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Home My WebLink About0039 BIRCHILL ROAD v • n u [ry ` F .. IF ,.- �t►4WE, Town of Barnstable *Permit Expires 6 months from issue date `Regulatory Services Fee r, nc w BARNSTABLE, Thomas F.Geiler,Director MASS. $ Vf✓— �''CI�� 1659. �.• Building Division Tom Perry,CBO Building Commissioner. 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 611 Property Address 2 pl i L� atn, 1�� [residential Value of WorlA_�)i Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address r w—,-/ 32 G�c �� e CQr1kV0lll•e_ r &AA 03G 52— Contractor's Name�,r„Cc,CI A l C&n(l l Telephone Number Home Improvement Contractor License#(if applicable) 105 0,_D� Construction Supervisor's License#(if applicable) _ �� ...'W� 7u�''"R CI-Y`4n_ p 1 1�r ��l ` a orkmanf s Compensation Insurance 'k M [ Check one: ❑ I am a sole proprietor NOV ® 7 2007 ❑ I in the Homeowner - have Worker's Compensation Insurance �� r �(Cal, Insurance Company Name l v pG Workman's Comp.Policy Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) [/Re-roof(stripping old shingles) All construction debris will be taken toi ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side. Replacement Windows/doors/sliders. 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, Property f P m Owner must sign Pro a Owner Letter oission 1 ; A c y Vt�eHome Improvement Contractors License is required. j SIGNATURE:, ' - - r . Q:Forms:buildingpermits/express Revise091307 The Commonwealth of Massachusetts Department of Industrial Accidents ' Office of Investigations ' 600 Washington Street Boston,MA 02111 4 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual)'=.CO aly If q/4. ZnS C& Address: E; ( I rf''vSt-fc�nG, P . -PO c?bS C�A� , ��.f h nft c City/State/Zip: f(�_ 0- 1 N1 O Phone#: 56 _7c4,7 _9 O Are,you an employer?Check the appropriate box: Type of project(required):: 1.Lyam a employer with 20 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition workingfor me in an capacity. employees and have workers' y p ty• [No workers' comp.insurance comp.insurance.1 9. El Building addition 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.❑ Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152,§I(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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below.is the policy and job site information. �N Insurance Company Name: Policy#or Self-ins.Lic.#: � �-�� j Expiration Date: b Job Site Address:v( ��—�`t L �� City/State/Zip:&, AI"(A It e 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 hereb rtil uT a pains and penalties of perjury that the information provided above is true and correct. Si ature: ` Date: l d� 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#. f ACORD, CERTIFICATE OF LIABILITY INSURANCE 04TE/27/07nYYY) PRODUCER 1-860-560-2766 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Arthur J. Gallagher Risk Management Services, Inc. ONLY AND CONFERS NO .RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 10 Columbus Boulevard ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hartford, CT 06106 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A:Continental Cas Co 20443 J.T. Cazeault & Sons of Plymouth, Inc. INSURER B: 51 Armstrong Road INSURERC: Plymouth, MA 02360 INSURERD: 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. INSR ADD' POLICY EFFECTIVE POLICY EXPIRATION LTR POLICY NUMBER D M DDNYI —DATE M D - LIMITS - A GENERAL LIABILITY 2071252559 05/01/07 05/01/08 EACHOCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TOREN ED 300,000 PREMISES Ea occurence $ CLAIMS MADE OCCUR MED EXP(Anyone person) $10,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY X PRO• LOC A AUTOMOBILE LIABILITY 2071252562 05/01/07 05/01/08 X COMBINED SINGLE LIMIT $1,000,000 ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIREDAUTOS X NON-OWNED AUTOS BODILY INJURY(Per accident) $ PROPERTYDAMAGE $ (Per accident) GARAGELIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN. EA ACC $ AUTO ONLY: AGG $ A EXCESS/UMBRELLA LIABILITY 2084939235 O5/O1/07 OS/01/08 EACH OCCURRENCE $5,000,000 X OCCUR CLAIMS MADE AGGREGATE $5,000,000 DEDUCTIBLE X RETENTION $ 10,000 $' A WORKERS COMPENSATION AND 2071252545 05/01/07 05/01/08 X WOCSTATUS IR OTH- EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBEREXCLUDEDI es,describe under It E.L.DISEASE-EA EMPLOYEE $1,000,000 yy SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Evidence of Coverage. CERTIFICATE HOLDER CANCELLATION 10 days notice due to non-payment of premium. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Barnstable DATE THEREOF,THE ISSUING INSURER WILL OMXW44 MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,ffiY04yATM]tVb 9QI]xx Building Division Xffiffiffi�KT61XCxA�4Nk�]t7E]U�747C�g9g77S7�fxA�S7FXagN7d[ffiP[X 200 Main Street Xo( x* MggxXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE USA wl~a f+• �i .� 1 Town of Barnstable 3ARNSTABLE. + Regulatory Services MASS. � tbg9 `0� Thomas F.Geiler,Director �ED MA'S p Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230. Property Owner Must Complete and Sign This Section If Using A Builder I as Owner of the.subject property C hereby authorize_ ( CG + (D �4 ��li to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) A/to-7 Signature of Owner bate Print Name Q:Forms:buildingpermits/express Revise091307 ✓1. - o07vIl2fY�z[uP - \ Board of Building Regulations and Standards License or registration valid for tndividul u; HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return '} Board of Building Regulations and Standar Registration; 105024 One Ashburton Place Rm 1301 . . Expiration 7!`16/2008 Boston 4 g r e= ,Ma.02108 % T'pe element Card J.T.CAZEAULT&SpN�SO PLY UIffS CAZEAUL�T 51 ARMSTRONG ROADxj 0 `� N ah ithout signature.MA0236 Administrator J Town of Barnstable *Permit# L p� Expires 6 months from;slue date „,PM,,ars, : Regulatory Services Fee MAM 1639. ♦� Thomas F.Geiler,Director r • QED�.�• Building Division X-PRESS PE Elbert C Ulshoeffer,Jr. Building Commissioner 367 Main Street, Hyannis,MA 02601w 0 C T 2 3 200 Office: 508-862-4038 Fax: 508-790-6230 TOWN OF BARNSTABLE EXPRESS PERMIT APPLICATION Not Valid without Red X-Press Imprint Map/parcel Number 106 Property Address_ , Ma-e/sidential OR F1 Commercial Value of Work 3 7 CJ .OD Owner's Name&Address 6 v/� Contractor's Name Z J- elephone Number. Home Improvement Contractor License#(if applicable) Z p 7'L�(> Construction Supervisors License#(if applicable) CS U72 7�d rorkman's Compensation Insurance Check one: I am a sole proprietor ❑ Yam the Homeowner UI have Worker's Compensation Insurance Insurance Company Name tool-1 Workman's Comp.Policy#_ f1(,Cj 1 'a 7 J 926 6 Permit Request(check box) Re-roof(stripping old shingles) Re-roof(not stripping. Going over existing layers of roof) �e-side Replacement Windows. U-Value (maximum.44) [ P16�her(specify) ,nA&&n Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. Signature expmtrg !+ 7 EVE Tp Town of Barnstable *Permit# ` �{•� Expires 6 months from issue date N Regulatory Services FeeBMWSTABLL 9 Mass.t639• p Thomas F.Geiler,Director �A �0 � 'fDN1A� Building Division X-PRESS PERM,_ Peter F.DiMatteo, Building Commissioner AUG 1 ZOOt 367 Main Street, Hyannis,MA 02601w J�M Office: 508-862-4038 TOWN OF BARNSTAB Fax: 508-790-6230 Ie� EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address J esidential Value of Work Owner's Name&Address '' elephone Numbers Contractor's' ame ` Home Improvement Contractor icense#(if applicable) Construction Supervisor's License#(if applicable) �°. � Z. ��®r�n'sCompensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the—Homeowner ave Worker's Compensation Insurance t / ��( i Insurance Company Name f ///—c/_ /�/ � � Workman's Comp. Policy# Perrrut Request(check box) ❑ Re-roof(stripping old shingles) ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-sid - Replacement.Windows. U-Value e 3 (maximum.44) ❑ Other(specify) "Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic.Conservation,etc. j Signatu Q:Forms:expmtrg:rev-070601 ✓J2C C�JO I7LIlGO�LU/P.ClGU'L o��:<(II.JJO"Cl2fl46Ctd � ✓/ce'l�ovrvruoncveall�o�✓!•�rdaac�rule�Gl BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR HOME IMPROVEMENT CONTRACTOR Number: CS 067195 Registration: 120456 All Birthdate: 08/16/1952 Expiration: 01/02/2002 Expires: 08/16/2003 Tr.no: 1191 Type: Private Corporatio �- Restricted: 00 BIL-RAY ALUM. SIDING CORP ' PAUL S MACDONALD A G�ce�ric a &J" L MACDONALD 25 MASON RD [�A«n 6 ADMINISTRATOR ELMONT RD DUDLEY, MA 01571 Administrator ELMONT N4 11003 DP45 ti CM ALS IDE 170669 ' WINDOW COMPANY NFRC ME Rol DCURP ONE HANG - CPD#004-R-011-006 FenestratSOLID VINYL - WELDED - DBL GLZD National Council ion 13/16" IG, DS LO-E, 'Rrgon Y _ Energy Savings will depend on your specific climate,house and lifestyle. For more information,call 1-330-929-1811 or visit NFRC's web site at www.nfrc.org. Solar Heat Gsiin Visible U-Factor 34 Coefficient 1 Transmittance...51. . ........ . 32 . 321 . 53 Manufacturer stipulates that these ratings conform to.applicable NFRC procedures for determining whole product energy performance.NFRC ratings are determined for a fixed set of environmental conditions and specific product sizes. V VII L.l C.UV 1 Ilull UC JC 1711 PHA NUI P, 01/01 06/25/2001 14:38 5168295857 SCSAGENCY PAGE 02/02 AC-QRD w ...,.'. �>` :,^,� �••� ' %-.."1; Ott,' ,ti "",h• �,n f„4....OATF Wit, i� S 1II>wrODn�7 .I.u.Y:.:vs.t_:.: `PROuUCE>Z• 1r""^ CO •.:ir, n••..:r1';. .O ��1 ::rrt ,'• ,,... "C:: fl�• 06/aZ/o.F 5CS Agency, Inc. HIS RTI'CATEISISSUERASAMA 911OF INFORMATION P.Q. BON 2204 9 3 NL 0 CONFERS NO RJGHTS UPON THE C1:R'T'IFICATE 0 THJ9 CERTIFICATE DOES NOT AMEND,EXTEND OR 11 Grace avenue suito 300 TE HE COVERAGE AFPOROEDBY THE POLICIES BELOW. C3:cat Heok iPY 110a�-0493 COMPANIES AFFORDING COV RAGE HoUAc Ph . ry . S - �6 F'CtNo. 516- 7 - . - - cA &erni.tagTs Iristuraa0t Comfy INSUY'iA C 8 Clarandon 1Qat.ion,f�1 ins Co ail-Ray alumiaux siding Corp. G Scottsdale Insurance Company 40 Sl=nt Road cal PA 3lmont NY 11003 O :ii�3X11Cr: n'.::I;: :a':w ,;:ul+LI,�� .Y.• •11 Sl.gtr;> 1 }�y}D[j��y��+.[.��1- cI!Y,^ >L I..�10��n7r'r:..y� ,nlF:T.�iu.� ,,<< �11 —MIiV� :;:1',4•wnl:in.�..•..0 .'....,..J:'t.l'n.11'I�i.:4uF,�� ,:I µ.H `.�• -wy�. �"�r ��I:�i4•.sY4� .t•('F .��I�IT'��1•V�C� �.',I 11f-1..:..::ir, "�� t.i.J.M�i •�:.I rllnl"M:ar,.r',w. 1 u•<w.:::�.� "..:.__.r."�.�NI..... r.r ,I:.,.w:l J.I.....w. nJ ,r,. ..H:. ..... ...._ a...........,-,a iN6:.._.....Ln•,„I:,,.n?:..._...•n�J Y... a /. .� I,....w..>u1w::.:w,�G:$:'f::� I� t•' c;R::�e`.I::�:t�: }w .):...... .I�iM<.'�f:::..Z�✓r�....:..":UIIA. .:110n,.w!nM::i�i..�l(:I.G.W%'.[..iwln�L•f'.`.a.,,<,.'1.::^..: THIS m TD OGRnPr TWAT TUC POLICIE8 OF INBUPARCL'L`JTEO 9ELQW mkvc ZGN ASU&D TO T EH NAMED ACOVF FOR rile rOLr—Y CCRIOD - f(D(GTEC4 NmwTTTISTAHDINO ANY R6Q)JI te.e ,TERM OR CONDITION OF ANY cOHTAACT 0 OOUMENT YM RE-PCC-f TO WWCH rH15 CW"IC►TQ HAY BE WLSD OR MAY MF<rA)K THE IH9URANC2 AFFOR000 BY THE POL)CK$QWRe HeREIN 188UBJCCT TO ALL T14F TEFLUS, EXCLL=NS AND CONDITIONS OF SUCH POtiow,UMrr3 SHOWN MAY 4AvE pC!N ADDUCED B LpAj TYPE OF mur%NCL POL(C`+Fj! IPOLICYEXMMAT1Orf ,8 LTFR POUCY NUMBGQ CA=,n.Ti DATE(MMIDOr Y) "EPAL UO LTY GENCPAL AaoRG(?ATE 133,000.000 A X COMNGRCIA WrRALLWILITV =A431>i43 08/25/01 FlIO DUCTS,GOMPrOPA00 I 11,000,a00 CLAIMS MAW 7x OCCUR FtRSONAL i ADV INJURY 141,000,000 OWNER'S a CONTRACTOR'S PROT EACH OCCURRENCE 21,000,009 PIRL OAMAOG(Any ww Mo) UGO C)(P(Any on.PO-1 a 5,000 'LUTOmOBU LIABn.m _ .. F-1 ANY AUTO COMemGDaINdLELWIr s AL'OWNED AVrO3 - SOOILY IMVRY ' SCHEDULID AUTOS - - - (Pqr P—) - u(4EDAUTDB BODILY INJURY NOH-OWNW AUTOS - I (Far Acod�nq - PROP!RTYCAAAAGk S 0ARAOELU9ILl1Y - I AUTO ONLY-GAC�CI—DGNNTT�l, AkY AUTO •• - - - OT)%A THAN ALTO ONLT:' EACH ACC*EW .f.. .. FFxCt89LIANUTY FJ+GHOCCURRrMCa f 6 000 000 C I UMMMLLA91ww I NLS0009269 08/25/01 A=A9=1E 35,000,000 OTHCR TW1d Uhf9.R2LLA FOFUA f c►oLOYsts;LuolLrry I EL tACH AcaaaaT f$0 0,0 0 0 '- s A z SCiCOZ360501 0f•� O3/14/02 cosF8 - OLICYRTN&8=tr✓a ML LIM(T f 500,000' OFFICMARe I EXCL I eL msEW.EA EMPLOYIM s 5 0 0,0 0 0 omCR CaSCRF)TION CFOI"QIAnONSI�GTICNSNEHICLE3�8P£GAL ITGFki.�: - .x � -_ I ` :,( p.1, �.;wr,: ..•e.^�,.} ,.,vw� «i`✓e 1�,:uYa:,.. 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I.ru... ^2^ BABXSTASLE, TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION TO THE INSPECTOR OF BUILDINGS: The u^ndersigned hereby applies for o permit according to the following information: 2 ^Location Proposed Use Zoning District ./V Fire District Nome of Owner Address Name of Builder ./..f..Address Nome of Architect Address Number of Rooms .......TtT.Foundation Exierior Roofing ... Floors Interior ... Heating Plumbing Fireplace Approximate Cost Difinitive Plan Approved by Planning Board 19 Diagram of Lot and Building with Dimensions v^-?.0 '3L<iiP ^o I/ti.rS /5^cj %.r. f^£/Q £2. hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the^bove construction. Name><<r. Small,Alan E* No Permit for single family dwelling-garage Locatio?I..B.^J:®??S..?S«^ Owner Type of Construction Plot Lot #1^ Permit Granted 19 Dote of inspection 19 Dote Completed 19 PERMIT REFUSED 19 Approved 19