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TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WIND O W S/DOORS/TENTS/S TOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: ER r STET VILLAGE Owner's Name: L/`l�' ��-1/r'` --,���/i r J Phone Number Email Address: Cell Phone Number Project cost$ l � Check one Residential (/ Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK Q Siding 0 Windows(no header change)# 0 Insulation/Weatherization 0 Doors (no header change)# Commercial Doors require an inspector's review oof(not applying more than 1 layer of shingles)going �i Construction Debris will be g g Z to �' 'dv '! CONTRACTOR'S INFORMATION Contractor's name CK-2- eec-C ff Home Improvement Contractors Registration(if applicable)# 6 5�-Gd (attach copy) Construction Supervisor's License# ( o 0 3-1 3 (attach copy) Email of Contractor Ca Z��� � ? Phone num ber 5 ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. ... .. .. . j14 APPLICATION NUMBER............................................................ *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X. X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent Fuel source being used LP tank 20 lbs. or>Yes No___, if yes, a gas permit is required. Natural Gas Yes No , if yes,a gas permit is required. If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4.30pm. Commercial events may require Fire Department approval *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's.Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature Date e G All permit applicatio are subject to a building official's approval prior to issuance. 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 OCIL Please Print Le •blName(Business/Organization/Individual): ✓� -rtel lz�!Py Address: City/State/Zip: �'� �U` y(� 4 ��G 3)-Phone#: �— Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4.lam a general contractor and I employees(full and/or part-time).* o�have hired the sub-contractors 6• ❑New construction 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have g• Demolition working for me in any capacity. employees and have workers' 9. El addition [No workers'comp.insurance comp.insurance.$ required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.F Plumbing repairs or additions myself~ [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §](4),and we have no employees.[No workers' 13.[7�bther 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. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$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 pa' and p alties of w ryry that the information provided above is true and correct Si ature: OKI ' Date: �Pe G 6 d Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority (circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information 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 enterprise,and including the legal representatives of a deceased employer,or the e foregoing engaged in a joint rp g g of the g g gag ] 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 „ a 'licant who has not roduced'acceptable evidence of compliance with the insurance coverage required." pp. P 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-contractors)name(s),address(es)and phone number(s)along with their certificates)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. SloUiU you hove uuy TuestioLs re^ �?.�^+t,P taxx,^r;fyoux are repired to obtain a workers' 0 o---_u.. .1 -- 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 in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or 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 Massachus tts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 0211.1 TeL#617-727-4900 ext 406 ar 1-977-MASSAFF, Fax##617-727-7749 Revised 4-24-07 wvw.mass,gov/dia mum ® J 'I 2112/18 CERTIFICATE OF LIABILITY INSURANCE THIS CER71FI(WM IS ISSUED AS A MATTER OF RWOR1fI ARON OALY AND CONFERS NO RIGHTS UPON THE CERnRCATE HOLDER THIS CERIIFICA7E DOES_,NOT AFF[RMAMELY OR MMATiVELY•AMEAD, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES 13mm. THIS CERTIRCATE OF INSURANCE DOE'S NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING iA6umms),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND IW CERTMATE HOOML - - IMPORTANT: If the cerfilicate holder is an ADDTiiONdL INSURED,The polies)must be endorsed. ff SUBROGATION-M WAIVED,subject to the terms and conditions ofthe poft%certain Policies may require an endorsement A stalement on this certificate dogs not confer rights to The Certificate holder in ffeu ofsuch endorsement(s). ` PAOWCER CONTACT mm RnmNAN Schlegel & Schlegel Ins Broker PF101E 508 ??1-8381 �N : (508) 771-0e63 (Ara Na mal-34 Mai- Street a L schl e c,„�,•�nCe@ _cow West Yarmouth, Ida 026i3 11NSUREM)AFFORGINS CMERAGE NAICO INWRERA:TR&VI~TaruS PROPERTY AND CAS INSURED INSURER 8 OINTAM CAHOON INUR2RC- DRA CAHOON CONSTRUCTION IISUtU3;:'D: 16 WEQUAQUET AVE INSURERS: CENTFRVILLE, MA.026323 NSUReR.F- COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CEKIIFY THAT THE POUCIES OF INSURANCE USTM BELOW HAVE BEEN ISSUEDTO THE INSURED NAMED ABDVE FORTHE POLICY PSWD INDICATED. NOTIMTHSTANDING ANY REQUIREMENT.TERNS OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CETtMokTE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN M SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OFSUCH POUCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID GAINS. SUBR ILNSR TYPEOFINWRANCE POUCY 1MER P LJrA7S GENERALLIASHM EACH OCCURRENCE S C7ERCUILGENERALLIABIUTY OANWGETORENTED S LAM-MADE OCCUR RED SP ore esm) 5 - PERSONAL&ADVINJURY S GENERALAGGREGAiE 5 GEN'LAGGREwrELMT APPLIES PER PRODUCTS-OOMJ�A]PAGG $ POLICY PRa LOC $ AUMAODILELIABIUTY Cfle �SiNGLELR7ff S ANYAUW BODILY INJURY(Per pemon) 5 ALLOWNED SCHEDULED BODILY INJURY(Peracddent) S AUTOS AUTOS NON era t %1kGE HIRED AUTOS _AUTOS $ UMBWJ-LALIAg OAR EACHOCCURRENCE S e)QCESSLINB CLAIMS AGGREGATE $ DED RETENTIONS S A WIMERSCOMNSATWN WC-1165040 .2/13/19 2/13/19 WGSTATU- 00- AND EMPLOYERS'LIABR.LTY ANY PROPRIETORIPARTNER XEXTNE Y NfA EL EACHACdCENT S 100,000 OI7ICEAENBEREXCLLDRm7 Y E.LDISEAS -LA OY s 100 000 (mandatory in NH) } H PTION F desonbNOOPENSbrJow } ELDISFASE-POIJCYLIMIT S 500,000 DESCRI �SCRIP7IONOFOPBtAT[OHS/LflCA7�NSiVEJSCLFS fAaatl1i01.Adrigrretl6S .Hmmespacsisleq�in� J n MM CAHOON EMS.ELECTED NOT TO BE COVSRSD i)D M ESR CUFdM=.WOR KIMS CCHMSATION POLICY CER71FICATE HOLDER CANCELLATION SHOULD ANY OF-ME ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TM EXPIRA noN DATE THEREOF, NOTICE WIL 'BE DELIVERED 94 RICHARD C.AZTxATiT$ ACCORDANCE MTHTHE POLICY PROVISIONS. CENxi Ry* ut N& 02632 AUTHORM sommTNE 1 8.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered of ACORD Phone: Rx E-Mail: CAZHAVLT7 @CONMST.NBT f r R (CA ZEXT -\ ROOFING & REPAIRS PROPOSAL Proposal No. 18-102018 October 20,2018 To: Linda Bailey-Davies Work to be performed at 942 West Main Centerville MA Bourne MA We hereby propose to furnish the materials and perform the labor necessary for the completion of.- NEW ROOF (Back L Section) 1. Remove existing shingle roof 2. Install drip edge 3. Ice &Water First 3 ft,valleys and penetrations 4. Cover roof with Rhino paper 5. Re-roof with 30 yr architectural shingle 6. Install ridge vent 7.,. Flash all pipes,and penetrations 8. Reinove,all rubbish from project Labor and Materials$4,800. GUTTERS 1.Install gutters and downspouts to areas discussed Labor and Materials. $950 VENTS 1.Remove 2 gable vents on Garage 2. Cover opening with plywood 3. Install sidewall shingles 4. Install ridgevent and recap ridge Labor and Materials $1,100 All material is guaranteed to be as specified,and the above work to,be performed in accordance with the specifications and completed in a substantial workmanlike manner for the sum of Six Thousand Eight Hundred and Fifty$6,850 with payment as follows: . Three Thousand Four Hundred.and Twenty-Five$3,425 deposit with acceptance of proposal and Three Thousand Four Hundred and Twenty-Five$3,425 due upon completion j a w Respectfully submitted, --------------------------------- Richard P. Cazeault,Jr. HIC# 168607 CSL#100393 198 Five Comers Road `Workmans Comp and Liability with. Centerville, MA 02632 Leonard Ins of Ost `(508)420-5482 Acceptance of Proposal No:18-102018 The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment is outlined above. Signature 41e,f 6.de P(a (.c Date *Removal of additional layers of roofing not forseen with result in additional fees of$75 per Sq *All quotes are valid for 30 days i Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constru ion'§gpe.rvisor CS-100393 Expires: 0210312020 •. f } - RICHARD P CAZfAULT,JR M 198 FIVE CORNERS ROAD CENTERVILLE MA 02632 ,a .a Commissioner V Off'ice of Consumer-Mirs&Business Regulation - _ ' ' HOME IMPROVEMENT CONTRACTOR Regfitration valid for individual use only le TYPE:Individual before the expiration date. If found return to: MW 7 R ist on irahon Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite_5170 i Boston,MA 62116 RICHARD P CAZEAULT;JR D/B/A R Cazeaulf°Roofing;:&Repairs _ RICHARD CAZEAULT -1:98-Five Corners Centervi0e,MA 02632 Undersecretary Not valid witFout signature ,,:Aj R _57 �4• "Ri+`tCK✓ .'.+✓�`w'S.V?TM "SYi.TA+ ., KIM �' P.s •��Lnwr�aaS � - U+S'Department of Labor , s ~upatjor aus to and Health AdinmistraUon ` ties suaoessfully completeda 10•tiour�upadona!Safety and Mealth� �T�in�ng Course m "� �'�GonstnicGon Safe &Heatth�� �.� r.� z„ ' t �: YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates(cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town(which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI.,367 Main St., Hyannis,MA 02601 (Town Hall)and get the Business Certificate that is required by law. ff DATE: U Ig ll �i. Fill in please: r APPLICANT'S YOUR NAME/S .i t0 tj BUSINE l Y� YOUR HOME ADDRESS:_ W Q,( _r. _r- V v`( t •' " : ItIEPHONE # Home Telephone Number 0 :s r NAME OF CORPORATION: NAME OF NEW BUSINESS t VVO/ TYPE OF BUSINESS Vti UA. s C W/ft2sessing) fM IS THIS A HOME OCCUPATr�e- YE NO ADDRESS OF BUSINESS ;k . C MAP/PARCEL NUMBER C 7 / When starting a new business there relseve�aI thingsdy'"A do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St.-(corner of Yarmouth Rd.&Main Street) to ak ure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING CO MIS�10 -R'S�GE MUST COMPLY WITH HOME OCCUPATION This individ I h e i form d (ayr7d n t ertain t is type of busilLES AND REGULATIONS. FAILURE TO Auth rized i at re'" — COMPLY MAY RESULT IN FINES. C MEN Q�j i 2. BOARD OF HEALQ J This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: M Building Department Services dpTHE Tp� Brian Florence,CBO Building Commissioner F s�xxsrAs[E. 200 Main Street,Hyannis,MA 02601' . Mwss. 9 9 i639• ,m� www.town.barnstable:ma us aprE �k Office: 508-862-403 8 Fax: 508-790-6230 Approved: (A- Fee: 3 S Permit#: - -a Ll S HONM OCCUPATION REGISTRATION • s Date: 0 Name: 111/1 1 l INN P oe#: ��w l'L Address: Name of Business: � N U N Type ofBusiness: if ' INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,*subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the.dwelling: there shall be no increase in noise or odor,no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carved on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit •" Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated'in excess of normal residential volumes, t • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking.generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There are no commercial vehicles related to the Customary Home Occupation, other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the s t containing-the Customary Home Occupation. • No sign shall be displa dicating e Customary Home Occupation. • If the Customary e Occupation listed or advertised as a business,the street address shall not be included. • No perso shall bg employed' the Customary Horn ccupation who is not a permanent resident of the dwe g unit. I,the undersi have m d a e with the above re c' r my home occupation I am'registering. Applicant: Date: 30 Homeoc.doc Rev.06&0116 NO7/06/2007/TUE 12: 59 COMM FIRE DEPARTMENT FAX No. 5087902385 P. 002 FIRE DEPARTMENTS OF THL+ TO" OF BARNSTABLE Fire Prevention Office - Hinckley Building 200 Main Street, Hyannis, MA 02601 (508) 862-4097 BUILDING CODE COMPLIANCE FOR Plans dated for the,prop located at also known as �[ Z e AL have been reviewed by feAff&dAALA of the ❑ Barnstable OMM ❑ Cotuit ❑ Hyannis ❑ West Barnstable Fire Departmen THE CHART BELOW INDICATES THE STATUS OF THE REVIEW: TYPE OF CONSTRUCTION DOCUMENT N/A RECEIVED REVIEWED COMPLIES 1. Narrative Report 2. Firefighting & Rescue Access 3. Hydrant Location &Water Supply 4. Sprinkler Systems 5, Sprinkler Control Equipment 6.Standpipe Systems 7.Standpipe Valve Locations 8. Fire Department Connection 9. Fire Protective Signalirig System 10. F.P.S,S. &Annunciator Location 11. Smoke.Control/Exhaust 12. Smoke Control Equipment Location 13. Life Safety System Features 14. Fire Extinguishing Systems v 16. F.E.S. Control Equipment Location' 16. Fire Protection Rooms 17. Fire Protection Equipment Signage 18, Alarm Transmission Method 19. Sequence of Operation Report . 20.Acceptance Testing Criteria We believe this document to be complete and compliant for the issuance of a building permit. We have completed the acceptance'testing for.the occupancy permit and believe that within the scope of the building permit, the above issues are incompliance. - 6 G ` TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application #06 10 Health Division Date,Issued ei' lZ Conservation Division y Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board ply Ct/I?-//ti Historic,- OKH Preservation / Hyannis Project Street Address 9ya UJ- th1%0 Sit Apt, Village C e"4U VO It Owner W e3i (311e 06021 kC Address If, 0• Cif L_C� : MA Telephone S071 a (9B 3� Permit Request losksW n.-'30 Cell,,loge A 4AIC- r- �r< AM 4 4#_� 11-0 aft e L, Ce. "�,e k A doorS c.✓raC Nal tur sc,9 4 ,q did -k AdJt—+ Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total-hew c Zoning District Flood Plain Groundwater Overlay /� Project Valuation D O Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentafion. Dwelling Type: Single Family. ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure /9`/f Historic House: ❑Yes ❑ No On Old King's Highway: ❑l�s No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New _ Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing U.new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size -Shed: ❑ existing ❑ new size Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current-Use r_— r. _ _ Pro osed-Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) 1e," CAS Name C A-tv-e co cQ TN J O, a 0x> Telephone Number Address J S-S- YWM o,-.+k (�J � License # /O® f F /yyd'a"o M14- 6'a-bo Home Improvement Contractor# /53 Worker's Compensation # (AZ-A00 S 9-S`3 0 1 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE r FOR OFFICIAL USE ONLY n ' APPLICATION# t r DATE ISSUED MAP/PARCEL NO. z ADDRESS VILLAGE. OWNER r C. p { DATE OF INSPECTION:' it=,, FOUNDATION' s ;. FRAME INSULATION s FIREPLACE ''.° ELECTRICAL: ROUGH FINAL x / PLUMBING: ROUGH FINAL r GAS: �4, .:,. ROUGH -" } FINAL n:FINAL BUILDING` f DATE CLOSED OUT- ASSOCIATION PLAN NO. • e t The Commonwealth ofMassaclzusetts .Y Department of Industrial Accidents 1` Office of Investigations 600 Washington Street %y Bdston, MA 02111 www.rnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LelZibly Name (Business/Organization/Individual): TM [�d DZ��SV (.011 )tn- Address: ►�' Ci /State _l h' /Zi P� "'' t CC.. Phone #: V0 ? 7 .S , I � Are you an employer? Check th appropriate box: Type of project(required): 1. I am a employer with 4. 0 I am a general contractor and I — — ❑ eiispioyees(full and/or part-time). 6. New construction have hired the sub-contractors.. _ 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' com insurance.$ required.] 9. [] Building addition . workers p'comp. insurance required.] 5. 0 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.❑ Pltirnbing repairs or additions myself. [No workers' com right of exemption per MOL P• 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no . employees. [No workers' 13.0 Other 6)Jg4ktg,;Ea t.I py� comp. insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers' co nip ensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: A+ ��dZI [��CIA nCo Policy# or Self-ins, Lic. Y9 0 Expiration Date: 3o Job Site Address: -/qa u i. mad tj Si, 63 ° City/State/Zip:6e tJ4yb l _ MA. 0,103)— 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. Ldo hereby certify u e pa' and penalties cf perjury that the information provided above is trite and correct. Signature: _ Date: Phone#: 0 7 ?5 �J Official use only. Do not write in this area., to be completed by city or town officiaC 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#: Client#:4597 CCINSUL ACOM. CERTIFICATE OF LIABILITY INSURANCE °7/012011""' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). S Margaret Young PRODUCER Rogers&Gray Ins.So.Dennis 4602 508-258-2102 PHONE 508-760- AIC No Ext: A/C No 434 Route 134 AIL ADDREss: youngma@rogersgray.com P.0.BOX 1601 CUSTOMER ID#: South Dennis,MA 02660-1601 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA:Peerless Insurance 118333 Cape Cod Insulation Inc INSURER Ohio.Casualty Insurance Company 455 Yarmouth Road INSURER C:Atlantic Charter Insurance Hyannis,MA 02601 INsuRERD:Commerce Insurance Company 34754 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. a LICY EFF POLICY EXP LIMITS L TYPE OF INSURANCE SR POLICY NUMBER 0MUM MWDD A GENERAL LIABIUrY CBP8263063 04/01/2011 04/01/201 EACH OCCURRENCE $1 00O 000 X COM —a I w RENTED MERCIAL GENERAL LIABILITY PREMISES Ea occurrence $100,000 CLAIMS-MADE 7 OCCUR IVIED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 FGE111'LGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $Z,000,OOO LICY PRO LOC $ D AUTOMOBILEtIAB&ITY 11MMBCKVMK 04/01/2011 04/01/201 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 ANY AUTO BODILY INJURY(Per person) is ALL OWNED AUTOS BODILY INJURY(Per accident) $ X SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS $ (Per accident) i X NON-OWNED AUTOS Is $ B I UMBRELLA LIAB I X J OCCUR 0001254514645 04/01/2011 04/011201 EACH OCCURRENCE $1 000 000 EXCESS UAB CLAIMS-MADE AGGREGATE $1 000,000 4DEDUCTIBLE $ RETENTION 10000 $ C WORKERS COMPENSATION WCA00525902 06/30/2011 06/301201 X To I C YTAT IT OR- AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $500,000 OFFICERIMEMBER EXCLUDED? � NIA E.L.DISEASE-EA EMPLOYEE $500,000 (Mandatory in NH) f yes,describe under E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS beBw DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Add-itional Remarks Schedule,if more space is required) Workers Comp Information Included Officers or Proprietors (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 01988-2009 ACORD CORPORATION.All rights reserved. ACORD 25(2009/09) 1 of 2 The ACORD name and logo are registered marks of ACORD #S68575/M68179 MEY f 10 Park Plaza'- Suite 5170 Boston,Massachusetts 0211.6 Home Improvement Ctractor Registration Re g istration: Type: PrivateCorporation _..... /15/2012 Tr# 206433 .• `'^r-_-~, .--: Expiration: 12 CAPE COD INSULATION, INC _--- - __ -- -.........._...__..._._....... HENRY CASSIDY 455 YARMOUTH RD. HYANNIS, MA 02601 :- :;,Update Address and return card.Mark reason for change. 17 Address L Renewal (, Employment (-� Lost Card r . ;-CAI 0 SOM-OVO4-6101216 . Office o mer Aftairs as,n� Re III tioa License or registration valid for irdivide!use�::ly HOIdggme ����'ddella before the expiration date. if found return to: Type: office of Consumer Affairs and Business Regulation Registration: 153567 YP _ � -Suite 5170 10 Park Plaza Expiration: 1#1512012 Private Corporation Boston,MA 02116, D INSULATIOT'�,1-.Pt_. HENRY CASSID` '`• ;;s`•.' -, `s•: 455YAR 0UTH U"!:;';? ;•: g:.�-7��� - ---- t`' alid ith t si ture HYANNIS,MA 0260d`: ;x°::•;•;.: Undersecretary j '-j Massachusetts - Department of Publi4• Sat'ctN Berard e.r#'13uiidin�� Regulation, mw StalhhLrds Construction Supervisor License License: CS 100988 Restricted to: 00 HENRY, CASSIDY - , WE$T YARMOUTH, MA 02673 Expiration: Ii/11/2011 G:niinissi,.rn'1• TrR: 100988 ��US�1vG 460 WestI`,'Iai1i Srreet Hyannis, ,MA 02601-3695 ASSISTANCE . ENERGY & HOME REPAIR T (SOS) 771-5400 7 F (508)790-2425 - CORPORATION TTY on all lines wuiit -haconcapecod.org LANDLORD �(�/f cJ/ �lr ry L G TENANTCj,'�f PHONE 5�0 '- •?S5_6 Spa. PHONE i L_ � J Dear Landlord, Your tenant is eligible for services through the Weatherizati.on Program. Program regulations permit us to spend an average of$5,000.00 in materials and labor per dwelling unit- Program regulations require us`to weather-strip and caulk doors and windows; insulate attics,sidewalls and floors. All work is professionally done by established private contractors. We will conduct a final inspection to make sure that all work is completed to specifications. Prior to making the inspection and doing the work we must have your permission. If you want your tenant to participate in this program,please sign the agreement and return the form to me. This agreement states that: 1. You will not raise the rent because of the Weatherization work or for one year from the time the work is completed. 2. You will not evict your tenant for one year following work completion date except for good cause related to the tenants failure to pay rent or,serious or repeated violation of the terms of tenancy. F 3. If you sell the property during the specified period,either the new owner must assume the obligations under the agreement prior to sale,or you must refund to us the entire amount of materials and labor we spent in weatherizing the unit- ' If you request,you will be informed of the estimated measures before they are done and provided with a list of the actual measures and costs following the completion of the work. We also need proof that you own the property. A copy of a CU—IM ENT TAX BML OR DEED listing you as the owner will satisfy this requirement. Please fill in all blank areas of the enclosed agreement and return with the proof of ownership as soon as possible. Failure to fill out the entire form will result in a delay in processing the application. If you have any questions-please call Michael Sartori at 508-771-5400,x. 105: Sincerely - - Ruth Bechtold Assistant Director _ Energy and Hor e Repair Department I , TENANT/PROPERTY OWNER/AGENCY WEATBERIL T10 A N AGREEMENT 1. The Parties to this Agreement are the following: a1)l CQ_ 00f (hereafter known as Tenant), ) (print your tenant's name) w z S Sale Mate (hereafter known as Property Owner),{ (print your name) and Blousing Assistance Corporation(hereafter known as Agency)" In consideration of the mutual promises hereafter stated,the Parties agree as follows: 2.. The date of Agency's signature wilt be the effective date of this Agreement. The Agency will sign and return a copy of the Agreement upon completion of the proposed Weatherization work. 3. Property Owner and Tenant consent and agree that the Agency may do the following with respect to the property located at(street,town) �j u r ll�iot4 .S s`. . ? {1 unit# �, and currently leased or rented to old the Tenant: a) Enter the premises for the purpose of performing a Weatherization inspection. b) Enter the premises to perform Weatherization work which the Agency determines in its discretion is necessary and appropriate as a result of the Agency's inspection of the property and in accordance with the appropriate priority list for the type of dwelling. The Agency.and the Agency's contractors may also enter the appropriate common areas of the building for the purpose of accomplishing the ' Weatherization work_ The Agency and representatives of the Commonwealth of Massachusetts, r, Executive Office of Communities and Development(Office of Energy Conservation)may further enter the property to inspect any and all work hereunder" The Agency will provide reasonable notice of the timing of the Weatherization work and inspections. The Weatherization work will be performed in accordance with the Property Owner's consent as further specified below: ***INITIAL ONLY ONE OF THE FOLLOWING. *** I consent to performance by the Agency and its contractors of any Weatherization woikT determined necessary and appropriate by the Agency as a result of its inspection of the property. I 'understand that the Agency will provide a detailed statement of the actual work performed and the associated value at the completion of work. I will provide a separate consent to performance by the Agency and its contractors of Weatherization work following my receipt of the Agency's inspection.report and a statement of the estimated work and associated value. This additionalconsent will be sent under separate cover as Attachment A. -I understand that the Agency will provide a detailed statement of the actual work performed and the associated value at the completion of the work" ' ; 11. For breach of this Agreement by the Property Owner,the Property Owner shall reimburse the Agency in an amount equal to the cost,as certified by Agency,-of the Weatherization materials installed and labor performed on the premises,as well as attorney's fee and court costs. The Property Owner may also be liable for damages to the Tenant in accordance with applicable law;in such instance,the Property Owner shall reimburse the Tenant for attorney's fees and court costs. Without limiting the foregoing,the Agency may at its option terminate this Agreement,by providing written notice to the Property Owner and Tenant,in the event of breach by the Property Owner or Tenant. 12, Performance of the Weatherization work hereunder by the Agency is contingent upon the availability of funds to the Agency from the commonwealth of Massachusetts and the federal government, as,well as the eligibility of the Tenant under WAP program requirements. The Agency may terminate this Agreement, ,_..__.__ providing written notice to the Properly Owner and Tenant,if the Agency determines that the unavailability of funds or ineligibility of the Tenant warrants termination. 13. The Parties acknowledge that this Agreement is under seal. It is intended by the.Parties that the Tenant or any successor Tenant is the intended beneficiary of the Agreement and shall have a right of enforcement. Property Owner's S ignature:�,L-s`dr F)OW le Date Phone: Address: 1A2 kX --- - Tenant Signatur (ice` Date Agency Approved Weatherization Company: v All Cape Energy Caliber Building&Remodeling (]ja�eCod lnsulation Cape Save Creswell Construction Frontier Energy Solutions Lohr&Sons Peter Smith Resolution Energy Rock Solid Construction . Sprinkle Home Improvement e This Agreement becomes Effective as of the Date of the Agency's Signature. -The Agency will sign,and return copies of the Agreement to all parties,upon completion of the proposed Weatherization work. The Agreement shall remain in Effect for one full year from the Effective Date. . Agency Signature Date 1 f 4_ The Property Owner understands and agrees that any and all work,including related repairs for which the Property may also be eligible,will be performed at the Agency's discretion. 5. If the Property Owner is required to make repairs to the property prior to the commencement of Weatherization work by the Agency,the Property Owner will be notified by the Agency and will be required to make the repairs as soon as possible. Except where the Property Owner receives a written extension from the Agency,time is of the essence in the performance of repairs by the Property Owner. 6. The Property Owner and Tenant authorize the Agency to receive a statement from the fuel supplier/utility supplier as to the quantity of fuel/utilities used at the above address in each of the past three years and the future three years. The information is to be used only to determine the cost effectiveness of the TT T.•.fll-QLr1��.tfoTrj�rJ.pr©��mC - -'_—._ .__ _ 7. The Property Owner agrees that the rent for the dwelling unit will not be raised because of any increase in the value thereof due solely to the Weatherization work performed.. 8. * In consideration of the Weatherization work hereunder,the Property Owner further agrees that upon the effective date of this Agreement and during a period extending one full year from the time the work is completed: z�v a) The present rent$ 0'a 13U: per month will not be raised for any reason. (The rent amount must be filled in). "*However,this Paragraph(8a)will be waived by the Agency in writing if,and only if.,the premises are leased under a state or federal rent subsidy program,in which case the actual rent charged by the Owner shall conform to the standards of the rent subsidy program. Please state whichiHousing Subsidy program yaur to nt is on and through which Agency: b) The Property Owner will not institute any summary process actitorssession except in the case of non-payment of rent or other good cause related to the Tenant(or any successor. Tenant). c) -In the event the Property Owner.decides to sell the premises,Property Owner shall comply with one of the two requirements below: --The Property Owner shall not sell the premises unless the buyer agrees(with a copy forwarded to the Agency)in writing prior to sale to assume all obligations of the Property Owner set out in this Agreement;or --The Property Owner shall pay the Agency an amount equal to the'cost,as certified by the M Agency,of the Weatherization materials installed and labor performed in the premises as of the date of sale. Said amount shall be paid to the Agency immediately upon sale' 9. (*Applicable only if Tenant's heat is included in rental payment and blanks are filled in.) At the end of the period set forth in Paragraph 8 above,the rent shall not be raised more than AM_%per /V for an additional period of one year,and the provisions of 8b and 8c above shall continue 'in effect for such period: However,the rent provisions of this Paragraph 9 may be waived by the Agency in writing if,and only if,the premises are leased under a state or federal rent subsidy program,in which case the actual rent charged by the Owner shall conform to the standards of the rent subsidy program. 10. The Parties agree that the terms of this Agreement are incorporatedinto any other lease or agreement between the Property Owner and the Tenant,and between the Property Owner and any successor Tenant,and if there is any conflict between the provisions of this Agreement and the provisions of such other lease or agreement,the provisions of this Agreement shall govern. However,if such other'lease or agreement, including without limitation a lease or agreement under state or federal rent subsidy program,contains stronger protections for the Tenant,such stronger protections shall apply.'- r Certified Mail:7005 1160 0000 0191 2205 Town of Barnstable Department of Health,Safety and Environmental Services 16;9•E4� Public Health Division ♦0 200 Main St.Hyannis,MA 02601 Office: 508-8624644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health May 19, 2006 West Side Place, LC P.O. Box 245 Orleans,MA 02653 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II-MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION You are scheduled to appear before the Board of Health for a public hearing on Tuesday, June 13,2006 at 3:00 p.m. The hearing room is located in Barnstable Town Hall, Selectmen's Conference Room,2nd floor,at 367 Main Street,Hyannis,MA 02601 The property owned by you located at 942 West Main Street, Apt. 3 &4, Centerville was inspected on May 10, 2006 by Donna Z. Miorandi,RS,Health Inspector for the Town of Barnstable. This inspection was performed as a result of a complaint of mold. Based on the results of that inspection, the Town of Barnstable Health Department finds that the dwelling is unfit for human habitation. Pursuant to M.G.L c. 127B and 105 CMR 410.831 (D),the Health Department further finds that the conditions within the dwelling are such that the danger to the life or health of the occupants of the subject dwelling is so immediate that no delay may be permitted in making this finding. The following violations of 105 CMR 410.00, State Sanitary Code II: Minimum. Standards of Fitness for Human Habitation were observed: 105 CMR 410.750: Conditions Deemed to Endanger or Impair Health or Safety(I) "Failure to comply with any provisions of 105 CMR 410.600,410.601, or 410.602 which results in any accumulation of garbage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease." Q:\health\order letters\Condemnations\942 West Main Street,Apt.3&4,Centerville.doc 105 CMR 410.750 (0): Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (5) Failure to eliminate, rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. 105 CMR 410.550 (B) & (D): Extermination of Insects,Rodents and Skunks The owner of a dwelling containing two or more dwelling units shall maintain it and its premises free from all rodents, skunks, cockroaches and insect infestation and shall be responsible for exterminating them. Extermination shall be accomplished by eliminating the harborage places of insects and rodents,by removing or making inaccessible materials that may serve as their food or breeding ground,by poisoning, spraying, fumigating, trapping or by any other recognized and legal pest elimination method. All use of pesticides within the interior of a dwelling, dwelling unit,...shall be in accordance with applicable laws and regulations of the Department of Food and Agriculture's Pesticide Board, including those appearing at 333 CMR 13.00,which provide, among other things, that pesticide applicators or their employers must give at least 48 hours of pre-notification to occupants of all residential units prior to any routine commercial application of pesticides for the control of indoor household or structural indoor pests. During inspection, squirrels were observed in the chimneys and in the attic space of this building. 105 CMR 410.500: Owner's Responsibilty to Maintain Structural Elements During inspection of these two units much mold was observed on the interior of the plywood roof sheathing. 410.831: Dwellings Unfit for Human Habitation: Hearing Condemnation: Order to Vacate. (A) Finding that a dwelling or portion thereof is unfit for human habitation. If an inspection pursuant to 105 CMR 400.100 or 105 CMR 410.820 reveals that a dwelling or portion thereof is unfit for human habitation, the board of health may(after complying with 105 CMR 410.831 (B), (C) or(D)-if the dwelling is occupied)issue a written finding that the dwelling or portion thereof is unfit for human habitation. (C) Hearing if dwelling or portion thereof is occupied. If the dwelling or portion thereof is occupied,then the board shall, prior to issuing a finding under 105 CMR 410.831 (A), and at least five days after service of the notice required by 105 CMR 410.831 (B), conduct a public hearing to determine whether the dwelling or portion thereof is unfit for human habitation and whether an order to secure and to vacate should be issued. At the hearing the occupant(s), owner, or any other affected party shall be given an opportunity to be heard, to present witnesses or documentary evidence and to show why the dwelling or portion thereof should or should not be found unfit for human habitation, and why an order to vacate and an order to close-up should or should not be issued. Q:\health\order letters\Condemnations\942 West Main Street,Apt.3&4,Centerville.doc You are directed to correct the above violations within Five (5) days of your receipt of this notice. You may request a hearing before the Board of Health if written petition requesting same is received within ten(10) days after the date the order is served. You have the right to inspect and obtain copies of all relevant inspection of the board of health; the right to be represented at the hearing; and that any affected party has a right to appear at said hearing. Furthermore, anyone who fails to comply with any order of the Board of Health may be subject to fines of not more than$500. Each day's failure to comply with an order shall constitute a separate violation. Note: This is an important legal document. It may affect your rights. PER ORDER OF THE OF HEALTH Thomas A. McKean, R.S. Director of Public Health Town of Barnstable CC : �j COMM Fire Department �l TOB Building Department, Thomas Perry Susan Brackett,tenant Crystal Clark, tenant Q:\health\order letters\Condemnations\942 West Main Street,Apt.3&4,Centerville.doc f Town of Barnstable OpVE r Regulatory Services Thomas F.Geiler,Director Building Division 3A RN3CABI.E, Tom Perry,Building Commissioner ArEp p�p`l A 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved:— Fee- Pe HOME OCCUPATION REGISTRATION Date: 12- 4_S_ Name: � 6 IL %"�.� m 22 Phone#: C �6 0 7 o d - 3 4 4Z Address: `7 z tje-ST jVIA1'U :S-r -37 3 village: �e e/'UtLle Name of Busine Type of Business: :D_re0 y e 7— Map/Lot: Z 7 g d 6_�Ll INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the.Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Custo Home Occupation is listed or advertised as a business,the street address shall not be included. • No person all be employed in the Customary Home Occupation who is not a permanent resident of the dwelling t. I,the undersigned,ha rea and agree th the above restrictions for my home occupation I am registering. Applicant: / . Date: 3 z 6 S Homeoc.doc Rev.5130103 TO ALL NEW BUSINESS OWNERS DATE: Fill in please: F APPLICANT'S w„ YOUR NAME: o nJ F �: LLln e4 USI ESS YOUR HOME ADDRESS: cmm Lue-sr, malq Sr 4D7 3 eA) eputue mA Oz63Z TELEPHONE Tale hone Number Home d S'7' A!M4. OF NEW BUSINESS l•Li'A sS0 Clf¢Te� .� �. • TYPE OF us NE IS TH IS A HOME OGCUPAT�ON� ; YES NO Have you been given approval from the building dvasion� YES NO ADDRESS OF BUSINESS q�f2 G'�eSr;13'TRla�1 C�� e `u�L,LMAP/PARG> NUM --D �_ DER.. _ . ........ .. . ........... When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. Once you have obtained the required signatures, listed below, you may apply for a business certificate at the Town Clerk's Office (Ist floor- Town Hall) or if you get the business certificate first you MUST go to the following office to make sure you have all the required permits and licenses.. GO TO 200 Main St. — (corner of Yarmouth Rd. & Main Street) and you will find the following offices: 1. BUILDING COMMISSIONL'S FFICE This individual has en inforny permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 2. BOARD OF HEALTH This individua mad of the permit requirements that pertain to this type of business. Authorized Signature" COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual her een i armed Ye li s' requirements that pertain to this type of business. v Authorized Signature" COMMENTS: Business certificates (cost $30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in the town (which you must do by M.G.L. - it does not give you permission to operate -you must get that through completion of the processes from the various departments involved. "SIGNIFIES APPROVAL FOR A BUSINESS CERTIFICATE ONLY. a TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map LA Parcel Application# � Health Division ;. Conservation Division Permit# Tax Collector Date Issued Treasurer Application Fee d Planning Dept. Permit Fee , Date Definitive Plan Approved by Planning Board 1 z 11y�a, Historic-OKH Preservation/Hyannis i Project Street Address aJE5 "H 0 Village ceu�e vl LLe�— t(/C5°T Owner G(10(Lo A Address PO.&Y, 245", ©jZ Z—A A— p26S-5 Telephone Permit Request C 7 �,11�(, S70n i►/AY E&A4 �G ZAJJ> ML-K/S { Square feet: 1 st floor:existing_ proposed 2nd floor:existing proposed ` Total new Zoning District Flood Plain Groundwater OverlayCn 3 , Project Valuation �;_QO Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting'documentation.c� Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) ✓ Age of Existing Structure f0 7, Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes XNo Basement Type: 4 Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) I I ZZS— Number of Baths: Full:existing 9 new Half:existing 1 new Number of Bedrooms: existing new Total Room Count.(not including baths):existing new First Floor Room Count Heat Type and Fuel: )(Gas ❑Oil . ❑Electric ❑Other Central Air: ❑Yes ' IN0 Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes VNo If yes, site plan review# Current Use Proposed Use , BUILDER INFORMATION Name G r' U)1►) . (—A) 464 S=1 Telephone Number �0 K 428 �Z$ Address 90, 6ay, 763 License# f' gi?,73 (� — —te-7k/ L ®�`3 Home Improvement Contractor# Worker's Compensation# 1 07 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE C DATE l_ FOR OFFICIAL USE ONLY PERMIT NO. 3 DATE ISSUED MAP/PARCEL NO. 1 ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION r y FRAME INSULATION FIREPLACE , ELECTRICAL: ROUGH FINAL , PLUMBING: ROUGH FINAL r i GAS: ROUGH FINAL FINAL BUILDING z , DATE CLOSED OUT ASSOCIATION PLAN NO. - The Commonwealth of Massachusetts rn Department of Industrial Accidents Office of Investigations a' a 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plu><nbe>1•s A_pplicant Wormation Please Print Legibly Name(Business/Organization/Individual): ( C��?�� 7C" 4� �L C Address• Q 69 v 7(0 3 City/State/Zip: r /7 .1/`I t�(.C� Phonet <0g, Are I am a'sole proprietor or partner-you an employer?Check the appropriate box: Type of project(required):. 1. I am a employer with 4 0 I am a general contractor and I 6 New construction.. employees (full and/or p ,tune).* have hired the sub-contractors 2.❑ listed on the-attached sheet. 7. El Remodeling ' ship and have no employees 'These sub-contractors have g, E]Demolition • working for me in any capacity.. employees and have workers'comp. Building addition [No workers' comp.insurance comp.insurance.$• 5. We are a corporation and its 10.❑Electrical repairs or additions required.] ' ❑ 3.❑ I am a homeowner doing all work officers have exercised their 11. Plumbing repairs or additions ' myself. [No workers' comp. right df exemption per MGL 12.0 Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13 Other �37,011 lL VP1t comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside.contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is.the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: (/l 1� �S�A'd 3 ' D :Expiration Date: Job Site Address: �¢� W � A44 t N S-7 City/State/Zip: 4,14V ✓10 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-and penalties of perjury that the information provided above is true and correct Si afore: Date: 7 _ Phone 4: Official use only. Do not write in this area, to be completed by city or town offzciaL 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#: Y Information 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-o.rtrustee-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-contiactor(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 pemut,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. lease be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant .th-at must submit multiple permit/license applications in.any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address the applicant should write"all-locations in (city or A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or 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; ha k Commogwealth of Massachusetts Depart=ut of lRdustrial A.ceidents Office of Investigations 600 Washington Street Boston,MA 0.2111 TO. 617-727-4400 ext 406 or 1-977-MASSAFE Revised 11-22-06 Fax#617-727-7749 www,mass.pv/dia Town of Barnstable Regulatory Services r BMWSTABLE, Thomas F.Geiler,Director MASS ,orEp39,ta Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: 0 —15 1 DC '5-A-4 UAt Estimated Cost Address of Work: 94Z. WG`,7 MAio,I S'7 47"_A/1 S Owner's Name: Date of Application: I - Z—r/7 I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: x/► O$ 27 D to Contractor Name Registration No. OR Date Owner's Name Q:forms1omeaffidav RightFax H2-3 8/31/2007 3 : 13 :39 PM PAGE '003/003 Fax Server ACORD. CERTIFICATE OF INSURANCE - DATe(MMioo►YY) 08-3,-0� ^'ODUCER THIS CERTI,FICATEIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE --ROGERS&GRAY INS AGENCY HOLDER. THIS CERTIFICATE DOES NOT, AMEND,EXTEND OR 341 CUURT ST ALTER THE`COVERAGE AFFORDED BY THE POLICIES BELOW. PO BOX 3700 COMPANIES AFFORDING COVERAGE PLYMOUTH,MA 02360 COMPANY 72WFB A HARTFORD GROUP INSURED, COMPANY B CAPEWIDE ENTERPRISES LLC COMPANY PO BOX 763 C CENTERVILLE,MA 02632 COMPANY D COVERAGE THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING TERM OR CONDITION OF ANY CONTRACTOR ANY REQUIREMENT, OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN.MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER DATE(MMIDDIYY): DATE(MMIDDIYY) LIMITS GENERAL LIABILITY_ GENERAL AGGREGATE $ - COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $ CLAIMS MADE OCCUR. PERSONAL&&ADV.INJURY $ OWNER'S&&CONTRACTOR'S PROT. EACH OCCURRENCE $ ` FIRE DAMAGE(Any one fire) $ MED.EXPENSE(Anyone person) $ 'AUT01d10BILE LIABILITY. ANY AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS BODILY INJURY(Per Person) $ SCHEDULE AUTOS BODILY INJURY(PerAccidenq $ HIRED AUTOS PROPERTY DAMAGE . NON-OWNED AUTOS $ .GARAGE LIABILITY ANY AUTOS AUTO ONLY-EA ACCIDENT $ OTHER THAN AUTO ONLY. EACH ACCIDENT $ AGREGATE $ EXCESS LIABILITY UMBRELLA FORM EACH OCCURRENCE $ OTHER THAN UMBRELLA FORM AGGREGATE $ WORKER'S COMPENSATION AND A EMPOLYER`S LIABILITY . UM845A033-07 04-14-07 04-14-08 STATUTORY-UMUS X THE.PROPRIETOR/ EACH ACCIDENT $ 100,000 PARTNERS/EXECUTIVE iNCL DISEASE-POLICY LIMIT $ 500,000 OFFICERS ARE: X EXCL DISEASE-EACH EMPLOYEE $ 100,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLESIRESTRICTIONSISPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP.COVERAGE. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TOMAIL 10 DAYS WRITTEN NOTI::E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATNE3. AUTHORIZED REPRESENTATIVE Ramani Ayer )RD 26.5(3193) Oct 12 07 06:42p s p 3 a FROM :CAPEWIDE FAX NO. :SON283929 Oct. 12 2007i 11:41AM P3 i Eown of Barnstable Services C�e�lar,Aireoker T iz�Yearty, mundwo Comm* Ianee' 2 0.9�I�tngtzaat;'k y rc_s_a,b!A 02601 • �r#otrs�.berostable.ms,ua j ; I 'I Fax. 502-790-6230 Off: S0&86Z-�38 pwpe ty.onerMust Cop�lete a�ad Sign This SectIOa Xf U�iisg d Owner of the subject proY v� s' to.03orinVbef>�# au , .sa�,a�txe� re3ative to iAot�Ior�ed bpthi+but�d� ' 9pli0d=for, ji 11 LC g p • • a of Jo ) I signatux G+e o ate I Y� I L j i , I Psmyynanate�a BOA D OF BUILDING"REGULA`TIflNS {alb icemen e`CONSTRUCTIOI U R , �< Numb � 089273 t tRM ' � m �727/007 'aTr�no 8.8273 ` �1^ ix c } RIC�HARM�CAS l _ 3 r ¢LSAGKTH�OR� a" ARSTONS MILLS �ib�2648k' z � w i" Board of Buildmg�ltegulations sad Sta_ndards } IOMEfIMPRO EMfNT CONTRACTOR r :Registration 143958.: �F �Ex_piration 7�8/2008 �- * ', T$ '6 LtiiJL`iability Corporation L ?t: CAPEWIDE ENTI RPRI LOLL.; f° 205'BIACKHORN RC� 9 MARSTON MIl3LS MA 122648'. Deputy Aduunistrator Y � 1 t y r t Z- EEE. . ---------------- - - 71 a> t f t Z LLLI M C-TA G s �G/►'1 PoS r- 6 . Parcel Lookup Page 1 of 2 r JwrZl ` x`1 � f y of t, •i,'U�4ST1[3lG?'� �iv ° '` 4 + './ . w 'aiV, 58 ;. �n'R aa t� ra- Mh55 - a, f Logged In As: M Parcel Lookup Novei Road Lookup Condo Lookup Multiple Address Lookup Reports Search options Search By IStreet Street 942 Street WEST + - Name _ _ Village JAII villages =Search' Page 1 <PrevNext>of 2 Rows/Page: Parcel Location Owner Village Index Map 249-054- 942 WEST WEST SIDE CEN 1813 249054 OOD MAIN STREET PLACE LC 249-054- 942 WEST WEST SIDE CEN 1813 249054 OOE MAIN STREET PLACE LC 249-054- .942 WEST WEST SIDE CEN 1813 249054 OOA MAIN STREET PLACE LC 249-054- 942 WEST WEST SIDE CEN 1813 249054 006 MAIN STREET PLACE LC 249-054- 942 WEST WEST SIDE CEN 1813 249054 OOL MAIN STREET PLACE LC 249-054- 942 WEST WEST SIDE CEN 1813 249054 OOM MAIN STREET PLACE LC http://issgl2/intranet/propdata/lookup.aspx 11/5/2007 I Parcel Lookup Page 2 of 2 249-054- 942 WEST WEST SIDE CEN 1813 249054 OOG MAIN STREET PLACE LC 249-054- 942 WEST WEST SIDE CEN 1813 249054 OOH MAIN STREET PLACE LC 249-054- 942 WEST WEST SIDE CEN 1813 249054 001 MAIN STREET PLACE LC 249-054- 942 WEST WEST SIDE CEN ' 1813 249054 OOJ MAIN STREET PLACE LC http://issgl2/intranet/propdata/lookup.aspx 11/5/2007 Assessor's map"arid-lot number ......... ... ............... ........ THE See Letter 10/17/84 Copy attach F r Sewage Permit number ....................... TIC SYSTEMf + t IN A TALLER I � Z 33A i UST House number r�s a OR ENVIROMWENTAL TOWN OF BARNSTA111311L '' ,HUMS BUILDING INSPECTOR APPLICATION FOR PERMIT TO Erect 6 Unit Apartment House ............................................................................................................................. TYPE OF CONSTRUCTION Wood Frame 2 Story ...................................................................................................................................... October 22 84 ................................................19........ :*; TO THE INSPECTOR OF BUILDINGS: { The undersigned hereby applies for a permit according to the following information: / 1 Lo`,.oc .,n ................. .............................................Centervil...........�a.......... ....... . ....... .... ProposedUse ...............Apartment Hous................................................................................................................................. R C 1 Centerville—Osterville ZoningDistrict .........................................................................Fire District ..................................-�m.......................................... =.t John S . Lebel Address B'ox 1011 Osterville, Ma Nameof Owner ................. .................................................................................... Name of Builder .John S . Lebel Address .•32•.Wianno Ave Osterville ........................................................... ............................................................... Name of Architect James Stewart Address •Marston Mills Ma . .................................................. ........................................................................ n Twenty Four 1'V' Poured Concrete Numberof Rooms ..................................................................Foundation .............................................................................. Exierior ......Wo. od. ...Shingle. . . . . .... ... s & Cl. .apboards. . . . ........Roofing ..Asphalt. . . . ....Shin. .g.le. .s ....................................... .. .... .. .. .. .. ....... .. . .. .. .. ....... .. .. .... .. .. ....... .. .. . ....... .. .. . .. .. Carpets & Vinyl Interior Sheetrock jFloors ..................................................................................... ............................................................ Electric Yes Heating ............................................................ ......... .........Plumbing ....... ......... ......... ......... ...................................... Fireplace ...None....................................................................Approximate. Cost .. 210,000 ........................................................ N/A 3600 14 = $504. Definitive Plan Approved by Planning Board _______________________________19________: Area ................................. Diagram of Lot and Building 'with Dimensions Fee Plus 480' stora e SUBJECT TO APPROVAL OF BOARD OF HEALTH Iq El t c Is a ?ror Do 1L I h! OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the own of Barnstable regardi e a ove construction. Name . . . .. .........(.... ......... .. .. ....... ... 006232 C struction Supervisor's License .................................... ,t - _ ` LEBEL, J017E S. No ..27293... Permit for ...MULTI-FAML ILY DWELLING/ Apartments 3600 sq. ft. ti,942 West Main Street • Lgcation = .................Centerville................................... zy J c = y c Owner ....Jdnn S....Lebel.... .............. .......... �- _ _ Type Hof Construction ... ra............................... ................................................................................ — - r Plot ..... - ............... Lot .................. . ............ r _ December 3 ..- - •Permit Granted ............................ ...... 19 84 c Dateaof Inspection ....................................19 Date Comple ed ��.. .�j� �.190c 4 _ s /� = _ r z zz K TOWN OF BARNSTABLE'-,_. Permit No--___27293 . , . � Building Inspector �I s�as�.0 i �,.,-`.• #;.-r Cash ----------- f OCCUPANCY PERMIT Bond Issued to John . LI Add' re s x Apartment 1, 942 West 'Main Street, Centerville Wiring Inspector. _ f Inspection date Plumbing Inspect or % � Inspection date f/ ro Gas Inspector �/ A ji Inspection date Engineering Engineering Department Inspection date Board of Health--_— �i +Y�G �.✓.�� � � Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED -BY THE BUILDING INSPECTOR UPON SATISFACTORYc COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0.OF THE-MASSACHUSETTS STATE BUILDING CODE. ... ...., �:.,..:..... ... 1 Building ,Inspector 7. TOWN OF BARNSTABLE permit No. ------27293---_--______ { = Building Inspector Cash Iwo TX r�/ (�� OCCUPANCY PERMIT Bond __—___ � _ ` Issued to John S. I.elel ` �, Address r Apartment 02, 942-West Main Street. Ca tea-yi 11e Wiring Inspector �/ Inspection date Plumbing InspectorV Inspection date Gas Inspector ' , �" ` Inspection date \ ` 3,Engineering Department ' d'�. a I-.Inspection date- Board of Health Y�--!\ y Isti Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. ' Building Inspector !. u1 TOWN OF BARNSTABLE Permit No. _._______27293 �� _ Building Inspector cash - - us. OCCUPANCY PERMIT Bond ______4-_:__��1 4. 4t- Issued to 3phn S. Lebel Address ` Apartment #3, 942 West Main Street, Centerville Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date r Engineering Department c�A Inspection date,,�� , C I 6° I f Board of Health =Mx� ��� kLa�� Inspection date J/!/y. THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. ..ti.... ....................._..., _ _ tom, ................Building-'Inspector f. 1 o• TOWN OF BARNSTABLE Permit No. ---27293 i Building Inspector STAR cash -------------------- OCCUPANCY PERMIT Bond ----------------------------- Issued to John S. Lebel Address Apartment A. 942 West Main Street, Centervi71P Wiring Inspector r � --� Inspection date Plumbing Ihspectoi F L Inspection date v Gas Inspector Inspection date Engineering Department t 4 }: Inspection date f� d� � f Board of Health i=� �� e• v�G i Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING- INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. �a Building Inspector S TOWN OF BARNSTABLE Permit No. _-- - 27293 - -------------- sin = Building Inspector Cash ---------------------- wa _ ,e,a -~-OCCUPANCY PERMIT Bond ------- - Issued to John S. Lebel Address i tApartment #5, 942 West Main Street, Centerville Wiring Inspector `" l 1� e` / s-Inspection date 1 " t Plumbing Inspector' �' Inspection date Gras Inspector A N Inspection date ` . Engineering Department G "f ''Inspection date. t(-a t 'y Board of health Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN s REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE 'BUILDING CODE. L� Building,Inspector � - .. � '� -�. - ' � �` � r f ..... � _.. -• _ . - -^r' _ Tom. - , r . TOWN OF BARNSTABLE 93 Permit No. ---272-------------------------- x Building Inspector ; „* Cash ---- -- °'"� OCCUPANCY PERMIT Bond` __________________—____ Issued to John S. Lebel Address Apartment l6, 942 Weft Main Sheet_;, Centerville Wiring Inspector �� Inspection date Plumbing Inspector i7C �� Y ` Inspection date �� � Gas Inspector Inspection date i A Engineering Department Inspection date; Board of Health =- �t C° A �l f'�lyr. Inspection date- i 1 IMF� THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. o- _ s ....a'................ �s ................................... r , Building Inspector ��P�o t 'O•°ew TOWN OF BARNSTABLE BUILDING DEPARTMENT t seaasx : TOWN OFFICE BUILDING r�ua erg' i679• � HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department 250-" DATE: An, Occupancy Permit has been issuedfor the building .authorized by BuildingPermit #...........��..... f.` ............................................................................................_................................_............»..... issued to l e '10GZ• „ 1:.*" 7- Please release the performance bond. - �CenterbiYCe=®�terbiYYe ,dire �igtrict Office of the -fire 30epartment 999 MAIN STREET OSTERVILLE, MASS. 02655 John M. Farrington t Tel. Emergency 428-9111 Chief Non-Emergency 428-2467 December 17 , 1985 Mr . Joseph Daluz Building Inspector 'lbwn- of--Barri`sta'bi-e 367 . Main Street Hyannis , Mass . 02601 Dear Joe : This letter is in regards to .the multi family dwelling Galles "Westside Place" locates at 942 West Main, Street in Centerville . The listed owner is a Mr . John Lebel . After checking our files for plan review the following questions have risen concerning this occupancy: 1 . Has occupancy permit been issued? 2 . Has electrical health, building depts , etc . , inspected this occupancy? Note: Some units are occupied as of this date. 3 . Fire Alarm System - Final inspection concerning the Fire Alarm has never been completed by the owner, or builder . Your cooperation in this matter would be greatly appreciated . Lt . David R. Currier Lieutenant Ce tervi le-Osterville Fire District 9 i TOWN OF BARNSTABLE Zoning; Board of Appeals JOHN S. 1, 'BEL .. ..........__._...._.......----............................................_.........._.......... Deed duly recorded in the _i#►lt7.l��1��� Property 0\vner //II ff�� County Registry _f D vvn __..__._......__._ 13 ....................._............_............................................._......................._......__...._....... .-_....._............ , Petitioner histi-Wt of the Land Court Certificate No. ........................ ._............._..._. Book ........ Page _.__....._ ,o so n: �; 1 .r .j..- (654 A.ppeal No. ............................................................._.._ _.........._........ . ..........,.........::. 1 FACTS and DECISION Petitioner J IJ t> L _z ..............:................................_......_.._._..........._..._...._.................................... filed petition on _..c.%.:';?3. .._ .:!........_....__ 19 t,4 requesting a variance-permit. for premises at ................. .�Sa I'll...... .Zain...S. ........................................... to the village (Street) Centery Me _____._.._.., adjoining premises of ._............._ (see attached list) . __...._._......_—.. Locus under consideration: Barnstable Assessor's Map no. _._...._.24°._...._:._.._.....__ lot no. q LC h4.0,V /,07g7 -C! Petition for Special Permit: 0 P Application for Variance: ❑ made under See. .......J.......A-4........_.......... ....... of the Town of Barnstable Zoning by-laws and Sec. ......................_............................. _...._...... _.................._.... Chapter 40A., Mass. Gen. Laws for the purpose of ,.. • ... ... ... _- ., ._....m...._, .__ ,..�...,_, ..-_.-._ �..__....___�. • 4b 'COYc meT 7lSL'S 7JN�n 7) Qi!. ?( '7.02' ZCQ..-e DZY Locu; is presently zoned in....___._.:`:~..............................................................................................._._......._..........---- --......_._.... _...-- Notice of this hearing was give,, 1.,v 7u;,i1, postr. 'c prepai 1, to all persons deemed affected and by publishing in c Pat""`'— „ewsp;,l'er published in Town of Barnstable a copy of which is attached to the record of thew proceedin_s 'filed with Town Clerk. A public hearing by the Iward of :\ppeals of the Town of Barnstable was held at. the Town Office Building, Hyannis, glass., at. ........:_ .: . :. _.... �_,.—..__..r_....-- , upon said petition un:ier rosin, by-laws. • r Present at the hearing were the followiw, members: �: r:i 77✓ Chairman ----_—.__ jAt the conclusion of the hearing, the Board took said petition under advisement. A view of the locus was made by the Board. Appeal No._ 1984-__�_...._.._�_._.._ Page _ of On __._. August_-1.6 ..............___._..._.....__ 1�)84..._._..._, The Board of Appeals found ittornoy CharZes McLaughlin .represented tf'le petitioner, Bonn S. LobeZ, Wro is seeking a SI)�c:aZ Permit to construct seven ( 7) 'esidential apart nts tU rep Lace ti:e e. istin C71Oiic T'cial uses, .Y:C7?c iy, a beauty pay'Tor and contractor �s garages, at 956 W. i fain .St. , CentOrUiZZe on a. 53,120 square foot i l'C in an PD-1 zU':if g district. Pans i:ave been submitted as well as a traffic by the Town DP;'.' - and a purchase Mna sale agreement, dated 1974. The commercial uses on the property pre-date, zoniYa. In Order to comply with the regulations o ) rr,.Z:ng Section M o=' the zoning by-Zaws, the , bet .tioner has -educed the number .'If aL,-rtments to be six instead Uj t.hevOrlginal seven. Tli (>i' iity pa GU' 0 32x if2Cl_'i :�S 3e, :i' I�i2l� pr.�LLLVnC:r' Wil.i. Lzoan(.I.on a7,7 (�01,'U',i '�� .. _:Ses. or L/1e o;_e: A total o six a_-ar-u.meY?✓S plus storaje bu; Zw".,ng Wi77 be cons "... :�. T) c»e a2, �o bo nZ.el)e (__) parking space on the site.) The proposed buildings r.;ill consist of 1200 •square ;oot - tW'o-bedroom apartr„a)its. For the next six years, titEZ'E r�ilZ be nine (9) apartments - when file beautp pa_rZor lease expires there wiZZ be a total of ten (10) apartments or, the site - to be one two-story building - for aetota? land coverage of 7667 of all the buildings on the locus.- (600 per unit). With trle submittal of .the definitive Zandcourt Plan and update on the egress and ingress on Lot 62, and in accordance hiti the newly revised Plan submitted - for six (6) units, the Board voted unanimously to grant the petitioner a Special Permit to aZZow the construction of one two-story building to contain a total of six residential apartments to replace the existing commercial use (upon the termination of beauty parlor) to be tan (10) apartments on the locus. I ' _rClerk of the Town. of Barnstable Barnstable County, D'tassachusetts, hereby certify that. twenty (20) days have elapsed since the Board of Appeals rendered its decision in the above entitled petition and that no appeal of said decision has been filed in the office of the Town ('lerk. ^ Signed and 5e;;Icd this ._........:_..::...... day ct: ...._...............:...... ................._.............._.... 19 under the pains and�.....�._. penalties of perjury. Distribution:— Property Owner ......................................-.....Town Clerk Board of Appeals Applicant 'Town of Barnstable Persons interested I;uilr.lin Inspector !'ul:4ic information Bmird of !Appeals Ci;ttii.m:.n f -,INC ZONING BOARD OF APPEALS IU]S. q \3 6j9 0, i PARTIES IN INTEREST 1984-80 JOHN S. LEBEL Mtg. of 7/19/84 Hilda B. Wahlowick 971 W. Main St. , Centerville, 02632 Dorothy M. Crawford 125 Blantyre Avenue, Centerville Margaret Iliffe .932 W. Main St. , Centerville Alfred L. Gold 683 Strawberry Hill Rd. , Centerville James-C. Desmond 52 Davis Ave. , Arlington , MA 02174 Catherine M. Elliott 223 Elliott Road, Centerville ;I Ernest Marino 264 Long Beach Rd. , Centerville George J. Kerkorian Butternut Dr. , Sutton , MA 01601 rank Moss Box 3034, Springfield Inst. .or Savings Springfield, MA 01101 Raymond Blackburn ,143 V1. Main St. , Centerville John R. Bryant 987 W. Main St. , Centerville John S. Buckler Strai-;berry Hill Rd. , Centerville Charles L. Sappett 1325 Crabtree Ln. , Port Richie, FL 33568 Harold A. Boyne 990 W. Main St. , Centerville Pamela Kelly Box 144, Hyannisport , 02647 Diane D. Bolt- Gladys Lihou 703 Strawberry Hill Rd. , Centerville MASHPEE PLANNING BOARD YARMOUTH PLANNING BOARD SANDWICH PLANNING BOARD h c a TOWN OF BARNSTABLE SOARV OF APPEALS G NOTICE OF PUBI1 WS als,under UNDER ZONING BY-LA of Appe or affected by the Board Laws of the Commonwealth of 1*1 Jj person A e Ssachusetts interested notified that: ,111 oEChap• hereby 7:30P.M• 1 all amendments thereto,you are d of API and petitions �P N0.1984 77 THELMA BENSO Boar Marston Thelma Benson has alp to the pZoning nt at 97 Whaler Rd., for a Spy pertrttt to allow a family apartment S PEI'1T10N AT 7:30 P.M• RF zoning district• 7:45 P•M- Mills in WILL BE HELD ON THIS m a deci- ' A PUBLIC HEARING RIC��ARENSTRUP Board of Appeals from N0.1984- nin B nstruct a tw0r APPEAL has appealed to the Zo g Variance to co district. Richard Arentcup ctor and petition for a zoning the Building InsPe t 1 Bearse s Way Hyannis m an AT 7:45 P.M. Sion of located at Lot 8:00 P.M• family dwelling WILL BE HELD ON'THIS PET1 p PUBLIC HEARING' CHARD ARENSTRUP of Appeals from a deci- APPEAL NO.1984-79 is ed to the Zoning Board ce to construct a two i Richard ArentruP has aPP� for Varian RB zoning district. Sion of the Building Inspector and petitionsHyannis in an g;00 P.M., t 6 Quaker Rd., Y S PETILION AT 8:15 P.M family dwelling iocated WILL BE HELD ON THI A PUBLIC HE`S 800JOHN S.•LEBEL Board of Appe�from a decision of 1984 t to construct seven APPEAL NO 1 has appealed to the Zoning B 1 Peru won, t John S.Le Inpecto, and petition for a Special use(beauty the Building ents to replace the existing .in an RD-,1 zoning district. I (7)apartm St•,Hyannis PETITION AT 8.15 P.M- contractor's e)at 956 West M I ON THIS8:30 P.M- ' j contractor s garage) WILL BE petitions for PUBLIC HEA C,,LEDOUX Appeals and Pe ! A N0.1984-81 EARL Board of APP. APPEAL 11199 has appealed to the Zoning and area to be utilized as a i Ear1G• ctcnt.frontage in an RF zoning a Variance to allow a lot with insuffi 'der Marston Mills• Barberry H30 367 1 buildable lot located at � BE HELD ON THIS POTION AT district. A PUBLIC HEARINGwill a held ING,JULY 19,1984.You s: r These hearings w�be held m the HEARING ROOM,TOWN MAIN STREET,HYANNIS on order the Zoning Board LUKE P.LALLY. - `l Appeals. are in to be present.By Clerk r Barnstable Patriot --- ,' Iuly 5,12, 1984 �h i,�� �QR Oc�11 ' ' T ON 206 STp ST tl�rpy � /or ccs few Fs ` TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma `\ Parcel CAW Application # 1 Health Division Date Issued i �! Conservation Division Application Fee to.- Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH - Preservation/Hyannis Project Street Address 942 West Main St ftombs Village C2nt2ryi 1 1 e Owner Address , Telephone 908-955-6839 Permit Request Air sealing. R-23 insul to attic attic thPrmnrinrm, R-9 3fiberglass to house siii, thermestats Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay P.,roject Valuation $1 2 nnn Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation: Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes 0'No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other L:? C) Basement Finished Area(sq.ft.) Basement Unfinished Area(sq'�ft) -- Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new ` Total Room Count (not including baths): existing new First Floor Room Coun#~' � Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Othercn Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name RISE Engineering Telephone Number 401-784-3700 EXT 161 Address 1341 Elmwood Ave, Cranston RI 02910 License# 100459 Home Improvement Contractor# 120979 Worker's Compensation # 3730961-01 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO RI Resource ReSpVerV SIGNATURE -__ DATE 0 / 0 Erik Nerstheimer for RISE Engineering FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP./PARCEL N0. . ADDRESS VILLAGE OWNER Z DATE OF INSPECTION: r -•-•FO:UNDATION,: FRAME INSULATION = A ; ;y FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH i FINAL 'GAS jE'- ROUGH ;'' t a I FINAL _ FINAL BU1LDING3j ?:` }} P ` DATE CLOSED OUT - . ';`' ASSOCIATION PLAN NO. t The Commonwealth of Massachusetts r Department of Industrial Accidents ., t Office of Investigations ' 600 Washington:street ._ Boston, Mass.'02111 www.mass.cov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/E9(�etricians/Plumbe>rs Applicant Information Please Print Legibly Name (Business/organization/Individual): RISE Engineering a division of Thielsch Engineering Address: 1341 Elmwood Avenue City/State/Zip: Cranston, RI 02910 P1ho>ne#: (401)784-3700 or 1-800-422-5365 Are,you an employer? Check the appropriate.box: Type of project(required): 1. i am an employer with . 4. ❑ 1 am a general contractor and I 6. ❑New construction employees(full and/or part time).* have hired the sub-contractors 7. ❑Remodeling 2. ❑ I am a sole proprietor or partner- listed on'the attached sheet. ship and have no employees `These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑.Building addition [No workers'comp.insurance comp. insurance.$ required] 5.0 We are a.corporation and its -10. ❑Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11. ❑Plumbing repairs or additions myself [No workers' comp. right of exemption penn MGL insurance required] t c. 152,§ 1(4),and we have no 12. d Roof repairs employees. [no workers'.. 13.N Other Insulate comp.insurance required.]. *Any applicant that checks box 01 must also fill ouf the section below showing their workers'compensation policy information. tHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $contactors that check this box must attach 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.policv number. , I an an employer that is providirig,workers'conipeiasati.on insurance for niy employees. Below is the policy and job site information. Insurance Company Name: The Preston Agency Policy#or Self-ins.Lic.#: 3730961-01 Expiration Date: Job Site Address: - City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing,the policy number and"expiration (date). Failure to secure coverage as required under Section 25a ofMGL 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 $250.00 a.day against violator.Be advised that a copy of this statement maybe forwarded.to the Office of Investigations of the DIA for coverage verification. I do herby certi ,under the tins n7 'enralties of perjury that the information provided above is true and.correct. Signature: Date: Print Name- Erik Nerstheimer Phone#'("401)784-3700 or 1-800-422-5365 extll� 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 heath 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other 'Contact person: Phone#• _ OP ID:31 '� • DATE(MM/DDIYYYY) CERTIFICATE,OF LIABILITY INSURANCE 12/30110 ®�®R THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT,BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements). CONTACT PRODUCER 401-886-8000 NAME: .- The Preston Agency,Inc. 401-885-1700 PA CNN Ext: : Fa c No 1350 Division Rd Suite 303 E-MAIL ADDRESS: PO BOX 810 PRODUCER TH►EL-1 East Greenwich,RI 02818-0810 CUSTOMER,,,: - INSURER(S)AFFORDING COVERAGE NAIC# INSURED Thielsch Engineering,Inc INSURER A:Zurich-American Ins Co. Thielsch Group Inc. INsuRERB:American Guarantee&Liability Hi Tech Realty Inc. INSURER C:North American Capacity 195 Frances Avenue Cranston,RI 02910 INSURER D:Hartford Insurance Company INSURER E IN F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. lNSR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DDIYYYY MM/DD/YYYY GENERAL LIABILITY _ EACH OCCURRENCE $ 1,000,000 A X COMMERCWL GENERAL LIABILITY 3730962-01 01/01/11 01/01/12 PREMG1SEEST(Ea Foccurrence $ 300,000 CLAIMS-MADE ®OCCUR MED EXP(Any one person) $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 - GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 POLICY X PP.O- LOC Emp Ben. $ 1,000,000 AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT $ 2,000,000 (Ea accident) A X ANY AUTO 3730963-01 01/01111 01101/12 BODILY INJURY(Per person) $ ALL OWNED AUTOS - BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE - $ HIRED AUTOS (Per acddent) $ . NONOWNED AUTOS T UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 10,000,00 EXCESS LIAB CLAIMS-MADE 10,000,00 g AUC-4857188-00 01(01/11 01/01/12 • AGGREGATE $ DEDUCTIBLE RETENTION $ WORKERS COMPENSATION - X WC STATU- OTH- AND EMPLOYERS'LIABILITY - TORY LIMIT ER [A ANY PROPRIETOR/PARTNER/EXECUTIVEY� NIA 3730961-01 �` 01/01/11 01/01/12 �rEL::D L.EACHACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? - 1,000,00 (Mandatory in NH) ISEASE-EA EMPLOYE $ It yes,describe under L:DISEASE-POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS below C Professional Liab DVL000026800 04/01/10 04/01/11 Prof Llab 2,000,000 D Leased/Rented Eqp 02UUNTD5678 01/01/11 011 1/12 Equipment 100,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule;if more space is required), CERTIFICATE HOLDER CANCELLATION TOWN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ' ©1988-2009 ACORD CORPORATION. All rights reserved. "ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD I . tHIEC-1: PACE 2 O EPAD INSURED'S NAME Thielsch Engineering,Inc OP I®: 31 DATE 12130110 I� o or:. Ris�E En ineering,a division of Thielsch En�ineering,Inc. Ca bcellssociaTes,a division of Thiels h Engineerin Inc. SAL Laboratory,a division of Thielsch engineering,I c. ES86aboratory,a division.olThielsch En ineenng,Inc. AL Engineering3 division of Thielsch wngineerin ,Inc. Water Managemer�� ervices,a division of Thielsch Ingineering,Inc. 1 a -_ an 10 usinets emu anon Oft ce o onsumer b - 10 Park Plaza - Suite 5170 _ _ Boston, Massachusetts 02116 ]Nome Improver sN ontractor Registration —��- Registration: 120979 Type: Supplement Card Expiration: 3/25/2012 . THIELSCH ENGINEERING ERIK NERSTHEIIViER w 10. 1341 ELMWOOD AVE. CRP,NSTON,'RI02910 Update Address and return card.Mark reason for change. F-1 Address "F-I Renewal ❑ Employment Lost Card DPS-CA1 Ct 50M-04/04-GG1�1{j0/1216p / pQ Jfze (IG✓Y�I�AC% ✓ULG d6d,CJ2ll6e4. Office of Consumer Affairs&Bu mess Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date..If found return to: ` Office of Consumer Affairs and Business Regulation _ Registration 120979 • Type. 10 Park Plaza-Suite 5170 Expiratwn 3/25/0.12 Supplement Card Boston,MA 02116 THIELSCH ENGI<�EER(NG ` ERIK NERSTHEINIER", �i 1341 ELMWOOD A8/ �'a`W" '" Not valid without signature CRANSTON;RI 02910-Z Undersecretary I Licensee Details Page 1 of 1 The Official Website of the Executive Office of Public Safety and Security(EOPS) Mass.Gov Home Public Safety Department of Public Safety Licensee Complaint License Type Construction Supervisor License# 100459 Restriction WS,IC Name Erik Nerstheimer City,State,Zip North Scituate,RI,02857 Expiration Date 3/28/2012 Status Current No complaints found for this Licensee. Back To Search s I http://db.state.ma.us./dps/licdetails.asp?txtSearchLN=CSLI00459 1/7/2011 i�pa q. - - r� � j04� � - t +nr 4 Er,aa k1�,IiI ! r alr�'d� 13ktbp di�1�IIG ik 'r tr IM$ 7 � - I wf ".F' �LYE T\y� 4'f3��✓}�n�s�„5 �.,-,¢� 1 ig Ili 0r�2ddr�"� i •ti r3r^ y� ���`` �ar k� ' `"� �•f��_ ifi �Rti�'. G'rt��`- Eti�: l+'V_J,f n .�.,� "'��Yk P hl�y1 ftl�l � � Y�JC4'MGrYRC�;' a,,.✓ �T-23.1 - 1 J r RISE ENGINEERING rwa«e�+w a ._ �t�oruracearRaglaabasfoa NogiBti A 4MOM of 7Weltb aver NItA OotRrss r ilagb4ratlon e!o " ,` t:B t:adract3or Raglebsffion we 1�Dtls1 1341 Eftwood Avenue,Creaston.It102910 CONTRACT T (401)7�43700 FAX(401)'11"716 f ..r r COp6pN! l�il" C Is E - _ rat ocw�1a atatFaao taro aanabar+tote MF-CLC aroe®uw�umne;cuetoe�,s�svw�u�s ENGINE52ING uSam West Side Place LC (508)255-M32 09/2612011 . :_" 1:123986`. esAMea evxokT - aaaMia araeEr p .. 942 West Main Street 942 West Main Street MM cn:.oTA.a.m ' _. _._. eaawo ew.smma. — Centervilik MA 02632 Centerville,MA 02632 JOB DESCRIPTION The Cape tow Comps will have RISE HMO CwTact fluaa wwa Mw-in lamps in existt radios $137.99 The Cape tAgbt t ompast will have MSE i mull low flow flumet moos and sbcwnlew*as apple. SUM RISE Eaighadng will pnwide labor and ms Wals w aad asass 'ibis wa rlt will be , poft ned in awcat with the use of speoW tools and d-ugmm&tests to asset that your ham will be left with a hit level of air exefiauge and fmkwr air quality.Mai miale to be used to seal your humc caa irbclude couUm,foaabs,weal ersteiNping abed Oder products. Primary areas the sealing ine]ade air ItdW to 1Rtim basamc s aid othet wood areas(wbndows are not gay addressed.) This w tk will be pe f mod at be rate of S66 per mat per hoar,v4ix b includes maWWs aW tesgin& 42 man!rams. U.169.00 ® i RISE Enginea®g will provide Idw and materials to install a r layer of R-23 Class 1 Cell dose added to 3600 square fba ofagbaa attic space: $3,600.00 RISE Engineering will provide labor and ma Wds to instal an easily moved,►ed ham houlaling cover for the attic swess folding stair_ The cover has integral webelwanipp mg to restrict air Malwo S%0.00 RISE Enghwaing will pnovida labor and materials to fiaW 900 square Poet ofR-19 faced fiberglass Wwla dw to the paeimeaer of axe basement wailing at the boost sU SM.00 RISE Erngi odng will provide iebor and nos to intWi up to I I line vabltaga paopammabk sethadt dmna gate. $2.430.00 USE Eapaoering will apply all applicable,d4oble hwauim to this a wsact. You well be billed w ly the Net a motmL Cmuntly,for eligible mteaArea the Cape 14M Compaq offas 100°,4,incentive far this Pae ty,net to exceed 32,000 per unit " . .S11,309.88 ft At3M!!td MB1r 7U FrNEW GWAMAM•COWL E roM IM MM A9y MEMM710M FM 711E afro OF '001 DtOles $0.00 aPOaralY aaiRGTlONanlmA9s11011ALnlrab��0ile101adHla�OlOaa�l'A�e1lNr aftarRai.�til�a'rO111walaaLlYlalla0 al0ari�T0a111N1 - - IaflllDa�Lll�e�ltfiBl>I10A10.e�IRYWl/OaaaiOlRlerl'a/�1t10M019tIRaAl11@a,f11a1naOFaf�lAal�At�COa1�lYCTtaa/Ar1RA1M!!IL. _ DD NOT 8M TM CONTRACT IF TWU ARE ANY fbkAW 3PAM e raaaeilmuff p q�Anaborrraes ' aorenaooarrarueraw►raswnbartasrxeffaorarr®ranrs oRneaF �. � ' . Aoa:�reacroaFobimri+xer•T�aawenu«i�s�nprariu�owasaobors� ,�� - m►ta.�acrarcr,ou.+,owe<rxubawaoasanmroa�>tun+orxaartnoonaE.rosa _ ran. asaiw►+n�arwuasareoeAsounaamarobe � -, T _ r col/d Y5 S N S U L A T I O=,N, �',5 Pit 1 5 FIBER GLASS SEAMULSS SPRAYEOAM SUSPENDED r • • _ {F BATTS BUTTERS INSULATION CfILINOSza + '+`B"'K O'�'9� pP 1-800-696-6611 V S T1:;3 Y 4 _ • • a ' r - * �! Town of Barnstable f Regulatory Services Building Division 200 Main St Hyannis, MA 02601 Date: Dear Building Inspector , i Please accept this Affidavit as documentation that Cape Cod Insulation, Inc:performed& j completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute (BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. jProperty Owner aProperty Address Villa e ! UlJ C S� 5�CQ� C��C•e �.�- l�a_ lk�'E'b�'V't\`A��1��a'• i�l�� , 1 r ' Insulation Installed: Fiberglass. Cellulose R-Value `' Restricted Unrestricted { I Ceilings ( ) (7�) ( 3 0) t Slopes Floors OO ( ) 3 C>) ( ) ( ) Walls ( ) ( ) ( ) ( ) ( ) erely bpe Ca idy Jr resident ; d I sulation, Inc. Town of Barnstable r - �j Regulatory Services P� Thomas F. Geiler,Director - Building Division • s�xxsrnsr.E, 9 1 ��" Tom Perry,Building Commissioner t� °� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: -D Permit#: O ( 6� HOME OCCUPATION REGISTRATION Date: �- �a -e2DI oZ ' Name:l 4)(1'0 IQD Phone#:'�5T=l5 C2&7( Address:740 1U,00/* n S� 63 ,f"3 . &11,k(\1'J Village: Name of Business:1 AX 0 411- 010q o I o& Af,-)b Chef Type of Business:-( Qaa n i A Map/Lot:- G y-9- oS L-4 INTENT: It is the intent of this section to allow the residents of the Tovnm of Barnstable to operate a horiie occupation 'within single family dwellings,subject to the provisions of Section 4-1.4 of the'Zorung ordinance,provided that the activity shall not be discernible from outside the dNvelling: there shall be no increase in noise or odor;no visual al[e-r•ation to the; premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration A ith the Building Inspector,"a customary home occupation shall be permitted as of right subject to them follovvang conditions: ` ",; a • The activity is carried on by the permanent resident of a single family residential dwellirng unit; zdi located 1' n that dwelluig unit. r. • Such use occupies no more than 400 square feet of space. l • There are no external alterations to the dwelling"'I'l-tich are not customary m residential bunlduhgs;and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production'of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionabie'effects. • There is no storage.or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing die Customary Home Occupation,and not riathin the required fi-ont yard. • There is no exterior storage or display of materials or equipment. • There are no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,ahnd one trailer not to exceed 20 feet in length and.not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating die Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business, the street address shall not be included. • No person shall be employed uh the Customary Home Occupation who is not a permwient resident of the dwelling unit. - I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. �. Applic t: Date: Homeoc.doc Rei%01/3/08 YOU WISH TO OPEN A BUSINESS? For Your, Information: Business certificates (cost$40 00 for 4 vParGl A business certificate ONLY REGISTERS YOUR NAME in town (which you must,do by M.G.C. - it does not,give you permission to operate.) You must first obtain the necessary sign".AL11'es can this farm at 200 Main St, Hyannis. Take [lie completed forni to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by lavv. DATE: - r'D-o��('a Fill in please: APPLICANT'S YOUR NAME/S: X I M j Kt A -3 BUSINESS YOUR HOME ADDRE 94Q a Gar 1: tJV LA V ,2 TELEPHONE # Home Telephone Number NAME OF CORPORATION: %_ NAME OF NEW BUSINESS GZ - A (ry� f Q& 6 TYPE OF BUSINESS Iq Iv l Vj IS THIS A HOME OCCUPATION? yep NO. ADDRESS OF BUSINESS 4� l k � MAP PARCEL NUMBER o2 l7��'/ (Assessing). When starting anew business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. .You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your usiness in this town. 1. BUILDING COMMISSIONER'S rd E This individual has bee oof an jpr-mit`requirements that pertain to this e f ` 'i MUST COMPLY ME OCCUPATION AE orized Signa ire** RULES AND REGULATIONS. FAILURE TO COMMENTS o rMAY RESULT IN FINES. 2. BOARD OF,HEALTH This individual has been in rmed of the per requir Onts that pertain to this type of business. MUST%AMPLY..WITH ALL ed Signature** XAZARDOUS MATERIALS REGULATIONS COMMENTS: 3. CONSUMER AFFAIRS(LICENS[W AUTHORITY} This in has b info d f e licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: 'W-Engineering Dept. (3rd floor) Map 2 �/ ` Parceli O 5-4 -00L Permit ` House# `7` Z-- l✓ /`Tllf(l Si • Date Issued Board of Health(3r floor)(8:15 -9:30/1:00-4:30) 217 e Conservation Office(4th floor)(8:30- 9:30/1:00-2:00) Planning Dept. (1st floor/School Admin. Bldg.) SEPTIC SY UST BE Definitive P14rApproved by Planning Board 19 iNTALLE DANCE .� wiNVIRONW`4 OE AND A TOWN OYBARNSTABL a Building Permit Application Project Street Address Village 51 NoxamC / t/eeL�' Owner Address 0`7 �iv�✓r7� 44%JE,Q111 f: dfZ 5_3 Telephone 8 - 22_ Permit Request �� ��f- �'Ti�z+C 1�1�/`►¢r�� G�I�-t,(.�S �� �/1 -,C-T� �L ,P 5A 7 7- _First Floor 3(oY square feet Second Floor square feet Construction Type Estimated Project Cost $ 6Z9�I Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dw Type: Single Family ❑ Two Family ❑ Multi-Family(#units) c Age of Existing cture Historic House ❑Yes ❑No On Old King's H• ay ❑Yes ❑No Basement Type: ❑Full Crawl ❑Walkout ❑Other y Basement Finished Area(sq.ft.) Basement U s ed Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No. of Bedrooms: Existing New Total Room Count(not including baths): Exi ' g New First Floor Room Count Heat Type and Fuel: ❑Gas ❑ ❑Electric ❑Other Central Air ❑Yes ❑ Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detac (size) Other Detached Structures: of(size) ttached(size) ❑Barn e) ❑None ❑Shed(size) ❑Other(size) Zoning Board of eals Authorization ❑ Appeal# Recorded❑ Commercial Yes ❑No If yes, site plan review# Current Use Proposed.Use Builder Information Name A-7)'J' Se_%-l lle , Telephone Number Address 9!�- License# C9 O 7 z- 1)�4- E6 ZG -7/ Home Improvement Contractor# Worker's Compensation# r��� NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE_y��/�- DATE / BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) _ - _ �� Sr _ _ FOR OFFICIAL USE ONLY _ PERMIT NO. DATE ISSUED ' MAP%PARCEL NO: ADDRESS . ' VILLAGE' OWNER DATE OF•INSPEC'rION: FOUNDATION ! FRAMEL •. I INSULATION - - FIREPLACE , ELECTRICAL: ROUGH FINAL PLUMBING: r ROUGH FINAL GAS: ^_,ROUGH FINAL FINAL BUILDINQ) DATE CLOSED OUTS ASSOCIATION PLANit..NO.� ! - + 1 t m a t a r lhe-Commonwea&h of Mussachuseus - = Department of In&atrial Accidents „ - _ , �� ` • 011lcr ollmresl/�Blloos 600 Washington Street ' Boston,Mass. 02111 Workers' Comyensation insurance Affidavit /..�•n name: 1tX.•dtlon' .. . City W phone# + ❑ I am a homeowner performing all work myself. ' 1 am a sole eior and have no one woildng in any capacity ❑ I am an employer providing workers compensation for my employees working/on this job. comoanv name: /l�L/s��9 •� 71 /.�L address: city o insurance CO.' �i � i� !'vim niicv# ❑ I am a sole proprietor,general contractor, or homeowner(circle one)and have hired the contractors listed below who have ... ._. the following workers' compensation polices: comoanv name- address: ,Z dtv - shone th r" `", ...... ... insurnnce cm ... .t: . . A...... . lieu#4 - •' ,.w<•.:,", '",".,..3::. . "__ _. MM comnanv name, address• dW. phone insurance cm iicw#' Failure to secure coverage as requited under Section 25A of SiGL 152 can lead to the imposition of criminal patdtla of a One up to SL50LOO sadlor me yearn'tmprbonmem as well m dvll penalties in the form of a STOP NORK ORDER and a One of 5100.00 a day against me. I understand that a copy of this statement may be forwarded to Nun OOiee of Investigadons of the DIA for eo►etage reriOorion. J do hereby cadffy order the pant:anti penalties of pedwy that the information provided above is trw and eorred �- S*ature _5 e�5 Print name oindal we only do not write in thb area to be completed by city or town offtM city or town• .-, permiunceme o 3Buiidin Department QLieensing Board ❑cheelciflaunedlateresponsebregnitsd 1]seleetmewsonice (3Health Department contact person: phone ti: ❑Other (tenwa 9/93 PJA) Information and Instructions - Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers compensation for their employees. As quoted from the"law",an employee is defined as every person in the service of another under any court-- of hire, express or implied. oral or written. - An employer is defined as an individual, partnership, association, corporation or other Iegal entity, or any two or sore of die foregoing engaged in a joint enterprise.and including the legal representatives of a deceased employer, or the receter. 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 ,..a,—..ate�lo.,s-no rws to do maintenance . const action or repair work on such dwelling house or an the grounds o: building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renew of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who ha not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commomvealth 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 coaa�ctzag authority. �. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to yaw sitnI and - supplying company names,address and phone numbers along with a certificate of insurance ash affidavits may be and submitted to the Department of brdusUW Accidents for confirmation of insurance coverage. t sign - 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 ifrou are required to obtain a workers' conipensatron policy, please call the Department at the number listed below. city or Towns Please be sure that the affidavit is complete and printed Depart, has provided a space a ed legibly. he t � . �. _. tthe bottom ofthe 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 permitlliceose number which will be used as a reference member. The affidavits may be returned t^ the Department by marl or FAX unless other anatrgements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please.io not hesitate w give us a call. 5 The Depaunent's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents :-Omce of imtesdgadoas 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 eat 406, 409 or 375 DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION°,SUPERVISOR LICENSE Nu�6gr Expires: estrieted�To 00 WIL'IIAM 95 St0U6N RD BREWSTER, NA 02631 �i4KFar' Pt fit ? ,1��� ��„�*y �"'�iEe Z�rmyveoxu�ea�o`.,/�taddaa�uae�ld n7 �t ',. HOME IMPROVEMENT CONTRACTOR + .,Registration .106439 -jype PRIVATE;CORPORATION ,Expiration 07/23/00 , Y � xYILLIAM C. LADD ASSOC , INC. William C..�ladd lough Road Road r e=ADMINISTRATOR :Brewster MA 02631 7 or) Map y Parcel Pe mit# 0.0 House# Date Issued '' j� PPM Board of Health_(3rd floor)(8:15 -9:30/1:00-440) - Fee Conservation Office(4th floor)(8:30- 9:30/1:00 2:00) Planning Dept. (1st floor/SchoolAdmin. Bldg.) THE De De ' i PI n Approved by Planning Board 19 : BA MA95. * e r t67+per E D TOWN OF BARNSTABLE, . Building Permit Application 9 Project Street Address Vhcc;� Village 4 CL/V1% Owner a h 1.A doss-aG Address Telephone - Permit Request ✓lamcinAS S First Floor sq ar&-teet Second Floor square feet Construction Type Estimated Project Cost $ 6 000 Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Z� Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No. of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) A ❑Other(size) tZoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information NameGtdl C F✓�-G�� _ Telephone Number .. Address /7 License# w Home Improvement Contractor# X1�5:36 Worker's Compensation# /� � 3 63 0/7> 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 v` SIGNATURE DATE-7-Z 1142h -C- 14 BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) o S� FOR OFFICIAL USE ONLY _ _ <' - - • 1 PERMIT NO. -, DATE ISSUED l. -MAP/PARCEL NO. , _ - - Qi _ e , ADDRESS VILLAGE OWNER Vt i - • - i ! DATE OF INSPECTION: FOUNDATION ! .! ► ` + f = ' FRAME Y _ a' "_� INSULATION 'FIREPLACE � _ ` � ► "• � .. Y —� ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL' + FINAL BUILDING DATE CLOSED OUTS ASSOCIATION PLAN NO. The Town of Barnstable HAM �g Department of Health Safety and Environmental Services BuiIding Division 367 Main Sari,Hyannis MA 02601 Ralph Ctossen Office: SOS•790-6ZZ7 Building Commission: Fax: 509-790-Q30 For office use only Permit no. Date AFFIDAVIT HOME OWROVEMENT-CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION t MGL a 142A requires that the "reconstruction, alterations, renovation, repair, modernization. conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least-one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions.along with other requirements. Type of Work: ' Tlrtt.Cost „ Address of Work• S Owner's Name zha �, Date of Permit Application: g I hereby certify that: Registration is not required for the following renson(s): Work excluded by law Job under SI.000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGI Ahi OR GUARANTY FUND UNDER MGL c. 142A SIGYED UNDER PENALTIES OF PERJURY I hereby ap ty fora permit as the agent of the owner. ':�/"'9 4,q C Datd Contractor Name Registration No. OR Date Owners Name _ The Commonwealth of Massachusetts a =` Department of Industrial Accidents elfice eflavestigatfaas, 600 Washington Street +r Boston,Mass. 02111 � -" Workers' Com /nsation Insurance Affidavit e �@�rr4��!���������ftr����������������������������������������%��s name location: r? city Co`i-c�A phone# ❑ I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one working in any capacity am an employer providing workers' compensation for my employees working on this job. company name Y'/LGc> /' �✓l�G��n" address: city phone# , ' r C / insurance co. olicv# l�(J� �lJ L 2� 3 i ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: company name- address- .. _... city: phone#: insurance co. company name: - address. city phone#: insurance co 011ty# Failure to secure coverage as requued under Section 25A of 11GL 152 can lead to the imposition of criminal penalties of a fine up to S1.500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby eery under h enalties of perjury that the information provided above is truo and correct Signature Date _ Print name Phone# official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other (tensed 9/95 P1A) i a Information and Instructions 7 Massachusetts General Laws chapter 152 section 25 requires all emplovees to provide workers' compensation for their "law", an employee is defined as every person m the service of another under any con=c the la employees. As quoted from , of hire, express or implied, oral or written. partnership, association. corporation or other legal entity, or any two or more of a An employer is defined as an individual. P p, rP the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver: 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 o: building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renew of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who ha not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits 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. City or Towns 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. The affidavits maybe returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. MEMNON The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents l,. alike of Investlgatlons 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 -=� � . :� :'t �, .�[ �<y� 5 ; tt -�Y.t n5 1 �rN 3��3yb ya,Y '• '� �t.i `r(�L� • .._•, a �' � �� �y���^_���•' � 49a�:�- ��[ �r x` �K�{�t� �..�. f 5• Y xy. 'Fw�. [ - ^'i_]"Y� 1�',i�J�Rj't.K � S � P_". j� 1 •= s � � r 4}}��..c" r � � rit, qr� fi�rt,a j�t r < -_ VVAM r s y( 1 4 � S �" ,mac, 4 'f .�y+L+i'e✓x i-. � )µ _ r F it 09-02-98 12:03 22 15093353773 -L;DD INC 001 WILL LADD ASSOCIATES, INC., 95 SLOU014 ROAD, BREWS TER, MA., 02631. Phone�08-3816-7003 Cell:578-246-0812 Faxt608.386.3778 [Please allow 7 rings] FAXj9Q,V9R„ HEET FROM; WILL LAD®AMC., INC., PAGES (Includes 1 age,) MESSAGE: Z 1411CO. 7 e36 K 95/ 996 A ('249/�4 Assessor's ma and lot n6n.— ............... p 0*TNE TOE 4 See Letter 10/17/84 Copy attached Sewage Permit number. ......................................................... 7 ;g NAG& t-&eet 0 33AUSTIBLE. House- number' I........... I..... 1639- TOWN OF BARN.STABLE. BUILDING INSPECTOR Erect 6 Unit Apartment House APPLICATIONFOR PERMIT TO .............................................................................................................................. TYPE OF CONSTRUCTION ...........Wood Frame 2 Story......................................................................................................................... October 22 84 ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: A Location .... C�enterville, Ma ........ .................................................................................................................................................................... Apartment House ProposedUse ...................................................................................................................................................I......................... R C 1, Centerville—Osterville ZoningDistrict ........................ ..........................................Fire Fire District .................................=......................................... 1, John S . Lebef Box 1011 Osterville, Ma Nameof Owner ........................................................I ..............Address .................................................................................... John S . Lebe'l . �2 Wianno Ave Ostervilld Nameof Builder ................................................... Address .. ............................................................................... James Stewart Marston Mills Ma. Nameof Architect James :...............................................Address .................................................................................... rr Twenty Four 113 Poured Concrete' Numberof Rooms ..................................................................Foundation. .............................................................................. -Wood Shingles & Clapboards Asphalt Shingles Exterior ...................!................................................................Roofing .................................................................................... Carpet's & Vinyl Sheetrock Floors .......... ..........................................................................Interior .................................................................................... Electric Yes Heating ...................................................................................Plumbing .................................................................................. None ..�210,000 Fireplace ..... ...................................................................... pp roximate Cost ................................................................ Definitive Plan Approved by Planning Board -------N/A __19--------- ,,Area .........6.o.o...@........14...=....$.5o4. Diagram of Lot and Building 'with Dimensions Fee .........Plus 4801 storage SUBJECT TO APPROVAL OF BOARD OF HEALTH 14-- Iq OCCUPANCY PERMITS 'REQUIRED FOR NEW 'DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding"the a'ove construction. Name .. .... ............... ............ ................... oo6232 Construction Supervisor's License .................................... .-,LEBEL, JOHN S. A= 49-54 No ...27293... Permit for LY....... ft- Location 942 West treet ........................... ...... ........... ..................Centerville................................................ Owner :....John S. Lebel Type of Construction .............................. ................................................................................ Plot ............................. Lot ................................ December 3, .......-19 84 Permit Granted ............................ Date of Inspection ....................................19 Date Completed ........................... .........19 7 --ado /54 Assessor's map and lot number .....249.. — '`ltJ�.r,I. .�. �FTHET� 8 4/9 7 6 VI-,r /--& r i�L c- ., � Se a e Permit number «� y Lots��<��s ��Q ♦� a 942 West Main Street Afat 3 �`e, t MARISTADLE, : Housenumber ............................................................ ......... r Maas 1639.. :x • �Fa MPY a. TOWN OF BARNSTABLE t �v,,4B�U:tDING IN'S=PECTOR { APPLICATION FOR. PERMIT TO Convert Beauty Sllop to an Apartment ........................................................................ ................. Wood Frame .. ... ..r.1.......... .......... TYPE OF CONSTRUCTION £/TL S 1 .....October..25...............19...g5 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ......942 West Main Street, Centerville ..... ........................................................................................................................................................................ Apartment Beauty Shp converted to ProposedUse ................................................................. .... .... ................. ................. ................... R C 1 C-enterville Osterville ZoningDistrict ........................................................... ..Fire District .... .. ................................................................... Name of Owner John,-: S . Lebel Box 1011- . Ostervile, Ma ...................................................Address .................................. - Name of Builder ................Sam.e..........................................Address .......:.:............Same.......::.......................:.................. Same Same y Nameof Architect ..................................................:...............Address ..................................................................................... Number of Rooms Three Existing.........:........:........................... .............................................................Foundation ................................ Existing " Exterior ..................................................................Roofing ................................................................I................... Carpets Sheetrodk Floors .................... ................................................................Interior .................................................................................... f HeatingGas Fired Hot Water Copper ..........................................Plumbing .................................................................................. None Approximate Cost 2,000 Fireplace ....................:......................................................... ..................................:.................................. N/A ; Definitive Plan Approved by Planning Board -------------------_-----------19-------- Area .....*...........f......................... Diagram of Lot and Building with Dimensioris Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH Floor plan attached OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the/Town of Barnstable regarding,.the above construction. -- . Name .................................. .. ..... ..................................... Construction Supervisor's License ........:........................... f LEBEL, JOHN S. A=249 —54 No ...28:F'�76...' Permit for .Remodel Beauty Shop to Apartment Location ...942 West Main Street ..................... Centerville _ ........... ............................................................ _ Owner ......John S. Lebel ` ................................................... Type of Construction ....Frame ................................................................................ Plot ............................. Lot ...r............................. " ` November 14 85 '- Permit Granted .................................'........19 k Date of Inspection .......................... ........19 r Date Completed ............................:..........19 11 • jo 1 T� Assessor's map and lot numbed .....•z49/5?+ a" r S�k�/'iL J YST�`y G rL �.� ''u - UJ T U �i� �l �_ s h°v� � �pG THE tp� N 84/976 Se age Permit. number L y T r «`ys 942 West Main Street . Ajit 3 GGv✓� i eaaaAGa LE, : House number ................................. .................. .. 9 DR/G G� �i 63 9. \0� 0 Jul a' TOWN OF BARNSTABLE BUILDING INSPECTOR Convert Beauty Shop to an Apartment APPLICATION FOR PERMIT TO ' . ........................................................................ ...................................... ............. Wood Frame TYPE OF CONSTRUCTION October...25...............19...85 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ......942 West Main Street, Centerville ..... ........................................................................................................................................................................ Proposed Use Apartment Beauty Shp converted to ............................................................................................................................................................................. Zoning District ........R C 1 Centerville, Osterville ...............................................................Fire District .............................................................................. John S . Lebel Box 1011 Ostervile, Ma Nameof Owner ......................................................................Address .................................................................................... Name of Builder ...............Same........... Address ......................Same................................................... Name of Architect .............Same..........................................Address ......................Sam...................................................... Three Existing Numberof Rooms .................................................................Foundation .............................................................................. Existing " Exterior ....................................................................................Roofing .................................................................................... Carpets Sheetrock Floors .....................................................................................Interior .................................................................................... Heating ............Gas Fired Hot Water Copper .....................................................................Plumbing .................................................................................. Fireplace None ..............Approximate. Cost ..,2.,,000 Definitive Plan Approved by Planning Board ---N/A ---_---------------19-------- . Area .....�.�.�....................... 00 Diagram of Lot and Building with Dimensions Fee . .........SUBJECT TO APPROVAL OF BOARD OF HEALTH Floor plan attached OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of a own t e reg ding t above construction. ..... . ......... .................... onstruction Supervisor's License .................................... r _ 77 { ;REBEL, JOHN S. No ..28676.... Permit for ...Remodel Beauty...Sjjgp..t�..Apartme . .................. _ ' - 942 West Main "Location ....................................Si x�e.t............... c Centerville.................................... _ c •...Lebo_ - p _ r Owner ......ohn S 1 _ Type of Construction ....Zr.ame........................... - t �- ....... ........... ............................................. C .Plot .......... ................ Lot t............................... Permit Granted ........November 14, - lq 85 ............. . . Date of Inspection ................................. .19 Date Completed _ 1 r S O 01 _ro ----^ter --�------�' \M E 1 1 -9IZ 01.1 -n4to 4 zvvw� Q4. _ . �,t�lourrl N�'Tl�� di+J'} c� ,NoT 1�rL BAx z- qqg de— t J VK OF FNfC-HARO , v A. HAXTER wo 2?0* { ♦ate IL err- -7 4-7 G- LG"T U Af- �r ly.L� ' � t►., - �� �'r 1p,�\_T-S i t- 2"a-mod. L 2/W � FND. (o�N34 54 76./9 SHEET I OF 2 o,Zr ouch Ra o�c� 17 a kOk,o. F am o N5�8 r�66 1 zz R.LB rn eSt v= _ FND. rn rn� 1 � ' LOCUS co (b� pine St. arn — / S G C.B. � o\ FND:.=.' � O 6 N PARCEL LOCUS MAP �/ 1,37S.F. CID N `) g.13 C.B. O - 0 3 SCALE: 1" = 2,000' o' p ti / 1 W FND. 5�7�' 1 O.ZO ZONE: RD-I / 4 Z- Z MAP 249 - PCL. 54 \\ f 1 �-- c.B. G FND.: i r 1 KD DM N X rn -c N 0 D 00 U Cn 7) 1 10 Cv • � I . v 1 P_/6 _ /^ C.B. _ FN D. R P_/S _ 1 6 - 09 - C.B. N 1 f P_/4 97. 57 FND. — \6 C.B. --. /`'~S8B - 04 - 36 E —� - _� 62 FND. --, /00. 9/ - --- t • l S NOT TO BE CONSIDERED A °� o \04 G e' NOTE. PARCEL # I g BUILDABLE LOT, AND IS TO BE COMBINED Q 1 WITH LOT D-4. PARCEL #1 IS NOT REGISTERED. ry N r r- S64 moo LOT D-6 IS TO BE USED FOR RIGHT \� ` 4 LOT D - 4 rno OF WAY PURPOSES ONLY. 9 �<v �- 9 TOTAL AREA = 51,860 S.F. cn �0 AREAS A, B, $ C, ARE NOT SEPARATE LOTS, � - o CH SPECIFIC RIGHTS ARE ti P^� `g3 BUT AREAS TO WHICH \ �.r.,f ,\0 � �� TO BE ASSIGNED. ` Cv Cb I CERTIFY THAT THIS ACTUAL _ G (° F'4,��Y G GE ' \T-0 - SURVEY WAS MADE ON THE GROUND'1N �� ( � ,o ACCORDANCE WITH THE LAND COURT d` �. r INSTRUCTIONS OF 1971 ON OR BETWEEN -Az 1> '- _ o �• JANUARY 13, 1982, AND MARCH 6, 1987. �• �. s DATE: (� REGISTERED LAND SURVEYOR IfQs 7 PARKER ROAD ) C.B. •'� E OSTEPVILLE, MASS. FND...' / AV y _ a j M ti /r3 �� �0 l y> I HEREBY CERTIFY THAT THE PROPERTY Ci �o �� �} � �,' / LINES SHOWN HEREON ARE THE LINES DIVIDING I CERTIFY THAT THIS PLAN FULLY AND h o / EXISTING OWNERSHIPS, AND THE LINF-S OF THE ACCURATELY DEPICTS THE LOCATION AND ° =' AS BUILT q °• �j`> o ' I s: STRE. TS AND WA".aS SHOWN ARE THOSE OF DIMENSIONS OF THE BUILDINGS / , PUB!-IC OR PRIVATE STREETS OR WAYS ALREADY AND FULLY LISTS THE UNITS CONTAINED a, N CAN/T o , ' O ESTABLISHED AND THAT NO NEW LINES FOR THEREIN. ` � Cj h • ' DI!SION OF EXISTING OWNERSHIP OR FOR cy o : / Cj ° cU NEW WAYS ARE SHOWN. 9 co 00 s o��/ •� 30 o I Q DATE REGISTERED LAND SUR EYOR 5g\�8 M l AREA B FND. .• 5,733 S.F. �co ^�( � I ( Side �; � / West Place 4 . 4 O raj 0 �� O h� AREA C / �' ti� r �o `/ ,� / z 2,797 S.F. LAND COURT PLAN OF LAND Z4 \• r; IN :• ,, . . �J h 9. .'� � / \6�. BARNSTABLE (CENTERVILLE) MASS. BEING A SUBDIVISION OF LOT D-4 7 'a,?k ` / AS SHOWN ON L.C.C. I0747 - C � �� ,�, S�,N►Lt. = 20 MARCH 31, 1987 �JQ4 FND. ,� �, / m 1, BAXTER $ NYE, INC. q •o / '.� , • ,. � REGISTERED LAND SURVEYORS R �33 O $ CIVIL ENGINEERS TERVILLE MASS. 4/40 OS M. H.B. FND. 9 44 yy Ptt�or Mess\ OFF 83-29—_ S �- P - PlIRKING SPACE or W►u.IAr1t G. /8 / '(g - - G UNIT 9 6 ,y S - S-i URA E " ` e Mn. 19334 /6, 20 N gs °' �a/ �o' �,o o y�2, S'>. � M.H.B. RID. OWNER: JOHN S. LEBEL