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0029 NOBADEER ROAD
IeW Town of Barnstable Building F';!:w-»r`7-.m;.: Post This 917, So That it is Visible From the Street Approved Plans Must be Retained on Job and this Card Must be Kept �i I', . tn�ASTwHts . . . Mwss Posted Until Final Inspection Has Been _� r 4 i Permit 63Q 0� w ? x ice Where a Certificate of Occupancy�s Required,�sucf Building-shall Not 6e Occupied until a Final Inspection has been made Permit No. B-17-4441 Applicant Name: SOUTHERN NEW ENGLAND WINDOWS LLC. Approvals Date Issued: 01/04/2018 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 07/04/2018 Foundation: Location: 29 NOBADEER ROAD,HYANNIS Map/Lot: 250-131 Zoning District: RD-1 Sheathing: rW Owner on Record: TROPEANO,MATTHEW&PAULA i �' "` Contractor Name: SOUTHERN NEW ENGLAND Framing: 1 WINDOWS LLC. Address: 29 NOBADEER ROAD � K . : 2 CENTERVILLE, MA 02632 }� x Contractor License: 173245 Chimney: r y: Description: Replacement windows(UValue.29(17) Replacement Door(1) . Est Project Cost: $45,655.00 Insulation: Permit,Fee: $232.84 Project Review Req: m Final Fee Paid: $232.84 Date: 1/4/2018 r Plumbing/Gas JP Rough Plumbing: V i Final Plumbing: # Building Official Rough Gas: This permit shall be deemed abandoned and invalid unless the work authli—orized by this permit is commenced within six months after issuance. Final Gas: All work authorized by this permit shall conform to the approved application.and the`approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures`shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Electrical k� work until the completion of the same. Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Bulding and Fire Officials are provided on this permit. Rough: Minimum of Five Call Inspections Required for All Construction Work: -» -- - --�- _:� 1.Foundation or Footing Final: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Low Voltage Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Final: 6.Insulation 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Final: Work shall not proceed until the Inspector has approved the various stages of construction., Fire Department "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 All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT �oFs"e�wti Town of Barnstable *Permit#� s qqq p Expires 6 months front issue date { l Regulatory Services ,,p,Fee � 1 ' nnatvsTnacaMASSEA�.,xtlrtnt 9c� 1 a Richard V.Scali,Director '�FDMP•�� B I�av�s�®n p DEC 9 I�dI>IIg Tom Perry,CBO,Building Commissioner �.Ov o . 200 Main Street,Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-740-6230 EXPRESS PEWIT APPLICATION - RESIDENTIAL ONLY Not valid without Red X-Press Imprint Llap/parcel Number Z�d,•��j ' ------ Property Address kb dResidential Value of Work$- '/���7 Minimum fee oftt$35.00 for work under$6000.00 Owner's Name&Address Pa j " f f 6tc� r ea PO nn- A)06 "ems Contractor's Name E r7rl ( //r Sp/( Telephone Number(q o f 2Z !r FOCI Home Improvement Contractor License#(if applicable) L73.2 q Email: Construction Supervisor's License#(if applicable) O 1 707 t CKorkman's Compensation Insurance Check one: ❑ I am a sole proprietor in the Homeowner L_TI have Worker's Compensation Insurance Insurance Company Name F; r ame— n Ln-s ura e K',o. Workman's Comp.Policy# W C A 31 2T 8 7 2-9 — 2— Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders.LWalue ,Z. (maximum.32)#of windows 17 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 Pwner must sign Property Owner Letter of Permission. A copy the Home Improvement Contractors License&Construction Supervisors License is require SIGNATURE: C:\Users\Decollik\AppData\LocaNMicrosoft\Windows\Temporary Internet Files\Content.0utIook\2PI0I DHR\EXPRESS.doc Revised 040215 Renewal Agreement Document and Payment Terms Andersen. dha:Renewal By Andersen of Southern New England Paula&Matthew Tropeano Legal Name:Southern New England Windows,LLC . 29 Nobadeec Road ��� RI #36079,MA#173245,CT#06345551 Lead Firm#1237 . Centerville,MA 02632 wixoow FE �ncEwEwr 10 Reservoir Rd I Smithfield,Rl 02917 H:(347)276=9285 Phone:866-563-2235 1 Fax:401-633-6.602 1 sales®renewalsne.com C:7744704634 Buyer(s)Name: Paula & Matthew Tropeano. Contract Date: 12/04/.17 Buyer(s)Street Address: 29 Nobadeer Road, Centerville,_MA 02632 Primary Telephone;Number: (347)276=9285: Secondary Telephone Number: 7,744704634 Primary Email: tropeanoshome@gmaii.com SecondaryEmail: Buyer(s)hereby jointly.and severally agrees to.purchase the products and/or services.ofSouthern New England Windows,LLC d/b/a Renewal By Andersen of Southern New England("Contractor'.),'in accordance with the terms and conditions described in this Agreement Document and Payment Terms,any documents listed in the Table of Contents,and any other document attached to this Agreement Document,the terms of which are all agreed to by the parties and incorpporated herein by reference(collectively,this"Agreement'). Buyer(s)hereby.agrees to sign a completion certificate after Contractor has completed.all work under this Agreement.. Total Job.Amouni: $45,65S.. By signing this Agreement,you'acknowledge that the Balance Due,and the Amount: Financed must be made.by personal check,bank check,credit card,or cash. Deposit Received: : $0 Balance Due: $45,655 . Estimated Start: Estimated Completion: 8-10 weeks 8-10 weeks Amount Financed: $45,000 Method of Payment: Financing We schedule installations based on the date of the signed contract and secondarily on the date in which we complete the technical'measurements.The installation date that we;are providing at this time is only an estimate.We will communicate an official date and time at a7ater date:.Rain and extreme.weather are the most common causes for delay. - Notes: 50%DEP 50%ON.COMP TXS PD in BARNTSTABLE MA Buyer(s)agrees and understands that this Agreement.constitutes:the entire understandings between the parties and thatshere are no verbal understandings changing or modifying any of the.terms of this Agreement.No alterations to'ordeviations from this Agreement will.be valid without.the signed,;written consent of both-the Buyer(s):and Contractor.Buyers)hereby acknowledges that Buyer(s). 1)has read this Agreement, understands the terms of this Agreeinent,'"and has received a completed,signed,and dated copy of this Agreement*,'including the two attached Notices of Cancellation;on the date first written above'and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO BUYER: Da not sign this contract if blank.You are entitled to a copy of the:contract at the time you sign. YOU,THE BUYER,.MAY CANCEL THIS TRANSACTION AT ANY TIME NOT.LATER THAN MIDNIGHT OF 12/07/2017 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT Legal Name:Southern New England Windows,.LLC dba:'Ren i By Andersen'of Southern New England Buyers) Signature of Sales Person ": Signature Signature ' Eric Woods Paula Tropeano Matthew Tropeano. Print Name of Sales Person Print Name Print Name UPDATED: 12/04/17 Page 2 J 14 R rJ;J '� l% f ,: J .t.,�i % %/ fir: iil;.�T >ti' � _ /{•i • .. ¢j Office oI Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 - Bost-on, Massachusetts 02116 . Home ImprovemP Contractor Registratio Registration: 173245 Type: Supplement Card Expiration: 9/19/2018 SOUTHERN NEW ENGLAND WINDOWS LL = BRIAN DENNISON 26 ALBION RD = LINCOLN, RI 02865 - Update Address and return card.Mark reason for change. Address Renewal 7 Employment - Lost Card — 9- c of Consumer A:'Tairs&Business Regulation Registration valid for individual use only before the =K expiration date. If found return to: --HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation Registration: 7T245 Type: 10 Park Plaza-Suite 5170 = Expiration gjT9/2018 Supplement Card Boston,N1A 02116 SOUTHERN NEW ENGLAND WINDOWS LLC. RENEWAL BY ANDERSON BRIAN DENNISON I 26 ALBION RD LINCOLN, RI 02865 4-Uhdersecretary Not valid without signature Massachusetts Department of Public SafetyrM ' Board of Building Regulations and Standards License: CS-095707 +Ion C,' er'viSv BRIAN D DENNISON 7 LAMBS POND CIRCLES t. CHARLTON MA 0160 � A Commissioner 09/08/2018 I ` The Commonwealth of Massachusetts _1 Department of Industrial Accidenis 1 Congress.Street, Suite 100 Boston,MA 02114-2017 sl www.mass.gov/dia 11 orkers'Compensation Insurance Affidavit:Builders/Contractors/Electrtriciaus/Plumbers. TO BE FILED R'ITH THE PERMITTI.tvG AUTHORITY. Applicant Information Please Print Le iblY Name (Business!Organizationlndividual): kJ e .E �9.ils Address: .Z& v4 .wf2Q :R j City/State/Zip: P Phone 4: Are you an employer?Check the appropriate box: Type of project(required): 1 Xl am a employer with ZO ?-emplovees(full and/or par-time).' 77. New construction i.D I am a sole proprietor or partnership and have no employees working for me ir. S. [:]Remodeling any capacity.[hloworkers'comp.insurance reauiree1 �. El Demolition O]am a homeewnes doing ail work myself ado workers'comp.insurance repaired.;' l0 Building addition 4.❑lam a homeovrner and wil_be hiring contractors to conduct all work or my property_ I will ensure that all contractors either have workers'compensation insurance or are sole I 11.0 Electrical repairs or additions prop-iemrs-Aitt nc employees. 12.Q Plumbine repairs or additions �I am a ener contractor and'have hired the sub-contractors listed on the attached sheet.h � 1-,_❑Roof repairs These sub-contractors have employees and have workers'comp.insurance. 14. Other /IlJ 60 E.❑1n'e are a corporation and iu officers have exercised then right of exempron pet,MGL c F 1(4).and we have ne employees. c workers'comp.insurance required._ i I bo Repl Q�l�'Y(ti� ny applicant that cheeks box'I', must also fill ow the section befow showing their workers'compensatior policy information.. Homeowners who submit this affidavit indicating they are doing all worl.and then hire outside contractors must submit a new affidavit indicating such Conmactors that check this box mist 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 mu5 proyZde their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for mr employees. Below is the policy and joh site information. _ Insurance Company Dame: ire me Policy g or Self-ins.Lic.#_ a Expiration Date: �6l Job Site Address: A Iq r"� )0b� eer City/state./Zip:64if e Attach a cope of the workers' compensation policy declaration page(showing the police number and expiration date). Failure to secure coverage as required under MGL c. 152,F25A is a criminal violation punishable by a fine up to$L500.00 and/or one-vear imprisonment,as well as civil penalties.in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A coF), ofthis statement may be.-forwarded to the Office of Investigations ofthe DLA for insurance coverage verification. I do hereby certify under th ains and penalties of perjure°that the information provided abope_is tri4e and correct 5i ature: Date: Phone f Official use only. Do not write in this area,to be completed by cite°or town officiaL ` Citti or Town: Permit/License to 4• Issuing Authorit}°(circle one): 1•Board of Health 2.Building Department 3.City;To%,n Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: ESLERCO-01 SANDERSO ,acoR� CERTIFICATE OF LIABILITY INSURANCE D 0 610 712 0 1 Yl1 06/07/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE.OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or 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). CONTACT PRODUCER NAME: CoBiz Insurance,Inc.-CO PHONE FAX Nd)_(303 988-0804 1407 Lawrence St,Ste.1200 (Ivc,No,Ext>:(303)988-0446 ) Denver,CO 80202 ao REss:COMaiI@cobizinsurance.com INSURERS AFFORDING COVERAGE I NAIC X INSURER A:Acadia Insurance Company 131325 I INSURED INSURER B:Firemens Insurance Company of WA D.C. 21784 Southern New England Windows LLC.dba Renewal b r lus Insurance 110725 South g Y INSURER c:Libe Su Andersen of Southern New England 26 Albion Road,Suite 1 INSURER D: Lincoln,RI 02865 INSURERE: I i INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD i I 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 ADDL SUBR POLICY EFF POLICY EXP _ LIMITS L 1 TYPE OF INSURANCE INSD WVD POLICY NUMBER mmrnn mMfDDrYYM A 1 X I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 1,000,ODO CLAIMS-MADE L II OCCUR CPA3158728 0110112/D17 1 01101/2018 PREMISES (RENTED 300,000 PREMISES Ea ocamence` 5,0001 MED EXF(Any oneperson) 1.000,000 PERSONAL S ADV INJURY 5 i 2,000,OOOI i i GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE X POLICY C PRO- CI LOC I PRODUCTS-COMP/OF AGG 5 2,000,000 I JECT i EBL AGGREGATE 27000,000' OTHER: COMBINED SINGLE LIMIT 5 1,0002000; i A I AUTOMOBILE LIABILITY _ Ea amdent ANY AUTO CPA3158728 01/01/2017 01/0112018 BODILY INJURY Per erson 5 i i OWNED SCHEDULED BODILY INJURY(Per acdtlent)!5 AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per amdenC - S S A X UMBRELLA uA6 I X OCCUR I I = 1,000,0001 EACH OCCURRENCE I EXCESS LIAR CLAIMS-MADE 01/0112017 10110112018 AGGREGATE I gpl ICPA3158728 Aggregate I 1,000,OOO1 DED X RETENTIONS _ I - I B WORKERS COMPENSATION I X STATUTE ERH AND EMPLOYERS'LIABILITY YIN WCA3158729-20 01101/2017 01/01/2018 1,000,OOOI ANY PROPRIETOR/PARTNEWEXECUTIVE E.L.EA ACCIDENT S OFFICER/MEMBER EXCLUDED? ,I N I A 1,000,000�' (Mandatory m NH) E.L.DISEASE-EA EMPLOYE 5 r yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E_L.DISEASE-POLICY LIMIT 5 B Worker's Compensatio WCA3158730-20 01/01/2017 01l0112018 1,000,0001 117 01/0112017 01/01/2018 1,000,000 i I 1DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more space is required) 17-18 Workers Compesnation Includes-All states except ND,OH,WA,WV,WY I I I i CERTIFICATE HOLDER CANCELLATION i SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE W E ILL BE DELIVERED IN ACCORDANCE WITH THE POLIE'Y PROVISIONS. ` I i AUTHORED REPRESENTATIVE I I I F RI f rm i n IP r ACORD 25(2016/03) ©7988-2075 ACORD CORPORATION- All rights reserved. The ACORD name and logo are registered marks of ACORD I � Cape Save Inc. T O',IN 0 F. A UN'S T E 7-D Huntington Avenue - `: South Yarmouth, MA 02664`-�d fF ` ' xt Tel: 508-398-0398 Fax: 508-398-0399 8/21/12 Town of Barnstable - Thomas Perry CBO • �,, �, s Building Commissioner „ 200 Main St. Hyannis,MA 02601 r " RE: Building Permits Dear Mr. Perry, f ' This affidavit is to certify that all work completed for 29 Nobadeer Road, ilte.has been ` inspected by a certified Building Performance Institute(BPI)Inspector. Ceiling: R-19 cellulose and R-11 cellulose. All work performed meets or exceeds Federal and State Requirements. '. . },• �. • Sincerely, R ., :William McCluskey TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 3 I Application #�0169 v , Map � Parcel pp Health`Division Date Issued Z Conservation Division Application Fee �0 Planning Dept. Permit Fee Date Definitive Plan.Approved by Planning Board fI Historic - OKH _ Preservation/ Hyannis Project Street Address 9 N o �, ol�(` b a a Village IG"4eF yyann�S Owner bm aS Rn�©S CIa Address _<a,r t Telephone 5 © 8 - g Permit Request R41 0 M1 R ' 19 celk*\0je 40 +4 t rk�i bec cIoLg +5 fi�e Grcx\4s0ace ce'lVi\6 , Ric- sea,� w"ic .. ` E M n i -t-a a Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 3 Nbo Construction Type' Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family .XL Two Family ❑ Multi-Family (# units) Age Hof Existing Structure Q 3 Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other a Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing r�new-�-A Number of Bedrooms: existing _new `fl Total Room Count (not including baths): existing new First FloorrRoom Count Heat Type and Fuel: .Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes No Fireplaces: Existing New Existing wo d/coal sigve: }3!Yes ❑ No Detached garage: ❑ existing ❑ new size Pool: ❑ existing ❑ new size _ Barn: U existinC ❑ 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 ��I'1e�cr' uSi''6 I "'► e SnvC ^� Telephone Number Address - Y yfiA in6-}oA CYVC License# ZG 5D W4 YkMdkk_% M VO���� Home Improvement Contractor# Worker's Compensation # 1 W C 3 3 1 8 00 T ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO `aXMO SIGNATURE DATE _ 4 r FOR OFFICIAL USE ONLY APPLICATION# ` DATE ISSUED .r 1 MAP/PARCEL NO. ADDRESS VILLAGE OWNER s DATE OF INSPECTION: t!.FOUNDATION ? FRAME INSULATION_' I� FIREPLACE {� ELECTRICAL: ROUGH FINAL IFS PLUMBING: ROUGH FINAL ty . GAS:: ,?.� „.- ROUGH FINAL FINAL BUILDING'F- . . DATE CLOSED OUT . ASSOCIATION PLAN NO. ` It � � t . 460 ,est Main Street HOUSING Hyannis, MA 02601-3698 ASSISTANCE ENERGY & HOME REPAIR T• (508) 790-7106 F (508) 790- CORPORAT I01_v 2425 HOME OWNER WEATHERIZATION WORK PERMIT& FUEL RELEASE: Plz rA tY- rll 1 llllT A1.11'1 nnAt Tllf[�CllC7ll! ff-yllff All E-1 T111SFOR rn I QLJ r'%RE THEAPPLICANT HOMEOWNER- 4ereby consent to and agncthat weatherization work may be done by the Weatherization Program of Housing Assistance Corporation (herein after referred as "Agency") on the property located at I^ Theweatherization work done will be based on programmatic priorities and availability of funding an it may include all or some of thefollowing measures , Weather-stripping& caulking of windows and doors, insulation of attics, adewalis& basementsy_ attic and other ventilation measures and possibly replacement of badly deteriorated windows In consideration of theweatherization work to bedone at my home I agreeto thefoliowing a` 1. 1 give permission to the"Agency" its agents and employees to travel onto or across said property with such equipment and materials as may be necessary to perform weatherization ` work on said property. L ? 2- The H ousi ngAssi stance Corporation reserves the right to inspect thefuel or utility bill for the. . weatherized unit on an ongoing bass for no more than five(5) years after thew eat herizati on work is completed. , I haveread the provisionsof thisagreemeit as listed and fr y consent. Home Owner: (ggnature) Date Agent: (signature) a Date: , HAG approved Weatherization Company :_ C�6Lv•ei All Cape Energy, Caliber Building&Remodeling, Cape Cod elation, Save Creswell Constmcdon, - Frontier Energy Solutions, Lour&Sons, Peter Smith, Resolution Energy, Rock Solid.Conshuction ' s ', The Common of Massac] usetts _ Departinent of Industrial Accidents rf Office of Itrvestigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly . Name(Business/Organization/Individual): t► o d�Yir, S n 1 ' Address:_ ' D H"ii'n9+on City/State/Zip:,so0,t�+ YarCnOVA MR 0;W Phone:#: 5o8- 30 - 0 .3 91 Are you an employer?Check the appropriate box: — l.� I am a employer with 1 4• []-I am a general contractor and I Type of project(required): employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. _7. ❑Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in;any capacity.- employees and have workers' ` [No workers'comp,insurance comp.insurance.) 9. ❑Building addition , required.] 5. We are a corporation and its 10.❑Electrical repairs or additions:. 3.❑ I am a homeowner doing all work officers have exercised their I I.❑Plumbingrepairs or additions P ons myself. ,y [No workers comp. . right of exemption per MGL 12.[]Roof repairs insurance required.]f c. 152, §1(4),and we have no employees.[No workers' 111K Other MT S u►.1 a�i on ' comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. )Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. 1f the-sub-contractors have employees,they must provide their workers'comp.policy number. ; am an employer that isproviding workers'compensation information. insurance for my employees. Below is thepolicy andjob site Insurance Company Name: . TP 01 n 0 0 a Policy#'or Self-ins.Lic.#: Twc 3 3 g • Expiration Date: y 1 ! 13 Job Site Address:_ 0 �kJ e@� �6a�,� City/State/Zip: Q��ltS Attach a copy of the workers'compensation policy declaration page(showing the policy numb r and expiration date). Failure to secure coverage as required under Section 25A-of MGL c. 152 can lead to the imposition of criminal penalties of a 'fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator:. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pants andpenalties ofperjury t/raf the information provided above is,'true and correct. _ Signature: _ I Date- Phone#: 5©$ - 3 9 3 - 0 3 9 R Official use only. Do not write in this area,to be completed by city or town official City or Tomm: Permit/License# p 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#: ACe0RO 510/CERTIFICATE OF LIABILITY INSURANCE D/10/UD2012D1N2yM . 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 BEZOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN,THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of.the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Risk Strategies Company- Risk Strategies Company PHONE (781)986_4400 1 FAAIC o .(791)963-4420 15 Pacella Park Drive EMAIL Suite 240 INSURE S AFFORDING COVERAGE NAIC# Randolph MA 02368 INSURERA:SeleCtive Insurance INSURED _LNSUIRERs:Safety Insurance Company 3618 ` Cape Save, Inc INSURER C.-Technology C.-Technology Insurance Company 7 D Huntington Ave INSURER D: INSURER E: South Yarmouth MA 02644 INSURERF: COVERAGES CERTIFICATE NUMBER-CL125948081 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 ADDL UBR POLICY EFF POLICY EXP - LTR TYPE OF INSURANCE POLICY NUMBER MMIDD MMIDD LIMITS GENERAL LIABILITY 1,000,000 • EACH OCCURRENCE $ X COMMERCIAL GENERAL LIABILITY DAMAGES Ea en TO RENTED $ 100,060 A CLAIMS-MADE ®OCCUR CPPS1994480 0/16/2011 0/16/2012 MED EXP(Any one person) $` 10,000 PERSONAL 8 ADV INJURY . $. 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ 2,000,000 XPOLICY JFCT PRO LOC $ AUTOMOBILE LIABILITY UMBINED SINGLE LIMIT(Ea accident) 11000,000 ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED 6208200 1/6/2011 1/6/2012 BODILY INJURY(Per accident) $ ' AUTOS AUTOS R HIRED AUTOS X NON-OAUTOS ROPERTYtDAMAGE . $ X Underinsured motorist BI lit $ 1100 000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 2,000,000 A, EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 DED RETENTION PPS1994480 0/16/2011 0/16/2012 $ C WORKERS COMPENSATION I WC STATU- OTH- AND EMPLOYERS'LIABILITY •. ANY PROPRIETORIPARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? F91 NIA t �3�18007 /9/2012 /9/2013(Mandatory In NH) E.L DISEASE-EA EMPLOYE $ 500,000 ' If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) Issued as evidence of insurance. Issued as evidence of insurance. Thielsch Engineering, Inc. is listed as additional insured as respects General Liability as required by' written contract. µ r CERTIFICATE HOLDER CANCELLATION msong@capelightcompact.org SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Cape Light Compact ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Margaret Song PO BOX 427/SCH AUTHORIZED REPRESENTATIVE 3195 Main Street Barnstable, MA 02630 . Michael Christian/BM ACORD 25(2010105) 01988-2010 ACORD CORPORATION. All rights reserved. INS025rontrmnt Tho Ar_non nama and Inn^nro ranieforarl m7rlrc of ArnRr1 n A4:•- l-lassachusetts- Department of Public Safety Board of Building-, Re�-ulations and Standards Construction Supervisor Specialty License License: CS SL 102776 � Restricted to: IC WILLIAM MC CLUSKY r:.• t 37 NAUSET ROAD 4 1.: WEST YARMOUTH, MA 02673 Expiration: 6/28/2013 •* (unnni<.ioner t Tr#: 102776 Office of Consumer Affairs and usiness Regulation 10 Park Plaza - Suite 5170, _. ^ Boston, Massachusetts 02116 Home Improvement Contractor Registration ° Registration: 171380 Type: Corporation t ` Expiration: 3/14/2014 Tr# 222184 CAPE SAVE INC. WILLIAM McCLUSKEY 7-D HUNTINGTON AVENUE , SOUTH YARMOUTH, MA 02664 " Update Address and return card.Mark reason for change. Address n Renewal Employment Lost Card PS-CA1 0 50M-04/04-GIO1216 • — , s 1. J� & a�✓js'adaac�ation a License orsre registration valid for individul use onl`� Office of Consumer Affairs&Busines Regulation � y ' e before the expiration date. If found return to: _ HOME IMPROVEMENT CONTRACTOR � P Office of Consumer Affairs and Business Regulation Registration: ._1.71380 TYPE g ' b - C) 10 Park Plaza-Suite 5170 7' Expiration: =3/14/2014 Corporation Boston,MA 02116 CX SAVE INC.' .i4- WILLIAM 7-D HUN`fINGTON SOUTH YARMOUTH MA'02664' Undersecretary Not valid withn a ��_�� - ' 9 v �I � �� Jam`. 6 - 6 -{j TAssessoes office(1st Floor): Assessor's map and lot numb / 'G�-� �4�' ha ST BE o*THE ro Cignservation.(4th Floor): .7 COMPLIANCE- or)- Board of Health(3rd flo � �I�®���if TITLE 5 • Sewage Permit number ' � _ � �i � A $® '�!T°�lL. �:���Af�9d� osear1639 ►nt,,� Engineering Department(3rd floor): EG�L ®�' o asr►. House number , Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30 AM and 1:00-2:00 P.M,only TOWN ., OF A3ARNSTABLE BUILDING INSPECTOR APPLICATION.FOR PERMIT TO PD ' f TYPE OF CONSTRUCTION Q D — T I J 19 S I TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: I ��n Location aq giMoer-,Q- -iQbA S u-2 m A Qa(,o3a- Proposed Use Zoning District Fire District MAAM M IG Name of Owner qhs NW'®S�A Address WMD6EE l� ILLe � Md)I. and 1106 AddressAQWWNEAD RD., M.9§9M ,Name of Builder Name of Architect3IAW� MN-00k- Address '7�-1�n + �sra(W66P-kl -41L-j- PD. CaLIE�ILIE Number of Rooms?�O Foundation+FEFLe0W k- GCS HA '4 4 FAAMk- _ %�(°1oX �+f6� �tSP4�A�� Exterio Roofing Floors Two al Interior RMiSHIM Heating Plumbing Fireplace Approximate Cost { Area Diagram of Lot and Building with Dimensions Fee 4-5 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above constru2 'on. Name Construction Si ipervisor's License1 R R ANTOSCA, THOMAS ,r r No Z ti -� ADD TO DWELLING Permit For Location. 29 Nobadeer Rd, Centerville . Owner Thomas Antosca Type of Construction i 0 1 Plot Lot f Permit Granted May• 2 7 1.9 94 Date of Inspection: { ^ Frame I Insulation 19-f fireplace 19 e Date Completed 19 ru J , it A/DII,I:11® CERTIFICATE OF INSURIhNCE ISSUE DATE (MM/DD/YYJ 05 26 94 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE KERRY INSURANCE AGENCY INC POLICIES BELOW. EASTHAM COMMON ROUTE 6 COMPANIES AFFORDING COVERAGE P O BOX MM ............................................................................................................................................................ ............ NORTH EASTHAM MA 02651 COMPANY A LETTER ................ ..................................................................................................................................: COMPANY B INSURED LETTER :.................................................................................................................................................................... ... PAUL JOSEPH COMPANY C ................................................................................._......_ ................... PO BOX 390 COMPANY D NO EASTHAM MA 02651 LEER WORKERS COMP INS PLAN OF MASS ................................. COMPANY E LETTER COVERAGES. ::.: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. .................................................................................................................. ................................................. Co TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE :POLICY EXPIRATION. LTR DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ ................... ............... COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. :$ ........... ........................................ CLAIMS MADE: OCCUR.: PERSONAL&ADV.INJURY $ ......... ................................................:....................................... OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE $ ............................................:......................................... FIRE DAMAGE(Any one fire) $ ............................................................................ MED.EXPENSE(Any one person):$ AUTOMOBILE LIABILITY COMBINED SINGLE ANY AUTO LIMIT ALL OWNED AUTOS _..........._........ _....................... $ ..... BODILY INJURY $ ....... SCHEDULED AUTOS (Per person) .. HIREDAUTOS ..................................................................................... BODILY INJURY NON-OWNED AUTOS (Per accident) $ .......... GARAGE LIABILITY PROPERTY DAMAGE _..........._ P $ EXCESS LIABILITY EACH OCCURRENCE $ ................................................:.....................................:. UMBRELLA FORM AGGREGATE $ OTHER THA N AN UMBRELLA FORM . U O WORKER'S COMPENSATION PENDING 0 6/01/9 4 0 6/O 1/9 5 X STATUTORY LIMITS ......................................>::.:.............:..::.........::::::>::: AND EACH ACCIDENT $ 100 I 0 0 0 DISEASE--POLICY LIMIT $ 5.0.0.10.0.0.... 'EMPLOYERS'LIABILITY - ....................... DISEASE--EACH EMPLOYEE $ 100, 000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS CARPENTRY CERTIFICATE liO.AER „ GANCEkU1710:N _. Y SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO ATTN: BUILDING INSPECTOR MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE TOWN OF BARNSTABLE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR TOWN HALL — 367 MAIN ST LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. HYANNI S MA 02601 AUTHOR2ED REPRESENTATIVE KERRY INSURANCE AGENCY IN S C ACdgD 2.;5 S(T/9Q OAdQRD�pC#PgHA'#I:QN a9go. ... £,y --°'1 �. :. ._' Y M1 s K kr,•44 V Zi t l A EQ OF ��pVTVV�COMMONWEALTH� r DEr-AR-1Iv `T OF LNDUSTMAI&ACCIDENTS ` 600 WASHINGTON S y �{,y�T'i .fames.; canmei, BOSTON, MASSACHUSEM 02111 corns ssione WORKERS' COMPENSATION INSURANCEAFFTDAVIT p+�3 � a T,� t a L�F�,h r a ;, a > •. r� 7 ,''L"' � yN c- �• �'�'.i��� ';_�,�A§i v4c�k -�`�"��� }< '^'� � ' "„#,f'�s `, jp 14 . 7s G �I: Y .:Paul Joseph « t x� � au 4y�r4,� Y .a Ft rr` x y'f' r a .A R "fi2 j -�. i9Y•,w+,�".' 4 d `,�1 , 'z` ;-^ , t. s- �.' *' wY. ±'„h'4"`� ;>> °a -.::h.'rCSYr, m.v'�,.: t� §' zr �y *r a t + 1 r.,,�' { %'°g, .' sxt[.yVrk•«. .aa�'-.. "�'.�a, a F ro. �K �IGCaSC[ 1L[et) :»' 'F. z s r i g S�t "� 4 ? r��r F # a ra r d r.. '4.� mr---'�''.taa rri;:E°:�.�m. �' -,- �' :>t,+u�' sn ' t b s �F +' a g �� '�+.v+++ : t •• +r t ,«.�, + .* :•.,'S *' c:l +r° a ;s +'e gr ',T ° x ts4� j' w � r ? ..,� ,t.. Y �+, Een i$ - ♦r{?' is Y '° Y't.. s § # vsnth a'pnna al place of bu3iness/resldenee at:L ry j r _ � .z 4. .i.�a_" 't•!_•.+_.b 9 J{�:s � �-f"µ�.,3-.c 4.; i e"•`¢�'�,^ r,4� �'S t.� i aF L� �",� .n,.,. ''K`"'3tr'' ix i4`r yMvm- ^,�Y:• F-'! E."`"` �y-` x,..,s ,. ,. -.. -. y; �,�.G ..:.�.. -` 9'.hs^?iyy .. ,. . 10Arrowheacl Dr ive F Ar thEa3fihamMA !f E�y�,u z�.q...,„s( ^�k..^;-;,S r.�' '+'�+^7.z{ytki, 3 :� ..z^'.:•'�t "� F'4YT 'fix t � x`�'3'6- 'F"�...� t�-�':x, "�",rv°'�:�a,tai 'ti .;i.:..c,r�.,la.Y az,�_.,+• �� u..z�.ill �q �+•x Cif. `3% ",�5,v,��` +�a"'>:.a.. .vc��.�.s?C...b �zi._. Ee :i °u.'a 4 �3 �;,�'°�"'t r'�,� R � 'F�" iVr��Jr`!+wp� :,"-,�e v" :.'y ,M''"" � $� '.�- �y'�2��`"6 r ,W-yam• „�� 4'a, b�ufr�, ' z��`�` '�`t r . ��'�t�ff'� r).+y��:,..��Y,s�, _� x"�a�'�r.•� c—�,.Nts.� �r�,c�'«� ;>',•:r �, r>�� tt� �"`� ��� ., � � is.�f �$h sc :c'•.� �., .. ..,�.;. s n..-'t.i.• E�3,�rv,,: t.,t± <,5� a>•-_..: �, • >,;� "sr r l�. � ,a.. s (i.1k`. � �sz��`�` ,� �.� '� , fi"�4 (lemployer� :pr g S � �. �� Y tiM I am an providing the following workers compensation coverage for m employees worlung.on this lob• Workers Compensation Plan of Mass Insurance Company Policy Number OI am a sole proprietor and have no one working for me (J 1 am a sole proprietor,generad contractor or homeowner(circle one)and have hired the contractors listed below who have the following workers'compensation insurance policies: - Name of Contractor Insurance Company/Policy Number.~, ; Name of Contractor Insurance Company/Policy Number s Name of Contractor Insurance Company/Policy Number Q 1 :m a homeowner performing all the work myself. NOTE;.Please be aware that while homeowner:wbo employ persons to do maintenance.construction or tepairwork on a ' dwcliinr of not more than free uaiu in wbicb tie homeowner also resides or on the grounds appurtenant thereto arc not ccaerally considered to be employers under the W orkers' Coravc=ation Ace(CL C 152.sect. 1(5)),application by a homeowner for a license or permit may evidence the Ic=al status of as employer under the Gorkcrs'Cormpensation Act } l cared^;:nd t.^.a;:coo. cf t: s::zc-�c:;will be forwa-ccd to the.rice:.:-.crt of Indus; J Aeaderiu'Ofnec of lnsuranci for coverage vc"+:.::ion ar,c ;o ic- rc cave;-ee:s rceui;cc under Scen'oa 'c:of�;G�'c_err.icad to me imposition of erir::inal peralcics ccnsi:c;:£of:zJ.c of ur to S i 500.00:nclor iz:orisormcm of uD zo orc yc::snc c.:i•pen::acs an the form of a Stop Work Order and a fine of S l oo.o0 a a€ains;me. Sicned this day of 19_ T L:Cc::sor;r:rr:1—.:,: t 1 r TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE . JOB LOCATION OE�S F V I LL-e Number St eet Address Section Of Town "HOMEOWNER" ThONAS WEDS CA rfQd -ozfN 77 �- Name nnHome Phone Work Phone PRESENT MAILING ADDRESS 0)�m7T,2V 1 kj,-F_ HA l��f�3 3_-, City/Town State - Zip Code The current exemption for "homeowners" was extended to include owner occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one to six family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109. 1. 1) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements HOMEOWNER'S SIGNATURE f i i APPROVAL OF BUILDING OFFICIAL I Note: Three family dwellings 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0, Construction Control. AISC5 i y HOME OWNER'S EXEMPTION The code, states that: "Any Home Owner performing work for which a building permit is required shall be exempt. from the provisions of this section r (Section 109. 1. 1 - Licensing of Construction Supervisors) ; provided that if Home Owner engages a persons) for hire to do such work, that such Home Owner shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for Licensing Construction Supervisors, Section 2.15) . This lack of awareness often results in serious, problems, particularly when the Home .Owner hires unlicensed persons. In this case our Board cannot proceed a94ainst the unlicensed person as it would with licensed supervisor. The Home Owner acting as supervisor is ultimately responsible. . To ensure that the Home Owner is fully' aware of his/her responsibilities, many communities require, as part of the permit application, that the Home Owner certify that he/she understands'-the responsibilities of a supervisor. On the last page of .this issue is a form currently used by several towns. You may care to' amend and adopt such a form/certification for use in your community. r 4 4 - 3v N Z42,.04& .5 6 m W . K A T, Uti ,_r re �DUNf7ATI:U :Ct:VT r1C�'(IOt�J t:vT �4 D C(;NrEt.?VILLC, �nrznJ�-, t3L�,.Mh. . )n the basis of my,knowledge, :information d )elief, I certify to T- To"J'? " / rf"I44,6 G that as result of,a survey made on_the ground .VjM,&A, WA-2:W tc14 Dn 7Zz11Z3 , I find that::' 13oIG v01 .00.r-AL►A0Lrrj4 &AA35, the st cture(s) are located on the site u3. shown.//JCi..:P/ih:�,-GIv/lin9 / -,(Q`./� : tN 07 the title: lines .and hines,.,ot occupation of. the ��,E"� �s Bite are as shoim hereon.: WILLAM ��yG the site.is situated In flood Gone G.• � wAewicK ` .� omnunity Panel No: zEj=gl ovzPi4Date,: 9�".. 19771a )ate• zj �yo�isTEa yob: V111ic ::M. Wurwlok;RLS r, 3� o r; zo 04� S S. Q:U� 0 5�:o• v E�� r\ W aAA CUi �"'�L� � I I - - 'S �� ¢:.i/ A L Inc E h •.` I 12 : . e,0.(v; �3: �aUI JDA"Iv G �T C TIQr J -OT 34 i 1or3,ti cv r r� >7 ' G�Nrr: :viLLr--, 0ArzAJ L U, FA Al JULY z5, )n the basis of my,knoWiedge, 'information and r belief, I certify to LA Tosu�.. / arnJ J chat as result of,a survey made on the ground VjM. M. WA 2:w tGt,4. on 7 zl 3 , I' find that::' K vOt .�JD.�AL►�olJT�l , n�lA�S, she st cture(s) are located on the site as 3 h own./.,G'..«�7�h;,,x w,:4�i.�s Twn 2vn<n9 /3.i'�a"" Phe title• lines ,and lines ..o4 occupation of the ���"�1N 0F"�4 ° w Site are as shoim hereon,': '`' :• . � iuu.M G the site. is situated in- Flood Gone G, � W�%i CK Jomnunity Panel 11o: 24Q&j oozo?2Date: 19771 N )ate: 7 z3 SU 'vE Uillic�n}'h:. Uarvlok,1L1,S I . '' �alhrtato�s+p COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY �a +h _ ? *"&t"smsts"Sair dl - OF ONE ASHBORTON PLACE `• l �Isesaa►s*for rNoA MASSACHUSETTS BOSTON,MA 02108 LICENSE CAUTION t s. EXPIRATION DATE C'O�'ISTR• SUPERVISOR ..� FOR PROTECTION AGAINST , ..r 0 7/17/1 9 9 5 y _ „r s'EFFECTIVE DATE LIC-NO. i THEFT, PUT RIGHT THUMB RESTRICTIONS { %3 6/3 0/1913 015015 ; PRINT IN APPROPRIATE BOX ON LICENSE. ?AUL R �SEPN A R RO W I+E� D R D g' BLASTING OPERATORS ' .!!�� O Z 5 iV E A S T.H A i19 `1 A 02651 =4 MUST INCLUDE PHOTO. SS M 034-3 U�21 .�5 m; J . PHOTO(BLASTING OF R ONL`n FEJ.O b.O - P]�TT • _ NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY t'LID HEIGHT: STAMPED-OR-SIGNATURE OF THE COMMISSIONER 1. B. i17/17/1942t6Ql « J�lN 2 1 1993 V t SIGN NAME IN FULL ABOVE SIGNATURE LINE rflrrR 4�2 �� rTHIS DOCUMENT MUST BE I- .-GARRIEDONTHE PERSON OF ATUR ll SEE '(� j'� "r'A_I THE HOLDER WHEN EN z l 1�P+�S• .�'_ COMMISSIONER i/ i - - OT{.� JjUMBPRINT AGED IN THIS OCCUPATION I HOME IMPROVEMENT RCTOR Registration 110681 TYp2 - 'INDIVIDUAL ; Expiration 11/03/94 I PAUL R ?OSEPH j PAUL R. JOSEPH 10 ARROWHEAD RD P 0 80X 390 ADMINISTRATOR N EASTHAM MA 02651 - r..+`+..:`; ,< ...v =wwx:..tia.:: '.•ar"+:. :v� (=. i � ,-' :..� _\.� s,M1;...'s ., r s.y. :;t'.S•�"c' - 4 t., 2535 i, • TOWN ;OF g ARNSTABLE Permit.No - -- --- - r - 1 Bwldln ••Yrispector s ,.. �'' f . 1 sae»TAst639 ,t0 vo► u. OCc'AJPANCY PERMiT Bona` - -X 02 Issued to b` L 5 Tl rust „rAddress ..a ... . Ldt 34, 29 Nobadee`r Road, 'ervi3le Wiring Inspector .�` r _ Inspection!date y of nspection'date Plumbing Inspector/ wlI PAS - - Gas..Inspector• f ,Inspection date'' XEngmeering Departure -C-7\ `-Z .1 ''C i=tom�fit�L. �-e-�In�pection,date ( € Board of Health ` `� 'r Insp ction date THIS.•PERMIT WILL NOT BE VALID, AND E BUILDING ;SHALL NOT BE .00CUPIED UNTIL ' SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS .STATE BUILDING CODE " A�9 is ? . ....... ..... f Building. Inspector >J .S T. N Zo, F r� ti 09viA K Eh MT. oc� SAT I orJ G 9T1 P16ATIOM ' L�07 34 000A- p s DULY Zr-), -5GALa,; I -30' ,tit �• ,. On the;;basis of my knoW .edge rinfaxtion and belief, ;�':cex'ta-,fyo ow e n x that as }>r®salt o f 'sure ma ® on the ground W M.- &A WA fZ u./1 G l� A 5 SQG. t�- i Y 9,3, , T find, theft s v>� 4�0, l 0p.r-AL wWLnId ntiA,�S, 'The 1,8t ctuxe('e) area located an '<tha $�.te ` e , shown:/i7 Th lines o� the'e 'title,; in T N OJT 7site.,are as. shown k�ereon,.�"t'ykr;, « �° wuuAM The- site -is tAtuat@d. A'?7.Aod',Gone G'• 1NARWICK 24ne1 Iio. 2641 OOlO 1?ate, ` No; 19771 C�ST %'E� �. •. �f � 4 Y 4,�,3! r5 d n F�}, d sk4'7/!y n; *✓ SVRy k ..„ ', ,✓ xF t � ! t ��1J �'�,.5-r ki�d.e 7 r ..J�'t.-� �3•'`S r'��"")r��a!{,�'� v .. ,�/,�A♦.� MY 4► �Q�Y. - � y - ,�: . ray- /may (,/-OA3 Assessor's map_and lot number ..................................... Sewage Permit number . Z BASd3TAIILL i p Cr House number ......... ............. ........................ r 90po�MAGIL 6 9. TOWN OF BARNSTABLE ' RLDING:,,,- INSPECTOR � y ' a APPLICATION FOR PE IT TO z !!�....:�� .......P /yy ' TYPE OF CONSTRUCTION ...... ........ qe�.............................................................. 23 1 7........... l f ................19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit a cording to. the following ' formation: �J n� ram. Location ......... .. ..:/......../....T..f /7 ... ...............� 1...V..� ..1. . l` 1�T-e. :......�Qa f Proposed Use ........ ../...l.Y�.............................. ............................................. ... .. ..... hh Zoning District ................ ...J..��..................................Fire District ...................�. ... .................... Name of Owner ..�� Tt ✓ ! .Address . /...� 4...:. N.N�S Name of Builder /�iY�P/L........./../�! IL�i.......Address ............................................................`........ Name of Architect, /.A�.V:`-......�� ......Address ..6 .. �v. .... ///-P Number of Rooms ............... ..............................................Foundation �v .... 1/r �. ...... Exierior ..... .... . ....................................'.........Roofing . ...,. (�`.1... �/ .. Floors ... ...(4�..k,., .V....P.j2.....t L1...1... �..........lnterior ..........✓ �..... LJ ............ Gem Plumbing ..... �� !�d • / t Heating ................. . lOP Fireplace ................. ... ................... ................................Approximate. Cost .......... .. (/• .................. .......... .. Definitive Plan Approved by Planning Board -----------_______-----------19--------. Area ..................... .........�/..:Z Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH to OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . . ...... . . ................................ Construction Supervisor's License �( �j / �..... S L S TRUST 25357, 13-2 Story :.No .................. Permit for .................................... Single Family Dwelling ........................................................... ... ............. Location L...o...t... 34.,......29...Noba de..er.. .Ro.ad ...............Centerville................................... . . . .. ....... .. .. .. Owner ...S ,L......S, Trust ....... .........6............................ ........... Type of Construction .....F;-KATRP........................ ..................................................::......:..................... Plot ..... ..................... Lot................................... Permit Granted .....J.....uly..........27,......................19 83 Date of.Inspection . .......................19 Date Completed . ........ ..19 N3- .7 Assessor's map and lot number. ........................... •••r••••• _ o tNe a - F t� Sewage Permit number .......... .71 33ARIISTAZLL i House number ............. .... ......... ............................................. ,,"6 9. `'r '°0 3 �e �0 MAy p TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ...................... ..................,........................... ........ ... ! �' � ✓'� - ................................. TYPE OF CONSTRUCTION .......,.•:..,............:................�`.�..................................................... ............. •` .......19..!�... TO THE INSPECTOR OF BUILDINGS: The undersigns hereby applies for a permit according to the following information: Location ..........:e'....:.........� . .., ............. ............. ...... ..,,.�- ...... , Proposed Use ......... . ,��,L , ' '......... a. -: ':: ,/.. `f�' .............................. Fire District ................... ..�� Zoning District ................. .o.......................................... ... ......�............... Name of Owner _ —. .. .. .. .... Address 6 ?;;� i Name of Builder ! ..be L........�C ..I-e-4 .....Address ....... 4....... .... ......f .........................`.`...f. . Name of Arch itect� e � �`.i.pe. ..... ......Address .�' �.��'. .... .�.,. ��? F`.:;�p. . Number of Rooms .......... .... ..............................................Foundation ............................' #.a !`:: �'-::� i Exlerior ....., /, / .... g � f .. .f.... �.,.........�' ...Roofing :`.......,. Floors �J /y •! fit �� P (-A :;p...........Interior ......... # . �......�r % f ` ....�................. Heating `.............. .....e:- "................................................Plumbing ... °1f.....:J......" ....... .............. gg Fireplace �r".I:! ..................................Approximate Cost . �r. .... ...� .... ........................................ Definitive Plan Approved by Planning Board ---------------____-----------19________. Area .......................................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH 'VF W r OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. f r Name a' ............:....... :............,.,r,......,....................................... Construction Supervisor's License S L S TRUST A=250-41H4 &j' 40H4 25357. 112- Story No ................. Permit for .................................... , Single Family Dwelling ............................................................................... Location ,_,Lot 3.4, 2. ... 9 Nobadee. . . . ... r Road.. .. .. ....... .. .... .. .. .. Centerville ............................................................................... Owner ......S...L..S...TK'.11At............................... Type of Construction ...Fr?j.?.Q.......................... ................................................................................ Plot ............................ Lot ................................ Permit Granted July 2 7, 83 Date of Inspection ....................................19 Date Completed ......................................19 i I i 1 1 1 Lk* CIO,r ,r i i �TILE E to�q�T o ii g o ,rjai , 3 OA r FA AA l 4 Re)DM t I ''`�� �/coo icA �+ Aid i 9 y,4 /f CAPV13— i COIV T TC>-':>T 7/J 6 it9 S a 7 - -- I -- ---- ------- - - - - i CiX�C 5£E- CLl`Nr) CALE i I i i i I , _ I I 1 , i I , ►� �- I i i i AT 4-ffli flu E _AFT ELEVAT1oA1 FRO/Of ELEVAnon1 'Rk-A & EtE�/ iln� e u a„ J J r}} it u� Y O 41 O ti Z GC o ' n APPROVED BY- A/lp G SCALE: / = %_O DRAWN BY Q O .' U I; DATE: 5�07 y - 97 REVISED O. 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