Loading...
HomeMy WebLinkAbout0041 PERCHERON WAY f w �j 0, (5T NO. 1521/3_®RA o wYf! Town of Barnstable *Permit# Regulatory Services wee 6 months from issue date t BAMSTABIA ASS,M � ������ Mass. Richard V.Scali,Director Building Division Paul Roma,Building Commissi MAR 31 20�� 200 Main Street,Hyannis,MA 0 www wn rn I .m .0 1����]�� LO".to .ba stab e a s /�� Office: 508-862-4038 R,V V,4&t ��0-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY C ' - 0—D5 Not Valid without Red X-Press Imprint Map/parcel Number Property Address ill Pe�r,heam 1 U,y��lTi residential Value of Work$ 2 0. Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address %i Contractor's NameQ.0 i.c%(_ ��it,,�, Telephone Number �� A Home Improvement Contractor License#(if applicable) ��� Email: Construction Supervisor's License#(if applicable) CJsc U I Workman's Compensation Insurance ((V Chec one: I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name TAIW" w/e V,), . Workman's Comp.Policy# ���� �� YN2 Copy of Insurance Compliance Certificate must accompany each permit. Permit R uest(check box) e-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to 21, ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) l/Z/G`f7 kc, ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: i C:\Users\decollikWppData\Local\Microsoft\WindowsUNetCache\Content.Outlook\L7U69LF2\EXPRESS(2).doc 01/25/17 Property Owner Must Complete and Sign This Section If Using A Builder 6 IV` ,as Owner of the subject property to act on my behal hereby authorize f, iri all matters relative to work authorized by this binding permit application for. I . (Address of Job) p r . $' of Owner. ate �Ul/r a Z>✓w/� P t ame If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. The Conrniomvealth of Massachusetts viDepartment of Industrial Accidents Office of Investigations 600 Washington,street Boston,MA 02111 wwtn nias&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Bus nem/organization&dividual): _ Address: ,]R 1 C I City/State/Zip. mane 9-0 C � Are YGU an employer?Check the appropriate box: T of project(required): 4_ I am a general contractor and I Type P ] am a employer with ❑ g 6. ❑New construction Iayees(full and/or pact-time}' have hired the subcontractors I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling strip and have no employees These sub have g. ❑volition w for me in an capacity. employees and have workers' � Y � t3'- 9_ ❑Building addition [No workers'comp.insurance comp.insurance.I required-] 5. ❑ We are a corporation and its to.❑Electrical repaits or additions 3.❑ I am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additicns myself [No workers'comp- right of exemption per MGL 12. LGftep3ifS insurance mod-]I c. 152,§1(4h and we have no employees-[No workers' 13_ — comp.insurance required_] ;Any applicant that checks boil#1 rust also fill out the section below showing theii wnakera'compensation policy information_ Homeowners who submit this affidavit buhaiting they are doing all wol and then hire outude contractors must submit a new affidwit indicating such tContractors that check this box must attached an additional sheet showing the name of(be sub-conusrtars and state whether or not those entities have employees. If the sub-untmctors have employees,they must provide their workers'tromp.policy number. I ant an employer that is providing workers'compensatton insurance for my eniptWom Below is the policy aced job site injarnration. Insurance Company Name: Policy#or Self-ins_tic_#: I CtJ Expiration Date': Job Site Address: City/State/Zap: �l/ �►!/J �k.�! Attach a copy of the workers'compensation policy deAaratiou page(showing the policy number and expiration date). Failure to secure coverage as required under Section 23A 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 fate 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 Imtiestigations of the DIA for insutan coverage verification. I do hereby verb rider the poi s and pena 's ojperyu that t e information provided above is trite and correct Si true: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town of'icia[ City or Town: Permit/License Issuing Authority(circle one): j 1.Board of Health 2.Budding Department 3.CitytTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: David Sawyer Construction 318 Meiggs Backus Road Sandwich,MA 02563 508-539-1992 Proposal Submitted To Work Address Mr&Mrs.Conway 41 Percheron Way W Barnstable,02668 5083647965 Worked to be Performed: *Strip Roof-Replace with CertainTeed AR Architect Landmark Shingles Color-custom to decide *Nail Plywood as needed *Clean Gutters as needed *Install: White Aluminum Drip Edge Ice&Water barrier on all edges of roof,valleys,chimney and velux Underlayment Paper System Hurricane nail shingles Ridge Vent Pipe Flange *Clean yard and take all debris to landfill. *Remove rake boards on left side of house Replace with Azeck trim-(painted white) *Remove two velux's-Replace with two new M08 Velux's Total Labor&Investment$9,400.00 nine thousand four hundred dollars Deposit to begin job$4,000 and balance due of$5,400 at completion of work. All materials guaranteed to be as.specific,and work to be performed as stated above in a workmanlike manner. Please remove and/or secure any fragile household items: Not responsible for broken or damage to household items. Five year Labor Warranty/Plus Manufactures war nty. Contract may be withdrawn if not accepted within 30 days. Pleases ack for addi onal terms Respectfully Submitted ✓' Date'3 Acceptance of Proposal The above prices,specifications and conditions are satisfactory and hereby accepted. You are authorized to do the work. a ent is d as stated above. Owner signature: \ Dat 31,3 �� f WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY r INFORMATION PAGE AGENT NO 3020 OFFICE NO 3020 MARK SYLVIA INSURANCE: AGENCY LLC 404 MAIN ST CENTERVILLE MA 02632-2916 FARM FAMILY CASUALTY INSURANCE COMPANY 508-428-0440 NCCI COMPANY NO. 16721 POLICY NO 200IW6406 1 5 4 INSURED AND MAILING' ADDRESS: RENEWAL OF NO. 200IW6406 EFFECTIVE 3/05/17 DAVID SAWYER DBA SAWYER CONSTRUCTION 318 MEIGGS BACKUS RD SANDWICH, MA 02563-3131 THE INSURED IS INDIVIDUAL Workplaces covered by this policy: ST WP NO. ADDRESS OF WORKPLACE RTG.BUR NO. INTRASTATE NO. MA 01 318 MEIGGS BACKUS RD 210677 SANDWICH MA .�TEM:.�.:..P(3LYI�Y...P ............... ... :..:.. .......................... . : The policy period is from 3/05/17 to .3/05/18 12:01 A.M. Standard Time at the insured's :mailing address. ................................. '.................................: ::: . . `.:::; :: :: :::::::::::..........:::::i:::::`:::::: i'"::::i::::::::?::;::::>:::::::::":::i'::: :: :<;`::::::::::::..... :::::::2?:::::::::::i::z::f ::::R:::;'::::: ': ::': c i'^:::::::maim :'::r:::`':::: :.. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the state listed here: MA B.-Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3-A. The limits of our.liability under Part Two are: Bodily Injury By Accident Bodily Injury By Disease Bodily Injury By Disease $ 100,000 each accident $ 500,000 policy limit ' $ 100,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: All states except the states designated in item 3.A. of the information page and ND, OH, WA, and IVY D. This policy includes these endorsements and schedules: WC 00-00 00C WC 00 00 01B WC 00 03 15 WC 00 04 14 WC 00 04 228 1VC 20 03 01 WC 20 03 02A WC 20 03 03D WC 20 04 05 WC 20 06 01A Copyright 1987 National Council INSURED COPY PROCESSED 01/13/17 on Compensation Insurance WC 00 00 01 B Issuinq Office - PO Box 656 a ALBANY, NEW YORK 12201-0656 Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 ' Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 134313 Type: DBA Trif' 270759 Expiration: . 10/24/2017 DAVID SAWYER CONSTRUCTION = = e DAVID 'SAWYER di _.318 MEIGGS BACKUS RD. SANDWICH,"MA 02563 Update Address and return card.Mark reason for change. Address Renewal ❑ Employment Lost Card SCA 1 Q 20M-W11 Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CSSL-098859 Construction Supervisor Specialty :. .. - DAVID R SAWYER t 318 MEIGGS BACKIIS ItOADR SANDWICH MA 02563 t ' �•- Expiration: Commissioner 01/27/2019 Town of Barnstable Regulatory Services Thomas F.Geiler,Director BARNSTABLE. 9 • . $ Building Division qj 059. 0 MA'1 a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fay;: 508-790-6230 i PERMIT# FEE: $ P�` SHED REGISTRATION 120 square feet or less Location of shed(address) Village. ho q. V 1, 5' Property owner's name Telephone number o c_ .z.- AI �7�- Map/Parcel# c ` Size of Shed Un a co rn �l Si a e Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? n� Conservation Commission(signature required) PLEASE NOTE: IF YOU ARE BE A REVIEW PROCESS AND APSDICTION OF PLICATION O T OWN EEo� COMMISSIONS,THERE MAY PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:121901 N 14to y4� .00 rh � N A V m W �39•Zo 14d- OF yz P,.0 A. V w aRAkTMio�a GT'��•1 SpAc.� SVPS��v�S tv iJ •{�,� �0 ASS ESS Pas MAP n4 PGL c A4 / Y 7,UA7- THE �vvN a4T�o✓ LaG,4Ti��c/ X/a�r Ba�zN Sro O,'x ,.S'�/ol�t/iv yE�2E0.C/COMf�L YS !s//rho SC.4 L E- /_ ,�' OATE (� • �'7-.97.•:� „i-,�/oF.C/.c/� AA .SE7 SA Cl- �EQU/.2E�lE�/rS of T/-/�' Tz�w�Vc�F 8/1/2'ki9"A8[Z' A,vo /.ss tibT' Lor 145 .LOC.4 TE.a !•t//T/,///./ T.�/E .�.LOQaPLfl/.t! /.�fJ,V�� /�i II.t St L TII' . g , ZA j BoaK , 439 Pasar •14 OATS: b'�7-�7 AgAXT.E.e¢A/YE /NC. Tom//S P.L4.t//S.t/c�"BA.SEO O�c/.4�t/ .2EG/STE.2E0 LQ�/O SU.E'/i6Yt�.e /N..S�".2Uiy�it/T,SU•eYEY� T/�E � as7�,�2✓/.GL�a M.4.Ss,. TOWN OF BARNSTABLE I.. . _r. .-'------ ----------.--- CERTIF3-CATE--OF-GGCUPANCY-- ---- -. . -- - _'------_-_ - PARCEL ID 174 001 053 GEOBASE ID 38874 1ADDRESS 41 PERCHERON WAY PHONE '`W BARNSTABLE ' ZIP" — LOT 145 t. BLOCK LOT SIZE DBA " DEVELOPMENT DI ST.RI CT��WB PERMIT 26095 DESCRIPTION SINGLE FAMILY' DWELLING (PMT-023416) PERMIT—TYPE BC00 TITLE CERTIFICATE OF OCCUPANCY '� CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: BOND $-00 O�1HE � CONSTRUCTION COSTS $.D0 756 CERTIFICATE OF OCCUPANCY t � ; * BARNgrABLE. MASS. g► OWNER DACEY; BRIAN T TR s6 i ADDRESS CENTERV I LLE MA BUILD rDI'VIS DATE ISSUED 10/03/1997 EXPIRATION DATE TOWN .f }i(1I1.,llttlt; !-r,{,E' 11 �U- t3�92Nsr�g Z I P : .1 ! '!' � �► ,,: ,�1,':,.'I;LU„It 49'f.' NEW ( ,kPE ')TI ,)- H(�(J;x t:W 1'r' TYVt. F'U I +, 1 I'I'1'.t'N .':'I %LVN I'L AL HI, C I.M , (.(,WIT6 H,.,: ,AY',", 'F UU., LL-r NG . 114C Department of:Health, Safet- K! :I i r'+'r,C'I'': : and Environmental Service q � St�Nll s.00 TNE ( `M"J')L.<.(' *T, T c $1.U2'41O ►gyp Qe► 1t:1 .;1b('LF FAi, HUMP: L`142Ts34NF+..1 1. : K) dATI, t' # 4 + BARNSTABLE, • . -- MA85( �► , Uk'Ntih 1­' " , BV I AN T '1'E' }sT 1639' �0 Pi;)UhES., F' +• ►0x CM`+'ERV I LIJE VA BUILDING DIVISION � .By �-- ,'.li: IfXPIk.;kTI'ON +•)ATE s �� THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR a ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.TH=ISSUANCE OFTHIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- ELECTRICAL,PLUM13ING AND MECH- (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS. 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. 4.FINAL INSPECTION BEFORE OCCUPANCY. - • • EM • - • BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION#PPROVALS 064 76L10 0_ •Obo i olvs/v aAft/= 2 2 2 ���i''V� go-- ,{r 9-2 �(� 3 , 1 HE I G INSPECTION APPROVALS ENGINEERING DEPARTMENT x''g' 2 BOARD OF HEALTH' OTHER: -SITE PLAN REVIEW APPRtKI Ilf WORK SHALL NOT PROCEED U IL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS I- THE INSPECTOR HASAPPROVEDTHE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARJOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. r a C V ...,.,r .. �,._,+�. � .�,.rs+i*r"4.z.--.•n�.-...-.-C..�v.-r+r.V . 4..r-.^•r:...;r'....alr-- '.'.:t,,,� F ,y`�tHET The Town of.Barnstable - BA RAgl;- E. ic M � Department of Health Safety and Environmental Serves ASS Ft►- Building Division 367 Main Street, Hyannis, MA 02601 Office: 508-790-6227 Ralph Cmssen Fax: 508-790-6230 Building(Commissioner Inspection Correction Notice i Type of Inspectio -� ` Z_ L`-- �lfel? �t�t Permit Number '� Location Owner ky SI o 6- Builder One notice to remain on jobsite, one notice on file in Building Department. The following items need correcting: �k I���i t c C C ASS 1_0 `.-A( ICJ ao` Ti �11S14c� L� � ! C,�J �yNl� �,�1� �l.l�S �ti-�1E✓'�R. T1Uf�)l ► IN ���.�� Ce LU t:C..G L ex-V e l-I(Oi, C)y -DW et'l % 0 �F Please call: �`508-790-6227 for re-inspection. Inspected by 1 Date j� ' . i Engineering Dept. (3rd floor) Map f7 Y Parcel 1 0 5'3 .Permit# 2 7 House# Date Issued (p 2 >2 Board of Health(3rd floor)j8:15 -9:30/1:00-4:30) Fee /7 y Conservation Office(4th floor)(8:30-9:30/1:00-2:00) Z I Fp 4nitian floor/School Admin. Bldg.) roved by Planning Board — / U 19 ,p 1 k �-e 1 ec SP ' — a TOWN OF BARNSTABLEBuilding Permit Applicationss y/ �i(/lGt7 V L0 �� Village _3&U4 - Owner �. Mdo Address ® Telephone 7 Z1-16,116 , Permit Request a A:L4 ep �o First Floor 910 square feet Second Floor , square feet Construction Type W mZ Estimated Project Cost $ Zoning District Flood Plain Water Protection (o P Lot Size /6. Y 30 Grandfathered ❑Yes ❑No OWE U 5P4-CP— Dwelling Type: Single Family 09' Two Family$ Multi-Family(#units) - — Age of Existing Structure PEW . Historic House ❑Yes Rf No On Old King's Highway ❑dies @'<o Basement Type: Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) l Number of Baths: Full: Existing -3 New Half: Existing New No. of Bedrooms: Existing —3 New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: 03"Gas ❑Oil ❑Electric ❑Other Central Air r"res ❑No Fireplaces:Existing New L Existing wood/coal stove ❑Yes PIo Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) --� ❑Attached(size) / C ❑Barn(size) None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑t Yes U o If yes, site plan review# V - Current Use &044 JQ-t Proposed Use "� ��.,, //)) ��II (� Builder Information Name _ agw4& /51O1 / 9� Telephone Number -7 7/— Le W Address 9 5' License# l 0 J i y6 Home Improvement Contractor# Worker's Compensation# UJC l 3 J Z 2 Zp l 7 F J Q NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Cd � SIGNATURE A DATE (oAlf 7 BUILDING PERMIT DENIED FOR THE OLLOWING REASON(S) ' t C► FOR OFFICIAL USE ONLY - PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS f VILLAGE f 1. OWNER • v DATE OF INSPECTION: S` FOUNDATION r FRAME y INSULATION , Y � . FIREPLACE y r l ' r ELECTRICAL: ROUGH FINAL PLUMBING: -t� UGH FINAL 4 GAS. `' *4 RO6CQH FINAL FINAL BUILDQG'i5 DATE CLOSED OUT ASSOCIATION PLAN NO.A ' y� r I I I ! 1 .3oa 1 ' I: T � , t a % ` . FMJ � FFFFl rL i f I . i -- - -- ----------- - ---- ------- --- it -..._ -, L E F T S 1 0 E GA2.AG C_ i i ' i - i - _ � I ;\I •� j a ; � -_C N CRirTE ii I _. `-iCG1-1-r SIr7 fa)AYSIn E rbUILr71NC. C� CE1-A E RVI LL£ SCALE:1/4.A Ip�.�'• APPROV ED BY: DATE:JA, Jam) E GLEVAT I C t S CES7Et2 4 ANN \VXr-)E 4S-cAP-'N 1SIAN'6 II , J ' =- 9 zr LT i I-l_E ! --UN-A I � � i •L i �I�, � , i � Z � 0 � I I 11 ! I C I ! > I I I ' I) � I I ' I I rm ar■o.+000l au�nmer• I - - I a' o„ � I 90 5-J I 40 �� I 10 G ✓� p A tl { 9 i {-— L rn o tP 61 _ m i,(2 47rT.,.,.l,, tn o J a I a ILJ' J �1 _Zc l: I — — -------- -- -�- {- ---- ►-�'-e -F-G J i .o Z'.D Z Ij `n s I i -T p i Fr- op t E F Ipo, I r- �v z n x swn s � y -- - --1- --- -=_ s I � m � O J ➢ 0 � ,l a iZ p--- I 10 JI i r r• 1 S i,y.�� � •14'. o' �2: o• � cry I 9 9 x se•-- �- --� -- 2 6- ----���-t" - - ----- -3 OJS-7 1 ri -1 _AA bl LO Lo -4" OR 2'.G I I i ,� -O T7 0 e� lu ip Lo IL Sl 11)t o I -FUL-L-.P-UrC ULI- Cc"C- kq Azi:lr I IV- lix --bov S-7 I ; I � � � I I i � ! c�. L co 7—C rt-,F—A//\. I-IL'STE C L M.P cA-T C. NA FILL- dN 07, LN G. I to V—Z 4- :e>--A.5 N : 48/� q 050 � 4WVII m W Alq /3y.Zo OF yz PZ gXCHAFO I BAXTEA to voaawe cfai.l SpAc:� Sv1SDJviSLAOu ASSESSDOS MAP n4 QG(- / CI!F 27'/.cy 7WA7- TfZE FVVVAoAr1aA) L06t17-/0TC/ A/t-sr EaAzNsro,5L.0 Sf/OWN yEi2E0.1/COA-!,Z7Z-YS W/;9v S'CA L /_ .gyp" C.ATE !o - /7- 97 AA/o SETBAcfe ��AA/ ,eEFE�2E�G'� OF T/lF 7'2:) Al BA2�STA8L�' A//o /.s AO- Lar 145 �GCA TEl-� !•�/T.;�/.t/ T�/E .�,LOGia oL.4/if! NIJV j�?1. /�i II.�, St G nr . 6'/7-17 0 P[AiJ BOOR •139 PA#ar /G OATS: ,6AXT-.=,O j.VYE /NC. d v A,,V �26G/STE.2E0 L SO SU.e�.SY1�e /it/..5`r,2U�/��t/l,.$tieYEY€ TyE 0•�.4SE'TS Sh�aw�V Sf t�L� //oT g� A�,o.L./C,Q/i/`r� 8A I LI-: 8O)4z�u6 "-'o AG USED T� OET���tf/�C/E SOT L/Nr�S_ fo m PO C/7 N fT � U QO Ll 1 V] v\ GC —4 Cr F-r q 7 V p0 O_ -•--� m_ c� pQQq 'A+ 60 — A O O 934 O m D� Epp %� Pq v'1 O •'-1C �a—Q 1 py m d U A a �l a— Pa c� 1 Ol O C cn al Q4 ' owu ��pl) i P CoMMONWEALTH OF MASSACHUSETTS �.—a LQ DErAIC-,,IENI' OF INDUSTRIALACCID.Vgn 600 WASHINGTON STREIrZ' BOSTON, MASSACHUS= 02111 fames J canpDel: �:ornm:ssr°ne• WORKERS' COMPENSATION INSURANCE AFFIDAVIT �. 1J 0iccnscc/permirrc0 . with a principal place of business/residence ac 3 (Gry/Staeemp) do hereby certify, under the pains and penalties of perjury,than. [] I am an employer providing the following workers' compensation coverage for my employees working on this job. �2-D 1 7 Insurance Company Policy Number O l am a sole proprietor and have no one working for me.. ( J 1 am a sole proprietor, ncn�comppcns2rion r homeowner (circle one) and have hired the eontnaors listed below who have the following won c:s insurance politics: Name of Contractor Insurance Company/Policy Number Name of Contracor Insurance Company/Policy Number Name of Conimcror Insurance Company/Poliey.Numbtr 0 1 am a homeowner performing all the work myself NOTE .Please 6c awuc tilt wbilc bomeowacn •ono empior persons to do mainteaaacc. construction or repair..oric on a dwciiine of not More tb' Ln wrec untu to which the oorneowner aiso resides or on the rrouocs apvurtrnant thereto arc cot reoerail% considered to be crrplovcrs ujoacr the Woriccn' Compcnsauon Act (Gin C 15=. sect. 1(5)). appiieatioo by a bomeowner ror a license or permtt may cnccncc the icEal tutus of an cmpiover under the Worken' Compcaution Act r 1 unr;crstand -tide eorw or this stat=cnt will be forwilrccd to Life Depar.:ncnt of Industrial Accidents' Office cf 1nsuranec tot tovc--Cc ren:,:::ton ant ::ta: :allure to ieeure ev2ra.re a mctsirec undo Seenon _'5A'of.MGL 15: net leas to 6c imposition of crir llj Re'r- mnstsone or: i,ne or ue to S1 500.00 andior imprssons cat or up to one ant atii pcnaiuu in the form of a Stop donne Orfle' zne a fine of S100.C-u a day a€a:ns: me. s 6 ys r SUBCONTRACTOR'S INSURANCE ENGINEEER: BAXTER & NYE ENG: (L) FIREMENS FUND - S30MXX80564866 (W) LIBERTY MUTUAL - WC1312595563023 WELLER & ASSOC: (L) NAT'L GRANGE MUT.- MSP45246 EXCAVATION & SEPTIC: ROBERT J. OUR (L) U S F & G - 1MP30109550901 (W) U S F & G - 771521695 DECO CONSTRUCTION (L) TRAVELERS - 660364K8342 (W) LIBERTY MUTUAL - 312446298044 FOUNDATION: BAYSIDE FOUNDATIONS: (L) COMMERCIAL UNION - ABR406267 (W) LIBERTY MUTUAL - WC1312201785044 WELLS: DENNIS SCANNELL (L) TRAVELERS - 660873E5627COF92 (W) WAUSAU - 151300062926 CELLAR/GARAGE FLOORS: MICHAEL BROWN: (L) AETNA - MP0023672849 FRAMERS: ROBERT DORRER: (L) TRAVELERS - W680526K991TIA9 (W) AETNA - 006C0023972416C MICHAEL DUFFLEY: (L) COMMERCIAL UNION - NBF821356 (W) LIBERTY MUTUAL - WC1312492127024 MASON: SHERMAN, WAYNE: (L) COMMERCE INS CO - N60689 (W) WAUSAU INS - TO BE ASSIGNED ELECTRICIAN: CHAVES ELECTRIC: (L) HANOVER INS. - LHN2964649 (W) MISCELLANEOUS INS CO. - 0708878 91 1 PLUMB & HEAT: WHITELY PLUMBING: (L) TRAVELERS - 660365K1782COF9 (W) EASTERN CASUALTY - POLICY IN MAIL ALARM SYSTEM: BALTIC SECURITY: (L) FIRST FINANCIAL - FF0131 G400831 (W) COMMERCIAL UNION - CB0743379 CENTRAL VAC: VACUUM HOUSE: MERRIMACK MUTUAL - SBP1608045 r s y INSULATION: MAP INSULATION: (L) AMERICAN STATES - 02CC326435-3 (W) U S F & G - 7711099932 SHEETROCK: MEL REED: (L) WORCESTER INS - CB817530 (W) COMMERCIAL UNION - CBH557387 INTERIOR TRIM: DAVID'S REMODELING: (L) COMMERCIAL UNION - NB F821442 M & R CARPENTRY (L) MARYLAND INS. GRP- SCP30235965 (W) CIGNA PROP & CAS.- C80049997 OAK INSTALLER: ROBERT BUDDEN: (L) NORTHERN ASSUR. - NBF528652 PAINTING: CAMPBELL PAINTING: (L) TRAVELERS - 1680251K4083COF (W) AMERICAN POLICY - WCC 186604 GARAGE DOORS: ALL CAPE GARAGE DOOR: (L) U S F & G - BSC14667590301 (W) COMMERCIAL UNION - CBH573757 STORMS & GUTTERS: ALUMINUM PRODUCTS: (L) AETNA - MPOO21014146 (W) AETNA - JC89258880 OAK FINISHER: AMERICAN FLOORS: (L) TRAVELERS - 680 342W754-0 CARPET, VINYL & TILE: CARPET BARN: (L) VERMONT MUTUAL - SBP6507393 (W) PHOENIX INS. - 6NUB476J652794 TILE INSTALLER: TONY AVERINOS: (L) ASSURRANCE CO. - CFP26528977 (W) HARTFORD FIRE - 77WZCY2409 WIRE SHELVING: CAPE COD CLOSETS: (L) U S F & G - BSC146983441 APPLIANCES: KITCHEN APPL MART: (L) FIREMENS FUND - AZC80453098 (W) HARTFORD INS CO - 77WZNB1603 MIRRORS & SHOWER DOORS: L & M GLASS: (L) COMMERCIAL UNION - CBR409003 (W) U S F & G - 0071439933 LANDSCAPE & SPRINKLER: COY'S BROOK: (L) COMMERCIAL UNION - ABR345850 (W) CIGNA COMPANIES - C41138178 DRIVEWAYS: NORTHERN SEALCOAT: (L) MARYLAND CASUALTY- EPA18716945 (W) THE PHOENIX - UB387K530 A Assessor's office(1st Floor): C/ /�yo�—S3 SEPTICSE Assessor's map and lot number l 1 INSTALLED IN COfB�LIAN Bbard of Health(3rd'floor): ' ` WITH TITLE 5 Sewage Permit number - e W ENVIRONMENTAL CODE ASd9T11DLI: i � Engineering Department(3rd floor)': �/` E1s � �• ;" TOWN REGULATIONS House number `T/ Definitive Plan Approved by Planning Board I 1.9 il APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only • arnSta,5 TOWN .. OF - BARNS arvO V eD atZOn BUILDING INSPECTO 2g°a c°_���Ss�°n APPLICATION FOR PERMIT TO U D !7 TYPE OF CONSTRUCTION 19 1 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location Proposed Use A��C� . Zoning District )e F Fire District G O Name of Owner //�i�.<.l.QP // Address Name of Builder Address Name of Architect � � Address Number of Rooms -7 - Foundation Exterior / '` ' , a Roofing Floors G��"%/� Interior d�4 v _ ieating Plumbing L �. 4 fireplace l c ���/C�+/% �/ili`�- Approximate Cost Area' Diagram of Lot and Building with Dimensions Fee 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 1j4 No Permit For •Location rti r' Owned -Type of Gbnstruction • -sue„ '' .- • _ � 1� `� ti j yr- /r _ C' nl , Lot Plot � f I.. Permit Granted 19 Date of Inspection 1 r 19 Date Completed— < 19 . (• { r`� E 14 *s VS 7 IL. m -. {CO j � 1 , .. Lid., "� , _. �'3.�1� � f� ��/�%//��"` .� `t• ����w` -� �// ' Assessor's office(1st Floor):, ��� /'G ' AssessorsZmap and lot number �l��s yob THE To` Baard'of Health(3rd;floor): Sewage Permit number _---v-Y ��� i r t DA"STADLL i Engineering Department(3rd floor):', ,// House number. Definitive Plan Approved,by,Planning Board 19 ' �Fo MP°• APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN - OF BARNST -- BUILDING INSPECTOR. APPLICATION FOR PERMIT TO T TYPE OF CONSTRUCTION - �19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location Proposed Use 9 G o- titer Zoning District Fire District Name of Owner Address W' Name of Builder Address /41 Name of Architect 16�41W Address Number of RoomsFoundation Exterior Roofing a4 at a �4_1 7 Floors ( �G��� iC �i� Interior Heating / /� ��'� Plumbing �• C d'JG Fireplace 6/�� Approximate Cost /L) Area Diagram of Lot and Building with Dimensions Fee p 1 ` h OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS 1 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 No -Permit For Location i Owner' Type of Construction Plot Lot G Permit Granted 19 Date of Inspection 19 I' Date Completed. 19 i I} ' i Wtf rJE55'. J. DOW 1*3&, r Q+4 DATE' a 19, Nl i r$ r1 G-tl l � 2 !20 �� I �. C�t�?.;�• WVStr Jrw iC To PROM LA, I � � � �P��Q. _ ,�,�,� � 'S ,. '' �- � -- � PI��_ F, L►•1� �l� i�--r�}►any c7T��w►�.E �vTE'J. —44 T. �' G> qy' j►�.L.���,,,� p� i fG, :Cat 5. PI Fes" J 04J lS _;"A L-k- e,6 MA Pa kl�'TSV T164 \ ..�%� .._ ✓ - �^\ y//r / / � // `��! WG� �o G.��ti.l=>Tf_-(�-T-:��I ::'�T�i��, TO P.� I►.t c;.�c�f'�A�1LE l.�ll�Ml CL i rV L.10(7 C*-J_`� 1 / e / �� ✓Try 1 + `t F--[,.�'( i �.+V l.i r., :1- I j[ f C 4'ogs-v ►l ri 1 0 41 lbop cpp C01!wjCA- ,a9. � Ili 5SI2S.�IT 14�LZS {tI .00 1 � 1130. Lor �`� 4 t{ 2 FC-b,�� 0of 0, '+eve', 3•S --- ---.� FANG t�-,eorznnvMs Lz GPO GAL USE Oo� GAuO.t -r.► \(- t��-roM,�- _ ►�� � �', �. -�= i � � i --�—�.. c' I�-�:_ �v c�c ltiaAGE �..�.t� _—=__'_— t � W P t77 ..�J-L,4 01 r•. _ C 1 >' y 7„,? 1 1 1 1 i '�a ;+sYl+iE .�y♦ Jg'�� At'tNt• r! •� .4 1. `.'..A 4 t �r7+^ T��� 1 ��w �'T{Ir1... � �7 T't�..� 1 � v!" 1 c1a�n Ca�e Ir7cCr�i'a4 � /r7G . F �-[�►LE. � __.__. __ __ ---- I Il_EtasItiEEC Lnt.1D SU¢JE`(cit?S ��� •*•; .. �, ;� ,/`.�� t J ��f/ p+�etaoF �Ea.U'h AQt� CX3PLA i 1Z.L DATE Ar PepJEC DATE PAr�1E>_ -53 ao F'E�G iZ4?E• t L 1 2 4 I I ©aC �� E i14-\ /�� /� , / f /�" 11 i V��' �• C'd1"T,_tr.• �./�l_ ! :.!,"'' Te.kE�.� c QD►�/�.�-=— N`f[tr,;►.1'S_Q�1�.0 I l l `9,2 �y-���, ''f , i �' r3o 3 Ptr'� pl'G+�= 'la /rr�J►1�_cy� E�wi� r.,r�r�D. —44 `� �_ ` � �' �- • �� s3 te/ _ 20�- t :04. 5. PtF . .)�,��Jt� ,t�A,t~L I?£ MAc)F--- lit -Sv—rtG-�T. ..:r?'tw uc, TO 13E iki t-r-f4 � ;.�*`� �. ...-'^ ��/ '' / ��.� // J 1�'t t►,r;•� �tt�t��.'t �-l�q F,r.lrli� GoG�F Trr-t_,E� a �s/- �1_+ � �t3 ��-V �/�( t I � ,/ 'i T t�t :' �'�t.�k.) �y"'1 t_l .f:>`r `'.�r7 �„jQ(�� df�.��Y �1.•f��i ��'J 1..� ,r c.M t b-T?o Sc.a.t. 4 (v) -Ice of coU Uca*.asj `��� i�rce STr r.16 I �- ''sue/� � �,, •d c , � , czz-�-- ice��/jam// �� � � j �— _.. — __L M I►J_.l__�-ti 1. Ile Z, 44, r 2 of r G oL)+ lop r � �.Jg � —II(Z WA��CD�T�•Jc--� 1/� �J� ��"!V � L,a l._.� � L.., �?�'yr1 oG. '�F.�•aT t-IOt..E.'E-4 �t.�o4 0 _ t- L CD►•l GAL tJSE lc /' GAt_iC*,i Y4"V_ I111 eel IT agar- I _ r t � ARSE ------ s 3 �E Li R{TE i-'. F 1 C.l. _ I�t t_A►I p S0¢I1 E`110ZS OAt_R OP r 1�-1 ��o� vftF�OI�Tµ 1"�t�• '-:.�..'•' � r --�_—_— ���^.N'�TF�e�\ �. ; j`�� AQrIE 14 . Cx3ALA% j ;2.L.c..7 . ,P E, PATE eogr-r_, OAT M F DATA . Large Format Box # Doc # �1 Image #