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0017 HAMDEN CIRCLE
V, , ) r7 Application number... / S Fee ...........................3s ....................................... Building Inspectors Initials....... .... ................... JUL 112019 Date Issued' ( .1 ................................ INN OFSARNSIASLE q Map/Parcel................Z...... ................................ TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO WS/DOORS/TENTS/STOVES/WEATHERIZATION n PROPERTY INFORMATION Address of Project: 1-7 C S' NUMBER STREET VILLAGE Owner's Name: _ o Phone Number ��=Clio - Email Address: �t°�(`f o r �n V2 fMo E'f Cell Phone Number i Project cost Imo._- �_��� Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK at el Siding ❑ Windows (no header change)# ' ❑ Insulation/Weatherization ❑ Doors(no header change)# Commercial Doors require an inspector's review ❑ Roof(not applying more than 1 layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable)# (attach copy) Construction Supervisor's License# ' : (attach copy) Email of Contractor Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTYIS IN A HISTORIC DISTRICT. YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. s APPLICATION NUMBER............................................................... R *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s)of each tent Fuel source being used LP tank 20 lbs. or> Yes No_____,if yes, a gas permit is required. Natural Gas Yes No , if yes,a gas permit is required. If food is being served at.your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3.30 pm-4.30pm. Commercial events may require Fire Department approval, *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: rt �- C' e F Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE t� Signature - Date All permit applica ns are subje t to a building official's approval prior to issuance. r� •%fir . The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' C<o�mp�ehsation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Info°rmation Please Print Legibly Name (°BB i'ness/Organization/Individual): dre' ss: .- City/State/Zip: S' Phone#: Are you an employer?Che k the appropriate box: Type,of project(required): 1.❑ I am a employer with 4. 1 am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g• Demolition workingfor me in an capacity. employees and have workers' Y P h'• � 9. ❑Building addition [No workers'comp. insurance comp.insurance. 10. Electrical repairs or additions required.] 5. We are a corporation and its ❑ P 3.' •a'`m a homeowner doing all work officers have exercised their I LM Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.E]Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.[1 Other comp.insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit'indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic:#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers',compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Si afore: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permittlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street . Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 www.mass.gov/dia To: Page 2 of 2 2019-07-12 14:19:01 (GMT) 17742839906 From: M.T. McMahon&Son ti e.. ..,, ..._. ;`' i' V'':..4., ::i GrLX{'<i•�z:vt•.f:mrr.'w4:-x ,.,..�:.$g ... .:wse''!iat 2 Fuller St. Carver,MA 02330 mcmahoninsulation@gmail.com 781-831-1234 July le,2019 Re:Insulation Permit Close Out Permit Number:B-17-2081 Tanya Moyer 17 Hamden Cir. Hyannis,MA Attn:Building Inspector for the Town of Barnstable, We installed the following insulation/completed the following work at the above listed property, including: • Air seal attic floor and basement ceiling using canned foam to prevent air leakage • Install R-19 fiberglass in the perimeter of the basement at the sill for damming purposes • Install 6mm poly vapor barrier over dirt crawlspace areas to prevent moisture from coming into the crawlspace areas • Install R-10 rigid board on the crawlspace perimeter This work was completed to stretch energy codes applicable at the time of installation,andl has been- c 3 inspected by Rise Engineering,a.Mass Save program. Please don't hesitate to contact us with any questions! Y Respectfully, Michael T.McMahon Owner D� To: Page 1 of 2 2019-07-12 14:19:01 (GMT) 17742839906 From: M.T. McMahon&Son FAX COVER SHEET TO COMPANY FAX NUMBER 15087906230 FROM M.T. McMahon&Son DATE 2019-07-1214:18:50 GMT RE B-17-2081- 17 Hamden - Permit Close Out COVER MESSAGE Good afternoon, Please see attached letter to close out the permit for 17 Hamden Cir. Please let me know if you have any questions, or need any additional information. Sincerely, -� Kail.a O'Farrell Office Manager " McMahon Insulation "- 2 Fuller St. -� Carver MA 02 E 33o *please note address change* W Office: 781-831-1234 Email: mcmahoninsulation cugmail.com Website: www.mcma.honinsulationma.com WWW.MYFAX.COM ,. `� � i �� 1 p-`� + 1 /„ � 0��� ?` �1 � y ....�- t i l Rt� pFTME,py Town of Barnstable *Permit# — Y �p Ex�r�res 6 months from issue date Building Department Fee BARNSTAB ��,� Brian Florence,CBQ 1' ,�� Building Commissioner AjFD 59. A NOV00 Main Street,Hyannis,MA 02601 OV 2$ v V` �r w Ti�4�/�� ww.town.bamstable.ma.us - Office: 508-1-2 40380�- � I Fax: 508-790-6230 EXPRESS PERMIT APPLICATION '- RESIDENTIAL ONLY Not Valid without Red X-Press Imprint \ Map/parcel Number Property Address Lc— V ` [�Residential Value of Work$ 0 D Minimum fee of$35.00 for work under$6000.00 i Owner's Name&Address Lf k. Contractor's Name l � Telephone Number Home Improvement Contractor License#(if applicable) 'I 1 Email: tC��', Construction Supervisor's License#(if applicable) C50 k [2Workman's Compensation Insurance Check one: ❑ 1 am a sole proprietor ❑ I am the Homeowner ® I have Worker's Compensation Insurance l Insurance Company Name t T'l M 04 04_r l Workman's Comp.Policy# 9 D Z 7 - 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 existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders.U-Value t 2S (maximum.32)#of windows /P #of doors: / *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. •' ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Q:\WPFILESTORNIS\EXPRESS2017 Basil Congro CONGRO REMODELING / Mass.License#CS082529 7 DANA ROAD Page of Mass.Registration#141496 FORESTDALE,MA 02644 (508)826-2561 FAX:(508)477-4642 I/We the owner(s)of the premises mentioned below,hereby contract and authorize Congro Remodeling(hereinafter referred to as the"Contractor")to furnish all necessary materials,labor and workmanship,to install and place the improvements according to the following specifications,terms and conditions on premises below described with references to which I/We warranty that I/We are the record holder(s)of title: mom L} / -L p Lf- Owner's Name y'e+� Telephone Job Address 11 L�µ. Q/�-, c((r v City ' "S State Zip SPECIFICATIONS: / e 4, wP-kS k, I - G14 Sic viol kk< �- Lrtie� , �� �vw G 4 sS s�H,w,f. Ins0 wry. . f 'h S 1/ -7 Z,& L l K E{� 6�. +� � ST r c — w v <k I OS CL ti L LeVIL 9✓ /tcv-Ll. s k v -, f,. r-A -s t,l c In consideration of the labor and materials fumished by the Contractor,the Owner(s)agree(s)to pay the Contractor the sum of.$ Deposit:$. 62,10 ' O-b ;Day Job Starts:$ c ;Second Payment:$ ' Day of Completion:$ (P Z36 ' °° Est.Start �" - '� /`` V/ Est.Comp. s It shall be the obligation of the Home Improvement Contractor to obtain such permits as the Owner's Agent.The Owners who secure their own construction-related permits,or deal with unregistered Contractors will be excluded from the guaranty fund provisions of MGLC 142A. All work performed by the Contractor is fully covered by liability insurance. This Agreement constitutes the entire agreement of the parties and no other agreements,representations and/or warranties expressed or implied,shall be binding on either party hereto unless in writing and signed by both parties.Any alteration or deviation in the specifications listed above involving extra costs of materials or labor wil be furnished and performed only upon written order and will be in addition to the cost price of this contract. The Owner(s)hereby certify(ies)that he has(they have)read the Agreement,that the terms and conditions and the meaning hereof have been explained to him(them) and he(they)fully understand(s)them. The Owner(s)acknowledge(s)the receipt of an executed copy of the Agreement at the time of execution hereof. If any provisions of the Agreement are in conflict with any statute,regulation,ordinance or rule of law,then such provisions shall be deemed null and void to the extent that they may conflict therewith,but without invalidating the remaining provisions hereof. COMPANY'S GUARANTEE:The Company guarantees its workmanship for s years.It will replace defective material within the period of guarantee free of charge.All requests for service must be in writing! This Agreement may be cancelled by an officer of the Contractor,but only within three(3)business days from the date of execution and in a similar manner of the Owner(s)right of cancellation. You may cancel this Agreement without any liability to you,provided that you send a written notice to the Contractor by midnight of the third business day following your signing of this Agreement,by ordinary mail,posted,by telegram,or sent by d live WITNESS our hands and seals this h day of 20 — CONGRO REMODELING Do Not Sign this Agreement before you read it. Accepted by: ( r) uthorize fflcer (Owner) (Owner) r s Massachuetts De -' BoardMassachusetts Department of Public Safety Building Regulations and Standards License: CS-082529 Construction Supervisor BASIL J CONGRO 7 DANA RD . FORESTDALE MA 02644 1 CommissionerExpiration: 12/10/2019 _ a Office of Consumer Affairs and Buslness Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration:. 141496 Type` DBA " Expiration: 4/26/2018 Tr# 288682 CONGRO REMODELING BASIL CONGROrA == 7 DANA RD. FORESTDALE, MA 02644 _ Update Address and return card.Mark reason for change. SCA 1 20M-OS/11 Address Ej Renewal Employment Lost Card i; � � - Office of Co sur .-r'skusidess Regulation Q License or registration valid for individual use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: ,.141496 Type: Office of Consumer Affairs and Business Regulation , 'Expiration: 4126k2018 DBA 10 Park Plaza-Suite 5170 Boston,MA 02116 CING BASIL CONGRO 7 DANA RD. £.E; FORESTDALE, MA 02644 Undersecretary No id-iAtho t signature T7ie Coanuromveakh nfMassardiusetts Department o,f rudustrial Accidents - Offire a,f' M-W5tigatians ' 600 Washington Street - Boston,MA OZ111 ftly m rn�gov}dia Mrarkers' Caffipensat an Insurance Affidavit:Builders/CantractursMechicians/Phrmhers Applicant Information Please Print Na= 621� Address Cites/Stahl Phone- Are you au employer?Checkthe appropriate bon: ' Type of project(regaired): 1.fA I an a employer with. 4. ❑I am a gmecal contractor and I 6. 0 New eonstructim employees(fall andforpart-time)-* have hired the sub-c=tmctm 2.DI am a sale proptietor orparr- listed on the attached sheet. 7- 0 Remodeling ship and have no-employees These sob-contractors have g-,0 Demolntion woniting forme in any capacity. employees and hnre wodous. g. ❑Buildmg addition. [No wad mm' comp.imsu ante Comp_iosu ml recpiE 5. 0 We are a corporatimand its 1 0 Electrical repairs or adtfitions officers have e�ised their 3.❑ I am ltomeou�er tieing alI•�orlt: - 1L❑Pltnnbingrepairs or additions myse1€[No wosltens'cep- right of exemption per MGL 12.0 Roofrepairs insurance reqaired.]i c.152,§I(4 andwe have no employees.[hlbwodoers, 13-0 Other comp_==ai=mquized_] *Amy wHczot6at ebedrsboz Pl mast also facutthe swd-be10-d slog t-rsuo&me co®pmsatio-apericy iafa ngdon_ tHomeownerswhosubmitdaisaf6daiti�c.'th-yaxedoingauwanksadBien}saeantd&contxactarsnmst submit anewaffidaebtiadicatinsurTi fConnactmffstcheckibis box mastattachedassddinions]sheet shouing&a mime ofthesob-comic aDmsadstatewhed"or not ftseentitiesliar —Plmn.Iftbesnb-c=txctumbsve employee%&eymnistpmvide their uorkm1 comp polig number- I arr�eta eaaep r fDtatirprzuiriirag lvarkers'conrperesrrlirrti insrlranrs for err}*enrplof�ees HeToav is the pa cy and f ab site anfarrarrrtian. , Instuance Company Name: A( 4- Pflhcy,crSelf-ins.IiC.A /Py L L4,00 °70 - S-L S•Lf'Lo' FbxpimtionDate: Job Re Address Cityl5#afe��p: /�i� Ate-•®2 yr p/ Arch a copy of the workers'compensationpolicy-declaration page(shaving the policy number and expiration date). Failnre,to secure coverage as requiredunder Section 25A of MGL cz 152 can' lead to the imlposition of criminal penalties of a fine up to S1,500:t)U anitor one yearimpaisontneig,as we11 as civril penalties in the form of a STOP WORK ORDERand a fie of up to$250-00 a day against the violator. Be adcdsed that a copy of this statement maybe forwarded fo the Office of Irrvest gatiom of the DIA for insurance coverage+v t tom I eta Hereby cesi r auder the pains and pe nafties ofperjury that the in,forrsx gwtpronr kd abmv is hue and correct Simature: Date: It yf /7 Phone �O $� 2!,' 2r 4 elf Edd use amf. Da trot write in thb area,tar be carrapleted by city artolm offiirciat City or Town: PertmtUrcense# Issuing Authority(circle one): L Board of Health 2.Building Department 3.City rown Clerk 4.Electrical Fnspector 5.Plum-bing Inspector 6.Other Contact Person: Phone#: faformation andlastructions Massachusetts Getm-A Laws chapter 152 redid s all employers to provide wcF[k-ras'compensation fcs their employees. pursm is this st&te,as enplayre is defined as.6:every pers633-m.1he service of soother under airy corfrac t ofhirv, express or implied,oral or writfteu." An MnployM_is defined as"an induvidzral,partneasb p,association,corporation or oihea IegaI entity, at any two or more of the foregoing=gaged in.a Joint eotezpdse,and inchedmg the Legal regrew a afives of a deceased emplopea,or the receiver or trustee of zn individual,patiershIp,association or other Iegal entity,employing employees. However the owner of a dwelling house having not more:than three apartments and-who resides therein,or the occupant of the - dwellmg house of another who emglops peons to do raahtm ce,construction or repair woik on such dweIling house or on the grounds or building appurtena ttherefo s allnotbecanse of such employmentbe d=nedtn be an employer." M- GL chapter 152,§25q6)also stales that aevery state or local licensing agency shall withhold ffie issuance or EL business or to construct buildings in the commonwealth for arcy o permit to operate _ renewal of a licexzse r p p the msmrance.cove�ra e r ed." 'cantwho has not produced acceptable evidence of compluance with g � aPPh P fits divisions shall oIrttcal sub states fiTeifher the commonwealth nor any o P Additionally,MGL rbapter ISZ,§75C(7) - enter into any contract for thepP ante ofpnblic woikuntI acceptable evidrnm of compliancevtith the insurance._ this tPS have been ented to th.e Contra-�antho�" rcqoi�ents of �P P Applicants ' d Ietel �b ch the boxes that apply to your sitnafion and,if Please fill out the worloaas compensation affidavit"�coin p, y, y necessary,supply sob-eontradnr(s)name(s), addresses)andphone w— er(s)alongwiththeir cmtficate(s) of Dance. LimitedLiabD.iLyCompanies(LLC)or LmmitedLiabh7ityParfncships(LTP)withno employees other than the members or partners,are not required to carry workers' compensation insurance If an LLC or LLP does have empToycm a.policyisregoized. Be advised that this affidaYrtmaybesubmiftedto the Department of Indvsttial Accidents for confirmation of insurance coverage Also be sure to sign and datethe afTtda The affidavit should be-retnmed to the city or town that the application for the permit or license is being rmpmsted,not the Department of . LodasfriBlAccidzols. Shonldyou have aay questions regacdmg the law or ifyou are regaied to obtain a workers' compensation policy,please caII the Department at the n=1cr lisind below. Self-ioMU`ed companies should enter their self-insTaance license number on the line. City or Town Officials t _ Please be sure that tie affidavit is complete and prixfrd legibly. The Department has provided a space of the bottom of the affidavit for you to fin out in tie event the Office of Investigations has to comet You regmtling the applicant e number which will be used as a reference number. In addition,sn.applicant Please;be sure;to fill in the penn>tJIicens at must sabmil ID.uYtiple peumit/Iicense zpplizotiom is any given year,need only submit one affidavit indicating can ent th policy infbm ation.Cif necessary)and under`Job Site A ddrm&*the applicant should write"all locations n ( 'Or :)wn)"A copy of the-affidavit that has been officially stamped or markedbyihe city or town maybe provided to the applicant as prooftbzt a valid affidavit is on file for fufar 'pe�ip3 or licenses A new affidavitmust be tilled out each year.Whew a home owner or citizen is obtaining a license or permit not related to any business or commercial veotUlm (Le. a dog license or permit to bum leaves e5c-)said person is NOT requirr-d to complete this affidavit The Office of InvcSdgafions would Like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give-as a caZ The Depsrtment*s address,telephone and faac number Departnmt¢f Iu&Eshial Accident% Qftce of lavegukatia= �astr�I1��11� Tf,-1<4 617.' 7-4- Qxt 4-06 car I-V MA MOE Fax 617 727 7749 Kevised4-24-07 fg� I A(C"RO® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) `.../ 05/09/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must 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 NAME; MARYJO ANDERSON ALMEIDA&CARLSON INSURANCE AGENCY IAIC.No PHONE . (508)888 0207 1 A/C No: E-MAIL s: MANDERSON@ALMEIDACARLSON.COM PO BOX 719 INSURERS AFFORDING COVERAGE NAIC# SANDWICH MA 02563 INSURERA: AIM MUTUAL INS CO 33758 INSURED INSURER B BASIL CONGRO INSURERC: CONGRO REMODELING INSURERD: 7 DANA ROAD INSURER E: FORESTDALE MA 02644 INSURER F COVERAGES CERTIFICATE NUMBER: 152714 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. ILTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MMIDDY/YYYY MMIDDNM LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE DOCCUR _. AMA T R NT 0 PREMISES Ea occurrence $ MED EXP(Any one person) $ N/A` PERSONAL&ADV INJURY $ GEN'L AGGREGATELIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑ PRO- ,F JECT LOC. - PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY Peraccdent AUTOS AUTOS ( ) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DEC) I I RETENTION$ $ WORKERS COMPENSATION X STATUTE EORH AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 A OFFICER/MEMBER EXCLUDED? , NIA NIA NIA AWC40070352542017A 02/07/2017 02/07/2018 (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 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. . Sole proprietor has not elected coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN SUmm@NVOOd AssociationACCORDANCE WITH THE POLICY PROVISIONS. 300 Falmouth Road 113 AUTHORIZED REPRESENTATIVE Mashpee MA 02649 Daniel"{M.Crq�)Iey,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD "1111DaAI(; D JZJ� MAR 22 2011 T®wN0F13AF11VSfA nationalgrid Completion Certificate Lead Vendor: RISE Engineering Program: NGCC-HES A division of Thielsch Engineering Auditor: PMK Patrick Kett 5 Dupont Ave Unit 2,South Yarmouth,MA Client#: 230129 508-568-1926 FAX 508-568-1933 Contractor: 0075 M T McMahon&Sons Work Order: 24302 Homeowner: Tanya Moyer Contract Date: 1/19/2017 17 Hamden Circle Hyannis,MA 02601 Start Date: 2/16/2017 Phone: (941)204-8051 Completion Date: Home Performance Improvements • AIR SEALING: Performed (9)working hours of air sealing in your home. • ATTIC FLAT: Insulated (1400) square feet with 10" Class I Cellulose at R-37. • ATTIC ACCESS: Installed (1)insulating rigid board cover for the attic access folding stair. • VENTILATION: Installed (12)ventilation chutes to rafter bays. • VENTILATION: Installed (12)4"X 16"rectangular aluminum soffit vent(s). RISE Representative Signature This home has achieved an estimated energy reduction of: 26 mBtu = 256 Therms(Natural Gas)* *Actual savings may vary. Mass Save®is an initiative sponsored by Massachusetts'natural gas and electric utilities and energy efficiency service providers.The Sponsors of Mass Save work closely with the Massachusetts Department of Energy Resources to provide a wide range of services,incentives, �l trainings,and information promoting energy efficiency that help residents and businesses r� �0 ass samanage energy use and related costs. For more information,please visit www.masssave.com. RISE Engineering is the.Lead Vendor hired by select Mass Save sponsors to implement all aspects of the Mass Save®Home Energy Services program including conducting home energy assessments for customers,implementing various initiatives and managing contractor WISE agreements. For more information,please visit www.RISEengineering.com. MGM RIM _ Town of Barnstableding it�sVis�ble Frorn the.Street-=A rouedPl.ans Mus#be;;Retained,on Job ands#his Card Must Ise:Ke t �r, •. Post This Card So That, PI? s p _ Permit atr „ ~ Posted UntilFinallns ection„HasBeen Made �d � T` r Final Ins i.n�hasFie - e Where a Certificateof Occu ane:>.is Re �airedsuch Bulldmg shall Not:be,Qccupied un#il a, pect„o enxmad ��, r.p yduo �.,�-.�:. .Ha, i,�.<aa. ., �•:� ,e ��.�;��.". ,, ,,.ae:: .u�, ,, .e�.� :�£�_ :.fir�,.�.�,::«v,�,�-x £ u�a.R Permit No. B-17-198 - - Applicant Name: Mike McMahon Approvals Date'Issued: 01/30/2017 Current Use Structure Permit Type: Building--Insulation-Residential Expiration Date: ''07/30/2017 Foundation: Location. 17 HAMDEN CIRCLE,.HYANNIS Map/Lot 291-189 Zoning District: RB Sheathing: s Owner on Record: MOYER,TANYA _ Contractor Name: MICHAEL T MCMAHQN Framing: 1 .., Address: PO BOX 2562, Contractor License C5-068111 2 HYANNIS, MA 02601 EstProject Cost: $3,300.00 Chimney: Q Description: 'Weatherization,air sealing,weather stripping blown cellulose Permit-Fee: $85.00 - s Insulation: Project Review Req: Weatherization,air sealing,weather stripping b b cellulose Fee Laid: $85:00 s n D t Final: a e 1/30/20 17 r Plumbing/Gas Rough Plumbing =.Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. fi Rough Gas: All work authorized by this permit shall conform to the approved applicaUon.and the approved construction documents-for which this permit has been granted. All construction,alterations and changes of use,of any.building and str.'uctures shall be in compliance with the local zomng�by laws and codes. -Final Gas; This permit shall be displayed in a location clearly visible from access street or 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 the Buildmgia�nd Fire Officials re provided on thls'permit. Service: Minimum of Five Call Inspections Required for All Construction Work: k _ i 1.Foundation or Footing 'r �r, �< v Rough: 2.Sheathing Inspection ».. ' .w. - 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 approved the various stages of.construction. Final: "Persons contracting with anregistere.d contractors do:notihave':access to_the guaranty fund" (as set forth in MGL-c..142A) ;, Fire Department Building plans are.to be available on site Final- All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Town of Barnstable RE,��EI'PT " MAJIM. * 200 Main Street, Hyannis MA 02601 508-862-4038 Application for Building Permi Application No:. TB-17-198 Date Recieved: 1/24/2017 Job Location: 17 HAMDEN CIRCLE,HYANNIS Permit For: Building-Insulation-Residential Contractor's Name: MICHAEL T MCMAHON State Lic. No: CS-068111 Address: PLYMOUTH, MA 02360 Applicant Phone: (781) 831-1234 (Home)Owner's Name: MOYER,TANYA Phone: (781)831-1234 (Home)Owner's Address PO BOX 2562; HYANNIS,MA 02601 Work Description: Weatherization;air sealing,weather stripping blown•cellulose ZE r Jr- .Total Value Of Work To Be Performed: $3,300.00 Structure Size: 0.00 0.00 0:00 Width Depth Total.Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance wi6the Workers Compensation Act(Chapter 568). - I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by �. filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office..Requests for inspections must be made at least 24 hours in advance. Signed: Mike McMahon 1/24/2017 .(781)831-1234 Applicant Date Telephone No. Estimated Construction Costs/.Permit Fees - Total Project Cost : $3,300,00 Date Paid Amount Paid - Check#or CC Pay Type Total Permit Fee: $85.00 1/24/2017 $85 00 XXXX XXXX-XXX{-i Credit Card' . ..........7ois................. :. Total Permit Fee Paid-.' $85.00 s Town of Barnstable *Permit# 2D(50- O`f Expires 6 nths from issue date Regulatory Services Fee • snxrsrnBte, , 163 Richard V.Scali,Director XI"REsi 9. �0 Building Division AUG Tom Perry,CBO,Building Commissio 'n'pf� o Z�jS 200 Main Street,Hyannis,MA 02601 v V V/V OF 8 p www.town.bamstable.ma.us A R N T Office: 508-862-4038 Fax: IOU40-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY /zY Not Valid without Red X-Press Imprint Map/parcel Number �-I I Property Address ` Residential Value of Work$ 5)&GO-(DO Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address I�a[y � S• N, C �� CA t Contractor's Name A �� Telephone Number � � 0 10, 1� Home Improvement Contractor License#(if applicable Email: ��� CZA.A— Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance. Check one: ❑ I am a sole proprietor I am the Homeowner. I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit R q st(check box) n ,3 ^ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will betaken to 0DkOL � ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy op Keome Improvement Contractors License&Construction Supervisors License is required - SIGNATURE: C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content Outlook\2PIOIDHR\EXPRESS.doc Revised 040215 BARNSTABLE, 639. ' Town of Barnstable Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO 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 M � \ I• � "`� �, `�",v�'� ,as Owner of the subject property hereby authorize ��typf� to act on my behalf, in all matters relative to work authorized by this building permit application for: �qbmu Q!AT` NAS (Address of Job) Signature of Ow Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\2PIOIDHR\EXPRESS.doc Revised 040215 77te Commonwealth of Massachusetts Department of Industi al Accidents Office of Insestigations 600 Washington Street Boston,M.4 02111 irwis:massgosldia NVorkers'Compensation Insurance Affidavit:Builders/Contractors/Electncians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization&dividaal): C7(, p '1m Address: , City/StatelZip: N w 1 Phone 1 CO Are you an employer"Check the appropriate box: Type of project(required): 1. I,am a employer with 1_ 4. ❑ I am a general contractor and I employees(full and(orpart-time).* have:hired the sub-contractors 6. New construction 2_❑ I am a sole proprietor or partner- listed on the attached sheet. 7. N'Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity., employees and have workers' 9. ❑Building addition [No workers' comp.insurance comp.insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]S c. 152,§1(4),and we.have no employees.[No workers' 131D Other comp.insurance required.], *Any applicant that checks box#1 mustt also fill out the section below showing their workers'compensation policy information P Homeowners who submit this affidavit indicating they are doing all watts and then hire outside contractors must submit a new affidavit indicating such r $Contractors that check this box must attached an additional sheet showing the name of the stab-contractors and state whetter or not those entities have employees. If the sub-coatractors have employees,they must provide*air workers'comp.policy number. I am an ernpioyer tliat is promgding tworkers'congmisation insurance form►,eniployeeL Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.it. Expiration Date_ Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a.STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the.DIA for insurance coverage verification. I do hereby certify rut t e pains and penalties of perjnty that the information provided abm�e is true and correct 5i true: Date: I l Phone#: Official use only: Do not write in this area,to be completed by city or town official City or Towne Permit/License# Issuing Authority(circle one): 1.Board of Health 1 Building Department 3.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other ' Contact Person: Phone.#: r. s /re��t�ntaiutur<ill/r,n�'C3!r'(�ci.ffcce/rtr.;el/3 Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ( FIOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration A82094 Type: Office of Consumer Affairs and Business Regulation expiration 5/26/2017. Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 EXCEL BUILDING SYSTEMS COMPANY INC. RENATO DA SILVA �,r "rr+ 8 JAN SEBASTIAN DR STE25 SANDWICH,MA 02563 `r t Undersecretary No4vlidw out signature Massachusetts-Department of Public Safety Board of Building Regulations and Standards .._ un3trii CtiOA siipQi'JiSOT _ License: CS-098849 RENATO F DA SLx"VA 8 Jan Sebastian DAveio. a Sandwich MA 02363 .A,0A v Expiration Commissioner 06/20/2017 Li i I Client#.38860 2EXCELBU ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) r THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:if the certificate holder Is an ADDITIONAL INSURED,the pollcy(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 endomement(s). PRODUCER _NAME: Dowling&O'Neil PHONE— --------------- ----TAX----------- (.-Ln C No,Ext);508 775-1620 _�-(A��5087781218 Insurance Agency E-MAIL --_ --- --,AOD - ---_-- INSURER(S)AFFORDING COVERAGE NAIC if Hyannis,MA 02601 !INSURER A,National Grange Mutual Insuranc INSURED Excel Building Systems Company,Inc INSURERS:Associated Employers Insurance 8 Jan Sebastian Drive#25 INSURER C: l INSURER O: Sandwich,MA 02563 --�--- _ - -- ---- -- -- INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR 'ADDL UBR POLICY EFF POLICY EXP 1 LTR TYPE OF INSURANCE POIYNUMER LIMITS _qk - A GENERAL LIABILITY MP02774T 2/22/2015 02/=016I EACH OCCURRENCE $1 0_00,000 - - XICOMMERCIALGENERALLIABILITY ppEAISES-O{Eaoccurrence�_ $500000 —]CLAIMS-MADE OCCUR ; MED EXP(Any one person)— $10,000-- _ PERSONAL&ADV INJURY $1 000 000 GENERALAGGREGATE $2 OOO 00O GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2 OOO,OOO POLICY Ea LOC j $ AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT _-- _—_ ANY AUTO _ r BODILY INJURY(Per person) $ ALL OWNED SCHEDULED ~ — AUTOS -.... AUTOS j BODILY INJURY((Per accident) $ NON-OWNED !PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LU18 OCCUR EACH OCCURRENCE $ i EXCESS LIAR_ CLAIMS-MADE! 1 AGGREGATE $ DED RETENTION$ I $ B WORKERS COMPENSATION ! WCC50050098182015A 3/05/2015 03/05/2018 X We srnru OTH- AND EMPLOYERS'LIABILITY -TO�Y11lY1.lTS 1 ANY PROPRIETOR/PARTNER/EXECUTIVE,)/N E.L-EACH ACCIDENT_ $5OO OOO OFFICER/MEMBER EXCLUDED? N I!!N/A --- j(Mandatory In NH) -! E.L.DISEASE-EA EMPLOYEE $SOO OOO j 11 yes,describe under DESCRIPTION OF OPERATIONS below ! E.L.DISEASE-POLICY LIMIT $8;OO,000 i I i i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,AddRbnal Remarks Schedule,If more space is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of Insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. 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 -2 ►'1- - L , ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD ..... ---•.•....... - 1 C4 YOU WISH TO OPEN A.BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUH,NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must,first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate'that is, required bylaw. Fill in please: DATE: . a e APPLICANT'S YOUR NAME/5: .i BUSINESS YOUR HOME ADDRESS: �' n i ��* s, y t ' 1 TELEPHONE # Home Telephone umber NAME OF CORPORATION 5... NAME.OF BUSINESS TYP E OF BUSINESS NEW IS.:THIS.A HOME OCCUPATIO YES;. NO A DRESSOF;'.BUSI.NESS...- c /:.:: G. MAP/PARCELNUMBER S� V .... :.[.:s - g) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main-St. - (corner,of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate.your business in this town. n 1. BUILDING CO ISSIO ER'S OF ICE. _�` This individ al en in or �d fanlpe mi r uirements that pertain to this type of business. - MUST COMPLY WITH HOME OCCUPATION Au hotize ignat e** RULES.AND REGULATIONS. FAILURE TO COMMENT MAY RFqtjl T IN FINES. 191-1 2. BOARD OF H ALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature** . COMMENTS:. } 3. CONSUMER AFFAIRS IC. NSING AUT ITYJ This individual ha bee informed of a lice nsi require ents that pertain to this type of business. thorized Signature* �s COMMENTS: 701 ,4 Tow of Barnstable Regulatory Services. P� '►�� Thomas F.Geiler,Director Building Division MAM 9 1 � Tom Perry,Building Commissioner °for a` 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.ns Office: 508-862-4038. 8-790-6230 APProve Fee: S�e �--D Permit#: HOME OCCUPATION REGISTRATIOl�T Datea-471- vJ 1 7 Name: ../ Phone#: Address: l 7 /��- - tom ✓� .0 �C✓�ti.,ti.:�� •yy [' c (� �J/ ` Name of Business: �`lfrz ,2��1J C., - Type of Business:_ -L� --'�7LrC� Map/Lot: INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation ,,i itlninn single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance;provided that the activity shall not be discernible from outside the dwelling. there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;.no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution.. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential-dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. . • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There are no commercial vehicles related to the Customary Home Occupation, other than one gun or one . pick-up truck not'to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires;parked,on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be rt included. No person sln<all be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. - I,the unndersigned,�have read and agreewith the above restrictions for my home occupation I am registering. Applicant:. Y�L L� y�t�`.�� � � M i Y Date• �- Homeoc.doc Rev.01/3/08 Assessor's map and lot number ....Q(.7..1"..1. .............. SEPTIC StvSTEN1Mu INSTA 5 .;.7,! q ,g, Permit number,- , . /8d •, 4 v Z BARNSTABLE, i House number .......................................................:................ E�1!/I�i®n6 1 I� AL C"" # NIP TOWN REGUL RO CMPYa\ TOWN OF BARNSTABLE DUILDING.--.- INSPECTOR APPLICATION FOR PERMIT TO TYPEOF CONSTRUCTION ..................................................................................................................................... F ........... .... .....192. _.,. .. "TO 'THE INSPECTOR OF BUILDINGS: " The undersigned hereby applies for a per it according to the following information: Location ................, ��............ ....... jy,0 £:/�d �'1/e C Ci` fJ/i �f'.:..:.................................... ProposedUse ....... ...... ( ........................................................................................................................... ZoningDistrict ......✓..................................................Fire District .............................................................................. Name of Owner ..4.DW/ .D....... Address J..2..&.Q -ce�'/)......c Name of Builder 21 ....5: �.N..I� E ........AddresS Name of Architect .1.t� .....L� .... Vj.. l�l �e.�®< Address ............................................................................./r... v / or e Number of Rooms ...........Foundation �Y U.LI✓�>?U....C,U�.GJ��'.� .................o............. Exterior ....�U/ ...... h/. �oAS............................:...........Roofing ..ASp&97'7 y. ........ .J..`,. ............................. � . Floors ..............................................................Interior .................................................................................... HeatingGUATm ..........:....................:...................Plumbing .........................................::........................................ Fireplace ..................................................................................Approximate Cost .......5c�j Q.6 Definitive Plan Approved by Planning Board _____________________________ ---19--------• Area .......................................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH hoc `� i NEW /FAD1791i 8 X I ST►'n J f I XI 6f0us I hereby agree to conform to all the Rules and Regulations of the Town of Barnstgb a regarding the above construction. Name . ...................................... .......... OSTROWSKI , EDWARD • No 2.2,11.6.6.... Permit for ...A d iJ ............ ............ Location J�9:�... ....17...Ha.nde.n...C.i r.c.1 e .... ..... ....... .. .. .... .. ... I.................Hx.an.n.is............................................ Edward OstrowskiOwner .. ...........Type of Construction .......EX?kIAP...................... ................................................................................ Plot ............................ Lot ................................. Permit Granted ...May. l.e ..........19. 80 Date of Inspection ..........19 ...2 Date Completed ...................... nde�40-19,az L PERMIT REFUSED ...... ......................... ........ ....... 19 ................ ........... ..................... ....................................................... ........... ....................................................................... ............................................................................... Approved ........ ....................................... 19 ............................................................................... ly ................. ............................................................ Assessor's map and lot number .... QFTNEtO Sewane Permit number ..... *4 Z 33AUST&BLE, i House number ........................................................................ 9� MABa Ufa MAY a' r TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ................................ r .... ........................................................ TYPEOF CONSTRUCTION ..................................................................................................................................... ., ........... ............................9.fit). TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according .,to the following information: tAJLocation Q .. ?............�.�f... l.''. ,C'. ........... i�/P...4... .....TT / fi�/(�� .......................................... ProposedUse ...... ........�t-=;;.f e..............................................................................................................I............ ZoningDistrict ........................................................................Fire District .............................................................................. Name of Owner ..' .I�Ca,;s� {' ......:' ) .1/!r���;.`iR.!.....Address ..... . ....... :.11 Name of Builder � F�r< ,J!�!/�l. � �.f .........Address :1.i' l fr',Y+�r............................................................../t ?.! ....................... ...... . .Name of Architect .:AN5.....�.K...e ..S.WMPIK;!t . Address ............................................................................... ... Number of Rooms .................r�..............................................Foundation ............................... Exterior ....(r.!;J ...... . ........................................Roofing � . ...n� ...... _ .... . .................... Floors .........................,.............................................................Interior .............................................. -Heating- _.:.`: r:.'r.. .." ..... .?:......................................................Plumbing f Fireplace ..................................................................................Approximate Cost .......ton ��A..... .................................... Definitive Plan Approved by Planning Board ________________________________19________. Area . .S !........ Diagram of Lot and Building with Dimensions �Q1...--___........................ .��Fee .......... ..... SUBJECT TO APPROVAL OF BOARD OF HEALTH _ NP w �12-,11 I I I hereby agree to conform to all the Rules and Regulations of the'Town of Barnstable regarding the above construction. Name i .................. .... .��..`.��.....!�.......�'1:........ WOSTROWSKI , EWARD ' -A= 89 No ...2 16.6. Permit for ................�Z _-8 9 t n ... .... . ................ �iagq�...T�fppily Dwe ling I . ......... ................. Family ..... ...... ......... M Location 1�gt ...17 Ham n Circle ................ .. ....................... . . ...............Hyannis.............................................. Owner -.Edw-ard...0 st r.ow. sk i ...................... Type of Construction .. xame......................... ..................... .......................................... Plot ................... Lot ................................ *Permit Granted ......May...I....... ............19 80 Date of Inspection .................. .................19 Date Completed ................ ......................19 PERMIT REFUSED ............................U.. ............................ ................................ ... . ........ .... ...L . ...... .................. ... ...... ............ .......................................... ....... Approved ................................................ 19 ............................................................................... ............................................................................... ` 9 4o G _ - 77 . Assessor's map and lot number " SEPTIC SYSTEM MUST BE INSTALLED N COMPLI r "age Permit number%,.................:............... .. ..... � QIVITH ANC � ARTICLE II STATE SANITARY n; °`THETo - TOWN OF B ARNS'TJA L� � "u` 039 BUILDING INSPECTOR �p • `g� ,T APPLICATION FOR PERMIT�'TO .......... ?...... ...............:.......:..........................:.............i... , e r}i ............ r TYPE OF CONSTRUCTION `1 .. � Y! 1.! ez�t'1 ./1..... .................,�:.-. ....f.......19 :.;7 ��or � TO THE INSPECTOR OF' BUILDI, GS: The undersigned hereby applies for a permit according to the following informa/ion: .) Location .... ... ... ., ,.. e �, .... ..t ....C.•.:, � lT ® .N ...................................... ProposedUse ........... .1.. .... ................................................ ...................................................... ZoningDistrict ........................................................................Fire District .............................................................................. Name of Owner L. 2 :.!?r .�? .. ,5, 904k dress ...........� Name of Builder , r.� SJ... ,%C� �?� ..Address .............. .X.... ... • �............... Nameof Architect .................v............................................. .............::........-.......................................................... •............. .Foundation Number of Rooms �!�::C•.C/h..:.................. ...)4�7-Cs� .....�.�:rl�..�:.�...�. ..,�:..... Exterior ...: ..!d,.�'� .. , J �: ...... !.�? 1...Roofin �. ... Floors ........C.. cv`: .... .... ....... ...........................................Interior ........... . ..��wit!�s1 .. / ............................... Heating ,�7-?' .•••• .%`C .. ..� ..........Plumbing ............. a'�r'h��:... .�� h`.. .� _ , . Fireplace ................... ............................................Approximate Cost ............ .........'. Definitive Plan Approved by Planning Board ________________________________19________. Area `-e ?. ..........Qa. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH A/\ 1 .� i 3-6 r 3� I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. . .ri f.i:?..... 14i-1114 .�. `?54�-'- •• J :Cedar Acres Realty Trust 19708 " I No ................. Permit f ; or walling............... :............... .......: ........ t Location .!.. . rOaK:'1;F/ .Hamden.. ........... i ................. .........) ............................... Owner GQdaz..Ar.raa..Realty..Trust............. r Type of Construction Wood•.Fram*e••••••.• F � , ........................• •••...•.......••...•.......•..•• ••.•.•.•.•......•. ♦ ` \ J ,'� Plot ......................... .. Lot ........291-189......... Permit Granted Oct. 31 19 77 . .... . Date of Inspection ..Date Completed ......................................19 PERMIT REFUSED ; ........................."..................................... 19 r ' ..................... ... .............. . ................................ , o r , b (.. ..• _ ••" .......................l.. .....................................•........ Approved .... 19 ............................................................................... t �( ' ;4ssessor's map and lot number .................. . ......... ....... '1 ' e L� Sewage Permit number .......................................................... Y O�THEtp TOWN OF BARNSTABLE BAHBSTA M i M6 �•� = BUILDING INSPECTOR G MP a' • lfl c r ..................../ .- �' s APPLICATION FOR PERMIT TO A' yTYPE OF CONSTRUCTION ...... � ...'.�? C : :::.............. ...:............',�E.' ..a . %... �.;:.................:........ i ....................................... ....... `~ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: a� Location .... '^.. '.:.. � M; '" lJ -z- :? ,!.... ,�: / fi714�'`� Proposed Use ................... ? .. ,...................................................... � 0.... ......0.. .............. .. ...... ...................................... .. ... .... . ....... ,Zoning District .................................................................Fire District .............................................................................. Name of Owner ............�.,.......!��.: .:?.... , •./�"+ -�1•+►Address .......... �' Q Jar r^? .I ✓r ! ! •�!/1 , Name of Builder .. ...............................................................!! s7 tAddress .......... .. .Y!<x .:� ; _✓s> ;f� � �. .. .............. i Nameof Architect .......................---r�r�.................................Address ..............:...................................................................... �--~ Number of Rooms -"" r i +- .....................Foundation Exlerior ....i .; rl f .�9 �•:. .!rfc9.^....Roofing to �i f`.�' . ..... f , Floors .................... ...............':......................... ..................Interior .......................!....:....:....:.. f..... ............................... Heating :""„`':`:.:........................... .......:.......J! ..........Plumbing ................. �....:C .......µ,................... Fireplace .............................. ...............................................Approximate Cost ............. ,.... !n:.�1E?�. ....................... f ,� f .i I ) Definitive Plan Approved by Planning Board ------------------------_-------19________. Area r Diagram of Lot and Building with Dimensions - f Fee ........................................ SUBJECT TO APPROVAL OF BOARD OF HEALTH r I i 4 j 9 i I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ...... ...........':?....... .� `!„ -r..+..�:.... j Cedar Acres Realty Trust No ......Permit for ....I.... ............ ..................... ............................... Location . t.... ..... ... .4..................... 1a i a............. YV4;1................... PUS................................. P.gOgN...Ac P s t........ Owner .... ..ReAlty'.. A........ r Type of Construction Wodd..F* ame........... ....................................... .............9..... .89............ . . 21 1 Plot ............................ Lot ................................ \e Oct- 31 [a�nt d ................... ........... Permit Gr ......19 77 Date of Inspection .�...................................19 Date Completed ......................................19 PERMIT REFUSED ..................... ....................................... 19 ....................................... . ...... e�A AAW-0 ............ ...................................... At 4.IV /........................... ....................... ....... .......... ....... v Approved ................................................ 19 ............................................................................... .................... .......................................................... ' 19708 10/31/77 TOWN OFiBAR,NSTABLE Permit No. I »nA ; Building Inspector Cash - 7r3 OCCUPANCY PERMIT Bond No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit- therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Cedar Acres Realty Address South Yarmouth ` lot #86 Hamden Circle, Hyannis Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department Inspection date THIS PERMIT WILL NOT BE VALID,-AND THE BUILDING SHALL NOT '.BE OCCUPIED UNTIL SIGNED BY THE BUILDING -INSPECTOR UPON SATISFACTORY COMPLIANCE WITH .TOWN REQUIREMENTS. ...................................................... 19... . _ ........................... .... ...................._........_......... Building Inspector TOWN OF BARNSTABLE Permit No.19708.10/31/77 t NAUST , Building Inspector Yua Cash �0 YpY OCCUPANCY PERMIT Bond V,/A_ "No building nor structure shall �be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Cedar Acres Realty Address South Yarmouth lot 486 N.ar�df Circle, Hyannis Wiring Inspector r - Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. ..................................................... 19».... ...............»................................................».»» Building Inspector „•`"” • TOWN OF BARN TABLE 19708 10/31/77 . e Permit No. Building Inspector - --- t Cash OCCUPANCY PERMIT Bond ?NI0__ ' ".N,building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Cedar Acres Realty Address South Yarmmt lot #86 men Circle, Hyannis Wiring Inspector ! Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. ` ..................................................._, 19_... ..................................... ..........................._.....__ .._._.._ . Building Inspector � U a COM�ao v)ra A � 70 o00 o tk 3.9 N - v HEREBY CERTIFY THAT THIS FQtTKDKfI0N 15 LOCATED ON THE LOT AS %,,-.CWVN 6—M%` ft'OT MAShcE -7ffil - ONFORM$ TO THE TOWN Chi' 34,Qi1/-PM4Ls� THTS PLC'- PLAN WAS ZONING REGULADOVS NEC-,�2.RDNG SETS47Wq STR UtY►EPdT T�EJidt�LY AND I5 FOR TiiE OF THE IL41V" OrdLY. UNDER NO CIF?C Ctc USED F� FROM STREET UNES4WC .14DT IlNtu. �Af�C.E9 A�2E OFFF-r.'rS T.) 4e1CS, �R1ALL-5> 1i£OGES. EEC. N cSQ� � a i� 7lS h �• a � � . � � d < v, fr � Ic CK o 3,91 ko y ti I HEREBY CERTIFY THAT THIS FOUNDATION IS LOCATED ON THE LOT AS SHOW^ AM,F" - THE: CONFORDlS TO THE TOWN OF )3v4-eA1X7 ZZ'r �� ANT URw Y AN Is [�R T '1Ai37RliM�P�T'3+JR�dEY Att!?t5 FC.1'R ;:IrZGI'J[i►• ZONING REGULATIONS REGARDING SET$ THE !CONK 0,Q. v 7JcR�.USED F� FROM SREET LINES AND LOT IMES, � ARE OF7 ." - A}lC�S•WAi.i.i3. HEDGES ETC.