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0055 PACKET LANDING WAY
i UPC 12543 _ - - -" No.53LOR 'IVST.CON1116� HASTINGS, MN Town of Barnstable d _ � • __- _-_ __ --_._- B d� � � I ui g n e Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept 14AS& Posted Until Final Inspection Has Been Made. ■��y�Y1'�Jlll 1t ibs9 Permit ` Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made Permit No. B-19-900 Applicant Name: Anthony Capelle Approvals Date Issued: 04/03/2019 Current Use: Structure Permit Type: Building-Foundation Only Expiration Date: 10/03/2019 Foundation: Location: 55 PACKET LANDING WAY,WEST BARNSTABLE Map/Lot: 179-013 Zoning District: RF Sheathing: Owner on Record: KRAUS,RICHARD A&LYNN T TRS Contractor Name: NORTHEAST FOUNDATION Framing: 1 REPAIR LLC DBA DBA RAMJACK Address: 55 PACKET LANDING WAY NEW ENGLAND 2 WEST BARNSTABLE, MA 02668 Chimney: Contractor License: 185517 Y: Description: Foundation stabilization Est. Project Cost: $93,775.00 Insulation: Project Review Req: Permit Fee: $135.00 Final: Fee Paid: $135.00 Date: 4/3/2019 Plumbing/Gas Rough Plumbing: Final Plumbing: Building Official Rough Gas: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Final Gas: All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Electrical work until the completion of the same. Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Rough: Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing Final: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Low Voltage Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Final: 6.Insulation 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Final: Work shall not proceed until the Inspector has approved the various stages of construction. Fire Department "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT I i I °F � 91RES1 of Barnstable *Permit# o Expires 6 nrorilds jroin issue dote `Regu wy Services Fee RARNSTAB14 = R OCT Ibchard V.Scali,Director (/ H96YA9 Dililion 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 PERMIT APPLICATION - RESIDENTIAL ONLY rvot Valid tpitlrout Red X-Press Imprint Map/parcel Number / 79 o/-5 Property Address S S 1 �e� �i/14 ire e �� kj<S f let rng�•� ` e- 2/a`esidential Value of Work$ 17, 0 7W — Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address T/I C1,44 Kro y S SS Pack_e Lang/;n, /�c� �is� c&,W JA5le ., &I A 06466 f - Contractor's Name `llOva! 2Z/I / /I rSoll Telephone Number q0( 22- 00 Horne Improvement Contractor License#. (if applicable) / '3 Z 4457 Email: Construction Supervisor's License#(if applicable) ��; 7O 7 �Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ nm the Homeowner LY I have Worker's Compensation Insurance Insurance Company Name F', r P,�''1€' n�� ZtISC�ra. C Workman's Comp.Policy# �(C A l S a :2 9 — Z D Copy of Insurance Compliance Certificate must accompany each permit. 1 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) ❑ side placement Windows/doors/sliders.U-Value • Z• (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required_ Issuance of this permit.does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. PTPeTtykOwper must sign Property Owner.Letter of Permission.. A copy the Home Improvement Contractors License&Construction Supervisors License is require _ SIGNATURE: C:\Users\Decdllik\AppData\LocaNMlicrosoft\Windows\Temporary Internet Files\Content.0utlook\21`101 DHR\EXPRESS.doc Revised 040215 i keriewal Agreement Document and Payment Terms byAndersen. dba:Renewal B Andersen of Southern New England Y 8 Richard Kraus WL.A Legal Name:Southern New England Windows,LLC 55 Packet Landing Rd RI#36079, MA#173245,CT#0634555, Lead Firm#1237 West Barnstable,MA 02668 wigoo 10 Reservoir Rd I Smithfield,RI 02917 H:(508)362-9549 Phone:866-563-2235 1 Fax:401-633-6602 1 sales@renewalsne.com C:(774)487-2388 Buyer(s)Name: Richard Kraus Contract Date: 10/06/17 Buyer(s)Street Address: 55 Packet Landing Rd,West Barnstable, MA 02668 Primary Telephone Number: (508)362-9549 Secondary Telephone Number: (774)487-2388 Primary Email: august-moon@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: $17,034 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: $5,677 Balance Due: $11,357 Estimated Start: Estimated Completion: Amount Financed: $0 6-9 weeks 6-9 Method of Payment: Credit Card 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: 1/3 deposit,1/3 at start,1/3 at completion 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 10/11/2017 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:Re B Andersen of Southern New England Buyers Signature of Sales Person Signature Signature Paul Sandrey Richard Kraus Print Name of Sales Person Print Name Print Name UPDATED: 10/06/17 Page 2 / 12 r The Commonwealth of Massachusetts Department of Industrial Aeeidents -� I Congress Street, Suite 100 Boston,MA 02114-201 www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/ElectriciansrPlumbers. TO BE TRED NVITH THE PERWT T143 AUTHORITY. Please Print Lembl)- Applicant Information ?Fame (Business!Organizatioridndividual). Address:�,C�l Cit :/State' `Zip: p Phone W: Are you an employer?Cbeck the appropriate box: T•pe of project (required): i ]arr,a employe•with Z��employe�(full andlor pan-time j.' New construction i }Gk g. Remodeling I 171 l air.a sole proprietor or parmership and have no employees worl_inp for me rr. an. capacity.[No workers'comp.insurance required) 0, Demolition :.�l arr..a homeowner doing ali wort:myself Rye workers'comp.insu ance reauirec.j' D Building addition c,❑1 an.a homeowner and wil;be hiring contractors to conduct all work or..mN.y propeYy. ]ti�li 1 ❑Electrical repairs or additions i ensure that all contractors either hive workers'compensatior.ins�*anct or a*e sole Plumbing repairs or additions proprietors witi.nc emplo,ees. 7 L <.Ql air..s genera contractor anc'have}tired the sub contactors listed on the attached sheer. = �}�oef repairs� i Tnese sub-contractors havt empioyees ane have workers COMP,ins urance Bother w +^ .j i i I I f.Cv,.t art a corporation,and it-, officers have exercised their right of exemption.per 2v1GL c. i 014 f em ellr- �;"i 1(4).and wt have Tic emplovees. rNc.workc7'comp.insurance required._ -An. applican;than checks box ! mus.also fill our the section belot*shOwut€their worker..'compensatior"police information. Homector�ethar check this box mtu attached,ar additional shoe€shpwin€the name of the usub-conpactors and state whether or�1 thost ent tie nhzti ccr Coot a employees. Lithe sub-contractor h=ve employees;they mu5 pm-6de their workers-comp.polio'num er. workers`compensation insurance for my employees. Below is the policy and-jot sire J air an emplot-er that is providing information. Insurance Company Dame: ExpirationDate: ! �/ Police� or Self-ins.i,ic.;`: 1fJ l�*'t / City/StatelZip: l� ✓� Jot, Site Address: aCK e Attach a copy'of the workers` compensation pobc} �^ deciaration page(sb 'in€the Folic. number and expiration ate i" fine up to S1,{DD.DC Failure tc•secure coverage w required under 1.�1GL c. 1J2 F2. A is a T�violation punishab RY O ERlane acfine of up to "SD.DC'a and%or one-year imprisonmen� as well as civil penalties in the form o, - rthe D1A for insurance dai against the violator.A cop)' of this statement may be forwarded to the office of Investigations o� coverage verification. Idol ereb��certify under th ains and penalties ofperjun•char the information provided above is��e an�correci Date: �0 ure: Phone#': Official use only. Do nor write in this area,to be completed by city or town official Permit!License k i City or Town: Issuing Authority (circle one): � 1.Board of)health 2.Building Depal-mient 3.Cin�:"FoR'n Clerk 4.Electrical Inspector 5.Plumbing Inspector 6" Other Phone : Contact Person: r . �dBusiness eplation cr f �J 4 ��afl CL coa.Suraa Tiflis _ 10 Park Plaza - SLite 5170 Boston, Massachusetts 02116 Horne IMprovement Contractor Registration: Registration: 173245 Type: Supplement Card Expiration: 9I19/2018 W ENGLAND SOUTHERN NEW WINDOWS LL- BRIAN DENNISON 20 ALBION RD LINCOLN, RI 02805 Update Address and return card.Mark reason for change. _ Address — Renewal Employment = Lost Card Office o:Consumer Affairs&Business Regulation Registration valid for indnvidual use only before the _ i expiration date. 1f found return to: -HOME iRHPROVEAAENT CONTRACTOR Office of Consumer Affairs and Business Regulation Registration: 17?2�5 Type 1®Park Plaza-Suite 5170 Expiration: .gi191201 8 Supplement Card Boston.NLA 02116 SOUTHERN NEW ENaIAND WINDOWS LLC. RENEWAL BY ANDERSON r ' BRIAN DENNISON 26 ALBION RD '�r� Not valid without signature LINCOLN, RI 02865 Q-Uadersecretary - ;Massachusetts Department sfa d Standa ds Board of Building Regulation License. CS-095707 BRIAN D DENNISON 7 LAMBS POND CIRCLE _ CHARLTON MA •0150. Expiration: _Colmmissioner 09f�D812018 I ESLERCO-01 SANDERSO CERTIFICATE OF LIABILITY INSURANCE DATE 06107120 1 7 ) osio7�2o17 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS GE AFFORDED BY THE POLICIES BEOW CERTIFICATE THISDOES NOT CERTIFICATE FORF 14TIVELY OR SURANCE DOES NOT CONSTITUTETIVELY AMEND, XAEND OR ALTER THE CONTRACT BETWEEN T HESSUING INSURER S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or 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 CoBiz Insurance,Inc.-CO PHONE 1401 Lawrence St,Ste.1200 Alc,No,Ent:(303)988-W6 ac,Ntl:(303)988-0804 E-" Denver,CO 80202ADDRESS:'LMail@cobizinsurance.com INSURER(SI AFFORDING COVERAGE NAIC# INSURER A:Acadia Insurance Company 31325 INSURED INSURER B:Firemens Insurance Company of WA D.C. 21784 Southern New England Windows,LLC.dba Renewal by INSURER C:LibertySurplus Insurance 10725 Andersen of Southern New England 26 Albion Road,Suite 1 INSURER D Lincoln,RI 02865 INSURER E: INSURER F: j COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: I THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD i 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 BE OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I INSR ADDL SUBR TPOLICDY EFF IP��Y EXP LIMITS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER A X I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 01 CLAIMS-MADE FX OCCUR CPA3158728 01/01/2017 01/01/2018 PRM I Q RENTED 300,00— PR MI Ea occurtence i MED EXF An-one erson? 5,000 k—j 1,000,000. ' PERSONAL S ADV INJURY I (GENERAL AGGREGATE �f 7.UUU OOO II GEN'L AGGREGATE LIMIT APPLIES PER;, I 2,000,0001 X , POLICY❑jECT F LOC PRODUCTS-COMPIOP AGG I S EBL AGGREGATE s 2,000,000 OTHER: COMBINED SINGLE LIMIT 1,00D,000 A AUTOMOBILE LIABILITY a acutlem X ANY AUTO CPA3158728 01/0112017 01/0112018 BODILYINJURY Perperson) I S OWNED I SCHEDULED BODILY INJURY(Per accident) S AUTOS ONLY AUTOS I HIR D I NON WNED A,a=TI'DAMAGE EE Per accident? I AUTOS ONLY !ALTiO�ONLY I is I,UW000I �MBIELLA X OCCUR EACH OCCURRENCE EXCESS LIAR CLAIMS-MADE I CPA3158728 01101/2017 �1104112REGATE c 0 regate 1,000,000� DEC) X RETENTIONS PER OTH• I gRKERS COMPENSATION STAT R EMPLOYERS'LUIBILTIY YIN WCA31581729-20 01/0112017 01/ 1,000,OOOj PROPRIETORIPARTNERIEXECUTIVE I . .EACH ACCIDENT << I'ERIMEMBER EXCLUDED^ 1_ NIA 1,000,000ndatory in NH) E.L DISEASE-EA EMPLOYEE S s,describe under 1,000,000� E.L.DISEASE-POLICY LIMIT I S DESCRIPTION OF OPERATIONS below I 1,000,00D g Worker's Compensatio CA3158730-20 01/0112017 01/01/2018 EDE654299117 01/0112017 01/01/2018 1,000,000 C Pollution Liability I I I DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 10'1,Additional Remarks Schedule,may be attached if more space is required', I 17-18 Workers Compesnation Includes-All states except ND,OH,WA,WV,WY I I CERTIFICATE HOLDER CANCELLATION I I I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE � THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE { i I I I F R InformationalPr O 1988-2015 ACORD CORPORATION. Alt right` reserved. ACORD 25(2016/03) The ACORD name and Joao are registered marks of ACORD -3641L.0 tee. CP-015,03(a 5 I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel `' v �� i Application Health Division Date Issued Conservation Division Application Fee /Ob•� v 1 I Planning Dept. ermit Fee .0 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis. �VV Project Street Address A.�1` O �i i Village a rn 6 ) /7 Owner )q ym AddressIA"l Telephone 31 5111 b/1 13 Permit Request S A,�r� iZ t MO-Y z a sh ds ( e LcA&)- ` Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new C—' Zoning District Flood Plain Groundwater Overlay Project Valuation a D v Construction Type Lot Size 1,G Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family iH' Two Family ❑ Multi-Family (# units) p Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other S . . Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑ Yes 0 No Fireplaces: Existing New Existing wood/coal stove: " Yes ❑ No y. Detached garage: ❑ existing ❑ new size—Pool: ❑ existing El new size _ Barn: ❑ existing Wrnew size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization 0 Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER)Name CLIMBS /\• C �2 Telephone Number y)oG ^ g3e)_,,,1700 Address License#_ CS M 01 3k �(JAVAeZ4 ��-f (�a j i_ G/7 Home Improvement Contractor# /31.24 � Worker's Compensation # /y�r� wr l/CJ ALL CONSTRUCTION DEB IS SULTING F OM THIS PROJECT WIL BE TAKEN TO SAS �iXLl� SIGNATURE DATE t t r FOR OFFICIAL USE ONLY -� APPLICATION# DATE ISSUED MAP/PARCEL NO. i ADDRESS VILLAGE . t OWNER C . . DATE OF INSPECTION: FOUNDATION �d/;z t c �� r FRAME - } INSULATION '+ FIREPLACE p ELECTRICAL: ROUGH: FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL } FINAL BUILDING 1 mit, f2f-4ff DATE CLOSED OUT �< ASSOCIATION PLAN NO: l�,- tr pp q . LoL neu%Dvll 100001/0001 MCGRPOS-01 THORNE CERTIFICATE OF LIABILITY INSURANCE DATE(MM;MD/YYYY) 15 jH15 CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CO15 NFERS 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: It the Certlllcato holder Is an ADDITIONAL INSURED,the policy(los)must bo endorsed, If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,co►tain policies may requlro an endorsement. A statoment on this certlflcato does not Confer rights to the F4Rt'e iflente holder In Ileu of Such endorsernont e. CER Co s&Gray insurance Agency, Inc, N�AME,_� 134 P —' Donnis,MA 02660 Imo' , I;(8 ) g C.MAI A/C No 77 816-215 INSURERS)AFFORDING COVERAGE NAIC o - INSUAegA:TRAVELERS INSURANCE COMPANIES INSuaeD 31194 McGrath Post&E3com Corp INSURER D:NOrGUARD Insurance Com any dba Plno Harbor Wood Products INSURER C: - 259 OU00n Anne Rd INSURER 0; Harwich, MA 02645 INSURER e I COVERAGES INSupr•R P: - CERTIFICATE NUMBER: F O CERTIFY THAT THE POLICIES OF INSURANCE LISTEp BELOW HAVE BEEN ISSUED TO THE INSURED NREVIAMED ABOSION VE FOR THE POLICY PERIOD D. NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACTr OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS ATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, NS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REOUCL'D BY PAID CLAIMS. A TYPE OF INSURANCE POLICY NUMBER POLT MMERCIAL GENERAL IWaILnY MMro /YYY MMrDanYYY LIMITS ll CIAIMS-tv1A0tCC OCCUR 16600368B196TCT15 CACU�IfA"CCTO-RE NEI s 1,000,QQp 01/31/2015 01/31/2016 P MI,gF,S(kooC4unenc°) , $ 100,00 RAND EXP(Any ono Der.onl 3 5,000 PERSONAL S ADV INJURY $ 11000,00 GENL AGGREGATE LIMIT APPLIC-S PER: tM POLICYjC�T 0 LOC GFNEMAL AGGREGATE S 2,000,000 1 MUDUCT,-.C,OMNIUI'AGG 3 2,000,000 OTHER. . . LIABILITY S INh IN BA4487B68615SEL idon1)— s 1,000,000 D X' 01/,11/2016 01/312016 DODIIv INJulty Ira;peraa^)AU70SULtDNON-0WNrD DODILY INJURY(Per acad°nl) Z OS X AUTOS Pa0PF9T7 I7A-Mtr (1'^r�Oeldenll S UMBRELLA LIAR S OCCUR hACH,OCCURRENCE S EXCCSS LIAR _... ,_ CLAIMS•MADC AGGR[GATE S DCD RFTF.N1'ION S - •• WORXERS COMPENSATION S AND CMPLOYCRV LIABILITY )( I I H- B ANYPROPRICTOR/PARTNFRrEXECUTIVE YIN MCWC691686 07/OaQOls 07/08/2016 S'IAI r R•- �- 100,000 OFFICCR/MCMRFR EXCLUOtO7 N/A C L EACH ACCIDENT (Mandatory In NM) II yee,desulbe under E.L.DISEASC.CA FMPLOYt Z 100,000 DCSCRIPTION OF OPERATIONS below " E.L.DIRFASE-POLICY LIMIT $ 600,000 OCSCRIVnON OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101.Additional Remarks Schodulo,may be attached It more space Is rodulred) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main St ACCORDANCE WITH THE POLICY PROVISIONS, Hyannis,MA 02601 AUTMOR1260 REPRESENTATIVE M 1988-2014 ACORD CORPORATION. All rights reserved. kCORD 26(2014/01) The ACORD name and logo are registered marks of ACORD V n��,. svKw s s 00 02�43 49 Z - nail iai i S> ,.sue,,--•,e�'x r`�h'?<~�;� 7111017weal.1/t of 117assacla11setts ' Deparinzelzl of Industrial.Accidelzts 4: Office of In.vestio ati.otzs 600 N'ashi.lzgton Street Boston M,4 0?111 Www,nza§ .00 v/dia Workers' Compensation Insurance Affidavit: Builders/Cont1 actors/Electricians/Plumbers Applicant Information Please Print Legibly �Iame (Business/Organization/Individual): q Address: r/o City/State/Zip: �Qfw1` , �I ` Phone #: Are you an employer? Check the appropriate box: 1.['I am a employer with 4. ❑ I am a general contractor and I Type of project (required): 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. ?. ❑ Remodeling ship and have no employees These sub-contractors have working for me in any capacity, employees and have workers' 8• ❑ Demolition [No workers' comp, insurance comp. insurance.$ 9• ❑ Building addition. 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 myself ' 1 I•❑ Plumbing repairs or additions y [No workers comp. right of exemption per MGL insurance required.] t C. 152,§1(4),and we have no 12•❑ Roof repairs employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks bogy:N1 must also fill out the section below showing(heir workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then)tire 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 is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: ® . U Policy # or Self-ins. Lic. 4:_ �VV i 9�� �0 E'piration Date: ®� Job Site Address: ('%� kaiiif f UA City/State/Zip: - -/� Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a Fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of(lie DIA for insurance cover,aee verification. /do hereby certify undo th pains and p za ties of p ry that : forma(ion.provided above is true and correct. S innatu re: � �f / gg�� Date: Phone>y: 08• 3 b 2V kC/10 — Official use nrtLi. Do not ratite in this area, to he cnnapLeted bi cir),or toKvr of�ciaL City or Town: Permit/License 4 Issuing Authorio, (circle one): I. Board of liealfh '-. Building Departmenr 3. Cite/Tows, Clerk 4. Electrical Inspector 5. Plumbing Inspector I! 6. Other---�---- (:onmct, Person: _VI'v Office of Consumer Affairs and Business Regulation. 10 Park Plaza- Suite 5170 Boston, Massacl�u�etts 02116 Home Improvement Ct�actor Registration.. McGRATH POST & BEAM CCO. Massachusetts - Deparfinent of Public Safety JAMES McGRATHI , � >. Board of Building Regulations and standards 259 QUEEN ANNE RD. Construction Supen'isor I & 2 Family HARWICH, NIA 02645 License: CSFA-073865 JAMES R MCGR4-11i - Al - '� 204 CRA.NVIEW - ':�r BREWSTER MA%02631� 1• y } ., anAe-nemi-rim9+a k i ytIL Expiration. Commissioner 0311412016 Office-of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement 6.ntractor Registration Registration: 132935 Type: Private Corporation Expiration: 10/31/2016 Tr# 259394 McGRATH POST & BEAM CO. _ JAMES McGRATH 259 QUEEN ANNE RD. `. j:'•: :, ,.._: 7 HARWICH, MA 02645 _ , Update Address and return card.A4ark reason for change. Address C Renewal. R Employment R Lost Card ?S-CA1 Co 50M•04/04-GG�IO1216pp ,per �/fte '(00�»UJ)z002cl�PtitGt/L o�✓�[�ittdeG�6 .\ Office of Consumer Affairs R Business Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration:..-1.32935 Type: Office of Consumer Affairs and Business Regulation sr Expiration: 16/31/2016 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 Mc RATH POST EA, PINE HARBOR WbOD.Rf20'DUCTS JAMES McGRATH'. 259 QUEEN ANNE HARWICH,MA 02645 . : Undersecretary V Not valid without signature Barnstable Old Kings Highway Historic District Committee z BAMST,B,E, i 200 Main Street, Hyannis, MA 02601, TEL: 508-862-4787 Fax 508-862-4784 y MAS& P �A 1619. `Oro rf°""AAA APPLICATION, CERTIFICATE OF APPROPRIATENESS Application is hereby made,with five(5)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 Buildin .� El ® Garage/barn ❑ Shed El Commercial El Other I Exterior Painting,roof ❑ new roof ❑ color/material change, of trim, siding, window, door 4. Sign : ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign 5. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Retaining wall ❑ Tennis court ❑ Other 6. Pool ❑ Swimming ❑ Other man-made pool ❑ Solar panels ❑ Other Type or Print Legibly: Date NOTE All applications must be signed by the current owner Owner(print): _ fd71 l�e�dS T )(,rt 1!i fs'� xl i 0 J .9 lfs �®, Telephone#: Address of Proposed Work: � � e r�> ` Village_k/ &M C" !e Map Lot# Mailing Address(if different) Owner's Signature Description of Proposed Work: Give particulars of work to be done: 0_ksJ&if 9q_fira Y 1_15-q rAl' Agent or Contractor(print): C7iJt°C C( Telephone#: �' Address: Contractor/Agent' signature: / o co ee use only. This Certificate is hereb PROVE /DAD Date embers signatureS _ r RECEIVED 91) n_x/11 -c-j OCT 0 7 Z015 GROWTH MANAGEMENT APPROVED OCT.2 8.2015 Old King's Highway Committee Q:IBoards and Commissions101d Kings HighwaylOKHApplicationsl0KH2O11 Cert Appropriateness.doc 1 r , CERTIFICATE OF APPROPRIATENESS SPEC SKEET Please submit J copies Foundation Type: (Max. 12"exposed) (material-brick/cement, other) (20. �L ,a ,� a ,��. Siding Type: Clapboard_ shingle_ other )� Material: red cedar white cedar other AP fL.t2 A341JJF: Color: Chimney Material: A/ ,J- Color: Roof Material: (make&style) _�n AEEA-I.'J j,�ty,� Color: -A-In �a Roof Pitch(s): (7/12 minimum) ( /( --. (speck on plans for new buildings, major additions) Window and door trim material: wood other material, specify V Size of cornerboards x(P size of casings(1 X 4 min.) I X L4 color Rakes Ist member 14 2; 2°d member I X 3 Depth of overhang (::,y -I-/. It Window: (make/model)S fh, t-t l ,,ems material P?U.C color Jai k (Provide window schedule on plan for new buildings, major additions) Window grills (please check all that apply true divided lights_ exterior glued grills X grills between glass )( removable interior None Door style and make: e,p,0 bh,41-,<,q material met. Color: Garage Door, Style 4AW P ( J3,4>rt.nd Size of opening �c �ij `l Material%Oqo hftColor UL'te -v Shutter Type/Style/Material: �� Color: Gutter Type/Material: /�� Color: Deck material: wood other material, specify Color: Skylight,type/make/model/: material Color: Size: eEE Sign size: Type/Materials: Color: Fence Type(max 6' ) Style material: Color: E® � I Retaining wall: Material: CCT.2 8.2015 GROWTH MANAGEMENT Town of Barnstable Lighting, freestanding on building Old K�mrs„ Wftating sign OTHER INFORMATION: THE ATTACHED CHECK LIST MUST BE COMPLETED AND SUBMITTED Please provide samples of paint colors,manufacturers brochure of windows,doors,garage door,fences,lamp posts etc Signed: (plan preparer) � �,� /lr I' � ��� Print Name c 2 Q:lBoards and Commissions101d Kings Highway10KHApp1icationA0KH 2O11 Cert Approprialeness.doc Town of Barnstable Geographic Information System October 7, 2015 179034 179037 179019 #422 #102 #433 179035 #436 179010 #99 179036 #86 156025 #960 179017 179011 #68 #89 179001002 #976 179012 #65 4 179016 ' #52 �Q,� 179 04 `#42 156026 Q 179014 179013 #970. 179003 #41 #55 K#26 178009002 179001001 CN O ® #1060 #990 179015 #29 179002 � #1000 178010 178022 . . . . . . . . .#.1074 . . . . . . . . . . . . . . . . . . . . . . #:1022 :.. *178011 155024 ® #1084 178012001 #975 #995 178008 #1090 #1040 178009001 #1064 155033 v+ ® 1 #1106 #102502 � #1025 �AQ �i�, `® • #999 S` 178012� 0 e e 178026 � #8049 ��� #1094 #27 DISCLAIMERS:This map is for planning purposes only. It Is not adequate for legal Map:179 Parcel:013 boundary determination or regulatory interpretation. Enlargements beyond a scale of Owner:KRAUS,RICHARD A&SHERWOOD, Total Assessed Value:$411400 Selected Parcel 1°=100'may not meet established map accuracy standards. The parcel lines on this map are only graphic representations of Assessor's tax parcels. They are not true property Co-Owner: Acreage:3.03 acres Abutters boundaries and do not represent accurate relationships to physical features on the map Location:55 PACKET LANDING WAY such as building locations. Buffer �✓ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 i r i i • ' APPROVED f� �ImII OCT 02015 L t I Town of bemstabfe Old King's Highway Committee f t • I FRONT ELEVATIONS 1/4-1" ."ROM Rr: OR—el CBM DeIE: 9/26/2015 REheED PINE HARBOR WOOD PRODUCTS m.�wD,.uMe[e Re: KRAUS-55 PACKET LANDING ROAD,WEST BARNSTABLE 14 X 24 BARN 1 i i ij , I is FRONT ELEVATIONS CBM .c�scu 9/26/2615 PINE HARBOR WOOD PRODUCTS 2 Re: KRAUS-55 PACKET LANDING ROAD,WEST BARNSTABLE ' 1 14 X 24 BARN " i t e - - - � 16"LVL Rige 2 x 6 Rafters 24"O-C 2 x 6 Rafters ties \ 1"Premium Pine Roof Boards I 6 x 6 D-Fir Top Plates • i - — _ .� 2 X 8 D-Fir loft joist i — -- — 1"Premium loft decking 4 x 6 Door and Window post 4 x 4 Diagnal Wind Bracing 1"Premium Pine Sheathing Pressure Treated Sill 4.5"Concrete Floor 2 No.4 Rebars horizontal at slab perimeter I 10"x 20"monolithic slab footing D , 44 h'ARK a ip � CROSS SECTION ti�<<ErJz . V - q x"u: 1/4-1° •Dvaov[o ar: oc.wr,er CBM 9 f3TE%i�e�4`� o.': 9/26/2015 two HARBOR WOOD PRODUCTS Re: KRAUS-55 PACKET LANDING ROAD,WEST BARNSTABL �3 14 X 24 BARN • !. .. F116 . r S cl f l• t N ��i kFF Rli� f 1 i _ a _ ._ L.._- Town of Barnstable *Permit# Kwbw 6naada from kaw Regulatory SerAca FeeNAM Richard V.Scab,Interim Director 2, UErRII Building Division d� Tom Perry,CBO,Building Commissioner MAY - 8 2014 ' 2W Main St eet,Hyannis,MA 02601 R' 4, www.town.barnstable.ma us Office: 508-862-4W8 TOWN OF EbKRANS M L° >tl✓ RIESIDENTLAL ONLY Map/parcel Number �) Not ValFd tvfdEoat Red X„Phhess . Pt,opercy Address s51PATS G•/ �e ICJ 6 GUo� ,�.��u�lI? je- P�Residential value of work s Z 4 yy Minimumm fee of s3 OO fo;work padce$6000.00 Owner's Name&Address O LIZAtL$ !� vtsot✓ Contractor's Name _rt) � yQ u��A t1 td/c Telephone Number qN-Z 7, h2D Home Improvement Contractor License#(if applicable) 17.3 Email: Construction Supervisor's License#(if applicable)_ O ISLWorkman's Conpeasaticn Insuuance Check one: 0 I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance � Insurance Company Name % _ c.--tJ' Workmen's Comp.Policy# c,- o? 2 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(cam box) ❑ P.&roof(hurricane nailed)(stripping old shingles) All consttuction debris will be taken to Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side Repplacement Wmdows/dooWslidem U-Value • 30 (maximum.35)#of #of doors: ❑ Smoke/Carbon Mmoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of fts permit does not swamp-complwam with other Iowa depazcmew regulations,Le.Hi udr,Conswva M etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construes Supervisors License is r SIGNATURE: T-.WEV1NJY8 ' Revised 061313 � f W . BY DX"BN w r M..ecQ�a tvA .I T fi. a6 Alhiata ,Q. . W-collea RE W194a ��* ,�t, Qea ue e49?0099170 - - ------------------ 1.r1aCa,A64[a1p ---:.. _-- .. W.- .' $NM •. V.YtrR Af�nI Mi�Mr_ y 1 WJor 1tr raa pJ&Wo and/opmrVicies ef Sq0&ftnN va► ay'Whtt�ftfk t3P d(b/al3c�acyvwl by ArAMaft0 50-u-MeRn ZFFCW.zr4gLmne1 CV0ntracmr7,!a ectaaldnapaaa:.vrlm fha3 G>Vri[l5 Oatad QMdCS GM d0talbcd ctu-tha Scut and the rc r Cal *sp araeAt aaA ass the etc ede" _. Olt chso. 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K�b 9dd VMIIIb ►IA1Fti#raM d611 n.fR yaoaar 4WItas a e �+4va1W11a i.altil`hoatrl .+r 0��'aru n�.q_ ! �11i tlt�hri th 1 Ar aMy+ ifrM.tip+911b 1��Mtp�lle t o t W !o tKIS'�oklN e-1.J"" � oft,ate,til9" ,' a6 va3W" 'a lal to thm UW%%W 4.&11 06 um�than 444M Who am-b`le Oar Isar o1 oil qbWjpdmpoe utedaer 1 law ramasl►� Ila�s 410 pariltst warme of all oUgaadaagv iu der +! o,R:w "Ni" Or �ava_wa� 9aaaa +. t �iE� _ � OF drrlr' a!tom Md *qW of tMlr MWM&Aoll l0000 t Or 1 •&almer art 401m A gocko 4 r MW •t1or wrCtamm, o mated .4 kk�ftvp" to lhraaa at gar .a a wtrlt�ll twftvr to :v ,� �1h to Re" Andarno or toMOwea*MAW No�_.ad m 013_7 tt 0-r*4!-t .. t t aasf Mma mm"WNW�w �J.37 M. I � r 4 IR 7751EMM. Qmow 1016.43i�111y lMt►1 ► .�.- �irrM aliiii mom. aa�r , ;KIaA Ggpr:Whim '�alydaf Ca�1r YIlow �Yia7frr Ga�Rtaalt ' I Southern New England •Windows d.b.a Renewal by Andersen of SNE •Massachusetts -Department of Public Safety Boaid of 8dilding Regulations and Standards Crmstruction Super`'isoc License: CS-NS707 ._.�..-.�_......_....,....--.. ,.._,�._...-.....---_ __— BRIAN D DENNLSE)N• 7 LAMBS POND E1111C Chariton MA 01507 'I j5t Expiration Commissioner 09/08/2014 C�,lie �panr o oun e,F A o�n�aftef.& Office of Consumer A rs Business 10 Park Plaza-Suite 5170, Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 173245 TWO: Supplernertt Cord SOUTHERN NEW ENGLAND WINDOWS LL Emiratbn. gIF1912014 DENNISON MAN 1137 PARK EAST DRIVE WOONSOCKET,RI 02885 Update Address and return c&nL Mark rams for thane. Sur o mr.xnt Address 0 Renewal 0 Employment LAU Card "YL 6. ."....w. VIE arcoasoeer Again l 0odarn ReaWdoa Liceawarreestration valid farindividul meanly DaPROVEMENTCONTRACTOR before the expiration date.If found return to: Ortiee ofCoamner Attain and Badness Regulation . 1732. A'W: 10ParkPlan-Sa1te5170 xpiration:Brims Supplement 4wd 805ton,MA 02116 SOUTHERN NEW ENGLAND WINDOWS LLC. RENEWAL By ANDERSON DENNIS AST n 1137 PARKRK EAST DRIVE WOONSOCKET.RI MM Uade rotary Not valid without aigaature i The Commonwealth of Massachusetts Department&f Indastrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers Applicant Information Please Print Leveibl Name(Business/Organizari n/Individual): �N ae, Address: a (o I oAl �OC Gf City/State/Zip: L/Il/CD/A/ , . c s /� � ML21.5 Phone#: 410/- ,?P g' f dDD Are you an employer?Check the appropriate box: Type of project(required): 1.1 I am a employer with A D 4. E] I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner-, listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, []Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers'comp.insurance comp.insurance. required.] S. We are a corporation and its 1D.❑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 13,�Other W/lrs tp employees.[No workers' comp.insurance required.] *Any applicant that checks box tl1 must also fill out the section below showing their workers'compensation policy. rmation. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such_ #Contractors that check this box must attached an additional sheet showing the name of the sub-contractor;and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. �1 Insurance Company Name: 5U1—tl4 4 a.N Policy#or Self-ins.Lie.#:R'le, �a�d �O 3 S-02 3�� Expiration Date: L9_:I�T/ Job Site Address: �� �i W-City/State/Zip: V•,3wf.,L &t ei 4,+ 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$250.00 a day against the violator. Be advised that a copy of this statement may beforwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided ab e ' true and correct Signature: Date: shone#: �D f' a o'2 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: i Client#:30124 SOUTNEW ACORD. CERTIFICATE OF LIABILITY INSURANCE J DATE(MMIDD)YYYY) 8/0612013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed.N 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 NCONTACT AME: Anita Little Willis of New Jersey,Inc. P "aa E�56 914.4660 Na: 856A74-1881 1015 Briggs Road,PO Box 5005 EiWL ADDRESS: anita.littie@willis.com Mount BOX SODS INSURERS AFFORDING COVERAGE NAIC i Mount Laurel,NJ 08054 INSURER A:Selective Insurance Co of the S 39926 INSURED INSURER a:Argonaut Insurance Co. 19801 Southern New England Windows LLC INsuRERc:Beacon Mutual Ins.Co. 24017 DB/A Renewal by Andersen 26 Albion Road INSURER D: 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. 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 ADDLSUB POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR POLICY NUMBER MMD MIDD LIMITS A GENERAL LIABILITY S202945900 8110/2013 08110/2014 X EACHOCCURRENCE $1 OOO 000 pEmreCOMMERCIAL GENERAL LIABILITY PACIG Ea ae S 1 QQ QQQ CLAIMS-MADE 51 OCCUR MEO EXP(Any are person) $1 O 000 PERSONAL 3 ADV INJURY $1 00O 000 GENERAL AGGREGATE 0,000,000 000,000 GEN'L AGGREGATE LIMIT APPLIES PER, PRODUCTS-COMPIOPAGG s3,000,000 POLICY PRO- JEcT El LOC $ A AUTOMOBILE LIABILITY S202945900 8/10/2013 08/10/201 fECOMBINED oaciSINGLE LIMIT 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUT0.S AUTOS BODILY INJURY(Per accident) S NO"WNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per acddent $ S A X UMBRELLA LIAB OCCUR S202945900 01811012013 0811012011 EACH OCCURRENCE s5.000.000 EXCESS LIAB HCLAIMS-MADE AGGREGATE $5 000 000 DED I I RETENTION $ C WORKERS COMPENSATION 0000068028-RI 8121/2013 08/21/201 X TO Y LIMI OTH AND EMPLOYERS'LIABILITY YIN B PRORE /PACN ERIEECUT�F AJC927818352394 8/21/2013 08/21/201 E.L EACH ACCIDENT $1 000000� MR NIA (Myyaaandstory In NH) E.L.DISEASE-EA EMPLOYEE $1 00O 000 DESCRIP�TIunder O OF OPERATIONS below E.L.DISEASE-POLICY LIMIT s1 000 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Ramarks Schedule,N more apace to required) CERTIFICATE HOLDER CANCELLATION Southern NE LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 26 Albion Road ACCORDANCE WITH THE POLICY PROVISIONS. Lincoln,RI 02865 AUTHORIZED REPRESENTATIVE ' A ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S215109IM215088 AXL Town,of Barnstable *Perm txipA� Regulatory Services Fu months from issue • wtrsres>E. stT79. Thomas F. Geiler,Director �� Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL. ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address -s-5- e.k, 5 0 W�ZS T li; tO�,Q, Q Residential Value of Work$ l �_a�'�, Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address L NN ' C k"GLII_s Contractor's Name C I v /� �t''1�N AN $&V Telephone Number yb Home Improvement Contractor License# (if applicable) 17 3 Email: Construction Supervisor's License# (if applicable) �( b ❑Workman's Compensation Insurance X RESS PERMIT Check one: ❑ I am a sole proprietor NOV - s ZU13 ❑ II am the Homeowner Vhave Worker's Compensation Insurance Insurance Company Name F' twu� 5;j 5 . Co _ TOWN OF BARNSTABLE Workman's Comp.Policy# k(C/ ! .9 7 g / S 3 5Z -3 G Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) e-side Replacement Windows/doors/sliders.U-Value d . 3 0 (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is equire i �, SIGNATURE: C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\8R76BDVA\EXPRESS.doc Revised 061313 t Southern New England Windows d.b.a Renewal by Andersen of SNE Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supenixor License: CS-095707 BRIAN D DEmq"N ' 7 LAMBS POND CE s Charlton MA 01507 .`%�...•�J.6cq�. " "'1 Expiration Commissioner 09/08/2014 cTfie o��zar uuP,a /o �iGGc�da -' ,Midtld Office of Consumer A airs Business egu adon 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 173245 Type: Supplement Card SOUTHERN NEW ENGLAND WINDOWS LL Expiration: 9119f2014 DENNISON BRIAN 1137 PARK EAST DRIVE WOONSOCKET,RI 02895 Update Address and return card.Stark mason for cbange. eu r 0 20M.WI D Address i3 Renewal i)Employment 0 Lost Card Illre orCmsomv AI41n&Bodoea Regalanaa Lfeense or registration valid for Indlvidul use only 061E DIPR0 ENT CONTRACTOR before the expiration date.If found return to: Office of Consumer Affairs and Business Regulation Roglatrodon: 173245 Type: 10 Part Plan-Suite 5170 - Euplration: 9rygf2014 Supplement t;atd Boston,NA 02116 SOUTHERN NEW ENGLAND WINDOWS LLC. RENEWAL BY ANDERSON BRIAN 1137 PARK 11]7 PARK EAST DRIVE WOONSOCKET,RI 02895 Underser—Y Not valid wllbout signature i The Commonwealth of Massachusetts r Department of Industrial Accidents OfficeInvestigation s s 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly N11T1E(Business/Organization/Individual): ,Fn/ LLr✓ Address: JOA/ /�DCC.0 City/State/Zip: 1_IA/C016/ , /2�.r� 0.1QbS Phone#: Yo/ ?V00 Are you an employer?Check the appropriate box: Type of project(required): 51 1. p I am a employer with A C) 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 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 I.❑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 13.[ ther 4 e.M� employees. [No workers' — /l comp. insurance required.] te�sr,Er� *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. (Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: 5Ur6Ull! aa✓ Policy#or Self-ins.Lic.#:j!I`' /, .375 /O 3 S02 E4piration Date: gA�- / ky/ Job Site Address: �lC. 4 LayeA City/State/Zip:l )e.5� gy1S4b�1 /* Attach a copy of the workers' compensation policy de aration page(showing the policy number and expiration date). 0; C 6 S' 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 certlf under the pains and penalties of perjury that the information provided above is true and correct Si nature: Date: Phone Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Client#:30124 SOUTNEW 106/20t3Y AOORD,M CERTIFICATE-OF -LIABILITY INSURANCE O 8 YY) roso13 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 CNTACT NAME: Anita Little Willis of New Jersey,Inc. PHONE A/C No Ext:856 914-4660 856-914-1881 AIC No 1015 Briggs Road,PO Box 5005 E-MAIL : 'anita.little@willis.com DDREPO Box 5005 ; INSURER(S)AFFORDING COVERAGE NAIC# Mount Laurel,NJ 08054 INSURER A:Selective Insurance Co of the S 39926 INSURED INSURER B!Argonaut Insurance Co. 19801 Southern New England Windows LLC INSURER C 1 Beacon Mutual Ins.Co. 24017 D/B/A Renewal by Andersen INSURER D 26 Albion Road INSURER E Lincoln,RI 02865 ' . ' 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD MM/DD A GENERALLIABILITY S202945900 0181,1012013 08/10/201 POEM.occurrence) $1 000000 X COMMERCIAL GENERAL LIABILITY PREMISES EaE�rrence $100 000 CLAIMS-MADE FJKOCCUR MED EXP(Any one person) $10 000 PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE $3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: I PRODUCTS-COMP/OP AGG $3,000,000 CT POLICY PJE RO-- LOC ' $ - MBINE A AUTOMOBILE LIABILITY S202945900 8/10)'2013 08/10/201 Ea acc".DISINGLE LIMIT 1,000,000 X ANY AUTO J BODILY INJURY(Per person) $ ALL OWNED SCHEDULED I BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED Pe PROPCEcR DAMAGE $ AUTOS A X UMBRELLA LIAB OCCUR S202945900 8/10/2013 08/10/2014 EACH OCCURRENCE $5 000 000 EXCESS LIAR HCLAIMS-MADE i AGGREGATE $S 000 000 DED RETENTION$ I $ C WORKERS COMPENSATION 0000068028-RI 8/21/2013 08/21/2014 X wcsTATU- OTH- AND EMPLOYERS'LIABILITY B ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N AIC927818352394 8/21/2013 08/21/211 E.L:EACH ACCIDENT $1 000000 OFFICER/MEMBER EXCLUDED? FNI N/A ) (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1 000 000 If yes,describe under DESCRIPTION OF OPERATIONS below i E.L.-DISEASE-POLICY LIMIT $1,000,000 , I I I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more apace Is required) ! + c CERTIFICATE HOLDER CANCELLATION Southern NE LLC SHOUL6 ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 26 Albion Road ACCORDANCE WITH THE POLICY PROVISIONS. Lincoln,RI 02865 AUTHORIZED REPRESENTATIVE i - ©1988-2010 ACORD CORPORATION.All rights reserved. 1 ACORD-25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S215109/M215088 AXL -v"w ;Q v all L it-C 4 S .3 4. —0 Liz, vl� —.2 Cr-j t f2 a ml 2. k 'A Q 4c a +em S �" za , A ,f t!.1 C6 CA 7a. vll in m ra v J31 GP 45- Hal w 0 1 01 .46 41 im:5 1, w 6 14 -9 5, t .6 I a Zill l �1 10. 41 C utj U-0 Z. 1-dul u 16 E 9 4e In pi 4$ 41t El A lz 1c, 0:jj a 0 t 4p w 31 .0 916 4�1.4 F,I in c cp M t V1, Im p g V5, 0 z IptP.L1 16*-C A Inc. •AN ;b r R, isz- 1w w v Vk 1j. 0 $ --. (�� ::9 - 'i— 1 f 64 I t 4"D 0 z --41 ga,it C - c o Ij 0 t P9, @ b. Lo 16 IL C6.9 uj u I ie- 14jj E E ia 0 n--- P5 tx Ck6M 1 19 v r- 4 rx kv LL t -j E w I . I ., . d% M..-- IV '41 a-.9. fS d 1 10 Al -d 6 r, eu Z—tv a IE TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 79 Parcel Permit# TOy1NOSPE t S E Health Division 10_ 112,103 6AM6 i i Date Issued a Conservation Division �� a AN c�?9'!Fkf�W � Application Fee ��0, �z� & S"uR�Y Tax Collector ©/< ���//, ,�� '��9rP,¢� Permit Fee ) Treasurer �� ' f /✓e1 SEPTIC SYSTEM MUST BE e J IISTALLED IN CONIPLIAN%w Planning Dept. VWTH TITLE S Date Definitive Plan Approved byy Planning Board EMIS®NMENTAL CODE ANL 9/��a3 TOWN REGULATIONS Q, Historic-OKH 0 Preservation/Hyannis Project Street Address 5 Village W,LSf 1 arr i fr.Lbi-t Owner , rAna,rd Kra/Linn Shfr IVdAddress Y'�� (P5`e/.-5 Pa. df Telephone Ne 2 — q 59 q, Permit Request (a` X c Q1GLro-gF 44�/ Q ab ` X P Free Square feet: 1st floor: existing proposed ea 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 4, f Construction Type IAM Lot Size ) a Crc3 Grandfathered: ❑Yes O No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure 15 f S Historic House: O Yes ❑No On Old King's Highway: ❑Yes ❑ No Basement Type: 404l ❑Crawl ❑Walkout ❑Other G/ /��ev✓ L Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing a new Half:existing new Number of Bedrooms: existing_ new Total Room Count(not including baths): existing TT new First Floor Room Count Heat Type and Fuel: ❑Gas il ❑ Electric O Other Central Air: ❑Yes 1lo Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing . new sizeOl0lcl Pool:❑existing ❑new size Barn:O existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing 0-new size ,) Other: �4}F dw-a y4-0y__, Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes �o If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION pnL , Name I le hone Number 5m umber50 q7-?'3aoq Address A bi., �� License# MCI Ask P qq Home Improvement Contractor# Worker's Compensation# C[.- 666/O 3 f ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN W U IV SIGNATURE DATE o2.6,6 FOR OFFICIAL USE ONLY Y PERMIT NO. DATE ISSUED MAP/PARCEC NO. ADDRESS • VILLAGE OWNER DATE OF INSPECTION: FOUNDATION: ¢A0 ,,® :l7/ 6, E' FRAME AT goix INSULATION . f.`.. ,FIREPLACE ' ELECTRICAL: ROUGH FINAL ' PLUMBING: ROUGH FINAL S GAS: ROUGH FINAL ' FINAL BUILDING DATE;CLOSED OUT ASSOCIATION PLAN NO. r• I oFVE, Town of Barnstable Regulatory Services I anaxsr LE, Thomas F.Geiler,Director 9�p 1639. 14, Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-962-4038 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.T e.of Work: a 9 /� Z-Z Estimated Cost - ' 41/,Oe® yP --U Address of Work: r d-c Owner's Name: _% J_ k 1-4 n n -Sh eru0 v Date of Application: I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law ❑Job Under$1,000 OBuilding not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMMNT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: 3- Date *3���� trActor e Registration No. OR ,, +o Owner's Name I�r _ _ The Commonwealth of Massachusetts -_ Department of Industrial Accidents 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance davit i name: (chat-d location. 5-5 Pack-x-T city Wt/ 1 phone# ❑ I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one workin in ca achy %%/O%------ /%%%///%/%%/G%%%/% 1 er rovidin workers' compensation for my employees working-on this job. „• >,},,,,.,.;>;;;$,;,,:, am an emp .... oY..... ..:.:::::::.::.g.:..........,........:........:.. .......... comn 8IIY Ma `�f ....v:.:^:w::::::. .... ....:..n..., x.v.:vt.....•v.v:::\v.::t�: {4�:?$};;5;}:4}Y.$$$'fiii�i:::;•$$}:4:;i�::.}•:!i^i:•i}:ti?•}}}:�4i:^:$iiii$$$$::$isf`$ii$$ii$:i:.>•:}:$$i>ii::i::::;i�$$i:':$ii:;';ii$:>vi?$:•:':;is�::i`?::}:;i:•:i•:?......vv......... .Y r 01 4 •:v?O'$::$$:;::y$;:?;:;:?,$$$..:vM1i$j$:^$:$:}i{y>:?;:;:;.r$X;v;::i.$$j$$:;$kL�i:;:;:j$$:!4:!iY$$;.`,v:;. ':• $$$4'.'�.......: lio .......4,x. t.}:.$:;;::::» ;ate>: :;:;:�?�'•�:''•'::?x"�$i:}!•:;5,$.',j;`:j!:itii!:v: $i•i{:}%:::'j�'YiY�:;::�:i?$$}i$}}iiii:v}:}:{::;<4i}}i.�i:;..:-.i:::•}::':;.ii:4'J:':.�.•_��;i;�.�$'.•}::}•:;:iY•••••,j•�. :•i}Sf•}i:•.:n ❑ I am a sole proprietor,general contractor,or homeowner(circle on and have hired the contractors listed below who have thefollowing workers' comp ntion. o...l.i..c..e..s..:.........................................................:.:..�..:.:.:.:.:.....�........,...........:...:...�.:.:.:...:.:...:...,::...:.:.r::t:..::..:t:.:::::::.:.:.,..:..:.:.:.:.:.:.:.:.::::::::::::::...}::.:::.:::.�::::::.:::::::.::..::.}:{.,»..:,,:::{:.�::.}.,;x;;,:;..:.:...x::?..tk...,n..rt.::.J.?�..::x::.:,:.$ .com an.. ...n.........:.. ............:v.::.:...v•v:::::::::v;::::::nv:v.....•: ......................•:w:.::::::w:•.v::::.v::.•r.::::::•:::::n...•::::.:x •.•. .............:..........r............,..t...,r.:...................................................... ............................ ...................:.}..,....t............:. .:::}•::.�o::}}:4}}}:•}}}ii:4+:•::::•..,.?.:.4::::.,:r.....:.t.....�;k...v..... ...................... .::...:.:.:::::::::::•::::..:.::.}:�>::•:•:}.,•.�::::::•:::.�:•.�.�::::::::::;::::.;•::.:};•:..;.. ..':}•::.�:.tra:`�$$r�:�:'t?:;{t•:t, ,. . .t}wfi ni,}:. . �y ...... ............. ................ .................. r.:...... r......r...,,•r:::{::.:.::t;�$-$:;:::rx+t... .}:;•}}:;-}:?`•}}}};.�.,:•.:t�:.;; �; ^�;`,�-',.taw .. .... ...... n.. .... ... ........::::::.v.v:::-.:vw:::n:}:•.r...v..v.r..n....:n......X•:ti?{4}%:.%$•::::n:v.t:,v,;vx-;:.;:.,; l:'v:... v.....>> .x .............. ........r.r..4 v:...... ..v......... ..,...........v....... ..{:.......... rii...:•..... ..... •...v f•$%i?$:$}h.v::.:}: ..... :............. ..,...,....,.. \...v.......... ...............X,:. ,...: .......r....v....... .w.<. n'.v \}.his;': .....,.. ........ ..A. ..... ...t......t : ........:...............v vv.:..., w...... .....ny;:;:. .i...v... ...........:... .v............... ................. ....n........................•:•:.:v:::::.v:::::•::•wr• n vnv rr:x w•.�:• • Y.......... .................,......}........r......}...:..........................:....................:.............................r.:::}:•: ..v,4}`,J:4:�:t::::.v::w:.v:::::.:.v:::X•}}}:?.}::nvxnv..n.\•:..:}}:1•i}i%;�+-�}..:}:}.�..\ ............ . .... . ......... .r...:...... ..... .t........ ....t ........... ....................... ... .........,.::::::.t.:.,t,-:'{?,:.?.::.:..�........ .. . r....::..rr..�;.:... a•� $......:.....t........................................:.:. :•.: .. ......... ....r...... .............. ........... r...., ......:>.:?..4:.v:r..:. ...... :: ... n:r.;-}},.:b$:O:;r-:+.:•:n,.:n,+.,:.x.v4:r.:,n rr,''?v.'•..'•::$}•} ..v1.•7ri:•i i$$ :r.vnr.n........v..........,.n...vk}...<... ...........:v......................?:•:..f.r.......:.v...{$iv.{:.err::...............:.:.... ... .v.. ?,-.;.1'•C .J]�•.v:::::::::. t�hra3t¢eca�::>::>;:>::z::>.: ::s:;:{$:<•:;$::.<:::::;. :.,:::?$:>..:::.}•.}::::{:;};::::::;::>•:::: rz:$:>:::::><;::::::;:•}::::;::.:..>.............. . . �. /%///f/l%//.. ......... ....... :..... 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I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature 4G.( -/' ,�' Date Q 61�9/&-3 Print name Phone# 611 V77-L336V omcial use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department ❑Licensing Board ❑check if immediate response is required ❑Selechnea's Office ❑Health Department contact person: phone#; - ❑Other 55555555515 0eviud 9/95 PJtu Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any contract of We, 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.I 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. I MGL chapter 152 section 25 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,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 in the workers' compensation affidavit completely,by checking the box that applies to your situation and 1 ' names, address and phone numbers along with a certificate-of insurance as all affidavits maybe DPPYmg co �an Y : . submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and ci_ 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. City or Towns 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. The affidavits may be wt mchRio the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you 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 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 °FINE Tp Town of Barnstable Regulatory Services r • Thomas F.Geiler,Director 1639• �0 iDlEo,,,pra 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 I.Q' d �&au5 LLIVi n GnenLYA as Owner of the subject property hereby authorize 1orn�1 �&L, �`ns, `� IC�V►w� r o act on my behalf, v in all matters relative to work authorized by this building pemut application for: P r mn (Address of Jo 26 J LSigdk— of�0 ner Date 1 k A <y, Q print Names Q:FORM&OWNERPERMISSION i RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE CO New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 i FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x.0031= plus from below(if applicable) ALTERATIONSMENOVATIONS.OF EXISTING SPACE square feet x$64/sq.foot= x.0031= plus from below(if applicable) j GARAGES(attached.&detached) 11 Mb square feet x$32/sq.ft.= O%b x.0031= 7 Z ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00, >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) q 2 Permit Fee ,7 i . — BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR —_ Number: CS O46234 T 's Birthdate: 11/30/1959 Expires: 11/30/2004 Tr. no: 3952 Restricted: 1 G TIMOTHY GRAY 15 TOBISSET ST ( �— MASHPEE, MA 02649 Administrator i • ,%/tr: l.'CxrrlgruirtfOaU�/1[. r/, l(�iJ.l(LG•�t41e/%i Ituard of Ruiltiiu;;ICcI;la�iuus:uul Stand ii ce �` '.k it F'=j{y HOME IMPROVEMENT CONTRACTOR -' Registration: 102633•1 Expiration: 7;LOO4 Type: DFA ';'ItviOTIAY GRAY BUii_DiNG&REM .;rnclhy Grey 15 Tobis• ei St PA;rhi�Nc. MA 02649 i :r : is 0. ,�.:._..r.-�:,._.. �. x.•. ;,.:—._ a:: •.:,. :. oaf y S — .. mot. .:-..:...'� .. ..: ... .. .,... - t I'. S a I' ■ as+g . Y o. e� B� r a 14 3 • 1 Q E: J g. e 9 X a " .. BmUA .Do NZ: -.- - - -- T�10 • i. FI ti ----------- -------------- S. I. -w -ARA.9 17 "-P ---------- ------------ w jc 7 -7 w Fg6T FLOOR PLAN FOUNDATION PLAN s. JO-g, 7- .----------- j 77 777T —D; tR. f is --------------- BILL PLAN ................. j II.D RI.' ADDR�B6r 0- .ly -'Y ?4 'b.PARA(krw")(;4�. ARkA.... TIM GRAY _or_ Z T�k .'k. I� . ..1 .. — .. . . .. .I " - ' -' .'E7.LANE.-- Ail 0.N., ----------—--------- Application to ®Yb Rinq'o- 3[giabbiap Regional 30iotoric Miotrict CL1II mittee In the Town of Barnstable TV;'-i Lr 7A kNSTABLE ?9510ERTIFICATE OF APPROPRIATENESS' JUL 23 �P; IQ 3� Application is hereby made, with four complete sets, for the issuance of a Certificate of-AppropriL\1e�s nder- ion 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as descnb'ed�belo and on plans, drawings, or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior building construction: 51 New ❑ Addition El Alteration Indicate type of building. ❑ House Garage ❑ Commercial ❑ Other 2. Exterior Painting: ❑ 3. Signs or Billboards: ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign 4. Structure: El Fence El Wall El Flagpole ❑ Others TYPE OR PRINT LEGIBLY: DATE �'I �9 ADDRESS OF PROPOSED WORK SS ?QC1',J V&n( d%4 W,3, ASSESSOR'S MAP NO. OWNER 0^6` S�)e ASSESSOR'S LOT NO. 013 HOME ADDRESS S� 1�a�c �^a''^r�`nq Rd We-S4 13a�ns�'��- TELEPHONE NO.SDt 34�-q ke FULL NAMES AND ADDRESSES OF ABUTTING OWNERS, including those of adjacent property owners across any public street or-way. (Attach-additional sheet if necessary.) W. e t c 8 m c k�� cL,�� �. i il, S' Od6 68, y.. 1e.�n l�at L4 a. J:cam W. arnS t. OaC 6 M&,h S� b ba;�+ Qa66S +\-+e ee iS 10140 'V S+ lJ, s ea 6 6 � a� n►e. S�3a..� c�, - � I�nP► oaSG 3 AGENT OR CONTRACTOR 1 Md uo� r'°"� TELEPHONE NO 5D q 77'33`4 ADDRESS I S 10 b%S5 C�- DESCRIPTION OF PROPOSED WORK: Give particulars of work to be done, including materials to be used. Please include locations of proposed signs. `ot\s ? c � new .��'X a4� g � 'j a.k1^ an g' x a , S\(At 0A&k'11on WAS at\ 6tb&& as C �� o.& ar ec�s� Side, o� b \�,:.,� Signed -64L Owner-Contractor-Agent M For Cori mittee Use Only This Certificate is hereby Date 1 75 -,*3 pprove enied 4. M ittee Members' Signatures: Town of Barnstable Old King's Highway Historic District Committee SPEC SHEET FOUNDATION vo X aye QctTt5� - SIDING TYPE 0.} 'e.X\ k)i\Ck COLOR CHIMNEY TYPE N R COLOR ROOF MATERIALI &I C eMS\ iVI COLOR `(Yla h eXl$�r1 PITCH ��X WINDOW COLOR W"r\t SIZE TRIM COLOR 'maw DOORS t COLORS W�l SHUTTERS COLORS GUTTERS 'Maw COLORS DECKS MATERIALS GARAGE DOORS �� x COLORS `�l'"� SKYLIGHTS Ck \160);1 30 y SIZE 3651g 'A 3g COLORS :SIGNS . P\ COLORS FENCE ` ' COLOR NOTES: Fill out completely, including measurements and materials/colors to be used. Four copies of this form are required for submittal of an application, along with Four copies of the plot plan, landscape plan and elevation plane, when applicable. SPECSHT Revised 11198 I ' {E�� The Town of Barnstable vu;LL Department of Health Safety and Enviromnental.Services S&.�•' BuildingUvision M,y 367 Main Street,Hyannis,MA 02601 08-8624038 ' 08.790.6230 PLAN REVIEW owner: raK L �&-ww"1 Map/Parcel: 613 P� cry J \ 'roject Address: �'�t Builder v►^ 56: I • The following items were noted on reviewing: Ce4S S A C S 6-tee\ ,h eere�L I to w.b fir" 9lhla3 N/F TOWN OF BARNSTABLE CONSERVATION �,P�O�G�\' ,,�o , up. ASSESSORS MAP 114 G 'S fx sr PARCEL 6 h h / NEW o GARAGE ( po F� ��-FOUNDATION ° c'ss QP DRIVEWAY �- N/F- 1. G� ^n LAWRENCE &'pp- !y EXISTING i NORMA CATON •� EXISTING HOUSE ASSESSORS MAP 179 PARCEL 14 SHED'S N/F �� NORMA M. CATON o� N/F ASSESSORS MAP 179 �1�' RICHARD A. KRAUS 'St` PARCEL 15 ASSESSORS MAP 179 p PARCEL 13 2.6±ACRES N� h � N M m ! m E ,,V tG N/F KEVIN & MICHELLE BOYAR ASSESSORS MAP 178 gyp,, PARCEL 9/2 co N/F p0- JOHN & LINDA COBLISH ASSESSORS MAP �• � THE STRUCTURE IS LOCATED IN ZONE "C" AS SHOWN ON FIRM COMMUNITY PANEL PARCEL 250001 0011 D EFFECTIVE DATE: 7/2/92 PREPARED FOR: RICHARD KRAUS I HEREBY CERTIFY TO THE BEST OF THE BSC GROUP, INC MY PROFESSIONAL KNOWLEDGE, 657 MAIN STREET WEST YARMOUTH MA. INFORMATION CORNERS D MENSIONS AND THE � TM�LOT C� SETBACKS TO THE STRUCTURE AS CERTIFIED SCALE: 1"=80' 3 DETERMINED BY INSTRUMENT SURVEY I CRAIGA. PLOT PLAN AND AS SHOWN ON THIS PLAN ARE c�i FIELD ; DATE 10131103 CORRECT. _N 455 PACKET-LANDING ROAD BSC# 4-8613.00 0) ��`� ` �~ / 3o�'' 'WEST BARNSTABLE• CRAIG A. FIELD, PLS DATE FOR THE BSC GROUP, INC. D MASSACHUSETTS SHEET 1 OF 1 a J I�I Assessor's offioe (1st floor): THE Assessor's map and lot number T� Board of Health (3rd floor): r7 y Sewage Permit number . • i 11AUSTADLE, 1 Engineering Department (3rd floor): ' r639- nea `e House number .........:7..... °o e�pr a• �° APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOW N OF BARNSTABLE 7 o 9 UILDING INSPECTOR APPLICATION FOR PERMIT TO ......- ......�..........................r..........�r.•--R...................................................I............. f^ TYPE OF. CONSTRUCTION ...( �1Jvc%... ✓. ................... ............................................................ ............. '..........7�2,5.......-- ..19. E TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .:..:..............::........`................ ....e- /.......�7..........!(.M............ \.........T....4�...�.. ProposedUse .:....> iw.���?....FAh-�I..� .............................................:............................................................... Zoning District /1..�:.......�<c,�.,...�Z,....................................Fire District ,.. .................................... .................... Name of Owner i�Rgg �j �Y �f l� ..................... ......./?�.(/.�.........................Address ....7....� fa�...1............fi!1 b0r..$ . r........1.. .:�......M..::e.. e`16 Name of .V!a-. �-.. R.n..•...Ic(........Address .� Q.. !'1 n�a...d....!'�►� ..!�-t :u... r �3 N f Builder 9g3 j �. ........ Name of Architect tC�3/ R ?....C��...IF.'g.}11. ...................Address ....................................... .............................................. Number of Rooms .. ... .Q.ms...1...... Z... DATO.5.............Foundation .,................................... Exterior Q_r...1.34-r.64.............IN) . �.1.A../.�.yIC.S..Roofing ..... ��IW"G�Gtr ................................................... Floors .. 1#&...,1',In@. ..... ....4.a��? e.K9.....................Interior ....... �e 1!bc .. • / Heating ..P........ CB ........4�'..41.1r.............................................Plumbing ...: .............................................. 1 NtlJS .........................Approximate Cost .. . l� . D Fireplace ..............1.....M�. ......................... t pp 1 `.... ....................................................... Definitive Plan Approved by Planning Board. ��_ _I_d______�_--------19fuu1_ _ . Area . {fL . .. ... . ................... Y)OA 1zLLvz IF y Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH y OCCUPANCY PERMITS, REQUIRED FOR. NEW DWELLINGS I hereby agree to conform to all;, the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .........................: .. .��.�/✓.'........:. Construction Supervisor's License ?I......... KRAVS, RICHARD. `A=179-013 I No ...30509- Permit for ....11.:.StorY........... Single„Fami.1y..AW.e Lj.jjag......... Location . 55 Packet Landing Way W. Barnstable ............................ ................. Owner Richard v .....................Kra...........s........................ Type of Construction F.rame .. .. Plot ............................ Lot ............................... Permit•Granted March 12',........19 87 Date of Inspection ....................................19 Date Completed ......................................19 6 a • PERMIT COMPLETED 1/1/--qL l / . I o I? l� �11��� 8P�3 711 11 �6 � V,� o�C � /�j SEPTIC SYSTEM �U�3 �• OR-- is offioe (1st floor): —/ Assessor's map and lot number ....r..��.?.....ILVO... INSTALLED Ili] �`QMPL , you.;"ETo�, Board of Health (3rd floor): �Q rj q WITH TITLE 5 Sewage Permit number ENVIRONMENTAL C�" (� ' 311$a9TODLL, Engineering Department Ord floor): FQ1^�N� REGU!-1% - �a rasa House number o,s�i639 �e MIN APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only, A P p R Q V E D tab consemats°n N OF B A R N S T A B L E lg •d DateGILDING INSPECTOR � J t nn�^^.� .....rw!! �4..... ... ..41! ............................................................. APPLICATION FOR PERMIT TO ....... TYPE OF CONSTRUCTION ...U,?. v...Ci 0*• ............................................................................................. .......................... ...z.s............19.fj� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..........P cep../.......... .(7..........j0 ........ ..4.07-4f.. ProposedUse ......5 ............................................................................................................ Zoning District ..f .. 0..... ,...IC.J.....................................Fire District ...4!t..A.,........................................................... Name of Owner ..�%G//IQ/liiQ..+�!?,�4.f/S........................Address . .7.. Q5../ ..1:'[pora4wS„ .4..M P.O.I Name of Builder � �. ........ ..........k.........^...� ...�QO eqb 3gg361DC ........Address ...... .............................. Name of Architect .TtC Acp....ter... AVS..................Address .................................................................................... �+ ber of Rooms ./ ... '?,M ............Z....!J. .............Foundation ...-PO.wr�.:.481.NPY.4. .R ................................. fExt ier- M ...1�� 3 �............W.��C. U!..�.V.•..... S..Roofing .....� ihw - -p a..f .................................................... Floors �Qf��., 1v��,....P�7�.�...�'.... � Interior .......S1AVlt�Ydc.�:. ................... rteating .....NQ '.. r............................................Plumbing .... ...!'J. .............................................. 045M1.. .................................................Approximate Cost .A.Iqq�Fireplace .............. .. ...� ........................................... Definitive Plan Approved by Planning Board 64-ARD6F- DiagramI �'-I-�-----�--------19 fP�____ . Area .... . . ...�/of Lot and Building with Dimensions Fee ...... .................... SUBJECT TO APPROVAL OF BOARD OF HEALTH I ol c OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ...... ................ t 00. .8�. Construction Supervisor's License ...©........... � ......... A �44, _ - KRAUS , RlCHARD 30509 1 Story 'No ................. Permit fi". .....: ............................ c�.......� ......................Single Fami y Dv 11ing 55 PaL-cAt, nding Way Location .............:... ... ...... - ............................. W. B&�rrsta le ........................ .ads Owner .................. .. ........ ............................. - z o Frame Type of Construction ........ .. ......................... ................... ........... . ..... ........ ................. Plot Lot ................... Permit:-Granted ......March...l 2,..-1.......19 g ~ Date of,. Inspection /.. ?..:..?....?............19 Date Completed J`�_'17..: ... ..........;°19 ~ y 1 I ,._.,.-..�% ..� ._ � � .. �,,..�y�__r.:.=.^a.�' 1. � � •r-.;. �✓7i t7%��4."n. il.r�^' vy �i�Y'Js-ft:••ate �..?� .w� ... {-.��.s--"+y...rr� •c^.x _ .. ...... ��..� °•. TOWN OF BARNSTABLE BUILDING DEPARTMENT BAR ST = TOWN OFFICE BUILDING rua HYANNIS,'MASS. 02601 I} �OrAYM' • MEMO TO: Town Clerk FROM: Building Department DATE: S 17—0 ' An Occupancy Permit has been issued' for the building authorized by Building Permit—#. .5�?. »............... .......:..... .......»........»... »........ »»»».._.»...» »»»»» » » ' issued to ».......................................... .... Please release the performance bond. TM�> TOWN OF BARNSTABLE 30509 Permit No. ......:......... ` A BUILDING DEPARTMENT t 14'n I TOWN OFFICE BUILDING Cash 670 p �'�ro„r► HYANNIS.MASS.02601 Bond ................ CERTIFICATE OF USE AND OCCUPANCY Issued to Richard Kraus Address 55 Packet Landing Way West Barnstable 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. May 17 93 19................. • Building nspector TOWN OF BARNSTABLE 30509 Permit No. ................ BUILDING DEPARTMENT t 'u"` I TOWN OFFICE BUILDING Cash ■IT p ' !TV X HYANNIS.MASS.02601 Bond I CERTIFICATE OF USE AND OCCUPANCY Issued to Richard Kraus Address 55 Packet Landing Way I West Barnstable I 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. May 17 93 I .. ........ ... ... ..... ..... 19 ................. ......... . iBuildin�nspector i I E Application to \' SgV as DOE ENS�a Ea~et Old Kings Highway Regional Historic District Committee R E� in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS Application is hereby made, in triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs accompanying this application tor: CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: (i�New Building ❑ Addition 7 Alteration Indicate type of building: 21 House ❑ Garage ❑ Cornrnerciei ❑ vii.a. 2. Exterior Painting: ❑ 3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other (Please read other side for explanation and requirements). TYPE OR PRINT LEGIBLY DATE ADDRESS OF PROPOSED WORK ASSESSORS MAP NO. 17 01 OWNER ;< c/71n, iq ASSESSORS LOT NO. HnME ADDRESS _6 7 113J� !Z"P h` 14rJ�-1S r•'d"/b MiA. TEL. N0. `�Z i; ' G 10� FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). c't_ f47Ti4r-nc- JAG C`T. AGENT OR CONTRACTOR TEL. NO. ADDRESS DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done (see No. 8, other side), including materials to be used, if specifications do not accompany plans. In the case of signs, give locations of existing signs and proposed locations of new signs. (Attach additional sheet, if necessary). S t e A Tlo c t4 e cr P[.A w 3 Signed Owner-Contractor-Agent ce below line for Co ee use. l ceiued by H.Q1Q- L-ALL.hU\`J L13 ) �. Date .The Certificate is hereb - \ Date �• T,me - �� �' 05 JO/ BM,4 Approved ©� IMPORTANT: If Certificate is approved,approval is subject to the 10 day appeal eriod provided in the Act. Disapproved ❑ Ck N/F TOWN OF BARNSTAa CONSERVATION ,gyp ��� ASSESSgi ORS MAP 11 ' �4 / �%K cps, As, PARCEL 6 �S• "� / NEW d ��'�� , �r o�� ,• ARAGE tip'• `a F UNDATION V DRIV AY •� 0 w ° Cf . N/F �p QS� �,�` XISTINGi�: LAWRENCE �w SHEDS EXISTING NORMA' CATON ` .� �- HOUSE ASSESSORS MAP 179. PARCEL 14 �%yam N/F R NORMA M. CATON �tK* ,,.:.-•�,r-�.,_�. _, q'Qiy t ASSESSORS MAP 179 �L t PARCEL-15 e , N/c•y. ! r w.. c� RICHARD A. KRAUS ASSESSORS MAP 179 I PARCEL 13 r, 2.6±ACRES �w KLV1N "& MICHELLE-60YAR ASSESSORS MAP 178 p� PARCEL 9/2 N/F �?po, REVISED 12/09/03 — ADD LIMIT OF CLEARING ,s JOHN & LINDA. COBLISH THE TRUCTt1RE 1S LOCATED IN ZONE "C" ASSESSORS MAP �• ✓ ASS OWN ON FIRM COMMUNITY PANEL PARCEL 2500 i 0011 D EFFECTIVE DATE: 7/2J92 PREPARED FU RIC_ HARD KRA(Jz 1 HEREBY CERTIFY TO THE BEST OF THE BSC GROUP,miNC MY PROFESSIONAL KNOWLEDGE, �,�' 657 MAIN STREET WEST YARMOUTH INFORMATION AND BELIEF THAT THE OF LOT CORNERS, DIMENSIONS AND +►' SETBACKS TO THE STRUCTURE AS CERTIFIED SCALE: DETERMINED BY INSTRUMENT SURVEY °` __.. AND AS SHOWN ON THIS PLAN ARE Vie ' PLOT Pt..Af� DATE 10/31/C.,: � CORRECT. ® � #55 PACKET s ° t �� ' _. _...... d LANDING ROAD Bsci 4-66i3. Zoo` CRAP A.'RELD, PLS DATE WEST BARNSTABLE f FOR THE BSC GROUP, INC. MASSACHUSETTS SHEET 1 OF t 1 44 s o. ZD T 14, N�s':oo '3a" v✓ i 9 2f , 'TOWN OF BARNSTABLE ZONING BY-LAWS DATED FEBRUARY. 1986 RAUL 'w =� RYLL ZONE: RF R. No. 32,148 �Sa SETBACKS STI :'%�• ��?` FRONT 30' LAND �dfi ° wdw � SIDE _.. 15' REAR = 15' PROPERTY LINES SHOWN HEREON WERE COMPILED FROM. PLANS, OF RECORD AND DO NOT REPRESENT PROJECT N0. 3-1146-07 AN ACTUAL SURVEY ON THE GROUND. _ THE ,STRUCTURE DEPICTED ON THIS PLAN WAS LOCATED PLOT PLAN ON THE GROUND BY SURVEY ON MARCH 9 1987 in AND EXISTS AS SHOWN AS OF THE DATE OF LOCATION. BARNSTABLE MASS THIS PLAN 'IS FOR PLOT PLAN PURPOSES ONLY AND SCALE: i" - 60' MARCH 9 1987 a",x LD NOT BE USED FOR ANY OTHER PURPOSE: . A. BSC / CAPE. COD SURVEY CONSULTANTS -7 3261 MAIN STREET D TE PROFESSIONAL LAND VEYOR BARNSTABLE VILLAGE., MA. 02630 (517) 362-8133 r f 0 1` �7.ai Vi5:99 FDuI/i7. o 1 ELEV. i s9a�- ii•99 CI' �S 45 07 45 E 9 ss NSF. �- Y 303 ' A V 07' 4 S" W Q � r am 7-0O� C01,/G. ,3,D. Q +1 is li�j'f fA` h;t� P,J11 a �. TOWN OF BARNSTABLE ZONING v PAUL y� BY-LAWS DATED FEBRUARY 1986 R. RYLL y ZONE: RF y, No. 32448 oQ SETBACKS �F0 FRONT = 30' IL LANDS\! •. �-"" SIDE Q 15' REAR 15' "PROPERTY LINES SHOWN HEREON WERE COMPILED FROM PLANS OF RECORD AND DO NOT REPRESENT PROJECT NO. 3-1148-07 AN ACTUAL SURVEY ON THE GROUND. — THE STRUCTURE DEPICTED ON THIS PLAN WAS LOCATED PLOT PLAN ON THE GROUND BY SURVEY ON MARCH 9 1987 in AND EXISTS AS SHOWN AS OF THE DATE OF LOCATION. BARNSTABLE MASS . . THIS PLAN IS FOR PLOT PLAN PURPOSES ONLY AND SCALE: 1" 60' MARCH 9 1987 SHOULD NOT BE 'USEb FOR ANY OTHER PURPOSE. BSC / CAPE COD SURVEY CONSULTANTS ? 31,z18 �_ � 3261 MAIN STREET DOE PROFESSIONAL LAND VEYOR _ BARNSTABLE VILLAGE, MA. 02630 t617) 362 8133 vv