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Home My WebLink About0241 MAPLE STREET -A/A , r Y �I 1 4 � 1 oxftw NO. 1521/3 ORA MADE N USA ESSELTE r • • s 0 Rf Vie of Barnstable Bu11CI1I1g Post This Card So That it is.Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept M"S& Posted Until Final Inspection Has Been Made. Permit •' cl llj Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final inspection has been made. Permit No. B-18-810 Applicant Name: SCOTT PEACOCK BUILDING & REMODELING INC Approvals Date Issued: 03/26/2018 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 09/26/2018 Foundation: Residential Map/Lot: 132-004 _ _ Zoning District: RF Sheathing: Location: 241 MAPLE STREET,WEST BARNSTABLE _ Contractor Name:"-,JAMES S PEACOCK Framing: 1 Owner on Record: HARRIS,JOANNE H TR Contractor License: CS=094500 2 Address: 241 MAPLE STREET Est. Pro ect Cost: $4000000, . i Chimney: P WEST BARNSTABLE, MA 02668 ' Permit Fee: $254.00 Description: REFIT KITCHEN AND 1 ST FLOOR BATHROOM I Insulation: y Fee Paid: $254.00 Project Review Req: r ) Date: t:` 3/26/2018 Final: Plumbing/Gas Rough Plumbing: ,Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and the`approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for: ublic inspection for the entire duration of the Final Gas: work until the completion of the same. --- l Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are-provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: ` Service: 1.Foundation or Footing ��- Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site 3 Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Massachusetts Department of Public Safety 91 Board of Building Regulations and Standards License: CS-094500 Construction Supervisor ' - JAMES S PEACOCK ' "' v PO BOX 171 i•::::;,, OSTERVILLE MA 02655 C �/ n: tioa xpir E ommissioner Expiration: r`:%�r�rurrrrnirrnrrr�/� Cl` '• �rJcIYJ 2018 r n. ri.,.,rir•n Office of Consumer affairs&Rusiuess Rggulntion License or registration valid for individual use only 3 HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration:,-:;'151853 Type: Office of Consumer Affairs and Business Regulation Expiration:-7r/201.8 Private Corporation 10 Park Plaza-Suite 5170 Boston,Mai 02116 SCOTT PEACOCK BUILDING'.&`REMODELING ING JAMES PEACOCK 1046 MAIN STREET SUITE7: '..: _ OSTERVILLE,MA 02655 undersecretary JNot valid without signature I �SMEr � Town of Barnstable Regulatory Services BARNSTABLE, MAss Richard V.ScaG,Director FoMp+� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, Joanne H.Harris,TR , as Owner of the subject property hereby authorize Iscott Peacock to act on my behalf, in all matters relative to work authorized by this building permit application for: 241 Maple Street,West Barnstable (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. ignature of // er i ature of Applicant VCUCjmm n ej, 14. -TR, Print Name Print Name Date 1 i CASING Q CA51NG Q Sheet EXI5TING WINDOW(A) NEW WINDOW 66it 371j' # 34k r 37re 4 28j. 14' ) 521j' 37r? 34j' +37r' # 2e Rev. NEW WINDOW MATCHES 2.13.18 W WINDO (Al ;. EX15TING WINDOW(A) MAINTAIN CJL Scale 1 841t 71 47#' -- --------------------------------------------------------I----------------------------------------------- I------------------------------- Eng. I I 1 1 . ..... ............ I MAINTAIN WINDOW G125 I 43- v IY I 1 2.25 2.25 2.25 , Z 52.187 X 42 \\ \\ 34)094 X 42 \\ \\ 13.59X42 (%) I I 1 I N I I 1 I I I I I 18' I I I I I 1 1 1 Q I I I I 1 1 I I I 1 1 1 .._.... _.....,... .._ ..__......._.. .......... ................. ..... .... ._.. _ 32.25 472�.2 2 I 1 1 - I I I I I i u 10 9 ♦\ IO 9 1 1 36' i i \ _ i i o 1 �...�,. ...,..T.. I I 119 119 lHAN19 I I � 1 I ♦♦ I 1 1 3 1 I 77.531%90.75 54.26 X 30.75 c -'------------------------------------------------------------------------------------------------------------------------------------- C K DOUBLE KOHLER 5285 DISHWASHER LEMAN5 =c TRASH PULLOUT 5TAJNLE55 5TEEL CORNER 5YSTEM 25' 77k 24' 53¢' j 23e j5 rz f o ----------------------„ �r--------------------------------------------------------------------------I I m � i I ' I i � i � a E3 & i � I i I iI a s , I I iJ 1 I I I I I I r___________________________________________ w rw,.orocumwl Tc' Horgan Millwork HARRIS 30 Ch Ave,Hyannis MA 02601 m m w < Ph:(508)779.9941-Fox(508)778-0110 Qp . i Ile Commoniwarlth olfMassachasetfs Deparkxext of huLuhial Accidents - Office oflmx niigations 600 Maybingiou,Street Boston,MA 02M wnjv.taias&govldia Workers' Compensai onIusnranceAffidavit Bddders/Conn-actorsMectricians/Plumbers Applicant Information C1 Please P`rbnt LtgibN Name a sores Orpniza(iowlndivid al):JC-�J R t-t c_i?c'_IC. 131J j�(+��c `l 1Qe yy� P,j i 0lr , I�'1�. Address: P, 0, i uY( M CG )Y-) 6 S 11i k '7 CitylStat,/ ip-0Sfe f V) P lL A 0 Phone 4r 57*-�` q;Lg-_)6 00 Are you an employer:'Check the app3ropriate box; Type of project(required): 1_ I am a employer with 4. ❑I am a general contractor and I employees(full and(orpait-#ime)_ hired * have hir the sub-contractrns. 6- ❑Nev o�sEtizcison 2_❑ I am a sole proprietor or partner- listed on the attached sheet. 7- R, deling s and bate no These sub-contractors have T\ employees 8. �Demolition working forme in any capacity emplayem and have workers' [No workers' comp_insurance COMP-mace-1 4- ❑Building addition required-] 5- We area corporationand its 10-[]metrical repairs or additions 3_❑ I am a homeou ner doing all work officers have exercised(heir 11-0 Plumbing repairs or additions myself. [No workers'camp_ right of emmptioa per MGL 12 0 Roof repairs inmxanre required.]F c-152,§1(4),and we have no employees-[No workers' 13_0 Other comp-tnstnance.required-1 'Any amptiauat that coeds hox nl most also fill out the section heTawshnwins iheawo�ceis'rnmpensid policy informx iom- t Homeowners who sabmit dais sfitdzsnf indicsting dey ate doing all uu&aadthen bue oastside coatamctors nmst salmmt a new affidavit mXrsting mch- 40 mtmcmrs that cbedc this bar must sttacbed an additinnal sheet shoxmg the name of the sob-cmift3cbm and state whether ocnot those e4ilks:have emprnyees_ If the sub-contmaurs hie employees,they must provide tbar workers'comp,policy number- lam art employer That is prmdding tyort-ers'compRrLvaiion irL=rarice for rtty ampLayees Betaty is tie po£icy and job site inrformatio4L Insurance Company Name: �3>^GI r)i ' S �"'� Vl U ✓f.{�1 (�� Q, Policy,;#or Self-ins-Lct ic_:' ,' S 05 5 y(n L4 Expiration Date: Job Site Address: o� T I i Cit#StatelT_tp: VV' e)a )q k{,bU W tea,(06 e Attach.a copy of the m-orkers'compensation policy declaratiou 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'cd final pm-dfies of a fine up to$1,500.00 andlor one-year imprisa2ment as well as civil penalties in the form of a STOP WORIK ORDER and a fine of up to$250.00 a day against the violator_ Be advised that a cry of this statement maybe forwarded to-the Office of Irrtestigations of the DIA for insurance coverage verificatiorL I do hereby h'rtnder the pal aitd penalties ofpetlruy thatYlie intfortriation prot¢ded bone isrl and correct S.iEnature: Date: 2vD Phone#: — 1 2 u \� 6 0V --.._. -"----- --�f�ctiiI ti:se`rsrafy:-�}o-t>otsyrite-irrtlri�trrerr�fu-bs-co or•tatcn ' L---- trrpieted-byGriy- �� ---------•— -- - City or Town-. Permit/Ucense# Lssui n Authority(circle one)-- 1.Board of Health 3.Bw7d);i�-'IDepartmeut 3.Cityaown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contract Person: phoned_ 6 CERTIFICATE OF LIABILITY INSURANCEP�071ml ( MMO/YYYY) 0/2017 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 does not confer rights to the certificate holder in lieu of such endorsements). PRODUCER CONTACT NAME: Germani Insurance Agency PHONE p r - (508)428-9194 908 Main Street E-MAIL Fax No): (508)428-3068 AOQR s: cens@germaniinsurance.com OSterville INSURER AFFORDING COVERAGE NAIC R INSURED MA 02655 INSURER A: SAFETY INS CO 39454 INSURERS: Granite State-AIU Holdings 000000 Scott Peacock Building&Remodeling,Inc INSURER C P.O.Box 171 INSURER D INSURER E: OsteNllle MA 02655 INSURER F COVERAGES CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUR REVISION ED ED ABOVE FOR THE POl1CY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERIJI OR CONDITION OF ANY CONTRACT OR OTHF�2 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. rA A B TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP X COMMERCIAL GENERAL LIABILITY MIDD MMlDD LIMITS EACH OCCURRENCE S 1,000,000 CLAIMS-MADE n OCCUR DAMAGE PREMISES(Ea omur0ence is MED EXP(Arty one person) S BMA0022118 07/05/2017 07/05/2018 PERSONAL&ADV INJURY S GEN'L AGGREGATE QUIT APPLIES PER: POLICY❑PRO. ❑LOC GENERAL AGGREGATE s 2,000,000 JECTOTHER: PRODU�S-COMPlOPAGG S AUTOMOBILE LIABILITY W S COMBINED S GLE LIMIT ANYAUTO Faaraden S OUMIED SCHEDULED BODILY INJURY(Perpersan) S AUTOS ONLY AUTOS HIRED NON-OM.ED BODILY INJURY(Per accident) S AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE S Peraccident -_ UMBRELLA LIAR OCCUR EXCESS LIAR EACH OCCURRENCE S CLAIMS-MADE S OFD RETENTION S AGGREGATE S INORKERS COMPENSATION S AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY B OFFICERIMEP BER PARTNERrEXC UDE07(ECUTIVE ❑ N 1 A EL EACH ACCIDENT S $00,000 (Mandatory in NH) WC 005-81-5464 06/22/2017 06/22/2018 If yes•describe under E.L.DISEASE-EA EMPLOYEE s 500,000 DESCRIPTION OF OPERATIONS belu:vO15EASE-POLICY LIMR S SOD,OOD DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES(ACORO 10t.Additional Remarks Schedule.maybe 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 Scott Peacock Building&Remodeling Inc ACCORDANCE WITH THE POLICY PROVISIONS. PO BOX 171 Osterville,MA 02655 AUTHORRED REPRESENTATIVE Fax: Email: ©1988 2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD I Select Language Assessing Division Property Lookup Results - 2018 367 Main Street,Hyannis,MA.02601 <<BACK TO SEARCH<< (M) rin Owner Information-Map/Block/Lot: 132/004/-Use Code: 1010 Owner Owner Name as of HARRIS,JOANNE H TR Map/Block/Lot GIS MAPS 111/17 241 MAPLE STREET 132/004/ Property Address WEST BARNSTABLE,MA.02668 241 MAPLE STREET Co-Owner Name 241 MAPLE STREET REALTY TRUST Village:West Barnstable Town Sewer At Address: No GIS Zoning Value: RF Assessed Values 2018-Map/Block/Lot: 132/0041-Use Code: 1010 2018 Appraised Value 2018 Assessed ValuePast Comparisons Building $173,600 $ 173,600 Year Assessed Value Value: Extra $8,300 $8,300 2017-$474,100 Features: 2016-$474,100 2015-$516,800 2014-$508,200 2013-$516,800 Outbuildings:$97,300 $97,300 2012-$507,800 2011 -$520,900 Land Value: $ 178,500 $ 178,500 2010-$530,000 2009-$565,600 2018 Totals $457,700 $457,700 2008-$550,200 2007-$588,000 Residential Exemption Received=$93,229 Tax Information 2018-Map/Block/Lot: 132/004/-Use Code: 1010 Taxes W.Barnstable FD Tax $0 (Commercial) Fiscal Year 2018 TAX RATES HERE W.Barnstable FD Tax(Residential) $1,272.41 Community Preservation Act Tax $105.08 Town Tax(Commercial) $0 r Town Tax(Residential) $'3,502.57 $4,880.06 Sales History-Map/Block/Lot: 132/004/-Use Code: 1010 History: Owner: Sale Date Book/Page: Sale Price: HARRIS,JOANNE H TR 2010-07-01 24657/143 $10 HARRIS,JOANNE H 1999-02-03 12039/277 $0 HARRIS,CHARLES R&JOANNE H 1993-02-24 8457/4 $212000 BLOOM,CAROLINE C 1986-03-07 4953/47 $1 BLOOM,R BARRY&CAROLINE C 1977-08-19 2567/91 $0 Photos 132/004/-Use Code: 1010 Sketches-Map/Block/Lot: 132 1 004/-Use Code:1010 10 ——24- T 6 OAS 3 I o 14 4-gg 12 —36 Z 1- FHS. 2 2 OAS 20. 16 F�@ As Built Cards:Click Caro to view:Card#1 Card#2 Card#3 Constructions Details-Map/Block/Lot: 132/004/-Use Code: 1010 Building Details Land Building value $ 173,600 Bedrooms 4 Bedrooms USE CODE 1010 Replacement Cost $267,114 Bathrooms 3 Full-0 Half Lot Size 2.92 (Acres) Model Residential Total Rooms 9 Rooms Appraised $178,500 Value Style Conventional Heat Fuel Oil Assessed $ Value 178,500 Grade Average Heat Type Hot Water Plus Year Built 1875 AC Type None Effective 35 Interior HardwoodCarpet depreciation Floors Stories 1 1/2 Stories Interior Walls Plastered Living Area sq/ft 2,574 Exterior Walls Wood Shingle Gross Area sq/ft 3,758 Roof Gable/Hip Structure Roof Cover Asph/F GIs/Cmp Outbuildings&Extra Features-Map/Block/Lot: 132/0041-Use Code: 1010 Code Description UnitslSQ ft Appraised Value Assessed Value SPL2 Pool Vinyl 578 $15,800 $15,800 FGR6 Gar w/Lft Avg 1280 $44,300 $44,300 FEP Enclosed porch- 114 $6,200. $6,200 roof,ceiling PAT1 Patio-Average 360 $ 1,700 $1,700 GRN1 Greenhouse-Res 144 $4,500 $4,500 SHED Shed 224 $2,000 $2,000 WDCK Wood Decking 120 $2,000 $2,000 w/railings BRN3 Barn w loft 640 $20,300 $20,300 STB1 Stable/Avg Qty w 144 $3,800 $3,800 grade FNCC CORRAL 351 $2,400 $2,400 FENCING FNC9 Fence Gate 10' 1 $500 $500 SOL1 Solar PV Panels 46 $0 $0 12-24 FOP Open Porch-roof- 50 $2,100 $2,100 ceiling Sketch Legend Property Sketch Legend 132N Barn-any 2nd story area FPC Open Porch Concrete Floor REF Reference Only BAS First Floor,Living Area FTS Third Story Living Area(Finished) SOL Solarium BMT Basement Area FUS Second Story Living Area SPE Pool Enclosure (Unfinished) (Finished) BRN Barn GAR Garage TQS Three Quarters Story(Finished) CAN Canopy GAZ Gazebo UAT Attic Area(Unfinished) CLP Loading Platform GRN Greenhouse UHS Half Story(Unfinished) FAT Attic Area(Finished) GXT Garage Extension Front UST Utility Area(Unfinished) FCP Carport KEN Kennel UTQ Three Quarters Story (Unfinished) FEP Enclosed Porch MZ1 Mezzanine,Unfinished UUA Unfinished Utility Attic FHS Half Story(Finished) PRG Pergola UUS Full Upper 2nd Story i (Unfinished) FOP Open or Screened in Porch PRT Portico WDK Wood Deck PTO Patio gPrin Contact Director 'Edward F.O'Neil.MAA i 'P 508-862-4022 F 508-862-4722 8:30a.m.to 4:30p.m. :367 Main Street Hyannis,MA.02601 Public Records Ann Quirk :Public Records Reauest P 508-862-4022 367 Main Street Hyannis,MA.02601 Helpful Links to ,Downloads Abatements SALES LISTINGS Barnstable FD Residential C.O.M.M FD Residential i Commercial-Industrial- Mixed Use Cotuit FD Residential Hyannis FD Residential Townwide Condominium W.Barnstable FD Residential Exemptions Parcel Consolidation Questions about values FY18 Combined Tax Rates! Town Land Use Codes ,Helpful Maps All Town Maps Flood Insurance Mapes Property Maps FY18 Tax Mats Owned and Operated by The Town of Barnstable-Information Technology Home Departments&Services I Boards&Committees I Residents&Visitors I Doing Business Town Calendar phone Directory Employment Email Town Hall I Applfcadcm N=bc�....�.g......L5........ SULDING DEpT. PeMrtF ... . ...').......................Ofer F=........................ 2" MAR 26 2016 � Toil Fa Paid.................................................................... T®UVI�n R�,�, , TOWN OF BARNSTA$I 'T�Btr= Pert ApFovai by.../.f .........om..: BUILDING PERMIT APPLICATIONMV........ ............................. ........... ................ Section 1— Owners Information and Project Location Pro j ect Address �a l I`�La P�� I Village V Y - �:%t��➢"�-� Owners Name ©c1,n ►,-ems � Owners Legal Address a4 1 S T-- City�-f-,2:�, State MA Zip 03 Cn� Owners Cell# J��= Ca`� " D E-mail ' Vl Y),e-� . �'l�t rr1� ,GGl'�'t� ��►'IQ�I Section 2—Stractaral Use Single/Two Family Dwelling ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet Section 3-Type of Permit ❑ New Construction ❑ • Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty. ❑ Fire Alarm Rebuild ❑ Deck Apartment ❑ Sprinkler System ' ❑ Addition ❑ Retaining wall ❑ Solar �+ Renovation ❑ Pool I ❑ hsalation . Other-Specify, Section 4—Detail . Cost of Proposed Construction Square Footage of Project Age of Structure lHD• r Dig Safe Number #Of Bedrooms Existing AlTotal#Of Bedrooms (proposed) 11.0 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Last updatc&1 In2017 Section 5 -Rork Description e Section 6—Project Specifics ❑ W",ning [] Oil Tank Storage . ❑ Smoke Detectors. ❑ Plumbing ❑ Gas i ❑ Fire Suppression ❑.Heating System ❑ Masonry Chimney ❑Add/relocate bedroom Water Supply El Public ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hy sHistoric District El �Hi ghway Debris Disposal Facility: I am using a crane C Yes ❑ No Section 7—Flood Zone Flood Zone Designation Within or adj acerd to a wetland,coastal bank? Yes ❑ No ❑ i Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq.Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required. Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes . 0 No Last updsft&11C12017 I' Section 9-Construction Supervisor a LC `�' P C �8.�� Telephone Number 5 0&_ -�(booName f _ Address P.0, PX 1G l - Citybs o_-r 01[C State 14A Zip Q LL S i License Number Z S -Qq L1 SCE JLicense Type (IS L— Expiration Date Contractors Emall _ 1 - 36 4- -1 3 I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and doctunentation required by 780 CMR and the Town of Barnstable.Attach a copy of your license. Signature Date h I Section 10-Home Improvement Contractor Name ,Sc,.,m-e_ cus a6JVr,_, Telephone Number Address City State Zip Regisization Number' �S Expiration Date I understand my responsibilities under the rules and regulations far Home Improvement Contractors in accordance with 780 ` CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C... i Signattzte Date Section 11 —Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Canstraction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Bansstable. Signatuze Date APPLICANT SIGNATURE Signature Date Print Name Jr CcT4+ Pe C'L _: Telephone Number TU 8- E-mail permit Q-Q_ OA,e OC._ Ue V-1 — -OVI , n °6 _ Last updated:I In2017 Section 12—Department Sign-Offs Health Department ❑ Zoning Board(ifrequired) Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ f Conservation ❑ For commercial work,please take your plans&edly to the fire departure&for approval Section 13—Owner's AuthorizationQ Cal I, as Owner of the subject property 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 i 1 i �r I Last vpdat#-117R017 -- j i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION , Map Parcel 3 Z -DDT- j 3 ZD07" Application' Health Division Date Issued (o Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board �m — Historic - OKH _ Preservation/ Hyannis Project Street Address 2 UT Village Owner Address 2 7 l �Q 1p�Q Jf F Telephone O Permit Request d 0143" c11 C_ di Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation M Construction Type Lot Size j2 ?� f�5 Grandfathered: El 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 W No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION . (BUILDER OR HOMEOWNER) Name \ L50I01r, Telephone Number 6,11 / - 777 z S Address �S Q�1 61CV, License # &7 Home Improvement Contractor# Z Email 'D D t��5 i�ti I'M-Sol°t, �f- Worker's Compensation # V 14)C-[6*D-LPO1 3 ` ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE Z �� FOR OFFICIAL USE ONLY- APPLICATION # DATE ISSUED. ` MAP/ PARCEL NO. K i . a l� ADDRESS - VILLAGE f OWNER DATE OF INSPECTION: _ FOUNDATION - FRAME -INSULATION 'FIREPLACE t. ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL . +. "GAS: ROUGH FINAL FINAL BUILDING k DATE CLOSED OUT ASSOCIATION PLAN NO. w `t i Skyline Solar HOMEOWNERS AUTHORIZATION FORM Addendum to Contract I, Joanne Harris (print name) am the owner of the property located at address: 241 Maple St. Barnstable, MA 02668 (print address) I hereby authorize Skyline Solar to act as my Agent for the limited purpose of applying for and obtaining local building and other permits from the Authority Having Jurisdiction as required for the installation of a Photovoltaic System located on my Property. Customer Signature: Electronic Signature Accepted/Addendum to Contract Date: 7/5/16 Sign Name: noamu_ Skyline Solar LLC 4 Crossroads Drive Suite 116 Hamilton,NJ 08691 HIC - 13VH0613060 Connecticut Office 121 E North Plains Industrial Rd. Wallingford, CT 06457 HIC.0632594 Massachusetts Offices 95 Ryan Drive Suite 3 35 Mill Street Central Raynham, MA 02767 Marlborough, MA 01752 r ^ HIC -172284 CS-02747 The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 .• www mass.gov/dia lVorkers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Anolicant Information Please Print Legibly Name (Business/Organization/Individual):Skyline Solar LLC Address: 124 Turnpike Street Suite 10 City/State/Zip:West Bridgewater, MA 02379. Phone#: 732-354-3111 Are you an employer?Check the appropriate box: Type of project(required): 14Z I am a employer with 60 employees(full and/or part-time).* 7. ❑New construction 2.a 1 am a sole proprietor or partnership and have no employees working for me in $, ❑ Remodeling any capacity.(No workers'comp.insurance required.] 3.a 1 am a homeowner doing all work myself[N o workers'co 9. ❑Demolition y mP.insurance required.].: 4. I am a homeowner and will be hiring contractors to conduct all work on m 10 Q Building addition ❑ g Y Property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 501 am a general contractor and I have hired the sub-contractors listed on the attached.sheet. These sub-contractors have employees and have workers'comp.insurance.: 13.[]Rdof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.gOther PV SOLAR 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box kl must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit tivs affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. =Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.. I am.an enrpdoyer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:A.I.M. Mutual Insurance Company Policy#or Self-ins. Lic. #:VWC-100-6018336-2015A Expiration Date: 9/16/2016 Job Site Address: 241 Maple St. Barnstable, MA 02668 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 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. I do hereby certiplyer the is penalties of, u he information provided above is true and correct Si nature: J 4/22/16 Phone#: 732-354-3111 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 I . I Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-093717 Construction Supervisor , DAVID DOYLE - 1a ASHLEY AVE . - V E FREETOWN MA 02717 i 1: Expiration: Commissioner 05/20/2017 Construction Supervisor Restricted to: use group Which contain Unrestricted-Buildings of any less than 35,000 cubic feet(991 cubic meters)of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. DPS Licensing information visit:WWWMASS.GOV/DPS (92egj6 tPammzooacuealC�i o�� aac`ivaet7a ffice of Consumer Affairs&Business Regulation License or registration valid for individual use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: TReqistratiQn.:A6Office of Consumer Affairs and Business Regulation .9�• Type: 10 Park Plaza-SuiteEx iratort= 5170 =2 $;i Supplement Card Boston,MA 02116 SKYLINE SOLAR, DAVID DOYLE 4 CROSSROADS DRIVE;:SUIE T1 r��•_cr��y�, PIAMILTON,NJ 08691 Undersecretary I Not valid without signature i I F Ac" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDmYY) 2/4/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER CONTACT NAME: The Hamilton Group, LLC PHONE FAX IA/C3 Wing Drive E-MAIL g 3 9 - 9 ac No Cedar Knolls NJ 07927 ADDRESS: INSURERS AFFORDING COVERAGE NAIC k INSURER A:Selective Way Ins 26301 INSURED SKYLI-3 INSURER B:Selective Ins Co of the S.E st 39926 Skyline Solar LLC INSURER C:A.I.M. Mutual Insurance Company 124 Turnpike Street, Suites 5 8r 10 INSURER D: West Bridgewater MA 02379 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1644296191 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LT R INSR WVD POLICY NUMBER MM/DD/Y MM/DD/YYYY LIMITS B GENERAL LIABILITY S 2106548 2/6/2016 2/6/2017 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE ORE RENTED PREMISES Ea occurrence) ccurcence $100,000 CLAIMS-MADE OCCUR MED EXP Any one person $10,000 PERSONAL 8 ADV INJURY $1,000,000 GENERAL AGGREGATE $3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $3,000,000 17 POLICY X PRO- X LOC $ D SINGLE LIMIT B AUTOMOBILE LIABILITY A 9093015 2/24/2015 2/24/2016 Ea accident 1 000 000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X X NON-OWNED PPe�accidenDAMAGE $ HIRED AUTOS AUTOS A X UMBRELLA LIAB X OCCUR S 2000480 10/11/2015 10/11/2016 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED X I RETENTION$10,000 $ C WORKERS COMPENSATION VWC-100-6018336-2015A 3/8/2016 3/8/2017 X I WC STATu- OTH- AND EMPLOYERS'LIABILITY Y/NER DRY LIMANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $1,000 000.00 OFFICER/MEMBER EXCLUDED? Y (Mandatory In NH) E.L.DISEASE-EA EMPLOYEd$1.000.000.00 II yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$1 000 000.00 B Installation Floater S 2106548 2/6/2016 2/6/2017 Any One Occurrence $100,000 Property Contents $104,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) This Certificate does not afford coverage for Additional Insureds. The Certificate is only evidence of insurance coverage for the Named Insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Evidence of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD April 11, 2016 To: Code Enforcement Division From: James A. Marx, Jr. P.E. Re: Engineer Statement for Residence, 241 Maple St., Barnstable, MA - Solar Roof Mount Installation I have verified the adequacy and structural integrity of the existing Main House (one layer shingles): 2"x 6"wood truss at 24"o.c. max., having sloped distance 16'-0",pitch 31 deg.; Barn (one layer shingles): 2"x 8"rafters at 24"o.c. max., having sloped distance 21'-4", pitch 31 deg.; for mounting of solar panels and their installation will satisfy the structural roof framing design-loading requirements of the Massachusetts building code— 780 CMR Residential Code 8th Ed. For the installation of solar mounting,the Unirac Solarmount rails will be anchored with L-foot supports with flashing located on the center of the rafters and will be securely fastened at 48" sp. max. with 5/16"x 3 ''/2'' SS lag bolts. All attachments for are staggered amongst the framing members. The mounting system has been designed for wind speed criteria of 110 mph Exp. B and ground snow criteria of 30 psf. The Photovoltaic system and the mounting assemblies will comply with the applicable sections of the Residential Code and loading requirements of roof-mounted collectors. Thereby, I endorse the solar panel installation and certify this design to be structurally n adequate. OFPA.,gg . Sincerely, cn Mo.36365 �i 0�n�G/STE- James A. Marx, Jr. Professional Engineer ` MA 36365 10 High Mountain Road Ringwood,NJ 07456 cc Amergy Solar '.l 5 ®'Y WIND CHIME v ` H:16" LH SL W !V Main House AZIMUTH:228° SL TILT:31° Barn AZIMUTH:228° TILT:37° Conduit runs from MEP in basement of main house to sub panel in barn. o-/Z Underground conduit Customer Signature: FRONTDate: Adr:255 Old New Brunswick Rd. Project: Residential rooftop grid-tied solar photovoltaic system PV Modules Layout Suite N280 Piscataway,NJ.08854 Work Site Joanne Harris-241 Maple St Barnstable MA 02668 Sheet Title Phone#:(908)396-1388 Property ID(BBL) #####-## SCALE N.T.S. Fax#:(732)297-3951 JC260M-24/Bx 4/13/16 o Solar Module Type Renesola Jiangsu " '® ' � License#: 13VH05630800 5 o I a r Drawn By:Carrie #of Modules 49 PV System Size: 12.74 KW American Renewable Energy Inverter Module 49 x Enphase Energy M215-60-2LL-S2X-IG p`�_ Revision: UtilityAcct Sheet No, r V As Built: Eversource RAFTER:256" 192" ti Supporting racking system is Solar Mount by UniRac. ® Solar flashing will be used on every roof penetration. WIND CHIME E9H fit fit t Main House sL AZIMUTH:228' TILT:31' 3'-3" SL Barn N SL AZIMUTH:228° TILT:37' oo"dun Runes (10)20ft rail— i' xwH Revenue Meters / Dropf ft rail— AC Dlsconneq� Drop from 20 ft rail— ——— aity Meter �MSP (8)SPLICE (114)L FOOT PLACEMENT X Need 2 extra drop rails FRONT MAPLE ST Customer Signature: Date: Adr:255 Old New Brunswick Rd. Project: Residential rooftop grid-tied solar photovoltaic system Suite N280 PV Modules Layout Piscataway,NJ.08854 Work Site Joanne Harris-241 Maple St Barnstable MA 02668 Sheet Title Phone#:(908)396-1388 Property ID(BBL) #####.## SCALE N.T.S. G.m le Fax#:(732)297-3951 • �5�>p/ Solar Module Type Renesola Jiangsu JC260M-24/Bx 4113/16 S O 10 8 License#: 13VH05630800 #of Modules Drawn By:Carrie 49 1 PV System Size: 12.74 KW Inverter Module 49 x Enphase Energy M215-60-2LL-S2X-IG PV-1 Revision: As Built: Utility Acct Eversource Sheet No. 120240 Vac 1PH AFFIX B.I.S STICKER HERE 4 BRANCH CIRCUITS UTILITY METER 49 RENESOLA JIANGSU JC260M SOLAR MODULES EVERSOURCE#1418996DO17 BRANCH CIRCUITS A 8 B(ON MAIN HOUSE ROOF) (6)#10 AWG THWN-2 MA 3R O(1)#10 AWG THWN-2 EGC s�wvAavL POLE AC Disc IN MIN 3/4'PVC CONDUIT AMP O +z Parr+orcAv !INMINNI,PVCCONDUIT ; ITH 30A FUSES DOB STAMP m WITHIN LOFT OF . AP POINT LINE SIDE TAP IN MSP Enpnane M2+5 Mvoinvener EnDl+au+Erpapn AC Trull Cagy zPW IF #8 AWG GECCONNECTNTO THE GROUNDING12024 c BAR IN MSP200 AMPTHWN-2 MAIN SERVICETHWN-2G SINGLE PHASE1 PVC CONDUIT AC OUTPUT CURRENT=0.9X22=19.8A 0CPD-19.8'125%=24.8A TO MSP (MAKE SURE THE BREAKER BRANCH CIRCUITS A 8 B(ON BARN ROOF) (6)#10 AWG THWN-2 NEMA 3R FEEDING THE MSP FROM (1)#10 AWG THWN-2 EGC Ac 2 POLE AC Disc THIS SUBPANEL IS ON THE O Pere�/e IN MIN 3/4'PVC�COIN 60 AMP OPPOSITE SIDE OF THE SUNRUN WITH 35A FUSES MAIN BREAKER AND THE m A.v PV KWH FEEDER BREAKER CAN NOT A FOR SUBMITTAL 4114-6 MTER AP IN'OF,OF I_ER TAP POINT BE GFDI BREAKER(REF NEC No. RevLtioNLawe Dam Z'EnpAate N215 Miboin 1 EnpA Enaapd ACT=kca 705.32)) INE SIDE TAP 0 3 Pell Orie m�au M N SUBPANEL ➢ uw AT THE BARN y #eAWGGEC ��o�� wryan.nca SOIA► EripMse M2+5 MvoJnvMr 1PEll.AC Trunk Cade CONNECT TO THE GROUNDING OWNER:JOANNE HARRIS v L BAR IN MSP 120240 Vac PROJECT (3)#6 AWG THWN-2 1DOAMP Residential Rooftop Grid-tied Solar PV System (1)#6 AWG THWN-2 G MAIN SERVICE 241 MAPLE ST IN MIN 1'PVC CONDUIT SINGLE PF1A� BARNSTABLE MA 02668 ❑BRANCH 12 PANELS IRCUITA n111 RPANELS ANCH IRCUITB ❑BRA14 ANELS RCUITC nBRANCHCRCUITO,3PANESI ACC PO 3125%ENT=O.9X27=24.3A BR A ------------------ Et IT D B �UITB ❑ Qf SYSTEM INFORMATION: RENESOLA JIANGSU JC260M 12.74KW PV SYSTEM(49 MODULES) MODULE INFORMATION: AC OUTPUT CURRENT=0.9X49=44.IA vmp60 SV SHEET TITLE 3 LINE DIAGRAM Nominal AC Voltage=240V voc Imp=8.53A =37.6V SCALE Isc=8.95A DWG# NTS DATE E-001.00 4/14/2016 f7 BRANCH-CIRCUI.T_C� JOB# 152207 F Barnstable Old Kings Highway Historic District Committee UAM 200 Main Street,Hyannis,MA 02601,TEL: 508-862-4787 Fax 508-8624784 f6}y. `ae rfo" s AJPPLICATION, CERTIFICATE OF APPROPRIATENESS 470,Application is hereby made,with five(5)complete sets,for the issuance of a Certificate of Appropriateness,under Section 6 of Chapter Acts and Resolves ca 1973,for proposed work as described below and on plans,Massachusetts, drawings,or photographs accompanying this application for. Check all categories that apply; 1. Building construction: ❑New ❑ Addition Alteration 2. Tempe of Buildine: R House Garage/ban ❑ Shed ❑ Commercial ❑ Other 3. Exterior Painting roof ❑ new roof ❑ color/material change,of trim,siding,window,door 4. Sign: El New Sign ❑ Existing sign ❑ Repainting Existing Sign 5. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Retaining wall ❑ Tennis court ❑ Other 6. Pool ❑ Swimming ❑ Other man-made pool ❑ Solar panels ❑ Other Type or Print Legibly: Date NOTE Aft opppcorions nwsr be signed by the camera ow er Owner(print): n�; ^^o I i ram' S Address of Proposed Work- Telephone#: �y� M�n�n ��-- Village 4�.b Map Lot# Mailing Address(if diffe nt) I � Owner's Signature �' Description of Proposed k: Give particulars of�rv,.be done: �•�,-5�\ ��, r. �,� d a o s�lw a�D 1,-) CG r �. �: a Al a 15 m:yrn r.x, r- a + a-7 nr Agent or Contractor(print). p TeIe hone#: Address: AA A- Contractor/Agent'signature. C1 For committee use only. This Certificate is hereby APPROVED/DENIED Date G• ! Members signatures p E E r MAY 1 1 2016 GROWTH MANAGEMENT APPROVE JUN 0 8 2016 Town of Barnstable Old King's Highway 1 21EoardsmidCommfssions101dKtngsHi96woylOKHAppltc»tions10KN2011 Cer[Approprtateness.doc Committee 1 r S i ,e CERTMCATE OF APPROPRIATENESS SPEC SHEET Please submit.5 copies Foundation Type:(Max. 12"exposed)(material-brick/cement,other) ub%)SJL Siding Type: Clapboard_ shingle'( other r. Material: red cedar white cedar other -„b a�� Color. u Sam f . Chimney Material: � Color: Roof Material: (make&style) Color: Roof Pitch(s): (7/12 minimum) ~7 (specify on plans for new buildings, major additions) Window and door trim material: wood A\) other material,specify Size of cornerboazds size of casings(I X 4 min.) color Rakes Ist member 2°w member Depth of overhang g Window: (make/model) material color (Provide window schedule on plan for new buildings, or additions) — T r^^`R mstabie g'm ddi ) Old King's Highway Window grills(please check all that apply Committee true divided lights_ exterior glued grills_ grills between glass_removable interior_ None Door style and make: material Color: Garage Door,Style Size of opening Material Color 044%3 1 Shutter Type/Style/Material: Qaq\ Color: Gutter Type/Material: _ .� ty - Coloor: Deck material: wood other material,specify Color: _ �- Skylight,type/make/modelh material Color: Srbu� size: a K 3 9 Sign size: Type/Materials: soci C� 1 Fence Type(max 6')Style material: IJ i Retaining wall: Material: Lighting,freestanding on building illui�'�v�j NAGEMENT OTHER INFORMATION: THE ATTACHED CHECK LISP MUST BE COMPLETED AND SUBMITTED Please provide samples of pai colors, anufacturers brochure of windows,doors,garage door,fences,lamp posts etc Signed: (plan preparer Print Name 11" f`� Waards and CaMML diOW 101d Kings Hi9hwoy10KHAppUcations10KH2O11 Cert ApproprJateness.doc 2 y 1 ModuleVirtusfll Ren&%Qma 6, 2 0 5 W, 255W, 260W .._ 992mm 40mm 949mm ,o •ams1; tlto4wnn' gun 6D1 ww a . S • 100Whn' E E E E � a 2001Mms' sa amucinnu! Is e 0 e 10 to t0 at 60 i5 b Vbbgo(v) •lido • Relaina l[It VfMMIMSluTf\ Varied Irradiation Efficiencies 1 trradnnce 21totN rii' _ _ _Orawbtg OdYtar Refererrze I,E afd c7y"_I9.87G; 162><.. ..�.36.1Ts -1cl" �) t Mallmun F 2SS W 2w W i MAY 1 1 206. 0-+SW 0•.5w a% m7m 16ArA Maxi Power Current(Imp) Ul A USIA 833 A P—valtap(Vmp) Bull 30AV Sas, � Short Ct a Current 0sc) 843 A .U6 A 8.95 A �em� i=VenROW/TH MANAGEMENT .aV 375V 376„ Valuer at tanclard Test COndillonS bK IAML5.Irradiance mElectrical Characteristics , emperor r - sCT = , Maximum Power(Pmox) ley w 189 W 193 w Maximum Power Current limp) 8 47A G63 A 15.74 A Maximum Power Voltage(Vmp) 282 V 28.S V 28.6 V . Short Cucuft Current(in) 7.12 A 720 A 727 A Open CtrcvO Vottaae(Voc) 354 V 3S.1 V 3S2 V Velues at Normal Operming Ceti Temperature,Irradanre of 8DO W/W,AM 1.5,ambient temperature 20Y,wind speed 1 m/s Ceti Type Vbtaa 0(PQ*ry -e)156 x1S6 mra,60ISM)pes to turn Temperature Coe8ldent of Voc -0.30%rc Gast Hier Transmission.low bon,Tempved pas$ Temperature Caeft{dent of Ise OAWC Frame Anodized Aluminum Apoy Temperature Coefedett of pmaa -0AOfFPC Jurxtfon Box ow/aw paten,With eypan Own Nominal Operating Cell Tempeaature(NOCf) 45'C121C Dimension •160 x 992 x40 mm Output Cable 4 MO(EU)/12 AWO(l15),3000 sun WelaM 19la butallation Note location See Drswbi8 Above Packing InicifMation Maxiniurn Ratings �. Comtabxr 20'Gp WGp WHO Operating Temperature -we-*e5'C Pallets per Container 12 Ze 28 Maximum System Voltage SOOOVDC(El)/600VOC(US) pleMs per Container 3w 700 770 Maximum Series Fuse Tattre 20A(EU)/20A(US) e.IRLIm/mlaw Yem ananp rtrt..nryNops fAt11101u Nrtpb,eeewe.enlpw•9,dvxvaw rµnbO.y.MUNMr,lda JUN 0 S 2016 Town of Barnstable Old Ki!10 Highway ReneSola.com I E C E �h MAY 1 2616 • II - GEMENT 250W, 255W, 260W PR�v� Furry High Module Conversion Efficiencies w�of Ba��stable .. .... .....�<-�._,��.,.._....,.�.. ,....:,. To s ghwa! — 0 Q old Cottnmittee. Cary�qulc4 Easy Installation and Handling for Various Applications j G Mechanical Load Capability of up to 5400 Pa Conforms with IEC 61215:2005, ms'O IEC 61730:2004,UL 1703 PV Standards 1509001,OHSAS18001,15O14001 Certified W Ftr rn. . Application Gass A,Safety Class 11,Fire Rating C ••-- Also Applicable For Module With Black Frame p�e GU � 0 100% N y+ 10 - y 95% t LL 90% Adyed�a1u® worMnanshlp «'; m 1 BO% m i i i a 0% finearpower 0 1 s 20 is 20 25 I output «' YEAR /® PV FF u bwtek / ReneS • . • i 1 09:50:25 08-05-2016 1 /1 Skyline Solar L L C;r R'p'1r 4)Y `:iLd+e,'}1 F{r1'Y(ih tni j'is 1 '�i I {'�tl�7f�i': !�2-..�-4-3111 Fax:'t'-351'3071 5 l�.Y L l N k SC.��AR Town of Barnstable Building Department 200 Main St Hyannis, MA 02601 8/05/2016 To Whom It May Concern: This letter is to cancel the permit application number TB-16-2145 for 241 Maple St. in West Barnstable. This permit was submitted In conjunction with another Solar Panel permit application. We were told this permit would need to be pulled for the second structure on the property. TB-16-2145 was pulled with the wrong CSL number. So we,are cancelling this permit and re-applying using the proper CSL Information. Phil Chouinard CS-027047 11•� � Pete D(?4& cn Owner of Skyline.Solar.LLC. : ' HIC -.172284 w r SSky;:l 1{l`: �i 't I �✓ t f-j..;ivj€rs�i? i'�� u 'lti-ltif �'tf i:�-.'tTy ^-s- � i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # Health Division m• 'Date Issued Conservation Division ® � � Application Planning Dept. Q Permit Fee ev m Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis M 1r O Projecl . l, treeet Address �t ��/e, S1 g Villa e"" U Owner T1d_AA,, 86.rr S Address 1 Ample S afns ��ey 66� Telephone (50 Permit Request ^Tj�s4�1 I of a s,��o and Ce co �IPA e/! A�' \ 1 �wi}¢ I� �r 7T C-�-ji W Qn Q� e�i Gina r25 /1L-CI [j)0j Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Ov y Pr !t oject Valuation 2 Construction Type Lot Size Grandfathered ❑Yes ❑ 6 1 yes, attach supporting documentation. Dwelling Type: Singe Family Two Family Mul '-F r- ily (# units) Age of Existing Structure Hi use: ❑ ❑ No On Old Kin 's Highway: ❑Y 9 9 ges ❑ No Basement Type: ❑ Full ❑ Crawl ❑ t r Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing \ new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name S "i in 2, SD i az C1_L Telephone Number _ (73?1 3 V—3111 Address rl a y Tlfierq o ea S}. R to License# a 7 q 7 W &JIg Wo4ec . a-3 -7 Q Home Improvement Contractor# 2 Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS/PROJECT WILL BE TAKEN TO SIGNATURE DATE 2a k FOR OFFICIAL USE ONLY APPLICATION# loo 4 DATE ISSUED MAP/PARCEL N0. • f, �?..,.�;fir. ADDRESS VILLAGE ` .OWNER -•, r" DATE OF INSPECTION: FOUNDATION FRAME INSULATION r FIREPLACE ELECTRICAL: ROUGH . FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL . FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. T TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION . Map t Parcel Application# Oo70 Health Division Date Issued Conservation Division Application Fee Tax Collector Permit Fee ! r Treasurer pk Planning Dept. l Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address a4 Village Owner ��,�n-e- ��5 Address �41�1�1 r� n�, tm�n Telephone c$- uat- 1��1C.;7J Permit Request A d,:- l`c� Q 'TC�j 00 s.•C :Bf)rz-n Square feet: 1 st floor:existing _proposed 2nd floor:existing proposed Total new 514 Zoning District Flood Plain Groundwater Overlay Project Valuations Construction Type ` Lot Size 4 Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure t Historic House: ❑Yes XNo On Old King's Highway: 1�d Yes ❑No Basement Type: ❑ Full ❑Crawl ❑Walkout %Other C2 t!C;( ;9= 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 A Other NONE Central Air: ❑Yes No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ;dNo Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:Xexisting gnew size aspe Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: G (-t ZoninyBoard of Appeals Authorization ❑ Appeal# Recorded❑ o -- Commercial ❑Yes 0 No If yes, site plan review# Current Use Proposed Use CY' 3 94(a6NC, BUILDER INFORMATIONName cA L4 Teler hone Number CX) ry1 Address/6?'-/ License# o' 3 C Home Improvement Contractor#T � . Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE _i FOR OFFICIAL USE ONLY APPLICATION# `f DATE ISSUED fMAP/PARCEL NO. ' I ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION � 3 f FRAME _7 INSULATION ;AAf r 1 , FIREPLACE ` ELECTRICAL: ROUGH FINAL ` PLUMBING: ROUGH FINAL GAS: ROUGH FINAL a t _ FINAL BUILDING {z DATE CLOSED OUT' �r ASSOCIATIONS PLAN NO. z' - ,t` Results Page 1 of 1 Licensed Contractor Look Up Select the search method: I License - Maximum number of matches: 25 Enter Search terms separated by spaces. 153638 Select Search type: AND C OR Search Search Results City/Town Name ILic. Type Lic. # Restriction Expiration Street State Zip W BARNSTAB IGALLAGHER, DANIEL J CSL 53638 00 IPO BOX 471 [R 2] Total of 1 Records matched. Back to Home Page BBRS Privacy Statement http://db.state.ma.usibbrs/contract.pl 10/31/2007 P f ko RP,6F E ` xR„GULATIgI(�3 4 r � LIcehge CONSTRUCTION SUPERVI$�R • / o , 6 �luitlpel:��t ' Q53638 •, i 1 (7lj�,s r o 1+Ir/40 0 (; R trted l FF O � Dq.NIEL J GALA 0 a�(��x , ! ;,• Ei � G� r ';r�sP;� r,�i 1•�`�t n��>'�" '(��X�� r{ �r'�'��Pl $l0 9 it E J� ;�%/nr- (�cYnUnca:uuea�.l� o�.�lla::iac/craeCla Board of Building Regulations and Standards License or registration valid for individul use only a f. ,;=t•�__ i HOME IMPROVEMENT CONTRACTOR before the expiration date: if found return to: Board of Building Regulations and Standards Registration: 149259 One Ashburton Place Rm 1301 Ex iratlon: 12/16/2007 p Boston, i�1a. 02108 :,.Type::Private Corporation GALLAGHER.SHIELDS BUILDING CO INC DANIEL GALLAGHER �\ (\ 94 FALMOUTH RD'#135 ��__ .✓ ) �� `1 -.. -- CEPiTERVILLE,MA 02632 Administrator Not vali without Signature '23 'mot rq�, ' 'own of Barnstable 'Permit# t Etpires 6 months rom Mite date, �s Regulatory Services gee IARNSTAffi.F, 9� 1 ,0�' Richard V.Scali,Interim Director P ; ATFD��p Building Division ®CT 3 p Tom Perry,CBO,Building Commissioner®""'V ®� ?0,� NO Main Street,Hyannis,MA 02601 �ARAI www.town.bamstable.ma.us rA�� Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERAUT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 13 2 /o o Property Address oZ 41 a,o 1 e S fire C-f aou n s t(0 l e (Residential Value of Works b�y, Z O S — Minimum fee of S35.00 for work under$6000.00 Owner's Name&Address 'go q n n P 14 a rr I,S o2y1 Manlc St til arinS+4La(f- MA 01G (oQ Contractor's Name rn 0,I.e.t );r An-,S / �,��.•t `��o/l n i.5nn Telephone NumberOC)117 Z Z R-q ff zo Home Improvement Contractor License#(if applicable) /7 3 X Email: Construction Supervisor's License#(if applicable) _O ci.S 7 7 UgWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner �3 I have Worker's Compensation Insurance Insurance Company Name_Ar!2),on ckut lnsu<cgy1« rXri�Gen� Workman's Comp.Policy# WC 9 Z.,ep,5$3.5 2.3 q y 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 , 3 0 (maximum.35)#of windows Z Z #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: Property wner must. Property Owner Letter of Permission. A copy o the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: QMVPFILES\FORMSIbuilding permit forms\EXPRESS.doc Revised 061313 R Rewa a ti is esrn gees» Nk';�1°AL BY AiNTI)E1RSE\' saran .,ta:.s rt tam*�ss� «�ti�' ttrtxt'.+.x.lrwtLyw 26 Mbcon Read • Ilncdn,it1.0W tw.rn,4ItP. Pbone 866.SG82M•}8x-401.633,6m relent to W•4&CX .V r4e Ne w V1adow9.tLCQ/b/a ReaevralbyAadert"ofSow UcroNowF�mbd isle CUSTOM WINDOW AND DOOR REMODELING AGRE,£.yl£YT t+�o+pp .._._.......�.J��.�..,..��.5 _ _ ® . _ , tAt.di►oso�rx �"�i� egat4taacANvs.4�sa�eea�wleote r►0.eau i�yl ��T�& ST• _...__. _.,. _.,�-_-= - �,�.�. .d.._� � Uu)v<s)htre4*ndy and.c osily,agev to pumhtw tau products and/w"im of Souihtm Ncw T,nglatW Wiedvw�Ilk d/bla ikneM-al by Andenen of`Southern.Xe r U4"("Contnctot"),in uccocdmw Mlle the terms and eondSdom destti rant and dire mvne of this asre m"t AM on the muoted sptdficadoft AcKs)(cake ivtl�;this 1%grecmenvl� fatlwtoeig O Condo t3 HO1? I ly' Toed jobAn+aa+t � f k++o"s OdeOaod sr<Phmx»s a 0*& a Cnh O firuncoe Otpolt all -' _k'ts� tteee>re4 Cra1Es Cods are accepted for deposit o+th-truxAntrn 1/J of ehs e it Son of job ._- ftoft a Coetp'toaft om proiett cant see CAW Coro By t ratio Aveen w e,You edvwated1V Out db SAUX0 a Son o(1*end the • �� Btla+cQm Sd bsaMlsl �/ &"ks Um"an UstvAW CvVIedon of job camm be mtdo by cev r OF lop card vd not be made by p wrW dvck buds dned�or reek Boytr(s)agrees and understands that this Ap"ment constitutes the cadre watitmuttdsog between the part",and that there are no herbal understandings caaaoging any of the terms of this Agreement.Buyer(s)acknowledges that Buyer(,) (1)bas read this Agrev"tet,understands the terms of this Agreement,and has received a completed,signed,and dated - copy of this Agreement,Including the two atftcW Notices of Cancellation,on the dace first written above and.(?)was orally � informed of Bayerets sgjht to cancel this Agreement.DO NOT SiGN THIS CONTRACT IF THERE ARE ANY BLANK SPACJdS. (Mods Mawd$ates Only)Notice.to Bayen(1)Do not sigo"Agftemeat if any of the spaces lateaded for the agreed teams to the exteatof then available iatbrmadoo art left bls ah-(2)You are gadded to a copy of this Agreement at the time you sign. it.(3)You may at any time pay oft'the:full unpaid balance due under this Agsieemeat,and in sro dotog you may be eudded to receive a partial rtbate of the finance and,assurance charges.(4)The setter has ao right to unlawfully enter yovs premises or eomw4t any breaeb of the peace,to repossess goods purchased under this Agreement.(5)You may cancel axle Agreement ,11 it has not been sigptd at the tealn office or a branch office of the selleA provided you notify the salter at his or her male office or branch office shown in the Agreement by registered or edified rnAll.whkh shall be posted not later tasanmidnlgbt of the third calendar day aRer the:day on which rho-brayer elps the Agreement,excluding Sunday and any holiday on whieb reptu maildeliveriea are afar triads.See ttv aceompaoyLag aotice of cancellation form for an explanation,of bnper'd riShra 8uyeQrtctkVdthc.eomniaxredueaslon mattrW1 pm rated by list Rbodle humd conuacto.Re oruion Boart g fsiaeb� Renewal b>4ndessct of S there New England Buyet(s Buy es(s) S;vw%lrt of NroduttNhMZ er Sigdtadtu Sigwtufc IMAI E Brant'Nameof.Pro&ct'%fsna„rer Print\Arne Wisot i unt, Y09 THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANY TINS:PRIOR TO Ai1DNIGHT OF THB.TI!m w BIFSIV1rSS DAY IlYTER TE{E DATB OF THiS TRAN&ACTION.see TH6 AT'rACHf3D;`once OP CwaillAT10N i:ORms FOR AN EXPLANATION OFTHIS RIGHT IRYC�9� .1 I t3.OQ - 1 4� r Date ofTransaceion You may cancels Oate of Transaction _ _._ _You may cancel Ws transactlon,without any,penalty or"obligation,within this transaction,without any penalty or.obligation,within three business dar ca(roan the above date.If you cancel,any t d m abaft three business days Pro the aba dace~if you cancel,any property traded irk any payments made by you under the: ► property traded in,any payments made by you under the Contract or Salo.and any no-sotlabte instrument c�cccutod t Contrast or Salo.and any a instrument executed by you will be,returned:within ten business days following I by yov will be returned within ten bustnpts dwys following receipt y the,Seller of your cancelladon notice,and etny l treecipt bur the Seller of Our cancellation notice,am any sec ty merest arising out of the transaction will be security nterest arising our of the transaction will be eancelod.If you cancel.you must make ayagable to the Seller t canceled.lf you eaned.you must make available to the Seller -at your resltleace,In substandally as good condition as when I at your residence,In substandatly as good condition as when received,any goods delivered to you under this Contract or i received,any goods delivered to you under this Contra"or Sahnor You onay,tiyou wish,tornglr with the lnstructlonl of t Sato;or you miry,If you wish,eon with t%o Inseruet;ons of return shi dw Seller regarding theretuprttent of the,goods at the the Seiler regarding the return shipatont of the gods at the Seller%expense and risk.If you do make the ids available � Seller expense and risk.if you do make rho gods tiraitablo to the Seiler and the Seller does not pick them up within to tiro Sailer and tiro Salter does not pick ef+cm vp wldrir twenty clays of the data of cancellation.you may retain or 1 twenty days,of the data of eancelladot%)you may retain or disperse of the goods without any further obligation.If you I dispose,o the:goods without arty further obligation:If you foil to tn,ako taus goods available to the Seller,or if you agree t fail to malotr the goods'ayailable to the,Seiler,or if you agree to return the staods to the Seller and fail to do so„then you t to return tiro 1*06 to tiro Saitar and fail to do so,,hear you r+eriW,n liable for penformamo of all obligations under tiro remain f'atabto for performance of all obligations under the ' Cantrae t,To cancel this txartsacdorp rreaii or deliver a signed I ContramTo cancel this transaction,mail or tie liver s signed and dated copy of this Cancellation notice or any other I and"dated copy of Ols eancellatton notico or arty od written notice,,or send a teleeVamm to Renewal byAndersen of I written notice,od send a Wevarn to Renewal brAtoden^to of 'Southern New England at 26Albion Ro&4Lincoln.NJ 02845. 1 Southern New End atlt Alblon Road.L2ncotn,Ri 0266S, (NOtT p LATEA TKAN MIDNIGHT OF _ Z:&-,[�, t (Date) LATER THAN MIDNIGHT Or - ,PM (Haw ERIDY CANCILTHISTRANSACTiON. ))l,, f NERICBY CA.NCELTHISTRANSACTION. ttputvr Pft"mzw* eat.:. M+h#a-V r.. - e e„trans aa• Pj A,Cop1:wNto &W C0 YtftW &W Coq At A Southern New England Windows d.b.a Renewal by Andersen of SNE . I z'. Ma5*achuset-s-Deparfrrlent.cif Public:3af ty u Board o,Building RegWatlons and St.1ndards !. T _ CS-095707 BRUN D IDENNISOIV - 7 LAMM POND CIR(:1 Charlton MA 01507 ?: fZ21 .1J Expiration C •'rrriniss rmer 09/08/2016 I 'W" 'I Office of Consumer affair;and Business Regulation 10?ark Plaza-Suite 5170 Boston,MassachuseTts 02116 Hone Improvement Contrncplr Regislrltion Registration: 173245 ,. Type, 1.1.:' Exolnlion: 9nW(116 Tr. 25-M2 SOUTHERN NEW ENGIANC WINDOWS LL MATTHFt4r ESLER " 26 ALBION RD LINCOLN,RI 02865 _......_............... Update.W dress and return card.9lark reason for change. Ad.l ss f!Renrm) :-1 Erarla,•nrm „f7Fre of Cnosoner.lRalreS Dusiosst Rr niartoa License'or registration valid for individul us:only tal +OVE APROY£61EUT CONTRACTOR before the espirution date if found return to: t ',rn"ppistrntion: 1732.5 .Type: Office ef Can.cmrr.v!L•sin unu Rusinev.ReKuiutiuu 'gxr'apiraticn, 9/SJ2016 ILC 10 Park Plans-tiuitc 5l Tt - �''�==` nos;an.MA 01116 iry _. SOUTi=RN kEsO ENG-ANC\MN?OlV3 I.I.C. r I REY_!:'?L'BY ANDERSON NATn-EY/c8LEli 26.4.1lION 47 its l�t n UNCQt H.R102855 I:ad--tary N,)nilid ai:nou:signature._.._....___. r The Commonwealth of Massachusetts Department of IndustrialAccidents Office oflnvestigations I Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/O agmization/Individual): SOUTHERN NEW ENGLAND WINDOWS Address:26 Albion Rd City/State/Zip:Lincoln, RI 02865 Phone#:401-228-9800 Are you an employer? Check the appropriate box: Type of project(required): 1. I a employer with 20+ 4. 1 am a general contractor and I� acfrt ❑ * have hired the sub-contractor 6. ❑New construction employees (full and/or part-time).., is 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' 9. ❑Building addition [No workers' comp. insurance comp. insurance required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.M Other Window Replacement comp. insurance required.] *Any applicant that checks box#t 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. FContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy andjob site information. 1. Insurance Company Name:ARGONAUT INS. CO. , Policy##or Self-ins. Lic. #:WC 928058352394 Expiration Date:8/21/2016 Job Site Address: cZ L4 i (nap le S&- City/State/Zip:16) &1a_&(eh't 1A 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\nsurance coverage verification. I do hereby certi under the ' s and penalties of perjury that the information provided above is true and correct. c Si ature: Date: Z 01 Phone#: 4012289800 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): L Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: L — - SOUTNEW-01 PARKERNATHCO A�oRo CERTIFICATE OF LIABILITY INSURANCE . DATEM 13120"""' 8113/2016 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 j 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 po(icy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to I the terms and conditions of the policy,certain Policies may require an endorsement. A statement on this certificate does not confer rights to the j certificate holder in lieu of such endorsement(s)- PRODUCER I CONrACT Willis of New Jersey,Inc. 1 NAME Willis Certificate Center C/O 26 Century Blvd JAIC.No.E<tI:(877)945-7378 Not(888)467-2378 ! P.O.BOX 305191 :ADDRESS: Nashville,TN 37230-6191 INSURERS AFFORDING COVERAGE NAIL INSUItERA.Selective Insurance Company of Southeast 39926 INSURED `INSURERS:OneSeacon Insurance Company 21970 .Southern New England Windows LLC ;INSURER C;Argonaut Insurance Company 19801 DIWA Renewal by Andersen 28 Albion Road INSURER D: Lincoln,RI 02865 's INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THE PO THIS IS TO CERTIFY THATLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. 4 EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE Rf POLICY HUNGER MWDD� no CY FJCP LUM A X ICOMMERCIAL GENERAL LIABILITY [EACH OCCURRENCE $ 1r000, ' CLAIMS-MADE 1XI OCCUR x IS 2029459' 09/10/2015 0811OJ2016 PREMISES Ea oarrrance S 100, 1 1 MED FXP(Arty ors person) $ _1�0,000' ,PERSONAL BADVI"RY $ 1,ODDjON GEN'L AGGREGATE LIMIT APPLIES PER: j GENERAL AGGREGATE $ 3,000,000 i POLICY a JERCaT C,LOC PRODUCTS-COMPIOPAGG 'S 3100010001 OTHER: AUTOMOBILE LtAaILRY ! COMBINED SINGLE LIMIT )1 accident) X ANYAUTO ! X I 2029459 08H0/2015�08/10/2016 BODILYI 1�,00 INJURY s r ALLOWNED SCHEDULED AUTOS AUTOS I i I BODILY INJURY(Per eoddanq S X HIRED AUTOS X I NON-OWNED I j PROPERTY DAUAGE S firer accident 8 UMBRELLAWIBHCLAIMSMADE OCCUR EACHOCCURRENCE S EXCESS LE48 AGGREGATE S -DED RETENTIONS WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN( i X SPENT P TATUTE 1 _ B ANY PROPRIETORIPARTNEREEXECUTIVE 000068028 !08/21/2015 OB/21/2018 IOMCERNEMBER EXCLUDED? 11N I A! I EL EACH ACCIDENT S 1 r000,000 t(Mandatory bn NH)und ! ! EL DISEASE-EAEMP S 1,000,000 �0yeSsC describe under 1 ! EL DISEASE-POLICYUMIT S 1,000,000 1 OESSCRIPTION OF OPERATIONS bebW I C Workers Compensation 1 , C928068352384 OB/21/2015I 08/21/2016 See Attached i 1 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD I IH.Additional Remarks Schedule,maybe akached U more space Is required) ' THIS CERTIFICATE VOIDS AND REPLACES THE PREVIOUSLY ISSUED CERTIFICATE DATED:8/11/2015 Auto Policy includes additional insured when required by written contract/agreement as per policy form. HSS Holding Corporation,lne.and any,subsidiaries are included as an Additional Insured as respects to General Liability when required by written contract/agreement as per policy form •i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITITTHE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 01988-"14 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD f a, Barnstable Old Kings Highway Historic'District Committee 200 Main Street,Hyannis,MA 02601,TEL: 508-862-4787 Fax 508-862-4784 2639. APPLICATION, CERTIFICATE OF APPROPRIATENESS Application is hereby made,with five(5)complete sets,for the issuance of a Certificate ofAppropriateness under Section 6 of Chapter 470,Acts and Resolves of Massachusetts, 1973,for proposed work as described below and on plans,drawings,or photographs accompanying this application for. Check all categories that apply; 1. Building construction: ❑ New ❑ Addition ❑ Alteration 2. Type of Building: ❑ House ❑ Garage/barn ❑ Shed ❑ Commercial ❑ Other 3. Exterior Painting,roof ❑ new roof ❑ color/material change,of trim,siding,window,door 4. Si n: ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign 5. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Retaining wall ❑ Tennis court ❑ Other 6. Pool ❑ Swimming ❑ Other man-made pool ;Solar panels ❑ Other Type or Print Legibly: Date D NOTE All applications must be signed by the current owner Owner(print): Telephone#: Address of Proposed Work:2s f� Mj%e S"r Village 1)•54A)%7A$/e— Map Lot# Mailing Address(if different) Owner's Signature Description of Proposed Work: Give particulars of work to be bone: Agent or Contractor(print): ^^ / /V.. Telephone#: Address: ox) pil d'da Contractor/Agent'signature: o mittee use only. This Certificate is hereby VED D Members signatures RECF,MD f )Z015 Get®V6''i'H TvIA,1A CEMENT a&G1`17d ws Q.IBoards and Commissionsl0ld Kings Higlnvayt0KHApplfaa1ionsl0KH2O11 Cert Appropriatenew.doc OCT 2 G 2015 1 .. Town of Barnstable Old King's Highway Committee CERTIFICATE OF APPROPRIATENESS SPEC SHEET Please submit 5 copies Foundation Type:(Max. 12"exposed)(material-brick/cement,other) Siding Type: Clapboard_ shingle_ other Material: red cedar white cedar other Color. Chimney Material: Color: Roof Material: (make&style) Color. Roof Pitch(s): (7/12 minimum) (speck on plans for new buildings, major additions) *Window and door trim material: wood other material,specify ��B Size of cornerboards size of casings(1 X 4 min.) color Rakes Ist member 2nd member Depth of overhang Window: (make/model)AP,�, materiaL�f color (Provide window schedule on plan for new buildings, majo�ons) Window grills(please check all that apply true divided lights exterior glued grills grills between glass removable interior None Door style and make: materia Color: Garage Door,Style Size of opening Material Color Shutter Type/Style/Material: Color:. RECEIVED Gutter Type/Material: Color: 022015 Deck material: wood other material,specify 'Color: GROWTH MANAGEMENT Skylight,type/make/model/: material Color: Size: Sign size: Type/Materials: Color: A n o o nv ,D. Fence Type(max 6')Style material: Color: _ Ul.l o �G15 Retaining wall: Material: _x--stable �� .,, • �- hway Lighting,freestanding on building ..illuminating sign ��d Co m tttee OTHER INFORMATION: THE ATTACHED CHECK LIST MUS OMPLETED AND SUBAffMD Please provide samples of paint o s,m ufacturers brochure of windows,doors,garage door,fences,lamp posts etc Signed: (plan prepare Print Name 2 Q:IBoards and Commissionsl0ld Kings High%WIOKHApplications10KH2O11 Cert Approprlatcness.doc .. i TOWN BARN, C C 20131vov aiF INSULATION 19 R 3: 06 IIBER 4lA55 SSAMEESS SPR�SOAM SOSP-GE4 RAM OOMI* IN3OSANON CEILINGS 1-800-696-6611 Town of Barnstable Regulatory Services Building Division 200 Main St Hyannis, MA 02601 P- Date:. �,1' 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 ��, ✓✓i cPV1 AAUpk S4' Insulation Instal.led: Fiberglass Cellulose R-Value Restricted Unrestricted , Ceilings ( ) ( (OOLO) ( ) Slopes ( ( ) (fib ) ( ( ) Floors ( ) ( ) ( ) ( ) ( ) Walls ( ) ( ) ( ) ( ) ( ) r Sincerely He y E Cas y Jr, President C e Cod I ulation, Inc. r Town of Barnstable SINE RegWatory Services ti Thomas F. Geiler,Director � t Building Division TORN OP-BARNSTABLE: k R4L1UgSrA=, - PIAM g Tom Perry,Building Commissioner ZQ13 S�� _S P M I2. 200 Main Street, Hyannis,MA 02601 3$ i www.town.barnstable.ma.us � 8�7�0- 30 Office: 508-862-4038 DIVI, Ia %v;1 Approved: Fee: O3-, 0 Permit#: HOME OCCUPATION REGISTRATION r Date: ( J Name: `JGI�� f t.S Phone#: SCI— rl 3 I OFS Address: Z c (I L*/C*(J'- Village: Name of Business: Type of Business: W`^`�` f `^* `^S —Map/Lot: 3,;),^Qd DI TENT: It is the intent of this section to allow die residents of the Town of Barnstable to operate a home occupation hizdhin single family dwellings,subject to the provisions of Section 4-1.4 of die Zoning ordinance,pro`nded that the acthity shall not be discernible from outside the dwelling there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in tiafhc above normal residential volumes; and no increase in air or groundmater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the follohhing conditions:. • The acti`aty is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to die dwelling which are not customary m residential buildings,and there is no outside evidence of such use. e No traffic will be generated ih excess of normal residential volumes. • The use does not involve die production of offensive noise,hribration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials, in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not gathin the required front yard. • There is no exterior storage or display of materials or equipment. • There are no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on die same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If-tie Customary Home Occupation is listed or advertised as a business, the street address shall not be included. • No person shall be employed ii die Customary Home Occupation who is not a permanent resident of the dwelling unit. I, the undersigned an n die above restrictions for my home occupation I am registering. Applicant: Date: c� 3 Homeoc.doc Rev.01/3/08 1 YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. f , r 4A� t 9� � , DATE: 4 S 13 Fill in please: APPLICANT'S YOUR NAME/S: o crr S BUSINESS YOUR HOME ADDRESS: 2c(i !nap(C T-J, (J, barn GV ✓VI,A CJz�6f� ,W � E TELEPHONE # Home Telephone Number cr 9 S— Fat �t s7 Y9i NAME-OF CORPORATION: NAME OF NEW BUSINESS �,� Tt TYPE OF BUSINESS IS THIS A HOME OCCUPATION? YES NO ADDRESS OF BUSINESS U L,� ci t� ?III ffJ,3w�i�ti�MAP/PARCEL'NUMBER (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COM ISSIO R'S OFF This individ I ha a inf rm d any er it a ire ents that pertain to this type of busindWST COMPLY WITH HOME OCCUPATION RULES AND REGULATIONS. FAILURE TO Aut orfze gn tar COMPLY MAY RESULT IN FINES. A MENTS _ oI/1! OctIS / ICY '^ t 2. BOARD OF H LTH -�- � t 7/ This individual h infor e e p r it req is that pertain to this type of business. Authorized i ature** MUST ,OMPLY WITH ALL COMMENTS: 3. CONSUMER AFFAIRS [LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: Date:/1'/.5 / t3 TOWN OF BARN-STABLE Date: _"ffl2j0 , F&-sKT TOXIC AND HAZARDOUS MATERIALS ON-SIT NAME OF BUSINESS: 7_114 art . BUSINESS LOCATION: hume. INVENTORY MAILING ADDRESS: '5 02-66b TOTALAMOUNT: TELEPHONE NUMBER: 5 U6- 73 7- D 9S CONTACT PERSON: G - . � Irr S EMERGENCY CONTACT TELEPHONE NUMBER: SUS- ?3 7 - G 9 S I MSDS ON SITE? TYPE OF BUSINESS: /V0 INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The board of health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene,#2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison"labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initialsc,�,, TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION i G1 Map I Parcel Application #� 13 D6'7/ Health Division Date Issued 3 Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address ,; Y-1 Village r !: L rz J 2!2 4_1 9� Owner r/� ez ef Address Telephone OW ,z,?,._;-'7 Permit Request 4VJ Jvi G'` sJ / 4! �1 .14 — `d Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation f ,),52`, ©Construction Type a6;/AI�rl�� o Lot Size Grandfathered: ❑Yes ❑ No If yes, attar supporting doimentation. == -_04. Dwelling Type: Single Family ;9. Two Family ❑ Multi-Family (# units) � NO c o Age of Existing Structure Historic House: ❑Yes ,6,No - On-Old Ki� 's Highly: WYes �'_1Vo Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other y Basement Finished Area (sq.ft.) Basement Unfinished Area &q.ft) ' lJl iY7 Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including bath;): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number Address r'/��i � �� License # Home Improvement Contractor# Worker's Compensation ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE k-,A3 FOR OFFICIAL USE ONLY f APPLICATION# DATE ISSUED MAP/PARCEL NO. 3. J ADDRESS _ ' .� Y VILLAGE - OWNER c DATE OF INSPECTION: y L FOUNDATION ' Z FRAME 4 i, INSULATION ' p± FIREPLACE s s� ELECTRICAL: ROUGH FINAL , PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING .•� DATE CLOSED OUT ASSOCIATION"PLAN NO..- ' I yy�� 1ta�sac'husctts - Ut•It:u'tnu•nt of Public tiafrt� ��p�� liu:u'(I ul' 13ttililin;; Rc��ulatinru :uul Jtandartls C„onstruiCtion Supervisor License Licen :'•CS 100988 d; it HENRY CASSIDYa•;y. 8 SHED ROW VVESs1' 1JARMOUTH, MA 02673 Expiration: 11/11/2013 ( .nunisi.urr Trw 7620 i_jn��\—=:` ��LI.E'• �Cz'��L%yJ'1•-CZ•�'Z-II�E'�1��1, (�':•>��. •` G ,�C-.'��1 _ - Office. of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 153567 Type: Private Corporation Expiration: 12/15/2b14 Trti 233031 CAPE COD INSULATION, INC HENRY CASSIDY ----.`-__.._.._.._...._._._..... . ... 18 REARDON CIRCLE ----_.....__._..._._.._...._._._......._... . SO. YARMOUTH, MA 02664 __._......_...._-.._......-_--__..._.._....._... ..._ .. .. . Update Address mud return card. Marls reason for change. l� Address (11 Renewal -) Employnta+tt I.. I Lust Card (•rue.iic�rrrNi°:rrl/l Of•Co'F'(.rrJJrlc1/rlrlr:•��J ,_ uitir, of 0msumer Affairs J nosiness Itegulatio„ License or registration valid for indivitlul use only M .:t11OME IMPROVEMENT CONTRACTOR befure the expiration date. If found return to: 4" eyistratiun: 153567 Type: Office of Consumer Affairs and Business Regulation jExpiration: 1211'5/2014 Private CorporatiC•u 10 Park Plaza-Suite 5170 Boston,MA 02116 i:ni't:Cl?li WSl1lA1•ION,,;INC. -IiONIO' (ASSID) t i i2l:Af20O(J CIRCLE Si) 1'i1RM01J1'l1 MA 02664 Undersecretary 0 f val' witho t ' nat re i i • If _• CAPECOD-27 MYOUNG CERTIFICATE OF LIABILITY INSURANCE 1 DATE 7 /1'YYY) /8120/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License#PC-514062 NAME: Margaret Young Rogers&Gray Insurance Agency,Inc. PHONE FAX 434 Rte 134 A/ o r A/C No): South Dennis,MA 02660 A DRlesS:myoung@rogersgray.com INSURERS AFFORDING COVERAGE NAIC If INSURERA:PEERLESS INSURANCE COMPANY INSURED INSURER B:COMMERCE INSURANCE COMPANY Cape Cod Insulation,Inc. INSURERC:Evanston Insurance Company 18 Reardon Circle INSURER D:ATLANTIC CHARTER INSURANCE GROUP South Yarmouth,MA 02664 INSURERE: r INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR D POUCYNUMBER MM/DD MM/DD GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CBP8263063 411/2013 4/1/2014 PREMISES Ea occurrence $ 100,000 CLAIMS-MADE FK OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO- LOCjECT $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident $ B ANY AUTO 13MMBCKVMK 4/1/2013 4/1/2014 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS PER ACCIDENT) X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 C EXCESS LIAB CLAIMS-MADE XONJ453512 4/1/2013 4/1/2014 AGGREGATE $ 1,000,000 DED I X I RETENTION$ 10,000 $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY L SER D ANY PROPRIETOR/PARTNER/EXECUTIVE Y 1 N WCA00525904 6/30/2013 6/30/2014 E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? El N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) _ Workers Compensation includes Officers or Proprietors. Addtional Insured status is provided under the General Liability when required by written contract or agreement with the Certificate Holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cape Cod Insulation,Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE @ 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations IF 600 Washington Street Boston,MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Apulicant Information Please Print Legibly Name (Business/Organization/Individual): Address: /,�' ,% L�pi� CJi� City/State/Zip: e,? Phone#: Are you an employ r?Check the appropriate box: general contractor and I Type of project(required): 1.❑ I am a employer with 4. ❑ I am a g 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' I 9. [No workers' comp. insurance comp. insurance.i Building addition r uired: 5 We are a corporation and its 10. Electrical eQ � rp ❑ repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.[3 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 3a.❑ I am a homeowner acting as a employees. [No workers' 13.❑Other Zg(,gjylia general contractor(refer to#4) comp.insuranCe required.] *Any applicant that checks boa#1 must also fill out the section below showing their workers'compensatiodi oficy information t Homeowners who submit this affidavit indicating they are doing all work and then him 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. j I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: ��,c/T/ Policy#or Self-ins. Lic.#: Expiration Date: (/P�,�AV-- Job Site Address: 07`f- Sg/ �`,�1,f �/�� —City/State/Zip:1� 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 upder the pains an, penalties of perjury that the information provided above is true and correct: Pam_ ��' �7�1 a� �`` Official use only. Do not write in this area, to be completed by city or town ofciaL City or Town: Permit/License# 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#: , OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at (Property Address) (Property Address) hereby authorize cc� a S (Subcon ractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. Owner's nature 7 q Date ts �oaTME Town of Barnstable Permit? , 03 E.Virer 6 iron rom issue date Regulatory Services Fee %• L►EtNSrAst,E, • MASS • � e39. A�e� Thomas F. Geiler,Director 1 Fp Mip►'t Building Division AA Tom Perry, CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 "" Office; 508-862-4038 www.town.bamstab le.ma us EXPRESS PERMIT APPLICATION - RESIDENTIAL, ONLY Fax: 508-790-6230 Not Valid without Red X-Press Imprint Map/parcel Number 1 Property Address Residential Value of Work_ �(�1 l•�'C Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address �� ^�' r� �P ' ski UA �,>°l� (�r`rC Contractor's Name l Telephone Number s U COYc�/ �X Home Improvement Contractor License#(if applicable) 3onstruction Supervisor's License#(if applicable) C. Cz SWorkman's Compensation Insurance Cl l am e: ❑ X-PRESS PERMIT I am a sole proprietor g�I❑ I am the Homeowner JUL 1) 7 2O11 have Worker's`Compensation Insurance isurance Company Name ��Ovj -- �� -. lC � 70 N OF QARN�TASLE 'orkman's Comp.Policy# opy of Insurance Compliance Certificate must accompany each permit :rmit Request(check box) 9.Re-roof(stripping old shingles) All construction debris wit be taken to LU ❑Re-roof(not stripping. Going over, existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value #of doors (maximum .44)#of windows 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. copy of the Home Improvement Contractors License&Construction Supervisors License is Zr, ired. 'qATURE: Y 1 The Common rveakh of Afassach usetts ( Department ofIndustrur114ccidenis I ! Office oflnvestigations 600 Washin on Street t`� Boston,MA 02111 f z- www.rnass goo/raid Workers' Compensation Insurance Affidavit: BuRders/Contractors/Electricians/PIa.mbers Applicant Information . Please Print Lebly Name:(Business/Organization/hdividual): o t1�;t'Ir1, •�• yw c►��t �15.11 Address: City/State/ tJi .1�r_h/l//A _ G,�2 Pbone #: . A krean employer?Check the appropriate box: Type of project(required): NN: a employer with 4. ❑ I am a general contractor and Iloyees (full and/or part-time).* have hired the sub-contractors6 ❑New construction a sole proprietor or partner- listed on the attached sheet t .?•. ❑modelingand have no employees These sub-contractors have 8. ❑•Demolition ing forme in anycapacity. workers' comp. insurance9 ❑Building addition orkers' comp. insurance 5. ❑ We are a corporation andits red.] officers have exercised their10.❑Electrical repairs or additions a homeowner doing all work right of exemption per MGL 1 LE] Plumbing repairs or additions lf. [No workers' comp. c. 152, §](4), and we have noIZ�Roof repairsnce required] t employees.[No workers' comp. insurance required.] 13.❑ Other *Any applicant that checks box f 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 their workers'camp.policy information. I am.an employer that is providing workers'compensation insurance for information. my erinployees Below is the policy and job'site Insurance Company Name: .Policy#or Self-ins.'Lic.#: wC . 7c'jQLQQ� K / 6 Expiration Date: 72 Job Site Address: L{_� City/StatelZip: 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 S250.00 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. F do hereby u dA�e' and penalties of perjury that the information provided above is a and correct 3i store: 'hone Official use only. Do not wrfte in this area;to be completed by city or town bffu:ial City or Town: - Permit/License# Issuing Authority(circle one): - . . p: Information and Instructions. Massachusetts General Laws chapter.]52 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 onto 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(T)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-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for conformation 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 ifyou are required to,obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line: ! City or Town Officials Please be sure that the-affidavit is complete and printed legrbly. The Department has provided a space at the bottom of the affidavit for you to fill out ih the event the Office of Investigations has to contact yod regarding the applicant Please be sure to fill i;i 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 Iicenses. 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 venture (Le. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would Re to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. . The Department's address,telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office-of Investigations' 600 Washington Street Baston,.MA 02111 t I , Town of Barnstable 0 . � . Regulatory Sex-vices �g $ Thomas F.Geller,Director )6% Building Division Tom Perry,Building Commissioner 200 Main Street HYaunis MA.02601 www-towmb arrastab le.ma,us Office: 508-862-4 03 8 Fax: 508-790-6230 Property Owner*Must Complete and Sign This Section If Using,A Builder ' 6 '• , as Owner of the suhject•property r y authorize to act on my behalf, is all matters relative to work authorized by this budding permit application for. ,qj j (.Address of Job) j Signatiu:e of Owner Date Pant Name If Prop e Owner is applyfng for permit pleas e'c oia fete. the Homeowners License Exemption Form on the reverpe-side. Town of Barnstable P� THE 1p�y o Regulatory Services i stxxrdsust s TbninaG F. Geiler,Director • ,tsts� . 8 . e63� .4 Balding Division Tom Perry,Building Commissioner _ 200 Maai•5'trcct; Ayannis,MA 02601 wwp.town-b arnstable.ma.uis Off-c: 508-862-4-038 Fax_ 508-790-6230 HOMEOWNER IlCFh'SE Exy-MMO*N Please Print DA7E ' JOB LOCATION: numbs strxi village '740MEOWWER": naxnc bamc phone# work phone# CURJtENT MAlLINO ADDRESS: ettyhvwn state xtp code The current ex=ption for"haumeowners"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 stmcryisor. '. DTFPjTTOIV OF BOME07r?m Pnrson(s)who owes a parcel of land an which he/she resides or iufmds to reside, an whichtI=c:is, or is intended to- be, a one or two-family dwcUfiiL attached or detaphed siructures accessory to such usa and/or fanzl structures. A person who canstrgcts mart than 6ne horse in a two-year period shin not be considered a homeowner. Such "homeowner shall sabm t to the.Bu lding OfEcia1 on a fo=acceptable to ttic Burg Official, that he/she shall be respoi siblc for all such work pczl > e 'umdcr the building Permit: (Section 109.1.1) The undersigned`nomcowner"atzmyrnrc responsibility for compliance with the State Building Coda and other applicable codes, bylaws,rules and regulations. The undersigned`homeowner"eartifcs that,helshe.understands the Town ofBamstable BuildingDepart>Rcnt �niminninspection pro=hmcs and rests and that he/she will comply with said procedures and req th==nts. Signatiuz of Hon7ccwna Appreval ofBurldmg•OfficW , Note. Threc-family dwellings containing 3 5,000 cubic feet or larger will be required to comply Vi h the ' 3tato Building Code Section 127.0 ConstroctUm Cantrol. ' HOII�OWPlr3t'S F.XEMP7ION • The Code states that Aay bnaieowne pclnarraag worn for which a buiDding po7nit is required shall be erupt from the provisions r this srrtion(S=ddn 109.1.1-Licasmg of conshmc;d=Supayiscrs);provided that if the bmn=Cwna engng=s a posoa(s)for hire to de such that such HarneownashaA aei as supervisor" k>Eamy borncownas who use flits tion ors unawar=that tbcy are:xmrming the responslIftes of a supervisor(see Appendix Q, Iles do Regulations for)Jec ring r^^xt^+�an Supervisors,Section 2.13) This lack ofr%w=ess nfk=r=ulnt in serious problems,partieular9y 1m the hameownc hires unlicensed per.== In this ease,our Board cannot proceed against the=Ii=nsed person as it would with c Iicensrd �a'visar. The:homeowoa aciang ss 5upervisar is ultaratety t=tpoasible. i Office of Consumer Affairs and usiness Regulation 10 Park Plaza - Suite 5170 Boston, Massacsetts 02116 Home Improvement &ot'raitor Registration Reqistration: 167739 Type: LLC z r_ Expiration: 10/25/2012 Tr# 205252 NORTHERN COLONY BUILDERS DANIEL GALLAGHER 1694 FALMOUTH RD #135 CENTERVILLE, MA 02632. — �< Update Address and return card.Mark reason for change. Address Renewal Employment 0 Lost Card DPS-CAI 0 50M-04/04-G1012' Massachusetts= Dep•artmcrit of Public Si ?; Board of Building; Regulations and Stinduris,J �qons.trucfio9,Supervisor License I.• fricense:,CS 53638 R .0ricted to: 00 � R DANIEL"J`�G LLAGHER I #t( N iFi4st rR4 'Vy BARNSTi 6 E;RMA 02668 „ t[1 } ,�. • Expiration: 10/27/2011•�*, Cnnunissluncr ,. •i Tr#: .9773Y y J • I J U 1. 6. 2011 3 42P N o 7005 P. 1 2VDDIYYYY) AWNL %or—ATIFICATE OF LIABILITY INSURANCE 07/06/2011 ODUCER 508.997.6061 FAX 508.990.2731 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION oLftheast�ern Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE.DOES NOT AMEND,EXTEND OR 439 'State Rd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 79398 North Dartmouth, MA 02747 INSURERS AFFORDING COVERAGE NAIC# INSURED Northern Colony Building Co LLC INSURER A: Central Insurance Companies 20230 1694 Falmouth Road #135 INSURERB: Merchants Insurance Group Centerville, MA 02632 INSURERC: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR D' POLICY EFFECTIVE POLICY EXPIRATION LTR NS TYPE OF INSURANCE POLICY NUMBER DATE M gFFE DATE MM/DD LIMITS GENERAL LIABILITY CLP7997489 07/08/2011 07/08/2012 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 300,000 CLAIMS MADE r—x I OCCUR MED EXP(Any one person) $ 5,000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE' $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY P CT LOC AUTOMOBILE LIABILITY MCA7013965 01/05/2011 01/05/2012 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY $ X B SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WC799749014 07/08/2011 07/08/2012 X TORY L MITS ER AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y❑ E.L.EACH ACCIDENT $ 100,000 A OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Town Of Barnstable REPRESENTATIVES. Attn: Building Department AUTHORIZED REPRESENTATIVE Karen Bernier ACORD 25(2009/01) FAX: 508.790.6230 ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ��► A Town of Barnstable Permit# Expires 6 nronlhs from issue dole AB Regulatory Services Fee BARNSTM"S& Thomas F. Geiler, Director .16396 Building Division Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 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 V 3;Z Property Address 2 4( tT STRee-t Residential Value of Work �I 0W CC Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Contractor's Name s kioAs (n'ruc,. Telephone Number—ua — Home Improvement Contractor License#(if applicable) NBC kh 4/G Construction Supervisor's License#(if applicable) C KWorkman's Compensation Insurance f Check one: -PRES.S,PER ❑ I am a sole proprietor 2009 ❑ -•I am the Homeowner JUL 2 W—I have Worker's Compensation Insurance RNSTAB�- _ TOWN OF.BA Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) Re-roof(strippin old shingles) All construction debris will be taken to -T{1 C('7m(._�— ❑ 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 Oxner must sign Property Owner Letter of Permission. H m [ ro men,Contractors License& Construct Supervisors License is required. SIGNATURE: Q:\WPFILES\FORMS\ xpress\EXP REN SPERM IT.DOC Revise06O4O9 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 Lezibly Name(Business/Organization/Individual) � Address: t6TJ dlA � i►� �� Ci /State/Zi Phone.#: Are you an employer? Check the appropriate bog: Type of project(required): 1.(� I am a employer with 4. I am a general contractor and I employees(full and/or part-tim.e). * have hired the sub-contractors 6. ❑New construction .2.❑ I am'a soleproprietor or'partner listed on the attached sheet. T. ❑Remodeling ship and have no employees These sub-contractors have g. •❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'•comp.-insurance comp. insurance.t required.] 5. ❑ We are a corporation and its J0.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.10 Roof repairs insurance required.] t c. 152, §1(4), and we have no Ink 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 state whether or not those entities have employees. If the sub-contractors have employees,they must providt:their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: %V_ Policy#or Self-ins.Lic.#: W 9 '� ygC7 Expiration Date: Job Site Address: cli4l City/State/Zipu) &/V J C:a Coto$ 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 f6r insurance coverage verification. l do hereby certify under h ins and penalties of perjury that the information provided above is true and correct Signature. 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#: In-formation and Insttuctions 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." I 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 . i 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-con6actor(s)name(s),-address(es)and.phone number(s) along with their certificate(s)of insurance. Limited Liability Companies'(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete"and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permittlicense 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 maybe 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 to any business or commercial venture (i.e. a dog license or 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22.06 www.mass.gov/dia TToti Town of Barn-stable Regulatory Services 9a' 'r AB&BM Thomas F. Geiler,Director 1619. 16 Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder k , as Owner of the subject property` hereby authorize ; �-�`� � VA(40 1 to act on my behalf, 77 in all matters relative to work authorized by this building permit application for. c f UJ 9AIZF-) Address of Job) S* ture of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. N Town of BarnstableTHME y Regulatory Services Thomas F.Geiler,Director • t3wtrxsTast.e. . Building Division PJFD µlb t' Tom Perry,Building Commissioner ......200 Mair Streeter Hyaimis-MA 02�601 _......_...... ._ _. .._.._. . . _........ www.town.barnstable.ma.us Office: 508-962-4038 Fax: 508-790-6230 SOI EOWNER LICENSE EXEMPTION Please Print DATE. JOB LOCATION: number street village "HOMEOWNER': name home phone# work phone# I CURRENT MAILING ADDRESS: i i city/town slate 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.L 1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned.."homeownee'certifies that.he/she understands the Town of Barmstable.BuildiDg Department inuumum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of 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 EXEMYTION 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 1 o9.1.1 -Licensing of amstruetion 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 assurning 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 horneowner hirrs unlicensed persons. In this ease,our Board cannot proceed against the unlicensed person'as it would with a licensed Supervisar. The homeowner acting as Supervisor is ultimatrly responsible. To ensure that the homeowner is fully aware of Ms/hQ msponnibr7itics,many conununitics require,as part of the permit application, that the homeowner certify that helshe understands the responnbilitics of a Supervisor. On the last page of this issue is a form currently used by several towns. You may caret amend and adopt such a fomJcertification.for use in your community. Q:forms:homccxempt ®1' : Jun, 16, 2009 3: 12PM No. 0935 P. 1/21IDDIYYM AC;L)KL �r-RTIFICA`TE OF LIABILITY INSURANCL El18 ® rw 04/21/2009 �tODUCER ``09) 97-6061 FAX (508)990-2731 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ®ggiouthea ern Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 439 State Rd. ALTER T I HE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 79398 N. Dartmouth, MA 02747 INSURERS AFFORDING COVERAGE NAIC# INSURED Gallagher Shields Building Co Inc. INSURER A: Central Insurance Companies 20230 1694 Falmouth Road #135 INSURERS: Merchants Insurance Group Centerville, MA 02632 INSURERC: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADO'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRE TYPE OF INSURANCE POLICY NUMBER DATE MMIDD DATE MMIDD LIMITS GENERAL LIABILITY CLP7997489 07/08/2008 07/08/2009 EACH OCCURRENCE $ 1,000,00C X COMMERCIAL GENERAL LIABILITY PREMISES(EE a occurrence) $ 300,OOC CLAIMS MADE FI _I OCCUR MED EXP(Any one person) $ 5,00C A PERSONAL&ADV INJURY $ 1,000100C GENERAL AGGREGATE $ 2,000,OOC GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,OOC POLICY PRO LOC JECT AUTOMOBILE LIABILITY 7AM0277013965 01/05/2009 01/05/2010 COMBINED SINGLE LIMIT ANY AUTO (I::� w,;.dor,I) $ 1,000,00C ALL OWNED AUTOS BODILY INJURY B X SCHEDULED AUTOS (Per person) $ HIRED AUTOS _ BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS 1 UMBRELLA LIABILITY EACH OCCURRENCE I $ OCCUR El CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WC799749012 07/08/2008 07/08/2009 X I ORY L MITS I I ER AND EMPLOYERS'LIABILITY A ANY OFFICER/MEM ER EXCLUDRED?ECUTIVE Y❑ E.L.EACH ACCIDENT $ 100,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 100,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ S00,000 OTHER 1 I DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Town of Barnstable NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Attn: Building Dept. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 200 Main Street REPRESENTATIVES. Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE I Karen Bernier ACORD 25(2009/01) FAX: 508.790.6230 ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD `a �\ ✓�E �O�gYlIC492ClJP,CGGUL (J•L ,��t�rN.Lf,�.fIOBG[O _-._-...___..-___._ ----._ Board of Building Regulations and Standards License or registration valid for individul use only _ HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: _- Registration: .162946 Board of Building Regulations and Standards Expiration: 4/27/2011 Tr# 283446 One Ashburton Place Rm 1301 Type: Private Corporation Boston,Ma.02108 GALLAGHER SHIELDS BUILDING CO INC. DANIEL GALLAGHER 180 HIGH STc_J\ WEST BARNSTABLE,MA 02668 Administrator Not va I �t 'out si nature � Board of Building o��i�a�aazG/7. Cand St ' onstruction Supervlsor Llcenseandards f License- CS 53638 NOV 2712009 Tr# 8586 I tt r� DANIEL J GALLAGHE _fl P.O BOX 471 • W BARNSTA BLE,MA 02668 S Commissioner i Town of Barnstable *Permit#Cl?00 Expires 6 months from issue date Regulatory Services Fee . , anxrvsTasi a Thomas F. Geiler,Director [Hass. i639• o� Building Division �� PERMIT Tom Perry,CBO, Building Commissioner JUL 1 0 2008 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 50tftfW?JF BARNSTABLE Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number ( aU 7 . Property Address t� Y �� r p L i✓ - S12GrT" ,j 0-r✓1 miesidential _ Value of Work a.�3c�U db Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address ��. t W a _1CA N yVt . ,-S Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I m a sole proprietor VI m the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris•will be taken to ❑Re-roof(not stripping: Going over existing layers of roof) Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) *Where required: Issuance of this peimit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: Q:\WPFILES\FORMS\building p it fonns\EXPRESS. oc Revise020108 S The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, AM 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly_ Name(Bvsincss/OrgamizarionlindMduo): XA 9 XZ • Address: �`{ \ � �� .. City/State/Zip: c� Phone.#: 5�8 - off =15� Are you an employer? Check the appropriate bow Type of project(required): 1.❑ I am a employcr_with 4- ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time):* have bired the shlrcontractors 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 employees and have workers' working for mein any capacity. 9. ❑Building addition . [No workers' czmp.-mrr sramc comp.insurance. X&fuir�] 5. ❑ We an a corporation and its 10.❑Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their I L E]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 bave no employees. [No workers' 13.❑ Other cow_bimrance rDq*cd-] 'Any applicant that checks box#1 must also fill out the section below showing their workers'corupmm4on policy informatim-L t Homcowncn who submit this a$davit indimting Grey are doing all work and then hire outside contractors must submit snow affidavitindiratsng such. cContractors that chccic this box must attached an additional sheet showing the name of the sub-confractnrs and state whether or not those entities have mnploycas. if the sub-conhmctms have cxoploymr4 they roust pnrvidt their work='comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Belaw is the policy and job site information. Insurance Company Name: .,j Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/Statc/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 a 152 can lead to the imposition of criminal penalties of a e fin tip to S 1,500.00 and/or one-year,imprisonTn nt,as well is civil penalties in the form of a STOP WORK ORDER and a fine of up to$250A0 a day against the violator. Be advised that a copy of this statcmerit may be forwarded to the Office of Invrziit?ations of the DIA for iner,rance coverage verification. I do hereby certi n the painEa � f perjury that the information provided above is true and correct. Si e. Date: h �� — Phone#: D frclal use only. Do not write in this area, tb be completed by city or town offtciaL City or Town: Permit/License# Tssuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk .4.Electrical Inspector S.Plumbing Inspector 6. Other Cantact Person• Phone#: oFIHErO�s• Town of Barnstable Regulatory Services r . -�swxx MASS. Thomas F. Geiler,Director qjA 039. �m Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, _-:s 1't as Owner of the subject property hereby authorize B 1J Cj A��1h��CZ_ to act on my behalf, in all.matters relative to work authorized by this building permit application for: .f (Ad dA s of Job) Si tore of Owne ate Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Town of Barnstable �pf THE Tti Regulatory Services Thomas F. Geiler,Director BAt ST"LK � 16 Building Division�9• �� g ATED 1`��a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 R•ww.town.barnsiabl e.ma.us Office: S08-862-4038 Fax: 508-790-6230 HOhItOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: t number stre village "HOMEOWNER": i� name home phone# work phone# CURRENT MAILING ADDRESS: ® � city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow 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 fonn 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. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department rrunim pection procedures and requirements and that he/she will comply with said procedures and re em tS. Signa a of Homeowner A roval 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 homeowner perfomung 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. r x- < i� >ti 4 F 1� rty2 `-1� — •� .fir r� ` �;err r. X.'l 11 y4=D �I t J 163 s lI ► r'r � ls�t�9hr•r �ri.l .. '�••.� S r tY , 11 OClgp e! - ►„ s'a! iD917N a31 K,. � / l f;� y � .T.ij \`�� +�i11 �.•`iFa- `� - ,y^ �i� `� T''�.� H F��.�'4r. I i. 7!/J�♦// s MUM lop f s L 1q Ilk i F:t - f / r � I �� • . III s I ' Application to ®rb 1.ing'5 AW91OWaP 3&C91[1010I )�i5tfltic �Di5trict C201-umittee In the Town of Barnstable CERTIFICATE OF APPROPRIATENESS Application is hereby made, with four complete sets, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings, or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior building construction: ❑ New Addition ❑ Alteration b Indicate type of building: ❑ House ❑ Garage ❑ Commercial Other bF12MC 1ryw--FF " 2. Exterior Painting: ❑ --iao 3. Signs or Billboards: ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign o D 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other. M DATE 0 'TYPE OR PRINT LEGIBLY, � ADDRESS OF PROPOSED WORK ASSESSOR'S MAP NC1,0 + OWNER �c�c�onne N l-�Ca RCS%'`� ASSESSOR'S LOT NO. HOME ADDRESS ` TELEPHONE NO. 5(, — 157 FULL NAMES AND ADDRESSES OF ABUTTING OWNERS, including those of adjacent property owners across any public street or way. (Attach additional sheet if necessary.) AGENT OR CONTRACTOR --V)CaQ A(Q, TELEPHONE NO. ADDRESS h t3?S DESCRIPTION OF PROPOSED WORK: Give particulars of work to be done, including materials to be used. Please . include locations of proposed signs. Signed Owner-Contr ctor gent For Committee Use Only 71 This Certificate is hereby Date ro Denied —� �j ittee Members' Signatures: AUG .0 2.2007 1 J i i �:. Town of Barnstable �1=::_' Old.King's Highway Historic District Committee SPEC SHEET FOUNDATION �: Cst �U© - t�i�► �Lb U O e (:31'1 SIDING TYPE ►)C1 COLOR OCZ3 CHIMNEY TYPE PJ'A COLOR AJ / r ROOF MATERIAL LOR PITCH t I WINDOWS ( 1 1 COLOR W\n A(SIZE )( a TRIM COLOR DOORS � \F j COLORS SHUTTERS l" COLORS GUTTERS !� I x COLORS Aj DECKS MATERIALS �P i GARAGE DOORS &I pt COLORS_ SKYLIGHTS SIZE_ COLORS_ SIGNS COLORS raa UU� <�J\// ill ^•`1 COL FENCE NOTES: Fill out completely, including measurements and ma t��.�ra�l�;Sl�c�i:oz9 be u� /� Four conies of this form are required for submittal of an application, along with•PdU ,copies,of the plot plan, landscape plan and elevation plans, when applicable. SPECSHT Revised 11/98 ACORDM- CERTIFICATE OF LIABILITY INSURANCE 10/15/200' PRODUCER (508)997-6061 FAX (508)990-2731 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Southeastern Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 439 State Rd. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 79398 N. Dartmouth, MA 02747 INSURERS AFFORDING COVERAGE NAIC# INSURED Gallagher Shields Building Co Inc. INSURERA: Central Insurance Companies 20230 1684 Falmouth Road #135 INSURERB: Merchants Insurance Group Centerville, MA 02632 INSURERC: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOWHAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICYPERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANYCONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY CLP7997489 07/08/2007 07/08/2008 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 300,000 CLAIMS MADE F OCCUR MED EXP(Any one person) $ 5,000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PROECT LOC J AUTOMOBILE LIABILITY 7AM0277013965 01/05/2007 01/05/2008 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY $ B X SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $E OTHER THAN AUTO ONLY: AGG $ EXCESSIUMBRELLALIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC799749010 07/08/2007 07/08/2008 X WC STATU- oTH- EMPLOYERS'LIABILITY TORY LIMITS A ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYE $ 100,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER -7 DESCRIPTION OF OPEMONS/LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS any and all operations performed during policy period CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Town of Barnstable BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 200 Main Street OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE Scott Lowe ACORD 25(2001108) FAX: (508)790-6230 ©ACORD CORPORATION 1988 r f Pad i►+E too Town-of Barnstable Regulatory Services BAxrWreSt.E, Thomas F.Geller,Director 163� `� Bi ldinb Division Tom Perry,Building Commissioner 200 Main Street, Hya=*s,MA 02601 Office: 509-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT• HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction, alterations,renovation,repair,modernization,conversion, -improvement,removal, demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements. (� Type of Work: ' u � Estiro4ted Cost Address of Worlc:- . Z_V Owner's Name: Date of Application• I hereby certify that: Registration is not required for the following reason(s): MWork excluded by law []Job Under$1,000 OBuilding 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 here y apr y for a p t as the agent of the owner: Date Contractor Name Registration o. OR Date Owner's Name The Commonwealth of Massachusetts Department ofludustrialAccidents Office of Investigations a d 600 Washington Street Boston,MA 02111 www.m ass.gov/dia Workers" Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Q Please Print Legibly Name (Business/Organization/Individual):S, all c o,f� ��\D.A An I�C L\ ) jrn(- , -Address: U09 L cnot+� RO&A 13's City/State/Zip: O_ (�jW\)' \k Q_ H c. t�a�g�Z Phone A 56 yea- 14 OI 5 Are you an employer? Check the appropriate box: Type of project(required):, IN I am a employer with 4. I am a general contractor and I �, have hired the su'b-contractors 6. New construction . . employees (full and/or part;time). . 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 workingfor me in an capacity. `employees and have workers' Y P tY• $. 9. ❑Building addition [No workers' comp. insurance comp. insurance. 10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ P 3.❑ I am a homeowner doing all officers have exercised their work 11, 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' . .13.0 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. $C6ntractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether ornot those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site Information. Insurance CompanyName:6 pwe (1 Q1 (Q(1C_o . (F,l art,\ mot— . Policy#or Self-ins.Lic.#: �C ��7y lea 1 Expizatitioonn Date: 7— O Job Site Address: 22 ` -)! QD� City/State/Zip:M, 6pjns" 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$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereb ertify.rn he ain -an enalties of perjury that the information provided above is true and correct: Sienature; Date: Phone #: Official use only. Do not write in this area,Yb be completed by city or town.offcial City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: ='�D1e OT3d�(eaattane� pmcriptin psdaget for aae aa8?no-FAmc'iy Realdeatial Baitdinp Hestsd with'Fasa peels 114AXfI1dI7M , mEgmum alaziag Glaaag Ceiling Wail floor Baxmess3 Stab I •$eatiaglCooling Ancar('/aJ U•Ynlnes R-Valuer A-YaluC' K•Ysju� Walt 1'�t�n F'JWFm enl Effidea _ P rye R-v31ue� R-velue? 570I U d300 Flesiiag Degm Dmys� 1 38 13 19 10 6 N°rmel IZ�a 0s2 30 19 -. 19 10. 6 Alorrrsel 96 I3 19 10 • 6 13-AFUE I5/r 036 38 13 2.3 NIA NIA. NQ� T e .Normal - LJ 15% 0.46 38 19 19 10 6' y 15% 0.44 31 13 23 NIA NIA AFUE �y 13% am 30 19 19 10 6 �AP al X 18'/r 032. 31 • 13 2 NIA NIA Nomm Y ;8%, IL47 38 19 23 WA NIA, N°rrrtal 18'!a 0.4� 33. 13 19 i 6 9AFE 30 19 19 10 8 9UAlUE i, ADDRESS OF PROPERTY: 2 gQJARE FOOTAGE OF ALL EXTE- MOR' S; 3, SQUARE FOOTAGE OF ALL GLAZING: 4, % GLAZING AREA 03 DIVIDED BY'42): 5. SELECT PACKAGE(Q--AA-sea chart above 0 OTHER MORE INVOLVED METHODS OF DETERMINING MiERGY g,EQUIREIv 9kTS ARE AVAILABLE, AM.US FOR THIS INFORMATION, , e a ,DING I2 SPECTOR APPROYAL! , YES,. NO; q-Evros•©c0303a • I Town of Barnstable. Regulatory Services BARICASM Thomas F.Geller,Director �bATE ��1` Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.b arnstable.ma.us office: 5 08-862-403 8 Fax: 5 08-790-62 3 0 Property Owner Must Complete and Sign.This Section If Using A Builder as Owner of the subject property hereby authorize \;\ AQ �_ to act on my behalf, in all matters relative to work authorized by this bi ilding permit application for, . 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House number Definitive Plan Approved by Planning Board 19 T, APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1`00-2:00 P.M.only TOWN , O{F BARNSTABLE L BUILDING INSPECTOR APPLICATION FOR PERMIT TO r 9 I TYPE OF c .{CONSTRUCTION �G(J �. t �I l 1 19 � i TO THE INSPECTOR OF BUILDINGS: The undersign hereby applies for a per it accordin to the following infor"on: / Location L kY Proposed Use ' Zoning District A< Fire District Name of Owner i dress- Name of Builder W+�� /G �!'��il� Address Name of Architect Address Number of Rooms Foundation Exterior Roofing Floors Interior Heating Plumbing /� Fireplace Approximate Cost Q d� Q(/ Area v Diagram of Lot and Building with Dimensions Fee ©' I I OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above c rstru�' n. Nam,r-2, Construction Si ipervisor's License HARRIS, CHARLES & JOANNE y No Permit For INSTALL SWIMMING POOL Accessory to Dwelling Location 241 Maple Street W. Barnstable Owner Charles & Joanne Harris Type of Co°rYstruction Frame Plot Lot Permit Granted March 24 , 19 94 Date of Inspection: Frame 19' Insulation 19 f=ireplacea 19 Date Completed "r 19 1 i i AV - - • e� FENpIE SOor ME ON Is � ;j►i�i�i�i�i�Oi�i�i�i�i�i�i�i�i�0i�i�i�i�i�i� ii�i+i�i�i�i • • • • - • - • ►�� i��♦ ►��i�i�i1i-i- 6;Wl+i�i i�i�+�i�i�is • - � I►��O��O��O��O��O��OiO�i�i�iO�i+i �''+�O��i�i�� - I I►�i�i��i�i�i�i�i�i�i�i�i�i�i�i�i�i�i+i�i�i�i i+��i�i�i�i�i � t , •111 = y 1 TOWN OEM BARNSTABLE LOCATION Ll I rm►rt E �c SEWACt VILLAGE Cv;/�� 5 ASSESSOR`S MAP 6 LOfi G� INSTALLER'S NAME & PHONE NO. E 9-gl 14w� SEPTIC TANK CAPACITY :;i?x" LEACHING pAC1LITY:(type) � i� �� STvlt�•�si�) L�` LC�� NO. OEM BEDROOMS PRIVA'�E WELL--OR �......� BUILDER OR OWNER- DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: / VARIANCE GRANTED: des NO { J' V� I w . s -�- sz I cc) _4 9 •h o� ,. b o QJ �o L - .Aso•9� q s-z es= - n PIP*. - ` j E ` Application to 1993 175 Old Kings'Highway Regional Historic .District Committee in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS Application is hereby made, iri triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts,"1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: . 1. Exterior Building Construction: New Building ❑ Addition ❑ Alteration Indicate type of building: ❑ House Garage '❑ Commercial ❑ Other 2. Exterior Painting: ❑ 3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other (Please read other side for explanation and requirements). p TYPE OR PRINT LEGIBLY i/�? DATE AroJ ADDRESS OF PROPOSED WORK LE 9r, AO�WASSESSORS MAP NO. R 13 2- OWNER t I/T ASSESSORS LOT NO. DD 4 HOME ADDRESS 2y1 MAHE RAZi- sT)4 RZ6 TEL. NO. ,362 — �Z S' 7 FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). SeE E AGENT OR CONTRACTOR ty�o,� A&VI, S+o 3Bq TEL. NO. 36Z— 6sle� ADDRESS z'I�g �T �A P ANS`. B�-C w*P DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be'done (see No. 8,other side), including materials to be used, if specifications do not accompany plans. In the case of signs, give locations of existing signs and proposed locations of new signs. (Attach additional sheet, if necessary). OF o10E7�C1f4E,6 05'44 4 6E . Signed Owner-Contra r-Agent ittee use. ffieftivejH - t The Certifica is hereby p" Date Nk Time TOWN OF BARNSTABLE LD I ' IG'S HIGHWAY Approved IMPORTANT: If Certificate is approve ,approval is subject to the 10 day appeal period Provided in the Act. Disapproved ❑ Assessor's office(1st Floor): f. Assessor's map and lot number 3 rl. SYTEM MU�-�' THE Conservation 74 SEPTIC �+ � INSTALLED 1N COMP �w Board of Health(3rd floor): S S TITLE Sewage Permit number %� Z��_ d�� w �VI�T ►nc Engineering Department(3rd floor): EKVIROmMEN'TAL CID i639. House,number ! �� l SOWN REGULATIO�+ , east Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9.30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO �4,5 TYPE OF CONSTRUCTION 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 2-HI Lt--A P i_F_ -t- W' 94k",4 T_48 6— Proposed Use Zoning District / ` Fire District CY . Name of Owner ' 1144 �P41VAJ Address 27I I frig Iv, AtelusT�"/�g /1W. Name of Builder (/W ' y"`wv Address Name of Architect 8Z& Address Number of Rooms / Foundation ExteriorMa � � ��G�s Roofing Floors. �� / /!�� Interior /� - Heating Plumbing Fireplace��- Approximate Cost G d o Area tQ Diagram of Lot and Building with Dimensions Fee i i OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barn le r ardi tea ve nstruction. ti Name t Construction Supervisor's License HARRIS, CHARLES & JOANNE ADD SHED & REMODEL No_ __Permit For GARAGE TO 1ST FLOOR r Single Family Dwelling � Location 241 Maple Street West B4rnstable Owner ,C.harles & _Joanne , Harris Type of Construction Wood frame Plot Lot Permit Granted October 19 19 93 Date of Inspection / 19 Date Completed //yy 19 PP�r� N� 4e •�E�j '6 i� Application to �OpPN��gtfP y14 5 Old Kings.Highway Regional Historic District Com in the°Town of Barnstable for a JUN 2 1 1993 CERTIFICATE OF APPROPRIATENESS Application is hereby made, in triplicate, for the issuance of a Certificate of Appropriateness uDder SM40roG f;IAQNFM 0, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on r)aw �oRi Nph�a`,b".gP�' s t , accompanying this application for: x t * k CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: ❑ New Building ❑ Addition Alteration Indicate type of building: ❑ House EK Garage ❑ Commercials ❑ Other 2. Exterior Painting: ❑ 3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign 4. Structure: Q Fence Wall ❑ Flagpole ❑ Other (Please read other side for explanation and requirements). TYPE OR PRINT LEGIBLY DATE Qf ADDRESS OF PROPOSED WORK c 41 rnP®1e__�-. ASSESSORS MAP NO. R_ OWN ER �'�C1 0�� cyFZ. 4E^��a 4 sr-�r) 0A Q fir"� ASSESSORS LOT NO. HOME ADDRESS 04 1 rn 1[_tC✓ &k7, L�7:T'��nrz.n A �1� TEL. N0. ',3G-23?'-11—,E5-7 FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). Scl- �a-�r��,e�l • AGENT OR CONTRACTOR C Cr�� nc3t #�� TEL. NO. ADDRESS 262 R--f (r2f��.2-,R.ry-c--Ac 1e_ 1y-P.) DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done (see No. 8, other side), including materials to be used, if specifications do not accompany plans. In the case of signs, give locations of existing signs and proposed locations of new signs. (Attach additional sheet, if necessary). ice► A��rtZ. G-C�.:coJG_ �'c1-�eC� MC��Dbc�tL_�crlitOcx�r� ��a.�� U DD,Qd.�C� ,Pr Signed a Ei . Owner on ctor-Agent a re* Received by H.D.C. Date T C ' icate is he y Time By Approved ({ IMPORTANT: If Certificate is approved,approval is subject to the 10 day appeal period provided in the Act. Disapproved ❑ i OLD KING'S HIGHWAY HISTORIC DISTRICT Spec Sheet Foundation Type' IV � ' Siding Type Chimney Type erxJ s 11v1a i,q� ,- Color ,u Roof Material C.s Color Pitch '' p �` Windows WOOD ._ W ff l TE Size Trim Color J�� TA�1�1 / �/ s i� r Doors "' i•'e ;+ !/�l'/ Co �i,. 'l. d C� i Shutters •i.�� d+1 Gutters Deck /� / it »• �� l' Carage Doors y 1� � ' �j Color Notes: Fill out completely, including measurements and materials/colors to Three copies of this form are cequired for sgmittzl of an applicat along with three copies each of the plot plan. landscape plan .ind plans . when applicable. 'Plot plan need not be "Certified" , but should show all struc:uros - i to scale . 4 STuc .o �.. WcA,.l.l. 3 l000�e%—z III I , I ! I -- � r I I •� I ��I a �I i I• i ! ;i 1 ';j } i .it{ ; ; BI i • i �! t I , i i � r I'Iit /.'C�arnn�arnunea/,l/o�,./l ac/r�welGs HOME ?MPROVEMEN COtiinP,CiO; R, ti atl0il1:0'J62 iMD?V?DUAL Extniration 10/20/94 CHORGE "jING GEORGE ,,. 11417NG 2976 R.T. A oDMwisTRoroR BARNS i ABLE MA 02630 j ,4 J I' � I Assessor's map-and--Iornumber........................... THE . ......... .... Sewage Permit'number ;..-... re / S BABa9TADLE House?number ..........................:.. .:l.? ....................:.... 9 rasa 039. • �'0 YPY a\B. TOWN OF BARNSTABLE rl BUILDING INSPECTOR* c-r APPLICATION FOR PERMIT TO ... ............. ......... ........................................................................... TYPE OF CONSTRUCTION ............................................ hG 'Y................................................................. .. .. .1 a -� ... . .>qr. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby ff applies for anperrmit according to the following infW ormaation. Location ............. . a..d./�.�6. ....� ....................................^ ...... ........................ I / ProposedUse ..............Xz r4.�.f.........../,,qXX7...................................................................................................................... !'I Zoning District ................1F.... ...........-............................Fire District ...........W..! .. ............... ��o .n. 1�..'.. . ...�.e�. .....eA_ �... o� ��....../ P '....ti ....��rsT...I��r��£ Name of Owner ........ .. �. �! .�.... Address ......... l Name of Builder .. r.G.(..n.......L.r.C.C...f.....................Address .Q�.....:.1..on...c(4m....../........... d�� Nameof Architect ..................................................................Address .................................................................................... 4 Foundation �L-�—T '--' Numberof Rooms ............................................................. .........mil?)..................... .............................. �- /£ £N Exterior ...4..'...t..............�.......P.�..............:............................Roofing ......,A...C�.�.!��°1.. ....................................................... iFloors ......................................................................................Interior .................................................................................... f � j Heating ..................................................................................Plumbing ...................................................:.............................. ♦ oo Fireplace ..................................................................................Approximate. Cost ............oO.a.().0............................... Definitive Plan Approved by Planning Board ----- - 19 - -. Area ...................... Diagram of Lot and Building with Dimensions Fee �/ .'. SUBJECT TO APPROVAL OF BOARD OF HEALTH y Xc� I C OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ............ .....-�: �................................ ConStructibb Supervisor's License .-! .. ....... ,,........ BLOOM, CAROLINE & BARRY A=132-4 25779 ADD TO BARN No ................. Permit for .................................... Accessory...�2...Dwelling .......................... ............................... Location 21 Street,.............................................. West Barnstable ............................................................................... Owner Caroline & Barry Bloom .................................................................. Type of Construction ..,Frame ....................................... ................................................................................. Plot ............................ Lot ................................ Permit Granted ...NQYP� pr... 16,......19 83 Date of Inspection' ....................................19 Date Completed ......................................19 Assessor's map and lot number 3a THE ..................y............. .. ..°% rot Sewage Permit number Z BAUSTADLE, i House number X ' r PAS& �p s639. 90 �C YFY a` TOWN OFF BARNSTABLE BUILDING :INSPECTOR APPLICATION FOR PERMIT TO � ........................................ TYPEOF CONSTRUCTION ................................:............ .. . ........................................................ .............. ...i..�.......19. ..... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information. Location ...................4JJ f. 5 ....."...................... .:.....a I......... �. tf4, ProposedUse ..17/axs..4..........47xzz. .................:............................................................................I......................... Zoning District ................i1C... .........................................Fire District ...........1JV..t... ................................... Name of Owner .....�C1.0�..Address .. ..J1....... .*. P.�.... ....cr!�',fT...��!Y/p��f Name of Builder .. �.G.l... ...... .....................Address .,1� .....s�P.�t bP.G�......lA......... Nameof Architect ..................................................................Address .................................................................... Number of Rooms .........................................:........................Foundation .......' "U?7.�..— .......-.................... Exterior ...Esiyt.. E.......C. ...........................................Roofing ......., U��/°/. .................................................... Floors ......................................................................................Interior ...........:777777-...................................................... Heating ..................................................................................Plumbing ....................;A-*—***—*--****..... .... ............................ Fireplace ..................................................................................Approximate. Cost ............. 0.o !.Q.Q............................... Definitive Plan Approved by Planning Board ________________________________19________. Area c� ^ .o............................ Diagram of Lot and Building with Dimensions Fee ......... .. .. ..................... SUBJECT TO APPROVAL OF BOARD OF HEALTH �e♦ OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. cName .... ... ...... ........................... Construction Supervisor's License ..,? .. .. . ........ BLOOM, CAROLINE & BARRY i 25779. ADD TO BARN t No ................. Permit for r ABC.�Ss:Q)y...°...Dwelling.................. I. Location ..................... Owner ....C.a]CA.J.�.ri ... ...8?rr�'. Bloom I Type of Construction .........F.xZtme.................... ................................................................................ Plot ............................ Lot ................................ Permit Granted ..,T ??ember 16 19 83 Dgte of Inspection ....................................19 Date Completed ......................`:.. ....19 • J y 1 i - ji- r FIT 1 r r -• I r I I ' r i I I � � I =---- 77 r I -- --___- I _ I T--_ _� ! � Imo_-' i�.j IJ _- J ' ' ' � .... >!� __• . i I r : r ! ' it IA -I 1 I \ i I II11 I ! j i i I I I I I -I�-T I �• - ! _ _ _ � __,ter.- _ _.. -la i�71 I FT� Q j _- Cil t I i I i I I i '• ! I i_I I ' I II_ ! I I ' I I _ _1 I I i ' '+ i I I i I I I• � .... . ...... . ., I 1 • I : I • I I i i I l I { • I I 1 it j ' I • 1 i Li i I : -- I _ I 1- - - -I - -- - - I `• � `fir I I 1 I �- � � � { � _I__ I ! I I I � _ ; I I I I • - - -- - -f- I- I \ I\ I !44 . : I • � I tj I Li I I i ! I 1 L 77-7 i i ! ,J. I : I • i : t : I i i.. ! j. "i . 1 ! . ...... .. .. i I I U} s I ! i : : I : : I i i i I ..i I -L Ile Iij • I �I I I ! : - I ' . : i I • I I ' 1 1 ! T I . I : 1 i r : - _ I j ! f • ! _.I ' , I i 1 i , i , ..I t Assessor's map and lot number+ '!...t:3i,�Z.4-..t............. ' Sewage Permit number � �+� < :....!��! ^, `� r ��YL✓J yF7NEro�y TOWN OF BARNSTABLE Z BAWSTSDLE, i "b q BUILDING INSPECTOR r CFO MPY p' • i r�Jv1 i l_� Q � (N rr K I��:l�5 �"w A(ZACA i_� APPLICATION FOR PERMIT TO .................:........................... ................................................�........ I l TYPEOF CONSTRUCTION .........��... :......-............................................................................................................ ..............................z. ..................19.... . TO THE INSPECTOR OF BUILDINGS: • The undersigned hereby applies for a permit according to the following information: Location .A 10\t::..:C,:,..... E ,, rya n C A ?�..:............................................................................................ ................... Proposed Use Ar^ �`�- Qc)-,4,y\ .............................................................................................................................................................................. Zoning District i .......................................................Fire District .. .« ! Name of Owner .. R ......:.. ...........................Address .....: Rom\ . C�.:...... rn.^�kjz .................... 1 Name of Builder l AC7`111 Address .....\, ! Arz Sk........1 ) tZ f.cz„�.... fa`C..\ .... Nameof Architect .............V5?.-\.7".....................................Address .................................................................................... Number of Rooms .....................................................Foundation .. .:.�� ^`� ............. ...............::................................................... .; n Exlerior ....................................................................................Roofing ............................�.................................................6.... , Floors x.;. .:.^. Cf.�� ..� w.'t�. '� f ..�.�,� �� .....Interior t..Lj `:' .^o C�Qcta�f:. ..pMR�ff�.....�'�,X 2y .............. . . .. Heating �:.�c� U_a .. �„tss�. ........................Plumbing ........�r),�r............................................................ ................................. i Fireplace 11 :.s-. Cost ........�� .p...... ..................... Definitive Plan Approved by(Planning Board ________________________________19_______. Area ...... ......... Diagram of Lot and Building with Dimensions Fee .......... ............... . ..}.:..,...... SUBJECT TO APPROVAL OF BOARD OF HEALTH- LA GCUj Vim I I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ... .. ......... . ............�.....,f .............. .... Bloom, Barry A=132-4. 19947 remodel garage No ................. Permit for .................................... to family room ............................................................................... Maple Street Location ................................................................ West Barnstable ................................................................................ Barry Bloom Owner .................. .................................................. frame Type of Construction ................................. ................................................................................ Plot ............................ Lot ..................... .......... Februar 8 78 Permit Granted .................... ...................19 Date of Inspection ............ .......................19 Date Completed ......... . 19 77 PE IT REFUSED ..... 19.......................... ................................ .............................. .............. P E ................. ............................................................. —V-Vt7., je7 Coley OeP Approved ................................................ 19 ............................................................................... ............................................................................... Assessor's'map and. lot number' '!. �. i 0 SEPTIC SYSTEM MUST BE � �, / INSTALLED IN COMPLIANCE yy Sewage iPermit number .......... . ... WITH ARTICLE II STATE uF THE o' " T�� OWN OF BARto RWLjjANfNWTOWN Z H9H3STdDLE; • ,pY��r RUITLI)MG INSPECTOR O i639- �1 n , 1 1 •� l APPLICATION FORPERMIT TO ? TYPE OF CONSTRUCTION .:. ........................19........ � TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for ,a 1permit according to the following information: Location rn.R..�7.`�...��.1......4�1'�.��2J1�R tab, �........................................................................................... ' ........... . . . .... ..... ..... ProposedUse ......t'A r!!\ ......Q.,3V`! ...............................................�............................. 1 Ci(` .rf ZoningDistrict ............ .........................................................Fire District ..... ...... ........2........................................ � a Name of Owner ... . . ? ... . .... ?M...........................Address ...... ..,..... ��`?��thS�0.��5C.,.:..... Name of Builder .C��:{� i\' .....�� ,.150"�..........Address ......C'r.,��!� S�..... �� ..... CZJ\� A ...... Name of Architect `��'.....................................Address Number of Rooms ..........:I.....................................................Foundation :aJ1.° .................................................. ExteriorU...........................................................;;.......................Roofing ........�.t.�. ��. wA``..i�. �n (aczAl.�. Mia 2 �:n �. �,� � A U1 Floors �.1IC+�S......... .�....`!c�........`^?`��.... .`.{..... �.. ......,....Interior .......... 1a1.�..�..�?....... �Q.........��....`��.. y Heating ..............�� i.�..... ........................Plumbing ......... ......................................................... O� Fireplace) t. It ... a`.M'nE ...�.AV. .�..1�?1f>;-c: .C�� pproximate Cost ... ��.1. ®.ice. ..... Vt- Definitive Plan Approved by anning Board ________________________________19___-___. Areo ' `i' t......fr. �::. ! ...... Diagram of Lot and Building with Dimensions Fee ............ ................. ... ....... SUBJECT TO AIP ROVAL OF BOARD OF HEALTH V` ate_ Va j I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . ........ ........................... J Bloom, Barry 19947 remodel garage No ................. Permit for .................................... to family room r^' ............................................................................... Lo cation ....Maple...Street....... . .. ........... . ...... . .. ...........................West Barnstable................................................... ....... .. .... . ...... . . Owner ........Barry Bloom ............................................ Type of Construction ..............f rame ... .... .................. Plot ............................ Lot ................................ 7 78 Permit Granted ...... .........19 Date of Inspection ....... ........19 Date Completed ... z....... . ..........19 NIN PERMIT REFUSED ..... . .................................... . .. ................ ..... .19 ............. ............................................ .................... ................................................................................ ..................................................................... .........................................................;..................... Appr()Ved ....... .............................'�..... 19 ............................................................................... • ............................................................................... jr +� Assessor's office(1st Floor):. r - Assessor's map and lot number �rF•*� ,n S" T"[ Conservation(4th Floor): v ---' °STALLED im COMPLIANCE ��°�•'� Board of Health(3rd floor): v° ' a r• -WITH TITLE 5 Sewage Permit number t ssatSr�ni VIRONMENTAL CODE AND moo `6 0. d° � E.gineering Department(3rd floor): t •House number JT®�I11'REOUI-ATIONS Definitive Plan Approved by Planning Board 19 (" APPLICATIONS PROCESSED 8:30-9:30 A.M.an 1:00-2: .M.only TOWN ± OF BARNSTABLE ,BUILDING . INSPECTOR APPLICATION FOR PERMIT TO uf, TYPE OF CONSTRUCTION _ /mo r'C �,S _ o,,w a r 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a ora permit according tothe following information: Location Proposed Usei�I��G' Zoning District ' t Fire District 4/ Name of Owner Wfi� ZroAm" � Address Name of Builder �Cl2 v VIA, Address �1%� /`�' �STL9-� Name of Architect ,d/ Address Number of Rooms Foundation Exterior /�'>« /`�' Roofing Floors JDNM96-A '�G/ � Interior FA-2 Heating �✓ dN� Plumbing Fireplace �/�N Approximate Cost Area ` 17 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 of Barnst le regardin t v onstruction. Name Construction Si ipervisor's License o 7 T t 1 11 HARRIS, CHARLES & JOANN No Permit For BUILD GARAGE Accessory to Dwelling • Location 241 Maple Street West Barnstable r ' 1 Owner- Charles & Joann Harris 'f Type of Construction Frame Plot Lot December 28 93 - - Permif Granted �' - � 19 - i Date of Inspection: Frame,-.. ShALI 19 y{ Insulation, 1 g CC ^ Firepla ef=, 19 Date'Compieted d 19 rn i . . ! I I w j� o. 1 I 4 O Its- ! CU X. y i I . ' v N I I I i I 1 r. r F,�'t r��' .��' r _ — �� .�>� p�x � f.-', ^`"��, a,°�:` P:iJs' i,��, N.4A t I j 0CP9Z0 VH �ByISNJya j Y aoldtusnmwav i�• 9fr_'r,'a • 46/01/01 ;:r Tdx„ �VP,0 I01ti' a'.tr U "ov4G4lq9 I l J: 7 COMMONWEALTH OF MASSACHUSETXS D ErhJ;C T�rT O F 1 ND US-rP-LA1 ACCI D F_NTTS ' 600 w/LSHI1�'GTOT� STO= cf games Ga-s�ae� liOSTON, M SSACHUSETTS 02111 j �c-m:ss�one -,cvORKGRS'COMPENSATION INSURANCE AFFIDAVIT L � rob (licensee/perrttictcc) with a principal place of business/residence 2v g4w* 5 T 4 ri4,0- 4V)0r ,. O ) (City/Sta(c/Zip) do hereby certify, under the pains and penalties of perjury, that: j ) 1 am an employer providing ncc following workers' compensation coverage for my employees working on this Job. Insurance Company Policy Nsmbcr lama sole proprictor and havc no onc working for mc. (] lama sole proprictor,gcncrzl eonmaor or homeowner(eirdc one) and havc hired the eontr2aors listed below who havc the following worker compensation insurance politics: Nmme of Contractor Insuiwice Company/Policy Numbcr Nzmc of Contractor Insurance Company/Policy Dumber K-2mc of Contmaor Insumncc Company/Policy Numbu Q 1 am a homeowner performing all the work myself NO*T F- Plcasc be awzrc that wbilc hoocowncrs who craploy perwas to do raaiatcaaacc.coastruaioa or rcpair—ortic on a ,e—cllins of not wore tba.n three uaits is wbid the horacowacr also resides or oa the Erouads apputuaaat thereto arc act Eeaerall)• considered to be employers tm&r the Gorl;cri Cempcosatioa Act(cl—C.152.sect. 1(5)),appli itioo by a boracowacr for a liccosc or permit rrzy evidcaec the JqJ surus o(t=cr_ploycr uoder the Corkers'Corap>easatioa Act. i unccrstant: tnzt a copy of ties stztcmcns wiu be lorMvdcd to ti•,c TDcpz.7.=cnt of lndustriJ Acodcnu'Of,cc of Instance for.covcratc ---crifseztion end that failure to sccurc cor+crac is rcyuircd undcr S<ction 25A of MGL 152 tin ksd to the imposition of-ctiminal pcnzJucs consisting of a fine of up to 51500.00 zndor imprisonmcnt of up to onc year and evil pcnaltxs in the form of z Stop Work Ordcr and a fine of S100.00 a day against mc. Signc 's e2y of 16 4 , 19 Liccnscc/Pcr cc Licensor/Pcrmittor Form "A-1" OLD' KING'S HIGHWAY REGIONAL HISTORIC DISTRICT BARNSTABLE HISTORIC. DISTRICT COMMIT _ .. 367 MAIN S.LREET, HYANNIS, MA 02601 Spec S1-ieet Foundation Type Z�r y4 C,�/ Siding Type /l ��/�j' w/✓ � -� !J'�T� Chimney Type � Color Roof Material .4kr/f �• �i" v`� Color - Pitch 112, Windows (ii/�pD (/y tZ`/ Size t Trim Color Doors �V/ ��` �i�-�� /J'�G� Color Shutters Gutters A Deck Garage Doors �/� /�/�'�" L/J�S7 Color Notes: Fill out completely, including measurements and materials/colors to be used. Two ccpies of this forte are required for submittal of an application, along with two copies each of the certified plot plan, landscape plan and elevation plan, when applicable. a s m N N C)Oki o ti fR opens E D , I' r� • r m ►v 593. ail ; o. Locus M. �P w map ledl ee street Str { 0 Ns+n G c�J PARCEL 4 LOCUS MAP �o�• - 2.92 ACRES •. FOB SCALE 1"=2000'f /'• ASSESSORS MAP 132 PARCEL 4 N O LOCUS IS WITHIN FEMA FLOOD ZONE C OWNER OF RECORD JOANNE HARRIS ASS 241 MAPLE STREETMA 02668 WEST BARNSTABLE, NOTES: \ ,�?29 1. DWELLING, GARAGE AND POOL AS PER TOWN GIS MAP 2. BARN LOCATED AS PER SURVEY D. 7/31/07 EXIST. GARAGE JCS EXIST. \, BARN r, PROP. - 46 DD'N. T ti \ 50 EXIST. DWELL POOL ,9 Q PLOT PLAN � \ SHOWING PROPOSED BARN ADDITION \ \ AT \ \ 241 MAPLE STREET off 508-362-4541 \ \ �� WEST BARNSTABLE fox 508-362-9880 PREPARED FOR down cape engineering, Inc. ARNE � JOANNE HARRIS H. CIVIL ENGINEERS \ \ " OJAIA y !� . �ONo.26348 J U LY 31, 2007 LAND SURVEYORS607\ \ j 939 main st. yarmouthport, ma 026 \ \ 1ADATE ARNE LA, P.L.S. 0 15 30 45 60 75 FEET