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At tt -o'.: q11 �,, �' 'A' i1, alr„` 4 y a 1 u` ,�, « s, s',A p, P, q ^A, + +hG A n.,:,o AI oa�' A '1 � ,'�, P� } '.I�'. r> 6 'r` t ,e1,`,1 hx a,+, .} d dAl'' . r'} ,9 J y. 4Yi 't " c FRIy�#F `� v fl v V�„ <A11 : ,d'^ Fi''.' ' #°.! � V 1 ,. .zl > ,,+ x_. .Y , ♦ ..< .. h .,...,., .. �'•A V ...Ir�,. .l°� Y 7 A. , +,tl.. ,W ,•, � �_ —. .I —�„ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map t" Parcel " Application pp I Health Division ' Date Issued co Conservation Division Application Fee Planning Dept. Permit Fee c r Date Definitive Plan Approved by Planning Board b/13 Historic - OKH Preservation / Hyannis Project Street Address `1 1 Village Owner �U�yc-c� Address Q(� Telephone `6 Perm,Request S��( c� 3 L �DhO� ►o Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# -:nits) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway o❑YE4 ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other a.m C> Basement Finished Area(sq.ft.) Basement Unfinished Area(scj ) Number of Baths: Full: existing new Half: existing newer Number of Bedrooms: existing —new Total Room Count (not including bath-,): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# _ Current Use Proposed Use APPLICANT INFORMATION \_ \ (BUILDER OR HOMEOWNER) Name ! �X��`� �� S� �l Telephone Number Address �(�/`�� �- License # Home Improvement Contractor# Worker's Compensation # ':�i 5 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT �WILL 12BE'TAKEN TO SIGNATURE DATE !F'h d/ 7 FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. P f ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION. l FRAME INSULATION f FIREPLACE i ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Print For=m , Department of Industrial Accidents Office of Investigations k 1 Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Rebello Construction Address: 24 James Birch Lane City/State/Zip: Swansea, MA 02777 Phone#: (508) 567 -4109 Are you an employer?Check the appropriate box: Type of project(required): 1.21 1 am a employer with 9 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.: 9. Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.ElI am a homeowner doing all work officers have exercised their I LEJ Plumbing repairs or additions No workers myself. ' com right of exemption per MGL y [ p• 12.❑ Roof repairs •` - insurance required.]T e. 152, §1(4),and we have no weatherization-ReSic�l employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. ' Homeowners who submit this affidavit'indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. >Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. /am tin employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Liberty Mutual Ins.Co. Policy#or Self-ins. Lic.#: WC5-31 S-362857-022 Expiration Date: 07/27/ 13 Job Site Address: C�,a &-�` 1n RA City/State/Zip: p fxpn6 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 tine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u d ie p ins and enalties o erjury that the information provided above is true and correct �... Signature: __. _._ ._..__.. _.__-. _. _._ Date S �3 Phone#: (508) 567-4109 Offrcitil use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Persom Phone#: :7R!<Lrr.-Nr vsevn�+'r:rlA✓:a� tCrz>�rrJt�r>�7„' +�..Office or Cons--Affairs&Business Regulation License or registration vatid for indisridul use only $ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: D Office.of Consumer Affairs and Business Regulation z �2egistration 170375 .„ Type: 10 Park Plaza-Suite 5.170 Expiration 10t1413013.- Supplement Card Boston,MA 021.16 RE13ELLO CONSTRUCTION-IIdC'.- „ t. x_ DAVID HERBERT x e---"- 24 JAMES BIRCH LN r ..._7._ .. ..._.......... SWANSEA.MA 02777 _.... IinAcrcecretary at valid without signature �'M-sachus,elts-Departmer:t of Pu6lie Safety, .Board cif Buildin Re ulations'�antandards 9` d S . _9 � t"zna`trucEiun Sii,pc„rct++sr Lseense:CS-056216 DAVIDJHEBERT \ 247 CENTRAL AVE Nex Bedfurd'vIA 427�; Expiration Connnussioner 101242014:: 1 REBEL-2 OP ID:MA CERTIFICATE OF LIABILITY INSURANCE DATE(MMD°"""' 05/29/2013 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 INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Partners Ins.Mizher Division Phone:508-675-0308 NAME; Maria Arruda 560 Wilbur Ave. Fax:508-675-3006 .,C No El:508-491-3176 Ali No:508-491-3108 Swansea,MA 02777 E-MAIL Kristine Rodrigues-Swansea ADDRESS:marruda@partnersinsgrpllc.com INSURER(S)AFFORDING COVERAGE - NAIC# INSURER A:Safety Insurance Co. 33618 INSURED Rebello Construction Inc. - •Carl J.Rebello wsuRER B:Liberty Mutual Ins.Co. 24 James Birch Lane INSURERC:NGM Insurance Company 14788 Swansea,MA 02777 INSURERD: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSIRLTR TYPE OF INSURANCE ODL UBR POLICY NUMBER MM/DDPOLICY/YYYY MM DD/YYYY - LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 C COMMERCIAL GENERAL LIABILITY MPT4696E - 05/02/2013 05/02/2014- PREMISES(Ea occurrence) $ 500,000 CLAIMS-MADE OCCUR MED EXP(Any one person) $ 10,00 X BUSIneSS Owners PERSONAL&ADV INJURY $ 1,000,000 y GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT JCjAPPLIESPER: PRODUCTS-COMP/OPAGG $ _2,000,000 POLICY PRO LOC $ AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT Ea accident $ A ANY AUTO 6206368 05126/2013 05/26/2014 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED - - AUTOS IX AUTOS BODILYINJURY(Peraccident) $ 1,000,000 XHIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ UMBRELLA LAB H OCCUR- EACH OCCURRENCE $ 1,000,000 C EXCESS LAB CLAIMS-MADE CUT4696E 05/02/2013 05/02/2014 AGGREGATE $ 1,000,000 DED I X I RETENTION$ 10,000 • - $ WORKERS COMPENSATION - WC STATU- OTH- AND EMPLOYERS'LIABILITY TCRY LIMITS ER B ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N WC5-31S-362857-022- 07/27/2012 07/27/2013 E.L.EACH ACCIDENT.- $ 500,000 OFFICER/MEMBER EXCLUDED? Fy under NIA If yes,describe und - E.L. (Mandatory in - .L.DISEASE-EA EMPLOYEE $ 500,000 - DESCRIPTION OF OPERATIONS below - E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE INSUREDS RECORDS THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED/REPRESENTATIVE I ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25,21101051 The ACORD name and logo are registered marks of ACORD f � o 'Town of Barnstable` Re io e rv�i�ce rYS s � Thomas F.Geier,Director Building DiPision Tom Perry, ommissioner:: Euldmg'C... . 200 Mffin:Sfree Hyaz�is;.MA 0260:I _ www.town.harnsta&e maul Office: 508-862-4038 Fag: 508-790-6230 Property Owner Must' . Complete and Sign This Section If UsW A Builder i \ , as owner of the object gropeztp liereb autb.orsze to act on my behalf is all matters rel ttire to work anthotized by this binlding b r�,t (Andres of Job) Pool fences and alarms are the responsibility,of the applicant. Pools are not to be filled or utirt zed before fence is-installed and all'Eml ' inspections are performed and accepted. S e o er ' Signat re of Applicant Print Name Print Name' Date wy QFORMS:OWNERPERMISSIONPOOIS'62012 The Town of Barnstable oP Permit#_ S Massachusetts aRNernstL : Date X:31%Ae 1g6 SOLID FUEL STOVE PERMIT F This constitutes an official stove permit after inspection and approval by the building inspecto: OwnerO 1A �I - `0 I�Ifev Telephone no. 0 4YJ30 Address of Property, EN S(2,m �� Village CA W� Location and Stove Type &R-D(Acp- — Te=wp� ;b m4 , Date: Building Inspector L , Aj;sor s map and lot number ..1:. e�f�.%...:...:............ ..... Swage. Permit number ............qg..� .3'�.>._7................. 1C Z BARISTAME, i 11��//c. INSTALLED IN C 'ALIST ® ° rASa Huse number. ................... ..........................................+r'....... !hd ��Il+IPLIAIVC q° i639 WITH TITL � AND 5 a war a ,n TOWN. OF 'BAR = r E DE "?. _. � � r L.ATIONS BUILDING' 1NSPECT0 APPLICATION FOR PERMIT TO ':.:.........::. ` ::®.l�J....../.. ......................... ..... . TYPE OF CONSTRUCTION .................................5. .......... ...�f` ............. .......................... ` ...............19a..� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ............................ i'••( •..........[..-••Cll. i!v........ ... . . U�e.. Proposed Use ............. ... ............. - Y� Zoning District ........................................................................Fire District ............ �.. ............... Name of Owner .....� ............ Address ........Pox,... [: ................................... Nameof Builder' ...................... '.. ...........................Address .................................................................................... Name of Architect ..................................................................Address Number of Rooms �... r— ...............IV.........................................foundation ........ ....�. � • Exterior ........... , '` ! ...... .... '4.. ................Roofing ,? . ./iYP�- `. .. ..... Floors 1........... (. . . ..............Interior ..................... $r L� .. .. Heating ................. ..C9i¢ .......:..............Plumbing ................P--;,� '� a�,�``", ....... ....0 ........ p /..'� :5.4 ............Approximate Cost �.................................... Fireplace . Definitive Plan Approved by Planning' Board ----------- _----> G__�_____19,74----. Area .............'TO.�................. Diagram of Lot and Building with Dimensions / l 9 g Fl aalt,5 Fee .....". ILI,................................ SUBJECT TO APPROVAL OF BOARD OF HEALTH --�0, ►V� ' �p ov `i-e OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the TownJBIeclinregar bove construction. Name ..... ...... . ..... ........................ GREENBRIER CORP. 2A 2 0 11� 112- Story ................. Permit for .................................... Single Family Dwelling ....................................................—11...................... Locati c� Lot #10 92 Ensign ........................................... Centerville ................Greenbrier C........................................orp........................ Owner .................................................. Type of Construction- Frame..................... ................................................................................ plot .............. ............... Lot. ................................ July 12, 82 ;Permit9 Grant ................................ .......1 `D6te a ....... 19 .. ......... 'Date Completed ...... -1 9Fa~ r' - 41 3t . >^ y L a r - f TO r 22� w\\ J, .. w 4 �,F ," 3� � J.V \k E N -K m t, ��• � � �o duo � �00r/Nr.v GcriDT?1 Fs8 = 30 s 62 = /o' a _ 7,? f� T NOfM, � CERTIFIED PLOT PLAN reoBe�T cya I_a 7- 10 e n/s i NEW CONSTRUCTION ONLY i - TOP OF FOUNDATION. ISM FEET IN ABOVE LOW POINT OF ADJACENT �ST� o� ,�,�'�J�� '�,� 1 L� • ROAD. ND sum SCALE. / "= 4:? DATE : J01-y9,Ilea LDREDGE ENGINE£ ING CO.IN CREB9✓Bk1E=R I CERTIFY THAT THE CLIENT EGISTER ED REGISTERED LAND SHOWN ON THIS PLAN IS LOCATED CIVIL JOB NO. ON THE GROUND AS INDICATED AND ENGI�agER SURVEYOR DR.BYE A.A. - CONFORMS TO THE ZONING LAWS OF BARNSTABL , MASS. rPSWW 712 MAIN STREET CH.BYl !" HYANNIS, MASS. % � 82 � SHEET_LOF �� TE REG. L ND SURVEYOR TOWN OF BARNSTABLE Permit No. 2�201 _ Building Inspector Cash _--___--- Yaa OCCUPANCY .PERMIT Bond ---- V,_ I , "No building nor structure shall be erected;and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building-Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector."{ Issued to Greenbrier Corp. Address Box 5101f Cenntervi"21e lot #10 92 Ensign Road, Cen.texville f � Wiring Inspector `�/' ;^ ' Inspection date Plumbing mspecto �' t• Inspection date Gas Inspector 0Wei it �� � 1,,,.�.'ter-. 13 Inspection date ' f Engineering Department L¢'7�'/per Inspection date" Z l THIS PERMIT WILL-NOT BE VALID,'' AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. . .� :_........................ 19.......�.' .............................Building ..Inspeetor __........._.._._... Assessors map and lot number THE Sewage Permit number ............ 1 ................. 33AUS'TAMIL House number ................... ...f7....... .clf-4_6 9 MAGIL t639. 0 11110 TOWN . OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ................ ...Q`OV.-5�... ........ ................... TYPEOF CONSTRUCTION ................................................................... ....................�.r ............ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ........................... ........... I I? � .................. ..................................... Proposed Use .............. ...................... ............. . X, ................. I................. ........................................................... ZoningDistrict ........................................................................Fire District .................. ................... Name of Owner...... ......!2jW<.//).Address....... ............... ................................................................ Nameof Builder" ................... .................... .....Address .......................................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ..................... Foundation .......... ......................................... Exterior ............... ......4 ........(2-.1„ �. ...Roofing 4 45....................... ...................... . Floors .................. ........0- .. .........Interior ....................... ...................... ... Heating ................ ......................Plumbing ................ ................................ ....................... C) Fireplace .............................. ....................Approximate'Cost 0 L ............................................ Definitive Plan Approved by Planning Board ----------------ne, 1 19 ,7/----. Area .......................................... Diagram of Lot and Building with Dimensions (/z Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regard i ng,t6-a'bove construction. 01/ ,001�9 Name ........................................ .......................................... GREENBRIER CORP. A=147-59 '420P 2 Story No ................. Permit for .................................... Single Family Dwelling ............................................................................... Lot #10 92 Ensign Road .Location ................................................................ Centerville ............................................................................... Greenbrier Corp. Owner .................................................................. Frame Type of Construction .......................................... ................................................................................ Plot ............................ Lot ................................ July 12, 82 Permit Granted ........................................19 Date of Inspection Date Completed ......................................19 ` 'Engineering Dept. (3rd floor) Map': -14 4 Parcel05'9 91L Permit# '1 3 5-7- -s House# QZ ALOL Date Issued 9� J? Board of Health(3rd floor)-(8:15 -9:30/1:00-4:30)-gF, `3 Fee �25,o<o - Conservation Office(4th floor)(8:30e- 9:30/ 1:00 2:00) SEPTIC SYSTEM DUST bE Planning Dept.(1st floor/School Admin. Bldg.) INSTALLED LiANCE Definitive Plan Approved by Planning Board 19 ENV[RON e ®E AND TOWN OF BARNSTABLE ® � ONS Building Permit Application Project Street Address aV s1 qlu c. Village cg-A a T Zyl f a uest #ia Owner K4,V J&)' 7.. . (5 MAJI-ey Address 9� FAN&N IT. Telephone L O _ f Permit //ZNb!`LSd�C �-IZ(5o `�JCfU� J �C�'jlif t%f First Floor . square feet Second Floor square feet Construction Type Estimated Project Cost $ � �®00 Zoning District Flood Plain Water Protection Lot Size �.D l AG,?�S Grandfathered El Yes ❑No Dwelling Type: Single Family d Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes �10 On Old King's Highway ❑Yes @6 o Basement Type: Of ull ❑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 Z New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: &Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes &<O Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) " ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# - Current Use Proposed Use Builder Information Name O_ZO Telephone Number ` 3 7 ?6 Address License# Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE SITE PLAN AS BUILT) SHOWING EXISTING AS WELL AS Ar ( T) , PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 6 BUILDING PERMIT DE_N FOIE HE L WING REASON(S) k 14, w I FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE; -OWNER .e 1 � tr y DATE OF INSPECTION: n_ 7 FOUNDATION FRAME INSULATION FIREPLACE - ELECTRICAL: ROUGH ;` FINAL ' r^ PLUMBING: `',N ~"TR0 LIN H FINAL s_n �1 a•• GAS: OUDH -__ FINAL FINAL BUILDI ("� c DATE CLOSEI?QJITM 4*"� ASSOCIATIONxP_LAN NOz : t x,Z �VI AGE INSPECTION PLAN. s 69z. sv CENTURY MLMGINEEIUNGR`�tiR V a TELEPHONE(617)861-0789 Ri fcnFRal HAME 1 aaN_IAORTt:a 5� ,rnRP _ . . .. m ,lid m 1 hereby state that In rrry profeselonal opin- N Ion the permanent structures are approxi- W Metal located on the ground as shown. L n That they silhpr conformed to the setback t Id (dimensional as cis) requirements of the -n WA caning ordinances in effect at the time ;U of construction,or are ammpt from violetlon N < 1-13 enforcement actin under M.G.L.Title VII, c`a n Chapter 40A,80000 7,and that Thera are 't � H no encroachments of major improvements (p -n 2114 , across property lines swept as shown and a' noted hereon. 3b _ SNI r5.4 1 further state that according to Federal �.�y N Efforgency management Agency map..the �3\J major lawrovemards on this pnoperly fall In an C� 103 area named as Zane__ Cff ,Mrdly Panel Wo.: yh()00 Q 5 C �S � t0 Eflacthm tame: �` JdQ Note:Zone C is areas of minimal flooding(no chadinW. This designation Is not based on an h' elevatfon oertiticate. � `'� NOTE:Thle Is sot a boundary or We Insur- epos survey. Property Line Information are �c O' Wen from deed dekWpftn proWded.by cYerrL a ' 1 enters are rrksde as�o the or No uar aaooaaxxaarc�yy O iMO such desorption. Ihls plan was prepared In somrdance witir the procedural and technical ' standards for mortgage loan Inspections es Zy� Qd. adopted by the Massachusetts boatd of mgWbw i fop of professtonel engineers and land survey- gyp, ors,250 CAR 8A6,atd use for any other put- �S �■ goes is prohPblted. This plan Is not to be used to noording,prepad deed descriptlore ct,ere - 9 $S. In fences or on of any Mnd. vinl "u4 oic s�' s ldtl 0 SAND a V. c a iMOSSAVAT N #37663 APMCANT;K,F •I_V j-. QUA I.Y SCALE: r = 60' DAIS: MAR 21, 1996 LOCATION: 22 ENSIGN ROAD, CENTERVILLE, MA DEED: 6638/236 FILE A 104465 PLAN: 293/28 ' a A cn pn x o aC� a ND OD 7 o T' A ' �(WLTOls� Zx ®" *&L P� A* wicy Meter o�z exce6 AeAd otfb codcj, Fo-tA�s /'deep x 13 CONKRdC 266� �z fly oveL Peck Uroly 4 its-bF . r � � New SO- bV. 55 \ 51.2 7-1 }� 33.7 7-10 l X 28.4 ` �' r 57 5.091 57. 4' 7Q, ; ' ,40':5 � 40.6 •.r .J 1 60 \/ }/3�1 6L 11-9 iz tip_ ,i ��-,� _ _ �, _� _ _. `- ,-,• .� 37 -8 r; 7hr Coltr»roltmcalllt of- ., fascaclluscfft• Dt'ftUrflttC'lll Of IlIdiarrial Accidents • - '� \- � O�cEol/m�estlgatloas 1—+s" 6111111 ax1thigmin Srrccr Banvinn.Afaax (12111 _ ` Workers' Compensation Insurance AlTdavit • A ii jli ant mformatitin• -- Please pRiNT'1 •"'�'"^' `--� �amc. l�-P.0 iN �T �Nib (ley • a;'/Vs NY 7�D_ ' 1 am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity [� am an employer providing workers' compensation for m}Yemployees working on this job. entntinav name: atltires�• Clft" nhnne . incftrattce cn. nniict•a M I am a sole proprietor. pneral contractor. or homeowner(circle one)and have hired the contractors listed below who havl- the following workers' compensation polices: cnm tint• name• adtirosc• citt nhnnc 0! incffranrr rn nnlict•a i cnnt ant• anmc• afiflrC[t� 'Ift^ nhnnc ' nSurnnee co nnlie{' Ittachadditio_naishcetifneces_iary •• ;� , --r :••.. a ___ .N.. _ r« :•i.. ,..�..?�r. :�.M.� '•� aiiurc to secure curernec as required under Section 3A of AlGL 152 can lqd to the imposition of criminai penalties of a line up to S1300.00 and/or ne i cars' imprf%nnment ar tt•cil as cit•ii penalties in the form of a STOP WORT:ORDER and a fine of S100.00 a day against me. 1 understand that a OP).1)f titia,tatemcttt ma% be funt•arded to the 01111ce of Investigations of the DIA for coterape verifteation. do lierehr ccrr/ft•sear! the r! enalties ojpedurr Ilia,the injornsarion prot7ded above is true an .cv ^acvrf: Date - a� 'Tint name Phone 0 ofllcial use univ do nut write in this area to be completed by city or town ofrciai cin•or town: 11 .. itilicentse# rtlluiiding Department ❑Licensing Board L. check if immediate response is required Qseieetmen's office (311calth Department contact percftn• phoneft nOther��� •�. \� . ..l ..5 ..7}.i , ,..1_.. a.:rT.l.LYI•:li J}•i ..'•T f:. _f ti•A.+.9 �'.u"�l' tf 4:1',!. ! ,.�-" .J ll„,`.i,;; P Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers compensation f employers. As quoted from the "Jaw-.an cmrpinree is dcfincd as every person in the scrvicc of :trtother under contract of hire. express or implied. oral or wrinen. An rmplm•cr is dcfincd as an individual. partnership. association. corporation or other legal entity. or any two c the fore;,=oinks ena-aged in a joint enterprise,and including the legal representatives of a deceased employer, or tl recciver or trustee of an individual , partnership. association or other legal entity. employing employees. Hove- owner of a dwelling !loose haying not more than three apartments and who resides therein. or the occupant of th dwelling house of another who employs persons to do maintenance, construction or repair work on such dwclli: or oil the _wounds or building appurtenant thereto shall not because of such employment be deemed to be an em: MGL chapter 152 section =5 also states that eti-er}•state or local licensing agency shall withhold the issuance rcncwal of a license or permit to operate a business or to construct buildings in the commonwealth for un: applicant who has not produced acceptabie evidence of compliance with the insurance coverabc required. Additionally. neither the commonwealth nor an} 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 cltn. been presented to the contracting authority. inW- Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation supplying company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial �►ccidettts for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affid:wit should be returned to the city or town that the application for the permit or license is being requested. not tiie Department of Industrial Accidents. Should you have any questions regarding the "law"or if you are rec }•. please call the Department at the number listed below. to obtain a workers* compensation polic City or •ro wils Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottc the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding tite applicant. be sure to fill in the permitilicense number which will be used as a reference number. The affidavits may be retur. 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 que please do not hesitate to _give us a c:if. The Department's address. telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents ... Office of 1mresil9ations 600 Washington Street Boston,Ma. 02111 # fax . (6I7) 727-7749 ant fnn "7� The Town of Barnstable Department of Health Safety and Environmental Services _ Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissione. 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: rQ�W�e( Est.Cost J, Address of Work: "I)- F—AI501 RD Ca&EQ 4 f A v O .ner's Name Kgi&) T. :/ Date of Permit Application: �I I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. Oilding not owner-occupied wner 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 age of the owner. . ;.. � n Date Registration No. OR TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION P,Yease print. ... _ DATE 6 V JOB LOCATION rw l? Number Street address Section of town "HOMEOWNER" C(�U � ���.I - Name Home phone Work phone PRESENT MAILING ADDRESS City town State Zip cod: The current exemption for "homeowners" was extended to include owner-occup: dwellings of six units or less and to allow such homeowners to engage an is dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Persons) who owns a parcel of land on which he/she resides or intends to side, on which there is, or is intended to be, a one or two family dwellinc attached or detached structures accessory to such use and/or farm structurE A person who constructs more than one home in a two-year period shall not h considered a homeowner. Such "homeowner" shall submit to the Building Off= on a form acceptable to the Building Official, that he/she shall be responE for all such work performed under the building permit. (Section 109. 1. 1) The undersigned "homeowner" assumes responsibility for compliance with the Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requiremen- and that he/she will com jt procedures and requirements. HOMEOWNER'S SIGNATURE,"- APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be requires to comply with State Building Code Section 127. 0, Construction Control.