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HomeMy WebLinkAbout0067 BREAKWATER SHORES DR /�.�.� i .� . . .�- __� .� C&D - � - �7 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION -IY1 I e4 Map Parcel Application # Health Division Date Issued . Conservation Division Application Fee Planning Dept. Permit Fee a Date Definitive Plan Approved by Planning Board m .. Historic - OKH _ Preservation/ Hyannis Project Street Address •rt��4- � ��• Village Owner ..-�c�. fit:/ Address t ` Telephone 'Y7W1`0 -1*r Permit Request _(Jt-A-.xJ,., coo a/0,1- h o44,c r Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 2"' Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No i Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑existing ❑ new size — Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# qy1 Current Use Proposed Use y`V d, APPLICANT INFORMATION -(BUILDER OR HOMEOWNER) - - - - Name Telephone Number Mile McCarthy Construction Address ]P® Box 52 License# West Dennis, MA 02670 Cell Cam) 280-6964 Home Improvement Contractor# CSL-58633 HIC-169393 Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE /'/ FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. t & eguWory Stei v ces BUM Rich krd-V:Scati,.Director. $ 16S9. �0 '°rEa�` �u�ldzz�:g D�ivsian `era 1'eriy,.Building o=mssioner L40,Aifa rr Str Ilya�uus,lYL4Z2'601 S{ YSY tO�YA;haritSkabTe.ma:Us<. Office: 508=$624039 Fax: ,508-79M230 Property'Owner Must -15 Cazxlp�e�e �nd.S�b�i.'�"Iz�s Scc.�io -if Us M.JRYAE�Wlder Ub T,. L.o�v t Z�`+-Z. W. as( Jnerf the;s �rc �ro �xt:yr b'ercb'y'autl�o�ize��_ . c�aci.on rnybehaJf,• in a1I rnamrs.relative to work.autborizedby thin 4a& ,pernut•appl cation for: {r'1�idrl ss ".Poaf{eases an --ait, respon5 il�ey of t� �p licani. I'ac is a e nc�t:zo G filled`�� uul edtefbie•fe =A azid-O'fiaal irispecuoxls are pe fbr-mea and accepted.. Signatua�of Sipature..of Aip.ka-at Print Name: Pixnu,Nar r- Date Q:BOXttc4Sa01'v'1.?FR���3[rSStONi�C3c�t5 Massachusetts.Department of Public Safety Board of Building Regulations and Standards License: CS-058633 Construction Supervisor —� MICHAEL.J MCCARTHY P.O.BOX 52 1- WEST DENNIS MA 02S70 *Expiration: Commissioner 04/10/2018 . Cr/�., Office of Consumer Affairs and Business Regulation 10 Park Plaza •- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 169393 Type: Individual Expiration: 6/16/2017 Tr# 264961 MICHAEL MCCARTHY MICHAEL MCCARTHY ___._....."........--.--•.-_---..__-_-- P.O. BOX 52 _._......___...--•____-- WEST DENNIS, MA 02670 - _.-.......--------------- Update Address and return card.Mark reason for change. SCAT 0 20M-05/11 Address r Renewal -.i Employment i Lost Card '"/irc LZ'nnxrrznrtuccall�c�^'l'lu.ucic%ix::e�A Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME I before the expiration date. If found return*to: Registration:MPROVEMENT CONTRACTOR .�� '169393 Type- Office of Consumer Affairs and Business Regulation Expiration: .;6/1' /2617 Individual 10 Park Plaza-Suite 5170 Boston,MA 02116 MICHAEL MCCARTHY f MICHAEL MCCARTHY 6 RANGLEY LN. SOUTH DENNIS,MA 02660 Undersecretary ` Not id with t signature J f The Commonweerm ofmassachuseft Depw*mnt of1x*uWa1Accidenft 1 Congress S&W194 Sirens 100 BOND MA 02114-2017 wwa inamps1diia ` Workers,Compensation Insurance AfAdavit:BulbbudConhieten/Electr eho/Plumbers. TO BE FILED WITH THE PERDiIITTI@ G AUTHORITY. 'on Please PrintLegibly NtllLlte(Easiness/Orpntaahonlindividual): ►r.-+� / ' .�"l Address: City/tStai Mp: we Ocn-,-, �''j/�- o1c'7`Phone M 5z4 - -Id;r, -0 Areyou am ea~Ch=k eta tabs Type of project(ceq�: l.�.am a aeployer with emp>Dyaee(tilt m d/ar part-dme).t 7. ❑New Consfiuction L[3I ama eple p vpdoterorpaemerahip and haven employees wo king formo In , 8. Remodeling ew��lno '�h l 9. ❑Demolition 3.01 am aboamownerdoing an work aqtselE[No wo iMW comp.ba nncerequited.]t 9.[]I am a bomeavnerend will be hbvtg conbaemre to tontine eq work on my property. 1 wiU 10[]Building addition emote tint au coofte to eidw have werkars,componsaft tgeoraaee or are sots 11.0 Electrical repairs or additions proriam with no employe. 12.[]Plumbing repairs or additions 5.01 ama general eanimatorand I have hired the s0h-wntmcto:;1k t4d on dw attached sheeL , These s64on"ars have employees and have workers'camp.tmummt ,3.oRoof remits 6.[]We ate aw*oradm and its oflicets have mmiW th*rlght of mmptton per tdGL c. 14. Other IA JRQ.ad we have no a mployeea(No wodmre'oomp.iasumm mpdmd.] *Any appliew thatclaxks box#1 must also 511 out the section below showing their workers'compensation policy intbrmation. t Homgowners who submit this atlbinvft indlosting they ate daft all work nd then hits o»tefde oontraetors awst subndt anew aftavit inuring sub. tContdetors that ebeck fds box must ansahad an addiional shed showing the name of the su'o•corttraetars and state whether or not nose eatitin have !!fteas Ifdre schoemmo=have employees,shay sou t provide:h*workeea'comp.poltcy member. I am anemployer turret ispmvkft worms'codes baswomfor nt0►ewphym Belowts dxpoltcy and joh sue insurance Company Name: �d�.•�( 1-►`��( ., a..9 Yt s. policy#oe Seo-iaa.Lic.#:� ExpirWon Date:_ )A, - t Job Site Address: City/Stawip: Attach a copy of the.smorkers'compoundon policy declaration page(showing the policy number and expiration date). Faihtre to secure coverage as required under MGL e.152,§25A is a criminal violation punWiable by a fore up to$1,500.00 and/or one-you imprisonment,as well as civt'1 penalties in the arm of a STOP WORK ORDER and a fine of up to VM.00 a day against the violator.A copy of this statenteat may be ibMarded to the OfficO of Investigations of the DIA for insurance coverage verification. I do hefflby W derth ofperp"thatihe inl'ormtrdan pmnided a6eve k mrta and correct g' Date: It Pl[bii 1• f62r40-K X 4 offlaid eras oilµ Do not wdo In This arse,to be cold by city or town offl L CHy or Town: Permit/License# Imuiag Authority(cirde one): 1.BoaW of health 2.Baildhtg Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other pContact Pelun: Phone M. MCCART9 OP ID:KS ACO DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 12/20/2016 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 endorsements. PRODUCER NA2MeACT Dennis Office Bryden&Sullivan Ins Agency of Dennis Inc. .508-398-6060 PHO WC No:508-394-2267 485 Route 134,PO Box 1497 EAIWL. So.Dennis,MA 02660 ADDRESS: Dennis Office INSURERS AFFORDING COVERAGE NAIC# INSURERA:Natlonal Liability&Fire Ins INSURED Michael McCarthy INSURER B: Construction Inc INSURER C: PO Box 52 West Dennis,MA 02670 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADD SUB POLICYNUMBER MM/uDDYE� MMMIIDDY�P LIMITS LTR COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLANS-MADE F]OCCUR PREMISES a occurrence $ MED EXP(Anyone parson) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO- POLICY1:1 JECT LOC PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMB $ accident ANY AUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ ! AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS eraxident UMBRELLALWB HOCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X STATUTE OTH AND EMPLOYERS'LIABILITY ER A ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 9WCi747574 12/15/2016 12/15/2017 E.L.EACH ACCIDENT $ 1,000,00 OFFICER/MEMBEREXCLUDED? y NIA (Mandatory in NH) E.L DISEASE-EA EMPLOYEE $ 1,000,00 Dyes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Michael McCarthy has Opted to Exclude himself for Workers Compensation benefits. CERTIFICATE HOLDER CANCELLATION CAPELIG SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Cape Light Compact Box 427 AUTHORIZEDREPRESENTATIVE Barnstable,MA 02630 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD r TOWN OF B,ARNSTABLE BUILDING PERMIT APPLICATION Map �o Parcel 2 Application # opy 5 q Health Division Date Issued I'L' l Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address (W7 V_ Village Owner_ 0, Address 25 �� l Telephone (Tlb) Permit Request SU3YrtC1-k Ws:> lbw 3xpcla- , Square feet: 1 st floor: existing proposed %'2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 600 .0'0 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documen4ation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) w Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's rHighway: 0 Yes4❑ No CD Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing -new,— Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: dGas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number �r090co 02:R(,2 Address \�O c, O� " , `\�;\.1QJ\ License# Home Improvement Contractor# Email �CAP �PQsD� Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO :--)I.\ sc<C7 ? SIGNATURE DATE `� �`� 2XD1� FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: ° FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. The Commoyrivealth o,f Massachusetts Departinerlt. aflndztstazalAccidents Office oflm-tnrtigatiarts 600 Washingtori Street Boston, MA 02111 rt�rvx�l.rtaass:.got/din Warkers' Compensation Tusurance Affidavit Builders(Cantractnrs)EIecfricians/Plumbers Applicant Inf n-ration Please Print LeagibIY Natrie ISusraesslOigana i iowhdi%idnaia:_ Address- City/Stat&Zip Phoneme- �C�� :ire you an employer^Check the ap ropizate bom: Type e of project r 4. I am a general contractor and I F l � �=. 1.�I am a employer urith 2— ❑ D New construction (full andfor part-time),* h 6. 'have hired.the sub-contractors ❑ 2.❑ I am a sole proprietor orpartner listed on the attached sheet. 7_ /VRemodeling slu and have:no employees These sub-contractors have F8. E]Demolition working far m n in any capacity employees and have workers' 9. Buildin addition [No�vorkt:rs'comp.insurance comp.imsuranml g required.] 5. ❑ We are a corporation and its 10_❑Electrical repairs or additions officers have,exercised their 3. I.am a homeowner doing all work 11_0 Plumbing repairs or additions myself [No workers'romF right of exemption get MGL 12.❑Aoofrepaua insurance required.]Y c. 152,§1(4),and we have no employees.[No workers' 13.El Other comp.insurance required.] #Ai3y appffcaat that checks hog rl mast also fill out the section below sharing then woskere compensation policy informsu n_ FFomeowners who submit this affida6t indicating they are doing all waak and then hire outside contractorsnmst submit a new affidavit iadicatin-sacii 'Contmctoraihat check this box must attached an additiarW sheet showing the n-ne of the sub-contractors and state whethu air notthnse entities have employees.Ifthesubtanhactor bare employees,theymustpnnadethxir workers'comp.policy number. I attt art etteplay-er that is protddrirg rnorke.rs'contpertsad,vii insurance for rity enipLoi-ees. BeIorw is tltepolicy and job site information Insurance Company Nam:A 7, AA Policy 4orSelf-ins.Lie. Expiration Date- V0��j201to Job Site Addsess: (,o `C7�� (� � � 5 City/State/74p 1m,3io\`-> Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of NfGL a 152 can lead to the imposition of criminal penalties of a fine up to$1,500:00 amdror one-yearinVdsoument,as well as ci-ril penalties in the form of a STOP WARS ORDER and a fine of up to$250-00 a day against the-violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations ofthe DIA for insurance coverage verification. Ida hereby cet ttf,under the pants and penalties of 'uty�thatthe information provided a bore.is true and correct Si:mature- , Date- \2��112d715 Phone : 7 Sb � Official use only. Do notwrite in this area,to be cantple a by city ortown ofciat City or Tomm: PermitlLicense ig Issuing Authority(circle one): 1.Board of$talth 2.Budding Department 3.City]T.own Clerk d.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Taformation and hastrnctions Massachusetts Geheral Laws chapter 152 requires all employers to provide workers'compensaton for their employees. y Pm �sto this mute,an employee is defined as."-.every person m the service of another Under any contract of bite, express or implied,oral or written_" An employer is defined as"air iadiviffiA partnership,association,corporation or other legal entity,or any two or more of the.foregoing engaged is a)omt caturprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an iudiviffiA partamz iP,association or other legal entity,employing employees. However the owner of a dweIIing house having not more than three apadments and who resides therein,or the occupant of the - dwelling horse of another Who employs persons to do maintenance,conshuction or repair work on such dwelling house or oa the grounds or btnldmg appurten thereto shaHnotbecause of such employmentbe dbemedto be an employer." MGL chapter 152,§25C(6)also states ttlat"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,MCTL chapter 152, §25C(7)states`Naither the commonwealth nor any of its political subdivisions shall enter into a-ay contract for the performance ofpublic wont until acceptable evidence of complia:a=with the ins rrauc6. rrz,irements of this chapter have been presented to the contracting avfhority_" Applicants Please fill out the wodcers'compensation affidavit completely,by checking tha boxes that apply to your situation and,if necessary,supply sob-conira-cto*)name(s), addresses)and phonenumber(s) alongwiththeir certificates) of hinuanCe. Limited Liability Companies(I.LC) or Limited LiabilityParinerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation i asuuaace. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insuance coverage. Also be sure to sign and date the of davit The affidavit should be retrmmed to the city or town that the application fur the permit or license is being requested,not the Department of lod-n trial Accidents. Should you have any questions regarding the law or ifyou are required to obtain a workers' compensation policy,please call the Department at the n=bez listed below. Self-insured,companies should enter their self-m sarmnce license number an the appropriate lime. City or Town Officials Please be sure that:the affidavit is complete and piiatedlegibly- Tine Departmenthas provided a space at the bottom of th_e 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 perma t cense number which will be used as a reference number. In addition,an.applicant that must submit multiple pen itllicense applications in any given year,need only submit one affidavit indicating current r e Q dtiress"the licant should'n,rite"all to cations in (city cr policy information Cif neces_ary)and tinder"Job Site__ app town)_"A copy of the-affidavit that has been officially stamped or marked by the city or town may be provided to the - apphr-aut as proof that a valid affidavit is on file for fctm permits or licenses. A new affidavitmust be filled out each year.Where a home owner or citizen is obtaining a license or putt not related to any business or commercial venture (i.e. a dog license or permit to bum Ieaves.etc)said person is NOTrequi and to complete this affidavit The Office of Investigations would like to thank-you is 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: ]I� CD.=aMWt�,altbE of M ssachu&-Ats Dt parhneufi of 1ud ial Accidents Office 4f hvesantio- 600-Wa+shhool,Ste:C--t Bodon,YA 02111 Tf,-1,4 617-' 7-4}QO ext 4-06 ar 1-9 MA.3�`F' Fax 617-727-` 749 Revised 4-24-07 W mas,,LgavI is A . . 3 e WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE A.I.M. Mutual Insurance Company 54 Third Avenue, Burlington, Massachusetts 01803-0970 (800)876-2765 NCCI NO 26158 POLICY NO. I VWC-1 00-601 61 87-201 5A PRIOR NO. I VWC-100-6016187-2014A ITEM 1. The Insured: Dream Construction Inc DBA: Mailing address: 150 Depot Street FEIN:*"*'5011 Dennisport,MA 02639 Legal Entity Type: Corporation Other workplaces not shown above: See Location 2. The policy period is from 10/05/2015 to 10/05/2016 12:01 a.m.standard time at the insured's mailing address. 3. A. Workers Compensation Insurance:Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers'Liability Insurance:Part Two of the policy applies to work in each state listed in item 3.A. The limits of liability under Part Two are: Bodily Injury by Accident $ 100,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 100,000 each employee C. Other States Insurance: Coverage Replaced by Endorsement WC 20 03 06 B D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules,Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Classifications Premium Basis Rates + Code Estimated Per$100 Estimated No. Total Annual Of Annual Remuneration Remuneration Premium INTEA 576519 INTER SEE CLASS CODE SCHEDU E Minimum Premium $500 Total Estimated Annual Premium $7,443 GOV GOV Deposit Premium $5,887 STATE CLASS MA 5645 State Assessments/Surcharges. $7,066.00 x 5.7500% $406 This policy,including all endorsements,is hereby countersigned by 09/16/2015 Authorized Signature Date Service Office: Harrington Insurance Age 54 Third Avenue 111 Torrey Street �ij E Burlington MA 01603 Brockton, MA 02301 OCT 0 7 2015 WC 00 00 01 A(7-11) - Includes copyrighted material of the National Council on Compensation Insurance,used with its permission. r 6 J V Massachusetts-Department of Public Safety Board of Building Regulations and Standards Constructir)n Supervisor 1-&2 Famih License: CSFA-106016 DOUTAR NOTEV`- 150 DEPOT STREEVi S ?I Dennis Port MA 02639 Expiration Commissioner 01/13/2017 e zea��zneo�uue�cl�/i o� aJrac/zuJe Office of Consumer Affairs&Business Regulation UVOME IMPROVEMENT CONTRACTOR egistration: 'l:*73596 Type: Expiration:; J.0%18/20F6 Private Corporatia DREAM CONSTRUCTION--JNC::- DIMITAR NOTEV 150 DEPOT STREET 4�� v DENNIS PORT,MA 02639 Undersecretary �e�poweano�caea��a�G>�czc�ccaeC� Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: i egistration: ;1 13596 Type: Office of Consumer Affairs and Business Regulation Expiration:;-1 T8/201.6 Private Corporatica 10 Park Plaza-Suite 5170 Boston,MA 02116 DREAM CONSTRUCTION INC DIMITAR NOTEV _- 150 DEPOT STREET = DENNIS PORT,MA 02639' Undersecretary Not valid without signature _ I Town of Barnstable Regulatory Services ' MAM ' Richard V.Scali,Director •� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 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 behalf, in all matters relative to work authorized by this building permit application for: o al (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant �ifu�r��� S o'✓�p; li Print Name Print Name r Date qr- BARNS ' xu� Y9f9NwaSxYMc'swnw. / r 1 "C 11J - RM 1TVTST77 k � k it i f 3 � � e T P4 ARIST �m 1 a 'I I i , i "C TOWN DF BAUSTME M • ppFFv4sF+� Iwm#y1��+� �"p'myll t„a� v j,. �te"F 7 t 1 F•/� S t �. I OF BARNSTABLE PH • r)TVISION A r4 ►� K LE ! {„ L . { . } / , { : . x• r Asi • m J�il�lfill" �im 4. FA � ►* rr+ i �sli w OWN-To q 04 '4 ` TO!IN OF BARNSTABLE `�i 1 �f� '�+• �f it N - C � e 1 7 ...j.P r 00 6� _ 1 i T f I a } f ------jj i I 1 i i l i - ��`�3 I AC Town of Barnstable erirut .' Expires 6 mon s ro 's e Regulatory Services Fee Thomas F.Geiler,Director. N►1/�(/v_ TEp Mp;1' Building Division Tom Perry,CBO, Building Commissioner : 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us --Office: 508-8624038 Fax: 508-790-6230 EXPRESS PERNUT APPLICATION - RESIDENTL L ONLY . Not Valid without Red X-Press Imprint Map/parcel Number r2a.S Property Address(� 7 ��C'Q� ` ShrJre�s ✓G AA tS mig r Residential Value of Work 80` Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address LlQt,J CCV102 MCtl.rrP F 0 AteL j' 3 Q` U Rd ever Md ®I 21-�� � Contractor's Name '5 . r'A K e_ � r tr►�E r�T Telephone Number 56k .Home Improvement Contractor License#(if applicable) 1 0 3 .,S Construction.Supervisor's License##(if applicable) c, LP Co Vorkman's Compensation Insurance - AUG 9 010 Check one: , TOWN OF BARNSTABLE ❑ I am a sole proprietor � ❑ I am the Homeowner ®Thave Worker's Compensation Insurance Insurance Company Name Q,-:no c C: t- ZY1aL S4. -+Sa, mpt Workman's Comp.Policy# J L K, 7 W 49 4 3 O I�L OO J Copy of Insurance Compliance Certificate must accompany each permit. Permit Requestb( heck box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side #of doors Replacement Windows/doors/sliders.U-Value (maximum.44)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note:, Property Owner must sign Property Owner Letter of Permission. A copy of th Improvement Contractors License&Construction Supervisors License is e SIGNATURF,: QAWPFILESTORMS\building permit forms\EXPRESS.doc Revised 090809 I The Commonwealth of Massachusetts Department of Industrial Accidents Offlce of Investigations, 600 Washington Street Boston,MA 02111 www.mass.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ti y i Please Prin Legibl Name(Business/Organization/Individual):S A r,'�11L j� tt�LW "Ern 11 fOVe_me n� Address:- L99�E rAS 6l2 ROOA City/State/Zip: 4VIA6 ailq Od(oCll Phone#: 60�- -7 7.5' 1-77 3 Are you an employer?Check the appropriate box: Type of project(required): I� . 1. 1 am a employer 4. I am a general contractor and I with� Q 6. Q New construction employees(full and/or part-time).' have hired the sub-contractors 2.Q I am a sole proprietor or partner- listed on the attached sheet. 7. Q Remodeling ship and have no employees These sub-contractors have g, Q Demolition working for me in any capacity. employees and have workers' 9. Q Building addition [No workers'comp.insurance comp.insurance.; , 10.Q Electrical repairs or additions required.] 5. [] ,We are a corporation and its officers have exercised their 11. Plumbing repairs or additions 3.Q I am a homeowner doing all work ❑ B � myself.[No workers'comp. right of exemption per MGL 12.Q Roof repairs insurance required.]t c. 152,§1(4),and we have no . employees.[No workers' 13,mW] Oth comp.insurance required.] 'My applicant that checks box#1 must also 11 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 subcontractors and state whether or not those entities have employees. If the subcontractors 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 fob site information. Insurance Company Name: Policy#or Self-ins.Lic.M AUX, 706 Li 9 g 3i'Sl e1e�to Expiration Date: nt 0l Job Site Address: (0 ( Breni_4h4 Sbo j S City/State/Zip: _ t'`` M od.601 y Attach a copy--of the workers'compensation polley'declaration page(showing the policy number and expiration date). Failure to seC.ure coverage as required uinder.Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,i00.00 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 oft a covera a verification. 1 do hereby i the p d penalties of perjury that the information provided above Is true and correct. Signature: Date: Phone#: 2 Official use only. Do not write In this area,to be completed byeity or town offlclaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City own Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: L , ra,� Town of Barnstable Regulatory Services :�xsri►s[.E, Thomas F.Geller,Director, . . rues. � ED �`m Building Division - Tom Perry,Building Commissioner '200 Main Strmt,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder, o— I, i r e as Owner of the subject property hereby authorize r ' . Off r to act on my behalf, in all matters relative to work authorized by this building permit application for. -13rea-LuxJZy- 5boi-es -1)r .(Address of Job) c AAGS MA- 7h J //0 Signature of Owner Date lilt, Cr Print Name If Property Owner is applying for.permit please_complete-the Homeowners License Exemption Form on the reverse side. !1•Ff1RMC•f1WNF.RPF.RMT.CC1(�N .�Cl�" RO® CERTIFICATE OF LIABILITY INSURANCE OP ID DS- DATE(MM/DD/YYYY) `f SPRIN-1 01/05 10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Bryden & Sullivan Ins Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 88 Falmouth Road ALTER THECOVERAGE AFFORDED BY THE POLICIES Hyannis MA 02601 BELOW. Phone: 508-775-6060 Fax:508-790-1414 �INSURERS AFFORDING COVERAGE NAIC# INSURED - INSURER A: Associated Industries of MA I INSURER B: Spprinkle Home Improvement Inc. wsuRERc. _ 1J9 Barnstable Rd t INSURER D_ _ Hyannis MA 02601 — - - ---------- INSURER E: i COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. bK ALMA LTR INSRE TYPE OF INSURANCE POLICY NUMBERO�vE TP�CYE%Ei1�ATT6 DATE MM/OD/YYYY (DATE MMfDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ _ COMMERCIAL GENERAL LIABILITY uAmAitI PREMISES(Ea occurence) $ CLAIMS MADE [_1 OCCUR - i MED EXP(Any one person) $ _ I PERSONAL&ADV INJURY $ i GENERAL AGGREGATE S� _ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO- - -- JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO i (Ea acc tlenq ALL OWNED AUTOS I BODILY INJURY $ SCHEDULED AUTOS (Per person) HIREDAUTOS i BODILY INJURY I$ NON-OWNED AUTOS, I(Per accident) I ( PROPERTY DAMAGE $I P ( er accident) I GARAGE LIABIUTY I AUTO ONLY-EA ACCIDENT $ ANY AUTO I OTHER THAN EA ACC S AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ I S - DEDUCTIBLE $ RETENTION $ I$ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY I TORY LIMITS ER A ANY PROPRIETORIPARTNER/EXECUTIVrrYIi AWd7004943012010 01/01/10 01/01/11 E.L.EACH ACCIDENT $500000 OFFICERIMEMBER EXCLUDED? L—I - (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500000 Des,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500600 OTHER I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION SPRNKHO DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Sprinkle Home Improvement, Inc IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Fax #508-775-1350 REPRESENTATIVES. Margo Mack AUTHO199 Barnstable Rd. Kell RED A. SullivE Hyannis MA 02601 Kelley A.Sullivan ACORD 26(2009101) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD OfficeTt`�ojume'r�1 airs 2iness egu ltll nse or registration valid:for individul use only Lice HOME IMPROV•EM1=NT CONTRACTOR before the expiration date. If found return to: Registration: U3757 Type Office of Consumer Affairs and Business Regulation Expiration: 12 Private Corporate,! 10.Park Plaza-Suite 5170 -- Boston,MA 02116 VSKLHO E` MNC. Brad SpnKkle — i99'Barn9tatlRd Hyan'isIs, �,�% Un 6ceitgq Not valid Without sign,'tur,.e Massachusetts= Department of Public..$afetN ! Restricted to: 00 Board of Buildint; Re.gulatioits.and Stiindards Construction Supervisor License 00- Unrestricted IG-1 2 Family Homes i License: CS 6643 Restricted to: 00 BRAD.K SPRINKLE; Failure to.possess a current edition of the .190 LOT14ROPS LANK-``' I Massachusetts State Building Code W BARNSTABLE, MA 02668 is cause for revocation of this license. ! Refer to, WWW.Mass.Gov/DPS Expiration: 10/8/2011 ('unimisiune, Tr#: 5478 Property Location: 67 BREAKWATER SHORE DR MAP ID: 306/225/ Vision ID.- 24474 Other ID: Bldg#: 1 Card 1 of I Print Date:0911411999 VEW UJ1L1J;1b_3; -A I UINEILL,IWAUKELIN b 01 Description Code Appraised Value Assessed value SULLIVAN R G&MARINO,P A RESLAND _IU5U__----5(FM 5010C 3 RINDGE RD -RESIDNTL 1050 45,60C 45,,60C 801 BEVERLY,MA 01915 E DATA-Barnstable,A I 3. N, Ccoun an H ax Dist. 400 Land Ct# Per.Prop. #SR Life Estate #DLI LOT 20A Notes: VISION #DL2 GIS ID: Total 17U UL jql��,'SALPtPA, INJULU,IVILAUKEEN b& U I I A Yr. (-,Oae Asses-sed-Value Yr. Code Assessed Value Yr. Code Assessed Value ULLIVAN,HELEN R 4641/168 07/15/198! U I H -rm I(j5U ."b 1050 50,10( ULLIVAN,HELEN R M-792 6143/297 Q 0 1999 1050 45,60( 199E 1050 45,60( ULLIVAN,ROBERT T 1551/245 0 4 oa. 9 5,7 0 -1_0751 95,7U( 75-FaT- 112,4ut gr This signature acknowledges a visit by Data Coftector o—F-As—sessor 1E IT, Year typelVescription Amount Code Description Number Amount Comm.Int. IVARY /V1 R' Appraised Bldg.Value(Card) 45,600 Appraised XF(B)Value(Bldg) 0 —To-VaE, Appraised OB(L)Value(Bldg) 0 Appraised Land Value(Bldg) 50,100 ! i Special Land Value "ALL lu " Total Appraised Card Value 95,70( Total Appraised Parcel Value 95,70( Valuation Method: Cost/Market Valuatior Net Total Appraised Parcel Value 95,70 WIN IMA UA -, �FUJL A 4� g,43o, Permit ID Issue Date lype Description -Amount Insp.Date No Comp Date Comp. Comments Date ID Cd. PurposelResult w- I I UINII A IN 777T H# Use Code Description one D Erontage Depth Units unit Price 1.Tactor S.I. C.Pactor Nbhd. Adj. Notes-AdjlSpecial Pricing Adj. Unit Price an Value _RB­-4- 0.1-)At- J47,UUUM LOU 5 LOU 7UAC____ff.F_SFCL(.l7,U[0)N __Z9T195M 50, oa and Untj 0.1 AT otal an Vau Property Location: 67 BREAKWATER SHORE DR MAP ID: 306/225/// Vision ID:24474 Other ID: Bldg#: 1 Card 1 of 1 Print Date:09/14/1999 i. . ' Element Description ommercia ata Elementss Style/'Iype )3 Colon a ement Ca. Ch. Description odel 1 Residential Heat ade C C Frame Type Baths/Plumbing tories 2 Stories UBM ccupancy 0Ceiling/Wall ooms/Prtns FUS xterior Wall 1 14 Wood Shingle /o Common Wall 2 Wall Height 11 Roof Structure 3 able/Hip Roof Cover 3 sph/F GIs/Cmp a' Interior Wall 1 8 Typical �S'A 2 Element Code Description h7ctor Interior Floor 1 0 Typical Complex 4 2 2 Floor Adj Unit Location Heating Fuel 3 Gas Heating Type 9 Typical Number of Units C Type 1 None Number of Levels 12 1213 /o Ownership Bedrooms 05 5 Bedrooms Bathrooms 3 Bathrooms V* 1-6a � �• 0 Full unadj.Base Kate 5.UU 8 otal Rooms 7 Rooms Size Adj.Factor 1.06755 32 ath Typerade(Q)Index 1.07 32 YP Adj.Base Rate 54.83 1 Kitchen Style Bldg.Value New 94,966 Year Built 1960 ff.Year Built 1970 rml Physcl Dep 7 uncnl Obslnc con Obslnc 25 pecl.Cond.Code o e Description ercen 1050 ree am ta a Overall%Cond. 48 eprec.Bldg Value 45,600 � • , Code Description RE Units Unit Price Yr. Dp Rt YoUnd Apr. Value Code Description LivingArea ross rea E U.Area unit cost Undeprec. a ue First Floor , FUS Upper Story,Finished 801 80 80 54.83 43,86 UBM Basement,Unfinished 76 154 10.99 8,44 WDK Wood Deck 9 1 5.71 54 M. ross LivlLease Area g a: , !=ice?. IliNA - Gk2 ' e - r [ ] [R306 225 . ] LOC] 0067 BREAKWATER qSORES CTY] 07 TDS] 400 H KEY] 216322 ----MAILING ADDRESS------- PCA11051 PCS100 YR100 PARENT] 0 ONEILL, MAUREEN S & I MAP] AREA170AC JV1394834 MTG10000 SULLIVAN R G & MARINO, P A SP1] SP21 SP31 3 RINDGE RD UT11 UT21 . 17 SQ FT] 1568 BEVERLY MA 01915 AYB] 1960 EYB] 1970 OBS] CONST] 0000 LAND 38300 IMP 74100 OTHER ----LEGAL DESCRIPTION---- TRUE MKT 112400 REA CLASSIFIED #LAND 1 38, 300 ASD LND 38300 ASD IMP 74100 ASD OTH #BLDG (S) -CARD-1 1 74, 100 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE #PL 67 BREAKWATER SHORE DR TAX EXEMPT #DL LOT 20A RESIDENT'L 112400 112400 112400 #RR 0172 0067 0075 OPEN SPACE COMMERCIAL INDUSTRIAL EXEMPTIONS SALE] 05/87 PRICE] 1 ORB] P0418E1 AFD] I 87 A LAST ACTIVITY] 08/12/93 PCR] Y R306 225 . P R A I S A L D A T A• KEY 216322 ONEILL,� MAUREEN S & LAND BLD/FEATURES BUILDINGS NUMBER ZN/FL=RB 38 , 300 74 , 100 1 A-COST 112, 400 B-MKT 107, 300 BY 00/ BY /00 C-INCOME PCA=1051 PCS=00 SIZE= 1568 JUST-VAL 112, 400 LEV=400 CONST-C 0 ----COMPARISON TO CONTROL AREA 70AC -- TREND EXCEEDS STANDARD NEIGHBORHOOD 70AC HYANNIS PARCEL CONTROL AREA TREND STANDARD 101 10 LAND-TYPE 383001 LAND-MEAN +0% 1124001 130961 IMPROVED-MEAN -430 200 ] FRONT-FT ] 100 DEPTH/ACRES TABLE 02 1001 LOCATION-ADJ APPLY-VAL-STAT 1 LNR] LAND LFT/IMP] ADDS/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 [?] R306 225 . • P E R M I T [PMT] ACTIOR] CARD [000] KEY 216322 000000001 PERMIT-NO MO YR TYPE VALUE CK-BY MO YR oCMP NEW/DEMO COMMENT FOUNDATION ' BSMT. & ATTIC PLUMBING PRICING, �i LAND COST Cbnc.WaIU Fin.Bsmt.Area Bath Room ) Base o{ BLDG.COST Conc:Blk.walls`' Bsmt.Rec.Room St.Shower Bath CE- Bsmt. PURCH. DATE Conc Slab' :`'' Bsmt.Garage St. Shower Ext. Walls PURCH.PRICE. 'Brick Walls;.. Attic FI.&Stain Toilet Room Roof RENT ,q Stone Walls Fin.Attic Two Fixt.Beth Floors °'Plam "( INTERIOR FINISH Lavatory Extra .rBsmt., ` 1 2 31 Sink ' •"Ar/s Plaster Water Clo. Extra / Attie . EXTERIOR WALLS Knotty Pine Water Only Double Siding Plywood No Plumbing . Bsmt.Fin. , Single Siding Plasterboard Int. Fin. Shingles TILING _Conc.Blk. G F P Bath Fl. Heat / Faes•Brk.On Int.Layout _ Bath .&Wains. Auto Ht.Unit 7 ® 2y r? Veneer Int.Cond. Bath FI. &Walls Fireplace . Com. Brk.On HEATING Toilet Rm.Ft. plumbing Solid Com.Brk. Hot Air ,0A' Toilet Rm.FI.&Wains. 0 Tiling /DP H Steam Toilet Rm.FI.&Walls . . Blanket Ins. Hot Water St. Shower .Roof Ins. Air Cond. Tub Area Total Floor Furn. ROOFING COMPUTATIONS a Asph. Shingle Pipeless Furn. 71S.F. •Wood Shingle No Heat ��! S.F. Q Asbs.Shingle Oil Burner S.F. Q Slate Coal Stoker S.F. Tile Gas S F OUTBUILDINGS ROOF TYPE Electric S.F. 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 617 819110 MEASURED Gable Flat Hip Mansard FIREPLACES S.F. Pier Found. Floor Gambrel Fireplace Stack Wall Found. 0.H.Door LISTED FLOORS Fireplace Sgle.Sdg. Roll Roofing ) %L , F Conc. 40, LIGHTING Dble.Sdg. Shingle Roof DATE Earth No Elect. — Shingle Walls Plumbing C f^^ Pine Cement BIk. Electric Hardwood ROOMS ICED Asph.Tile Bsmt. 1st t'f TOTAL Brick Int. Finish Single 2nd 3 f 3rd FACTOR REPLACEMENT OCCUPANCY CONSTRUCTION SIZE AREA CLASS AGE REMOD. COND. REPL. VAL. Phy.Dep• PHYS. VALUE Funct.Dep. ACTUAL VAL. DWLG. `�+ t7 �.+ ._.9707 �� j ck'��. �2✓�� _ . 1 2 3 4 5 . B 7 8 - 9 10 TOTAL RESIDENTIAL PROPERTY MAP NO. LOT NO. FIRE DISTRICT SUMMARY STREET 67 Breakwater Shores Dr. Hyannis73 LAND /D ,-c ,�2_ H BLDGS. , 0306 225 OWNER TOTAL �3-/,3 O c LAND RECORD OF TRANSFER DATE BK PG I.R.S. REMARKS: Lot 20A BLDGS. B TOTAL LAND , Sullivan ' Robert T.- & Helen R. 11 5 71 1551 245 •17 ac BLDGS. o TOTAL O P J J O LAND BLDGS. • — TOTAL LAND BLDGS. TOTAL LAND BLDGS. TOTAL LAND BLDGS. TOTAL LAND •,6 INTERIOR INSPECTED: BLDGS. TOTAL DATE: .� .�„�f/ LAND ACREAVE COMPUTATIONS BLDGS. LAND TYPE # OF ACRES PRICE TOTAL DEPR. VALUE TOTAL HOJWOT 6,Z / o o /D SO O /O SO.. LAND CLEAR D FRONT - BLDGS. REAR TOTAL WOODS&SPROUT FRONT LAND REAR BLDGS. Q! - WASTE FRONT TOTAL REAR LAND BLDGS. - TOTAL LAND / BLDGS. � PC.0 / J "JU [0) LOT COMPUTATIONS LAND FACTORS - TOTAL FRONT DEPTH STREET PRICE DEPTH% FRONT FT.PRICE TOTAL DEPR. COR. INF. VALUE HILLY TOWN SEWER LAND ROUGH TOWN WATER 01 BLDGS. HIGH GRAVEL RD. TOTAL LOW DIRT RD. LAND SWAMPY NO RD. BLDGS.' PROPERTY ADDRESS I ZONING I DISTRICT CODE SP-DISTS.I DATE PRINTED I STATE I PCS I NBHD PAR EL JIDENTIFICATION NUMRFRKEV NO.CLASS 0067 BREAKWATER SHORES 07 RB 400 WHY, 07/09/95 1051 00 70AC 0 LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS T ONEILL, MAUREEN S Br MAP- 216322 LarW By/Dale Size D,menson LOC./YR.SPEC.CLASS ADJ. CON D. YPE RrICE AD PRICE IT ACRES/UNITS VALUE D-iolion CD. FF-De Ix Acres #LAND 1 38,300 CARDS IN ACCOUNT - 10 1BLDG.SiT 1 x .1 =10 347 64999.9 225549.97 .17 38300 #3LDG(S)-CARD-1 1 74,100 01 OF 01 4 BATHS 3.0 U X C= 100 10500.0 10500.00 1.00 10500 8 #DL LOT SHORE DR ARKET 167300 V I 0 41RR 0172 U067 0075 INCOME A JSE D PPRAISED V-.. E D J k 112,400 A U ARCEL- SUMMARY ' T S AND 38300 T ILDGS 74100 M -IMPS E OTAL 112400 N CNST DEED REFERENCE Type DATE RecorEep R I O R YEAR VALUE a T Book Page In MO. Yr.D S.1-P"p' -AND 38300 S P0413E1 87105/87 A 1 3LDGS 74100 4647/163: 107/85 H 1 rOTAL 112400 3 1551/245; 00/00 BUILDING PERMIT N umbel Dele Type Amount LAND LAND-ADJ INC ME SE SP-ELDS FEATURES BLD-ADDS UIV.ITS 38300 10500 Class Con sl. Tol pl Base Rale Atl Rale r Bu'1' AObsv. Units L'nils 1 A e Be Depr. Contl. CND Loc 0.y R.G Fepl Cost New Apl Repl value Slorias Meighl Rooms Rms Batna I Fia. I PNywall Fac. 03C 000 100 JOG 71.20 71.20 60 70 24 74 100. 74 100174 74100 2.0 7 5 3.0 10.0 Description Rate Sqp a Feet Repl.Cost MKT.INDEX: 1.DD IMP.BY/DATE: / SCALE: 1 J 01.0 D ELEMENTS CODE CONSTRUCTION DETAIL BAS 100 71.20 768 54682 GROSS AREA 1568 THREE FAMILY: DWELLING CNST GP:00 UFO 60 42.72 32 1367 *--------- STYLE 07 ARRISON 0.0 .0 FWD 35 8.50 96 816 ! 820 ! LSI6 ADJMT_ 0 __ 0 0.0 B20. 60 42.72 768 32809 ! ^XTER WAVE s _01 OOD FRAM£ .0 11 . ! EA fAC TYPE 02 _____________ 0 AS 0.0 --- ------ -- --- NTER.FINISH DO 0.0 -- _-______ NTER�LAYOUT J1 , 0.0 '---8---* ! NTER_�IUALTY _ __OZ AME AS EXTER. 0,0 FWD 24 BASE 24 LOOR STRUCT 00 0.0 D O LO W ! -----R -COV- ER--- -(T0 ------------------- - _ - c 0�0 u . Base- E T-1 Areas Ax 6 _ 768 12 12 ! UUF TYPE----- �0 ------------------D._0 BUILDING DIMENSIONS 13 L E C T R I C A L U0 0.0 T BAS W32 UFO SO1 E32 N01 W32 .. ! ! OuNDATIOri - -00 --------"--------99.9 A BAS N13 FWD W08 S12 E08 N12 .. ! ------- -------------------------- I SAS N11 E32 S24 .. B20 N24 W32 *---8---* ! NEI'oIfBORH660 TUIGC HYAN--- L S24 E32 .. *---------------32-------------- NIS x LAND TOTAL MARKET *-------------UFO--------------* PARCEL 38300 112400 AREA 8730 VARIANCE +0 +1187 STANDARD 20 TOWN OF SARNSTA 3LE REPORTS MENTARY/CONTINUATIO REPORT NAME (LAST, FIRST, MIDDLE) DIVISION IDS" NOTE DETAILS i OBSERVATIONS-ITEMIZE EVIDENCE. SERIAL Is ETC- C)--(O CAS V, � .., t CA-AD Gam- �, 4 mow• � �:. tovi- 0�� Ll 0 G V-�s AYU6 ykem& Yt-&T6Vl 0 UC-/2 Iq 7 PAGE 8 I atinuTTTTTI RY {I f ai SENDER: I also wish to receive the :o ■Complete items 1 and/or 2 for additional services. y ■Complete items 3,4a,and 4b. following services(for an d ■Print your name and address on the reverse of this form so that we can return this extra fee): card to you. d ■Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address permit. y ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery N c ■The Return Receipt will show to whom the article was delivered and the date .. delivered. Consult postmaster for fee. Z 0 v 3.Article Addressed to: 4a.Article Number d E 4b.Service Type u ElRegistered �'Ce�rtified Im Cn ❑ Express Mail ❑ Insured Z ¢ ❑ Return Receipt for Merchandise' ❑ COD aO 9 7.Date of Delivery Z / p 5.Received By:(Print Name) 8.Addressee's Address Only if requested W and fee is paid) r g 6.Signature: (Addressee or Agent) y PS Form 3811, December 1994 Domestic Return Receipt 1; � IGG TED 5�� S POSTAL First-Class Mail Postage&Fees Paid USPS Permit No.G-10 • Print your name, address, and ZIP Code in this box• Town of Barnstable Building Division 367.Main St. Hyannis, MA 02601 I P 339 592 294 Ostal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail 69ee reverse Se to Strget N er ice,State,&Z Code Postage $ Certified Fee Special Delivery Fee Restricted Delivery Fee Ln Return Receipt Showing to Whom&Date Delivered n Return Receipt Showing to Whom, Q Date,&Addressee's Address WTOTAL Postage&Fees $ M Postmark or Date E `o LL a Stick postage stamps to article to cover First-Class postage,certified mail fee,and charges for any selected optional services(See front). 1.If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service window or hand it to your rural carrier(no extra charge). m 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the m return address of the article,date,detach,and retain the receipt,and mail the article. 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card,Form 3811,and attach it to the front of the article by means of the r � gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article a RETURN RECEIPT REQUESTED adjacent to the number. Q 4. If you want delivery restricted to the addressee, or to an authorized agent of the C addressee,endorse RESTRICTED DELIVERY on the front of the article. Go 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 38� to 6. Save this receipt and present it if you make an inquiry." Cl) t "Town of B rn: . a st ale BaRrraTnBi.E. • `6 ��' Department of Health Safety and Environmental Services '0ri�nr�o't° Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner May 1, 1997 Maureen O'Neill 3 Rindge Road Beverly,MA 01915 RE: M-306/P-225 Dear Property Owner: Our records indicate that your house at 67 Breakwater Shores,is currently being used as a multi family home contrary to Barnstable Zoning Ordinances. You must contact this office as soon as possible to either: 1) apply for a building permit to restore the property to at-single family home 2) apply to the Zoning Board of Appeals for a variance 3) prove that this is a legal multi-family You must contact this office immediately to tell us what direction you wish to take. Sincerely, loria M.Urenas Zoning Enforcement Officer GMU:lb CERTIFIED MAIL-P 339 592 294 J P9703IIa