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0006 SUNBEAM LANE
� � � i ,1 r 1 i ----_._ - - - - . _ _ -��_.. �_ -- -- - - --L--� � r' -_. .�.-� r - � �, I Town of Barnstable *Permit# " Ex�tres 6 months from issue date Regulatory Services Fee y $, Richard V..Scali,lei �A 1639. rEp MA't •',1 •.�J . Building DIVIS10 Paul Roma,Building Comm> Ine(�Jr 2017. 200 Main Street,Hy �'';;��°°��02601 www.town.b eMO BA RA]S..i n B L ' Office: 508-862-4038 !/� � Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Map/parcel Number Not Valid without Red X-Press I4Yint /� / Q� (f ` VResideutlAddress S �W1 w4 al Value of Work Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address C 0-'2,1eS LQ b'Ju e be Contractor's Name kz,(�e. 0 �� Telephone Number $ �f6��01O�L Home Improvement Contractor License#(if applicable) Email: @ G Ac. lL.CZ M Co Supervisor's License#(if applicable) (0 GC>k0 Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ Jlm the Homeowner ffYI have Worker's Compensation Insurance- Insurance Company Name Ctv—M tf Workman's Comp.Policy# :4 k 6 3g 2— Copy of Insurance Compliance Certificate must accompany each permit. Permit Ree t(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to S J 6-GoID&JA.N-�S ❑Re-roof(hurricane nailed)(not stripping. Going over. existing layers of roof). ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value {maximum.32)#of windows #of doors: *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. A copy o e provement Contractors License&Construction Supervisors License is require SIGNATURE: Q:\wP=S\'FORMS\buildmg permit formsWXPRESS.doc 01/25/17 ppartwmt d'lydmsbid Accidaztv Officec Bostoi 1 lyf Ji 02111 tPFmv mmmgov/7a wa rkus' C''ti MPeniX6,rsn Inmrance Affidavit 13,mldeISJC�IIt radw MwE*'ir Ln s fflli mbers Information Please Print •Nmm C l-�V ^ ro�e f�•i Addresw W, �(D�-42rt OZ6�3Ph� S `t65 al 0 2: tyre an employer?:C heekthe appropriate bay Type of project(re�cl}= I- I am a employer vzith. t; 4_ Eldt I am a general contmar and I ; �o (fan. anfor Paz�fiimer.* havelvredit sub-contraCima 6. El I�e�ocm kiu;tioa � 2.❑ I am a sale proprietor orgsrta r- listed o•4the attached sit~ 7- [:]:RPM deHng. These s�cuxdmctmv base ship and lave no�1 esapla�a�rttdhave�orlcr�ss' g' ❑Demifio ola - wo&dng forme in any capacity_ 9. ❑ adxlition INo svod32rs msnl=e cmP reed.] 5. ❑ We are a corpomfim and its 1O-❑Elecfdcai repairs or ad&ions 3.❑2 am a homeomw doing aft vm& of5cws have exercised their 11.❑phmbiag repairs or$ddi ions Myself END worker'comp-, of e�empflon yesBf1rI. L❑Roafregairs ,km==ret�sd-j Y r .. d-�.§i{4�amdwe Dave� employem[NoWOADE& 13_0 fltfzer cow •�ar,egg&e �acebeftbasflmastalsoffioEtrhe swfi=bgaw &ekwuce mmp�tia�porsegia�os�ca Iavm�av�o subs aus ��g sne,r a�aa �ce�C�d�eab�aa�ideca �sc submit$news�ac mclic ,UCT3L =%aMxCW=*911-1Msblocmast—shedatsdditknO shed sbowh9ibeaaaaeofthes%Vcaub=6omzndstorevrhedmwarnatihme line . emplayem lfthesd�-aa sI=e empioya2%rbeyamsrpmvzetb2k nachos'C=rP•PODU maabm am an euiploysr flint isPrQuiriing worFrers'catagmum fan frrsurazres for my etrrp& -wm $eroty is tTiaFvHcF rumiab sae �,�armotiotL j , Imsura � iM nCompaIIp me: -- -- . -Pfl-ficy 4 or Self-im11C.;k ftirdimDate_ f . Job Sibs Address` Attach a-copy of the warkere compmsatiaagolfcy Mara Page-(showing the policy m=ber and respiration darted. Fazlnre to secure davet; p as m4aimd wader Se4ctioa 25A of MO a L5 can lead in Sze imposition of criminal penalties of a hoe ap to$000 OQ aadlor oui-:y asimpds=w2eaty-as win asrivil Penalties is te fay of a STOP WORK ORDERand a fne of up-toa slag against the vi&ztur. Be advised' a copy of thk.xhtement snap Ua forwarded to the offrce of lmvesf oar ofthe D.T for fimmm ci coverage Ida hereby cart fy rrxdw t1w a, the igfOn smffmPr OFi&d abotf h face and correct Phone �Sbg� L(69-a tq 2— OJ07dd use a ly Da not iyrEtis in fFat s areq to be cxurriglded by city artaten ajORrat 'City or Town: PerudtGieease;ff I=ming AmAw ity(chrle one): L Ba=d of Hez i 1 I3uilffimg Drat 3.MO TUSM Clerk 4L Electrical I pector 5.Phmmbm'ng Lnpectar 6.09zer • Contact Person: Pltnlze 9- ! 1 li 11 1 1 ! l ! ! -Its a :.a I► 1 i...l. ■•�F [I •, • . ••■1■1�F r■la■vI�. ./a■1■ ter i.' . �1.1• ••� ON see u ■.nt ■■ is w rnnc _n �•u . ■ m�■ . EIR ' . %I II • •� w ■ill/■�. J. 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Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.maus Office: 508-862-403 8 Fax: 508-790-6230 Property.Owner Must Complete and Sign This Section If Using A Builder I, ,as Owner of the subject property hereby authorize to act on my bebalf, m all matters relative to work authorized by this building permit application for. (Address of Job) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all-final inspections are performed and accepted. Signature-of Owner Signature of Applicant Print Name Print Name Date Q:FORMS:OWNER ERMSSIONPOOIS Town of Barnstable e Regulatory Services p1F Richard V.Scab,Director Building Division. vsmscs. Paul Roma,Building Commissioner ��� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.maus Office: 508-862-4038 - Fax: 508-790-6230 HOME_OWNER LICENSE EXEMPTTON 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 Hermit (Section 109.1.1) codes assumes responsibility for compliance with the State Building Code and other applicable , The undersigned `homeowner' ass reap ihty mp dmg 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 he/she will comply with said procedures and requirements. 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 persons.--In this cgs results in serious problems,particularly when the homeowner hires unlicensed p e,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 this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. 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C"" F,. � .1 ...».. . - ' , . } /" i ' •SLG.N DA`l-M r l • «� _ TALt,EC}PROPERLY CAPE COD HOME I,MPROvEMENT TM GUARANTEES THgT ALL COM PaNEb� ESi lCt P! g`�(ONE C'.I?tt i PLEASE FEEL FREE TO CALL CAPE COD HOME I.MPRO,VEMENT ' � e Office of Consumer Affairs&Business Regulation-Mass.Gov Page 1 of 1 The Official Website of the Office of Consumer Affairs&Business Regulation(OCABR) s, Consumer Affairs and Business Regulation Home . Consumer Rights and Resources Home Improvement Contracting Home Improvement Contractor Registration Lookup To search by registration number, enter the registration number in the textbox below and click the 'Search' button. Search by Registration Number I Search You must click the "Search Registrant" button to search by name or location. Search by Registrant Company name Search by Registrant Last name Isivitski CitylTown I i Search Registrant State Zip code -� Click on the registration number to view complaint history.You can also view arbitration and Guaranty Fund history. The list is current as of Thursday, May 4, 2017. Search Results RESPONSIBLE REGISTRATION EXPIRATION RegistrantName STATUS INDIVIDUAL NUMBER ADDRESS DATE CAPE COD HOME SIVITSKI, ANATOLI 168043 27 MILL POND RD 12/06/2018 Current IMPROVEMENT, INC. WEST YARMOUTH, MA 02673 ©2012 Commonwealth of Massachusetts. Mass.Gov®is a registered service mark of the Commonwealth of Massachusetts, i h4s://services.oca.state.ma.us/hic/licenseelist.aspx 5/5/2017 i M. a�.. � .,,! U S e'4^ L.+. a_ '+a.r. K.,-=i .�. g �e,.Y .,i y 2. '.,.. # �, �-..) x Board o " Builk ng Reg Lfl ations . aric.1 S t a., n S. ,11c l it ) kk rN S 4 p ) tc', i 1 1 vInv CSSL-106040 ...i -5` / Jc5 .............. .:. 9 � • -�� i a�4'� � ���� yam. ......... ATOLI S ITS K "t ti 222 BUCK ISLAND RD.-I. Y 'west YarmouthM' A 02 6 �Y � a. ,. r ACC k.--- CERTIFICATE OF LIABILITY INSURANCE "r608/20r"Y""' �-� 06/08/2016 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(les)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: Christine Davies DOWLING&O'NEIL INSURANCE AGENCY PHONE._—(508)775-1620 FAX — — (PNot: E-MAIL : cdavies@doins.com 973 IYANNOUGH RD. INSURER(S)AFFORDING COVERAGE NAIC# HYANNIS MA 02601 INSURERA: AMGUARD INSURANCE CO 42390 INSURED INSURER B:__ CAPE COD HOME IMPROVEMENT INC INSURERC: INSURER D: 27 MILL POND ROAD INSURER E: WEST YARMOUTH MA 02673 INSURER F 'COVERAGES CERTIFICATE NUMBER: 59476 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 TYPE Of` ADDLSUBR POLICYEFF POLICYEXP LT POLICY NUMBER MM D LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ ! DAMAGE TO RENTED CLAIMS-MADE OCCUR ME ISES(Ea(?QcmrrencelS i MEDEXP Any one person) N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S �.J POLICY C PRO- JECT I J LOC I i ( PRODUCTS-COMP/OP AGG S OTHER: i $ AUTOMOBILE LIABILITY i (Ea ac NEeDtSINGLE LIMIT $ ANY AUTO I BODILY INJURY(Per person) $ I ALL OWNED SCHEDULED i AUTOS AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERTYDAMAGE HIRED AUTOS AUTOS Per accident) $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB !CLAIMS-MADE i N/A I s AGGREGATE DED RETENTION$ i$ WORKERS COMPENSATION v AND EMPLOYERS'LIABILITY Y/N - I XPTJl TU E OTH- ! ANYPROPRIETOR/PARTNERIEXECUTIVE I E.L.EACH ACCIDENT is 1,000,000 A OFFICER/MEMBEREXCLUDED? N/A N/A N/A R2WC746392 06/03/2016 06/03/2017 t (Mandatory in NH)If E.L.DISEASE-EA EMPLOYEE $ 1,000,000 yyes,describe DESCRIPTION under OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe 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.gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Daniel M.Cr 'fey,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. A r`non ox toniA/nil Th.A/�non nomn—i Innn ore ron:cfnrnrl mer4o of Ar`nQf1 ( F. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION e r m Ai l e-4 Map ✓ Parcel Application # Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address -$�/tv/0 Z) Village&4.iIA1/5 Owner Address _00.1 Telephone_ 2 f <4 Z!2 2 4, 9 Permit Request ,/,k/1 L ,�� /2 7 Zo ��� �r.� /^�,ifs 7"�� P�.��>• • Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District. Flood Plain Groundwater Overlay Project Valuation Z-Ta &4!_Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family A Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes 4No On Old King's Highway: ❑Yes ,kNo Basement Type: ❑ Full ❑.Crawl ❑Walkout ❑Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑existing ❑ new size —Shed: ❑ existing ❑ new size — Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# BUILDING DEPT. Current Use Proposed Use Vr. Zulu N OF BARNSTABLF APPLICANT INFORMATION_ (BUILDER OR HOMEOWNER) Name _ ZAZ!°a 1,4 Telephone Number 67? �,, l ,1 Address ��� l`r✓� wed_ J1 is�License #_ Home Improvement Contractor# /6�3 l4 z Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY f APPLICATION # R DATE ISSUED MAP/PARCEL.NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. Tow of Barnstable - LOU Services : . Maud V.sc4 Dh- ctor A� 90ding DMslou Tom Ppziy,B :Cooner 200Mafia gftc4$yannf.MA 02661 WWOY town tiara bie mb ut OM= "8462-4438 Fax: 508-790-6230 pr Opeay Omw ff must Go ebe=and- S This S►ccftoin Ij . ,as cvu&x-the fiaro�ha� \ S � w act o�.a�pbe , m A apt=relafM W .a 6oiazed by skis Molding pem*VpIkatim far "Pool fences and,a] are the rapow&k..of• 'appficaht Pools um ni xobe:f ar> d•i of f ::k$U&d'aid aRfi lial . 'ors aEr�� onne��d.a�c�pt�. a r o er 5of.Apphc" ►t�a� Wit• Dame Q30RM-OWrnRe oNrao;s The Conimomvealtit of M assachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 0211.4.2017 v"A rim s,gov/dia 'VW-kers' Compensation Insurance Affidavit: Builders/Contractors/Eleetricians/Plumbers, Alicant Information TO BE FILED WITH THE PERMITTING AUTHORITY, Please Print Le ibl Name (Business/Organization/Individual); C/17 Address: city/state/zip. "� � '� / � '/ i✓ /�r� Phone #; Are you an employer? C eck the appropriate box: _ Type of project (required): I. am a employer with_11 employees(full and/or part-time).' 7. 2.7 I am a sole proprietor or partnership and have no employees working for me in ❑ New construction any capacity.(No workers'comp. insurance required,) 8• ❑ Remodeling 3.❑1 am a homeowner doing all work myself (No workers'comp. insurance required.)t 9, ❑ Demolition I i i 4.�I am a homeowner and will be hiring contractors to conduct all work on my property. ( will 10 ❑ Building addition e ensure that all contractors either have workers'compensation insurance or are solo Proprietors with no employees. I l.[] Electrical repairs or additions 5.a I am a general contractor and I have hired the subcontractors listed on the attached sheet, 12'[]Plumbing repairs Or additions These subcontractors have employees and have workers'pomp, insuranoe.t j 13.pRoof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 152,§I(Q),and we ha no employees. (No workers'comp, insurance required.) 14. Other / /����/�� ve `Any applicant that checks box NI must also till out the section below showing their workers'compensation policy information. r Homeowners who submit'4his 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 subcontractors and slate whether or not!hose entities have employees. If the subcontractors have employees,they must provide their workers'comp.policy number. am an enrployer that isprovirling workers' compensation Insurance for my employees. Below is the policy andiob site infortnatiotL Insurance Company 2 Policy #or Self ins. Lic. #: J`'�,;"%,fl Expiration Date:. Job Site Address: �v Attach a copy of the workers' compensation Policy declaration page (showing the pCity/Statol cy nu '—rand��O/ Failure to secure coverage as required under MGL c. 152, §25A is a criminal violatiption l 500 00 A copy dfthis stat ) and/or onetyear imprisonment, as well as civil penalties in the form of on punishable by a fine up to$a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. , ement may be forwarded to the Office of Investigations of the DIA for i coverage verification. insurance 1 rdo hereby certify under the pains andpenalties ofperjury that the information provi 11 d I'll I'll ed a 11 bove Is true and correct, Signature- Phone Official use only; Do, write In this area, to be completed by7000,11'11,offlclal City or Town: Per Issuing Authority (circle one); L Board of Health 2, Building Department 3, City/ToIvn Cl , ecrical Inspector 5, Plum '6, OtherPlumbing Inspector Contact Person: Phone#: ^-----�-�^ >. Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-100988 Construction Supervisor HENRY E CASSIDY. \. •:. 8SHEDROW WEST YARMOU;fH WW Expiration; Commissioner 1111112017 rr,r ty _ d a Office of Consumer Affairs and Business Regulation 10 Park Plaza -' Suite 5170 Boston, Mai ' 02116 Home Improvemera L�.�Usetts iractor Registration Type: Corporation ` 7 i = - I x' Registration: 153567 Cape Cod Insulation, Inc n; --- .f Expiration: 12/14/2018 18 Reardon Circle So. Yarmouth, MA 02664 a At q iCA 1 0 20M•05/11 Update Address and return card. Mark reason for change. ------ --- ---- -----------------...---.. C -Ac! - ^s,r!-! � ED �e�panz��aaratuealC�c�C�oac�udeCCa Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only Type.; Corporation before the expiration date. If found return to: =====-._�=ieaistration Expiration Office of Consumer Affairs and Business Regulation -�— 10 Park Plaza-Suite 5170 i 12/14/2018 6 Boston,MA 02116 Cape Cod Insula` r►jflr �'� :. _- Henry Cassidy ?,,r_. 18 Reardon Circid So.Yarmouth,MaQ24� ` `" Undersecretary Not valid without signature CAPECOD-27 DEATON TE(MM CERTIFICATE OF LIABILITY INSURANCE . 7/29/201201YYY) /26 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(les)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, 4g NAME: 34 Rte 13 ray Insurance Agency,Inc. PHONE N E t: a� No):(877)816-2156 South Dennis,MA 02660 nbm Riess:mail@rogersgray.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Peerless Insurance Company INSURED INSURER B:Safety Insurance Company 39454 Cape Cod Insulation,Inc. INSURER C:Endurance American Specialty Insurance Company 41718 18 Reardon Circle INSURERD:Atlantic Charter Insurance Company 44326 South Yarmouth,MA 02664 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY_PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN_IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE O POLICY NUMBER MM/DD� POLICY M ICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE FKIOCCUR CBP8263063 0410112016 04/0112017 DAMAGE TO RENTED__ PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE,LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,000 X POLICY a PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 B ANY AUTO 6232707 COM 01 04/01/2016 04/01/2017 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) X HIREbAUTOS X NON-OAUTOS NED PROPERTY DAMAGE AUTOS per accident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 c EXCESS LIAB CLAIMS-MADE EXCl0006636001 04/01/2016 04/01/2017 AGGREGATE $ DED I X I RETENTION$ 10,000 Aggregate $ 2,000,000 WORKERS COMPENSATION I PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER D ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N WCE00431902 06/30/2016 06/30/2017 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Workers Compensation includes Officers or Proprietors. Additional Insured status is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder. CLEAResult,Eversource and National Grid are listed as Additional Insureds on this policy on a primary,non-contributory basis. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All riehtn racarvarl TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map (/- Parcel Application ' l Health Division Date Issued /0 �1 er— Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved, by Planning Board ` Historic - OKH _ Preservation / Hyannis Project Street Address Village Owner C f-1�ZLC�S L�'E3c�Ljz e Address SyJ 3C�r n Telephone Permit Request F,�i bti (WrLox 650 !& 14 "i343CmC:-.r► Fort.- 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 Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old K!rT s Highw %: uc*s ❑'No Basement Type: EIIF�ull ❑ Crawl ❑Walkout ❑ Other ° a Basement Finished Area (sq.ft.) Basement Unfinished Area .ft) Numberinf Baths: Full: existing new Half: existing C new Number of Bedrooms: 3 existing —new �v Total Room Count (not including baths): existing new First Floor doom COL,;R Heat Type and Fuel: UGas ❑ Oil ❑ Electric ❑ Other Central Air: ly'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 X4 j 1'lonm QJZ'J'J Telephone Number Address I SS D &Pt i a�D License # 06(6_ !9 f "N�l lS(��n-i (Y19 C�263�I Home Improvement Contractor# 12- r'1)3T Email: Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO :9 3' C—)4C sod► 'i D c-,r"J' s ffw SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# T� .-DATE-ISSUED- xC MAP/PARCEL NO. e ` ADDRESS VILLAGE OWNER f x DATE OF INSPECTION: ;4 Oft-V-UNDA*TI.ONfuW,lavtg11�-;=.;�!Yt���!,)ox . FRAME .INSULATION4�s;1?�_::uL n;,b r FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING - t DATE CLOSED OUT , ASSOCIATION PLAN NO. - ?'he Commonwealth of Massachuseffs Department ofIndustrial Accidents — Office ofInvestigations ' +600 Washington Street Boston,MA 02111 wnniv.nincr olvldia Workers' Compensation Insurance Affidavit BIDidersrContractors/EkctricianMumbers Applicant Information Please Print Legibly Name(Busn .at. duid=D: f`tra"kioeV4 6X)a rq-J Address: 1'5 O&M( f &! City/Stat JZip D W41 S r` )'l-`r M4 026`3ci Phme#: S03 Are you an employer?Check the appropriate box: Type of project(red): 1.❑ I am a employer with 4. ❑I am a general contractor and I 6_.❑*New construction epVl (fn11 and/or part-time).* have hired the sub-contractors II am a sole proprietor orpartner- listed an the attached sheet 7 [:]Remodeling ship and bathe no employees These sob-contractors have g- ❑Demolition working for me in any capacity employees and have wotits' 9. ❑Building addition JNo warlcers'comp.insurance comp-insurance repaired_] 5. ❑ We are a corporation and its 10-❑metrical repairs or additions 3_❑ I am a homeowner doing all work officers have exercised then 11-❑Plumbing repairs or additions myself[No workers'comp- right of exemption per MGL 12❑Roafrepaim insurance required.]Ti c-152,§1(4),and we have no employees-[No vvorla�s °ua 1311 Other ,rt-4 i S14(-0 DJ&Un'► comp-insurance required.] *Any appbcw That checksbos'1 mast also fill out the sectionbeIow showing iheasrO&ers'eompensatiampolicp idormatiaaL T Homeowners who submit this affidavit indicating they ate doing al vaA and rhea hov outside coahacmn mast submit anew affidavit indicatuta such_ tContmcoors that chest this boo:must attached an additional sheet showing the m®e of ft sub-cemtracmrs snd state whether ornot those entities have employees. If the sub-contactors have employees,they must pmvide their workers'comp.policym®ber. Iran art employer iliatisproviding ttwrkers'compensation insurance for my emp&yeex Bdotp is thepalky curd job site MformadaiL Insurance Compaq Name: Policy#or Self--ins.Lic.# Fxpiration Date: Job Site Address: CitylStatelZtp: 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 ofrrim nal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of s STOP WORK ORDER and a fine of up to SP-50-00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of Ae DIA for insurance coverage verification- I do hereby a tinder the pains andpenabies ofpeduty thatthe information prordded above is true and correct Signature: 1 _ 2- 1 -- l '3 Phase#- GfI41 O,,( ciaT use ontft Do not write in this area,to be completed by city nrfown of m&L City or Towta Permit/License# Issuing Auffioritp(circle one): 1.Board of Health, 2.Building Department 3.{CitpTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#c 6 Massachusetts Department of Public Safety Board of Building Regulations and Standards Construction Supervisor # ' License: CS-068599 ANTHONY S Q" �• 17 ASHIQNS DR, SOUTH DENNISMA 02'' �,•�.. �1/e�l ,rW Expiration Commissioner 04/06/2014 Office of Consumer Affairs&B siness Regulation HOME IMPROVEMENT CONTRACTOR. Registration:. 41.25537 Type: ?. > Expiration: =1/15/2014 Individual ---_=,__- AN ONY SEAMUS QU1NN ANTHONY QUINN.'•�-�� s 1 17 ASHKINS DR SOUTH DENNIS MA`02660 Undersecretaryl i Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor1-0 r License: CS-068599 ANTHONY S QUI$N ,. 17 ASHKINS DR SOUTH DENIVIS�VIA02'' ,I J.•G..� �� `.,rii��` Expiration Commissioner 04/06/2014 icense or registration valid for individul use only ibefore the expiration date.- If found return to: Office of Consumer Affairs and Business Regulation 40 Park Plaza-Suite 5170 Boston;MA 116 f — Not valid without signature L Town of Barnstable Regulatory Services XAMThomas F.Geiler,Director 6 ►,� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstalile.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, C H A2LE L cL 3y Z c ,as Owner of the subject property, hereby authorize I'ti4TI-�10r-J1 Q J I ry r-4 to act on my behalf, in all matters relative to work authorized by this building pemvt (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant L©;3w!g i ylOV'J GJ l Ai" Print Name Print Name Date Q:F0RW:0VMERPERN0SI0NP00Ls 62012 Town of Barnstable Regulatory Services � s MASS Thomas F.Geiler,Director 6.9. 1. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 w;-,w.towu.barns tap b1.e.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 he/she will comply with said procedures and requirements. Signatue 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. C:\Users\dewllil\AppData\Loca]Microsoft\wmdows\Temponuy Intemet Files\Content Outlook\QRE6ZUBNIEXPRESS.doc Revised 053012 �o'- a' 2B•-o• Z Pcs T� 7UaP c � E s Pt TABL E.-- 2013 CC . o q A p N N .it D r - 2as.+ati S �q - p Y -T O. ► QIEl /A"ASTC R._.SU 17H� id op w N 1 N I L4V. m •. �I— .— - is M— — r dF 13•-cr T•-4'• 12'. 4.o,. �r � r � .. L_ _l I 1 PTO '� 10 2 MCAKFA_ST Q 0 - ,, - -Y..wT.HC.q.vzeL I Q OT _ ._ _ P r �. 444 'co cr t 5-rep. YCUR neOR 9 _ P 3 ; gzlG w 11 PTO 4^la9 Ir GARAGE PT SaJ - 9 .8/6 F•L._.SHE- vim.,.,,.. __. -.. 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AMw _ Yp f , I r' TOWN OF BARNSTABLE - CERTIFICATE OF OCCUPANCY PARCEL ID 273 258 GEOBASE ID 37683 ADDRESS 6 SUNBEAM LANE PHONE' HYANNIS ZIP LOT 41 BLOCK " LOT SIZE ._ DBA DEVELOPMENT DISTRICT HY i PERMIT 30809 DESCRIPTION PERMIT TYPE BCOO TITLE CERTIFICATE OF OCCUPANCY CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: tME BOND $.00 CONSTRUCTION COST9,11 . $.00 Qi► 756 CERTIFICATE OF OCCUPANCY 1 PRIVATE BI.E, +' � MASS. 039. A�BUILDING:D VAS ON -- - --- DATE ISSUED 04/27/1998 EXPIRATION DATE yk.lY�6,iV 'q.+3,:R.'.�:g.A r�.�LyLL�ISgI,:�•A113.�riS:,n _ '✓..4 ADDRUSS SUNBEAM LA14E .DAA, DEVELOPMENT �►l.�T ��'or 14Y F { P f*1IT 2�099 DESCRIPTION B CAPEW/ ATTACHED 2—CAR GARAGE r RUMIT .TYPE: BUILD TITLE NEW RESIDENT11AL BLDG PMT. CCNTRAC` OR'.3.d BAYSIDE BUMPING, I C .. Department of Health, Safety. ARCH ITF= a and Environmental Services INE BOND $.00 1Q!I: I�-iGLF . "A' -1E .t '�"�'A:CR}+D 3 PRIVATE. R41 �L'� _ ,► s 3 SARNSTABM :*., .L MASS. �► BUILDING DIVISION BY 1)ATE ISSUED 01/02/1998 E iRAT:ION eA"_CR. THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK'-OR ANY PART THERE O ,'EITHER TEMPORARILY OR PERMANENTL-Y:EN CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUS+ BE APPROVED BY THE JURISDICTION.STREET OR wl ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE-.THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS. ARE .REQUIRED FOR" 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE"A CERTIFICATE OF OCCU- ELECTRICAL,PLUMBING AND M FOR (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS. CH- 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. 4.FINAL INSPECTION BEFORE OCCUPANCY: VISIBLEPOST THIS CARD SO IT IS BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS �fR/n — m2 98 1. Q J d� r1 /�✓� 1 �03 lP R .61 .: 2 .- 2 2 3 1 HEATING INSPE TI N APPROVALS ENGINEERING DEPARTMENT i 2 BOARD HE H OTHER: 4SITEREVIEW APPROVAL WORK SHALL NOT OCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED-ON THIS THE INSPECTOR HA APPROVEDTHE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERM_IT'IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. BUILDING PERMIT 7"m 61- N 131 R Ll � I ....,�..._.,r,,,..�.a.-.�..,,�-....�.�,.:.._.,.�„ .-.b+.c-,.r.'...:,..9.,<,,..ir-r:,."�,.t.'v-�-v'.n;��.'''`"-_" +..-,-r.r•......_^..^.+...,..-,...,•:wq....a._-.r•..�.•.° INETpy. The Town of Barnstable BARMAR.-LS NSTABLE. Department of Health Safety and Environmental Services -: MAS0 &639. Building Division 367 Main Street,Hyannis, MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner t Inspection Correction Notice . h. Type of Inspection , +2 - ---- Location (� ��, ,.�—� Q.;,,. �, / Permit Number '), 9 rry. a Owner Builder One notice to remain on jobsite, one notice on file in Building Department. The following items need correcting: e ca S" 4,-r" r"j, 44L (9,) Qe4 .,, -To fk. c P Na� N&, c- e A?Pry o 0-Pt- 1 t 4'A) `>O (st?t�l J fi'd L t i ^� tip.Jt't�^✓ -e—( U(''',rr' Ic - t:k: v'1 law .9 f'A d� Please call: 508-790-6227 for re-inspection. Inspected by Date It ho,_C'- r / a-73 Engineering Dept.(3rd floor) Map A-" Parcel SA S Permit# ) House# �p �-S. Date Issued 1 -2— Board of Health(3rd floor)-(8:15 -9:30/1:00-4:30) was U1114M it 05WER Conservation Office.(4th floor)(8:30-9:30/1:00-2:00) W CONNECTION PRUIT PROS TBB BNGINEBgIN4 D1Ymn I"to Planning Dept. (1st floor/School Admin. Bldg.) CON3T1<UCT 1HE Definitive P Approved by Planning Board a-c4 19 6 L �,/ RNSTABLE PY TOWN OF BARNSTABLE BuiId' Permit Application Pro treet Address j�� L� f y/� Village Owner .. C Address Telephone 7-71 l ®y0 i F Permit Request First Floor l ad square feet Second Floor square feet Construction Type � �Lliyrsc,� Estimated Project Cost $ r 4 Q:o Zoning District R c- Flood Plain C Water Protection Lot Size 9 /5`? Grandfathered p'*'es ❑No Dwelling Type: Single Family lid Two Family ❑ Multi-Family(#units) Age of Existing Structure A/e6V Historic House ❑Yes BNo On Old King's Highway ❑Yes Uy&o 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 / No. of Bedrooms: Existing New .3 Total Room Count(not including baths): Existing New _ , First Floor Room Count I/ Heat Type and Fuel: O bas ❑Oil ❑Electric ❑Other Central Air Wes ❑No Fireplaces: Existing New f Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# 111114 Recorded❑ Commercial ❑&a4�� Yes Q'l�To If yes, site plan review# - Current Use Proposed Use Builder Information f� Name 6 .�14.C, Telephone Number 7 7/ 4Q L Q f/ I Address J 5 License# QO d ZG 3 Home Improvement Contractor# Worker's Compensation# WC1 3/Z a A0 17 YQ 13 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO&Z/W SIGNATURE DATE /Z-11hl —7 BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) To1U.- o((e,t6r,; A• il� s V FOR OFFICIAL USE ONLY t PERMIT NO. r DATE ISSUED MAP/PARCEL NO. - ADDRESS VILLAGE OWNER j DATE OF INSPECTION: _.. FOUNDATION FRAME INSULATION' FIREPLACE ` ELECTRICAL: ROUGH FINAL PLUMBING'c We- ROUGH FINAL six, GAS: ROUGH FINAL FINAL BUI.' G C- f 43ma DATE CLOUT oc as ASSOCIATION PLAN NO. 1 i O i f N S "• 16 ' .65 '.moo L-6;'T41 4 \� 91583� o, ''°' ••.cog O� V PROPOSED PLOT PLAN I CERTIFY THAT THE PROPOSED DWELLING SHOWN ON THIS PLAN CONFORMS TO THE FOR ' MINIMUM SETBACK REQUIREMENTS OF LOT 41 SUNBEAM LANE HYANNIS, MA. THE TOWN OF BARNSTABLE. PREPARED FOR BAYSIDE BUILDING CO. ��I,�\'.,N a SCALE: 1" =30' DECEMBER 23, 1997 RUMBA 7s q0" p� l�,MO SUAVE��Q Weller & Associates z -L -g1 1645 Falmouth Rd. —Suite 4C Centerville, Ma. 02632 (508) 775-0735 tl f•^ .��e Lc)uJ)ton�uealt� c�'✓l�a�.;ac�uselt� DEPARTKENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE Rusher: Expires: Restricted To: 00 BRIAR T DACEY 62 FERRBROOK LN CERIERMLB, HA 02632 COMMONwEALTH OF MASSACHUSETTS P DEPA IC'MENT O F INDUSTRIAL ACCIDE'+'M 600 WASHINGTON STRF_EI' BOSTON, MASSACHUSETTS 02111 fames.: Gar-laoel: �ornr- SS'one' WORKERS' COMPENSATION INSURANCE AFFIDAVIT (liccnsce/permiaec) . ' with s principal place of business/residence ar- y,2 6 3 a- (Gty/Statemp) do hereby certify, under the pains and penalries of perjury, thar. (J 1 am an employer providing the following workers' eompermtion coverage for my employees working on this job. W cILtI4 - / 3 D 1 D l lnsurinee Company Policy Number ( J I am a sole proprietor and have no one working for me. ( J 1 am a sole proprietor, neral contr cror r homeowner (circle one) and have hired the eontraaors lined below who have the following wor ers eompenmrion insurance policies: Name of Contnaor Insurance Company/Policy Number �... Name of ContractorInsurancc Comp?ny/Policy Number Name of Conrnczor Insurance Company/Poliey Numbu 0 1 am a homeowner performing all the work myself. NOTE Please 6c aware t at .••bile borneo—ncrs •wao emoiov persons to do maintenam. construction or repair worx on a 6—ciiint of not more wic three untu in which the Homeowner aiso resiau or on the Erounas appurtcoint thereto arc ant Ltnerx.ilt• considered to be cr_movrn unarr the Woriccn Cornvensauon Act (GL C 152. sect. 1(5)). appiI -2tion by a boromwoer for a license or permit may c+rnccocc the IcFiJ sutus of a.n cmpiovrr under the Workers' Cornpenaation Act_ 1 unoc:stand that : coo"•of ties ststc-:ent will be forwarced to the Deou-nnent of Industrial Accidents' Office of lnsuranQ tot mac .Tr.:i:-::ion inc :Liurc to secure cu C zrc u rreuiree unot Seetson .'.A or.MGi 15: can Ieac to the imoosiuon orai�L P-zjun ee^stsone or: 1-inc or arc to S1 500.OG and/or 1mpruon=.c::t or up to one vca: and r.cvu peaities in the form or a Stop Dior[ Droe 'n0 a Fine of 5 100.N a aav if Lns-. me. t SUBCONTRACTOR'S INSURANCE ENGINEEER: BAXTER & NYE ENG: (L) FIREMENS FUND - S30MXX80564866 (W) LIBERTY MUTUAL - WC1312595563023 WELLER & ASSOC: (L) NAT'L GRANGE MUT.- MSP45246 EXCAVATION & SEPTIC: ROBERT J. OUR (L) U S F & G - 1MP30109550901 (W) U S F & G - 771521695 DECO CONSTRUCTION (L) TRAVELERS - 660364K8342 (W) LIBERTY MUTUAL - 312446298044 FOUNDATION: BAYSIDE FOUNDATIONS: (L) COMMERCIAL UNION - ABR406267 (W) LIBERTY MUTUAL - WC1312201785044 WELLS: DENNIS SCANNELL (L) TRAVELERS - 660873E5627COF92 (W) WAUSAU - 151300062926 CELLAR/GARAGE FLOORS: MICHAEL BROWN: (L) AETNA - MP0023672849 FRAMERS: ROBERT DORRER: (L) TRAVELERS - W680526K991TIA9 (W) AETNA - 006CO023972416C MICHAEL DUFFLEY: (L) COMMERCIAL UNION - NBF821356 (W) LIBERTY MUTUAL - WC1312492127024 MASON: SHERMAN, WAYNE: (L) COMMERCE INS CO - N60689 (W) WAUSAU INS - TO BE ASSIGNED ELECTRICIAN: CHAVES ELECTRIC: (L) HANOVER INS. - LHN2964649 (W) MISCELLANEOUS INS CO. - 0708878 91 1 PLUMB & HEAT: WHITELY PLUMBING: (L) TRAVELERS - 660365K1782COF9 (W) EASTERN CASUALTY - POLICY IN MAIL ALARM SYSTEM: BALTIC SECURITY: (L) FIRST FINANCIAL - FF0131 G400831 (W) COMMERCIAL UNION - CB0743379 CENTRAL VAC: VACUUM HOUSE: MERRIMACK MUTUAL - SBP1608045 I INSULATION: MAP INSULATION: (L) AMERICAN STATES - 02CC326435-3 • (W) U S F & G - 7711099932 SHEETROCK: MEL REED: (L) WORCESTER INS - CB817530 (W) COMMERCIAL UNION - CBH557387 INTERIOR TRIM: DAVID'S REMODELING: (L) COMMERCIAL UNION - NB F821442 M & R CARPENTRY (L) MARYLAND INS. GRP- SCP30235965 (W) CIGNA PROP & CAS.- C80049997 OAK INSTALLER: ROBERT BUDDEN: (L) NORTHERN ASSUR. - NBF528652 PAINTING: CAMPBELL PAINTING: (L) TRAVELERS - 1680251K4083COF (W) AMERICAN POLICY - WCC 186604 GARAGE DOORS: ALL, CAPE GARAGE DOOR: (L) U S F & G - BSC14667590301 (W) COMMERCIAL UNION - CBH573757 STORMS & GUTTERS: ALUMINUM PRODUCTS: (L) AETNA - MPOO21014146 (W) AETNA - JC89258880 OAK FINISHER: AMERICAN FLOORS: (L) TRAVELERS - 680 342W754-0 CARPET, VINYL & TILE: CARPET BARN: (L) VERMONT MUTUAL - SBP6507393 (W) PHOENIX INS. - 6NUB476J652794 TILE INSTALLER: TONY AVERINOS : (L) ASSURRANCE CO. - CFP26528977 (W) HARTFORD FIRE - 77WZCY2409 WIRE SHELVING: CAPE COD CLOSETS: (L) U S F & G - BSC146983441 APPLIANCES: KITCHEN APPL MART: (L) FIREMENS FUND - AZC80453098 (W) HARTFORD INS CO - 77WZNB1603 MIRRORS & SHOWER DOORS: L & M GLASS: (L) COMMERCIAL UNION - CBR409003 (W) U S F ,& G - 0071439933 LANDSCAPE & SPRINKLER: COY'S BROOK: (L) COMMERCIAL UNION - ABR345850 (W) CIGNA COMPANIES - C41138178 DRIVEWAYS: NORTHERN SEALCOAT: (L) MARYLAND CASUALTY- EPA18716945 (W) THE PHOENIX - UB387K530 YI- s9 %:9 5� S `�? T lu �J sP •o�, 0 CERTIFIED PLOT PLAN I CERTIFY THAT THE FOUNDATION FOR SHOWN ON THIS PLAN IS LOCATED ON THE /r LOT 41 SUNBEAM LANE HYANNIS, MA. GROUND AS SHOWN HEREON AND THAT IT W CONFORMS TO THE MINIMUM SETBACK REQUIREMENTS OF THE TOWN OF PREPARED FOR BARNSTABLE. BAYSIDE BUILDING CO. OF c SCALE: 1" =30' JANUARY 6, 1998 � sTEVEN RUMBA H -79 r P` Welter & Associates 1645 Falmouth Rd. —Suite 4C Centerville,Ma. 02632 (508) 775-0735