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0026 BAY SHORE ROAD
- -- �, 1 •w -2bJI-7 t Town of Barnstable *Permit# Z— E�rres 6 months from issue date Regulatory Services Fee Ulm Richard V.Scali,Director 1639. Building Division aal Roma,—Building Comm�ssione� �-- T — -------- 200 Main Street,Hyannis,MA 02 r 01 www.town.bamstable.ma.us Office: 508-862-4038 JUL Q 6 ?gVax: 508-790-6230 _ EXPRESS PERMIT APPLICATION - RESffl§5 .AQK Ll Not Valid without Red X-Press Imprint Map/parcel Number Property Address 26 . e �i0�140,25 ❑Residential Value of Work$=�Ta C� Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name GItL C 9- !'►G, Telephone Number "2 P C applicable) Email:T 1 �f>� d `f r£vtG h S�-, c l/C�.C041 Home Improvement Contractor License# if a hcable (0 5 ,Are ., u Construction Supervisor's License#(if applicable) �, �7� (a d oorkman's Compensation Insurance Check one: ❑❑ I am a sole proprietor the Homeowner I have Worker's Compensation Insurance Insurance Company Name — 5 — ��yyJ ' 1-7 Workman's Comp.Policy# kq-,i L" Copy of Insurance Compliance Cerfificat6 must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re- (hurricane nailed)(not stripping. Going over existing layers of roof) e-side ❑ Replacement Windows/doors/sliders.UfValue (maximum.32)#of windows #of doors: f *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. " ***Note: I erty must Si Property-Owner Letter of Permission. opy of the ome provement Contractors License&Construction Supervisors License is uired. SIGNATURE: Q:\WPFII.ESTORNObuilding permit forms\EXPRESS.doc 01/25/17 The Cammumveadt efMawa&Hsetfs 600'Wa&h m,street ' �urv�aznrr��fa�ra . Warlmrs' Camp ensgimInsu=ca ATLwit Bide s/CwrtractarslEled-e� hmzhers AIufiT6H Please Pint Addge Of 5 s DID J Are .an empl�er?Qreckthe,appropriatebaa ' Tppeof project(re'TAVed): , L�� aalaa esnployw ui. - 4. ❑I am a ge a al wnfractor and constudiin e�oyees(Rd as for part-•time * Inge lvredthe sub-Co� t�a 6. New 2.0 I am a sole propfietor orpadne listed enthe a#ar�d sbeeL. 7- El�° deling shr p and have>no employees =b-comfracf ors hafie S.-0 Deamolifioa worfdng fbrnn is any capaci4. employew andhave ors' 9. ❑Builfi3g arMifion . Arlo vupdm& comp.fimmme, Camp-i tsumncl I - . 5. ❑ We are a cmpomfiouand its 10- Elec(i;ical repairs,cr addifioas 3.❑ I ama horrm-mer doing aft wo&r o$cers lsave ed f II-El Ph=bk.grepi=or aid&ions, o Noes' a of na perU-0- � rapse'[N Wig- .l�❑Rflofn:gaits c.152.§ ( k an:dweave no �as�rerd,.� 14 h l3.Of�1heC �oyem[No ` casq_imaumce required.] •$�Y�Fsa �stcbed��aZ lt�scalp¢sna t seC�u6*wshmd3M$ieswu&eeCm3pmsziaspaTcyhrffiumsfimL -W $tTC E KES bax=rst z"Arbe3=.9ddifi=21 Shed SIMd=g&M'M-Of 15E SRf-COS xad Sfd2 vdiat B arnotgmu wfideshzm Pd.�OfECs.��SES�-Cesnfiartn�e���jp���pIDL71�E�t'I[R'CC�PS5'�.j1G�1C�II7�'�1CL lam ari $eiow is tiffs poffcy am;iah zIe FTi�Qr71i[rfPOIL / . TSsnr;nee:Co npagyNkme: C��� (.y l J rORCy 9 or ice.uc- l Q L C, 7 Job Om Address Af#ach a coFy of the workers'comgensaiionpoHcT dec!rafion page(shwwIng fbe poncy anmb �tnd expiration date). Faifnre ha sem coverage as requiredundtr Section 25A of MM c.157 can had to the impost ion of min final penalt%es of a fine up to$UOD OG 2sdfo3r one-gear.m--sor=ted,as weg as civil peaalt%es in the form of a STOP WORK OB'DERand a f of up to$25100 a dap am rinr. Be'advised gxa a copy ofthis sbh mentmaybe f xwwded in the Office of Inns af9�e D cove�gea T rfa - y cep psraes�Flm}'t7ro�t7asarraa{iau prmir£ed a€iai is bas anti correct V/ Date g, t 4�-,W - :2�zq C. = O,J dd aw,wdy� Da not mi&in 66 zweoi ita be-crospked 5p citp arfanrt Paz t"atS'r or Taww. Pe-rnafficease:9 Lssng AJutharity(Ch-de one): L Berard of Healffi 2.BuWM2 Department I CAYIrowa clerk 4.Elec teal hmpector S.MmAing Easpecter Coact Person Phone 9: hfim GCb=ral Laws M requires an eusplOyess'fo pro Vide ems'�p �C$tea��- , parsam to t}iis sue,a a ee is dryed as_":�YeaYPelsdn in$te sea n=of anUffifT der aMy carte Ofliue, or fimPH4 oral or vow." An=rp&ym-:is dfemcd as"gymmdixv� paifn=Erip,amcbfiOm,cmpmcff t1 or of m legal=f±9a or=7 two or IUAae of the fo n i og m aJ°iat .min g ff=Iegal of a deceased mnPIOye�,ore= ==iV=or tOZS�of an individ=L p=ta=np,assofaaioon Cr Off=leg d MtifY,Mq109mg CF1oY - However the owns[of a dteMh==havingaotmOre tbmt n-ee-apadm=fs m dwho resides$,orthe o Offl=- dw�mg house of molffi F who e�IOps persons to fin �o °r 1paa w°ik on sOr1x dwelImg boast or an fire gr=,& Or bmlfimg qiF aL ffiiettD shaIlnotbecansc ofsoch emplDymedbc d=edto be an employe,-" MCM c3spt=ISZ,§25C(6)also sister flat"every state or IDcal I"=VS6ag agmcy shZ wiffi.hoI3 ffie iss¢an r#or renewal of a Umeam or pa'mitto Operzfe a bMkess Or to contract bwlrmgs is the commom mlfft for=Y apg&cantwho has notproduced acceptable evi&mm of comp�ance wiCii tixe rII.cn =m cov=z gerega Adr2OnaIIY,MGZ dOPt t I52,§2SdM sf l=-Ne3i�fhe _ nor any ofiis polhical snbdxv%si®s shall end into my forthcpc&mn n.oeOfgubliOwD73cmmlacceptablecTiammofcontpliancewzhthemsuran=. regnrre�e s of this aLBI rhave been.p=entmft fhe ag.afdho3jl}:, APPHCaX[ts PIM=fa 0T± fhe•WO7k=w=03pansatim afdavit MUIPY:b s by axlangtheboxes thaf apply tic)yoar Onatim andj nary,supPf9 sub--a�s)n=.e(s). =)andph°ne]IISmbef(s)alongwifhtb==rdficatr(s)of ECT in . Limifed LiabR4 COmpardes(LLB orI.imit Lisb�ity PMtr ers S(IJP}wAn°CMPb s of surance fizanihe members or parft=w,are notreqcdred to caay wow cmmP irL=mlc:— If an LLC Or 112 does hate joy aPobcyis mid. BeadyisedthdtlisaffdmykmaybesnIm�edt°f oDegaiimr�toflndnsfdd Accideds far com fs 26m Of fimmm=cove$ag �Iso Ire sure tO sign and date ate afidavit: The affidavit shDvld beref�ed to�e ciiY ortnwnti�9=agplica im for thspeu�or license is being not ilia Deparfm®f of ' 9XM1dYou havo any guest L ms regal m the law or ifyou,=mpur-d to obtain,a WOO iC=' enmpmsatic policy;PImsmczaf=DePBrftm ofafthennmberlistedbeIow: pelf-ias«dcampanicssbaIIld® rtheir self-insru'�ce Iiceose nambfx on fire line city or TOwn OMdaTs - t Please Tie sure ffiBt tiie affidavit is"lefz andp:ea�d Ieg1Iy- The Department has pmvided a qn m st ff=bDt'um of the affidavit for yDUt[)fx11 Dirt mthe OVM3t tha Office ofmmmr °T's has to CaAactyO¢regardmgthe applicant. pleasebesfrrein ffiJjMfl=pMLbT==MM3J=WhiChVMbe used asa=5==n=bm Tnaddiii"-enaPPhcaot fit must submit mzr�leP= ;tli r==a en ppht2kom m any givYear.need.Only sfdmnt®e affidav mdicafiag c policy mfo=nafiom gneessmy)and TmA "lob�eAd #'the me shOrldwr$e�sII Iawfains in (city or town)^A copy of ffeaf5davitihathas boen officially stamped Orma lmdby_the city or tam maybe provided in ibe applicant as proof that a valid affidavit is On file for fatal e pcfmits or hceuses. Anew affida��rst be fiIled Oiat earls year.V1herc aborne O=or ciii7m is obtain Ti obtaining a =m or pemitnotze7six:dt�i auYbvsmess or yh $ a dog lic®se orpe k to bmn leavm etc,)said pmsm is NOT to�plete this affidaYit hm Ogre of lnvesfig2fi=wOvldh -,to ti>enk youk adeancc fr3r yO=MOp=Bfln and sbanIdYou have any gII i°ns. plmase da nDthesitatZto&ns a call 'I.heDepar(me�sa�dres��h�aad�Cv:�bex= _ _ . - T 5*of 4assac vset s Bw m&W IT- Fax#a7 727-'749 IZevised¢24-07 rria g Town of Barnstable , Regulatory Services oIF Richard V.ScaI4 Director Building Division ` ��. t Paul Roma,Building Commissioner 6396 �� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.maus Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEN=ON Please Print DATE: JOB LOCATION: number ; street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: c4hDwn state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provide_d that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the buil " permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor " (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. r To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit fomu\EXPRESS.doc 06/20/16 • s Town of Barnstable Regulatory Services ` sArnms. ' Richard V.Scal,Director " s� , ►`� Building Division. Pawl Roma,Banding Commissioner 200 Main Sfte�Hyannis,MA 02601 www.town.barnstable.mans Office: 509-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder . ,as Owner of the subject property hereby authorize to act on my behA in all matters relative to work authorized by this binding permit application for- (Address of Job) "Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized beforo- fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date Q:FORMs:OWNMU-M MI3sI0IeWIS 1 Office of Consumer Affairs&R°si ess R HOME IMPROV gulch°° Registration ;% MENT CONTRACTOR 11665936---� Type: Expirat o Private Corporatiolf CAPE&ISLAND C ! INC. - JOSHUA.-KOURI \ 55 ELM AVE, HYANNIS,MA 02601 Undersecretary Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-074660 Construction Supervisor r` JOSHUA X KOURI • PO BOX 21 0 3w I CENTERVILLE MA 026 h: Expiration: 9 /Commissioer 02/12/2019 S t ' l r License or registration valid for individul use only before the expiration date. If found,return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 0211-6 , e I of al' without signature • s i r o t. 4 Estimate 1418 i l k L t FDate Jun•28 2017 Cape & Islands Construction Co: Po Box 210 Centerville Ma. 02632 Terms 508.775.7663 Ship Via Date � s s • Sandra Gregory 26 Bayshore Rd. Hyannis, Ma.02601 771-3224 617-595-3152 CEDAR SHINGLE Cedar shingle siding 9,420.00 SIDING Strip old(lower new shingles to remain)existing cedar sidewall shingles from rear main and rear inside corners to top of storm shutters. "Inside rear left and right rake shingles to remain`, Secure any loose sheathing. :. Install blue skin underlayment. Install new Eastern white cedar sidewall shingles. (Existing stock on site to be used) Dispose of all job related debris. TRIM Trim Replacement i - 1,800.00 Remove rear gable-rakes. , Instal new Cortex blind fastened Azec composite trim: aa cgs - J I�A 4tzv 675' Total $11,220.00 g ture s C , r A���® CERTIFICATE-OF LIABILITY INSURANCE DATE(MN1/DD/YYYY) ` 5/14/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF.INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this.certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER FRANK L HORGAN INSURANCE AGENCY INC NAME': 44 BARNSTABLE ROAD PHONE FAx PO BOX 250 /C o Ext A/C No HYANNIS, MA 02601 ADDRESS: INSURERS AFFORDING COVERAGE NAICti INSURERA: LM Insurance Corporation - 33600 INSURED INSURERS: CAPE & ISLANDS CONSTRUCTION COMPANY INC PO BOX 210 INSURERC: CENTERVILLE MA 02632 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 35624081 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP - LTR POLICY NUMBER MM/DD MM/DD LIMITS - COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE DOCCUR _ DAMAGE TOR NTED PREMISES Ea occurrence S ME D EXP(Any one person) $ PERSONAL 6 ADV INJURY S GEN'LAGGREGATE LIMIT APPLIES PER: ' GENERAL AGGREGATE b POLICY JRI ECT ❑LOC PRODUCTS-COMP/OP AGG S OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accldenl ANY AUTO - BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY t - Per accident UMBRELLA LIAR OCCUR ' EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTIONS $ A WORKERS COMPENSATION WC5-31 S-377540-017 5/7/2017 5/7/2018 rE.L STATUTE fRHAND EMPLOYERS'LIABILITYANYPROPRIETOR/PARTNER/EXECUTIVE Y/N - - EACH ACCIDENT S - 100000 OFFICER/MEMBEREXCLI. NIA (Mandatory In NH) DISEASE-EA EMPLOYEE S .100000 If yes,describe under RIPTION OF OPERATIONS below DISEASE-POLICY LIMIT $ 500000 DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more space Is required) •• WORKERS COMPENSATION INSURANCE COVERAGE APPLIES ONLY TO THE WORKERS COMPENSATION LAWS OF THE STATE OF MA. This certificate cancels and supersedes all previously Issuedl certificates,only as they relate to workers compensation coverage. CERTIFICATE HOLDER i CANCELLATION TOWN OF BARNSTABLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ZOO MAIN ST THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN HYANNIS MA 02601 ACCORDANCE WITH THE POLICY PROVISIONS. . i AUTHORIZED.REPRESENTATIVE - LM Insurance Corporation ©1988;-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD 35624081.1 1-377540 1 17-18 WC 1 n0270258 1 5,/14/2017 11:09:46 PM (PDT)'I Page 1 of 1 - r Ile Tptt, Town of Barnstakble *Permit# 7-Q<7- v� / +, Expires 6 man om'sue date Building Department Services, feehsfr is Brian Florence,�CBO MAS s639. ��� Building Commissioner iOrFo tom" 200 Main Street,Hyannis,Mr'/A/02601 www.town.barnstable.ma.us,',/,4' Office: 508-8624038 / Fax. 508-790-6230 4/3f EXPRESS PERMIT APPLICATION - RESIDENTIAL /ONLY _ Not Valid without Red X-Press Imprint Map/parcel Number l� ® i/ Property Address ba,t a ,-e 1�t u k'1i 5 ❑Residential Value of Work$ -7, 1®0 0 " Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name �' L L L 1A _ Telephone Number (7 �7?u yM3 Home Improvement Contractor License#(if applicable) /&S 'S (� Email: �� S(,e Cti �hi�r 1rzk lS �ew t '-�e 44, Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance " Check one: ❑ I am a sole proprietor [] I am the Homeowner U[have Worker's Compensation Insurance A Insurance Company Name (/' L Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request-(check box) e-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to " 1 ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side , ❑ Replacement Windows/doors/sliders._U-Value (maximum.32)#of windows ' #of doors: *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign-Property Owner Letter of Permission. A Com of the ome Improvement Contractors License&Construction Supervisors License is requir d. SIGNATURE: G k r • QAWPFILESTORMSUilding permit forms\EXPRESS.doc 08/16/17 f Aril DATE.(MMIDD/YYYY) x acoRo CERTIFICATE OF LIABILITY INSURANCE 5/14/2017 . THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 4 CtER FICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES "=BELOW r THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:. if the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. rlf SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on t thts certifcate does not confer rights to the cecate holder in lieu of such endorsement(s). CONACT ,PRO, cER`,FRANK L HORGAN INSURANCE AGENCY INC NAME: 44 BARNSTABLE ROAD PHONE FAx A/C c EYt: A/C No): PO BOX 250 E-MAIL HYANNIS, MA 02601 ADDRESS: INSURERS AFFORDING COVERAGE NAICS INSURERA: LM Insurance Corporation 33600 INSURED ' INSURERS: - CAPE & ISLANDS CONSTRUCTION COMPANY INC PO BOX 210 INSURERC: CENTERVILLE MA 02632 INSURERD: I INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 35624081 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER `POUCY EFF POLICY E(P LIMITS LTR TYPE OF INSURANCE - POLICY NUMBER MM/DD MM/DD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE TO S CLAIMS-MADE OCCUR ) PREM SES Ea occu RENED nce S - MED FRCP(Any one person) $ PERSONAL 6 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑PET LOC PRODUCTS-COMP/OP AGG $ OTHER: S AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT S _ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY Per accident S UMBRELLA LIAB OCCUR EACH OCCURRENCE, $ EXCESS L.IAB CLAIMS-MADE AGGREGATE $ DED RETENTIONS i _ $ A WORKERS COMPENSATION WC5-31'S-377540-017 5R/2017 5/7/2018 ,/ STATUTE ERER H AND EMPLOYERS'LIABILITY Y I.N ANYPROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100000 OFFICERIMEMBEREXCLUDED? � NIA ' - (Mandatory in NH) EL DISEASE-EA EMPLOYE $ .100000 If yes,describe under 500000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMITS DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 10i,Additional Remarks Schedule,may be attached If more space is required) WORKERS COMPENSATION INSURANCE COVERAGE APPLIES ONLY TO THE WORKERS COMPENSATION LAWS OF THE STATE OF MA. This certificate cancels and supersedes all previously Issued certificates,only as they relate to workers compensation coverage. i CERTIFICATE HOLDER CANCELLATION TOWN OF BARNSTABLE a SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 MAIN ST ACCORDANCE WITH THE POLICY PROVISIONS, HYANNIS MA 02601 AUTHORIZED REPRESENTATIVE ' y 41 Z. .Y ' LM Insurance Corporation . ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD 35624081.1 1-377540 1 17-iB WC 1 n0270258 1 5./19/2017 11:09:46 PM (PDT) I Page 1 of 1 - fJ Ru"sines R g ;3 Office or Consumer Affairs C^0 ACTOR HOME IMPROVEMENT Type: Registration' 936 private Corporation s' � c Expiration =^ l C C. ND CO CAPE? ISLAND T I JOSHUAr-► oURI e 55 ELM AVE. Undersecretary HYANNIS,MA 02601 t , License or registration valid for in-dividul:use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation'. 10Park Plaza-Suite 5170 -Boston -MA 02116 of al' without signature 3 Massachusetts Department of, Public Safety Board of Building Regulations and Standards License: CS-074660 Construction Supervisor ——.—---.. JOSHUA X KOURI Supervisor .PO BOX 210 i Construction Sup CENTERVILLE MA 02632 Restricted to: s of any use group which contain Unrestncted-Building 1 cubic meters)of J.+ less than 35,000 cubic feet(99 enclosed space. , Expiration: Commissioher 02/12/2019 etts .ure to possess a current edition ev. cation of this license. Fail Code is cause fo State Building MASS.GOVIDPS DPS Licensing information visit:WWVV o ' r The Cotner oTmeaiilt of Massadjusetts _ Deparkatnt qf1uihu&ia1 A cdde7ds - - Offlre afLmwfigatia= 600 Washineon&creel _ Bowty s,CIA 02111 k4'FPm,i1 amg0rldta , iarlmrs' Cnmpensaficu nsucm-nceAfEdavrffi Bmldexs/CnntractgrsMect cians/Phambers AppHcamt Tnfw=fi= Please Pi inf Curly Na=Plsiueessfl kga�ationlf- d -OY- C ( e e C Address: Citgfstatel Ike Ph0a0�- 14 . 7 7(g.. .j Arre yo-u an enzplo er?l reckthe appropriate ba= T of project r L D I area 1 u�i �- 4 ❑I am a general contractor ant€I Pik e 1 t ad}= �P� 6. ❑Iyletzv construction employees(fall anNor part timed* -cave hired.the soFr caahs-acEozs 2.D I am a'sale pmpFdetor or partaw- listed on the attached sheet.. 7 ❑Remodeling ship and haves no employees Thew sub-contractors have $. ❑Detnolifiotx w forme employees andhare wadwrs' orlong � $ 9. ❑B,uildiag additionL`p Up n& Comp-rnmiranne « CIP-im2moc reglured 3_ ❑ We are a corporationand its 10-❑Electrical repairs or a,dcEtioas . 3-❑ Famahomeormer doing all work offcershava'es=.Bed their 1L❑Plumbiagrepaissofadditions. figbi of per MGL my-self[No workers' _ ,2 l// amou d�ve have no employees- Rflaf repairs insurance re4Eired . ][ g t� employees-[No workers' 13_0 Other coil-=Bu=ce require&] � 'bay app&cmtdiatc1ecksbasL1-1mustalso fill aattheswfianbdmshavingdl-kwalet amp—sat; npaFxyiafofms caL i Mmeowaerswho submit this affidava i!nxgcating they an:•doing mUvrc*axai tb mbim outmdecontna<tmsxmLst.m bMk a newaffidamt iadiaaia=CTL fCan=ctou,ff=d,ec1t1-; baymuststtadseaaaaddiLmA shad s1wwfagffienmmeofmesdb- sxadsuiewhehuar=ibnseeadtksbm emplapes.Ifthesub-cantractotshaceempIoyea%fiiey I pmtmideth'ek wwke&i=p.porky numbeL I dirt all enfpFaper campm- sirffmi fimiranzefor my emplay�ees $elocv is f7cepaticp raid jah site irffarmattom InsuranceCompanyxaIIlE C Po-T1cy-5 or self im 11C.4 • r EgpiultiouDate: Job Site Addre= CitylStaWEV: Attach a copy of the works re compensationpolicy-declaratitmpage(shoving the poRcy,n=ber and expiration date). Failure to secure coverage as required under Section 25A of M(H.e-157-can lead to the imposition of criurmal penalties of a fine ap to$1,540:Oa awYor one-year impdsor—ent asw6H as dvil penalties,in the farm of a STOP WORK ORDERand a fine of up to$2fO-00 a dap against the violator: Be addsed first a copy of this statement.maybe forwarded ta the Office of Inesfigations of the DI&for inserts coverage iomfrcatindL 'Ida Fferzby cer1ffy r W,8r the s andpv=Wes afpa&q f1satflis bzfbrmafv=prat ilea abates h true and caafrmt Siffiature ! Date- 0 ,okid use mily. Do not wake in firs-area,to be cainpfeW by trip ar town n i City or Town: PernatUcense:9 issuing Aai3var€t)(drdeone)c L Board of Health Building Deparbnent 3.City-Town.Clerk 4.Electrical hmpector sr.Phmmbmg Fmpector 6.Othiw Coatact Person: Phone#: information aAd lastructiolas Massachusetts Gebea:a1 Laws chapter 152 respres all=q3Ioyea3'to provideworic sensation fort3ieir employees. PM=MttD•(hys ,au.,47L*e=is def-fined as".eY�aypersonia.die service of another under any contxart afhfi--, express or impliDd,'and or writtE . Aun_Moyer is defined as-an m�idual,partnr�,asso®tion,�P°�on or otbm Iegal=dify,o ore r any two or m of file foregoing a Joint enterprise,andm kft fiie legal�seaafives of a deceased=aployer,ar the raceiV=or trastee of an p ip,association or other Iegal entity,e�IoYTog employees. However the owner of a dweIlinghouzsehavingnotmarethantiureeaP a�r[�nmin mawho residesthe�,orthe occ x mt ofthe- dwelling houise of anon who employs perms to do urtamir. a ,caast„t_r_t;on or repay v�on sorb dwel7>ng house or on the grounds or building agp=t=z33tthea-eto shzRnotbecanse of such employmedbe deemed to be an employer." MGL chapter 152,§25C(6)also stares that¢every sty or local H=xsIn agency shall withhold f he iMance or reuzewaI of a ce>?se or permit to operate a business or to construct buRdings is the commonwealth for any vi ; a reu applicantwho bas notprodneed acceptable evidence of complianenor�gy ofits political Subdivisions s IaII AddltionaIly,ML cbapta I52,§25CM staPs-Nehr he enter into any contract for the pmfono anc6 ofpnbho wo3k miff acceptable evidence of compliancewiJfi ihe insurance._ requMrea>iea>fs of this chBp{E xhavebeenpresentedt0 the con Eracimg.ard3ooutyf AppHcaat3 Please ffi oiof &e WoJ='compensation affidavit completely,by g the boxes ffiat apply to your sitnaiion aac�if necessary,srpply svb�Ear(s)nmne(s), add=-s(es)and phonenummbm(s)along wu$ith=aerfifrcate(s)of mst nce. Limited Liability Companies(fLC)orLiucitndLiabiliiyPartnexships(LU)•-Yvnno maploYces ofiier ffimtbe members or pa bacav,are not rftgaaed fn carry workm&compensation.inscnance- If an LLC or LLP does have employees,apolicyisrmpi ed. Beadvisedtfid this a�xdaya maybe snhmit�dtath-,Depa-finentof rndasirial Accidents for conffimafion of in=ncce coves Also be sure to siga and date a ai xdavit the affidavit should b eTetmned to the cify or town that the application for the permit or license is being requested,not the Departmenf of B2dast dd A-cdd :L- T ocMyouz have any q=stions rega[rding the law or ifyou are required to obtain a workers' compensation pofiey,please call the Departm ea3t at fhe nunabes listed beIow- Self-imaed companies should enter oleic self-n+ ice license M=`ber on the appropriate line. City or Town Officials - Pleas a be sore ti at the affidavit is Clete and.primed legr'hly_ T.he Departmeat has provided a spa the bottom of the afMavit for youto fill ourt m.the event the Office oflnvest gati=has to comic:tyouM%Mdmg applicant Please be sure to f Minthep=it/Hc`=enzumbeawhichwillbeusedas arefercmcen=ber. Inn,addition,an applicant that mast submit nzu lbple peffiit Rcense appliesions m auy given year,need only submit one affidavit indicating D=eot policy iuforniation.Cif necessary)and under"lob 55te Qb the applicant should wee-all locations in (citY or t:)7n)»'A copy of the affidavittbathas be a officially steed or maimed bythe cry c¢town may'be provided to fihe applicant as proof that a valid affidavit is on file for futm 'poufs or licenses A new affidavit mast be.filled ovt earh year."Where a home owner or ciii=is obt63mg a license or penoit not re•Iated to any business or commercial venbrre (fie. a dog license orpeumittobornleaves etc_)saidpersonisMOT=gUi edIn eourletethis affidavit Office o f� 'ten. worldhke to thank you is advance for your cooperzdaa and should you have any T=tions, Theplease do nothesi to giva'm a Caz The DeZar cut s address,trl- one and fax rsomber: ' . '��a �-tom of 1�1�ac1��i•#s - - - ���A�ient� • . . RQOMz 1A Q111 T(�-L 4 617- -4 cxt 406 or 14M MA&MM Fax#617 727 7M 1Zevised¢24-D7 .mas gf dim 1 j . �� �5ao � � i �- p Application number �— c �- ` ! Fee ...�. ......................................... .......... . ....... • = JUL 1`7 2Q19 Building Inspectors Initials........ Date Issued............�. .�..z1-m............. Map/Parcel.....v.. .9Y..... ........................ TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION- Address of Project: Apy,51--Q, ER STREET VILLAGE Owner's Name: � (! 4� Phone Number Email Address: Cell Phone Number Project cost$ 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 E Siding ❑ Windows (no header change)# ❑ Insulation/Weatherization ❑ Doors(no header change)# Commercial Doors require'an inspector's review ❑ Roof(not applying more than 1 layer of shingles) Construction Debris will be going to v ✓ CONTRACTOR'S INFORMATION Contractor's name (� Home Improvement Contractors Registration(if applicable)# 13 (attach copy) e Construction Supervisor's License# 07 0 (attach copy) _ " TO!;4e.Gc.Ae- AN C14 151cmCJ5 Email of Contractor ��i ��,���`��. C��'" Phone.number ' �r 3 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. 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 All permit applic 'o s aLesu j uilding official's approval prior to issuance. J The�Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ff Please Print Legibly Y Name (Business/Organization/Individual): � 14 - Address: City/State/Zip: bed) r��!`'K__ lT Phone#: > Are yob an employer?Check the appropriate box: Type of project(required): 1.al am a employer with 4. ❑ I am a general contractor and I 6. New.construction employees(full and/or part-time).* 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 workingfor me in an capacity., employees and have workers' Y P h' 9. ❑Building addition [No workers'comp. insurance comp.insurance.: required.] - - '5: ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs'or additions myself. [No workers'comp. right of exemption`per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers'. 13.❑Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their,workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must 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 ) e� Insurance Company Name: ••(� ✓ �— Policy#or Self-ins.Lic.#: 2�r V9--491G1 Expiration Date: 5 Job Site Address: 0? .9a- v-zi. City/State/Zip: Attach a copy of the workers' comp nsation 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' ce c verage verification. Ida hereby certify u er p d penalties of perjury that the information provided ab a is tr a and correct Signature: Date: 7 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 . 4. Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who'resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." 1 . 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-contractors)name(s),address(es)and phone numbers)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 cant'workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permittlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town 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 burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts' Department of Industrial Accidents office of Iuvestigatiuns 600 Washington.Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 www.mass.govfdia . a.; .__. .ire (QOOl7/IJ2047.LCY30,G./L O���vlCLdd2Cfl(.I4(./A.O- z Office of Consumer Affairs&Business Regulation �LL HOME IMPROVEMENT CONTRACTOR I I 1 TYPE:,0erooration i Registratian Ex iration 165936 �4/08/2020 CAPE&ISLAND CON CttON''CO INC. «tom � 4 t • 55 ELM AVE. "yam-��..�V i HYANNIS,MA 02601 - " Undersecretary Cornmon'�'�ealth of Massachusetts of Professional l_icensuredards Division and Stan "ons ® rd of Building Re9ulat� , '..� .Boa � to rvisor Const`. �� �ires:0211212021 j ,<. Cg-074660 I �� y JOSHUA X KQURIu. p0 BOX 210 .. 'w CENTERVILLE NI� �r6 �5 �Vpl3S1 Commissioner e mast prrr� F "Moot parrsIN "Rags �� D m << iM NlpA � x so TO F d t. _. r I I .I • � 1� i �� l � � � \� 1 � I ' I i i I �� I � i �� � � � � i - � �� � , O i � �� �, i � . � � � i � � � I .�. � � .,. 4 , . i f ,� e i i � I .f• I -! � �a ..� � , (� ke i i i � i n (4. Town of Barnstable *Permit# l �o4 i Regulatory Services 'Fee T MM Ricbard V.Scali,Interim Director ®® PERMIT Building Division ® �J Tom Perry,CBo,BvH ing commissioner J�'�' 1 L�3 2M Main Street,Hyannis,MA 0260I `N., www.twm.barnMble.ma us Office: 508-862-4038 TOWN O ' `NLE PERMrrPLRESIDENTIAL ONLY � Nam. 3 614, Not vWa> �rx.� r Property A&b= Q 6 aReswential value of work S J4-706 Minimum tee of M88 for work Tder$60MOO Owner's Naas&Address 5AvdkA aLOZ"D k 26 13 �/ram 9YAPLItIc vcso�✓ r�� g Cotmactor's Nam la"E �.t A wS jOl Telephone Number -Z 7 i �OC�) Home Improvement Contractor license#(if applicable) l 73 NJ Email: Construction Supervisor's License#(if applicable) a / pWorkman's Compensation Insurance ` Check one: ❑ I am a sole proprietor I am the Homeowner I have Worker's cmmpensaation Insurance / Insurance Company Name Av"Aw-- workmajn'scomp.Policy# C/ a 2 Copy of Insurance Com Certificate most amompany each permit. Permit Request(check box) , ❑ Re-roof(hurricane na8ed)(stripping old shingles) All eonstruawn debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side gReplacmeut Windows/dooWsbde,m U-value c (maximum.35)#of #of dotes: f ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections requhv& Separate Electrksi dr Fire Permits required. *Wham mgmm& Imm=of On pemnt does not eXetltpt o mpliww with odw bm dMahm d Wdgms,Le.Hotadc,Canserv6hoal,aw **•Note: Property Owner must sign Property Owner better of Permian. A co of the Home Improvement Coutractars License&Construction Supervisors License is, r SIGNATURE: T.-VMVnJ D11 Rsss PERAffrMaRESSAoc Revised 061313 17 Client#:30124 SOUTNEW ACORM CERTIFICATE OF LIABILITY INSURANCE , DATE(MM/DDNYYY) 6/06/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement($). PRODUCER cNMONTEA:cT Anita Little Willis of New Jersey,Inc. PHONEFAX A No Ezt:856 914-"60' arc Ne; 856-914-1881 1015 Briggs Road,PO Box 5005 E-MAIL : anita.little@willis.com PO Box 5005 ADDRESS INSURERS AFFORDING COVERAGE NAIC 8 Mount Laurel,NJ 08054 INSURER A:Selective Insurance Co of the S 39926 INSURED INSURER B:Argonaut Insurance Co. 19801 Southern New England Windows LLC INSURER c:Beacon Mutual Ins.Co. 24017 DB/A Renewal by Andersen ; 26 Albion Road INSURER D: Lincoln,RI 02865 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSR UB POLICY NUMBER POLICY EFF M�DY EXP LIMITS A GENERAL LIABILITY S202945900 8/10/2013 08/1012014 X l EACHOCCURRENCE $1 00O 000 COMMERCIAL GENERAL LIABILITY pMp� RE AEaoran.)E $100 000 CLAIMS-MADE a OCCUR MED EXP(Arty one person) $1 O 000 PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE $3,000 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $3,000,000 JECT POLICYEJ PRO-- LOC $ A AUTOMOBILE LIABILITY S202945900 8/10/2013 08/1012014 COMBINED BINEaccideD SINGLE LIMB 1,000,000 X ANY AUTO 1 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS ar.caZI $ $ A X UMBRELLA uAB OCCUR S202945900 8/10/2013 08110/2014 EACH OCCURRENCE $5 000 000 EXCESS LIAS HCLAIMS-MADE AGGREGATE $5 000 000 t DED I I RETENTION $ C WORKERS COMPENSATION AND EMPLOYERS'LIABILITY 0000068028-RI 8/21/2013 08/21/201 X WC STATu OTH- AN B Y PROPRIETORIPARTNERIEXECUiIVE- A16927818352394 8/21/2013 08/21/201 E.L.EACH ACCIDENT $1 000 O00 OFFICER/MEMBER EXCLUDED? N NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1 000 000 ff yes,desoribe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,N more space Is required) i t CERTIFICATE HOLDER CANCELLATION Southern NE LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 26 Albion Road ACCORDANCE WITH THE POLICY PROVISIONS. Lincoln,RI 02865 AUTHORIZED REPRESENTATIVE f, ©.1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD - #S215109/M215088 AXL r- The Commonwealth of Massachusetts Department of Industrial Accidents Office oflnvestigations 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information OW Please Print Lea-IbIv o Name(Business/Organization/Individual): JAC S 616 Address: 9 (o City/State/Zip: L/Il/C;plj�/ , ./e� �J8b5 Phone#:_ -j/D/ $- ?VDD Are you an employer?Check the appropriate box: .Type of project(required): 1. I am a employer with v2 0 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. Demolition working for mein any capacity. employees and have workers' 9 Building addition (No workers'comp.insurance comp•insurance t ng required.] 5. n We are a corporation and its 1D.0 Electrical repairs or additions 3.❑ I am a homeowner doingall work. officers have exercised their 11.0 Plumbing repairs or additions . myself.[No workers'comp. 'right of exemption per MGL 12.0 Roof re airs insurance required.]t 6.152,§10),and we have no 'employees.[No workers' 13.0 Other T�__ comp.insurance required.] 'My applicant that checks box#1 must also fill out the section below showing their workers,composaon policy nnation 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 member. I am an employer that is providing workers'compensation uuurance for my employees Below is the policy and job site information Insurance Company Name: svj-s/-9 te Policy#or Self-ins.Lic.#:�'f �a��f 8 � 3 t f Exp�on D ��7AtJob Site Address: S City/State/Zip: �1 � . tach acopy of the workers co pensation 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 kerb under the pains and penalties of perjury that the information provided above is e d correct Si store: l Date: . Phone# Official use only. Do not write in this area,m be completed by city or town officiaEEnspe��o] City or Town: PermWLicense# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical I6.Other Contact Person• Phone#: r- Southern New England Windows d.b.a Renewal by Andersen of SNE Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-095707 k BRUN D DENM!EON . 7 LAMBS POND CERC Chariton MA 01507 Expiration - Commissioner 09/08/2014 k t d/=nl l('O'7jL�/ZO�2.RIJP,<4f1 Qf�{.�/�CCl1Q(l��GtGi. 3 Office of Consumer Affairs sand Business Reguahon 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration . Registration: 173245 ' Type: Sttpplemefd Card SOUTHERN NEW ENGLAND WINDOWS LL Emimtion: 911912014 DENNISON BRIAN 1137 PARK EAST DRIVE WOONSOCKET,RI 02895 F , Update Address and MGM ard.Mark reason for change SC.t o 1 Address f Reamsl Lj Employment [l Lost Card <-0Ilkt offoammrr A143n 6 Bndam Regolaeaa License or registration"lid for Individul an only `^l°t[�?`�+¢ tMIIE IYPROVEYENf CONTRACTOR before the expiration date.If found return to: P H s �Replatratlon: 173245 ,. T Office or Consumer Affairs and Business Regulation G ;• yam' IB Park Plea-Sotle 5170 - +- EaplraWn: 9I111l2014 $upplemeN�;ard Boston,MA 02116 SOUTHERN NEW ENGLAND WINDOWS LLC. RENEWAL BY ANDERSON DENNISON BRIAN - 1137 PARK EAST DRIVE WOONSOCKET.R102095 "�.--.__..___._._ . Uad—rrtary Not Mlid wilhom sigo. re t , Renewal W I:ntik ttSbJ 7y RENEWAL BY ANDERSEN .Ttkw"006.4 a' Andersen. - �iure�4�"ry.� . WIn6OW eeruet■t.r -A.$(,,,g., 26 Nbion Road Lincoln,RI 62665 teAt nMI mlz3s: Phone 866:563.2235•Faz 401.633,6602 raicmt va:ui au y36ar u) u� � Southern New England Windows,LW d/b/a Renewal by Andersen of Southern New England 6 v CUSTOM WINDOW AND DOOR REMODELING AGREEMENT SNa2A 62�6o2y S/5� 1y dn� livrcr(p Nuns: - oam of Atrtemturc . v liuyertsl SvccAddress.Gry Soso,and Zip Coee r l!O..ttm..�`4q e( f I.T• f'il 35 A 0 21 1 l 1�(Y�n e i s MA QZ6011 EMaaAddreu:- Name Telephoirc.Nurta�n_L_.7�-:?��O :WorkTNe l�um&r: �2 _ Huycr(s)hereb jointly and severally agrees to purchase the products and/or services of Southern Veld England%Mndo%vs.LLC d/b/a Rcneveal Iry Andersen of Southern.-New England("Contractor'),in accordance%vial the terms and condition:,described on the fr nt_and the reverse of this agreement and oil the attached sptcciilimtion shcei(s)(collec well;this°:Agreement"). ❑Historic ❑Condo ❑HOA? Total Doti Amounc.u� vo Estimated Snrdng Duel Method of Payment 0 Check ❑Cash' I'huriced Deposit Received(33%): OZ — ZWLy CredfuCards are accepted for,deposa only-maximum 1/3 of the Balance at Stan of lob(33X) project cost.(Please see Credit Card PWr entFbm%)By,slgning this Estimated Completion Gate Agreement,you acknowledge that the Balance- Start of job and die: Balance on Substantial Q�t/ X-7 k7•K U.."i on Substantial Completion of Job cannot be made by credit Completion of-job(33%): card and must be made by personal check bank check;or cash: Buyer(s)agrees and understands that this Agreement constitutes the entire understanding between the parties,and that there are no verbal understandings changing any of the terms of this Agireement.Buyer(s)acltno`wledge's that Buyer(s) (1)has read this Agreement,understands the,terms of this Agreement,and has received.a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and(2)was orally informed of Buyer's right to cancel this-Agreement.DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. (Rhode hiland Sales Only)Notice to Buyer.(1)Do not sign this Agreement if any of the spaces:intended for the agreed terms. to the extent of then available information are left blank.(2)You are entitled to'a copy.of this Agreement at the time you sign it.(3)You may at any time pay off the full unpaid balance due under this Agreement,`and in so doing you may be endued to receive a partial rebate of the finance and insurance charges.(4)The seller has no right to unlawfully enter your s premise . or commit any.breach of the peace to repossess goods purchased under this Agreement.(5)You may.eancel this Agreemeat if it has not been signed at the main office or a branch office of the seller,provided you notify the seller at.his or her main office or branch office shown in Agreement by registered or certified mail,which shall be posted not Pater than midnight. of the third calendar day after the'day on which the buyer.signs the Agreeae ut,excluding Sunday and any holiday on which regular mail deliveries are not made.See the accompanying nod f cancellation form for.an explanation of buyer's rights. Buyer(s)reccivtd the consumer education materials pun loco by the Rhod i and Cantrtcton Registration_Board, (Ikgr{'s Inrtirrls) Renewal by Andersen of Southern New England Buyers Buyer(s) By: bY�Jt/ Si nature'o�/rrmduci Lklanagcr Srgttatu'„ Signature: W utt7t:.'sJ , PrinrName of"Productan.'tger n tt Vame Al PAni Name YOU, THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT. -. 4.0 - - - - - - - - - - - - NOTICEOFC LATI NOTICE OF CANCELLATION Date of Transaction You may cancel Date of Transaction. You may cancel this transaction,without psAilty or obligation,within this transaction,without any penalty or obligation,within three business days from the above date.If you cancel,any i three business days from°the above date.if you cancel,any property traded in,any payments made by you under the I property traded in,.any payments made by you under'the Contract or Sale,and any regotiable instrument executed I Contract or Sale,and-any negotiable instrumenteiiecuted by you.will be returned within ten business days following I by you will be returned within ten business days following' receipt by the Seller of your cancellation notice,and any I receipt by the Seller of your cancellation notice,and any security interest arising out of the transaction will be security interest arising out of the transaction will be. canceled.If you cancel,you must make available to the.Seller canceled.if you cancel,you must make available to the Seller at your residence,in substantially.as good condition as when 1 at your residence;in substantially as good condition as when received,any goods delivered to'you under this Contract or I 'received,any goods delivered to you under this Contract or Sale;or you may,if you wish,comply with the instructions of I Sale;or you may,if you wish,comply with the instructions of the Seller regarding the return shipment of the goods at the the Seller regarding the return shipment of the goods at the Seller's ex ense;and risk.If you do make the goods available Seller's expense and risk.If you do make the goods available r to the Seller and the Seller does not pick them up within i to the Seller and the Seller does not pick them up:within twenty days of the date of cancellation,you may retain or I twenty days of the date of cancellation,you may retain or dispose of the goods without any further obligation.If you l dispose of the goods without any further obligation.If you faihto make the goods available to the Seller,or if you agree I fail to make the goods available to the Seller,or if you agree to return the goods:to the Seller and fail to do so,then you i to return the goods to the Seller and fail to do so,themyou remain liable for performance of all obligations under the remain liable for performance of all obligations under the Contract.To cancel this transaction,mail or deliver a signed I Contract To cancel thfs.transaction,mail or deliver a signed and dated copy of this cancellation, notice or any other i and dated copy of this cancellation notice or any other written notice,or send a telegram to Renewal A dersen o�,,J written notice,or send a telegram.to Renewal byAndersen of " Southern New England at 26 Albion Road, O,iBS�, i Southern New England at 26 Albion.Road,Uncoln,RI 02865, ` NOT LATER THAN MIDNIGHT OF I NOT LATER THAN MIDNIGHT OF. Date) (Date) HEREBY CANCELTHISTRANSACTION. f HEREBY CANCELTHISTRANSACTION. Buyer's sknature Print Name Date Boyles Slgnau" Print Name Date RbA Copy:White Buyer Copy:Yellow Buyer Copy:Pink h LAY �� � a� .. t c� � �� � � � . E ,_ . , 1323 L a 8 18 98 326 085 SEN £ a� i WOMAN CALLED TO SAY IT LOOKS LIKE s• THEY ARE BUILDING A THIRD FLOOR. � f.µ Ee jJ S a Pn _ «t... E i 1 i R326 085 . P P R A I S A L D A T O KEY 240563 SAMARAS, NICHOLAS T TRS - LAND BLD/FEATURES BUILDINGS NUMBER ZN/FL=RB 195, 600 61, 800 1 A-COST 257, 400 B-MKT 208, 300 BY 00/ BY ML 7/88 C-INCOME PCA=1011 PCS=00 SIZE= 978 JUST-VAL 257, 400 LEV=400 CONST-C 0 ----COMPARISON TO CONTROL AREA 69WC -- TREND EXCEEDS STANDARD NEIGHBORHOOD 69WC HYANNIS PARCEL CONTROL AREA TREND STANDARD 151 15 LAND-TYPE 1956001 LAND-MEAN +Oo 2574001 210000 IMPROVED-MEAN -710-. 250 ] FRONT-FT ] 100 DEPTH/ACRES TABLE 02 10001 LOCATION-ADJ APPLY-VAL-STAT 1 LNR] LAND LFT/IMP] ADJS/SB/FEAT STR] STRUCTURE ARR] AREA-MEASUREMENTS NOR] NOTES COM] MARKET INC] INCOME PMR] PERMITS GRR] GRAPHIC FUNCTION- [ ] STRUCTURE-CARD NO- [0 0 0] DATA- [ ] XMT [?] f Massachusetts Department of Environmental Protection Bureau of Resource Protection Waterways Regulation Program 120393 Chapter 91 Waterways License Application -310 CMR 9.00 Transmittal No. Simplified,Water-Dependent, Nonwater-Dependent,Amendment. G. Municipal Zoning Certificate Douglas &Sandra Gregory Name of Applicant 26`Bay Shore Road'—"' Lewis Ba, � — - Y (.Hyannis) Barnstable Project street address Waterway City/Town Description of use or change in use: Non-commercial docking and boating access to navi ble waters t To be completed by municipal clerk or appropriate municipal official: "I hereby certify that the project described above and more fully detailed in the applicant's waterways license application and plans is not in violation of local zoning ordinances and bylaws." c..__ Printked e of Mu c' al Official Date r gnature of Municipal Official Title City/Town � I CH91App.doc•Rev. 10/02 Page 6 of 17 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Waterways Regulation Program 120393 Chapter 91 Waterways License Application -310 CMR 9.00 Transmittal No. Simplified,Water-Dependent, Nonwater-Dependent,Amendment B. Applicant Information Proposed Project/Use Information 1. Applicant: ` Douglas &Sandra Gregory Name E-mail Address 2 Avery Street Unit 33A Mailing Address Note:Please refer Boston MA 02111 to the"Instructions" City/Town State Zip Code Telephone Number---- Fax Number 2. Author' Aged' nt (if any): nne Whitin Haml n, Haml n Consultin hconsult2 comcast.net Lame E-mail Address 690 Thousand Oaks Drive Brewster MA 02631 Cit n State Zip Code 896-5203 508 896-5203 (T508) elephone Number Fax Number C. Proposed Project/Use Information 1. Property Information (all information must be provided): i Owner Name(if different from applicant) Assessor's Map 326; Parcel 85 Tax Assessor's Map and Parcel Numbers Latitude Longitude _26 Bay Shore-Road Hyannis MA 02601 Street Address and CityfTown State Zip Code 2. Registered Land I ®Yes ❑ No 3. Name of the water body where the project site is located: Lewis Bay 4. Description of the water body in which the project site is located (check all that apply): Type i Nature Designation ❑ Nontidal river/stream Natural ❑Area of Critical Environmental Concern ® Flowed tidelands ❑ Enlarged/dammed ❑ Designated Port Area ❑ Filled tidelands ❑ Uncertain ❑ Ocean Sanctuary ❑ Great Pond ❑ Uncertain ❑ Uncertain CH91App.doc-Rev. 10/02 Page 2 of 17 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Waterways Regulation Program 120393 Chapter 91 Waterways License Application -310 CMR 9.00 Transmittal No. Simplified,Water-Dependent, Nonwater-Dependent,Amendment C. Proposed Project/Use Information (cont.) Select use(s)from Project Type Table 5. Proposed Use/Activity description on pg.2 of the "Instructions" Amend License No. 10301 to extend and maintain corrugated steel sheathing; and install and maintain pilings 6. Is the project a pre-1984 existing structure AND less than 600 square feet? ❑ Yes ® No 7. Is the project a post-1984 existing or new structure, less than 300 square feet AND water dependent? ®Yes ❑ No 8. What is the estimated total cost of proposed work (including materials & labor)? $12,000.00 9. List the name & complete mailing address of each abutter(attach additional sheets, if necessary). An abutter is defined as the owner of land that shares a common boundary with the project site, as well as the owner of land that lies within 50' across a waterbody from the project. Clifford & Lisa Gluck 137 Hinckley Road, Milton, MA 02186 Name Address Paul & Nancy Besse 28 Bay Shore Road, Hyannis, MA 02601 Name t Address Name Address r D. Project Plans 1. I have attached plans for my project in accordance with the instructions contained in (check one): ® Appendix A(License plan) ❑ Appendix B (Simplified License plan) ❑ Appendix C(Permit plan) 2. Other State and Local Approvals/Certifications ❑401 Water Quality Certificate Date of Issuance ❑Wetlands SE 3-4278 File Number ❑Jurisdictional Determination JD- File Number ❑ MEPA File Number ❑ EOEA Secretary Certificate Date ❑ 21 E Waste-Site Cleanup RTN Number CH91App.doc-Rev. 10/02 Page 3 of 17 i Massachusetts Department of Environmental Protection Bureau of Resource Protection -Waterways Regulation Program W05O522 Chapter 91 Waterways License Application -310 CMR 9.00 Transmittal'No. Simplified,Water-Dependent,Nonwater-Dependent,Amendment G. Municipal Zoning Certificate Douglas &Sandra Gregory Name of Applicant 26 Bay Shore Road Lewis Bay Hyannis Project street address Waterway Cityfrown Description of use or change in use: Shoreline stabilization for the protection of existing structures To be completed by municipal clerk or appropriate municipal official: "I hereby certify that the project described above and more fully detailed in the applicant's waterways license application and plans is not in violation of local zoning ordinances and bylaws." 22 c Pri to of Mun i f Official Date ignature of Municipal Offici itle City own f t CH91App.doc-Rev. 10/02 Page 6 of 17 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Waterways Regulation Program W050522 Chapter 91 Waterways License Application .310 CMR 9.00 Transmittal No. Simplified,Water-Dependent, Nonwater-Dependent,Amendment B. Applicant Information Proposed Project/Use Information 1. Applicant: Douglas &Sandra Gregory Name E-mail Address 2 Avery Street Unit 33A Mailing Address Note:Please refer Boston MA 02111 to the"Instructions" Ci�ty/T�own State Zip Code 1 1 Telephone Number Fax Number 2. Authorized Agent(if any): Lynne Whiting Hamlyn, Hamlyn Consulting hconsult@gis.net Name E-mail Address 690 Thousand Oaks Drive Mailing Address Brewster MA 02631 City/Town State Zip Code (508)896-5203 (508)896-5203 Telephone Number Fax Number C. Proposed Project/Use Information 1. Property Information (all information must be provided): Douglas D. &Sandra V. Gregory Owner Name(if different from applicant) Assessor's Map 326; Parcel 85 Tax Assessor's Map and Parcel Numbers Latitude Longitude 26 Bay Shore Road MA 02601 Street Address and City/Town State Zip Code - 2. Registered Land ®Yes ❑ No 3. Name of the water body where the project site is located: Lewis Bay 4. Description of the water body in which the project site is located (check all that apply): Type Nature Designation ❑ Nontidal river/stream ® Natural ❑Area of Critical Environmental Concern ® Flowed tidelands ❑ Enlarged/dammed ❑ Designated Port Area ❑ Filled tidelands ❑ Uncertain ❑ Ocean Sanctuary ❑ Great Pond ❑ Uncertain ❑ Uncertain CH91App.doc-Rev. 10/02 Page 2 of.17 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Waterways Regulation Program W050522 Chapter 91 Waterways License Application -310 CMR 9.00 Transmittal No. Simplified,Water-Dependent, Nonwater-Dependent,Amendment C. Proposed Project/Use Information (cont.) Select use(s)from Project Type Table 5. Proposed Use/Activity description on pg.2 of the "Instructions" Permit and maintain existing stone revetment, and install and maintain vertical corrugated steel sheathing 6. Is the project a pre-1984 existing structure AND less than 600 square feet? ❑Yes ® No 7. Is the project a post-1984 existing or new structure, less than 300 square feet AND water dependent? ❑ Yes ® No 8. What is the estimated total cost of proposed work(including materials& labor)? 20$ ,000.00 9. List the name &complete mailing address of each abutter(attach additional sheets, if necessary). An abutter is defined as the owner of land that shares a common boundary with the project site, as well as the owner of land that lies within 50' across a waterbody from the project. Clifford D. & Lisa Gluck 137 Hinckley Road, Milton, MA 02186-2121 (AM 326; P 84) Name Address Paul E. & Nancy L. Besse 28 Bay Shore Road, Hyannis, MA 02601 (AM 326• P 141) Name Address Name Address D. Project Plans 1. 1 have attached plans for my project in accordance with the instructions contained in (check one): ® Appendix A(License plan) ❑ Appendix B (Simplified License plan) ❑ Appendix C(Permit plan) 2. Other State and Local Approvals/Certifications ❑401 Water Quality Certificate Date of Issuance ®Wetlands SE 3-4278 4 File Number ❑ Jurisdictional Determination JD- File Number ❑ MEPA ; File Number ❑ EOEA Secretary Certificate Date ❑ 21 E Waste Site Cleanup RTN Number CH91App.doc•Rev. 10/02 Page 3 of 17 Massachusetts Department of Environmental Protection DEP File Number: Bureau of Resource Protection - Wetlands • 8� • WPA Form 5 - Order of Conditions SE3-4278 ai,►ss. ��p '°��.� Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP rf0►M� and Town of Barnstable Ordinances Article XXVII A. General Information Important: From: , When filling out forms on Barnstable the computer, Conservation Commission use only the tab key to This issuance if for(check one): move your cursor-do ® Order of Conditions not use the return key. ❑ Amended Order of Conditions r� To: Applicant: Property Owner (if different from applicant): Douglas D. & Sandra Gregory Douglas D. & Sandra V. Gregory Name Name P.O. Box 2331 P.O. Box 2331 Mailing Address Mailing Address Hyannis MA 02601 Hyannis MA 02601 City/Town State Zip Code City/Town State Zip Code 1. Project Location: 26 Bay Shore Road Hyannis Street Address City/Town 326 085 Assessors Map/Plat Number Parcel/Lot Number 2. Property recorded at the Registry of Deeds for: Barnstable County Book Page 146672 Certificate(if registered land) 3. Dates: ° May 6, 2004 June 8, 2004 - JUN 2 4 2004 Date Notice of Intent Filed, Date Public Hearing Closed Date of Issuance Y 4. Final Approved Plans and Other Documents (attach additional plan references as needed): Site Plan (2 sheets) April 12, 2004 Title Date Title Date Title Date T 5. Final Plans and Documents Signed and Stamped by: • ; Daniel Ojala, PE Name ; 6. Total Fee: ' • . $202.50 (from Appendix B:Wetland Fee Transmittal Form) Wpaform5.doc•rev.6/18/04 f Page t of 7 Massachusetts Department of Environmental Protection DEP File Number. Bureau of Resource Protection - Wetlands • 8 WPA Form 5 - Order of Conditions sE3-4278 Mnsa. g. Provided by DEP EDru+��0 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 and Town of Barnstable Ordinances Article XXVII B. Findings Findings pursuant to the Massachusetts Wetlands Protection Act: Following the review of the above-referenced Notice of Intent and based on the information provided in this application and presented at the public hearing, this Commission finds that the areas in which work is proposed is significant to the following interests of the Wetlands Protection Act. Check all that apply: ❑ Public Water Supply ® Land Containing Shellfish ® Prevention of Pollution ❑ Private Water Supply ® Fisheries ® Protection of Wildlife Habitat ❑ Groundwater Supply} ® Storm Damage Prevention ® Flood Control Furthermore,this Commission hereby finds the project,as proposed, is: (check one of the following boxes) Approved subject to: ® the following conditions which are necessary, in accordance with the performance standards set forth in the wetlands regulations, to protect those interests checked above. This Commission orders that all work shall be performed in accordance with the Notice of Intent referenced above, the following General Conditions, and any other special conditions attached to this Order. To the extent that the following conditions modify or differ from the plans, specifications, or other proposals submitted with the Notice of Intent,these conditions shall control. , Denied because: ❑ the proposed work cannot be conditioned to meet the performance standards set forth in the wetland regulations to protect those interests checked above. Therefore, work on this project may not go forward unless and until a new Notice of Intent is submitted which provides measures which are adequate to protect these interests, and a final Order of Conditions is issued. ❑ the information submitted by the applicant is not sufficient to describe the site,the work, or the effect of the work on the interests identified in the Wetlands Protection Act.Therefore, work on this project may not go forward unless and until a revised Notice of Intent is submitted which provides sufficient information and includes measures which are adequate to protect the Act's interests, and a final Order of Conditions is issued. A description of the specific information which is lacking and why it is necessary is attached to this Order as per 310 CMR 10.05(6)(c). General Conditions (only applicable to approved projects) 1. Failure to comply with all conditions stated herein, and with all related statutes and other regulatory measures, shall be deemed cause to revoke or modify this Order. 2. The Order does not grarit any property rights or any exclusive privileges; it does not authorize any injury to private property or invasion of private rights. y 3. This Order does not relieve the permittee or any other,person of the necessity of complying with all other applicable federal, state, or local statutes, ordinances, bylaws, or regulations. Wpaform5.doc•rev.6/18/04 Page 2 of 7 Massachusetts Department of Environmental Protection DEP File Number. Bureau of Resource Protection - Wetlands WPA Form 5 - Order of Conditions SE3-4278 WN*STAB U. Fo •. Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP and Town of Barnstable Ordinances Article XXVII B. Findings (cont.) 4. The work authorized hereunder shall be completed within three years from the date of this Order unless either of the following apply: a. the work is a maintenance dredging project as provided for in the Act; or b. the time for completion has been extended to a specified date more than three years, but less than five years, from the date of issuance. If this Order is intended to be valid for more than three years, the extension date and the special circumstances warranting the extended time period are set forth as a special condition in this Order. 5. This Order may be extended by the issuing authority for one or more periods of up to three years each upon application to the issuing authority at least 30 days prior to the expiration date of the Order. 6. Any fill used in connection with this project shall be clean fill. Any fill shall contain no trash, refuse, rubbish, or debris, including but not limited to lumber, bricks, plaster, wire, lath, paper,cardboard, pipe,tires, ashes, refrigerators, motor vehicles, or parts of any of the foregoing. 7. This Order is not final until all administrative appeal periods from this Order have elapsed, or if such an appeal has been taken, until all proceedings before the Department have been completed. 8. No work shall be undertaken until the Order has become final and then has been recorded in the Registry of Deeds or the Land Court for the district in which the land is located, within the chain of title of the affected property. In the case of recorded land, the Final Order shall also be noted in the Registry's Grantor Index under the name of the owner of the land upon which the proposed work is to be done. In the case of the registered land, the Final Order shall also be noted on the Land Court Certificate of Title of the owner of the land upon which the proposed work is done. The recording information shall be submitted to this Conservation Commission on the form at the end of this Order, which form must be stamped by the Registry of Deeds, prior to the commencement of work. 9. A sign shall be displayed at the site not less then two square feet or more than three square feet in size bearing the words, Massachusetts Department of Environmental Protection"[or, VA DEP"] "File Number SE3-4278 10. Where the Department of Environmental Protection is requested to issue a Superseding Order, the Conservation Commission shall be a party to all agency proceedings and hearings before DEP. 11. Upon completion of the,work described herein, the applicant shall submit a Request for Certificate of Compliance (WPA Form 8A)to the Conservation Commission. 12. The work shall conform to the plans and special conditions referenced in this order. 13. Any change to the plans identified in Condition #12 above shall require the applicant to inquire of the Conservation Commission in writing whether the change is significant enough to require the filing of a ' new Notice of Intent. 14. The Agent or members of the Conservation Commission and the Department of Environmental. Protection shall have the right to enter and inspect the area subject to this Order at reasonable hours to evaluate compliance with the conditions stated in this Order, and may require the submittal of any data deemed necessary by the Conservation Commission or Department for that evaluation. Wpaform5.doc•rev.6/18/04 Page 3 of 7 n+e Massachusetts Department of Environmental Protection Bureau of Resource Protection- Wetlands DEP File Number: LUMSTABM = WPA Form 5 - Order of Conditions - sE3-4278 M"M 039. � Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP and Town of Barnstable Ordinances Article XXVII B. Findings (cont.) 15. This Order of Conditions shall apply to any successor in interest or successor in control of the property subject to this Order and to any contractor or other person performing work conditioned by this Order. 16. Prior to the start of work, and if the project involves work adjacent to a Bordering Vegetated Wetland, the boundary of the wetland in the vicinity of the proposed work area shall be marked by wooden stakes or flagging. Once in place, the wetland boundary markers shall be maintained until a Certificate of Compliance has been issued by the Conservation Commission. 17. All sedimentation barriers shall be maintained in good repair until all disturbed areas have been fully stabilized with vegetation or other means.At no time shall sediments be deposited in a wetland or water body. During construction, the applicant or his/her designee shall inspect the erosion controls on a daily basis and shall remove accumulated sediments as needed.The applicant shall immediately control any erosion problems that occur at the site and shall also immediately notify the Conservation Commission, which reserves the right to require additional erosion and/or damage prevention controls it may deem necessary. Sedimentation barriers shall serve as the limit of work unless another limit of work line has been approved by this Order. see attached Findings as to municipal bylaw or ordinance Furthermore, the Barnstable hereby finds (check one that applies): Conservation Commission ❑ that the proposed work'cannot be conditioned to meet the standards set forth in a municipal ordinance or bylaw specifically: Municipal Ordinance or Bylaw Citation Therefore, work on this project may not go forward unless and until a revised Notice of Intent is submitted which provides measures which are adequate to meet these standards, and a final Order of Conditions is issued. ® that the following additional conditions are necessary to comply with a municipal ordinance or bylaw, specifically: Article 27 of Town Ordinances - Municipal Ordinance or Bylaw Citation The Commission orders that all work shall be performed in accordance with the said additional conditions and with the Notice of Intent referenced above. To the extent that the following conditions modify or differ from the plans,specifications, or other proposals submitted with the Notice of Intent, the conditions shall control. Wpatorm5.doc•rev.6/18/04 Page 4 of 7 SE3-4278 Gregory Approved Plan =April 12, 2004 Site Plan (2 sheets)by Daniel Ojala,PE Special Conditions of Approval I. Preface Caution: Failure to comply with all Conditions of this Order of Conditions can have serious consequences. The consequence may include issuance of a stop work order,fines,requirement to remove unpermitted structures,requirement to re-landscape to original condition,inability to obtain a certificate of compliance, and more. The General Conditions of this Order begin on page 2 and continue on pages 3 and 4. The S ecial Conditions are contained on pages 4.1,4.2 and 4.3 if necessary.All conditions require your compliance. II. Prior to the start of work,the following conditions shall be satisfied: 1. Within one month of receipt of this Order of Conditions and prior to the commencement of any work approved herein,General Condition number 8 (recording requirement)on page 3 shall be complied with. 2. It is the responsibility of the applicant,the owner and/or successor(s)and the project contractors to ensure that all conditions of this Order are complied with. The applicant shall provide copies of the Order of Conditions and approved plans(and any approved revisions thereof)to project contractors prior to the start of work. Barnstable Conservation Commission Forms A and B shall be completed and returned to the Commission prior to the start of work 3. General Condition 9 on page 3 (sign requirement)shall be complied with. j: 4. The Conservation Commission shall receive written notice 1 week in advance of the start of work. 5. The Natural Resources Dept. shall be notified at least 21 working days prior to the start of work at the site, to inspect the areas for shellfish. If deemed necessary by the Shellfish Constable,shellfish shall be removed from the work area to a suitable site and/or replanted at the locus following construction. The foregoing r i measures for shellfish protection shall ensue at the expense of the applicant. III. The following additional conditions shall govern the project once work begins. 6. General conditions No. 12 and No. 13 (changes in plan)on page 3 shall be complied with. 7. The Conservation Commission,its employees,and its agents shall have a right of entry to inspect for compliance with the provisions of this Order of Conditions. Page 4.1 8. This permit is valid for 3 years from the date of issuance, unless extended by the Commission at the request of the applicant.Caution: a future Amended Order does not change the expiration date. 9. All areas disturbed during construction shall be revegetated immediately following completion of work at the site. No areas shall be left unvegetated for more than 30 days. Mulching shall not serve as'a substitute for the requirement to revegetate disturbed areas at the conclusion of work. 10. Herbicide,pesticide and fertilizer use is discouraged on lawns within Conservation Commission jurisdiction. If fertilizer is used,only slow-release low-nitrogen fertilizer(with 30-50%.water insoluble nitrogen or `W.I.N') shall be applied. Over-fertilizing shall be avoided. 11. Work shall occur during the off-season only: October 15 through May 1. 12. For the repairs shown on sheet 2 occurring landward of the revetment,salt-tolerant shrubs shall be substituted for the indicated grass. xi 13. Work shall ensue mid tide rising to mid-tide falling or as otherwise necessary to prevent the grounding of the work barge on the substrate. 14. Top of sheeting elevation shall be certified by the project engineer/surveyor at the time of installation. IV. . After all work is completed,the following condition shall be promptly met: 15. At the completion of work,or by the expiration of this Order,the applicant shall request in writing a Certificate of Compliance for the work herein permitted. Barnstable Conservation Commission Form C shall be completed and returned with the request for a Certificate of Compliance. Where a project has been completed in accordance with plans stamped by a registered professional engineer,architect,landscape architect or land surveyor,a written statement by such a professional person certifying substantial compliance with the plans and setting forth what deviation,if any,exists with the record plans approved in the Order shall accompany the request for a Certificate of Compliance. At the time of the request for a Certificate of Compliance,an updated sequence of color photographs of the undisturbed buffer zone shall be also submitted: Page 4.2 • Massachusetts Department of Environmental Protection File Bureau of Resource Protection- Wetlands DEP 42Number. STABM = WPA Form 5 - Order of Conditions sE3- 78 Massachusetts Wetlands Protection Act M.G.L. c. 131 §40 Provided by DEP and Town of Barnstable Ordinances Article XXVII B. Findings (cont.) Additional conditions relating to municipal ordinance or bylaw: j see attached This Order is valid for three years, unless otherwise specified as a special condition pursuant to General Conditions#4,from the date of issuance. Date This Order must be signed by a majority of the Conservation Commission.The Order must be mailed by certified mail (return receipt requested) or hand delivered to the applicant. A copy also must be mailed or hand delivered at the same time to the appropriate Department of Environmental Protection Regional Office (see Appendix A) and the property owner(if different from applicant). i Signatures: On Of Day 9 Month and Year before me personally appeared to me known to be the person described in and who executed the foregoing instrument and acknowledged that he/she executed the same as his/her free act and deed. 3/),1/p`I Notary Public } - My Commission Expires This Order is issued to the applicant as follows: ❑ by hand delivery on by certified mail, return receipt requested,'on Date Date Wpaf0rm5.d0c•rev.6/8/04 Page 5 of 7 E *^ 4_B oor) Map J Parcel 4 8S �`U Permit# 3 0 -3 ' Hous #` ear( PA Date Issued a 'W S A� :3- a �JJ 69 Board of'�3rd floor)(8:15 =9:30/1:00- 3�0 Fee ,. � Conservation Office(4th floor)(8:30-9:30/1:00`-'2:00) q � voa��lb�j Planning Dept. (1st floor/School Admin. Bldg.) i �THE►p;- gecrojt a Plan Approved by Planning Board `19 M � -" BARNSTABLE. MASS. g } TOWN OF-BARNSTABLE Building Permit Application Stre et Address 11AV ` Is 1 Village ►4y qA/ .s Owner pav d- Ad • � - , Address . '7810 13©Vls �C�N S'17,Rr # Telephone 5 ` : ' - 8 o S 7 O"w) ✓ A, Ci g -fv 17- 7 -SSB�- cy Permit Request -Arij4,'I',,cw -rhm Tbn/a . Sr i. ST A d secew61 Flae.+ ^First Floor /,5-00 S t= square feet Second Floor J &J oo S P square feet Construction Type CtJ c o d Estimated Project Cost $ 9, a,�,060, y CU Zoning District Flood Plain Water Protection Lot Size 0 Q .5 Grandfathered .&Yes ❑No Dwelling Type: Single Family Er Two Family ❑ Multi-Family(#units) Age of Existing Structure Q Historic House ❑Yes ,0TNo On Old King's Highway ❑Yes Q-No Basement Type: ❑Full _0'Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 13—g y s-1c Number of Baths: Full: Existing—�— New ;. Half: Existing r- New 1 No.of Bedrooms: Existing_p�New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: .e vas ❑Oil ❑Electric ❑Other Central Air Ales ❑No Fireplaces: Existing / New Existing wood/coal stove ❑Yes J,-kIQo Garage: ❑Detached(size) /V T 14- Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) " ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes allo If yes, site plan review# Current Use ,'.., t Proposed Use S e r= Builder Information Name Telephone Number _0i 3 5 k-7 Y o 0 Address iy A v k AN 1-� License# p)(o J 9!C/ S�,.T'Zti AAA�n���� 44aA 02 Y Home Improvergent Contractor# Worker's _�"�`ALn# PA 1. -7 o o 5%U 3 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING F OM THIS PROJECT WILL BE TAKEN TO ,F,_ SIGNATUR DATE 7?2 BUILDING MIT DE FO E R THE FOL OWING REASON(S) i { FOR OFFICIAL USE ONLY c fir- �• = Y , - F k� PERMIT NO. DATE ISSUED , � _ _. r, f` .. ,.• : 1 � .' � _' f :. �� MAP/PARCEL NO. ADDRESS t _ VILLAGE OWNER DATE.OF'INSPECTION: ;! � + `� - s_ • . � _ _ � .` .. ,� �_ . FOUNDATION FRAME INSULATION FIREPLACE ( - ELECTRICAL: ROUGH -' FINAL " PLUMBING: ROUGH ., FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT - ASSOCIATION PLAN NO. Y a Q1i1,j99tlI9cr9aWflnr 967zI79 •gsvQ �------- b' 7f1 i�d aor —�I 1iI�t s 9-9-99—OZt, XV11 �� a�lslaj��'r� 5500-8z� . 7 L ^� do S�L11IlVH,�CIIn(�Hy �L. V91LIS ozs °m A b 7 O11II11IOZ VIIL DL LLj2L0Y1�0J 9P9z0 SSI�I� 577II� S1lIOLSdb'I� 1M3H1�N�+� V. n ----- � nI01LISOd S LI s UVOY AY-T jMTI 90t, `r,JINn �y �n �� 'Qjv `V�olic se Qjvnox;g HHL �9Z XO8 '0 d 'b� ,y"Jo NO- 991 VJ07'SI Af01Y VJNf]OY ;S,LjVVL711SMO ASAYnS HMV A n o8 zWLL JVHL AYLL(YJJ I SA 09V 999. 1,779 � S 919Z �Yd'7d 00=,, Z-Y7VJS SIJVJV HH-NJ8 OL --- 8� YA1OZ SJY MOM VJI IJJIJ� r1OilL V([JVY O Y,,6V g ire, ZATOz 00072 t, 'fit = 79 MOILVQjVnOY 10 dOJ 7 HO Vffff ''°HS2IIyV o Vs PITi� • o a 0 99 L07 ) o S2fOSS.7SSY O 90C dVH SXOS99.9sy 4 � 2 • 107 911 ,L 07 6 �o dos 11IOILIQQ b' Oy o �� j gat.foz <AsoeiatE-i, -qne. 28 -Saznita9fz �oaa L41yannli, :Aog 026oi (P&Z CT Sax (50&) 'ggo-OS6 August 12, 1998 Sara Jane Porter, Architect 240 Main Street Route 6A Yarmouth Port, MA 02675 RE: Gregory Residence 26 Bay Shore Road Hyannis, MA Area Subject to Flooding Relief Windows Dear Ms. Porter: The basement design could include knock out panels for flood relief. The foundation windows may be used provided that the glass will be pushed out by a force of 5 psf. This can be accomplished by providing that the glass is not fixed into the window frame by only caulking in place. The total area of glass required is 50.33 (26.3) = 1323.68 5.5 (22.30) = 122.65 4.0 (11.2) = 44.8 7.3 (5.5) = 40.15 1531.28 sq. in. Total Area = 10.63 sq. ft. 144 Secnnd Floor 4. Second floor framing span 16'-10" w8x21 A-36 or w10x19 5. Span 16'-0" 3 - 1 3/4"xll 7/8" gang lam 6. Span 8'-7" 2 - 1 3/4"x9 1/2" gang lam 7. Span 12'-1 1/2" 3 - 1 3/4"x9 1/2" gang lam or 2 - 1 3/4"xl1 1/4" gang lam 8. Span 19' w10x22 on 4"x6" posts or 3 1/2" dia. Lally col. each end 9. Span 17'6" wlOx19 10. Span 10' header 3 - 1 3/4"xl1 1/4" gang lam or w8xl8 First Floor 11. First floor framing span 6' 3 - 2XIO'S fb=900 psi If you have any questions, please do not hesitate to contact me. � Sincerely ` ` •`\' R. Grego lor, s �C, 7a�[,o,z 'S E&i.qn Ag ioei.atFsi, �rae. 2S -Saaznaitag E c-Road O�lia1212[5, og 02607 J/PfionE & 9ax (50S) ggo-4686 August 12, 1998 Sara Jane Porter, Architect 240 Main Street Route 6A Yarmouth Port, MA 02675 RE: Gregory Residence 26 Bay Shore Road Hyannis, MA Dear Ms. Porter: During the design phase of the subject project the following beams were designed to comply with the Massachusetts State Building Code, 6th Edition. �f 1. Roof valley rafter span 18' 2 - 1 3/4"x14" gang lam fb=2800 psi 2. Ridge beam span 14' 2 - 1 3/4"xll 1/4"gang lam 3. Span 15'-10 1/2" at roof 2 - 1 3/4"x14" gang lam or 3 - 1 3/4"xl l 7/8" gang lam r This will meet the F.E.M.A. regulations for areas subject to flooding, not in a velocity zone. The owner will be well advised to install a sump pump that will discharge above elevation 12.0 feet. If you have any questions, please do not hesitate to contact me. Sincerely � O R.GM-- o TAYi ATRUC r? p 27770 O� R. Grego ' a SF STEM � y o NAL E��' JOB- /1.L�f7 � k _� J tJ �OYC.r�Jj TAYLOR DESIGN ASSOC., INC. SHEET NO. OF p(� 29 aacwta to '?load CALCULATED BY DATE << l L] WWo WW9S, Mdf 02601 C- 7T (508) 790-4686 CHECKED BY SCALEYL ss9 .. ... ...... .. :... .-. ..... ... 7 . � O S/ONAL E. ' .. ..... ce�6-i�-�44-T ST-v . . .4►c � ._._.. : ........... ........ __. ....... .. `r i,�0._ T_..'F•1X... TD ... Yt/wC.. ...... „ : ...... ........ ._...... .. t.�...._. -ow e-+� 8 e-=c.�-�.. _ .... . -t-► *.�. ...... . ... o . .......... .,,, . ....._..... ........ ..._.... .... _ . ................. . _ .....:... _... e),�� Lt... .......... ........... ............ ..-__ _............_..... __. `t' ...._. . .. ........ . P ii�-� 1471' TO I P F9 m ship! �■���i��iii�r"+�siii�fi�f+ i a m �r.. laid 71 :r Ililoom lift JP t� Bag ■ !�19illILlll`�� -- is i 1 j +Tr IIIOIi I / NOW EVIL •Md� I-nil u i i,71 11, f� f 1 1 � I ' dd 1t -• i ELJI t: J / I I 2.. *OMP dW4o Mr•I ro �O� yP Cr,?W oaarl? lot (■ EAuw low irk I = 1 AIR 11 Is �. _� -! - --�•r'.ill rt ^ Wwbs t e�tt�tt�ttl li i��fl. If: a n a \ f4 \ n;:4 cr Ipp Xi � o ► � \ .�, I/ � is ps g �. °y sk. toN�a� o The Commonwealth of Massachusetts = _ Department of Industrial Accidents == Office ofinlresligaGons 600 Washington Street _.......... ;� Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit name: J /j R A T A4 o-A/ location: a/,* R 4 vs #o c e, dzo-tA n city phone# 39 E -2ROO ❑ I am 4 homeowner performing all work myself. I am a sole ro rietor and have no one workin in any ca acity ❑ I am an employer providing workers' compensation for my employees working on this job. company name: .. address. -.. ;. ,. cttyi i phone#: -.. insurance co. V01icV# I am a sole proprietor enera=contract//o//>/r//%/homeowner(circle one)and have hired the contractors listed below who aye the following workers' compensation polices: company name: address. city phone insurance co` ` ohcV WZWX cambany name- address. ` city one ' insurance o Failure to secure coverage as required under Section 25A of MGL 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$100.00 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. 1 do hereby certify the pains and talti ry that the information provided above is true and corr41. Signature Date � g Print name l+ETE d Phone# 9�f -28 O 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 ifirnmediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other Oemed 9/95 PIA) 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 contract of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance , construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 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, 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 may be returned io 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. FEE The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Me of Investigations 600 Washington Street Boston; Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 MCutAr" dkJ Tablo A=(continued) prescriptive Packages for 0ae and Tw6-F2miiq RetdeatW Buldiaga Seated with Fmtii Fact MAXIMUM MINIMUM �g Q�8 Ccilin Wall Floor tv;alaJ. �ent Slab H S��oLIIB Ann'(%) U-valucl It value' R value' R valuer aII � Equipment E denm? pwmw Q valuer 5"1 to 6500 Heating Degree Dare' Q IrA 0.40 38 13 19 10 6 Normal R 12% 0.52 30 19 19 10 6 Normal S 12-A 0.50 38 13 19 10 6 8S AFUE ) 13% 0.36 38 13 23 WA WA Normal U IVA 0.46 38 19 19 10 6 Normal V 13-A 0.44 38 13 23 WA WA 83 ARM w isX. an 30 19 19 10 6 83AFUE X 19% Q32 38 13 23 WA WA N� Y 19% • 0.42 38 19 25 WA WA N� z 12% 0.42 38 13 19 IO 6 90AFUE AA Ir/- 0.50 30 19 19 10 6 90 AFUE 1. ADDRESS OF PROPERTY: o'Z Bay -Shave_. I , 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: �/� p 1 . 3. SQUARE FOOTAGE OF ALL GLAZING: 692. SF 4. %GLAZING AREA(#3 DIVIDED BY#2): 141 z S. SELECT PACKAGE(Q—AA -see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-4980303a 780 CMR Appendix J Footnotes to'Table 35.2.1 b: Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and basement windows if located in walls that enclose conditioned space, but excluding opaque doors)to the gross wall area,expressed as a percentage. Up fa, 1%of the total glazing area may be excluded from the U-value requirement. For example,3 fl of decorative glass may be excluded from a building design with 300 ft of glazing area. 2 After January 1, 1999, glazing U-values must be tested and documented by.the manufacturer in accordance with die National Fenestration Rating Council (NFRC) test procedure, or taken frorii Table,J1.5.3a. U-values are for whole units:center-of-glass U-values cannot be used. ' The ceiling R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R'values represent the'sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. •Wall R values represent the sum of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding, structural sheathing, and interior drywall. For example,an R-19 requirement could be met.EITHER by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frame or mass(concrete,masonry,log)wall constructions, but do not apply to metal-frame construction. 'The floor requirements apply to floors over unconditioned spaces (such as unconditioned crawlspaces, basements, or garages).Floors over outside air must meet the ceiling requirements. `The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as above-grade wails. Windows and sliding glass doors of conditioned basements must be included with the other glazing. Basement doors must meet the door U-value requirement described in Note b. 'The R-value requirements are for unheated slabs.Add`an'additional R-2 for heated slabs. ' If the building utilizes electric resistance heating use compliance.approach 3, 4, or 5. If you plan to install more than one piece of heating equipment or more than one'piece of cooling equipment, the.,,equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. 'For Heating Degree Day requirements of the,closest city or town see Table J5.2.1 a NOTES: a)Glazing areas and U-values are maximum acceptable levels. Insulation R-values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b)Opaque doors in the building.envelope must have a U-value no greater than 0.35. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table J1.5.3b. If a door contains glass and,an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c) If a ceiling, wall, floor, basement wall,slab-edge, or crawl space wall component includes two or more areas with different insulation levels, the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). t , , h HOME.IMPRO.VEMENT CONTRACTOR ' Re9i;s .r:gtldw 1.07788 Typo IiD,I;V$OUAL ExPi'ra'i�' r::O8/0.6198 EDWIN C. PETERSON PO 80-z 13.1:143.0aUtical Ln. AMMSTRATM +e DEPARTMENT Of PUBLIC SAFETY t CONSTRUCTi0lt SUPERVISOR LICENSE - Nueber; Expires: r GRIN L`` TERSO#0 PO BOY 131 SOUTt4 YARMOUTH, NA 62664 The Town of Barnstable } KAM ' Department of Health Safety and Environmental Services rFDr�a't� Building Division 367 Main Street,Hyannis MA 02601 t Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no. . Date t + 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: AddTrw 4 h 17ZAZ, Est. Cost a ZS o oo. y o i Address of Work: o 6V islinirw— R cad UVO&AIWe'?!, Owner's Name CJ U a. + d , Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. ! 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 PROGZAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I here y a ply for a permit as agent oft own // 10?7 9 Date t 7 1ntractor Name Registration No. OR Date Owner's Name i! TOWN OF BARNSTABLE - "" CERTIFICATE OF OCCUPANCY --� PARCEL .ID 326 085 GEOBASE ID 24056 ADDRESS 26 BAY SHORE ROAD Y� PHONE HYANN I S , ZIP - LOT 115 LC BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT HY PERMIT 37683 DESCRIPTION .ADDITION & ALTERATIONS (BLDG PER 30838) PERMIT TYPE BC00 TITLE CERTIFICATE OF OCCUPANCY CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: BOND $.00 Ox CONSTRUCTION COSTS $.00 753 MISC. NOT CODED ELSEWHERE * BARNSTABLE, • _... MASS. 16.1q. E,p�A BUILD > I BY DATE ISSUED 04/08/1999 EXPIRATION DATE a •_ ���'' io -F © :. � _`lF err Q 0 •~ .. -�Depar�tment of Health, Safety.d 41 �i• and Env��onmeal Services IN ` :� Jt'!�,r 'E t -��L7 k.� �^�K�rg'�x���1"��V VV.:--V�° .���.:• '�-,'`iAy n � EL42NM® } .. . F. BLtILDING DIVI�I�N ' r yw..F m A BY; q •k :.k TH S PERMIT CONVE�lS NO.RIGHT7 OCCUPY ANY STREET,ALLEY OR.SIDEWALK OR ANY PART TFiEREOF'EITHER'TEMIPORP,RILY OR PERMANENTLY.EN-. ` CRl 7. P NJENT N'PUBS JC PROPcRT',NOT'.SPECIFICALLY PERMITTED UNDER THE BUILDING CODE;:MUST BE E}P�-Hi�VED'BY.THE JURISDICTION:STREET OR ALL Y�Y b IADF�ASWEL�ASDEPTH,AND LOCATION OF.P0BLI6 SEWERS MAY BE OBTAINED FROM THE DErAr,.CMENT OF PUBLIC WORKS.THE,ISSUANCE OF THIS PERMIT DC;- SNOT�RELEASE:THE'APPLICANT'•FROM THE CONDITIONS OF ANY.APPLICABLE SUBDIVISION RESTRICTIONMINIM M OF FOUR CALL INSPECTIONS REQUIRED n"'F -F F OF-^ LL CONSTRUCTION WORK APPROVED PLANS MUSTsDE RETAINED ON JOB AND -WHERE APPLICABLE,'SEPARATE < THIS:CARD KEP POSTED UNTIL FINAL INSPECTION'- PERMITS. ARE REQUIRED FOR ,rl rOkJNDATIONS OR FOOTINGS •- 2 PRI(QR TO COVERING'STRUCTURAL MEMBERS HAS.BEEN�4ADE.WHERE A CERTIFICATE OF OCCU y. : -ELECTRICAL,PLUMBING AND MECH; (READY TO LATH).' -'� h ' " PANGY;IS REQUIRED, SUCH BUILDING SHALL NOT BE , ` 3 INSULATION. rOCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. ANICAL INSTALLATIONS: j.F AAL-INSPECTION BEFORE OCCUPANCY. BUILDING INSPECTION APPROVALS . PLUMBING INSPECTION APPROVALS ELECTRICAL,INSPECTION APPROVALS �O (5!4 ° 3 '1 HEATING INSP TION APPROVALS f ENGINEERING DEPARTMENT G� Y 2 B RD�;E,,ALT A OTHER: SITE N REVIEW APPROVAL WORK SHALL NOT ROCEED UNTIL PERMIT WILL BECOME NULL AND-VOID IF G ' I- INSPECTIONS INDICATED ON THIS THE INSPECTOR S APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN:,1,I CARQ CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. / 4, TIOw �. mom APPROVED TOWN OF BARNSTABLE ` El WIRING El GAS ❑ PLUMBING Cl-BUILDING I- T 7 Y ,. •'{a • 4t ny Y ,- :d, ', a..l'1s�'. A p��k,. 7 •.y i%� .- fir, �j� 690 Thousand Oaks Drive, Brewster, MA 02631 Phone & Fax: (508) 896-5203 February 9, 2007 Barnstable Conservation Commission 200 Main Street Hyannis, MA 02601 Reference: Douglas and Sandra Gregory 26 Bay Shore Road, Hyannis, MA Wetlands.File No. SE 3-4278 Request for Amended Order of Conditions Dear Commission Members: The Conservation Commission issued an Order of Conditions to Douglas and Sandra Gregory approving the repair of an existing stone revetment to include the installation of corrugated steel sheathing. The portion of the seawall perpendicular to the shore and contiguous with the abutting structure was being undermined by the ongoing impacts of the passing ferries. The toe stones were exposed and sediments from the landward side of the revetment were being washed out through the bottom of the wall on a continual basis, creating large voids, causing destruction of the applicant's property, negative impacts to the environment and a public safety hazard. The sheathing was proposed to end at the southeast corner because, at the time of the site inspection, only the portion of the wall perpendicular to the shore was compromised. In addition, it was believed that . the existing loose configuration of stones beyond the SE corner would serve to break up wave energy and mitigate for typical end erosion. However, due to the excessive and ongoing water turbulence caused by the ferry traffic, the remaining portion of the wall that was not reinforced has been undermined by the wave action; sediments are dramatically siphoned away from the shoreline every time a ferry passes. That, combined'with the age and construction style of the revetment, has resulted in the continued failure of the wall where it has not been reinforced with sheathing. Toe stones have become exposed and the yard upgradient of the wall has collapsed. The applicant undertook emergency measures to fill in the large void and is seeking an Amended Order of Conditions to repair the rest of the revetment. The sheathing is proposed to be installed in the same manner as was done previously, against the toe of the stone revetment to provide resistance and longevity to the structure. The elevation of the top of the'sheathing is to be at approximately elevation 3.5 feet. The sheathing will be exposed approximately 2.5 feet above grade and driven to a minimum elevation of-12.5 feet. Installation is to occur from the water side: The base structure of the revetment is proposed to be reinforced by the placement of granular fill, choke stone, rip-rap stone and filter fabric, ds shown on the detail of the proposed wall repair. hz order to prevent the collapse of the revetment during the repair, the following construction protocol shall be followed (Philbrook Engineering): Excavate belund the wall a minimum of 2 feet clear to the water level; the excavation is to be no More than 12 feet wide at any one time, leaving intact the adjacent sides. Observe the-stonework and , drape the filter fabric in order to create two sides and bottom. Install approximately 8 inch and 3/4 choke stone and wrap landward end of fabric overtop creating a blanket wrap. Finish fill. Access for the landward work is to be from the landward side of the revetment. The stone revetment is proposed to be reinforced with steel sheathing only to the pier. On the southwesterly,side of the pier, 1- foot diameter pilings are to be driven,at the toe of the revetment, 5 feet on center, to preclude dislodgement of the toe stones,while 's providing an area along the wall for,the dissipation of wave energy. The pilings will hold the toe stones of the existing revetment in their location along the shoreline, while allowing waves to break between them along the wall face. There will likely be shifting.' of the stones as the wall continues to be impacted by the passing ferries. Ongoing maintenance of the structure by periodic filling on the landward side or the addition of stones as the wall settles against the pilings is more easily managed at this end of the property. Abutters have been notified by certified mail of the project's consideration by the Conservation Commission on February 27, 2007. If you have any questions or-require , additional information, please'call me at (508)896-5203. . Yours truly, Lynne Whiting Hamlyii" Environmental Consultant cc: Douglas and Sandra Gregory - Arne Ojala,.P.E., P.L.S., Down Cape Engineering, Inc. _ - ... d _ ._ •_ Ili :,` .2 t HILBROOK ENGINEERING FIELD REPORTMORKSHEET Project No: ���0 � 107 BEACR STREET {, OEIIMS.M 02s39 Sheet . No: of I Lill I f C 0 i -4 E E r`,: )rI 6:eyLu ' A i LL.i f IBM ti gg ._..___s•-� ]fE `(5,� Vim^ re��^� N 54 �� - Y ..fdJ i � li ij I f: :i I p I I; 1 [i f b Town of Barnstable Geographic Information System January 29, 2007 32Gi01 °� �2G1=t > 13261 1 ;- 67 e TJ d ,..... .0 .a^ ,. p5102 � J TS5 326097 � f 5 r z 3261o7 ��ry � d Jvv'9Gy r 'i'2a r 093A, I � Y 1rr >0 l' 4yW fi. :i O X� ,., tr• k � - . �4V - s € F e p � Y✓ f 25' �£ gu x� a f-s r 32 0 7 . 3261.E 1 11 13 5165 �w50 u 06S4.Li�}Qr�t 325JC) F 3251072 `. s u5 'or DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:326 Parcel:085 Conservation Notice of Intent(NOI) boundary determination or regulatory interpretation. Enlargements beyond a scale of Selected Parcel 1"=100'may not meet established map accuracy standards. The parcel lines on this map Abutter List Type-Property owners within 100 feet of the perimeter of the subje t A x are only graphic representations of Assessor's tax parcels. They are not true property parcel upon which work is proposed. Abutters '� w '"°E boundaries and do not represent accurate relationships to physical features on the map such as building locations. Buffer cr t . i Tx 1R,,qx Ain45 .......... 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RESIDENTIAL PROPERTY MAP NO. LOT NO. �'�� FIRE DISTRICT STREET 26 Bay Shore R . Hyannis SUMMARY g LAND 326 85 -23 3f a ~� �t�:,�� �, ��/�: Zc pl OWNER BLDGS. G?G'� ter' TOTAL �-S. �. LAND RECORD OF TRANSFER DATE etc PG I.R.S. REMARKS: 1-a T //g 7y r Pt � BLDGS. c c. ;,. --R a>3 ;._3/21/63 232 _..:.,,IU4,, :......._.. B TOTAL 2 a LAND SAMARAS NICHOLAS T. & EMILY W. (tens ent) 2-16-73 Ctf.5 756, 463/1 ' � " - rn BLDGS. ,,?� (�`,R� �►Fc�+�� R'd. �) ►UNi� YIlA:S, osan/ TOTAL LAND BLDGS. TOTAL LAND BLDGS. TOTAL LAND 01 BLDGS. TOTAL LAND BLDGS. TOTAL LAND _ BLDGS. INTERIOR INSPECTED: rn TOTAL DATE: LAND ACREA01E COMPUTA'[IONS 22 aj BLDGS. LAND TYPE �j # OF ACRES PRICE TOTAL DEPR. VALUE LG '76/s, TOTAL HOUSE LOT �lg h J -- __ _ __ .. __ ____ LAND CLEARED FRON Ot BLDGS. EAR TOTAL W SMPROUT FRONT LAND REAR BLDGS. WASTE FRONT TOTAL REAR LAND' BLDGS. Ol TOTAL LAND oZ d 1 BLDGS. LOT COMPUTATIONS A.-b FACTORS TOTAL FRONT DEPTH STREET PRICE DEPTH% FRONT FT.PRICE TOTAL DEPR. COR. INF. VALUE HILLY TOWN SEWER LAND ROUGH TOWN WATER BLDGS. HIGH GRAVEL RD. TOTAL LOW DIRT RD. LAND SWAMPY NO RD. BLDGS. TOTAL TOWN OF BARNSTABLE. MASS. HNITFn —P-1-1 I"n FACT HARTFMRI•I l:nNN. FOUNDATION BSMT. & ATTIC St. Shower Bat PLUMBING PRICING LAND COST Cont.Wails Fin.Bsmt.Area Bath Room Base 6.J�..�p BLDG. COST Bsmt.Rec. Room h T Bsmt. °Cont.Blk.Walls Conc.Slab Bsmt.Garage St. Shower Ext. PURCH. DATE Walls PURCH. PRICE. .(' Brick Walls Attic FI.&Stairs Toilet Room Roof RENT MI Stone Walls. Fin.Attic Two Fixt.Bath Floors iers INTERIOR FINISH Lavatory Extra Bsmt. F 1 2 3 Sink j Z✓� s/ 1/2 1/4 Plaster Water Clo. Extra Attie EXTERIOR WALLS Knotty Pine Water Only ouble Siding Plywood No Plumbing Bsmt. Fin. Ingle Siding Plasterboard Int.Fin. _ Shingles TILING 5 ° onc.Blk. G F P Bath Ff. Heat !;J �y • ace Brk.On Int.Layout Beth Ff.&Wains. Auto Ht.Unit Veneer Int.Cond. Bath Fl. &Walls Fireplace r ° 3 _.. om.Brk.On HEATING Toilet Rm.FI. t 4 ATT / Plumbing L- l 3 olid Com..Brk. Hot Air Toilet Rm.Ff.&Wains. rt Tiling Steam Toilet Rm.Ff. &Walls 3 6 ('70 Blanket Ins. Hot Water fl St.Shower L oot Ins. Air Cond. Tub Area Total , Floor Furn. ROOFING COMPUTATIONS Asph.Shingle Pipeless Furn. S.F. Wood Shingle No Heat S. F. Asbs.Shingle Oil Burner S.F. Slate Coal Stoker Gl S.F. Tile I Gas S F OUTBUILDINGS ROOF TYPE Electric S.F. 1 2 3 4 5 6 7 8 91101 1 2 3 4 5 6 7 8 9 10 ME SURED Gable Flat Hip Mansard FIREPLACES S.F. Pier Found. Floor t, Gambrel Fireplace Stack Wall Found. 0. H.Door LISTED FLO R Fireplace / Sgle.Sdg. Roll Roofing Cont. LIGHTING Dble.Sdg. Shingle Roof Earth No Elect. Shingle Walls Plumbing Pine Hardwood ROOMS Cement Blk. Mw Electric ' Asph.Tile Bsmt. 1st fa TOTAL Brick Int.Finish CED Single 2nd 3rd FACTOR /j / •'Xs_.i REPLACEMENT "> D 71. OCCUPANCY CONSTRUCTION SIZE AREA CLASS AGE REMOD. COND. REPL. VAL. Phy.Dep. PHYS. VALUE Funct.Dep. ACTUAL VAL. DWLG. �;') = S C J`�-� 3 J O O 4 S- 1 - 2 3 4 5 6 7 8 9 10 TOTAL PROPERTY ADDRESS I I ZONING I DISTRICT CODE SP-DISTS.I DATE PRINTED I CSTATE LASS I PCS I NBHD KEY No. 0026 BAY, SHORE.ROAD 07 RB 400 07HY 07109/95.1011 00 69WC. R326.:085_ 240563 LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS T,, UNIT ADJ'D.UNIT Land By/Date SF, Dimen��on LOC./YR.SPEC.CLASS ADJ. COND. P PRICE PRICE ACRES/UNITS VALUE oexription SAMARAS. NICHOLAS T TRS MAP- CD. FFDeI Acres #LAND 1 195.600 CARDSINACCOUNT L ' 15 1WATERFNT:.I X' .23 =10c 270 314999.94 850499.91 .23 .195600 #BLOG(S)-CARD-1 '1 61o,800 01.: OF 01 A #PL'26 SAY: SHORE RD HY ST Q- N BATHS 1 .0 U X C= 100 3500.0C 3500.00 1.00 3500 $ #DL LOT'115 LC7615-e MARKET 208300 D FIREPLACE U X= C= 100 3100.0C 3100.00 1.00 3100 3 #RR 0090,0080 INCOME q USE D APPRAISED VALUE D i A 257,4CC A U ARCEL ' SUMMARY T S AND 195600 A T LDGS `61800 GIMPS E UTAL 257400 F EI CNST E N DEED REFERENCE Type DATE R--ded R I O R YEAR VALUE q T Book Page '"" Mo. yr p sae.P,u AND 195600 T S C121425 I09/90 A 1 LDGS '61800 U C114467 : Ib6/88 A 1 ° OTAL 257400 R C87716 b1/82 BUILDING PERMIT tlkl :STALL SHOWER LANDx S LAND-ADJ ' INC ME SE SP-BLD FEATURES BLD-ADJS'' UNITS Number Date TYpe Amount A T H 195600, 1 6600 I 1 Const. Total Ye r built Narm. Obsv. yr,ae Class Units Uoils Base Rale A.,Rate A I Age I Depr. Cond. CND Loc %R G Repl Cost New AOI Repl Value Sloriee Reign, Rooms �JeO Rms Bans •Fia F_ 101C : 000 ':100.100 . 60.20 60.20 . 51 75 19:8n0 100 80 _ 77302 61800 %2 5 2 2.0 7.0 D scription Rate Square Feel Repl.Cost MKT.INDEX: -1.()U IMP.BY/DATE- 'ML ' 7/88 SCALE: 1/00.74 ELEMENTS CODE CONSTRUCTION DETTJL S 100 60.20. 978 58876' SINGLE ,FAMILY DWELLING CNST•GP:00 FWD+ 85- 8.50 312 - 2652 *------- 26--------*; TYLE 04 APE COD 0.0 T FfG : 30 .18.06, 280 5057 R $92 "7. 4.21 978 411'7 12 ' fW0: ! ' E SIG N ADJM7_ =00 ------------- --- 0_0 12 -XTER.WALLS 11 006 SHINGLES 0.0 U --- ------ --------- ! ! EAT/AC"_ TYPE 09 IL-HOT" WATER 0.0 T ! INTER EINISH 04 RYNALL 0.0 T *--�----*----36--26--- *----14---*; NTER.LAYOUT f VER.%N6RMAl ----0.0 R - B12 ..� -FFG ; " NTER:flUALTY .62 AME -AS EXTER.--0.0 8 ! [.bOR STRUCT 02 6 JOISTIaEA.M 0.0 f W E LONR CbYER__ -01 ARDMOOD -- - --0.0 L D 1570 . 978 *-6-* 20. 20 OD_F.-TYPE---- -07 ABLE=ASPH -S-if r.-a E otal Areas Aue a Base= BUILDING DIMENSIONS 7,, BASE 26 ' ' ! " LErTRIZAL 01 VE9AOE_ _ 0.0 SW36 N11 W06 N07,E06 NO3 E36 !` OUNDATI�N - -02 _ONCR'tT BLOCK 9�:9 7, 2 DtN12 .W2b.S12'E26 FFG E14 *-6-* i , ------- --- - --- ---- ----- -- - - 0 W14_N20 .. SAS S26�.. B12 ! *-- 14---* ' -----NEIGH80RH66D;64WC-HYANNY.1------ 6 .W36...S08 .W06'S07,E06. S1.1 :E36` :11r ! LAND TOTAL' MARKET: ! ! PARCEL 195600 257400 * ----------36---_------.--X . AREA 70000 ' VARIANCE ' +0 +268 STANDARD 25 f - DOUGLAS D. SANDRA V• C;P GREGORY v0 P.O. BOX .2331 �p ��, O LOCUS HYANNIS, MA �2 �p 02601 °� z o LEWIS - - O BAY �v EXISTING DWELLING - zY LOCATION MA ' #26' BAY +s�� SCALE 1: 25,000 , SHOR 2 c R D. OF Rl qc '� A H E u o � y OJALA w r z1 �o• No.'26348 s r a O EDG OF/ gT0 Qf Y n N L qN s y n 9�, � ,�n �o� ARNE H. OJALA, 'PE, PLS DATE PROP• S ���� /� . STEEL 9 F. CORRUGATED SHEATHING .(SHEET .PILE) C�? TOE 6�� STONE. CONNECT .TO EXIST. . p F+ SHEET PILE s� PROP: 1' DIA. WOOD sfr EXISTING.. TOP RIP.-RIP PILINGS @ 5 O.C. (TYP. EL= 8.0't OF. 5) R • 10' MIN. LENGTH _ PROVIDE. 3" 2 a — � ` 6" CHINK' STONE a M H W EL 3,1' roes o M,L,W, EL.= 0,0' EXISTING PROPOSED STEEL SHEATHING' R -RIP—RAP SECTION A-A TOE = 1:0't (NOT TO SCALE) - BARNSTABLE ASSESSORS MAP % i 326 PARCEL 85' off. 508-362-4541 • .y .- L` fax 508-362-9880 MLW, 4 . DATUM L 10, Al2 down cape engineering, inc. FLOODZONES; B; A9 E r' EL- 12, '& V15 EL. 15 PLAN s w 30' CIVIL ENGINEERS 0 15 30 LAND SURVEYORS ') PLAN' ACCOMPANYING PETITION OF • • ° -� 939 main st. yarmouth, ma 02675 SANDRA GREGORY DO.UGLAS D. 8c TO, AMMEND LICENSE #10301 TO .EXTEND -CORRUGATED STEEL . SHEATHING AND INSTALL PILINGS IN AND OVER THE WATERS OF LEWIS BAY .(HYANNIS), BARNSTABLE, MA' SCALE AS NOTED FEBRUARY 6, 2007 SHEET 1. OF 1 Mono— #03=186 HAMLYN_GREGORY.DWG (ARG) cf; A e r C� Q LOCUS z DOUGL,, D. & �o�, v Q SANDRA V. I ^� � � �j LEWIS G J REGORY �� EXIST. SHEET o` 1 BAY P.O. BOX 2331 PILE WALL HYANNIS, MA 02601� - ,, LO: 4 [ON MAP S, += 1: 25,000 EXISTING DWELLING #26 Fi,A Y ARNE_ c / SHORE H. OJALA I RD. `� No.26348 - �i - i i i / � aid' ,.e-`� _ _. ... _ •. _ ., — - ,.. .. < ^ A A OF `gT� W� ss�o EAW TO j' . '� _ .� ARNE H. OJA LS DAIS jBE F PAIRED .��, O- XIST. CONC. PROP. / •, N STEEL O.°••• CORRUGATED 6 ;; O;• �2� SHEATHING 9'1'�S `—' ���•• (SHEET or PILE) ` 77' L IS BAY CONNECT TO O`�3p0Sc` ABUTTER'S PLAN EXIST. SHEET 1' = 30' MHW EL. PILE • 3.1 0 15 30 I ti BARNSTABLE ASSESSORS .MAP / 326, PARCEL 85 MLW DATUM FLOOD7_ONES: B, A9 EL. 10, Al2 EL 12, & V15 EL: 15 off. 508-362-4541 fox 508-362-9880 down cape engineering, inc. CIVIL ENGINEERS PLAN ACCOMPANYING PETITION OF LAND SURVEYORS 9:39 main st. yarmouth, ma 02675 DOUGLAS D. & SANDRA GREGORY TO PERMIT AND MAINTAIN EXISTING STONE REVETMENT & INSTALL AND MAINTAIN PROPOSED CORRUGATED STEEL SHEATHING IN AND OVER THE WATERS .OF LENS BAY (HYANNIS), BARNSTABLE, MA SCALE AS NOTED APRIL 12, 2004 SHEET 1 OF 2 #03-186 EXISTING ' TOP RIP—RAP EL.= 8.0't PROVIDE 3" — 6" CHINK STONE BEHIND SHEATHING O M.H.W. --_- I .L.W. EL.= 0.0' EXISTING + PROPOSED STEEL SHEATHING TOE RIP-RAP EI_.=1.0'- ----{CORRUGATED SHEET PILE) DRIVEN TO MIN ELE`, -12.5' SECTION A-A TOP OF STEEL SHE t�.G (NOT TO SCALE) ELEV. 3.5' NOTES: 1. FABRIC WRAPS BOTH GRADATIONS OF STONE. FREE END EXITS AS SHOWN; SHEAR AND TUCK BELOW LANDSCAPING. ` _ 2. SEE CONSTRUCTIOPv PROTOCOL FOR ROCK RETAINING WALL REPAIR '(ON LANDWARD SIDE OF REVETMENT) 3. SHEATHING TO BE INSTALLED AT EDGE OF TOESTONE 3/4" 1 1/2" RIVER RUN STONE (12% 24"+ FREE END WIDE) FABRIC TOPSOIL & SALT-TOLERANT SHRUBS APPROX. EXIST. STONE 24" DEEP } GRANULAR .PROPOSED STEEL 3/4" CHOKE FILL 'CORRUGATED � STONE SHEATHING " EL. 3.5' (APPROX. w 24 DEEP) 8"(-) RIP-RAP STONE PACK MHW EL. 3.1' IN BLANKET, APPROX. 72" DEEP EXCAVATE TO UNDISTURBED BASE SOIL (APPROX E�.: . . 1.0') C.K'A�� t y' DETAIL OF PROPOSED REPAIR TO FAILING SEAWALL ' _1RNE H. ,OJALA (NOT TO SCALE) :' 1 r,iViL to �!c 30792 ARNE H. OJALA-k .�•,WDATE DOUGLAS D. & SANDRA GREGORY #26 BAY SHORE ROA!) y LEWIS BAY (HYANNIS), BARNST•ABLE, MA APRIL 12, 2004 SHEET 2 OF 2 #03-186