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'%e k• 1 1i } v:f. .'.��i n' i 1 '1 1 s !, t ,r ,a P .. 3., , k r '37,. 7 } '�i., i? rE A r'ar r a' t r, i. .; d t' r , , '{t i= a 4, .,:.' { L�. A i j .3 x ,t 5 \ ?ti i f'i ;) .. ,' s <i «,r a'. S t, sl ' :::' ,. X..'. :-..,f ,�y ,r .. .:,,, ..�.. .•..E..,,f ,r,.., , , ,�r.:Y, -,a:....,..,, ..:� d:2,......,.".rd:.n.i,,,tr.,,t:bt r, _„,..r, 5. .. R .....,,r,.. ". F. I ,'� r... ,r .rS.�e,a„r,e .:f:,,d,,.G'6.r .,� ----_-_�— _.._. ,._ .iu, +x.. r .. .. iTd':, ,s.'..e,,...t.a.. .... „-�,',.,,,,.., •u:.. >+r., ,, _.. , ,...._ ,, ., r .._«, 3.,�_','1 is_....t.....>, aa:_, ,_ , ,,.1 _. ..,, .,3 .b.,t,t< _ J , THE The Town of Barnstable Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Ralph Crosses Office: 508-790-6227 Building Cors:r Fax: 508-790-6230 ` For office use only Permit no. Date -— l 7 AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work: �� d/�ij'rl S� Est.Cost Address of Work: C6,6; If Owner's Name ✓�C �`/ Cz S/ Date of Permit Application: -J ^�� -7 I hereby certify that: Registration is riot required for the following reason(s): Work excluded by law Job under S1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WPPIi UNREGISTERED CONTRACTORS FOR APPLICABLE HOME ]IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL G 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Date Contractor m Registration No. j /0 2,e IeC , /Z a 97, '! In } �• Z.c. /249 A �yc oe 1 1 -44 E ,h f r` F w t �,'� C •�� WN We o: -a Ot. �.. Z , -Sa ' _ I q�2 9 oc d 2- c�rz r •. i �-, � t ')29ap, -9 `--- o i w sses'sar's map and lot number. ... ........... ...........Glr..:.... (/^J _4 - /' SEPTIC SYSTEM MUST BE _ r INSTALLED IN COMPLIANCE ', g ��j SANITARY COD E �a Sewa a Permit number / lld . ..� � WITH ARTICLE II STATE Cud �� N °f TOWN OF BAR S� fiEVO b�v c O r3 a MARNSTaDLE; "�a =0� IL I INSPECTOR 1639- MAX{f• " c: - cr 0 <c APPLICATION FOI>cyPERMIT TO .... 1..L.rGr.......! ....!v�.. 'Y��..r.Ct. ..�. ...:� ................ t1i [D TYPE OF CONSTRUCTION .......V. A.!!�. ���.F�.!Yl. > ....................................... . .............. ........................................ . ...............:..........192E7 i TO THE INSPECTOR OF BUILDINGS: The undersigned phereby /applies for a permit according to the following information: Location ....�.!�..9.5�.......1...�ZA..�G V 1 LC 6--......./✓L 4C!�1...../`. .............. � LS .ilf C�L.L................................ ProposedUse ...........4 /�./'�,.! . .............................................:.............................................. ZoningDistrict ........................................................................Fire District .................................................f................................ Cry/� ��� a ro�..�..........Address GtJ/�:L.T7 ?�iy� Name of Owner ... .. .... ......................... ................. .....................................�............. ... .�.......... Nameof Builcl .............. ..../..................................Address .............................. .... Name of Architect i l. .Address Numberof Rooms ..............rv6..�!. ................................Foundation ......:�.�A'?........................................................ Exterior ........t'/.V.d'hI.LAC.....ce.Gt.f .Q?....... .........Roofing .....AS.,f�. ........... .................. Floors ........................................Interior .............................................. ...,................................................................ Heating ...............Plumbing ' .....................!�!6..N.. .... ........................................................ Fireplace NA.1UX............................................Approximate Cost ... .... ..............`................................... Definitive Plan Approved by Planning Board ________________________________19________. Area ...... � ........ �, .....,.. O Diagram of Lot and Building with Dimensions Fee .........� , "�............................ SUBJECT TO APPROVAL OF BOARD OF HEALTH AA e e s e% e.,r 5 ee"74- c01� � . hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . .t/ � ?? .... ►.AC.. ..... ` ' . 20166 garage ~�vo ---.. re,mv 'or ---.------_—.. .----�-------.---~------- - 1085 11e ���ch Rd° �oconon ---.—..--.—��—~.-------~. Centerville ' —~--.----------.-----------.. Joseph Graziomi � ��vvner ------....-----------.---. � � . � frameType of Construction —.--..---------,. � ---'-----'-'---~`—^-------'--- � Plot ............................ Lot ................................ | ` - � . � ^ � � May 3 78 / Permit Granted ----.------..--..lV ' ^ Date of Inspection .....................................l9 . . Dote ../ .^��'---]q Completed ^ ~ ^ - � � ^ PERMIT REFUSED ^ . ' ' ........ ...................................... 19 .�—�...�.—.—..~---.--.~------..~....— . � ' . ' ` ( ' —_..-.—^....,..,.......`........—~.,..,.—. � ...+....._.`—.-----.~--..'.—......— . � � � --�..--.—~.~.......-.~...—...,.~...—.~. � � . .. � ^ ' Approved ................................................ 19 , . . � -------._--.—.—........--.—~.~—.. . � ' ` -------`--.-----.-----~---.—. ^ �,/essor's map and lot number ....:.........:":.......... ............. J Sewage Permit number ....... ..... b�Q�OF7NEpO�y� TOWN OF BARNSTABLE Z ,All i M6 9 BUILDING INSPECTOR APPLICATION FOR PERMIT TO ....�..�..!.�.'.............. V.....`V...........�.... '.. �...�.....r.. ..re...!�. ..'................... I i i TYPE OF CONSTRUCTION ............!.........r.:..............�:�..'.�.!::!................................................................................... o ....:....:`.......'...............................19......... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ... .. ... ....................:...... ................................................ Proposed Use .. G i-- .................................................................................................. ...........�............................................................. Zoning District Fire District Name of Owner ?,::: S .........Address ............................�v7yr�tJl, ���1/ff; ....................................... .... ....... 1............................................... Name of Builder i / / t�/1� v !� 179,E 5,f- Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms Foundation '....... Exlerior .c..........Roofing ... ......... .�:�...." r.:...................... ................................................................... ............V............. .. ...... Floors ......................................................................................Interior .................................................................................... Heating ..................................................................................Plumbing .................................................................................. t i Fireplace •......................................................Approximate Cost ` Definitive Plan Approved by Planning Board ________________________________19________. Area ....... :f{ 5 ................. Diagram of Lot and Building with Dimensions Fee ?i ..... ............................ SUBJECT TO APPROVAL OF BOARD OF HEALTH j � Y j Jw I I y9 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . ....."l^ ........................:f...... .......................... Graziosi, Joseph Aa206-100 20166 garage .. ' 'No ................. Permit for .................................... ............................................................................... ' Location 1. .. 085 Craigville. . ...Beach. . ..Rd.. ...... ...... .. ................. . ...... . .. .... . Centerville ............................................................................... ' Joseph Graziosi Owner .................................................................. frame Type of Construction .......................................... 1 ................................................................................ tPlot ............................ Lot ................................ i Permit Granted .........May .................................19 78 Date of Inspection ....................................19 Date Completed ......................................19 P IT REFUSED :....... /�/ 19 r ................................ ............................................ ......................... ::I ............................................. Approved ................................................ 19 p ............................................................................... ............................................................................... r TheTraveler's j The Travelers Companies Gateway Center 1000 Legion Place P.O. Box 3556 Orlando FL 32802-3556 FAX: 407 649-3574 May 7, 1997 STARLINE STRUCTURES INC 6C 2 PINE HILL PARK RTE. 1 SHARON MA 02067 Policy No: 7PUB 276X821597 Effective Date: 04-05-97 Dear Customer: The Travelers Insurance Company has been assigned as the Servicing Carrier for your Assigned Risk Workers' Compensation Insurance. We have received your application and check. Your policy will be issued within the next 30 days. In the meantime, if you find it necessary to file a claim or communicate with our Orlando Service Center,please note the following: For Claims Reporting: For Policy Services: 1-800-832-7839 1-800-842-9886 ext2758 The Travelers Insurance Company CL Residual Market Division Orlando Orlando FL Safety and Loss Prevention are critical concerns to any business. We have long been a pioneer in the field of accident prevention,having the experience,resources and capabilities to provide a complete range of safety services. Your policy will include more details regarding these services. Please make a record of the above policy number and include it on all your correspondence. WELCOME to The Travelers Insurance Company! If we can be of service,please call. Sincerely, GWENETH LIDDY Account Specialist CL Residual Market Division Orlando Service Center cc: SMITH BUCKLEY&HUNT INS AGCY 500 FOREST AVENUE BROCKTON MA 02403 Restricted To; 00 10136` DEPARTMENT Of PUBLIC SAYETY • CONST bfRi SUPERVISOR LICENSE ' ••00 - None uaber� =.:_ Expires; `' 1G`- 1 & 2 Yadly Hoies 1 00 failure to possess a current edition of the 1 Kassachusetts State Buiilding Code i C18i V PLAMONDOR is cause for revocation.of this license. 1.�HBNRICES ST `•191TRAL YA, RI 02863 C���.QOdadK/gif& '. \ HONE IMPROVEMENT CONTRACTOR i Registration '10099v Type - PRIVATE CORPORATIO Expiration 06/2096 ySTARLINE 'STRUCTURES",INC t �5 LwPlamondon (� �o t'o2,Pine-Hill Park,,;Rt ADMI77R Sh$ron HA..02061 fi s 4 s w "'=• The Cumntuttivculth of.1 tassachusctts ;;, 'j..�; •i�;. Department of Industrial Accidents • `' t. f t i�cbin-run Street Biala".Masx. 03111 1 �•' Workers' Compensation Insurance A>Tdavit i ii •tn int rm inn- I am a homeowner performing all work myself. [l I am a sole proprietor and have no one wok-im_ in am•capacity ____.. _- Qum an emplover rovidin_workers' compensation for my employees working on this job. ntn tnm• nnmr- P Cit F-3 00 " ly insimince en. I ,.—� ..._._....�. — _ I am a sole proprietor. ener contract or homeowner(circle oite) and have hired the contractors listed below a•hc Q P P e the followin__ workers' compensation pol'_es: nm n nnv nnmr- Ttqle-t"�� adtiresr. V T� I (^ t 1 � �cf CfJ boor�• ^(goo "(% 8�/�97 in "Mier if F3 _ nm an%• nntne* iddrrsv- policy Ii �• _ .. r. •r.....��.. �.Mr.�aA�...q... __-. _yam..•._ ...M: Attach adtlitio_nai sheet if neres_ia_rv� ���,.�.....�..•—_-- , Failure to secure coverage as required under section 3A of A1GL I5.can lead to the imposition of t nmtnai penalties of a Itae up to S1S0U.UU a. one can imprisonment as swell as civil pcnaltics in the form of a STOP WORK ORDER and a ritic of S100.00 a day apinst me. 1 understand t. cop.,ofthia atatcntrot ma% he forwarded to the Olrtce of Investigations of the DIA for coverage verification. 1 rlo lrercht•crnJ irJcr r/rc pare rid penalties ojpe that the J r anon prodded above is true raid comet ace Sianature / 2 y� ofCciai k-rfrno N)O� Phone 1 Print name y��a�rr '•official use anly do not write in this area to be completed by city or town pertnit/licensc# siuisildind Department city or to wn: Cucensing Board C3Scicctmcn•s Uf 1cc Q check if immediate response is required �ticaith Department f- Aassachusetts General Laws chapter I52 section 25 requires all employers to provide workers' compensation for their :mployecs. As quoted from the an cmpinree is defined as every person in the service of :mother under anv :ontract of Nice: express or implied. on. or written. \n eYnpl(trersis?,dcfrncd as an individual. partnership. association. corporation or other legal entity. or anv two or more rc forcaoin�_ cn_raged in a,joint enterprise. and including the legal representatives of a deceased cmplover, or the _cciver or trustee of an individual , partnership. association or other legal entity, employing; employees. However the wncr of a dwellinu house having not more than three apartments and who resides therein. or the occupant of the \\'cllirt�_ house of another who employs persons to do maintenance , construction or repair work on such dwelIing hour - oil the `-rcunds or building appurtenant thereto shall not because of such employment be deemed to be an employer. 1GL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or ,rrewal of a license or permit to operate a business or to construct buildings in the commonivealth for any )plicant who iras not produced acceptable evidence of compliance with the insurance coverage required. dditionail•,-. neither the commonwealth nor any of its political subdivisions shall enter into any contract for the rformanee of public work until acceptable evidence of compliance with the insurance requirements of this chapter lta en presented to the contracting authority. )plicants :ase fill in the workers' compensation affidavit completely, by checking the box that applies to your siturtion and ,,plying: company narnes. address and phone numbers as all affidavits may be submitted to the Department of ustrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The jayit should be returned to the city or town that the application for the permit or license is being requested. the Department of Industrial Accidents. Should you have any questions regarding the "law" or if you are required ,lbtain a workers' compensation policy, please call the Department at the number listed below. y or -rowns :se be sure that the affidavit is'complete and printed legibly. The Department has provided a space at the bottom of ifdavit for you to f ill out in the event the Office of Investigations has to contact you regarding the applicant. Pleas ire to ftil in the permit/license number which will be used as a reference number. The affidavits may be returned to )epartment by mail or FAX unless other arrangements have been made. Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. se do not hesitate to give us a =11. -- ...._, _7. Department's address. telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 «'ashinbton Street Boston,Ma. 02111 fax #: (617) 727-7749 phone #: (6I7) 727-4900 ext. 406, 409 or 375 THE FOLLOWING IS/ARE THE BEST . IMAGES FROM POOR . QUALITYORIGINAL (S) IM7 DATA Town of Barnstable *Permit# Expires 6 months from issue date Regulatory Services Fee Thomas F.Geiler,Director Building DivisionXPRESS Tom Perry,CBO, Building Commissioner - 200 Main Street,Hyannis,MA 02601 G y, 6 2005 www.town.barnstable.ma.us Office: 508-862-4038 TOW OF RW EXPRESS PERMIT APPLICATION - RESIDENTIAL NLY Not Valid without Red X--Press Imprint Map/parcel Numbei � �r!��� Property Address O�c� L'2�`G'!�/LL e ,9(ngC/4 Rp. Q Residential Value of Work 3 a oo. o c) Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address -_ jJ Oe ORA Z/OS/ /0 86— OP-A16 VILL to Z3&,40N RD. C',E II�,ecrez_Le Contractor's Name (A)jF5rDtJ W 000S R(/1404e.5 _TNt. Telephone Number 7?1-5_Fq-6 33 Q Home Improvement Contractor License#(if applicable) 1 Vy'V w Construction Supervisor's License#(if applicable) 0 d 3 U 0 ❑Workman's Compensation Insurance Check one: 0 I am a sole proprietor am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) VRe-roof(stripping old shingles) All construction debris will be taken to 7_1?/P11z—1 741W 1e/2 ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) --- - —--------- *Where required: Issuance of this permit does not exempt compliance with other town depai r �\ Board of Building Regulations and Stalldlirds ***Note: Property Owner must sign Property Owner Letter of P HOME IMF�R VEMENT CONTRACTOt2 Home Improvem ntractors License is required. Regis 450 SIGNATURE: /v' ��5. �e�%O 1 . ` x. {4 ual Q:Forms:expmtrg5e Revise071405 " STEPHEN M;'RYAT STEPHEN 12YAN 154 NORTH AVE WESTON,MA 02493 Administrator. r The Commonwealth of Massachusetts Department of Industrial Accidents ' Office of Investigations R a 600 Washington Street y: Boston,MA 02111 www mass.gov/dia Workers' Compens.ation Insurance Affidavit: Builders/Contractors/Electricians/P'lumbers Applicant Information Please Print Legibly Name (Business/Organizationdndividual): .Wf cjfD iy W ooy: &/Lp g TWC, Address: CU&E2&2 �2 < City/State/Zip: jgayDG� Are an employer? Check theappropriate bog:. Type of project(required): l.M I am a-employer with _ . 4. ❑ I am a general contractor and I 6 ❑New construction employees(full•and/or part-time).* have hired the sub-contractors Remodeling ?.El am a sole proprietor or partner- listed on the attached sheet 1 g ship and have no employees These sub-contractors have 8. ❑ Demolition working for mein any capacity. workers' comp.insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its Officers have exercised their 10.❑ Electrical repairs or.additions required:] . . 3.❑ I am a homeowner doing all work right of exemption per MGL 1.1.� Plumbing repairs or additions myself.,[No workers' comp. c. 152,§1(4),and we have no. 12.❑ oof repairs insurance required.] t employees. [No workers' comp.insurance required.] 13. Other AIOr 404 t Any applicant that checks box#i must also fill out the section below showing their workers'compensation policy information: 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•contma tors and their workers'comp:policy information. am an employer that is providing workers'compensation insurance for my employees."Below is the policy and job site. nformation. - nsurance-Comp any Name: ?olicy#or Self-ins.Lic.#: Expiration Date:" fob Site Address: City/State/Zip: &-ttach 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 6ne up to$1,500,.OQ and/or one-year imprisonment, as well as civil penalties in the form of a STOP'WORK ORDER and a fine )f up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to.the Office of [nvestigatious of the DIA for insurance coverage verification. I do hereby certify under the pains d enalties of peduryrth`at the information` provided above k true and correct: S' atare: Date: Phone#: 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#: oFINE 1 Town of Barnstable Regulatory Services R'MASS."STM Thomas F.Geiler,Director �' '°�Fo111e+a 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 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize b'T21��1�N ►�`�R W (We,5TO")0006 ) to act on my behalf, T in all matters relative to work authorized by this building permit application for: '►015' CRP ta y 1u.e ZEAO- K -R6D (Address of Job) -&. JI-OL $dab lOS Sign e of Owner Date t Print Name Q:FORM&OWNERPERMISSION �t r Town of Barnstable . *Permit Regulatory Services Fees 6 monthsfrom issue date r r a r • BARNSTABLE, ' � 0ss. Thomas F.Geiler,Director I i63q. �0 / ,prFD�r A _ . 4P Building Divisions�)� ���5 PEA �`� erry,CBO, Building Commissioner MAY 1 1 2000 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 50 € 6 WtF �pRNSTAE3Lk Fax: 508-790-6230 EXP SS PERMIT PPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number LO(0 j00 Property Address ZQ(f,- 0^G7 le,- V1 Residential Value of Work 9 D Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address r �G� Ate• �,��„�e�-✓�•/% 1�� ISZ�3 Z Contractor's Name ZZjjo�bF C-76,) Telephone Number Sad•- Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name AL l Workman's Comp. Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) Re-side ❑ Replaceme indow doors/sliders.U-Value (maximum .44) * ere requi d: I uance of it does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Pro erty O ne must sign Property Owner Letter of Permission. A c y of t e ome Improvement Contractors License is required. SIGNAT < C:\Users\decollikWppl)ata\Local icrosoft\Wi owsuemporary Internet Files\Content.Outlook\MY7NB41L\EXPPESS.doc Revised 100608 [Wasslachusetts- Depai-tment of Public Safety r Board of Buildin!- Regulations and Standards ,'Co.nstructi6n:Superv:isor License �* License: CS 69058 ' Restricted to. ,00 RICHARD STOPPER r;` r s ,79 B MID TECH DR p;;k�. � WEST'YARMOUTH,;MA`02673 Expiration: 12/31/2010 ('ununi, ionei". Tr#: 7545 � I I a � Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration:. 121845 Expiration=6%19/2010 Tr# 268787 -1 Type -lncfividual RICHARD TOPPER ,� t RICHARD TOPPER 29 Roberta Drive W.YARMOUTH,MA 02613 Administrator i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.govldia Workers' Compensation Insura ><davit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeLlibly Name (Business/Organizati 'vidual): Address: Q� City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1I 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 shipand have no employees These sub-contractors have 8. Demolition working for mein any capacity, employees and have workers' [No workers' comp. insurance comp. insurance.1 9. E] Building addition 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 I I.❑ 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#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. 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. A ' Insurance Company Name: Policy#or Self-ins.Lic.#: ��� Expiration Date: Job Site Address: Q�Late/Zip: Attach a copy of the workers' compensation p cy declaration page(showing the policy number and expiration date). Failure to sec_ coverage as req d under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine $1,500. and/or one-, prisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine o ' to$250.00 a d y a ' st the vio tor. Be advised that a copy of this statement may be forwarde to the Office of estigations of the IA for insuranc coverage verification. do ereby certi un the pains enalties of perjury that the information provided abov true d correct Si e: Date: / Phone#: 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#: 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 personsito 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." F MGL chapter 152, §25C(6)also states,that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall' enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must'submit multiple permit/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 year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. r The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, NIA 02111 Tel.# 617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax #617-727-7749 www.mass.gov/dia - t ACORDM CERTIFICATE OF LIABILITY INSURANCE 12/02/i i PRODUCER (508)997-6061 FAX (508)990-2731 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Southeastern Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 439 State Rd. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 79398 N. Dartmouth, MA 02747 INSURERS AFFORDING COVERAGE NAIC# INSURED Tupper Construction Co LLC INSURERA: Arbella Protection Insurance INSURER B: AEIC 27 Roberta Drive INSURERC: West Yarmouth, MA 02673 INSURERD: INSURER E: x'.y COVERAGES :;J< 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 ADD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY 8500008743 11/01/2008 11/01/2009 EACH OCCURRENCE $ 1,000,00 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ ZOO,.O.O CLAIMS MADE 7 OCCUR - MED EXP(Any one person) $ 5',.00 A PERSONAL&ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 29000,000 POLICY PRO JECT LOC AUTOMOBILE LIABILITY 56662400002 12/01/2008 12/01/2009 COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) 11000,000 ALL OWNED AUTOS BODILY INJURY $ A X SCHEDULED AUTOS (Per person) X HIREDAUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) - PROPERTY DAMAGE ak $ (Per accident) INC GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WCC5005593012007 10/03/2008 10/03/2009 X WC 1 ER B ANY PROPRIETORIETOR/PARTNER/EXECUTIVE STATULIM - OTH- EMPLOYER ILITY RICHARD TUPPER IS E.L.EACH ACCIDENT $ 500000, OFFICER/MEMBER EXCLUDED? INCLUDED FOR WC COVERAGE E.L.DISEASE-EA EMPLOYE9$ 500,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/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 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,LL".` BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY '"' OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. For Informational Purposes Only AUTHORIZED REPRESENTATIVE 11(rista Hartford ACORD 25(2001/08) ©ACORD CORPORATION 1988 i r?S**)TUPPER CONSTRUCTION CO.PLC 79B Mid-Tech Drive West Yarmouth, MA 02673 Phone 508-778-0111 Fax 508-778-5010 Registration#121845 License#069058 Date: May 8,2009 Town of Barnstable Attn:Building Department I hereby authorize Tupper Construction Co.,LLC to pull the permits necessary to complete the project described on the attached permit application form. " ' / Thank you, a Owner's Signature Qr� 4L,& M-61 Print Owner's Name: Joseph Graziosi T- ps f�°Z ����/�s) Street Address: 1085 Craigville Beach Rd.,Centerville,MA 02632 r SHED REGISTRATION T' location of shed(address) Q�a�Z ZZ p perty er's name / �© D size of shed natur date Old King's Highway Historic District Commission jurisdiction? THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN shed r / ,Mss A- Z- , psi' • o � ���9�c.11� �e A-�G /2 ?�cy� 406 a 9 7,. to t ::• . A a w R1 N P w ti I x� N � vm + •`r \ ah I IF, - i ,�..� / �� ,'4,� �!'�6�<✓Win/ �� ;,v 92 o -99 Cape Save Inc. TO"ViN OF 7-D Huntington Avenue RINSouth Yarmouth, MA 02664 22 AN -• Tel: 508-398-0398 Fax: 508-398-0399 f'F 6/18/15 Thomas Perry CBO Town of Barnstable Building Division 200 Main St. Hyannis,MA 02601 RE: Insulation Permit 201502968 Dear Mr. Perry This affidavit is to certify that all work completed for 1085 Craigville Beach Road,Centerville has been inspected by a third party Certified Building Performance Institute(BPI)Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, e , William McCluskey TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION pl,Map_ 0 �i Parcel (� _ Ap`pliction # U��� Health Division ` -Date Issued ` 3//J� Conservation Division Application Fee Planning Dept. Pe it.Fee ( �S Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 10 8 5 C ck i q Village ceAM(-y I G Owner To Se �` Ci- �z i p S i Address 5 amC Telephone S 0 8 —+3-5 $ 0 19 I Permit Request JenSc. oa_Gk WaLU w1A `k -13 cedktose Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 0'b 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 V1,1111M - S nr e L C• Telephone Number S08 318 d 3 9 g Address A-v e.. License # l 0 ( 3 6 �14 Home Improvement Contractor# (3 0 0 Email Worker's Compensation # W W :1 '�b a LI' ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE • FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. 'r 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. f The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02I14-2017 a ee ww».massgov/dia R`orkers'Compensation Insurance Affidavit:Builders/Contractors/Elects eians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information _ _ _ Please Print Legibly Name(Business/Organizarion/Individuat):Cape Save Inc Address:7'1) Huntington Avenue City/State/Zip:South Yarmouth; MA 02664 phone#1508-398-0398 Are you an.employer?Check tbe.appropriate box: Type of Project(required): l: ✓ I am a employer with.20 employees(full❑ - 7. New construction. 2.❑I am a sole.proprietor or partnership and:have no employees working;forme in- any capacity.[No workers'comp.msurance.required.]� � 8. 0 Remodeling. 9. Demolition 3.F1 I am a homeowner doing all work myself.[No workers'comp.insurance required.] 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.M Electrical repairs or additions` proprietors with no employees. 12. Plumbing repairs or additions 5.M I am a general contractor and I have hired the sub-contractors,listed on the attached sheet. 13:a ROOFrepairs These sub-contractors have employees and have workers'comp.insurance.. 6.❑We are a corporation and its officers have exercised their right of exemption per MGL:c; 14.DOther Insulation 152,§1(4),and we have no employees.[No workers'comp.insurance required.] 'Any applicant that checks box 91 must also fill out the section below showing their workers'compensationpolicy 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.anl state whether or.not those entities have. employees. If the sub-contractors have employees,they must provide their workers.'vomp,policy number: I am an employer that is providing workers'compensation insurance for my employees. Below isthe policy and job site information. Wesco insurance Company Insurance Company Name:. P Y WWC3136274 04/09/2016 Policy#or Self ins.tic.#: Expiration.Date- Job Site Address: 1085 Craigville Beach Road City/State/zip Centerville 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 statement may be forwarded to the Office.of Investigations of.the DIA for insurance coverage verification: I do hereby certify under the pains andpendides ofperjury drat the information provided above is true and correct Si ature: _ Date: 5/19/2015 Phone.#:508-398-A398 'Official use only. Do not write in this area,to.be completed by city or town official. city or Towi; Permit/License# Issuing Authority(circle. one): 1.Board of Health 2.Building Department 3..City/Town.Clerk 4.Eleetriesl_Inspector 5.Plumbing Inspector 6.Other Contact Person:..... Phone:#: __ - acr ,.- CERTIFICATE OF LIABILIT INSURANCE ATE(IAMIDDIYYYO 3/24/2015 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 i€the certificate holder Is an ADDITIONAL INSURED,the polo y(I s)must be ertdorsAd. If SUBROGATION tS WAIVED,,srtbject Ia N' the terms and condiilons of the policy,certain policies may require an endorsement. A statement on this certiflc.ate does not confer rights to the certificate holder in lieu of:such endorsement(s). PRODUCER NAME: Colleen Crowley . Risk Strategies damp PHONE .. (781)9$6.-4400 FA /C o:t781)963�4420 15 Paeella Park Drive - ,ecrowley@risk-strategies..com Suite 2413 . . INSU S AFFORDING COVERAGE NAIC I� Randolph A l 02-368 INSURERA:S61eC Ve "Ins. OE' Arica INSURED � . .::. _.._ .. • INSURERs A11R64rica Lri$SSClel iA11Z3IICe 0212 CapO SaVB A Inc INSURERC WesCO ZnsuranS2. an 7 D Huntinaton Ave INSURERD: INSURERS South Yametuth M�ii 02664; INSUtrERF F. COVERAGES CERTIFICATE NUM BER:CL1532491501 REVISION NUMBER: THIS IS TO CERTfFY T}IAT Tti•E f>0' ES OF'iNSURANCE sTED sELOW'HAVE BEEN IS-SUED'TO"THE WN URE6'NA�IED ABOVEFOR"TKE`POLICY FEW INDICATED. NoTw HSTANDING ANY REQUIftEMENT,TERM OR CONDTTION'`OF AN�"CONTRACT OR tSTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE'ISSUED OR MAY.PERTAIN;THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN S SUBJECT TO ALL THE TERMS, EXCLUSIONS;I NI CONDITIONS OF SUCH POLICIES.LIMIT'S SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS: INSR TYPE OF INSURANCE,: OLICY EFF POLICY EXP POLICY NUAABER LIMITS GENERAL LIABILRY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL-GENERALUTABILITY 1 Yt D PREMISE Ea occurre ce S 100 000 �+ CLAIMS-MADE-x OCCUR 2994480 0/16/2014 0/16/2015 i- MED EXP(Any one person) PI us NAL a ADV IPIALRY A 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT.APPLIES PEW. - PRODUCTS-COMPLOP AGG $ 2,000,000 POLICY X PRO- X LOG $ Avromos LE_LIAHiLRY_ _ Ea a dart ! 1 000 000 $ ANY OWN BODILY INJURY(Per person) $' ALL OWNED SCHEDULED 6796600 1/6/2014 1/6l2ols AUTOS AUTOS; BODILY INJURY(Per eca lent) $ ` X HIREDAUTOS X NON-OIA'M AUTOS PeOr esAIWAeiE::: X - $ X UMBRELLAuAR. X OCCUR EACH OCCURRENCE $ 1,:0'OO,,000' EXCESS CIAB CLAIMSU4DE AGGREGATE $ 1,000,000 DED RETENTION Hz 29 46a 0/1612014 0/16/2"5 $ {' WORI�FRSCQMPENSATION ffSG81'S Itclualea for X 'vcsTATu- TH rwucr.�� AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETORIPARTNER/EXECUTIVE Overage RFFtCERINEMBER EXCLUDED? N lA E.L.EACH ACGDENT $ 50O 000 (Mandatory In NH) 13ii274 /9/2OV5 }9/2016 If,y2s,do—beunder E:L-DISEASE-E+4EMFLOYEE $ 50a 00 DESCRIP710NDFOPERATIONSbelow E:L.OISEASE-POLICY LIMIT $ 500,060 DESCfPop,nON OF OPERATIONSILOCA7IONS I VEHICLES(AQach ACORD 104,Additional Remarks:Svfied4le, f more apace to roquired) Issued as eva:dence of.. nsuranee. _ Thiel Engineering, Ine6 is listed as additional insured:as respects Ger>eral Liabilit�r`as requiseci..by �zritten coa tract. CERTIFICATE HOLDER CANCELLATION @capel 96 conpac .Qrg SHOULD ASS IIIF'TiiE A$OFtE'DESCRISI:D`POt(CI[=8 BE CAOCELLED BEFORE. THE :EXPIRATION DATE THEREOF, NOTICE WILL SE DELIVERED 'IN Cape Light CoMaCt ACCORDANCE WITH THE POLICY PROVISIONS, Attu: M�rgazet song 90 AQX $27/3CX <AUTHORIZEDREPRESENrATIVE 3195 Main Street Barnstable, MA D2630 'chaea. Christa.an%CLC. ACQRD'-25 {)1445j #98�.2U70AC IRD CURPQRATItlp}. All rigtrte reserve d, 1NSt125(zotoos).ot The ACORD name and logo are registered,macks of lCORD Building Permit Authorization I, oseph J . raziosi as owner - hereby give my permission to Cape Save, Inc. 7-1)Huntington Avenue South Yarmouth,MA 02664 Office:508-398-0398 to take all necessary steps to obtain a building permit to perform work at my property located at 1085 Craigville Beach Rd Centerville, NIA 02632 Signed !- Date o� D Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 171380 Type: Corporation Expiration: 3/14/2016 Tr# 249649 CAPE SAVE INC. WILLIAM McCLUSKEY 7-D HUNTINGTON AVENUE SOUTH YARMOUTH, MA 02664 ._ " ----- --- { Update Address and return card.Mark reason for change. scn t 0 20M-05n t Address D Renewal 0 Employment Lost Card Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: *T71380 Type: Office of Consumer Affairs and Business Regulation Expiration�3/1 416 Corporation 10 Park Plaza-Suite 5170 ,4/Zit _ Boston,MA 02116 CAPE SAVE INC. WILLIAM McCLUSKEY t 7-D HUNTINGTON SOUTH YARMOUTH, MA 02664 Undersecretary Not vali rthout signature Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor Specialty License: CSSL-102776 W ILLIAM J MC C-LUSJCEY ' 37 NAUSET ROAD West Yarmouth]VIA Expiration Commissioner 06/28/2015 V Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 , Tel: 508-398-0398 Fax: 508-398-0399 11/11/2014 Thomas Perry CBO Town of Barnstable Building Division 200 Main St. Hyannis,MA 02601 RE: Insulation Permits Dear Mr. Perry This affidavit is to certify that all work completed for 1085 Craigville Beach Road (#201404720) has been inspected by a_thirdparty Certified Building Performance Institute(BPI)Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION TOWN OF BARNISTA"'L7. Map a 0 6 Parcel �00 � Application # Health Division ���� �� 2 �, } a� Date Issued Conservation Division Application Fee v Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address n AS arZ a.14 yl ll6 Beal- k Village C lt'er y-1 Ile Owner U 0$ep t, G rig 41 OS 1 Address C M L Telephone Permit Request �K-M mj R ' 0J ce jl% lose -M + P, e4i1r. LP S" -ike JnV oline wnJ 6oxmimf i WI • Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 5 0 0 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 ULaoy (BUILDER OR HOMEOWNER) Name W11110 /noe Telephone Number Address - License # a�c L o aT r7 5QLAA A.�`MOA M 0 0 Home Improvement Contractor# Worker's Compensation # VJKCA0 656, � ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE �� FOR OFFICIAL USE ONLY .. APPLICATION# .4 DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER ` f DATE OF INSPECTION: {�+ ` ,}FOIJIVDA�I,ON�� �°—:�.��:•�-�s�t��,r,c��G ' FRAME INSULATION �. FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL i, GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. F Building Permit Authorization I, Joseph ;Grazosi , as owner hereby give my permission to 6 Cape Save, Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Office:508-398-0398 to take all necessary steps to obtain a building permit to perform work at my property located at 1085 Craigville Beach Rd. Centerville, MA 02632 Signed J Date v� r= The Commonwealth of Massachusetts 4 Department of Industrial Accidents Office of Investigations 1 Congress Street,,Smite 160 L: Boston,MA 02114-201 7 www.massgov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumb..ers Applicant Information Please Print-Les= blV Nanle (Business/Organizatiorvtndividuat): Cape Save Inc., Address: 7D Huntington Ave - City/State/Zip: South Yarmouth, MA 02664 Phone 50&-398-0398 Are you an employer?Check the appropriate box: Type of project(required):. 1.;[✓ 1 am a,em loyer with t 4. 0 1 am a general contractor and 1 P 6. []New.construction employees(full and/or part-time):' - have hired the sub-contractors 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 an ca acity employees and have. workers' 9. ❑ Building addition [No workers' comp.insurance coinp.insurance.= required.] 5. 0 We are a_corporation and its 10E.Electrical repairs or additions. 3.11 1 am a homeowner doing all work-, officers have exercised their I Ln Flumbing repairs or,additions. myself.[No workers'comp. right.of exemption per MGL. 12 p Roof repairs insurance required].r c. 152, §1(4);and we have no employees. [No workers' 13, '.Other Insulation comp. insurance required.:]. `Any applicant that checks box#il must also fill out;the section below showing their workers'compensabo rpohcy mfonnation. t Homeouners who submit this affidavit indicating_they are doing all work and then hire outside contractors must submit a newaffidavii.ndicatingauctk aContractors that check This boxmust attached an additional sheet showing the name of ihesub-contractors and state w6i6r or i of iho§e enitttes awe h...: employees. If the sub-contractors have employees,They musC:provide;their workers'comp:policy number: I ant an employer that is providing workers'compensation insurance for my employees. Below is the policy:und johaife information: Insurance Company Name: Wesco Insurance Company - Policy#or,Self-ins.Lic.M. WWC3085633.. _ .. _ _ . Expiration Date: 04109/2015 II_ Job Site Address: C 1 r..lII (e ?cr&c City/State/Zip., G, q4et y I Attach a copy of the workers'compens on policy declaration page(showing the policy nn.mber:and expiration date)`.. Failureto secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of cn6inal<penalties of a fine up to S 1,500.00 and/or one-year imprisonment,as well as eivil penalties in the fort 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 O'ffce of Investigations of the DIA.for insurance coverage verification: 1 do hereby cerdfy tinder the pwins atdpenalfi.cs of 0er' that the in ortnation provided above is true and correct. Siatature: Date Phone 4: 569-399-039; -. Official use only., Do not write to this'-area,.to be com leted b y ci. or town official .ff Y• P 1 t1 .. .�' City or Town: Permit/License.# Issuing Authority,(circle one): 1.Board of Health 2.;Building Department 3.C ty/Town Clerk 4,Electrical Inspector $.Plumbing inspector 6.Other Contact Person: _. Phone 9- ACVRU DATE(MMyS1DJYYW) CERTIFICATE OF LIABILITY INSURANCE 414/2014 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 .F INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THEs ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the poilcy(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 NAME: Colleen Crowley Risk Strategies Company PHONE (781)986-4400 FAX (T81)963-4420 A/C No 15 Pacella Park.Drive h-MAILccrowley@risk-strategies.com Suite 240 `INSURERS AFFORDING COVERAGE ... .. :NAIC#. . Randolph MA 02368; insuRERA:Selective ins.., or America INSURED INSURERS:Safet . Insurance C c an .... 3618 Cape Save, Inc iNsuRERc:wesco Insurance Company 7 D Huntington.Ave INSURERo: INSURERS; . . ... South. Yarmouth MA 02664 INSURER:F; COVERAGES CERTIFICATE NUMBER CL1441475243 REVISION NUMBER: THIS IS TO CERTIFYTHAT 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.. .. POLICY EFF POLICY EXP_.._. _. - . . ' :. ... - LTR TYPE OF INSURANCE. POLICY NUMBER MMIDDIYYY MMIDDIY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ _ 1,.0.00,000 X COMMERCIAL GENERAL L"ILITY" PREMISES fE an $ 100,000 A CLAIMS-MADE RENTEU- Q OCCUR 1994480 0/16/2013 0/1 ti/2014 MED EXP(Any one person) $ 10,000 PERSONAL 8 ADV INJURY . $ 1,000,000 GENERAL AGGREGATE $. 2,000,000 GENIAGGR EGATEsLIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X, PXCT RO X: LOC $ AUTOMOBILE LIABILITY coWSIFEU SINGLEI I Ea accident 1. 000 000 BIR ANYAUTO BODILY INJURY(Per person) �. ALLOVJNED X SCHEDULED 208200 1/6/2013 1/6/2019 gODILYWJURY Per accident $ AUTOS AUTOS,. ( ) NON-OVMiED PFOPERTY'DAMAGE. HIRED AUTOS B AUTOS Peraccldent $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE 1,000,000 - A EXCESSLIAB CLAIMS-MADE AGGREGATE $ 1,000,000 QED RETENTION' NIL 1S1994480 0/16/2013 0/16/2014 C WORIfERSCOMPENSATION -- - Officers Included For - . x ATU OTH- ANDEMPLOYERS'LIABILIY :YN R ANY PROFR(ETORIPARTNER/E)(ECJJTIVE, Coverage OFFICEPJMEMBER EXCLUDED? NIA E.L.EACH ACCIDENT $ 500,060 (Mandatory In NH) WWC3085633 /912019 /9/2015 EiL,DISEASE-:EA EMPLOYEE $ .50.0 000 dyes.describe under DESCRIPTION OF OPERATIONS below El.DISEASE-POLICYLPb1T It 500 000 DESCRIPTION OF OPERATIONS l LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if.more space is required) Issued as evidence of insurance. Issued as evidence of insurance. Thielsch Engineeririg Inc. is listed as additional insured as respects General Liability as,required by written contract- CERTIFICATE HOLDER CANCELLATION' mson0capelightcompact.org: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF; NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POL16Y.PROVISIONS. Cape Light Compact Attn: Margaret Song PO BOX 427/SCH AUTHORIZED REPRESENTATIVE 3195 Main Street Barnstable; MA: 02630 Michael Christian/.CLC ACORD 25(201010q. 01988-2010 ACORD CORPORATION. All rights reserved. INS025(261005).01 The ACORD name and logo are registered marks of ACORD 77 Office of Consumer Affairs"ar1d:Buslness Regulation 10 Park Plaza=Suite 5170 Boston;Massachusetts"021.16 -Home Improvement Contractor Registration Registration 171380 Expiration: 3/14/2016 7r#-249649 Yq CAPE SAVE INC. WILL-IAM McCLUSKEY" 7-D HUNTINGTON AVENUE SOUTH YARMOUTH, MA 02664 `x t �' Update:Addres"s and return card:Mark reason for change: Address Renewal Employment Lost Card SCA 1 £i 20M-05/11 V/ZP. (rsC✓/7!/IJ7RJ2LlJ�CLLLIL 6�� (O:IfIL'fLLG3Pw� ,. €7— Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ; OME.IMPROVEMENT CONTRACTOR _ before the expiration date. If found'return to: !' egistraUon: 1713g0 Type: s Office of Consumer Affairs and Business:Regulation gnat MC OAD Expiration: 3/14/2016 Corporation i 10 Park Plaza-Suite 5170 { t Boston,MA 62116 t CAPE SAVE INC: WILLIAM McCLUSKEY 7-D HUNTINGTON AVENUES -% r 1 SOUTH YARMOUTH,MA 02664 t Undersecretary Not va,li tthout siure Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Superisor Spectalt} License. CSSL-102776 � W ILLIAM J CtUSKE; 'r 37 NAUSET R " West Yarmouth NA0273 ' r � t J,•�.•• /Sl . ,��.; Expiration . Commissioner O6/28/2015 c. Engineering Dept. (3rd floor) Map - 29(4, _ Parcel LO O Permit# G �� House# Date Issue d Board of Health(3rd floor)-(8:15 -9:30/1:00-4:30)ez1-;o(_eW A a a�V • °7 SEPTIC SYSTEM MUST BE Planning Dept.(1st floor/School Admin. Bldg.) ONSTALLE COMPLIANCE E5 Definitive Plan Approved by Planning Board 19 ENVIR CODE AND TO 'LIONS TOWN OF BARNSTABLE Building Pewit Application Project Street Address ` Q. , Village Owner l Address Telephone Permit Request < S L,, First Floor square feet Second Floor square feet Construction Type Estimated 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 To On Old King's Highway ❑Yes VNo Basement Type: ❑Full $Ocrawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New D Half: Existing New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: 0 Gas ❑Oil ❑Electric ❑Other Central Air (A 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 &o If yes, site plan review# - Current Use Proposed Use Builder Information Name tAla - Telephone Number 3V®L -3 Address (3 License# �? Home Improvement Contractor# J - Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUIL )SHOWING EXISTING,AS WELL AS A PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS G FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE _ DATE BUILDING PERMIT DENIE THE L OWING REASON(S) FOR OFFICIAL USE ONLY - - •• /) i ' PERMIT NO.,'-- DATE ISSUED MAP/PARCgL NO. ADDRESS °' d VILLAGE OWNER DATE OF INSPECTION: FOUNDATION ` FRAME t . INSULATION a ' • F FIREPLACE , s ELECTRICAL: ROUGH FINAL —• PLUMBING: ROUGH t FINAL GAS:` ROUGH FINAL � { FINAL BUILM" ct DATE CLOSES ' ASSOCIATI6N AN NO. --- ' 1 The-Town of Barnstable � qt Department of Health Safety and Environmental Services ��• Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commission For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. ://Type of Work: Est.Cost Address of Work: C&SZ L Owner's Name ,/ Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. 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 a ply f a permit the a nt of the owner. Date Contractor Name Registration No. OR IL - , The Contt»unsl-eulth of Ifassucbusai •rt! ;-�•=�•�= Department of Industrial Accidents zOcP�llttyestJgatlons 600 !i'aWdirrtun Street ` = A' Bustu►r.A1uss. pZlll Workers' Compensation Insurance Affid:t-s•it - i ii n inf rn%- ion:' _. LaWn" ) (�acsti n• � � Q �• hon•i1 1 am a homeowner performing all work myself. I am a sole proprietor and have no one working_ in any capacity _ - [� I am an entplover providing workers' compensation for my employees working on this job. cmm�•rny n•tmc• •tddrecr city- nhnnc ft• incur�ncc cn nplicy tt [i I am a sole proprietor. general contractor, or homeowner(circle one) and have hired the contractors listed beiow who h.- the following workers compensation polices: cmmn•tn,• n•ttne, •tddretc• cin nhnnc 0, - incnrnncc ro cnnirmn\' n• ine, add rccc- rin•• nhnnc it• incur•tnee co.' neiicy _ Attach additional sheet ifneces_sa_ry- ^_• _,,�_:`;:;L, -- -'"• "`-�-^.ate fir_.~� �y�1`.'�-••',,;,,•�_ Faiiurc to secure coverage as required under Section.SA of NIGL 152 can lead to the imposition of criminal penalties of a tine up to SI.500.00 andiu. unc years' imprisonment as well as cit•il a t the form of a STOP WORK ORDER and a fine of SI00.00 a dad•against me. I understand that cope of this statement ma un.•ar cd to the oMc f Investigations of the DIA for coverage verification. 1 rio re r ccrti t u tdcr tl p tits and et tics of pe 'un•that the information prorided abov is true and co gets tZlSi Datc 1 w Print name Phone>r w W - oflicial use only du not write in this area to be completed by city or town ofliciai city or tmvn; permit/license t# rlt3uilding Department C3Ucensing Board I] check if immediate respunse is required OSeleetmen•s Office i �. 011caith Department E contact person: phone 0: rt)ther. n ormatton and Instructions Massachusetts General Laws chapter 152 section 25 requires all emplovees to provide workers compensation for their employees. As quoted from the -Um". an etnpl(tree is defined as every person in the service of another under any contract of ltiire:express or implied. oral or written. An enrpinrer is defined as an individual. partnership, association. corporation or other legal entity, or ally twee or morc . the fore�_oin�_ enuaged 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 6%-ellin__ house having not more than three apartments and who resides therein. or the occupant of the dwcllinu house of another who employs persons to do maintenance , construction or repair work on such dwelling_ hous or oil the _rounds or building, appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that even- state or local licensing agency shall withhold the issuance or -ene��:rl of a license or permit to operate a business or to construct buildings in the conimonivealth for any Applicant who 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 )crformance of public work until acceptable evidence of compliance with the insurance requirements of this chapter lia )Cell presented to the contracting, authority. ,pplicants lease fill in the workers' compensation affidavit completely, by:checking the box that applies to your situation and ipplying 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 affidavit~ The 'fidovit should be returned to the city oritown 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 «•orkers' compensation policy. please call the Department at the number listed below. itv or Towns case be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of affidavit for you to Fill out in the event the Office of Investig,ations has to contact you regarding the applicant. Pleas sure to fill in the permit/license 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 uive us a cz-ll. :e Department's address. telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washinbton Street Boston,Ma. 02111 fax #: (617) 727-7749 phone #: (617) 7274900 ext. 406, 409 or 375 J t 1 1 .. I!"W+kI •:'YVr fnP- :edY SAS ..x,. �, y.. �"^ 1 HOME IMPROVVENT CONTRACTOR- -Registration 121845 �. TYPe- - INDiVIDUAI i.4 Expiration 06/19/98 RICHARD+TUPPER. w?��- CHARD S. TUPPER aoMiMsTRn1oR 1173 PHINNEIf'SA;IANE/QU �� CEATERVILLE M 0`2632 s L Pi ' ✓J2C V/04)7/ht4�lU/C2L12 6�v"I�CQ kfQ�iLCCJPGC(I . DEPARTMENT Of PUBLIC SAFETY i CONSTRUCTION SUPERVISOR-LICENSE Nuiber _Expires: z - Res T teu 40 { �� RFCNARD S TUPPER OC BOX 117 ' CENTERVILLE, MA 02632 1 r 0 . 13573►' : 1 ' 1/1 10"sauna tube or footings FOOT S TO BE 4'BELOW GRADE 4 SECOND FLOOR o � N `1 T-8" all framing to be 2"x8'pt 16"o.c. N 4 00 S. RS TO MEET WITIOWEIRVECK 8'-3" 81-0" 6'-6" supporting post to "WPT 40'-8" rim joists to be 2 2" PT FRAMING PLAN Maloney Kathy From: Schlegel Frank To: Maloney Kathy Subject: Address Change Date: Thursday, July 10, 1997 9:51AM Kath, I just changed the address for map 206 pcl 100 from#1083 to#1085 Craigville Beach Rd. Centerville. I believe there is a permit for an addition to the second level of the existing house. Please check you records on this. THANX! Page 1 Engineering Dept. (3rd floor) Map Zd�o Parcel 1,06 0- Permit# -` --- House# Date Issued 2 Board of Health(3rd floor)-(8:15 -9:30/1:00-4:30),� J-" Fee Conservation Office(4th'floor)(8:30-9:30/1:00-2:00) I O Planning Dept. (1st floor/School Admin.Bldg.) SEPTIC SyP�M BE Definitive Plan Approved by Planning Board 19 INSTALLEDNCE f IRt3NME ��® TOWN OF BARNSTAB TOWN RREG � Building Permit.Applicat' n Project Str et_Address l G?V✓l 6 v/L_Le Village �- T i C_(e Owner CF71 H Q 1ko+�z Address 10 C9 5 cf1 C;m l W �6qt 4 �1 Telephone , Permit Request `gin, First Floor; ,/ square feet Second Floor` square feet Construction Type F)Q QY`'l C-7- Estimated Project Cost. $ ;�O©©e '- Zoning,District Flood Plain Water Protection Lot Size . Flo i9 Grandfathered ❑Yes ❑No Dwelling Type: Single Family p"' Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: LE(Full [Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.). c Basement Unfinished Area(sq.ft) A9-C. Number of Baths: Full: Existing 3> New --• Half. Existing - New No.of Bedrooms: Existing 4 New Total Room Count(not including baths):Existing 3 New First Floor Room Count 7 Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Othef Central Air ❑Yes ❑No Fireplaces: Existing / New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) L-K "1,4 Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) V " ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded El Commercial ❑Yes ❑No If yes,site plan review# - Current Use P&_-s r Proposed Use Rvp-r l(g�- —S 8$miw Builderjnformation Name //�i�� % E�ll(l L ��6 !�- �� ��rIU��Jd�+/ Telephone Number Address 7/- License# � -S-�771` Home Improvement Contractor# Compensation# ���(/�G S 7pva Worker's Com p 176.x91tSR7 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCT N DEBRIS RESULTING FR/pM THIS PROJECT WILL BE TAKEN TO 16r—I zc�,6,i SIGNATUR � �;� DATE r �' BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED ' MAP/PARCEL NO. ADDRESS VILLAGE - OWNER `V DATE OF INSPECTION: f ' FOUNDATION FRAME INSULATION _ . FIREPLACE ' ELECTRICAL: RQUGH <= FINAL PLUMBING.- _GH!f—Z s FINAL GAS: FINAL FINAL BUILDINUQ`�fwz - x' DATE CLOSED OUTS E' ASSOCIATION PLANNO. 's I ,V/gto - 2-06— hoop //�� sEPTI Assessor's map and lot'number�•�O.?......./ .�114ST,4LLSYSTEM MUST BE %TNET PLIA INSTALLED IN COM off,, o� Sewage Permit number .......... �trL ..... G� t/ r7kil ARTICLE II STATE `°``Pys�' ♦0 I C / yy + �Ti ¢ Y3„ CODE AND � A, = BAWSTAIILE. i House number ..l...D.Y .S� 01AT9�.UNs.' /9De7 `+,rV , 9 V a ........... �a ¢ OO 039. 0 �0UPYP\ TOWN 'OF . BARNSTABLE,-. . . BUILDING INSPECTOR APPLICATION FOR PERMIT TO ............................ ..... .:........:....... ......................�...........:.Z5 ......... TYPEOF CONSTRUCTION .................................................................................:................. .::............................... ' ..... .. ...Z .....19..E , TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .. ..................... ....: .�i ...... .....l.l.c...................... :..t ........ ........................................................ Proposed Use ..........., �..�'?�.I� ......�nd!!��...�....st:f�o4v..a4...... ��..�4��:�............... ZoningDistrict ........................................................................Fire District .............................................................................. Name of Owner .V...P ��.. .. ►.t/.1....N.4�:�OOAddress ........Sf�M.g....I ......./.4.4.4.3(.ir..................... Name of Builder ..t .. ......!7......�.1./J�' ��. .........Address Name of Architect ....Address ..................:............... .............................................................. .................................................. Z Roo pi x Foundation 7 Q . Number of Rooms, ..:.... ........ M ................... N �i v r.� o rt .. c / d P J Exterior ...USlO..?..d....... ..Roofing .......A G1 A Floors G .n..�JQ. .................................../.......Interior ......SiS fe.. ............................................................. /Y��/lq� ...... . J� A! h C410Pe -OveNfCeWto-eHeating ........y/.H.2 !..... . �.{ .....................Plumbing ..... . ........................................................Fireplace ............ .Q..'........................................................Approximate Cost ..........5°`'� �. :. .................�........... b Definitive Plan Approved by Planning Board ________________________________19________, Area .......�.......9.......:. . ............ Diagram of Lot and Building with Dimensions Fee f.. .................. SUBJECT TO APPROVAL OF BOARD OF HEALTH T`� 0 tAAQr I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ................... .....��....... ... .-............... ........ Graziosi, Joseph 50 too ..2C1............... Permit for ....I?Ax'.171ar...&..S.tairs .............................................................................. y Location ....1085..Erai v lle..Bch.-Ed,........... �- r Center.Y.jjIg..........................:................... .> r Owner .......Jozeph...Gr Type of Construction .'.............................................................. ............ r } T Plot .2Db.....1 w......... Lot................................. . f, , .. ,...— .ems � a !� j • ! Permit Granted .... ugSt. 147$ , ......... Date of Inspection ..17' .3/. 7..................19 Date Completed ..1 -........ .C. .... .19 .. PERMIT REFUSED .... ................ ........... .............. ~• . 19 It is understood that this ad�l�,tQ i s not an ' .................................................... l ✓....... �. a artment a d I j ...k?....................�1....:�9..1��..u���. �s..a..�ingle family � .-�" -, • �, _ residence. ........................ . ..u.�.�:.:.....b.., �..t�...f.... . Rita Graziosi 'September 27, 1978 . . Approved ................................................ 19 s � T .......... ...... ......................... ....................... } As,dssor's map and lot number rT yoF'rNe rot Sage Permit number .................................�- -- � !..... t G,'9� d�Q� ♦�........ i '/ r 1 Z 9HHSTU r B LE, i House number ...... .....'...:'..................:a:f.:.:..�...a. .......� -.: 1 y MA86 �p 039. \e� MPY p TOWN OF BARNSTABLE BUILDING INSPECTOR ..� Fes, ��- APPLICATION FOR PERMIT TO ............................................,............... ................................... `........................ TYPEOF CONSTRUCTION ........................................................................................:............................................ • ........................ . . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ........................:....`....................... .....�.....:..................:?.:.. !............. .................:........:... :.......:............... .. Proposed Use .........................................................1.!.. `......`�''.........................�....^�..... �11..:riir nn. .............. ZoningDistrict .........................................................................Fire District .............................................................................. Name of Owner .....: E�,®i?(./..^ ...1/t: fl....�C/ A?/O.Address ....... 5.f!�.`.`.'.C.... .......a�.. .�'..'�. '..................... Nameof Builder .............Address....................................................... .................................................................................... Nameof Architect .......................... ........................................Address .................................................................................... j Number of Rooms Foundation ......................... ........................................................... ..................................................... Exterior ..... .....::.....Roofing ........, :`" ................................................................ Floors 0 Interior Heating ..................................................................................Plumbing .........................:.................................:.....:.......:........ Fireplace ..................................................................................Approximate Cost .............?//:.......,-,,. .`..°............... ! .......... ... . Definitive Plan Approved by Planning Board -----------_------_-----------19 . Area ....... .. .......... ............ Diagram of Lot and Building with Dimensions Fee ' ?........ . ............ SUBJECT TO APPROVAL OF BOARD OF HEALTH 2'yj// !, /f f f rf + c - J I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ... l.....r`':... ........................`! ............. jh �., ?y��0 ..3tair�--'-----'- -----'--^Loco�on --1�8 ..Bch...Rd. -.--------..�Q2te r.vi 112-------- Owner - ^- _ __ . . Type of Cm . . .. . . ,- `'"' .206` 1.00 l�� ~~. Permitv Granted" Date of Inspection � . , Date Completed ..../ ^ � � PERM ` - ` ^ UT REFUSED~=~=' ~ � _. .. ............ lV ~----1-'^^'1-..L--i---------... ' --------.-...------~--.-.---- ` -.--.-...-,.------~...----~..--.... ' . -'-------^'~-^^'-----^--^^----'- Approved ................................................ lg ^ -------..------------.--..---. \ ---------------------'---~^'' � ' A ° r - z-o 777 .1, ANT v... ... I . STARLINE STRUCTURES, INC. - PIN f � � E.HILL PARK, ROUTE 4 I SHARON. 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J 10 5 62 • o, \ GARAGE SHED EXISTING DWELL I NG s ' \ y . . MOBS \ +ti IL N 8737'55"w VOTES PROPERTY LINES SHOWN HEREON WERE COMPILED FROM AVAILABLE PLANS OF RECORD AND DO NOT - B A R Al S TA .L ' REPRESENT AN ACTUAL SURVEY •J �-b 4s� ' ON THE GROUND. REAR PROPERTY L I ME,SCALED _— �� C b! �S l'