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0072 HARBOR BLUFFS ROAD
1 �. _ J r _(\1 \ .� l O� O � V �' a� �, i i ,� �'� �. I f � � t i �� � ., �+.�. _ _ _ iF. - _ S x . }�• (Sw)790-6227 T i • , ALFRED E. MARTIN BUILDING DEPARTMENT TOWN OF BARNSTABLE BUILDING INSPECTOR } TOWN OFFICE BUILDING OFFICE HOURS: 367 MAIN STREET 8.30.9:30—3:30-b:SO 1 HYANNIS•MA 02601 r r • i r , r .. r� ✓ r r 3 M • y i r i s _... - .. ,i. �{d l ' � � � � � � .� �� '� r �jr _,/j" ` �� 1 I �J r' all 72 Town of Barnstable Building Post This-Card So Thai,�t s.Uisible Frorn the Streets Approved=Plansw:Must be..Retairied on J:ob anduthis Card.Must be.;Kept Posted Until Final Inspection Has Been Made a r �� F � ,R W.h'ere aCertificateof Occu anc is Re u�redsuchB:uildm h'alhNotbe Occu iedbuntil�a FinalIns ect�onhasbeen made f £,r. Permit Permit NO. B-19-104 Applicant Name: Michael Rockwell c/o The House Company Approvals Date Issued: 01/25/2019 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: - 07/25/2019 Foundation: Location: 72 HARBOR BLUFFS ROAD, HYANNIS' Map/Lot 325 128 Zoning District: RB Sheathing: Owner on Record: GILLILAND, DAVID A&THERESA A �tkj Co tractorTName s,MICHAEL S ROCKWELL Framing: 1 Zia Contractor Ucense CS 074034 Address: 72 HARBOR BLUFF ROAD a 2 n .� a 5 HYANNIS, MA 02601 Est Protect Cost: $35,000.00 Chimney: Description: Remodel 3rd floor with the installation of drywallfloonng and Permit Fee: $228.50 { �5`13 l�DedY1 p „ Insulation paint. Replace one exterior door and install new 6 8"X 5 1, box Fee Paid S•228.50 7 V window. � r Final:. 1q& Date 1/25/2019 Project Review Req: � N � um ing/G Ile— t PI b' as a Rough Plumbing: ,• '� Building Official � , Final Plumbing: TV3 7 Rough Gas: ' .. A This permit shall be deemed abandoned and invalid unless the work author¢ed�bythis permit is commenced within siz months after issuance. Final Gas: All work authorized by this permit shall conform to the approved application and the approved construction documeriti for which this permit has been granted. All construction,alterations and changes of use of any building and struct resshall be incompliance th thelocalzon ng by laws and codes: Electrical This permit shall be displayed in a location clearly visible from access streetorroad and shall beMmaintalned open for public inspection for the entire duration of the work until the completion of the same. Service: . s ' The Certificate of Occupancy will not be issued until all applicable signatures by the Building aand�re Official ; s are provided this permit. Rough: 5.. � Minimum of Five Call Inspections Required for All Construction Work:° 1.Foundation or Footing Final: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Low Voltage Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection S.Prior to Covering Structural Members(Frame Inspection) Low Voltage Final: 6.Insulation Health 7.Final Inspection before Occupancy Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Fire Department "Persons 'ng with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: I ' 1 ' , U I I P 1I r _�... t' �.� is ,• I Mt- 71 �r711 . . �� -- I i '� I I ! t .0 -� r �dIl}. r,l .t,r e r � t I 11-, r •0 :il N i, l _:I _,• , �. I d Jv� , � rd- i 1 ''6 rvI I� f!¢i I� �QNOR .,4M�7W�`'�Or 4r_,gg��wwao"�'i �q�$' .���`�t,y.f•,3 i t - ` IF, '' ri ,yA. }1 ;I +��1 j �ry �It r,� 1}� in � ,14�,���t 1<ib l r�1 }d.�.;�`.r'O��Frs`..-.0�-1._..+..'j,. e. ,1;� '4 tl•hl�^ op'r:.�'�w?1,�.+q'... .i6..il`_.�..... 1 ..t„�' �•.b-..�.,.�d.l� .i�l{QM.IN+v... .1..... + .. - e T" Nee= I Ir r. i - n IME, J _ Cm- t is Ui1 I� r� •, � t � ' � � i it gal ica IXc=V WONS : m-" NORTHSIDE DESIGN ASSOCIATES �•w � s.J•. :g=�,'�..:.;.�:R�.,,�,`.^+n.�.'JW-!. ..,.....e.:.�f+tl„•. ..•�.dtl•��.sSF..�h...�..n�w-b a.►s,.e�.laK.��.x:.,., ,'.. ....a.: t._.._.... ...,...L�:_ .._ � - .. - 1 1 ; I .•, T a. 171 � I 77 I MM IL L: a q p R . _ N�GHSIDE - s".may s1 ASSOCIATES'. qr u w.a wtea,q .' GUW •fG •i t` Ou- 06 ItwR iIyMY M/M+§. A41AC u20KE Z��i/ � OA! IIRM90Msi1, y l I I I f i �. { n L. PCij�l,• 1 I{ }ff 7 t, ' I 'yl ., 1 t ¢ ,� 4�� I III ! 1 1 ° it 1 •.l {.lo Ira , NORTHSIDE �•*ON, �• '"Neu�I n++ THIRD FLOO�I ...:�Y n oc ��.r�� _ DESIGN rNe -�—`�- !± r�u= PIIKIM MSgMaI cmOVA RY71 01Y[Y At,b IOri , - �Q crr!'nteM4tmaexue9llsAev �yi'..SSI!!"'°"MO�Ya e""'°` are pEgSONs -5I-- `! -Y M.fMrIA'ie,Mnen.YcH/rodrra r.•• II .. •{' f Y ?t' 14 a'4jrro S77 y • 9 1• # I _ J 4, u ��. . _ I - i�� 1 � Y� I CAM 6�ccrio lit o P[AN :.Z, NORTHSHIE µov.�,Nt4 DESIGN MRK d C 1 llASPCIJkTPj tosMi�e �iS7Q�+p �iild'si-'�P.""'°'""°"ai '�°�"�•,�.'�K' aic xcvlsas" °`°u°—fil-• +! o s` ' � �� .i1HWA8 Mktg 1 • lc �7r Lt ' ,�.. .,y.*. , . . _. ....... r ...t,.�,.i.:�'.. ,.1w�.a.x.��:.U7�h".�aY�9.l..:a.blt.'.a...,`.kz�" �• .�..,...s �...r7. . _ �_ ^ CI I a 0 T i4 77 � w q ! � it .,,- in f .r PL A/ �_:x:-�" NORTHSIDG b ems,ac,Jo ri , DESIGN m.. ,..R.... Rn e. Ffx&1✓Fa/zP.�L ASSOCIATES_ �•. �,�*�� vr{I :* aoo L+t waw DAR RMUM T 1 O l T 1. ro mma s nm� •I F ( � r - zr I 1 T1 11" I, 77 tr r 1 -0 F,. ' Fyn 1� if �� O I � � i1 1^1 � II }t, I �N � ,� 3.i.1�•l�,J, ',,y }( i^ f LI 1 log t bepy� I yy 1 4 I oL aow.,;n f X//VQilTitaN fiAN ;; NORTH8IDE ., aLn Ln 0 R��`5/' q/Q�.N: •�'' DESIGN .o. ��lu ASSO ._ DRAIN Tn ,,.:� '7. /D ✓a'V.lc. _ 6��7 mnrne�oana L WROW as o.o.ry..a. ao sav+r a.aem DATE ...RENSI°Ns I 4d i I t 44 ) N y, %I �i :i j r i x a • � t 6� i 1 8 lk JJ q q�� 1 � � o •f lit ll r H4RTHSMS Naval�r4 .•OC//!G/Nq.�C.'T/C.WS � r� ,y� TES' ®'A � f _ hr �P' , ./Q't�f,(,.t�'R��C�i« i"r rar n wwr runa�er �• pptMr-]�_ .. ^a rpn�pr DM rr�+oq� 7��t� K �IK7M1■Ioa Ir OgtOOtk'0.Wr' r0 M g YY OKO ID_+.f �.` /(�'. ' '�Tjp.° RpoR` 'NO,o �,: PaC•'+�.'•,�"I'-••�r;r,, " KM UAL[. rrtM90N! 4 r15 , Ito rC t i IIIPPP... r • �' .. .. e. -,... ._:./.�..n .a_ ..... __ h•p:Nldyrr'�.. _.PLL.11:a.d..ARe(.�i+M�! M1aii -.. � �'�� - ; I pp IYYI {••.=1� II i .. —4— Iv, p __ _— i, fa 1 r �. J- .... I t. 7trT jTi� , i � � I ::.I 1 I I•' I it J f jTrTT. 1 • t ,;I 111111111 I �I �I��1 � 1 � � ,y^ ` k 1 1. y j --r•- SZ T- .,{ ri c 1y. , a f t s"- ' I I � � II ' ' ■1n�}AD .1 it T` 3@41 'ca,ncHT" Joe/ ;- PAIR: 5e,._r4n P7L r R PRN IKirai M N ......is iONORTHSIDE:DESIGN3T, �.."'� OOCIATES q RE':�t�2NC4' aNen;�0. I�mno. c _ m.atJF�.oast t Fwrt,..t at...lo,w , rr •,u 1 w+7ar xc►4s h...: L.:'Y DATE RENSIONS IOOy t I I r Val eggs f 711 $ �•�" i � IIy� II�� p I Ij �I i, B a �'l94s Il I rl r: I ,� I "t rl I I { I r. ti \• { I �� pal t NORTHSIDE ' ^f re+ I Fm w�tarNar�►J DESIGN W TES r°ONw a w.mno. •' OM1M � k G7LfJ.�'�1.�'I` }.: a ner uvula na- •.- I P�mwac Momou�a Momi '�"� �.ertoJFa.�u.l QA1R }IM?IOtli Oic1�*,�--,.F I . .. k -,1 i. -'. - - . .�:.t v ..-. �°'' Y�:-1..4�k3 b .. . r �Y'�': 1 a ,S._•.1 I,,r �+"'' .. �I. DEPARTMENT OF PUBLIC SAFETY ONE ASHBORTON PLACE I f• BOSTON,MA 02108 LICENSE CONSTR, SUPERVISOR ���� EFFECTIVE DATE LIC-NO. R 06,«:.30.94 042447 WILLIAM 8:. STRONG l / zo 5 SCOTT DRIVE m PLYMOUTH? MA. 02360 NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY STAMPED-OR-SIGNATURE OF THE COMMISSIONER _ . SIC TORE F ICENSEE - - ONER 11%02'94 17:02 IM17727 r122 DEPT IN'D ACCID -y J. Colnlno12-LVeQtt`L o/ YWaJ�acicuset ' �JaParfnte,af o�.�naluafria�,�ticcic�en� 600 Wuhinytoa..S'tmet l castle ; James J.CampbeA 02111��n, �� Commissioner Workers' Compensation.-Insurance Affildavit (QamsecJpermiace+e) with a principal place of business at: (Gcy/stM#JZ1p) do hereby certify under the pains and penalties of perjury, that: () 1 am an employer providing workers' compensation coverage for my employees working on this job. . insurance Company Policy Number () I am a sole proprietor and have no one working for me in any capacity. () I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation policies: / 7 2—zi YJ_6 Contractor Insurance Company/Polity Number Contractor Insurance CompanylPolicy Numbe e c 3,5' 72f Contractor Insurance Company/Policy Number O I am a homeowner performing all the work myself. 1 under_und th;z a copy of this statement will be four:zrded to the Office of investigarions of the DTA for coverage verification and that failure to secure ccverage as recd ed under Section 25A of MGL 152 can lead to the Imposition of criminal penalties eonsisdne of a fine of up to S 1,500.00 and/or cn years' impriscrrent as well as civil penalties in the for of a STOP WORK ORDER and a fine of$100.00 a day against me. Signed this day of 19 Licensee/Permittee Building Department Licensing Board Selectmens Office Health Department TO VERIFY COVERAGE INFORMATION CALL: 617-727-4900 X403, 404, 405, 409, 375 ..:.-.......::....: ..� n....N.... . :c; �.: .:....._,:..........�. )," 'S?��.:'.»iX r� ,.`i' ;Y;'ct���:i:<•r'1fi�C C/TL i n£s c:»Y•''ts�k �,<. k:v%x:x:»tSx.x.Fbt'.' Y,y + `�, •r. Sy :>:%f;'2:f:S:vwka.:ak:fc«o:a:i4>.:i::i:wf: iGi:>:L:<:x.f:1:<7�t: '' f,F .J.Sa'4:<,e,:OfGk«cx.xe««x.%Mox.;aexi(%Kkx�xi` 10/O.//94 , i CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THI8.CE ICATE THE L R N¢E INSURANCE AGENCY DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDSV BY THE ! j 290 J E ROAD POUCIEJ BELOW. FALMO TH TA 02540 COMPANIES AFFORDING COVERAGE 508-5 1.Q0 �LIPAWTER :A Commercial Union Insurance M f ANY LETTER Arbe l l s — CAR Auto i Gallo cols1ruction Co. , Inc. CIW : P.O. fox 4�3 Liberty Mutual 80 Sindvi.th Rd. SagarA r'o TEA .D: MA 0 25 Ei 1 t�APANV j LnER E 'ti x.' ,i�::�,,k•:r�.K:r<L.ee>4o.4w.aYg•�uJ<.: FINER }a i TKIS IS T C TFtY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVS SEENISSUM TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD i INDICATE T'WITHSTANONG ANY REQUIREMENT,TERM OR CONDITION•OF ANY CONTRACT OR OTHER DOCUMENT WITHRESPECT TO WI ICH THIS CERTIFIC TE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORD40 BY THE POLrAES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUS NED CONDITIONS OF SUCH POLICIES.LMITS SHOWNMAY HAVE BEEN REDUCED BY PAID CLAMS. I POLIGYAtuTnlB�i iCLIpYRf�OT1yE OOLIOYOTPatA7 Lam L DAT9Q4WCWYV) OAYL'(JAWM/YV) tiCt�'Ail L L nY GENERAL AGGREGATE _ d00040 A X C GENERAL LIABILITY CBR406305 4/10194 4/18/96 PRODUCTS-COMP/OP A66. S 00000 MADE FX OCLUR. PERSONAL & AN. tNJuRY >a 1600060 i R a �ONTRACTOR•S PROT. EACH occuRRFNCf IN0000 i fIRE DAMAZE (Ayry one find MID.EXPENSE(ANY oac esrsom =' soda 4wom GILT L COMGINEO SINGLE E3 AN AUD 03K084447-00 4/18/94 4/18/95 LIMIT 1"0000 j E]A1 DOUD PUTOS BODILY INJURY I I X I U IDUUD#TOS I t I lin persorJ ! I { X MR D A JIU$ BODILY INJURY S I X OIAUTO$ [Per UtidenU 61 LIA ILIIY PROPERTY O"ffUJU _ i R EACH OCCURRENCE IN REL row AGGREGATE i OT ER 111 UNidRELtA fORM ?:. +"• : ? :r: ym s QOMP04ATION X STATUTORY LRAIT$ %i;><3i(•`'iiii is ii:i 1 C WC1312214504014 7/22/94 7/22/95 EACH A.CVDEN1 t 1 110Q00(0 DISEASE-POticy L"T t $000010 I YE is uAe,l.lTv asEASE-EACH EMIPtOY1E t 1soo0L0 oTrrcR • i ! j DeMPTIM Of ATIO WL00ATfomwvr tsxEV$PB01AL ITEMS I i Inc. is; named as additional insured { • I I '.:p:{r• .J. .. .4. .e...'.arGkow�o:BR'>tb::KRM:F:Y.S)fr';Jf:':rY4:k...:.::>.•.•`J`.,•.. ...,. .! '.3taJ SW. S►OULD ANY OF THE ASOvEDESCRIBEO POLICIES BE CANCELLED BEFORE THE 3, EXPIRATION DATE Tt-LEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO i MAIL 10 DAYS WRIT TFNNOTICE TOT HECERTDICATEHOLOERNAMEDTOTHF } LEFT,BUT FAILURE TO MAIL SUCH NOTICE SHALL MPOSE NO OBLIGATION OR I :yk LIASLIT,YOF ANY KINOUPONTH£COMPANY.ITS AGENTS OR REPRESENT ATIVES, WTMOAMM RCPRCSCKTATty .--� 110.193000 >,:�:y�o u r .��. 2� ,.x �:.y:�f::•.a::sx:;ax.;:x ,.p n.<:..x...n.-: I I�, --------------------------------- --- ---------------- --- ----- - I TOWN OF BARNSTABLE Building Department- Foundation Permit Date Name Location a ell, li zs 4 Insp. of Bldgs. f 1 l i Failure to possess a current COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY ( Massachusetts StateBaUdlap OF ONE ASHBORTON PLACE Code iscausslorrevocatloo MASSACHUSETTS BOSTON,MA 02108 v of this license. L I C E N S E/ I CAUTION EXPIRATION DATE C O N S T R. SUP,E VISOR Q5/�6( FOR PROTECTION AGAINST RES 26ION 9 9.6 EFFECTIVE DATE LIC-NO. THEFT, PUT RIGHT THUMB N RICT 0 6/3 0/1 993 0115352 PRINT IN APPROPRIATE BOX.� o BOX ON LICENSE. DANA H ULLER 15 CHE KcRBERRY LN g I 0BLASTINGOPERATORS SS 029-40-6149 mFORES DALE MA. 02644 MUST INCLUDE PHOTO. PHOTO(BLASTING OPR ONLY) FEE: 100.0a i NOT ALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY I HEIGHT: S AMPED•OR•SIGNATURE OF THE COMMISSIONER DOB: 05/26/1952 THIS DOCUMENT MUST BE I SIGN NAME IN FULL ABOVE SIGNATURE LINE CARSIC TORE OF LICENSEE THE HO ON LDER PERSON OF . THE HOLDER WHEN EN- OTHERS-RIGHT THUMB PRINT GAGED IN THISOCCUPATION. ONER ) PERMtI NU: TOWN OF BARNSTABLE SEWER coNNECT I ON PERMIT i OFFICE USE ONLY :: 3�'ATER;ACI;OI3 F#T NO ass esso rs N iap No.. �ER SLY' WR cssors Pa rcel No. �! : >::>:» := tree - - t: fit' - J ti 16 a c-• _ PR07ECT ::,:_...> CONTRACTS: SEWER INSTALLER j PROPERTY OWNER(Mailing Address) j i Name Name: Addrers:� Address: Phone: Fhonc:, O OWNER'S AGENT/ENGINEER u - Alm 15,,N4 N �ADDRESS:!�&* pROJECTDESCR REGULATOR:'REQUIREMENTS FACILITY&L•%ND USE DATA The installation of all scorer conx---ions must be done in :.. _ :::::::::•::::::::::::::..: accordance with the ions a Article XXXVI.Town C. s pravu ru..,.B :..of;;»<>»=<:>;:;.. _ . .. .._. :::>_� ohm c ra aun v� z ¢ a B 1 a s Bc.crc t le Ge nr 1 a rz orb n 0 fB _ t:. - Y a Town Way the sewer installer=st also obtain a Road RESIDENTIAL Opening Permit and roust comp:zwith the Construction Standards and Specifcations out�=;therein. At least 48 COMMERCIAL hours prior to the inst2llation,1. arriicant must notify the Department of Public Worla En&eering.for the RESTAURANT purpose of inspecting the installzioa_ The Inspector will complete the Compliance.Sketc iocting the installed INDUSTRIAL lines and connection. By signing c Application.the applicant acknowledges and und-rs-nds the regulatory • NUMBER OFBUILD NGS requirements and understands fzilure to comply with NUMBER OF BEDROOMSthem shall be grounds for revo=ion of the.Sewer Connection ISIZE OF PARCEL., ACRES Permit and the denial of any fu..-e fcrmit applications ESTIMATED DAILY SE`„TAGE GALLONS PIPING:LENGTH 3q'f DIAMETER EtPECTrD INSTALLAT.ON DATE NOTE:A Copy of a Sewer Tic(�Rccs_�tion is Attached ' SIGNATURE(INSTAIL�/AGENT) cAPPROVAL SIGNATURE �:,3'Z d SC-2(F/15/92) cA,7 0-17-77 1 w Application number-. Fee . .............. 1 Building Inspectors Initials.... tab................... ' D MOx Date Issued.....5...... -`...1................................... . Map/Parcel.. .. � ...0..................... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO W S/DOORS/TENTS/STOVES/WEATHERIZATION f PROPERTY INFORMATION Address of Project: - 4 n )S H i} 09W I NUMBER STREET VILLAdE Owner's Name: 0 9;�f 11kP ' Phone Numb' � �y(0 - � 3 0�j Email Address: t' 9dc 1` i&co"ccAST„NCT Cell Phone Number Project cost$ Check one Residential V Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize h Gl� a M L L C to make application for a building e�-me wi 80 CMR Owner Signature: --- Date: TYPE OF WORK ❑ Siding Windows (no header change)e # ❑ Insulation/Weatherization g ❑ Doors (no header change)# Commercial Doors require an inspector's review 13 Roof(not applying more than 1 layer of shingles) Construction Debris will be going to DU $w CONTRACTOR'S INFORMATION Contractor's Home Improvement Contractors Registration(if applicable)# (attach copy) Construction Supervisor's License# d gaol 1/6 (attach copy) _ Email of Contractor l 7 Phone number DO$" `4(o I ALL PROPERTIES THAT HAVE STRU URES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY.IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER........................................................... For Tents Only* Date Tent(s):will,be erected Removed on number of tents total Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent Fuel source being used LP tank 20 lbs. or> Yes No ,if yes, a gas permit is required. Natural Gas Yes No ,if yes, a gas permit is required. ' If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4.30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date ANT'S:SIGN-T_URE__, Signature Date All permit applicatiVnare sub'ect to a building official's approval prior to issuance. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / /yh // Please Print Legibly Name(Business/Organization/Individual): 0�I JG C>M A �7 /T /H 4 C Address: wr si m lq, 9- City/State/Zip: ��`''"'3 r►l 0�6©1 Phone#: JZY"77� SOW Are you an employer?Check the appropriate box: Type of project(required): 1.RI am a employer with /0 4. ❑I am a general contractor and I employees(full and/or part-time).* 'have hired the sub-contractors 6. ❑New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. emodeling ship and have no employees These sub-contractors have g, ❑Demolition workingfor in an capacity. employees and have workers' y p ty. $ 9. ❑Building addition [No workers' comp.insurance comp,insurance. 10.❑Electrical repairs or additions required.] 5. ❑ We are a corporation and its P 3.❑ I am a homeowner doing all work officers have exercised their. 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t .c 152,§ ( ),1 4 and we have no employees. [No workers' 13.❑Other ' comp.insurance required.] *Any applicant that checks box#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 subcontractors 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: Z&v7iC C 2Ie Policy#or Self-ins.Lic.#: ,,�(' (7[�I� U�b Expiration Dater / rfhpat7 Job Site Address: �� D�yd� City/State/Zip:�/� /r1�r^-C�', y17 . Colo/ 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 a_-Id a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverageverification. I do hereby certify under the pains and dpenalties ofperjury that the information provided above is true and correct Signature: ln. " �— Date.' Phone#: SOS- 7$ /S/'b/ 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 ., 47 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 4 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-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the 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 permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 4-24-07 wwv.mass.gov/dia CERTIFICATE DATE®F _ L1A�ILIT'Y IIV��l1RAIVCE . / 01/31/2019 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 COVERARE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTi1'UTE A CONTRACT BETWEEN THE ISSUING AF INSURER(S), AUTHOR¢ED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy ss)must-be endorsed. if SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may requir®,an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 00395-001 T .Qwep J Horgan Insurance Agency,Inc. 'PO Box 250 AfAtN-6 (508)775.5830 _ Hyannis,MA 02601 :....,.��----.•----...-�.S(9f:Rts7:AFE4R_4tN0FOVEF9aE - ......1_._ arter Insurance Company VDAG 64326 Atlantic Ch Graham,LLC 326 ._ 358 West Main Street Hyannis,MA 02601 COVERAGES CERTIFICATE NUMBER: M_ 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''HIS 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. TYPE OF INSURANCE POLICY .:•..._._._.__r,._.`....._._,,,, .... ... .^on�WUOi NUMBER � P�C�,�.p + pOL�Y.�p •,,, .__ OWNS, (4lIdU0D1YY�YY),_ �� LIMITS GENERAL LIABILITY T$ COMMEiaCIAL GENF'gAL LIABILITY EACH OCCURRENCE DAVWGE CUR6`N7to $ CIAIMS•MADC OCCUR 1 g5�9$GS_(Eck-Kcunopso) VIED EXP(Any cne pomsonl $ I PERSCNAL 9 AOV I iURY .$ 'GENERAL AGGREGATE: Is , GEN'L AGGREGATE I WIT APPLIES PER ~ -POLICY PRODUCTS,COMPIOPAGO b. w PRO- . __ lOC �..�._..-....... ..,.,,..,.w_._....�_..,..... AUTOMOBILE LIABILITY _�E.� -•C�M9:EVE0 SINGLI LIMP _ ANY AUTO n. OWNED AUTOS S SOS ULED I BODILY tN BODILY (Per pM50n1 -- BODILY INJURY°Pet ace;aent)!S. HIRED AUTa% NONtOWNED AUTOS I UMBRELLA LIAR _..00CUR ? $ (� EACH CCCU•RRENCEE _ $ I EXCESS UAS OLAINI ,MADE --S --� DED I RETtNYION i �'IQI���i�&3�IPs€Cl4�rr �;-___•---- .-.-,..�._.._,_, _��. .� ~- _. X "OR�°IIMIT$ r��,>{• � AA YRpP pPfPpp)NEB' rCi17IVs"vN 11NCV01059006 {� A 6 PI ER r �I Eq EXC.I.pe ' Y . N t At 1/29/2919 OW12112020,E.L.EACH ACCIDENT S 500,000.00 (Mandatory In NH) ... - _ POIICy COV�rage State;.•M�. 'E,L DISEA$E EA EM?LOYEE.$._...._._ .�50D,OQ0.00 �PERAI NSavow I f _ _.__. .• 000.00 - __.._.,..__.....___.,. ,_,,,_,_�_.,�.•«..._.._.....__.. '_ _ .. E._._i..... DISFASE POLICYLIMI $ 500, Gary C Graham is covered by.the workers cOmpensation policy AND Laura A G' m 'is nollcovered by;he workers compensal n p y. . I I DESCRIPTION 6 F OPERATIONS!LOCATION 1 VEHICLES(Anwft ACORO 101,Additional Remarks SbAoduN,if more space is required) •w CERTIFICATE HOLDER _ CANCELLATION -. Town of Barnstable 230 South Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE.CANCELLED Attn:Mariann Hughes BEFORE THE'EXPIRATION•DATE`THEREOF, THE•ISSUING COMPANY Hyannis,AAA 02601 WILL ENDEAVOR TO' MAIL ,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE a( - 019W2014 ACORD CORPORATION.All right ACORD 25(20:14101) The AC1 RD name and 1690 are s reserved.registered marks of ACORD '� '' CERTIFICATE HOLDER COPY • ,a r.���c�%irtrritr irn rq/(�r�,#'l[rt..JrrC�rrJr// ,� .•, ry Office of Consumer Affairs&Business Regulation f '' HOME IMPROVEMENT'CONTRACTOR { > TYPE.LLC Regisdatlon valid for Individual use only �q ,fir �# ° 119 before the-expiration date.'If found return to:4 , w, RRAIIAM LLC.A� 01111100 of Consumer Affairs and Business Regulation 10 Park Puss-Suite 5170 ' Boston,MA 02118 3 GAFRY GRAHAM 358 WEST MAIN ST.b a ` HYANNIS,AAA OM t Undemecrel>Eiry NOt valid Wlthiu sige9s��tar® 2.'.. - - Commonwealth oP P1lassachusetts Divisi®n of Profeffisional Licensure 'tl Boated OtBuilding Regulations and St_andarft Co�nstrudlJ6i, Supervisor :- ,. ., CS•042246 m. P r ' •gip Exit Tres 03J2Q12g20 �►Onau ala lien$UpeNi50r' 7 r v Unrestricted-Buildings of any use group which contain ;, t3ARY C GRAHAM �less than 381000 cubic feet(881 cubic m ers)of enclosed BB BRANT WAy a x�" ' "4_ space. 'HYAMIV ,7 CommissioneA . ALI � N Failure to possass a coat edition of the Massachusetts 4 State Building Code is cause for revosatlon of this license, For information about this license Y Call(017)727-3200®r viait,www-Fnasa.gov/dpl .- t } • r �oF�r+ero Comp[ainfi Cak11'4RepQl"t PnntedOn:4/23/2019 c� aAxxsrna[E, a ,a mn � Ea w.a F IN a 72 HARBOR BLUFF S`��ROAD HYA NIS ' � �rfO MPV� a s # C-19-263 `a ,, ay..; `rnfiad'� air 1 fsaSe . Case#: C-19-263 Address: 72 HARBOR BLUFFS ROAD, . Date: 4/11/2019 HYANNIS Owner Info: Property Info: GILLILAND, DAVID A& MBL: THERESA A 72 HARBOR BLUFF ROAD 325-128 HYANNIS MA 02601 Owner Notified?: Complaint Details: Type of Complaint Classification of Complaint Method of Complaint Prohibited Use , Building Code, Medium Priority Phone Complaint Summary: Owner of#73 Harbor Bluff's informed the electrical inspector that there is work that there is an unpermitted bedroom being created at#72 Harbor Bluff's Road. Permits show no use of space on "3rd" floor. ' Action History: Action Taken Date Description Fee Inspector Close Case 4/23/2019 Has a building permit and $0.00 lauzonj electric permit for work on third floor. . I Inspector Assigned to Complaint: lauzonj Filed by sheas Comments: Comment Date Commenter Comment 4/17/2019 andersor Bob said there is permit for finishing a space but now an elect permit came in for THIRD FLOOR. Not sure Bob checked 3rd floor. .�...�..-wrv- Syr,..»." r a"..."`;,�x. a n:«n:r a r i+a ,,toak ,.v t Date 4/23/2019 K Town of Barnstable°°'' - oF1HE ram, Town of Barnstable *Permit# P� ti0 Expires 6 months from issue date ~' Regulatory Services Fee * BARNSTABLE, y MASS. Richard V.SEali Director3J9 o b 1639. 0 Building Division Tom Perry,CBO,Building Commissione1P c • 20.0 Main Street,Hyannis,M-mIssl1 btC 3 02016 www.town.barnstable.ma:us WAI r ' Office: 508-862-4038 6+' �F?,A1Sj�F�aJx: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL 8Wf Not Valid without Red X-Press Imprint Map/parcel Number Property Address 'T7Z— PR-e's`idential Value of Work$ *2_00• Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address ` P,J 1 0� G--1 Lt-1 ti ate- -72— 2 -?>,__U �ti1 �►w t✓l S pit A- y 2 6 6 Contractor's Name 1p?"y L S_ Telephone Number Home Improvement Contractor License#(if applicable) /0 3-"`(Y Email: O cfl r=lC o r e, 2 e a L "1 4. C_C'L- Construction Supervisor's License#(if applicable) S° I U 6/S 4 ❑Workman's Compensation Insurance Check one: ❑ 1 am a sole proprietor ❑ I m the Homeowner ave Worker's Compensation Insurance i Insurance Company Name L M. o-'S • GD Workman's Comp.Policy# VV C Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) n4e-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 (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. i *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: f C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\2PIOIDHR\EXPRESS.doe Revised 040215 A� i / �. � � / J !�u /� ry / s r I �. `"e':%.i Ya' %Z �f!t% -�r' C -.:CNv�:�r_'.ti l_. "-y `� Office of'Cons' Affairs and Business Reguation 4; p ct 10 Parr plaza r Suite Boston, Massachusetts 02116 Nome Improvement Contractor Registration Registration: 103714 Type: Supplement Card PAUL J. CAZEAULT & SONS, INC. Expiration: 7/9/2018 RUSSELL CAZEAULT 1031 MAIN ST OSTERVILLE, MA 02658 Update Address and return card.Mark reason for change. SCA.1 C! 20rn-0:111 Address, Renewal Employment 0, Lost.Card �`ilP�!1'a;i;;��('rJii:C'!r/l�.'/`L'1�YrJ�.!�li.ir•�� Office of Consumer Affairs&:Business Regulation license or registration valid for individual use only n +=i before the expiration date. If found return to: g VIOME IMPROVEMENT CONTRACTOR l l_; Office of Consumer Affairs and Business Regulation Reistratiom a- - 9 _ 1'Q3714.,. TYPe: 10 Park Plaza-Suite 5170 Expiration: _7/g%2O18 Supplement Card Boston,MA 02116 PAUL J. CAZEAULT&SONS,INC. RUSSELL CAZEAULT 1031 MAIN ST :. . ....__..::.rf. ... / / OS T ERVILLE, MA 02658 Undersecretary Not valid withoutq_4nature 1 Massachusetis Ceparimen'i of Public Safety Bourg of 3uiidingRegulations and Stanc!ards ; ± >;'unsiructinn 5ttperrisor ��' License: CS-108157I ON r-.1 RUSSELL C.A.ZEA LT—.- _ _ - '2071 TYL41N STREET Brewster MA 02631 Comm ssioner 1112312018 lV ERTI11 AClr=TE OF UQLoJUT II NSIJL'1:Atl CE DATE01MIDD/YYYY) 08/11/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESEIVTATIVE 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 requite an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME; Linda Sullivan DOWLING &O'NEIL INSURANCE AGENCY IAIC,N Ext• (508)775-1620 FAX No: ADDRESS: Iullivan@doins.com 973 IYANNOUGH RD. INSURER(S)AFFORDING COVERAGE I NAIC$ HYANNIS MA 02601 INSURERA: LM INS CORP 33600 INSURED INSURER B: PAUL J CAZEAULT& SONS INC INsuRERG: 1 INSURER D: 1031 MAIN ST INSURERE: OSTERVILLE MA 02655 INSURERF: COVERAGES CERTIFICATE NUMBER: 76558 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. INBR ADDL SUBR POLICY EFF POLICY EXP - LTR TYPE OF INSURANCE I D WV POLICYNUMBER MM/DD/YYYY MMIDD/YYYY - LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence $ MED EXP(Any one person) $ N/A PERSONAL 3 ADV INJURY $ GEN•L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS' AUTOS N/A BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTYDAMAGE AUTOS Per accident Is $ UMBRELLA LIAB OCCUR EACH OCCURRENCE Is rRKER ESS LIAB CLAIMS-MADE N/A. AGGREGATE $ RETENTION$ $ WORKERS COMPENSATION rE,L. TATUTE �RH LOYERS'LIABILITY Y/N RIETORlPARTNER/EXECUTIVE CH ACCIDENT $ 1,000,000 MEMBEREXCLUDED? NIA N/A N/A WC531S386670026 08/10/2016 08/10/2017 in NH) SEASE-EA EMPLOYEE $ 1,000,0100 cribe under ION OF OPERATIONS below SEASE-POLICY LIMIT Is 1,000,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe 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/iwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO14 DATE THEREOF, NOTICE WILL BE DELIVERED IN Paul CaZeault ACCORDANCE WITH THE POLICY PROVISIONS. 1031 Main Street A—UTTHHORIZED REPRESENTATIVE Osterville MA 02655 Daniel M.Cro ey,CPCU,Vice President—Residual Market—WCP,IBMA @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts W Department of Industrial Accidents tl 1 Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia ��M S eve Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information I Please Print Le ibl Name (Business/Organization/Individual)' I It 7 . GWC� -l-So S Address: I D_J( M Cuo City/State/Zip: MPhone Are you an employer?Check the appropriate box: Type Of project(required): lam a employer with employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in $• [:]Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3❑I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10❑Building addition 401 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 11[:J Electrical repairs or additions proprietors with no employees. 120Plumbing repairs or additions 51]I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.n We are a corporation and its officers have exercised their right of exemption per MGL C. 14.�Othe_r_ (' � 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. 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. Instuance Company Name: �1 lJ CC) Policy#or Self-ins.Lie.#: -�,N S p� O ai.(2 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 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 for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: _ jj Z�lDate: Phone#: —`i 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#: ' I i Property Owner Dust Complete & Sign This Form i If Using a Roofer / Builder. i i I (print) C-1�)Or y l`" Gri 1 1 GC tit ck as Owner / Agent of the subject property hereby authorizes Paul J. Cazeault & Sons Roofing Inc. to act on my behalf, in all matters relative to work authorized by this building permit application for. Address of Job �12— N ve 30�2-- UFO P-0A ai)--S Signature of Owner Mailing Address of Owner Z- �+A 30 P,-- 'E>i--or-F Pt�1 0"2-6v Telephone # b g—2y 6 — 13a- Date I Please return this form to Paul J. Cazeault Roofing along with your signed contract. It is needed for us to obtain the building permit required by your town to complete your roofing project fax#508-420-4555 office@cazeault.com i ti Parcel Detail Page 1 of 4 �YQ� tU`�) a�is � � ' � r✓� y � h Logged In As: Friday,December 30 2016 Parcel Detail Parcel Lookup Parcel Info Parcel ID r325-128 �m N I WDeveloper Lot L'OT 23; LOT 22A; LOTS Location 72 HARBOR-BLUFFS--RA Pri Frontage 11771 I r Sec Road��:--:�M,,- :. ;;...:•n ,., .. Sec Frontage village Hyannis Fire District HYANNIS� I Town sewer exists at this address RYeS L Road Index 0659 Interactive Ma p Owner Info Owner FOGELGREN, MATTiid C0 Owner a %GILLILAND, DAVID A il i streets 72 HARBOR BLUFF ROj�streetz city+HYANNIE � .. state MA.... zip .Land Info .I....... ...... ....... Acres 0.31 l use Single Fam MDL-01 "'I zoning RB Nghbd 50111 , Topography Level `• - " Road Paveda-_.'� Utilities All Public .�.�I Location Mew Construction Info Building 1 of 1 Year 1995 Roof Gable/Hi _ Ext Wood Shin le Built struct p Wall -, Living'2650 Roof JAs h/F GIs/C AC Central Area Cover p p Type Style Colonial wau'Ply astered a, Rooms 4 Bedrooms J -1 Model Residential I"t Ca et Bath Full-1 Half l Floor Rooms; b Heater,_,,,.,.• ,"F> Total ...,,,.� .,.. Grade Overage Plus " I Type IHot Alr Rooms',8 Rooms Heat m Found- stories>2.3 Gas Poured Conc. ;�;� Fuel�`� anon t Gross Area 16476�� Permit History Issue Date Purpose Permit# Amount Insp.Date Comments j 3/1/1995 Demolish B37565 $0 " HY DEMOSF 3/1/1995 Dwelling B37566 $150,000 1/15/1996 12:00:00 AM HY 2 STOR Visit History...... ............... . ............. .......... tt http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=27083 12/30/2016 Parcel Detail Page 2 of 4 Date Who Purpose 10/17/2016 12:00:00 AM Anne Leonelli Change of Address 6/10/2016 12:00:00 AM Jeff Rudziak In Office Review i 6/10/2016 12:00:00 AM = Pamela Taylor In'Office Review 3/7/2013 12:00:00 AM Pamela Taylor In Office Review 10/2/2012 12:00:00 AM Denise Radley Change of Address 4/18/2002 12:00:00 AM Paul Talbot Meas/Listed-Interior Access 7/15/1996 12:00:00 AM IML Meas/Listed-Interior Access i j .. Sales History_____ _�,.._.......�_ _..... Line Sale Date Owner - Book/PageSale Price" 1 12/26/2012 FOGELGREN, MATTHEW TR D1209775 $0 2 12/26/2012 FOGELGREN, MARCIA T TR #D1209774 $0 t. 3 3/11/1998 FOGELGREN, A ROY& MARCIA T TRS C147708 $1 4 6/17/1981 FOGELGREN,A ROY & MARCIA T C85846 $0 5 9/27/2016 GILLILAND, DAVID A&THERESA A C210801 1 $1,000,000 Assessment History Save Building Total Parcel # Year Value XF Value OB Value Land Value Value 1 2017 $257,000 $47,400 $6,700 $353,100 $664,200 ` _ i 2 1 2016 -$253,600 $47,400 $6,700 $409,500 . $717,200 3 2015 $242,300 $44,000 $9,000 $395,500 $690,800 4 2014 $242,300 $44,000 $9,300 $395,500 $691,100 5 2013 $242,300 $44,000 $9,500 .$395,500 $691,300 6 2012 $247,800 $43,400 $7,500 $395,500 $694,200 7 2011 $295,400 $0 $0 $395,500 $690,900 8 2010 $295,800 $0 "$0 $395,500' $691,300 9 2009. $404,000 $0 $0 $633,200 $1,037,200 10 2008 $421,500 $0 $0 $6591,700 •$1,081,200 12 2007 $419,900 $0 $0 $659,700 $1,079,600 13 2006 $378,700 $0 $0 $441,200 $819,900 14 2005 : $338,500 $0 $0 t $399,500 $738,000 15 2004 $283,400 $0 $0 $299,600 $583,000 : 16 2003 $256,500 $0 $0 $149,000 $405,500 ` 17_- 2002 $243,400 $0 $0 $149,000 $392,400 18 .: 2001 $243,400 $0 $0 $85,600 $329,000 r 19 2000 $174,800 $0 $0 $56,100 $230,900 20 1999 $170,300 $0 $0 $56,100 $226,400 21 1998 $170,300 $0 $0 $56,100 $226,400 ' 22. 1997 $176,300 $0 $0 $37,000 `$213,300 23 1996 $85,600 $0 $0 $37,000 $123,100 24 1995 $85,600 $0 $0 $37,000 $123,100 25 1994 $92,100 $0 $0 $66,600 $159,200 26 1993 $92,100 $0 $0 $66,600 $159,200 http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=27083 12/30/2016 Parcel Detail 4 Page 3 of 4 27 1992 $105,000 $0 $0 $74,000 $179,500 ` 28 1991 $111,500 $0 $0 $83,200 $195,200 29 1990 $111,500 $0 $0 $83,200 $195,200 x ' 30 1989 $111,500 $0 $0 $83,200 $195,200 31 1988 $54,100 $0 . $0 •$25,300 $79,400 32 1987 $54,100 '" $0 $0 $25,300 $79,400 33 1986 $54,100 $0 $0 $25,300 $79,400 Photos t- Y h, mm R http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=27083 12/30/2016 I Parcel Detail w Page 4 of 4 w 4 � i l i http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=27083 - 12/36/2016 J� Town of Barnstable 0 61163y7� *Permit# Regulatory Services Expires 6 m.andis from issue date Fee St . • R�x*nc'*itn w i �h�a� Thomas F. Geiler,Director t Building Division -PRESS PERMiT Tom Perry,CBO, Building Commissioner ,. . P 200 Main Street,Hyannis,MA 02601 1 L(! www.to wn.batnstab l e.ma.us Office: 508-862-4038 TOWS O.f=.BAR:1*TF±Ei, EXPRESS PERMIT APPLICATION - Fax: 508-790-6230 RESIDENTLAl, ONLY � Not Valid without Red X-Press Imprint Map/parcel Number Property Address II n 1 residential Value of Work �b t n Minimum fee of$35.00 for work under$6000.00 Dwner's Name&Address i :ontractor's Name J pfir-n J AC Telephone Number u A d7.Z tome Improvement Contractor License#(if applicable)__'3 s(5 3 ci onstruction Supervisor's License#(if applicable)_ c`j 1 J,-1 ]Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ Iam the Homeowner have Worker's Compensation Insurance urance Company Name f 1 tl04 irkman's Comp. Policy#_w C. 1 oy of Insurance Compliance Certificate must accompany each permit. nit Request(check box) Re-roof(stripping old shingles) All construction debris will be take — t ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value #of doors (maximum.44)#of windows ` *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. **.*Note: Property Ownef'must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is re uir . ATURE; I nS befor e or r 047 e the egist ti ..lee o f epAir ratio4 / Bp parkpConsu o anon daracid for stony a�,s erg ffafo god*. p jl6,te 3 s I�p and.& tl ret'o use oni ti' s�ness to: 1 _ Regu/adon t`. N� C of ,d No uts� d' -------------- na to e Office of Consumer A�us' ess Reguiatib - t HOME IMPROVEMENT CONTRACTOR Re91stration: A:38539 3 Expiration: 4Q1a2013 Type': DBA. SE IDE}ROOFINGt n vt S�EE3FEV6''" r• JOSEPH JACINT6I 3 LAKEWOOD DR a HARWICH MA 02645 Undersecretary". t _ r 1pik pepxrtmcnt bt Qu 'tA.nda��4 tVlassachusett5 Regtitat ons:and S. Bu�ld►n� g ecialty:License 4P Board of ery R is tr ction SAP Cons 163 g9 „y License. CS SL Restricte d to RF WS r *ax O JOSEP;H a 3:"LAKEWOOD DRIVEa HARW ICH IJ 02645 EXFira Uon ',1017l 11 F 1} fL^ Tr# 99163 • 1 The Commonwealth oftMlassachusetis Department of jndustrial Accidents f ;! Office of Investigations 600 Washington Street \v/ Boston, lYlr4 OZIII ;. l t z- www.mass gov1,diri Workers' Compensation Insurance AffldaAt: Builders/Contractors/Electricians/PIumbers Applicant Information Please Print Le ly Name (Business/organization4ndividuw): �fr� 1 Address: � �-& 14lleVdnz.e City/State/ A PLJI oL, Phone #: F a employer?Check the appropriate box: T e of pro re uir y a employer with 4.'❑ I am a general contractor and I yp' P ( q loyees(full and/or part-°rime).* have hired the sub-contractors 6. ❑New construction a sole proprietor or partner- listed on the attached sheet t 7.. ❑Remodeling and.have no employees These sub-contractors have 8. •Demolition ing forme in any capacity. workers' comp. insurance. 9. Building addition workers' comp, insurance 5. ❑ We are a corporation and its red.] officers have exercised their 10.❑Electricalrepairs or additions a homeowner doing all work right of exemption per MGL 1I.❑ Plumbing repairs or additions lf, [No workers'comp. c. l52, §1(4), and we have no ]2, f repairsce required] t employees.[No workers' comp. insurance required.] 13.❑ Other *Any applicant that ch=ks box#1 must also fill out the section below showing theirworkers'compensation policy informadon, t Homeowners who submit this affidavit indicating they am doing all work and then hire outside contractors must submit a new affidavit indicating such. 'Con tractors that check this box m ust attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information: I am an employer that 1ss providing workers'compensadon insurance for rrty employees. Below is the policy and job site information Insurance Company Name: •Policy#or Self-ins.Lic.#:�� 1. .q /f a, 0 , -5� � ' ' Expiration Date: Job Site Address: AR&t- �-�-` K� City/State/Z' Ip: 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/o'r 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. s i'do here fy un pains and penaftu of perjury that the information provided above is true and correri ` ii ature: Date: 'hone Ofcial use only. Do not write in this area;to be completed by city or town bffuia! City or Town: - Permit/License# Issuing Authority(circle one): r 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 ofhire, 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()states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone numbers)along with their certificate(s)of insurance..Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry•workers'compensation insurance. If an LLC or LLP does have employees,a olic is Te uired. Be advised that this affidavit may be u policy q y 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 ifyou 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 provideda space at the bottom of the affidavit for you to fill out iii the event the Office of Investigations has to contact yod regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary•) and under"Job Site Address"the applicant should write"all locations in (city or town)."A.copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (Le. 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 p l y Town of Barnstable Regulatot}^(�'/ Services '� Al A7JRr1 RIB 1 �/ Thomas F.Geiler,Direcfor Buildin Division g Tom perry, Bui Idin Co�I Y IDIIllSS]O , g ner 200 Main Strad I3y2=i4 MA 02501 www-town.barnstab ie.ma.us Office: 508-862=403 8 Fax: 508-790-623 0 Property Qwner'Must Complete and Sign This section If Using A Builder ' I, ►a�-i ��(� (�o r[ , as Owner of the subject property hereby 2utlZoTi7p' to act on my be.1a f,- is 01 matters relative to wQr1e authorized'bythis'buildingpermit application fora (Address of Job) Signature ofDate rint Name If_ :rope , Owneris applying forperrnitplease com Iete. the` Homeowners License Exemption .dorm on the reverse side , Town of Barnstable Regulatory Services i RlArucrlR 1h nms F. Geller,Director saS� ` *� Banding Division 'rEn lvcs't Tom Perry,Building Commissioner _ 200 Mani•Str JrMA 02601 _ - ,— y_ s, WWW.town_barnstable_ma us Office_ 508-862-4038 Fax: 508-790-6230 gonMOWNER L MISE=MMON Fleue Print DATE JOB LOCATION: numbs street village '710MEOWNER": name home phone# work phone# CUR2UN7 M kUNO ADDRESS: erty/>Liwn at do zip code The current exemption for"homeowners"was extended to include owner-occupied dwt:l zs of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor_ DEFk=ON OF EOMEOWI•'ER Person(s)who owns a parcel of land on which helshe resides or inf=ds to reside, on-% ichtbere is, or is intended to- bc, a one or two-&rmly dwmIlmg, attichcd or detached structnrrs accessory to such use and/or farm strucfiars. A person who constrgcts more than bne home in a two-year period shaIl not be considered a homeownrs, Such `homeowner"shall sabm t to the BmZding Official on a form acceptable to the Building Official, that heVshe shall be respoi sible for all such work-ptaf mcd'undertbe buildine'De>miL (Section 109.1.1) The undersigned`homeowner"assumes responsibility for compliance with the State Building Code and other. applicable codes, bylaws,rules and regulations. The undersigacd'homeowner"certifies that,helshe•understands the Town of Bamstable Building Department �imum inspection procedures and rcquircment3 and that he/she vU comply with said procedures and requirements. Signature of Homeawna Approval afBuflding•Of5cW , Note: Three-family dwellings containing 3 5,00 0 cubic feet or larger vvU be required to comply with fibs ' 3t do Building Code Section 127.Q Construction Control. ' $oa�ow��s T-sox • ' The Code states that: "Any bgmeawncr pmf=dmg wo t for which a bmlding permit is rrquircd shaA be exrsipt from the provisions t•this suction(Section 109.1.1-L=u-rtg of corutr artiam Supavison);provided tha t if the horn=v/ncr engages a persod(s)for hire to do such 064 that ruck Hameowacr sball act as supawar." k�aay homeawnas who use this are unaware that they at xmnning the responn'hslities of t sups risor(see Appa dix Q, iles do 1Zcgulzdms for g=r=ing C=strueSaa Sup yisaa,Soctiam 2.15) This lack ofawz=cw bfkn rrsulrs in serious problems,particularly 1a the hamcowner hirers unliczased persom In this ease,ova Board czrmot proceed against the unliecased person as it would with R licaiscd oavisar. The havi=-%mcr acting u Supvvisor is n}tarntely rrspoWbla sN a„ F'd NOTICE NOTICE TO = TO EMPLOYEES EMPLOYEES . ..........: The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 1 Congress Street, Suite 100, Boston, MA 02114-2017 617-727-4900 - httn://www.mass. og v/dia As required by Massachusetts General Law,Chapter 152,Sections 21,22& 30,this will give you notice that I (we) have provided for payment to our injured employees under the above-mentioned chapter by insuring with: LIBERTY MUTUAL INSURANCE CO NAME OF INSURANCE COMPANY ?0 Box 9102 Weston, MA 02493-9102 1-800-762-5026 ADDRESS OF INSURANCE COMPANY qC1-31S-342974-031 04-26-2011 04-26-2012 ?OLICY NUMBER EFFECTIVE DATES 4ARK T VOKEY INSURANCE AGENCY (508) 945-3535 vAME OF INSURANCE AGENT PHONE # PO BOX 1247 WEST CHATHAM MA ADDRESS OF INSURANCE AGENT JOSEPH JACINTO DBA SEASIDE 3 LAKEWOOD DRIVE EMPLOYER ADDRESS EMPLOYER'S WORKERS'COMPENSATION OFFICER (IF ANY) DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers'Compensation Act.A copy of the First Report of Injury must be given to the injured employee.The employee may select his or her own physician.The reasonable cost of the services provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury.In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the XT A A4Ir CIT7 TJ"0DT'T A T A TIM?P QQ April 7, 1995 72 Harbor Bluff Road, Hyannis, MA n Water service has been shut off. CJ� cep �z ����/ Sewage has been disconnected. LI C. rS �' 11 S/� Electric service has been discontinued. There is no gas service at this site. Telephone service has been disconnected. ZIT" • Commonwealth Electric Company 2421 Cranberry Highway OME16 Wareham,Massachusetts 02571 Caric Te lephone (508)291-0950 484 Willow St. Hyannis, MA 02601 April 4, 1995 r Town of Barnstable Building Inspector 367 Main St. Hyannis, MA 02601 Dear Sir: The.electric service and meter at 72 Harbor-Bluff Rd., Hyannis were removed on March 31, 1995.This was done at the request of the owner, Arthur R. Fogelgren . Very truly yours; Barbara A.Trocchi Customer Service Rep. To Date Time WHILE YOU WERE OUT M of Phone Area Code Number Extension TELEPHONED PLEASE CALL CALLED TO SEE YOU WILL CALL AGAIN WANTSTO SEEYOU URGENT RETURNED YOUR CALL Message v OLA_. C �. Operator AMPAD 23-021-200 SETS EFFICIENCY® 23-421.400SETS CARBONLESS - S +� BUILDING DEPARTMENT TOWN OF BARNSTABLE Correction Notice Job Located at ... Z.. .a' .... �,�?. I have this day inspected this structure and these premises and have found the following violations. .�� ..... ... ?. .......................................... ................:................................................................................................. .................................................................................................................. .................................................................................................................. .................................................................................................................. .................................................................................................................. When corrections have been made, call for in- spection. Date ................................. .................................................................. Inspector for Building Dept. DO NOT REMOVE THIS SIGN sses;or's Office(1st floor) Map �2 J _.- Lot Z �� Permit# 3� O4 Conservation Office Oth floor) Nr 1� ��_ . Date Issued usr valmsArrIAWM A SLWf.'R Board of Health Ord floor CONNECTION PERMIT]MOM moal PM To n+s Engineering Dept. Ord floor) House# Planning Dept. (1st floor/School Admin.Bldg.):,!/ VT RAMSTABMMAM 'r Definitive Plan Approved by Planning Board J 19 (Applications processed 8:30-9:30 a.m.& 1:00-2:00 p.m.) TOWN OF BARNSTABLE -Building Permit Application Pro•ect Street Address 7 Z 6 /-, C)/L 124a f 7" i A/Y44)A Village r `1 G_2 Ii Fire District �'/�v,k?i Owner /Q / �y' /'--e� �i/��i�J Address / / 01C e v C4' I C D, �✓�TO�� +� Telephone — �Y 7 6 Permit Request: or`"` ,c•�-isTi>v�1' �r, � Zoning District /� �F Flood Plain Water Protection Lot Size /�.l'� 7 Grandfathered Zoning Board of Appeals Authorization Recorded Current Use S//Z!1'/C Proposed Use �lJ �✓ Construction Type Liu ©C.) 0 / /D�/VV-'r Existing Information Dwelling Tyne: Single Family c/ Two family Multi-family Age of structure ycro'er Basement type /�G��/� ru -����✓'.ne-1` T Historic House e) Finished `/If Old Kings Highway Unfinished Number of Baths / No. of Bedrooms 3 Total Room Count not including baths First Floor .S Heat Type and Fuel Central Air Fireplaces Garage: Detached At 10 Other Detached Structures: Pooh Attached Barn A10 None ,/L' Sheds Other Builder Information Name 0171 Fl 06� f/1�r�r f z" Telephone number 2 Y6 V© Address_ �' �'U/C e(/j J jo�2�.a�f�� License# Z-2 y In 00/7 , M/V ©2_36� O Home Improvement Contractor# Worker's Compensation # NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN (AS BUILT) SHOWING EXISTING, AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE Pro'ect Cost 1S0 dv Fee a� SIGNATURE DATE �/" ��-' 57 BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) 05 A GC o2 S r BPERM T 3� 2 G 9 l`'• FOR OFFICE USE ONFLY 3/28/95 -3-7-56.6- - r 325. 128 ADDRESS 72 Harbor Bluff Rd. VILLAGE Hyannis A. Roy Fogelgren OWNER DATE OF INSPECTION: , FOUNDATION FRAME INSULATION FIREP f ELEC `:' ' . `ROUGH FINAL PL ROUGH FINAL GAS: „[O ROUGH FINAL FIN ING: / t DATE CLOSED OUT: t ASSOCIATE PLAN NO. " . R_ ._. ;y��Y*•fit, � r x- �Cvy- _ 3 STEEL STA-TRU SPECIFICATIONS FEATURES BENEFITS eG i -24 gauge galvanized steel, bonderized prime *Thicker gauge resists denting, won't warp, crack painted faces. or peel. Primed for easy finishing. *Full thermal break, all egdes are 1-3/4"thick toxic -Keeps cold from transferring from outer to inner treated softwood. skin,far superior to doors with steel edges. *Lock block is 12"of solid wood located 9"above *Provides added security and allows almost any i and 3"below the standard face bore. type of lock to be installed including mortise. *Full through mortise hinge. *Prevents door from sagging unlike surface mounted hinge. , -Polyurethane foam core,gives Stanley up,to -7 times more efficient than a wood door. .15.00 "R"value-the highest in the industry. Provides up to 50% more insulation value over bead board core doors. -Magnetic weatherstripping on lock and head jamb, -Provides a refrigerator type seal. compression on hinge jamb. -Patented Lock and hinge corner seals. -Makes it one of the tightest doors on the market, no water leakage at 35 mph wind and rain test. -Pre-hanging clips,to be removed after -Ensures proper and ease of installation, installation. eliminates call backs. -Five year limited warranty. -Backed by Stanley,the name known and trusted for quality. PERFORMANCE AND ACCEPTANCE DATA Air Infiltration- ASTM E 331 Water Infiltration- ASTM E 283 ANSI/ISDSI - 101 ANSI/ISDSI - 104 Specification: 0.004 cfm/ft. Specfication: Zero penetration Tested to:0.004 cfm/ft. 0 15 mph with 1.57 psf @ 5.00 gph/ft2. Tested to:0.005 cfm/ft. 0 25 mph Tested to: Zero penetration Acous erformance: ASTM E413-70TSTC 28 Energy Savirig Index- (I.S.D.S.I.)-D.I.S.I. 1.5 C fire door smoke-draft door 1/3 HR UBC Latch Bolt ThrowHersey Compliance Report#10101available upon request. All Stanley doors are shipped with a high quality finish which requires no special preparation before finishing. Sta-Tru i doors must be painted with latex paint. All door surfaces, including decorative trim, window trim and jamb must be i finished. Failure to finish all door surfaces within 45 days of installation or use of dark colored paint and/or a storm door with an entry door that has plastic decorative or window trim will void warranty. See finishing instructions for full details. E TOWN OF BARNSTABLE CERTIFICATE OF OCCUPANCY PARCEL ID 325 128 GEOBASE ID 23919 ADDRESS 72 HARBOR BLUFFS ROAD -PHONE Hyannis ZIP - LOT 3 LOTS BLOCK. LOT SIZE � DBA DEVELOPMENT DISTRICT HY PERMIT 13432 DESCRIPTION SINGLE FAMILY DWELLING (TOWN SEWER) PERMIT TYPE BC00 TITLE CERTIFICATE, OF OCCUPANCY CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: BOND $_00 CONSTRUCTION COSTS $_00 756 CERTIFICATE OF OCCUPANCY * BAR�Ns•r�AHLE, MASS. 9 OWNER FOGELGREN, A ROY & M 1639.E A ADDRESS 16 THOREAU RD ACTON MA BUILDING DIVISION DATE ISSUED 02/23/1996 EXPIRATION DATE _ I TOWN OF BARNSTABLE, MASSACHUSETTS I L D N G PER M A-325.i28 I Sfir� TE March 28 051. Q `�7er?B I Dana t11 e` 19 P R M I r Fo APPLICANT D - ADDRESS ec er erry n• ores a ! Build dwelling - (NO'.1�. (STREET) (CONTR'S. LICE RMIT TO after demolition 2 ) STORY Single family dwelling --. NUMBERDWELLIN OF G UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) AT (LOCATION) 72 Harbor Bluff Road, Hyannis ZONING RB _ (40.) (STREET) DISTRICT-- BETWEEN AND (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE I BUILDING IS TO BE FT. WIDE BY FT..LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION i I I TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: r AREA OR I VOLUME 2,700 Sq. ft. ESTIMATED COST $ 150,000 FEEMIT S 280.00 i _ (CUBIC/SQUARE FEET) OWNER A. Roy Fogelgren f' ADDRESS 16 Thoreau Rd. , Actia, MA BYILDI�QE i i I K OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL 'APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ALL CONSTRUCTION WORK: .ELECTRICAL, PLUMBING AND I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MINAL INSPECTION TI TO LATBEFORE FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 2 2 ��v IS/T ✓/�U..v� 2 3 ' HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT ` BOARD OF HEALT OTHER SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT 'W!L L BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY -ELEPHONE OR WRITTEN CONSTRUCTION. I PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION. Assessor's Office(1st floor) Man. 2(1 Lot Permit# II Conservation Office 4th floor ��►—�,.-1� �31.�0�g�d `� - Date Issued Board of Health Ord floor A En ineerin Dept. Ord fl r House# Planning De pi 1st floor/Sch 1 Admin.Bldg.): s R,ffrAN _ MAW Definitive Plan ADDroved by P)kning Board 19 (Applications Drocessed 8:30-9:30 a.m.& 1:00-2:00 .m. T %-Idin�g F BARNSTABLE Permit Application Proiect Street Address 7 2., Village _ Fire District Owner © O�� �G��� Address/(� 02�jo�. �-�•Telephone 2-6����''' 2-G 26 Permit Request: o s 1 rl w i v cl Zoning District rJ Flood Plain Water Protection Lot Size YJ-02 Grandfathered Zoning Board of ApMls Authorization Recorded Current Use �� �2 /`/�/h/ `�. �i'1-� Proppsed Use e-w �� '� /=/✓�i/4-V Construction Tune 4� / Existing Information Dwelling Type: Single Family C/ Two family Multi-family Age of structure �^U �/C.,dit's Basement type 1?Z-6e-X- Historic House C Finished Old King's HighMay /1/O Unfinished Number of Baths No.of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel /� /,/• — O /L- Central Air iL/O Fireplaces / Garage: Detached A,.-F-)I'✓'e Other Detached Structures: Pool A/O Attached Barn O None Sheds r Other Builder Information �U �� T � / ,f7X<-�•//U�Ielenhone number/ � Address 7 57 �� iJ,f'� /�.�-►� c..� License# G l/s'.� �-- L cu FYI A �2 3�G Home Improvement Contractor# Worker's Compensation # NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN (AS BUILT) SHOWING EXISTING, AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJEC WILL BE TAKEN TO Project Cost Fee (�f �C� SIGNATURFZ�',vg�r /`� � DATE_ 2.-2---r 2/ BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) '� BPERM T FOR OFFICE USE ONI TLY ADDRESS VILLAGE y OWNER DATE OF INSPECTION: FOUNDATION 4 FRAME INSULATION FIREPLACE i I ' ELECTRICAL: ROUGH FINAL .� .-PLUMBING: ROUGH FINAL GAS:. ROUGH FINAL FINAL ' DATE OUT: r - ASS = NO. • 1 � a Assessor's Office(1st floor) Map 2 Lot f `mil �`` Permit# Conservation Office(4th floor) '^*"-' -----~- a�130V�y demtl.=�t� Date Issued Board of Health Ord floor) r nsf Engineering Dept. Ord floor) House# Planning Dept. (1st floor/School Admin.Bldg.): s a�nr�sreeis MAML - Definitive Plan Approved by Panning Board 19c ''�� (Applications processed 8:30-9:30 a.m.& 1:00-2:00 p.m.) x � 3E^- TOWN OF BARNSTABLE Building Permit Application Proiect Street Address Village Fire District Owner /�c0 C�}E' �G2e� ,Address/ r/ O d c.L r1Z-/�, c'ic�l ly2lj. Telcphonc Permit Request: r> Inn D' P, /n r" 1. � 04 Zoning District I� (J Flood Plain Water.Protection Lot Size. YJ Z� i Grandfathered Zoning Board of Appeals Authorization Recorded Current Use Proposed Use fY, (A 74,4, Construction T 'IA_/oG�i Existing Information Dwelling T)Tq: Single Family Two family Multi-family Age of structure ClC.�+/a C Basement Historic House A-.I G Finished P r, _e - Old Kings Highway Unfinished Number of Baths No.of Bedrooms ? Total Room Count(not including baths) 6; First Floor ? Heat Type and Fuel © Central Air Fireplaces / Garage: Detached d/l,C) Other Detached Structures: Pool Attached Barn 1L., U None Sheds / Other .--- Builder Information Name �� /� %r/� C- C� r �f/<:t' �fU�" Telephone number f c''J �- t - 0 Address-?r' �'�t� �✓iJ ��' % +�.mac 2 License# (1)./ Home Improvement Contractor# Worker's Compensation # NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN (AS BUILT) SHOWING EXISTING, AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO•;,, f Protect Cost r '+ Fee ' SIGNATURE'r: -/r ./'` /%/ ° "-i r%."; DATE,/ BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) BPERM T FOR OFFICE USE ONLY y ADDRESS VILLAGE _ OWNER DATE OF INSPECTION: FOUNDATION ' 4 FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING: I i DATE CLOSED OUT: r ASSOCIATE PLAN NO. t ; i i r I I 114E' ti The Town of Barnstable BARAS& E. MASS � Department of Health Safety and Environmental Services t63q. �0 prED Mo+° Building Division 367 Main Street, Hyannis, MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice Type of Inspection V -> Location Permit Number Owner K �`j6LC a '1•-� Builder One notice to remain on jobsite, one notice on file in Building Department. The following items need correcting: L/ Q Re J r t e Coo C-7 A\1 Lp�ge�- i;:;n -ZC. k r Please call: 508-790-6227 for reeinspection. Inspected by Date Yfj 1 �\ �i,ucw D456 o,bl AG.W=A D) /,� op E 1 oese, ad RM AARD \' A. .. M lii.9101Y . '. : A 35eS5Dtt5;MAP �2S PGL U41- TPE EXlTnk)t. �ooOt) .Tifla Cr4L� /z XO ATE /5- ' 15 Lo c e. r-�, oat -r-N u C o O 4 n) 5+46w�J ic74AA1 asaw- N 4p b is L.oc�&Ts-c� w ir4 w TUG . 100 yeae. T+-oop 1�AZarta ZOQP P ) ��-SS�a�a� �Aug �riv�fo2 ,B�XTE�26.VyE /NC. �2EG/.5'TE.2�O Lr4��0 SU.eV6S2�� ISSUE DATE(MM/DD/YY) AQD0Io1Do CERTI .1 Ilk FICATE OF II�SU■ �,VC PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. fai-.NE L I:A & C:F=tRLl,:_C-)N :i:Iq_'E COMPANIES AFFORDING COVERAGE i Pi N 3 W 1C t,2"�fj 6 - COMPANY A LETTER "B'UI":I': FY COMPANY B - INSURED LETTER COMPANY`. S)'A°•IIJIW.I.C_.'H II_ & Fill I NC LETTER COMPANY ;(tl�iDWIC I I`1(A r?'�::.6{� LETTER D [rC i.INjf F'!__(af�� _l!` i�I(it7::i COMPANY E LETTER COVERAGES . 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. CO! 1 POLICY EFFECTIVE POLICY EXPIRATION; TRi TYPE OF INSURANCE POLICY NUMBER ; DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS i; !(}t.}.:i?�.�.3i:.%'i�fL{.:' ''?+%.:�i. W_2 {Y:'.::�.j{: GENERAL AGGREGATE ..m- r1 GENERAL LIABILITY i II= ., ( t t 3 t COMMERCIAL GENERAL LIABILITY f I !PRODUCTS-COMP/OP AGG. 4$ .I g(rC?!) C K)C) ___.__.?____ __M___--r.:. a ;CLAIMS MADE]j A OCCUR. i !PERSONAL&ADV.INJURY =$ ,_it.)(_) +C3:}:,) OWNER'S&CONTRACTOR'S PROT.g ;EACH OCCURRENCE 1$ ;�t_?(:) ;FIRE DAMAGE(Anyone fire) E$ !() ,(:1�•�C} _, f .. MED.EXPENSE(Anyone person) I AUTOMOBILE LIABILITY ! 1 COMBINED SINGLE ANY AUTO ! ;LIMIT $ ALL OWNED AUTOS BODILY INJURY $ ! SCHEDULED AUTOS (Per person) ! 1 HIRED AUTOS h I BODILY INJURY — S 4 NON-OWNED AUTOS (Per accident) i GARAGE LIABILITY F PROPERTY DAMAGE is EXCESS LIABILITY ! EACH OCCURRENCE !S �UMBRELLA FORM # j AGGREGATE S OTHER THAN UMBRELLA FORM t - }_� a v,LL.L.-77,7Hr',',_+.c`... j ?' ' is I WORKER'S COMPENSATION j ; L........ STATUTORY LIMITS , <�.....,.,... I EACH ACCIDENT t$ Oil)q tt t!'t,3 AND i I DISEASE—POLICY LIMIT $ 5t,•3[,) EMPLOYERS'LIABILITY ! ( DISEASE—EACH EMPLOYEE j$ ' OTHER ! DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS t,L,/:. F,F.1�.•+F�..I_E I�ES!:I:)I .I\IL,I: t k-,!_.l�It 1!_I fi1-I� IYiI u SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATI,QN.) DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL .t.. DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE J t,1°I RCID131 LEFT, BUT FAILURE TO MAILS CF fJOTIC SHALL IMPOSE NO OBLIGATION OR I, I , LIABILITY OF ANY KIND UPON T E MPAN , ITS AGENTS OR REPRESENTATIVES. ..?A ; r AUTHORIZED REPRESENTATIVE AGQRD 25 S .7/90 ;' ©; ORD CORPO ATION=1990 �:,: -. _.�.�• �� _;g�. • �y.. ` v. DATE(MM/DD/YY) ' CERTIFICATE OF INSURANCE 3/24/95 . PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR RICHARD A SCHELLE INS AGENCY INC ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P 0 BOX 887 COMPANIES AFFORDING COVERAGE PLYMOUTH MA 02362 COMPANY A GENERALI US - INSURED COMPANY W E STRONG CONSTRUCTION B US FIDELITY. &_GUARANTY WILLIAM STRONG COMPANY 5 SCOTT DRIVE C PLYMOUTH MA 02360 COMPANY D COVERAGES _ v 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. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MM/DD/YY) DATE(MM/DD/YY) GENERAL LIABILITY BODILY INJURY OCC $' A X COMPREHENSIVE FORM ' ' BODILY INJURY AGG $ X PREMISES/OPERATIONS PROPERTY DAMAGE OCC $ UNDERGROUND PROPERTY DAMAGE AGG $ EXPLOSION&COLLAPSE HAZARD X PRODUCTS/COMPLETEDOPER GLOO1238 , 2/10/95 2/.10/96 BI&OD COMBINED OCC $5001000 CONTRACTUAL BI&PD COMBINED AGG $5 00,0OO INDEPENDENT CONTRACTORS PERSONAL INJURY AGG $ X BROAD FORM PROPERTY DAMAGE „ PERSONAL INJURY AUTOMOBILE LIABILITY BODILY INJURY $ ANY AUTO (Per person) ALL OWNED AUTOS(Private Pass) BODILY INJURY $ ALL OWNED AUTOS (Per accident) (Other than Private Passenger) HIRED AUTOS NON-OWNED AUTOS PROPERTY DAMAGE $ GARAGE LIABILITY BODILY INJURY& PROPERTY DAMAGE $ COMBINED EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ WORKERS COMPENSATION AND STATUTORY LIMITS B EMPLOYERS'LIABILITY 28C 888 7504 94B 2/16/95 2/16/96 EACH ACCIDENT $100,000 THE PROPRIETOR/ INCL DISEASE-POLICY LIMIT $5OO1000 PARTNERS/EXECUTIVE OFFICERS ARE: EXCL DISEASE-EACH EMPLOYEE $ZOO/000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE TOWN OF BARNSTABLE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL BARNSTABLE MA DAYS WRITTEN NOTICE TO.THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,/ITS/AGENTS OR REPRESENTATIVES. ATIV AUTHORIZED REPRESENTEC��/i��'/C.-' -- . . .......... ACORD 25-N(3/93) z OR "" ORPORATION 1 993 +i A-0r) tiopcCle-0 iz( r High 94 FS 15 4OvJ My t 6 T I M& 5 TA,k 9-'5 V0%AJ 4a A-SML 0 0 Npip KA t 0 GL WALLS, A'M L-4- -PECZ-7)9-4 Z�S T7') c r Hbrbo Stuff • Veto Me on II !Park I II Kalmus /4 -ch MAT::' MAP 325 R%Ze-'GL 12,6 SPA' 7(D7 &.7 4, /4 A/ y C-) Lor .20 zi 7.5 7-5 RAY 24 7.4 ALI 7-2- �VA —Z ILMSTI Fi6s A�7 ool arm p A I -TC5-AJ (s) I U, ENAC 4 T-t-) (a C 4-nN w A- A--ov �� /e 74- Ex%5-n►j C.-Lo Ij 3 F T7t !Yl \I 23��. �A �i �• � 9 4 ( � � -p 5XI QN, 4-A5 \761 4 9G& 4-(- smq EL \-L -:BLJ,)FF5 A-7 /9-9 -01 OF or AKMARD SULLIVAN A. 13AXTM No. 29733 cr, AL ttO L),S C- e,-;,C-T P,#Ar C-Y-- Teo Co So.03 V— --Pao 906 e 0 Ts w.. A , 1�0� 770ewt=L-4,R2� U Y, —DE6.Z1 (qq,3 �2E4 OAIJ 1,0i'99'A 27, 1:-:JJ 44�EE24 OSTEWI(IL-r— lwv- P-t5p.i-� -ZotJs A C) C) AAA 'ZI�i -00456 V/r=: - Q7D V--WZ-4 5q0V,1W A A-i L A --7 -5EFt--BV IGAT ljq -EMZWeU-=, -VV620-M4--L-s".A4t!,