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0050 HI RIVER ROAD
�d /'� I `I P ;�r:_4;;��.. r x_� 1 {� � l'r ��� `Vv. `'1\`O'�UMM//� V� Assurant Use Only I VID# 89910 I WO# 24199060 I PID# 2111379 I Regular Mail Town of Barnstable 1200 Main St. I Hyannis I MA 1 02601 1 508-862-4038 REGISTRATION AND CERTIFICATION FORM FOR FORECLOSING/FORECLOSED PROPERTY Thank you for registering in accordance with Town of Barnstable Code chapter 224 sections 224-3 and 224-4. Please complete one form for each property in foreclosure (section 224-3) or already foreclosed for which possession has been taken (section 224- 4). Please file the original with the Building Commissioner and a copy with the Chief of the Fire District in which the property is located. If you claim you are exempt from registering under Massachusetts law,please state the reason(s) and complete section 1 (property information)and the first paragraph of section 2 (foreclosing party,court, etc. and foreclosing party representative,but not other representatives and attorney) so that the Town can review the exemption and update its records: N/A Section 1 —Prop=Information 50 HI River Rd Property Address: Marstons Mills MA 02648-1767 Assessors Map#: N/A Parcel#: M060L011002 Land area and description N/A o za Building(s)description and contents N/A CI Occupied: N/A Occupant(s)(if borrowers so state and include name(s)) N Borrower,if known: FILKINS JOANNE y Phone: N/A email: N/A other: Vacant: Yes Date: Anticipated Length of Vacancy: N/A Last occupant(s))(if borrowers so state and include name(s)) N/A Phone: 800-468-1743 email: AFSVPR@xome.com other: Has possession been taken Yes If so,please explain and complete and file the maintenance and security plan form(unless exempt as stated above) The property is vacant and will be maintained. Section 2—Foreclosing PgM Information Foreclosing Party(full name/title) Mr.Cooper Foreclosure Case Court: N/A Docket# N/A Please forward all notices/confirmations to AFSVPR@assurant.com, 101 W Louis Henna Blvd,Ste.400,Austin,TX 78728,800-468-1743. PID# 1 2111379 Date filed: N/A Current Status: N/A Foreclosing Party's representative(s) for property(entry,management,repair, etc.)(name,title,):Assurant Field Services c/o CHRISTOPHER SIDEMAN Company(if different from foreclosing party): Assurant Field Services Address:268 MAMMOTH RD,LOWELL,MA 01854 Phone: 800-468-1743 email: AFSVPR@xome.com other: If an exemption is claimed,please do not complete the remainder. Other representative(s)(if foregoing representative is primarily responsible for property and/or foreclosure and is most likely to be able to address town matters concerning the property and/or foreclosure,please so state and do not complete contact information(i. e."none"or"see above")). Name,title, other: N/A Company(if different from foreclosing party): N/A Address: N/A Phone(s): N/A email(s): N/A other: Name,title, other: N/A Company(if different from foreclosing party): N/A Address: N/A Phone: N/A email: N/A other: Attorney representing foreclosing party N/A Firm name(if different from attorney's name): N/A Address: N/A Phone(s): N/A email(s): N/A other: I acknowledge that the information provided is accurate and correct. I also understand that any inaccurate information will result in non-compliance with section 224-3 of chapter 224 of the Code of the Town of Barnstable. - Date: December 27,2018 Name: Eric Knudtson Title: Assurant Field Services Manager Please forward all notices/confirmations to AFSVPR@assurant.corm 101 W Louis Henna Blvd,Ste.400,Austin,TX 78728,800-468-1743. PID# 2111379 I hereby certify that the above-named foreclosing party is in compliance with the provisions of section 224-3 of chapter 224 of the Code of the Town of Barnstable. Date: Building Commissioner, Town of Barnstable i ASSURANTO BUILDING PLAN / STATEMENT OF INTENT Occupancy Status: -Occupied Building Plan Property Address: 50 HI River Rd Marstons Mills MA 02648-1767 I AS OF: December 27,2018 THIS BUILDING PLAN SERVES AS OUR STATEMENT OF INTENT TO MAINTAIN,SECURE,AND INSPECT PER ORDINANCE. THIS PROPERTY WILL NOT BE DEMOLISHED. THIS PROPERTY WILL BE LISTED FOR SALE. IF OCCUPIED,THE PROPERTY WILL BE INSPECTED ON A MONTHLY BASIS UNTIL VACANCY. OWNER CONTACT: Mr.Cooper 350 Highland Dr., Lewisville,TX 75067 AGENT CONTACT IS: ASSURANT FIELD SERVICES 101 WEST LOUIS HENNA BLVD.STE.400 AUSTIN,TX 78728 T: 800-468-1743 E:AFSVPR@assurant.com A�ORO® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/D0IYYYY) osns/zola THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDEFIL 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.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this w certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACTNAME: Aon Risk Services Southwest, Inc. PHONE (866) 283-7122 FAX (800) 363-0105 m Dallas TX office (AIC.No.Ext): AI,.No.: n CityPlace Center East EMAIL p 2711 North Haskell Avenue ADDRESS: _ Suite 800 Dallas TX 75204 USA INSURER(S)AFFORDING COVERAGE NAIC p INSURED INSURER A: Great Northern Insurance Co. 20303 Nationstar Mortgage Holdinqs, Inc. INSURER Bi Chubb Indemnity Insurance Co. 12777 8950 Cypress waters Blvd Dallas TX 75063 USA INSURERC: XL specialty Insurance Co 37895 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:570072097262 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. Limits shown are as requested LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDAI-M fMPO1UD`Dy1AYXYPYl LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADE X❑OCCUR DAMAGE TO RERTEIT-PREMISES Ea occurrence) $1,OOO,OOO MED FRCP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 0 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,0001000 m POLICY X❑PRO- ❑X LOC PRODUCTS-COMP/OPAGG IncludedJECT n OTHER: o r A AUTOMOBILE LIABILITY 73542588 07/11/2018 07/11/2019 COMBINED SINGLE LIMIT $1,000,000 'n Ea accident IXX ANYAUTO BODILY INJURY(Per person) Z OWNED SCHEDULED BODILY INJURY(Per accident) dt AUTOS ONLY AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE v ONLY AUTOS ONLY Per accident 0) C X UMBRELLA LIAB H OCCUR US00079378LI18A :7/11/2018 07 11 2019 EACH OCCURRENCE $25,000,000EXCESS LIAB CLAIMS-MADE AGGREGATE $2S,000,OOO DED RETENTION B WORKERS COMPENSATION AND 717O17H5 7.1 2016 07 11 2019 PER OTH- EMPLOYERS'.LJASILITY y I N X STATUTE ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500,000 OFFICERIMEMBER EXCLUDED? N NIA (Mandatory in NH) E.L.DISEASE-FA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000- DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached B more apace is required)- - - - -- 6a Ai 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. Nationystar Mortgage LLC AUTHORIZED REPRESENTATIVE 8950 l TX pres75019ersABlvd. IQCM �� p�Q .o Q _ sJ'LrDlr�c clile Y�heur�JL 1&1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD I f p REGISTRATION AND CERTIFICATION FORM z FOR FORECLOSINGNORECLOSED PROPERTY O Thank you for registering in accordance with Town of Barnstable Code chapter' 4 w z sections 224-3 and 224-4. Please complete one form for each property in foreclo ure t (section 224-3)or already foreclosed for which possession has been taken(sectio 224- 00 4). Please file the original with the Building Commissioner and a copy with the hief of N the Fire District in which the property is located. w If you claim you are exempt from registering under Massachusetts law, please state the reason(s)and complete section 1 (property information)and the first paragraph of section 2 (foreclosing party, court, etc. and foreclosing party representative, but not other representatives and attorney) so that the Town can review the exemption and update its records: I Section 1 —Propeqy Information Property Address: 50 HI RIVER ROAD, MARSTON MILLS,MA 02648 Assessors Map #: 060/011/002 Parcel #: Land area and description Building(s)description and contents 1.5 STORY RESIDENCE Occupied: X Occupant(s)(if borrowers so state and include name(s)) (BORROWER/HOMEOWNER)JOANNE FILKINS Phone: UNKNOWN email: other: Vacant: Date: Anticipated Length of Vacancy: Last occupant(s))(if borrowers so state and include name(s)) Phone: email: other: Has possession been taken If so, please explain and complete and file the maintenance and security plan form (unless exempt as stated above) Section 2—Foreclosing PaM Information Foreclosing Party(full name/title) MR.COOPER Foreclosure Case Court: Docket# a 1 Date filed: 1/3/2018 Current Status: FORECLOSURE Foreclosing Party's representative(s) for property (entry,management,repair, etc.)(name,title,): Company(if different from foreclosing party): Address: Phone: email: other: If an exemption is claimed,please do not complete the remainder. Other representative(s) (if foregoing representative is primarily responsible for property and/or foreclosure and is most likely to be able to address town matters concerning the property and/or foreclosure,please so state and do not complete contact information(i. e. "none"or"see above")). Name, title, other: Company. (if different from foreclosing party): CYPREXX SERVICES.LLC Address: 3804 COCONUT PALM DRIVE,TAMPA, FL 33619 Phone(s): 877-339-8202 email(s): VPR@CYPREXX.COM other: Name,title,other: Company (if different from foreclosing party): Address: Phone: email: other: Attorney representing foreclosing party Firm name(if different from attorney's name): Address: Phone(s): email(s): other: I acknowledge that the information provided is accurate and correct. I also understand that any inaccurate information will result in non:compliance with section 224-3 of chapter 224 of the Code of the Town of Barnstable. C/O CYPREXX SERVICES, LLC FOR Date: 1/15/2018 MR.COOPER Name:, JAMIE RAY Title: VPR COORDINATOR I hereby certify that the above-named foreclosing party is in compliance with the provisions of section 224-3 of chapter 224 of the Code of the Town of Barnstable. Date: Building Commissioner, Town of Barnstable 1 I i DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 07/2512017 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. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate w does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT 4) PRODUCER � � AOn Risk Services Southwest, Inc. NAME: PHONE Dallas TX office tAJC.No.Ext: (866) 283-7122 aC.No.: (800) 363-010S 13 City Place Center East E-MAIL _ 2711 North Haskell Avenue ADDRESS: Suite 800 Dallas TX 75204 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Great Northern Insurance Co. 20303 Nationstar Mortgage LLC INSURERS: Chubb Indemnity Insurance Co. 12777 8950 Cyypress waters Blvd Coppell, TX 75019 USA INSURERC: XL Specialty Insurance Co 37885 INSURER D: INSURER E: INSURER F: COVERAGES 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 B ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUC POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested LTR TYPE OF INSURANCE SUBR VD POLICY NUMBER O C O C UNITS A X COMMERCIAL GENERAL LIABILITY 3589376 07 Oftpffff EACH OCCURRENCE $1,000,000 CLAIMS-MADE ❑X OCCUR PREM SES(Ea occurrenra) $1,000,000 MED EXP(Any one person) $10,000 PERSONAL BADVINJURY $1,000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S2,000,006 POLICY ❑X JET ❑X LOC PRODUCTS-COMP/OP AGG Included OTHER: A AUTOMOBILE LIABILITY 73542588 07/11/2017 07/11/2018 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) 0 OWNED SCHEDULED BODILY INJURY(Per accident) Z AI ONLY X HIREDED AUTOS r AUTOS NON-OWNED PROPERTY DAMAGE Al ONLY AUTOSS ONLY (Per accident) t d C X UMBRELLAUAB X OCCUR US00079378Li17A 07/11/2017 07/11/2018 EACH OCCURRENCE $10,000,000 t) EXCESS UAB CLAIMS-MADE AGGREGATE $10,000,000 DED RETENTION B WORKERS COMPENSATION AND 71701785 07/11/2017 07/11/2018 X I PER STATUTE I OTH- EMPLOYERS'LIABILITY YIN ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S500,000 OFFICER/MEMBER EXCLUDED? N N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500,000 It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S500,00 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101.Additional Remarks Schedule,may be attached If more space is required) 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. Nationstar Mortgage LLC 8950 Cypress Waters Blvd. AUTHORIZED REPRESENTATIVE Coppell,TX 75019 USA Qd C YL ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD CAPE COD INSULATION m1t OtA3s SUMLUs sMAYMAM 3UMNOW \AT pylT�g3 INSYSATp31 p131N(IS 1-800-696-6611 Town of Regulatory Services n�l, Building Division �(C Address - Address 2 - Date: _ ( s- 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 ` JU�N1`� �•\�/�iN.� S� l-�1 (�iJ-(f` �. Mr41'3 i/Y�1IU Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings 3v ) ( ) (X} Slopes ( } ( ) ( ) ( ) ( > Floors ( } ( ) ( ) ( ) ( ) Walls ( ) ( ) ( ) ( ) ) Sincerely cn Henry E Cass' y Jr, President v Cape Cod Insulation, Inc. �u M i • Town f Barnstable *��Isd 6 o a nstable Permit# „y� 0 Expires 6 months from issue dame rT Regulatory Services Fee �3 S + snaxsrnaM M"M m� Richard V.Scali,Director �o � > 'plE1639.D p� K-Ftic1L� � L1 EDPSI�U ,Building Division Tom Perry,CBO,Building Commissioner JUL 2 2 2015 ©� 200 Main Street,Hyannis,MA 02601 TOWN OF B A R N STA B L E www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address ❑Residential Value of Work D Q Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address �06S Contractor's Name L a\""_ Z pV-`,_� L r_Que.m--e , Telephone Number Sb� —S�9 b27 Home Improvement Contractor License#(if applicable) Email: L L nwAl-If 1_M prryy Qwi.el�i✓y �� Construction Supervisor's License#(if applicable) (P P 1 Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. 'Note: Properly Owner must sign Property Owner Letter of Permission. copy of the Home Improvement Contractors License&Construction Supervisors License is e uired. SIGNATURE: Q:\WPFILES\FORMS\building Permit orms\EXPRESS.doc Revised 040215 n 77te CommomveaIth of 1Wassachusetfs Deparament of Indus&ial Acciderrjtr ©,ice of Lmwstigadons 600 Washington Street Boston,M4 02111 wwvtu niassgovIdia Workers' Campensatian Insurance Affidavit:Bi ilders/ContractarsJEIectricians/Plumbers Applicant Infarmatian Please Print fegibIy Nate tBus�esslDtganizatianllndivic}nil): �i� �`t��. /yl�'OueM 2e( Address: c)l - L(-_C&hd oa K Ed City/Scat Mp= -e 5 Tc�a 4 0 z Phone 41k_ Are you an employer?Check a appropriate btu: Type of project(required): I. I am a employer with 4. ❑ I am a general contractor and I 6. ❑New constructim employees(full and/or part-time)-* have hired the sub-contractors I❑ I am a sale proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees. These sub-contractors have g. ❑Demolition w Q for me n an c employees and have wodcers' cueo i Y �1 9. ❑Building addition [NO lYoflcerS'comp-insurance comp.m¢rrrart. required-] 5. ❑ We are a corporation and its 10.❑Electrical repairs or addition 3.❑ I am.a homeomer doing all work officers have exercised their 11.❑Plumbing repairs or'additions myself[No workers'camp- right of exemption per MGL 12.❑Roof repairs insurance required,]a c.152,§1(4),and we have no employees.[No workers' 13.0 Other comp.insurance required.] 'Any appticsat Beat checks box g1 mast also fill out the section below showing their wu&ere compensation policy information_ Homeowners who submit This affidatdr;ndryr=g they ue domg all wank anti d en hie outside contmcfarsmnst submit a new affidadt indicating rnrli IContractors that rhea this box must attached au sdditianal street shoring the name of the mb-co=zctm sod state whether ar not those entities have employees.Ifthesub-contractors have employee%they mustptvridetheir workea'{mnp.palkynumber- I am art eitiployer that is providirtg workers'cot gmnsafivtt insurance-for itzy cHiplo3�ees. Below is the pa cy imd job site information. Insurance Company Name: 0A \C Policy or Self-ins.Lic_ Ekpiration Date: 2 I Job Site Address: �� l � V E'v' t�C` City/StatelZip:_Z Gi 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$150D.00 andlor one-year imprisoumeut,as we11 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 maybe forwarded to the Office of Investigations of the DIAL for insurance coverage verification_ I do hereby cm fy u. thapain az penahYes ofpelury that Ste information provided aboire is bare and correct SiM23t2re: Date: -7115LI 5 Phone ik Offici rl use only. Do not avrite in thus area,to be completesd by city ortOirn of(frciaL City or Town: Pernutllicense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.C tyffown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone 9: ; oft Information and Instructions Massachusetts Geaeaal Laws chapter 152 requires all employers to provide wormers'compensation for them employees. pursuantto this stye,aa.empkg ee is defined as.--every person in the service of another under any contract of bire, express or impphecl,oral or wrh=L" An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more Of the foregoing engaged in a Joint mt rprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of tare - dwelling house of another-who employs persons to do maintenance,construction or repair worm on such dwelling house or on the grounds or btnlding appurtenaiit thereto shall not because of such employment be deemed to be an employer." MCYL chapter 152,§25C(.6)also status that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance.covearage required_" Additionally,MGM chapter 152, §2SC(7)states"Neither the commaaweatth nor any of ifs political subdivisions shall enter into any contract for the perf6imance ofpublic woricuntil acceptable evidence of compIiancewith the insurance. requirements of this chaptPa have been presented to the conf w,tinoa authodty_" Applicants Please fill out the workers'compensation affidavit completely,by chc T ng the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s), address(es)and phone numbers)along with their cer d—acat*)of insunce. Limited Liability Companies(LLC)or Limited l other than Liability Partnerships(LLP)with no empoyees er an ra the members or partners,are not rbquired to carry wormers' compensation insurance. If an LLC or LLP does have employees, a policy is required. B e advised that this affidaYrt may be submitted to the Department of Industrial Accidents for confIImation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be retinned to the city or town that the application for the permit or license is being requested,not the Department:of Term,�triat Accidents. Should you have any questions regarding the law or if•you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-rosined companies should enter their s elf-h sm-d ce license number on the appropriate line. City or Town Officials . Please be sure that the affidavit is complete and printed leg21Iy. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the per it/liceuse number which will be used as a reference number. In addition,an applicant that must,submit multiple permit/license applications in.any given year,need only submit one affidavit iadiratmg current policy information.Cif accessory)and under"Job Site Address"the applicant should write"all locations in (city or town)-"A copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the applicant as proof that a valid affidavit is on file for fut¢-re permitr or licenses A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial veutire (it_,a dog license or permit to bum leaves etc.)said person is NOT requ red to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The DeReitrunfs address,telephone and fax number. TbL- Weattb�of Mamachu&tM , Deparbnent dhiduskdal Accidents Ofitce of fltve&tfoliol 6Q�� tQn t Bastan�MA G1 I I I TeL 4 617 727-49W=t 406 ar 1-V7 MASS Fax 9 617-727 7M Revised 424-07 ww imas,,,�gwldia i oFTHE t� anaxsrABM ,. Town of Barnstable Regulatory Services Richard V.Scali,Director Building Division Thomas Petry,CBO Building Commissioner . 200 Main Street, Hyannis,MA 02601 www.town.barnstable.m a.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section. If Using A Builder I , as Owner of the subject property hereby uthorize �C y l'��" to act on my behalf, in all ma rs relative to work authorized by this building permit application for: (Address of Job) qc tune of Owner Date � 1 V �P)int Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. QAWPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 Town of Barnstable Regulatory Services °FV�E rO Richard V. Scali,Director • ° Building Division • santasr i;m Tom Perry'Building Commissioner MASS $ 1639. 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 C HOMEOWNER LICENSE EXEMPTION 1 DATE: 1 J I 1 Please Print ll n V- ` JOB LOCATIO \1 K 4 v�� (� N (kh n i 5 number street village "HOMEOWNER . homOA)tn r e phon # rk hone# . CURRENT MAILING DRESS: -22 ,�`�p �,�, o�`GJ l•�t w V cityttown state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,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 acceptable 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 State Building Code and other applicable codes, bylaws,rules and regulations. 4Thegned"hom own r"certifies�that he/she understands the Town of Barnstable Building Departmentminimum inspection and require en d that he/she will comply with said procedures and requirements. omeowner App valof Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner 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 the homeowner engages a person(s) for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix,Q,Rules &Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. . To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner 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 t amend and adopt such a form/certification for use in your community. Q:\WPFILF,S\FORMS\building permit formsENPRFSS.doc Revised 040215 • 1 t 3 3 3 • k ' 4 1 ✓�ie Toomvnzoou�eall/z /�iraaaclauoet�; t: Oflice.of Consumer Affairs& B sines Regulation ' License or registration valid for individul use o HOME IMPROVEMENT .CONTRACTOR. my before the ex�ir�tion date. If found return to; - Registration f,�172172 1 � ' Expiration: �5/31/2016 Type: :':.T3ffcc:pf.CPusurrier Affairs iind-Busiiics's'Rcgulation DBA 10 Park Plaza'-suite 5170. LO HOME IMPRO =" Boston,MA 02116 VEMENT < t SCOTT LOHR 23 GRAND OAK RQy^ FOREST DALE, MA'02644 Undersecretary s J without signature Massachusetts -Department �`— of Public Safety Board of Building Regulations and Standards ��r�itrLialir7 Sil�rei v754r . License: CS-053961 SCOTT A LOHR 23 ern oAIC tip Foriestdale MA 0U44 Commissioner Expiration 06/09/2017' n' i (540 unread)-lohrhomeimprovement-Yahoo Mail 6/30/15,2:43 PM L , Certificate.pdf Download 1 of t ,aco CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTII CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORD BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSU REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does I certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Erica H O'Connor NAME: HART INSURANCE AGENCY,INC. NAME: 243 MAIN STREET 508 759 7326 x205 PO BOX 700 E-MAIL ADDRESS: BUZZARDS BAY,MA 025320700 INSURERS AFFORDING COVERAGE INSURERA: PENN-AMERICA INS CO INSURED Scott Lohr dba Lohr Home Improvement INSURERS, ACADIA INSURANCE COMPANY 23 Grand Oak Rd INSURER C Forestdale,MA 026" INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUM THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE R INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJE( EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER POLICY EFF POLICY EXP LTA TYPE OF INSURANCE InIL POLICY NUMBER MM/DD/YYY M/DD/YY A GENERAL LIABILITY Y PAV0052901 05/15/2015 05/15/2016 EACH OCCURRENC DAMAGE TO RELATE ft—lo MMERCIAL GENERAL LIABILITY PREMISES Ea occu CLAIMS-MADE V OCCUR MED EXP one PERSONAL&ADV II GENERAL AGGREG GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP POLICY PRo- LOC AUTOMOBILE LIABILITY COMBINED SINGLE Ea acci ent ANY AUTO BODILY INJURY(Pe ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Pe HIRED AUTOS NON-OWNED PROPERTY DAMAG AUTOS Per accident UMBRELLA LIAR OCCUR EACH OCCURRENC EXCESS LIAR HCLAIMS-MADE AGGREGATE DED I I RETENTION B WORKERS COMPENSATION WC202000555900 03/26/2015 03/26/2016 Z WC STATUS AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNEWEXECUTIVE E.L.EACH ACCIDEf\ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory In NH) E.L.DISEASE-EA E If yes,descdbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLI DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,It more apace Is required) NATIONAL GRID CORPORATE SERVICES LLC dba NATIONAL GRID,ACTION INC,COLONIAL GAS COMPANY AND NSTAR E ADDITIONAL INSUREDS CERTIFICATE HOLDER CANCELLATION Fax#:(508)790-2425 SHOULD ANY OF THE ABOVE DESCRIBED POLICIE https://us-mg4.mail.yahoo.com/neo/launch?.rand=aokcrjtghju9p#8421726760 Page 1 of 1 - _ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 11 I r y lJ .l'�" fi r ►BARl?STABlt Application #20I G� Health Division r ,s�; �f? �i l0: 39 Date Issued Conservation Division Application Fee 120 Planning Dept. Yy - : Permit Fee 35. oo Date Definitive Plan Approved by Planning Board (� Historic - OKH _ Preservation / Hyannis Project Street Address Village Owner 'Vo AV4,&�f Address � 00 B Telephone c��,f :f�Z P 3,? Y-y / Permit Request �12/f ���,� /�, �� ,�����Lr ��✓,L �G�Gii�.9�� 1✓ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 2®o, a Construction Type Lot Size Grandfathered: ❑ Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes 6d-No On Old King's Highway: ❑Yes Flo 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:.0 existing 0 new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial 0 Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �/�� �d ,iiL./ Telephone Number &09 F �f- Address 2 df License #--IX�,�' Home Improvement Contractor# As lq 5rG Email Worker's Compensation # 4 e DD ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY * APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION r FRAME INSULATION r FIREPLACE - ' ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ' DATE CLOSED OUT , :' ASSOCIATION PLANNO. f a HOME OWNER WEATHERIZATION WORK PERMIT: PLEASE COMPLETE AND SIGN THIS FORM AS THE APPLICANT HOMEOWNER. Ile //.5 hereby consent to and agree that weatherization work may be done by the Weatherization Program of Housing Assistance Corporation on the property located at: SO / The weatherization work done will be based on programmatic priorities and availability of funding and it may include all or some of the following measures: Weather stripping; air sealing; attic& basement insulation; exterior wall insulation; ventilation measures In consideration of the weatherization work to be done at my home I agree to the following: 1. I give permission to Housing Assistance Corporation the property with such equipment and materials as may be necessary to perform weatherization. 2. The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the weatherized unit on an ongoing basis for no more than five (5) years after the weatherization work is completed. I have read the provisions of this agreement and give my consent. Home Owner(signature) C% Home Owner email: � 6��t /�iiJS(��' !'`� 1 Date: aJ� Agent:(Signature) t} Date: Weatherization Contractors: Adam T Inc Cape Save All Cape Energy Frontier Energy Solutions Alternative Weatherization Lohr Home Improvement BuildiS.cience_C nstruction Resolution Energy Cape Cod-Insulation Tupper Construction The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 -www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbel-r Ainfflcant Information Please Print Legibiv Name (Business/Organization/Individual): t �i Address: C11/0 City/State/Zi :��V ` AV-&b a P : -4 Are you an employer? Check he appropriate bor: -�I am a employer with � 4. ❑ I am a g '_`--- eneral contractor and I Type of project (required): !. � employees (full and/or part-time).* have hired the sub-contractors . 6. ❑ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 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.t 9. ❑ Building addition required:] 5. ❑ We are a corporation and its 10.0 Electrical repairs or adclit�or;s 3.❑ I am a homeowner doing all work officers have exercised their H Plumbing repairs or additi ❑ g ai P ons myself. [No workers' comp. right of exemption per MGL airs 12. Roof re insurance required.] t c, 152, §1(4), and�we have no p 3a.❑ I am a Homeowner acting as a employees. [No workers' 13. general contractor(refer to #4) — - --� -- --- comp. insurance required.] Any applicant that checks box#I must also fill out the section below showing their works'compensation --— -- ` t Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submio'n new affidavit indicating sucin. tContractora 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'co olic number. mP•P y I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and jolt sits-information. l� r\ "Insurance Company Name: 'C (/�/ , I (� �/(r7 mull C..( Policy#or Self-ins. Lic. #: j,V��QQ '� Expiration Date: Job Site Address-J;;3 �i /2i -ZZ � 5 hZ,/.tYy/State/Zi Attach a copy of the workers' compensation policy declaration page (showing the policy number and espiratiort Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties oi'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 line 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 certify un ena an r the ais d penalties o P p f perjury that the information provided above is true and correct Si a Date• � r ��/,5 _----- - - Phone #: 9 ff Official use only. Do not write in this area, to be completed by city or town official t City or Town: PermitfLicense # Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing inspector, 6. Other Contact Person: Phone #: -- ---•------- -- it From:Rogers&GraJ InsgaFax: To:+1 5087 7 85736 Fax: +'15087785735 Page 2 of 2 03/3012015 10:04 AM CAPECOD-27 BDELAWRENCE AFRO` CERTIFICATE OF LIABILITY INSURANCE DA7E(MMIDOrcYvv)- ' 313012015 j 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 I BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZE() REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcy(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 endorsement(s). PRODUCER CO C I - NAME: ROgers&Gray Insurance Agency,Inc, PHONE - - 434 Rte 134 Arc No Exc: arc No: (877)816-2156 South Dennis, MA02660 EMAIL — -- ADDRESS: INSURER(S)AFFORDING COVERAGE PIAIC a-_ INSURER A:Peerless Insurance Company-see LIBERTY MUTUAL INSURED INSURER B:SAFETY INSURANCE COMPANY 39454 Cape Cod Insulation,Inc. INSURERC:Endurance American Specialty Ins. Co. --1 18 Reardon Circle INSURERD:ATLANTIC CHARTER INSURANCE GROUP _ South Yarmouth, MA 02664 INSURER E INSURER F -- J 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 POLICYIO PERD_-I INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOALL THE TERMS. EXCLUSIONS ANDCONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSO WVQ POLICY NUMBER MMIDD/YYYY MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00(y. CLAIMS-MADE D OCCUR CBP8263063 04/01/2015 04/0112016 PREMISES Eaaccunence $ 100,0001 MED EXP(Any one person) $ 5,000. PERSONAL&ADVINJURY $ 1,000,000, GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO- GENERAL AGGREGATE $ 2,000,006 JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,OOU Ea accident _ _ B ANY AUTO �. TBD 04/01/2015 04/01/2016 BODILY INJURY(Per person) $ _ i ALL OWWED X SCHEDULED -------- . . AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PRO ER DAMA ----' "" J. AUTOS (Per accident) $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,0001 „ C. EXCESS LIAB CLAIMS-MADE EXCl0006635000 04/01/2015 04/01/2016 AGGREGATE DED I X I RETENTION$ 10,000 A re ate $ 2,000000,U00 WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER D ANY PROPRIETORIPARTNERIEXECUTIVE YIN WCE00431900 06/30/2014 06/30/2015 E.L.EACH ACCIDENT $ 1,000,000 OFFICERWEMBER EXCLUDED? � NIA _ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,ODU 11 yes,describe under _, DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000, i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) - Workers Compensation includes Officers or Proprietors. ; Additional Insured status is provided underthg'General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder. l i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE � Cape Cod Insulation, Inc, THE EXPIRATION DATE THEREOF, NOTICE Vu1LL BE DELIVERED IN 18 Reardon Circle ACCORDANCE VUTH THE POLICY PROVISIONS, South Yarmouth, MA 02664 AUTHORIZED REPRESENTATIVE �T O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD d/xe �Q�/d// �?/Zf�Ci�#/l/Ud'fi Obi (��/(�ia/l/1�i�l1d1Z(16dKJ1 - -- Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 153567 i Type: Private Corporation Expiration: 12/15/2016 Tr-4 259188 CAPE COD INSULATION, INC HENRY CASSIDY -- -- --- 18 REARDON CIRCLE — -- ------ SO. YARMOUTH, MA 02664 ---- ------- Update Address and return card, Mark reason for char c. Address Renewal Employment (—? I.,nst C;ird SCA 1 C:• 20M-05/iI V/ie�ro�r:•�,�r>7aurerc/C�o�P/lla�arrc/%urelr� Office of Consumer Affairs& Business Regulation License or registration valid for individul use only iTlIOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Gl� ��'` ;registration: 153567 Type: Office of Consumer Affairs and Business Regulation .Expiration: 12/15/2016 Private Corporation 10 Park Plaza-Suite 5170 ? Boston,NIA Olt 16 CAPE COD INSULATION,'INC HENRY CASSIDY 18 REARDON CIRCLE SO.YARMOUTH,MA 02664 -- Iv - Undersecretary N valid id wi ut sign ' e MaS'SWJlltsetts - Department.of public Safely ..:board of Bulldlily Regulations and Standar cl s Coils( •uction Snpervisol. License: CS-100.988., HENRY E CASSJ1 8 SHED ROW " I•� WEST YAItMOUrfHA", p �p Expiration Commissioner 1 1/1 1/2015 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Oil Map_ Parcel Y Applicati6p # Health Divisiofi "Date Issued Conservation Division Application Fee , . Planning'Dept; Z Permit Fee, Date Definitive'Plan Approved by Planning Board Historic - OKH Preservation Hyannis e Project Street Address U li f Ag!ra 0 Village In 416-,i-ovys 45 Owner Address Telephone /7 '11wrmit Re' quest . L /6 C/ A-1 I.J Square feet: 1 st floor: existing—proposed 2nd floor: existing proposed Total new Zp.hing District Flood Plain Groundwater Overlay e> , oject Valuati4/ 000 Construction Type EFIV R Lot Size Grandfathere'd: 0 Yes Q No lf*yes, attach supporting documentation. Dwelling Type: Single Family Two Family Ll Multi-Family (# units) Age of Existing Structure Historic House: Ll Yes El No On Old King's Highway: Q Yes Q No Basement Type: mull Ll Crawl Ll Walkout L11 Other Basement Finished Area (sq.ft.) /A Basement Unfinished Area (sq.ft) Ad Number of Baths: Full: existing new Half: existing —new Number of Bedrooms: existing —new ,:I:tl c. Total Room Count (not including baths): existing new C-) First Floor Rjorn Cott Heat Type and Fuel: 0 Gas a-oil Q Electric L3 Other N) r—n co, Central Air: Q Yes Ell" No Fireplaces: Existing New Existing w /coal stove:,:'Q Yes @4o Detached garage: Ll existing El new size Pool: Ll existing Ll new size Barn: existing LJ gew size Attached garage: Q existing O'new size Shed: L] existing El new size T- CA Other. Zoning Board of Appeals Authorization Ll Appeal # Recorded Ll Commercial U Yes Ll No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Y Name 0 X/, Telephone Number Address C.) License # 1W dfieS AU A/5 Z?2 I'd 5 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 4-2:5 cf r i FOR OFFICIAL USE ONLY ' APPLICATION# DATE ISSUED !. MAP/PARCEL N0. `ADDRESS VILLAGE OWNER a , DATE OF INSPECTION: - FOUNDATION FRAME i w :INSULATION i FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL µFINAL BUILDING ' DATE CLOSED OUT,• - ASSOCIATION PLAN NO. L i { � r Town- of Barnstable Regulatory Services Y,lRN3TAULE, •• . uicc Thomas F. Geiler,Director � Building Division Thomas Perry, CBO,Building Coin=ssioner 200 Main Street, Hyannis,MA 02601 www.town.b arnsta b le.ma.us Office: 508-862-4038 Fax: 508-790-6.230 PLAN REVIEW Owner: A) 5 Map/Parcel:. o D l! o oZ. Project Address so. W-Wiut�/A . Builder: o rYeC-OW The following items were noted on reviewing: EQ utU�4 c C-'O T ?tests wo k s z 0 E A-if Fqrc rya. rya s �-ri �'w:Y-k 4Pg-K b t rxi.`z e 9 Steno Awl Gn;,Vt: - S�_`=eY�l� IG�� l'.LIPS VV�.wS� ICE .• l��L� �`L' �f4—F'"tLy�- Ic� . Tzr PLIA-rE l 0NN-C— -rr00Jr, l,e"W (�6tK -{v W�4-c� �yekr yi s . (&.3*Lc. co MNYE:702 3 crtrE.n 'ro-P PcA re). �ssr410_EC- 7'G�-� 01'j 7�- E 4-w 14-K&(lr, OC Reviewed by: Date: Q:Fo=:Plarvw The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations• ' 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: City/State/Zip: �Y/ �j f 0�5 /�/���5 Phone.#: J`�� �/ �� =:3_ L - Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-.time).* have hired the sub-contractors ,2.O I am a sole proprietor or'partrter-' listed on the'attached sheet T. ❑ Remodeling ship and have no employees These sub-contractors have 8.'❑ Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'.comp.•insurance comp. insurance.$ r a a ed) 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions �.3.t td i' homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions myself.[No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other 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. tContractors that check this box must attached an additional sheet showing the name of the subcontractors and stata whether or not those entities have employees. If the subcontractors have employees,they must provide their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.M Expiration Date: Job Site Address: City/State/Zip: _ Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day.against.the violator. Be advised that a copy of this statement maybe forwarded to the*Office of Investigations of the DIA for insurance coverage verification_ I do hereby certify der the pains and, er�al 'es of perjury that the information provided above is trine and correct Signature: t/ Date: S/ 0 Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health '2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their.employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as "an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees'. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall . enter into any contract for,the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s),address(es)andphone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please-call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Offrsials .Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant, Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy'information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town).".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related fo any business or commercial venture (ie.a dog license of permit to bum leaves etc.)said person;is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number: The C6mmonwealth of Iv=achusctts Department of lndustrit Accidents office of Investigations• 600 Washington Street Boston,ILIA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 6.17-727=7749 Revised 11-22-06 s' www.mass.gov/dia i Town of Barnstable �.Tt•IE rq� .; Regulatory Services Thomas F.Geiler,Director - tbs>a .• Building Division prf0 l�A - Tom Perry,Building Commissioner 200 Mairi•Street,_Hyannis,MA 02601.. www.town.barnstable-ma.us Office: 508-962-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION x �j Please Print DATE: ✓/' `�5- JOB LOCATION: S L) ll-;61- /C 0Ee z 1n11/e51o&S /w/' number street village �/ "HOMEOWNER" on 1 t /!\/f%/ name ,l /home phone q Q work phone p CLJR.RENT MAILING ADDRESS: state up code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as suuervisor. DEFINITION OF HOMEOWNER Persons)who owns a parcel of land on which he/she resides or intends to reside,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 acceptable to the Building Official,that he/she shall be responsible for all such work performed under the buildinepermiL (Section 109.1.1) The undersigned"homeowner"asst es responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that.he/she understands the Town of Barnstable Building Department r,,;rr;rrHim ' e-ction procedures anti requirements and that he/she will comply with said procedures and requireme ) v Signature o Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION .The Code states that Any hameowocr perfomung work for which a building pernt is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor.^ Many homeowners who use this cumption are unaware that they arc assi n ing the msponsibi'hties of a supervisor(see Appendix Q. Rules&Rcgulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this ease,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of hiAcr responnbrlities,many communities require,as part of the permit application, that the homeowner 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 t amend and adopt such a fomr/certifieation for use in your corrvrrunity. Q:fomu:homcc empt o� Tti Town of Barnstable Regulatory Services . B� Thomas F.Geiler,Director i63s>6 A Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.tow n.b arnsta b l e.ma.u s Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using ABuilder as Owner of the subject.pmperty hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete.the Homeowners License Exemption Form on the reverse side. Q:FORMS:O WNERPERM ISSION a \'�� � Jam-'O�� �7-i�' �!•t1E2, � i� -=-_ - �I (OU tit ® p lwm h,'n1 do le c 4-af goo _ w N 10 rr. 0?"C y- ;� b ' 3 � ¢ 000 f � o � i 1 it C.E �S � �� N Oak DLO uE why . `:"Srt`..T•e.,_^-.-.,:.. --•-•... .,i+-.!r^-�-f-�-�^_:.:-ii..3�r..w,�..-�tr; ... -�. .I:.�,,,..r:'i r`:/�tc�t i,_ ..`,4� :rsi..LJ!'w=.:ram-:_,..r+:...:+�.....:'.�•w. ...s�.....�::•..•.:�...-,w�.,�.��. :€�_-,.i"";-bf� .. �,23 ,*IWE TOWN OF BARNSTABLE Permit No. --/*&n......... BUILDING DEPARTMENT I ■..,n I TOWN OFFICE BUILDING Cash a�v HYANNIS.MASS.02601 Bond ................ CERTIFICATE OF USE AND OCCUPANCY Issued to Joanne Filkiris Address 50 High River Road Margrnns Mills. MA USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. December 23 94 ... ... ......... ...... .. ..... 19................. . ................... Building Inspector ; 7 a? qs B TILD!JilG, PEMUT No. 3 ?� ( S� D`.' ASSESSORS PARCr-L NO. CONTINUATION Or ROAD BOND - T'ne urae=scned oc.�er/contractor he=ebv a�_es to �i:.ca_n t:ie road bard it force un--'un--'l the follow-n; wort ite=s are ccntletaA_ to tte sa==act_on of t e E zineer`-Z Sec==on of the 'Depar=ent of Public wo::;s: Zca— and sesa slaculde_s as Sao-,: as pe e_`;lam C_7�JTP c; .%C"., / (pZ_nL -'IIG-a i i j i _ . 'S-R�,�y�-�.h•�^i.�yiyi��:7;��•.>�^�-r.y'1�-'F'•`'�yi''.�' :�F;� 'E�T�"'A_Y,�i?t�•�� _r. "'t��"f y n .; __.. _ _..' x'�uF;. �....!!-. TOYI•,410P BARNSTABLE, MASSACHUSETTS I L D I N G PERMIT ! ' A=060-ui7. September 7 94 DATE �Ti( Fy N4 37015 APPLICANT Dennis Cenzalli ADDRESS Vy/ Bay erry H, :L Ii�dNO, h..Vi mout 35 (NO.) (STREET) ICOI:TR'S LICERSEI PERMIT TO, Build dwelling S :gle family: dwelling NUMBER OF 1 ( •—_) =:STORY DWELLING UNITS (TYPE OF IMPROVEMENT) - NO% - _ (PROPOSED LTSEI AT (LOCATION) • Hi River Road, rstons tulls ZONING RF (NO.) (STREET) DISTRICT— ; BETWEEN ._ AND (CROSS STREET) (CROSS STREET) SUBDIVISION LOT L07 BLOCK SIZE 111 BUILDING IS TO BE FT. WIDE BY t FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION i (TYPE) j REMARKS: Dewage #94-422 AREA OR 816 $q. ft. 60,000 BOND65.50 VOLUME ESTIMATED COSTS FEEPER (CUBIC/SOUARE FEET) • OWNER Joanne Filkins /18 ADoaess Strawberry i oa , en ervi e, I BUILDING D - BY — —OF�ChTY�rppLTCxat� -L)tJvronrvTa-rct>rNrt� vrv�-- ---- -------- ------- 9 OF THREE IAPF-nOVED PLANS MUST BE RETAINED ON .iOB AND THIS WHERE APPLiCA6Lc w�T v - rtE.r::I•.c_,rG.. CARL) KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ANE HGQQIhfEL `U" .,�L CONS RUCTION MORK: ELECTRICAL, PLUMBING AND I. FOUNDATIONS OR FG071NGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR. TO CO.'ERING STRUCTURAL QUIRED,SUCH BUILDING SHA.LL NOT BE OCCUPIED UNTIL EMBERSIREADY 7C LATH). 1FINAL INSPECTION HAS BEEN MADE. 3. F'!N cAL INSPECTION _c FORE OCCUPANCY. POST THIS CARD SO IT i5 VISIBLE FROM STREET � //BUILDING INSPEC7IDN APPROVALS P UMBING INSPECTION-APPROV L pal~ INSPECTION APPROVALS / pale I 2 2 • - -- 2 1Z- �2-9� �11j-� � HEATING INSPECTION:=PPROVALS ENGINEERING DEPAR i MFN7 E . — A BOARU O: REALM VvU=•.SH L' :Gi PRUCEEC '._':TII.THE INSPEC PERMIT 'W!LL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS C+•PG CAN BE H TO= AS APP=:WED THE Vtc 3UUS STAGES OF WORK IS NOT STARTED WITHIN SI i MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OF .VRITTEFI CU:.STPUCTI,,: I PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION. ,�. J,`s ' ��, h �. ,� ,� � . �:; l� � i ..�: �� �'d _ �7 �y �/ _� � �J �_L c ." • J r � . 1 l ` ` �� — � a . e-� I II � o I � -rt�-I>✓ti1 o 3'S' I y9a 5%S I . 10-9u u I v►li ; ' a 7�Oa ; , I PQ N _ a N -- Ind' 3-v' a•�"! m� 12=2" I I - I LM►JGt IZmNI I , �' ����H a in �,u.lpn-rblJ I ' I g I po R- , I FIRST FL.z2vfz- FL-NJ f I A 11 Z�i.'.4�-4�' DcxJ�E.—Nv{J� k1DkJ . I i o -- - 4o K►JEx�.W.� _ _1 �t b-- I ou i i I o; 0 X ' 1��-9'' 14- 5�� a � rQ313 00 dQ . � I � �C2�'i1�T EL�.�/AT�D►-I. ' I I �Op-I I)e4o EKF— To 61E1--s4" trm -- 4Wr^ (og1T'tt,YS (TYPE (T� Lei t�E16Z£- (TYM RIM . STaCX W�.IDOe1 TYJfh (TYA� CA-VrJZ 4d TO 1..7[A'TFIEfL SLALE= I/4�c V-Ol IZ '�ELOw1C FLyo¢ —_ E-F SI qYL 19 xll) tir(� v�vc c t b¢c+1 tZ 1 ■ -- TO 6LEf.'TLI" [TW) �� (q(J7'1titti trt" ® _ .4 -4 .:c,T- LJ►tDaJ�Jlat k1000-?AID- .. A '/2 t 2 y I EF ° sit L.r--u -noel PLAN REFERENCE: BARNSTABLE COUNTY REGISTRY OF DEEDS PLAN BK. PG. LoT I All -4o.c., ... ao N N N Li II p J Dc 1� LOT 16 •d < 1.023 Ac . � s 6. oc ESCIST. FOviJP,&TIof r c Q - N d O 2� I, a OF I HEREBY CERTIFY THAT THIS FOUNDATION IS.LOCATED ON THE GROUN tip. SHOWN AND THAT IT CONFORMED TO THE TOWN OF 6A,2►.1ST*f_-, NORMAN ZONING BY-LAWS REGARDING MINIMUM SETBACK REQUIREMENTS AT TH EDROSSMA IT WAS CONSTRUCTED. - _ $ No. 12775 0 / �E' '�ECISlCRE aim NORMAN GROSS=MA_N R.P.L.S. DATE FOUNDATION LOCATION PLAN OF LOT 152 H l RIVER ROAD o� �y M Co GR �A�5TOLJCD MILLS, MA . 12_ IV P,N NORMAN GROSSMAN, R, ,S, C 90� AFC/STEREO �Q 10 MARSH VIEW ROAD AL EN� � EAST FALMOUTH, MA, 508-548-1920 SCALE : I" _ �I o� DATE: SEPr �, I�4} PLAN NO.: C-340 �L COMMO OF MASSACHUSETTS - . DErAjC'1rff,'?OF LNDUS7RLQACCMV-M . 600 WiASH NGMN STREET ,sR+es: Cmnaaer. BOST'ON, EM 02111 ' ,•,or- ssayse• WORKERS'DOMI'MMON DGURANC E AFFIDAVIT . .ems_ RiAis , • with a principal place ofbusinesshesid to zat- / p� do hereby certify,sander she PIVU and penalties ofperjmT drat: D am an employer pro i&q dsc following woAzze on mvcrage for my employ=wroridng on this job. R07�01 4)c 4��2- Insurance Co piny Pblicy Number [� 1 am a sole proprietor and have no one vo&ng for mL i am a sole proprietor,general contractor or homeowner("c one!and have hima she eontrac ors Imed below %no love the following w orke.-i eempeantion insuranee polioec -•- -• 20-2,7 Name of Contractor Insurance Company/Policy Number .. . 4�4"�_ nor � Name of Con: c:cr. tnsuranee Company/Policy Number Name of eontaactor Insurance Company/Policy Number Q T am a homeowner per orming all d e work mpelf. N'OTL PlcaW be aWvr La:Torbile boraeeraen Irio emeiq!prriew to do munteaaaa.Construction or repair.ori: oa a Cy-ciint"of no: Poore Sat tares mat'j Yµ,n ra,ci We bo:"*eorar. aiaotrn,riu or on dic Irouoos appurwnaat tbcrtto are mot Seac ail:• ccn.-ocreo to be erzolaven moor► Liar Voritcn' Coraocruauoo Ar.IGL C M.aec 1(5);. appiieatioo*a bomeo•raer for a butam ®r �rren,t Ph",e"erncc tar JcEw guru of as eraaio• .-maier tac Torten'Co.peaution Act Yr6r-%:3nC tits: s Car, a tint ststca:t waV be for+ateeo to tire'rosr_rt=of ineusaial Ac6deno'Once diasarasti i r wvr--w W: :ia: &;:;;c to ieeure mveratc m ►etuire: unit- Sr_,o,:!.i'o'MC:l:: mr ieai m the im2c ition of e:�i vcai::u r;ne of ue to S:500.0:ami or imprzso:=•::e of up to one vaw an:ar:per. :t= e form a a StoF Van Oros v: a b a,S l -Tom.... o��o�wh,-_ ` C'L��e, '��'3S"�— �JV �"z�or® i�v�wa7e�- • � � ���/ �.5�" i ,,4. `. �_ ;, Assessor's office(1st Floor): /,- © S p and lot numb Cy t i THE Assessor's ma t q: _ 3 rKZEPTIC SYSTE Conservation(4th Floor):' 0 STALLED IN C Board of Health(3rd flo i < Wimp Sewage Permit numbs — ENVIR M;;�ntc . Engineering Departm (3rd f r). _ - ONMENTAL House number j' TOWN REGU Definitive Plan A oved Planning ardS.• P0/6-. 3d .Q,�. .19 -/5 y APPLICATIONS PROC SED 8:30-9:30 A.M!and 1.00-2:00 P.M.only 4 TOWN i O•F BARNSTABLE BUILDING .INSPECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION Ike- W ' s —"'Ap 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location-.! D % ►- / Proposed Used L� . I Zoning District ` Fire District Name of Owner�o��ti/Iic 1,Id'1 LDS" Address Name of Builder , .vt,/�t �w��, Address Name of Architect y--i vC � Qt�i�(,ry + Address Number of Rooms Foundation r?c . CaccVIC Exterior ('-A O - ��� Gtl�l'eDer �'t c 'Roofing FI'oors I? 17 a Interior i Heating ,� / Plumbing z Z 2 'r3''f Fireplace Approximate Cost l Area -6-0_ ;?� �a Diagram of.Lot and Building with Dimensions Fee OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town Ustablerding th7conion. Construction Siipervisor's License� � FILK.INS, JOANNE -74z( No � Permit For 12 Story FS k -Single Family Dwelling Location 50 Hi River Road ; Marstons Mills Owner Joanne Filkins Type of Construction Frame Plot Lot Permit Granted Sept. 7 , 19, 94. Date of Inspection: Frame 19 Insulation t) —,2-4 19 u° Fireplace 19) Date Completed `2 c 19 4 ; A CommQNWEAL`TF- .._.,. v' l2EP..A?T!!9ENT.OF PUBLIC SAFETY:. --- _ OF ONE ASHBORTON•PLACE ( . q 'gc MASSACFIUSETTS n^BOSTON,MA-02108 $ FxdlcLrcQc ,:' Y'' LICENSE EXPIRATION DATE , � CONSTR. . SUPERVISOR ore+� FOR PROTECTION AGAINST 7 EFFE.T!\rE DATE LIC-NO. + THEFT, PUT RIGHT THUMB RES _ IC I�i NS" �� zf > PRINT IN APPROPRIATE a ; Gqq C . {D 05,13l /1991s 04�235 a eox-oN LICENSE -" q! �`xFi �. .14'l.diw,: °;7ii'i"}�.. .�M' �..lx'�'�k+#• .e:^.fi:C c�`�'- -i•t:.^C. ..Y - ..it .. CT ill ALL I ,'.1 07 yBAYBERR,`� ,.HILL RD ' ELASTINGOPERATORS S5 032 k0�F 4`$ '' �Z' E E�A,LM0UTIi'' 02536 z. 149USTINCLUDE PHOTO. I PHOTO(BLASTING OPR ONLY) FEE; .I L•I. Y�b. ,�� ` 1 0 0,y 0 Q NOT`iALIG NTIL SIGNED BY LICENSEE AND OFFICIALLY :' s 'STAMPED• R.SIGNATURE HE COMMISS' R { HEIGHT: ( �, � t4V r "(I DOB: .' , ;4„ u f r 10/03 Ill 95: I S GN NAM FUCL ABOVE SIGNATURE LINE THIS DOCUMENT MUST.BE l CARRIEDON THE PERSON OF¢ w®� N �1SEE I J lx./rs ,p` THE HOLDER WHEN.EN-< �y,, OTHERS-RIGHT THUMB PRINT GAGEDINTHISOCCUPATION P COMMISSIONER " a t. j Lo o K -� ( s . �I! 1 Aga-,�- i II � 7� i f �I lI I i I i i I b �l 33 FIRST FLOOR SEPTIC SYSTEM PROFILE SOILS LOG & ELEVATION T"' FIN. GRADE FIN. GRADE OVER FIN. GRADE OVER FIN. GRADE OVER PERCOLATION TEST TOP of AT HOUSE SEPTIC TANK DIST. BOX LEACHING PIT FOUNDATION 74.0 - S _ '13 -i3.o TEST HOLE I TEST HOLE 2 - - 0" ELEV. - '13.2 c' ELEV. - '12- ELEVATION LEVELING RING TO WITHIN / \ �" INVERT of v•:�o: •: 12" OF FINISH GRADE ,_ I „ 2 of I/8" TO I/2 -�oPsott� � -('oPsotL WAS PEASTO ,L FOUNDATION ,�,' ,. r.:; :•.rL - `- - ¢'`' WASHED E svosso, Su o ELEVATION '1t.85 .: '� ;.,►,'.�j,(:�:.;,r.'i;. .�l �.:•::vr:.p..•.::.�•`,a ' ... •ate .o:.'.. :•,,.•a:?, .i; 'ti: n Z4v .. 3„ 2,f �: 24 J W w - �• 7 I.35 '1 t• !2 'To.75 " 'j0.-!o '' PRECAST, C.I. OR P.V.C. TEES o �? 3" - 1000 GALLON Cr "' DIST. BOX 3T40" CGE,&J, MH-10 LOADING TANK �olvM MEnt�M 0 it WASHED ° ' H-10 LOADING TO BE SET ON A BASEMENT FLOOR CRUSHED s ELEVATION 3 LEVEL & STABLE ISTONE `° PRECAST �7.5 — ,, : :',•. :: :�. '... •'. �� 8'_6" _ I BASE Y r c ACME DB-3 OR LEACHING PIT APPROVED EQUAL ) TO BE SET ON A LEVEL AND STABLE BASE H -10 LOADIN ( ACME ST-1000 OR APPROVED EQUAL ) ( Profile not to scale ) ' W O We.TER ►J a wa.TE R - PERCOLATION RATE: 2 MIN./INCH EFFECTIVE DIAMETER TESTS BY : dcFmAJ e; oxNmx 1 . r•RE TO BE SET ON A LEVEL AND STABLE BASE. WITNESSED BY : E-n0• F 15,&-ErLY ( ACME 1000 GAL LEACH PIT OR APP'D EQUAL ) g�R>J�T'a.�t� BOARD OF HEALTH. DATE : JULr DESIGN DATA WATER ENCOUNTERED AT PERG. APP L-. do. P- es4-'D R NUMBER OF BEDROOMS 3 G.P.D./BEDROOM 110 G.P.D. GENERAL NOTES TOTAL DAILY FLOW 330 G.P.D. \ GARBAGE DISPOSAL NO �� LEACHING REQUIRED 330 G.P.D. I. ELEVATIONS BASED UPON l�2� tj.-5.L- DATUM. LEACHING PROVIDED 550 G.P.D. 2. ELEVATIONS AND LOCATIONS SHOWN ON THIS PLAN sF N r ArsnJoo.l.lEr� , • �� I �� ar � + ARE NOT TO CHANGE WITHOUT WRITTEN APPROVAL \ , OF THE ENGINEER AND THE TOWN HEALTH AGENT. SIDEWALL AREA = 168.5 S.F. x 2.5 = 471.2 G.P.D. 3. ALL SYSTEM COMPONENTS ARE TO BE INSTALLED IN BOTTOM AREA = 78.5 S.F. x 1,,0_= 78.5 G.P.D. ACCORDANCE WITH S.E.C. TITLE V AND LOCAL HEALTH �.� �p � '•� TOTAL PROVIDED= 267.0S.F. �`49.7 G.P.D. RULES AND REGULATIONS. \� - 549.7> 330 G.P.D. 4. ALL PIPES ARE TO BE CAST IRON OR P.V.C. SCH. 40. 5. THE BOARD OF HEALTH AND/OR ENGINEER TO BE ? NOTE: EXCAVATE TO EL. OR LOWER AS SOIL NOTIFIED WHEN SYSTEM IS COMPLETELY INSTALLED -0� CONDITIONS REQUIRE TO REMOVE ALL TOPSOIL, SUBSOIL, AND READY FOR INSPECTION. CLAY OR OTHER UNSUITABLE MATERIAL BENEATH THE 6. NORTH ARROW IS NOT TO BE USED FOR SOLAR INLET INVERT OF THE LEACHING PIT FOR A DISTANCE ORIENTATION. r 7. WHEN COMPONENTS ARE SET SUCH THAT THE TOP OF 10' AROUND THE PIT AND BACKFILL WITH CLEAN OF STRUCTURE IS GREATER THAN 4' BELOW FINISH SAND HAVING A PERC . RATE OF 2 MIN./INCH IN PLACE. GRADE, HEAVY-TOP OR H-20 LOAD UNITS SHALL BE _� \ b REQUIRED. LEGEND Lo 1 -� ELEV. 23. 50 _a' ? EXISTING SPOT E 1. '5 + C • I44�� 'o �0 \ �Q 6a EXISTING CONTOUR 24 PROPOSED SPOT ELEV. s d• � 6c •75 REV BY DATE DESCRIPTION N DOE f.L. tlr Piss, 34' PROPOSED CONTOUR �N N11-174". +, '± 68 TEST HOLE : 19 PROPOSED SEWAGE DISPOSAL SYSTEM t I N srzvri� N Q t W I L.P. o-e t�H OF y LOT 115 {-•I 1 V� I F� DAD I ? I p 2SAt Aso NORMAN �^ M.&-.` ) JT 'It 1 IAN . GROSSMAN No 12705 f. r_1vrL APPLICANT: J040LIS P. Flt-V,16e> {y -A -- SS�CISTO �`�� ADDRESS: 'fl8 �3T"tz.��BERQY NrLL [Za r1O NA, 74 >2 >o ENGINEER: NORMAN GROSSMAN* R.P.E. 10 MARSH VIEW ROAD 7A ZONING DISTRICT FLOOD ZONE ELEVATION EAST FALMOUTH, MA. 508-5484920 tJD. P-824� MAP SEC PCL LOT HSE SCALE DATE I DWN. BY / CK'D BY PLAN NO. PLAN REFERENCE: BARNST. CNTY. REG. PLAN BK PG SITE PLAN---SCALE I" _ r Go MAT- It IB �` SO AS NOTED JUL,( vi f 1"�� JfH / NG