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HomeMy WebLinkAbout0160 POINT HILL ROAD N oxbw NO.1=113 ORA FADE N USA { ESSFL?E �� ._ � �-.� . .�.._. .,.�.. . �.,. ... ,, _ �� � � ,t. .�...... 3y -1Y o � � • to s ` iS'rl Al('o/✓ ZoT 3� A ��I fo�Na,vr t ACRES u.FL.9N0 ti 3Os � 3. O 'I`63 /S.3},gc/�cs r„A/�sH I'Qvl col of I cl CERTIFIED PLOT PLAN LOCATION SCALE . ./. .''.=/.QG'.. DATE PLAN REFERENCE .•Q�/./y�{, ,�07-,���_ Q�1N Of M4Ss ED D LLEY N I CERTIFY THAT THE EX/-FT/e/rr. No. 26100 SHOWN ON THIS PLAN IS LOCATED ON THE GROUND '�FCISTEP���F��a, AS SHOWN HEREON AND THAT IT CONFORMS TO THE � �pyAL Lhr`�� SETBACK REQUIREMENTS OF THE TOWN OF /72,9.WHEN CONSTRUCTED. DATE S OooLi'7- 7om', — E 7-/7';lo1iE/z REGISTERED LAND SURVEYOR p V-z Assessor's map and lot number ....1K../..3Jc.,—..-. .. d S� .. SEPTIC S STE�NI MU��P�,S���Cq��� �pf?HE tp�` Sewage Permit number .............. -�'_ c�S �.! I N.5`� I LV ANC+ r ��� ,� s,. r Z SAWST"LE, i House number ,fir S......................................::.... ENMRONMENTA.CODE AN *oo�"6` e� TOM REGULATIONS o'F0M Ar. OWN OF BARNSTA.BLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION .............4.1.4MA..... !LAt!?. ....... ......................................... Sj t ......... .... . ...........19 Y i TO THE INSPECTOR OF BUILDINGS: _ The undersigned hereby applies for. a permit according to the following information: / Location .......�.0..7.: ..3.'A....... P4./�tlr...H. .L........:Q. !q�...J. .. � 4� 1 ............ Proposed Use ..........J�.�!t/�.� .... /�?/1�i .�..ff....� 1..��. 11/. ....................................................................... Zoning District ............Fire District .... . Name of Owner ?Lt/*/,4..Address ...4.� Name of Builder ..G .%I�� l3�..�Q.�..�< L yc.,/t4.Address ..................................................................`............... �aL Name of Architect �r. }�� ...�f�..;�.�1��..�T �✓.'.Address .................. `............................................`.. .................. , Number of Rooms ..................................................................Foundation ........................................ �4. /°�1!y .Q .. 11 ?�tl / ............. Exterior .... r .................:....Roofing ........1�4/U1�X1.. Floors ....... lGYk-.....x. -/ .........................................Interior ........?.,......../Z�. ... ....... Heating ......,t &0...... .............................Plumbing .......1!��p`�....�1/O �.O � ................................ Fireplace Z.....................................................................Approximate. Cost .....I. ..��...Q..?�.�........................ ... .... Definitive Plan Approved by Planning Board -----------_______-----------19 . Area ..... 5.....`...... Diagram of Lot and Building with Dimensions Fee / .............. .............:...... SUBJECT TO APPROVAL OF BOARD OF HEALTH 0 N� I . G 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 .................................... DOOLITTLE, CLYDE B. JR. 28411 1j Story "No ................. Pqfmit for .................................... Sing-. 7ity Dwelling Location Lot 36A, 160 Point Hill Road ................................................................ West Barnstable ............................................................................... Owner ...___Clyde .....C1 yde...B. Doolittle J.r.............. Type of Construction .....................Frame..................... ................................................................................ Plot ............................ Lot ................................ Permit Granted .......... 85 Date of Inspection ....................................19 Date Completed .................. ....19 yy 'A• � e 17 • f i`PINK-DEPT,FILE COPY/WHITE-.FIELD COAY./YELLOW:rAPPIICANT COPY': i �BUILD1N.G,., .BARNSTABLE=-MASSACHUSETTS'. s- '>.TOWN OF PER. :Yn �AT:oN .f 8411 i' DATE SepteIIlbeY''il 19 85 PERMIT OWner .•ADDRESS APPLICANT CONtN S L'ICENSE) . .' - •' (NO:I ;:; (STREET) .. 1 i NUMBER OF " e Build• dwelling 1}I' STORY`'" Single,:f�mi1� dWelliriQ DWELLING.UNITS: 1 PERMIT•'.TO '` '• + ••'' : (TYPE O/ IMPROVEMENT). NO.:.. - (PROPOSED USE)^ / ZONING:'.. �F, <; :.:.: ::.: 160."Point Hill:`''Road West-'Barnstable% .• DIS.TRICT ' AT,(LOCATION)' (STREET) • di. .. AND :... r BETWEEN (CROSS STREET) :..•._...r-:.-.v;:•'. ..:..: ,...(CROSS STREET) LOT . SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT.. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL':CONFORM'IN CONSTRU.C71 ' ,.: '. :; .... :. ;. is ': '••?`1..:;.:: .' ,,,;:;:T.O,'TYPE:" ' ' `• • ' USE GROUP`""'` •BASEMENT WALLS OR,FOUNDATION'• (!TYPE): REMARKS Sewage ;tt85 r198 bond. . .,• i.3320:'s ..: .ft:. 140 .000 PERMIT: 163:75 :.. ",•,.=.:',VOLUME;..,...... .. .', b; . ST•I MATEO,•.COST.:.� .rt. FEE, . ' ,...i:.].:::�a; ' :e.;:"arc.. :.:.:. .. .::::: BIC/ DARE ►E ET):.:..' _. : ...... _ _ .,.: ...; :>:".,• R'. .:Clydei~B�::•.<Doo`littl•e '::`Jr•.:•'_ .'i'',OWNE _ :�BUILDLNG:DEPS.: �:;,•�Crooked:Meadow>I:n: ev THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY w PERMANENTLY. ENCIRC)ACHM,ENTS ODI PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAIN FROM THE DEPARTMENT OF PUBLIC WORKS.- THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT•FROM THE CONDITIC OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED- FOR ALL CONSTRUCTION WORKt .. ELECTRICAL, PLUMBING AND 1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MEMBERS(READY TO LATH). FINAL INSPECTION HAS BEEN MADE.9. FINAL INSPECTION BEFORE F OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET ` 1 BUILDING INSP TION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS " it r I. I 2 2 IJ +�iw 2 3 HEATING INSPECTING APPROVALS REFRIGERATION INSPECTION APPROVAL N NG z_3o _k� QTH 2 2 BOARD OF HEALTH WORK SHALL NOT PROCEED UNTIL THE PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIb/j INDICATED ON'THIS C� j I INSPECTOR HAS APPROVED THE VARIOUS WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE CAN BE A'RRANGEO FOR BY TELEOH l STAGES OF CONSTRUCTION_ ..___.. .. y FF1 o TOWN OF BARNSTABLE Permit No. ...2841,1...... BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash ytouvR HYANNIS,MASS.02601 Bond x../.. . CERTIFICATE OF USE AND OCCUPANCY Issued to Clyde B. Doolittle, Jr. Address Lot #36A, 160 Point hill Road West Barnstable, Massachusetts USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. ... .�. 19...�10....... .... ... .. .,'.......... .. Building Inspector e F TOWN OF ' BARNSTABLE BUILDING DEPARTMENT �aai�T TOWN OFFICE BUILDING rut tg i619' �� HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department DATE: An Occupancy Permit has been issued for the building authorized by Building Permit #.. .»._ j�»...».......... .. _...... .»...._.».._»....». ....._ » __....» .... _. issuedto ..i --------- --------------------....... _..._.......... Please release the performance bond. f , TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ` �i. `✓ s�✓v Map 3S , Parcel o Permit# : p T ;°:'�! OF BARNS TABLE Health Division O 5 -uy013 Date Issued � s � y Conservation Division ZIroq �C PIW?212* �Q A�1 j ' 9: 02 Application Fee Tax Collector Permit Feel"" Treasurer DIVISION wit rc' ?r Planning Dept. Date Definitive Plan Approved by Planning Board E�,..,tr::r�.� _\• �� 1� _Wo � I tOL4 Historic-OKH I' I reservation/Hyannis " ' Project Street Address 140 ?O,u:� H ILL 1 ohD Village �S'T _l I1Tt4,3S-TA-0)t_6 0 Z Wo S Owner lAa- 1G TRuST Address I60 'Rd,'41 Niu.IZD.. Telephone 0;oM 31o2 - 41 (o 0 Permit Request w1g 1�?ULtA h (Arm) F -PlrM &,4�. Square feet: 1 st floor: existing proposed 2nd floor: existing 10 89 proposed Total new Zoning District Kir Flood Plain Groundwater Overlay Project Valuation s. Goo Construction Type UWT-�i Lot Size 8!3 S Grandfathered: ❑Yes ❑No If yes,attach supporting documentation. Dwelling Type: Single Family 18 Two Family ❑ Multi-Family(#units) Age of Existing Structure ?_0 Nei .S Historic House: ❑Yes 9f No On Old King's Highway: (9 Yes ❑No Basement Type: 9 Full ❑Crawl ❑Walkout ❑Other }kofteD 1s 5c 4c>`Tu13 s Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) I S S(o Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing 4 new C6 Total Room Count(not including baths): existing new _ First Floor Room Count Heat Type and Fuel: KGas ❑Oil ❑ Electric ❑Other Central Air: A]Yes ❑ No Fireplaces: Existing <5NhE New _ Existing wood/coal stove: ❑Yes ONo Detached garage:❑existing ❑new size Pool:Aexisting ❑new size U0 Barn:❑existing ❑new size Attached garage:) existing ❑new size 572 Shed:&existing ❑new size_jH Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ ---Commercial ❑Yes P�No If yes,site plan review# Current Use spuyv �2't-ICE Proposed Use S1VME BUILDER INFORMATION Name3o6-R loct-_-T; S Z.t.Telephone Number (so 5� 2-1$ -COO j Address 71 .4• � 133 License# 0'+8 851 b� CSC►-�UDL ,S I. Home Improvement Contractor# 100131 C.c�-T TT • TY)A nz2 ss Worker's Compensation# LAP-1_6145(oZ-0--0 3 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE l S FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. 1 ' ADDRESS VILLAGE OWNER } DATE OF INSPECTION: FOUNDATION _ �a d 06, 7/2G/p FRAME A p 0-0* INSULATION -6//✓5 Cj o 'k o j 4L ' FIREPLACE " ELECTRICAL: ROUGH FINAL F7 PLUMBING: ROUGH FINAL GAS: ROUGH FINAL 5 FINAL BUILDING i DATE CLOSED OUTS ASSOCIATION PLAN NO. t RESIDENTIAL BUILDING PERP FEES 1' APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x.0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0031= plus from below(if applicable) 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: x.0031= square feet x$96/sq.foot= STAND ALONE PERMITS Open Porch _er 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) permit Fee projcost �pFIME Tod Town of Barnstable Regulatory Services 9BAMNSTABL&g Thomas F.Geiler,Director lEOMA'��' Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: c p 1 o(- e f YjA i ti S v n r co w, Estimated Cost jdo , 6 O Address of Work: In d �21,,,-4 LA) �-A rn -te C Owner's Name: 1'1 t v1 �) GY15 Date of Application: S�1 I d 4 I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the ge. t of e��r: �\ ' �. /1 2 MA,��, UK 2 e17C 5 r D U 13 Date Contractor Name Registration No. OR Date Owner's Name Q:forTwhomeaffidav l r °F1NE r° Town of Barnstable Regulatory Services BARNSTABLE, Thomas F.Geiler,Director `�ptF169..�A Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize 1 I06 I OQOT I Ai���f 1 5c•AD NSF�� to act on my behalf, in all matters relative to work authorized by this building permit application for: /(op PUYT HILL (Address of Job) &AA Ad Signature of Owner Date Print Name Q:FO R M&O W N ERPERM I S S IO N L ENERGY CONSERVATION APPLICATION FORM FOR LOW-RISE RESIDENTIAL NEW CONSTRUCTION and ADDITIONS 780 CMR Appendix J Applicant Name: TeRWce 4- C,� e�.IC�, Site Address: c>kmE Applicant Address: 1Ga ?o.oq K►L Ro. City/Town: vl, 13Fl�.1St� Use Group: �i- 1'1A 0?_�(,S Date of Application: 74, Zo d Applicant Phone: C 50 36Z.- Lhlog Applicant Signature: /" P qM- Elf- Compliance Path(check one): t��t-r ❑ Prescriptive Package(Limited to 1-or 2-family wood frame buildings heated with fossil fuels only) Package(A through KK from Table J5.2.1 b): Heating Degree Days (HDDbs) from Table J5.2.1 a: (For items d. through i., fill in all values that apply from Table 15.2.1 b:) a. Gross Wall Area sq.ft f. Wall R-value R- b. Glazing Area' sq.ft. g. Floor R-value R- c. Glazing% (100 x b+a) % h. Basement wall R- d. Glazing U-value U- i. Slab Perimeter R- e. Ceiling R-value R- j. Heating AFUE ❑ Component Performance: "Manual Trade-Off" (Limited to wood or metal framed buildings only) Climate Zone(from Figure J6.2.2) ❑ Zone 12 ❑ Zone 13 ❑ Zone 14 Attach Trade-Off Worksheet from Appendix J, (and HVAC Trade-Off Worksheet, if applicable] ❑ "check Software Attach Compliance Report and Inspection Checklist printouts ❑ Home Energy Rating System Evaluation Attach Home Energy Rating Certificate(HERS rating score must be 83 or higher) ❑ Systems Analysis OR ❑ Renewable Energy Sources Attach Mass Registered Architect or Engineer Analysis ALTERNATIVE FOR ADDITIONS ONLY: a. Gross Wall+Ceiling Area sq.ft. b. Glazing Area' sq.ft. c. Glazing%(100 x b_a) ❑ ADDITION with Glazing % (c.) up to 40% may use 780 CMR Table J1.1.2.3.1 below: MAXIMUM U-value MINIMUM R-Values Fenestrarion' Ceilin ' Wall Floor Basement Wall Slab Perimeter De th 0.39' R-37 I R-13 R-19 R-10 R-10,4 ft i Glazing Area may be either Rough Opening or Unit dimensions. 2 Based on NFRC listing. Applies either to every unit,or to area-weighted average of all units. 3 R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R-value over the entire ceiling area (e.e.-not compressed over exterior walls,and including any access openings.) "SUNROOM" addition (greater than 40% glazing-to-wall and ceiling gross area) /Attach"Consumer Information Form" from 780 CMR Appendix B. Official's Name: Official's Signature: Application Approved ❑ Denied ❑ Date of Approval/Denial: Reason(s) for Denial: (provide additional details as needed on back side) I r MS'.:'_�; - aches �State� niIdin Co r 80r en echo L .23:1 - The Massachusetts State Building Code (780 CAM) includes provisions to ensure that houses and house additions meet energy efficiency standards. This supplemental CONSUMER INFORMATION FORM is to be filed as part of the building permit application when a builder/contractor or homeowner, constructing/installing a house addition with very large percentage of glass to opaque wall, seeks to utilize a special energy conservation exemption option for "sunroom" additions to,an existing house (780 CMR, Appendix J, Section J1.123.1). This FORM is not intended to prevent a homeowner from selecting a "sunroom" of any size, configuration, orientation, form of construction or percent glazing, but rather is only intended to assist homeowners in becoming aware of some of the important energy conservation and year- round comfort considerations involved in selecting and utilizing a"sunroom"addition. The connection of "sunroom" structures to residential buildings may create comfort and energy consumption issues due to uncontrolled solar gain or uncontrolled radiation cooling of.the main house. In the selection and construction/installation of"sunrooms", included below is a non-required, open-ended list of product and design donsiderations that a homeowner may wish to consider before actually constructing/installing a "sunroom". It is recommended that consumers carefully review these options with their designer, builder, or contractor, in order to minimize potential energy consumption and/or house discomfort issues. In addition, the qualifications and reputation of the company or individuals to be hired are important considerations. PRODUCT AND DESIGN CONSIDERATIONS RELATED TO "SUNROOMS" • Solar Orientation and Natural Shading • Type of Glazing • Insulating value • Solar heat gain • Frame materials • Glazing to frame sealing and gasketing materials/seal durability and/or weather tightness of the sunroom • Adequate ventilation Operable windows and fans • Applied Shading Systems • Insulation level in floors,walls,and ceilings • Possible Sunroom isolation from the main house via a wall and/or door or slider • Heating and Cooling Methods: Efficiency,Zoning and Controls Homeowner Acknowledgment The Massachusetts State Building Code, Section J1.1.2.3.1,..requires that the actual Property owner (not the owner's agent or representative) acknowledge receipt of this CONSUMER INFORMATION FORM prior to issuance of a Building Permit for a project that includes "sunroom" additions to an existing residential building, In accordance with this requirement, the undersigned hereby acknowledges that she/he has read the information in this document concerning sunroom comfort and energy conservation. Z00'fi Signature of Actual Build' Owner Date 1(.0 i6i.17 NULL Print Name Address of Permitted Project Owner Address (if different than project location) Owner's telephone number ------------------ UO-35,000cf enclosed space ti i I /�ze L�°�nmzo7wieaC a��a°°acfu�aella .112S.80L) jIA-'Ma so ry only BOARD OF BUILDING REGULATIONS 'IG-1 8 2 amily Homes License: CONSTRUCTION SUPERVISOR Failure to ossess a current edition of the Number:`.-CS 048859 I Massach etts State Building Code Is cause for revocation of this license. BIrthaa e: oz%zz s44 i i� Ezpl ®s b4/2212006 Tr.no: 16904 Restricted" ROBERT R PADGEsTT��_:;:1 oy 184 SCHOOL ST/P& X;J,3 DIG SAFE CALL CENTER: (888)344-7233 COTUIT, MA 02635 Acting o miss ner `ram �lae i�IoorUnzoozu�e� o�,.�cuaac/aueelia Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: = Registration: 100131 Board of Building Regulations and Standards Expiration: 6/9/2006 One Ashburton Place Rm 1301 Boston,Ma.0 08 Type: Private Corporation i PADGETT BUILDERS,INC. Robert Padgett PO Box 133/184 School St � �.,� Cotuit,MA 02635 Administrator Not v'alia without s ture A001H). CERTIFICATE F INSURANCE DATE(MM\°°\Yn - - ........ ......... ......... 06 06 03 ...... .......................................................................................................... THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION PRODUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE MYCOCK INS AGCY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 20 SCHOOL ST ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PO BOX 437 COTUIT MA 02635 COMPANIES AFFORDING COVERAGE COMPANY 297SB A ROYAL INSURANCE COMPANY OF AMERICA INSURED COMPANY PADGETT BUILDERS INC B PO BOX 133 COMPANY COTUIT MA 02635 C COMPANY D COVERAGES '. I THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS COTLTR DATE(MM\DD\YY) DATE(MM\DD\YY) GENERAL LIABILITY GENERAL AGGREGATE S COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. S CLAIMS MADE FI OCCUR. PERSONAL&ADV.INJURY S OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE S FIRE DAMAGE(Any one fire) S MED.EXPENSE(Any one person)I S !AUTOMOBILE LIABILITY COMBINED SINGLE S ANY AUTO LIMIT ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per Person) S HIRED AUTOS , BODILY INJURY S NOWOWNED AUTOS (Per Accident) PROPERTY DAMAGE S GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S I ANY AUTO OTHER THAN AUTO ONLY: - EACH ACCIDENT S AGGREGATE S EXCESS LIABILITY EACH OCCURRENCE S UMBRELLA FORM AGGREGATE S OTHER THAN UMBRELLA FORM A WORKER'S COMPENSATION AND STATUTORY LIMITS EMPLOYER'S LIABILITY (LIB-733X562-0-03) 06-01-03 06-01-04 I EACH ACCIDENT S 100 000 THE PROPRIETOR/ , PARTNERS/EXECUTIVE X INCL DISEASE-POLICY LIMIT IS 500.000 OFFICERS ARE: EXCL DISEASE-EACH EMPLOYEE S 100,000 OTHER s DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/RESTRICTIONS/SPECIAL ITEMS I THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER I CANOE.LLATI0 ......... ....... ....... SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL TOWN OF BARNSTABLE 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE BUILDING INSPECTOR LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR .367 MAIN ST LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. HYANNIS MA 02601 AUTHORIZED REPRESENTATIVE ACORD ®AGORD CORPORA 1993 ROYAL.& SUNALLIANCE 1000 LEGION PL ORLANDO FL 32801 - TOWN OF BARNSTABLE BUILDING INSPECTOR 367 MAIN ST HYANNIS MA 02601 Q= o= ' N ACORD n= CERTIFICATE OF o- INSURANCE (On Reverse) 044665 _ The Commonwealth of Massachusetts t Department of Lndustrial Accidents Office offayestigatioas _ 600 Washington Street Boston,Mass. 02111 Workers' Co ensation Insurance Affidavit • i ail riaioiaoraiiiiiir /////////%///%//%////////�%%%%%%�%%%/�/ � f a � �A,�G,t= Fo rZ �fY��,e�'T—f�to iU��(LS ��►e location- T o zoo �T- L' oTix MA b e--6 `J vhone# � O,3 4vS-cool Q I am a homeowner performing all work myself. ❑ I d have no one wor am a sole rietor an in c a achy � �%%/%%/%�/%%/�/%�%%/�%//%%/%%/%%/%%��%%%/%�%/%%///%%%%/%O%%///%/////%lam/%���%/ din workers' co ensation for my employees working on this job..:.......y,:.:,,,•4},•.,•+ :::}:•'t::,{;;} :•;:4'{;`>,x4::},:}: em 1 rove mp ...............:::::•::.:.n.n.:.........:.:......... ....... .::n•.v. ...n ......... ...,..... ...5.... ........ r........... .............................. r ........,/.•:).:{^xv::.v:.v:?M:•Y?'•):{;:Y:3}}:}:•.}:;}}:?�:::ri:;vi i;SSV t::y3,}.,::J}::;.5?•: ... .....n. ....... ........ •....::.v:::::::: :: .:•:+v:........:}r:::::::::r..:.v:{:nv::::t?iS:4'rSS})':......... ....... ......... ,........ ..u.... ... ..... +......4. .....t.....::..... ......... f:.>:•ist+:3:�.'•:'{:^•.•:4}:;•Y:•ii>:+•}:.x}::•:::..�::::.L..,:L•?.;-•;:{::::......... t.t. 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I do hereb certify under th arras and. naltiof the information provided above is trru and correct y SPzv/off -� Date Print name d , - L Phone# Cho CDO 1 oiHdal use only do not write in Oils area to be completed by city or town official city or town: pera ittlicense# ❑Building Department ❑Licensing Board once is required ❑Sele-dmen's Office ❑check if immediater-p 4 ❑Health Department contact penon: phone9; _ ❑Other omsed 9/95 PIA) r 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 coritract of hire, express or implied, oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 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,neitherthe 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 incmrance 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 supplying company names, address and phone numbers along with a certificate of incitrance as all affidavits maybe 'r Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and submitted to the Vie_ 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 permrt/Iicense number which will be used as a reference number. The affidavits may be retmaied io 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 Dince of lnvestlgaftns 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 1'-9 5/6' 1'-9 5/8" T-6" -9 3/8"42'-9 3/6' 2'-01/4, V-5"2'-0 3/4" I C °I Propo6ed Gunroom 21 t I I I +� tle floor Q t in ip m vault ceiling � N N LEFT SIDE PERSPECTIVE RIGHT SIDE PERSPECTIVE ' b' FLOOR PLAN Scale:l/4"=1%(Y' p p ec ' WINDOW SCHEDULE L NUMBER QTY R/0 DESCRIPTION CODE MANUFACTURER S W01 2 361/2X653/8 FIXED GLASS CXM55 ANDERSEN@ - WI . W02 1 36 VZX65 3/8 SNGL CASEMENT-HL O 65 ANDERSEN@ '�' O W03 1 361/2X653/8 5NGL CASEMENT-HR O WI56 ANDERSEN@ Q W04 3 287/8X65318 5NGLCASEMENT-HL CM55 ANDER5EN0 F W05 3 287/8X653/8 5NGL CA5EMENT-HR CM55 ANDER5EN0 L W06 1 287/8X653/8 FIXED GLA55 CM55 ANDER5ENO z �l • line of new 6_2" 7-6" SD GENERAL NOTES construction above 1.ALL DETAILS,5ECTION5 AND NOTES Asphalt roof shingles SHOWN ON DRAWINGS ARE TYPICAL Snow and ice barier 21/2 AND SHALL APPLY TO SIMILAR SITUATIONS ELSEWHERE OTHER- b 1/2"COX Ply 12 Demo existng WISE NOTED. I structure above d 2x10 16"O.C. C 9"FG Insul.w/Prop R 2.THE CONTRACTOR SHALL VERIFY ALL I _ N Vent 'or equal baffles DIMEN51ONS AND CONDITIONS AT SITE PRIOR TO O ,1 : COMMENCEMENT OF CONSTRUCTION. =23 CRAWL SPACE I W ci 1/2x6 ar cedar siding 3.BLOCK OVER ALL CARRYING BEAMS,BEARING 2 N — n Typar House Wrap IT WALLS,AT ALL STAIRWAYS,&WHEREVER ELSE 2 b 1/2"CDX PLY NEEDED FOR FIRE STOP OR NAILING L I o y 1 2x41s i sul u N 0 _ R11 F Glass insul O 4.A MIN.OF TWO JOISTS UNDER ALL LONG m PARALLEL WALLS Remove existing —I--- --- ----- z monlithic slab ——— — 5.PROVIDE SIMP50N#H2.5 HURRICANE TIES® ——— — —— ————— OX6PT5YPPost ALL RAFTERS THAT DO NOT ABUT CEILINGJ015T __________________________________= Q 2x1016"OC AND AT ALL TRUSS LOCALS --I Simpson'ABU66 ---------------- 6.ALL STAIR R15EK5 TO BE EQUAL,+/-1/16"&ARE FOUNDATION PLAN post base ----------------- - NOT TOEXEEV&VV Simpson TM 5calc.1/4'-1'-0 N LU5210, 0 12"poured concrete metal hangers, 7.ALL FINISHED STAIR TREADS ARE TO BE 10%" O column both ends to 42 C 9.MIN.FINISHED STAIR WIDTH 15 36" .M- C Bigfoot®concrete tube install Va"galy.lags k o0 anchor and footing 2'OC,stagger *10.CONTRACTOR TO VERIFY ALL ENGINEERED yJ go o eV LUMBER WITH REGARD TO SIZE AND APPLICATON pwj O En WITH THEIR RESPECTIVE MANUFACTURER AND O SUPPLIER. p '� CRO55 SECTION Scale.t/4"=1'O" ' POINT HIU ROAD 14 / �3.8 1 i co Lawn `}113.9 187.25' +13.6 I 143 143 , I i EX —) lstiggDWellin 13. + 13.3 I13.3 ( douse #160 g ' 1 / ',' 12.7 I1 1 14�,;' RemoydExisting 8.0'x 16.2 11 I 1 11 P�; 1 14.4 Sunroom and Rebuild Same 12.5 °,+ ;n W ii th 4.0'x 9.2 Addition.New 12.4 h 1 i �Ptic Tank 'Sunroom to be Se�a-Sono-Tubes _ _ +ZP Lawn / With no Foyn'dation Under. — — — — — — — — — — — 1 4 —1V / — At� 11.5 l \% f7 - -/ / 1 \ 4/ — _ —�iI Exist Leeching I - J /' - fo.� '— - — - — - - - \ � p 7,7 7J - - \ a¢ LEGEND Salt Marshy v 7. Exist. Spot Elev. 35+3 Exist. Contour............. - - - -36 - - - - Prop. Spot Elev.............. 35.9 Prop. Contour................. 36 - Setback Dimension........ _ _ 13' 72 Perc. Test Location........ Prop. Water Service...... W Lot 36A is shown as on a plan recorded in Barnstable County SCALE: 1" = 30' Registry of Deeds Plan Book 351, Rev/se Sunroom Dimensions 03115104 jth Page 51.A copy of which is attached. REWSIoN DATE er 30 15 0 30 60 - tT ----- -- - - - rn SITE PLAN ����`" °` '" � ndLOT 36A (135/0051 way CNtL P �a ��a �,� Fullers #160 POINT HILL ROADcrsrEa Point y BARNSTABLE, MA, ! �y ♦ oa1ye, 1% OV LOCKSAPPLICANT: ENGINEER: 6A Eileen L. Heng, TR Norman Grossman, PE, RLS `� ciao sWAN 0 MAN 160 Point Hill Road 10 Marsh View Road No. 12775 � W. Barnstable, MA 02668 East Falmouth, MA. 02536 LOCUS MAP L�oS� SCALE : 1"= 2000' 508-548-1920 I MAP SEC PAR LOT FLOOD ZONE ELEV. MAP SCALE DATE SHEET NO. PLAN NO. 135 005 36A C &A-3 11 12500010011 DI 1" = 30' FEB. 27, 2004 1 OF 1 C-854 PAGE r 1 ►,,;�' Application to Old Kings Highway Regional Historic Dis6a Comm,, in the Town of 88IMSU l+s for a CERTIFICATE FOR DEMOLITION OR REMOVAL Application is hereby made, in triplicate, for the isru4ncl of a Permit for Demolition or Removal of a.building or a stn,cture or part thereof, under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings of photographs accompanying this application. TYPE Oli PRINT LEGIBLY DATE ADDRESS OF Pf{OPpSED WORK a... -�..— ASSESSORS MAP NO. OWNER f� 1 ----- __ ASSESSORS LOT NO. HOME ADDRESS���/ `• ,� ,�� � � •-�� �' TEL NO. :EdZ NAMES AND ADDRESSES OF ABUTTING OWNERS; Include nartrss of ad•am, ~J L� 1p Of waY. (Attach additional sheet, if necessa 1 prOOe*h owners across any ovrbllc 1pv*t AGENT OR COMTRACrOR z Air " �s e— y,,y,•� '" _ TEL. N0. Jr o�y � yz_y A00AESS Z 6 �� n DESCRiFTIGN OF PROPOSED WORK: If building fs to be removed, v* building must accompany application. (Attachmaw location. Snap shop showing all.?7 s of additional sheer. if necessssary)..i �1~.-s AV vZ e—x iS sv ti ro cr w7 G e-C v 5 �- f p�s-,�6 0)J/Gv Nair: If approval it granted for relocation, a separate Certificate of Appropriateness is required for now location if within the Old King's H;jhway 14agional Historic Oistrict. SIGNS Swee bw-avv line row C0^rn1rrM W". Owner t-0nersetor•Aa�t' Aece!vad by H.O.C_ The Certificate is hereby ate ��- Date r_ 1,tlleA%dersigned,hereby certify that I am a rk a an stabs a%•e cu matxiaRec an.+ deaths,regwrea" 't'dt+t-Utc*cpt4trmN abo is a opt m s cards. WPESS: My hand and the SEAL OF T TAB E — A TRUE . -Bamstabl 400r0ved Q IMPORT T: 11 nLG[G�/ �%lL Certificate ,s oved, ao o al t s p,,auo,evea n provided in the laip�a E. Hutchcnndver.�ot�tY f�.�rh M19 A'r �opr�l O� 7rt (If this attestation is-Mt in red.this doctunent has been illegally copied-do not accept it). e Application to. / 6 01b Rinq,q; 3[gigbbiap 3•Egional �EqIsstoriL Miquitt Committee In the Town of Barnstable. CERTIFICATE OF APPROPRIATENESS Application is hereby made, with four complete sets, for the issuance of a Certifcate 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 CATEGORIES THAT APPLY: i CZ c� ❑ ® =' 1. Exterior building construction: ❑ New Addition Alteration ❑ Other Indicate type of building: House ❑ Garage 2. Exterior Painting: 3. Signs or Billboards: El New Sign Existing Sign Repainting Existing Sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other TYPE OR PRINT LEGIBLY: DATE _ W m ADDRESS OF PROPOSED WORK ��� ��N /d'f/ �vL ASSESSOR'S MAP NO. OWNER �f'�+Gt-, �C" ASSESSOR'S LOT NO. S HOME ADDRESS f �� / �� �' /l�'�•��"s • lc- -d� TELEPHONE NO. 3,(2 =VAOW FULL NAMES AND ADDRESSES OF ABUTTING OWNERS, including those of adjacent property owners across-any W public street or way. (Attach additional sheet if necessary.) Fri • Pam. ♦ � INN AGENT OR CONTRACTOR J �&A 9-- c- �''° ��s ���� TELEPHONE NO. ADDRESS .may �� �yg `�f ° s O7,e DESCRIPTION OF PROPOSED WORK: Give particulars of work to be done, including materials to be used. Please include locations of proposed signs. �/{� /� �`tiGZ •_f ---0 N'GV sfiN /Jrtirq �ti/��4q ► sd.wC. � G��rOy► lr'✓G rG/ c.. l-,p lap a....�C. ,�•!/�-• •) 7 +• /, ��G r f� , Signed x yu, d i ,o 14, r� No e- -VW I Own er-Contractor4Aqent yy For Committee Use Only This Certificate is hereby Date l o 0 pr ve ommittee Members' Signatures: Town of Barnstable Old King's Highway Historic District Committee SPEC SHEET FOUNDATION 9 yr " -0" C eC, • Ct r�a-r • SIDING- TYPE ✓►�Z C`•..�0 J COLOR ���G G,t�-•.S •"1 CHIMNEY TYPE /Y /7 COLOR ROOF MATERIAL �f�� l✓�'G�r COLOR WINDOWS �y'„Gz-�S�a C�fZMf��-OLOR SIZE TRIM COLOR �✓�1• ' t �v //�- G.�•s d i'�y DOORS �h�WSmh �� /l7 COLORS k/ �•'1�� SHUTTERS COLORS GUTTERS /yl o COLORS MATERIALS GARAGE DOORS /Y COLORS 70 SKYLIGHTS SIZE COLORS SIGNS 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 plans, when applicable. SPECSHT Revised 11198 f C o� . o o ' ff. .e ,407" 36A 3. 0 31' 'geAfs V,0-4 '0 3 3, CA CS N StLS / 40 . DQ i � o CERTIFIED PLOT PLAN LOCATION �r9/8li!,T 7--q 6� � SCALE . ./. . .=�44'.. DATE Ji PLAN REFERENCE ,q,�iiyQ., ,�Q 7-.3�►q• .019r ..3",l. .. �y` o EDWABO .. . . . . . . . . . . . .. . . . . . . . . K40 . .. .. . . . . . . . . . . . . . . . : . . . . . . s 40. 2o100 ; 1 CERTIFY THAT THE 47(/STlvr,. SHOWN ON THIS PLAN IS LOCATED ON THE GROU140 AS SIIOWN HEREON AND THAT IT CONFORMS 10 THE �1►��d1 Lf,N SETBACK REQUIREMENTS OF THE TOWN OF rrryv In V.WHEN CONSTRUCTED. DATE CLyQ D OoUL/TILE Tie. .''�tr'••�' S' � � SET/7rioitiEiE? REGISTERED LAND SURVEYOR 7, QME rok, Town of Barnstable *Permit# 7 tiQ Expires 6 nrontlis front Issue date �gpISTABLFn Regulatory Services Fee v� asaBs Thomas F:Geller,Director .; '°'Eo►9. Building Division - Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 X-PRESS PERMIT Office: 508-862-4038 Fax: 508-790-6230 JUN 11 2004 EXPRESS PEPMT APPLICATION - RESIDENTIAL ONLY . Not Valid without Red X-Press Imprint _TOWN OF BARNSTABLE Map/parcel Number SOU I Address �O f(DLff ILL 11.�. e7A� b21�8 toll Property o Residential Value of Work p- Owner's Name&Address I(ten i�ot�9-f I�tLL W• W s-ri-15 HA0 2 CGS Contractor's Name Grp '4u't1aRfi�% T1 C Telephone Number �45—000 Home Improvement Contractor License#(if applicable) ' D 0 131 Construction Supervisor's License#(if applicable) b85 r � o 13 _n ❑Workman's Compensation Insurance co Check one: D ❑ I am a sole proprietor o � MP N ❑ I am the Homeowner g_I have Worker's Compensation Insurance m _ (�,� N r Insurance Company Name C g n CE "�' ' a' rn Workman's.Comp.Policy# " /7 "I"O q_ Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) gRe-roof(stripping old shingles) All construction debris will be taken to F>F ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side. s4 ❑ Replacement Windows. U-Value (maximum.44) c) •Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: LHFep r m t sign Property Owner Letter of permission. r e e Contra tors tense is required. A07 � s , Signature c 349acTr Q:Forms:expmtrg Revise053003 Y °OHE Town of Barnstable Regulatory Services BAMSres[.E, i 9 Muss. Thomas F. Geiler,Director 039. �0 O Building Division ATF hAAi� 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 r �ED��c , as Owner of the subject property hereby authorize oP� (t(�Gt-=`1 I �( 7CET �Lt) S� `,x to act on my behalf, in all matters relative to work authorized by this building permit application for: - /�,O 7OAJ-T H I l-L D. w. �)Ai;;�,.►s2( &k (Address of Job) Signature of Owner Date l Print Name Q:FORMS:OWNERPERM[SS(ON F U (MGL cf enclosed space (MGL C.112 S.801.) BOARD OF BUILDING REGULATION$ IA-Masonry only tacense: CQNSTRUCTION SUPERVISOR G t 8.3 Family Homes Z allure to possess 13 current edition of the 4rnI er:1& 048859 assachusetts St@te Building Code _ s'cause for revocation of this license. r EX to 2 0 Tr.no: 16904 ROBERT R PADG -- i I 184 SCHOOL ST/PO' I DIG SAFE CALL.CENTER: pp)344-7233 COTUIT, MA 02635 Acting'- o, rn sAjpner _--- _-- ___.- fie 'Vomranoouuea�i a�,/vcaaaac/zuae�a Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: r" Board of Building Regulations and Standards Registratiod:,100131 One Ashburton Place Rm 1301 Expiration:_619/2006 Boston,Ma.0 08 }Type: Private Corporation PADGETT BUILDERS,.INC.p . ,1,,I i Robert Padgett h Ia << PO Box 1331184 School`St ''✓; a:,eF Cotuit,MA 02635 ` Administrator Not v lid without s' ture 06/03/2004 i0'1: 57 508-420-5584 MYCOCK AGENCY PAGE 0101 i : ..... .•r.o...!:^:'.'•,......s»n..,xa...::cre�o... ..w$+;•an.:v .r:.,.r;.q...,. ' ....,...gr'a.vGo..:. ,... -.nar.e ..:s>:S<•:.?.».:�;.w.::..:�a _ s.. I f PRODUCER THIS G RTIFICATE 19 ISSUED AS A MATTER Of INFORMATION MYCOCK INS AGCY ONLY ND CONFERS NO RIGHTS UPON THE CERTIFICATE 20 SCHOOL ST' HOLDE . THIS CERTIFICATE DOES NOT AMEND, EXTEND OR PO BOX 437 ALTER ME COVERAGE AFFORDED BY THE POLICIES BELOW. ! ; COTu I T MA 02635 ! COMPANIES AFFORDING COVERAGE COMPANY r 29758 A AMiRICAN ZURICH INSURANCE COMPANY -I INSURFD _ COMPANY PADGETT BUILDERS INC PO BU.X 133 COTUI T MA 02635 COMPANY ? — C ' ,.:...:..�:..:................>y...� HIS IS TO C >7;I;<;<><>-4:::r::•::: ,:.;...: CERTIFY THAT THE POLICIES OF INSVRANCE LISTED BELOW HAVE BEEN IS UED TO THE INSURED NAMED A80VE FOP. THE POLICY PERIOD JEC CATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT Oq OTHER DOCUMENT WITH RESPECT TO IV)Y THIS TIFICATE MAY BE ISSUED OR MAY PERTAIN, THF. INSURANCE AFFORDED BY THE,POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, LUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUtEDBY PAID CLAIMS, CO TYPE OF INSURANCE I POLICY EFFEO POLICY EXPIRATION L i POLICY NUMBER I DATE 'MM O\V UMIT9 , ( � DATE IaRt�DD1YY1 • I 03ENEFIAL LIABILITY GENE'PAL AGGREGATE b COMMERCIAL GENERAL LIABILITY I _I �---I PRODUI CT8•COMPIOP AGG. t C'.AIMB MAD;. OCGUR. ! p&ASONAi 6 AOV.INJVAY ~ b iOWNER'S 8 CONTRACTOR'S PP,OT. EACH OCCURRENCE FIRE DAMAGE(Any one}Itel b MED.EXPENSE(Any one pzonl b -� AUTOMOBILE UASIUTV I ANYAL'i0 I COMBINED SINGLE t — too�,(Pat ALL OWNEC ALiT08 YNJ URY SCHEDULED AU70S P1f46n) S HIRED AUTOO I BODILY INJURY i $ NON-OWNED AUTOS I (Pei Aocldcnn i ! PROPEATY DAMAGE GAM"NA8IU7Y AUTO ONLY•EA ACCIDENT b ANY AUTO 1 j OTHER THAN AUTO ONLY' UCy ACCICENT .b ,I AGGREGATE t EXCE33 LIA6IUTY _ EACM OCCURRENCE g r�UMBRELLA FORM AGGREGATE b —I I OTHER THAN UMBRELLA FORM --� A IWORKER'S COMPENSATION AND �—�-1 EMPLOYER'S LIABILITY (US-9716AG7-7-04) 06-01-041 i 06-01-05 STATUL YUMIT8 THE PROPRIETOR/ I EACH ACCIDENT t.... 100i000 RARTNERBIEJ(ECUTNE INC` I 048EASE-POLICY LIMN t 540 000 ' OFFICERS ARE! EXCL OT'NER DISEASE-EACH EMPLOYEE b 100,000 I I ' l I OESCR� ION OF OPF.gAT10N9/IOGATION6NEiNCIJ`9/REETYryCTTONS/SPECIAL TEM6 1 i I Application to: E ' Old King s Highway Region'al.His�,oric District Committee in-the Town of Barnstable for a 6' 9 CERTIFICAT ION.OF EXEMPTION' Application is hereby made, in triplicate,for the issuance of a certificate of exemption under Section 6 and 7-of_Chapter 470,. Acts and Resolves of Massachusetts, 1973, as amended for proposed work as described below and on plans, drawings, or photo- graphs accompanying this application. . TYPE OR PRINT LEGIBLY ILQO DATE S `�. 2-002 ADDRESS OF PROPOSED.WORK _���I�T t 11-L-?2,_ � Sffig ASSESSORS MAP NO. 13S OWNER - �I �.IG ASSESSORS LOT NO. OOS ]LOO HOME ADDRESS �Oi1ST �1�-L l� • . �'�Pt12+JMn!nE TEL. NO. (SOS, 8 . AGENT.OR CONTRACT ORo� A�G�-rT I-PAD GG-���U,��1� C5� L ADDRESS �,� �✓OX 18 c�� 6b1r �T. lc uT t " 1�}(�2(C TEL. NO.(S60Of This application is for exemption of proposed exterior construction on the ground that: ❑ (1) It will not be visible from any way or public place. (2) It is within a category declared entitled to exemption by Old King's Highway Regional Historic District Commission. (Check applicable box) PROPOSED WORK: Describe and furnish plan of proposed work, showing location on lot, and, if an addition is Involved, show, ing location of existing building. Se✓ 1 S7�:rp �:-5� -i�1Cl u5 C�-1J/�eiov� �.a�J T►-t "1 «�C 1�' � Re-N , L-KTarzi b/Z N-VUXOs kJo �q- aZoz SIGNED ' Owner•Contractor-A e Space below line for Committee use. . 9 Received by H.D.C. The Certificate is here6y ~' Date Time BY Date U efINE}0 TOWN OF BARNSTABLE Permit No. ...?A4.11...... BUILDING DEPARTMENT { NAM TOWN OFFICE BUILDING Cash �... ' 'touv� HYANNIS,MASS.02601 Bond ...... CERTIFICATE OF USE AND OCCUPANCY Issued to Clyde B. Doolittle, Jr. Address Lot #36A, 160 Point Hill Road West Barnstable, Massachusetts 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. i o ...... � ... :......... .. 19........ l Building Inspector ` k �` .. Assessor's:map:and lot number ...... .. THE ZINE Sewage Per number ........................................... r iS House number ....... .eP1fS.......... ............................ i s cB ASB9TSD n p� MAE6 .. � �'OIIPY a TOWN ' OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .6. lN✓�LE.....f . zf'... eel,S.-/..4..��«..................................... l!�( i TYPE OF CONSTRUCTION .........1. �.......P Tl d!2/)'I................... ................ �8.... � ............19 �� TO THE INSPECTOR OF BUILDINGS: The undersigned' hereby applies for a permit according to the following information:' Location ....... ......./�Q/�IJ'...H� .L....... �R:4. .`. �/A1./�...aA �'�, ............. ProposedUse ......... ...... .4v4N..G .............................................................................. Zoning District .....�� ..........................................................Fire District ... lv�f�'i� ................... Name of Owner ... G yld ...�:... �d� /r,�i ..Address ...` .� �..r./��::✓�....n?cT�0�.c� hN/. .fti .... �f.�h✓�'� iName of Builder G l�� ��..�.��.a�..<. G /.v/i Address ............. Name of Architect G.4.�ee Z �.��.l��I ..!?T . ✓.A'Address ...... ... 1. .. .........................................F......................................... 6 ���� - Number of Rooms ..................................................................Foundation .... ..... ....... ... w..��'......................................... Exterior ......................Roofing ........ . ............. Floors .......04-.�..... .........................................Interior ........7........... ...✓ .. Heating . ..... t.W..............................Plumbing ......... .....�.We4 .............................. Fireplace ..................................................................................Approximate. Cost ...... .......... Definitive Plan Approved by Planning Board -----------_______-----------19________. Area .......................................... Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH I 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 ` 1.�� '.��.:..f.:.t .. , a a q......./. Construction Supervisor's License v 40// �U DOOLITTLE, CLYDE B. Jr. 28411 1j Story No ................. Permit for .................................... Single Family Dwelling ............................................................................... Lot 36A, 160 Point Hill Road Location ................................................................ West Barnstable ................ .............................................................. Owner ... ................. Type of Construction ...Frame.............................. ...........................;.................................................... Plot ........................... Lot ................................ Permit Granted ..,,,September ........19 85 Date of Inspection ....................................19 Date Completed ............................... .......19 -3 6 d 00 A'ssessor's'.offioe (1st floor): i f' " Assessor's map and lot number A � ---- -!i- ...... K µ� �oF THE Toy Q Board of Health (3rd floor): �; Sewage Permit number ...:..Q� ......1: .�.1(�.- .......n. a i 9aaasTllDtE. �' � ' ' Engineering Department (3rd floor): moo rb 9- House number 3 `e i APPLICATIONS.PROCESSED 8:30-9:30 A.K."and 1:00-2:00 P.M. only TOWN OF BARNSTABLE y ,6 BUILDING INSPECTOR APPLICATION FOR PERMIT TO 15 U Ln I N� O UM D G �\ Nl T E l�00 L— 2 .................................................................................. ............... C,�1N 1' �k.� I I R" 1� W) R TYPEOF CONSTRUCTION ............................................................ ........:.....................y......pp..pp....I..........................Q..... .!..!f..1�.�L....1.�.......19.0 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location . ..►..��.......?8kkT......MIL�....R N�............�...............�1CST......13....1Z1.. ST ....13L.......::........ Proposed Use 700 L ( .CLI UMT�—..).............................................................. Zoning District .............. y..................... .... .......s...........i...:.....,,Fire District ... Name of Owner r1..��.....R.1).V . I�1n......MIA���..WI........Address l6Ll, L1.11..T....1.......1;... ..:......a/�31�[i��STV�IgL� Name of Builder ....cu1u..SN.,�zt..C.. .�..t.......... ...........Address. 3...�'L�,h...SZ.:..I:�I�I1I,��VK.......C�L....3............. G Name of Architect ... /.S :LI Al T L 3 PO n S T. 14 fl N Q U EK U Z Z 3 `t / .....................................................Address .................................................................................... Number of Rooms ..................................................................Foundation .....'............ CUM 1 T.L........................................................ Exterior ....................................................................................Roofing .................................................................................... Floors ......................................................................................Interior .................................................................................... Heating ...................................................................................Plumbing Fireplace ......................Approximate Cost /Sr'10 Definitive Plan Approved by Planning Board --------------_-----------------19________ . Area _:.>:'.?.r7..�Tr?'`".............. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of 'the Town of Barnstable regarding the above construction. / Name oar - �yy . Construction Supervisor's License ..................................... KENNEDY, RAYMOND A=135-005 30784 Build Pool No .............I.... Permit for .................................... Accessory to Dwelling .......................................................................... L I ocation .....1.60...Point...Hill....Road........... .... .. .. ....... .. .. .... .... .. .. West Barnstable ............................................................................... Owner ....M./.M......R.ay.mdn.d...Kennedy. . . . ........... .... ....... .. .. .... .. .... .. Type of Construction .................Gunite......................... ................................................................................ Plot ............................ Lot ................................ Permit Granted .......Ma y...2 8.......... ......19 87 Date of Inspection .....................................19 Date Completed .............................. ........19 /V � t , Assessor's offioe (1st floor): 2 x, 4 Assessor's map and lot number ....../.�.1 .-...Q ..... . P"o*THEs>o`` Board of Health (3rd floor): SYSTEM MUST E Sewage Permit number. ...... :.j: Z�.-/.l.-:�iS7.....:.. I `fa:�ALL.ED IN C.OMP1.1/�P9C:' • Z 13AMSTADLE, Engineering. Department (3rd floor): WITH TITLE 5 � rhea House number ........... ,:ud CI�I E�TAL. C®®� �1:w,.: o° 0rAYa`�0� APPLICATIONS PROCESSED 8:30-9:30 A.M.,and 1:00-2:00' P.M. only 'TiN° RE0o.,.ILATR0V A P P R 0 V EN .OF B'ARNSTABLE raetablzC0 ervstion Safft L/ U I L D I H G' "•I H S P E C T 0 R _ - i Date 1111�CCOl1ND G UNITC 1�OOL.. 2 � x3`l APPLICATION FOR PERMIT TO ..EUlLt..............................................................................................................:............ a TYPE OF CONSTRUCTION ...............Cc AR ,T� 1 r ........................................... .......................................... ........................ .......................... .. .� .........19.g�3 TO THE INSPECTOR OF. BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..................................................... ......... .. .............../.......................................................................................... 16 U ?8 ULT la IL L IRL A D ULST - BRVA ST IM1 L� S.11!'ll`'l . .... ... l'UU L �11�1�T� }` ProposedUse ............. . . ................................. .. ................... . ........ ............................... _ Zoning District ........................................................................Fire District ............................................................ ................. `' VV 160 T8I1AT "ALL MMW dal 10INX)THLE Name of Owner PI rl..... DI��.....K 4n..4........Address ............................................................... ..........I......... Name of Builder .... u1a S{IhRE t,�.►i t....F.Clia S....... Address 3 t'Ottll... ST: IaaN..V ... ' bL 3 3 S C-U NIT 3 PONn S T. u.aNlA\IEK 0.L33I Nameof Architect ....... ..........................................................Address .................................................................................... Number.of Rooms ................................:.................................Foundation ..L U M IT.L.......... I r Exterior .................................................................`...........:......Roofing .......... Floors ..................................................:...................................Interior .............. Heating .............................Plumbing .............:.. ... . p ......:...................Approximate Cost �`SC�Q 6Fire lace ........................................................ Definitive Plan Approved by Planning Board ________________________________19---------- Area �� .. .. .,:'.......... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Nam ................. oaL - 917y Construction Supervisor's License .................................... KENNEDY, RAYMOND •r 30784 c� BU D POOL No ................. Permit for .. ...... . ..................... Accessory Dw(�Ali ...• ......... ..................... Location 160 PointIl Road ......I... .............. 0 r West Ba�ns�tab e " . ..... .........7.. ,,... .... ......................... _, :_ Owner ..........Raymond v*Ken edX................. Type of Construction .....gluPi ...................... Y_ .-. .................................. .... ........................ PI, f' Lot ................................ Nay 28 87 � f Permit Granted Date of Inspection nn...........:::..... ,19 Date Completed ..... .•`. '19 4"+ c` � C P DD \ 0 V- oS i 2 20. Oo � r 44 IL D T .3 to ti0 3� 3. O r yCRIS vPLA y0 er / O�� �I �f CT'��►L N�:c � . I Sort h r ry n�N�7 r rl 1 I � 1 �C D� CERTIFIED PLOT PLAN LOCATION i?z,� SCALE . .r. �4A'.. DATE PLAN REFERENCE ,aec/4,si. �QT,3l��. �o EDWADO / . . . . . . . . . . . . . . .. . . .. . . . . . . . .. . . . . . . . . KEl . . . . . . . . . . . . . . . . . . $ yldo. 26100 1 CERTIFY THAT THE 4WIsrlva. ; �'�Si�P�� SHOWN ON THIS PLAN IS LOCATED ON THE GROUND ass• ' AS SHOWN HEREON AND THAT IT CONFORMS TO TIIE SETBACK REQUIREMENTS OF THE TOWN OF ti � ►��1�tvt+/'t In-*.WHEN CONSTRUCTED. DATE CL YD s' � � E7 A0, A REGISTERED LAND SURV:?OR Q Ns ul W W 'L o `b T MI91, �- Z N ���� '� Ui k Ul q z a LJ14 °Z W ti v1� tlC�1 aN ��qp kn act �QU I. Ci Li N t� Q , ��a�� i VQ J� Q °o R ���� Q IQ �� h � ZQ0. j\aLQ� Q �� V �QQ D v Q L�4 = a U, � 4 \ im Q `nFZ 'jv L ) � Q N Q vQ ZQ � 4 Jt : Qz Z o � j a�4 _ v � Z e o � o z� �� h � Wv h-4 v o � 4 Ao III ��� �.. w o g W� e 0. k IZZ) LJ4 Z) 4 UI vJ . Z.4,j ~ �� v Oh ��� z IL x Os Q CNN I QC �q W �� �-4 � � o Z E tQ rk a r o f8 (Z o, V 17 ` aY P - S•a� ?ate v ca ? Q I v 44 W vrk , o � V j W W tk Q � '• .�k J °o � 0i �'.� vm o]to h I a 44 oc T t v — p' t / �r a o o;� I I � O W O Q ,� ?�O 00.o I 2 j W k Z v Q C� C) �l W ZC4 'V N s 44p l> CZ �Opo Va �� o Q 0 2 VW 44QO Q Q �� a a o 0 . �oFTHt , Town of Barnstable *Permit# � L I3 y�Q ti� Expires 6 month from issue date Regulatory Services Fee j 8U BARNSTABLE, ' v MASS. $ Thomas F. Geiler, Director i639• �� A�fD M. a I Building Division OIb� Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,' MA 02601 www.town.barnstab Ie.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 r Residential Value of"Work Minimum fee of$25.00 for work under$6000.00 Owner's Name & Address 3` i Contractor's Name /) A-e &4,11,04 AA Telephone Number IZ I Ionic Improvement Contractor License# (if applicable) 446 0 •� Construction Supervisor's License# (if applicable) 'orkman's Compensation Insurance X-PRESS PERMIT Check one: ❑ I am a sole proprietor MAR 19 2009 ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance TOWN OF BARNSTABL Insurance Company Name 114m� Workman's Comp. Policy# 17 / Copy of Insurance Compliance ertificate must be on file. Permit Request (check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum .44) '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 Im vement Contractors License is required. SIGNATURE: - .... ORMS\building permit forms\EXPRESS. Revised 100608 I j The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'bl Name(Business/OrganizatiorAndividual): &Z1x:__1r1 Address: City/State/Zip: l F� - /���_ Phone.#: ! Van employer?Check the appropriate box: Type of project(required): 1 a employer with ZU 4. ❑ 1 am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors .2.❑ I am a sole proprietor or partner listed on the'attached sheet. T. ❑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.msurance.t required.] 5. ❑ We are a corporation and its '10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LEJ Plumbing repairs or additions myself.[No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required.] *Any applicant.that checks box#1 must also fin 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: 6 Policy#or Self-ins.Lic.#: (,�G✓L 9/ �`Z .� Expiration Dater Job Site Address:�0 0/v�T /�tu oe 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 crimi ial penalties of a fine tip 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 hereb ce fy under the ins na of perjury that the information provided above is true and correct. Si afore: - Date: Phone#: S U/f 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 i Contact Person: Phone#: i ' ' r , Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house of on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states`Neither the commonwealth nor any of its political subdivisions shall . enter into any contract for,the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s),-address(es)and.phone number(s) along with their certificate(s)of insurance. Limited Liability Companies.(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town).".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related io any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to.thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number: The Commonwealth of Massachuscas ' Department of Industrial Accidents 4f ee of Investigatkus, 600 Washington Street Boston, MA 02111 TO. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 i Revised 11-22-06 VrNw.mass.gov/dia 1 . I Client#:33723 CAREF ACC 1 0 ACCORD,. CERTIFICATE OF LIABILITY INSURANCE 0'VM/DDIYYYY) 904/08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Herlihy Insurance Agency,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 51 Pullman Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Worcester, MA 01606 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 508 756-5159 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Acadia Insurance Company/ Care Free Homes Inc 239 Huttleston Avenue INSURER B: Interguard Insurance Company INSURER C: Fairhaven,MA 02719 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFFECTIVE POLICY EXPIRATION LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DDIYY DATE(MWDDIYYI LIMITS A GENERALLIABILITY CPA0265674 09/01/08 09/01/09 EACH OCCURRENCE $1000000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED P E ISE E occurrence $300 000 CLAIMS MADE 51 OCCUR MED EXP(Any one person) $15 000 PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE $2 000 000 ML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $2000000 POLICY JE O- LOC - AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS ' BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESSNMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ i $ DEDUCTIBLE RETENTION $ $ B WOER RKERS COMPENSATION AND CAWC917429 09/01/08 09/01/09 WC STATU OTH EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $1 000 000 , ANY PROPRIETOR/PARTNER/EXECUTIVE + + OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $1,000 000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION ? Town of Yarmouth DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 'In DAYS WRITTEN Building Department NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 1146 Route 928 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR South Yarmouth,MA 02664-4492 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001108)1 of 2 #M35563 MSS O ACORD CORPORATION 1988 _ .. 0 • �� �j ,w,u�re Board of Building Regulations and Standards Construction Supervisor License ?I License-:CS- 95228 BIrthdates 3 1982 +. _ Tr# 95228 'a Ezpiratibip.1 I' 2010 E , Restriction I nol -- �( ' DANA'PICKUP 19 HAMLET STREET MJ // - FAIRHAVEN, MA 027A9. `Commissioner ,tom ✓fie 'Coom��za�iurecel�i a�.,iUGcraaac�ucae�6" � .• ." ' �\ Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR 1 before the expiration date. If found return to: '. Board of Building Regulations and Standards — _ Registration;,,100503 One Ashburton Place Rm 1301 Ezpi ratio n=_g/�:9/2010 }} T uSuS Iement Card `mi Boston,Ma."02108 I- yP� PP 1 A 1=l CARE FREEHOMES=@NC 1 i DANA PICKUP 239 Huttlestori41 Fairhaven,MA 027=19 Administrator Not valid without • nature OFFICE: (508) 997-1111 °° MA. Builder's Lic. #021330 'FAX: (508) 997-1297 flWCARE FREE Home Improvement TOLL FREE: 1-800-407-1111 ��� IgHC Contractor's License WEBSITE: #100503 MA. www.carefreehomescompany.com 239 HUTTLESTON AVE. (RT 6)•FAIRHAVEN, MA 02719 #15179 R.I. T P,9P 71il � E%1,6416 I-1,A/6- ,3�9 0� NAME // � DATE ADDRESS��io A01AIr /V/61, /VIP W. 8141elVS7728tE ZIP CODE 0.2666 >� ADDRESS OF JOB S�-r�� � TEL ,08-36 16 46 JOB DESCRIPTION RE m 0U` l3'li. 1CI l�lsST/ EYVC-k OR C-64144, taryD&-;eLA-c.,me--7yT 7-0 45 ,57",6C1- 11-7- Y "' 7-D /.t 66i V� To ERMA1 T OF" /&11-54 Ole_ 6U WTE 0,6FDAR SAGES 5" - ©Tf-i 2 APB OF 146USE - -BF 6�IW t�D 140 *7V DL11VPSTEp, L- C 2T!r/CAr,-r-7 ar 11V5t1R1-?'1'V C.5 /his 65�1 s6yF IN 1n11-1L, °Y Q Scheduled Start ! GU�� /� S Scheduled Completion /— 2- Wec-1<s A. Replacement of missing or rotted lumber is not included unless specified. B.Ali start&completion dates are approximate and could change due to weather conditions. C. Stripping of roof includes removal of up to two (2) layers of shingl s, each additional � layer to be charged @ L ft2. D. Replacement of rotted roof boards/plywood to be charged @ 3", Q T-T ft2. E. Existing chimney flashings will be reused; replacement, if necessary, is not included. F. Care Free Homes, Inc. is not responsible for mold/mildew conditions that are pre-existing or result from leaks not brought to the attention of C.F.H., Inc. promptly. The Company hereby proposes to furnish labor and material to complete the above work for the amount herein. Fulfillment of this order is contingent, however, upon the want of strikes, fires and any natural disasters, the ability to obtain materials, or any other conditions beyond the control of the�CCompany. �t Cost of Project$ �8• 0 06 y PAYMENT TERMS N Cofer P667/0 N . ` 'a ! � Date 3 q 1. You,the Owner,may cancel this transaction at anytime prior to midnight of the third business day after the date of this transaction. 2. You,the Owners,agree to pay any and all expenses incurred by Care Free Homes, Inc.in collecting money due under this contract and enforcing the terms of this contract, including but not limited to, reasonable attorney's fees, interest and court costs. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES CARE E� MES f1C. �/�' A ///,,� C T B !iL'te-1✓Y Buyer acknowledges Owner Y� CARE FREE HOMES.INC. receipt of fully completed — - ---'— copy of this Agreement Owner All contractors and subcontractors shall be registered by the director and any inquiries about a contractor or s contractor relating to a registration should be directed to: Director, Home Improvement Contractor Registration One Ashburton Place, Room 1301 Boston, MA 02108 Tel. (617)727-8598 p Exr r,.✓G r✓�t L •✓cc t N A Q LD T °"JS n/OTE - ELE✓f�To..Et .S/�C r✓,.i ��c /ABC,✓� Mks).✓ .CFI Lt✓FC r E� LE'G<'.,io.' - - ,- ,'.zoo E�F✓�; c, s y� WP � �—�-� �xnc-r.n.G ELF✓�TiDNS � SER�e; " q It O ti 2�'O 00 00 a' ► �� J N r Q i8 Z 71 �J,.�f '7t!/Qr.,� /Y��,QS/I [ t / l '�• .� �, l -, ____ — k ~ " } t.. �� � �.. - 'y r,.. y.. -x/k �,"a. w)5�.... a'.�-$� �d ns�4 a ...(4�.t 4 �..- r I\ - ;. 'Y.:_ei.•/i. ..8h.1 r;._ t�:p. d 1..•L .1:_ T �-:C` r JS..S ...,.L»a i++ ..tlL:.l -�-.Y1t aF-'r'v+�..1w A p ,..._, -. a Py / t ,�e, t✓ELL 'pOPOFOUNDATION CONCRETE:`COVERS CAST'IRON r y '" , l0 �i P.IPEI,OR : 12 AX. �4 .SCH. 40 PV.C. (OR fQUiv,) `Z`c R�. \ ` �2• r- / I o c EQUiV)— MIN, , PIPE . MIN, �! -sr ,JE ' ►• lT✓ .d _ _ , PITCH y4• PER F PITCH Pea ;pr,�sravt. wRuf[b / e v / • '� i 4�� i a' INVE IT �. fo / o0 EL �!_ . :. =1N1�ERT pl`ST., INVERT- i r� �, c-�..».` :•�� �B o'. SEPTIC TANK io $5� EV_c,.�_., SEP - - I, / INVERT f .. BOX $'. 8 �•R' --- --- ---— -- — -- -- -- -- - r .- __ ' GAL INVERTt` -ram EL�1,G lt4,t /o.ia• �a� E •ro ,� Aloe"'- 7 11< CE7c./ PROFILE OF !/SG$ ,eov. r.rgr .gas S6. - --._ _ 9No R�o�,�w � �--►�o-r�^�°� _. - a , SYSTEM,SEWAGE DISPOSAL NO ;SCALE rvooN'ep rf..v•a'sni. s.r.r-��c9 S`r o.,r we sr Np C�'HgaFv ram, " z l89 16 1 ` 1L LOG_ WITNESSED -BY '_SO O ATE :.Qld/d.�': TIME /�.�00 r/l. a M _.►! CD _,8�4. 19_ _ _ Eo TEST HOLE{ 1 . TEST HOLE'2 `�.c• era - � -/Q„ � ?�AnJr_C- •_ _ ENGINEER EL�EV /Qt . . . ELEV /A,7Z / :9.�- ',�N �. co�•►�. cG9r DESIGN DATA t f✓.9R0 rr ------ - J., 743'. - � 8 7, ;NUM.B'ER ,OF..BED ROOMS Oi rc 4, S�.�a •' 4r,,� GARBAGE' DfSPOSAL °UNIT. ---- - _-___ __ _____._ _._-_-__._. -_ -___ __-- y✓�7T Q' _ =, TOTW EST,"FLOW • GGeA� J' �_7'/'.r✓Ar�x Ciro ,GAI,/Bai/rDAY:k ;• r >MFa C1 . REq. �+/. CAP x iS0e1o). .'4SL3{,'.�iL - " SEPTIC TANK 'ji` c5:3j''' r/, Z ACTUAL SIZE OF. 'SEPTIC TANK _ /490 15_q4_• _ LEACHtNG.AREA REQUIREMENTS SIDE:WALL AREA 4?Aa GAL,/S.F.cB ,,+c2dd• .� 0's��i BOTTOM A R EA• 't.,GALJS•F�a r-3a x .83 - 2%1 •��it ,4, 7e _ _�.q�.,,/�i,✓e.V LEACHING CAp (BOTTOM SIDE WALI)_'fO$JQ AO SITE PLAN WEST BAPNSTABLE, MASS 1 APPROVE _ _ RESERVE LEACHING CAP, _ 09gD � - - - - - - p _ _ BOARD OF HEALTH Y DATE- ' _ 4 AGENT OR 'INSPECTOAX YEBTT R L D L � ��� M OF�yH OFCJ r � �� EDW Er j o KELL ^'i f -LET ,9vRiL ,7 /9 %Sr4e c 4o' r _ - �%ISTEP� - An@ a u a v E -- I�,7, _d`/3 'nYS?�ESL E ;^074 • iSTE� r"'L� ✓ �7F� er va: CDT .yd g silo►✓.✓ a.✓ 1--� PLn.,i Fc.e i'r,n.r f annrt�a��� y.« <?4917-r TrercgTpETMONER r�yaE s4 Ooo rrrtg 'ir�r,