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0184 WOODSIDE ROAD
0 UPC 12534 No.2-153LOR HASTINGS.MN 5 J-7O � 75 1 w y 1 1 { l x i f } I 1� i o f.l 3 3� 9 1 d 'i a I 3` r� Iu 1 ARNSTABLE, W: Large bedrooman.guiet area pr. + ! "vale deck 8 entrance Includes aIf;5636566 a t I. 4A r a � a a To rj b Date Z/ Time -� RILE YOU W E OUT M of Phone Area Code Number Extension TELEPHONED PLEASE CALL CALLED TO SEE YOU WILL CALLAGAIN WANTS TO SEE YOU URGENT RETURNED YOUR CALL Message ' Operator eftAMPAD 23-021-200 SETS EFFICIENCY® 23-421-400 SETS CARBONLESS Town of Barnstable Building •� Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept snnv�eet,e, tesq. �� Posted Until Final Inspection Has Been Made. ' Permit Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-20-1420 Applicant Name: Heather Capelle Approvals Date Issued: 06/15/2020 Current Use: Structure Permit Type: Building-Add ition/Alteration-Residential Expiration Date: 12/15/2020 Foundation: Location: 184 WOODSIDE ROAD,WEST BARNSTABLE Map/Lot: 127-008 Zoning District: RF Sheathing: Owner on Record: FELEGY,SCOTT& PATRICIA Contractor Name: NORTHEAST FOUNDATION Framing: 1 REPAIR LLC DBA RAMJACK NEW Address: 184 WOODSIDE ROAD ENGLAND 2 WEST BARNSTABLE, MA 02668 l Chimney: Description: Stabilization of foundation with underpinning using driven or helical Contractor License: 185517 piles Est. Project Cost: $ 17,350.00 Insulation: Permit Fee: $ 135.00 Final: Fee Paid: $ 135.00 Reviewers Note: FOUNDATION REPAIR Date 6/15/2020 Plumbing/Gas RMCK Rough Plumbing: Project Review Req: Foundation Repair Final Plumbing: Building Official Rough Gas: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. i E Final Gas: All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and-shall-be-maintained open for public inspection for the entire duration of the Electrical work until the completion of the same. I Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided.on/hi, ermit. Rough: Minimum of Five Call Inspections Required for All Construction Work:l 1.Foundation or Footing Final: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Low Voltage Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Final: j 6.Insulation 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Final: Work shall not proceed until the Inspector has approved the various stages of construction. .Fire Department "Perso ting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: F �i� Building plans are to be available on site ISSUED RECIPIENT All Permit Cards are the property of the APPLICANT- Cape Save Inc. 7-1) Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 8/14/19 0''x> Brian Florence CBO Town of Barnstable Building Division 200 Main St. Hyannis,MA 02601 RE: Insulation Permit 19-1899 Dear Mr. Florence: This affidavit is to certify that all work completed for 184 Woodside Road,W. Barnstable has been inspected by a third party Certified Building Performance Institute (BPI)Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey i Town of Barnstable_ RECEIPT; 200 Main Street, Hyannis MA 02601 508-862-4038 63; Application for Building Permit o o . Application No: TB-19-1899 Date Recieved: 6/7/2019 U = O Job Location: 184 WOODSIDE ROAD,WEST BARNSTABLE e>n Permit For: Building- Insulation- Residential Contractor's Name: WILLIAM J MCCLUSKEY State Lic. No: CSSL-1 r776Address: West Yarmouth, MA 02673 Applicant Phone: (508) 390398 T (Home)Owner's Name: FELEGY,SCOTT& PATRICIA Phone: (508)737-6561 (Home)Owner's Address: 184 WOODSIDE ROAD, WEST BARNSTABLE, MA 02668 Work Description: Add R-38 fiberglass,R-37 cellulose,R-13 fiberglass,R-19 fiberglass,and R-10 rigid insulation to the attic. Air seal the attic plane with expanding foam. General weatherization. Total Value Of Work To Be Performed: $3,100.00 Structure Size: 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by- filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: William McCluskey 6/7/2019 (508)398-0398 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $3,100.00 Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: $85.00 6/7/2019 $35.00 XXXX-XXXX-XXXX- Credit Card 0299 Total Permit Fee Paid: $85.00 6/7/2019 $50.00 XXXX-XXXX-XXXX- Credit Card 0299 y -e :THIS ISNO.T A PERMIT f1 �OFINE Application number... ...�!.. .... ....JN �¢ Date Issued. 1..1 I " MRNISTABM " MASS. �$ 1639. `0� Building Inspectors Initial ....... .................... 001 Map/Parcel....../.°?7 .... ..................................... TOWN OF BARNSTABLE t6 6VT SUL 0 ,5 2018 EXPEDITED PERMIT APPLICATION: AI & /W&;OWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY FORMATION Address of Project: / G✓D�nlS':gl /� 4t/ &r s c NUMBER STREET VILLAGE Owner's Name: 4 it C"ek N.e/e 6 y Phone Number 5 vZ�3 - SAS Email Address: Cell Phone Number Project cost$_5�1� Check one Residential ✓ Commercial OWNER'S LVER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: 5e e ad4-e� C,"-c+ Date: TYPE OF WORK 0 Siding 0 Windows (no header change)# Insulation/Weatherization 0 Doors (no header change)# Z Commercial Doors require an inspector's review El Roof(not applying more than 1 layer of shingles) Construction Debris will be going to Wa .5 L,er\9LA a tom,�.T — eye"„+1, CONTRACTOR'S INFORMATION Contractor's name An.�ie,/ �✓P �e ( ys Home Improvement Contractors Registration(if applicable)# -//Z 7 8 S (attach copy) Construction Supervisor's License# 0 7W Z LIT (attach copy) Email of Contractor Ad-q 5"- &Q Phone number d16/- 7/'/-6 VT 9 ALL PROPERTIES THAT HAVE STRUCTUR OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS l v i A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORICAPPROVAL BEFORE A PERMIT CAN BE ISSUED. L APPLICATION NUMBER............................................................ *For 'Vents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one:this event is a:for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9.30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles:front back left side right side HOMEOMWER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 Cliff the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date /APPLICANT'S SIGNATURE E Signature Date - 7- All permit applicatio are subject to a building official's approval prior to issuance. I { 1 ,�- SPECIAL SERVICES CUSTOMER INVOICE Page 1 of 5 NO. H2612-80238 Store 2612 HYANNIS Phone: (508)778-8948 65 INDEPENDENCE DRIVE Salesperson: RHP4LE HYANNIS, MA 02601 Reviewer:VXG1123 Name Phone 1 • FELEGY PATRICIA (954)854-1196 REPRINT Aftoss 184 WOODSIDE RD Phone (865)243-0455 Company Noma • cM W BARNSTBLE JobDownption patio door install 2018-06-25 09:24 State MA Ztp 02668 cwn" BARNSTABLE INSTALLER DELIVERY #1 MERCHANDISE AND SERVICE SUMMARY sWe the old roc sttome right REF# 101 STOCK MERCHANDISE TO BE DELIVERED: REF# . SKU OTY UM DESCRIPTION PI TAX PQrJSA EXTENSION R03 0000-677-137 2.00 EA 3/4"X5-1/2"X8'AZEK S2S TRIM/ A o $24.45 $48.90 R04 0000-677-401 6.00 EA 3/4"X7-1/4"X8'AZEK S2S TRIM/ $32.17 $193.02 R05 0000-119-698 4.00 EA 1X5X16 PRIMED FJ PINE/ Y $29.24 $116.96 R06 1002-961-477 1.00 EA 6"X50'WINDOW 8t DOOR SEALING TAPE/ A Y $17.97 $17.97 R07 0000-715-499 1.00 RL MULTI-PURP 160X48"ROLL INSUL 5.3SF/ A Y $5.48 $5.48 R08 1001-361-475 1.00 EA 1/24.X 4-1/2".72"WW472 OAK SADDLE/ A Y $22.98 $22.98 R10 0000-570.469 2.00 EA DOOR HARDWARE 2001400-GLIDING WHIT / A Y $59.00 $118.00 R11 0000-321-257 2.00 EA SCREEN FOR 200 PS510- DOOR WHI A Y $139.00 $278.00 R12 1000-049-619 1.00 EA PS510L FRAME WHT PART ON A Y $215.00 $215.00 R13 1001-493-506 1.00 EA PS510L OPER PANEL BB ONLY/ A Y $557.00 $557.00 R14 1001-493.509 1.00 EA PS510L STAT PANEL B PART ONLY/ A Y 1 $557.00 $557.00 R15 1000-049-623 1.00 EA PS51 OR FRA ART ONLY/ A Y _ $215.00 $215.00 R17 1001-493-553 11.001 EA I PS510R EL BBG WHT PART ONLY/ A Y $557.001 $557.00 R16 1001-493-542 1.001 EA ER PANEL BBG WHT PART ONLY/ A Y $557.00 $557.00 $3 459.31 DELIVERY INFORMATION: 1pyrw. TE:INSTALLER WILL SCHEDULE CONTINUED ON NEXT PAGE•'" O Check your current order status online at 1 www.homedepot.com/orderstatus !� Page 1 of 5 NO. H2612-80238 Customer Copy J SPECIAL SERVICES CUSTOMER INVOICE-Continued Name: FELEGY Page 5 of 5 NO. H261 2-80238 INSTALLATION #2 (Continued) REF#102 COUNTY: BARNSTABLE SALES TAX RATE: 6.250 TAX: Merchandise- Y LABOR- N • • $135.01 PHONE: 954 8541196 ALTERNATE PHONE: 865 2430455 BASIC INSTALLATION LABOR INCLUDES: ARRIVE ATJOBSITE ON DAY OF INSTALL AND LEAVE WITH CUSTOMER. POSTAGE AND ADMINISTRATIVE). OR INSTALLER.IF DELIVERED TO INSTALLER,THE INSTALLER WILL FEES.ENGINEERING,WIND LOAD CALCULATIONS,RECORDING, PICK UP FROM THAT MUNICIPALITY AND DELIVER TO EITHER JOBSITE 'ALL FEES ASSOCIATED WITH OBTAINING PERMIT(MUNICIPALITY DELIVER COMPLETED PERMIT PACKAGE TO PROPER MUNICIPALITY. SPECIAL NOTES: 'CUSTOMER IS RESPONSIBLE FOR PAYMENT OF THE PERMIT.ONCE IN FULL.NO REFUNDS ON PERMIT FEES AFTER 72 HRS.OF PAYMENT. THE PERMIT IS PAID FOR,WORK ON THE PERMIT ASSEMBLY BEGINS IMMEDIATELY.CANCELLATIONS WITHIN 72 HRS.WILL BE REFUNDED END OF INSTALL#2 TOTAL CHARGES OF ALL MERCHANDISE & SERVICES Policy Id(PI): • ' • - • $4 801.32 A: 90 DAYS DEFAULT POLICY; .SALES TAX $216.21 TOTAL $5 017.53 BALANCE DUE $0.00 'The.Home Depot reserves the right to limit/deny returns. Please see the return policy sign in stores for details.' END OF ORDER No.H2612-80238 Customer's Sig Aatu� A &P Date Page 5 of 5 NO. H2612-80238 Customer Copy o P y i r� o I O f , t t CS-0742,47 L`.#Stt�ttts��t4it{ �up�rvt�gr �4 It PAUL M 0OWNINt3. `. M KESWICK ROAD BrROCKTON MA 03302 Expiration-,Commissioner $�441t4# I Tlie Commonwealth of Massachusetts Department of Industrial Accidents "1. Office of Investigations 2 l Congress Street, Suite 100 Boston,AM 02114 2017 -• www.massgov/dia Workers' Com- pensation Insurance Affidavit: B-ailders/Contractors/Electricians/Plumbers Ap�licalnt Information Please Print LeLyibIy Name (Business/organization/Individual): Address: City/State/Zip: [�:•,f :r� j�c Phone#: Are you 3n employer?Check the appropriate box. Type of project(required): I.❑ I am a employer with a- ❑ I am a general contractor and I ,� employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.L9 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ' ship and have no employees These sub-contractors have. g. ❑Demolition Working for me in any capacity. employees and have workers' [No workers' comp.insurance comp.insurance.1 9. M. 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 11.❑Plumbing repairs or additions myself_ [No workers' comp. .right of exemption per MGL 12.❑Roof repairs insurance required.]! c. 1521 §1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required.] "Any applicant that cliecl—box fl must also fill out the section belowshowino their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing al!.work and then hire outside contractors must submit anew affidavit indicating such. #Contractors that check this box must attached an additional sheet shoring 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. lain an employer that is providing workers'compensation insurance for nzy employees Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.•#: Expiration Date: Y Job Site Address: City/St4e/Zip: Attach a copy of the workters' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A ofMGL 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 cert under the pains and penalties of perjury that the information provided above is true and correct. _ . _ _ Signature: -- - Date: ............_�.._. - Phone#: s• Official use only. Do not write in this area,to be completed by city or town.pffrciaL City or'Gown: Permit/License# Issuing Authority(circle one): - 1.Board of Health 2.Building Department 3.City/Town CIerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street,Suite 100 91 Boston,AL4 02114-2017 nww mass.gov/dia Workers'Compensation Insurance kffidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'biv dame (.B=s 3ess/Urgaru tioivTmdividual): .. O �i �/ D — -Address: * f �6 S l VANP/4e_, Citv'State/Zip: �•l, tb /f • v/Syr Phone#: 7 7S " a'ass Are you an employer?Check the propria b x: Type of project(required): 1J 4- I am a general coactor and I ]..' I am a empiover with 6. 71 New construction employees(full and/or part-time).* ve hired the sub-contractors Ir' I am a sole proprietor or partner- fisted on the attached sheet 7. Remodeling ship and have no employees These sub-contractors have i g. r Demolition in� forme in any caps emoiovees and have workers' work o '• 9. V Building addition p msiaance o workers' coin comp.insurance.*- ed-] We are a corporation and its I 10.❑Electrical repass oradditions i officers have exercised their 11. Plumbing repairs or adci ons ;.[ I am a homeowner doing all wort g mySeLr ;No workers' comp. right of exemption per;VIGL L.❑Roof epzks i insurance required.]t c. 152,§1(4),and we have no —�// mnplovee4. [No workers' 13. Other ti ou( comp.insurance required.] I , Pe •:v:y applicant tha:checks box 01 must also fill out the section below showing their workers'compensation pobcv information. t ilomcovmcs who submit this affidavit indicating they are doing all work and then hue outside connac=must submit a new a>�davii indicating such. :Conmetors that check this box must attached an additional sbeet showing the name of the sub-contractors and state whether or not those entities have -=piovem. 1 the;ub-contractors have emplovecs,they=,ast provide their workers'comb.policy number. Jam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job sire informatiom L-tsurance Company dame: r — Pohcv#or Self-ins.Lic. 'a -I o Expiration Date: 3 Job Site Address: M/ A)jo 3'St dle gc(/ City/State/Zip:l✓• Attacb 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 ofMGL c. 152 can lead to the imposition of crmmma]penalties of a fine m to$1,500.00 and/or one-y imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day a • st a later. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DLk r• ce coverage verification. I do hereby certify un e ine4ury4har the information provided above is true and correct Si att�e: Date: Phone 4: — r ficial use only. Do not write in this area,to be completed by city or town offrcdaL ity ur Town: PermitUcense suing Authority(circle one): 1.Board of Aealtb 2.Building Department 3.City"Town Clerk 4.Electrical inspector 5.Plumbing Inspector 6.Otber Coutset Person: Phone t : r 41 �c Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Type: Supplement Card Registration: 112785 HOME DEPOT USA INC Expiration: 04/22-'2019 2455 PACES FERRY RD C-11 HSC ATLANTA,GA 30339 Update Address and return card. Mark reason for change. ❑ Address ❑ Renewal El Employment 0 Lost Card ' Office of Consumer Affairs&Business Regulation FG-f; HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:SUDGIement Card before the expiration date. If found return to: Registration Expiration , Office of Consumer Affairs and Business Regulation —_ 112785 041'2212019 10 Park Plaza-Suite 5170 FTOME DEPOT USA INC Boston;MA 02116 ANDREW SWEET � o' J 2455 PACES FERRY RD C-11 HSC d Iili6ut signature ATLANTA,GA 30339 Undersecretary 9 / l DATE 1MWDDIYYYY) ACOPR O CERTIFICATE OF LIABILITY INSURANCE 0222/2018 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 have ADDITIONAL INSURED provisions or be endorsed. IfSUBROGATION IS WANED,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 IACT CONT MARSH USA,INC. PHONE FAX TWO ALLIANCE CENTER aC No: 3560 LENOX ROAD.SURE 2400 E-MAIL ATLANTA.GA 30326 ADDRESS: INSURERS AFFORDING COVERAGE NAIL 0 CN101642069-HameD-GAW-18.19 I INSURER A:Old Republic Insurance Co 24147 INSURED THE HOME DEPOT.INC. INSURER B:New Ha hire Ins Co 23541 li HOME DEPOT U.S.A.,INC. INSURER C:HorneRisk Captive Insurance Company 2455 PACES FERRY ROAD INSURER D BUILDING C-20 ATLANTA.GA 30339 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-OD4353439-16 REVISION NUMBER: 3 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. INSR I ADOL SUB POLICY EFF POLICY EXP LIMITSLJ LTR TYPE OF INSURANCE POLICY NUMBER MMIDD A X COMMERCIAL GENERALABILRY MWZY312717 ]03 112018 ITM1/2019 EACH OCCURRENCE S 9•wo•000 CLAIMS•MADE I A I OCCUR PREMISES 1Ezocwnence" S 1.ODO.000 LIMITS OF POLICY XS MED EXP(An one person) ;S EX LADE OF SIR:S1M PER OCC PERSONAL 8 ADV INJURY S 9.000.000 GEWL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 9,000.000 N POLICY PRO' LOC PRODUCTS-COMPIOP AGG S 9,000.000 S JECT OTHER: A I AUTOMOBILE LIABILITY MWTB312718 031012018 03101/2019 COMBINED SINGLE LIMIT 5 I.000.000 Ea amdenl X ANY-AUTO BODILY INJURY(Per person) S OWNED SCHEDULED SELF INSURED AUTO PHY OMG BODILY INJURY(Per accident) 5 AUTOS ONLY AUTOS HIRED NON-OWNED I PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY Per awdml S UMBREIIALIAB OCCUR EACH OCCURRENCE S EXCESS UAB HCLAIMS-MADE AGGREGATE S CEO RETENTIDN S S B WORKERS COMPENSATION WC 014122577(AK,NH,NJ,VT) ON012016 03101/2019 X PER OTH- STATUTE ER B AND EMPLOYERS LIABILITY YIN WC 014122578(WI) 0310120% 030/20% 5.MD.CM ANYPROPRIETORIPARTNERIEXECUTNE NIA A E.L.EACH ACCIDENT S OFFICERIMEMBEREXCLUDED'/ S,000,ODO (Mandatory to NH) E.L.DISEASE-EA EMPLOYE S 0 yes describe under Continued on Adchonal Page EL DISEASE-POLICY LIMIT S 5.000.000 DESCRIPTION OF OPERATIONS below C Excess Auto 297-1-10011-00.2018 031012018 031012019 until: 4.000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be atlached it more space is required) EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION HOME DEPOT USA.INC SHOULD ANY OF THE ABOVE DESCRIBED POLJCIES BE CANCEI LED BEFORE 2455 PACES FERRY ROAD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BUILDING C-20 ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA.GA 30339 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. ManashiMukherjee _3"LaLuoo'-� ©1986-2016 ACORD CORPORATION. All rights reserved- ACORD 25(2016103) The ACORD name and logo aro registered marks of ACORD l i AGENCY CUSTOMER ID: CN101642069 LOC#: Atlanta '`+C C)R IDO® ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY MARSH USA,INC. NAMED INSURED THE HOME DEPOT,INC POLICY-NUMBER HOME DEPOTU.S:A.,INC. 2455 PACES FERRY ROAD BUILDING G20 'CAFtWER ATLANTA.GA 30339 NAIL CODE .EFFECTIVE ADDITIONAL REMARKS DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liabilit i Insurance Workers Compensation Continued: Cartier:Indemnity Insurance Company of North America Pdicy Number.WLR C64763191(AL,AR,FL.ID,IA,KS.KY,LA,MS.MO.NE,NM,ND.OK,SC,SD,TN.WV,WY) Effective Date:03/012018 Expiration Dale:03012019 (EL)Lirtil:S1,000,00D Cartier.New Hampshire Insurance Company Policy Numbar.WC014122576(DC.DE.HI,IN,MD.MN.MT;NY,RI) Effective Date:031012018 Expiration Date:03101/2019 (EL)Limil:S1,000,000 Carrier.ACE American Insurance Company Policy Number.WCU C64783221(QSI)(AZ.CA.IL.NC.OR.VA,WA) Effective Dale:031D12018 Expiration Date:0310112019 (EL)Limit:S1,0D0.000 SIR,S1,0DD,0D0 SIR for the states of AZ.CA,IL,NC.OR,VA,WA Carrier.National Union Fire Insurance-Company Policy Number.XWC 4595580(OSI)(CO.CT,GA,ME,MI.NV,OH,PA,UT) Effective Date:DYD12018 Expiration Dale:03f01/2019 (EL)Limit:S1,000,00D .S1,000,000 SIR for Ihestates of CO.ME,NV,MI,OH.PA,UT S750,000 SIR.for the state of GA S350,000 SIR for the state of CT Cartier:National Union fire Insurance Company Pdicy Number.XWC 4595581.(OSI)IMA) Effective Date:031012018 R Expiration Date:031012019 (EL)Line$1,000,00D SIR:S500.000 TX Employers XS Indemnify. Carriedlinios Unnon`Insurance Company Policy Number.TNS C4916693A(TX) Effective Dale:031012018 Expnbon Date::03101/2019 (EL)Emil:S1D,ODO,DDD SIR:S1,000.00D i ►CORD 101 (2008/01) ©:2008 ACORD CORPORATION: All rights reserved. The ACORD name and logo are registered marks of ACORD Assessors map and lot number 7 7 SEPTIC SYSTEM MUST BE Sewage Permit number ................................................... INSTALLED IN COMPLIANCEWITH ARTICLE II STATE 'THE T° , TOWN OF BARNSTAAttND TOWN Z BABB9TADLE. i BUILDING INSPECTOR o way a l/ APPLICATION FOR PERMIT TO C'�t1s �`& /............................................................ ................................................................ TYPE OF CONSTRUCTION ..................�I�C7.�A S.� ........................................................................................... ............. ......7. .......19.1..( TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according tothe following /information: l Location ...................41�..4.........1. ....... 1....�.0(� S,ICI ..... ....�. .... 1.........�.��(.�:�.. �� _ .!.. .............. ProposedUse .......... A.� .......................`'".5,........................................................................................................ Zoning District ........ .......................................................Fire District ....44. )... . .... ........ ....................... Name of Owner .... o Gfi �..�� .. . :.Address 1 - F�:'b G .�.. :.:`.` .:.��. If— Name of Builder ......... . :. ....... ........Address �� - ► "` ...... t.....:....... c,.�. . Nameof Architect ..................................................................Address ..........................................................I......................... Number of Rooms ..................................................................Foundation .....� C�((�� _ r(i.t.. ................................................ Exterior ..��: ;nb� ��,��OQ. ...Roofing ....... 5 r 1�•x� S�IN�`4.. .................. VV ..... ....................... �, .......................Interior ... c Floors ....0&��'ko...................... ........................................................ ............................Plumbing Heating ..1 1.............................. g ............ ' ............................................................... D ()O Fireplace ..... `. . ...f.......... ..��:tf� V.�...............Approximate Cost ........ ... ...........r.............................. Definitive Plan Approved by Planning Board ---------------____-----------19_______ . Area ........,1 D.V'. ..... ............ Diagram of Lot and Building with Dimensions Fee r . �-..U..V. SUBJECT TO APPROVAL OF BOARD OF HEALTH /� r( 30 - �' Z 3 3 6Xv txP 01 9 -7s '��o I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. . .c.: .—c.,;... ...,,� �, z�x. ...... ..'... Pritchard, Robert Jr. No19212 Permit for 1 1 2 story ................ .................................... 41 single family dwelling ............................................................................... Location Woodside Road ................................................................ West Barnstable ............................................................................... Owner Robert Pritchard, Jr. .................................................................. Type of Construction ......frame .................................... ................................................................................ Plot ............................ Lot ...... P................... Permit Granted ..........M$y...16................19 77 Date of Inspection 7 �/�7.. ................19 Date Completed ... 1..? ............19 PERMIT REFUSED ................................................................ 19 ............................................................................... ............................................................................... ............................................................................... ............................................................................... Approved ................................................ 19 ............................................................................... ............................................................................... Assessor's map and lot number ...... ....... Sewage Permit number .......................................................... TOWN OF BARNSTABLE S . MAS i B9flB9T11DLE, i 16 BUILDING INSPECTOR ®r V Dar a APPLICATION FOR PERMIT TO . TYPEOF CONSTRUCTION ......................: .:.....°......s.............................................................................................. ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..................... .................... ..... ... ...................................................` ................ .................... ` Proposed Use ...... � � � � _. Zoning District ...............................................Fire District �-�.... .... ......... ..... ..... Nameof Owner .........:.. ...... :...:.Address ........ ......................................................................... Name of Builder Address . .. ........ ........ ......... ........ ......... ......... .......... .. . .... .......... ......... ....... Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms `..................................................Foundation ...........................:.................................................. Exterior .... ........ ......... ........: ......... ......................Roofing ........ .. ................ Floors .Interior .......: ......... ............................................................... Heating ..................................................................................Plumbing ............. .11............................................................... Fireplace Approximate Cost .................................... ......... .......... ............ ... .............................................................. -—- �. . ... 5 Definitive Plan Approved by Planning Board -----------_____-----------19 Area ..........c��✓� Diagram of Lot and Building with Dimensions Fee ......... ................. SUBJECT TO APPROVAL OF BOARD OF HEALTH r Ij I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. o�:.c' : � .. ...�/. ,.� �� ...... U Pritchard, Robert Jr. A=l27��8 ^ ' ~ . . ' lg�l� ' l l�2 otor�^ � No _----.. Parmhfor ----— —---—-- ' f dwelling _______. ^ ' Location —^'...............................oad__^_______. __~___.Wmat.. table........................... ` . Owner Type of Construction . ^ ' . Plot , .. . . , ^ Permit Granted A May 16 19 77 ' . Dote of Inspection ....\k.........................19 ' Da— Completed_ --,— . ' PERMIT REFUSED _ .. . ............................................... . ' ' ' _____. . . . — ^� ... .............................. . —..~ ..�. ..................... @ � . " Approved ................................................ 19 . .—.,----.-----------------~-- . . � --------------------~—......, . ^ | ' ' 4 rJ W.I U, 10 fj c� G4� N1 � St�t�c �4w1L • ``� Pvv tO ilr L a T t l r � VJ LL• ! �UU DOF A1 WILLIA`A yam\ C. t� YE y �No. 19334 0 CEZT,1,F 1 aD P LcUTST PL..l11J ��ro sUR�yo4 LOGATiO" Wt;. ST- Qp�O�STAf3Z'c v l � *C>ATI= C-MAZTtK%( T"AT TWr ►J 'RE4:'aV-a ca WW EM" CoMPL VS WIT" TWF-- StD'E_Lt►-jE AUD SET$ACK VE-QU1tZeME;WTS OF -r"e 'tow►. O>~ �,A�',. 1 STA6t_C , QIJ 30U� Z3�1 PL�Gt . 13�7 DATE ►J E�/�7CTEtZ tF ►-rYE . REbIS"tT.-iZ�D LA►.Cp SU�vcYo25 T"IS V'LAW K LIOT BASE :) O►.1 A W OSTE��/iL_LE o �1,t;�4S5� 1I49MUAAEk,4T SvQvcY i "Tt•IE APPLt C-A, KbT Br-- USGc� To Oe•TCV-M414E LET t_t1�l�:.S Parcel Detail Page 1 of 3 ok t He ra 7 BARNSTA Opp 1G79. �a� I� I' \ '�+....,•` ," �En M„�a. ....:a" !_r���;J �ti`Gi%G�!�������� �,`•`�:'/)`3"' spy,, Logged In As: Parcel Detail Wednesday,July 18 2012 Parcel Lookup Parcel Info Parcel ID r127-008 ( Developer LOT 10 Lot Location 1184 WOODSIDE ROAD I Pri Frontage 1160 Sec Road I Sec F Frontage village IWEST BARNSTABLE I Fire District W BARNSTABLE Town sewer exists at this address NO I Road Index 1876 i Asbuilt Septic Scan: Interactive 127008_1 � Map ��Sr Z• ar Owner Info Owner 1PRITCHARD, ROBERT I Co-owner I%FELEGY, SCOTT& PATRICIA Streets 1184 WOODSIDE ROAD I Street2 city IWEST BARNSTABLE I State MA zip Fo-26681 Country I _J Land Info Acres 0.75 UseI Zoning INghbd 0105 Topography I Level I Road Paved Utilities Public Water,Gas,Septic I Location Construction Info Building 1 of 1 Year 1977 ( Roof Gable/Hip I Wood Shingle Built Struct Wall all s I Living 1516 I Roof Asph/F GIs/Cmp I Ac None Area Cover Type Style Wall Saltbox I ant Drywall I Bed Rooms 3 Bedrooms I F, r Model Residential Int Car et Bath.2 Full �` $` Foie. Floor p I Rooms I i Grade Average I Heat Hot Water ( Total 7 Rod— oms Type Rooms 1. Heat Found- Stories 1.5 Fuel Gas ation Typical I - Gross 3224 -I Area 1 Permit History http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=8141 7/18/2012 Parcel Detail Page 2 of 3 � r Issue Date Purpose Permit# Amount Insp Date Comments 11/21/1996 Remodel 119443 1$200 09/08/1997 00:00:00 Re kitche Visit History Date Who Purpose 02/16/2007 00:00:00 Paul Talbot Cyclical Inspection 09/08/1997 00:00:00 Lloyd Kurtz Meas/Listed-Interior Access Sales History Line Sale Date Owner Book/Page Sale Price 1 07/19/1976 PRITCHARD, ROBERT 2371/28 $0 2 05/10/2012 FELEGY, SCOTT&PATRICIA 26321/26 $283,000 - Assessment History Save# Year Building Value XF Value OB Value Land Value Total Parcel Value 1 2012 $105,600 $25,000 $5,500 $151,100 $287,200 2 2011 $133,200 $0 $0 $151,100 $284.300 3 2010 $132,400 $0 $0 $153,500 $285,900 4 2009 $152,000 $0 $0 $156,200 $308,200 5 2008 $171,400 $0 $0 $162,800 $334,200 7 2007 $165,400 $0 $0 $162,800 $328,200 8 2006 $144,200 $0 $0 $176,900 $321,100 9 2005 $135,200 $0 $0 $160,800 $296,000 10 2004 $109,800 $0 $0 $160,800 $270,600 11 2003 $98,500 $0 $0 $43,800 $142,300 12 2002 $98,500 $0 $0 $43,800 $142,300 13 2001 $98,500 $0 $0 $43,800 $142,300 14 2000 $77,000 $0 $0 $43,900 $120,900 15 1999 $77,000 $0 $0 $43,900 $120,900 16 1998 $77,000 $0 $0 $43,900 $120,900 17 1997 $73,900 $0 $0 $39,500 $113,400 18 1996 $73,900 $0 $0 $39,500 $113,400 19 1995 $73,900 $0 $0 $39,500 $113,400 20 1994 $74,300 $0 $0 $27,600 $101,900 21 1993 $74,300 $0 $0 $27,600 $101,900 22 1992 $84,300 $0 $0 $30,700 $115,000 23 1991 $82,100 $0 $0 $61,400 $143,500 24 1990 $82,100 $0 $0 $61,400 $143,500 25 1989 $82,100 $0 $0 $61,400 $143,500 26 1988 $65,400 $0 $0 $28,300 $93,700 27 1987 $65,400 $0 $0 $28,300 $93,700 28 1986 $65,400 $0 $0 $28,300 $93,700 Photos http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=8141 7/18/2012 Parcel Detail Page 3 of 3 ii w http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=8141 7/18/2012 Official Website of The Town of Barnstable - Property Lookup Page 1 of 3 Select Language Assessing Division Property Lookup Results - 2012 367 Main Street,Hyannis,MA.02601 ,,.1, <<BACK TO SEARCH< Print Friendly Owner Information-Map/Block/Lot:127/0081-Use Code:1010 Ak'z/ Owner Owner Name as of 111112 PRITCHARD,ROBERT Map/Block/Lot GIS MAPS BOX 1327 127/008/ All POCASSET,MA.02559 Property Address Co Owner Name 184 WOODS.IDE=ROAD 'C7-V'illage:-West Bamstable Town Sewer At Address:No Assessed Values 2012-Map/Block/Lot:127/008/-Use Code:1010 2012 Appraised Value 2012 Assessed Value Past Comparisons Building Value: $105,600 $105.600 Year Total Assessed Value Extra Features: $25.000 $25.000 2011•$284.300 Outbuildings: $5,500 $5,500 2010-$285.900 Land Value: $151,100 $151,100 2009-$308.200 200 -$3200 2007-$328.28,200 2012 Totals $287,200 $287,200 2006•$321,100 f Tax Information 2012-Map/Block/Lot:127 1 008/-Use Code:1010 Taxes Q �UJ W.Barnstable FD Tax(Residential)$775.44 nV Fiscal Year 2012 TAX RATES HERE Y ' r Community Preservation Act Tax $72.55 Q Town Tax(Residential) $2,418.22 $3,266.21 ," Sales History-Map/Block/Lot:127/008/-Use Code:1010 :1 �i ZA i y V v History: �1 Owner: Sale Date Book/Page: Sale Price: 1% PRITCHARD,ROBERT 7/19/1976 2371/28 $0 n�v Sketches-Map/Block/Lot: 127/008/-Use Code:1010 V" ` 't r,WDKt 1 t 2 f �{ 11 r F FOPI. 41r X, ✓ \ sBA$� 1��s.� 1,' •8 3, � l\n� �b �" � � •� `�� S CafdS.Click card#toview:Cefd#1 1 C ctions Details-Map/Block/Lot: 127/0081-Use Code:1010 ding Details Land �1 ilding value $105,600 Bedrooms 3 Bedrooms USE CODE 1010 nn� Total Improvements,4. $122,841 Bathrooms 2 Full Lot Size(Acres) 0.75 I ` �q/ Model ^t Residential Total Rooms 7 Rooms Appraised Value $151,100 ' Style �l1{• . Saltbox Heat Fuel Gas Assessed Value $151,100 /IGrade� Average Heat Type Hot Water 0 http://www.town.bamstable.ma.us/Assessing/propertydisplayscreen l 2.asp?searchparcel=12... 4/Q/2012 IOfficial Website of The Town of Barnstable - Property Lookup Page 2 of 3 .a Year Built 1 7�AC Type ot� ne Effective depreciation 14 Interior Floors Carpet Stories Interior Walls Drywall Living Area sq/ft 1,516 Exterior Walls Wood Shingle Gross Area sq/ft 3,224 Roof Structure Gable/Hip Roof Cover Asph/F Gls/Cmp Outbuildings&Extra Features-Map/Block/Lot:127/008/-Use Code:1010 Code Description Units/SQ ft Appraised Value Assessed Value FOP Open Porch-roof-ceiling 128 $4,200 $4,200 BMT Basement-Unfinished 1048 $20,800 $20,800 WDCK Wood decking 532 $5,500 $5.500 w/railings Sketch Legend Property Sketch Legend AOF Office,(Average) FTS Third Story Living Area(Finished) SFB Base,Semi-Finished BAS First Floor,Living Area, FUS Second Story Living Area(Finished) TQS Three Quarters Story(Finished) BMT Basement Area(Unfinished) GARGarage UAT Attic Area(Unfinished) CLP Loading Platform GRNGreenhouse UHS Half Story(Unfinished) CAN Canopy MZ1 Mezzanine,Unfinished UST Utility Area(Unfinished) FAT Attic Area(Finished) MZ2 Mezzanine,Semi-finished UTQ Three Quarters Story(Unfinished) FBM Finished Basement MZ3 Mezzanine,finished UUA Unfinished Utility Attic FCP Carport PAT Patio Outbuilding Listed UUS Full Upper 2nd Story(Unfinished) FEP Enclosed Porch PTO Patio WDK Wood Deck FHS Half Story(Finished) REF Reference Only WKO Wood Deck Outbuilding Listed FOP Open or Screened in Porch SDA Store Display Area a Print Friendly Contact Director of Assessing Jeffrey Rudziak P 508-862AO22 F 508-8624722 8:30a.m.to 4:30p.m. Helpful Links to Downloads Abatements Department of Revenue Exemptions Parcel Consolidation Questions about values Town Tax Rates-FY12 Town Land Use Codes s ,Helpful Maps All Town Maps Flood Insurance Maps Property Maps Contact Director of Assessing Jeffrey Rudziak P 508-862-4022 F 508-862-4722 8:30a.m.to 4:30p.m. Related Boards Board of Assessors Owned and Operated by The Town of Barnstable-Information Technology http://www.town.bamstable.ma.us/Assessing/propertydisplayscreen l2.asp?searchparcel=12... 4/2/2012 Official Website of The Town of Barnstable - Property Lookup Page 3 of 3 f, .f 1 Home I Departments&Services I Boards&Committees I Residents&Visitors I Doing Business Town Calendar Phone Directory Employment I Email Town Hall http://www.town.bamstable.ma.us/Assessing/propertydisplayscreen l 2.asp?searchparcel=12... 4/2/2012 ,..Engineering Dept.�(3rd floor) Map Parcel Permit# l q�4' 3 :. House# �� Date Issued ,Board of Health(3rd floor)(8:15 - 9:30/1:00-4:30) FeePIRMiRg .) OFtNE 1q;. 19 ''� BARNSTABLE. fo Mar Vare TOWN OF BARNSTABLE Building Permit Applicatio Village Owner ,e,Q 7: ��f T��9 i1 Address 13-7-7 Telephone ��3 - l„ Permit Request first Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ _2jod o y Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family k3 Two Family ❑ Multi-Family(#units) Age of Existing Structure q 77 Historic House ❑Yes No On Old King's Highway ❑Yes Q No Basement Type: &0 Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) �*6 , Basement Unfinished Area(sq.ft) = Z 1 Number of Baths: Full: Existing New Half- Existing New No. of Bedrooms: Existing New Total Room Count(not including baths): Existing •2New First Floor Room Count �t Heat Type and Fuel: 5 Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing 1,.-, New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE IC � C __ DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY • l a Ll PERMIT NO. Ll 3 DATE ISSUED- MAP/PARCEUNO.: l ADDRESS` j t ' VILLAGE OWNER i DATE OF INSPECTION: , FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH ` FINAL FINAL BUILDING _ • DATE CLOSED OUT r t ASSOCIATION PLAN NO. ' The Commonwealth of Massachusetts Department of Industrial Accidents ' - I Office AlfM.st/g.700S 600 11 ashington Street Boston, Mass. 02111 ' Workers' Compensation Insurance Affidavit A {-t'^� Ot:n tion= '� _ Please PRINT'legit � name Kn1,,g Incitinn / 52 o od to cc..? r-%P i +\ it. 1�„1Q i(9�$' �G�v nhnne if �S_r%3l 5 v I am a homeowner performing all work myself. C) 1 am a sole proprietor and have no one working_ in any capacity I am an employer providing workers' compensation for my employees working on this job.v� comP•tm•name: \ - address: city: phone 0: insurance co policy f! I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who �. the following workers' compensation polices: comr•tnv n•tme- itlres city• phone#• incur-ince co ram nn% name• addre c- city• phone ft- incur�ncc co nolicy a Attach -addititieal sheet if Ite IT!:—, +-4,r -'<-=' :ri:;.:: ::�' `"'-='� 'a--=-'• "''' - = -^�"`• ure iu secure cuvernge as required under Section 25A of INIGL 152 can lead to the imposition of criminal penalties of a fine uP to S1.500.110 andr unc rears' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I understand that copy of this statement ma%• be furwarded to the Office of investigations of the DIA for coverage verification. I do herehr certiJ uttdcr tlrc p 'ns mid pe�talties ojperjun•that the information provided above is true and correct. Date ���/y/s Si_naturc Print name 1` , Ale e T ��r �� ��• Phone# 3 i-5 �ofriciai use unh• do not write in this area to be completed by city or town oRcial city or town: permit/license 0 r111uilding Department C3Licensinr Board check if immediate response is required 05electmen's Office Qllealth Department contact person: phone it• r JOther , M1 .information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for:1 employees. As quoted tom the "la%% an einploree is defined as every person in the service of another under an% contract of hire, express or implied. oral or written. ' An eynplurer is defined as an individual. partnership, association. corporation or other legal entity. or any two or mt the foregoing enLn`_ed in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or tn►stee of an individual , partnership, association or other legal entity, employing employees. How6ver owner of a dwelling house hiving 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_ or oil the `rounds or building appurtenant thereto shall not because of such employment be deemed to be an emplo-, MGL chapter 152 seciion 25 also states that ever,• state or local licensing agency shall �vitliliold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapte: been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the boa that applies to your situation all, suppl\ing company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the aMda�it. 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 ream- to obtain a workers' compensation polio•, please call the Department at the number listed below. . City or 'foi-t•ns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the botton- the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. F be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returne the Department by mail or FAX unless other arrangements have been made. Tile Office of Investigations would like to thank you in advance for you cooperation and should you have any questi please do not hesitate to give us a call. The Department's address. telephone and fax number: €t= The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Wasiington Street Boston, Ma. 02111 fax #: (617) 727-7749 The Town of Barnstable Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only 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 ertain exceptions,along with other requirements. Type of Work: 6� Est.Cost Address of Work: Owner's Name /` O b Date of Permit Application: 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 agent of the owner: Date Contractor Name Registration No. OR Date / / Owner's Name TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB LOCATION- - Number Street address gection of town "HOMEOWNER" Z�:a �.s G - 2 Name Home phone Work pho e - - PRESENT MAILING ADDRESS /3 �. City town State Zip code The current exemption for "homeowners" was extended to include owner-occupied dwellings of six units or less and to allow such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Persons) who owns a parcel of land on which he/she resides or intends to re- side, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official on a form acGeptAble to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1. 1) The undersigned "homeowner" assumes ,responsibility for compliance with the Stat Building Code -and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands .,the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 0, Construction Control. y. HOME OWNER'S EXEMPTION The code state that: -`,"Any. -Home Owner performing work for which a building permit is. required shall be exempt from the provisions of this section (Section.' 109.1:>1 - Licensing of Construction Supervisors)'; provided that if Home. Owner engages a person(s) for hire to do such work, that such Home Owner shall act as supervisor. " Many Home Owners who use this exemption I are unaware that they are assuming the responsibilities of a supervisor (see Appendix 01 Rules and Regulations for licensing Construction- Supervisors, Section 2. 15) . This lack of awarenes often results in serious problems, particularly when' the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home 'bwner. actin as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her responsibilities, man communities require, as pa of the permit application, that the Home Owner certify that he/she understands the responsibilities of a supervisor. On the last page of this issue is- a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. P 229 805 . 343 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail(-Lee reverse Sent to Street&Number Post Office,State,&ZIP Code o ?. Postage $ Certified Fee Special Delivery Fee Restricted Delivery Fee LO Return Receipt Showing to Whom&Date Delivered Rehm Receipt Showing to Whom, Date,&Addressee's Address 10 TOTAL Postage&Fees $ M Postmark or Date 0 LL Cl) a CEStick postage stamps to article to cover First-Class oats certifl p g p postage, ed mall fee,and charges for any selected optional services(See front). 1.If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service m window or hand it to your rural carrier(no extra charge). m 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the m ! return address of the article,date,detach,and retain the receipt,and mail the article. 3. If you want a re rnturn receipt,write the certified mail number and your name and address � on a return receipt card,Form 3811,and attach it to the front of the article by means of the i gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. 4. It you want delivery restricted to the addressee, or to an authorized agent of the O O addressee,endorse RESTRICTED DELIVERY on the front of the article. CO)5. Enter fees for the services requested in the appropriate spaces on the front of this O) receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. li 6. Save this receipt and present it if you make an inquiry. n. r UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid LISPS Permit No.G-10 • Print your name, address, and ZIP Code in this box• TOWN OF B A R k S T A B L E BU I L D I N G D 1 V.I S 1 ON a l 367 MAIN ST HYANNI S MA 02601 �-C/ 8 s: GLJ• Q r , i �� ill��111111111111111111111111111 fit toil ItIII...11"i.,I'll111,11 SENDER: ■Complete items 1 and/or 2 for-additional services. I also wish to receive the H ■Complete items 3,4a,and 4b. following services(for an y •Print d toou.o name and address on the reverse of this form so that we can return this extra fee): Y d ■Aerm t this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address m ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery N ■The Return Receipt will show to whom the article was delivered and the date a delivered. Consult postmaster for fee. o •d v 3.Article Addressed to: 4a.Article Number d d � ¢ 2Z S 3 E - 4b.Service Type �O� 3 a� ❑ Registered ertified ¢ rn W ❑ Express Mail ❑ Insured c ¢ N 2 S51 G1-Aet�Receipt for Merchandise ❑ COD l—— J ' `• '' 7.Date of Delivery, •° a c z 0 5. eceived By: (Print 8.Addressee's Address(Only if requested r �� �� and fee is paid) co 6.Sig ure: (Address r Agent) o X N PS Form 3811;December-1994' '" ' " " � ' Domestic Return Receipt oFWE r s The Town of Barnstable • •nRrsrnste. • 9� ` Department of Health Safety and Environmental Services AfEOnne'tA Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner October 24, 1996 Robert Pritchard Box 1327 `. Pocasset,MA 02599 Re: 184 Woodside Road,W.Barnstable,MA Map/parcel 127/008 Dear Property Owner: A review of our records,including the permitting history of 184 Woodside Road,as well as the Zoning Board of Appeals records indicates that the use of that address as anything other than a single family home is illegal. You are hereby ordered to discontinue the use of the above referenced property as it is now being used and restore it to a single family home. You are to accomplish this work and notify this office to inspect within 14 days of your receipt of this letter. A building permit must be applied for to redesign the layout to accommodate the conversion. You must do this before you make any changes. You have the right to appeal this decision. If you so choose,we will be more than happy to help you. If we do not hear from you within the 14 days,we will be forced to seek criminal action against you. Very truly yours, loria M.Urenas Zoning Enforcement Officer GMU/km - i" CERTIFIED MAIL P 229 805 343 R.R.R Q960712B [ ] [R127 008 . ] LOC] 0184 WOODSIDE ROAD CTY] 03 TDS] 500 WB KEY] 69393 ----MAILING ADDRESS------- PCA] 1011 PCS] 00 YR]'0,0 PARENT] 0 PRITCHARD, ROBERT MAP] AREA] 82AC JV]' MTG] 0000 BOX 1327 SP1] SP21 SP31 UT11 UT21 . 75 ` SQ-, FT] 1516 POCASSET MA 02559 AYB] 1977 EYB] 1977 OBS] ? CONST] 0000 LAND 39500 IMP 73900 OTHER ----LEGAL DESCRIPTION---- TRUE MKT 113400 REA CLASSIFIED #LAND 1 39, 500 ASD LND 39500 ASD IMP 73900 -ASD OTH #BLDG(S) -CARD-1 1 73 , 900 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE #PL WOODSIDE RD W BARNS TAX EXEMPT #DL LOT 10 RESIDENT'L 113400 113400 113400 #RR 1876 0160 OPEN SPACE COMMERCIAL INDUSTRIAL EXEMPTIONS SALE] 00/00 PRICE] ORB] 2371/28 AFD] LAST ACTIVITY] 11/12/86 PCR] Y f, ROPERTV ADDRESS I I ZONING I DISTRICT CODE SP-DISTS.I DATE PRINTED I CSTATE I PARCEL LASS I PCS I NBHO KEY NO. 0184. WOODSIDE ROAD 0.3 RF 500 03WB 07/09/95 1011 . 00 82AC R127. 008. 69393 LANDIOTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS �, UNIT ADD.UNIT Land BylDale Size Dimonslon LOC./YR.SPEC.CLASS ADJ. COND. P PRICE PRICE Description VALUE Description PRITCHARD. ROBERT MAP- CO. FFAC INAbes . . #LAN D 1 39,500 CARDS IN ACCOUNT - 10 18LDG.SIT.1 x .7. =10 117 44999.9 52649.99 .75 39500 #BLDG(S)-CARD-1 '1 73.900 01 OF 01 a #PL WOODSIDE RD W BARNS OST _113400 BATHS 1 .0 U X C=' 100 3500.00 3500.00 1.00 3500 B #DL LOT 10 4ARKET 9.3700 #RR 1876 0160 INCOME A SE PPRAISED VALUE 113,400 "ARCEL SUM U AND 39500 T LDGS 73900 -IMPS M OTAL 113400 - E - CNST _ N DEED REFERENC Type DATE Rar•woad R I O R YEAR VALUE T Book Page In91. MO. Vr.D Sales Pr ce -AND 39500 � S 2371/28 1 00/00 LDGS 73900 1 OTAL 113400 i � I BUILDING PERMIT ESTIMATED-83 NumGer Dale Arrount 3 LAND LAND-ADJ INCOME SE SP-BLDS FEATURES BLD-ADJS UNITS Tyq .39500 3500 Cons". Total e r B ill Norm. Ods. Class .is Vni19 Bose Rate Adj.Rote A Age Depr. Cond. CND Loc %R.G Repl Cos"New A01 Repl Value Slwies Heignt Room9 Rma Balna /Fix. Partywall Fec. 01C. 000 105 105 59.40 62.37 77 77,17 83 100 83 89029 7390U 2.0 5 2 1.0 4.0 Description Raw Sauer.Feet R.pl.Cost MKT.INDEX: 1 00 IMP.BY/DATE: / SCALE: 1/0 0.69 ELEMENTS CODE CONSTRUCTION DETAIL BAS . 100 62.37 468 29189 DWELLING CNST GP:00 820 60 37.42 468 17513 *--------26-------*. STYLE _ _ 12 ALTBO_ ___X 0.0 1S8. 100 62.37 580 36175 ! � " ESIGN ADJMT _01 ESI6N ADJUST 5.0 t FWD 85 8.50 312 2652 ! 12 XTER,CJALL:S _01 OOD FRAME 0.0 FWD ! LAf/AC TYPE 02 AS ---------------0.-0 AI• TcR.FI1VISH 00 __ - 0.0 *--------26----46-*------------* ! 1 SB ! " NTER.LAY60T-_ -0f ------------------_0.6 ! ! ' ATz_R:oUACTY 112 AWIE AS EXTER. 0.0 j 16 LDOft STRUCT 60 0.0 W 40 ! E LDotF COV€R-- -00 ------------------0.-0 ' E TelalAre.a Aua_ 312 Be... 104$ -*--r----26-------* ODF-"._TPA --__--_ Q0 ------------------0.0 --- - - -(for::DIMENSIONS 2$ 6 ! L E C TR I C A L 60 0.0 T SAS N18 E26 S18 W26 .: 1SS N18 ! *-----20-----* . OUN6aTI0N- - OQ -- ---- - q�=q ----- - --- - E26.SO6 E20 N16. W46 S10 S18 1SB 18 BASE 18 --------------- --- ---------------------- FWD N28 E26 N1 2 W26 S12 S28 ! ! " --IdEIG?fSORH 66 BTRC-i1I:ST_:Vk9ASl A0 L ! ! LAND TOTAL' MARKET ! PARCEL 39500 ' 113400 Xr-------26-------*: AREA :19293 VARIANCE +0 +488 STANDARD 25 I f RESIDENTIAL PROPERTY MAP NO. t LOT NO. FIRE DISTRICT SUMMARY STREET Woodside Rd. W. Barns. W.B.127 8 LAND S oo � 7 BLDGS. OWNER .— TOTAL 2 CIO ... . 9 LAND 9sd • RECORD OF TRANSFER DATE SK PG I.R.S. REMARKS: Lot 10 �" BiOGS. 2.37S TOTAL , ,,NAQ 30700 ! Rp LAND �l��d ! BLDGS. z9�p0 - Pritchard', Robert, .Jr. -19-76 2371 28 6 000 TOTAL LAND BLDGS. y' TOTAL LAND I r•i. - BLDGS. r ;;t,• ;- ,'� y� .6,fhl t �,9 8a� c.rwp TOTAL 1 7 LDS a LAND f L S' �i9��_ O) BLDGS. TOTAL j LAND BLDGS. ch• _ _ � TOTAL LAND + ".INTERIOR INSPECTED: � — � � BLDGS. j b TOTAL > DATE: -� LAND ACREAGE COMPUTATIONS 01 BLDGS. i I„ LAND TYPE # OF ACRES PRICE TOTAL DEPR. VALUE TOTAL HOUSE LOT LAND 'CLEARED FRONT �p �j D BLDGS. j 1. REAR TOTAL ! WOODS&SPROUT FRONT LAND + REAR � BLDGS. WASTE FRONT Y11 wasO TOTAL REAR now �oZ 7 - •�•d /a �27 LAND ) 0) BLDGS. TOTAL LAND 1 - O) BLDGS. LOT COMPUTATIONS LAND FACTORS — TOTAL F FRONT DEPTH STREET PRICE 'DEPTH% FRONT FT.PRICE TOTAL DEPR. COR. INF. VALUE HILLY TOWN SEWER LAND ROUGH TOWN WATER BLDGS. HIGH GRAVEL RD. TOTAL r LOW DIRT RD. LAND ! ° - SWAMPY NO RD. BLDGS. f! I FOUNDATION BSMT. & ATTIC PLUMBING PRICING . . . LAND COST !, Oonc.Walls ✓ Fin.Bsmt.Area Bath Room s/ Base 3,O BLDG.COST ",Cone.Blk;Walls a" Bsmt.Rec.Room St.Shower Bath Bsmt._ ( ' PURCH. DATE Conc.Slab Bunt.Garage I S St. Shower Ext. Walls PORCH.PRICE. Brick Walls Attic Fl.&Stairs Toilet Room Roof RENT Stone Walls Fin.Attic Two Fixt.Bath Floors ' Pier_ INTERIOR FIN I H Lavatory Extra /$� Bsmt. F , T 2 3 Sink I T%Isu - �- / poo % 1/2 - 1/4 . Plaster Water Cie.Extra Attie /!s EXTERIOR WALLS Knotty Pine Water Only ` Double Siding Plywood No Plumbing Bsmt.Fin. Single Siding Plasterboard Int. Fin. Shingles TILING A10 ' Cone.Blk. Gj F P Bath Fl. Heat f pR 3 0 p Z G Face Brk.On Int.Layout Bath Fl.&Wains. J�o Auto Ht.Unit Y' ` Veneer Int.Cond. Bath Fl.&Walls Fireplace 7` / 00400 ' Com.Brk.On HEATING Toilet Rm.Fl. 1 Plumbing 7L �0 Zeo S •Solid Com:Brk, Hot Air Toilet Rm.Fl.&Wains. '+ Tiling Steam Toilet Rm.Fl.&Walls t Blanket Ins. Hot Water /-/ f/ St.Shower .t Roof Ins. Air Cond. Tub Area Total if .�Floor Furn. ROOFING 3 ZONX COMPUTATIONS 'AspA.Shingle Pipeless Furn. 6 S.F. 0O 7A , Wood Shingle No Heat 6?0 S.F. /Q ""Asbs.`Shingle Oil Burner S.F. ' Slate Coal Stoker S F Tile Gas S F OUTBUILDINGS I ROOF TYPE Electric Gable Flat S.F. 1 2 .3 4 5 6 7 8 91101 1 2 3 4 5 6 7 8 9 10 MEASURED HE Mansard FIREPLACES S.F. Pier Found. Floor Gambrel Fireplace Stack / ✓' Wall Found. 0.H.Door LISTED FLO RS Fireplace / Sgle.Sdg. Roll Roofing Syr/ Conc. LIGHTING Dble.Sdg. Shingle Roof T, =Tile No Elect. DATE Shingle Wells Plumbing `Z e9,71 r ROOMS Cement Blk. Electric Bsmt. 1st Lj/ TOTAL BrickInt. FinishJ. IPRICED 2nd 3rd FACTOR , y S `1 3 T3R REPLACEMENT 3 0 OCCUPANCY CONSTRUCTION SIZE AREA CLASS AGE REMOD. COND. kEPL. VAL. Phy.Dep. PHYS. VALUE Funct.DeP. ACTUAL VAL. DWLG. F/� 2 s�' r,7 F $ if-1 Ex 30 S .2-9716, 1 - i 2 3 1� 4 l d 5 '6 1 7 y B # 9 II 10 '* TOTAL t j JOSEPH D. DALuz ._ - - - 7-90-622T Building Commfaiongr TELEPHONEe Rx3frXNM XX7S)= TOWN OF BARNSTABLE BUILDING INSPECTOR TOWN OFFICE BUILDING HYANNIS. MASS. 02601 April 18, 1991 Mr. Robert Pritchard P. 0. Box 1327 Pocasset, MA 02559 RE: A=127-008 184 Woodside Road, West Barnstable Dear Mr, Pritchard: This office is in receipt of a written complaint re the use of your dwelling located at 184 Woodside Road, West Barnstable. Please contact this office immediately re the above matter. Peace, J Z h D. DaLu Building Commissioner JDD/gr cc: Town Manager Certified mail: P 317 333 791 R.R.R. R127 008 . A P P R A I S A L D A T A KEY 69393 PRITCHARD, ROBERT LAND BLD/FEATURES BUILDINGS NUMBER ZN/FL=RF 39, 500 73 , 900 1 A-COST 113 ,400 B-MKT 93 , 700 BY 00/ BY /00 C-INCOME PCA=1011 PCS=00 SIZE= 1516 JUST-VAL 113 , 400 LEV=500 CONST-C 0 ----COMPARISON TO CONTROL AREA 82AC ----------------------------- NEIGHBORHOOD 82AC WEST BARNSTABLE PARCEL CONTROL AREA TREND STANDARD 101 10 LAND-TYPE 395001 LAND-MEAN +Oo 1134001 96467 IMPROVED-MEAN -230 250-. ] FRONT-FT ] 100 DEPTH/ACRES TABLE 02 10096] LOCATION-ADJ APPLY-VAL-STAT 1 LNR] LAND LFT/IMP] ADJS/SB/FEAT STR] STRUCTURE ARR] AREA-MEASUREMENTS NOR] NOTES COM] MARKET INC] INCOME PMR] PERMITS GRR] GRAPHIC FUNCTION- [ ] STRUCTURE-CARD NO- [0 0 0] DATA- [, ] XMT [?] R127 008 . P E R M I T [PMT] ACTION [R] CARD [000] KEY 69393 000000001 PERMIT-NO MO YR TYPE VALUE CK-BY MO YR %CMP NEW/DEMO COMMENT