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1072 CRAIGVILLE BEACH ROAD
r '�� f .r M vIY r d..p °} b:! f � t 1 - t.I�t v r i g �., i t S r S � � i t ��„ � po f (�, r / 4 v� 1 � � } t�. t i + � r 9 �� �( �i.f }� �,. t r t c i 7 -�i �. .��.� tA.�Y.. ..' ,r.. ..).:a, t. .,�...h;t, .t,, ..a �I ;�. ..., � .:.� �', � ui r � � i qi.it ai' Town of Barnstable B�l1IC�111 � r g t oThStit,.is Visible"Fro'm;the;:Street �A""" raved�P,lans Must a=Retamed;on��ob and�th�s;Card Must�be Kept�d Pos This Card pp * I s ection•H s:Been"l�lade �, � �� r � - R �cate of:Oceu an-. is�Re vired`such Buldm tshall�Not�be Oceu ied,�u�t�l a'F�nahlns""ectfon ha's been,3made Permit, lijlt i Permit No. B-17-3199 Applicant Name: Russell Cazeault Approvals .Date Issued: 09/18/2017 Current Use: Structure Permit Type: Building-.Siding/Windows/Roof/Doors Expiration Date: 031/18/2018, Foundation: , Location: 1072 CRAIGVILLE BEACH ROAD,CENTERVILLE Map/Lot: 206 132 Zoning District: CBDCB Sheathing: Owner.on Record: SCOTT,THOMAS A&CAROL.A Contractor Name: PAUL J,CAZEAULT&SONS,. framing: 1 Address: 125 KENDALL RD INC. 2 LEXINGTON,MA 02173 ` � --"Con-,ac#or License 103714 Chimney: Description: Remove existing asphalt shingle roof on the entire house,and replace ., Est Project Cost: $,7,500:00 with new HD architectural asphalt shingles. Insulation: ee:Permit , $38.25 Project Review Req: Remove existing asphalt shingle roof o' the n se,and fee Paid $38.25 Final: replace with new HD'architectural asphalt shingles Rate: 9/18/2017 y Plumbing/Gas Rough Plumbing Final Plumbing: Building Official This permit shall be deemed abandoned and invalid unless the work authoI d'by this permit is commenced within six months afce issuance. Rough Gas: All work authorized by this permit shall conform to the approved appl�atiori and the approved construction documents for wh O this permit has.been granted. Final Gas: All construction,alterations and changes of use of any building and stru"c' ;shah in with the local zomng=by1laws a d codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the . work until the completion of the same. Electrical a Service:_ The Certificate of Occupancy will not be issued until all applicable signatures by the Buildmgand Fire Officials re,prowded on this permit. Minimum of Five Call Inspections Required for All Construction Work: z �+ Rough: 1.Foundation or Footing ... 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: S.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage.final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical;Plumbing,and Mechanical Installations. Final: Work shall not proceed until the Inspector has approved the various stages of construction. "Persons contracting with unregistered contractors do not have access to the guaranty fund (as.set forth in MGL c.142A). Fire Department Final: Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Town f Barnstable,o t!n` ABt<~ : 200 Main Street, Hyannis MA 02601 508-862-4038 �a Application for Building Permit Application No: TB-17-3199 Date Recieved: 9/18/2017 Job Location: 1072 CRAIGVILLE BEACH ROAD,CENTERVILLE Permit For: Building-Siding/Windows/Roof/Doors Contractor's Name: PAUL J. CAZEAULT &SONS, INC. State Lic. No: 103714 3 F�2 �•' Address: 1031 MAIN ST, OSTERVILLE, MA 02658 Applicant Phone: (508)428-1177 (Home)Owner's Name: SCOTT,THOMAS A& CAROL A Phone: (617)835-6990 (Home)Owner's Address: 125 KENDALL RD, LEXINGTON,MA 02173 Work Description: Remove existing asphalt shingle roof on the entire house,and replace with new HD architectural asphalt shingles. Total Value Of Work To Be Performed: $7,500.00 Structure Size: 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: Russell Cazeault 9/18/2017 (508)428-1177 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $7,500.00 Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: $38.25 9/18/2017 $38.25 XXXX-X)M-X3OOC Credit Card r .............................................................................._.........................._.._.............................................................:............0985........... .....................__:............ ..........................._............................ Total Permit Fee Paid: $38.25 a Tp� Town of Barnstable *Permit#L'J- - 3Y I OExpires 6 mouN from issue date Regulatory Services Fee BARNsTnet.E. v� MASS. g' Richard V.Scali,Director Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-8624038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Iruprint Map/parcel Number 0<o (3 Z Property Address Cra ti v ille /3eae Q/Residential Value of Work$ � �_ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Tot+-a % -(�c 7 ` / L {tr✓i/� Contractor's Name WY-I atJ Word r/GFF S , Telephone Number 7�f/ OF aVC--1VAJ Home Improvement Contractor License#(if applicable) 1&fie DZS' Email: ft '4 Construction Supervisor's License#(if applicable) 87 Z:']2— Ymorkman's Compensation Insurance Jv� Check one: f(JI41A El am a sole proprietor !� ❑ I am the Homeowner ' t11 I have Worker's Compensation Insurance Insurance Company Name JTHRTh ?L FJR)P— 1IUSIC6ZA-A E MQ�" Workman's Comp.Policy# 22 W�-C-(—T Z6 34�— Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction.debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders.U-Value Z'? (maximum.32)#of windows Y #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 equired. SIGNATURE: C:\Users\Deco)t eta cal\Micros mdows\Temporary Internet Files\C6ntent.0utlook\2Pl01 DHR\EXPRESS.doc Revised 040215 *Window World.of Boston,LLC MA H►c Reglstrauo Offices&Showrooms Number- 0 15A Comm rigs Park O 296 Old Oak Street 166025 Woburn,MA 01801 Pembroko;'P¢A 623S9' Federal ID S "Simply the Best for Less" (781)932.4805 (781)828-t�81 ?a81665 P Y wNwi.WindowWoddotBoston.6am` �pp Custarner /77995 C4TT Phone(h)l t6 'a Install Address:_&ZZ 4ZP9/GALLS As4cl Phone(uv)Gj/7' City:y�c7Y y��LLiE State:MAZi.p E-mail WINDOW WORLD GLASS OPTIONS // 1000 Seises Single-hung AR-Weld $.189 Sold. Elite. $119 666 �000 Series OH MechiWalded Sash $215 _Tripfe,GiAzed TG2' $195 4000 Series DH All-Weld $225 (1 ('Seiiesattw0 Only) =6000 Series OH All-Weld $354 WINDOW OPTIONS A 2 LrteSlider $354 Glass Breakage Warranty $1519CL 3 Ute Sfrder rim ie,vu pro+n;vb. $545 1/2 Screens S9INCLUOEO _Picture/Filled Ute $354 Foam Insulation an:Jambs and Head $11 DICLUDED. _Awning $280 -Double Strength Glass $15 INCWDW Doubfe Locks >26° $S WCLUDW IkP/ Casemertr; . ci ( _ )2 Lale Casement $595. Full Screens $223 Ule Casement 'rruuaiNl prj,,jr Nv* $880 _77Colonial Grids otoure a.0 Easement Hopper $334 _Prairie Grids $51_ Diamond Grids .$69 _Bay Wintlow-Soffit Mount/iN S Seat$2660 _ " Simulated Divided Litt $182 _Bow Window•Soffit Mount(INS Seat$2785... —Tempered OH Sash(BSO)(TSO) $65 ,_Garden Window, $2040 _Obscure Glass(BSO)(TS0) $35: _SpeowiY indow. _ ...:$.. . _OdefStyfe(40/60of60/40) $30 Beige/Almond $40 _Foam Enhanced Frame $35 7—Wood Gran nteriar{Series4000/6G00oNy)$t001878BUILT HOMES(EPA LEADSAFERENOVATfON). (tight 0akl Dark 0ak1 Cherry/ ox m� �¢/!!/ Lead Safe Practices Required $30 Rich Pdaple) MY HOME WAS BUILT IN THE YEAR A.�Initfal t _Brown Exterlor(Arch Broriae/AmeticairTerra)$-100 _Designer6Wortxteifor $175 MISCELLANEOUS �7•Custom Exterior Aluminum Cladding Window Cot or /f/J� H/ O Teziured$75' Smooth$75 * $/OSfJ. wr ` outside Facing Color / NokwSTOM DOORS _Metal Window Removal $50 . _NewConstitrellorrVmyl Removal SIT_Vinyl Rolling Patio Door SR.or 6tt. $ti195 _Urryl Raging Patio Door'6it. $1.1ti5 _Specialty Window.Exterior Trim. $. Add tobaseprioe for CustainRa0ingPatioDocr$1256 _Mull to Form Mufti.Unit $30` French Rail Sliding Patio Door 50::or 6% S13gs _Install tntedor/Exterter Stops $so _French Railsgdmg Paco Door aft. S1495 Instalflnterior Casing Starts At Sg5 _ _French Rail Socing Palo Door gift' .a1595 Insulate Weight Boxis $20- -_Custom Exterior cladding.- .$15D- _Road fat Bay/Bow Windows $500. ScWZone Efae or ETC Glass $205 _Existing New Const.Eat.Refro Fit $150 _Grids Patio Door $t49 _Removal of Etosfing Bay/B9vw 3250 . yloodgrabilnteriors $2&''i.,.... .— - - _Repair Sill,Jambnrreplacesillnosing $30 _Frtetior0esigner Colors` $395 Full SuIt Sill Si.. 19 r lacement $150 _Intwior Casing T'2 3t2. $175 ( ') ep _Mullioin Removal, $30 _Handlassto;i ons s S, _Bay/Bow Conversion Eat.Retro Fit $350 New Siding Will Not Match) DoorColon\' 1NitIDOwaf Raltexi�ES Inside. -Ou7side: (`'`� Cuslomer declines.eMerforairap;and understandspainting and/or repair may be required;InlUal . Customer declines grids on `lip windows/doors initial DiSC),IA MER:Customeris responsible for the following in coaneelion ivdh this contract PolnSng,Stafrung,Alarm System Qsccl eeeUrecannaU 80019 Permit tees In excess ci525 tTO,Homeowner aref erCondo Assacla0on Appmvai Hlsleric D ririMApprcni.C+PJ ai8o;tan paAbr g8 stdalvaCt Pzrtnittees in caliaeutrt wnh htstanafm r: NO EXTRA WORK IF NOT IN WRIT NGt Customer agrees to the terms of payment as fol owe: AP Z p/jr* ✓� 00 Extra Labor&Materials $� Site Set Up;Permit;Disposal&Delivery Fees$ $389.00 Total Amount S. np4`J'OfO� n 3Z4 CuSlomOrderDepastt50°S Balance.Paid to Installer upen Completion $ off Amount Financed S / W ltQairVkrid of Boston ardldiagas starting this work on and bdnp subsYet ly comp'eled)'Z da7s Securely lNerest Yes No Any deposit regtdred in advaece of the start of the'Ark SHALL NOT exceed 331/3%of tie total contract price dr the actual eostof any material Or equipment ui a_ apedalorderarcustommadenature,tvfichmustbeorderedbadvanceofthestartoftheworktoassuie.thattheproject%viiaproceedonsdiedute No final payment shad ae demandedunill the contract is compieled to Olt satisfaction of both partles_ NIT homelmprovementcoraectors and subcdatradamshallbe registered and thata yIrnpiresabouta contractor subcowworrelannqtoarepetradon should Le diredadta Office at Consumer Aflaus and Business Regulation,Tan Park Plata.Suite 5170 Boston,MA02ilS.Phone:(617)M11709 Na workshall begin prior to the dilding of The United Bid Transmittal to Tho Omar of a copyol such Contract., tdpvi World of Boston emfw prow slat of Chapter 142A of fire gmersl laws is required ttr apirpi for and obtain a0 constructian•retated penriiils VAndew World of BasidrrstaB not bedeemsd fespwsibleror debys in tha walk de�n'be4 in 0ris agteemzntcaused regutelory,perm]tiranBngag�icies,atMoritles or indbiduats Thence:8 the PUMMASER(S)obtains his own edminuctbn slated permits for the work descd6eddby under thb agreement or deals wills unregistered conhaciars; IN PURCHASL91[s)Is hereby advlsed ihatla the aviat all a.dispute judgement and nonpayment,the PURCHASERS)will riot be enfltted ld make!claim or colteellon from the guaranti fund oslabttshed by chapter 142A,'M.G L You The buyer may camel this Transaction stony hint priorto midnight of the mild business day after Has date of This.traftsac ion, Nonce of Canceilation most be in willing postmatkod no later than midnighlol The following third business day. RESALE!THIS IS A CUSTOM QRQ0 NOT FOR ThIsviindow Vioria-Franchiso is Indepandenity,omed and operated V WU>dawftildot9oston,LIAunderlicersafrom Window Wb Ida: 6 717 Owner-oonotsignittheream any htankepacae•- 1199 \ 6Zi Salesman:Do not'ai are'aro any blank spews ate warner.oo not sign it there are any blank spaces. .Deco eGra.n.a.t 1..7 :Mite;copy-Odgaal Yellow copy•rle Pink CoPy•Cub rur.3 _ vcans eeoser�tiio'. Massachusetts Department of Public Safetj Board of Building Regulations and Standards License: CS-072772 Construction Suoeriiscr - JEFF C STEELE 24 SHERWOOD AVE DANVERS MA 01923 Expiration: Commissioner 04/07/2018 _ Office of Consumer Affairs&Business Reptation —'`HOME IMPROVEMENT CONTRACTOR Registration: 166025 Type: Expiration:. 4[12j2018 - LLC WINDOW WORLD OF BOSTON.L-C. JEFF STEELE 24 CUMMINGS PARK SUITE 15-A �.s..t_ N. WOBURN,MA 01801 Undersecretary License or registration valid for individual use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation i 10 Park Plaza-Suite 5170 Boston,MA 02116 Or AOt valid Without signature The Commonwealth of Massachusetts Department of IndustrialAccidents kvi 1 Congress Street,Suite 100 Boston,MA 02114--2017 www massgov/dia lVorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Letribiv Name (Business/Organization/Individual): /,jl4:4 _ t�/pf/p�2f_ jS_�On L C Address:_J5'H C !h M r s r K City/State/Zip: akb f% 0190 1 Phone#: Are you an employer?Check the appropriate boa: Type of project(required): l.�am a employer with _employees(full and/or part-time).* 7. New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 3.D I am a homeowner do' all work myself 9• El Demolition doing ys [No workers'comp.insurance required.]t 4.❑I am a homeowner and will be hiring contractors to conduct all work on my Property. I will 10 Q Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractori listed on the attached sheet. These sub-contractors have employees and have workers'comp.insuranceJ 13.❑Roof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.QOtherIngo t.J 152,§1(4),and we have no employees_[No workers'comp,insurance required.] r- (ei PP/y7--4—*-S *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must.provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is thepolicy and job site information. Insurance Company Name:__ (4 41-1:G-/-9 F re Tn s J RAd C S C© Policy#or Self-ins.Lic.#:--2-Z M/+E, C L „).2 3 5� Expiration Date: /— 2- 7— /R Job Site Address:_ 107,2 C'�g;g ,'/�� �/, !t'�� City/State/Zip:_Cpnf(",I,Ile rt-(/-} Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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$250.00 a day against the violator.A copy of this s tement may be forwarded to the Office of Investigations of the DIA for insurance coverage verifi lion. I • I do hereby cer under a pai erjury that the information provided above is true and correct Si ature: Date: 7-,Z&-/ Phone#: _- - 3 2-- 0$ a 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#: WINDO-2 OP ID:HI oR0' CERTIFICATE OF LIABILITY INSURANCE DATE 05;M41DDI0Y1Y7YY) 05l04/2 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Marsh 8,McLennan Agency-GSO NAME: Carli Witcher CISR,CBIA,CIC PHONE 3625 N.Elm St A/C,No.E><t:336-272-7161 .c.N.I,336-346-1397 Greensboro,Ward, ,CPC a D lESS:Carli.Witcher marshmma.com C.Timothy Ward,CPCU,CIC INSURERS AFFORDING COVERAGE NAICS INSURER A:Hanover Massachusetts Bay 22306 INSURED Window World of Boston,LLC INSURER B:Allmerica Financial Benefit 118 Shaver Street North Wilkesboro,NC 28659 INSURER C:Hartford Fire Insurance Co. 19682 No INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE D SUB POLICY EFF 1 POLICY EXP I LTR I INSD MD I POLICY NUMBER I MMIDD { MWDDNYYY LIMITS A I X COMMERCIAL GENERAL LIABILITY { I ' i i EACH OCCURRENCE IS 1,000,00 CLAIMS-MADE � OCCUR ! OD6790252708 04/01/2017 04/01/2018!DAMAGETO RENTED I PREMISES(Eaoccurrence) is 500,000 i ' f MED EXP(Any one person) S 5,00 PERSONAL&ADV INJURY 1 S 1,000,000 j GEN'L AGGREGATE LIMIT APPLIES PER:PRO GENERAL AGGREGATE is - 2,000,000 I POLICY 1 JECT I_j LOC i i f i t PRODUCTS-COMPIOPAGG S 2,000,00 I OTHER: is j AUTOMOBILE UABIUTY j ( j ; COMBINED SINGLE LIMIT B X `ANY AUTO I ! !AW68757615 I (Ea accidenU i 1,000,00 J 1 06/16/2016!06/16/2017!BODILY INJURY(Per person) {S I ALL OWNED 1 ''SCHEDULED AUTOS L`AUTOS ; i { i BODILY INJURY(Per accident)!S NON-OWNED I i HIRED AUTOS !AUTOS j PROPERTY DAMAGE is Per accident S XJ UMBRELLA UAB i X !OCCUR I I J EACH OCCURRENCE i S 2,000,000 !EXCESS LIAB �— A i ! CLAIMS-MADE i iOD6790252708 04/01/2017 i 04/01/2018'AGGREGATE is OED RETENTIONS S WORKERS COMPENSATION !! AND EMPLOYERS'LIABILITYi ! X P LITE 1 FOR i H I C IANYPROPRIETORIPARTNERIEXECUTIVE YIN ( 122WECLJ2635 !01/2712017101/27/2018 E.L.EACH ACCIDENT IOFFICER/MEMBER EXCLUDED? ❑ NIA, I I S 500,00 ,(Mandatory In NH) j If yes,describe under I ! E.L.DISEASE-EA EMPLOYEEI S 500,00 DESCRIPTION OF OPERATIONS below I i E.L.DISEASE-POLICY LIMIT i S 500,00 i 1 , I i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD l �tHE Town of Barnstable *Permit# Expires 6 moisthsfrom issue e Regulatory Services Fee • inRNsres[a + 9cb s ,�� Thomas F.Geiler,Director Building Division Tom Perry,CBO, Building Commissioner.°. 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma us Office:_ 508-862-4038 Fax: 508-790-6230 EXPRESS PERNUT APPLICATION - RESIDENTIAL ONLY Valid without Red X-Press Imprint Map/parcel Number Pro rty Address �V ` G f Residential Value of Wor (/ Minimum fee of$35.00 fo work under$6000.00 Owner's Name&Address Contractor's Name V✓l elephone Number `/ '� Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) �%W,09-RESS PERMIT AF ❑Workman's Compens tion Insurance. check MAY 2 4 2013 am a sole proprietor ❑ I am the Homeowner 14 ❑ I have Worker's Compensation Insurance Wit' TOWN OF BA,RNSTABLE Insurance Company Name Workman's Comp. Policy# >, Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re- of(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows ❑ 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 ired. SIGNATURE: Q:IWPFILESTORMS\building permit fonmsTYPRESS.doc '' .Revised 053012 .. fir. The Commonwealth ref Massachusetts DepwhnentofIndushid Accidents _- Offw--of Investigations 600 Washington Street Boston,MA 021I1 wrr.'w,mass govldia Workers' Compensation Insurance-Affidavit: Builders/Conicactors/E.lectric ans/Plumbers Applicant Information Please PY ut Le 'b Naive l): Address: ` AL1,q City/State/Zip: 5ifK VV Fhone Are you an employer?Check the appropriate boa: . Type of project(retluired): 1-❑ I atn p;foyyer,with 4- ❑ I am a general contractor and I foyees{frill arad�ix}�act-time}- * have hired the snob-�contacicrs 6- ❑Neer construction I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have $. ❑Demolition working for me in any capacity- employees and have wodoers' [No wodmrs t.' comp.insurz ce comp-instrraDCe,2 9. ❑Building addition rewired.] . ❑ We are.a corporation and its 10.❑ Electrical repairs or additions I❑ .I am a homeowner doing all work officers have exercised their i 1_❑Plumbing repairs or additions myself o workers'comp sight of exemption per NIGL ed.]t c. 152,$1(4).and.we have no i2-.❑Roafrepairs insurance w employ-[No workers' 1 J..❑ ether cs h i' comp,nlsOranm requir'ed.} J IS i 9 •Any apphcant that checks boa#1 must also fill out th,e section below showing their workers'comper sat en policy information. Y Homeowners who submit this affidavit indicating they are"doing all work and then bire ouCside conawmrs amsx suborn a new affidavit indiczang inch_ vcacrors that check this boat must attached an additional sheet showing the name of the sub-ca aractors and state whets or not those enatms have. employees. If the sub-coatzctobave employees,they mast:pmvide tbbeir Wwkers'comp.policy cumber. I am an employer that is providing workers'conrtmusattern inmrance far my eutplvyeax Below is the poficy end job site informaiie m Insdrance Company Name:, ' Policy#or Self-ins-Lie.9: Expiration Date: Job Site Address: CityfStabEYZip: Attach a copy of the woi*ers'compensation policy declaration page(showing the policy member and eapiratlon date). Failure to secure coverage as required under Section.?5A 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 ciW penalties in Ille form of a STOP WORK{?RIDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement-i ay be forwarded to the Office of Investigations of the.DIA for insurance cove:rage verification. " Ida herreby cetli order thep tuns d vfptdmq that the informdtia n protdded is and correct Date: Phone#: 7 3 7—. O ciai am only. Do not write in this azeae to be completed by city or town s f Scia! CSity or Town: PermitiUcense# Iisning Authority(a: tdrele one): 1..Borci of Health Budding Department 3.City/Town Clerk 4.Electrical Fnsper-tor 5.Plumbing Inspector 6.Other Contact Person: Phone#: 6 searrsraaus. KAM Town of Barnstable Regulatory Services Thomas F.Geiler,Director �y Building Division Thomas Perry,CBO Building Commissioner 200 Main Street,`Hyannis,MA 02601 t www,town.barnsta ble.ma.us Office: 508-86 -4038 Fax: 508-790-6230 • Property`owner Must Complete and Sign This Section If Using A Builder` I X f as Owner of the subject•property - hereby authorise ► 0 h-1 /^i to act on my behalf, in all matters relative to*oth authoriaad by this building pem:dt application for 0 X. Cif Z d 1+1 (Addres f Job) �_j ?P �2 V Signature of Owner Date Print f4wne If Property Owner is applying for permit, lease complete the Homeowners License Exemption 1t _ n. e F p Form o th reverse side.•- , p 0WPFn.ES%F0RMSlbufld4g permit fbnwTXPRESS.doc ` Revised 070110 'F d.i711'ett;s 0eilalt tile,eli;nl 1 tl lip S►1it� I30►i l'01 Bu►i'd�n!L (L4jiil ►hlt►►s uu6 St►7►da►ds Construct ion' :ul rvisar License I a ues►se: "GS 98015 TH WAS ELDRIDGE *: ; . 16 AVALON CIRCLE t ', OSTERVILLE, MA 02t55 -4• Expiration: 6/3/2013 Tr#: 17397 17 ('unuui.,i incr ; S a.a . "_ -• -- U46 �Qo99Zi9ta92toettGl� �J�%/�GCt" � Jel� .. License or registration valid for individul use only Office of consumer Affairs&Busidess Regulation before the expiration date. If found return to: ME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Bu ' Type: .123.0,110 Park P smess Re ulati A laza Suite 5170 g O° lFeIgistration: piration 12/2I2014 DB Boston,MA 021.16 THOMAS EDLDRID STRUG`TION THOMAS ELDRIDGE'`i;E a i 16 AVALON CIR o OSTERVILLE,MA 02655 Undersecretary Not valid without signature ` Q.Assessor's map and lotumber,n ,._ l+ ...,... ... .�l.�icTZ. . ....� �Qy FTNETO�o M Sfwage :Permit number./..... R!:w7 C.. . . . ....... d w E' TOHL{ i�/ BABd9 `'House number ..........1Q.7... .............................. .. ......:....... rAN s i s639. :. TOWN * OF �ARNSTABLE BUILDING.;. 'INSPECTOR APPLICATION FOR PERMIT TO' TYPE OF CONSTRUCTION .............W..O.a ;........ :................................................................................................... E ........19.. ... 3.Q..........19.9a TO THE INSPECTOR OF BUILDINGS: , The undersigned hereby applies for la/ permit according to the following �information: Location ......,�Q. ��....�YGt III.[.1 ... .. �aa/.j. ....(,...G'1? �'l/1..1.r. .jr.. . Proposed Use ...'�7J....GC/[Ck .C'..... 77�2Q...�Y�.GZ. .%h../�i: 2Yt............................................................................ Zoning District ........ �..... ...... ............. . ..`........ ..................Fire District ..L/�T�'.[u.I.1.�C... '...�L'A!l.(.�t �!1.���............ Name of Owner ..7 QI?1�5.. ,csC' ........................Address ..�11. 1 .. r r 11.���Pa.. PGd` .-1,U .... Nameof Builder" .....n....-......./...../.J......n......,../.j..............:...........Address ..... /.`.>. .....................:............................................... Name of Architect GJ.LIU�' Address ..10..77.... �lrUil��... C�,../.';AGI�l'... Number of Rooms ... XTenQ 11? 6-.00.Yt................... Foundation Exterior ..,. )Axk...ceQ'(�i.':..."Sky- ..........................Roofing ...... G'ec/,tr...($hJ�'1r f�Je...................... Floors• .......hn. .ale&A"-overt---P1 j 0,0. .....................Interior ......... .0..1. ............................................ Heating .....�/.11..J.1 .0 dd. ... u.C,Y.t.f........................:....Plumbing ........1/U.1.. . ...1'!'I:QY.. ..... .lr !1NI�l.. iY1. ..... Fireplace ................Y.1D.Y.le...................................................Approximate. Cost .... �!r!a.QQ.�............. ........... Definitive Plan Approved by Planning Board -----------_______-----------}9_______. Area Z��.................... Diagram of Lot and Building with Dimensions Fee ..........4-3J............... ............... SUBJECT TO APPROVAL OF BOARD OF HEALTH Cj 73 93 �rv�pse exjmv sti.0 1 _! /07 ye-ai-S'QGIIO S�cvQ�� 5�,s�.rn 7s �u.11 �u,�c`�to�-,��• � _~_.-�-•�..�`_�...,'~.�„-�� `mere... 11a_g nv �►��c��c�e� load c�;11 6e �c��ec� -to -.t. Ado ac ck h on4.l, TVIe. f Soevn�2j`"j �t�Pro.ximR.�i� 3 r►�o�`�S, OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the T wn of Barn table regarding the above construction. e Name ................... . .Q'rn:. �......... .......... SCOTT, CAROL & THOMAS A. 2 4*'3 4 ADDITION N ................. Permit for .................................... . Single Family Dwelling ja......................................................... i Crai gville Beach Rd. Locat6n. ............................................ Centerville . ...................Centerville Owner .-.Carol & Thomas A. Scott ................................................................ Frame Type of Co"nstructi6n. .......................................... .................................................................................... % Plot ............................ Lot .................................. Permit Granted ........August 31; 9 82 ; � ' DateoflnWecfi on .......X //�r ....-.1 .19 Date Completed ..........................19L-? 1.4 . _ - * .. ;`�. 1 � :;. � .. � - � .Y�� rr may. •. .e r Assessor's map and lot number . ,-an.(`......!i # BpiTH ETp1► Sewage Permit number Xkj"67, zzl...1/16.1 '!. ..........` sABIISTABLE i Ouse number .......... ��7.. ..........................i.................. +� NAA ` 't•0 YP�d TOWN OF ' BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .......s'.X'�P..`:? ...... ..1. ....1"!!..o......... — ..�� � ...Sf � .. ..... lw. .. ...........,....... ..................... TYPEOF CONSTRUCTION ............Z41 .001......................................................................................................... rIlr,cf... 19.�.�s. .. ......... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for permit according to the/following information: Location .... .,✓1. ��....C.l,..Yf !1:1.1.! �... Cf l:?... .C?'.. r...... 6t? �.'1 �1..�.1..r.4��..f.. i� ............................... , ProposedUse ...4)..: ............................................................................ Zoning District ..... '.. Fire District ..La.`�tc',�:±i,,, ,�C'.........C.dPerV►. �'.:........... Name of Owner .. Uk?!lf.,S..�`t..;, t? .............................Address .. < .. ,.... ! ({ l�s��:°:...s:. :'���'/:Z..l.�.±?.lt..... J Nametof`"Builder' .....................................................................Address .................................................................................... Name of Architect .art)�...14.cs'(70&........................Address ll (,t✓>f�p.:...;:' ,^ ...! t ...... Number of Rooms ... >!..rno.. ...................Foundation ... .X7r'Y Y ..,....1.?/l1r ............ ............... Exterior .. . ; t�7;.x!:.. . '(? !�'.�"... `�J. i.Fal��..,.. Roofing ...... �Jh...�2 ..... ?o�rl.:'.f'..... �� � ./P..................... Floors ......... a..t."t�;F?1 . t} 1.n/_.,21................. .Interior ........... .......................................... Heating--_-... f .. !'±':^ .............................Plumbing ....... i�.1.1.. �...Yra �1/ ..... ,i ... ez �. .S.t.Y:. *.,..... Fireplace .................F1. ...............................................Approximate Cost .... ,.: ? ..`.f"� ?I!3C .......... - 19 -----. .... Definitive Plan Approved by Planning Board -----------__---__-------- Area ......... �,�................... .s Diagram of Lot and Building with Dimensions Fee,;..........J�!. ............................. SUBJECT TO APPROVAL OF BOARD OF HEALTH Fj K3 00 P w, .ode d to 61vi ec ro8jCkjj, A/v c,cid',41 oia j .1 l5 J Lv1 } t,(ze CY f a OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS 1 I hereby4 agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. { , '4 Name ...... .... ... :............{ r .......... SCOTT, CAROL & THOMAS) A. aA�=206-132 243� ADDITION No ................. Permit for .................................... Single Family Dwelling .............................. .. ............................................ Location 1�94 C.rai.gville. . . ...Beach. . . ...Rd:. .. ....... ....... .. . .. .. .. .... .. .... Centerville ............................................................................... Owner ,,,Carol & Thomas A. Scott Type of Construc on Frame Plot ........... ........... Lot .......... .................... Permit G anted ......:A..C us t 3 :........19 82 Date of Inspection ........ .................. ........19 Date Co ;pleted ........... ................... ......19 �4 .:Engineering Dept.(3rd floor) Map (0 Parcel FJJ° Permit# ZS, f t House# - In 7,x r') , Date Issued Board of Health(3rd floor)-(8:15 -9:30/1:00-4:30) Fee Conservation Office(4th floor)(8:30- 9:30/1:00-2:00) Planning Dept.(1st floor/School Admin. Bldg.) ��HE Definitive Plan Approved by Planning Board 19 • BARNSTABLE. ' rE1 M. j TOWN OF BARNSTABLE ldnP rmit A H oBuii d Project Street Address /�' �}� JV,7�� Village ry;' Owner Q, Address Telephone (� Permit Request c� First Floor square feet Second Floor square feet Construction Type K- JEstimated Project Cost $ Zoning District 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: f 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 �_e Proposed Use •`� Builder Information Name t 6 Telephone Number Address ,d I. License#_ 2y , o i (C. MA o& Home Improvement Contracto #. Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DE I• E`It SULTING FR THIS PROJECT WILL BE TAKEN TO en SIGNATU —S , 9Z90 C BUILDING PERMIT DENIED F F OWIN REASON(S) 1 � �a1 • FOR OFFICIAL USE ONLY . t PERMIT NO. DATE ISSUED f MAP/PARCEL NO. ADDRESS t ' VILLAGE z `: OWNER t DATE OF INSPECTION: FOUNDATION FRAME f INSULATION { r s FIREPLACE ; ELECTRICAL: ROUGH FINAL . 3 PLUMBING: ROUGH t FINAL GAS: ROUGH t FINAL FINAL BUILDING 2/'2, DATE CLOSED OUT E ASSOCIATION PLAN NO. t OFF�o The Town of Barnstable f � 9g Department of Health Safety and Environmental Services ram, Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 , , Building Commissior. For office use only , 'Permit no. Date 4 + AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along wi other requirements. Type of Work: Est. Cost O Address of Work: Ow ner's Name Date of Permit Application: Q 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 DWROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I here apply or a per a ent of the wner:�_, -�� Date Contractor Name Registration No. OR r The Connttonwealth of atassachusctts Department of Ltdustrial.4ccidcnts '• Ol�cea!/nvestlgatlons ji;ls.._ 600 !f'ashittrtott Street •emu`.+.`• �� Boston, Mass. (12111 A" workers' Compensation Insurance Affidavit i Ik •tn rn inn• - Lngitiow. Q riz. Ale- I am a homeowner performing all work myself. I am a sole proprietor and have no one working_ in an capacity -L [] I am an entplover providin_workers' compensation for m� emplovees working on this job. cons anv name, 'ttidrecc• - city' Phone�!• incur•tner cn _(telicv tt -.... .. ._., .,... _ _._.— ---............ _----.. �..___.__.r.�.. _. [� I am a sole proprietor, benerai contractor. or homeo��ner(circle one) and have hired the contractors listed below who h: the following workers' compensation polices: cmmrnm• n•tme, atltirc5c: Clf�'• nhnnC�• in-mr-Incc rn nnllct• •T.. q-..- _ — .y.r- �.'—— �T•���::�—ZL:T'.f"►.w•S•.�� .� .TS � —���".i._._... cnm am• name: addresc� city nhnne 0! nniic�• incur•tncc ce _ Attach additional Sheet it nee -a..�I.;.0• •T _-J:-'.•:a�y.S.".,..:L�.. -.., .-•...r. -...r..-:.,ilYl�-.. ....waw-. Failure to secure coveraec as required under!Sectton_5A of AIGL 152 can lead to the imposition of criminal penalties of a line up to S1.500.U0 andiu unc�ears'imprisonment:ts we I enaktics in the form of a STOP WORK ORDER and a fine of S100.00 a dad•against me. I understand that: cop} of this auttctncnt ma a forwarded t he 0Mcc of Investigmi.ons of the DIA for coverage verification. I do her err t•a Ice I e paitrs d pert /tics of perjuty that the information provided above is true art Corr Cr,S!_nII[Ur Datc S '` Print name Phone>* .yr�Trrrr - •official use univ do not write in this area to be completed by city or town official ` cite or town: permit/license d r ltluifdin;:Department OLiccnsinr.hoard check:if immediate response is required OSeieetmen's office ►_ Cllcnith Department ,� • contact person: phone4: nUthcr Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "lacy". an entpl(t•ee is defined as every person in the service of another under any contract of iiire;'express or implied. oral or written. An einplot-er is defined as an individual, partnership. association. corporation or other legal entity. or any two or more . the forc�goi►rg cn�ga�ged 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 dwellim- house of another who employs persons to do maintenance , construction or repair work on such dwelling hous or oil the _gr:,.u►ids or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chanicr 152 section 25 also states that even- state or local licensing agency sliall withhold the issuance or renelval of a license or permit to operate a business or to construct buildings in the commonwealth for an- .tppiicant wlio has.not produced acceptable evidence of compliance with the insurance coverage required. -%dditionall,.. neither tite commonwealth nor any of its political subdivisions shall enter into any contract for the )erformzncc of public work until acceptable evidence of compliance with the insurance requirements of this chapter ha ,een presented to the contracting authority. applicants !-ase fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and spplying company names. address and phone numbers as all affidavits may be submitted to the Department of idustrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affdaviL The =tidayit should be returned to tite city or town that the application for the permit or license is being requested. of tite Department of Industrial Accidents. Should you have any questions regarding the "law" or if you are required obtain a workers' compensation; policy, please call the Department at the number listed below. ity or "Towns ease be sure that tiie affidavit is complete and printed legibly. The Department has provided a space at the bottom of e affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Pleas sure to fill in the permit/iicense number which will be used as a reference number. The affidavits may be returned to Department by mail or FAX unless other arrangements have been made. :e Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. :ase do not hesitate to _give us a call. . :e Department's address. telephone and fax number: The Commonwealth Of Massachusetts _ Department of Industrial Accidents -, r r Office cf investigations • 600 Washington Street Boston,Ma. 02111 fax #: (617) 727-7749 phone #: (617) 7274900 ext. 406, 409 or 37S 49 +.5;,,.�� (C \ �/Rb 7D0'771/IJt6'RI!/C(ll[/L O�✓lL6dda�ldCQd. HOME IMPROVE►'ENT CONTRACTOR Registration 121845low '- ' Type - INDIVIDUAL y:^ Expiration 06/19/98 RICHARD TUPPER ZAP,", g 7 &CHARD S. TUPPER 1173 PHINNEY'S LANE/PO, BOX.:V t, ADMINISTRATOR :. CENTERVILLE MA 02632