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0264 BAY LANE
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'� " . _ _ ,. ., �. _ ..- _._ .' 1 • ,. ,. � � , o:� � � .. ,. 6fo OW-IC" POST" e R Town of Barnstable Building R Post This Catd So That it.is�Visible From the Street-Approved Plans.Must be.Retamed�on fob andth�s CardzMustt beKept • s�vsru3ue. � :�� � t I F nal In�. .,.. ,.,_� ,�. ,� � a f ,� � � ��,° ��� �;,� � �: mKsa. Posted Un spectton Has Been Made. � � � •• � � � �" ,.�,� ,.,z.a � �- �' ..„.,._..� erinit� ..�..,..�,.r-.-..�.— y Where a Cert�ficateof Occu anc '�s Re u�red,such Build�n hall Not be Occu red until a Final Ins ect�on has been made � Permit NO. B-17-3330 Applicant Name: HENRY E CASSIDY Approvals Date Issued: 10/04/2017 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 04/04/2018 foundation: Location: 264 BAY LANE,CENTERVILLE Map/Lot 186-022 Zoning District: RD-1 Sheathing: Owner on Record: JOLY, MICHAEL D&BARBARA S Contractor NameCAPE COD INSULATION,INC framing: 1 a , Address: 264 BAY LANE ContractoCLcense 153567 2 CENTERVILLE,MA 02632 Est Project Cost: $5,600.00 Chimney: Description: INSULATION/ WEATHERIZATION tPe mit-Fee: $85.00 ,� Insulation: Project Review Req: fee Pah = $85.00 F'®gate 10/4/2017 m al =N=�—� Plumbing/Gas Rough Plumbing: & Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved applcation and the'approved construction documents fo whiEh`this permit has been granted." All construction,alterations and changes of use of any building and structuresshall be in compliance with the local zoning by-laws and codes. final Gas: This permit shall be displayed in a.location clearly visible from access street or road and shall be maintained open for public Inspection for the entire duration of the Electrical work until the completion of the same. , g�z Service: The Certificate of Occupancy will not be issued until all applicable signatures by the 13" ing and Fire Offcials are provided on°this permit. Minimum of Five Call Inspections Required for All Construction Work: Rough: 1.Foundation or Footing 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough:. 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund"(as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map I `by Parcel U Ur Dr Application # — 1 -333 Health Division Date Issued '/ l 7 VXV Conservation Division,/ Application Fe Plannirg Dept. �4 Permit Fee Date Dafinitive Plan Approved by Planning Board w` Historic --OKH _ Preservation/ Hyannisi 01 Project Street Address�� Village �-�2 yi Ile Owner 9i94/ Rm 171 4 Address Telephone Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project:Valuation Construction Type --fe,' Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes /76-No On Old King's Highway: ❑Yes ONo Basemant 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 ti Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric Q 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 Number -J`7e�7�� 1,?! `� Address ,/,e„ License # f a Home Improvement Contractor# /J� 5 Email f,11JeJJ e4l' 6f .4 ,tIS �r�,�..�6t Worker's CompensationIF ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO M SIGNATURE DATE %la 71/7 FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. Town of Barnstable Regulatory Services �sAaa awaKAW Z Richard V.Seali,Director °� `ter Building Division Tom Perry,Buddine Commissioner 200 Main Street,I1yannis,MA 02601 www.town.barnstable-ma.us Office: 508-862-4038 Fax: 508-790-6230 Propezty Owner Must Complete and Sign This Section If Using A�Bu.ilder H P,E L O LY ,as Owner of the subject propeny. herebyauthonze Cape Cod Insulation to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of job) Pool fences and alarms are the respons ibility of the applicant,. Pools are not to be filled or utilized before fence is installed and all final ins p c ons performed and accepted_ ignz of Signature of i A �04AEL JOLT{ MMC,ua6L, ToCY Print Naar Print Narne —I (A�— Date r QTORMS 0%-NF"ERMISS10NKXXS i The COmmOnwealth of Massachusetts Department OfYnduslrlalAccldents I Congress street, suite 100 Boston, MA 02114-2017 www,mass,gov/dla Workers' Compensation Insurance Afndavitt Build ers/Contractors/Electr(clans/p lumbers, Ayplinntln orrngdon TO BE FILED WITH THE PERMIfTINO AMTHOPITY, Name (Bus!Hess/organization/Individual); Cape Cod insulation le se P nt Address; 18 Reardon Circle City/State/Zlp; South Yarmouth,MA 02664 Phone #; 608.775-1214 Art you an employer?Cheek the appropriate boxt IQ l am a employer with 48 employees(Nil an&orparwima),e Type of project (required); 2,[]1 un a tole proprfetororpartnerohlp Md have no employees working forme In 7, ❑ Now construotlon MY oapeolty,(No workera'oomp, insuranoe requlred,) 8, Remodeling 3,❑1 em a homeowner doing ell work myself, No workers'oomp, Insw1noe roqulred,)t 9, ❑ Demolition 4,0 1 am a homeowner and will be hiring contrnotors to vonduot ojl work on my property, I will 10 [] Building addition ensure that aJl oontraot"either have workers'oompensation lnsuranve or are sole Proprietors with no tmployom 11,❑ Electrical repairs or additions general oontreotor and I have hired the sub•oontrtractors Ilstod on the ettaohod shoot, 12,❑plumbing repairs or additions These sub�oontractors have omployees and have workers'oomp,insuranoe,t 13, ❑Roof re airs 6,[]We are a oorporadon and its ot�Ioen have exerolsed their right of"em on per MOL o, p 152,11(4),and we have no employees, P 14, Other Weatherizatlon (No workers'oomp,lnsurenos required,) 'Any epplloant that cheeks�x�1 must also flit out the section below showing their workers'oompensatlon polfoy Informetlon t Homeowner who submit t�ttk,nz~fidavit Indlaating they nn doing all work and then hire outside oontraotora must submit a now aPtidav tContraorors that check thJs box must attached an eddidonal shoot showing the ns,me of the sub.00nvaotors and etate whether or not those enddes hove employoes, 1f the rub-eontrbotors hive employees,that'must provide their workers'oom , It(ndioadng such lam an employer'thV is provtdtng workers' eo p lloy number, t�ormadom mpen'allon Insurance for my employees, Below is the pollcy and Job slue )nsurmoe Company Name; Atlantic Charter Policy#or Self Ins, Llo, 91 WCE004 31902 BXpiration Date- 06/30/2018 job Site Addresst_ �57�i?�.r ,�f� �' � _��1� -- Attach a copy of the workers' Compensation Polley declaration page(sbow!>agtthe policy nu- Z Failure to secure coverage as required under MOL o, �' er and explration date), and/or one-year imprisonment, as well as civil Penalties In the form of a STOP nal iWOiRK On O nRDEaRblo by a flee up to o$250,00 day against the violator, A Copy of this statement may be forwarded to the Office of InvesH atlons d a fine of up to S2S0 00 a coverage wrigoat.lon, g of the D1A for Insurance !do hereby cer undo t alns and penallles of perjury that the 170rmatton provldgd above Is true and correct, 508.775.1 14 9g `:71 Official use only, Do not write In this area, to be completed by clty or town q/ficla4 City or Towns Permit/License # LlssulngAuthorlty (circle one)i lth 2, Bulldln>; Department 3, Cltyrl'own Clerk 4, Electrical Inspoctor.,5, plumbing Inspector Phone#t '" Ma�aaQ,huaelts Depenment of Publlo 9afaSyy �I,,,,,,,1' Board of 6ullding Regulatlon� and 9tandard9 l.Ioenae109.100888 Ual�atruvtlon 9upervls�r Ir HUNRY B OA8810Y;"` $ 9HE0 ROW ; YAR Wg3T MOVJ'H �9F, ,. I �1101 vim' �xplraSlonl Co misslonor 11111IZ01T � y Office of ConsumerAffalrs and Business Regulation 10 Park Pla;a • Suite 6170 Boston, Ma 0211 $ Home Im rovems,;, Registration (r 14'b�(fi1"l�til `4,Cii;j�r'•ih1 ., r� �"wtili,c1�il. '��`'�iItiltiLilil4ir.h� ) Y pal 00( Or&t10 Cape C'Q�� Insulation, Inc Istra p n 18 Rear* Clro e " �;t���' %rl `'' Iw �x �ion1 163667 t, Ion; 12/14/2018 So,.Yarmouth, MA 02e$4 '" ' A'%I �� li�'il;,�l t,, w�l';• � dl� dr{J, II;I��IIJ1�41�1,' lilt` `��acn,r �9 aoM�oani „ , ,>.,,. ,....__,_..._,_. ._... ..�,,..,,.. Vpdato and Address ralurn card""—'—o*•- , Mark mason Ior ohenge �v�o�rt���crvarr��/oyo�G`rr�Jrro/rwattJ ��`�dr„p�,'8a'.,n„f1��ufar;nZ.,n,,a-n; Iq!. n ofllv�of 0ontumerAlle1re & 9velnvse Repvlallort P �mantl.Cvl.�aat'^F' HOME IMpR0V8MSNT OON711AOTOR Reglafretivn valid Ior Individual use only tt i Oorporallon before the explratlon date, If loun un tol ll4p OHlov of Oonsumar AHelra and r,; 10 Park Plata a 6170 al ss Re9ulallon O'ape Cod i*1�1" 1 ' 1ti, eotttvn,M 11 Henry Oaaaldyy'ry 90 Yarmouth, Vndoraeor9tary S al hout el atu CAPECOD•27 KDOYLE AFRO' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/OD/YYYY) 06/30/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certaln policies may require an endorsement, A statement on this certificate does not confer rights to the certificate holder In Ileu of such endorsements . PRODUCER C ACT Rogers&Gray Insurance Agency,Inc. PHONE 434 Rte 134 Arc No Exc: ac No: 877 816.2156 South Dennis, MA 02660 .mall ro ers ra .com I RER 9 FF RDIN9 99YERAQE NAIC q N R RA;Peerless Insurance Company 24198 INSURED IN RE :Safety Insurance Company 39454 Cape Cod Insulation,Inc. IN RER C;Endurance American specialty Insurance Company 41718 18 Reardon Circle IN RERD;Atlantic Charter Insurance Company44326 South Yarmouth,MA 02664 INS RER E NSURERF: COVERAGE CERTIFICATE NUMBER: REVISI N NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY P INSR AID CLAIMS, _LTELTYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP POLICY NUMBER LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR EACH OCCURRENCE 1,000,000 CBP8263063 04/01/2017 04/01/2018 DAMAGET RENTEDPREMISES Eaoccwrrence) 100,000 MEDEXP(Any one n 5,000 N'L AGGRE E LIMIT APPLIES PER: PER NA &ADV INJURY RY 11000,000 EL. NERAL A R AT 2OOO,OOOX POLICY LOC OTHER: J PRODUCTS-COMP P AGO 2,000,000 B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO6232707 COM 02 1,000,000 AWNEDUTOS ONLY X SCHEDULED 04/01/2017 04/01/2018 B DILY INJURY Per person) RED AUUTNOSSWNEp RD'LYX AUTOS ONLY X AUTOS ONLY B OPERTNY AMAGE ccidenl Per accident C UMBRELLA LIAO X OCCUR X EXCESS LIAR CLAIMS-MADE EXC10006635002 EACH C URRENCE 2,000,000 04/01/2017 04/01/2018 A REG r 2,000,000 DIED RETENTION E D WORKERS COMPENSATION X PER AND EMPLOYERS'LIABILITY OTH• ANY PROPRIETORIPARTNER/EXECUTIVE / R/O WCE00431902 06/30l2017 06130/2018 �FFICERIMEMBEREXCLUDED? 7 N/A EACH ACCIDENT 1,000,000 (Mandatory In INJFFii) DES Ilyes,describeunderRIPTI N OF OPERAJIONS slow E,L.PISEASEEA EMPLOYE E 11000,000 --,DISEASE-POLICY LIMIT 1,000,000 DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Workers Compensation Includes Officers or Proprietors. Additional Insured status Is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder. CERTIFICATE OLDERC L TI ON SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Thlelsch Engineering Inc . THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 195 Frances Avenue ACCORDANCE WITH THE POLICY PROVISIONS, Cranston, RI 02910 AUTHORIZED REPRESENTATIVE L ACORD 26(2018I03) ©1988.2015 ACORD CORPORATION, All rights reserved, The ACORD name and logo are registered marks of ACORD Cape Save Inc. 7-1) Huntington Avenue South Yarmouth, NL4,02664 Tel: 508-398-0398 Fax: 508-398-0399 �0, 9/21/17 Thomas Perry CBO Town of Barnstable ^� Building Division 200 Main St. Hyannis,MA 02601 RE: Insulation Permit 17-2807 Dear Mr. Perry This affidavit is to certify that no work was performed at 264 Bay Lane in Centerville. Sincerely, William McCluskey V I �I► Town of Barnstable Building a�axsreet� Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job`and this CarcfMust be Kept 6' ' Posted Until Final Inspection Has Been Made. Permit F,630. Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-17-2807 Applicant Name: William McCluskey Approvals Date Issued: 08/29/2017 Current Use: Structure Permit Type: Building- Insulation - Residential Expiration Date: 02/28/2018 Foundation: Location: 264 BAY LANE,CENTERVILLE Map/Lot: 186-022 Zoning District: RD-1 Sheathing: Owner on Record: JOLY, MICHAEL D& BARBARA S Contractor Name: WILLIAM J MCCLUSKEY Framing: 1 Address: 264 BAY LANE Contractor License: CSSL-102776 2 CENTERVILLE, MA 02632 Est. Project Cost: $5,000.00 Chimney: Description: Add R-30 fiberglass to the attic.Add R-19 fiberglass,and 2" rigid Permit Fee: $85.00 insulation to the basement.Air seal the attic plane and basement with Insulation: expanding foam.General weatherization. Fee Paid:Date: 8/ 9/2 29/2 017 Final: Project Review Req: Add R-30 fiberglass to the attic.Add R-19 fiberglass,and 2 rigid insulation to the basement.Air seal the attic plane and Plumbing/Gas basement with expanding foam. General weatherization. Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Town of Barnstable RECEIPT BA ssBL ' 200 Main Street, Hyannis MA 02601 508-862-4038 ILe39 �fONtD�� Application for Building Permit Application No: TB-17-2807 Date Recieved: 8/16/2017 Job Location: 264 BAY LANE,CENTERVILLE Permit For: Building- Insulation- Residential Contractor's Name: WILLIAM J MCCLUSKEY State Lic. No: CSSL-102776 Address: , West Yarmouth, MA 02673 Applicant Phone: (508) 398-0398 (Home)Owner's Name: JOLY, MICHAEL D& BARBARA S Phone: (508)776-9503 (Home)Owner's Address: 264 BAY LANE, CENTERVILLE, MA 02632 Work Description: Add R-30 fiberglass to the attic. Add R-19 fiberglass,and 2" rigid insulation to the basement. Air seal the attic plane and basement with expanding foam. General weatherization. Total Value Of Work To Be Performed: $5,000.00 Structure Size: 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by tiling a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: William McCluskey 8/16/2017 (508)398-0398 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $5,000.00 Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: $85.00 8/16/2017 1 $35.00 XXXX-X3M-XXXX-E Credit Card 0299 Total Permit Fee Paid: $85.00 8/16/2017 $50.00 XXXX-XXXX-XXXX Credit Card 0299 THIS IS NOT A PERMIT �� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel (� o�� Application# X6�7150(Vn Health Division Conservation Division Permit# 2-00WIT1 Tax Collector Date Issued i - Treasure- Application Fee /'- Planning Dept. Permit Fee Date Def nitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis e451-- 4A�_ Project Street Address2:,c,-1 L a-N e Vill — Village i 1 1 n l�7 Si- W, r\ Owner rC V. 0 1 Address —Go v%,N�• t Telephone b 1 7) 3 J67 9 b o I Permit Request -T® .�\c)t 161 Y% \Oi` MCA V%0 ¢.rn- Ott e k4% O V-f.r `gym 1 IN I p YN p S t Square feet: 1st floor:existing 1Z000 proposed `30 4 2nd floor:existing proposed Total new b� Zoning District P4 Flood Plain Groundwater Overlay 4't� Project Valuation 10 o b 0 O Construction Type UAo©a 1(<r-rfVk_ Grandfathered: ❑Yes ❑ No If yes, g attach supportin �documen Lot Size 6 � , y°l � 'S� o� _;-_ Dwelling Type: Single Family !/ Two Family ❑ Multi-Family(#units) Age of Existing Structure a Historic House: ❑Yes /No On Old King's Hig way: QoYes No Basemert Type: M Full ❑Crawl ❑Walkout ❑Other ` 1 6 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 Roam Count(not including baths):existing new First Floor Room Co t ` cn r- r a� r n 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 BUILDER INFORMATION Name � f �a 3 �� � 3 3 0 Telephone Number i Address Ci«e.r 4L0 Q)� r License# G `a ® i ® ® ` 6,0 . OehY-N% S of�6(a o Home Improvement Contractor# , C Worker's Compensation# C Z- 1 S- 'Z , H 06 m ► 5 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY x L PERMIT NO. DATE ISSUED 3 MAP/PARCEL NO. I ADDRESS VILLAGE 8 OWNER I t � r DATE OF INSPECTION: f FOUNDATION I FRAME INSULATION y FIREPLACE ELECTRICAL: ROUGH FINAL i PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING I DATE CLOSED OUT 1 t ASSOCIATION PLAN NO. - o { 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 y Please Print Legibly Name(Business/Organization/Individual): ���.Tt.` ®lAi�- ��0✓� ��f' Address: A°1 C rev^ 10 0 tw, <0 o., City/State/Zip: -�a�, ®AnVn" S c Z 660 Phone.#: 5 DES '3 W-5 S S 5 0 Are you an employer? Check.the appropriate box: Type of project(required):. I am a employer with # 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or.part-time).*, have hired the sub-contractors 2. I am a sole proprietor or partner- These on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition ; workingfor me in an capacity. employees and have workers' Y P h'• 9. ❑Building addition [No workers' comp.insurance comp.insurance.$ required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' 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. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. � i Insurance Company Name: L ` , `^{ a^»IL4L Pol_cy#or Self-ins. Lic.M lO C. 0 1- Expiration Date: d Job Site Address: 2 b y f1c"I LcnZ CeVA-x t tkL City/State/Zip: C;k- 0 Z .-SZ- 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 coveram verification. I do hereby cer der the ains and penalties f perjury that the information provided above is true and correct. Si afore: 'C � Date: - 5 - 0 b — Phone#: S o a, - S S 6 - 'i5 7,> -1 o Official use only. Do not write in this area,to be completed by city or town official i City or Town: Permit/License# Issuing Authority(circle one): L Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ` ce 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 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' 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 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"I:he 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 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. 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. ##6.17-727-4900 ext 446 or 1-977-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass..gov/dia -1 V VT 1L VA L LLL ALO LCL J1%;1 REgulatory Services Thomas F.Geiler,Director ass. Building Division Tom.Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town..barnstable.ma.us Face: 508462=4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion, impiovement;removal, demolition,or construction of an addition to any pre-existing owner-occupied buileing containing at least one but not more than four dwelling units.or to structures which'are adjacent to ding be done by registered contractors,with certain exceptions,along vzth 0rher such residence or buil requrements. ® q ��©(. �, r� ^SCh . Estimated Cos i o (' 0 D Type of Work: i�1���1 v00 � pv Address of Work: L �G L�► CC. rC�/a �i� Owner's Name: Da`e of Application: i 2 ^ S I hereby.cer*that: Registration is not required for the following reason(s): []Work excluded by law ❑Job Under$1,000 []Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: 0;FRS pULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the ag f e owner; � � 1t Date Contractor Signature Registration No. OR Date Owner's Signature Q:wph-les.forms:homeaffi d av Rev: 06060b Town of Barnstable Regulatory Services suu'tn8 . ` Thomas F. Geiler,Director MAM Eo.19. $ Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject pxoperty hereby authorize ���'t'-� ly)O tA,-�O 'N to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Si gna e of wn Date , 0A0 Print Name Q:FORMS:OWNERPERMI.SSION n C�\tAG REGULP\SpR Che °m� OF BVV lAo �R 5OPR 0Nsv- p1a 5e: G 010 0 n e GS 14 55 NUmber•. 1122I19gS Sr ro. 6\�hdace. p01122j20pa �xP`res. 6"qeJoA33 S�ooe� EN o o gg0 co + S G�N\S, P r � r � ✓�+e iJo�mmta2luseacu� o� �LUQBQ6 Board of lug E HOME th Rsil \NIF -. 4 Iq 00 i I'� � 1 � - � 1 0 LA tA 1-14 s'- �- E ! 1 ° y I LA co RI N r p m `� o � vrr 03 OT-4 p GALLON LEACHING RA 2 CHAMBERS(H-20) \ 6� 5 DISTRIBUTION BOX ►� PVC `t \ WRA 3 �Fk 4 E ` w \ 1500-GALLON 9°46'28 , SEPTIC TANK � � 1 N C11 Z e y l � S wo x59 5.5' � i fir, 12.0' P G REA ' ` C Va NV. 21.15' qO #264 . \ g x . EXISTING � 3-BEDROOM 7 8." DWELLING ' OF=23.W 9 21.03' ' 27 2 RA 10 _ / J WRA26 L(OT f / I WRA V WRA 25 24 RA 2.1"% 3 AL ✓WRA 21 'BA LAN \ / WRA 14 WRA 20 o_ �a �� A A RA 15 WRA\ik - —_ �WRA 19 / \ + XXRA1l7 � WRA J \ a iY 1 GOODELL, JOHN E. & POROTHY C. A=186-22 No 24364 permit for .,ADDITION ............ _Dingle Family Dwelling . ............... ....... ........................................... Location ..?.&&1 Bay...Lane............................... Centerville ............................................................................... Owner ...John E. & Dorothy. C....Goodell Type of Construction ..,Frame ..............:...................... ................... ...................... Plot ..... ................... Lot ........ ................... Permit G anted . .....Sep .....13.......... .......19 82 Date of I spection ............................. ......19 Date Co pleted .............. ................ ......19 f' d PERMIT REFLED ................ ............ 19 l00 ........... .............. a ................... ............................. ............ ................ Approved .. .......................................... .. 19 Assessor's map and. lot �/� : -p �� /7(/,$T (/��'�l�lG��'�'gs�s ^!cC/! 'tC���: � ��� nOFTNEo O ' Se*age Permit number .....I co��pl0,ta�NSTA .LED IN C � � 'A�eITH �p �� r �C ii/4"I/ W TIT MST& E L • • • Huse number ......................::.... �a ................................... NVIRONIvIgNTAL 3 TOWN'REGUI� QY{1y TOWN OF BARNSTABLE BUILDING INSPECTOR •= . . , . . nipp . . APPLICATION FOR PERMIT TO .. ......... .... � i.Ii X ...F,. j. ...Add..TD... a G2.2n .Al!�. .. TYPE OF- CONSTRUCTION ....................U-13.0:D..... ..Z&t1,i' t .................................................................... ............. ........a..... 19.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: A LocationDAY. L.A..M. ..............c .. .................................................................................. Proposed Use . �.N\1..�LL I rJ Gj Zoning District ........)z...D....I.............................................Fire District C Name of Owner Sjo. n a :t�®.lt?\ P.. CAG?F�t1f.Address ....;15 A.y L.k, 1'...... ....... Name of Builder ...Y�( .................Address ... A. ..... . .....QLs..T. . . .. ............... Nameof Architect ( `"..................................................................Address .................................................................. Number of Rooms .................... C.)................................Foundation .................. F:............ Exterior ............ .......y-0.,I�d.LI.Ci:L..� y.A....:...................Roofing .......................'46..] 1 ....................................... Floors .\V C2C;7.A7 .................... ................Interior ............... fk.0.111 .............................................. q .Heating ....� ../..... .........t.....................................:.......Plumbing hio...................................................................... � .Fireplace ......................P. .................................................,....Approximate Cost .................................................................... Definitive Plan Approved by Planning Board ________________________________19________. Area .......................................... Diagram_of_Lgt_and_Building with Dimensions ......Fee s. - - Q•- . ........._.��. SUBJECT TO APPROVAL OF BOARD OF HEALTH / Qcr/a�i�idNs ply— "yd 'ze-C f C- I J s I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Namec .............:....................................... GOODELL, JOHN E. & DOROTHY C. ADDITION No.................. Permit for .................................... Single Family. Dwelling fi .......... .... N�-aiion-2=—Bay Lane ................................................................ Centerville ................................................................................. Owner ..J.0h.n...E......&...Do.rot.hv...C....Gg�q.dall .. .... .. .. . .. ..... ....... ... ..... ... Type of Construction .........me. .......:........... .................. .............. ................................ ............................. ......Plot ............................. Lot ....................... ..4 W4 Sept Permit Granted 13........................... ............19 82�1 Date of Inspection .......................... ......:-:-19 1 Date Completed ... PERMIT REFUSED ...................................................................... ..149 ................... ..................... .......................................................... ................... ......................................................... ................... ............................................................................... L Approved ........................................ ......... 19 ................................................................................ ............................................................................... - Assessor's map and lot number ...Yti `:.°..... }J..........:..:..:... r _ -G!c �f THE Se!aage Permit number .......................................... .... ' r• BAR3STADLE, i house number ..............................0 ....................................._ yo Mae& pi, p 2639. \00 �QMPY�' TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ............A:.,... f' .. ,� I J �, - � cF 1..- r'' r r C ^.f ,i ............................:.......................................................................... TYPE OF CONSTRUCTION ..................... /•, () i~?.... ....o . ..................................................................... .............?........:.......t'............19... .'.. l TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .. 1 .�`1... ..... .. a ............... �...r: ` . .. ...' �..�. .. ... '.............................................:.................................... ProposedUse ...... .....:4`................................................................................................................................I......................... ' J) ZoningDistrict ......... ..... .....�..............................................Fire District ...................I..:........................................................ Name of Owner "P 11 _? ...:.. ....`..... .-......... Name of Builder ..._..r , �� P� r ( i r `{ Address !�., rh 1{. ! ,% F.:....%.I�......................... I ........ #........ ... ... ....................... 4 Nameof Architect ..................................................................Address .................................................................................... Number of Rooms .................... ...>:!....?.................................Foundation ��.E w. ..............................:.............................................. Exterior �t% _ ! j� ;, r. + 1..................................................... r, ................................:........................:..........................Roofing .........................,..:... i r r- ......................Interior 19:_ ,' 'ei i F Floors :..... ........................... .:............................................................ Heating ..................... ........ ... ...... Plumbing ........ ...................................................................... . t Fireplace ..:....................!j...........................................................Approximate Cost .................................................................... Definitive Plan Approved by Planning Board ________________________________19________, Area ......... ................................. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH r r , t- /1 A T hereby agree to conform to all the (Rules and Regulations of the Town of Barnstable regarding the above j construction. Name .. ..................................................... -1� MAP I E,t PC hZ j ` 1 t, � �ToP [� ,•�. { 21 .7 AvDiT lo Mae— r' wn s�, � �,, b, C �r V.,, ''' 13�7 i'i.d- 2i•-3 �r � YI � ;Jd•4 � �1.► � .r *J / G 2.1 V} � • � � �{bl.. -4..I x, ` .`+i ,��.„', :•�g t is j' gyp_ �+ � `P ^. �' +� ,.r+".,� - 4E' S��r "J-'•�,..` ''� •- �A"' � '�$`,��,�i� '�?d''i'' '� �,A `,ao�' m, ��-� ,�� s,;. ✓'_ C4"�. �fi P �w1,�' ,. �$�..p J d _y , �� �®® 'DO � .2`�' ! •T �y � �ao�,� i�G. JV'aT�i ':a'�`'i.+r��.t ",...,.�.'r`Y �r• t+�-'6v;ddb. � ".�P'; +a �j�t. kk Y • €s � ,�;s' .A�_ dFa-p- i' G' Fes' rm a'ev. V AV ''�,�'�ii '"�+'ai t& • Q\•$, aaffPf�iya '^g �: iW mp J °{.. 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P. �: 4 �€. : Y � e � r y { i y � E4 r a :. k ry•� r n a e � q r c s P a m .L r 'fee v- a : z y � p IIY � ,o�. .�,.. - ,�✓•-�;�'� was � � d x p r — _ E fi 264 Bay Lane, Centerville 12/6/06 A � b IZAa ; s � k a hIFoj if i.�ti r ,S.mi i ile L S Sr' ' i r k P ��,,,. ' �. �'tl r. ,'`.�.. � �,'i 4,,.-;� :i �: �n�'��'�+✓w'^.'. #,, I ,� � r '��.�>; 0 �zws;. t �'`a'�.'"`x r- . r a a M», u�r r� w x `T -� ♦ iw • u6 ri s, Sz rt q 'v - ' - °M .rfr M , r , { r « z n .�. k� A� `{w '.€`°'Y' � 'M, ,�,- y `�,Ew, .{#`�•s%$ L •-e�" y:S' '.n..,k 4 a r a _ x y a-� wy. ,1� y ^ r 'uW+wbumu.4uyy,,.s „Flold wiyuuWUUWmr nw�,�pym W iitL tl@ .WNUd1u%rn� '� • a1�,y� �r1fi Um,' uw�yNuurlluwolmuryw�ON w51 in�Ni@�dw d^io-.lu or „�� riw.NiWmu •w,n lam.�..•. a '* T w 264 Bay Lane, Centerville 12/6/06 g .� •- .sS✓ II �y t y ✓.r ,.. .::, .. », t�d7 is .rt �v ...� ..,_ ��.� ill ... i... -, - ��Xf•T"-. \40. ..5 � .Y.`' `,a,�-�,�4^�.a� '.�� � +. ���t T,,.. ♦ �' �•,,� .1��' C� �, .v�L I 1 .- )�i �� �4 L � ! � 'r L..�'' --'e`�-�5 `�„�, x �C �., .y � ,� t � � � '-a 1-f-.._..� ,�';., t � �a',``1-.�C -.•.- � �'.� 4 .P'�:✓`'r`-r-''s'�4t .,�°lr,,-"'r,ST,-�'.F,..Y�"` `..+ ,y s r,� .:..?� ;.::., �, rr' �w y.-'sue.• c i r 1 a 0 n t x .a u 5 � , y a I I m �e: 264 Bay Lane, Centerville 12/6/06 PLOT PLAN OF LAND CLIENT FILE NO. 581 DEED REF: BOOK: 21384 PAGE: 218 OWNER: MILAN & JEAN DAY KOFOL PLAN REF: BOOK: 73 PAGE: . 5 ADDRESS: 264 BAY LANE LAND COURT CERT. OF TITLE: CENTERVILLE, MA 02632 LAND COURT PLAN: ASSESSORS MAP: 186 LOT: 22 I � MAP 186 Q MAP 186 I LOT 18 �. `41 MAP 186 LOT 21 N/F JONES 0 LOT 23 N/F MACDONALD W�1 N/F CAROTHERS \ N61o25 0 \ •. RA 2 " ' \ 6 5• WRA 3 \� \ 131.26'- -_ S84(5 ()0"E S89°46'28"E \ c'o \ 1 , W L- .d0 R\ 77�85'\ i 37.'g0'\ 53.40' \ \ \ I X 36� \ \ \ / \ \ \\ WR�`� w �* �� \ /�� \ �ti� XISTING 16 x 19 \ ' \ // \ SCREENED POR& I � 64 4 �� o x 33 Cb A I GAR. if If x RA 32 ^ � // / /^ 9 �, J o: •\ \ \ry ///� / I _ MAP 186\ ,9 ak°\ all. X �_G VRA 3t iii _ - \L 2 \ `• // I — — ' 64,4'9.i S F. \ EXIS�NG \ \ \ \z \ / WELLING I r •BRA$9\ \ \ \ ��6, \\ \ I I I I : �) P. o 00 _VR1C26 `�• - �s � �� ��1�8� �T\ /-20YVETLA�D/L1 WRA 25 WRA 24 j�/ / .oAL MAP 186 WRA 23 ,, �� / / RA 1 1^ dk- D w �N LOT 24 i ��wRA 21�s� \\ ` / z �� N/F TOWN OF BARNSTABLE WRA 14 rno jik WRA 20 \ �a� JQ0/•' tt \ i�XWRA15 WRA'1�-i AL `WRA 19 / E 7�. WRA 196VRA 17 a a MAP 186 '9 LOT 25 N/F HOLTZMAN a � CB/DISK/HELD S � I� I hereby certify that-the lot comers, dimensions, elevations and setbacks to the existing building or structure, including any outside JC ENGINEERING, INC prot;usion such as decks, steps, bulkhead, etc. as shown on this plan 2854 CRANBERRY HIGHWAY are correct and have been located from an instrument survey. EAST WAREHAM, MA 02538 TEL. (508)273-0377 FAX. (508) 273-0367 JOHN y`�. DATE: DECEMBER 7, 2006 SCALE: 1 = 40' U R. N FARREN N0. 33590 A REVIEW OF FLOOD INSURANCE RATE MAP COMMUNITY PANEL NUMBER 250001 0016 D DATED 07/02/92 HAS BEEN /X/NN CONDUCTED AND TO THE BEST OF MY INTERPRETATION,THIS DWELLING IS IN FLOOD ZONE C AND IS NOT LOCATED Date Professional Land Surveyor WITHIN A SPECIAL FLOOD HAZARD ZONE. i . r II i