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HomeMy WebLinkAbout0028 WELLESLEY CIRCLE J �- i � Town of Barnstable Building Post,This Card So That rt.is«V�s�ble;From the Street .Approved,`,PlansMust be;Reta�ned,on Job and this Card Must be..Kept� PostedLUntil Final Ins ection HaszBeen Made �3 r R :Where aN.Certificate of=0ccu anc, �s�Re u�red �uch�B.uildm sFiall Not be Occu- ied unt�I��Final Ins 'ection has lieen�made � Permit - ..«..:_.p�.Yc ,?•�qi;': `�..; :� �.. gpt..«..tp Permit No. B-18-2231 Applicant Name: Jonathan Whipple Approvals Date Issued: 08/28/2018 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 02/28/2019 Foundation: Location: 28 WELLESLEY CIRCLE,HYANNIS Map/Lot: 270-101 011 Zoning District: RB Sheathing: Owner on Record: DAWSON, LYNNE A Contractor Name JONATHAN N WHIPPLE Framing: 1 Contracto Licen a CS-078683 Address: 130 FARM DRIVE 2 CUMBERLAND, RI 02864 e ` y Est Pt� iject Cost: $4,200.00 Chimney: Description: Installation of insulation & Pe mit Fee: $85.00 � F. Insulation: F�eePaid '` $85.00 Project Review Req: ; Date 8/28/2018 Final: k� Plumbing/Gas �. !, Rough Plumbing: -< i. Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authcii�iieabj,this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application A&andl approved construction documentsfior wh ch this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shalDbe in compliance with the local zoning by laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street orroad and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. - :- r 71 � R Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire officials are provided on this"permit. Service: Minimum of Five Call Inspections Required for All Construction Work: x �.. 1.Foundation or Footing Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work sl eel until the Inspector has approved the various stages of construction. Final: "Pers s contracting th unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: � se� All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT f i commonwealth of Massachusetts = ' Constructlon Supervisor. Division of Professional Licensure Unnestncted :Buildings of any use group which contain Board of Building Regulation"sand Standards ' less Phan 35,00D cubic feet f991:cublc meters)ofenclosetl Conttrud cn twrvisor t Space _. CS495581 _ xpires:05/12/2020" IMLLiaM cAW-AHAN 175,QUINCYSHORE DR.y v �' r B81 �A.. 1 QUINCY MA 0217�1 . 1=ailureto,passess a cu(rent edition ofttie Massac6usetts State Budding Code jscause for revocation of'this license. For Infom�ation about this license _. Commissioner _: Cafl(617):T27-3208 ervisrfwww, ssgov/dpl G� Office of Consumer Affairs and Bus'iness'�Regu(ation One'Ashburton:Place = Suite 13U1' Boston;,Massachusetts 02108. Home ImprovementyContractor Registration Type;: Supplement:Carif EFFICIENTBUILDINGS LLC'` gistration`Re . 169944 P.O.BQX 246 Expiration: 08/18/2019- BRIDGEWAT ER,MA. 02324 Update Address and Return Gard. SCA t 0 2MA-05117 . ��C' ltr'tt)7IY71C.I1lt�Bp�fl G (:`lCfLijQ'CYItISPI�u:: ... . Office of ConsumerAffairs�Business Regulation: DOME IMPROVEMENT CONTRACTOR R RegLStration valid for;nd�vidual use only i YPEs Supplement Card before them iration date. if`found return to: Regi lion EX1Z flan Qffice of Consumer Affatis'and,Business Regulation ifig944 08118/2019. One;Ashburton Place-;:Suite:1301 EFFICIENT BUILDING81LC: Boston,`NIA 02108; i 300 ELM ST � �, BRiOGEWAfER;MA 02324` Ndtva{id without Sigrlatuce Undersecretary � v POVISMO JO NMOI J x gel 14/ � Ope— Town of Barnstable THE E Regulatory Services TOW/VOrRAR IVS Thomas F.Geiler,Director �J " '"R'''AN. ` Building Division �F1639. Tom Perry,Building Commissioner 1 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us � . Office: 508-862-4038 Fax: 508-790-6230 PERMIT#1 FEE: $ � SHED REGISTRATION RESIDENTIAL ONLY 200 square feet or less 2Y 1/1 eI&S11- Location of shed(address) Village Proll6rty owner's name Telephone number )2?� , 70Ilt,,1/ O// Size of Shed Map/Pa cel# afore to Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? If over 120 square feet,you must file with Old King's Highway Conservation Commis siorr(signatur� is re-quir_ed)____...— Sign off hours for Conservation�8:00-9-9:30&'3t30=4 30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION-'OR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg . REV:052813 Sys - _ �� N 40 7f3 `' S 4S Vl/ u �o r k'(3 c, 6ou O ' Zau� � � "• : _ C _ .. C, L t rs-` Z .1i.p' • PLAN CERTIFIED PLOT YA IV IN ad� ,,r, , ri^40q ' DATE_ �cf�g4 SCALE / FOVNGA7,Oti I CERTIFY THAT THE GE �Al� CLIEMY -�-- SHOWN ON THIS PLAN IS LOCATED REAI3TERE0 �z14S Off THE GROUND. AS INDICATED AtdO E�.IST�R Job MO. ,-.-.--- GONFORI�S TO .THE ZONING LAWS LAND � �' . .. _ __C I V_I-L_._.._-. -_--_ YOU WISH TO OPEN A BUSINESS? For Your, Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. to DATE: Fill in please: APPLICANT'S YOUR NAME/S: �`!G GS S o s_> o. I BUSINESS YOUR HOME AD RESS: tS�U � �.¢�� l,�c t lavc�nc�c MAr C7a�rrl TELEPHONE # Home Telephone Number SG NAME OFCORPORATI NAME OF:NEW BUSINESS :. '�ch T T1F ,;E OF BUSINESS. (N) IS THIS A HOMEi OCCUPATION? YES ' NO�~ � � , ADDRESS OF BUSINESS l...`1 s��r MX�P/P/aRCEL.NUMBER (Assessing) O 631 When starting a new business there are several things you must do in order to be in.compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING CO ISSI ER'S FICE This individ�l h� ep . f r o any permit requirements that pertain to this type of business. Authorized Sigrya re* COMMENTS: kyu r 2. BOARD OF HEALTH This individual has- en infor e t ments that pertain to this type of business. Authorized S' ature** COMMENTS: 3. CONSUMER AFFAIRS ENSING AUTHORITY) This individual ha be n informed f he licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: 4� 4", .:,,t„G,c"' � q-.ti'S�.,n,.'i�`4' ^r.'kt ,'+ 3 k'L.,i'i gY+ sFr;',a*, 4• , ,h�+�t- .k�.V,1+ t3f" ',yj.."L-*..'tt '-sf+y,rt + X.� �r y� f'' E ,d�{''k ,,..,,a..�Yay.��;F- hs �'' T �5 'C�' �j ..a a ,,; ` ,;«. �f'• r 3r..,.a 4..r S �?� .. i t,�V-> 'a n, TUWld OF BPiRNSTABLE, permit.No ' °27380�, � ,ding Inspector s aiuST.e, r, a Cash t t c , v, ^ k.'kPERMIT Bond 4 x+ r a ti Issued to C3LJr1CQrI1Real ' iS t.,. Address I,dtk 11;; �'28`FiJeT'4es'ley `Circle _Hyann�sL � - 4 R Whin Ins ector, f `� a Ins ection date g Plumbing inspector f; r , { ` Inspection date 'Gas Inspector Q �� .. Inspection date r v'a XEngireermg Department01. : ,�� � Inspection Board 7,of:Healthr� ;T�G2 % Y �f` Inspection THIS PERMIT,WILL NOT BE VALID, AND THE,;BUILDING SHALL -NOT BE~.00CUPIED UNTIL SIGNED?BY THE ZUILDING INSPECTOR? UPON •SATISFACTORY COMPLIANCE WITH TOWN '+ REQUIREMENTS ANDt IN ACCORDANCE'',WITH SECTION 119 0-Og' THE MASSACHUSETTS STATE `.t =r y �t x r,�'1 �`j:',�r .. `v �} i.•i -L*r y8' i 19 13uiMlna Jnspector x� a . V • - 4 - C� �. .f. a �Rs.•'• `E. .� , .i �._ .' ` s • . F •.� �•� TOWN OF BARNSTABLE . BUILDING DEPARTMENT TOWN OFFICE BUILDING rua. HYANNIS, MASS. 02601 MEMO TO Town Clerk FROM: Building Department �j DATE: An Occupancy Permit has been issued for the building authorized by Building Permit #.. r ........_.... .............................. ~ .... ...... _ . issued to ..........__......... G. �.� .:. !C Please release the performance bond. Assessor's map and lot number .G. y ; I�W 0X r0 &(�lLD,/7,9,ZM/T'/VEEP5D � COivN6t.7 � QypFTHET�y ti Sewage Permit number G.t ?fsa.�t�.art,l.(�... ....S. io <! P ER' MU T CONNECT TO TOWN SEW . :- Y r ! Z BARNSTAILE, i House number 4M r rasa - ......`.. ...... ,� °o k+. 039. + OppYOr' - ' z TORN "OF BA�RNSTtABLE BUItD.IHG INSPECTOR APPLICATION FOR PERMIT TO or� tt, �ogle : ���3: 3wtr3.lr�g 1 x t TYPE OF CONSTRUCTION .........WpO�•,�3 m@ ......................... z Sept ,� 4 TO ,THE INSPECTOR OF BUILDINGS: The, undersigned hereby applies for a permit.-accordirig,to`the following information's Location :.:Ito .:#....�. .... e11es1e�r.:.C.i�c�.�,.::�iya�nas, alas •.: ........................... :... hi Proposed .Use .........................:...........................::..:....... :::. :..:.. .....:: .......... w Zoning District . ...$ Fire* District` {{ • Hya'nnie . l Name of Owner Capr�lCrfY'YT"R$a Tr�,i Address* liTn'LT7;�1"'f�aradi .FIs1'c'LTaYi �; N 8$� Name of Build rx'83TC0 Real 'L,-,,$'�':'Dev-4-Ca'�Inc-iA'dd.ress ;. ap:ICt� y . Name of Architect ......'...:.:. :Address .......:...... ...... .......... . Number:of Rooms ... .•. Foundation ..s ..P. s Exlerior Roofing { ...0la �roard...an . .or. Sh -n eI :.. .... As • p: df gl �3��I�`Cc •Sf�ingl�$ .................. ...... ...:::Interior F ' Floors flY2@8'tY'OCk arPe. . ........ ti Heating.' :Ga$..... .. -:�.... .�'`�W-0-A.�. ........ ::...... Plumbing .. _ _ 'Tv�o `Copper .. Fireplace lYQrie .. . . Approximate-Cost .... .• Definitive Plan Approved by Planning Board __ _____ _______________19 ____,_. Area ::.. $Q. f'�• Diagram of Lot and Building with Dimensions• ° g g •. � ya Fee: •�`" .. ' SUBJECT TO APPROVAL OF BOARD. OF: HEALTHC7 �' r } �.# OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS. I hereby agree to conform to all the Rules and Regulations the Town of-Barnstable regarding :the above construction, Name ......................... Construction, Supervisor's License ........ ;AI?RrL--ORN REALTY TRUST owNo 27380 ........... Permit for ...One-Sto.,...................... ....... vI-Si�!v le Fami�y.p�� Ri q, .............. ............... Locption .....28 Wellesley Circle ........................................ ....... is.....................................I............ Owner ....... . �LpX.i.c.om..Realty Trust Type s...t.......... Typ,6 of Construction Frame.............................. . ........... ............ ................................................................... 77 Plot *....................... Lot. .................................. 7 , Permit-Granted January 3 .......I-9 85 Date,.O.,fdnspec Cjo/� ................ 9 Date CdMpleted Zf.i ...... 19 prs� 15Z C\) ' <5' 7a GS € _ N -- l t r - LA a 24 N 40 -t +� 4 tg w N 78 2S.,4S„ w a4 /vl oqu 5. . Al 78 " Z-57' -=ASS'14/ ' �1/zGLEsL y C I c..�.E CERTIFIED PLOT PLAN a yA A,�V/s "b IN a ,y : a SCALE, / `�:<19 DATE; a IE' EE' Giz�A�✓c v CI.IEMT I CERTIFY THAT THE /= -' I Al iit>A7/J 81STERED REGISTERED " "" SHOWN , ON THIS PLAN IS LOCATED d b CIVIL LAND Jo® NO. �2 .. ON THE GROUND AS INDICATED AND ENGINEER SURVEYOR OR,SY.l � '1 ' CONFORMS TO .THE ZONING LAWS OF BARNSTABLE, MASS. 7H YA IV t�t' MAIN S T R E.ET C)L DIY S, MASS S. l /! / �' ���-% :.�.,.�•,,_._._.__ `. 41MEET„�,' 0 A E REG. LAND SURVEYOR s 1 _—....—.mow..-..�-_.. , l//.o 0 Ph jj , 92��o ww t Q Z b — _ TaF F 0 _S N �/ lalao tu. 4rnw t \ \ Z o NL— J<.0 ` QV) LZ)/ N . Q �.0 2 a � o Y 2vop CQ b�J,yAt""j! p78 ' • y r10,.;FIr r c, f (3RUCE ELDFZE y . 1 + �vrJsr�Vc.rivn/ .!,\'S7 E LEGEND - ri EXISTIN® . SPOT ELEVATION OxO :EXI STIN0 CONTOUR --- O - - CERTIFIED PLOT PLAN �P�i. 1914ED SPOT ELEVATION Lo 7- we c.�.F� �-y Ci) . Ft0I�8NE-D ,CONTOUR O � Al r: NQTE• The location of any existing underground sewerage, wells, o.r other utilities shown on this plan is approx- IN y mate only as determined from records and/or verbal �Finformation. The contractor is responsible for the �1 •d�1..� J J } �erification of the existing locations in the field. SCALE# P/ 40 DATE 'DREDGE EiVGONEERIdV(i CO INN CLIENT I CERTIFY THAT THE PROPOSED POISTERE REGISTERED JOS NO, Y2-1 qS BUILDING SHOWN ON THIS PLAN a"t >° CIVIL LAND CONFORMS TO THE ZONING LAWS „ Y . EN©INEER RV DR.BY OF BARNSTAf3LE , MASS. `712 MAIN STREET CH BYE 7z.13`�- •a l HYaNNIS, MAgS. gNEET. Z, OF ._. DATE2KEG. LAND SURVEYOR .�.. ,• ,- .3, ;rY ' ...�f.r y�� rv/ �� � �,t��1�..7!>,>r t ..��� ��j� ������'t� �.Y/". •• ...art,,,.... •� Assessor's•map and lot number .......... !/.... . .:... ......... .�. *THE TOE ' Sewage Permit _nnuumber -fi Z BABBn98TAXE, i House number. .......................................................... r a 00 1639• \0� iOlE p IIPY p �. TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO Construct Single Family Dwelling ................................. .............. ......................... .... . .... ... .:. Wood Frame. - TYPEOF CONSTRUCTION ..:................................................................................................................................. r` September .........t TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information:. Location ..LOt...?#.... . ......................in).P121P l..r.13.rel9.S ..1�1:?a c . .M?Vic............. .. ProposedUse ...............................................................................:........................................................:.........:::: Zoning District R. B...........................................................Fire District .......HxAYlXliB ......... .................... i Name of Owner Truat............Address 265 Falm uth Road H Name of Buil .c.o...Re.al....E.st. De.v... !Address .............. m �............... ....: : . .. ..... .... .. ........... .. . . Nameof Architect ..................................................................Address .......................................... .................................... Number of Rooms .....Six....................................................Foundation ......, Cr .......&A. .... l Exierior ..Clapboard„andfor.,Shingle.15...............Roofing .............Aspha�..t...Shingles......................... Floors 4Y'p@t........................................::........................Interior .............wSYle.etx'01Ck; .;.::..... ..................... ... . �_ _ Plumbing ......�...... . ............�rAj�BE�x'..::: Heating Ga$......'.'.....F•W.A. ..................... g ........... - Fireplace NO1�@.................................................:......................Approximate Cost $40 ©00.06................................................ I. Definitive Plan Approved by Planning Board -------------------_-----------19________ . Area 0.r?6::.Rg,:e... t,•.......... Diagram .of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH r.. i OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations flthe Town of Barnstable regarding the above construction. Name .. .. eaa. Construction Supervisor's License ..000.989.................. CIAPRICOFU REALTY TRUST A=270-101 26 -le oll , 7380 One Story No ................. Permit for .................................... Dwelhn ..................... Locvion ...LQt.-11......2,8..WeUe5leY.. ...................... -MIA ......................................... Owner Capricorn Realty Trust ............ ...................................................... Frarre Type of Construction .......................................... ................................................................................ Plot ............................ Lot ................................ Permit Granted .....JdP:4arY..3z.............19 8.5 Date of, Inspection ....................................19 Date Completed ... ..................................19 i Town of Barnstable Expires 6 months from'sue de R IT Regulatory Services Fee snxxsres�. � � MAM Thomas F.Geiler,D 'n �irector Building Division Tom Perry,CBO, Building Commissioner TOWN OF BARNSTABLE 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X Press Imprint. Map/parcel Number t r. Property Address29 \ ❑Residential Value of Work ` Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address h-e 0- .( Contractor's Name Telephone NuZ r r Home Improvement Contractor License#(if applicable) �OQ� Construction Supervisor's License#(if applicable)j dS�Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner Cj'I have Worker's Compensation Insurance Insurance Company Name J l Workman's Comp.Policy# !/9tA � Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) _ i ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to *e-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side 2 f #of doors c Replacement Windows/doors/sliders.U-Value 4 (maximum.35)#of windows -0. '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 of the Home Improvement Contractors License&Construction Supervisors License is required: { SIGNATURE: A-Y C:\Users\decollik\AppData\Loca]\Microsoft\Windows\Temporary Internet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 I i I The Commonwealth of Massachusetts Dgwrtment oflndusqial Accents QKwe of Investigations 6#0 WashingtonStreet Boston,M4 02111 nwmmass gor dia Workers' Compensation Insurance Affidavit:Biilders/Contr-actors/EleCtricians/Ph mbers Applicant Information ( Please Print Legibly 1. Name(B ): ffiza acc ! 0<i6, Address: City/State/Zip: t L l s Mane Are Zam employer?Check the appropriate boa: ( Type of project(required): 1. a employer v nth 4- ❑I am a general contractor and I s have hied the sub-contractors 6. ❑New construction employees(full an P L). 2.❑ I am a sole proprietor or partner- listed out the attached sheet 7. ❑Remodeling ship and have no employees These:sub-cofactors have 8. ❑Demolition working for me in any capacity. employees and have wa s' 9. ❑Building addition [No wozkeers'comp-insurance comp-insurance-I, required-] 5_ ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am.a homeowner doing all wow officers,have exercised their 11.❑Plumbing repairs or additions myself[No workers'comp-omp- tight of exemption per MGL 12❑Roof repairs insurance required.]I c.152,§1(41 andye have no employees.[No wodws' 13-❑Other cramp.insurance required-] •Any app"fit$at that checks 6aa C�also 5ll out the section beYow showing theme tvoiters'caampEusetiom pethU mf metioa fi Y$o s who smbmd this affidavit imdfuning they are doing sly wa*and then hire o contisrturs mn submit anew affidavit indicating such tartars that cheek this box must stmcbed an additional seen showing the n—of the and state wbedw or mot ibose entitks have employees.Xthe sob-coataam haee employees,they nntst pm made their waike s'comp.policy number. .1 ant an employer that is prosi P wormers'compensation insurance,for my enW1qjwe& Below is the pact'a"job ske information Insurance Company Name: (� 2 Policy#or Self-ins.Uc.#: lLpiration Date: Job Site Address: � �� _ _ � CitylState zip_ L +Z- �U Attach a co of the workers'coin ensation o dedaratios (showing the number and expiration date). PY P policy Pam.( � lo�y� ��' ) 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 andlor one-year imprisonumak as well as civil pies in th,e form of a STOP WORK ORDER and a fie 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 Imreshgatioms of the DIA for insurance,coverage verification. I do hereby eer/tify atrdew tkapQins and penah'in of pediuy that the it formation provided alcove is trrreJs and correct Date: Phone#: rV / e2-T (M l� , Offidal arse only. Bo not write in this area,to be completed by ci.or toivn o ficiai _ City or Town: PermitlLieense 9 Issuing Authority(circle one): 1.Board of Health 2.Building Departmeat 3.City1l'owrn Clerk 14.Electrical Inspector 5.Plumbing Lapector 6.Other Contact Person: Phone 9: j 4 snarrsrABM ; A,� Town of Barnstable Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I I 4 ,as Owner of the subject property 1 hereby authorize (( 61^jig/ r 4b. to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Jo Signature of Owner Date Print e T If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decolliMAppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 r ass:tclt Ilse t'ts - of'Public ti:tfctr Board ul' l3uiltlin" Ilc-ulatittns and ,(antlartls Construction Supervisor License License: CS 102260 a Restricted to: 00 MICHAEL MEAGHER JR 97 EMERALD LANE MARSTONS.MILLS, MA 02648 o-- J"' ' 'y"'i''e-` Expiration: 11/5/2012 U.,fill ni,.i.,Ile r Tr#: 102260 - s '..c d `'"r;""En (•r +�,y-+^r-'•r r,rtt z ,�-ny, ,>:tiyya�+ .�•:..."7 ,. - +: ✓�1.�"�00I7iJ/6dlZfl�6��✓I�GQdJCGC�LU66�d •" I' Office of Con�umcrcAtfai'rs&Bifsiness Regulation . HOME IMPROVEMENT CONTRACTOR 1 _ Registration :1;62938 Type: Expiration;• 4/27/2013_— __. DBA — M A HER BROTHERS CONSTRUCTION MICHAEL MEAGHER\:JR :, } 97 EMERALD LN MARSTONSMILL, MA'02648 Undersecretary r Restricted to: 00 a�+ 00- Unrestricted 1G-1 2 Family Homes Failure to possess a current edition of the .Massachusetts State Building Code is cause for revocation of this license. Refer to: WWW.Mass.Gov/DPS . i l' ' License or registration vad�id foc?,.individul use only before the expiration date. If found return to: office of Consumer Affairs and Business Regulation r: 10 Park Plaza-Suite 70 +. Boston,MA 0211 'v Not v d without signature, { N ONLY Am, UED AS A MATTER OF INFORNIATtO NOT AFFIRMATIVELY OR NM ATIVELY AMEND,EXTEND OR ALTER THE COVERAGE ERC AUTHORI"/ED REPRESENTJC T1VE CA THE CERTIFICATE HOLDER NSTITUTE A CONTRACT,SETWEENTHE ISSUING INS{lRER(S)� dDUCER ' IMPORTANT:N t certlfia�holder Is. ADDITIONAL MSUR�EDe Te r n Iust be n or dais eaftlloeteAdvaFN no cm+ler riotp t°lho termcend eorrdld ft d1 the policy,cNdein poDdee envy xrdtlerde holdseo at such endoeeemel+l(s} CONTACT PRODUCER NAME: FAX PHONE FAX (AIC,No,E%* (AIC.No): OLDE CAP I*a COD WS A,GCY E-MAIL 296 1�� ... ADDRESS: - I _" . :PRODUCER • pp�'OMER ID rfi NNC at HYAtMN .JrAA n�61 INSURERS)AFFORDING COVERAGE 236RG I INSURER A. CRAVFstL riDDIN TT COMPANY INSURED INSURER B C��]ER CONSTRUCTION ...INSURER C: �1IFAG$.ER MiCHAEL BA A+fEA INSURER 0, INSURER E 97 DSTREEr.. INSURERF: MAii M9 ti MILLS.MA (12Crd 6 REVIRDN NUMBER: COVERAGES CERTiFlCA rE NUMBER: THIa la To CERTI�rIII��THAT.TNE POl1GEfi OF INGURnµcE.LIGTED BELOW HAVE BEZN INN TO THE INSURED NAlE2D ABDVE FORTFIE POLICY Pplloo INDICATED' NOTWfTHSTANDI rA THE INSU�RANO �R��BY THE POLICIES DESCRtI)ED HEREIN M SURJECT 0 ALLTHAMY CONTRACT OR OTHER DOCUMENT nETERMS FxGL[1sI0N9 AND CONDfTIONSEOFABUCrI OWCI6S. eR MAv PERT I , UElITG:HO?MI YNAVE BEEN REDUGEo BY PAID CLAIMS POLICY EFF oATE P.OUCY ERP PATE ADOLGUBR DDl INO�E 0tAyTm UTAIT S INeR . POLICY NUMBER IIE� YYYh ' TYPEOF.INSURANOE INBRWVD EACHbCCURRFJ•ICE' S LTR*. GENERAL LABILITY S. COM RCIAL GENERAL LIABWTY DAMAGE TO RENTED (E PREMISES a OccunPPa) C�IM9 MADE OCCUR. MED Ex(Any one pernort 9 PERSONAL A&AbV INJURY S GENERALAGGREGATE GEML AGG GATELIMIr APPLIES PER PRODUCTS COIANOP AGO ¢ POLIt.Y PROJECT IJ]C COMBINED SNGLE AUTOMOBI E LIABILITY LIMIT(Ea Bwldent) ANY 0 BODILY INJURY ALL. NED AUTOS (Par pnracn) 5 SCHE ULE AUTOS BODILY,IRFURY HIRE AUTOS (Per acc'vlont) S PROPERTY DAMAGE NON.IWNED AUTOS ;' (Per smiler q EACH oCCURRENCE UMS LLkLIAB OCCUR AGGREGATE S EXCE UAB CL 41M=MADE A DED TIBLE RE- I ION¢ WO STATIJTORYIJUITS OTHER WORK CDMPENsA'i10N•AND uB 4R ,Rsa-11 11/0EU201 I 11/oh2012 : E,L.EACH ACCIDENT $ 100.ODO EMPLOYE S.I.IABIUTV YIN . EL DISEASE-EA EMPLOYEE 3 100,0DO' ANY PR ITORmARTN0vEXECUT1vE N 500,000 os FIcEIaN[ .ERExCItmEDz EL,DISK&SE•PCLICY.LIMIT D [Wndmeryl NH). II yea,00900 Sny+r DE3CNIPTIO j OF OPERATIONS bolew DESCRIPTION OPERAM0NS&OOATIONSNE► cLESIRESTRICTIONSISPECIALITEM= . WD��t C0LV CPVM�ACgL [[IZSS Rr41w ANY PRION CP.ZTMcA*=Lz To T Q�17KC!& iz R0L DE APFB= G bffiAGFIER MI I IS co r- CANCELLATION CERTIFICATE HOLDER SHouLD ANY OF THE ABOVE DESORIBED POLICES BE CANCELLED TOWN OF' BEFORE THE EXPIRATION DATETHEREOF.NOTICE MLLBE DELIVERED IN If;Cc`FFAT K RD-' ACCORDANCE WrrHTHE POUCY,PRO%RSIONS, AUTH DRIZED REPRESENTATIVE. Charles 7:Cla rk MA.9FIP_EE MA 01649 19WE009 ACORD CORPORATION. AR rights reserved. ACORD t