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0170 WHITEHALL WAY
4 Ll TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 2n/ 0 1 Parcel O 7 21 A J Application # i b Health Division Date Issued: 2,h`'t 117 Conservation Division Application Fee Planning Dept. Permit Fee �,� Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis � � S Project Street Addresst zI$' y _ � -j`� ✓�y Village�.14 llann t5 Owner,rr _ r'- ,' f _� 0.S;' 1 v' Address Telephone 5-6$� - `13`7-9 y� Permit Request �; -�� ( �t: Wct '3cL5e_r.»en'T aad o rsc.,ia -(bn n ojKc t eu SA-031 05obAe. ht Se_ +n e_5cr's4 ro 6,4k Pan inr54e�f t C�-Ofe& +-o la rr ba;l G ct,® ajd in So q'4- yo-en--S Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation �?'1 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: ❑ 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: ❑ existiQa ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: W O W �_- Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ o Commercial ❑Yes ❑ No If yes, site plan review# CO o Current Use Proposed Use r m APPLICANT INFORMATION - (BUILDER OR HOMEOWNER) Name Rp lO-nA knr)n e v'i''r\ Telephone Numbers 6_6!,l a Address 4110 Grove- st- License # l nag b l _ra.lt AArr Mo_ Home Improvement Contractor# 70 Email S-S_Sx �Sl }p2 5ay'e -1U Of Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO GIJaSfi2rnD � ,� T In90 ' Xr- Abe') Ma SIGNATURE � DATE .2 2f 7 FOR OFFICIAL USE ONLY APPLICATION # ` t DATE ISSUED ' MAP/PARCEL NO. f 4�1 ' ADDRESS 41 VILLAGE OWNER S i f 5. a DATE OF INSPECTION: FOUNDATION t FRAME i INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL r FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. r RISE,Engineering RISE = S Dupont Ave,South Yarmouth,MA 02664 ENGINEERING" CONTRACT 508-568-1,926 FAX 508-568-1933 Page 1 PROGRAM, THIS CONTRACT IS ENTERED INTO BETWEEN RISE NGCC-H..ES ENGINEERING AND THE CUSTOMER FOR WORK AS 'DESCRIBED BELOW CUSTOMER PHONE 'DATE .CLIENTS WORK ORDER. Marcelo Dasilva (508)737-9454 01/19/2017 228942 26002 SERVICE STREET BILLING STREET. 181 Whitehall Way 181 Whitehall Way SERVICE CITY,STATE,ZIP BILLING CITY,STATE,.ZIP Hyannis,MA 02601 Hyannis; MA 02601 JOB DESMPT[ON BARRIER:We have discovered what appears to bed,mold/mildew.,tike substance in your polite:This is being brought to your attention. to identify it as a pre-existing condition to the;insulation and air seating work planned for your home:Your signature is your acknowledgement of these conditions and agreement to proceed. AIR SEALING:Provide labor and materials to:seal areas of your home against wasteful,excess air leakage. This work will be performed S 162.00 in concert with the use of special tools and diagnostic tests to assure that your home will be left with a healthful level of.air exchange and indoor air quality.Materials to be used to seal your home can include caulks,foams,weatherstripping and otherproducts. Primary areas for seating include air leakage to'attics,basements;attached garages and other unheated areas(windows are not.gencrally. addressed:) (6)working hours. A reduction in cubic feet per minute of air infiltration will occur,but the actual number of efin is not guaranteed. ATTIC PLAT:Provide labor and materials to install a 10"layer of R-37 Class I Cellulose added to(512)square feet of open attic space. $686.08 KNEEWALLS:Provide labor and materials-to install rigid board at R-10 or greater with the regi fired fire rating to,(144)square feet.of S476.64 kneewall area. KNEEWALL FLOOR Provide tabor and materials to install an 8""layer of dense packed R-25 Class:J Cellulose added to(128),square $256.00 feet of kneewali floor. KNEEWALL FLOOR:Provide labor and Material to install a 6.25"laver of R-19 unfaced liberglass.batts to(128)square feet of $217.60 kneewall floor space. VENTILAT.ION:Provide labor and materials to install(1)insulated.exhaust hose to existing bathroom fin(s): 550.00 VENTILATION:Provide labor and materials to install ventilation chutes in(72)rafter bays to maintain air Holy. 5251.28 VENTILATION:Provide labor and materials to install( 1.0)4"X 16"rectangular aluminum solTit vents to increase ventilation in attic $289.10 areas.Specify color:White or Gray. r ,RISE Engineering M EI R I S 5 Dupont Aye,South Yarmouth,MA 02664 ®�� ENGINEERING CONTRACT 508-568-1926 FAY.508-a68-1933 Page 2 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE. - N G CC-H F S: ..ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER - PHONE'. DATE CUENTO WORK ORDER Marcelo Dasilva (508)737-9454 01/19/20117 228042 26002 SERVICE STREET BILLING STREET 181 Whitehall Way 181 Whitehall Way. SERVICE CITY,STATE,ZIP .BILLING CITY,STATE,ZIP Hyannis,MA 02601 Nyannis,:MA 02601 JOB DESCRIPTION" INCENTIVE:RISE Engineering will apply all applicable,eligible incentives,to this contract. You will he billed only the Ncramount. $90.00 Currently,l'or eligible measures,National(rid offers 75%incentive,not to exceed$2,000,per calendar year,and an incentive of 1;00%q I'or the Air Sealing mcasures. For the safety and health of your iiome's.ihdoor air quality,.we might be conductiiig'a blotter door diagnostic.of the available air[low in your home both before the work is begun,-and aflerthe weatherization work is,coinpietc(not to be conducted if asbestos,is present).We will also conduct a diagnostic assessment of the combustion fumes in.the exhaust flue of'your heating system,and water.heater.I is has a value of$90 and is at no cast to you. The permit will be secured by the insulation contractor,at no additional cost:It is the homeowner'sresponsibility to close;out this permit by contacting their municipality,atthe completion of this work Total. $2,778.70 Program incentive: „ =$2,222.03 Customer Totals $556:67 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.-FOR THE'SUM'OF 'Five Hundred Fifty-Six&67/100Dollars $556.67 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES SO REMIT AMOUNT DUE IN FULL-INTEREST OF iR WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER.30 DAYS.SEE.REVERSE FOR-IMPORTANT INFORMATION ON GUARANTEES;.RIGHTS OF RECISION;SCHEDULING,AND CONTRACTOR REGISTRATION.. Z", a' AUTHORIZED-SIGNATURE-RISE EngineoAng C RACCEPTANC NOTE-.THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN. DATE OF ACCEPTANCE ...._./O 0),�SPECIFICATIONS ACCEPTANCE OF CONTRACT-THE ABO E PRICES AND CONDITIONS ARE 30 DAYS. SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU:ARE AUTHORIZED TO DO THE WORK AS SPECIFIED.PAYMENT WILL BE MADE AS.OUTLINED ABOVE,. I f, :fie Mato S'ex-VIM Yt�ItvsrABu:° b"` 41 ySAQC RiL•tr�rd V.Scali,:D:rect.or:: �Fo;r,�y► ;uxltiing,Aivisio I ont41.rr�a 13z ldpg C'.q Wgjbq$x 200l.aiu Stye t,,T j nn sAA;026Ci1 . Fi�vSv tv����.bai nstzbte axia:us of,fce: 708-:562:4038 Fax,.• Pjopert,,Ownez N ast,- Co.a�per and S� z"�'�ais,Sec, io hereb` -auzhc+i=ize; in aU,a!itt6zs zcl tutrc to vvork authorized:hy this budding penmi a ica6o'n-to:r: 4 s , ( dxrss`°cb)t y 'WoLfo&&c -.and alai is aie the eSpo ibxlt 5i f,t6c Ic. are at`'to b 'ftllec '` r ut> 2 cl h° 'fare i nc e`;iim, 4 A all f %l iusp�,cc�c��s-�r� pe�ort�ed�an�:accepi�t�... , 0 ,i 1 --1z- rent Name P1nt Nazi. 4L D, c Q:EOTtIsIS;04VIXFLZP� DATE(MMIDWYM) 4�JD CtRTIFICATE OF LIABILITY INSURANCE 11/30/Is6 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 holderin lieu of such endorsement(s). CONTACT 'RODUCER NAME: - Anthony F. Cordeiro Insurance PINE 508' 677-0407 FAX No> (508) 671-0409 171 Pleasant Street ADDRESS: hsouza@cordeiroinsuranc.e.com. Fall River, MA 0,2721 INSURE RSI AFFORDING COVERAGE NAIC# INSUREiA:Liberty Mutual Insurance NS URED TNSU RER B Insulate 2 Save, Inc. iNSURERC: 410 Grove St. INSURER6: Fall River, MA 02720 INSURER E4 1 INSURER F OVERAGES CERTIFICATE N UMBER: REVISIOWNUMBER: 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'BYTI E POLICIES DESCRIBED HEREIN IS,SUBJECT TO ALL THE•TERMS', EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE-BEEN REDUCED BY PAID CLAIMS: VSR , __ AODL SUBR "POLICY EFF POUCY EXP.. LIFMtTS .. _TR TYPE OF INSURANCE POLICY NUMBER MM/DDlYYW MM/DDYYYY A GENERALCIABIUTY Y y gjtgj6Lj1$791 12/10/116 12/10/17 EACH OCCURRENCE $ "1 000 •000 DAMA GETO`RENTED X COMMERCIAL.GENE RALUABILITY gEmIS,Ei_(.Ea_occ��ncg} $ 300 000 CLAIM&MADE a OCCUR MEO EXP(Anyoneperson). $ 5' 000 PERSONAL 9 ADV ImURY $ 1,000,000, GENERALAGGREGATE $. .2 0'00- 000, GEN'LAGGREGATELIMITAPPUESPER PRODUCTS-COMPIOPAGG i 2 000s 000 -- }{ ROLiCY PRO- LOC $ COMBINEDSI GLELIMIT A AUTOMOBILE LIABILITY Y Y BAA 56418741 12/10/16. 12/10/17 aacci $ 1,000.,000 BODILY INJURY(Per person)- $ ANY AUTO ALLOWNED SCHEDULED BODILY INJURY(Peraccident) $ AUTOS X AUTOS PROPERTY'DAICMGE NON=OWNED (Perecident X HIRED AUTOS X AUTOS. $ A X UMBRELLAUAB }{ OCCUR Y' y USO 56418741 12/l0/:16 12/1Of17 EACH OCCURRENCE $ 2 0QQ 00- EXCESS LIAB CLAIMS MADE AGGREGATE $ 10,0010 DED RETENTION$ S. WORKERS COMPENSATION XWS 56418741 12/l0/16 12/10/17 }{; TbRV I I WCSTATU- " - P' MITR ER_ AND EMPLOYERS'LIABILITY YIN �E1.EACH ACaDENf $ 500r000 ANY PROPRIETORIPARTNERIEXECUTNE N/A OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $. 500 000' ` If yyes describe under E.L.DISEASE-POLICY LIMIT'. $ 500 00:0 DESCRIPTION OF OPERATIONS below DESCRIPTION OFOPERATIONS/LOCATIONS/VEHICLES (Aftach,ACORD1ot,.Additional,RetmrksSchedule,ifmorespaceisrequi'red) Proof of Insurance. CERTIFICATE HOLDER: 'CANCELLATION . SHOULD ANY OF THE ABOVE DESCRIBEOPOLICiES BE CANCELLEDBEFORE. THE EXPIRATION GATE THEREOF., >NOTICE :WILL BE DELIVERED IN Town of Barnstable ACCORDANCE:WITH THE POLICY PROVISIONS:; 200 'Main Street HyarinlS, MA �2;601 AUTHORIZED REPRESENTATIVE O1988-2010 ACO'RD CORPORATION: All rights reserved.'. ACORD-25(2410/05) The AC:ORD:name and log o,are registered marks of ACORD ' Phone: Fax: E-Mail: 3�?l �Yiiltr�l7�I[ (Jf.�b.ItlsstrcJtNt7GL1;J��� x.S F p°^• ,:} , • � Ja '` +�, �+ »,�,E. . '`r r �Deiirrtrnni o � rfusricct A' iffsE ' . -jam arc of Irr+ stiQs • ,:«. �� .' "r { /: x' J�/"�/A� [�r/jp�,�,/'y'rt� �arp-��{�,{�/y+�y�.r/s 2 "�' � •;� •,�:6.`.t 2f3 ) '�"7"`�„* '4.,}.#".�4.' 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T�the sul>-eonfracnrs have crnplaytt`s thTcy.ngsf prdvtc wmrl;cxs carsp..pa�c�#nvn'st?�ci' . �m�' , ��,€ ,} „�: ,� ��"�,� ��x a - .� t;. x y3"a*'a�•^ f am Mn r�rz 04Y mat is proyulrfs� �i€�iirk�rs'comp�.nsatiotf tn�urtrrice for r��? �", �� �«� l� � � ; Surance Company,N Libe Insurance xr ;• .,€ t *�'.r •1* �zt~ , g # x c + ;'oizcy X``nr Sol£tns 31Wt # XWS..564187A 1�4 Exfrir3tzort fete 12i10/17 n} , � r + w x$ r �':+ * +gSKd x 3 � x r €ate y"4 Job Site`Ac3resr 28 Couner,Dnve. ,_ x C�tyl5te12DennisMa 02638 Attach copy,°atthe;worker �erttnfietzsasor'polrcp tlectarurc.xe�sgwxtz ttte'paticyi bed pfrtturs+ Zte� _ y '� .• +.•+a. .,3.� �`+y�.,,.xiat8'#'l LI,Al't ^. _£allure to secure coverage.as:rr quire a cr Sect�ati 5A all++Gt,c l5 c lead to J l" --1 a' a1"pe I es w �5rie up;ta$1, Otl OC}an or one-gear pr► nrneut, swvf3 "civil pcialtses to# etn ova S"fOp� UIa � a - ' a of up to$254.tlfl a dsy;aauist tfie vit~slator 11e'advzs that a:-copy tiftic�s stat�nzentivay�e ftxw��rl ttlze0#�ee of� ,�`�,��� -;I�ILV,CStI •4xa�J'F.af`tlie.I?IA far7tzxan. e�cavf�ra.. e ilr1J1t43Fi L1V 4M _ '.� b* �•� � g�� ..«k.�>�f'° £^�.�'Y&�'�iL 4�i..•.•F* XrcCo�f�r�by cer#r�y unzler Ike paares�.�t�rettu�lt�s e�fpertu�r t/cttt tf:e irr,�oranat�rvrr�rfvs�fci�rl cr�ove�.r�trcre ersrcorre€�,�� Y .�'��� � • •:t� ate<17 + - SIt13rC €a r.i ._- - m�,},w "fir�,+.. +max. 'r3�s'i,�" �h.•�'�"xY�s� $@� r �'--'t4 ='l'lxsne 508-567_-6706 f/-tcta use cinly trot wroten tars ureai e,corrzpCy crfy afi town vfcctcrL w. " ^ Ak .' C�ty;or ..'. '� ., .. g ✓. rs sty. ¢y -�'£ day �'e?o"��f s{'� lS5tlitt Autflartty(C7TGIt att } F . f Board nfklc�alUz 2€Ba ru D partrne_W 3 -lityfk•�.wn�Ci k�4�, f�ctrtti~ cot 5 I'lu4nbxng irtspeetar � 3 fit' dfher N ° $ r v • m VS a r.-' .> r � ait lCt # �@!son,,- 1�l�tkT3l' p ' I GEC/ `{1i/'OJ Office of Consumer Affairs and Business 'Regulatior: 10 Park Ptaza - Suite 5170 Boston Masse-hu setts 0211 6 Home Im provem tor registration ' Type: 'corporation 711 INSULATE 2 SAVE , INC. _ a' w Registration: 180747 a _� r 1 Expiratloh: 12/24/2018 410 Grove St Fallriver, MA 02720 ' scar r, zoo+-ostii Update Address end retum card: Mark reason for change. ftne al C7 Employment 0 Lost Card. a` c�,3r�,raa7zrr�cu��c�'C�=�+�u:�rac�uualta�• Office of Consumer Affairs&;Business Regulation HOME iMPF10VEMENT CONTRACTOR Registration valid for Individual use only z TYPE;Corporation before the expiration data. If found return to: . 1' tion Office of 6ansuMe Affairs and Buslnass Regulation 1w807I 12t28/2018 10 Park Plaza-Suite 5170 Boston,MA 02116 INSULATE i2 SA.V fiN Roland Langenn 3 ' 410 Grove St Fallriver,MA. 0272Q� e Undersecretary Not Varlid,without sigh* re t Massachus,etts Depnrtrnent of Public Safety Board of Building i2dgutolions and 5tandards ,.- Liceose.CS-10386 t Can struclion Supervisor IkOLAND,LANGEVIN 56 FlfiGtiCRCST i��A{). . FAt ONVER MA 027 fi Expiration; . Gpmrrliw's'styttOr U51��i'!Qti`7' I� �t r Town Of Barnstable *Permit# ZOisb � �36 Expires htomisue eRegulatory Services BMWgrABLE, � MAM 1e39. ,0$ Richard V.Scali:Interim Dire PE cr® prfD MA'S�' Building Division �®� Tom Perry,CBO,Building Commissione�rUG. 1 `� 2015 200 MwravmwStreet, own.barnstable.ma.u - " of BARNSTgg,� Office. 508-862-4038 E Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Map/parcel Numbers I �}7 r o��_D/1 Not Valid without Red X-Press Imprint Property Address I70 w4jjTv 8 Il wAj , RV AnvN,Tf` S \ Residential Value of Work$ St,0o U o — Minimum fee of$35.00 for work under$6000.00 Owner's-Name&Address &�e_MO i w L b o UCAi2,n 0 LV>•Y iT� �`t J yi S Contractor's Name C "y�._. Telephone Number_- Home Improvement Contractor License#(if applicable) I S��a1� Email: L 11N Construction Supervisor's License#(if applicable) 0 orkman's Compensation L*isurance Check one: ❑ I am a sole proprietor P;am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# �J C. O IU T 1 ©01 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request.(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑ Re-roof(hurricane nailed)(not stripping." Going over existing layers of roof) [�Ke-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 requ' ed. C- ,/ SIGNATURE: Q:\WPFILES\FORMS\building permit fonns\EXPR doc Revised 061313 l� L " : ...- Y .!'axe COMM— ,wealth of Massachusetts Deparhnent of fir huft ual Accidents 600 Washington,Sheet Boston,MA O211I www.7nas&goWdira Workers' Compensation Ins=nce Affidavit:Pt>Enders/Contract rsMet tricians[Mumbers Applicant Infarmation Please Print Legibly Name(Busmessiorganizafiontfndizu at): L l-11 Address: �(� 1�Q.�wT wwti city/Stat&Zip: N Wr-^�- yr o9bd i Phone 4: fi-O� 77�—/1161 Are you an employer?Check the appropriate box: Type of pro ect r L L►�'I am a employer with_( 4. ❑ I am a general contractor and 1 6. ❑New c=s.trucbm employees(full and/or part fee)-* have hired.the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet; 7. ❑Remodeling shill and have no employees These sub-contractors have g_ ❑Demolition wotio ng for me many capacity. employees and have workers' [No workers' comp.,"„��„�-e comp-TM's',",-1 9. ❑Building addition required_] 5. ❑ We area corporation and its 10_❑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'cramp. right of exemption per MGL 12.❑ f repairs insurance required-]f c. 152, §1(4),and we hn--na , employees.[No workers' 13.. Other t- comp:insurance required-} *Aay aapUCtW that chedLs boa-1 amst also 51z out the section below shaving the¢wodsets'cotrtpeasaiiaa policy iafnrmatiae I Homeowners Who submit this sfRdavn indicating day are doing aR wmk amfl then hire outside contractor mast submit a new affidsvit mX�stinv 5a-h- tContractor that check this b mt must attached as additional sheet shoving the name of die s_comnc nand stale whether txnot those em ibes have employees. lithe sub-contractors have employees,they must provide their workers'comp.policy number. -Taman employer thatis prm idfag ti orke-rs'compmuytdon insl;rance for my emplayem. Below is the policy and job site informadam Insurance ComFae: TL 141Tim y 0�t}2T Policy;9 or SSelf-ins.Uc_9:_ t V C.V 010 0 0 Expiration Date: /1g 9 k D l b Job Site Address: 170 IAN R( JAYI w6 City/StateMp: Attach a copy of the workers'compensation policy heclaration page(showing the policy number and expiration date). Failure to secure coverage as rexluiredunder Seetion.25A of MGL c. 152 can lead to the imposition of'rriminal penalties of a `fine up to S1,500.00 and/or one-yearirn risonment as well as civil penalties in the form of a STOP.WORIK ORDERand a fine: of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification- . I do hereby aerh,fy' render tha its altdpanalties ofperjury that the inj'ormidion prodded above is his and correct Simature: C Date: lS<1. 1 Phone#: OUEd4 ri use only. Do not sprits in this area,to be completed by city or town official, City or Town: PermitUcense# Issuing Authazitg(circle one): L Board of Health 2.Building Department 3.CiglTown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: c 1 rJ Fi oETME Teti Town of Barnstable Regulatory Services • r t RARNSTABLE, • .. r KAS& Thomas F.Geiler,Director i659• pT� � Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,.MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-623 0 Property Owner.Must Complete and Sign This Section If Using A Builder I, ���2hnt�iwli �oU cN+�4D , as Owner of the subject property hereby authorize GftM e. . an to act on my behalf, in all matters relative to work authorized by this building pemsit 1-70 wlhulioII t-A'j 01 14 (Address of Job)f, Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted'. 0 Signature of Owner Signa e of Applicant ( � ocJck(p.e.L) PrintName Print NaLe C [ /5- Date Q:FORM&OWNERPERMISSIONPOOLS 62012 CERTIFI+CATF OF LIABILITY INSURANCE 16 2015 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: tithe certificate holder's an ADDITIONAL INSURED,the policy((es must be endorsed. If SUBROGATION IS WAIVED,Subject to the terms and conditions of the policy,certain policies may require an wWor-wm rt. A statement on this c arfificate does not confer rights to the certificate holder in lieu of such endomements(s) PRODUCER CONTACT NAAA Horgan Insurance Agency,Inc- PHONE No.may; (508)775-5830 FAX No.;) PO BOX 250 E-MAIL Hyannis,MA 02601 PRODUCER INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA- Atlantic Charter Insurance Company VDAC 44326 Graham,LLC INSURER B: INSURER C: 66 Brant Way INSURER D: Hyannis,MA 02601 INSURER I_ INSURER P 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 MOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDI. sum POLICY NUMBER POLICY IVE EFFECT POLICY EXPIRATION LIMITSLTR INSR Ypyp DATE R AW)DIM DATE(MM=1YY) (in Twusand:) GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PRBAIES ma ooaafenm S CLAIMS MADE ❑ OCCUR ❑ �EDEXP(Anyonepmw) $ 0ERSONAL&AVVNJURY $ GENL AGGREGATE UWTAPPLI[S PHt GENERAL AGGREGATE $. PRODUCT POLICY a PROJECT ❑Le7C S-COMPMPAGG S AUMMOBILE LIABILITY ��Sotl�.E LtA,HT ANY AUTO (Fa Axtlertt) $ ALL O1NNm AUTOS ❑❑ BODILY IWURY SCHEDULED AUTOS (Pwp—) $ BODILYMJURY $ HIRED AUTOS iE8ACdd" PROPERTY DAMAGE S NOttpWNOW AUTOS _ - (En Aoaderd) NIBRELLA ❑ OCCUR LIABILITY EACH OCCURRENCE $ EKCESS LIAB❑ CLAIMS MADE - AGGREGATE $ D®UCRTILE ❑❑ $ RETENDON $ VVORMFM COMPENSATIONND XAroRrA MPLOYER Ury WCV01059002 01/29/2015 01/29/2016 uu OTHER ANYPROPRETWIPARINERExECCUDVE YIN LIMITS °w0 r'O7JDm' Y — EJ POhCy Coverage State:MA EACH A��Errr $ I00,000 Llaaarory In NH byes ee=ft undwSPEeaLPRwISIONs DISEASE-POLICY UMrr $ 500,000 DISEASE-EACH EMPLOYEE $ 100,000 OTHER 100 D DFOPeuT[ONsrLoeanaNSArar&L®(Amd,aeOIr oTm,m.Aaaalo„el Rmreesaa, e=fAA G� h 1 -ul7L'+J - �� CERTIFICATEHIDtDER: :. CAkEU AIM14 SHOULD ANY OF THE ABOVE OESCWBED POLICIES BE CANCELLED BEFORE THE Town Of Barnstable EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 200 Main Street 12 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. Hyannis,MA 02601 BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES_ UTFIORIZED EtEPRESENTATiYE /�J��3 " �r�►•r ACORD 25(2009A19) lGij,,yy�L, Page I Of 1 CERTIFICATE HOLDER COPY 0 198WM ACORD CORPORATION.AD righb reswved. EN ryA� CERTIFICATE OF LIABILITY INSURANCE 1/19`2015' 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 WANED,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 endorseme s. PRODUCER NTACT Maureen RoderickE: Horgan Insurance Agency PHONE (50$)775-5830 FAX (508)775-6688 P.O.Barnstable Rd. EdYWL �++ maureenr@ho +n snranae.com P. Box 250 INSURE S AFFORDINGCOVERAGE NAIC8 Hyannis MA 02601 INSURER Western World Insurance C u+suRED ompany Graham I.IrC INsuRER B:safe Insurance Co- Gary Graham D13URER C INSURER D 66 Brant Way INSURER E• LHyannis MA 02601 INSURER F- COVERAGES CERTIFICATE NUMBER:GL 14 - 15 w/Snowplowing 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 TERM, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I-TR TYPE OF INSURANCE �) suBR POLICY EFF POLICY FXP P UMBER MIDD M UMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERALUABIUTY DANIA TO D $ 100,000 A Cuul�s n�ADE ❑X OCCUR P8237460 2/12/2014 2/i2/2ois ��, am $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 X /sR PLOW LIABILITY PERSONAL AGGREGATE $ 2,000,000 GENL AGGREGATE UMITAPPUESPER. PRODUCTS-COWIOPAGG $ 1,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SIN UMIT acdde tt B ANY AUTO BODILY INJURY(Per persm) $ 100,000 ALL OWNED SCHEDULED /4/2015 /4/2016 AUTOS X AUTOS 221447 BODILY INJURY(Per accident) $ 300,000 NON.owNm HIRED AUTOS AUTOS P DAMAGE $ 200,000 UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS4AADE AGGREGATE $ DED I I RETENTION$ $ WORNERS COMPENSATION WC STATU OTH AND EMPLOYERS'WIBILITY YI N ANY PROPRIE OEN EL EACH ACCIDENT $ C>FFICERA4IEMBEREXCLUDED? ❑ NIA (Mandatory In NH)tf yam,desaibe under EL DISEASE-EA EMPLOYE $ DESCRIPTION OF OPERATIONS below EL DISEASE-POUCY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks scAedufe,if more space is require CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main St. Hyannis, MA 02601 AUTHORIZEDREPRESETMTATWE i o ACORD 25(2010105) ©1988-201M&ORD CORPORATION. All rights reserved. INS025(2010oaal The ACORD name and logo are registered marks of ACORD Massachusetts -Department of Public Safety . Board of Building Regi)iations and Stand ards Construction Supenfisor License: CS4)42246 GARY C GRAHAM _ 66 Brant Way Hyannis MA 02681 y • Expiration Commissioner 03/20/2016 Unrestricted-Buildings of any use group which ' c°nt�less than 35,000 cubic feet(991m)of enclosed space Failure to possess a current edition of the Ma State Building Code is cause for rev ssachusetts ovation of this license. For DPS licensing information visit www-Mass Gov/DPS V 211 6.9m omweahIt a��acl u sew Office of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR : -gistration: 8?219 Type: iration: LLC 4 GRAHAM LLC. - GARY GRAHAM * y 66 BRANT WAY HYANNIS,MA 02601 , '� Undersecretary �:i tion valid for individul use only License or reg *a Regulation before the expiration date. If found return Office of Consumer Affairs and Business 10 park Plaza-Suite 5170 Boston,MA 02116 . . L of valid without signature Y � �tMMET Town of Barnstablt Permit _�oCID�a � Expires 6 mox isfi a date t Regulatory Services Fee + r s :bb Thomas F. Geiler,Director Building Division Tom Perry,CBO, Building Commissiraner 200 Main Street,Hyannis, MA 02601 www.town.barnstab le.ma.us Office: 508-862AO38 Fax: 508-790-6230 j EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY i ( ( Not Valid without Red X-Press Imprint Map/parcel Number Jy l Property Address )7 G yyrA- UJIIGsidential Value of Work 0 Minimum fee of$25.00 for work under S6000.00 Owner's Name&Address I70 0-17 /_G,,q Contractor's Name i GQ.2� �jp� — Tc ephone Number�5 Home Improvement Contractor License#+;if applicable)_ J Construction Supervisor's License#(if applicable) ❑Workman's Compdnsation Insurance -PRESS PERMIT Check one: El lam a sole proprietor El Tam theIomeowner [�I have Wbrker's Compe'nsatit. n Insurance 1 QVVN OF B/�`RnIST BLE Insurance Company Name L �r Workman's Comp. Po�icy# I.r C,�` j _a — Copy of Insurance Compliance Certifcs<te must accompany each permit. Permit Request(checiQ box) E] Re-roof(tripping old shingles) All construction debris will be taken to _ E Re-roof(riot stripping. Going.over existing layers of roof) Re-side #of doors ❑ Replacer tent Windows'doorJsliders. U-Value (maximu..l .44)#of windows 'Where requiredk Issuance of this pennit does not exempt compliance with other town dcpartmei.regulations,i.e.Historic,Conservation,etc. "Note: ! Property Owne, must sign Property Owner Letter of Pern.ission. A copy of the Home Improvement Contractors License 6: Construction Supervisors License is required. SIGNATURE: ; _— ri.uvucn The Cornrnonwealth of Massac.`tusetts Department of Industrial Accr--dents ] If Office of Investigation,. 600 Washington Street � ; Boston, IYA 02111 wivfv mass.goY1dia Work�rs' Compensation Insurance Affidavit: Builders/C'ontractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organizatign/ln(?ividual).- rAaw �t - Address: �g f City/StateZip:— ,/iii & 1 `��__ Phone #�:_ 0 Aretployer ployer?Ch k the appropriate box: Type of project(required): 1. I am a with 4. ❑ 1 am a general contractor a�-d 1�--- to ; 6. ❑New construction em p ytves(full and/or part-time).* have hired the sub-contraa:trs 2-❑ I am a side proprietor arpariner- listed on the attached sheet 7. ❑Remodeling ship and have no employee:: These.sub-contractors have g, Q Demolition workin� for me In any' apacity. employees and have worke:3' [No workers'comp. insurance co.mp..insurance.t 9. ❑ Building addition required.) 5. ❑ We are a corporation and it-, 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised the r 11.0 Plumbing repairs or additions myselfNo,workers comp: right of exemption per MG 12 insurande required.]t c. 152,§1(4),and we have:�_.o ? employees. (No workers 13.F�"Other�s i j comp. insurance required.] *Any applicant tha checks box#1 must also;fill out the section below showing their workers'comp_rsation policy information. t Homeowners wh submit this affidavit indicating they are doing all work and then hire outside cor tractors must submit a new affidavit indicating such- Icontractors that ick this box must attached an additional sheet showing the name of the sub-eonl.,�ctors and state whether or not those entities have employees. If the spfb-contractors have emp.3yees,they must provide their workers'comp,policy number. I am an emplo.{er that is providing ivorkers compensation insurance for eny employees. Below is the policy and job site information. ! Insurance Co m�an, Name policy#or Selfins..Lie. expiration Date: l ___3__�1b - Job Site Addresr: 170 (14121,A 9j1_lwl0I _ ity/State/Zip: }vrtir, .___0�'bp7 Attach a copy tf the workers'compensation policy declaration page(showitrb the policy number and expiration date). Failure to secure coverage as requir-cd under Section 25A of MGL c. 152 can leFd to the imposition of criminal penalties of a fine up to$1,50P.00 and/or oo-year imprisonment,as well as civil penalties in 1.7:e 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 staterr:cnt may be forwarded to the Office of Investigations o�the DIA for sasuran a coverage verification. I do hereby cer#fy_under fit epains andpenalties ofperjury that the info rm atio,��.p ro vided above is true and correct SiQnatru At�c ---- ]:ate: 6bAl h)—_ --- Phone ft: Official use Only. Do not fvrite iu,ihis area,to be completed by city or town i 1 City or Town: Permit/License h Issuing Authority (circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4. Elet:L-4cal Inspector 5. Plumbing Inspector 6. Other -- •.. +L"'��' `f -'�c<rF-1: _ ,L[lSi.iL�itc�irvlS.LOI75.Cc7Cii—'t'l.i; U8ift�bb88 Pages: � CERTIFICATE OF LIABILITY INSURANCE ATEINiMf00/YYYY) THIS CERTIFICATE IS ISSUED AS A M TTERI OF INFORMATION ONLY AND CONFERS I CE RIGHTS UPON THE CERTIFICATE HOLDER. 7Hts 5/10/2011 CERTIFICATE DOES NOT AFFIRMATIVE LY OR NEGATIVELY AMEND, EXTEND OR ALT_i3 THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSU NCE DOES NOT CONSTITUTE A CONTRACT BE-TWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is n A'DDITIONAL INSURED, the pot yes)must be:indorsed. ff SUBROGATION IS WAIVED,subject to the temts and conditions of the policy, in policies may require an endorsement. A stet gent on this certificate does not Confer rights to the certificate holder in lieu of such enders ent(s. PRODUCER FRANK L HORGAN INS AGENCY INC 44 BARNSTABLE ROAD CONTACT NPJM, HYANNIS, MA 02601 PHONE -G8)775-5830 AIC Nq: fs ios27r,ssst E-MAIL ADDRESS: . INSt�geR{S}AFFORI]ING COVERAGE .. wsuRERa LIBERTY'MUTUAL GROUP ++Aics GARY GRAHAM -- --` - - DBA CARPENTRY SPECIALIST WSURERB: 66 BRANT WAY INSURERC: HYANNIS MA 02601 WSURERI : PISURER E c COVERAGES INSURER F: _ CERTIF ATF.NUMBER: 10157939 THIS IS TO CERTIFY THAT THE POLICIES OF INSUFtOkNCE LISTED BELOW HAVE BEEN ISSUED TO T 3E INSURED REVISION ABOVE THE POLICY PERIOD NUMBER.- INDICATED. NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT C OTHER DOCUMENT WITH RESPECT TO WHICI I TI IIS CERTIFICATE MAY BE ISSUED OR MAY PER11 AIN. THE INSURANCE AFFORDED BY THE POLICIES .)ESCRIBED HEREIN IS SUBJECT To ALL THE TERMS, _EXCLUSIONS AND CONDITIONS OF SUCH POLI IES.'LIMITS SHOWN MAY HAVE BEEN REDUCED BY PC.'{;)CIJi1MS. T R OD Bl TR - TYPE OF INSURANCE POLICY UCY EFF F, JCY"E%P —"—_------- +CENERALtlABILtTY NUA76ER • - _ LHNITS COAIMERCtAL GENERAL LIABILITY EACH OCCURRENCE g DNAAGE'TO RENTED CLAIMSdiADE Q OCCUR PREMISES Ea occurrence S MED EXP(Any one person I $ PERSONAL BADV INJURY y --- GENIC AGGREGATE LIMIT APR IES PER. .- .. GENERAL AGGREGATE $ --- ....----- POLICY PRO- LOC - ` - ' PRODUCTS-COMPIOP AGG $ ' ALIT OMOBILE LIABILITY - $ -- O ANY AUTO � Ea aoci1 L enl) $ ALL OWNED AUTOS SCHEDULED BODILY INJURY(Per pe.son) AUTOS $ HIRED AUTOS NON-OWNED BODILY INJURY(Per acdgeru) $ I AUTOS PROPERTY DAM 1 - Per accident) AGE S- UArBRELLA LIAR OCCUR _ $ EXCESS UAB CLAIMS•MADE EACH OCCURRENCE $ DED RETENTION S AGGREGATE .-"__-.__._- .._.,.. i 1 s WORKERS COMPENSATION I AND EMPLOYERS,LL4BIUTY WW2-31 S-328005-021 -012 WC.STATu. $ —�- +WYPROPRETOR/PARTMEReEXECUTNE YIN 3r23/2011 3/23r;) -UFTLCtr J TORY LIMBS ER R/AIEa NH)FJCLZUDED? � my NIA (Marldararyfa/IH} E.I. F..ACF3 ACCIDENT 5 1()CSOfi{1 DEes,SCRIPTION IPTION under - E.L-DISEASE-EA EMPLOYEE $ DESCR WTION OF OPERATIONS below - E.L.DISEASE-POLICY LIMIT S 500000 Cr�T10N OF OPERATIONS t LOCATIONS/VEHICLES AI h AC - _ { ORD/01,Additional Remarks Schedule,If more space is requlrr'--, - rkers Compensation Insurance:Part One of the Policy applies only to the Workers'Compensation Law> of the State of MA. WORKERS'COMPENSATION POLICY DOES NOT.PROVIDE COVERAGE FOR GARY GRAHAM 2T1FtCATE HOLDER � ------- ' CANCELLATION AWN OF BARNSTABLE SHOULD ANY OF THE AE oVE DESCRIBED POLICIES BE CANCELLED BEFORE 10 MAIN STREET TIME EXPIRATION DATL THEREOF, NOTICE WILL BE DELIVERED IN t'ANNIS MA 02601 ACCORDANCE WITHTHE:OOLICY PROVISIONS. AU WMUED REPRESENTATIYf: Jeff Eldrid e RD 25(20101o5) Q 1988-201V ACORD CORPORATION. All rights reserved. The CORD name and logo are registered marks of AC ORD 1015J939 CLi EkS CODE: 1236006 Anne r'han;ler 5 t0J2011 6:10:06 An page L of L r L1 ltCate can els and SupercedeS ALL Prey jouS1 LSSu,., Cectl.flCate S. ' opt r Town of Barnstable. s Regulatory Services BARNSUBLE. = Thoinas F. Geiler,Director kcns& Building Division Tom'Perry,Building Comrnissionei 200 Main Street,Hyannis,-MA 02601 rvwmtown,barnsta ble.ma.u s Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Usine A Builder I, as 0 ...f of the subject property h Y to act on m behalf, here y authorize _ in all matters relative to,work authorized by this building pent application for (Address o Job Pignature o Ownet Date /C&0 tAA- Print Name If Propeirty QmL er is applying for permit please complete the Homeowners License Exem0t-ion Form on' the reverse side. 0:F0RNIS:0 WNERPERM ISS 1QN1 Mass,tchusetts= Dcpal•tincnt of Public Safety Board of guildim+ Rc�rulations and Standards Construction Supervisor License" License: Cs 42246' Restricted to: 00 GARY c GRAHAM 66 BRANT WAY; HYANNIS, MA 02601 v � . Expiration: 3/20/2012 (bfillII tuner Tr#: 18292 s ) � � Office of Consumer Affays& smess Regulation HOME IMPROVEMENT CONTRACTOR Registration: 1,23659 Type: Expiration: .3/257013 Individual _ Ga .Graham Gary Graham MEN J-J . 66 Brant Way Hyannis,MA 02601 :may Undersecretary License or registration valid for mdividul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation I 10 Park Plaza-Suite 5170 Boston,MA 02116 I J Not v id without signature �' i Town of Barnstable *Permit# Expires 6 mo rths j anj sue date l Reg , latory-Services Fee ' EARNSTAB s MASS. v� i639. Thomas F. Gei.ler,Director 'DTEn�y a r I i� BWIding Division Tom Perry,;C$O, Building Commissionter 200 Main Street, Hyannis,MA 02601 wwwJown.barnstable.ma.us Office: 508-86 -4038 Fax: 508-790-6230 EXPRESS PgRMIT APPLICATION - RESLt-iFNTIAL ONLY Not Valid,ri4thout Red.X--Press Imprint a Map/parcel Number 7pZou o15 Property Address 7 LL,N 1 Tt 11 D Residential Vahl of Work Ly Minimum fee of$25.00 for work under$6000.00 Owner's Name&Add ess 02�Q/Yl14r�c l-7 V t.� �r It.kid ItA h l�1�1411-1-0,Lh- I� Contractor's Name 6, (>(t- �1,go Telephone Number 79 '1W/ _... Horne Improvement C ntractor License#(tJf applicable) Construction Superviso 's License#(if applicable) 7 Alt, Workman's Compe ation Insurance PERMIT Check one: _❑ I am a sol9 proprietor r�. Elm the H mt owner ET I have Wo ker's Compensation,insurance ]-OWN OF BARNSTABLE Insurance Company Na ne LC uc/i4u, Workman's Comp.Poli y# Copy of Insurance Co pliance Certificate must accompany each permit: Permit Request(check lox) ❑ Re-roof(stf ipping old shingles);:Al.l constructiod debris will be taken to Re-roof(no'stripping. Going over existing layers of roof);: ❑ Re-side #of doors' C] Replacem Int Windows/doors/sliders:U-Value ; (maximum 44)#of windows *Where required: uance of this permit doffs not exempt compliance with other town departmento.gulations,i.e.Historic,Conservation,etc. . { ***Note: I Property Owner must sign Property Owner Letter of Permis'ion." I A copy of the Home Improvement Contractors License & t onstruction Supervisors License is requi d. SIGNATURE: / . Q:IWPFILESVORMS\build ink ocrmitforms\EXPRES� doc f ? The Co.tnrrionrvea th ofMassa.ghusetts Depar ent!of Industrial Ace dents Office of Investigations;; 600 Washington Street ;Boston, MA 02111 fNrvry.1nass go v/dia Work rs' Compensatipn Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A lican Information Please Print Let ibIy Name(Bus i ess/Organizatioron6l.,Atdtial): Address: 6 CiiylState ip: /��vr=o t h1✓� U: by Phone #: F oy an ployer2 Check tl��appropriate b6i: am a plover ivith �` 4 ❑ Iam a general contractor ai T'pe of project{rQqulred): mploy (full and/or part tame),* hive hired the sub-con[rac�ors 6. ❑New construction am a e proprietor or partner- :listed on the attached sheet 7. Q Remodeling ship an ave no ernpaoyee<< These sub-contractors have g ❑Demolition workin or me in any capac!� _ employees and have tivorke ' [No wo k 'comp, insuraMA pomp insurance.# 9. ❑Building addition. require .] 5. ❑ !U4/e are`a corporation and its, ME]Electrical repairs or additions 3-❑ I am a h wrier doing all vMork �fcers have exercised their l I.❑Plurrtbing repairs or additions myself o workers'_pomp fight of exemption per MG / insurance required.)t _ 152,§I(4),attd eve have ne 12`�1`oof repairs I truployces.[No workers' 13.❑Other `- t aornp insurance required.] 'Any applicant tha c ecks box#1 must atsc fig out the section below showing their workers'comr=.scion policy information. t Homeowners wh bmit this affidavit rndilc4ing they are dotng:>Jll work ind then hire outside cor trzctors must submit a new affidavit indicating such.;Contractors that c cc this box must attacht;d jo additional sheet showing the name ofthe sub-cont:-ors and state whether or not those entities have employees. If the b contractors have employes,they must provjdo their workers'comp_policy r;ur,ber. I am an empto to that is providing w. ers'coinpeni Won insurance for my e n loyees Below is the policy and joh site information. Insurance Com ty Name:_ Policy#or Se i Lie.#:` Bapiration Date: Job Site Addrel: l7V f.',Ntlie �Il� (,Q; t itF?/State/Zip: /git/Itil" Attach a copy f. a workers'corup tsatioa policy d ration page(showing t<hepolicy nurn er and expiration date). Failure to secur�"i verage as requir d under Section 25A of NIGL c. 152 can lead t6 the imposition fine up to$1,5 .0 and/or one-year p of criminal penalties of a imprisonment,aswell as;eivil penalties in the 'orm of a STOP WORK ORDER and a fine Of tip to$250. a y against the viol or. Be advised that a copy of this staternen'.may be forwarded to the Office of Investigations o DIA for insurancecoverage verifi'cation. J do hereby cer fy er the sins�zn en aides a ' /� P fperjury that the info provided above is true and correct. Signature: " A- 0 DaW 1 Phone##: ? '7 Y_17 6 Official use Do not write ttr Ihs area,tti be coinpteter!by city of town +ffi^rat City or Tow : Permit/License h Issuing Aut -ori (circle one}: I. Board of eat h 2.Building llep •rtnnent 3. City/Towa Clerk 4.Elect iew inspector 5. Plumbing Inspector 6.Other o�,rF r Towift of Bar>astable °-� Regulat6ry Services sAxNsresie Thous F. Geiler,Director v� MAM Mi lding Division Tom Perry,Budding Comxnissioner. 200 Maid Street,Hyannis,NW 0260t www towr.barnstable ma.us Office: 508-862-4038 Fax: 508-790$230 i i Property Owner Mush Complete an4 Sign This Section If Using A.]Builder I, G kkry,04 IUF, o u as Own�.r of the subject property hereby authorize. '7 �""' to act on my behalf, in all matters relative toy vork authorized by this building perr, application for. F��7 al I;va AMu i (Address of Job) - x 4Z ignature of Owner � e 7 6l� Print Name If Property Comer is applying for permit pease complete the Homeowners License E nnptxon Form o� the reverse side. i r ; O:FORM&O WNERPERM ISS M ® CERTIFICATE OF. LIABILITY INSURANCE OATE(MMI°D/YYYY) ACORN `.� 7/26/2016 PRODUCER FRANK L HORGAN INS AGENCY INC- THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 44 BARNSTABLE ROAD ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HYANNIS, MA 02601 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (508)775-5830 508.775-6688 INSURERS AFFORDING COVERAGE NAIC# INSURED GARY GRAHAM - INSURERA:.LIBERTY MUTUAL GROUP DBA CARPENTRY SPECIALIST INSURERBi 66 BRANT WAY INSURER C: HYANNIS MA 02601 INSURER D: - INSURER E: COVERAGES 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 IoAY 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD' _ - POLICY EFFECTIVE POLICY EXPIRATION LIMITS R POLICY NUMBER D M DD DATE MM DD - GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED ]fCLAIMS LIERCIAL GENERAL LIABILIi( REId�SES'Eaccwrrance)MADE OCCUR - ,_ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ - GEN'L AGGREGATE LIMIT APPLIES PER: n PRODUCTS-COMP/OP AGG $ POLICYF—j PRO- LOC - - - AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT ANY AUTO - (Ea accident) $ ALL OWNED AUTOS - BODILY INJURY - SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNEDAUTOS. (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO - OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE - AGGREGATE. $ DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION WC2-31 S-328005-020 3/23/2010 3/23/2011 �/ WC STATU- OTH- AND EMPLOYERS'LIABILITY y/N - ANY PROPRIETOR/PARTNER/EXECUTIVE - E.L.EACH ACCIDENT $ 100000 OFFICER/MEMBER EXCLUDED? (167andatory in NFL) - .. E.L.,DISEASE-EA EMPLOYE $ 1 nnnoo If yes,describe under - SPECIAL PROVISIONS below - E.L.DISEASE-POLICY LIMIT $ 500000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLESI EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Workers Compensation Insurance:Part One of the policy applies only to the Workers'Compensation Laws of the State of MA. THE WORKERS'COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR GARY GRAHAM CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION TOWN OF BARNSTABLE DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN 200 MAIN STREET NOTICETO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL HYANNIS MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. _ AUTHORIZED REPRESENTATIVE Jeff Eldridge ACORD 25(2000/01) 1988-2009ACORDCORPOR)ATCtd, A;1 ,i F - =32-2— License or registration valid for i0afvidal use only before the expiration date. If fougd return to: Board of Buildink!Regulations and,Standards: . One Ashburton fiace Rm 1301 �dd Boston,Ma.02108 If- Not ald withauf signature -- J J. <. � �e �a�zvntancueall�- c� ��zoaac�cc6etit "1` --__ Board of Building Regulations and Stand:.rds —_f HOME IMPROVEMENT CONTRACTOR Registration: 123659 i Expiration: 8/25/2011° Tr# 281647 I' r Type: Individual . Gary C. Graham it Gary Graham 66 Brant Way », .` _Hyannis, MA 02601. Administrator t Massachusetts- Department of Public S;tfetl Board cit'Suildin,, Re,;ulaticins and Stitt,(III'ds Construction Supervisor License License: CS 42246 " Restricted to: 00 z GARY C GRAHAM . 66 BRANT WAY HYANNIS, MA 02601 Expiration: 3/20/2012 . (unnnissioncr Tr#: 18292 1 �. - -- y LAN �..�v. tr" 1�11) o 4-1 0000 41: r { ®G�rm x�:; i SUBJECT TO CH.v�y' DATE f i >�, � 'rKy.,,. x! :�e�4 �' r•:n.rtef �. /: e • '� ar.;.:�-S'f. [, ..t.;f.Y: .7wrtl-l;rr:.5 '.NK� ._y .... .s' .4 �' tti. 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R. a r l r ' ^ • k Ilk a IR NN g $ N F t f Assessor's office(1 st Floor): ` \ Assessor's map and lot number 7 a2 ®`©� , V �o�THE To` Board of Health(3rd floor): ('UNit ' o�♦ ✓ 1 Sewage Permit number ^.]3-9e'� ��'� �� I�ilJt�l� Z DAHd9TADLL Engineering Department(3rd floor): House number !` � �. oo�ob}v.a`,� Definitive Plan Approved by,Planning Board 19 r� APPLICATIONS PROCESSED 8:30 9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR JAPPLICATION FOR PERMIT TO fA'� 2�' d �/N L�L� f�i4fiG �ruG1�� TYPE OF CONSTRUCTION 19 1 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: P S Locatior( Ll/ V f Proposed Use 1 5 UIv f di�fff _ )N? 1 R tJSL� �sF1 � Zoning District— Fire District 41 S Name of Owner r Male 1 Address Name of Builder jA- Cj 1) � w Address Name of Architect ( J)14��� ��t2 QS tt Address Number of Rooms 1 Foundation -PL(LU7 C'_o►ucit99 4-Z Exterior R e c) f�a(z, t.0 ,'Ti2 Gc-DAoofing fq<-,H-l"�'(t: Floors Interior C, ec k Heating 11/Di'✓� Plumbing Y�JdYr66_ Fireplace lVo K10 Approximate Cost 'l,� .00d. 0C) Area Diagram of Lot and Building with Dimensions Fee -SOO 1� C �bvSE PIS- Pi(q.VV)l f 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 constructi U---N—ame a,�tw—� L Construction Supervisor's License BAUCHARD, GERMAIN y r Is No 33936 Permit For Build Addition f Single Family DwelLing Location Lot #37, 170 Whitehall .Way • t Hyannis - - Owner ''Germain Bauchard ' Type of Construction -` Frame Plot Lot t , 9 - -~ Permit Granted August 27, - 19 !9 0- . Date of Inspection 63 3 r 19'; l Date Completed 1 a s r > f Asfessor'sVffice(1st Floor): Assessor's map and lot number D Sri Board of Health(3rd floor): Sewage Permit number -_ Zr yrr� �. �,,7 �� ��J �� l• •.� Z DAH39?ADLL i Engineering Department(3rd floor): / x � rise House number °°,� e�o,• \�r' Definitive Plan Approved by Planning Board 19,? y -APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only t TOWN OF BARNSTABLErn �J BUILDING INSPECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION 1 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for apermit according to the following information: Locations(- `t 71� C t1 i i'/' ►� t()11�4 Proposed Use. Zoning District (r- Fire District �'�U W Name of Owner (7 F 9YYIQ,✓V Ott Pe 1� Address Na ,l me of Builder /ilr�- � l J 0, t,c� Address — + Name of Architect t 1)4-1"F(z-Rc �tq- Address Number of Rooms Foundation pc?t 12 r_0 C-0KVG t` 4T- Exterior = D C-r t1aK C� C'�_(YRoofing 4<1 9+_) It Floors C',::�nr' 41— Interior C, �G .. - p .. _ ✓Y` q r Heating `yon,�fi Plumbing hV0ril Fireplace YV0kiltz Approximate Cost o0o. 0d Area-a Diagram of Lot and Building with Dimensions Fee , ,t A 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/17 M L-�Name (Vk�,'21,fj n � , 4e. 'Construction Supervisor's License 0 y 3o BAUCHARD, GFRMATN A-272--aO5-019 No 33936 Permit For Build Addition Single Family Dwelling Location Lot #3 7 . 170 Whitehal.:L Way Hyannis Owner. Germain Bauchard Type of Construction Frame Plot Lot Permit Granted August 27 , 19 90 Date of Inspection 19 Date Completed 19 PERMIT COMPLETED 1/1/ 9/ A,4 '�,�P�rii'• r "` 'sue ?' •,.��3 y�, y TOWN OF BARNSTABLE 12l BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION,- Iease print. y i ' S �L0CATION /�O �� r � N f f I {? y umb ` er Street Address S t K }1F30MEOWNER p�E pL con OfT'o 4n ' Name ` , pRLSENT MAILING ADDRESS Home Phone psy'cs /�D GU Wor one'. Town State O a(p,•C� r current exemp Z tion for "homeowners P ,COd x occupied dwellings of six unite wn ; wc13 extended to include >; ngage an individual for hire le'''' and to owner—.... .•;,+ lre who allow such owner acts doeO noL homeowners as su ervisor. possess a license, Provfded-'"tja' +'fDEFINITION OF HOMEOWNER;Person s � ) who owns a parcel of land on which he reside, on which there is ,here is , or is intended lie/she resides,g, attached to b or, .intend$ , ru,atturesr °r detached structures e' a one to six. famil 1t�0 A person who cons accessory to h ' . ' ;to`rthe `shall not be considered constructs more than one Y such use and/p� farm Buildin a homeowner. Such ,,hOme in a Y ` g Official on homeowner'.. Qar. Rt�h8t e' she shall be a form acce F °' bttiIditig hermit , res onsible for alptable to shall 8ubm3.,t the Building ,Off.icia . yeti (Section 109 , 1 . 1 � Such work erformed under tfib . �Thte;undersigned "homeowner" $te Buildin assumes f,F ' �t ' 9 Code and other a -'ponsibility for com regtdlations. pplic pliance' �r '?xf '.e codes, b with tote the Y-laws, rules...anda <>. Ba'r undersigned "homeowner" . .] nstab;le BuildinDepartmentcertifies L}lat t LRµ ers .e wire 9 he/she hr c �r q ments minimal!, inspection Procedurestand the: ToWi1 p` r s ,HoNto, WNER SIGNATURE and Hl ' R E .4- I rAPPROVAL OF BU r" AILDING rr11l1) r 7/ fi 92 �i"s y'ip t t 4 1 e family ,squired to comply om Y dwellings 35 , 000 = Y, C t pl with Sta ci.ibi fee �4 e:LI rol, to Building t, or Jar r r g C de Sect ger, w111 ion r 127 . 0, COnstruCt i. '7 •}Y Cyx I z' - r Assessors office(1st Floor)- Asses s map and lot numbet p Pv r� ConS@Nat10n Board of Health(3rd floor): ��,�� _ sasisr = Sewage Permit number �rd��1 � rua Engineering Department .7(3rd floor): :� 0 '6j0' House number �o YSY Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9.30 A.M.and 1:00-2:00 P.M.o 1.nly TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERIUITTO Construct Single Floor Kitchen/ Dining Addition TYPE OF CONSTRUCTION Unprotected— Wood Frame May 12 1993 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 170 White Hall Way, Hyannis MA Proposed Use Kitchen/ Dining Room Extension - New Deck Zoning District RC-1 Fire District Centerville/ Osterville Name of Owner Rose & Germaine Bouchard Address 170 White Hall Way Hyannis Name of Builder Address Name of Architect Richard Fenuccio Arch itectskddress 3217 Main St. Barnstable MA Number of Rooms 1 Foundation Poured Concrete (811) Exterior WC Shingles to Match Existing Roofing Asphalt Shingles to MatchE Floors Oak Flooring over Plywood Interior 2 x 4 Frame walls Heating RP1 nnatP F.xi sti ng RagPhnard Plumbing Relocate Kit. Sink Only Fireplace NA Approximate Cost $2 0, 0 0 0 .0 0 Area 210 s . f t. Diagram of Lot and Building with Dimensions Fee c� (See attached Site Plans) OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Construction Supervisor's License A/ BOUCHARD, ROSE & GERMAINE ' No 35868 Permit For ADDITION Single Family Dwelling Location 170 White Hall Way -Hyannis I I } AJ Owner. ' Ro"se "&`,Germaine Boudha rdIA Type of'Construction Frame w� •' � kT � 1 E i � � Cif "' I i � t' x' r I i i ; �• *� Plot tot - =• I I ,' Permit Granted May. 13, 1 g93 Date of Inspection i 19 i a t Cr Date Completed � 19 }i'gg ' T • A � � :.fr . - I a TOWN OF BARNSTABLE BUILDING DEPARTMENT 2 sasnr : TOWN OFFICE BUILDING rb 9 � HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department DATE: D e�T— /F /,5P?7 An Occupancy Permit has been issued for the building authorized by BuildingPermit #... //ZQ........................................................................................................ ......................................................... issued to .&.j........1.. .r ..... ..... ::.��. ....... 7Ct/t" ? vW �. ' Please release the performance bond. t` -:y. _ ::$... �'_ ,w;:ya.',r�. .:4 '+it-5,+,ry''�- rYjl'bf ,:'�a�"trFP y�'... n-.�,,�.��..,���,r�y��rvg','p'MT..;ri..y.. ,nr� ., "F+'»-yr:lF}.v,.,r,�.,�,1.,.,K,;i•-'�n, .- .�.s'.-#•.,y.. .. ..-"tr! r w: 1 TOWN OF BARNSTABLE . Permit No.3,1120•...... BUILDING DEPARTMENT Cash TOWN OFFICE BUILDING '°�cbiiSiv► HYANNIS,MASS.02601 Bond ....X..... �U.���/ CERTIFICATE OF USE AND OCCUPANCY Issued to Greenbrier Corp. Address Lint #37, 170 Whitehall Way 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 16, 19 87 / . ....... Building Inspector f TOWN OF BARNSTABLE, MASSACHUSETTS BUILDING PERMIT' DATE x 19_ PERMIT -P n8 C LO APPLICANT is .= _ i)% L �•:,� -` ADDRESS c. - '7(, `C) , (NO.) LICENSE) I.iu1 Lbly NUMBER OF i tl :!C PERMIT TO ,� ( ) STORY � .DWELLING UNITS _ (TYPE OF IMPROVEMENT) NO E.. I.PftOPOSED US ZONING AT (LOCATION) `''�')L i('-% ) r ! ') DISTRICT__1. - (NO.) •..(STREET) -. .._.. — BETWEEN AND (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) :�Uydc REMARKS: ci, N u li_ l:�•O AREA OR VOLUME J: A J 0 .S{,; c� ;y ', _ _ PERMIT - ESTIMATED COST �P � x •-%<%L�� �-?!.1 FEE � Jil (CUBIC/SO UARE FEET) OWNER :. BUILDING DE PT ADDRESS `—' U. .t;_,..i �-:ll x �t� r.•L....•. '-:`_I. BY - ...!:':....:.. ! % �•- / THIS PERMIT CONVEYS NO RIGHT TO 'OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- 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 CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND I. 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 FINAL INSPECTION TI TO LATHE FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE OCCUPANCY. POST THIS CAR® SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS .• I ILo- ivoel ` 3 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT _ ro OTHER BOARD OF HEALTH , WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT W!LL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE TOR HAS APPROVED THE VARIODUS STAGES OF i WORK IS NOT STARTED WITHIN SIX. MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN CONSTRUCTION. I• PERMIT IS ISSUED AS NOTED ABOVE: NOTIFICATION. 111 e eg 1 ��" ..f! �•. � f, t k „Px � +" r ae'`c� _K{ AK J V s -itf, e 41, W. F xy',1y'"S�s•� �.2'."t.a �' ; '' .. ,,vy'. >N �vt,�3„''L�fs;� �r. t 9f , J4 `,T'Yt t_ �SSL•° .. . 3 4 p)kwf rrtfy.S fr ss y�sgg^s�r�,th� ?C tt �, yZ.�'r �x.31.•3 � .. .. .,. f E.at� 4i ", TM, t 4�A - •* ♦Fi . t. T� a"tra4*4" �� �.��-.,��� . '>' .y . �GAR: - i ,�;a -37 ' J'i' $�£ Fii y �i 29/+� ' - i ,�X. t f f, 4Z J < 1�� milk;�; s 4A. ..Pov,, 't t.;f N1 i�A } > G Z_I „t4 07 24. - �.. //// F�� •' ��a is 01" a ee lr 'ik - h�f �i -i,.'� l re Ng'r t , a N � f 4j n t� •. f x{9 i 5� 14 ( i4_ Yxt dt l ,s k'cy x r t 4 p 40, Ary M f a � T llY' , I CERTIFY THAT THE Foc-1,vL,4 I /Ue�j - _�•�� ,f't�t tt'r�pYc`td�' ., C } ���+•� a Ott G v e r r SHOWN ON THIS PLAN IS � .t # LOCATED ON THE GROUNDPAUL A. r a >r AS INDICATE® LEVY " E ty .. '. x DATE REG ST RED LARID SURVEYO Y l EVYr& ELDREDGE ASSOCIATES,INC. CLIE TGR BRI T I LOT Y"xENGINEERS = LANDSCAPE ARCHITECTS ®® NO. 10 -T 40727 0117T 1,q yL �Y w�y PI:ANNERS LAND SURVEYORS , A S is ., DR. N . .WEST MAIN STREET CHKD. BY, I LLE, MA. ®2632 SHEET OF SCALES RA QAT _., E "h Ott DL Assessor's offioe,(1st floor): ' '/- MUST B Assessors map and lot number ,. .....¢2�. . �►E7 \j 5 � THE tp�' 2 r IN Co 5 Board of Health Ord floor): 9NSTALLED fO .' Sewage Permit number .•.�• . s : ��H �'CO� L' Tsnte, Engineering Department (3rd floor) +� !7�{ -1 S ' tom ,. ME�YA` ,�'® ,, Oe3Y a�e� House,number •........'............... . V �1VIR ............... ..:............................ 0� ■ � v..r. -r®WN REGULA YP -APPLICATIONS "PROCESSED-.8:30=-9:30 A.M. and 1:00=2:00 P.M.,only TOWN OF BARNSTABLE RUI^LDIHG 'JOSPECTOR APPLICATION :FOR PERMIT TO ... .. ..Q .S....d'u ..... .6.. . . �.... .............®`................ TYPE OFR CONSTRUCTION �� .. lf .e. ......... ................... �.. ...:......... - , t .-1 .. 19.. . TO THE INSPECTOR OF BUILDINGS: r The undersigned ereby opplies for a p rmit`according to follows information: Location . ............... . :.... :Y`........ .... . ... ........ . `i��. .(. .................... Proposed Use ... ./. `— . Zoning District .... ............ ....................... ....... .. ......:Fire District -VT........ re Name of Owner .... Name of Builder ..'.... ..Address .............................................:•................:.............•...... Name of Architect ..........'....................................................:...Address Number` of Rooms ..... ....................................... ....... ..-....Found'ation .. .... .. n .• .. P • .• Exterior ...!�✓. ..4 ..�J. :. L. :... ... ..... .... . ...y.. oofing .. ......:. .. .... .. ... � � ). ............: - .Interior ....... Floors .1.. ..... ..�..... ..:.,..5_. �. .... ... ........... ...... e .... .I .....................•:.... • - ------- .. .:.... v .. .. ...::._ .::.•'P,lumbmg_ ".. ...: .................................. 0...Fireplace ..........'. ....::............................ .......Approximate Cost ... ... .... Definitive Plan Approved by Planning Board ____________/_ZC� fig Area l.L.... ...............:....- Diagram of Lot and Building with Dimensions Fee (� ' ............................. SUBJECT TO APPROVAL OF BOARD OF HEALTH 9 OCCUPANCY,PERMITS.REQUIRED FOR NEW DWELLINGS I hereby. agree to conform. to all the Rules and Regulations of the Town of Bar able regarding the above construction.' Name ..... ........ ... ..?.. .'...... Construction Supervisor's License .. .. .. .. r t ( GREENBRIER CORP. - o• 31120.,Permit for.....1z...Story........... "u - :SiricTle Fami1X..Dwelling ........ - ' Location Lo`t -#37 , 170 Whitehall ihay r .. ...... ................. _4i.......... f •r / /� t, ^e Flyannis ............ �^'� J♦`.J s Owner- Greenbrier Cora?...................... i!' <•` ( -�`� _,.-- ,Y d A Type of •Construction . Frame - !. t `�•`:, ,,..�. +a• s as � ! s tf� ..� . ,' 'r. Plot ..:...... :. Lot. ....... ....i ......... ' !; august--2/5 ,� {' 87 r + Permit Gran ed ....................�..41 .... �19 - Date of Inspection {....p....:�.. :,�"19 � � iJ Ur Date Complet d .l 119�7 lf �T,•�.(.R � i. `"TP�� �1 i i: _ 1 F'`'�:`_ '' I• r {# - � r (�_� rrf tF� � i . F �b *� fit' s' � -s--� V '� ��`..►�-~_�. ` J IMM .. f'/ ' ;�`� -J r .-"C��,�3'' �,.,r---�''. ,7.• t _ - - ,�'1 t _ _ l y <f Assessor's offioe (1st floor): � � I �. oFTMElo� Assessor', map and lot number .y............................. �Q� o Beard of Health (3rd floor): fO Sewage Permit number ff Gam.... ............tn......!. Z..�! aJ Z EAUSTADLE. i Engineering Department (3rd floor): r h' �o b a House number 1 w �o,1639. �q `e......................................... CFO MAI a' APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR S' u l� APPLICATION, FOR PERMIT TO ....�..��...........1.r......:. ....... .........�........`.�.... ...................................... TYPE OF CONSTRUCTION ..1. .......d� ...I.... �-� P............................................... ....................... ....................... .....19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies fora permit according to th following information: � l Location ,/..(..J.. .� ../.........(. ........'.. Vl ..............1.. jC�...............;..... . .t. 17..0..(.... .................... r ProposedUse 1..(f?. ..... ...... .: ...................................................................................................... Zoning District .......�.... ......'.".... .....................................Fire District .`.1��............ .r���� �................ . .. ...... .......... Name of Owner ,l.C>.... ....:.Address .......%....... ...0:x... Nameof Builder .....t:. d.4S.-. ..................................Address .................................................................................... Nameof Architect ..................................................................Address ............................................................................A...... p Number of Rooms ....... ........................................0......!.......Foundationr—.�� . ©�.�.�C�...... J )Exterior ...1... .. .//�!. ......!.�j5.....�Z....0 ..... ....CRoofing .. ........�5........ .... ... .,, \ .. ............... Floors /..r...�t... ../.... .......1...-..�r� ,`...... ...............Interior .....� .......e ...... �. ...V�............................ Heating ... . >!.U..... C4..:. ......Plumbing ..... ...'�.J,��` . Fireplace ..................................................................................Approximate Cost ...... ..a.l� . .` J ..... ................................. Definitive Plan Approved by Planning Board ___________l�_ �� C1�9 ? Area .......................................... J Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH A 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 ............. ............. � Construction Supervisor's License .C.... ..��C....1 GREENBRIER CORP. A=272-005 No 31120 permit for ..1 z Story `Single Family..Dwellin5 Location ....Lot...#3.7.,.__._ 17,O...Whitehall Way ...................Hyannis.......................................... Owner Gr.eenbrier. . . . ....Cor ... ......................... .... .. .... .. .... .... Type of Construction Frame ............................................................................... Plot ............................ Lot ................................ Permit Granted .....August ..........19 87 Date of Inspection ....................................19 J Date Completed ......................................19 I