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0135 BEECH LEAF ISLAND ROAD
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Thomas F.Geiler,Director Building Division Tom Perry,'CBO, Building Commissioner 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 Imprint Map/parcel Number r /0 n 1 � ) IV v Property Address Residential Value of Work j Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name Telephone Numbers Home Improvement Contractor License#(if applicable} Construction Supervisor's License#(if applicable) X-PRE ❑Workman's ompensation Insurance Che one: - O C T 22 2013 I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Irisurance TON OF BARNSTABLE Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request heck box) • Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken t ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) , ❑ Re-side ❑Fence over 6' #of doors Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows` .*Where required: Issuance of this permit does not exempt compliance with o er town department regulations,Le;Historic,Conservation,etc. ***N te: kq ty Owner must sign Property Owner Letter:of Permission. of the Home Improvement Contr tors License&Construction Supervisors:License is ed: - SIGNATURE: QAWPFILESWORMSIbuilding permit forms\EXPRESS.doc ' Revised 051811 CA The C'ammaniveah*of Massat husetts Department of Industrial Accidents 09we of Investigations 600 Washington,Stmet - Boston, 02,111 , nmv mas&gov1dia Workers' Compensation Insurance Affidavit Builders(ContractorsX34chiccians/Plambers Applicant Information Please Print Lezi•b Name Address_ Ctylta�elTp: Pkane# " Are you` employer?Checkthe appropriate box: Type of project(required): 1_❑ I a employer with 4_ ❑ I am a general contractor and I loyees(full andforyact-t 6 Newime).* have hired the sub-contractors ❑ conshuctim 2. I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling These sub-contractors have ship and have no employees8_ ❑Iemolition wcd ng for me in any capacity_ employees and have wrodmn'[No worl=s'`comp_innuance comp_,insuranml 9_ ❑Building addition mod_] 5. ❑ We we a.corporation and its 10-❑Elettci repairs or aslditicros 3_❑.I am a homebwner doing all*oair `. officers have exermsed their 11-E1FJv&bing repairs or additions myself[No workml camp. right of exemption per MGL " 12_ZRoof repairs insurance requued]T G.152, §1(4�and we hive no employees.[No workers' 13.0 Other camp:insurance required] *Any applicant that checks boa#1 nmst also:fai out the section below showing their auorkere ca®Pe tiou policy iafomatlm Homeownerswho submit this af6dasmt ihcati.g they are doing all woak and then hire outside cantmctors mm,mb®it a new affidavit indicating SU& FConbMctors that check this box must attached an additional sheet showing the name of the sub-cams.and:btste whether ar not those entities have empht}ree3. lfthe.sub<aottactaws have employees,they nmsr F--Ade.their workers'romp.policy uunilser. I am an smplayer that is providing►vorken compensmivn insurance for trey enrpinyed& Below is the pati y 0d job site informadviL Insurance Company Name:: Policy#nor Self-ins-Lic.#: Expiration Date: Job Site Address: ` CitylState/zip: Attach a copy of the workers'compensation policy*declaration page(sh:owing the policy number and expiration date). Failure to secure coverage as required under Section 25A of c 152 can lead to the imposition of criminal penalties of a fine up to$1,500.O0 and/or one-year imprisonmerit,as well as civil per#eSiurlhe form of a STOP WORT ORDER and s fine of qp4mN50.00 a day against the violator_ Be advised that a copy of this statement may be forwarded to the Office of htfe!tiA- of the D for insurance coverage verification. Ida+h r u th "s art aNgs qfpeduty that the a rmwiv prm*&d have is aura cv Efate: Phone#: Official use only. Do not wrfte in this 'Me p to be completeid by city or town o Fj etc t city or Town: Permit/License# isuing.Antfiority(darde one): 1.Board of Health 2.Budding Department 3.CitylTown Clerk 4._Electrical Inspector S.Plumbing Inspector . 6.Other. Contact Person: Phone#• . , 6 THE Town'of Barnstable x RegulatoryiServices F, KAM � � Thomas F Geile ,Director, � �^ ��F p 9. Ma+��O � BuildingDivision `f .� . �= Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601� �x I.Wwm us` : Office: 508-862-4038 - � N Fax: 5087790-6230 Ad x.' a Property Owner Must, Complete and`Sign This Section a t If Using A.Builder` ` I, ���` . ;as Owner of the subject property hereby authorize to act on mpubehalf, in all matters relative lo,work`authortzed by this building perriut : pk `(Address of Job) *Pool fences and alarms are the r""esponsibility 'f the'applic in Pools are not to be,filled or utilized before fence is installed.and all,.final inspections are performed and accepted. Signatureof Owner afore of Applicant Print Name- Print Name ?' g ; . Date QYORMSDWNERPERMISSIONPOOLS 6/2012`" "` $ x �r C w e � t 'Town: ®f'Barnstable " Regulatory Services ; ~� • swxxszMl,E Thomas F.Geiler,Director tKass. _. . . 9�A i6g9 �,�� Building Division . rFD MA't _ Tom Perry,Building Commissioner .200 Main.Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4,038 Fax: 508=790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: - number street. village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form.acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other. applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official 1 Note: Three-family dwellings containing 35,000 cubic feet-'or larger will be required to comply with the ' State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions f of this section(Section 109.1.1 -Licensing'of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work that such Homeo wner shall act as supervisor." I Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed. Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor..On the last page of this issue is a foils currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt ( e wpoo.zn.zoaacuealf�o1/6 dac uadM Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date..If found return to:. 1 egistration: 2822 T pe Office of Consumer Affairs and Business Regiflation %Expiration 6/7/2015 Individual' 10 Park Plaza-Suite 5170 Boston,MA 02116 Peter Kennedy 4 ij r I i - tsJ I Peter Kennedy —; jl 444 MISTIC DRIVE MARSTON MILLS, MA 02648' Undersecreta y Not v id without si natut•e' � Massachusetts'-Department of Public Safety Board of Building Regulations and_Standards Construction Supervisor I License: CS-073395 I PETER J KEN1.49 Jly 444 MISTIC DR = M arstons NU Its M�► 02648 J.•�.. �11 ` ,� i„ Expiration 11/02/2014 Commiss ioner TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION . T � Map Parcel" �43/0 - Application # 6'763 Health Division Date Issued Conservation Division ;Application Fee Planning Dept Permit Fee3 � Date Definitive Plan Approved by Planning Board - Fit 1 � Historic _ OKH _ Preservation/Hyannis Project Street Address 3S` Q ez L It A I�' �S���CA R,-D lvd' r Village t cv4c.-V� 1-I e Yin e, 3� Owner H eyri yK li'm O+kl4 vv, } Gel►. Address Telephone Permit Request P pp elp I(,tt e x?st,',^—T Ch�,�t I�enmo Aloe l 04d, paf¢&on G+'t', L'dlh 'I �'� t �► w►4S�Cs S m '� �'r, �G t 4 f l Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay G r� Project Valuation •otonstruction Type Woo rtiM Lot Size C► Grandfathered: ❑Yes No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure J Historic House: ❑Yes &(No On Old King's Highway: ❑Yes ❑ No Basement Type: 5dFull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing_ new t Half: existing neV Number of Bedrooms: existing Q,new Total Room Count (not including baths): existing new First Floor Roomm Count2) Heat Type and Fuel: m Gas ❑ Oil ❑ Electric ❑Other t , XJ Central Air: d1l Yes ❑ No Fireplaces: Existing New Existing wood/ oal stove,❑` ❑ No Detached garage: ❑ existing 0 new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing �Xnevrrrlsize_ Attached garage: fAr'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 _ _ _w= Proposed-Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name NA 6 C Telephone Number Address 3' License# 1 Home Improvement Contractor# 11� vtl� 03 Worker's Compensation # 1)64 69 ALL CONSTRUCTION DE RIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �. M SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED } - MAP/PARCEL NO. ADDRESS VILLAGE • OWNER - s 1 - • DATE OF INSPECTION: r FOUNDATION FRAME Z �c - 1 . { INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING Cft 1440 DATE CLOSED OUT F ASSOCIATION PLAN NO. a The Commonwealth ofllfassachusetts Department of Industrial Accidents r 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): Q Address: o City/State/Zip: ") 1 Phone':#: Are ou an employer? Check the appropriate box: Type of project(required): �y 4, [] 1 am a general,contractor and I . 1. 1 am a employer with 6. New construction employees(full and/or part,tim.e).* have hired the sub-contractors listedon the attached sheet. 7.. e Modeling ..2.El 1 am a solepropnetor or parizier- These sub-contractors have,, 8. D ' ship and have no employees employees and have workers' [] emolition working for me in any capacity. 9. ❑Building addition . [No workers'-comp.-insurance comp. insurance.$ 5. We are a corporation and its 10.[]Electrical repairs or additions required) ' 3.❑ I 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 insurance required-] t c. 152, §1(4),sad 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'eomprnsa6on 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. g the name of the sub contractors and state whether or not those entities have iContrractors that check this box must attached an additional sheet showin employers. if the sub-contractors have employers,they must provide their workers'comp.policy number. Iam an employer that is providing workers'compensation insurance for my employees Below is the policy andjob site Lnformatl0lt. Co hsurance Company Name:_ Policy#or Self-ins.Lic.#: -0 k 0 64 Expiration Date: ® f� C l City/State/Zip: ( W ���� (!�(7 Job Site Add.res, ation page (showing the policy number and expiration date). Attach a copy of the workers'compensation policy declar Failure fo secure coverage as required under 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 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 for- warded statement may be forarded to the Office of Investigations of the DNA for insurance coverage verification. I do hereby cerfi under the ains and p nalties ofperjury that the information provided bove,is true and correct. pc i d - Signature:. 1 Date: Phone#: 1tf'b q ! 5 Official us .on 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 Phone#. __ , a Information a'nd Instrneti®ns 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 tiustee 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 m of 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." AdditionaIly,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 vrith 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)andphone number(s) along with their certificates) of insurance. Limited Liability ConTanies'(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'aad 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 permittlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permiblicense 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 borne 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 at 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: Tho Commonwealth of Massachusetts Deputment of ladustrial Accidents Office of IaVestigatlons- 600 Washington Straet Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 11-22-06 wyr.mass.gov/dia FL-24-2010)� 10:24 From:MARK SYLUTA INS '. 5084209227 To:5087906230 P.1/1 IrCERTIFICATE OF LIABILITYINSURANCE °07/24noosIII, torsi Serial# 10383E THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION MARK SYLVIA INSURANCE AGENCY ONLY AND CONFERS NO-RIGHTS UPON THE CERTIFICATE 771 MAIN STREET HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE.COVERAG FFOR fl BY THE POLICIES BELOW. OSTERVILLE, MA 02066 - INSURERS AFFORDING COVERAGE NAIL# INaurvsD NIALL HOPKINS BUILOErRS INC INSURCR K FARM FAMILY CASUALTY INSURANCE P.O. BOX 231 IN9URM 6 SOUTH YARMOUTH, MA.02864. INSURER C: INBURF3R O. INSURER E: COVERAGES: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PORIOD INDICATED.NOTWITHSTANDING ANY ReQUIREMD'NT;TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY Be IGGL IUD OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN I6 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIBG,AGORC4AT2 LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, II& TYPQ OF INSURANCE POLICY NUMI9BR P I P LIMITS GONERAL LIABILITY CACH OCCURRONCE S 1 OOO 000 A X COMMCRCIAI.GENERAL LIABILITY. 2001 L6275 10/30/2008 '10130/2000 A A M 0 LN'I t 50,000 CLAIM$MADE Q OCCUR MFD F.XP An One rndn S 5 000 PORSO A A ADV INJURY 6 1,000,000 OANRRAL AOORROAT9 6 2 000 000 P129N'I,AOGRfEGATB LIMIT APPLIES PER PROOUCTG•COMP/OP AOO 6 - 2,000,000 OLICY P_ LOC AUTOMODILO LIABILITY cOMDINHD SINOW LIMIT 6 ANY AUTO a, (Gs aa4ldenL) ALL OWNED AUTOS POOILY INJURY „ 9CHE°DULOD AUTOS (Par porson) 6 ' HIRED AUTOS NON-OWNL"-D AUTOS Par ficala ntl INJURY § P�OPHR -pAMAGE 6 (I sr aeoldanU OARA013 LIABILITY . AUTO ONLY-GA ACCIDENT: 6 ANY AUTO "_ CA ACC S OTHER THAN AUTO ONLY Aida S. OXCESGIUMBRBLLA LIABILITY r-,ACH OCCLIRRPNCR s OCCUR r7 CLAIMS MADE AOORr13ATI' S a 6 DIEDUCTIDLE° RETENTION, S 6. WORKER'S COMPENSATION AND 2001 W8458 10/30/2008 10/30/2009 X °. - A QMPLOYERS'LIABILITY ANY PROPRIETORMryAyRTNERIEXECUTIVG m I ACM ACCIDENT" EB $ C7 100 000 OFMCOWMEM©UR VOLUDED9 fL Di 1iA41a-rA I?MPLOYf*F 6 600.O00 If descrIboundar apr_CIAL PROVISIO 6 belrn 191 DIt�68h.Pou u "r s ' 100,000 OTHOR 1 'T1 DQSCRIPTION OPFOPISRATION8ILOCATIONBNEMICLL3BIEXCLUSIOND ADDED OY.ENDORBUMUNTISPECIAL PROVISIONS I BUILDER a 5. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ADoVG DCSCRIDLD POUCILS pe CANCELLED SEFORf.THO OXPIRATION TOWN OF.BARNSTA6L� DATE THEREOF,THE ISSUING INSURER WILL ONDUAVOR TO MAILDAY UN 6UILDINGDEPARTM6NT - NOTICE TO THE CfcRTIFICATGH0I.DCRN CD(QjHL�LGPT;D •AI o�ia,ALL: 20O MAIN STREET IMPOSE!NOOSLIOATION OR LIABILITY OF, N INDiJ LN A R HYANNIS, MA 02804 ROPRGSCNTATwGS. FAX 508-790-13230' NAB` r ALIT HORIZEDREPRUSgNTATIVS i ACI RD 26(2001/08) 0ACORD CpRPOAATIO�I,1080 DIME, Town of Barnstable Regulatory Services seaxsrAIILE, Thomas F. Geiler,Director F ►. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.b arnstable.ma.us 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 property hereby authorize to act on my behalf, in all matters relative to work authorized bythis building permit application for. (Address of Job) � rfv"r Signature of Owner D to Print Name If P%perty Owner is applying for permit please complete the . Homeowners License Exemption Form on the reverse side. Q;FORMS:OWNERPERMIS SION Town of Barnstable Regulatory Services Thomas F. Gei.ler,Director + BARNSTABLE, KAS& ButUding Division ATfD 1��A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town" state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work'performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Bamstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORIvtS\homeexempt.DOC I 11 aaci►usetts Ue}ti ttlent+ Pul�Irr_ :ttc#r i titrd`gf Burlcl tt„ t' ttT< (111114114.St indrtt t7s Cc ostrutif inn to ervisor s Ltceltse.CS 84916 MALL J HOPKINS BOX 231 .. YARM11UTH MA 02564 r £zpirafion 4/2/2011 t F,urnitwsin�tei' .. Tr##: 13216 Boar o ui din a u.1 ions an to g g One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement. ontractor Registration .......... Registration: 161773 - Type: Private Corporation Expiration: 11120l2010 Tr# 278011 NIALL HOPKINS BUILDERS IN Grt y NIALL HOPKINS P.O. BOX 231 := SOUTH YARMOUTH, MA 02664 n Ln•} Update Address and return card.Mark reason for change. Address Renewal ❑ Employment Lost Card 6PS-CAI 0 5OM-07107•PC8490 ✓lt8•U/04JYnta9ul/6¢LIAz-O�.✓l'U1'*IdQ�Lf[d6� ��'�f.�•�:.� . Board of Building Regulations and Standards t License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR 41`° _ before the expiration date. If found return to: ' Board of Building Regulations and Standards Registration 161773. One Ashburton Place Rm.1301 Ezpicetto0_.11/20/26i�,Q Tr# 278011 jNtotd Boston Type=private Coration NIALL HOPKIN$BUILDERS ING NIALL HOPKINS,: ' ,-<..:. ....'':. ' 21 G FRUEANSOUTH YARMOUTH,MA 62664 Administrator without signature §.. ✓fte Board of Building Regulations and Standards I License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: s 1' Board of Building Regulations and Standards _ Registration: 161,773 One Ashburton Place Rm 1301 Expiration 11/2Q/201�J Tr# 278011 {�` 1 y j Boston, a. 2108 ,Type. Private Ccrp�ration , i t NIALL HOPKINS BUILDERS'INC - i 6Ai NIALL HOPKINS V\ 15 21 G FRUEAN AVE:; �..�^' � �` 1 ------- ----- ------- SOUTH YARMOUTH,MA 02664 Administrator 1Not d without signature IV,6's clit�sett -Depai-tmeilt of Public Sitfct� Btiiird:of'Building Reo 111tion4 and Sta��l a dti Constr.uction:Su pervisor�.iicense'' License CS 84916 00 Restncted.to ex ?s I 1€ NIALL J�'HOPKINSK, BQ. X 2314 ''SO. YARMOUTH MAt02664a ' r 'S. = ,. , Gi G— iy �f Expiration: 4/2/2011 r#: 13216 C'milmissioner T JiIt t - .40 ;--- Y z w �V C k. f, f 1 � 4 S • Fv t Rpn S' �a. r t., 181B" 1 —164 - NEW BASEMENT BATHROOM SUPPLY & INSTALL SEWER EJECTOF NEW TOILET . 14 NEW N-- --- SHOWER UNIT STANDARD VALVE AND SHOWERHEY N NEW PEDISTAL SINK FAN/LIGHT COMBO SEPARATE SWI7 I' VANITY LIGHT FIXTURE GFCI OUTLET ----- `* HEAT REQUIRED AS PER EXHISTI� df 1 - _ Jc� k _ t d ' •- ,� fir. M� �/ /fn U r II I i e 3`I' tl 7-13 \tV+ x° # El l s. s t 1 ,- TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel l002 Application#_ Health Division Conservation Division Permit# Tax Collector Date Issued Treasurer Application Fee (� Planning Dept. K Permit Fee �- Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 135 geec,L t e U /� (.5 t/a d 92 Village CF-N UT Ul LLF- Owner & 1 Address Telephone --5AG';9 Permit Request Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay 1407- "-S 15-5SAgc.p Project Valuation 42-0 ID 0 0 Construction Type cl Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. �- l Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) �J 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) 0 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 I ❑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: w.., Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ V;. CJl Commercial—❑Yes— :❑No_ --.If-yes,site plan review# c Current Use Proposed Use BUILDER-INFORMATION ' I co Name �J%�L�lr'/( ��,Y- C.� SOLML Telephone Number Address 6y 0&Sh& -e_ P-d License# a,2 Home Improvement Contractor# I q 6 7- Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO �� Coo P�y� SIGNATURE DATE T! Q7 i f ' FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER ,r C DATE OF INSPECTION: ; S FOUNDATION FRAME INSULATION i FIREPLACE 's ELECTRICAL: ROUGH FINAL k PLUMBING: . ROUGH FINAL GAS: ROUGH FINAL s FINAL BUILDING DATE CLOSED OUT ' ASSOCIATION PLAN NO. r JUN-21-07 81 :34 PM TALANIAN BUNKER INS AGCY 781 b59 2499 P.AI o'A / VL 0 — T `t r a i• 1 CAT!(MMIDD ><. 6/05./0 THIS CERTIFICATE IS OWED AS A MA R INFORMA D Bunker Insurance Agency ONLY AND CONFERS NO RIGHt6 UPON E CERTIFIC ; 2 Washington $treat HOLDER THIS CERTIFICATE DOES NOVA M D� VC17 D. ALTER THE COVERAGE AFFORDED 61f E lIC1E8 W Well _• COMPANIES AFFORDING _..E. E MP''02061 • 81 659-0400 - COMPANY _._L_.. ._ ( j -_ _ A"Scottsdale 'Ins. Co. COMPANY ouiBQXa89r }_ a Granite-State Insurance mpan' ' 4 Old Shore Rd. COMPANY Arbehla Protection Ins. Co. uit MA 02635- ,- - - 428-8442 C pANY : a __.:w w..... Its IS TO CEfiTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW NAVE BEEN I88UED TO THE INSURED NAMED ASOVE FbR TH POLICY PERIQ ,:I 1 DICATEO.N07WITHSTANDINO ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH'RSPE TO WHICH T#I i.El LUSTFIC NS MAY BE 18SUE0 Oii MAY PERTAIN,THE INSUMNCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 16 SUBJECT TO ALL THE tERM,B;. .I CLUSIONS AND CONDITIONS OF SUCH POIICIEe.LIMITS SHOYYN MAYIIHAVE BEEN REDUCED BY PAID_CLAIMS. ; TYPE OF IN —_ POUOYNUMBER l POLR:YEFFEC7IYE POLK;YEI�IRATKNI) —_-_ 111 DATE IMM/D " DAIS(MUMD/M ! Lmun {t UASAiT1/ GENERAL AGGREGATE 621 00,0 COMMERCIAL GENERAL UAgurf +CLS1384056 :06/01/07 06/01/08 rFR0OUCT6•OOMPA7PAm 12 000 1HY cwMs MADE OCCUR _�. PERSONAL&ADY INJURY. 61 0 0.0 0 _ OVIMEFS a CONTRACTORS PROT _ FAW OCCUMENW 11,00,0 0 0., — ; FIRE OAMAGE Wry b►.�_ i 5 0 ISUADILITYMEDEAPOM01qpe w) S :5 0 0:[ FAUTO T/B/A 04/30/07 04/30/08 c OmBINED SINGLE LIMIT 110 0WNeoAUTOs DULED AUTOS Sr iar AUTOS NON-0WNED ALR� BODILY INJURY 8 IPwAscidulp PROPERTY DAMACE SA . LWA ! of LIABILITY AUTO ONLY•EA ACODENT 1 i ANYAUTO I OTHER THAN AUTD ONLY: _--' EACH ACGDENT AMbREGATE S` ! t r0:THER BILITY EACHOCCURRENCE LLA FORM AGGREGATE THAN UMBRELLA FORM _ $OMPENSATION AND'LIAMUTY PROP�EroRl _ t/b/a 0 6/0 5J 0 7 0 6/0 5/0 8 EL EACH AMIDENT; _ 6500 00 C ERB ARE: UTn/E i►vCL, E0.osEASE-POCKY'#ff. a 5-0 0 .0 0 ' EAB ARE: X ExcL EL MEASE-EA gMAOYU $5 0cR01000, I ON OFOFMIONS11AC M)IGNEHICLESISPECIAIITEMS I ....:�... .. .. .. .._ . .......... . .-.......... �..,< SHOULD ANY OF THE ASOYE DESCRISEO POUCRS SE _.0l►0RE EXPIRATION 0AT! THEREOF. TILE 6*IjgNO COMPANY WILL ENDEAVOR,TO L 'DAYS WRITTEN BIOTIC!TO THE CERTIFICATi HOLDER NAMED TO THE LEItT, I� BUT FAILURE TO PAIL SUCH NOTICE SHALL IMPOSE NO OSL CATION OR UASI f OF ANY KID UPON THE COMPANY, ffS ACIVITS CA REPRESINTA - AUTHO EPAEO ATRI! r...........ixnf.' sx�a�,:�:t•�>x.•xu> .exo ......... IN , The Commonwealth of Massachusetts Department of Industrial Accidents 1• '� Office of Investigations M— / a 600 Washington Street Boston MA 02111 �V r; www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legiblv Name (Business/Organization/Individual): f.:.1) O ty Address: F City/State/Zip: 60TU M A- D L6 3 5- Phone #: © 9 q Z f — S V Y 1 Are ou an employer?Check the appropriate box: Type of project(required): �I 1. am a employer with 5 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired thesu -b 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 8. ❑Demolition - working for me in any capacity. workers',comp. insurance. 9. ❑Building addition [No workers' comp, insurance 5. ❑ We are a corporation and its i` \r \ 10.❑Electrical repairs or additions required.] ( �. officers have exercised their 3.El am a homeowner doinglall work ,t right of exemption per"MGL 11.0 Plumbing repairs or additions . myself. [No workers' comp. ,} c. 152, §1(4), and we have no 12.E]Roof repairs insurance required.]t Jac. 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`aF d then hue 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 their workers'comp.policy information. I am an employer thPat is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: S tJ /C--E Policy#or Self-ins.Lic.#: 874474 Expiration Date: 2®0 Job Site Address: 13 S f�N Lf— tf _'F5cAl N 0 l2 City/State/Zip: C PqA 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 c i under t e p ' s anddpenalties of perjury that the information provided above is true and correct Signature: 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/Town Clerk 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,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-contractor(s)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 �ndustrial 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 shouldenter their self-insurance license number on the appropriate line. City or Town Officials t s � 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 perinii/license applications in any given year,need only submit one affidavit indicating current information if necessary)and under"Job Site Address"the applicant should write"all locations in (city or policy inform ( ary) PP 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 f 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. # 617-727-4900 ext 406 or 1-8.77 IMASSAFB Fax#617-727-7749 Revised 5-26-05 www.mass.gov#dia X V rrll VA 11ax L&a .a1✓1{o Regulatory Services s�uvsres . ' Thomas F.Geiler,Director :639. .•`' Building Division Tom.Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us dice: 50 8-862-403 8 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW -SUPPLEMENT TO PERMIT APPLICATION MGL c, 142A requires that the"reconstruction, alterations,renovation,repair,modernization, conversion, improvement,removal, demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units.or to structures which'are adjacent to such residence or building be done by registered contractors,with certain exceptions,along V dth o*ther requirements. Type of Work: c)t_A-(, 73 0 Estimated Cost 4 I S, 0e 8 Address of Work: 115 B r__�K LsA-,F '6",s Lt,--J ® Fla. M A. T31� Owner's Name: Date of Application I hereby certify that: Registration is not required for the following reason(s): OWork excluded by law •Job Under$1,000 []Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: oWnRS 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, SIG UNDER PENAL S OF PERJURY I hereby apply for a permit as the a nt f the own . Date Contractor Signature Registration No. OR Date Owner's Signature Q-.wpfnes.forms:homeaffi day Rev: 060606 1 91te -0 Board of Building Regula ions and Standards ' One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 146276 Type: DBA Expiration: 4/8/2009 Tr# 131107 COTUIT SOLAR CONRAD GEYSER P.O. BOX 89 COTUIT, MA 02635 Update Address and return card.Mark reason for change. DPS-CAI Co 50M-05106-PP�C8490p Address ❑ Renewal Employment Ej Lost Card • ,�., ✓d2G "C/J6I7tiIJ2O42I,C+C(ZGG/L O�i/l�Gll/JdlrC>/GC14¢�d . Board of Building Regulations and Standards License or registration valid for ludividui use only Y HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: F " Registration: 146276 Board of Building Regulations and Standards One Ashburton Place Rut 1301 Expirations 4/8/2009 Tr# 131107 r Bos o Ma.02108 Type::,DBA COTUIT SOLAR / CONRAD GEYSER % 3800 FALMOUTH RD. —�.y �..` Yt 'Town of B,arnstable Re t Services - - �,�, � Thomas F=Lefler,Director . Tom Perry ag commissioner 200 Main . <Hya�mis,MA D2601 www,to 3 arnstable ma us office: 508-862-403 8 Fax: 508-790-6230 : Properwner Must Complete and sign This Section If Usmg.A Builder TI, 4a �l ,as Owner of the subject property hereby authorize to act on my behA in aIl nramers relative to work authorized bytU binding permit application for. (Address of job) Signature of Owner Dke 5- e, -� � Print Name Q•F0MB OWNER7Mkb MW r Current Use rruputim u,-vu BUILDER ENTF Map http://www.town.bamstable.ma.us/arcims/appgeoapp/map.aspx?proper... Town of Barnstable Geographic Information System New search Home Help Parcel Viewer 11 Custom Map Abutters Map Size 13 ❑ Zoom Out L a n n Q U O 0 Bn N��1 FtP ® )PG Map: 187 Parcel: 063-002 Full —ID63 Property 1a7Da2!„�1a7DDa Location: 135 BEECH LEAF ISLAND ROAD Info p 104 p .87080001 156 ` 51 Owner: HERRICK,TIMOTHY W&BETH B iLoc_a_tion Information 187080002 p0 187MMI Map&Parcel 187063002 0121 Location 135 BEECH LEAF ISLAND ROAD { Acreage 1.22 acres 187080001 .Current Owner 859 - P�i�W�0 --w- ---t 8143 Mailing Address HERRICK,TIMOTHY W&BETH B 135 BEECH LEAF ISLAND RD W _ CENTERVILLE,MA 02632 1 1a7D79DD1 Appraised Value(FY 2007) l — Extra Features $30 300 -i p� 187063001 p 135 � Out Buildings $0 187070W2 Land pD $306,600 Buildings $420,800 Total Appraised $737,700 Assessed Value(FY 2007) i 180092 Extra Features. $10,300� -- pD Out Buildings $0 0 106 Feet 187034 Land $306,600 Buildings $420,800 Total Assessed $737,700 Set scale 1°=106 { Aerial Photos rnnctn�eFinn OPtaih~ � Copyright 2005 Town of Barnstable,MA All rights reserved.Send questions or comments to GIS BarnstableMA v0.2.91[Production] - 1 of 1 3/30/2007 3:17 PM f l y S C o nl lF.5=G , .. 3' 2. ' � '.. ^-� '. ----�------^�-t� -- ' � y �' ✓'L..:. t..t � �--fib' .�a j � r i 3 a .~` 12^-c� ry I t n The Commonwealth-of Massachusetts i Department of Industrial Accidents ! - Office of Invesfigations tqLt 600 Washington Street Boston,MA OZIII www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lepibl Name(Business/Orgmization/In"dual): C 1DVVz ` _ i Address: Box 8ff i i City/State/Zip: 60*t_csX-N_ 1°d Ar 0 Z6 3 S Phone#: 5-OR - f Z P " 8 V Y 2 AWreou an employer?Check the appropriate box: Type of project(required): 1. 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-cofactors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.t y Remodeling and have no employees These sub-contractors have 8. ❑Demolition s �P working for me in any capacity. workers, comp.insurance. g• ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions required] officers have exercised their t of exemption per MGL 11.❑Plumbing repairs or additions . 3.Elri�I am a homeowner doing all work myself. [No workers' comp. c. 152,§1(41 and we have no - 12.❑Roof repairs insurance required.]t 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. tcontractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. 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.Lie.#: S 7 4 4 7 6 Expiration Date: _57/.5`/2 D a Job Site Address: City/State/Zip: 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 Stignsw—M Date: Phone#: �� `_ci L L/ 1 Off vial 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#: pv 5 w'rc v 6 r _^y 41. C O T U 1 T SOLAR P.O. Box 89• CotUk MA 02635. 508-428-8442• Fax 508-428-8450 Got e-mail? My guess as to how the week goes: Monday: Barzun dock installation Ben, Todd, Larry sand and fair decks of new boats Bry, Dan hardware on of itand Keally Dan, Bry Service call to Frank Todisco Nate wire-commission system at Pecks Nate, Larry IS GREASE OUT OFF WAY? , Tuesday �Nlove-Keally_`Bring up Long, flip, bottom paint two part poly on Goodwin and Benoit Dan Prep for StackpoleMeymouth installation see launch schedule for boats to go after Wed Stackpole/Weymouth SDHW installation Launch Long two part poly on Goodwin and Benoit Dan see launch schedule for boats to go after Thursday to be continued....... 1 t 3 S t3 EFc td, sS LA+l C V-r4,N-CA v NALF f`r f / f0 'K r pFSME 1p� Town of Barnstable �. Regulatory Services 9 BARNSTABLE, Thomas F.Geiler,Director �ptE� �pie Building Division Tom Perry, CBO,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Building Permit Procedure for Residential Addition Or Remodel Or Dock ❑ Determine map and parcel number and enter it on application. ❑ Historic District Commission,200 Main Street, approval required prior to construction/demolition for any properties located in a Historic District: • Old Kings Highway Historic District(north of the Mid Cape Highway) Hyannis Main Street Waterfront Historic District(See map for boundaries) • Historic Preservation(if applicable). ❑ If ZBA relief(Special Permit or Variance is required for Project): ❑Copy of ZBA decision ❑Documentation proving that decision was recorded at the Registry of Deeds w/in one year of ZBA decision date ❑ Approvals from the following departments are required and can be obtained at 200 Main St.: ❑Health Department (8:0 v—9:30 Airi&3:3"v—4:3"PM {^ rr,r.._ w 2nd I_nnct v aS of 1VlalCll , c.vv_�f ❑Conservation Department (8:00—9:30 AM & 3:30—4:30 PM) ❑Tax Collector {can be obtained from Building Department} ❑Treasurer {can be obtained from Building Department} ❑ Permit must contain complete owner information, full description of project, correct square footage of project,valuation of project(must agree with Total Cost from Project Worksheet), building detail for Assessor's Office, complete builders information, including signature and date of application. ❑ 5 sets of reduced house plans measuring 11"x 17", scaled 1/4"= 1' & fully dimensionalized are required. Plans must include a foundation, cross section,framing schedule, insulation detail & floor plan showing location of smoke detectors (located with a Red `S'.) ****** IF USING ENGINEERED LUMBER AND/OR STRUCTURAL STEEL,ENGINEERING DATA MUST BE PROVIDED****** ❑ Plot plan or mortgage survey required for any addition. ❑ Home Improvement Contractor's Affidavit ❑ any Workers Compensation Insurance Affidavit form must be submitted for workers hired. In the event the homeowner takes out the permit, subcontractors hired must supply this. Copy of Insurance Compliance Certificate must be on file. ❑ Energy Compliance Form ❑ Construction Supervisors License&Home Improvement Contractor's License OR ❑ Homeowner License Exemption Form must be submitted if homeowner is acting as general contractor or builder for the project. ❑ Property owner must sign Property Owner Letter of Permission. ❑. A NON-REFUNDABLE Application Fee must be paid upon receipt of application number. All checks should be made out to the Town of Barnstable ❑ CHIMNEYS: Need Home Improvement License,no plot plan required ❑ PIERS AND DOCKS-Need Construction Super License AND Home Improvement License. OWNER CANNOT PULL OWN PERMIT. Projects requiring the use of a crane must complete the forms issued by the Aeronautics Commission Q:forms/bldgpeMit/R_addalt 101106 �1J3�1o6 �z r Town of.Barnstable *Permit z�7 g 7 Expires 6 month sJrom issue date tznarvsrestE. : Regulatory Services Fee Thomas F.Geiler,Director r. Building Division °9 f-r Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 NOV 8 2006 www.town.barnstable.ma.us Office: 508=862-4038 TOW"MARM55ABLE EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not.Vaita without Red X-Press Imprint, Map/parcel Number 3 0 Property Address 5 e C Le ajr -V ill le Residential Value of Work �Q Minimum fee of$25.00 for work under$6000.00 Owner's Name&Addressry1 011 U kn-� CK S a vtr RJ CD✓l r-V I lL e AAA62J03>2 Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable)_ Construction Supervisor's License#(if applicable) 02AD 2)as kworkman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name_ TY Q JcO rSA7 5 Workman's Comp.Policy#� (`�L rj 9 t, b Copy of Insurance Compliance Certificate must be on file. 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 ❑ Replacement Windows. U-Value. (maximum.44) •Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Home Improvement Contr ctors L' nse is required. SIGNATURE: Q:Forms:cxpmtrg Rcvisc071405 U 1 , �s The Commonwealth of Massachusetts ! Department of Industrial Accidents Office of Investigations 600 Washington Street i Boston, MA 02111 www.mass.gov/dia. Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): P ` (—T Au - Address: a l n S City/State/Zip: OS�-P_(`V l -p 'A ,4-0Xo 55hone #: <4 2F— Are you an employer?Check the appropriate box: Type of project(required): 1.14 I am a employer with `2— 4. ❑ 1 am a general contractor and 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 8. ❑Demolition working for me in any capacity. workers' comp. insurance: 9 ❑ Building addition [No workers' comp. insurance 5• ❑ We are a corporation and its required.] officers have exercised their .[:]'Electrical repairs or additions I❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12�toof repairs insurance required.] t employees. [No workers' comp. insurance required.] 13.❑ Other 'Any applicant that checks box#I 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 their workers'comp.policy information. 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. �3 to Expiration Date: a Job Site Address: tyIState/Zip: 74 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 cer ' under the pains and penalties of perjury that the information provided above is true and correct Si nature: Date: Phone#:. 50 fir- 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#- ors"E,�ti 'Town of Barnstable Regulatory Services ISAIWSTADLE, v XA g Thomas F. Geiler,Director 109. �0 Building D yision. Tom Perry, Building Commissioner 200 Main Strcct; $yannis,MA b2601 www.town.b arnstabl e.maxs ffice: 508-862-403 8 Fax: 508-790-6230 Property Owner.Must Complete and Sign This SQctioxl if Using A Builder as.Owner of the subject property hereby authorize GA �'&,\ to act on my behalf, in all matters relative to work authorized by this building pem�t application for: (Address of rob) Signature of er Date Kell Y'f I ,Print hTatne . of Q:FORMS:O WNERPERMISSION t n•n:•.....;�.; a �$ �� i I�t� F a » yy OATE(MMIDDIY "j�L PRODUCER: THIS CERTIRCAT.E IS ISSUED AS A MAITTER:aG IIJi LF.yR+f�;w,ta► ` DOCVLING &'O NEIL INS AGC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE: ` 222,WEST=),WIN .STREET. HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND"Ofl 'P:O:;,Ito:c '1990 ALTER THE COVERAGEAFFORDED BYTHE P.OUCIES BFl nW_ HYANNIS 14A 02601 COMPANIES AFFORDING COVERAGE '22 LCR CONRA\r♦ INSURED A TRAVF[,KRS PROPE,R.TY CASUALTY COMPANY 01, AMERICA ' COMPANY PAUL J CAZEAULT 6 SONS INC. B 1031'NA.I14 STREET O5TERVSLLF, KA•02655 COMPANY C COMPANY :Cl7SlElCAGES:°>'; ;.: M,: ;• ah D Y:. " ,./:e..ha:;::n•.n..:» 'lfi:�!:r.L:YSX: . >.. �c::•::::A.::•i':'i'.. 'j..... i a.. ak< ) .ak TH s Ts Ta CE RTIFY FY AT TH PO Ll .CIE S'�OF I NSU RA E .,TED BELOW� IC .»ai•; 'INOICATEO;'NOTVJITHaTAM1tDING ANY R HAVE BEEN ISSUED NAMED* POL ABOVE EOUIREtdENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT O WHICNETHS, ".%CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, "''EXCLUSIONS AND CONDIYION3 0P 3UCH POLICIES.LIMITS SHOWN MAY-HAVE BEEN REDUCED BY PAID CI'AIMS: .T TYPE OF INSURANCE POLICY EFFECTIVE POLICY EXPIRATION' LTR POLICY NUMBER - ' DATL(tdtADtAYY) OATE(MWUU'kYY).• LIMITS GENERAL LIABILITY CUMMhH(31AL GtNEFIHLiIABILUY' GENERAL AGGI'iLGATE y 1+II000CIy1;Ijf,AN%UI°M3L:. j CLAIMS MADE a OCCUR. PERSONAL 8 ADV.INJURY f3`niN@Ft'S a ttivty7HAGTiiR�PRDT,' y EACH OCCURRGNGG y RRE.DAMAGE(Any one tire) y AUTOMOBILE LIABILITY MED..EXPENSE.(ArN one peraen) y, ANY AUTO COMBINED SINGLE y ' - LIMIT ALL OWNED AUTOS SCHEDULED AUTOS 80811:Y INJURY (Per Person) i HIRED AUTOS NON-OWNED AUTOS BODILY INJURY 3 (Per Accident) PROPERTY DAMAGE ; GARAGE LIABILITY ' ANY AUTO' 'AUTO ONLY-EA ACCIDENT' y uTi+FR TiiAN AUTO ONLY: EACH ACCIOLNr, S. EXCESS LIABILITY AGGRLGAIL y UMBRELLA FORM EACH OCCURRENCE . y OTHER THAN UMUHELIA FOHM AGGREGATE ; WORKER'S COMPENSATION AND A EMPLQYERS.LIABIUTY. (LIB-0095B64-A-06) 08-10-06 08-10-07 STATUTORY LIMITS •THE PROPRIETOR! EACH ACCIDENT PARTNEFWEXECUTIVE ` INCL OFFICERS ARE: EXCL DISEASE-POLICYUMIr ; DISEASE-EACH EMPI OYES- Im,on "♦ L P IT. , T1-1IS REPLKE3 A14Y PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKER COMP C..••a;•FIC,`. :�' OL R :- i:, ii3?: s:i COVE ,. ..:♦f^,, ''£,3' ;'s'� <4. Er sa��s:v;#;•.t:;Eisvt,: RAGL�. t `SHOULD ANY OF^THE ABOYE DESCRIBED'POLICIES BE CANCELLED BEFORE THE r Paul J.Cazeault 8�SOITS EXPIRATION DATE TIIEHEOF, THE ISSUING COMPANYWILL ENDEAVOR TO MAIL Roofing,lac. 10 DAYS WRITTEN NOTICETO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION 1031 Mai a Street GATION 0 H wa PILITY OF A11Y•KiND UPuNTF1iEC94WiA -'i ITSM,CI�TS r G K RGP FiES.FiiTA•TIYES.. Ostervlllc, MA 02655 AUTHORIZED R S AUTOO EPRE ENTNATIVE p 1.��...-mac, . on:cnpORa7laH1�9�: v Client#:19989 2CAZEAU LTPA ACORD- CERTIFICATE OF LIABILITY INSURANCE ' 0DATE(MMIP 519/06DNYY-Q PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling$O'Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency HOLDER.THIS CERTIFICATE DOESAOT AMEND,EXTEND OR 222 West Main St.PO Box 1990 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hyannis,MA 02601 INSURERS AFFORDING COVERAGE NAIC# INSURED - INSURER A: Western World Paul J.Cazeault&Sons Roofing,Inc. INSURERB. 1031 Main Street Osterville,MA 02655 INSURER C INSURER D: INSURER E: 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. POLICY EFFECTIVE POLICY EXPIRATION LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD DATE MMMD LIMITS A GENERAL LIABILITY NPP1012091. 04/30/06 04130/07 EACH OCCURRENCE $1 00p 000 X COMMERCIAL GENERAL LIABILITY DAMAGESE a TO RENTED occurrence) $50,L000 CLAIMS MADE Q OCCUR MED EXP(Any one person) $2 500 X BI/PD Ded:1,000 PERSONAL BADV INJURY $1 000 000 • GENERAL AGGREGATE $2 000 000 GEN•L AGGREGATE LIMIT APPLIES PER_ - PRODUCTS-COMP/OP AGG $1 00O 000 POLICY jEcT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) i GARAGE LIABILITY AUTO "AC $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ I OCCUR CLAIMS MADE AGGREGATE $ I _R DEDUCTIBLE - $ RETENTION $ $ WORKERS COMPENSATION AND WC STATU- OTH- j EMPLOYERS'UABILITY I ER j ANY PROPRIETOR/PARTNEPoEXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ If yes•describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER i I DESCRIPTION OF OPERATIONS I LOCATIONS l VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS :j Certificate of insurance will be issued directly by the-insurance carrier. ;I 1 CERTIFICATE HOLDER CANCELLATION i SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Informational purposes only DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10_ DAYS WRITTEN' NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SA SHALL IMPOSE NOOBLIGATK)N OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATNE ACORD 25(2001/08)1 Of 2 #42866 LSD G ACORD CORPORATION 1988 I I I i I %e &mmowawa&Jt Board of Building Regulati ns and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration. Registration: 103714 Type: Private Corporation Expiration: 7/9/2008 PAUL J. CAZEAULT & SONS, INC Paul Cazeault 1031 MAIN ST OSTERVILLE, MA 02658 Update Address and return card. Mark reason for change. C_1 Address ,[ I Renewal I Employment ! Lost Card DPS-CAI CP 5OM-05/06-PC8490 ✓1. 00/l/la4auclucaP/16 Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. if found return to: - Registration: :103714 Board of Building Regulations and Standards Expiration:>7/9/2008 One Ashburton Place Rm 1301 Boston,Ma.02108 _;Type::Private,Corporation PAUL J.CAZEAULTA\SONS,INC 1 Paul Cazeault '� Cp- 1031 MAIN ST OSTERVILLE,MA 02658`" Deputy Administrator Not valid without signature i Board of Buildin egulations One Ashburton Pace, Rm 1301 Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 10/20/1959 Number: CS 026325 Expires: 10/20/2007 Restricted To: 00 PAUL J CAZEAULT 1031:MAIN ST OSTERVILLE, MA 02655 Tr.no: 7696.0 Keep top for receipt and change of address notification. `.:,DPS-CA1 G 50M-04/05-PC8698 ' i ✓1. ZJO'I)YI17R'IL!//QQ.G[/L o�✓��,MaC�tu6elt4 BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR �! I Number:aCS• 026325 8(rtpdate: 10/20/1959 ` Expiresi 10/20)2007 Tr.no: 7696.0 t. �. Restricted: 00 c_. PAUL J CAZEAULT'`; l 1031 MAIN w ALBERT J. SCHULZ 20868rc.ltr ATTORNEY AT LAW WILLIAM CHARLES PLACE 7 PARKER ROAD OSTERVILLE, MASSACHUSETTS 02C355-2034 TELEPHONE(508)428-0950 FACSIMILE(508)420-1506 February 1, 2000 Ralph Crossen Building Commissioner Town of Barnstable 367 Main Street 1 Hyannis, MA 02601 Re: M Beach Leaf Island Road, Centerville, MA 02632 Dear Mr. Crossen: This letter will serve to confirm our meeting on Monday, January 31, 2000, concerning the above captioned premises. As I mentioned to you, I represent the prospective purchasers, Timothy and Beth Herrick, who have agreed to purchase the above captioned premises on February 2, 2000. Yesterday, while reviewing the building permit and related documents in your office, I discovered that the house plans submitted with the building permit application are not the plans for the house that was actually constructed. Specifically, the plans submitted with the application are for an eight room, 3-bedroom residence with a garage at the first floor grade. The house, as constructed, is a nine room, 4-bedroom dwelling with a garage under. A reduced copy of the submitted plans are attached to this letter. The dwelling was completed and the Town issued an occupancy permit on November 16, 1993. A copy of this certificate is also attached hereto. The septic system has recently been inspected in connection with the purchase and found to be sufficient for a 4-bedroom residence, without a garbage disposal.' Based on the above facts, you have advised me that the house, as constructed, is not in violation of the Town of Barnstable Zoning Ordinance. If this remains your opinion, I ask that you sign the original of this letter and return it to me at your convenience so that the closing can go forward on Wednesday, February 2, 2000. ' The original septic permit was issued for a 3-bedroom residence with a garbage disposal. 20868rc.ltr If you have any questions or need any additional information, please feel free to call me. Thank you for.your cooperation in connection with this matter.: Sincerely, Albert J. Schulz AJS/mm Enclosures E � ? i� - — t - - 3 K O GN ATE M.1/A4C1f tiCCT 00 Li I u - = oo rL- I .S�IDCR1 Dv PGI�-4 I � 1 6>R.�OMLl'SY LTA�1lG� i o •ol _ ..—V 4.1 La 1. __ "SIT !•'—- ., - I'` l Z6? '4fM„�*.. ty - 5-1 L_ i .-0 i 1 -0 i r _ vluy� v/Ny� wit Le1NgM1 I �. i, &Licir vrl.ly� t °• m ail � day d. ,. '. _ f>' 1 -,�-• d • ti �0 - - I sTer I LIVI IJG 2do��. ! C1aPCT NA. xdn cma I m I r I i 4' ¢el"F C01_JGR Sing. I - u'• JI 01TGR V To I TLS•(.6rL;... N I( s/g F.c. suaerrroui ------ -- 2v o W-4" I e' -- Imo•"a•.__ 1■� 1 , 4 • V , �oI O F I - I I Imo',• q'' CONGR APrtoN - . Ij i 1 �M C� 4,-p..e fo''o'• , �- 11'-8' ...... ...I..r—_G.'.p," .,y., ,6 �`_ ,.. ¢ 1J ti; x =a�I �J, • N YLOiLOYA • ; C�RPaT . 1 � � ..�G i q— CCGCs�. r I � 2— SToR,4cat i O — A-m c. cal 1 Su6 rboll pPeU !Zp - I FoYG R. i- i • 41 3o,�gq • ct 1 T ti TOWN OF BARNSTABLE Permit No...3 G 1 0 6..... BUILDING DEPARTMENT ................TOWN OFFICE BUILDING +v NYANNIS.MASS.02601 f' Bond ......li........ CERTIFICATE OF USE AND OCCUPANCY Issued to `tthornberry Lane Nominee Trust Address trot #4, 135 beech l,C'iat Island Road Centerville, .LbSass. USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTdRY COMPLIANCE WITH TOWN REQUIREMENTS AND.IN ACCORDANCE WITH SECTION 119.0 OF.THE MASSACHUSETTS STATE BUILDING CODE. November..16.,..., 19......9.3....... .............. • . Buildin�nspector L04'- e1v lPe,-,5-:�'W 0 -,5 - Assessor's office(1st Floor): 3 / (JQ Sep-ric Assessors map and lot number G /�1D(t� e� �� � - rpCAI TUC ro Conservation Board of Health(3rd floor): Sewage,Permit number �l" 3� rC7V � ssrsr►ntt �� � v Engineering Lepartment(3rd floor): House.number I 3.5_ Definitive Plan Approved by Planning Board — �3 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE . BUILDING INSPECTOR APPLICATION FOR PERMIT TO uQ.+✓GLG � ///��z.2 TYPE OF CONSTRUCTION 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for --a��permit according to the-��following information: ,� Location s / � 2 J2A �� ! � 4--?- 1 / J Proposed Use l Zoning District Firestrict t��� • Azzar Name of Owner Address Name of Builder Address Name of Architect 11<1114Address `iif�✓C Number of Rooms Foundation Exterior Roofing �f r Floors ' b` v Interior r y- Heating `' 2 Plumbing U a Fireplace / y�G h Approximate Cost Zp d6,60krea �G D Diagram of Lot and Building with Dimensions ee 1,3� `vim pg o �3 Z OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name / Construction Supervisor's License 41,9a 5�' S THORNBERRY LANE NOMINEE TRUST 3 No- 3,610 6'T permit For 11 STORY Single Family Dwelling �Looation'' .Lot #4 , 135 Beach Leaf Island Road ' Centerville Owner ; Thornberry Lane Nominee Trust _ f .. • T_ - Type of Construction Frame , Plot LotTZ August i9 , 19 93 , Permit Granted Date of Inspection-' nspection 5/15/ 5 - 19 # , � Twr TOWN OF BARNSTABLE Permit No. .. 96 BUILDING DEPARTMENT 4 ""M } TOWN OFFICE BUILDING Cash HYANNIS,MASS.02601 Bond ......x........ CERTIFICATE OF USE AND OCCUPANCY Thornberry Lane Nominee Trust" Issued to � Address Lot #4, 135 Beech Leaf Island Road°- Centerville., Mass. USE GROUP FIRE GRADING OCCUPANCY'LOAD THIS PERMIT WILL NOT BE VALID, AND-THE.BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR ;UPON SATISFACTORY COMPLIANCE.WITH TOWN` , REQUIREMENTS AND.IN ACCORDANCE WITH SECTION 119:0 OF THE MASSACHUSETTS STATE BUILDING CODE. November 16.c.. I9 9 3 .. if ....... � Building Inspector � I � {14 Tt 75 14-1 A l /4 Q I 717, fi GoT LI- cG L ac f � _ r�l t3 �- oI . _ .. �.. a �6C.4T10A,1 fC �'Y T�/.4T Sf%OLt/,N%lE.2EO.t(/COtiIp.L YS�/-1//T � �i ``r /oE ,v �._. h': SCAL G /=5� o�►�-E B �3 93 It l�A2J�J5 A�1E�c/Ys/c.IO f�L.4Al A-La SE O d� N --r .4it/ i2EG STE.eE1J L,qc/ Y O;crt,4SE7-S siy4J.i/y; =.S.S�vLaoT 8 �p X-OT %it/&S ��i��./C,Q�t/7� ,q S/2) /�(,�L- /�(J� • j 1 . The Town of Barnstable NUAW Conservation Department 4 9. 367 Main Street, Hyannis, MA 02601 Office 508-790-6245 Robert W. Gatewood FAX 508-775-3344 Conservation Administrator TO: Joseph Daluz, Building Commissioner FROM: Robert Gatewood RE: occupancy Permit/Final inspection DATE: The following project has been granted an Order of Conditions by the Conservation Commission. Applicant: " k ,16M Project: Location: Map/Parcel: ���/(.I ` Our Permit #: SE 3- ly�� We would kindly ask that no Occupancy Permit or Final Inspection (as may apply) be granted by your department until a Certificate of Compliance for the project has issued from the Conservation Commission. Your assistance is very much appreciated. F3 'J THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I A , m / �(�C�"- LI DATA a'.y1t�1,�,a:Y� PE���� TOWNb"FBARNSTABLE, MASSACHUSETTS BUILDING"' ti--1 T ; 3 � `JV t DATE ==li�''U:�`� �--3 + 19 ` � Ni a .1. E:3 PERMIT NO. - 1S u i_ _ li L l.1.�i i.i is .` L(_ :_APPLICANT ` ADDRESS (NO.) (STREET) (CONTR•S UCENSEI cilCili`f DW .ii_:I UMBER OF PERMIT TO •' (_) STORY WELLING UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) .1 -) i 5 i it �`:,1; :_:: is 1aInd ':Ci C. �:sltc.!rv3J_ ZONING i,D AT (LOCATION) DISTRICT (NO.) (STREET) i BETWEEN AND (CROSS STREET) ;-1CROSS STREET( SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE-FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND.SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: :JE:t•Juy xfyl"3SG. — _ AREA OR 08C, s 15_' r 000. 100 FEEMIT s VOLUME ESTIMATED COST (CUBIC/SQUARE FEET)OWNER BUILDING DEPT. _ ADDRESS BY � (P THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ALL CONSTRUCTION WORK: . ELECTRICAL, PLUMBING AND I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL OUIRED,SUC .9UILDIt:G SHALL NOT BE OCCUPIED UNTIL MEMBERS(READY TO LATH). I h'FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE - OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET 1 BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS I t ,aAl 1_ . 0-2 t '_� t 4 1 3 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT t S ' p� �A S BOARD OF HE<TH OTHER SITE PLAN REVIEW APPROVAL c "iN WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT W!LL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN qE TOR HAS APPROVED THE VARIODUS STAGES OF WORK 15 NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN CONSTRUCTION. , PERMIT IS ISSUED AS NOTED ABOVE. 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