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HomeMy WebLinkAbout0019 SUMMERSIDE LANE 1 I V 7 �. iApplication numbers `�. ...-......q:-....2,J133 ttte pF � Fee......................... ................. ............................... PsV �^ Building Inspectors Initials.... MM 0.4.............................. t639w JUL 01 2019 Date Issued........ .�1..�.�.9...... TOWN lj B.NH N S-M Map/Parcel.............. �...tl. TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHFRIZATION PROPERTY INFORMATION Address of Project: I q S it 11 n E K S I DE L N W#N 13 fy NUMBER STREET VILLAGE Owner's Name: �0$E-?,V WW 1J E H C—k Phone Number 5702`2tr7 Email Address:+K o CM e-1(@ 0.0 • l;ow, Cell Phone Number Project costs Do 0 Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK ❑ Siding ❑ Windows(no header change)# ❑ Insulation/Weatherization Doors(no header change)# Commercial Doors require an inspector's review MRoof(not applying more than 1 layer of shingles) Construction Debris will be going to at. CONTRACTOR'S INFORMATION Contractor's name W;�—,W S 6 E A A M IJ Home Improvement Contractors Registration(if applicable)# 2 0 �- (attach copy) Construction Supervisor's License# t O W o 2 (attach copy) Email of Contractor r gLAO to r0 0 t-0 c. Phone number S�B'7 E ' IS N J ALL PROPERTIES THAT H VE STRU RES OVE S YEARS OLD OR IF THE SUBJECT PROPERTY A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. i APPLICATIONNUMBER............................................................ *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X 3 X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one:this event is a: for profit non-profit event Check one:Food served Yes No Flame Spread Sheet of each tent must be attached.Provide a site plan with the location(s)of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approvab *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number 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. Date Signature PPLICANT'S SIGNATURE Date ' Signatur All per it applications are bject to a building official's approval prior to issuance. The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual):ARMEN SAFARYAN Address:67 SEA ST APT.A4 City/State/Zip:HYANNIS, MA 02601 Phone#:(508)776 2900 Are you an employer?Check the appropriate box: Type of project(required): 1.1211"am a employer with___employees(full and/or part-time).* 7. []New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in any capacity.[No workers'comp.insurance required.] 8. 0 Remodeling 3.O I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 4.❑I am a homeowner and will be hiring contractors.to conduct all work on m property. I will 10❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 1 5.❑1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 12.❑Plumbing repairs or additions These sub-contractors have employees and have workers'comp.insurance.t 13.�oof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[]Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. 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.Lic.#: 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 MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify un r th p ' s n pe allies of perjury that the information provided above is true and correct Si ature: Date: Phone#:(5 , )776 2900 1 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#: ,a►coRo® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 09/13/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME. Ashley Paiva Eastern Insurance Group PHONE (508)997-6061 Fax (508)990-2731 AIC o Ext: t1C.No): 439 State Rd. ADDRESS: apaiva@easterninsurance.com P.O.Box 79398 INSURER(S)AFFORDING COVERAGE NAIC# North Dartmouth MA 02747 INSURER A: Arbella Protection Insurance 41360 INSURED INSURER B: Armen Sefaryan INSURER C DBA:Corey and Corey INSURER D: 67 Sea Street UnitA4 INSURER E Hyannis MA 02601 INSURERF: COVERAGES CERTIFICATE NUMBER: 2018-2019 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS ' CERTIFICATE MAYBE 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. tNSR POLICY EFF POLICY EXP LTR- TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD MMIDD LIMITS COMMERCIAL GENERAL LIABILITY _ $ 1,000,000 EACH OCCURRENCE CLAIMS-MADE FXR OCCUR PREMISES Ea ocwrrence $ 100,000 MED EXP(Any one person) $ 5,000 A 952004644104 09/18/2018 09/18/2019 1,000,000 PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑PECT 171 LOC PRODUCTS-COMPlOP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO OWNED SCHEDULED BODILY INJURY(Per person) $ AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED AUTOS ONLY AUTOS ONLY PROPERTYt DAMAGE $ Per acciden UMBRELLA LIAB OCCUR EXCESS LIAB CLAIMS-MADE EACH OCCURRENCE $ DED RETENTION$ AGGREGATE $ WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY PER OTH- ANYPROPRIETORIPARTNERIEXECUTNE YIN STATUTE ER A OFFICERIMEMBEREXCLUDED7 NIA 952004644104 09/18/2018 09/18/2019 E.L.EACH ACCIDENT $ 1,000,000 (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 1,000,000 DESCRIPTION OF OPERATIONS below 1,000,000 E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Display Purposes Only ACCORDANCE WITH THE POLICY PROVISIONS. ' AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Office of Consumer,i Nils and Business Regulaaton One Asfibu n Place Suite 1301 Boston, achusetts 02108 Home Improvers I 'Co:. .. l7tractor Registration ARMEN - _ _- Type: Individual SAFARYAN Regis�adon: ts32o2 67 SEA ST APT A4 _ - _ l�e�= 0911s/2o19 HYANNIS, MA 02601 M' 20nnmm7 - Ldatie address aed rem„cry, Office of consmerAffalrel Busing Rogwason HOME IMPROVEPAENT CONTRACTOR rMe indh idual R 'on valid for indnddual use ordy Reaisirat�m, b t2ofhe eoq�iration date. it found return to: of Consumer Affalm and BUSIM-183 '- :0 911 3/2 01 9 'LWA RBBtd�tpR MEN SAFgR lkjCol /A COREYWt�WD _ MEN SAFARYA - =SEASTAPT'`NIS,MA 02Wj-- Und �ry Not valid thou n re assachus 9ePartment Ot Public.Sar Board ofBuil in 9 Regulations end Standards r_icense^C 106102 Conz:r�.iction Su t!SOT speciaity ARMENS 6T SEA S7R 72 .Ad Y . "YANIGS MA Comnissi "ner F--piration: 10/0212020 I - r I i ` �COREY' &, CO .REY The R6o6rs " N d 67 SEA STREET APT#A4, HYANNIS MA 02601 PHONE -5100 =77�S-0Z490 CERT°AI NTEEID LANDMARK t LIFETIEM kLGAE RESISTANT ARC; HITECTURAL STYLE RE - ROOFING PROPOSAL March 25,2019 ROBERT WHITEHEAD 19 SUMMERSIDE LN. E4: tkocapel@aol.com HYANNIS,MA Tel 508'847-1847 COREY & COREY hereby proposes to perform the following services in a neat and professional manner and in accordance with the manufacturer's"P ecifications and local building codes. Remove and Haul Away All of the Old Asphalt Roofing Shingles(One Layer) and the Skylight from the Whole House.Re Nail All The Roof Boards as needed. Supply and Install CERTAINTEED LANDMARK AR: LIFETIME WARRANTY, 10 YEAR SURE START PROTECTION CLASS A FIRE RATED, COPPER/CERAMIC STONES for a FULL 10 YEAR WARRANTY AGAINST ALGAE CONTAMINENT,240 POUND,?EXTRA HEAVY WEIGHT, 130 MPH WIND WARRANTY,CATEGORY IIIHURRICANE STORM/HURICANE NAILED (6 NAILS PER SHINGLE ill MULTI-LAYERED,LAMINATED ARCHITECTURAL STYLE,FIBERGLASS BASED ASPHALT SHINGLES. COLOR: MOIRE BLAC Supply and Install 8"WHITE ALUM INUIVI/HICk S VENTED DRIP EDGE on All of the Eaves. Supply and Install 8"WHITE ALUMINUM' DRIP EDGE on All of the Rake Boards. Supply and Install CERTAINTEED WINTERGUARD (Ice& Water Shield)WATERPROOF UNDERLAYMENT SiSTEM on Roof Eaves&Valleys Under the Step Flashings,on the Skylights and Chimneys. Supply and Install CERTAINTEED'S 46RPOF RUNNER" SYNTHETIC ROOFING PAPER Supply and Install AIR VENT SHINGLE VENT IT RIDGE VENT on the Entire Ridge. Supply and Install ALUMINUM & NEOPRENE SOIL PIPE FLASHINGS Supply and Install ALL NEW VELUX VENTING C04 SKYLIGHT WITH THE FLASHING KIT, REPLACING THE SKYLIGHT ON THE FRONT RIGHT SECTION Clean and Remove Debris from work area after j6 b is;completed. 9 TOTAL INVES� ENT -=----------- $9 000.00 j COREY 'COR, Eyl i The' Roofers " � t ADDITIONAL POSSIBLE WORK:: Supply 1 and Install ALL NEW 3/8 CDX PLYY 1 OOD OVER THE EXISTING ROOF BOARDS ON THE ENTIRE HOUSE------------N --- -----4--$3,950.00 i POSSIBLE EXTRA CARPENTRY: Any Rottedlor Otherwise Deteriorated Trim Boards,Plywood Sheathing,Missing Metal Flashing,Side Walling for Any Other Carpentry Needing Replacement will be done and charged for as an Extra: Materials Plus Labor at the Rate of$50.00 per Hour. PAYMENT SCHEDULE: A Deposit of OnejHa4 is due at the Signing of this Roof Proposal and the Final Payment for the Balance is Due Immediately Upon Completion. WORK SCHEDULE: All Roof Work is Scheduled for.Completion Within 90 Days of Acceptance and Deposits Received are Non-Refundable After a Three Day Cooling Off Period from the Date of signing. t ; , i Please Make'Checks Payable to: COREY & COREY COREY & COREY Warranties the Shuigles and Labor for 5 years. CERTAINTEED Warranties the shingles and labor 1001/6 for the First 10 Years and the Shingles your LIFETIME if the shingles becomes defective. u CERTAINTEED Warranties the Shingles g p t a CATEGORY III HURRICANE430 MPH WIND WARRANTY. CERTAINTEED Warranties the Shingles to be Algae Resistant for a Full 10 Years. COREY & COREY carries Workman's Compensation !public Liability Insurance on the above work DATE OF ACCEPTANCE: S 1 ACCEPTED BY: SUBMITTED BY: t j ROBER WHI EA ARMEN SAFARYAN HOMEOWNER { COREY & COREY HIC # 183202 CSSL# 10610211 a 1. 1 Town of Barnstable BU11Clln �... gPost This Car So Thai itis:zible From the°Street=§A roued..Plans Must be„Reta ned on Job nd'this C rd Must,be Kept 'il ,b. Posted Untll Final Inspection Has.Been Made ° iWherea Cert�ficateofOccu anc �sRe aired such Buldie :„shallNot be Occu ied until aFinal Inspection has•,been made i e1 11i1t Permit No. B-19-1558 Applicant Name: STEVEN KADY Approvals Date Issued: 05/14/2019 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 11/14/2019 Foundation: Location: 19 SUMMERSIDE LANE, HYANNIS Map/Lot 307 069 Zoning District: RB Sheathing: r Owner on Record: WHITEHEAD,ROBERTJR&VANTASSEL, 4 Contractor Name $TEVEN KADY Framing: 1 Contractor Licensees 126014 Address: 19 SUMMERSIDE LN r 2 HYANNIS, MA 02601 Est Protect Cost: $1,000.00 Chimney: Description: remove&replace 3bf flue chimney roof line pup Pan flashed Per�mlt Fee: $85.00 T. ;�a insulation: k Fee Paid $85.00 Project Review Req: Final: to a * 5/14/2019 r D !G;C Plumbing/Gas Rough Plumbing: rf Building Official _ Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorzed by this permit is commenced within six-months after.Jssuance. All work authorized by this permit shall conform to the approved application andthe;approved construction documents f r which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoni g by laws an codes. This permit shall be displayed in a location clearly visible from access street or;road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. - � Electrical The Certificate of Occupancy will not be issued until all applicable signaturesrlythe Building and Fire Officials are providedois permit. Minimum of Five Call Inspections Required for All Construction Work:, > Service: 1.Foundation or Footing 5 t�:'k- " 2.Sheathing Inspection. r A, Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 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 �"P s a n oceed until the Inspector has approved the various stages of construction. Final: rsons contractin with unregistered contractors do not have access to the guaranty'fund" (as set forth in MGL c.142A): �c Fire Department Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: 1 - - i �ttE t °' • — /S5� O Application Number........�.1........................................... • BUILDING DEpT. MASS. Permit Fee...... ................Other Fee........................ Ea Ate. MAY-0 7 2O19 rTotal Fee Paid.................:............................................. ...... OWIVOFBA"STAgLE le,0 W—/e- TOWN OF BARNSTABLE Permit Approval by.................................On..... ...1..:..�1...........: BUILDING PERMIT ^'� / I. ..............Parcel..........�i( ................... .Map... . ..... .. .. .. APPLICATION Section 1 - Owner's Information and Project Location Project Address ( 7 swwc-?),4 L✓ Village RY��°"S Owners Name �,B Owners Legal Address L Ci State Zip G Owners Cell# �G� - ' 7 17 E-mail �0 Ca�F d�'•Cc Section 2 -Use of Structure Use Group ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet ❑ 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 © Sprinkler System ❑ Addition ❑ Retaining wall ❑ . Solar K ❑ Renovation ❑ Pool ❑ Insulation Other—Specify i Section 4 - Work Description + &CNIVC-� V(, W - a 46 I " C Application Number.................................................... Section 5—Detail _ '`' 01 Cost of Proposed Construction DQQC Square Footage of Project Age of Structure Dig 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 ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System y LYMasonry Chimney ❑Add/relocate bedroom Water Supply ❑ Public ❑ Private Sewage Disposal ❑ 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 ❑ 1 Section 8—Zoning Information Zoning District Proposed Use Lot Area S . Ft. p q a Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No 1 AC}1i-g.t-4- 11 I1 ar)m 4 Steven Kady Phone: ;508-563-2515 Ma. Licensed Construction Supervisor#059847 .-Toll free: 800-567-9787 P.0 Box 493 Falmouth. Ma 02541 Cell: 508-566-5087 Fax: 508-563-251.6 - Email: Steve6TSteveKadyMasonry.com www.SteveKadyMasonry.com PROPOSAL June 17,2018 Bob Whitehead 19 Summerside f . . Hyannis, Ma 508-790-2648 508-847-7847 c TKOCape1 cOol.com WORK TO BE PERFORMED: • Construct ground staging Construct;roof staging Remove wooden box • Remove masonry chimney,down to roofline • Chatham'panflash • Re-construct chimney o Using Rocky Mtn. Blend Brick.brick o With detailed crown o Re-use,stainless steel cap TOTAL: *Labor, Material, Disposal: $6,000.00 50% to Schedule, balance due upon completion ® DATE(MM/DD/YYYY) AC40R o CERTIFICATE OF LIABILITY INSURANCE 08/23/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME; Suzanne Harrington MURRAY&MACDONALD INSURANCE SERVICES INC A",�"N Et): (508)289-4170 a N,: ADDRESS: sharrington@mmisi.com - 550 MACARTHUR BLVD - INSURERS AFFORDING COVERAGE NAIC# BOURNE MA 02532 INSURERA: TRAVELERS INDEMNITY CO OF AMERICA 25666 INSURED - INSURER B: KADY STEVEN DBA STEVEN KADY&SON MASONRY CONSTRUCTION INSURER C: INSURER D: - P O BOX 493 INSURER E: FALMOUTH MA 025410493 NSURERF: COVERAGES CERTIFICATE NUMBER: 306845 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 TYPEOFINSURANCE ADDLSUBR - pOLICYNUMBER MOLIIDYEFF FOLIC EXP - LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAI�E TO RENTED CLAIMS-MADE ❑OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY1:1 JECT F1 LOC PRODUCTS-COMPIOP AGG $ OTHER: $ AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS NIA BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accdent $ UMBRELLA LIAB OCCUR - - EACH OCCURRENCE $.- EXCESS LIAB - CLAIMS-MADE N/A - AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X1 STATUTE ERH - AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETORIPARTNERIEXECUTIVE E.L EACH ACCIDENT $ 500,000 A OFFICERIMEMBEREXCLUDED? NIA N/A NIA, 61HUB931X732118 08/29/2018 08/29/2019 (Mandatory In NH) _ E.L.DISEASE-FA EMPLOYEE $ -500,000 If yes,describe under DESCRIPTION OF OPERATIONS below - E.L.DISEASE-POLICY LIMIT $ 500,000, . N/A' DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) - Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov4wd/workers-rompensationAnvestigaUons/.. Sole proprietor has not elected coverage. 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 . - AUTHORIZED REPRESENTATIVE Hyannis MA 02601 Daniel M.Cr ey,CPCU,Vice President—Residual Market—WCRIBMA @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD commonwealth of Massachusetts 5,jq Division of Professional Licensure Board of Building Regu Flations and Standards - Constructf00 i�S I?�r r Specialty = t ire s 10/0312020 s CSSL-059847 STEVEN L KADY PO BOX493 FALMOUTH MA;025415 1b/ Commissioner �'��e r0anzmo�rri�uecc��p�G��//lauaedri� 'Office'of Consumer Affairs&Business Regulation. ; HDME IMPROVEMENT NT CORACTOR' {, TYPyElritlnnduala;' Registration:` Ezotration; I 196 '04/07/2020` STEVEN KADY ''B'M; - 110 w g STEVEN L iOFROCKLEDGE DR r <,:.. N_FA'LMOU:TH MA:„02556; 4-` p Undersecretary w i r The Commonwealth ofMassachuset;ts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Org�ajnization/Individual): Address: City/State/Zip: Phone sy` Are To 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-time).* have hired the sub-contractors 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 mein 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 officers have exercised their 3.❑ I am a homeowner doing all work � 11.❑Plumbing repairs or additions myself[No workers'comp, right of exemption per MGL 12.❑Roof repairs insurmce required.]t c. 152,§1(4),and we have no employees.[No workers' . 13: Other comp.insurance required.] *Any applicant that checks box#I 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. tContracton;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. r I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. �C Insurance Company Name: R���� S t Policy#or Self-ins.Lie.#4 UPS 10�4�I(S Expiration Date: Job Site Address: , i Sar. UV City/StatelZip: i 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 certify un nitres ofperyury that the information provided above is true and correct Si Date: — Phone#: Officiat 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#: 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 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 r 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 contract 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 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 Me 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 Mausachusetts Department of IndustrW Aeaidents Office of Investigations 600 Washiugton Beet Boston,MA 02111 - Tel.#617-727-4900 ext 406 or 1-877-MASSAM Revised 424-07 Fax#617-727-7749 Wvw:mass.govldW Application Number........................................... Section 9- Construction Supervisor Name � rC64( Telephone Number SQL Address I d 80 C City State Zip O kG, License Number C License Type C Expiration Date La—3 1 G Contractors Email STEW 6 SV10n Rk 5ad� -aq Cell# Saab`SU-SOq* 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 7 d the Town of Barnstable.Attach a copy of your license. Signature Date Section 10—Home Improvement Contractor ! Name � W Opy Telephone Number Address city l� �a State Zip Q Registration Number (X0 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 requir' by 780 C the Town -arnstable.Attach a copy of your H.I.C... Signature Date ,�— t Section 11 —Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number 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 APPLICANT SIGNATURE Signature Date -7`� Print Name S Teler hone Number E-mail permit to: fM � 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 i 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 r Print Name AK oFIMME lad, Town of Barnstable *Permit# 7S-J�- 9/ Expires 6 months from issue date BAMsrnai.E. : Regulatory Services Feed_ Thomas F.Geiler,Director Building Division Tom Perry, Building Commissioner X-PRESS PER 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 AUG 2 0 2004 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESMENTIA �F BARNSTABLE Not Valid without Red X-Press Imprint Map/parcel Number O 7 O 6 Property Address S u An^,Le `JC_ R R residential Value of Work `7 .Y O O,o a Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address 'C o�ep-T— L_ 1 9 j e_ (q Contractor's Name 2 (e S o v, Telephone Number S O a�• 7 7 lz-? 2 '7 2- Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor /DrI am the Homeowner ❑'I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ErRe-roof(stripping old shingles) All construction debris will be taken to y4-1 c C a,4 b 2 ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Home Improvement Contractors License is required. Signature Q:Forms:expmtrg , Revise063004 a G Assessor's Offi (1st floor) Map, Parcel � .Q �a)Permit# /t1 4t ) Date Issued JV - Fee 7 •0 0 , engineering Dep . 3rd floor ouse# THE T . • MASS ' 19 ,esq. ED MA'S TOWN OF,BARNSTABLEf , Building Permit Application Project Stree A re 19 Village 1YA115 Owner e2 417't.I e91V / jE3 1/9 L}_ Address "r^ Telephone Z/ Z— 2 2 Z— Permit Request le- First Floor square feet Second Floor square feet Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type Commercial Residential e/ Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House Unfinished Old King's Highway Number of Baths No. of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds Other Builder Information Name 1 Telephone Number 7.11a— Address _3 7 7— License# Home Improvement Contractor# Worker's Compensation#NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE l/�� DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR-OFFICIAL USE ONLY RMI N DATE I U D MAP/P" R L NO. ? , ADDR S 4 VILLAGE OWNE DATE( F I SPECTION: , f FOUN) ATION FRAME / v ' - INSULATION ' FIREPLACE ELECTRICAL: ROUGH FINAL _ _ - PLUMBING: ROUGH FINAL r. GAS: ROUGH FINAL FINAL BUILDING + p t v, DATE CLOSED OUT ASSOCIATION PLAN NO.. ? , The Commonwealth of Alassachusetts Departnient of Industrial Accidents ' �_ � OIIlceollovest/gaUons , . it. mi.--y+�' 600 Washington Street ` Boston.Mass. 02111 '1 Workers' Compensation Insurance Affidavit 151icaan nform//atfa- /+ Please PRiIYT"lebtbly �,� ; ^stir•• 3 7 4-',0-m4/F city S VlRo-dr"Uell /�M nhonc 1t 1 am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity L..•: .ri..�a/r•-..e-..�:r! '4 ,.11 M .. '.T' - .*ley, �•_'!�e^e"r'w�,e"^.^'""'tea.' I am an employer providing workers' compensation for my employees working on this job. company n•tmc' address: r city: nhonc#: insurance co policy# 0 1 am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: comp•+n•name: •tddress• City phone#: insurance co nolicv# �. �-.� :�:•:.T:: .' — wC/l•✓,-r,•�:.:,7't'�4n'�'%.""TyiY�fT'�;'/�:yM.pr• .•Th�P7�¢�•',4►rt:R•."��r _��I•�^�?L�'�'4_•�'TgyC�Y.•..�":.?�S company name: address- city phone#: insurnnce co _ pole'# _ :Attach additional sheet if riecrss�-:•:e�::-_•y:s ,.�::�t:.s,tX C ar :r;���.to a.��_.rn''..+ "- !__ - --t±�! ,•+7"�a "Sys�.'�.tl^ +ti ' uilu-r to secure cuverarc as required under Section 25A of 11iGL 152 can lead to the imposition of criminal penalties of a fine up to S1.500.00 and/or unc years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the D1A for coverage verification. I do llerebt certij under Cite pains and penalties of perjur}•that cite information provided above is true and correct. Signature /,t;7 Date Print name •J o4N /V, M c Gglzj l Phone# 740- s a s'D "official use only do not write in this area to be completed by city or town official city or town: permit/license q nBuilding Department OLicensing Board O check if immediate response is required OSelectmen's Office [3fiealth Department contact person• phone#; nUther hosed V95 P1A) The Town of Barnstable KAM ,S Department of Health Safety and Environmental Services 1639. Building Division' 367 Main Street,Hyannis MA 02601 Office: 508 790-6n7 Ralph Crosson Building Commissions Far- 508 775-3344 For office use only Permit no. Date p AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO pERma APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,oonveraion, improvement,.removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other. requirements. Type of Work: /A/s 7-,911 Est Cost 41 s 00 Address of Work: : 9 J u% n .LE Owner.Name: _/1/y (3/PLC Date of Permit Application: A19 V' 7 /r/0S' I hereby certify that; Registration is not required for the following rcason(s): Work excluded by law Job under SI,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: CONTRACTORS OWNERS PULLING TFIM OWN PERMIT OR DEALING wrm VNREGISTI ED FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Date Contractor name Registration No. OR ' Date Owner's name . \1 COMMONWEALTH DEPARTMENT OF® PUBLIC SAFETY =� � OF I ONE ASHBORTON PLACE r MASSACHUSETTS BOSTON,MA 02108V%' EXPIRATION DATE ' CO,lqSTR. SUPrRVISOF RESTRICTIONS EFFECTIVE DATE LIC-NO. ; 1G ( 915/01 /1993 06C,294 1 R 2 FAMILY H3PIE a JOPI4 H I+I"GARRY 114 OLD 60LOMY DR SS 4 73-26-755 MASHPLIE MA C2449 r; PHOTO(BLASTING OPR ONLV� FEE: NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY y HEIGHT: i STAMPED-OR-SIGNATURE OF THE C .MMISSIONER j DOB: THIS DOCUMENT MUST BE CARRIED ON THE PERSON OF SIG REOFLICEN5f.E'- THE HOLDER WHEN EN- _ - OTHERS-RIGHT THUMB PRINT GAGE DIN THIS OCCUPATION. /I� ••' ` —� MMISSION..•i-4 • � ✓/CC LOOYNlC09KUPQG(IL 6�''l��C�[ixcW HOME !MPROVEMENT CONTRACTOR R2giStidtion. 116174 TYGE - 06A EXCiidti0l 05/25/96 MCGARRY CONST CO jOHN H. MCGARRY 5 �'o�SW 80,X 281 - sr ASPINET R0 ADMINISTRATOR 5O YARMOUTH MA 02664 I ov�Nt� ,2 o i Su o _ laEA6 df .5/uuXAE- J' - S K yL/'r /4 Uy r"o.4/ l�(`4;kkRy f }-� y S UMME'.R,��`1.�E LA NAE (BY RLA l ?80196) S89,50 E 67 7- _H,SE.—_-_ AS5� LOT AS,5 LOT 1?3,o' - ASS LOT 89 ti N l -T :ASS': LOT A,5S L 0 T 67 66 Ar��TE• RRE—E'.��I.S'TING NONCONFORIIING. RE , ZONE: "R.O" This MORTGAGE INSPECTION Ian is Frr FLOOD ZONE- "C" _ Bank Use Only TOWN: .ff4A YVzz_z_ _._ .� REGISTRY OWNER: ZL41&&ZAL_lHZ&0 _ DEED REF: _4 �. _ _ --EUYER: _ANTK91_..J _.U1 Lz.. —_— --- DATE- ��QL�� � .� PLAN REF: �__ SCALE:1" 0 _F'T, I HEREBY CERTIFY TO OF YANEE_._ URVEY y — THAT THE BUILDING �S SI-iOYVN ON THIS PLANISLOCATED ON THE GROUND AS � PAL ��6 CONSUI-TAN'l"S, SHOWN AND THAT ITS POSITION DOES _ CONFORM q.pB (SUITE 7.) TO THE ZONING LAW SETBACK REQUIREMENTS OF THE � � . �; TOWN OF ,6.ABLV,3Z&&Z �_.--_._AY�D T�iAT bio.3 INDUSTRY RCAD IT 7-- LIE WITHIN THE SPECIAL FLOOD HAZARD a MAx. rotas MILTS, MA, 02648 Q AREn AS SHOT��'N ON THE H•Li,D. MAP DATED_c%,� ,�_ TEL: 428--0055 t _OtEool 0006 D FAX 420-5553 THIS PLAN NOT =5 FROM AN INSTRUMENT �� � 5�,—�L SURVEY NOT TO BE. USED FOR FENCES, ETC. . 1'��� ���j S'fjee� / Ot= Z /9A/TIA ""Sy SIAt E 7 W;1;Here sraE �A'rvE, �/y���l�s /ra yz 4 1.7 [LAG Scot/ i 3 RNfES X b X 2 P, 7- `� B.9L Z4rS -,,Qs EvF_/zy p axe x 3� J ¢-�PaNi �4 z74 /'l, Posi 36 l�Et� GAF- NausE OF t16dsE � PLActS 4 .PNo 0Nc? i C i� i r3 y; o�w M`��►2r2 � 8-/8• ss Rk vi seal Z Ss SgEFT DFa ANT11O1/y /,4JL l 13Coc kin!G '� �JC' !, F120n/! .3 STRINGERs �X12 I'.T I STf�/R lcle// ';1 �p1lT ol 6 � e) 2..x 8 P.T. FLVOR jels 2x 8 PT. BAND. P IL �. i r PGA VIF /;I GN7- 13 � of Noy/sue / o 1 v� y 8 8 9s *. pe lose-cl COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY. OF ONE ASHBORTON PLACE { _ MASSACHUSETTS BOSTON,MA 02108 LICENSE EXPIRATION DATE ,CONSTR. .S U P E R!.Y.S O R 1 /2$/1996 EFFECTIVE DATE. LIC-NO.RESTRICTIONS i 1G& 2 FAMILY HOME 05/01/1993 06t}294 -J.OHN H MCGARRY s SS 373-26-7558 MASHPEE MA`02649R PHOTO(BLASTING OPR ONLY) FEE: 0.0�/�(� 77- NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY _ HEIGHT: STAMPED-OR-SIGNATURE OF THE C',MMISSIONER DOB: b, 10/28/19 2.. THIS DOCUMENT MUST BE �2 - CARRIEDON THE PERSON OF SIG RE OF OF LI -- THE HOLDER WHEN EN- OTHERS ►W�"•�T�' -RIGHT THUMBPRINT �GAGED IN THIS OCCUPATION. MMISSIONE ✓lie�omvr„ &Wald o�/�ivaac%uaelYa HOME IMPROVEMENT CONTRACTOR Registration. 116174 Type - DBA Expiration. 05/25/96 4 MCGARRY CONST CO ' JOHN H. MCGARRY 37-ASPINE-T-RD ---- = - ADMINISTRATOR SO YARMOUTH MA 02664 Barnstable J : . = The Town of � � Department of Health Safety and Environmental Services BuiIding Division 367 Main Street,Hyanais MA 02601 Office; 508-790-6227 Ralph Cross Fax 508-775-3344 Btrrldmg CA: For office use only Permit no. ' Date AFFIDAVIT HO mE 1 WROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERNIIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,ccmr== improvement, nmcn-al, demolition. or construe = of an addition to atryy pie-esisting owner aocugim building containing at lest one but not more than four dwdling units or to sttUcm=which are adla= to such residence or building be done by registered cmmm= s,with certain emotions, along with athe i of Work: G o EsY. Costl 912 o O 4 �ype 13al 1) Fx rE e r {rWlv&u�� �Addres5 of Work: /9 S'll/Y/!?'/E/2 sio �OR�ier.Name: A.t/T//O A✓V f-31 A G Date of Permit Appl ication: - o?3 -1�.5' I hereby certify that Registration is not required for the following rcaon(s): Wane excluded by law Job nailer SI,000 Bniming not ow=-ocenpied owner pulling own p=n?t Notice is hereby gn=n that: CONIRACTOF - OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREG MTRID FOR APPLICABLE HOME IMPROVEMh 4T WORK DO NOT HAVE ACCESS TO TF ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIG;IED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the Owner. X3 s� Zj o �l /16/7e _T Date Conuaaor name Registration No. OR ' 11l0=:'91 17:02 'C8177Z7712.' urrl UNAO XV-. — ConunonUlFa& o f M4ajiac/zud4G6 600 W I=slw 02f f f 7 _ Commiss;oner Workers' Compensation Insurance Affidavit J6AA) W IV6)yflel with a principai place of business at: / 7 A-5 P//✓4' l 12oda S A&120a"rf/ D a 6 6 5e, do hereby aemry under the pains and penaides of perjtuy, th= () I am an employer pravidmg'workers' c=penmtion coverage for lay employees we this job. Insurance Company Policy Idamuer (l I an a sole proprietor and have to one working for me in any capacity. ( " I am a sole propri eras coatrz,=r,br homeowner (ard a one) =d have Trim con=--=rs Cured below who have me oiiowing workers' ;:vri;ensadcn policier: Contraczcr Inszrance Campanylpailcy Con=csor Insurance Company/PvficY Contractor Insurance Company/Policy t O ( am a homeowner performing aff,the work myself. 1=,,=- m will be fa.-xz td=cr.,CM=ai inns d din CIA for trm ze veiIcaim=d shot' cc:rr:Fe rs r:ci'zd under Sets:an LA of MGL I SZ an fe=m cbe lnsaasition of a=W=t Penlifss CctEisZfIICC(a floe of uo to yeas' impt=nam zss wdI as cmi Penaities in dse fare:&a STOP WORK ORDER .-ZdZ f eef S1CO.00 3 d:y 2pi=me. Signed this✓ c;�,3 A day of censee(Permi )2 Building Depm=e= Licuasing Board Selectzne= Office w Assessor's Office(1st floor Map v D Lot Permit# �d - /.Conservation Office(4th floor 2 f Date Issued Board of Health(3rd floor :30-9:30/1:00-2:00) W ee Engineering Dept. (3rd floor ouse#1 /, � SEPTIC M use'BE Planning Dept.(1st floor/School Admin. Bldg.) !` !NS°�°�" PLIANC Definitive Plan A by Planning Board 19 VCR® CODE AN D TT OW LATIONS TOWN OF-BARNSTABLE Building Permit Application Project eet A ess ,G Village li)/ZPAILS / Owner �NT/,f®N A9 L rr_ Address ,Telephone .21;t J Permit Request -Total 1 Story Area(include 1 story garages&decks) .5"8 square feet Total 2 Story Area(total of 1st&2nd stories) square feet stimated Project Cost $ ti Zoning District Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type.- Commercial Residential �e/U 'l Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure Basement Type: Finished i Historic House Unfinished Old King's Highway Number of Baths No.of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds Other / Builder Information Name J 0 i1 N �jf rn���g pie�/ ATelephone Number .S-O /Address 9i�License# a�D Q /Home Improvement Contractor# 116/7 orker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE _ A7 C DATE 3 BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. 10098 ., DATE ISSUED 8/.31/9 5 ' MAP/PARCEL NO. 307 069 19 Summerside Lane Hyannis ADDRESS VILLAGE Anthony J. Biale f,> OWNER DATE OF.INSPECTION: FOUNDATION FRAME INSULATION I FIREPLACE. ry i ELECTRICAL: ROUGH FINAL I ' PLUMBING: ROUGH -' FINAL .r GAS: : ?":1OUG FINAL ry FINAL BUILDIN..E'a" DATE CLOSED-';OUT ASSOCIATION-PLANNQ;:-;, `"'