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HomeMy WebLinkAbout0010 REGATTA DRIVE /D �.,.� /,�°. ._��� i D 9--tq-G ii TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION .Q�' A i l Map Parcel: Applic4ion J—[ L_La� J Health Division Date I Conservation Division A lic `� 6 pp Planning Dept. Permit 3 . Date Definitive Plan Approved by Planning Board Historic -.OKH _ Preservation/ Hyannis v Project Street Address }C, Village r A S Hl Owner a.m 1a''� Address Telephone Permit Request 2 S X Z 'c d A 1 0 Goy 5 AF A 1 4 G 4 Y1 O )r) /mil e t' o Square feet: 1 st floor: existing/S�proposed� existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation=94- Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 112 Two Family ❑ Multi-Fa:�No units) Age of Existing Structu �.. s Historic House: ❑Yes On Old King's Highway: ❑Yes No Basement Type: uIl ❑ Crawl ❑Walkout ❑Other Basement Finished Area (sq.ft.) A 5.� o w K Basement Unfinished Area (sq.ft) Number of Baths: Full: existing Z new Half: existing nev� Number of Bedrooms: 3 existing _new Total Room Count (not in ding baths): existing First Floor Room Count Heat Type and F el: Gas ❑ Oil ❑ Electric ❑ Other Central Air:and ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size_Poole,❑ existing ❑ new size _ Blarfi: ❑ existing ❑ new size_ Attached garage:®'existing ❑ new size _Shed:��°e�A%ing ❑ new size Other: Zoning Zoning Board of Appeals Auth zation Y/AppQealy# Recorded ❑ Commercial ❑Yes o If yes, site plan review# Current Use Proposed Use - APPLICANT INFORMATION (B'UILDER OR HOMEOWNER) Name Jc--Y n a Telephone Number -5-�O W -7-7 - 9 7 7 Address Z C-pc ­c License'# 0 s, 77 � 7 Home Improvement Contractor# Email /'1 1),Y)2 �) o� j, c G M Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE A DATE Z. 0 A __7 FOR OFFICIAL USE ONLY _ ~APPLICATION # ` -DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME 13) -7 i� INSULATIONCB 13 Q FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. The Comm.-o ire zlUt of f 14as-wadtusetts, . Dvaskfreut cs,fIudas&id AcciderzYs 600 WasI`ingtoyt jkr'eet Bastott,IL4 0211 ' t►�rvrurrras�gav�a�ict Nfficwkers' Campensafim Inmrance Affidavit B�uiIder-dContracbmrsMecb icians/Phmibers lufm=fian Please Print Name(Bnsi mimfi ti71R41&VL'E1TTd - E I Le Ad&ess: Z o n e , C t r c AWefiu an employer?Checktheappropriatebum ' T of ti ect rI am a to wift 4 ❑I am a general contractor.and I Y project( : employees(fix11 andfor par timt~�* leave hiredthe Sub-commas s 6. =o&Hng consircdon 2.❑.I am a sole "etas orp3rftwr listed on the,attached sheep. 7. These sub-camtractors have ship and have no employees 8_,❑Deowl6on. ,,v :-; employeesnv forte in sup capacity. andhave workers' 9. ❑Building addition.LNO vcadms' camp.insuran ice Comp. muzac # required-] 5- ❑ We are a corporatim and its 10 El Eleo;r.lrepairsoradditim officersh"a e=dsedtheir 1L Plumbin r airs or additions 3_❑ F am:a fwmeotimer doing aid wont ❑ g ep myself[No woklmrs'manp- iighIt of ememgfio4 per MGL 17❑ROofregairs imu anrereriuiEed][ c:152,§I(q6 andwe have no . employees-Wo workers' 13-❑Other comp-insizanne requireq ;Any L" Chatched�s5ax�l ma t elsa fll autthc sectioabeTawsbn�g i�eaiuorlced c�peasatinupuycyia��sricm ffa�evwaes Who sahnrit s'his�'Sda�'i¢ia�xratm' g trey Yre+3m�sgwa�G sad f5enhaE aatside cantrsctarsamct 5ohmit a aem�ffidsei�iodi�aa sstrTi ', run=ctmff=t ohedctIxi boo[must zmeh xmi[inns,shed showingffiea2.e of the sob-comt=tam and stdevrhe*es or not ihnse a fideshave emplo]x�.7fthesah-cau>ntctflesh�e�PIcSt�tbegnmstpivt��dexheir markea'romp.paIi�at�brs . . I am an empba}vr flea!is pra}zdir�n�orkers'catrtperrsrririart i�szirarrca�'vr m3*elrrFlal�ees $eIo�v is fha paticy�arrd jeb srt� in,�ormritiarz . insurance CompanyHanie: S' r a,41"' Policy 41 or Self -ate: ExpimtionDafe: y, JobSite tlddress / 6 a_.2c ee, Cdy/S# Fp: �r��.n Y) 1 S A[#ach a copy ofthe workers'tourp:nsatioapoUcy-dectarationpage(showing the policy number and expa-ation date). Failnre to secmm co9emge as required under Section 25A of MGL c.'15ry can lead to the imposibaa of cdmhml penalties of a fine up to$L50aOG an&Gr one-lrearimpzisoumet as well as civil penalties in the form of a STOP WORK ORDERand a line of up to 0_00 a day against the violator. Be added fir a copy of taxis statemerLt.may.be forwarded fn the Office of i0yestigadom ofthe DIA for insurance coverage yredficaii"on_ T rfa hereby cif j�ran is pruns arcdpsrrahtins a.fFffjur�H=t Me urforisrafzvrn prmzt&d a bat ig bar$ d correct SioRature: Date Z C3 Phone J57 o 1 OjEdid use miry. D'anat t"rrlte in flda area,to be crrrnpletesd by Gdy artarr�ri afficiat Y or Town: Permiff iceuse# Lmring An9roritg(cirdefloe): L Board.of$ealth .27.Building Departmcut 3.City1Towa Clerk 4.Electrical Inspector S.Plaffibmg Inspector 6.Othher Contact Person: Phone#: ormatioln an' d Tastruefions M�eea rl�vse s Geeaal Laws chaff 152 req�es aU��to provide work'�pensat ua for flies employees. Pm this staff,an ezrq7layee is defined as 6:eve rppeasonin the service of another under any cortmct ofhIle, egress or i nplie4 oral or wrn=a" An�&yer ys defined as-an mdrvidnal,per ,associatwn,coaper�ron or otb a legal=± or any`two or more Of the foregoing=gaged in a joint ,and mclndmg the legal=Pres euhdves of a deceased employes,or fiie r=eim or tcuste�of an kaTidmLL per,assoch6m or oti�er Iegal entity,=Ploymg Ploy - How ever the owner ofa dwelTmghouse)iavmgnotmar0ffimtbree apartraeois anduho resides$atin,orIhe oc ofthe- dwelIi g house of aaoffim who eaploYS persons to do mai�ce,r,,,,cfmr on or repay w on sack dwelling house or on the grotmds or bm7.dmg appmtenarttheaefn sballnotbecanse of surds=Iploymentbe d=nedto be an employer_" MGL chapter 152,§25C(6)also states iiiat¢everys ztm or local licence agency shall WithhDM fhe issuance or renewal of a Hc— r-or permit to operate a jmdness or to cnnstmct buff ings in the commoaePealth for cap applicant who has notprodnced acceptable evidence of cdrupUmcewitli the ftmurance coYerageregtrir'ed:' Additionally.MGL chapter L52,§25C(7)stairs N6ithcr the co=m=weala nor any ofits political subdivisions shall enter ink any confract farthe performance ofpublic wDik u�I acceptable evidence of compliancewith$ie msozan•�•, reTn em=fs ofthis cbaptcrbavebeenpreseI±1-,dto fbe o g.anthozhy.7 ApPlican-f_s Please flI oil the wow'compemsaiion affidavit campy: jy,by ch=Idng fhLo boxes$at apply to your sifnahon.and,if necessary,supply sob-contractor(s)name(s), addresses)andphone zmnber(s)alongwiftthur=t1acst*)of inscaance. L�itsdLiabilitp Com-Fames(LLG�o't'Ir�ifi�dLiab�ityPar�hips(LIP)w�.n°�L'Y�oti�ertlian.tbe members or partner are not rid to camy wmkF&compmsatron fi smance If an LLC or LLP does have rmployees,apolicyisr - Beadvisedfhat this affida:-yrt maybe snbm�ttedto the,Department ofludnsfrial Accid=±S a m for conf af on of insurance cow ATso be sure to sign and date the affidavit. 1$e affidavit should beretumed to$e city or town that the application for the permit or license is being sb,not the D epartmeaf of LnAa,tRal..Dciden:L-, Suonldyon Have any question regaldmg the law or ifyou are required in obtain a workers' comp=s:ationpoficy,plmsecall ieDepartmeotatfficn mberlistedbelow. Self-fiLwred�pa�essboulden rthair self-msm2nceHc®senmnbmonthe Ime. City or Town Officials Please be sore that the affidavit is complefa andp6rted.le gtfly- The Departmeathas provided a space of tiie bottom of the affidav�for you to fa otst in the event the Office of lnvestigafwns has to coafactyoIIrega g e applicant Pleas a be sure to fi11 in the pe (license number wbich will be used as a reference number In.addition,an applicant tb�must sabmit m_trtfiple penntlIiceatse appliesions m any given.Yeax,need only sabmit one a$davrt mdi g t policy information[rf ne�a ry)and under"lob�e Q s9 the applicar¢should write�aII Iocaty�ns in (�'or town)»A copy of the-aff davitthathas beep officially stumped or ma bed bythe city or taws maybe provide$to flue applicant as proofthat a valid affidavit is on file for fl6me'pe�its or Iiceuses Anew a$davitmust be tilled out eia rdi year.-hire a home owner or ciii=is obbLdng a Iioease or permit not related to any business or commercial vmxbze rie- a dog license orpemitto bum.leaves eta.)said pmsou is NOT isgoiredto cazTldz lids affidavit The Office of TnVcsfigajj=would hZoe to ffiank you in advance for your cooperation and shouldyon bave any qu�ons, please do notbesifafe to give a Caz The Departmeuf's addxms,telephone and fax rmmber. y - ' CGMMMWeaSihE of R - Deparfmmt c6f hibstial Accdant-q- t4-Vaahataa BndD3CL.,MA 02111 . Ta 4 61'f-' -490a cxt 4-06 cr 1477 MA&RAM Fax It 617` 27 7749 Revised 4-24-07 - �fca I ' 03 z c �F . O 0 9zm o (/ c 0 mu u ( o t!� 1 c w C v fj'W (n ; o z.b x a m p'i° C o� c e 3 rTl t N yIP cc �iea�aoaaiuen z o-. Office of Consumer Affairs&Business Regulation IMPROVEMENT �ME IMPR CONTRACTORType: _ - 2 ' T pe: gistration: 1;84551 xpiration: 2L2/ 8 Corporation - - MASS BUILDING SYSTEMS,LLG STEPHEN BOBOLA 24 ST.FRANCIS CIR HYANNIS,MA 02601 -t-_ Undersecretary MASSBA OP ID:DS CERTIFICATE OF LIABILITY INSURANCE UATE(MM/°°"""' 07/21I2017 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,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER CONTE: H annls Office ACT B den 8 Sullivan Ins A NAM 88 F Agency y Falmouth Road AIC NNo, No Ell:508-775-6060 n/c No),508-790-1414 Hyannis,MA 02601 EMAIL Hyannis Office ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Associated Employers Insurance - INSURED Mass Building Systems LLC INSURER B:Mapfre Insurance 34754 - 24 St. Francis Circle Hyannis,MA 02601 INSURER C:NGM Insurance Company 14788 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILICY EXP LTR TYPE OF INSURANCE IN DDL VD POLICY NUMBER MMIDDY� MMIDDIYYYY LIMITS C COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR MPI4495Q 09/24/2016 09/24/2017 PAMAGE TO RENTED REMISES(Ea occurrence) $ 500,00 X Business Owners MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: - GENERAL AGGREGATE $ 2,000,00 X POLICY JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident B ANY AUTO Z03579 05/21/2017 05/21/2018 BODILY INJURY(Per person) $ 35,000 ALLOWNED X SCHEDULED BODILY INJURY(Per accident) $ 80000 AUTOS AUTOS NON-OWNED PROPERTY accident)TYDAMAGE $ 250,000 HIREDAUTOS AUTOS UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION I PER. OTH•' AND EMPLOYERS'LIABILITY STATUTE ER A ANY PROPRIETOR/PARTNER/EXECUTIVE YIN WCC50050150972016A 09/16/2016 09/16/2017 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? �N I•A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate issued for insurance verification. CERTIFICATE HOLDER CANCELLATION BARNS-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE -`` THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. Building Dept. 200 Main Street AUTHORIZED REPRESENTATIVE Hyannis,MA 02601 Hyannis Office ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD PROPOSAL FROM: Mass Building Systems LLC 24 Saint Francis Circle PAGE NO. 1 OF 1 PAGES r, Hyannis,MA.02601 DATE:5/22/17 508-771-8979 PROPOSAL SUBMITTED TO: Mr.&Mrs.Hamilton 10 Regatta Drive JOB NAME:Same Hyannis,Ma. ADDRESS:Same PHONE:631-757-2277 A CITY/STATEOP:Same We hereby submit specifications and estimate.for: 1)Dente-E k4hoa,reffmve-A&411 and install rough wiring and plumbing to plan for new kitchen. 2) e; ew acess to basemen* fill ��� ln_ o`opeti>ng; t r,make all plumbing and electric alterations,close walls and prep ready for paint. 3)Repair all drywall seams throughout first floor,prep,putty,caulk,prime and paint two coats on ceilings,walls and trims,spraying two vanity cabinets included. 4) sraple�,tac s Pile betL y.Install solid Santos mahogany flooring,sand,seal and two top coats in satin finish. 8)Other electric to include Three set ups for ceiling fans with dimmers,wiring for tv over fireplace and cabinet wiring for audio. 9)Install new kitchen cabinets,tops installed by fabricator,plumber to connect sink,dishwasher,gas stove,icemaker,electrician to complete all finish wiring,install backsplash tile at cabinetry walls.Cost associated with sink,faucet,tops and cabinets based on estimates from others and are not included in this quote.There is a 200 allowance for backsplash tile. 10)Man cave includes finish enclosed staircase to b sement,framing out perimiter walls with doors to garage stairs and unfinished portion of basement. and re v, Applt drylock to concrete walls and floor in finished area. Install rough electric to code with recepticles,switching,recessed lighting and tv set up.Insulate all walls to code.Cover walls with blueboard and apply plaster finish.Install coretex plank flooring over concrete.Install doors and trim to windows,doors and baseboards. 11)Set up plumbing and elecric for washer and dryer. We hereby propose to furnish labor and materials—complete in accordance with the above specifications,for the sum of Sixty Seven Thousand Four Hundred Forty Dollars($67,440.00)with'payments to be made as follows: 20,000 at start,20,000 progression,20,000 progression,7,440 upon completion All material is guaranteed to be as specified.All work to be'completed in a workmanlike manner according to standard practices.Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate.All agreements contingent upon strikes,accident or delays beyond our control.This proposal subject to acceptance within 15 days and it is void thereafter at the option of the undersigned. Authorized Signature ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are hereby accepted.You are authorized to do the work as specified.Payment will be made as outlined above. ACCEPTED: t Signature U . DATE 5/ 1 7 Signature i (DE-Z CONTRACTORS FORMS FORM NO.PROP 31 :J �l2-0��s Town of Barnstable *Permit#C;)D Expires 6 montom issue dateC PERMIT Regulatory Services Fee 1 $ Richard V.Scali,Director 172015 Building Division TOWN OF BARNSTABLE Tom Perry'CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: .508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL. ONLY f,,�( �1 Va�Not Valid without Red X-Press Imprint Map/parcel Number 2 o 1 Property Address ❑Residential Value of Work$ �� /qg) Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address ot3(P Contractor's Name Telephone Number 60—g 3?-�3 qS"� Home Improvement Contractor License#(if applicable) �?jL/'y Email: Olh� ' v(' vivfJr C(yl' Construction Supervisor's License#(if applicable) C5 67 ( U ❑Workman's Compensation Insurance Chec ne: am a sole proprietor ❑ I am the Homeowner ❑ I have.Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Reque c eck box) Ll Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to fIV,q A /1 ly i ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. "Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ` ***Note: Property Owner must sign perry Owner Letter of Permission. { A copy of the Home I ovement Contractors License&Construction Supervisors License is required. I SIGNATURE: Q:\WPFILES\FORMS\building perm' orms\E SS. Revised 040215 HIC 133950 EAGLE CUSTOM BUILDING CS 076980 I' P.O. BOX 819 PEMBROKE,MA 02359 TEL:617.838.6395 * FAX:781.294.1135 EAGLECUSTOMBUILDING@YAHOO.COM PROPOSAL Proposal submitted to: J;Itoo lem Date: 2 3� jZ Job Location: (o Thank you for the opportunity to_ q�Iote your construction project. The following represents the specifications and estimate for: — - cl w 9, - �h cl �l Xt's¢" y Ga s C� Z- We propose hereby to furnish mate ial and labor complete in accordance wit above specifications for the sum of: Dollars 11, o�() Payments as follows: 96u4k The purchaser dree§to pay all costs of collection, including attorney fees. All work is guaranteed as specified.All work to be completed in a workmanlike Authorized manner according to standard practices.Any alteration or deviation from above ,Signature specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate.All agreements contingent upon strikes,accidents,or delays beyond our control.Contractor Note:This proposal may be;thdrawn by us if not accepted within_days to cant'General Liability insurance and Workman's Compensation insurance. Acceptance Of Proposal The above prices,specifications and conditions are satisfactory and a hwiereby accepted.You are authorized Signature to do the work as specified Payme le made as outlined above Date of Acceptance: S Signature { C.-icense or registration.valid for individul use only . before the expiration date. If found return'sEo's ;Office of Caiisumer Affairs,and:Business Regulation; ,0,10ark Plaza-Suite-5170 "t 'Boston,MA'021.16 fp. „. ? g w Not valU' hout mgnature ; r k, 1i ' �I Massachusetts -Depart � Bo Department of Public Safety and of Building Regulations and Standards Construction Supen-isor License: CS-076980 I STEPHEN C OKE `FE i 12 HOLLY HII,L `PENMMROKE MAF 02 Commissioner Expiration -� • 12/03/2015 • a - 27re Comynorriveakh o,f Massachusetts Depart went o,f Industszal Accidents - d,f lee o,f Inve stigations ' 600 Washington Street y.... Boston,M4 02111 ivis m:niassgavfdia Workers' Campensatian Insurance Affidavit-.BluildersiCnntractnrs/Electricians/Plu nbers Applicant Infk-oration Please Print LegibIy NAt71iP3,>S �Organiz�tionFlnciivi:3na1}. Address: City/StatelZip Phone Are you an employer?Check the appropriate box: Type of project(required): 1.❑Xaajmn a employer Uith 4 ❑ I am a general contractor and I 6. ❑N=odeHng ction oyees(full andlor part-time)* have hired.the sub-contractors 2. I a sale proprietor or partner- listed On the attached sheet. 7_ slip and have no employees. . These sub-contractors have 8. ❑Demolition working for me in any capacity- employees and have wodcers' q. ❑Building addition [No nrorlcers' comp.insurance comp. nsurance- � rewired] 5.,❑ We are a corporation and its 10_❑Electrical repairs or additions 3.❑ I am.a homeommer doing all work officers haveexercised their 11-❑Plumbing repairs oradditions myself [No workers'camp- fight of exemption per MGL 12-❑Roofrepairs insurance required.]-I c.152,§1(4X andwe have no employees-[No workers' 13.0 Other camp.insurance required.) •Airy gTffc=that checks box Fl rmast also fill cathe sectioabelow sb=iug their wodeze compensation policy iaformaCian_ 1 Mmeo nets who submit ibis afhdmit i Akzting they are:doing all wadi sad dwn hire outside contractors— submit anew affidavit indicating such- fCaatxactors that check This bmc must attached as additional sheet showing the name of the sub-contractors and state whether or nut those eafides have employees.Ifthesub-contacturs have employee%they must provide their workers'comp.policy number- I am an eIIlgIoycrr that is prenzriirtg in rkers'cotrtpertsadon hisasrance,for my employees Below is 11te polity and job srte in formattom Insurance Company Name: [ Policy 44 or Self-ins.Lie.4_ U[ O��/"1 �� =1 iration Date:' 02 Job Site t ldress: M 'Oft, CCiWState{Zip: I f�19 p. . Attach a copy of the workers compensationolicy declaration pa (Showing the polity maffibes and eo�iration date).. Failwe to secum coverage as requiredunder Section 25A of MGL c. 157 can lead to the imposition of trim+nil penalties of a, fine up to$1,50D-00 and'ajr one-year imprisonment,as well as civil penalties.in the form of a STOP WORK ORDER and a fine of up to$250-00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DID for imsurancti ge yerificaticm. I do hereby cR&-ft,under the Is aI penahYes ofpetjury that the urfbnuafion prm�i&d abmw fs blots and correct Sit tune: ]pate: T/-7 l Phone;v Ofj'acial use only. ,Do rtat write in this area,to be cautpletM by city or town official City or Toga: Permit✓Ucense# Issumg Authority(,cirde one): 1.Board offf—ealth 2.Budding Department 3.Ctyfrown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Mas�husetts General Laws chaptPa 152 requires all employers to provide workers'compensation for their employees. {n this ,an.emplayrne is defined as"_.evay person in the sm-vice of another under any contract of bu e, express or implied,oral or wffttrm" An employer is defined as"an individml,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a Joint enterprise,and including the legal representatives of a deceased employer,or the receiver c r trustee of as individual,parinmsbip,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occapant of the - dwelling house of another who employs persons to do man t e an ce,confirmction or repair work on such dwelling house or oa the grounds or building appurrtenam therein shall not becanse of such employment be deemed to be an employer." MGL chapter 152,§25C(5)also stains that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the 4n5nrance.coverage required." Additionally,MCrL chapter 152, §25C(7)state•,s"Neither the commonwealth nor nay ofifs political subdivisions shall enter into any contract for the perfomaace ofpublic woik until acceptable evidence of compliance with the incRrran cg._ requirements of this chapter have been presented.to the contracting author" Applicants ease fill o� the workers'co ensation affidavit completely,by checking ffie boxes that apply to your sitnation and,if PI mP _ c s necessary,supply snb�ontractor(s)name(s), address(es)and phone nurmber(s)along with their ce rfifi ate()of insurance. Limited Liability Companies(LLC)or Limited Liability Partammhips(LLP)with no einployees Other than the members or partners,are not requaed to carry workers' compensation insurance. N an LLC or LLP does have employees,a policy is requiL d Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also he sure to sign and date-die affidavit The affidavit should be ret-uned to the city or town that the application for the permit or license is being requested,not the Department of lnrlLr frial A ccidests- Should you have any questions regarding the law or ifyou are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-in sisal,ce license number on the appropriate line. City or Town Officials . f . Please be sine that the affidavit is complete and primed leglly. 'l$e Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the peumitllicense number which will be used as a reference number. In addition,an applicant that mnst submit multiple permitllicense applications in.arty given year,need only submit one affidavit indirafing curr ent p olicy inffbrmation Cif necessary)and under"Job Site Address"the applicant should write"all locations ia (city or town)-"A copy of the-affidavit that has been officially stamped or marred by the city or town may be provided t o the applicant as proof fiat a valid affidavit is on file for future permits or licenses A new affidavit must be.filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i_e. a dog license or permit to bum leaves etc.)said person is NOT reqaiced to complete this affidavit The Office.of Investigations would at to thank you in.advance for your cooperation and should you have any questions, please do not hesbate to give us a call. The Departmerifs address,telephone and fax number f-G-nmix4nwealth-of Massa chus-Fatts , De-parhnent cif Iiid dal Accidents ��4shinton t Blau=MA GI I I T(,-I.4 617'27-4900 Qx- 406 or I-a7-MA AFF, Fax#617-727 7M Revised 4-24-07 w w ass-gQg/dia CERTIFICATE OF LIABILITY INSURANCE DATE rMM/DD/YYM TNMXERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require and endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER CONTACT NAME: MASON&MASON INS AGCY PHONE FAX 458 SOUTH AVE (A/C,No,EXt): (AIC,No): E-MAIL WHITMAN,MA 02382-1730 ADDRESS: 29SFG INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: TRAVELERS INDEMNITY COMPANY OF AMERICA O'KEEFE,STEVEN DBA EAGLE CUSTOM BUILDING INSURER B: INSURER C: INSURER D: P.O.BOX 819 INSURER E: PEMBROKE,MA 02359 INSURER R. COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,DCCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR- ADD.SUB POLICY EFF DATE POLICY EXP DATE ' LTR TYPE OF INSURANCE L R POLICY NUMBER (MMIDDIYYYY) (MMMDIYYYY) LIMITS GENERAL LIABILITY CH OCCURRENCE COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ $ CLAIMS MADE OCCUR. REMISES(Ea occurrence) ED EXP(Any one person) $ ERSONAL&ADV INJURY $ + GEHL AGGREGATE LIMIT APPUES PER - ENERALAGGREGATE $ POLICY PROJECT❑LOC RODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND WC STATUTORY OTHER EMPLOYER'S LIABILITY YIN UB-0104N233-15 02/05/2015 02/0512016 X uMITs ANY PROPERITORIPARTNER/DXECtmVE NIA E.L EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? 100,000 (Mandatory in NH) E.L DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLESIRESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. THE WORKERS'COMPENSATTON POLICY DOES NOT PROVIDE COVERAGE FOR O'KEEFE,STEVEN. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENT ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. EAGLCUS-01 GVOSBURGH CERTIFICATE OF LIABILITY INSURANCE DATE(M 4/20/20152015 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,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT _ NAME: Mason A Mason Insurance Agency,Inc. PHONE FAX 458 South Ave. AIc No Ext:(781)447-5531 AIC.No;(781)447-7230 Whitman,MA 02382 ADDRESS:info@masonandmasoninsurance.com INSURER(S)AFFORDING COVERAGE NAIC if INSURERA:Westem World 00007 INSURED INSURER B Stephen O••Keefe INSURERC: PO BOX 819 INSURER D: . Pembroke,MA 02359. INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURPD 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. 1LTR TYPE OF INSURANCE NSD WVD POLICY NUMBER ADDLSUBR MMIDDY EFF MMMD 1� LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ❑X OCCUR NPP1403445 04/17/2015 -04117/2016 PREMISES E.ocaurence $ 100,00 MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIESPER GENERAL AGGREGATE $ 2,000,00 POLICY❑JEa LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per acrJdent AUTOS AUTOS ) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION P R OTH- AND EMPLOYERS'LIABILITY YIN STATUTE I JER ANY PROPRIErORIPARTNERIE—CUTIVE r OFFICER/MEMBER EXCLUDED? N 1 A E.L.EACH ACCIDENT $ (Mandatory in NH) - E.L.DISEASE-EA EMPLOYE $. If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is require Evidence of workers compensation to follow under separate Cover. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD ulahon" .: office-of Consumer Aftairs&Bysiness Reg I ME _IMPROV EMEN7 CONTRACTOR Type, e41-stratlon* 50 DBA _ Expiration 1201�2Q45 YEAGLE CUSTOM O'KEEFE " � STEPHEN t �\ ! . HOLLY HILL LW , F Undersecretaryr. a t II PEMBROKE'AMA 02359 Massachusetts Department of Public Safety Board of Buildin g Regulations and Standards 'Construction Supervisor I' License: CS-076980 STEPHEN C OEM I 12 HOLLY HII,L ,N PEAMROKE MAr AA Commissioner Expiration 12/03/2015 Assessor's Office(1st floor) Ma AA 0� 3 Lot /Q Permit# Conservation Office(4th floor) :�qJC Date Issued �a� -9 � ' Board of Health Ord floor) /( - x e,� ;�-> Engineering Dept. Ord floor) House# Planning Dept. (1st floor/School Admin B1dgj: -- "R, s s Definitive Plan Approved by Planning Board` 19 6 3, (Applications processed 8:30-9:30 a.m.&�1:00 2 00 p.m.),' /,1(- S ,TOWN, OF BARNSTABLE Building Permit Application 5 1-07 Pro ect Street Address Villa e r ¢"` Fire District •LC/ thvner %Ur,. Address Telephone` �� -riQ 10 r Permit Request: l�(J l' 7� Zoning Districts Flood Plain c Water Protection �t1 Lot Size -[ a, I S rl Grandfathered Zoning Board of ApRpals Authorizatiop, Recorded Current Use ole Proposed Use . Construction Type W"r lj'p4a u-e_ t Existing Information Dwelling Tym Single Famil Two family M�ulti-famil Age of structure �"� Basement type a G(it.�d Historic House Finished Old Kings Highway Unfinished o/ Number of Baths No. of Bedrooms .� Total Room Count(not including baths) o� f� First Floor �2 Heat Type and FuelW44,m aM —1CI���n Central Air -V40o Fireplaces Garage: Detached Other Detached Structures: Pool Attached CGvI Barn T None Sheds Other �- Builder Information Name l62� X Telephone number -7 7 Address License# DO S 6 y� Home Improvement Contractor# — Worker's ComMusation #k&_l 3/7- U 13 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN (AS BUILT) SHOWING EXISTING, AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Project Cost ®S dTV Fee So - 3.255a SIGNATURE DATE '-. J BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) BPERM T FOR OFFICE USE ONLY ' w ADDRESS VILLAGE OWNER DATE OF INSPECTION: — FOUNDATIONAl FRAME c INSULATION ? f ' 1 ck, FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL + FINAL BUILDING: DATE CLOSED OUT: ASSOCIATE PLAN NO. ' e + TOWN OF BARNSTABLE CERTIFICATE OF OCCUPANCY PARCEL ID 000 000 050 GEOBASE ID ADDRESS 10 REGATTA DRIVE PHONE (508)771-1040 HYANNIS, MA ZIP 02601- LOT 30/30A BLOCK LOT SIZE BA DEVELOPMENT DISTRICT PE IT 18001 DESCRIPTION SINGLE FAMILY DWELLING (PMT.014699) PERMIT TYPE; BCOO TITLE CERTIFICATE OF OCCUPANCY CONTRACTORS: --~ Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES. BOND $.00 CONSTRUCTION\COSTS $.00 756 CERTIFICATE OF OCCUPANCY ; • L►RNSPABLE, • MASB. OWNER BAYSIDE BUILDING, INC. , i6�9. A� p ADDRESS � P.0.BOX 95 BUILDING DIVIS10N 1 CENTERVILLE,MA BY �( DATE ISSUED 09/19/1996 EXPIRATION DATE �" 'I't'WN OF BARNST ABLE BUILDING PERMIT t:"kt�'_'; L .Ill C)0C-i 0(0 t E �i GEEOBASE :U E1 sL=RE+c lc; :t� _J'ti;l,TA i✓i." `�L? i�iIQNL' LC`A. B L OC L011 SIZE _ I:)f.i^, is `JI Lt�l�CwtEN'.t Doi 3TRIC`. 'D""' �! .NIPT�I:�%' ,:,INGL,►+� i{'AMI _,Y D6v:L .LLING I:001- i MT. #9-- 3+} r ?�"r?;:ti�1I:I, 'I'1'�':s iai✓IL, 1.'1 Li �.'",& l ! E'S)"I'D�'IV`.l'r:�L ?'LDG PM'3' h::, : :V :t i; a. 01 ('LD Ncl, i ra(~ Department of Health, Safety- �? and Environmental Services � (_..'.,talrl <., ii�-L' 1!; } I. C,I .F: t.. Ri A.iE ib 10� d�•T ,:h .Ay' iD� �?tea. .; .idt.,. P-0 A_FY.,$X 95 BUILDING-VIVISI W ��Ent.(-L'•.Il1?.1.3_�.Lil',..'.��y BY -A'?'j « '�1 � 6 1,/ ?4/1S_i ��i 'XI-)I}2A l'.IUN 1'aI TF+' THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAYBE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED APPROVED PLANS MUST BE RETAINED ON JOB AND FOR ALL CONSTRUCTION WORK: WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- ELECTRICAL,PLUMBING AND MECH- (READY TO LATH). PANCY IS REQUIRED, SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS. 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. 4.FINAL INSPECTION BEFORE OCCUPANCY. VISIBLEPOST THIS CARD SO IT IS BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS Re c, .n/�IA/s y! 2 7194, 2 j;Wg4W4._ 1 t#TING INSPECTION APPROVALS ENGINEERING DEPARTMENT 2 BOARD OF PEAqH OTHER: SITE Pj�#REVIEW APPROVAL /ryQ WORK SHALL NOT PROC.E UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPR EDTHE 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. r r oPc,J SPI�c-- 50 c �, o \7- oil0. Ir4 \\ 3G Fou hro AT,I o N 10.6 O I oo •4 �H or. RICHARD DRXlER v' , etv 391M® L • ' � cE,eTi�'iEr • o,�,or . PLa,y ,GaG.4Ti�iC/ L��7VTFeYiGLE j° A'1S GE.27-/may T,U.4T Tf/� vt/DAT/aN Sf/OWN h�E.2E0.C/CGt�7f�LYS l�/Thy SCE► 7-X,r-SAc- 4IZ-- ANo SET BA Cl.e- ,eE�'Ei2Ei(/CE- • T.S/�' 7`�N/it/DF L0�"S 10 ,�,acq r6�, W!Ty/.v T E FLoaa�G4/�i! L CC 36G00 Ice Re. 5D5 16. 713 OATS=s - ,6A XT,E,2y�.VYE /NC. BASSO .v Aif/ .2.�G/STE•2E0 LSO SU.e/�61� .__.. �-/N.ST,2�i�i��/7"-.S�/•2!/6Y� TNT a�T�..21�%C.L�'.v H1.4SS��.nn / 0.�.4SE7:S Sh�o%✓�V Sh�DUt� -/47- 1HElpt,_O� The Town of Barnstable RARN6. Department of Health Safety and Environmental Services 9 MASS. t619. �0 prFDMpya 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 Inspections v^� Location Permit Number '�� Owner � i � Builder rx One notice to remain on jobsite, one notice on file in Building Department. The following items need correcting: Cek Please call: 508-790-6227 for reeinspection. Inspected by , Date i I r� . � a > � c -�'� • i.. i i l COy o, GO o� N m C" op H p DO PO4 O G00 ' W pq PC p�pqqi ?pCq u's O P" 22 to C 1 C� t�•1 D a--� \V A w d N 4.3 Q N O V] d I S _ CONfMONWT.ALTH OF MASSACHUSETTS DErAFC',mZN-TOFLNDUSTRIALACCID.Vgn, 600 WASHINGTON STREET .: BOSTON, MASSACHUSEM 02111 fames Ganooel: Corn ss+one WORKERS' CON ENSATION INSURANCE AFFIDAVIT (licensee/permitree) with s principal place of business/residence at: d,2 6 3 a (City/Sutemp) do hereby certify, under the pains and penalties of perjury,thar. [J 1 am an employer providing the following workers'compensation coverage for my employees working on this job. cZ � wG / 30' �z�)-0 17 D1 Insurance Company Policy Number (� 1 am a sole proprietor and have no one working for me.. ( J 1 am : sole proprietor, ncnl contractor r homeowner (circle one) and have hired the contractors listed below who have the following woe z txmpensation insurance policies: Name of Contnaor Insurance Company/Polity Number _ .. Dame of Contractor Insurance Companylpolicy Number Jame of Contnaor Insurance Company/Policy Number 0 1 am : homeowner performing all the work myself. NOTE: .Please be awuc t.ttt wbilc borneo-mers wbo emoiov persons to do tnaintcoaaee. eoustruetioo or repair cone on a 0-riiinc of not more taan tares units to wb1cn the hormrowDer aiso reside or on the FrvuaGs appurtenant tbercto arc not rcoerstil%' considered to be er_niovers untirr the Q•orken' Coraeensatsoa Act (GL C 152.sect. 1(5)), application by a bomeoweer for a license or Derma msv evtcroce tae ieo surtu of an cmpiovrr under the Workers' Compensation Act. 1 understand :hat : cnv%•of this stat=cnt will be forwuccd to tier Dcour rtcnt of lndusvul Accidents' Office to ltuuranae for mar vcn:t:.::ton inc :ha: :a lurt: to:ecurc �•e:are as recuircc untie Secvon:5A'of�1GL 15: an lead to the impaction of air..or ar;aJn� ccnstsn:te of: ftnc of ue to S1500.00 and/or impruons::ent or uo to one N•ea:and civu pe:aiuu in the form of a 510p boric Orrice and a fine of S100.N a day a€a:ns: me. - yam ) 'i SHEETROCK: MEL REED: (L) WORCESTER INS - CB817530 (W) COMMERCIAL UNION - CBH557387 INTERIOR TRIM: DAVID'S REMODELING: (L) COMMERCIAL UNION - NB F821442 DAVID BIK: (L) MERCHANTS INS GRP- 8CM0278579150 (W) TRAVELERS - 176K337-8-94 OAK INSTALLER: ROBERT BUDDEN: (L) NORTHERN ASSUR. - NBF528652 PAINTING: CAMPBELL PAINTING: (L) TRAVELERS - 1680251K4083COF (W) AMERICAN POLICY - WCC 186604 ROUSSEAU, AL (L) MERCHANTS MUTUAL - 8CM0278570179 (W) EASTERN CASUALTY - ??? GARAGE DOORS: ALL CAPE GARAGE DOOR: (L) U S F & G - BSC14667590301 (W) COMMERCIAL UNION - CBH573757 STORMS & GUTTERS: ALUMINUM PRODUCTS: (L) AETNA MPOO21014146 (W) AETNA - JC89258880 OAK FINISHER: AMERICAN FLOORS: (L) TRAVELERS - 680 342W754-0 CARPET, VINYL & TILE: CARPET BARN: (L) VERMONT MUTUAL - SBP6507393 (W) PHOENIX INS. - 6NUB476J652794 WIRE SHELVING: CAPE COD CLOSETS: (L) U S F & G - BSC146983441 APPLIANCES: KITCHEN APPL MART: (L) FIREMENS FUND - AZC80453098 (W) HARTFORD INS CO - 77WZNBI603 MIRRORS & SHOWER DOORS: L & M GLASS: (L) COMMERCIAL UNION - CBR409003 (W) U S F & G - 0071439933 LANDSCAPE & SPRINKLER: COY'S BROOK: (L) COMMERCIAL UNION - ABR345850 (W) CIGNA COMPANIES - C41138178 DRIVEWAYS: NORTHERN SEALCOAT: (L) MARYLAND CASUALTY- EPA18716945 (W) THE PHOENIX - UB387K530 u r SUBCONTRACTOR'S INSURANCE ENGINEEER: BAXTER & NYE ENG: (L) FIREMENS FUND - S30MXX80564866 (W) LIBERTY MUTUAL - WC1312595563023 EXCAVATION & SEPTIC: DRISCOLL, JJ: (L) U S F & G - HG.L 110093 (W) U S F & G - 7708711936 FOUNDATION: BAYSIDE FOUNDATIONS: (L) COMMERCIAL UNION - ABR406267 (W) LIBERTY MUTUAL - WC1312201785044 WELLS: DENNIS SCANNELL (L) TRAVELERS - 660873E5627COF92 (W) WAUSAU - 151300062926 CELLAR/GARAGE FLOORS: MICHAEL BROWN: (L) AETNA - MP0023672849 FRAMERS: ROBERT DORRER: (L) TRAVELERS - W680526K991TIA9 (W) AETNA - 006C0023972416C MICHAEL DUFFLEY: (L) COMMERCIAL UNION - NBF821356 (W) LIBERTY MUTUAL - WC1312492127024 ROOFER & SIDEWALL: JOHN MEE: (L) AMERICAN STATES - 01CD1486783 (W) TRAVELERS - 6NUB448K275894 MASON: SHERMAN, WAYNE: (L) COMMERCE INS CO - N60689 (W) WAUSAU INS - TO BE ASSIGNED ELECTRICIAN: CHAVES ELECTRIC: (L) HANOVER INS. - LHN2964649 (W) MISCELLANEOUS INS CO. - 0708878 91 1 PLUMB & HEAT: WHITELY PLUMBING: (L) TRAVELERS - 660365K1782COF9 (W) EASTERN CASUALTY - POLICY IN MAIL ALARM SYSTEM: BALTIC SECURITY: (L) FIRST FINANCIAL - FF0131 'G400831 (W) COMMERCIAL UNION - CB0743379 CENTRAL VAC: VACUUM HOUSE: MERRIMACK MUTUAL - SBP1608045 INSULATION: MAP INSULATION: (L) AMERICAN STATES - 02CC326435-3 (W) U S F & G - 7711099932 , 5f�lC � � ! _ �r � i i l- r Jz1,. �I t'PAi L I C_ TANk.I I ' I I /d 23 f I _fil SPoSQ P � 5 g 5 At��A 1�3 Sr I I `.�3.9 np L 1 19 AL .. 1 t Y - I }—t181,�D, -� ' 1_ . a _ �IS� 1 �q I _ I -TOTAL `tip N_,'=, 1..5lGjjij F. ... `.•I.;.. 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