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0311 NAVIGATION ROAD
UPC 12543 No. 53LOR twnn„s ' HASTINGS, CON 0 �r,�.;.m.�,..,�'*a;+��'r,�•Xfy�'�;_�r'�"'?�T',e.+;--...+mr•'�,,.,/"+r^�.�ox��.�;s.;.�a^�`,j'�'^;t_y-. ,�,..*rc�-�""^,"-m..,'.• ,+s b+---=-^r...--,-.,_.......r.�^-�*^�n._:�-• — — - =-- — -- - _ -- -- Page 1 of 3 Anderson, Robin From: Cyrus Buffum [cyrusbuffum@gmail.com] Sent: Friday, January 13, 2017 3:04 PM To: Scali, Richard Cc: Roma, Paul; Lauzon, Jeffrey; Anderson, Robin; Karle, Darcy Subject: Re: Meeting-311 Navigation Rd. Mr. Scali, Thank you kindly for your prompt response. I greatly appreciate your taking the time to consider my inquiry. If your schedules allow, I'd be grateful to have the opportunity to meet with you and any - available.staff on Tuesday, January 17 to discuss the below. As for context, I recently purchased the property at 311 Navigation Road after nearly three years of process--much of which lead me down the deep rabbit holes of Barnstable's storied past and the mechanics of Massachusetts's regulatory framework--two areas I, admittedly so, find quite fascinating. I am certainly familiar with the current restrictions on the property and am fully prepared to work collaboratively with the Town to maintain compliance with all existing regulations in place to protect human, environmental, and public health. That said, my goal, ultimately, is to legally lay my head at the cottage located on my property and to serve, as generations have done before, as a steward of this special place. I'm a native of West Barnstable, a graduate of Barnstable High School, and one whose passion for nature can be singularly traced to my youth on Cape Cod. For the past 14 years I've lived in Charleston, SC. I first move south to study physics and coastal dynamics at the College of Charleston. Then, two years out of school, I founded a small nonprofit and committed the next seven years of my life to the conservation of Charleston's waterways (http://charlestonwaterkeeper.org). Most recently I've begun an oyster farming operation and am working again to protect Charleston's delicate ecosystems--but this time, with something edible. Despite my life in Charleston, my roots are in Barnstable, and several years ago the pull from home became unavoidable. I identified the property at 311 Navigation Road and began what became a multi- year process of due diligence. As I understand, the most recent Order of Conditions and subsequent Certificate of Compliance issued by the Conservation Commission for the property at 311 Navigation Road (SE3-2370) state the following observation: "Finding # 1: The structure is considered a day use 'duck camp', with no septic system and none proposed. It is not considered habitable." I see no issue with this finding as the cottage at the time of the inspection(s) certainly did not comply with Chapter II of the Massachusetts State Sanitary Code (105 CMR 410.000) nor Title V of the State's Environmental Code (310 CMR 15.00). In short, I would like to propose the necessary corrections to comply with building, sanitary, and environmental codes, along with the single remaining special condition outlined in the Certificate of 1/13/2017 Page 2 of 3 Compliance noted above: "Special condition# 8: There shall be no disturbance of the existing salt marsh vegetation." Based on primary accounts I've gathered and evidence offered by previous owners and former residents of the cottage, I understand the structure's historic use (primary and intended) to be just as it is zoned- today--residential. I am prepared to present an operational plan that offers and maintains complete compliance with all state and local regulations while providing the basic allowance for habitation. Beyond this initial request, and well into the future; I envision great opportunity to bring heightened. value and protection to this sensitive tract and other adjacent parcels through crafted cooperation between the Town's Conservation Commission, the Barnstable Land Trust, the Lombard Trust, and other abutting private land owners such as myself. Though I may be putting the cart well before the horse on this, I am eager to begin such a dialogue when the time is right. In the meantime, this property is undoubtedly unique and the challenges ahead are no less, but I look forward to our conversation next week. Thank you for your time and consideration. Humbly and respectfully yours, Cyrus Buffum On Fri, Jan 13, 2017 at 12:56 PM, Scali, Richard<Richard.Scalin town.barnstable.ma.us> wrote:. ..J Mr. Buffum: I am sorry for the delay in responding to your email. Our email system has been down recently and I lost all emails from Wed Jan l lth. Luckily I was able to retrieve your email. I have consulted with our Building and Conservation divisions with regards to your property at 311 Navigation Rd. It seems there are restrictions on this property. I am not sure what visions you have for the property. I am happy to meet with you and the appropriate departments. We are closed on Monday Jan 16th for the holiday. Tues Jan 17th is a possibility. However if you could lay out forme. what questions you have ahead of time, it would be helpful before we meet. All the best, Richard Scali 1/13/2017 Page 3 of 3 Richard V. Scali, Esq. Director of Regulatory Services 200 Main St. Hyannis, MA 02601 508-862-4778 508-778-2412 fax 1/13/2017 f� Qh _a�_:r.=ttI.r•i,�f`-t'�I »yrr+f II='c',r l.f��trI-(-tr(�i`.a e,v°rF I y I`/_`e,�-#-€�r'3fi 5 �t,f_,,,rf`•.I_t_�-_,U i Jt.�_.:�J i, Ir�/_l-•I�I, pa��� Legend x Spot He ig hts(N AVD88) Intermediate Contours A VD8 ) — Index Contours(NAVD88), Parcels x l f!� X Town B, oundary t Railroad Tracks 1 Buildings A. PaintedLines;#Q t - t Parking Lots V Paved Unpaved / f Driveways ' `tu _ I S , �r t __ lyf } �jr• '�- l _ {t �_r f - i:t. Cl Paved •,, .Yr, 1, /i ly #{' l�t. I - t. �I 10.- Y. -,Z.I r, I��•. i !T , " .Y- I ,,.'i. ~r, Unpaved Roads Nn Bridges 1.. +,.tY �,�. O Paved Roads sl r r 'k 1 sJ Unpaved Roads - -V f-.1!,. - �! f - vl: t, l I; al _ :t. t Streams I I,_ "tf'•I .t ` -, 1. ' vt { ,lli I- ,17 � 1 11 ti, t.- Marsh I .. +, =� ❑ Water Bodies ��ir• �- .T'` _ r_� ��CCC fJ t #252 [= w yl y tom • _ .I ' ,Ir _ ;� n J:. =U ) q, nt• Ir t •� '}. _ •}G'^ 1i - „,s 'f 'Jl _ ',.Y._ .�• ?. - _ Ir - Fla. I -- / t ,i- ! � Oyu -�, v( � #248 4t• �,,_ _ �� ,,. ,, ,;till .+ir •. 0,; I 47 J. - ,!.• ,tis(e `_ r /., . It ,1:__.1 #239,� �J r+ : fir/ ,, _J� il, r° - � I j t! �•` y Fri z #243 r'� rl�F•� !1 ��J,`4 r Ir �`�.`� � ' ,t' � Ir �_ `,S?' f �1i --. �t��G - ,fit • j.� �1 "� },--�l! .:w t� I,-- I. _: �"' •Jr � •� ~#229 � �� 14, #24 4 #�••225 trZ 213 I +,,t���/•J}((' 5 lr#\0' _ - "- ' ,.�-_ atl1 4`t, `_,�-.•_,,�f _I _'�'i.trf- 7.l^-1��`I. y #2aJ #'2Ye 3rr 8#0 M_`_Y.�R _�rr�_/*/'.�,�1�. ",I..I.1 `�_I�,'.t•i_,��,tr, _ 1 .❑� l ' 43 t Map printed on: 1/17/2017 This map is for illustration purposes only.It is not Parcel lines shown on this map are only graphic Town of Barnstable GIS Unit adequate for legal boundary determination or representations of Assessor's tax parcels.They are Feet regulatory interpretation.This map does not represent not true property boundaries and do not represent 367 Main Street,Hyannis,MA o26oi O 167 333 an on-the-ground survey.It may be generalized,may not accurate relationships to physical objects on the map 5o8-862-4624 reflect current conditions,and may contain such as building locations. Approx.Scale: i inch= 167 feet cartographic errors or omissions. gis@town.barnstable.ma.us Town of Barnstable, MA Page 1 of 2 Town of Barnstable,MA Tuesday,January i7,2077 Chapter 240. Zoning Article III. District Regulations § 240-14. RC-1 and RF Residential Districts. A. Principal permitted uses.The following uses are permitted in the RC-i and RF Districts: (1) Single-family residential dwelling(detached). B. Accessory uses.The following uses are permitted as accessory uses in the RC-i and RF Districts: (i) Renting of.rooms for not more than three nonfamily members by the family residing in a single-family dwelling. [Amended"-7-i987 by Art.12] (2) Keeping,stabling and maintenance of horses subject to the provisions of§240-iiB(2) herein. C. Conditional uses.The following uses are permitted as conditional uses in the RC-i and RF Districts, provided a special permit is first obtained from the Zoning Board of Appeals subject to the provisions of§24o-i25C herein and subject to the specific standards for such conditional uses as required in this section: [Amended 8-i7-i995 by Order No.95-1951 (i) Home occupation,subject to all the provisions of§240-46C, Home occupation by special permit. (2) Renting of rooms to no more than six lodgers in one multiple-unit dwelling. (3) Public or private regulation golf courses subject to the provisions of§240-iiC(2) herein. (4) Keeping,stabling and maintenance of horses in excess of the density provisions of§240-1iB (2)(b) herein,either on the same or adjacent lotus the principal building to which such use is accessory. (5) (Reserved)E'3 [1] Editor's Note:Former Subsection C(4),regarding family apartments,was repeated7i-i8-2004 by Order No.2005-026.See now§24o-47•7. (6) Windmills and other devices for the conversion of wind energy to electrical or mechanical energy,but only as an accessory use.. (7) Bed-and-breakfast operation subject to the provisions of§240-i1C(6). [Added 2-20-i9971 D. Special permit uses. The following uses are permitted as special permit uses in the RC-i and RF Districts,provided a special permit is first obtained from the Planning Board: http://ecode360.com/print/BA2043?guid=31772736 1/17/2017 Town of Barnstable, MA Page 2 of 2 (1) Open space residential developments subject to the provisions of§240-17 herein. (2) Private initiated affordable housing developments: A private-initiated affordable housing developments(PI-AHD) on seven acres or more,subject to the provisions of§240-17.1 and in full compliance with the standards set forth therein. Added 11-18-2004 by Order No.2004-1131 E. Bulk regulations. Minimum Yard Setbacks (feet) Minimum Maximum Minimum LotL o tMinimum Lot B u i l d i n g Z o n i n gArea Frontage Width Height Districts (square feet) (feet) (feet) Front Side Rear (feet) RC-1 43,5602 125 - 303 15 15 30' RF 43,5602 150 - 303 15 15 301 ' Or 21/2 stories,whichever is lesser. 2 A minimum lot area of 87,120 square feet is required in RPOD Overlay District. [Added 10-26-2000] 3 One hundred feet along Routes 28 and 132. http://ecode360.com/print/BA2043?guid=31772736 1/17/2017 Town of Barnstable, MA Page 1 of 2 Town of Barnstable,MA Tuesday,January 17,2077 Chapter zoo: Zoning Article III. District Regulations § 240-14. RC-1 and RF Residential Districts. A. Principal permitted uses.The following uses are permitted in the RC-i and RF Districts: (i) Single-family residential dwelling(detached). B. Accessory uses.The following uses are permitted as accessory uses in the RC-i and RF Districts: (1) Renting of rooms for not more than three nonfamily members by the family residing in a single-family dwelling. [Amended ii-T-i987 by Art.i2] (2) Keeping,stabling and maintenance of horses subject to the provisions of§240-i1B(2) herein. C. Conditional uses.The following uses are permitted as conditional uses in the RC-i and RF Districts, provided a special permit is first obtained from the Zoning Board of Appeals subject to the provisions of§240-i25C herein and subject to the specific standards for such conditional uses as required in this section: [Amended 8-17-i995 by Order No.95-1951 (1) Home occupation,subject to all the provisions of§240-46C, Home occupation by special permit. (2) Renting of rooms to no more than six lodgers in one multiple-unit dwelling. (3) Public or private regulation golf courses subject to the provisions of§240-iiC(2) herein. (4) Keeping,stabling and maintenance of horses in excess of the density provisions of§240-iiB (2)(b) herein,either on the same or adjacent lot as the principal building to which such use is accessory. (5) (Reserved)E'] [1] Editor's Note:Former Subsection C(4),regarding family apartments,was repealedi i-i8-2oo4 by Order No.2005-026.See now§240-47.7. (6) Windmills and other devices for the conversion of wind energy to electrical or mechanical energy,but only as an accessory use. (7) Bed-and-breakfast operation subject to the provisions of§240-11C(6). [Added 2-20-i9971 D. Special permit uses.The following uses are permitted as special permit uses in the RC-i and RF Districts,provided a special permit is first obtained from the Planning Board: http://ecode360.com/printBA2043?guid=31772736 1/17/2017 Town of Barnstable, MA Page 2 of 2 (1) Open space residential developments subject to the provisions of§240-i7 herein. (2) Private initiated affordable housing developments: A private-initiated affordable housing developments (PI-AHD) on seven acres or more,subject to the provisions of§240-17.1 and in full compliance with the standards set forth therein. Added 11-18-2004 by Order No.2004-1131 E. Bulk regulations. Minimum Yard Setbacks (feet) Minimum Maximum Minimum LotL o tMinimum Lot B u i l d i n g Z o n i n gArea Frontage Width Height Districts (square feet) (feet) (feet) Front Side Rear (feet) RC-1 43,56o2 125 303 15 15 301 RF 43,5602 150 — 303 15 15 301 1 Or 21/2 stories,whichever is lesser. 2 A minimum lot area of 87,120 square feet is required in.RPOD Overlay District. - [Added 10-26-2000] 3 One hundred feet along Routes 28 and 132. . http://ecode360.com/print BA2043?guid=31772736. 1/17/2017 r 311 Navigation Road, West Barnstable, MA, 02668 - MLS#21203536 - Estately Page 1 of 6 �C C�OSe 1 bed/-baths!336 sqp� _ Great Marshes y � r I �s Map data 2017 Googi= " � Not `SoIJ -( 4. rr�rae. 'mob e to",%, rc * ,, . 4 � `FKiti"1, -C� �T P� ..4�y 1= i1 t r� ' 4 M ,'•!..- ~� r 1 1St1ng courtesy o aywew ea state More properties for sale Similar Nearby Similar properties FORSALE : x close F° 1LS'.2i,01136 MLS 2161b09 A51 -"JLSx?i SM136 — — t �T. Fry /94, _ 21610111 or 5alt.37�- td �+ pyJ800 135,000 }' = 1,2 be r.. D E 98 West Main Street U, I, bed,1 bath,864 sgft (http://www.estately.com/Ii4E1 ?it� fIC}��'c�F14P1t�ae �v�fly'Cb'R �� ' ww.estat( bearses--80?ref=similar bear sa �sr a�� ii� ref=simil�� �t �r(Wimilar Patton rd dui a�1 NV2? west maio�s�eet footer) listiVoter) ref ��� ng) GALLERY listing�ef=similar-footer) ref=similar f�ooter) http://www.estately.com/listings/info/311-navigation-rd--2 1/12/2017 311 Navigation Road, West Barnstable, MA, 02668 - MLS#21203536 -Estately Page 2 of 6 pp x CIoSe MLS#21610221 1 bed/-UR�1�5ilk soft MLS#21610354 $135,000 $159,900 398 West Main Street Unit $142,000 85 Woodland Avenue Unit C 4D 18 Brookshire Road 2 bed,1 bath,696 sgft 2 bed,1 bath,864 sgft 4 bed,1.5 bath,1,188 sgft (http://wvvw.estately.com/listingq/I ft)/Bgww.estately.com/listingOAinfo/B9&w.estately.com/listings/info/18- woodland-avenue--2? west-main-street--3? brookshire-road? ref=similar-listing) ref=similar-listing) ref--similar-listing) 0 Browse all properties for sale in Mid Cape,Barnstable Town (http://www.estately.com/MA/Mid-Cape,-Barnstable-Town) Newest homes in Barnstable Town, Massachusetts Foundation:None Family Assessors Recor s Roof Description:Asphalt Style:Cottage Interior Similar properties FOR SALE x close "-p'ice:No Floor- I'.: Fui"J -��,� ML$=71610059 Fo'S .'1 !` 1 i For Sal(B Y--m+ or sal, MLSx 21610Z27 I�oom Dimensions it *hNa"x 0 Famil dtS161:0 x 0 $135,000 �l't00 Bearses Way Unit 3W6 A 5 Woodland Avenue Unit C 398 West Main street U y2 bed,2 bath,845 sgft bed,1 bath,696 sgft 2 bed,1 bath,864 sgft (http://www.estately.com/listings &iakit'ftar SstingOtfp:/8g&w.estately.com/listinggliaWlvgemeestately.com/listingOUJOIB&m.estat( bearses-80?ref=similar- bearses-way--363?ref=similar-oattontrive?r(§�imilar- woodland-avenue--2? west-mdlnes�reet-� footer) Assof�{gflj No Othe Ngppmnents�a13208 Total#� Fg§KW468RA 08 ref=sim lar-footer; http://www.estately.com/listings/info/311-navigation-rd--2 1/12/2017 311 Navigation Road, West Barnstable, MA, 02668 - MLS# 21203536 - Estately Page 1 of 6 �C C�052 1 j1ed/-baths/336 sgft _ Great Marshes ' Map data 201%Google Prev TT I . 4,t s ing courtesy o ayview Keal Estate More properties for sale Similar Nearby ` Similar properties Ff SALE t ti 1 = 2160-I136 MLS#21610059 X CIOSe t. 21610221 or sail���, y - VV s 800 135,000 ni - �2 be ;c G .e 98 West Main Street Ui bed,7 bath,8ev1 sqh (http://www.estately.com/iiii t I �c� tea yt��t fi/ I estate bearses--80?ref=similar- bear sars�'srt�aPIVJ3�ef=sirnA 5- Wr imilar- Pattor�rd�a�i�a��19=-2? west-m�'in-�reet-- footer) listin oter) ref���� ng) GALLERY listing6=similar-footer) ref -ooter) http://www.estately.com/listings/info/311-navigation-rd--2 1/12/2017 311 Navigation Road, West Barnstable, MA, 02668 - MLS#21203536 - Estately Page 2 of 6 MLS#21610221 1 bed/-Ms'1939V sgft I MLS#21610354 $135,000 $159,900 398 west Main Street Unit $142,000 85 Woodland Avenue Unit C 4D 18 Brookshire Road 2 bed,1 bath,696 soft 2 bed,1 bath,864 sgft 4 bed,1.5 bath,1,188 sgft (http://www.estately.com/I istingsattAfn/gwrw.estately.com/listingOikmo/391&w.estately.com/listings/info/18- woodland-avenue--2? west-main-street--3? brookshire-road? ref--similar-listing) ref=similar-listing) ref=similar-listing) 0 Browse all properties for sale in Mid Cape,Barnstable Town (http://www.estately.com/MA/Mid-Cape,-Barnstable-Town) Newest homes in Barnstable Town, Massachusetts Foundation:None Family Assessors Recor s Roof Description:Asphalt Style:Cottage Interior Similar properties FOR SALE x close —pl�ce:No Floorr- F.,Sal,�"^,�'"""' or �^,! For Sale�"'�„� or Sal, •r"L5::1,ull a MLS#21610059 •�—.., 1 MLS#21610221 nr I(oom Dimensions it $13WMIl x 0 Famil 9MMA:0 x 0 $135,000 V800 Bearses Way Unit 3WB e 85 Woodland Avenue Unit C 98 West Main Street U y bed,2 bath,845 sgft bed,1 bath,696 sgft bed,1 bath,864 sgft (http://wvvw.estately.com/listing■fi$M$ @iaks&t'ferfflgisting$ tip w.estately.com/listing5(#inWlvg meeatately.com/listingOtfp)g&Aw.estat( bearses--80?ref=similar- bearses-way--363?ref=similar-[Uatton{drive?r4Wimilar- woodland-avenue-2? west-mjinfs reet-- footer) AssorfW"No Oth�0% — ents�1t3r208 Total/� WpRtf6a{�' 08 ref=simlla looter; A__..,,rnn T_..,,___, � http://www.estately.com/listings/info/311-navigation-rd--2 1/12/2017 /, •-_ - + .ram L�`�` 7 ;r TI 1 � , 311 Navidbtidh ,,® o f` f • • • i Go:-',gle Earth meters 200 800 311 Navigation Road, West Barnstable, MA, 02668 - MLS# 21203536 - Estately Page 3 of 6 �C Close Location 1 bed/-baths/336 sqft Convenient To: Location Description: Town:Barnstable Conservation Area,Golf North of 6A Village:West Barnstable Course,Horse Trail,In Miles to Beach:0-.1 Town Location,Major Zip Code:02668 Street Description:Dirt, Highway,Medical Facility, Unpaved Shopping County:Barnstable Directions:Rout 6A West, pass rt.149 on left. Navigation Road is next right.Cottage at end of Road sitting in Great Marsh. The Property Al Water Access:Salt Parking Similar properties FOR SALE x close Garage:No .w1 w s _ Pr �, `1 For Salf �„�,'^' or Sal, ""` ' •-+JLS-21601136 For Sal, MLS#21610059 1 t MLS#21610221 Iiiat it's like to li i n Road $139,999 $159,900 135,000 800 Bearses Way Unit 3W8 85 Wcodiand Avenue Unit C 98 West Main street Ui 2 bed,2 bath,845 sgft 2 bed,1 bath,696 sgft bed,1 bath,864 sgft (http://www.estately.com/1isting�ht fpjgO@vw.estately.com/listing�Aid /Bt39dw.estately.com/listing0n#jlvgeneeatately.com/1isting ffpjKaww.estat( bea rses--80?ref=sim ila r- bearses-way--363?ref=similar-oattorLidrive?rEWimilar- woodland-avenue--2? west-mints reet-� MA Eel GALLERY footer) Tooter) footei ref=similar-Tooter) ref=similar-ooter) http://www.estately.com/listings/info/311-navigation-rd--2 1/12/2017 311 Navigation Road, West Barnstable, MA, 02668 -MLS#21203536 -Estately Page 4 of 6 /. 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Provided by H- Lodi-- r� 9 t�,ComLnorrNealth oI Ssachusetts EOEA,USDA Fairn Barnstable United Elemen N/A (/MA/Barnstable_United_E Public 4-S •rlilar properties FOR SALE Barnstable Intermediate S x close (http://www.greatschools.org/massachusetts/barnstable/5324- (/MA/Barnstable_Intermec 7 For s� }�, "".'r1Tq��pp�{ {�$Cf: r DII.F�-S h y��'�'.,,,'-'� or Sall ;tt •1dLS#2i60i i3o it MC33F Z'1611�59 �;i i r a .3 MLS421610221 n able High School(/� tt ';//www.greatschools.org/mass �zz139,9rnstable-High-School 159,900 135,000 800 Bearses Way Unit 3WB 5 Woodland Avenue Unit C 98 West Main Street U 2 bed,2 bath,845 sgft bed,1 bath,696 sgft 2 bed,1 bath,864 sgft/www.estatel .com/li tin � estatel .com/I.stin �i /g000 gerst el com/II tin g v o,,,tat�l .com/listin s(l dpl8yww.estat( y �G $tools scor�srasec�on cue fr 1 o wy}�ere 1�Is6ov�r�ge. y� g hearses 80.ref-similar- earses-way-- re-similar- a on nve.r ImI ar- woo an venue--2. west-mine reet-- Tooter) The del-)ervice areas are not defltWCio fd'shoLN'F&hly be used aslgt4i�ln&r-footer) ref=similar-ooter, L..........----.--L--1�—..� http://www.estately.com/listings/info/311-navigation-rd--2 1/12/2017 fir``, `,��� ;zti(":�`' �-j�.f` � ,I. ,. 4t.'° ,/��� � � +'� +i 1• 1 d t j 3. lw GoogleEar:.th Google Earth lee, �800 00 `i r - t• t' /In 7�7T J 1( � r oogle EartN feet' 70 Goc gle Earth r„eters 20 } i a4y a ` VAN C700gle Earth Y EarthGoogle 1 metersi 1 311 Navigation Road, West Barnstable, MA, 02668 -MLS#21203536 - Estately Page 2 of 6 x C�OS2 Msn 21610221 1 bed/-Dd1AS%°�°3 sgft MLS#21610354 $135,000 $159,900 398 West Main Street Unit $142,000 85 Woodland Avenue Unit C 4D 18 Brookshire Road 2 bed,1 bath,696 sgft 2 bed,1 bath,864 sgft 4 bed,1.5 bath,1,188 sqft (http://www.estately.com/1 istingOM fo/8ww.estately.com/listing(Mkb ftWBQ&v.estately.com/listings/info/18- woodland-avenue--2? west-main-street--3? brookshire-road? ref=similar-listing) ref=similar-listing) ref-similar-listing) Qb Browse all properties for sale in Mid Cape,Barnstable Town (http://www.estately.com/MA/Mid-Cape,-Barnstable-Town) Newest homes in Barnstable Town, Massachusetts t _ Family sessors Records Foundation:None Y Roof Description:Asphalt Style:Cottage Interior Similar properties FOR SALE xclose -pl ice:No Floor,,- � r Si --_ Salr " - 1WR 17bed, r Salr�"^^ or Sall y _ — MLS#216 T 0059 MLS#21610221 Room Dimensions it $FF�'t�x`�:�x0 Familt�la61:0 x 0 135,000 800 Bearses Way Unit 3WB dland Avenue Unit C 98 West Main Street U k2 bed,2 bath,845 sgft 1 bath,696 sgft bed,1 bath,864 sgft (http://www.estately.com/listingf%*V$ iaisbt'lerfflgstingsVitlfp)BOWw.estately.com/listingOmWlvgep"at,3tely.com/listingOdofifiww.estat( bearses--80?ref=similar- bearses-way--363?ref=similar-[Uatton&rive?r(Wimilar- woodland-avenue--2? west-m�io�s{�eet footer) Assoc No Oth � sments�d08 Total § T�d�§08 ref=similar-footer: http://www.estately.com/listings/info/311-navigation-rd--2 1/12/2017 311 Navigation Road, West Barnstable, MA, 02668 -MLS#21203536 -Estately Page 1 of 6 �C CHOSE 1 bed/-baths/336 sgft a Great Marshes FE COOO, lu �,�{� (6Aj Map data 2017 Google Prev 1s 1ng cou esy o aywew ea sta e More properties for sale S11T111ai Nearby Similar propertle-ss FOR �'Iy1L 1t1 s x close 2 ,U 136 M t5#21610059 •,ULS#2160113b p 1 _r i-C _ _.I for te^ 461 ! rS3t t21610221 1"98 r Sall it ,tl tl A. —�800 135,000 2 be West Main Street Ubed,1 bath,864 sgftw. http://wwestately.com/lis�l 191 1 tt� ity��F 3t e A f4ANMy.'csblfl�H/�0ri� AFNA .estatf bearses--80?ref=similar- bear �srt a�� ��5ief simile t Wrlgimilar- Pattortl rd9a =B9[5Y---2? west-m�inn �eet-- footer) listinoter) ref�����ing) GALLERY listing�ef=similar-footer) ref=similar-ooterJ http://www.estately.com/listings/info/311-navigation-rd--2 1/12/2017 311 Navigation Road, West Barnstable, MA, 02668 - MLS#21203536 -Estately Page 4 of 6 x Close to SoundscoreTM Ir-. Pi -Videdh5 f�{ 9�achuseas on�.veaith o M- EO€,i,USDA�am - AL Barnstable United Elemen N/A (/MA/Barnstable_United E Public 4-5 •nilar properties FOR SALE Barnstable Intermediate S x close (http://www.greatschools.org/massachusetts/barnstable/5324- (/MA/Barnstable_Intermec ,For Sias �-nt SCt �"` If��F als �""� or Sala MCSaF lTOWP ;( �*u., i MLS#21610221 n able High School(/N S ti //www.greatschools.org/mass �22 5139,9�rnstable-High-School 1 1159,900 135,000 J Bearses Way Unit 3WB a 85 Woodland Avenue Unit C IS 98 West Main Street U k2 bed.2 bath,845 sgft 2 bed,1 bath,696 sgft bed.1 bath,864 sgft (htt ://www.estatel .com/li tin $tin /g�p��estate) com/1'sting$fi ?gg�g��,,,es el com/Ii tin ��p at,3t�l .com/listin O estat( p y G �t�ools scor� ased on,Wd1h e fr 1 o wy}-erme/1 tiovp�vuv �e y� g w bearses--80.ref=similar- earses way-- re-semi ar- a on nve.r fmf ar- woo an venue-2. west-mio�s feet-• footer) The skJW&;ervice areas are not defli tiot3 d`shotfltf Uhly be used aslgdidamWar-footer) ref=similar-ooter, hap://www.estately.com/listings/info/311-navigation-rd--2 1/12/2017 311 Navigation Road, West Barnstable, MA, 02668 -MLS#21203536 -Estately Page 3 of 6 X C�OSt' Location 1 bed/-baths/336sgft Convenient To: Location Description: Town:Barnstable Conservation Area,Golf North of 6A Village:West Barnstable Course,Horse Trail,In Miles to Beach:0-.1 Town Location,Major Zip Code:02668 Street Description:Dirt, Highway,Medical Facility, Unpaved Shopping County:Barnstable Directions:Rout 6A West, pass rt.149 on left. Navigation Road is next right.Cottage at end of Road sitting in Great Marsh. The Property t it I . Water Access:Salt Parking Similar properties FOR SALE X close Garage:No •MLiz?1601136 For S�lt ,�ti'� MLS#21610069 Or � "'^ �1.-� FFor Sal, ��'-'� MLS#21610227 or Sal. , Oiat it's like to li i n Road 139,999 159,900 135,000 OOBearses Way Unit 3WB 5 Woodland Avenue Unit C 98 West Main Street Ui bed,2 bath,845sgft bed,1 bath,696 sgft bed,1 bath,864 sgft (http://www,estately.com/listing0u#igO@vw.estately.com/listingOlafpAhigvw.estately.com/listingOdiwnvgeoleeatately.com/1isting$fitl#A%wm.estat( bearses--80?ref=similar- bearses-way--363?ref=similar-[Uatton*rive?r(Wimilar- woodland-avenue--2? west-m innteet-- footer) footer) loote'J EET GALLERY ref=similar-footer) ref=similar-ooter) http://www.estately.com/listings/info/311-navigation-rd--2 1/12/2017 311 Navigation Road, West Barnstable, MA, 02668 - MLS# 21203536 - Estately Pauc 1 of h �C C�OS2 Great Marshes 1 bed/-baths/336 sq --•—� _ _--- _ Map data 2017 GoogleI Rim Prev Next - _ - -= i tf, . 1' l I Listing courtesy o ayview ea sta e More properties for sale Similar Nearby Similar propertie's FOR SALE + 1 x close �AISR`21601136 ^' NIS-216100 9 IS, 491 tt 4.51 ...,.... �--�p15#27607736 _6t OJ5 �°f Y- 27670227 or Sall ' i�• �� sip �- . Boo 135,000 2 be a 98 West Main Street U, bed,1 bath,864 sgft (http://www.estately.com/lisp its l}��c�l -wMdwI w.estatf hearses 80?ref=similar- bearsa97Srays &fef=similetWrtimilar- Pattorrda�i -a� ��-2? west-m in- reet footer) listinCter) ref���� ;ing) ��ER listin4ef=similar-footer) ref=simililarsfooter; http://www.estately.com/listings/info/311-navigation-rd--2 1/12/2017 i 311 Navigation Road, West Barnstable,MA, 02668 - MLS#21203536 -Estately Page 2 of 6 x Close MI5#21610221 1 bed/-*a� s'Mi'9scift MLS#21610354 $135,000 $159,900 398 West Main Street Unit $142,000 85 Woodland Avenue Unit C 4D 18 Brookshire Road 2 bed,1 bath,696 sgft 2 bed,1 bath,864 soft 4 bed,1.5 bath,1,188 sgft (http://www.estately.com/listingl',`Hut' fnf8iww.estately.com/listingVAinft)/898w.estately.com/listings/info/18- woodland-avenue--2? west-main-street--3? brookshire-road? ref=similar-listing) ref=similar-listing) ref=similar-listing) M)Browse all properties for sale in Mid Cape.Barnstable Town (http://www.estately.com/MA/Mid_Cape,_Barnstable-Town) Newest homes in Barnstable Town, Massachusetts < > I Foundation:None Family sessors ecor s Roof Description:Asphalt Style:Cottage Interior Similar properties FOR SALE x close ,.a�,:� •. =,.--�Plice:No Floorr•."--' r<r Sal. ""`•' for "^,,, For Sal. �""^ or Sal. -- � MLS#21610059 � 1- ��•� ML6#21610221 �- - I doom Dimensions it �x 0 Famil 9MAW:0 x 0 $135,000 �800 Bearses Way Unit 3W6 8 2 bed,2 bath, 45 sgft e bed,1 bath,696 sgft Nt C bed,isbath,864 soft (http://www.estately.com/listingOWanwiai&tTermSistingOffpjg@&w.estately.com/listing fpjgOAaw.estately.com/listing id#nvgeuleestately.com/listing idfjcrl%ww.estat( bearses-80?ref=similar- bearses-way--363?ref=similar-oatton*rive?rEo�gimilar- woodland-avenue--2? west-m�inlreet-- footer) AssoT6;6"No Othe fM mnents3r2�108 Total pia§KWtf634- 08 ref=similar-flooter; http://www.estately.com/listings/info/311-navigation-rd--2 1/12/2017 311 Navigation Road, West Barnstable, MA, 02668 - MLS#21203536 - Estately Page 1 of 6 �C CHOSE 1 bed/-baths/336 s Great Marshes Map data 2017 Google Prev may'� --•;SC'_' — Listing courtesy ot CCI Bayview Keal bstate More properties for sale Similar Nearby �+ Similar properties FOR SALE x close A . f11tS#2160113&" MLS 21610059 451 + a �` �,K •. TdLS#21601136 _ - 2161005� °r �-- .9451 '°""� -id MLl 21610221 or Salr 'F 11�r _:... 135,000 800 is 1 2 be rD a 98 West Main Street U bed,1 bath,864 sgft (http://www.estately.com/lis�1111� 1��� �tt A m2fto�f�'�lylt�b'�$�/��c� ' w.estat( bear is�sf a� ��5ref=simil�� 5t �EW' pattonWffi' li=OV2? west-m innteet-- bearses--80.ref=similar- �a r Imilar- footer) listin oter) ref���� ing) �AttEa listingW=similar-footer) ref=simi- -ooter; http://www.estately.com/listings/info/311-navigation-rd--2 1/12/2017 311 Navigation Road, West Barnstable, MA, 02668 -MLS#21203536 -Estately Page 2 of 6 X CIOSe l21610221 1 bed/—DdLRM9 sgft I MLS#21610354 $135,000 $159,900 398 West Main Street Unit $142,000 85 Woodland Avenue Unit C 4D 18 Brookshire Road 2 bed,1 bath,696 soft 2 bed,1 bath,864 sgft 4 bed,1.5 bath,1,188 sqft (http://www.estately.com/1isting$M fnfg5ww.estately.com/listing#iinfnf898w.estately.com/listings/info/18- woodland-avenue--2? west-main-stl brookshire-road? ref=similar-listing) ref=similar-listing) ref=similar-listing) ffj Browse all properties for sale in Mid Cape,Barnstable Town (http://www.estately.com/MA/Mid-Cape,-Barnstable-Town) Newest homes in Barnstable Town, Massachusetts Foundation:None Family Assessors Records Roof Description:Asphalt Style:Cottage Interior Similar properties FOR SALE %close w ' ^p'ice:No Floor,,'A 1-4 SalE MLS#21610069 o.i., 1 '� ' or SalE "^''a or Salt D,t—,.�. MLS#21610221 -01 Iloom Dimensions i va%"x 0 Famil �Z�9cRA61:O x 0 5135,000 800 Bearses Way Unit 3W13 85 Woodland Avenue Unit C 398 West Main Street U 2 bed,2 bath,845 sgft 2 bed,1 bath,696 sgft bed,1 bath,864 sgft (http://www.estately.com/listi ng�$kt�l¢C4hlsting$#itifjpw.estately.com/listing�til�jro/lv�oleeatately.com/Iisting9lit1J85�ww.estate bearses--80?ref=si mila r- bearses-way--363?ref=similar-0jattonjdrive?r4Wimilar- woodland-avenue--2? west-m in �eet-- footer) Assoc No Other�bsments,1L3r208 Total § T�a §08 ref=similar-ooter; http://www.estately.com/listings/info/311-navigation-rd--2 1/12/2017 311 Navigation Rd, Barnstable, MA 02630 Zillow Page 3 of 9 Calling all artists, writers, hunters and those with the desire for solitude. Beautiful camp retreat on it's a great time to check rates 2.5 acres on the Great Marsh with to a local lender 8, Fee what I Spring Creek 100ft away. Fishing, yuu, mortgage rate could be kayaking, swimming, and hunting are right outside your door with spectacular 360 degree views. Wildlife galore.An unusual and unique property. Report this ad FACTS ■ Lot: 2.55 ■ All time Candidate acres views: 2,007 for a ■ Single ■ Last sold: community Family Apr 2016 for solar ■ Built in 1900 $115,000 program ■ Last sale Sun price/sgft: Number TM: $342 33 FEATURES More\/ See data sources Zestimate Details Add owner estimate Zestimate® Rent Zestimate Zestimate $403 605 forecast Last $ nT,ol se,,�MaUast $14,114 ��i �T 30 days $44 Last 30 U $303K $480gays0 One year Zestimate range $1.2K $2.2K Zestimate range I disagree with my Zestimate http://www.zillow.com/homedetails/311-Navigation-Rd-Barnstable-MA-02630/55856363... 1/12/2017 311 Navigation Road, West Barnstable, MA I Trulia.com Page 1 of 4 Buy Rent Mortgage Sell Find an Agent Local Scoop More Saved Homes 1 Saved Searches Sign In West Barnstable.MA 0 SAVED♦ Q Get Pre-Qualified C Save 0 Share Find out What your home Is Worth. Get My Home Value a r Contact for estimate > Refinance your home» Heather Miller ® (508)306-1903 *****(31) • 24 Recent Sales Livia Freitas Monteforte (508)403-2969 *****(36) 38 Recent Sales 9 Smith&Mooney it (508)762-1401 *****(28) 29 Recent Sales Your Name ®,. Email view Map Phone UNKNOWN I'm interested in selling my home at 311 311 Navigation Rd Navigation Rd,West Barnstable,MA 02668. West Barnstable,MA 02668 © See your commute times Request Info Single-Family Home Lot size:111,078 sqft Provided By:Bayview Real 1 Bedroom Built in 1900 Estate Trust By sending.you agree toTrunas Term of Use&Privacy Policy 336sgft 180+Days onTrulia ® Edit Home Facts $446/sgft Property Details for 311 Navigation Rd Sold>MA>West Barnstable>02668>311 Navigation Rd 25 views Residential,Cottage-West Barnstable,MA Description provided byTrulia This Single-Family Home is located at 311 Navigation Road,West Barnstable,MA.311 Navigation Rd is in the 02668 ZIP code in West Barnstable,MA.The average listing price for ZIP code 02668 is$554,340.311 Navigation Rd has 1 bed,approximately 336 square feet,and was built in 1900 https://www.trulia.com/proper-ty/1076204555-311-Navigation-Rd-West-Barnstable-MA-0... 1/12/2017 311 Navigation Road, West Barnstable, MA Trulia.com Page 2 of 4 I BC GREENHOUSE , BUILDERS LIMITED Over •4 Years in Business Get a . . Catalog Prove You're Ready to Buy rind a local lender on Trulia who can help you get pre qualified. Get Pre-Qualified See businesses, schools, and crimes near this home © Calculate your commute time from this home TOSee businesses within 1 mile of this home + 8� See demographics within 1 mile of this home QSee 3 schools assigned to this home.West Barnstable Ele... v ® See reported crimes near this home v https://www.trulia.com/property/1076204555-311-Navigation-Rd-West-Barnstable-MA-0... 1/12/2017 311 Navigation Road, West Barnstable, MA, 02668 -MLS#21203536 -Estately Page 6 of 6 Cobbs Village Homes Seattle,WA(/WA/Seattle) x C�OSe (http://www.estately.com/MA/CobbsVacpgelsur CA/San_Diego)Bid,MD(/MD/Leisu e_World), Cotuit Homes e (http://www.estately.com/MA/Cotuit,_BarnstablEP?FdAvo,OR(/OR/Portland) Hyannis Port Homes Myrtle Beach,SC(/SC/Myrtle Beach) (http://www.estately.co m/MA/Hyannis_Po rt,_Ba rbstablp,_([A*4WCo ro na) Marstons Mills Homes New Orleans,LA(/LA/New_Orleans) (http://www.estately.com/MA/Marstons_Mills,_BShilta�gtearTi vt k)(/AL/Birmingham) Mid Cape Homes (http://www.estately.com/MA/Mid-Cape,_Barnstable-Town) Nyes Neck Homes (http://www.estately.com/MA/Nyes-Neck,_Barnstable-Town) Oysterville Homes (http://www.estately.com/MA/Oysterville,-Barnstable-Town) West Barnstable Homes (http://www.estately.com/MA/West-Barnstable,_Barnstable-Town) Wianno Homes (http://www.estately.com/MA/Wianno,-Barnstable-Town) Estately Inc.O Call 1-800-241- J Similar properties FOR SALE x close r "-i•�,"'Q' _ or Salt MLS#27610059 i For Sal, or Sal, MLS#21610221 $139,999 159,900 135,000 800 Bearses Way Unit 3WB 5 Woodland Avenue Unit C 98 West Main Street U bed,2 bath,845 sgft bed,1 bath,696 sgft bed,i bath,864 sgft (http://www.estately.com/IistingO w.estately.com/IistingO*1MWm.estately.com/Iisting0u#nvgenmtately.com/Iisting%h fpjKw w.estat( bearses--80?ref=similar- bearses-way--363?ref=similar-oattonjlrive?r4Wimilar- wood la nd-avenue-2? west-m innlreet-- footer) footer) MA�oote�E� GALLERY ref=similar-footer) ref=siml ar-ooter: w http://www.estately.com/listings/info/311-navigation-rd--2 1/12/2017 311 Navigation Road, West Barnstable, MA, 02668 - MLS#21203536 -Estately Page 5 of 6 x Clos 1 bed/-baths1336s ftft sold comparable home s More recently sold homes in Mid Cape,Barnstable Town,MA (http://www.estately.com/MA/Mid-Cape,-Barnstable-Town/sold) ....� Q � OLD 16 S�i� �/8/7G �� '• r� 1/4/16 _ 130,001 00 Bearse bed,2 bai (http://www.estately.com/listings/info/817- (http://www.estately.com/listings/info/3040- (http://www.estately.com/listings/info/855- (http://wvw old-strawberry-hill--4?ref=sold-listing) Falmouth-20?ref=sold-listing) west-main--9?ref=sold-listing) bearses-WE Newest listings in Barnstable View all homes for sale in Barnstable Town,MA Town, NIA (http://www.estately.com/MA/Barnstable-Town) 195,800 1 Aldeas Ave bed,1 bath, (http://www. (http://wvw aldeas-avenu pine-lane- > i 02601 Homes for sale Harwich (http://www.estately.com/MA/02601) (http://www.estately.com/MA/Harwich) 02632 Homes for sale Mashpee (http://www.estately.com/MA/02632) (http://www.estately.com/MA/Mashpee) 02633 Homes for sale Similar propertie�,F%RLE x close ik,*p•"www estateiV.com/MA/02633) 'k-1 ta' l .c^m/MA/Plvmouth) - -4.1LS»215ot 136 F SaIF ""�"^' MLS#21610059 - 1 - For Sah� ""� MtS#21610221 or 5ah ... - ..,a4 �orri n tvt�aiC "" - pkHomesforsale .estately.com/MA/02649) ,t c /MA/Sandwich) 5 p �ately.com/MA/02655) reham) 135,000 7B&fOIa15'31e3W6 5 Woodland Avenue Unit C 98 West Main Street U, p ��a���f?�om/MA/02673) A1'�`a1r(�t`bWh) bed,1 bath,864sgft (http://www.estately.com/Iistinglh fpJgfWw.estately.com/Iisting%hd*Ng aw.estately.com/listingO fpnvgeneeatately.com/IistingOUQDA%vm.estat( bea rses--80?ref=sim ila r- NeartagOg�*rJAg4f=similar-oattonjlriRR AIMPs woodland-avenue--2? west-m�io�s�reet-- footer) BaxtOP�K Homes M"�ootePJ�` Las` gas,NV(/NV/Lak"jgar-footer) ref=sim ar ooter) http://www.estately.com/listings/info/311-navigation-rd--2 1/12/2017 � �h ome 508-775-7701 Cell 508 326-1321 Home: 508-477-0526 Cell: 508-962-2045 Home: 508-428-2594 Cell 508-294-1371 Home: 508-776-1590 8 Pager: 391-8809 forms:QEMERGINSP—REV 06/08/06 1 Town of Barnstable �-;Ple # �� • C• Expires 6 monthsjrom'ssue date Regulatory Services Fee • BAMSMBIB MASS. Richard V.Scali,Interim Director Building Division Tom Perry,COO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL. ONLY Map/parcel Number /8 O O 6 q Not Valid without Red X-Press Imprint (� Prope Address 3 �� ��Vt �u��� �Qu� w�� pjwhyc�J Residential Value of Work$ S O L v Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address I`,,n 2 l( 0,ZC 30 Contractor's Name De, 0 Le t l Telephone Number S v :7 3 7- 3 T�F Home Improvement Contractor License#(if applicable) /C U 7 A 2__ Email:A to y- ,epa +F Construction Supervisor's License#(if applicable) G J F — 0 S / ! / r_-. eft "Aft,,,e Workman's Compensation Insurance Check one: ❑ I am a sole proprietor MAY 16 2014 ❑ 14in the Homeowner a-11have Worker's Compensation Insurance Insurance Company Name, rti Ve 1{f `S Co r 1 `�OWN ®F SARNSTABLE Workman's Comp.Policy# C, ` I " LI S — L/— 1" Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) T(Ws u� &.Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders:U-Value (maximum.35)#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 i required. SIGNATURE: qbl TAKEVIN D\Building Changes\EXPRESS PERMI'REXPRESS.doc Revised 061313 77ie Coniniornvealth of Massachusetts Department of Industrial Accidents Office of Investigations WJ 600 Washington Street Boston,MA 02111 ivivin nias&gvv1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Elechzcians/Plumbers Applicant Information / /� Please Print Le4ibly Name(Busmeesslorganizatimindividoal). Dui. L . �,Ive��r Cw pe tl e Address: P, 0, QG 4 City/Statc/Zip: �fh�f- /�ti OA`3 Phone#- S y Are you an employer"Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4- ❑ I am a general contractor and I 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 Y c for me in an ci employees and have workers' capacity.[No workers'comp.insurance comp.itlsurance.I 9- ❑Building addition required-] 5. ❑ We area 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'camp right of exemption per MGL 12.( K Roof repairs insurance required.]1 c. 152,§1(4),and we have no employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks boat#1 must also fill out the section below showing their workers'compensation policy information_ 1 Homeowners who submit this affidatdt indicating they are doing all wa t and then hire autade contractors rust submit a new affidavit indicating such. lCentractors that check this boat must attached an additional sheet showing the name of the sub-ca ntrmctors and state whether or not those entities have employees. If the subcontractors have employees,they most provide their workers'camp.policy number. lam are employer that is prmiding workers'compensation insurance for aey employees. Below is the policy and job site inforaratiou. 1 I �+ Insurance Company.Name: T� l Zye,l<» Policy#or Self-ins.Lie.#: � 0�Q — ` n- P LJ 3- � 1 ( 5— ^r Expiration Date: & Job Site Address: Ni.V t 5 C.b u, 1` 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 2.5A 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 hereby ce raider the ns mid a talties of pet7ury that the information proWded abm�e is true/aced correct Signature: Date: S Phone#: Sy U �3 3 Official use only. Do not write in this area,to be completed by city or town official. City or Town: PermitUcense# 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#: k NOTICE i W NOTICE TO V > a TO EMPLOYEES �` EMPLOYEES O9M SV The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 Washington Street, Boston, Massachusetts 02111 617-727-4900 — http://www.mass.gov/dia As required by Massachusetts General Law, Chapter 152,Sections 21, 22&30, this will give you notice that I (we) have provided for payment to our injured employees under the above mentioned chapter by insuring with: THE TRAVELERS INSURANCE COMPANIES NAME OF INSURANCE COMPANY P.O. BOX 1450 MIDDLEBORO, MA 02344-1450 ADDRESS OF INSURANCE COMPANY (6HUB-4776P45-4-13) 07-12-13 TO 07-12-14 POLICY NUMBER EFFECTIVE DATES NORTHWOOD ESHBAUGH INS 540 MAIN STREET HYANNI S MA 02601 NAME OF INSURANCE AGENT ADDRESS PHONE# O'NEILL, DANIEL L . DBA 1314 OLD QUEEN ANNE DANIEL L . O'NEILL CARPENTRY CHATHAM MA 02633 EMPLOYER ADDRESS EMPLOYER'S WORKERS COMPENSATION OFFICER (IF ANY) DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS 002098 W20P1G02 TO BE POSTED BY EMPLOYER r - anaNsTeet.e. ,` Town of Barnstable QED MA'S� Regulatory Services Richard V.Scali,Interim 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, j.4 A V V \ j O.eVx ,as Owner of the subject property hereby authorize 141LI j ��/��> ( � t arL/Jca �Vy to act on my behalf, in all matters relative to work authorized by this building permit application for: Z<< (Address of Job) < �d Signature of Owner Date —Q'�65 Q1 bU L (i Print Name i If Property Owner.is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. ' T:\KEVIN D\Building Changes\EXPRESS PERM I T\EX PRES S.doc Revised 061313 u Board of Building Regulations and Standards Cmistructiun Super%i.ur I & 2 Family License: CSFA-105994 DANIEL O'NEILL,` --- P.O.BOX 1871 = _ Cotuit MA 02635= Expiration Commissioner 10/23/2015 (777777 C%���iiiraeniitoen�/�r�C%llrr.r.7�n•lu.lr•/%1 Office of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR' egist ration: 16.8722 TYPE xpiration: 5/15/2015 DBA DAN L.O'NEILL CARPENTRY DANIEL O'NEILL 9 CAPTAIN ISIAH'S RD 4 o -�- - -- - - COTUIT,MA 02635 Undersecretary License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation f 10 Park Plaza-Suite 5170 Boston,MA 02116 f Not valid without signature E Restricted -One-and two-family dwellings or any ?.ccessory building thereto, irrespective of size. ailure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. -nr_nDC 1 ironcina infnrmatinn vicit• eienu�Aacc(:mi/f1DC TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Yo-32 Z� Map `' Parcel Application # Health Division Date Issued 5 Conservation Division 1 Application Fee i Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address S A)G v Cr f r'& Village W-0 S f- h rf-,6/e.. -7 j� Owner 4 3 Ile�( �l!, ,/�i(G /! Address / � T 1 %Coln,SI$c✓l 3144 Telephone Permit Request Rv- em ir- roof the 114-��� rc-pct r f'o t- t.-, RC- 4v5 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation a,SGa Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: dYes ❑ No On Old King's Highway: l(Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑ Walkout ❑ Other Alu^o Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing 0 new Half: existing new Number of Bedrooms: 0 existing _new Total Room Count (not including baths): existing a_ new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric QkOther Na"��-- Central Air: ❑Yes If 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: I Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes 14 No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name `�+;e 0 W e� G� Telephone Number Address P 0, License # C S F/f — f O ! y� Home Improvement Contractor# Email Ao wpe^tT Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 7 w. 13�.s-� �i�` fir�.s _r SIGNATURE o DATE G FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP'/PARCEL NO. G ADDRESS VILLAGE OWNER DATE OF INSPECTION: 4 FOUNDATION :: FRAME ` r A INSULATION �a ; FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING; r DATE-CLOSED OUT 4 A, SOCIATION PLAN NO. f , Town of Barnstable Regulatory Services Richard V.Scali,Interim 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 CV,UJ vl ,as Owner of the subject property hereby authorize QiLk to act on my behalf, in all matters relative to work authorized by this building permit application for:" (Address o Job) Signature of Owner ate QIJ$5Q L VD NA A Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. TAICEVIN D\Building Changes\EXPRESS PERMMEXPRESS.doc Revised 061313 NOTICE N W NOTICE TO 0 TO a EMPLOYEES EMPLOYEES yc �W 1 V The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 Washington Street, Boston, Massachusetts 02111 617-727-4900 — http://www.mass.gov/dia As required by Massachusetts General Law,Chapter 152,Sections 21,22&30, this will give you notice that I (we) have provided for payment to our injured employees under the above mentioned chapter by insuring with: THE TRAVELERS INSURANCE COMPANIES NAME OF INSURANCE COMPANY P.O. BOX 1450 MIDDLEBORO_, MA 02344-1450 ADDRESS OF INSURANCE COMPANY (CHUB-477GP45-4-13) 07-12-13 TO 07-12-14 POLICY NUMBER EFFECTIVE DATES NORTHWOOD ESHBAUGH INS 540 MAIN STREET HYANNI S MA 02601 _ NAME OF INSURANCE AGENT ADDRESS PHONE# O'NEILL, DANIEL L . DBA 1314 OLD QUEEN ANNE DANIEL L. O'NEILL CARPENTRY CHATHAM MA 02633 EMPLOYER ADDRESS EMPLOYER'S WORKERS COMPENSATION OFFICER(IF ANY) DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of —' employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the '— injured employee. The employee may select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS 002098 W20P1G02 TO BE POSTED BY EMPLOYER i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): DC- t CGcpg, 4,4w Address: R 0, NJ 1 u 1 City/State/Zip: Cx4—+ A, 0 4 3S Phone#: Are you an employer?Check the appropriate box: I am a general contractor and I Type of project(required): 4. 1.[3 I am a employer with ❑ 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' 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 I I. 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' 13.2 Other Frw*e RePq,'rl comp. insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the 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. h II Insurance Company Name: t,,'Ud }^SwG►,!� C O r�.Pun►e S Policy#or Self-ins.Lic.#: G Q -" y S- q- I Expiration Date: Job Site Address: U City/State/Zip: We l fIL Ott, 01(,C8 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 y under the pains and penalties of perjury that the information provided above is true and correct. Signafore: c_ Date: �- D Phone#: S U S 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#: Accessory building thereto. irrespective of size. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For DPS Licensing information visit: www.Mass.Gov/DPS o s ..,.--ate--'--rr---` _ � -�_ .__,: .�-..q- .---•.T.--� c • License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116t 1 { Not valid without signature l-1�( (C�11 J71//CIII/CCG'lCll/'/.I)f�'G"/lCJ9U(�/CJGI�J Office of Consumer Affairs&Business Regulation - - ME IMPROVEMENT CONTRACTOR egistration: 168722 Type; xpiration: 5/15/2015 DBA DAN L.O'NEILL CARPENTRY DANIEL O'NEILL 9 CAPTAIN ISIAH'S RD COTUIT, MA 02635 Undersecretary I SLOZ/£VOL Jauo1ss1tuwo0 uoijeJidx3 :cMz0 VW 1!n7o,O J L81 x09 -�, TII3N A,13INtV4 V66SOL-VASO :asuaoi� 4!uta3 z 1` ! a��..,!.�radnS uoil. t.un•) spJepue;s pue suo!;e"In6a.8 6u!pfin8}o pivo8 Town of Barnst able *Permit# Expires 6 months from-me date Regulatory Services Fee_r7 omas F.Geller Director au 16 2 Building Division S rry;CBO, Building Commissioner y, �0��� j P' 200 ain Street,Hyannis,MA 02601 ,1 S �'��__ www.town.barnstable.ma.us s//DD Office: 508-862-4038 q1/�F x: 508 EXPRESS PERMIT APPLICATION - RESIDENTIA`t,''ONLY 6 06 Not Valid without Red X-Press Imprint Map/parcel Number Property Address t2ff 4/i411 f P_47/ON te. esidential Value of Work A 0196 --- Minimum fee of$25.00 for work under$6000.00 1 Owner's Name&Address &Ll o 17 DO W li,LC W 37 94 r-V(S-A)aLC A70- Contractor's Name e Dj CI�Gi2SDs't/ Telephone Number ok lf,,kg Home Improvement Contractor License#(if applicable) /00 SY,J Construction Supervisor's License#(if applicable) orkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name jg K I¢AJ/TC-: S 7,4— Workman's Comp.Policy# t t/ C "a — !(t'- g"Z Copy of Insurance Compliance Certificate must be on file. I Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to 20 In 19 ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission.. . Home Improvement Contract nse is required. SIGNATURE: Q:Forms:expmtrg Revise071405 M I ne t,ommonwealm of lvlussucnuyeus Department oflndustrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/lElectricians/PluYnabers Applicant Information Please Print Legjbly Name (Business/Or, nizationadividual): W Zf• /r-/«�Sc� Address: /i 2, 'TkS IAIIQ-4 City/State/Zip: 7 47 Uri _/ 19- Phone#: L �fAS- Are ypu an employer? Check the-appropriate bog: Type of project(required): 1.2rI am a employer with O 4. ❑ I am a general contractor and I employees (full and/or part-'time).* have hired the sub-contractors 2. New construction 2.El am a sole proprietor or partner- listed on the attached sheet 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for mein any capacity. workers' comp.insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.[1 Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12. roof repairs insurance required.] t employees. [No workers' comp.insurance required.] 13.❑ Other *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 we doing all work and then hire outside contractors must submit a new affidavit indicating such tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy inforrnation. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information. Insurance Company Name: Gq 4c1/ITG z'Tp�/n01!'UKA-n,C(�_— CI DV",? to'$)ti� Policy#or Self-ins.Lic. #: it/e— 8- /J1. r'y, Expiration Date: Job Site Address: 311 /Vl9 Vl iorl 11D�/ � City/State/Zip: &,qBZ M13�_ 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 under the pains d nalties ofperjury that the information provided above is true and correct. Si atire: Date: — Phone#: S-0 C-f� 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#: Ii.formation and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as "an individual,partnership, association, corporation or other legal.entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152;§25C(6)also states that"every state or local licensing agency shall withhold the issuance or . renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,.§25C(7)states"Neither the commonwealth nor any of its political subdivisions. shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-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 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 permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications m 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-S77-MASSAFE Fax # 617-727-7749 Revised 5-26-05 WWW.Il3aSS.QOv/Q1a ate„E� Town of Barnstable Regulatory Services vMASS, Thomas F.Geller,Director ' Building Division.' Tom Perry, Building Commissioner 200 Main Street, $yannis,MA b2601 www.town.barnstable.ma.us ice: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and $ign This Scction. •If Using A Builder I, P.4 7'T ® �L ,as.Owner of the subject property hereby authorize 1, i1C ,2.�l1� to act on my behalf, in all matters relative to work authorized bythis building permit applica'don for, (Address of Job) (Y rho o �i S ture ofJDwner ate Print NamW Q:F0RMS:0 WNERPERBSSION " . ;/fze �jp�/��zoouuea�i o�✓auraaac�uiaP,� Board of Building Regulations and Standards License or registration valid for individul use only HOME IMgROVEMENT CONTRACTOR before the expiration date. If found return to: �� Board of Building Regulations and Standards Registrdti?o'nLj00560 One Ashburton Place Rm 1301 E -€ '1 2008 Boston,Ma.02108 NICKERS Ck }O ourne Nickerso� " its Way \ �y.�Q.�•• — + rville,MA 02655 Deputy Administrator Not valid without signature j I t i f � r GRANITE STATE 'INSURANCE COMPANY 91328-o000 WC 873-71-29 13102 --------------------------------------------- 013-66-03o6-oo ••••- PENNSYLVANIA algiml ..- A KEMPTON NICKERSON 13 THIS WAY Member Companies of )STERVI LLE, MA 02655-0000 011n American International Group EXECUTIVE OFFICES: 70 PINE STREET, NEW YORK,.N.Y. 10270 ;EE NAME AND ADDRESS SCHEDULE - WC990610 .D# MA U1#7 Lem ROGERS & GRAY INSURANCE AGENCY WORKERS COMPENSATION AND EMPLOYERS 434 ROUTE 134 LIABILITY POLICY INFORMATION PAGE SOUTH DENNIS, MA 02660-0000 NSURED IS PREVIOUS POLICY NUMBER NDIVIDUAL RENEWAL 008724182 )THER WORKPLACES NOT SHOWN ABOVE:SEE NAME AND ADDRESS SCHEDULE - WC990610 ITEM 2 POLICY PERIOD 12:01 A.M.standard time at the Insured's mailing address FROM 03/02/06 TO 03/02./07 ITEM 3 A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to the work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 100,000 each accident Bodily Injury by Disease $ SOO.000 policy limit Bodily Injury by Disease $ 100,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: SEE ENDORSEMENT - WC200306A rEM 4 The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Estimated Total Rate Per Estimated Classifications Code Number MV Remuneration $100 OF Re- Premium Annual❑3 Year muneration Annual 3 Year SEE EXTENSION OF INFORMATION PAGE - WC7754 TAXES/ASSESSMENTS/SURCHARGES $16 PENSE CONSTANT(EXCEPT WHERE APPLICABLE BY STATE) $1 4 2 MA VIMUM PREMIUM $500 MA TOTAL ESTIMATED PREMIUM $50 ndicated below, interim adjustments of premium shall be made: Semi-Annually 11 Quarterly Monthly DEPOSIT PREMIUM ENDORSEMENTS(FORM NUMBER) SEE ATTACHED FORM SCHEDULE - WC990612 ,/15/06 ASSIGNED RISK 66 sue Date Issuing Office Authorized Representative WC 00 00 01 67 INSURED'S C)PY � � Y �. k, � k �a, ' 2 � .. ,, l n �. ::.� 'a �: t t�.1 �' �k �f �, _.. _ -..Y ._ � .._. �_ s � _ .�. ��.• .. ._a.., � - ,, a ,. ,_ �. � ,. ., r� ., ; .-- A �.� �� . jj ggj s _ _ _ g' '� � e� w. .. v N a 1 �,°,* �.. 1 �,_-