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HomeMy WebLinkAbout0158 WHITEHALL WAY i�`� �-i��e�ha t t CUa�:,� . f T Application number.klz 71v Date Issued.....10.i11.r..................................... BAMsrmm NAM f0W Building inspectors.initials .... .......................... o Map/Parcel . ao .................................... TOWN OF BARNSTABLE ENPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION 'PROPERTY INFORMATION Address of Project: /6r tTAt'� wil-I NUMBER ST T VII.LAGE Owner's Name; i�SA� ?� Phone Number 6$=z?2 Email Address: Cell Phone Number Project cost$ Check ore Residential Commercial al OAR'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building pernut in accordance with 780 CMR Owner Signature: -xSee AN-��.BQ CQLI s- Date: TYPE OF WORK ❑ Siding ❑ Windows (n 7er ge)# ❑ InsulationlWeatherization Doors(no header change #_ ommercial Doors require an inspector',s review Roof not applying e( more thshingles) Construction Debris will be going to w as-E, M e,. Q g e -n _( )e yn-ed, MA CONTRACTOR'S INFORMATION Contractor's name ,4 Home Improvement Contractors Registration(if applicable)# //2-7 8-S' (attach copy) Construction Supervisor's License# 07`f 2 Y 7 _ (attach copy) Email of Contractor Phone number -!{o/-7 iz/-6 3 c 9 ALL PROPERTIES THAT HAVE STRUCTURd OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS[IV A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER................. *For Vents OnIV* Date Tent(s)will be erected Removed on Does the tent have sides?Yes number of tents total No Dimensions of each Tent (If yes please attach floor plan with exits marked) �_ Additional tent dimensions can be attached on a separate piece of paper. ------ Check one:this event is a: for profit non-profit event Check one:Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each te nt If f ood is beam seised at your event please obtain a® wealth Department approval between th f�:00am-9:30 am or 3:30 pm-4:30pme Commercial events may require mare Department a hours p tment approval Manufacturer# *WOOD/COAL/PELLET STOVES Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front=back ______left side right side HOMEOMINERIS LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand any responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the'down of Barnstable. Signature Date APAICANT S SIGNAT Signature Date 0 All permit applicad are subject to a building official's approval prior to issuance z � ............ SPECIAL SERVICES CUSTOMER INVOICE Pagel of 5 No. H2612-94581 Store 2612 HYANNIS Phone:(508)778-SM @� Yk 65 INDEPENDENCE DRIVE Salesperson:RHP4LE ' HYANNIS,MA 02601 Reviewer:VXG1123 Name KOUSAR TART REPRINT Q { (508)292-3616 Address 158 WHITEHALL WAY Phone company mime i cey HYANNIS Job Devervion "patio door install 2018-10-2616:23 $tAtO MA. zv 02601 couay BARNSTABLE INSTALLER DELIVERY #1 MERCHANDISE AND SERVICE SUMMARY ssooldrtservecustomers9r►ttlimttihequantitieso(merchandise REF# 101 STOCK M RCHANDISE TO BE DELIVERED: REF# SKU CITY UM-1 DESCRIPTION PI TAX PWa CAW EXTENSION R03 0000-274-257 3.00 EA 3/4'X4-1/2'X8'AZ K TRADITIONAL TRIM/ A o $26.26 $78.78 R04 0000-677-401 1.00 EA 3/4'X7-1/46X8'AZEK S2S TRIM/ $41.82 $41.82 R05' 0000-458-066 24.00 LF 11/16 X3-1/2 PFJ WM444 CASING/ - Y $1.94 6.56 R06 1002-961-477 1.00 EA 60X50'WINDOW&DOOR SEALING TAPE/ A Y $17.97 $17.97 R07 , 0000-715-499 1.00 RL MULTI-PURP 16'X48'ROLL INSUL 5.3SF/ A Y $5.48 $5.48 R08. 1001-361-475 1.00 EA 1/2'X 4-1/2'72'WW472 OAK SADDLE/ A Y $23.98 . $23.98 Rio 0000-570-469 1.00 EA DOOR HARDWARE 200/400-GLIDING WHIT / A Y $59.00 $59.00 R11 100 -049-623 1.00 EA PS510R FRAME WHT PART ONLY/ A Y $205.00 $205.00 R12 10011 493-642 1.00 EA PS51OR OPER PANEL SSG WH Y IA Y, $547.00 $547.00 R13 1001-493-553 1.001 EAl PS51OR§TAT PANEL 13BGaloftAf ONLY 1A Y - $647.00 $547.00 R14 1 0000-321-257 1.001 EA SCREEN FOR 200 P 51 R WHITE 1A I Y $139.00 $139.00 , v $1711.59 DELIVERY INFORMATION: IDELIVERY DATE:INS ILL SCHEDULE INSTALLER WILL DELIVER ME TO: SITZr0fWcWAI LATION 0101 AT TIME OF INSTALLATION. CONTINUED ON NEXT Check your current order status online at wwwAomedetwLconVorderstatus Page 1 of 5 No. H2612-94581 Customer Copy. Z SPECIAL SERVICES CUSTOMER INVOICE-Continued Name: TARIO Page 5 of 5 NO. H2612-94581 INSTALLATION #2 (Continued) REF#102 IMMEDIATELY.CANCELLATIONS WITHIN 72 HRS.WILL BE REFUNDED END OF INSTALL#2 TOTAL-CHARGES OF ALL MERCHANDISE & SERVICES Policy Id(PI): $2,405.60 SALES TAX $106.98 A:90 DAYS DEFAULT POLICY: TOTAL S2,512.58 BALANCE DUE $0.00 'The Home Depot reserves the right to limit/deny returns. Please see the return policy sign in stores for details.' END OF ORDER No.H2612-94681 Customer's5ignature / - Dater j Page 5 of 5 NO. H2612-94581 Customer Copp ol C 7,4 ttr x AV r 3 f Jz Iss ` �_• Tlie Commonwealth of Massachusetts v. Deparbnent of IndustrialAccidents _ - + Office of Investi ations I Congress Street,Suite 100 ' Boston, , _. M.4 021142017 www.mass gov/dia Workers� Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers Applicant Information 4 Please Print Legibly Name(Business/Organization/Individual): '. L 1�£-) &)a,)c Address: City/State/Zip: :ra ; E ,� • Lr iJi'G Phone#:Are you an employer?Check the appropriate bog: ❑ I am a general contractor and I Type of project(required): 1.❑ I atn a employer with 4. ,employees(full and/or part-time)." have hired the sub-contractors 6. ❑New construction 2.L'J I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have, g. ❑Demolition Working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp.insurance required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 l.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL I2.❑Roof repairs insurance required.]t C. 152: §44),and we have no employees. [No workers' 13.❑ Other �- comp.insurance required.] *Any applicant that diecks box#1 must also till out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all.work and then hire outside contractors must submit anew affidavit indicating such. . 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 sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providlno workers'compensation insurance for illy employees. Below is the policy•and job-site information. Insurance Company Name: Policy#or Self-ins.Lic.•#: Expiration Date: F Job Site Address: City/Siate/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. ' I do hereby certi ul)der the pains and penalties of perjury that the information provided above is true and correct Signature: c - - Phone#: s� Official use only. Do not write in this area,to be completed by city or town.vfficiaL 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#- Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Type: Supplement Card Registration: 112785 HOME DEPOT USA INC Expiration: 04/22/201�? 2455 PACES FERRY RD C-11 HSC ATLANF17A,GA 30339 Update Address and return card. Mark reason for change: O Address ❑ Renews! 0 Employment ❑ Lost Card - — Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Suflolement Card before the expiration date. If found return to: Reoishation Expiration Office of Consumer Affairs and Business Regulation i =— 12785 04/22/2019 10 Park Plaza-Suite 5170 HOME DEPOT USA INC Boston,MA 02115 ANDREW SWEETIf 2455 PACES FERRY RD C-11 HSC ATLANTA,GA 30339 Undersecretary d ithOu signature The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations s 1 Congress Street,Suite 100 _ Boston,,i'L4 02114-2017 `y www massgov/dia Workers'Compensation Insurance9ffidavit: Builders/Contractors/E]ectricians/Plumbers Applicant Information `�� Please Print Le 'blv Name (Bu:siness!Cr- n mrioatTndividual): 0 Pi 1/ D — Address: Citv'State/Zip: ShI` t� X • Phone#: 7 / 41 Are you an employer?Check the sypropri2 b Y: Type of project(required): 7 I am a empiover will 74• am a general contactor and I 6. rL7_New construction i !�. 'z employees(full and/or part-time).* ve hired the sub contractors i I atn a sole proprietor or partner- listed on the attached sheet 7. I17 Remodeling ship and have no employees These sub-contractors have g, L Demolition wor-. �j�g for me in any caps�' emojovees and have workers' �-rp 9. Uj Budding addition [No workers' ;omp.insurance comp.insurance.- � n �. We are a corporation and Its I0.,J Electrical repass or additions 3.C I am as homeowner doing all work officen have exercised their i 11.7 Plumbing repairs or addittons myself. [No workers' comp. right of exemption per IVIGL 1=.❑Q/Roof. :ss --- - it;surance required_] t C. I52,§1{4),and we have no 13.i v' Other 0"— - + employee. [No workers• i n comp.insurance required_] 11 1 l &0--ttfVl J •Ar:y apniicant La:checls box e,must also fill out the section below showing tbeir workers'compensation policy mforr6bon. .homeowners who mbmitthis affidavit indicating they are doing all work and they hire outside corttraetars must submit a new af5davu indicating such. :Cortrzaors that check this box must attached an additional sheet showing the name of the sub-contractors and stare wbether or not those entities have =ploytes. :f the gush-cantractost have employees,they must provide their workers'comp.policy amnber. I ain an employer that is providing workers'compensation insurance for my employees. Below is the policy and job sire _ infunnation. Lmm—mce Company Name: r Jar Q. o y4.� !/N!��✓ r'//`L �it�s t.9 _ Policv A or Self-ins.Lic-#: !� W (ti 7 0 7 ��% E�tpiration Date- Job Site Address:/ / O W!/�� _, City(s-cater'Zip Attseb a copy of the workers' compensation policy declaration page showing the policy number and expiration date). Faihlre to secure coverage as required under Section 25A of M- GL c. 152 can lead to the imposition of crimbal penalties of a fine up to$1.500.00 andbr one-v imprisomnent,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250-00 a day . st a lator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DL9 ce coverage verification. I do hereby certify un a at the information provided above is true and correct Si atumre: Dat e: Phone T: � — Official use only. Do not write in this area,to be completed by city or town of jiciaL Citv or Town: PermitlLicense# Issuing Authority(circle one): 1.Board of Health Z.Building Department 3.CityPTown Clerk 9.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone t=: DATE(MWDDNYYY) AC� CERTIFICATE OF LIABILITY INSURANCE 02/222018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY.AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER-THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY.THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAM MARSH USA.INC. TWO ALLIANCE CENTER PHone FAx Alt No 3560 LENOX ROAD,SUITE 2400 E-MAIL ATLANTA.GA 30326 ADDRESS: INSURERS AFFORDING COVERAGE NAIL 8 CN101642069-HomeD-GAW-1&19 INSURER A:Old Republic InsuranceCo 124147 INSURED THE HOME DEPOT,INC. INSURER B:New Ha shire Ins Co 23841 HOME DEPOT U.S.A.,INC. INSURER c:HomeRisk Captwe Insurance Company 2455 PACES FERRY ROAD INSURER D BUILDING C-20 ATLANTA,GA 30339 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL•OD4353439-16 REVISION NUMBER:3 THIS 15 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. ZGEWL ADD SUBR POLICY EFF POLICY EXP LIMITS TYPE OF BiSURANCE POLICYNUMBER MlWDD MIDMMERCIAL GENERAL LIABILITY MWZY312717 031012018 03M12019 EACH OCCURRENCE S 9,ODD,000CLAIMS-MADE aOCCUR A NTED LGDD.000 C I PREMISES Ea acwrrence S EXCLUDED LIMITS OF POLICY X MED EXP(Any one pl rsonj SOF SIR:$1 M PER OCC PERSONAL&ADV INJURY S 9.000.000 GGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 9.000.100 ICY PRO- LOC 9,000,OGGJECT PRODUCTS•COMP/OP AGG S S ER: A I AUTOMOBILE LIABILITY MWTB312718 031012018 03/012019 CEOaMaBaI d-11 INGLE LIMI7 S t.00G,000 h X ANY AUTO BODILY INJURY(Per person) S OWNED 1­11 SCHEDULED i SELF INSURED AUTO PHY DMG BODILY INJURY(Per acadent) 5 w - AUTOS ONLY AUTOS HIRED NON-OWNED I PROPERTY DAMAGE S w> AUTOS ONLY AUTOS ONLY Per acudenl 1 S UMBRELLALb4B OCCUR EACH OCCURRENCE 5 EXCESS LIAB CLAIMS-MADE AGGREGATE S DED RETENTION S s B WORKERS COMPENSATION WC 014122577(AK,NH,NJ VT) 031012016 03!012019 X PER OTH- STATUTE ER B AND EMPLOYERS'LIABILITY YIN WC W4122578(WI) OWDI2018 031012019 5,000,01M ANYPROPRIETORIPARTNERIEXECUTNE E.L.EACH ACCIDENT S OFFICEWMEMBEREXCLUDED7 NIA - 5,000.000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE S 0 yes.describe under Continued on Additional Page EL.DISEASE-POLICY LIMIT S 5,000.000 DESCRIPTION OF OPERATIONS below C Excess Auto 297-1-10011-00-2018 031012018 031012012 Urns 4.000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101.Additional Remarks Schedule,may be attached if more space is required) EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION HOME DEPOT USA,INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 2455 PACES FERRY ROAD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BUILDING C-20 ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA.GA 30339 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukheryee �ta�tiQo� 1 01988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are rogistered marks of ACORD a AGENCY CUSTOMER ID: CN101642069 LOC#:. it ,4c Rom® ADDITIONAL REMARKS�-� SCHEDULE AGENCY Page 2 of 3 MARSH USA.INC. NAMED INSURED THE HOME DEPOT,INC Poucv NUMBER HOME DEPOT U.S.A.,INC. 2455 PACES FERRY ROAD CARRIER BUILDING C-20 ATLANTA.GA 30339 I NAIC CODE ADDITIONAL REMARKS EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Workers Compensation Continued: Carrier.Indemnity Insurance Company of North Amence Policy Number WL^n C64783151(AL,AP.FL ID,IA,".'Y,LA,;iS,MO NE.N.";,ND,OK,SC,SD,TPJ,WV wy) Effective Date:0310112018 Expiration Date:03R11/2019 (EL)Limit:S 1,000,000 Camer New.Hampshire Insurance Comparry Policy Number.WC 014122576(DC.DE.HI,IN,LID,MN.MT,NY,RI) Effective Date:113101/2018 Expiration Date:03111112019 (EL)Limit:S1,000,0DO Carrier ACE American Insurance Company Policy Number.WCU C64783221(OSI)(AZ.CA,IL,NC.OR;VA,WA) Effective Dale:03/Di/2018 Expiration Date:031012019 (ELJ Limit:S1,00D,00D SIR S1,000,000 SIR for the states of AZ.CA,IL.NC.OR VA,WA Carrier.Nations Union Fire Insurance Company Policy Number.XWC 4595580(OSI)(CO.CT.GA.ME,MI,NV,OH,PA.UT) Effective Date 03/01/2018 Expiration bate:03101/2019 (EL)Umil:S1,000,000 S1,000,000 SIR for thestalas of COME NV,fdl,OH.PA,UT S750,000 SIR for tha stale of GA S350.000 SIR for the state of CT Carrier.National Union Fire Insurance Company Policy Number.XWC 4595581(QSI)(,W1) Effective Dale:031012018 pp rp Expiration Date:03/D12019 (EL)LimiCS1,000,000 ,YL SIR:S500,000 TX Empoyers XS Indemnify. Carriar0linios Union Insurance Compam; Policy Number.TNS C4916693A(TX) Effective Dale:03/012018 Expiration Date:03101 019 (EL)Linw:SiQOOD:ODD SIR:S1,000,COD XORD 101 (2008/01) 2008 CORD CORPORATION: All rights reserved. The ACORD name and Jogo are registered marks of ACORD 6112 z ��- �TKE T wn.of Barnstable *Permit# P� �{• Eapir nths from' ue date Regulatory Services F 9� nsass $ SE� 3 Q Richard V.Scali,Director a ATFo . SCAB B IBNO uilding Division . Tom Perry,CRO,Building Commissioner 200 Main Street;Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY l./I of Valid without Red X-Press Imprint Map/parcel Number Property Address ( �� Residential Value of Work$ Minimum fee of$35.00 for work under$6000:00 Owner's Name&Address Llj u-✓C- fiq tl 16 � \ Contractor's Name --- Telephone Number 6 91 23� Home Improvement Contractor License#(if applicable) T l Email: D��� SS G� 'l c:C,9-r-• Construction Supervisor's License#(if applicable) G j ❑Workman's Compensation Insurance Check one: , ❑ I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name�1,n A,,L k Workman's Comp.Policy# 44 P 0 J (2 e- 6`0 .4 0 O j Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ' # JX Re-roof(hurricanenailed)(stripping old shingles) All construction debris will be taken to �6� L,0554- ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value ` ' (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,.Conservation,etc. 'Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is requir d. SIGNATURE: Q:\WPFILES\FO uilding permit forms EXPRESS.doc Revised 061313 ... - . --- -•-- -_.. Hie Cr7i~ mo mff_�of�assachmsetts e lrl exrt rr�`�'tu�s Accidents -- 0e rfr r a izggatiens 6001% aylking€on Sheet Rastarj,MA 02LU wnju7namgov1dira Workers' Compensafion Insurance davit:$liilder-JConfra;ctursMectricmnMumbers tplica>ort Infer afian Please Print L�iby Name( 101pnizalian,dvidnaq= A4 tf�f/�. lm S Address- uf- 5&7dw G, 17,v • e72,S7.7- City{5tat�elZip_ j- - 07 Phone 4 -7 A Y7-Z�, 3 Art you an employer?Check.t�approppriate box: p? I _I l El I am a employer with _ Mnant 2 l confracfar and I 6: ❑New r +,tl„ on employees(full antltor party me)* have hired the sub=contractors. I El I am a sole prnprie#�tr or paitner listed on the allwlied sheet 2- ❑Remodeling strip andhaire noemployeesThese sub-contractors have. $_ ❑Demolifi�ou w forme in an ci �_ employees and have woEicers' ork�-ng y capes i� 9: ❑Building addition 6 workers,C6Snp,in�7ETanF'e comp_inSnrancel .. 5_❑ We area corporation and its lfl_.0 FL-_:trical repairs or additions I am a homeowner doing all wad. officers hanm ❑ g rep al their I1_ Plumbia airs or additions, 3_❑ Myself.[No workers'corop- �tt of exeatpfionper MGL 12_0 Roof repairs immninre required]I c-152,§1(4),and we hati�e no empl'�Y�-[Na Viers 13-®Other comp_insurance require4,] 11xty avp nt that checks boa rl taus#41:o fill out the section below showing tbea Vo&e1s'compensidon policy iumrm #��H�n�m��ea�wness who submit this sfiidavi2 in3icstzxg they are doing aR-relic and dteo hire outside contraemrs remit submit R new a�adavit m.rrs9 MrTi "t.(lotc&cturs that rhprk this h}wc n=q 3tiarhed an altiltional sheet sh wmg the ymne-of the sBbFCotQ23tmrs and st—whether oEnQt Those Mrtit1Ps h� ?mpIvyees_ Ifthe snlr conttactms hn a empIbyees,they must pravide their warke4s'tamp_policy nttothes lam an employer ifird isprm iding it�orke_rs'conqwLvatio.n im4rance for my empioyeeu BeIarr is the paHc,}an.d}ob cite informizfian . Insurance CompauyN=e: P-olic-y 4 Cr Self ihr,Lic-497 Fxpiration Date: .Too Site Addtess: CitylstatelZip= Attach a copy of the workers'comp eusatitm policy dedAration page(sh-owing the polio}namber a'<rd expiation-date). Failure to secure-coverage as reg6red wider Seeticn 25A cf MGL c 152 can lead to the impositim of criminal penalties of a fine up to$1,50D-OD andlor one-yearimpriscnment,as well as civil penalties in the form of a STOP WORD ORDER-and a fine ofup.to$250-00 a,day against the violator_ Be advised that a copy of this statement maybe forwarded to the Office of Iti estigations of the DIA for M- SMAnM cot,Arage V1=ffit°ati0n_ d correct Fdo#crreby certi rrder tks �71 � ttas alfper�ur}'fhatfhe rzfnrmaiianprm cif abrrt�e is kur n Signattxc: Date: Phons#: . 34 -7 )—_33 Qfzciai use only. Da no-t-write in th&area,to big crrr p&ted by ci47 or town officiaL City or Town PermitlLiceuse# Euuing Authority(tdrde one): 1.Board.of Realth ?.Building Department I CitTIFowa C2erlt 4.Electrical Inspector S.Plumbi ig hmpecter. 6.Other .. Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto this statute,an.ernployee 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 Iocal licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance.coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the.periormance of public work until acceptable evidence of compliance with the insurance. requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their 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 insin-ance_ 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. 11e 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 requiredio obt=ii a workers' compensation policy,please call the Depatment at the number listed.below. Sell 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 perm/license number which will be used as a reference number. In addition,an applicant that must submit multiple pemit(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"ail locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be;filled out each year_Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i_e.a dog license or permit to burn leaves etc_)said person is NOT required to complete this affidavit The Office of Investigations would 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. Tnc Loan ouwmalt�of Massachusetts Degar{mcnt Qf Industrial Accidents Qxce ofu-esfig�ttxa�s 600 WashiDZan Street BostQnz IAA G21 I I .Tel.A 617 72 - ,9 0-W 406 4r I-S Revised 4-24-07 F=#f 617-727-7749 9/24/2014 7 :31:06 AM PST (GMT-8) FROM: 100005-TO: 15087906230 Page: 2 of 2 ® DATE(MM/DDt YY1 I, AC_.O CERTIFICATE OF LIABILITY INSURANCE 9/24/2014 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 endorsements . PRODUCER MARK SYLVIA INSURANCE AGENCY NAME:ACT - 404 MAIN STREET PHONE FAIX CENTERVILLE, MA02632 EMAIL° �"t ac Ivor ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: LM Insurance Corporation 33600 INSURED - INSURERB: - JANIL B ARRUDA 56 TOWER HILL ROAD INsuRERc: OSTERVILLE MA 02655 INSURERD: ( INSURER E 1 INSURER F COVERAGES CERTIFICATE NUMBER: 21711472 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 ADDL SUBR POLICY EFF POLICY EXP YY LIMITS LTR INSD WVD 'POLICY NUMBER MM/DD/YY MM/DD/YYYY COMMERCIAL GENERAL LIABILITY - - EACH OCCURRENCE $ DAMAGE TO NTED CLAIMS-MADE OCCUR PREMISES Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY ECT LOC PRODUCTS-COMP/OP AGG $ PRO F OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS t NON-OWNED PROPERTY DAMAGE $ " HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUREACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION $ A WORKERS COMPENSATION " WC5-31S-363081-023 12/28/2013 12/28/2014 sTATUTE ERH AND EMPLOYERS'LIABILITY - - ANY PROPRIETOR/PARTNER/EXECUTNE YFy N/A EL.EACH ACCIDENT $ 100000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 100000 If yes,describe under - DESCRIPTION OF OPERATIONS below -- E.L.DISEASE-POLICY LIMIT $ 500000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES.(ACORD 101,Additional Remarks Schedule,may be attachedif more space is-required) r�a Workers compensation insurance coverage applies only to the workers compensation laws of the state of MA. THE WORKERS'COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR JANIL B ARRUDA i_ This certificate cancels and supersedes all previously issued certificates,only as they relate to workers'compensation coverage. „ wA CERTIFICATE HOLDER CANCELLATION TOWN OF BARNSTABLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES.BE CANCELLED BEFORE THE EXPIRATION 'DATE THEREOF, .NOTICE WILL BE DELIVERED IN BUILDING DEPARTMENT ACCORDANCE WITH THE POLICY PROVISIONS. 200 MAIN STREET HYANNIS MA 02601 - - AUTHORIZED REPRESENTATIVE - - r , � �. -i�r Wit.�. • LM Insurance Corporation '©1.988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD _ CERT NO.: 21711472 CLIENT CODE: 1649676 Anne Chandler 9/24/2014 10:29:47 AM (EDT). Page L of. L. Client#:42347 2LOPESALI ACORD. CERTIFICATE OF LIABILITY INSURANCE UAT D/YYY1f7 05/01/201/2014 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 NAME: Dowling&O'Neil PA/C"No E:t:508 775-1620 FAX (A/c, , 5087781218 Insurance Agency E-MAIL ADDRESS: 973 lyannough Rd., PO BOX 1990 INSURER(S)AFFORDING COVERAGE NAIL# Hyannis,MA 02601 INSURER A:National Grange Mutual Insuranc INSURED Alessandro Lopes INSURER B:Associated Employers Insurance 9 Timber Way INSURER C: INSURER D: Sandwich,MA 02563 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 CONTRACTOR 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. LTR TYPE OF INSURANCE NSRL WVD POLICY NUMBER MMSUBR /DD EFF POLICY EXP LIMITS A GENERAL LIABILITY MPT0605H 1/28/2014 01/2812015 pEACHOCCURRENCE $1 000000 X COMMERCIAL GENERAL LIABILITY PREAGE SES EaE ence $5O OOO CLAIMS-MADE FX_1 OCCUR MED EXP(Any one person) $1 O 000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY jE OT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATION WCC50050117132014A 1/28✓2014 01/28/201 X WE RYLIMI- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECU -Y/N E.L.EACH ACCIDENT $50O 000 OFFICER/MEMBER EXCLUDED? a N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMrr $5009000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Town Of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ew..�. ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S129889/M129827 KKM oF�rots 1 59- � Town of Barnstable ''Tfn rrw'�a Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 5.08-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, )ZnQSAV -- 4 , as Owner of the subject property' hereby authorize SSG3,-i. � -s to act on my behalf, in all matters relative to work authorized by this building,permit application for:. (Address of Job) Signature of Owner Date 5—rint Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. Q:IWPELESTORMSCbuilding permit fomisEXPRESS.doc Revised 061313 I Town of Barnstable Regalatory Services P�oF'THEr°tyy Richard V.Scall,Director )Building Division snaxsrascE Tom Perry,Building Commissioner MASS. %639. ��� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 568-862-4038 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:\WPFILES\FORMS\building permit forms\EXPRESS.doc . Revised 061313 I Aussaichuseft �!# r me public sate ` oo . . i & , Regulations . ` IV ` p T� in yyJ1i1 'A e P - 9 1t CON r p at .LSO L LE i C • .. e SANOWJCH MA - itilime a �a ' A di e4}^S�` "q "•. '±sP.N,;�+F'�n+l�;iw+- . / �.w'`#y�fit, '.",""ilaoR` '.� ♦ ,F � q� "�'�' • �°��ue +fpy Y ,,�` s�'�,�'w -�,ur ' + .,.d x ^xar :�.a ti wF; � ".a+•. �.,.'r�'wa �"W4�" r -,err �Yf,.r`�'!�° �e,,x , �-•f-" �r ' +m x� �" L �'" 'gyp *�t ,w.m -. '€i"h'`"`t��4 e''?�``# �x, g �^w'4-m�.,,,(�� �Mt�r��r'� .'�.q,.� 'yii r" ks 'M" ,�z �1 f�44+� ������ � „`u'L�; #,y'�K� dt={' S`��"�'�'Tx'aFarSr�"'1 w.,: »�,�q,"`t °�F��•. .>.-- c'�"" f, d�^+a.�y"'S�,. t '.� �^� � ..'m4§� +Mtn y +1�'k "�+'' ��•'aia� �,�" �t v?�' �,, � �;*"«�` �,✓1+���='°k'x€,� .��� �.�..,a.�5.��'+#+iy„ �4. w%)c.,"��a•f k ,; a4c" �. i.-. a-` .fie T" �y,�, Aid fa mid Ja, Ric Coos'�(�, , '. 4 `.� - •tea .,._ .'� .Y° :N. .::^ k J,a:+�. - �L -..•-'�,,�,r. - . d' - Y � :,..w j'y •x- ...:w�}, -+;sm' 'I'" i/ ,F '�ww+ _ .� ao/w, ✓ritW%ciw9�'wy�.'Y�4YNrcAa _ - r : 35 ,9 �4 cn � 4 era Fk k n TO �-�' @:t. � � - a :�• k. $ {�^ �^_Say' as ;�a. „�� Ot Tot Won ns 4 � r � �,r5 � "r'-w•" who 4.t E"Cw�e .. '.v 4+14, 'a, 3 w-,k _ -gr' `h �.i... ay,a�s, "► :.�y7 ., t j�Z;'. ��,J U �VE r, The Town of Barnstable Department of Health, Safety and Environmental Services MUMAttt.E. * Building Division KAM 1659. 10�' 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph M.Crossen Fax: 508-790-6230 Building Commissioner Home Occupation Registration Date: 2*1 ( �9 7 Name: m�K J. Sr9-6',� C m3 S-2.rV I CQS,I Phone ft• -]c�' _1 �O�- Ij F Address: l�tJ �J0 Jh Rj1a-d v>ilage�_ N CLh r` Type of Business: Mapa ot: aka I J 01 INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling there shall be no increase in noise or odor,no visual altereuon to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of tight subject to the following conditions: • The acclivity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling-which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pickup truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit I,the undersigned,have read and agree.with the above restrictions for my home occupation I am registering Applicant % �t u wX Date: 4-4/ 7 f. -Hnmenr finr x - s� •j it Hv" i a r,_ �. .x r a ol t pp 1 t� at4 ' t L✓H/TE Hal L L VA Y DE `mow h 9 5 1k ,CDT 3� L.oT 36 � I L0 3:7 `° •" ``: t3 , iso�,o s f o h Q h e 49 qz { k ' h Lo/ 2f3 407' 27 1or 26#" tau r� �e y ��. [ e� •�fytiE�(:s "I �4. 3 �r l SI�4 y{Yy l CERTIFY THAT THE or SHOWN ON THIS PLAN. IS '+c� Q w PAUL A' �o LOCATED ON THE GROUND r o LEVY s AS INDICATED ,• ,.a � " NoI0617k�� ,�� SP DATE R Gi. TERED LANDS LEVY 8 ELDREDGE ASSOCtATEs� cLiENT�, �r� L.0 Tt x� © Lo 3� ALL 9%Y Wi ENGINEERS - LANDSCAPE ARCHITECTS JQB, NQ• l,✓�1/ Pt.ANNERS-- LAND SURVEYORS DR, BY �•SL lP� u -� 4. WE , MAIN' MEET F �',.....�,.,.,�. ', mks •� i 1we 77 M .. 8 act.[KOK 13 )L Assessor's offioe (1st floor): ��L �a _ SEPTIC SYSTEM MUST o Assessor's map and lot number %`'� ` � T Go.s� ANSTALLED IN COMP Board of Health.(3rd floor): WITH TITL19 5 . Sewage Permit number ................................:......al..a. Z. �` AWLE. . ENVIRONAIIEN'TAL CO , ^�pt639 Engineering Department Ord floor): J .f S _ ,b� ♦� House number ........... r` � ............. . . .` TOWN REGULATI o�AY a� APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00.2:00 P.M. only ;- i TOWN ;OF B kRNSTABLE BUILDING --INSPECTOR APPLICATION FOR PERMIT TO ....��)�I�S �(.P.dz) 1. . • TYPE OF CONSTRUCTION .....Z4jd O.Z. e......................................................... ..................... ................... .5.....,9:. TO THE-INSPECTOR OF BUILDINGS: The uncle r/9;. herb applies for rmit ac ordin to the follow' g information: Location .. . .............a�.C�7........L /. .!/ ` ��./(...... ... ..... ... /.C( ............................... Proposed Use, .. f...... .... .l.e.....!...C�t..�Y�/../ ..................................................................................... ( ..................Fire District ..... '. .�k ...........I..5 Zoning District ........ .. ...... ............................... r�1 r1 . . ......... .... i � r Name of Owner ..; .�� .. f.�VLC�.� ... .....Address ..�i.,u.�..... a�4..5 ' :.(/<ll Name of Builder .. ./........�........................................Address Name of Architect ..................................................................Address Number of Rooms ......1:9......................................................Foundation ...idn . l('. . Exterior ....... ...1�si�.. .. Ce�S..:. ., ... .C... s.....Roofing ..w . . ..f�l .l.. ... ..................... i r Floors ..f. .. . ..1..... .:.�ca ��� ... ......................Interior ..y .. .... .e.. .. 4!. /(1C.................................... C Heating' .....1....... ... ::. C'uS.. .........Plumbing ........ �j.... :�1�. ..... �.?... i4 ................. .. . Fireplace ..................................................................................Approximate Cost ... .............. . . Definitive Plan Approved by Planning Board ________ _ sZ?_____19 Area ..... �P.. Diagram, of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH C C�L ' ; , V . OCCUPANCY PERMITS REQUIRED. FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .... .. .......... ..... ...4:2 � Construction Supervisor's License .�.�.. ........ ... 4�y GRr�ENBRIER CORP. � No ..3,111 L Permit for ..1.z...S,tory.............. Sin ie Family Dwelli�-�c� ....... ............................................................. ,. Location .LQt....46. ,,,.,,•158,.....Whi .ehail Way t .............11Y.ZA xla i n................................,......... Owner ......:Grf�enprier Corgi.................... { Frame- Type of Construction ........................................... _ .............................................. ............................ Plot ............................ Lot ............................... { Permit Granted ........Augup'q...�5.........19 87 `. Date of Inspection .................... ... :......19 ` � �� 19 Date Complete _.... .. ..`...... ., � lu ✓ jA 4 , Assessor's offioe (1st floor): Assessors ma and lot number /� F?NE T G O Sf �o c� Board of Health (3rd floor): Sewage Permit number Z SAUSTLUE Engineering Department (3rd floor): )5--� �15 oo MAM 0� Housenumber ........................................................................ �Ep MAI a� APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00.2:00 P.M. only TOWN " , OF ,- BAIRNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .... !? �C v C./, .../.. �f //1'.11.�il......................................... TYPE OF CONSTRUCTION ...../ ��..D..0 ..... C��/�'1. ................................... ............................................ ........................ , ..7.....19..0..� TO THE INSPECTOR OF BUILDINGS: " The undersigned hereby applies for a permit ac ordin to the following information: Location .. .................. ,.. ........&.. ../ ...!.. .... ........��../.......vl....J.Q.L1...1.!...(....... I... G i'I C- ProposedUse ..:_ G./ ......!.. ..<<.. 1.. ............................................................................................................... l .� Fire District .. !'1 n Zoning Distract �.............1................................................. � !� ....��............l...S................. . . . ....... Name of Owner �C ' ) Nameof Builder ........................................Address .................................................................................... Nameof Architect ........�.........................................................Address .................................................................................... Number of Rooms ......� :1......................................................Foundation d,C ,l-(� �d.? ��..��'. i ........ r l YExterior .... t � 1. ........!. ,5... ../C.. ..........S...Roofing .. ......1✓�C ... � .• �...I................. Floors ....�. ..c�.lrt.... (. C G�. ...��... ...................Interior .. .. .ee......� c�. .� .................................... .. ...................... Heating .....!......1. 6 ^ 3 ........Plumbing ......... 1--/1 t/1�I . . .......................... ,.�n................,..................................... �j Fireplace ..................................................................................Approximate Cost ... S�. _J ............................... Definitive Plan Approved by Planning Board ________ -4e�CAgcZ>_____19 Area .......................................... Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH 5 lr. OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .... ...... ` ....................I... ... ..... 4 Construction Supervisor's License .'(.1............/....... GREENBRIER CORP. A=272-005 No 31119 Permit for ..j.1...StorY............. Sincrle...Fami.ly,..:Dwelling,..,,..,. Location ....Lot #36,......1.58, Whitehall Way .................Hy,ann i S............................................ Owner ....Greenbrie.r...Corp...................... Type of Construction ......Frame....................... ............................................... ............................... Plot ............................ Lot .............................:.. Permit Granted .....August 25, 19 87 Date of Inspection ....................................19 Date Completed ......................................19 tNfT TOWN OF BARNSTABLE..', 31119 Permit No. ................ BUILDING DEPARTMENT a TOWN OFFICE BUILDING `Cash .......... 679• t* � �'fa 4Y�• HYANNIS.MASS.02601 :'"�, Bond ...... CERTIFICATE OF USE AND OCCUPANCY Issued to Greeebrier Corp. `awl Address Lot #3 6, 158 Whitehall Way Hyannis, Massachusetts USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. October 24, 88 Building Inspector TOWN OF BARNSTABLE BUILDING DEPARTMENT i Bsaaarasz rua6 TOWN OFFICE BUILDING 7 .639. HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department DATE: /D1/71"- An Occupancy Permit has been issued for the building authorized by BuildingPermit $ ...�-3///.5-. ................................................................................................................................ issued to ....... f E'! sari` r.` . /'. ..... ..:•3rs'....... /J—P........ 4Jif y Please release the performance bond. THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA __ �. BUIL®IIVGb-.PERMIT " TOWN OF BARNSTABLE, MASSACHUSETTS DATE �'G•I �i'.`,C. J , 19 87 ERMI T Ti� A `t c, P a APPLICANT �..�::1]S';it;Jl' �i.::i� C.vl`'tJ, • ADDRESS `�. U. Bi9:4 ' 5 10 . ('(;S,(`..k.,rvil] :q0y397 (N0.) (STREET) (CONTR'S LICENSE) PERMIT TO i3iii,lo 1)W!l iI1;(T (�k�) STORY I_,� '- •F' i9.ili�J_ � .NUMBER OF yWL'-1.'1:�C1CnWELLING UNITS (TYPE OF IMPROVEMENT) NO. Y (PROPOSED USE) -_ AT (LOCATION) • •C)L 4 ;6 / i`_)i; ,'i.1].. ...:i), .. L ;i ZONING ( (N0.1 (STREET) DISTRICT �'C J. 1 BETWEEN AND i (CROSS STREET) (CROSS STREETI. i i SUBDIVISION LOT LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY - VFT.. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION . TO TYPE USE GROUP BASEMENT WALLS, OR FOUNDATION ' (TYPE) REMARKS: :��i\lc.l,'r,, 'F'Oi'1�.10 �5ond ARE� OR VOLUME LU /U :i�I• - i_ 4J� 000. UU Q� UARE FEET) PERMIT �',Q - ESTIMATED COST `D FEE (CUBIC/SQ - � OWNER hlta:Tl�{8i1E C CiiL"1J. a n f ADDRESS �' u• bCJi: jlU l 1 L-:•tii'��=L\rill!: BUILDING DEPT. CONVEYSBy THIS PERM#T ® PERMANENTLY. ENCRO CHMENTS ON PUBLIC Y PROPERTY,NOT LSPECIOIICAILDLY PERMIEWALK ORTTED UNDER ANY PARTTTHE BOUILD I NGE CODE, MUSTRBEY OR PROVED BY THE JURISDICTION. STREET OR 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 THREE'" CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING ANDy 1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS.,2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MINAL INSPECTION TI TO BEFORE FINAL INSPECTION HAS BEEN ;MADE. - 3. FINAL INSPECTION BEFORE OCCUPANCY. - POST THIS CARD SO IT IS VISIBLE_ FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 2 2 — — 3 CiM HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 1 O/ // - 101117 &5 OTHER 2 � /}rJ BOARD OF HEALTH WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION TOR HAS.APPROVED THE VARIODUS STAGES OF I WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE INSPECTIONS INDICATED ON THIS CARD CAN BE CONSTRUCTION. ARRANGED FOR BY TELEPHONE OR WRITTEN PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION. i' .,1