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I , i:,, "N"'. it "O - " , � � k �� f, , , '.-:,; "".� . ;, ,""4,� , � , I ;,�, 11 ­ ',­ � " - � - 1�­1'1 ,�,,4. � ":-1 "Wy,�' L�l i , 1 j"��.�,,, 1-,;-� � " ­ " )a"�Qmv 4, �i� , �e,,' � �, , �, , , j , " `­�,,��'� �, , , I,., , _ ,. , i � j , , , - , I q "moo-,; � .,,,;��-�.-�',­ , � �,� 7 , . ! ,� �, , , � , WIN& ,-,;�V�� ,��,���l.,.",,IittmnotaetowNpownsavRa imloo"�,��,,-,.�"�i,���l��,�,�tv�,',�)�'!!,����.:vi;�-.,,:� i"',��11',*i,o Cz�_, � ��e, �`�' i� ,�z",-I I , - �'_,,�";­', " t,�!: . � -, ,-�-,,' �',',,'��,,� � ";"" ��" i �'-��",������"",-,:�,2;''�-,��'l�t, ���!�-I'���,'�?''-"",-,��,Z".":- '' �,�L,;,�, ! .��""����7,',,,,�,,��,�.�,��i�";.�i�,,�Z,,z'�',,'.��::,,. f"'01"', !`.,��,�,� � - �,'� � ,"r;: , � 'S , , , - �,-,,,,� ,� , L�', ,,�', .,�, �`� __ , � - __ __ .1, i - L � ": 4 A Wwb.,"�i�,i,,`,"'� - r"Off"",ik 8�31 �9 'Iliko/fit y Cape Save Inc. ; 7-D Huntington Avenue ✓AN p South Yarmouth, MA 02664 rON 0 �16 Tel: 508-398-0398 Fax: 508-398-0399 12/14/18 Brian Florence CBO Town of Barnstable Building Division 200 Main St. ' Hyannis,MA 02601 RE: Insulation Permit 18-2868 Dear Mr. Florence: This affidavit is to certify that all work completed for 59 Blue Water Drive, Centerville has been inspected by a third party Certified Building Performance Institute(BPI) Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, ' William McCluskey .. Town of Barnstable uildin '* Post':Thi "'Card..So.That Otis-V�s�ble FromatheStreet A „ rovedyPlans°Mustbe Retained on I,ob and this CardalAust be Ke t �6sv �' Posted tlntil�Fina)Inspection Has Been Made "E y � � , � ;�� � ��ri � yam �°i here a Cert�fi ateof%Occ anc _isMRe" 'aired such Builtl�n ,shall Not be.Occu ied unt�la Final-lns ectton has:been7made Permit �,., .; ,.� -�_..� r;.� ..q�r p, ., y.::,�. q• ��'�•. �=u. .. � , �t. . p �,r=.: e .�.. �..€�. ��p,,. ��. � ram:,. �a, Permit No. B-18-2868 Applicant Name: WILLIAM J MCCLUSKEY Approvals Date Issued: 08/31/2018 Current Use:, Structure`:. Permit Type: Building-Insulation-Residential Expiration Date: 02/28/2019 Foundation: Location: 59 BLUE WATER DRIVE,CENTERVILLE Map/Lot 253 033 Zoning District: RD-1 Sheathing: Owner on Record: MARTIN,CASE L f Contra for Name:: WILLIAM J MCCLUSKEY Framing: . 1 Address: 59 BLUE WATER DRIVE _ Contractor Ucense' �CSSL-102776 2 - ... �'_ CENTERVILLE, MA 02632 ,4 J Est Protect Cost: $5,000.00 Chimney: V f'L Description: weatherization P,errnitFee: $85.00 N. Insulation Fee Paid $85.00 Project Review Req: x Final: Date 8/31/2018 g L Plumbing/Gas j Rough Plumbing: Building-Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized. y this permit is commenced within s x months afteryissuance. Rough Gas: All work authorized by this permit shall conform to the approved application and theapproved construction.documentso�which t s permit has been granted. RIF All construction,alterations and changes of use of any building and stru Lures sh ll bb in compliance with the local zoning by taws antl codes. Final Gas:-` This permit shall be displayed in a location clearly visible from access street orroad and shall be maintained open for,publI ms�pection for the entire duration of the work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Buildmgande"Official arerpro�uided on thispermit. Service.. Minimum of Five Call Inspections Required for All Construction Work ; 1.Foundation or Footing Rough: 2.Sheathing Inspection ; 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection - 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage.Rough: 6.Insulation 7.Final Inspection before Occupancy Low.Voltage.Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction'. Final "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department . Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 4,53 Parcel 033 Application # 3 Health Division Date Issued ' S 3 I h Conservation Division Application Fee Planning Dept. Permit Fee 'i Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis �M� Project Street Address `U v P� Village C04t( yi'�e Owner COL-Se- Address Novo ,-�Cu) 5}6� Telephone Permit Request NA 12 i9 �t'ftiIQ�SS R` �1� t�tir� �ny�ylG�ig r —� e�I IpfP o ��� R--�9 is e l e �ctA A e M14n i okm. Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation t5 4 0 0 Construction Type Lot:Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑Other �D- Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑res Elk Detached.garage: ❑existing ❑ new size Pool: ❑existing ❑ new size _ Barn: ❑ eXis�ng ❑ ne�v s _ Attached garage: ❑ existing ❑ new size _Shed: ❑existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ a Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) � Name m LC C /Canp � L Telephone Number _ 398 Q 3 4 B Address --1) ` Tdy� License# :�t t 0 D 5 k A � U� Home Improvement Contractor# Email Worker's Compensation # 5 � ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE J t 0 FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. -The Comonwealih of Massachusetts ` m t 41t1: 4;11�:r, t r., ,t' Department of Industrial Accidents �1/.i't�'+f r1 F?:if .a.. ... , r 't`� .3 11 • 1 }Iti". l d� 7.V .i 'i. u r i . .w :`Congress Street;Suite 100 - - Boston,MA 02114-2017: T .7.i .f ;A. I r+t r 6d. ._ '""mass-govldla G';_i sR.., 'p fl.. .ht t .t F:r�a;1 C, , •. NVorkers'Compensation Insurance AfSdavit:Builders/Contracto`rs/Elect icians%Plumberi* TO BE FILED WITH TIiE.EERMITTINGAUTHORITY. - Pl Ply ' .. ,. Applicant Information - h � ease rint Legib Name(Business/Organization/individual):Cape.Save inc '"` f Address:7-D"Huntington Avenuett' 'r''..9 t, " City/State/Zip:South Yarmouth, MA 02664 . o `x'T.phone:#:508-398-0398 Are you an employer?Check thcappropriate bog:. f ' i" or, Type of project(required): 1.E I am a employer with.. 15'``employees(full and/or part-time). New construction r 2 I am a sole.proprietor or partnership and have i k6 employees working.forme T,. t ,t i 4 � 8 = Remodeling,- any ca act o workers co insurance re uired « "! a D• a P .ty mp 4 ] v .l. } �d n rt tt ^r i y 3.M l am a homeownei.doing au work myself.[Ivo workers comp:insurance`eoi ed]t ''F; :'9'�I Demolition 4.10[�Building addition' 4.❑I am a homeowner and will be hiring contractors to conduct all work on myproperty_I will ensure that all contractors either have workers'compensation ursurance or are sole 11: ElectrtCal.repairs or.additions proprietors with no'employees +- { ;{� 12.❑Plumbing repairs or additions. 5.❑I am a general contractor andI have hired the sub-contractors listed on the attached.sheet. These sub-contractors have employees and have workers'comp.insurance.,; 11[]R6of repairs. 14, Other.Insulation 6.�We area corporation and its officers have exercised'their right of exemption per MGL C. _ , . _ t52,§1(4),and we have no employees:[No workers'comp.insurance required,] °Any applicant that checks"box#i must also fill out the section below showing their workers'compensation,policy information, .. 1 '' t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit iodicaog'such.` --a,v *Contractors that check this box must attached an'additional sheet showing the name of the sub-contractors and state whether or not those..entifies have sr i employees. If the sub-contractors have employees,they must provide their workers'comp.policynumber: v, r I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site ` information. Insurance Company Name Employers Mutual Casualty Company >-,. +..; �a -, r. • Far_. .. ..."i "+ - .Policy#or Self''ms Lit# 5D77852- -Expiration Dater 10116/2018' - �r'r't �1 (� ty - .ip`Centerville v ! .kr x. � dl�Fbla Yt w - •'u ' � '�Job Site.Address:. 'S9'Blue Water'Drive• Ci /Sfate/Zi ,Attach a copy of the workers'=compensation policy declaration page(showing the policy number and.expiration date) > Failure to secure coverage as required under MGL a.-152,§25A is a criminal violation shable`by a-fine, puni .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$250.00 a day against the violator_.A copy of this statement may be forwardedto the Office of Investigations of the.DIA for insurance coverage verification: I do herebycerdfy'under th pains and penalties of perjury that the information provided above is true and correct Si attire:_ Date: 8/29/18 Phone#:508-398-0398 ' Official use.only. Do,not write n this area,to be completedby city or town official. _. _ .. _ " , -• ,rr.,c,3 �+fir � ^� �.. —•- ___ :.,"ice .. `,-, ,,... ._'.•_ _ ___..._ .� .._ .�,131t;�f.=a.'. z�� City or Towns VPerWtlicense#� IlIssulng Authority(circleNx:cr r, t, 1.Board of I3ealtli 2.Building Department'3.C>tty/Town Clerk 4..Electrical tispector;5 Plumbing Inspector , _ .6.Other. 3t Contact Person: , '. Phone.#: . t:o`• . .:37 •,)i*i E� I...,1•f fr.� .,.3v3,ts"5�:, ; .,e a tr,; i'.�• :.3a,,..'i:7 C!""� . ' t3�:Uv.�its:?r�..•i,_;f�l• .t y...�;$fir+.::;�F i�[t ?i;r,a{!s'.•j':�'r�.v^.' r , ' µ +i �-� CAPESAV-01 HWOODS ACORO° DATE(MMIDDNYYY) CERTIFICATE OF LIABILITY INSURANCE 1 0/1 912 01 7 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE.POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder Is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER CAN MEACT Rogers&Gray Insurance Agency,Inc. PHONE FAX 434 Rte 134 (A/C,No,Exs): (A/C,No):(877)816-2156 South Dennis,MA 02660 Ep'' mail@rogersgray.com - INSURERS AFFORDING COVERAGE NAIC# INSURER A:Employers Mutual Casualty Company 21415 INSURED - INSURER B: Cape Save,Inc INSURER C: 7 D Huntington Ave-• --- INSURER D: South Yarmouth,MA 02664 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY,THE, POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I TYPE OF INSURANCE AODL SUBR POLICY NUMBER POLICY EFF POLICY EXPLTRI I IYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ❑X OCCUR ' SD77852 10/16/2017 1011612018 DAEAGE TO RPR FS aENTED occurre n� $ 500,000 MISMED EXP(Any oneperson) $ 10,000 PERSONAL&ADV INJURY $ 1,000'600 GEN'L-AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY❑X JECT LOC PRODUCTS-COMPIOPAGG $ 2,000,000 OTktk` EBL AGGREGATE $ 2,000,000 A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 accident X ANY AUTO 5Z77852* * 10/16/2017 10M612018 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY- AUTOS SWN D BODILY INJURY Per accident $ AUS ONLY EAUTO ONLY PPe�a�ccRidern AMAGE $ $ A rX UMBRELLA LIAR M OCCUR _ a EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS-MADE 5J77852 . ? " i 10/16/2017 10116/2018 AGGREGATE $ 2,000,000 DED I X I RETENTION$ 10,000 $ A WORKERS COMPENSATION " :, �( PER OTH- ANDEMPLOYERS'LIABILITY YIN SH77852 10/16/2017 10/16/2018 AT T ER 500,000 ANY PROPRIETORIPARTNER/EXECUTIVE NIA i ..,I E.L..EACHACCIDENT $' FFICat MEMUM EXCLUDED?d;'<< •, �Ylandatory MUM E.L.DISEASE-EA EMPLOYEE $ 600,000 If yes,describe under " 600,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addittonal Remarks Schedule,may be attached if more space Is required) •� 3 e ' s CERTIFICATE HOLDER CANCELLATION ' o w SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cape Light Compact Joint Powers Entity THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 ty ACCORDANCE WITH THE POLICY PROVISIONS. r Housing Assistance Corporation 460 W.Main St. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ACORD 25(2016103) 01988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs and Buslness,Regulaton One Ashbtai to mplace - Suite 1301 , Boston, Massachusetts 021;08 Horne Improvement Ciontractor Registration z Type .Corporation ; CAPE SAVE INC. a Registration 171380 7-D HUNTINGTON`AVENUE: Expirapon 03/13/2020 SOUTH YARMOUTH,MA 02664 ' 77777 Update Address and Retum Card SCA..1 +a 20M-05/17 U/!� T(Iovma tIL.GGGl Lam(P�V//GGA22CftildP.t S r Offq. ice of Consumer Affairs&Business Regumon « e HOME IMPROVEMENT CONTRACTOR ` Registration valid for mdiuidual use only •_ TYPE:Combration ;before the expiration date: If found return to Registration Expiration Office of Consumer Affair§and"Business Regulatiori 1713130 ��03l13l2020 One Ashburton Place Suite 1301 CAPE SAVE INC t Boston,`MA 02108 WILLIAM MCCLUSKEY= 7 D HUNTINGTON AVENUE.` SOUTH YMMOUTH MA o2664':.S NOt V111C�W 19118tutE Undersecretary: Commonwealth of Massachusetts Construction Supervisor Specialty UIV Division of Professional Licensure: Restricted to.: o Board of Building Regulations and Standards CSSL-IC-Insulation Contractor ConstructiojS ♦♦r Specialty= r6 - CSSL-102776 E4' ires 06/28/2019 WILLIAM J M CPbSKEY . •• ' C �' 37 NAUSET ROA • ` WEST YARMOU,FHMA 02673 Failure to possess a current edition of the Massachusetts State Building Code.is cause for revocation of this license. ' Commissioner DPS Licensing information'visit- WWW.MASS.GOV/DPS �yoF:T'HE Ta�yy, Town of Barnstable y ws Building Department Services Brian Florence,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 4 ., If Using A Builder 1, Case Martin , as Owner of the subject property herebyauthorize er J�y� �h( � to act on m behalf, Y in all matters relative to work authorized by this building permit application for: 59 Blue Water Drive Centerville (Address of Job) Signature of Owner Sgnatur f Applicant /7Z William J.McCluskey Print Name Print Name Date Application number ....... Date Issued..........61.111is................................ BAMUSM MASS AUG 3 1'2018 Sk Building Inspectors Initials......... .................. A HN S 6 Map/Parcel.......... tcp.......... ................... tv TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEA=IUZATION PROPERTY INFORMATION Address of Project: 'Bair 1)6"L I NUMBER STREET VILLAGE Owner's Name: k1 -&Vfne-- iC14 Phone Number Email Address: Jk Cell Phone Number -1-7 256 �3 comcasi. ne* Project cost $ 46, 000 Check one Residential Commercial. OWNER'S AUTHORIZATION As owner of the above property I hereby authorize lx-b ac— to make application for a building permit in accordance with 780 CMR Owner Signature: PowprotEFZ Date: TYPE OF WORK &Siding 121/Windows (no header change)# 0 Insulation/Weatherization El Doors (no header change) # Commercial Doors require an inspector's review 0 Roof(not applying more than I layer of shingles) Construction Debris will be going CONTRACTOR'S INFORMATION Contractor's name' 19--b CA),C,+rM 1U%A—A&A ac- Home Improvement Contractors Registration(if applicable) (e 2,1 E Q (attach copy) Construction Supervisor's License# CS '7 t,3:3 2 (attach copy) Email of Contractor �e-q"o 6aCZKc0J- Co 11�r) Phone number q 9-4- 130 ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER................. .......................................... *For Tents Only* ;,f Date Tent(s) will be erected Removed on number of tents total Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location (s) of each tent If food is being served at your event please obtain a Health Department approval between the hours . of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval, *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles:front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature Date-4341,6 All permit applications are subject to a building official's approval prior to issuance. The Commonwealth of Massachusetts � a Department of Industrial Accidents ....._. Mr Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information i r Please Print Legibly Name(Business/Organization/Individual):, Irb 6U6+7w1 14s$, t 3A C Address: -T"d .`b X_21 City/State/Zip: tM 02 6 Phone#: -7P7.4 VA - t 35 Are you an employer?Check the appropriate box- Type of project(required): 1.El am a employer with ' 4. am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- 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 n'• $ 9. ❑Building addition [No workers' comp.insurance comp.insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information. Insurance.Company Name: Policy#or Self-ins.Lic.#: Expiration:Date: Job Site Address: ( ?01)(`l�M l o o Do oe_ City/State/Zip: a runs � ,�/�(F} az&(O 6 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure toIsecure 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 der the pains and penalties of perjury that the information provided above is true and correct Signature: L� C,k TYRate: � 3l) Phone#: " 135 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 _.5 renewal of a license or permit to operarte a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"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 (Le.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 v Office of Investigations 600 Washington.Street Roston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MA.SSAFE Revised 4-24-07 Fax#617-727-7749 www.mass.gov/dia Commonwealth of Massachusetts q Division of Profess onai L�censure Board of Building Rertj.affotls and Standards trgct: `'U 15 a ©76332 .xpires: Ogr'05i201s KEVIN BOYAR PO BOX 21 f WEST BARNSTABLE MA"02668''" �Yry Commissioner Office of Consumer Affairs Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE-Corporation before the expiration date. it found return to: Rsalstratian x ratisan Office of Consumer Affairs and Business Regulation 162150 01`25 201g 10 Park Plaza.Suite 5170 Boston,MA 02146 B&D Custom Guilders, Inc.' KEVIN BOYAR 1050 Main Street r� West Barnstable,MA 02665 i311 -ecreta-ry Not valid wit ut;signature Client#:31686 2DETAILSI (MM/DDIYYYY) ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE 210912018(MWDD J THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:if the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Q TAC N ME: _ Dowling&O'Neil Insurance Agy PHONE 50 F sac,Ne,E,al: 8 775-1620 _ (A Noy, 5087781218 973 lyannough Road E.M L P.O.Box 1990 ADDRE s: _ Hyannis,MA 02601 INSURERS)AFFORDING COVERAGE NAIL e _ tNSURERA:NG+t-umnc•c0m r 14788 INSURED INSURER 8:carU,trce,nsurwx60 nparry y 34754 Detail Siding,Inc. _ — i 55 Wolley Road INsuREac; Hyannis,MA 02601 INsuRERD: INSURER E: INSURERF: _ — COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM'OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TRW �TADDL SUB — i POLICY EFF POLICY EXP L7R TYPE OF INSURANCE IN D POLICY NUMBER MMtDDNYYY MMIDD_ _ _ LIMITS _ A GENERAL LIABILITY _ MPF1060Y 2101/2017 121011201a EEAACMN(j HpjT eEOCCURRENCE S$1 000_ X COMMERCIAL GENERAL LIABILITY pRE NTED rrence! SSQO,OQQ _ CLAIMS-MADE F OCCUR MED EXP(Any one person)_ $10,000 _ PERSONAL SADVINJURY $1L000O00 GENERAL AGGREGATE $2,000,000 GEN*L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOPAGG s2,000,000 �POUCY E"° LX LD- _ $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT B BBWC98 1/0712017 11/07l201 Ea acrJdentl 1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS X AUTOS BODILY INJURY(Per acuderd) $ NON-OWNED PROPERTY DA HIRED AUTOS MAGEAUTOS 9-tagUdmll $ UMBRELLA UAB OCCUR EACH OCCURRENCE S a EXCESS UAB CLAIMS-MADE AGGREGATE $ LOEO t I RETENTION j_ $ WORKERS COMPENSATION �W�C STAT -- I 10TTH- i AND VMPLOYERS'UABILITY YIN — — TQRY I MnnANY PROPRIETOR/PARTNFIjlE'7r-Q11T1VF. _ .. ,r _ _ C OFFICERIMLMBER EXCLUDED? I _� NIA E! A +t ACGIL�ENT - (MandatoryinNH) _ E.L.DISEASE-EA EMPLOYEE $ If yes,describe under _ — - OESCRIPTION OF OPERATIONS bo"_ E.I_DISEASE POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD t01,Additional Remarks Schedule,If more space is requtrad) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions.. CERTIFICATE HOLDER CANCELLATION B&D Custom Builders SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO BOX 21 ACCORDANCE WITH THE POLICY PROVISIONS. Percival Lane West Barnstable,MA 02668 AUTHORIZED REPRESENTATIVE 01988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S206085/M206031 RPCC1 ti . A g CERTIFICATE 4F LIABILITY INSURANCE DA 2(MDN ) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:if the certificate holder is an ADDITIONAL INSURED,the poilcy(ies)must be endorsed. It SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 10083-002 k2AJACT 10083 10083/2 Dowling&O'Neil Ins Agcy l fAH1C0 ..F t1 (508)775-1620 Ne. 973lyannough Road E AIL cIrtail@doins.com - Hyannis,MA 02601 ANORESS- INSURERISS AFf INSURER • A.LM.Mutual Insurance Company INSURED SURERB� Detail Siding Inc — -- -- INS C_ _ 55 Wolley Road INSURER D� Hyannis, MA 02601 — INSU ERE. COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WFQCH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED yB�YpPAID CLAIMS . I�TR TYPE OF INSURANCE IFtOSR 6 POLICY NUAABER 1AOMlOD1YYYY) jMMIDDYlY1fW� � LIMITS _^ OENERAL LIABILITY EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY AEG EIS ti—NTH— $ CLAIMS MADE OCCUR I MED EXP(Any one person) S PERSONAL S AOV INJURY $ GENERALAGGRF..GATE $ EITL AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMPIOP AGG $ — ICY IO' OC — AUTOMOBILE LIABILITY COM IN S(NZaLEI $ .LF�_accEdenO ANY AUTO BODILY INJURY(Per pelsm) S ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED 'PROPERTY DAMAGE $ AUTOS .(Per accident) _ _ 5 UMBRELLA LIAB I OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ r— - yyyyppRRyyO{{EEER�gg pp''r EER��EgTpENTIIONNN S 'Y _ yy��ggTT uu S ANNyD EIb�toPPL{O�Y�E7�pSR'�LpI ASILIETY X TORY,DJW OER _!_ aFFlEEA1tdEjMBERi�Bt 6RR/VECU7IVE ! E.L.EACH ACCIDENT Y �(��My�a�nsdatory In NH) N t1 t -VWO-100-6022860-2018r ti2St2 "MSf2� EL DISEASE-EA EMPLOYEE S DETCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S _600,000,00 DESCRIPTION Of OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Addiftnal Remarks Schedule,if more space is requtred) CERTIFICATE HOLDER CANCELLATION B&D Custom Builders P.O.box 21 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Percival Lane THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN West Barnstable,MA 02668 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 01988-2010 ACORD CORPORATION.All rights reserved. ACORD 26(2010105) The ACORD name and logo are registered marks of ACORD Town of Barnstable Building ;. ,,�. ,ri _. .-� tit�s Visible From,the Street .Approy�ed PlansMust be.gRetamed,ort Job and this�Card,IVlust be Kept d;., AB3.4 a�''_' `•, �,- `' •• �„_ .; ,. ^•a ,: � Z cuss ?� -: e ';„' e— .�. e a, . . '"M.! Permit Permit No. B-18-2830 Applicant Name: American Tent&Table, Inc. Approvals Date Issued: 08/31/2018 Current Use: Structure Permit Type: Building-Tent Expiration Date: 02/28/2019 Foundation: Location: 339 WEST BAY ROAD,OSTERVILLE Map/Lot 116 010 Zoning District: SPLIT -Sheathing: Owner on Record: CALLAHAN, RICHARD P TR Contractor Name American Tent&Table, Inc. Framing: 1 Address: ATTN: KAREN ROWE F = aContractoi Li ense ,EXEMPT55 2 WEST PALM BEACH, FL 33401. Protect Cost: $0.00 Chimney: Description: install 132'x30'& 1 51'x91'tent with sides up 9%28own 9/30/18 Fee: $100.00 for King Wedding Insulation: Fee Paid $100.00 Project Review Req: EXITS AND EXIT ACCESS TO BE AS REQUIRE® `: Oates 8/31/2018 Final: Plumbing/Gas • � Rough Plumbing: � - Building Official al Final Plumbing: Rough Gas: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved apples anon anthe approved construction documerrts four which this permit has been granted: Final`Gas: All construction,alterations and changes of use of any building and structuresshall�be in compliance with the local zoni,!b"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 work until the completion of the same. Electrical Service: The Certificate of Occupancy will not be issued until all applicable signaturei�by�the Fi Building and re Officials ar s permit. Minimum of Five Call Inspections Required for All Construction Work: F. , ..9, Rough: . .w: 1.Foundation or Footing - 2.Sheathing Inspection . . Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Final: Work shall not proceed until the Inspector has approved the various stages of construction. "Persons contracting with unregistered contractors do not.have access to the guaranty fund" (asset forth in MGL c.142A): Fire Department Final: Building plans are to be available on site p�,�a: ►F All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Ungineeririg Dept_(3rd floor) Map es, Parcel Permit#` a(g 3 ' } _ House# Date Issued to Board of Health(3rd floor)(8:15 -`9:30/1:00-4:30) Z' /U Fee • T� Conservation Office(4th floor)(8:30- 9:30/1:00-2:00) ^ '� CY i Planning Dept.(1st floor/School Admin. Bldg.) THE Definitive Plan Approved by Planning Board 19 ; BARNSTABLE. ' MASS TOWN OF BARNSTABLE' 'FON� r ' �) BuildingiPermit Application Project Street Address 52 ,3L(l E VV A r,c-7-`p> . b"K. Village C iff&I- R k l L,G E CID Ownert�' ���f p NV 12PrS P/ N T'F 0 �, Address ' '2 a L u E �rtr,+,7T t .Telephone L4,29-57 y o s Permit Request C,9 LF_N*0 .A-ND 5"6 . G E RaaM APbl77o/Y First Floor 13 X A 3 ���� square feet Second Floor square feet Construction Type QA5 -a-ALVIVI)Atum 69F-E&H0u5E 4XIP kV Estimated Project Cost $ _1y. DOO,DD Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes La-N-o On Old King's Highway ❑Yes ❑No Basement Type: WrFull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use / pp Builder Inform�Non ✓ Name_ _�e�e5fe ]�2rno�e n -t�esi�� Telephone Number '/d 3 yb Address 43So FALI c Lo ,T_-t- r/License df-, C6-ty I I . /Y,,4 oa G.3 5 i/iiome Improvement Contractor# 116361 � ,,VVorker's Compensation#_ w r- NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE O BUILDING PERMIT DENIED FOR FOLL WING REASON(S) .A C, wh)- ^� � f 4 FOR OFFICIAL USE ONLY67 _ PERMIT NO. DATE ISSUED MAP/PARCEL NO. a 'i r - ' ADDRESS VILLAGE+ u � OWNER " r DATE OF INSPECTION: FOUNDATION- FRAME INSULATION FIREPLACE ELECTRICAL: . ROUGH ' FINAL ., PLUMBING: ROUGH FINAL 1 Y 9 GAS: ROUGH FINAL . FINAL BUILDING DATE CLOSED OUT 1 ASSOCIATION PLAN NO. . ; The Town of Barnstable • nAsNsrABIMA • 9 M �0�' Department of Health Safety and Environmental Services 10 Nam' Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work: 6 C;:�7 tJ Est.Cost aG!�O-e90 Address of Work: ✓ 13L�J;7w47—Af D/e �wner's Name �r1YT�fibN�/ /�fl-�PA/Vr� ..�te of Permit Application: l-9�`� /9 9 I hereby certify that: Registration is not required for the following reason(s): * Work excluded by law Job under S1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent/of the owner. 4ContrAtor //a3o/ Date Name Registration No. OR The Cunntton svealth of A trrssac h usetts Department of Industrial Accidents 011ice ollttvestiyatlons 600 11 a.v in-tun Street Boston. 3fass. 02111 Workers' Compensation Insurance Affidavit �nnftcant information• Pfe•tse PRINT 1e- name: location: cily nhonc# I am a homeowner performing all wort:myself. I am a sole proprietor and have no one working_ in any capacity ' .. --.... .-.......- .�a.-..,.-,.......,....��,-:�.r.s�•a+�Sll'T'�++„/7�:!rr...T� .. .r.+w.Rw�..�.�.s.*..r.:-.�.�w-+...ww—..;►..w....�....�-....... I a employees an employer providing workers' compensation for my emploees working on this job. ._a — _ enmmanc onme: OC b To amodelinq D S/mow . address: 4326 F,4LM U U7(f R b MI.: /h77,/ r nhnnc#• 'S� —��yb insurance cn. �' ST/%�/I! fl L4•L7�S/ �IllCuJ?IiNcE �i� nofic� # C�Obo/SiG o [) 1 am a sole proprietor. general contractor. or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: comnanc nntne: addres�• i city. nhonc#• insurance rn. nnlicy# I •i_- � .�..^ - .�..:Y. � __.. -� -�r.�-'N:�-.1L iT••J!�ww.s. .�T•..:._. - •e.ti .�......... comnnnc nnmr: address: rite- nhnne#- insurance co. .Attach additio _._... _._. - nal sheet itneccssaty -•:r + --+� ;L, - -J- -_ .Lr. ___� :� � �..�• �•_ •�•...�.� �. ...,.,.J..�--w.w.—.—.spy��-...i.-�.--. ilY!'�wi.�.i!•.MSc'wriL F:tiiurc to secure coverage as required under Section ZSA of AIGL 152 can lead to the imposition of criminal penalties of a line up to S1.500.00 andior one years*imprisonment a.s well as civil penalties in the form of a STOP NVORK ORDER and a fine of S100.00 a day against me. 1 understand that a copy of this statement mac be forwarded to the Once of Investigations of the DIA for coverage verification.. 1 rlo hercbr certi tentler the pains and penalties of perjury that the information prorided above is true and correct. Si=nature 44 Date 10,7L�3 Print name Phone# ' official use only do not write in this area to be completed by tiny or town official . city or town: permit/license# riBuilding Department a Licensing Board 0 check if immediate response is required QSclectmen's Office I contact person: phone#: ❑llcalth Department p rtOther information and Instructions } Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for thc: employees. As quoted from the "law". an emploree is defined as every person in the service of another under any contract of hire, express or implied. oral or written. An enzplorer is dcf mcd as an individual, partnership, association, corporation or other legal entity. or any two or rnor: the foregoing cnuaged in a joint enterprise, and including the le al representatives of a deceased cmplover. or the receiver or trustee of an individual , partnership. association or other legal entity, employing employees. However the owner of n dwelling house haying not more than three apartments and who resides therein, or the occupant of the d\N.-cl ling house of another who employs persons to do maintenance , construction or repair work on such dwelling ho,. or on the `,rounds or building appurtenant thereto shall not because of such employment be deemed to be an empioyer MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance o:\ renewal or., license or permit to operate a business or to construct buildings in the common%•ealtli for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter , been presented to the contracting authority. Applicants Please fill in the %vorkers' compensation affidavit completely, by checking the box that applies to your situation and suppivin`= company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial Accidents. Should you have any questions regarding the "law- or if you are require- to obtain a workers' compensation policy. please call the Department at the number listed below. . Citv or ,towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom o: the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Ple: be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned the Department by mail or FAX unless other arrangements have been made. The Office.of Investigations would like to thank you in advance for you cooperation and should you have any questior please do not liesitate toLive us a ca11. -..y..,.-.+..-.... ...__,.�.-..,..... ..�.,....r...-.•.,e�:.�..��--r-.-....-_.-....w+.raw-.�...._....�..n.rP. ..—._..-�..•.w..r�..o.n:rrir'�.. n�.�o+.....�,_' The Department's address. telephone and fax number, The Commonwealth Of Massachusetts WI Department of Industrial Accidents Office of investigations -- . 600 Washington Street Boston,Ma. 02111 fax #: (617) 727-7749 phone #: (6I7) 727-4900 ext. 406, 409 or 37S �a e , i R=170.00' 4216 Common Area Easement N. Lot 6 Z8p 4ari p 1� ND •o. 46' o w cp� •,�, rn gp 0 2q0 0. �/ / ;8, TOF El. = 52.8 Cb Lot 5 51,609 sq.ft.t � ,1l, AL IL i,11, o J4 a / Shallow- Pond 1 3/25/92 INITIAL ISSUE elk THIS PLAN IS NEITHER INTENDED NO.1 DATE I DESCRIPTION BY FOR, NOR SHALL IT BE USED FOR AS—BUILT FOUNDATION PLAN—LOT 5 MORTGAGE LOAN PURPOSES. Blue Water Drive N Barnstable, Massachusetts Dennis Star Construction SCALE: t" 5o' JOB NO. 1257 1 CERTIFY THAT THE FOUNDATION .: 0 50 too SHOWN ON THIS PLAN IS LOCAATE ON THE GRO S INDI T 3/25/92 LEVY, ELDREDGE & WAGNER ASSOCIATES INC. DATE REGI TE D LAND SURVEYOR ' ENGINEERS UHDSCHE ARCHITECTS PUNNERS UND SURVEYORS 586 STRAWBERRY HILL RD. CENTERVILLE, MA 02632 PO I N T- D F fl'TTh cf>`NI C NT �a ,r FOUR -SEASONS O 'k ARCHITECTURAL DETAILS GRE � NOTE:STANDARD FULL SCALE"SHOP DRAWINGS" ENHOUSES AVAILABLE ON REQUEST Im M Ga 1z 1+ . m:J.n i SYSTEM 4 SIZES _ - NOTE DIMENSIONS DO NOT INCLUDE FLASHING A B �rabfes fit, �ls - — — - BAYS 1�� ntl$ fntssrBends a,rt, i DA"iAl Aff,41WI. If a r°I r t 1 �Srh•,`�(� t�,5 eTy" � 3� +, LEFT GABLE END I ICl•"I � a 3"I i 4 DF� f ,11",'il i v12611 '9 f( `2su+pd': 2�1soi (j 3k1 INM2 iq`�##) j 3ti';`.�Y SURFACE UPON WHICH rs _ / ���G�SGP r.� onOy he unit dimeTE:When nsion sho the wn or Addth of ttl Bays times hs more than 12 e numberdof GREENHOUSE SILL SITS t, ",: T bS bays over 12 to the dimension shown for 12 bays.e.g.•to obtain the 15 SURFACE UPON WHICH ) bay length for a System 4 greenhouse without gable ends,add the DOOR THRESHOLD ITS ° f;`r' , NO DOOR OR Add'tl Bays unit dimension(2'•65/s")multiplied by 3(T-P/e")to the S ' II WINDOW HERE I,,.11� I I�� \ 12bay dimension(30'•9'/.")for a CORRECT total length of38'-5!%e".DO \ NOT ADD the 3 bay dimension(7'4111)to the 12 bay dimension BASE WALL HEIGHT (Above Finish Floor) t �I� (30 944"1 for an INCORRECT total length of 38 6's" ABLEw t asx DOOR POCKET 60" OPENING WIDTHS�1 ' _. (BASE WALL INSTALLATION) (Centered) (SIDE FILLER KIT) 4 I �'3 aI 01.1, ,�I MIDI I IS y4�114iu u N NOTE:Thermal Break Shown in Red ®I 'i � & r � r 4s , v '/s' _ 30V O.C.TYP. COUNTER FLASHING(BY OTHERS) t,r• { {( + 5 (S ' , j 1 2'�a rig I CAULKING THERMAL-BREAK RIDGE— (I d rlashln r.' `1 X#r EPDM GASKET o BAR CAP --- f x 44"SPACER(TO - FLEXIBLE _ '� COPOLYMER TAPE -----° INSULATED GLASS --ALLOWrOR % /\ —GABLES/! •� (_ \ �, EXTERIOR .� \ FLASHING INSULATED GLASS ! 7 'r LOW PROFILE MUNTIN CAP A— k SIDING-NO i 'z SPACERNEEDED ��/ AGAINST ji \ GLAZING BAR - -- /4 �.: ^- -'»-"( t�< BRICK ETC.I _ RIDGE CLIP 7-15 O.C. GLAZING BAR SHADE TRACK— \WOOD TRIM(BY OTHERS) ,d.LAG BOLT 8 FLAT WA INTERIOR BEAUTY CAP SHER I 1 'NIT WIDTF�1 ;- MUNTIN NIfC�N�fI P'"i 1 A. GABLE END OMITTED B. RIDGE C. LOW PROFILE CROSS MUNTIN I EXTRUDED FLASHING - k UNRr1NIDFH# 'a )l INSULATED GLASS- — 4'SILL N GLAZING BAR BAR CAP— I WALL CONSTRUCTION INSULATED GLASS )I�� f f11 FASTENER EPDM GASKET ° >'' �NOTINCLUDED I a WALL BAR 'rWl '.2;n j = THERMAL-BREAK 1= �IJI TT EPDM COPOLYMER :' 4 (�- SILL 'z f3, GASKET TAPE �� o`s l � CAULKING zI� �, _ GABLE INSULATED LLri L ( CORNEADD-O'R - GLASS EXTRUDED ��-, _ � '/4"LAG BOLT AT r_''I �r":. I I I BASEWALL OR %`� { -EACH GLAZING BAR + �� __� --- LATE GABLE END SILL A ' FOUNDATION r BLOCKING(BY OTHERS) j- - P UNI1 LENGTH r/ / J' BEAUTY CAP �s O C TYP. /s 116' - 7/ i/;� i ;�i UNIT LENGTH a,'# D. FRONT AND END SILL E. RIGHT CORNER F. WALL BAR I . -,- � ✓fze"rOanrii�ioourseaccs2 o�✓�Gculaa�uvef,�t � _ _ _ Restricted To: 00 DEPARTMENT OF PUBLIC SAFETY 5 2434 • CONSTRUCTION—SUPERVISOR LICENSE 00 — None Number Expires: 1G — 1 & 2.Family Homes Restricted�Jo .:BB T Failure to possess a current edition of the Massachusetts State Buiilding Code ANDRE C LAFERRIERE is cause for revocation of this license. -X :, BOX 872 E FALMOUTH, MA 02536 CJ.�""" � ' ``c� , - � fie -�anvrn:oayuu�ez�� o��/G�za��zc��rsae� o HOME IMPROVEMENT CONTRACTORS REGISTRATION Board of Building Regulations and Standards One . Ashburton Place - Room 1301 Boston, •Massachusetts 02108 HOME ,IMPROVE:MENT CONTRACTOR Registration, 110301. Expiration 10/13/98 Type - PRIVATE 'CORPORATION DECOSTE REMOD & - DES CENTER LTD j+ MARY A GAUTHIER 4380 FALMOUTH RD COTUIT MA 02635 I F • � —— ,per `�'.T/,�"'lOomrineonwealdc o�✓�amac/uraella� j HOME IMPROVEMENT CONTRACTOR !, Registration 110301 Type - PRIVATE CORPORATION i Expiratioi,-_ 10/13/98 DECOSTE REMOD & DES CENTER LT MARY A.-GAUTHIER 0 FALMOUTH RD ADMINISTRATOR COTUIT MA 02635 i a Assessor's map and lot numbers,, ......`D..� ' of To Y 4 SEPTIC SYSTE , �� THE y Sewage Permit number .. ..��T...�..., ....,,�.......... ' :. `�: F. INSTALLED ALLED IN COM �t pDLE, .. FJ. House•number ....................... a� �11� L.�T�T�E g Y1►�f7 90� 2639. e� { 4 i, ENVIRONMENTAL co a` APPR ,► �TOWN� OF BARNSTA I� u TIO 8 Barnstable Canwt t ILDING •"AS',P.ECT0R i APPLICATION FOR PERMIT ....... ......... TYPE OF CONSTRUCTION .......... `.... ........: • ....................... .. ........ ..19...1. TO THE INSPECTOR OF BUILDINGS: J " The undersigned hereby applies for a permit according to the following-information- Location ...... ......... . ..... �: ...C1 .7" ({.1/1 1 ".............................s Proposed Use ...... .5.,..uxn Z_,45........ -..................................................... Zoning- District ...FC4`S�A. �4L. .. . ...... Fire District .. ...... Name of Owner �NE6 C•owS�iGL..G�"7U.i/ Gd. a ddress .. 4.Y....:�T-F�.�^T.....i ?N...ZQ: ..�. .................. Name of Builder ..:............... 'fi r . .::...:.....::.....:..:......:Address ...`.:.... ...., �`✓ .. .......................................... Name of Architect' ....... .. .............:------.. . ..Address ::....... Number of Rooms'.- ..�.. ......... .......:. .........Foundation` .:w��'..�:.�C..� Cl:....:k ...... ...... .. .. <.NlT /tip s u..b!' hk� 7" 1uL-G .S ; Exterior .......... .� �C4t1i�..S?V........ .. ..........Roofing /4.S.P.f1 f9�....:......•...:. N,L ......................... Ar Floors ...............cZ,0,e8F/......:d:....Rt•'OBE............. ................Interior ......6l4.63:PAAA......'a:..:.��J4.��............ Heating :.Plumbing ....:: .T ?� ................................ Fireplace ....4TOVC-k..... .....: . .......Approximate. Cost .141AJ1 '... •..� Definitive Plan Approved by Planning Board ________7________�_____19 Area ......:/.1. ............ ...........:. Diagram of Lot and Buildingwith Dimensions '' 5 9 �. Fee ................... ......... SUBJECT TO APPROVAL OF BOARD OF.HEALTH VP OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS 741 I hereby agree to conform to all.the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .......................... ' �r6 Construction Supervisor's License d� / THEO CONSTRUCTION CO. No 34 915 'Permit for .. Two...S,tory,....... f ~ ` f r ll .... Singl.................. y.. ............ 01 ..... v j .. Ivcation .L4t... �,�*,�o.. 5.9. .'+,1d�:..W.at ...Drive T ...�.Y.f t.Sr.Y. .�.Y. . .. Owner Theo CAm .. t u� .7;0?T...C.Q....... Type f Construction. �....................... s'• ..... .�.. w ......•.......... • '� _. ,r '�'• r • _ ., .. Plot ...... .......:... Lot ..... % (?ermif A ril: ............. 92 Granted P ! l9 s Date of Inspection ........ Dater°Completed �1.. G1................ 19 TOWN OF BARNSTABLE Permit No. . 4.91 BUILDING DEPARTMENT I ' TOWN OFFICE BUILDING Cash � .Ml 'ro.•+' HYANNIS.MASS.02601 Bond CERTIFICATE OF USE AND OCCUPANCY Issued to Theo Construction Co. Address Lot #5 r 59 Blue Water Drive Centex-�rille, Mass. ri 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. July..?1... ..... , 19.......9. ..... / .,,!a. • Building uildi �!...c ��..� g Inspector THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) M AC DATA � ' I ' TOWN OF BARNSTABLE, MASSACHUSETTS 1UIL LNG PERM. DATE / 19 PERMIT NO. 'APPLICANT �••�'�3i `• ADDRESS S 3W #039608 I 1" (NO ) (STREET) ICONTR'S LICENSE) PERMIT TO < ��I, ;+•1(' 1 NUMBER OF STORY(_ ) - .6 c Jt -'1 ' 1G7 DWELLING UNITS tTYPE OF IMPROVEMENT) N0_. (PROPOSEDUSE) ! AT (LOCATION) i.'. ZONING - STREET)(STREET) , DISTRICT BETWEEN (CROSS STREET) AND (CROSS STREET), (. SUBDIVISION LOT LOT BLOCK SIZE ' BUILDING IS TO BE-FT. WIDE BY FT. LONG BY FT. IN:HEIGHT AND SHALL CONFORM IN'CONSTifUCTI TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION `REMARKS: 7y tJ�',i. t, t .. '.: )U1 (TYPE) ' REA OR VOLUME ESTIMATED COST $ 12:51 000•00 PERMIT,� 1.J4• 50. (CUBIC/SOUARE FEET.) FEE ;OWNER ADDRESS BUILDING DEPT. B ^r! f THIS PERMIT PERMANENTLY. ENCROACHMENTS ON CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY c PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST 8E A •► PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINS FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIOI OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL INSPECTIONS REQUIRED FOR -APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ELECTRCALI. FOUNDATIONS OR FOOTINGS. MADE. .WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL',INSTALBLIATIONSD ,2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOTB'E OCCUPIED UNTIL MEMBERS(READY TO LATH). 3. FINAL INSPECTION BEFORE FINAL INSPECTION HAS BEEN MADE, OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTI APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 � 2. 2fc 2 �G "�- V o 7 1 HEATING INSPECTION APP OVALS;'; ENGINEERING DEPARTMENT !� 2. BOARD OF HEALT • OTHER SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED UNTIL THE INSPEC• PERMIT 'WILL BECOME NULL AND VOID IF CONSTRUCTION j TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE INSPECTIONS INDICATED ON THIS CARD CAN I CONSTRUCTION. ARRANGED Ff 9 BY TELEPHONE OR WRITTE PERMIT IS ISSUED AS NOT ABOVE. NOTIFICATION. -t 1�e R=170.00' L=1 2�6 i Common Area Easement N_ Lot 6 Za d 40 � �' LP .� o. 46 0 Co- L0_ ZD TOF El. = 52.8 0' Lot 5 51,609 sq.ft.f / All, �. / 1'I ... .... 1 [ /M 6e n Shallow Pond 1 3/25/92 INITIAL ISSUE elk THIS PLAN IS NEITHER INTENDED NO.1 DATE I DESCRIPTION 1BY FOR, NOR SHALL IT BE USED FOR AS—BUILT FOUNDATION PLAN—LOT 5 MORTGAGE LOAN PURPOSES. Blue Water Drive IN Barnstable, Massachusetts FOR Dennis Star Construction I kA°g.1. SCALE: 1" = 50' JOB NO. 1257 I CERTIFY THAT THE FOUNDATION 9r� SHOWN ON THIS PLAN IS LOCATED °r RAUL A. 1 , D 50 100 ON THE GR INDI AT LEVY NO- 10617 3/25/92 LEVY, ELDREDGE & WAGNER ASSOCIATES INC. DATE R E S T E D L SURVEYOR <� ENGINEERS LANDSCAPE ARCHITEC S PLANNERS LAND SURVEYORS 586 STRAWBERRY HILL RD. CENTERVILLE, MA 02632 r � ; r ' � ' ' r v '# t t t� __:s.. Y >a � r .? w "�.",�✓v� 1' tE�i , r - Si... xt < - '; r- tl P•r,.p°f' N i. i -,{y I�5 ` !� N.H:�„v . .:s.:a� r :z, �wi t a �.� tx s:g 't• { } � U a r...:"� S e x;'•].�_ a{�:.i: `�. t•1` ..r.i:1 7 4 i fi t ti'.� r -77 777 is, t <.. 6ya NNW '* :2P-'sx X �.� r ..;,,::.n .., .. .- _. Yr`x��,c.�"" ..': �?5.r-i'� ux t. Es a-.f �`cyf rr;-.3 - y,-�.> �-�-p�, :s7,s:,r r� -s t- $,'t•�hi, '•5; r r. 7 S,- ✓, t.._ - �: Y _ .. 'ti- ,u -r e '. 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