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HomeMy WebLinkAbout0104 MOCO ROAD UPC 12543 No.53LOR MAC�INOQ YN ��..��„ -._ �..._.�.. _.,mow_--•- .., .:., ..,... � _ _. _ _ .r-. _ . �Sai�ira�'"i.r��1i14vWiLC:Wi•�•. R•:- _ �/(IL�:•- .....M�t:�i-.�. •s.� ..... -._._�-< y. .... a .. .. .� T I Town of Barnstable *Permit# r3 Fxpires 6 months from issue date of Regulatory Services Fee • �M n n�. P��� `�' Richard V.Scali,Directo 1 A ims' �p Building Division Tom Perry,CBO,Building Commis 1 31 2016 200 Main Street,Hyannis;.MA 0260P 1 www.town.barnstab�e � pO''`` nn�� } Office: 508-862-4038 N OF BANS 1 RA a�c-. 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number �/ Property Address f 1©�i axp u) Residential Value of Work$_ JESZ:aD% Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Mhogaa: Contractor's Namey)a � 2VD1� Telephone Numbe Q-jRsqg Home Improvement Contractor License#(if applicable) 22Zu Email m'51 )OL—) P 1 1C.Al ,COI.., Construction Supervisor's License#(if applicable) U(0`I ❑Workman's Compensation Insurance Check one: I am a sole proprietor I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name J�l� Workman's Comp.Policy#' Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over. existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders.U-Value _Q_ _(maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. rk.,�,_� SIGNATURE: C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\2PIOlDHR\E)PRESS.doc Revised 040215 The Commonwealth of ALassachtisetts Department of Ltdttstrial Accidents Office of Investigatims vi 600 Washbigion Street Boston,ALA 02111 frwinmass.gmldin Workers' Compensation Insw-ance Affidavit: Builders/Conh•actors/Electricians/Plumbers Applicant Information Please Print Legibly None(Business!organization/Individml): S 0 , LlAddress. g . —T City/State/Zip Phone#: Una Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer Kith 4. ❑ I am a general contractor and I employees(full and/or pact-time). s have hired the sub-contractors 6. ❑New construction 2.)kI am a sole proprietor or partner- listed on the attached sheet. 7.�KRemodeliug ship and have no employees These sub-contractors have S. ❑Demolition tar for me m an capacity. employees and have workers' working y � n'•� 9. ❑Building addition [No workers'comp.insurance comp.insurance..-' required] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.[-1 I am a homeoumer doing all work officers have exercised their I LE]Plumbing repairs or additions myself o workers'c right of exemption per MGL insurance required.] 13.❑o Ottheher d 1 c.152,§1(4),and we have no 12.❑ repairs employees.[No workers' comp.insurance required.] •Any apphcam that checks box#1 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this offldn it indicating they are doing all walk and then hire outside contractors t>mst submit a new affidavit indicating such :Contractors tbat check this box most attached an additional sheet shown;the name of the sab-contmctors and state whether or not those entities here employees. If the sub-coatmttos bare employees,they must provide rhea workers'comp.policy number_ I ant an employer that is protdding workers'compensation insurance for uty employees. Below is the policy d►►d job site information. Insurance Company Name: Policy#or Self-ins.Lic.M Expiration Date: Job Site Addres 11 [)QD CA,:J V]99[Zej��� City/State/Zip: � Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 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 here ' ertify under the pains and penalties ofpednry that the information prmdded above is true and correct Si ture.: Date: 7 Phone#: Official use only. Do not write in this area,to be completed by ch),or town official vial 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#: r MASS, Town f Barnstable Regulatory Services % Richard V.Scali,Director Building Division Thomas Perry,CBO 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, (—V'96YL--,as Owner of the rize1�I ) p property erty ��,, l hereby authoe*� 'gun '.! to act on my behalf, in all matters relative to work authorized by this building permit application for: 1 rYbro L&2 (Address of Job) Sig ature of Owner Date Print Name If Property Owner is applying for permit,please complete the homeowners License Exemption Form on the reverse side. C:\Users\Decollik\AppData\Local\iMicrosoft\Windows\Temporary Intemet Files\Content.0utlobk\2PIOI DHR\EXPRESS.doc Revised 040215 ' �e�ammaxeaeall�i.a�C>/�aaaac�icc�eCta � � . Office of Consumer Affairs&Business Regulation F HOME IMPROVEMENT CONTRACTOR Registration: .:;='--472220 Type: Expiration. .5.4. 5412Q-].8 Individual ROBERT M.SNOVF/t::i:=':, •._;L:.;.:; k ROBERT.SNOW 29 HEATHER LN. YARMOUTH,MA 02675 Undersecretary I Massachusetts Department of Public Safety�f Board of Building Regulations and Standards License: CS-106188 Construction Supervisor ROBERT SNOW 29 HEATHER LANE `"w"•� • YARMOUTH PORT MBA ' K CA­_ Expiration:— - -- _. Commiss;oner .. ...._... ..�_.:....._. License or registration valid for individual use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 i .II Not valid w out signature i I ------ Construction, i Supervisor Restricted to: s of any use group which contain Unrestricted-Building of enclosed less than 36,000 cubic feet(991 cubic meters) space. / possess a csurrent dii�1Oevocation of thi of the Massachusetts license. Failure top Code State Building it:YVN1W•MASS.GOVIDPS r DPS Licensing information vis r CAPE COD INSULATION K Fq N 110110M11 IIAMSIII MAY IOAII iYi11H010 IA111 OVTT111 IN I YIITIOX CIIlI.0' 1-800-696-6611 Town of Barnstable Regulatory Services Building Division 200 Main St Hyannis, MA 02601 Date: Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute '(BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Prope�wner Property Address Village 1'��.re 2 She�r v'�odcL 1 O L1 C'1Oco Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted nE Ceilings (u ) ( © 01 � ra Slopes � ) Floors ( ) ) ) ( ) w Walls 6UOr r�10r, e,'01 Sincerely H ry E ssi r, President pe C Ins ation, Inc. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map- J Parcel Applicatio .'O U Health Division Date Issued I Conservation Division Application Fee Planning Dept. Permit Fee Jb Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Village vv l Owner Address Telephone % bit - .Permit Request - v Air wliu ., 4'qe Q U ib Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation %/1���' Construction Type_A Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family( 9 Age of Existing Structure Historic House: ❑Yes ❑ No On ' 0 ay: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout 0 Other EC � ® Basement Finished Area (sq.ft.) Basement Utikaia sq ) NumbeY of Baths: Full: existing new Half: existing ST 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 R No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) ✓✓�� Name ( Telephone Number Address License # (U D UI� Home Improvement Contractor# r �� Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROY THIS PROJE T WIL BE TAKEN TO ell SIGNATURE DATE ) 2 I f . I ' FOR OFFICIAL USE ONLY APPLICATION# = DATE:ISSUED MAP./PARCEL NO. ADDRESS VILLAGE i' OWNER �+ t DATE OF INSPECTION: FOUNDATION FRAME INSULATION t , FIREPLACE r_ ELECTRICAL: HOUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE�CLOSED,IOUT ASSOCIATION PLAN NO. J K r Massachusetts"Department of Public Safety Board of Building Regulations and Standards License: CS-100988 Construction Supervisor. HENRY E CASSIDY Lt`% 8 SHED ROW = li!`s �•r'? WEST YARNIOUTH fj�` Expiration: Commissioner 11/11/2017 Commissioner 11/11/2015 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement C6-hht.ractor Registration ' Registration: 153567 Type: Private Corporatlon Expiration: 12/15/2016 Tr-4 259188 CAPE COD INSU'LAT,ION, INC HENRY CASSIDY -- 18 REARDON CIRCLE 80, YARMOUTH, MA 02664 Update Address and return card, Mark reason for change. KAI ';; zoM•05n1 (] Address Renewal Employment LostC'a; ...... .. V/iB (pOmY97tO�1uUaC[•GC�0� 4GCWJCFOI[[d6G�J Office of Consumer,Affnlrs& Business Rcgulatlon License or reglstratlon valid fol. Indlvldul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to; eglslratlonl •:133567 Type; office of Consumer Affairs and Business Regulation xplrallon;:.1 '1:4'S/20:16 Private Corporallon 10 Park Plaza -Suite 5170 :;,.... •.,.•:�: N1 Boston,MA 02116 CAPE Coo INSULAT.f.b., HENRY CASSIDY 16 REARDON CIRCLI -'., $0.YARMOUTH,MA 026.64 Undersecretnr Y N. valid wl ut sign e I Ilse U0111monwea.lth of Massachusetts Department of Industrial Accidents :..'j Office of Investigations 600 Washington Street '.,. " -- jl ;`' `., Boston, MA 02111 www,mass,gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors[Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/Organization/tndividual): (f�/�t � Yt jr, Address, City/State/Zip; ,V/L "f�al� I��/L` t 11y� Phone #: 158 Are you an employer? Check th• appropriate box; l, ,I am a employer with^ 4. ❑ 1 am a general contractor and I Type of project (required): employees(full and/or part-time).* have hired the sub-contractors 6. ❑ New construction p ) rs ,Y 2,❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7, ❑ Remode.ling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp, insurance comp, insuranceJ 9, ❑ Building addition required.) 5, ❑ We are a corporation and its 10.0 Electrical repairs or additions 3,❑ 1 am a homeowner doing all work officers have exercised their I I,❑ Plumbing repairs or additions myself, [No workers' comp. right of exemption per MGL insurance required,) t C. 152, §1(4), and we have no 12,E] Roof repairs employees, [No workers' 13.� Other f ' comp, insurance required.) *Any applicant that checks box#1 must also rill 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 attaphed an additional sheet showing the name of the sub•conb-actors and state whether or not''hose employees. If the subcontractors have employees,they must provide their workers'comp, policy number, entities have I am an employer that is providing worker's' compensation insurance for my employees, Below is the policy and job site •.�nfo.rmation, Insurance Company _4�Name: , , �1 C/1/�, j' Q� � � V o � Policy # or Self-ins, Lic, #; t �i 06 Expiration Date;&, 14 JobSiteAddress: City/State/Zip; I'l( 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 vi prisonment, 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 Investi ations of the DIA for insura coverage verification. I do hereby certify d the pal an penalties of perjury that the information provided a ve is true/and correct. ^ Si nature; ` Date; Z Phone#: Official use only, Do not write in this area, to be completed by city or town offr.cial. 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; i �1 CAPECOD-27 BDELAWRENCE ACORO" CERTIFICATE OF LIABILITY INSURANCE DATE 1 6/30/230/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: Rogers&Gray Insurance Agency,Inc. PHONE ac No; (877)816-2156 434 Rte 134 E-MAIL South Dennis,MA 02660 ADDRESS: INSURERS AFFORDING COVERAGE NAIC fI INSURER A:Peerless Insurance Company-see LIBERTY MUTUAL INSURED INSURER B:ATLANTIC CHARTER INSURANCE GROUP . Cape Cod Insulation,Inc, INSURER C: 18 Reardon Circle INSURERD: South Yarmouth,MA 02664 INSURER E: INSURER F: 7o 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. ILTR TYPE OF INSURANCE POLICY NUMBER MMIODY� MM/DDT P LIMITS' A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE a OCCUR CBP8263063 04101I2015 0410112016 IJAMAG'ToPREMISES Ea occurrence $ 100,000 MED EXP(Any one arson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES P.ER: GENERAL AGGREGATE $ 2,000,000 X POLICY PEC LOC PRODUCTS•COMP/OP AGO $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ee ac'Idenl $ ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERT DAMAGE $ HIREDAUTOS AUTOS $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE S DED I I RETENTION$ g WORKERS COMPENSATION PER OTH• AND EMPLOYERS'LIABILITY STATUTE ER B ANY PROPRIETORIPARTNERIEXECUTIVE YIN NIA WCE00431901 06/3012016 06/30/2016 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED9 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If es,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Addltlonal Remarks Schedule,may be attached If more apace Is required) Workers Compensation Includes Officers or Proprietors. Additional Insured status Is provided under the General Liability and Auto 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, 18 Reardon Circle South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE . ©1988.2014 ACORD CORPORATION, All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Town of Barnstable Regulatory Services eswss Richard V.Scab,Director � Building Division Tom Perry,BuMn Curamissioner 200 Main Street.Hyannis,-Ak 02601 wtiRv.town-barnstable.mams Office: 508-862-4038 'Fax: 50S-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder i, Maureen O shea _ ,as Omer of the subject propeny hereby authorize ra act:on my behalf, in a1I matters relative to work authorized by this b+l-dim permk application for. 104 Moco Road West Barnstable Ma 02668 (Address of,lob) "Pool fences and alarms are the responsibilky of the applicant. Pools are not to be filled or utilised before fence is installed and all final inspections are performed and accepted. S' ttuz of-Owner Signature of Applicant avr-Q?1 D' S ko-C Print Flame PrinC Na= /2- f Date I. DEC 3 Q:FORb1S:0y'vh`FA,?E-WISSIONPOO S F 4; 2013 Town of Bar»stable *Permit ago 6 �hWAe D Regulatory Services 6 anaa Thomas F.Geller,Director ift ilding Division Tom Perry,CBo, Banding Commissioner 200 Maas Sheet,Hyannis,MA 02601 Www.tmmbarnstable.ma.ns office; 508-862-4038 Fax: 509-790-6230 CA Y �[� Not YaBd w�dYwit Bai X-l'nss L�prlM Map/parcal Number� v1 ft9wt Addtesa /is2,� �r17 �1/ �c.SZr y, eRwidential Value of Work (d D) Minimum fee of 535.00 for worm under SM-00 owmes Name&Address '�•n o>e-ic7i S/VIS3a Con"atot's Name ��'//�� Telephone Number Some improvement Coatmotor License#(if applicable) f�-2 ,.,�,n REM CousUwbn Suporv49or'sLiQease#(if spplicable) 11,253�'' ❑wQ�'B�casationlnaureace APR 3 0 2014 r Check one: [� I ant a sole proprietor I am to Homeowner won��� TOWN OF i3ARNSTA3LE (rI We'Worlcee s Comp �autaace Company+Name.,.,.`,(/���i���,�T,�l•� wMiaman's Comp.Policy# �21° --- Copy of bsursuce Compliance CerdgWate mast accompany each permit Pttmft Requo(dick Rrfoof(burrimrr+e nailed)(strippingold All construction debris will be taken tom 72WW Z/ZW ) -- ❑Ra roof(hnrrime sailed)(not stripping. Going over wdsdng layers of root) Pe-aide #of doors ❑ Repyacement Wyi adows/d00%Ws.iidem U Value (maximum 35)#of windows ❑ SwWCut=Monoxide detectors 4 floor plans marked with red S and inspections required. Seprate Eleetrltal dt Fire Permits required. d oo area oshm Down epattr8ant maulaf3ens +. .a Fiutorio,ConeetvtoO4°M •wee tagtdt+ed: beasaee Of ft does cot�t oo00= ***Note. Property!Owner moat sign Properly owner Letter of Permission. A of the Home Improvement Contractors Lleeaee&Construction Supervisors License is . ra SIGNATUR& lo I - • Ts4e Cot;t:rionwgalin of hzcssacr:;:�"r�s De arfttte r p nt of Ir._tcstrirrl�4ec�d2,�ts Offcce of Investigations 600 Washington Slreel Boston,Mil 02111 www,,nass,gov/dia Workers' Carapersation Insurance Affiftvit: Builders/Contractors/'Llectriciaa$/PlLabers Ao licant information .Please Priat Le rib1v Name (Business/OrgaaiaatierAndivid(jai); Address: City/State/Zip: phone Are ou an employer? Check the approprizte boz: I•( I am a employer witb _ 4. F7.;P" f project(r equired): ❑ I am a general contractor and I employees(full and/or part-time).c have hired the sub-contractors New construction 2.❑ I am a sole propridtor or partner- Iisted on the attached sheet 1 modeling ship and have no employees These sub-contractors have working for me in any capacity, workers' comp.insurance. 9, Demot ion i [No workers' comp. insurance 5. ❑ We are a corporation and its 9, ❑ Building adlition I� 3•❑ required.] oftiicers have exercised their 10.0 Electrical repairs or additions Il I ant a homeowner doing all work right of exemption per MGL. I I I.[1,Plumbing repairs or additions Myself. [No workers' comp. c, 152, §1(4),'and we have no ] insurance required. t xts 12LVRoof repairs employees.(No wo6 ' comp, insurancerequrrsd.J Lp-o-iic-y—;n-1f-orr-,jaUorL 3• Other •Artr applicant that the �s boz k I most a!so fill out the suction b:loq•showing their workers'compensation t Uomeowners who submit this slfidavit indicating the),am doing all work and tixn hire outside contractors must submit a new ldavit indicating such. -Contrnetcrs that ch:ek this box must attached an additional sh:etshowing the name oPfhe sub�on�ators and theiubmIt:rs'cum . oti P F cy iaPormation am an employer thal Lr providirt wor/tiers'compensation Lrtsurance for trry eriPlov_as•, Below is the pofi;y andtab site ittfortrtt aam Insurance,Company Name: Policy#or Selkns.Lie.#: _ 9 � . a:}:pL*at10n Date:�J ,lob Site Address: City/state/zip: / 2. t�l�Attach s Copy of the vrorkers' cotapensation policy declaration page(showing the policy number and expiration date). Pal*lure to sscure coverage as required under Section 25A ofMGL c, 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORT,'-ORDER and a ED5 of up to$250.00 a day a;ainst the violator. Be advised that a copy of this statement may be forvardcd to the Office of Lnvestigations of the DIA for insurance coverage verificat on 1 tzis"ture eeby certtfy un er the pains and penalties of per)ury,that the ucforNW1on provided above is t,-ue axd correct : Date: Pb one 9: !� OJ)'Fcla!use on[y. Do not write in this area, to be completed by city or town 0 7cial City or.Town.: Permft2,icense 4 ` Issuln Authort g ty(circle one); f 1.5oard of Heslth 2. Building Department 3-. City/Towa Clerk.Other 4.Electrical Ins scor S.Plumbing Inspector contact Person., li Phone T: Ir From:Kethy Geddis F&AD: ,,..Mo% DAVID-2 OP ID:KG CERTIFICATE OF LIABILITY INSURANCE DAM OAMIDONYM Q3111/2014 THIS CERTIFICATE 13 ISSUED A$ A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE MOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, T14I8 CERTIFICA71 OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING iNSURER(Sb AUTHORIZED REPRHSENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: lithe Certlfloete holder Is an ADDITIONAL INSURED,the pOIICy(les)must be endorsed. It SUBROGATION IS WAIVED, subject to the terms and condlUons of the policy,certain policies may require an endorsement. A statement on this certificate dons not confer rights to the awdicsts holder In lieu of such endorsement e. PRDDUCBR NA61E: KMyGedcllc Northwood Ins.�i!nay Inc. Arc s08-771-1 B32 :508.398.29� 540 Nsln 8lreq Ulto 9 — Nysnnis,MA 02 i es: MBURL' 'e AFFORDINO COWRAOE �— NAIC 1 INet MRA:Travelers Insurance Company _ wa1ll� Devi Cox, Inc, INsuarae: P.O.Box401 Irc S Yarmouth,MA 02664 — � INeuasa a: i INsuRSR M: �_•1 COVERAGE'S CERTIFICATE NUMBER: REVISION NUMBER: TM13 IS TO CERTIFY THAT THE POL0E:S OF INSURANCE LISTED BELOW HAVE BEEN OSUED TO THE INSURED NAM ASOVE FOR THC POLICY PER tOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDRION OF ANY CONTRACT OR OTHEP, DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE N DURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _— TYK 06*81.4 AhIm POLICY NW INER MM1D bWOO/YYYY LOOS - ottl�tAiLIABILtTY I! `` EACH 0_'_J-ZzE JC_ I. 1,000,_ A COVM?FCIALGtNCRALUA8I.ITY �680149`IM?96 0311412014I03114/2015 FREh115ES(Eaoc.carnn.2 S 300, 1 CLAMS-MADE 7X OCCUR I 1r'G�>E?DIE ER>wAL A\GnG cRaEe GyeTrsEo n iS S, E.1 trineaa Owners n PERSONAL e:ALA INJLFY `,DOD, 00 2.001OWC F2UDUCrS•GOM�,IF A9v S 2,DOO,000 OR10A-E.INI-APPLI'SR C F7"'PRT 117 LOC l S — E LIMIT AtlrOBILB UASWTY � I �accide MO nt! � I r ANY AU 0 I I I BCDI-Y 111.URY iFa:pw30r.I S Al.l OWNED SCHEDULED I 1 I SOD!-'!iN_UP.Y(Pat <.L'Tfi5 AUTOS — NON•CYlNED ;P_RACCID'!;T) HIRED A11fO5 AUT103 5 i UMMM'AUAM HOCCUr, ESCNO-`JagE'.:= OXCEls LUB CLANS-10 AGOREOATE S D 4- 1 INC1VV s wim C PIR" ON I-5 _ —rj r,I LIT AND ItYPLOYOW LiA11111 Y I N FA ANr paOPRIETQt^�R�lPARTNE3�CJTrvs I WILL FOLLOW FROM CO 07/16/2013 07111111114 E.L.EA r ACCIDENT 100,00 �n�ry I1 N►1) yI NIA WITHIN S DAYS E L.DiSEASc'•E+EH�L +EE i —--_ 100' Wo Ify►►.dticrloe inoa E.L CdSEaSi .FALC--Y WAIT s 300,00 �5 TI 14 OF OPETMATI HS 6010W 1FT VEBCRPTION OF OPWTI"l LOCAT10Ne 1 YLIKCLle (A@echACORO 101,Addldongl Remarks Schedule,Nmore oprce Is reWred) cERTIFIC ATEER CANCELLATION TOWNEIAR eMOULA ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOItg THE LXPIRArAM DATE r4RBOF, NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH TMaPaucvvR0V11100Ns. 230 Maln StrW Hyannis,MA 022601 AUTWIUZ OaGPRIieMNrATIV@ 61888.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010M) The ACORD name and logo are reglaterad marks of ACORD ��ieo�ir��zo�uaeul!/e'o�'C �tiuoc�u�elf� Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: staatiom 100497 Type: Of a of Consumer Affairs and Business Regulation piration: .3l25M16 Private Corporator10 Park Plaza-Suite 5I70 Boston,MA 02116 DAVID COX,INC. David Cox 19 LAVENDER LN W,yARMOUTH,MA 02673 Undersecretary Not valid without signature Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: d 4)6.301 DAVID R COX PO BOX 401 =` t _ South Yarmouth FAA 0 ?. �J..�..► ,� „�t.. ;:xoiranon 1011512015 commissioner �tag � 4ML Town of Barnstable Regulatory Services Thomas F.Geller,Director Building Division Thomas Perry,CBO Building commissioner 200.Main Street,'Hyannis,MA 02601 • www.towmbarnstabie.ma.us Office: 508-962.4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If using A Builder , I� 7/� t� / Sl✓ ; as Owner of the subject'property hereby authorize to act on my behally in all matters relative to work authorized by this buildin permit application for. (Address of job) 1 Signature of,Ouse: to Priat Name If Property Owner Is applying for permit,please.complete the Homeowners License Exemption Form on:the reverse side. TOWN OF BARNSTABLE r '' BAR-W _ J Ordinance or Regulation WARNING NOTICE Name of Offender/Manager �� � z� v9 Address of Offender /6� ;/ MV/MB Reg.# Village/State/Zip Business Name /°/�', am/pm on 20/0 Business Address Signature .of Enforcing Officer Village/State/Zip Location of Offense Enforcing Dept/Division Offense X < i Facts f� 0 � ���� �b ��^� �L= �� ��� � 1� �� This will serve only as a warning. At this time no legal action has been taken. . , It is the goal of _ ,Town agencies to achieve voluntary compliance of Town Ordinances, Rules"and Regulations. Education efforts and warning notices are attempts,; to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. kA yea 4" �` •-•v � IrW �3. ` 3 0 , op� Teo 3, .. {. - � �R✓"� �F tea!# {.� 'ff 'r t .4* �gw y7°^�a A°Yi7A$$� 3 6 ow Lt ., FOR SALE ira_. t _ � c r i � z t �i i d, t I ' 1 � r TOWN OF BARNSTABLE BpR_W 19 Ordinance or Regulation 4 WARNING NOTICE Name of Offender/Manager ��' apj �G, � Address of Offender ,/� .� - � - ��� MV/MB Reg. � Village/State/Zip /�/ �, yyp�; � Business Name � on 20/0 Business Address Signature of Enforcing Officer Village/State/Zip Location of Offense c4o,e,,,6, ���� •�� Enforcing Dept/Division Offense Al y Facts F �✓ � iP �- �1 oi•� c�Lc."PV !��I'�-ram�"4.' This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations . Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. i Town of Barnstable Geographic Information System September 13, 2010 N 4r� 1 T#�4 0 25 Feet DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:215 Parcel:011 N boundary determination or regulatory interpretation. Enlargements beyond a scale of Selected Parcel Owner:BARNSTABLE,TOWN OF(LDG) Total Assessed Value:$402200 . 1 "=200'may not meet established map accuracy standards. The parcel lines on this map w .. —E are only graphic representations of Assessor's tax parcels. They are not true property Co-Owner: Acreage:0.83 acres Abutters boundaries and do not represent accurate relationships to physical features on the map Location:780 OAK STREET /+r such as building locations. Buffer Aerial Photos Taken April 19,2008 Town of Barnstable Geographic Information System September 13,2010 216069, 196022002 �216002002 216068 #5 #190 #49 216002001 —/ 439 #29 218001 #830 Z 196012002 #16 215013 *812 195013 #23 .��. 1_ P5036 215012 #139 #80o 14 195015 195014 #88 195016 215006 215030 #104 #76 #70 #58 215011 2115007 215008 215009 215010 #720 #38 #26 #01 14 r I OCO RD 215014001 195012 1gr0�1, #781 #119 #103 195020 I #89 195019 0 #75 215005 #63 215004 #45 e2l3 r 215031 °.,.."a 195024 #126 }� 216015001 106028043 #766 195028042 #26 #28 215002 #754 44 196025001 215001001 215015002 0 67 Feet #732 4749 DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:215 Parcel:011 N boundary determination or regulatory interpretation Enlargements beyond a scale of Owner:BARNSTABLE,TOWN OF(LDG) Total Assessed Value:$402200 Selected Parcel >$�,., 1"=100'may not meet established map accuracy standards. The parcel lines on this map Wy _ „E are only graphic representations of Assessor's tax parcels, They are not true property Co-Owner: Acreage:0.83 acres Abutters - boundaries and do not represent accurate relationships to physical features on the map t such as building locations. Location:780 OAK STREET Buffer .f a f,+ b � n 1 �hy e�z � .yx i 4 4 n maNO's a * ' a� a - r k'�s t,t ` - �7 s. '• `a'k4^3t.t @°' s c cc� Assessors 'map 'and lot number . ...I. ......... STNE r �, t Sewage Permit.' number .......:.:........'........ .:..5.................:..... 6�Q ? a Z BJ$BSTABLE, i House number 9 MABA 0......................:...........,..... ...... Gp 1639• 90 �OMAY a\ TOWN OF: BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO:. !.�!!,.��.:..�R. QT�;A.. (r yr.>(.DQ.� ..ar-44.!'.'C.� TYPE OF .CONSTRUCTION ..�16Qh �.. ..9. /. .. 0.tAP.l .6K ��a .. ...............19cpSv TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..................(..bg...... .. . .Ado....:.R�............................................................................................................ ProposedUse ............... .. ....... ............................................................................................................................................ .Fire District 'l` Zoning District ........ ,�/...'..... �,r,!" ...................... Name of Owner ...R1/YyAti.... .R-A7..6(0.1[.......................Address ,.wr...�l�....t?...I�L►....G •..(.?1 1"t'1�l�jktl�....... Name of Builder FUS.S.�I�....C� ULQ�.�.O..l'U................Address ..7�......Oy' G..... I� ... Nameof Architect .........................................................:........Address .................................................................................... Numberof Rooms ..................................................................Foundation ...... . ..... .. ..... ......................... Exterior ................ ..............................................Roofing ......................................................................:............. Floors ..........................` ............................................................Interior .................................................................................... Heating ..................................................................................Plumbing ....................... ......................................................... Fireplace ..................................................................................Approximate. Cost ... ........ . Definitive Plan Approved by Planning Board ________________________________19________. Area ..!... .............. Diagram of Lot and Building with Dimensions Fee ... � ................ SUBJECT TO APPROVAL OF BOARD OF HEALTH �a8 oz Y 3a J t 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 ...,,raF%�/ .1.......d�!.. Construction Supervisor's License -...Q.QSkk-3....... GRINSELL, ALMA 28155 Add Deck if- No ................. Permit for .................................... Single Family Dwelling ...................................s........................................... Location ....1.Q4..MQ.r-Q..Xo.ad................................ West Barnstable ............................................................................... Owner .........A!Tn.ql..GIZI.aaell........................... Type of Construction ........Frame,..,, Plot ............................. Lot ................................ 85 5, Permit Granted .... July 9 .............................. Date of Inspection ...................................... Date Completed ............. 19 ........... Assessdr's ma and lot number f `. ..../..p :.. T E Sewage Permit number .........................................::...... ::..:: Z MAUSTLELE, i Housenumber ............................:.............................................. y MAM �p t639. `00 — p Mix Or• TOWN OF BARNSTABLE BUILDING INSPECTOR ; L r APPLICATION FOR PERMIT TOv�.� ..... G'll{�[I„/lilw�l!„/�(?G,L �t 4 f ,0 „ UriSC' ,/;'1, YILI TYPE OF CONSTRUCTION /r C ih/�/Il!S - a. ............ ................19w TO THE INSPECTOR OF BUILDINGS: I ` The undersigned hereby applies for a permit according to the following information: - Location .................. :11.... ........ .. .. ..0.do....... ... ................................................................................................................. ProposedUse .�.......................................................................................................................................:r..,,. Zoning District ..... ......... District Lam" r .....nf 7X,-4...................... Name of Owner ... I :.....C�!.Iz.1.1� 5�d,1/ Address .A� �'�'GC Gee %li:• />ll Y yi.5� 6�`�. .......... ..... ................. ....... Name of Builder 65.S.. h....m/ /a.. X...................Address 79 �/�c......�.`� 1/;:,h��c �hS7. ...... .... . ........... .... Nameof Architect ..................................................................Address :.........: ................................:.::............................:....... Number of Rooms ..................................................................Foundation. .......i. ..... : ... . ..... ............... ......... Exterior ............... ...�:............... .....,...;...,,....:...Roofing .... ...—�.... - Floors .................Interior ..................................................................... ....................:..:............................................................ Heating .....................................................:............................Plumbing ...:.................. ....................................... Fireplace ..............Approximate. Cost ... ..... .I�.V........................................... Definitive Plan ApprovedF by Planning Board ---------------____.__ 4 .� - - -----�9-------. Area ........../...^.�...................:....... Diagram of Lot and Building with Dimensions Fee ` /'............................................ SUBJECT TO APPROVAL OF BOARD OF HEALTH 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 ... ........ .........`...................: .. .. ................ t Construction Supervisor's License GRINSELL, ALMA A=195-i4 No ....28155Permit for .....Add...Deck.............. jk SingleFamily...................................... ........................ Location ....................................104 M6co Road................. ........... West Barnstable ......................................................... ...................... Alma Grinsell Owner .................................................................. Type of Construction .....Frame...................................... .................................................................... Plot ............................ Lot ... ............................ Jul Permit Granted ....... X.. ................19 85 Date of Inspection ....................................19 Date Completed ................ .......................19