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HomeMy WebLinkAbout0069 MITCHELL'S WAY �, �� -�/.�S -- -- ,� ;� i ., �� Ai TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # Health Division Date Issued Z Poe Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address JvT 6kZ11e7 Village '5, Owner' Address .Telephone U :Permit Request t4 7.21, .Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new `Zoning District Flood Plain Groundwater Overlay Project Valuation Construction TypeifZ_111 1 L Lot Size Grandfathered: ❑Yes ❑ No If yes, attach+sw porting ocur tation. Dwelling Type: Single Family a Two Family ❑ w Multi-Family (# units) ,a' o Age of Existing Structure Historic House: ❑Yes ❑ No On Old King' Highway,;0)Q's ❑ No Basement Type: ❑ Full ❑ Crawl ❑ Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) m Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization r❑ Appeal # Recorded ❑ Commercial ❑Yes a o If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) - Name1015064frp—) Telephone Number �0� -775% t ZJ Address License # 100 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO p SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER d DATE OF INSPECTION: F-UNDATION FRAME - - - - - - iINSULATION t r. FIREPLACE ELECTRICAL: ROUGH FINAL E - ,ti; " PLUMBING: ROUGH FINAL GAS:. ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. Massachusetts -Department of Public Safety I . i� Board of Building Regulations and Standards ul Construction Supervisor i License: CS-100988 I tli, ,. 1 t HENRY E CASSllO l 8 SHED ROW k' " WEST YARMOLP i+y.. 2 z,. � .... �,.... JJiSG�, Expiration Commissioner 11/11/2015 0 I Yr r . , o f C OF)SL RIC.t Affai1S and BLISmess Rt. 1.11LAI1C0II 10 Park Plaza - Suite 5170 ' Boston, WSSLUhQSCtts 02116 H 0111 ' 1rnprovemer1t Contrxtor Registration Registration: 15:3b67 .. .. 1ype: I'riV�l[t: C:u6f.iiuc.Uit:nl Expiration: 12/15/2014 1'r# 23;I6J1 INSUL-.A I ICON, INC I II_N-0/ CASSIDY Iti I\I-:AF�D0N CIRC:L.,E _. ......:... .........._.. .. .... ._ YARMOU-I-I--t, MA 02664t UpdMIC1ktldress Mid rCtut'u cltrll: Malt rcasuu lilrclwge. 1..J Aildre�s L 11lcncwltl �....I !!;lullluynluut I .1 hISI Dull l� i�;rrrr rrr,•r� cir((`fG.r� i 'l�f�r.i.irn'�rr.i�<'I.i • ,. „i l ,n,uull,t' �Iluir.ti ltusul s�.ltul;ulauun 111ccuar or intlividill use unly d i- 'ill{t M liviF'K(iVL.NltEN f CC)N I'RAC'I'OR hcrule OR c.+piratiun d;tle. If fuund ITIU1 i lu: "t 1 �.I:trau rr Ih3�ti7 1'ype: l)lii cofCunsumcrAliitirsand l3usivass ltegidnliwu F'r;v tle l orporatirn lU 1'arl.Plaza-Suitc 5170 Huston,MA 02116 ' r ' (filtic:rsi^rrclary lllvill witho t ',,Illtl i-0 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street .Boston,MA 02111 www.mrass gov/dia Workers' CoUlpensutiou Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A )Ucant Information % le so I''rint e ibl Naar, (}3tL,inrss/Orbanization/Individual : �G' / City/State%Zi r , _ c z Phone#: .5� �' 7'��J Z :U"c your an employ rY Check the appropriate box: , I am a general contractor and I Type of project(required)_ 1.�1 aria a Crnployer l� 4 ❑ rtrtployces (full ands�oe part-time).* have hired the sub-contractors 6. ❑ New construction Z.❑ I and 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 and in any capacity. employees and have workers' 9. Building[No workers' comp. insurance. camp. insurance.; - ❑ U addition required:] 5. [] We are a corporation and its 10, Electrical repairs or.additions .Q I am a homeowner doing ail work officers have exercised their ;:I 1.[]'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 3u.(] I am it homeowner acting as a employees. [No workers' 13. Other general contractor(refer to #4) comp,insurance required.] 'Ally applicant that checks box*1 must also fill out the section below showing their workers'compcnsstioi5 jSolicy information. t Efoatcowucn who submit this affidavit'indicating"arc doing all.wor-k raid then hire outside contractors must submit a new affidavit indicating such. :Coutnu:wrs that check this box must attached an additional sheet showing the came of the sub-coanvcton and state whether or not those entities have cn,pluycca. It the sub-conrractors have employees,they must provide their workers'comp.policy number. - /am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site lnform[ttiuit. .. Insurance Company Name: w/i Policy 4 or Self-ins. Lic. #: vC! ' Upiration Date: � U r Job Site Address: City/State/Zi P Artach m copy at the workers' conapeasatio 4policy declaration page(showing the policy nt4mber and expiration date). Fallurc to 36curG,cover4ge as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a rule up to S 1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the1Qtfice of Investigations of the DIA for i.nnuance t overage verification. I do hereby certify rider the nd penalties of perjury that the information provided above is true and correct nate /1J Ofj 'iuJ use only. Do not write in this area, to be completed by city or town official City ur'ronm: Permit/License# Issuing Authority (circle one): I.Board of II(ealth 2. Ftuilditn 17eplartnient 3. City/T'own Clerk 4.Electrical Inspector S. Plumbing Inspector 6.Other Contact Per3ou: Phone#; CAPECOD >7 MYOUNG A�.'� AYi .., uATVl0inuDDlrYrr) CERTIFICATE OF LIABILITY 7rerzu 13 lulS t ER 1IFICAI"E IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS 'j CER"fIFI'CAI l' DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE. COVERAGE AFFORDED BY THE POLICIES HEl_OW I HIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. - IIVIPORTAN"1 If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED;subjuctto tnu rornls and conditions of the policy,certain policies may require an endorsement, A statement an this cellificate does not coufur rights to the CurlihcalU 60I(1e17 in NQU Of Such endnrsunit9nt s . r,,,nuuH Llcensc It PC-514062 CONTACT NAME: Mar_aret Young �RugUa Giay Insuracu Agency, Inc. PRONE_-� --- ------ ro n n 1`:1•I R(U 134 - - AIC o Ezt: _ —^__.._._,_.._.__.:,...._...-_.__._._.. Inlc EMAIL :nl 0LI II r0 er5l ra .CO11'i 1SuuUl Dcllnls,IVIA 02660 ADDRESS: g��.^..J� __.�:_._..._.._..__.._:.....-.--- ....._.,_....._'-- INSURERS AFFORDING COVER{WE - -- NAICM... _..._.....--_...__..-_._......--'-_— INSURERA:PEERLESS INSURANCE COMPANY wsuRERB:COMMERCE INSURANCE COMPANY Cape Cud Insulation, Inc. INSURERc Evanston Insurance Cornpatiy- ID Roardon Circle INSURERO;ATLANI IC.CHAR_TER IIV_SU_RANCE GROUP i Juuth Yarnlouth, 111)A'0<'6G4INSURERE. INSURER F CUVLjRAGLS r CERTIFICATE NUMBER: _ _ _REVISION NUMBER: IN", cj 10 CER I IF Y THAT THE.POLICIES OF INSURANCE-LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ADO VL 1=OR THE POLICY PERIOD INDICAIt U NO I'VVITHSTAN DING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RL,PLC1 10 WHILHTIIIS, I CLHIIF(CA1L MAY GE IS*S',UED OR MAY PERTAIN, THE INSURANCE AFFORDED,BY THE POLICIES DESCRIBED HEREIN IS'SUDJECTTOALL IHETERMS, I'nCLUSION5 AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. � _ _---'—'--'"`--`-"A-LSISCSDOR T P�C`7—C-F POLICYEkP LIMIIS I.fN IYRE OF INSURANCE POLICY NUMBER WIVII001YYY (mming/YYYYj - ._....-,._._., UtINokAL LIA1JIUTY EACH OCCURRLNCL y 1,000,000 i A X CUBAIvh: U RCIAL GENERAL AUILI Y CBP8263063 411/2013 411l2Q14 �AMAC E TO"RENTED_ `I00,000 �... PREMISES IF:ri ocsu7oncoL � ICL AIMS.MADE I_ ..I OCCUR M_Ep EXP(AnY utla Ltorwn) 5 ... _.5,000 PERSONAL 4 A)V INJURY ,b 1,000,000 GENERAL AGGREGAXIE I — . I'ROOUGII COMPIOP AUG 11 2,000,00( ULNA A(ikAq.GAI k LIMIT AI t UES PER --- I' -_ LOG— ^- COfv1DINkCi 51RGLE L1MI7 f I r�U IUaIUUILE L.INpILI IY - '- _ ) F..a a(.ta(wlp],:_ _ 5 1000,000 ANIAuIII 13MMBCKVMK 411/2013 411120.14 BODILY INJURY(Pelpulsan) 1 -- :at UVAI)LD SCHEDULED EIODILY INJURY(Pnr ecddent) b 1Olos X Autos pROPE TYl)iCMAGE7- - -.__ I N0N-OVVNEO § h Ima UAUroS X AUTOS }• PL KCCIDFN __. .-. . . -- -- _—_--.•_ 1000,000 . 1,Y UNItn10-1 A I_iAp X orcul� (ACH o(cut:rtNCE l ! 4/112013 4(1/20Iq �T-- — — 1,000,00 LIAq CLAIMS-MADE XONJ453512 AGGRLOKI E $__. Llt(I )! I X REIENIION ' 10000 _�,;T_:_,_..._� — •— _. OTII � M)IiKEHj COMPkNSA r10N AND khn'LOYERS'LIAUILI I'Y � U I YIN iNIFn(nNI:IORIPAHINEFVEXECuriVE . WCA00525504 613012013 6130120'14 E•L,EACHACCIDENT" y QOU,OOU clm OVNIEMBER EXCLUDC07 hJ N 1 A I hiqudglu(y hl NH) EX,DISEASE-EA EMPLOYEE $ u Iv,daxnl undar --^ — 1,000,UUU neiCKiPI ION('IF OI'E=kA I'IGIIVJ ur,law - — 171.DISCA!iE--POLICY ur idtul'PION Ot•VPL:RA I IONS-I LOCA I IONS I VEHICLES (Attitch ACORD.101,AitdllmiAl Ramuks Schad-la,It mars SVOG-la requh•aa) - IWml,dni Compensation includws Officers or Proprietors. !AU01.1011A IlgUred status is provided under the General Liability when required by written contractor agreement with the Certificate Holder. 1 , CERI'IFICAI-E HOLDER CANCELLATION -------- _..._. __---__ SHOULD ANY OF THE ABOVE DF-SCRIQ613 POLICIES QF_CANCELLED DEFORE THE EXPIRATION DATE THEREON, NUTICk WILL BE DELIVERED IN i Capu Cod.In5uldtic ll, Inc ACCORDANCE WITH THE POLICY PROVISIONS._ i AUTFIORIZED REPRESENTAT IVE 01988-2010 ACORD CORPORATION. All rights reserved. ACORt)25(201 U105) The ACORD name and logo are registered marks of ACORD ! /.., OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at k (Property Address) 6 2 G O (Property Addre s) ' Ca dhereby authorizeV l (Subdo ctor) f an authorized subcontractor for RISE Engineering,to act on my.behalf to obtain a,building permit and to perform work on my property. Owner's Sign re 3 Date : Y NSULATI.ON 213 €�sl I ?' -A : 1 .CAPE .COD TOWN Or- 91--lARNSTABLE P1RER PEAS$ SEA MEE5S SPRATTCAM SUSPENDED R - RATT5 PUTTERS MSU 110N CEILINGS 1-800-696-6611 DIVISION Town of Barnstable Regulatory Services Building Division 200 Main St Hyannis, MA 02601 Date: 1413 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 (BP•I) inspector. All work preformed meets or exceeds Federal & State Requirements, Property Owner Pro e�rty Address Village . (A(+�- .�. Insulation Installed: Fiberglass Cellulose R-Value . Restricted Unrestricted Ceilings Slopes Floors Walls �I r S,Q a t n Sincerely hCod Jr, President + on, Inc. �9 RE-ROOFING/RESIDING COMME ❑ If located in OKH or Hyannis Historic District- Certifica required unless same color/same materials specified on ap ❑ Map/parcel number Approval Sign-offs from: ❑ Tax Collector ❑ Treasurer ❑ # of squares of shingles or square footage of roof or sidewall ❑ Specify stripping old shingles or going over old roof. If going over ❑how many roof layers existing now ❑what size are rafters? What is span? ❑ Owner's name & address ❑ Builders Information ❑ Signature n �a�^'�'*n?n's Con, Fnrm '('n„v ofTnsnrqncp C'mm�liance l J TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION T WN OF BARNSTA'BLE Map Parcel Application # 2013 CC -2 t.-IM l0. 04 Health Division Date Issued AO _Z Conservation Division Application F Planning Dept. UIS 04111 Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Z;f Village5/>Q�/>U/� Owner �yy�/f� fZ�>� Address _5" Telephone ?-7 4?-F7 Permit Request ,j!f��e ofz?,O/ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Z,644z 7�,A`o Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family vr' Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes �o On Old King's Highway: ❑Yes 41-No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.j Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: 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 Telephone Number Address / /� � License c� iB� y77�� Home Improvement Contractor# Worker's Compensation # �2 4�g,,:7L)��✓���� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO r SIGNATURE DATE . ,Z4/, // 5 t FOR OFFICIAL USE ONLY • `APPLICATION# DATE ISSUED MAP/PARCEL NO. { ADDRESS VILLAGE OWNER DATE OF INSPECTION: r k ' FRAME ]NSULATION,-,,. . FIREPLACE ELECTRICAL: ROUGH FINAL 0. ,4 PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING x DATE CLOSED OUT ASSOCIATION PLAN NO. • OWNER AUTHORIZATION FORM. ' ' (Owner's Name) owner of the property located at (Property Address) £, u ►n� � Q 2 GU/ (Props Address) e_--coc)4nhereby authorizeV (Subdo ctor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a•building permit and to perform work on my property. Owner's Sign re Date , r a• ,t �lnssacllutictl� - Dcllar[nlctlt of*Public l.Ifci� Board of Utrildin' Rc"'ulatiow" and �11;1I1(1.u(is Qonstruption Supervisor License ±i Llcen - CS> 100988 i� .. A yy 1k HENRY CASSIDY ✓ a4i; 8 SHED ROW � 4;Y WESfF IJARMOUTH, MA 02673 r s Expiration: 11/11/2013 . l „uuuissiuucr TrF: 7620 t • Office of Consumer Affairs and Business Regulation r� A 0 Park Ptaza - Suite 5170 Bostoia,,Massacliusetts O2i l6 1-1 o In e Inlprovemerit Contractor Registration Registration: I53567 Type: Private Comoration :- Expiration: 12/15/Zb14 Trk 233831 CAPE COD INSULATION, INC HENRY CASSIDY 18 REARDON CIRCLE SO. YARMOUTH, MA 02664 ' update Address and return car-ll. Mark reason forchenge. . Address Renewal nlploynlout I 1,osi Cart) uili c u1 t oiiswnu_Aftnn s d K(1 1111 s Regulation License or registration vulitl for individul use only ��} tOME IMPROVEMENT CONTRACTOR before the expiration diiltC. If found rchu'u to: 09istration: 153567 - Type: Oft-ice of Consumer Affairs and Business Regulation 111 �,• • ,Expiration: 12/15/2014: Private Corporatic ii 10 Park Phlzx-Suite 5170 ,.. Bostuu,MA 02116 t . Al',:C00IWi JLATION INC. ' ru.N10' CASSIM' 18 R Al )()W CIRCLE } v,hrl��luT1 I,MA 02664 - --- -- - - — --' - - { Undersecretary ntvar WItho t lult re - The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Bu lders/Contractors/Electricians/Plurabers Applicant Information Please Print Legibly Name (Business/Organizabon/Individual): I J4 ,!;, � J Address: City/State/Zip: C Phone #: y7� 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,2; _ / employees(full an"r part-time).* have hired the sub-contractors 6 New construction i 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition i working for me in.any capacity. employees and have workers' [No workers' comp. insurance comp..insurance.t 9. ❑ Building addition required:] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their I I.❑ 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 3a.❑ I am a homeowner acting as a employees. [No workers' 13.1.Other genera!contractor(refer to#4) comp,insurance required.] Any applicant that checks box#1 must also fill out the section below showing their workers'compensati,oti li information. Homcowncrs who submit this affidavit indicating they are doing all work and then hire outside contractors must tsubmit a new affidavit indicating such. tCowractors that check this box must attached an additional.sheet sho*ing the nano of the sub-contactors and state whether or not those entities have cmployees. 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:_,,I�_,_r�,Q J/�_,- 4X11,2 X�,," Policy#or Self-ins. Lic.#: Expiration Date: 01 Job Site Address: City/State/Zip: /l�,( d /,G Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c..152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDERand'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 cent rider pa and penalties of perjury that the informad'on provided above is true and correct i Da Phono "Offlcial use only. Do not write in this area, to be completed by city or town officiaL City or Town: Pertnit/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 MYOUNG CERTIFICATE OF LIABILITY INSURANCE DATE(Mh11DDlYYYY)_ _ _ _7_/81_2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE. AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. _...... ......... -.--..—_--- IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subjectto the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to tho Certificate holder in lieu of such endorsernent(s). — Pr<anucER License#PC 514062 CONTACT NAME, Margaret Young _ Rogers&Gray Insurance Agency,Inc. PHONE-� — - "- 434 Rto 134 A C o Ext:^ Fax_ m�(AIC __ South Dwinis,NIA 02660 E-MAIL m 011n rr7r0 ers ra C0171 ADDRESS:- y g� g g y• - - INSURERS AFFORDING COVERAGE NAIC 0 INSURER A:PEERLESS INSURANCE COMPANY INSURER B:COMMERCE INSURANCE COMPANY _ Cape Cod Insulation, Inc. INSURER C:Evanston Insurance Company — 18 Reardon Circle INSURER o:ATLANTIC CHARTER INSURANCE GROUP South Yarmouth, IVIA 02664 INSURERE: ...-..._, .. ._....___..-_-_------- ,,.--'..--^- INSURERF: -- ---- ---- CUVERAGES CERTIFICATE NUMBER: REVISION NUMBER: _...-- ---......._.. ---- ------ ----- �_ -- ------ ------ THIS IS W 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 WITI-I RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Askr__...__.—_._—.._—_—.. PEOFINSURANCE A'DDTSU�BR —' POTC�FF POL'ICYEXP " LIMITS -_� _ POLICY NUMBER MMIDD/YYYY MM/DD/YYYYI - GeNERAL LIABILITY EACH OCCURRENCE $T T-1,000,000 A X COMMERCIAL RENTED-,, L GENERAL LIABILITY CBP8263063 411/2013 4/1/2014 P a REMISES Ea ocurence $ 100,000 CLAIMS-MADE L X� OCCUR MED EXP(Anyone porxm) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GFN L AGGREGAT.E LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,001) POLICY L..—I�� '�.PRO- LOC $ f __1 _ L�lES�I.-C .T_-- - _ AUTOMOBILE LIABILITY COMBINED IN�MIT- 1,000,000 Ea acddenll $ --- -- B ANY AUTO 13MMBCKVMK 4/1/2013 4/1/2014 BODILY INJURY(Per parson) $' " All.OWNED SCHEDULED BODILY INJURY(Per acddanq $AUTOS X AU'IOS X HIRED f'ROPRTY6AMAGE --- ----HIRED AUTOS X NON-OWNED AUTOS PER ACCIDEN $ X UMBRELLA LIAB X_ OCCUR EACH OCCURRENCE - $ 1,000,000. C excess LIAB CLAIMS-MADE XONJ453512 4/112013 4/1/2014 1,000,000 T—�—^ — AGGREGATE $ _ DELI X RETENTION$* 10,000 $ WORKERS COMPENSATION WY;STA7U- OTI'I AND EMPLOYERS'LIABILITY L II ER - 1) I ANY PROPRIE'TOR/PARTNER/EXECUTIVE Y/N WCA00525904 6130/2013 6/30/2014 E.L.EACH ACCIDENT $ Y1,000,000- OFFICER/MEMBER EXCLUDED? N 1 A (Mandalory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 It Yes desaiaa under E.L.DISEASE-POLICY LIMIT $$_ 1,000,000 OcSCRIP110N OF OPERATIONS below ^-- _ .I ----..._------- UESCRIPI'ION OF OPERATIONS 1 LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Workers Compensation includes Officers'or Proprietors. Addtional Insured status is provided under the General Liability when required by written contract or agreement with the Certificate Holder. I 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 ACCORDANCE.WITH THE POLICY PROVISIONS: - = AUTHORIZED REPRESENTATIVE - ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD _f TOWN OF BARNSTABLE CERTIFICATE OF OCCUPANCY PARCEL ID 290 155., GEORASE IDr 19818 1ADDRESS 69 MITCHELL'S WAY PHONE HYA.NN I S ZIP - LOT 5 BLOCK LOT DBA DEVELOPMENT DISTRICT HY PERMIT 29987 DESCRIPTION SINGLE FAMILY DWELLING (PMT, #87499) PERMIT TYPE BCOO TITLE CERTIFICATE OF OCCUPANCY CONTRACTORS: Depar-tmen�of Health, Safety Al H ITECT-S - w --- - - - _.. _. _._--_- - -- - - -and Environmental-Services- TOTAL FEES: THE 1 BOND $.00 CONSTRUCTION COSTS ,a:U. Qi► 756 CERTIFICATE OF OCCUPANCY RAMSTABLE, MASS. D BUILD .6 DIVI91 BY DATE ISSUED 04/'08/1998 EXPIRATION DATE RI -- � T OW..-N-OF BARNSTABLE, MASSACHUSETTS I $IiVG PE I`Tµ Am290.155 �{ f�Ay® C DATE March 14 19 9J ERM.�T NO. N• 7�Vv APPLICANT John J. Maffei* � ADDRESS .iU/. ka"1m,pu u R�.� Yl�,r'annis UVIUL $ IN0.) (STREET) (CONTR'S LICENSE) PERMIT TO Build dwelling 1) STORY Single family dwelling NUMBER 1 NG UNITS (TYPE OF IMPROVEMENT) (Aft - - (PROPOSED USE) AT (LOCATION). 69 ,Mitchell Way 5) Hyannis ZONING (N0.) (STREET) � - �. DISTRICT BETWEEN AND (CROSS STREET) (CROSS STREETY > LOT SUBDIVISION LOT-BLOCK-SIZE BUILDING IS TO BE FT, WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN COWjRUCTION.,r,, TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: Sewage #E95-55 AREA OR 1,504 sq. ft. - /5,000 PERMIT �x�•'•� VOLUME _ESTIMATED COST $ FEE (CUBIC/SQUARE FEET) �.•'` OWNER JBaeph & Dolores DaLuz 90 Mitchell Way, Hyannis, MA U2 1 BUILar F r ADDRESS BY. THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY' 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. v MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. Z. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL - MINAL IN (RE INSPECTION TO BEFORE FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE OCCUPANCY. - POST THIS GAR® SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS F5. APB Ile _ - , 2 i �p 2 t 3 HEATING INSPECTION APPROVALS ENGINEERING DEF)kRIMENT V V •�/NV, �, 2 _ / q 7 - BO RD OF HEALTH OTHER SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED UNTIL THE INSPEC- PER W!LL BECOME NULL AND V010 IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE TOR HAS APPROVED THE VARIODUS STAGES OF i WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN CONSTRUCTION. I PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION. BUILDING PERMIT TOWN OF BARNSTABLE TEMPORARY CERTIFICATE OF OCCUPANCY PARCEL ID 290 155 GEOBASE ID 19813 ` ADDRESS 69 MITCHELL'S WAY PHONE HYANNIS ZIP - ..LOT 5 BLOCK LOT SIZE : DBA DEVELOPMENT - DISTRICT HY PERMIT TYPE BTC00 DESCRIPTION TEMP. OCCUPANCYWPERMIT (PMT.#258 (37499) CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: BOND $.00 Ox tNE CONSTRUCTION COSTS $.00 756 CERTIFICATE OF OCCUPANCY C • BARNSTABLF, • MASS. 1639. A1� F Ep BUI V B DATE , ISSUED 10/20/1997 EXPIRATION DATE TOWN "OF BARNSTABLI TEMPORA�Y CERTIFICATE OF OCCUPANCY PARCEL ID 290 155 GEOBASE ID 19813 ADDRESS 69 MITCHELL'S WAY PHONE HYAN`NIS ZIP I LOT 5 BLOCK LOT SIDE ._ DBA DEVELOPMENT DISTRICT HY j i, PERMIT 26387 DESCRIPTION SINGLE FAMILY DWELLING (PMT.0258 (37499) PERMIT TYPE BTCOO TITLE ' TEMP. OCCUPANCY PERMIT 1 CONTRACTORS: Department of Health, Safety : .ARCHITECTS. and Environmental Services j TOTAL FEES: BOND $.00 tME CONSTRUCTION COSTS $.00 756 CERTIFICATE OF OCCUPANCY BARNSTABLE, + MASS. ED�1� j BUIL � `DIfiVTO B DATE ISSUED 10/20/1,9 7 EXPIRATION DATE � TO Q BAIkSTABL�+, TEUdlPURAY CEE'1`3 'IC:ATE OF OCCUPANCY PARCEL I'D. 290 155 �GROBASE Ili 19813 ADDRESS. ES MITCH LL`S CLAY 'PHONk H3YAMNIS ZIP LOT 5 BLOCX LOT SIZE DBA DEVELOPMENT DISTRICT BY t f a PERMIT 28387 DESCRIPTION SINGLE'FAMILY DWELLIN {Bt��'.�1 68 (37499) PERMIT TYPE BTt,OO ' `xTLE �> OCCUPANCY PEH�"I CONTRACTORS: ` ,Department of Health, Safety ARCHITECTS. and Environmental Services TOTAL FEES- BOND CONSTRUCTION COSTS .00 1NE 756 CERTIFICATE OF OCCUPANCY * BARN • MASS. . � 030. EC NAB A BUILD -V IVI3t B �` DATE ISSUED 10/20j1�' 7 EXPIRATION DATE THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS�ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY;THE JURISDICTION.-STREET OR ALLEY GRAD4ES'AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERT 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 2. PRIOR TO COVERING STRUCTURAL MEMBERS PERMITS .ARE REQUIRED FOR HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ANI C L INSTAL L TIO N. AND MECH- 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. ANICAL INSTALLATIONS. 1 4.FINAL INSPECTION BEFORE OCCUPANCY. POST THIS CARD-SO ISVISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 2 2 2 1 3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 2 BOARD OF HEALTH J OTHER: SITE PLAN REVIEW APPROVAL ,I I WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. BUILDING PERMIT THE Tpy The Town of Barnstable pp CF BA MAgI BLE. MASS � Department of Health Safety and Environmental Services s679• �0 �fo►��° Building Division 367 Main Street,Hyannis,MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice Type of Inspection ) ,,.. Location ( ermit Number Owner f G J h k c r i Builder ,t J--1 -Q One notice to remain on jobsite, one notice on file in Building.Department. The following items need correcting: Do 42At L Please call: 508-7 -6227 for re-inspection. Inspected by Date 5 • -�- : The 'own of Barnstable Department of Health, Safety and Environmental Services o Building Division N 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Fax: 508-775-3344 Ralph Crossen Building Commissioner October 4, 1994 Mr. Joseph DaLuz 90 Mitchell Way. : Hyannis, MA 02601 Re: 69 Mitchell Way, Hyannis 77 Mitchell Way, Hyannis 83 Mitchell Way, Hyannis 103 Mitchell Way, Hyannis Dear Joe: In trying to reorganize the Building Department, we have gone through all permits to check for i completeness, and to see if any are considered abandoned. We found numerous permits in both categories that require a particular type of action by the owner. We found four permits of yours, all on Mitchell Way,that are over six months old and lacking the following documentation: 1)building plans 2)Workman's Compensation information for Mr. Maffei 3) fees One of the changes we made here is to require the fee at the time of application. This change would apply to all permits that are beyond the six month life cycle. Yours, unfortunately, are in this situation. If you still want to build the houses, you will need to send in the above items at which time the permits will be issued. Sincerely, Ralph M. Crossen Building Commissioner RMC/km i Q941004A w iAl • I Ap t r i r i i ► r - - _ I�1 + _ , I } r r i N _ .. ,a _ I 1 t-� 77To�orI-.a j V t 7 1A7T�TNE �G<iTid S.�/OWN h��.2E0.C/COis-lf�L YS W/Tf/ ` - SCA L G 0.4 T� ,QvG; 29 /977 -7`-',�%�,5"/O.E.C-%.<%�•-�1it/.viSETBAGk '....__._ _ —i ._.__ ---� / _ _:_�--._ w_; _%. -�.._._ :�EqU/.2E�lE•t/y'-s O��T/-/� Tow�/DF _ - $,4 .•L.oc.�T�'�•r� 1.�iry%N Tye F�aa.�l.�4/�f! 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IZ•r, - - _ .t�foa Kau FLK -_•.-1 1- Y1G YT -;ILL ol•i - 1911­TE A—ILvr� - - t2"x 3'X5• /TL.tiCAl114 1 j°LAl C WCLD•EO TO COL. l 1�•Q� ,•_-- ---_.- ....1 .•. _-______..__-_-. ... .•_....-_-._...._ Tom__- _- .- -3-1 1 `.1 ••, ':'I/L' Cr 1 IC (it.1.0 V COL ... n L _ - 1 r 1 I --W:-TCw l•FOAFu IC, -10 L_ I L�RAGL L-1 �p v.l!Z•YCLIr Ev �IIC - �:L.'.C• -q 1-, I. ----t'�•rPXCC D, COI IC 1 V1 I I_ �— t'SC/4r GVY•1 T_ COLIC (Gb7b1(y v W: rGr!1'1L;/ KGYw.ay. I t r+ COMMONWEALTH , y PUB OF DEPARTMENT OF LIC SAFETY f�Y ONE ASHBORTON PLACE MASSACHUSETTS BOSTON,MA 02108 FrTc*t- EXPIRATION DATE �, i.'�'=�/ I—CIN_:TR- SI_IF-'E RV I SOR ' CAUTION RESTRICTIONS EFFECTIVE DATE LIC-NO. FOR PROTECTION AGAINST THEFT, PUT RIGHT THUMB -!i/1 9 001 t726. PRINT IN APPROPRI _OHN ._I MAF=F=EI 7; "7 R =tc i7 F(11._Mi_il I I"H RD TING O R PHOTO(BLASTING OPR ONLY) FEE: I F IYANI\I I [i MUST II1t`LubE PH NIA i..)260 j r NOT VALID UNTIL SIGNED BV LICENSEE AND OFFICIALLY MAY 1 2 �gg4 HEIGHT: STAMPED-OR-SIGNATURE OF THE COMMISSIONER DOB: THIS DOCUMENT MUST BE I ������ CARRIED ON THE PERSONOF , T fI \ S4AE F LICENSEE IGN NAME IN FULL ABOVE SIGNATURE LINE F HOLDER WHEN EN. - OTHERS,BIGHT TNip•IL,PRIM GAGED IN THIS OCCUPATION. S ER i. e 1 I i - � a i • I y aRCAHLffatr7l N --- ► - �Ol$.OdMM4lhyrAL��r� $WON,MAN.$loll LICENHE 21,2 CONSTR. EUPHItVIs��I! `` l - 0110Tw!DAT! 04/;!G►/19a� 001014 rw 6HN -J MAPIVE j i ! 4 ST'ARLIOHT DR ARNSTARLE. MA OP449 1 110A login���+lfyiy fr f1R saf�IdA4i "I ! . ..�� l `I I f <.un1Mc_�N\v1/1_:III :I I-1 01- MMSALI I U`SI :"1•"I'S i�EI'AIr; Ml l\T OF INDUSMAL ACCIDI Goo WASHINGTON STREET ames Gar-.::-)Cl BOSTON, MA-S.SACHUSETTS 02111 �o ss,one WORKERS' COMPENSATION INSURANCE AFFIDAVIT 1, I �e,m ' 1 'p i nee) with a principal plan of business/residcntc ar: do hereby terrify, under the pains and penalties of (Gu/Sacc2;p) perj ry, that: [) 1 am an cmplover providing the following workr s'compcnsuon covcngc for my cm loves job_ p working on tiro Insurance Company Policy Number [) I am a sole proprietor and have no one working for me. I am a sole proprieto k neral contract or r homeowner(arc!c one)and have hired the contractors listed b-: who have the rollowing workers compensation insur.nce polio I�amc of Contractor Insur.oce Company/Policy Numbe. 4X-amOf Contraaor t ` Insuana Company/Policy Numbc: �r1Ap Inv► i n -��„ Home of Contractor L 11miran' Company/Poli Numbc: am a homcownc;performing all the work myself. NOT-L Plcuc be aware that wbile homeowners who employpersons to do maintenance eonst dwe:licr of not rnorc than three uniu in whieb the homeowner also resica or on the grounds a purtenant thereto _� . consictcrcd to be croployc;s undcr the Wcrkcn'Compcnsatioa Itc.(CL C 152,act 1 ruater or repair work on P art not r z 11CC� or permrt may e`idcocc the legal sutua Oran ernployrr under the Workcn'Compcnration))/tcpplintion by a homeowner rota(ice=sc l u-71de-it�id that a copy ors stasemcnt will be forwarded to the De vc ;'c'rion and th_t fz""c to secure eovc;arc m required undo Section 2�A of 1IGL 152 can lead to the Imposition or pus:c:_o(Industnzl Acadcaa'Oricc of lnsu:ancr for covc:a<: of 2 eor.su s 1 0,0 a of f to : 500.00 and/or imprisonment of up to one r`�-ia avd penalties in the form of a Stop Work Ordc:a--- rmc of S 1 OG.00 a day a P rnminal pc �cs {�zinr: me. d2y of , urn - -- --- - The Town of Barnstable • a�tuvsr�a�, ,� Department of Health, Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-775-3344 Building Commissioner October 4, 1994 Mr. Joseph DaLuz 90 Mitchell Way Hyannis, MA 02601 Re: 69 Mitchell Way, Hyannis 77 Mitchell Way, Hyannis 83 Mitchell Way, Hyannis 103 Mitchell Way, Hyannis Dear Joe: In trying to reorganize the Building Department, we have gone through all permits to check for completeness, and to see if any are considered abandoned. We found numerous permits in both categories that require a particular type of action by the owner. We found four permits of yours, all on Mitchell Way, that are over six months old and lacking the following documentation: 1)building plans 2)Workman's Compensation information for Mr. Maffei 3) fees One of the changes we made here is to require the fee at the time of application. This change would apply to all permits that are beyond the six month.life cycle. Yours, unfortunately, are in this situation. If you still want to build the houses, you will need to send in the above items at which time, the permits will be issued. Sincerely, Ralph M. Crossen Building Commissioner RMC/km Q941004A Assessor's office(1st Floor): 290-155 Assessor's map and lot number poi THE>o` Gi � w Conservation(4th Floor): SEPTIC SV E' VT EE-E Board of Health(3rd floor): u BALLED PLlt'a �:S ; Sewage Permit number �fj ' ,_ �� f�` iTH tl 6 0 6� ry Engineering Department(3rd floor): ®✓� "� �. House number I . '6 9 TOW L DE AND Definitive Plan Approved by Planning Board 19 ®NS APPLICATIONS PROCESSED 8:30-9:30 A.M'and 1:00-2:00 P.M.only TOWN OF BA LE BUILDI'M INSPECTOR APPLICATION FOR PERMIT TO Build Single Family Dwelling TYPE OF CONSTRUCTION Frame February 19 94 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: LocationLot #5 69 Mitchell Way Hyannis Proposed Use Residential Zoning District RB Fire District Hyannis Name of Owner Joseph & Dolores DaLuz Address Name of Builder Same Address Name of Architect Address Six Comcrete Number of Rooms Foundation Exterior W/C Clapboard Roofing Asphalt Floors Carpet Interior Sheetrock Heating Gas Hot Water Plumbing 2 baths Fireplace Approximate Cost $75,000 Area Diagram of Lot and Building with Dimensions Fee OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable gardinVfe a construction. Name h M Construction Sitpervisor's License 001026 3/1.(4C//9yJ5 A=290. 155 No 3 Permit For Build dwelling Location r69 Mitchell Way (Lot 5) Hyannis- Owner Joseph .& Dolores DBLuz Type of Construction i ,•l Plot '` Lot i • , Permit Granted 19 y ; Date of Inspectiori: Frame 19 � -` }InsdIation- 19 ,Fireplac6 19 Date Complefed q 19 E q t•`A �s • 9 ,E.f A ' • i f I E r q t , i q E Y r D F r 9 r F y tl 9 n Western Surety Y n F F J F Y • F LICENSE AND PERMIT BOND For County,City,Town or Village Only-Not Valid for Bonds Required by the State.Not Valid for Contract, Performance,Maintenance,Subdivision,Agent to Sell Hunting and Fishing Licenses or Utility Guarantee Bond. r J T KNOW ALL MEN BY THESE PRESENTS: BOND No. L&P•4 2�5 0 4,14 0 ` That we, Joseph Daluz _ U r of the Town of I -Barnstable State of Massachusetts , as Principal, and WESTERN SURETY COMPANY,. a Corporation duly licensed to. do business in the State of Massachusetts , as Surety, are held and firmly bound unto the Town of Barnstable , State of MassachusettG , Obligee, in the amount (Valid only when a County,City,Town or Village is named as Obligee) of One Thousand and 00/100 DOLLARS ($1, 000- 00 ), (NOT VALID FOR MORE THAN$25,000) lawful money of the United States, to be paid to the said Obligee, for which payment well and truly to be made, we bind ourselves and our legal representatives,jointly and severally. THE CONDITION OF THIS OBLIGATION IS' SUCH,, That whereas, the :Principal has been licensed Street Permit Bond - 69 Mitchells Way., Hyannis., Ma by the Obligee. NOW THEREFORE, if the Principal shall faithfully perform the duties and comply with the laws and ordinances (including all amendments), pertaining to the license or permit, then this obligation to be void, other#1 11 am in full force and effect for a period commencing on the 13th day of T �.,� March 1995 , and ending on the 13th day 0 `� : •'' pP%March 1996 ,unless renewed by continuation certificate. n J -&rminated at any time by the Surety upon sending notice in writing to the Obligee and to ' cipal, in t;a' the Obligee or at such other address as the Surety deems reasonable, and at the expira- G f irty- 've days from the mailing of notice or as soon thereafter as permitted by applicable law, evez�ist °` bond shall terminate and the Surety shall be relieved from any liability for any subsequent acl , Abe Principal. �•�1�>t® 13th day of March J995 Principal Principal r Counters' ed -WESTERN �UY. MPANY n n r n By BY Resi ent Agent President F ACKNOWLEDGMENT OF SU OETY F STATE OF SOUTH DAKOTA ss (Corporate Officer) r County of Minnehaha } n c On this day of ,before me,the undersigned officer,personally y appeared Joe P.Kirby ,who acknowledged himself to be the aforesaid officer of WESTERN . F SURETY COMPANY,a corporation,and that he as such officer,being authorized so to do,executed the foregoing r instrument for the purpose therein contained,by signing the name of the corporation by himself as such officer. Y IN WITNESS WHEREOF, I have hereunto set my hand and official seal. r S. BARNES s h c �1 NOTARY PUBLIAC SOUTH DAKOT � .�C Nota ry Public, South Dakota s 1 ; r My Commission Expires 1-22-99 Western Surety Company F Form 849—6.93 1-605-336-0850 fi e G fi F u F ACKNOWLEDGMENT OF PRINCIPAL y G (Individual or Partners) G STATE OF ° n e fi ss e F ^ County of F e ^ tl ^ u On this day of ,before me personally appeared F e F ^ F e c 9 G Y G G 9 G Y known to me to be the individual_ described in and who executed the foregoing instrument and 6 f � n u acknowledged to me that_he_ executed the same. My commission expires Notary Public ACKNOWLEDGMENT OF PRINCIPAL (Corporate Officer) STATE OF ss County of On this day of ,before me, personally appeared , who acknowledged himself to be the of , a corporation, and that he as such officer being authorized so' to do, executed the foregoing instrument for the pur- poses therein contained by signing the name of the corporation by himself as such officer. My commission expires Notary Public G r G - r• r ^ e Ey r � c r � n G n , � F fi a F G 0 n ^ V1 a 01 G DZ Z a� w1 z o z n rA W a U o a o 214 ^� F SOIL LOG NO. 1 2L . N0. 2 .3 4 SITE PLAN - _+5_ a lot' ArJr) SUN - o O C7rKP<. ..�^. i);}.. lR+ 7 a� v 600 cr v er>o SOIL f ��u�' �,> o Z 3 - cf ), v d , }- dJ �v / ��� r , r r 2 J 3 4' , - - - AM) 5A m to ' �`v L �I 2a,-L 5 TOP OF FOUNDATION EL .: �7 . � 'h ; ,4 30tfl 5MALL �y � I°1, Z , /. F�� /� t' _J f �j (t C' /.: frr; fj 1 ' () } e �C)�._+�, 7 i n �7 • • /�� 2(., �__�� V ` .p, ` �;Ir ;f �1.! ,yV•�71�7''�I' Ch `i (���'C�� ' �� \ U '!j►� , / `M4k i I Fl 1 + B IN Ft 15 o q n ,N rr 23�� ;0,- IN Et �3145_ >~r'23,`74 ,r 10 f$ u IN Et 24,88 1 t ���� ©� WASFI � 2 r, l IaIN El � 3 � _ Q Ti)oe,� Hu `mArcR -fir /3, Z 12 - -- • 4' ll U10 LEVEL • D/B W/ 6" SUMP 10v, e.1 22 ,24 `7 IZ,z 13 Q ZvTc>► )%--) 0 14 w t v L 15 o k` (f" D 4 L_.h r_ r �� , T+nor � STotoE PERC TEST RESULTS ''RLCAST SEPT!C TANv W!TP PERC RATE : __<.._Z mItJ,/ 1 ,.Jc- CAST IN PLACE INLET AND __ —_-___. ...._ E7 LV r2 NID Wn,t2 L-01 , WHiTNESSE"u Bi : %_ l OUTLET T 'S PER TITLE V 6T71)r-1 d'r 7-ESr ok.f � �A�z�7� r�_�._�..__ BOARD OF HEALTH SIZE : IooD r-, nI-►vr, DATE : _ z.- 01. ._. .. ..._ __ vr � r)b c� I--c 4x. S - J = IID97 _F571o3 _�..E hz L i I I t,1 L., 05 (V 0 o PROFILE OF PROPOSED SEWAGE SYSTEMTJ SYSTEM DESIGNED BY THE TOWN OF _BhV_VAS _1,6LE REGULATIONS AND >_-, � STATE TITLE V FOR SUBSURFACE DISPOSAL OF SEWAGE . SCALE 1/4 - 1 0 24 N . B . q r" La , 1 . ALL PIPES SHALL BE SCHEDULE 40 P.V.C. SEWER PIPE r- � ��Y� �,f 2. All PIPES SHALL BE SLOPEO 1/4 PER FOOT EXCEPT FOR 2v' 4° _ I$' q THE FIRST 2 FEET OUT OF THE 0 /8 WHICH SHALL BE LEVEL 3. DESIGN FLOW -_3 BEDROOMS AT 110 GALDAY PER BR . 33 o GAl /DAY t2?� ° -� 00 wF2o►MI SEPTIC TANK SIZE 33D X I , 5 = 4-96 GAL . !a� \ USE 10oo - GAL. W/00T GARBAGE DISPOSAL ►�° `" � ` O NkWL a WD12t� �►� \ LEACHING SYSTEM : USE 3 - 4 �, P-; FLbh/ D I FF J g G R�� wID-I 1 t~ S1011 C 5A c ►-1 4V P o v'I r �41 A,-arEN �rtLEA EL1U1R 1� 0 G, (J -1-- .7.57 GlCl = 440 , I ` vE' `� rr� A)c" FAe— A)p , � � ` EFFECTIVE AREA : SLOE --ANp _ AfL A PtzO I Dt vE ) i3755 ( I -�- 17_� � �. 1 -f- 3�l - 4-5 S � �IZ,I 1 51 rJ 6 b E ., BOTTOM r- AWL -/ J �� TOTAL FLOW 4554 ). .-7s r ;/o it 341 6A) AA DdELLIh1/ t TOTAL REQ 'D FLOW _ 33__b X 1 . 0 = � 30 Wi 0T GARBAGE DISPOSAL RESERVE FLOW 3 4-1 - 330 i ! GAL / DAY _ A 1K% I�A J E)A L E-1? AT V \AIL REFERENCE PLANS : ?LA, _Z)opK, 275 'F>6 9b OP �= I� r�r�= rt - 'l L_► � E _f3RD SIFT / 972 L 1 � - N5� 1 APPROVED BY .- BOARD OF HEALTH z--1 s ��l � i „ _ _ _Z_Q 3 A&hso A 3i E _.�... DATE - PROPERTY . OWNER : Sa s t o /-I Ak)D 1� /J L_ ©e � � 17r� x__ �� � _______--._ ______ SITE AND SEWAGE PLAN tV,,*°f 4� FOR S o s E (',a A A 0 1) o¢.F_ �, "'"�_ �Il�M ti� �weEaMAN 5 BEDROOM SINGLE F MILY DWELLING 04,M, 69� pp. 239T1 p 9 LOT : J f-1 I -t C� 1-I E L L`7 A `� �TM-9 2 q0 PO r1,61.L 4- / 5� 0 DATE . SA N Z_�, I g c� 4- SSIoN E ��� "/t � L I r M L r t=13 c R /W! (a tt 1 4 _ , M 1VLt T ►� 11 L_L S I M A o 2,49 L. a 29- -Z. 1Z