HomeMy WebLinkAbout0067 MORGAN WAY NO. 152 1/3 ORA
yr ; oF'THE Tod Town of Barnstable *Permit# IV'� �-�"
i ~o� Regulatory Services wee 6monthsjromissuedare
Pr MD Richard V.Scali,Director
$� 1639. �0
0 5 2017 Building Division
Paul Roma,Building Commissioner
TOWN OE SARNSI ABLE 200 Main Street,Hyannis,MA 02601
www.town.bamstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X--Press Imprint
Map/parcel Number
Property Address
Q16'sidential Value of Work$ f h S Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address /7� A Apr !Qj(ir/[.r tx
r
Contractor's Name--� SUn LJS�D Telephone Number 7 7 7 2 2 4 7 7
Home Improvement Contractor License#(if applicable) / 7l 3.3/ Email:
Construction Supervisor's License#(if applicable) 106651 (/
�rkman's Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ I pithe Homeowner
0-11"have Worker's Compensation Insurance
Insurance Company Name 6 L GCI a /Lt S U fA/& (/_D
j Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Requ (check box)
Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to,, ? e Uu'1^,&r 5 `��rzn � (
P
❑Re--roof(hurricane nailed)(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows
#of doors:
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Home Improvement Contractors License&Construction Supervisors License is
q ired.
SIGNATURE:
QAWPFILES\FORMS\building permit forms\EXPRESS.doc
01/25/17
' DATE(RAi00VYYYYJ
ca r CERTIFICATE OF LIABILIT INSURANCE
-
4t5/2017'
THIS`CERTIFICATE IS.ISSIIED A$':A'MATTER OVI.NFORMATION ON L.Y.AND CONFERS NO RIGHTS.UPON THE;;CERTIFICATE:HOLDER: THIS'
CERTIFICATE :DOE$ NOT'AFFIRMATtVELY pR NEGATIVELY::AMEND: EXTEND...OR.ALTtR:THE COVERAGE,AFFORDED BY THE POl1CIE$
BELOW. THIS.CERTIFICATE'OF INSURANCE'DOES'NOT:CONSTITUTE :Ar.CONTRACT,BETWEEN THE:ISSUING INSURER(SJ;:AUTHORIZE0
'REPRESENT°ATIVE'OR PRODUCER AND-,THE CERTIFICATE HOLDER.
IMPORTANT; If the.c4rtlfIcat#holder,is•an ADDITIONAL.INSURED,the•,policyi(lesJ:must': ►e'endorsed 7fsSUBROGATIONASMAIVED:subject;to the
terms and aon4itians Of the`policy,'Certain policies may require an endorsement: A;statement an:this certlficate.Coes not confer rights to the
aertlficate holder In IIeU of such-endorsement s . ..: _
PRODUCER:
Leonard Insurance Agency Inc:
883 M a1nY S18 800),634-4589
. ...... .MUW AFFORDING COVE7iAOE ......... _..NNC i
Ostefville;MA 02t365, .... ... ._. _ _ .._.:31325,
..:INSURED._.__.. .. .._. _...._ ___. _ .. .. ..
Herbst Home ImoroVement9 "L :. INSURER W.
DISURM C:
35 Peep Toad Rd iN8uAE/i o::
INSURER 8 ...
terVille;, NIA: 02B32- iNsuam F: ,
COVERAGES CERTIFICATE NUMBER- REVISIO 'N MBER:>
THIS;IS TO CERTIFY THAT H POLICIES::OF INSURANCE USTED:8ELaYV..HAVE BEE .ISSUED O THE:INSURED NA�dED:'AB.OVE FOR:.THE:;POLIC'Y:PERIOD
INDICATED. 146*hH3 ANDING'ANY REQUIREl,1ENT;TERM OR'CONDITIOPI:OF.A4JY.-Cf1NTRACTOR:OTHER.Dt1C[1MENT:WITH RESPECTTO'WHICH.THIS
CERTIFICATE MAY:BEIS&UED;OR MAY PERTAIN THE'.INSURANCE AFFORDED,.BY:THE,P'QLICIES.DPAID-CLAIMS'.-
OFESCRIBED: EREIN;tS;.SUBJECTTO.AIl:THE::TERMS,: S
.
,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES'Ltyrrs SHOIMN yAY HAVE BEEN REDUCED BY
.LTR: ::TYfFE INSURANCE: POLICYNUMHEN .'►v utr • POLAGY►6FYDDIYYYY eUi1rtS.... -.. .. -INSA WVD ...... :
AUTOMOBILEUlSILITII -
S
WOAKERS'COMPENSATION.
WC STATU•.. :; _: OTTi•
.AND EMPLOYERS`UAtRLRY Y!N TOAY'ULIIT ER
ANY PROPRIETWAATNERIEXECUiNE"y� r. -... : - E l EAC,N ACCIDENT' 5...� 100000_00
-A,, OFFICE/1/EMBEREXCWDEDt: "' N)A :aMAARP30Q898.
1N>tagawryieNH)° ..,. .. >11/1:8/2016.- 11/1812017:; £.cr°DISEAs£>EAEMPLOYEE 5,.. 't 000.00
II yyQaI.4eTe�4 un'ggr<' ,;
D£SCABrit011 OF-OPERATIONS tKbr_ '_ _...... ... . . _ E.LiUISEASE:'POLI LIMIT S 5t110000.00
DE3CRIP1 JONO OPERATIONS 1 LOCATIONS CLES-,( n.At*13.101,A4diF4a4IRrtrotAcs ScRemu roars apace:.a requ4epJ - ... .. .. ...... .....
`8ectlon,Categmy,Eledpp::Status Name: ISsueState:, AI_E:ntlUes/Insureds:
Meml3er 6C,11,de Jason :Hirtiit MA Herbst Home tmpiovements LLC
i'.
i
i
CERTIFICATE HOLDER__ __._ .. _.__._._.._._ . _..._.._ . .___.._ _._ _CANCELLATION
SHOULD ANY,OF THE ABOVE:DESCRIBED POUCIES BE CANCELLED BEFORE
Tovm0lBemSteble THE EXPIRATION DATE''THE.RibF,AIOTICE WI,L!'BE DELiVEREI);IN
200 M0Ztreet. ,ACCORDANCE WITH THE"POLICY,PROVISIONS.
aTlnit. MA;, 02801; ''AUTHORIZED REPRESENTATIVE.
ACORD 25{20101105) 'BRAC3139
Herbst Home Improvements LLC
35 PEEP TOAD ROAD
CENTERVILLE MA 02632
774-238-2937
www.herbsthomeimprovements.com
PROPOSAL SUBMITTED TO: WORK PERFORMED AT
Heather Moriarty 67 morgan way west Barnstable
We herby propose to furnish the materials and perform the labor necessary for the completion of:
New roof
Remove one layer of shingles
Inspect roofing deck for loose p ywood
Install ice and water shield at eaves
Install new drip edge
Install Certain Teed diamond deck roof paper
i
Install Certain Teed Landmark PRO shingles$8,625.00
Replace all plumbing boots
Install certainteed ridge vent and CertainTeed can shingles
Clean all debris daily
All material is guaranteed to be as specified. The above work will be performed in accordance with the specifications submitted
And completed in a substantial workman-like manner for the sum of:eight thousand six hundred twenty five
Dollars($8,625.00)with payments as follows: deposit of 3,000 and remainder upon completion
*Any alterations from above proposal involving extra costs will be added under a separate written agreement and become an extra
charge over and above said proposal.
RESPECTFULY SUBMITTED
on Herbst
ACCEPTANCE OF PROPOSAL
The above price,specifications and conditions are satisfactory.I herby accept this proposal. You are authorized to do the work anc.
payments will be as specified above.
SIGNATURE: 61A
*This proposal may be withdrawn by said company if not accepted within 30 days.
i
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Office of Consumer Affairs&gusmess Reguladoa
HOME IMPROVEMENT CONTRACTOR
Registration:. -
x
17,1331
Expiration+—=37 TYPe:
2fl1'8 LLC
HERBST HOME IMPR E.
1�1 L`C
;
r dASON HERBSTRap
35 PEEP TOAD "r h
CENTERVILLE RD y'632"- -yam h
Mi4 02
UnderseCcetary
Massachusetts Departme'o sand Standard
Board of Building Regulat
License: CSSv'sos Specialty
Construction Supe
JASON HERBST
35 PEEP TOAD ROAD _ f
CENTERVIL"LE MA 02632
f Expiration:
^^� 1010112018"
CoMmissioner
f
y: ; �—L-i6ense or rggistration valid for individ'ua1 use
before the expiration date. If found return to: ' ' ;
Office of Consumer Affairs and Business Regulation
10 Park Plaza-Suite 5170
�. Boston,MA 02116 .
i
Not valid wit out signatu
Massachusetts Department of Public Safety' '`,
R ulations and Standards{�.
�- Board of Building e9.
License: CSSL-106051ecialty ' '<
Construction Supervisor Sp
jASON HERBST F✓
35 PEEP TOAD ROAD,
CENTERVILLE MA 02632�
— CA, Ezp ration
" ^^� 1o10112018
Col sioner
The Coasmarn yeah*of Manadlrrueft
FDep=humt of rad-moi- d Accidmitr
Oirwe of Finaes*adans 600 WasTiS eon Shwa
Boston,MA.02111
iPFtn-vmassLgor/dia
Workers' C Insigne davit Bmlde -JConbracWrs/EIectdcianslPhunbers
APPUkan#Infermatian Please Prm Env
Name �����Y ��n yYLL _L/�rP(U�►'►�f�h-�S •
AddFess: Lod
'7%1
Are uanetaploper?:Cipecktheappropriatebox:
I. I am a 1 vritls�` 4 ❑I am a gesreral contractor-and I Type of project ucticmed}:
P * ]ravelured.the sob confactors 6_ El New• employees(fall atpdfor part�ime j_
2.❑ I am a sale propFietor or part mr- listed on the attached sheet: I ❑Rernodeiiug_
sh�p and have no employees Thew sub-contractors have 8. ❑Demnlifioa
w forme in employees and wod='
°� �Y�P�Y- 1 9..❑Building addition
[NQ Zv�r'Comp_mstttan m
ce comp_ ertrmice
required_] S_ ❑ We are a corporation and ifs 10-❑Electrical repairs cr adQiow
officers have exercised f Bir
I El am a Eiomeolx�doing all work 11-❑P repairs or$ddsfions
myself[No warkers'°omp- ugU of a empfiou per MGL 1? Roofrepaits
incnsanrrreqakedL]y c-152, §1(4).andwe have mo
employees,[Nowo&ers' 13-❑Otfier
cam-;*,m umnce required.)
'AnyappKc-td-tcherlab=91mast also Mca<thesed-sanbeiaarsla ng&awwmtes'a=R--riaapeTiryiM5==6ML
Sam wwnex wbo sab=t dos affldscit indmcatin9 they ate dam ag ward[and_ffim hue auwde coataa=�t sn&=a new a$idadt'inchul, such_
TCaat<a Spat AWktb"burr mast aVarlsed m a1di6mmal sheet showing the acme of the z d stafe whedw,"nott m,emitieshaV
' employees.Iftheaa&caatm�ashave emglagers,they�stpmride-fbea markets'imp.gali�ata�ret:
I am act euipIafar fliat is prvuidirrg�varkers'conrperis�'ort utsrirartcs far aty etrrpFa3�ees $elory is tJie pvFicy arm job ante
�tformatiara, n
Irssurance Company Natne: /7CGif i cz, j✓1'bS yr�✓1 L.Q� �fI /
"Policy�or Self-its€ITC-* enW A 2 l0j� �S �pifatiaa Dade: lit Z 1
Job Site Address: i O 1:1 fQ rCArl (n- l- C41Steepry-_2 Grin.5AL IM4 D 2me
Attach a-copy of the w arkere compeusationpolicy declaration page(shaving the policy number and expiration date).
Failure to secure amnge as requiredunder Sechoa 25A o€MGL c�157 can lead to the imposition of crimistal peaaltses of a
fine up to$L50D OD indlor mie—yearimprisonmenk as w 11 as ciiil penalties in fbe form of a STOP WORK ORDER and a Fite
of up to$2s0_00 a dap against the violator_ Be adtdsed'that a copy of this statement maybe forwarded to tine Office of
Irccvestcgatiafls offbe DIA for ibsurnce coverage v on-
I`da Itersby dieprrnis d nahies a,f perPUy fhatfhe utfbigsm6vnprmmikWabmv is�bue and correct
Si e Taate- J
Phcm '
0.UEdd Use eerily. Do not mite in ddcs area,to be cmapieted by atp ortown a, I
City or Town: Per—tlIA ease f
Ling Axflor4(tacle one):
L soazd of$ealtfi I.Built ing Dgmtroent I CStylrosn Clerk 4.Electrical inspector S.Plumbing baslteCiar
6.other
Contact Person: Phone�-
6
Information and Instructions ,.
7Msasmchuceft General Laws cbap�Ise regomes all employers to provide WOMkMs=MPesian fir tfMM employees_ .t
Puisuant-W this statute,an anployre is dcfined as=every person m ffie=vim of anof zr under a¢y contract ofhi r,,
cspress or implied,oral or wraten_"
An Mayer is.deed as"an mdxvubA P sl= assoc�zon.ccmporatton or other legal entity,or any two or male
of the:foregoing engaged in a Joint etdxaprise,and i aclndmg the legal representatives of a deceased employer,or the
receiver or trustee-of an mdzvidual,patUxslup,association or otherlegal entity,enploying employees. However the
owner of a,dvm1Hng bonne having not more than three apartments and who resides therein„or the occupant of the -
dweIIing house of mother who employs persons to do mamtffiancc,cn^stra'"F'on or repair wow an such dwelling honse
or on the grounds or building appu�
ffiemto sballnotb=anse of such employn=vtbe deemed to be an employer°'
MQ.CbaptCr 152,§25C(6)also staters that-every stafe or local licensing agency shOwithhold ffie xssU ace or
renewal of a license or permit to operate a business or to construct buildings fa the commonwealth for any
app&cant who has aotproducxd acceptable evidence of cdmpliance wirtlz the a r ace.coverage require
Additionally.MCrL cbapt r 152,§25C(7)states-Feithm the ce=mw�nor�3'of its political subdvi_.- shall
E,n into any contract for the pmf miaucz-ofpabhowcak�tr1acceptableevidenceofcompliaRcewiththemisuranCe..
requseuie is of this dupter have been presented to fine cantwting anfhoiity."
App4cants
Please fill out the worlo=, compensation affidavit completby by chmkiag the bones&at apply to your sifnation and,if
necessaxy,supply sob-contractor(s)name(s). addresses)and phone numbers)along with their certificate(s) of
insurance. Limited Liability Companies(LLC)or Lnited LiabilityPaituesliips(LLP)wino employers ofhea than the
members or parb s,are not regrked to cry workers ceoapeusaf m insurance. If an LLC or LLP does have
employees, a policy isregnaed. Be advised that this a$zdayit maybe submitcdto the Depatimentof Iadnstrial
Accidents for confnmatim of insurance coverage: Also be s=e to sign and date the aftidri it The affidavit should
be mt=(--d to$e city or town that the application for the permit or license is being requested,not the Department of ;
k&ctrtal Accidents_ Should you have any questions rega-c1mg the law or ifyon are mpired m obtain a Wori=`
DOMpensatinr,policy,please call thzDepactmentatthen=bezlistedbelow. Self-fi uredcompaniesshouIdentrrtheir
self insor-mce license number on the appropdate line.
City or Town OfSrcials
Please be Sure that the affidavit is complete and printed.IegIlY. The Depnimeot has provided a space at the bottom
of the affidavit for you to fill oiA in the event the Office ofInvestigafions has to contact Yourimg the applicant-
Please,
urd be s to fill i a the pe�/Hcense n=ber which will be used as a mb: enm unmberr_ In-addition,an applicant
that must submit multiple pemoitilicense applit sticros in any even year,aced only submit one affidavit indicating current
policy information.(if necessary)and uudrd`mob Siin Address'°ffie applicant should wm "all locations in (onY or
town)-"A copy of tho affidavit that has been officiaIly stamped or marked by the city cr town maybe provided tD the
applicant as-proo�t3�at a valid affidavit is on file for fA re permit-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 busmrss or commercial venture
(ie.a dog license orpem<rt to bum leaves etc.)said person is NOT required to complete this affidavit
The Office of Investigations would hka to thank your in advance for your cooperation and sh on]d you have any questions,
please do not hesftto to&c us a call-
The DepartruenfS address,tnlephOne and fax=mbca:
' *of Massachnsdts ,
Deg�nent of IndEstdral Accidents
Qf�ce of�tio� .
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Assessor's Office 1st floor MaD Lot _ w Permit#
Conservation Office Oth floor Date Issued 1 0- - 9 'T'
Board of Health Ord floor ,
Engineering Dept. 3rd floor House# 15 �o"! f 0, r�, "
Planning Dept. Ist floor/School Admin. Bldg.):
NAM
Definitive Plan Approved by Planning Board U 19
(Applications processed 8:30-9,30 a.m.& 1:00-2:00 p.m.) ��e° 3,�,j+ 0
C� Z _ TOWN OF BARNSTABL
Building Permit Application
67
Proiect Street Address * LOT Is 7
Villa e 22 Fire District /�- �a,-21 /
vnc Address
Telc hone lDWt -Z
Permit Request: ) �� q Id �L/ll'la� Garl7l� 7
Zoning District C Flood Plain C Water Protection
Lot Size Grandfathered
Zoning Board of ApMls Authorization Recorded
Current Use 1/ Proposed Use
Construction Tyne yl//� FL44/PI�a—
. / Eaistin2Information
Dwelling Tyne: Single Family 1/ Two family Multi-family
i� "
Age of structure ly Basement type �D7.UL�G� C �cx n
Historic House Finished
Old King'sEighway Unfinished
Number of Baths a No. of Bedrooms -3
Total Room Count not including baths -7 First Floor /
Heat Type and Fuel W Central Air A16 Fireplaces
Garage: Detached Other Detached Structures: Pool
Attached y X a 1 Barn
None Sheds
Other
Builder Information
Namc �✓ Telephone number ��+ 11,4 1V0
Address q License# 0.4
Home Improvement Contractor#
Worker's Compensation # AIC/ UX 9,2-tl 7 E Q 3
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN (AS BUILT) SHOWING EXISTING, AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO. low
�tl J?b 8 r55 Pro'ect Cost ,CW
SIGNATURE DATE d
BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S)
BPERM T
FOR OFFICE USE ONLY
ADDRESS �Ce� e VII.LAGE 1
OWNER
DATE OF INSPECTION:
FOUNDATION
FRAME 2 -1
INSULATION
FIREPLACES
ELECTRICAL: ROUGH FINAL
o ,
PLUMBING: ROUGH FINAL
v
GAS: " ROUGH FINAL
FINAL BUILDING:
DATE CLOSED OUT: `
ASSOCIATE PLAN NO.
d
TOWN OF BARNSTABLE
CERTIFICATE OF .OCCUPANCY -
I PARCEL ID .174. 001, 065 GEOBASE ID 38886
( ADDRESS 67 MORG49 WAY PHONE.
W BARNSTABLE ZIP -
I,LOT 157 BLOCK LOT. SIZElj� �
�DBA . DEVELOPMENT DISTRICT WB
PERMIT, ' 28807 DESCRIPTION SINGLE FAMILY DWELLING (PMT.026311)_�
'PERMIT Ti E BC00 TITLE CERTIFICATE OF, OCCUPANCY
l Department of Health Safety'
. CONTRACTORS: `!. + P Health, �
ARCHITECTS: and Environmental Services
TOTAL FEES: pkTNE lbw,
BOND y $-'00 '{Q�
CONSTRUCTION COSTS $.00
756 CERTIFICATE OF OCCUPANCY '* BARNSTABLE,
MASS.\ g
1639.E
Ep�'l► A �
BUIL P6i IV 'I
B
DATE ISSUED- 02/1041998 EXPIRATION DATE �
_ TOW OF BARNS'..
�. Br1I Lnl tar pBRMi'1
.CEL, ID I 4"U01 066 GROBASE IL -38c386
r�DDRESS 6-7 MORGAN WAY PIiUNR
W BARNS`l'ABI-F 2IP
LOT 157 BLOC% LOT SIZE
DBA ) VEWPMENT DIST11CT WB
PERMIT 26311 )ESCRIP^1CN 2STORY COI,.W/2CAR ATTACH GAF'. (SEW #95-349)
PERMIT TYP%' -BUILD TITLE— NEW RESIDENTIAL BLDG PMT
CONTRACTURS: BAYS I DE BU I LD1 G, INC Department of Health, Safety
ARcxTTE�Ts: and Environmental Services
TOTAi, FEES: $301.44
BOND $.00 Oki
CONSTRUCTION COSTS $91;240.00
101 SINGLE FAM HOME DETACHED 1 PRIVATE P - ,�
* BARMABM
MASS.
1639. A�O�
,/
BUI DING ISI N
BYi �
DATY1 ICSIUI�D 10/14;1.997 EXP1RATIO►3 tD.ATR
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN-
CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR
ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS
PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM OF FOUR CALL INSPECTIONS REQUIRED
FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE
1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR
2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU-
(READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ELECTRICAL,PLUMBING AND MECH-
3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. ANICAL INSTALLATIONS.
4.FINAL INSPECTION BEFORE OCCUPANCY.
VISIBLEPOST THIS CARD SO IT IS
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS
G!- / 1 I It � 1 -iZ-aa-97 ��sw
�
2 1
F�r-t:� J�1�► . 2VA,c �',�O�,G„Ve 2
3 r 1 H TING INSPECTION APPROVALS INE IING DEPARTM T
OTHER: (Q F LNS t` &tulj SITE PLAN REVI A PROVAL
y�J. .(_. • dt 171TT.
WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS
THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY
VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA-
'i TON. NOTED ABOVE. TION.•
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Western Surety e
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LICENSE AND PERMIT BOND
For County,City,Town or Village Only-Not Valid for Bonds Required by the State.Not Valid for Contract, ;
Performance,Maintenance, Subdivision,Agent to Sell Hunting and Fishing Licenses or Utility Guarantee Bond.
KNOW ALL MEN BY THESE PRESENTS: BOND No. L&P-4 2 7 816 2 8
Thatwe, RnV-irle Building 1ne y
of the Village of Centerville State of Massachusetts as Principal, n
and WESTERN SURETY COMPANY, a corporation duly licensed to do business in the State
of Massachusetts , as Surety, are held and firmly bound unto the
Town of Barnstable , State of Massachusetts , Obligee, in the amount
(Valid only when a County,City,Town or Village is named as Obligee)
of Two hundred and 00/100******-*.*-****.**.***.*.**.*:*_DOLLARS ($200 . 0.0***** ),
(NOT VALID FOR MORE THAN$25,000)
lawful money of the United States, to be paid to the said Obligee, for which payment well and truly
to be.made, we bind ourselves and our legal representatives,jointly and severally.
THE CONDITION OF THIS OBLIGATION IS SUCH, That whereas, the Principal has been
licensed to construct a single family dwelling, at Lot 157 Morgan Way,
West Barnstable,' MA 02668 50 feet frontage by the Obligee.
NQ,33'�a' FORE, if the Principal shall faithfully perform the duties and comply with the laws and
orc rire'g6.R Ag all amendments), pertaining to the license or permit, then this obligation to be void,
o li s a R `r"vn full force and effect for a period commencing on the 7 t 1, day of
1 9 9 7 , and ending on the 7 r h day
00 c t o ei D= 19 9 8 , unless renewed by continuation certificate.
S3t.hiV d�ray der;rminated at any time by the Surety upon sending notice in writing to the Obligee and to
tl ' z)ci-aAn p the Obligee or at such other address as the Surety deems reasonable, and at the expira-
tion ) days from the mailing of notice or as soon thereafter as permitted by applicable law,
whichrevdal§ a,,,this bond shall terminate and the Surety shall be relieved from any liability for any subsequent
acts or omissions of the Principal.
Dated this 7 t h day of 0 c t o Le r 1 9 9 7
Principal
Principal
Countersigned WESTERN S U E T Y�C 0 M N Y
G L
By 7 I/
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By /-/�Resident Agent President
P 6
ACKNOWLEDGMENT OF SURETY
STATE 0 SOUTH DAKOTA 1 (Corporate Officer)
G f
County of Minnehaha
On this day of ,before me, the undersigned officer,personally
G appeared Stephen T.Pate ,who acknowledged himself to be the aforesaid officer of WESTERN
SURETY COMPANY,a corporation,and that he as such officer,being authorized so to do,executed the foregoing ;
instrument for the purpose therein contained,by signing the name of the corporation by himself as such officer. ;
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
G +4�C�:'�:ii!'f:f:44f;:s4 iyaifijt�4f•+ l
B: THOMAS ;
G �1 NOTARY PUBLIC ��
c SEAL SOUTH DAKOTA SEAL
.�. Notary Public, South Dakota
G My Commission Expires 6-2-2603 J Western Surety Company y
G Form 849-A—3.96 1-605-336-0850
I
ACKNOWLEDGMENT OF PRINCIPAL
(Individual or Partners) ;
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' STATE OF
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County of 4 e
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G On this day.of ,before me personally appeared
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' known to me to be the individual_ described in and who executed the foregoing instrument and
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acknowledged to me that—he_ executed the same.
My commission expires
Notary Public
ACKNOWLEDGMENT'OF PRINCIPAL
' (Corporate Officer) -
STATE OF
ss
County of
On this day of ,before me,
personally appeared , who acknowledged himself to be the
of , a corporation,
and that he as such.officer being authorized so to do, executed the foregoing instrument for the pur-
poses therein contained by signing the name of the corporation by himself as such officer.
My commission expires
Notary Public
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COMMONWEALTH OF MASSACHUSETTS
P' ACCIDENTS
L DEFAIU^viFEN'I' O F IND USTFtIAL
600 WASHINGTON STREET'
BOSTON, MASSACHUSEITS 02111
James.: Oant7oe1'
for r-s ss�one WORKERS' COIVfPENSATION INSURANCE AFFIDAVIT
(Iicensce/pe mirrec)
with ! principal place of business/residcncc ar-
�P
(Gty/Sacc/Z;p)
do hcr;cby certify, under the pains and penalties of perjury, that.
(] 1 am an employer providing the following workers' eompensarion coverage for my employees working on this
job.
lnsunncc Company Policy Number
( J 1 am a sole proprietor and have no one working for me..
( J 1 am a sole propricror, neral contactor - r homeowner (circle one) and have hired the contractors listed below
who have the following wor c:s eomper=rion insurance politics:
Namc of Contractor Insurance Company/Policy Number
Y
Name of Contractor Insurance Company/Policy Number
lame of Contn=or Insunnce Company/Policy Number
0 1 am a homcownc. pc,formi.ng all the work myself
NOTE: Please be aware tilt wbile bororo»•oen wDo erooiov persons to do muntenanes. eoostruetioo or rcpur—ork on a
o--riiinc of not more tbao three untu to 1w16 the horor—ner aiso resiau or on the Frouoas appurteoa.at tbercto art not reoera;)t'
constacrcd to 6c cr_olovers uoacr the Q'oricen' Comocosauon Act (GL C 152. sect. 1(5)). appiintioo by a bomeo•+•oet for a Iseensc
or Derma msy rnccocc We 1cpJ statw of a.n empiover under the Qoricen' Coropenution Act
1 understand :nat : coop•of trus statt-:rnt will be for+wuceo to the Depu--rent orIndtuvi3i Aeodeno' Ofnee or Insur=Cr rot CO �`
vc^:t�:ton ant : sa: :Wurc to iccurr a yr.-Ire as rceuirce undo: Semo s :�.i'of.MGL 15= rsn Ieac to the imposiuon of a�=in ; Dcr-2J6C1
crnstsone of: Jtnr of ere to S1 500.00 andror imprisont:cr.t of ere to one ••t:a: and otv pe.r:a;ucs in the form of a 51op worx t7roc' erne a
finr of S l 00.w a day ifa:ns: me. t
SUBCONTRACTOR'S INSURANCE
ENGINEEER:
BAXTER & NYE ENG: (L) FIREMENS FUND - S30MXX80564866
(W) LIBERTY MUTUAL - WC1312595563023
WELLER & ASSOC: (L) NAT'L GRANGE MUT.- MSP45246
EXCAVATION & SEPTIC:
ROBERT J. OUR (L) U S F & G - 1MP30109550901
(W) U S F & G - 771521695
DECO CONSTRUCTION (L) TRAVELERS - 660364K8342
(W) LIBERTY MUTUAL - 312446298044
FOUNDATION:
BAYSIDE FOUNDATIONS: (L) COMMERCIAL UNION - ABR406267
(W) LIBERTY MUTUAL - WC1312201785044
WELLS:
DENNIS SCANNELL (L) TRAVELERS - 660873E5627COF92
(W) WAUSAU - 151300062926
CELLAR/GARAGE FLOORS:
MICHAEL BROWN: (L) AETNA - MP0023672849
FRAMERS:
ROBERT DORRER: (L) TRAVELERS - W680526K991TIA9
(W) AETNA - 006CO023972416C
MICHAEL DUFFLEY: (L) COMMERCIAL UNION - NBF821356
(W) LIBERTY MUTUAL - WC1312492127024
MASON:
SHERMAN, WAYNE: (L) COMMERCE INS CO - N60689
(W) WAUSAU INS - TO BE ASSIGNED
ELECTRICIAN:
CHAVES ELECTRIC: (L) HANOVER INS. - LHN2964649
(W) MISCELLANEOUS INS CO. - 0708878 91 1
PLUMB & HEAT:
WHITELY PLUMBING: (L) TRAVELERS - 660365K1782COF9
(W) EASTERN CASUALTY - POLICY IN MAIL
ALARM SYSTEM:
BALTIC SECURITY: (L) FIRST FINANCIAL - FF0131 G400831
(W) COMMERCIAL UNION - CB0743379
CENTRAL VAC:
VACUUM HOUSE: MERRIMACK MUTUAL - SBP1608045
i.
S
i
.A
INSULATION:
MAP INSULATION: (L) AMERICAN STATES - 02CC326435-3 i
(W) U S F & G - 7711099932
SHEETROCK:
MEL REED: (L) WORCESTER INS - CB817530
(W) COMMERCIAL UNION - CBH557387
INTERIOR TRIM:
f, DAVID'S REMODELING: (L) COMMERCIAL UNION - NB F821442
M & R CARPENTRY (L) MARYLAND INS. GRP- SCP30235965
(W) CIGNA PROP & CAS.- C80049997
OAK INSTALLER:
ROBERT BUDDEN: (L) NORTHERN ASSUR. - NBF528652
PAINTING:
CAMPBELL PAINTING: (L) TRAVELERS - 1680251K4083COF
(W) AMERICAN POLICY - WCC 186604
GARAGE DOORS:
ALL CAPE GARAGE DOOR: (L) U S F & G - BSC14667590301
(W) COMMERCIAL UNION - CBH573757
STORMS & GUTTERS:
ALUMINUM PRODUCTS: (L) AETNA - MP0021014146.
(W) AETNA - JC89258880
OAK FINISHER:
AMERICAN FLOORS: (L) TRAVELERS - 680 342W754-0
CARPET, VINYL & TILE:
CARPET BARN: (L) VERMONT MUTUAL - SBP6507393
(W) PHOENIX INS. - 6NUB476J652794
r
TILE INSTALLER:
TONY AVERINOS: (L) ASSURRANCE CO. - CFP26528977
(W) HARTFORD FIRE - 77WZCY2409
WIRE SHELVING:
CAPE COD CLOSETS: (L) U S F & G - BSC146983441
APPLIANCES:
KITCHEN APPL MART: (L) FIREMENS FUND - AZC80453098
(W) HARTFORD INS CO - 77WZNB1603
MIRRORS & SHOWER DOORS:
L & M GLASS: (L) COMMERCIAL UNION - CBR409003
(W) U S F & G - 0071439933
LANDSCAPE & SPRINKLER:
COY'S BROOK: (L) COMMERCIAL UNION - ABR345850
(W) CIGNA COMPANIES - C41138178
DRIVEWAYS:
-NORTHERN SEALCOAT: (L) MARYLAND CASUALTY- EPA18716945
(W) THE PHOENIX - UB387K530
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