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0178 KILKORE DRIVE
IMMM Town of Barnstable C3 a. c Building Post Thi Car:,dSo That It isU�sible From the Street Approved Plans:Must�beRetamed on Job and this Card ust beFKept Mt6}4¢�: �.Pohs..te e,<rde aU�nCt,en.rI tF,.�.finicaa:.l t eIn,a.aosr pf eOcctci.ou.,wnp kca Hn,a;cs.y B;.�se_eRne gMawrd�.e..ed,such Bu..�l.zd.mgs,.;h�a✓ll Not..be.',Oc�cu.f.p.ie.d�sur..nt�l afF<inal Inspection��ha,.s�be,ren,m. ad. re ��b Pe rm it" 4W ' 'a,,..a.�.-;5�:._,..�:«.a.wH«...;; .....s..�::h&.'3�.�...a,.;.,...�.: ,.«°«�t;.ob;�...,,�a. b'�ii .. .rrY.wS:«'�,.�`A«�`'t,�,.�'•':;=�'�,....os..»..;...ai�.; 5w .; .;a ?... "��w.o,aM&i<:.-._mow. Permit No. B-19-2194 Applicant Name: Dean Fraser Approvals Date Issued: 071/12/2019 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 01/12/2020 Foundation: Location: 178 KILKORE DRIVE,HYANNIS Map/Lot 272-193 020 Zoning District: RC-1 Sheathing: Owner on Record: LAFRANCE,JOSEPH R&PAMELA W Contractor Name Fraser Construction Company Inc. Framing: 1 Address: 178 KILKORE DRIVE x A Contractor License 194747 2 &r .- HYANNIS, MA 02601 Est. Project Cost: $ 15,741.00 Chimney: Description: Remove and replace(4)sliding glass doors an#,`(!y,,fixdd panel on Permit Fee: $80.28 Insulation: rear sunroom , Fee Paid $80.28 Project Review Req: Date Final: e � Plumbing/Gas _ � , Rough Plumbing: � g g: ;m r_ x , Diii This`permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced'within sixmgnths after issuan Final Plumbing: All work authorized by this permit shall conform to the approved application and the approved construction documents for,which-ihis permit has been granted. All construction,alterations and changes of use of any building and structures�shall b in compliance with the local zoning by laws and codes. Rough Gas: This permit shall be displayed in a location clearly visible from access s i or road and shall be maintained open for public inspection for the entire duration of the P Final Gas: work until the completion of the same. The Certificate of Occupancy will not he issued until all applicable signat�,es by,the Buildingkand Fire Officials�'are'Orouided'oon this"oermit. Electrical - Minimum of Five Call Inspections Required for All Construction Work. . 3f 1.Foundation or Footing r.. '��� Service: 2.Sheathing Inspection k Rough:. k � 3.All Fireplaces must be inspected at the throat level before fire flue bnmgJ in s �a d 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Final: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Rough: Low Voltage 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. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: . Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: z 7- 40 P� CAPE COD INSULATION 110B 71Af3 SlAMl3S7 INS SPRA /OAM SUSPIN010 SANS 0U1119! INfUI 'ON C11{INOS 1-800.696-6611 Town of Barnstable Regulatory Services Building Division 200 Main St =� Hyannis, MA 02601 Date: 21N (p � rr, Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the property listed,below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance .Institute '(BPI)"inspector. All work preformed meets or exceeds Federal& State Requirements. Property Owner Property Address Village 1 AA,.,e-f_ /7y IeI114" A2 MY4"ls Insulation Installed: .Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings Slopes Floors ( ) ) ( ) ( ) ( ) Walls Knc,_ �N�►^� 6VOr k FPr)Sor,*je,01 _ Sincerely 2eHrE ssi r, President Ins ation, Inc. LKORE DRIVE KI 120 0� � fU IN O W LOT 62 8941.3 S,F. EXISTING W FOUNDATION co .0 13,2, uj \a, \<D 4369 49�� CERTIFIED PLOT PLAN I CERTIFY THAT THE FOUNDATION SHOWN ON THIS PLAN IS LOCATED ON THE FOR GROUND AS SHOWN HEREON AND THAT IT LOT 62 KILKORE DRIVE HYANNIS, MA. CONFORMS TO THE MINIMUM BUILDING SETBACK REQUIREMENTS OF THE TOWN OF BARNSTABLE. PREPARED FOR BAYSIDE BUILDING INC . . s STEM/-- SCALE: 1" = 30, DATE: JUNE 1 2000 a �R, 5791' i WELLER & ASSOCIATES C, L> 1645 FALMOUTH RD. - SUITE 4C CENTERVILLE, MA 02632 (508) 775-0735 I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map - Parcel I Application # Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis /1 Project Street Address � u �I �f�✓-� V� ' ► ' Village KI/ Owner �' 1►`�* Address Telephone 7b Permit Request 0 , !r , GRopf/ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation ����� Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new CD . Total Room Count (not including baths): existing new First Floor Room Coup# ,e_ Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Cn I Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood'coal stove: ❑des ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing O n e-vo" size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size — Other: _ E2 �- M Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes *No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name w1�V/�'Jn',p Telephone Number Address �af,4 (JW'� ' License # l U Home Improvement Contractor# Email Worker's Compensation # 1it�Cid 3 t 0 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. • ros i'. Massachusetts Department of Public Safety Board of Building Regulations and Standards . License: CS-100988 Construction Supervisor ,• HENRY E CASSIDY. 8 SHED ROW a WEST YARMOVTH 2' _r Expiration: Commissioner 11/1112017 �f Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 153567 Type: Private Corporation Expiration: 12/15/2016 Trsr 259188 CAPE COD INSULATION, INC HENRY CASSIDY 18 REARDON CIRCLE - SO. YARMOUTH, MA 02664 Update Address and return card.Mark reason for change. SCA 1 L5 20M-05/11 Address Renewal Employment Lost Card (2571-le.cpoa���zoazcuetcCC�a�C�/T/lturoac�ccaeCt \ •Office of Consumer Affairs&Business Regulation License or registration valid for individul use only 1{� OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: c� egistration: ;153567 Type; Office of Consumer Affairs and Business Regulation % xpiration: :;_1;211:5¢2016 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 CAPE COD INSULATION.WINC-.'-. HENRY CASSIDY 18 REARDON CIRCLE g SO.YARMOUTH, MA 02664 Undersecretary N- valid wi ut sign •e The Commonwealth of Massachusetts = l 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 - . Please Print Legibly i �-y Name (Business/Organization/Individual): �, tl Address:X'_,��d� � L,w6' &VOlkw&City/State/Zip: , ,, W- Phone #; Are you an employer? Check th appropriate box: Type of project (required): Tam a employer with_i_� 4. 7 I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' insurance.$ 9. ,❑ Building addition [No workers comp.comp. insurance p. required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3•❑ I am a homeowner doing all work officers have exercised their 1 l.❑ 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 r Er employees. [No workers' 13. Other 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 affiBftit 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: r Policy # or Self-ins. Lic. #: �i �d �. Expiration Date: Job Site Address � � ��� Vf City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy uun4r and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of investigations of the DIA for insura5d coverage verification. I do hereby certify d the pai an penalties of perjury that the information provided above is true and correct. G Signature: 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#: CAPECOD-27 BDELAWRENCE ACORN" CERTIFICATE OF LIABILITY INSURANCE DATE 1 6/30/230/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pblicy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Rogers&Gray Insurance Agency,Inc. PHONE FAX 434 Rte 134 Alc No Ext: AC'No): (877)816-2156 South Dennis,MA 02660 ADDRESS: E MAIL INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Peerless Insurance Company-see LIBERTY MUTUAL INSURED INSURERB:ATLANTIC CHARTER INSURANCE GROUP Cape Cod Insulation,Inc. INSURER C: 18 Reardon Circle. INSURER D: South Yarmouth,MA 02664 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS'SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I SR TYPE OF INSURANCE DD BR., - POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDD/YYYYI (MM/DDIYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE T OCCUR CBP8263063 04/01/2015 04/01/2016 DAMAGETO RE PREMISES occurrence $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY ECT L"OC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY o - COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE HIREDAUTOS AUTOS Per accident $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 14EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY - STATUTE ER _ B ANY PROPRIETOR/PARTNERIEXECUTIVE YIN WCE00431901 06/30/2016 06/30/2016 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED9 ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If,yes,describe under , DESCRIPTION OF OPERATIONS below I I I I I E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES ()CORD 101,Additional Remarks Schedule,may be attached If more space Is required) Workers Compensation includes Officers or Proprietors. Additional Insured status is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cape Cod Insulation,Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 18 Reardon Circle ACCORDANCE WITH THE POLICY PROVISIONS. South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD P (mass save CONTRACTOR i PERMIT AUTHORIZATION FORM I!, \/DSE�y 4 owner of the property located at: i (Owner's Name, printed) 40 .(Property Street-Address) (City7Town) ! hereby authorize the Mass Save Home Energy Services Program assigned-Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my,property. a Owner's Signature 12 Date + FOR CSG OFFICE QSE ONLY >- Conservation Services Group has assigned the following Mass Save Home Energy Services. Participating,Contractor-to the above referenced project: ® 3 Particip ing Contractor Date f Rev.12132011 �j Parcel Detail Page I of 3 n 1 XtAtiS J},A,i , Logged In As: Parcel Detail Friday,.January 15 2016 Parcel Lookup Parcel Info _..r._w Parcel ID 272-193-020 I Developer Lot:,LOT 62 :„W.I Location 1178 KILKORE DRIVE Pri Frontage Sec Road� Sec Frontage Village[HYANNIS I -Fire District 1HYANNIS Town sewer exists at this address YeS,_ Road Index Interactive Map '4 � w Owner Info Owner KENNEY,THERESE H vI C0-Owner,c%LAFRANCE,JOSEPH I streeu 178 KILKORE DRIVE (streetz city HYANNIS,, - I state�Mq zip,0 6 1 ..m,,,,,,w.,,,_a,.,._ Country IV Lan.. . .. Acres use Single Fam MDL-01 zoning SRC-1 I Nghbd 0107 Topography -I Road:: utilities Location .Construction Info Building 1 of 1 � Year p.�:.» _ e..- ,,, .moo. Roof Iext ,Gable/Hip Struct Wood Shh,in< le Wall; g Living734 Roof yAs h/F GIs/Cm AC>Central Area 1 I Cover p p I Type I Style Ranch wall Drywall Rooms F3 Bedrooms Model Residential Flo Hardwood Rooms�2 Full-0 Half �, yp Total Plus Te Hot Rms7jRooms -», stories 1 Sto � Heat Gas �,�.�w„u Found- Poured Conc. ry Fuel anon Gross Area J i Permit History Issue Date Purpose Permit# Amount Insp Date Comments 6/30/2016 RE-ROOF STRIPPING 11/10/2015 New Roof 201507682 $11,245 12:00:00 AM OLD SHINGLES - YARMOUTH 4/28/2000 Dwelling 45743 $1,101,720 http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=20851 1/15/2016 1 7 Town of Barnstable *Permit# EVires 6 months from issue date Regulatory Services Fee S?, MASS. Richard V.Scali,Director' Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 NOV 10 Z015 www.town.barnstable.ma.us TOWN V►v of� p Office: 508-862-4038 Fax: 5'0�,RLE EXPRESS PERMIT APPLICATION - RESIDENTIAL. ONLY t Valid without Red X-Press Imprint Map/parcel Number 1 43 oC Property Address k,- C ❑Residential Value of Work$ i l�. `� 5 Minimum fee of$35.00 for work under$6000.00 Owner's Name&"Address ly z I Ai g 5- L C. V"a Contractor's Name Telephone Number 77 - 4;:-30 Cv Home Improvement Contractor License#(if applicable) Email: • . can...,,. Construction Supervisor's License#(if applicable) t� IL/ orkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner Fall have Worker's Compensation Insurance Insurance Company Name L t 4-r Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) EKe-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to 4 ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: , Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical& Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. 'Note: Property Owi4.must sign Property Owner Letter of Permission. A copy f t o e Improvement Contractors License&Construction Supervisors License is requ' e / SIGNATURE: Q:\WPFILESTORMS\building permit forms\EXPRESS.doc Revised 040215 TTie Comnronivealth of _ assachusetts Departiriejrt o,f Industrial Accfderds -- 0 fw-e o,f1nvestigaddns 600 Washington Street >twmv ,.mass gov/dia Workers' Campensation Insurance Affidavit:Bnillders/Cnntracturs/Electriciaus/Plumbers Applicant Infarmaian Please:Print Le�lly Name Busmess�Organizat�oal a i _ � ( ( � h Address: City/statPlzip: C „`` (C Phcneuk Are,you an employer?Check the appropriate box: Type of project(required}: I.Ll5'I am a employes with /he 4- ❑I am a general contractor and I 6. ❑New construction employees(full and(or part-time).* have hired.the sub-contractors 2.El am a sole grupaietar arpartuer- Tisted on the attached sheet. I. ❑RP +odeling ship and have,no employees These sub-contractors have 8. ❑Demolition worldng for me in any capacity employees and have workers' [No WMrt ers'comp.iusu=e comp.insurance-1 g- ❑Building addition required-] 5. ❑ We area corporation and its 10❑Electrical repairs cr adcF&= 3.❑ 1 am.a homeoumer doing all wofk officers have exercised their 1L❑Plumbingrepa=i or additions myseX[No workers'comp_ right of exemption per MGL 12.❑Roofrepairs C.152 §1(41 and we have no in�rra�,cerued]i 13.0 Other ~ employees.[No workers', comp_insurance required.] ''A•ay WBcsatthat cbedrs box 91 must also M cru€the sectioabeldwsl Mdng their mrorkere compensaiiau policy information_ 1 H-mmeourners who submit skis afGdasu indicating they are domg all wan}and&M him outside contractors zmact submit a new affidavit indicate sadL ZC.aatractors that check this boar must attached an additional sheet shaving the same of the sub-canUw w3 and state whether ur not those entities have employees. Ifthe sub-conumctors have employees,Efieymustpmuide their markers'comp.poliy number. I ant an e�repIo�Crr that is prot�iidirtg yvorkers'cattrpertsatiart iasuratrce for�y enrplay�ees Below is rite policy gmd job rite in, ornuatiom Insurance Company Name: /. L �i �� ©/�r Policy n '1 or Self-ins.Lic.#: l� C r 31 5 ?7 F_xpiratianDate: Job Site Address city/Statetzip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to semen coverage as required under Section 25A of MGL c 1572 can lead to the imposition of criminal penalties of a fine up to$1,500-OD anVor one-year m43risontnenk as well as civil peaalties.in the form of a STOP WORK ORDERand a free of up to MOM a clay against the violator. Be addsed that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verifrcatitan. .17 Ida hereby ccerd' the is andpenahFies ofper,jury thatthe infbnuaffvir prat'&4 a W is and correct 7 Sittature: Date: i Phone Official use only. Do not write in this area,to be campieted by city or tatrn of`aciat City or Town.: PermitlLicense#t Issuing A.atharity(circle one): 1.Board of Health 2.Budding Department 3.Cityl Town Clerk d.Electrical Inspector S.Plumbing Inspector 6.Other 11 Contact Person: Phone#: Information and Instructions ' MaGsachuse#ts Geamal Laws chapter 152 requires all employers to provide workers'compensation for their employees. pvrsuantto this statute,as errplayee is deed as."—every person in the service of another under any contract of hire, empress or implied,oral or written." An e nployer is defied as"an individual,paitaeah ip,associations,corporation or other legal entity,or any two or more of the foregoing engaged in.a Joint enter'pnse,and including the legal representatives of a deceased employer,or the ee of an individual, arts i association or otherlegal entity,employing employees. However the receiver or trust �P ��P� - o resides there or the o ant of the - o er of a dwelling house having not more than three apartments and who m, . �P win Ilzng _ dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenaat thereto shall not because of such employment be deemed to be an employer." MGL cbapter 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,MG-L chapter 152, §25CM7)states"Neither the commonwealth nor auy of ifs political subdivisions shall enter into any contract for the performance ofpuhho work until acceptable evidence of compliance with the incrr-ancC._ regain eme -ts of this chapter have been presented to the cmtracting auhmity_" 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 withtlieir ceiifficate(s)of incrrrance. Limited Liability Companies(LLC)or Limited Liabrlity-Partnerships(LLP)withno employees other than the members or partners,are not regrmed to carry workers' compensation h1 nrance If an LLC or LLP does have employees,a policy is rego Be advised that this a$davit may submit to the Department of Industrial u-ed. Accidents for conformation of fimlrl nce coverage. Also be sure to sign and date-the affidavit. The affidavit should be retsmm(-,d to the city or town that the application for the permit or license is being requested,not the Department:of Tn d stri_al Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' ben listed below. Self-insured auies should enter compensation policy,please call the Department at the� c�P .their s elf-in saran ce license number on the appropriate line. City or Town Officials . t _ Please be sore that the affidavit is complete and prhtDd legibly. T7he Department has provided a space of the bottom of the,affidavit for you ti)fM out in the event the Office of Investigations has to contact you regarding the applicant- Please be sure to fill i a the pen is /license number which will be used as a reference number. Iu addition,an applicant that must submit multiple permit/License applications m any given year,need only submit one affidavit mdicat mg=aat policy inlf6rmation Cif necessary)and under"Job Site.Add_r s the applicant should write"aII locations n (city or town)."A copy of the-affidavit that has been officially stamped or maiked by the city or town may be provided to the, ' applicant as proof that a valid affidavit is on file for frame permits or licenses- A new affidavitmust be filled oit each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial v=tIrC (Le. a dog license or permit to bum leaves etc.)said person is NOT requited to complete this affidavit The Office of Investigations would like to thank you is advance for your cooperaiiOn and should you have any questions, please do not hesitate to give us a call. The Depm-tmeufs address,telephone and fax number. Tht C<ammm Sth of Massachurt#s ' Departra mt cif lridufzial Amidenta Offke of krvestikatio= 604.waahftoan stmd Boston.,MA G2111 Tf,-L 4 617'27-4900 Qxt 406 or 1-977-MASS AM Fax 9 617-727-7M Revised 4-24-07 ma..s,:"�gavldia 'Estimate 1111 ,, " t - ° � Date Sep 30,2015 Cape & Islands Construction Co. Po Po Box 210 Centerville Ma.0.2632 Terms 508.775.7663 x Ship Date - 9 Mr.&Mrs. LaFrance 178 Kilcore Hyannis, Ma.02601 914-403-7661 CERTAINTEED Certainteed Shingle Roof 11,245.50 2% Discount$229.50, Regular$11,475.00 Strip existing shingles from roof. Secure any loose sheathing. Install Hicks brand vented aluminum drip edge. Install Will brand Ice&Water Shield to all eves, rakes,valleys and all protrusions. Install Rhino brand Synthetic Felt Underlayment. Install Certainteed Quick Start starter shingles to all rakes&eves. Install Certainteed LIFETIME Landmark architectural shingles. Storm nail all shingles. (State building code requires 4 nails,we use 6) Re-flash all vent pipes with new boots. Install Rigid Vent II ridge venting. Remove and dispose of all job related waste. leave your property looking like we were never there! Provide all manufactures warranties and LIFETIME warranty on our labor, if it ever fails due to our workmanship we fix it,forever! It's The Best In The Business. Please note our wind warranty is also the best And longest available ANYWHERE! Total $11,245.50 Signature i �5 AM PST (GMT-8) FROM: 100065-TO: 15087756688 Page: 4 of 18 Rom® DATE(MM/DD/YYM CERTIFICATE OF LIABILITY INSURANCE 5/8/, ,rIS 015 CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. .IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER FRANK L HORGAN INSURANCE AGENCY INC NAAME: - 44:BARNSTABLE ROAD PHONE FAX PO BOX 250 c o t ac Na E-MAIL HYANNIS, MA02601 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC 9 INSURERA: LM Insurance Corporation 33600 INSURED INSURER B: CAPE& ISLANDS CONSTRUCTION COMPANY INC PO BOX 210 INSURER C: CENTERVILLE MA 02632 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 24610723 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP. LIMITS INSD WVD POLICY NUMBER MM/DD M W M/DDIYY COMMERCIAL GENERAL LIABILITY EACH OCCUT_oRRENCE $ CLAIMS-MADE OCCUR AK A PR I S :NItoccur nce $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GERL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ JECT POLICY❑PRO ❑LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident) $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ A WORKERS COMPENSATION WC5-31 S-377540-015 5n/2015 5f7/2016- STATUTE ER AND EMPLOYERS'LIABILITY Y/N - - ANY PROPRIETOR/PARTNERJEXECUTIVE - E.L.EACH ACCIDENT $ 100000 OFFICER/MEMBER EXCLUDED?. N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 100000 It yes,describe under 500000 DESCRIPTION OF OPERATIONS below - E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks.Schedule,maybe attached If more space Is required) Workers compensation insurance coverage applies only to the workers compensation laws of the state of MA. This certificate cancels and supersedes all previously issued certificates,only as they relate to Workers'Compensation coverage CERTIFICATE HOLDER CANCELLATION TOWN OF BARNSTABLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 MAIN STREET HYANNIS MA 02601 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE LM Insurance Corporation 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD CERT NO.: 24610723 Anne Chandler 5/8/2015 1:54:54 PM (EDT) Page 1 of 1 , 1' l Ogce of Consumer Affaiz &Business Regulation MEll PR W MMENT CONTRACTOR .Type: n egtstration. ;165936. M xpi:iatiion. 4k�lg=, Private Corporatia CAPE 8 FSLAND'CQI C ( � 0 INC. JOSHUA KOURI )�< 55 ELM HYANNI:S,M-02601 Undersecretary 41 License or registration valid for individul �Y { before the expiration date. use only Office of If found return to: If Affairs and:Business Regulati I -Park Plaza-Suite 51�20 on Boston,MA 02116 fouhsignatare Unrestricted-Buildings of any use a ;_ ---- + contain less than 35,000 group which cubic feet(991m3)of enclosed space Failure to possess a current edition of the Mass State Buildin achusetts g Code is cause for revocation of this license. For DPS Licensing information visit: 1vyvyy,Mass.Gov/pp5 Massachusetts -Department of Public Safety Board of Building Regulations and Standards LVL�tI LII LIVL Supel Y'So License: CS-074660 JOSHUA X KOUI�" ,• PO BOX210 CENTERV1 LE MA Expiration . Commissioner 02/12/2017 E TOWN OF BARNSTABLE CERTIFICATE OF OCCUPANCY PARCEL ID 272 193 020 GEOBASE ID 37615 ADDRESS 178 KILKORE. DRIVE PHONE HYANNIS ZIP — LOT 62 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT HY i PERMIT 48918 DESCRIPTION } III PERMIT TYPE BCOO TITLE CERTIFICATE OF OCCUPANCY 1 I CONTRACTORS: Department of Health, Safety ARCHITECTS:. and Environmental Services TOTAL FEES: BOND $.00 IME I CONSTRUCTION COSTS $.00 I Qi► I 756 CERTIFICATE OF OCCUPANCY 1 PRIVATE P;[11. • BA MASS. s' I i639. �Ep � MA'S BUILDING DIVIS BY DATE ISSUED 09/26/2000 EXPIRATION DATE () Department of Health; Safety and Environmental.Services MASS. 1639. A�O� A -BUILDING DIVISION BY THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST.BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ELECTRICAL,PLUMBING AND MECH- 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. ANICAL INSTALLATIONS. 4.FINAL INSPECTION BEFORE OCCUPANCY. VISIBLEPOST THM CARD SO IT IS BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS / --I I'�d ' �o.v c,ps� ' ,�'G- ?-/Z-lam✓ � L 0� 1 C f G 2 2 1 NAIL �,t o'•y► 2 I 3 1 HEATING PECTION APPROVALS ENGINEERING DEPARTMENT s q ?2 me C?1 0'-.vcoc 2 n BOARD OF HEALTH d� OTHER: fi SITE PLAN REVIEW APPROVAL D WORK SHALL N PROCEED U PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC v MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. I 10,e '' - +.Sr aver i.s i.' �r,Je aa.tiY u.L t'1.13z.1ta Bt3I,,, II PERMIT I PARCEL -I . 7 1^193 020 GEOBAS:E+ ID 3'761.v I ADDFwS3 17-Q,kI rLKORE DRIVE LOT 62 BLOCK LOT SIZE DBA DEVEIa-OPMkNT. DISTRICT .HY Pr4.R 11T -45 74 3 DESCRIPTION 3 33 R-SINGLE �'l�KIL'� DWELLING PERMIT TYPE BUILD TITLE_,, NEV RE` DENTIAL BL,DG PMT CONTRACTORS: BAYSIDE BUILDING, INC Department of Health; Safety RCLLITErTS and Environmental Services TOTAL., FEES: $315.33 fy DIME�y,, = CONSTRUCTION COSTS $101.,72mo 101. SINGLE FAM H'<:3M.E DETACHED;_ I.__.;- . �' PRIVATE P BARNSfABU, MASS. i ' .BUILDING'DIVISION DATE ISSUED 04/28/2000 EXPIRATION DATA 2 THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN CROACHMENTS.ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OFTHIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED . FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- ELECTRICAL,PLUMBING AND MECH- (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS. 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. 4.FINAL INSPECTION BEFORE OCCUPANCY. BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS !/ ex/ 9-ZZ�Zc+x �5. V Vim-•' 4i- �..8; y.'� � � 3 1 HEATING PECTION APPROVALS ENGINEERING DEPARTMENT rj -C 1�, -.000C 2 ,ia BOARD OF HEALTH .' OTHER: x SITE PLAN REVIEW APPROVAL I ,4• WORK,SHALL N PROCEED U PERMIT WILL BECOME NULL AND VOID•IF CON INSPECTIONS INDICATED ON THIS THE INSPECTOR AS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE-PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. BUILDING PERMIT L 0 7 0 V,L C. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 4� Parcel 3 Qo� I Permit# � � APPLICANT MUST OBTAIN A:SEWER Health Division { � trrr ^'i �"; P:.R.r. Date Issued CC A'JIT FROM THE ENG!N,s":_?.it'J DMSION PRIOR TO 3/5 j3 Conservation Division -� oo �- GO.NSTFiUCTJON.._ Fee Tax Collector Treasurer '- t Y•:F Planning Dept: P ` .�� Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address /`7 9- K 1LK0 E 1 O , LQ.T 6 a t;S S ' Village Owner 6141l5 AE. 61,A G '. Address . CE Al TER ✓ t L I-4 Telephone 1 7/ LD yo Permit Request 7U CON 5 T2vCT ;4 _51V6 Lje: f 4Mc LY -1 Iz��,' 6&T/-I AlWcH ui ' c.i 2 /I-X-/I C Square feet: 1 st floor: a isting proposed ! A 7 2nd floor:existing proposed Total new 1 l SoZ Estimated Project Cost A-Ve ,V Zoning District k C — Flood Plain Groundwater Overlay Construction Type WOO l7 FI�Am9 Lot Size �, 'g y Grandfathered: U*Yes ❑No, If yes, attach supporting documentation. Dwelling Type: Single Family 2111' Two Family ❑ Multi-Family(#units) Age of Existing Structure 1VF_ W Historic House: ❑Yes a/No On Old King's Highway: ❑Yes 31N0 Basement Type: mull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new O Number of Bedrooms: existing new J—r Total Room Count(not including baths): existing new 7 First Floor Room Count . 7 Heat Type and Fuel: C3 Gas ❑Oil ❑ Electric ❑Other Central Air: LKes ❑No Fireplaces: Existing New y Existing wood/coal stove: ❑Yes C_fq0__ Detached garage:❑existing ❑new size •Pool:O existing O new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ' 3No If yes,site plan review# Current Use ✓ '�r L� Proposed Use BUILDER INFORMATION , Name 13AY5 AE ?>V1LA1A16 /AC Telephone Number Address 66 x 4 S License# do 56 46 (' F-Al%i—'A ✓I LL �oZ�a '� a Home Improvement'Contractor# Worker's Compensation# T C 9 919 /16 V I ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO JAN D CVC.C-0 L-AAI) F I U_ SIGNATURE DATE ql L -(4G FOR OFFICIAL USE ONLY _ PERMIT NO. DATE ISSUED - MAP/PARCEL NO. 'ADDRESS `— VILLAGE • "' t OWNER DATE OF INSPECTION: 'a+ FOUNDATION FRAME �[1, 6 SriC - INSULATION . . , � • - .. FIREPLACE ELECTRICAL: ROUGH FINAL f - PLUMBING: ROUGH -FINAL GAS: ROUGH FINAL FINAL BUILDING t — DATE CLOSED OUT ASSOCIATION PLAN NO. _ • y } Rho, ' `gyp 1HE► The Town, of Barnstable BARMASS, � . . MASS. Department of Health Safety and Environmental Services Y t639. �0 prEDMP�b Building Division.. h 367 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice ftLA-1 Type of Inspec-t�ioon,} Location �; U 6� � / . ,� Permit Number 45 Owner Builder" One notice to remain on job site, one notice on file in Building Department. The following items need correcting: A . Ld eA (�7 N. Please call: 508-862-4038 for re-inspection. Inspected by - Date �✓` - i - - K ILKORF DRIV F ,0941 sF m PROPOSED PLOT PLAN FOR LOT 62 KILKORE DRIVE HYANNIS, MA. �SN OF PREPARED FOR N BAYSIDE BUILDING INC. N. 4 SCALE: 1" =30' APRIL 13, 2000 4. 14-va Weller & Associates 1645 Falmouth Rd. —Suite 4C Centerville, Ma. 02632 (508) 775-0735 �! BOARD OF BUILDING REGULATIONS � License: CONSTRUCTION SUPERVISOR A Number: CS 005645 Birthdate: 04/19/1956 Expires: 04/19/2002 Tr.no: 18679 Restricted To: 00 BRIAN T DACEY _ 62 FERNBROOK LN CENTERVILLE, MA 02632 Administrator 00-35,000 cf enclosed space (MGL C.112 S.60L) 1A-Masonry only 1 G-1 &2 Family I lorries Failure to possess a current edition of the Massachusetts Slate Building Code is cause for revocation of this license. DIG SAFE CALL CENTER: (888)344-7233 c 1� CONiMON1VEALTII OF MASSACHUSETTS — `— DEI'MM EN'T OF IND USTRIAL ACCI D ENTS 600 WASHINGTON STILEET ames Car-,::00; BOSTON, NLkSSACHUS FITS 02111 nor-n:ssicne' WORKERS' CONMENSATION INSURANCE AFFIDAVIT 1, l� /11 AI r %�/`JC.E- Y (l ice nsee/perrnitrcc) with a principal place of business/residcncc at: f> No �ILc i11�� . U� h 3- (City/S t1tc/Z:p) do hereby certify, undcr the pains and pcnalcics of perjury, drat. 19 1 am an employe: providing dre following workc:s' cornpcas. ion coverage for my employees working on this job. 41000—TfI6-kA/ 1Ns Ut �t/Y, T L I g l y_II 4 q l _- Insurancc Company Policy Number [ ) 1 am a sole proprietor and havc no one worlcing for nrc. [ ) 1 am a soli proprietor, general contractor or homeowner (cirdc onc) and havc liircd the contactors listed bc:ca who havc the following workers' compensation insuancc policcr Narnc of Contactor Insumicc Company/Policy Nurnbc. Narrrc of Contractor Insurance Company/Policy Nurnbc- Namc of Contractor Insur:nCc Cornpany/Policy Nunrbc: 0 1 am a horncowric. performing all dre work myself. NOTE: Please be aware that while homeowners who ernploypersoes to do maintenince,construction or repair work on dv,cNing of not more tban three units in which the homeowner also resides or on the grounds appurtenant the.eto are not geoer:11% considered to be emplove:s under the Workers' Compensation Act (GL C 152,sect_ 1(5)), application by a homeo.ti,ner for a Tice ZIC or permit msv e.idence the legal surus of a.n employer under the Workers'Compensation Act. I undc:st:nd that a copy of this statement will be forwarded to the Depar:r:c.:of Industrial Accidcnu' Ofnce of Insurance for covc.:s: vc:::ic::ion and th:: failure to secure coverage as required undo Section 25A o,MGL 152 can lead to the imposition of cirninal pc.: eons-Ing of a fine of up to Sl 500.00 and/or imprisonment of up to one ycz:.-sd civil penalties in the form of a Stop Work Orde: a".c fire of 5100.00 a d:v mains: me. Siuncd this day of , 19 Licc:rscc'i'unliuct Licc-isor/Pcrrnirror r SUBCONTRACTOR' S INSURANCE BAYSIDE BUILDINNG: (L) ZURICH - SCPM31195788 (W) NORTHERN INS N.Y. - TC1 91911041 ENGINEEER: BAXTER & NYE ENG: (L) KEMPER - 7CQ27676000 (W) EVANSTON INS - AE802232 WELLER & ASSOC: (L) NAT' L GRANGE MUT. - MSP45246 LAND CLEARING: PETER GOVONI : (L) CNA INS CO - C179997230 (W) CNA INS CO - WC179997244 EXCAVATION & SEPTIC: ROBERT J. OUR (L) U S F & G - 1MP30109550901 (W) U S F & G - 771521695 NORTHERN SEALCOAT (L) TRAVELERS - 660364K8342 (W) LIBERTY MUTUAL - 312446298044 FOUNDATION: GARDNER CONCRETE FORMS : (L) ST. PAUL -. BFS00000169269 (W) ST. PAUL - 7717171998 WELLS : DENNIS SCANNELL (L) TRAVELERS - 660873E5627COF92 (W) WAUSAU - 151300062926 CELLAR/GARAGE FLOORS : MASON WORKS : (L) TRAVELERS - 1680204Y4465TCT FRAMERS : ROBERT DORRER: (L) TRAVELERS - 680526K991A (W) ST. PAUL FIRE & MARINE INS CO. - 6S16UB-510X322-3-99 MIKE DUFFLEY: (L) COMMERCIAL UNION - NBF821356 (W) LIBERTY MUTUAL - WC1312492127024 DAVID HILL: (L) COMMERCIAL UNION - NBF821356 (W) LIBERTY MUTUAL - WC1312492127024 MASON: SHERMAN, WAYNE : (L) COMMERCE INS CO - N60689 (W) WAUSAU INS - TO BE ASSIGNED FERNANDES WAYNE : (L) HINGHAM MUTUAL - ART9800896 DANNY TORTORA: (L) ZURICH - SCP 3187405'1 (W) WAUSAU INS - TO BE ASSIGNED i r . GAS PIPING: BAYSTATE PIPING: (L) CRUM & FORSTER - 5031766863 (W) CRUM & FORSTER - 4086081999 ELECTRICIAN: CHAVES ELECTRIC: (L) MISC. INS . - ZDN5245913 (W) MISCELLANEOUS INS CO. - WCP0006299 AMES ELECTRIC: (L) NORTHERN INS . - NBF418165 (W) AMERICAN EMPLOYERS- QBH2O8297 BAYSIDE ELECTRIC : (L) ST PAUL INS . BFS00000400422 (W) EASTERN CASUALTY - WC98695063 PLUMB & HEAT: WHITELY PLUMBING: (L) TRAVELERS - 660365K1782COF9 (W) EASTERN CASUALTY - POLICY IN MAIL ALARM SYSTEM: BALTIC SECURITY: (L) HANOVER INS - PAC105393 (W) WORKERS RISK - WCS-80414040 INTERCITY ALARM: (L) FIRST FINANCIAL - FF0131 G400831 (W) COMMERCIAL UNION CB0743379 CENTRAL VAC: VACUUM HOUSE: MERRIMACK MUTUAL - SBP1608045 INSULATION: MAP INSULATION: (L) AMERICAN STATES - 02CC326435-3 (W) U S F & G - 771.1099932 SHEETROCK: MEL REED: (L) WORCESTER INS - CB817530 (W) COMMERCIAL UNION - CBH557387 INTERIOR TRIM: DAVID' S REMODELING: (L) CGU - NBFB40.738 M & R CARPENTRY - (L) MARYLAND INS. GRP- SCP30235965 (W) CIGNA PROP & CAS . - C80049997 K FITZPARRICK: (L) MARYLAND INS . GRP- SCP30235965 (W) CIGNA PROP & CAS . - C80049997 OAK INSTALLER: ROBERT BUDDEN: (L) COMMERCIAL UNION - NBF824090 (W) LEGION INS. WC30024039 PAINTING: CAMPBELL PAINTING: (L) TRAVELERS - 1680251K4083COF (W) ASSOC INDUSTRIES OF MA. MUTUAL - AWC 7000126-01-99 GARAGE DOORS : ALL CAPE GARAGE DOOR: (L) U S F & G - BFS000000348188 (W) TRAVELERS INS CO - 1810336H8138T1A99 STORMS & GUTTERS : ALUMINUM PRODUCTS : (L) CNA INSURANCE - 1074079839 (W) CNA INSURANCE - WCC174080411 OAK FINISHER: AMERICAN FLOORS : (W) EASTERN CASUALTY - WCV3001745 CARPET, VINYL & TILE : CARPET BARN: (L) TRAVELERS - 1680625Y1691TILOOS (W) MA. RETAIL MERCHANTS - 8100-06 TILE INSTALLER: TONY AVERINOS : (L) ASSURRANCE CO. - CFP26528977 (W) HARTFORD FIRE - 77WZCY2409 WIRE SHELVING: CAPE COD CLOSETS : (L) ARBELLA - NBF8410782 (W) TRAVELERS - 7PJUB-521X529-4-99 APPLIANCES : KITCHEN APPL MART: (L) FIREMENS FUND - AZC80453098 (W) HARTFORD INS CO - 77WZNB1603 MIRRORS & SHOWER DOORS : L & M GLASS : (L) COMMERCIAL UNION - CBR409003 (W) U S F & G - 0071439933 LANDSCAPE & SPRINKLER: COY' S BROOK: (L) TRAVELERS - 6880937DO453 (W) RENNAISSANCE INS - TBD DRIVEWAYS : NORTHERN SEALCOAT: (L) MARYLAND CASUALTY- EPA18716945 (W) THE PHOENIX - UB387K530 SUSPENDED CEILINGS: ATC CEILINGS : (L) TRUST INS CO - TMP1005666 (W) SAVERS PROPERTY - WC0000873 RUBBER ROOFS : CAZEAULT CO. (L) AMERICAN EQUITY - ACC 060106R-1 SIDEWALLER: STEPHEN CRESSWELL: (L) MARYLAND INS - SCP29031342 i MAScheck COMPLIANCE REPORT Massachusetts Energy Code Permit # MAScheck Software Version 2.01 Checked by/Date CITY: Barnstable STATE: Massachusetts HDD: 6137 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 4-27-2000 DATE OF PLANS: 4/27/00 TITLE: #178 KILKORE DR. , HYANNIS PROJECT INFORMATION: COBBLESTONE LANDING II COMPANY INFORMATION: BAYSIDE BUILDING, INC. COMPLIANCE: PASSES Required UA = 378 Your Home = 315 Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 1524 30.0 0.0 54 WALLS: Wood Frame, 2411 O.C. 1860 19.0 0.0 109 GLAZING: Windows or Doors 237 0.350 83 GLAZING: Skylights 32 0.400 13 DOORS 21 0.350 7 FLOORS: Over Unconditioned Space 1524 30.0 0.0 50 ------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here 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 1251s of the design load as specified in Sections 780CMR 1310 and J4.4. Builder/Designer Date MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.01 #178 KILKORE.DR., HYANNIS DATE: 4-27-2000 Bldg. Dept. 1 Use CEILINGS: L l 1. R-30 Comments/Location WALLS: [ ] 1. Wood Frame, 24" O.C., R-19 Comments/Location WINDOWS AND GLASS DOORS: [ ] 1. U-value: 0.35 For windows without labeled U-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location SKYLIGHTS: [ ] 1. U-value: 0.4 For skylights without labeled U-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location DOORS: [ ] 1. U-value: 0.35 Comments/Location FLOORS: [ ] I 1. Over Unconditioned Space, R-30 Comments/Location AIR LEAKAGE: [ ] Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. When installed in the building envelope, recessed lighting fixtures shall meet one of the following requirements: 1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated, in accordance with Standard ASTM E 283, with no more than 2.0 cfm (0.944 L/s) air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled. 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 shall be insulated per Table J4.4.7.1. DUCT CONSTRUCTION: [ ] All accessible joints, seams, and connections of supply and return ductwork located outside conditioned space, including stud bays or joist cavities/spaces used to transport air, shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. 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. HVAC EQUIPMENT SIZING: ( ] Rated output capacity of the heating/cooling system is not greater than 1251W of the design load as specified in Sections 780CMR 1310 and J4.4. [ ] SWIMMING POOLS: All heated swimming pools must have an on/off heater switch and require a cover unless over 2011 of the heating energy is from non-depletable sources. Pool pumps require a time clock. ( ] I HVAC PIPING INSULATION: HVAC piping conveying fluids above 120 F or chilled fluids below 55 F must be insulated to the following levels (in.) : PIPE SIZES (in.) HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 Low temperature 120-200 0.5 1.0 1.0 1.5 Steam condensate any 1.0 1.0 1.5 2.0 COOLING SYSTEMS: Chilled water or 40-55 0.5 0.5 0.75 1.0 refrigerant below 40 1.0 1.0 1.5 1.5 [ ] CIRCULATING HOT WATER SYSTEMS: Insulate circulating hot water pipes to the following levels (in.) : PIPE SIZES (in.) NON-CIRCULATING CIRCULATING MAINS & RUNOUTS HEATED WATER TEMP (F) : RUNOUTS 0-1" 0-1.25" 1.5-2.0" 2.0+" 170-180 0.5 1.0 1.5 2.0 ,f 1140-160 0.5 0.5 1.0 1.5 100-130 0.5 I 0.5 0.5 1.0 ----NOTES TO FIELD (Building Department Use Only) ------------------------- a I u Ili ! I Ij j C 1 I I II TI ° EEEE I / CO) IL d W v TT-M, � _c n i Z i Cl) � � O � " nd 9� rC � Z DWG � I u • � � I I; � I I _ it�� � I I II _ ii I i li I i L I n H M Jolo 00 r c = o rf I Z v • j I A� Lr^ o y� 3 or�7 3.{S7 C C i v a D I 410 ,Pj3 D 0 p�.'j O r a . 214.. r i _ k _a N I c 4b z IJ �4 fo I _ P STE Ano t P tog 0 - ++ee n• � 10 k P P J pU�z D p` iV P � �D do L P 1 i D DeDa A tD t0 . uW r YZ D LA Z � sn i y N � fy o s co I � I s I m o ( L. J Q VF D- cblm I I D Ai fG do 1-0 2 '-o- Mr � Q � �- PZ z �I n D p o J'° L N LP Y� C �I o 0� 1p f+C _ �c6 N 4-Sr-t?4 -7-6%i.. 1p It c a / aD �r Q / 0t Z / D fD I Q� — h- o� .z �m ti yX fq � p �°� NZUs anti Am My DP .Z. �D oM0 rl FJ c r D < Z r9 ➢ Z z q L r� w a ; (-G r L fq 0 0 P P� rl o Jt i tDo ! Nn. �A�C EST/MA TED PROJECT COST WORKSHEET Value LIVING SPACE Jr�- square feet X$55/sq. foot= F3 ,F1 Q GARAGE (UNFINISHED) 3 ! square feet X$25/sq. foot= C o� square feet X$20/sq. foot= 3 PORCH /f DECK square feet X$15/sq. foot= �y OTHER square feet X$??/sq. foot= Total Estimated Project Cost Q 7O2 D For Office Use Only /nghu&n Affordable Housing Fee []Residential Commercial** t Property Owner's Name �, A xS ���L_ Project Location �J�J 13 Project Value Permit Number "Existing Sq. Ft. "Proposed New Sq. Ft. Fee $ ZO/ 7, _