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1107 FALMOUTH ROAD/RTE 28
� x f T 4t,. n �'"4'ta , a . � G y - r . AL'o '.. VF, a ,I ° c s o a o I o. , e 0 Town of Barnstable Building a. Post This Card So Tt at it is,Visible,From_the Street App:roved=Plans M'uust be Retam'ed on Job and ahis Card Must be Kept Posted Until'Finall�nspection Has Been Mader y Where#a Certificate"of Occupancy s;Required,.such Building shall�Nottbe Occupied until a Fnal Inspectionv=has been made mit Permit No. B-19-3557 Applicant Name: WONG,SUSAN TR Approvals Date Issued: 11/13/2019 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 05/13/2020 Foundation: Residential Map/Lot: 250-009 Zoning District: RD-1 Sheathing: Location: 1107 FALMOUTH ROAD/RTE 28,CENTERVILLE . Contractor,Name: Framing: 1 Owner on Record: RODRIGUES,ADENILSON -Contractor=�_',License: 2 Address: 1107 FALMOUTH ROAD � -- — Est. Project Cost: $0.00 Chimney: I �3 CENTERVILLE MA 02632 ;. Permit Fee. $85.00 Description: finished basement-bathroom,office,storage and utility room Fee Paid- $85.00 Insulation: Project Review Req: PROPER HEADROOM FOR STAIRS TO BE PROVIDED Date.. 11/13/2019 Final: 40 STAIRWAY MAX RISER HEIGHT. PROPER INSULATION REQUIRED IN WALLS. � � Plumbing/Gas Rough Plumbing: Building Official This permit shall be deemed abandoned and invalid unless the work authonzi4by this permit is commenced within sb months`aft&jssuance. Final'Plumbing: All work authorized by this permit shall conform to the approved appllication and the'approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures'shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas work until the completion of the same. f The Certificate of Occupancy will not be issued until all a licable si natures b ahe 136if m and.F,re Officials are rovided on this e-rmit. Electrical P Y pP g ,Y . g P. P Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing 4_ 2.Sheathing Inspection w - Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is1i ta11 d—-"" '`' •- -" M 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Rough: 7.Final Inspection before Occupancy Low Voltage Final: 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. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: Application Number..... ........... .................. BARNUMBLE, MAS& Permit Fee...........4Y Other Fee:....................... 019�. TotalFee Paid............................................................... ....... TOWN OF BARNSTABLE Permit Approval by....... On... (V- :1. .... ......... BUILDING PERMIT map.......... ...........Parcel..............A7.9............... APPLICATION Section 1 — Owner's Information and Project Location ag e— P 1�qj et Addresses, Awvr;Lf Owners Name c'4- �,c•i Owners Legal Address llo:v State-..�X���N��z:ip 0. ers Cel mail Section 2 —Use of Structure c. Use Group F-1 Commercial Structure over 35,000 cubic feet Commercial Structure under 35,000 cubic feet ❑ Single Two Family Dwelling Section 3 —Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use; El Demo/(entire structure El Finish Basement 0 Family/Amnesty D FireCVkarD Rebuild 0 Deck Apartment ❑ SprinkleLPk-em ❑ Addition ❑ Retaining wall, ❑ Solar El Renovation ❑ Pool ❑ Insulation � Other—Specify, \—S-ectiod-14=W—ork-Descripti 13 03.1 C, 14'11- 44"k' 2'1 271 yJ :r—k-44 A=i F->Cp 0 0 &06,,Vr LAO iinfinied- 11/15/?.nl R 1 i i f 5 Application Number.................................................... Section 5—Detail Costtof,P.roposed�C-onstruction Sop, Square Footage of Project �'� Age of Structure. Dig Safe Number # Of Bedrooms Existing Total#Of Bedrooms (proposed) i 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics ❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating'System ❑ Masonry Chimney ❑ Add/relocate bedroom Water Supply El Public ❑ Private i Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑' Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes ❑ No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage # of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No I Last updated: 11/15/2018 The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass-gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name-(Business/O.rgani�z�ation/Individual): Address: City/$tat/Zlp �N V 1 Z-L_Y 7 ZPhone#: A e you an employer?Check the appropri to box: Type of project(required): 1.❑ I am a employer with- 4. 1 am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no-employees These sub-contractors have 8' Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp.insurance Comp.insurance.: �] . 5. We are a corporation and its 10.0 Electrical repairs or additions 1:3*__. _I_am,a homeowner doing all work officers have exercised their 11.�Plumbing repairs or additions m sel£ o workers'comp. right of exemption per MGL y [N p 12:❑Roof repairs insurance required.]t c. 152,§1(4)9 and we have no 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. " t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors mast submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. . Y I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: 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 pains andpenalties ofperjury that the information provided above is true and correcit Si attire: a .► Liite.��o�� ��V" Phone-#:^'�~-,-� •��JO � �S�(� Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to constrict buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the r members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be retained to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to buns leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 0mce of bVestigations 600 Washington Street Boston,MA 02111 - Tel.#617-727-4900 oxt 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 WWW maw.gov/dia II Barnstable Bldg.Dept. , - - Approved by: v Permit#: l5 ".3,55 r - 9 ,J J C:) Ci k orTi , 4� rn r i q r a� �.. .,�.....,.._.._..,__._...�...�....�,__,...,....,_�._,._. .....,..,_.�...�-�.., �._.,u.,.�,�_..,......-.try .._,.,... �....b....-.,.�. ..�x ....v....,,...�,..M,..,�.,�-.�...a,....W.. .�. ' I , ( � r a r , s t y 9 t p7 q� 4 F 16,91 ------------ A�k F 5 F-L'() D P- y � a In -- Mo if JA APPRAOR" I e R � 0 NOT i Aw E CHP►N , � I t TOWN OP BARWI P. Building In section c Application Number........................................... . Section 9= Construction Supervisor Name Telephone Number Address - City State Zip License Number License Type Expiration Date r' Contractors Email Cell# 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.Attach a copy of your license. Signature Date Section 10-Home Improvement Contractor Name Telephone Number Address City State Zip Registration Number Expiration Date I understand my responsibilities under the rules and regulations for Home Improvement Contractors 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.Attach a copy of your H.I.C... Signature Date Section 1 Home-Own.er_s_Licease-Ezem-ption Home Owners Name: N� ©N Telep� hone�Number __2 g5l Cell or Work Number { -.2 -F 5 bo 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 78ZC =6 of Barnstable. Signature --Date --2 20 r C::APPLI-C-ANT SIGNATURE Signature Date��07,--P-—I -Y-)0 Print Name___ r LSc:v Telephone Number ti mail permit to:-: ,Q t L-.-so tj r2o " Last updated: 11/15/2018 { s Section 12--Department Sign-Offs Health Department ❑ Zoning Board(if required) ❑ Historic District^ ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation ❑ For commercial work,please take your plans directly to the fire department for approval. Section 13—Owner's Authorization as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of job) r Signature of Owner date Print Name Last updated: 11/15/2018 Town of Barnstable • ng , P.o`s#This Card So„That i#=is Visible Fro the,- treet Approved Plans,Must be R_etamed on lob antl this Card MustEbe Kept 1039 Posted Untd,Final Inspection HasBeen MadeR, e - �fi " of=0 c anc -�s Re urea such..Buildin shallNotbeOctu �edeuntil.a Fna`t I'ns`ec#ionhas been.m'ade e1 Wherea Cert cate cup y q _ g p �. Permit NO. B-19 3104 Applicant Name: Sue Wong Approvals Date Issued:, 10/16/2019 z ~Current Use: I If Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 04/16/2020 n Fou dation: `Residential Map/Lot: 250 009 Zoning District: RD-1. Sheathing: Location: 1107 FALMOUTH ROAD/RTE 28 CENTERVILLE ' Contractor-Name' Framing: 1 Owner on Record: WONG,.SUSAN,TRUSTEE r ContractorLicense 2 Address: 396 WASHINGTON ST ,' Est ProjecYCost: $ 100.00 _ 3 Chimney: WEtLESL'EY, MA 02481 - Permit Fee: $85.00 Description: Install interior hand rails with spindles'at base_ment= nd a second Fee Paid is $85.00 Insulation: floor stairs - Date � - - 10/16/2019 'Final , Project Review Req: HANDRAILS/GUARDRAILS. s W , Plumbing/Gas o*/ ¢' Rough Plumbing:. F Building Official Final Plum - Bing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months afteraissuance. . All work authorized by this permit shall conform to the approved application and the°approved construction documentsfor whichtl is permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall'be in compliance with the local zoning by laws a9d codes.. , This permit shall be displayed in alocation clearly.visible from access street or road and shall be maintained open for public mspection for the entire duration of the Final Gas: work until the completion of the same. pMR E ` ffl The Certificate of Occupancy will not be issued until all applicable signatures by the;Building and,Fire Officials a e,provided on this permit. Electrical Minimum of.Five Call Iris Required for All Construction Work: ` P q r Inspections Re41 Service: 1.Foundation or Footing _; 2.Sheathing Inspection g Rou h: I m before firest flue linen is installed' .All Fireplaces u h throat level be o e 3 must be ins ected.at the t g p P 4.Wiring&Plumbing Inspections to be coin Ieted prior to Frame Inspection Final: g P P. 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation e g g Low Voltage Rough: 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shalt not proceed until the Inspector has approved the various stages of construction. Health Final: I: t have access to the guaranty fund as set forth m MGLc.142A). a ,Persons contracting with unregistered contractors do no g Y � Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT• Ow Final: Town of Barnstable Building Department Services Brian Florence, CBO Building Commissioner BAMSTABLE 200 Main Street H annis MA 02601 &RNSTAB E•FNRAVI E•CONR•M ANNIS , ./ 7 ib39'-2014 www.town.barnstable.ma.us �Dg Office: 508-862-4038 Fax: 508-790-6230 NOTICE OF INTENT Applicant Name Street Address Town, State, Zip Phone Email PROPERTY INFORMATION 250-009 Map &Parcel Number 1107 Falmouth Rd Street Centerville Village . . - 5, The subject property has been determined to contain a legal former.familya rtment,'an affordable accessory unit or an un-permitted apartment. ®ot This property has a hsitory'of un=permitted dwelling units. w It is my intention to obtain all necessary permits (in my name) and all re fired inspections in order to: **To maintain this property as a single-family home without rental units. ❑ Restore the property to a single family home ❑ Register the unit as a family apartment &obtain zoning relief(detached units only) ❑ ❑ Apply for and obtain all permits to create an Affordable Accessory Unit 1 have been made awa of the property status and agree to appropriatel ._remedy the matter as "ndi abo within 30 days and subject to the town's enforcement--- �pol_icy' - � a I �I Ck ' n Q .. Li U CAPE aF 1AIIIIALE INSULATI 1mi, Y 24 AM It: ' PIBtR OlA35 3lAMlFii SPRAT FOAM SYSPENOED , OARS OURFRS INSUIpfION CGEINOS ' 1-800-696-6 Town of Barnstable" Regulatory Services Building Division 200 Main St Hyannis, MA 02601 r Date: Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the.property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute (BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address Village . Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Slopes Floors ( ) ( ) ( ) ) Walls Sincerely He y E Cas y Jr, President C e Cod I I ulation, Inc. x ;F a °F114E .Town of Barnstable Regulatory Services r r r r ` an MAW.i e' MAW. r Thomas F.Geiler,Director 9 i679• Building Division Elbert Ulshoeffer,Building Commissioner 367 Main Street, Hyannis,MA 02601 Office: 508-862-4038' Fax: 508-790-6230 SHED REGISTRATION 120 square feet or less al®7 ce-Z17101V usu c Location of shed(address) Village Property owner's name Telephone number d'01-0Z CSC Size of Shed Map/Parcel# E-/o/ Signature Date Hyannis Main Street Waterfront Historic District? . Old King's Highway Historic District Commission jurisdiction? Conservation Commission(signature required) PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg A L_®CAL-T0C)N of RRC3RERw LANES AA.AY No-r 1E ACCUP,^-FE STANDARD-LEGEND NOTE:not all symbols will appear on a map GOLF COURSE FAIRWAY EDGE OF DECIDUOUS TREES EDGE OF BRUSH r i ORCHARD OR NURSERY V—V-7—V EDGE OF CONIFEROUS TREES l MARSH AREA — — EDGE OF WATER DIRT ROAD DRIVEWAY F---PARKING LOT PAVED ROAD — - - — DRAINAGE DITCH — — — — PATH/TRAIL PARCEL LINE P WP - PA MAP# 2 2 \ 1 E—PARCEL NUMBER #teen HOUSE NUMBER 2 FOOT CONTOUR LINE 07 `1 —lB— 10 FOOT CONTOUR LINE Elevation based on NGVD29 f `A' ------ i�4.9 SPOT ELEVATION STONE WALL -YMAP 250 --------- ----- ----------"- - -X—X— FENCE RETAINING WALL 49 1 RAIL ROAD TRACK # 980 STONE JETTY SWIMMING POOL PORCH/DECK �. 0 BUILDING/STRUCTURE F4=V;'` DOCK/PIER HYDRANT 6 VALVE 0 MANHOLE O POST OFP FLAG POLE O W N O ,F 13 A R N S T A B L E G E O G R A P H 1 C 1 N F O R M A T I O N S Y S T E M S U N I T p SIGN ® STDRMDRAIN H PRINTED SCALE:IN FEET *NOTE:This map is an enlargement of a **NOTE:The parcel lines ore only graphic representations DATA SOURCES:Planimetrics(man-made features)were interpreted from 1995 aerial photographs by The lames * o G - 1"=100'scale map and may NOT meet of property boundaries.They are not true locations,and W.Sewall Company.Topography and vegetation were interpreted from 1989 aerial photographs by GEOD 0 UTILITY POLE Q TOWER " e 0 . c 20 40 National Map Accuracy Standards at this do not represent actual relationships to physical objects Corporation. Plonimetrics,topography,and vegetation were mapped to meet National Map Accuracy Standards �� I INCH=40 FEET* enlarged scale.. on the map. at a scale of 1"=100'. Parcel lines were digitized from 2001 Town of Barnstable Assessor's tax maps. 0- LIGHT POLE O ELECTRIC BOX 71 =:: _ i _ may- .. - •.. t ✓ � k r 4 � �Ft Apr 3 i 4. 1. � ra Y `row, 107 Fal e Rd. , Cent. 8/25/2011 A `lei Y* a 7;� N '��+' i (�!�!' _ �{. i Q:x� M; .I — _' •Ma {3 � 1. *'� S'��,�_ .. 1 . � • � i 1 l 'Dow, ,0,,- . 40 1107 Fal . Rd. . Cent. 8/25/2011 r 1107 Fal . Rd . , Cent. 8/25/2011 �'THE Town of Barnstable Regulatory Services saxrtsrnace Thomas F..Geiler, Director 116J�9. � Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis, MA 02601 Office: 508-862-4038 Fax: 508-790-6230 March 2,2010 Alice Fardy 6 Kensington Drive Sandwich, Ma 02563 Re: 1107 Falmouth Road; Centerville, MA Dear Ms. Fardy; Please be advised that I inspected the Tower level of your property located at 1107 Falmouth Road on Feb. 17, 2010. This area consists-of an independent living unit separate from the principal residence.on the first floor. As I was unable to access the primary and second floors during this inspection I left my card on the premises;those tenants have not responded. At this juncture I am compelled to advise you that the current confirmed use as (at least) a two family violates the governing single-family zoning provision under Chapter 240 Section 11 of the Zoning Code. If you believe you are entitled to nonconforming status as a use other than a single family home I would be happy to review any supporting documentation you may submit otherwise you must contact me by 3/12/2010 in order to discuss the procedure to restore the property to that of a single family home. Sincerely, Robin-C. Anderson Zoning,Enforcement Officer JA1107 Falmouth Centery Fardy.DOC s i DATE: March 10,2010 ,. TO: Building File FROM: Robin Anderson, ZEO RE: 1107 Falmouth Rd, Centerville • Met with property owner,Alice Fardy and FPO Mike Grossman(COM FD) • Inspected all floors of residential building. • Found basement apartment separated from primary unit. • Single tenant in lower level unrelated to tenants above. • Housing voucher for three women living in primary unit. • Property neat and clean and well-maintained. • Lower level unit contained one bedroom with egress window • Lower level unit did not have a traditional kitchen. • A full sized refrigerator was found in the bathroom hallway. • Was informed that tenant relies on the bathroom sink. • Built in cabinets (as typically found in a family room) with microwave on top. • Advised owner to give notice to tenant. • No deconstruction necessary. • Property limited to single-family use only. • Gave 60 days for tenant to obtain another place. • Tenant needs 1 bedroom/studio within walking distance of 7/11 where he works as he does not drive. • Left card with tenant to call me. I'll check on available Amnesty units. • Requested info from Cindy regarding available Amnesty units within 5 mile radius of Greek Church. • Cindy emailed my 3 first names with corresponding phone numbers. • Tenant has not called me yet. i w Message Page 1 of 1 Anderson, Robin From: Dabkowski, Cindy Sent: Friday, March 12, 2010 10:45 AM To: Anderson, Robin Subject: RE: Available Amnesty Units Hello Robin I don't know if these sites are within your five mile radius Please do not hesitate to have renters contact me, for vacancy information 508-400-9018 Karen 508-420-1832 Gloria i 508-420-5678 Judy Cindy -----Original Message----- From: Anderson, Robin Sent: Friday, March 12, 2010 10:02 AM To: Dabkowski, Cindy Subject: Available Amnesty Units Cindy, I need to know if you have any available units within a 5 mile range of the Greek Church. I am displacing a tenant and I think he may qualify as an Amnesty tenant. I would like to be able to let him know we have some units to consider. He needs a one bedroom or a studio. Please advise. �Xq6in Rodin C. Anderson Zoning Enforcement Officer Tbwn of Barnstable 200 'Wain Street Hyannis, NA 02601 5o8-862-4027 3/12/2010 . Town of Barnstable �p THE Tp� o Regulatory Services Thomas F. Geiler, Director • BARNSfABLE, y MASS. Building Division i639• �� p'Fo �a Thomas Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXIT ORDER DATE: LOCATION: /107 6/Alou71'� F.J. UNDER THE PROVISIONS OF 780 CMR, THE STATE BUILDING CODE, SECTION 3400.5.1, YOU ARE HEREBY ORDERED TO IMMEDIATELY DISCONTINUE THE USE OF THE CELLAR/BASEMENT AREA FOR SLEEPING PURPOSES. L CTOR SIGNATURE OF RECIPI ODEM DE SAIDA DATA: LOCALIDADE: DE ACORDO COM 0 PROVISORIO 780 CMR, CODIGO DE CONSTRUCAO DO ESTADO, PARAGRAFO 3400.5.1, VOCE ESTA ORDENADO DE DEIXAR DE USAR, IMEDIATAMENTE, A AREA DO PORAO/BASEMENT PARA 0 PROPOSITO DE DORMIR. INSPETOR LOCAL ASSINATURA DO RECIPIENTE f - . 08/02/2011 13:05 7815858914 VCF'KINGSTON PAGE 01 __.. ,.._ AUG-G2-L011 13 23 TODAY REAL ESTATE 1 508 790,1380 F.0011001 AFFIDAVIT August 1, ?0 l l I, Steven L. Murphy cf the Law Office of Holmgren, Koreta,Smaro&Murphy, 8t2 Man St."ee,, 0s:e1ville,Massachusetts, herein ca fy under el';e pains and penalties oC A)T%i7t ;v l> perjury that rtillijes at l0�Fal p rtiuutki!load is currently used by Alice Se_ler,fik/�a Alice Fardy ovnar acid a Sellei,as-a three(3) bedroom single-family dwelling, and that Buyers,Seth J. Andreson and Leavitt Z. A.ndreson have been informed Ey Seller,Alice Seller now That pr-=' ices must be rises as a three(3) bedroom single.-family dwy.]Nn3 and wil! use Same as said rrree(3; bedroonn single family bemc w•:ith no other use. Boyers are a)90 aware that the lower rc.oms in the premises are not to be used as bedrooms. 5t L hy,Esquire Accepted: A•l�cfe Seiler.Mda Alice Fardy, Seller Accepted: - .--� Seth J. , itd esoi,Buyer - ---- .accepted ZAnlresony. , Buyer Tota P.001 Town of Barnstable Building ,.;.` �,✓„ $f-' � ,�."�'. Z. y •[q,. �,„_ 1 �_':-�I� 'h�� �,7' ''�i'.�,5,'L'2,�ha� . - " k "" K ..,83% ,,.;a "��' �"`�6" '$i.LL �,�E,ie- �,�•�,` � -."`'. ,-'��', Post This-Card So'That rts Vis�ble:From,„theS,treetA roved PlansMustbeRetamed onJ-,ob andth�snGard Must be Kept •„ Posted U,ntIl;Flnal Inspection Has Been Made, , . rPermit n Where a Cei tificateFof`Occu anc. %is Re `u�redEsuch'Buildm 'shall No#be®ccu ietl until a Final&ins` ectiori has beenmade Permit NO. B-18-131 Applicant Name: ARMEN SAFARYAN Approvals Date Issued: 01/17/2018 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 07/17/2018 Foundation: Location: 1107 FALMOUTH ROAD/RTE 28,CENTERVILLE Map/Lot 250-009 Zoning District: RD-1 Sheathing: Owner on Record: WONG,SUSAN,TRUSTEE �' �� g Contractor.Narne ARMEN SAFARYAN Framing: 1 Address: 396 WASHINGTON ST �< Contractor`License 183202 2 WELLESLEY, MA 02481 . Est Project Cost: $5,650.00 Chimney: Description: RE-ROOF STRIPPING OLD $35.00 Permit Fee: . e Insulation: Project Review Req: �bFeef Paid:' $35.00 Date.. 1/17/2018 Final: rf r _. Plumbing/Gas , Rough Plumbing: z � .. - Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized bythis permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved applieWtio and the"approved construction documents,orMhidh this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by laW!�arid codes. Final Gas: °� �in :ate {; This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public spection for the entire duration of the work until the completion of the same. 81 Electrical � Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire1Offiaals are provided on this permit. Minimum of Five Call Inspections Required for Al Construction Work K ��. 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: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health 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 f 1 i 4 ` f Town of Barnstable *Permit#8 3 ties 6 months from issue date kj Building Department Tee ° ® . Brian Florence,CBO VX59• �+' ,1��� Building Commissioner FD MA4p." 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us > 08-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number ,:ate(- Property Address f b 7 P 4.�jYL lC � Ali/Ile . ZA-es-i-d'ential Value of Work$ �� C� Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address set M Q Yt 0L Wo vq 1�a 7 r-rel�yv�-P-�-t► �o� ���-l��rl� , G��- Contractor's Name �/rn" C� k, C til Telephone Number C—o '7 7 Home Improvement Contractor License#(if applicable) l 3 ZO 2 Email:Careycy440 r!!Y/oot,-� A,a"I Ce t.•, Construction Supervisor's License#(if applicable) �d 00 Z ❑Workman's Compensation Insurance Check, . am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. - Permit Reque (check box) LJ'Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to Ya df1�1 ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: *Where required: Issuance of this permit does not exempt Ompliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: gPiropeOwner must si P o e Owner Letter of Permission. f the Hom I pr t o t act License&Construction Supervisors License is i SIGNATURE:. g C:\Users\decollik\AppData\Local\Microsoft\W indows\INetCache\Content.Outlook\9NNOKXYW\RESIDENTILONLYEXPRESS.doc 09/26/17 The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERNUTTING AUTHORITY. Aialicant Information Please Print Legibi Name (Business/Organization/Individual): Address: S e a 4 - �/ City/State/Zip: k anjq 5 0 2 -0 I Phone#: So' '7 7 5' t7 Are you an employer?Check the appropriate box: Type of project(required): LEEYI am a employer with_employees(full and/or part-time).* 7. New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. Demolition 3.❑I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 Q Building addition 4.[:]I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.[]Pl mg repairs or additions 5.]I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.FiWoof repairs These sub-contractors have employees and have workers'comp.insurance. 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'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 thepolicy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy I this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verificatio I do hereby certi hnder t e a n a d enald perjury that the information provided above is true and correct. Signature: Date: Phone#: o 7 7 2 y o Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: _ Massachusetts Department of Pubiic.Safety Board of Building Regulations and Standards .License:CSSL-106102 Construction SuperVisor Specials/ -, ARMEN SAFARYART 97 SEA STREET APT A4 WANNIS MA 02601 Expiration: Commissioner 10/0212020 s Office of Consumer Affairs and Business Regulation One Ashburton Place- Suite 1301 Boston, Massachusetts 02108 Home ImprovemOVContractor Registration Type: Individual ARMEN SAFARYAN = Regis4�on: 1W202 67 SEA ST APT A4 Expiration: 0s/131�1s HYANNIS, MA 02601 i o zone osm UPS Address wid MUM card. ''✓ie �nir�mcnm�ll�n�✓���so���tefl _ -- - Office of ConsumerAffalm&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual useoNy TYPE:Indnadual before the expiration date. If found return to: Registration'__. i an Office of.Consumer Affairs and Busim R 1:83202-= =...t>0113/20t9 10 Park Plaza-Suits S17 _ Boston,MA 02116 ARMEN SAFARYAN=._` ?, DB/A COREIk-AND GOREX= ARMEN SAFARYVN:,' 67 SEA ST APT A4. c HYANNIS,MA 02601 * - Undersecretary Not valid vurthout '0 re C DATE(NIMMO f" '' CERTIFICATE IFIll�>�TE ® LIABILITY INSURANCE F9/21/2017 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 3ELOW. 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). ODUCER CO TACT Ashley Pai va )utheastern Insurance Agency, Inc. PHONE (508)997-6061 IFAX (508)99n-2T31 Af No 39 State 93 AUE)R!(EW-.apaiva@southeasternins.com .O. Box 7 9398 INSURER(S)AFFORDING COVERAGE I NAIC a )rth Dartmouth NIA 027a7 LURED A INsuRERArbella Protection Insurance 141360 INSURER B AEIC .men Saiaryan, DBA: Corey and Corey INSURERC• 1 I Sea Street ll.t A4 INSURER D ' INSURER E (aIIn15 NIA 02601 INSURER F• DVERAGES CERTIFICATE NUMBER:2017-18 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 VUHICI4 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. R I TYPE OF INSURANCE INSD I vivoI POLICY NUMBER I fP yACY EFF POOLICY DIP TYPE DNYM LIMBS I n I COMMERCIAL GENERAL LIABILITY } E� nOCCURRENCE 15 1,000,000 I I CLAIMS-MADE 1 -- 'OCCUR I t i i i OAMAG O RENTED PREMISES Ea ccaurenc� Is 100,000 95200464aI 03 l 9/18/2017 9/18/2018 MEDDCP(Anyone pa'son3 S S,DOo PERSONAL&ADV INJURY IS 1,000,000 E N L AGGREGATE R APPLIES PER: I i I ftEt.AGGREGATE 2,000,000 +� POLCY- P DUCTS_ I JECT �LOC COMPIOPAGG I S 2,000,00o �I OTHER_ jlll I Is I AUTOMOBILE LIABILITY I { I I I COMBINED SINGLE LIMIT S l Ea accidentl `ANY AUTO � I � � � BODILY INJURY(Per person) S If--I ALL OWNED SCHEDULED AUTOS IL—J AUTOS I ( { BODILY INJURY(Per accident)I S HIRED AUTOS AUTOS�� PROPERTY DAMAGE I Peraccident 5 IS UMBRELLA L1AB OCCUR - EACH OCCURRENCE IS HEXCESS UAB I I CLAIMS-MADEI I AGGREGATE Is I S I DED I (RETENTIONS WORKERS COMPENSATION { I { PER OTHER AND EMPLOYERS'LIABILITY I I STATUTE I ( O'FlCERR EIN JANY IP BER EXCLUDED?ECunVE Y�1 N l A I { I (EL EACH ACCIDENT Is 1,000,000 3 (Mandatory in NH) �� I I ACC50D50150912017A 9/18/2017 9/18/2018 EL DISEASE-EA EMPLOYS 1,000,000 If yes,describe tinder I {DESCRIPTION OF OPERATIONS belaw 1 I E.L.DISEASE-POLICY LIMIT I S 1,000,000 ESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additianal Remarks Schedule,may be attached if more space is required) x :ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Display Purposes Only. THE EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED IN- ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Ashley Paiva/AMP - ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025 nnuml i CORE, Y C' ORE, Y' `6 The Roofers 6` 67 SEA STREET APT#A4, HYANNIS MA 02601 C E It T A,I N!T E� E� Di L A ND Nh.A R.K L ET1 N; E ALGAE RESISTAXT ,E O O:F1 It,0 P- .O O�S A.L, December 29,2017 SAMANTHA WONG 1107 FALMOUTH RD EM: head.meadow.beach@gmail.com { CENTERVILLE,MA Tel: 424-777-8997 COREY & COREY hereby proposes to perform the following services in a neat and professional manner and in accordance with the manufacturer's specifications and local building codes. Remove and Haul Away All of the Old Asphalt Roofing Shingles (One Layer)from the Whole House Only. Supply and Install CERTAINTEED LANDMARK AR: LIFETIME WARRANTY, 10 YEAR SURE START PROTECTION,CLASS A FIRE RATED, COPPER/CERAMIC STONES for a FULL 10 YEAR WARRANTY AGAINST ALGAE CONTAMINENT,240 POUND,EXTRA HEAVY WEIGHT, 130 MPH WIND WARRANTY,CATEGORY III HURRICANE,STORM MURICANE NAILED (6 NAILS PER SHINGLE). MULTI-LAYERED,LAMINATED ARCHITECTURAL STYLE,FIBERGLASS BASED ASPHALT SHINGLES. COLOR• Black Supply and Install HICK'S VENTED DRIP EDGE on All of the Eaves. Supply and Install CERTAINTEED WINTER-GUARD (Ice &Water Shield)WATERPROOF UNDERLAYMENT SYSTEM on Roof Eaves& Under the Step Flashings,on the Skylights and Chimneys. Supply and Install` #15 BLACK SATURATED FELT ROOFING PAPER Supply and Install AIR VENT SHINGLE VENT H RIDGE VENT on the Entire Ridge. Supply and Install ALUMINUM& NEOPRENE SOIL 1PIPE FLASHINGS Clean and Remove Debris from work area after job is completed. TOTAL INVESTMENT ------------- $59650.00 OR C R E- Y & C 6' The Roofers " POSSIBLE EXTRA CARPENTRY: Any Rotted or Otherwise Deteriorated Trim Boards,Plywood Sheathing,Missing Metal Flashing, Side Walling or Any Other Carpentry Needing Replacement will be done and charged for as an Extra: Materials Plus Labor at the Rate of$ 50.00 per Hour. PAYMENT SCHEDULE: A Deposit of One Half is due at the Signing of this Roof Proposal and the Final Payment for the Balance is Due Immediately Upon Completion. WORK SCHEDULE: All Roof Work is Scheduled for Completion Within 90 Days of Acceptance and Receipts of Deposit providing the Materials are Available.Therefore Deposits Received are Non- Refundable After a Three Day Cooling Off Period from the Date of signing. Please Make Checks Payable to: " COREY & COREY COREY & COREY Warranties the Shingles and Labor for 5 years. CERTAINTEED Warranties the shingles and labor 100% for the First 10 Years and the Shingles your LIFETIME if the shingles becomes defective. CERTAINTEED Warranties the Shingles up to a CATEGORY III HURRICANE-130 MPH WIND WARRANT. CERTAINTEED Warranties the Shingles to be Algae Resistant for a Full 10 Years. COREY & COREY carries Workman's Compensation and Public Liability Insurance on the above work Roof to be repaired during winter in January/February. DATE OF ACCEPTANCE: 12/29/2017 ACCEPTED BY: SUBMITTED BY: SAMANTHA WONG ARMEN S YAN HOMEOWNER COREY & CVOREY , i -Assessor's office(1st Floor): ry 1� R, Assessor's map and lot number i�.�� �/�7 f�3» LLED ON CC 0*'THE TOE o Board of Health(3rd floor): 6 � � nTL[ �) '` Sewage Permit number - - l G dv�v��nCIA ENTAL�� e . f g 3At39TA1DLL i Engineering Department(3rd floor): i l D moo r & House number 111639. e 3 Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN, OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO Add Z Ad .T_1(0rfe �G/'I�G C- f•�� TYPE OF CONSTRUCTION GvG® Q 19 . 'TO THE INSPECTOR OF BUILDINGS: 'The—undersigned hereby applies for a permit according to the following information: �� �� �� v ccn i✓ z Location .v Proposed Use �f Le �'�'+? � GL LIF S IC IJ Fire Districts ,Zoning District _ Name of Owner FP �-!E& Address �2�60 46. Name of Builder p,fhSr 0°e�C16Pmen"f Address Name of Architect Address Number of Rooms Foundation /Z X s ! v5 �'} Roofin -W �-� Exterior �� 9 A Floors ► t � �'d Lootz�a Interior - Heating ' X!S "v J Plumbing Fireplace AJO AJ -P— Approximate Cost ©rid Area Diagram of Lot and Building with Dimensions Fee i OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS ' I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name RJ ell,, / Construction Supervisor's License "' FARDY, GEORGE JR. 3 3 No 33743 permit For Add 2nd Storv/Remodel Interior Single Family Dwelling Location 1107 Falmouth Road t� Centerville - Owner. George Fardy, Jr `. L J' k Type of Construction Frame 4 Plot Lot r Permit Granted May 14 , 19 90 t. Date of Inspection 19 �! "Date Completed �/��/ 19 -� j Ar y s r a �:re � �,.tom _;.,;.: '.<.'3•`fi••�'.r!'. ..r. ,..,�:r.^..;�+,. ...�,:;-rt.=""e�'. .. � _ ..,,,.d..a..air r •. .:vim �.4 r» .. . ,. : r`4 '"g',._:� w Assessor's office(1st Floor):Assessor's map and lot number r . 7� � / Q�oT THE Board of Health(3rd floor): Sewage Permit number -11 9G L` ,� ` • _ V = DAUST = i Engineering Department(3rd floor): a �) NAB& House number °o i639- Definitive Plan Approved by Planning Board 19 yo r�Y A, APPLICATIONS.PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only 1 TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO 4� Add 2 �Gj .57 a-c TYPE OF CONSTRUCTION GvUp TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 1107 1V!D0 T2 Proposed Use l7� Fire District s �t Zoning District � , Name of Owner 6 e0/2, F14 S/L, Address ;2-;16 40 Name of Builder Address ' -- Name of Architect 12 Gus� L o_ Address Number of Rooms Foundation S %, Exterior �e'c Roofing A 7— r Floors A rei c-'� Interior Heating Plumbing Fireplace A✓6 N Approximate Cost 1 ©OCR Area Diagram of Lot and Building with Dimensions Fee x is OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Construction Supervisor's License FARDY, GFORGF JR. . A=250--0051 No 33743 Permit For Add 2nd. Story/Remodel interior 0 Single Family Dwelling Location 1107 Falmouth Road Centerville Owner George Fardy,, j r. Type of Construction frame Plot Lot Permit Granted May 14, 19 90 Date of Inspection 19 Date Completed 19 PERMIT COMPLETED 1/11 .. _ Town of BarnstableBuilding Post This Card Sd That=it is`Visible' From the Street-,,Approved Plans Must",beRetained on Job,and this�Card Must be Kept tAR3V�'CA .C. - g Posted Until Final 11- pection Has Been Made: _ = 'sues - Where.a Certificate�of,Occ,e�pancy'isRequired,such Building shall Not be Occupied until a Final Inspection has been made Permit Permit No. B-19-2432 Applicant Name: Sue Wong Approvals Date Issued: 08/06/2019 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 02/06/2020 Foundation: Location: 1107 FALMOUTH ROAD/RTE 28,CENTERVILLE Map/Lot: 250-009 Zoning District: RD-1 Sheathing: Owner on Record: WONG,SUSAN,TRUSTEE Contractor Name:` Framing: 1 rr �� Address: 396 WASHINGTON ST Contractor Licenser 2 WELLESLEY, MA 02481 ( _ "� Est. Project Cost: $ 1,000.00 Chimney: ) Description: Replace existing windows with new replacement windows', Permit Fee: $35.00 Insulation: Fee Paid., $35.00 :Project Review Req � r Date 8/6/2019 Final: .' � '✓ Plumbing/Gas ." Rough Plumbing: Building Official Final Plumbing: m hs.afterissuance. .� . ont , This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has.been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws-and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. i i4. i Electrical all applicable signatures b the Building and Fire Officials are provided on this,permit. I� The Certificate of Occupancy will not be issued until pp g Y - - g : p. a Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing 2.Sheathing Inspection Rough: 3.All Fireplaces must be inspected at the throat level before firest flue Iming'is*installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Rough: 7.Final Inspection before Occupancy Low Voltage Final: 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. Health . - "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth In MGL c.142A). Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: GYn✓�` S e,�T Town of Barnstable F: Building HAWMni Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept Posted Until Final Inspection Has Been Made j 1 Hua Where a Certificate`ofOccu'pancy is Required,such Buildingshall Not be Occupied until'a Finalanspection°has been made. Permit No. B49-2363 Applicant Name: Sue Wong Approvals Date Issued: 08/06/2019 Current Use: Structure. Permit Type: Building-Deck Expiration Date: 02/06/2020 Foundation: Location: 1107 FALMOUTH ROAD/RTE 28,CENTERVILLE Map/Lot250009 Zoning District: RD-1 Sheathing: Owner on Record: WONG,SUSAN,TRUSTEE Contractor Name Framing: 1 Address: 396 WASHINGTON ST Contractor License: ": 2 WELLESLEY, MA 02481 Est. Project Cost: $500.00 `ID Chimney: 4. Description: Replace rusty joist hangers and install new deck floorboards(80 Permit Fe3e:. $ 110.00 1 Insulation: square feet) ( Fee Paid $ 110.00 " Date:- 8/6/2019 Final: Project Review Re q f 1 � . Plumbing/Gas Rough Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is corriinenced within six months after issuance. Final Plumbing: ngranted. All work authorized by this permit shall conform to the approved application and the'approved construction documents for which this permit has been Rough Gas: and changes of use of an building and structuresshall be in compliance with the local zoning by-laws and codes.- g All construction,alterations c g y g � P � � This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. Final Gas. r The Certificate of Occupancy will not be issued until all applicable signatures by the Building.and-Fire-Officials are"provided on this permit. Electrical Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing Service: 2.Sheathing Inspection i' 3.All Fireplaces must be inspected at the throat level before firest flue;lining is installed _ _ _ aV Rough: 4.Wiring&Plumbing inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation 7.Final Inspection before Occupancy Low Voltage Rough: Low Voltage Final: 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. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: Em A S Town of Barnstable _ Building. rwyrA Post This Card So That it is Visible From the Street-Approve d,Plans Must be Retained on lob and this Card Must be Kept" ;. .. Posted Until Final Inspection Has Been;Made. el it Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final lnspection.has been made. Permit No. B-19-2361 Applicant Name: Sue Wong Approvals Date Issued: 07/24/2019 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 01/24/2020 Foundation: Location: 1107 FALMOUTH ROAD/RTE 28,CENTERVILLE Map/Lot: 250-009 Zoning District: RD-1 Sheathing: Owner on'Record: WONG,SUSAN,TRUSTEE Contractor''Name: Framing: 1 Contractor License: Address: 396 WASHINGTON ST ' 2 WELLESLEY, MA 02481 Est. Project Cost: $2,000.00 Chimney: Description: Replace 3 existing exterior doors and storm doors Permit Fee: $35.00 Insulation: Fee Paid:' $35.00 Project Review Req: {° Date. 7/24/2019 Final: Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. g /e Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Service: F 1.Foundation or Footing 2.Sheathing Inspection - Rough: 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 Final: S.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health 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). Building plans are to be available on site % Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT -�P Final: S� i W e a herizatian & Insulat, ion 4io Grove Sc Fall River,Ma o2723 Insulatessavezet 7/15/2019 To whom it may concern, This affidavit is to certify that all insulation/weatherization work that Insulate2Save Inc.completed at the following address meets or exceeds Federal and State requirements: Susan Wong Permit#B-18-2276 t1107 Falmouth Rd/RTE 28 Centerville MA 02632 Please let me know if you have any further questions. Thank you, ` ' -E- Insulateaave, Inc. �, d Alison Pinheiro/ Office Manager Epp[, Phone:(508)567-6706 (Fax:(508)617-8092 a Visit us online: CD � CD www.Insulate2Save.net www.Facebook.com/Insulate2Save.net I • Town of Barnstable Building " ' :':� o,£.-R,."w' y .' ^.sy:""""'" .a �..,rt ..: .i h .."""".-.'An 1',.m? .a.t. • n Post Thls Card So That�t is,Visible From the Street-Approved Plans-Must be Retained.on,Job and this Card;Must be Kept ~"t MASS � Posted;Uitil Final ction Has Been Made ; u -- 163p..��.� 3� ,.�..':.k Permit : M� ,Where a Certficae of Occupancy is Required,such.Bu�Idingshall;Not be Occupied until a',F"mallnspection_hs been made ; . Permit No. B-18-2276 Applicant Name: INSULATE 2 SAVE,INC. Approvals Date Issued: 07/18/2018 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 01/18/2019 Foundation: Location: 1107 FALMOUTH ROAD/RTE 28,CENTERVILLE y r Map/Lot 250 009 Zoning District: RD-1 Sheathing: Owner on Record: WONG,SUSAN,TRUSTEE A p Contractor Name INSULATE 2 SAVE, INC. Framing: 1 Address: 396 WASHINGTON ST F ' Contractor License 180747 2 WELLESLEY,MA 02481 - X Est Project Cost: $1,833.00 Chimney: Description: Weatehrization f � 6 p Permit F.ee: $85.00 Insulation: } Fee Paid: $85.00 Project Review Req: s �2414*1'1ar Date 7/18/2018 Final: _ Plumbing/Gas " Rough Plumbing: g g ABuilding Official ". .r -` Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within sii months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the'approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street-or road and shall be maintained open for,public inspection for the entire duration of the work until the completion of the same. 3 --- _ ` Electrical The Certificate of Occupancy will not be issued until all applicable signtures by the Building and Fire Officials are provided on hs'permit. Service: Minimum of Five Call Inspections Required for All Construction Work , , 1.Foundation or Footinga' Rough: 2.Sheathing Inspection �"- 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection S.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation s1 �r'� Low Voltage Final: 7.Final Inspection before Occupancy � Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health 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 .t i s-+ a � - VrSa NEWs:asaa:✓ �rz. `s ::r3 i - 3 � �:..� ti:33a•, _:..� - e Y!.�a 1: 'i •'i I e - - -•✓"x � � YY-.\3' �3 j,Y33: � �: z5_�- .-_ - �.�.7. 77x:f" Yall i a/ a.W . .dal ® •SaLS•aII � - f 7al• f � f" .f„tea ' af.s ctta• e.tf.`�a 0 4it �,p� ::1; 0:•:;f:. ! `}•3a: i Y. ���11 s�d'_x i:E:ix4. ice:t.` —C b _ n g �. 'E.8 ,8L•�- f'f3}9 .✓.tE.6:- la�:'ai.ei �/ - �i x.�'ft- _ t a1�:; s:v5�,4_� Ing At en ` n����bQa A/0 o 01� cLwki Q l�e`C A 74 iar Stela 4eVf � Section 6—Project S W' ' Oil Task Storage Smoke Dete = Q Q ❑ Q Plumbing Gas Q Fire Suppression Q• Heating System Q Masonry Chimney Q Addlreloc ate..bedroam F .. Y .( py�=gyp . ,,pp Q i ii fft Water supply Q Pi1bIfC i Sewage:Disposal Q Municipal Q on Site Historic.District Hyannis Historic District. k Q Chid KiAp H ay Debris r�el)o sal Facility: e u 611L .zi< Prs : I using a craneFYes',0 Nod 0 / i� �^ �d0 T. Section 7—Flood e.Zon Flood Zone Designation Within or adjacent to a wetland,coastal bank? Yes,{{Q No Q Section 8inforiwkn District Proposed Use Lot Area Sq.Ft. Tote Frontage Pie of Lot Coverage J#of Dwelling Units(on sift.) Setbacks Fro4t Yard Regwredo Rear Yard Required___,_— ed , , Side Yard RequiredeProplor- this.pro y Igo i relief from the Zoning.Beard is the past? Section 9—.Ea33t tru • Acme D�C P ! 2 Telepl .N .. :ba 5ro Id 6; Hess �a Gr o v& S'� city 2�`ye� �Z p O a 74 o. 'License-Number 10,E�> / License Type Contactors wait 0//.j o n aO'`A y <O�i 2,5 ez 06-, neJ�-- # F aty regxd Ii#i I under d rules emdregdado SmUcemedf CIS State Bmlft Cods. F mideastwd the oe by , do 78fl C�+FR aad the Tows of .A a' ..of y� � Section 10-Holue Inw.WeMM� . Tel N. . 0 P ��� -76 -1 d s . o �tum* ��o?y Expiration Date F axy respOnSf W ties under the rules and regui�m for Ci t assay u}se Steft.BniFd�.Code. F�d dye co op pro ?es,. o dcict oo d by�CMR To o web a t y a LM... Date :Sean 11.-Rome.0 Home:Name: 2 4 vl Telephone Number Cell or Work N L d:a.y respoasbil da under the niles n .for L,iceatsed S acc o a%atbe-jas StateBWlft.Code. I MderStand ftr CO=WfM. by M Cla adthe Town offtmstabie. Sure. e� 2. e Date / IC C Tag 7`. I th Department ❑ Zoning Board(if req i;r4 rl Historic District Q Site Plan Review(if m4 ) Fire Department r-1 Conservation 13 i For.conowcId world please take yo,Trr plate day to-ta f e Sec�u 13-Owaer's n I, u e 00 as Owner the authorze hereby matteis receive to wort to act on may .in ail autho ' a by this bldi4g apron for: 1 e (Address of jai) Sigaatre of(honer l l� e e Prhit Name RISE Engineering R1:,too 16=r' : 5 Dupont Ave,South Yarmouth,.MA 02664 ENGINEERINGCONTRACT . WZ 508-568-1926 FAX 508-568-1933 Page 1 PROGRAM TNIS CONTRACT M ENMRED.INTO BETWEEN RISE ENGINEERING AND THE CUSTONER.FOR WORK AS - . CLC-HES DESCRIBED BELOW - - SUE WONG (424)777-8997 07/02/2018 256923 26002 -BILLNG-STREET 1107 Falmouth Road 396 Washington Street#241 Centerville, MA_02632 Wellesley Hills, MA 02481 .DESCRIPTION QTY COST :INCENTIVE TOTAL KNEEWALL CONTINGENCY A kneewall area in your home that could benefit from weatherization K""3 ,teals} work has been identified. Although your home would benefit from weatherization.work in this area,we have to remember the safety of the workers who will need to enter this space. The insulation contractor may need to inspect this space prior to scheduling the work, to verify their ability to accomplish the scope of work. , ATTIC DAMMING-R-38 FIBERGLASS 20 $49.20 $36.90 $12.30 Provide labor and materials to install a 12"layer of R-38 unfaced fiberglass batts for damming purposes. ATTIC FLAT-10"OPEN:R-37 CELLULOSE 400 .$624.00 $408 00, $156 00 Provide labor and materials to install a 10"layer of R-37 Class Cellulose to open attic space. KNEEWALI_:RIGID BOARD 98 $377.30 $282.98• $54.32 Provide labor and materials to install rigid board at R-10 or greater with the required fire rating to a kneewall area. KNEEWALL FLOOR-10"OPEN R-37 CELLULOSE 36 $56.16 $42.'12. . . $14.04 Provide.labor.and materials to install a 10"layer of R-37 Class Cellulose to an open kneewall floor. .;ATTIC HATCH:SEAL&INSULATE 1 $60.00. $45 00 $15..00 Provide labor and materials to insulate the back of an attic hatch with 2"rigid insulation board.Weatherstrip the perimeter. TEMPORARY ACCESS THRU DRYWALL 2 $148.38 $1IT.29 $3709 Provide labor and.mate,rials to make a temporary access to an attic area. The openingwill be closed with materials similar to those existing. ;Finish sanding and painting is not included. VENT BATH'FAN THRU ROOF 4" 1 $118.75 $89 06.. 3,29.60 Provide-labor.and materials to install an insulated exhaust hose with roof mounted flapper vent to exhaust existing bathroom fan(s).. AIR SEALING 4 $320:00 $320.00 Provide labor and materials to seal areas of your home against wasteful,excess air leakage.Materials to be used to seal your home. ' can include caulks,foams and other products. Primary areas for sealing include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed.) A reductlo l in cubic feet per minute(cfrn)of air infiltration will occur, but the actual number of cfm is not guaranteed. RISE Engineering 5 Dupont Ave,South Yarmouth,MA 02664 ENG,NEERING7 CONTRACT - WZ 508-568-1926 FAX 508.568-1933 Page 2 PROGRAM THS CONTRACT IS ENTERED INTO BETWEEN RISE ENGINEERING AND THE CUSTOMER FOR WORK AS CLC-HES DESCRIBED BELOW CUSTOMFR PHONE uATF CUE WORK ORDER SUE WONG (424)777-8997 07/02/2018 256923 26002 SERVICE STREET ANG STREET 1107 Falmouth Road 396 Washington Street#241 S P BILLING CITY,STATE,ZIP Centerville,MA 02632 Wellesley.Hills, MA 02481 DESCRIPTION QTY COST INCENTIVE TOTAL At the completion of the weatherization work,and at no additional cost to the homeowner,a final blower door and/or combustion safety analysis will be conducted by the sub-contractor. WEATHERSTRIP DOOR W SWEEP 1 $80.00 $80.00 Provide labor and materials to install Q-Ion weatherstripping and a doorsweep to door(s)to restrict air leakage. Total: $1,833.79 Program Incentive: $1,476.3.5 Customer Total: $358.44 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Three Hundred Fifty-Eight$44/100 Dollars $358•0 UPON RECEIPT OF YOUR RISE ENGINEERING IN CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL INTEREST OF 1'Y WILL BE CHARGED MONTHLY ON ANY UNPAID,BALANCE AFTER 30 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARAHTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. NOTE:THS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE 3Q DAYS. - ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE SATISFACTORY TO US AND ARE HEREBY ACCEPTED-YOU ARE AUTHORIZED TO DO THE WORK AS SPECIFIER PAYMENT WILL BE MADE AS OUTLINED ABOVE Town of Barnstable Building Department Services Brian Florence,CBO r 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 Lf Using A Builder h Sue Wong , as Owner of the subject property hereby.authorize��s"&2 yia ve,7at e- - to act on my behalf, in all matters relative to work authorized by this building permit application for: 1107 Falmouth Road Centerville (Address of Job) Signature of Owner Signature of Applicant 0 c� P t Name Print Name Date .' �. i The.Commonwealth of Massachusetts aDepartment o,f Industrial Accidents I Congress Street,Suite 100 Boston, MA 02114-201 7 �4 wwrt mass govldia Nt'orkers'Compensation insurance Affidavit:Builders/Contractors/Plecte eianslt'tuimbees. TO BE FILED WITH THE PERMITTING AUTHORITY. Anylicant Information Please Print Le ibly Name(Business/Organization/individttai): Insulate2Saye Inc. Address:410 Grove Street City/State/Zip: Fall River MA 02720 Phone#:508-567-6706 Are you an employer?Check the appropriate box: Type of project(required): i,Mx 1 am a employer with 20 employees(full and/or part-time).' 7, New construction 2,[]1 am a sole proprietor or partnership and have no employees working for me in $. Q Remodeling any capacity.[No workers'comp.insurance required.i 9. 3Qam a homeowner doing all work myself.[No workers'comp:insutanct rcquired.j t DemolifiiQn . 10 0 Building addition '41.MI am a homeowwr and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.[]Electrical repairs or additions proprietors with no employees, . 13,Q Plumbing repairs or additions 5. I am a general contractor and.1 have hired the sub-contractors listed on the attached sheet: These sub-contractors have employees and have workers'empp.ir,surance.t 13.�RgOf repairs , 6.®"We are a corporation and its officers have exercised:their right of exemption per MCL c. 14,M Oiher Insulation 152,§1.(4),and we have no employees.[lfo workers'cottap.insurance required] 'Any applicant that checks box#t must also fill out the section-below showing'their workers'compensation policy information. i'Homeowners who submit this affidavit indicating they are doing all work and then hire outside:contiactors must submit:a.new affidavit indicatingaueh. *Contractors that check this boxmust 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. t am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. . Insurance Company Name: Liberty Mutual Insurance Policy#or Self-ins.Lie.#. XWS 56418741 Expiration Date:. 12/10/2018 fob.site Address; `./d492 / O GL r,. /, ,/� Cit /stafe/Zi : E'u- h tJ! ©d to 3 a r 4 1!L K 1 � y l� Attach a.copy of the workers'compensation policy declaration page(showingthe policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to S1,500.00 and/or one-year imprisonment,.as wIell as civil penalties,in the form of a STOP WORK ORDER,and a fine of up to$250.00 a day against the violator,A cop}:of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification: I do hereby certify ironer the an e ties�f perjtery.tl�r�t th, ittfornrution provided above is trite and correct. .Signature: . Date: Phone M 508-567-6706 . , Official use.only. Do not write in this area,to be completed by city or town official City or Town: Permit/License#. Issuing Authority(circle one); . 1;Board of'i-l.ealth 2,Building Department 3..+City/Town Clerk 4. Electrical Inspector. 5.Plumbing Inspector 6,Other Contact Person: Phone#: { i , Office of Consumer Affairs and Business,Regulation 10 Park Plaza - Suite 5170 Briton, Ma usetts 02116 Hume Imp'rovem ` �tractor Registration Type: Corporaton Registration: 180747 INSULATE 2 SAVE , INC. Expiration: 12/28/2018 410 Grove St y Fallriver, MA 02720 � 9 , "~€ Update Address and return card:.Mark.reason for change, 3CA t 45 zoM-rl5rtt •' �_ _.. -,.__ _ __._w.. ._ . LZ A+dd ;_.��n Mal Em,loMent 0 Lost Card _ �- - 'w'.l'�z� t,�e��n�azcYi�,crantr��o��/v��feaxrc�is�lii Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for indlvddual.use only Y TYPE:Corporation before the expiration date. If found return to: . Office of Consumer Affairs and Busines&Regulation EXRbtlQn 1 W28/2018 10 Park Plaza-Suite 5170 r Boston,MA 02116 INSULATE 2 sv Roland tang 410Grove St Failriver,MA is 2 R Undersecretary Not valid without signature � Com nvcreal Kof Massachusetts i Division of Pfoussionol Licensure t; hard of Building Regulations and Standards on � rvisr F • CS-103861 irf :,Otii�019 3 qg ROLAND HIGHCRE R� FALL,.RIVER f Commissioner R � 'Y • �e s 1t 03�. TY AMERNOMPOW _ Anthomy F. Cordsiro ZXnsnsaace _ 171 Pleasant•:street Fa.0 Raver, Ili 02721 -- - � p { . . Insulate 2 Save, Inc . Aid Grove St. yall. River, MA 42.724 - 1C OR£ 4F AEY 74 . CEt7i ME►1f�E •l} AYf,t 'BY TEEt '�Cl . t3tlt7S y y: . 55d28'74S s J AM Wc - & JA et .4 Y 4 Y MiA 56418741 t2lloii MIYA=' ir•..�rb� . iiLGOiM1�ED X SCHEDULED AVTOS X X �eoatsras Au'os � a8 fWB DCCUR Y Y:U$4. 5bA3$7dl10 77 56 41$741 ~ Yna „t• 7: � '3!�'t1t .ry�sds .40f�/4d�o[al ReAstks�dw�ieaf _ . _. _. nw- • Sii013l,DAll1f�'tli�A8Q1��% Fi= _ _ ,.. .... .—. .... � ....,- .- ..... .. ��� "t 3" )_° S•" t ,. espy AC6aj T#ts./ICCR�i aatd b ' Application number.................... .... A � ' Date Issued.........vh.� .k.................................. MASS 1,639. 10% Building Inspectors Initials... Map/Parcel....... .5.�.. ..... ........................ TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project:' #0 7 /r'rvu-L� �� �rl�Cry,'/� NUMBER / STREET VILLAGE Owner's Name: Phone Number 11,?q- 7 774179 7 Email Address: Cell Phone Number Project cost$ 2 9' 5 5 Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: See C\4ac[44 c awfra.c--� Date: TYPE OF WORK E-1 Siding " Windows(no header change)# D Insulation/Weatherization 0 Doors (no header change)# Commercial Doors require an inspector's review Roof(not applying more than 1 layer of shingles) Construction Debris will be going to tJa5S e CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable)# / 6 6 0,� S (attach copy) Construction Supervisor's License# C7 2 7 7 L (attach copy) Email of Contractor N5w ee .ca rp Phone number 7 9'/ — 13 Z- gY0 S - A LL PROPERTIES THAT HAVE STRUCTURES OfIER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. r 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. Check one:this event is a:for profit non-profit event Check one: Food served Yes I 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/J.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 LICANT'S SIGNATURE Signature Date All perms a 'ons are subject to a building official's approval prior to issuance. 11 Window World Of Boston MA HIC Registratio e Offices & ShOWt'OOms Number: O 15A Cummings Park ❑295 Old Oak Street 166025 Woburn,MA 01801 Pembroke,MA 02359. Federal ID# (781) 932-4805 (781) 826-6281 82-4898432 www.WindowWorldofBoston.com Customer:-�AX /9 Phone(h)f2 777r 7 Install Address: /U7 �[�J7Q,Cflf//D, Phone(w) Ciry:�it"1E�J��L�C State:MA Zip WINDOW WORLD GLASS OPTIONS 1000 Series Single-hung Ail-Weld $199 `T SolarZone Elite-Dual Pane $119 12117f 2000 Series DH Alf-Weld $215 Triple Pane/Krypton $369 4000 Series DH Alt-Weld $240� (•Series 6000 Only) 6000 Series DH Alf-Weld $260 2 Lite Slider $374 WINDOW OPTIONS 3 Lite Slider ),13.113.,,3) (114.+/2.114) $575 ss Breakage Warranty(4000/6000) $15 INCLUDED Picture/Fixed Ute (0-83 UI) $365 2 Screens $g INCLUDED Picture/Fixed Ute (84-130 UI) $445 am Insulation on Jambs and Head $11 INCLUDED " Awning $310 ([)ouble Strength Glass(4000/6000) $15 INCLUDED. Casement Plus$49(DH Sash Rail)$330 r Double Locks(>26") $5 INCLUDED 2 Ute Casement $595 Full Screens $25 3 Lite Casement {��,, ,,�) (,I4.,2,/4) $910 Colonial Grids(Contoured/Flat) $65 Basement Hopper $434 Prairie Grids $75 Bay Window-Soffit Mount/INS Seat $2660 Simulated Divided Lite $182 Bow Window-Soffit Mount/INS Seat$2785 Tempered DH Sash(BSO) (TSO) $75 Garden Window $2040 Obscure Glass(BSO) (TSO) $75 Bay,Bow,Garden Oversize (+109 UI) $975 Beige/Almond $40 Oriel Style(40/60 or 60/40) $75 Wood Grain Interior(Series 4000/6000 only)$100 Foam Enhanced Frame $35. (Light Oak/Dark oak/Cherry/ Fox Wood PRE 1978 BUILT HOMES(EPA LEAD SAFE RENOVATION) Rich Maple) Lead Safe Practices Required $30 /Z Brown Exterior(Arch.Bronze/American Terra)$100 MY HOME WAS BUILT IN THE YEAR/gam Initial Designer Color Exterior $175 MISCELLANEOUS .Speciality Window $ _ ? Custom Exterior Aluminum Cladding (Two-Bend) Window Color / 0 Textured$90 s�-8 Smooth$90 $�d inside OWde Facing Color f✓/TJ7 NON CUSTOM DOORS Metal Window Removal $75 Vinyl Rolling Patio Door 5ft or Eft $1098 New Construction Vinyl Removal $175 vinyl Rolling Patio Door 81t. $1195 Multi-Bend Cladding $20 Add to base price for Custom Rolling Patio Door $1250 Mull to Form Multi Unit $30 French Rail Sliding Patio Door 5ft.or Eft. $1395Install Interior/Exterior Stops ! $50 Z®O French Rail Sliding Patio Door 8ft. $1495 Install Interior Casing Starts At $95 French Rail Sliding Patio Door 9ft. $1595 Insulate Weight Boxes j $20 Custom Exterior Cladding $300 Roof for Bay/Bow Windows $500 SolarZone Elite or E7C Glass $305 Existing New Const.Ext.Retro'Ft $150 Grids Patio Door $210 Removal of Existing Bay/Bow i $250 Woodgrain Interiors $395 Repair Sill,Jamb or replace sill nosing $75 Interior Designer Colo ✓ $595 Z Full Sub-Sill (Single)replacement $175— Interior Casing 272 Iz $275 Handleset Options (l '� $ Mullion Removal $50 $ Bay/Bow Conversion Ext.Retro Fit $450 (New Siding Will Not Match) Door Color / Inside outside •• ROUND UP FOR WINDOW WORLD CARES V St Jude Children's Research Hospital - $ customer oecnnes gncls On w_Inaowsr000rs initial Ic _ DISCLAIMER,•Customer is responsible for the following in connection with this contract:Painting,Staining,Alarm System disconnect/reconnect Miring Permit fees in excess of$25.00,Homeowner and or Condo Association Approval,Historic Oistrict'Approval.City of Boston parking&sidewalk Permit fees in connection with installation. NO EXTRA WORK IF NOT IN WRiTINGI Customer agrees to the terms of payment as follows: 31,4.1/^/G 4Z0A-aF_,j5; Extra Labor&Materials ${ 39� 5ffii✓�Tt�.t/ Site Set Up,Permit,Disposal&Delivery Fees$f $389.00 Total Amount ,Z 1774 67-7-091 Custom Order Deposit 33% Project Start Payment 33% $1 �S 95 Z Balance Due Day of Installation Amount Ananced $I Window World of Boston anticipates starting this work on ZQ and being substantially completed inl,Tdays.Security Interest:Yes No Any deposit required in advance of the start of the work S A NO exceed 331/3%of the total contract price or the actual cost of any material or equipment of a special order or custom made nature,which must be ordered in advance of the start of the work to assure that the project will proceed on schedule.No final payment shall be demanded until the contract Is completed to the satisfaction of both parties. All home improvement contractors and subcontractors shall-be registered and that any inquires about a contract or subcontractor relating to a registration should be directed to:Office of Consumer Affairs and Business Regulation,Ten Park Plaza,Suite 5170 Boston,MA 02116.Phone:(517)973-6700 No work shall begin prior to the signing of the contract and transmittal to the owner of a copy of such contract. Window World of Boston under provision of Chapter 142A of the general laws is required to apply for and obtain all construction-related permits.Window World of Boston shall not be deemed responsible for delays in the work described in this agreement caused by regulatory,permit granting agencies,authorities or individuals. Notice:If the PURCHASER(S)obtains his own construction related permits for the work described under this agreement or deals with unregistered contractors, the PURCHASER(S)is hereby'advised that in the event of a dispute,judgement and nonpayment,the PURCHASERS collection from the guaranty fund established by chapter 142A,M.G.L. y ( )will not be entitled to make a claim or You the buyer may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. Notice of cancellation mus 'be in writing postmarked no later than midnight of the following third business day. THIS NOT FOR RESALEI This Window Word®Franchise Is independea owned and operated by L&P Boston Operating, Inc.under license from Window World,inc, Ow er•Do not sign If there are any blank spaces. Date �* "22 I esman:Do not gn N any blank spaces. to Owner:Do not sign if there are any blank spaces. 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JEFF C.STEELE - 15A CUMMINGS PARK WOBURN,MA 01801 Undersecretary ' The Commonwealth Of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders!Contractors,Tlectricians/Plumbers. TO BE FILED VVITE THE PERMMLN(3 AUTHORITY. Annlicant Information Please Print Legibly Name (Business/Organization/Individual): JAZ lCA rJ &/D r/q/MC Address: 15�H C C 1� City/State/Zip: "LrA Phone #: -78 1 — 3 2_ - IFS O 5— Are you an employer?Cbeck the appropriate box: Type of project(required): I.[311 am a employer with '_O _employees(full and/or part-time).{ 7. New construction 2. I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling � any capacity.{Tie workers comp.insurance required.] ; vI an;a homeowner doing a;work myself.?vo worker'comp.insurance required. n Demolition 4.71 am a homeowner and will be hiring contractors tq conduct all work or,my property. I will 10 ❑Building addiron ensure that all contractors either have workers'compensation insurance or are sole 11.F�Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions S.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.' 1-•[]Roof repairs � I 1 14. �tl1eI 1•n,;in Cf O w .Ir l We are a corooration and its officers have exercised their right of exemption per MGL c. i152,§1(4),and we have no employees. ?io workers'comp.insurance required.; i f e '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 ther,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 emploi-er thar is providing workers'compensafion insurance for my emplt-vees. Belox is the policy and job site information. Insurance Company Name: P al'l--fa-r Ere Tn s J M 11(C E CeD . Policy# or Self-ins.Lic.#: Z Z W E C L -2 Expiration Date: 1- Z 7— /9 Job Site Address: 7 ��'+�y��* �� City/State/Lip: re,14or-v,de HA Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152:§25A is a criminal violation punishable by a fine up to S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator.A copy of this s tement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verifi lion. I do hereby cer under a pair erjury that.the information provided above is true and correct 5i ature: ' Date: —7 Phone#: - .3 2--- o5 a use only. Do not write in this area, to be completed by city or town official City or Town: Permit..License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: r �.....� CERTIFICATE OF LIABILITY INSURANCE DATE{(d�4/00PYyyy THIS CERTIFICATE L5 ISSUED AS A MATTER OF 1NFM NO RIGHTS UPon THE 3/2912018 ERT CERTIFICATE DOES NOT)FIC APFI F TNSVEI.Y OR NEGATIVELY AMEND.E TEND OR ALTER.THE COVERAGE A1:FORpEDIFICASY THEPOLICIES BELOW. 7M3 VER'r1F1ROD .OF INSURANCE DOSS NOT CONSTITUTE A CONTRACT$BTWEEN THE ISSUING INSURER Y AITFHORIZ» REPRESENTATIVE OR PRODUCFit,AN13 THECWMCATE HOLDER. IMPORTANT.fSUOGA If the certificate holder is an ADDI710NAL lNBUREG the If SUBROGATION IS WAIVED,subject , poLCy(esj ntitst have ADDTIIONAL INSURE))Prosnisioies Or Be endorsed. this certificate does not confer ri i to thec 3eTlns and*Allditions•of•the policy,certale policies may require an endersemeet A statement on PRODUCER g ���m'in l'eU ofsuch endorsm*M(s>. Marsh&lUlcl ennan Agency"C CO a Carl VI of er CtC,C13R,CBIA M5 N.Elm St. PH0t1E Greensboro NC 27455 336-644-685D a No:292 6p7 6516 A Cari). marshmma.cvm AFpolaJaua covERAc-F NAIc(M bwN00.2 IMURMA-Altmeri(a Financial Sendt f 10-4ndow World of 8ostoirk LLC a B-Hartford Fire Irmura,ce an 118 Shaver Street 31b34 19682 North VWkesbom RUC 28659 INSDRER 2:MassachUsOft Bay Insurance Company 22306 INS 1NS1JR6R8: ' COVERAGES CERTIFICATE�MSM-1016D15T72 temp.- THIS IS TO CEP.TIFY THAT THE POLiC1ES OF IPISURANCE2157 ED'B@L01)U}rA}/g SEEN 1S3IJ1EE TO THE INSURED MAIMED AB F THE POi1CY PERIOD M1NDICIhED. N07WJ9i{$TANDWGANY P.EQUIREMENT,TERM OR CONDTTIOIV OF ANY COA)TRgC7 01iQTHER.DOMAMED VIll7H RESPECT TO 1MilCHTHIS CLUTCATE MgY BE ISSUED OR MAY PERTAIfif,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED kHERpN IS 7�CLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HA1/E BEEN REDUC>:D 61'PAED ClAAWS� SUBJECT TO ALL THE TERNS, TYPE4F1N508ANm ySUM 3f COMMERCTALGI NM 1 POLIMNU POLMYEFF P EXP RgLLIABILITY i ODIUM= LIMITSr CLAllMSMADE aQP`CUR i aM1R�18 4>G20,9 'ACHOCCFXMC-r 51t10.00D PRE 0 $� i I MAEO e-,P(Airy Mo Imrnotl) _ 250.00 I rGC-D17.AGGREGATEL@IJiP,PPLIESPER: � � r'ERSOTaALSAT}VR�IJW..Y 9?.o00.otY� ��----77 i EM POLICY�1 LOC GENr](ALAQGRLGJSTE_ $2000.0m trJiER j j PRaDuoTs_COMnPJDPAeG I S2.000.000 A �AUUTCI80eiLE LIAHJLrry M i ' AbV6875I6rb 1 S i Fa Jl i ANY AI:TJ ! ! I i �M62.DM7 219BIZD'18 ED NGLE LJM[T OWNED I i 0 000 SCHE AUTOS ONLYULEO I I ? BCJ71LY1NJUPY(Perpersa HIRE $ A ,may R�N-0WNED I j BODILY pWURY;Psr-w em) $ �—� ` AUTOS ONL, j i OPERTY PdAGE -------�I I ' UMBRELLALIAS S OCCUR , OD8790�J127 ZJ1R017 4/1J2018 n ExrOWLIAB 1 e1M" nc ..ACHO000RRENCE 5Za00.000 DW ON5 ! AGGREGATE g7-0oixom B IWORIQ4RSCOMPENSAIR $ AND9WLDYERS,LIAEIUTV i 1J27JZ019 PER IOPi Or'FtotIIXCeup pllsivE YIN 2amm-t2®O 1=20m i , IMaadatoryinNH) JA EL•EACHAOCIDEW S=0W it ",de be under i ' EL MSEASE-EA EMPLOYE $500.000 GRIPTTON OF ERA IS below i ' EL17L4EASE-POLICYUA91r SSMWO i 9ESCRB+TIOVOFOP=RATION9(LACATIONSJH68(C65S(ACORD96r,Add>FIO�ylRerfiarllsSchePfo(e,maybegt�cbed7411myim-19-tiW" CERTIFICATE}!OLDER CANCELLATION SHOULD ANY OF THE ABCNE-DESCRIBED pOL(CMS BE CANCELLED SMI E - Tl'lE E)PRATION t1ATE iMMWF, NOME WILL BE DELIVERED 1N ACCORDAMW WITH THE RXICY PROVISIONS. A ORMREPRRSENTAIWO WORD 28 2016103 ©1989-2016ACORD CORPORATION. All rights reser ed. f j TheACOi2D name and logo are registered marks ofACORD TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map s Parcel 01Z i Application # a©� � (0 Health Division Date Issued a _ Conservation Division Application Fee J Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street ddress 0 1 �I�D��yw . Village A&VI Owner 66PShd f�e,4V&145 Address Telephone - '0 -;) I Permit Request . W,&4 . d74_, Own AAY5 MY 9MU,' -1J1VV �3 gn a-he ak Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 0Qo tO Construction Type ��1'�-� Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family q/ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ King,No On Old Kin Highway: Yew ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sgft) Number of Baths: Full: existing new Half: existing newer_ 1.0 'Y Number of Bedrooms: existing —new A° Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use ,' `• .-- ".` ='__ ,-- -APPLICANT,INFORMATION .�.�..-,ter-- ---j-,�- ...� (BUILDER OR HOMEOWNER) Name% g�d 9�v �y� ,7/r�� Telephone Number AddresV License # /4,Q Home Improvement Contractor# /cvr3,s'� Worker's Compensation # k� d��s� 91 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY L APPLICATION# DATE ISSUED S MAP/PARCEL NO. ADDRESS VILLAGE r' r OWNER y ,y iw e DATE OF INSPECTION: FOUNDATION °n FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL i GAS: ROUGH FINAL FINAL BUILDING ' DATE CLOSED OUT ' 1 ASSOCIATION PLAN NO. 4 The Commonwealth of Massachusetts xRnnVF.ormn.,,. Department of Industrial Accidents Office of Investigations ' 1 Congress Street, Suite 100 1' 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): ej vt e7u landMI Address: &Vdat �tVU I City/State/Zip: V I/Iti IN1 A' Phone #: yJDO- I 7 I - IZ Are you an employer? Check t e appropriate box: Type of project(required): l. I am a employer with 20 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 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.❑ I am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions myself. o workers' com right of exemption per MGL Y h`l P• 12.❑ Roof repairs 4 insurance required.] fi c. 152, §1(4), and we have no r j al kt-lif� employees. [No workers' 13.� Other W 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. nn Insurance Company Name: Policy#or Self-ins. Lic. #: WGA OD 2�5 01 Expiration Date: Job Site Address: 1®, 1�� City/State/Zipi�M G'1 1 ^ Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Sectiorr25A 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 ce0&4fi#er the p ains d p enalties af E er'ury that the rmation provided above is true and correct. Si nature: ' Date Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: i 1 Massachusetts- Department of Public Safety Board`of-Buil-dinr Rel:ulations and Standards- teonstruption Supervisor License Licence: CS 100988 HENRY CASSIDY 8 SHED ROW1" WEST. ARMOUTH MA 02673 x Expiration: 11/11/2013 ('unuuissiacer Tr#: 7620 _— Office of Consumer Affairs and Business Regulation w, 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration - Registration: 153567 Type: Private Corporation Expiration. 12/15/2bl4 Tr# 233831 CAPE COD INSULATION, INC HENRY CASSIDY -- ----_-- - - ----- 18 REARDON CIRCLE -- - - -- SO. YARMOUTH, MA 02664 Update Address and return card.Mark reason for change. SCA 1 co 20M-05/11 Address Renewal ❑ Employment Lost Card C P: lOO-Y/(79 OW'ellea.(CIez Olb- 14ZJJacll CJB�J _ Office of Consumer Affairs&Business Regulation License or registration valid•for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: :1'53567 Type: Office of Consumer Affairs and Business Regulation jxpi ration 12715/2014 Private Corporation 10 Park Plaza-,Suite 5170 c Boston MA 02116 CAPE COD INSULATION;1O,:-.._..;;:`; HENRY CASSIDY 18 REARDON CIRCLE S0.YARMOUTH, MA 02664 Undersecretary AO ( witho t nat re Client#:4507 CCINSUL pco�rnl., cErIFMcAr OF LABILITY irv �rR,�NcE UATE(MhII11111YYY"YI THIS CFRTIFICAI"F.IS ISSUED q5 A MATTER OF INFORMATILTN ONLY AND CONF@RS NO RIGHTS UPON TWE CERTIFICATE HOLOC/RAI IOS2 CERTIFICATE DOES NOl'AFFIRMATIVELY OR NEGATIVELY AIVI! ID,EXTEND OR ALTER THE COVCRACC AFFORDED BY THE POLICIES HLLOVW,THIS CERTIFICATE OF INSURANCE DOES NOT CONS I'I I U fF.A GONTRACT BETWEEN 1'HE 1;;5UING INSURINR(S),AU I HORILLO REPRE3ENrATIVE. OR PRODLICER, AND THE CERTIFICATE ItOLOCK. IMPORTANT:It tho certlflcatr�hUltter is an AbDITIONAL INS,IRCj.thn pulicy(ies)must be entlufxecj.It SUBRUCATION 1 WAIVCG suty yt.t io T IhC ICI IIIS UrII)CQIIlII fink,J of tITC(JUIICy,Ctl1I911I IJGIICI01d lll�Y I'a,l,.i6v all gIILlRrfiglllqlll.A 6l!lINIflBlll llh this C61�1N3L:11W does ITUI CUnlq(rltf Ills IU DIr fw1111c�1U Iwidur in IItlU qt SUGh tlllGluf96n1tl111(S), � dlumU L L it _-- RoUerY&Gray Iris. -So. Otlrulls FNAMF: M�nipn'etYowlU d341tuuta 134 o11e C No Ex1:5O8 7tlO 4(lO2 _---_,_-- .AIL tiuuHl L1unnl>;, MA 02660•i GU'I ._ ._ UR.1`a11-79D0 INS00 -I- -.----- , UR )AFFORIANU COVL=flAI'IG NAIL N_ �Nouln.0 INSURERA;Pt @f10SS Insufdllea Cape Cocl Insulat(oll [no ]INSURER6.Evanaton Insuranco COlnpany T - �—- - wswaeac:Atlttrdic Charter Insurance __......_._...._--<t5S Yarinoutli hoad 1 yURenD Co(nolerce Insurance C0111Nany Ilyruufis, IVIA 0260'I _. INSURER lvllcal F:S --- NelJnertr; (:ER_FlFJCAI L NUMBER: __ 1 HI 6Ic) CERTI!1' 1 HAT 'I HE I�pl ILIrS REVISION NUMUL=.f1. Or.INSL1r2ANGE u5'I't O t)u t� .AVE BEEN ISSl1ED TO'I'HE INSURGD IJ7IMI=Q ABOVE FOR fI1L POLICY PkUIQD dVl 41 L U, tvu)WIT Hd iTANUINC ANY REQUIREMENT, T�Km OR CCidIrII IOPI OF ANY CONTRACT OR OTHER QO'UMENT WITH RESPECT TO wi-IICI-I IIIIS lkllFk;A1L MAY ESL ISSUED OR MAY PERTAIN THE INSURANCE- ArrurtOEO,aY THE P01_ICIGS DESCRIBED.HEREIN IS SUOJC-CT TO ALL. THE TEI(NIS. �\GLUS10NS AND CONDITIONS OF SUCH POUCIES. LIMITS SHOWN w1,�1' N,�V p N REDUCEp'BY MAID CLAIMS. N k _______._.—.__.____ AQD 4UI., ITR _rYNr;OF INSURANWE — — ! POLICYEFF. Pt:ILICY.eI( F•OLIcYnUm�clt lMM1DD/YYVY1 MMIDDA'YYY ' ' '•''.. _ LIMlTG A 4kNLRAI LIAlIILII'1' '• -,, , CBP0263063 A101/21112 04/0'11201 x races occutlrttNCE` 1 UUU UpU�Ci)MMI-R AAL GENERAL LIABILITY^ it, _ �--� erlru� a� T•'Il1U DUD I L:LAIMs-MADt l Al cTccul, ,• - •- rcy,,, hIEDEXN(AnY•arw arson). YS,OUI) ' PFAft'lAc&ADVTNIURY 41 000000 I4 GENERALA001103Alt $2,000,000 N L A4bNlW 1 k LIMIT AP_PLIQU P&R: I utILT Prof} NRODUCTs^COMProP Auo �l 11, uU,L1UIl _ L1 AUT0MOF11Lk uAbluT'Y — .....__._ •- 1. 12MMBCKViviK 410112012 04101/201' E ti"I irvGLCLIMIr I UUUUUU - A 'DODILY INJURI' Pc LL 11W NL:U _X sc)ro ut G.a AUrUS AUTOS BODILY INJURY 4.(l.AP.laa kI s. a.u._n,)— l :BX AUTxNCN-OWNED PROPERTY-' UTOS 1;• r - IPnl L+[l;Alltlllll Y H X UMUKR: LA UAB ..—.___:...".- -- gecur XONJ453SI2 410112012 041011201 CAc1ior.cuR1ikNCIE 0 000 00U I:xt Htil:uAe .. _..._ GLAIMS•MAQE - ' ' y UUU UUU AccnecA're irl l X Rt lrlvnorr 1� uaQt1 L- - C WURntKt lI-, ltNtlAllpN ANOEMNL0`1'ERY LIAFIUTY �f.QA00,525, U<'. 613UI2092 UGI3Ol?0'1 X WwcslAiYl ';��1.� tttl. AN" IRUPRIL IIIIICEIUM�M�EFt E•`(4�.U4 �')kCUTIVk Y!N ,' � NIA c.L;rwACH ACGInr-N l L'I,UUU,000 (hlmluulnry iu NN) _ N r, � i::L.`uisLA�l:..r-�cr,,tLOYLL �'I,UUO�UUU 111 SCRIPTION OF OPI::RAIIONS bHuw - - G.L.asEASs•POLICV LIMiT a'I ODULUUU -x I , i n[ 01i'IION OF OPERA'IIONS I LOCATIONS I VEHICLES(Atlaah AC Oki)ICI,AdJl,im,,N, a,kc BChpquld,II RIPN BpxCd.ld fd(INIrdGJ "Workers comp InforrnatiDrl'" ollaudud Officers or Proprletui,s Ctlrtlrlcate Flalder is included as ran additionalinsurod U110ai Gunural Llau lily wllon raqulretl by written contract or a�jreement. 's .>, °t CNfa'IFII,AI E:HOL UEFt _-_ _-.__. -•_.-.--____.__�— CANCELLATION " C+INn GULL ITIt uIatiQ1I,IrTC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES IIF CAN WLFORL . THE .EXPIRATION DATE. THEREOF, NOTICE WILL BE DELIVEkEO 1N. ACCORDANCE WITH THE POLICY PROVInIONS. AU INORIZEO REPRESEN I ATIUE 1b 18L1 -2D10 ACORD CORPORATION.All right Iv:101 ll. MLl.nil, (=U1U(Vy) 1 of 1 The ACORD name and logo wu roolAmd harks ofACORD ksaae4�►1Ma3�4(► MFY 00 � kt. mass save PARTICIPATING CONTRACTOR ILiV�V C1 Savings through energy.efficiency ! PERMIT AUTHORIZATION FORM I, Bryson Beavers owner of the property located at: (Owner's Name,printed) 1107 Falmouth Rd Centerville (Property Street Address) ,. (city) hereby authorize the Mass Save'Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property: i' ature - - 01/10/13 Date FOR CSG OFFICE USE ONLY Conservation.Services Group has assigned the following.Mass Save;Home Energy Services Participating Contractor to the above referenced project: V Participatin ntra or Da e - Rev:.12132011 L _ U , : Lo Ln Ln ry 10 rco C� ' Z O LL Ll. t 6d INV Holl vj _—j=.,__ :_.-_ - s -..�,�-- -.-.,ter r:--a,-.-e- az --. -__ _-r--.- _-�—• '.--�.-�- , -�- - .�_-. � � j S ; k i i ice; :..�✓'" ' t` . �. •'` / V- - - 2O •x _ { Ir 4.1 _ _.]L) ti • Q CY � �+.. r!p �`(� f � ebb %'r I X--Y.i 14 Uj a t- � 0 fi BATE SCALE APPR'P;;% VE0 eAEc�'A: x AAA N ; O NOTE CHANG S --+ — - _ m h ` A i AEI. TO N 0 BAD cm Building In tpect ca Depart er.� ----- - SHEET fl 7- -