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0067 CAPTAIN BELLAMY LANE
n . e o� Town of Barnstable -..*Permit# THE "�► ' '`` ° Expka 6 months from Issue date Regulatory Services r Fee KAMA Thomas F.Geller,Director �kp M �,�0 a Building Division. Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601„ ` www.town:barnstable.in,a us Office: 508-862-4038 -`° * - Fax: 508-790-6230 EXPRESS PERMU APPLICATION' = RESIDENTIAL ONLY , o ® Not Valid without Red X-Press Imprint = Map/parcel Number. x Property.Address Residential Value of Work _7 4�.�' Minimum fee of$35.00 for work under$6000.66 —T V,Q.f}-S avVs ,has � .• �`•` t Owner's Name&Address • / lei x�` D e _tL�u '' - /7er'�'E Contractor's Name isrN �w W` 5 f'r / Telephone Number Home Improvement Contractor License#(if applicable) / ! 3 Y S ` Construction Supervisor's License#(if applicable) 2/workman's Compensation Insurance } ' ������.P E®g� 4 Check one: - �1 Yil1 1 z ❑ I am a sole proprietor 4 - ❑ I am the Homeowner y d A UGI. 12013 [ I have Worker's Compensation Insurance Insurance Company Name o RNST ASLE 3 8.3Sa Py - Workman's Comp.Policy# - - Copy of Insurance Compliance Certificate must-accompany each permit: Permit Request(check box) -' _ `` t _ { A. Re-roof(hurricane nailed)'{stripping old shingles) All construction debris will be taken to x i _ z ❑Re-roof(hurricane nailed)(not stripping. Going over =M existing layers of roof)` a i ❑ Re-side' 3 #of doors /ReplacementWindows/doors/sliders.-U Value' 0 •_3l 0 - (maximum.35)#of windows 3 ❑°Smoke/Carbon Monoxide detectors 4'floor,plans marked with red Sand inspections required.: Separate Electrical&Fire Permits required. •.Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Consei ation,etc.- 2 '.i .• **.*Note: Property Owner must sign Property Owner Letter of Permission A copy,of the Home Improvement Contractors License&Construction Supervisors License is required: s SIGNATR.E•, Q:\wPFILES\FORMS\building permit fonnsTYPRESS.doC Revised0530.12. r .r Southern New England Windows d.b.a Renewal by Andersen of SNE Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supers isor. , License: CS-095707 BRUN D DENNISON - l 7 LAMBS POND EIIR, /s Charlton MA 01507 Expiration Commissioner ` 09/08/2014 cqe wpt�� �oo�urea�G 12L C� aQ�aC�2ufleG�t1 Office of Consumer Affairs nd Business Kegulation 10 Park Plaza.-Suite 5170 Boston,Massachusetts 02116 ` Home Improvement Contractor Registration Registration: 173245 Type: Supplement Card SOUTHERN NEW ENGLAND WINDOWS LL Expiration: 9/19/2014 DENNISON BRIAN 1137 PARK EAST DRIVE WOONSOCKET,RI 02895 y Update Address and return card.Mark reason for change. sc..0 z -11 - Address Renewal 0 Employment O Lost Cord mce of Consomer ARatre&Best.—Regalatiou License or registration valid for Indlridul use only • OME IMPROVEMENT CONTRACTOR before the expiration data If found return to: Office of Consumer Affairs and Business Regulation 'eRoglstrauon: 173245 TYPO: 10Park Playa-Suite 5170 `+ar, E.hatfon:OMM014 Supptenenl:ard Boston,MA 02116 ' SOUTHERN NEW ENGLAND WINDOWS L-C. RENEWAL BY ANDERSON- DENNISON BRIAN .. 1137 PARK EAST DRIVE WOONSOCKET,RI 02895 a F Unde.....y Not valid without signature. - _ ' Pri.ntform ' The Commonwealth of Massachusetts 7 Department of Industrial Accidents Office of Investigations 1 Congress Stree4 Suite 1.00 1 - Boston,MA 02114-2017 •°� www mass.gov/dig Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information - Please Print Legibly Name (Business/Organization/Individual): Al&u Ljy&a WaNhw�> LLG Address: 2 41 D l mN 49,4-6 City/State/Zip: e-/NG®lN ®4S45- Phone#: ��D� ��� _ ?& Are you an employer?Check the appropriate box: = Type of project(required): 1.EWI am a employer with 9 b 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 workingfor in an capacity. employees and have workers' y p ty. 9. ❑ Building addition [No workers' comp.insurance comp. msurance.t required.] 1 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no // employees. [No workers' 13. Other comp. insurance required.] tA ` S *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $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: E6 N " rG-�ol C�d�r�t Policy#or Self-ins.Lic.#: �C �"Z 6 g �vZ 3 1 Expiration Date: F l.3 Job Site Address: City/State/Zip: ��' �`� A44 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 cerdby under the ggLns and enalties o er'u that the in ormadon provided above is true and correct Si afar . . ..._. .. __... _.- latef FI- 3 Phone#: g®l a.g g - ?,Rev. Official use only. Do not write in this area,to be completed by city or town of City or Town: PermitlLicense# 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#: Client#:30124 SOUTNEW ATE(M ACORD.. CERTIFICATE OF LIABILITY INSURANCE D MIDD/YYYY) 5/08MIDDN 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 Anita Little NAME: Willis of New Jersey, Inc. PHONE g56 914-4660 FAX(AI 856 914-1881 1015 Briggs RoadE-MAIL o,Ext: Alc,No gg PO Box 5005 ADDRESS: Anita.Little@wiIIis.com ' INSURER(S)AFFORDING COVERAGE NAIC# Mount Laurel,NJ 08054 INSURER A:Selective Insurance Co of the S 39926 INSURED INSURER B:Argonaut Insurance C.O. 19801 Southern New England Windows LLC INSURER CBeacon Mutual Ins.Co. 24017 " D/B/A Renewal by Andersen INSURER D 26 Albion Road Lincoln,RI 02865 INSURERE: INSURER F: ' COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY'THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY 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. LT R TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LT SR INSR WVD POLICY NUMBER MM/DD/YYYY MMIDD/YYYY A GENERAL LIABILITY . S202945900 8/10/2012 08/10/2013 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $50,000 CLAIMS-MADE 7 OCCUR MED EXP(Any one person) S 5,000 PERSONAL&ADV INJURY $1,000,000.. i - GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY 7 PECOT- LOC - $ A AUTOMOBILE LIABILITY S202945900 8/10/2012 08/10/201 COEaMBINED accidentS INGLE LIMIT $1,000,000 X ANY AUTO _ , BODILY INJURY(Per person) S ALL OWNED SCHEDULED - BODILY INJURY(Per accident) S AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident ` S A X UMBRELLA LIAB OCCUR S202945900 8/10/2012 08/10/2013 EACH OCCURRENCE s5,000,000 EXCESS LIAB HCLAIMS-MADE AGGREGATE $5 OOO OOO DED I I RETENTION$ B WORKERS COMPENSATION -AIC927698352394 8/21/2012 08/21/201 WCSTATU- OTH- AND EMPLOYERS'LIABILITY Y I N TORY LIMITS ER C ANY PROPRIETOR/PARTNER/EXECUTIVE7 68028 8/21/2012 08/21/201 E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N N I A (Mandatory in NH) [ E.L.DISEASE-EA EMPLOYEE $1,000,000 " If yes,describe under - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) . CERTIFICATE HOLDER CANCELLATION Southern NE LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION' DATE THEREOF, NOTICE WILL BE DELIVERED' IN 26 Albion Road ACCORDANCE WITH THE POLICY PROVISIONS. Lincoln,RI 02865 ' AUTHORIZED REPRESENTATIVE x p ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S214638/M214631 AXL CUSTOM WINDOW AND DOOR REMODELING-AGREEMENT Buyer(sr Name Date of Agreement s �s12VOIS Buyer(s)Street Address.City.Sete,and Zip Code!P.O.Box. E-Mail Address Home Telephone Number W rkTelephoneNumber ?S 6 r y o 7`8 37 Yz:" Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Southern New'England.Windows;LLC d/b/a Renewal by Andersen of Southern New England(".Contractor"),in accordance with:the terms and.conditions described on the front and the reverse of this agreement and on the attached specification sheets)(collectiNTly;this,'Agreement"). ❑:Historic ❑ Condo ❑ HOAT Total Job Amount) / Estimated Starting Data: Method.of Payment:'O Check ❑Cash Financed Deposit Received(33%): /j Credit Cards are.accepted for deposit.only-maximum 1/3 of the Balance at Start of Job 33%: �l N project cost(Please see Credh Cord Rayment Form.)By signing this ( Estimated Completion Date: Agreemen,you acknowledge that the Balance at Start of Job and.the Balance on Substantial _ Balance on Substantial Completion of job cannot.be made by credit Completion of Job(33%): �fC card and must be made by personal check,bank`check,or cash. Buyer(s) agrees and understands that this Agreement constitutes the entire understanding between the parties, and that there are no verbal understandings changing any of the terms of this Agreement. Buyer(s) acknowledges that Buyer(s) (1)has read this Agreement,understands the'terms of..this Agreement, and has received a completed, signed,.and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and(2)was orally informed of Buyer's right to cancel this Agreement.DO NOT SIGN THIS CONTRACT IF THERE ARE ANYBI.ANK SPACES. (Rhode Island Sales Only)Notice to Buyer.(1)Do not sign this Agreement if any of the spaces intended for the agreed terms to the extent of then available information are left blank.(2)You.are entitled to.a copy of this Agreement at the time you sign. it.(3)You may at any time pay off the fuU unpaid balance due under this Agreement,and in so doing you may he entitled to receive a partial rebate of the finance and insurance charges..(4)The seller has no right to unlawfully enter your premises or commit any breach of the peace to repossess goods purchased under this Agreement.(5)You may cancel this Agreement if it has not been signed at the main office or a branch office of the seller,provided you notify the seller at his of her main office or branch office shown in the Agreement by registered or certified mail,which:shall be posted not later than midnight of the third calendar day after the day on which the buyer signs the Agreement,excluding Sunday and any holiday on which regular mail deliveries are not made.See the accompanying notice of cancellation form for an explanation of buyer's rights. Buyers)received the consumer education materials provided by the Rhode Island Contractors,Registration Board. (Bgw's Initial3) Renewal by A rdien'of Sou ern New England Buyer(s Buyer(s) By: igna of Product Manager Sign re `-� Signature I /t Wl. C�A-6 PI-0J Print Name of Product Manager Print Name Print Name YOU, THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANY TIME .PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE:DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT. - - - - - - - - - - - - - - -�.c- - - -- - -.- - - - - - -�-- -. - - - - - -- - - X NOTICE OF CANCELLATION Date of Transaction I .You may camel 1 Date of Transaction .You may cancel this transaction,witho or obligation, within this transaction, without any penalty or obligation, within three business days.from he above date.N you cancel,any I three business days from the above date.N you cancel,any property traded in,any payments made by you under the I property r traded in,any;payments made by you,under the Contract or Sale,and any negotiable Instrument executed I Contract or. Sale,and any negotiable instrument executed by you will be returned within ten business days following I by'you will be returned within ten business days following receipt by the Seller of your cancellation notice, and any I -receipt by the:Seller of your cancellation notice, and any security interest arising out of the transaction will be security interest arising out of the transaction will be canceled.Nyou cancei,you must make available to the Seller I canceled.if you cancel,you must make available to the Seller at your residence,in substantially as good condition as when I at your residence,in substantially as good condition as.when .received,any goods delivered to you under this Contract or I received,any goods delivered to you under.this Contract or Sale;or you main,if you wish,comply with the instructions of I Sale;:or you may,N you wish,comply with the instructions of the Seller regarding the return shipment of the goons at the the Seller regarding the return shipment of the goods at the Seller's expense and risk.If you do make the goods available X Selle's expense and risk.N you do make the goods xvallable to the Seller and the Seger does not pick them up within I to the Seller and.the Seller does not*k.'J 11iM twenty days of the date of cancellation,you may retain or I twenty days of the date of cancellation,you may retain or dispose of the goods without any further obligation.If you I dispose-of-the goods without any-further obligation.N you fail to make the goods avaibtble to the Seller,or if you agree I fail to make the goods wrAlableto the Seller,or N you agree to return the goods to.the Seger and fail to do so,then l to return the goods to the Seller and hil to do so,then you remain liable for°performance of-all obligations under 1 you remain liabler for performance of all obligations under else-Contract.To cancel ,this transaction, mail or deliver the Contract.To -cancel this transaction, mail or delver a sinned and dated-eoov of this cancellation notice or anv I a tinned and dated-copy of this cancdtation.notice or any TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel* Application # 5� Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee X Date Definitive Plan Approved by Planning Board + ��I3olll Historic - OKH _ Preservation/Hyannis Project Street AddressT� `�— Village - draw TAeyllle ' Owner t"I e7 Address Telephone - Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning:District Flood Plain Groundwater Overlay v r� C> Project Valuation yp 10 0�• Construction Type— Lot e •� ti Lot Size Grandfathered: ❑Yes ❑ No If yes, attach',supporting clgg�mentation. f ' U3 Dwelling Type: Single Family UY/ Two Family ❑ Multi-Family (# units) A Age of Existing Structure t A $� g g A5 ��' Historic House: ❑Yes �lo On Old Kin' Highway: O Yes o Basement Type: 5 ull ❑ Crawl ❑Walkout ❑ Other ' Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing i new Half: existing new Number of Bedrooms: 3 existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: UrGas ❑Oil ,❑ Electric ❑ Other Central Air: ❑Yes a'No ` Fireplaces: Existing / New Existing wood/coal stove: ❑Yes W<O Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size Barn: ❑ existing ❑ new size_ Attached garage: 2xisting ❑ new size _Shed: existing ❑ new size — Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes V'wo If yes, site plan review# Sheer _. Current Use - _ " " � - Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number Address �eleLl License # Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO &XJ,1S' /e SIGNATURE DATE FOR OFFICIAL USE ONLY x APPLICATION# s. DATE ISSUED MAP/PARCEL NO., . r ADDRESS VILLAGE OWNER f s DATE OF INSPECTION: t 1 FOUNDATION FRAME I��31)VI INSULATION'(a 0 31 c� FIREPLACE y . w _ ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL G r -GAS: ' ROUGH ,y• L tt-• FINAL FINAL BUILDING` 2)11!l . DATE CLOSED•OUT t ` ASSOCIATION PLAN NO. NThe Commonwealth of Massachusetts Department of Industrial AccidehIs - .1 Yy•�lr Y 5 Office of Investigations 600 Washington Street 1 Boston, MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Nam(;(Business/Organization/Individual): J`LP7,17— Address: L City/State/Zip:A44 /�1�� Phone #: 5b F 771�= F2.0 u an employer? Check the appropriate box: Type of project(required): am a employer with 4. ❑ I am a general contractor and I mployees(full and/or part-time).* have hired the sub contractors 6• ❑New construction am a sole proprietor or partner- listed on the attached sheet. t ?• [remodeling ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity., workers' comp. insurance. 9. Building addition [No workers' comp, insurance 5. ❑ We are a corporation and its ^yequired.] officers have exercised their 10.0 Electrical repairs or additions 3. I am a homeowner doing all work right of exemption per M'GL 1 1..❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.E] Roof repairs insurance required.] t, employees. [No workers' comp. insurance required.] ]3.❑ Other *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. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. 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$250.00 a day against the violator. Be advised that a copy of this statement may forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify under thepains andpenaltiess ofperj/ury that the information provided above is true and correct Si afore: 74r �/ Date: l/ Phone#: / O�' �`IS�� /�!o F only. Do not,write in this area,to be completed by city or town official n: Permit/License# hority(circle one): Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspectorson: Phone#: Information and. Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual, partnership,association, corporation.or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building ap purtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required.,$ 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/licease 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"ail 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 proofthat 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 Iicense 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. r The Department's address, telephone and fax number: ` The Commonwealth of Massachusetts Department of lndu.st ial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-490.0 ext 406 or 1-8'77,MASSAFE Revised 5-26-05 Fax 4 617-727-7749 www.m-.a.ss..gov/dia Town of Barnstable of Tt+r r.� . Regulatory Services t;�ttxsuate Thomas F. Geiler,Director KAss. g �o tbsh- 16.$ Building Division rEa µa{ Tom Perry,Building Commissioner 200 Mau[-Street, Ayaanis,MA_02601 www.town.barnstable rna.us Office: 508-862-4038 Fax:^ 508-790-6230 HOMFLOWNER LICENSE EXEmTTION Pleare Print DATE: ���Al ' JOB LOCATION: . �� num ct street Village J 6zo' 7 �7 S name / �home phone# �qt CURRENT MAILING ADDRESS: 6 (t{d✓ / � ,e7 �RAI city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwel1ini?s of six units or less and to Bllow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINM. ON OF HOhSEOWnER Persons)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to- be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. -A person who constnlets 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 Barnsiable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and - requirements. Si re of Homeo a 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 EXEMFTION The Code states that "Any homeowner pc forming work for which a building permit is required shall be exempt from the provisions of this sectiga.(Section 109.1.1-Licensing of construction Supenzsnrs);provided that if the homeowner engagrs a person(s)for hire to do such, work.,that s-uCch Homoowna shall act as supervisor."' MJany homcowncts who use this exemption are unaware that they are assuming thc responsibilities of a supervisor(see Appendix Q. , Rules&Regulations for Licensing Construction Supavisors,Section 2.15) This lack of awarmass bftcn results in serious problems,particularly when the homeowner hires unlicensed persons. In,this case,our Board cannot proceed against the unlicensed person as it wrould with a licensed Supervisor. The homcowncr acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her r,;sponsrbilitics,many communities require,as part of the permit application, that the homeowner eatify that hdshc understands the respannbilities of a Supervisor. On the last page of this issue is it form currently used by several towris. You may care t amend and adopt such a form/certification for use in your community. • ' Q:forrns:homccxcmpt 1 Town of Barn-stable Regulatory Services t stixxsrss[, MIM g• Thomas F. Geiler,Director 'Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.b arnstable.ma.us Off ce: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using ABuilder as Owner of the subject.property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:O WNERPERMISSION guar„ New • £X1 S�LIn Door �^+t f-1 a, e^�r Proposed changes to Garage: 1. Insulateexisting 2X4 walls 16" OC vvi g-R=13 Kraft faced fiberglass insulation; f __ Existing walls are 8 5 from floor to ceilmy. 2. Insulate existing 2X6 ceiling joists 16" OC with;R=19 Kraft faced fiberglass insulation. Existing joist spans 13' 5". 3. Add partition wall 2X4 construction 16" OC. Insulate 2X4 wall withR-13 Kraft faced fiberglass insulation. Install 36" exterior door in the new wall. 4. Sheet Rock existing common walls to house with5/8 type X fire code material. Tape and joint compound all seams. 5. Sheet Rock all exterior,walls and ceilings with 1/2 material. Tape and joint compound all seams. I j• TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION -734, Map -273 0 Parcel': I �+ ; Application # tJJ Health Division Date Issued ( t 3v< < 6 Conservation Division ti :Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Village Owner �i✓E iflSkOdSk-�S Address s�'J Telephone /SU g-� Permit Request Zed v 1, 1 Sr I�v(a 2` K 2-q )C 3` Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District 6 Flood Plain Groundwater Overlay Project Valuation o 06 Construction Type Lot Size 201 o" 5a Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Wr" Two Family ❑ Multi-Family(# units) x Age of Existing Structure 2s It S_ 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 o2. new Half: existing new Number of Bedrooms: 3 existing —new Total Room Count (not including baths): existing 6 new O First Floor Room Count 7 Heat Type and Fuel: r2Gas ❑Oil ❑ Electric ❑Other , Central Air: ❑Yes Flo Fireplaces: Existing / New Existing wood/coal stove: ❑Yes [flo Detached garage: ❑ existing ❑ new size Pool: ❑ existing ❑ new size _ Barn: 01 existing .� newt; size_ I ..� ED Attached garage: Coexisting ❑ new size _Shed: ®existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ cL %.n sM Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name .105694 �d 2��� S(29 7Q ?�y 6 Telephone Number ei Address I G Aloa 1)st PQ,I v E License# Cl 3 G 61.1 5A'(a) Mo tq 13m clki /KA Home Improvement Contractor# d"L 5 Z Worker's Compensation # Al ALL CONSTRUCTION DEBRIS FSULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE !® /L i FOR OFFICIAL USE ONLY y APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATIONCai Soau5 Q I! tl 3 FRAME r INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL - PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING l\ DATE CLOSED OUT ASSOCIATION PLAN NO. • The Cornmoftwe"Ith ofmassachusetts .Deparfrn'etzt of rndustria1Mccidenty " Office of Investigations . . 600,FYd�h�ngion Street 13osto�?, MA02111 xVWW.mcrss.gov/din 'Workers' Compensation Ingarance �da'vit: Builders/Contractors/EIectricians(Plurilbers Please Pant Lp 'bl Applscant Xnformafioxi Name (BusinosslOrganizgtionllndividuel): '36 SE AN v(LI� Address: Ott 04-i 7� city/state/Zip:`J4 MA e Are you an eraployer7 Check the appropriate box: Type of project(required): ❑ T 4. 0'I am a general contractor and T_ 6. 9cw construction I. am a employer with employees (full andlor part.d=).* have hired the strb-contractors ,/ Remodeling a'sole ro rictor or partner- listed'on the attached sheet 21$ 1 un p p These sub-contractors have" 9. Dcmohti•on ship and have no employees working for me in any capacity, employees and have svorke'rs.' 9 Bg addition .I, wrap. iasUiance.t [No workers' comp.•insuranrlc', IO.�]•Elcctrieaj repairs or additio. r6gttired] 5• [] V,re are a corporation an its ,officers have exercised their lI_(]Plumbing repairs or . 3,❑ T am a homeowner doing all work ., rigbt of exem tion er MGL myself, [No workers' co p 12.[❑ Roof repairs �� c. ISM. §I(4); and we have no ins -ancc regti red],t -13 ❑ Other . cmployecs: NO workers' comp: insurance rcquired.j 'Any applicant that oheckc box to irrust aiso fill out the`roction below showing their workers' compcosahon Po}icy irdmTrabon t Homcowncrt who avbnait this a$idavit indicating(fiep arc dog owWtonklh d anai1c of thc hirr u u'b contrartars and si1{c whether or ot thosc Cotidcs havcch: XContracton lint chcck this box must atiathcd additional ah g n'P policY number. anploycrs, Ifthc sub-ronb—ton•havr cmp1oycc6,they muri prwidh their workers'co ` Xarn an employer M djs providirigworkers',�cvrnp'Ell sallon insurance far'cny employees BeCatV is the paCiry artdjob site site Company-game: . w• - - .. ==Expiration Date. Policy# or Self-ins, Lie.,i#: • - City/Statc/Zip: Job Site Address: Attach a Copp of the worker`s' compensation policy declaration page (showing the policy rit�rnber and expiration date). Failure to secure covcragc`as required under Section 25A'of MGL c. 152can lead'to•theyimposition of rrim;rial penalties of a fine up to 51,500.00 andlor one-ycai.imprisonment, as well as civil pmalti•cs in the form of a STOP WORK ORbER and 2 fv of up to $Z50.00 a day against the violator,,Bb adriscd that a copy of this statcmc-dt may be forwarded to the Office of rnvcsti ations of the JD for'. cc cavern c vcritication X`do her cerirfy untie he p s•a�tdpenalttes ofperjuryAl cd fhe information provided above is true anti coireLt DatLl 10 (1 Si ature: Phone #:. - � u Official use only,1Db not write in.this area, fb he completed by city or town official' City or Towa: Pernvt/License# _ Xssuiog kutbority (circle 6ne): -' 1. Board of Health 2, Building Department 3, City/Tow-n Clerk 4, Electric=2[ Inspector; 5, Plumbing Inspector 6. Other Information and lnstr uctions :• Mass a thus etts Gcneral Laws chapter 152 requires all employers to provide workers' o P ndti0a y contract ooflbisc) pursuant to this statute, an employee is defined as "...cYcry person in the service of an express or implied, oral or written- ciatio oration or other legal entity, or any two or more An e�p/Dyer is dcfimcd as "an individual,partnership, also n, co rP or the of the foregoing engaged is a joint cntrrprisc, and including the legal representatives of a dceeaslod emlHowcYcr tho receiver or tlllsteo of an individual, partnership, association or other legal entity, employing mp Y owner of a dwelling lloUsc baying not more than throe apartments and who resides therein, or the occupant c the dwcllin.g house of another who cMPloys person to do mainty mince of such mplooyrncnt be deemod to bedan e pgoyo Sr or on the gzounds or buulding app�nani thereto shall not b MGL chapter 152, §25C(6) also stags that "every state or local licensing agency shall 77ithhold the issuance or reaevYal of a-UCenSe or permit to operate a business o th r to consiTU dthesursbx2_nc co eragn rtequized. applicant Who has not produced•acceptable. evidence of Compliance AdditionaIly,MGL ohaptcr 152, §25C(7)states "Neither the conumoublctevidcncc of complies nor YOf:T�I its political 1�`"r �e entcr•into any contract for.thc performance of public workun� P zcquir,Monts of this chapter have been presented to the contracting authority. Applicants- thc boxes that apply to your situation and, i . Please fill out tho workers' comp)at'o( ddrress(cs) and phone ncumbcr(s) along with thciz ccrtificste(s) of necessary, supply slrb-contractor(s names , insuzance, Limited Liability Companics•(LLC) or Limited Liabili op��an Ps (LEY)anLLC or°LL.P does havc�er�� the . momb ors or partners, arc not zequurcd to carry workers eompeos n ws employees, a policy is required. lac advised that this affidays ma ure to c sub gu and date the cp&affid t.rtmnt�hc a�da»�sb°uld Accidents for confirmation of insuranec coverage. Also b bo returned to the city or town that the•application for the permit or license is o �rq cs to obtain aewo rs t of Industrial Accidents. Should you have any questions regarding the law or if y compensation policy,please call.the Dc p�cnt at the number listed below. ScLf insured companies should enter thcil self-ixrsuran�o license number onthc_a ropriatc Zinc. CIty or Turn, Of)1cfuls Please be surd that the a idavit is'complete and printed legibly. The Department has prtad yudte Bi�gthetapplicant of tho affidavit for you to fall out in the evcnluerOfE ch co f I besusgd o a)Ic to number_ In addition, an applicant Plcaso bo Sure to fi]1 in the Permit/liccnsc n cuizcnt that must submitmultiplo Pcrmtt/liccnc applications in any given year, Do't only submit onp affidavit indicating policy information(if pcccssary) and under"rob Sitc Address" lho applicant should write"all iota broYided to th as In-(City or town)."A cbpy of the ef�davit that has been bff cially stauup ed or marked by the city or town may p applicant as proof that a valid affidavit is on file for future ocrfnitor not arcs.d fo any a in ss or�cozoin real�1q�c r or ci EW11 is obtaining a liccns c P. year.'Whcro a home owns . . c said ersou is NOT required to comploto this affidavit (i_c, a dog)iccnsc ox'pert to burn leaves et .) p oration and should you baYc any questions, Tha Office oflnYcstiga.tions would like to thank you in advancc for your coo P please do not hcsitato tc give us a call The Department's address, tcicphone•and fax number: Tht} Commonw(-,4th of Massnhus�tts DGputme It ofj dvst O A.GCid=ts Office of IuestiPtI.ous 600 Washington St-ciet Boston, MA 02111 T(,-1; # 617-727-4M cxt 40.6 w 1-8'77-MASSAFE Fax# 617-727-7749 RcYiscd 11-22-06 www.mass-gov/dia rHrr Town.of Barris.table, FZegU12-to-ry Services # w SA]ZNSTADLx, Thomas F: Geiler, Director F o:19. 131ji]ding Division ^ Tom,Perry, Building Comm+ssioner 200 Main Street, -Hyannis, MA'02601 - wwW.towrn,'ba'rnstable-rna.Lis ` r 9 Fax: �sos-7.90-62-'. Office: 508-862-4038- �. . r P O e ty_� tze Ust: A Complete a�r�'Sigll Th-is,S ctioi ` Cf`Us I 1-ig :A,Builder iCleSkOtJS `9,-S ,:as'Owiiexofthe-subj.ectptoperty, _ hereby authorize CldSE J ��/.�` A,-1 to act on my behalf, '- e, in aII matters relative to work authorized.by this building permit application for v . (Addtess,ofJob) Od63 ' Si a rem of O If Property wner ner, is applyi D to . Print Nae # r i •, „ O " ng for perm' t pleas P `e`com Iete'thr Homeo�amet"s L%cense, Exemption Forrri on the reverse side. y. r Town of B anastable of 7NE rp��� Regulatory Service's LI Thomas F. Geiler, Director � 9ARNSTABLE, ,' - M 155. Building Division ,6jq �jfo JAP�A Tom Berry,Building Comn-LissI0rlel' 200 Main Street, Hyannis, MA 02601 vt�Yty,town.barnstable.ma.us Fax: 508-790-6230' Office: 508-862-4038 ROo TEOwl\T-R LICENSE EXEMPTION please Print DATE: )O13'LOCAT)ON: a trcct Yi l loge number "l-IOMBOWNLR": home phone P work phone# name CURRE14T MAILING ADDRESS: state zip code city/town Thy current exemption for"homcdwnc 'was extended to includeot loars a h'pce d de rovided th t the owner act n as d to allow homeowners to engage an individual for hire who does n possess supervisor. DEFINITION OB H0li4EOWNER , e, on which the Persons) who owns a parcel of land on'which he/she resides or intends ee accessory toto rsueh use and/or farm t7vctutes,dA rd to be, a one or two-family dwelling, attached or detached structures person who constructs.more than one home r a ion.aaformtacd shall nole to the Budding ered aOfficial,homeowner. t has he shall be "homeowner"shall submit-to the Building official' res onsible for all such work crformed under the buildingrrnit,e (Section 109.1.1) The undersi. ncd "homeowner" assumes responsibility for compliance with the Stata Building Code and other applicable codes, bylaws, rules.and regulations, able Th•e undersigned "homeowner" certifies that he/she undthat he/she ail compl the Tovm'of y thtsaid procedu�es�andent minimum inspection procedures and requirements and requirements. Signature of Homeowner Approval of Building Official •. mily dwellings containing 35;000 cubic feet or larger will be required.to comply with the Note; Three-fa State Building Code Section 127.0 Construction Control. KO) Eao"ER'S ExE,KPTlON The Code states(ha[ "Anyhomeownerperformm g work for which a building p ermit is required shall be exempt from the provisions etion supervisors);provided that if the homeowner engages a pason(s)for-hire to do such of this section (Section 1119,1,1 I irensing oCeonstru work, that such Homeowner shall act as supervisor," are assu the ari(cularl Many homeowners Who usnshctio Sidon isorsr Scclioaware n 2t 1t5)y7his la k of awar ncsooftcnlrctsultsf in serioussproblcrosppartcri ic Q,y Ru)cs &*Regulations for Licensing Co P when the homeowner hires unlicensed persons. In this cast,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 thal the homeowner is fully awaTo the rcofp ins br TC5s ofsa Sutpervi or,many the last page of hisaissue is a part of tform currentlyil tused by that the homeowner certify that hdshe understands- rnr-/rrri;fic2tion for use in your community. I — �..., NOW t Massachusetts- Department of Public SafetN Board of Building Relgulations and Standards Construction Supervisor License . License: CS 93664 Restricted to:. 00 :. JOSEPH J BORDEN £' A 16 NOREAST DR ;. k SAGAMORE BEACH, MA 02562 — ` Expiration: 1/19/2012 Commissioner Tr#: 17581' # ? ✓fie i�on�nooxurea�z o�../�aaaac�zuaelta ` - Office of Consumer Affairs&Blisiness Regulation !- "HOME.:IMPROVEMENT CONTRACTOR a, ROistration 150921 Type: i = Expiration 5I8/2012 Individual i JO +PFi BORDEIIE � T JOSEPH BORDEIV 16:NOR'EAST.DRIY r BOURNE, MA 02562 ;., Undersecretary Massachusetts- Department of Public Safet% Board of Building Re!-ulations and Standards Construction Supervisor:License License: CS 93664., Restricted to: 00 JOSEPH J BORDEN 16 NOREAST DR. '7'. SAGAMORE BEACH, MA 02562 - Expiration: 1/19/2012 Tr#: 17581 v ft-ltu Zi . - t -+ b License or registration valid for individul use.only x before the expiration date. If found return for 3ai. s i. Office of Consumer Affairs and Business Regulation x lO Park Plaza-Suite 5170 r w� F 7 Boston,MA 02116 N t valid without signature j r o � � 51 zk � :Z©w,F--- ` .,f.Z ,:NET�' A s.�ur.,•z: n� L.v y • 7 7 To c_viJ � '/lt+..��` j (^o.1.3C . a Ck c I r a 1. s }- col i siev.:1ar { 1 i I r� � f i CbY,C 1 XA T 1 33 L �$" .. .. Fir' tVL C.l -C K.J01 4111 1 j - •I �• '; i i I j � f ' - ,. s � is �1 d; 1 : f G J7 rye, . �I i I _ • 1 � I " 1 • TOWN OF BARNSTABLE Permit No. -------28205 - { . = Building Inspector Cash -___-_-_---- -- wa . OCCUPANCY PERMIT Bond -------__X-------------- Issued to Greenbrier Corp. Address lot #9 57 Captain Bellamy Lane., Centerville Wiring Inspector ��' i ..� Inspection date L Plumbing Inspector Inspection date Gas Inspector r fiYLLn A Inspection date �a %Engineering Department�—"Ii�� ta'�f`(i' 6sl�/!G'/a Inspection_date Board of Health �/��N ./7 Inspection date -�/- THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE, OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MAsSACHUSETTs sTATE BUILDING CODE. J � � r:� � ......._., 19 _ � a n . .:..z ra= M,:\ - x _ �r.,.{ '!:i x�a .�;:� ��.r,'�...h��,1''. a �k,'"l"r.,.., ti" b..,'fv ,-• ax. .. ram% ti TOWN OF BARNSTABLE BUILDING DEPARTMENT i INARWST NAM ru = TOWN OFFICE BUILDING � 1639' �� HYANNIS, MASS. 02601 �0116Y�' MEMO TO: Town Clerk FROM: Building Department �t DATE: Ari� Occupancy Permit has`been issued for the building authorized by Building Permit #.. ::1... � ' 06 .».» » .».............. .............»».................... ..»»...»»»». issued to ...................»..�........»..................................... ...........»........ ...........:..............................»............»......... .....»»».»..».»......».»»..». »» Please release the performance bond. A s t- c� l 1 / o �, 4 v J' 5. 5 r, f; .�C�-c-. - S .I l IJJE:J fj pF'dT �T�ca�1 j'c ` ,, ,;► CERTIFIED PLOT PLAN IN Z j 8CALE, / ''_ moo DATE$ 7--"Pl.I, s Sr ,, I CERTIFY THAT THE SIDTEREQ LRellu'll ISTERSHOWN ON TH13 PLAN 19 LOCATED CLVIL ANOON THE GROUND AS INDICATED ANDVEY0R sum CONFORMS TO THE ZONING LAWS OF RARNSTARL MAS . ' 712'M A I N STREET RYA ....... '.... k HYANRIS, MASS. SHEET_„ OF.,:,_, TE REG. LAND SURVEYOR r.. + , It.v�� J(1,1�05••V�?,l?fl a/_V�. 4 s? i�' IM, i Rr� �. } •, ' 5 F 5,t,. X F 4 Z ;'>� A J:;, P .� X Y 'Z'f d Ft '' , t t - k 3 r •^b ix l p w i s y ` l J Y S 4 it J.h •d �.. 4 4 6'' /}�{ F- k f �Q � k .t` At; f + _ 1 4 x�' �J �`� �, :� �� •t '1 '. —sa t t 's 'r s {'4S, s 1,: O. M 'F r '4t yiY 4 t a( ,Rrf;.'• sJ' �zry G„�j -,[ t. r.: s`•` r '� L P� t s� ,(`�` � ` a\ � s �' t, k t i ,x 're!- 'l! kt srf 1 s .St d 1 M 'fa tft -r,c�as`s• 1F..- O S �`'lr ' s'� e ``�A.OFt'syjAS 'id U ,O PlAn •.• i §r .Pisi ..'.R t :. is , r. S?t ..�.0. ...� � .P: •,I a B. :•`' `' $,:4� No. 13vfo7 t1 f-r �,�„ P �..Y�.. pf s ,S„'V C"D r fyt LJ a "kin. s rLA L U n/ °'•" ' tr d 10 A a (t � f t" �,,+.r . _ V No."10951�Q - r - m Ni�`6��' �` ; EXISTIN® ``SPOT CERTIFIED PLOT PLAN EXIgTIN® CONTOUR O 't .R1.Nt8MED' SPOT' ELEVATION : , L 7 c/iPT �E4-L AMy Lit rF1N19>♦fEO.:CONT04JR — -- ,x b } �-, NQrI'E w°The aocation of any.:exzs t;in�Y under ound sewera,&e, swellshaor°.other.util?ties :showrt on tris plan is approx- I N ;r y :. i*gate°pnly �5 determined from r,ecords�and/or verbal ♦ 1 X t infgrmliti,on :-The contTact`or a.s `respQnsibl's fox; the y J r 'veri" cat 'o�i of the` existing 1`o'catia s in rthe,'fie'ld* scALE+ / ,,_ 4 0' DATES tex. �Y , �.` RED6E=ENG/E R/NG. l',ec- ✓3 CLIENT`_., :......;.. CERTIFY THAT THE. `PRO.POSEp 413TEFiEdfl? ;REQISTt:RhQ � J08 NO ° 3 -,. .CONFORMS BUILDINGS'TO THE HOWN NZONINO PIAWS , z * s GINUR OF. BARNSTABLE , MAS9, x °E }fit T 12 M A I N S TR E ET MYANN I S NlA�S: " 4 r s SHEET' ' OF:; A E REG. .LAND SURVEYOR t RT OF I LIT /10� -? 9C � c� f \ . AssessofAs map and lot'number ....o`i3b.�..:1.�.�'1...:.............. SEPTIC SYSTE ` INSTALLED IN COMPLIANC Q�pF THE TD�y ti Sewage Permit number lu.................. ............. ....... . WITH TITLE 5 ENVIRONMENTAL CODE A BA"STADLE, House number ............ �... .. .....................:........:. s rasa ... TOWN REGULATIONS po 1639 '�o gar a TOWN OF B tR NSTABLE t DUI,LDING jASPECTOR APPLICATION FOR PERMIT TO ................................................. TYPE OF CONSTRUCTION ....,f� .................................................................................. .............j TO THE INSPECTOR OF BUILDINGS: The undersigned here y applies for a permi according to the following information: Location .... 4. ............. 1....... ....f..u.'. Z..... ic%1. ... ..../... ...... �..4..�(�..rl. ./ �.......................... ��_ �•Proposed Use ...... �.�..... ... ....... .....4 � ................................................... .. .........................:,......................... Zoning District .... ... ... ........(.........................................Fire District ....... .... .............................. Name of Owner ...... 2.<'. .. ..i....Address ...f ....... .....4. ./..I~. /�//" Nameof Builder ....... .................• ......................................Address .................................................................................... Nameof Architect ............. .........:..........................................Address ............................................................................. ...... Number of Rooms ....... ................................... ................Foundation ..../.....C.l.�/�C�L......4.e.,c ... / f Exterior ....l�J/ . 1 .../�...... ...Roofing .....�.. ... .rat./ .3..�..................... r . Floors G/ .1 l l.,G ....................Interior ....... �./.�.� ��,�. ............................... �L'[/ / i� ............Plumbing .......... ...z.�' `J S Heating . ...................................... Fireplace ..................................................................................Approximate. Cost ........Z-115 (.,l. .�. Definitive Plan Approved by Planning Board ----- - --------19-y-- • Area ......... ....` ...... ......, v Diagram of Lot and Building with Dimensions Fee � �'�......... ............... . . . SUBJECT TO APPROVAL OF BOARD'OF HEALTH 0�� ell Ge) ry I� 3 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 ...../ ' ' Construction Supervisor's License ... .l'..,7. G,REENNAIER CORP. 11 Story No Permit for ..... .............................. Familykti, Single ...Dwelling........................................ Location ....Lot...9 67...Captain Bellamy Lane .............................. Centerville ........................... • Owner ..�R..E.E.NBR.I.E.R..CO.RP................................. ...... . . .. .... .... Frame Type of Co'nstruction, .......................................... .................. ....... ............................................... Plot ............................. Lot ................................ July 15 Permit Granted .........................................19 85 Date of Inspection ....................................19 Date Completed 9 el.t,? YA Fl, ri A zo -j -i Assessor's map and lot number .... .�0'...� �................... i 7M E Sewage Permit number ............... �� -/ry Z EARNSTADLE, i House number ........... ?...,A......................................... y NAG& ............ 00s�i639. \00 QED MAY p TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO J <-� .. C / �%! � /�Q . ..,..... .. .... .. TYPE OF CONSTRUCTION // !�/ *-''���.. Qr? ...... ................................................................................................. ............��1C P/�1. .. .. ..19.� r- TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permi according to the following information: �, Location c i'I .. .. ...1...`^ ......a. ...... 1...lGq./yl .,,f..(``�,1 C.i�r/f('......................... Proposed Use .......... �1.. ......,1..��...... C,!/�1�..... ...................................................... Zoning District �!..... ..... :......Fire District ....... ............ .................................. r r Name of Owner .....V�:.•�.C,'�'l ...�.�/....4�.�..!.e� .. :..r:. Address �0 . ..... Nameof Builder .......:-� /�'1. ......................................Address .................................................................................... . Name of Architect ..................................................................Address ...........:..................................................................... Number of Rooms .......�................................... ................Foundation .... .�).�t111�!.......1...�! �f. t. ....... Exterior .... �... . .. ...Roofing ..... e! !Gc/C:�.� .> ......... �........ / r C ....................InteriorFloors ...4. �....i•f..f..... ...... ........... ' ' . Heating / / . ............Plumbing . �C+. � Fireplace ..................................................Approximate. Cost ....... ........................... r Definitive Plan Approved by Planning Board __________________19_�S. Area .......................................... Diagram of Lot and Building with Dimensions � ) Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH 1 ' ? C µ _e 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 ... c ....... .. Construction Supervisor's License ..�.��. GREENBRIER CAP. A=230-119 a3d., r�-o No 28205... Permit for ....lz... tory.............. Single Family Dwelling ............................................................................... Location Lot 9, 67 Captain Bellamy Lane ................................................................ Centerville ............................................................................... Greenbrier Corp. Owner .................................................................. Type of Construction Frame .......................................... ................................................................................ Plot ............................ Lot ................................ Permit Granted .....July. ...15, 19 85 . ...... . r Date of Inspection ....................................19 Date Completed ......................................19 i PH �. � `oFTME Town of Barnstable P "o Regulatory Services Thomas R Geiler,Director � fAIiNSTABLE, � . 16 Building Division � Tom Per ry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 TERM IIT# ?61FEE: $ �,5-- r%J/oa SHED REGISTRATION 120 square feet or less vocation of shed(address) Zvi`L Village 'roperty owner's name Telephone number Iv 'ize of Shed /,o Map/Parcel# in e �— Date ✓dams Main Street Waterfront Historic District? d King's Highway Historic District Commission jurisdiction? nservation Commission(signature required) �r PLEASE NOTE: IF YOU ARE WITHIN THE AMISDICTION OF ANY OF THE ABOVE COMIIIISSIONS)THERE MAYBE A REVIEW PROCESS AND APPLICATION FEE, PLEASE SEETHE APPROPRIATE M CO USSION FOR DETAILSAP AP ' THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN LO 1 N o F P R R Y L ES MAY o-r E ACCU RA STANDARD LEGEND { NOTE:not all symbols will appear 0 a map GOLF COURSE FAIRWAY ,..('_. EDGE OF DECIDUOUS Ti�EES \ / EDGE OF BRUSH \ 4 ❑ / ORCHARD OR NURSERY — M ° 4 7 11:t EDGE OF CONIFEROUS TREES MARSH AREA 1 - -- EDGE OF WATER ....... . . . ..... 49 DIRT ROAD / \ ❑ DRIVEWAY 7 PARKING LOT t kid I�E PAVED ROAD ,ok.�1 — — — DRAINAGE DITCH — PATH/TRAIL / MAP 230 PARCEL LINE** I MnPtto E--MAP# ! � 80 #1 E PARCEL NUMBER f� 1 #teao E HOUSE NUMBER I/ / �j i � 2 FOOT CONTOUR LINE may ❑ I k —ice— FOOT CONTOUR LINE Imo/JI f / Elevation based on NGVD29 r / /4.9 SPOT ELEVATION It I STONE WALL ❑ X_— X- FENCE 1 i RETAINING WALL RAIL ROAD TRACK STONEJETTY P"" SWIMMING POOL PORCH/DECK —1 I ❑ BUILDING/STRUCTURE DOCK/PIER HYDRANT ° e VALVE O MANHOLE o POST pFP FLAG POLE T O W N O F B A R N S T A B L E G E O G R A .P H 1 C 1 N F O R M A T 1 O N S Y S T E M S U N 1 T .a SIGN ® STORM DRAIN N PRINTED SCALE:IN FEET *NOTE:This map is an enlargement of a **NOTE:The parcel lines are only graphic representations DATA SOURCES: Planimetrics(man-made features)were interpreted from 1995 aerial photographs by The James ❑ TOWER 1"=100'scale map and may NOT meet of property boundaries.They are not true locations,and W.Sewall Company.Topography and vegetation were interpreted from 1989 aerial photographs by GEOD UTILITY POLE w e 0 20 40 National Map Accuracy Standards at this do not represent actual relationships to physical objects Corporation. Planimetrics,topography,and vegetation were mapped to meet National Map Accuracy Standards LIGHT POLE O ELECTRIC BOX : 1 INCH=40 FEET* enlarged scale. on the map. at a scale of 1"=100'. Parcel lines were digitized from FY2002 Town of Barnstable Assessor's tax maps. 08/15/2011 02:43 508-7757625 JANET KRASKOUSKAS PAGE 01 67 .Ln Captain Bellamy m Ctervme,MA OM2 � TON F B-A w vII-S�ABLE en (508)7754140 , (508)73744S6 OCTi?3i = 09 (kak3@mn.com IVI1 N Fm I . Tin Jeff Lauzon,Bugdh►p WOPM Janet Kraskouskas 4 Faw (508}790-6230 Pie: t horn (508)862.40M Dabea 10/27/11 RM Therrnacore Garage Door cc: ❑Y ❑For RwvIew i7 l ❑rl�KNOy .` 1 Mme ftaycle ATTENTM.. i i Please find attadted the brochure a 'spedIRAMWns on the ThemOr.M garage door currently installed at 67 Captain Bellamy Lane, tervile, Thank you for taking the time Io review of this door_ 1 THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) MA- F DATA The (;rnuille. 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"� �,<, , ,Y.A ;�Me 1s^ :4'�a,,�b A+^!'! ,k'"'", Ir:,�'., �1 { �.af ,.r r. t t :vL' 1fi ,t.+ 'k,11 ^i,ae !Yi,;y`"ry• .� y , P��•4u. 1 U,1,lrff �J 8 ,bd1.,�rvh a @ 3r:}u« ft-T .,,P,„••,,,,,T W ?, :, nl'";,f;,err-.�'�,. 51}}�t f $at ( '� ap ��51 wJ rQ',t atsw �ryFrl a f;r '- M 'i 31 65 �1I41r�f11.�'�rillr i u I ,.� <tliA,'�F1 pirM1 08/15/2011 02:43 508-7757625 JANET KRASKOUSKAS PAGE 03 r; Panel style Model series - � Our Thermacore•doors feature a woo grain embossment to enhance the appearance of your or. Choose standard panels or flush panels, eatures.a continuous layer of foamed-in-place pol retha insulation _ sandwiched between two layers of r y rust- sistant, corrosion- resistant steel. ''^'.r"t°kw- - .. • .. .. �f1'i _ _ _ i rum _ •K° Standard panel(S) Rush panel(F) Color Terminology 'Polyurethane insulation:Our polyurethane foam Doors are available in the colors shown of insulation contains no CFCs or HCFCs(IW%water-blown can be painted to match yourOT4wraio foam)-Thormacore4l.section construction provides low U-factors for maximum wwgy efficiency. IR-value: A standardized measure of thermal efficiency. The higher the R-value,the greater the insulating properties. White Almond Sandstone Punter 'U-factor. A standardized measure of the rate at which bronze" green" the heat passes through.a material,tasted in accordance fAvailable in 190 and 490 Series ony. with DAShWs TDS163_The lower the U-factor,the "rAvailable in 190 Series only. greater the insulating properties. *Colors may vary slightly from these shown and F.nat be 'Backing: available on all individual series-See paining i for. . ifs Interior-side steel backing,standard on Thermacoree products,provides strength and a finished,dean Windload-rated door appearance, Our WindStorm"Windload rated system 5 available on selected products to meet regulations for a variety of windspeeds,ensuring your door is built to withstand varying wind conditions,including hurricane-force;.winds, and meet the most stringent local buildin codes. Windows Complement your home with custom-lo k window options Beveliteo acrylic elegance The beauty of leaded glass,without the added expense of custom glasswork_ "oafs; Obscure glass �Vfi xn To further enhance your door's appeararice, choose our obscure glass panels. G �+ "r}1•.' ' Obscure - .. 7: .�A!`!`'s: 'iF'ei'a "ti. �• t"P`�: `t The Genuine. The °P :. Original. - �� � W., a v ! t +,. r0 ( LIFI fIMF, Lifniic,d w�trr;int'y 1 i 'A I!c (;c�nuirlr. I Ilia (hi�in:fl. -' -�.gqg R PER ,;�r IjJkkr,�I6II �bh 01,