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0151 CAP'N LIJAH'S ROAD
� � ��. , � n �. x .. . . � �. E.�� 3 II .. �_ 4 Q� 4 _ _ .. 9 I o .. k _ .. a CERTIFICATE OF INSULATION NATIONAL FIBER r NATIONAL FIBER PART I-GENERAL - ADDRESS OF RESIDENCE: NAME&ADDRESS OF INSTALLER: � -I 40+ P.O. Box 52 f DATE OF INSTALLATION COMPLETION: (116 ill PART If—AREAS INSULATED WAILS( r>^F SQ. FT.) CfELiNGS( a SQ. FT.) FLOORS( SQ. FT.) TYPE OF INSULATION: C - �`'� r TYPE OF INSULATION: �g TYPE OF INSULATION: MANUFACTURER: MANUFACTURER: MANUFACTURER:- R-VALUE AMOUNT R-VALUE AMOUNT nR7VALUEFAOUNT INSTALLED INSTALLED INSTALLED INSTALLEDTALLED PART III-CERTIFICATION CERTIFY THAT THE RESIDENCE IDENTIFIED IN PART I WAS� INSULATED AS SPECIFIED IN PART I!AND THE INSTALLATIONWAS CONDUCTED IN CONFORMANCE TO APPLICABLE C DES, STANDARDS,AND REGULATIONS. (AUTHORIZED SIGNATURE) This certificate must be completed and prominently posted adjacent to all areas which are insulated with program funds. Town of Barnstable / - 1 iP t�This:Card So=That`it�is,V�s�ble From,tbe Street A roved-':Plans Must,be Retained onJob andthis Card Must be Ke t ' ' � ■AR'V5'1FA8LE. - �;` ,.# ,t ,a-- :;y,',.- ��+:- `�.:_. h'+s•:- � -�"� '"# 'S-„ ny 3 ��-� n e` `. P-,�"^ ' Permit �. t ,,,� ,; .Where a,Certificate of Occupancy,is•Resquired,such:-`Buildin ••shall�;Not b:e Occ�u�p�ed,until a Final Inspection has�b�eenmade � �,, Permit No. B-17-767 Applicant Name: BROWNE,TIMOTHY J&ANNE MARIE Approvals Date Issued: 03/24/2017 Current Use:. Structure Permit Type: Building-Shed-Residential-200 sf and under Expiration Date: 05/24/2017 Foundation Location: 1S1 CAP'N LIJAH'S ROAD,CENTERVILLE Map/Lot192-169 Zoning District: RC Sheathing: Owner on Record: BROWNE,TIMOTHY &ANNE MARIE � '.f. ' Contractor Name: Framing: 1 ' Contractor Licenser 2 Address: 149 JUDITH E DRIVE 41 TEWKSBURY, MA 01876 Est Project Cost: $0.00 Chimney:. Permit Fee: $35.00 Description: 12x16 Shed -I insulation: f Fee Paid' $35.00 Project Review Req: 12x16 Shed Date. 3/24/2017 Final: - � .. Plumbing/Gas Rough Plumbing: I` P _Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application<and the:approved construction documents for which this permit has been-granted. Rough Gas All construction,alterations and changes of use of any building and structuresshall be in compliance with the local zoning by IaAws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for,public inspection for the entire duration of the �. work until the completion of the.same. c Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection'before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction.... Final: "Perso.ns contracting yith.•unregistered'contractors do:no.t.have access to the guaranty fund" (as set forth'in MGL c.142A) Fire Department Building plans are to be available on site Final: ,. ISSUED RECIPIENT All Permit Cards are the property of the APPLICANT- Town of Barnstable ,�TME Regulatory Services Richard V.Scali,Interim Director B" MASS. ' Building Division 1639. A,� ` Tom Perry,Building Commissioner ED MA'S 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Mf'' ' . PERMIT# FEE: $ S' z '"'' 03 w :Z- can SHED REGISTRATION RESIDENTIAL ONLY 200 square feet or less pis /"_ 1 �► s j2c l �v� � e Location of shed( ddress) Village �ru e- 27�- Z126 -23( 7 Property owner's name Telephone number Size of Shed Map/Parcel# dk s'Ll 7 Signature Date Hyannis Main Street Waterfront Historic District? N� Old King's Highway Historic District Commission jurisdiction? �/o If over 120 square feet,you must file with Old King's Highway Conservation Commission(signature is required) JD Sign oft'hours for Conservation 8:00-9:30&3:30-4:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY'0A , PLOT PLAN forms-shedreg REV:110413 r /n I ( 6,0V0 � 7 1 /s 1 s � � V cIL j { � 1 � . TM �4ZA , y r,� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION , Map Parcel CJ Application # Health Division Date Issued Conservation Division Application e Planning Dept. -�, /� Permit Fee Date Definitive Plan Approved by Planning Board - a / �(�— lf-` _I ry Historic - OKH _ Preservation/ Hyannis-, . �,� Project Street Address Village��P.� a l�1 . Owner GDe�,r�U���— Address Telephone -17`6 ��dy Permit Request Wau i I Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation '�;1(3.o 1 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing .❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name L�XT/ I i l(1 ��� Telephone Number 751` 6 '"J Z3 Address �'I�C�c51U `�-� License # Home Improvement Contractor# Z1 (� Email M291,tc Worker's Compensation # V CUJ— �W_�a l�J(D y � ALL CON TRUCTION DEBRIS RESULTIN FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE �/ j , { FOR OFFICIAL USE ONLY APPLICATION # i. DATE ISSUED MAP/PARCEL NO. I i' i ADDRESS VILLAGE is OWNER, rt� DATE OF INSPECTION: is FOUNDATION FRAME INSULATION s f; FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING. DATE CLOSED OUT ASSOCIATION PLAN NO. j Federal ID#05-0405629 s RISE Engineering RI Contractor Registration No 8186 I Contractor Registration 20120 A division ot'1'hiclsch Engineering CT CT Contractor Registration Noo 620120 S E ENGINEERING 5 Dupont Avenue,South Yarmouth.MA 02664 CONTRACT w RAC^� 508-568-1926 X-6613 FAX 508-568-1933 y : Page 1 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE CLC-RCS - ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER PHONE- �• —�_�' DATE CLIENT p WORK ORDER Timothy Browne T (978)420-2367 02/29/2016 217997 00002 SERVICE STREET BILLING STREET 1 151 Captain Lijahs Road i, ti m,aP 2-8 -2016 149 Judith E Drive SERVICE CITY,STATE,ZIP s t .{ - BILLING CITY,STATE,ZIP I ,, Centerville, MA 02632 LF " "°Tewksbury,MA 01876 JOB DESCRIPTION AIR SEALING:Provide labor and materials to seal areas of your home against wasteful,excess air leakage. This work will be perfomred in concert with the use of special tools and diagnostic tests to assure that your home will be fell with a healthful level of air exchange and indoor air quality.Materials to be used to seal your home can include caulks,foams.weatherstripping and other products. Primary areas for scaling include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed.) (7)working hours. A reduction in cubic feet per minute(cfm)of air infiltration will occur,but the actual number of cfm is not guaranteed. $539.00 AIR SEALING:Provide labor and materials to install Q=Ion weatherstripping and a doorswecp to(1)door(s)to restrict air leakage. $77.00 ATTIC FLAT:Provide labor and materials to install a 7"layer of R-24 Class I Cellulose added to(680)square.feet of open attic space. $843.20 ATTIC ACCESS:Provide labor and materials to install(1) easily moved,insulating cover for the attic access folding stair. A small slat surface of plywood will be created around the opening within the attic. '['his will allow the cover's integral weather-stripping to restrict air leakage. $237.65 VENTILATION:Provide labor and materials to install(3)8"diameter rool'yent(s)to increase ventilation in attic areas. The vent can he supplied in(circle color)black. $261.45 VENTILATION:Provide labor and materials to install(1)insulated exhaust hose to existing bathroom f'an(s). $50.00 VENTILATION:Provide labor and materials to install ventilation chutes in(56)rafter bays to maintain air flow. $195.44 BASEMENT CEILING:Provide labor and materials to install(78)linear fret or 1i-19 unfaced fiberglttss insulation to the perimeter of the basement ceiling at.the house sill $170.82 BASEMENT DOOR:Provide labor and materials to insulate the back ofthe basement door leading to the bulkhead with 2"rigid board that.meets the sections R-316J.4 and 316.6 requirements or building code. Seal all edges and scams with FSK tape.. $72.22 BARRIER:Homeowner is responsible for the removal of any ceiling tiles blocking access to the sills. $0.00 REMOVAL:Remove(40)square feet of halt style insulation from the basement area. $38.80 CRAWLSP'ACI :Provide labor and materials to install(225)square feet of R-2I closed cell spray foam insulation to the crawlspace perimeter wall,sill and band joists. 'then install a spray applied ignition barrier over all exposed foam. Any crawlspace access within the.perimeter wall will be weatherstripped and insulated to R-21. Any present crawlspace vents will be permanently nently scaled. $1,237.50 f Federal ID#05-0406629 RISE Engineering MA Contractor Registration No 8186 MA Contractor Registration No 120978 RISE A division of'1'hielseh.Engineering CT Contractor Registration No 620120 ENGINEERING S Dupont Avenue,South Yarmouth,MA 02664 CONTRACT . 508-568-1926 X-6613 FAX 508-568-1933 Page 2 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE CLC-RCS ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW- CUSTOMER - PHONE' DATE CLIENT N WORK ORDER Timothy Browne (978)420-2367 02/29/2016 217997 00002 o SERVICE STREET BILLING STREET , 151 Captain Lijahs Road. 149 Judith.E Drive. SERVICE CITY,STATE,ZIP _ BILLING CITY.STATE,LP Centerville, MA 02632 Tewksbury,MA 01876 JOB.DESCRIPTION INCENTIVE:RISE Engineering will apply all applicable,eligible incentives to this contract. You will be billed only the Net amount. Currently,for eligible measures;the Cape Light Compact offers 75%incentive,not to exceed$4,000 per calendar year;and an incentive of 100%for the Air Sealing measures. For the safety and health of your homes indoor.air quality,we will be conducting a blower dotrr diagnostic a the available air now in your home both before the work is begun,and after the weatherization work is complete.We will also conduct a diagnostic assessment of the combustion fumes in the exhaust flue of your heating system and water heater.This has a value of$90 and is at no cost to you. ' $90.00 Total: $3,813.08 Program Incentives $3,007.21 Customer Total: $805.87 WE AGREE HEREBY TO FURNISH SERVICES•COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Eight Hundred Five&87/100 Dollars $805.87 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL.INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER 70 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES NA AUTHORIZED S TURE•RISE Engineering CUST0ICER ACCEPTANCE NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE / o� U ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,/SPECIFICATIONS AND CONDITIONS ARE DAYS. SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE f ':7'/a'trrrr,r,rrrr,.,vi/f/n��l�r<.tr.�rrJrll;• I Massachusetts Department of Public Safety t7ffice of Consumer Aiiatu s&alubiuria Rehuiatiun Board of.Building Regulations and Statiiiarda OME IMPROVEMENT CONTRACTOR C'++mtnactiunulirr�i.�ar License:CS-068111 eg{stratlon ,F181816 Type: W)EXpiration:_11-12412016 Private Corporatic M[CHAEL T MC 0, MICHAEL T.MCMAHON 8 SON INC. '19 FULDSTONF-'WAN r' { _ ! PLYMOUTH MR WeW , MICHAEL MCMAHON 19 FIELDSTONE WAY Expiration* PCYMOLI H,MA 02360 Undersecretary 08117/2018. Commissioner. t • "--�w Unrestricted-Bwldings of MY use group which ., con tainkiss than 35,000 cubic feet(991m9)of or registraeicn valid for individul use on: before the expiratio.+date. tf!.-:,nd return to: a enclosed space. Office of Consumer Affairs and Business avoitlatioit 10 Park Plaza-Suite '170 Boston,D1A 02116 t Failure to possess a current edition of the Massachusetts Pov, State Building Codels causefor revocation.of this license. lid without signature-' for DPS Ucensing Intormatlon visit: www.Mass,Gov/OPS I 1 i r I ' [f f + f The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston,MA 02114-201,7 www.mass.gov/da Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers _Applicant Information Please Print Legibly Name(Business/Organization/individual): M.T. McMahon and Son, Inc Address: 19 Fieldstone Way - - - - City/State/Zip: Plymouth , Ma 02360 Phone#:781-831-1234 Are you an employer? Check the appropriate box; Type of project(required): l..0 I am a employer with 9 4. ❑ I am a general contractor and 1 ti ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ l 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 mein any capacity. employees and have.workers' 9 ' ❑Building addition [No workers' comp. insurance comp. insurance.x required.] 5. ❑ We are a corporation and its I0.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions right of exemption per MGL myself: [No workers' comp. 12.❑ Roof repairs insurance required.] c. 152, §1(4),and we have no 13.❑■ Other Weatherization employees. [No workers' comp. insurance required.] *Any applicant that checks box#i must also fill out the section below showing their Nvorkers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. =Contractors that check this box.must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees.they must provide their workers'comp..policy number. I am an employer that is providing workers'compensation insurance for.my employees Below is the policy and job site ' information. Insurance Company Name:Aim Insurance j Policy#or Self-ins. Lie. #:VCW-100-6014109-201 ExP iration'Date:12/08/20 8 _ In r4 6 6 3 Job Site Address: / 5/ �/>d�7 -ik7 C_- LWS Itz) City/State/Zip:(/� A4efy 1 �`� p2 pZ 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 DI for insurance coverage verification. I do hereby cer ' nder the pains and pe alties of perjury that the information provided above is ue and correct. ![ Si ature: Date: Phone#: 7818311234 Official use only. Do not write in this.area,to be completed by city or town"official. City or Town: Permit/License# l 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#: f rrown of Barnstable Regulatory Services e t � s�nn ASS Richard V.Scali,Director '�Ebwwd� Building Division` ;Tom Perry,Building Conunissioner 200 Main Sheet,*Hyannis,:VLA 02601 www.town.barnstabl.e.ma.us Office: 508-852-4038 Fax:,.508-790-6230 Property Owner Must Complete aid Sign Ills Section. If Usiincr A& Idex' 7, % /j�'G2vn� ,as Ovoier of tbe_:subject pro rr�y herebyaudlorize � � ui acC,on;inyoeftaJf; in L matters relative to work authorized by this building permit.application for: dress,of jc .-- l'aol fences anti alarms-are _-- resporisibilitydf- eAapplicant. Pools are not,to be filled car utilit_ed before-fe= is,IMtalled and.all final inspections are performed and acc.epteci_ ,{\, Sr�nature of Owner 5tgnatt2re of:A;ppLcant Print Name Print Name: Date Q;F0RK4WWNF.1tJ'}:AJSSI0NPWLS ACVRV CERTIFICATE OF LIABILITY INSURANCE GATE, 12/14/ 12 14 15 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 INURED,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 endorsemen s PRODUCER CONTACT NAME: Thompson Insurance PHONE 781 335-1890 FAX NJ: (781) 335-97e2 and Financial Services a I'�oR ss• JJTins@Comcast.net_ 380 Union Street INSURE S AFFORDING COVERAGE NAICC Weymouth, MA 02190-316 INSURER A:Travelers INSURED INSURER B:AIM Mutual MT McMahon and Son Inc, INSURER C:Torus National 19 Fieldstone. Way INSURER0: Plymouth, MA 02360 INSURER Et INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE A_tND SUER POLICY NUMBER MM�IVEFF MMMC Y� LIMITS- C GENERALUABILITY .y I NPP8082574 8/26/15. 8/26/161 EACH OCCURRENC�ij $ 1 000 00 DAMA X COMMERCIAL GENE PAL LIABILITY PREMISES rI=_a ocn� $ 100,000 f CLAIMS-MADE �-OCCUR {ME EXP("ore S 5 000 j PERSONAL&ADVINJURY I S 1,000,000 GENERAL AGGREGATE $ 2,000,000 (GGEEN'LAGGREGATE LIMIT APPLIES PER ` PRODUCTS.-OOMP/OPAGG $ 2,000,000 I g I POLICY n PRO- n LOC I ! I4 I S 4 A [TOMOBILELIABILITY 'BA 2CB82729 8/31/15 8/31/16COe%INEDSINGLELIMiTS 1 0O0 OOANVAUTOBODILY INJURY(Per person) $ ALLOWNEDX SCHEDULED BODILY INJURY(Per accident) S AUTOS . AUTOSNON-OWNED PeOr acad Y DAMAGE MIREDAUTOS X AUTOS I $ -- 'E UMBRELLA UAB 11/24/15 11/24/16 C X OCCUR 80313L140AI,I I I EACH OCCURRENCE S 1,000,000 EXCESSLIAS CLAIMS-MADE) ! AGGREGATE S 1,000,000 t DED RETENTIONS ' S WC STATT_ OTH- B AND YERS'LI COMPENSATION IVWC-100-6014109-201 12/8/15 12/8/161 g ` AND EMPLOYERS'LIABILITY Y 1 N � + 1 . ANY PROPRIETOR/PARTNERIEXECUTIVE /N I E.L.EACH ACODENT $_ 5001000 . OFFICER(MEMBER EXCLUDED? N f (Mandatory in NH) _ i I E.L.DISEASE-EA EMPLOYEE $ - 500,000 If yes.describe under DESCRIPTION OF OPERATIONS below ' E.L.DISEASE-POLICY LIMB S 5OO DOO. { DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Altach ACORD 101,Additional Relrarks Schedule.It more space Is required) + Insulation installation and carpentry. 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. tAUTHORIZMD REPRESENTATIVE i John J. Thompson CLTC ©1988-2010 ACORD CORPORATION. All rights reserved. .,, ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: f , DEBRIS DISPOSAL AFFIDAVIT v t In accordance with the provisions of M.G.L. c. 40,s. 54, Building Permit # was issued with the condition that all debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by M.G.L c. 111, s 150A The debris will be disposed of in: ABC Disposal Name of Waste )~acility, ' 1245 Shawmut.BLVD New Bedford Address of Waste Facility 111.5 Debris: As a .condition of issuing a permit for the demolition, renovation, rehabilitation or other alteration of a building or structure. M.G.L.c.40 s. 54 requires that the debris resulting therefrom shall be disposed of in a properly licensed solid waste, disposal facility as defined by M.G.L.c. I I 1 s. 150 A.Signature of the permit applicant, date and number of the building permit to be issued shall be indicated on a form provided by the Building Department and attached to the office.copy of the building permit retained by the Building Department. If the debris will not be disposed of as indicated; the holder of the permit shall notify the building official,in writing,as to the location where the debris will be disposed. .780 CMR—6"'Edition Signature of Permit Applicant bate t Town of Barnstable 11dlit g , .wtHtrteBLc Post Tf►is;Card.So,Thail e From the Streets Approved,Plans,Must be Retained on Job:and,this:Card J e"lI"l be Kept osted Until Final Inspectlan Has Been MadeA. ''„ ✓,,, <, 1. ., W: c. r Where a.Certificaie•of Occu ancy, Requred,:such Building•shall-Not•6e;,0ecup�ed untiiaa.Finai Inspection_has been made ej 1 t ' „ p . ..r,, :ate, . ,;, •„-• x. .. F- , Permit No. B-19-1358 Applicant Name: xMargarita Sergeeve Approvals Date Issued: 05/02/2019 Current Use: Structure y Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 11/02/2019 Foundation: t Location: 151 CAP'N LIJAH'S ROAD,CENTERVILLE Map/Lot: 192 169 Zoning District: RC Sheathing: Owner on Record: SERGEEVA, MARGARITA ,.. x: r a' CS Framing:Names",,, Framing: 1 Address: 151 CAP'N LIJAH'S ROAD, Contractor License:" 2 R . Est Project Cost: $3,000.00 CENTERVILLE, MA 02632 Chimney: Description: Left side wall shingles £_ Permit Fee: $35.00 y Insulation: ai $35.00 Project Review Reg: Fee Pd ate-, 5/2/2019 Final: Plumbing/Gas - m Rough Plumbing: v Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. All work authorized by this permit shall'conform to the approved application and the approved construction for whicths permit been granted. Rough Gas:' 3. All construction,alterations and changes of use of any building and strdctures shall be in compliance with the local zonini ,by laws`,and codes. ` This permitshall be displayed in a location clearly visible from access street or road and shall be maintained open for ') Alic inspection for the entire duration ofthe Final Gas: work until the completion of the same, 4911a s Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Bmldg and Fire:Officials areprovided onthis-permit: Minimum of Five Call Inspections Required for All Construction Work , Service: 1.Foundation or Footing> 3 2.Sheathing Inspection Rou h: :,,. g 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed' ' ` 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection - - - Final: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Rough: 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c:142A). Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: Town of Barnstable Building Y :Post This Card So T,h"at it is Visible From,the Street A `ro„ved,.PlansMust be,Retained on I,ob and,thisxCard Must:.beKept ,. sexrtsr%f= •. n ".` ,.�sk ".£?:r ';sv', %1';' 5 pP,.. �• ''� 'a 2` ., 'Posted UntilFinal Inspection Iias..Been Matle ,, �', �. Wherea Certificate of Occupancy is Required;d-such..Buildmgshall Not beOccupied wntil a Final�Inspection hasbeen made Permit Permit NO. B-19-2869 Applicant Name: FABIO G ZOCANTE Ap provals Date Issued: 09/05/2019 Current Use: Structure Permit Type: Building-Sheet Metal-Residential Expiration Date: 03/05/2020 foundation: Location: 151 CAP'N LIJAH'S ROAD,CENTERVILLE Map/Lot 192-169 Zoning District: RC Sheathing: 7,117, Owner on Record: SERGEEVA, MARGARITA og Contractor'Name -; FABIO GZOCANTE Framing: 1 Address: 151 CAP'N LIJAH'S ROAD e� Contractor License 8586 2 CENTERVILLE, MA 02632 y Est Protect Cost: $0.00 Chimney: Description: iNSTALL cENTRAL aIR EQUIPTMENT AND DUCTWORK IN THE ATTIC Permit Fee: $85.00 TO SUPPLY HETING AND a/c TO SECOND FLOOR 1281Insulated K Insulation: Fee Paid $85.00 sheetmetal 60.K BTUH furnace 80%2.5 tons 17,4 final: Date - 9/5/2019 Protect Review Req: l' Plumbing/Gas Rough Plumbing: . _.. . Building Official . �., '--' Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months afterissuance: All work authorized by this permit shall conform to the approved application and the approved construction documentsfow Bch this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning=by 14w"'s and codes. �'' w = Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for p'biic mspec ion for the entire duration of work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures�by the Build rig and Fire O cialtiare� owded on thi, ermit. Minimum of Five Call Inspections Required for All Construction Work Service: 1.Foundation or Footing r Rough: 2.Sheathing Inspection ,,_ ,,,, •- _ � •: g 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). 1 Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: Commonwealth of Massachusetts Sheet Metal Permit Map I Parcel Date: N. Permit# Estimated Job Cost: $ SEP 0 3 2019 Permit Fee: $ U� Plans Submitted: YES NO� q_t M Plans Reviewed: YES NO Business License# Applicant License# 8586 Business Information: Property Owner/Job Location Information: Name: Air Rite HVAC Name:[—\rAcz;gr*-1Li hA "YE 955GeVA Street: 88 West Mein 8.t Street: 5 r--` C: I pFL �S l2� City/Town: Hyannis City/Town: 6Z^A-en ( yz Telephone: 508-360-766 2 Telephone: 5-00 - �P&— 36 9 Photo I.D.required/Copy of Photo I.D. attached: YES R NO Staff Initial J-1/M-1-unrestricted license J-2/.M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft./2-stories or less Residential: 1-2 family vl,— Multi-family Condo/Townhouses Other Commercial: Office Retail Industrial Educational Fire Dept.Approval Institutional_ Other Square Footage: under 10,000 sq.ft. over 10,000 sq. ft. Number of Stories: Sheet metal work to be completed: New Work: Renovation: HVAC Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/.Vents ' Air Balancing Provide detailed description of work to be done: cz, L A P^J S a...�2 P-6441&.a • -,-J to o 1. 3�OL tee ^_ Town of Barnstable Building Department Se g $Tian Florence,CBU;:. sd1o. Bundiuig Commissioner 200 Main Street,Hyannis,MA 02601 www.tombarnstable-rna.us Fax: 508-790-6230 Office: 508-862-403$ r 5.�.�s....s.,:�.`s,.,...w.r '` v.�:.Wia::,-: � ,�tt�a.a.-aka '*v • Property Owner Must Complete and Sip This Section Yf U sits A B� udi—lder as Owner of the subject property hereby authorize ��/(� , �jG'Gp�7 //¢� �� I� 'Gto act on my behalf; y in all matters relative to work authorized by this building pe=k application for. Addle s of Job} **pool fec7.ces and al=ns ace the responsibility of the applicant Pools ..ry , ,. • ; (yf(�xe fence is installed Md all findt l lt;1AUL LU J. l,l. .�.+�-+4.�b4. 4,J W .� inspections are performed and accepted. - of Owner of Ala ant VA !� Print Name ---------------- x 'P t p �I ,. r'�anRr�ta�WNF?RPFR74lLfi:ttOtaPo(�G5 ,�.. . .. i 7 I'hSURANCE COVERAGE: I have a current liabilifit insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes❑ No ❑ If you have checked Y L indicate the type o coverage by checking the appropriate box below: A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner Agent ❑ Signature her o wn is Agent By checking this box[],1 hereby certify that all of the details and Information I have submitted(or entered)regarding this application are true and ,accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation:YES NO J!rojiress Inspections Date Comments Final Inspection Date Comments ;Master e of Lic se: By Title ❑ Master-Restricted City/Town ❑Joumeyperson i nature of Licensee Permit# ❑Journeyperson-Restricted License Number: Fee$ Check at www.mass.aov/dnl Email. Inspector Signature of Permit Approval The CammomeaM vfAfaswchweft Mr meat c�'�n�rsbzr�t�ccia TM Ofj5zVc�ft6#OM 600 FF'ashhWan meet Bason,r MA 02111 WFMLmwmgoWdxa Warkere cuwpensz6mAInsarmceAffidavit BuRderslCtntractm--Meeb cbmwT mnbm Amilican# Ple2se Pit Ns�e _ .Air Rite Hof AO Addrem 88 West. Main St Cj{S p:Hyannis, MA, 02601 PhowiL- 508-360-7662 Are you as employer?Cherkthe appropriate bow ' Type of project{required}_ L❑ I am emplayer v&h 4. ❑I am a gem c ctar andI ❑ emplag anfor par"Me)* bm bired&6 snit-cam 6. lei tiseed oathe at z❑I am a sale paopsietor orpartaer- #srhed sheet ?- ❑Tiemodelizxg ship and ham as employees • Those sab-cornl=actam have g ,❑Demolition woddn, $or nm is any capacity-. UqAo9ees aadhave worms 9- ❑S,udffixg additicm jNa tv odae&camp_iasw=e cosgp.�„�•�,*�# 5. Wawa a-cooperation.andits 1a❑MecEQcal repairs or ad&flons 3.❑ ��-j. cfncrs is� have exerced the 1L PhmA aim or as I am.a homeovmerMmg allsrosk ir ❑ a reP utddiiita rYT£[No�vao&ce - of a on per I GI. t?❑Hoof requima-1 j u �p� Hoye•[No'vcrb ' 13.�tIleC �JT�.. camp.insittxam mqured.] 'bays;rpff B�atcbedsb=Mtamstelsafacutthemcfimbdowsbas sao>icecs'®peasaticaPQHwi = ?ff�naraexs�lmsabmitff&efadasa`i tLep�tisia�slE�aoi:audB�ealuteauCsid�caahacmts�stsnEfmftanemxffid i sacTL fca=cm6,ut,hea t9gs boxma t wft x.sadHi=d dwd 9wuTz9t7w"—Deft sub-c^^*--'^�and Stdowbeghm crmttbme eatitieshm empkyem Iftbp-mb-c=t=bwz emPIopers,dLeg=Lstpiaside tb it scams'--P•PCRF M"bM I arrr an ernpIo€sr F7irrf is prauidri �vrtrlCeu s'taa rerisatirrrr iasriraars fvr az}�amPTi+}}e�x Setriav Siff Pam and jah s5ts hZfM Uaatiaa Insuraac,ccmpafryY'Iame: Dowling & O,Neij Insurance Agency — P�r y �r -0 MgT854 nl� 04/13/2D 20 ' Job fellddres �� /a �ti �t T(�� S C41Stai� g� 1 •C�. N✓�l Af =h a COPY Of t1M WOrke&c=pensatioaPCMCFd=ara6=page(Ahowing the paHcy number and expiration date). Fai=to semen coverage as require dunder Swffim 25A,o€Brig.c.M can lid to ffie imposifiou of taimimal penalties of a fiat up to$I50D Of}andh3r one-yearkgdsvnateA as wa as dO.penalties ra te farm of a STOP WORK 01ME?,md a Em of up to$250-DO a clay;gaiast the violator. Be advised that a aW of this stated maybe fk-vvarded.fa the Office of Iavesfigratia o€ihe DIAL.for ibsumnce coverage sp a. Ida tiw*eet aardar fh' d psr pan ury thdifre orusra#iau�t-vs-i d alrm�e i hors and carrect Phwe Ck Offal 'aL Ass aru£y. Do not mite in fiats wra,fa be cot P&dd 5p citp artglvn Offwiat CW or To= PeroftUcense# Ismaiag Auffi (drdc om): L Board of$ealtii 2.l mg Deg rat 3.Cityjrovm Clerk 4 Electrical.hmpedor S.Ph mda F 6.Cher Conbct Person: Phi#- 6 • Client#:21832 2AIRRI ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 4/25/2019 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not-confer any rights to the certificate holder in lieu of such.endorsenient(s). PRODUCER CONTACT NAME: The Hilb Group of N.E.dba PVHcN o EXt:508 775-1620 FAX 5087781218 Dowling&O'Neil Insurance Agy E-MAIL Alc,No P.O.Box 1990 ADDRESS: Hyannis,MA 02601 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:NGM Insurance Company 14788 INSURED INSURERS: Air Rite HVAC Inc. 330 Elliott Rd. INSURER C Centerville, MA 02632 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY 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. LTRR ADDLSUBR TYPE OF INSURANCE NSR WVD POLICY NUMBER MMIDDY EFF MMIDDY/YYYY LIMITS A :.X COMMERCIAL GENERAL LIABILITY IDT8454A 04/13/2019 04113/2020 EACH OCCURRENCE $1 000 000 CLAIMS-MADE a OCCUR PREMISES Eaoccurrrence s500,000 MED EXP(Any one person) $10 000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY�E� LOC PRODUCTS-COMPIOP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY M1T8454A 4/13/2019 04/13/202 COMBINED SINGLE LIMIT 1 00O 00O Ea accident $ r r ANY AUTO -%BODILY INJURY(Per person). $ OWNED X SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY Per accident $ A X UMBRELLA LIAB X OCCUR CUT8454A 04/13/2019 04/13/2020 EACH OCCURRENCE s2,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE s2,000,000 DED I X RETENTION$10000 $ A WORKERS COMPENSATION WCT8454A 04/13/2019 04/13/202 X SER ETH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E�EL. L EACH ACCIDENT $500 000 OFFICER/MEMBER EXCLUDED? N I A (Mandatory In NH) DISEASE-EA EMPLOYEE $500,000 scribe under Des a ESCRIPTION OF OPERATIONS below DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered.waived,,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Town of Barnstable, Building SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF; NOTICE,.WILL BE DELIVERED IN Department ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S234915/M234911 RPSW1 I r i y j4' 4 i N: r• 1j a. �B e 4+ 'Ct� .V W W4,c,....••z Pf r 7 N ii�r I1rrZy F r N� al - .N•� E��zi"i l Z' �N r I , ILUHN �� wr N W I— t . W = Z N 1� ,N: J llit ao W V° �y y4. I I � A i 172/99/79 3576DO601 i www:massrMcom MINI 1 CLASS D'.Small vehicle less Man I • 28A0716a'exeepipehool w .,R"` s �,b+;� � ��•' .. bw S r _ - '1 p CNANRE OFpADD/RESS PPoM�LOW� I J CON YROL# J1085238 IMPORTANT If your license is lost,damaged or destroyed;is inaccurate;or needs to be corrected,visit our web site at mass.gov/dpl for instructions to ensure the proper mailing of your Renewal Application andiany other correspondence. 1 i This license is subject to Massachusetts General Laws,and regulations.Your license is a privilege,and cannot be lent or assigned to any person or entity under penalty of law.Keep this license on your person or posted as required by law and/or regulations. ........... F` T TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION y Map Parcel 1 Application# Health Division Conservation Division ��� 4,.., � ®l4 Permit# q(� Tax Collector CrTJC Ni,'Eate Issued-S Treasurer Application Fee .ro Planning Dept. Permit Feed Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address s 1 C,Pti L t Sti LJ �\ Village l _C___'T? r— a ' Owner �l�=T� L� C-© © IC Address 1 S I C P y L(,T �,s Telephones " -7 16 Permit Request 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 O t— Historic House: ❑Yes )a<o On Old King's Highway: ❑Yes ❑No Basement Type: mull drawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 7, 4Ph.,-' Number of Baths: Full:existing Z new Half:existing new Number of Bedrooms: existing 3 new Total Room Count(not including baths):existing new First Floor Room Count �l Heat Type and Fuel: ❑Gas 01951 ❑Electric ❑Other Central Air: ❑Yes rho Fireplaces: Existing 1 New Existing wood/coal stove: .�es ❑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 ZNo If yes, site plan review# _ Current Use Proposed.Usex- I 0 ew� BUILDER INFORMATION Name 1 'iC 7_i: r C� I� Telephone Number s - 7 Address 1sl Cc-P-t,--' License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO P l� SIGNATURE',, — DATE I Z o FOR OFFICIAL USE ONLY 9 PERMIT NO. ' DATE ISSUED . , MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION �� A FRAME �- �j` "7 INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING boy- bG t. DATE CLOSED OUT ASSOCIATION PLAN NO. MIX I r.�....uwv....u�...0 Department ofbidasti rat Accidents Office of Investigations•' ' 600 Washing ion StreetBoston,MA 02111' kvi www.mas&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Pluzmbers ,piplicant Information Please Print Le 'bl ame (Business/Orgaxii7.ation/Individual)• COO K_ address, 15�j C ,� • `L► f �� lty/State/Zip-�-�(- - 1 • Phone#: sir ' 7 '7 re you an employer? Check the'appropriate box: Type of project(required): I am atmpioyer with 4. ❑ I am a general contractor and I ' employees (felt'and/or part time).' have hired the sub-contractors 6• ❑Now construction I am.a sole proprietor or partner- listed on the attached sheet 1 7• ® Remodeling ship and have no employees I These sub-contractors have E. [] Demolition working for mein any capacity workers' comp.insurance• g ❑ Building addition [No workers' comp.insurance 5• ❑ We are a corporation and its 10. Electrical r �equired.] officers have exercised.their ❑. repairs or.additions I am a homeowner doi-4g an work. rigbt of exemption per MGL 11.[3 Plumbing repairs or additions myself•[No workers' comp, c..152, §1(4),and we have nq 12.❑ Roof repairs insurance required.]t es.[No workeW. erploye 13.0- Other ' comp.nsuranee required.] ry applicaut that checks box#1 must also fll out the section below-showing their workers'compensation policy infonnation: . omeowners who submitthis affidavit indicating they are doing 4-work and then hire outside contractors must subrmt anew affidavit indicating s=h, . rntractcir.that checkthis.bo?L must attached an additional sheet showing the name ofthe subcontractors and their workers'coin:policy iuforrnatioa M.an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site °ormation. Durance.Company Name: licy#.or Self-ins.Lia#: Expiration Date: b Site Address-- - City/State/Zip: tack a copy of the workers' compensation policy declaration page(showing the policy number and•eaplrat3on date). dare to.secure coverage as required under Section 25A of MGL a 152 sari lead to the imposition of criminalpenalties of a ie to$.1 500,09 and/or one- ear b up Y inrpnsoamen as well as,civil penalties in fife form of a STOP'W()RK ORDER and acne >.p to$250.00 a day against the violator. Be advised that a copy of this statemen{may be forwarded to the Office of vestigatidw of the DIA.for insurance coverage verification. to hereby ce;. der the pains and penalties of perjury that the information provided above is true and correct atcrre: Date: 3 2 G V lone#: Official use only. Do not write in this area,to be completed by city,or town o fc4d City or Town: PermitUcense# Issuing Authority(eircle.one)s 1.Board of Health :.,Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Persoa: Phone#: Information and Instructions f • to provide workers' compensation for their employees. ;sachusetts General Laws chapter 152 tequires`au mP to err person in the service of another under any contract of hire, suant to this statate, an employee is defined as ..,every ress or implies oral of wntten. ; e as`: �j� yi�tjaal,partpers]}ip,•:associatioa,�rporation or other Rid entity,or any two or more er is deem d employ a and including the legal representatives of a deceased eiployer,or the ' the foregoing•engaged in a.jointenterpris , to to ees. Hovteyer:te elver or trustee of an individual,partnership,association or other legal entity,employing em `3' ner of a dwelling hoes a having not more than three apartments and who resides therein,or,the occapant of the yelling persons to do maintenance,construction or repair wo'k vu such dwelling house house of another who employs p ereto shallnotbecause of such employmentbe deemed to be an employer." onthe grounds or building appurtenant th GrL chapter 152, §2,5C(6)also states I•,,"every state or local licensing.agency shall withhold the issuance or or permit to operate a business or to construct buildings in the commonwealth for any ,nelwant al of a license who has not produced acceptable evidence:of compliance with the insurance coverage required." dditionaAY, MGL chapter 152,§25 C(7)states"Neither the commonwealth nor any of its'political subdivisions shall 1ter jen any contract for the perfoumance of public work until acceptable evidence of compliance with tine insurance ufremcnts of•this chapter havebempre'sented to the contracting authority." kpplicants w Tease fill out the workers' con•�ensation affidavit completely,by checking the boxes that apply to your situation and,if. sub-contractors)name(s),addresses)and phone m to rbcr(s)along with their certifieate(s)of necessary,supply �. with no enrployees..other-than the nswcance: Limited Liability Contlianies(LLG)Or Limited LiabilityPartnerships(LLP) members orpartners; are not required to carry workers' compensationinstirance. If an LLC orLLP does have to ees,a policy is required. Be advised that this affidavit'may be submitted to the Department Of Industrial emP y tnon of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should Accidents for coafirma to the dtY or that the application be returned for the permit.or license is being requested,not the Deparfinemt of Industrial Accidents. Should you have any questions regarding the law or•if you are required to obtain a workers'.. ompensationpolicy,Please call the Department at the number listed below, Self-insured companies should cater their c self-insurance license number on the appropriate line. City or Town Officials Please be sere that the affidavit is COMPICUtC and printed event the Office olegibly. Investigations has to contact you regarding ththe happlicantt Of the affidavit for you to fiIl out m the licant' Please be stre-to fill is the permitllicense number which wdl be used as a reference number. In addition, an app that mast submit multiple permitnicens a applications in any given yea4 need only submit one affidavit indicating current oliey Woraratiou(if necessary)and under"Job Site Address"tine applicant should write"an maybe.pin (city or p o€the affidavit that has been officially stamped or maTlced by the city or town maybe provided to the t0 )•"A SPY v is oa file for.furore permits•or-licenses..A new affidavitmust be frlled out each applicant as proof that a valid aft . year.y�en a home owner or citizen is obtaining a licans a or permit not ielated to any business or commercial venue i e.a dog license or p ermit to burn leaves etc.)said person is NOT required to complete this affidavit ( ofIm�esti lions would bke to thank you in advance for your coRperation and should you'lave asry questions, The Office us a call. please do tot hesitate t4 give The Dep Mtnent's addre$s,telephone and•fax member: The Commouwealth-of Massachusetts . t of In&1striaLAccidents • ~.. 1 >. P ..d Qf Investigations , . a• f + 600'Washkgron Street, . BoWn,MA 02111. ' Tel.#617=727-4900 ext 406 or•1-877 MA.SSAFE Tax#617-727,-7749 Revised 5-26-05 wwwmass.gov/ai °FTMEI� Town of Barnstable Regulatory Services t B"NSCABLE. ` Thomas F.Geiler,Director y MASS. . Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 509-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition;or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other - requirements. • w�I Type of Work: �� 1 Estimated Cost Z UoO Address of Work: )� Can,✓ L►�'�, �,sL , Owner's Name: 1 -rC Date of Application: �L ( 0 v I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑�B ding not owner-occupied 1'JVwner pulling own permit Notice is hereby given that: OWNERS"PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date ^Contractor Name Registration No. v C _ R Date Owners Name Q:fomvslomeaffidav -- % g '` -. r - - 4 � --�-' ��'�...,.. ': ""W--V%-1-1 —_:...� '7 141; I �:. ... .�' — � 6y ' S.. 6_.--- t ;• -. . a ;,�. .l -'�- . M . .L . - � T f �. ' �4:t 44 ��` .. " -- e .+G? '`-: 3s�'�"F Lam. - - nN } ir_ =_ :. r� .� , ''" L, , . t �L / /i , , - � . , -' - : �-::. .-f. : -;-- ,a L:...t-�,&',- p.t .: ,- :i . � .��'� .1.:.�.�:� 4 * � . � ;, . a .r! k i«' _�J r F i - i �" : - s g I e iS.Y CE 'T1F)''7',c.A 7> - N EX sT--. �� <N - 6A L 14 7 SON L4�L17'QN/S Cbk'+G'E 0 71 --� .1 A5 S,HflI'llnl.4NZ3 CO�vF€�,�—, -:: .. .�:.. .—'.. , � . ..:AWn � � �.� .�.. �:��......��:�p .:� —.., ' ' _ � �: - - . . S" ..: ,- .- .. . . , ,.. .. - ,;..::. ..31,4 .. ...i��:��.'�. ..':.. .. .. .--.. - '�.. . . � - . '. . . : � . . 0'�w —" �' . .:.,�� . : l,�'� ..::..r.,�-:�:_� t. . : 1 I :'�.' - . � - ... . . . . 7�'.- — .1 '. - � - , - . : ; %� . 000�1. .. . .' :� . . lo�- . �. ' �� � : - :.* � wKewyn. w� .. . � .- . ::�.::: i�: , . - - I ��. l.fit.�,'�:. , � .......qd::��- . .. ....' .'��::� 1 �4 . � - ..- . . ... � :- ��;::..:: -*��. : � '�.:-�: Q� - ,I ,. % �:' J40. . . . � . . - . .� �. - 11 -t� ., ,."''.. - . .."I. Y?MKOY I . - I _0 r 10 z � 1, .1 . - �. - ' :Mg:L.1,: ..�.::���..�'..��:�,�.:;:�.��,:,::�, .. .� :� :� �',- �- , , - , dar 3`u. _ *.... .. - . '' . . - . . - � � . � �1.11 t✓ yP - .: . . � �i—.!�;;;4.�.�� .� . .'.-''� -� o2 Gv1Gcrr�! 3r�?2Q.tf?7/ �T Mr1 Town of Barnstable �Po`z►►s'ei ,o� Regulatory Services i Thomas F.Geller,Director KAM Building Division �TED MAte1e Tom Perry,Building Commissioner 200 Maier Street, Hyannis,MA 02601 www.town barnstablema.us Fax: 508-790-6230 dice: 508-862-403 8 HoNmoWNER LICENSE EXEmMON Please print j DATE 3 JOB LOCATION street r village number Sod-362 `�d�v s-oo?—Vg --aity "HOD2EOWNEr ; .home phone# work phone# tame AA cuRR. 1r1 MAII G ADDRFSS• (s- zip Gout city/town state S of six tnitsor less and for"homeowners"was extended to include owner- m— cnsew r�d The current exemption ed that the owner acts as to allow homeowners to-engage as individual for hire who does not posses s a cngCL is—or. DRYIN ION OF HOMEO•WnR Person(s)*wbo owns a parcel of land on which he/she resides ortcces oo to such use there structures.intended A to: be,a one or two-family d�c'ollsng,attached or detached stmcttaes accessory ear period shall not be considered a homeoer. Such _ on who cons perstructs•more.than one homeOf won form acceptable to the Building official,that he/she shall be "homeowner'shall submit to the Bdg re onsable for all such work crformedunder the buildingermit (Section 109.�.1) The tmdersigaed"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. , ed 'homeowner"certifies ' ifies that he/she understands the Town of Barnstable Building Department The vnd..P z�ign �. - a im=inspection procedures and requirements•and that he/she will comply with said Froced�:res and requirerwAts. /^ Signer Ho er Approval of Building Official Note: Three.Family dwellings containing 35,000 cubic feet or larger will be required to cozaply with the State Building Code Section I27.0 Construction Control. : - ROZYMOWNgR'S EXMdPTION PTOYWOns The Code States that: "Airy homeowner perforasing work for whiclh a building ded that if the bomls Ttquircd.shall be eowner engages?pers exempt b��o such of this section(Section lo9.1.1•Licensing of construction Supervisors);pro work,tsmdoa(Homeowner shall act as supervisor:' lylb homeowners who use this oremptibn arc unaware that they are assuming the resyonsiblities of a supervisotz results in sPr(see App articu�y Rules&Replatio s f�Uc�ine p ons. in this '� .15)d�g�the�ess �� Peron as itwould with a licensed whe4 the homeov+a a visor is ultimately responsible. Supervisor, •!he bomtowner acting as Sup art of the m=ita 1icat'on, To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as P PP that the bomeowner certify that helsbe understands the responsibilities of a supervisor. On the last Page of this issue is a form currently used by several tovvna. You may care t amend and adopt such a fora ea dfieation for use in your community. _ 1 f �. REAR 0 F H O O S E © C S'('GsTrIINC.'eRs air ON 12 ' j t } , ' v i _ C rli G 29 _... .a._..._ _ ...... _ - --- J i . Y ... _ - a, E � a e A ssor's offioe (1st floor): ' SYMM ��TNETO Assessor's map and lot number .. ...�.... �,'..I. 0 ..........WrALLE � ,g IN COMPLIAN(74 card of Health Ord floor): Sewage Permit number za.... ........ Wp�n � 5 • ENV1A0NW7�Q Z HlSMAII& L p�� rasa Engineering,,Department (3rd floor): ME �. moo i639• Housenumber ..................................................:..................... TOWS APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only' TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ....: V.AJlr 7....&N!... AT1.0.lh J.................................................................. TYPE OF CONSTRUCTION .........1'(J3OO.D....�r �� i ..........:........................................... ..........��... ..................19. ..b TO THE INSPECTOR OF BUILDINGS: b. The undersigned hereby applies for a permit according to the following information: ,. C /�.. .Location I5 CR> � ................................................................ ProposedUse .......1.-`.. ? .a :........................................................................................... Zoning District ........................................................................Fire Distract ......... S Name of Owner ........ ... .. . ..- .....1'!'.! �. ...................Address . .S.�L....Cr��-......J...��.�.. W.... .•.�....1✓.( Nameof Builder ....................��YVI�:....................................Address ....... ......................................................... Name of Architect ....!�. .D ..... .�'G�4K f / 1J...........Address ..,.1...�..�� r e " K... �2.:!�!.w% U!r!!�d fsT�: . ....r.. 2 b Number of Rooms ...........Q-�r................................................Foundation ..........t....7t. �!!�4 .� ........... .. ........................ y Exterior ...�f� 4'.....Ii..I..................................................Roofing ....... S��CII h�............ ............o... $.......................... Floors .... li�l. ..� i�. ".7...............................................Interior ... .�£'�:1...'if� ...r.��L...!.. i.AA.............. ( .................................................Plumbin ........N IV.lr. Fireplace .............A/A..............................................................Approximate Cost .....�65.ay.?.ti?.o..................... ............... Definitive Plan Approved by Planning Board ________________________________19________ . Area ....... �..................... Diagram of Lot and Building with Dimensions Fee 1 a. SUBJECT O D OF HEALTH s 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. Name ... ...........a..... Construction Supervisor's License ....(. ................. .......... KIMBALL, CHARLES A. No ...3.1611.. Permit for ...B.u.i.l.d......Addition .... .. .... . Single Family..!?K�.in5....... . ............ ........................... ..... . Location Centerville ................................................................................ Charles A. Kimball Owner .................................................................. Type of Construction .,..,Frame M. ........................ .................................. ................... Plot ............................ Lot ................................ w. Peimit-, February.... 16.,..19 88 ,Gron.ed ............................. ..... . Date of. Inspection'........ a M c!T'e CO m,, 19 pleted ............................... #A 0 gas- r t .y; r. �„y t _.�.c• 1 TOWN OF BARNSTABLE 4 G , BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please.p.rint 4, p L tip r; Lit a 5 „U�r y JOB LOCATION ( c4p 10 did/7 Wv)�� z ,1 um er, ,, treet address � - t Section o f, .town.,,.,- ,.,.. Yi!'HOMOWNER" t it L l.i�'I. �,� t , ame x ,f ome phone y or p yone t G4'13 PR{ESENT`MAILING ADDRESS ! , ,jc� s ity own < ate r r P F �,� t �, , � .� �SThe current exemption fore'!homeowners!' was extendeT' 6 include gwner:oc cupie d; {dwel'pings 'of siXunits ,or4. essaan 'ao alloy such h"omeowrters to. engage an, in g {$4 ivi qua { for hire�who does; not possess a'-I�rcense;r.provi'ded °that`.the owner, m;acts� asp su ervisor r P (State Building. Code Section DERNI ' TION OF HOMEOWNER.: - - 1 , , 'Person(s);wh0 owns a parcel of ,land on which he/she resides or intends to re side; on which there; is, or is intended to be., a one to 'six1famil dwellin attached or detached_.structures .accessory to such use .a`nd/or'farmystructures. P .. erson who constructs „more than .one home., in-:a two=year-��,period':�--shall notbe... ;considered ;a homeowner Such, "homeowner" shall. submit to the Building :Orficiel, formiacceptable �to =_the' Building Official, Ghat he/sheshall be `responsible lfor�all such work (performed under the bui'iding permi ec ion" ffi lyv undersigned;,"homeowner" assumes responsibility',for'-compliance with the Stage _° ° BulIding Code and other applicable codes, by-laws, rules and:reguIations: Cw y."ki 4 - - C tx a 9 ; lThe °undersigned "homeowner" certifies that he/she understands the 'Town of : B ;nstabieguilding. Department..Cnimum inspection pr..ocedures, and requirements sand that he/she wi I1 com 1 with aid P Y procedures and requirements r HOMEO01 WNER'S SIGNATURE APPROVAL OF. BUILDING OFFICIAL Note Three family dwellings 35,000 cubic feet,`'or large r, will be required to comply with State Building Code Section 127.0, Construction`ControI. _ a ...... _---------_._. HOME OWNEI'S :EXEMFTION ' Code state that r "Any Home Owner performing work for which , a `' 6u( i`ding5 permit Is required shall be exempt from the (Section. 109.1 1 - Licensing of Construction 3uperviso�s)sijopsooidedi`that cff�a _I Home Owner engages a person(s) for hire to do such•wor.k, ts .hat: such.-Home Owner . shalI .act as supe.rvlsor. ":. -• Any,.Home Owners who.use- this exemption are' unaware b .that .-they are 'a the respons'fbll'Ities ssumIn of a supervisor 9. pervlsor (see A for, Licensing Construction Supervisors, Sectione2tl15)�� ThsRulelacktlofeawareness often resuits. In serious,1. :3 J s pfiOblems par_, cularfy when the '`Home Owner hires unlicensed ' persons. In this case our Board cannot ,proceed againstthe: unlicensed Per-son as It would with licensed SupervlsQr': The Home Owner, act`Ing ;_Kas supervisor is ult imatel y. ,respons I b l e 'To!'ensure that: the =Home Owner is fu I I aware'`'of his/her?.r communities :requlre, as part of the permif a Ileation, esponsibilities, many• certify that he/she understands the responsibpllt'ies of a superv.lsorome .o0w Owner ; lasttpage;of this issue is a form currently used- b 'several 'towns: Yo ` ' 8 ;t. : Care`to amend and adopt such`a form/certification for. use in'your:commuriit may, r . r y r y. r i a, r • Assessor's offioe (1st floor): aa , FTNEt Assessor's map and lot number ..:�...�.... ,l .:.... ��o card of Health (3rd floor): ! ✓ ewage Permit number ✓.......�� ..' • ..... Z. BARNSTABLE. i V clue J Engineering Department (3rd floor): oo te39• a� Housenumber ..................................:..................................... APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ..... B.U...I,t"-i)...lN.... .................................................................. TYPE OF CONSTRUCTION .........��P.�0..f m E7 .M)�5 E ...................................................................... . ..... .......... .... ...........F ...-(ir..................19.9j...2 TO THE .INSPECTOR OF BUILDINGS: The undersigned Kereb° -d lies` fora ermit`saccordin to`the following information: Location .......«...... .r... ��. t�.��... NA,....ce—wi „�Y\!•��.(7 .4 A................................................................ . Proposed Use ....... �.. Q.... �. ............ Zoning District ...............�... ...................................................Fire DistrictY.!/!.�.!�" �.l� l�Q e1GrS1A�1S ,'��S Name of Owner r.....1.h'�. .¢. ....................Address ....... ..... ....:.....I1 C...r...;....f" 1!1 ,�'I�11J����f Nameof Builder ............. ...a...e-.............. ........ laW�.- .......................................................... Name of Architect ....D.f.pe......S.T? K / •1.............Address AA...C.�K'LS ���Y. i�-��:.�G!'!�1,W►,C ho�ltt� sb3 2 Number of Rooms ...........!......................................................Foundation ...✓...�.. . ..)4. ...... 3!)G1(� ( (,, t ...................... Exierior ..�Tpx`t e....�.L.�. .....k.: Roofing .......a���A� vl � ... .!!��.!n�..\' .C....................... Floors 'PtV) ..600.r: s Interior ..S.�.�G ;r G ,� hlY1�9:::... -..: '� .............. ............. f ......................�?.............. Heating ,( �n.� f" ...Plumbing .�t!o.M.6.'. . .�.._.. >y .. , ..... Fireplace .............::WA.............................. ...............................Approximate Cost .... .e. ............ Definitive Plan Approved by Planning Board ________________________________19________ . ..,-Area ....... ..................... Diagram of Lot and Building with Dimensions Fee .........S..... .... . SUBJECT TC) A.P_P_R.OVA.L—OF—BO-A-RD"OF—Fi A T f 1 �y >y OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Bar nstabie regarding the above construction. Name ... ... .....JA . .......... y 'Construction Supervisor's License ........................ .......... ` y y KIMBALL, CHARLES A. A=192-169 No 31611 Permit for ...B.uild... ddition Single ;Family...Dwel.ling............ Location Lij h.v...RQ.P4d.... ................................. r � Owner ......Charle.s..A.....Kimbal.l............ Type of Construction .......Fr.aMe...................... i Plot ............................ Lot ................................ Permit Granted February 16, 19 88 ......I............................ Date of Inspection ....................................19 Date Completed .....................................:19 - I 1 a 1 n yi S } i i I } } I 1 10 i 6 06 I h > I 1 r I J tr: a� =1 >vaY +m 1 ;1 4 1 .'I .I :1 1 1 1' -----__-- -- ..--- ' LM:vCA4J� taHe I. G jq P►A LI,JAHS ROA Town of Barnstable , , *permit# G 2 7 Expires 6 monks from issue date BAWMAM2. Regulatory.Services Fee Thomas F.Geiler,Director prED MAY► . Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office.: 5 0 8-8 62-403 8 Fax: 508-790-6230 AUG' EXPRESS PERAM APPLICATION - RESIDENTIAL O BV OF AR rig.rt F P Not Valid without Red X--Press Imprint ° °�i t-,: (� a p/parcel Number "I L `p petty Address CA MA ��•� r residential Value of Work ®o Minimum fee of.$25.00 for work under$6000.00 mer's Name&Address atractor's Name__ Ott } 1 �. &-�,Q /� �' Telephone Number —1 me Improvement Contractor License#(if applicable)_ 10-�S—j I nstntction Supervisor's License#(if applicable) JZ S Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance ��� e-- surance Company Name T4-A- ),Q l F. 'orktnan's Comp.Policy# j( 1� opy of Insurance Compliance Certificate must be on file. srmit Request(check box) *P-e-roof(stripping old shingles) All construction debris will be taken to l ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other.town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property'Owner Letter of Permission. Ho ovemeat Contractors License is required. ignature l-Fomu:expmtrg '. zvise063004 °fTMEr Town of Barnstable ti P °T. Regulatory Services s�xr►srnsIX, t Thomas F. 1l Ge' er Director.. 19, `. ass. T Building Division Tom?erry, Building Commissioner . 200 Main Street, $yannis,MA 02601. www.town.barnstable;maxs Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If,using A Builder I, YL as Owner of the subject property •hereby authorize; v( J- [ �'?� S u a ��' `"� to act on my behalf, in all rriatters relative to work authorized bythis building permit application fora Address o Job} h 6 , Si ature of O�ruer _ Date to G Print Name .«+ t 7t7}Xi vY T✓+'j et '�- iC1, ;Gr.3.. °r „�i` ? i „h; A.- tea•. .r.:. Y -. "�-:'^ r..� `n.. V w e 0 TORM S.OW NMPERMIS SIGN gxe vomwwwaze� 0 Board of Building g to s an Re ula f n tan a�s � One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement`'.Contractor Registration Registration: 103714 Type: Private Corporation Expiration: 7/9/2006 PAUL J. CAZEAULT & SONS, Paul Cazeault ` 1031 MAIN ST ' I r OSTERVILLE, MA 02658 Update Address and return card.Mark reason for Chang DP3-CAI Ca SOM•04/04•G101216 Address Renewal Employment Lost Card ' ✓lac o - �'"- Board or Building Regulations and Standards -�— HOME IMPROVEMENT CONTRACTOR License or registration valid for iutliyidr.il use ouh Registration-. 103714 before the expiration date. If found rdurn to: Expiration::7/9/2006 Ifoard of Ituildinf;Regulations and 5la11dards Uuc Ashburton Place Rin 1301 <Type Private Corporation 1;,,,ion, ML1.02108 PAUL J.CAZEAULT;B.SONS,INC. Paul Cazeault 1031 MAIN ST OSTERVILLE,MA 02658 Administrator �1-u Oooiroii�suuer rl�" BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 026325 Birthdate: 10/20/1959 Expires: 10/20/2005 Tr.no: 8603.0 Restricted: 00 PAUL J CAZEAULT 1031 MAIN ST ,� OSTERVILLE, MA 02655 Administrator — *—Ihe Board of Building C qq lation- One Ashburton Place, m 1301 Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 10/20/1959 Number: CS 026325 Expires: 10/2012005 Restricted To: 00 ,PAUL 1 CAZEAULT 1031 MAIN ST OSTERVILLE, MA 02655 Tr.no: 8603.0 ' Keep top for recept and change of addre-qe nnf;f--t:... Asses_ or"s map and lot number .....(R4..". .... { SEPTIC SYSTEM MUST BE ^ - m INSTALLED IN COMPLIANCE L.. �.....�Z ... ..... ........... . a r, Sewage`4Permit number - WITH ARTICLE II STATE Pc °` u '" . SANITARY"CODE AND TOWN P C7.F is.> P�FTBETp�y 'r � TOWN OF, BARNSTATOLE f? Z B9HFirsnLE; � '" a . BUILDING INS.P.ECTOR a { t t= 0 APPLICATIONS FOR PERMIT TO ........cnh7 T4LX t. o nx,...:--1-�... W !'��.l�Y1Q'....... I es .TYPE OF :CQ`NSTRUCTION ...........:W. .oad........ .GI.IY..Y.LR,..............................................................2.................. ' .................,,�a .-s l.�..............19....q.6 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Q Location .......�.. ?r.1.4.....04+. n.s....1 �b l!1 �. ),..lZ Y1' .....M a,:,6 .......................... r.t..... ProposedUse ...... ........................................................................:................................................................ Zoning District. ...........�.g..............................................Fire District .....l...Q.Y.+jjx. ....`...0,15 f..V4:ul. . Name of Owner ...WaC1�.Y.1.-.4�kV.-.-D.Y.1R.,.. C...Address .,c=..... —0.V.p.araik 1 R.d.^., .Lrxr .5 � Name of Builder ...............,..G a xnp....................................Address ................a!Yvk—q....................................................... Nameof Architect ................ . .Q!Y.I,Q.r.................................Address .................................................................................... 4 t Number of Rooms .....................W.........................................Foundation ... r d..... .... Exterior ...:,.1�./t?. .&da...1........5.�{i4�X.o&kcL ..Roofing .c;2-�.;.7r...._L1Q......#6.P.h& �............................. Floors ........Lil......PAI,,;AZ4_.....................................................Interior ......VA........lJ. ...4.X, Va.C_ ........... .................... Heating ...........FW�......-....Q.e�, ..................................Plumbing ...........�.. .. .�1..r- .................................. -- — -- - YY �� p Fireplace .........M.CIaA.Y).Y..I�.....-....(15, Q...I.L.....................Approximate Cost ............ .��.,..Q.QC?.: Q............. .. .......... Definitive Plan Approved by Planning Board ________________________________19________ . Area .1..:.....:..................... Diagram of Lot and Building with Dimensions Fee 0. a'r............................................ SUBJECT TO APPROVAL OF BOARD OF HEALTH o� I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. e ..... ......................................... ...................... /ociates Tellegen-Ferron 18487 story, O Permit-fer�¢ .................................... single family dwelling � �......... . ... . .... ............. JSI Captn.Lijah Road a r Centerville ll g errone Associates Owner .......................................... ... ........... ✓ frame - ,., - C ype of Construction ...........'�................................................................ `Plot ..1 .................. .. Lot ..........#14............... - A June 28 76 1 "Permit Granted .... ........ Date.of Inspection ............. . .....19 Date Completed . . .. :'19 PERMIT REFUSED .........._................ 19 ws ... ......................................'.................... Cn ^.. . ....................................................... S) �....... ........................................................... {.. ..... ....................... ...... y t r .... ................................ ............ ' 19 Approved : : ......................................... 19 r f d n /fir- l-2 Assessor's map and lot number �..Q........ v/� Sewagk Permit number ........................................................... �F7MET� TOWN - OF BARNSTABLE BARNSTADLE; i mumCba DU1LDING INSPECTOR APPLICATION. FOR PERMIT TO ........................ 'r r - ��'r`q. �t��1 a G ! ' �D la 1 P' G ! r`r? TYPE OF CONSTRUCTION ............ inn! ... :�... R.............................. .................... ........................ o �+ - �?.... ......19.. !2A 4 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: L (IT iILI.....rtr�• ` i^ � �n,��, C� �y D•►-4.. ),,fit., : .:... �' �45; Location .......................... :. .,.,,..t. :. ProposedUse ............................Q' '�' . ....................................................................................................................................... Zoning District ........... .: ..............................................Fire District .....0-uYA. .:. ......�� '{'�h� 2.2 t7 Name of Owner s.C.. .@,n o tr,_ I y V/) ���U�'....Address ��„ !,,.f�k (1hY/)..... k;v� �C�. �s ►`lr1 M .... Name of Builder 60 P,,..................................Address Name of Architect ................ !° ?'?:r: .................................Address .................................................................................... .... Number of Rooms .n........ Foundation .....ra �D : 0 ol (A.� �-P . ..... .............. gExierior /./ ...... Roofin . , ... k , k-A iC ..... - Floors .........................A�..o........ ......................... Interior ....................-`..?.Y:.F: ..::.1�(,�' . Heating - h .........Plumbing �. �� n-'f Lr� Fireplace F�{O {��-i v ( , - �.�E Approximate Cost (,C..l Definitive Plan Approved by Planning Board ________________________________19________. Area .?5E.......... .. ............. Diagram of Lot and Building with Dimensions .... .....Fee � 'a• e. ..:........ ......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH �u t ao I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. O Name ........................................ ................................. Tellegen-Ferrone Associates A=192-169' 18487Permit'fo'r 1... ... 1 2 story, .. . single family dwellin ...................... .... ............................ ............. ' Capt'n. Li4ah 4oad _ Location .. ............................................................ i Centerville .......:...............................................I...................... � C i Tellegen. . . -Ferr. . ...one Associates. . Owner ............. ........ . ........ . ........... .... . .......... r frame Type of Construction .......................................... ............. ............................... .......... ... > 7 #14 v z Plot ............................ Lot June 28 76 Permit Granted ....:...................................19 Date.of Inspection ....................................19 r Date Completed .....19 s PERMIT REFUSED .......................................... ............. 19 ................................. ' ............................... E ............................................................................... e Approved .................... ......... 19. ;.;. AV ' ................................ P .......................... ............ ....................................... 1 . •--"" !Off✓,�J --- t • y � s 1 I I a. 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