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1094 BUMPS RIVER ROAD
., . t�x�, ,- �� , �� � � �� 4 � R �. �, .. �, � _ .W . . , . ; . . �> :, e e .. .. v ,. � ... .. a ., .. P V ,. ., - ,. �� _ ,. .�. .. .� e c _, _ ,.�,� .. .. '� Town of Barnstable .*Fermi ° Regulatory Services Fe ,y xaea Richard V.Scab,Director 7, Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma us Office: 508-862-403 8 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Valid without Red X-Press Luprint Map/parcel Number Property Address t O C/ !'✓l f V r1� . [residential Value of Work$ roo,-Oa Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address /y�� i�TTI SOS Rz Contractor's Name -PAVl-P �1 ,/�e(p / (' Telephone Number S6 F 3A4? Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) orkmanIs Compensation Insurance ec am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance , Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit.' Permit Request(check box) ❑ 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 ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: [Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this penuit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Zpy wner must sign Property Owner Letter of Permission. ; the Ho prov ment ontractois License&Construction Supervisors License is SIGNATURE: eg6 7,A - QAWPFnM\FORMS\building permit forms S.doc Revised 040215 TM CownmlD of & Lkwarfiment o0dusbialAccidemtr of afifflu .8o toN 02M mPmm=.gvP1dxa Workers' C ompensaf m Insurance Af Minit BW1de7JCMft=WrSM ers Aft Iufarm afian Please Print y Ad&e= "P4 , J � lHw a Are you an eaaployert the appropxiate boa Type,of project(required}_ L❑ I zm a eraplayer 4. ❑I am a general ccnh=tar and I' 6.:❑New oousixucEica employees(halt armor p&t-iime).*' have hired the Sub-contractacs 2.Q>gm a sale arp -. Tisted o the attached sleet: 7. ❑Remodeling sbip and have no employees These sob-cmA actars have 8_ ❑Demalifion Woddng forma in any capacity- empl°yees andhave wars' 9_ El Building addition INN ttiodmrs'comp insuzm= camp_i,sura,c MTEM&I 5.❑ We are a corposztoa and its 10.❑El.ectacai reps cc adds 3.❑ I am.a homemmer doing an wo& , aTwets limm examise.d tmir IL[:]Pluxnbiogrepz:=ar adcliiiaes o worin� _' of per M(H insr id,]i c.M 11(4�and we hm mo 12.❑Roaf employem Wa wow' 13_❑Other c=zlx iasura=e requira] •saS spF inar chedu box#1 mast elsa m aat*e secfi=b9w-31 &&WD&Ee C=PMM poEryi ff ' HML #l n�aun4rawbo submit dais�dat im g they zm3cia6-xn w =d tliealmm vmsi&eeaatmctiusamrt mdirsqir SRCT fCa>r>mci�s8z�cbecl�tlw ba�msst s�che��sddiiioaal sly sboamgthen�of�e sub-card st�zvrLethes orant•EhoSe ehs� awkyem iftl�eso&toa ahavee�Ia s,c6eyaa�tpmsidsrl�ir arorke�'�p paresa�bez lain att euep sr 9irrtisprauirluta workers'caorperts�irrtt irtsrirarrca for oy eucplof7ees. Bebw is thepaaicy and jab she i7L�OrJlxQ'�iOtl, , It>SuramcecompanyNama: olicy 4 or ins.JUeAkgirafinziDate: Job Rte Address Citg/5tafeElp Af#ach a Copy of the workers'coaapensafloa policy dechwation page-(showing the poficy,number and lespiration date). Failure to secure coverage as requiredunder Section 25A o€MGL c_I5-7 can Lead to the imposzidon of r-drn aal penalties of a fine up to$L 500-OD anifor one-yearimprisonsueid as vaell as civil peuaffies is tfie fiaffi of a STOP WDRF OM)Maad a f e of up to$250_00 a day ffie violater. Be advised flat a copy of this sWetnent snap ire forwarded to the Office of luvestzatic� ofthe 9M3mr insmmmm aqmVp vesiEcatim Ida Jrersby c the Fe F the His inforina iaaprnutdeff abmne B hus and correct Date: �t1i 1/ Phone OffidduwanEy. Do nflt mite in t1ds arert,.to be completed by city srtown ofjacraL City or Town: PerLieease 4 lwming Aafarity(drde ouej: L Baud of Health I l3�&ag Department 3.MyYrown.Clerk 4.Electrical I'uZPWAoe S.Pi>-bag I=Pector C.Other Contact Person: Phow 9: �/: •.: .■1•I.i■R - •�: _ •• ■:[.it :•■n1�+ _I �I■n No•i.R we al • •- ••■1■�r1. •1■■a■�!•T.■■•lm t.1 t■- ■ r■■1• ••�- '.■ .rn1 n n 1. r_um _n �.�• a m�• - - ••!R•■ u i• - • :n•i■� m■� :n rnn■ :r • m- ��n rw • n■n �■ ur'. a ••■u■�■ • ■ i�u • ■an■>■ : _u u o au1: .r:■ n�.R■1■. :••=••wrn n■ ►u •■ a■o. •1 ■■m� -_ an■s •: a■• •.• Nov No.1 - • ■■- a•1 - •n• �+•-r.•�.■ n : •u1 ruses ■uw- _n■ n, a n.•_ u- n =.r•Irn • ❑ ■> �■ it■[I. 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Towm of Barnstable Regulatory Services Richard V.'SmIi,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.towmbarnstable.ma.ns Office: 508-862-4038 Famc 508-790-6230 Property Owner Must Complete and Sign This Section If.Using A Builder C�4 L ,IS er of the subject property hereby authorize 2&IIIP 1�e ti J� to act on ray behalf, in all matters relative to Work authorized by this building permit application for. Loaf 3� 2� 1�►��n (Address of Job) _ Signature of � gel Date 4 r K Print Name d If Property Owner,is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. Q:\WPFZESTORMS\bm7dmg pe®it fc=s\E3PRESS.dDo Revised o4=5 Town of Barnstable Regulatory Services Richard V.Scab,Director Building Division BARNST IM4 Tom Perry,Building Commissioner bs¢ �`�� 200 Main Street, Hyannis,MA 02601 www.town.barnstable mans Office: 508-862-4038 Fax 508-790-6230 HOMEOWNER LICENSE E O MMON Please Print DATE: JOB LOCATION: nmnber stred village "HOMEOWNERT: name home phone# work phone# . CURRENT MAILING ADDRESS: dtyhown state zip code The current exemption for"homeowners"was extended to include owner-occupied.dweliin vc 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. DEFII MON OF HOMEOWNER Persons)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- f anily dwelling,attached or detached strictures 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 1#uildmg Official on a form acceptable to the Building Official,that he/she shat be responsible for all such work performed under the building vermit. (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. Sigiahue of Homeowner Approval ofBtuldmg 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. h 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 folly aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. Yon may care t amend and adopt such a form/certification for use in your community. QWPFU ES\FORWIn ildmg peamrt forms\ERPRFSS.doc Revised 04mu G I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map C> Parcel 1 ., . Application # 201, 61"'l Health Division Date Issued Conservation Division Application Fee7. ° Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis- Project Street Address Village 0122k_12A)I IY Owner t ?_afh'S01J Address k; 1_ h Telephone lU ! - '� / 5�)J -7 'f(r)5kl N11 , m8 0 2AQ 3 Permit Request mop�L -WU `A'malw-rnS s )�t_lMeh. 1p�M `e_ J�J�e.n 1A)4 11 aS sh mh orl ptan reu-) njvtv lam Square feet: 1 st floor: existing 4 proposed D 2nd floor: existing _4f- proposed O Total new Zoning District Flood Plain Groundwater Overlay Project Valuation ©� Construction Type NOW Lot Size n• `� Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure UrS. Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: XFull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) _1 � Number of Baths: Full: existing_ new 0 Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new C"� First Floor Room Count Heat Type and Fuel: ❑ Gas ` 0il ❑ 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 A No If yes, site plan review# Current Use ��n�l� ++� hhNn� Proposed Use � I�VI a� APPLICANT INFORMATION --.- --- (BUILDER OR HOMEOWNER) Name � �. Pea(,oc.(_ Tk. 15 Telephone Number V� `1 --7t,DD Address 1 License # 0' ffiP t/I ( If rn19 D20J J Home Improvement Contractor# 15135 S Worker's Compensation # W- XS- 01 . JLI& 1 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO `ImkU D-' SIGNATURE a DATE r� FOR OFFICIAL USE ONLY 4 t APPLICATION# =J DATE ISSUED k MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: `PFO_UNDATION�:; ;.: - FRAME t INSULATION . ,I L,3 If` Af FIREPLACE ELECTRICAL: ROUGH FINAL - F PLUMBING: ROUGH FINAL ;f GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT t ASSOCIATION PLAN NO. Double 1-3/4 x 9-1/2 WERS _ ' Boise Cascade " A-LAM® 20 310D SPF� - Floor BeamIF1302 Dry 11 span I No cantilevers 1 0/12'slope October 2, 2015 13:29:43 BC CALC®Design Report ' Build 4137 File Name: BC`CALC'Project .E' Job Name: PATTERSON 4 Description: 2ND FLOOR GIRDER Address: 1094 BUMPS-RIVER RD Specifier; City, State,Zip:CENTERVILLE, MA ;'Designer. Customer: $ Company: Code reports: ESR-1040 Misc. w v . l w •'f f .1 2 i BO 12-00-00 .. , r ; °R B1: . , Total of Horizontal Design Spans=12-00-00 ° Reaction Summary(Down/Uplift) (lbs Bearing Live R' Dead,,a Snow" Wind Roof Live BO 1,922/0 . ; 1,0541/0 594/0 ' B1 4 A922/•0 1,054/0 , �5947 0, Live Dead Snow Wind Roof Live Trib. Load Summary Tag Description Load Type Ref. Start End• 100% 90% 115% 160% 125%" .1 Standard Load, Unf.Area,(lb/ft^2) L. 00-00-001 ;=12-00-00 40 .12 r 01-04-00 2 Unf. Lin.(lb/ft) L,•00-00-00.' 12-00-00,267' 150 ' 99 . ,-n/a' Controls Summary value. € %Allowable Duration : Case Location ' Pos. Moment ," 8,927 ft-lbs ," 64% 100% 1 06-00-001 End Shear 2,547,lbs. '40.3/o • 100 1 00-10-06 _ ° o 0/0 Total Load Defl: 1;L/311 (0:463") 771% .- n/a 1. . 06-00-00 Live Load Defl. ,° ` L/482(0.299") 74'7% `: n/a ^. `4 � 06-00-00 Max Defl. 0.463"' 46.3% n/a , 1 v p06-00-00 Span/Depth 15.2 ,n/a k n/a 0 00-00-00 Notes Design meets Code minimum (L/240)Total load deflection criteria. Design meets Code minimum(L/366)Live load deflection criteria. Design meets arbitrary"(1")'Maximum total load deflection criteria. Minimum bearing length for BO is 1-1/2 f Minimum bearing length for 61 is 1-1/2 Entered/Displayed Horizontal Span L'ength(s) Clear,Span'+ 1/2 min:end bearing'+ 1/2 intermediate bearing Calculations assume Member is Fully Braced. ' Design based on Dry Service Condition: " Deflections:less than 1/8"were ignored in the results: n Page 1 of 2 a : ®Boise Cascade } Double 1-3/4" x 9-1/2" VERSA-LAMO 2.0 3100 SP Floor Beam1171302 Dry 1 span No cantilevers 0/12.slope October 2,2015 13:29:43 BC CALC®Design Report Build 4137 File Name: BC CALC Project Job Name: PATTERSON Description: 2ND FLOOR GIRDER Address: 1094 BUMPS RIVER RD Specifier: City, State,Zip:CENTERVILLE,-MA Designer; Customer: Company: Code reports: ESR-1040 - Misc: 'Connection Diagram Disclosure �{ b d Completeness and accuracy of input must L be verified by anyone who would rely on a output as evidence of suitability for • • • particular application.Output here based ` on building code-accepted design c properties and analysis methods. Installation of BOISE engineered wood •� • products must be in accordance with current Installation Guide and applicable building codes.To obtain Installation Guide 3 or ask questions,please call a.minimum=2" c=5-1/2 '(800)232-0788 before installation. b minimum =3" d= 12" ` BC CALC®,BC FRAMER®,AJSTm, Calculated Side Load= 516.0 Ib/ft -ALLJOIST®,BCRIM BOARD- BCI®, BOISE.GLULAMTSIMPLE FRAMING Connectors are: 16d Common Nails SYSTEM®,VERSA-LAM®,VERSA-RIM PLUS®,VERSA-RIM®, VERSA-STRAND®,VERSA-STUD®are ,trademarks of Boise Cascade Wood Products L.L.C. • • R ' ®Boise Cascade Double 1-3/4" x 9-1/2" VERSA-LAM® 2.0 3100 SP Floor ReamT1304 Dry 1 span I No cantilevers 1 0/12 slope October 2, 2015 13:29:18 BC CALC®Design Report Build 4137 File Name: BC CALC Project Job Name: PATTERSON Description: 2ND FLOOR GIRDER Address: 1094 BUMPS RIVER RD Specifier: City, State,Zip:CENTERVILLE,MA Designer: Customer: Company: Code reports: ESR-1040 Misc: BO 10-00-00 131 Total of Horizontal Design Spans=10-00-00 Reaction Summary(Down/Uplift) (Ibs) Bearing Live Dead Snow Wind Roof Live BO 2,980/0 1,043/0 65/0 B1 2,980/0 1,043/0 65/0 Live Dead Snow Wind Roof Live Trib. Load Summary Tag Description Load Type Ref. Start End 100% 90% 115% 160% 125% 1 Standard Load Unf. Area (lb/ft^2) L 00-00-00 10-00-00 40 12 07-00-00 2 Unf. Lin. (lb/ft) L 00-00-00 10-00-00 316 115 13 n/a Controls Summary Value %Allowable Duration Case Location Pos. Moment 10,058 ft-Ibs 72.1% 100% 1 05-00-00 End Shear 3,327 Ibs 52.7% 100% 1 00-10-06 Total Load Defl. L/332(0.362") 72.4% n/a 1 05-00-00 Live Load Defl. L/448(0.268") 80.4% n/a 4 05-00-00 Max Defl. 0.362" 36.2% n/a 1 05-00-00 Span/Depth 12.6 n/a n/a 0 00-00-00 Notes Design meets Code minimum(L/240)Total load deflection criteria. Design meets Code minimum (L/360) Live load deflection criteria. Design meets arbitrary(1")Maximum total load deflection criteria. Minimum bearing length for BO is 1-9/16". Minimum bearing length for B1 is 1-9/16". Entered/Displayed Horizontal Span Length(s)= Clear Span+ 1/2 min. end bearing+ 1/2 intermediate bearing Calculations assume Member is Fully Braced. Design based on Dry Service Condition. Deflections less than 1/8"were ignored in the results.. Page 1 of 2 ®Bol3ecascade Double 1-3/4"4x 9-1/2" VERSA=LAM® 2.0 3100 SP•,': '`Floor Beam1Fl304 £- Dry. 1 span.1,No'cantilevers 0/12 slope October 2,2015 13:29:18 BC CALC®Design Report 6 Build 4137 File'Name': 'BC CAL'C Project" +s Job Name: PATTERSON Description::2ND FLOOR GIRDER Address: 1094 BUMPS RIVER RD Specifier:. 4` City, State,Zip:CENTERVILLE„MA Designer: Customer. Company: Code reports: ESR-1040 :Misc. Connection Diagram Disclosure b d j Completeness and accuracy of input must t be verified by anyone who would rely on a � ,. ., � �� - r . 'output as evidence of suitability for c '. particular application.Output here based on building code-accepted design • + properties and analysis methods. , „installation of BOISE engineered wood a m• "' products must be in accordance with current Installation Guide and applicable r building codes.To.obtain installation Guide .,or ask questions,please call a minimum=2"k c 2-3/4" ` (800)232-0788 before installation: b`minimum= 3". , 'd=.12" BC CACC® R® S . x' •' ,BC FRAME BOAI,AJ -_, Calculated Side°Load=808.0'lb/ft5 BOIS ALLJOI ST®LAM RIS MPLEDTRAM NIG v LTM' x EM@,VERSA-LAM®,VERSA-RIM K` -Connectors are: 16d Common Nails Y SYST PLUS®,;VERSA-RIM®, VERSA-STRAND@,VERSA-STUD®are . ema ks of Boise Cascade Wood w ` -trod .. Products L.L.C. P ' x Y r r Yr w r t I oc uy� �-x /D { C! l 6)-x �- f > OfE t Town of Barnstable Regulatory Services ISARlYS1'AIILE, r MAss. Thomas F.Geller,Director Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, l�f AA Mr , Al N D S h5P. 50 ,as Owner of the subject property hereby authorize_SGOIT Pg-Agaf.LC BW iAIC two act on my behalf, 1JC . in all matters relative to work authorized by this building permit I f1{ RhM PS t y� Q.�,. C£ ':W"l MA . (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 inspe •ti.ons are performed and accepted. S�* Sig at r of Owner (*ature of Applicant r (` avow` A . Ppir lsc9a Print Name SA�1 Print Name Date Q:FORMS:OWNERPERMISSIONPOOLS 6/2012 ACZ® DATE IMMIDDM(YY( �� CERTIFICATE OF LIABILITY INSURANCE 06/24/2015 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 CONTACT NAME: Germani Insurance Agency PHONE 508 428 9194 AX 908 Main Street No: 508 428 3068 E-MAIL Osterville,MA 02655 ADDRESS:cerLs@Qermaniinsurance.com INSURERS AFFORDING COVERAGE NAIC q INSURER A:SAFETY INS CO INSURED -INSURERS: Scott Peacock Building&Remodeling,Inc. INSURER C P.O.Box 171 Osterville,MA 02655 INSURER D:Commerce&Industry Ins.Co. 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 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 ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE 1=WVp POLICY NUMBER (MMIDDIYYYYJ JMWDDIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY BMA0022118 7/5/2015 7/5/2016 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE1-1 DAMAGES( RENTED OCCUR PREMISES Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO r LOC PRODUCTS-COMP/OPAGG $ PRO- OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Par accident) $ AUTOS AUTOS - HIREDAUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ -1705-T $ O WORKERS COMPENSATION WC 005-81-5464 6/22/2015 6/22/2016 SPER TATUTE EERY AND EMPLOYERS'LIABILITY Y/N - ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ S00,000 - OFFICERIMEMBER EXCLUDED? � N/A (Mandatory in NH) 1 E.L.DISEASE-EA EMPLOYEd$ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached It more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Scott Peacock Building&Remodeling,Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 171 ACCORDANCE WITH THE POLICY PROVISIONS. Osterville MA 02655 AUTHORIZE TATIVE © -2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are regis ed marks of ACORD ... JUfIClJ<LCfI tjj�NOffice of C-ousm"er Affairs& Business Regulation License or registration valid for individul use only iMOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Ifegistration: 151853 Type: Office of Consumer Affairs and Business Regulation /Expiration: .7/7/2016.... lU Park Plaza-Suite 5170 �i Private Corporation SCOTT PEACOCK BUILDING& REMODELING INC Boston,MA 02116 JAMES PEACOCK 1046 MAIN STREET SUITE 7 OSTERVILLE, MA 02655 ti -- udersecretary Not valid without signature 111 Massachusetts -Department of Public Safety -F Board of Building Regulations and Standards Cuustrurtiun Suhcrcis,u- License: CS-094500 y JAMES S PEACOCK 1 PO BOX 171 Ostetville MA 02655'; Expi(at ion Gutllnti55;urr,•r 07122/2016 ° ..� The C'onutionwealds of Massachusela Department of Industrial Accidents l Office of Invesagaftew 600 Washington Street :.� Boston,MA 02111 fviviv.mass.gov/dia Workers' Cuss aensatian Insurance Affidavit::Builders/ContractorslElectiiic nns/Plu bex-s hcaint Infortnatinn Plewe Print Le 'bl Natrle tBustnesaeOrgauizituourlud►uidual). f Acldreys ;z. . City/stateizi ,�- ,' ! '� � � �'" Phone Are you an employer?Check the appropriate box: Type of projee't(requh-ed): 1. .I am a employer with 4. ❑ I arm a general contractor and I r * - have lured the sub-contractors b. Neu,constructionerzrploy ers(fall.and.or part-time).* '..❑ I aryl a sole proprietor or partner listed on the attached skeet. 7. Rrodeling ship and have no employees These stab-contractors have 8. ❑Demolition working for cue in any capacity. employees and have workers' 9. []Building addition[No workers'comp.insurauce comp.insurance,: required.] 5. ❑ 1V'c are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 I-[]Plumbing:repairs or additions myself. [No wrorkers'comp. right of exemption per 1MGL 121�Roof repairs insurance required.)F c.152,§1(4),and we have no employees"[No workers' 13-0 Other comp.insurance required"]! 'Any applicamt that checks box#1 nun also fill oug the section below showing their workers'compensation policy informatiarL T homeowners who submit this affidavit indicating they are doing all wars and then hire outride contractors must submit a new affidavit indicating such_ Contractors that check this box must attached an additional sheet showing the name of the sub-comuacums and stage whether or not those etvitses have employees. 1f the soh-rantracton,have emplayees,they erusrprovide their amrkers'comp.policy number. 1 ant are arrtploa err fleet ix protidrarg ttrorkers'eonrperlsatia►t irtsatrmrce for troy enrpIayees. Below is the policy acid job site informartors 6 Insurance.Company Name: Policy#or Self-ins-Lic_ _ ;� i ,}j- ? i� f 117�1 Expiration Date:) Job Site Address-ja"m"-� -, QtyoStatelZip6M �A 111e, m17 V Lt 2 Attach a copy of the workers,compensation policy declaration page(showing the policy number and expiration date). Failuree to secure covezage as required under Section 25A of h'fGL 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 herok),c fjr rartder d rs atd pertah7 of pedury that Me it forrrration prov died above is true and correct S Date: 1 Z I I'Y�otte#: > Z L j '� Official Ilse only .Do not.,write in this area,to be Completed by dot or town official, City or Tovm: PermitfLiccuse# Issuing Authority(circle one); I.Board of Health ''.Building Department 3.Qt` 6,Other ITonra Clerl►'4.Electrical Inspector 5.Plumbing Inspector ` Contact Person:. Phone#: ' 6 Town of Barnstable *Permit IV 0� (Y�5ye Expires 6monilr�m issue date Regulatory Services eel Thomas F.Geiler,Director Building.Division D/c /lllyfa8 A N'-.+Ly tlk'el �� -; P Tom Perry, CBO, $uilding.Comtnissioner 11/ R411 q 200 Main Street,Hyannis,MA 02601 QQ www. wn.barnstable,ma.us Offide; (S'9,8 $ 2-4038 c�� Fax: 508-790-6230 A/eL RESS PERMIT APPLICATION — RESIDENTUL ONLY Not Valid.without Red X-Press Imprint Map/parcel Number �) _ Property Address 1 [Residential Value of Work `'t � OOMinimum fee of$25.00 for work under$6000.00 Owner's Namc&Address thI� i � Intel Contractor's Name '`� ��J Y �U�e Telephone Number• Home Improvement Contractor License#(if applicable) 1 4 4 S i 0 Construction Supervisor's License#(if applicable) : q 9106 ❑Workman's Compensation Insurance �Ch-,�e, k one: l� a am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) i.. (stripping g ') 1�' Re-ro.ofold shin les All construction.debris will be taken to - ❑Re-roof(not stripping, Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations;i.e.Historic,Conservation,etc. ***Note: Prope Ter gn P.}-operty Owner Letter of Permission. c e Ho e Im rd ement Contractors.License is required. SIGNATURE; Q:Forms:expmtrg Revise061306 - I :,,; 9-Construction Massachusetts - Department of Public SafetN Board of Building Regulations and Standards Supervisor Specialty License License: CS SL 991384 ReStrictedlo:, .RF,WS j- JAMES CURLEY 287 FULLER ROAD_ CENTERVILLE, MA 02632 j • j c�.. Expiration: 1/28/2012 ('unmiisiuner Tr#: 99138 ✓fze:i�aminzaruaea�C o��i/2aaaac�ivaet2a Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registrabb-6-__1.24310 Board of Building Regulations and Standards Expirations U112009 Tr# 130873 One Ashburton Place Rm 1301 __Types_Jndividual Boston,Ma.02108 James Curley - James Curley 287 Fuller Rd. Centerville,MA 02632 Administrator Not valid without re i i «z THE 7, Town�,� . � of Barnstable. Regulatory Services i HAANSTABrz. + y WS& Thomas F. Geller,Director Building Division Tom Perry, Building Commissioner . 200 Main Street, Hyannis,3v1A 02601 wft'w.town.barnstable.ma,us Office: 508-862-403 8 Fax: 50B-790-6230 Propexty Owner Must Complete and Sign This Section If Using A Builder I, G T S as Owner of the subject property herebyauthorize s � to act on my behalf, in all matters relative to work authorized bythi5 buildiiag permit application for: , (Address off ob) Signature of Owner bate Print Name QIORMS:OWNERPERMIS S ION . 1 i . � .• , The CornmonweaXth ofMassachresetts Department oflndustrialntccidents Office afInvestigations 600 Washington Street a Boston,MA 02111 ` www.rn ass..gov/dia Workers' Compensation InsurAnce Affidavit: Builders/Contractors/Electriczans/PIumbers APPHcantlnfbrmation n Please Print Le 'bI Naule(Business/Organization/Individual):• 4 •Address: ®. X 'J31 City/State/Zip: mn 6 MA 1A - 0aVJ'Q Phone.#: —19 0` Are you an employer? Check the appropriate box: -Type of project(required);. 1.❑ I am a employer with 4. ❑ I am a general contractor and I loyees.(fulland/orpart,time),* have hired the sib-contractors 6• El New construction . 2. T 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' [No workers'comp.insurance comp.insurance.$' 9• E]Building addition required.] 5. [l We are a corporation and its 10.[]Electrical repairs or additions 3.❑ I am a homeowner doing ell work officers have exercised their 11.❑Pl b' repairs or additions anyselL [Noworkers'•comp. right of exemption perMGL insurance sequired.]'t c. 152, §1(4),and we have no 12. oofrepairs employees, [No workers' .•13.0.0ther comp.insurance required.] *Any applicant that checks box#1 must also fill out the section bolowshowing thcirworkcrs'compensation policy information. t Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an.additionaTshcet showing the name of the sub-contractors and state whether ornot those entities have employees. If the sub-contractors lave employees,they must pravidt their workers'comp.policy number. lam.an employer that is providing workers'.compensation insurance for my employees Below isjhe policy and job site information Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address- Attach 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 S250.00 a:day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the 1)IA for insurance covers ge verification. I do her fy un er the al sand enalties ofperjurythat the information provided a ova is ue and correc4 Signature: Date: Phone #; O Official use only. Do not write in this area,Yo he completed by city or town offciaL City or Town: Permit/License# Issuing Authority(circle one): x.Board ofHealth 2.Building Department 3.City/Town Clerk 4,Electrical Inspector S.Plumbing Inspector 6. Other Contact Person: Phone#: Assessor's map and lot number .... ....4.. ..................... Sewage Permit number' &... .7�.:.....:......................... SEPTIC SYSTEM MUST B � r-a INSTALLED IN Cp,M1gpLl 3 EAR33TAILE. • �'1 House number l� BAN` 9 raea .............................. ......................................... WITN AIi71t;LE II °o .e39. ♦� ,�'7 SANITARY CODE STATE '�BpMA`(a� r` ® N TOWN OF BAR N °t � ; , TOW or DUILDIlut� `NSPECT0R APPLICATION FOR PERMIT TO ...` ` '� ' ' ��fe 7Y .... ...1!••.....:r .....................................f.... ........................................ ..... .... )C7� � TYPEOF CONSTRUCTION ............ .. .........................._......................................................................................... TO'THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a/permit according to the following information: Location ! 6 r, 1. 3�,��,r /�Pw �Y�/t �j-e............................................................ . ............. ........ ..................................................................... .::. ........ ProposedUse ............ ...5..................................................................................................... .......................................... ZoningDistrict ........................................................................Fire District .............................................................................. Nameof Owne :�............................... ......................Address ................................................................... Name of Builder .......L:�.....J/......�.................................Address ............ ........................... Name of Architect .... --7�� �� �Ge�l/ f ....................Address ................................ ..........................................................,......................... Number of Rooms ..........1 Foundation .......� C............................................................ ................................. Exterior .... .��¢� /'!/ iG�'' 'r Roofing l�/7r�C.: . ..................... .......................................... ............................ ....................................................... Floors .............. Z....... .................. Interior ......... �GC� '4C iG ................................ �.................................... ............................ C' /�GiJ C0/cr ....Plumbin Heating :.............................. g ........ .......... ...................................................... ." nn Fireplace ..:................................................:..............................Approximate Cost ........ U ........................ ....... ......... Definitive Plan Approved by Planning Board ---------------_---------------19________. Area .....456.0... : ...:......... Z Diagram of Lot and Building with Dimensions Fee ........... SUBJECT TO APPROVAL OF BOARD OF HEALTH --�6 A/C I%r IV I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .lt� ................................. .......'!...................... 5;e C J ` Dunn, Leo J. Realty Co. � No pemni� �y ......� l/2 —otory � .�--.-- . ---— ----- ' ~� I` single family dwelling ---..-----~----.------.~.----. 94 Road ^~^...~. -------------.-------. ' ^ Centerville——.. -----� _---.'----------. ''— " Ow'na, --..�q��.J�'Dggg'Realty ...Co:......... ^ �^ � Type-of Construction .---.ƒr.AP9.................... ........................................... #ll Plot .--------.� Lot _---------' , � � - t 22 rermn uron`ao 77 � Inspectionof , ~~'~ Completed ''—'�—~--''»....... '— ^ ' � . . -�~ PERMIT REFUSED _____~___—�—_---._-----. lg ' ~^� .-------~--------.--�-------. ` — —.--.'_—~—~---~—.—~.,.;----.—. � -'~---^'—''—''r—'—~--^^—'^''--''—'�—'` . ----.--~.—_.—..--....-----.^.---. ` ` \ Approved .......................................... —.. lA . � -------.�.----..~~~.----..--�... . . , . . ................................................. . - . ' -~ 7d Assessor's map and lot number �..I .. s M ftHE Ov.... �Sewage Permit number ............................................ d� �,► J 'R q ,t i BARNSTABLE, i House number ' . j .." .......... so M^ea A MAV a' TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATIONFOR PERMIT TO ......................................................................................................................... .. /WCC p/ �e-�,-r11 c, TYPEOF CONSTRUCTION .............................:.............................................................`......................................... N._ ............C1 ,�2�................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a�permit according to the following information: f` Location �f /J/� -� �-E' ......................................................................................................................... .G'... .......................... ProposedUse ............ :5................................................................................................................................................... ZoningDistrict ........................................................................Fire District ...............p.............................................................. Name of Owner 5 r! ...� ,�L"c/,(/ T1ct�sL'1`/Y ('........Address .1 3 ...... .`..�........................................................... Name of Builder .......G. C� 1. � G.....�:�...................Address ...........SOS....�....................................................... ......................... Name of Architect � ......�' ....................Address ......... .r'�f�/.II>'L............................................. ......... .................................. p1r Number of Rooms ........-7....................................................Foundation .......l, ............................................................ Exterior .... .............................. ................................ (�6s ,-2 dr Roofing ........ /�7C. .................................................. ... Floors . .... Ac 't .....................................................Interior .......... .................................................................... Heating ...........r- . ..............O/�...............................Plumbing ........ .........:..............: i�................................. Fireplace ..............'Z`...............................................................Approximate Cost ........!! � ��...................................... s' _ Definitive Plan Approved by Planning Board ________________________________19________. Area ... ! . ... . .:......... 4 r.... . .. Diagram of Lot and Building with Dimensions Fee �-- ................` '`....................... SUBJECT TO APPROVAL OF BOARD OF HEALTH c _ 4 _ I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name -.. .................... / Dunn, Leo J. Realty Co, � = A=188~I34 � � No __..205I%Permit fra. . single famil - ----. ...�����. _'-�:`-Jag ..... \ `v%umno River Location ........................................................ ....... � _____.Ceutervill�._____.. .......... Leo J. Dunn 8aal C��� Owner ---.-------..������'�=`----' ' Type of Construction ---��ame.------- ' � � Plot .........................../I ot X�L----- ... ......August 22 ' Permit G,pnn,o /................................1978uo'o of / ' ._, ZPERMIT REFUSE � ' ----' ` ~—'' ' ' ' U - . Approved ___ ....................... 19 ` ` -------'-------~'—'--'^^'—^---'' ............................................................................... ' ^rJ'v/°/l J R I Va R 4 t j3� Zr :�•hi-.n—�.rox�:!;-,.r•` ...- ic,..:w.:Mw:a14.�+aH - - �, r''rj E�,�.�i y` ' r )e 619 L T Y TR Us 77 -----Z.l-- R� xs �,� �'°$�r ! .. - - � • lid i rW IV a s t i(:.' t 7� .'., #) -..'�A ,' R �,� • t' ti 7 kt L"Riax, 1y y/ �• S, t e: _ "[ i' ¢ ,'��4 Y '�S�$ t���,S �.'r'{S>r�. �,I N4 { k x �i� ° 1�R .. � "'t "` L_ 1k• 4J' r* �T.-,�.?r�wxy ° �ti � _.5d� ���'i' If t} t F`��„S'J � e• � Ti,e �t `4a r. -.� �4. _', 1 4::h + '1 f r "{ x ??� I3F 1','.�` r C,�� i � ec� � (-►V�' •�� ,�� ^ '9, ,. �'r� ,.' r:'_ _ J a e ..A. : �3,y "t.s d�rg� .,� � fay 7tlt ���y[�i 01,7 �' xsi Ala! '.� rr �fl�_ �J �4.� '' �p(Jf7G:'� � Q f/I e-� \V ,r �: r.t a,, �R a f. ���N�Y•�. �"F .�" Tlr+^° t a +...,,I tC"��i) 1 � I,�! . '. i�•'/ ; r --.. .e' --f R 5 �.?�'iT s '':�y 4 �� � t�/. � f �. � � 'l.� � n. /' . 1 �-���eti:../�� :a-`n" „s/J' �'` 4 r ""'yFirr��.M•� -: r 3 _ � -�, #.R r ;?,� .. 3• tti k v ,Y '"",t 4',p,ti` °*v'•-�$`.: i,� '3°. �� � '., � .F j • � '. z She � �1..a�.+¢ �rF !'ir� r 5";C ro y;Jk4tA / n t i��' �F .a-a � :.v '.f, �4-r t 1 i.. ss�.�i5 �y rc+"C��wh ij�; ,t•��5.„� i�`` ,A. ;: A '.�: x.. �. .y � -•� .vi � •� 1�I t .ss� t .s rs e t�!,# �tiirr .b t r„ •.,.*t ,... . w 4✓ x �i NOTE BtJLA'NEF�f.� ' lJ �R, G6 A/TE,P_ V/LLE � ,eemovao A ® P'7�f�/�T {�'��.�.�`t�et z .30 �.f�T�: U�t ., P� P/9Gl�r'�'.E-Qv%rc?E/�Elt�'�;'; •�� }� 3 R,.2 � i �{ •. A. a F ft�' 'sy 2 rt P !J b T/WFiT t �� *. .clGSi+�OA✓. G.�/ Ta//S fs'L AN /S• L.00.-97-o OA/ THE F + 7 ry "' Y4ritslq►t BS ®,' 7'.!;/&P 7-OW" OF+ ,E'Iy Rft'C1E�r4�� 2, OJA q Rl '�' e:'� `�e°�9�tr� r✓r� � ��k � � , wok' dIr OL pn Ilb E.JTE c�s��-`��v✓IOcJT�/e M+453. —aA �' ¢��. �i44/� GI.�✓�b�'.� rr, o„o• " TOWN OF BARNSTABLE Permit No. _______2051-1 1 NWUR Building Inspector Cash sum - 3411 OCCUPANCY PERMIT Bona ____x � "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Leo J. Dunn Realty Co. Address lot #11 a094 Bumps River Road, Centerville Wiring Inspector , - Inspection date Plumbing D soec�tor �e' w P / '' Inspection date a v Gas Inspector Inspection date VEngineering Department - j� /�°(/ ( /-,61—Inspection date/(q j�c5 0 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. 94 �� r Building Inspector