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- -� c,��=� � , i it I I i i I I i I I i i i ��5 l dja� CAPE COD INSULATION. �� ®® � Ile IA OIAII IIAMMS IPA AY 10AM IUIYIN010 'to IAII! OUIIIII INi111A Ito N CCICINOI ` 1-800.696-6611 t' Town of Barnstable Regulatory Services <I Building Division 200 Main St Hyannis, MA 02601 Date, Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed.& completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application, All work has been inspected by a certified Building Performance .Institute *(BPI) inspector, All work preformed meets or exceeds Federal & State Requirements, Property Owner Property Address Village POMAa 1-17,�444« Insulation Installed; .Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings Slopes ( ) ( ( ) ( ) ( ) Floors ( ) ) ( ) ) ) Walls C /IJAP ( ) ( ) ( l0 ) ) ( ) �N-e►^°l WO r k 17e ro r. ,e l Sincerely 2Hi *ssir, sident c• TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ► � TOWN OF BARNSTABLE 0 r, Map �. Parcel (/ Application # ?Health Division , . * 07Date Issuedl`/�/`," 1 Conservation Division Application Fee Planning Dept. Permit Fee V i n10IN Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address .`GP- Village Owner Z:2&�9 AI � ` y_p Address 1zr e!-, Telephone d.2 e f<,2 Z Permit Request 2a ,lJAA,&ZZ_q _/,• s Ur ,� .SG�h a7rJ�' l`���/r,� ��✓211j'f���D,tl ��z1 1'�J il� r`i���_T Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation ePConstruction Type �'D D� / Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 1;1( Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes 4No On Old King's Highway: ❑Yes ONo 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 o e c a ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION _(BUILDER OR HOMEOWNER) - - Name G ,�L C�O J�J.fii�i��OX1 Telephone Number Address Z e g,4m ,, G'�/� License # / D 9 k1,4 rVyH,6 y�j Home Improvement Contractor# Emai Co� rJ � Dom, r* Worker's Compensation # 4 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Z SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION # 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. Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-100988 Construction Supervisor HENRY E CASSIDYI 8 SHED ROW s " �J WEST YARMOUTH o Expiration: ' Commissioner 11/11/2017 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite S 170 . Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 153567 Type: Private Corporation Expiration: 12/15/2016 Tr11 259188 CAPE COD INSULATION, INC HENRY CASSIDY — -- 18 REAR DON ON CIR CLE -S0, YARMOUTH, MA 02664 'Updatp,Address and return card, Mark reason for change. SCA I C5 2oM o5/iI [] Address Renewal Employment 0 Lost Card �ie�paarr��zarzcve«�C�o�C%�l�cJdac�ccaeC�l t -Office of Consumer Affnirs&Business Regulntlon License or registration valid for individul use only U, OME IMPROVEMENfCONTRACTOR before the expirntion date. If found return to: egistration: .153567 Type; Office of Consumer Affairs and Business Regulation xpiratlon: :12/1:5(20:1.6 Private Corporation 10 Park Plaza-Suite 5170 �,. Boston,MA 02116 CAPE COD INSULATCQN:;:;INC HENRY CASSIDY 18 REARDON CIRCLE` . 60. YARMOUTH, MA 02664 Undersecretary N valid wi ut sign~ e ' I f The Commo nwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 ►vww mass,gov/dia rkers' Compensation Insurance Affidavit; Builders/Contractors/Electricians/Plumbers, TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le ibl Name (Business/Organization/Individual): Address: City/State/Zip: , " Jam, 6 2 Phone #: Are you an employer?C eck the appropriate box7and/or Type of project(required): I.�E am a employer with Type(fupart-time).' I am a sole proprietor or partnership and have no employees working for me in [7, New Construction any capacity.[No workers'comp. insurance required.) g. Remodeling 3.[]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 my property. [will 10 [] Building addition ensure that all contractors either have workers'compensation insurance or are sole proprietors with no employees. 11.[]Electrical repairs or additions 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. Roof repairs 6.®We are a corporation and its officers have exercised their right of exemption per MGL c. 14.MOth,r ce 152,§1(4),and we have no employees. (No workers'comp.insurance required.) 4 'Any applicant that checks box#1 must also till out the section below showing their workers compensation policy information. t Homeowners who submif3his 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. 1 aman employer that is providing infoormation, workers'compensation insurance for my employees, Below is the policy and job site Insurance Company Name: �Z✓. 1 Policy#or Self-ins. Lic. #: �_ / Expiration Date:_Z 4 Job Site Address:P 3 1�) —T- Attach a copy of the workers' compensation policy declaration page(showing he Policy cy nu an e P ration ate), Failure to secure coverage a`s 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. 1 do hereby certify.0 ider the pains andpenalaes ofperjury that the information provided above is true and correct. Signature- Phone#: Official use only, Do./hot 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#; CAPECOD•27 QUI)F v�zo° CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD 4/27/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. Tills CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIE, 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 certiflcate-holder In lieu of such endorsement(s), PRODUCER CONTACT NAME; Rogers&Gray Insurance Agency, Inc, PHONE AAic No: (877) 434 RIB 134 c o E 816.2156 South Dennis,MA 02660 ADDRESS:mall rogersgra ,com INSVRER(S)AFFORDING COVERAGE NAIC P INSURER A:Peerless Insurance Company INSURED INSURER 8:SafetyInsurance Company 39454 _ Cape Cod insulation, Inc,: INSURER C Endurance American Specialty Ins,Co. _ 16 Reardon Circle INSURERD:Atlantic Charter Insurance Group 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 PERIOC INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR LTR TYPE OF INSURANCE I D WVD POLICY NUMBER MOLIC� MMLICY X LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,C CLAIMS-MADE �OCCUR CBP8263063 04/01/2016 04101/2017 PREMISES(Ea occurrence) $ 100,C MED EXP(Any one person) $ S,( PERSONAL&ADVINJURY $ 1,000,C GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,C X POLICY�PRO. JECT LOC PRODUCTS•COMPIOPAGG $ 2,000,C OTHER: $ AUTOMOBILE LIABILITY COMBI EO SINGLE LIMIT B Ea accident) $ 1,000,C ANY AUTO 6232707 COM 01 0410112016 04/01/2017 BODILY INJURY(Per person) $ AUTO QED X SCHEDULED X HIRED AUTOS X NON•OWNEO AUTOS BODILY IN (Per accident) $ AUTOS PRO ER DAM GE $ Pe accident $ .X UMBRELLA LIAB X OCCUR -- EACH OCCURRENCE $ 2,000,C O EXCE33LIAR GIAIMS•MAOE R/O EXC10006635000 04/0112016 04/01/2017 10000 AGGREGATE $ , OED X RETENTION$ Aggregate g 2,000,C WORKERS COMPENSATION _ AND EMPLOYERS'LIABILITY YIN STATUTE �R D ANY ECUTIVE ❑ WCE00431901 OFFICERIMEMBEREXCLUDED? NIA 06/30/2015 06130/2016 E.L.EACH ACCIDENT $ 1,000,0 (Mandatory In NH) If yes,describe under E.L.DISEASE•EA EMPLOYE $ 1,000,0 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,0 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHI CES (ACORD 101,Additional Remarks Schedule,maybe attached It more$pace Is required) Workers Compensation Includes Officers or Proprietors, Additional Insured status is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holde CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED SFFORE Bill Swanson Builder THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 50 Camelot Lane ACCORDANCE WITH THE POLICY PROVISIONS, Brewster,MA 02631 AUTHORIZED REPRESENTATIVE ©1988.2014 ACORD CORPORATION, All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD table Vo Dirfttur.. bly Tam_jexTye�u iiig; o iussioiier 200;I�aiayaruus, 4 02601 K�tGF�n barnStablexn�.;tis� Office., 50.8462-488• arc 08=790=62 (} Ord.' Qw.ne l us < tax ? ^' int > f' S' C �3 �-0+v%4n%- e9e I ^� mQ oe , sub�ecr�?xoext ki bpau onze: J-.. A. I: z o j' y in,at�matiiers:relative to. �rk•aufi3 orizect b}his busls3i pernnitfzF*avan for b C t:r C(e- �CtL& 23 146 Cwlo) H�C►-n�:S hA ��"-Pti �:f ezc�s and.���•,t �-+�"c�ifii��' <al � • �. Pods ;:ae: x tao be d oruaerl bef�rt#ends ised` d$l 1' mspegmovs . anise :az�d cc pted;. S�aah,►�:nt.C•s �: . . ,.�. . •S�guature�-o�App�c ;t - , -prinnt Name ;Piano I�Iat�e.. 'Date Q�orccxso�� �r�rss�or€e�a�s: - � . TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map � �� Parcel Applicationv Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee M 5-7— Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Address �— Village O.V�V1 I,-S " Owner R®i-,oot �' ,1') Address 113 � l 1°f S A Telephone 6/ 7— Y &— -s7---S— p / / Permit Request !� � �� C� W,/ b Q LLf( ,�•'.� pAl 3 Lie`� PIC /fie lb W �qs, EL i XiAubi" lam, t'�s Square feet: 1 st floor: existing propose 2nd floor: existing proposed Total new Zoning District !, Flood Plain Groundwater Overlay Project Valuation H 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 King's Highway: ❑Yes XNo Basement Type: Full ❑ Crawl Walkout ❑ Other Basement Finished Area(sq.ft.) F 1/MIS Basement Unfinished Area (;sq.ft) Number of Baths: Full: existing new Half: existing Dew /�> Number of Bedrooms: .3 existing _new o -" Total Room Count (not including baths): existing new First Floor R Jom Count, 2 s !q � Heat Type and Fuel: XGas ❑ Oil ❑ Electric ❑Other LY >_ Central Air: kes ❑ No Fireplaces: Existing New Existing wood/coal sto 16:XYes ❑ No Detached garage:-❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage:Xexisting ❑ 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 yRA Telephone Number 7 ®� Address OQ License#C 45)�)J� Y/ �Ij6'7 ° g Home Improvement Contractor# 0_3 Email 10'rii fl._WakS E k6ZOILI/+ Worker's Compensation # 09W Ee_EH 096i( ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TA tch dl -To.D us�wes; 17�*b SIGNATURE DATE r ie FOR OFFICIAL USE ONLY Y a i APPLICATION# DATE ISSUED MAP PARCEL NO. ADDRESS VILLAGE OWNER f q 1 DATE OF INSPECTION: FOUNDATION i FRAME INSULATION FIREPLACE '. k ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts + _ Department of Industria(Accidents Office of Invesdgations ' 600 Washington Street , Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'b Name(Business/organi7ation/tndividual): �- �• a Address: �Q/ � City/State/Zip: C ,N I ►f /�/� AV167 Phone#: 617—`�2_2_ "040a3 Are u an employer?Check the appropriate box: . I Type of project(required): C 1. I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. T. ❑Remodeling' ship and have no employees These sub-contractors have g• ❑Demolition workingfor me in an capacity. employees and have workers' Y � tS'• 9. El Building addition [NO workers'Comp. insurance comp,insurance.: required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t C. 152,§1(4),and we have no employees.[No workers' ' 13.El Other comp.insurance required.] *Any.applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the subcontractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing worker 'compensation insurance for my employees. Below is the policy and job site informatiom r�,y� d, Insurance Company Name: ` PIlam/�b 14S U R O O&E Policy#or Self-ins.Lic.`#: 1�1/ i�e�L /7 0 �� Expiration Date: Job Site Address: • C/g i t �s w o l-� mQighState/Zip: / I ��L�J-S � � "/� / y& . 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 df fication. I do hereby c u er + e airs pen erjury that the information provided abov is a and correct Si mature: // Date: Phone#: F'17 � Official use only. Do not write in this area,to be completed by city or town of City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Balding Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all•employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in*a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C( )states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificates)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 (Le.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Ix><'uestigatians 600 Washington Street. Y Boston,MA 02111 Tel,#617-727-4900 ext 406 or 1-V7-MAS9AFE Revised 4-24-07 Fax#617-727-7749. www.mass.gov/dia DATE(MMIDD/YYYY) A�� CERTIFICATE OF LIABILITY INSURANCE 3/31/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER - CONTACT Edward Lukatsk NAME: y Lukatsky Insurance Group PHONE (617)928-9222 -AC No:(617)928-9296 950 Boylston Street ADDRESS:Edward@ lukatskyinsurance.com Suite 101 INSURER(S)AFFORDING COVERAGE NAIC# Newton MA 02461 INSURERA:Travelers C & S of IL 19046 INSURED INSURERB:Hartford Casualty Insurance Co 29424 Ilya Ballin INSURERC: INSURER D 28 Broadlawn Drive INSURER E: Chestnut Hill MA 02467 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1431244382 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 INSURANCE ADD SUBR - POLICY EFF POLICY EXP LTR S POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 300,000 A CLAIMS-MADE Fx_]OCCUR 6806B315755 /19/2014 /19/2015 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,J00 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER:. - _ PRODUCTS-COMP/OPAGG $ -2,000,000 X POLICY PRO- LOC $ AUTOMOBILE LIABILITY - - COMBINED SINGLE LIMIT Ea accident $ ANY AUTO - BODILY INJURY(Per person) $ ALLOWNED SCHEDULED -AUTOS AUTOS BODILY INJURY(Per accident) $ - HIREDAUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB HOCCUR - EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE - AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1 OOO OOO OFFICER/MEMBER EXCLUDED? [NE] N/A - (Mandatory in NH) - 08WECEH0961 /16/2014 /16/2015 E.L.DISEASE-EA.EMPLOYEE $ 1,000,000 If yes,describe under - - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,.Additional Remarks Schedule,If more space is required) Job: Roman Regelman, 4 Toby Circle, Hyannis MA 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. Town of Barnstable Building Department 200 Main Street AUTHORIZED REPRESENTATIVE Hyannis, MA 02601 :. E Lukatsky/SROLUK - ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INSn25 r9nionsi M The arew 1 name and Innn arc rcniefcrcrl mar4o of ARr1Rr1 ��e 0477/J9204?.LUGCl,�G/Z C/U//Kad6(aCX(ej6f Office of Consumer Affairs&13u'siness Regulation License or registration valid for.individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. 'If found return to: egistration: i139840 Type: Office of Consumer Affairs and Business Regulation xpiration 8/27/2015 DBA 10 Park Plaza-Suite 5170 �. Boston;MA 02116 ILYA BALLIN CONTRACTORM1 —� • ti _tLYA/BALLIN 28 BROADLAWN DRIVE CHESTNUTHILL,MA 02467 Undersecretary, . Not valid ,thout signature --- Massachusetts -Department of Public Safety Board of Building Regulations and S j � g Standards i Construction Supervisor f License: CS-082233 I ILYA BALLIN -' 28 BROADLAWNDRIYE I Chestnut Hill MA=02467 Expiration i Commissioner 03/06/2016 ' �THE Town of Barnstable Regulatory Services * s uexST"LE, MAS& g, Thomas F. Geiler,Director EnM,y16 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax:.-508-790=6230_T _:-:_-- Property Owner Must Complete and Sign This Section If Using A Builder z RO Y\A a V, lK Qj J ,as Owner of the subject property hereby authorize rG y Q l I 1 l/� to act on my behalf, in all matters relative to work authorized by this building permit- /6 M C R; c )ss c (Address of Job) Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled before fence is installed and pools are not to be utilized until all final inspections are performed and accepted. hIA-K ZIAAO u Signature of Owner Sign tore of p F(V n Print Name Print Name Date Q:FORM&OWNERPERMSSIONPOOLS IME r Town of Barnstable Regulatory Services BAIiNSPABLE, « Thomas F.Geiler,Director MASS= . .�� Building Division 'OIEn near" Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel.of land on which he/she resides or intends to reside,on which there is, or is intended to be,a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall.not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that 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 wbich a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt TOWN OF BARNSTABLE Roma Recgelman I6 3tw11 Project j 3 n Irti 133 � ! �yfGY ft'ay 111)(749 SINK i 13 C E yt „ \, I,L.)1.i1.1`5.11: .1_ :. : ..i; �': "CD 12 IJ2" r " 1, / � "r t � ,5 0. +z Qt� 11 Roma Regelman Pt eject 1. R ,R l Y151 �L� coo a 09 �iR IL C 9 ie 33 pa e Roma Regel an Project kiii. v - , I� 't4hIlpi aka \ - _ a 41 Pli AM OW F ' E , x .. 6 X � r A d .` 01 , "A & � . t \ v ®�w77 .� � S � � a�; ,tee\"" fi�� '. � � � \�� � �� .--�• �? .�. Lope-C5-P AYS 7rAq� �o LU IY1 —7-7-vW/ vdan V c r o N o N,4 , �. Street Address L� o�"1 Lr Vill ge i. �� Owner �JEA V o J Address 1n O J..-7 �.,,�i a►9,�sL S�S�� Telephone to 1 -1 4 9 Permit Request &ty4 o A cA Z L41w u OVA Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay — Project Valuation 0" 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 King's Highway: ❑Yes ❑ No Basement Type: �Ull ❑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 bath;): existing new First Floor Room Count ►3 Heat Type and Fuel: Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes Colo Fireplaces: Existing—I-New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑existing U new size _ Barn: ❑ existing ❑ new size_ Attached garage: Ur existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Aut�h,rization ❑ Appeal # Recorded ❑ Commercial ❑Yes C�3Tlo If yes, site plan review# Current Use y3I 9 t / Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name _!S�-o V-9,k S ��• i + �V" Telephone Number Address D License Home Improvement Contractor# '0(9 Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE ,. DATE 0-30/ F Town of Barnstable Regulatory Services MAM Richard V. Scali, Interim Director N9. ► Building Division r Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.ba rn sta ble.ma.u s Office: 508-862-4038 Fax: 508-790-6230 November 12, 2013 Mr. Sturgis St. Peter 65 Cindy Lane Barnstable, MA 02630 RE: 4 Toby Circle, Hyannis Building Permit Dear Mr. St. Peter, As we had discussed in my office some months ago regarding whether a building permit was necessary for a project you were hired to perform at 4 Toby Circle in Hyannis. Here are the code references why a permit was not necessary. According to the International Residential Building Code,(IRBC) 2009 edition,.with Massachusetts amendments, section R105.2,work exempt from permit, a building permit is not required for the following activities: #5 (which covers the activities which are described in your list, supplied on 11/1/13 and this list is the Same as what we talked about in my office) painting, papering, tiling, carpentry, cabinets, counter tops and other similar finish work are exempt. Also according to R 105.2.2, which some of the items described, fall under ordinary repairs. A building permit is not required for ordinary repairs. So to emphasis the answer to the question, a building permit was not necessary for the tasks that were described in the list of 11/1/13. Sincerely, Thomas Perry, CBO Building Commissioner i i 'L C>G>q � 2- too Ti� � I�Qh i TOWN OF BARNSTABLE S b 3333 II, E( 9 ,1 4 ��7 C� _ )- to 1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 3z�� °r Parcel A licatio.n # C OR Za/ pp Health-Division Date Issued 3 Zs Z Conservation Division Application Fee Planning Dept. Permit Fee ( i7 Date Definitive Plan Approved by Planning Board `. Historic - OKH _ Preservation /Hyannis Project Street Address ? Wy C14 de- Village /! -qQv1illI-S Owner Rowt 1K f �itii a Address Ali, Rik- Telephone G't 7- g®/ -S��T 7 Permit Request lc kevw va, -es 1� /S- / U cos W WAO S. f s oA/CV u Ale CS u� R1 4/0-K Square feet: 1st floor: existing proposed 2nd floo' : existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation �!'3p 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 .s Historic House: ❑Yes No On Old King's Highway: ❑Yes No Basement Type: XFull ❑ Crawl Walkout ❑ Other Basement Finished Area(sq.-ft.). P/1//s Basement Unfinished Area (sq.ft) Number of Baths: Full: existing 3 new Half: existing _new Number of Bedrooms: existing _new p_ -� Total Room Count (not including baths): existing new First Floor Zoom Court Heat Type and Fuel: Gas ❑ Oil ❑ Electric ❑ Other_ ' a Central Air: XYes ❑ No Fireplaces: Existing -2, New Existing wood%coal sto'd1e: s ❑ No Detached garage: ❑ existing ❑ new size Pool: ❑ existing ❑ new size _ Barn: ❑ existing near; size_ Attached garage: existing ❑ new size Shed: ❑ existing ❑ new size _ Other: _ �n m Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes No If yes, site plan review# _ Current Use at Proposed Use �°`� APPLICANT INFORMATION - - (BUILDER OR HOMEOWNER) - Narhe Yu R, y A A k-evlc Telephone Number 7 Adr"ress 1133A 114Av. J d, License# 7 //3 Y?,U�AV,, Xk 002,q 6 7 Home Improvement Contractor# /37, 9a_ Worker's Compensation # 1 ALL CONSTRUCTION DEBRIS RES LTING FROM THIS PROJECT WILL BE TAKEN TO R S•� IGNATUFiE. DATE -3 �� _ t - Ft4 t FOR OFFICIAL USE ONLY # APPLICATION# F . zDATE`ISSUED:...c...== , f ,MAP[PARCEL NO. y t ADDRESS VILLAGE OWNER J L K DATE OF INSPECTION: 'FOUNDATION FRAME r iINSULATION, J FIREPLACE ; ELECTRICAL: ROUGH FINAL , PLUMBING: ROUGH FINAL -GAS: — ROUGH FINAL `€ ...,.FINAL BUILDING . _DATE CLOSED OUT ASSOCIATION PLAN NO. 4 F � F 4 f v .i ' f The Commonwealth of Massachusetts Department of Industrial Accidents Office oflnvestigations 600 Washington Street Boston,MA 02111 www.mass gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electrician.s/Plumbers Applicant Information Please Print Lep-ibl Nitme-(Bnsiness/orgamzationitndivi �, City/State/Zip: Phone#: 310 Are you-an-employer-?Check`the appropriate box: 4. I am a en Type of project(required): . 1.❑ I am a employer with ❑ general cantractor and I employees(full and/or part-time).* have hired the sub-contractors 6• ❑New construction 2. I am a sole proprietor or partner- listed on the attached sheet. 7. []Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity, employees and have workers' [No workers'comp.insurance comp,insurance,# 9. []Building addition . required-] 5. 0 We are a corporation and its IQ.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL m �� nce required.]t c. 152, §1(4), and we 12 have no ❑Roof r ePairs employees. [No workers' 13L.0'Orhetf�`Od �G�;., �y' l� 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 d5davit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such, $Contractors brat check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employes. If the sab-contractors have employees,they must provide their workers'c policy number. " omp,p cY I am an employer that isproviding workers'compensation insurance for my employees. Below is thepoFiry 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 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 imp somnent, 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' coverage verification. I do hereby certify under the es o.perjury that the information provided above is true and correct Date Phone Official use only. Do not write in this area, to be completed by city or town official City or Town: PermitUcense# Issuing Authority(circle one): I:Board of Health 2.Building Department 3. City/ToWn Clerk 4.Electrical Inspector 5;'Plumbing Inspector 6. Other Contact Person: Phone#: Town of Barnstable Re gulatory Services awaxsrnst�, names g, Thomas F. Geiler,Director Eon Building Division Tom Perry,Building'Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 -Tim-508MM230- -.------- Property Owner Must Complete and Sign This Section If Using A Builder AEU+ ,as Owner of the subject property hereb uthoxize���� < y = to-act on`iny behalf in all matters relative to work authorized by this building permit ti n (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled before fence is installed and pools are not to be utilized until all final inspections are performed and accepted. �lgnature of Own1 e�'r' Sign e of Appiphicant I >k y / Print Name .Print Name Date , Q:FORMS:OWNERPERMISSIONPOOLS TME,�y,. Town of Barnstable Regulatory Services BARNWAac,E, Thomas F.Geiler,Director y hrnss. i639• •�� Building Division rEVMAy� Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption.for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building_permit (Section 109,1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that 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 results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt i III IN .d$✓{jj�>�'�t��((�a� ey�` �t�� R 3° '' r !f'�� �9'ar�f,, ¢ A. ,e8 ed 't7.ef ' MPROT CONTRACTOR tr 3 «. ^'.�pdk'1..1 OW 1 `12, /�P' _ PLtd Jabi `r µ i k }Al � .. ri r r E z am Z' d r �C tVl KC. MA a <rj M111 ry � . L it 39 " "I1 nth ( k T'` p pa,R't11/�tN R ' ' 13 � F b - ^ WAS C(1lAn 1l1 m P ,� NE /4r', �,�11A 0r@` " 4. so nif 12 r r r . r }va14, �� ailIs.. � +l -t `' '' + •tr } � - 0i vr ryinonu�ea t ' X.�cet�s re r ion�^alii3£a zx to do r e ten, 4 ty- .` OltieeofConsamer;At�aus&B ►nessRegutafioa t ', - xHOME IMPROVEMENT CONTRACTOR ` b beffl�e the e�pit�o da�e�`LT €rn retctrn Eu Reg►sUation �37582 _ �z��_ € ` -Office.of Consumer �ffaiz�s a�nd�B�sines��2��atE�s� Exparabon 12/z10J2012 Lfd Uabi ty,Part , , Park Plaza= urte l�0� A€ s ` m= �. . JIDAIOROY � � aston.§fn1t6 � '., 13, tt J.. s ¢ -� A tj •ri*� a* c.F k� �- 4'' ilOWN �� � 1�'q^,�,�y�;p,*I/�,�J�j� a7L''�1T�",V:�a/T11RW ."{ .; } 3r P S 'r•! { q i_ai } i .fro t +i, y4 f ',. .k+ay�_ rw -' G, �:. 0 F 3 A"FW' lid rbfitx char ` 1 v Roma Regelman Project NK �a E {_ .,.�..�� '� �f u� S It 1.IL LET`I , \ $' 131),224 VIEW. D a L aL�i.�.l(I L 6 " GENERAL PLAN. IMF t_ 4 25 CAT^ F 7 T t T F L W, .� o & 04 �• \ P AP \ w y w \ Roma Begelman Project M 65 112" v, 7Y?W" IN 46 /4" ONE MW $. k3r ri i �..u, �• � � ;, �;� ��. � 3r �� � � ate,, �•.. '\\ 3 ems. ; 3 d f ' L F' r^x 4, _,..,�,• �, r wit '� '': E Sr.. ,. 24 EWT 2 5181 151 24' 6. 165 5115, Roma Regelan 37 2" 4 k,2" 30' Project 36' 9 f€ tea 1 f3 v U ks .fie ", `` ' I ..q 'O a PoE A.ro"" S � ,€�' � &�` 1� � E e•'.. C E6H\� R �Et Y �...� I•ks .., �, °.1�C„ ;. �:, �a�, ,F �'�.i' 3` � E p p 'h�. �', � ram' x �' � � � � ,: c� "� 9 ? •� '? \ N FOR ig Ai '� -"' _ - •� i''.. "i,11WMWf' dk��YNNAfMIk 5 y t w ti 14, L C+y ��gg99 qqccss pp__gg yy e�gygg �p Lgg��t� 1rI,��.Cy y F .[' 1. £fa .E7 Z�f :'.F11� .' F�ETRIG'-' .11°f.,1i \ h a ON 3 4` 1 " 15" A' Kati 31 18" 30 18, G 1'' " DiF 314' stoma f2e elrnan Project r FRONT � r 3 .: .k w• x. E m STOVI / Re 3d P µ 4.� Ln Y E s hs £ 4P w rM' " r"3'ark" r loma Regelman Project :. 1' I ..;1 WIM R; � Fm n x 3' A 67 5W Project 4i`7 PENINSUl". 'k II BACK 5TOVE Cri 29„ M �a� .. All LEE: x �r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 1 I7 v Permit# � `3 Health Division TTT� Date Issued 7 ©� Conservation Division lA �,�^� Fee �J 06' Tax Collector �uy V Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address / rz, C l Village Owner �i Address ,� e Telephone Permit Request Square feet: 1 st f oor: existing proposed 2nd floor: existing proposed Total new Valuation 5,50E- 4V Zoning District Flood Plain Groundwater Overlay Construction Type Mn Z_ 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 King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing new -Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑ No If yes,site plan review# Current Use Proposed Use B DER INFORMATION Name ti Z1 Telephone Number . D �� Address �/ G�� S fle �� License# Home Improvement Contractor# 9 �F Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE i DATE ?/7 IZao 0 ' FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. wr t ADDRESS VILLAGE OWNER DATE OF INSPECTION: - i FOUNDATION FRAME INSULATION r FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING e DATE CLOSED OUT ASSOCIATION PLAN NO. fs -== Department of Industri cc: en {FIN OffICZ OfldYBStl�BUOdS 600 Washington Street r. Boston,Mass 02111 - _ Workers' Com ensation Insurance Affidavit ;inn{rc•... name: vocation' �� r� city C I am a ho owner Performing all Work nYs" am a sole aronrietor and haven°one Wo�anQ is aav 1 over workers �� for my employees working.on.thls job.•:.::;:.;:<:::> 1 � compon Prove ...�,.:;.:.>::,,::............::.:::::::...... .. . .. ::::::... :'Y x- ti•{{;i . ....::?;:v:;v':i:?:�)iiiis�iii:•}:4}:i}:^:•}}}:}S:}':.}w::::.:r}:•{:^i>:i:i.iv:.. ..: ;.... ... vn ernW. e:. ::............ .. ...........v::n�:::v .':{;!{.}};•y{.xr....addres .......v;.. ,.',...;{..:;... .......;..:.•:{s:.y.:::::n;:{{{r::. .... 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' . a•n•.�• / • i11 II // •�1.1111 rw11. tl•1•I • �1 ' I) Mt •• I] - • •/I an • • 11 •-1 Milo • // -. •1•r.It yw.1-..1•. 1 • _-•• It✓• . • - / i• • I �+ • L:1• •11 • / • /• 11 .11 • • 1 a 11 1 • .11 r 1.1 . 1 r•• •-1 .0 •11 .11 I t . 1 • • 1 •11 • 1 w ••• �jjjjj�jjjjjjj�j/�j��jjj�����jjj/�jjj�jjjj��jjjjj�jjj��j���j�����jjj�jj/���j� - . p•�1.1 •• 1 • tie-Ili .11 • K.' 1111.1 ._ 1 r .+1 1 O'ArMurrmin1 1 / I I I 1 1 1 1 1 Mfilt I I • = 1 1 t ( 1 , 1 1 + + 1 ' II � • 11 • 1 ' 1 VE74 The Town of Barnstable 9' W,�' Department of Health Safety and Environmental Services `b i°1¢ g Buildin Division 10TEc►„p.'l► 367 Main Street,Hyannis MA 02601 Ralph Crossen Office: 508-862-4038 Building Commissions: Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, 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: /0�/ Z__atim�ated Cost `�S00 Address of Work: Owner's Name: Date of Application: 71-7 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job Under$1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITHUNR UNREGISTERED HAVE CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK UNDER MGL c. 142A. ACCESS TO THE ARBITRATION PROGRAM OR GUI FUND SIGNED UNDER PENAL'IMS OF PERJURY I hereby appiv for a permit as the agent of the owner. c �LZ I Date Contractor Name Registration No. OR Date Owner's Name q:fb ms:Affidav W Y YS Board Hof Bull' Q eg � � � dards . �`•�"� ne.'�A�shb� i Stand Room 301 Home mprovem. ., otratront t f-rt4im'+'✓r f+ � Regstrtiaiot � . 3 fiSHONCFiOEIEL[ n c 8e s�E2 P_ '' Q "zi^-y�.;4§e b'� dYFSF,,,r Yr9?la��711�1"nt -. a34 HAMPSHIaE f � 3c +.k sk A..t� 5 k's.f ai-1 epw',w^• ! '7": k . s.HYANNIS•�" Nf ��� r L i -•._.r•-,.-� . . -.;�. ;S ;3-....: J".,-t+``*,s+j""�d , �`ti.a'R �'"'�. _.'sS.•"*'C-T:i"�r"�0-•"`:r-•.,.,,' .',.�.'..=y�,�t,r=?`2.'w,.�,G.^..'- ..t«-�.,c.r ti.^"y,.�_,... _... - - —•-_.•- Assessor's map and lot number ........ ......... ......... D� , It " Sewage Permit number ..........'7.. ................................... yoF?NEr,�° TOWN OF BARNSTABLE ro�Q n 0� Z ]IMSTADLE, i 0 M6 9 BUILDING INSPECTOR �0 NpY Or• t/�� !�..•a�.! X .......................................................... APPLICATION FOR PERMIT TO�,,..... .'............... TYPE OF CONSTRUCTION ......;�.......: ...... �`�!� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: v S Location 'rj h...............�........ . .1//V/...................................... ProposedUse .. !" �4i?�! :., ..... f 5i /.. �`/ ". ` ....................................................................... Zoning District ..... .::?....,�;,�..................................................Fire District .... / h!�,//............................................. Name of Owner vas � ... !'7,/.!fin!/ . Address A.��... .Azw..S...i *Q:....//.4?, /`�/•1��4/1//1//-�r��'!�, y y Name of Builder Address .f�r. � QX , t7 G✓./G.h' /!!.1�• Nameof Architect ..................................................................Address ....../... .................�........................................................ Number of Rooms L-17- .�...�.� ...........................Foundation .<r �! :?... .,.�a�v ,Q��"T` .1%..V. Exterior Roofing ./...,,.. -17s4 ...a;]r !�. /! F...? w/ • !'�C,!J.+I�E'!/��K Floors ?!.!Interior .!r!! ??l......it s .............. .� n..... rf .... Heating ... � 11-14 �� ............. ...Plumbing , � . - .7 ` . ! .. Fireplace Cost0C/� � � ' ;ox Definitive Plan Approved by Planning Board --------------------------------19--------. Area ...�.... ...... . .. c� Diagram of Lot and Building with Dimensions ( 4,e U ..l��F.9,Q9�� ,S,y,�Er Fee ""`",'..-. SUBJECT TO APPROVAL OF BOARD OF HEALTH 1 � I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. l �, ;. l I Rudman, Dr. & Mrs. H. 17523 two story, No ................. Permit for .................................... single family dwelling ............................................................................... Location .. .....Tobey.......................Circle................................. Hyannis ............................................................................... Owner Dr. & Mrs. H. Rudman .................................................................. Type of Construction frame ................................................................................ Plot ........................ Lot .........4.58................ r December 30 74 Permit Granted ........................................19 Date of Inspection ....................................19 Date Completed ......................................19 PERMIT REFUSED ................................................................ 19 ............................................................................... ................................................................................ ............................................................................... Approved ................................................ 19 ............................................................................... ............................................................................... .r-.-.. .-n...,A.rd....+�..,�.r.=..�-+:.,,,�,:.n.:.,,wav ;s"M,' -'-i...../^^rb�5;k..�.{- i _deq•.�:rr,.�„>n,.trp.+.....*^•q.�'a'.'e,..-�r�,r^-.'?` +.-+.•„-y""-.` •'vim,,.-�.. R 14jN }ngyp t MRS H. e FEE $66.30 a " TOWN,. Q477 ARNSTABLE,' MASS. d°en { -THIS-IS TO CERTIFY THAT'A PERMIT IS 'HEREBY GRANTED TO. �_- " o _ A m � (PROPERTY OWNER) �IADD RESSI M $TtL I . ►gyp r f ► E � - (BUILD)- �,�: (ALTER) - (REPAIR) - A a cs VO .................... ......... - - .. _ ITYPE.OF BUILDING) (APPROXIMATE SIZE) - lot 04 Tobo C�.TIClt� HYillRti�i4 � A LOCATION .... _»__ ._».w ....y »_. _..._ _ ...... »..... ....... _....... ... d (STREET AND NUM ER) - (VILLAGE) As soesatcQ II Inc, NAME OF BUILDER OR CONTRACTOR � � APPROXIMATE COST � ._.. 83t wo y o I HEREBY AGREE TO C NFORM TO AL` L THE RULES AND RE ULATIONS OF THE TOWN OF BARNSTABLE, REGARDING THE ABOVE CONSTRUCTION. oMc ft3 _....._.......... ................_.»_._......»....»»................................................... p E1 (OWNER),; - _ (CONTRACTOR) 6 SamSe 0494 a r� F R iN PUILDING INSPECTOR Subject to Approval of Board of Health. J 1 ;.../:, � �'.� •ror�,�•�2 t`.:��`J.�.i.rs y:AJa •'.3 3a{.�."„z ,*?�' b .F*`� ."i{tl— �a!"�. ,�'..'.aS�'�+' '��I `..,a'.•" -;3'J ��Js ��,b3 T'� ' y,�*` ��-Y" SiS`�... E4 la..J.iCrj,�+„�-'.. �,.�, a 1 .• as y, �= r at • �, i s TOWN OF BARNSTABLE BULK RATE COUNCIL ON AGING U.S. POSTAGE PAID 198 SOUTH STREET NON-PROFIT ORG. HYANNIS, MA. 02601 PERMIT NO. 2 �/ _ l � � ��� r . e. `� 3 I � MEMO Date nec_ 240 1924 Joey We have received a Notice of Intent on the Rudman property- at Toby Circle in Hyannis. This means we will he Having a wetlands hearing on the project. Itlim all j+igbt t.rith nc if trynn_nrta=t the application for a Bldg. permit on the site now. Signed EFFIMENCY.UNENa2750 ANAMVADFRODUCT !� s,esso*s map and lot number .......................................... SEPTIC GyqTrM. COMKI Sewage Permit number :......... ................................... WIT�iz,ART1� MM ^.1.� if SiA7E THETo�y TOWN OF BAR d. HkE Z BABBSTABLE. i 01 9 �•� BUILDING INSPECTOR APPLICATION FOR PERMIT TO j ...............�l/!e4 .............. .f - TYPE OF CONSTRUCTION ..��!v4........ j 0�?y.....T l�! 1 [N�v ........................ .. ................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a ermit according to the following ' formation: Location .?�0/...... -!... ...................�� .. � �..`. ...... ./Y"f ................................................. ProposedUse ...................................................................... Zoning District ..... 2........... ......................................Fire District ...,r 1. l !y�.... ............................................. Name of OwnergjQ..�9!?!44 r°�5.:... ✓...../. l� N Address ... NO.IDS.. t��.. fPr.y.. .?�/4N!11�� �. Name of Builder A-60PG 47 .//VG..Address Pt.O.c..g®X 4b�..y./../��Q{a!`G Nameof Architect ..................................................................Address .................................................................................... Number of Rooms .Gf.7 .... .d... ..............................Foundation //���.,�1.. i CltSl.. l.!?!�e5 �r _ � W.(.a.C.COX........Roofing ..,����'-°....�h.'`/.t.✓��..�. .�.`.-.�N���/.4�iN E�r� AND,' G/,p1C n/aC416? � Floors d ..... `,'IA!nP.. iQA...E. .T....�..............Interior /L 4.1.....k14441................................................... Heating ..,=.Vi..1,4.... ....�,� .irk... ....................................PIumbing 4TEA. .. . Fireplace ...�..�..�...��...SQ�R. .��N.STiQf!�.�P�pproximate Cost ...C�Q. .. ... �—' Definitive Plan Approved by Planning Board ---------------__ ....�4 S�. -- - - 19 ---. Are .................... Diagram of Lot and Building with Dimensions(S,6Z— S �g,Q�T��j�E -, Fee ...... `�I....................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH / n t I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable'regarding the above construction. ........:.......NN../ SSoG: `NG. .f: Ritdumsn, Dr. & Mrs. B. ' � ' ' ~~ � �o ^~~�� Pe,n�hfor tww Vdwlin . ____..o��m�_. ..�a�l � Location �%--I�h§Y..���K���_ -- ' | ` ............................ ................................... = / Ovvne, ----- ^ / Type of'Construcdon ---fmmme...................... ' - '-------------------------.. � Plot ............................ Lot ---.�58.----.. ` Perm � x �,onn�o - - i ) ' i Date of . � *�w~`~~'�� Doha Completed ' �.� . ' � � , � w) PERMIT REFUSED ' ---------^----------- lp � --------------------.------ < -'------^-----------`-----^- � / ^ '-'------'—_------'^----'-^---' | � � --.------.-.---.--.--.,-.-----. . � ^roved~ ........................................... lV ^ -------------'------------- -------------------~--^^^~^- ` ' . `