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SCANLON Permit Type: RC00 CERTIFICATE OF OCCUPANCY RES Comments: Building Department Signature Date Signed TOWN OF BARNSTABLE ���ETti Building. Application Ref: 200801994* BARNSTABLE, * Issue Date: 05/07/08 Permit: y .MASS. Qp 1639• Applicant: J.K. SCANLON C, ArFO .l.A Permit Number: B 20080911 /1 Proposed Use: Expiration Date: 11/04/08 t F cation. 780 CRAIGVILLE BEACH ROAI2? 3g District SPLTPermit Type: SP PROJ RES'ADD/ALT Map Parcel 22614000F Permit Fee$ 25.00 Contractor J.K. SCANLON Village CENTERVILLE App Fee$ 50,00 License Num 040692 Est Construction Cost$ 0 Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND TENENT FIT OUT FOR TRADEWINDS UNIT 780 A-3 THIS CARD MUST BE KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: ISENSTADT,ALAN TR BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: PO BOX 477 INSPECTION HAS BEEN MADE. CENTERVILLE, MA 02632 Application Entered by: JL Building Permit Issued By: THIS PERMIT CONVEYS NO RIGHT-TO OCCUP,.Y ANY STREET'ALLY OR SIDEWALK,OR AN ART THE IT R TEMPORARILY OR PERMANENTLY. ENCROACHEMENTS ON PUBLIC PROPERTY,NOTSPECIFICALLYPERMITTED UNDER THE BUILDING CODE'MUST BE•APPROVED BY THE"JURISDICTION. STREET ORALLY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS�MAY BE-OBTAINED FROM THE DEPARTMENT OF PUBLIC,ONWORKS.;- THE ISSUANCE OF:THIS PERMIT DOES NOT RELEASE'THE APPLICANT FROM;THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIS . MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONTSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 3.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 4.PRIOR TO COVERING STRUCTURAL MEMBERS(READY TO LATH). 5. INSULATION. 6.FINAL INSPECTION BEFORE OCCUPANCY. WHERE APPLICABLE,SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS. WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION. PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.I42A). 3 09C E P', BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 0 -fi; 2 2 � �)� � 2 ��w L . I 3 �1cyNp�L p (, 1 Heating Inspection Approvals Engineering Dept E Fire Dept ' 2- . F7, ) �s oao of He h 3rI� � TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 226 Parcel- 140-OOF Unit 780-•*A-3 Application # ` 1 Health Division Date Issued D� Conservation Division y Application Fee Planning Dept. Permit Fee Date Definitive Plan.Approved by Planning Board Historic OKH Preservation/Hyannis Project Street Address 780 Craigville Beach Road Village - Centerville Owner Trade Winds Residences, LLC Address One State Street, 14th Floor Boston, MA ;02109 Telephone 617-861-2055 Permit Request Tenant Ftout l Square feet: 1 st floor: existing proposed 1063 2nd floor: existing proposed 1063 Total new2126 Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type New Cot Size 1 acre Grandfathered: ❑Yes ® No If yes, attach supporting documentation. Dwelling Type: Single Family :® Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes M No On Old King's Highway: ❑Yes ® No Basement Type: M Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) 1,000 Number of Baths: Full: existing new 3 Half: existing new Number of Bedrooms: existing 2 new Total Room Count (not including baths): existing new 10 First Floor Room Count 5 Heat Type and Fuel: M Gas ❑Oil ❑ Electric ❑ Other Central Air: M Yes ❑ No Fireplaces Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing new size—Pool: ❑ existing M 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 JdNo If yes, site plan review# mow, Current Use Proposed Use Residence W4 APPLICANT INFORMATION f - M - __;-,(BUILDER OR HOMEOWNER).—_-_ _ -. _4 - Name John Scanlan Telephone Number 508-540-6226 Address 15 Feruvood Road License # CS O40692 N. Falmouth, MA 02556 Home Improvement Contractor# Worker's Compensation # WC6-111-258096-037 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE *fi�� U� a FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED: z MAP/PARCEL NO. ; ADDRESS VILLAGE OWNER t 5 DATE OF INSPECTION: FOUNDATION t FRAME '-INSULATION FIREPLACE > ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION,PLAN NO. t R r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION J Map 2 Parcel Application # t )O Health Division Date Issued Conservation Division Application Fee Planning Dept. ,Permit Fee ­7 Date Definitive Plan Approved by Planning Board - �� Ajol Historic - OKH _ Preservation/ Hyannis . Project Street Address P7 g o CtA`5 1 - Village �� �� 41,e p Owner ��de� JCS o ye� P+�k ��I Address 7CO O'er�S be refeel Telephone ry = Z Permit Request u A-3 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation _ = Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 'f_ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: L Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) ��`7 Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: OGas ❑ Oil ❑ Electric ❑ Other Central Air: A-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) Namee-.JI—S-�C° v` Telephone Number Address Rve 7W License# &,� `S r0d'' V- N I) Home Improvement Contractor# Worker's Compensation # n ALL CONSTRUCTION DEBRIS R TING FROM THIS PROJECT WILL BE TAKEN TO I f SIGNATURE , DATE FOR OFFICIAL USE`ONLY APPLICATION# DATE ISSUED c= MAP/PARCEL NO. 1 1 ADDRESS VILLAGE ' OWNER' r..: DATE OF INSPECTION: FOUNDATION FRAME OPi Slzxl ^ INSULATION - + FIREPLACE ELECTRICAL: ROUGH FINAL _ PLUMBING: ROUGH FINAL GAS: ROUGH FINAL { FINAL BUILDING DATE CLOSED OUT , ' x ASSOCIATION PLAN NO. . j - The Commonwealth of Massachusetts r. Department of Industrial Accidents I_ 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 Name (Business/ anization/Individual): C Address: C� t ' City/State/Zip: Phone #: 0 Are you an employer? Check the appropriate box: Type of project(required): 1.El am a employer with 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 workin for me in capacity'. employees and have workers' g any 9. ❑ Building addition [No workers' comp. insurance comp. insurance.# required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner'doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.]' *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit.indicating such. tContractors 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. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job:cite information. Insurance Company Name: Policy#or Self-ins. Lic. #: Expiration-Date: Job Site Address: City/State/Zip: Attach a copy of the workers'.compensat>ien 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 maybe forwarded to the Office of Investigations of the DIA for insu ance coverage yerifi.cation. 1 do hereby certify under t azns d penalties of perjury that-the information provided ab ve s 41rue and correct. Signature: Date: B L Phone#• Offici ccse only. Do not write in this area,to be completed by'city or town of City or Town: Permit/License# Issuing Authority(circle one): 4. Board of Health 2. Building Department 3. City/Town Clerk. 4..Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: 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 appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." PP . , Additionally,MGL chapter 152, 25C 7 states"Neither the commonwealth nor any of its political subdivisions shall P § ( ) 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 th6permit 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 pennitJlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."a.copy of.the affidavit that has been officially stamped or marked by the.city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each a 'Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn 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 dd 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 Te4,4 617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 4-24-07 www.mass.gov/dia OF THEMASS 1p� 9� Town of Barnstable Regulatory Services Thomas F.Geiler,Director Building Division ; Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign 'Phis Section If Using A Builder I, rocs e i�c •�✓� OT h G ,as Owner of the subject property hereby authorize /it�G LAP„/ �� to act on my behalf, in all matters relative t0 work authorized by this:building permit application for: (Address of Job) fl Signa re of Owner ate nL go ca..� Print Name If Property Owner is applying for permit,please complete the Homeowners'License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 r y THE Town of Barnstable Op Regulatory Services sARNSIASLE, Thomas F. Geiler,Director MASS. t619. ��� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village. "HOMEOWNER": name home phone# work phone# CURRENT 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 homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or.farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable,to the Building Official,that he/she shall tie responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations- . The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply wi+,said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.)5) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt 1 - zsso '411. , £LOZItrZI£ :uolle,idX3 r L},9Z0 VW '12�OdSINNV kH 96L X09 0d w 1aV1Sl,4 31V1 aooilonalsuc slnaadnS u asuaol� ,u!p{. 9•}o p.trog to )ur. suoih'In'�i21 r sp.�i�{iur.lS { n t{i tillasnyirsrr.►1! jr. P,_/�aaaac�ivae/.ts a` i �.a a Board of Budding Reoulatlo sand Standard, ` License-or registration valid,for iridrvu'u1 use ou!Y !` 1� HOME IMPROVEMENT CONTRACTOR ' before the expiration u.^.tc. If found I e:u'n to: } Board of Building Regulations and Stay lards Registratioii 155997 Pi One Ashbf02 1301 I, Expiration 5iU'2011 Tr# 283563 g Boston,Ma. Type 'Pnv�te Corporation i ' tt 'i:D I FEALTY GROUP INCH r" I ATG' ISENSTADT j 55 ll".KE"AVE. N Lt signature 14y!,,11110 or n' MA 02647="r Administrator 7 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # Health Division Date Issued Conservation Division Application Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis ook- C- Project Street Address b VC,619Q, Village Owner �l (4,( Q �S Address pig �c r� C4 1 Telephone Permit Request ) k h e. d (� (,Js 201 A--5- ao�8 [99 a a zoo C_- t ^� �� 2 ' Square feet: 1 st floo . existing propose 2nd floo . existin pr ' (Gal new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including 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 -fiekd Telephone Number �� � Address Po 06x- 79 License #tf �l /X'YV', S 91q0 - o���FlOme Improvement Contractor# Worker's Compensation # VJC_4 _31 ALL CONSTRUCTION DY RESULTING FROM THIS PROJECT WILL BE TAKEN TO/I X r SIGNATURE DATE It FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER AV DATE OF INSPECTION: . FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH _FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING t DATE CLOSED OUT ASSOCIATION PLAN NO. 4 TOWN OF,BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # Health Division Date Issued 'Conservation Division Application 'ee .62 Planning Dept. Permit Fee i Date Definitive Plan Approved by Planning Board 01' Historic - OKH _ Preservation / Hyannis Project Street Address Village Owner l4' 0q, t" S Address pf� e n, C,4 1 Telephone 1 Permit Request i1L L C' n(L ti, ).j ,LJ 0 Q) r, 0 0 7 0-S b �0 C�l E- <� Square feet:1 s floo . existing propose 2nd floo . existin��p �? ,ptdl ne , 10 ZlZiiDis,trJ t Flood Plain /PGfo n�dw�ater Overlay n ("r Project Valuation rQ!n)( fru nkType7l Lot Size �) rand'fat�eKe • ��I #� � . /b'No If yes, atta--h'�upp&rring documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi ami (#units Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: �'Yes ❑ No ZZ�� 9 Basement Type: ❑ Ik ❑ raw WaN�oSt- .34 9Ahe� l 33 -& `7 Basement Finished Area(sq.ft.)� �� U� fi� Basement Unfinished Area (s; ) r :,Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing -new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other 06 Central Air: ;❑Yes ❑ No Fireplaces: Existing I ew r i Existing wood/coal stove: ❑Yes ❑ No oX Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size_ B�arri:"❑ existing 10 new size_ Attached garage: ❑ existing ❑ new size - d ❑ existing.,O n w, 0!e­_,Other: _ Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use . Proposed Use APPLICANT INFORMATION CDERrOR HOMEOWNER) Name "�@ Telephone Number ��-� Address NBA 2 6 J �� Lice e3 �l 02941Ho 1 me Improvement Contractor# Worker's Compensation # WG -0 6 ALL CONSTRUCTION DE S RESULTING FROM THIS PROJECT WILL BE TAKEN TO g SIGNATURE DATE �� 7 4 III FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. � rp , t= llj�v"uy� ConstrUctiodingRegulat r� ions an fNli Supervisor d Standards «x 3' Lice . License. IK a a'r x.. Gg 98149' ' t , Restrictid, j, Try 9 I �»� :00� 8149 6 gyp:: T y y ` E + lV x* _ AT ISENSTgDT �' r i er yp a Pp 13OX 796 :k( f AN HY NISPpRT Mq p2'�`�-®' , 7 III' t tk it AN Y r h � w: _ l i RSS H �f CC @@ &' -5 b k, M dry 1 gp � s MA Wr L F t t t o 1 ' 2 M F��;l•Y i f3 b$ Yg 1 ® DATE(MMIDOrNYY) �►�o CERTIFICATE OF LIABILITY INSURANCE- F 4/1/2009 PRODUCER NORTHWOOD ESHBAUGH INS AGENCY INC THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 540 MAIN STREET ONLY AND' CONFERS NO RIGHTS 'UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR HYANNIS, MA 026010000 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (508)771-1632 INSURERS AFFORDING COVERAGE NAIC# INSURED T D I REALTY GROUP INC INSURER A: Liberty Mutual Group PO BOX 796 INSURER B: - HYANNISPORT MA 02647 wsURERC: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW'HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR OD' POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR POLICY NUMBER DATE(MMIDDLYYYL DATE(MMIDDfYYYYI GENERAL LIABILITY I EACH OCCURRENCE $ _ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY I PREMISE�Ea orcurrencej_ $___" CLAIMS MADE u OCCUR MED EXP(Any one person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ POLICY PRO- LOC AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT _$ (Ea accident) ANY AUTO - ALL OWNED AUTOS BODILY INJURY $ (Per person)- SCHEDULED AUTOS � - HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) -. GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO - OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABILII-' - EACH OCCURRENCE $ OCCUR CLAIMS MADE SAG-GREGATE _ $ I $ DEDUCTIBLE RETENTION $ A WORKERS COMPENSATION - WC1.31S-365323-019 3/5/2009 3/5/2010 WC STATU- OTH- .. AND EMPLOYERS'LIABILITY Y I N E.L.EACH ACCIDENT $ _ 100000 ANY PROP RIETORIPARTN ER/EXECUTIVE OFFICERIMEMSER EXCLUDED? a - E.L.DISEASE EA EMPLOYE $ 1 OOOOO (Mandatory in NH) - _--" If yes,describe under I - E.L.DISEASE-POLICY LIMIT $ 500000 SPECIAL PROVISIONS below OTHER - DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS - - CERTIFICATE HOLDER CANCELLATION - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING.INSURER WILL ENDEAVOR TO MAIL 7 DAYS WRITTEN TOWN OF DENNIS NOTICE TO THE-CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL ROUTE 28 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR DENNIS MA 02638 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Jeff Eldridge ' � (J � ACORD 25(2009101) ©1988-2009 ACORD CORPORATION. All rights reserved. CERT NO.: 4116578 CLIENT CODE: 1365323 Anne Chandler 4/l/2009 6:51:28 AM Page 1 of 1 t,I. 29. L 9 :38PM, 0•_G n I!LfVU, �569�F' Z��N Ta -j4GE 02 'down of Barnstable, e Regulatory Services rs °X'hOMBs F,Gener,Director ` BuRdiag Division Tom Perry')) u ldjng C*MtWssaonar 200 MOiA 3ttoct,Hy ads,MA 02601 Office: 508-862-403$ Fax; 50$-790.0230 NOTICE TO THE BULDI G D1V S10rq f3F CHANGE OF LICENSED CONSTRUCTION SIJPERVISO'R Din Ile, er OfpropertY located at ' t �C hereby certify that zs no longer Construction, SuPexvisor listed on the appl icaticn for the-pxoJeet X�ndex constrjcticr.as authorized by bugding permit# , issued on 200 l understand that the project unds,construction must cease urAtil s successor licensed Construction Supervisor,is-submitted on the recot3s tjf the Building JDiv,'sion. 3 P ERTY OWNER � 1) T I`It 9/forats/nevvconw , ' � _ rs�c cc R-5 730 CMP rpo,080;02 R-'CEIVED TIME OC T. 29. 3:20PM �, Town of ar)mstable elatox°y Scltc.es 73A3tN�iA� `,thotna$F,Geiler,Director 16 Building Division Tom Perry, Building Comm issiOngr . 200 Msia Strict, Hyannis,MA 0260 W ww,town.barnstabloama.us fax: 5og.'190.6230 Office: 505-962-403 Property Owner bust Complete and Sign This Section ff Using A Builder, Y, _rtwLJe .W' N jy et.0 o A'e- h t ,as a rAer of the subject Propertyr ` r ' eEeby authorize 9L - S � } Cr ACC on trey behalf, in ail matters relative .o work zaffio izecd by this building poxmit dppficat(OA F'or: /ic •- dxess of rob) ,I Siva [Owner Date . tf.PrOpEcty OWnir is applyiAg foapermit please complete the 146meo,%teks Uccnae Exemption Po=on tU'e revere side. RECELYEP TIME 001'. 2 9. 3;201 The Commonwealth of Massach usetts Department of Industrial Accidents Office of Investigations — 600 Washington Street t _ Boston, MA 02111 www.rnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lej4ibly Name (Business/Organization/Individual): rem it e,�f ! t ►� 4�t (oo v Address: F-0 Pox City/State/Zip: Phone Are.you an employer? Check the appropriate ox: Type of project(required): 1.❑ I am a employer with 4. DI am a general contractor and I employees(full and/or part-time).* III have hired the sub-contractors 6. New construction 2.❑ I 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. employees and have workers' Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. F1 We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I 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.] *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: 4 7c v ra Policy#or Self-ins.Lic.#: 1 +�/ J 3(O 32 ! r xpiration Date: Job Site Address: C(A` V a 1 �j�. 1�— City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,.as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification._ I do hereby certify a he pains and penalties of perjury that the information provided al five i trttiiee and correct. Signature: Date: l 6 / Phone#: b �CI Z�_ o�-b � Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority (circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: r. Y )N 4. EXIT ORDERS YES kii- "a 5 ZZ � e JOT HAVE CLIENTS TO THE HOME BUT OF HER CLIENTS AND REGISTER FOR ;, ON SHE COMPLIED WITH THIS }g$t f, s3oh Yr. - 1 am sou ' a - • � m Ovo LauuEm-m '-" _ Andersenm GXVJI 9(egrass compliwn+l ' - - " - - 1214-eps to opening (,. f Q " - system shut off%, ® L Ywcume u.it > v � Ir. V o ! rt Nr s t 7 i Nore. kt pk [� y Jae Armstrongm Orywwll by +ems ae I'nq - '' grid wnd frwmmq Q G l _ W W pc lum the c t d '�y Q - � �* p r m.,a d ola•aye(+yp}� �ueo'� • .. J -- New ° to • ....-.. r. ,Sd sto v I u W a N _ rwge O m K m y 00 Y- _ .r•"• Q W a J 3 m v7 2 by F+ fnishedspace , # ' w p columns w;+h deeorw+i—wood - U V -I V a N p—trim wnd mouldings(+yp.) - ' Z W V m - ox a • 9"oiewcr line . - / A \FOUNAATION FLOOD PLAN - o$ u _ - 'a m a_ - .---------- �xistinq wwlls y m U o r$ d�� New 2.4 Dwwllc w/R-1 9 insNwtion n o O D t 3 p c♦ 3 rywall(pain#edl n u€v m J g m e 6_ . Q 6QQ pug-.+v E_a o m o`u L ' Boa w DRAWING TYPE: - - - - - - - basemen}Floor plan SHEET NUMBER: _ A 1 00