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1340 BUMPS RIVER ROAD
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TO'!!eiS TABLE E �r tf ; d STABLE C: _. ,. .,. _ ,r ... ... ... . . . _ .;. ti ?� <: '=� f, r � ^\ '.z� _'�' � `, � , � 1 t - �T. i _ .. � ... �k; k 6 `�� � �� .� 1 .. ._ ." �v +2 �I ���yy�.. � r., v. t' ,!�Q'MISTABLE - f" �� ,��, {� 'd§' ` ..4^ �s�, } � �/{� �.et �� ♦�~' �*fit �f i a+ Lc, GO i — cc) ;S C-lif (2r � . Town of Barnstable Building BARMNSTA Post Thls Card So�That�t as'V�s�ble.From the Street :A rovedA Plans.Must beRetamed on Job and this CrdyMust be Ke t , 16 Posted UntllaFinal�tnspection Has Been Made _ ss*` - �- . , �,-. y Permit 2-er,.e a Certificate of.= nc. .is Re`'°ui ed such.:Buildiri shall Not be:Occu red unt�I a�F.nal lns action has been made OCtupay:: . 4 gt. p: .r.•, p. Permit No. B-18-1012 Applicant Name: JAMES, MARY M Approvals Date Issued: 04/12/2018 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 10/12/2018 Foundation:. Location: 1340 BUMPS RIVER ROAD,CENTERVILLE Map/Lot: 188-048 Zoning District: RD-1 Sheathing: Owner on Record: JAMES, MARY M Contractor Name Framing: 1 Address: 1340 BUMPS RIVER ROAD Contractor License 2 CENTERVILLE,MA 02632 ,' _ Est Project Cost: $50.00 Chimney: Description: Interior of existing structure for purposes of a artCave,No Perm Fee: $85.00 m sleeping quarters Insulation: p g q Fee Paid.: $85.00 Project Review Req: $ Date 4/12/2018 Final: 77 F � Plumbing/Gas Rough Plumbing: _ Building Official k e Final Plumbing: This permit shall be deemed abandoned and invalid unless the work autlionzed by this permit is commenced within six'monthafter issuance. All work authorized by this permit shall conform to the approved appl cation a i', t e approved construction documents for which this permit has been granted. Rough Gas: Y � 't All construction,alterations and changes of use of any building and structuresshall be in compliance with the local zoning by laws arfd codes. This permit shall be displayed in a location clearly visible from access street or oad and shall be maintained open for public idspe&i n for the entire duration of the Final Gas: work until the completion of the same. �, " �a � .01 Electrical The Certificate of Occupancy will not be issued until all applicable signatures,' the Budding and Fire Officials-;pre.provide on this permit. Minimum of Five Call Inspections Required for All Construction Work: r F Service: 1.Foundation or Footing x 7 Rough: 2.Sheathing Inspection „ 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation .. 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit-Cards are the property of the APPLICANT-ISSUED RECIPIENT ApplicafionNumber.:.......... .11_. .........,.................. � * sue$. * �0_�`s'� ;✓V Permit Fee.. .... .:.. O...other Fee........................ MABEL 05 aToW Fee Paid... ... . ................................ ... TOWN OF BARNSTABLE Pew ApprovsI .............F.....»............on.... . BUILDING PERMIT B Map........._... ..................ParceL..........0-.-3f..................... APPLICATION Section 1—Owner's Information and Project Location Project Adress�—���0 ���/2� �o Village Own�Name Owners-Legal-Address--_, City_ �.�;c�-�r.•� ��,,,.,,Qj V�•a` vv�-.G-�\ „ CGS--•t Owners-Cell# CAS Section 2—Use of Structure Use Group ❑ Commercial S ?ova 35,000 cubic feet ❑ . Commercial S ,punderr 35 000cubic feet Single y Dwv � Section 3 -Type of Permit ��'9iVS� ^ ❑ New Construction ❑ Move/Relocate ❑ Accessory.:Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment ® Sprinkler System [] Addition ❑ Retaining wall ❑ Solar ❑ Renovation ❑ Pool ❑ Insulation Other—Specify Section 4 Work Description" T 5u t tmdate&-n=1 S t Application Number...........................?.'.......:.... .......... Section 5—Detail Cost of Proposed"Coinstraction 1 �0. Square Footage of Project. Age of Structure Dig Safe Number # Of Bedrooms Existing Total#Of Bedrooms(proposed) 110 MPH Wind Zane Compliance Method F1 MA Checklist ❑ WFCM Checklist ❑^Design Section 6—Project Specifics - ❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System El Masonry Chimney _ ❑Add/relocate bedroom Water Supply ❑ Public ❑.Private Sewage Disposal ❑ Municipal ❑ On Site lEstoric District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes ❑ No Section 7—Flood Zone Flood Zone,Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq.Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last undatEd. 21/92019 d 18 c\ce APR ®6 20. TO\NN OF BABNSTASL �yr _ cccx- T,1,�\ APR o 6 2010 TOWN OF U �-IUILDINIG DEPT �e2 '��-. -'7-'�s_\ss - loth APR 12 2018 ✓ DURABLE POWER OF ATTORNEY TOIlVN OF BARNSTAB KNOW ALL MEN 'BY THESE PRESENTS, that L MARY MARGARET JAMES, of Centerville, Massachusetts, have made, constituted and appointed and by'these presents do make, constitute and appoint, MICHAEL D. JAMES as my agent, to be my true and lawful attorney. If MICHAEL D. JAMES is unavailable to perform her duties under this power, then do I nominate MATTHEW S. JAMES to serve in her place and stead as my agent, to be my true and lawful attorney. MY TRUE AND LAWFUL ATTORNEYS to exercise alone or jointly the powers set forth below on my behalf as my attorneys)-in-fact for me and in my name, place and stead from time to time and at all times until this authority shall be specifically revoked and notice of such revocation be actually received by persons dealing with my said attorney or attorneys hereunder to act as agent or agents for me as follows: To collect and receive all property, now or hereafter due, owing or belonging to me from any person or persons. Also to make, sign and deliver any and all checks and other orders fof the payment of money drawn upon or made payable by or at any bank in the United States of America, and to settle and adjust my accounts with any such bank or banks, investment company, or broker/dealer. Also to endorse and deliver for deposit with or collection by any bank in the United States, or in any other jurisdiction or country, any and all .checks or other instruments for the payment of money. Also to execute all state and federal tax returns required by any other jurisdiction or country to be filed by me,which I may now or hereafter,be required to file. Also to lease any interest in any real estate wheresoever.the same may be situated which I may now or hereafter have at such rents and upon such terms as my said attorney(s) may think proper; to sell and convey all of such real estate or any interest therein, and valid deeds of conveyance and leases therefore to make, execute, acknowledge and deliver, even deeding back to me individually from my real estate trust, if needed for refinancing and/or Medicaid Planning. Also to keep any and all real estate now or hereafter belonging to me and the buildings thereon in repair and insured against damage by fire and generally to do all lawful and necessary things in and about renting and preserving the said real estate, including the payment of all taxes or assessments now or hereafter assessed against me or my real estate. Also to sell, deliver or transfer such tangible personal property, as is owned by me or held in my name, and valid and effectual instruments for the transfer of the same in my name to execute, acknowledge and deliver. Also to sell, assign, deliver or buy on my behalf or for my account any stocks, bonds or other securities owned by me and valid instruments for the transfer of the same in my game to execute, acknowledge and deliver. Also to have access to any safe deposit box standing in my name in any bank lorpated in the Commonwealth of Massachusetts, or in any other state. Jk Also to transfer any of my assets to the Trustee of any revocable inter vivos trust which I may have created, or to transfer from any revocable inter vivos trust back to me individually, as needed. Also,to make gifts to my issue, my relatives and friends as may be.deemed appropriate or in such manner as I may have been making gifts, and to continue the same or terminate the same as my attorney(s)deem(s)appropriate. Also to commence and prosecute or defend any suit or proceeding in the courts of the United States of America or elsewhere in my behalf, and generally to act for me, and to take the entire charge and management of my business, hereby giving to my said attorney authority in my name to sign, seal, execute, acknowledge and deliver any and all papers and documents in any way necessary to give validity or effect to any of the powers hereinbefore granted or in any way affecting the general administration of my affairs. Also to have the authority to employ and discharge physicians and other health care providers, and the authority to make all necessary arrangements for my care at home or at any hospital, hospice, nursing home, or similar establishment. I further agree that all questions concerning the validity or interpretation of this power of attorney shall be governed by the laws of the Commonwealth of Massachusetts. This power of attorney shall not be affected by subsequent disability or incapacity of me as the principal. IN WrMSS WHEREOF, I have set my hand and seal this 1 lth day of July, 2005. MARY MAR ABET J S B. Lori Case,Witness Sharon A. O'Connor, Witness COMMONWEALTH OF MASSACHUSETTS ) ) SS. COUNTY OF BARNSTABLE ) On this IIth day of July, 2005, before me, the undersigned notary public, personally appeared MARY MARGARET JAMES, B. Lori Case, and Sharon A. O'Connor proved to me through satisfactory evidence of identification, which was a valid driver's license or personal knowledge, to be the persons whose names are signed on the preceding or attached document, and acknowledged to me signed it vont for its stated purpose. / r r � Charles C. Case,Jr.,Notary Public My commission expires: 11/22/07 CHARLES C.CASE,JR lie Notary Public Commonwealth of Massachusetts MyCo nmssionExpiresNov22,W 4r. The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street n Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Binders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly_ Name-(Business/orgmli7Aun/rndividual): S Address:l (.e City/State/Zip:C 2� �\�Q �� Phone#: Are you an employer?Check the appropria box: 'Type of projeef(required): 1.❑ I am a employer with 4. []I am a general contractor and I * have hired the sob-contractors 6. ❑New constaictian employees(bill and/or part-time).* 2.[1 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have S. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition No workers'comp.insurance comp.imams CO required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions officers have exercised their 11. Plumb' re ahs or additions ,�3.� I am a homeowner doing all work ❑ �rap airs [No workers'comp. right of exemption per MGL 12.❑Roof repairs in� „ee required]t c.152,§1(4),and we have no 13. employees.[No workers' ` " v comp.msncerequired-] arm *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 1 t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contactors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing fie name of the sub-contractors and state vybether or not Those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. a I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. rnsinan.ce Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showuig the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL e. 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. m I do hereby c pains andpenaldes ofpajury that the informationprovided above is true and correct �Si-- �-e t�`Phone�phOIIe� C Og> Official use only. Do not write in this area,to be completed by city or town official City or To": Permit/License# Issuing Authority(circle one): L.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector. 6.Other ' Contact Person• Phone#: �. TOWN OF BARNSTABLE . f BUILDING DEPARTMENT MASS APPLICATION FOR CERTIFICATE OF OCCUPANCY Date Building permit application number map/par Address of structure Area of structure C.O.will be issued to Name of Tenant Edition of Building Code Use and Occupancy Classification Type of Construction Design Occupant Load Is the facility licensed by a State agency Yes ❑ No ❑ if yes If yes, name of agency Relevant Code of MA Regulations(CMR)that apply Automatic Sprinkler System Sprinklers provided? Yes ❑ No ❑ Sprinklers required? Yes ❑ No ❑ Building Department Use only Special Conditions: Application Number........................................... Section 9—.Construction Supervisor Name Telephone Number Address City State zip -License Number License Type Expiration Date Contractors Email Cell# I understand my responsbi7rties under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Bufldirig Code.. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Bamstable.Attach a copy of your license. signattae Date Section.10—Home Improvement Contractor Name Telephone Number Address City state Tip Registration Number Expiration Date I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and do=entaiioa required by 780 CMR and the Town of Bamstable.Attach a copy of your H.LC... Signatare Date Section:ll�Home_Owners:License empti Home Owners Name: e Telephone Number Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts Code. I understand the construction inspection procedures,specific inspections and docummentation reed b d the Town of Bamstable Si e Date — "I-TEF CANT SIGNATURE _ Y-- Signature S � `^^QS Date q� \ Print Name U `\U. 60 Telephone Number E-mail permit to: �� c Section 12—Department Sign-Offs Health Department ❑ Zoning Board Cif required Historic District ❑ Site Plan Review Cif required) ❑ Fire Department ❑ Conservation For commercial work,please take your plans directly to the fire depo*nmt for approval Section 13—Owner's Authorization L as Owner of the-subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of job) Signature of Owner date Print Name . F Last ua&W&2l9=18 �r L4 I b-A - - - T -- - - AQ� r r � � � _ . � . , iA � _ _ � � � . � � � � . � . . � �. � _ �° ._ � � _ , . . �, i ' � 2 n � � ..` } � � - i - e � R � � � - i ',. Official Website of The Town of Barnstable - Property Lookup Page l of 5 Select Language Assessing Division Property Lookup Results - 2018 367 Main Street,Hyannis,MA.02601 <<BACK TO SEARCH<< APrint Owner Information-Map/Block/Lot:188/048/-Use Code:1090 Owner Owner Name as of 1/1/17 JAMES,MARY M Map/Block/Lot GIS MAPS CD 1340 BUMPS RIVER ROAD 188/048/ Property Address y CENTERVILLE,MA.02632 1340 BUMPS RIVER ROAD Co-Owner Name Village:Centerville Town Sewer At Address:No GIS Zoning Value:RD-1 Assessed Values 2018-Map/Block/Lot:188 1 048/-Use Code:1090 ^ 1 2018 Appraised Value 2018 Assessed ValuePast Comparisons O Building $151,500 $151,500 Year Assessed Value / Value: Extra $15,900 $15,900 2017-$326,000 Features: 2016-$327,500 2015-$319,200 2014-$309,500 , 4 Outbuildings:$2,700 $2,700 2013-$315,000 2012-$307.500 2011-$308,700 n\ Land Value: $169,800 $169,800 2010-$313,400 ' 2009-$334,800 �v1 !� 2018 Totals $339,900 $339,900 2008-$350,600 , 64 v 2007-$368,300 �/V Residential Exemption Received=$93,229 I '. v Tax Information 2018-Map/Block/Lot:188/048/'-Use Code:1090 Taxes C.O.M.M.FD Tax(Commercial) $0vi C.O.M.M.FD Tax(Residential) $5472 Fiscal Year 2018 TAX RATES HERE4 l Community Preservation Act Tax "$71.12 yl� Town Tax(Commercial) $0 ` o Town Tax(Residential) $2,370.51 $2,988.87 http://www.townofbamstable.us/Assessing/propertydisplayscreenl 8.asp?ap=... 4/3/2018 Official Website of The Town of Barnstable - Property Lookup Page 2 of 5 Sales History-Map/Block/Lot:188/048/-Use Code:1090 History: Owner: Sale Date Book/Page: Sale Price: JAMES,MARY M 2005-06-15 19935/309 $0 JAMES,WAYNE L&MARY M1976-04-02 2318/179 $0 Photos 188/048/-Use Code:1090 a Sketches-Map/Block/Lot: 188/048/-Use Code:1090 This property contains multiple sketches. Please use the navigation below the sketch to browse sketches, — '� Current Building ID=13211 details below Additional Sketches 1 1 21 Click Here for print version that displays all sketches at once . AS Built Cards:Click card#to view:Card#1 1 r Constructions Details-Map/Block/Lot:188/048/-Use Code:1090 Building Details Land Building value $151,500 Bedrooms 1 Bedroom USE CODE 1090 Replacement Cost $76,608 Bathrooms 1 Full-0 Half Lot Size 0.42 (Acres) Model Residential Total Rooms 2 Rooms Appraised $169,800 Value Style Cottage Heat Fuel Electric Assessed $ Value 169,800 Grade Average Heat Type Elec Minus Baseboard http://www.townofbamstable.us/Assessing/propertydisplayscreen l 8.asp?ap=... 4/3/2018 Official Website of The Town of Barnstable - Property Lookup Page 3 of 5 Year Built 1947 AC Type Central/Half Effective 37 Interior Carpet depreciation Floors Stories 1 Story Interior Walls Wall Brd/Wood Living Area sglft 576 Exterior Walls Wood Shingle Gross Area sq/ft 576 Roof Gable/Hip Structure Roof Cover Asph/F GIs/Cmp Outbuildings&Extra Features-Ma /Block/Lot:188/0481-Use Code:1090 p Code Description Units/SQ ft Appraised Value Assessed Value j FPL1 Fireplace 1 story 1 $2,900 $2,900 WDCK Wood Decking 322 $2,700 $2,700 w/railings BMT ` Basement- 672 $13,060 $13,000 Unfinished Sketch Legend Property Sketch Legend B2N Bam-any 2nd story area FPC Open Porch Concrete Floor REF Reference Only BAS First Floor,Living Area FTS Third Story Living Area(Finished) SOL Solarium BMT Basement Area(Unfinished)FUS Second Story Living Area SPE Pool Enclosure (Finished) BRN Bam GAR Garage TQS Three Quarters Story(Finished) CAN Canopy GAZ Gazebo UAT Attic Area(Unfinished) CLP Loading Platform GRN Greenhouse UHS Half Story(Unfinished) FAT Attic Area(Finished) GXT Garage Extension Front UST Utility Area(Unfinished) FCP Carport KEN Kennel UTQ Three Quarters Story (Unfinished) FEP Enclosed Porch MZ1 Mezzanine,Unfinished UUA Unfinished Utility Attic FHS Half Story(Finished) PRG Pergola UUS Full Upper 2nd Story (Unfinished) FOP Open or Screened in Porch PRT Portico WDK Wood Deck PTO Patio Print � !Contact�� ��� �� I h.ttp://www.townofbamstable.us/Assessing/propertydisplayscreen 18.asp?ap=... 4/3/2018 Official Website of The Town of Barnstable - Property Lookup Page 4 of 5 Orector {Edward F.O'Neil.MAA P 508-862-4022 F 508-862-4722 18:30a.m.to 4:30p.m. 367 Main Street i Hyannis,MA.02601 Public Records Ann Quirk !Public Records Request �P 508-862-4022 367 Main Street iHyannis,MA.02601 )Ielpfullinks to t 'Downloads t . Abatements j SALES LISTINGS I Barnstable FD Residential I C.O.M.M FD Residential 1 3 Commercial-Industrial- Mixed Use 1 E Cotuit FD Residential Hyannis FD Residential Townwide Condominium W.Barnstable FD Residential s i Exemptions Parcel Consolidation Questions about values � FY18 Combined Tax Ratesi. Town Land Use Codes Helpful Maps All Town Maps Flood Insurance Maps j Property Maps 1 FY18 Tax Maps i Owned and Operated by The Town of Barnstable-Information Technology http://www.townofbamstable.us/Assessing/Propertydisplayscreenl 8.asp?ap=... 4/3/2018 I �IMMEall, Town of Barnstable *Permit 401 0 Expires 6 m llr from issue to 0 Regulatory Services Fee I x r r x r BARNSI'ABL& Thomas F.Geiler,Director �fD MA'I A Building Division Tom Perry,CBO, 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 / c_en 4-Cr vt Q Property Address 1Z>`{0 ,4 [Residential Value of Work$ 12—%VC� Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name \Pa,+� �:(�?r¢Q��I a Telephone Numberscl,—Y>s—16 Home Improvement Contractor License#(if applicable) 1d 7`� Email: c, ef—rcc _,Glwk9au I[_C_C� Construction Supervisor's License#(if applicable) Cr$-OZ/0*5� �orkman's Compensation Insurance �-PRESS PERMIT Check one: ❑ I am a sole proprietor ❑ I am the Homeowner JUL 15 2013 ❑ I have Worker's Compensation Insurance Insurance Company Name L41�f M,� '1 TOWN OF R e"N5TABLE Workman's Comp.Policy# ��S"�i5 �� -TZ� �p Copy of Insurance Compliance Certificate must accompany each permit. Permit Reque t(check box) [ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to 9011'Ak- LCIII t ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#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 permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: C:\Users\decollik\AppData\Local\Microsoft\ dows\Temporary Internet Files\Content.Outlook\8R76BDVA\EXPRESS.doc Revised 061313 i , Property Owner Must Complete & Sign This Form If Using a Roofer / Builder. I (print) as caner Agent of the subject property hereby authorizes Paul J. Cazeault & Sons Roofing Inc. to act on my behalf, in all matters relative to work authorized by this building permit application for. Address of Job Signature of Owner Mailing Address of Owner y %,A Telephone # Date Please return this form to Paul J. Cazeault Roofing along with your signed contract. It is needed for us to obtain the building permit required by your town to complete your roofing project fax#508-420-4555 office@cazeault.com 771e Commonwealth of Massachusetts Department of Indusftial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 tirn eriass.gov/dita Workers' Compensation Insurance Affidavit: Builders/Contractors/ElectricianslPlumbers Applicant Information Please Print Legibly Name gkidnessiorganizationandiui l): f.." Q'gL �� rU�E� z•, Address: co,31 Vla_ip, 56-e.e* City/State/Zip: as"L1e . M- c> 7c"j-5— Phone#_ ;2-S- 117 A,ree,you an employer?Check the appropriate box: Tyke of project(required): 1.L;d aoum a employer with IL?;, 4. ❑ I am a general contractor and I employees(full andlor part-time).* have hired the sub-contractors 6. ❑Neu oonstauction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g_ ❑Demolition working for me in any capacity. employees and have adcus' �''• to 9. ❑Building addition [No workers'comp.insurance comp.insurance.1 required.] 5.. ❑ We.are a corporation and its 10-❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.[_1 Roof repairs insurance rewired.]1 c.152,§1(4),and we have no employees-I[No workers' 11E]Other comp.insurance required.] •tiny appicaw that checks box#1 must also fill out the section below showing their workers"compensation policy information. Z Homeowners who submit this affidmrit indicating they are doing all work and then here outside contractors must submit a new affidavit indicating such. »Contractors that check this box must attached an additi an!sheet showim the muse of the sub-comrmtors and suite whether or not those entities have employee;. If the sub-contractors have employees,they mast provide their workers'romp.policy number. lam an empTnyer that ispm-i4aYrW nforkm'congmnsadon insurance for uuty engx1gves. Below is thepaLcy Quad job site inf rmadom Insurance.Company Name: GAJ2W+14 AN_ A4 Policy#or;Self-ins_Lie.4: 31 S-�Zv�66�c7 p 12 Expiration Date: IL bob Site Address: 134® 'Cx Ve/- e CitylStateizip: cls�vyt I(e Attach a copy of the workers'compensation policy declaration page(:shoring the policy number and e4iratson 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-yeas imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.D0 a day against the violator_ Be advised that a copy of this statement may be forwarded to the Office of Investigations of the D1A for insurance coverage verification. I do h ere.by certify uauder the pain s and penalties of peduty thatthe htforrrr ado nprratdded abmre is traua and correct sionture: -{� Date: �7 S 7-�13 Phone 077 Official ruse only. Do not write in this area,to be completed by city or town of ciat City or Tomm: Permit/License# Issuing Authority(circle one): 1.Board of Health r.Building Department 3.City/Ton m. Clerk 4.Electrical Inspector 5.Plumbing Inspector G.Other Contact Person: Phone#: r Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor - License: CS-026325 PAUL.I CAZE T 1031 MAID ST OSTBRVII T7,MA 02655 i Expiration Commissioner 10/20/2013 lu Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 103714 Type: Private Corporation Expiration: 7/9/2014 Tr# 228652 PAUL J. CAZEAULT & SONS, INC. Paul Cazeault 1031 MAIN ST OSTERVILLE, MA 02658 Update Address and return card.Mark reason for change. Address Renewal Employment Lost Card ?S-W 0 50M-04/04-G101216 Office of Consumer Affairs&Business Regulation.. License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: • 103714 Type: Office of Consumer Affairs and Business Regulation a Expiration: 7/0/20.14 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 PA J.CAZEAULT&SONSjNC. Paul Cazeault 1031.MAIN ST g -- OSTERVILLE,MA 02658 Undersecretary Not valid withou ature /4/LUIJ 1U:14:U5 AM PST (GMT-8) YROM: IUUUUS—'1'U: 15Ub4LU4555 Page: 2 of Z CERTIFICATE F LIABILITY ILIT INSU C DATE(MM/DDIYYYY) 1 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 endorsements . PRODUCER DOWLING &O'NEIL INSURANCE AGENCY INC CONTACT NAME: 973.IYANNOUGH RD PHONE 1AIC.No Ext 508 775-1620 1 FAX A/c No): 508 778-1218 HYANNIS, MA 02601 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC/t INSURERA: Liberty Mutual Insurance INSURED INSURER B: PAUL J CAZEAULT&SONS ROOFING INC 1031 MAIN ST INSURERC: OSTERVILLE MA 02655 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 15420453 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYY MM/DDIYYYY GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE F-IOCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea acadenq $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) AUTOS AUTOS $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS R AUTOS (Peraccidenl) $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ $ A WORKERS COMPENSATION WC5-31 S-386670-012 8/10/2012 8/10/2013 we sTATu- o�l- AND EMPLOYERS'LIABILITY YIN N ✓ TORY LIMITS ANY PROPRIETOR/PARTNERIEXECUTNE E.L.EACH ACCIDENT $ 1000000 OFFICER/MEMBER EXCLUDED? N NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1000000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1000000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Workers compensation insurance coverage applies only to the workers compensation laws of the state of MA. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE.WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 1r '' Jeff Eldridge V V {/ ©1988-2010 ACORD CORPORATION. All rights reserved. name and logo are registered marks of ACORD CE �4/Z013 10:10.:43 AN ea e 1 of I. Tl __Viously issued certificates. i Assessor's office(1st Floor): f� Assessor's map and lot number 1Zf��o ��� a l d yp 'Board of Health(3rd'floor): !'�`/ �`�'� `* Sewage Permit number I.irk](,.J. . Z Z T�it2' Engineering Department(3rd floor): �( / 1 I �� 3 _ rua House number U �/�— � , °o,.�ta3o.6\��'' Definitive Plan Approved by Planning Board --� 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only � u� TOWN OF BARNSTABLE BUILDING ISPECTOR APPLICATION FOR PERMIT TO i7/7 itiFi /Zoo ' // TYPE OF CONSTRUCTION F�6/yF - y 19 26 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 13 9-So r-►©s RI C/ Proposed Use �/ NiA.G �oorl Zoning District Fire District 9C-42 Name of Owner AIA YAe Address 137 G 73VO/4,5 Name of Builder tF�� Address S�i'7c Name of Architect Address Si}i7c- ,o Number of Rooms/ Foundation /�acr2c..n Logic. �'Er efa&g c.G sa-eL—) Exterior `liDoD $;151-64E. Roofing Floors �i3.�t7,dd�- // Interior Z�/�yGc gL-G Heating /�w� —6il Plumbing >r Fireplace ��'�fT/N� ( / Approximate Cost o` Uy y Area Diagram of Lot and Building with Dimensions Fee 1(ig•Lc s: 02 X y i 00 'o OCCUPANCY PER ITS REQUIRED OR NEW DWE S-1 I hereby agree to c nform to all the Rul an a ns df A Town of Barnstable regarding t bove construction. 1 Name 33 Construc i is License DlSGGc3lS� JAMES, WAYNE L. & MARY M. No 3 3 7 9 2. Permit For ADD ROOM Single .Family Dwelling ,t Location 1340 Bumps River Road J r= _ Centerville Owner. Wayne L. & Mary M. James - Type of Construction Frame - p Plot" Lot Permit Granted June 4 , 19 90 1 - Date of Inspection 19 �? L--• " . x Date Completed f�� g� 19 T • F G5}y t'Y / • 1h a ' i•s ! , e •r I. Y'e`v.-s.:X.':�.:I"ivkfi�+ '��"e� '. ,�.. fY �"'�•�'���-�iar'^;bY;W^•`t.''�'.S�jer4i':�i''wfi: +k"'""^`.s��''`��� �.a•! <�'.:�° w y, r a^, at Assessor's office(1st Floor): Assessor's map and lot number //i7 lZe C�/ ('y19 -^''`� "k Of TN E TO 'Board of Health(3rd floor): h7/ Sewage Permit number • w � Z DAHSS7 UZ i Engineering Department(3rd floor): /' ,/ MAaa House number /�7 A� °° 1639- Definitive Plan Approved by Planning Board 19 ��r�r d- APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNST_ABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO /� ��ti rc• /�o o�y //�X// l/,2 TYPE OF CONSTRUCTION I-/E:- 19 96 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 13 yo ( u t:xa s Proposed Use IP/ *Zoning District Fire District ' - ...� .. Name of Owner 1,tIX YA,z- L 19. / //, j2l//z�s Address /NO I vc-R 17W. &�,r 4p Name of Builder Address Name of Architect S%-i%c= Address Si9i`7c Number of Rooms/ Foundation Exterior S'//641 , Roofing Floors ��/%'y�G� Interior Heating /=G� -G / Plumbing Fireplace ��'rsT/ti ( / Approximate Cost Area 40, Diagram of Lot and Building with Dimensions Fee f� > PRO i f �oo t OCCUPANCY PERMITS REQUIRED OR NEW DWE L S-1 ` I hereby agree to conform to all the Full s and Regu ns of'04 Town of Barnstable regarding t6 above construction. Name �. Construction SuP ervisbr's License aal9G 3S� JAMESI WAYNE L. & MARY M. A=188-048 No _ 33792_ Permit For Add Room Single. Family Dwellinq Location 1340 Bumps River Road Centerville Owner Wayne L. & Mary M. Jam(:s Type of Construction Frame Plot Lot Permit Granted June 4 , 19 9 ) Date of Inspection 19 Date Completed 19 Assessor's map and lot number A�q � � .... �r ' --�— i Sewage Permit number TOWN OF BARNSTABEE ypi HE T� Z BABBSTABLL i NAGL 9 . BUILDING INSPECTOR APPLICATION FOR PERMIT TO A ??.....rp...... )(!, ! :!......... Q11% ? �....................................TYPE OF CONSTRUCTION ... � S Tea "'`�... ......... J ............................................................. ..............................:�/,:--�.._19 . .e. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location �'3'�7��...... %R/.:y..�5 �vF'�' ........................................................ ............ .... . ........... ............ .. ..... ......... Proposed Use .........{/,! !? �s . !` ....................................................................................................................................... �. Zoning District — ...........Fire District .... ' ......................... Name of Owner .�'���'!�>!�" .. :.c�/ ��'Y. :.: ff��/ �"Address Name of Builder ..1.............................. .................. ...................Address ............_........................................................................ Nameof Architect ..................................................................Address .................................................................................... ...... j� /� Number of Rooms ....... '.......................................... .....Foundation l -d,L1�................... ....../... Exterior Roofing. ....... .. ...:_ ...,.. ............................ �i2� � l � • � Floors ...... .����'s^�' � Interior .. �.:.. Heating ! .................................................:.. Plumbing ...........'... }t/`.......................:.........................._.: Fireplace ....... .......................................................:.:: ..Approximate Cost ....... .................. Definitive Plan Approved by Planning Board _--____-__-__� � .. --------------19--------. �, Area ....�.... ........................ Diagram of Lot and Building with Dimensions /r~.�_____ Fee ..........` ............................... SUBJECT TO APPROVAL OF BOARD OF HEALTH 0 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. y �--� Name%:�:-r� r y `:....:...................................... � 18360 add to single No ------ Permit for .................................... . . -faou1ly dwelling _--.--.---.—~~-------.—.—.---.. ^ ` . . ^ Locationf24O Bumps River Rmad__. ' � Centerville ' =���� �/ ----'---'--------' ---'' �. �� ��vvnar .--.'�—yne---_ ' _______.. ` - Type of Construction — -------_ ' . . - ----'—^--'—'-------^--------- - ~ . ' ^ Plot ---------. % Lot ----------' . ' � . . ` Permit" Granted~ May ^ - ^ � ~~'~ of Inspection^ . ' oo�e Completed ' . ` . . . . . . ' . PERMIT . . . . 7 l'V . . ^ . —.— ----. ^ - - ........�� .............. �� � � .................................................. ............... ' . . ` -------.,.---.----.—..---.-~.—.. � . ' Approved l� ' ^ . .................................... /� '----' . |' ' . . ___ _ ../� ' --' --- ]��------... /y Assessor's map and lot number. ,/d!, ..1Q . SEPTIC SYSTEM MUST' BE e, INSTALLED IN COMPLIANCE Sewage Permit number ...� ?%�.,.: :V..�! (,r��? WITH ARTICLE :I I STATE SANITARY CODE AND TOWN v oftNETo� TOWN OFBARN �TR'LE__ i IAHBSTAELE,',i ^r MA & i639 BUrcIDING INSPECTOR ppp� • g0 ••.� < APPLICATION«FOR PERMIT TO ,,!�.Z1,o...:. .... ........ Li a G:'1 ti Tom. TYPE OF CONSTRUCTION ...... .....f//..... 'T.. / :..:..: ..� .............................................................. ` ...........................:. 97".. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ........L. e....../f. 5......... v �. . C '!v�—��.1 ............................................ ProposedUse ..........!f. do..(`7................................ .................... ......................... ....................I.......................... Zoning District ........... .. .....I.........................:..............Fire District ..... r���%�'.rv��G�� ' Name of Owner � 4fd 'X .jN- 116c1dress �?���% Nameof Builder ............. .................................................Address .................................................................................... I( < Nameof Architect ........................................................•.........Address .............. ................................... .................................... Number of Rooms ........ ....................................Foundation ......PQG// .......�.C?..../......................... Exterior ...L.. S? .......1AO .4.4 .....Roofing .......!/ .fs'.4✓...... f}67-�:4.4 ........................... Floors ....!.-� � .........:................................:...:...Interior .•��..��.�4•�.f�:G:�.................................................... Heating 'G✓/ ......... ............................................ .Plumbingd. ., .b................................................. Fireplace ....... ....................................................... A.. ..Approximate Cost ....... �� ......................................... Definitive Plan Approved by Planning Board ________________________________19________. Area ....1ly. ... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH I , I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name✓ . .. .......... ................ ...................... James, Wayne L. & IN Mary —18360 add to single 14o .................. Permit-for .... .......................... .... to single .................. ... family dwelling .......................................................... ......... ......... R d Location ........................................... ..... ..............l340Bumps'Rive Centerville ............................................................................... Owner .....Y�yp,�..L.....&..M.a.r.y..J.ames.............. .. . .. .. . . .. .. ........ frame Type of_Construction .......................................... Plot ....... ..• .......... ........ ................................. ................... ................... Lot ................................. ay 76 .Permit dranted ........M... ............................19 Date of Inspection .. .a ......19 1 .�1-mpletecl ...... .... I ........ 19 Date,C PERMIT,REFUSED :19........................... ...............:1...................... .......................................................... ....................................................... ................... ............. ................................. ................... Approved .............................................. 19 .............................................................!................. . ................................................................................. Assessor's map and lot number .............................i......—...... r�! Svvage Permit number '� v.......................................................... TNETp�O TOWN OF BARNSTABLE • i BARNSTABLE. S 9 'BUILDING INSPECTOR • ° OM a' APPLICATION FOR PERMIT TO L�i-r� l?? T4 .L 4t...e v`S......................................................................................................... 1 / TYPE OF CONSTRUCTION ... 1!�' ,�`1 ....( ,'�! ;S,�,JaF�...... ............................................... i ........................ ............: �-.....19,7 r TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location / 3' �?.....f?lL�r� ?f.....�1�1 1�rG ....... 7........ p!�... ' r�.A....................................................... 'r. ProposedUse ... ................................................................................................. ZoningDistrict ...... �......... '.j ........................................Fire District ...... .... . .............................................. Name of Owner .L'i9%x ......Z. 7 /`T ` .................Address ...`a^ .!?' ................................................................... Name of Builder ......4'--i X Address ..... _ .. ......................................................... l / JI Nameof Architect ..................................................................Address .................................................................................... Number of Rooms Foundation Exierior .........................................Roofing ............................ ,.......................................................... Floors / i�.W/l,�s/�r ,,�+ s- .. = ._teri-� ��a'' !��"r4L.!�...... ................................................<.............. ...................................................... ...interior ..... .1... �'�'� .......Plumbin i ... zz Heating g,�....:............................................................................. ..................................................................j., Fireplace .....�d...................................................................Approximate Cost .� fJ....................................................... ......... Definitive Plan Approved by Planning Board ________________________________19________. Area !? ................................ Diagram of Lot and Building with Dimensions .A�1.9�-y�J Fee '" ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH ' a .� 6 e: �b c f 5 h hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name. ............................ Jeuuaa» Wayne L. A=188~48 .401 Ar � 4_k � �v��.w��� add to ^ � No ��. — Per for -----''o»�,��z��' , / ---------------------.---.—.. � 1340 Bumps River Road ' Location ................................................................ Centerville � ........~............................................................... , Wayne L. James Owner —.............----.-----.—.-----.. � �| Type of Construction .........frame................................. ' --^~'--~'-------'~—^^--`—''--'--- Pkt Lot Permit Granted Date Complfetec!�J...............................19 P PERMIT REFUSED �' 19 ��'' ���� '�������� � .............................................. �—^'~----~~—'' `-~~~-^^'— —~^^--^^~^--''—'' ^� ............,..........,..,...,'...'...,',,,,,......'...,...'',,' Approved ................................................ lQ ` -------------^^~—'~^—`~^'~^^^^-- ^ --------'---------'---'---'~^'' ~ . ` Assessor's map and lot number .. ..-.•:. .• SEPTIC SYSTEM MUST BE , INSTALLED IN, COMPLIANCE 'Y y I✓ Stage Permit number ..............% tk!1. ............................... 14 WITH ARTICLE II,STATE SAN]TARY CODE AND TOWN oF7HETo�a TOWN • OF BAR NSTA LE Z BARNSTA.B E— i s 9�o aY pr � .: RUI IN SPE"TOR, • ..1 s 4^ all 0 .,10 AP.PLICATION FOR .PERMIT TO .(J� ....., !�!.......... �} :....T�... LL-/,G ..................... ' TYPE OF CONSTRUCTION /E' ................................................... ` ............ . .....fir:. ..A ......197r� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following i�nformati`onn: p� Location .......� �?..... �1� !�.... i �.Ux�! ......��� ...... . !1.l �Y..✓.//P., .....!1... ................................. .. ProposedUse ...ft./TCf/ .Gl...... ................................................................................... I......................... Zoning District .......RI) "A ................Fire District .... .......................................................... - I Nameof Owner A.4y G....... .... .................Address ................................................................. Nameof Builder .......iC4•Y.. ................................................Address '.................................................................................... If Name of Architect ......................Address ............................................ .................................................................................... Numberof Rooms ........................................... ...:..................Foundation .............................................................................. Exterior ko- ...... ........................................Roofing ..�5 �...,Jr�!J.1.�1 5.............:.......................... J U Interior .......................................................Floors ..................................................... Heating ! %................................:.............................'.....PIumbing 67.................. Fireplace ..................................................................................Approximate Cost .................................................................... Definitive Plan Approved by Planning Board ________________________________19-------- . Area ...�.��....:.®................. ..... Diagram of Lot and Building with Dimensions 1029C-11`-D Fee -� SUBJECT TO APPROVAL OF BOARD OF HEALTH 757/"'� -- I hereby.agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Nome'�%1. ... r%.... .'............................................ _ ^' James, Wayne L. � . , ' 202L� add to dwelling ' No ~............. Permit for .................................... —.---..---.----.-------.--.—.—.. ^ � ,1340 Bosapo River Road Location ------.---.---.^—.------.— Centerville .--~...—.--.-----.—~^—...-------- ' L. James Owner ---.�����.—.-------------. frame / Type of Construction .......................................... ^~ q ^ —~.—.—�--...----.----..---..----.. . ' ' plot ............................ Lot .................................. May 16 78 � Permit Granted ......................................... / Date of Inspection .. --]9 � �~ � Dote Completed .—�-�/��� � �` ��� . ~^/^.. `.—�.�--�. \ ^ ' | \ ' ' PERMIT REFUSED ........................................................ �.-- l� - � ~''.--^^~—^-^'~^^'—`~---'^,^'---'—^^ —'�^'—^-'-^`^-----`—~^--- '—~^'----' . ' ` ' '--'r'-'''---'—^^--~'^^'—~--''--'—^ .. . ...—.—..—~.--... Approved ' .................................................. lR ' ' - ` � ----'^---.-----'----...~.—_..~—. --------.--------...---.--...�.. . ^ ��� � • I Qy�FTNETp�y TOWN OF BARNSTABLE Z 33MOST"LE, i s639. p N BUILDING INSPECTOR O•FPY Or APPLICATIONFOR PERMIT TO ............................................................................................................................. TYPEOF CONSTRUCTION ..................................................................................................................................... ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ... 5.......n.J..J/.t°.r....... �....... ..... .. ................................... Proposed Use ... °.�l �/7.Pq� .................................................................................................. ............... ............................................ ZoningDistrict ..../ .. (........................................................Fire District ...... ..../V.e.>............................................. ........ `/Name of Owner .C.GC.I`/.!.'... �f�Y ..) k!...............Address ... �....�ct.>a9/�...'\ � 'I`f.�°l"1/i Name of Builder ........7.4...? -9...........................................Address ............... ..!? ...V............................................... Nameof Architect ..................�...............................................Address ..........................`....:.................................................... Number of Rooms ..................................................................Foundation ......../.:3/D..c°�1.]. ...�. .r�.�1.s.................. Exterior ...... /.0..0. .....r.... /K..'.................................Roofing ......... .T.. l ......... .(1...,....................................... Floors ..... .I....,..W W........................................................... ........(�..�..�Q .. t..................................................... -Heating �...0...1 �.c...................................................Plumbing ..........�a....U..1!1.... ........................................... Fireplace .............Approximate Cost ..........�..a..Q..e... ............... Difinitive Plan Approved by Planning Board - __________19________. Diagram of Lot and Building with Dimensions f 1z 77 !II hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name 8,1 ..... ." !.`...r......... Ryberg, Carl H. Sr. i 13876 tool shed No ................. Permit for .................................... ............................................................................... a Location 13 O..Bumps. ...Raver. ....Road. ............. ......... . ........ . ...... .. Centerville ............................................................................... Owner ......... ... Carl H. ... Ryberg. .,...Sr.. ........................ ... ...... ...... . .... . frame Type of Construction ............. .................. t I Plot ............................ Lot ................................ Permit Granted NTH 24 1 x Date of Inspection 1 { Date Completed .....y 19 .......�. ...... ., C on AO e- � I PERMIT REFUSED ................................................................ 19 ` ................................................................................ ............................................................................... s ............................................................................... 1� , Approved ................................................ 19 ............................................................................... M ............................................................................... L p�{U V Map` Parcel rmit#-' Conservation Office(4th floor)(8:_30-9:30/1:00- 2:00) Date Issued Board of Health(3rd floor)(8:15 -9:30/.1:00-4:45) Fee Engineering Dept. (3rd floor) House# _ IMF Planning Planning Dept.(1st floor/School Admin. Bldg.) RNSUBLE,�` Definitiv . ,,lam A roved by Planning Board 19 - u - e v ENS 6-ALLE TOWN OF BARNSTABLE WITH rITLE 3 Building Permit Application ENVERONMENTAL CODE AND Project e ddre�sTOWN REdULATIO'�nF!8 .s Q Village _,.- .\@ J`y VIZ, `` c7.,S�e Q?Z to 3'2 Owner W 01L�SL,.'P— G..VA-e—S Address Telephone Permit Request \ .v��.p c� Gt�.� --�.®F5 \V:, � 5 ,� tv.c First Floor square feet Second Floor - b0 square feet Estimated Project Cost $ Zoning District Flood Plain Water Protection, Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type Commercial Residential Dwelling Type: Single Family r 11� Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House Unfinished Old King's Highway Number of Baths No.of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached . Barn None Sheds Other Builder Information Namelo,,3\ e CO3Ze_t3�.3/kN/ Telephone Number Address .> / �r . /7 f l� f� icense# /� 6 0,2 Home Improvement Contractor# Worker's Compensation# 0C:C-J?611'-S®I y-S NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTIO DEBRIS SULTING FROM THIS PROJECT'WILL BE TAKEN TO ,��1 Z AP-l�/ & x �� SIGNATURE �D;iJn GCx� ` DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) . i i` FOR OFFICIAL USE ONLY PEIfiMIT NO. DATE ISSUED M1'P/PARCEL NO. - ADDRESS VILLAGE OWNER c DATE OF INSPECTION: _ FOUNDATION ` FRAME INSULATION ` FIREPLACE ELECTRICAL: ROUGH ' FINAL PLUMBING: ROUGH FINAL — GAS: ( ROUGH `-; . r FINAL ` FINAL BUILDING DAE CLOSED OUT s ASSOCIATION PLAN NO. i I M1J -� F TH OF MASSACHUSETTS La OF INDUSTI;IAL ACCIDENTS ° 600 WASHING TON STREET w BOSTON, MASSACHUSETTS 02111 fames J CamvDell AFFIDAVIT �orrm,ssio�e` KE WORRS' COMPENSATION INSURANCE (licensee'perm,nee) with a principal_ place of busin z ess/residence ar. © �� - , Vx OCO'�� 'U�.V�- (Cry/state/zip) do hereby certify, under the pains and penalties of perjury,that: ` in workers' compensation coverage for my employees working on this ] I am an employer providing the follow g job. s5� Policy Number Insurance Company [ J I am a sole proprietor and have no one working for me. hired the contractors listed below [ ) I am a sole proprietor, general contractor or homeowner(circle one) and have _ who have the following workers` compensation insurance'policies:` Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Number: Name of Contractor Insurance Company/Policy Number Name of Contractor 0 I am a homeowner performing all the work myself. nstruction air rk on 2 NOTE:..Please be awue tha t while homeowners who employ persons to do mainteaaace.CO naat therctor arepaoc a riendh a lication by a homeowner for a license dweliine of not more than three units in which the homeowner also restdu or 2, the grounos appurtenant considered to be employers under the status an employer yer under the Workernsation Act(GL s'Compensation Act. or permit may evidence the legal su P of Insurance' for vcrazc ` cnaltiial Accidents' OfFict a 1 understand that a copy of this statement will be forwuded to the Department f MGL 152 can lead to the imposition of criminal p and a venfiution and that failure to Secure coverage as required under Seenon 25 'Work Order consisting of a fine of up to 51500.00 and/or imprisonment of up to one yeu and ei�perry°u the form of,a Stop fine of S100.00 a day against me. day of Signcd.this LicensoriPermi-6mr Lic�r.sccr PPr;ni;-cc 9 , O -P : 23407 DEPARTME,'NT OF PUBLIC SAFETY � Q � © 23407 ONE ASHBURTON PLACE, RM 1301 OCT3 U �n 5 BOSTON,'TJbA:02108-1618 CONSTRUCTION SUPERVISOR LICENSE " Do Pti cSSo Number: 4xpires: B �� CS 026325 10/20/1997 1@ Restricted To: 00 - - - _ PAUL J CAZEAULT _ _- ^ch bottom, fold signon 1580 MAIN ST Y= Eck, and laminate license card. OSTERVILLE, MA 02655 -' , Keep top for receipt and change `t== —f address notification. 17. Restricted To: Of 23407 321ll;m" of PRUC Si4fBTy , COOS SOPBEYISOR LIMSB 0 - bone Birthdate: . 19 - Masonry only `1012911957 10/26/1959 A - 1 & 2 family Homes _ 499 failure to possess a current edition of the . Massachusetts State Buiildinq Code F- f4 d CA8BAlILLT is cause for revocation of this license. OST$AYM, Kh 62655 f { .'.: ... :.::: .. � -i FIC QP.ID pA DATE(MM/DDNY)A/1OHI. C;ER [ A. : � ; 10/30/95 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Drake, Swan & Crocker HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 14 Lot's Hollow Rd. ,PO Box 429 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Orleans MA 02653-0429 COMPANIES AFFORDING COVERAGE Peter G Walther COMPANY 508-255-3212 A Assurance Co. of America INSURED COMPANY B American Policyholders Paul J. Cazeault etal DBA Paul COMPANY J. Cazeault & Sons Roofing C P.O. Box 2781 COMPANY Orleans MA 02653 D .. ........... . ..... .. ..... ... ...._... _................... .......................................................::.........................................................._.........._.................... .._. FOVERAGES .. .... 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. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MM/DDIYY) DATE(MM/DDIYY) GENERAL LIABILITY GENERAL AGGREGATE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CFP25552812 05/01/95 05/01/96 PRODUCTS-COMP/OPAGG $ 1,000,000 CLAIMS MADE 7 OCCUR PERSONAL&ADV INJURY $ 500,000 OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ 500,000 FIRE DAMAGE(Any one fire) $ 50,000 MED EXP(Any one person) $ 5,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMB $ ANY AUTO ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ B WORKERS COMPENSATION AND STATUTORY LIMITS EMPLOYERS'LIABILITY EACH ACCIDENT $ 100,000 THE PROPRIETOR/ INCL WCC1861950195 08/09/95 08/09/96 DISEASE-POLICY LIMIT $ 5OO,OOO PARTNERS/EXECUTIVE OFFICERS ARE: EXCL DISEASE-EACH EMPLOYEE $ 10 0,0 0 0 OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES/SPECUIL ITEMS Roofing , CERTIFICATE HOLDER' : CANCfLLA71OI�t ns.GOZZ 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Peter G Walther ACORD 2,5-5:(3/93) 0AC,ORD CORPORATION 1993 i o The Town of Barnstable ,P Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Off= 508-790-CM Ralph Cmssm Fare 508-775 33" Building Commrssic For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair;modaniration,Conversion, improvement,.remo%al, demolition. or construction of an addition to MY Pm-cdsdng owner o=qficd building containing at least one but not more than four dwelling units or to sm=nn r s which are adjacent to such residence or building be done by registered conuaaom with certain occcptions,along with other Type of Work: Est. Cost�c9 a , Address of Work: ,�'�/U --� e� , cN �v� f' Oamer.Name: ��ric.es Date of Permit Application: -� 0 I hereby certify that: Registration is not required for the following reason(s): Work ccdudel by laW Job under SI.000 Building not owner-ooarpied Owner pulling own permit Notice is hereby ghen that: OWNERS PULLING THOR OWN PERMIT OR DEALING Wrm uNnum- SIZED CONTRACTORS t FOR APPLICABLE HOME IMIPROVE TENT WORK DO NOT HAVE ACCESS TO TBE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c I42A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: ate Conuacxor name Registration No. OR -1