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0621 SCUDDER AVENUE
�z� �Cudo(er s4 v - . a CAPECOD INSULATION e ' PIYiR p[.SYS' S[AM[[ii SPRAT ipAM jIISPENDEp . B'-� ' - r�.n � - YAKS 3iif YS INYYWSIpN CSIIINpf - 1-800-696-6611 ['own of Barnstable Ln Regulatory Services Building Division r N r81 200 Ma in atn t Hyannis, MA 02601 Date. Dear Building Inspector Please accept this Affidavit as doctunentation that Cape Cod Insulation, Inc. performed & completed the insulation and weathenzation~work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute (BP.I) inspector. All wort:preformed meets or exceeds.Federal & Mate Requirements. Property Owner Property Address Villagge lnsiilation Installed: Fiberglass Cellulose R.-Value Restricted Unrestricted Ceilings Slopes Floors Walls Sincerely He ry L Cas,- y Jr, President (:' e Cod I ulation, Inc. Col 72- 6 - OoO7 la"o's ol e 5 )rj-,I-.e- la arnstable Services Her, Director IVISIOn ing Commissioner annis, MA 02601 stab le.ma-:us Fax: 508-790-6230 Additions/Alterations iIT applicable). he location and setbacks of existing/proposed ate of Appropriateness is required. th of the Mid Cape Highway) District(See map for boundaries) IiIl sized plaits and one complete set ist be submitted with the building permit ct or engineer's stamp. .Note: The ropriate Fire Department for review. The TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Cu`/ .0 Map. Parcel Application # 4 Health Division Date Issued Eqb. P� Conservation Division Application Fee Planning Dept. , Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street-Address --maw Village i�6 � s/ r A; V Owner Address Telephone 0 Permit Request WMI. At, 60Klaf k U w 1{,V -ellY( 10 h ac,4 T- t �' ' y 2 _:Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation L a Construction Type lVL f A Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting Ogcurr72ptation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King s ighway:��;C7 Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing newer Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No. Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existings ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes aA No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION I /� (BUILDER OR HOMEOWNER) Name Gk l �fi� Telephone Number �GI `' ��� �i;J Address ���G - C� ���" License # toe L Home Improvement Contractor# �5 Email Worker's Compensation # UN-V b,5Z5!q1) 1 ALL CONSTRUCTION DEBRIS RESULTING FR M THIS PROJECT WILL BE TAKEN TO tv"A' L SIGNATURE DATE f FOR OFFICIAL USE ONLY APPLICATION# t DATE ISSUED G' MAP/PARCEL NO. i ADDRESS VILLAGE �f g' OWNER r. DATE OF INSPECTION: r FOUNDATION k t FRAME ' INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL r GAS: ROUGH FINAL FINAL BUILDING I; p�T!&,-ELOSED OUT A$SS AFTION PLAN.NO.. 4 - r 1 Commonwealth of Massachusetts Class A Large Capacity License to Carry Firearms(M G L' c 140,-.§131), License.Numbbe. Date of Issue p -wh Date 12444,P74A 01/1512014 '1 .9 a� V Issuing:CRy/Town: 1ri1RM0 TMT :- '. a Restrictions.Nona 6 CASS1,DY1,AENRW ' y WEST YARMOUTH `4 Office of Consumer Affairs and3usiness Regulation ` 10 Park Plaza - Suite 5'170 Boston, Massachusetts 02116 Home Tlnprovement Coritractor Registration Registration: '153567 Type: Private Corporation Expiration: 12/15/2014 Tr# 233831 CAPE COD INSULATION, INC HENRY CASSIDY - 18 REARDON CIRCLE ............ SO. YARMOUTH, MA 02664 ----_-----_-.--.___-.._...__._. Update-Address:ind return earl. iWark reason for change, r Address L� Renewal [ _) 1?mploymcnt lost Curd av\, Offi e of Consumer Affnirs Business Regulatiou License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date-If found return to: . Office of Consumer Affairs and Business Regutatiou egislration: 153567 Type: 5 a-Suite 517U 10 Park Plaza.;Expiration: 12PI 5/2014 Private Corporation 02116 �Boston,NIA 02 t 16 t:,=,r'C:Ci?I)nv:iuL.AT1(�N,,'uVC ti:-i tf1 (;ASSIDY Iti WI-API)ON CIRCLE 1',:7 ' F;tv10l.I(hi. MA 02664 ' Uuderseere(ary of val witho t wit f4 The Corrrnionwealth of Massachusetts r= Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 wiww.mtass.gov/dta Workers' Cotiapeasatiou futsu>lance A-ffidlttvit: Buhders/Contrarctvrsi..Elec:triciausl�Yua><y>ber5 �: ,lil.ie':urrt Ir><.tort�:u�tyt>'>it �'`Wt:��ls� �rivtt >C.,e ikil c 1ilu,incsstOr uitirtttiotAndividt.Ial ty 5t ztt/Liu_ �•r,�`;.'�/.� �.�7 jai .'/ Phone#: /� ' 1 --"C YOU 4tn etrtplayer? Check the appropriate box: hype of project (re.iyttlred): I .u11 a C1111iU Wltl]. y `l'• ❑ I ant a general contractor and I t > yi t - b. [] New construction I employees (hill an,Vpe par-t-tinne).* have hired the soh co7imactara l cunt :, tiole proprietor or partnar- listed on the attached sheet. 7. ❑ Rernodelinb ilp 41.1d have no nmployecs These sub-contractors have 8. ❑ Dernal.ition employees and have workers' tivurking for me i.n.aay capacity. 9. ❑ Building addition [No workers' camp. insurance comp. Insurance., 5. We are a corporation and its 10.❑ Electrical repairs or additions t cyetircd:) ❑ I am a homeowner dowg GLII work officers have exercised their J:I.❑ Plumbing repaus or udditioas Myself. [No workers' comp. right of exemption per MGL 12•0 Roof repairs _ 4113u17ancC rcgUArnd.] .t c. 152, §10),and we have no I" I aw u hatrlcowncr acting as a, employees. (No workers' ;cncral contxactor(refer to 41t) comp.iwurarice required_/ 'ni:y ippltc;wt that ehccki box*1 must also till out the seeaou below showing their Wodccn'Cumpcusatio6jwticy infonsuidou- ' ttwItcuWUGr)who xubaw this aff-wavit indicating chey arc doing all wort:and then hire uutside coatraetors must subuut it new atlitLivit iu:licating such. tCUWIU4::4](3 that chi k this box rnult attuchcd an ack-Litional sheet showing the=Luc of the sttb-coup-wtors fluid straw wticttter or not diosc cutitica have .:uypicyccv. tr We sul)--cvnErmctuf3 have crnployec,, Ihcy must provide their worka3'comp,policy uutubar. I um an casployer that is providing workers'compensation insurance for my employees. Velaw is the policy and job site ;nfufmulru�c, kl>w4ilcc i:uuipuixy Name: A 2� 4*- �, l / Expiration Date: l o14i}' if or Solt-Lila. 1.1C. 4: `G'�:,f� �j'`� 5 ����] 1,;u>llc Address: --- X/�� /!V "t,�' r__�_ _City/State/Zip: [� a�e shu��in the policy rxulualber tar>raI eatpirutiorr elate). vr;,lt.;.copy of the vvorkera corupensatioue policy declaratlou p ( p y k .idac to 5c.urc•covcr4bc as required under Section 25A of MGL c. 152 can lead to the impositiotl of cruninal penalties of a rtnc up to S 1,500.00 and/or one-year irnpnsonment, as well as civil penaltie-3 iu the form of a STOP WORK 01W R and a fine i up to '5250.00 a day against the violator. Be advised that a copy of this statement tray be forwarded to the Office of I.tivC,ti u: oa;s of the DIA for irraur"Ce coverage; verification. ttu ircrrtyy ccrrrfy, ender the -tru /4nd penalties of perjury that the informsrattan providedbbov��is true andcurrec� �Dat / ! tl(jfciui uic only. Do not write tree this area, to be completed by city or town official I t'ity of 1'uwrx: Permit[L.icense 61t44,g Aurhurity (circle oac): ,. ,nixed of lieu/,/,, 2, Building Department 3:City/`I'awa Clerk '4.Electrical Inspector S. pltjrrabirtg Inspector I b.Other t.'otttuct t'enoa. Mae#; I I ' I l:Af�k:C0D-'27, MYOUNG - �1 r��^ }Hq "�''y�---• LIABILITY Y .__............ �•-, CEO TI` IC ^ 1 E OF �-+IABILIT 1 INSURANCE WC4_.., I)A Tk INIMIf.+01YYYY) :Lat11lICA1 E IS I.SSUEp AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIG FITS UPON TI-IE CL:14T11=1CA1'E IIULDLR.'fFIIS t:t:itIIIICAI"L. OUE-1i Nc?T' AFFI(iIV1ATIVELY OR NEGATIVELY ANIEND, EXTEND OR ALTER THE: COVF'FR.AGt: AFFORDED BYTHFF`OI.ICIES 1I11 S CERTIFICA I I� Of- INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN TFIE ISSUING INS UIRL--R(S),AU'CHORIZED ! i rki'kI-SL-N'IAI-IVE OR PROOUCER, AND THE CERTIFICATE HOLDER. tlt't)tt IAN I: It lhu t,ultihc "'I,Q IIu1Ucr is �m ADDITIONAL INSURED,the PohCy(lee)must Ue OIWOI-St cd- IP 5UI hC)C:A1'ION IS VVf\IVLD, ub)o�[tu 1ui Hanle, .,uJ cun,UUi)tts t�l Lhu Palley, c.arrlin P011cies may t quuo an ondorsanlant. A Statolnunt Olt this Cultificiltn Bans nut con(vi 1411115 tulhu I,IihC,uu IwlUc:f In IIULI uP such uri<lgr5<intulll 5 . (( l'C-5`I4tOG.`'. CUNIACI' ),:n l,I,,I InSurullCu AcU4ncy, It1C. NAhtL Nlar2et Y0UI1Q __ _..__ _ PHONC I (AX i I i I�Ir/ I 1-1 1AIC o Eal• _—_ _- - IAIt,Nul' I:'If\U':G(.iQ k•hIAIL AQ.&Ss mYOUnq[I)roger5gr.ty coal ' INtiURI:R S AFPCIROINU C:aV13RAC9E NAICu _. wsurttltA;PEkfiLESS INSURANGk COIVII'AIVY lwi R?RB;C.OMMERCE INSURAIVCF, C0I0I--4ANY IN[iulellfUll, Inc. msuitP:Rc:Evanstan InSLII'dl1t'0 C OI'Il carry . IH I-Woldall CirclM uusuaenp:ATLAN"I"IG'CI-IAhTkR IIVSUtiANl:.I: GROUP caul t i arnlcl l.11h, IVIA 02136 zt - IN�UHER __..._ry,�._.... INSURER F: ._...._.._..._._.................. ....._....____ ___-__—__—__-....__.__.,._.__._.._._._._,.___.._.. ....__.,.__._1....... ....... ..__.._ CkRTII=ICATE NUMBER: _ __ RihzVIS1QN NUIVIUER: III'1` 'I'FiF\l 'IIIt' POLIC;IL,S OF INSURANCE LISTED 13ELOW HAVE BEEN ISSULO1Q THE INSUREDNANIIaO ABOVE FOR IIII. POLICYPLN100 HUIV'✓IIHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOItO'IhIEIRUOCLIML.N'I VV171IFtLCit't'.Ct'IOWHICHINIS :rriul,:. lc- MA1' LiP Iti5l1Ca:) OR MAY PE:ftTA1N, ThIE INSURANCE AFFORDEQ,HY 'CHB.POLICIES OI:SCRIBED FIERLINISSUI7JECTTOAI..L11'IETLRMs, li:,ll uV:;AIVIi C:UN01TIONS OF SUCH POLICIES,LINIITS SHOWN MAY HAVE BEEN REDUCE(]BY PAID CLAIMS. .."i Ab0LSU6f7'-----"-T._T'�""'" 150TIC4[FF-- POL`ICY*FkP'"-.__ ❑II Ittt.Ul=l PIS U KA N II ....(CtSL ,• , --__, POLICY NUMBL'Ji UInN-�u hNI011Y 1'j CAC.H QCQUItkU.ilcc y 1000,000 _. --- -._. u _...._. :+ n It+INeu-Itt.1-LI GFNERALL.IAUILIIY CUP8263063 411/2U13 41'1i q-let TaAMMI�i3SL�lu�ivn i�n,u Y 100,000 � Mt_P kxP tAnY unw I,olaan! s S,UUU 1.1 41Ivt'LMAI)t-. � X l OC:L:LItt ._ Per.:.oNAL.x P1lV IIVJUI'tY >, 1,UUp,000 CCNI Rld.ACi(iftl ... Y 2,000,UUU ,.-A I t:I.IMIY APPL.RI S PER: 1'RQOU<:15-GUMP/(�1'AGl i 2,000,000 � � COMIJINla1SINGIa':1.1M17�-- IOUO,OUO .. _._._'._..id,._..__...,......, ......... ,. :tnl:Lli,I 13MMEiCKVMK 41'II'20'13 dh1l'2U'IA UQOILYINJURY(Parpawrq L .II u'A'1•+I:.LI X 5CHUL)ULED _..T.._..-,.._....,__— _...,..__............._...._.___._. :Ili)U' AU I ki, Ilq(11LY INJURY(Por ucadaru) b 1 0")" f1'I'iAf�IAG. _'.. NON-i:IWNEq FR Fk�:• �'--_._.- t A I if:1 1 I a l l-): X AU 1*0s _ ......... 1000,000 X O( C llh GA4ti OC.CUI�Ii L'N4.L 1' nulhI t-11NIiuNT_l.-LN 1,000000L1�t2 II�M4t�l XONJ4535I i2 ? 1 -,_. - 10000 _ I -I �I 41NI1 ,'N jA IICAN uIA.SIAIt�' I IapI- _ rh•I.oI sec tj w I 1A 1-Y 1JT21 hlJR1Ll�L .._.1 1J1., lun/r'ruclNlwr:x�rurlvrllrl WCA00525904 613012013 613012014kL.IrACHACL:IO Nl IUUUUOU N I A —_..—.__............_..._......._._ I��i r;,rrt;rdr Ntll r'It t_\t^LUDL^I.I? � 'r t1141-J f'j Ill NI I) --'- C:.t..OISEASE-FA 4NI LOYCIii 4 _ . .. I,000 UUU .. ._Y _._... ..._. .... I'l)LII. LINII„ I Y •.,�,..iUr r;,,;,.n��I,:r:r<n II CJ IV�/I_QCi('rIONJ/VEFIICLE"�(Attach ACORP 101,AgUu meal Itunmrh�Schctl�la,II n+ora iPaw Is rcyulro[II .:,��1:,1'.n++l,:,n:.auon Includes Qfl'icurs qr Proprie[arS. • ._ ,11+I;hIII.0 Inawut):;lulus is IJrovidud un(1e,r th(:Gl:nerul Llahility when rt:qulred Uy wriueu cunlrac[or agreernunt with the Cnl'li(icdtu hluld�r. e: r.nIH`1:AIt 11C�LDt.h CANCELI..ATION _—... . SHOULD ANY OF THE ABOVE DESCRIOED POLICIES DG CANCI:LtkDU6f0R6 l,� Cad IR ulztllun, II1C THE EXPIRATION DATC 1hI:REQF, . NQTIGL WI(_l. UL UELNl]liL'D 1N ACCORDANCE WITH THE POLICY PR(]V1510NS. AUTtIQIirGEU ftkPRC-Sk,NI'ATIY� �, 411 x l2 W c (5,1906-20,10 ACORN CORPORATION. All rlUtlls reserund. ;,;:'yFkl)26(,010/05) The ACORD narlta anil logo arl;registered rnarlus of ACORD f j OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located atC. (Property Address) Pya n Ni r G Property Address) hereby authorize C ! S✓ t CL l d U (Subco tractor) an authorized-subcontractor.for RISE Engineering,to act on my behalf to obtain a building permit and.to.perform work on my.property. Owner's Signature Z Date I RT IN, OF f+u a ,h 2 ti RUCTION O tl t s J-gl and Commercial Buolder ,y ; $ t ` litc 49 r E �EA 72AT�ON SP�CIAGIST �+-°a ^� 1 . . March 15, 2014 U Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main Street Hyannis, MA 02601 RE: Insulation Permits Dear Mr. Perry., This affidavit is to certify that all work completed for permit application#201309478;Status A; Parcel 328088 at 52 Spring Street, Hyannis, MA; Permit Type RADD and issued on 12:00:00 AM has been inspected by a certified Building Performance Institute(BPI) inspector.All work performed meets or exceed Federal and State requirements Sincerely, Michael McCarthy McCarthy Construction TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION /� Map Parcel lJ Application91 # Health Division Date Issued Conservation Division Application Feel&Is Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation /Hyannis Project Street Address ��t�1 5c C"- ve nuo_ Village �01— Owner 51 Address sccty r Ave-. N)�,nTr-r Telephone 9 Permit Request & C: UCnL on-e_ 'x f D 0—cy _ Q._ C�t2se C2 �� Square feet: 1 st floor: existing�0�proposed 0 2nd floor: existing 1-proposed _Total new Zoning District Flood Plain Groundwater Overlay Project Valuation� 30 Construction Type VJ Lot Size I Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ®' Two Family ❑ Multi-Family (# units) Age of Existing Structure f 8� Historic House: ❑Yes t(No On Old King's Highway: ❑Yes No Basement Type: ❑'Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft)T, O q 9 Number of Baths: Full: existing new Half: existing C.Yp newer Number of Bedrooms: existing new Total Room Count (not includi baths): existing new 0 First Floor Room Count Heat Type and Fuel: as ❑Oil ❑ Electric ❑ Other Central Air: ' �es ❑ No Fireplaces: Existing QNew Existing wood/;coal stove.. ❑'rob tNo Detached garage: ❑ ex' ing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing 3 new +size_ Attached garage: existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number Address License # r—S 0793,5b aC. -V► �2 , Home Improvement Contractor# Worker's Compensation # WC- O(oPMo ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO K)&LAJ5 'I C1 .44 SIGNATURE DATE fCC r r FOR-OFFICIAL USE ONLY APPLICATION# 7 - k DfE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER t Y. DATE OF INSPECTION: FOUNDATION FRAME ,r t INSULATION ' FIREPLACE ELECTRICAL: ROUGH FINAL. f PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT - r ASSOCIATION PLAN NO. SR + ne Caarrmorat altfa.QfMaSSMIJUXeftDepartment of Indissolal Accidenis Office gf l ngadons- . ." Boston,MA 0711 Workers, Compeu Safion;%ri ve davit:BaDders/Contralaa cdridau Am Ucant Information les�sa�, . . �L ib . � MSAC e� ,tJ, Px� Icy ` (a Pb'o'ne, LJ 8 Are an er:. th appropriate box. �of Prof' ( : 1.LI I atm a loyer�t s 4, 1 am at t at3 and I p : have hired tie •c�xus � �3�Ye�v cxs� st� , etp10 (full andAhr partficme)_ 2_❑ 1 am a sole proprietar or parkr- Ested on the aftnelvedsheet °t_ eRemodeltaa slop and bare a o,employees These sub-cantractan have Demolition " woddmg for me,in my city' 10yees and IMM.wars' l3atil ` o U�ot "camp.fi ce adman 5., We are at empotation-and its 10,0 Elechical repairsor additions 3_n 1.mu a homeowner doing all-*wk Myers have,eaemsed their 11_E]Plum tkigg repo=or additiam myself[No wcork m camp dghtDf exemption per MGL 12.0 Roafrepaim, karance.requimd-1 t c.115 ,§1(41.as have no loye a, o 13-(j Other . 'Any oatk=dw che&s box fls=do Ml out the sect; slw%Wng&&wcdwe=Mpamew PONCY inftwtim, I Haweaa bniit this mffdtVn in&cstiq diey areftbg a meat a&m bfiecauide tonnumn subnall-,a mw aft s 1Ccn= chx deck Ibis box 12ftZdWd M addifiowlspas ng tits n ®� a -c ^R= a tvlEei�er�nit eeitt$e,15 e f employees,F€tffie sa-caatr ctum have a layee%they pi-gde their vark-e policy number_ I earl art eat sPaJ.er a{ItHt isprovii&g naorheps'cnarrpensarftsn iT2setr fOFVF:YeHWIVJVM J i01 is tJte e d r►b site IMSUrdnCe Company P a me; ' palm carSelf=ia s-lac- (.JG at7 �� y' ., , aratioar D.a�: .� �I S C U c►�cr2r- A V 2: ty� !� Job Sift Ate_ ` CifisP �! ���D Attach a cepy of the workm'compensation poUcy declaration pray(3.ovdaag the lid _ am date).a ta . Failure to seem coverage.as requiredunder,Section 25A of MOL c, 152,cat,lead to dw imposition of- .Yi penalties 6f a fim tap to S151 :411 and/or on"earimprisonment as well as cixilpenalties in the fom of STOP WORK ORM and a of up to -00 a day agaima fat~v-io9ator. He adt d that a copy of this tement way be forwarded to Office of lnvesOpbnxis of the DIA for in s coves vnification, — - - -- -- & - - — -- - -- - - - -Ida hereby cer�ijfy Him rh err tr r i rfrrpi Sin Phone effldaluse anity. Do not nits in this area,to be comnpkto by city or tom qffidffz City or Town; PermitaAcense Issuing Authority(eir t ones 1.Board ofRealth 2..Ruilding.Department. 3,CHyfrown Clerk 4.Electrical Inspector S.Plumbing.Impector 6.Other G'orttact Person: Phone 9: 6 L Aco CERTIFICATE OF LIABILITY IN °/17/ D°14 INSURANCE 1/17�2014 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 Kathy Silvia The Fair Insurance Agency Inc. PHONEC. (508)775-3131 FAfAlX No:(508)790-1677 619 Main Street EMAIL ADDRESS: y g y- kat:h @t raenc hefai com - Suite 7 + F INSURERS AFFORDING COVERAGE NAIL# Centerville MA 02632 INSURER A:Western World HTBO18 INSURED -INSURER B:Citation.Ins. Co. MA 40274 Macallister Building LLC wsuRERc:Star Insurance Company 18023 64 Ebenezer Road INSURERD:Peerless Insurance 4198 INSURER E: Osterville MA 02655 INSURERF: COVERAGES CERTIFICATE NUMBER-CL139900587 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 LTR TYPE OF INSURANCE ADDL S BR POLICY NUMBER POLICY EFF MMIDD EXP YYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY ( DAMAGE TO RENTED PREMISES Ea occurrence $ 300,000 A CLAIMS-MADE DOCCUR NPP1318574 , 8/11/2013 8/11/2014 MED EXP(Any one person) $ 5,000 _ PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X1 POLICY PRO- LOC $ AUTOMOBILE LIABILITY - - COMBINED SINGLE LIMIT -• Ea accident B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED X2082 9/7/2013 9/.7/2014 BODILY INJURY P $ AUTOS AUTOS (Per accident) NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ + $ 4UMBRELLA LIAB OCCUR , .� EACH OCCURRENCE -$ EXCESS LIAB CLAIMS-MADE - AGGREGATE $ DED RETENTION$ - $ - C WORKERS COMPENSATION - - WC STATU- OTH- AND EMPLOYERS'LIABILITYER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN . E.L.EACH ACCIDENT $ 100,000 + OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) C0632030'• /1/2013 • /1/2014 E.L.DISEASE-EA EMPLOYE $ 100 OOO If yes,describe under - - DESCRIPTION OF OPERATIONS below E.L.'DISEASE-POLICY LIMIT $ 500,000 D IM8492273 8/11/2013 8/11/2014 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) r • - - CERTIFICATE HOLDER CANCELLATION 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. • 200 Main Street Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE Jackie Stewart/FAIJS2 G `_ act ✓�"� � .ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS0257gmnnrini Th.Arnon -nr1 I—ern—i-f—aa—1—of ARnon Massachusetts-Department of Public Safety' 4 Board of Building Regulations and Standards Construction SuperN'isor x- License: CS-079358 " e MARK A MACALJL `ISTER 64 EBENEZER RD OSTERVILLE t Expiration 08/12/2014 Commissioner $ 1 . �e rpoo�unzo7zcaea c a aaac�cc�e��y� ' � � � ' Office of Consumer Affairs,&Business Regulation License or registration valid for individul.use only ME IMPROVEMENT CONTRACTOR _ before the expiration date. If found return to: egistration j3374q Type ..r Office of Consumer Affairs and Business Regulation i xpiration 8/312015 DBA # 10 Park Plaza-Suite 5170 Po Boston,MA 02116 MACALLISTER BUILDING,. roc, f MARK MACALLISTER 64 EBENEZER ROAD OSTERVILLE,MA 02655 ,...... Undersecretary Not valid without signature BARNSTABLE _ 6 19. Town of Barnstable 639 ,0� Regulatory Services . . Richard V.Scali,Interim Director Building Division Thomas Perry,CBO Building Commissioner " 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 s Fax:-508-790-6230 Property Owner Must Complete and Sign This Section' ` If Using A Builder ' I, !3Zw'..ran �-A , Gn.�. LP.c -+.�cz ,as Owner of the subject property hereby authorize t�aS,AS [AmgW t. ,akeC to act on my behalf, in all matters relative to work authorized by•this:building permit application for: 4 (Address of Job) Signature of Owner Date �U�sA�O �. GALL�4G\�►�"i� Print Name If Property Owner is applying for permit,Please complete the Homeowners License Exemption Form on the reverse side. r TAKEVIN D\Building Changes\EXPRESS PERMIT\EXPRESS.doc Revised 061313 �cALClit MI6 1 cc AV cc Ir +�qi. ` or SCL m 7 .17, 77 ,Y ,w R . z s kir4CT, : Wk a +, 44 IW h't2 r� � t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # O Health Division Date Issued i Z Conservation Division Application F ;At�>_ Planning Dept. Permit Fee �� Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis Project Street Address 5CQ6A Jr P� Qt_ Village Np1i Owner E� 5 c.a5crl- C"-1-e.d -4r, Address SAAL% Telephone 00 Permit Request 1 ��. ,C h' h� f�ua �- luoo& 4+�.C. pSur� ,� S®� tki k,N11q_ Ch C711" Square feet: 1 st floor: existing proposed 2nd floor: existing proposed' oal nr Zoning District Flood Plain Groundwater Overlay Project Valuation 8',bOO Construction Type ) rn Lot Size Grandfathered: ❑Yes ❑ No If yes, attach s "pporting ocumentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) E5 Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway)❑Y Ts ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION ]] (BUILDER OR HOMEOWNER) Name Hour' Gi- �5`T'Ct� Telephone Numbed-' 0-M Address (�9 t3 �� r� Rm Ra) License #. 0_�) ��J`� V Home Improvement Contractor# 133 v_1 qq Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �iQLC_rd SIGNATUR DATE / r, i FOR OFFICIAL USE ONLY (APPLICATION# P DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: p FOUNDATION FRAME 1 INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL IL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING y� DATE CLOSED OUT ASSOCIATION PLAN NO. Q The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street c Fr Boston, MA 02111 ` i www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Na.c.aft5ltr BU4 M( LLB ' Address: (0 fo ei-�' � City/State/Zip: �i Phon ca e #: Are you an employer? Check the appropriate box: Type of project(required): 1. I am a employer with 4. ❑ 1 am a general contractor and I 6. ❑ New construction employees (fill and/or part-time).* have hired the sub-contractors � 2.El I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling s These sub-contractors have hip and have no employees g, Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers' comp. insurance comp. insurance.$ 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 l LE] Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lie.#: [5��� .��i� `d��q_A--�� Expiration Date: 2,1 1 I ,o t R Job Site Address: (Q�` � �� City/State/Zip: 0" j5 - Attach a.copy of the workers'compensation policy declaration page(showing the policy number and expiration date). 1 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 cert' and the pains penalties of perjury that the information provided above is true and correct 0 � Si nature: �+ Date: Phone#: Official use only. Do not write in this area, to be completed by city or.town officiaG City or Town: Permit/License# Issuing Authority (circle one): 1. Board of Health 2. Building Department 3, City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual, partnership, association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, constriction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." . Additionally,MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub.-contractor(s)name(s), address(es) and phone number(s) along with their certificate(s)of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be 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 burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call, The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street ' Boston, MA 02111 Tel. #.617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.mass.gov/dia 9c -. i 14 ,�� 2 "� Ulu '� MM r Loci �,c - 5 2 a�• ��.s�:,.� Cl�l��� of m, RICHARD v, A-, /iBAX STFR�`�' CE.e T/�'/EO �'L�OT OL4�t/ • / CE2T/.may 7-,U,47- THE ,IZO Cl AJ�Vl T _ I Lac,aTioc/ N���J�JiSr'�rz�- ,S.yO�✓� 7"NE s/vE.C1XZ-- ANo SG' 7T6,4C,,� I I 8.4 xT,E,2E TN/✓`S P�-�4�//S rt/vT BASED ON.4�f/ �2E"G/STE,eEp l.�gc�/O SU.eY_6yt�.C� /NST,eU�lEit/T,$U.21/E Y. T.yE GZSTE,eY/,C.L o 4'��;SETS Syv�y Sf,bv�� �tloT B� A.,'.111-/Cf ,4-17 11assachusctts- Department of Public.Safet3 Board of Building-Regulations and Standards; Construction Supervisor License License: CS 79358 Restricted to: 00 1 MARK A MACALLISTER 64 EBENEZER RD I OSTERVILLE, MA 02655 i Expiration: 8/12/2010 Commissioner Tr#: 606 • u - Restricted to: 00 00- Unrestricted 1G-1 2 Family Homes ' g Failure to possess.a current edition of the, Massachusetts State Building Code is cause for revocation of this license. Refer to: WWW.Mass.Gov/DPS F _—_�LP.V�Om7/hT,O�tll�8 a�✓(�(.Q4d2GLUJP.ua .4 _. Office of Consumer Affairs&Business 12egalatiox HOME IMPROVEMENT CONTRACTOR - Regis 4tion;_ 133744 i Tr# 287245 Expiration=•-,=__12091 Types--, DBA ' MACALLISTER;BUILDING MARK MACALLISTER 64 EBENEZER ROAD ga } OSTERVILLE,MA'02655-- Undersecretary :I { License or registration valid for individul use only before the expiration date. If found return to: f Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 • I . Not valid without signatur TRAVELERS J WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE'AR INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (6KUB-0187N49-A-09) RENEWAL OF (6KUB-0025M37-5-08) INSURER: THE TRAVELERS INDEMNITY COMPANY , NCCI CO CODE: 11347 1. INSURED: PRODUCER: MACALLISTER BUILDING LLC FAIR INS AGCY 64 EBENEZER ROAD 619 MAIN STREET OSTERVILLE MA 02655 P 0 BOX 430 CENTERVILLE MA 02632 Insured is A LIMITED LIABILITY COMPANY Other work places and identification numbers are shown In the schedule(s) attached. 2. The policy period is from 03-01-09 to 03-01-10 12:01 A.M. at the Insured's mailing address. 3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compensation Law of the state(s)listed here: MA o N— a B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in Item 3.A. The limits of our,liabilky under Part Two are: Bodily Injury by Accident: $ 100000 Each Accident Bodily Injury by Disease: $ 500000 Policy Limit Bodily Injury by Disease: $ 100000 Each Employee C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06A m� 0 D. This policy Includes these endorsements and schedules: o� SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE o� 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating R- Plans. All required information is subject to verification and change by audit to be made ANNUALLY. DATE OF ISSUE: 03-18-09 KB ST ASSIGN: MA OFFICE: ORLANDO INDUS AFF 161 PRODUCER: FAIR INS A.GCY 260SU kcF a c • A r / �3 r �.� S s 1 Town of Barnstable f THE Tp� K ti� Regulatory Services B&A RMNA&Q- E M Thomas F. Geiler,Director . fo;p;�►`0� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property i hereby authorize CtA 1(_,�-i� �� to act on my behalf, in all matters relative to work authorized by this building pernut application for. (o?i SC udj-%�— �)VjM , O�C.4*,sll (Address of Job) I b-i Signature of Owner . bate c�- Print ame If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:OWNERPERMISSION Town of Barnstable w of ZF1E Tp� o Regulatory Services anrtxsrnsLe Thomas F. Geiler,Director MAS& 9�A 1639. a mp Building Division TEo MAy Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma,us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: 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 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 or two-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,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that be/she will comply with said procedures and requirements. I Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her,responsibilities,many communities require,as part of the permit application, that the homeowner 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 t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\homeexempt.DOC TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map --.,Parcel - l Applicatio # V L10 Health Division ln' f y - SSS Date Issued I Ufa7 Conservation Divi lion Application Fee Planning Dept. Permit Fee (t�� Date Definitive Plan Approved by Planning Board Historic _ OKH Preservation / Hyannis ' Project Street Address yex)0�, Village �01 Owner ad, vS10 '—c-d I "G�_e Address SC,t�� Telephone Permit Request hid L cam. 6 F 1�- Square feet: 1 st floor: existing proposed 2nd floor: existing proposed �� Total new Zoning District Flood Plain Groundwater Overlay Project Valuation / �� Construction Type Lot.Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family be, Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes C-P� On Old King's Highway: ❑Yes ❑ No Basement Type: O'Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) �-f Number of Baths: Full: existing, new 0 Half: existing new Number of Bedrooms: 3 existing A new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: Ur6as ❑ Oil ❑ Electric ❑ Other Central Air: O'Yes ❑ No Fireplaces: Existing New Existing wood/ oal stow& ❑des ❑ No Detached garage: ❑ existing ❑ new size Pool: ❑ existing ❑ new size _ Barn: F isting P new= sizeAttached garage: existing q new size Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ C Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION / (BUILDER OR HOMEOWNER) Name &CLCC , S-��r' Telephone Number Address, (0 License # CS 793E_6 Home Improvement Contractor /3 3 7 yy to O -Aq3jNq9_p,_oq Worker's Compensation # t ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO C OLS-e.. I]0,- 4"C(co; SIGNATURE DATE 7�� 09 e _ FOR OFFICIAL USE ONLY APPLICATION# =r s DATE ISSUED MAP/PARCEL NO. - ADDRESS VILLAGE OWNER C DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING 5 DATE CLOSED OUT { ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents 132 Office of Investigations ' 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lezibly Naive(Business/Organization/Individual): kuJ E 01(i,, t c . Address: U g City/State/Zip: 0(_+znj' 0 Ss, Phone-#: fib' *`ji 'IVII Are an employer?Check the appropriate box: Type of project(required): 1. I am a employer with � � 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-tim.e).* have hued the slab-contractors 2.❑ I am a sole proprietor or'partner-' listed on the*attached sheet. T. ❑ Remodeling ship and have no employees These sub-contractors have 8.'❑ Demolition working for me in any capacity. employees and have workers' 9 [2uilding addition [No workers'•comp.-insurance comp.insurance.# 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 11.❑Plumbing repairs or additions myself.[No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp,insurance required.] *Any applicant.that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. XContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self ins.Lic. ly j A P 6 I Expiration Date: ��l Job Site Address:_ ejj SC044�zr RVQc\uA_ City/State/Zip: 4ySAri')S rRQ,(+l • d�(,p•q7 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the"imposition of criminal penalties of a fine tip 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi lundr the pains n enalties of perjury that the informationprovidedab e ' trueandcorrect Si atu '' Date: O _ Phone#: � Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# ' I 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as "an individual,partnership,association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or tiustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall . enter into any contract for,the performance of public work until acceptable evidence of compliance azth the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contsactor(s)name(s),-addresses)and.phone number(s) along with their certificate(s)of insurance. Limited Liability Companies•(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please-call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials .Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permittlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town).".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related fo any business or commercial venture (Le. a dog license of permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone-and fax'number: The Commonwealth of Massachusetts Departrnent of ladusbitI.Acciftts Office of InVestigatlans- 600 Washington Street Boston,MA 021.11 Tel. #617-727-4900 ext 406 or 1-$77-MASSAFE Fax# 617-727=7749 Revised 11-22-06 • - www.mass.gQv/dia a� rosy Town of Barnstable, Regulatory Services _ _ WIS& , Thomas R.Geller,Director Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.towa.barnstable,ma.us Office: 508-8 62-403 8 Fax: 5 08-790-62 3 0 Property Owner Must Complete and Sign This Section If Using A Buildtx kgr , as Qwner of the ProPertY subject - , J hereby authorize /UiZt k MG 66L1 C/1 A- to act on my behalf, in all matters relative to work authorized by this buRding permit application for; (Address of Job) Signature of Owner Date 19, 0-4 Print Name Q:FORM S:OwNERP ERMIS S ION Massachusetts- Department of Public SafetN Board of Buildin Aegyulations and.St Construction Supervisor License ,r License: CS 79358 Restricted to: 00 w MARK A MACALLISTER i 64 EBENEZER RD OSTERVILLE, MA 02655 �i--�- -� Expiration: 8/12/2010 ('nnmisinner Tr#: 606 • E ✓� p ie T��»z�n�uue��ft� n���l�aJ�n,�•�uael�i License or registration Valid for.lndkidul use only \ Board of Building Regulations and Standards before the expiration dW. If found return to: Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR 4 One Ashburton Place Rm 1301 ' - Registration: 133744- ' Boston,Ma.02108 Expiration: 8/3/2009 Tr# 132899 Type: DBA MACALLISTER BUILDING - MARK MACALLISTER Not valid without signature 64 EBENEZER ROAD ,OSTERVILLE A 02655 • � M.. Administrator r TRAVELERS J WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE..AR INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (6KUB-01 87N49-A-09) RENEWAL OF (6KUB-0025M37-5-08) INSURER: THE TRAVELERS INDEMNITY COMPANY 1 NCCI CO CODE: 11347 INSURED: PRODUCER: MACALLISTER BUILDING LLC FAIR INS AGCY 64 EBENEZER ROAD G19 MAIN STREET OSTERVILLE MA 02655 P 0 BOX 430 CENTERVILLE MA 02632 Insured is A LIMITED LIABILITY COMPANY Other work places and identification numbers are shown in the schedule(s) attached. 2. The policy period is from 03-01 -09 to 03-01 -10 12:01 A.M. at the insured's mailing address. 3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compensation Law of the state(s) listed here: MA B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in Item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident: $ .100000 Each Accident Bodily Injury by Disease: $ 500000 Policy Limit Bodily Injury by Disease: . $ 100000 Each Employee C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06A D. This policy includes these endorsements and schedules: SEE LISTING OF ENDORSEMENTS -,EXTENSION OF- INFO PAGE. 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All required information is subject to verification and change by audit to be made ANNUALLY. DATE OF ISSUE: 03-18-09 KB ST ASSIGN: MA OFFICE: .ORLANDO INDUS AFF 161 PRODUCER: FAIR INS AGCY 2608J •TM� TOWN OF BARNSTABLE Permit No. 27194 • £ Building,;Inspector sanaac J } .; Cash OCCUPANCY PERMIT' Bond -------g---- Issued to Edward Gallagher Address s ,r Lot A, Scudder Avenue, Hyannislzbri Wiring Inspector �/ � Inspection date Plumbing Inspector/ s Inspection date Gas Inspector Inspection-date aJ �•�=�tu R ;Engineering Department t o Inspection date ?�--2.4-8,jr i� 1 Board of Health ^ �t � � Insp ction date ' t THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED 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. ........... ................................. 19_...,_ ...........................Building...Inspector......... ........ r l •n TOWN OF BARNSTABLE BUILDING DEPARTMENT = DAUSTAU t TOWN OFFICE BUILDING rua Mgr 1619• `� HYANNIS,, MASS. 02601 MEMO TO: Town Clerk FROM: Building Departments .�P DATE: a An Occupancy Permit has been issued for the building authorized by BuildingPermit #........ `. .» ...... ..... ............................................................... .. .........................................»..... issued for.......................... j Please release the performance bond. � l .. 7. 4=4tto nsy at 1'awr . 280 qV InfE4 cSb z t 1, Jn-osf COfftee Box 759 oTyannls, ovmassacguszUs 02601 !M&gsone (617) 775-710o October 5 , 1984 Mr . Joseph Daluz, Building Inspector Town of Barnstable Main Street Hyannis , MA 02601 Re : 612 Scudder Avenue Dear Mr . Daluz : I am writing concerning a request for a Building Permit by Edward and Susan Gallagher for the property located at 612 Scudder Avenue, Hyannis Port , Massachusetts . The builder requesting the permit is Mr . Tyler Foster . I have been told that you have requested title information and verification that the lot is grandfathered from the current zoning . Please- be advised that the property was owned by William J. O 'Neil , Jr . and Mildred D. O ' Neil from 1943 to 1982. The O 'Neil ' s transferred the property to their grandchildren, Dana Spencer Wills and Margo Linnell Wills in 1982 and they in turn transferred it to the Gallaghers . At no time since the current zoning has been in effect have the owners of this lot in question had any ownership interest in any of the contiguous lots . - Therefore , the lot should be grandfathered and is , in my opinion, a buildable lot . If I can provide you with any further infor tion please let me know. Peter L. O 'Kee ' e PLO: cros 9G F I G,i tN OF N 1 Fac a^w° . BAXTER H ' JCVD�t1�- 3. WL 0o x Yc. I� ' CE,e T/�/EO PL�07' OLQ Al 10C471OA-1 �Aj41Sr20AEr / CEe r/.Cy T,�AT Tf�/� /Z-o A Y, �tii p�4 TE AO•� ,S',yok/ov iyE.2E0�/�OMf�L YS W/rh' Sc�1 L do 7-AdC—S/L7E.C/,</E A,4/0 SE7-,eAC,4e ,r,LAAl ,2EF"E,2E�t/G'E ,czE4v/•2EME�/y'S of 7,'/E r'ow.-✓aF /2tiJA F3L ANv L OCA 7'E•L0 W17-,VI V TyE FLo�PG4/.f! 7,',V f>.GA�//S �/o�' BASED D v A.-V �2EG/STE,2E� LA��O SU•eY6Y0a //1/ST,2!/MENT,$'liej/EY� Tf/E QSTE,C�✓/�.�E P M/.45.5 O��,E'TSSiYa/.✓�VSs�vL� .t/oT B4— U.SEl� T4 OETE.�i�l/NE •�-�hT�/it/6S. _ - - •F r � a In 2- 71 j d - c. 74 _ PETER / RJCHARD � Gf�, SULLIVAN " MXTER No..29733 " f No,24W 4 °�sTaa �d4 �sS/ONAL E��� \ . . \ \ ' ` ` \\ \J ' F3 /-,As'sessor's map and lot number ........ ............ THE THE House number -111"& TOWN OF BARNSTABLE BUILDING INSPECTOR .....................Fgy . .....6�, TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the followin information: ....1W Name of Builder ......FIPSZT�. ...............Address (,ld fT�....ROW Diagram of Lot and Building with Dimensions Fee ............1..1. 'T I....... SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS | hereby agree to conform to all the Rules and Qegw|ohonx of the Town of Barnstable regarding the above r WGALLAMER, EDWARD r,k, r Na 27194 Permit for .......Zt,�o St. . '.......... . 4- .................. Scudder Avenue # Location Lot A ....................... Wannisort .................... ................................ Owner Edward Gallagher..... x Type of.Construction` Frame t ................... ........................ ............ ........... _ - Plot ............................ Lot .....:......................... . November..... 84 Permit Granted ........................................19 , .Date of Inspection ................19 Date Comp ete t• 49 Assessor's map and lot number ....... 1.77......................... THE 0 - 7_r17 Sewage Permit number ........................ 33ARN9TAXLE, House number ... ........ azw................... V MAO& 03o. a MAI TOWN ' OF BARNSTABLE BUILDING ' INSPECTOR APPLICATION -FOR PERMIT TO ..... ..... ....... TYPE' OF CONSTRUCTION ...........I../?......S.. .................................. ......... I qR± TO THE INSPECTOR OF 'BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .................. ......1.41,1,5.................... ........................................................................ /&x_--kZ7 Proposed- Use ........S7 . 7 .... . ....I................................................................................ Zoning District ..... .....................................Fire District .... I.S..F ................................. Name of Owner Address Name of Builder . . ................Address P Name of Architect ...... ........................Address .... .................................. Number of Rooms .................5.............................................Foundation ....!'o 14 ..................................... Exierior ..............a-20.0_0.................: ...Roofing ....... ............................................... Floors .................. ....................................................Interior .......... ............................................ Heating . ...... .........................,,.,.,..Plumbing .............. .......................................... Fireplace .............../.................................................................Approximate Cost .....��69c) 1...0 I?- .......... .......C)................................... Definitive Plan Approved by Planning Board ---------19--------- Area .......................................... Diagram of Lot and Building with Dimensions Fee ............................................. 'SUBJECT TO APPROVAL OF BOARD OF HEALTH 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. --I Name - . .... . . . ........ Construction Supervisor's License -J 4 GALLAGMR, ED�T'ARD t No 2.7,19.4. Permit for : 0..�tox'y.............. ......Single—Faud1y.:.Dwel ling.......................: Location ....I,c;..A,... -Sc�.u�der Aven.p Iiyansiipor .......... .................... .... s- Owner ....EcjdarCL..Gall�i;ghexx ..... .. Type of Construction .....,Frame E Plot ............................ Lot ................................ Permit Granted .....N4VeiClbeX.. ,...........19 84 'b. Date of Inspection ....................................19 Date Completed ......................................19 Assessor's office(1st Floor): Assessor's map and lot number ( M �74 SEM SV EM MUST BE THE ro o� Board of Health(3rd floor): l �S� IN� `' 9 CO PUANCE ,'"PIN, # Sewage Permit number �[ �► , fi F?'; Z BAB35TABLL i Engineering Department(3rd floor): a/ J�� rummRoMENTAL CODE �i xy rnsa House number 0 r r'`! . °° 1639' \®�' Definitive.Plan Approved by Planning Board 19TOW� ����� �� .. T - APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN . OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO LC J lQ, TYPE OF CONSTRUCTION �jJ J,(� [ �e ✓7 "Y 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location LQ11660nnrulunz Proposed Use Zoning District Fire District 12 Name of Owner W(�( C1��(/(�LIC/T i" 1AIdress MA Name of Builder i�G/�zledi Address���� wt Name of Architect Address Number of Rooms' Foundation Exterior Roofing Floors Interior Heating Plumbing Fireplace Approximate Cost 00• 0-b Area Diagram of Lot and Building with Dimensions Fe , 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. r Name Construction Supervisor's License '�--GALLAGHER, EDWARB zR & -SUSAN f No 32874 Permit For Build Pool Accessory to Dwelling Location 621. Scudder Avenue s Hyannisport Owner Edward & Susan Gallagh, Jr. ,f , Type of•Construction Frame Plot Lot 's Permit Granted May 4 19 89 , .r Date of Inspection 19 Date Completed 19 s LOT! � a 1 4 ��, Ron , fie, = f f t . - Y h �*r�' Jz r fi..l,t ��-A�:of-v'ir „-ii{,� p:d,•.<•xi� .r ' it:., Assessor's off �(1st Floor): �j� -rwE Assessor's map and lot number Oe of to Board of Health(A floor): Sewage+Permit number = BABd9TeDLL i Engineering Department(3rd floor):, V rasa House number � &A °° i639 % Definitive Plan Approved by Planning Board 19 ��raY d. APPLICATIONS PROCESSED 8:3.0-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE . BUILDING INSPECTOR APPLICATION FOR PERMIT TO h u/ A TYPE OF CONSTRUCTION 19 TO THE INSPECTOR OF BUILDINGS: �✓ The undersigned hereby applies for a permit according to the following information: Location �/ �(/!,! 0a a ,S (' f i Proposed Use Zoning District Fire District Name of Owner^40(IA ja jl yjJGI 4A/(?��/��A"f` Address D - c POnT f�f .M� '! 1 , �.l, 1J Name of Builder ld�le ffi i Z/Ve� Address 9_S�� �/ /.3� G n ,n! f rnf7 - I 1 Name of Architect Address " s Number of Rooms .Foundation Exterior Roofing Floors Interior Heating Plumbing t Fireplace Approximate Cost l h 0 90" Area Diagram of Lot and Building with Dimensions Fee ti OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS _ r I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding,the above construction. Name C l,�/I l_ �.��(�t ��41 , . Construction Supervisor's License GALLAGHER, EDWARD JR. , & SUSAN A=287-048 No 32874 Permit For Build—Pool Accessor to Dwelling Location 6 2 J G^�'"- Avenue 4Q 1 Sat e-,t- v9 v e , Hyannisport Owner Edward & Susan Gallagher, Jr. Type of Construction Frame Plot Lot Permit Granted May 4 , 19 89 Date of Inspection 19 Date Completed 19 v s 'tl 4 vo� a JA 4 �i 4 f • Z, 7/ / FO,, = ,yTo vie 5 � • 3` ZH OF E s VA of k`-•c, �. 4 •.�/ +` % j. �� PETER � • a a► MCHA O : �� v SULUVAM BAXTER M► N0.29733 N 1 14 e t5-r 1 r=ncIITtA ,Cti Hoq--�eALN R.li Pj'-z. Tyr'• j i2ovv6cTOR SmlC LImo•b w.row.w..w.w+w..nwr_.......w...M r.ww.w «+ 3� 4ASPIJ- SN )O-L' e tWAN'L � ZI,► Lhsx- U Pq6 _tI v�.,•C• TTt Nlr�r�w 8 xyq slobs Y�,.►�.,a i ,5q 371A s =Wl (y�Frc .>ST, (�(�"D�4 - 1 �tAr rc. S,�S� CS /(o STrzf�? 4 fl c/t tom......._�;...�.....:...rk..._..... _...._._.._..,.._..�.,..,._.r...._,__� _.....M..:t�,.,.. ...._ __-•-� ._..r._.___....�.,._. ——- - � Lew. aXr� �,���. �u�SxS � CGSZ.NefZ iU SIW PL4X- OFT, , 2x1C3 � 1 � Zx¢ �XT` WALL pCl STD 4 _._.._.._ ___. . __-__�. ........._.,........ ._,,, •- . OF �s�cti� G� Sv�A,\) L L''14 6 P• (91-1 C ibb-f- t• /�i�10G11 NHCHEL SCALE APPROVED BY: DRAWN BY v CUUiLO a S S��v�lJ 0 fro.34774 oA7H 3 U�' REVISED ' STRUCTURAL c,�1 � "`�R£r,'��a� SF k�'c�NAI- ' t� .. T� ,� f`�111Gljt,Sa SIB 1�i(. l�J —jL(A DRAWING NUMBER