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0038 BACON LANE
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'fyf 7 `y !' a # `�� 1' �• � 4 t f' j ,� �. i �. r ''r t< S ' n5 f I !1' p: � M�� 'F } ) J... ?t ''��r • R r t f r, jr ! } +• s i :JJf; :l` tr a " t 3tt t , /t'��;f r ;� a t y•�- rp I 1 'j a, t' -{ ; {}.4 ! >,{I �,�' :i t.�': 'r, f fr � ,7, •� , ,! '' V: I I, d�('t...r hh� Eil .,,i' '"'1. J if i ,f�Y }, F i k.. !w: A• f� D: .. f1• � �} 7 t. 9.. P iti' `r �'� � : ,.� ,If �` 1� `,�r �,. 1,�� ( `#' *r i" `f'�' GN�It'G: 1 .{ ,:� '• `t t�� �. r s 1. 9 )�� f ti � � 3 ¢: k ,�'t , a� ',. fti{ S 1,�' v' t �,. ,y,r., A'�r .S'• l? `'i,1z :�n �' - 4>1 � el. p 1.• 1 ;FP 7 , i , .I 7+ 6 C �-: t G' .1.`r � - f' ,f • •f' � t i. . - 1 :1' t • q� i , '' ,i ) , YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$3 3.00 for-4 years). A business certificate ONLY REGISTERS YOUR NAME.in town (which you must do by M.G.L:-it does not give you permission"to operate.) " Business Certificates are available at the Town Clerk's Office, 1"FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) Fr,�+ ZI! DATE: 2.J 22 12 C?l U Fill in please: c i tix 3a APPLICANT'S YOUR NAME S: ¢ r. frf BUSINES As S YOUR HOME ADDRESS. f} C otv 1 A [=z �, TELEPHONE # Home Telephone Number. 3 qS CG La S NAME OF CORPORATION: NAME OF;NEW.BUSINESS 6 t kks 5 —::(n�eZ IS THIS A HOME OCCUPATION? YES ND TYPE OF BUSINESS'' l�— ADDRESS':OF BUSINES9_.3i 31f d1�1.i_�4n, crfln�'6� 2 _EEn�; Ru'I�Lr�: MAP/PARCEL NUMBER :_ C� . (:Assessing) When starting a new business there are several'things you,must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. MUpST COMPLY WITH HOME OCCUPATION 1. BUILDING COM 10 R'S.OFFICE RULES AND REGULATIONS. FAILURE TO This individua h be infor_me an, p rmi requirements that pertain to this type of busir�aOLVIPLY MAY RESULT IN FINES. uthorizsd-Si to e**... CO ENTS: It AV V 1 2. BOARD OF HEALTH This individual has,been informed of the permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of. business:`' Authorized Signature* COMMENTS: r Town of Barnstable Regulatory Services OFtHE 1p� P` o Thomas F.Geiler,Director Building Division * BARNSfABLE. ye MASS. g Tom Perry,Building Commissioner "Op 1639. A�0 s , r 200 Main Street Hyannis, MA 02601 ED MP Y www.town.barnstable.ma.us Office: 508-862-4038 Fax:. 508-790 6230 Approved: Fee: o7S. — Permit#: can 00 C HOME OCCUPATION REGISTRATION Date: 2 .1221 9 O 1 f7 Nance: I L N s t=(�-E R ' A l E-P l E R R E Phone ff: J 3 95 66 Address: 3 $ A C ow GA-/U E ` - Village: ( Eltn-e R U1 L Name of Business:_ _ LLE � �Z---- P----------------------------- '--------- Type of Business: Cc_)N c y L-'i^i !\1 Map/Lot: A _.� INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation . haithin single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity sliall not be discernible from outside the dwwelliug: there sliall be no increase iu noise or odor;no visual alte►ation to tlhe Premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation sliall be permitted as of tight subject to the following conditions: • Tlhe activity is carried on by the perniauent resident of a single family residential dwelling unit,located within that dwelling unit. Such use occupies no more.than 400 square feet of space. • Tliere are no external alterations to the chiselling which are not customary in residential buildings,and there is no outside evidence of such use. • No traflic will be generated in excess of nomial residential vohunes. • The use does not involve the production of offensive noise,vibration,smoke,(lust or othher.particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • 'There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of nornial household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not mthin the required front yard. • There is no exterior storage oi•display of materials or equipment. • There are noncommercial vehicles related to the.Customary Home Occupation,other than one van or one . pick-up-truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in lengtli an(1 not to exceed 4 tires,parked on the.same lot containing;the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary.Home Occupation is listed or advertised as a business,the street'address shall not-be . included. ;;v • No personshall be employed in the Customauy Home Occupation wlto is not a pernhaueut resident of the s dwelling unit: I, the undersigned,have read and agree i6th the above restrictions for ray home occupation I auu registering. Applicant: t-�4 r' i e orrR 1 L_L G-N Date: 2 2-12 C'10 Homcoc.doc Rev.01/3/08 - i � 1 oEt r Town of Barnstable *Permit# �{ EYpires. wnthsfro . ' le date Regulatory Services + BARNSTABLE, v M^ Thomas F. Geiler,Director �pTEo��A'� ��ylyd�Ae- Building Division I -PRE S F u rry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 2 o-� -- ----------------------------------=------------------ --wwwaown.barnstable.maus _ Fax: 508-790-6230 Office: 508-$ 80F BAR q� EXPRESS.EI�T APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 2—c-f-2 O L 0 Property Address 3 3 CC-a. v c c i t A •.E9 Residential Value of Work 60 Minimum fee of$2S.00-for work under$6000.00 Owner's Name&Address 1ti E • Contractor's Name a r 7 n,�ns Ceti S't.rive Z Io dj Telephone Number Home Improvement Contractor License#(if applicable) '7f;L7/7 5 9 5 Construction Supervisor's License#(if applicable) r7 19/Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ Lam the Homeowner Y1 have Worker's Compensation Insurance Insurance Company Name Yx�sz v-v-\ W.orkman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(stripping old shingles).All construction debris will be taken to Re-roof(not stripping. Going over existing layers of roof) Re-side.' #of doors [✓Replacement Windows/doors/sliders.U-Value (maximum .44)#of windows_ *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 t-t e` ome Imp vement Contra-tors License& Construction Supervisors License is requir d SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doC nQOROQ - ® 0 i � r 508-323.1635 --- -- ------SPECIALIZING-IN-ALL--FORMS-OF ROOFING--- doyle-thomas@comcast.net (508) 328-1635 P.O. BOX 168 . Fully Licensed '& Insured CENTERVILLE, -MA 02632 LIC# 145954 the following work: Doyle and Thomas Inc. Proposes to perform g Location of proposed work: Mr. &Mrs. Mandavi 38 Bacon Lane Centerville, Ma 02632 Date on which construction should begin: February 2010 The homeowner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that cannot be avoided by the contractor shall not be considered as a violation of this contract. The contractor agrees that when such delays become known to the contractor,the contractor': _will advise the homeowner as soon as possible. The homeowner hereby acknowledges that in certain remodeling work,the demolition process may reveal defects in the existing structure which must be repaired,creating additional work which may need to be carried out in order to complete the work described-in this contract.—In such case the. -- -- homeowner agrees that the duration of the work and the schedule date of completion may differ,and that such variation is not to be considered a violation of this contract. The total cost for labor and materials under this contract: Clapboard &-Paint for the back of the entire main garage '$4,543.63 Install of 6 Andersen windows (400 series) $3,618.30 . Thank you for Giving us the Opportunity to. Help You Improve Your Home In the event that while stripping the siding we find rot that needs to be replaced,the homeowner then has to agree and authorize any replacement or restoration. Then in addition to the above contract price,the homeowner agrees to compensate the contractor for any repairs or restoration at the hourly rate of$45.00 for a carpenter and$30.00 for a carpenters laborer, plus the cost of materials. -Siding to be stripped and cleaned of all old siding and debris -Siding area to be papered with tyvek house wrap -Replace rotted trim and corner boards as needed -Install of Andersen double hung windows to include exterior trim (7 Total windows) -Install,of primed red cedar clapboard on entire back of garage -10 yard container will be needed on site;and will be removed at completion of the job -Contractor will be responsible for all building permits needed at the property NOTICE REQUIRED BY LAW With the , agreement of the contract$3 000.00 of estimate is due. g Further payments under this contract are as follows: -- ------------------Balance-of all-materials-and-labor shall be-payable in full-upon-completion-of.work-described-.in this contract. Payment as agreed upon shall be made when due. Any payments which are delayed shall be subject to a finance charge of 1.5%per month.The contractor warranties the workmanship completed under this contract for period of five years from the date of completion. — During the stated warranty period the contractor shall be responsible for the service of the repair or adjustment, but the contractor shall not be responsible for the normal maintenance,repair due to abuse,misuse,and or normal wear and tear,which shall be the responsibility of the homeowner. All warranties for the materials supplied by the contractor shall be passed directly to the homeowner. The homeowner may be required to register or mail in such warranty card or evidence of, ownership in order to activate such warranties. Homeowner failure shall not create any responsibility ..for the contractor under the warranty provisions;the choice of repair of replacement shall be at the discretion of the contractor. The homeowneracknowledges that the form,content,and..notices contained Ill this contract are intended to comply with the applicable portions of the Mass.General Law Chapter 142A, and regulations promulgated there under. In the event of any instance of non-compliance,only such portion shall be invalid and the remainder of this contract shall be in full force effect. In addition,any such portion not in compliance shall be read and interpreted so as to have its intended meaning to the maximum extent allowed under such law and regulation. Signed as a sealed instrument on this date: Dater / ply Homeowner Contract NOTICE REQUIRED.BY LAW ' With the agreement of the contract.$3,Ooo.00 of estimate is due. Further payments under this contract are as follows: Balance of all materials and labor shall be payable in full upon completion of work described in this contract. Payment as agreed upon shall be made when due. Any payments which are delayed shall be subject to a finance charge of 1.5%per month. ' The contractor warranties the workmanship completed under this contract for a period of five years from the date of completion. During the stated warranty period the.contractor shall be responsible for the service of the repair or adjustment,but the contractor shall not be responsible for the normal maintenance, repair due to abuse,misuse,and or normal wear and tear,which shall be the responsibility of the homeowner. All warranties for the materials supplied by the contractor shall be passed directly to the homeowner. .The homeowner may be required to register or mail,in such warranty card or evidence of sibility ownership in order to activate such warranties. Homeowner failure shall not create any respon for the contractor under the warranty provisions;the choice of repair of replacement shall be at the discretion of the contractor. The homeowner acknowledges that the form,content,and notices contained in this contract are intended to comply with the applicable portions of the Mass.General Law Chapter 142A, and regulations promulgated there under. In the event of any instance of non-compliance,only such portion shall be invalid and the'remainder of this contract shall be in full force effect. In addition, any r` such portion not in shall be read and interpreted so as to have its intended meaning to the maximum extent allowed under such law and regulation. l i; x Signed as a sealed instrument on this date: Date: Homeowner Contract r T o: 15087906230 sr 12:09 From:MARK SYLUTA INS 5084209227 DATe(MMIUUIT T) ' PC -` J D AEI T'fFICATE 2009 OF LIABILITY I NSURANCE 081031 THIS CERTIFICATE CONFERS NO RIGHTS U IS ISSUED AS A MATTER HE C RMATION ON R efial# 46 , ONLY -AND PON 7HE ERTIFICAT S 1038 ,., MARK SYLVIA INSURANCE AGENCY . HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 771 MAIN S"fREET ALTER 7HE COVERAGE AFFORDI=D BY THE POLICIES ELOW- OSTERVILLE,MA 02068 NAICFF TEL: 608,428,4440 FAX: 6OR-420.9227 INSURERS AFFORDING COVERAGE "' - ., lN9URER A FARM FAMILY CASUALTY INSURANCE CO IN$ I2Fi•1�` INSURER D; DOYLE 8 THOMAS CONSTRUCTION INC. P0.BOX'108 INSURER C•: I INSURER 0: CENTERUILLE, MA 02532 . wsvarR c covr:RAaEs ITHSTANDINQ 'Tr(f°POl.IC1E6 OW;INSURANCE°LICTf?D t3ELOW HAVE!BEEN ISSUED TO TWE INSURED NAMI'_D ABOVE!f70R TMG POLICY Pl°RIOD INUICATL'D.NOTW ANY REQUIREMONT,TERM OR CONDITION OF ANY CONTRACT OR OTM6R DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED'OR •MAY'PERTAIN,THE INSURANCE'AFFORDED OY THE POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF 6UCM POLICIES,AOWREmATO LIMITG SHOWN MAY HAVE BEEN RBDUCED BY PAID CLAIMS F. T p L oY x T N LIMIT5 tN: TYPG OP INSURANCE POLICY NUMDRR EACH OCCURRIINCE � 1 000 000 ' :6UNSRAI.LIABILITY A 0 iL 'MD q 50,000 07/21/2009 0721/2010 L---5,000 A I X COMM,RCIAL OL!NLTRAL LIABILITY 2001 XOQ85 IVIED BXP An tine mraan -- Chf11M)?MADI"a OCCUR prRf3QNAl_R ADV INJURY 6- CiRNIIRAL AGGRIiOATC 6 2 OOO OOO PRODUCTS-COMPIOP AGG b 2 OOO OOO EjE.N'L AGGRDGA`i'0I,I1,4I F APPI-IFS PaR X. POLIOY P LOC COMDINGD BINOLF,LIMIT & AUTOMOBILE LIABILITY (Ea 000idonl) ANY AdTD DODILY INJURY g ALL OWNED AUT06 (Par Pamon) ACHCOULCO AUTOLi OOOICY INJURY ; s HIR(31 AUTOS (Par ancidonq .' NpN-OWNED AUTOG P OPERTY DAMAGE g (�or eaoidonU. AUTO ONLY-AA ACCIDENT (..... .... . aARAn!LIABILITY 'EA ACC 6 ANY AUTYJ OTHER THAN. AUTO O14LY IJLY ACiO 6 ....... ..... CACPI oCDLIRRIZ t L'XCE66NMBftgLLA LIABILITY AGORI3GATE 6 OCGUIZ CLAIMS MADL' ! DE]DQCTIDL(9 C i IRITfBNTION S �( 0 UIORKIII"COMPENSATION AND 2001 W6390 07/01/2009 07/0112010 500 000 GL GACIi AGCIDfaNT 6 RMPLOYCRW LIABILITY 500,000 ANY PRQPRIMQRIPARTNCRn:XCCUTIVP_ EL 01fiI ASF•f A EMPLOYER: 6 50O OTC OPFICL•RIMEMIN5R I"rXCLUDGD? Y S ry,.OICf At9[+•POLIOY I-IMIT 6 II yao'da6eribe undnll )SPQLIA PROVIEIO S Below 'OTHER. ' � .._—• bt3 ORIPTION OP OPCRATIONSILOOATIONONBHIC4i35IE3XCLV610N8 ADDQO pY 6NDORBl3MDNTIBPQGIAL PROVI810N6 P CARf?.ENTRY Lt.r f� WN DOYI.E� d THE WORKERS COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR TROY A THOMAS, SHA P' M3 CERTIFICATE HOLDERCANCELLATION ,,,,•,• ,.. GHOULD ANY OF THQ ADOVG OnCRIBGO POOCIDE1 00 CANC'BLLEP BE3FORPTHE UCPIRATION DATI3 THf. GOP,T),I�IB9UIN0 INGURCR WILL EINDEAVOR.TO MAIL DAYS WRITTEN TOWN OF BARNSTABLF_ NOTICE'O 'HI3 CGRTIkATE HOI,DCR NAMPD'f0 THD L@PT.BUT'PAILURE 70 DO GO SHALL BUILDING DEPARTMENT ATTN SALLY. IMPOP•N 0ILIGTATION OR LIAOILI' P ANY ND UPON TI,IC INBURGR,ITS AG[N'fG OR HYANNIS, MA 02601 Rr:P ,rr T �' FAX1 508-790-6230 JSD ALIT RIZ e v E10 A RD CORPORATION 1888 ACORD 28.(2001108) The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations x, z 600 Washington Street /1 Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly f Name(Business/Organization/Individual): Y Address: City/State/Zip: v.r�z eA �J Phone#: Are you an employer?Check the appropriate box: Type of project(required) 4. E] I am a general contractor and I - 1:0'`I am a employer with y 6. [�New construction ' employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have g: Demolition working for me in any capacity. employees and have workers' comp.insurance.: 9. 0 Building addition [No workers' comp. insurance p ] re uired. 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions q - , 3.0 1 am.a homeowner doing all work officers have"exercised their 11:❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. oofP re airs insurance required.]t c: 152, §1(4),and we have no employees. [No workers' 13.D Other comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. TContractors that check this box must attached an additional sheet showing the name of the sub-contractors and'state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic. -i .. Expiration Date j, Job Site Address: f 5��;9 �,,n ' City/State/Zip: M ..' Attach a copy of the workers'compensation policy,declaration page(showing the policy number and expiration date).. Failure to secure coverage as required under Section 25A of MGL c..152 can lead to the imposition of criminal penalties of a_ fine up to$1,500.00 and/or one-year imprisonment;as well as civil penalties in the form of a STOP WORK ORDER and a fine" of up to$250.00 a day against the violator. Be advised that a copy of this statement may forwarded to the Office of Investigations of the.DIA for insurance coverage verification. I do hereby eertify.:under the pains and penalties of perjury that the information provided above is true and correct Signature. Date: 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): ' Board of Health Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other . Contact Person: Phone#• I � ,. . ;. �\ Board of Building Regulations and Standards License or registration valid for individul use only � 71 HOME IMPROVEMENT CONTRACTOR before the expiration date. if found return to: 1 7 s Registration: 145954 Board of Building Regulations and Standards Expiration: 3/15/2011 Try# 282668 One Ashburton Place Rm 1301 Type: Private Corporation Boston,Ma.02108 'DOYLE+THOMAS CONST INC TROY THOMAS —_�,✓ 499 NOTTINGHAM DR CENTERVILLE,MA 02632 Administrator Not valid wit out signature * Massachusetts- Dep:u-tmcnt (it,Public SarctA Beard of Buildin- Re-,nations and Standard. Construction Supervilsor Specialty License License: CS-SL 999t3 Restricted to: RF,WS - TROY THOMAS .499 NOTTINGHAM DRIVE { CENTERVILLE,MA 02632 ' Expiration: 4/13/2012 t , imni•<i ncr Tr": 99913 � f 4, k Town of Barnstable Permit# Expires 6 month fr sue to Regulatory Services Fee i65¢ , PERMIT Thomas F.Geiler,Director 9 2010 Building Division °®�� Tom Perry,CBO, Building Commissioner OF Bi RM,91ABLE 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press linprint Map/parcel Number V Property Address D Residential Value of Work � i . Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address 17jAyt• r"4: y) Contractor's Name Telephone Number - Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) i/ems orkman's Compensation Insurance - Check one: ❑ I am a sole proprietor ❑ I am the Homeowner P-1 have Worker's Compensation IInnsurance Insurance Company Name J "-r✓1 6"� /!�, � i, Workman's Comp.Policy VJE Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) l�C� d'e Ce dSte. ❑,Re-roof(stripping old shingles) All construction debris will be taken to tt'Cv ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.44)#of windows *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 C:\Users\decolliklAppData\LocaiNicrosoft\Windows\Temporary Internet Files\Content.0utlook\4STGU5QO\EXPRESS.doc Revised.090809 NOTICE REQUIRED BY With the agreement of the contract$3,000.00 of estimate is due. Further payments under this contract are as follows: Balance of all materials and labor shall be payable in full upon completion of work described in this contract. Payment as agreed upon shall be made when due. Any payments which are delayed shall be subject to a finance charge of 1.5% per month. The contractor warranties the workmanship completed under this contract fora period of five years from the date of completion. During the stated warranty period the contractor shall be responsible for the service of the repair or adjustment,but the contractor shall not be responsible for the normal maintenance, repair due to abuse,.misuse,and or normal wear and tear,which shall be the responsibility of the homeowner. All warranties for the materials supplied by the contractor shall be passed directly to the homeowner. The homeowner may be required to register or mail in such warranty card or evidence of ownership in order to activate such warranties. Homeowner failure shall not create any responsibility for the contractor under the warranty provisions;the choice of repair of replacement shall beat the discretion of the contractor. The homeowner acknowledges that the form,content,and notices contained in this contract are intended to comply with the applicable portions of the Mass.General Law Chapter 142A, and regulations promulgated there under. In the event of any instance of non-compliance,only such portion shall be invalid and the'remainder of this contract shall be in full force effect.. In addition,any such portion not in compliance shall be read and interpreted so as to have its intended meaning to the maximum extent allowed under such law and regulation. Signed as a sealed instrument on this date: Date: Homeowner . Contract v✓ I 508-328.1535 SPECIALIZING IN ALL FORMS OF ROOFING & SIDING doyle-thomas@comcast.net (508) 328-1635 P.O. BOX 168 Fully Licensed & Insured CENTERVILLE, MA 02632 LIC# 145954 Doyle and Thomas Inc. Proposes to perform the following work: Location of proposed work: Mr. &Mrs. Mandavi 38 Bacon Lane Centerville, Ma 02632 Date on which construction should begin: End of January 2010 The homeowner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that cannot be avoided by the contractor shall not be considered as a violation of this contract. The contractor agrees that when such delays become known to the contractor,the contractor will advise the homeowner as soon as possible. The homeowner hereby acknowledges that in certain remodeling work,the demolition process may reveal defects in the existing structure which must be repaired,creating additional work which may need to be carried out in order to complete the work described in this contract. to such case the homeowner agrees that the duration of the work and the schedule date of completion may differ,and that such variation is not to be considered a violation of this contract. The total cost for labor and materials under this contract: Red cedar roof of the main garage $8,172.05 Thank you for Giving us the Opportunity to Help You Improve Your Home OAUG-03-P,009 12:09 From:MARK SYLVIA INS 5094209227 To: 15087906230 P.1/1 DATE(MMiuurr T) ® ACORD CERTIFICATE OF LIABILITY INSURANCE 08/03/2009 PRoIaUCC'R ...... Serial# 103646 THI5 CERTIFICATE IC ISSUED AS A MATTER OF INFORMATION ® ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ® MARK SYLVIA INSURANCE AGCNCY HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 771 MAIN STREET ALTER THE COVERAGE AFFORDED BY THE POLICIES EI.OW- OSTERVILLE,MA 02068 NAIC4 TEL: 808.428,4440 FAX: 509-420.9227 INSURERS AFFORDING COVERAGE INf:tUI�EI? INSURER A FARM FAM14Y CASUALTY INSURANCCO DOYLE 8 THOMAS CONSTRUCTION INC- INSURER B: P0.BOX'1 fib INSURER C: CENTER;VILLE, MA 02532 INGURFR 0- INSURER U COVERAGES THE POLICIES 019*80RANCE LISTED BELOW HAVE'13QEIN ISSUED TO THE INSURED NAMED ABOVF FOR THG POLICY PERIOD INDICATQD.NOTWITHSTANDING .ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHCR DOCUMI?NT WITH RSSPEGT TO WHICH THIS CERTIFICATE MAY DE ISSUED OR MAY'PERTAIN,THE INSURANCE APFORDED OY THE POLICES DESCRIBED HEREIN Is SUBJECT TO ALL THE TERMS, BxCLUSION8 AND CONDITIONS OF SUCH POLICIES,AOOREGATC LIMIT:,SHOWN MAY HAVE BEEN REDUCED-BY PAID CLAIMS INt Of°INSURANCE' POLICY NUMDI3R 170, F' Y N L Y X Y N LIMITS aatlN9RAl.I,IADICITY EACH OCCURMINCD s 1 000 000 07/21/2009 0721/2010 A o x rrD s 50 000 . A X COMM*RCIAL UNDRAL LIABILITY 2001 XO485 $000 X OCCUR MFD aXP An one mrann L C1111Mt)i MADG PRR 7oNAL R ADVOINJ $ OInNCRAL A013RIiS 2 OOO"0 6EN'L ACIGkIdA'Q I,IMI'(APPLIF4 PER PRODUCTS.COMG 2 OOOOOOLOCAUTOMOSILB OApILITYCOMt31NC^D BINOLf (6a oaaidenl) ANY AOTO ALL OWNFrD AUTOU DODILY INJURY g (Par parson) DCHCOULCO ALIYOO HIRgIJAUT03 DODILY INJURY g IPar anaidanq .: NpN-OWNI;O AIJI'OG PppOPDRTYDAMAOLT g (pa'eom4onll AUTO ONLY-DA ACCIDf:NT ( GIARAO'e LIABILITY I'_A ACC $ ANY AUtYJ OTHEER N AUTO ONLY ACit3 $ PACPIOCCURRCNCL* RXCD66fUMI9RgLLA LIABILITY Occult CLAIMS MADE° AOGIRCOATE C DQDQCTIDL6 RB"i'ENTION $ C 07/012009 07/01/2010 X o WORKQR'S COMPENSATION AND 2001 W8390 500.000 RMPLOYCRS'LIABILITY PL GACH ACCIOIaNT $ ANY PRQPRIC70RIPARTNgRIQx[CU1'IVE FL OfL FASF•f A EMPLOYER. G 500 000 OPFICL=RrMEM13QR FrXCLUDGD� 5OO OOO II yy�ai dat<ar@e unddll YES G1.DICt:..ARE!•POL.ICY I-IMIT 6 IiPa IA .PROVIEIO :1 below _ r••.:-q Tf q'q IPTION OP OPOR.ATION3ILOOATIONDNgHICLi9BICiXCLU6IONS ADDM BY GNDORBGMnNTIBPQCIAL PROV1910N6 5 C'ARPEN.TRY u =f= TIHB,WORKER&C,OMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR TROY A THOMAS, SHAWN DOYLE- CERTIFICATE HOLDER CANCELLATION GHOULD ANY OF THr ADOVC DEuGRIBGD POLICIDD DG CANCOLLL'D BeFOPMTHC EXPIRATION DATE THG EDP TIT t891JIN0 INGURGR WILL IINDEAVOR TO MAIL DAYS WRITTEN TOWN OF BARNSTA9LF NOTICE O 'HI]CrRTIFICATE HOI,DCR NAMCD TO THO LHFT,BI,I1'FAILURE TO DO 00 SHALL BUILDING DEPARTMENT ATTN SALLY IMPO N 0 7uG1ATION OR LIABILI' P ANY INI)UPON TI IE INBUIiGR,ITS AGEN'fG OR HYANNIS, MA 02601 FAX1 508-790-8230 JSD LIT err T 1' ALIT RIZ L!, V A'GpR02E(2001)08) O A RD CORPORATION 1988 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lezibly Name(Business/Organization/Individual):..;, ;w icK: se Address: PO, &))z City/State/Zip: PA'A 6 S.;2 Phone#: A,rree,youwan employer?Check the appropriate box: Type of project(required): 1.k3 1 am a employer with_ 4. I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees . These sub-contractors have g. EjDemolition working for me in any capacity. employees and have workers' t 9. ❑Building addition [No workers'comp.insurance comp:insurance. 10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ ep 3.❑ officers have exercised their I am a homeowner doing all work 11.E]Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12 oof repairs insurance required.]t c. 152,§1(4),and we have no 13.❑Other [N employees. o workers . comp.insurance required.] *Any applicant that checks box#1 must also fill 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. lContractors 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 my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: cif! Expiration Date: Job Site Address: S City/State/Zip: 1 ' Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,-as well as.civil penalties in the form of a STOP WORK ORDER and a fine of up to.$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Si •� Date: Phone#: 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): 1.Board of Health 2.Building Department 3.City/I'own Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: -- --- - ✓1e �o�ninwnrue� ,� �'��z;.�uccLzuaP,/,la a4 Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. if found return to: Registration: 145954 Board of Building Regulations and Standards Expiration: 3/15/2011 Tr# 282668 One Ashburton Place Rm 1361 Type: Private Corporation Boston,Ma.02108 DOYLE+THOMAS CONST INC TROY THOMAS _��s 499 NOTTINGHAM DR ,,� — CENTERVILLE,MA 02632 Administrator Not valid wit out signature lassachusetts- Depat tment of Public Safet. Board of Building Red-ulations and Standards Construction Supervisor Specialty;License License: CS-SL 999t3 Restricted to: RF,WS TROY THOMAS t � 499 NOTTINGHAM DRIVE ff CENTERy.I- MA 02632 Expiration: 4/13/2012 un+ni>�i mcr' Try: 99913 TOWN OF BARNSTABLE BUILDING PERMIT;APPLICATION; Map ` Parcel Application- cdUoD8 Health Division Date Issued Conservation Division Application Fee Tax Collector r Permit Fee Treasurer2z1�� Planning Dept. AI Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address / dAl e Village Owner �' z,�q 2�,.,vlv"Xz9 Address 191.J 1N1 a1111f"e)11'4 Telephone 96 p i �� —� � 7 , Permit Requestaewy ear.�,s✓o .r�ias��e�-.li��/ ry��v�.o���`�ii+:,�s C �. L'�'/N 19 �X Y Z // -004/ ,rNS'uII /;o®/ ;Vg1?9e_e_ $_r® SrASy , e6 a ® /ter �x�� , ,may r. .a✓� Square feet: 1 st floor:existing proposed 2nd floor:e ' ng �, �proposed Total new Zoning District -flood Plain Groun war veray Project Valuation Construction Type r � R Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family 1 Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House:/VYes ;Wo On Old King's Highway: ❑Yes to Basement Type: ❑Full Ucrawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) B�asefnent Ynfinished Area(sq.ft) Number of Baths: Full:existing new p� Half:existing new Numbe7 of Bedrooms: existing_� new Totall�om Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes KNo Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑r e size `ass: Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: t n Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ P w Commercial ❑Yes ❑No If es, site plan review# Current Use Proposed Use ✓ ` --� UILDER INFORMATION Ow - zvi` Z P'6 Oe7ll Name cX � Telephone NumbeJB'c39r ' Address D License# o�6� v Z-50- ®Z6 3/ Home Improvement Contractor# Worker's Compensation#its ' - 6-3 )& z3 -c0/6`� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 6Z2� s s � 17,101 01 SIGNAT DATE FOR OFFICIAL USE,ONLY �r s _ APPLICATION# DATE ISSUED •s`. MAP/PARCEL NO. , ADDRESS VILLAGE OWNER r DATE OF INSPECTION: FOUNDATION FRAME r �rf F INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ' ' GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. ;' r - ' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ." 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name(Business/Organization/Individual):7Z&,o,, Address ,OU City/State/Zip:L�� �D� Phone.#:L Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with �. 4. 0 I am a general contractor and I YP P 1 ❑ � - 6. F1 New construction employees(full and/or part-tim.e).* have hired the sub-contractors 2.ElI am a sole proprietor or partner listed on the attached sheet. 7. emodeling ship and have,no employees These sub-contractors have, 8. ❑Demolition workin for me in an capacity. employees and have workers' g Y P ty 9. ❑Building addition [No workers' comp.insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.El am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself, [No workers' comp. right of exemption per MGL 12.❑Roof repairs 3 insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required.] ` ti*Any applicant that checks box 41 must also fill 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. 'IContractors 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 my employees. Below is the policy and job site information. Insurance Company Name: );z 7 Policy#or Self-ins. Lic.#4� /,�""'c3.Z1�5`~�?3—' ®f 6t Expiration Date:egifg,�/��j Job Site Addresss Za� City/State/Zip: 4 /�P P' ,!/PS�/1 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u the pains an pe alties?62iiury tJs a in o ation provided above is t ue and correct Si a e a e: X� � Phone#: 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): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone M Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees: Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representative's of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance;construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not.because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings inrthe.cornmonwealth„for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states`Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s),address(es)and phone number(s) along with their certificate(s)of insurance. Limited Liability Companies*(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations lias"to contact you regarding the applicant. Please,be sure to fill in the permit/license number which will be used as a reference number. In'addition,an applicant thatkmust`submit multiple pem-ntllicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy-of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number: ' The Commonwealth of Massachusetts _ Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-72.7-4900 ext 406 or 1-877-MASSAFE Revised 11-22-06 Fax# 617-727-7749 www.mass.gov/dia T � P s if ✓XI &1111�/da a�✓�aaaacfxuaelta , License or registration valid for individul use only Board of Building Regulations and Standards before the expiration date. If found.retui ri to: I HOME IMPROVEMENT CONTRACTOR Board of Building Regulations and Standards Registration 1:90124 i One Ashburton Place Rm 1301 Boston,Ma.02108. Expiration 1 0/612 0 0 8 TYPe DBA';,= YANKEE BUILDERS i THOMAS TURCKETTA ' 65 RED TOP RD Not valid without signature BREWSTER, MA 02631 Deputy Administrator cj Regulations and Standards i r Board of Building erv14 or License Construction Sup Licehs'e GCS 29893 • B� hdate y81211955 Tr# 872 Ei.. ... 5 � irat on 81212009 IEXp- I( >t 4 4`E Res4rtctton , i ETTA� , 1't �• G S U THOMA 65 RED TOP RD Commissroner MA 02631 BREWSTER, I � I I i Thomas L. Turcketta d/b/a/YANKEE BUILDERS 65 RED TOP ROAD BREWSTER;MA 02631 508-385-3672 Construction Supervisor Home Improvement License #029893 Contractor Reg#110124 1/6/08 To BuildingDepartment, P > I Reza Mandavi, have contracted Thomas L. Turcketta to perform the restoration and repairs on my home located at# 38 Bacon Lane. In Centerville Ma. And act as my Agent in the permitting process, hiring of subcontractors and the managing of the project. Reza Mahadavi, Pzr---10—tY)1-T FJL�Q u,"j,02e M�% 4' 2D I Town of.Barnstable: *Permit# Gv7p � Expires 6 mo rs from issu d XpP�ESS PERMIT Regulatory Services Fee 'Thomas F.Geiler,Director DEC 2 8 Z007 Building Division It ate Tom Perry,CBO, Building Commissioner TOWN OF BARNSTABLE 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY ' 508-790-6230 Not Valid without Red X-Press Imprint Map/parcel Number 0yO Property Address t.I i✓ t �i/l(-i-E A 0 3 2� Residential Value of Work +'SA Z SO Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Contractor's Name TADS EJI 201(�PEKS., , Telephone Number'5Ov:`4;Z8 C)oo Home Improvement Contractor License#(if applicable) 100 j'3 Construction Supervisor's License#(if applicable)_ 048859 Xorkman's Compensation Insurance Check one ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name A v-I F-ga W workman's Comp,Policy# Copy of Insurance Compliance Certificate must be on file. ?ermit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑.Re=roof(not stripping, Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders. U-Value o3G. ( 44) *Where required: Issuance of this pernut does not exempt compliance with other town departmenfregulations,i.e Historic,Conservation,etc: L ' ** Note: ro erty O e .pertyOwner Letter of Permission. of e o e ntractors License is required IGNATURE: / :FomLs:expmtrg : 11 / l`I�i lJl liLl��(ZS L.,.1c_ wise0613o6 _ ' The Commonwealth ofMassachusetts Department of.1ndustrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111, www.massgov/dia ' Workers'-Compensation Insurance Affiddvit: Builders/Contractors/Eleetricians/Plumbers Applicant Information .Please Print Legibly Name(Business/Organizatiowb&vidual): f AVC El-1 c.e &SM- 1 _PA06rz1-r •Address: `�.D -gc�x' 1� 1�� ScmooL City/State/Zip: 60'T.0 17 10 MA OZ635 Phone.#:�J 4ZO.060-1 e y an employer?Check the appropriate box: :Type of project(required):. o4., I am a general contractor and I 1.� L a employer with 6• New construction leyws(full and/or part-time) have hired the sub-contractors 2.❑ I am a'sole proprietor or parft=- listed on the'attached sheet. 7. ❑Remodeling ship and have no employees . These sub-contractors have g• Demolition *orldng for me in any capacity. employees and have workers' [No workers comp.insurance comp.inanrant;a,$' 9. ❑Building addition 5. [� We are a corporation and its 10.❑Electrical repairs or additions reed] officers have exercised their 11. Plumbin repairs or additions. '3.❑ T am a homeowner doing all-work . ❑ , g P myself[No workers' comp. right bf exemption per MGL 12•❑Roof repairs insurance.required.]t c. 152, §1(4),and we have no , � •p employees.[No workers' 13AOther 4A//Noo t)E�LLAGtP t► comp,insurance required.] *Any applicant that checks box#1 must also'fill out the section below showing thcir workifr'compensation policy information. t Hameowoers,who submit this affidavit indicating$hey are doing all work and then hire outside contractors must submit a new affidavit indicating'such. tcontiactms that check this box must attached an additional sheet showing the name of the sub-contractors and state whether ornat those entities have employees. If the sub-contractors have employees,they must providb their workers'comp,policy number. I am an employer that isproviding workers'compensation insurance for my employees Below isthe policy and job site• information. Insurance Company Name: _ 1 E 1 oA Z u L) t,iQ& Policy#or Self-ins.Lac.#: 03 ` 9-'16 A6 4 " T -O T Expiration Date: 6 M O8 Job Site Address: 3B Bpi cA 4N City/State/Zip: at,�QV w_lzz;11A 0Z434'- Attach a copy of the workers'compensation policy declarafion page•(showing the policy number and expitation 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 tip tb.$1,500.00 and/or one-year imprisonment;as well as civil penalties in the form of a STOP WORK•ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the-Ofte of Investi lions of 1)IA for insurance coverage verification. ' I do herebyPeet e a penalties of perjury that the information provided above is true and correct Si storeL Date• to®q'Phone# �Oo 0GE7F .3c�t.fUW-S, Z4 , Official use only. Do not write in this area,tb be completed by,city or town,of City or Town: ' Permit/License# Issuing Authority(circle one): A.Board of Health L Building Department 3.City/Town CIerk 4.Electrical Inspector 5•Plumbing Inspector 6.Other Contact Person: Phone#: 12/26/2008 12: 42 15084200117 PADGETT BUILDERS PAGE 01 :.... ............ mYY)ADATE(YM11D N k:> PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE MYCOCK INS AGCY HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR 20 SCHOOL ST ALTER THE COVERAGE AFFORDED BY THE POLICIEi BELOW. PO BOX 437 COTUIT MA 02635 COMPANIES AFFORDING COVERAGE COMPANY 7 A MERICAN ZURICH INSURANCE INSURED COMPANY PADGETT BUILDERS INC 9 PO BOX 133 COMPANY COTUIT MA 02635 C COMPANY D .D� ...................... .:............:..:......:.....:. .. ;::>?:> :>: HIS 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.D000MENT 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. CO TYPE OF INSURANCE POLICY NUMBER MM POLICY EFFECTIVE POLICY EXPIRATION LTR DATE \DD\YV) DATE(YYIDD\YY) 11Y1T0 QENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. B CLAIMS MADE a OCCUR. PERSONAL A ADV,INJURY 5 OWNER'S•®CONTRACTOR'S PROT. EACH OCCURRENCE g FIRE DAMAGE(Any one fire) g MED.eXPENS6(Any one poreon) S AUTOMOBILE LIABILITY COMBINED SINGLE S ANY AU��''Taa""OLL� LIMIT ALL OV4 AU BODILY INJURY SCHEDF�ILED ALIT®S (Par Pr rpon) E HIRED RhJT08 BODILY INJURY NON-OVMED AL90:S (Per Accident) 6 r iaJ PROPERTY DAMAGE 6 WIRAQE YAIWTT AUTO ONLY.EA ACCIDENT S LLJ ANY AIJTfl ® OTHER THAN AUTO ONLY: : x•:.;;. r` EACH ACCIDENT :® AGGREGATE S EXCESS UASIUTV EACH OCCURRENCE I UMBRELLA FORM AGGREGATE OTHER THAN UMBRELLA FORM v A WORKER'S COMPENSATION AND STATUTORY LIMITS THE {U8-B716A67-7-07) 06-01-07 06-01-08 THE PROPRIETOR/ EACH ACCIDENT g PARTNERB/EXECUTIVE X INCU DISEASE—POLICY LIMIT III OFFICERS ARE: EXCL On nflln DISEASE—EACH EMPLOYEE g OTHER JJo� 2 1 1;' l DESCRIPTION OF OPIRATIONS/LOCATIONS AINICLES/RE®TRICTIONSM!"ECL4L ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE MOLDER AFFECTING WORKERS COMP COVERAGE. : .........:.a1IouLD ANY of THE ABOVE..........::::..::::::.::.Y::;.::Y::.;,;:.:;�:,•::>:•:: .;::.::;;.:,.:.::.Y:�:.YY::.:.:> :�:>:>��:.:..:.:. DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,"THE ISSUING COMPANY WILL ENDEAVOR TO MAIL TOWN OF BANSPECTOR 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE NSTABLE BUILDING INSPECTOR LEFT, BUT FAILURE TO MAIL SUCH NOTICE 61IALL IMPOSE No OBUQATION Oft 367 MAIN ST MYANNIS MA 02601 LIABILITY OF ANY KIND UPON THE COMPANY,IT8 AaENTS 00 REPRESENTATIVES. AUTMORIM RCPRLGENTATIYE Ir "ar.ftU L!Lb. i 95-03-07 09:E7am F'on-AIG +973 33i B583 T-0E1 P,001/002 F-3GO T. �e�4't f �F�iaQ►i�Err�I 'i�a7V �lti:r .. n:, I,. I !. , ', yq + 61//2007', .ft PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF iNFORMATIUN ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Rogers&Gray Insurance Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR j 434 Route 134 ALTER THE COVERAGE AFFORDED BY THE POLICIES SELOW Soltn Dennis, MA 02660 COMPANIES AFFORDING INSURANCE INSURED COMPANY A GRANITE STATE INSURANCE COMPANY M Kempton Nickerson 13 This Way Oster✓ille,,'VIA t)2655-0000 , COVERAGES!- THIS — THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TC THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOT WIT"-I�STANOING ANY REQUIREMENT,TERM OR CONDITION OF ANY CDNTRACT OR OTHER .f DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE WY BE ISSUED OR MAY PERTAIN:THE INSURANCE AFFORDED THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUC-4 POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Co - ! LTR I TYPE CF IN6YRANCE PCL!CY Ni1M9ER POLICY EFFPCTW&DATE PCLICY EXPIRATION DATE i { A ORKFR CONPENaATION NO EMPLOYERS'LlAljLllY �H=PROPRIETORI LIMITS 'PAATNERVEXECUTIVE OFFICERaARE: I I ! NCL M EXCL 0 8&4$385 1 3/02/2007 3/02/2008 ATU70RY IMTS or,ER overage Apples m MA Operetbna Omv. �EP:CHACCIO'cNT $ T�7C,000 �=ASE PO-:CY LIMIT $ SDC,RCt�, -- -- •_„_�,�SfASE•EACN EMPLOYEE 5 '.QC OC•0 DESCRIPTION OF OPERATIONSNEHICLESISPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION PADGETT EUILOERS SHOULD ANY OF THE AVVE DEGCRIHED POLICIU Or CANCELLED BEFOFE THE EXPIRATIOS DATE-4ERECF,rNE fSSU1NG COWIANY WILL ENDEAVOR TO 61A'L;,s PO BOX 133 DAYD WRI—FN NOTICE TO-HE CERTIFICATE HOLDGR NAMED TO THE LEFT,DI' COT:I IT,MA 02635 FAYLUPE TO". 1.BJC;-H NOTICE SHALL VIOSE NO.OBLISATON CR LIAK17Y OF ANY MIND IPON THE COv?AIVY,ITS AGENTE OR R PREEENTATIVES, i AUTHORIZED REPRESENTATIVE /7 I Mill J, }-- arr�m�uuec> i a� aoac�ivaeha 00 35,000 cf enclosed space -- --- j BOARD OF BUILDING REGULATIONS i I. (MGL C.112 S.60L) 1A Masonry only �;E _ 'License: CONSTRUCTION SUPERVISOR \ 1 G.,1&2 Family Homes Numbe Cg 048859 y' i i �,., Failure.to possess a current edition of BI bc7 to 02/2 i 1944 I'r' Massachusetts State Building Code 1 tjjl ill '�r is cause for reJocahoin of this license: r 1 e 0 22 008 . Tr.no:. 17133 j i - ,a;:,.�, fie."• ..R t Ce�e�li� �.,��� I is - . ROBERTR-PADS 184 SCHOOL ST/P COTUIT MA 02635' � l :' Gommiso pner DIG SAFE CALL CENTER: (888)344-7233 I T� ✓�ze 1°omvrna�uuealC/� �✓G� ett -- --------------- , , Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Reg(stroton�.„1.00131 Board of Building Regulations and Standards Expiration; 6/9/2008 One Ashburton Place Rm 1301 1T Boston M . 2 08 c ype,. Private Corporation ' f PADGETT BUILDER§SFJNC,.:.;;y Robert Padgett •£ PO Box 133/184 Scfiool �- - Cotuit,MA 02635 Deputy Administrator Not valid without signatu UHME Town of Barnstable Regulatory Services MASS. Thomas F.Geiler,Director nsass. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I�A O`DAVT, , as Owner of the subject property herebyauthorize p���- - 1LJ�{ IZS�ZI�tGa to act on my behalf, in all matters relative to work authorized by this building permit application for: ?jAcdA LAI-IE y GF-NTEf2vIL-L'6 (Addre'ss of Job) Sign re of 0,Zer Date f / Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FO RM&O WNERP ERM ISS ION PARCEL NO. 7 , 3 TOWN OF BARNSTABLE Notice is hereby given that in accordance with the By-Laws of the Town of Barnstable Article V Numbering of Buildings. Adopted March 3, 1931 and approved March 25, 1931. Public convenience and necessity requires the (numbering,) (changes in numbering,) (re-numbering) STREET VILLAGE your number is............."3... ......................... and should be affixed to your building so as to be visible from the street. Barnstable Town Manager TOWN OF BARNSTABLE ENGINEERING DIVISION �d� M k1L tA)&Z Li 1 -7;�yArL 1e0 Engineering Dept. (3rd floor) Map Parcel (��,/(� 0SPermit# House# 3g FJS Date Issued Board of Health 3rd floor 8:15 9:30%1:00-4:30 Fee ; ,®� Conservation Office(4th floor)(8:30- 9:30/1:00-2:00) Planning Dept.(1st floor/School Admin. Bldg.) DIME efin'ti Plan Approved by Planning Board 19 s619- �f0 MPS TOWN OF BARNSTABLE Building Permit Application . o'k 7V Pro' ct Street Address TD C1E.„ 06;ff Village -,�,�✓! �� d� Owner Address Telephone Permit Request First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ �c9� Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No 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 No.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 Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name _D4e49tti-__) Fo&,6kn Telephone Number Address �� / %ttl Men C(P License# �U Home Improvement Contractor# Worker's Compensation# &)(7/_Va OQ 7 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE tJ A;' BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) _ n FOR OFFICIAL USE ONLY PERMIT NO. .� DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER y DATE OF INSPECTION: F � r FOUNDATION _ FRAME ' INSULATION Y FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING J' DATE CLOSED OUT ~ ASSOCIATION PLAN NO. THE r� y The Town of Barnstable & De artment of Health Safety and Environmental Services ,39. P Building Division 367 Main Street,Hyannis MA 02601 Ralph Crossen Office: 508-790-6227 Building Commissioner Fax: 508-790-6230 For office use only Permit no. Date__-----. AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work: Est.Cost Address of Work: Owner's Name Date of Permit Application: " I hereby certify that: Registration is not required for the following reason(s): Work excluded by law _Job under S1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: PERMITER OWNERS PULLING �'HE CABIi E OME McRO MENT WORK D OR DEALING WITH ORNOT HAVE CONTRACTORS FOR AP ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. 1 Contractor Name Registration No. Dat OR The Commonwealth of Alassachusetts •!.it ' _=�;:r Department of Industrial Accidents 600 Washington Street Boston,A1ass. (1 111 Workers' Compensation Insurance Affidavit �fR1�Rnt Rntormatton• '�' Please PRINT leetbly � � „— na eo `�P14crJ ��C�4 P2 r Incition• n/ I nhonc# �/r�� Cc�S� 1 am a homeowner performing all work myself. 0 1 am a sole proprietor and have no one working in any capacity f esa •�*o. +' •c-a,,•:''-: ^x'.:.?�e!{+.q'aeclw?:--*SRTRrt--,R. .pa�ls-,,. .-r. •eaiR�er� _ _ ^'•' rr+�w.....-- M:"- -•..e- I am an employer providing workers' compensation for my employees working on this job. company name: F-aV�sxv) �ClYI ST/UVG�"/dY� addrese: 17 l / fitz�±5i city: Co JLZ nhonc#: . insuninc lic•# 190 0 1 am a sole proprietor, general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: company name: atldress• SjX}' phone#• incur.ince co policy# N +7f,!43�5'; 'CF", ^"": ::.r•„a'�4°j'-".:R�t�hi '-'..,..,�.� company name: address: city phone#• incur�nce co lLS}'# :Atiach addihonal'sheef ifrecess :;'. � ,;Ksrr;: i- ,�; .':, ... :. is Failure to secure coverage as required under Section 25A of NIGL 152 can lead to the imposition of criminal penalties of a fine up to S1.500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. 1 understand that a copy of this statement may be forwarded to the Once of Investigations of the DIA for coverage verification. !do herehr cc ij• the aims d enalties of peduq,that the information provided above is true and correct. Si nature Date Print name 2t1 Fjf—r/lG�.a.�1 Phone# official use only do not write in this area to be completed by city or town official city or town: permit/license# riBuilding 7ment Licensingcheck if immediate response is required OSclectme�liealth Dcontact person• phone#; rJO1her4 t iu Irevlsed V95 P1A) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an etnp1({ree is defined as every person in the service oi'another under any contract of hire, express or implied, oral or written. An empliti,er is defined as an individual, partnership, association. corporation or other legal entity. or any two or more of the foregoing engaged in a.joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual , partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance , construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an emplover. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant,vvho has not produced acceptable evidence of compliance with the insurance coverage required. Additionally. neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. I _ .�....-'..,.anw........ .. +..�•.++ "4 1•J'.' ;' ,f. \:+*: .+ •.ida,.. `r,.. Y. 1, j„•i.•Cy ....'— Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying-company names, address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial Accidents. Should you have any questions regarding the "law" or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. r., Cite or Towns w Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. �•,a►a.;.t.....� •- ._.•,,,.,,.. ,. ,e.,. ,•,-r.r!vt+.t-:�...a...,rr-e+.. --•+ems '--` 71 7..w -re.n!.��r►a�-^--^in.^�' The Department's address, telephone and fax number: ` The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 f PADGETT BUILDERSW CUSTOM HOMES & ADDITIONS P. O. Box 133 Cotuit, MA 02635 Telephone 508-428-0001 Fax 508-539-0557 January 30, 2008 Jeff Lauzon, Building Inspector Town of Barnstable 200 Main St. Hyannis, MA 02601 Re: Express Permit W -3-5-Bacon Lane Centerville, MA Dear`Mr-°��I✓auzon; as. � -' As�I'was'h6t awarded the job at the above listed residence, I wanted to return to the Town, and have marked null and void, the attached X-Press Permit#200708245 issued for window changes at the above listed residence in my name. As work has started at that residence, I did not want any confusion to exist as to who the contractor was or is—it is-- not my company, Padgett Builder's, Inc., or myself. If there are any questions in khis matter, please do not hesitate to give me a call at (508)428-0001. w T, -^ Thank you, CD � 7Z Yert f' Rob Padg President Padgett Builders; Inc. Attch: Original Permit 4200708245 CC: File Pizelml-T rl��Q ul-jooe. I i�Ss n)k CO h 2Di'(byJ, Town of Barnstable *Permit# 09-7 Expires 6 mo:tlu from i X-PRESS PERMITssud� Regulatory Services Fee �''f/ Thomas F.Geiler,Director DEC 2 8 2007 Building Division Tom Perry,CBO, Building Commissioner TOWN OF BAMSTABLi; 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 EXPRESS PERNUT APPLICATION - RESIDENTIAL ONLY l Not Valid without Red X-Press Imprint Map/parcel Number Z Odd / 0LAD Property Address. AC J--AtJE Cet fff- 11.i.E, A C�)6�� Residential Value of Work +3 Z�BO Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address 'c.z,,C0 MAIAJ2611QE: `?tE�R.tr l7eLt.cal3cCa�� Contractor's Name d 1="T-f" ?UII.D�S, -ir.tc. Telephone Number �J0.r; "q,28 -GOO 1 Home Improvement Contractor License#(if applicable) 100131 Construction Supervisor's License#(if applicable) O H 88 59 Xworkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's``Compensation Insurance [nsurance Company Name /-�F`IEd�IGA� y�t G J,,SyP.A� Workman's Comp.Policy# Q5 -9-4-16A6? Copy of Tnsurance.Compliance Certiflcate must be on file. ?emit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders. U-Value o 32- (maximum.44) •Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: ro erty O er si P perty Owner Letter of Permission, of e o e ntractors License is required. IGNATURE: o f/h4e777 :Fonm:expmtrg evise061306 TOWN OF BARNSTABLE BUILDING PERMIT.APPLICATION. 7 �, Map Parcel � - Application # Health Division Date Issued 4 '16165 Conservation Division - Application Fee Planning Dept. Permit Fee a . Date Definitive Plan Approved by Planning Board C() yl�lo� Historic - OKH _ Preservation/Hyannis Project Street Address i9CG/t� 1191V el Village �✓ �,�Y'J'�/ Owner/b cy�.9 ��A`7�/,�Y/ Address�.J y?�9Goi,1jf/ Telephone Permit Request �, A ec✓�Ce A,11REed�9� �i✓� ay .�.P6¢ J 9i[i�.Qco/,t�� ea� ��� . //.Pry e/Y�/c�e.v C°/YI�Y����/ iJ )✓in��/okJ Un/i,l ,N e �s'�g�/ ® �v%u �� i H��, .J Square feet: 1 st floor: existing - proposed 2nd floor: existing proposed Total newts Zoning District Flood Plain Groundwater Overlay ;: Project Valuation 26 0 Construction Type `o r Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ,❑ Multi-Family (# units) ; r Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Hig way: ❑Yes ❑ No Basement Type: ❑ Full kCrawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ 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 Telephone NumbeRJOF 3 6 / Z AddressAS -z��,e License# 4�9 � e 2,6 Home Improvement Contractor# Worker's Compensation # �3�.5 -��-s ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO�r9�P�S�`A�/e SIGNA R DATE l t FOR OFFICIAL USE ONLY APPLICATION# DATA ISSUED MAP/PARCEL NO. ADDRESS VILLAGE I OWNER DATE OF INSPECTION: FOUNDATION FRAME s INSULATION FIREPLACE IIS , ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH I FINAL GAS: ROUGH FINAL FINAL BUILDING e ,3 DATE CLOSED OUT ASSOCIATION PLAN,NO. N t ` X , , t The Cornmonwealth of Massachusetts , Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, M,4 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):776,12, t5 Address: �s City/State/Zip: ,gzeg: � / �� 3 Ph one..# 05 Are you•an employer?Check the appropriate box: Type of project(required): 1 4. I am a general contractor and I _ �I am a employer with S j� ❑ 6. ❑_New construction employees(full and/or part-tiin.e).* have hired the sub-contractors 2.❑ I am a'sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g• Demolition employe and have workers' working forme in any capacity. 9. []Building addition . [No workers comp.insurance comp. insurance.# 10- Electrical repairs or additions required] 5. � We are a corporation and its ❑ P . 3.11 I am a homeowner doing all work officers have exercised their 11.[1 Plumbing repairs or additions myself[No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. No workers' 13.[]Other comp. insurance required.] *Any applicant that checks box#1 must also fill 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. xContractors 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.. lam an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy andjob site information. Insurance Company Name: lT '�UrJ� Policy#or Self-ins. tic.#: I.S �� `®/.S' Expiration Date: '/ j e� Job Site Address �/ ��tJ� City/State/Zip:Z'✓��/'i/ IV17 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 crimirial penalties of a fine tip to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDElZ"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 ce ti un a pains-and enald er'ury that the information provided above is true and correct Si afore.: Date�'��L�/ Phone# Official use only. Do'not write in this area,to he 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#: Information and Instrncti®ns x, Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees: Pursuant to this statute,an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." . An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership; association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work.on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance . requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'. compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s), address(es) and phone numbers) along with then certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry.workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirrnation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials. Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affdavit indicating current policy information(if necessary)and under".lob Site Address"the applicant should write"all locations in (city or town)."A copy of the af3davit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related fo any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The.Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number: The Commonwealth of Massaohusetts Department of ladustriai Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Te1: #617-727-49GO ext 406 or 1-877-MAS_SAFE Fax# 617-727-774.4 Revised 1.1-22-06 www.mass.gov/dia I f - A 1 DATE(MM/DD/YYYY) I 01/07/2 sORD,M CERTIFICATE OF LIABILITY INSURANCE 008 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION � ,y UCER (508) 432-4822 - ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ,' athleen W. Kenney Incorporated Insurance Agenc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. "� 120 Main Street, Suite 101 P.O. Box 1 INSURERS AFFORDING COVERAGE NAIC 4 West Harwich MA 02671-0001 INSURER A:LIBERTY MUTUAL INSURANCE INSURED INSURER B: THONGS TURCAETTA INSURERc:' DBA yANKEE BUILDERS INSURER D: 65 RED TOP ROAD INSURER E: BREWSTER MA 02631- COVERAGES NG ANY THE POLICIES OF INSURANCE LISTED OF ANY CONTRAEEN ISSUED TO THE CT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATEMIAY BE ISSUED IOR MAY PIELICIES REQUIREMENT,TER THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICI AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. PoucY EFFEcrIVE PO (I EXPIRATION LIMITS INSR ADD'L TYPE OF INSURANCE 'POLICY NUMBER DATE(MM/DDNY) DATE(MMIDWYY) LTR INSRD / / / /' EACH OCCURRENCE S GENERAL LIABILITY DAMAGE ( RENTED S Ea occurrence PREMISESS COMMERCIAL GENERAL LIABILITY / / MED EXP An one erson) S CLAIMSMADE'❑OCCUR PERSONAL&ADVINJURY S / / � / /" GENERAL AGGREGATE S PRODUCTS-COMP/OP AGG $ GEN'L AGGREGATE LIMIT APPLIES PER: PRO- POLICY JECT LOC / / / / COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY (Ea accdent) ANY AUTO / / / / BODILY INJURY S ALL OWNED AUTOS (Per person) SCHEDULED AUTOS / / / / BODILY INJURY $ HIREDAUTOS (Per accident) NON-OWNED AUTOS / / / / PROPERTY DAMAGE S' (Per accident) AUTO ONLY-EA ACCIDENT .S GARAGE LIABILITY / / / / OTHER THAN EA ACC S ANY AUTO AUTO ONLY: AGG S EACH OCCURRENCE S EXCESSIUMBRELLA LIABILITY. AGGREGATE S OCCUR CLAIMSMADE S DEDUCTIBLE $NP WC STATU- OTH- � .i' RETENTION $ 04/14/2007 04/14/2008 TORY LIMITS tt ER CCV.-. 00,000 WORKERS COMPENSATION AND WC1-31S-3 215 23-013 E.L.EACHACCIDEN7 S ... EMPLOYERS'LIABILITY s00,000 ANY PROPRIETOR/PARTNER/EXECUTIVE / / / / E.L.DISEASE-E PLOYEE S OFFICER/MEMBER EXCLUDED? LIMIT I 5100,000 E.L..DISEASE-P01,C S If yes,describe under SPECIAL PROVISIONS below / / / / (A ',. OTHER / / / / ,;.•t DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS I' CERTIFICATE FOR WORKER'S COMP. i CANCELLATION CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE (508) 790-6230 ( ) EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL I DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED,TO THE LEFT,BUT TOMOF BARNSTABLE FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES.�/ AUTHORIZED REPRESENTATIVE - V �51 111 ©AC/(ORD/lCCOIpRPIORATION 1988 'Page 1 of2 ACORD 25(2001108) INS025(0108).06 t t c� co Y N I ,• r License or registration valid for individul use only -el a 1 Board of Budding Regulations and,Standards a before th..e expiration date. If found return to: Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR One Ashburton Place Rm 1301- Registratioh 11;10124 Boston,Ma.02108. i Expifation 1,0/6L2008 ,� Type DBA I s !' YANKEE BUILDERS THOMAS TURCKET,TA - Not vali 65 RED TOP RD d without signature Qom, BREWSTER., MA 02631l Deputy Administrator Re ulations and Standards Board of Binding $ �i Construction Supervisor License ram., LicQt►se=.,GCS 296L B.irthdate�81211955 iExp►ration 812J 09 60 r . . Restrtctton .t Ag 'i. THOMAS L TURcK, 65 RED.TOP RD BREWSTER,MA 02631 Commiss►oner �a Thomas L. Turcketta d/b/a/YANKEE BUILDERS " 65 RED TOP ROAD BREWSTER, MA 02631 508-385-3672 r Construction Supervisor Home Improvement License#029893 Contractor Reg#I J 0124 1/6/08 To Building Department, I Reza Mandavi, have contracted Thomas L. Turcketta to perform the restoration and repairs on my home located at# 38 Bacon Lane. In Centerville Ma. And act as my Agent in the permitting process, hiring of sub contractors and the managing of the project. .' Reza Mahadavi, fl } - .. u .. ! e •.�F T� '—:�.-✓' sir ..-. ts. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map o?0 Parcel ® /O � Application# Health Division Date Issued. Conservation Division Application Fe Q Tax Collector _ Permit Fee 57q 6u Treasurer G r= �, 6S 1�3 / Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street'AAd�dress�//(y /, 7�9CO1�/ .��1✓ Village ( tA✓ Owner �Zl� /��,�/j��/�Y>� Address�Y'f �i9COi✓ �� Telephone — — — 1-3/6 - 22-7:3!VVI Permit Request / ry >�.�i'e •� ,� .��rc ` /e:rr✓ ���- .9�rg /le/~ke! Zx,& /�D�tIG oCi4�l�✓6' �A»�/'�s'.v ' �J/���ir SL%/T�cc V40ec Square feet: 1 st floor:existing proposed 2nd floor:existing proposed i Total new Zoning District Flood Plain Groundwater Overlay Project ValuationConstruction Type c` Yp Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting DcumentAon. W Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes VNo On Old King's Hig ay: �-_LYes Pcop No Basement Type: ❑ Full Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 4 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: as ❑Oil ❑ Electric ❑Other Central Air:- ❑.Yes ❑No Fireplaces: Existing New Existing ❑ ❑ s� � wood/coal stove: Yes No Detached garage:�p 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 -- _ _ _ _ v_ - Proposed Use._ BUILDER INFORMATION Z V^6 $(Z Name V A' J/v e Telephone Number Address License# .5�?W Q -5 Home Improvement Contractor# Worker's Compensation 5 2-1,5, O 15 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO lam`/zV X,-Iz SIGNA RE DATEC—�c/L) �� t r a FOR-.OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL N0. J ADDRESS VILLAGE , OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE r ELECTRICAL: ROUGH FINAL _ PLUMBING: ROUGH FINAL -� GAS: ROUGH FINAL ,,- a FINAL BUILDING x ' DATE CLOSED OUT ASSOCIATION PLAN NO. r c . z' The Commonwealth of Massachusetts Department of IndustrialA.ccidents. Office oflnvestigations 600 Washington Street z Boston,MA 02111' ww'Mmass.gov/dia Workers"Compensation Insurance Affidavit:-Builders/Contractors/Electricians/Plumbers Applicant Information j .Please.Print Le gib N e(Bu es r tion/individual):.. ,5 ./o Address: E;v`�- / 'eG� ��°i� �T—d City/State/Zip: � /�7G� ��� Phone.#:,JZ 8& �' 7 2� .Are you an employer?Check the appropriate boas :Type of project(required):. 1.❑ I am a employer 4. ❑ I am a general contractor and I mP Yer with�--- 6, ❑New construction . emp loyees(full and/or.pait time).*• have hired the sub-contractors 2.❑ I am a'sole proprietor or partner- listed on the'attached sheet 7. XRcmodeling ship and have no employees These sub-contractors have g• ❑Demolition working for me in any capacity. employeeg and have workers' comp insurance. g• ❑Building addition [No workers' comp,insurance' p required] 5• ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing ill-work . officers have exercised their 11.0 Plumbing repairs or additions myself.[No workers' comp. right of exemption per MGL 12.kRoof repairs c. , 1(4),and we have no insurance required.] t 152 § 13.[] Other ' employees. [No workers' comp,insurance required.] *My applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners.who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating'such. $contractors that check this box must attached en additional sheet showing the name of the sub-contractors and state whether ornot those entities have employees. If the sub-contractors have employees,they must providb their workers'comp.policy number. r I i nm an employer that is provfdfng workers'compensation insurance for my employees. Below is.the policy and job site• information. 77 Insurance Company NaYne:. / L t� U/� p— Policy#or Self-ins.Lic.#:�C .S'� ���• 3��L5 Expiration Date: ��aP/��� aC7 lob Site Address: i C13A) �y L c���ty��Y..°/�' CitylState/Zip:-2�� e Attach a copy.of the workers'ycompensation policy declaration page•(showing the policy number and expiration date). Failure•to secure coverage as required under Section 25A of MGL c. 152 can lead to the-imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK•ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of' Investigations of the CIA fpr insurance coverage verification. ' I do he certify under t ains ar�d penah'es per' hat t n' ration provided above is true and correct. Sizaa • Date. A�� �✓• • Phone# Official use only: Do not wrfte 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 CIerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact.Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,as corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house. or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'corripensation insurance..If an LLC or LLP does have employees,a.policy is required. Be advised that this affidavit may be submitted to the Department of Industrial + Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom 3 of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year;need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in__(city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture a (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. r The Department's address,telephone and fax number: & # The Commonwealth of Massachusetts Department.of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 TO. #617-727-4900 ext 406 or 1-877-MASSAFE Revised 11-22-06 Fax#617-727-7749 www.mass.gov/dia ad q c - , License or registration valid for in el only, i�l nonac ea&a before th.e expiration date. 1'f found return to: Board of Building Regulatiods and Standards I Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR I. One Ashburton Place Rm 1301 Boston,Ma.02108 Registration 1-10124 Expiration 10/6/2008 ,r 4 Type: DBA'( YANKEE BUILDERS eo"', � ( THOMAS TURCKET,TA - -Not valid 65 RED TOP RD without signature ;;ei ` BREWSTER, MA 02631 4 7p. u..e Deputy Administrator ✓l, ns and Stan it i Board of Building g, , Construction Supervisor License CS 29893 �� I " ��: Blrthdate 81�211955 872 � a ��` �xp►ration 8121�09 Try { 0o Restr1tto� -'��3, (" �.. .. THOMAS L TURC\KETTA C ' 65 RED.TOP RD °v� s Commissioner a BREWS-TER,MA 02631 r Thomas L. Turcketta d/b/a/YANKEE BUILDERS 65 RED TOP ROAD, BREWSTER, MA 02631 508-385-3672 Construction Supervisor Home Improvement License#029893 Contractor Reg#110124 1/6/08 To Building.Department, I Reza Mandavi, have contracted Thomas L. Turcketta to perform the restoration and ' repairs on my home located at# 38 Bacon Lane. In Centerville Ma. And act as my Agent in the permitting process, hiring of sub contractors and the managing of the project. Reza Mahadavi, f lei-sue 1v ILI — ��, ' e ? � ¢ � o . . _. . �� i � o �- _ � � � � _ ti 3 0 .. ...... ...... r. �.M . . ...... . ... . c : . i.......01. _......... o Q _ 000 .. . ... ..... .. ... .. .... L / ....... �- --- :E z . Q : a, �D x u � U V) uEn ACORD,M CERTIFICATE OF LIABILITY INSURANCE DATE(MYYY) 01/0M/D°N 01/07/2o08oe PRODUCER (508) 432-4822 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Kathleen T4. Kenney Incorporated Insurance Agenc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATEHOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 120 Main Street, Suite 101 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 1 West Harwich MA 02671-0001 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A:LIBERTY MUTUAL INSURANCE THOMAS TURCKETTA INSURER B: DBA YANKEE BUILDERS INSURER C 65 RED TOP ROAD INSURER D: BREWSTER MA 02631— INSURERE: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS: INSR ADD'L _ POLICY EFFECTIVE POLICY EXPIRATION - LTR INSRD TYPE OF INSURANCE 'POLICY NUMBER DATE(MM/DDNY) .DATE(MM/DDNY) LIMITS GENERAL LIABILITY _ / -/ / /'. EACH OCCURRENCE $ - COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES(Eaoccurrence) $ CLAIMS MADE DOCCUR / / / / MED EXP(Any one person) $ PERSONAL&ADV INJURY $ ' GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY JECT LOC AUTOMOBILE LIABILITY / / / / COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ' ALL OWNED AUTOS / / / / BODILY INJURY SCHEDULED AUTOS (Per person) S HIREDAUTOS _ - - / .. / - / / BODILY INJURY NON-OMEDAUTOS' - - (Per accident) S PROPERTY DAMAGE (Peraccident) S GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO / / / / OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY / / / / EACH OCCURRENCE $ OCCUR CLAIMSMADE AGGREGATE - S S DEDUCTIBLE / / / / $ RETENTION $ JOTH- WORKERS COMPENSATION AND WC1-31S-321523-013 04/14/2007 04/14/2008 T RYLMTS ER cw mac= EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE. _ - E.L.EACH ACCIDENT $L"' r�00 OFFICER/MEMBER EXCLUDED? / / / / E.L.DISEASE-E PLOYEE$ .0 -00,000 If yes,describe under .,,.,,:1 - '- SPECIAL PROVISIONS below E.L.DISEASE-POL(CY LIMIT $ goo,000 OTHERLn DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE FOR WORKER'S COMP. (n Ln CERTIFICATE HOLDER CANCELLATION (508). 790-6230 ( ) — SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT TOWN OF .BARNS TABLE FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE ' INSURER,ITS AGENTS OR REPRESENTATIVES.AUTHORIZED REPRESENTATIVE '���� /�/`bA ACORD 25(2001/08) ©AC//ORDCORPORATION 1988 INS025(0108).06 - Page 1 of 2 TOWN OF BARNSTABLE BUILDING PERMIT.APPLICATION Map �® Parcel ~, PP A lication # Z� Health Division 2 0 0 7_ y SY �° Date Issued Conservation Division �% , Application Fee, Planning Dept. Permit Fee �? L 00 •C) Date Definitive Plan Approved by Planning Board 0, 7/Zg�°s Historic - OKH Preservation/ Hyannis ` Project Street Address 38 A94coA/ 106 / ` Village &_JVAe Y Owner}fie?_�,? �'��j�q�s+vi Address %38 ,415-4CO Al .Ci9N c Telephone 49/?-1.3 f e =- 06.g8y^� �` Permit Request � �ui'� J"e�G <<YJGcv iv 04 vws Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain /Groundwater Overlay Project Valuation �eyS63�Construction Types d Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family .A( Two Family ❑ Multi-Family (# units) Age of Existing/Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No '- Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood.6al stovk ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑Oisting Unewx size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: x MID Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ o m Commercial ❑Yes ❑ No If yes, site plan review# _ Current Use _ Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER)11 Name 4 T�-�,eG�7/"' Telephone Number k5a6' Address 6���-(��'i'o �� License#k� f"3/sjo Z.5 ©!S Z 6 3 Home Improvement Contractor# //D/Z-el Worker's Compensation # 0 Y49.9 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNAT R FOR OFFICIAL USE ONLY a- w. APPLICATION# - `> DATE ISSUED MAP/PARCEL N0. .ADDRESS VILLAGE OWNER { DATE OF INSPECTION: FOUNDATION 3 d-os /ewcr(' FRAME .:r w� INSULATION to .. ' FIREPLACE ELECTRICAL: ROUGH FINAL ^� PLUMBING: ROUGH FINAL a GAS: ROUGH FINAL o-FINAL BUILDING llkjoym= DATE CLOSED OUT ASSOCIATION PLAN NO. `t y aches iState aihdin Co e• 80 "` ' echo en The Massachusetts State Building Code(780 CM) includes provisions to ensure that houses and house additions meet energy efficiency standards. This supplemental•CONSUMER INFORMATION FORM is to be filed as part of the building permit application when a builder/contractor or homeowner, constructing/installing a house addition with very,large percentage of glass to opaque wall,seeks to utilize a special energy conservation exemption option for "sunroom" additions to,an existing house (780 CMR, Appendix J, Section J1.1.23.1). This FORM is not intended to prevent a homeowner from selecting a "sunroom"of any size, configuration, orientation,form bf construction or percent glazing, but rather is only intended to assist homeowners in becoming aware of some of the important energy conservation and year- round comfort considerations involved in selecting and utilizing a"sunroom"addition. The connection of "sunroom" structures to residential buildings may create comfort and energy consumption issues due to uncontrolled solar gain or uncontrolled radiation cooling of the main house. In the selection and construction/installation of"sunrooms", included below is a non-required, open-ended list of product and design donsidemdons that _a homeowner may. .wish to consider before actually constructing/installing a"sunroom".It is recommended that consumers carefully review these options with their designer, builder, or contractor, in order to minimize potential..energy consumption and/or house discomfort issues. In addition,the qualifications and reputation of the company or individuals to be hired are important considerations. PRODUCT AND DESIGN CONSIDERATIONS RELATED TO"SUNROOMS" • Solar Orientation and Natural Shading - - • Type of Glazing • Insulating value • Solar heat gain, • Frame materials • Glazing to frame sealing-and gasketing materials/.seal durability and/or weather tightness of the sunroom • Adequate ventilation Operable windows and fans • Applied Shading Systems • Insulation level in floors,walls,and ceilings • Possible Sunroom isolation from the main house via a wall and/or door or slider • Heating and Cooling Methods: Efficiency,Zoning and Controls Homeowner Acknowledgment The Massachusetts State Building Code, Section J1.1.23.1,.•requires that the actual vroverty owner(not the owner's agent or representative)acknowledge receipt of this CONSUMER INFORMATION FORM prior to issuance of a Building Permit for a project that includes."sunroom" additions to an existing residential building. In acco. 'th this requirement, the undersigned hereby acknowledges that she/he has read the info ion in s cument concerning sunroom comfort and energy conservation. Si ture of Actual Building Owner: Bate Print Name Address of Permitted Project Owner Address(if different than project location) Owner's telephone number ' Thomas L. Turcketta d/b/a/YANKEE BUILDERS 65 RED TOP ROAD BREWSTER, MA 02631 508-385-3672 Construction Supervisor Home Improvement License#029893 Contractor Reg#110124 1/6/08 To Building Department, I Reza Mandavi, have contracted Thomas L. Turcketta to Build a Sun.Porch on my home at 38 Bacon Lane in Centerville Ma. And act as my Agent in the permitting process. Reza Mandavi, all 2`he Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Was hington shington Street Boston, MA 02111 • WWtf�.rnass.gov/die Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers _Applicant Information �-+ ) Please PrzntLes?ibly Name (Business/Organization/lndMdual): 77P&,0V, 10 a 4 Address: ,!.6"' City/State✓Zip: II MGge a7 c-le Are you an-employer? Check;the appropriate box: Type of project(required): 1. I am a employer with 4. 0 I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the stab-contractors 2 listed on the attached sbnct 7. ❑Remodeling El I am a'sole prop o rietor or partner- These snb contractors have g. Demolition ship and have n employees employees and have workers' working for me in any capacity. 9. ❑Building addition No workers' CQn7p,incrrranCC COMP.i s�nctJ 5. We ale a corporation and its 10.0 Electrical repairs or additions required.] officers lave exercised their I1.[]Plumbing repairs or additions 3.0 I am a horneownrr dniing all work right of exemption per MGL 12.0 Roof repairs to crirainCC regnlleCL]t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other GMT_insurance required.] *Any agplimnt that cheep box#1 must also fill out the section below showing their workers'coropmsehon policy infommtim-. t Ilomeowncrc who tubrmt this affidavit indicating they arm doing all work and then hire outside eantrectors must tubrmt a new affidavit indicating such. Tcontractors that cbcck this box must attached an additional shed tbowing the name of the sub�oatractnrs and stain whether or not those entities have =&yecs. If the sub-contraetnrs bave nnployeet,they niuA prwidb their vmrkrrs'comp.policy number. I am an employer that is prov g idin workers' compensatznn insurance for my employees Below is the policy and jab site information. Tnstuancc Company Nam e:.A;Oe-,qqI • 2,VIJT t!oP Policy#or Self ins. Lie.#: Expiration Date: 00101W.1 Job Site Address: X4�G 6�vv �City/State/Zip: /1024 Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required undrr Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip to$1,500.00 and/or one-year imprisonmLnt, as well as civil penalties in the form of a STOP WORK ORDER and a fins of up to$250.00 a day against the violator. Be advised that a copy of this statemmit maybe forwarded to the Office of lnvcsti ations of the DIA for insurance,covers c verification. I do hereby certify un the pains•wxd ena1da o erju h, the information provided abbo'vee s true and correct ' Si Ene• Date � �` '�� fJ� — Phoac#' ��—3 8,5 3 6 7 Official use only. Do not write in this area, to be completed by city or town offuiaL City or Town: Permit/Liceam# IssuingAuthority(circle one): 1.Board of Health 2.Building Department 3.City/Towu Clerk 4.Electrical Inspector S. Plumbing Inspector 6. Other Contact Person: Phone#: JW, Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees: pursuant to this statute, an employee is dcfined as"...every person in the service of another under any contract of hire, express or implied, oral or written." , An employer is de5ned as"an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant tbcrcto shall not because of such employment be deemed.to be an employer." MGL chapter 152, §25C(6) also states that"every statE or Iocal licensing agency shall withhold.the issuance or. renewal of a license or permit to operate a business or to construct buildings in the commonwealth for azry applicant who has not produced-acceptable evidence of compliance with the.iusurance coverage.required.", Additionally,MGL ohaptcr 152, §25C(7) states `Neither the commonwealth nor any of its political subdivisions shall enter intD any contract for.the periormancc of public-work until acceptable cvidcncc of compliance with the insuranoe requirements of this chapter have been presented to the contracting authority.' Applicants please Ell out the workers' compensation affidavit completely,by chocking the boxes that apply to your situation and, if accessary, supply s�ntractnr(s)name(s), address(cs) and phone numbers) along with their certificates) of insurance. Limited Liability Companies*(LLC) or Limited Liability Partnerships(LIP)with no employees other than the nembers or partners, arc not zcquired to carry workers' compensation insurance. If an LLC or LLP does have :mployees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial kcci&nts for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should )e returned to the city or town that the application for the permit or license is being requested, not the Department of ndustrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' .ompensa.ion policy,please call the Department at the uumber listed below. Self insuredcompanies should enter their :clf-insurance license number on the appropriate,line. ;ity or TuWP Officials 'lease be sure that the affidavit is complete and printed legibly. The Dcparhncnt has provided a space at the bottom f the affidavit for you to fill out in the event the Office of Investigations has,to contact you regarding the applicant 'lease be sure to fill in the perunittliccnse number which will be used as a reference number. Iu•addition, an applicant hat must submit multiple permitlliccnse applications in any given year,nccd only subnut onF affidavit indicating current Dlicy information(if necessary) and under"Job Siie Address" the applicant should write"all locations id - (city or )wn)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the pplicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit,must be filled out each ear.Where a hDme owner or citizen is obtaining a license or permit not related{o any business or commercial venture _e. a dog license or permit to brim leaves etc.) said person is NOT required to complete this affidavit he Office of Investigations would hkr-to thank you in advance for your cooperation and should you have any questions, [ease do not hesitate to give us a call- in Department's address, tcicphonc•and fax.number. v .The G61D-monwQalth of Massarhwetts Dg)artmt nt of lndustrial Accidtrnts Office of Investigations 600 WashingtGn Strt-,et Boston, MA 02111 Tel. # 617-727-4900 cxt 4.06 o-r 1-M-MASSAFI _ Fax# 617-727-7749i ;d I1-22-D6 www.mass.gov/dia 07/21 /2008 09 : 10am From : Kathleen W Kenney Page 001 of 002 ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDrrNY) 07/21/2008 PRODUCER (50.8) 432-4822 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Kathleen W. Kenney Incorporated Insurance Agenc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 120 Main Street, suite 101 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 1 West Harwich MA 02671-0001 INSURERS AFFORDING COVERAGE NAIC 9 INSURED NSURFR'A LIBERTY MUTUAL INSURANCE THOMAS TURCKETTA rJ;,uRrR ri DBP. YANKEE BUILDERS ra_'uREu c: 65 RED TOP ROAD Nh'Ln?tR o: BREWSTER HA 02631- ra;uRrR r COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD DATE(MM/DD/YYI DATE(MMIDD/YY) LIMITS GENERAL LIABILITY / / / / EACH Cii_i_:LIUNENi_.t $ CCiMMEk! IAL CitNLNAL LIABILI I Y LiHMHC%t Ci ItI: tLi F�R�mni;; �1�uccnnr!ir.r. !6 CLAIM,".MADE !'iC!"91R - / / / / MLL,E:cJ I(Any nne parse m) $ PERSCttdAL-Y:ALiV lr\o-vY 5 !FNr-RAI A GRFGATF :6 GLN'LAC%CNECA1LLIMII APPLIEJPEN: PINQ U(.1 -COMPA);-AC•G AUTOMOBILE LIABILITY / / / / i_.CiMLiIrdEL'iINIC%LtLIMII ` MI'i AtIT!'i Ite�e�i=:a4anq �� ALL C iVVhItL'i AU 1 U _1C.HELiI ILELi A!i I i--i:-_t (F'ci paisnn)- HIRELiAL110_' ./ / / ./ f9!71011YINAIRY NON OWVrrlAlITN; PI OPLI:I Y L'WMAi a I I'aI'e�Cil[Ianl I ¢ , GARAGE LIABILITY AU 10 i ONLY-EAAC:i_IDEN11 T MJY AI ITC1 / / / /', Ci1Htle.IHHrJ RM!C: ;6 EXCESSNMBRELLA LIABILITY - / / s / / EACH C iCC!11?I?tNCt `� OCCUR R ❑ C1-A1M'-MALiE ACI;NEC%A1 t 1?EIENIIQN 5 F WORKERS COMPENSATION AND WC1-31S-3 215 23-0 13 OQ 1d 2008 OQ 1d 2009 WBTATU OT11 / / / / TC)R'i I IMIT;; rR EMPLOYERS'LIABILITY MJ'iF'R'i)F'F'ITT!7R/F'AF'Thl(-R'/�ii�CaITIVr- E.L.tACHAC-:.IULN1 6; 100,000 CirrlCtR/MEMNtR t%f:L1 JL'1LU7 / / L.L.Lil_,tASt-tH tMl'Lijytt;6 100,000 Ir ves,'�esca-Ite urnaar , >PFCIA PRi.)VI2I0I+JR b(,Iow C I Cq;FASF `F'C11 U:."r'.I IMIT 6 500,000 OTHER C DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS. m`` coverage for worker's comp' N CERTIFICATE HOLDER CANCELLATION �p SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 13EMRE THE S3ID Pd1.IIl�'Tlne EXPIRATION DATE THEREOF, THE ISSUING INSURE WILL Et&aVOR TO MAIL 'DAYS WRITTEN NOTICE TO THE CERTIFICATE HO ER NAMED TO THE LEFT.BUT town Of Barnstable FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES. _ AUTHORIZED REPRESENTATIVE //�` ///I L ACORD 25(2001/09) i ACORD CORPORATION 1988 INS025(n1i1i1)in alga'I cr2 s y .ygy, 61, "ROM ift At M. - :. �. y `�r,'t vCr t° .✓�?L 3�'?{.A.dfea'.'� t' c9.f'a °l� ata afi e w ard,.�'.�. Bo rd.rtE arl a rog 9k u.taraeaer� rah A rate.aita r � F2egstatiera 9 9�3 ' YANKEE e3s1II RS . E Top RCSo BRED' S ER MA 0,2631 Ar}aras�heratr r i.7f�[3 • r y I„ +�s�partD> a a,.,r��� ;v .,.�✓+k'.�d9fa,''.,.""'S� :7 3.,axna?•msn, s s h eat e r re s t: tiara tfit H`lwdividut 4. tt1y � bcf�rHw' t Op1t"dttaWift tdHHte fil"ih�aHati Ke4�aert�i�:. oar �x llH�p,f�l�:mg l�eg€it�tuH�ia�.�a� �tat�HaEar s' x astH�eHe Nita"02109 lit k.. .; . N� Ot lH '4NjthEt9lL 5'1.g14a$uYo d,?r THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I A , m / �C(�J IL DATA 38'1 FOR SEPTIC SYSTEM UPGRADE. JC ENGINEE FOR USES OF RING WILL NOT ASSUME ANY LIABILITY —�- THIS PLAN OTHER THAN ITS INTENDED PURPOSE. 22- A 4"PERFORATED SCH.40,PVC PIPE SHALL BE PLACED IN A,VERTICAL POSITION,TO A DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3"OF FINISH GRADE. A REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS. N �r 31 6 v D I I i LP.E. 2007 LEGEND x 50.0 EXISTING SPOT GRADE -—- 50 -—- EXISTING CONTOUR �� 50 PROPOSED CONTOUR —eiric —Eiiic — EXISTING UNDERGROUND UTILITIES LINE w —" EXISTING WATERLINE TEST PIT LOCATION PROPOSED 2000 GALLON SEPTIC TANK PROPOSED 4"SOLID SCHEDULE 40 P O VC PIPE 8' PROPOSED DISTRIBUTION BOX NVHD 1dl� �---� PROPOSED 500 GALLON LEACHING CHAMBER 1do 005 REV. DATE - 5-8 I' BY APP'D. DESCRIPTION PROPOSED SEPTIC SYSTEM UPGRADE i PREPARED FOR: CAPEWIDE ENTERPRISES 0 } s LOCATED AT 0 38 BACON LANE ` CENTERVILLE, MA SCALE: 1 INCH = 20 FT. ° 10 20 DATE:SEPTEMBER 25,2007 'NIW.Z 11111111111111 40 -- 80 FEET JOHN L. CHURCHILL PREPARED BY: JR. 0N1L d'�7 JC ENGINEERING, INC. 2854 CRANBERRY HIGHWAY °i°I,3dOs Nlw EAST WAREHAM, MA 02538 508.273.037-7 Drawn By:BSM Designed By:BSM Checked By:JLC JOB No.1302 S8404720"E 158.67' W - o , j� N CV) o O U) PROPOSED 5-500 GALLON Benchmark c Nail Set in Tree cc LEACHING CHAMBERS Elev. =44.62' N a TREELINE Approx. M.S.L. Co PROPOSED 42-- \ 3 3 DISTRIBUTION BOX PROPOSED INSPECTION PORT p } ) �) 42 , SHRhBS• 00, 0 to 00 Lo Lo Pi l . a \ � =42x O (2) 13— / i S82 ) 43/ N79o252 5,W / �30'00"E / rr / ( 20.4 1, _ 30.00' 44— —44� / / — �� _ �. "B,, \ ; PROPOSED 2,000 \� EXISTING GC GALLON SEPTIC 7� ; � r"-. � GARAGE /4' TOF=48.7'± PROPOSED 90°•LC 6� SWEEP WITH, CLEANOUT TO GF ( HC 4) l DRIVEWAY \ l MAP 207 \ �, PARCEL 40 11#38 N 40,423 S.F. ±. c EXISTING 6-BEDROOM _--------- - DWELLING C,, �� ----- i'1G C. `A 1 JA - u BACONS ED—E- oi,TREET �V' E M-EEN T((33' TY�P — WIDE PUBLIC x. LAYOUT) £ SITE PLAN MAGNETIC MA PLACED ALON SCALE: 1^ 20' EACH SEPTIC �. 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