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HomeMy WebLinkAbout0087 STERLING ROAD'� -.� � � � . � � �� �- f�,, ��;� �. ='-1 ��J a l �� . /� n �I-CA./�� / I - I Il �� �`/ ' �S 3�2r�s �j � OruV, 00 Z asta altS .16J sauzoH sjj3snu3vssuw so ` ,� 3 ` r j) � 8 - i Town of Barnstable Building Permit Post This Card So.That�t,is Visible From theaStreetA, _roved Plans-:M.ust be Retained oii�J••ob and tfiis Card;-Must be Kept w�xsrwus pp a , gPosted Until FinalInspecLonHas Been,Made •;- u �` hee'a Certificate ofdccu ancis.Re aired::such*8uldin shall No Abe Occu 'iedunt,lf a Final Iris ectiort ha_s°;been made. Permit NO. B-19-2061 Applicant Name: BURCHILL,DAMON A&STEIN, BRENDA L Approvals Date Issued: 07/02/2019 Current Use: Structure Permit Type: Building-Deck Expiration Date: 01/02/2020 Foundation: Location: 87 STERLING ROAD, HYANNIS Map/Lot 268 162 Zoning District: RB Sheathing: Owner on Record: BURCHILL,DAMON A&STEIN, BRENDA L� Contractor Name Framing: 1 Address: 87 STERLING ROAD ContractorLicense� 2 HYANNIS, MA 02601 r �. EstPrlect Cost: $7,000.00 Chimney: Description: BUIKLD 2 NEW DECKS REPLACING OLD ROTTEN NCE Permit Fe: $340.00 N Insulation: Fee Paid $340.00 Project Review Req: Dates 7/2/2019 Final: ` 3 y � Plumbing/Gas Rough Plumbing: 4?N,, Building Official „ - Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. ;, W" n ranted. All work authored by this permit shall conform to the approved application an�d�the approved construction documents four which this permit has been g Rough Gas: All construction,alterations and changes of use of any budding and structuresshall,be m compliance with the local zoning by lawAand codes. This permit shall be displayed in a location clearly visible from access street or road,a;nd shall be maintained open for publicx in#5erft i for the entire duration of the Final Gas: work until the comp letion of the same. _.a,.. - ~-° Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the�Buildmg and Fire Offs alsare provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing - 2.Sheathing Inspection Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining"is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction.' "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: �1 Fire Department Building plans are to be available on site fir-- All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: OF FIE q 8 / Application Number....... .J�.!...^-............................. MaxernBLE, : J Fp MASS. &/V 2 Permit Fee.:...................... .Other Fee: Total Fee Paid................................................................... ...... qqN � � 4 w STge`� ,,pperG� TOWN OF BARNSTABLE PermitApprovalby.....�`.........................on....... ../ . BUILDING PERMIT ` Map ....... ... ....5. ... ............Parcel.....`... . . ..:. .................. APPLICATION Section 1 — Owner's Information and Project Location Project Address Village 14V*.^j l S Owners Name PrVP,,o N v✓��► Owners Legal Address SA w►t City 1 t►u 14 State Zip ® z o r- -Owners Cell# e F 7 7(y 01 3 !S— E-mail CC C ep"�' J-b Mot � i I ea, Section 2 —Use of Structure Use Group F Commercial Structure over 35,000 cubic feet t ❑ Commercial Structure under 35,'000 cubic feet +U/Single/Two Family Dwelling ` Section 3 — Type of Permit ® New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use . Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment El Sprinkler System ❑ Addition ❑ Retaining wall ❑ . Solar ❑ Renovation ❑ Pool ❑ Insulation Other—Specify Section 4 - Work Description +wo 11fW diecks rcipl q-e. rive Old r0 fl>e ✓1 OV1 C Last undated: 11/15/2018 Application Number..........::.:.. Section 5—Detail •a pick ( 3 ,Cost of Proposed Construction—$ ?d 00 P Square Footage of Project -F.,t--(k z �faa Age of Structure g r• �,� y f S . Di Safe Number # Of Bedrooms Existing Total#Of Bedrooms(proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics ❑ Wiring ❑ Oil Tank Storage e ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑ Add/relocate bedroom A W i. Water Supply ❑ Public ❑ Private Sewage Disposal t ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes ❑ No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland,coastal bank? Yes ❑ No ❑ i. Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage # of Dwelling Units (on site) Setbacks Front Yard Required i Proposed Rear Yard Required Proposed q P Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last updated: 11/15/2018 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Buffders/Contractors/Blectricians/Plumbers Applicant Information Q Please Print Legibly Name(Business/0rgan:ationV1ndividual):�8�'Vln Address• �.7 S`� C fy/State/Zip: 1'�' MAW 1G, MA- Phone M 19`D $ 71 Are you an employer?Check the appropriate box: Type of project(required): L❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New conshuction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity.-acin'•- employees and have workers' _ 9. El Building addition [No workers'comp.insurance comp.insurance.: recp*ed-] S. ❑ We are a corporation and its 10.❑Electrical repass or additions 3.[ I am a homeowner doing all work officers have exercised their 1 L❑Plumbing repairs or additions j ""myself. o workers'com right of exemption per MGL y [N p. 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 hue outside contractors must submit a new affidavit indicating such. lContraators 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. , I 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.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL.c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK 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 ciTV under the pairs and penalties of perjury that the information provided //above is true and correct Date:-). (O 2-4 f ; Phone#7n 65,.6 --7?b 1 J/ Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone M 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'id the service of another under any contract of hire, express or implied,oral or written." An wFloyer 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,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 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-contractors)name(s),address(es)and phone nu nber(s)along with their certificate(s)of insurance. Limited Liability Companies(LLQ 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 affidsvit. 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 firdrre 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 Dgwtmmt of Industrial Aoddenis Office of fnvestigatlons 600 Washington Street BostM MA 02111 Tel.#617 727-4900 ext 4.06 or 1-877-MA.SSAFE Revised 4-24-07 Fax#617-727-7749 WWWQ mam.gov/dia Application Number........................................... Section 9 Construction Supervisor Name Telephone Number Address City State Zip License Number License Type Expiration Date Contractors Email Cell # I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with.780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your license. Signature Date Section 10—Home Improvement Contractor_ Name Telephone Number Address City State Zip Registration Number Expiration Date I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your H.LC... Signature Date Section` —1—HoineiOwners License Exemption Home Owners Name:-VA 410 N V kt m I q Telephone Number Cell or Work Number 60 C- 0 27(o R 315'- I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date & - L`I - I APPLICANT SIGNATURE Signature Date T Print Name T ly?-e t tt- Telephone Number '?d� 77& Cl 15� E-mail permit to: 10 a t G 0 M Last updated: 11/15/2018 Section 12 —Department Sign-Offs Health Department ❑ Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation ❑ For commercial work,please take your plans directly to the fire department for approval Section 13— Owner's Authorization as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of job) Signature of Owner date Print Name a Last updated: 11/15/2018 f Page 1 of 1 f �'f ', is 1F Y1`��P-'(Tf - h ✓ y 5 � t Y cr/lam o`G� https://townofbamstable.us/propertyimages/00/16/33/78.jpg 2/22/2019 f Town of Barnstable *Permit. ,6 Expires 6 months from issue date �T Regulatory..Services Fee 5' BARxsrasta;. � BUM Richard V.Scali,Interim Director a 16�a1� ��EDp Building Division Tom Perry;CBO,Building Commissioner cn ` 200 Main Street,Hyannis;MA 02601 www.town.bamstable.ma.us � Office: 508-862-4038 A - EXPRESS PERMT APPLICATION - RESID WbAENTA Not Valid without Red X-Press Imprint Map/parcel Number d (v Property'tjiddress 7 G`1 iLJIS Residential Value of Work$ ZZ VX10 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address bAAQjQ3 4�L- B RE-Mah S77,W) Q-7 S eaiA BwR,v - Contractor's Name t l.So� Telephone Number Qd!-1Zg-�'BtflS Home Improvement Contractor License#(if applicable) 732�f� Email: Construction Supervisor's License#(if applicable) 0 7S76i 7 AWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance Insurance Company NameAAQA)A&Crf P r Workman's Comp.Policy# We,9,2 gQS g"is Q-3 9 y Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) .Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of-roof) 4❑ Re-side / Replacement Windows/doors/sliders.U Value t 3 V (maximum.35)#of wi ows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. f Separate Electrical&Fire Permits required. sihfheie required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must.si'gn Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Q:IWPFILESTORMSIbuilding permit formslEXPRESS.doc Revised 061313 Renewal h,p l l enit I,176 RENEWAL BY A1VD);KSEN [� `13_ �� �rlpenKeacl�lc;a byA IUerseR 26 Albion Road • I.inc•uln,Rl 021165 / tEnd 41r alesi ensesw arnwernesr rAed. Cie phone 866.563.223.)•Fax 401.633.6602) Fcderil rJK II Not uu+1 se (� 3:ou P)J Southern Now England Windows,LLC d/b/a Renews]by Andersen of Southern New England CUSTOM WINDOW AND DOOR REMODELIN / EMENT D 6erarls)Nerm,bft -r--- surmis)saeetAdilmmC y Samand Zip Code I P.O..smc S..l�L-L..0 . vE�+..[ HomeTekP Work TdePhone Number: E-Mail Addmr. hone Number:, t Buyers)hereby jointly and severally agrees to purchase the Products and/or services of Southern New England Windows,LLC:d/b/a RencWL1 by Andersen of Southern and the reverse of New England("Comractor"),in accordance with the terms and conditions descri�Historic oil the f Ot Condo O HOA? this agreement and on the attached specification sheegs)trullrclively,this'}lg,ti ement"). Method of Payment U Check Q Cash Yinanced Total Job Amount��(� Estimated Starting Dace: Deposit Received Credit Cards are accepted for deposit only-maximum 113 of the project cost(Please see Credit Card Payment Form.)By signing this Balance at Start of Job(33%): �__ Estimated Completion Date: u acknowledge Agreement yonowledge that the Balance at Start of job and the Balance on Substantial ���N� -/h - �� � Balance on Subsrandal Completion of Job cannot be made by credit Completion of Job(antial r-�----� and and must be made by personal check•bank check.or cash.t Buyer(s)a nd grees a understands that this Agreement constitutes the entire understanding between the parties,and that there are so verbal understandings changing any of the terms of this Agreement. Buyer(s) acknowledges that Buyer(s) (1)lute,read$is Agreement,understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and(2)was orally informed of Bayer's right to cancel this Agreement.DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. (RAods Ishord Soles ore y)Notice to Buyer:(1)Do not sign this Agreement if any of the spaces intended for the agreed terms to the extent of then available information are left blank.(2)You are entitled to a copy of this Agreement at the time you sign it.($)You may at any time pay off the full unpaid balance due under this Agreement,and in so doing you may be entitled to receive a partial rebate of the finance and insurance charges.(4)The seller has no right to unlawfully enter your premises or commit any breach of the peace to repossess goods purchased under this Agreement.(5)You may cancel this Agreement if it has not been signed at the main office or a branch office of the seller,provided you notify the seller at his or her main office or branch office shown in the Agreement by registered or certified mail,which shall be posted not later than midnight of the third calendar day after the day on which the buyer signs the Agreement,excluding Sunday and any holiday on which regular mail deliveries are not made.See the accompanying notice of cancellation form for an explanation of buyer's rights. Buyer(s)received the consumer education materials provided by the Rhode Island Contractors Registration Board. (Buyers Initials) Renewal dersen of Southern New England Buyer(s) Buy (s) BY' Si nature igrtature of Product Manager Sig»al re g 79 Print ie of Ptrrduct Manager Print Name Print Name YOIJ, THE BUyER(S), MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAYAFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT. _ _ _ _ _ _ _ _ _ _ _ _ _ s'- - — — — — — — — — —N — — T. — — — — — — t- - - - - - NOTICE OF CANCELLATION Date of Transaction You may cancel I Date of Transaction You may cancel this transaction,without any penalty or obligation,within this transaction,withoutany penalty or obligation,within three business d from the above date.If you cancel,any I three business days from the above date.If you cancel,any property traded'inn,any payments made by you under the I property traded in,any payments made by you under the We,and any negotiable instrument executed I Contract or Sale,and any negotiable instrument executed ill be regimed within ten business days following I by you will be returned within ten business days following by you w receipt it the Seller of your cancellation notice,and any I receipt by the Seller of your cancellation notice,and any security interest arising out of the transaction will be ) security interest arising out of the transaction will be canceled.If you cancel,you must make available to the Seller canceled.If you cancel,you must make available to the Seller at your residence, substantially as good condition as when I at your residence,in substantially as good condition as whin atyour any goods delivered ll you under this Contract or I received,any goods delivered to you under this Contract or •received, u may,goods wish.comply with the instructions of I Sale;or you may,if you wish,comply with the instructions of tum of at to the Sol anti the Seller does not pick ern up within to the Seller and the Seller"does not pick them up w n dais of the date le cancellation,you may retain or I twenty days of the date of cancellation,you may retain or twas she of tfhe goods without any further obligation.If you 1 dispose of the goods without any further obligation.If you me the goods available to the Seller,or if you agree 1 hil to make the goods available to the Seller,or if you agree Inc r fail to do then you er ape orman�ae��obligations under l to do so,then ythe i remain to liable for performancou oods to the e of all obligations ounder the ti tattheel this transacts,mail or deliver a signed Contract To cancel this transaction,mail or deliver a signed D1!#r of tfiis camellluion note' or any other I and of i writtented notice,or send atele te of this llation notice or egram to Renewal byAndersen of tw.send atekgram to Renewal byAnderse^ g RI 0286S, at 2i Albion Road. n, 02863, ! Southern New England at 26 Albion Road,Li y N MIDNIGHT OF " I NOT LATER THAN MIDNIGHT OF L I (Date) CELTHISTRANSAtCTIOM 1 HEREBY CANCELTHIS TRANSACTION. roan road. ow sur.rr sb„a,a PAM N.me o RbA CowWhite Buyer Copy:Yellow Buyer Copy:Pink Southern New England Windows debea Renewal by Andersen ®f SNE If� '. ! Massachusetts-Department of Public Safety Board of Building Recuiations and Standards i vonstructioal 5uperiasor License: C - 7 MIAN D DENN NOON 7 LAB POND� - Charhon MA 01507 II( I Expiration t C�issioner 0976 f II Office of Consumer Affairs tind Business Regulation 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Reg-istration: 173245 Type: Suppientetd Card FA�ira6on: 9119MOIS SOUTHERN NEW ENGLAND WINDOWS LL _^ DENNISON BRIAN 26 ALBION RD -- — LINCOLN,RI 02865 'Update Addres and return card.Mark reason far dfflIg" Addresr C Renewal 0 Emptoytoeot [I Lost Card sCA:a zavav++ VExpiradon: aseAttain do Bmians RepuleGoa License or registration vntid for iWMdul me onb,1'E adPROVEtAENT CONTRACTOR before the e:p'uatioa dme.ufonnd remra to:Ofrme of Comnmer Afrairs and Bosioen Regulation isbatlon: 173245 Type. l0park•Plana-Sude5170 9119=6 .Suoplemerd-Laid Soma,MA 02116 SOUTHERN NEW ENGLAND WINDOWS L LC- RENEWAL BY ANDERSON DENNISON BRIANi LINCOLN.RI 02865 Not valid without srgoamre ' The Commonwealth o•f M assachusetts Department of IndustrialAccidengs Office of Investigations I C,otigress Street, Suite 100 1 i Boston,MA 02114-2017 www mass goildia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers ApyUcarnt Information Please Print Ledbl�► Name (Business/Organization/Individual): SOUTHERN NEW ENGLAND WINDOWS Address:26 Albion Rd City/State/Zip:Lincoln, RI 02865 Phone#:401-228-9800 Are you'pn employer? Check the appropriate box: Type of project(required): 1. I ari a employer with 20} 4. E] 1 am a general contractor and I 6 New construction., employees (full 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 ship and have no employees These sub-contractors have g• Demolition working for me in an capacity. employees and have workers' y p ty. 9. ❑Building addition [No workers' comp. insurance comp. insurance: required.] 5. We are a corporation and its 10.❑Electrical repairs or additions s.❑ 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 Window Replacement employees. [No workers' I3. 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 anew affidavit indicating such. tdontractors 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 acid job site information. Insurance Company Name:ARGONAUT INS. CO. _ Policy#or Self-ins.Lie.#:WC 928058352394 Expiration Date:8/21/2016 Job Site Address: 0 I I I JIX, City/State/Zip: Attach a copy of the workers' compensation policy declui ation page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25fi .oT 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for nsurance coverage verification. I do hereby certi under the ' s and penalties of perjury that the information provided above is true and correct. Si afore: Date: y Phone#: 4012289800 Official use only. Do not write in this area,to be completed by city or town official. .� City or'Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/'Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: SOUTNEW-01 SHETTYSHT DATE(MMMDNYM CERTIFICATE OF LIABILITY INSURANCE 8/19/2015 IS THI�TIflCATE IS ISSUED M A MATTER OF ELY OR NEGATIVELYTION AMEND,LY AND CONFERS NO RIGHTS UPON THE CERTIFICATE EXTEND R ALTER THE COVERAGE AFFORDED BY THE POLIR.CIES CERTIFICATE DOES NOT AFFIRMATIVELY BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDlTIQNALINSURED,the policy(ies)must be endorsed. if SUBROGATION is WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). cO"TAcr PRODUCER NAMIF Willis Certificate C@Eller Willis of New Jersey, PHONE 877 945-7378 ,No:FAX (888)467-2378 y AIC No.Ext:\ ) cio 26 Century Blvd aoDAREsS:ce�Ncates w1II1s-com P.O.Box 305191 NAiC Nashville,TN 37230-5191 INSURER(S)AFFORDING COVERAGE INSURER A:Selective insurance Company of Southeast �g7® INSURED INSURER B:One$eaCOn Insurance Company 19801 Southern New England Windows LLC INSURER C:Argonaut Insurance Company. DBIA Renewal by Andersen INSURER D 26 Albion Road° INSURER E l� Lincoln,RI 02865 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 Wt tiCH 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. uMrrs POLICY EFF POLICY EXP ILTR TYPE OF INSURANCE NS WVD POLICY NUMBER MMIDO MMIDDIYYYY 1,000,00 EACH OCCURRENCE A X COMMERCIAL GENERAL LIABILITY S S 2029459 0817012015 08/1012016 PREMISES(Ea 100,000 CLAIMS-MADE ®OCCUR 10,000 MED EXP(Any one person) S PERSONACB ADV INJURY 5 1,000,000 GENERAL AGGREGATE S 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG S 3,000,000 POLICY Q PRO- JECT ®LOC 15 OTHER: COMBINED SINGLE LIMIT s 1,000,000 AUTOMOBILE LIABILITY (Ea 'Ly''t S 2029459 08/10/2015 08110/2016 BODILYINJURY(Perperson) I5 A X ANY AUTO BODILY INJURY(Per accident)I S ALL OWNED AUTOS - AUTOS PROPERTY DAMAGE s NON-01NED (Per accidentl HIRED AUTOS I I AUTOS 5 EACH OCCURRENCE 5 5,000,00 X UMBRELLA LIAB X "OCCUR 5,000,000 A EXCESS LIAB CLAIMS-MADE S,2029459 08/1 D/2015 0811012016 AGGREGATE i S IS DED RETENTIONS X PER STATTJr E ER WORKERS COMPENSATION - 1,000,00 AND EMPLOYERT LIABILITY 0000068028 0812112015 08/21/2016 E-L EACH ACCIDENT 5 B ANY PROPRETORIPARTNERIEXECUTIVE Y- NIA EL DISEASE-EA EMPLOYE 5 1,000,00 OFFICERIMEMBER EXCLUDED? ' (Mandatory in NH) 1,000,00 If yfis.describe Under' EL DISEASE-POLICYLIMtT $.. DESCRPTION OF OPERATIONS below C Workers Compensation C928058352394 0812112015 0812112016 See Attached DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFt3RN THE EXPIRATION DATE THEREOF, 'NOTICE WILL BE DELIVERED iPt ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE A4 Evidence of insurance O 1988-2014.ACORD CORPORATION. All rights reserved- ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD MLS Pagel of 3 Listing Summary Listing #20808978 87 Sterling Rd, Hyannis, MA 02601 * ® Active (09/11/08) DOM/CDOM:4/4 $349,900 (LP) Beds: 5 Baths: 3 (3 0) (FH) Sq Ft: 2624* Lot Sz; 12196sgft* Town: Barn Yr: 1974* Remarks - _ iPicture\, Report Listing Violation WOW is to say the least about this gem You will feel as if you walked into a home that Martha Stewart decorated. 5 Bedrooms 3 Full baths,Central Vac, and an in law suite on the walkout lower level makes this a great home for the extended fami or our summer guests. This gem has ,, been completely renovated from the kitchen to the bathrooms (MarbleI//a ? � Countertops), Plus the exterior of the Additional PicturesW11111 ? r - Pictures.(12). See Map Agent Thomas J Dillon (ID: U2RZ)Primary:508-477-8677 x207 Office RE/MAX Classic(ID:CLAS1)Phone:508-477-8677,FAX:508-477-2767 Property Type Single Family Property Subtype(s) Single Family Status ® Active(09/11/08) Town Barnstable Commission Sub Agent Comm. Buyer Agent Comm. Dual Agent Comm. Dual Var Comm 0% 3% 3% No Facilitator Comm 3% Listing Type Excl. Right to Sell Owner Name Philip A Laroche County Barnstable Tax ID 268-162-0-0-BARN Beds 5 Baths (FH) 3(3 0) Approx Square Feet 2624* Sq Ft Source Assessors Records Lot Sq Ft(approx) 12196* Lot Acres(approx) 0.280 Lot Size Source (Assessors Records) Year Built 1974* Publish To Internet Yes Listing Date 09/11/08 All Office Remarks Please Ready Willing and able Buyers for this Deal. Directions to Property West Main to Pitchers to Sterling Listing Page Commission-Other NA Showing Instructions Appointment Req.,Call Listing Office,Yard Sign General Page Zoning RB Year Built Desc. Approximate http://ccimis.rapmis.com/scripts/mgrqispi.dll?APPNAME=Capecod&PRGNAME= 9/15/2008 MLS Page 2 of 3 Total Rooms 9 total Levels 2.0 Basement Baths 1.0 Level 1 Baths 1.0 Level 2 Baths 1.0 Level 3 Baths 0.0 Basement Yes Basement Description Finished,Full, Interior Access,Walk Out Foundation Concrete Foundation Width 40 Foundation Depth 34 Fndation Wing Width 0 Fndation Wing Depth 0 Irregular No Lot Depth 0 Lot Width 0 Topography/Lot Desc. Cleared, Level,View,Wooded Association No Annual Assoc.Fee $0 Assoc.Fee Year 0 Garage Yes #of Cars #1 Garage Description Attached, Direct Entry Year Round Yes Separate Living Qtrs Yes Sep Living Qtrs Desc Basement,In-Law Apartment Waterfront No Water View No Convenient To Golf Course,Major Highway,Medical Facility,School,Shopping Miles to Beach .5-1 Water Access Beach,Nantucket Sound,Public Beach Description Ocean Beach Ownership Public Street Description Paved,Public Interior Page Fireplace Yes Number of Fireplaces #3 Master Bedroom 15x15 Level: First Floor Mstr Bdrm Features Tile Floor Bedroom#2 OxO Level:Second Floor " Bedroom#4 OxO Level'.Second Floor Foyer OxO Level: First Floor Living/Dining Combo No Living Room 13x20 Level:First Floor .. Living Room Features Cathedral Ceilings, Fireplace,Skylight Dining Room 11x12 Level:First Floor Kitchen 11 x1 3 Level:First Floor Kitchen Features Fireplace,Granite Countertops;Kitchen Island,Tile Floor Family Room 11 x1 5 Level:First Floor Other Room 1 OxO Level:Basement Other Room 1 Type Bedroom Other Rm 1 Features Fireplace, Private Master Bath,Sliding Door Other Room 3 OxO Level:Second Floor Other Room 3 Type Loft Floors Hardwood,Tile,Wall to Wall Carpet Interior Features Interior Balcony,Linen Closet,Mud Room,Pantry Exterior Style Contemporary Style Description Contemporary Pool No Dock No Exterior Features Deck,Porch, Prof.Landscaping http://ccimis.rapmis.com/scripts/mgrqispi.dll?APPNAME=Capecod&PRGNAME= 9/15/2008 MLS Page 3 of 3 z Roof Description Asphalt Siding Description Clapboard Mechanical Heating/Cooling 3+Zone Heat,Natural Gas Water/Sewer/Utility Private Sewerage,Town Water Hot WateNWater Heat Natural Gas Legal/Tax " Annual Tax $3309 Tax Year 2008 Land Assessments $218300 Improvement Asmt $265100 Other Assessments $19600 Total Assessments $503000 Annual Betterment $0.00 Unpaid Betterment $0.00 To Be Assessed Unknown Mass Use Code 101-Single Family Title Reference-Book 1493 Title Reference-Page 858 Land Court Cert# 11111 Underground Fuel Tnk Unknown Lead Paint Unknown Asbestos Unknown Flood Zone Unknown The listing contract has not yet been validated by MLS Staff. Denotes information autofilled from tax records. Information has not been verified,is not guaranteed,and is subject to change.Copyright 2006 Cape Cod&Islands Multiple Listing Service, Inc.All rights reserved Copyright©2008 Rapattoni Corporation.All rights reserved. Generated:9/15/08 10:49am "Ratt6l : ,;5� http://ccimis.rapmis.com/scripts/mgrgispi.dll?APPNAME=Capecod&PRGNAME= 9/15/2008 WOW is to say the least about this gem You will feel as if you walked into a home that Martha Stewart decorated. 5 Bedrooms 3 Full baths,Central Vac, and an in law suite on the walkout lower level ` makes this a great home for the extended family or your summer . guests. This gem has been completely renovated from the kitchen to. the bathrooms (Marble Countertops), Plus the exterior of the home has been freshly,painted. Enjoy those cool evenings around one of the 3 Fireplaces and enjoy the breeze and view from your deck or sun room. Enjoy a leisurely stroll to the beach Or Kennedy Compound. This house is priced to sell as it is $150,000 under assessed value and will not last. If you are a picky buyer, then this home is for you. COME SEE NOW a . Parcel Detail Pagel of 3 _ y• r 9�p`f 41�i39. . 401 �� � $y '�a, ,� k ,� r�,i� ,/���j�I7/'•'/ � F_-�• s ; �� ,, •,. ..k .. '.. i-a' yr Logged In As: Parcel D eta I I Monday, Septemb. Parcel Lookup Parcel Info Parcel ID 268-162 I Developer LOT 26 Location 187 STERLING ROAD Pri Frontage 51 Sec Road Sec Frontage village HYANNIS I Fire District JHYANNIS Sewer Acct I Road Index 1532 Interactive Map Owner Info Owner ILAROCHE, PHILIP A I Co-Owner ISTEPHANIE A LAROCHE Streets 187 STERLING RD I Street2 City HYANNIS I State MA j zip 02601 Country US Land Info Acres 10.28 use Single Faim MDL-01 I zoning RB Nghbd 0105 Topography Level I Road Paved Utilities 1 Public Water,Gas,Septic I Location Construction Info Building 1 of 1 Year 1974 I Roof Gable/Hip I ext Wood Shingle Built Struct Wall - effect 2958 I Roof Asph/F GIs/Cmp I AC Central Area Cover Type , Style Modern/Contempt wall Drywall I Rooms Bed 5 Bedrooms Model Residential Int Bath I Floor t Room 2 Full + 1 H Grade jAverage. Type Hot Air Total Rooms 8 Rooms http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=19490 9/15/2008 Parcel Detail - - Page 2 of 3 1 Q OK Heat Found- Stories 2 Stories I Fuel Gas ation I 'Ypical Permit History Issue Date Purpose Permit# Amount Insp Date Comments Visit History Date Who Purpose 2/27/2002 12:00:00 AM Paul Talbot Meas/Listed-Interior Access Sales History Line Sale Date Owner Book/Page Sale P 1 LAROCHE, PHILIP A 1493/858 Assessment History Save# Year Building Value XF Value OB Value Land Value Total Parcf 1 2008 $265,100 $19,600 $0 $218,300 3 2007 $264,100 $19,600 $0 $218,300 4 2006 $252,400 $19,600 $0 $217,500 5 2005 $224,600 $19,100 $0 $196,800 6 2004 $182,800 $19,100 $0 $196,800 7 2003 $163,900 $19,100 $0 $43,000 8 2002 $132,700 $18,600 $0 $43,000 9 2001 $132700 $18,700 $0 $43,000 10 2000 $125,800 $18,300 $0 $32,100 . 11 1999 $125,800 $18,300 $0 $32,100 ; 12 ' 1998 $125,800 $18,300 $0 $32,100 13 1997 $148,200 $0 $0 $32,100 ; 14 1996 $148,200 ,$0 $0 $32,100 15 1995 $148,200 $0 $0 $32,100 ; 16 1994 $133,500 $0 $0 $28,900 17 1993 $133,500 $0 $0 $28,900 18 1992 $151,800 $0 $0 $32,100 19 1991 $168,400 $0 $0 $44,900 http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=19490 9/15/2008 Parcel Detail Page 3 of 3 i 20 1990 $168,400 $0 $0 $44,900 21 1989 $168,400 $0 $0 $44,900 22 1988 $94,900 $0 $0 $21,600 ; 23 1987 $94,900 $0 $0 $21,600 24 1986 $94,900 $0 $0 $21,600 Photos f . http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=19490 9/15/2008 Assessor's map and lot number .. .:�...:..�. TiC s�fwTE='. f11UST 8E � � Yli"l �t �•� a EI � a.JVE. d Sewage Permit number ............ ........................:...... ... i� TOWN THE�Q �oTOWN OF BAD "f5id"'' "LE �..: Z BABBSTABLE, i "6 9 NA BUILDIAG , INSPECTOR APPLICATION FOR PERMIT TO ......trr k/. �f�/ �uJ fi/.. 1.............. ...`......: . ...11e2.. ................... TYPE OF CONSTRUCTION .....6O.0..A.V.19.-r a? .r..................................................................................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location D. ..o ....J� e✓l.!/� .. 4.G�:N/.. �L�!�sr�!:-5................................................................................................ Proposed Use Zoning District ......... .....................Fire District .. y ���5 Name of Owner !/J. ./lr .. .... I.�...................Address .r'�u�!'!/!.. .e!.U?'?..l..l?�P:. .t�../Yy%✓ /d ' ,. Name of Builder !?. ��'► P C �- Cl....:�xl..:.l^.............Address ......................... ... . /...... ... . .... ........................... Nameof Architect . ..................................................Address .................................................................................... Numberof Rooms ......7........................................................Foundation .. ...C. .L y. e........................... Exterior ...Roofing FloorsC_.: ! / ..f l!i!!<:.......................................................Interior ! ✓ /..................................... Heating J :...................................................................Plumbing rit :.' .:iG�/ xl" i ................ . . G Fireplace ..��..:........................................................................ ..Approximate Cost ....v�.0...� .................................................:..... Definitive Plan Approved by Planning Board ________________________________19--------. Area ............. ,3?', ZS Diagram of Lot and Building with Dimensions Fee ............. ............................... . SUBJECT TO APPROVAL OF BOARD OF HEALTH / s I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .................................................................................. Philip A. LaRoche I-lap 268 Lot 162 No 1.6920...... Permit for .. ........ .. . .... ...............1.7....0 ..atr ..../N�..... .... ....... Location ..... .......Lot #26 .................................... . ......... ............. ...................... Owner ........ U)..A.. .La R.o . . .che...................... . ...... . ...... Type of Construction Wood Fr ................. ................................................................... ............ Plot ............................ Lot ................................ Permit Granted ...... ........... .Febru&3:7 28 . ....19 74 Date of Inspection ....19 Date Completed PERMIT -REFUSED ................................................................ 19 ............................................................................... .......................................................:.:...................... ...........................:.................................................... ......................................................!........................ 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