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0143 IRVING AVENUE
��� � G� ____ _ , r i I �� r , a 1265 Route.28 •AASoAuth Yarmouth,MA 02664+• 508-"44=0549®e�MA UC #i m It HOU { Feb..ruary`ll,2,0,1_S Hyannis Building Departmerit; .. 200 Main Street Hyannis MA 02601 Re Express.Permit:#201506,45 Munford Residence,.143`Trvng Ave yHyann's. Dear Inspector; r Seaside Alarms has completed the fire alarm;8- em at the above address l he system was installed per the plans and perrnat submitted to;your office and is in"compliance. uvith.ah"applicable.state building atid:fire codes: Al device$have' een tested a0d are"opera dual"at; &time Seaside arz�}s }ll provide routir}e and emergency;service.for theFsystem as required The Fire<Departmenf and Electrical Inspector have�been eontac ed to:do their,inspe,,c oris' Please let me know if'there.-,'s,anything further required to closeout this permit; Ilex""s; A 1 4Y. goo . Town of Barnstable *Permit�90/ Expires 6 months fr issue date Regulatory Services Fee KAM Richard V.Scali,Interim Director ADD Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 ;_ r Fax: 508-790-6230 EXPRESS PERMIT APPLICATION -, RESIDENTIAL ONLY aC� Gl Not Valid without Red X-Press Imprint. 1 Map/parcel Number o& T I Property Address o A ���i' F//`7 og 9-Residential Value of Work$ ] ®�� Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address �/t Z!'��_ v? Contractor's Named / / l��y/�1SL ` Telephone Number 6�ez7t?le / J License#(if applicable) f-�� Email: a�-l d Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ®PRESS IT ❑ I am the Homeowner' %�-I have Worker's Compensation Insurance FEB, 6 2015 Insurance Company Name � St�Gi�T 2 �N��/® Ve yS IN Ur BaRNSTABLE Workman's Comp.Policy# W Gz_,s',0®_®/ 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 (maximum.35)#of windows #of doors: Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. "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; µ � > 4 SIGNATURE _ x �`£ a F SE AS A t 6 TAKEVIN_Muilding Clfanges\EXPRESS PERMIMXPRESS.doc Revised 061313 f twx The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): _5_ e_G__s i Address: City/State/Zip: _S- , A 1 , c0i L , t� hone#: Are you an employer?Check the appropriate box: Type of project(required): 1.9 I am a employer with t' 4. I am a general contractor and I employees(full and/or part-time).* have hired the sine-contractors 6. 'D New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g• Demolition working for me in any capacity. employees and have workers' [No workers'comp. insurance comp.insurance.# '9. � Building addition _ required.] 5: We are a corporation and its 10.[V]Electrical repairs or additions 3.❑ 1 am a homeowner doing all work' officers have exercised their I LEl Plumbing repairs or'additions self. Y ' m ' . right of exemption per MGL �o workers comp. _ 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no 13.❑ Other employees. [No workers' . comp.insurance required.] r *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. lContractors 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. 7V7 Zo/y,9 Expiration Date: /0 / Job Site Address: 3 I e City/State/Zip: Attach a copy of the workers'compensate olicy declaration page(showing the policy num er and expiration date). Failure to secure coverage as required under Section 25A of MGL a 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 a/ndpenaltnies ofperjury that the information provided above is true and correct z St�riature:` ��/1�,� >�` t`� ✓� Iv��s,o.r.� 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 M i Client#:21641 - 2SEASIDEAL ' ACORD,. CERTIFICATE OF LIABILITY INSURANCE r DATE(MMID_ oE(MWDDIYYYY) 014 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 B,FLOW.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). P CONTACT PRODUCER NAME: Dowling&O'Neil PHONE 508 775-1620 5087781218 INC No,Ell: AIC No Insurance Agency " ;EMAIL ADDRESS: 973 lyannough Rd., PO BOX 1990 f INSURER(S)AFFORDING COVERAGE NAIL# Hyannis,MA 02601 +INSURER A:Associated Employers Insurance INSURED INSURER B: Seaside Alarms,Inc. INSURER C: 1265 Route 28 'INSURER D South Yarmouth,MA 02664 INSURER E i INSURER F• COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR ADD SUBR POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE I POLICY NUMBER° MMIDD MM1DD GENERAL LIABILITY EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY I c^ PREMISES Ea.a�i ante S CLAIMS-MADE OCCUR MED EXP(Any one person) S i PERSONAL&ADV INJURY S i GENERAL AGGREGATE S GEN'L AGGREGATE LIMIT APPLIES PER: I' q PRODUCTS-COMP/OP AGG S POLICY PE OT- LOC AUTOMOBILE LIABILITY { i COMBINED SINGLE LIMIT I I. t Ea accident) S ANY AUTO ( BODILY INJURY(Per person) S AALL UTOS OWNED SCHEDULE i BODILY INJURY(Per accident) $ AUTOS NON-OWNED PROPERTY DAMAGE S HIRED AUTOS AUTOS Per accident ( S. UMBRELLA LIAR OCCUR j EACH OCCURRENCE S EXCESS LIAR $ AGGREGATE S DED RETENTIONS ' A WORKERS COMPENSATION WCC50050117472014A 2110/2014 02/10/201 'X WC STATU- oTH AND EMPLOYERS'LIABILITY YIN t ANY PROPRIETOR/PARTNERIEXECUTIVE r E.L.EACH ACCIDENT S1,000,000 OFFICER/MEMBER EXCLUDED,? N]!N I A (Mandatory in NH) - E.L.DISEASE-EA EMPLOYEE S1 OOO 000 If yes•describe under • i ` - DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT S1,600,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional 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: r t • CERTIFICATE HOLDER CANCELLATION Town Of Barnstable THE ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Regulatory Services ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main St Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD , #S124730/M124613 KKM + BAINSTABLL Town of Barnstable Regulatory Service Richard V.Scali,Interim Director Building Division n Thomas Perry,CBO Building Commissioner 200 Main Street,,Hyannis,MA 0260.1 www.town.bat!rnstable.ma.us « Office: 508-862-4038 Fax: 508-790-6230 P r®p�rty Owner Dust Complete and Sign This Section, If Using A Builder as Owner of the subject property hereby authorize �'l f7/Ge2"li"�,` to act on my behalf,, in all matters relative to.work authorized by this building permit application for: 0, - (Address of Job) p Sign a,,*of OwneA Date V-d Print Name If Property Owner is applying for permit,please complete'the Homeowners License,Exemption'Form on the reverse side. TAKEVIN D1Building ChaneeslEXPRESS PERMITIEXPRESS.doc Revised 061313 Commonweafth of P,9ass act use`ts Department o, Public Saieiy _ q . ticcurits'Ss arms-S-).irrnst• Y-, _�cense SSCO-000046 x ROBERT K BOU HER 1265 ROUTE 28 S YARMOUTFI MA,0r1664 "' / It A—eex CCpir-anon.' - cur lmiss'i,,Pr 01/05/2017 V. OMMOMWM=0 � 1�5ET��w . • �. �.� • l A or , EE1rTft I C 1 ACES t ISSUES THE FOLLOWING E` irENSE AS ' h. A 1�1: rtRED SY CON'fRACTO} S)tA1E ALARMS 1NC ft0`BE.RT K .84 CHhR 1265 ROtI'I'E 28 ' Y1IRMOUT1 1'4A 02664 4455 � 1317:>C o 73403 • ,• -- AL3Afi'i�l` a- 'tTf�I G1 Al��a i ISSUES TI fO.,dwjNG fi ENSE AS i f? Rfl tT xx K. BOUCHESR 218 SETUCK7=T 'RD 10 F10UTH wFQRT R� 02675"2-25g 463 D 07/31/136: gild- yc✓,��s orb (96 E�rS� (Dp tea' . --nn w o 0110 ►JET PIE ®p Co G"CETECTOR A e NUT OET RIR♦iRaw _' BAEAKERJNOti1w1 ASOKE D TECTORS REVIEWS A BARNSTABLE BUILDING DEPT. M16ATE i F/oQ 'Y FIRE DEPARTMENT DATE T ,BOTH SIGNATURES ARE REQUIREO!OR FERMITING I , - F Op K� GOPD OA + ADN e ii 7- o d, } r' - .. ail p M,7tif i . A Ow f �0'Z?—rs �t rqy, Town of Barnstable *Permit# Expires 6 onths from issue d e Regulatory Services Fee * BMWSrABM F Mass.1639. � Richard V.Scali,Interim Director Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X--Press Imprint Map/parcel Numberto {J Property Address �<J 7 ❑ Residential Value of Work$ ��- d®d,WMinimum fe f$35.00 for work under$6000.00 C Owner's Name&Address , Contractor's Name Telephone Number Xd A Home ImprovemeJUon7tractor'Licen' e#(if applicable) E ail: PRM PEA Construction Supervisor's License#(if applicable) ® D I ❑Workman's Compensation Insurance O C T 2 8 2013 Check one: ❑ I am a sole proprietor I am the Homeowner TOWN OF BARNSTABLE I have Worker's Compensation Insurance . 6 Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accon6any 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 yR� Replacement Windows/doors/sliders.U-Value_ o (maximum.35)#of windowsa V #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 co y of the Home Impro ent Contractors License&Construction Supervisors License is re ire SIGNATURE: Q:\WPFILES\FORMS\bui din permi orms SS.doc Revised 061313 i --- ---- .... the t;vmrftoranteakh of Massachusetts Deparhnent of bufusftialAccrdents 0,07ce of lnvest gafians 600 Washurgton greet � Boston,M4 021I1 . wnnv.inas&gov-1dia Workers' Compensation lusurance Affidavit.-Builders/CantractorsMectricians(Plumbers Applicant Information Please Print ,ibly Name;(Business/Organizafion(Individnat)_ Address: CityfStabelZip: �: p 11,ke u an employer? Check the apprapriate box- Tape of project(rrqured�_ . I am a contractor and I ❑ 1_Al am a employer with 4 ❑ _ �� 6_ New construction employees(full and/or part-time).* have hired the subcontractors. 2..❑ I am a sole proprietor or partner- listed on the attached sheet 7- ❑Remodeling ship and hate no employees These sob-contractors have g_ ❑Demolition. w for me in an capacity. employees and have workers' orkrng Y I 4_ ❑Building addition [No workers' comp.insurance comp_insurance_ required] 5. ❑ ttte are a corporatioai and its 10_❑Electrical repairs or additions officers have exercised their 3_El am a home�rwner doing all work 1 _.❑Plumbing repairs or additions exemption myself [No workers'comF_ - right of�mp per MGL 12,❑Roof repairs insurance required_]F c- 152,§1(4),and we have no employees (Iv o workers' 13_0 Other . comp-insurance required.],. *Any appiicwt that checks boa#1 must also fill out the:sectioa beIow showing they woriken'compensation policy inform 4on— T Homeowners who submit this affidavit indicstmg they are doing&U wc3 k and then hire oaztside contractors mast submit a iww afdnit indicating such_ acantractors that check this boot must attached an additional sheet showing the name of&a smr-caursobars and state whether ormot those entities have employees. If the sub—contactors hose employees,they nnrst provide their warkers'comp.policy number. I am an employer that isprmiding workers'compensation insurca far my emplbyecss Below is Stepolicy and job site information. Insurance Company Name- Policy 9 or Self-ins-Lic-#: Expiration Date:_ - Job Site Address: Ctty1'StatelZrp: z 1-17 Attach a copy of the workers'compensa ' alicy declaration page(showing the policy)num er and elm ation date). Failure to secure coverage as required under ection 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 iraprisortment,as well as ciinl 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 Imiestigations of the DIA for insurance,coverage verification_ I do hcreby�certify re er f pains an n as a ury that the information prat�ided abm is and correct Sitmature: Bate: b Phone#: Qfji al use onI,}. I)a not trrite irr this urea,to be completed by rio or fawn offriiaL City or Town: PerndtUcense# Issuing Authority(drele one): 1.Board of Health 2.Budding Department 3.CityfT`own Clerk 4.Electrical Inspector -5.Plumbing Inspector 6.Other Contact Person: Phone#: 6 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 IocaI 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 cez%ificatc-(s) of insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or pa-tners,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 'I1-e 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 tilled 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 Gffke of kyestiptions 600 Washington Street Boston,MA.02111 TO. A 617-727-4900 W 406 or 1-977 MASW-E Fax# 617-727-7749 Revised 4-24 07 www.massgov/dia 4. �n+E. • * enRNSrnsta • 'Town of Barnstable 'FORA 'lR.egulatog`y Srv>ces Thomas F G'eler,D"rector Building Drvis; on Thomas Perry,:Q Q. Building Commissioner 200;Mai Street H}-arnns;:Iv1A 02601 www.town.barnstable ma.us Offce 508-;86?=4038 Fay; `503 790:-62 :0 Property ®whet Must Complete and Sign This Section If Using A'Builder_ ;.a� C)� .her cif the sp.b" t j�ro crr h;c.tOy authorize 44 c) 1ct can:[-n behalf. III all matters. Yi lati�e /authblr ,ea this build j�crinit ail lieatic�n for: 1 Li-3 _1 AV l n G- ' l�t/� o►�n h t S�U17 l (Address;of.Job} ¢. I S tma _rc of'Ow .f Date 13. 1Itu'A t FOY-C( { l.'<rult Name: 1f Property.Owner is apply mg'for Permit,please,complete the H`omeow.ners License Eacemptton.Form on the reverse.side: C U+ors'Jccnllil.itl Oat�tL:ivc ikMidds afdW indiiiqti cniroran Intcrn�t i d� >;C omtuu Jut'c��ihiUt)Vg7\A%1[.\PRC SS d ic. Revised 0721..10 I Client#: 10798 ACC✓'RDA, 2RILEYCJ .. C,E TIFICATE OF LFIABff f t Y ff � �r r HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND COIJFERS NO RIGHTS UPON THE CERTIFICATE (M05/ M/06/2013 D/YYY1) CERTIF2ATE 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),AUTOHOR ZED 1S 'RESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, ANT: H the certificate holder , e ADDITIONAL INSURED,the poflcy(les)mus4 be endorse.'..If SUBROGATION IS WAIVED,subject to sns and conditions of the policy,certain policies may require an endorsement.A statement o ce*at; e holder In lieu of such endorsement(s). n this certificate does not confer rights to the ODUCER Wing$ O'Neil ME: urance Agency PHONE A1C,No.En:508 775-1620 3 lyannough Rd., PO Box 1990 E-MA L — AA:,No: 5087781218 annis, MIA 02601 ADDRESS: INSURERS) (RED AFFORDING COVERAGE INSURER A:National Grange MUtual (nsuranc NAICs C.J. Riley Builder,Inc. INSURER B P. O. Box 382 i INSURERC: OSterville, MA 02655 INS SURERD: I INSURER E ERAGES CERTIFICATE NUMBER: -tr+suRERF: S IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD ITIFICA NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMEREVINT WITSION NH R®SPEC7 TO WHICH THIS ITIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUB ECT TO ALL THE LUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. S TYPE OF INSURANCE 'ADOLSUBRTERMS, ENERAL LIABILRY INSR WVD _ POLICY NUMBER POLIC EFF POLICY EXP iiflP059664 MM./DD/riYY MM/DD t COMMERCIAL GENERAL LIABILITY5�2�013 05/02/201 EACH OCCURRENCE LIMITS_ CLAIMS-MADE OCCUR 1 pAMA%J _A $1 OOO OOO IEM S aoccccurrrence S500000 I MED EXP(Any one person) S_1.01000 I PERSONAL&AOV INJURY $ 1 000 OOp V'L AGGREGATE LIMIT APPLIES PER: (POLICY PRO- n GENERALAGGREGATE s2 000,000 LOC '^MOBILE LIABILITY PRODUCTS-COMP/OPAGG s2,000,000 I I M9059664 5/02/2013 05/py207 COMBINED SINGLE LI IT s YAUTo ED scMEDULEo , Ea accident _ 11000,000 AUTOS BODILY INJURY(Per Person) s HIR OS 3( NON-OWNED I AUTOS BODILY INJURY(Per accident) $ P eOaccE dTnl AMAGE s IMBRELLA LIAO X OCCUR EXCESS LIAR BINDER359107 ��— 5/t12/2013 2/201 0 $ CLAIMS-MADE EACH OCCURRENCE s3 000 000 ED RETENTIONS AGGREGATE $3 000 OOO ERS COMPENSATION NPLorEas'Lu►BIL I WC059664 'OPRIE-'OR/PARTNERJEXECLJTIVE Y/N 5/05/2013 05/05/201 X WC s�AITU- OTH• $ RIMEMBER EXCLUDED9 ® N/A� Iory Ie Vnd E.L.EACH ACCIDENT ��Under �---—___` PTION OF OPERATIONS bebr S500 000! I I E.L DISEASE-EA EMPLOYEE $500 OOO IE.L.DISEASE-POLICY LIMIT S50O 0O0 :IF OPERATIONS/LOCATIONS/VEHICLES(AttachACORD701,AddltionalgcmcrkaSchedul H Coverage is limited to the terms,Conditions,exclusions, other limitations and endorsements. 4 more LDaec Is reQulreed) rntained in the Certificate of Insurance shall be deemed to have altered, waived,or extended the :rovided by the Policy Provisions. HOLDER CANCELLATION !own Of Barnstable !DO fylaln Street THE SHOUEXPIRATIIO ANY OF kHDABE VTHEREOFOESCRIgENOOCEI WIBE LL CBE CDELLED ELIVEREDORE Iysannis, AqA 02601 ACCORDANCE WITH THE POLICY PROVISIONS. N A UT14ORIIZ'EDDRREPRESENTATNE 0/05) 1 of 1 The ACORD name and logo are registered marks of A o19 8-20�10 A'--COOR-D CORPORATION.All rights reser ed. VIVII 10878 m assach usetts -DepartMent Of Public Safety Board of Building Regulations and Standards C Junc�i.:ur Lice "a� nse: C8-068147 C'RAIG J RILEy PO BOX 382 4, OSTERVILL,E WA O26 g 7 Cornm93sroner 'Expiration 02JOS12015 Office of C os r Ati HOME IMPROVEMENT CONTRACTORnew R License or registration valid for individul use onI Registration. 125799 before the expiration.date. If found return to: Y Expiration: 1f30/2014 Type: Office of Consumer Affairs and Business Regulation Private Corporatia, 10 Park plaaa_suite 5170 V- ILEVY BUILDER[Nc Boston,MA 02116 CRAIG RILEY 10 B WIANNO AVE, '4 OSTERVILLE,MA 02655 Undersecretary � a out signs — Town v � T - o YT n o[•Barnstable 2eguito-ryServices Hate: t �3� l oFVE t'4pmas F C,e�Ber,Dire for . /', Fee. 'B CXJ uilding Wvasion • BAR\57'ABI.E, CGm—P,rrx ;..�1TItifing Commissioner T MASS. '�639. �� 266'Main Street Hyannis;MA 02601 atED www:towri.barnstabte.ma:us Office:' Sob'-86Q 4038 Fax; '08-79o-6230 TOWN OF BARNSTAB, L V v eta M �U 7 75 l 0 01 Phone _ `F� _ Install at (`{3 ��LLv�h Cu E VilEat � a_►�i�s_ l�Y-� Date: Map/Parcel `,�$ 7- b4o �_. Stave f3. I ype: Radix Circulating' �r�S�(,L 7"37 Manufacturer a Lab.I\10 "��' ,dd���� i D. Model No:: Chunney A. N.eN�LLxist in(If existh1g Please note_date of lost cleanit39) Y _ 13. flue Size_ 0 C. Arc Gather;apptlance5 attached to D. Pre-fab`i ype and Manufacturer7-7�- ---" L Masonry. :,, tnt nlined , Hearth j.. A. Materials: t f tG _ _r s B. Sub 1~loort onstruction: C,, G . ` . Installer Name w.+-,e r c �,.,� Address " /. _ Phone 1�1> c ,a laccattori,o In-sa'llatiori` yt k 1J Registration Con fstruction S'u rvlsor. J v 6 OR check lomeowner Installing,no ltccnse-required, APPROVED BY: Please make cheeks payable io the Town I3artrstirble This:constitutes an official:stove permit after inspection, photogi phdd, and approved 4o the Btiildirag h7spector . = Q :forms.stor. Rev 1010 The Commoftwealth'bfMassachuseats Depar ent of lndustria1 Accidents Office of 1'nvestijations ' 600 Washit gton Street Boston.,',MA 02111: wttnv: mass kov1dia b . Workers'Compensation Insurance Affidavit: Bi ilders/Contractors/Electricians/Plumbers Applicant Information Please lPri�if Legibly Name(Business/Organization/Individual}: Address:_ City/State%Zip:_ e.� evv ��.4- .I r�..U`' hone.#: <6' Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with 4• ® I am a general contractor and I emp ti loyees(full and/or partmel. * have hired the sub contractors 6. El:New construction .2-Q l am a sole proprietor or partner: listed on the attached•sheet. 7. 0 Remodeling ship and have no employers These sul contractors have 8."C_Demolition working for me in any capacity: employees and have workers' i [No workers'comp.,insurance comp.insurance. t 9. [(Building addition required.] 5. We are a corporation and its IO.0 Electzical repairs or additions j 3.[j I am a homeowner.doing all-work Officers have exercised their I LEI,Plumb atg repairs or additions myself.[No workers'comp: right of exempiion per MGL 12.C#Roof repairs insurance required.] c.152,§f(4),and'we Have no eesjNo workers' 13. Other —( �oae ernployc S'��► insurance,re, ed: comer �: J .. . *Any applicant that checks box#1 must also fill out the section below showing.their wo>ias'coiapextm ioa policy infomiatian. t ftomeovffim who submit this affidavit indicatipg tie doing all work and then hire outside rontwtots iucst subrfii new affidavit mdicating such. tcontractors that cheek this box must attachtd.an additional sheet showing the:narrse have employees. if the subcontractors have employees,they must provide their workers"comp.policy t€umhu I am an employer that is providing workers'compensation insurance for my'e4loyees.,.Belo w is the polity and job site information: Insurance.Company Name: f t Policy#or Self-ins.Lit. :�A-i 1 �(.3 �471- Expiratioa Date: Job Site Address: �j. 3 MVC(l(- ftdr— City/State/Zir: Attach a copy of tfie wtsrkers'cm in declaration page(showing the policy numxpiratitfn date). Failure to secure coverage as required under Section 25A of MGL'c.7 52 can lead to the imposition of:crimiztafl penalties of a fine up to$1,500.00 and/or one-yearimprisonunent,as well as civil penalties in:the fbrm 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 staten-setit maybe forwarded to the•Otfi'ice of Investigations of the DIA for insurance coverake verificati6n_ 1 do hereby certi nder the pains and penalties of perjury that the infoiniation provided a. ove is true:vid correct Signature: 4 Date... Q-) 3(710A Phone# Official use only. Do not`write in this area,to.be cotnpteted liy city or town offu:url, City or Town: ferniiilLtcense Issuing Authority'(circle_one): I.Board.of Health 2:Building Department 1 City/T'own Clerk 4 Electrical Inspector: S.Plumbing Inspector b.Other Contact Person: Phone#• i Licensee Details Page 1 of 1 s The Official Website of the Executive Office of Public Safety and Security(EOPS) Mass.Gov Home Public Safety Department of Public Safety.Licensee Complaints t License Type Construction Supervisor License H 105026 Restriction SF Name Scott Smith City,State,Zip Centerville,MA,02632 Expiration Date 8/12/2013 Status Current f No complaints found for this Licensee. Back To Search http://db.state.ma.us/dps/licdetails.asp?txtSearchLN=CSL105026 10/28/2011 Licensee Details Page 1 of 1 The Official Website of the Executive Office of Public Safety and Security(EOPS) Mass.Gov Home Public Safety Department of Public Safety Licensee Complaints License Type Construction Supervisor License# 105026 Restriction SF Name Scott Smith City,State,Zip Centerville,MA,02632 Expiration Date 8/12/2013 Status Current No complaints found for this Licensee. ,Back To Search http://db.state.ma.us/dps/licdetails.asp?txtSearchLN=CSLI05026 10/28/2011 HIC Registration Lookup Page 1 of 1 The Official Website of the Office of Consumer Affairs&Business Regulation(OCABR) Mass.Gov Consumer Affairs and Business (Regulation Home> Consumer>Home Improvement Contracting> Ligl url y� ................... ................ Home Improvement Contractor Registration Lookup The list is current as of Friday, October 28, 2011. You can search/filter the registration list by any of the criteria below. RELATED LINKS Search by Registration Number 161642 I Ionic Improvement Contractor Search Registration Number) !! Registration Home Page Search by Registrant Name Search by City Zip Code Search Registrants) Click on the registration number to view complaint history.You can also view arbitration and Guaranty Fund history. _.... ......... ......... Search Results REGISTRANT RESPONSIBLE REGISTRATION EXPIRATION NAME INDIVIDUAL NUMBER ADDRESS DATE STATUS P.O.BOX 202 CHIMNEY CARE�SMITH,SCOTT 161642 11/12/2012 Current MARSTONS MILLS,MA 02632 © —[ J 2011 Commonwealth of Massachusetts c http://db.state.ma.us/homeimprovement/licenseelist.asp 10/28/2011 _ WORKERS COMPENSATION FIND'EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Associated Industries of Massachusetts Mutual Insurance Company 54 Third Avenue,Burlington,Massachusetts 01803 . Ncct NO 261;58 (Boo)876-2765 POLICY NO. AWC 7024208012011 PRIOR NO. AWC 7024206012010 ITEM 1. The insured Scott Smith dba.Chimney Care of Cape Cod' Mail Address: P O Bok202 Marstons Mills MA 02648' Street No, Town or City County State Zip,Code FEIN xxxxx7764 ®Individual []Partnership ❑Corporation []Joint Venture []Association ❑Other Other workplaces not shown above: 2. 'The policy period is from 04/27/2011 to.04/2712012 12:01-a.ryi:standard time at the jnsured's mailing address. 3. A. Workers Coryipensation Insurance:Part One of the policy applies to the Workers Compensation.Law of the states listed here; B. MAEmployers Liability Insurance:Part Two of the policy applies to work in each state listed in item 3:A. The limits of our liability under Part Two are: Bodily Injury by Accident$ 500.000 each accident Bodily Injury by Disease.$ 500:000 policy limit Bodily Injury by Disease $. 500 9p0 each employee C. 'Other States Insurance:Coverage Replaced By Endorsement WG2003 O6A, D. This policy includes these endorsemenis and schedules-SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules,Classifications,Rates and Rating plans. All information required below is subject to verification and change by audit. Classifications Premium.Basis Rates Code- Estimated Pei$100 Estimated- _ N_o. total Annual Of- Annual Remuneration 'Remuneration Premium _ IN RA 904123 SEE E ENSION OF INFORMATI T PAGE Minimum-premium$ 500,00 Total Estimated Annual Premium $ 2,165.00 As indicated interim adjustments of premium shall be made:. Deposit Premium $ 2,284.00 ®Annually ❑ Semi Annually [:] Quarterly ❑ Monthly MA Assessment Chg. $1,766.00x 6.8000% $119.00 04/07/2011 This policy,including all endorsements;is hereby countersigned by Authorized Sign a Date EGOVGOV KIND PLACING CLAIM NAME SAFETY Twinbrook.Insurance Brokerage CLASS AUDIT OFFICE OFFICE' CHECK GROUP Inc. 9014: 2 704 400A Franklin Street Braintree,MA 02184 WC 00.00 01 A(11-88) includes copyrighted material or the National Council on Compensation Insurance, used-vnth.its permission, t i , 4 /y , r w • : w _ w-- - I- �- �: �, .: ,u -�• ,,::�,;.*� —.�'�,.� •„.. .►.�;� ��� i��'�. ,�` �" .. ._„",..,.�,�i ..� F, ,�vas,f ,. '� a � xe I d T M.W, -jo G Fr a . ri%r O .✓�.r _ __ � �4 l 1 r v F �Et — �' _. 41 Ap _.� G �' R t.. _-� �y • Rt. i a .; r"' {'.,,,+i'r �rt'y .iF`s,��'^�n _ •,", ¢ � �`i� '.,,,� v r , -1.43 I rvi ng AYa n'n rs- I � Town of Barnstable *Permit#c240 X 36 a 1-:> Expires 6 months from issue date X-PRESS PERMIT Regulatory:Services Fee :d0 Thomas F.Geiler,Director JUN 12 2007 Building Division TOWN Tom Perry,CBO, Building Commissioner OF BARNSTABLE 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address �J(�V!N� AV&- . Residential Value of Work 8DD Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address /Lj UMFo R.a -�L l i�A 8r_774 '79s Contractor's Name 4!�; .8 14D 1eR/.5 L 0Kj /iJ CG Telephone Number $�8" .a75 o �S7 , f Home Improvement Contractor License#(if applicable) /O a 6 Construction Supervisor's License#(if applicable) /5 4rg ❑Workman's Compensation Insurance Check one: ❑ I am as ole proprietor ❑ I am the Homeowner j [M I have Worker's Compensation Insurance / Insurance Company Name Co Al T s,41FIZ ',Q'I- N RX61Ce 0 . Workman's Comp.Policy#_ {/Y CA eil z *6!4 Copy of Insurance Compliance Certificate must be on file. 1 Permit Request(check box) } ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) Re-side � k Low-E^ Replacement Windows/doors/sliders: U-Value i (maximum.44) *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. i A copy of the Home Improvement Contractors License is required. SIGNATURE: . ri ? o7 t Q:Forms:expmtrg Revise061306 DIME ram, Town of Barnstable. Regulatory Services MASS. $ Thom-as F.Geiler,Director Building, Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 "w.town.barnstable.ma.us officer 508-862-4038 Fax: 508-790-6230 x Property Owner Dust Complete and Sign This Section If Using ABuilder ETA M��p ,as Owner of the subject property hereby authorize j, A3 40RMS !iPti1 fa C-2 , , to act on my behalf, in all matters relative to.work authorized bythis building permit application for; . (Address of Job) Sign=4 of Owner Date -0e- 12t2-a,6e*4% M�" ' (,u L' S o N Print Name Q CFO RM S:OwNERP ERM IS S ION f I NOTICE NOTICE TO TO EMPLOYEES EMPLOYEES The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL.ACCIDENTS 600 Washington Street, Boston, Massachusetts 02111 617-727-4900 - http://www.mass.gov/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: Continental Western Insurance Company NAME OF INSURANCE COMPANY One Acadia Commons,Westbrook,ME 04098 ADDRESS OF INSURANCE COMPANY WCA 0212464 05/03/07-05/03/08 POLICY NUMBER EFFECTIVE DATES Dowling&O'Neil Insurance Agency 222 West Main St.,PO Box 1990,Hyannis,MA 02601-1990 NAME OF INSURANCE AGENT ADDRESS PHONE# E B Norris&Son,Inc. 385 Sea Street,Hyannis,MA 02601 E OYER ADDRESS EMPLOYER'S WORK RS' COMP SATION OFFICER(IF ANY) DATE ME ICAL 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 serf vices 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 NAME OF HOSPITAL ADDRESS TO BE POSTED BY EMPLOYER s • j ✓{L6 �dIILII[6J2[IJQCl��{! C v'lCQ1JRC/fUIP.ttl BOARD OF BUILDING REGULATIONS •::',: '` License: CONSTRUCTION SUPERVISOR Number: CS 015851 Expires: 09/28/2007 Tr.no: 5196.0 Restricted: 00 CRAIG N ASHWORTH 385 SEA STREET G HYANNIS. MA 02601 Commissioner ,, ���e ��ic�izoizuealC� n��`laJJac�iuJel�J Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: F Registration; 102014 Board of Building Regulations and Standards One Ashburton Place Rm 1301 Expiration: 6/30/2008 Boston,Ma.02108 Type: Private Corporation ERNEST B.NORRIS&SON INC Craig Ashworth 385 Sea St ...Z4�� —-- Hyannis,MA 02601 Deputy Administrator of valid without signature 7f Engineering Dept. (3rd floor) Map 7 Parcels 4,"prmit#i ✓ 49 .. House#' _ Date Issued a r Board of Health(3rd floor)(8:15 -9:30/.1:00-4:30) _6, Fee `sep�" " Conservation Office(4th floor)(8:30- 9:30/1:00-'2:00) r4`��� / '° 4Dee ' Dept.(1st floor/School Admin. Bldg.) F �'��Al I�' ^/ Plan Approved by Planning Board 19 �� A } r e�q p 4A1,0 TOWN OF,BARNSTABLE �F `''� . �J t Building Permit Application reet Address 1413 /I(J6�G, Owner s/Z 57'£6rf GtJ/L 50O-1 • mom ap'if 1: Address Arl2y/o-.04P /Oc,Z Telephone 7 7 S- 90.,2�7 Permit Request 44W /8V 2 i4oDeTzoM 7rD 4Cc76*'Z^r - AV0171 a`M Wit-( 0 f-ZL First Floor 2/4 SF 00 nab square.feet Second Floor �'�rS%- square feet Construction Type e O,,50/0- Estimated Project,Cost $ 76 OVe a MAZoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure 90 Historic House ❑Yes )4 No On Old King's Highway ❑Yes ANo Basement Type: 0 Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) N4 I Basement Unfinished Area(sq.ft) E-2gs;_ Number of Baths: Full: Existing New d Half: Existing New .,6No. of Bedrooms: Existing New d Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas Oil ❑Electric ❑Other Central Air ❑Yes ANo Fireplaces: Existing New Existing wood/coal stove ❑Yes A No Garage: ❑Detached(size) E g s,, Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes U4o If yes, site plan review# Current Use Proposed Use s 1 /Builder Information Name d IOVlf l-i 4EA/ 1 A'' Telephone Number 2 7� �' -7 Address / License# y Home Improvement Contractor# /0 �l 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 SIGNATURE DATE If K BUILDING PERMIT DENIED FOR THE LLOWING REASONS Gl -1 - .... w, .. „ _ice♦ ' FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL MAP EL NO , ADDRESS VILLAGE' OWNER DATE OF INSPECTION: FOUNDATION ! �'�i-•�i_ .'l . , " ~ FRAME INSULATION .. } _. FIREPLACE r a ELECTRICAL:' ROUGH + FINAL - - PLUMBING: fl, ROUGH FINAL GAS-..£; ROUGH FINAL` FINAL BUILDING - � '"���� "fir^"' f - + r . ' ',� •' � . ` r ;. , DATE CLOSED OUT ASSOCIATION PLAN NO. T 4 a I ter,rrte r� The Town of Barnstable . b$� Department of Sezith Safety and Environmental Services - Building Division 367 Main Strew,Hyacis MA Q7-601 Rains G Office: SOB-790-6Z7 Building Cz Fax: 508-,90-b730 For ofiice-use oniv Permit no. Date /< <Z �R AFMAVIT HOME nffROVOUNT CONTRACTOR LAW SUPPLEMF-4T TO PERMIT APPLICATION • MGL c. 142A R9 uires that the "reconstruction, alterstions, renovation, repair, moderni=tion. conversion, improvement, removai, demolition, or construction of as addition to any pre-existin"s owner occupied building containing at least one but not more than four dwelling anus or to structures which are adjacent to such residence or building be done by registered contmetars, will: terrain exceptions.along with other requirements. Type of Work: P � X/2 bra "� � Est. Cost Lo o b Address of Worn: 3 l '�IjWC AJ6 .0),Jt,gL�aOC7 Owner's Nurse Date of Permit Application:_ I hereby certify that: Registrrtion is not required for the following resson(s): Work excluded by law Job under 5I,000. Building not owner-occupied Owner pulling owe permit Notice is hereby given that: OWNF.IIS PULLING THEIR OWN PERMIT OR DEALING NITS UNREGW1ZRED CONTRACTORS FOR AP PLIC-kBR RANI ORS LAORK 130 NT HAVE UNDER MGZ.O I4ZA ACCESS TO THE ARBITRATION SIGNED UNDER PENALTIES OF PEIL=1' I hereby apply fora permit the agent of the aware. 2 8,, untraczor Name Registrstioa No. Date 4 i.0 r .;' "•�' a :;,. '-,..I F..f•.-'� —s.�„ y"t.^--" -' a .'V.YQi.A ad 5.rk',�r,n_F t�,T..yd f 9 t �,a�cCr yF, `�y '4• i.r:`q: 'N,£�,,g �f t,�a�J�kj,'r", ,a M f dh' $ �t A.+A r:a{S c ew.:. +�•t '�•„v d' alx ('�# >.. ' ,f',t rs. s^wl' .;;� ''� h t a 4itc i Mw `. 0.1 . ,', ;+4,k•4'Xvn1 L' rn:ti�w�*a•,�+,;;�,'fi�!"�.�i'�;.a'*�H`��`�auv y„.*•`«Yy�7,�'A��.4 n• y�sVF k G� saor�•�m�R�;;HOME IMPROVEMEN, ONjT4RATORS ~BOaT 'l� Ci';n9% e9A d.Jo BU � R i r�Efia�dtG1 y`t 0a1T„M�One� Mhiburton Pl r.. .i t wr /aBostanMassachu settsZR0210 'S:}i•tYE^ e. t Y'.E"qf ,:!i'# !WWI A ,,5 fJ� r.e.,�,a ``� 4Lxrs^', x�F rc:.�A'.k., ""a ak f M•S AZ( f ..,.,.. ^ri !•'iaf4, d^�x '.,r,X Yr `4. w 7 4 - j,� w+�: ;'�`F4dti` +"�• 3 .k ,.y r'a j +r.','Y.+r h."�;td' s 4 �' f ...scx .T v `�, 2 .' ' T' "A+. :,( t�' � f"� 1# i.. !'`>vitat3a. �Ie.��T} ara,y� �4.^„ '+..�j`.T'�i? s� „k }, ..: i' x r, , HOME IMPROVEMENT CONTRACTOR ' Krn v �# # r-rR is �— kt e«',,''xXMt,>Ac r`-ro+h+ d 1„}� ,t ,k` „}i yv r„ Y S i+. 7 "-` x+�t }t .j�- S -- I — ———� Registrat�one 102014Ex arfia °op sI� P 3 /00 - ., ..Ti,,..� x:.a..t! Nipy,-r:F 1� '•?�'kr+s.t iF l.. _ n,A V��Mry Type TE wC.ORPORATx�T_ONS `... — PRIVA A + # < ...�SrSyvswLb. �<,§'xy.'.a"{ ` HOME IMPROVEMENL CONTRACTOR s: G c 4,k v - `v 't^6J a y rs>`'`x S4 $ A. I +k'r"�..ii Pik r. .�, �-'qrt `'�Yc" s `''' "'"R'. r}. P Ydx.�n.; nzha.jns� ,`'"t+Rv`g,,^ s.,1 �'.a''_' .',.. s '..- i +' ..;+ah"Gfitxt^"s`w r'",.y :-: '+lrcit'A �,Jt.t .4c ' ,ta .,:? s, � ' r tRegistration �102014 ERNESt;t B z NORRI5 & SON rINC � ,< > . �,y � s >.� IssTYPe.as }PRIVATE 'CORPORATION j Cray g °,N �4Ashworth t� >. n t, f�,..y r ;, Ora ,I Ez ration: ,p6/30/00'' ,;vk „�, gp} k ° a p � v: a '�. ,' < -'..�ri,-`,r". y,ac »# e'+"a�X .� fVi.F+.:.'dssk �€.W: �fi � .. .p`°E' '`',a`k Pam., 385,`Sea` St-. , t� ?e ^a �57 � I� c r. �r :•- tr .} a ..N. v{a S +rrSeY'c. .s:` i� t.S' J 's r.�� 'a } t` .,i #'y�L ,t.,c.�rj(� I �qM�t !4 ct Hyannis, MA *0260.1 r4 d, , �x , �, ¢ , r E i I t ERNEST B .NORRIS.& .SON INC. i .. `4 3a c act. ,�' dt ^,° } ♦. 7. 4 xL'Sf., s �x� 'f dkl .5',`7- {Afx Jw� ,"� k �3' 'a;�,},�h 1, , <<Crag:N Ashworth •'k� t - Se 11 St. ATORu'..": sF [ "�-�.`"+� l,�.a_^` �.,�w'C'a`'tvZ yCc^,:1� ��;?` °`?. w �.i4'�Aa' Yt`#"`C� �a tTyc �t , Ya� r.;'+Yj d•�tS Ci,� A�,.. 1''+Hyannis MA.�02vo� A Y T x y_. k I ;,`G �� 'fit r, �- t> �� yd. M#, �, xy �:7�' cF+'„ xl�'•� x x � � �t M 5?.3• 9 ! �5._..,_h�6�+..�'�4 ��'th�� "1 r 4*,�� x vt �N, �p'�a^ � i+aj� `�w'S$ ' . � - i .,i.�a,k i A,•yv>+ �ty� �'�'.k4s r ::.3' 1`fti.� � !,#.—St..�,�.. Y t .kt. ,,, �! r�N�t*J yi,�} _�=ea:t �f�a.—.�.— _.�__ —. �_ �. __. 1 ! DEPARTMENT Of PUBLI C SAFETY i CONSTRUC IU ":SUPERVISOR LICENSE � Numbr; Expires : _ Restfib a. .10 : 00 l w CRAIG ASNWORTH 385 SEA STREET #. HYANNIS , NA 02501 j` TheCumnrunx•calll1 of fassadnaerts ` 1 `�..� '• • Deparinleflt of Industrial Accidents r 07ce-0f1MMtPffff= , 6(V f t aallmgran Street Eovan.Afa x 02111 4X.: .! workers, Compensation Insurance A1Ttlavit locniinn- phone C , - IN ❑ 1 am a homeowner performing all work myself, ❑ I am a sole proprietor and have no one work-in= in any capacity .. 1 am an employer providing workers' compensation for my employees working on this Job. ERNEST B. NORRIS & SON, INC. 385 SEA STREET 508-175-0457 HYANNIS nhnne#: EASTERN CASUALTY INSURANCE CCMPANY ntit icy a WCG 1000807 A instinince co ❑ 1 am a sole proprietor,general contractor, or homeowner(circie one)and have hired the contractors listed below.,r„ the following workers' compensation polices.• V. - _ Chone rr - t ucity- Co. _ „sr,tiF, ��r�rr>rr�9+.• Z r+>�s7f�- _ •-...••�.�..+...--�...,yip , m •In na Mc• .h• . insunince co. � ice• 1•...�i•e-•�^fv •aor ice. .. ___ :Attach zdditlonsi•shect!f riece�ss Un ota tins a to SISOO.UO Failure io srcnrc cover=izc as required under �of MGL 15=can lead to the itaposidon oteriaunal penalties P one rears'imprisonment its%I c11 as civil penalties is the form of a STOP WORK ORDER and lilac ofSI00.00 a day against tie. I undersund copy of this statement mad be forwarded to the Office of Investigations of the DIA for coverage rrrifleadon. I do herchr certif}'under tI,&pains and p aides of perjurr that the information prodded above is rjue and eorrrrt Sie_nmurc air Print name CRAIG N. ASHWORTH _Phone# 508-775-0457 official•use only do not write is this area to be completed by cite or taws otllcial ixrntit/llccase# r18nilding DePartment city or town: ❑Ueensiiag Board Osdectmen's Office check irimmedi2te response is required C311ealth Drpartment phone tt: r'tOtber contact person: I MAScheck COMPLIANCE REPORT Massachusetts Energy Code Permit # MAScheck Software Version 2 .0 Checked by/Date CITY: Hyannis STATE: Massachusetts HDD: 5973 CONSTRUCTION TYPE: 1 or 2 family, detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 11-17-1998 DATE OF PLANS : I TITLE: COMPLIANCE: PASSES Required UA = 50 Your Home = 43 Area or Insul Sheath Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 216 38 .0 0 . 0 6 WALLS : Wood Frame, 16" O.C. 240 15 .0 3 .0 16 GLAZING: Windows or Doors 27 0 .400 it FLOORS : Over Unconditioned Space 216 19 .0 10 ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design represented in these documents is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125$ of the design load as specified in sections 780CMR 1310 and J4 .4 . Builder/Designer X)oR,<1,5 Date HX l Z j MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2 . 0 DATE: 11-17-1998 Bldg. Dept . Use CEILINGS : [ l 1 . R-38 Comments/Location I WALLS: [ ] 1 . Wood Frame, 16" O.C. , R-15 + R-3 Comments/Location WINDOWS AND GLASS DOORS : [ ] 1 . U-value: 0 .40 For windows without labeled U-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes C ] No. Comments/Location FLOORS: [ ] 1 . Over Unconditioned Space, R-19 Comments/Location AIR LEAKAGE: [ ] Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. Recessed lights must be type IC rated and installed with no penetrations or installed inside an appropriate air-tight assembly with a 0 .5" clearance from combustible materials and 3" clearance from insulation. VAPOR RETARDER: [ ] Required on the warm-in-winter side of all non-vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION: [ ] Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R-values and glazing U-values must be clearly marked on the building plans or specifications . DUCT INSULATION: [ ] Ducts in unconditioned spaces must be insulated to R-5 . Ducts outside the building must be insulated to R-8 .0 . DUCT CONSTRUCTION: [ ] All ducts must be sealed with mastic and fibrous backing tape. Pressure-sensitive tape may be used for fibrous ducts . The HVAC system must provide a means for balancing air and water systems . TEMPERATURE CONTROLS: [ ] Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. �1 1 HVAC EQUIPMENT SIZING: [ ] Rated output capacity of the heating/cooling system is not greater than 1250-. of the design load as specified in sections 780CMR 1310 and J4 .4 . MISC REQUIREMENTS: [ ] Refer to 780 CMR, Appendix J for requirements relating to swimming pools, HVAC piping conveying fluids above 120 F or chilled fluids below 55 F, and circulating hot water systems . 1 ----NOTES TO FIELD (Building Department Use Only) ------------------------- � t 1 1 E 3 1 I 1 1 1 i x0 IIzN pox I �9 �- o , °b e,4 co c1-4 \Q a cr 'j n G o D a o i � I ROM �u�cr uP 2 AY-$ C-Ur ic .2�F6 Q ., CK `7 IrAoF7r, . IZ I Q'co SI�JGI7X - f - ��eJbtZl►J(� t4r G b J o , C4 _- IA\z p«r UP. `7 1iA' F7e, . NY 1Z r I ,-..crcy 2 sT-o, y W e m + m Ll o�C /5oo_ygcto,� E, 7 /�Y//�� �(/E, / X O � J• ITlZ.EE SPl/G SnM/c 4f . Zo.30' I � Q STOnIE. .i.' T/ %ia .:.� y Z o 1 —1 m W d �" �A��E N n 6 \ 113.70 3 70' N ®C,nf R rL4+W D R E�xoG t,f, 1 /S•/3' (.RTE \\ r: c�'_P_ir.�w�Z—sro�e(f z O � , _ a � , � �'s� �F -f2• ON I .► f N 11 cEo�a" i rl) l _ �i'y .�--CEO�i E. /, - _ � •� Cx s'b STy \ EXIST. I -NOUSt ' C PLAN VIEW SCALE: 1 = 10 1 0 10 20 30.FEET - =� To �X61�T -gip - I-..,.WINE L:Ah foY6K.: I ...I:-. P15N STORA E..UNIT. • .:SUB2E ° I j � ,,,\ 1cENrl<FR I b�o — 'zyZll q%II�/ ` � 9 2 I PI-UMSIN FtoWT....PAUE45 - (.�/ ;.: ,. s I FFoN. I : I I !pBL: 6 v✓t_,..; CEI .NG.I:Ff_CAfHE RA - - cH l c I- _'_: IFAUGET� CN I- 5uj I r , - r 21� ...t IN'T;:.HI °TJ WALL ,s. r I' _ Av Gxf xf. 41I \.: I .a r st 1- 3 �-=-' Z.��- '-- :...:.LS �, P:.•. ��'�� , ' a f ;,� :�. r p —�r- I J. '♦\ 3 � �, I q `v �tl - .,: ai LMMI ZL ir -o-.-... ._ _.., _.�:•..__ -�.... mod_.-3a`.. :: �,f,- �j. �.w. ., ; _� ... � -P - .r. �- �I - �:;."..- .s - ,..,� -,_„-�UI.1..1{T. � �; .9..o..evEfWAu ...,Mn .>, .. .-, - .. :•'�... ae-s�• H'�` ��t �f'c'. �F`i .I� L.:� .• :.•s�s°"r - .r_ _ �, - r _ r� g-'o✓niE¢: .4, :\'. .. � .,,., pax. 'aea-.,.•e :�-;. >:. ., ..t , _..,.. � -:.crs� s-_ I. ..� � f .:3Gc..IEEE`,.GP \. AILs. r r.„ � -. ..;: E : LE14:,fo R'.PET.. ..::: k u•-: :: .• .: :: a.. "�`-�i: x ->!t.. �>^ R4, ^Cr^. �.,:. _,.z a� 4. .-.. .: •e/PLL-i DVEN:' Ata:�.' oD 1 NtSel +� ser p IN ,O O :-o✓T P W/D RAIN�. <.x `✓/ / I [ROW R°P P� i z1bos ARE-P:.,I4T..FINISH. .. InauslDNs r, .srrs. `.. '_ `�,. - ....' _ :.__` .� :mow'. ,la ~;• .,, Ca .�I�.r*,..f .5: < _� -'m s.•,t ..a.�\-_ ,,._ ..�Y.�<+„», �.kyc. •.t.:-:��':� s.�:�.Qy_� x..Yczr yL. •ra+i.,<f_ �.� _'# ?7 -•3, ,,..3' I.. , �, .�s i 0 > z c� SHALLOW EXCAVTION rm c D (n 3r r s„,, li J r z a � O-) o - FULL DEPTH BASEMENT r z -P _ �- _.__ �UrZ€w'JINE—STORAGE----- -- --- _ �. Zl- Engineering Dept. (3rd floor) Map Parcel 6 Allmit# .2-1 T , House _. ace Issued o2 Board.of Health(3rd floor)(8:15 -9:30/1:00-4:30) IV� a k' Conservation Office (4th floor)(8:30- 9:30/1:00-2:00) Planning Dept. (1st floor/School Admin. Bldg.) r : ,ne �� SEPTIC S Defini - a Approved by Planning Board 19 INSTALLED NCE W1 TOWN OF BARNSTABIR®NME s � ® Building Permit Application TOWN REGULATIONS ProMtreetddress /' !JP Jl/�1 — ✓� Village VA.J Jl 5 ,62011?1:2' Owner SZ`EUE L(2 W!4.5y,,<J Address Telephone a/ '2-7 5- Permit Request f f�p L,A C 6 eC If &c) First Floor square feet Second Floor square feet Construction Type GJ O D D R A Cl 6— Estimated Project Cost $ Zoning District T/ Flood Plain / Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure &p Historic House ❑Yes W No On Old King's Highway ❑Yes Q�io Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces:Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use S<�-u�� v -x- Proposed Use 1311 A Builder Information Name IJmpg 2 4s 21, 5P cJ _ JG Telephone Number 7?5 ip Address 5 J� �.��,4 �? License# 6915-IF5-/ Home Improvement Contractor# ,'/Cg 2 Worker's Compensation#� 10, e9e*J 7 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 e SIGNATUR DA o� IZ74( g BUILDING PERMIT IED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE- OWNER F DATE OF INSPECTION: ' FOUNDATION - FRAME INSULATION p FIREPLACE ` ELECTRICAL: ROUGH FINAL LUMBING: °ROUGH FINAL GAS: t" rRQUGH FINAL FINAL BUILDING""" DATE CLOSED Ot " '' YC: ASSOCIATION PLAN NO. ' ' i The-'ToW n "of,Barn'stable kAM ��$ Department of Health Safety and Environmental Services A Building Division 367 K- n St=4 Hyannis MA o260i Offioe: 508 790.6227 Ralph Crmea FAY- sne_775.3?� Pua�:^r•��.�.�:�. Daft: —T-7 AFFMAVIT ROME II"ROVE UMCONTRAI.`MRLAW SUPPLEMENT TO PERN11TAPPUC IGN �. 1 MGL c 142A requires that the-mwnsUu ion.Altezations,tcwvjtiaa�tee modemi=dan,aonvemoa, l irnprevemettt, remoml, demolition!_ or constriction of an addition to tom►Ong owns occupied building containing at least one but not more than four dwelling units of-to ttbcactmet wWch we ai*ceat to such residence or building be done by t+egivered contractors,with ct is e=epdons,along with ether GcJi•t��o u�j Tjpe of Work: (151 2c,,,l zirt•Cost D o ?� Address of Work: /h 'J e'j t, A L1 6 Owner Name' �5'�Gf�E �l.Z Date of Permit Applic2tion: a—LI Z-2 ,2 •- I htrdn t>�fv that: Registration is not required for the following rmson(s): Work trduded by law Job under S1,000 Bunning not owner-ooc*ed Owner pulling own pewit Nct:cr is hereby given&z-,: OWN'ERS PULLING THEIR OWN PERMIT OR DEALING IVTTH UNREGIS7f= CONTRACTORS FOR APPLICAELE HO,\T MiTROVOMEIN7 WORK DO NOT HAVE ACCESS TO THE 05Z GUAI. A NM'FiT`,'D U7,'OER MG1.c, 342A SIGNED UNDER PENALTIES OF PERMRY I hereby apply fora permit as the agent of the owner: DateC� uactor name Regiismtion No. OR D::;c Owner's name Tlrc� Cunrnronr+•call/r of fassacllwitr ;71. 'j•�}_:t= Dcpartnrc�nt of ludustrial idcnts 600 if ashin.tan SIMI Bua7atr.Afitsx OZIll �X='`•' Workers, compensation Insurance Afrdarit AR 1'—t''i _'-ton._. _ t'le�se P N•T`1e� P Inantion- °I am a homeowner performing all work myself - I am a sole proprietor and have no one working in any capacity .. I am an employer providing workers' compensation for my employees working on this job. ERNEST B. NORRIS & SON, INC. MMpany fill k'.. 385 SEA STREET 508-7.75-0457 HYANNIS EASTERN CASUALTY INSURANCE COMPANY i •o WCG 1000897 A sur�nro, 1 am a sole proprietor,several contractor,or homeowner(circle one)and have hired the contractors Its►mod belowwh the following workers' compensation polices: .... COMMIny n Mon city- m gym•na e• Chane fq :Attach sddltionarsheef irtiee��essa w �'•'1 ' •ram•~� `' ' .,d. a+• iP' - °—dc.. � , � tla of a tine n to 51.50D.t}0 a failure to secnrc coverage as required under Section.SA of MGL 15.can lead to the imposition of criminal penal P one.eats'imprisonment as well as civil penalties in the form of s STOP NVORK ORDER and a line ofM00.00 a day against mn I understand t cc of Investigations of the DIA for coverage veri0adon. copy of this statement may be forwarded to the OM I do herehr certify under the pains and p alt cs of perjure that the infornmtion pn n ded above is Me and correct: ate Sie_nature CRAIG N. ASHWORTH Phones! 508-775-0457 Print name ofRcial use onto do not write is this am to be completed by cite or tram oRlcial ltermitalcense# r1fluilding Department ein or top n: pW�ng Huard OSdeetmen's Otiice check if immediate response is required C31lesith Department p t!• nOther- hone contact person: f II I i, F F DtART�tEJT OF PUBLIC SAFETY COUS§ijb ION? SiJnRRVISOR LICENSE Expires: RP,St1Gte� '0' 00 CFA?G E AS,HWO AT;i 38S SEA STREET HY'MiNi , �JA O`lbO1 r �/ dc�cl icd�tta �° rc� �V/ZCVO7YLllEO�U �. ttyi � Y `} HOME IMPROVEMENT CONTRACTOR ; 102014 Registration0. ;Type PRIVATE CORPORATION i Expiration Ob/30/98 r- ERNEST' B. NORRIS & SON INC N. Ashworth • r �frai9 °G - 385 Sea St, ADMINISTRATOR Hyannis MA 02601 i i� APPLI TION FOR PERMIT TO INSTALL A EQUEST FOR ELECTRICAL SERVICES Inspector of Wires . j Wiring Permit# COM/Electric# j Town,of B a.^s T..6�� Massachusetts Building Permit , Date 10 -z° • n ; *customer: Pa �f� . /` a t. n(St t-#) 3 i o ree Lot# -in the village Off e.�•+• -utility pole number or underground number Customer's billing address 0 11- Temporary New installation Change of service Starting Date f Job.description R! {ti 57c /J- t.;._ . :.-.-. • �.?•t5.s; I /( ""` w Service.entrance voltage Amperage Phase ` Wire size.(cu.or Conductor per phase $° Number of meters Water heater Off peak:Yes— No— Estimated load: Electric heat: kw, lights kw; Range dryer Motors, H.P.&Phase Ready for first inspection Ready for final inspection Electrical Contractor �`"b �� R��'^`!'• - Lic.# 3 `' Telephone# Address Additional Remarks: �. RO° oilc� b e ;L.- reso « n 4e Do Not Write Below This:Line - ELECTRICAL WIRING INSPECTION CERTIFICATE fi INSPECTOR OF WIRES ,.n t INSPECTIONS ; DATE FEE•CHARGE "Temporary Service Roughing in X Service and Meter `* Off.Peak Meter— Final F..inal Approval, 1fU/ Disapproved' 'For the following reasons ' r CERTIFICATE OF INSPECTION DATE To-the COMMONWEALTH.ELECTRIC.COMPANY.The installation described above has been completed and has this day been inspected and ` approval granted forconnection to your service._ r, Inspector of Wires WIRING INSPECTOR TO BE NOTIFIED WHEN WORK IS READY FOR INSPECTION Permit Good For One Year From'Date Of Issue CA as-, White—COM/Electric `Green-Inspector Canary—Town Receipt Pink—Inspector's Copy Goldenrod—Electrical Contractor - to COM/Electric Office Use only ., The Commoo-calth of Alassachusetts VENo. Deportment of Public Safcry Occupancy&Fee Checked BOARD OF FIRE PREVENTION.REGULATIONS S27 CMR 12U0 3/90 0mveblank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed In accordance With the Massachusens Electrical Code. S27 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORHATION) Date TOWN OF BARNSTABLE To the Inspector of Wires:-..,.. The undersigned applies for a permit to perform the electrical work/described below. Location (Street b Number)— 3 / Q S o 1 f- / X7 c.Ln 3 Owner or Tenant Owner's Address SCl Z Is this permit in conjunction with a building permit: Yes No ❑ (Check Appropriate Box) Purpose of Building _Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work .few-. ovJJc w ! o ,� c s 7 �l T•� e_ dcs� � c '. No. of Lighting Outlets No. of Hot Tubs ; No. of Transformers Total KVA No. of Lighting Fixtures Above In- B 8 Swimming Pool grnd. ❑ grnd. ❑ Generators KVA � No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total No. of Detection and tons Initiating Devices No. of Disposals No. of Pumps Total Total No. of Sounding Devices Tons KW g No. of Dishwashers Space/Area Heating KW No. of Self Contained Detection/Sounding Devices No. of Dryers Heating Devices KW Local Municipal ❑ Connection❑Other No. of No. of Water Heaters KW No,nsf Ballasts Low Voltage Signg No. Hydro Massage Tubs No. of Motors Total HP OTHER: �-y--� `^ C ( 4•ti 4 t.� 2 Q'-e /L7 / v /-0 0 7 INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liabilit Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES NO I have submitted valid proof of same to this office. YES NO [3 If you have chec d YES, please indicate the type of coverage by checking the a7ropriate box. INSURANCE 4 BOND ❑ OTHER ❑ (Please Specify) G c c-c I l' s 6' T2 xpiration ate Estimated Value of Electrical Work S &I d e) i Work to Start �� - /'7 -S / Inspection Date Requested: Rough Final Signed under the penalties of perju FIRM NAME-0-Ll i Rc ti C7, LIC.-NO_ F 3 03 Licensee Signature otS cl/ LIC. NO. r- �� Bus. Tel. No. Address /� Z Ne oS/o w Q t "�'� i S 3gS - 3 y 2 ' Alt. Tel. No. 5/ OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) �- Telephone No. PERMIT FEE S21�L P Signature of Owner or Agent c Assessor's map and lot number ?`�- ..... a !SYSTEM MUST �F� �oFTHE,o� Se loge Permit number ....... ............................. CO L House number ...�.`�. ..... ut � f-..(kwz ...... v��Ji ''.�(ro8� ` "-3 t)7 yOO MAB6 00.r.............. 039,Ar `0 TOWN 'OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ....R �V.l�. ,.�..'�.. 4. ' ��.................................................. l TYPE OF CONSTRUCTION ....�J �?0 1`i ...................................... . ..... ........................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: i Location ............................... .... ..................... .................................. ��f3 ,eve.v ..:... v. ................... rc.y,�a.............. ProposedUse ..... ................................................................ .................................................................. P r I Zoning District ..... ..f: ...d. ....................................................Fire District ................. ..... ................................................ Name of Owner ...u�.t;:1151111ftov....fte-AM...jR.05 ......Address L`{ ...... 6v.F.......................... Name of Builder C:......P...W. .C40.............Addr�ess ..)5:6......O.0 .W....AkUr .......UnW ......... .b`!.®. it ; Nameof Architect ... en...............................................Address .................................................................................... Number of Rooms .......6:.0....................................................Foundation ...RL o(.( Exlerior ;. .Ik` •.Roofin ... .. PR. It Floors ....�'L�©.�''.....................................:..............................Interior ......V0.0VA......$.MEE .2O442................................. y� 11 ,. Heating ... .S.RR..... 1............./.p....................................Plumbing ...:...1�. .............................................................. Fireplace k�.ucr—,....t.!)..5 o(,rk............................Approximate. Cost ...�.,t.U�.�........................................... Definitive Plan Approved by Planning Board --------------------------------19-------- . ' Area zle ),9f4 C,4 45�.......�.._. .........,.. � DD Diagram of Lot and Building with Dimensions Fee .................... ........................ SUBJECT TO APPROVAL OF BOARD OF HEALTH I OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the To r rding the above construction. Name .. .. .............................................. Construction Supervisor's License ... .......... OVERFLOW REALTY TRUST 312�3' Remode No ........I........ Permit lor .................................... Single Family Dwelling ............................................................................... Location ....143 Irvinq Avenue ....................... ................................... ................................... ..................... .....................;....... Owner ..Overflow Realty trust .................................................... Type of Construction ........................... ........... ..................:................................................ Pl6t ............................ Lot ................................. 'Permit Granted ..October 14, ..........19 87 ...................... Date of Inspection ....................................19 Date Completed ...................I...................19 Ile, Assessor's map and lot number I.. — ....... �pF THE t0� 'Sewage Permit number 7 ' r g Z BA"STADLE, i /j House number ... .`3. -T451,.� !i ...!"It :......................... -°�' aO NAG& 00 G i639• 9 'E11 AIRY d\ TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ..... ... . 141. :..": f 1; T .........................................:.......... TYPE OF CONSTRUCTION ....�)P. 12..........it';t`it� .±� ..................................... ............................................... f f `-7 ...... .. . .19. TO THE INSPECTOR OF BUILDINGS: i The undersigned hereby applies for a permit according to the following information: Location ........................... ...... ;K:44. !.A�<....... ........................ G� fn� I� ........:............................. ProposedUse .... ................................................................................ Zoning District .:.. :..... .....................................................Fire District ......................... ............................. Name of Owner ..t .p F r. i i i l t=.t €..$..{...r i'a $S�! Address .........".IS I i'... (�:af . ....................... Name of Builder .W0.— AA( ?...... .. Rt, V.T..............Address ...... C.(AAJ. ...nU �'F�(� .r.......... )......... Name of Architect WA . ................................................Address.. .... ...Number of Rooms ....Foundation f"-[9N3t I t rit' F I�'#,.Ot d� a Exierior ...Roofing .... t:? t3..tk:E................ Floors ....................................................................Interior .....�'o7i� �I€ t t! tleh . ' .....��. .i... .................................... Plumbing...1 ...... 0 ............................................................... Fireplace `t .f;o�: ..............................Approximate Cost f -t `....................... ............. .................................................... j � , � c! J Definitive Plan Approved by Planning Board ________________________________19________. Area .......�........................ i ' oo Diagram of Lot and Building with Dimensions Fee • D SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS y /d �',,h �'` I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable; regarding the above construction. Name .. ................. Construction Supervisor's License r). .. � ............. OVERFLOW )REALTY TRUST = 8-�=®-6-�� No 31293 Permit for ..Remodel Dwelling ................ Single„F........... Location ....143...IrViag... �1. x141 ............... .....................Har?l?.�SR.Rx ............................. Owner ........Ov„erflow Real.ty,,,Tr ,s „ Type of Construction .....Fr.d e....................... ............................................................................... Plot ............................ Lot ................................ Permit Granted .,,.October 14, ..19 87 Date of Inspection ....................................19 Date Completed ......................................19 y9� F ,4T t AG bi e ,00