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"I'll, I ))- ,....,,,i .!�:.."": L� , , , ,�, " , �i,�i,��::",t-�,,�L-'��'-�,-,,����I��,�,,_,,,�,�-�,�l����"!�,',i�,�,i;, �/,�,�;h�, !�,�,,�,��,,, �, 1401 1 ,��, . , � _ . _ ._ ,� -- _4'�w_l "". .,I,Iyv�,,:'it�,,�,,.�,�it� i ���ildwasumn,� I .. , _i� "I'Ll'Al il"�" 1 ,. ����"':,�`! ,"'�', to' �, �';;;��,` , t R;w`1;3, I�hllll , p L & '�`r"y�3 F J.j Y 1La-� �� �' (i �•. fir, t Town of Barnstable Final Inspection Affidavit Pate:-. C7 Building Division 200 Main-Street Hyannis, MA 02601 RE: Insulation Permits Dear This affidavit is to certi y that II work ompleted at: Street: �, oGIL Village: has been inspec ed y a certified Building Performance Institute (BPI) Inspector. All work performed meets or exceeds federal and state requirements. Permit application umber: ?-177 '�RQD Issue dat Sincerely, a Francis Sheehan President Frontier Energy Solutions, Inc. 502 Harwich Road Brewster, MA 02631 Office: 774-237-0410 Email: fssfrontierenergy@gmail.com .` Town of Barnstable Building. Thss Card So�That�rt°is�Uis�ble[ om the,S reet A �'toyed;iPlans.Mus ,-:Retained on Job and-this, „ rd lVl'„ 'be Kept ,,,,, ,; - lAR3iSTABl.�. a r ,z ' ,. ( a •�, c c7` • * �bs e, nt�l anal 9nspectionNasyBeen Made ► here,a.Certifica a of Occu a�nc his Re"'"wired.suche.u�ldi shall Notbe®c'tu red-unto!asF�r>al Ans ect�ora>has been,made Per ana� , #. �,, per• Y.t. :. q �w ,. : ;. t?.� ,. < , ,p, � P Permit No. B-17-3242 Applicant Name: FRONTIER ENERGY SOLUTIONS Approvals Date Issued: 09/28/2017 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 03/28/2018 Foundation: Location: 20 EVELYN CIRCLE,CENTERVILLE Map/tot 187 062 003 Zoning District: RD-1 Sheathing: Owner on Record: TWENTY CIRCLE LLC �` x Cont actorNarneFRONTIER ENERGY SOLUTIONS Framing: 1 �� on#'ractor License Address: 650 PLYMOUTH ST SUITE 10 160854 2 EAST BRIDGEWATER, MA 02333 x � Est P�roiect Cost: $.2,200.00 Chimney: Description: . WEATHERIZATION T Permit Fee: $85.U0 � �� Insulation: Fee Paid:? $85.00 Project Review Req: . } &Date 9/28/2017 final: frr �a iL Plumbing/Gas Rough Plumbing: N final Plumbing: This permit shall be deemed abandoned and invalid unless the work au hoiiedby 31s permit is commenced within s1z�nchs after jssuance. Rough Gas: All work authorized by this permit shall conform to the approved appllcatlon n tr approved construction documents for wh ch th permit has been granted. . Final Gas: All construction,alterations and changes of use of any building and structu es hall be incompliance with the local zoningby Laws and codes. This permit shall be displayed in a location clearly visible from access�s& et<or road and shall be maintained open for public mspettlon for the entire duration of the work until the completion of the same. s �� Electrical until II applicable si natures b�the'Bultdm and:Fire'Offclal�s.a e• rovlded on this permit. Service: .The Certificate of Occupancy will not be issued t a pp g y g p Minimum of five Call Inspections Required for All Construction Work Rough: 1.Foundation or Footing 2.Sheathing Inspection final 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough' S.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. + Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting With unregistered contractors.do not have access to the guaranty fund"(as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel BUILD I NC D _EPT Application Health Division Date Issued /7 0 5EP 2 0 2017 Conservation Division Application Fee Planning Dept. ®`J11�9 O` `� N`�TC° ` ` Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Ad��drpperss�� n U&JYU e EQ Village ��II�'(�1J0 C� Owner o Addresst---�% �x� �-- � a�t Telephone Permit quest ( �I *-)LaZLbk - ° 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(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes 49D If yes, site plan review# nn Current Use 12(2 1 x Proposed Use APPLICANT INFORMATION - (BUILDER OR HOMEOWNER) �^ 01-4 Nam Telephone Number 777 4�7-04i( Address._ L 0=111) License 0 R a-_A A-- 0,� 2:3 1 Home Improvement Contractor# S Email v� I�'p�Qf�/T-. �® e ' pensation # ALL CON RUCTION DEBRIS RESULTING FROM THIS PR JECT WILL BE TAKEN TO -P 4L- (Icy iMA-Ca&'� SIGNATURE_ DATE Y 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 DATE CLOSED OUT ASSOCIATION PLAN NO. of 114 r� Town of Barnstable Regulatory Services gaaysTnnr , Richard V. Scali,..Director 1 V V�� 639. qdp &39. ��', Building Division p Argo (� Paul Roma 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: 1, Edward 13aggla as Owner of the subject property ._._.._.._.__._.__..___. _. _-_:--_---.-. ...... ............___.......... hereby authorize Frontier Energy to act on my behalf; in all matters relative to work authorized by this building permit application for: 20 Evelyn Circle Centerville,, 4A 02632 (Address of Job) i .r Signature of Owner Date I Print Name If Property(Owner is applying ror permit,please complete the llomeowoeMLicense Exemption Form. C:ltisers\deco.11 k\AppDatatiLocal\M.icrosoft\V1findowskCN.etCacheiContent.0utiook\1,7tI69:L:F2\EXPRESS(2),doc n l/25/17 C•Y. • .... .. .........„„..w,.�_. „- •._.:<.....,v:...n.<. w.m,.A-war. .:.,:. xm .� - They,Omhiv)r weafth,�of i s cf res its. t I3e�iartntettt of Inil atridI A't cidertts 1 C an;Tess Street,Suite 1 Q:11 Boston; M fl211 20.1 �Z'otkerc' {ctngtnt�titi;n't'gcurance Afficla�tt Buildcrsi [tntr-acEgrSlElectrtcransr7'Ittmbers "ro AE I'FLEt3 WRI-I THYPERNIIPITS4 A"l'TE t7ttlT.l. pnlicant Ftafortnat 4n F•'kase yeinf IC ibly Mrh7 (j3Usines/0rgaoizatton/Ind tviduat) ��t1 j�<1• t' �vl(�tr r ��i�T1Gn� L/�� 421 C fty,/SotatelGtp ( Lo ! Rh,,ne#:.:. r Are;yon an enr.piotier" tirckj'the nNprnpri7ie'•bnz: Type of projet f�1'e(ynt 1, t lam.a•emptoycr w;th t� . itnplo}:ee tfull=ttt l/or part•'simel:' 7.. Ne-,x,Catistrttaion a sole proprietor,or I annetshtp Wn hare no'employees woiking-PgFf me irk $:<�Retnodel:n any capacity;l'Ne workers°comp Insurance reyukr rt j 3,01 aun n Fbmco>;mer ijoi..g a!1 wprF,a•}AEI (^Sa wo kern comp m�urancu°cyusred.l." ltjr�[�Ulli�ingaddjti4n 1 Q t am a holrtepwrter 1 td wkit be ti¢n�cocnractors to'cunduct a:k wdi on my.propertp :_t:.vil! m{ ensure that fit onC axon erther ha+e work'Grs.'czt ten2atton insurance-or are sole I 1 r❑I (r C'CICIII rep31r5,QC 4rtdttt4ns`' � propnetor§wktt•no employees I. .,EJ Plurtitot+t repatrs'or addttibm 5•Q:t aril a gera'cra!cnntta:.tor arxi i Eiaee h red the,utreontirastors IsSt<1 p�trxc•aitauh�dst?ee* , These sub=eeintraa(or�ttSv emp}uyces and°gave worker �oknp,'insurarce: 1�.�Goof r4�zArS .3 S. Vearca:corpnntiaraardt[en ura•h+o�atxetcised ti+ici r,,gi;tdre.<emption-ptrNt(Mc. wt gave rw cuiplayee�.[1 ju unrtC t5'.ctitttp.insurance rayti(reri,1 A^y'appitctuittliat checks Ixrz t l muu dsn H!!o ik the section beiQw,showing,theitworkers"sotrneI wation po!'xy;informatiiiri, Humeo.vners-wWWbmit this aP."davit mdkca t ig they are doing a?!work and their huc,ou sine contactors must submit ttp"eis>'attidavit rndtaaung such_ C ontraetnrs;Fh tt check this bnY oust arat hed:iri`addatonal"sheet showitrg hr:name af'tlre sqp cciiitiactocs acid stiite,Nhvther ht rioi hose enuhas have' erxoloyices Jfitiraubcorrtractgrs"ha�c;eknplo�ee thci`mcttt.pr4yiderheir-workers cvmo poI' numbs. 1 am-ari eiirptrzyer tli?t a proviitrrcg tvorlceds Core_rpensadon insurance for: r .ernptvyeYs BelUw•rs llic policy n�rl fr�h'sit information, _ --((' [nsuraace C:oinpap-y tame 1 J 1 n P6licy�6r Wf tnS G;ic is r g i r` <a I-S 2L I Kpaatton WA- Job 'ite.A.ddressD City/siatciZi Attach a cupv'b a wo"rkers''compeosal"on policy, c aratii)ti prgt s 0w.iflk the policy. m[ier and,erprre"lion bate Failu"re to secure coverage as.rtyuired'tii do r lvtGE ia2 ;y�35r ,is a crirn Hal violajdn pun skiable b4 a%Inc tip t4 I SOq.gG and/or one-year ttnprisonmertt;as weRA �,y-'t nIIlttes.[`i"t the-f6t-rri of a.ST0,,P W.oRK 00',F-R.and a'tlne nf;izp to 2 (!_Qq'i day:against the r�-iolat4r•A ccipy Qf thtasstatt bt tit_quiy bu,fb,warde'to the:Offlce of Investigati4ns:oflhe a1.1 for ut uraree c ttveca�e ertt�atton I do{ereby certify 14nrt�r tire,priins a 0 trey of pc jwy that the rrif ornratlon provi ve tit a anti:correct I Si "stature: Chace:_ ! (aj ctril rise:orrty . 3r riot t'rite-ire.this area,to he ro:' retest b cr vr: awn n irirrz, ; hW._ y' t!'". fl.W" . 4 'pity or T6Nv—n. P,ermttr ic'ensc f# { Is�itiag�.ttthortt 'clrcic'Hite:; !:'Board t f Health I Btfddiiia pepartinerif 3.C Ay.IT6wn C'terk 4; Ljectri611[nspector 'plumbia `lnspectpr,. 6:other t ! ! Contact Person:.. _ k'hnnc�� i i r.+?il/IYC 7,e tva/7fII,C/b;�L«^`If✓1/Jflz �,l � License;or registration valid . for individual use only Office of Consumer iffairs&.Business Regulatton> t before the expiration date If found return to: mow' HOME IMPROVEMENT CONTRACTOR t Office of Consumer Affairs an.d'Ausiness Reguta#ion Registration i60854. Type: rrr �10 Park'�Plaza-:Suite 5,170 Expiration9/8f20}g 'LC Boston,iV1A 02116 1 FRONTIER ENERGY,,SOLU;TIONS $ .. II FRANCIS 502 HARWICH 1TD BREWSTER,MA'0263} `'`" i)ndcrsecretarp N t val ithou signature s II - i - Construction SupervisorSpeciaity Restricted to- ivtassachusetts Cepartment of Pcsblac Safety GSSL-It-Irisuiafion.Contractor Board of BuRad,, 9 f2egu16tiosns anti Sta€}dards ; License• CSSL 1U5941. = cbnst,uetl Su er�isdr.°SFeci ty - FRANGIS S SHEEHAN Y 502°HARWICH RD , BREtMSTER MA 0RE 263i � . . k �s Failure tp",possess.;a current edition of the Massachusetf3 State Budding Cods e� cause for revocation of this license. xps, t- DOS Licensing information visit:W►NW:MASS:GOV(DPS �..o rmss3aner" = 021}7-/20;}8 DATE(MMIDD/YYYY) AC"R& CERTIFICATE OF LIABILITY INSURANCE 03/16/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTNAME: Rogers and Gray Processing ROGERS & GRAY INSURANCE AGENCY INC PAHONE ,N Ext: (508)398-7980 a No: E-MAIL ADDRESS: mail@rogersgray.com 434 ROUTE 134 INSURERS AFFORDING COVERAGE NAIC N SOUTH DENNIS MA 02660 INSURER A: AIM MUTUAL INS CO 33758 INSURED INSURER B: FRONTIER ENERGY SOLUTIONS INC INSURERC: INSURER D: 502 HARWICH ROAD INSURERE: BREWSTER MA 02631 INSURER F: COVERAGES CERTIFICATE NUMBER: 134675 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM/DY LTR D/YYYY MMIDD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAG CLAIMS-MADE 1-1 OCCUR PREM SES Ea occu ante $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑JET LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTYDAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X STATUTE OERH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBEREXCLUDED? I N/A N/A NIA VWC10060153152017A 03/14/2017 03/1.4/2018 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) - Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Frontier Energy Solutions Inc. 502 Harwich Road AUTHORIZED REPRESENTATIVE Brewster MA 02631 Daniel M.Cr,ey,CPCU,Vice President—Residual Market—WCRIBMA @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD �WE Town of Barnstable *Permit# - —a eal71 Ewes 6 months from issue date Regulatory Services 'Q Feeik - �MAMA ER Richard V.'Scali,Director 1639. " Building Division T ,/, ' AUU 2 9 2016 Tom Perry,CBO,Building Commissioner ®AV l u ,OF —�.---200-MainTStreet;Hyannis,=MA-02601 �--. 'www.town.barnstable.ma us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 7 le6 Z Property Address 2 e) 6yel'yt-i Ow L E ®Residential Value of Work$ G ii!oo•GU Minimum fee of$35.00 for work under$6000.00 , Owner's Name&Address 7�1,f i Ty Cy i/L�`1.f •f .' & Contractor's Name L7—' .A 4 Telephone Number (-rde-9 /J'- YJ ,0 Home Improvement Contractor License# if a hcable ������ Co`•, P ( PP ) ��`� Email: �� i�s✓r��?is Construction Supervisor's License#(if applicable) of-13lp0 51�/ AWorkman's Compensation Insurance Check one: , ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name ' /7"e6144 .. Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ® Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to 7/1QJ/�v �eYC�iwG ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Value (maximum.32)#of w Replacement Windows/doors/sliders:U- indows' #of doors: ,❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red Sand inspections required. Separate Electrical&Fire Permits required. E *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\building permit forms\EXPRESS.doc Revised 040215 4~ i 17m Commompeakh of Mawa lrtrsett De1wtwent of 1nd=tria1 ctad-mts 13,-ce of rows# a icw : 600 Washirigton&reef , Boston,CIA 62111 ., mt mmaxLgvv/din . - Wdr` bir _ a_..._-ensaf cfn 7nsu a ce avz Bz ders��C�ntract rslEl - - -- - = — `Please-Pr1IIfEI�I�Y Na=�1Lcsn�SSj ann"at+ Il p3 3 -t Address: to efLr/la�TH J Cftar �T -f� �-/sl�yr y. Y Are you an employer?Check the appropriate bo= Type of project(required): I.© I am a employer uith 2 4_ ❑I am a general contractor and I 6-,❑New eonafructim, employees CRZ andfor part timer* .. . #lave hired the sub`contmctm 2.❑ I am a sale proprietor or partner- ` listed on the attached sheet 7- ❑Remodeling slip and have no employees These sob-congractar-s have g ❑Demalifson ' worLing :For me inany capaci4p_ employees aid have wogs' 9. ❑Building sdxiitiau Wo tvarTeers'comp.instant comp-imuran p1, required-] 5 ❑ �J7r a are a=pmation and,its 1OL❑Electrical repairs or additions 3-❑ I am homeoumer doing all vrosk '< officers have e=dsed their 1L❑Plumbingrepairs or ad€li ions o workers' _ of ez�fiou per MGL Q fep� ;flumuc�e_ire&]i„� ., c.152,§I(4)6 and we have no 17 Roaf employees_[NOod=3■ 13.❑Other ,w camp-insurance requit ] •Any MUCMt6atchedU box 91mastalsofiIIootthese tioabekra'si agtbe¢ s3tecs'ca®peasatiaapolscyiafoem ia� I Sameowaemwho sub aft this dfidasft mu csting they am dGmg allwz*sad dmhitm outndeco==t=mast sd7h=anew affidwk mdics=iie;each FCoatzactoss$tat cbeck this boa mast attarh as additiaoat sheet stawbg them'of The s&-c noel state whether ar not tbase eafities hsm employees.If the sub-c==aamhmm emplayws,&W=nsr pund&tLe<ir workeW comp.policy avmbm I am an enfplayer timtis proui&W workers'compensation insurance}or my eurpinyem Below is the-pvUey and jab site inforraatiols. , 4 In uraace,Company Name: ���ieLrJ t Pfflicy�or ms_Iic.��.' �/yl�o9rl��3 022,3� , • Eipi >s Rafe: Job Site Address: © �5y�'[_Yy, ea, 4 -c CitytSt Mp:OA retUt&r�, ;04 0243 Z Attach a copy of the wnrliers'COMIpensativapolicy declaration page(showing the policy number and epiration date). Fadure to secure coverage as required under Sez&n 25A of MGL c 1572 can lead to the imposition of criminal penalties of a fine up to$00D OO aadror one-year iumprisanraent,as well as ciao penalties in the fog of a STDP WORT ORDER and a fine of up to.$ZSO-OO a day against the violator. Be adiised that a copy of this sWement maybe ceded to the Office of ImvesEgafims of the DIA for insurm m coverage verifcaticm Ida hereby certify under thapains aTrrf,perratti�zs a,�getjury that the infbrrrratioi>prmirikd abot a is bare and correct Si�attxre: •• Date- G �o - r Phone ko iln?YT Oociat use only. ,Do not write in thb area,tc►be wmp&te d by cite ortonn o fj`ic&L City or Town: Permitfr icense# Issuing Authority(drde one): L Board of Health —7 Bing Department 3.C tylruwn Clerk 4.Electrical Inspector S.Plumbing Fnspector 6.Other Contact Person: Phone#: 6 -formation and lastrn.c•ions , .e Massachuse#fs Geh: a Laws cfiapt=152 requires all employers ID P:tMdeworkers'coarpensafion farfbeg employees. P this ,an.errployee is defined as.`�---v ay person i a hie service of another under any coitmd of hire, espa.-ess or implied,oral or wriifrn." An.e"PIoyer is defined as"an indhvidzral,parlmsship,assodzfion,corporation or other legal entity,or any two or more of the foregoing engaged in a joint entrrp ,and mclndmg the legal represMta&M of a deceased employer,or the receiver or trustee of an mdividaal,partae�,.association or other legal entity,=Ploy3'empmyem However the owner-of a dweIImg louse having not more than three apartments and who resides therein,or the o=4=t of tho - dweIling house of another who employs p¢sons to do mamtmance,omstjuc on or repair work on such dwelling house or on the grounds or bm7ding app theist o shallnotbecanse of such employment be deemed to be an employer." MGL chapter 152,§25C(b)also st7d Ps that"every state or local RceTrsing agency shall wifiihold ffie issuance or renewal of a license or permit to operate a business or to construct buSdmgs in the commonwealth for ray applicant who has not produced acceptable evidence of compiance with thin i„surance coverage required." Additionally,MGL chapter 152, §25C(7)states¢Neither the coanm aawealfh nor my of its political subdivisions shall enter info any contact for theperf=mce ofpnblio wmkumtiT acceptable evidence of compliance with the;ns*rance.. req�ents of this duPtnr have been presented to the coiffi�m thoity_" Applicants Please fill out the workers'compensation affidavit completely,by cherk the boxes that apply to your sifnation aud,if necessary,supply sub-mntractar(s)name(s), addr=(es)and phone numbers)along with their cm ifcat*) of ;ncm•ance. Limited Liability companies(LLC)or Limited LiabilityParffierships(LLP)withno err�Ioyees other than the members or partners,are not rrqufi7ed to carry workers'compensation insurance. If an LLC or LLP does haTe employees, a policy is required. Be advised that this affidavit maybe submitted to the Department of Iudustiial Accidents for confomati.on of m' suiance coverage Also be sure to sign and date the affidavit The affidavit should be retnmed to the city or town that the application for the permit or license is being requested,not the Department of haCiustrial A c mt� Should you have airy gnesdans regarding the law or if you am regco ed to obtain a worker compensation policy,please call the Department at the number listed below. Self-limn companies should e at r their self-fi saran ce license number on the appropriate Ime. City or Town OfFacials . f - Please be sore that the affidavit is complete and printed legibly. The Department has provided a space at the bottcun of the affidavit for you b fM out in the event the Office of Investigations has to contact you regarding the applicant, Please be sure to fill.in the pen:�iUliccmt number which will be used as a re5=mce number. In addition,an applicant that must sob=t mubiple p=WHC.ense applitmtions in aay given year,need only submit one affidavit indicating dent policy inl =&lion(if necessary)and under'rJob Site Address"the sppli= should write"all locations n (city or town)_"A copy of the-affidavit that has been.officially stamped or maiked by Ahe city or to may be provided to the applicant as proof that a valid affidavit is on file for futmm permits or licenses_ A new affidavit must be fHIled out each year.Where a home owner or citizen is obtaining a license or permit not related to any busmess or commercial vent= (ie. a dog license orpcnmk to bum leaves a .)said person is NOT regnired to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any gw=dons, please do not hesifntr to give us a call- The Department's address,tDlephone and fax mmmber: ' Co=:tan .I*of Massachuacffs , =Depart nent cf hidustdat Ac cident% Off!=of IMVe&#gatio= B MA CdI I Tf,-L .4 617-727-49W cxt 4.06 W 14 MAS-S-A� Fax 9 617-'�7 77D Revised 4-24-07masgfta OF MASS Town of Barnstable Regulatory Services ; Richard V.Scali,Director ----_.__ Thomas..Perry,CBO_.:-_.__ r Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 , _ Fax: 5.08-790-6230 Property.Owner Must Complete and Sign This Section If Using A Builder I, as Owner'of the subject property hereby,authorize �i 1 G ,e- to act on my,beb4 in all matters relative to work authorized by this building permit application for: (Address of Job) , Signature of Owner t' Date Print Name If Property'Owner is applying for permit,please complete the Homeowners License Exemption Form on the, reverse side. Q:1WPFUMTORMS\building permit forms\E)TRESS.doc Revised 040215 Town of Barnstable Regulatory Services oFtHE Richard V.Scali,Director Building Division Tom Perry,Building Commissioner &619. ��m� 200 Main Street, Hyannis,MA 02601 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": name home phone# work phone#,`. CURRENT MAILING ADDRESS: city&Wn 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 or detached-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 ofBuilding 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.", 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.doe Revised 040215 Mass. Corporations, external master page Page 1 of 2 a Corporations Division Business Entity Summary ID Number: 001233973 Request �- q certificate � New search Summary for: TWENTY CIRCLE LLC The exact name of the Domestic Limited Liability Company (LLC): TWENTY CIRCLE LLC Entity type: Domestic Limited Liability Company (LLC) Identification Number: 001233973 Date of Organization in Massachusetts: 08-01-2016 Last date certain: The location or address where.the records are maintained (A PO box is not a valid location or address): Address: City or town, State, Zip code, Country: The name and address of the Resident Agent: Name: EDWARD J. BAGGIA Address: 650 PLYMOUTH ST. STE. 10 City or town, State, Zip code, E. BRIDGEWATER, MA 02333 USA Country: The name and business address of each Manager: Title Individual name Address MANAGER EDWARD J. BAGGIA 650 PLYMOUTH ST. STE. 10 E. BRIDGEWATER, MA 02333 USA MANAGER MAUREEN BAGGIA 650 PLYMOUTH ST. STE. 10 E. BRIDGEWATER, MA 02333 USA In addition to the manager(s), the name and business address of the person(s) authorized to execute documents to be filed with,the Corporations Division: Title. Individual name Address SOC SIGNATORY EDWARD J. BAGGIA 650 PLYMOUTH ST. STE. 10 E. BRIDGEWATER, MA 02333 USA SOC SIGNATORY MAUREEN BAGGIA 650 PLYMOUTH ST. STE. 10 E. BRIDGEWATER, MA 02333 USA http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.aspx?FEIN=001233973&... 8/29/2016 Mass. Corporations, external master page Page 2 of 2 The name and business address of the person(s) authorized to execute, acknowledge, deliver, and record any recordable instrument purporting to affect an interest in real property: Title Individual name Address REAL PROPERTY MAUREEN BAGGIA 650 PLYMOUTH ST. STE. 10 E. BRIDGEWATER, MA 02333 USA REAL PROPERTY EDWARD ]. BAGGIA 650 PLYMOUTH ST. STE. 10 E. BRIDGEWATER, MA 02333 USA ❑ ❑Confidential ❑Merger, ❑ Consent Data Allowed Manufacturing View filings for this business entity: ALL FILINGS + Annual Report - Annual Report - Professional Articles of Entity Conversion > ' Certificate of Amendment v'= View filings Comments or notes associated with this business entity: A. j New search I http://corp.sec.state.ma.us/Corp Web/CorpSearch/CorpSummary.aspx?FEIN=00123 3 973&... 8/29/2016 e !'%/c`fc;r�rrnc.,zra�rrf/l rf'? �« ray/rrse/G. C. Massachusetts Department of Public Safety Office of Consumer Affairs&Business Regulation i p HOME IMPROVEMENT CONTRACTOR ,t Board of Building Regulations and Standards UT' Registration: �185349 Type: i License: CS-080911 Expiration: '518112018 LLC Construction Supervisor J4 LLC ,y f JOEL E BAGGIA .► 650 PLYMOUTH STREET JOE BAGGIA * R EAST BRIDGEWATER MA 02333 ` A x 650 PLYMOUTH ST.#10\ ' BRIDGEWATER,MA 02333` Undersecretary r'-jZ.n CA— Expiration: Commissioner 12/14/2017 TOWN OF BARNSTABLE Permit Igo. 14a6.5....... 9�. BUILDING DEPARTMENT t s.a"l TOWN OFFICE BUILDING Cash �8.4.e 010).. . 7 a1 a67V• HYANNIS,MASS.02601 Bond CERTIFICATE OF USE AND OCCUPANCY Issued to Clover Realty Trust Address Lot 43 , 20 Evelyn Circle Centerville. Mass USE GROUP FIRE GRADING" OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID,' AND THE BUILDING s HALL NOT'BE OCCUPIED UNTIL , ' SIGNED BY THE BUILDING INSPECTOR.UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND'IN ACCORDANCE`WITH SECTION 119.0 DF THE MASSACHUSETTS STATE BUILDING CODE. 19 Building Inspector, Assessor'. office (1sf floor)-" f?ME _ ` Assessor's map and lot number ...... .��.. ...�.a.-. . ... To�y� Board of Health (3rd floor): /�"3y a C � - .1. q Sewagje Permit number ....................................................L.. , `�EPYIC SYSTEM ML457 BE Z BARNSTADLE, Engineering Department (3rd floor): SYpLLED IIV C®IIAPLI�a�6c�E 'oo rb 9. House number ..................................:.1&.......�?...............:..... WITH TITLE 5 �am 6 APPLICATIONS PROCESSED 8:30-9:30 A.M. .and 1 00-2:00 P.M.-only NViRONMEIIYAL CODE All 3 L Alp N IV) TOWN , OF BAR,I . BURPING , ].(C)/2,5 SPECTOR .APPLICATION FOR PERMIT TO ��.C .... .................................... L TYPE OF CONSTRUCTION ..... '... C.��. , .:••fir-r1... ........................................................................ / ....----•----5 ...>I9.. � TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the followin inform tion: Location ....l.0 .. G�.�.C....... ..!�7...... ..... ........ ..... !....... .................................... Proposed Use ........ y Zoning District ... /.......... .....Fir District ......... ..... .......... ��� 7�tissS ........................._............ i Nameof Owner .....:............. ...:. ............... ........ ........ . :.<...Address ............................ .............. ................ .. .. ... yny � w� i c ; it r�I Nameof Builder ........ i�?1.. .....................................Address .........................................................................Q 1.3 Nameof Architect ..................................................................Address ...........................................:.....................................,.. Number of Rooms ........... ......................... ......................Foundation ... C.e .G. .. . Exterior .... -�. .. .. .1 ... .l.e..5..:.. .... ..(. . .. '....Roofing .. .. �,� ............................ Floors (. ..... ... ��.� .. .................Interior ...... ,?f ....... .. ........ .Q.. ,. .............................. Heating. . .. Q .. ............. .. g ........,..,,. ........................................................... Fireplace .... .�..f'1.0..C�.. ............................Approximate Cost .....��..�i .J...®.Q .................... 94 Definitive Plan Approved by Planning B rd _ _CX-__ ___________ ....`.. 1.. ..... . -f 9 Area .. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF 'BOARD OF.HEALTH P � C.x a� I� i � • OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regardi e a o . construction. Name .. .r .... ... .............. Construction Supervisor's Licens -77 "CLOVER REALTY TRUST '3 0 4 6.5' ...Story............ ......... ..... Permit for .....2 ........... Single Family Dwellig.......... .............................................................. LocatFi8n ....Lvt.... ........2.Q...Eve.lyri..-C'.ircle Ce ter ........... .........V.j.1je................... ....... O�vner ............................ q?�J.ty. Tj:.uat Type of Cons r fructi�n .....Frame ........................... .......... ................................................................................ 4, A- Plot ............................ cot ........................ Permit Granted ....6e embdr'...�.6.......19 91 .............. Date of Inspection .......... :.".,19 ............ Date Completed 19, J f , . >� "' '„� � � .. - 4 S •- a ,. — ` �o i : Win IT Li --- _ 42 i Fot`1 r_E FVaTrorl i 1 ' • ii ..2�Y It TmOArev. %C1 gp0.._..Oe-r ,, II I! I 0 1?a Sf ALK I _ VD D.oura E F N — .. fLB1N . OR l-A1$ .S - a PLTG11 .�' o 000rs�a U Cd u , 1 Q 11 x LZ= - .. l � - l._ # • � =Sj�Y,I� O.K OOo 4, 41ce13 L O C=>IZ'._.f>.L✓a IJ .. _(.aa '�q_36 AtZSA =s 4'•o^ 1 all 7 EiSL1o6R 9rB�ditilC � s � . 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(.j t I. .laA C J *,�•/ `V 44- G � +r ,s\,/, ,/U>_ r - '''J ' "�4 gs µma., .:`�w"'��.��J .: ��•' Q'r...+ ,.., :: CY y RLs.t N °Pg �v..' r rr U �I//''�� , ^ ^_,�+_F f *, ! •Ya'r4o`�� 7M( i_ - f# n rt )� %' Y �`, k s� tdo 1�5�1 C) / a ` a 1 r,\,t \r"Gl VC �,!y�. / ! ,lt, rs,>r; w t t +. - n ) V 1 7...., ,1�p r'j .: I / . 2�. ..'` y' 45:\rf j �-�' *��� '.. fit "�; "4 tf 3" .:4 e T ! rvy o "'TY„ ") Fu` S` I (/ i ti. r a>n s ? +'fk J<s, >" fJ o e ' k ' i.. i �K t a x k'' F}j` ` 5 F )L"E�GEND ti it if r f r . > t EXISTING SPOT 'EL;E_VATI ON O,cO v , >, ;EMSTIN® CONTOUR .;0 a CERTIFIED PLOT PLAN FINISHED ::SPOT ELEVATLON! [ ] ` M { %. r ,�,f ! /Rctf Y GOTT-4*I * V., FINISHED'CONTOUR 0, '~ a Y CI , —*----- 1 i i ,„ NC1fL The ljocation of any exl5tang) under >,.ou d sewerage, '__� y s ' Wel ls;y OT.. Ogler ';Ut11.lt]C5 'S�lUWn OI1 ti.7 S *plan 1S =a T O?C § K., n t+:s °<' ' NY �'P f im, gnAly.._as deterniined 'from records, end/or verbal information. 'The':cont:racto.14ti Oxr,., onsible;_' oxL the Kfr, ,%g, zt `� nf, ,�# ,. . ./ �1 �'�v,s D. 5- /9-;f er�f�cat�;on. of the existin7 locations yxri$<.the..Tf:.,, d � <:gCA'L.EF" j DATE YG .fsG v - �U Y` 1..". _ - l r�l y fr ! (,� 1p 1� ,s N, ; 1_ r ! �"rt +"'� -<:, ,9Y f,; "� 4'OREOGE ENGINEERING CO:1N CLIENT` � � I ;C.EIRTtFY THAT •'THE PROPOSED ;,, r,: E6ISTERE ' RE4ISTEREO J08 :N0. .S'/_/ BUILDING";:SHOWN ON THIS PLAN , 1;1� r - -CIVIL t t.. L'AND1 sR r �� r ` w' `; '� 'CONFORMS TO'THE ZONING'.. LAWS ;" ENO NEER RV 4 �,,k D+R�pYT� -- 1, " RNrS&T ,< E ;'' MAS ,#, k!y J ti, 3... ,. �r ,z y rr 1 Ya��) 1 '�°�.s t} 5 <'! •,.e'r� �, ..i e S r ?12 ;M'A I N S T*klk T i CM. pY� g >A HYA•NN i'S,` AAASSr �H. .Ii � r RbEYOR ,,_ i, .n S EET FY t- A ; - I EG'. LAND SU "; 4 _;r 1 t) is u ..,,.,, , YF:.p,� v. r n�i p.,, # +, < -LA F,.: 3q-7(oS �Ea � , igQ BUILDING. PEM!IVNOi; Dz.- ASSESSQRS PARCEL No. 18 7 -0�2 CONTI\rUATION OF ROAD BOND The undersigned ow-aer/contractor hereby agree to maintain their road bond in '? force until the following war" it=s ara co_pleted to tue satisfaction of t:.e Engineer :g Section of the Depar—ent of Public war-cs: { L,,Z_ loa_ and seed shoulders as soon as wea- er pe omits: other (e_xmiain) LOCATION: '& Z O E—:VFLYAJ Ctyl— C 1,3 1 �S- i,7NZ:./CO:;.,ACTOR) I (print na_e ) c GL:ycE 71; aL ERLATTON J � a ® ' TOWNS OF BARNSTABLE, MASSACHUSETTS BUILDING PERMIT/� g �187-U62.003 DATE December 26 19 91 PE' l 9 PERMIT NO. �e34765 APPLICANT John Delaney ADDRESS K 009961 ' IN0.) (STREET) (COHTR'S LICENSE) PERMIT TO Build dwelling ( 1} ) STORY Single family dwelling NUMBERN OF G UNITS s I (TYPE OF IMPROVEMENT) NO. (PROPOSEO USE). lot #3 20 Evelyn Circle, Centerville ZONING RD I AT (LOCATION) y DISTRICT 1 (N0.) (STREET) BETWEEN AND (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT-BLOCK-SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION 6 TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) Sewage #91-541 REMARKS: (John J. Delaney d/b/a Delaneylusf3 84.00 AREA OR 1344 sq. ft. 45,000 PERMIT s 107.50 VOLUME ESTIMATED COST $ FEE (CUBIC/SQUARE FEET) OWNER Clover. Realty Trust ADDRESS 404 Main Street, Cientervi e, 1 BUILDING DEPT.' BY J THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND 1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MINAL INSPECTION TI TO LATHE FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE OCCUPANCY. POST THIS CAR® SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 2 2 /�G A Z 2 3 1 �: �HEf.TjUVoINSPECTION APPROVALS J ENGINEERING DEPARTMENT .S j� �1 Ta WAV_t!I`� Cis o X j/ . l</ z-G �Z ) BOARD OF HEALTH OTHER SITE PLAN REVIEW APPROVAL r3 WORK SHALL NOT PROCEED UNTIL THE INSPEC. PERMIT W!L L BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN CONSTRUCTION. I PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION. TOWN OF BARNSTA'BLE Permit No,147.6,5„ t ,.ten I BUILDING DEPARTMENT yi TOWN OFFICE BUILDING Cash HYANNIS.MASS.02601 Bond CERTIFICATE OF USE AND OCCUPANCY Issued to Address Lot Bye I USE GROUP FIRE GRADING x OC. UP Cy;* THIS PERMIT WILL NOT,:BE V SIGNED BY THE BUILDING.INSPECTOR UREQUIREM ON SAT S A ORENTSAND IN ACCORDANCE WITH SECTION 119,BUILDING CODE. ��•'I t. y! - Bu�ld,ng.Inspec(or r +lll�V.\• \N6P Y. .�.�•�. NRE.'F.`•'C...KI`�,._..:Iw.-.�..:irr:.ti/...w...,............:.1........_ . .. ,. i r 3�• 1 TOWN OFBARNSTABLE PAYABLE To: BUILDING MM1881ONERS OFFICE DATE y o��a� John. J. Delaney ACCT.# (�1n� d/b/a Delaney Homes Trust 404 Main Street � VENDOR#AMT. Centerville, MA 02632 �'�. •-- PO# NI/3 APPROVED BY BUILDING, PERMIT N0. 3 L/'7(o S_ Dz:E�EQ ASSESSORS PkkCEL NO._ ( $ 7 -©.2 --C oa N'tJATION -OF ROAD BOND CONTI The urde_sig^ed one_/contactor hereby agree to mai nta=n their road w- bond is force until the following work- it=s ara c-_=leted . to the sat_sfac-;on of the :: i Egne___:.S Section of the Denar.=ent of Public worts: �� Ioa= and seed shoulders as soon as wear:er pe=its: . other (e.--mlain) • LO CnT_O.T:_ (L o-r ''b,3 J z o E�V FLVAJ Cry . �EN'T�i'Lc1r L[r� TW4.-v� S- �; ;YL;ER/CO: CTOR) _ (Print name ) E Gt:tLE:.�`; (:i J31 T=0N THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) M DATA I :TOWN OF BARNSTABL'E, MASSACHUSETTS I D i . 'PE RM LT A�-187 062.003 AT /��' DATE December 26 19 91 PERMIT NO. N9 ' `v347S5 a APPLICANT_ ' John Delaney ADDRESS b °.0099617 r. ' 1 - (NO.) (STREET) LICENSEI _ PERMIT TO' Build dwelling ( 1Z ) STORY Single family dwelling pwEBLRN OF G UNITS' l " • (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) AT (LOCATION) lot #3 20 Evelyn Circle, Centerville ZONING ,��~ S (NO.) DISTRICT 1" 1 (STREET) Syr,, BETWEEN. AND > a x (CROSS STREET) (CROSS STREET)'. _ SUBDIVI LOT ?} SION LOT-BLOCK-SIZE ' BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION', TO TYPE - USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) Sewage #91-541 REMARKS: (John J. < Delaney d/b/a DelaneyTruseS 84.0 own°e 1344 sq. ft tll *. 45,060 .y` 'PERMIT 107 'SO�° ESTIMATED COST $` '. .. y - (CUBIC/SOUARE FEET) '.' FEE''"" OWNER Clover Realty Trust, ._Y ADDRESS 404 Main Street,, Centerville, MA 02632 BUILDING DEPT. a _ BY i r FROM THE-DEPARTMENT OF PUBLIC WORKS.` THE ISSUANCE OF THIS PERDOES ' --•-.r=.. .w:•:.' OF MIT ANY APPLICABLE SUBDIVISION RESTRICTION NOT RELEASE THE APPLICANT FROM THEC IVDIy S. O T IONS MINIMUM OF THREE .CALL INSPECTIONS REQUIRED FOR APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE FALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR I. FOUNDATIONS OR FOOTINGS'.' 'ELECTRICAL, PLUMBING AND MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL OCCUPANCY BUILDING SHALL NOT BE OCCUPIED UNTU ..,_. MEMBERS(READY TO LATH). 3. FINAL INSPc�LL_ -- OCCUPANC' BUILDIr BOARD OF HEALTH OTHER SITE PLAN REVIEW AL r WORK SHALL NOT PROCEED UNTIL THE INSPEC. PERMIT W!L L N U L AND VOID I ON S T R U C T ION SPECTIONS INDICATED ON THIS CARD CAN BE TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT S RTED WITHIN SIX MONTHS OF DATE T CONSTRUCTION. PERMIT IS ISSUE NOTED ABOVE. ARRANGED FOR BY TELEPHONE OR WRITTEN NOTIFICATION. i r > Engineering Dept. (3rd-floor) Map Parcel D 6 7i' permit# 9 � t House# �® -� Date Is ued " Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) �(�4 �%L���Fee • 5"d Conservation Office (4th floor)(8:30-9:30/1:00=2:00) Planning Dept.(1st floor/School Admin. Bldg.) THE,q, G.. , Definitive p ved by Planning Board 19 ; RNSTABLE MASS TOWN OF BARNSTABLE ° Building Permit Application Project Street Address (90 Eyr�Alk) . Village. Owner'!W, W f� - +- Ar1q/C E 10 qdjfill Address a 0 W et y A) Telephone Permit Request 5 c A 3 2 '' - l G-r0 2 ad T r 'J�= First Floor j 2 square feet Second Floor — square feet ,Construction Type ��� t'� 1✓ Estimated Project Cost $ "— Zoning District AD Flood Plain N® Water Protection /(/® Lot Size 2.5 I Grandfathered ❑Yes ❑No Dwelling Type: Single Family �J( Two Family ❑ Multi-Family(#units) Age of Existing Structure IO AL5 Historic House ❑Yes >(No On Old King's Highway ❑Yes XNo Basement Type: ❑Full Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) 0 Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing 2 New Half: Existing _ New No.of Bedrooms: Existing New �_ r Total Room Count(not including baths): Existing New ' First Floor Room Count J Heat Type and Fuel: XGas ❑Oil ❑Electric ❑Other Central Air ❑Yes gNo Fireplaces: Existing New Q Existing wood/coal stove ❑Yes )'No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) Attached(size) 15141/X ag� ❑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 JI -LA Builder Information /U Name � �J t Telephone Number Address ZZ� Zltl License# U,/J� Home Improvement Contractor# 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 F OM THISM&C7 WILL BE TAKEN TO �sr SIGNATURE DATE 2 r �� BUILDING PE DENIE FOR TH OLLOWI G REASON(S) s_'-Ike �, } FOR OFFICIAL USE ONLY _ t PERMIT NO. DATE ISSUED: ' •� ..,h ... • � F� F s -- �. MAP/PARCEL NO. �, iADDRESS: VILLAGE ! OWNER DATE OF INSPECTION: r I FOUNDATION � 18 . FRAME � TO INSULATION FIREPLACE - f ELECTRICAL: ROUGH FINAL . > PLUMBING: ROUGH FINAL t - GAS: ROUGH FINAL , y FINAL BUILDING DATE CLOSED OUT, t ASSOCIATION PLAN NO. J MAScheck COMPLIANCE REPORT Massachusetts Energy Code Permit # MAScheck Software Version 2.0 Checked by/Date CITY: Hyannis STATE: Massachusetts HDD: 5973 CONSTRUCTION TYPE: 1 or 2 family, detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 3-23-1998 DATE OF PLANS: TITLE: COMPLIANCE: PASSES Required UA = 377 Your Home = 370 Area or Insul Sheath Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 1066 30.0 0.0 38 WALLS: Wood Frame, 16" O.C. 1992 19.0 3.0 107 GLAZING: Windows or Doors 365 0.480 175 FLOORS: Over Unconditioned Space 1047 19.0 50 ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design represented in these documents "is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% 91 the design load as specified in sections 780CMR 1310 d J .4 Builder/Designer Date 3 d (9 t ' oFrne rq� . The Town of Barnstable • s�ar►sr�.E. • 9q, NAM �m�' Department of Health Safety and Environmental Services ''rEo Na►" Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Fori office use only ; l Perm i it no. • r 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. n` A Type of Work: k1c 7 n d Est. Cost S� r� Address of Work: fl,46Z 6)P2G/k� v. Owner's Name(���Y �/V 74 14 �� 0 Date of Permit Application: - �d I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the17/A 3-) 6 -M_- Date Contractor'Name Registration No. OR Date Owner's Name �` '" Tltc• Ginrnrunn•cttlllt of:Itussacltt��cttx iw� _•f_� Dc pdrrnrmi of hamrr al.4e demrs • � t�'�'�'�I� • •• OflJcEalJ�gallOas' • 600 if arkht-Iun Street Bastan.Jfa= =11 �- %larl crs Compensation Insurance Affidavit eunIiEn RfOTR i*6City —� r�C•t5!' �N•t`1MTiti�l su��� ' niltm e 1 am a homeowner performing all wort:myself. I am a sole proprietor and have no one working in any t pacify .� G 1 am an employer providing workers' compensation for my etnployees working on this job. rrmn•rm nnme +drlrrt� tits ntinne/h • inainnr iirt•N ,_ I am a sole proprietor general contrscto or homeowner(circle one)and have hired the=n=ctors listed below who R: the following workers* compensation poiic= m am• name• - 7 A r atirire•r. �,���-I"IV LJ%1l��' i I nhnne No 7 nicer it _ �mn�n• nnrnr ��//!i (dre�r nitnne fl• in'.4urnifee rim, _ Attach additional sheet ifneeesiarr• �•� ter!'^:��••'� " � ram" x,• -•_r••���_~a - —=- ' •_ Fbiiure to seenre curcraee as required under 6ectton 3A of A1GL in ran tend to the imposition of cnassam penatun of a tine np toS1300.u0 oadruc une.ears'impnsonment as•yell as chit penattirs in the form of a SPOT AVORX ORDER and a Qne ofSI00.00 a day apian me. I understand that coin'of this statentrat ma. be forwarded to the 011kc of lavcstications of the 01A for canTa0e+erillatioa l do herchi.cerri •It riic.pail a d can! ojperjurr r/rar the information pros ided above is arts and/correct Si.rstttrr Date � �b `�� Ph Print nmtt —� one� amcial use univ do nut irrite in this area to be completed by city or town aMcial pertaizMcense d r'tlluildint:Department chv or town: Q pub C G check if immediate response is required Qsdeetmen's Onlce C311ealth Department phone m r'IUther��_ contact person: ' r- Information and Instructions Massacftusetts Gener-.tl LZU'S chapter I52 section 25 requires all emplovers to provide workers' ctmlpettstttian for employees. As quoted loom the "fa��".an e»rpluree is defined as every person in the service of arttrther under contrac: of hire. express or implied. orni or��Titten. An einplt rer is defined as an indi6dual. partnership, association. corporation or other Iegal entity. or any two or .r. the focc;_oim_enaa_cd 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. t o«the owner of a dwelling house having not more than three apartments and who resides therein.or the occupant of the dig clline house of another who employs persons to do maintenance, construction or repair wort: on such dwelling or on the_rounds or building appurtenant thereto shall not because of such employment be de-med to be an empio: MGL chapter I52 section 25 also states that erer}•state or local licensing agency shall withhold the issuance or rclici al of a license or permit to opernte a business or to construct buildings in the commonwealth for uny applicant who Itns not produced acceptable evidence of compliance with the insurance coverabt: 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 cfiac:.-: been presented to the contracting autltorit}. Aplulica as Please fill in the workers' compensation affidavit completely, by checking the box that applies to;cur situc:iozi ant supplying_company names. address and phone numbers as all affidavits may be submitted to the Department of industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date due affidavit. The a., .vit should be returned to the city or town that the application for the permit or license is being requested. nut :e Department of Industrial Accidents. Should you have any questions regarding the "law"or if.you are recu;r� to e' -ain a workers' compensation policy. please call the Department at the number listed below. City or Towns Ple-se 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 reatrding 'lie cppiicant. P'. be sure to f::1 in the permidlicense number which will be used as a rzference number. The affidavits may be rett:rnec the Department by mail or FAX unless other arrangements have been made. Tile Office of 1»vesti=ations would like to thank you in advance for you cooperation and should you have any questic :ease do not hesitate to give us a call. The Department's address. telephone and fax number. - Tbe Commonwealth Of Massachusetts Department of Industrial Accidents _.. Office cf lnvesugatlons 600 NVashington Street x>` Boston,Ma. 02111 fax #: (617) 7 Z7-7 749 I i �Po/Z�// S //� ff // We _lr — — SJ - - --wc,s - I Z.= � 6 ---- Ntsu�t��- ,Js Co. Lc1 - O400S3(o _ DRY LA,7 _ - --- ii -q3 7 OZ -- uA4 f -Zcv _ coo 6 s' --- --_____-- ` GO�rr1�RGi�4L. Ghy�onJ Sr✓s . C!3�-f $S7 3 517 W L L --- P - -'-7NA /6qX 3 q3-b'4� t 4 3 1 r 11 • i iI II ij li — -i-;--�U�-CFlu^��� • CdIU��G D�_�_--- WDI�O���LOj-1'j'.� i . I if it � I 111N 6A 69 __ - �}--��� �� I . • u l�� w�Z_"-�✓ - T z.���z,' asap �__-____ Al 1 - ---- F �Ss. � --- ------- --- 1Mg�qchAAIIXgTp Ynogs . 1 - 1 i .44 we P- oaa 6�5 q7 ------.. i - w f . R�� •�E � � U�o - u�-_�'o_ �ok-, gi b i � I . i I I --- _ , • . >a:.'....s ..... .. ,..a.,. ,.r r:n.........,� , J- .r.t .. [i'. . . ✓/LB TOM/NAON(//9QUIE O� UdB�Cb S HOME IMPROVEMENT CONTRACTOR . Registration 125524 Type - INDIVIDUAL Expiration 01/15/00 JO6HN� J. DELANEY G 6 NAIN80W DR �`fERVILLE MA 02632 ADMINISTRATOR C� > D6FpRSRgNT OF 4D8LIC SAFm CONSTRDCTI4R SDFBRVISOR LICSRSE Number. 041141195 CS . 005561 Restricted TO' 00 300 J DgLA1dEY ; 36 RAINBOW DR HA 82632 ?- • � � .-. .. , vim' /�//J— , I I , 1 L07- Z. r c A1JLO T PAL- 7- )(:'A T.Eo W/Ty/�c/ .S5 CLOar, //.S' P-LA///S' ,VO r ST.0 U/�1Ei(/l s!/.0 1�EY E Th��- ,f. ' � � c�S%-E,•�l�/,��.cam .c- �O �-o o�'�c.2�/i�C/� ,G✓_>T j�c.%=�-' �f�•-=�'C_i�,r',ti'�" �ixl1�.� f.�C �d.✓,c�i GUAPN:i-(%.;S MUST BE '.61tiFicu�'t ":41f:iAi IUP Q SUJLUjt4p XKV AFT ELLV -T 0l,1.... _ 4�p '.�. •.Y� .K:0� A 9• b•0' 4 S' \ T SOS/ -428.6191 _- - -: @us On'1 N �A ii r 0 o Signs - t�65ruos:`�rXs:�i uuM:: coWgnt O »sa All Rif LL������ Re:crvtC �Q It1 to 7omn,__::.- .. ............. ..,. ._ .., .....__.... . ........... ..___.fcll4_'OIwq _:=:G7¢SLc�.. .NATtRPRLDF lll4 ..._. II LIJ s . r Oz _ Q