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0086 BUCKSKIN PATH
� vcs�; Pam 4 " ra a 109 Town of Barnstable Permit# Regulatory Services fee 6monthsfromissuedate BAF 'AO= Richard V.Scali,Director ` Building Division --_--------------_—`— -----.—._._�.—�__�-Panl-Roma,—Building-Commissioner--- ----- ------------ 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma us Office: 508-862-4038 Fax:508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number D Property Address *Residential Value of Work$' "000 Bo Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address , Contractor's Name 1 ''y � � Telephone Number sb �C� C63 Home improvement Contractor License#(if applicable) SIMLAEmail: �1 NKsp w ;.( 1� rWor ction Supervisor's License#(if applicable) �� kman'sCompensationInsurance CoCheck one: a ❑ I am a sole proprietor JUL 31 ��17 ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance TOWN !A U NSTABLE Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) 1 `'1k Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over' existing layers of roof) ❑ Re-side 4 ❑ Replacement Windows/doors/sliders.U-Value - (maximum.32)#of windows #of doors: *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 thelftqne Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Q:\WPFIL ESTORNIMbuilding permit forms\EXPRESS.doc 01/25/17_ r Town of Barnstable- ` Regalatory Services t s, , . � Richard V. Scab,Director •`� Building Division. Paul Roma,SuBding Commissioner 200 Main Street,Fb nnis,MA 02601 ,.. www.town.barnstable.maus Office: 508-862-4038 Fax: 508-790-6230 Property Owner Mkt: ~`' Complete and Sign-This Section If Using A Builder • as Owner of the subject property hereby authorize V to act on my b6A in all matters relative to work authorized by this bull ing perrnit application for: ,�.X r (Address of Job) "Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of 4plicant 2fPrint Name Print Name Date It Q.F0RIVM.0W4ERPERMI9sI0IUWIS Town of Barnstable Regulatory Services dF Richard V.Scali,Director Building Division u�. t Paul Roma,Building Commissioner 03 �� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.maus Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEIVIMON J Please Print DATE: V JOB IACATION: Sca C s k 4+t r`s number street village "flolvlEowNER":�bt�,e9eV name home phone# work phone# CURRENT MAIL NG ADDRESS: fc /3 ucbC S y If b9 cityhown state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work Rm formed under the building_permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply.with said procedures and requirements. SignaLue of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack-of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of hisJher responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page this issue is a form currently used-by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFII.ES\FORMS\building peanit fonm\EXPRESS.doe 0620/16 . 3 OMB Approval No.2502-0265 A.Settlement Statement (HUD-1) B.Type of Loan 1.❑FHA 2.❑RHS 3. Conv.Unins 7.File Number. 8.Loan Number: ��gage Insurance Case Number 4.❑VA 5.❑Conv.Ins 6.❑Other 2017-598 C.NOTE:This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "(p.o.c.)"were paid outside the closing,they are shown here for informational purposes and are not included in the totals. D.NAME AND ADDRESS OF BORROWER: E.NAME AND ADDRESS OF SELLER: F.NAME AND ADDRESS OF LENDER: Edward M.Butler,Sr. Julie L.Alperen and Jennifer Beth Alperen Cash 30-8329th Street,#El,Astoria,NY 11102 G.PROPERTY LOCATION: H.SETTLEMENT AGENT I.Settlement Date: 86 Buckskin Path,Centerville MA 02632 Dubin 8 Reardon 0 7/1 312 0 1 7 1645 Falmouth Road,Suite 4A,Centerville MA 02632 508)771-0330 Place of Settlement Disbursement Dater 1645 Falmouth Road,Suite 4A,Centerville MA 02632 07/13/2017 J.Summary of Borrower's Transaction K.Summary of Seller's Transaction 100.Gross Amount Due From Borrower 400.Gross Amount Due To Seller 101.Contract sales price 290,000.00 401.Contract sales price 290,000.00 102.Personal Property 402.Personal property 103.Settlement charges to borrower(line 1400) 1,951.74 403. 104. 404. 105. 405. Adjustments for items paid by seller in advance Adjustments for items paid by seller in advance 106.City/town taxes 406.City/town taxes 107.County Taxes 407.County taxes 108.Assessments 408.Assessments 109. 409. 110. 410. ' 111. 411. 112. 412. 120.Gross Amount Due From Borrower 291,951.74 420.Gross Amount Due To'Seller 290,000.00 200.Amounts Paid By Or In Behalf Of Borrower 500.Reductions In Amount Due To Seller 201.Deposit or earnest money 501.Excess deposit(see instructions) 202.Principal amount of new loan(s) 502.Settlement charges to seller(line 1400) 2,244.00 203.Existing loan(s)taken subject to 503.Existing loan(s)taken subject to 204. 504.Sierre Pack 228.688.78 205. 505. 206. 506. 207. 507. 208. 508. 209. 509. Adjustments for items unpaid by seller Adjustments for items unpaid by seller 210.City/town taxes 07/01/2017 to 07/13/2017 104.12 510.City/town taxes 07/01/2017 to 07113/2017 104.12 211.County taxes 511.County taxes 212.Assessments 512.Assessments 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220.Total Paid By/For Borrower 104.12 520.Total Reduction Amount Due Seller 231,036.90 300.Cash At Settlement From/To Borrower 600.Cash At Settlement From/To Seller 301.Gross Amount due from borrower(line 120)' 291.951.74 601.Gross Amount due to Seller(line 420) 290,000.00 302.Less amounts paid by/for borrower(line 220) 104.12 602.Less reductions in amount due seller(line 520) 231,036.90 303.CASH From BORROWER 291,847.62 603.CASH To SELLER 58,963.10 The Public Reporting Burden for this collection of information is estimated at 35 minutes per response for collecting,reviewing,and reporting the data.This agency may not collect this information,and you are not required to complete this form,unless it displays currently v lid OMB control number.No confidentiality is ' assured;this disclosure is mandatory.This is designed to provide the parties to RESPA covered tra lion wit ormation during the settlement process. �s2 Borrower Edwar .Butler,Sr. S u ie L. P714 A,4-� n L Seller-Minder BeUlperen •Items marked"(POC)"were paid outside the closing by the indicated party(Key:B=Borrower;L=Lender,M=Broker;S=Seller;0=Other) Previous editions are obsolete Pagel or3 form HUD-I(1/09) - L.SETTLEMENT CHARGES 700.Total Real Estate Broker Fees Paid From Paid From Division of commission(line 700)as follows: Borrower's Seller's 701. Funds at Funds at 702. Settlement Settlement 703.Commission paid at settlement 704. 705. 706. 800.Items Payable In connection with Loan 801.Our Origination Charge (from GFE#1) 802.Your credit or charge(points)for the specific interest rate chosen (from GFE#2) 803.Your adjusted origination charges (from GFE A) 804. (from GFE#3) 805. (from GFE#3) 806• (from GFE#3) 807• (from GFE#3) 808. (from GFE#3) 900.Items Required By Lender To Be Paid In Advance 901.Daily interest charges From 07/13/2017 To 07/31/2017 (from GFE#10) 902. (from GFE#3) 903. (from GFE#11) 904. (from GFE#11) 1000.Reserves'Deposited With Lender 1001.Initial deposit for your escrow account (from GFE#9) 1002.Homeowner's insurance 1003.Mortgage insurance 1004.Property taxes 1005. 1006. 1007.Aggregate Adjustment 1100.Title Charges 1101.Title services and lender's title insurance (from GFE#4) 600.00 1102.Settlement or closing fee to Dubin&Reardon $600.00 1103.Owner's title insurance to (from GFE#5) 1104.Lender's title insurance to 1105.Lender's title policy limit 1106.Owner's title policy limit 1107.Agent's portion of the total title insurance premium 1108.Underwriter's portion of the total title insurance 1109.Title-MLC to Dubin&Reardon 40.00 1110.Title-Title Exam to Dubin&Reardon 150.00 1111.Title-Plot Plan to Olde Stone Plot Plan Service 145.00. 1200.Government Recording and Transfer Charges 1201.Govemment recording charges (from GFE#7) 125.00 1202. Deed$125.00 Mortgage Releases 1203.Transfer Taxes (from GFE#8) 1204.City/Countytaxlslamps Deed$1,879.20 Mortgage 1,879.20 1205.State tax/stamps Deed Mortgage 1206.Record MLC to Barnstable Registry of Deeds from GFE#7 65.00 1207.Record Homestead to Barnstable Registry of Deeds from GFE#7 35.00 1208.Record Mortgage Discharge to Dubin&Reardon Discharge from GFE#7 75.00 Account 1300.Additional Settlement Charges 1301.Required services that you can shop for (from GFE#6) 1302.Deed Document Preparation to Dubin&Reardon .1150.00, 1303.Mortgage Discharge Tracking Fee to Dubin&Reardon 75.00 1304.Property Taxes-8/l/2017 bill to Town of Barnstable 791.74 1305. 1400.TOTAL SETTLEMENT CHARGES(enter on lines 103,Section J and 502,Section K) 1,951.74 2,179.20 orrower EdwafTV.Butler,Sr. Seller .At an Seller Jennifer Bet AI even The HUD-1 Settlement Statement which I have prepared is a true and rate account of this transaction.I have caused or will cause the funds to be disbursed in accordance with this statement r Settlement Agent: Date: r *Items marked"(POC)"were paid outside the closing by the indicated party(Key:B=Borrower;L=.Lender,M=Broker;S=Seller,0=Other) Previous editions are obsolete Page 2 of 3 form HUDA(1/09) QUITCLAIM DEED We, JULIE L. ALPEREN, of 30-83 29"' Street,Astoria New York, 11102, and JENNIFER BETH ALPEREN, of 25-51 33`. Street/2R, Astoria,NY 11102, N in full consideration of TWO HUNDRED NINETY THOUSAND and 00/100 ($290,000.00) N DOLLARS PAID o Grant to EDWARD M. BUTLER, Sr., individually, of 86 Buckskin Path, Centerville,MA 02632 with quitclaim covenants A certain parcel of land,together with any buildings thereon, located in Barnstable a� (Centerville), Barnstable County,`Commonwealth of Massachusetts, more particularly V described as follows: WESTERLY by the curve of Buckskin Path, by two courses as shown on plan hereinafter referred to there measuringon an arc for a total of one hundred 'eighty-five-five and g Y 59/100 (185.59)feet, more or less; NORTHEASTERLY by the curve of Naushon Circle, as shown on said plan, there measuring on an arc thirty-nine.and 27/100 (39.27) feet, more or less; 00 NORTHERLY by Naushon Circle,as shown on said plan, there measuring on an arc forty-one .. and 31/100 (41.31) feet, more or less; w EASTERLY by LOT 46, as shown on said plan,there measuring one hundred fifty-nine and a 13/100 (159.13) feet, more or less; A SOUTHERLY by LOT 39, as shown on said plan, there measuring ninety-seven and 14/100 (97.14) feet, more or less. F+ a All of said boundaries are shown as LOT 47 on a plan entitled"Subdivision Plan of Land in W Centerville-Barnstable Mass. for Alan E. Small, et us., Scale: 1 inch=60 feet,"dated July 22, 1968, on file at the Barnstable County Registry of Deeds in Plan Book 224, Page 87. 0 - P-4 - 1 - There is granted as appurtenant to the above described lot a right of way over the ways and roads . as shown on said plan and those on plan of land entitled"Subdivision Plan of Land in Centerville-Barnstable, Mass. for Alan E. Small and Dorothy A. Small—Centerville Highlands, Section Four"recorded in said Registry in Plan Book 204, Page 117 to be used in common with all others nor or hereafter legally entitled thereto. Subject to and with the benefit of all rights, restrictions, rights of way, easements, appurtenances, reservations of record insofar as are now in force and are applicable. Meaning and intending to convey the.same premises conveyed to Grantors herein by deed dated July 5, 2012 recorded with the Barnstable County Registry of Deeds in Book 26490, Page 92. Grantors hereby release any and all homestead rights to the within premises, whether created by declaration or operation of law, and further state, under the pains and penalties of perjury, that there are no other persons entitled to homestead rights in the property being conveyed herein. - 2 - Client#:38860 2EXCELBU ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE`MMVDD/YYY1T) 3/22/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED - REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed.M 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 NAME: Dowling&O'Neil Dowling&O' Neil Insurance Agency PHONE F A/c No Et):508 775-1620 A/C Noy 5087781218 973 lyannough Rd,PO Box 1990 E-MAIL col@doins.com ADDRESS: Hyannis,MA 02601 508 775-1620 , , INSURER(S)AFFORDING COVERAGE NAIC� INSURERA:NGM Insurance Company 14788 INSURED INSURER B:Associated Employers Insurance 11104 Excel Building Systems Company,Inc PO Box 436 INSURER c:Safety Indemnity Insurance Comp 33618 - ' Forestdale,MA 02644 INSURER D: 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 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. INSR ADDL UB POLICY EFF POLIC EXP LTR TYPE OF INSURANCE IN WVD POLICY-NUMBER MI/DD MM/DD LIMITS A GENERAL LIABILITY MP02774T 2/22/2017 02/22/201 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY PAEMIS �ao�un�ce $500000 CLAIMS-MADE �OCCUR ' MED EXP(Any one person) $10 000 PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE s2,000,000 hN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,000 POLICY PRO-; LOC $ C AUTOMOBILE LIABILITY 6231596 2/W/2016 12/09/201 CMBINED E'aca dentSINGLE LIMIT 1,0W,000 ANY AUTO BODILY INJURY(Per person) $ ALLOWNED 1XX SCHEDULEp AUTOS AUTOSBODILY INJURY(Per accident) $ X HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DIED I RETENTION $ B WORKERS COMPENSATION WCC50050098182017A 3/05/2017 03/05/2O1 X WC STATU- IER OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $500 000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500 000 n yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500 000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,I more apace Is required) . 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. • F CERTIFICATE HOLDER CANCELLATION Town Of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD AC1 AR197AAI RRi M ran , COMIJU07riveaT&ofJ11fwquu&rsset�s 6DD�P�,�f�eet brrsx, A 02111 Wturke& CunTens crnl ce -rvit:Suede -dCknfractarsMecfii an%1Plm„hers uuli Infcrnaf Please Print Wr nentploer?fed€theappropriateban ' Type of graject(reeled): Lama 1 Rift 4 ❑I am a g�dcoa�sctasandI ealplaees( andfor �rpar me).* �hited1he sakr com�at�s - ❑New I D I am a sole Propsieftw arpartaw- Tisted Ca the attached srheeL. 7. emadedrag slip and have no employee& s-eb-con?ractors hwo 9,Q Dem lftioa waidrg far.=is any capacity. emF1oYms andbare WO&Me 9. ❑Builc1mg acl iaa 190Tupdmrs' comp.imsmmnm reT.iked-j 5. ❑ We are a•cmpomfionand its M❑Electrical repaim or addifioas 3.❑ lama bameow�er doing all vok ofrkm have exes wed f Lek 11-❑Phnabiugrepaim or addifibns. c of per h�Ct 7 L- ��aems'&]I - c.15Z,g1(4k an.dwe have no ❑Roof employees-[No worms' 13_❑Other cosh-iasoxauce required] •our apg �sccheckst�az 1 nmst alsn fiIloartth�sectinabdaws va t5eswo�cea*mmpeasa5aupc,T�cpaE 03L fi ff•�rm�stvho sab�3 saris g i 6�zp�3am�s1f sPa�c®dtheal�xe a�E�cuams#an'b�t anews��mdi�smcl� TC��ffutA cf 6mc�t eaad�S�alslzeeisLo�ciagtLen�eoEthe mulst�e�the acnoY�nseeoditiesh �plo3rees.7ft3�esah-c���,�IuceemPio�',t�e}'a�Fm►•idef�trodce�'tnmp.pa�maubet , lam ars slxpjga ffjat is prmMjrg markers'campawaffan iu=rai w jbr rah*empkwgs: Bdow is Agpoffcp and jab sda iTi�afm[rIfDS. Tacrtranc4t:01IIpaIIyi�a�.e: ' 'P licy g or self-ins..Iic--¢ FSpi iaaDafe: lob OmAd&e Cify/Stafief p: Attach a copy cif the worms'roanpeasaflonpopcydeciaraifion page(showing f e,p6&7 amber aad expiration date). Fafre to semen coverage as requimd under Secfi=25A of MM c.I52 caa lead to tfie imposition of climisml peaatfies of a fire up to$I,500:4U mWor cne-gear iminiso as weg as cif peualtirs in the fora of a STOP WORT ORDERand a 5me of up to$25 OO a clap ago ast The violator. Be advised that a copy of this sbatemed=sy be faded to the Office of Ids oft e D.TA far i m-ran =cove p erica- , Ida hawby Ca* pass=dprwhhks v'irecgs y fis tTw informafimprin-fi d abmw is bars and caned ^tiasi�tarr� a bate- i Phase g: aid use wdy Do not witir in fps area,fa be cmnpkai by dfp arfacrn affmifiL City or Toren: Perudffieease f E=dng A ffior ty(dr&-one): L Board of M21th r.Buung Depm-[meat 3.CAyf'£own Qerk 4.Electrical I' 4mfnr S.Plmmhbg Inspector Comet p'enow Phone : -- 6. i laform ation and las" c ors ; ��ts GPI Laws chapt=I52 req=aII toprovi&wa±c&�mvzsf f=for t'hea=npIo- Ptsrsaa ttofis.mac,anEnl7L7Wisdefinedas¢—�esyPeisanm.�asavieeofSherffidrTMly ofh ml e q==ar implied,'oral or wrlftffi An BznpIvyEr is def"med as—M iw ' pT P=n=hip•amcmc,CmPonfim.or of m Ieg d=±tr.or any two or mote o€$�fi�egviag a Jonzt amdmGlndmg•die legal ves of a decsased amployra,or fhe recei=or t=as of en kffVjffiML per,asocisiion ar offimlegd maY,eMPIDY1119 mnPIDY=R- However the own=of a dweITmghou=havmgnotmo=tb m.ibree-aPmt=3 s=Iwho residesffiezenO,or the oa f oftbe- dweT mghouse cf moflimwhn=plops P==t4 do caashuctirsn orrepairwD kons�Th dwelling horse or on.•Line gotmds or bmVzogq7pmt=zntff=cfD sballnotbecanse of such moploymedbe deemedin be am employe" MGL chspter 152,§25C(6)also sbdEs that¢everysfsIe ar local II=nszng agency shall wif hold•fb.e is5aancg or renewal of a Fcease ar permit to operate m hasmess or to constmct b ldmgs fn fhe comuaoaweal$h for nay • apglicaatw•ho has aotprodnced acceptable evidea�of campIIanCe with flit mrsatancE coverage re�a�-" Ad iOnally,MCEL chap,=152,§25CM states=Termer fha _awmalffL nor any ofifs poIrtical sobd3vi signs slzzaIl eni�r into any cactmd f or tbz penance ofpnbhO wm k mmI suable evhdmm of=uTlisum ifih the msQran. . re�m�enfs offiais rhap�sbavelie�.pre$e�din the confracfnig.aidiiozdy." ' A.gpHaLuls if Please fill oil $ie wont=,compeasat3.on affidavit completely,by Ong the boxes•that apply to poor sifnaiion ninth, .mszY.=pPIY sob�acta s)name(s). des)andphrmen=&E:r(s)alongw&hthr.°s=tffCate(s)of msn-smce_ UzbMty Compm es PA or IImited.Lisbhfity?eih=n hiFs(LU)--vvA o empbY=of=than.th e m=i},=s Cr pis,arenotrimedt0 cm:[-Ywad=�e co=Peasationice. If enLLCarI.TP does have. employees,a.policy is rimed. Be advisedii�attbis affdaY maybe sn fn the DeF cut of lndnsfrial Am ideds for COMEMBEM of iDS �- . caveaage Alsa be sure to sign and daim the affidavit: Tbc affidavit Should beretmed to the city ar town that f c appHcaiou ft fie pemat or Ilc=se is being r ,not th a D.eparimed of ' Inrmsi�a' I_A oddentr Sbonldyou bavo my g�'ft� g the Ian or ifyon aie regr�ed to obtaia a wort=' �e�on policy;pleasecaaf.6Depmtncntatfh mmnbrr isfedbelo� Self-msuxedcampa�essliovldeaiett�ieir self-;ns rzamH e.mem=beraatie==mrisf D line. V City or Town 0-Mdals - Please be sore that the affidav is wmplete sndprmmd Iegxbly- The Departmeathas pmvided a space of the botEam of the affida�kfor youb fill omit intro event the Office oflnvesff atirms has to 003tactyouiegax3mg Hie epPTir zat Pleasebe stneto flliatheplice�.senbeswhichWillbeusedas arefce�bec Inaddn,ao agPIica� flat must submit mx4Ie p=mtUc==a This =in MY give year.need only saTmnrt nine affidavit iu e� policy kforma (if 3')and maces=Tob�Address'$.e aPPlica�shonldwrif�"aTI lucafions in (r:L or •town)'.'A copy of the•a:ffi v ttbathas bey.officially ebuoped ormarl�dbytlhe city ar tuvm may be provided to tlhe applican#as proof that a valid affidavit is an file for f&a peoniis or Hc=C& A new of ddavlfmust be filled ort each year.Vhrre ahome owner or c is obbffi3iag afireose air pamoit not reIatedin mybasin=or corm= al ventme, - (ie.EL Clog license orpemk to bum leaves said pmsan is NOT regcdred to compldD fins affidayst Tlie office ofT3xvcsfi92di=woaUI10--to thank you in advance for your coopraafioa and shovldym hmm mly gII=ficos, - plmse do nntb=NfmtD its a C;a Ibz Depsri s address.tG�and;Bix=nber: DepartnwtcfIi&EsfdaI Awidenta ' . . MM CfIwe&tk-IfL0= 60awaahj�= Fax#Q7 727-W49 Beviscd4-24-07 -Y� a +®`"t Commonwealth of Massachusetts ' + Division of Professional Licensure Board of Building Regulations and Standards;. ConstrtlmtiOn Supervisor CS.-098849 ` EXpires:06/20/2019 r RENATO F DA SILVA .. P.O.BOX 436;� FORESTDALE MA 02644 ?*� 41 Commissioner ` (C�may • ' ' �i"/" Il �:'""�.",�' ` Office of Consumer Affairs&Business Regulation T,y• 3• HOME IMPROVEMENT CONTRACTOR ✓-' ',TYPE:Corporation `Registration valid for individual use only ; Regiitration Expiration before the expiration date. If found return toc rF182094 05/25/2019 f Office of Consumer Affa• and Business Regulation" EXCEL BUILDING SYSTEMS COMPANY INC. Boston,10 Park Mq a02 Suite 0 RENATO DA SIL � p F 8 JAN SEBASTIAN DR.STE 9` r� SANDWICH,MA 02563 Undersecretary Not without signature y s n Town of Barnstable Assessors Division Page 1 of 3 Ff Your Location : Home : Town Departments : Administrative Services : Assessors Division : More About <e ack- Forward» Tuesday, February Search Website y ss+85501'S ®IVlSi®B1- More About Town Departments *All Departments Data is based on Fiscal Year 2002 Assessor's database and is provided for inft *Town Council purposes only. *Town Manager *Administrative Services 86 BUCKSKIN PATH a Regulatory Services Map/Parcel/Parcel Extension: Mailing Address: *Community Services 170/047/ THURBER, HARLEY J &GRACE *Public Works Owner of Record: *Police Department THURBER, HARLEY J &GRACE 86 BUCKSKIN PATH Property Location: CENTERVILLE, MA 02632 Town Information 86 BUCKSKIN PATH Parcel ID: 17°°�� *All Information *Agendas *Annual Report *Committees *Co m es Fiscal Year 2002 Assessed Values *FAQ's Appraised Value Assessed Value *Forms and Applications Building Value: $ 111,600 $ 111,600 *Hearing Schedules *News/Press Links Extra Features: $2,500 $2,500 *Operating Budget Outbuildings: $0 $ 0 *Ordinances *Property Assessments Land Value: $44,900 $44,900 *Regulations Totals: $ 159,000 $ 159,000 *Town Charter *Town Calendar *Town Maps Town Newsletter Receive Town Updates By E-mail Sales History Click Here To Join Owner.: Sale Date: Book/Page: Sale F THURBER, HARLEY J &GRACE 1459/710 $0 Contact Town Hall Town Hall 367 Main Street Hyannis, MA 02601 Land and Building Description Phone 508-862-4000. Land Building E-mail Contact Town Hall Lot Size(Acres): Year Built: 0.35 1969 Appraised Value: Living Area: $44,900 1570 ticcaccnrl VA110. RonInnamant rnct- http://www.town.bamstable.ma.us/comeonin/.../resultsk02.asp?MAPPAR=170047&BI=SubmI 2/12/02 Town of Barnstable Assessors Division Page 2 of 3 r $44,900 $ 132,906 Depreciation: 16 Building Value: $ 111,600 Construction Details Style: Interior Walls: Ranch Drywall Model: Residential Interior Floors: Grade: Hardwood Average Grade Stories: Heat Fuel: 1 Story Oil Exterior Walls Heat Type: Wood ShingleClapboard Hot Water Roof Structure: AC Type: Gable/Hip None Roof Cover: Bedrooms: Asph/F GIs/Cmp 3 Bedrooms Bathrooms: 2 Bathrooms Total Rooms: 6 Rooms Outbuildings & Extra Features Code Description Units/SO FT Appraised Value Assessed Val FPL1 Fireplace 1 $2,500 $2,500 Building Sketch a 55 F F W r y, \ S http://www.town.bamstable.ma.us/comeonin/.../resultsk02.asp?MAPPAR=170047&B1=Submi 2/12/02 r Town of Barnstable Assessors Division Page 3 of 3 Back- Forward Home Departments Town Information Contact Town Hall Website Developed and Maintained internally by the Town of Barnstable Information Systems Department Town Hall-367 Main Street- Hyannis,MA-02601 -508-862-4000 DISCLAIMER: Although we strive to provide accurate information,we are only human. Please consult directly with the appropriate department.if there is a question of accuracy. Copyright 2001©Town of Barnstable. All Rights Reserved. http://www.town.bdmstable.ma.us/comeonin/.../resultsk02.asp?MAPPAR=170047&B 1=Submi 2/12/02 Insulate W e a t h e r 1 z a t i o n & Insulation qao Grove St k'211 River,Ma o2723 Insulate2sa• zet q ' T"j emu„. . March 6,2014 Town Of Barnstable . Thomas Perry, CBO 200 Main Street Hyannis,MA 02601 R1;: 86 Buckskin Path Dear Mr. Ferry, This Affidavit is to certify that all work completed at 86 Buckskin Path has been inspected by a certified BPI Inspector. R35 Cellulose was added to open attic space.R.38 unfaced fiberglass batts for damming purposes. All Work Performed Meets or exceeds Federal and State Requirements, Sincerely, Roland Langevin Insulate 2 Save, Inc President CSL 103861 HIC 166311 ti „ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION � ( TOWN OF A; A�CrA� I Map Parcel `C _: pplication # �0(b�20 C� Health Division ZI ' FL n" ,Date Issued Z �' Conservation Division Application. Planning Dept. .. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH = Preservation / Hyannis Project Street Address Village Y\/1 Owner Address ct TelephoneCorn ` Permit Request � 'e nSrt_� ( Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuati 4_�:) 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 Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name l Y QL_R \Aq Telephone Number 7� 5� Address Ch 0 63 l� J�- sil License# y Home Improvement Contractor# Ito o 6 Email Worker's Compensation # -f'�) ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY F y . APPLICATION# s j DATE ISSUED MAP/PARCELNO. I 4 ADDRESS ' VILLAGE OWNER DATE OF INSPECTION: I FOUNDATION t FRAME l- INSULATION r FIREPLACE ELECTRICAL: ROUGH FINAL 4 PLUMBING: ROUGH FINAL GAS: ROUGH FINAL Y I FINAL BUILDING f 4 , t DATEaCLO.SED OUT I ASSOCIATION PLAN NO. } (Ff RISE ENGINEERINGFederal ID#05 OA05629 Rt Contractor Registration No 8186 A division of"I'hielsch Iinginceriil{ MA Contractor Registration No 120979 CT Contractor Registration No,620120 1341 Elmwood Avenue,Cranston,RI O 910 COP (401)1 -3700 TAX(4101)7t3 - `° CONTRACT _ Page. 1 PROGRAM, THIS CONTRACT 15 ENTERED INTO BETWEEN RISE _c,tJ�N._�2C,� ENGINEERING.AND THE CUSTOMER FOR WORK AS ENGINEERING DESCRIBED BELOW .......... _:...w.,_. _,.,. ._.. ..,...... _. ._..........._..... . . . ............ . .... .. CUSTOMER PHONE DATE Client _ Cynthia Shields (508)280-4288 11/1 1/20I 3 144067 _ ........ �,_ .. ..._..,... .._.. .. SERVICE STREET BILLING STREET 86 Buckskin Path 86 Buckskin Path _ ,....................._ _ ._ .... _. _.. . . ..._,. -..... . SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Cenlervtlle,-MA:02632 Cerite,rville, M.A 02632 .10B DESCRIPTION Provide labor and materials to seal arias of your home against wasteful,excess air leakage. This work will be pert rrmed in concert tivith the.use of special tools and diagnostic,tests to assure that your home will,be fell with a healthful level:of air exchange and indoor air quality.Materials to be used to seal your Hume can Include caulks,foams,weatherstripping anti other products. Primary areas for scaling include air leakalae to attics.basements,attached garages and other unheated areas(windows are Hot Lcricrally addressed) (12)working hours. At the completion of the Sveatherization work,and at no additional cost to the homeowner,a final blower door and/or combustion s itctti auialysis will he conducted by the sub-confractor to ensure the safety of'(he indoor air quality. $924.00 Provide labor and materials to install a l2 li-)w of R-38,imiac.ed fiberglass baits to(.100)square i'µI for damming purposes. $205-00 -Provide labor and materials to install a 10"layer of R-35 Class I Cellulose added to(.1292)square feet of open attic space. $1,731.28 Provide.labor and materials to install 12)insulated exhaust hose with roof mounted flapper vent to exhaust existing bathroom fan(s). $232 20 Provide labor and matt rims to install ventilation chutes in(72)rafter Bays to maintain airflow. -.---- -- .. $251.28 r-- r.. FE y kg a"Yv'�h t i tit _ Total: $3,343.76 a Program incentive: $2,738.82 Customer Total: $604.94 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Six Hundred Four&94/1.00 Dollars $604.94 UPON FINAL INSPECTION AND APPROVALBY RISE ENGINEERING.CUSTOMER AGREES TO REMIT'AMOUNT DUE IN FULL.INTEREST Or i%WILL BE CHARGED MONTHLY ON ANY UNDAJD t9ALANt FTER':;<D O YS.SEE:REVERS dpt IMPORTANT INrORMATiO OW GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. - DO NOT N THIS'CONTRACT IF THERE ARE ANY BLANK SPACES _ �//// �) CE AUTHOR'... SIGtUITURE•RISEENGIN£ER NG�. .... ........... .,,. ...,........ CUSTOMER ACCEPTAN �� ..... NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE ;- SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO 00 THE WORK .......... GAYS. AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE - I , i ,' . OWNER AUTHORIZATION FORM my (Owner's Name) owner of the property located at v(Propert Address) (Property Address) hereby authorize ✓ _� + --�? - � l G'l (Subcontractor) an authorized subcontractor for RISE,Engineering, to act on my behalf to obtain a building permit and to perform work on my property. Owner's Signature ` Date ` The Commonwealth of Massachusetts Department oflndustrialAccidents u Office of Investigations d 1 Congress Street, Suite 100 0�Q Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Insulate 2 Save, Inc. Address:410 Grove St City/State/Zip: Fall River, MA 02720 Phone #: 508-567-6706 Are you an employer? Check the appropriate box: Type of project(required): 1.9 I am a employer with 18 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ 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.❑ 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 Insulation/weatherization employees. [No workers' 13.❑■ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. . t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Guard Insurance Group Policy# or Self-ins. Lic.#: INWC311431 Expiration Date: 12/10/2014 Job Site Address: 2(5 �IUocs U'n �G-�'1 City/State/Zip: C R 1' Ak KA 1��1 I Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under th ains andpenalties ofperjury that the information provided above is true and correct. JAN132014 Si nature: Date: Phone#: 5b 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#: R Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 166311 INSULATE 2 SAVE Type: DBA. Expiration: 5/11/2014 Tr# 222532 ROLAND LAN.GEVIN 536 EASTERN AVE. FALLRIVER, MA 02723 _._- __... ...._._. _. --- DPS bp1 c SOM-04/04-G701216 Update Address and return card.Mark reason for change. Address Renewal �� Employment ^ Lost Card Office of Consumer q fairBu ess Regulation HOME IMPROVEMENT CONT g License or registration valid for individul use.only RegiSKration: �GTOR before the expiration date. If found return to: 166311 Office of Consumer Expiration• 5/11/2014 Type. Affairs and Business R DBA 10 Park Plaza-Suite 5170 egalation iNl TE 2 SAVE Boston - ,MA 02116 RZ LANO LANGEViN 53 EASTERN AVE. / FALLBIVER; �A 02723 Undersecretary _........ _...- ....._— _ Not valid with_ ——out signature Massachusetts - Depar �, e^:o ub?ic safe*.•, Board of Building Reguia-io^s =nd S°andarcJs Construction supervisor ,cease: CS-103861 ROLAND LANGEVIN 536 EASTERN AviiE. Fall liver MA 02723 = n ~iss:o-e 08/24/2015 7 DATE(MM/DDIYYW) At_X>R© CERTIFICATE OF LIABILITY INSURANCE 12/11/13 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIRCATE 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 RERI2ESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INURED,the policy(its) must'be endorsed. If'SUBROGAMON I$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 CONTACT NAME: _.__ _.... ._. Anthony F. Cordeiro Insurance PHONE FAX (50t3) 6 7 7-0 4 0 9 I)i Pleasant Street EE-M 1LF.>ci (508 677-04A7 ! No: ADDRESs: lbrizido@-cordeiroinsurance.com Fail River, MA 02721 INSURER(S)AFFORDING COVERAGE INsuR.RR A:Atlantic Casualty Ins. Co INSURED INSURER B:Torus Specialty Ins. Co. r Insulate 2 'Save, Inc. INsuRERc:Great American Ins. _ _ 410 Grove St. INSURER D:Guard Insurance Group _ Fall River, MA 02720 INSURERE__`— 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 ........, iA00L�SUBR .,....., ..".....- . .. I...".''POLICYEFF P 1. VOIJ-G`Y ._.... .......... ..... ......._ .. ... LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER M/DDIY YY) (MMIDIYYYYYi LIMITS A GENERAL LIABILITY Y Y M081000174-1 6/12/13 6/12/14 EACH OCCURRENCE S -- DXJWGE TO RENTED }S COMMERCIAL GENERI�ALLIABILITY -PR,F.M1c>:,$(E30;pJ6eaC?) $ 100 —_I CLAIMS-MADE I ^1 OCCUR ME EXP Wry one person)....,$ 5,000 jPER80114L&ADVINJURY. ;_$.....1,.000,000.._. ,...... ...._ .?ti.-_..__..__....w._,._ ----------I 1 GENERAL AGGREGATE—_..$2.,000.,00O ... GENiAGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG PRO- �.....� }( LOC POLICY T I $' AUTOMOBILE LIABILITY CoNB IN L I -(Ea 2CciU9RiI $ _ ANY AUTO I BODILY INJURY(Per person) s ALL OWNS D SCHEDULED _AUTOS AUTOS BODILY INJURY(Per sccidenq $ _ NON-OWNED PROPERFY HIRED AUTOS AUTOS er arx $ B X UMBRELLA LIAB X OCCUR I 78264D131ALI 6/12/13 6/12/14 EACH OCCURRENCE s 2,000,000 EXCESS LIAB - _..__ .. CLAIMS-MADE AGGREGATE _ s_ =_2 _( 00,000 DEO X RETENTION$ '10.000 $ MRKE D AND EMPLOYERS'IABIL0ITY YIN INWC311431 12/10/13 12/10/14 X,_LT4&Y 1N!tSS ...... ER- ANY PROPRIETOR/PARTNER/EXECUTNE E_L.EACHAGODENr S 500,000 O_FICERMIEMBER EXCLUDED? N/A (Mandatory In NH) E L,DISEASE,_EA_EMPLOY�$ _ 500,000 If yyes describe under — DESGRlPTION OF OPERATIONS below E.1..DISEASE-POLICY LIMB's 500,000 G Equipment Floater i IMP 375-99-76-01 6/12/13 6/12/14 Shop Storage 75,350 Veh Storage 76,250 i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is recitired) Proof of Insurance. Residential Insulation Contractor. p CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN T6i4n Of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS, 200 Main St Hyannis, Ma 02601 AUTHORIZED REPRESENTATIVE l• I ©1988-2010 ACC D CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: __ II TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 1;7 Parcel Permit# Z� L / eaNh Division I 1 - Date Issued — o 14 Conservation Division Application Fee Tax Collector Permit Fee 2 ,5 Treasurer somc SYSTEM MUST BE VWALLED IN COMPLIANCE Planning Dept. NTH TITLE S NO Date Definitive Plan Approved by Planning Board lIIRONMENTA� ON Tp REGULA Historic-OKH Preservation/Hyannis Project Street Address 6-1(f4•- ,S e� Villager ` /j_ VGL— L—I Owner Address Telephone Permit Request4. �L L. ��C/ fill' � �✓�G�f G�c �,e¢� l— �� Gs��/,= Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay ,Project Valuation Re6:::�,,6® 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 Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed: ❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ , Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION 3 7��` Z`7✓� Zv 2 Name 14YL E7hA f PL, 6 Telephone Number/,�W '2y2'7 ` 1 Z Address License# rG7/ l Home Improvement Contractor# 1 Z 2 L Worker's Compensation;#C9A 6 S f f a b 731 Of ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Xi4//,2t-rG L— SIGNATUR) DATE 0 3 f� FOR OFFICIAL USE ONLY r4 . } PERMIT-NO. DATE ISSUED MAP/PARCEL NO. s i ADDRESS VILLAGE OWNER- DATE OF INSPECTION: FOUNDATION FRAME —U S INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGUR W FINAL ' 0� GAS: ROU - FINAL Nam. 29q FINAL BUILDING X Q 20 cl r• 0 O i DATE CLOSED OUT L :r , co ' ASSOCIATION PLAN Nc)eTr r The Comi WnxM 77th'of 1Vlassachusetts - - Department of IndusHat.Accidents' 6Q0'WashingtonStreet _ • BASt^MASS. . . workers'.C m ensation.usuranceAffidavit-General$usfnes`ses /' address: , ®Z ho e • �• � � state• �5 tit _. . • . -..«. work site iocatio>t full address (,�G �`ypa. []Retail �Restauran ai/Eatiug I?stablisliment El I aln.a.sole props etoz and have no ones has ess (�Office[�SaTes(mclnding REa1 Estate,Antos etc.) in an capacity. yrorging �' 'lo ees(full&' art time: ❑Other ' //%////%/OMENN [] am an em 10 er with / ////y%///%//// //// �//�////%%/G////////� gets' cbm�ensadon for my employees working n ,• ;,• .o this job..': •• . �, ' 10 LO�1d3I1Q,lYi'iu t t .,..1 5 :r•, ••r•t :' ,. � 't•'? .•.r.,,'•H 'i' .: J•'r^P+r.•�^'.,{'♦ 'pp 4. '• •t� ;7� 7�..• .. 11' .:!' 'F' :'�i 11t�'f l�`t t!',,•;:•1f�t,l'•,R:.�.i1 yi.1� :rl.:''•.J 4•.'tl•'�`"v�• "i ' i t,;t„ti. ''� ::lY:�l?'5S?�:..'.y:..:•...�t"'t•i11,�i1v ^';."t''7 •.t••::3'' :' •'t•• .5;�' .j 5••.t�' , 'T .�. ,�4:: :i etr •�' ..1'. ,i.:' • f.t� 7: 1••k• :i• 1 •,• ' ^ ,� 7. .' . .. ,t.. . .. _'1• .•. , .I 5' �l :l.lr. .�J.:'1'^.i., . 4'!%• A5 tii:• • :•-� • :r eFnee •i• 'r et' ;i `,J�rn;:ta:�wrr.+,•..,,' fy.:' r M; •••„ r'• •� •_ .. y�• 'f. 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'3�'77:�:t 7•v.�:••' '7 N:r:'�t'��� ',V• t�•• i tj"is i'.SI�'l'; S rt 'lJ by •r ''•t:•:L r'r 'ja r•i�r..iiati',,'' •'L ! ',l.r•:t' J tr;. •. 7 ."1•'t.l'7'••'ei(I~'I�!f� ti ^' it 4•� t• 4'i:•':`..tt:•.y,l.l�•'.,Y+a....t.• ''t' �.:v, + ..i t. t �7; `•' «•1•:�•!�''�i ' COm an. na1de J *:.. - t' !'• t,, •y,. t ly;l e ' BadTes5: .,: •,r ., '.,p t• •4.•A. .rp..r,.ri. "i•. y{J4• ;i�r'i; �:••1; jZ�tf'. .r t C; .,'1 :'t5;«•7. •• .• ^• : • r•".•. • ' i ''r :w f„I• '`• ��lOItE.tti, .,, •�..r•\ + • ...•:•1•:. •�• , ,• , 1. ye. �.. 11•. I t r,' I,c:. ';it:•,. ;j iI••t1.1 .:I,.ik• Z. .i,• ( • : '' ' ' ; •A.Z••o-: .i.• �a'.1,1:1!••. III Ii:• .: 1•, • . 1' l} ..rJ1 •.ir ry ., •,,:, .. .t • L 11 I t t:•�I.' •• 1"j 't•'''-�Y+ •' '�' ��•,•..••, SL.I, .•Y�1', 's„�+.i..t l •• I. .�tf.l'• I' Y,L I''.�Y:•,e�'4'h�.lt rt.f V:•.t•.1�:'K•1.'•..t. r'T •.e;.• t Cl: t• ' ' •,�.Y• �•ram ' •fir.���.':F4:;'!. •;•"f•:>.';p..tt• r�':it. .Y•.r. ,4y:.',�: �iii�+,;ati5• }ti.i.5'4,S i:IL•..1.�• O'ilC1':tf'r• �t ,t•y:i' it. rti •.:' r ��� •4' it ,t•(�••�t.'}. �.i;:•:J•.:. ' insiir$nce£b+'{ WN analtirs of a fine up to$1,500.00 an or ,�ties the fo5rm of s STOP WORK ORDFIR and a find of�100.00 a'day against ma, I undaratand that tL Failure to secure coverage as required unenrlSectn 25A of MGL 152 can lead to the imposition o crimfnsl p one years'imprisonment as weu ciXllp • copy o f statement maybe forMrded to the Office of Investigations of the DlAfor coverage verification. er the pain d p Italties b I do hereby CertiarJury that the inform anon provided above is free an3orle� ^� 5igna hone# S_�.9 -i7 < 2!. P&t amp , official use only do not writa in this area to be completed by city or town officls) permit/license $oiza# []Building Ile ent ❑Licensing oard city or town: []salectmeu's Office [}cbackif inimedista response is required ❑HealtliDepartment . •[]Other phone#; contact person: (r,yHdd Sept 20 3) - �_..."...r:••:aieactv.�l'ir. • Information and Zz tructions' j General Laws*-chapter 152 section 2.5 requires all employers to provid'c Qvorkers' compensation fir their MaSSBCh1LSett$ i .•v;:. 1c,i; , quote F` gy/' an employee is.defined as every person m the.service o another under any contract of hire, expr•ess or in�?Xted; oral or written. ,p n erxployer is defli�ed as an individual,P'a�ers4, association, corporation or other legal entity, or any two or mgre of the foregoing gaged'In djoint enferpnse,and including the legal ieepr�tatives of a deceased,employer, or the receiver or artriershi association or other legal entity, to ' g employees. 'Howevei.the owner of a ,trustee of an individu�,p . P dwelling house having• of more than three apartments and who resides therein, or the occupant�oI the,dwelling house of another who. '. 9 -1. .s to do maintenance, constrgction or repair work on such awea ag li 4e.dr on the grounds or bu g pp ,ant thereto shall not because of such.employment.be'deemed'to be ari employer. ilat' t licensing•agene shall withhold the issuance dr renewal MG,chapter.152 sectibn 25 also'states that'every state laeaI h g b y of a license or pe?'�to operate a business or to construct buildings in the.cdrnmonweaIth for any applicant who has not produced acceptable'evidenc*e'of coinpliance with the insurrance coverage requii~e - Afidice of y;neither the' '• coixm�:onwtalth nor.any.of Its Political subdivisions shall enter into any contract for the performance of public work unto acceptable evidence of compliance with the insurance requirements,of this chapter have been presented to the contracting authority r Applicants d op ,bkgthxha Please s' ]p a m cn tt applies to your stuation.,Please supply company name, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department'of fndustrial�c"dents-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 peparbment o(Sndusirial AccideAts. Should you have any questions regardifi�the'"Iaw"or if you are orkers'•compensati Datrnnt at he niwmber lisdbelow. requi edtoobtainaw r . r. city or Towns please b e sure that the affidavit is ebmplete andprinted legibly. The Department has provided a space at the bottom of the affidavit for you to fi11 out in-the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fillip the perMit/iicensa number which will be used.as a reference number. The.affidavits maybe returned tQ mail •p.A wiles othei''ariangeFds have been made, thsDeparfinentb}�. °T • • '. . • • . ' •� •• .. .. •.:.•• , .•. , The Office of Investigation would like to•thank y'ou in advance for you cooperation and Gould you have any questions, please do nothesitate to give us a-wn F ONE EW / address,telephone and fax number, The Deparfrnent's The Commonwealth Of.Massachusetts De artment.of Industrial Accidents . Bike of ts�sstiena ' 600 Washington Street Boston,Ma. 02111 fax#: (617)7Z7-7749 .rr_ �iiftN rrn Pr..1nrnn Town of Barnstable ' • -�E►�`'""o,� Regulatory Services Thomas F.Geiler,Director sr .$ •��r s63 Building Di V iSIOU ed Mp Tom•Perry,Building Commissioner ' 200 Main Street, Hyannis,MA 02601 , Fax: 508-790-6230 Off ce: 508-862-4038 permit no. Data ' A"MAVIT OVFMzNT HOTJPP MERNT TO PERMITT APP CA1'IONACTOR w S coon of an addition to any p er-oecu ied MGL c.142A requires that the"rec ons onstra alterations,renovation,rep a exis grnio z tion�co P or on, •improvement,removal,demolition, buildg containing at Least one ed contractozs,wit but not more than four dwelling units or to structures which ark other a�r nt to such residence or building be done by registerh certain exceptions,along wi requirements, CMG G(� % ® J Estimated Cos 'type of Work: Address of Work: � — S�. Owner's Name: .' . Date of Application: I hereby certify that: 1z4#stration is Lot required for the following reason(s): []Work excluded by law ' []lob Under$1,000 (]Building not owner-occupied (]Owner pulling own permit Notice is hereby given that: OR DEALING WITH UNREGISTERED OWNERS PULLING THEIR OWN iERMIT CONTRA CTORS FOR APPLICABLE HOME Il1dPROVElYIE TX�' D UNDER IYfGL 142A, ACCESS TO THE NITRATION PRO GRAM OR GUARANTY SIGNED UNDERPBNALTIES OF PERJURY I hereby app1Y fo a Permit as the agent of the owner: Contractor Name Registradonl�Io. D e OR Owner's Name i ' 1 1 owTME T°�ti Town of Barnstable Regulatory Services snxx �' Thomas F.GefIer,Director Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 office: 508-862-4038 Fax: 508 790-6230 Property Owner Must Complete and Sign This Section. If Using A Builder the.subjectpropErty- ._.�..._. .: hereby authorize p to:act�n my..b.ehal . is all inattets relative to wotk autb:oiized hp this bu ding•pe= -application fot: ; ' L Z- �= (Address of Job) c .rf, Statute of Owner ate pit Name �� BOARD©'FBUILQ'IN REGULATIQ'� . i License. CONSTRUCTION SUPERVISORS Number GSA 061251 1 Birthaat� 2F14f�94.8 rregy lf2f , Tr.no: 9928 I Rescfe GERARD M IfiIR6I Al 1151„ NEWFIELD ST . f PLYM.®l�1TH; Mi4 Ad'min"strator Board of Building Regulations and Standards ` HOME IM'I---.OVEMENT CONTRACTOR i I ` .� Reglstra' di ].12216 ;Y^Elxp[ira�on 3%5/2005 KIRBY REMODELING 1 t GERARD KIRBY— 115 NEWFIELD ST. PLYMOUTH,MA 02360 Adminik6ator r- i i _ f i ,, i ,� I• ,i. !;! � - - - �. �,, - �' , � i ,; ;� -- ; i --� __� �,