The URL can be used to link to this page

Home My WebLink About0006 CRANBERRY LANE�� r >' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 2,Z,�J Parcel ' Application #ZQ I W'" 11 14 Health Division Date Issued /ILL Conservation Division evtoft on Fee 5066 `p Planning Dept. ✓AP1,Permit Feer° Date Definitive Plan Approved by Planning Board 7%jvOr 2016 Historic - OKH _ Preservation/ Hyannis 3gANSTq�C� Project Street Address (0 1 ,_t Village IG01NAP �1 t , 0A A- Owner � ' Address Telephone %1 -1`b1 -1441A0 `Permit Request tQrla W1(n e-=, u� UPw �4mai 5 6X l ,-nth` a5 exoxn f�a^-xk_ /�1PGM fe-L- VY "15 L\1 _ a(I Square fee : s oor: Vxisting proposedauk 2nd floor: exis ing proposed U Total new Zoning District Flood Plain Groundwater Overlay ✓Project Valuation' 2-0,0M 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: 0 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 41�r�` Telephone Number Address Q lyo-,V,_ —1 License# 0-1 Q-1R Cy. oy T c : AAo, 07,6I2 Home Improvement Contractor# 1�Z Email \ Worker's Compensation # ct.5tosot i otowLo l5A ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO IYl Ra?a�.�L SIGNATURE f DATE FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED '*'MAP/ PARCEL NO. ADDRESS VILLAGE 9 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. ClieW.454M 2CCCUt ACORDL ' CERTIFICATE- OF LIABILITY INSURANCE DATEMMIDDRYYy) THiS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,E KTEND OR ALTER THE COVERAGE AFFORD®BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSUREA(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT:ff the 11!111! TIONAL INSURED,tit9 pDI:N6 (�)BrH I I t>e � ff SUBROGATION IS WAIVEp,subject to Me terms and condifions 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 endorsemenI �J PRODUCER Dowling&O`Neil Insurance Agency N 5�775-1620 tir—,�:5087781218 973 lyannough Rd., PO Box 1990 ADDS Hyannis,MA 02601 INsuR>3I AFFOROINGcxivEBAGE NacNr MsuRED INSURM A.Essex insurance Company - Cape Cod Custom Build,Inc, WSURERB:r►a�VNated EmplDy�s Insurance P_0.Box 27 aLsuaETc: Cummaquid,MA 0=17 INSURER D: aMDRER E. COVERAGES INSUpER F - GERTIFICATENUMBER' REVISION NUMBER: THIS iS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTm BELOW HAVE BEEN ISSUED TOME INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TD WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIB®HEREIN IS S EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. UBJECT TO ALL THE TERMS, FN—LTR TYPE OF INSURANCE U am WVD, POUCYNtMBEA POLiCYffF -POLICYEXP - A GENERAL LIAomm LIMITS 3DY6050 5 04/05/�1 EACH OCCURRENCE ; X 51 Q00 000 COMMERCIAL DAMAGE RENT® CLAIMS-MADE M OCCUR PAHNl4 amalence S50 000 M®E7P Ole &SM) '- $1 000 PERSONAL&ADVINJURY ? $1.000.000 ' - I GEN GEVEIALAGGREGATE S 000 000 IAGGREGATEIJMITAPPLIESP6t -El POLICY LOC PRODUCTS- AUG $� 1000000 PRO AUrQWBILE LUIBRlTY $ COMBINED SINGLE UdIT ANYAUM - Ea ml : s A OWNED $CMULED BODILYIUURY(Perpinsn) g ANON40WH D BODILYINJURY(Pern ii" S HIRED AUTOS AUTOS PRorOPEFIY DAMAGE S UMBRELLA LA UAB $ OCCVA EACH OCCURRENCE S DICESS LIAO CLAWS-MADE AGGREGATE S D® RETEMiONS B WORKIIIINSATION S AND BI9LOYERS'LIA8Any Y/N WCCSM=119O42015A 15 0 07 �( wcSTATU-ANY OTFf; OFRCCERb EXCLUDED? N/A E.L.EACHACCIDENT $5o 000 11�be� E.LD(SEASE-EAEN S5M 000 6yBs davibetmder - DESCRIPTION OF OPEAAnONS hebv , ELDISEI36-P0r.ICYLryrri 55oD DBD DES'CMPTMN OF OPERATIONS/LOCATIONS/VEMCLMWMch ACORD-IM,AddMlotgl Reawim sdredWe, insurance coverage is limited to the terms,conditions,exclusions,other Iimifations and endorsemNnrts. Nothing contained in the certificate of insurance shall be deemed to have 2111111 waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Pat Whit@.` r SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Mash ee Building THE ExPIRAMON DATE THEREOF, NOTICE WILL BE DELIVERED IN P ACCORDANCE W IEH THE POLICY PROVISIONS. ` 16 Great Neck Road North MOShpee,MA 02M AUMFUZ®REPRFSEVTATWE 01988-2010 ACORD CORPORATION.A0 rights reserved. ACORD 25(2010" 1 of 1 The ACORD name and logo are regishm0 rT adm of ACORD #S154MW154504 CBS uk T'a,Peter Rmarmmg C'ammfiRde� MG.J MMn Ste,Hy 1 w w.A:--yy Fr Recrmta}�I�m mx G3 Q S f'= 59&7-W--Fi O Property, Lmit Complete and Sign This Secdon Ir Ott »ag Geer Of ffi2,--smEject FVTZ%±T im,ai =12,6vc to votk MIthID=Cd by f M bWICFig pl==2pVfi=M fa= PaaZ fps a ,a lar arm theMspansffffitT of the agp8mut 7 ICOIS am nut ta be Mail or utEir-e£ m fen=is iastO and zZ,fiuzl t rrnr-rrrrrm�a�p:� a�r�t RintNz= F J r rrrOneSS 'C Bus (�rsTFCRT ner A NA cons TCO eTgy° e: �lp{{�cOeME{VA?RpV,E g�7745. Co{Povg1on eglst��o 712Z12617 ... ' INc> ` 'p�PECOD CUSTOM gEpPRp 6 'Vodersee�e UYNpA ER ENE 637 53 0(� k. CUMMAQVID.MA p2 Mass Board achlsetts ard0fB C}, ePartMent Of pj b— nstrucio9 Re9ulati c Safety license CS` nrsor and Standards P U BOx 1 DAf Cu�Inaqufd t ' 02637 ' . �V,�, Commissioner ExPiratiOn - 0511612017 1 I Tlie Commorrivealtii of-Vassachusetts DVartilrent afrudustrial Accidents - - O,rwe o,f rrr►?estigatiom 600 Washington Street Baston, M402111 1131V1b.ittas.Sgf!v�dl is Warkers' Camipensatean Insurance Affidavit Builder--/ContracfnrsJEIectricians/Plumbers Applicant Infarmatian Please Print few-bIy Na=(SasmessAOrganizatianflndry rat} Cam C�� Cal P�� k�r L.��1,�1a, Address: Nx zLn. CitY,/Stabe/Zig U% Phone- Are you an employer?Check the appropriate bow ' r Type of project(required): I.❑ I ant a employer with 4 $ I am a general contractor and I 6. ❑New construction employees(full and/or part-fiime).* have hired.the sub-contractors 2.❑ I am a sole proprietor orpartuer- listed on the attached sheet 'i- $LReaaodeling slip and have no employees These contractors have g_ ❑Demolifion w Q for me in an i• . employees and have workers' a� Y f3` l 9�. �Building addition worloers'camp.insurance comp-m¢i"�n required-] 5. ❑ We are a corporation and its 10=❑Electrcal repairs ar addition officers have their 3.❑ I am.a homeowner doing all wow 11-❑Plumbingrepairs or additions mysdE[No workers'comp- right of e$eaipfiou per 14IGL 12_ repairs i„v „tee rued.]i C.152, a s-(N and have no employees- 13.(K Other 21A e -e J6 p _k comp.inwrance required_) 'Any applicmit that cheft boar K nmst also fMoutthe section belaw shawmg di&woskere compematianportcy itdb=2a-mL I Iiomeuwaers who sabot Iris sffdatqt iu&cxtmg they am dhing all wa¢k and den klm auto&contractors nm submit anew affidavit in&ctig sacTI fCantractors 1&t check this boat must attached as additional sbeet siroaing the name of the sub-ccatwAD=and state whether ar not those entities have. empimes. ifthesnb-cantr=mmhaveemployee%theymaastprovAetheir amrken'romp.palicyn=ab&r. I am an sn�pia}�er that ispranitiing nrorkers'ranrpertsrrtir�n insairatras for at}*enrpIay�ees Betory is the pvtiry arrd job site infotanath7m Insurance Company Name: Policy,4 or Self--ins.Lic- Fbxpiration Date: ` Job Site.AddresS: City/State/2.p: Attach a copy of the workers'compensation'Policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required.under Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a fine up to$U.0100 anWor one-y=earimprisonmeut,as we11 as chit penalties,in the farm of a STOP WORK ORDERand a fine of up to$250-00 a day a ainst the vaolatar. Be adtdsed that a capy of this statement maybe forwarded to the Office of 1mvestigatiom of the DIA for insurance caserage verificatisn- afa hereby certif��riatd the pouts and a) s tafpet j uty�&&the iafot�a&7;.prm rted abos� bars and carrect Si�ature: LDate: o Phone o ('1 -3 i3—y Sao - OBacial use apil. Do nat write in tlas area,to be ctrmpleted by c4 artetrn ofj`aciaL City or Town: PercmtUcensse.if Issuing 1k uthority(circle one): 1.Board of Hw1th 2.Building Department 3.Citydrowa Clerk d.Electrical Inspector S.Plurnbmg Inspector 6.Oth-er Contact Person: Phone#: 2�LI��I�IMMLI�22I�22��M�LI�J L�'��kJVL5L5��LIV� �CORPORATFD December 29, 2015 t�,PbjN of 'Y Ms. Lynda Bedard PO Box 27 g ERIC J. N Cummaquid, MA 02637 o STRUCTURAL -11 v No. 38962 y RE: 6 Cranberry.Lane, Centerville, MA—Beam in Kitchen ro Dear Ms. Bedard, At your request, I have analyzed the existing beam you recently uncovered during the renovation work at the referenced property location and find it to be inadequate. The beam should be replaced with a triple 1-3/4" x11-7/8" LVL beam supported on 44 timber posts at either end. Since the interior post is offset from the existing center girt, the post should be carried by a double 1-3/4"x7-1/4" LVL beam spanning between the existing center girt and a new 3-1/2" lally column on a 2'x2' footing as shown on the attached sketch. Should you have any questions regarding these findings, please do not hesitate to contact me. Sincerely, Eric J. ederholm, PE Transition Engineering, Inc. 44 Chadderton Way Middleboro, MA (508) 404-0358 ejcpe@verizon.net I Page 1 of 1 n F . OVNI �2 LA �F Y` TOWN OF BARNSTABLE BUILDING PERMIT APPLICATIION Map /'u Parcel Application,-# Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis /v Project Street Address U CAn.1Lp� tam Village C'� �eti. �t�' Lick, i Owner Address ► Telephone_ 611 Permit Request ask_ &CC 6cl, p� x 14 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain tj Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes O-No On Old King's Highway: ❑Yes ❑ No Basement Type: M-Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) "-r- 9., sk c Basement Unfinished Area (sq.ft) Number of Baths: Full: existing Z.- new Half: existing -gym-- new Number of Bedrooms: L_A_ existing _new Total Room Count (not including baths)`. existing new First Floc�'J�bom�p I h �� J Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood coal-s over 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 64d o Telephone Number (P Z-0 Address TO 90A f a—) License # CIS —l 0-1 -1 i_,VVVkA �a N �G� Home Improvement Contractor# Email -I CL 11�-,e : (o N\ Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO lkuc,JA d��Y_ SIGNATURE DATED�� FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE .OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL .FINAL BUILDING 9 07 AM6 xby&� DATE CLOSED OUT ASSOCIATION PLAN NO. i Q�nssl-3lba NO/LVO/j TGWRof Barnstable ! �4 Retry Savices won Ym Perry, MO M2&Stee,,Hyanmk WA('MIE y h vFRcw�.' i t�nP;tan,9ci�a�8�w rms,�a; C013*cte and Sign This won if U Bug' der s -u , r 25 dyer Of P=PzdT ; aI raluuc-to,vutk by �r�cvli f ,2n FT!%t the p sffi ffty of the nluc mt PGalls ate.not tal be fx O d fie is iutaHed and al`I final Sigmt=afp FI�Tam TTie Commonwealth of-VassacTlusetts . �1 D epartimuit ri, Industrial Acddertts , f3} -ce oflmNshgadmu 600 Washington Street Boston,M4 02111 f��rvt�trnas�gos�fdiri . . Warlmrs' Cumlpensattan Insurance Affidavit:SudldersICantract-arsMectricians/Plumhers Applicant Infarmatian Please Frinf Lmffi1X Name( asiueSStl�Fgen�E3onFTnd :inx� l�Q�. � �l 17�t �� f��C1A (Y�t� Address; City/statelK*. `1► Phone-iuk Are you an employer?Check the appropriate bow ' Type of project(required}: I_El am a employer with. 4. $1I am a general contractor and I employees(fu11 and/or part-time. * have hired the sub-conkcatfozs 6. ❑New construction 2.❑ I am a sole proprietor orpartner- listed on the attached sheet. 7- [XRemode-hng These sub-contractors have ship and have no employees $-,❑Demolition urotlring for me in any capacity employees and bare wodmrs' [No wpdoers'comp-insurance comp.insurance 1 g- ❑Building addition: required-] 5. We are a corporation and its 10,0 Electrical repairs or additiom 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions set€ o workers' light of exemption per MGL ' ' �' � - 12.[�,Roofrepairs • insurance required-]i c.152, §1(4);and we have no . employees-[No workers' 13_[�Other q e 1; p comp.insurance required-) 'Anywlicsatfiatcherksboxfflmastalso fill ovt the section below slim�gdw-irwo&erecompersatiau policy in5nnatiaL l Honmawnarc also submit dus.affidm a m&kxt m_q matey am&mg sn wa&asrd tlum bire outsa&contractors zanst submit a new affidivit indicatiq;such- fContzsctoas rhst check this bmc mast attached as additional shmt shag the mmue of the sub-cotucto-rs snd state whether or scot tbose entices bay employees.Ifthesub-contzactors have empleyees,they smsstpravAetheir workers'comp.policcyn=ber. I ant an errtplaVj eF that ispra�zriing workers'catrrpertsatiart irrsrsrarrce nr rux}'¢mpiQ} es $eIow is f to pansy and job sitar information. Insurance Company Nam: Polity,4*'or Belf-ins Lac. V Ekpiratioa Date: Job Site Address: City/StatdZip: Attach a copy of the workers'compensationpolky decl2ration page(showing the policy number and espir`ation date). - Failure to serum coverage as required.under Section 25A of MGL c- 152 can lead to the imposition of criminal penalties of a fine up to$U00.00 ancIfor one-Dear imprisonment,as well as civil penalties,in the form of a STOP WORK ORDER and a Eme of up to$250.00 a day against the violator. Be ad,,dsed that a copy of this statement may.be fortsrarded,to the Office of Investigations of the DIA for insurance coverage verification- I rIo lier.Rby cRrlrfl,U11dT tkRpaias and awes of g tty that the informad w prm•�d abm�R is bu8 and correct Signature: Date: rl , ti Phone r Official use arty Do not ankle in this area,to be crrrnpLTeteJ by city arfarrn a,,fj`icfuL City.or Town: PermitUcense# Issuing Authority(cu-de one): t 1.Board of Health 2.DnTding Department 3.[htpj con,Clerk 4.Electrical Inspector S.Plu¢nbing Inspector 6.Oher Contact Person: - Phone#: Client:45466 2CCCU1 ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(NINODJY M 7h4/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF nIffORMATION ONLY AND CONFERS No RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIvELY OR NEGATIVELY AMEND,EXTEND OR ALTERTHE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CER71RCATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORRED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER_ IMPORTANT:It the certificate holder is an ADDITIONAL INSURED,the poficy(ies)must De endorsed,H SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,Main policies may require an endorsement.A statement on this certificate does not confer rights to the cerBnrate holder in lieu of such endorsement(s). PRODUCER CONTACT Dowling&OWeif PRONE Insurance Agency Imti ad 508 7&1620 Moli 5087701218 9731yannough Rd., PO Box 1990 ADDRESS, Hyannis,MA 02601 WWRO( AFFORDING COVE RAGE NAIC# INSURER A;Essex Insurance Company INSURED Cape Cod Custom Build,Inc. V,MRERB_Associated Employers Insurance P.O.Box 27 DIS RER C_ Cummaquid,MA 02M INSURER D_ INSURER Ea INSURER F- COVERAGES CERTIRCATE 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 REOUREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS .CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADM SU LLTRR TYPEOFINSURAHCE. am Vol WB POLICYNUt®ER POLICY� -POLICYEXP LmRIiS A GI�NERAL uAB°mr 3DY6050 4/05=5 04(05MlE EACH occURReacE s1 000 OOQ X COMWJ9CIALGENERALLIMILITY DAMAGETORENTED PR9NISFS omure�Arg $50 000 CLAIMS-MADE lid OCCUR MID EXF one person) $1 000 PERSONAL&ADVUUURY $1,000,000 GENERAL AGGREGATE S 000 000 GEN'L AGGREGATE LIINITAPPLESPER: - / - - PRODUCTS s1,0D000D POLICY PRa LOC _ AUTDIrOBnELU1BILlrY COMBIND SINGLE LIMIT ? 5 ANYALRD - BODILY INJURY(Perpelsuu) $ ALLOWN® SCHEDULED - AUTOS AUTOS BODILY INJURY(PeracmidLe ) S HIR�AUTOS NON-OWNED AUTOSPROPERTY DAMAGE $ UMBRELLAIJAB OCCUR � EACH OCCURRENCE S EXCESS LIAR qS.MADE AGGREGATE s D® I RETENTION$ _ $ B WORKERS DEDITL VEER SRSAUiT WCCWOSO119042015A 15 04/05/201 X wcsrATl> oTI AND EI{iPLOI/BiS LJABBJIY YIN - OFRANY P EXCLUDED? N/A ELEACHACCMENT S500000 (Menda"I"NH) F�o1sEAsE-EA Ed s500 000 If yes,de=''ha under _ - • a,...• D IPIIONOFOPMATION6bei— .. EtDMEASE-POLICYLMMT SSOo,DOD' DESCRIPrWN OF OPERATION$/LOCATIONS/VEMCL61AU-h ACORN IOI.Ad8&Wad Renmrla SChadUL-_M Moeegmmis tapd,eM _ Insurance coverage is limited to the terms,Conditions,exclusions,other limilaitions and endorsemerrts. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Pat WhIte SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE E mm-nON DATE THEREOF, NOTICE WILL 9E DELIVER@ IN Mashpee Building Dept. ACCORDANCE WITH THE POLICY PROVISIONS. 16 Great Neck Road North MRrShpee,MA 02649 t: AUrHOIBZW REPRESS NTArm ®19W2Ol O ACORD CORPORATION.An ro is reserved. . ACORD 25(2010" 1 of 1 The ACORD name and logo are registered marks of ACORD #S15450SM154504 CBD' AC R CERTIFICATE °^�( ) OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER/THIS 5 CERTIFICATE DOES NOT AFFIRMATMLY 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), AUTHIORZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the oerfificate hdder is atl ADDITIONAL INSURED,the pOlicy[es)must be endorsed. H SUBROGATION IS WAIVED,subject t0 the tefms and oondtions of the Polity,certain policies may require an endorsement A statement on thi s certificate does not confer rights to the certificate holder in lieu of such endorseme PRODUCER JOE DEOLIVEIRILDeoliveira Insurance Services ��-ACT E . 509 477-3023 FAx N :(508) 638-6463 800 Falmouth Rd. UNIT101-A �= Roe@dinsinc.com Mashpee, MA 02649 SURE AFFORDING COVERAGE NAICs INSURED INSURER A•MSA Jeremy Nickerson INSURER a:Travelers DBA East Coast Professional .I66U INsuRERERc •O 27 Metoxit Road East Falmouth, MIL 02536 INSURERS. INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POUCLES 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 POLI(AES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAD. INSR ADD SUER POLICY NU1 3ER PY�EFF YM MPM)D�Y LTA TYPEOFOISURANCE LIMITS A GENERAI'LIABILITY MPT3201F 8/25/15 8/25/16 EACH OCCURRENCE s 1,000,000 X COMMERCIAL GENER4LLIABLrrY DAMAGE TO RENTED $ SO OOO CLAIM -0rADE OCCUR PREMISES(Ea=ffivned)NED EXP(A one pasm) $ 10 000 PERSONAL&ADVINJURY $ 1,000,000 . GENERAL AGGREGATE s 2,000,000 GENIAGGREGATELYufITAPPLESPER _ PRODUCES-ODMPA•WAGG $ 2,000,000 POLICY PRO- LOC s AUTOMOBILE LJABIUTY COMB WED SINGLELIMIE a aeddent s ANYAUTO - BODILY INJURY(Per pamon) S ALLOWNED SCHEDULED - - AUTOS AUTOS BODILY INJURY(Per aedderrt) $ HIREDAUTOS AUTOS NON-OWNED PROPEREY DANVIGE eracd Z t UMBRELLALIAB OCCUR _ EACH OCCURRENCE s EXCESS LIAB LCLAIMS-MADE AGGREGATE S DED RETENTION • s B iwRKERs MDEUPLOYEFWNSATXIN 6KUB0072123907 11/7/15 11/7/16 g wcsrATU OEH /RID EMPLOYERS'LJABILIiY ANYPROPRIETDP YIN OFFICER&MBEIR EXCLUDED?D? N/A _ _ , EL_EACHACOD=NE - 100,000 IMS Ifdesal6e under EL.DISEASE-EA EMPLOY 100 OOO DESCRIPTIONOF OPERATIONS below El.DISEASE-POLICYLI IT S 500,000 DESCRIPnONOFOPBLMXN3/L.orAMoNS/VENICIES(Ansel ACORD 101,Ad'd analRauaAsSdmxk&,dmore space IsrecIdra!) CARPENTRY 3 STORIES OR LESS JEREMY NICKERSON HAS ELECTED TO BE COVERED UNDER THIS WORKERS COMPENSATION POLICY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED .IN CAPE COD CUSTOM BUILDING INC ACCORDANCE WITH THE POLICY PROVISIONS. PO Boa 27 Cummaquid, MA 02637 AUTHORIZED BEPRESENTATNE AMA DA ELDRIDGE m 1908-2010 ACORD CORPORATION. All rights reserved. ACORD 25(201 W The ACORD name and logo are registered marks of ACORD Phone: (617) 322-4520 Fax: E-Mail: BUG67@LIVE.COM A`4 „R� CERTIFICATE OF LIABILITY INSURANCE DATE( AMWYYYY) 9/24/15 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, MMND 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: ff 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 erldarsement(s). PROWCER ,„ CONTACT JOS DSOLIVEIRA . Deoliveira Insurance Services PHM Fax rt) 638-6463 ADDR 509 Falmouth Rd. E•� E • (508) 477-3023 N so Unit 6 ESS: 'oe@dinsinc.com INSURERS)AFFORDING COVERAGE NAIL# Mashpee, MA 02649 INSURER A.MSA INSURED INSURER B:Travelers/Assi ed Risk ROBERT R PIERCE INSURER C: 121 OXFORD DR INSURER D: • COTUIT, MA 02635-3021 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 OFSUC H POLICIES.LMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUBR POLICY NUMBER PIO�YEFF POLICY EXP LIMITS LTR TYPE OF INSURANCE A cE1ERALUABILITY MPT9555P 9/22/15 9/22/16 EACHOCCURRENCE $ 1,000,000 X CONMERCI ALGENERALLIABI ITY DAMAGE TO RENTED $ SOO OOO CLAIMSa ADE OCCUR r LIED EXP(Any one person) $ 1 10,000 PERSONAL&ADV INJURY . $ 1,000,000 GENERALAGGREGATE $ 2,000.000 GEN'LAGGREGATELIMITAPPUESPER PRODUCTS-COMPADPAGG $ .Z OOQ OQO POLICY JECT PRO- RO LOC $ AUTOMOBILELIABIUTY COMBIta DrsSINGLELIMIT $ ANYAUiO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERrY DAMAGE $ HIREDAUTOS _AUTOS - eracddent UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION B WORKERS COMPENSATION AND®IPLOYERS LIABRRY 7PJUB2E509336 10/9/14 10/9/15 we SrATu OTH- Y/N FR ANY PROPREMRIPARTNERIE)ECUTNE El.EACHAICODENT 100 OOO OFRCERIMEMBFREXCLlDED7 N/A (Manda-ry—NH) .. El.DISEASE-EA EMPLOY 100,000 ffy�,describe under DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT 500,000 DESCRIPTIONOFOPERMIONS/LOCATIOBS/VEHICLES (Ailad.ACORD1M,AdMbnalRermdcs Schedule,if mom space isrequired) ROBERT PIERCE IS LISTED AS A COVERED OWNER ON THIS WORKERS COMPENSATION POLICY . r CARPENTRY INTERIOR EXTERIOR CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CAPE COD CUSTOM BUILDING INC ACCORDANCE WITH THE POLICY PROVISIONS. PO BOX 27 CUMMAQUID, MA 02637 AI171OR®REPRESENTATIVE AMANDA ELDRIDGE ®1988.2010 ACORD CORPORATION. All rights reserved. ACOR0 25(201 OW The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: SUG67 @LIVE.COIN ClteW.-45466 2CCCUi ACORD DATE OF LIABILITY INSURANCE °"'E�"""°°'Y'""' THIS CERTIRCATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CON CERTIFICATE DOES NOT AF FERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS FlRMATNELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED 13YTHE 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:ffthe certifipteholder is an ADDT110NAL INSURED,the POUCy(ies)must be endorsed,ff SUBROGATIQN IS Wp1VEp,supject to the terms and conditions Of the policy,cmUln pOliCes may require an endom menL A statement on this certificate does not confer rights to the eerbficate holder in Geu at such endorsement(s)_ PRODUCER Dowling&O'Neil Insurance Agency 6a•508 775-1620 No.'5087781218 9731yannough Rd., PO Box 1990 ADDR r, Hyannis,MA 02601 DMRERM AFFORDING COVERAGE NAIL: rNsuRm INSURERA:F.-M insurance Company Cape Cod Custom Build,inm INSURER s=Associa'ed Employers Insurance P_O.Box 27 Cummaquid,MA 0=17 INSURERD= 1 SYSURBI E: - COVERAGES wsuliER F CERTIRCATE NUMBER` REVISION NUMBER: THIS iS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWiiHSTANDINC,ANY REQUIREMENT,TERM OR CONDITION OF ANY COMRACTOR OTHER DOCUMENT WITH RESPELT'TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESC ER HEREIN IS SUBJECT T ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMrTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPEOFINSURANCE AM SUBF WVD POLICY NUUBFA POLICY i}F .POLiCY EXP , p GENERfitLUlearnr LlMUTS 3DY6050 015 0405MIC EACH OCCWIRENcE ' $1 000 000 X COMMERCIALGENMALIJABIUTY pRgylgE SSO ODO CLAIA�MADE ❑X OCCUR MEOEXP aIe ) S1 0110 PERSONAL&ADV INJURY' $1,000.000 GENERALAGGREGATE " 5 000 000 GENLAGGREGATE LQiM![APPLIFS P6E POLICY PRO LOC - PRODUCTS-COMPIOPAGG 51000000 AUTOMOBILE LIABILITY $ - AB"W SINGLE LIMIT ANY AUTO S AUTTOINN®® SCHEDULED r B�dYINIURY(Perpetsan) S I. AUTOS BODILY INJURY(per a0dawt S HIRED AUTOS PRO DAMAGE : 5 UMBRELLA LIAR $ OCCUR EKCESS I.IM EACH OCCURRENCE S CLANS-MADE AGGREGATE % $ DED RETENTION S B WORIMRSCOMPBiSATiON - S AND EMPLOYEW LIABRRY Y/N WCC50050119042015A 15 04MISMO1 X nFA� oTM` ANY PROPRIETORIPARiNEWE O=CunVE OFFICERMAEMBER EKOWDED7 � N/A (Umdah"in NH) E.L EACHACCmENT SSOO OOO _ Ayyears,,de=be older E.L.DISEASE-EA EMP SSOD OOO DESCRIPTION OF OPHiAT10N3 beloYr - EL DOGNSE-POLICY WIT; §SDD ODD DESCRIPTIONOFOPERATIONS/LOCATIONS/VEHICLES(Atlad,ACORD10r,AddrdalalRemarbShcadWGitfOm3�Lsreqd� Insurance coverage is limitedterms, to the Conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have ath ed,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Pat White SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILLBE DELIVERED IN MaShpee Building Dept. ACCORDANCE WRH THE POLICY PROVISIONS. 16 Grant Neck Road North Mashpe%MA 0264E AUTHOIMMD REPRESENTATIVE ®ISM2010 ACORD CORPORATION.All rights reserved ACORD 25(201a" 1 of 1 Tim ACORD nalm and logo are registered marks of ACORD M 54505NA154504 CB[) { '.rrtrac'f�a `: c` 1�canon r- ,.��,ryr,rrrc'yr•`cr&Bus►ne5s fL c0tA p`GT0ype: OS{�ee o OVEM�N tAf- R 18jy7i5 Gorpgcat�on Oe9�stfto� 7Z1Z7; 0� } p :�GUS-COO.gUt 1NG GPPEGO s- gED N� Unaerseetetan 59 O t DER MA 0Z637 CUMMPQUIU. , Boa aacf�usetts p e at ��r of Building Re _ rnsrr 9u of ent of.Pualic ucriun.S ons an Safety License: U��'rl i.er,r d Standards A B Cg 107278 ED p D B 4 d7 C°�ma of 026 ' 37 0 _ Comrnrssionef Expiration O5/1612017 6 l I. FOP a Town of BarnstableBuilding PostThis Card So:That =is V�s�ble Fcom the StreetA roved Plans Must beFRetamedr on Job and=this,Card Must be�Ke t • wtrrtrewu s ' Mn�. �Posted�Untl Final�ln'spect�on Flas•Been iVlade � �' �r f � ,r�,� ` � � Where�Certificate"of Occu arc, is"12e aired"such,Bulldin shall Notlbe;Occu ied{Wntal a'Final;Ins ectio,� has•been made �. . Permit 9 Permit No. B-16-1184 Applicant Name: CAPECOD CUSTOM BUILD, INC. Map/Lot: 226-112 Date Issued: 06/13/2016 Current Use: Zoning District: RB Permit Type: Deck Expiration Date: 12/13/2016 Contractor Name: CAPECOD CUSTOM BUILD, INC. Location: 6CRANBERRY'LANE,GENTERVILLE s Esti,Prcj,ect Cost: $ 15;000.00 Contractor License: 182775 Owner on Record: LANDRY,JOHN M&KRISTIN R r -Perin it Fee* °,, $ 110.00 4 Address: 158 GATES"FARM ROAD x ,. Fee<Paid. $ 110.00 GLASTONBURY,CT 06033 ; Date: .13/2016 41, Description: constuct a deck 16x14 -. Project Review Req - .` if:%V. �, " Y V v ' .r., Building Official This permit shall be deemed abandoned and invalid unless the work authorized bythis permit is com"menced within six months,after issuance. All work authorized by this permit shall conform to the approved appl cation and the approued c nstruction di cumenfs for which this permit has been granted. , All construction,alterations and changes of use of any building and structures'sha114be in compliance with the local zo"ning by laws and 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. N � � � The Certificate of Occupancy will not be issued until all applicable sign stur'es by the Building and Fire Officials are prov dedzo'-n.t'is permit. - Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing 2.Sheathing Inspection p '� 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 " 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation , . .. . ' 7.Final Inspection before Occupancy Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map2Z Parcel Application _.- Health Division Date Issued 1 f ' Conservation Division __ 1`D Application Fee Planning Dept. Permit Feef •00 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 6P_r-c �9;A , (k 11�P iYVtA Village c&_Iba Q Owner n Address i �oa�P s �a�iv► �.�c+ Telephone C1 1`1 -- 131- `6yy� C, 1� �➢ CT "�Permit:Request C t :)m kg bi 'TA&I I XM Cv0A/n& te0_\QnW-RVff RWP- � ftwt to , A u dk f,13 o Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay 6project Valuation--I-W.ocoo Construction Type -� Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting d'o'.cuffj&ation. :> _ - Dwelling Type: Single Family fif, Two Family ❑ Multi-Family (# units) l A _ `.n Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway:40 Ye ❑ No Basement Type: &Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number Cf Baths: Full: existing `Z new Half: existing new Number of Bedrooms: +-' existing _new Total Room Count (not including baths): existing —1 new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes Vlo ' 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 U.No If yes, site plan review# 1 Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name L &4 AArx C6 A Telephone Number (on-31Q-yam O Address _PO p."1 Ch n yo License n 3-1 Home Improvement Contractor# ITS -A-1 S Email_•,�e.C.r.C: Jc&s► n Vim_ Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO - 1(V1 SIGNATURE DATE i lam- I FOR OFFICIAL USE ONLY APPLICATION # ' DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION I } FRAME f , '. INSULATION ' FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL r GAS: ROUGH FINAL FINAL BUILDING k DATE CLOSED OUT ASSOCIATION'PLAN NO. of Barnstable Sam,�ces ymm peny, :Prop must ' . .�tt - IfUding der r L'4 lot �;yti� �{a - ��.n�_Co��-[L�.�T,r�m�met msn�- n• am ��I fig aid .i .'��-�f t�e�� t:.1� 2. •` " ; � + ;-• t, to be 064 . car u need be&m& in' skafflid. 4-14 1N f i 27ie COMMOMwealth ofMassachusetts 4 Dvarbnarrt ofIndustrialAcciderrts - Owe o,f lmwtigadons 600 Washington Street y Boston, A 02111 ivniv.rnasmgov/dia Warkers' Compensation Insurance Affidavit:Builders/ContractorsJEIectricians/Plumbers Applicant Information Please Print Lemb'ly/ ' Nair]eBUs®esstl0rganizationf�dinal}: PQx �-1 Address: , City/Stater:' (Y1nQU%A ,JAA OIL Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. X,I am'a general contractor and I employees(felt arldlorprrt--time). * Have hired the sub-contr actors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7 [�,_.Remodeling , ship and have no employees These sub-contractors have g_ Q Demolition wod-ng for me in any capacity. employees and have worms' [No w arlom'comp.insura +�e comp-insurance-1 9.'❑Building addition required-] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions officers have exercised their 3.❑ I am a homeoumer doing all work 11.0 Piumbingrepairs or additions myself,[No workers'comp- right of exemption per MGL 12 [Zoofrepairs c.152, 1 4 andwe have no A i*+�+�n�e rerp�ed.j i § ( h 13_�Other employees.[No,workers' &�`@ o J 't camp.insurance required.] *Any app€icautthat cherks box#1 most also fill out the section belaw showing thieir wodere compensation policy idformaEion_ T] ameowners who submit dais afbdasdr indicating they am doing all wait;sad slum hie aurside contractors mast submit a new affidavit indicating such IContrsctgrs that check this bar must attached sn additwnal sheet shovdng the name of the sob-cantsctocs and state whether or not those entities have emplMes. Ifthesubcontrsctocs have employee%dLeynmsrpmuidedAdr workers'comp.palkynumber. lam au employ float is prenadL7g itorkers'corrp satiorr inmirauce for my enrpJnf ees SeIoiv is 1hepalicy a d fob s&ff inforrrrafiorn Insurance Company Mauve: Policy,4'or Self-ins-Lic- Expiration Date: Job Site Address: city/stawzip: Attach a.copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required.under Section 25A o€MGL c_ 152 can lead to the imposition of criminal penalties of a fine up to$1,540.00 and.for one-year imprisonment,as well as did penalties.in the form of a STOP WORK ORDER and a fine of up to 0.00 a day against the violator. Be adtdsed that a copy of this statement may be forwarded to the Office of ' Itarest ga#ians of the DFA for insurance coverage tierification- I da hereby certrfi�rind the pains andpa ahhks ofgerjatty'that fire infonnaf'ion prin*Md abmw is true avid correct Simature: 4 Date: Phone a- 6 (-1 —3 la—y Sa-o O eial use-only. Do not wke in this area,to be carnpleted by city artown a,,iciat City or Town.: Permitffikense# ' /suing Authority(circle one): 1.Board of Health 2.Building Department 3.CS.ty/rown Clerk 4.Electrical inspector 5.Plumbing Inspector s 6.Other Contact Person: Ph-one#: Information and Instructions husetts Geherat Laws r 152 requires all employers to provide workers'compensation for their employees. Massac . pnr=ZnttD this she,au mplayee is defined as-"-every person in the service of another under any contract ofhae, express or implied,oral or wIIff�" An errjpIoyer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in alomt e rterPnse,and including the legal repImsentafives of a deceased employer,or the receiver or trustee of au 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 occapant of the - dwelling house of another who employs persons to do mace,consixuction or repair work on such dwelling house or on the grounds or bu ildmg appurtenant thereto shall not bmanse of such employment be deemed to be,an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of at license or permit to operate a business or to construct buildings lathe commonwealth for any applicant-who has not produced acceptable evidence of compliancewith the hisurance.covermgerequired-" Additionally,MGL chapter 152, §25C(7)states-Neither the commonwealth nor nay of its political subdivisions shall enter into any contract for the pmfo mamce ofpublic work until acceptable evidence of compliance with the iusuranc a&. requirements of this chapter have been presented to the contracting avfhoity." Applicants Please fill oint the workers'compensation affidavit completely,by checldag the boxes td a apply to your sitnation and,if necessary,supply sub-contractors)name(s), address(es)and phone number(s) along with their certificates)of insurance. Linnited Liability Companies(LLC)or Limited Liability-Partnerships(LLP)with no employees Other than the members or partners,are not regtm-ed to carry wormers' compensation filsura ce. If as LLC or LLP does have employees,a policy is required. Be advised that this affida:vk maybe submitted to the Department of Industrial Accidents for confirmation ofinsurance coverage. Also be sure to sign and date-.he affidavit The affidavit should not the D be refrrmed to the city or town that the application for the permit or license is being requested, epariment of n , - Accidents. Should you have questions regarding the law or ifyou are requz>red to obtain a workers' T rh cfr,al yo ant'qn� . compensation pojicy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number an the appropriate line. City or Town Offic;aTs Please be sure,that the affidavit is complete and pried legibly. The Department has provided a space of the bottom of the affidavit for you to fill out in the event the Office ofIuvestigations has to contact you regarding the applicant_ Please be see to fill in the pemrit/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 infOIInation Cif accessary)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 madced by the city or town may b e provided to the applicant as proofthat a valid affidavit is on file for future permits or licenses. A new affidavit must be filed out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venttse (i e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you is advance for your cooperation and should you have,any questions, please do not hesitate to give us a call The Departmenfs address,telephone and fax number: The�aalti of IIaachusets Departraent of Iiidial Accidents f�it�e ref�.ve�g�f�io-A� �QQ�ashin�an � ° Bastes MA G� 111 Tf,-L 4 617 727-4 t € 900 ci �4 6 4r I-a MAS F, x Fax 9 f 1 F'727 7M Revised 4-24-07 .mass-gov/dia Client#:454M 2CCCU1 ACORQa CERTIFICATE OF LIABILITY iNSURANCE 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 Q$SURER(S),AUTHORED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT:ff ilia certifi(atae Irotder is an AODfIiONAL INSURED,the pofN,y(fes)must be endorsed f f SUBROGATION IS WANED,subject to the tefmS and Conditions Of the Pdcy,cuMin OWN may require an endommeft A statement on this certificate does not confer rights to the cWtIffeate holder In lieu of such endorsement[s). PRODUCER Dowling&O'Neil Nate Insurance Agency Ea!.508 775-1620 „� 500M121 S 973 lyannough Rd, PO Box 1990 A0D INSURED MA 02601 INSURERA:F.ssmc Insurance Comp eavlal/LCE ny naUc: Cape Cod Custom Build,Inc. °1e"'ER e°Asg°elated Employers Insurance P-O.Box 27 UISURERC: Cummaquld,MA 02637 INSURER D: 94SUREIE: WSDRER F: COVERAGES CERTiRCATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLIGES OF INSURANCE LISTED BELOW LAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWIT (STANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LMIrM SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. UTA L TYPEOFDISURANCE am gum POLICYNIB®ER PUBEFff -POtfClf� �� A GENERALUABiLITr 3DY6050 S 041OWMIC EAcHOCCURRENCE S1 000000 X COMMEIMIAL GENERAL LIABILITY D E RENTED P s50 000 CLAB�S MADE ®OCGIR MEO EXP ane ) $1 000 PERSONAL&ADYIN.AIRY $1,000000 GENERALAG,GRE GATE ` S 000 000 GENT AGGREGATE APPLt6S P[3t - PRODUCTS-00MPA7PAGG" $1000,OW POLICY AUTUNOBILE LIABRJTY 12PoBIN®StNG1E LIMIT �, � �A S ALL OWNED BOMILYINJURY(Prpasdn) $ AUTOS AUTOS BODILY INJURY (Pry; $ HIRE AUTOSAUMS POPEATY DAMAGE UAIBREILALIAS OCCUR EACH OCCUF RENCE $ EXCESS LIAB CLANS-MADE AGGREGATE $ DED RETENTIONS $ B DKERS os� imAN ER99A)vu A, v�N WCC50MI19842015A 5 OW05MI X �STATu- orrr �� EXCLUDED? N/A Et_ELCHaccLDErir $500000 If br E.L DISEASE-EA EM S500 000" DESScea•rlDn OF OPEtAMONS beeps a E ois&WE-Poor uurr s500 606 DE,SCRIFiI IN OF OPERATIONS/LAXATIONSI VEMCLES[Atlaeh ACMW lot,Add ReamU Sehedul4 B mme space Ts reg.*em . Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsem rd& Nothing contained In the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Pat White SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOAE Mashpee Building Dept. THE EXPIRATION DATE THEREOF, NOnCE WILL BE D_EUVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 16 Great Neck Road Month Mashpe%MA 02N9 AUTHORIZED REPREseurATArE 019W2010 ACORD CORPORATION.AII rig hts ram. ACORD 25(2010" 1 of 1 The ACORD name and logo are neglab s ed narks of ACORD #S154505/Yt54504 COD 2 AC R CERTIFICATEDATE(WMDYYYY) OF LIABILITY INSURANCE g/24/15 THkS CERTIFlCATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFCATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATNELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCMS BELOW. THIS CERTIFICATE OF INSURANCE DOES NDT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERP), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERnRCA7E HOLDER. IMPORTANT: 9 the Cerlfical a hdder is an ADDITIONAL INSURED,Ile policy(ees)must be endorsed, If S BBROGA71ON IS WAIVED,subject to th2 teflrls and CMdhons of the policy,certain policies may wire an endorsement A stal3emed on tN s certificate does not confer rim to Ile CartiBrate holder In lieu of such endorsene PRorucEl Deoliveira Insurance Services PHONE JOS DSOLIVSIRA 800 Falmouth Rd. (5081. 477-3023 FAX (508) 638-6463 UNZT101-A 6s: 'oe@dinsinc.com Mashpee, MA 02649 01sURE AFFORD90 CMM RAGE NAIC S INSURER A•MSA INSURED msumnB:Travelers Jeremy NickersonINSURER C DBA East Coast Professional INSURER 0- 27 Metoxit Road East Falmouth, MA 02536 INSURER E: INSUR F- COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE P4 S OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION CE ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY TIE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS ONDITIONS OFSUCi POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAM ManLTR TYPEOFDISUR/WCE 2 POUCV NUrBER OUCY EFF ICY ExP LOINS- A C;eC�ALuaeLrry MPT3201F 8/25/15 8/25/16 EACH OCCURRENCE s 1 00 0 X COMMERCIAL GENERALLIABILITY 00 ITY - DAMAGE TO RENTED $ 500 O00 00 CRAMS-MADE F OCCUR MED E7a'Mona perm s 20,000 PERSONAL&ADVINJURY $ 1,000,00 0 ' GENERAL AGGREGATE s 2 00O 000 GEN'LAGGREGATELYMTAPPLIESPER - PRODUCTS-ODW10PAGG E Z 000,OOO POLICY PEll RO LOC s AiTOMBILELUUBUTY COMBINED SINGLELIMff--- a accident ALLOVLOWNED SCHEDULED $ A BODILY INJURY(Per person) $ iIPE � .'a'�, AUTO AUTOS BODILY INJURY(Per accident) 5 HIREDAUTOS AWNED PROPERYDAMAGE meaident $ s UIBREUJRUAR OCCUR EACH OCCURRENCE E EXCESS W1B CLAIMS AM1ADE AGGREGATE $ DED RETENTION B DAN EM��UA 6KUBO072123907 11/7/15 11/7/16 g I WCsrATu OTH FR ANY PROPRIEIDRIPARTNERIE�TIVE �Y/N OFFICERMEMI*R EXCLUDED? NJ J N/A E.L.EACHAGa DENT 100,000pbridn"In > 1N under E.L.DISEASE-EA 2WLOY 100 000 oESCRIPnONOFOPERtATIONsbelow E.L.DISEASE-POLICY LIMIT S 500,000 DESCRUIMMOFOPERATMM/LOCATNMIVE9CLES(1-1 ACORD 101,Additional RerwAmSdodub,7 mom space isregdneto CARPENTRY 3 STORIES OR LESS a. JEREMY NICKERSON HAS ELECTED TO BE COVERED UNDER THIS WORKERS COMPENSATION POLICY ' t CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CAPS COD CUSTOM BUILDING I11C AOCORDANCE WITH 7HE POLICY PROVIWNS. PO Box 27 Cummaquid, IRA 02637 AUTHORIZED REPRESENTATIVE AMANDA ELDRIDGE ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010" The ACORD name and logo are registered marks of ACORD Phone: (617) 312-4520 Fax: EMail: BUG67@LIVE.COM S' kac CERTIF. ATE'�-OF�LIABILITY INSURANCE �"�`�'""°/24/ `� 9/24/15 THIS PERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIITMA71VELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NDT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSUIRER(S), AUTHORZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT- U the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed. B SUBROGATION IS WAIVED,subject to the terms and conditions of the polity,certain policies may require an endorsement. A statement on this certificate does not coffer rights to the certificate holder in lieu of such endorsenen reOOUCER CONTACT NAME: JOB DBOLIVBIRA Deoliveira Insurance Services PHONE FAR 509 Falmouth Rd. (Ar-N • 508) 477-3023 N :(508) 638-6463 Unit 6 ADDREss: joe@dinsinc.com INSURERS)AFMRDING COVERAGE NAIL# Mashpee, MA 02649 ., INsuRElia:MSA °SLR® INsURERa:Travelers/Assi ed Risk ROBBRT R PIffitCB INSURER C: 121 OXFORD DR INSURERD: COTUIT, MA 02635-3021 INSURER E. INSURER F• COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICES 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. INSRLLTRR TYPEOFINSURANCE AODLSU Q POUGY MUDS R POLICY EFF POUM M UPS A GENERALLIABIITY MPT9555P 9/22/15 9/22/16 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED B COMM92CIALGENEPo►LLIABMJTY dlSE (Eaocsu�_ $ 500,000 CLAIMSMADE ❑OCCUR MED DIP(AnY one Pam) $ 10,000 PERSONAL♦£ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LMTAPPUES PER ' PRODUCTS-COMP/OPAGG $ 2 OOO OOO POLICY PRO LOC $ AUTOMOBILE LUU9UTYCOMBINED SINGLE L Ir. a accident ANYAUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIREDAUTOS _AUTOS eraccident $ $ UMBRELLA UAB OCCUR F EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE ♦ AGGREGATE $ DED RETENTION B UYORKISL4 COMEENSA710N 7PJUB2$509336 10/9/14 10/9/15 we srATu- OTH- AND BrPLOYERS'UABOlTY ANY PROPREMIRIPARTNERIE)ECUTNE Y/N t. EL.EACHACCJDENT ZOO 000 OFRCERAEfuBERE)(CLWED? N/A (randalory in NH) E.L.DISEASE-EA SW LDY 'TOO 000 If yes,describe under ' DESCRIPTION OF OPERATIONS bdow EL.DISEASE-POLICY LIMB 500 000 ASCRIPTION OF OPERATIONS/LOCATIONS/VE ICLES(Atach AODRD 101,AddManaf Renerks ScIndute,it rnore space is required) , ROBERT PIERCE IS LISTED AS-A COVERED OWNER ON THIS WORKERS COMPENSATION POLICY CARPENTRY INTERIOR EXTERIOR CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DA7E THEREOF, NOTICE WILL BE DELIVERED -IN CAPE COD CUSTOM,BUILDING INC ACCORDANCE WITH THE POLICY PROVISIONS. PO BOX 27 CUMMAQUID, MA 02637 AUTHOR®REPRESENTATIVE AMANDA ELDRIDGE ®1968,2010 ACORD CORPORATION. All rights reserved. ACORD 25(201 OIX) The ACORD name and logo are registered marks of ACORD Fhohe: •Fax: E•Mail: SUG67 @LIVE.COM �ka�ci�o�s �rloo�.�ln✓�. t _ �, ��' � r Y - � ,`. ' _ a. .. - .�� ._ f . � .. �. � .-� � � 1 � y , l Y' Y � � • ' � � � N �` _ n .• � � � � • � — — e � e �. " � I i �, � — Client#:45966 '_ 2CCCu1 ACORD„ CERTIFICATE OF LIABILITY INSURANCE 1DATE(!M0V/ffM THIS CERTIRCATE(S ISSUED AS A MATTER OF Off ORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER S CERTIFICTHISATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES RCPRESENTATIVE RO PRODUCER-AND THE CERTIFICATE HOLDEFL CERTIFICATE OF INSURANCE DOES NOT N��A CaNTRACT BETWEEN THE ISSUINGp�SURER(S).AUTHORIZED IMPORTANT:ff fire cm0hgfle holder is an ADDITIONAL tNSI iR )must be endorsed.ff SUBROGATION IS WAfV®,s;fIghts. e�the the terms and condidone of fNe(mifcy,G"in polities may require an endorseinwL A statement on this c irate does not confer eeruficate holder In lieu of such endorsNnent(s). PRODUCER Dowling&O'Neil N Insurance Agency E 5Q8 775.1620 ,�:5�7781218 9731yannough Rd., PO Box 1990 AOo Hyannis,MA 02601 NS1JRW8jAFFOR=QcxiveRAoe NAfcs asuR® wsaReRA.F-ssex Insurance Company Cape Cod Custom Build,Inc. udSURER a ASSOclated EmpIDVers insurance P_O.Box 27 +�+�- Cummaquid,MA 02637 INSUMMD- 04SUREN E- COVERAGES DISURER F- CERTIRCATE 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 ABOVE WIT RESPECT:THE 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 POUCIE& LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TRME TYPE OF WSURANCE POUCY NUMBER POt�CIf EFF .PO CY EXP A GORRALLmmm 3DY6050 LEM X �ERCIALG9�IEAALU ABnlTY 5 0�05/201 EacwocarRReacE 51000 000 MAWJ-MADE ®OCCUR AIED — ) $1000 PERSONAL&ADVINNRY s1,000,000 oE►ERALAGGREGATE S 000 000(iENi A66REf3ATE UMR APPLIES pgt POLICY n Pao- EJLac PRODUCTS-COMPJOPAC,G 31000000 AlfrOMOBILE LTAswry S �MBN SING L E, ANYAUTD AUTOS ) ow - ;HIRED OWNED SCHEDULED BODRYAWUAY(P�P��) ' S AUTOS BOD�YINJURY(Pet 5 UTOS AUTOS NO AIP>@DAMAGE 1A LUUI OCCURUAB EACH OCCURRENCE $ CLAWS-MADE AGGREGATE g BED RETENTIONS B WORKMSCOlMPPENSATION $ AND EMPLOYERS LIABUny YEN WCC50050119042015A I5 04/05/201 X "'�STATu OTFF A0FRCUWERGFbi E--MQ nie EL EACHACCIDENf € S5 0(jD ayye�ss, �, E.L DISEASE-EA&A 000 DESCRIpT[O,r OF OFHiATTONS belay . �Da:�e-Poucviwrr a5000OD DESCRUMMOFOPERAIRMILOCATWMIVEMCLESYMadiACORDtOT, 'ValRemadesehedul4Hirespeis,eyydmm Insurance coverage is limited to the teens,conditions,exclusions,other limitations and endorsements.' Nothing contained in the certificate of insurance shall be deemed to have altered,Waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Pat Whit@ SHOULD ANY OFTRE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Mashpee Building Dept. Tw EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVLS90NS. 16 Great Neck Road North Mashpee,MA 02M AUTHOR®REPR®evrAMM 1908-2010 ACORD CORPORATION.AU rights reserved. ACORD 25(2010/0s) 1 of 1 7fm ACORD n8m 8nd logo are registered marks at ACORD #S154505/M154W4 CBD f � OO '�'ec,A ENT CDNSRACtype: cc OME 1QRPRDV 1$2�Zi5, Co(povation e9Isttion I27d20r7 , ., • EXp��t�on� NG�` , DP BED •' �-'�'§ Upa L5 oERLAN�A0263 CUMMAQVID, y: ' Massac • l4oard hUsetts_D , °f 8wilain epartr?ent o Conctrgctio gS 9-lations ahpublic Safety, License..CS uPrn iNor d Standards LYE 107?78 P.p Bp BEDARD Cum X 27 .. . � ma9uid]►� .�l � =� 0263 ✓ yam' �. ' mmissioner £XPiratio nl D5/16/2017 Town of Barnstable .. y *Permit# Fxpires 6 m t rom tssu e i7 Regulatory Services Fee BA NSIABLFw 9 AtMASS. a Richard V. Scali,Director Ep building Division Ea, L s 6�A— Tom Perry,CBO,Building Commissioner. 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Map/parcel Number 2,�r L' Not Valid without Red X-Press Imprint G.rO - ,�n , Property Address (P UkA1 e \A (O A X V Y�� N(Pk— Residential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address \ FJ 6 Contractor's Name _ Telephone NumberLT, j= Home Improvement Contractor License#(if applicable) a 1 Email: 1�l t1�c CL tJ4Lv►0, Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance - Check one: ❑ I am a sole proprietor ❑ I am the Homeowner X-PR I have Worker's Compensation Insurance Insurance Company Name mp j'�� \ �' �� FEU.Q 3 N 16 Workman's Comp.Policy# QJ C.� 5o G (3 0 1 016 Copy of Insurance Compliance Certificate must accompany each permit. TOWN®F i3ARNSTABL .. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑ Re-roof(hurricane nailed)(nbt stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows ; #of doors: ke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. YY Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. 'Note: Property Owner must sign Property Owner Letter of Permission. - A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Q:\WPFILES\FORMS\buil g pe it forms\EXPRESS.doC Revised 040215 - ' The Commorrivealth o,f kassachusetts Department o,f Indrtstrial Accidents f3,f,frce a,f1mwstigadens b00 Washington Street. . Boston„MA 02111 u.,vPi-v mass gov1dia , ""Tarkers' Campensafian Insurance Affidavit.Builders/Contractars/EIectr cianslPlumbers Applicant Infarmatian Please Print Legibly Name(St1s®essPOrganizatit}nrrndi�idnal}: Ir�,> �a� �ao C� o� Address: C City/State(Zip Phone� CQ C7—3 c'Z`,(; Are you an employer?Check the appropriate box: Type of piYrject(regnire�c I.❑ I am a employer with 4. [ Tl am a general contractor and I 6_ ❑New jectcon (rcti ' employees(full andlor part-time * have]tired.the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. odeling, . ship and have no employees These sub-contractors have g_ ❑Demolition, wodzing forme in any capacity employees and have wodmrs' INa workers' comp.insurance coma.insurance,! 9. E]Building addition required-] 5. ❑ We are a corporation and its 10'-❑Electrical repairs or additions 3.❑ I am.a h,omeoumerdoing all work officers have exercised their ILL]Plumbing repairs or'additiom myself o workers' right of exemption per MGL �' � - . insurance required]s c.152,§1(4�and we have_no 12.❑Roof repairs employees.[No worms' 13.❑Other camp-msurarrce required.] 'Any appBcan.titat checks box P1 most also fill out the!section belowshmeing their wa kexe compensatiou policy infor=ird a I Homeownen who subm t this affidmit iadkzbng they are doing all wait and then hire outside contractors mst submit a new affidavit indicatiag such. . fCantractors that check this boat must attar w d sn additional sheet shovdng the noire of dre sub-cont2ctocs and state whether.or not tbase entities base employees.Ifthesub-taata=ishave employees,thegmarstpmvide their worker'comp.policy aumbcr. I arrt art ernp r float is pnnzding yvarkers'contperrsri[zirrr iirsriratrce or atS*enrp£oy�ees Below is the polity and job rite irrfor mattom Insurance Company Name: , Policy or Self--ins.Lic.;�: " McpintionDate: Job Site Address: -CitylState,I2ip: Attach a copy of the zworlters'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 ptmalties of a fine up to$1,50a 00 andJor one-yeariumpriso—errt,as well as civil penalties.in the form of a STOP WORK ORDER and a fine of up to$250-00 a day against the-violator. Be advised that a copy of this statement may be forwarded to the Office of Imuestigations of the DIAL for insurance coverage verification. I do hereby ccertifi,under liR pains grid psrrahffes dfperjury t7tatfJte urforma#iv7i prmRrted abow is[crag and correct simisture: �" i Date: ° Phone 9 Official use only. Do not write is tlrrs.area,to be completed by city or toms official, City or Town: PermitUcense## Issuing A.utlaority(circle one): 1.Board of Health 2.Building Department 3.Cityffown Clerk d.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: , ormation and las-r-ctions f ; Massachusetts General Laws chapter 152 re:q=m all employers to provide workers'compensation for ffieir employees. p �fii,fie,an.nzrployee is defined as_"_.every person in the service of another under any contract ofhim, express or implied,oral or wntbmn An wTIOyer is defined as"an individual,pmtoership,association,corporation or ot3ier legal entity,or any two or more of the foregoing engaged is a joint enterprise,and including the legal representatives of a deceased emplayer,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 o=apa at of the - ce construction or air work on such dwelling house dwelling house of another who employs persons to do mam�� repair or on the grounds or budding apptntenarit therm shall not bwanse of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or 4 renewal of a license or permit to operate a business or to construct buildings fit the common wealth for ally applicant who has not produced acceptable evidence of compliance with the insurance.coverage required." the commonwealthnor ofits oTitical subdivisions shall CTL ter 152 25 states"Neither �3' P AdditionaIl M , § C(� _ Y� �P - enter into any contract for the performance ofpubhc work lmtil acceptable evidence of compliance with the in=ran ce. r ents of this chapter have been presented to the contracting anthodty_" Applica.n b> Please fill oi± the workers'compensation affidavit completely,by checkiag the boxes that apply to your situation and,if nessary,supply sub-contractor(s)name(s), address(es)and phone numbers)along with their certifi ec cates) of incT-rrance. Limsd Liabr7.ityCompanies(LLC)or LimitedLiablaityPartnerships(LLP)withno employees other than the members or partners,are not rr glmed to cauy workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this aff davit maybe submitted to the Department of Industrial Accidents for confirmation of ins�ce coverage. Also be sure to sign and date the affidavit The affidavit should be retrmmed to the city or town that the application for the pemdt or license is being requested,not the Department of hadL,s trial Accidents. Should you have any questions regarding the law or ifyon are regoaed to obtam a workers' compensation policy,please call the Department at tie number listed below. Self-insured companies should enter their s elf-m 5arauce licelase number on tine appropriate Ime. City or Town Officials f - Ple.ase be sure that the affidavit is complete and printed.legibly. The Department has provided a space at thee bottom of tie affidavit for you to fill out in the event the Office of Investigations has to contact you rega-d the applicant_ Please be sure to fill in the pemLiYliceuse number which will be used as a reference number. In addition,an applicant that must submit multiple pennWhcense applications in any given year,need.only submit one affidavit indicating current p olicy bif6rnation(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 madced by the city or town may be provided to the applicant as proof that a valid affidavit is on file for fut❑re permit or licenses_ A new affidavit must be tilled out Bads year.Where a home owner or citizen is obtaining a license or pmmitnot related to any business or commercial venture (Le. a dog license or permit to bum leaves_etn.)said person is NOT required to complete this affidavit The Office of Investi gations would like to fhank you in advance for your cooperation and should you have any questions, please do not hesitate;to give us a call. The Dep tinmfs address,telephone and fax number; 'fie COMMMWeela of Massac,.huttts ' Department ofliid ialAccZents Qffi=of f vegugatio= 604.Wasbivol,sftrett T(,-L 4 617 727-4900�t 4-06 or I_977- 6AMAFF, Fax 9 6I7-727-7M Revised 4-24-07 s�agQgfrlia • .� ,. pFtHE T �, _ ♦ f ♦ IMPNSULBM 9� MASS. Town of Barnstable ArED MA't� . Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 -Property Owner Must + Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my beh4 in all matters relative to work authorized by this building permit application for: (Address of Job) s Signature of Owner Date Print Name _ If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. .h Q:\WPFILESTORMS\building permit forms\EXPRESS.doc Revised 040215 Town of Barnstable Regulatory Services 'THE rorfr Richard V.Scali,Director , Building Division * aaMsrABM " Tom Per ,BuildingCommissioner Mass �' A 0.19. `0� 200 Main Street, Hyannis,MA 02601 k TFD www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": I name home phone# work phone# . CURRENT MAILING ADDRESS- city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached ordetached structures accessory to such use and/or farm structures.'A person'who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit, (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." i Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules &Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 0 Mbar" Cccc^i/iklG i"1A r� ro o &Amo", 2 y f - J�& - -- 2-13l« _7 (0 1Cn �cGlc 1 9 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ISID Map --VcG-75- Parcel Permit# Health Division "• Date Issued n c( Z 2�. Conservation Division Fee o,. �'O c✓ g� Tax Collector i �C �(zz Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis e , Project Street Address Lr"•� Village 4-c"l -P Owner U la'Qe V 1 L(y),S Address ' -Telephone Permit Request Square feet: 1st floor:existing proposed 2nd floor:existing proposed Total new Estimated Project Cost 701:7y Zoning District Flood Plain Groundwater Overlay 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 O new size Shed:❑existing ❑new size Other: J. Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑. Commercial ❑Yes ❑No, If yes,site plan review# Current Use Proposed Use a BUILDER INFORMATION Name Telephone Number Address 71 - ARAGON GIR License# COTUIT MA 02635 Home Improvement Contractor#, (508) 428-2202 Worker's Compensation# 4Lc/s/sc/9a 36a o/`.. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO t/a�rn.yU SIGNATURE DATE FOR OFFICIAL USE ONLY - f. P&RMIT,NO. DATE ISSUED r- MAP/PARCELNO. '? ADDRESS " VILLAGE ' OWNER:` DATE OF INSPECTION - i d FOUNDATION ' • F y r _ 43 � t " ' FRAME • y ! 4 ~ _ r INSULATION F a FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL' FINAL BUILDING DATE CLOSED'OUT - Y ASSOCIATION PLAN NO. f The Town of Barnstable NAM, ' Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Cresson Fax: 508-790-6230 Building'Commissioner 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-misting 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: Estimated Cost_2L�� Address of Work: Z c � Owner's Name: v Date of Application: I hereby certify that: - Registration is not required for the following reason(s): . Work excluded by law (JJob Under$1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED . CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Ddte Contractor Name Registration No. OR Date - Owner's Name q:fbmS:Affidav The COMMOXWA*h ofmomkmmgws r Depa tptat Q f IndusWAa ddeMts -leis 606 Wd�ln�iWr,S7fi`r�d sow Mem d2111 Workers'C lnmsa A�Idavdt M I , emir EP-ONSTRUCTION 71 T RAGON CIR. [] Iama i am a sole haw one no one in eavOviow I am an 9&muiMfl nmumflan ffW ca d&job• addma �. �P dIZ .1 S' 4' % �'��V: ..�,44•' r, ..:.1'.` r4•`l., .:'�.4?.•Ai.nN: :`r74�� :{�";.:;y.y . dft- 1101111 I am a sole prqSietQr, g=WMor,or homeowner(dmk av#and have Wn d the munaators listed below who have the ibuawing workers' Polices.• •''+'�!;ox.L••t r�'i• ..,�,t•,.'.�;.r.fb p rtt• St�•� r. r .A j.. .. x'•' 1 af;iai , .4;:.�4 f.••�4. •Y9,w4.�... •rw •'�'�..4� fines•:.. .4 r r W''\•.4• 4I•' •� .f ME `,+. , � 1'i$+;\:"4 •;. .., •. ., � .r, .• '.4..rf S,yti n.�i4yp, Mri:• + A�VI l F' N• 4i 'r.S �4'' '.111. •pia�ilal•• ,4i.•.w.. Lil'P.•.i!♦\� "•M�\ • �'4• vW• w:/+C'.'1•.. 4.. .4N. •Y• �:' y S�SQ��' dam:.. . •:µ:,, .. i t••., �� Y : .;4 •�<.?'H�: ��•• 4�,,�4' •. .. ' ' , ' • „' •: ;;.• ,ter •y. X p •..fM1 wn t 1 N f ♦n. •�7�'y.:4'•iaNf•V9�rr�v:�• �: p'r) :t?•r. .�!�:';� '•44y!pj• �..:4M1�.:fp(4;Sr n •..4'„i[, rit,'��'w ••P •rS K w�w. ''�• "Wes•.,..�A•YF.i• Late to eo....ee.. madwdmdm&U otMOL 1a ae iVod to tMe mmpodtlosoterdd.d Padua ar.One alp to aiPsoo.Oo.nduor onoyeawhaptMMMMwoYor dpwasb mhmoteMWW08KOIlOeRvdoduotlIOL89odpvpiWAua IMduMdums d�p�ettldeMe�gr boa NtMOIQadLwadpdmuotOlnDlAlkawtt�pw�oA I do may bp*mmdm pmWMsbm k We and amma Paint name eQeldowady d000l, suivrrlrMamplobdlpeiq►.e�anto l i oilyorto�s LDwD eheslctleimoddbr ro�poeenmeepent - i - HOME IMPROVEMENT CONTRACTORS REGISTRATION - oard of Building Regulations and Standards One Ashburton Place -- Room 1301 Boston; Massachusetts o2108 HOME IMPROVEMENT .CONTRACTOR Registration 112536 Expiratio-n 04/06/01 --- - -'-- -- TYPe - DBA -_--- -- - --- - - T,. c6 u \ t HOME IMPROVEMENT CONTRACTOR FRASER CONSTRUCTION co IMP Registration 112536 DEAN C. FRASER Type - DRA - 71 TARRAGON C I R------------ ------------ -- -- - - a ion 01 -------- -- COTUIT MA 02635 FRASER CONSTRUCTION co DEAN C. FRASER TARRAGON CIR Z,-masmATOR , UIT MA 02635 ocus ASSESSOR'S MAP: 22 ` ° GENERAL NOTES: i PARCEL: 112 ' c° REFERENCE: PL. BK: 76 PG.. 1 1. VERTICAL DATUM: Assumed_ c° o 2. MUNICIPAL WATER _ IS __ AVAILABLE. �y0 <<� 3 FLOOD ZONE: X Town of Barnstable 3. SCHEDULE 40 PVC PIPE TO BE USED THROUGHOUT c � �o ¢, v #250010564J (07/16/14) SYSTEM UNLESS OTHERWISE NOTED. 94 81 4. ALL PRECAST UNITS TO CONFORM TO a _ AASHTO: _ H_10�__ 5 ville Beach Rd • —1/4" PER FOOT UNLESS OTHERWISE NOTED. Craig PIPE PITCH 95.52 6• ALL CONSTRUCTION DETAILS TO BE IN CONFORMANCE a �oo -os� � � � � _ WITH EN VIR. CODE (TITLE 5) AND, LOCAL . A11 REGUL 0 S LOCUS MAP N.T.S. CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES 95, PRIOR TO CONSTRUCTION. _9Gravel..:., 6�� 5.99 m �IV LEGEND: :,.96,44 S a- PROPOSED CONTOUR � J i � G� 61 �1q,� ss PROPOSED SPOT GRADE V `�1�. �"� moo• x 97,.41 - _ �5., — 40 — EXISTING CONTOUR' Lots 26 & 27 96,36 F X 3 0.2 3 EXISTING SPOT GRADE 0 ;, _ 10,914f 'S.F. cc P - . 0.3f Ac. TEST PIT . 97,03 - Map 226 EXISTING WATER SERVICE Parcel 112 Deck 96,49 ��, �X o X o WORK LIMIT LINE a _ . <v g— 98.07 ego �8.03 \ ., #6 1 i 22' aF 97,58 / IP FND TOF=99.58 Bk BIN 18IN PINE � �� aF Mgff9� �� M9ff9�ti �a (Assumed) ,. PIN 96,63 96.19 AMY L. y� o TERRY if It :� �9 VON HONE AN N x 6 8 o ti WARNER y W o x 98,60 �7,89 15� � c� Not 1068 No. 38721 N o 98.94 Porch �� / x 9218 �WSTERP� �� GISIE - - 98,82 ..(Slab) \ 10, 1 N A 1 98.77 . IP FND T 9 a F 98.7 ( 13 96.59 96.61 srs age \ ti ti .y /5 l� 9poo, 99.41 �25'1 A ; ;75 ya NOTE: This plan is to be used for septic �,g. 24 . _ _ _ system. purposes only and is not to be 99.7P� ��3`S n,� 3 ; ' 98 considered- a property line survey. Opp 99,86 99.48 H 100, gyp. x, 99,16 W SH FF 99-9.98 19FT 9 I j - 6 CRANBERRY LANE �`e 9 .79 20' 101.9}3 V H CENTERVILLE, MA FT PI �'jE. .. s /�TOF ABUTTER BLOCK associates PREPARED I R EN E M. K UP R EVI CI U S 24 � x ' i Abuttin Foundation FOR: g SEP71C SYSTEM DESIGNS Maximum Feasible Compliance �'qC® I° 100,95 100,24 1Q141 2166 NORTH ST. JAM ES ndw Cotuit Rood Sf h, MA 02563 PARKWAY g Title 5 Variances: 310 CMR 15.405 1(b) 508.833.0041� _ � � CLEVELAND HTS, OH .. 1. 5' variance request, proposed 15' Benchmark set: H Brant to bolt T surveying by separation between leach facility and 44106 P H Y 9 erry A Warner.P.L.S. foundation (bulkhead) 01.58 i 22 Long Road EL 103.01 (Assumed) Harwich ,,,,� DATE REVISED SCALE SHEET N0. 101.36 (sob) 432-8309 05/21/15 1 = 2 0' 1 of 2 A VERIFY ACTUAL LOCATION OF Al THE SEPTIC TANK AND SYTEM 8'-4" 13'-3" 6'-0" 6'-1" 10'-0" COMPONENTS WHEN INSTALLING 1 THE NEW DECK FOOTING. LOCATION 1 / SEPTIC (\ 11 ( SHOWN IS FROM AS—BUILT CARD INSTALL FLASHING UNDER I HOUSEWRAP&DECKING TANK 1 i 6 DECKING J �o VEN EXISTING HOUSE I L SIMPSON DTTiZ FLOOR JOISTS TENSION TIES AT(3)LOCATIONS 1•— DECK JOIST PACED FROM HOUSE TO P.T.2 x 1 O's @ 16"D.C. 1 1 - I INSTALL PEEL&STICK 1 RUBBER MEMBRANE 0 BETWEEN II NEW NEW SHEATHING EDGER 8 OLTED TO DECK DECK SOLID BLOCKING WB(02)LEDG RBOK BOLTS 1 16"D.C.W/ZMAX JOISTS HANGERS DECK DETAIL NOTES: 1.) CONTRACTOR IS TO VERIFY ALL EXISTING CONDITIONS EXIST. &DIMENSIONS IN THE FIELD HOUSE 2.) CONTRACTOR TO VERIFY ALL INTERIOR&EXTERIOR MATERIALS, DETAILS,&FINISHES IN THE FIELD WITH OWNER 3.) ALL CONSTRUCTION TO CONFORM TO 780 CMR MASSACHUSETTS STATE BUILDING CODE,8TH EDITION AMENDEMENT&IRC2009 FLOOR PLAN 4.) FOLLOW ALL MANUFACTURER'S SPECIFICATIONS FOR INSTALLATION OF ALL SIMPSON COMPONENTS 5.) ALL CONCRETE USED FOR SONOTUBE FOOTINGS TO BE 3000 PSI 13'-3" 6'-0" 6'-1" 10'-0" 6.) RAILINGS ARE REQUIRED WHEN THE DECK SURFACE IS 30"OF HIGHER 6'-7 112" 6'-7 1/2" ABOVE THE ADJACENT GRADE,VERIFY IN THE FIELD. 7.) ZMAX OR STAINLESS STEEL SIMPSON COMPONENTS ARE SPECIFIED A FASTEN JOISTS TO BEAR DUE TO THE LOCATION WHICH IS NEAR NANTUCKET SOUND FOR Al W/SIMPSON H2.5 TIES CORROSION PROTECTION. 8.) VERIFY ANY BENCH SEATING AND OTHER DETAILS IN THE FIELD P. T.z 10 M WITH OWNER.INSTALL BLOCKING AND ADDITIONAL JOISTS FOR SEPTIC 1 SUPPORT\ TANK 10"DIA.CONCRETE SONOTUBES / JW W/24"DIA.BIGFOOT FOOTINGS UNDERNEATH TO 4'0"BELOW — GRADE.USE SIMPSON ZMAX ABU66 POST BASE w2x1 BE AT.2x10_BE - D D LAG BOLTED TO e O SOLID BLOCKING RyVBOAREDGERLLOK BOLTS P.T.2 x 10's 16"o.c. P.T.2 x 10's 16"o.c. () W/MID-SPAN BLOCKING W/MID-SPAN BLOCKING 16"o.c.W/ZMAX LU210 JOISTS HANGERS INSTALL SIMPSON DTT1Z TENSION TIES AT(3)LOCATIONS EVENLY SPACED FROM HOUSE TO O DECK JOIST a w - VERIFY DECKING MATERIALS m a m W/OWNERS W ] O v~i // o dAZEK 1 x 10 FASCIA P.T.2 x 10's 16"D.C. 17 3-P.T.2 x 10'si,�•�\�i FASTEN JOISTS TO BEAM D ilJ P.T.2 x 10 LEDGER BOARD LAG BOLTED TO 10"DIA.CONCRETE SONOTUBES W/SIMPSON H2.5 TIES (� SOLID BLOCKING W/(2)LEDGERLOK BOLTS W/24"DIA.BIGFOOT FOOTINGS INSTALL TIES DTT12 v 16"o.c.W/ZMAX JOISTS HANGERS UNDERNEATH TO 4'0"BELOW + TENSION TIES AT(3)LOCATIONS �� w� + EVENLY SPACED FROM HOUSE TO EXIST. GRADE.USE BASESIMPSON ZMAX +�• DECK JOIST ABU66 POST BASE HOUSE VERIFY LOCATION OF GAS METER rA-�S E CT I O N @ DECK ey IN THE FIELD&BLOCK OUT JOISTS A� DECK FRAMING PLAN AROUND METERTHE, COTUIT BAY DESIGN, LLC NEW DECK FOR; CONSTRIGNER ION.THL BE UILDIN CONTRED ACTOR SCALE : DRAWING NO.: ERRORS OR OMISSIONS ARE FOUND ON THESE DRAWINGS PRIOR TO START OF 43 BREWSTER ROAD ' WIN THESEDRAWNG IF CONSTRUCT ONS RUCTONNT�R 1/411 — 1'-0" MASHPEE MA. 02649 LANDRY RESIDENCE I DESIGNER OF ANY ERROR OROMISSI CHES E CES RAWN SAKEHOUT NOTIFYINGLELFOR HE TH Al PH. (508) 274-1166 DESIGNER ERNOTED.AS OTHER USE DATE . THESE DRAWINGS ARE SOLELY FOR THE USE FAX 508) 74-11 6 THESE RAWNGOTEQUIRES THE VVRIRUSE N 6 CRANBERRY LANE CENTERVILLE, MA THESITECTUNGSREORIRESTHETECTION 5/4/2016 CONSENT OF THE DESIGNER UNDER THE ARCHITECTURAL COPYRIGHT PROTECTION ACT OF 1890. 1 l 4 !I i A VERIFY ACTUAL LOCATION OF Al THE SEPTIC TANK AND SYTEM 8'-4" 6'0" COMPONENTS WHEN INSTALLING 1 THE NEW DECK FOOTING. LOCATION 1 / SEPTIC \ 1 DECK JOIST SHOWN IS FROM AS-BUILT CARD INSTALL FLASHING UNDER TANK I HOUSEWRAP&DECKING � 1 I I X 6 DECKING J o EXISTING HOUSE I INSTALL SIMPSON DTT1Z 1 _ FLOOR JOISTS TENSION TIES AT(3)LOCATIONS EVENLY SPACED CED FROM HOUSE TO P.T.2 x 10's 16"o.c. io INSTALL PEEL&STICK RUBBER MEMBRANE o j BETWEEN LEDGER& NEW a NEW SHEATHING II W DECK DECK BOARD BLOCKING W/(2) )LED ERLOK BOLTS 16"D.C.W/ZMAX JOISTS HANGERS 33'-8" 10'-0. Ii! - DECK D E TA I L f a i NOTES: i 1.) CONTRACTOR IS TO VERIFY ALL EXISTING CONDITIONS EXIST. &DIMENSIONS IN THE FIELD HOUSE 2.) CONTRACTOR TO VERIFY ALL INTERIOR&EXTERIOR MATERIALS, DETAILS,&FINISHES IN THE FIELD WITH OWNER 3.) ALL CONSTRUCTION TO CONFORM TO 780 CMR MASSACHUSETTS STATE BUILDING CODE,8TH EDITION AMENDEMENT&IRC2009 FLOOR PLAN 4.) FOLLOW ALL MANUFACTURER'S SPECIFICATIONS FOR INSTALLATION j� OF ALL SIMPSON COMPONENTS 5.) ALL CONCRETE USED FOR SONOTUBE FOOTINGS TO BE 3000 PSI 8'-4" 13'-3" 6'-0" 6'-1" 6.) RAILINGS ARE REQUIRED WHEN THE DECK SURFACE IS 30"OF HIGHER 6'-7 1/2" 6-7 1/2" s-o" h ABOVE THE ADJACENT GRADE,VERIFY IN THE FIELD. 7.) ZMAX OR STAINLESS STEEL SIMPSON COMPONENTS ARE SPECIFIED A FASTEN JOISTS TO BEAN DUE TO THE LOCATION WHICH IS NEAR NANTUCKET SOUND FOR Al W/SIMPSON H2.5 TIES CORROSION PROTECTION. 1 8.) VERIFY ANY BENCH SEATING AND OTHER DETAILS IN THE FIELD T.2 1D M _ i 1 WITH OWNER. INSTALL BLOCKING AND ADDITIONAL JOISTS FOR SEPTIC 1 Ii SUPPORT TANK 10"DIA.CONCRETE SONOTUBES 70 1 tD W/24"DIA.BIGFOOT FOOTINGS F _ UNDERNEATH TO 4'0"BELOW \ 92i 1 — _ pppli GRADE.USE SIMPSON ZMAX (1. ABU66 POST BASE . w P. .2x1 B T.2x10_BE m \ \ 0 7 p SOLID BLOCKING W(2)BOARD DG RLLOK BOLTS P.T.2 x 10's 16"o.c. P.T.2 x 10's 18"o.c. W/MID-SPAN BLOCKING W/MID-SPAN BLOCKING 16"o.c.W/ZMAX LU210 JOISTS HANGERS INSTALL TIES T DTT1Z TENSION TIES AT(3)LOCATIONS O EVENLY SPACED FROM HOUSE TO e i DECK JOIST a w VERIFY DECKING MATERIALS w W/OWNERS m W O O1- O 10 AZEK 1 x 10 FASCIA P.T.2 x 10's @ 16"o.c. I 3-P.T.2 x 1 0's I FASTEN JOISTS 5 T BEAM Vj W/SIMPSON H2.5 TIES 11F� P.T.2 x 10 LEDGER BOARD LAG BOLI'EU TO = ' '10"DIA.CONCRETE SONOTUBES ` SOLID BLOCKING W/(2)LEDGERLOK BOLTS W/24"DIA.BIGFOOT FOOTINGS a (� INSTALL SIMPSON DTT1Z 16"D.C. W/ZMAX JOISTS HANGERS I UNDERNEATH TO 4'0"BELOW TENSION TIES AT(3)LOCATIONS EVENLY SPACED FROM HOUSE TO GRADE.USE SIMPSON ZMAX DECK JOIST EXIST.HOUSE i'I ABU66 POST BASEAV +1 A� VERIFY LOCATION OF GAS METER A-- SECTION 0 DECK DECK FRAMING PLAN- T IN THE FIELD&AROUND METER LOCK OUT JOISTS I ER$HALL BE NOTIF D IF ® COTUIT BAY DESIGN. LLC NEW DECK FOR, HEDESU ION.THE BUILDING DING CONTRACTOR SCALE : DRAWING NO. ERRORS OR OMISSIONS ARE FOUND ON THESE DRAWINGS PRIOR TO START OF 43 BREWSTER ROAD ' WIN THESEDRAWIN DRAWINGS IF CONSTRUCTION 1/4" - 1'-0" MASHPEE MA. 02649 DESIGNER OFAN E RORS ROMISSI COMMENCES WITHOUT NOTIFYING THE {} % LA N D RY RESIDENCE DESIGNER OF ANY ERRORS OR OMISSIONS. DATE : PH. (5OV) 2'4-1166 THESE DRANER NOTRESOLEOTHER THE USE FAX (50$) 539-9402 OF THE TO FT HE DESIGNER OTHER USE OF 6 CRANBERRY LANE CENTERVILLE, MA AR HITERAWINGSREOUIRESTHETECTION 5/4/2016 CONSENTA THE DESIGNER UNDER THE ARCHITECTURAL COPYRIGHT PROTECTION Al ACT OF 1990. f OCUS ASSESSOR'S MAP: 226 �, ' � . _ GENERAL NOTES: _ 112 � -T Y._ cA __Assumed_______ �c � 2 PARCEL: � � _ � . 1. VERTICAL DATUM: ° REFERENCE: PL. BK. 76 PG. 1 _ -- �p� �. L , 2. MUNICIPAL WATER �S AVAILABLE. Apo FLOOD ZONE: X Town of Barnstable o-` I 3. SCHEDULE 40 PVC PIPE TO BE USED THROUGHOUT' �,, \° #250010564J (07/16/.14) o �o SYSTEM UNLESS OTHERWISE NOTED. rn p� �' g4.81 `}y 4. ALL PRECAST UNITS TO CONFORM TO Y c AASHTO: . =—H—=10 v `5 5• PIPE PITCH-1/4" PER FOOT UNLESS OTHERWISE NOTED. Craigvilie Be°ch Rd �/ 95,52 6• ALL CONSTRUCTION DETAILS TO BE IN CONFORMANCE oa A c� p WITH MA ENVIR. CODE (TITLE 5), AND LOCAL - . P Q-° 001. CL REGULATIONS. LOCUS MAP N.T.S. . _ 7• CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES. 95,32 �o�i PRIOR O CONSTRUCTION. w 9 Gravel b�� 5 99 �- e m LEGEND: -� _ ~ ' g6,2��Q: �� 96,44 SSCL PROPOSED CONTOUR '•C� o jam,: ss PROPOSED SPOT GRADE x 97,41 �S•- - — 40 EXISTING CONTOUR Lots 26 & 27 96.36 y , X 30.23 EXISTING SPOT GRADE Y o- • . 10,914f S.F. �� , P 0.3f Ac. O TEST PIT 97;03 Map 226 ® EXISTING WATER SERVICE Y Parcel 112 — - © o �� iX 4 �96 49 �( ..... WORK LIMIT.LINE Deck 98,07 '4 �°O -58,03 ,' #g [[22 OF ,yq OF p�q 97,58 / IP FND TOF=99.58 ,' gk l�BIN _ �P�� sf9� �P�� r'r. . is • (Assumed) r' PIN l8IN PINE 96.19 0� Am L. yam, i TERRY 96;63 VON HONE i ANN IX 0 x 96,g ti WARNER 9\7.,8 9 15 c' W o x 98,60 _ y�� ! X 9T18 No' i�� U No. 38721 0 98,94 Porch--, i GIStERP � cis�E ° N o 98.82 (Slab) 10' 1 N A —2 I IP FND Ci a Fa 8 7 , . 96 61 w 3 96 59 i �. � f 99,41 9 2 ,o l� 9 '1 A 7,75 - ;NOTE: This plan is to be used for septic �p „ 25 � P P • ;7 24' _ system purposes only and is not to be 3 `L considered`:a property line survey. 99.86 99,48 . p ppTN� /. H 98. i j 100,W SH FF 99,98 1 FT PI x 9 9,16 CRANBERRY LANE V�` CENTERVILLE, 'MA 9 ,79 /20 � : 101,93 H FT PI JP 1- E TDF ABUTTER BLOCK PREPARED 4 I REN E M. -KU P R EVI CI U S �i 2 , x associates Abutting Foundation sePzic sYs1 0es7cris FOR: 100,95 q 100.24 , 2166 NORTH ST. JAM ES Maximum Feasible Compliance �oos `� 1G .41 32o catuit Roans A \\\ ` Sandwich, MA 02563 PARKWAY ' \`\� 508.833.0041 Title 5 Variances: 310 CMR 15.405 1(b) «\ CLEVELAND HTS, OH` 1. 5' variance request, proposed 15' V P u 9 P P �� Benchmark set: Surveying b� 44106 separation between leach facility and fIH Brant to bolt T P y 9 erryA. Warner.P.L:S foundation bulkhead — 22 Long Road 01.58 (bulkhead) �'EL.— 103.01 (Assumed) Ha,win Mn SHEET NO. 1 ( Harwich, os645 DATE REVISED SCALE `1 .101.36 (508) 432-8309 05/21/15 1" = 20' 1 of 2 t �. � e Y ' . � - � -_ � . _ � a� o�- �-iav� u��-� . � � � � . . � -- , . : r. .. � . , . _ .. . , � ` . . ., fi' � '. � :f � , ocus ccz ASSESSOR'S MAP: 226 GENERAL NOTES: ter' PARCEL: 112 o� REFERENCE: PL. BK. 76 PG. 1 1. VERTICAL DATUM: _ Assumed 2. MUNICIPAL WATER _ IS _ AVAILABLE. c �oo� c`��' 3 FLOOD ZONE: X Town of Barnstable 3. SCHEDULE 40 PVC PIPE TO BE USED THROUGHOUT c � �o ¢, v #250010564J (07/16/14) SYSTEM UNLESS OTHERWISE NOTED. En Q, �o�° 94 gl 4. ALL PRECAST UNITS TO CONFORM TO Beach Rd AASHTO: _ H_10 _ ville B G 5• PIPE PITCH-1/4" PER FOOT UNLESS OTHERWISE NOTED. Craig 95.52 6. ALL CONSTRUCTION DETAILS TO BE IN CONFORMANCE Q-opa os f WITH MA ENVIR. CODE (TITLE 5) AND LOCAL P REGULATIONS. Focus MAP N.T.S. CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR TO CONSTRUCTION. Y -Gravel.":". :. 6-In 5.99 CIO co LEGEND: - - 961 vc p 9b,4`4 S a_ - �- PROPOSED CONTOUR O 9 s,19 x ss PROPOSED SPOT GRADE 7.41 — 40 EXISTING CONTOUR S•• 9`O �� Lots 26 & 27 �o 96,36 F X 30.23 EXISTING SPOT GRADE � M � o 10,914 S.F. ,c,� 0.3f Ac. TEST PIT ooe 9 7,0 3 Map 226 ® EXISTING WATER SERVICE o Parcel 112 Deck . � _ f �X 49 9 6 o X E WORK LIMIT LINE Ova _ 98— 98.07etc 58.03 � #g ° 'y22' e /1 97.58 // IP FND TOF=99.58 -Bk 8I P��, OF Mgffq ��,� �F A14XX /a (Assumed) N PIN 18IN PINE 96A9 ��` AMY L. �yG �P �y / Ii �� x ; 96 aa 96,63 VON HONE ANN �� TERRY w 7. 5' 8c' H WARNER y o X 98.60 ! No. 1068 Porc� . � X 97,18 �F �� No. 38721 N o 98,94 �� 4�- SISTER G/SIE 98.82 :. (Slab) �N- \ 10. 1 N A —2 I a 98.77 � IP FND = 8.7 9 C°,. ,' 13 96-59 96.61 a9 o 9 9 .6 LPL 7 �S n S .0 • 99.41 5'1 A .75 NOTE: This plan is to be used for septic 99 7Qf 79- 24'" Ir 98_, — _ _ system purposes only and is not to be � o�, 99 86 ,� 3 •�� o� considered a property line survey. 99.48 H 98,69 100• 'o- 19FT�9 I x 99,16 6 CRANBERRY LANE W SH FF 99,98 A79 V H CENTERVILLE, MA FT PI 9 � E 0' h.; 1OL93 \ o�� , T❑F ABUTTER BLOCK associates PREPARED �9 ® 24 100,24 Abutting Foundation SEPTC SYSTEM DESIGNS Maximum M. KUPREVICIUS FOR: Maximum Feasible Compliance `(AID 100,95 2166 NORTH ST. JAMES 320 Cotuit Road!/ 'Sandwich, MA 02563 , PARKWAY ?�C 508.833.0041 Title 5 Variances: 310 CMR 15.405 1(b) CLEVELAND HTS, OH ,: 1. 5' variance request, proposed 15' / l/ Benchmark set: separation between leach facility and Surveying by. 44106 foundation (bulkhead) P Hydrant tagbolt Terry t Warner.P.L.S. 01,58 EL.= 103.01 (Assumed) 22 Long Road Harwich. MA o2e45 DATE REVISED SCALE SHEET NO. 101.36 (508) 432-8309 05/21/15 1" = 20' 1 of i OCUS ASSESSOR'S MAP: 226 ' GENERAL NOTES: << r' PARCEL: 112 REFERENCE: PL. BK. 76 PG. 1 1• VERTICAL DATUM: Assumed_--____ o 2. MUNICIPAL WATER --IS —_ AVAILABLE. ��o� FLOOD ZONE: X Town of Barnstable 3. SCHEDULE 40 PVC PIPE TO BE USED THROUGHOUT c �o ¢,� a #250010564J (07/16/14) SYSTEM UNLESS OTHERWISE NOTED. 4. ALL PRECAST UNITS TO CONFORM_ TO �oc� 94,81 AASHTO: _=H 110---- 5• PIPE PITCH-1/4" PER FOOT UNLESS OTHERWISE NOTED. Craigville Beach Rd 95.52 r 6. ALL CONSTRUCTION DETAILS TO BE IN CONFORMANCE ooa o c� N WITH MA ENVIR. CODE (TITLE. 5) AND LOCAL �- se, a- REGULATIONS. LOCUS MAP N.T.S. ¢ 7• CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES ` 95 32 °'%�9 5,99 Y PRIOR TO CONSTRUCTION.Gravel ...�6 � m LEGEND. g6,2 �0 t J 0 96,44 S j o- PROPOSED CONTOUR PROPOSED SPOT GRADE ^� �o x 97.41 — 40 — EXISTING CONTOUR Lots 26 & 27 96,36 F X 30.23 EXISTING SPOT GRADE o� 10,914f S.F. �ac� �. TEST PIT P 0.3f Ac. ° 97.03 Map 226 Oe ® EXISTING WATER SERVICE Parcel 112 Deck 96.49 �0 �X\ F o X o WORK LIMIT LINE a _ 9$_ , 98,07 �a S8,03 \ .. #6 '22' e �F of IP FND � Mq Mq 97.58 i TOF=99.58 :^ Bk �r'8IN p 18IN PINE 96.19 ��P�� fq�y ��P� ffq�y� ,tea (Assumed) IN 96.63 0� AMY L. �, = TERRY X 96 o ANN � VON HONE �" W ` 1/1 ` 89 15' 82 y o WARNER No. 1068 �. o x 98.60 �� No. 38721 x 9718 P o o Pore FGISiER`` N .0 98,94 ,3 is -2 C/SIE - 98,82 `':.(Slab) �•. .:` 10' 1 N A I 98,77 IP FND 98,7 9 13' 96.59 .�/ Fog ! 96,61 e ,L 9 1 ,6 'go `L S 99:41 25' 1 A 7t75 ya NOTE: This plan is to be used for septic �> , 0 24' _ _ _ system purposes onlyand is not to be 99,7Q'` `9�3 ,, n� 3 I` 98 considered a propert line survey. 99,86 99.48 p�F .00 00 H 98,69 'S p 100, gyp. 1 FT PI ' { x 99,16 6 CRANBERRY LANE W SH FF 9998 9 490 V CENTERVILLE MA o� 9 ,79 /20 101.93 H. e�� FT PINE" 2iNE ' OF ABUTTER BLOCK associates PREPARED I R EN E M. KU PR EVI CI U S MyC® 100,95 24 100,24 Abutting` Foundation sEPnc sys,EM ocHs FOR. Maximum Feasible Compliance ,Io :1Gi,41 2166 NORTH ST. JAMES 3 cotuit Rood Sandwich, MA 02563 PARKWAY Title 5 Variances: 310 CMR 15.405 1(b) z 508.833.0041 1. 5' variance request, proposed 15' �j � CLEVELAN� HTS, OH ., Benchmark set: 44106 separation between leach facility and P Hydrant tagbolt TenyA Warn r P.L.S. foundation (bulkhead) 01,58 EL.= 103.01 (Assumed) Harwich"MA 02M DATE REVISED SCALE SHEET NO. ( 101.36 soe) 4az-eso@ 05/21/15 1" = 20' 1 oft