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Home My WebLink About1675 MAIN ST./RTE 6A(W.BARN.) 0 0 0 Cape Save Inc. 7-D Huntington Avenue South Yarmouth,MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 11/2/15 FYI � Thomas Perry CBO 1 "' Town of Barnstable Building Division 200 Main St. Hyannis,MA 02601 w m RE: Insulation Permit 201506773 Dear Mr. Perry This affidavit is to certify that all work completed for 1675 Main St,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 4 xl TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION` �„ �y, �I Q ►n04 Off' BARNt TARE "_ -7 Map. -d .��RP�5TA31►.Parcel a cJ Applications / -Health Division,,, i ''" - ►�°_ r . , 1-,.i l , ,, ,. rr Date Issued Conservation Division Application F 4 �;-d Planning Dept. Permit Fee FDar rtt nat s.31 1ST0 te-Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis (t44 Project Street Address See Village W tsi- Bizng-i to 6 I(e Owner V.1 AMLf J & V'tn A.s�sa �C s C.rs Address � � �-S rq 'n 64 Telephone 9 9 9 N Old b Permit Request RJa - I q OLOJ - 13 r e ll ikififg, +ke &A , AJ �-I9 ca � doe W 1' r� 1 40 , �� o 'fh.. �xAan ►nf Rm Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation `�� Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family .❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes )fNo If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILD-ER OR HOMEOWNER) Name +«tI m e O-v& Ivc. Telephone Number Address "� ITa.l 1y)t+a A License# —L C S . YarmO�-�� . 1'� oa66 Home Improvement Contractor# i30 Email Worker's Compensation # W C 313 G A q ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 1 o D A5 FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED ' ` MAP/PARCEL NO. - r ADDRESS VILLAGE OWNER DATE OF INSPECTION: r FOUNDATION 4 FRAME INSULATION t � FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH y FINAL` FINAL BUILDING ' DATE CLOSED OUT ASSOCIATION PLAN NO. . r The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www massgov/dia Rrorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Letibly Name (Business/Organization/Individual):Cape Save Inc Address:7-D Huntington Avenue City/State/Zip:South Yarmouth, MA 02664 Phone#:508-398-0398 Are you an employer?Check the appropriate box: Type,of project(required): 1.�✓ I am a employer with 20 employees(full and/or part-time).* 7. New construction 2.rl I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 1[]I am a homeowner doing all work myself.[No workers'co insurance ]t 9. Demolition comp. required. 4.M I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.❑1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.- 6.F1 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[R]Other Insulation 152,§1(4),and we have no employees.[No workers'comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ;Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the subcontractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy andjob site information. Insurance Company Name:Wesco Insurance Company Policy#or Self-ins.Lic.M WWC3136274 Expiration Date:04/09/2016 Job Site Address: 1675 Main Street City/State/Zip: West Barnstable Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify under th pains andpenalties of perjury that the information provided above is true and correct. Signature: \\- Date: 10/8/2015 Phone#:508-398-0398 Official use only. Do not write in this area,to be completed by city or town official, City or Town; Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: I i4 CERTIFICATE OF LIABILITY, INSURANCE 3/24/D24/201 IDD�Y5 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 cPatiflCate balder Is an ApDlTlONAL itQSURED,the policy(les)must be endorsed. It SUBROGATION IS WAIVED,subject to the terns and conditlons of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certlt)cate holder In lieu of such endorsements. PRODUCER CONTACT- NAME: - Colleen Crowley Risk Strategies Company PHONE {781)986-4400 FA C No•(781)963-4A20 15 Patella Park Drive -ADDRESs.ccrowley@risk-strategies.com Suite 240 INSU $AFFORDING COVERAGE NAIC t P.andtolph 0L 02368 INSURER a:Selective 'Ins. OF "America Cape INSURER A11MOXiaa Fiaaacial Alliance 0212 Cape Save, Inc INsuRERc Wesco Insurance Co=any 7 D Huntington Ave INsuRERD: INSURER E: South YA=6Uth 02494 1 RNSUPERF. COVERAGES CERTIFICATE NUMBER:CL1532491501 REVISION NUMBER: THIS IS TOCERTIF•Y TKAT Tf E POLICIES OF INSURANCE LISTED BELOW`HAVE BEEN`ISSUED TO THE'iNSURED'NAMED ABOVE T'OR TffE POLICY'PERIOD MOICATED. 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. AD LTR TYPE OF INSURANCE SUBR POLICY NUMBER PO ICYEFF POLICYEXP .. .. MMI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISE Ea occur $ 100,000 A CLAIMS-MADE a OCCUR 1994480 O/16/2014 0/16/2015 MED EKP(Any one person) $ 10,000 PERSONAL 8 ADu IN..ILRY $ 1,DD 0,Goo GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:POLICY FXPRODUCTS-COMPlOP AGG $ 2,000,000 hEaPRO- X LOC $ AUTOMOBILE LIABILITY Ea C0111,M) 1,000,000 B, ANY.AUTO -BODILY INJURY(Per person) $ AALLLOrED SCHEDULED 46796600 1/6/2014 1/6/2015 BODILYWJURY(Per acddenl) $ X HIRED AUTOS X AUTOSNON-OwN7 P 'PER7Y DAMAtaE $ X $ I UMBRELLA LIAB' X OCCUROCCURRENCE $ 1,OOO,OOO AEXCESS UAB CLa1tnS MADE AGGREGATE $ 1,000,000 DED RETENTION i Ell 1994480 1011612014 0/1612",5 $ C WORKERBCpMPENSATION pffiaarg Included for I14CSTATLL o H_ AND EMPLOYERS-UA13 LITY YIN X ANY PROPRIETORIPARTNERIDECUTIVE overage TORY LIMITS ER OFFICEWMEMBFF"E)(CLLCIED9 NIA. E.L.EACH ACCIDENT $ 500,000 (Mandatory In NH) 135274 /9/201'5 /9/2M 6 E:L.DISEASE-EA EMPLOYE $ 500 t}0 MWdescribe under " ` ' '• ` {PTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT §' 500,000 DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES(Attaeh ACORD iOI,Addlgone)Remarks Schedule,if more space Is mqulrccQ Issued as evidence of insurance.. Thielsch Engineering, Inc. is listed as additional insured as respects General.Liability as :required..hy Written Contract.. CERTIFICATE HOLDER CANCELLATION =g@ el ig r SHOULD ANY OF THE ABOVE DESCRIBED"pOL'ICIE$BE CANCELLED BEFORE 'THE EXPIRATION DATE THEREOF, NOMCE WILL BE DELIVERED IN Cape Light Compact ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Margaret Song rO AGX 427/SCH AU1MRIZEDREPRESENTATIVE 3195 Main Street Barnstable, NA 02630 ohael Christian/CLC �� ACORD Z6�2010705j 1899-2010ACORD CORPORATION. RI1 rigMsreserved. INS025(20IW5):oi The ACORD name and logo are registered marks of ACORD Building Permit Authorization I, Richard & Vanessa Rogers , as owner - hereby give my permission to `= Cape Save, Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Office:508-398-0398 to take all necessary steps to obtain a building permit to perform work at my property located at 1675 Main St W. Barnstable, MA 02668 Signed ; I/z� Date � �� dqo Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Reqistration: 171380 Type: Corporation Expiration: 3/14/2016 Tr# 249649 CAPE SAVE INC. WILLIAM McCLUSKEY 7-D HUNTINGTON AVENUE SOUTH YARMOUTH, MA 02664 Update Address and return card.Mark reason for change. sCA 1 C. 20M-05/1 s Address Renewal Employment Lost Card //ra Vnrirvier•iatuva�Cft r�1,i`�rii�:;rrr�rele/% _ _ • Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 171380 Type: Office of Consumer Affairs and Business Regulation Expiration:--3/-44/2016, Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 I CAPE SAVE INC. WILLIAM McCLUSKEY 7-D HUNTINGTON AVENUE' SOUTH YARMOUTH,MA 02664 Undersecretary Not vali Ithout signature IFMassachusetts -Department of Public Safety Board of Building Regulations and Standards n___.-_._ n_. n___n r—" -- _ a.uu+u u�irirTi ouriEi ri�Or our�ianv License: CSSL402776 WILLIAM J MC(1tU 37 NAUSET ROAD West Yarmouth 1HA �1l/r •'"""`' Expiration Commissioner 06/28/2017 Engineering,Dept!(3rd'floor) Mao ' PAice Pefinit#'-, < e-Iss Dat tied House#;I'� Board of Health_(J&d floor)(8:15:' 9:30/:1:00-4:30) Fee: Conservation9:30/1:06J _71 Office(4t�h floor)(8:�O- _2:00�-'-- 7 T4ftwimg-Dept.(1st floor/School Admin.Bldg.) Definitive Plan Approved by Planning Board BARNSTASM M-9. TOWN OFBARNSTABY L Building Pe' rmit Application Project Street Add'yess Village Owner i Address Ay�(Z; 'Telephone -Permit Request 0,v1c+-N (First Floor square feet Second Floor ill square feet '-Construction TType rn Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size Wo soe— Grandfathered [3Yes LJNo Dwelling Type: Single Family Two Family El Multi-Family(#units) Age of Existing Structure Historic House E]Yes CO/No On Old King!s Highway Ll Yes Od/No Basement Type: L)Full El Crawl El Walkout E]Other Basement Finished Area(sq.ft.) i Basement Unfinished Area:(sq.ft) Number of Baths: Full: Existing New Half: Existing New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing S New �a First Floor Room Count Heat Type and Fuel: El Gas B/Oil 0 Electric L1 Other Central Air L]Yes U/No. Fireplaces:Existing New Existing wood/coal stove L]Yes M_1�0 Garage: El Detached(size) Other Detached Structures: L3 Pool(size) 0 Attached(size) Ll Barn(size) 0.<On.e. El Shed(size) 0 Other(size) Zoning Board of Appeals Authorization C3 Appeal# Recorded El Commercial LJ Yes 2�9 If yes,site plan review# Current Use Proposed Use Builder.Information Name (fl 61, 1�,J E SU 66-AJ J�TZ Telephone Number :. —Address., 66k—S0_GJ7r6L 9, 60715., License# to + 0 LP V Home Improvement Contractor# vjtw Mu NO 01 3r7q — 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 rkd644;1J DATE 31o)6_ 19F BUILDING PERMIT DENIED FOR THE FIALAWING REASON(S) A • t. 1r it • "� ]l -� -� fir' i r C N � N y0j ii Cp'Fh• C� 9 � u a Y I I _ 1 � }1 III n dillY---------J7 I I I I � I III'll.�ll. 11l•I — � rlr •� I1 II fill I I gig, ---- - -- ---- g Ile. s� ba� 1 or.•bl At (� � 1 OZ 1 _ tn J - Ilk a , all o ' I fit •x of .. I I I O M f M CI- m n L I d¢N • h� _ s o a yi-KI I✓rbl .9y , gnus -' I o S FI a 11 I. - — I I �j '" - s I rl ! � � I I R 'UP M - - Dllen 0:::.0390od,,CPBD Residential Designer . PO 1166,735:134 Rt 6=R Sandwich, MD 02563 SCALE: APPROVED BY: DATE: �O Fi9'r I/yPG�i�*W}pgfFlW' V041-9AOO PE(.IIf Q -Ir5.,T;r I�Ill�lhl-.�, _ WAU' o I �a�� yoa.e, o e6L 9,2� 41 � I I � � j I � �i0" �b�•Grw�frrN�l� Q ��CSC If/M1�li Ae iWrL II 'Ut I N•'fTF�� I I �Z�CU tii W'"I/�//1 w�Ali II ��II A4 eW C/ Q•L• s�I.Bel gu q^I ta.,c•GAS az ----- I I k�• r=co� \ � • CF VE T . y The Town of Barnstable WANSTABM 9� M ' 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 certain exceptions,along with other requirements. Type of Work: l4lio(1 Est.Cost Sys 000, — Address of Work: I✓1 S"Y� (A ) IG CO S —T Owner's Name 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 a to the o er: Date Contr Name Registration No. OR a $ -- Date Owner's ame I. _ f F i � �ie �i%anrmxaoxiuea "I'A aac/ume,04 II OEPARTNENT OF PUBLIC SAFETY CONSTRUC-TIONISUPERVISOR LICENSE Nuebifm Expires: ---- - — Re t icteda ; AIN ST BOX 51 WENDELL, NA 01319 � ��1a4 a�,�iuuratuaea2 . HOME IMPROVEMENT CONTRACTOR Registration °119823 'Type ; INDIV.IDUAL Expiration 09/05/99 f '< MELVINv E.'.SWEENEY JR. '125.LOCKS VILLIAGE RD. ? LjL IDELL, MA 01379- i d A`Ml- S1FiATOR [ ] [R196 009 . ] LOC] 1679 ROUTE 6-A CTY] 05 TDS] 500 WB KEY] 121834 ----MAILING ADDRESS------- PCA] 1091 PCS] 00 YR] 00 PARENT] 0 ROGERS, DONALD S MAP] AREA] 8 0AC JV] MTG] 0 0 0 0 ROGERS, BARBARA H SP1] SP21 SP31 MAIN ST UT11 UT21 . 54 SQ FT] 540 W BARNSTABLE MA 02668 AYB11950 EYB11970 OBS] 150 CONST] 0000 LAND 27000 IMP 88500 OTHER ----LEGAL DESCRIPTION---- TRUE MKT 115500 REA CLASSIFIED #LAND 1 27, 000 ASD LND 27000 ASD IMP 88500 ASD OTH #BLDG (S) -CARD-1 1 37, 500 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE #BLDG(S) -CARD-2 1 20, 400 TAX EXEMPT #BLDG (S) -CARD-3 1 30, 600 RESIDENT'L 115500 115500 115500 #PL OFF ROUTE 6A OPEN SPACE #RR 1387 COMMERCIAL INDUSTRIAL EXEMPTIONS SALE100/00 PRICE] ORB11293/241 AFD] LAST ACTIVITY] 09/05/91 PCR] Y Zij•.. R196 009 . A P P R A I S A L D A T A KEY 121834 ROGERS, DONALD S LAND BLD/FEATURES BUILDINGS NUMBER ZN/FL=RF 27, 000 88, 500 3 A-COST 115, 500 B-MKT 104, 800 BY 00/ BY M 3/88 C-INCOME PCA=1091 PCS=00 SIZE= 540 JUST-VAL 115, 500 LEV=500 CONST-C 0 ----COMPARISON TO CONTROL AREA 80AC -- --MAY NOT BE COMPARABLE-- NEIGHBORHOOD 80AC WEST BARNSTABLE PARCEL CONTROL AREA TREND STANDARD 101 10 LAND-TYPE 270001 LAND-MEAN +0% 1155001 99229 IMPROVED-MEAN -110 256 ] FRONT-FT ] 100 DEPTH/ACRES TABLE 02 10001 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 [?] The Common 11'ctrltit of Atrrssachusctts Department aJlrtdustrial Accirlurts V& 011iceoll171vestl9allotts 600 !f•aching ton Street Bmvwn.Alas 02111 Workers' Compensation Insurance Affidavit t�I?Iilic:int information• Please PRINT Z- W— name• location• city nhone N I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity ..... '� �-r ..vim l• _•./. - _ _ •Y - _-_- -.-.. r _ I am an empiover providing workers' compensation for my employees working on this job. conrtmo•name: address- city. phone tt• insurance cn. Spurt•a 511 am a sole proprietor. general contractor. or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: cornrinny naine- uGW Ct co P_VOC-_ V addresc- 1,4` 1 L VP 6 C:6 �,/ 1 �� R� city: Q li d S O l-3 9 9 3 2 7 insurance ro. ins PnC n nlim-N company name: address- gin phone 0* insurance co Wolin is Attach additio_nal sheet ifnecessary _-_ - '3y•--.-- �T '�^ -"'•• -L' �ye�. ,y'v Y•� Failure to secure coverage as required under Section 25A of NIGL 152 can Iced to the imposition of criminal penalties of aline up to 51.500.00 andiur unc years* imprisonment as swell as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. 1 understand that a cop)•of this statement ma% be forwarded to the Offce of Investigations of the DIA for coverage verification. 1 do herchr ccrti r•untl r the pains and enalucs ojp• n that the information prorided above is true and correct. Signature— " Date Print name Phone# write in this area to be completed by city town ofTiciai'•official use uni% do not city or town: permiulicense# t'•tBuilding Department C3Liccnsing Board I]check if immediate response is required 0Scleetmen's Office t.. C311caith Department contact person: phone#• rI0lher . i. 1 t I_ Information and Instructions Massacliusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for;l; employees. As quoted 11rom the "law—. an empl(tree is defined as every person in the service of :another under any contract of hire, express or implied. oral or written. An enzplorer is defined as an individual. partnership, association, corporation or other legal entity. or any two or me the foregoing enuaf_ed 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 owner of a dwelling house haying not more than three apartments and who resides therein, or the occupant of the dwcllin�_ house of another who employs persons to do maintenance , construction or repair work on such dwelling_ h( or oat the grounds or building appurtenant thereto shall not because of such employment be deemed to be an empio%*: MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or rencivai 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 chapter been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying: company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confir►nation 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 requir: to obtain a workers' compensation policy. please call the Department at the number listed below. . City or rowns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom the affidavit for you to fall out in the event the Office of Investigations has to contact you regarding tite applicant. P1 be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returnee the Department by mail or FAX unless other arrangements have been made. The Office of investigations would like to thank _you in advance for you cooperation and should you have any questic please do not hesitate to give us a cz-ll. The Department's address. telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Office of investigations 600 Washington Street Boston,Ma. 02111 fax #: (617) 727-7 749 phone T: (6I7) 727-4900 ext. 406, 409 or 375 I 199� \ ,,,,uiication :o p 01s , dJ��d`. 4-7 Old Kings Highway' Regional Historic District Committee • �� ' in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS Application is hereby made, iri triplicate, for the issuance of a Certificate of Aopropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1.973, for proposed work as described below and on plans, drawings or photographs accompanying this application fur: CHECK CATEGORVS THAT APPLY: 1. Exterior Building Construction: ❑ New Building Addition ❑ Alteration Indicate type of building: House ❑ Garage ❑ Commercial ❑ Other 2. Exterior Painting: ❑ 3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other (Please read other side for explanation and requirements). TYPE OR PRINT LEGIBLY DATE ADDRESS OF PROPOSED RK I� "�' ASSESSORS MAP NO. /D OWNER ASSESSORS�L�OTT NO. HOME ADDRESS ' I n J TEL. NO. : 0 -3(a -&135 FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet ' necessary). AGENT OR CONTRACTOR7A )�� TEL. NO. ADDRESS 16 I ff Icli'tl W W &("61el DETAILED DESCRIPTION OF PROPOSED WORK: Give all particular of work to 6!done(see No. 8,other side), including materials to be used, if specifications do not accompany plans. Inc the case of signs, give locations of existing signs and proposed locations of new signs. (Attach additional sheet, if necessary). ?L v vV n JEI Signed Owner•Contr Agent Space below line for Cor^::ui—.. Received,by.H..D-C-- +I _ - 1'he Certificate is eby Date Da.Ce _ r_By, Y t. (. � APp•proved U IMPORTAN : If Certificate ;s approved, approval is subject to the 10 day appeal period - provided in the Act. TOWO Of B&MUabi! Old Klag's Mgbway 111mr is Maria Cammttgft SPEC aam CHINNEY TYPE COLOR ROOF MATERIAL i ►(� I OLOR PITCH_ 3 WINDOW SIZE � 5 J ' TRIM COLOR_ WWI DOORS [A) }-{� '� COLOR SEERS N COLOR N GUTTERS DECK GARAGE DOORS COLOR S IWZ RS 8 GNS COLORS SIGNS OLORS FENC COLOR U { � NOTES: fill out completely,Jinclud' measurements and materials/colors to be ui**d. Three copies + of this form are rewired for submittal of an application, along with three copies each of the plot Plan- landscape plan and elevation plans. when applicable. plot plan need not be 'Certified* except for now homes, but should show all structures on the lot to scale. SPECSHT Ir9 o Is 14,4f oT Map a Parcel --e5�D`� Permit# 30 f i r House# Date Issued Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) P-7-37 Fee 0 Conservation Office(4th floor)(8:30-9:30/1:00-2:00) �&sh =iv!675�nppjo�v,e �� SEPTIC SY T BE and 19 INSTALLED I NCE WIT (� {TOWN OF BARNSTABBEIRONMEN E AND `n Building LPermit Application Project Street Address -- (Y I C) IV) Village (AJ,2s-1 n Owner i ( Address �� ( Md i S �' (,C)V�jd MSS Telephone 3(p off- b i 85 Permit Request L 46 X n /Qkcd I n _k r\ t i to h v S( ea� -r-Y10A��, roves First Floor s uare feet Second Floor t\I ky square feet • Construction Type Estimated Project Cost $ 00 Zoning District 09 Flood Plain Water Protection Lot Size q, )U 0 SQrn�¢ Grandfathered ❑Yes ❑No Dwelling Type: Single Family L/ Two Family ❑ Multi-Family(#units) Age of Existing Structure A4()�J(Lf Historic House ❑Yes No On Old King's Highway IUYes E To Basement Type: ElFull ElCrawl ❑Walkout &/Other L�_ 6)U , Basement Finished Area(sq.ft.) q.I) s(1�j Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing I New Half: Existing New No. of Bedrooms: Existing c),_ New Total Room Count(not including baths): Existing 5 New �o First Floor Room Count Heat Type and Fuel: ❑Gas 0/oil ❑Electric ❑Other Central Air ❑Yes f/io Fireplaces: Existing New Existing wood/coal stove ❑Yes f1To Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) 21l0ne ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes Uj o If yes, site plan review# Current Use Proposed Use ,f Builder Information Z LL i 1 Name 1VJ S 1=. J6A�z(- Telephone Number I—`tip- Su4-38 '��l Address &k 20 G'Tft,�L- 96().15, License# 610 //o 3 y �� y f L(� �'✓ Fes' Home Improvement Contractor# /1 98a3 wt y 06(.,, 0 1 3 r7q 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 R TING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE U/ 1� ATE / BUILDING PERMIT DENIED FOR TH O OWIN ASON(S) .r w FOR OFFICIAL USE ONLY s .6 PERMIT NO. DATE ISSUED s ii MAP/PARCEL NO. ADDRESS VILLAGE OWNER - DATE OF INSPECTION: FOUNDATION O FRAME _ ! 4 —9 9 INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL �r PLUMBING: ROUGH FINAL GAS: ROUGE FINAL FINAL BUILDING ttit X . DATE CLOSED OUT ASSOCIATION PLAN NO. • •-•tom • 7100MAppgo tat �Q ` Table JS.2.1b(contianed) Ps escs ptire Padragn for Oae and Two-Family Residential Batldlap Hated with Foal Fade MAXIMUM MINIMUM Qtaang 1. pig I Qcil;ng Wall Floor Ba:emcut Slab Hessiawcoolmg Areal('K) U-valuer R value' R-value' it-values Wall Perimew B*dpmeot El0aeacy" pie I I I I Rwalmmt' R vdne 3701 to 6500 Hating Degeee_Dayrr Q IZ•/ar. 0.40 38 13 19 !O 6 Normal R I2% 0.32 30 19 19 10 6 Normal S 12% 0.50 38 13 19 10 6 SS AFUE T 13% 036 38 13 23 N/A N/A Normal U 159A 0.46 38 19 19 10 6 Normal V I5•/. 0.44 38 13 23 WA N/A 8S AFUE W 15% 6.52 30 W 19 10 a :i AFUE X IS% 0.32 38 13 25 N/A N/A Normal Y ig% 0.42 38 19 25 WA WA Normal Z 13% 0.42 38 13 19 10 6 90 AFUE AA 187. 0-50 30 19 19 10 6 1 90 AFUE 1. ADDRESS OF PROPERTY: IGl� 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: ' "" ' ` 7 1f��'r1d� Y<,� 3. SQUARE FOOTAGE OF ALL GLAZING: f a. %GLAZING AREA(#3 DIVIDED BY#2): 7►tw l 10 5. SELECT PACKAGE(Q—AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. &A�f 67k ?AA, _ �V, Ors S 66 70 C*Lt,, BUILDING INSPECTOR APP V YES: NO: q-forms-l980303a — 780 CMR Appendix J Footnotes to Table J5.2.1 b: ' Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and basement windows if located in walls that enclose conditioned space, but excluding opaque doors)to the gross wall area,expressed as a percentage. Up to 1%of the total glazing area may be excluded from the U-value requirement. For example,3 ft'of decorative glass may be excluded from a building design with 300 W of glazing area. 2 After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for whole units: center-of-glass U-values cannot be used. ' The ceiling R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. •Wall R-values represent the sum of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding, structural sheathing, and interior dryw-aii. For example, an k-19 requirement could be-met EDJiEk by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frame or mass(concrete,masonry,log)wall constructions, but do not apply to metal-flame construction. 'The floor requirements apply to floors over unconditioned spaces (such as unconditioned crawispaces, basements, or garages).Floors over outside air must meet the ceiling requirements. `The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned basements must be included with the .other .glazing. Basement doors must meet the door U-value requirement described in Note b. 'The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs. ' If the building utilizes electric resistance:heating use compliance approach 3, 4, or 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must-meet or exceed the efficiency required by the selected package. 'For Heating Degree Day requirements of the closest city or town see Table JSZ.I a NOTES: a)Glazing areas and U-values are maximum acceptable levels. Insulation R-values are minimum acceptable levels. R-value requirements.are for insulation only and do not include structural components. b),Opaque doors in the building envelope must haveta U-value no greater than 0.35. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table J1.5.3b. If a door contains glass,and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excltded.from tthic.req�iirem.enr(i_e., m.ay have a T T-Yahue hater than c) If a ceiling, wall;floor,basement wall,slab-edge, or crawl space wall component includes two or more areas with different insulation levels, the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). t PmhAAA Qf-h A,&1 04 57 I —�5 Lj 14 -14A =AAZ� AHA-U tA"Z� -- g R ahn�. t { : 't•.s t t .J �'�'r... t � <k 'J,} � '� -� 1 1� s� r � ' r r F• �- � I ,... r i•...:` t''.r1 ';' t,�..� <•.Id �� t\~t .\ .Sr.�`.% :1: '� ; �t ,d l� _ r r,l t iv. t �. f' C ��.) .�, 1 .t-'S ?. < Y 1 ,�h', •ate.^ ti �� a�c� .�. 1✓ -'.d�t.t ! .r: f$•�t ,ij. L,k r + ,t ` 1 t l , ,1 Vk;,.rl_it �f „ � `, _sia. ►r. . +...�! 1.. ,,�. `aid. r�.�t•J'ti. .t�\,�. �.� r i, s• :�' .. t� ►i1. � � .\ 1 t ,1� i It cam. .T•!4 .tom �•3.4-� t i t��_ 1.� ,� i y .v � �� '..F .i. J S? / I•t. r [h.r.. ;i •t ." \t. ►, �• 1 i f �1, (.f� t .ter—•:?."\ .1... r r t'ti t 1 , ( 1 r"1 q t � � t 4A 1 l� E i �._.t! i M.'. � I .... i �� ' ..�.». ....... ..�..�. i ....�. � �9 �..•... `r .\ � � .J@`\ C^ � � � ' �� G� I / \ \ ; i� � ; �, f \'. • , 1 �� \\ 4 �t r Town of Barnstable *Permit#�®moo Expires 6 months from issue date RA„, ABU. $ Regulatory Services Fee ,7 HAM `0� Thomas F.Geiler,Director Building Division Tom Perry,CBO, Building Commissioner oPSS PERMIT 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us � � �006 Office: 508-862-4038 {{Fax: 50 - 9 -6 3 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONL9k/V!J OF BARNSTABLE, //�� Not Valid without Red X-Press Imprint p Map/parcel Number / �9 O C7;�S Property Address /6 -2.S /Kj 6 IY— [Residential Value of Work ®®� Minimum, fee of$25. for work under$6000.00 Owner's Name&Address Contractor's Name_ �— Telephone Number a S Home Improvement Contractor License#(if applicable)_ J f 2 S 6 Construction Supervisor's License#(if applicable) 9workman's Compensation Insurance Check one: / SLt � vo ❑ I am a sole proprietor ❑ I am the Homeowner C✓l�vn-C.t Q J\ [kI have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be oii ile. ?ermit Request(check box) K_Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. e Improve ent Con rs License is required. IGNATURE: :Forms:expmtrg evise071405 The Commonwealth of Massachusetts Department of Industrial Accidents t ,�:• : Office of Investigations .f r�;�►, r' 600 Washington Street Boston,MA 02111 r z� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information (� Please Print Legibly Name (Business/Organization/Individual): Address: y 13 L) 1 9 Se,5 City/State/Zip: Phone #:_ —3D_5 -_ Are you an employer?Check the appropriate box: Type of project(required): 1.L?f I am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t ?• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.] t employees. [No workers' 13.0 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 sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information.Insurance Company Name: i Q Policy#or Self-ins.Lic.#;�9�/` 6 ` Expiration Date:_ O Ze Job Site Address: /6 75 /'" S�, AV 66eL/1^ City/State/Zip: {?4 A, Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify,u e p ' s a p aloes of that the information provided above is true and correct Si ature: Q, Date: 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#: �'lie {pa.,np,,a.,zuieal!/ a�,/�r�ac/zuaelta ' . License or registration valid for individul use only Board of Building Regulations and Standards HOME IM�',OVEMENT CONTRACTOR befotii the expiration date. If found return ds ` \ Beat'ti'of Building Regulations and Standards i Registra-66m, 12536 One kshburton Place Rm 1301 lugica3+aa�23 2007 Bost a,Ma.02108 FRASER CONS DEAN FRASER 71 TARRAGON CIR��, mil, f�^"� --- -COTUIT,MA 02635 Administrator Not valid without signature I Fraser Construc ti on Roofing & Siding Specialists P.O. Box 1845, Cotuit MA. 02635 Email: fraser constructionnvPrizo r`o�+ Z / 11L..IV n-net Y www.fraserroofing.com Phone 1-508-428-2292 & FAX.1-508-428-0123 RE-ROOFING PROPOSAL PARTIAL DATE: October 2, 2006 Cell 774-994-0160) NAME: Richard RogersI? MAIL ADDRESS: same �� PHONE: H 5.08-362-6911 JOB ADDRESS: .1675 Main St. West Barnstable, Ma. 02668 FRASER CONSTRUCTION hereby proposes to perform the following services a neat and professional like manner and in accordance with the manufacturer's specifications and local building code. -Remove and Haul away all of the old roofing material -Re-nail all plywood sheathing as needed. Supply and Install - CERTAINTEED XT AR- 30: 30 Year Warranty, 5 year sure start protection, CLASS A FIRE RATED, ALGAE Resistant, Extra Heavy Weight, Self Sealing, 3 -Tab, Fiberglass Based Asphalt Shingle with New England's Exclusive COPPER/CERAMIC Stones with a Full 10-year Warranty against ALGAE Containment. Color: Moire Black PRICE- $2,565 partial front only Initial Supply & Install - CertainTeed Winter- Guard: (ice & water shield) Waterproof Underlayment System (3ft. on eves and valleys, 18" on rakes, walls, and skylights) Supply & Install - Roofer's Select Underlayment Paper (as recomm by CertainTeed) ended Su 1 8a Install - Hick's Ventilated Drip Edge. Supply &_ Install -Aluminum & Neoprene Soil Pipe Flashing Su 1 A Install -Air Vent Ridge Vent (as recommended by CertainTeed I )Clean & Remove - Debris from work area daily. i i c � H� Fraser Construction Roofing & Siding Specialists y P.O. Box 1845, Cotuit, MA. 02635 3 Email: fraser_construction@verizon.net www.fraserroofing.com Phone 1-508-428-2292 &FAX 1-508-428-0123 6v4 !v 69 / 1 C � fj i� rLAJ T? , I-) 62D Y, I � -�� 00 A .;Onstruction I�Targa�>re of the caBIl / 9 a6-a 6 HoW did they hear about Fraser. � ,&ess �,anl To Phone.° 3 3� 2 - �4i .—�XT AR 2s �}- -_XT.R 30 Landnu-wk AIR 30 —Landmark Premium ---_Laaad2nark Ultimate (TL) Ice &Water Shield Felt Paper - Roofer's Select Tri Flew ---Hick's Vent Drip Edge White Drip Edge —�AIR Ridge 11 j --_Vent Pipe Flanges Copper pp Aluminum —Nails 1 %4 _Cap Shingles Starter Shingles �®ther i L LANDMARK AR 3 -O partial front only $2,565 y , Payable immediately upon completion NO MONEY DOWN- NO Payment at the start or part way thru Payments accepted are: CASH - CHECK- MASTERCARD -VISA -AMERICAN EXPRESS *Any payments not made within 30 days of completion will be charged 1 ''/z%for every 30 days the payment is late. I Possible Extra -After the shingles are removed from the roof, we will lift one sheet of plywood to make sure that the insulation is not up g p against the Plywood sheathing preventing ventilation from the eaves to the ridge. If it is, ventilation panels will be installed by; removing the plywood sheathing, installing the panels, turning the plywood over and then re-installing the plywood. If needed, this would be charged for as an extra at the rate of$4.00 per panel including Materials & Labor. There are 6 Panels per sheet of plywood. Possible Extra -Any rotted or otherwise deteriorated trim boards, plywood sheathing, lead flashing, or other carpentry needing replacement will be done and charged for as an extra at the rate of$50.00 per hour, plus materials, plus 20% overhead mark-up on total extras. FRASER CONSTRUCTION Warranties the labor for 10.years FRASER CONSTRUCTION Warranties the shingles against Blow-Offs for 10 years. CERTAINTEED Warranties the shingles and labor 100% through the Sure Start Warranty duration. CERTAINTEED Warranties the shingles to be ALGAE resistant for the duration of the Sure Start Warranty depending on the shingle that was purchased. Any deviation or alteration from above specification will be executed upon written orders and will become an extra charge over•and above the estimate. All agreements contingent upon strikes, accidents or delays are beyond our control. Owner should carry fire, tornado and other necessary insurance upon the above work. We, if not accepted within thirty days may withdraw this proposal. FRASER CONSTRUCTION: Carries Workman's Compensation and Public Liability Insurance on the above work, certificate available upon request. DA O EPTANCE: Homeo er Fraser o ction I ' • ` it EC ✓fie TDomnzovuaea ✓� �ac�iubnti"a Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR befori the expiration date. If found return to: v� BeaW of Building Regulations and Standards i Registratio�rr_ 12536 One Ashburton Pace Rm 1301 x I atian_ 23�/.2007 Boston,Ma.02108 Type: FRASER CONST 131Oj DEAN FRASER� 71 TARRAGON CIR�`=4` -'% 'z., COTUIT,MA 02635 Administrator Not valid without signature I ' r t vr," r ,� wf y,eaagx nws,..r,»,n-aru.usa„a mtus,.arazx cr+i�d,w.�r a nr� rc�to �,,Y R� ISSUE DATE' 09127/06 �?•A- 1b._. 6 �a.Js-w>,rw ifs_ _^rrt 4t,.. .. zt.ius«e�eV..�».:Gcx.uas_r.a.,'sry S F THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY. PRODUCER AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT,AMEND,EXTEND OR ALTER THE COVERAGE WISE 8L QUINN INSURANCE AGENCY AFFORDED BY THE POLICIES BELOW. 449 PLEASANT ST BROCKTON,MA 02301 COMPANIES AFFORDING COVERAGE • COMPANY A HARTFORD UNDERWRITERS INS CO LETTER . COMPANY B LETTER INSURED COMPANY C FRASER.CONSTRUCTION LETTER PO BOX 1845. COTUIT,MA 02635 COMPANY D LETTER COMPANY E LETTER COVERAGES sA � s ;' ;_ $ � i � IN 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: CO TYPE OF INSURANCE POLICY NUMBER POLICY POLICY LIMITS LTR EFFECTIVE DATE EXPIRATION DATE D (MM/DDIM GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $ CLAIMS MADE OCCUR PERSONAL&ADV.INJURY $ OWNER'S&.CONTRACTOR'S PROT. EACH OCCURRENCE $ FIRE DAMAGE(Any One Fire) $ MED.EXPENSE(Any one person $ AUTOMOBILE LIABILITY COMBINED SINGLE LB41T $ ANY AUTO ALL OWNED AUTOS BODILY INJURY $ (Per Person) SCHEDULED AUTOS BODILY INJURY $ HIRED AUTOS .. . (Per Accident) - NON-OWNED AUTOS GARAGE LIABILITY PROPERTY DAMAGE $ EXCESS LIABILITY UMBRELLA FORM EACH OCCURRENCE $ OTHER THAN UMBRELLA FORM -. AGGREGATE $ STATUTORY LIMITS A WORKEkl5COMPENSATION F.ACIIACCMENT $;00,000 AND 6S60UB-794X6191 09/26/06 09/26/07 DISEASE-POLICY LIMIT $500,000 EMPLOYER'S LIABILITY DISEASE-EACH EMPLOYEE $100,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS R THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE C�TtTIFIG�TE�HU_.LpsER� "�--.,�_ + , .., . ;��.�� ,;��ram. 'y} � Ca1NCEZLATI"_•lY'�� '��•"�',��'��'�.v` ' ��a�� ` SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ERASER CONSTRUCTION EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 » DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, PO BOX 1845 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR COTUIT,MA 02635 LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES AUTHOIUZEDD MPPRRE,SSEENN`TTAAATSIVVE xW-0i ull-MR77 CORD GORPOR TION 99.0 M d`, OON44 c 4 M O F q/ 6 S. �? q T� O . e RNS . RFF GFR p.� N k T s . 0414 o (e7 O sS, oh o ' AG 02 N• O' 0 4V h O Cb 61 "1 � �� 00 Op �• ^\ � S 880 2 Q 2s � V6 '29 0 4C5 r 5 � u o � � v (D-J fTT7c_ / ,? G s �o •� o Barbara A. BARNSTABLE Belonging to..Donald S. Rogers Deed in Book. 1293 .E �.and In .... .........:....................,.... . ,...... ........ ... ... .. • Pag o . Land Court Certificate No. ......•.••• in Book ...............Page .In „Barnstable. Registry, of,Deeds... Land in .Barnstable by Nelson B'earse E Richard Law,DateS r f ors Sept. 27f�60 . ",worded Plan.. . ... ..... ............ .... .... .. o Ian ................................... ..... ... Barnstable . of��Deeds, in planBcok..................•185 No.. 23.... filed Flan No. in ........................Registry...................................... ............................... ,.AORTGAGE :INSPECTION .PLAN THE MORTGAGE COMPANY OF THE CAPE I ISLANC I .an No. Donald. S. &.Barbara A. Rogers S7vNt k14 L L- j. Pis. .�. _ / '�. _•ra :, .... ... ` ONE »....;t;:;• .V1 ,!A LOT 3 LOT 4 . • 4y &4* Pro 4_....L-� ,o NJA1� � =- �®R PLANNING PURPOSES•ONLY I act. 27,1986 1 DATE 34. - 50913 NOT TAB .. . J FOK •SiRUPON ..:.....sue... r QUERY PERMITS : QUERY END QUERY PERMITS PENTAMATION----------------------------------------------------------- 09/15/98 PERMIT NUMBER 30710 PARCEL ID 196 009 1679 MAIN STREET/RTE 6A PERMIT TYPE BADDI BUILDING PERMIT ADDITION DESCRIPTION ADD BATH EXTEND KITCHEN CONTRACTOR PERMIT FEE 139 . 50 VARIANCE STATUS A ACTIVE CONSTRUCTION TYPE 434 GROUP TYPE 1 APPLICATION 05/05/1998 EXPIRATION VALUATION 45000 . 00 DATE ISSUED 05/05/1998 COMPLETED DEPARTMENT-----STATUS---DATE-----DEPARTMENT-----STATUS---DATE---- (N) EXT/ (P) REVIOUS/ (C) ONTRACTORS/: PR (0) PERTY/ (I)NSPECTIONS/ (H) ISTORY/ (F) EES/ (A) RCHITECTS/ (V) IOLATION/ (E) XIT i Town of Barnstable-Planning Department Old King's Highway Historic District Committee fD MKS MEMORANDUM TO: Building Commissioner FROM: Gwendolyn Brown, OKH Secretary DATE: Z Z, le?(�9 SUBJ: Modification to Prior Approved Plan A minor modification has been approved by the OKH Committee to a prior approved plan for the applicant (s) named below. The modification is briefly summarized and I have attached backup material for your records . Applicant (s) Address of proposed Work l 7 /'Mai�J Assessor' s Map & Parcel# [ 7 a Meeting Date Approved by OKH Minor Modification XV •�. mom_ Chairman Date If you should have any questions, please do not hesitate to ' contact me at ext . 862-4684 . MEMOBC 0 0 !> A3 64 � Ul � �25Op� •.c•B_ (� o J+ rrO�� V• Cb 0 w �. ti o - 2 .850 n /$400 'as N � 8 e -ch 26,260 C9 P p; o P o Q Nsc pole V cp y QO N � 3 0 Nkl 2_3.400 a W A �' 0 v� 4. 0; - TN :ja /9./0p Act^ V rh o. ° go n0j ' nI I�10E- 5� 0� GSA ZZ 6 y.: Iron Rjnq 3C�.Z7 _ 39• �j;/ In boulder+ 3Z`t ✓ G/ , 1_ aa�8° o r�3 7.ao , `Vol J �-� 1964 h h0 PLAN OF Lo-FS I N LlWE ST BARNSTA BL E, MASS. V y5 37 BEL_or.dGIN (::X- C)a iNEWT'ON NIKIFRED M. PERKINS 5� s61°f9 IOV1/ SCALE I IN = SC FT. SEPT 27, 1960 :, t. .:T = 'c j . 5 s'T Nc-LSON SCARS L� PICH/ARD ^�L��t{AW. SURVEYORS ..,'l r- �.r11V'J CENTERVILLE., MASS. OF M'q j NELSON ICHARD Jjr BEARSE iA i� L A W 1 2776 BAIRINSTIJ,UX O'�nD 01` �CISTl