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0091 ANSEL HOWLAND ROAD
�� �ns� � ��aWl� � , � _ � . . a� :c � -_ Y '. t .. �. �. �i .. t.a ,` r ,: � c: ` v- ,. F v .. v... n�'. �. �� �. . 6.. - ,. .. y�� \l � � � y � � � �� a � _ 1x ..:....� �. _. .. `� Q�V -' 4` � .. _ .. � F I' ' .. � g f t j .. � e a e ., � A _ .. c R �� _ ,. �. �. � _ �. .. - ®_. ,. 4 ... �� .. � ., 'W � �� ...�.. ` a .. a Iti .. r .. ,. � � .. �� � � ,. III .. � ., N I�_ � a j t - � �. r r+. Town of Barnstable Y; za uBuilding DAIROMA Post��Thrs Card SoThat rt as,Vrsrble From,the Street,Ap"roved Plans Must be Retained on.Job,and this Card Must be:Ke t . KAM Posted Un1639,, tridFinal Inspection Has"BeenMade U<3 r ° Where a Certificate ofxOccu anc• rsRe aired such Buldm : hall Notbe30ccu"Rigid until•a Finalslns ectio �h Permit ijjl l mA Permit No. B-18-2171 Applicant Name: DOHERTY,ARTHUR P JR Approvals Date Issued: 07/06/2018 Current Use: Structure Permit Type: Building-Shed-Residential-200 sf and under Expiration Date: 01/06/2019 Foundation: Location: 91 ANSEL HOWLAND ROAD,CENTERVILLE Map/Lot 172-223 Zoning District: RC Sheathing: Owner on Record: DOHERTY,ARTHUR P JR Contractor!Name Framing: 1 Address: 4A RIVERVIEW AVENUE tactorLicense 2 M.' EstPro ect Cost: $0.00 MASHPEE, MA 02649' J Chimney: Pe mit Fee: Description: 8x12 Shed 3 •. $35.00 try Insulation: �Fee,Paid': $35.00 Project Review Req: � Date 7 6 2018 Final: �� / / Plumbing/Gas 15 Rough Plumbing: Building Official Final Plumbing: kf , This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six roanths after issuance. 'Rough Gas: All work authorized by this permit shall conform to the approved applid,ion�a tithe"approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structuresshall be in compliance with the local zoning by laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for"public ins ected-n for the entire duration of the work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by-the Building amid Fire,Officials�are prautd d on�ths permit. Service: Minimum of Five Call Inspections Required for All Construction Work:,' 1.Foundation or Footing T Rou h: � . g 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final' 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) . - Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Town of Barnstable SHE r, Building Department Services Brian Florence,CBO avr STABi,E. Building Commissioner 1 ��� 200 Main Street, Hyannis,MA 02601 ArEG�Ap'�► www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 PEPJVHT# a I FEE: $3S.UU BUILDING DEFT JUL 06 2018 SHED REGISTRATION RESIDENTIAL ONLY TOWN OF BARNSTABLE 200 square feet or less Location of shed(address) Village Property owner's name Telephone number Sx l Size of Shed Map/Parcel# Si Date Hyannis Main Street Waterfront Historic District? iU Old King's Highway Historic District Commission jurisdiction? You must file with Old King's Highway Conservation Commission(signature is required) Sign off hours for Conservation 8:00-9:30&3:30-4:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCONWANIE]) BY A PLOT PLAN 51 Q-forms-shedreg REV:08/6/17 r _ FA/A - :5 BEORoo/A ►Jo GAROAGE 6WNDE2 �- _ i � _ A ri :, • . � pA►�- FL.oW :. Ilo x 3 = 33o6.Pt? _ SEPT'G 330x15o'/• : 'A95G.PC>, U5E l000 D AL P T V 5E I UOO GALL. 015 P 5 1 , S►1)SWAL. ActCA = 150 S.F, 15o 5.F X 2� 3?5 G.t'R \ 50TTOM A2E.A= �o S,F,_ 50 5.F X 1• 0 � . 5.Q 6.Po! / I .ToTA" -TOTAL.. DA►�.Y FLov�! = 33oGPc� ` .c�cH�aaK PE2c0L_AT10N RATE N 2MIN 0,V-L iil# -isr�ivEr S 5� I Ikk OF C ° ALANCy WCHARD W. BARTER tiN0. fDo No.240" p D SUS��' ! N TTr P FN.. .-SZ•c ,Lr 1000 INV. ' Svc�Sr1/c� DiST. INd. a pTIG oo Z � Io Iu�. Bv�c S/.G •rNK ti ' MEJ 54.�c� E`GP.a✓Ec. Gay.. `s/G` •- r `P -r INV. INY: g' WASKGD vro H E L o G 4-T 10 N C �►TEP�./ (�L:,C y/D NO� SCALE a SCALE ��`=coo' _ pATE .I15 m � �, p tr A N REP 6>Z6N c.E 1 t E RT 1 F Y ?H A-r:,-T 14 V--- Ir'cx�oa�A�-►�►.1 SNo µ N NERE.oN GoMPt-YS 1nJITN•"CHE S I oEt_1t-1 ' .LOT/�f AQP SET�GK`R.6Qv�t2.EMEPlT�'oF 'tµE- . C��r ✓� /�/i�i�IL � , • -(o W N O� B Ae-N STA,13t�� A N� I S t�l� ,$E G`T/o�S/�T$ - LOGp.TE D W ITNMT — "D'UAW0 PL.d. o 5.0 Rv EYoe`S "T1d15`PL.aN1 1 `� NET GASP p otd AN o3TE9-YILLE 1u$-r?-uMV--NT ;v2vEY �-rNE of-FSETS No-T C'�E U5EDT0 DE7E.tiZ1�I1.1E' Lo"r L.Ir.IE.�f- APPLIGAN,r A1.1.: 1I •, rn le Building Town o Ba sta •n .�uvsrwe Post:This Card So That it is Visible From the Street Approved Plans -Must be Retained on Job and this Card Must be Kept "'"9 Posted Until Final Inspection Has Been Made: Permit i639. A� - . � C 111111 c Where a Certificate of Occupancy is Required,such Buildmgshall Not be Occupied until a Final Inspection has been made. .. . .t.r. .. - -... r . .... ..._......-�`.._......w+..aws....a....,.w�, - Permit No. B-17-4390 Applicant Name: Arthur Doherty Approvals Date Issued: 12/26/2017 Current Use: Structure Permit Type: Building-Smoke Detector-Fire Alarm Dection Expiration Date: 06/26/2018 Foundation: System Map/Lot: 172-223 Zoning District: RC Sheathing: Location: 91 ANSEL HOWLAND ROAD,CENTERVILLE Contractor' Name �a,�Arthur P Doherty Framing: 1 Owner on Record: DONAHUE,JOHN f&DOHERTY,ARTHUR P 1 Contractor License 7197 2 -;� Address: 372 YARMOUTH ROAD -Est Protect Cost: $ 1,000.00 Chimney: HYANNIS, MA 02601 ' } � Permit Fee: $35.00 Description: install new hard wired smoke and CO detectors _ Insulation: } °Fee Paid: S 35.00 Project Review Req: � .� Date 12/26/2017 Final: �k. } f Plumbing/Gas . Rough Plumbing: ` -;Building Official _> - Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six montKs after issuance. All work authorized by this permit shall conform to the approved application.and the approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures;shall be in compliance with the local zoning ws a by land codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. ,� #s Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this.permit. Minimum of Five Call Inspections Required for All Construction Work: ° ' ' z ,°7{ Service: 1.Foundation or Footing ' i Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Town of Barnstable zRECEiPT ` BAWWABLIL 200 Main Street, Hyannis MA 02601 508-862-4038 Application for Building Permit Application No: TB-17-4390 Date Recieved: 12/21/2017 Job Location: 91 ANSEL HOWLAND ROAD,CENTERVILLE Permit For: Building-Smoke Detector-Fire Alarm Dection System Contractor's Name: Arthur P Doherty . State Lic. No: 17197 Address: 372 YARMOUTH RD, HYANNIS, MA Applicant Phone: (508) 771-7270 . 026012043 (Home)Owner's Name: DONAHUE,JOHN F& DOHERTY, Phone: (508)400-2350 ARTHUR P JR (Home)Owner's Address: 372 YARMOUTH ROAD, HYANNIS,MA 02601 Work Description: install new hard wired smoke and CO detectors Total Value Of Work To Be Performed: $1,000.00 Structure Size: 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). 1 understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: Arthur Doherty 12/21/2017 (508)771-7270 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $1,000.00 Date Paid Amount Paid Check#or CC# Pay Type 12/21/2017 $35.00 Pa--� .��. ,,_�....._..........,_......_�...... Total Permit Fee: $A00 ypal ; Paypal .. ..... ............................................_..........._..........._..._.....,..._..._...._........................ Total Permit Fee Paid: $35.00 SMOKE DETECTORS REVIEWED BARNST,� E B IN Eplu DAT �4y FIRE DEPARTMEN DATE BOTH SIGNATURES ARE REQUIRED FOR PERMITTING ..._...... ....--- i I i; s i it jl I I O 0 O O O O r „ II II 1 I ii .........................._._......._........_..__....- --... _.. ;r i' { ,_-........_...... II I I I' -. I �jH II 6ECFYY9.A � KI�CHJ: !!I w - -- ......_..__..__._...__.._... ._..._._..-----...._ V S or J f it 1 PORCH BATH BEDROOM KITCHEN DINING LAUNDRY �1'IOKE HEAT DET HALL q . BMOKE/CAMBO .. BATH - 'GARAGE U 1096MOKE , LIVING ENTRY ----------------------- ' . � �BnOKE/GOnBO �GO DEi U B enoKE BEDROOM Lr- V1 BEDROOM Avs6L y �«o AIP z� A 6MOKE UNFINISHED SASE EN A SMOKE/CAR50N r— �-K ObN n RECEIPT Town of Barnstable 200 Main Street, Hyannis MA 02601 508-862-4038 Application for Building Permit Application No: TB-17-4390 Date Recieved: 12/21/2017 Job Location: 91 ANSEL HOWLAND ROAD,CENTERVILLE Permit For: Building-Smoke Detector-Fire Alarm Dection System Contractor's Name: Arthur P Doherty State Lic. No: 17197 Address: 372 YARMOUTH RD, HYANNIS, MA Applicant Phone: (508) 771-7270 026012043 (Home)Owner's Name: DONAHUE,JOHN F&DOHERTY, Phone: (508)400-2350 ARTHUR P JR (Home)Owner's Address: 372 YARMOUTH ROAD HYANNIS MA 02601 > > ` '� C—D _Z Work Description: install new hard wired smoke and CO detectors . ` Uzi W Y 9� Total Value Of Work To Be Performed: $1,000.00 Structure Size: 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in'accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: Arthur Doherty 12/21/2017 (508)771-7270 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $1,000.00 017 Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: $35.00 12i21i2 $35.00� Paypal Paypal Total Permit Fee Paid: $35.00 ` 5 THIS;;yIS 1S OT> M PERIT u s s � e c a G 22/c� 1 Q dw I Egg PERQ Town of Barnstable _ *Permit#(9 ,/ o Expires 6 months from issue date 2016 Regulatory Services Fee M" -�1r R N ST BLE Richard V.Scali,Director Building Division E Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma:us Office: 508-862-4038 - Fax: 508-790-6230 , EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint ` Map/parcel Number 12" Property Address ❑Residential Value of Work_ $ `1 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name � }1y \ . Pr3��QN Telephone Number Home Improvement Contractor License#(if applicable) ,3`�\�� Email: co✓"1 Construction Supervisor's License#(if applicable) ®'LASO 3 11-1 ❑Workman's Compensation Insurance ' Check one: ❑ I am a sole proprietor ❑ I am the Homeowner S--I have Workers Compensation Insurance Insurance Company Name ` rPy Workman's Comp.Policy Q-5-0 �}ol�� ��t 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 2 f ' V ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) , Re-side XL Replacement Windows/doors/sliders.U-Value a�\, (maximum.32)#of windows CO #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. 3 ***Note: " Property Owner must sign Property Owner Letter of Permission. ' A copy of the Home Improvement Contractors License&Construction Supervisors License isD , require SIGNATURE: Q:\WPFILES\FORMS\building permit fOnns\E)P S.doc ! Revised 040215 F Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-035037 Construction Supervisor. ,. e DEAN F STANLEY Q " 359 CAPTAIN LIJAH ROAD CENTERVILLE MA 02632 �,,,�,� Expiration: 1 - Commissioner { 01/19/2018 4 A. ��e�anvn'co�racuea�i � - - \ Office of Consumer Affairs&Business sRReg ul ao _ OME IMPROVEMENT CONTRACTOR License or registration valid for individul use only egistration: �j32149 before the expiration date. If found return to: t Type: Office of Consumer Affairs and Business Regulation Expiration .11/28/z018 Individual ' 10 Park Plaza_Suite 5170 DEAN F.STANLEY' �� Boston,MA 02116. t DEAN STANLEY , ' - 359 CAPT.LIJAH RD' CENTERVILLE, MA 4 Undersecretary of valid witho signatu e s r ® DATE(MM/DD/YYYY) ACORU CERTIFICATE OF LIABILITY INSURANCE 11l0612015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Kathleen Geddis NORTHWOOD ESHBAUGH INSURANCE AGENCY, INC. PHONE 508 771-1632 ac No): E-MAIL ADDRESS: kgeddis.north24@insuremail.net 540 MAIN ST. INSURERS AFFORDING COVERAGE NAIC# HYANNIS MA 02601 INSURE RA: TRAVELERS PROPERTY CAS CO OFAM 25674 INSURED INSURER B DEAN F STANLEY BUILDING CONTRACTOR INC iNsuRERc: ` INSURER D: 359 CAPT LIJAHS ROAD INSURER E: CENTERVILLE MA 02632 INSURERF: COVERAGES CERTIFICATE NUMBER: 10754 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE LTA POLICY NUMBER MM/D MM/D LIMITS t COMMERCiAL GENERAL LIABILnY EACH OCCURRENCE $ CLAIMS-ME ❑OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ c ti MED EXP(Any one person) $ _N/A, PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: PRO- GENERAL AGGREGATE $ POLICY❑JECT LOC PRODUCTS-COMP/OP AGG $ . OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED z a AUTOS AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident) $ $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE NIA AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY X STATUTE. ER YIN ANYPROPRIEfOW/PARTNER/EXECUI IVE E.L.EACH ACCIDENT s 100,000 A OFFICER/MEMBEREXCLUDED. WA WA WA 70JUB2E49857515 10/08/2015 10/08/2016 (Mandatory in NH) E.L DISEASE-EA EMPLOYEE $ 10000 If yes,describe under DESCRIPTION OF OPERATIONS below E-L DISEASE-POLICY LIMIT s 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) ,• Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/invesfigationsL CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE _ THE EXPIRATION DATE THEREOF,. NOTICE WILL BE DELIVERED IN TOWN Of YarmouthACCORDANCE WITH THE POLICY PROVISIONS. 507 Buck Island Rd. AUTHORIZED REPRESENTATIVE - - - W Yarmouth MA 02673 Daniel M.Croxy,CPCU,Vice President—Residual Market WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD q , 27m Comm mveak*of CTiraddfs k Departnret t9f1ad=hid Acddtats &V W gtOn Blur MA 02M - wwmmamgmMra Workers' Campeasaf m Iu��Affi& -BuM*-JC afx acbar M ers Atmh-mot IIIfarmafiaa Please Fri E,e� IrTame Ad&. QAA V,, AA fire PaQ an enipl yer?Check.the appropriate bam Tyke of Project(regoirt -- L M-I am a employer With 4. ❑I am a general conb:actor and I 6. [:]New eo=ft - employeez(fn1l andfor part-time).* have hin d ifie s*- rs 2.El am a sole psi orpartmw- rested tm the attached sheet �- ❑� ship and have no emplagees These sob-cmrtractors ham 8 ❑ , wodzing for me is any capacity. mO worms` q- ElBiding addition [No ;m e or reqaired-] 5. ❑ We are a corpora andits 1 ❑Flrepaizs or addax 3.❑ I am a bomeawm er doing all Work °fficers have exercised to 1L❑P3 =biagrepais or additions myself[No=dze Tisu of exemption per iNLC:I. 1 i ce- c-�I.�5tt2��,.,,11(4)..aaesdwehsvenn L_❑Boofnepairs empl.I�.[NO W • L3: Other W i v✓S+1Qoorg camp-mmnnce,wed-] ffxatdhed1xb=#1mastR1mfM athsmx:f=beTaw fe¢WO&MeCDMPM=ati=Par+cFiw5hrm22Hoa Samea�svdsa Sab=t d&af5davft a neW afdMft h sorb_ = tomb=wmmc&rharbed add shag shoaingtLen=eofthe mactft—hP*—CwaAt*m l� agpbyem?ftbesvIr cans Dave empIv s,$�egx�stpavgide t3�T 3s' PaHc�nombrz I oat mt eatgla�-ter tiird•Er prauidircg workers'cc�z�iaet i�suraaca for uty��� Belaty is Ilia pvitcy�jab srt� ' iffforazation y` j1CRf Policy 4 ar Self.Lac¢ Q V S_(!SA Jab Site�ddsess` ` S�� �W �t� Ci qg St p= �e7��e-J`tJ L`\2 Attach a COPY of the warkere carapensardcnpoRcy decbratim page;(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL t`I52 can lead to the imposidea of aimiaa!penalties of a fine up to$l,5DD-00 mWor one-yeasimgasout md.as Welt as viva peraffies in the farm of a STOP WDFX OMMRand a fine of up to$2%OQ a day against the violator- Be advised drat a copy ofthis suftmumd maybe forwarded to tiro Office of IaveFig hansoftheDlAft—ancaveragt;veri ion Ida[=%by tA&f7ts hU2P abmv hF bas and correct, fi;�,aEntR- zhow - mad use an]£% Do not write in fids araai to be compTeted by diy erbmn afrc&L Cky or Ttrnw Perm iftLiceas�#' Isstzing Amity(drd a ene): ' L Board of$salth r.Bmlf ag Departntrnt 3.C)Yravm Cerlt AL Ekdrical hTWtor S.Plumbing Iuspeclor 6.Other Contact Person: Phan#: 6 .�_ uses�... r+.� _ .+.J.{�. �.nt... _t .anu .•�F n n .- .' ...:.,�.. rNnu�.,:.,Na ie: i. . run •sa ■Y_..1 ■• n L r_a.•Ia _aa �.lr •.1/It�• - - •�F.l{ a. i■ - • _u•is r al■.� :n r•s.lr _r ■{■ . /I to •-3811,—• : .I{ n.l ■l.f: •Y. 1■�.Yn.• :rr•.rf:t.•I■ r•] ••ll=t.•la .1 •.• 'J: �+r1■• •• _a•• ••• ■I ■.•I - . 11 - nl, ••.It■• �a•l:-�. 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DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one . home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) 'The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. 'The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner, .Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as-it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map �� Parcel Application # �'�l0 �J 73 Health Division a/(f41 ®F,o� Date Issued. 2K b Conservation Division ���c)p �&401S Application Fee Planning Dept. '99AIn Permit fee Date Definitive Plan Approved by Planning Board Ae�F Historic - OKH _ Preservation/ Hyannis �M�s.L, Ste " Project Street Address q ghSe ��LLd1 drcd Village C,eh f4P rV/;�� 1144 Owner -r--w•«.r �P_ 1)d ke ray dr• Address Telephone Permit Request ^1�►2 b �l�r� Gx/S ]�'lY1q VI OU S Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 00 0 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ 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: 3 existing new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name AnUnurP. bohedy Jr. Telephone Number J`��l � `�"a� '023 Address 3?oZ �I G�LI'h�t D l.(--T� /� License # Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO i SIGNATURE DATE t FOR OFFICIAL USE ONLY APPLICATION # i DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER r s DATE OF INSPECTION: FOUNDATION FRAME ' INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ,.k • GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT r °t ASSOCIATION PLAN NO. t 'down of Barnstable F Regulatory Services ' r Richard V.Scafi,Dsecinr t Building Didsion. Tom perry,S�dmg Commissioner M 1Q$ 200 M2m.Stret Hyaffiss,MA 02601 �Eb l ti www.t n mbarnstablr mz-us Office: 50 8-862-403 8 Fes: 508-790-6230 . HOMEOW2IL`g Irrucrr E�1ZON - T?ATE. JOB Cr sOowr : I C 8 e .: Pson� CURRENT MAMMID GADDRFSS: S - 19 7,L0 zip coda +The cu-ant exemption for`homeowners"was extended�mclBde owner-0ccBnied dweIImes of six Tmitr or less and in aI1oW hour,Owners to engage an individual for hirewho does notpossess a license,ufoyidEd that the owner ads as supervisor_ MFMIIION OF HOMEO P esan(s)who owns a parcel of land ou which he/she resides ar intends to reside,on which there is,or is intended to be,a ane or two-- family dwelling, attached or debched stractm$s accessory to such vse and/or farm stucco res. A person who constracts more than one home in a two-year period shall notbe �Trb��d,ah�cowner. guch`hnmeawnee'.shall sabmitto the Building Official an a form acccptable to the Bm�Owl,the hdshc sh2II be responsille for an such work perfarmed Tder$m bmZdialr permit-(Section 109_L1) The uadersigned`homeowna-as-=rMponsIRKy for campli2nce witiithc SiafE Bm7dmg Coda and ofiier applicable codes, bylaws,rules an 'Lbt /`homcownee fies'tbathe/she imderstands the Tower ofBams[able BinZding Depar(mmt P °n r WM comply with said procedures and rtqpirumeofs. Pro , S ofEromeot�ncr ' Agprovsl ofBmlcrmgOfcia1 - -Not, : Three family awenbW co dm** a 35,000 cubic met or larger WMbereq�edto comply v7hhth.e.Sta$Building Code Section 1±27.0 Cougar u-ContmL Hp owNEg'S E ODI _ The Code sfatPs that aAuy homeowner performing work for which a buiZting gem is required shaII be exempt from the provisions of this section(-ecfion I09�1-I.icensIng of constrac ion Supervisors),provided that if the homeowner engages a Person(s)for Hire to do such work,that such$omeowne r shaIi act as supervisor." Many homeowners Who use$xis a=mption arc unaware thatffiey are assuming ffia responseties of a supervisor (See Appendix:Q,RnIes&R egnIatioas for Licensing Cnnstr•acf S'Bpezvisors,Sectinn 215) This Iarh of awareness o$rn results is serious problems,particularly when the homeowner hues unlicensed persons. In this case,our Board cannot proceed against the�Iicensed person as if Would with a licensed Supervisor_ The homeowner acting as Supervisor is ultimately respoasMe. To espon $at$te honuawner is fuIIg aware of his/her r`espoasr'brZii5,many communities regna e,as part of t3ie fi permit:application, that the homeowner certify thathelshe understands the responsibiTrh'es of a5uger4isor. Oa tau IasEpage of&is issue is a form currently used by.seieral towers. You may care t amend and adopt such a fbrmIcertifiration.for use in your comiauaiiy. . Q:��II�SSFpg2,d,SL�+,,,�rF�P�it�ams1F�BEss.doc . Rcviscd 0613 3-3 �'ME Town of Barnstable Regulatory Services ' E Rl57NCrIRfF. f mesa. Richard V.SCA Direefnr 16 BBildnig Division Tom rerry,Ems COnmissioner 200 Maim Street Hymmis,MA 02601 wwW bwnlarnstable_ma.us Office: 509-862-4038 Fag: 508-790-6230 Propeity Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on mp behalf, in all matters relate to work authorized bytbis bmIding Permit application for. (Address of Job) "``Pool fences,and 2larms are the responsibilityof the applicant:Pools are not to be filled or d before fence is installed and all final inspections_are performed and accepted. Sign tore of Owner Signature of Applicant Pji=Name Print Name Date . QFORIMO WNERPEUMMIeDDIS Bk 29707 Psi 190 -028455 06-08-2016 a 09 s 06a UXT "IM DEED 1,JOHN F.DONAME,Individually,of 91 Ansel Lowland Road,Centerville,MA.,02632, For consideration paid of ONE AND 001100($1.00)DOLLAR PAID Grant to JOHN F.DONAHUE and ARTHUR P.DOHERTY;JR.,,as tenants in common,of 372 Yarmouth Road,Hyannis,MA 02601 with QUITCLAIM COVENANTS The land with the buildings thereon situated in Barnstable(Centervillp),Barnstable County, Massachusetts described as follows: Being LOT 14 as shown on a plan of land entitled"Centerville Highlands.Section IX Plan of Land in Barnstable(Centerville),Mass.for Alan E.Small,Inc.Scale 1 in=50'Feb.12,1980 Baxter-&Nye,Inc; Registered Land Surveyors,Osterville,Mass",recorded in Plan Book 343 Pages 84-86 inclusive In the Barnstable County Registry of Deeds. The Grantor hereby release any and all Homestead Rights as applied to this property and further certify that no other parties are entitled to homestead rights hereunder. For title see deed recorded in Barnstable County Registry of Deeds in Book 29691 Pago 317. PROPERTY ADDRESS: 91 ANSEL HOWLAND ROAD,CENTERVILLE,MA 02632 �~ f Bk 29707 Pg191 #28455 Executed as a sealed instrument this day 016. oz, N F.DONAHUE COMMONWEALTH OF MASSACHUSETTS Barnstable >ss 2016 On this 7day o ,2016,before me,the undersigned notary public,personally appeared, JOHN DON E as aforesaid,and proved to me through satisfactory evidence of identity which were, �/� acknowledged to me that he/shelthey signed it voluntarily and for its stated purpose,and who swore or affirmed to me that contents of the documents are truthful and accurate to the best of her knowledge and belief. Pynie Chapman NOTARY PUBLIC My Commission Expires: 6/3/2022 BARNSTABLE REGISTRY OF DEEDS John F. Meade, Ileglstet the Commonwealth of-Vassachusetts D rtlnferrtoflndrestiialAccidents t}ic�ofntstrgatiorrs 600 Washineon Street Baston,M4 02HI unvii mass govIdia Workers' Cumpensatian Insurance Affidavit B.EiIdei-s/Contrac-tGrsfEIectricians/Plu nbers licant Infht oration Please.Flint Legibly Name ame�llSQ72� 311573�1ffnlfnr�rca. na� � � J Address: City/StatelZip_ Phono.4 „ - Are you an employer?Chee the appropriate box: Type of project(required).- I.❑ I am a employer with. 4 ❑I am a general contractor and I 6_ ❑New construction employees(full anNor part-time).* have hired the sub-contractom 2.❑ I am a sole pmptietor arpartner-- listed on the attached sheet, 1 Remodeling shup and have no esmployees. These sib-contractors have , g. (�Demolitioa working for me in an c ci t r employees and hare wodcers' r"� b Y � t5 g. ❑building adiditia>z. [No wrorkers'. comp_insurances comp.insurance-1 required-] 5. ❑ We area corporation and its 16❑Electrical repairs or additions 3.[�1.am.a homeoumer doing au work officers have exercised their 11.n Plumbingrepairs or additions /\ myself o workers' right of exemption per MGL �' � P'- 13_❑Iinafrepaiis iT+�,t�nce required.]i c.152,§1(4h andvre have no employees-[Nb we 131:1 Other comp-insurance required.] _ *Any appEi=ttbstchedubos#lmatalsofilloutthesecdoabg wshuwin-gdmkwor]'leis'c-amp—satiaupolicyin5rmaiicaL Homeowners who submit this affidavu indicating they are mg alI wary anAi then lure outside contractors n,m subnut a new affidavit indicating suds tGantractors that rhea this lraa mast attached as additional sheet showing the nmeof the sub-caatrzaars and state whether ornot Those eatdt<esbave employees..If the subtaatractutshace employees,theynustpm4-idetheir workers'wmp.policyaurnber. I atn art s[[[pjvjxrr tl[trt is pr�zdi[rg u�arkers'cortrpeucsrrf[�r[ir[srtra[ce,for az}*¢ncpiny�ees. Betoav is fJ[e poiicy�ar�d jab sitar informadon. Insurance Company Name: Policy'a,or Self-ins_Lic_ F_xpitatio'n Date: Job Site iddress_' 2z "U_eZ Mr,-iz /A City/Stawzl p:�C'aa,l_t'-'Li <Ck � Attach a copy of the workers'coanpensationpolicy declaration page(shooing the policy number and respiration slate). Failure to secure coverage as required.uuder Section 25A of MGL c IT can lead to the imposition of criminal penalties of a fine up to$1,50D QQ andror one ye-ar imp7sonareut,as well as civil penallies.in the form of a STOP WORK ORDERaud afire of up to$250-00 a day agar the violator. Be advised that a copy of this statement maybe forwarded to the Office of Isavest gations ofthe DIA for insurance cot ge 7 cation. I rIa her Rby cRiti aaadrer tTre /1 is f�d a '`s a pet ur}�tliattlze iva,forma 7i-prm d d ab 1.- E arm correct Sionature: i Date: Phone ikS / j O f dal use a ly. Da not et:r['te in tiers.area,to be.colppfeted by city ar tonm oaf j`fctat City or Taum: Perrmtlf&ense# ' Issuing Antltority(curie one); - 1.Board of Health 3.Building Department 3. itj/Town Clerk 4:Electrical Inspector rr.Plumbing Inspector 6.Other , Contact Person: Phone#: lnfarmation and Instructions Massachusetts Genm-al,Laws chapter I52 retprires all empIoyees to provide workers'compensation for their employees. pursuant-to this st tate,a a ernpinyee is defined as-"-.every person in the service of another wader any contact of hire, express or i mplieti,oral or writfna" An employer is defined as`°an individual,partnership,association,corporation or other Iegal 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 irmstes of an individual,partnership,association or other legal entity,employmg employees. However the owner of a dwelling hose having not more than three apal(meats and who resides therein,or the 0cc¢pant of the - dwelling house of another who employs persons to do maintenance,constrnrtion or repay work on such dwelling house or on the gmimds or Melding appurtenarttfhereto shallnotbecanse of such em-ploymentbe 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 a-pplicant whohas not produced acceptable evidence of compliance with the inguxan=L coverage required-" Additionally,MGL chapter 152,§25C(7)sfaiPc`N6 therthe commgnwealthnor a'IIy of its political subdivisions shall enter into any contract for the p erformanco ofpublic wDik until acceptable evidence of compliance with the insurance._ requirements of this chapter have been presented to the contracting anthozityf Applicants Please fill out the workers'compensation affidavit completely,by checking file boxes mat apply to your situation and,if necessary,supply sub-cunt mctnr(s)name(s), addresses)and phone namber(s) along with their.certif1cate(s)of incr•rrance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not rbqui ed to carry woikers' compensation insurance. If an LLC"or LLP does have employees,a policy isregnued. B r,adyised that this affida:yit may be submitt--d to the De-partraftnt of Industrial Accidents for confirmation of incrirance coverage. Also be sure to sign and date the affidavit The affidavit should be retnmed to$e city or town that the application for the permit or license is being requested,not the DeparEinent of Ldustrial Accidents. Should you have any questions regar-ding the law or if you.me required to obtain a workers' compensation policy,please call the Dep arbnent at the number listed below. Self-insured companies should enter their self-fi sra-drice license number on the appropriate lime. City or Town Officials Please be sire that the affidavit is complete and priated legilbly. The Department has provided a space at the bottom of the affidavit for you to 01 out in the event the Office of Investigations has to contact you regarding the applicant- Please,be sure to fill in the pe-n tMicense number wbich will be used as a reference number. In addition,an applicant tbzt must submit multiple permit/Hcense applications in any given year,need only submit one affidavit indicating current policy infomation.(if necessary)and uader"Job Site Address"the applicant sho*lld write"all locafi ns in (city or town)_'A copy of the-affidavit that has been of stamped or markedbythe city or town may be provided to the ' applicant as proof that a valid affidavit is on file for futm-e permits or Iicenses- A new affidavit must be filed out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT rcgah'dto 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-=a call- Me.Departmenfs address,telephone and fax number: The CG-B3ManWc3 -of Massaclbm5M ' Departnmt cif 1adugtdal Aockdent�--, Of ace of eve fig�fzo�a �os�r�n,11�fA�111 - 'T(1.4 617-' 7-4900�t 406 or 1•-977-MA-SWE Facet 617` 27 7749 . Revised 4-2"7 ww ma&5-gckWd TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ��'o�. Parcel fAa 3 Application Health Division Date Issued S Conservation Division Application Fee �CJ Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board �►/{;�113 Historic OKH _ Preservation/Hyannis dk Project Street Address 9 Village Ceo,+ac sc i I l e Owner- .Si-a n 1 e ,j IV . ,9" 1, r vi ola-D r Address l ? L i w[5 i d c 0+. Telephoned$ ^ + — Permit Request C4#Aupe +0 'fi�e 0A1 C. A-i C '1wa 'F'l a a4k 0 14,/1B W 1+ LQ)CAa 10JInc 4W440, Square feet: 1 st floor: existing proposed 2nd floor: existing proposed To tg nevt� Zoning District Flood Plain Groundwater Overlay �. Project Valuation 3 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach sup ,orting doAum ration. l . Dwelling Type: Single Family ❑ Two Family ❑ Multi- Family(# units) Age of Existing Structure 083 Historic House: ❑Yes ❑ No On Old King's Highway: 0:Yesnb❑ 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 N(No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes �No If yes, site plan review# Current Use {- - Proposed Use APPLICANT INFORMATION, (BUILDER OR HOMEOWNER) Name (91' 1111LIM Ja t Telephone Number 5 0% 39S b3 4 8 Address Ave License # � C L 0�� t 6 Sews &mac4h, O a6 14 Home Improvement Contractor# T�3 Worker's Compensation # TJC 3353 B ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO YPWM fay SIGNATURE DATE d` I FOR•OFFICIAL USE ONLY APPLICATION# DATE ISSUED ~` MAP/PARCELNO. i ADDRESS VILLAGE ` OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION ' FIREPLACE ° ELECTRICAL: ROUGH FINAL. PLUMBING: ROUGH FINAL ,L GAS: ROUGH FINAL FINAL BUILDING r 4 Y DATE CLOSED OUT _ ASSOCIATION PLAN NO. + The Commonwealth of Massachusetts Department of Industrial Accidents ' 7t' Office of Investigations h I� Congress Street, Suite 100 d b '' Vk- Boston,MA 02114-2017 '14- www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Cape Save Inc. Address: 7D Huntington Ave' City/State/Zip: South Yarmouth, MA 02664 Phone #: 508-398-0398 Are you an employer?Check the appropriate box: Type of project(required):.. 1. ✓❑ 1 am a employer with 4. ❑ 1 am a general contractor and 1 6 ❑New construction have hired the sub-contractors employees(full and/or part-time).* ❑ listed on the attached sheet. 7. ❑ Remodeling 2. l am a sole,proprietor or partner- -These sub-contractors have g. � Demolition ship and have no employees working for me in any capacity. employees and have workers'comp. ❑ Building addition [No workers' comp. insurance comp. insurance.? " 5. We are a corporation and its 10.❑ Electrical repairs or additions q required.] ' 3.❑ 1 a homeowner doing all work officers have exercised their l l.❑ Plumbing repairs or additions right of exemption per MGL myself. [No workers' comp. 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no q ] employees. [No workers' 13.❑✓ Other Insulation comp. insurance required.] "Any applicant that checks box#1 must also till out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 'Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. if the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for ny employees. Below is the policy and job site information. Insurance Company Name: 'Technology Insurance Company Policy# or Self-ins.Lic.#: TWC3353968 Expiration'Date: 04/09/2014 Job Site Address: / sP u1J r< 1Z J City/State/Zip: C U 11 Ke Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152'can lead to the imposition of criminal penalties of a fine up to S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cerq under the ains and penalties of er' that the in orntation provided above is true and correct. Si nature: Date Phone#: 508-398-0398 Official use only. Do not write in this area, to be completed by city or town official. ' City or Town: Permit/License# Issuing Authority(circle one): ment 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector eetor I. Board of Health 2. Building Depart 6.Other Contact Person: Phone#: ® DATE(MMIDDNWY) v CERTIFICATE OF LIABILITY INSURANCE 4/9/2013 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(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsements. PRODUCER NAME: lle° Coen Crowley cxn Risk strategies Company PHONE . (781)986-4400 W .AC No:(781)963-9420 15 Pacella Park DriveA'Siss- Suite 240 INSURERS AFFORDING COVERAGE NAIC# Randolph MA 02368 INSURERA:Selective Insurance INSURED INSURERS.SafetV Insurance CCMpanV 33618 Cape Save, Inc . INSURER C.:TeChnOlOgY Insurance .Company 7 D Huntington Ave INSURERD: I t INSURER E South Yarmouth MA 02644 INSURER F: COVERAGES CERTIFICATE NUMBER:CL134960509 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN.MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DOL TYPE OF INSURANCE SlJB POLICY NUMBER MMIDO EFF MPMIODr CY EXP LIMITS LTR fYYl GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 REN X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 100,000 A CLAIMS-MADE ❑X OCCUR S199448001 0/16/2012 0/16/2013 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,DOC GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,DOC X POLICY PRE LOC $ AUTOMOBILE LIABILITY EaMaccident BINED IN UM 1,000,00C BODILY INJURY(Per person) $ B ANY AUTO ALL OWNED SCHEDULED 208200 1/6/2012 1/6/2013 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OVMIED PROPERTY DAMAGE $ X HIRED AUTOS M AUTOS Per ccident g Underinsured motorist BI tit $ 100,00( A X UMBRELLA LIAR X OCCUR 199448001 0/16/2012 O/16/2013 EACH OCCURRENCE $ 1,000,00C EXCESSLIAB CLAIMS-MADE AGGREGATE $ 1,000,00( DED RETENTION$ $ C WORKERS COMPENSATION fficers Excluded from X T RYST MT- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIE)ECUTIVE YIN overage E.L.EACH ACCIDENT $ 500,00 OFFICER/MEMBER E)(CLUDED? NIA 3353968 /9/2013 /9/2014 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,00( If yes,describe under E.L.DISEASE-POLICY LIMIT $ 500,00( DESCRIPTION OF OPERATIONS below TF DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) ' Issued as evidence of insurance. National Grid Corporate Services LLC d/b/a National Grid, d/b/a Boston Gas Company, d/b/a Essex Gas Company, Action Inc. , and Housing Assistance Corporation are listed as additional insureds as respects General Liability as required by written contract. s CERTIFICATE HOLDER CANCELLATION (508)790-2425 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ' r Housing Assistance Corp 484 Main Street AUTHORIZED REPRESENTATIVE Hyannis, MA 02601-3698 chael Christian/CLC ACORD 25(2010I05) O 1988-2010 ACORD CORPORATION. All rights reservec- IM Massachusetts -Department of Pudic Safety ' Board of Building Reguiations and Standards i Construction Supervisor Specialty License: CSSL-102776 i WILLIAM J MC CLUSKEY. 37 NAUSET ROADSIPT West Yarmouth MA 02673 Cxpiiation Commissioner 06/28/2015 y -Co-�e , Office of Consumer Affairs and usiness Regulation 10 Park�� Plaza - Suite 5170 ,A Boston, Massachusetts 02116 At Home Improvement C:gntractor Registration ' Registration_ 171380 4 Type: Corporation Expiration: 3/14/2014 Tr# 222184 CAPE SAVE INC. WILLIAM McCLUSKEY 7=D HUNTINGTON AVENUE SOUTH YARMOUTH, MA 02664 Update Address and return card.Mark reason for change. )PS-CAI a 50M-04/04•G101216 1 Address i ji Renewal (� Employment rL Lost Card ✓fe Zoaixmzaouoea� a�✓l�iczcfivael�a _ . _ - -- - __. .._.-- -- . _ __ Office of Consumer Affairs&Bdsiness Regulation License or registration valid for individul use only z HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: r" = If Registration 171380 Type: Office of Consumer Affairs and Business Regulation t r Expiration 3/14/2014 Corporation 10 Park Plaza-Suite 5170 - Boston,MA 02116 ��AVE WILLIAM McCLUSKEY 7-D HUNTINGTON AVENUE SOUTH YARMOUTH MA 02664' Undersecretary Not valid witho'ht signa 24252 460 West Main Street �0 Hyannis, MA 02601-3698 ®` ® � T (508) 771-5400 F (508)775-7434) ®CtSing r t 11Y on all lines www.baconcapecod.orda ASSIStanC� _. ti L \ U Corporation Cape Cod C,ll0LGg1• Free Wea erization ! Your tenant has requested and is eligible for weatherization of your rental home through government funding. This will be provided at no cost to you. Program regulations permit us to spend around $4,000- $10,000 in materials and labor per dwelling unit. Program regulations require us to weather-strip and caulk doors and windows; insulate attics, sidewalls and floors. All work is professionally done by established private contractors. We will conduct a final inspection to make sure that all work is completed to specifications. If you request, you will be informed of the estimated measures before they are done and provided with a list of the actual measures and costs following the completion of the work. We also need proof that you own the property. A copy of a CURRENT TAX BILL OR DEED listing you as the owner will satisfy this, requirement. Please fill in all blank areas of the enclosed agreement and return with the proof of ownership as soon as possible. If we do not receive the enclosed form within t.wo weeks, we will do a basic energy audit of the home, but no weatherization .work can be recommended or done. If you have any questions please call Ruth Bechtold at 508-771- 5400, ext. 102. LANDLORD `,�it.11� y+�J►�tC��e)�Glir� TENANT . y'1GiP6 1Kk, X NL)Y4h) iaf_ MA D 639 k C�j()tfrjrf III, M�iT �� G PHONE SoY �t3,J 9 2 o 0 PHONE T; ,t' E 1 h `,_ ��I. 1-_, c1- 1ord 1en,illt 1ti I 1 II - 21"a reque5fi I TENANT/PROPERTY OWNER/AGENCY WEATHERIZATION AGREEMENT 1. The Parties to this Agreement are the following: t L , Lam a ,^ aox (hereafter known as Tenant), (print your tenan 's name) 1 may (hereafter known as Property Owner) (print your name) and Housing Assistance Corporation (hereafter known as Agency). In consideration of the mutual promises hereafter stated, the Parties agree as follows- 2. The date of Agency's signature will be the effective date of this Agreement. 3. Property Owner and Tenant consent and agree that the Agency may do the following with respect to the property located at(street, town) unit# and currently leased or rentedlo.the Tenant: a) Enter the premises for the purpose of performing a Weatherization inspection. b) Enter the premises to perform Weatherization work which the Agency determines in its discretion is necessary and appropriate as a result of the Agency's inspection of the property and in accordance with the appropriate priority list for the type of dwelling. The Agency and the Agency's contractors may also enter the appropriate common areas of the building for the purpose of accomplishing the Weatherization work. The Agency and representatives of the Commonwealth of Massachusetts, Department of Housing & Community Development(DHCD) may further enter the property to inspect any and all work hereunder. The Agency will provide reasonable notice of the timing of the Weatherization work and inspections. The Weatherization work will be performed in accordance with the Property Owner's consent as further specified below: *** INITIAL ONLY ONE OF THE FOLLOWING*** _ I consent to performance by the Agency and.its contractors of any Weatherization work determined necessary and appropriate by the Agency as a result of its inspection of the property. I understand that the Agency will provide a detailed statement of the actual work performed and the associated value at the completion of work. I will provide a separate consent to performance by the Agency and its contractors of Weather4zation work following my receipt of the Agency's inspection report and a statement of the estimated work and associated value. This additional consent will be sent under separate cover as Attachment A. I understand that the Agency will provide a detailed statement of the actual work performed and the associated value at the completion of the work. 4. The Property Owner understands and agrees that any.and all work, including related repairs for which the Property may also be eligible, will be performed at the Agency's discretion. The Agency estimated completion of the Weatherization work by the end of 2012. 5. If the Property Owner is required to make repairs to the property prior to the commencement of Weatherization work by the Agency, the Property Owner will be notified by the Agency and will be required to make the repairs as soon as possible. Except where the Property Owner receives a written extension from the Agency, time is of the essence in the performance of repairs by the Property Owner. f 21).t'oC 6. The Property Owner and Tenant authorize the Agency to receive a statement from the fuel supplier/utility supplier as to the.quantity of fuel/utilities used at the above address in each of the past three years and the future three years. The information is to be used only to determine the cost effectiveness of the Weatherization improvements. 7. The Property Owner agrees that the rent for the dwelling unit will not be raised because of any increase in the value thereof due solely to the Weatherization work performed. 8. In consideration of the Weatherization work hereunder, the Property Owner further agrees that upon the effective date of this Agreement and during a period extending through 2012/2013, approximately one year from the time the work is completed, cA a) The present rent$ t 3 u 0 ";per month will not be raised for any reason. (The rent amount must be filled in). Heat included in rent?YNo However,this Paragraph (8a)will be waived by the Agency in writing if, and only if,the premises are leased under a state or federal rent subsidy Program, in which case the actual rent charged by the Owner shall-conform to the standards of the rent subsidy program Please state which Housing Subsidy program your tenant is on and through which Agency: b) ' The Property Owner will not institute any summary process action for possession except in the case of non-payment of rent or other good cause related to the Tenant(or any successor Tenant). c) in the event the Property Owner decides to sell the premises, Property Owner shall comply with one of the two requirements below: --The Property Owner shall not sell the premises unless the buyer agrees (with a copy forwarded to the Agency) in writing.prior to sale to assume all obligations of the Property Owner set out in this Agreement; or --The Property Owner shall pay the Agency an amount equal to the cost, as certified by the Agency, of the Weatherization materials installed and labor performed in the premises as of the date of sale. Said-amount shall be paid to the Agency immediately upon sale. 9. (Applicable only if Tenant's heat is included in rental payment and blanks are filled in) At the end of the period set forth in Paragraph 8 above, the rent shall not be raised moreahan % per for an additional period of one year, and the provisions of 8b and 8c above shall continue in effect for such period. However, the rent provisions of this Paragraph 9 may'be waived by the Agency in writing-if, and only if, the premises are leased under a state or federal rent subsidy program, in which case the actual rent charged by the Owner shall conform to the standards of the rent subsidy program. 10. The Parties agree that the terms of this Agreement are incorporated into any other lease or agreement between the Property Owner and the Tenant, and between the Property Owner and any successor Tenant, and if there is any conflict between the provisions of this Agreement and the provisions of such other lease or agreement, the provisions of this Agreement shall govern. However, if such'other.lease or agreement, including without limitation a lease or agreement under state or federal rent subsidy program, contains stronger protections for the Tenant, such stronger protections shall apply. i!� � l}� {.t'.F.[. D� 1, �_ E'—E_tl:hmt . rt-rs_LEL i,_�i c li�ilt�: i eli.;n i 11. For breach of this Agreement by the Property Owner, the Property Owner shall reimburse the Agency in an amount equal to the cost, as certified by the Agency, of the Weatherization materials installed and labor performed on the premises, as well as attorney's fee and court costs. The Property Owner may also be liable for damages to the Tenant in accordance with applicable law; in such instance, the Property Owner shall reimburse the Tenant for attorney's fees and court costs. Without limiting the foregoing, the Agency may at its option terminate this Agreement, by providing written notice to the Property Owner and Tenant, in the event of breach by the Property Owner or Tenant. 12. Performance of the Weatherization work hereunder by the Agency is contingent upon the availability of funds to the Agency from the commonwealth of Massachusetts and the federal government, as well as the eligibility of the Tenant under WAP program requirements. The Agency may terminate this Agreement, by providing written notice to the Property Owner and Tenant, if the Agency determines that the unavailability of funds or ineligibility of the Tenant warrants termination. 13. The Parties acknowledge that this Agreement is under seal. It is intended by the Parties that the Tenant or any successor Tenant is the intended beneficiary of the Agreement and shall have a right of enforcement. Property Owner's Signature: ti - Date Phone: Gk 3, a Address: t -I -C+ CTT t�L. h - Ins A- Tenant Signature Date Agency Approved Weatherization Company t.- All Cape Energy Cape Cod Insulation ape Save Frontier Energy Solutions Lohr& Sons Resolution-Energy t Agency Signature Date s`'.i f_' 1 _,;rt,i ��,i i '.l.C. Lc,_tili.r I _ .. :!C t1`lt_'�l.e le.ie'_ Cape Save Inc. 7-1) Huntington Ave;Q'N OF BARNS71ABLE South Yarmouth, MA g3664 111 .; Tel: 508-398-0398 Fax: 508`198=0399 D IVISj It�. .q .� 7/15/13 Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main St. Hyannis,MA 02601 RE: Building Permits Dear Mr. Perry, This affidavit is to certify that all work completed for 91 Ansel Howland Road,Centerville has been inspected by a certified Building Performance Institute(BPI)Inspector. Ceiling: R-19 cellulose All work performed meets or exceeds Federal and State Requirements. Sincerely, " William McCluskey r Town of Barnstable *Permit# 0) Expires 6 months from issue date Regulatory Services Fee z) Thomas F.Geiler,Director sa3.9 Pe uilding Division DEC �, ylrry,CBO, Building Commissioner Main Street,Hyannis,MA 02601 ',J �{�`e� www.town.barnstable.maus Office: 508-862-4038 lWvs L Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint tp/parcel Number )perty Address residential Value of Work��t� 3 Oo Minimum fee of$25.00 for work under$6000.00 vner's Name&Address c... At4', �ntractor's Name r� /� Telephone Number )me Improvement Contractor License#(if applicable) ///9 5; instruction Supervisor's License#(if applicable) lWorkman's Compensation Insurance Che one. I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance turance Company Name Drkman's Comp.Policy# ipy of Insurance Compliance Certificate must be on file. rmit Request(check box). e-roof(stripping old shingles) All construction debris will be taken to �s�/y`�°✓yz ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) *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.. Home Improvement Contractors Li ense is requir d. GNATURE: ?orms:expmtrg vise071405 i i o ,� The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street i Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers kpplicant Information Please Print Legibly ,1ame(Business/Organization/Individual):��, � �e, Address: / ���i� l amity/State/Zip: A-4 ell2173 Phone #: ,S`08� fl'b� — ,FYd S_ ,re you an employer? Check the appropriate box: Type of project(required): ❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction ewloyees(full and/or part-time).* have hired the'sub-contractors am a sole proprietor or partner- listed on the attached sheet. $ ? ❑Remodeling ship and have no employees These sub-contractors have S. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5• ❑ We are a corporation and its officers have exercised their 10.❑Electrical repairs or additions required.] of ❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑Roof repairs insurance required.] t employees. [No workers' 13.0 Other comp.insurance required.] ny applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. (omeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. antractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. im an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site formation. surance Company Name: dicy#or Self-ins.Lic.#: 'Expiration Date:. b Site Address: City/State/Zip: ttach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Lilure to secure coverage as required under Section 25A of MGL c. 152.can lead to the imposition of criminal penalties of a ie up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine .up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of vestigations of the DIA for insurance coverage verification. io hereby certify under a pains and pen tie ojperjury t t the information provided above is true and correct: �� mature: .� Date: lone#: Of use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: I 4 Results Page 1 of 1 Home Improvement Contractor Look Up Enter Search terms separated by spaces. Search terms can be Town/City, Name, or License number ~ Select Search type: r; AND r OR .Search" Search Results Reg. No. Applicant Street I ty State Zip Name Title Expiration 116227 RA CON. CO.NC SCHOFIELD AVE LDUDLEY IRE 1570 ROBERT PRESIDENT 5/31/2008 IF— XCE, 17397 B :1Ell `�' O 8 19983 SHON A SCHOFIELD 15 PARTRIDGE W. 02673 SCHOFIELD, OWNER 9/28/2007 HOME MAIN:& REP VALLEY RD. YARMOUTH JE SHON PO Box 67/220 SZ Fo Iie 125031 Reginald Schofield Peru Rd Windsor. MA 01270 Reginald Owner 9/30/2007 VAL-GO CONST. CO, 194 SCHOFIELD VALLEE, 144016 INC AVE DUDLEY ARTHUR OWNER a 01571 8/27/2008 Total of 5 Records matched. Back to Home Page BBRS Private Statement htt ://db.state.ma.us/bbrs/hic. 1 12/4/2006 p p Dec 01 06 04: 34p 508-879-3737 p. 2 12/01/2006'12:58 FAX QID02 PROPOSAL ;PROPOSAL1NOi:.:.,:1;;:;r•_i::,. , y. a // /�� cam, g 3 .:• . Sp Qp e5 7 $S/6 5 SHEE7 NO: re��- ,d�?/•!�"►ov/^ J' •q Q 73 DATE i ia/ / PRO130SAL SUBMITTED TO: WORK TO BE PERFORMED AT: NAME I DRESS 4 _..... ••IiV.. ... �. ram` -40:�;..: S DATE OF PLANS 1///1 PHONF'.NO./ ARCHITECT reby;{�rdpose-to.::fumiska the:mattr+ats`and perfo:rin the tabar'necessary'for the comptetion of _ T .. I..:.. Ag O :. / . All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and speciti- catinns submitted for above workk and completed.in a substantial wQrkmananlike���r for the sum of /i,.,e r Dollars (s with payments to be made as follows. 300.0 ro t S1 �16" v 6 3 Respectfully submitted Any M,tabor, of deviabon Irom above specifications Involving wtlra costs will b+.r.•,>tecuted only upon wtil,.on order.and will become an oxtra charge Per over :tnd above the estimate. AN agroamstns contingent coon sifts, at• cichent•s,)r dolays beyond our control. Note—This proposal may be withdrawn by us it not accepted within days. ;,....:_. ACCEPTANCE OF PROPOSAL ThA:.-above. prices,._specifications and"conditioris are satisfactory and are hereby accepted. You are authorized to do the work as sl)�citied. Payments will be made�S outlined above. `,�9'v Signature p _ ! U Signature NG39,9.4o PROPOSAL �9/b t r 1 �C 1-702 C 7 �.:. 'As ssor's map and lot number �•.Sewa a Permit num er ( `1 ti�,�'t THE t0 ` 14 ARNSTAH i House number .......................... ...... .q�l... 1:ek ... .1 r�f S�'�C�3 �`�� '�o HAW 3 TOWN OF; B S-- T�,ABLE BUILDING INSPECT0,11 APPLICATION FOR PERM11T TO .......... ...... .......... ......... >.. .....z:... .... :... ............... ................................ TYPg OF .CONSTRUCTION ................ ` 4 ........................................... ...... ................................. ........ ..�..� !'..19....... TO THE INSPECTOR OF-6UILDINGS. ` The undersigned hereby applies fog'a,permit according to,thy.follow•ng information: Location ..�r' , . . .� :..... .. ............................ ... . ..... .. .V: .. ProposedUse .1d ,......... ..... r ......................... .............................. . .................. ..... ZoningDistrict ........................................................................Fire District ... ............................................ .... 4 Name of•Owner. ................. ................................Address ..................... Name of Builder ......:.......... ....Address . Name of Architect` ... .................. ................ .,. ............Address ......................................................................................... ......... ....... ....... Number of Rooms .........>,,;. .....Fcsuildaion . . ....... ... �.7,. .. . .. . . ......... .........Roof rig Exterior ..... �.. ....... . ... .......... 0A polo, Floors :nl riiol .Plumbin ,.Heating ...................... ................................................. . g ....... ......... ... . .... ................................, Fireplace ..... :`...+. ........Approximate Cost .......`....... ........ ...................... Definitive Plan Approved by Planning Board -----------____-----------------19 Area �J� Diagram of Lot and Building with Dimensions i Fee ;... p _ -SUBJECT TO'A-PPROVAL OF -BOAR D_.QF•-:-HbALTH 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 4� .r.......:�i�.... 7, SMALL, ALAN E. ` ti t, 25304 Permit for One•..Stor.'...•......•.. Single Family Dwelling Location Lot 14., 91 Ansel Howland Rd. ... -- Centerville ........ .............................`................... : Owner ...Alan..:E.•...Smal.l............................ ,. r Type of, Construction ...Xr4PC... .................. i ! ... ':... . .'. .. ......................................... Plot . .......... ........ Lot: .......:'.. t,> m P=)'.��"� 8 3 ti Granted .....July..:l2...............19 Date c f Inspection ................... ...............19 Date Completed ...` ...........9 • Y. r l Y , - _ • • a *TME,• TOWN OF B.ARNSTABLE `} o` e Permit No. __.__.25 30 Building Inspector Cash OCCUPANCY PERMIT Bond ____.___ r Issued to Ala! 11.1 Address T,ot TTrit-I"i^tYel Road, L'F`r.tF�r�C1 In Wiring Inspector , Inspection date Plumbing Inspector `i•+' ar. 5 Inspection date F Gas Inspector Inspection date Engineering Department r� Inspection date Board of Health Inspection date 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. ......................................................1 19......_._ .................................................................................................................. Building Inspector �a i SINGLG- FAMILY - gEORooM ►,JD GARBAGE (�21NDE12 �� . � '' ` 3' DA1 Flow z 110 X 3 = �Y ISrcPTIG TP►•IK = 33ox150% =-495G.P. - =of •�9 - ,i�j U5E l000 GAS•.. � � • : ot5Po5AL PIT v5E tvo0 GAt_. \ � ,5 I-DcvJA1•L A2L-A- = 150 S.t= 150 5.1= X a-• ; J 50TTOM AIZE.A o F._ 0 G.P.0. Ix '•TOTA 1- D E' GN 42-5 (I,P.D. -�'OTAL T>A 1 L*4{ F\.OV,( = 33o G,PO, - \ coo► PE2GoL_ATIoN RATE , 1"iN 2M1N SZ Frisrivcr ; i.5'1 �5� �, ,_.✓�? `N of ol C O ALAN ti r MCNARD w i A. JON �I 00 .� o. No. A� 4a18TaP�� � / lE� � .� s� �00•jS�i �� i. ! � , TOP FNDQ ��i.l Y^. ! �c3 � 1000 d , �r�Scvc� A15T. tNJ. Q4L. I Doo I Boy. T 54s- ANK • ,• �ti,�•. _ • N�! �GP�✓EL Gay.. ,S/� ..s .: LE AGI•I . • PIT INV,. INV' WITLI ,�/L .S/•5C WAS%4r D ' -•� GE2TIPIS0 PLo-(' PI-AW, o PRUFILG o G 4-t 10 N C �►TEP�./t�..t:.,C- �//o 'DATE :&.I15. . zeN GE 1 C E QT►F Y THAT T H E �a�el�T�� 5No 1rYN NE.REoN GoMPI.YS YJITN'�t-IE SICELIN'� .LoT/� .' I. A u D S 6'c eQG K R.6 Q V►R.E M E N7'� o f 'C N G�is�r�' f//GGt� /7�/6fi�LSfl7s -To W N OP r3 A2.N STA'M4-1 AND 1 S N� SECT-ic�S/ LOGp.TED •WlTHL1�J.T .E F1-o PLv N ' 11D v 'T EQ.iQv REG 15 I prr Q �p pld AN OSTE�2VILl..� MAs 5. aN N a 5 u 5 T l L 5P iW,15TR.UMENT SDI-vEY >r�NE o1=F'SETS SuoU1D NoT 13E APPL1G.A►1-i-r ALAty E-. 6MaLL- I.kir— LAUNDRY ROOM O O O O C� EL IG PAN EXISTING CONDITION 5ASE~IENT O O O O O G NEW CONDITION z w 5A8EMENT G_ 7 00 7 c f1'I C" a. r 91 ANSEL HOWLAND ROAD CENTERVILLE MA .