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0046 CAPTAIN LUMBERT LANE
r 111 Jn r , i r r u a N c • y m • n." , r w a. rs , v S fl a 0 r I� r , k e /R� f /- ^ se lam. ���►� E Town of Barnstable � E Regulatory Services Richard V. Scali,Director , „�,� ' Building Division BARNSTABLE OANNSiABIE•RNRNW IF•[9NIf•Itt•1NHI5 v� . ,erg. Thomas Perry, CBO - «,.n° N S•OS Y E•NE5 NWSABE 16 9. 1639-2014 Building Commissioner 200 Main Street, Hyannis, MA 02601 www.to wn.b a r n s t a b l e.m a.u s Office: 508-862-4038 Fax: 508-790-6230 October 8, 2015 Eduardo Franco 46 Captain Lumbert Ln. " Centerville, Ma. 02632 RE: 46 Captain Lumbert Ln., Centerville, Map: 147 Parcel: 011-007 , Dear Mr. Franco, This letter is to inquire on the status of building permit application number 201502125 issued to remodel the above referenced property. As you may recall,this office issued a building permit on or about April 24, 2015 and to date there is no record of any building inspections. Please contact this office to arrange for inspection or provide an explanation. Thank you for your anticipated cooperation in this matter. Respectfully, L. Lauzon Local Inspector teffrey.lauzongtown.barnstable.ma.us , (508) 862-4034 , f Parcel Detail Page 1 of 3 B El TA y, Logged In As: Parcel Detail Thursday,April 16 2015 Parcel Lookup Parcel Info Parcel ID,147 011-007 DeveloperLot (LOT 64 Location 46 CAPTAIN LUMBERT LANE I Pri Frontage Sec Road Sec ` Frontage Village ICENTERVILLE ire District C-O-MM Town sewer exists at this address!No Road Indexcoor +� �'° ` �® Inte a V; p - Owner Info Owner(BUCHANAN, GLENN C I Co-owner N-FRANCO, EDUARDO M& BADAN, NATH� Streetl 195 ROSELAND TERRACE City jMARSTONS MILLS State iMA Zip I02648 Country - Land_ Info Acres�0.58 _ Use Single Fam MDL-01 I Zoning IRC _ Nghbd 0106 _ Topography(Above Street I Road(Paved Utilities Public Water,Gas,Septic ) Location Construction Info Building 1 of 1 Year 982 Roof Gable/Hip I Ext Wood Shingle !) Built: 1 Struct Wall Living 1360 I Roof�Asph/F GIs/Cmp ( AC F None I Area Cover Type Style i 1Ranch �- Int Bed Drywall3Bedrooms __ s ➢� Wall Rooms A T0 es Int Bath _ *-4,4 any : Model Residential Hardwood I 12 Full-0 Half ( � t AFloor Rooms7. Total Grade Average Plus Heat(Hot Air [6 Rooms 5 ° F A { g I TYPe I _ Rooms I + T Story I Heat - Found Stories 1 St0 Fuel"""S � ation Poured Conc. r „�� 4 per» I Gross2920 _ _I Area- Permit History http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=9618 4/16/2015 f Parcel Detail Page 2 of 3 Issue Date Purpose Permit# Amount Insp Date Comments 6/1/1985 Addition 627954 $10,000 1/15/1986 12:00:00 AM CE ADD'N - Visit History Date Who Purpose 10/2/2009 12:00:00 AM Denise Radley Change of Address 7/10/2007 12:00:00 AM Paul Talbot Cyclical Inspection 3/12/1999 12:00:00 AM Donna Dacey Meas/Listed-Interior Access Sales History Line Sale Date Owner Book/Page Sale Price 1 12/7/2007 BUCHANAN,GLENN C C184750 $290,000 2 6/27/2006 BURNS, RACHEL M D1037573 $0 3 10/15/1982 BURNS,WILLIAM C& RACHEL M C89767 $72,900 4 3/15/1982 BAYSIDE BUILDING CO C88184 $70,000 5 2/18/2015 FRANCO, EDUARDO M&BADAN, NATHALIE M IC205579 1 $305,000 Assessment History Save# Year Building Value XF Value - OB Value Land Value Total Parcel Value 1 2015 $112,300 $27,700 $4,800 $143,700 $288,500 2 2014 $112,300 -$27,700 $5,000 $143,700 $288,700 3 2013 $112,300 $27,700 $5,200 $149,400 $294,600 4 2012 $112,300 $27,900 $4,100 $178,200 $322,500 5 2011 $143,500 $5,700 $2,400 $178,200 $329,800 6 2010 $143,400 $5,100 $2,800 $172,400 $323,700 7 2009 $140,460 $6,300 $1,300 $166,000 $314,000 8 2008 $163,600 $6,300 $1,300 $177,700 $348,900 10 2007 $162,600 $3,600 $600 $177,700 $344,500 11 2006 -$149,100 $3,600 $600 $188,000 $341,300 12 2005 $140,700 $3,600 $600 $172,900 $317,800 13 2004 $114,500 $3,600 $600 $172,900 ' $291,600 14 2003 $103,200 $3,600 $600 $46,600 . $154,000 15 2002 $103,200 $3,600 $600 $46,600 $154,000 16 2001 $103,200 $3,600 $600 $46,600 $154,000 17 2000 $81,600 $3,500 $300 $28,400 $113,800 18 1999 $73,000 $3,400 $300 $28,400 $105,100 19 1998 $73,000 $4,300 $0 $28,400 $105,700 20 1997 $80,000 $0 $0 $21,300 $101,300 21 1996 _ $80,000 $0 $0 $21,300 $101,300 22 1995 $80,000 $0 $0 $21,300 $101,300 23 :1994 -$74,900 $0 $0 $25,600 $100,500 24 1993 ,$74,900 $0 $0 $25,600 $100,500 x 25 1992 $85,000 $0 $0 $28,400 $113,400 26 1991 $84,000 $0 $0 $46,100 $130,100 ' 27 1990 $84,000 $0 $0 $46,100 $130,100 28 1989 $84,000 $0 $0 $46,100 $130,100 29 1988 $68,500 $0 $0 $26,200 $94,700 30 1987 $68,500 $0 $0 $26,200 $94,700 http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=9618 4/16/2015 r Parcel Detail Page 3 of 3 II 31 I 1986 I $65,0001 $01 $01 $26,2001 $91,20011 Photos - , ti {ft 5T ' er 5 C ' f http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=9618 4/16/2015 �vr)tsL-ICT LFl NE .� C� j Lc�--r... 41, ..x i w 2 5 / / Sys, Fl LE:- r. RTIFIED PLOT PLAN �y`N Of I R E j1 s I � 29814 ' F`C/STRfco.pQ �NO SUR�F'� i SCALE, I "-4O DATE, MOKWA BAys"V, E 1 CERTIFY• THAT THE WART.: -- SHOWN ON THIS PLAN IS LOCATED LEXIN ISTERED REOISTlER�ID ON THE GROUND AS INDICATED AND CIVIL LAND j.;Ala. �.. ..,,..,,.,. "'A .. CONFORMS TO THE ZONING LAWS EER Sd)RbEYaR t �lf ?'. OR ®ARNSTA E , ly3S. ®Ya �li 712 M A�I N S.T.R E l T .; H YA Iv Pi 13, Plfl A?' bkfta•T�`Olf" � DATE G .AND SURVEYOR E Assessor's map and lot number SEPTIC SYStEW MIUS °`7NEr��`o ............. ....Sewage Permit number Y.=..� 4 � ... '. ... INSTALLED IN COMPU '� � House number WITH TILE Z BABB$TAII E. I � .......... { / EN�'�aL CODE rb .............. ...�... ........ ........ � 90 a NVIRNN O 39 ..Aj�,O YPY{r TOWN* 0E - , BARNSTX1fI BU.ILDINA •INSPECTOR r APPLICATION :FOR PERMIT TO poi C4.. ....................` vrtr TYPE OF CONSTRUCTION lU:��. d.. ..... • .. ...................... . ...................... ........ ............ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for.a permit according to the following information: Location ... �............ ...........CoLt✓ ....................... ................................... Proposed Use ....1 .. .. ....................... ...J. :.... .. ZoningDistrict .... ................ ....... ........Fire'-District-'.'.. f1!?.. � ..........� ...,r.:............. 3 Name of Owner �/ '...!i!�!.�,1/`��m'.. �l :.f ....... .Addresss ...4: :.................................................................. l �92l..'... Address Name of Builder .. � vJ ...... :. !.�.�.............. Name of Architect Address...... :�. .......... . ......... ........ ......... .................... Number of Rooms ........ ........... ..:................. ................Fouridation ... . . /...[!!sG V l�rGJ... ...... .. Exterior .....�/`!`<. ..'..` .�/.�a�.. %.......................::.........Roofing ............ $� t f: .............. Floors �• •y.. ...:.. °' ... ............Interior ......,. , �(.. ..1:... ...................................... /// .........Heating ...�! ...'..�.:. .. . .,.......Plumbing ............Y. � .......... , Fireplace .........!L/41 ............................................. Appr+oximate. Cost .. . j.�. ........................................ Definitive Plan Approved by Planning Board:______________________________19 _______. Area .....�?.6............................. Diagram of Lot and Building with Dimensions Fee .........Ile.. ... ... ...................... SUBJECT TO APPROVAL OF BOARD OF HEALTH 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. - - L Name . .a. / i Construction Supervisor's License BUINS, WILLIAM 27954. Build Addition Z 0 ................. Permit for .................................... Single Family Dwelling . ............................................................................... 46 Capt. Lumberts Lane n .....................................I............................Location Centerville ............................................................................... William -B ui.n s. Owner . .................................. Type of Construction ...Frame......................... L............................ .............. ........I...... Plot ...... ...... Lot ................ .......... June,;-3 35 Permit Granted .............. ...... Date-Of Inspectio 9 r-1 ....Date Completed ................ .......I..IZ—' !�1 9 4, At !h t >/ F. e n. TOWN OF BA&STABLE BUILDING PERMIT APPLICATION , . 7_ Map Parcel 607 Application # Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee % Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Stree Address / �z1 - Village /! Owner Address Telephone " 3 Permit Request F100 ' AlL"Z_J� A A 4A0© GAO P-6- 0�*_Alg W11VANDIS PWP,6 MIA 61-r— op 4 an4au, & (NY7 &60dei 14 P IV6 60�n iA3ba,in Square feet: 1 st floor: existing proposed 2nd floor: existing oposed 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 0 Two Family ❑ Multi-Family (# units) a=� Age of Existing Structure Historic House: ❑Yes ❑ No On Old King` Highway:,❑Yet ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other - Basement Finished Area (sq.ft.) Basement Unfinished Area (sq. Number of Baths: Full: existing new Half: existing new M 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- :FQ--AtC.7 Telephone Number OX- 3/ 7 Address 4Ch4ll/ c License # Home Improvement Contractor# Email in1�Zo rnJ��► (cA �tNl�%IL. C.O Worker's Compensation # ` v ALL CONSTRUCTION DEBRIS RESULTING FROMIHIS PROJECT WILL BE TAKEN TO SIGNATURE G2 '- DATE l' �� FOR'OFFICIAL USE ONLY APPLICATION# r. t DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: / FOUNDATION FRAME . INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL c GAS: ROUGH FINAL FINAL BUILDING G �-� � �} 11� DATE CLOSED OUT ASSOCIATION PLAN NO. ' Deporftent nfImft st-WAcddkz* Offire oflnvmtigat5io>7s 600 Wkshiagtan Sired Bestm MA 02M t www-M=gnv/dia Worlo=' Compensation Insu - ce AfWryid Btalders/ConiracfnrsMed icians�Phm4bers Applicant Information Please Pant Le�t�TY' Name Pmh=do anal: --------------------- ass: _ City/StatelZip: f� Phone#: �Z3 Are you an employer?Check the appropriate bow JrTyp6eof protect(req , 1.[] I am a employer wig 4. ❑I am a geoe�-aI cm�actar and Iemployees(fMU and/or part ice). have bored$u mb-co actors6. New cans(roction 2.Q I am a sole propdefar or pmtaw- listed on the, d sheet 7. []Remodr1og ship and have no employees Zh=sob-cmftactrus bxm S. []Demolition ' wozid g for is =plo3'=a nd hmve workers, �j me co�� comp,incrtranrl.$ f I -E]�IIIZdnlg addhlon 09. We=a corporation and its. 10-Q Blectrical repass or additions 3.V,�l am aha�eowne�doing eII work officeas have exercised then II.El Phmbingrepam or additions myselt [No ems'=p• tight of exemption per MGL 12.Q Roof repairs fio m,,w reqah-mL1 t a 152,§1(4),and we have no employees.[No warktrs' 13•Q.Ofr cep.k=ance regah=Lj *Amp amH=atthat check,box#1 mmst also tM omttbc ioetioa bdoq+showiagthcawo k=,eOmp—,Mfio?Pommy i dD-29 n. t Hbmeawn=who submittbis a5davk mdkzft they ate doing d1 wa&and*=hire ovtsidc Om*actoa mmst sabmrtanew afnduk iadiea�ng mck tCoahactos that d=kthis box mint arched an additional shed showimgihe mine of the sob-coanaehus and staff whdhc or nattbose cd!ties hm - emphryea.If the sub-mnftumn hwo c=p1urc=:thy mqst Avr&sh=wow'c=p-PaUcy mmab= I inn as employer the zs pravidnsg workers'carrrperLs�ion uzcwYusre for trry r�loyees: Belafv it the po&cy arsd job site . usfarmr�oa• - -. ' Insm$nce Company Name: Policy#or Self--ins.Lic.A. FnationDate ' Job Site Address: Affach a copy of the workers'compensation poruy declaration page(showing the policy number and ezpkxdon(late). Fmh=to secore coverage as re pbu d ender Section 5A of MGL e.152 can lead to the imposffm of m immal penalties of a , fine np to$1,500.00 and/or one-year imprisonment,as weRfRs cif penalties in the form of a.STOP WORK ORDER and a fine of i3p to$250.00 a day against the violator. Be advised that a copy of ff2is st exxac t maybe forwarded to the:Office of Investigatiom of the DIA for fi mmmm coverage veaficatiom I do hrreby the p o fPerjaiy that the ir¢ormian provided above is t5ue�coi�rect + S• Data: — —/0 Phone#k 0117d l use o Do not�in this to be cn kted rcI}'• n5P b3'�' rove n�iriaL City or Town: permitlT.;�rre# - -kmxing,&-M&orifp(circle one): L Board ofReaIth 2.Bm1dmgDepartment 3.Ci3pfTown Clerk 4.MedxicalInspector-5.Phamb' h' specfor 5 Other CoriiactPerson: Phone fl Information and Instructions -r m=ac n setts Geheral Laws chapter 152 rega ins all employers to provide worker"compenm ion for tin'employees. pen,anf to this stir,an emplayre is defined as"_.every person in the service of another under any contact of bye, eqx=or mzpH4 oral orwzlru." An.mFlayer is defmcd as"an individual,partacohip,assocdafiam,carporafim or other legal eny,or any two or more of fhe foregoing engaged in.a joint c&mpase;and mchrdmg fh legal rePresmtdj-ves of a deceased employer,or the receiver or tru d=of an individD9 parfaerhip,association or other legal entity,employing employees- However fhe owner of a dwelling house having not mare than fb=apari menu and who resides therein,or the oecrq ant of the- dwelling house of anotber who employs persons to do maw cans1ruct on or repay work on such dwelling house or on fhe grotmds or building appurhmantlhereto shall not becanse of such employmed be deemed to be an employer." MGL dVtcr 152,§25C(67 also states that'every shde or local licensing ag xcy shall withhold$re issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicautwho has not produced acceptable evidence of cdmpliian.ce with the insurance.coverage required_" Addbionalb,MGL chapter 152,§25C(7)sty=uNeither f m comm®wealfh nor arty of its political subdivisions shall _-. enter info any contract for theperfmmauc ofpnblic wai cotmtl acceptable evidram of compligneevvith the fi sura ce.- rcgmmrmm is of this chapterhave keen presented to the coniractmg aafhoaty." ApPlim is , Please tall out f=worlcrlrs'compensation affidavit completely,by checicing the boxes ffiat apply to your sifnation and,if nary,supply S°ba° s)name(s), address(es)and phone nnmbea(s)along with their certzfcatm(s)of Liab P s withno es other than the Liab antes or I�.�d ) �p� insurance. Limited .r7.tt3'Came (LLC) �Y ��P � . are not to wailaze eusation iasmunce. If an LLC or LLP does have mcmbeas or ariners, regrtired rant' comp P employees,apolicy is regnin d. Be advised that this affidayitmaybe submitted to the Department of Indushial Accidents for confmmaim ofinsmance covmsgm Also be sure to sign and date-the affidavit The affidavit should be retuned to the city or town that the application fin the permit or license is being rcgnested,not the Depwiment of hulasttial Acd&x s. Shouldyou bane any questions regarding the law or ifyou are regmrod to obtain a workers' compeusafion policy,please call the Department at the nuzmber fisted below. Selfmscred campanies should enter.their self-insurance license number on the appropriate line. City or Town Officials f Please be sure that the affidavit is complete and priufed.legibly. 7be Department has provided a space st the bottom of the affidavit for you to frill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill is the penh/licemse mimber which will be used as a nfercuce M=ber. In addition,an applicant that must submit multiple PMMU liicznse applibatons m any given year,need only submit one affidavit indicating cmrent policy h fonnation(if necessary)and under"Job Site Address"ine applicant should write"all locations in (city or town)_"A copy of the-affidavit that has be=officially stamped or marked applicant as proofthat a valid affidavit is on file for fulime P by the city or town may be provided to the epp ' ' mutts or licenses. A new affidavit must be filled of t each year.Whe=a home at or.citizen is obtaining a hearse or pmmrt notselated to any business or commercial ve ritzre (Le, a dog license or pmmit to bum leaves etc.)said person is NOT regaired to complete ibis affidavit The Office of Investigations would like to thank you in ad==for your cooperation and should you.have any questions, please do not hesitate to give us a call The Department's address,Weghone and fax number: he CammoaWwj&ta£Msssarh DepadmeatofIndn kAct: dints Wice of lXvvewgatiom 6U(�� n Siz�t Tel.A 617 727-4900=t 406 or I-M MAS 'E 'Fgx#617-727 7M Revised 4-24-07R m s rsQ,gig 'imn atzarnstabie Regulatory Services �°Fn�r�uiy Richard Y.Scali,Director : Building Wvwon 4 Tom Perry,Building Commissioner 20.0 Main Street, Hyannis,MA 02601 y . wwW town.barnstable maats Office: 568-862-4038 Fax 508-790-6230 HOMEMM UCEM E EMMON' 1 DATE ®' — �— h --- - -- -pinuPriat JOB LOCAIIOhL {D V�1�t lid ,y I T.L.p� lei �► 6 G1'— f le tv,A number shmet sSz_s0K- 3 r,--.`► 31 , name home phone# wow phone 9 CMU NTMAII.INGADDRESS: 1lD ( YVL LAJ' city/tDVM St&. Op code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor_ DEFINIITON-OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use,and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the burl ;ne 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 ua rsigned"ho eowner"certifies that he/she understands the Town ofBainstable Building Departmentminimum inspection and re he/she will comply with said procedures and requirements_' ignahuz of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control } HOMTOWIM'S EXE aUION , The Code states that: "Any homeowner performing work for Which a building permit is require"d shau be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are naaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor..The homeowner acting as Supervisor is " ultimately responsible. To ensure that.the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the'responsibilities of a Supervisor On the last page of this issue is av form currently used by several towns. You may care t amend and adopt_such a form/certification for use in your community. ; Q:IWPFUM\FORIMUbddmg permit h=UWRESS.doc Revised 061313 Town of Barnstable ' Regulatory Services ' ' KAM 'g► Richard V.Scab,Director tbsy. ♦� Bundling Division Tom Perry,Building Commissioner 200 Main Street;Hyannis,MA 02601 www.town.barnstable ma.us Office: 508-862.403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This.Section If Using A Builder 4 , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized bythis building permit application for. (Address of Job) *,,"Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or uttli'zred before fence is installed and all final inspections are performed and accepted S>a ahurn of Owner Signature of Applicant Print Name Print Name Date QTORMS:OwNWER IISS1DIeWIS Y� p 1 i y I rr R 8 Ll - s i vA O� ''iJ / \' r Solid Pine About Delivery... What sets Sheds USA ILL STOP r• SCREENHOUSES t ► "Sheds USA will acknowledge BYapart from other r MAIL the receipt of your order. ' �ovel Y addiEton �o an artx/ . ► `Sheds USA will schedule delivery by storage shed companies.- UNFINISHED FURNITURE • NOODENINARE • CRAFTS ' contacting customer one week in ji' DENNISPORT• W.HARWICH • W.YARMOUTH • PLYMOUTH PA E: UNSURPASSED CUSTOMERS SERVICE! NEW BEDFORD • CANTON • FALL RIVER,MA advance. �_' �. a....---:.,� � -- _, •� _: , � NASHUA,NH • SCARBOROUGH,ME ► yPlease know in advance any important //// // !, .J�tere J w4at our cWtomer-4 jay: details (location of nearest electrical outlet, directions, etc.) i "Outstanding... (the crew) went out of . I ► Skilled craftsmen completely their way to show the utmost courtesy, b "Y • respect and consideration." ' assemble shed on site. p R.T., Nashua, NH - E Many thanks... the quality of your - > product will be brought to the attention of neighbors and others..." ti —R.C.,Pembroke, MA Shed Construction- I• • "(The office staff was very helpful and rSite Preparation I friendly. WAILS " 1 —V.N.. Tiverton, RI s .r •_2x4 construction,24"on center When selecting your site please consider `Your construction"crew.left the yard ( � i • Pine&cedar I"tongue&groove. the following factors: immaculate. (horizontal) • Texture-ill.exterior siding(vertical] CLEARANCE —E.P., Plymouth, MA ...very competent, neat, polite and Remove tree branches or other obstacles, _ ROOF::.po� " K 3 around perimeter of shed and 9' aboven�y " -R.P.,Franfi klin Square, NYC • 2x4 construction,24 on center. r - GRADE -Manks again for our ollow-thro h `¢ • Self-sealing asphalt shingles w/15 year s ag f y f uy Land must be less than a 6" slope,with and diligence." t. AGE • Heights—8'wide standard=s 3" no protruding rocks or stumps the —L.R., Nashua, NH t: g STOR 8'wide gambrel P P j r area , —10'wide standard�8'11 . ". ' = courteous efficient and professional." F - -10'wide gambrel s 5" ACCESS —J.M., ocean Bluff, MA ( : HEDS FLOOR ti Shed is delivered in prefab sections; clear. , i- UNIQUE 10-YEAR WARRANTY• 5/s"plywood y access to site is necessary—stairs, nar / • 2x4 construction,16 on center for TOW walkways,fences,gates, shrubs, etc. Sheds USA, Inc.warranties labor, materials �• �� L / 10'wide units ac oN 'dip o you! Pressure treated floor joists optional aae difficult to maneuver and should be 1 and structural soundness for 10 years with II. y noted proper maintenance. This warranty does not WINDOWS 3 ' include fire,flood,windstorm or neglect. • F�Inctional windows w/flower LM� QUALITY Customer must stain or preserve building ] and shutters within 60 days of delivery. SHEDS USA boxes Consider other factors when choosing , 8x8,8x10 and i0x10 units include one i No other warranty is expressed or implied r window.An others include two your site, including proper drainage, , P.O. Box 6622 fes by any employee or sales agent. firmness of earth, etc. { Portsmouth, NH 03802 DOORS ' ;.�; - 1 . FINANCING ; -40"double door.standard . s PERMITS (603) 431-8489 •Optional s787 ;t } 100%financing available at selected locations." p Ingle and double doors up to Permits are the sole responsibility of the Loin interest rates, 90 days same as cash with j y 4 homeowner credit approval. See salesperson for details. *Ask about our 100% financing!, .tea...w...w.r•., ....fr .r'.yv t r., .:.•:' . ..'":1 c. an ar CED AR ► • Custom Placement*of door(s) and • window(s) at no charge vh, —shown in 8s12 —Shown in 8%14 r ► Choice of siding Texture-111, Pine or f G Shown in 8%10 „ x , Cedar ., ,.. -'-, .J..�..,... ... ...........:...�..+ ...:ti..�=:••S ,..'z '�1°•�^z'4 kKs, .. � Gambrel' w• �;'' Z �,r,.� ► Choice of roof styles•.Peak or C3am 1 no additional charge 1 ► Asphalt shingles—choice of 3 colors . ' I j , _ , :' ,1 ___ __ -, ;_.....��._ • .+Y�- •y ► Functional windows— 12'wide sheds and _ +.. _rill! larger have two windows with flower s ! !�, boxes and shutters 5/8" exterior plywood floor, 16" on center I ► 5/8,. exterior plywood roof tee• - - - i �, 1 J ; `�'� ' - Q_ _ v:- I + ' �i �..��,.t sl S ._ `. �; ),41! �I ► Heavy-duty 40' double door ► All galvanized nails &hardware included ► Concrete blocks used for foundation a ► 1•`ree delivery&setup to most areas • J. s - r _ hfxi nn // / D 7 ,�t�ove unit elwwn with�amb.reG d �e ► Most popular material Options ► Vertical exterior plywood siding t a. / a c e P. xa :. roo�and optiona6 26���'n� �or $50 00 " �� ► Withstands all types of weather Upgrade to 54" Double Door............. .... ► Durable ,y�r E: gu Y gr $95 00 •, _ le Door.... ► Classic ton a-and- oove a to 66" Double f ► Same quality features as cedar _ d we r-resist pgiad bl •• ` r u a LL. „ x;r construction ► 125.00 Durable an the ant andpine models . .,,. -� .�.;' , . , , . ,.. '};y�� M, _ r _ insects 26" Single oDoor D............................. ............$7 r . easant aroma naturally repels ' 1 w ed Economical _ .,; u ► Affordably is .... P ► and resists rottin Extra Window $ 60.00 g (includes window bax and shutters) r",t ► Ages beautifully Vents (pair) ............ $30.00 k Screens. ... ..ea. $15.00 • Exc ent base for stains and paint ., ► ell or . k ,,,,,. x - J Obi �'LP,eC� LL' • • • s ' ', ; ' ® ' ► One of the most stable es of lumber; bra 54 Doo ........ o Extra 40" Do .... $90 00 ! typ r $115 00 `. resists warping and buckling " Y „.; . ...your car has never seen the in x I i+ '�� !'f Extra 78 Door........................................... Extra 66" Door $145 0 of your garage. a r 5 P • I _ _ treats ) .......................$50.00 $155 00 tx �".a (ry' q I - — Ramp (4' pressure-treated) passers-by look at your lawn and - - _ — of (in-house)1; �'�l i I ; l k Custom Pool Filter Hole (in-h e). $75 00 ask if you're having a yard sale. I I _ ........ 99 Zar Exterior Stain ..... gal $24 _ Shed Uses...your basement's storage capacity ' d.� .'+ -- �` (We're proud to carry Zar stain for the tr�eown&of our ends at the last steps j� D j� sheds-available in clear,cedar,gray.brown&redwood) ••,the condition}of your workshop/' F` 4ti. 1 /"wl (..a�"'ui, �"r r �6�'eaE, Pressure-Treated Floor Joists craft room is affecting your marriage. c r z DD DD Q' a ular 6ayout� iild �lueouse, �rtisE e u to e ' { u p j �ca i�one o�o r mojt op you've been injured tnppfng over' , n •••••• 60 00 r rr ' 10x ... ndl a , �ue� // or D / / /a �tud� t ��/,abin + 8x10 $30 00 1Ox12..... $60 00 ehildren's toys �2ro `r r r; ,, , �t�r wct4 jui`e door on the gable en a C, _ door avalanche.. ` - D DD / ...opening the garage s >, xy .� >` optional 26 oin�Cle door in/font... eae� g $50.00 x14 cc77 ., tractor.�a ale' ,•� 8 $40 00 1Ox16 .. $7 00 acce�o or riding lawnmower anc`640d owner , ..r.._agne-_�•�• ,+w.•-r"r•�---r .v r: r r t:i Town of Barnstable *Per mit# `6� � Explres6rnonths�issue � Regulatory Services Fee Thomas F.Geiler,Director Building.Division Co ,��-)27)®� Tom Perry, CBO, Building Commissioner "J 200 Main Street,Hyannis,MA 02601 www.town.barnstab le.ma.W Office: 508-862-4038 Fax: 508-790-6230 i EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 141 — 0 1 1 + o it Q �P I Property Address TL r-4- L�, &kfg I [fResidential Value of Work J lI'J 0° 00 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address G1 f1 b/ -1*ulvl Contractor's Name �V9 Telephone Number 79 0 4J�9 Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) 1 1J 00 ❑Workman's Compensation Insurance � ��� � �� Ch one: I am a sole proprietor �00 ❑ I am the Homeowner MAY ❑ I have Worker's Compensation Insurance TOWN OF BARNSTABLFF Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request check box) _ Re -r o o f (stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over- existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***N=ropewvmnroperty Owner Letter of Permission. ement Contractors License is required. SIGNATURE Q:Fmmu:expmtrg Revise061306 - The Cammamveatth of Massachusetts Department oflndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 ` www•m ass.gov/dia Workers' Compensation II1Surdnce"Affidavit: Builders/Contractors/EIectricians/Plumbers " Applicant Information Please Print Legribly Name(Business/Organization/Individual):• I Q Address: o. K „� City/StatdZip: OnhS Phone.#: Are you an employer? Check the appropriate box: 1.❑ I a employer with 4. [] I am a general contractor and I Type of project(required): �Ila oyees (full and/or partitime).* have hired the n.b-contractors 6• ❑New construction2. sole proprietor or partner listed on the'attached sheet 7. ❑Remodeling ship and have no employees Thew sub-contractors have g, Demolition working for me in any capacity, employees and have Frork-ers l [No workers'comp.insurance comp.insurance.# 9• ❑Building addition required.] 5. Ej We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself [No workers' comp: right of exemption per MGL -y� insurance required.] t c• 152, §1(4),and we have no 12.Xoofre'pairs employees. [No workers' .•13.❑Other comp. insurance required:] *Any applicant that cbecks box#1 must also fill out the section belowsbowing 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. tContractors that check this box must attached an additionalsheet sbowing the name of the sub-contractors and state whether ornot those entities have employees. If the sub-contractors lxvc employees,they must providb their workers'cornp.policy number• Yam an employer that is providing workers'information. su compensation inrance for my employees Below is thepolicy and job site Insurance Company Name: Policy#t 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 tip 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$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investijzations ofthe JDIA urance coverage verification. Ido he eby ce :t er th ns. dpenalties ofperjurythae the information provided a ove ' true and correct; Sienahue: C rn n Q . Date:. Phone #: -- Official use only. Do not write in this area,'fb he,or town affciaL City or Town: Permit/License# Issuing Authority(eirde one); I.Board of Health 2.BuildingDepartment'3.City/Town CIerk 4,El 6, Other ectrical Inspector 5.Plumbing Inspecfior Contact Person; Phone#: t Op 1NF 7 Town of Barnstable: Regulatory Services �aNszABLE, �9 ,�$ Thomas F. Geller,Director Alfo �A Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable,ma.us Office: 508-862-403 8 Fax: 508-790-6230 Propexty Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property herebyauthorize CVA Cq to act on my behalf, I all matters relative to.work authorized by this building permit application for: .. (Address off ob) LU 4LE1 0 q Signature of Owner Date Gimp L 0A. -pkfl Print Name Q10PUMS:OWNERPERMIS S ION - iVIassachusetts - Department of Public Safety Board of Buildin Reirulations and Standards NW Construction Supervisor Specialty License License: CS SL 99138 Restricted.to: .R F,WS JAMES CURLEY I 287 FULLER ROAD.. j CENTERVILLE, MA 02632 j c cJ�� yi -Expiration: 1/28=12 Commissioner Tr#: 99138 Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT'CONTRACTOR before the expiration date. If found return to: Registration:;424310 Board of Building Regulations and Standards Expirationj}/2009 Tr# 130873 One Ashburton Place Rm 1301 Type individual, Boston,Ma.02108 James Curley James Curley 287 Fuller Rd. Centerville,MA 02632 Administrator Not valid without ' re ' l R 6 310 CMR 10.99 Form 2 File No. ED:A- I :97:0:06H E Tp� CitytTown Barnstable Commonwealth = BAsasTss>:X _ of Massachusetts ryes 9 q iicant Burns Oggpp %639• �� PP 31c5_ _ Dec. 30, 1996 Date Request Fled Determination of Applicability Massachusetts Wetlands Protection Act, G.L. c. 131, §40 TOWN OF BARNSTABLE ORDINANCES, ARTICLE XXVII From Barnstable Conservation Commission Issuing Authority To William C. Burns same (Name of person making request) (Name of property owner) 46 Captain Lumbert Lane Address Centerville, MA Address This determination is issued and delivered as follows: by hand delivery to person making request on_ Lp,-_ kG 0 (date) by certified mail, return receipt requested on (date) Pursuant to the authority of G.L.c. 131, §40, the Barnstable Conservation ro>mmi ssi nn has considered your request for a Determination of Applicability and its supporting documentation, and has made the following determination(check whichever is applicable): Location: Street Address 46 Captain Lumbert Lane Centerdil 1 e Map Number: 147 Par�Pl Nnmhar• 11-7 1. ❑. The area described below, which includes all/part of the area described in your request, is an Area Subject to Protection Under the Act.Therefore, any removing,filling, dredging or altering of that area requires the filing of a Notice of Intent. 2. The work described below,which includes all/part of the work described in your request, is within an Area Subject to Protection Under the Act and will remove, fill, dredge or alter that area.There- fore, said work requires the filing of a Notice of Intent. Effective 11/10/89 2-1 DA-97006---Burns Conditions of Approval: 1. All clippings,palates and other debris shall be removed from the wetland by April 1, 1997. s 3. C' The work described below,which includes all/part of the work described in your request.is within the Buffer Zone as defined in the regulations.and will after an Area Subject to Protection Under the Act.Therefore, said work requires the filing of a Notice of Intent. This Determination is negative: 1. C The area described in your request is not an Area Subject to Protection Under the Act. 2. p The work described in your request is within an Area Subject to Protection Under the Act,but will not remove, fill, dredge, or alter that area.Therefore. said work does not require the filing of a Notice of Intent. 3. ( The work described in your request is within the Buffer Zone.as defined in the regulations. but will not alter an Area Subject to Protection Under the Act. Therefore, said work does not require the filing of a Notice of Intent. 4. G The area described in your request is Subject to Protection Under the Act. but since the work described therein meets the requirements for the following exemption.as specified in the Act and the regulations, no Notice of Intent is required: Issued by Barnstable Conservation Commission Si (s) .. This.Determination must be sinned by a majority of the Conservation Commission. On this day of 19 . before me personally appeared L4 to me known to be the person described in, and who executet. the foregoing instrument. and acknowledged that he!she executed the sam as hisiher free a�t nd deed. m 1 My COMN41SSIGN, EXPIRES SEPT.27,2002 Notary Public My commission expires J J 'This Determination noes not relieve the aooticant from comoiying with all other aophcable tegeral.state or locil statutes.oroinances. by-laws or regulations.This Determination snail be valid for three years form the cafe of issuance. The applicant,the owner,any person aggrieved by this Determination,any owner of land abutting the lano upon which the proposed work -, is to be cone.or any ten residents of the city or town in which such land is located.are hereby notifieo of their right to request the Department of Environmental Protection to issue a Superseding Determination of Applicability,providing the request is mace by cendiso mail or nano delivery to the Department,with the appropriate f fling "and Fee Transmittal Form as provided in 310 C41R 10.03M within ten pays from the date of issuance of this Determination.A copy of the request shall at the same time be sent by cenif lec mail or nand delivery to the Conservation Commission and the applicant. 2-2A Engineering Dept. (3r� d fl oo ) Map 7 Parcel z Permit# r V 8 40 7 House# S - Date Issued - Board of Health(3rd floor)(8:15-9:30/1:00-4:30) Fee dam' Conservation Office(4th floor)(8:30- 9:30/1:00-2:00) w pFTHE rd 19 BARNSTABLE, QED MPS�`� TOWN OF BARNSTABLE Building P rm' Application Project Street Address Village Owner Address Telephone __ — `7 9 69 Permit Request x / First Floor square feet Second Floor square feet Construction Type 60 e- Estimated Project Cost $ Zoning District �e/ Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No 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 No.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 Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use 14-2-21 Builder Ibnformation Name Q -J_ - Telephone Number 0-5 Y-3 Address'= Q ,�' µ �b� �: .�, License# Home Improv ent Co trac r Worker's C m�on i 4?3° 50/0 r _ �/1 `f NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL S�do& PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE ,/ t2_ DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. O a DATE ISSUED MAP/PARCEUWO M ', ADDRESS VILLAGE. f OWNER DATE OF INSPECTION: 1 FOUNDATION FRAME t INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. IME fn. The Town of Barnstable • sexivsrnsie. • 0� Department of Health Safet3 and Environmental Services 'OrEon��° ' Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only t ,. Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATIdN s 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,alo with other requirements. Type of Work: Est.Cost / 9_O O d D s Address of Work: Owner's Name L,)del ,,-,) Date of Permit Application: /.2-— I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner 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. OR Date Owner's Name • A ' HOME OWNER'S EXEMPTION The code state that: "Any Home Owner performing work for which a building permit is required shall be exempt from the provisions of this section (Section 109. 1. 1 - Licensing of Construction Supervisors) ; provided that if Home Owner engages a person(s) for hire to do such work, that such Home Owner shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for licensing Construction Supervisors, Section 2. 15) . This lack of awarenes often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home'Owner-' actin as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/Fier responsibilities,. man communities require, as part of the permit application, that the Home Owner certify that he/she understands the responsibilities of a supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE •: ---� `--fie . -••- JOB LOCATION - Number 7qfreet ad ess Section of town "HOMEOWNER" -11790 Name Home phone Work phone - PRESENT MAILING ADDRESS City town State Zip code The current exemption for "homeowners" was extended to include owner-occupied dwellings of six units or less and to allow such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to re- side, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"- shall submit to the Building Official on a form acQaptable 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 Stat Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands .the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will compl with said procedures and requirements. HOMEOWNER'S SIGNATURE r APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 0, Construction Control. Information and Instructions ' Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for thei: employees. As quoted from the "law". an empl(�ree is defined as every person in the service of another under any contract of hire, express or implied. oral or written. An enrplt rver is defined as an individual, partnership, association. corporation or other legal entity. or any two or more 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 haying 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 hoE or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer MGL chapter 152 section 25 also states that every state or local licensing agency small withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant N-.-ho has not produced acceptable evidence of compliance with the insurance coverage required. Additionally. 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 h been presented to Elie contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to ;your situation and supplying company names. address and phone numbers as all affidavits 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 requires to obtain a workers' compensation policy. please call the Department at the number listed below. City or 'towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom o the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Ple. be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any question please do not hesitate to give us a call. •---.. The Department's address. telephone and fax number: The Commonwealth Of Massachusetts •Department of Industrial Accidents Office of investigations • 600 Washington Street _ Boston,Ma. 02111 fax #: (617)727-7749 nhone 4 (6.17) 7' -'(100 ext. 406, 409 or 3 75 The Commonwealth of fassach usetls Department of Industrial Accidents Office o//nveSM191 MS -�� ;;f; _ y�; 600 11'a.0ii igron Street `� �►� Boston, Mass. (12111 Workers' Compensation Insurance Affidavit 1' ant mt rniati Pligep ^• location- r / 1 am a homeowner performing all work myself. I am a sole proprietor and have no one working; in any capacity __ e � ._.��..:••..n..ws ^^.-�•r�:�'T...s.......�„r'as.w.�swR�rK`r��vs!tfltF'�.:..•►"`r .w�..K...'.!!• "_!�. ..� _ I am an employer providing workers' compensation for my employees working on this job. ont .nv name: address: city- phone iY• incurince co Jt^lice f! - 1 am a sole proprietor. general contractor, or homeowner(circle one)and have hired the contractors listed below who havZ the following workers' compensation polices: com am• name: address: On phone 4. insurnnee co 7. cnm any name: •tddre c- cite•• phone 0- - cur�ncc co policy a .Attach addititinai shot t if necess _+ �� "^""s'.<== `.= r.•....•. �.._,. n 'a..r..�a .. •'• �y M"•�%;'�• ;.z;d Failure to secure coverage as required under Section 25A of 11GL 152 can lead to the imposition of criminal penalties of a fine up to 51.500.00 and/or one Nears'imprisonment as well as civil penalties in the form of a STOP'WOR1:ORDER and it fine of S100.00 a day against me. 1 understand that a cope of this statement may be forwarded to the OMce of Investigations of the DIA for coverage verification. 1 d terebt•certij under the pains arrd penalties ojperjuty that the information provided above is tru nd correct. Signature l,�/L� e` C/y_/� Date Print name Phone# official use unh do not write in this area to be completed by city or town official sit} or town: permit/license# rilluilding Department OLicensing Board check if immediate response is required 0Sciectmen's Office Cllcaith Department contact person: phone#; nUthcr�_ --- �. (m ised;,)5 ri.a i �1 c� �„�• TOWN OF BARNSTABLE Permit No. ------- sauxasc Building Inspector cash.A.Y` ________________ ,639 WAI OCCUPANCY PERMIT Bond l O No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to -;V�I.'�nt?3.�.r�*1� fin, s I(7,r, Address Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department 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. ...................................................... 19 ._ _ ...................................... _.......... Building Inspector �_ +a a x i}r+,r+t + �.'��, •�° t a a- 7$r�, r. -� P x dr+i . "• r Y ` .- ' 1 / Yr L.. / d+e ki ,�� S f d tit i + \v {t NE m of 14 4-0 ` t l A,. j,`8. m rr ► r c fi p C i , 3 r rs 4 +'fir s y pd i� ��t i S+.-y �?Q fit L_�I•..�1...r 1"—�--• r ,r :' _ .. � 1 v ,� •- � � ��Cfki 0.r rf :� f �l_J�JI..�/ r ;S y, xa ,aat 01— y .y F. D ° Z C\ x \ry •'n[ Yc �,'§ r:v f5: �r�t'�1O(y' e�(\ Lam, p • '.*• `� -)q 3 r < �7'� ��Cf'�F f,7 •x ,�fir. ,�7{ .Y\R' I.O C.C. d'' J� , � s � a id �t y..• s x1na{i r r Ar c, - --�—— — q N�i,� v, -qTf RTIFIE® PLOT PLAN- OF flair 29 CAIG7, L g E a :g C'E/17-E 4"1 L- /_ IN olsice' Fµ ea ;SCS61.E: -40/ DATE d.D E E �1 / �. ��y.S,► 1.`�EPTIFY THAT THE ���N.� laA! � HOWN ON THIS PLAN IS LOCATED 9GISTEREO RE I>IITER 8l 3 ON .THE AROUND AS INDICATED AND. CIVIL tAAM ` 'y ,. EN®IIdEER SURVEY "' OQFO9�MS TO THE ZONING LADS f i ARNSTA E, SS. T•12' M A f Pal ".T:R E '< H YA NA 15 M°IDS& I~I �Tb, „OPw u;.: " '®ATE G LAND SURVEY ON Assessors map and lot number y: / p e SI*P�'IC SYSTEM DUST BE �P,,of7NE,o�o Sewage` Permit nwnber &.2. ............. 114STALLED IN COMPLIANCE WITH T i , : ,f House number ITLE 5 BasasTa Ls '� MAB :.................. .....��............... j,ENV ®NMENTAL CODE ���_ '°o ,"39 0� A q� h\ TOWN. OF -'BA:RNSTABLE o-130ILDING k INSPECTOR APPLICATION FOR PERMIT T w ' ' / ........................... TYPE OF CONSTRUCTION ...... 90QW�'................................... .......................................:........ ... ........... .....3Q.............19.. .. TO THE INSPECTOR OF BUILDINGS: The undersigned h reby applies for a permit according to th following information: Location ...�� 2.�........./.1 :...........................CAS.. ....��,�.�.��.. .�.r..�1 . ....... ........ ..p1. .......... ................ / ProposedUse O/.Vf,- ..f`. .................................:..................................................................................................... Fire DistrictC� 2�Zoning District ...............A .......... ...... ............... :. c aA............ ........ Name of Owner �G1 /. ......... ....:.. .. . ..............Address / . .... V&.............. Name of Builder- . .. ... . . ........ ........ ...................Address ..... ..... ... ....................................................... Name of Architect .. ..........Address...... .. . ... ... .. . . ........... Number of Rooms .......... .......................A................................Foundation ..®.. ...... .......:........ ....... ...... ................ Exterior(1"''F�... :..... t ..? :Roofing ........... .J.�.. ... ." .� „ U ..................... ' Floors ^. ... .`.... ...J•% ".....................................Interior .............:..........�. / .... Heating ......°...........�........................................................Plumbing � �'{. ....... Fireplace ......,//"e ............3.4�.5.................. .........Approximate Cost ...�`.../........:............:............. ................ Definitive Plan Approved by Planning Board ------- - 19 Area / -- - - ---. :....... ........... Diagram of Lot and Building with Dimensions Fee ........... V SUBJECT TO APPROVAL OF BOARD OF HEALTH l�1 3 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstabl re or joe above construction. (� Name .................. .. j BAYSIDE BUILDING CO. , INC. 24269 One Stor ................. Permit for .................................... „.; Single Family Dwelling . ........................................................................!...... Lot #29 46 Captain Lumber' is Lane Location ................................................................ 4 Centerville ............................................................................... Bayside Building Co. , Inc. Owner .................................................................. I, TyRe'of Construction ' Frame ........................................* ...................... Plot ......................... Lot ........... .................... Permit Gr nted ....A.qg.'V9J;... ...............19 82 .................19 �e Date Completed O.-327.?_ 2................19 n ,4 % ,/ Az Assessor's map and lot number ..., L !/�� ' Q�Of THE Sewage P rmit. niimber ' (( /] Z B9HH9TADLE, i House number ......................................... .!. ......t'�r'.cl. ro rose / o iv39'a\00� • �MAY TOWN OF BARNSTABLE _ BUILDING INSPECTOR m APPLICATION FOR PERMIT TO ............................7`f . ...:. :A...... (:!....... ....................................................... TYPE OF CONSTRUCTION .......ri1::t .... f.!n'`: ... ......................................................V...................... ............................. ..............19......... r ,r TO THE INSPECTOR OF BUILDINGS: ' The undersigned hereby applies for a permit according to the following information: , , t Location ....f... .. .`..i. ...........:..'. � ..'.....................................................` 1 ............ ................................................ PropoProposed \ sed Use .... ' :!........:G.......,, ......................................................... .... ...................................I......................... Zonin District +'�!�, �"" . !f. ' .... Fire District ! 5 ............ 9 / .. /, Name of Owner 11. �!'`S' .a ,�-'1i 1�«� ?....:..... .Address .... ................................................ Name of Builder' . /!/..... ... ..................Address .. v .....� Nameof Architect ........:..............................:...........................Address ......:� ................................................. v � ..........................................................." f Number of Rooms ..................................................................Foundation 1.. �y- Exterior �� 1 �. - .... f'7 Roofing f 14 /�' 11,,,..................................L .... .......................... ................................ 9 U " ' Floors . ........ ..:t�. ....................Interior d i Heating ..................................................`..............................Plumbing ...............;{.........f ....................... ..................... r r - Fireplace .........Approximate Cost ..� ...................... Definitive Plan Approved by Planning Board ___________- ___t__________19_`__t__. Area ...... r......r ... .......... °l �S, Diagram of Lot and Building with Dimensions Fee \ SUBJECT TO APPROVAL OF BOARD OF HEALTH �� /' _ F ► -) r v � r OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ............................... ........................................ :...... BAYSIDE BUILDING CO. , INC. A=147-11 24269 OnerStor No Permit for y00.7 ' Single Family Dwelling ............................................................................... Location ,Lot #2 9 46 Captain Lumbert Ln. ............................................. Centerville ............................................................................... Owner ...Bayside. . . . ...Building. . ...Co.........Inc. ..... .... .. .. .. ....... ....... ..... .... . . .... Type of Construction Fr.ame ..... ............................... . s ................................................................................ Plot ............................ Lot ................................ Permit Granted August 6, 82 ..................................19 Date of Inspection ....................................19 Date Completed ......................................19 `v O � , C 4-1 Assessors map and lot number ........,... ... .. . ......n. �Q�oFrNETo�o ' . Qa ^ o ► .. Sewage Permit number ......................` "1..� .......k..... ro Z SAUSTOFILE, i House number - raea /.....�. . .... ................. 1639. 0 MAY TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ... J&. ..`....... .. `-"t.......�... r'n:.................................. TYPE OF CONSTRUCTION ..... Ui9 ?... . ....F4 ALI ...............................................................................................f ! .....`�.(...................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: ,Ile � .� .� ►�� .... .�. f .......................................................................... Location ........:.................. ...........�.......... ........ ProposedUse ........ .... .....'.............................................. ............................................. ......................... Zoning District ........................................................................Fire District . . !` DS.. ................................... Name of Owner .... ...........!.?A................UM.... .............Address ............. ............. .......... Name of Builder /� ../: S .........................Address �.5 .� y/�ti/dv Name of Architect ............ ::.. ................................................Address Number of Rooms ........ .......................................................Foundation ... ......Y � — ��/, C - /rti ...Roofings /}/ - Exterior .....�!.......... ........`."/.....�.�i./G.S............................... .................�. Floors _�'N V. !..................................................: .......Interior ..........�// //(, Heating C',s./ ......................................................... Plumbing .......:..�(/ ... ......... .................................. Fireplace ........14.vel..........................................................Approximate. Cost ✓... Definitive Plan Approved by Planning Board -----------____---------------19________. Area .....d.��d.....1.................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH 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 ..../�...1 ,��..... . /...... ........................ Construction Supervisor's License .. ....... BUINS, WILLIAM A=147-011-007 27954 Build Addition No ................. Permit for .................................... Single Family Dwelling ............... .............................................................. Locatiori j§...Capt.... Lumberts Lane . .......................................... Centerville ............................................................................... Owner ..William...Bui.ns.................................... .. . .. ..... ....... .... Type of Construction ......Frame . . . ............. .. .. .. .. .... ....... ................................................................................ Plot ............................ Lot ................................ Permit Granted ..-..June...3....................19 85 Date of Inspection ....................................19 Date Completed ........................................19 s ad 306? 3 MAIM�� Town ,of Barnstable *Permit# Expires 6 months from issue date Regulatory Services Fee ��--- • saxtvsraHie, 9 Thomas F.Geiler,Director EDMAr� . Building Division _ Tom Perry,CBO, Building Commissioner 200 Main Street;Hyannis,MA 02601 www.town.bamstable.ma.us - Office: 508-862-4038 -Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address (O L tlM tr0 - Q�Residential Value of Work$ ��, 'Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address lety 0�ianJ � Contractor's Name cik'W"' 6r•t W PAN,se0J Telephone Number t o/ 9 a$ �ro Home Improvement Contractor License# (if applicable) Email: Construction Supervisor's License# (if applicable) '45 Q 0 q r �J t� orkman's Compensation Insurance . PRESS PE �'� Check one: ❑ I am a sole proprietor ❑ I am the Homeowner SEP 13 2013 B/fhave Worker's Compensation Insurance ., dd t >. Insurance Company Name o-Jcu.4f' " Workman's Comp.Policy# & �19 7 g 5�9 3 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will betaken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ e-side p [Replacement Windows/doors/sliders.U-Value ® 0 (maximum.35)#of windows 1 4 #of doors: . ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i:e.Historic,Conservation,etc. * *Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\8R76BDVA\EXPRESS.doc Revised 061313 �I' A 4%, V : .. �a y S r'.`4-f{6.•�f.Ar9 8l�1.N�i x:�1.:1a �- 'La s ac. 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' t � r r� asrr a - Southern New England Windows d.b.a Renewal by Andersen of SNE Massachusetts Department of Public Safety Board of BuildingRegulations and.Standards Construction Super iwr License: CS_095707 I Is BRIAN D DENNISON r 7 LAMBS Porn EIRCLE t Charlton MA 01!7 Expiration Commissioner 09/08/2014 Office of Co (/ U� Consumer Affairs�an�BusineraUon 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home improvement Contractor Registration . Registration: 173245. _ Type: Supplement Cab SOUTHERN NEW ENGLAND WINDOWS LL Expiration; e/1e12014 DENNISON BRIAN 1137 PARK EAST DRIVE " WOONSOCKET,RI 02895 Update Address and return card.Mark reason for change. sa 1 0 20sc%i ',C]Address ❑Renewal Q Employment CjUstCard _ '� mre otCo s ARaIn&B.A.—Rea Iati a' License or registration valid for Individul use only OME IMPROVEMENT CONTRACTOR before the espiratioa date.If found return to: Office of Consumer Affairs and Business Ragulation Ra0latre0on: 173245 Type: t0 Park Plan-Suite 5170 -. _ Eapiratlon:eflf7n014 Supplement;lmd Bosum,NA 02116 .. ;.. ., .. SOUTHERN NEW ENGLAND WINDOWS I.I.C. _ RENEWALBYANDERSON _ �• DENNISON BRIAN 1137 PARK EAST DRIVE _ '2 s.=�Ed.O_' J • .. .. WOONSOCKET,RI 02895 Uadrrsrrretary Not valid without signature The Commonwealth of Massachusetts ' Department of Industrial Accidents ' Office of Investigations 600 Washington Street Boston,MA 02111 + www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly h Name (Business/Organization/Individual): 4ellw 6/11 Address: 0 (o lbAJ �Otc . City/state/Zip: L-1 Phone#: n 2.;) 2" goo Are you an employer?Check the appropriate box_: Type of project(required): 1.4 I am a employer with AC) 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction .. 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers"-comp. insurance comp, insurance.$ required.] 5. ❑ We are a corporation and its ME]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:❑Ro re airs / insurance required.] t c. 152,§1(4),and we have no 13. employees. [No workers' comp.insurance required.] "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: Policy#or Self-ins.Lic.#:j!�le, �a� �0 3 Sot 3 Z Expiration Date: a Job Site Address: `7 L/fm4e,4 City/State/Zip:. e-eft)��1111e_ 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 cepTjylTder th ins and penalties of perjury that the information provided above is true and correct Signature: Date: 13 Phone#: tV(2 07 0'2 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Othe.r Contact Person: Phone#: 9 Client#:30124 SOUTNEW ACORD,. G RT-IFICATE OF LIABILITY INSURANCE 1 °AT °"YYY' 8/06/206/2013 THIS-CERTIFICATE-IS ISSUED AS_A=MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON:IHE<CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT-AFFIRMAIIVELY 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 CON"T Anita Little NAME: Willis of New Jersey,Inc. FAX ac°No Ext,856 914-4660 (A/C,No: 856-914-1881 1015 Briggs Road,PO Box 5005 E-MAIL 'anita.little@willis.com ADDRESS: PO BOX 5005 ? INSURER(S)AFFORDING COVERAGE NAIC# Mount.Laurel,NJ. 08054 INSURER A Selective Insurance Co of the S 39926 INSURED INSURER B�Argonaut Insurance Co. 19801 Southern New England Windows LLC INSURERci Beacon Mutual Ins.Co. 24017 D/B/A Renewal by Andersen 26 Albion Road INSURER D INSURER E Lincoln,RI 02865 INSURER F i ' COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY .REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE;POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER . MMIDDIYYYY MMIDD - A GENERAL LIABILITY S202945900 - 010/2013 08/1012014 EACH OCCURRENCE $1 00O OOO -� DAMAGE T RENTED X COMMERCIAL GENERAL LIABILITY �" PREMISES Ea occurrence $100 000 CLAIMS-MADE F OCCUR ! MED EXP(Any one person) $1 O 000 1 - PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: ; PRODUCTS-COMP/OP AGG $3,000�000 POLICY JERCOT LOC _ $ A AUTOMOBILE LIABILITY S202945900 8110/2013 08/10/201 Ea acdde'NED SINGLE LIMIT 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED j PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS Per accident $ A X UMBRELLA LIAB OCCUR.' S202945900 _ ` " 8f110/201.3 08/10/2014 EACH OCCURRENCE s5,000,000 EXCESS LIAB HCLAIMS-MADE AGGREGATE s5,000,000 DED RETENTION$ i $ C WORKERS COMPENSATION 0000068028-RI . 8/21/2013 08/21/201 X TO STATU- YLIMIT ER OTH- AND EMPLOYERS'LIABILITY ' YIN B ANY PROPRIETOR/PARTNER/EXECUTIVE AIC927818352394 8/-21/2013 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 I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) i - i i 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. 5 Lincoln,RI 0286 _ AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. rr- ACORD 25(2010105ykD' 1 of 1 The ACORD name and logo are registered marks of ACORD #S215109/M215088 -. - AXL - - ' �ti'^7 `i / .3 I ' 4 1 29 .8 40.6 60 1 _ \62 \ . 6 - i 11-5 - ^..r ;,, •`.� ram\ �7.� �%`• ......_ _\' 11-8 .' t \ t r f \ •2 f 84 i 1 1 9.9 �i42 I 119 e 90 r 9 \\ q-_�i ! 1 ATE_ %' r j 'ry i � n- -_ �` y 7V , e//%tea v tea+ ! - of IS ta ` tj .ram 7-31 z:71 1