floors ..Qa.�. '� �...��°.1� .Q..� Interior �.�. c Heating Q..l....A.d 1... �J.�....... ...... .....k..`.................Plumbing ....... �...�s'.t�....777. .....�.!...�.. Fireplace ......��. ................................................................Approximate Cost � o Definitive Plan Approved by Planning Board ________ 9 rea Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH A PeoVAL Q.D*r qM(P u t RLwl0 SfrP �64 Er=: AT7rte(4 c=--D FLAk) I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. ff Nam (. ?, �? ..4�.��........... �I McGrorI Ir. Thomas J � r / �o�o6 zn�� \ �o ---.--.. pe,mhfor -----.�~=^�� -.. � | � ...........������'������.���������- .......... . = \ o' don Meadow Lane . . ________.�est. ------' ' \ � Dvvne, .............Dr-_ ..Jx . -' ----'' .� ' -------'' Type of Construction .............gr .................. . � -----^---------------'r---- ' [ � Plot - Lot �o r-------' ----'-----' �| � ' Permit" Granted" --- of ''-r-^ — 4 Date Completed 19 v ......... | � PERMIT REFUSED ( � � .----._--- /. 9u�_ ---.�--/{�.... . ................... ^-------^^''----------`------- - -cz ^----~------------.-..--..---- | � .---.-----------.-.-^.--.----,- � . \ ! 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