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HomeMy WebLinkAbout0526 WILLOW STREET 3)4- �nM UPC 12543 No. Posrco '� HASTINGS,CAN i Town of Barnstable *Permit l 08D� Expires 6 nwnths oy tssu ate Regulatory Services Fee ,ARN,Sr,181�, ; v MASS. Thomas F.Geiler,Director Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma us Office: 508-862-4038 Fax:508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number ! 3 0 .t l a y , Proeesidential Address P w!Wad d f- P . Value of Work �1 y�(J Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Odgi, e0 Q ?4�/ �✓ Contractor's Name cJd�N J-f e ilmlle.i Telephone Number Home Improvekent Contractor License# tifapplicable) C 6 yr�l Cons ction Supervisor's License#(if applicable) 10 0'7 S/Q' orkman's Compensation Insurance X PRE SS PERMIT • Check one: [II am'a sole—proprietor ❑ I am the Homeowner DEC 2 8 ZU11 UI have Worker's Compensation Insurance Insurance Company Name Sf4[I TQ d kmllppl) rINf TOWnjsARN workman's Comp.Policy# W G C -5U i o y 7 STABLE Copy of Insurance Compliance Certificate must accompany each permit. J Permit Request(check box) f Q✓-jk/N e ed JI' 02 s" / �S�vgze 01 A Fill me,vA ke#f� ✓4M C V-olo dwfeekl [ 'Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to 01 LiA d I&JI/fP El Re-roof(hurricane nailed)(not stripping.PPi g. Going.over existing layers of roof) l��I/®tytl ei 10.4 ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. 14 copy of the Home provement tractors License&Construction Supervisors License is equ' SIGNATURE: C:1Users\decol]ildA ta\i.ocal\Microsoft\Wmdows\Temporary Internet Files\ContentOutlooklDDV87AAZ1E}PRESS.doc Revised 072110 - f Page 7 of 7 ' Capizzi Home Improvement Inc. Specifications and Estimates STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT I Alhje,—, �1���-1C_ OWN THE PROPERTY LOCATED AT � C� �-- IN �' q MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT�PO ATICE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDIN SIGNATURE OF OWNER: T .TM�' OWNER'S ADDRESS: OWNER'S TELEPHONE: LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: 1645 Newtown Rd., Cotuit, MA 02635 APPLICANT'S TELEPHONE: 508-428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: ?Massachusetts -tepartrnent of Public Sa" Soafd of BuOdtng Regida*hons and Standwds f Aottrucuon Saper%kar G Luzense CSi4QSM7 44 JOUN T SI'itM4ga ' IM i W At:M AVE Bu=ards Buy Ntf - Ceuv ssca�e 06MMOU Umee of t:ot s mer Ail M nusiness lu ulauuu g JUMM"or rs tstrauuu rauu aur.iuucrwut OME IMPROVEMEWC ONTRACTOR before the expiration date. If found return.to: Uffice of COasamerAffairs and Business. . .Type: 10 Pant P1a*-'Suite 5170 ' Regaiahor. g Supplement Carif Boston,MA 02116 CAPM HOMER _ 1� r JOHN STRUMS 1645 Newton Rd. n ,'7 Cotult,MA Undersetmbry Not v wt oat signs re i The Commonwealth of Massachusetts Pnnt Form Department of Industrial Accidents - -- Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Nc1Tne (Business/Organization/Individual): Capizzi Home Improvement Address:1645 Newtown Road City/State/Zip:Cotuit, MA 02648 Phone #:508-428-9518 Are you an employer? Check the appropriate box: Type of project(required): 1.❑✓ I am a employer with 40+ 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling These sub-contractors have ship and have no employees T 8. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.: 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I I.❑ Plumbing repairs or additions myself. ' right of exemption per MGL Y �o workers comp. 12.0 Roof repairs insurance required.] t c. 152, §1(4), and we have no 13.❑ Other employees. [No workers' comp. insurance required.] 'Any applicant that cheols box#1 must also fill out the section below showing their workers'compensation policy informations.,` t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors 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:Associated Employers Insurance Company Policy#or Self-ins.Lic. #:WCC5010 547012011 Expiration Date: 12/2512012 Job Site Address: IrA 6 aj City/State/Zip: 1A) ' /JAKaJ-ff 1•e 414 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi nder the pains and enalties f erjury that the information provided above is true and correct Sip-nature- Date: 11 2._ G ti Phone#: 50 28-9518 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: i 4 Client#:47298 CAPIHOM DATE(MMRIDNYYY) ACORD., CERTIFICATE OF LIABILITY INSURANCE 12126/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsemengs). PRODUCER NAME:NTAC Karen Walther Rogers&Gray Ins.-So.Dennis PHONE 877-816-2156 A/C No Ext: A1C No 434 Route 134 E-MAIL Do Ess: South Dennis,MA 02660-1601 INSURERS)AFFORDING COVERAGE NAICN 508 398-7980 INSURERA:Main Street America Assurance C INSURED INSURERB:Associated Employers Insurance Capizzi Home Improvement,Inc. INSURERC: Caplzzi Enterprises,Inc. INSURER D: 1645 Newtown Road Cotuit,MA 02635 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPEOFINSURANCE INSR WVO POLICYNUMBER MWDD MWDDIYYYY LIMITS A GENERALLIABILITY MPB1075H 6/08/2012 0610812013 EACH OCCURRENCE $1,000 000 X COMMERCIAL GENERAL LIABILITY DAMA E3 &Eo cEr°ence $SOO OOO CLAIMS-MADE a OCCUR MED EXP oneperson) $1 O 000 PERSONAL&ADV INJURY $1,000 000 GENERAL AGGREGATE S2 000,000 GENi AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG s2,000,000 POLICY PRO- LOC $ A AUTOMOBILE LIABILITY M1 M28044 6/08/2012 06108/2013 COW�ts'NGLE LIMIT $500,000 tA AUTOBODILY INJURY(Par person) S OWED SCHEDULED BODILYINJURY(Peraccident) $ OSXAUTOS ED AUTOS X NON-OWNED PROPERTY DAMAGEAUTOS Per accidente Oth Car $ A X UMBRELLALIAB OCCUR CUB1076H 6/08/2012 06/0812013 EAcHoccURRENCE s5,000.000 EXCESS LIAB CLAIMS-MADE AGGREGATE s5 OOO OOO DEO I X RETENTION$10000 $ B WORKERS COMPENSATION WCC5010547012012 12/25/2012 12/25/201 X WCSTATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVEY/N E.L.EACH ACCIDENT $1 O00000 OFFICERIMEMBEREXCLUDED? a NIA (Myyaa�nndatoryInNH) EL.DISEASE-EAEMPLOYEE $1 000000 If under DESCRIPe�TIO OF OPERATIONS below _ E.L.DISEASE-POLICY LIMIT s1,000000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,It more space is required) **Workers Comp Information** Included Officers or Proprietors CERTIFICATE HOLDER CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE 0198 •2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S91859/M91856 TLH CAPE COD INSULATION RM OEA3S SEA MESS SPUTTOAM .SUSPENDED BATTS OUTliES INSUtAT10N C[IUNOS 1-800-696-6611 Town of Barnstable Regulatory Services Building Division 200 Main St Hyannis, MA 02601 Date: Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute (BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address Village Gar + ✓/e y �iMe� �� C�. /lv� � �j• 136 of s"It— Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings ( ) (X ) (ZL ) ( ) (A C e t<19 9 s (,Yo? )C� Slopes ( ) ( ) ( ) ( ) ) C> Floors ( ) (• ) ( ) ( ) _(�, ') �= Walls dew Eta rS � F I l ;d { C3 Sincerely V hapeod as'/r P sident In , C. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION To OFBARNST LE Map Parcel Application # 11 . Health Division 1!7!Z MAY 15 RDafe Issued Conservation Division Application FkPt Planning Dept. DIVj Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis Project Street Address Village Owner�i�r�/g 9 JW," Address S Telephone�'D Permit Request � L_C�1fi�QSC �fi ��/C �6D�2 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. ti Dwelling Type: Single Family Er Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes RrfNo On Old King's Highway: ❑Yes allo Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal #_ Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION BUILDER OR HOMEOWNER) Name G9 e / lJ Telephone Number �d �' 7O'J Z Address �.�� Y�� „� License# /D 2 9 ge Home Improvement Contractor# Worker's Compensation #l' �6.A::' ,�/-o ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE J G 7i s; FOR OFFICIAL USE ONLY APPLICATION# DATEISSUED r MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: s : FOUNDATIONd s FRAME r t INSULATION z r FIREPLACE t s ELECTRICAL: ROUGH FINAL y; i PLUMBING: ROUGH FINAL GAS ROUGH FINAL <FINAL BUILDING ° g k • DATE CLOSED OUT _ • ASSOCIATION PLAN NO,..r ti I mass save PCONTRAA OR '" n41:Mouy,p,Rrpy aYCT+CY' . PERMIT AUTHORIZATION FORM I2ecr,':t: �c�� ,� owner of the property located at: (Owner's Name, printed) (Property Street Address) (City/Town) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my prope O is Signat r Date FOR CSG OFFICE USE ONLY Conservation Services Group has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Particip ting Contractor bate i Rev.12132011 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 153567 �.;_ .. Type: Private Corporation - __ Expiration. 12/15/2012 Tr# 206433 ;:..:. CAPE COD INSULATION, INC x = FP HENRY CASSIDY =r 455 YARMOUTH RD. a, HYANNIS, MA 02601 ;n Update Address and return card.Mark reason for change. Renewal Employment Lost Card Address � Rene � [� DPS-CAI Ca 5OM-04/04-G101216 Office o7 mer Affalrs us ne Re ul Rion License or registration valid for is 3ivida!ss:�.'.!y HOME 8V`Wre1 �'UQP before the expiration date. if found return to: =- Registration: 153567 Type: Office of Consumer Affairs and Business Regulation Expiration: 12/15/2012 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 - OD INSULATIO'N,.'INC;._ HENRY CASSIDY 455 YARMOUTH RD' �. Undersecretary HYANNIS,MA02601 ure t '= i\litxs.achusctts-d.)cpari[lien t of Public Safct% Board of BtAldin�g Regulations and Standards`, �. Construction Supervisor License License: CS' 100988 HENRY CASSIDY 8 SHED ROW WESrT YARMOUTH;-;MA 02673 Expiration: 11/11/2013 ('uimni...iun.r Tri#: 7620 t The Commonwealth of Massachusetts z Department of Industrial Accidents W Office of Investigations 600 Washington Street F f Boston, MA 02111 wwvv.mass.gov/dia Worker's compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): e C nnI el G , Address: City/State/Zip: ` YC Y2 (S_ WA a 6Cl Phone#: S0 9" "M 6 " ZL u Are you an employer? Check the appropriate box: Type of project(required): NX 1. LixI am a employer with 4 ❑ I am a general contractor and I have 6. ❑ New construction employees(full and/or part-time).* hired the sub-contractors listed on 7. ❑ Remodeling the attached sheet.$ 2. ❑ I am a sole proprietor or partnership These sub-contractors have 8• ❑ Demolition and have no employees working for employees and have workers'comp. 9. ❑ Building addition me in any capacity. [No workers' insurance.$ 10. ❑ Electrical repairs or additions comp insurance required.] 5.❑ We are a corporation and its officers have exercised their right of 11. Plumbing repairs or additions 3. ❑ I am a homeowner doing all work exemption per MGL c. 152§(4),and 12. Roof repairs myself. [No workers' comp. we have no employees. [No workers' 13. Other �'�erg Ztlp insurance required.] t comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attach 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: A ti C l) rQ Ac—e Policy#or Self-ins.Lic.#: W-CA ©©_1cl 5�(i J Expiration Date: -- Zn Job Site Address: City/State/Zip: OJT,t /� Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 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 ma a forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do here c i under the ins and penalties of perjury that the information provi d above is true and correct. Signature: Date: 7i Phone#: 27 Official use only.Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority (circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: IDate: 4/19/2012 Time: 10:13 AM Tot Cape Cod Insulation, Inc @ 1508-778-5735 Rogers Gray Ins. Paget 002 Client#:4597 CCINSUL ACOR& CERTIFICATE OF LIABILITY INSURANCE r,4,,9,2.12"""' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed,if SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME' Margaret Young Rogers&Gray Ins.So.Dennis PHONE Ext 508-760-4602 F No):508-258 2102 434 Route 134 ADDRESS: youngma@rogersgray.com P.O.BOX 1601 PRODUCER South Dennis,MA 02660-1601 CUSTOMER ID INSURER(S)AFFORDING COVERAGE NAIC 8 INSURED INSURER A:Peerless Insurance 18333 Cape Cod Insulation Inc INSURER B:Ohio Casualty Insurance Company 455 Yarmouth Road INSURER C Atlantic Charter Insurance Hyannis,MA 02601 INSURER D:Commerce Insurance Company 34754 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS'IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY 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. NSR 7ypE OF INSURANCE DDL UBR POLICY EFF POLICY EXP POLICY NUMBER MM/DD/YYYY) (MM/DDJYYYYI LIMITS A GENERAL LIABILITY CBP8263063 04/01/2011 04/0112012 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY DAMA E 7 RENTED PREMISES Ea occurrence $100 000 CLAIMS-MADE a OCCUR MED EXP(Any one person) $5 000 PERSONAL 8 ADV INJURY $1 000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY PRO- LOC $ D AUTOMOBILE LIABILITY 11MMBCKVMK 04/01/2011 04101/2012 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) 11000000 ALL OWNED AUTOS BODILY INJURY(Per person) $ X SCHEDULED AUTOS BODILY INJURY(Per acc dent) $ PROPERTY DAMAGE X HIRED AUTOS (Per accident) $ X NON-OWNED AUTOS $ $ B UMBRELLA LIAB OCCUR 0001254514645 04/01/2011 04/0112012 EACH OCCURRENCE $1 000 000 EXCESS LIAR CLAIMS-MADE AGGREGATE $1 000,000 DEDUCTIBLE $ X RETENTION S 10000 $ `+ WORKERS COMPENSATION WCA00525902 6/30/2011 06130/2012 X WCSTATU- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500 000 OFFICER/ME(Mandatory In N ER EXCLl1DED? N/A E.L.DISEASE-EA EMPLOYEE $500,000 (Mandatory In NH) If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMB $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101.Additional Remarks Schedule,if more space is required) Workers Comp Information Included Officers or Proprietors CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 1988-2009 ACORD CORPORATION.All rights reserved. ACORD 25(2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD #S80552/M68179 MEE }: Application to 6�J.1��tP PIAStN N OPPN J ENN`StE P'N�`' OPEC OE�t�� Old Kings Highway Regional Historic District Committee in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS Application is hereby made, iri triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: ❑ New Building ❑ Addition ❑ Alteration Indicate type of building: ❑ House ❑ Garage ❑ Commercial ❑ Other 2. Exterior Painting: ❑ 3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ® Othe.r_'yCleturbine blind Generator (Please read other side for explanation and requirements). TYPE OR PRINT LEGIBLY 1 DATE July 23, 1981 526 Willow Street ADDRESS OF PROPOSED WORK West Barnstable, Mass . 02668 ASSESSORS MAP NO. y � OWNER George R. & Shirley 0. Palmer ASSESSORS LOT NO. HOMEADDRESs526 Willow Street, W. Barnstable , Mass . TEL. NO. 362-6623 FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). Carol Johnson, 519 Willow Street , West Barnstable , Mass. 02668 Morris Willets , Jr . , Willow 'Street, West Barnstable , Mass . 02668 Commonwealth of Massachusetts, Di ision of Highways , Boston, Mass . AGENT OR CONTRACTOR Pinson Energy Corp. TEL. NO. 428-8535 ADDRESS P .O.Box 7, Marstons Mills, Mass . 02648 DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done (see No. 8,other side), including materials to be used, if specifications do not accompany plans. In the case of signs, give locations of existing signs and proposed locations of new signs. (Attach additional sheet, if necessaryl. Installation of C3 Cycloturbine an 80 foot Unr-Rohn tower ( steel ) on a cement base. Signed Owner-Contractor-Agent Space below line for Committee use. i OKH MIST.DIST. DateBARNSTABL_ The Certificate is hereby Date zd9z Time kA�X _ By JUL 2 7 Approved_ IMPORTANT: If Certificate is approved,approval is subject to the 10 day appeal period provided in the Act. Disapproved ❑ ] ~{ 1 v f ' • e ADDITIONAL INFORMATION FOR MAKING AND FILING,AN APPLICATION FOR A CERTIFICATE OF APPROPRIATENESS The four categories for which a Certificate of Appropriateness is required are: (application for demolition or removal is a separate form). I 1. EXTERIOR BUILDING CONSTRUCTION (new or existing buildings): An application is required for any exterior of a building to be erected or altered including windows, doors, siding, roof, light etc., that will be visible from any public street, way or public place. The following scale drawings are required in duplicate with application: plot plan (if addition — show existing buildings in outline), floor plan and elevations. Also required are snap shots of existing buildings, where additions or alterations are to be made. No plot plan is required for addition or alteration which does not touch the ground. 2. EXTERIOR PAINTING: An application is required for any portion .of a building, structure or sign to be painted that is visible from fa public streer,Lway or public place. Color samples must be attached to these applications. An application is not required when repainting existing colors, changing to white,or using coI ors,ap.p(oved'by'the Town Historic District Committee. J �• ° ?a z e J C ( � J 3. SIGNS OR BILLBOARDS: An application is required for any sign or billboard to be erected within the District, with the following exceptions: a. Existing,signs or,billboards on November 271 1974 shall.have until November 27, 1977 to secure an.approved Certificate of Appropriateness. b. Temporary signs for use in connection with any official celebration or parade or any charitable drive as long as they are removed within three days of the event.. Certain other temporary signs that the Committee feels does not detract from the Act may be allowed with the prior permission of the Committee. c. Real Estate-signs,of not more thani3_square feet in area advertising the sale or rental of the premises on which they are erected or displayed. ° d. A single sign-.of not more than, 1. square foot in area showing the name occupation or address.of the occupant of the premises on whist they are erected or'displayed iri a residential zone. V L 4. STRUCTURE: An application is required to build or alter any structure within the District which is defined by the Act'as a combination•of materials other than a building, sign or billboard, but including stone walls, flagpoles, hedges, gates, fences, etc. GENERAL REQUIREMENTS „ 5. Work on projects requiring approval shall not be started until the Certificate of Appropriateness has been filed with the Town Clerk by the Committee. Approval is subject to the 10 day appeal period provided in the Act. 6. No changes shall be made from the original approved specifications without advance approval of the Commission on an amended appl,ication,f)led with,the Committee. 7. A separate application must be filed with each project requiring a Certificate of Appropriateness., 8. Under:heading of "Detailed Description of Proposed Work" give detailed data on such architectural features as: foundation, chimney, siding, roofing, roof pitch, sash and .doors, window and door frames, trim, gutters —leaders, roofing and paint color. 9. Unless applicati.on,is coVnplete and legible and all material required is supplied, application will not be accepted or acted upon. yaCopies.of the Act establishing the Regional Historic District may be obtained at the Town Hall. Al I t t V�/ASP■ CM 242, JaNAJS 0 Al' � Aisessorl map and lot number /�Q'�1 *THE t0 Sewage Permit number ...:...................................................... Z BAHBSTADLE, i House number co MABEL 00 639- MAY a.` TOWN OF ' BARNLSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO r.....??......e .............................................�,✓�il/D >a2 TYPE OF CONSTRUCTION ........�S T!_^Fc........�wry...........Gcrsvc.e:L T ..i3.�Si`............................. .............. .. ......L.f.........19.) TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .. ..... ..... .............. 0, ../1G?ss:............ ProposedUse .... �c i c.4X.............................................................................................................. Zoning District ........................................................................Fire District .�i(/ �f.../ �rr{Shc?�e . .... ............................ Name of Owner ...a ? rj.f.........11:......P�t. h .....Address '.. .....5 � Name of Builder!`�/!� v?.. !? 1. ...... ?"„t`�.?...............Address �O. i�c?c 7 /�LusiY1,S/ i/1QSf ......................................y............. Name of Architect .. .......0 ..............Address ?O, 7 ................................... g r .,............... Number of Rooms ....... d/.............Foundation .............r. ow. ef ..................+................................ Exterior ...............l. n.K......4V7 ..It..GP�.�A...................Roofing ................/��•�...... �../,Cah•....................... Floors .............../11.P.?........ ...................Interior AIA /� �Ca�l .............. Heating / .... � �!CofJI ..................Plumbing /(� IC lr ............ .... ........ ................... .............. .. ...................................... 1S'` 00 Firepp .�41 /9�1 ..�'.rt!�1�...................Approximate Cost l.� 4 iJ lace .........,.. .0.:......... .. ............. ..y..... ............................. Definitive Plan Approved by Planning Board ______ __ ____________19________- Area . Sy Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH V � w �I I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name _....................... (J C Palmer, George R. erect wind No ... ... Permit for .................................... machine. ........................................................................... Location .....:...........526 Willow Street ........................... West Barnstable . ............................................................................... George R. Palmer- .Owner ....................... .................................... Type of Construction .......................................... ................:........................... ................................ �R ot ............................ Lot ................................. Permit Granted ..............Au s.t..2Z.......19 81 Date of Inspection ..........................19x Date Completed .......................................19 PERMIT REFUSED ........................................................... ... 19 ............. ...... ........... ................... .......... .......... 7......................................................................... ............................................................................... to Approved ................................................ 19 .......................................................0....................... ..........................................0................................. r� j3o � ... of THE to Assessors maP and lot number �y Sewage Permit number .............:...................:........................ Z BAB39TODLE. i House 'number ........................'. i ........................ .... y� MAB6j 0 G 1639. `00 • ��MPS a. TOWN OF BARNSTABLE BUILDING INSPE:OTOR APPLICATION FOR PERMIT TO .�=X/"C%,, G'YC� T �c3in// /�JIAIi�, C,151VI-5.e d>o/Z. TYPE OF. CONSTRUCTION ........ S.T./=i „ipr.... ...............Cor.!.c!?.: ..:Y...!3 ................................ ........................ ........... .........19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location s.r �2...... T-; Ow ..S 7�rc r 7�. s 7f �G�rr�S�az 6/ram /v/Oss........... . .......... ................................... ........ .. .... Proposed Use .... 'P.....!"�ec i.c,,y......................................... ................I......................... Zoning District .........................Fire District �1�?�.s ..../�.�Nr�S ..............................:................ ................................................... Name of Owner ... r'a{. .r....... ......: .��!z /.....AddressC? G�J.//ev.. �... 5 �s��-/e.. }' Name of Builderf�i!�Sv�?..1!?e� ,� OK ...............Address ?O. 0o-x 7 /WIC11S-Ii.1-iJ�,// /VGS$ �........... ......... ..........r................................. .I. . ........... Name of Architect ..✓.........o.... Address ...........................r......................................... ............... Number of Rooms /✓o f.....!�,(»�..4G: Foundation ............ ori c��fe.......................................... . ..... .......... Exierior ...............iof�6 ......4!7`4,..�14G h.�...................Roofing � Gab lY................... ................... .......... Floors //1/ / ...... ..... !?................ v.� CrsG(.....................Interior ...................`l./.T........ ��iCa�(t' 4 ,�,, /i Co`/Ir /vo � .eft9:��C �6Ir Heating .............!5...!�............... .a.........................................Plumbing Fireplace .............. ..... �i.,J,�i,C q.lJ"�.....................Approximate Cost ............ �1 �.v..@�..............:..... v.. �.. Definitive Plan Approved by Planning Board ______N/ ____________19________. Area Z-5 sl /� ; Diagram of Lot and Building .with Dimensions Fee �..�......... ...... SUBJECT TO APPROVAL OF BOARD OF HEALTH F 9 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ...,.... ?.I ........................ /r 0 � Palmer, George R. ' 23414` �� ..�� —..���'� Permit fo,--��K���.��J�l— ` ' ^ machine ! _ .--------------------.----..�� � , 526 W��1lnc .r---- ................... --------- -- --- � � ' �eat ' ---------------.�~~.�`~—~—^----- Ovvna, .............. .Il�� ' _.� .. — ----- .--... . Type of Construction -------------- ---------------',-----`---. . ' ` Plot Lot ---------. ----,'-----. ' ' ' Permit G,onha6 .........August 81 ' ' ' ' oota of | Date Completed ' ` ' . � ` ' ' ' . ` . ER... REFUSED .................................. ............ ................ lV ' | ' � --' ---� \ --''+=���"f ----+'�f'4f��------'. . . . -------------------^------'' ' ~ ` ` ' ---------------~—~.---.---- ^ Approved —'—,------------.. lA ----------------'---------- ^ ----------------'--------^—