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HomeMy WebLinkAbout0195 ANSEL HOWLAND ROAD R5 ANWL V400 Cab m wlw a .� Town of Barnstable *Permit# C�20/v G V(0� Regulatory Services �+�6►►,ten:hs from issue date 0� « 9ARNSTABM UV Muss, Richard V.Scali,Interim Director 6 9. � �014 Building Division `per` Tom Perry,CBO,Building Commissioner OF200 Main Street,H Hyannis,MA 02601 A RN37'ABLE y , 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 1 � 1 (0 1 Property Address )I l 4n re `'�U`'`�(e 1 -e (�`a-,.jr'If(° f lj f �� d?2 � GD ❑Residential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address�i// 1det-`Y Contractor's Name ( /M ep� "� Telephone Number �\� Home Improvement Contractor License#(if applicable) Email: ��` Construction Supervisor's License#(if applicable) ? � ,.1 Workman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance , Insurance Company Name Qz I Workman's Comp.Policy# t) 2 Z ZP l) 2—z ®� Copy of Insurance Compliance Certificate must accompany each permit. Permit Req est(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. ' Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: TAKEVIN_Muilding ChangesEXPRESS PERMITIEXPRESS.doc Revised 061313 ✓2. -el eczlC/ Office of Consumer Affairs&B sinIs Reeg' License or registration vaLd for mdmdul use only HOME IMPROVEMENT CONTRACTOR s Registration RACTOR before the expiration date.`�If found return to 143053 Type: Office of Consumer Affairs and Business Regulation Expiration. 6/W2016 Dgq 10 Park Plaza-Suite 5170 KE ING CONST�mI = Boston,MA 02116 r �C_�r i �1 TIMOTHY KEATWG- 54 LOWER BROOK 52,'-1 'SO.YARMOUTH MA'c 02664 Undersecretary Not valid without signature Massachusetts Department-- - Board of of Public Safety Construction Building Regulations and Standards Supervisor S License: pecialh CSSL-099351 Tim B Keating 54 Lower Brook s s . South Ya k6ad� ratouth SIA 02'J4, Commissioner . Expiration 05/11/2016 _ CERTIFICATE OF LIABILITY INSURANCE DATE IMM/DDIYYYY) 04/16/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE' COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must_be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement($). PRODUCER NAME: PAUL SCHLEGEL SCHLEGEL INSURANCE BROKERS INC PHONE (AfC,No,Ext): 508-771-8381 FAX 508-771-0663 34 MAIN STREET EanAIL ( No) ADDRESS: SCHLEGELINSURANCE@GMAIL.COM WEST YARMOUTH MA 02673 INSURER(S)AFFORDING COVERAGE NAIC q INSURER A:COLONY INSURANCE INSURED Timothy Keating Dba Keating Construction INsuRERe:CNA 54 Lower Brook Road INSURER C INSURER D: i INSURER E: South Yarmouth, MA 02664 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY 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 -AM EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDDY/YYYY) I IMWDD/YYYY) LIMITS pl GENERAL LIABILITY GL3594908 03/20/201403/20/2015 EACHOCCURRENCE $ 1,000,000 R COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ 500,000 CLAIMS-MADE Fx_1 OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 • GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO- JECT LOC 1 g AUTOMOBILE LIABILITY 791IMTE LIMIT-- (Ea accident) S ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) S NON-OWNED HIREDAUTOS AUTOS PROPERTY-DAMAGE S (Pei accident) S UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE S DED RETENTION $ - S B WORKERS COMPENSATION 0224N37-2-10 03/09/201403/09/2015 WC ST Tu- O H- AND EMPLOYERS'LIABILITY YIN N TORY LIMITS _ ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100.,000 OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 100,000 DESCRIPTION OF OPERATIONS betow _T E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) TIMOTHY KEATING HAS ELECTED TO BE COVERED UNDER HIS CURRENT WORKERS COMPESNATION POLICY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD The Contntonwealth of Massachusetts Department of Industrial Accidents Office of Investigations h 600 Washington Street Boston,l'tsMA 02111 ivmv mass gm/dirt Workers' Compensation Insurance Affida-vit:Builders/Contrac#ors/ElectricianslPlumbers Apylicant Information Please Print Legibly Name(Businesstownirationandhidoal): Address:. -3 i-a C1,11 City/StateJZip: G/mot 9 �I Phone k 71510 �® Are you an employer?Check the appropriate boa: . Type of project(required): 1.d I am a employer with 6 4. I am a general contractor and I s have hired the sub-contractors 8_ New construction employees(full and/or part-time). - 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no These sub-contractors h , employeesave. t3: Demolition working for me in any capacity- employees and have workers' 9. ❑Building addition [No workers'comp.insuuance comp:insurance required-] 5_❑ We are a corporation and its _ 10_0 Electrical repairs or additions 3. I am a homeowner officers have exercised their ❑ doing all work 11.E]Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL insurance required]i c. 152,§1(4),and we have ao 12.❑Roofrt pairs employees.[No workers' 13.0 Other comp.insurance required] •Any applicant that checks boa#1 must also till out the section Wow showing their workers'compensation policy inbroastion. 1 Homeowners who sub art this of ulmlit indicating they are doing all work and then hits outside contractors must mb=a new afftdarit indicating such. 'Contractors that check this boa must attached an additional sheet showing the name of the sub-caurectors and state wbetheror not those entities have employees. If the subcontractors here employees,they trout provide fir workers'comp.policy number. I nm an employer that is prosidbig rerorkers'compensation insurance for my employees. Below is the policy and job site information Insurance Company Dame: �pLH Policy#or Self-ins.Lic.4- t d Z 2/L11, '3-)— d Expiration Date: Job Site Address: r� zL�4 / t a el-'le" Cityi`StatelZip: �T����`/i t C�!✓ Attach a copy of the workers'compensation polio)declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section.25A of MGL c..152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as ci,.Yl penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certknn .ns and penalties of pegFury that the information provided above is brie and correct } Si cure: Date: 6� ^ Phone Official, use use only. Do not mite in this area,to be completed by city or town official, t City or Town Permit/License# Issuing Authority(circle,one): 1.Board of Health 2.Build ing Department 3.CrtyRotxn Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: _I V + MUMSTABIA + MASS, Town of Barnstable Regulatory Services Richard V.Scali Interim Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnftable.ma.us Office: 508-862-4038 F - -Fax: 508 790 6230 Property 'Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize r /'� � r f to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) k + Signature of Owner Date Print Name If Property Owner is applying for permit,'please complete the Homeowners License Exemption Form on the reverse side. l , TAKEVIN_Muilding Changes\EXPRESS PERMIT\EXPRESS.doe Revised 061313 , . 6/13 J►3 14- 'CAPE CO BARNSrA Lr N S U L A T 1 OQT JL1jN ! 3[�7A, 10: 00 NSIN GLASS SFAMIISS SPGATPOAM MPINDID - SAM GUT-S INSU/ANON MONO C Town of Barnstable Regulatory Services Building Division 200 Main St Hyannis, MA 02601 Date: //1/S 1Iz Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute '(BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address Village 2d , Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings Slopes Floors ( ) f ) ( ) ( ) ( ) Walls ( ) ( ) ( ) ( ) ( ) �iV er �,Uor /RPr)COr,#jeO1 y Sincerely rry ssration, sident Insc. i I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map !-7 1 Parcel 23 S Application #dd odd 7,3 6 Health Division Date Issued a- 1 I Conservation Division Application Fee �4,45-(o Planning Dept. Permit Fee }5: Date Definitive Plan Approved by Planning Board ��?'�Z�'� Historic - OKH _ Preservation / Hyannis U Project Street Address iS 5 N<Nsz\ yu_uJ Q)4 Village \ Owner Address ,"� �AS.2� �Mck Qd- Telephone Permit Request AA�\ (SL\W\\052 At) f)bVn O� kC NY se, \ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuations ,,c'\O-b,Db Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor RoomCount o Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other c Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: O�Yes E6No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new. size _ Barn: ❑ existing ❑ new size Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size — Other: i/ Y L_n 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 y- \ Telephone Number Address \so su.:� License # ����1�►� SC60 ALJ\C,V. AA Home Improvement Contractor# Worker's Compensation # \M C.I���53� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE ��' �� FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. `t ADDRESS VILLAGE OWNER'-' DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL s PLUMBING: ROUGH FINAL r GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO., 1 TheEonimoniveatth of Massachusetts Depart»lent of Inclustraal Accidents, Of ee of Investigutian s F a. . . 1,Congress Street;.Suite 1,00 P u h Boston, MA;0,2114401.7 # ' �ww,niass ga>uldta •� ri Workers' C'ompensa6on lnsurance Affidavit: BuildersiC- tract arslE]ectri'c>t am/Al m ers Applicant Inforiwifion ti Please Print Legibly Name:(Business/ .4iin zation/Indi iouat):CONSERVE ENERGY ING. :d.b a 'CON SERVIMWENERGY Addt'ess: 376 ROQTE-130,'SUITE C F $ANDWICH MA '02563: " GitylState/Z .px . . Phone M 508 833=8384 t Are you an employer?,Cheekthe appropriate box, Typg.of project` i Y � (regquired) 1: I am a emp,oyet with 6 4, ;E 1'atn a gc ncraf c©ntractotand.1 1 employees(full and/or part time)>; ` havee hird the sub=cotitraeto'rs b` Neiv eonstrtietton 2.❑ I am a sole proprietcir or.partner- listed oti the attached sheet; 7 '[ -Remodeling ship anti have no employees. T,4ese.sub contractors have. $. Q Demciliiioi working for me,iri any capacityY' employees and have workers` r [No workers'comp"insurance; comp insurance . 9. Q Bwldi,g addition ., required,] _ .We are a corpora`ton and its 10.0,Etectrical repairs.or additions officers have exercised-their. s 3.0 I am a homeowner doing;alf wail€: 1 l [ PlumbJng,repairs or additions myself..No workers'pomp. ,w, right ofexen onper;MCr'L 12>0 Root'repairs t c..1S2, 1 ';andwehave�no insurance requir'ei ja,'r { ) '13, ]:OtherEATf-{ERIZATION t. emplo Yee s;;[No workers' - s comp, insurance required:] fi. *Any applicant that checks box#i"rnust,dlso fill riot die section belour showing;therrwnrkers'compensation;poGcy it torrnation. r t Homeowners who submit this a da it indrea[in}I:they'a"re:dorm alI work art�,theri hire utside cryntractors;musi suiiiii"a new.atfidavrt indicating such. tContracWm that check this bale must offal lied an atidttioriat sheet showing the.name ot'ihe sub-contractors and atate,whether or not those entities have- employees. lithe sub-contractors-have einployees'-they must provide tilieirFworkers'-comp,poliep number, I am an employer that is pravrdiirg workern''crtrrtpertsation'insuranc foi my employees. BEEow is.tlte policy rnd jc►h.-site rxnforniation. R Insurance Company Nai e 4'SELECTIVE'INSURANCE COMPANY OF THE SOUTH 1 Policy#or,Self:ins.'L;ici#,WC795S539 Expiration Dais:31"15113. Job Site.Address: f City/State/,Zip:, Attach a copy of the wo"rkers' compen§anon"policy iieclarat'on page(showing the;oolicy'n iimbertand expiration-date): Failure to secure;coverage as required under Section 15.4 ofMOL c. 'I5 call fiead to"tile.imposition of criminal pena t es of a fine up-to$d,,500,00 and/or one=year intprisnnme t4 as i ell as civil penalties iri the forrrt of a STC}1'Vi?ORK ORMR:anA a fine. Of up to$250.00 a day against the-violator. Be advised�th t.a eppy ofxthis,statement may be:forwardcd;to the Office'af Investigations of the DIA for insurance coverage veril cation. : = I do hereby certi under the alas and ena?ties o eZi .that the in armation provideiWove is true and correct Si afore: ._ + Phone#:508-833 8384 t O cia/use piety 13o:nat write rn this urea,:'ta 6e c', I M.liy.eity or town offaciul. ~' City or I ermi, ic.ense# . Issuing Auth rtty(circle one) , 1.Board of I ealth 2 Building Department 3:Citvriiwii:Clerk 4.Electrical:[nspec"tnr 5i Pi`umbing lnspeefar b.Outer r_ . Contact Person Fitotie#:' Client#:68880 EONSER _- DATE ";ACORD. CERTIFICATE OF LABILIYINSURANCE 0311512dig TH.IS'CERTIFICATE IS ISSUED AS A MATTEROF INFORMATION ONLY.AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OREG NATIVELY AMEND.EXTEND OR ALTER THE COVERAGE AFFORDED.BYTHE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTEACONTRACT BE7WEEN.THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR:PRODUCER,AND THE.CERTIFICATE.HOLDER. ---- =— - IMPORTANT:if the certificate holder'is an ADDITIONAL INSURE Q,the pol icy{ies):must be endorsed.If SUBROGATION IS WAIVED,subject to the tarns and conditions of.the policy,certain policies may regu1e64n,endorsernent.A statement on.t4is certificate does notcohfer rights to the certificate holder.In.lieu of such endorsenient(g. PRODUCER CONTACT f Rogers&,Gray Insurance;Agency Inc, PHONE FAx Atc No,E�iq:508 3984980' ; , (A1C Noj: 434 Route 134 E-aaAIL _ADDRESS: _............. ' South Dennis,MA 0266,0- 508 398-79$0 —_ INSURERS)AFFORDING COVERAGE __ wy INsuRERA-Select h ive Ins.Co.of the South. , _. - ---t - INSURED INSURERS Con=Serve Energy,Inc; - - 376 Route 130.STE C< INSURER-C. Sandwich;MA 02563 INsuREaD:: INSURER E: . INSURER F: _ COVERAGESCERTIFICATE NUMBER:, REVISION NUMBER: THIS.IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED_BELOW HAVE BEEN,tSSUEO TO.THE INSURED NAMED ABOVE FOR THE POLICY PERIOD' INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR:CONDITION OF ANY CONTRACTOR.OTHER DOCUMENT'WITH HESPECT'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 BYE PAID CLAIMS, � INSR - - ,ADOL U8 - : POLICYEFF. POLICY L. TYPE OF INSURANCE ;INS- POLICY-NUMBER:- MWDD .-MMIOD. uMITS: GENERAL LIABILITY �'X S2011299. 031141201.2r0311'4/201!'EACHOCCURRENCE S1000000 COMMERCIAL GENERAL LIABILITY ; .� PR MISES�Ea o�RDe. $100 000 - CLAIMS-MADE OCCUR MED EXP(Anyone person) $1 0;OOQ ; j PERSONAL B.ADV INJURY' S 11OUQ,000! - t GENERAL AGGREGATE f.s3000,000 t GENT AGGREGATE LIMIT APPLIES PER: - I PRODUCTS-COMPIOP AGG $3 000,06.0 X.POLICY JECT PRO IOC' --- AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT(Ea ANY ALTO - I - S BODILY INJURY(Per peraonj $ J ALL OWNED r---1 AUTOS LED , �; BODILY INJURY(Peracddem), 5 AUTOS AUTOS 1 i' i --l NON-OWNEO PROPERTY DAMAGE HIRED AUTOS I AUTOS i I tPeracddentt _sty R A ueneRELLA.LIAB occuR ,X S20.11299 3/1412012 4 201 EACH OCCURI...... E {s1,000 000 X EXCESS UAB CLAIMS MADE AGGREGATE;H 53,000,000 DED. X.RETENTION . . :#! .-- A ANDEOERSL' r .... X WLAIZTQULT.:S:.. :� OTH 3/14401.2a031d12013EMPL ' I WG79565 YIN ANY PRgqP�RIETORiPARTNER/EXECUTIVE t E L EACH ACCIDENT ;$1 OO QOO OFFICERlMEMBER EXCLUDED? Y 'NIA I iMa,desry in NH} S - 3 E L Q[SEASE-EA EMPLOYEE O : ayes destnbeundar . DESCRIPTION OF OPERATIONS below I E,L.DISEASE-.POLICY LIMIT $500,000 :. s - . - e . t;ll _ N DESCRIPTION,OF OPERATIONS I LOCATIONS VEHICLES:(Attach ACORD:101;Additional Remarks Schedule,If more space N regyired). Excluded officers underwor,.kers'Camp-'Conor and Courtney,Mclnerney; Blanket additonal insured coverage applies=under CGL. n 'CERTIFICATE HOLDER CANCELLATION. ' r SHOULD ANY.OPTHE'AB'OVE DESCRIBED POLICIES BE,CANCELLED BEFORE Thielsch'Engineering,anc. THE EXPIRATION DATE. THEREOF,, NOTICE WILL e_E DEL•IVERED IN 1.95 Francis AVE;- ACCORDANCE WITH. THE _POLICY PROVISIONS. Cranston,RI 02910� �AUTHORIZEO REPRESENTATIVE _ '©198 -2010 ACORD CORPORATION.All rights reserved.. ACORD 25(20101.05) 1 oil The'ACORD name and loga are,registered marks of ACORD I #S788991M78898 'DDR The.Cominonwealth ofMassachusetts ] �o ' Department of Industridl Accidents_ - -_ Office ofTnvesl gallons i h Congress Street,,Suite:IDO Boston, 1 02114-2017 ivww.titass g6WW4 # Workers' Compensation Ingurance Affidavit, BuildersJContractorslElectri:c>Ian IPtum'ber Applicant Information _ _ Please Print Legibl. Name:(Bus'iness/Orgt6ization/lndtvidual):CONS ERVE ENERGY INC. d.b.,a CONSERVISI'ON ENERGY Address: 376 ROUTE 1,30,.SUITE C F - — Gity/State/Zi.p:SANDWICH, MA 02563 Phone#': 508 833=8384 t Are you an employer?Check tthe appropriate box. Type.of protect(required). 1.91 I am a employer with 6, 4.;.Q I am a general contractor and I 1 * have hired the sub-contractors 6, Q New construction employees(full and/or part ime),. 2,E] .I am a sole proprietor,or partner- listed on the attached sheet, 71. Q Remodeling These sub=contractors have. 3. Ship and have no employees 8. 0 Demolition working for mein any capacity:- employees:and have workers' _ [No.workers'comp`dnsurance comp insurance.* 9. ❑ Building addition required) co orationd its to..Q Electrical repairs or'additions � S: � We are a rP n a g � officers have exercised their Q 3.E I am a homeowner doin all work: 11. Plumbing repairs or additions myself: [No workers - 'lit t of exemption er MGL right g p p 12.Q Roof repairs: '. insurance required]t I c 152, 1.(4) and weltave.no TWEATHERIZATION employees. [No workers' 13, ]Othe _ COMP. insurance required.] *Any applicant that:check§-box::#1 miist also filidut the section below:showingj.heir workers'eoinpensation policy ioformatibn. fi Homeowners who subrnrt thi's affidavit indicatingsthey are:loing altvwk anti then hire outside caiitraet6N must submit a new:aTfidav�Eiiidicafi g such. tContractors that check this.box;must attached an additional sheet showing the;.name of the sub-contractors and tale whether or not those ientitie,s have a employees, tf the sub-contractors have employees,they must provi}e their workers'camp.policy number, y I am an employer that_isprav d ng workers'compensation insurance fqr niy employees. Below is thepv/ecy andjtib site Y information. , Insurance Cornpany Name: SELECTIVE INSURANCE COMPANY OF THE SOUTH Policy#or Self ins. Lie #,WC7956539 Expiration Date:3/1'S113 Job Site Address: Cityisiate/Zip: l Attach a copy of the,workers'.compensadon`policy declaration page(showing thepolicy number and expiration:date), Failure to secure coverage as required under Scot on.25A of SV1GL c. 152 can lead to the imposition of criminal4 penalties of a fine up=to$1,,500.00 and/or one=year nxtPrtsonmenr;as well as civil penalties in the forrri of a STOP WORK ORDER-and a fine of up to$250.00 a day:against the violator. '88 advised that a:copy of this l statement may be forwarded.:to the Office of Investigations of the DIA,for"ins Wane e.coyerage verification; F I do hereby tern under the sins and enalties o er'ur Aat the in ormation;provided above is-true and correct N -- Phone#:508-833 8384 O cia/use only. Ro:not writ, all s areai,to be c mpleterhby city or town uffici4i. City or Townt, Permit/:Licerise Issuing Authority(circle one): , 1.Board of Health 2-Building Department 3'.City/Town Clerk 4 Electrical Inspector 5.Plumbing;Inspector' 6.Oth.er Contact Person: ' Pltone#: I ._. . 71. , " Client#:"68880 CONSER CORD.\Dna :DATE(MMIDDIYYYYI CERTIFICATE OF LIABILITY INSURANCE 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 AFFORDEt).BYTHE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING 1NSURER(S),AUTHORIZED REPRESEN'1ATIVE'OR PRODUCER',AND THE:CERTIFICATE HOLDER: IMPORTANT:If the certificate holder is 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 eitidorsement.A statement on this certificate does not•coke'r rights to'the certificate holder In lieu of such endorselnent(s): _PRODUCER ; CON ACT - Rogers 8�Gray insurance Agency:In.c;, dN.; e I"FAX �aIC�No,ERtI."508 39$79813 {AIC.No):_ 434 Route 134 E:MAII - -_ _.. f i'ADDRESS,', ; 1 _ -- South Dennis,MA O266Q' �INSURER(S)AFFORDING COVERAGE :I — NAM:$ 508 398-7980 • --- -- IN§uRERA.Selective ins:Co.of the South. l INSURED _ Con=Serve Ener Inc INSURER 8 _ - gyt- INSURER C I 376 Route 130:STE C- •- .INSURER:O: Sandwich,MA 02563 - . •. INSURER E _...._. [INSURER F'. COVERAGES CERTIFICATE NUMBER:: REVISION NUMBER THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED'BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THEr POLICY'RERIOD` e INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM?OR CONOITIONOF ANY CONTRACT OR:OTHER DOCUMENT WITH RESPECT,TO'"-ICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE,INSURANCE,AFFORDED BY THE'POLICIES DESCRIBED HEREIN IS'SUBJECT To ALL'THE TERMS; EXCLUSIONS AND CONDITIONS OF'SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID:CLAIMS. LTR . - ADDL SUB POLICY'EFF. POLICY EXP - TYPE OFlNSURANCE" I ` .. - aINS POLICY NUMBER MMIDD . .J MMIDDNYYY -. LIMITS A GENERAL LIABILITY Xr S201129.9'. W14120121 031.1'4J2013 EACHG�OCCURRENCE S1 000 p00 r_ X COMMERCIAL GENERAL LIABILITY' PR AAAISES EaoNNxTE0__ s100.000 { rn, CLAIMS•MADE ..00CUR IMED:EXP(Anyone'erson) tI$1.0 { PERSONAL 8 A,DV INJURY '{S 1 000 000 -- GENERAL AGGREGATE'-" IS$3 000 000 _ GEN'L AGGREGATE LIMIT.APPLIES PtkI, PRODUCTS-COMPrOP AGG s 3,000,000 X'POLICY 17 jE 0T LOC'. • ! _..: _ :a.S ---- -- t. AUTOAApa1LE.UAe1LiTY a - - P.EOM3INEDSINGLEtJMIT - a ardent S ANY AUTO x ;' I BODILY INJURY IPerperson) '$ ALL OWNED :SCHEDULED:' BODILY INJURY(Par accideN),$ ' AUTOS f—I ON-OWNE4 11 PROPERTY DAMAGE - --' HIRED AUTOS I AUTOS IF&accident ` S - A umsRELLA uAs X 'OCCUR X S20.11299 03914 2.012 031.1:41201 -EACHI occURRENCE $1 000 000 X EXCESS UA.9 CLAIM&MADE AGGREGATE. !r}.83 000 000 _.. 'DED_ X.RETENTION"$.Oa 6 g A WORKERS COMPENSATION_ a WC7956539 3(141 X Yvc S r.TATU- LOTH-1 -AND EMPLOYERS'LIABILITY i 1 -201.2 03J14J2013 - - Y`L m — ANY PROPRIETORIPARTNERIEXECUTIVE YIN E L.:EACH ACCIDENT ` OFFICER/MEMBER EXCLUDED? NJA ;$100,000 {Mandatory In NH} EL DIS E-EA EMPLOYEE.S.00 000 Ifyes:describe under - YY - '•. DESORIPTIONOF OPERATIONS balow __ -_ { El DISEASE-'POLICYLIMITISS500,000 _ PESCR"ONCFOPkM'nONrs.ILOCA,T!PNPIVEHICLES•(Alti6hA(;ORD101;AdoltionalRemarki�SiK6duleiifrhb;rebo eeti.rciquired). Excluded officers under workerS'eomp :Conor"and Courtney McInerney:,Blanket additonaf insured'coVerage applies:under CGL, 1 1 CERTIFICATE HOLDER �. CANCELLATION Welsch Engineering,Inc. SHOULD ANY"OF`THE'ABLWE DESCRIBED POLICIES BE'CANCELLED BEFORE THE EXPIRATION DATE THEREO., NOTICE WILL; BE DELIVERED :►N 195 Francis Ave:" ACCORDANCE 'WITH. THE ,POLICY PROVISIONS.. Cranston, tl i02910 '• - -AUTHORIZED REPRESENTATIVE Coy @ 198 -2010 ACORD CORPORATION:Ail rights reserved. . _ a . ACORD 25(2010L05) 1 Of 1:'' 'The ACORD name and logo:are registered marks of ACORD' #fS.788991M78898- 'DDR s f •. ~' Cl OWNER AUTHORIZATION FORM ltk4 Ac 0/-0,! �j (Owner's Name) owner of the property located at 9-5 �-- (Property Address) 00-41 b -v ale . r4- 0 Z6 3 Z , (Property Address) hereby authorize l o o Ene-,0:41 Q . (Subcontra tor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. Al 0,J-101 >� Owner's ignat Date OCT 9 201.2 i Massachusetts - Department of Public Safety Board of Building Regulations and Standards Con%tructiun Supervisor SpecialtN License* CSSL-102778 CONOR D MCINERNEY 39 SIASCONSET DRIVE SAGAMORE BEACH MA 02562 , Expiration Commissioner 08/19/2014 Orfice 0 on�me �fS`irs tBirs'` mess egu a ton HOME IMPROVEMENT CONTRACTOR Registration: 171251 Type: Expiration: 3/1/2014 Partnership - ERVE ENERGY CONOR MCINERNEY 376 ROUTE 130 SUITE C SANDWICH, MA 02563 Undersecretary r ipcils (urr�ttousur1�upcnjvsl k� CSSL-102776 ¢, 33 SfASCONSEz �3sdd' SAGAMORF N3FA t ra.� c GO!s 9!201'`. �na:ill er a{Fer Ce ns r Fru fr Leensr r rc°„u€ abttt valid Io s stcrti€ctxt nt., HOME IMPROVEMENT CONTRACTOR before the expiration Batt if R �I.g`•;ration: Offiee f Consumer Aibi .ind i s tr n .s Re-uN=i 1.7 25i Type: Expiration: 3/1/201 t'ar,riarvrlp !Q Park Plaza-Su to 51?l), Boston MA€2146 . "ON SERVE:ENERG., c c ^R 11riN IE..RNEY j 1 376 f?r liT 1 30 SUITE s F_G �h a=.._ �-r T ✓ Lan . �0 - i i iihht_{ . k 0266 LNotlee4�cretnrti :14'ot�°and a4lttsoot ssgnature r - :r , r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ;p;pMap Parcel licioh # Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Village re4.ze- A 1z, &ze Owner ,ia�,�� �/ �/ Address ✓r Telephone V' d g 4f-1 9 �LZ�J? Permit Request I 5 e%.S� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation ,710/y, !� Construction Type�� a� Lot Size Grandfathered: ❑Yes ❑ No If yes, attach suap'o"rting doc�urnenion. �i r_J Dwelling Type: Single Family 4a" Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes �o On Old King's Highway: L37;es -a-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 '`' M Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ 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 ��i� /'o G� ,�/ /�D� Telephone Number Address License# Dd 9 !� Home Improvement Contractor# Worker's Compensation #ag ,Z6 '9 e/ ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Yll SIGNATURE DATE AllzhZ ' FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: t FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL r PLUMBING: ROUGH FINAL r GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT t i ASSOCIATION PLAN NO. t _ v OWNER AUTHORIZATION FORM 1, pNl2 �1>tqto ` (Owner's Name) owner of the property located at 0- (Property Address) ,. • a lk- NA d Z Z (Property Address) hereby authorize ec ---r) O!° (Subcontra tor) i an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. Owner's ignat Date f E IVF= OCT " 9 2012 4 i i 10 Park-Plaza'- Suite 5170 -� Boston Massachusetts 02 116 Home Improvement.Contractor Registration , Registration: 153567 Type: Private Corporation Expiration: 12/15/2012 Tr# 206433 CAPE COD INSULATION, INC HENRY CASSIDY 455 YARMOUTH RD. ` t HYANNIS, MA 02601 .:Update Address and return card. Mark reason for change. Address' I. : Renewal `.' I. Enrploynrent �. I Lost Card to 1216 Urticcjl of suwer Affair- ' 13us ne. KcgriI uiou _ License or registration valid for individu! s:on!", HOME"11G1P 'b(% jflfi� jl`ja �ucaetla before the expiration date. If found return to: Registration: 153567 Type: Office of Consumer Affairs and Business Regulation Expiration: 12/15/2012 Private Corporation l l';rrk Plaza-Suite 5170 Boston,MA 02116 QF�' OD INSULATION, INC ENRY CASSIDY 55 YARMOUTH RD. `. . YANNIS,MA 02601 __ - ---------- ._.. Undersecretary t alid ith t si lure }- husetts-Department ul•Public tiafi n Boars! ill,Building Rcoulations and St:uW:u'dx' a Construction Supervisor License w • � Licen�t: CS 100988 HENRY CASSIDY 8-SHED ROW WEST XARMOUTH, MA 02673 Expiration; 11/11/2013 ( unuui•,i„u,.l. Tr#: 7620 5 ' f 1605 Cl tenth:4597 , ACORD,,, CCINSUL CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDOIYYYY, THIS CERTIFICATE iS tSsu) 0 As a MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLO7 0: 01 2 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY ANIICND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOY CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND 1 THE CERTIFICATE HOLDER. IMPORTANT:If file cerlif(cate holder ie an AbD1710NAL INSURED-t-e policy(ies)must be endomed.If SUBROGATION 18 WAIVED,subject to the terms and condltlons of the policy,certain Policies may ruyuhu sn endoreemenl.A Statement ph this certificate N I W cunfer rightsec It the Certificate holder in lieu of such endoisement(s). NriouucErt Rogers&Gray Ins. -So-Dennis NAME: Mar aret Young 434 Route 134 PHONE _ AIC No Bxl:508-760-4602 F E-MAIL !C No: 677.816.2.156 South Dennis, MA p2660-1Gp1 -MAIL '----- -- 508 398-7980 INBURERiB)AFFORDING CpVERA6E "-"-- -_.- WSUR6RA;Peerless Insurance NAIC0 INSURED 18333 Cape Cod Insulation Inc INSURERB:Evanston Insurance Company 455 Yarmouth Road INSURERC:Atlantic Charter Insurance ---— Hyaiini3,MA 02601 wSUREftD:Commerce Insurance Company �~34754 INSURER E: -- COVERAGES 0 ' INSURER F: CERTIFICATE NUMBER:. - 'PHIS IS TO CERTIFY THAT THE r�pLICIES OF wSURANCE I ISTEo IJCLOW HAVE BEEN ISSUED TO THE INSURED NAMED BOVE NUMBER: THE POLICY PERIOD INDICAT'EU. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AWFY or BY TIII POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. gERXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY'HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPEOFINSURANCE AODLSUBR POLICY P6LIIDE A GENERAL LIABILITY ruLtcr Nun+oER MMIOD/YYYY MMIODAYYY CBP8263063 LIMITS t MMERCIAL GENERAL LIABILITY 410112012 O4/O11201 EACH OCCURRENCE $100U000 CLAIMS•MADE ', X OCCURntlru°n�, R100UUU MEOEXP(Anyoneperson) $5OOO - PERaONAI,&ADVINJURY $1 QOOODO GEN'L AGGREGATE QATAPPLI&$PER; GENERALA00REGATE $2,000,000 POLICY P;rrjRO' [71 LOC C , PRODUCTS.GOMP/OPAGG $2 000 UUU Q AUTOMOHILELIABILITY i 12MMf3CKVMK COMBINED SINGLE LIMIT $ _ ANY Aura 4IU1/2D12 p4/p1/2Q1 .Eaaude»I 1,000,000 AlL OWNED .I SCHEDULED BODILY INJURY(p.,.p.on) $ _. AUTOS X• AUTOS X NON-OWNED BODILY INJURY(Per 3.0ideal) $HIREO AUTOS X AUTOS PROPERTY AMA -- ----- H X UMORkI,LALIAe p ---- OCCUR XONJ453512 4/01/2012 04/01/201 EACH E1(c�5y ilAa _ CLAIMS-MADE - 3 $1 000 000 DEC) X RETENTION 10000 AGGREGATE $1 000 000 _ C WORKERS COMPENBATION - ANDEMPLOYERS'LIABILIT`r WCA00525902 - 6/30/2012 06/30/201 X WCSTATU• OTIi. $ANYPROP(2IE7OR�pga NE ( �CUTIV&rY//�N - OFFICER/y in NH)Ej(C�U0 I IN I N/A E.L.EACH ACCIDkNT 1 000 000 (MnnUaiary in NH) L-�-.I Ityse,0encd0e under - E.L.DISEASE-EA EMPLOYEE $1 000 000 I DESCRIPTION OF OPERATIONS Uelow - ""' DISEASE-POLICY LIMIT $1 000 000 - • t • - DE6CHIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Ar(aah ACORD 101,AddIII.—I kon—k.EGhedwg,It more gppog to raglgr6B) "Workers Comp Information " Included Officers or Proprietors Certificate Holder is included as an additional insured I-III Ganeral Liability when required by written ,ontract or agreement. CERTIFICATP HOLDER -- CANCELLATION Cape Cod Insulation,lnc SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 6E CAN CELLE[16EF O 'TH E_ f_XP1RATlON DATE THEREOF, NOYICE WILL BE IN DELIVERED IN A000RDANCE WITH THE POLICY PROVISIONS. } AUTHORIZED REPR@SENTATIVE ACORD 25(2010/05) ®198 -2010 ACORD CORPORATION,All right,9 Teseryod. M3849IM83848 1' of 1 The ACORD name and logo aru registered marks of ACORD A MEY -h- The Cornrno,;;; , „.![h of Nlclssac6�tus'etts Ueparaitem y r„thistrial Accidents ij rrvestigcttions _ --= 600 ti iogton Street 1'.goVIdi(I �V( ticL• l•'S C r l 111 )l.. ll 'Jcltlllll 111 -. 1 Jtll aut.e Att+.,.., .;. llutlders/(;ontl•acWrs/.�,keel.rlclalls/.1'{ut'l.>il►c�r \I;I;lit•�lut lnflrrlllatit.►u - Please Print Legibly •\,!!,L: .,I;usiutas/l)rg c i�tni.z. ttit)tt/InCiividuzll): � ' / ( t YqC ,J ItA— —_ _ ----- — — ` 1 hone#: � ,fir' ;� �I i�i t t uu au culpluycC! (.'heeler the nllpruprittle box: _. - .-----.__.._...._......._ i TYPe of Project (require(l): , I alli tt ru,pluytr with l am a uRCI'ftCCUr and I 1"lilV4' F. --- _ tl• New cunstrnt taco ru:iilu}t:c: (Dull and/i.,l`t) lit-tirnc)." hived il,: .i,i. ,,uuractorS listed oil 7. Remodeling the ami,i,..•I .Ir.:aj I an: :, ;t.,lc pruprieatar of l)art'ncrslrip These:;lii— -:�t; ctors have 8• ❑ De olitit.)41 - 1 have: nu cu,l:>loyecs working for employs. .: :,I have workers' comp. 9. Building adilitiuu ntc nI tu,}' capacity. [No insural)r; utul) ut.�urunt:r, rr.c uircicL to. Eil C[rtCal t'Cl)illl'ti Ur ildtllllUllJ ' l 1 S. We arc:;;.:,;,;cation and its Office',,,11: ,, : ,cicised their right of 11. E] 1'lurribing repairs ur addilivas L....� I:un a htnucuwuer cluing all work exem oil MGL c. l52 (4),and 12. Roof rel:)ait:s inyxa( I N„ wot kc)s' comp. we have iployees. (No workers' 1 ut;uuu, c tr.tutrctl.I .r 1 comp. tu,�.i �:,,.�requiretl.l 13. Otlicr 1C F :."PI)II a1u thnt Chucks box Ill rtiusi also fill out the section below shr:.;:i•ik,it worker'compensation policy inforrnatiorh. - ----- �— iiutc,:v:rtcn .,dl,ut.unrt this aCl'idavit'indicating thry tu'c doing all V.•in 1.t::::::i:,n hiro OUISide gOnn'tlCCO,'s must submit anew affidavit indicating such. u.ri,.n,that rl,rck th,s box must attach an additional sheet showing ti:, ::::.,of the sub-contractors and state whethar br not Chose etttit'ies have.euipluyres it. " :ua,ata�harvc cti,ployc", they must ptovidc then workats'couq: I:,.i�,, uutnbcr. !,lilt lilt employer that is providing workers'eompensation it/.,,:,,mc'e for my employees. Below is tiie policy aril job site — ut/ur'uuUiurt. , h�,ta :ir.r t.'iuul,any N<irnc: ;� V \ I �� l' I tx YtC.-.� (___Q • � !I,,I .�cl f-uls. I,it:. ll: A L/ Expiration Ditte: :5� City/State/Zip: t Ili,h ,rup,y of the workers' cuutpensatiuu policy declaration p:,g, i:i,:,clog the pulley number and expirtition date). -----'rcduircd under Section 25A of MGL c. 1,:...:1:16,id ro dtc irnposilion of criminal penalties of a fine up tvFC :41,500.uU atitvut%01 [it'll'isuutncnt, its well as civil penalties in the form of a ST•l)p 1c,,It h:ORDER and a fine of up to$250.00 a day agi iusl like viihlah)r. be;ulvtsed _- p, t f tlua atalc,ncut that c forwuriied to the Office of Invcsu,i;.:,,. :,„i ttte ll1A fur inswance covcrude vcril'icatioti. 1 du item c if antler the r arts and penalties of p, .Purl,that the irtformation provided above is true brut eorreer.. ' • _ . ..-.. Dote:- _ l!(lirutl u,c(mly. Uv rtut write in this area, to be complete,/ov,,at,oriown official ° I 'it or foml: y___.. I''crtnit/License# I l�suiuf :luthurity (care let lle): 1. lk,ard lit klealth 2. Building Dcparttrimt 3.City/i,i,t:I (Jerk- 4,Electrical lnshectol• S. Pitluubillg 111spec:tor Phone#: TOWN OF BARNSTABLE Permit No. _-___----.- { sm Building Irspector Cash OCCUPANCY PERMIT Bond --------------------- r Issued to Alan Small Address 'In ,.a Prvi 1 l r. Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department 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. ' ................................:................... . 19......_... .............................................................................................._.............._ Puilding Inspector 51►.161t FAMILY - '�LgErOROOM �: w -� WtO CARB�►GE (�RItJDEs1a a"� 't`~` uoW , a 110K 3Z 3306.Pp° SEPTIC, TANK a3ox�� . • . USE- 100o GA►.. « F t o 0 0-.GA1.: 0%,SP03AL PIT VSEv -yz 5►Dr.VIAL L. ARGA s 1 PO 4 A ' � ' a" � §'� 61, E , �13G•3` �' � a � ' � � f ►5o s.1= X ,1•5 � 3?5Wme9>. A • o ¢ � 4 3 4 't, S -TcTA L. 0 V51GN . 42 ar " ;lea ' *Y j ... ` •; i ; 6 TOTAL PA 1WY. FLOW( = 330 G.PQ A PE 2 co1-ATIOW RATE 14 11!•t ZM N �• i v {d q O �,yptN OF y O ALANo.24048 FaCHARD 10 MAL ao_y/LA 14z; TEST P-(,22 F6 l !oo rG►' Gi q�n' INV.51 LDA� (A.00 Svio1L. �sT iNJ. SvT c c �g'6 •" o` ,.� Z (oov k tN� aK 5a.6 Te►NK ,.. h' rg'�p. f � . 5AA�`I LE�►G�I.. INY• INY ' s• ` i I'/3/9'I�i ,•v �I�Dr Sam ...+(•�.-- C�' ---�1'�- t k .. , • i -CE2TIPIM.P. pi oT PLAN. P SZ.o F I L6 4i3 N o 5 GALE .5 G ( �� 10 D_r P.T lo-'ra Qo WATE`IZ N REF:62EN C& 1 GE aTIt=Y TNAT '�H� 1'Ot�F.)t'7ATID�ISN01tYN WzraoN GOMPLYS VJMA'TH1z Lor AWO -$ETbACY, i�.6QVIREMfzN'f� F'C11F` �t-1,�TEQViLL� UIdwi4LA6tD'4- i -(o W N G P IC?: Ili' R�lO AND 16 {�0'�-' �Ocp.TED •WITHIN T 6 {rLooD �.A.11� _ .. ,' DATtr ID` Q I3AXTEtZ hIYE INC. R.�c.G I STfai�6'D 1J111 O S u my itYoe,5 � 1a N osrE¢.V11.LFs • �AP35• Tuls Pt.aN 1 .� Nod• 8A56o o A Iu5TRufAeW i' 5ue.vr_-Y -TAS oF95ET-5 6VOUO � -I 1 ^-r rbr- y�C.D TGO DGT�c•.MI►�C__�.�T �.1t�G�� APPI-IGA/►1T AAQ E- 'jMALJ_. Assessor's.map and. lot number r ` ` � t q0u .�OFTNET01` r F Sewage Perrffit number ...... < ... d..t'3` ,[�qy}��y q��u,�(g�, •'U•. 1, • �c 5 I p 6e r; 11AUSTLU • ouse -number .. .�.. ........ ..... ..: _ �1.:' ;k sasaa ' s Ob tb 9• " t fl, . ' � � w Raj '�- ,�,"+�"I<,.P►��F �'0 YPY d' .,• WN ;0 ,-1- B A 1�.l S T A - _ . . ►[ l tJa I ~I UILD1 G . INSPECTOR . c ' l E: IRI? 1CT10�=''F ;PERMIT T6 .7 ...TYI ®Fl. �r fa ...... ..... .... .. ......... ......... ................ -6...?.............19,� t' TQ T-K1INSPECTbR,.OF BUILDINGS, t i' They'- ders.igned ` erreby applies for.a permit according•,to'the following mfocmatior> Logatiorr b.. '�,: ........ : s` .. .................... Propis�d Use ........................ r ... .......................... � I sr ! t t b Zoning, District .................................... .. .... . ..Fire District ... ................................. Name-of Gwaer-.... ... .r... .......... .............................................Address ......... . . . ................ Narne ®f ,,Builder,'�..... .................................' s .9. . Address ..................... ... .................... ` Name of Architect, . ...:..... ..... .1....._...A....... ,..�.i�.......�c it`s ......... i �:4:. Number of Rooms ..... ..... ......`.. 11.4t .....Ka. . .�Four�datlori ... ..... ..........L................. ....... Exlerior .. ... :........ :>tl,i-,.�. Rofng 1 A;, r., ,............... ......... Floors .......U "`..... .............................. ...................Int6ior .......(... ... . ...... ................................... ' 1 i a. "7 zg Heating .....�..... :... ........... ........................Plumbing ......................./` r j.4. �. ....... Fireplace ..............................................Approximate Cost ( �, ............................... Definitive Plan Approved by Planning Board ---------1.9 : : Area '' --... ........ . ...� g _ i ............ Diagram of Lot and Building with Dimensions. e' •• .... t; ! .� r 1IV - Slll<;JECT :T.O AAPROuAt<,OF BbARD7C� A€ALTki ! ;"I. T. . OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regar ing the above construction. Name�r'.��kl . r , SMALL, ALAN a r+ 24'�5 , One Stor to ...... Permit for ... ... Y......... Single Family„ Dwelling,,,,,,,,,,,,,, 4 ' Location „Lot 5/......1 Arx'Q pwIand Rd. .............CenterVl1, S,................................. Owner'...Alan,,,5ma11 tType of Construction. ......F7 AMe........................ X s _ Plot .............:....... ...... Lot .. i Permit Granted October 29, 19 82 . -. ...................... = - - Date of Inspection.....................................19 Date Completed r...`yam..... ....-4.f............. lw'0j,e . No 75-0~a t.vs✓P Assessor's map and lot;number . .d... /j... f• NE .�.. Sewage Permit number ................................. :...,.......a?:4::`.''''.:. c � •1•�,f•• � DADd9TA8L i House number ..........._ ............ J• ., 2............................... rues 1 i639• T ` WN OF BAR NSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ... ..� .... __. TYPE OF CONSTRUCTION ...... 1911 .. TO THE INSPECTOR OF,BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ... �...... u'...... ......:r�.... `...... ...........:: :7..! �cr::•l ' �� 1y{��� ...:........................... ProposedUse ....... ..t ......... ... ... .................................................................. ......... .. ....... ........................................ Zoning District ........... ..................................Fire District ...................... .................. .. Name of Owner ..........c.f <�2r ra'r �- / / ........................ ..:.............. ..... ...............................Address .........1.. ....... , Nameof Builder. ............:.......................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ......_/.......................................................Foundation .. �t'`f _:``.:. .': �`................................................ Exterior ........: :. ' . ...............................................Roofing ...... f .:� ::! .. ................................. ........ . . Floors ...... .yam ............................................ .Interior ref "1f. l ::.....� .........................I............... Heating ..... ...............:..:......:................................................Plumbing ........... . ........% ......................................................... Fireplace .......':'�.t::ffu.........?."`...............................................Approxi ..............�� ...:f ..�.............. ..... . .. mate Cost • Definitive Plan Approved by Planning Board ---------------_—-----------19_______. Area €-r 3 .......................................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH t f t 5 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 ......................� . ... �<r.�z..(....�................. SMALL, ALAN A=171-238 No 24503 permit for One Story Single Family Dwelling Location Lot #5 195 Ansel Howland Road ................................................................ Centerville ..... .................. ... ...... Alan Owner Small— .. ......... ................................... L- Type of Construction .......................................... ................................................................................ Plot ............................ Lot ................................ Permit Granted October 29, 19 82 ................ Date of Inspection ....................................19 Date Completed ......................................19 k-r