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0083 BLANTYRE AVENUE
c 0 ,� .� �: a a l Town of BarnstableBuilding snnsrrnr Post`This Card So That it is Visible From the Street-Approved Plans Must 6e Retained on Job and this Card Must be Kept amsa` Posted'Until Final Inspection Has Been Made. 4 Permit a63 Where'a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-19-1201 Applicant Name: Scott Murdock Approvals Date Issued: 05/20/2019 - Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 11/20/2019 Foundation: Residential Map/Lot: _229-010 Zoning District: RD-1 Sheathing: Location: 83 BLANTYRE AVENUE,CENTERVILLE r 'Contract ct i Contractor Name':° D. SCOTT MURDOCK Framing: 1 -lq_ <- 3 Owner on Record: HERLIHY,SHAWN M&WILKINS, LINDA M Contractor License: CS-080395 2 Address: 36 STANDISH CIRCLE Est. Project Cost: $20,000.00 J Chimney: WEiLESLEY, MA 02181 Permit Fee: $ 152.00 Description: interior repairs due to water damage. remove/repl'+ace insulation Insulation: d:; 5152.00 and drywall,wallsand ceiling in living room an I Fee Paid den.flooring in '" Final: living room, basement family room, remove/replace paneling Date;_ 5/20/2019 }fi suspended ceiling` O Plumbing/Gas' Project Review Req: 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 aftergssuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. 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 Final Gas: work until the completion of the same. ue ;� Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the'Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footingt 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 ON L--�E Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT 4 TOWN OF BARNSTABLE BUILDING PERMIT.,APPLICATION , Map �:L Parcel ��� <Application # Health Division Date Issued Conservation Division ,Application Fee Planning,,Dept`. Permit Fee Date Definitive;Plan"Approved by Planning Board r,n�27/0 �J Historic = OKH Preservation / Hyannis - Project Street Address 72 hm,)±m AV tic QZ.�O 2 Village CeV)7,rV i Owner Rarl krVdif- Telephone 69)- (a�)o lc,7 Permit Request .' 1 2 rGt; Kt Gh e d a l r� l v Sic S r od►� . Sti Y7 ✓0 0 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total riew Zoning District � Flood Plain iN Groundwater Overlay Project Valuation JDfago Construction Type Lot Size_ A�.Ye_S Grandfathered: ❑Yes ®'No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Historic House: ❑Yes C�No On Old Kin s Hi `hwa : "Yes �No zet 9 g — g y �., �,;,. Basement Type: iFull ❑ Crawl ❑Walkout ❑Other , Basement Finished Area (sq.ft.) Basement Unfinished Area (sq., sa. � Number of Baths: Full: existing new Half: existing nL_9�v Number of Bedrooms: existing 0 new v � Total Room Count (not including baths : existing new First Floor RoIrn Count Heat Type and Fuel: 4as Oil ❑ Electric ❑Other Central Air Yes o Fireplaces: Existing _New Existing wood/coal stove: ❑ Vd Yes No Detached garage: i iA ❑ new size_Pool: ❑ existing I Vt�,�iv size _ Barn: ❑ r ❑ new size_ Attached garage: existing ❑ new sizeL28hed: ❑ existingo I size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION F (BUILDER OR HOMEOWNER) JName , P �/ Jdaro; Ir Telephone Number 7 Address lQ 1=-P�1�1�1 Lin License# US 7 L D(a b (,�nyl+ervii)el m m- 02&'D� 2 Home Improvement Contractor# Worker's Compensation # W(�, ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO EPT, SIGNATUR ��ru-w DATE c) ,Si G 9 rFs I O FOR OFFICIAL USE ONLY 9 APPLICATION# DATE ISSUED MAP/PARCEL NO. f at ADDRESS t VILLAGE OWNER . f DATE OF INSPECTION: FOUNDATION FRAME R) 3 4 09 INSULATION Q87k 31-1 0 i FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL i GAS: ROUGH FINAL c FINAL BUILDING R '3130)07,94 DATE CLOSED OUT ASSOCIATION PLAN NO. r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations . ' d 600 Washington Street Boston, MA 02111 �4 ;Y www.mass.g ov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ^ / Please Print Legibly Name(Business/Organization/Individual): Address: ,(-v lie—rY_\ LV_� City/State/Zip: rti/1IIe 3 Phone.#: `�j ' DOI7 Are you an employer? Check the appropriate bryx: Type of project(required): 1.❑ I am a employer with 4. I am a general contractor and I employees(full and/or part-time). * have hired the sub-contractors 6. ❑New construction .2.❑ I am a sole proprietor or partner-' listed on the attached sheet. T. Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor in an capacity. employees and have workers' Y 9. Building addition [No workers' comp.msurance 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 I LE]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' 1311 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. lContractors.that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. Iam an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information. Insurance Company Name: 6 r\a n.I � - ��. 1mVr-Ao ,1-6_ Policy#or Self-ins. Lie.#: w Vl.'Z —DU - I U y Expiration Date: Z5 q` Job Site Address:%3Ff& M, kr I'1-G City/State/Zip: (_1hkry I/4, M� ,q/02"�3Z 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 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 this statement maybe forwarded to the office of Investigations of the DIA for insurance coverage verification. I do hereby f i under the pain d penalties of perjury that the information provided above is true and correct: Si mature: / Date: 4ZO - Phone#: 5 � '-7 G U ' 009 ' CC G I � / �' % e ! - 2,Z,d 6 — 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 d.acce-acc eptable evidence of coin liance with the insurance coverage required. applicant who has not produce p P _ 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-contiactor(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 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"the applicant should write"all locations in__(city or _ town).".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file.for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to 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 Indust i.d Accidents Office of Investigatians- 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617=727=7749 Revised 11-22-06 www.mass.gov/dia EIG Fax Server 2/25/2009 9: 13 : 44 AM PAGE 2/003 Fax Server ACORL�. CERTIFICATE OF LIABILITY INSURANCE 0212512009' PRODUCER 508-398-6033 FAX 508-760-1667 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Eastern Insurance Group LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 519 Station Ave HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. So Yarmouth MA 02664 Cynthia Jenks INSURERS,AFFORDING COVERAGE NAIC# INSURED David Sauro Inc INSURER A Essex Insurance Company 163 Tern Lane INSURER B: Granite State Insurance Co. Centervi77e, MA 02632 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 REQUREMENT,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 kDD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR NSR -DATE MMIDDIYY DATE MMIDDIYY GENERAL LIABILITY 3CZ4228 0410512008 0410512009 EACH OCCURRENCE $ 1,000,0001 X COMMERCIAL GENERAL LIABILITY - DAMAGE TSE,O RENTED $ 50,004 'REMccurencel CLAWSMADE �OCCUR MED EXP(Anyone person) $ - Exclude A PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00( GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ Exc7ude X POLICYF_j PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLELIMIT 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) GARAGE LIABILITY AUTOONLY-EAACCIDENT $ ANY AUTO OTHER THAN EA AGG $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR EI CLAIMSMADE AGGREGATE $ F1 $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC2509818 0812512008 0812512009 X we LAM- OETH R EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ 100,00 B ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? OR rGlNAL TO FOLLOW FROM E.L.DISEASE-EA EMPLOYEE $ 100,00 If yes,describe under SPECIAL PROVISIONS belay CARRIER E.L.DISEASE-POLICY LIMIT $ 500,000 ' OTHER DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS ^' Evidence of Insurance -n Lli c-n CERTIFICATE HOLDER CANCELLATION �C3 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE C NCELLED qj&RE tE- EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL NDEAVOR�MAIL Town of Barns tab 7e 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HO DER NAMED TO THE LEFT, Bui 7di n9 Department BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 200 Main Street OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Hyannis, X4 02601 AUTHORIZED REPRESENTATIVE Cynthia J Jenks ACORD 25(2001/08) FAX: (508)790-6230 ©ACORD CORPORATION 1988 .- Ezpirationj ate!0WCertifi`cate Of lnsurance�- 1 Expiration Dates, _ ,Insurer.' _ Certificate of.Insurance{-': _'_'folic Number, 1/27/2009 New England Landscape&Development General Liability 9946D5128 1/27/2009 New England Landscape& Development Automobile Liability BA-2660C60A 2/2/2009 UTS Worker's Compensation 3102800710 2/18/2009 Brian Bolton General Liability MPB90590 2/23/2009 Brian Bolton Worker's Compensation UB7254B64A07 2/25/2009 Brennick Building System LLC General Liability C64E1820 3/1/2009 Harvey Industries, Inc. General Liability 710012316 3/1/2009 New England Landscape&Development Worker's Compensation Wcc5001933012007 3/4/2009 Tangua , Martin Worker's Compensation WC8737405 3/11/2009 Luiz Romcelli Worker's Compensation WC000167884 3/14/2009 Miguel Tatara Neto General Liability BP00008250 3/27/2009 Airtech Energy System&Copper Worker's Compensation WCS2197G 3/27/2009 Airtech Energy System&Copper General Liability MPS2197G 4/1/2009 Brennick Building System LLC Automobile Liability T39797 4/1/2009 Northern Sealcoating &Paving Worker's Compensation NOWC904736 4/1/2009 Cape Cod Insulation, Inc. Automobile Liability BA9587917 4/1/2009 Cape Cod Insulation, Inc. General Liability CBP9587416 4/5/2009 Associated Alarm Systems General Liability CLS1489915 4/9/2009 Hickey Construction Company, Inc. General Liability 1680159513907 4/9/2009 Hickey Construction Company, Inc. Automobile Liability BA1944605A 4/11/2009 Buckmiller Roofing Worker's Compensation 7PJUB-7430A7 4/19/2009 Ace Arborculture General Liability NPP 1012003 4/25/2009 Belanger,Susan Worker's Compensation 6.00721E+12 4/27/2009 Belanger,Susan General Liability 3600031197 4/30/2009 Paul J. Cazeault&Sons Roofing Inc General Liability NPP1145484 5/1/2009 UTS General Liability C2094820462 5/1/2009 UTS Automobile Liability 2094820459 5/1/2009 L&M Glass General Liability CCP9721358 5/1/2009 L&M Glass Automobile Liability BA9721858 5/1/2009 L&M Glass Worker's Compensation WCC5004479012008 5/15/2009 Buckmiller Roofing General Liability CP46859505 5/25/2009 Cape Cod Custom Floors, Inc Worker's Compensation 08WECKL1007 6/1/2009 All Cape Garage Door Co., Inc. General Liability 168087K26379TIA08 6/1/2009 All Cape Garage Door Co., Inc. Worker's Compensation WCC5002586012008 6/6/2009 Wayne B Downey General Liability 53644633 6/7/2009 CapeCuts, Ralph Tovar General Liability SCP0661814 6/14/2009 Belanger, Steven General Liability BP17034414 6/19/2009 Tangua , Martin General Liability SCP031530224 6/21/2009 Coneco Geothermal Systems LLc General Liability 331671 6/21/2009 Coneco Geothermal Systems LLc Worker's Compensation 331694 6/30/2009 Cape Cod Insulation, Inc. Worker's Compensation WC2930665 6/30/2009 Builder Services Group, Inc.-CC Closets General Liability MWZY55525 6/30/2009 Builder Services Group, Inc.-CC Closets Worker's Compensation TWXJUB122D027 7/1/2009 LaFleur LLC General Liability CLP7924573 7/2/2009 Belanger,Steven Automobile Liability 95375400001 7/9/2009 LaFleur LLC Worker's Compensation WC792457406 8/24/2009 Pires Construction CorpWorker's Compensation WC5877222 9/6/2009 Lawrence Robinson Masonry Inc Worker's Compensation 76 WEG NQ5620 9/20/2009 J.C.'s Concrete Floors, Inc- Worker's Compensation AWC 7019708012005 10/1/2009 Luiz Romcelli General Liability GL3594203 10/1/2009 Ace Arborculture Automobile Liability 08MMMM9021 10/1/2009 Northern Sealcoating &Paving Automobile Liability MAA019849511 10/1/2009 Northern Sealcoating &Paving General Liability CLA019849411 10/5/2009 Brennick Building System LLC Umbrella Liability 5,16592 10/6/2009 CapeCuts,Ralph Tovar Worker's Compensation 7019907012008 10/14/2009 Wright, Richard General Liability MPB75769 10/26/2009 Wright, Richard. Worker's Compensation 7017064012008 11/7/2009 Pires Construction CorpGeneral Liability BP17040195 11/18/2009 J.C.'s Concrete Floors, Inc General Liability CLS 1514169 11/18/2009 Ace Arborculture Worker's Compensation WC 648-55-55 11/19/2009 Kevin McBride Plumbing &Heating Worker's Compensation 76 WEG FX7947 11/30/2009 All Points Mechanical Worker's Compensation WCA0200163 12/1/2009 All Points Mechanical General Liability CPA0200161 . 12/1/2009 Winslow.Plumbing &Heating Co., Inc. General Liability CBP9919974 Confidential age 1 12/1/2009 Winslow Plumbing&Heating Co., Inc. Automobile Liability 8218494 12/1/2009 Winslow Plumbing&Heating Co., Inc. Umbrella Liability CU9918875 12/1/2009 Robert B Our General Liability CPA130142817 12/1/2009 Robert B Our Automobile Liability MMA130144017 12/3/2009 Miguel Tatara Neto Worker's Compensation 7PJUB7744A71203 12/13/2009 Cape Cod Custom Floors, Inc General Liability 13720 12/18/2009 Kevin McBride Plumbing&Heating General Liability R0644392A 1/1/2010 Harvey Industries, Inc. Worker's Compensation TC2KUB100D279009 1/1/2010 Winslow Plumbing &Heating Co., Inc. Worker's Compensation 1630 1/1/2010 Robert B Our Worker's Compensation WC0008558 1/1/2010 Brennick Building System LLC Worker's Compensation 7015863012009 1/10/2010 Lambros,George General Liability CB834784 1/11/2010 Advantage Electric, Inc General Liability MPO95993 1/11/2010 Advantage Electric, Inc Worker's Compensation WCC500529901 1/17/2010 Hickey Construction Company, Inc. Worker's Compensation WC006940816 2/4/2010 Belanger, Steven Worker's Compensation VWC600293201 Confidential 2/24/2009 Page 2 �/ee 'C�ovnmea�uaea.�i o�.�,Craaac/uraeQa Board of Building Regulations and Standards Construction Supervisor License License: CS 12866 Birthda�e"__5f6/1951 516/2009 Tr# 13670 DAVID A SAURO.:: 163 TERN LANE �-�— CENTERVILLE,MA 026k Commissioner , Board of Building Regulations and Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home ImprovemerCo�tractor,.Registration Registration: 14k01 Type: DBA z U T Expiration: 9/13/2009 Tr# 133017 DAVID SAURO/ CONSTRUCTION'MANA:G A_ w / �%� DAVID SAURO 163 TERN LANE CENTERVILLE, MA 02632 { °� sd Update Address and return card.Mark reason for change. 0 Address Renewal Employment Lost Card DPS-CA1 0 50M-07107-PC8490 FEB 03,2009 04:01P 5087780897 page 2 tME'In� � uARNF'[ABI�. � MASS. Town- of Barnstable s639• � AlBDMPt} ,: -- Regulatory Services Thommi F.Geller,Director Belittling Division Thomas Perry,C%o Building Commissioner 200 Nhlill,& 0et. l lyannis,MA 02601 www.town.barnslable.mams 011j i': 5014-K67-40-18 1;1x: U18-790-6230 i Property Owner Mus L Complete and Sign This Section If Using A Builder f . 1 Ala TyADJaKi's ,as Owner of the SL1bj&L property hereby aut•hnri,, DI u 1 GI tSac.,l.l�D to acr t"n my behal l in all matters relative to work authorized by this for - an +� r✓1 J M 02 (Ad Tess of joh) r - SiKrta urc u('(.kvncr Print-Name If Property Owniris applying for pcennil,please complete the Homeowners License Fcen►plion Form on the reverse sides t� (:1l►:erxltkeolliklAppl)atoll.ocnllMicrosnlllWinJowsSt'umpixary Imerno V lcrWomum r'1nt1UU1l11bt I NR'III 1�X1''n1'SS.dUc g ' Received Time Feb. 3. 2009 3:45PM No, 19$$ 163 Tern Lane,Centerville,MA 02632 /Phone&Fax: 508-778-0897 /Email: davidsauro@comcast.net February 24, 2009 Scope of work for proposed alterations at 83 Blantyre Ave. Centerville: Kitchen Alterations: 1. Eliminate pantry bi-fold door and six-foot wall and re-locate re£ to this area. 2. Replace kitchen floor: tile over underlayment. ; I 3. Paint cabinets and replace hardware and countertop. ! p p' 4. Replace electric range with gas range. i s ! I 5. Widen opening from sunroom into kitchen to four feet in width. 6. Strip wallpaper and paint walls. i 7. Install seven ceiling lights and re-sheetrock ceiling where necessary. I i Sun Room Alterations: I 8. Replace two rear sliders with six foot Anderson Sliding Glass Door and Anderson double-hung windows. 9. Velux installed in cathedral ceiling. ! 10.Flooring: file over cement slab. . g I 11.Install ceiling fan and re-sheetrock ceiling where necessary. Ga//AZO Ki - I � 8���� � S7XL I I i i i r I ! ! , 15 P I 1 I ENERGY CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR ONE- AND TWO-FAMILY DETACHED RESIDENTIAL CONSTRUCTION (780 CMR 61.00) Applicant Name: uC_Q c Site Address: print Town: Applicant Phone: 548' Applicant Signature: ��� Date of Application: rq .ay 4 NEW CONSTRUCTION: choose ONE of the following two options) 780 CMR TABLE 6107.1 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA FOR NEW ONE-AND TWO-FAMILY BUILDINGS MAXIMUM MINIMUM Ceiling or Slab Option l: Basement — Fenestration exposed Wall Floor Perimeter U-factor floors R-Value R-Value Wall R-Value AFUE HSPF SEER R-Value R-Value and Depth National Appliance Energy .35 R-3 8 R-19 R4 9 R-10 R-10, Conservation Act(NAECA)of 4 ft. 1987 as amended,minimums or eater as applicable Note: This form is not required if you choose either of the two versions of REScheck as listed below. ❑ Option 2: REScheck Version 4.1.2 or later variant software analysis must be completed 780 CMR 6107.3.2) REScheck—Web which can be accessed at http://www.energycodes.gov/rescheck/ ADDITIONS.ORALTERATIONS.TO EXISTING BUILDINGS OVER 5 YEARS OLD* *Buildings under 5 years old must use option#1 or#2 in New Construction section above. Complete the following formula to determine the % of glazing: (a) Gross Wall & Ceiling Area equals Formula: (100 x b_ a) =� 'y�2 SF ' 100 x .5 1 - 414E % of glazing (b) Glazing area equals SF b a If glazing i<s<'40%.use the chart below. If glazing is> 40.% roceed to "SUN ROOM" section 780 CMR TABLE 6101.3 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTING LOW-RISE RESIDENTIAL BUILDINGS MAXIMUM MINIMUM Ceiling and Slab Perimeter Fenestration Exposed floors Wall Floor Basement Wall R-Value U-factor R-Value R-Value R-value R-Value and Depth .39 R-37 a R-13 R-19 R-10 R-10, 4 feet a R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R-value over the entire ceiling area(i.e.not compressed over exterior walls, and including any access openings). SUNROOM—An addition or alteration to an existing building/dwelling unit where the total glazing area of said addition exceeds 40% of the combined gross wall and ceiling area of the addition. Note: Owner to fill out Consumer Information Form (found in Appendix 120T oFtHE j Town of Barnstable *Permit# C7 G Expires 6 months rom issue date Regulatory Services Fee D • BARNSTABLE, 9 MASS, ; ,0� Thomas F.Geiler,Director �ArfD MA't A �/ A l09 V @� g!I'"� Building Division X-PRESS ER Ryn Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 FEB. - 6 2009 www.town.bamstable.ma.us Office: UVVN4 Fax: 508-790-6230 v� %A&N§T+"T APPLICATION - RESIDENTIAL ONLY �J Not Valid without Red X-Press Imprint Map/parcel Number C) Property Address g J l�,(� (r� v N O I M I I C2-�p j Z GiResidential Value of Work 31O Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address -eX '� —aff) � n 4. ,DG 0 10, 1 S f�l M � 1 � S 3 Ala ln-l� �e Av-e _ C nkKvOfe M 0�� � Sa(x" 02-&32 d Contractor's Name u Telephone Number S�Qj -77Qj•02�L3 7 Home Improvement Contractor License#(if applicable) 1 20 I Construction Supervisor's License#(if applicable) CS 1 2-?DlU(p 4workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance p Insurance Company Name 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 to ❑ 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 Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\MY7NB4IL\EXPRESS.doc Revised 100608 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):I.0 1d �Lr0 Address: `(0 2) City/State/Zip: GeV)-W I Ile • W DZjLi?_ Phone #: 5 776'.Cle)G/I Are you an employer?Check the appropriate bp x: Type of project(required): 1 I i f e o th 4. [v� am a general contractor and I yp e J ( t ) � 6. ❑New construction employees( n part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees . These sub-contractors have 8. Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.# required.] 5. ❑ We are a corporation and its 10.0 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.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.[`, Other UD(tAPO Q f]4Ct,MV, 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. L Insurance Company Name: a nt 7C, � Qi Policy#or Self-ins.Lic.#: W( 002 50 _93 1 ?� Expiration Date: (ZcJ(C) Job Site Address: 1/ ' VAY)!MrP AVI OMJC611 f 444 024.3 City/State/Zip:(L f l Q I I f f 3 Z 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 unde'r_thepains and penalties of perjury that the information provided above is true,and correct. Signature: L1G /��/�/I �L�%2i Date: Phone#: '7 7�3 ' 0923 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#: 71ee �o�vinanuralbi o� aaeac%uaek2 Board of Building Regulations and Standards Construction Supervisor License Licefise: CS -72866 Bkthk' 516/1951 i - 516/2009 Tr# 13670 ;, t� irtlon: 00 DAVID A SAURO': 163 TERN LANE �-- - —� CENTERVILLE,MA 02532 Commissioner , �;G Board of Building Regula ons and Standards One Ashburton Place - Room 1301 " Boston. Massachusetts 02108 Home Improvemei t Sb tractor Registration Registration: 148201, Type: DBA Expiration: 9/13/2009 Trk 133017 DAVID SAURO/ CONSTRUCTIO . ..AN DAVID SAURO M 163 TERN LANE ` CENTERVILLE, MA 02632 Svs Update Address and return card.Mark reason for change. DPS-CA1 ii 50M-07/07-PC8490 Address Renewal 0 Employment Lost Card FEB 03,2009 04:01P 5087780897 page 2 Town of Barnstable �o7raox► , Regulatory ServicCS '1'homns F.Geller,Director Bkvilding Division 4 Thomas Perry,CRO Building Commiainner 200 Mttid.Sirevt, Ilyannis,MA 02601 www.tow n.barnstable.nta.us )f'f ice: 5t)8-KG7-41)18 1�nx: 508-790-6230 Property Owner=Mast Complete. -tnd Sign This Scetion If Using A Builder Owner of the sUbjmt.proputy hereby suithoriic Dlow 1G1 3aU' rD ro acr nn ttq baluilf, in all mailers relative to w(')rk aulhorized by this building permir ahrlicarion for' -5-; n r) rV.s I M U 2�U3 2- (Ad. cs% of Joh) � iq S�ras� tiro of(.)wncr l)ut N'n't Name if Pro1wriy owner it applying ror per►ail,pleme wimplete the Homeowners License Exernptiun Form on the reverse xitlo: C`1llset�idecollitdlt}qit)at9ll.ocsdlMicr�isnOlWiiulowsil'am�rvry Internet FI1c�:ICunfud f►utlo��k1M1'7Nn11!1C'ar'!t!'C$.due R rvivivl l fl!J(i(itY Received Time Feb, 3. 2009 3:45PM No. 1968 Sub Contractor W-9 and Certificate of Insurance ;. , „..:.,, Ir►sucSd,, ., .' ;CQrtificate 9f:llisurance Ex_isatioii51, p© ,ndtitber iN9 Ern Ip e D Ace Arborculture General Liability 04/19/09 NPP 1082374 X 04-319-4573 - Phone: Automobile Liability 10/01/09 08MMMM9021 025-08-7944 Fax: Worker's Compensation 11/18/09 WC 648-55-55 Advantage Electric,Inc - - General Liability 01/11/10 MPO95993 Phone: 508-326-7921 Worker's Compensation 01/11/10 WCC500529901 Fax: 508-394-9620 Airtech Energy System&Copper Design Inc General Liability MPS2197G 03/27/09 Worker's Compensation WCS2197G 03/27/09 All Cape Garage Door Co.,Inc General Liability 06/01/09 168087K26379TIA08 Phone: 508-398-2757 Worker's Compensation 06/01/09 WCC5002586012008 Fax: 508-028-1184 All Points Mechanical,Inc General Liability 12/01/09 CPA-0200161-01 Automobile Liability 10/01/09 08MMBCGXXZ Worker's Compensation 11/30/09 WCA-020016-01 Umbrella Liability 12/01/09 Associated Alarm Systems,Inc General Liability 04/05/09 CLS1489915 Phone: 508-775-3442 Fax:508-790-2330 Associated Elevators Companies,Inc. _ X 04-309-3454 Phone: 508-760-3875 Fax: 508-760-2809 - Baxter,Inc. General Liability 08/01/07 - SRSGLMA05092 Phone: 508-775-0375 Worker's Compensation 10/06/06 US37961381705 Fax: 508-771-7324 Riggers Coverage 03/29/08 QT6607344B865TIL05 Belanger,Susan X 020-70-7459 Phone: 508-776-9482 Worker's Compensation 04/25/09 WC6007213012008 Fax: 508-420-3568 General Liability 04/27/09 3600031197 Belanger,Steven General Liability 06/14/09 BP17034414 020-60-4983 Phone: 508-428-1389 Worker's Compensation 02/04/09 VWC6002932012008 Fax: 50SA20-3568 Automobile Liability 07/02/09 95375400001 Brennick Building System LLC General Liability 0225/09 C84E1820 Worker's Compensation 01/01/10 7015863012009 Phone: 508-775-5111 Automobile Liability 04/01/09 T39797 Fax: 508-896-7997 Umbrella Liability 10/05/09 5,16592 Brian Bolton Worker's Compensation 0223/09 UB7254B64A07 Phone: 508-776-3466 General Liability 02/18/09 MP890590 Fax: 508-362-0129 X Buckmiller Roofing Worker's Compensation 04/11/09 7PJUB-7430A7 General Liability 05/15/09 CP46859505 Builder Services Group,Inc.-Cape Cod Closets General Liability 06/30/09 MWZY55525 dlb/a:Quality Insulation&Bldg Prod Worker's Compensation 06/30/09 TWXJUB122D027 - Cape Cod Custom Floors,Inc General Liability 12/13/09 13720. Phone: 508-778-1965 Worker's Compensation 0525/09 08WECKL1007 Fax: 508-778-5575 Umbrella 12/13/09 13720 Cape Cod Insulation,Inc. Workers Compensation 06/30/09 WC2930665 X 04-271-5757 Phone: 508-775-1214 General Liability 04/01/09 CBP9587416 Fax: 508-778-5735 Automobile Liability 04/01/09 BA9587917 Cape Cod Welding General Liability 09/13/07 TBD Phone: 508-028-3843 Workers Compensation 08/15/07 UB-5520084-1-06 CapeCuts,Ralph Tovar. Workers Compensation 10/06/09 7019907012008 017-72-6980 Phone: 508-726-4176 General Liability 06/07/09 SCP0661814 Fax: 508-430-0951 X Christopher N.Yerkes General Liability 09/10/06 MPB72549 231-35-3650 Workers Compensation 10/15/06 U1337741394205 X Coneco Geothermal Systems LLC Workers Compensation 0621/09 SINDER331694 General Liability 0621/09 SINDER331671 David O Nordberg General Liability 0529/07 2001X0450 X 010-09-8126 Phone: 508A28-0443 Fax: 508-028-8109 - DeNardo Home Improvement of Cape Cod,Inc. General Liability 09/10/08 6808830A359COF X 030-40-3734 Phone: 508-477-5574 Workers Compensation 1220/08 UB 0315815407 Fax: 508-077-8999 Automobile Liability 01/06/09 PMC7191293 Downey,Wayne B. _ General Liability 06/06/09 53644633 X 021-04-8836 Phone: 508-760-2091 Workers Compensation 08/19/08 6KUB692K742207 Confidential 0123/09 Page 1 I Sub Contractor W-9 and Certificate of Insurance Certificate o,f�insura�c�e AkiraU Aate }Pollc "numbee-- W8'� Em lo';e�IDi"# Y pY Filho Carpentry&Construction Inc General Liability 09/09/08 3CX7442 Worker's Compensation 09/10/08 6381312 Finnemore,Joseph R. General Liability 08/06/08 MPS30346 X 20-3902628 Phone: Worker's Compensation 01/01/08 UB-1323C97-1-07 Fax: Forest Keepers X 257-47-0515 Phone: 508-790-1620 Fuller Electric Company,Inc. General Liability 0922/08 MPO80356 04-228-2361 Phone: 508-775-0030 Worker's Compensation 0922/08 WCO80356 X Fax: 508-775-6977 Gardner Concrete Forms Inc. General Liability 04/04/07 1680346CC154 X 861141815. Phone: 508-759-5630 Automobile Liability 04/04/07 92079400002 - Fax: 508-759-5091 Worker's Com ensation 05/01/06 WC6700475 Govini,Peter X 043250384 Phone: 508-020-9195 General Liability 05/31/06 20011-6220 Fax: 508-420-9195 Workers Compensation 0920/06 WC006804404 Gray,Ian General Liability 0724/07 PX7843 X 014488938 - - Phone: 508-477-7696 Worker's Compensation 06/09/07 08WECJN0285 Fax: 607-724-7759 Gregoire,Frank General Liability 04/01/07 BHO03 52484287 X 043458812 Harvey Industries,Inc. General Liability 03/01/09 710012316 Phone: 508-775-7788 Workers Compensation 01/01/10 TC2KUB100D279009 Fax: 508-771-3217 Automobile Liability 03/01/09 OBR823136 Hickey Construction Company,Inc. Workers Compensation 01/17/10 WC006940816 X 042913741 - Phone: 508-771-4128 General Liability 04/09/09 168015958907 Automobile Liability 04/09/09 BA1944B05A Hill,John General Liability 02/09/07 BP17041543 X 018381622 J.C's Concrete Floors,Inc. General Liability 11/18/09 CLS 1514169 Phone: 508-775-8371 Workers Compensation 0920/09 AWC 7019708012005 Fax: 508-534-9050 Jesse Davies dba New Image Flooring General Liability 12/15/06 HJP371 Phone: 508-385-3727 Fax: 508-385-3496 JFM Floodnq General Liability 05/01/08 GL3326473 Phone:508-771-1608 Workers Compensation 0628108 6ZZUB-7982818 - Joyce Landscaping General Liability 11/15/06 8500029622 - Phone:5084284772 Automobile Liability 03/15/07 BA0837W91606SEL - - Fax: 5084284707 Workers Compensation 04/07/07 WC8954116 Kevin McBride Plumbing&Heating Inc x 20477-1754 Phone: 508-7784556 General Liability 12/18/09 R0644392A Fax: 508-778-2549 Workers Compensation 11/19/09 76 WEG FX7947 L&M Glass General Liability 05/01/09 - CCP9721358 Automobile Liability 05/O1/09 BA9721858 Workers Compensation 05/01/09 WCC5004479012008 I - LaFleur LLC X 013466674 General Liability 07/01/09 CLP7924573 Workers Compensation 07/09/09 WC792457406 Lambros,George General Liability 01/10/10 CB834784 Lawrence Robinson Masonry Inc. General Liability 09107/08 CB 7E 32 32 Phone: 508-524-1426 Workers Compensation 09/06/09 76 WEG NQ5620 Luiz Romcelli DBA: America Floors General Liability 10/O1/09 4. GL3594203 Workers Compensation 03/11/09 WC000167884 Miguel Tatara Nato General Liability 03/14/09 BP00008250 X 017-90-0816 Phone: 508-360-8365 Workers Compensation 12/03/09 7PJUB7744A71203 - -- Michael Monqeau General Liability 12/12/07 MPS57527 Phone: 508-778-9797 Workers Compensation 03/04/08 UB480X760907 Fax: 508-778-9797 X 030401009 New England Landscape&Development Corp. General Liability 0127/09 9946D5128 X 043016608 Phone: 508420-5188 Automobile Liability 0127/09 BA-2660C60A Workers Compensation 03/01/09 Wcc5001933012007 Northern Sealcoatinq&Paving Inc. General Liability 10/01/09 CLA019849411 X 042742821 Phone: 508-398-9474 Automobile Liability 10/01/09 MAA019849511 Fax: 508-394-0955 Workers Compensation 04/01/09 NOWC904736 Paul J.Cazeaull&Sons Roofing Inc. General Liability 04/30/09 NPP1145484 Phone: 508 428-1177 Workers Compensation 08/10/08 UB0095B64A07 Fax: 508 4204555 Pires Construction Corp. General Liability 11/07509 BP17040195 X 43499526 Phone: Workers Compensation 0824109 WC5877222 - Automobile Liability Residential Development,Inc General Liability 0725/07 CTR0006825 Phone: Automobile Liability 10/17/07 1628696 Fax: Worker's Compensation 01/12/08 WCC6004174012004 - Robert B.Our Company General Liability 12/O1/09 CPA130142817 Automobile Liability 12/01/09 MMA130144017 Workers Com ensation 01/01/10 WC0008558 Shaw,Jeffrey P. X 018365674 Phone: 508-776-2347 General Liability 0123/07 BHO0652460711 Automobile Liability01/O1/07 ZB142789 Confidential 0123/09 Page 2 Sub Contractor W-9 and Certificate of Insurance ; _.. ; �Ins«?red " Certtficateaf InsuranceEx;iralaoft Aat CP Polcy_numQe46er,,,,, NB •Emptoyr IDS Shorey manufacturing Co.,Inc General Liability 12/01/07 A730142815 Phone: 508-760-1070 Workers Compensation 01/01/08 WC0008556 Fax: 508-760-5716 Automobile Liabili 12/Ot/07 MAA130144015 1 Tanquay,Martin General Liability 06/19/09 SCP031530224 x 044-42-5987 Workers Compensation 03/04/09 WC8737405 Top to Bottom Chimney Service,Inc. General Liability 07/03/06 PAC6506144 X 043508281 Phone: 508-394-7986 Workers Compensation 09/29/06 7010131012005 Fax: 508-398-4328 Tuckahoe Turf Farms Inc. General Liability 12/31/08 ZDN4934142 Phone: 401-364-4020 Workers Compensation 12/31/08 MDA0274608 Fax: 401-364-6423 Automobile Liability 12/31/08 ABN4934082 USA Painting-Andre Luiz Costa Lessa General Liability 05/27/06 CPP0708740 X 919724280 UTS of Massachusetts Inc General Liability 05/01/09 C2094820462 Phone: 781-438-7755 Automobile Liability 05/01/09 2094820459 Fax: 781-438-6216 Workers Compensation 02/02/09 3102800710 Winslow Plumbing&Heating Co.,Inc. General Liability 12/01/09 CBP9919974 X 042846193 Phone: 508-394-7778 Automobile Liability 12/01/09 8218494 Fax: 508-394-8256 Workers Compensation 01/01/10 WC1630 Wright,Richard X 135347631 Phone: 508-246-1452 General Liability 10/14/09 MPB75769 Workers Compensation 10/26/09 1 7017064012008 ' x 4 f Confidential 01/23/09 Page 3 GRANITE STATE INSURANCE COMPANY 0024435-00 WC 002-50-9818 13102 --------------------------------------------- 013-66-o8o8-oo .. .inkirarorvirem . DAV I D SAURO INC Member Companies of 163 TERN LA �� CENTERVI LLE, MA 02632-0000 American International Group EXECUTIVE OFFICES: 70 PINE STREET, NEW YORK, N.Y. 10270 SEE EXTENSION OF ITEM 1. OF THE INFORMATION PAGE - WC990610 I.D# MA U EASTERN INSURANCE GROUP LLC WORKERS COMPENSATION AND EMPLOYERS 233 W CENTRAL ST LIABILITY POLICY INFORMATION PAGE NATI CK, MA 0176o-3133 INSURED IS PREVIOUS POLICY NUMBER CORPORATION RENEWAL 004381325 OTHER WORKPLACES NOT SHOWN ABOVE: SEE EXTENSION OF ITEM 1. OF THE INFORMATION PAGE - WC990610 ITEM 2 POLICY PERIOD 12:01 A.M.standard time at the insured's mailing address FROM 08/25/08 TO 08/25/09 REM 3 A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to the work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 100,000 each accident Bodily Injury by Disease $ SOO.000 policy limit Bodily Injury by Disease $ 100,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: SEE ENDORSEMENT - WC2003o6A D. This policy includes these SEE EXTENSION OF ITEM 3.D. OF THE INFORMATION.PAGE - WC990612 ITEM 4 The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Estimated Total Rate Per Estimated Remuneration Premium Classifications' Code Number ❑ munerat on X Annual 3 Year M Annual 3 Year SEE EXTENSION OF ITEM.4. OF THE INFORMATION PAGE - WC7754 TAXES/ASSESSMENTS/SURCHARGES $208 EXPENSE CONSTANT(EXCEPT WHERE APPLICABLE BY STATE) 1 8 MA MINIMUM PREMIUM $500 MA TOTAL ESTIMATED PREMIUM $3,661 If Indicated below, interim adjustments ofpremium shall be made: Semi-Annually Quarterly Monthly DEPOSIT PREMIUM 08 .20 08 ASSIGNED RISK 66 Issue Date Issuing Office Authorized Representhilve WC 00 00 01 39967 (Rev'd 04/08) INSURED'S.COPY Assessor's map and lot number ..............:............................ , mug a SGIr 1�� Sepvage Permit number INSTAUE0 IN CO OF THE TO TIT �Qy �o TOWN O� BAR �'F Z 8,8$9TME, i a "b q �•�om BUILDING INSPECTOR- 4 f _ APPLICATION FOR PERMIT TO ..........�..l:O®...�....� ....� � -� `SC .�n��.... �..... TYPEOF CONSTRUCTION ...............(sv .........................................................................:................................ .......... .....19 .. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according 'to the following information: Location d 3 6 " � Ave-- ................................ �fC ................................................ .................................. .r................ ProposedUse ............... �.... ra...........................................................................................................I............. ........ Zoning District ............. .. .......... 1Z�/{Ili...........................:.......... �. >/.......................................Fire District �.. ...... Name of Owner ..... C. ..............Address ......... : ..... �'`°n vk �" A v�.................�. d �J Name of Builder ........�°`� 'r.... ..Address 7/ „L i n t o/i1 yens ........ ........ ............ .... .... ....................... ................. Nameof Architect .................. ..............................Address .................................................................................... Z Numberof RoomsQl..................................................................Foundation .......... . ..........4....�................................. Exterior ........ ,e-84Ct- ` I P 5 ..°? ��.................................:.Roofing .................c ° ?-... .`.° ........................... A � Floors ....................................................Interior ......................v.^........'.°�.............................................. Heating .......................................... Plumbing N � ........................ ..... ........................... ......... . .................................. Fireplace .......................... `.....`..................................Approximate Cost .................L.s`jl...`.r .......a.......... ! ...... ��- Definitive Plan Approved by Planning Board -----------_------_--- --------19_______. Area ............................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH A ` b e 2 c 31` 140 V5 ISLVIA+�Xt, AVe I hereby agree to conform to all the Rules an Regulations of the Town of Barnstable regarding the above construction. Name .......1,1j6 .................................... TRACY, C(-� STANCE ' ti No ....2 2 7 2 3 Permit. for ADD IT ION Sin le Family..Dwe lin ...............J..................... ........� ........g.............. R Location 83 Blantyre Avenue r ..........................Y....................49........... k a. ....................Centervi.l.lq................ Owner .......Constance TracY.,,••••.••••••...... .. Type of Construction .......FXAMe...................... t Plot _ s .................:.......... Lot ...... .:.................... December 2, 8 0 := Permit Granted 19 Date of Inspection ....................................19 5 Date Completed .......................-: -.19 - x PERMIT REFUSED f ..........N... ... , z ................................. 19 .......... .............................................................. l' .. ra . .a ................................................. ., I.,. ....................................................... Appe ..:............................................. .19 ................................................................ J %✓ f � f � 'Llf Assessor's map and lot number .......r................................... Sewage Permit number .- .....%? ? -..- :.....,.^..^.u .... ...Q e TNET��y TOWN OF BARNSTABLE ii • i BA NSTABLE. i "b M �•� BUILDING INSPECTOR. Ay a• Gwz.. APPLICATION FOR PERMIT TO .........� .................................................................................................................... TYPE OF CONSTRUCTION ..............L+/0 0 z-c............................. . M{`- ....................................................................... 'Za ^--'dvV"L gqR- '1 �................................................ ..�..... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..............................................3 6 t (�.¢ Ave— - �cn' f 1/r f�t ✓t'14.$ ................................................. ............................................ .............. ..,..... v r Proposed Use ............... C5 Ot.+'1"�c..i .I................................................................................................................................. f Zoning District .. p .................................Fire District ......... '"�,` - ViCle ............................................................... Name of Owner ��5'�n t Q- "� .2 G t Address � (,H n h .............................................. .................................. .............v�........................ ... ....... J f nrs Name of Builder r�(Zl-....� 0L-A00e/— ..Address �� rn f� Name of Architect ....................... Address .................................................................................... Number of Rooms ......................�':"......................................Foundation .......... o'`nC �� k ................................................................. Exteriori ca l�.2 S ,rt0 !......................................Roofing .................... .,.....-..A...;;................................................................. v ! A Floors ro-r% c« &� Q-- Interior !' n �''' rSA a ..................................................................................... ........... ............................................................ Heating ..................!.':.�.............................................Plumbing ..........................N... .`..................................... Fireplace Approximate Cost 3 .........................�....................................... ................./...... -5--b-o............................. Definitive Plan Approved by Planning Board ________________________________19________. Area .......... -........ .�_...y....................... P r Diagram of Lot and Building with Dimensions Fee .......1... .... SUBJECT TO APPROVAL OF BOARD OF HEALTH - s aD 'z G I `° I hereby agree to conform to all the Rules and Regulations of the Town of Barns le regarding the above construction. Name ....... 1........................................................... I TRACY, CONSTANCE A=229-10 r J k 2S2i7 2j3.i.1 il ADDITION No ................ Permit for ,Dwelling ........... e y Location ....8.3....Bl.ant r.e...Av.e . .. .... ....... ..... .. Centerville ................... „ ............Constance T-rac Owner ...........A .................. ......Y...................... Type of Construction ..FramQ Plot ............................ Lot ................................ i Permit Granted .......-Deee ber...2.y....19 80 r ` Date of Ins ection p .19 Date Completed ................. 19 PERMIT REFUSED ` ..................................../ ................. .. 19 t r . . . .,. �.. . �.............. ......................�...................................................... t Approved ................................................ 19 E t ............................................................................... '. ...............................................................................