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HomeMy WebLinkAbout0126 CAP'N LIJAH'S ROAD J t � � s .. o .,, ,� 4 K a ,. n a r r� ,. v . � o o „ a y a ., i .. i i _. � i e ,. L �. r. �, „ ' ., TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map. Parcel Application # if Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee 1Lp Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street:Address Ow6er CZT/2 /QG�/�,P� Address Telephone�'"� '' .� v / Permit Request G �. Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation ' Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including bathe): existing new' First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 1)712/7 61a_ 176 rTelephc ne Number_ 9J7 0,M Address )—/lak License # CX�-alIl 6;r Al,302 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO t�IGIVATURE DATE ���3 r C } FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED +.. MAP/PARCEL NO. s f, ra ADDRESS VILLAGE RF OWNER DATE OF INSPECTION: r µ FOUNDATION . } FRAME to a INSULATION SIZA FIREPLACE ELECTRICAL: ROUGH FINAL r. PLUMBING: ROUGH FINAL GAS: ROUGH FINAL .c /J FINAL BUILDING 1011l3 t: r DATE CLOSED OUT ASSOCIATION PLAN NO. W X1 i 4 r � t 0 'CHF Town of Barn 16 Regulatory Services BARNMASS.LE, ASS. Thomas F.Geiler,.Director 9 M TF1 39. s Building Division Tom Perry, Building Commissioner 200 Main'Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 -NOTICE TO THE BUILDING DIVISION OF CHANGE OF LICENSED CONSTRUCTION SUPERVISOR I, /'/ �Qt.L�l tom owner of property located at 6 (// , ,e _ , hereby certify that is no longer Construction Supervisor listed on the application for the project under construction as authorized by. building permit #C 013(1 9'4 , issued on _ -` l 201_3. I understand that the project under construction must Cease until a Successor licensed Construction Supervisor, is submitted on the records of the,Building Division. ROPERTY OWNER DATE q/farms/newcontr reference R-5 780 CMR rev:1 10410 f The Commonwealth of Massachusetts _ Department of Industrial Accidents - Office of Investigations ' 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly N�a1T10 (Business/Organization/Individual): I /zQ a. Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.ElI am a employer with t 4�/❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' insurance.$ 9. ❑Building addition [No workers comp.comp. insurance required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions �r��q ] officers have exercised their 11. Plumbing repairs or additions id I am a homeowner doing all work ❑ g P myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Si—atur Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 1 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one,affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street. Boston,MA 0211.1 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 www.mass.gov/dia f Town of Barnstable Regulatory Services '" MABS. Thomas F.Geiler,Director 1639. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION 22 DATE: Please Print �,���;) � ` �i JOB I OCATION: � ��ID/> ,L///.U/]` CfOGC. LC�/�lI///� (/o�l0 3oZ number streetj/J p pQg village "HOMEOWNER":_ /rd"n e Q home phone# work phone# CURRENT MAILING ADDRESS: / O �� a - IZI?IIle zV oa o2 city/town Istate zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. / .! 0&/Z&//_ Signatafe of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of 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. You may care t amend and adopt such a form/certification for use in your community. C:\Users\decollikWppData\LocalWicrosoft\Windows\Temporary Internet Files\Content.Outlook\QRE6ZUBN\EXPRESS.doc Revised 053012 Town of Barnstable ti Regulatory Services * BMWSTest e. • MASS, g, Thomas F.Geiler,Director 'Argo 39ft- Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit. (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant 'Print Name Print Name Date Q:FORM&OWNERPERMISSIONPOOLS 6/2012 TOWN OF BARNSTABLE BUILDING PERMIT_APPLICATION Map I cta Parcel I7 `, Application # Health:Division : Date Issued Conservation Division Application Fe Planning Dept. R`: Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address C-NJA L I A to 'S Village Owner i1V1AO-' Address PO �k `t Co Cc=N 1,*1_ Telephone 9 �� c9 Permit Request Due ?'0 A rA1,L �-6 co&j /,/du567 709,4s a101� � nAE 1A.4I0 uo A ;S'f"t�tuGT� (. 12��/►tvL '� Fr12s 6 LE S t�r/L �/l,bucvS � Fc'l'Z/c��L iI�TCR`�a1 ° TR c vvx. IvA d 5u [s A-1 N — NO Pb F!C_ 6 No F4co4- PLAAJ c A�- o Square feet: 1 st floor: existing proposed _2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation /5, y ® Construction Type Lot Size 3�1 A,c- Grandfathered: ❑Yes �ANo If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure 39 �R S Historic House: ❑Yes )kNo On Old King's Highway: ❑Yes ❑ No Basement Type: Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sa. Number of Baths: Full: existing_ new Half: existing 41 rF I. Number of Bedrooms: _ existing —new N Total Room Count (not including baths): existing new First Floor Ro m Count° ' Heat Type and Fuel: AGas ❑ Oil ❑ Electric. ❑Other co m Central Air: ❑Yes T16 No Fireplaces: Existing New Existing wood coal stove: ❑ s ❑ No N Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing 0 new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name w�l� W��L .� Telephone Number 7 l00 k 7 l ( Address l ate. ST- t3dZ kv j >� License # w4u:. -y Su-SLuy-a-3 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE f&J DATE 3 J 'a FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL N0. t ADDRESS VILLAGE- OWNER i DATE OF INSPECTION: FOUNDATION F. `: ps x FRAME P " INSULATION_' FIREPLACE ELECTRICAL: ROUGH _ FINAL PLUMBING: ROUGH FINAL ` ` r GAS: ROUGH r.. FINAL :FINAL BUILDING'! Y DATE CLOSED OUT ASSOCIATION PLAN NO. '"`' L" TOWN'OF BARNSTABLE BUILDING PERMIT APPLICATION Map ! 7 Parcel Application # Health Division DaZIssued CC Conservation Division Applictation Fee J Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board o� y/o 3 ,I z Historic - OKH _Preservation/Hyannis Project Street Address oZ C-AiJA L JA iA '5 /xnA Village -����'Yc-v c Owner Address 3 130rA 1 ( Cc;N U; Gz_ Telephone 5 0�- 9 S-? Permit Request DI ua TQ A -rdte_-� rA1,L% G Aldv r,�F 3� 0,4 tj 5-rPcu L Re,-9/4 c N-S A Prt-YLS 6 A 3 b lAiiN bacu S t TC'00r, ►NTeR"ovi S/d 7RdL1 - , nR L' -C e ` NO F4ego✓Z pGAAi G NAti Square feet: 1 st floor: existing - proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation /si 000 Construction Type Lot Size S� A C_ Grandfathered: ❑Yes �No If yes, attach supporting documentation. r. .t j Dwelling Type: Single Family Two Family ❑ Multi-FamilY(# units) Age of Existing Structure 39 YR S Historic House: ❑Yes N>t No On Old King's Highway: ❑Yes ❑ No Basement Type: AFull ❑ Crawl ❑Walkout ❑Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing_ new Half: existing new Number of Bedrooms: existing _new NO Total-Room Count (not including baths): existing ( new First Floor Room Count Heat Type and Fuel: IO,Gas ❑ Oil ❑ Electric ❑ Other g Central Air: ❑Yes ;IkNo 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:,, k_. 1 Zoning Board of Appeals Authorization ❑ Appeal # Reco,rded 0• " Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed(Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name W`A,�vv- w'�k Lev,) TelephoneENumber _50� 7 b O t 9 I ( Address 13'a 19�&b ST- License # GS - O S u-LU lc.4-.3 Home Improvement Contractor# G Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE VJ DATE -3 FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents 0 Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.go,v/dia Workers' Compensation_ Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): whalen Restoration Services Address: 22 American Wad City/State/Zip: Phone #: 508 760 1911 Are you an employer?Check the appropriate box: Type of project(required): I.® Tama employer with 25 4. ❑ I am a general contractor and l employees(full and/or part-tithe).*. have hired the sub-contractors 6. ❑'New construction 2.El am a sole proprietor or partner-,' listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have- 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. O Building addition [No workers' comp: insurance -comp.insurance,: required.] 5. ❑ We are.a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 1 l.❑ Plumbing repairs or additions myself No workers' corn right of exemption per MGL Y [ _ p� 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.[:1 Other comp. insurance required.] *Any applicant that checks box#:I:must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doingall work and then hire outside contractors must submit_a new affidavit indicating such. -Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. if the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. insurance Company Name: Arbella' Policy#or Self-ins: Lic. #: 9091320411 Expiration Date: 4/1/13 'Job Site Address: ( 0 C-PPON L i T 4q lk� City/State/Zip: CGN j--M; M l= Attach a copy of the workers' compensation policy declaratioir 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 S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to,the Office of Investigations of the DIA for insurance coverage verification. I do hereby,cerli&u�nderthe pains and penalties of perjury that the.information provided above is true and correct. Signature: (fv .�J t.A _ Date: Phone#: 508 760 1911 Official use only. Do not write in this area, to be completed by city or town official. City.or Town: Permit/License# issuing Authority(circle one): I.-Board of Health 2. Building Department 3. City/Town Clerk y: Electrical Inspector-5. Plumbing Inspector 6..Other Contact Person: 1 Phooe#: Client#:245206 WHALENREST ACORDTM CERTIFICATE OF-LIABILITY INSURANCE DATE(MM/DD/YYYY) 03/27/2013 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 HUB International New England HUB International New England PHA N o E,�:508.945-0446 FAX A/C No): 508-945-9136 265 Orleans Road E-MAIL North Chatham,MA 02650 -ADDRESS: 608 945-0446 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Arbella Protection Ins Co. INSURED INSURER B: Whalen Restoration Services Inc.; INSURER a: Whalen Services Inc. s INSURER D: 22 American Way South Dennis,MA 02660 INSURER l INSURER F: - COVERAGES CERTIFICATE NUMBER: ' REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES'OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH,RESPECT TO.WHICH'THIS CERTIFICATE MAY BE ISSUED OR,MAY PERTAIN,-THE INSURANCE AFFORDED.BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE.TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.` LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP - LIMITS LTR. INSR WVD - POLICY NUMBER - MM/DD/YYYY MM/DD/YYYY A GENERAL LIABILITY 8500040398 4/01/2012 64/01i2013 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY DAM A�E TO RENTED PREMISES Ea occurrence $100000 CLAIMS-MADE 51 OCCUR MED EXP(Any one person) $5 000 ' PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY PRO-JECT LOO $ A AUTOMOBILE LIABILITY 58243400004 4/01/2012 04/01/201 COMBINED SINGLE LIMIT' Ea accident 1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident), $ - X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ - �•$ t- ` A WORKERS COMPENSATION 0091320411 4/01/2012 64/01/201 WCSTATU- OTH- AND EMPLOYERS'LIABILITY Y/"ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500 000 OFFICER/MEMBER EXCLUDED? a N/A ` (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE s500 OOO If yes,describe under - - DESCRIPTION OF OPERATIONS below - E.L.DISEASE-POLICY LIMIT $500 OOO' DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Project Location: 126 Capin Lijah's Road,Centerville,MA 02632 r , CERTIFICATE HOLDER CANCELLATION Marla Blauner SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 126 Capin Lijah's Road ACCORDANCE WITH THE POLICY PROVISIONS. Centerville,MA 02632 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are tegistered marks of ACORD #S890031/M703151 CH004 0* Restoration Services Inc. Fire, Smoke, Soot,Water Damage&Mold Remediation Services Cleaning • Deodorization • Reconstruction Specializing in Fire Restoration - All Work Guaranteed Access, Authorization and Direct Payment Request Form I (we) authorize WHALEN RESTORATION SERVICES to perform work as per estimate at property located at 126 Capp. Lijahs .Road, Centerville, MA 02632 to repair damage caused by tree on 2/10/13 As owner(s) of this property, I (we) understand that I (we) must authorize this work. I (we) hereby authorize WHALEN RESTORATION SERVICES to perform this work and accept responsibility for payment upon completion. I (we) authorize and direct my Insurance Company Mass Prop Ins Und Assoc Policy No. 0976402-13 , to make payments directly to WHALEN RESTORATION SERVICES, Insurance Claim Specialists, for doing this work and to that extent I (we) assign the benefits applicable to this loss to WHALEN RESTORATION SERVICES. I (we) acknowledge receipt of a copy hereof: /_3 OWNER DATED SIGNED ( OWNER nQ'pucL_ WHY RESTORATION REP. SIGNED 22 American Way,South Dennis,MA 02660 Phone: (508)760-1911 Fax: (508)760-9995 • 1-800-244-2598 •E-Mail: restore@whalenrestorations.com Web Page: http://www.whalenrestorations.com OFFICE COPY ti. Massachusetts -Department of public Safety Board of Building Regulations and Standards oSupervisor Cnnstrucn n ' License: CS-074928 1' WILLIAM WHAL N "" •� 122 POND STREFF BREWSTER MA=026, 1i v''` Expiration Commissioner 08/10/2014 R e�na��r�«racae��/G/o`'Ca/G/.arsa ation ion /Gs License or registration valid for individul use only Office of Consumer Affairs&Business Regul OME IMPROVEMENT CONTRACTOR before-the expiration date. If found return to: registration: 129244 Type i Office of Consumer Affairs and'Business Regulation 1, 10 Park Plaza-Suite 5170 xpiration 7/30/2013 Private Corporatie< Boston,MA 02116 3 Whalen Restoration Services Inc: William Whalen 22 American Way South Dennis,MA 02660 Undersecretary Not valid without signature t , a:c Main Level Remove•and replace roof sheathing 9xi2 area Reshingle the entire roof Remove and►eplaoe 5 sheets of the gable end sheathing and replace w/T-111 Remove and replace 4 damaged 11'roof rafters(front) Remove and replace 4 gable end framing studs Remove and replace 4 windows(2 bedroom and 2 front porch) Insulate walls Small interior sheetr'odc repair r4"*P av 39 4" -40' �elCG`""'�'VC F1(A) I o IV N ' V Q���2�0 I ,,AA L cc�(.�� 11 Lill �. F2.(g) V Repair Areas(Front left of the roof and siding) Main Level f T BLAUNERPERMIT 3/28/2013 Page: I S' Q 0 7A N m o /oNK NIN J G 49 07-28 - / f 0- 4/w 0 ICA L 1 ., �_ � DAre: eev� zG, �97G R £FE' RENCE: 0 £lN6 L 01'� AS SHOWN ON A PLAN RECORDED fed 2G, /9�G IN rN£ RARNSrABL £ COu.Nrr DATE- R£ GISrRY OF DEEDS PLAN BOOK 301v 'AGE /aG. REO. LAND Su VE Y OR / HrREBr CERr / Fr rYAr rHr oulLOliv SHowN CAN rNIS PLAN /S L OCArED ON THe- 4..R O UND AS SN OWN HEREON AND x rHA r IT Oo -S - _� ONFO�VIW rO rNE V&ItAOf4f �3C//G O/i✓�i SET.SAC� ,eEQ!//o2EM.E 75 c9F c WHL` N CONSrRt/ G rED. GEMGE sN LOW,A eon e Low a.ha� Co• %IST��wc p`t' SiURV f.. . '1......:...... . _., Assessor-'s map,and lot num �..........�...'s SEPTIC SYSTEM MUST BE INSTALLED IN CWAPLIAN tit _��,.C..• � , ,.c. g Sea .......emit number �.:..............:.:!..� ........ ........._..... , CE' , � �' •'' WITH ARTICLE -II STATE :T, r SANITARY 'C0 ANQ40WN 114ETo�� TOWN j OF B ARILS T16A L ... BABISTdDLE• ,^ " q `' .BUILDING INSPECTOR c3 i6. `e0 Te ,,..; to a - tt �[ •*_ -I_ .. bag ` , a r� APPLICATION 1FOR UPERMIT TO ...:1..0`l(:1 ' .. .l.J�.'a g .. . .... ..... . . Wool a .... 7 TYPE OF CONSTRUCTION ... .....W.00l... G ........... ..........:..............:...... ,.�?.-.c2,4.......19. !o e, td TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a -permit according to the following informations Location ....WT.:a-.7... .P......................... Proposed Use ........ ..�.�h;�4.-�.Q�l Y1�....................................................... :................................................................. Zoning District ............ ...................................................Fire District .....4r=Q�1�1 ..�J1!.:... �.� ..u.YZ.� QR........ Name of Owner .�Q,Q2 9,e�n. ... -,,�rra.n,Q ...Tess ...sPA..... Name of Builder ..........J�.G�...............................:......Address ................... +Q.s.......................................... Name of Architect ..........6JI Y. ....................................Add'ress .................. ........................................... Number of Rooms ................. ..............................................Foundation ...1.0.........P.0.-4.:(A2� ... ° .N. . Exterior ......JJ.A......�.�Aa,..'v......fto-P.�f� ..........Roofing ....sx, .. /.......T[s�? .��.�. ...._...................... Floors .......... ..........`.'. ..S.i1�Q�...............................................Interior ......... , .)....... /.4K.K� .k�0�°. ............................ Q Heating FWA. ' .....Plumbing �./c�, .Gl .hS Fireplace ........ ...:.....4+1. ........................Approximate Cost ............1. ,.. 1Q.•.....[`!L017.Y.. Definitive Plan Approved by Planning Board ________________________________19--------. Area .... �....5:...r........... 2 Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALT L0 . !S P d �d • I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Tellegen-Ferrone Associates 14636 1 1/2 story, No .......... Permit for .................................. family- dwelling......................................... -Lijah Road Location. .............. ........................................... Centerville . ................................................................................ Owner Tellegen-Ferrone' Associates 7 ...................................... .......................... T pe,of Construction .......... frame Y .................. ............. C, ..................... .......................................;............ 'Plot ............................ Lot .................#27............... 'Permit Granted ........Sepgember 3,........................I.........19 76 Date of Inspection Date Completed .. .... ... ....................19 PERMIT REFUSED ................................................................ 19 ............................................................................... ............................................................ ................... ........................................................................... ` -1 s -fi - tt � . .......................... .................................................t.. Approved ......................................... ..... 19 ......................................:....................1. --7 .......................................................................... .ter . h ..1-� {� � � !� (/ Ass r'sl map;and lot .number .....:� -'..:.... .... ............. t�i(' �` 7 56wage.Permit number ^t........`....... .................:............ - yoF711ETo�y TOWN OF BARNSTABLE Z BAHHSTADLE, i "b 9 .•�� BUILDING INSPECTOR' o M a' APPLICATION FOR PERMIT TO .... ........p �• ^ '� '� TYPE OF CONSTRUCTION ... . ..... . op......................... ....... ?.!;.,....19. , TO THE INSPECTOR OF, BUILDINGS: The undersigned hereby applies for a permit according to the following .information: . Location ...!,.�:*.. :.?'� n 'rn s <, K r ........�E �?: n n „� f i . n c<, _ __ . . . _i .. , ..... ._,�. r ProposedUse ...........! " ... ?.:. .... ..c....r~? .............................................................:.......:................................... . Zoning District ...........je.L ! ....... . .........................................Fire District .... q..!K,4-- ',.:..'.. Name of Owner ... ! . �. +�..... ..c, y..�rn,n,., ��cAddress .. (� �nr ���? rf n �,5 _ _I _ - Name of Builder "� ........Address � Name of Architect .......... r.-, ,r.......................................Address `5/, r Number of Rooms �� Foundation .. /N........ 0. < < P Z,� n �- ........ ....... Exterior ......1k t..! /� +....�1 .!1 11 S!)r!t L nl! ..........Roofingl- •., ... .. •. Y.. _. ..... cp .. .. _ _ Floors � •• Heating ....... I �.�.A .....n6 .......... ...Plumbing ...........� I!,,2.... .7,�/i � �? f t. Fireplace ....... ...... �.`, .............'Approximate Cost t1..j P-1- J Definitive Plan Approved by Planning Board ___ __________________________19________. Area .. ' . !. ...... ................... Diagram of Lot and Building with Dimensions C 4 � / Fee ,... ...,,.................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH r C �' {y �� I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. N .............................._ :./ Tellegen-Ferrone Associates -A--t9I---,r7V cm- .0 i� 636 1 1/2 ihory, Po ................. .Permit for .................................... sing4e family dwelling . ....................................... eup:t. Lijah Road Locajion ........................................................ Centerville .............................. Owner Tellegen-.Fer.rone Associates ............................ ..................................... ne Type of Construction ...............f ra........................... ........................... ............................... .................. Plot .................. ........ Lot ..........#27 .......... ...... .. ... -79 Permit Granted .../Setember 3 .19 76 Date of Inspecid....................................19 Date Cornpleteclk.......................................19 PERMIT .REFUSED ................................................................ 19 ....... .... ..... .. ......................... *...,/.o......................... ......... .... ...................... ................................. .............................................. ......................................................................... Approved .......... ............................... ..... 19 ....................................................... ....................... ............................................................................... Al OL 07- ZG 0 z �A � ` qi � N PL k ZA 50 06,W,�/Q 71 oA/ , I i&sue /oo # h /gl 3o i f-N7'7' m N 07 z8 A . CEi. RT/7—I r— D PJ. ® T PL1Q /!/ REr..ERENCC Be'/ N (; t. Or-j?-7—fAs sHow#v ON A PLAN RECORDED Add 2G, /97G _ IN rME ®ARNSrARL.E C011N.rr DATE REC /SrRY OF DEEDS PLAN SOOK 3oG pA 6E 42 - / N ,El�i' r-ar ceRrlrr rHAr rNE OU14D/N6 R!E' G. LAND SU 1+EYOR soioww ON rmls PLAN 1S LOCArED O.N rNE +Ci R O UN® AS SHOWN HEREON AND � H,4r it ,2 cONFORx r0 rHE 11AOF�, ,Bv/,t- �/i►/� SFT.BAC,G ;eE'!7v/,E EMEi�:sTS of ��� BAeti/S ,gBL� WHEN CONSroucrev. s GEORGE G St�� i`7�f EALS Boi5+e0 /IIOS. �f9,�°sp y IOW,A �, �.� �40 cn � so vTiy y�-7,2MdvTf/ A�1.9..�5. �'O sT�- �p - _ -- Assessor's offioe (1st floor): Q ;_ Assessor's ma and lot number FTMEtO� Board of Health (3rd floor):. /� 7 Sewage Permit number .............:. ........................................ �'fJ r7J r r /-r� Z BASd9TGDLE, i Engineering Department (3rd floor): ///— e-4-C-' '/ ' s �a rasa �• v psi t63q. House number � ,/....... ?, I',, iou�ys �EOYAya' APPLICATIONS PROCESSED 8:30-9:30 A.M. and. 1:00-2:00 -P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR n APPLICATION FOR PERMIT TO ........ �`�.�. !O IJ ............. ...................................................................................................... TYPE OF CONSTRUCTION W ... .................. .... ........................ .. . 19:. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location (......2-7A — (UP ►J 1--15A k.n......!Zp..... � 2 JILL �.--...:.......................................... ......................................... Proposed Use ....D1.!J Y� ?.... .F.��"( `t 'Y 2Oflh4 l7-+� i......................................................................................................................... Zoning District ........... c.............................................................Fire District .... 'PAoL- + HA-2rA 9L-.AJJ r7-K..Address Name of Owner ............................................. ....................................................-:;.............................. I' f Name of Builder vAVh1W�H'LL� (614QJ1L� Address 3 `�d " S Z 1F �'�AQ • .. ....................... .. ....................... .i. ............................ Nameof Architect ..................................................................Address .................................................................................... PF Number of Rooms o2 ............Foundation ........0 �.. . Exterior ' Roofing .....��. ........................................................................... ......................................................................... T`L-- �-• .Interior ....`/L r S t � ` �c/c.t . Floors .................................................................................. ............................................................. g - v)A - 61A-s Heatin .............................................................................Plumbing ............................ . Vi — x`S 1 . .. ........)................ Fireplace ...........`.....................................................................Approximate Cost .... ..2-.j..°.0.0............................................ Definitive Plan Approved by Planning Board _______________________________19________ . Area r ..3 . ' Diagram of Lot and Building with Dimensions Fee �! SUBJECT TO APPROVAL OF BOARD OF HEALTH /rJ lr i r OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Q/,c e7— r Name ...... .............. :.... Construction Supervisor's License .................................... BLAUNER, PAUL & MARIA A=192-175 29111 Build Addition No ................. Permit for .................................... Single Family Dwelling ............................... ..... Location Lot #27A�,�Cap'n Lijah's road Centerville Owner Paul & Maria Blauner. .................., Type of Construction ..,Frame . ............................ ............................................................................... Plot ............................ Lot ................................ Permit Granted ......August.................1,...............19 $( Date of Inspection .......I............................19 Date Completed ......................................19 1 . j i CC) I 7 .1 - O 0 o. L oT z� . 33 IV 2 7-4960 �� N TEST /o0 0 I; �07- 0 7 *401, LOGArto ..G'���Ez`/•c� E RElEa9 £NyC1r E / NG Z 0r 'Z7AAS SHOWN ON A , PLAN RECORDED � I rME PARNSlABLE COVN.rY pArE REGi'SrRY Or DEEDS ® LQa BOOK 3oG_ P,4 GE /ao NEf� fBY CERlT L RE0. LAND Sl! OR / / Fr rHAr THE OU / GOING ONYN Of/ r _P,t-A.N /5 LOGArfD, ON rNE GRO UWD� AS SM C7W*.V" 'Y.F-RfON ' `A�\o o�ES rNA y /`.x;' � ._C CNF ORAs TO PNE ' + OF,Bv/G C /- .S�TBAC,� ,2gU��Eis�lE�v7�5 a,� �P� N� BED it/.STf��G W p e N C O N S Tpl�of G r-E-D• sus 51�£r /9►'Pf�.�i�L.S ,..�oA�O �Os. vy,�sQ, - . ._. Q GEORu[ N J low, J.R. Assessor's offioe (1st floor): Assessor's map.-.and lot number ... .. ....�. .a ....$� oF7MEto�o 5r1oard;of Health Ord floor): 0� . �ewage Permit number .......:::.:...:...... a, f �/yic�� Z HAHd9TODLE, : �� Engineering Department (3rd floor): ��v9� �� ` 3 y f SEP��^ s rasa T Sys House number' ..... '.......................................yru ... .�.f6;e(ll auu, � � I� BIB o APPLICATIONS PROCESSED 8:30..9:30 A.M. and' 1:00.2:00 P.M. only, x a ", 1111 r TOWN N bO F B A R N S T A E��AL �����T y . BVILDIN , INSPECTOR" APPLICATIONz-FOR PERMIT TO .......4- ►U /2V ....!-,,).D,f i 11� ..................................................... TYPE OF CONSTRUCTION .....:0.610 P...:. . . ' s s y -TO THE INSPECTOR OF BUILDINGS: , 'The undersignea hereby applies for a permit according to the.following information: - Location ...... ......................................................�..................,...... Proposed Use . . .1.!J .........`°t?.14.. ...... ................'................................:......:............... ` l Zoning District .......L.EN.............:..:......:................. ......Fire District ... " /„D�i�+�t!'iCLzF:.......... aL " f1lIL fi P I g LA.O.J.'f�,...Address 'Name of Owner :...:...........:.........'................:.........:......................... Name of Builder v�Vfl1 PdILLEA, E r4 ,;lLl s �3 T't�01 1F.2� L1 )J_.. ........ I• 'L.L:. . ........../.......................................:... .Address .......... .... Srt Nameof Architect ........................:....::.,.................................Address ............... .....................................:..................... .. Number of Rooms ....Foundation ......'.0 � ,A i r Exlerior .... .... 1 >�� PL 1L't �41 /J F;:-� ......................................Roofing .................................................................................... Floor`s. TIL E Interior ..:.��7�/. ��. . ......... ............................. ...... ... . ........ ...... ............... / / 1 .... �7s ............. .................. .. .Plumbin j �K+S Heating g ... -........ \. �. r 2 Fireplace ......... ^........:..............:........................................Approximate Cost .:......2)„o®D.........,.^....:......................... :. Definitive Plan-Approved by Planning Board __ __ ____ ______________ _____19 ______:. Are . ............... . .......... Diagram of Lot and Building with Dimensions / �. Fee /, .... ../,d�>2........................... SUBJECT'TO APPROVAL OF BOARD OF HEALTH .t , OCCUPANCY PERM ITS":REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of,the Town of Barnstab regarding the e construction. Q�LIL ! 4 Name. ..... .. . ... ... ............... ^ Construction Supervisor's License 4 BLAUNER, PAUL a MARIA x 2R733t' Build Addition No .. ,Permit for ................................. N a � } Single Family Dwellings . ` r Lot #27A, .� Li ah s Road - Q4 ` c Location ......................................... . �.. t 1 Centerville. 1 .� ......... .. ................................... wwner Paul & Maria Blauner _ •• O Type of Construction .Frame.... ................. ................................................. . .... .......... f s j Plot............................. ' Lot ............. p M V Permit. Granted .. ..August 1'..... .19 86 - _ �• ';.' p/ + Date of Inspection' ........ .�� L3.........190�0 Date Completed .. ".......:19 71 . of r• r •+t- � � J 11 C i