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0036 WORCESTER LANE
, .3L uJ..-ceela�� o'�mx-�� The Commonwealth of Massachusetts Department oflndustrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plum hers Applicant Information Please Print Legibly Name pusiness/organiZati vidual),� !C- Address: City/State/Zip: Phone#: �� � 1 Are you an employer? Check the-appropriate boa: Type of project(required): 1,❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part time).*. have hired the sub-contractors 6. El New construction 2.❑ I am a sole proprietor or partner- - listed on the attached sheet # 7. ❑ Remodeling slip and have no employees These sub-contractors have 8. ❑ Demolition working for mein any capacity. workers' comp.insurance. g, ❑ Binding addition [No workers'ed] qmV.insurance 5. ❑ We are a corporation and its rim . officers have exercised their_ 10.❑ Electrical repairs or additions 3.Ilel'1 am a homeowner do}ng all work right of exemption per MGL l l.❑ Plumbing repairs or,additions myself.[No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs msnzance required.]t employees.[No workers' 13, er 1 comp,insurance required.] *Any applicant that checks box#1 moat also fill out the section below showing their workers'compensation policy inAmYhdoiZ t Homeowners wbo submit this affidavit indicating they are doing all work and then hire outside contactors must submit a new affidavit indicating such xContractm that check this box must attached an additional sheet showing The name ofthe sub-contractors and their workers'aomp,policy mformsbon. I am an employer that is providing workers'compensation Insurance for my employees. Below is the policy and job site , information. Insurance Compaay.Name: Policy#or Self-ins.Lie,#: Bxpiration Date: Job Site Address: City/State*- Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to securo coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,504,.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 Imvestigations of the DIA for insurance coverage verification. I do hereby certify u er the s enalties o rjury that the information provided above is true and correct Sr afire. Date: b• t'''hone#t, Official use only: Igo not write in this area,to be completed by city or town of lclaL City or Town- Permi#/Licease# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Towu Clem 4.]Electrical Inspector 5.Plumbing Inspector 6.Other Contaci Fersou: Phone#: Information. and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,.&al or written." An employer is defined as-"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the . receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant wbo 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 performance ofpublic work until acceptable evidence of com:5)liance 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 yow situation and,if necessary,supply sub-contracto*)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is requi e . Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation insurance coverage. Also be sure to sign and date the affidavit. The-affidavit should be returned to the city or tows that the application for the p ermit or license is being requested,-not the Department of the law or if you are re uired to obtain a workers' Industrial Accidents: Should you have any questions regarding yo q compensatioupolicy,please call the Deparmient at the mrmber listedbelow. Self-insured companies should cuter 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 lh affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fillin the permit/Ecense number which wM be used as a reference camber. In addition an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job.Site Address"the applicant should write"all locations in - ' (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that.a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year.Where a home owner or citizen is obtainfilg a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bmn 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 cumber: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1 a77-NIASSAFE Fax#617-727-7749 Revised 5-26-05 www.mass.cov/dia TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 41 Q , Map,, a�� Parcel 10 Permit# � ( f +Health Division Date Issued If —vim Conservation Division e�s fit/ ��� _ Fee v Tax Collector ' (/ O -Application Fee 60 Treasurer d, ovw Planning Dept. O Checked in By 'w Date Definitive Plan Approved by Planning Board Approved By Historic-OKH Preservation/Hyannis Project Street Address 3(Q Wic ccP&AP10 6�s Village IS Owner �NA< L InnA �_,Pry\n on Address 34 WcXCP_4 Q2 ILAO' I Telephone S6% — qll).5-- '7 1%1 Permit Request_10\Xto Vke,PQ_ f�-9650z--) a�t (00s) \ec\ c� Square feet: 1st floor: existing Sbto proposed �G 2nd floor: existing OS proposed �Q " Total riew Valuation 30,bOO Zoning District �-� Flood Plain Groundwater Overlay.,, -r Construction Type WmQ Lot Size O >raC.. '12,tq 79c C4,Grandfathered: ❑Yes ❑ No If yes, attach supporting docume tation. ' Dwelling Type: Single Family ud Two Family ❑ Multi-Family(#units) Age of Existing Structure '24o4Cv Historic House: ❑Yes ❑ No On Old King's Highway: 0 Yes ❑ No Basement Type: 13 ull Llf'CXawl ❑Walkout ❑Other Basement Finished Area�sq.ft.) 0 Basement Unfinished Area(sq.ft) Number of Baths: Full: existing - new Half:existing 9 new Plumber of Bedrooms: existing_ new Total Room Count(not including baths): existing .new 0 First Floor Room Count Heat Type and Fuel: Gas ❑Oil O Electric ❑Other Central Air: 5/Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: O Yes 0 No Detached garage:0 existing ❑new size Pool:❑existing ❑new size Barn:0 existing Cl new size Attached garage:O existing ❑new size Shed:0 existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes d(No If yes, site plan review# Current Use Proposed Use �4_&U&hw BUILDER INFORMATION Name ` K M - Telephone=Number Address License# ®�O� e ,\iep—on � :�� OZIa O� Home Improvement Contractor# 031 'up Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO ` c_1�4 � - T SIGNATURE DATE I I 2-01 0(-,P FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. - - '1 ADDRESS ' VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME 01� INSULATION B/C�-- FIRERLACE / ' ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL W FINAL BUILDING ' DATE CLOSED OUT - r ASSOCIATION PLAN.NO. Town of Barnstable Regulatory Services Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied. building containing at least one but not more than four dwelling units or to structures which--are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. ,� n '' . Type.of Work: 1( tarl ' �'Ld�"� Estimated Cost_ Address of Work: 36 JK( r - ' Owner's Name: �)Gn o lz LpvonOY) Date of Application:_ I hereby certify that: Registration is not required for the following reason(s): FWork excluded by law ❑Job Under$1,000 []Building not owner-occupied Downer pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH.UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: �*-Ion 0c61J Date Contractor Name Registration No. OR Date Owner's Name Q:forms1omeaffidav RESIDENTIAL BUILDING PERNIIT FEES APPLICATION FEE New Buildings $100.00 Residential Addition $50.00 Alterations/Renovations $50.00 Change of Contractor/Builder $25.00 FEE VALUE WORKSBEET .NEW LIVING SPACE C�a square feet x$96/sq.foot= x.0041= plus from below(if applicable) ALTERATIONSMENOVATIONS OF EXISTING SPACE 5t , square feet x$64/sq,foot= x.0041= 2-0o CH 2, plus from below(if applicable) . GARAGES'(attached&detached) square feet x$32/sq.ft.= x.0041= ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq,foot= x.0041= STAND ALONE PERMITS Open Porch x$30.00= (number) r Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocadon/Moving $150.00 (plus above if applicable) c Permit Fee Projeast m ofzHE Town of Barnstable i. Regulatory Services .Musa. ' Thomas F.Geiler,Director 9`bpifo; ►`e� Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Ommer Must Complete and Sign This Section If Using A Builder I 7�'z-&%nfS T)tg,)n A ZJPjn0(3n ,as Owner of the subject property hereby authorize ya(M CCU U—'�2LX QMV' to act on my behalf, in all matters relative to work authorized by this building permit application for: SLO Wac"e—L, f 'err'aS (Address of Job) Signature of Owner~ Date Print Name f QTORMS:OWNMERMISSION off'✓ Board of Building Regulations and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Regisg ' ' Type: Priva ora i Expiration: 7/10/2006 THERMCO, INC. WILLIAM MCCLUSKEY 7D Huntington Ave: S. Yarmouth, MA 02664 Update Address and return card.Mark reason for chang DPS-CA1 G 5OM-04/04-G101216 ❑ Address ❑ Renewal ❑ Employment Lost Card ✓.' tppmtnt4x�uea`!�i a�✓`Ga�UC/iu4elt6 f� BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 000671 y 1955 Expires: 03/09/200 Tr.no: 19961 Restricted: 00 THOMAS E NEY 17 SPARROW WAY S YARMOUTH, MA 02664 Acting C mis oner I I MAScheck COMPLIANCE REPORT I I Massachusetts Energy Code I Permit # I' MAScheck Software Version 2.01 I I I i I Checked by/Date I I CITY: Barnstable STATE: Massachusetts HDD: 6137 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 1-20-2006 COMPLIANCE: PASSES Required UA = 27 Your Home = 16 Area or Cavity. Cont. Glazing/Door Perimeter R-Value R-Value U-Value UA ---------------------------------- ------ --- -------------------- CEILINGS 60 •:*:0 �*:0 `L•.. xt 1 WALLS: Wood Frame, 16" O.C. 175 •15.0 •15.0 t ,:, , 8 GLAZING: Windows �3 % �� or Doors 7 0.300 2 GLAZING : Skylights 8 0.300 2 FLOORS: Over Unconditioned Space . 60 19.0 19.0 3 -------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in Sections 780CMR 1310 nd J4.4. Builder/Designer Date MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.01 DATE: 1-20-2006 Bldg. l Dept. l Use I I CEILINGS: L l I 1. R-21 + R-21 Comments/Location I WALLS: [ ] I 1. Wood Frame, 16" O.C., R-15 + R-15 Comments/Location I WINDOWS AND GLASS DOORS: [ ] I 1. U-value: 0.3 I For windows without labeled U-values, describe features: I # Panes Frame Type Thermal Break? ( ] Yes [ ] No I Comments/Location I SKYLIGHTS: [ ] I 1. U-value: 0.3 For skylights without labeled U-values, describe features: I # Panes Frame Type Thermal Break? [ ] Yes [ ] No I Comments/Location I FLOORS: [ ] i 1. Over Unconditioned Space, R-19 Comments/Location I AIR LEAKAGE: [ ] I Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. When installed in the building envelope, recessed lighting fixtures shall meet one of the following requirements: I 1. Type IC rated, manufactured with no penetrations between the I inside of the recessed fixture and ceiling cavity and sealed or I gasketed to prevent air leakage into the unconditioned space. I 2. Type IC rated, in accordance with Standard ASTM E 283, with no more than 2.0 cfm (0.944 L/s) air movement from the the I conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled. I VAPOR RETARDER: [ ] I Required on the warm-in-winter side of all non-vented framed ceilings, walls, and floors. I I MATERIALS IDENTIFICATION: [ ] I Materials and equipment must be identified so that compliance can I be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be I provided. Insulation R-values and glazing U-values must be clearly v 1 marked on the building plans or specifications. I I DUCT INSULATION: [ ] I Ducts shall be insulated per Table J4.4.7.1. I I DUCT CONSTRUCTION: [ l I All accessible joints, seams, and connections of supply and return I ductwork located outside conditioned space, including stud bays or I joist cavities/spaces used to transport air, shall be sealed I using mastic and fibrous backing tape installed according to the I manufacturer's installation instructions. Mesh tape may be I omitted where gaps are less than 1/8 inch. Duct tape is not I permitted. The HVAC system must provide a means for balancing I air and water systems. I TEMPERATURE CONTROLS: [ l I Thermostats are required for each separate HVAC system. A manual I or automatic means to partially restrict or shut off the heating I and/or cooling input to each zone or floor shall be provided. I 1 HVAC EQUIPMENT SIZING: [ ] I Rated output capacity of the heating/cooling system is I not greater than 125% of the design load as specified I in Sections 780CMR 1310 and J4.4. I [ ] I SWIMMING POOLS: I All heated swimming pools must have an on/off heater switch and I require a cover unless over 20% of the heating energy is from I non-depletable sources. Pool pumps require a time clock. i [ ) I HVAC PIPING INSULATION: I HVAC piping conveying fluids above 120 F or chilled fluids I below 55 F must be insulated to the following levels (in.) : I PIPE SIZES (in.) I HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" I Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 I Low temperature 120-200 0.5 1.0 1.0 1.5 I Steam condensate any 1.0 1.0 1.5 2.0 COOLING SYSTEMS: I Chilled water or 40-55 0.5 0.5 0.75 1.0 I refrigerant below 40 1.0 1.0 1.5 1.5 I [ ] I CIRCULATING HOT WATER SYSTEMS: I Insulate circulating hot water pipes to the following levels (in.) : I PIPE SIZES (in.) NON-CIRCULATING I CIRCULATING MAINS & RUNOUTS I HEATED WATER TEMP (F) : RUNOUTS 0-1" I 0-1.25" 1.5-2.0" 2.0+" I 170-180 0.5 I 1.0 1.5 2.0 I 140-160 0.5 I 0.5 1.0 1.5 I 100-130 0.5 I 0.5 0.5 1.0 ----NOTES TO FIELD (Building Department Use Only)------------------------- wa ,fie 1 �, ,,,,a��1,�.^,r„t r}`^q',ri•li .xr'� _ �* +.�..r �- � 'fir'K r •`. kC3MR # ,,,,. ri� x r .,.� sf a� `'} .i -'j' sx i,:!q V,�r•.. a ', AR v c.Y.;{t-a Ati 1 xx'�.,�»J��'1s�:�� aK -.,,.Fry :, x _ :p ',� _• �-�Y .. -� + sa� 1. t f ofiff �{ /� J �IyyTAI Q f 'Y ear`� y 5r.«'���#-� fifi �y An e. ..PT J7 }ffQrL : �r+� ti fir• � r 5•�� 2d�.:,� /�s'�� - ,�� Y s'.s 3� ' x 'E srf .:• �'�tc 'u!'T: h+ .Y�:4:.Fy ��d•�.. - � �V��1�� .'V �n y5�tr�:,-' i� h_. 50. C tC3�`.�S�r o`.Syv. 'i}x .' _: ,•. � �i:�..X'kat r-!'Y ... �.i a ':v'.:J";,' �xG•.i: ,1 � rz' .. .�,. -VI :k"} y. �.:: "1• s ahi4 f 01" i ' r s nx, i �" r . 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Ch. escription �t '�odel ��a 1 ` t fir; aeped eCtrohda l r, u ty.1 ?,tp -z oundation 1sr deb'ty ,y� `s s. � rs verage DK 19 PTO 10 IT Z s, . tones y ± s Bath Split 0 cpac MIXED USE. t terror Wall 1 out1 Sluugk Cody Description Pcicen(r. 10 D}C 3.§ tenor Wall 2 l�l 1; 164 r .` Y 1010 Single 100 10 8 itr r p r Cr � 5 �# 3+ able/HrP 32 J� oofCover 3v i ' sph/F;GIs/Cmp 4 z ., 3 iii �5 nteno Wall-P. rye II *ti' . = nieiorWal12� L t^ 4 x COST/MARKET VALUATION19 nt 2"; e°I tenor,Flr1�M Adj.Base Rate: ' x , ` 4rx tlteenor-Flr"`2 ' Yp Replace Cost , i�' eateFuel�` 3 YB FHS i LTypr°3ti 4q : of Air 1984 ep Code 6 BAS 2 WDK { CkTYPF €I , 3 " a entral 1993 Unadj.Base Rate BMT talr�ed ' t oBedrooms 3r � � Bedrooms � emodel Rating tJ otalrBthtms�t ear Remodeled u �� o otal Half BMhs3 * +r ep /o lip otal Xtra Frxtny u cnlObsin M a a, r f g con Obsinc c i tx otal Rooms Rooms 13 { 1 a h tyle q t tatus 199 Y , a ost Trend Factor'. : .. tchen '�'- •��,���zryr,,� Y.Complete O .�. .v.' - �� verall /o Cond } M,� pprais Val w s :,. 1101,151, rs3 , ep Ovr Comment Oise Imp Ovr _- �� , Lsc I yr Comment x: k t s Imp O mm ost to Cure Ovr .� ost to Cure Ovr Comme.I Me — �s -12 3 V .; OB OUTBUILDING&;YARD ITEMS(L)/XF,-BUILDING EXTRA FEATURES(B) tj r ode,<.k Descriptiom ub,13tib Descrr t B Units Unit Price Yr. Gde Rt Cnd /oCnd r Value ; :. HEDrs Shed, 3 00 1990 1 100 300 " PL22 ireplacea 1 ,000.00 1993 1 - 100' ,700 �Q - x„ x F 1�a Y t x a- a3 No Photo On Record '"; Jet SUB AREA SUMMARY SECTION 3Code1 escn fron - LivinjZ Area Gross Area E .Area Unit Cost Undre rec. Value % p ASS uirsstXloor 806 806 806 0.00 U MTV ; asement Area 0 806 81 0.00 0 � �T ar NHS "w alf StoryC 806 806 605 0.00 0 I O ' ' atio;j s 0 80 8 0.00 0 r Vood Deck 0 340 34 0.00 0 2.t !af1'i;Y' 71y,e j "'�i S 4,'g'• 11 3/0 3 Town of Barnstable "Peru-At 6 -3 � V NJtjrbu 6mexth f}»m brus date tt awstxtrrwatz, a Regulatory ServAces Fee___ Thomas F.,Geiler,)Director ° Building Division Tom Perry, Building Commissioner X-PRESS PERN 0 200 Main Street, Hyannis,MA 02601 APR 2 2 lUU3 Office. 508-8624038 Fax: 508-790-6230 EXPRESS PERNHT APPLICATION - RESIODE C. O�]'L,`Y°ST,�SLE Not Valid without Red X-Frew Imprint Map/parcel Number �0 w Pzoperty Address NQ wop:E� JaLml j 0 P In Lo 6C�&,() Mesidential Value of Work Owner's Name&Address 6a Contractor's Name ?G.y J Qazn- L X)RS ti`�%��l Tclephono Number Home Improvement Contractor Liccn5c#(if applicable) Construction Supervisor's License#(if applicable) f'Woriauan's Compensation Insurance Check ono; ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name I ray ew lr`, -fno 0C , Cf S l) ,t Y1Cj 4= workmen's comp.P olicy# .-I Pi U 6--q'2-of x Q 1j 3 - rj0 2 Permit Request(chock box) Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement WiAdows. U-Value (maximum.44) f ❑ Other(specify) •Where required: Issuance of this pcnrit does not axecnpt compliance anth other town dquunent regulations,i.e.Historic,Conservadan,etc. Signature pwl Q:Forms:WMtrg Raviacd 121901 R 0 0 . F I N G 1031 Main Street Osterville, MA 02655 www.cazeault.com P.O. Box 2781 Orleans, MA 02653 NAME . Thomas&Donna Gannon (S ) 775-7381 DATE March 28 2003 STREET 36 Worcester Lane CITY/TOWN Hyannis, MA 02601 Remove existing shingle roof. Re-nail any loose boarding. Install .032 aluminum heavy drip edge. Install WeatherWatch or Stormguard ice and water shield on bottom edge, in valleys, and around penetrations. Install Shinglemate underlayment felt. Install GAF 30 year shingles. All shingles to be storm nailed. Vent pipes to receive new flashing. Cut open and install Cobra ridge vent. All roofing related rubbish to be removed. Provide GAF System Plus Warranty (covers both labor& material)see brochure- COST- $4,340.00 for Marquis $4,790.00 for Timberline 40 year shingles. � ► PLEASE INDICATE CHOIC ,� ` U Dollars $ 7 Pa'T`eM`°be made asf°"°"g: 1/3 due with signed contract, 1/3 due when job is half done, 1/3 due upon completion Credit Cards Accepted Mastercard Visa, Discover All matter is guaranteed to be as specified. All work to be completed in a skillful manner according to standard practices. Estimated by: Mike Alden All agreements contingent upon strikes, accidents, or delays beyond our control. Owner is to carry fire,tomado, and other Note:This proposal may be withdrawn necessary insurance. -30 days by us if not accepted within Clcceptatwe of.1wpaoae : Customer Signature _ �����.7Uh Fn\"Ltt_l/171L�j �G'7 ��-'1 i✓Z��.� The above prices,specifications,and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment to Date of Acceptance be made as outlined above. Please Sign and return one copy to contract job Toll-free in MA: (800) 698-5569 Osterville: (508) 428-1177 Orleans: (508) 255-5569 Falmouth: (508) 457-1141 Nantucket: (508) 228-5911 Fax: (508) 420-4555 0 A I I, CERTIFICATE OF LIABILITY INSURANCE PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER 017 INFORMATION Mc Shea insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CL*I1,TII_`I(.,AIL. HOLDER. 1-1-11S CERTIFICATE DOE'; NOT AMEND, EXTEND OR 749 Main Street, Suite#H ALTER THE COVERAGE AFFORDED BY THE POLICIES BCLOV.' Osterville, Ma. 02655 --5-0 8- INSURERS AFFORDING COVERAGE INSURED INSI R Paul J Cazeault & Sons Roofing Inc. )HI-IIA ----------Yal. -------- - Roofing, Inc. -_ _Q Travelers .indoinnity Co of Iiiiijoi 1031 main Street canILHC Osterville, Ma 02655 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURLD NAMED ABOVE FOR THE POLICY PFFIIOD INDICATED.NO]Wil I IS]_ANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WF1 11 RI-SPECT TO WHICH I F-11S CERTIFICATE MAY I It- ISSUED(�fj MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCHIBE-DHEHI-111 I'3SUBJECT TOALLTHE TFIIMS,E,',CI_USI0NS AND CONDITIONS 01 Ij POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NsR F------- I-TVI TYPE OF INSURANCE _POLiCY_N_U_rv_1[_3FR__ POLICY FFFFr..FIVE POI-ICY F.XPIRAI ION GENERAL LIABILITY 1; im I r(mmamim DAli:(MMI()D/YY) LIMITS S LACI I(,G C il II I-NGI� `1, 000, 00000MMCHCAl- ,jil-i lAL I.IAIfl j.Ipe -. -..CI nun:;MAI)l 11111)AMAGI A,,v M)1)1:XP(Any S PAC5912908 04/30/02 04/30/03 PIJV;ONAI_&ADVINJ1 Y "1 100.0'.00 0 C.LNI-HAL A(.',(,Iil:CAll GFITL AGGREGATF LIMIT APPLIES PCH: 2_10.010_00 0 Fto PI 1004 K�IS-COMPIOP A(W. Pot-ICY - I LOC ..-1, 000, 000 _C� AUTOMOBILE LIABILITY ANY AU 10 c(_)mwriFw;INGI_L LIMI I (La acc,dpm) S ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) 1-1113ED AUTOS NON-OWNED AU-I 01; I BODILY INJURY (Perat:�"Wonl) $ P1 i0i'l.III Y DAMAGE (Peracci(jenj) $ GARAGE LIABILITY ANY AUTO AU 10 ONLY-FA ACCIF)E-N r $ IIA ACIC $ MAN IAN EXCESS LIA131LITY AU 10 ONLY: AGG S 1.-,A(',I I O(Gt.)HHLNCF _1.00CUIA CLAIMS MADE A I G iGA-1 E $ DEDUCE-1131-E RETENTION S WORKERS COMPENSATION AND t EMPLOYERS'LIABILITY WCSIAIU- Oill- X 1OI1YI.IMITS 7PTUB-922X653-502 FR 08/10/02 08/10/03 1.1 L--A(-,IIAC(',11)1-Nr $100, 000 E.L.DICI-A--,I-- EA EMI'l-OYEI sloo 1.00.0 OTHERPoucv5 0 0,-Q U DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER 3c ADDITIONAL INSIl.m.lmS11LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE-CANCELLED DLFOFE Till:11XI'llIATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WHIZ ILr; NOTICE TOTHE CERTIFICATE HOLDER NAMLO IOTHL LLFI,I3UrFAILUV1ETODOs0SH,1LI. IMPOSE NO OBLIGATION OR LIABILITY 01:ANY KIND UPON I HE INYJH-1 1 S AGEN r5 0 REPRESENTATIVES. AUTHORIZED REPRESENT 11YE -S(7/97) ACORD25 td OACORD COR130RATION 1�38 �,►, , ul1UI One Ashburton" oston , fVl a�G 1 02G�2� lic::Jll'ICll:l,l I� . 1 , 1• UOARD.;OI= L1UILDING RCGUI_i\rlilrl;; LicenLu: COJc-niuC7IOIJ ;;UI'1_IiVI: l_ili NulpUur:�C;; tul;a;�, Ex p i r u;S:::10/2 0/;_00:, Reslrictud::00 PAUL J CAZEAUUr 1585 MAIN S-r , 05TERVILLt, tJ1A iuJrnini:;Iralor _ I/i V Board of Building Regula ions and Standards . One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 103714 Type: Private Corporation Expiration: 7/9/2004 PAUL J. CAZEAULT & SONS, INC: Paul Cazeault P.O. Box 2781 Orleans, MA 02653 ......... - -- - --- Update Address and return,card. Mark reason for change. Address I" Renewal -I l.Ltnployment 1 Lost Card 91e 'Gazer/uaruue�� o�✓� cu�iuvelCb Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 103714 Board of Building Regulations and Standards One Ashburton Place Rnt 1301 Expiration: 7/9/2004 Boston,Ma.02108 Type: Private Corporation CAZEAULT&SONS, INC. zeault 3h Rd. C,Gi MA 02653 - -- ---- --- ------- - - ------- Administrator Not valid without signature '10"A essor's map and lot ,numb� � . . .:. C oFTHETo Sewage Permit number y House number ... .....`...` G ...... F �'';It�+�t;�QN�C asa S T ^68!^ Z B 9TanLE, j 9 A8 a F .TOWN SEWER TOWN OF., BARNSTABLE. RU [LD I N'G INSFECTOR'. APPLICATION FOR PERMIT .TO Construct Single Family Dwelling TYPE OF CONSTRUCTION .....•,, Wood Frame.. A 4 September 26, 8 I ........ , . ..............19......... (I TO THE JNSPECTOR .OF BUILDINGS: The`undersigned ,hereby applies for a permit according to the following information:;` Location Lot # 19 Worcester Zane, H annis Mass. anon ... y. .�. .... ...... .... Proposed.Use ... ......... ......... i... .... R. B. G Zoning Distract Fire Distract Hyri11s i Ca riCorxl Real Trust �6 Falmouth Road H anr;iig Ma s, Nameof Owner ,,..�............. . .. ......... ...... ................ ...Address . .... Name of Build ,ranc© Real. Est.Dev.C... InC.'Address ........ •.Same••• j . ddres :...... : .Name of Architect ................................ ............ ...... . .......A . I i Number...of..Rooms .....5 .............:............................ ..:...;..Foundation ...::...p.!.C+!........ ......... .... ' Clapboard anc../or Shingles........... v....................... .....................,..................Roofng As h Carpet....... ... .... .. ............... .... ..... . Interior ...... S Gas F.W.A, t Heating ....... .......Plumbing ... B�fi . Y . Two Cop ' None 0 00(� 00 Fireplace'' ._. . ......:. Approximate. Cost .:.. . .......t. i. .. .. Definitive Plan Approved by Planning Board ------------- ----------------19--------.- Area ; .. ..: ....... Diagram of Lot and., Building with Dimensions. r >Fee V ! . SUBJECT TO APPROVAL OF BOARD OF HEALTH �% mil . e • . , � 1. .. - .. OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS f I hereby agree to conform to all-the Rules and Regulations of the Town of. Barnstable regarding the *above.I construction. ? Name ?�?: .......... `.4 Construction u or s icense oaog89: ................ A rI f ..No ;��•. Permit for ........Sto.................... ... .dingle„Family.Dwelling........................ Loca#iori Wt..19.......36..LVAZC�S .. ...........Uyanrl is............................................ Owner ..Q?9.IdQQ.I.M..RAlty..rppt............... Type -of Construction .. . ............................................................. Plot ..................... Lot F.• Permit Granted ......()Q.tQ r..11.,...........19 34 - Date;of,,`Inspection ..................... ........19 s e Date "Completed ....:............ 19 r 1 i i q � i I. S,t r'rj 3e;k ti o' �o -Lot (:7G (4-/RY P2e✓A, 1. N 780Z 5 "x/ 7, . CERTIFIED PLOT PLAN S f �YAA//V S SCALES DATE :. �' QO OIVQ 1 CERTIFY THAT THE fa`��/94rioN .� CLIENT COISTERE RE®ISTERED rCNC� SHOWN ON THIS PLAN 18 LOCATEDD �. CIVIL LAND JOB ,� a, ON THE GROUND AS INDICATED AND ENGINEER SURVEYAR pig,®Y, `��� CONFORMS TO THE ZONING LAWS --- OF GAINNSTABLE , MA� , HYA N t�I S CH.BYs .. �a o //��/�! �! 7l2 MAI N , ST:RE.ET , MASS. SHEEP 4F ATE REG. LAND SURVEYOR IL ,ate R..3 ,q, Yoe-..aj.f d_M�:'X �{.L°a±:F,r.d` "�";�� �15'�,.�tx a'�.n7F�d�1.C:j43e��`a� �,I�,}�-n'_t.;d ''i-1'v�Wr�-:y�;•h+, =�tec�F�.-�tr..r`i 5'�` I clk t � s+ i�.d � _ -�—! ram• 4 t �. k�i:ram_' ° _.i'�'s. � ..c,'.--~ -i. � n a -0 27 $lOWPyFRNSTT BAABLE ermitallo P �^ u Xv 8uild�ng� W ecto"r- !, �� �..•- � .Cash `�`�ar_ a L cr A M s r OCCUP' NCY PERMIT '_lt1' ` Issuedtor -R ealty ,f Address rJj r�' lot '019 36".F,rCester '1Lane; Hyannis i `,` r t Wiring Inspectors, . +_ —7 r lj e ^wrti Inspection date Iry Plumbing inspctor' /.` �� J/�J Dmection date y i j r ' aas Inspector ` tl��. I n1' � !`J—+�.s-r�+f �-t Inspection date�2_+ Febgs � Ff Engineering Department l s yJ� / �Easpection'hate_ "/s� '.e+ y tis Board�of Health- `� Q;, yc'i3�b� i��% -v � �y Inspection date/x /�g� ti g ' THIS PERMIT,ya'II.L ,NOT BEy VALID, AND' THE_BUMDING BSALL.NOT BE-,OCC 'PIED UNTIL ;� Ks . a -1 +•� SIGNED3; ,,THE:B161 DING' INSPECTOR IIPON SATISFACTORY COMPLIANCE W1TS T. j 4 BEQT)TBEMEIVT$�pANDr IN 'ACCORDANCE WETS SECTION 1190�OF1THE MASBAC®08ETT8 STATE- SUILDiri(i,.CODE. y �+ � y� w F Building Inspector :1 G , ` • - FROM, Y - TOWN OF BARNSTABLE BUILDiNG DEPARTMENT Mr. Francis lalitE ine "a............... :...x.........> F976 MAIN STREET REET H i AIMS, MA i'IYwTJ 1 Phone: 775-1120 SUBJECT: FOLD HERE - DATE _ 7 . . F1 qR IdESSAG r -Twbrk has been i feted er Permit #2708 .(�a r corn 2 1t r�T t �r Please release Bold. �y . ,.�-�-.,`. Ems, •f .- f . SIG ED DATE i SIGNED - Ne7•Rml ,RECIPI•ENT: RETAIN WHITE COPY.RETURN PINK COPY • - - + PRINTED IN U.S.A, - SENDER: SNAP OUT YELLOW COPY ONLY.SEND WHITE AND PINK COPIES WITH-CARBON INTACT. - , r Besse ma's map and lot number ....A=210-101 �F THE t0 Sewage Permit number ...........TOWN..SEWER...................... DUPLICATE Z BARNSTAXE, House number .........................36........................................... 900 "6 9 \� I°TE'p ypY a• TOWN OF BARNSTABLE DUI•LDING INSPECTOR F APPLICATION FOR PERMIT TO 1 i R Story Single Family Dwelling s ... ...................... ....................................................................................... TYPE OF CONSTRUCTION .................................Wood..Fram.............................................................................. ..........Oct....,11.8....................19...8.4 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .....I'.ot..19, ...36 Worcester,Lane....HyaD ....................................: ..., ........... ............ ....... ............................................................... Proposed Use ...,,•Single Family Dwelling•,,,,•,,,•••••,,,,,• Zoning District .........RB..:.:..........................................................Fire District .........Hyannis..................................................... Name of Owner ....Capricorn..........Realty...:.?�t.................Address .................................................................................... ..... Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ................................................................. Foundation .............................................................................. Exlerior ....................................................................................Roofing ................................................:................................... Floors ......................................................................................Interior .................................................................................... Heating ...........................................:......................................Plumbing .................................................................................. Fireplace .......................................................................... .......Approximate Cost ,$40,0....00... .................................................. Definitive Plan Approved by Planning Board __________________________ 866 ft. ------19--------. Area ................s..�...................... Diagram of Lot and Building with Dimensions Fee .....$48..5,0........................... SUBJECT TO APPROVAL OF BOARD OF HEALTH 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 .................................... aAPRICORN MALTY TRUST 27081 1�, story No ................. Permit for .................................... Single Family Dwelling ....................:.......................................................... Location Lot 19, 36 Worcester Lane ................................................................ Hyannis ............................................................................... Owner .. Capricorn Realty Trust ................................................................ Frame Type of Construction .......................................... ............................................................................... Plot ............................ Lot................................. Permit Granted .....O.c,.tobe.r 11..............19 85 .. . ........ .. .... . Date of Inspection ....................................19 Date Completed ......................................19 --7 t, . x- .M,,§y '..t:.-...�,ti�.y.`�;,�.s..-....v��..,K:...�.;�Ff '�,"�r,i'� .•�—r}urh „� ;:; ",£.�•.�. yyx ( 1 �a,. ,..a. � �_ nA Assessors►map and lot number ......... .. �. ....... .......... 'x FINEr �o o� Sewage Permit number ....?................................................... d BARNSTABLE, i House number .............. r a ................................................t........:. gyp' i639. 9� a MPX a` TOWN OF BARNSTABLE l BUILDING INSPECTOR APPLICATION FOR PERMIT .TO Construct Single. Family Dwelling .. Wood Frame TYPEOF CONSTRUCTION ..................................................................................................................................... i September 26, 84 ...............................................19........ I TO THE. INSPECTOR .OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: li Location Lot # 19 Worcester Lane, Hyannisp Mass. ............. ...................... i ProposedUse .................................................................................................................... Zoning District .R.'...B............................................................Fire District ....Hyannis ........ I Ca riGorxl Real Trust Falmouth Raada Hyann �„ s, Nameof Owner .... .............................. ...........................Address . .... co Real Est 6Dev,Co. ,Inc Same Nameof Buildi �...............................................................94ddress ................................................:...:.....:..........:.............. + I Name of Architect ..............Address l Six Number of Rooms .....................................Foundation .......k!.Cs............. .Clapboard and Shingl.�s Roofing ............:AsP�aa ...s g , s Exierior ..... ....................... ..................... ............... Floors L'a @t ............................Interior .............SheAtrAck..... ...... 1 Heating Gas....:'.....F.W.A. ............Plumbing ...........TWO — Q.R�?8� .::.: ...:.......�.. .:........ ............. .................. None .....Approximate Cost W.R90 ..0.00 j Fireplace ............................................................................. ....... ... Definitive Plan Approved by Planning Board ________________________________19________. Area A95.6:.SQ+...:f'tr.x......... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH I. ;z OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS F hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name �! .D/ .�-� .. ..............Pr>as.•. s Construction Supervisor's License ............... CAPRICOR4 REALTY TRUST A�270-101 2 70 27081........1...... Permit for ... .Y............... a Single FamilX Dwelling ...................... Location 36 Worcester Lane ................................................ .............4Y .............................................. r Owner ....q�LPXiCOM.J��ity..rr Lls.t............. .. ........ .. Type of Construction ..F);.Q=............................. ........................................................................ ...... Plot ............................. Lot ................................ Permit Granted ......October...11............19 84 ...... ........ ..... Date of Inspection ....................................19 Date Completed ......................................19