Loading...
HomeMy WebLinkAbout0020 DACEY DRIVE Ko �P�. �9�.: ._ _- - � TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION . Map V2__ Parcel Application # Health Division UILDING t)5- i Date Issued Conservation,Division 20 Application Fee 'F Planning Dept. ,U Permit Fee I EA�1NcTR$L.t Date Definitive Plan Approved by Planning Boar dT®VlN QF Historic - OKH _Preservation/ Hyannis E+r►4zL S Project Street Address I-1po,s, M A Village Ay% Owner -Address -2-0 Q-Ice 0_ Or �72amili " 0:-! o Telephone 7/ 7 -c'YO -- Permit Request Ar-Szal C/10 K-Ii .3 6 60) 9_/et 1:68 4 kh6 ks F&8 A, 00 cdvl�� b arc. r'U �) T G,,,sx.--,ffty&4 f,, bald. ��a:��Z). DrsQ� s �lb� &��f,`E �r�s YXf� r`/��i Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project ValuatiJ 3 •T.SConstruction Type J ( Yp Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size Shed: ❑ existing ❑ new size Other: 9 9 9 9 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 R zn �an rn Telephone Number SZ)3— J?a 40 206 Address License # j D3 8'6 4 Fz1l 12 v I1A 4L7 i,-b Home Improvement Contractor# /80 7V7 Email k1seyc.- <ey- Worker's Compensation # X W S 5-4,Y 1 7 yt ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE �" ( DATE ldld I? FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER t DATE OF INSPECTION: .FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. Town of Barnstable • 7■1 1■ ' 'k'� :�'�"r 2 ^r ,::'' ii i n g : : ,. .,. t:;, s , .,. -, ,. Po t;T �Ga d<So That tt isV�s� I Fr mthe tree �-A roved:Plans.M st be.Reta�,ed onYJob.,and#his CardMust be Ke t ,„ 2 ;.... "S s a: M 6 NI x- '', ,� �, Pp p ' _� a� z r a I'usted U.ntrl Fina Ins ectlon Ffas Been..,Made. - F asa .... <a — Q�+m Where a.Certifica .of Occu, alnc: Is'Re ,u�reds' =h cnld�n shall Not be 0ecu ied£unt�IaF�nal Ins ect%n.L�as,beenumade wl iiil :-.. .�; Y� �Q.,� �. � -,� � 3.�. .:5 �� ...; ... .cal? . Permit-No. B-17-1941 Applicant Name: INSULATE 2 SAVE, INC. Approvals Date Issue.d: 07/05/2017 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 01/05/2018 Foundation: Location: 20 DACEY DRIVE, HYANNIS Map/Lot 252 051 032 Zoning District: RC-1 Sheathing: < � Owner on Record: DOE, ROBERT&SILVIA A ' s Contractor Name,: INSULATE 2 SAVE, INC. Framing: 1 k Address: 20 DACEY DRIVE Contractor License 180747 2 JA CENTERVILLE, MA 02632 ` ESt�Pro ect Cost: $5,331.55 Chimney: Description: INSULATION WEATHERIZATION Permit Fee: $85.00 Insulation:Nk I Project Review Req: INSULATION WEATHERIZATION ` n FeefPald: $85.00 "Da� 7/5/2017 Ina �7' Plumbing/Gas m V _ Rough Plumbing: • Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authonzed by this permit is commenced within siz rrionths�after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and�the approved construction documents for which this, permit has been granted. . . All construction,alterations and changes of use of any building and structures=shall be in compliance with the local zoning by laws and codes. �. Final Gas: This permit shall be displayed in a location clearly visible from access street 6r road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. Electrical - The Certificate of Occupancy will not be issued until all applicable signatures by he Building and Flre OfPicisls are prould n this permit. Service: Minimum of Five Call Inspections Required for All Construction Work:1. 1.Foundation or Footing Rough: 2.Sheathing Inspection g 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has p p approved the various stages of construction. _......_ _ Final:..:. :. .- .. ; , _ - rth;in MGL-c.142A;Personseontractin with.unregistered contractorsdo:not.have accessto the guaranty fund" (assetfo " fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT f DEBRIS FORM In accordance with the provisions of MGL c,40,s.54,a condition'of aullding permit Number Is that the debris resulting from this work shall be disposed of in,a,properly llcensed solid waste disposal facility as defined by MGL c.111,s.150A: This Debris will be disposed of fn: Republic Services Dum ster: 1080 Airport Rd Fall River, MA 02720 (LOCATION OF 1:ACILITY Signature of Permit Applicant An Date IF DUMP TER IS USEC1 IN EXCESS OP SIX 6 CUBIC YARdS Ak P99MIT'FR0M'THF- FIRE DEPARTMENT IS REL'MUIRED , FOR COMINERGIAL,IN U5TRIAL,INSTFTVT NAI ANb MULTI-FAMILY RESIDENTIAL.OVER;20,UNITS.l3EMO; RENOVATIONS OR ALTeRA-nONS bF THE.EXISTING BUILDING;' m CIRCLI C1NE "H VE YO .5t)B I ED THE 06 N!jtlFlC&TION TO THEMASIACHL15M, 5 D O YES NO The Commonwealth of Massachusetts" f o Department Industrial Accident P s a 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.govIdia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED ED WiTH THE'PERM iTTiNG AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): lnsulate2Save Inc.__ Address: 410 Grove Street City/State/Zip: Fall River MA 02720 Phone M 508-567-6706 Are,you an employer?Check the appropriate box: Type of project(required): _ ).[D I am a employer with 20 employees(full and/or,part-time).* 7. R New construction 2.R I am a sole proprietor or partnership and have no employces working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.]. 9. ❑Demolition 3.E 1 am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 Q Building addition 4.O I am a homeowner and will be hiring contractors to conduct all work'on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 1 I.[]Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insunnce.t 13. Roof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[EQther Insulation 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: p Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such: tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they.must provide their workers'comp.policy number. I am an employer that is providing workers compensation insurance for my employees. Below is the policy and job site. information. Insurance Company Name: Liberty Mutual Insurance Policy.#or Self-ins.Lic.#: XWS 56418741 Expiration Date: 12/10/2017 w Job Site Address: bf City/State/Zip: T ,, PEA 0�)_&191 Attach a copy of the workers' compensation policy declaration page(showing the:policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation'punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA far.insurance coverage verification. I do hereby certify under the s att e ties ref perjury that the information provided above is true and correct, Signature: �'" Date: w tCf Phone#: 508-567-6706 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#: e Office of Consumer Affairs and Business Regulation 10 Park Plaza -`Suite 5170 Boston, Ma spa husetts 0211.6 Home Improvemqft" tractor Registration Type: Corporation INSULATE 2 SAVE , INC.. Registration; 166747 410 Grove St Expiration: t2f2s%20j8 y Fallriver, MA 02720 , SCA I 0 2OM-owr, Update-Address and return card. Mark reason'for,change: .�...Addtass Ca Ren� ewal O Employment O Lost Card �m�int�rayuueea�liG c�C?/��cr:�scrc�irtrtal� Office of Consumer Affairs 8 Business Regulation HOME IMPROVEMENT CONTRACT-OR valid for Individual use oNy 4 TYRE:C on before the expiration date. If fognd'retrrrn to: Office of Consumer Affairs and Business Regulation �� 80 1 i��018 10 Park Plaza Suits Silo INSULATE 2 SO IN£ ( Boston,MA 02116 Ro►and LangevlR r Falriver410 o,MAt027�2p� r Undersecretary Not valld wlthout'signahlre s Massachusotfs I�,epartmenkof Public Safety Board of Building Regulations and Standards License: CS-103861 f' Construction Supervisor ROLAND LANGEVIi4 SS HIGRCRES'r POl FALL RIVER IAA 027 d Z;:K CA_ Expirition: Gori�n�issioner tl812d120Y�' 4 '��L> CERTIFICATE OF LIABILITY INSURANCE DATE(MM/1D2YYW)16 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Anthony F. Cordeiro Insurance NAME:PHONE FAx 171 Pleasant Street EdYIAIL 508 677-0407 A/ No: (508) 677-0409 ADDRESS: hsouza@cordeiroinsurance.com Fall River, MA 02721 INSURE S AFFORDING COVERAGE NAIC# INSURER A:Liberty Mutual Insurance INSURED INSURER B: Insulate 2 Save, Inc. INSURERC: 410 Grove St. INSURER D: Fall River, MA 02720 INSURERE: 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 ADDL SUBR POLICY EFF POUCY EXP LTR TYPE OF INSURANCE IMM Wvp POLICY NUMBER MM/DD/Y MM/DD/YYYY LIMITS A GENERAL LIABILITY Y Y BKS 56418741 12/10/16 12/10/17 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES DAMAGE (Eaocc rr ce $ 300 000 CLAIMS-MADE OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER PRODUCTS-COMP/OPAGG $ 2,000,000 X POLICY PRO LOC $ A AUTOMOBILE y Y $AA 56418741 12/10/16 12/10/17 EONBIcfED dentSINGLELIMIT $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALLOWNED X AUTOS SCHEDULED AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE X HIREDAUTOS X AUTOS Per accident $ $ A X UMBRELLA LIAB X OCCUR Y Y USO 56418741 12/10/16 12/10/17 EACH OCCURRENCE $ 2,000,000 EXCESSLIAB CLAIMS-MADE AGGREGATE $ 10,000 DED RETENTION$ $ A WORKERS COMPENSATION XWS 56418741 12/10/16 12/10/17 X WCSTATU- OTH- AND EMPLOYERS'LIABILITY Y/NPp ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DYSCRIPTIONOFOPERATIONSbelow E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) "For Insurance Purposes Only" CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: .� Gz r RISE Engineering b b RISE , ;�` 2017 7 Dupont eve.South Yarmouth.�11:1 't t ��l i ENGINEERING- (401)784 3700 Pal\(4Ql)7$4-371,0 P ge 1 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE CI..C-H°ES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER PHONE DATE CLIENT WORK ORDER SILVIA A DOE (717)940-4223 03/31/201.7 232353 26202 SERVICE STREET BILLING STREET 20 Dacey Drive 20 Dacey Drive SERVICE CITY,STATE,ZIP BILLING CITY,STATE.ZIP Hyannis, MA 02601 Centerville, MA 02632 .JOB DESCRIPTION AIR SEALING:Provide labor and materials to seal areas of your home against wasteful,excess air leakage. This work will be performed S t.280.00 in concert with the use of special tools and diagnostic tests to assure that your]ionic will be left with it healthful level of air exchange and indoor air quality.Materials to be used to seal your home can include caulks,foams,weatherstripping and other products. Primary areas for sealing include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed.) (I6)working hours. A reduction in cubic feet per minute(efin)of air infiltration will occur,but the actual number of cfm is, not guaranteed. ATTIC FLAT:Provide labor and materials to install a 6.25"layer of R-19 unfaced Fiberglass hafts to(60)square feet of attic space. $102.00 ATTIC FLAT:Provide labor and materials to install a 6.25"layer-of R-19 unfaced fiberglass hatts to(90)square feet of attic space. $153.00 DAMMING:Provide labor and materials to install a 12"layer of R-38 unfaced fiberglass batts to(1,00)square feet for damming $246,00 purposes. ArrIC FLAT:Provide labor and materials to install in 8'layer of R-30 Class 1 Cellulose added to(1042)square feet of open attic $1,500.48 space. A°I-I'1C ACCESS:Provide labor and materials to install(11 easily moved,insulating cover for the attic access folding stair. The cover M0.19 has integral weather-stripping to restrict air leakage. VENTILATION:Provide labor and materials to install(2)insulated exhaust hose:with soffit mounted flapper vent to exhoust'existing $237. 0 bathroom fim(s). VI N`rLLA,r]ON:Provide labor and materials to install ventilation chutes in(96)rafter bays to maintain air flow. $335.04. VI'cNTIL.A'fION:Provide labor and materials to install(14)4"X 16"rectangular aluminum soffit vents.to.increase ventilation in attic $40434 areas.Specify color:White or Gray. COMMON WALLS:Provide labor and materials to install 2"rigid board with the require(]fire rating to(176)square feet of cotm»on $677,60 wall area. RISE Engineering %\ LSE 5 Dupont Ave,South Yarmouth,M1'IA CONTRACT O NT CT ENGINEERING" (401)784-3700 FAX(401)784-3710 Page 2 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE. CLC-TIES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW .. .__.—___..._—____...__..._._....__._.__-__.....__.......,.__.__ _....:.........__....,..._... ._......,_......_._._._,_._._.__. ..a,..._..._.__................_..__.....- _...._ ......... ___.. . .....__ ___._...�.�.... ._.....-..._�_ .-._.-_.........__._.._._.._ CUSTOMER PHONE DATE CLIENT WORK ORDER SI.LVIA A DUE (71.1)940-4223 03/31/201.7 232353 26202 SERVICE STREET BILLING STREET 20 Dacey Drive 20 Dacey Drive SERVICE CITY,STATE,ZIP BILLING.CITY,STATE,ZIP Hyannis, MA 02601 Centerville, MA 02632 „_.,... JOB DESCRIPTION INCENTIVE:RISE Engineering will apply all applicable,eligible incentives to this contract. You Will be billed only the Net amount. $1-65.00 Currently,for eligible measures,the Cape Light Compact otl'drs 75°/n incentive not to exceed$4,000 per calendar year,and an incentive of 100%for the Air Sealing measures- For the safety and health of your home's indoor air quality,we might be conducting a blower door diagnostic of available air flow in your home both before the work is begun,and afler the Weadierizatiun work is complete(not to be conducted if asbestos is present).We will also conduct a diagnostic assessment of the co nbustion fumes in the exhaust Ilue of your heating system tend water heater.This has a value of$90 and is at no Cost to you. 41 °rhe Pemlit will be Secured by the insulation contractor.'rhis has a value of$75 and isat no cost to you.It is the homeowner's responsibility to close out this permit by contacting their municipality at tile completion of this work. Total: $5,331.55 Program Incentive: $4,359.91 Customer Total: $911.64 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Nine Hundred Seventy-One&64/100 Dollars $971.64 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING,CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL.INTEREST OF 1%MLL BE CHARGED MONTHLY ON ANY. UNPAID BALANCE AFTER 30 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS.OF'RECISION;SCHEDULING,AND CONTRACTORREGISTRATION. AUTH)IZED SIGNATURE-RISE Engine Ong CUSTOMER A EPTANCE NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE ..._ .._i ..�,._.+�'�...7.... ..._...... .__.. „.- „_,.____._,... ACCEPTANCE.OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE 30 DAYS SATISFACTORY TO US AND ARE HEREBY ACCEPTED,YOU ARE AUTHORIZED TO DO THE WORK AS SPECIFIED,PAYMENT WILL BE MADE AS OUTLINED ABOVE, t . T own of Barnstable Regulatory Services � �0i1 ' rurtsrarr JU�1 t �, ma Richard V.Sc:+lr,Director o �° Building Division TOM Perry,Building ng Curnhii.Ssiobe:Y 200'Ma.ru Street;Tlyarrmis_ A 02601 }41viv.ttDlvfl:b arnstable.ma.u s Ofli= 508-862-4038 :fax: 508- 90-f230 Property Ozer Must omplete and Sign This Seetian Silvia Doe /�_ { aS\Jtv1tL'r o die s-abject:propt ,ruyr h c by au-diol %e C Z 41 o to acts on my behalf: in all,rnattcrs rdative tip workautlaoa 7+ecl by this builr.g lemur appkat onfor: 20 Dacey Dr. Hyannis, MA 02601 ` Pool fences and al`u .s ue the responsibility of the applicant. Pools are n.ot:to b fill(Jd ear utitiucei l)tf yr6 fc nce is i osLA,.ect uid aU fin-.1 inspections Iare pe:rl'i;>z-rraed and accepted. iF.nature of Ow-ner SV'awre of Appkain X Au "C", Ptim Name P1mL Name x A� Date FQttY�lStCih-�:F:I2.Yr.y;�iSSIt;�At:Nc3t>ts ---- n A uNrz�.is /o L/wt Ir' DI LC, See g" J' �p0a17ArIo14 /At .4� -33A 5, *ft m a q�e SPAM Sub• SD/Io liD l"4. r7 32 cE.2TiF4E� PZ _ C �cAII/ CCV7-I -R V/[lam I ,cocQTioy �/yA S'f/OWA/h�E.2E0.C/C0,4-1,4�4 YS W/ThV S,=7 AHA ors' T/-/E 7"aWiV G?F L17-S TH/S .o.C..4e�//S.t/oT BASSO >IV.4it/ i2EG/STE.2 1 �� SU.2Y6Y�� 0.�.�v�'E?S Sh�aLdy sf,(Dt�t� AAV7 g� A�P� /C.4/�7' �,a y� O!J/LD/(/(, �o �i✓G 7� CIA hW,H •:,t"� ,�t. � ,C;,•.".P. r:- nnnr-rr: to% !O lO 1HE INCF1- - of IN fI =Y 11 CtSA21 uE p,on 0_FME J — KE(E r r fF Ed k:lS COif I i } :�.loL Ud ACC G 1�1� - - _... _ -_ �_ _.. � �_� I I I 1131;� I I I_I � I • _ I i .,.:. ,, _ - q�.�� SD 'a•- QS;Cam- _ - - �'IT r �-.� _ hI —� CPoSd1. PtT --la�o v�'Z s N �= } f 1 1 _I a 111�"j•,1 : f 6 J_r 1 � �I--�. � r, '(.. .1=1, ul=.;.�. I I,/w`�}.'� �-. ._� L., �Jr i'_ -I i _.,.� � I i I�/OlT - -- T7dM.-, � �'✓—J�:r—}-...._J _t.�l_.'._.._LL_ I__ �._ G_ i i I , , Il 5491' -r OrA�L 13 ,:DA�c. ��l-0N/, �330 6'D Cl a 'oc, "! . I , e?h �� I,'=� �.° ; i- /I a� ! I tI1I i i l la 1_ Qj y 'P f.AT1 oN I eArc I S _ _ I I I I I � �- � ' � ��•TTT f RCHAa® ` I $, I SUtt IE/A 8!�!(TEiC �+ — r r '_ I �fdor237331 I i SQ * I ' __I._I-1� r�I r�G/� ' O �' � I-._I ._�...!__ 1....!_I � � L t I �TI I � ' } �� `.� ' I...' `•_� i II „07 LTA+ c6l�� I , : I ' II : t rt �- Ar6 ._r E.- ;_- '^t'1_�---__-- - _''-"��77""� _..L`4_I. _' -- - _� I •1—r I I�CC%•l7� ,'. I I i I t 1, }' � ! 1 1 I � -" ' i t 5�a5o'Icr+- -�'- � I I ' E�-.._i_" �� , __� ��-_; -; � "5��I. � i � !o�oc., I-� P '- �N✓ ; r , , , ' I T u_�_ ( 3 � ��1 i I a i--; I I I D1 �N✓--; I �� iN✓ i Gd�' I { � ' ' f Boj? I G N , ec> t 4r,i' ' � �— � �1 �� •_' i I I- _I—._.— ._ ,__;_. ( I I , j �,n ! � i f-.� ! I.. I— � > Sa� Pr�._ LE i , iIi i I II , ., - -7, � �__ � . -,`�/M�ED- ►�It. TuRE3 — � ____— _ —�gT0�1�� �—�— � ��... �F Tt•!AW—�4. v- ; ;.'j_ —J', I 1 � I ,_._, I _L - lz (:_ _i r 1(0 i I 1=}_I 1 _� I C { 5G11':/�� �o/lo :i P i.M�QP 25'L� i 253 �9, i 5 SA,Z -r i i I 8.'. I �I I Its i�=i I i W+'1 I'�-I I I 1 • I I � � I �I I �-I I I- I I '. :, I�� r ' �' • rib I. olCEJJT�iZVIc,Lb -ryAuuls -- �. 1 �t f r �_' _` ` _. _ -�-yII}- SG�1'L�'r' 1�ATE;tImiM - - �r. � I , ..1I4 O�Y35� f I I I I I ' I, 1-�= y.a� - ^� '-+ , ,--r�__.1 ; . , _ i ,.-1 r , I ,:_PLAN a / vw sc.ia u __L_._ F�JC;E 5Ap r i IN I NE2vN-i cry' p� Ll' Tf^,�'G' T� t� I _,, 1.. . ' I �I 71-w�!'T ' 1.1.►t ! I I I .k r r hMEUiJE �ra$c ' I :pc� •B�, sos Pc, -� I i Arz.N wii!(T�17ri1 , ZoOvf_ LAlJr� 6ou J ; 1,- �- { {-r 715� iNG' r ' .3a D}:1 N' �Au� SueVEyotGs T { 7 `t nu;_;_,. . I� EEtC. ' —U -_L -l --I _ STLZv.�u.G_.�' �N � APPLtcgW-f S I�AYSI'L>: INC. , > r"#,...aATi'wa` t. 4u�''y,• k�,.;:;,,�5- ..mot 4y.. _ ���-»p l.x-�";.r.�., .. wa.. .:.. o._.. ._,. - __—__ __. —_ ___.. — Town of Barnstable *Permit# r Expires 6 months from issue date Regulatory Services Fee 1AMWABLA • MAC. Richard V.Scali,Interim Director 1639. Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Fax: 508-790-6230 - Office: 508-862-4038 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY e of Valid without Red X-tress Imprint Ma parcel Number 0-5 7 , b � Or", _ 1 J Property Address ---� [A Residential Value of Work$ 7 vU G� Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 2v �' D263 2 ,�. /� �7 Telephone Number SD,� 7/o Z 70? Contractor's Name` ( //�i /l P + Home Improvement Contractor License#(if applicable) IY799f ?. Email: -7- rs A(r-PtM';+C Construction Supervisor's License#(if applicable) 3s []Workmen's Compensation Insurance Xmu OE S 11 E MT Check one: ❑ I am a sole proprietor NOV —6 2014 ❑ lam the Homeowner © I have Worker's,Compensation Insurance,.. TOWN OF BARN STABLE Insurance Company Name C� Workman's Comp.Policy# LI) Z 2 //V 3 7 2-10 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to [�Re-roof(hurricane nailed)(not stripping. Going over t existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. r *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation etc. X . ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Rome Improvement Contractors License&Construction Supervisors License is r ired... SIGNATURE: TAKEUIN_D\Building Changes\EXPRESS PERMIDEXPRESS.doc Revi 061313 7a ' _JaaaaaQlart'�ar�t� Jrscas�atag Qt"ttai" stow,oflud irdal Acci 4ait ��0 ofEratAP,sfir��af ol,A M!�4/rR'��rAAaAg#.PAJ s�A�R�[ fypI-91110 MAI NUM il�lllg,J)►(lS.S�(JIpJ�(tJ(j: Warkeas' Compensada u Lasm-law-v—ffida W Boil_tfei s/ °on t e�toi 'le�t�2S ,�z3 fFlumbers Ap�tl eau�k Infttrmabipn Please Print Legibly Name(Sustue s�! �- praai A a�auiIuri�ysdt� �� , S� Luger 6nwi.,, C tr/Statclzip LhwtAtt ® tisane# Sc)k- 76U e 7dZ Ate you au e, lgyv l? - - mp 1teF k tie appro�tiate bins F Type of p lo]eet(t-eti*et) I 1 cltu a e!u.lr� € ltsilt bad tilted the dab�rtmtrat:#orb UV ft i t El�i @2'4u fow aFlt nl�d I r-�nrt��eer'� �cLfer or�rt�laflze�.* 9 listed Qa the attaebd e rlbeet=�,❑ Ftu 501eglRr QY�} 4 I 7_ � €li1QR1EIIg I chip and haove no employees two I 8, El Item htict I WO991—'aws �+ias+q� E+sy, emnlgt ee b�!! o?1 efsj I ^ o workers'cop 1C1fi1br6itlPF Pomp;iq� gc 1 �= U f3tt�dmg€lddttjoA . tar�t a �requFred 5, ire a€e r�PotporattAo d tta iu:Ll ie thlcaF repair oai-on i - l -+_ FCertt w m C EF ( 1 T"F, lag aP r.a r nr add! m - �.,� 1 aia N4 I1�I11CtItATFFR agtug,33�'.17y'C21'� _- > �.� I I � e"eu.'�.`�_�iw�aFll�13 M�!Fa.,,.+z�F.�"d I mr-d£(-No urorkere'co rt0i Oe-eavi©p per mG__L f-1 iusurattse re ttirgd, € e. 152,§1(4),and we have a� 2 i 3wfkag 9 •� cant,answaliee.te�uuecl,) ( I . 'any ePpliE nt}hgF chid 6F 1®u t R1s9 frl�qw ow ee€uog bow PonjDg mhplt warders`couFpgzrsaFia�poyEy nfpFz�t�pn 9Ftie9FYn4a$vfl5o gQatt 6ti?5 4St).,QAI�Ft ?l69t>a�they e t39 @!t v{ PIId IL1F?q AFF@ g'µty�gE,69AF €t9F4 ww SF 40 s'PPS`agi4avit FR4tE8tm'- eutr got t�F Eta�i�4s ttt$tt_e €a►$�? taan l Sheet s m �a4Le et€p sFib cunFF Fte�1a ao�l stele tyLgthes of am ftu ent?Stgi We etasPloyees, I€th-Q IA-f atlAEtg+F_s hash gui lgyees,they Est pmvi4e —tit 1 of $TS"comp,p91 RB u kF X QMt 414 eJttployer dow/s pr ildl, 1prprkers'ealirpom"W'0001 Imilmtare,for rrR'y elFtp/9,yPes. 13et�ty is r(tPpp ir-y-, 0'_ 'qb�2fe frt�BtP7lfalli�i( - . Tfl81V'hft�P Policy Qxr Set€tuy,Lic; z 2 Y�? ? 2 /6xprFtript�Hate 3/5�/f _. -- -_ - :attach a copy of the wo_r,•kerV rompenscloon polio}$declat mirlon pogo(shomng the policy numb nd eVit'at,on date)q a it�re tt�see a eovP�a ?a�tec Flwe911m4 a tlo d �oF'm iti c; Y i2 eoo feat t9 me intpAsttign 9F ct i p€na.'t,[ies of o, we PP to$i,3Q_O;Q0 ai0lou_r-a tZlreaR,r isei -Mie�ts q twit��iiYl oeii�tiea ui the i°9tm of a 5TOP' O ORM'",d a ft of up to$2-159_00 a day a nt the vi9la tlaa4 a e9py Qf tills stgteuent Fumy 13®fortt�arded tqe(�ffiee 9f r fo iasmrance coverage uea$cat oa; In�esti,�atiAns of the I��# , I A(n(#e+reby eMprify ttatd - _1to pains Mltdpe tMltle�g pet tt, a1/tnr rlt lttfort►tatrott pate �lstl cabal o is(t".te oitd colr�'ta Si tore: r eNn also 4ltE�y'; EJa il9t!write iat ihif ar$4,m be Sample.rsd UV d.0,or Own 100ri l ` City or`fQ"41 # Tssotttg Awbor-ity(Ptt'clg one,);; - I! II y.Board of 7Health 2.Bntldin ;Departuteltt 3.Otyrrawyn lerEZ ,` iePt�rical 3t►speetot ,PtuRnk�ing-Inspector _ r - CERTIFICATE OF LIABILITY INSURANCE. DATE(MM/DD/YYYY) 104/16/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE D6ES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement's). PRODUCEU NY R NAME: PAUL SCHLEGEL SCHLEGEL INSURANCE BROKERS INC PHONE 508-771-8381 FAX 508-771-0663 (A/C,No,Ext)i (A/C,No). 34 MAIN STREET AIL ADDRESS: SCHLEGELINSURANCE@GMAIL.COM WEST YARMOUTH MA 02673 INSURER'S)AFFORDING COVERAGE NAIC# INSURER A:COLONY INSURANCE _ INSURED INSURER B:CNA Timothy Keating Dba Keating Construction INSURER C.: ' 54 Lower Brook Road INSURER D: - INSURER E: ' South Yarmouth, MA 02664 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 DUL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MMIDD/WYY) LIMITS A GENERAL LIABILITY GL3594908 03/20/201403/20/2015 EACHOCCURRENCE $ 1,000,000 rGEN'L MERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ 500,000 CLAIMS-MADE OCCUR MED EXP(Any one person) $ 5,000 - f PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,01 GREGATE LIMIT APPLIES PER: - PRODUCTS-COMP/OP AGG $ 2,000,000ICY PRO LOC $ JECT AUTOMOBILE LIABILITY COMBINED SINGCETTgT- (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ - - NON-OWNED PROPERTY DAMAGE' HIRED AUTOS AUTOS _ (Per accident) $ UMBRELLA LIAR OCCUR I EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ B WORKERS COMPENSATION - 0224N37-2-10 03/09/201403/0g/2015 WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN N - TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? Y❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under - DESCRIPTION OF OPERATIONS below - E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if mare space is required) TIMOTHY KEATING HAS ELECTED TO BE COVERED UNDER HIS CURRENT WORKERS COMPESNATION POLICY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE _ THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN i ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©198 -201 d ACORD CORPORATION. All rights reserved.. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD eaiwsrnaus. a39 p�� Town of Barnstable Regulatory Services Richard V.Scali,Interim Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 1 � A414,4 , as Owner of the subject property hereby authorize ( / N1 �C PS `fr r�c to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. T:\KEVIN_D\Building Changes\EXPRESS PERNDEXPRESS.doc Revised 061313 ,r /,/ n� uadaacfu�4e�d License or registration valid for mdividul use only an�noouu Office of Consumer Affairs&B sines Regulation { before the expiration date. If found,return to: HOME IMPROVEMENT CONTRACTOR - Office of Consumer Affairs and Business Regulation TYPe 190` Registration 143053 10 Parr Pl19' [tAte DBA! :Boston,MA 112116 :- • Expiratio-rt 6114/2016 + - w , XE ING CONST'p & a r "R TIMOTHY KEATIN.. Via' 54 LOWER BROOK RD gas Not valid without signature SO.YARMOUTH,MA 02fi64 Undersecretary �� u Massachusetts -Department of Public Safety I Standards d , - �✓ Board of Building Regulations an Stand _ , ruction Su er�isor Specialty Cc m st p License: CSSL-099351 r Tim B Keating L 54 Lower Brook Road7. q6h. south Yarmouth f4A >r0�� Expiration r d vim , �11 05/11/2016 Commissioner 40 - S TOWN OF`-BAR'c�iSTABLE CERTIFICATE OF OCCUPANCY PARCEL ID 000 000 057 GEOBASE ID ADDRESS 20 DACEY DRIVE PHONE (508)771-1040 HYANNIS, MA ZIP 02601— LOT 33/33A . BLOCK LOT SIZE DBA DEVELOPMENT DISTRI`LT PERMIT 18592 DESCRIPTION ((BLDG. PMT. 015609)} I PERMIT TYPE BCOO TITLE CERTIFICATE OF OCCUPANCY CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: `� BOND $.00 Ox INCONSTRUCTION COSTS $.00 i 753 MISC. NOT CODED ELSEWHERE * HARNSTABLF� ";Y i MASS. OWNER BAYSIDE BUILDING, INC. , i639. A�� ADDRESS FD Mlr►I P.O.BOX 95 BUILDING DIVI IOIY f. CENTERVILLE, MA DATE ISSUED 10/15/1996 EXPIRATION DATE I�Lt .IJ_�1BI3I. Pi'TILD11'r 3 PERMIT A D I R;±T. ;�'�::T Y L�kI I" _`.YANNIS, MA I1_?? WT ^,•ter rr -DEVI,LOP ME.:a1_ 1)3:S T:' 1- { l.;n� 'E J� �,�..ryr•. ,-le„r t �+; �r �,� r�I � 1r�T 1 fyC i s {}llW flv,.''i )'•1 -f. �. :+,EMIT 15601? _ :.JL,j.,.T� �+ .,.I SIN(31,E k:AI_I—r DI TN � 4)13YY . �4d.� .#J.i , r.�r'ram r --) .+.�• �..� , n PERK T '' `f;: f3r I LD ?'I.I..U� NEW PJ� •. �I�°N l I �,L B"Lx: PM`>^ : .3,sY ;::).�, vsl:C f }tt"'I z aC Department of Health, Safet3 and Environmental Services a', 1i� .ria00,,201)- )i1 i( axidt:LE FAM If0t'i}:'�. =:�E'I'.�aC.~H�`:= '_ i?RIVA's}i: P:a '+BARxsrABI.E, rJ,_aR f��?. �I It,:�L__td.,,, �kv ,. , EG A o, 2(.:'n 'j BUILDING DIVISION LE MA 'BY :'.'?`.'e ISSUED 06/04/I99f7i E"IT-1-21A'rION DATE (/ THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR - 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- ELECTRICAL,PLUMBING AND MECH- (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS. 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. 4.FINAL INSPECTION BEFORE OCCUPANCY. • Lim 0-1 ujus . . BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 4001 ,le 9 2 C 2 L 3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 2j1> G, 51 O E L OTHER: SITE PLAN REVIEW APPROVAL WORK SHALL NOT qOCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. c Assessor's Office(1st floor) Mean .Lot Permit# - /'5109 Conservation Office(4th floor) '\��—�-1a a\ �.,\ Date Issued Board of Health Ord floor) Engineering Dept. Ord floor) House# 30 Planning Dept. (1st floor/School Admin.Bldg.): G`n - i „RNSTABM MAW .� Dcfinitive Plan Approved by Planniri Board,'V ' /0 19. &, Pa (Applications processed roce ed 8:30-9:30 a.m.&.1:00-2:00 .•m. l/r� c�_ TOWN OF BARNSTABLE .W � Building.Permit Application Proiect Street Address LO rt Village Fire District CL�. -✓ Owner d Address Telephonc 77 1 —1O yU Permit Request:/% C&ZVUA6t Zoning District �C — 1 Flood Plain C Water Protection Lot Size . 1'5'f 5 Grandfathered ` Zoning Board of A, / is Authorization Recorded Current Use I/a' C44t,(+ Proposed Use Construction Type ""o �� Eaistine Information Dwelling Type: Single Family \J Two family Multi-family Age of structure Basement type Historic House s Finished Old Kins—Highway Unfinished Number of Baths No.of Bedrooms Total Room Count(not includiing baths First Floor 7 Heat Type and Fuel in�� Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached 62 694 Barn None Sheds Other Builder Information Name -ClE'C�' �y�LC_ Telephone number —9 2 1 Address !c� S License# Jr G q S Home Improvement Contractor# Worker's Compensation # U- C l 3 Z Z Z L1 1 7 Y Q (j NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN (AS BUILT) SHOWING EXISTING, AS WELL AS PROPOSED STRUCTURES ON THE LOT. Q® ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN T016Ur°`U`'"//��� /(VO 0031 Project Cost 90. .�v �j Fee _ w 2 71 SIGNATURE 1 DATE__ S ,�/�Ji� BUILDING PERNET DENIED FOR THE FOLLOWING REASON(S) i /� 1Q X 7 i ' BPERM T FOR OFFICE USE ONLY s ADDRESS VILLAGE _ OWNER DATE OF INSPECTION: i l FOUNDATION:.4 , ' FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL f a r 1 GAS: ROUGH FINALor FINAL BUH DING: DATE CLOSED OUT: ASSOCIATE PLAN NO. t f 1 i ' B21GIC FALSE"CHI/AN E`( ASPHAt_T czooF SHt.NGt•- - tz 1 i I -1 L' ' - - IFT ''IITTS� �, •>.� I LflL 12� -- ..__.._7 ..... L i - _-- I _ _ - - --- -- ---- --_prD (i hl _ I u n 7 CTTI TTZ: .. - �I.SI_1-CLT-TT�- IT _ -- - ............-_. i 1 I I 2OOF S-141WGCE-5 i , � r r rk Yr t FS2�GK. ---- =ASGHGLT"2oOF-.SHINCaLES I r KET % i I�tlj � I 1 � � I , ! I ..� e�111QJLUB 9012_YA<9= _ REA2 E�EvA'c�ohl, r __ i I I 1 I So--occx #rua� VIT h T7'To '"—E> .r I 41 c9• I j I r -::FA/A1�,j 12 13•_8•. •_p•• �� � .._I ..12'CATHEDR1lL,.•.:'- I N � �I I I B0}5-? -oO 4 a> 1 G'• B' � d;.�- \�_•-r. It44Vg --.� IC �\92�- I I y .I g• 5:�•• � r .e I_ � `?.2'� n,IJ I IvC+ I 1 ti�ep - Q VlI.I YC. C I� - /hASTE R _ I es4o5 I - - 1 nt L. ?. I-r �J •� 1 m �• -�6 �./�u�L. C1 1 U1N•(L.' N _ �'ZNTN6p. Iq' ! f /3.0 •6. .OowN I I CLoSEr \\ .c1.1� _ 9•-�' -�.^2..- f •:1t-� .F"r. - tl11Q0+ I C/aTHEp17pC �`. 0` I , 1 \ _ SEE 71AVIL6//.. STCC S � 1 tiALp_=Ll OU 2�-voolz. I " II - _- .. �� Pouter ___ - - IQ ��N, I IY• - _�-.4'Pa1F 9,F. •� 9 -Lp2 pET - I•• g:p' I j - O.- b -I C�EO20o/i\ 2 .- � � ,.,�ii \_.$Eo rl.00ir. � o I •"�' - —. . ._ _ y. �9. •� .�. ..FoYEn-- oat. w 1, GeI L,H G.+ $,T T c 51dE�2rttl. .Y�--c•r•u ra I I O �11••.Q...AS�FJt TR.q� .. 1 S � 9}'+' oat_:moors ... .... ._ 9 r"1•..c,•1-(-joo2 6 1 I I .. ,• i 1 � I 1 7C0Ne.(C".AB7Co1J.. I o d I Y 4'-o' a a'_o g 9,q.•. � � � I I •a' I I � - � I � I � I I I I I l a � I I .2•�:• � - I t0 E)c7M 0 m 1 I J I - - gARS.:@.0."..EAG(1."�VAY� I, I � /' � ro• o � I I"'i -�j _ 1/2_rJEPF-.—_£emu/A:N4 —_ P�EA/A ,POGKE.T CAra E.N rJ _. I I _ � I G4IZ'/aGE::_..=_co7RpAGT_GQAVEC. j I aI Q.� I •. I I I I t S I I I I ` --------- --- - -- -- ------ •-- - - --- -- ---- - � .p Fail.- I I � I �24'-oo•. l 4,-cr i j I I a tj— I SIX I I �j I -�.loz•�,�� I $EAL-T•CT�`O:SpHnIT StlfuGtES _:��2•' �.�>L.91-I-L'•4T11fN4 / -.\ 1 I �c1A:ly \� TIE to 9 B1° \xa tJor T sc.. PITc.I-t 12� -is —z I 12 FLA 1 - I #4 v5 - - R•}Jo�F13 R.EGLns IIJ�UI .• 0,� -j .449/,}x 1 12h t I VENTInI c. Q21 '� Noop Fu y I, II%B FASG,is 1 II UPEN IN pININL .K IT_.I•CN ANrJ ;ALu/Alnlu/� GUT TCrL � LE/�c)ER /2•'so E E r I I I�AnILY •3P;11 a lx8 SoFFtT. F2rCzE \VtTH /Itncr�lu4_ i I I I•: � I �� . o � i I i � I � � .I 2x� s quo s �vs•• o.c.. { I I Fo.lG rt Ii I .`�i '.�!• Fla rZE 61_AS 1N5U1_T'IJ. I� �\l ENTR N 1 LIN, C I �i -�/L••C rj)t SF?G.I�Tl11 rJ I I C 0 p T_�(JE.G. a-AP GArz ' y. fr_n T..c.c��� r•.9•,..' SEE olA�rr..lain, 4 � � A C. M; 2•0'� I Lt I Ncs - fNt6Ht-N1��- .SIDING F OrL -- - r� 11 _C�RrbO4fZQh FIZndJ7 /0 PLY ruiSfLc C• _ r)G - - - _V. 111N S �J'I ., I' Cs l-L S f2 . .. 2et-.l a-a�t(o' I --.� �.•Ft* LE Gins ).. , i\ 7..1.J.j •t. f.. _ 'AS, lnC fLTr7...S.1_a.,L..- j�iiYi I o tJ.. S.I C.t.:-r.I L-1- r-)CA., Gown.I s J1 0. t . . (�fZ1X�F 3 ELp\V GR/DE I •d,. I i 3��2�Co Nc2 S�4rh -> FS AY S 1 r>C• f5 U t L rn I tU Cv C o S lac w9 Re c»rmoNfvealtl c1111lwacluselts DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE Ruben Expires: Restricted To: 00 ice► BRIAR T DACRY 62 FERNBROOK LN CENTERVILLE, MA 02632 ` c COMMO TH OF MASSACHUSETTS li;� «P. DEFARTMFN?OF LNDUSTRIAL ACCID.VM 600 WASHINGTON STREET .: Ganooei BOSTON, MASSACHUSEM 02111 games ::orr:nsstone• WORKERS' COMPENSATION INSURANCE AFFIDAVIT I, 7 `31� (licensa/permirice). with a principal place of business/residence at: (Gry/SuteON do hereby certify, under the pains and penalties of perjury,that. [] 1 am an employer providing the following workers' compensation coverage for my employees working on this job. 2LYax—l /-,2 D 17 D I lnsun Policy Company Number (� I am a sole proprietor and have no one working for me.. ( J 1 am a sole proprietor, nett) contractor r homeowner(circle one)and have hired the contractors Iisted blow who have the following wor compensation insurance policies: Name of Contnaor Insurance Company/Polity Number Name of Contractor Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Number 0 1 am a homeowner performing all the work myself. N07'- Please be aware tsat while borneowflers wbo empior persons to do taainteela t:e. eoostructioc or repairworit ors a dweiiint or not more than three untu in whrcb the homeowner aiso resides or on the Frouads appurtenant tbereto are act eeaerailti eonsidere.d to be er-movers under 6e Woricrs' Compensauon Act (GL C 152,sect_. IM), application by a bomeowner for a license or permrt may Md.cacc the ico sure of an cmpiover tandcr the Workers'Compcnution Act_ I undo stind :hat a copy or this statanent will be forwarded to tiu Depurnent of Industrial Accidents' Office of Insumner for apVr rer.:r:::ron ant : na: :uiure to secure eme at c as rrcuirec undo Seevon_:n'or MCC 15: an lead to the imposition of ai.:. L at;aJue� eensrsone or: line or ur to Sl 500.00 and/or impruonz:c:.t or up to one vn:and civu peruues in the form or a Stop Iro-c Order and a fine of S100.N a day a€a:ns: me. SHEETROCK: MEL REED: (L) WORCESTER INS - CB817530 (W) COMMERCIAL UNION - CBH557387 INTERIOR TRIM: DAVID'S REMODELING: (.L) COMMERCIAL UNION - NB F821442 DAVID BIK: (L) MERCHANTS INS GRP- 8CM0278579150 (W) TRAVELERS - 176K337-8-94 OAK INSTALLER: ROBERT BUDDEN: (L) NORTHERN ASSUR. - NBF528652 PAINTING: CAMPBELL PAINTING: (L) TRAVELERS - 1680251K4083COF (W) AMERICAN POLICY - WCC 186604 ROUSSEAU, AL (L) MERCHANTS MUTUAL - 8CM0278570179 (W) EASTERN CASUALTY - ??? GARAGE DOORS: ALL CAPE GARAGE DOOR: (L) U S F & G - BSC14667590301 (W) COMMERCIAL UNION - CBH573757 STORMS & GUTTERS: ALUMINUM PRODUCTS: (L) AETNA - MPOO21014146 (W) AETNA - JC89258880 OAK FINISHER: AMERICAN FLOORS: (L) TRAVELERS - 680 342W754-0 CARPET, VINYL & TILE: CARPET BARN: (L) VERMONT MUTUAL - SBP6507393 (W) PHOENIX INS. - 6NUB476J652794 WIRE SHELVING: CAPE COD CLOSETS: (L) U S F & G BSC146983441 APPLIANCES: KITCHEN APPL MART: (L) FIREMENS FUND - AZC80453098 (W) HARTFORD INS CO - 77WZNB1603 MIRRORS & SHOWER DOORS: L & M GLASS: (L) COMMERCIAL UNION - CBR409003 (W) U S F & G - 0071439933 LANDSCAPE & SPRINKLER: COY'S BROOK: (L) COMMERCIAL UNION - ABR345850 (W) CIGNA COMPANIES - C41138178 DRIVEWAYS: NORTHERN SEALCOAT: (L) MARYLAND CASUALTY- EPA18716945 (W) THE PHOENIX - UB387K530 I SUBCONTRACTOR'S INSURANCE ENGINEEER: BAXTER & NYE ENG: (L) FIREMENS FUND - S30MXX80564866 (W) LIBERTY MUTUAL - WC1312595563023 EXCAVATION & SEPTIC: DRISCOLL, JJ: (L) U S F & G - HGL 110093 (W) U S F & G - 7708711936 FOUNDATION: BAYSIDE FOUNDATIONS: (L) COMMERCIAL UNION - ABR406267 (W) LIBERTY MUTUAL - WC1312201785044 WELLS: DENNIS SCANNELL (L) TRAVELERS - 660873E5627COF92 (W) WAUSAU - 151300062926 CELLAR/GARAGE FLOORS: MICHAEL BROWN: (L) AETNA - MP0023672849 FRAMERS: ROBERT DORRER: (L) TRAVELERS - W680526K991TIA9 (W) AETNA - 006C0023972416C MICHAEL DUFFLEY: (L) COMMERCIAL UNION - NBF821356 (W) LIBERTY MUTUAL - WC1312492127024 ROOFER & SIDEWALL: JOHN MEE: (L) AMERICAN STATES - 01CD1486783 (W) TRAVELERS - 6NUB448K275894 MASON: SHERMAN, WAYNE: (L) COMMERCE INS CO - N60689 (W) WAUSAU INS TO BE ASSIGNED ELECTRICIAN: CHAVES ELECTRIC: (L) HANOVER INS. - LHN2964649 (W) MISCELLANEOUS INS CO. - 0708878 91 1 PLUMB & HEAT: WHITELY PLUMBING: (L) TRAVELERS - 660365K1782COF9 (W) EASTERN CASUALTY - POLICY IN MAIL ALARM SYSTEM: BALTIC SECURITY: (L) FIRST FINANCIAL - FF0131 G400831 (W) COMMERCIAL UNION - CB0743379 CENTRAL VAC: VACUUM HOUSE: MERRIMACK MUTUAL - SBP1608045 INSULATION: MAP INSULATION: (L) AMERICAN STATES - 02CC326435-3 (W) U S F & G - 7711099932