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R .r v x a, 4 'q a A .t r a► # r a, �" tF, 1I o'. w y6 Ix u r r! 0 9' ,.' t1. Itt'". ^*' a,°v qP, i `,a,. r4,xt r' , w 1 lq }' u rc, µ. �. x U rp+,� ''xil a ..a n °'"^ '� i':.,J, 1 L.wP'.' �� 1,-'u a.a y. 1. H a s� .8 .% ,T?,I ,'d,°.:`r' ,':rr.. `,.,r W 'i rr a P y 1` ,'� a 0r �', µ', ,j ak. "'r' nw?° `:tr, : M9.!.., ,.� r;. 4.+ it ,,: M!. •'Y ��,, ql d', a" a•, )', "' -v} its ,Y„" ':i" 'a,.;`.. " :+,. ," ,.,'a atr^:„,::: '++ a• r 4S' vI n } „ 4 , APPLICATION NUMBER ............................................................ *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am -9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model'/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by.780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature Dated All permit applications are subject to a building official's approval prior to issuance. . f @ t Convmnwealth of Massachusetts 'Division of Professional Licensure Board of Building Reguiations and Standards x r S ecialty Constructipo's-► p gpires 04/1312020 CSSL-099913 A ' TROY ATHOMAS E 499 NOTTINGI1M� ^ CENTERVILLE MA,020f , Cormissioner CjV_ 1�re�rrn�zrn��ru�alf�i n�(':l�auarfuselJ� Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE::,Co.=ration before the expiration date. if found return to: R stration ;_>, E llration Office of Consumer Affairs and Business Regulation IBc5422 : 061p8/2020 One Ashburton Place-Suite 1301 TROY THOMAS HOME IMOpOVEtVIENTS,INC. Boston,MA 02109 TROY THOMASGG ` 499 NOTTINGHAM DR Not aid without signature CENTERVILLE,MA 02632" Undersecretary a DATE(MMIDDlYYYY) ACC R V CERTIFICATE OF LIABILITY INSURANCE a512 no s HOL loeritervii1e, C CERTIFICATE IS ISSUED AS A MATTER OF INFORM LYION AMEND,EXTEND OR ALTER T AND CONFERS NO IHE.COVERAGE AFFORDED BY THEDPOLIC E1S . TIFICATE DOES NOT AFFIRMATIVIELY OR NEGATIVE IZED OW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSWNG tNSURER(S}: AUTHOR RESENTATIVE OR PRODUCER,AND 7HE CERTIFICATE HOLDER. RTANT: !fi the certificate holder is an ADDITIONAL INSURED,the PoileYoas)must have AbDI?TONAL[NSURED Provisions or be endorsed. BRO13ATION IS WAIVED,subject to the terms and conditions o t policy, certain sy!lcies may require an endorsement. A statement on certificate doe s not confer ri hts to the certificate holder In Ile N NME, {GT Donna Ostrowski CER PH y08 98rowsW 4 Ftic NaI f508)967 2781 Sylvia Insurance Agency,LLC — ain Street E-MAtL mark marks iviainsurance:coro erville,MA 02632 k_-- _���NAIC# INSURE S AfPORDINGCOVERAGE INsul:eAn.Farm Family asualty insurance INSURED INSURERS: --•-^ �� -- . as Horne Improvements LLC INSURER C: , ox 177 1NS RE R D; erville,.MA 02632 INSURERS: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO IOD CERTIFY THAT THE IYlRE4UIRt:ME18T TERM OR CONDITION OF ANY CONTRACT O OTHER DOCUMENT WITH RESPECT©UWHICHCY RTH S INDICATED. NOTVNtTH CERTIFICATE DYGONDITSUED OR MAY IO S OF SUCH POLICIES,GIt S.LIMITS SHOWN MAY HAVE BEEN DUCEDIBY PAID CLAIMSD HEREIN 1S SUBJECT�T TO ALL THE TERM Si EXOLt1S10NS AND e� POLICY EfP pOMLODY LIMITS L BR R TYPE Of INSURANCE POUGYNUM88R 1,000.000 2001x141s 5/ 1 018 / 1r a1 FACH OCCURRENc£ �` A X zcoMMERCIAL GENERAL LIABILITY 100,000 SISE$lEs ggrMffcmcel�-_. 5 000 CLAIMS-MARE F DCCUR I MEOW(Any tan erwn i s PERSONAL&ADV INJURY_,.�_ 1,000.000 �H —^ — GENERAL AGGREGATE 9 S 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG i Y 2.00O,01I0 X POLICY JEC 1L- )1 LOC I$ I i GLE L $ 7HER; s a AUTONIOBILELIABRJTY BODILY INJURY(Per Person} S ANY AUTO i ent} SCHEDULED S BODILY INJURY(Per accid � OWNED SC PROPERTY DAMAGE AUTOS ONLY AUTOS NED r i tPe r.aceiden!) . HIRED 8 AUTOS ONLY 'AUTOS ONLY EACH OCCURRENCE $_ UMBRELLA LtAB i OCCUR } AGGREG 4TE S EXCESSLIAO CLAIMS•MADE t S ER H. 1 DED RETENTION 2001 W8053 5/01/2018 5101/2019 1 TA A WORKERSCOmPENBATfON 1000,000 AND EMPLOYERS'LIABILITY E L,EACH ACCIDENT $ PROM Y/N I NIA 1.000,000 P> CERIMEMaERE7tCLU0ED i E-L.DISEASE-EAE6APLOYE S IO�a (lAendatt%y1n NK) I E-L,DISEASE-POLICY UMR ^� }If as,describe under ;pgSCRIPTION OF OPERATIONS tielcve 1 DESCRIPTION OF OPERATIONS}LOCATIONS l VEHICLES(ACORD 101,AddlHonet Remarks Schedule,MY be attathad it moro sPaae is required) Carpentry insurance coverage is limited to the terms,conditions; exclusions, other limitations Ipotion prodsn endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,Waived or extended the coverage provided CANCELLATION CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES Be CANCELLED BEFORE THE EXPIRATION DATE. THEREOF, NOTICE WILL BE DELIVERED IN, Troy Thomas ACCORDANCE WITH THE POLICY PROVISIONS 499 Nottingham Drive Centerville,MA 02632 AUTHORIZEDREPRESENTATNE ©19812015 ACORD CORPORATtO�I. All rights reserved. ACORD 26(2016103) The ACORD name and logo are registered marks of ACORD -Roof to be stripped and cleaned of all old shingles and debris -Roof to be papered with weather watch leak barrier,Synthetic roof underlayment,and installed with Timberline architectural shingles using galvanized nails. (Storm nailed) -8" drip edge& new pipe collars to be installed -Cobra ridge vent to be installed on all ridges -Timbertex premium ridge cap to be installed -A 10-yard dump trailer will be needed on site; and will be removed at completion of the job . -Contractor will be responsible for all building permits needed at the property NOTICE REQUIRED BY LAW With the agreement of the contract$500.00 of estimate is due. Further payments under this contract are as follows: 1/2 of the estimate due at the start;and remainder due at completion of the job. Balance of all materials and labor shall be payable in full upon completion of work described in this contract. Payment as agreed upon shall be made when due. Any payments which are delayed shall be subject to a finance charge of 1.5%per month. The contractor warranties the workmanship completed under this contract for a period of ten years from the date of completion. During the stated warranty period the contractor shall be responsible for the service of the repair or adjustment, but the contractor shall not be responsible for the normal maintenance, repair due to abuse, misuse,and or normal wear and tear,which shall be the responsibility of the homeowner. All warranties for the materials supplied by the contractor shall be passed directly to the homeowner. The homeowner may be required to register or mail in such warranty card or evidence of ownership in order to activate such warranties. Homeowner failure shall not create any responsibility for the contractor under the warranty provisions;the choice of repair of replacement shall be at the discretion of the contractor. The homeowner acknowledges that the form,content,and notices contained in this contract are intended to comply with the applicable portions of the Mass.General Law Chapter 142A, and regulations promulgated there under. In the event of any instance of non-compliance,only such portion shall be invalid and the remainder of this contract shall be in full force effect. In addition, any such portion not in compliance shall be read and interpreted so as to have its intended meaning to the maximum extent allowed under such law and regulation. Signed as a sealed instrument on this date: Date: Homeowner Contractor THOMAS HOME IMPROVEMENTS I.I.C. PROPOSES TO PERFORM THE FOLLOWING WORK: Location of proposed work: Mr. & Mrs. Monroe 55 Donegal Road Centerville, MA 02632 Date on which construction should begin: August 2018 The homeowner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that cannot be avoided by the contractor shall not be considered as a violation of this contract. The contractor agrees that when such delays become known to the contractor,the contractor•• will advise the homeowner as soon as possible. The homeowner hereby acknowledges that in certain remodeling work,the demolition process may reveal defects in the existing structure which must be repaired,creating additional work which may need to be carried out in order to complete the work described in this contract. In such case the homeowner agrees that the duration of the work and the schedule date of completion may differ,and that such variation is not to be considered a violation of this contract. Cost for labor and materials under this contract: $5,380.00 30 yr.GAF/Elk Timberline HD Architectural shingle(Life Time Limited Warranty) Above proposal is per dwelling includes 2-layer strip in the event that while stripping the roof we find rot that needs to be replaced,the homeowner then has to agree and authorize any replacement or restoration. Then In addition to the above contract price,the homeowner agrees to compensate the contractor for any repairs or restoration at the hourly rate of$55.00 for a carpenter and$35.00 for a carpenter's laborer,plus the cost of materials. The Commonwealth of Massachusetts ' - Department of Industrial Accidents Office of Investigations 600 Washington Street -- Boston,MA 02111 ' www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information j/ Please Print Legibly Name(Business/Orgatuzation/Individuai): OAAJ Address: P V, City/State/Zip: Ut 0JIM OA 3a Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1. 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 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 workingfor me in an capacity. employees and have workers' Y P h'• 9. Building addition [No workers comp.insurance comp.insurance.: required.) 5. We are a corporation and its 10. Electrical repairs or additions q ] 3. 1 am a homeowner doing all work officers have exercised their 11. Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12. Roof repairs insurance required.]t c. 152, §1(4),and we have no - employees. [No workers'. 13. Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: �-r"'t 1 I Policy#or Self-ins.Lic.#: - l3/ 6 Expiration Date: C7/p Job Site Address: n— 1_0d )&e1 l City/State/Zip:. ykk w�f j 14A Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.. Signature Date: - /9 Phone# Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# f 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#: . . The Town of Barnstable 'AM Department of Health Safety and Environmental Services " Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner SHED REGISTRATION 0 C-I e—, cao(- A,. 0 0A Location of shed(addreSW 001 � 02c� Property owner's name Telephone number Size of Shed Map/Parcel# Signature Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? q Conservation Commission(signature required) THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg BUYER: Serroni �1©.00 Q to *55 f t o.:30 Advantage Hortpape Corp. AANND IITTS(M E INSURERS. -� MORTGAGE INSPECTION PLAN IN I CERTIFY THAT THE BUILDINGS SHOWN DO( M TO SETBACK REQUIREMENTS �T� I.E. SID(FRONT. E, A REAR SETBACX ONL»OF Bars e C �1 L.I_ MTTLLEE W WAP�OR�ON E)CE7, UNLEPT SS 07HHERVASE NOTED.ENFORCEMENT ACTION UNDER MASS c.L WSACHUSEM I FURTHER CERTIFY THAT TH OD IS PROPERTY IS Not LOCATED IN THE ESTABLISHED FLOW HAZARD AREA OOMMUNITY PANEL NO.: 250001 0015C DATE: A_19-85 DEED THIS COMPANY IS NOT RESPONSIBLE FOR ANY INDENTURES MADE SUBSEQUENT TO THE RECORDED BOOK DATE OF THE LATEST DEED OF RECORD. PACZ WHENEVER BUILDINGS ARE SHOWN LESS THAN ONE FOOT FROM THE PROPERTY UNE IT IS ADVISED CERT. NO. jT�HAATTAA MORE PRECISE SURVEY BE MADE TO VERIFY THESE M TFUS CERTIFICATION IS BASED ON THE LOCATION OF SURVEY M , �'• DOES NOT PLAN BK. ��3 PACE 13� REPSENT A PROPERTY SURVEY. VERIFICATION OF SURVEY MA��R AS SHOWN, MAY W ATO PUSIFD ONLY BY AN ACCURATE,INSTRUMENT lR, T DEPICTED PLAN / DATED T%i RTIFICATION TO BE USED FOR MORTGA RPOSES ONL SE:-PT S 90� OFFSETS AS SHOWN ARE NOT JAMES W. : USED FOR THE ESTABLISHMENT OF PROM BtgNCB)LIKAB ^� B RA D FO R D ENGINEERING CO. ty � •� P.O. BOX 1244 HAVERHILL MA. OIB31 I -JAMFS W. BOUGIOUKAS R.L.S. #9529 TES (WO)373-2396 Engineering Dept. (3rd floor) Map 0 Parcel =a 26 Permit# House# •` ff S Date Issued 4" aim Board of Health(3rd floor)(8:15 -9:30/1:00-4 36) f5 � 'Z c� Conservation-Office(4th floor)(8:30-9 30/1:00=2:00) - 24 6;4ai -� Planning Dept. (1st floor/School Admin. Bldg.) -----SEPTIC SYST BE Definitive Plan Approved by Planning Board 19 INSTALLED IN I CE t WITH ate. , ON EN AID® ` TOWN OF BARNSTAI w N I Et�UL ®NS ?� BuildingTermit Application Project Street Address S' �00/-u t sct f' Village ,�eP y 7e G`l _e Owner ��_ SP s-�0 Al/ Address S�S' 00ti e e a/ (/i — s Telephone `/�D O y' r Permit Request yeG✓ Wye_C& k "/ 7 �Gc LP g to/ e;!" 4©G Le —e g eC e,e / Al e.,v c6, m %.L o `i e e&^ cG First Floor squarefeet Second Floor square feet Construction Type Estimated Project Cost $ }2 Zoning District Ci Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family p' Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes allo On Old King's Highway ❑Yes Lki4o Basement Type: aFull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) Done ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name Telephone Number Address cZ-7�7 /j' 7` 41 ah, C License# 0 b",/Q �/ i 40 7` X1-1A Home Improvement Contractor# /Cr 65( Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 5+ Spate SIGNATUREO -L'� �,�,� DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) 3c FOR OFFICIAL USE ONLY _ PERMIT NO. DATE ISSUED, = - ; ; f. t }s MAP/PARCEL NO. ADDRESS VILLAGE -OWNER + DATE OF INSPECTION: FOUNDATION !' r FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH- FINAL E `, PLUMBING: ROUGH FINAL - 4 GAS: _ROUC r FINAL In FINAL BUILDING y I DATE CLOSED OUT r' ASSOCIATION PLAN NO. `. " I / ..BUYER: Serroni j• a \;©.o0 i d�563 `�7� Ct TO THE( Advantage xortpape Corp. -) MORTGAGE INSPECTION PLAN AND ITS MILE INSURERS. LOWED I CERTIFY THAT THE BUILDINGS SHOWN DO( )CONFORM TO SETBACK REQUIREMENTS CF- *y�. p� w I.E. (FRONT.SIDE, i REAR SETBACK ONLY)OF T B43 a e aw I`T�y iWHEN 1.L MILE W.CCHHOTED.OR MTER 40A. ARE ON MPT FROM VIOLATION 7,UNLESS OTHERWISE NOTED�ENT ACTION UNDER MASS C.L MMSACHUSETTS I FURTHER CERTIFY THAT THIS PROPERTY IS Net LOCATED IN THE ESTABLISHED FLDOO HAZARD AREA OOMMUNITY PANEL NO.: 250001 0015C DATE: 8-19-85 DEED THIS COMPANY IS NOT RESPONSIBLE FOR ANY INDENTURES MADE SUBSEQUENT TO THE RECORDED BOOK DATE OF THE LATEST DEED OF RECORD. PAGE WHENEVER BULLRINGS ARE SHOWN LESS THAN ONE FOOT FROM THE PROPERTY LINE IT IS ADVISED CERT. NO. jT�HQATT A MORE PRECISE SURVEY BE MADE TO VERIFY THESE M THIS CERTIFICATION IS BASED ON THE LOCATION OF SURVEY M DOES NOT PLAN BK. ��3 PACE 139 REP T A PROPERTY SURVEY. VERIFICATION OF SURVEY M AS SHOWN, ,pE Be ACOOMPUSHED ONLY BY AN ACCURATE.INSTRUMENT,c,, r T DEPICTED PLAN / DATED 'U tARTIFICA-poN TO BE USED FOR MORTGA t POSES ON SST S 9 OFFSETS AS SHOWN ARE NOT JAMES W. 1• 9C�, 1•�Zp, USED FOR THE ESTABLISHMENT OF PROe UKAS MA 529 B R/"►/� D FFO R D l 8 ENGINEERING C O. P.O.BOX 1244 �y( HAVENWLL MA.01831 JAMES W. BOUGIOUKAS R.L.S. #9529 TEL (50B) 373-2398 r The Town of Barnstable • anaesrAI= • mma Department of Health Safety and.Environmental Services ArFD �, Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner 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: ke6y eX e ', S1dlw5 `F 6",t*4, `9st.Cost 3 _T C' Address of Work: Owner's Name 1 Date of Permit Application: Z I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Date Owner's Name 4 I , ' t I I , I P,T. ho Cc.k I I E I ! r I i j i I { c g 13e.0 r"..T. ; I I ! I I ! � j ! � j i : i I j j I ! I !� j--► I i. - -i--- ,.. -- - _ - -- - - I-----I ------ -____-._ i ! , -- r 1 j l 11 I ` I r I I i I I I I I - I i I , , III � III I i � I i III ! II r I� The Cominottivealth of Massachusetts Department of Industrial Accidenn OJliceollttvestlgatloos 7 �,I�f .` , 6t/(/ 1 t'as/ria,gton Strcc�t Bostoi t.Alias. 02111 Workers' Compensation Insurance Affidavit Antilicitnt int rmatitim Ple•tse pR(NT'1�iblv"'"""""'"!"'—""'"" name. IOc:ttion-_ /'/!1✓t�G3f%11fX L<�GL P City ti T�P_e U l`r!�Q O 6' p 7 1 am a homeowner performing all work dmyself- I am a sole proprietor and have no one working= in any capacity [� I am an emplover providina�workers* compensation for my employees working on this job. emmonm•name- city- Phone f! imur-ince en. "ofir-to [] I an_ a Solt proprietor. ;eneral contractor,or homeowner(circle one)and have hired the contractors listed below who have the following worker compensation polices: camnam• name- atltlrrtc- city. nhnnc H• incur-incr rn. "Olin-a comninv nnmc- addresc- rite- nhnnc k• incurnnce co. n"fir-of Attach additicin21 sheet if necessary �n. Failure to sec ure eOveraec as required under Section 25A of NIGL 152 can lead to the imposition of criminal penalties of a lineup to SISOU.UU aadiur unc!cars'imprisonment as wolf as civil penalties in the form of a STOP NVORI:ORDER and a fine ofS100.00 a day against me. I understand that a COPY of this statement may he funvnrded to the Office of Investigations of The DIA for coverage-eritltation. 1 do It erchr cerrifj•under the pains and pen allies of pci jun•1/1at 1/1e information protvded above is true and correct. Sicnaturc�Otitr,&J l� J_� Dace Print name Phone* oj.� w official use univ do not write in this area to be completed by city or town otlicial • '' `( city or town:n: permit/license q Mudding Department CC3LIcensinr 13uard C3 check if immediate response is required �5cleetmen's Uffice C3tleallh Department contact pennn• phone q• nUther i. 41 information and Instructions Massachusetts General Laws chapter 152 section 25 requires all ern plovers to provide workers' compensation for th employees. As quoted from the "la��" •an enrpl(ree is defined as every person in the service of another under any contract of hire, express or implied. oral or written. An emplurer is defined as an individual. partnership, association. corporation or other legal entity. or any two or me the fore�goin�s 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. Howes er owner of a dwelling, house having not more than three apartments and .who resides therein,or the occupant of the dwelling_ house of another who employs persons to do maintenance, construction or repair work on such dwellingh: or on the 1_rounds or building appurtenant thereto shall not because of such employment be deemed to be an empioy MGL chapter 152 section 25 also states that even-state or local licensing agency shall withhold the issuance Of- renewal of a license or permit to operate a business or to construct buildings in the commom%'eaith 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 performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter been presented to the contracting authority. r ..... .fit• Applicants Please fill in tite workers' compensation affidavit completely, by checking the box that applies to your situation and Supplying company names_ address and phone numbers as all affidavits may be submitted to the Department of Industrial Accide»ts 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 requir: to obtain a workers compensation polio, please call the Department at the numb er listed below. City or towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. P1 be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returnee the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questic please do not hesitate to Live us a call. . .. Tile Department's address. telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents office of investigations 600 Washington Street Boston,Ma. 02111 � _ fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406. 409 or 375 M WIN a �DBPARTHBAP OI PUBLIC SDPBTY '5 hzt v h rt a•. t a,�' �COAS9'RUCTIOA SUPERVISOR LICEASE �f fk�,a{ EI 4S nAd,UObErF [A Bxpiresi` aBirt e A-1u �2 `kZ4 PUfHAA AVB1P0 BOX 1�3 P [� 471�"RQ 1�a* FgGLL.:�k � " r �,r RESIDENTIAL PROPERTY MAP NO. LOT NO. FIRE DISTRICT SUMMARY STREET 55 Donegal Circle Cpntprvillp LAND 6 Jr� 169 26 c_o 7 BLDGS. 0 OWNER TOTAL LAND RECORD OF TRANSFER DATE eK Pc LR.s. REMARKS: Lot H BLDGS. Of B TOTAL 'v •. a� LAND_ . .4 aC - Sheehan -26 71 149H 33 0,Bryan A. & Ellen M. lZE�' ovc 1 BLDGS. ' ` C TOTAL 7 LAND ' j :Oa63 BLDGS. I TOTAL LAND BLDGS. Q� TOTAL ttI LAND i BLDGS. _ TOTAL i - i LAND 1 BLDGS. m TOTAL - - 'LAND INTERIOR INSPECTED:INSPECTED: BLDGS.� , �-Ceit-�� 01 - DATE: TOTAL LAND ACREAGE COMPUTATIONS BLDGS. r LAND TYPE # OF ACRES PRICE TOTAL DEPR. VALUE TOTAL 'OUSE LOT S�/O I D to�/� .� (o U LAND �I LEARED FRONT BLDGS. REAR TOTAL /OODS 8 SPROUT FRONT LAND 1 REAR BLDGS.TOTAL f /ASTE FRONT REAR LAND i BLDGS. I TOTAL ' LAND BLDGS. LOT COMPUTATIONS LAND FACTORS TOTAL FRONT DEPTH STREET PRICE DEPTH% FRONT FT.PRICE TOTAL DEPR. COR. INF. VALUE HILLY TOWN SEWER LAND ROUGH TOWN WATER BLDGS. HIGH GRAVEL RD. TOTAL LOW DIRT RD. LAND SWAMPY NO RD. O BLDGS. - TOTAL ' - TOWN OF BARNSTABL_E:MASS UNITED APPRAISAL CO., EAST HARTFORD,CONN. —J FOUNDATION I BSMT. & ATTIC PLUMBING PRICINCo y' F_LANn`cosr 1 'Cone.Walls' 'Fin:BsmY.Area' "O, Bath Room - - �. .Base.- - '.`.-r.'�.5`y_ 7,_ ` BLn"G.COST - - - - -- - - Cone. Blk.Walls Bsmt..Rec.Room St. Shower Bath Bsmt. pURCH:DATE /97/ Slab - BsmtEFI. arage St.Shower Ext. Walls PORCH.PRICE• .3- Conc. Or o Brick Walls Attic &Stairs Toilet Room Roof RENT Stone Walls Fin.Attic Two Fixt.Bath Floors - Pier< INTERIOR FINISH Lavatory Extra o� + 3 Jr Bsmt. F / 1 2 3 1 Sink Attic s� r�= y, Plaster Water Clo.Extra EXTERIOR WALLS Knotty Pine Water Only Double Siding Plywood No Plumbing Bsmt.Fin. Single Siding Plasterboard Int.Firi. We ,Shingles 2j' / TILING 6-4rY- 3 2- Conc.Blk. G F P Bath Ff. Heat 4- 7 7 Q Face Brk.On Int.Layout Bath Ff.&Wains. Auto Ht.Unit --if- .22 Veneer Int.Cond. Bath FI.&Walls Fireplace g S Com. Brk.On HEATING Toilet Rm.FL 27 g 78 ?$ Plumbing Solid Com_Brk_ Hot Air Toilet Rm.Ff.&Weans. + 3 Tiling Steam Toilet Rm.Ff.&Wells Blanket Ins. / Hot Water ;A i St.Shower /g' r• Roof Ins. Air•Cond. Tub Area Total Floor Furn. ROOFING COMPUTATIONS I-Asph.Shingle Pipeless Furn. S.F. t_Wood Shingle No Heat S.F. / - 7 Asbs.Shingle Oil Burner S.F. Slate Coal Stoker S.F. Tile Gas i S F OUTBUILDINGS i ROOF TYPE Electric 1 2 3 4 5 6 718 9 10 1 2 3 4 5161 7 819110 MEASURI {l Gable Flat S.F. Hip Mansard FIREPLACES -S.F. PierFaund. Floor -.0 Gambrel Fireplace Stack / Wall Found. 0.H.Door LISTED FLOORS, Fireplace / Sgle.Sdg. Roll Roofing _ Conc. LIGHTIN Dble.$dg. Shingle Roof L' Earth No'Elect. DATE Shingle Walls Plumbing- �.-_Pine Cement Blk. Electric Hardwood ROOMS Brick lot.Finish. PRI EC Asph.Tile Bsmt. 1st�•f TOTAL)3 1-2 Single 2nd 3rd FACTOR s 7 G 3 _ REPLACEMENT 7.7 OCCUPANCY CONSTRUCTION SIZE AREA CLASS AGE REMOD. COND. REPL. VAL. Phy.Dep. PHYS. VALUE Funct.Dep• ACTUAL VAL. DwLG. %. EA M. +� f sue. Z �9�� - G ;L 17033 oSo .:2• - .' - 3 4 5 . 6 710, TOTAL . [ ] [R169 026 . ] LOC] 0055 DONEGAL CIRCLE CTY] 10 TDS] 300 CO KEY] 95122 ----MAILING ADDRESS------- PCA11011 PCS100 YR100 PARENT] 0 SHEEHAN, ELLEN M MAP] AREA] 3 6AC JV] MTG] 0 0 0 0 15 VILLA DRIVE SP1] SP21 SP31 UT11 UT21 . 34 SQ FT] 878 FOXBORO MA 02035 AYB11970 EYB11971 OBS] CONST] 0000 LAND 26800 IMP 45700 OTHER ----LEGAL DESCRIPTION---- TRUE MKT 72500 REA CLASSIFIED #LAND 1 26, 800 ASD LND 26800 ASD IMP 45700 ASD OTH #BLDG (S) -CARD-1 1 45, 700 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE #PL 55 DONEGAL CIRCLE CENT TAX EXEMPT #DL LOT 8 RESIDENT' L 72500 72500 72500 #RR 0449 0110 OPEN SPACE #CL 41C COMMERCIAL *LIFE ESTATE SHEEHAN, ELLEN INDUSTRIAL EXEMPTIONS SALE] 05/96 PRICE] 1 ORB] 10203257 AFD] I A LAST ACTIVITY107/30/96 PCR] Y i R169 026 . A P P R A I S A L D A T A KEY 95122 SHEEHAN, ELLEN M LAND BLD/FEATURES BUILDINGS NUMBER ZN/FL=RC 26, 800 45, 700 1 A-COST 72, 500 B-MKT 60, 100 BY 00/ BY /00 C-INCOME PCA=1011 PCS=00 SIZE= 878 JUST-VAL 72, 500 LEV=300 CONST-C 0 ----COMPARISON TO CONTROL AREA 36AC -- TREND EXCEEDS STANDARD { NEIGHBORHOOD 36AC CENTERVILLE PARCEL CONTROL AREA TREND STANDARD 101 10 LAND-TYPE 268001 LAND-MEAN +00 725001 76734 IMPROVED-MEAN -400-. 200 ] FRONT-FT ] 100 DEPTH/ACRES TABLE 02 1000] LOCATION-ADJ APPLY-VAL-STAT 1 LNR] LAND LFT/IMP] ADJS/SB/FEAT STR] STRUCTURE ARR]AREA-MEASUREMENTS NOR] NOTES COM] MARKET INC] INCOME PMR] PERMITS GRR] GRAPHIC FUNCTION- [ ] STRUCTURE-CARD NO- [0 0 0] DATA- [ ] XMT [?] r�_. 'ROPERTY ADDRESS ZONING (DISTRICT CODE SP-DISTS.I DATE PRINTED I CSTATE LASS I PCS I NBHD KEY No. 0055 DONEGAL CIRCLE 10 RC 300 1000 07/09/95 1011 00 3 A LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS T Land By/Date Sze Dimension Y UNIT 'ADJ'D.UNIT ACRES/UNITS S/UNITS VALUE Description SHEEHAN,,. ELLEN-M $ MAP— CD. FF.DeINAces LOC./YR.SPEC.CLASS ADJ. COND. PE PRICE PRICE #LAND 1 26,800 CARDS IN ACCOUNT — 10 18LDG.SIT.1 XI .3 . =10 197 39999.9 78799.99 .34 26300 #BLDG(S)—CARD-1 1 45,700 01 OF 01 a #PL 55 DONEGAL CIRCLE CENT OST 72500 4 BATHS 1 .0 U X C 100 3500.0 3500.00 1.00 3500 3 #DL LOT 8 ARKET 60100 1 FIREPLACE U X C= 100 3100.OQ 3100.00 1.00 3100 8 #RR 0449 0110 INCOME A #CL 41C JSE p I ,Q±* .I-FE:_E"S7ATE"SHEEHAN�E:LLE.N PPRAISED VALUE J #TAB 500.00 A 72,500 N U #FAB 143.02 ARCEL SUMMARY S AND 26800 T LDGS 45700 M —IMPS _ E OTAL 72500 N CNST DEED REFERENC Type DATE RecordedPRIOR YEAR VALUE i T Book Page Inst' MO. Vr.D Sales Pi- LAND 26800 S 74081059: Ip1 /91 A 1 BLDGS 4570C 1498/33 ®0/00 TOTAL 72500 3 t t BUILDING PERMIT 7 Number Date Type Amount LAND LAND—ADJ INCOME SE SP—BLDS FEATURES BLD—ADJS UNITS 26800 6600 Class Cons,. Total Base Rate Ad'.Rate Year Built A Norm, Obsv. Units Units 1 A 1 Age Dept. Cond. CND Loc %FIG RePI Co.,New Adi Rep[ Value Stories Meigl,t Rooms Rms Balls a fis. Pariywall Fat. OiC 000 100 100 61.00 61.00 70 71 23 76 100 76 60158 45700 1.0 4, 2 1.0 4.0 Descrip,ion Rate Square Feet Rept.Cost MKT.INDEX: 1.DO IMP.BY/DATE: __/ SCALEz /01.00 ELEMENTS CODE CONSTRUCTION DETAIL BAS 100 61.00 878 53558 RE S[ INGLE;: FA'MILYDWELLING� GIST GP.00 *--------------32--------------* TYLE 03 ANCH 0.0 �i; ! ! ESIGN ADJMT 00 ------------------0.0 --------------- --- ') � ; X7ER.WALLS O1 OOD_FRAM_E_-------0.0 E AT/AC TYPE 02 AS 0.0 -- ---------- 0------------ - - ! NTER.FINISH D0 .0 NTER.LAYOUT 01 .----------------- 0_0 J N TER._+3 UAlTY 02 AME AS EXTER. D.D j LOOR STRUCT -00 ---------------- - 0_0 \ D W 27 BASE 28 E LOOR COVER- -t06 -------------------C.0 - C C Total Areas Aux Base 878 ! " ! 0_Of _T_?0- ---- �6------------------- BUILDING DIMENSIONS !. L E C_T R I C A L D0 Q.0 A SAS N01 � W18 N27 E32 S28 W14 .. ! ! OUNDATION-_.- Q0 -----------------99.9 ! -------------- {--- ---------------------- ! ! NEI6H80RH1100D 36AC CENTERVILLE L ! ! LAND TOTAL MARKET PARCEL 26800 72500 *--------18-------X—_—_--14-----* AREA 2824 VARIANCE +0 +2467 STANDARD 20 QyOFTNETp�Y TOWN OF BA.RNSTABLE Z BAHH MLE, i mum BUILDING INSPECTOR APPLICATION FOR PERMIT TO ..� 1. .... TYPE OF CONSTRUCTION .,- � �� .. ��I ►.� �j, ................1...�/................19.74 -.r TO THE INSPECTOR OF BUILDINGS: The undersigned herby applies for a permit according to the following information: l.... Location .hd.. ..... ,p... (,eC. .............. . .. ........^..... Proposed Use ' ............................... Zoning District ..;! Fire District ... .. ..�.... Name of Owner .. �t.� . ... r,�CE f�li.....Address �....1..�...(!Xd.•....I 1 . +... 1' �...... Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... ccyy or Number of Rooms ............`.. ...............................Foundation Zd....... �.�/ '!. Exterior .W`�Et ...... '( ......�� s.rls� Roofing .......... .. .................................................................... Floors ........................................................................Interior .....2_....��^ - .... ............................... Heating !�;... 11.4.T.....!'.0..tar T G�........Plumbing C.................................................... .............. Fireplace ........ ......................................................................Approximate Cost ........q".6.q.(2........ .... .......................... Difinitive Plan Approved by Planning Board ________________________________19________ . �. Diagram of Lot and Building with Dimensions Fe le 7 10 I=1-4 � �� � CL d = 1-- f- .w t � ® Q � J to Q � a as L Q m > I- � _ ! I~ LU ¢.Q tt ( ,/ �•Z � 1, W CIO cn w �z D 10 AJ Cl hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . ... �l✓a�.. �':.�!./..� ... Dac -, VJi][Limn E. Jk° \ - ,� �- -��10 � ,~ ` ^ No —. . permit for build one . � ^ — � Location - ' ------~~-~~~~^^^-~~------------' OwnerWilliam .IC°- ..Jr_________ Type of- Construction ~ ~ ............................ * ----------.. ---------------'' 1Z� ~ Plot ----_---_. Lot ---��------. � ' ' . �i Permit Granted — ....Q�toba� ~----.]V yO -~J� u° ���� � Date of Inspection .�����.—.�'���---.l9� ~� Dote Completed -------------lg ' � � PERMIT REFUSED -----_--------------.. 19 � --------^-----~—''...---------' | -------.----------.--------. ^^J �j —.--.----------------------. ---------'~----'—^'--^^--^---^' � Approved .................................................. lA --------.----.---------.---. ' � -------.---------------..—.,.