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0024 GOFF TERRACE
.. Co i Town of Barnstable Buildin ';:.�, >. :'""' v '° ; . <'� -.` ,y "", ,.r::b., .. '? •� may.. K, r sga "" xr_ ra .$ Post ThisaCaFd So-That rt isUis�ble Frorn the;Street A proved-Plans Must be.Retamed om.JobancJ„#his Card Mus#be Kept ,, Y �. f§A]fWNSM ASIL LB,. • s-_:j. ,? �`trj .,;'�� ,.,5,a ,� P y. �{ .:6; x� z *S� 'y"4` t„ mrA�: Posted Until Final�lnspect�on Has.Been Made � � � �� 3639 3 s. I r n n� r ,. �£, S Petmit ° ?- :her ifi °te'of-.Occu ancis:Re aired<such Bu�ld�nshall Not„be Occu �ed:untiLa Final lns action hasbeen made ; Permit No. B-18-1189 Applicant Name: BRIAN SHANAHAN Approvals Date Issued: 05/11/2018 Current Use: Structure ' Expiration Date: 11 Foundation:3V 01 a S� Permit Type: Building-Addition/Alteration-Residential p� /11/2018 �h1 tfr Location: 24 GOFF TERRACE,CENTERVILLE Map/Lot. 171-107 Zoning District: RC Sheathing: w Owner on Record: SHANAHAN, BRIAN W& KATHY L TRS 15 Contractor Name BRIAN SHANAHAN Framing: 1 Address: 32 GOFF TERRACE s Contractor License: 156211 , 2 CENTERVILLE, MA 02632 Est Project Cost: $4,000.00 Chimney: Description: Replace railings and decking on existing suncl&kland side entry Permit Fee: $85.00 platform. repair framing members as necessaryexisting footprint Insulation: FeePaid $85.00 f not to change = Date Final: 5/11/20 Project Review Req: REPAIRS TO EXISTING DECK AND SIDE ENTRY TO COMPLY 18 WITH 780 CMR NINTH EDITION. y " ' ` 7 --- Plumbing/Gas i r Rough Plumbing: Building Official g Final Plumbing: t This permit shall be deemed abandoned and invalid unless the work auth`onzed by this permit is commenced within sixtmonthsafter issuance. Rough Gas: All work authorized by this permit shall conform to the approved application,a d'theapproved construction documents for which this permit has been granted. Final Gas: All construction,alterations and changes of use of any building and structures�shall b'e in compliance with the local zoning by laws�and codes. This permit shall be displayed in a location clearly visible from access stree or a tor 'd and shall be maintained open for pu in blic spection for the entire duration of the work until the completion of the same. Electrical IF The Certificate of Occupancy will not be issued until all a licable si natures b t e BbiIdin a d Fire Officials a e�rovd d oo th s permit. Service: p Y PP g Y g �s P Minimum of Five Call Inspections Required for All Construction Work:[,,,;, Rough: 1.Foundation or Footing 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT OFFY,` IicationNumberi'.`�• .O ier Fee........................ * NAM Putt Fee. � •:� ... V - �V Total Fee Paid... ............... .............. ......... ... ...... �.. P Approval by....OF BARNSTABLE - *TOVN I BUILDING PERMIT .............................. � MspP=cL.. ..R.-I ....... APPLICATION s Section I— Owner's.Information and Project Location rk c Pillage C�h TC. yr I�� Project Address of`� G'd ►' owners Name S�a N r,1-1 C1 9 owners Legal Address a G�o f iru C? ` State i -_YM/9 zip oa G 3� °a4-e i City , 121LE-mail owners Cell# �pw��avla� ®: c�ti^c4 St.h f Section 2—Use of Structure ❑ Commercial Structure over 35,000 cubic feet Use Coup ❑ Commercial Structure under 35,000 cubic feet Single/Two Family Dwelling Section 3 —Type of Permit wture ❑ Change of use ❑ .New Construction Accesso❑ Move Relocate ❑� - �'St , "❑ Finish Basement ❑ Family/Amnesty El Fire Alarm ElDemo/(emir e structure) S rinkler System Rebuild Deck Apartment P ❑ Addition ❑ Retaining wall ❑ Solar BUILDING i)FP* El Renovation ❑ Pool ❑ Insulation ADD 1 a 7n1� Other—Specify E::Section 4-Work Description TOWN OF BARNS T��� AYF GP y,� h �e� ov► QY- c(c did 1 �-r �v►� C r h mew►6e<.� S c T act Tmdated:2/9/2018 i Application Number..............:..................................... Section 5--Detail Cost of Proposed Construction kyooa-'. Square Footage of Project Age of Structure ,3 b I rS , ; Dig Safe Number #Of Bedrooms Existing a i Total#Of Bedrooms(proposed). 110 MPH Wind Zone Compliance Method ❑ MA Checklist❑ WFCM Checklist ❑ Design Section 6—Project Specifics j n Wiring ❑ Oil Tank Storage. ❑ Smoke Detectors ❑ Plumbing [] ` Gas [] Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom Water Supply RPublic ❑ Private Sewage Disposal ❑ Municipal &bn Site Historic District ❑- Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: Y&rM J'a4' Ic"'a MI I am using a crane ❑ Yes El No Section 7—Flood,Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No 54 Section S—Zoning Information Zoning District R'9J Proposed Use P-ef' Lot Area Sq.Ft. Z V 5(�o Total Frontage D Percentage of Lot Coverage of Dwelling Units (on site) Setbacks FrontYard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes No Last undated 2/W2018 The Commonwealth of Massachuseta Print Form Department of Industtzal Accidents Office of Investigations ' 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leg bly Name(Business/OrganizationMdividual):Brian W.Shanahan Address:32 Goff Terrace City/State/Zip-Centerville, MA 02632 Phone#: 508-360-3567 Are you an employer?Check the appropriate box: Type of project(required): 1.211 am a employer with 2 4. ❑ I 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. 0 Remodeling ship and have no employees These sub-contractors have g. Demolition working for mein 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 11.❑Plumbing repairs or additions myself. ' right of exemption per MGL Y �o workers comp. 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no 13.❑ Other employees. [No workers' comp.insurance required.] *Any applicant that checks box#I 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 as 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 eWloyees: Below is the policy and job site information. Insurance Company Name:Acadia Insurance Co. Policy#or Self-ins.Lic.#:MAARP301005 Expiration Date:1/03/2019 Job Site Address: 24 Goff Terrace City/State/Zip:Centerville, MA 02632 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 terra un airs and enatties o erju that the in o�mation provided above is true and correct -— Signature: - - - - --- — - -- - ---- -- - -Date],--- Y/q_.aoi ------ — Phone#:508-360-3 67 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 Contact Person: Phone M i ® Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construction S3pervisor r ,N °1 CS-003247 Lw 1 E'Dices: 11/03/2019 BRIAN W SHANAHAN { 14 32 GOFF TERRACE CENTERVILLE MA 02632 � Commissioner 4, �i ��re�ar3znzantrreall�o��i��s.�c�irrlelT�t - -- Office of Consumer Affairs&Business Regulation _ HOME IMPROVEMENT CONTRACTOR ` - r TYPE:Individual n `R istr io _ ,Exoiratidn r, 56211, 06/11/2019 BRIAN SHANA # i 69 BRIAN W.SHANAHAN - ;V ` 32 GOFF TERRACE CENTERVILLE,MA 02632 Underseeretarl Application Number........................................... R Section 9—Construction Supervisor Name 13rr4k. Telephone Number k - 3,f 6? Address Cf0' City Ce n.4ery i (, ( State i�U 0l .Zip . QdL G Z License Number 0-G'1' )4-1 License Type Expiration Date Contractors Email 0'e f Cell# J�6 F-3 6 0-3 J"b I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massach etts State B g Code. I understand the construction inspection procedures,specific inspections and documentation re b '780 1 and the Town of Barnstable.Attach a copy of your license. Signature Date- t! L a Section-10—Home Improvement Contractor Name A�(Rt ��twv►�(nu� Telephone Number • v,?-3 bo -)J-4 7 Address 51 (ref f rVv- City 6n.4 ery ift e State fi4q 'Zip 0,�0 3 2- Registration Number 15W( Expiration Date GL Ij L.61 q I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Builgiag Code. I understand the construction inspection procedures,specific inspections and documentation regnir 0 and the Town of Barnstable.Attach a copy of your HIC... Signature Date y/1 112c,I P 6 Section 11 —'Home Owners License Exemption Home Owners 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 PLICANT SIGNATURE Signature 9 LUG F Date Print Name r`raij 7 Aq�ati Telephone Number 50 �'3 �0 �3J-6 7 E-mail permit to: G M c a f t. �?e Section 12—Department Sign-Offs Health Department ❑ Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required) El 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 to act Ion my behalf in all authorize � c<<' matters relative to work authorized F,,4e,,W(e this building permit application for: 6_0rf T2rv.-: (Address of job) WtLirener date Print Name 3 f y i • '1 Last undated:2J9201 9 i SSE Town of Barnstar1le *Permit Building Department a 6monthsfrom issue date r �► r Brian Florence,,CBO v ass.q. g a6 Building Commissioner I • 3 A Eo� 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 ®► r� Fax: 508-790-6230 EXPRESS PERNUT APPLICATION - RESIDENT�I ,ONLY � Not Validwithoui e resslinpr"Int1 Map/parcel Number ! 7 f 0 7 ,!� Property Address 2 q 6_0�1_ _( T4 rriac_� 6� -e ry i 1-P - ail 'lAo, kt [Residential Value of Work$ hol vo L' Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name L-an 5�,A q k`?a h Telephone Number -5 d P- 36 -3 f 6 7 Home Improvement Contractor License#(if applicable) t✓� Z/r' Email: bw Sha n o Aa-.B Cum Cyr J f , ri f f Construction Supervisor's License#(if applicable) C$- 0 0 3)_y-7 ❑Workman's Compensation Insurance Check one: al am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Aca d4, bl yl1 Workman's Comp.Policy# AAA /2-P 3o cy Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over- - existing layers of roof) - - - - - - - Er Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: jA erty er must sign Property Owner Letter of Permission. py f the Home Improvement Contractors License&Construction Supervisors License is ir SIGNATURE: Q:IWPHLESTORMSEXPRESS2017 r The Commonwealth of Massachusetts Print Form Department of Industrial Accidents ice of Invesfigations I Congress Street,Suite 100 Boston,MA 02114-2017 } www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lesibly Name(Business/Organization/Individual):Brian W.Shanahan Address:32 Goff Terrace City/State/Zip-Centerville, MA 02632 Phone#: 508-360-3567 Are you an employer?Check the appropriate bog: Type of project(required): 1.[Z] I am a employer with 2 4. ❑ I am a general contractor and 1 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. n Remodeling ship and have no employees These sub-contractors have g. ❑Demolition workingfor me in an act employees and have workers' Y capacity. $ 9. ❑Building addition [No workers'comp.insurance comp.insurance. requite_] 5. ❑ 10.We are a corporation and its ❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 l.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required]t c. 152,§1(4),and we have no employees.[No workers' 13.❑Other comp.insurance required] "Any applicant that checks box#t 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 subcontractors and state whether or not those entities have employees. If the subcontractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:Acadia Insurance Co. Policy#or Self-ins.Lic.#:MAARP301005 Expiration Date:1/03/2019 Job Site Address: 24 Goff Terrace City/State/zip:Centerville,MA 02632 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. 1.52 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 foqnsurance coverage verification. I do hereb certi er a ains and enables o erju that the in ormation provided above is true and correct: Sip-nature: — ----- ------ - ------ --- Date Phone#:508-360 3567 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 M OpTHE ram, Town of.Barnstable ti °^ Building Department 9RAM6TABMNAMg' Brian Florence,CBO `bArE16 9. Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This.Section If Using A Builder 4 I, ,as Owner of the subject property S!/l�fi�GtGl, t hereby authorize ,��/�/rl• � to act on my behalf, • in all matters relative to work authorized by this building permit application for: 6Ff 1,afvt-l� (Address of Job) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspectio are performed and accepted. Signa e of ner Signa e o pplicant j Print Name Print Name Date Q:FORM&OWNERPERMISSIONPOOLS Rev:10/17 1Vvvil V1 "aluaialuiv �OFTHE tq�, Building Department ~� Brian Florence CBO BuildingCommissioner w BARNSTABLE, 9 MASS. 200 Main Street, Hyannis,MA 02601 1639. �� �i0len Ma's a www.town.barnstable.ma.us - Office: 508-862-4038 Fax: 508 790 6230 �I HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occuoied.dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section )09.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection.procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require, as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Const\•4ctibn�Supervisor If f CS-003247 K G Expires: 11/03/2019 ' t+ r BRIAN W SHANAHAN 32 GOFF TERRACE " 1! CENTERVILLE MA 02632 1� Commissioner �/e rGamona7zu��f a�C�/l�tt�cco�aG� 4 - _ Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT L'ONTRACTOR �{ 6 TYPE Individual y - R j �str on �--�e a � Exavatlon � 1562-a 1 06/11/2019 BRIAN SHANAFFAN_ �10 BRIAN W.SHANAHAN ! , 32GOFF TER RACE %jy ' -d CENTERVILLE,MA 02632 Undersecretar Official Website of The Town of Barnstable-Property Lookup Page 1 of 4 JG seat Lar�I o Assessing Division Property Lookup Results - 2 W77 Min sueK HT&WK Ma aM1 —BACK TO to Prin Owner Information-Map/BIocWLot:171/107/-Use Code:1010 Owner Owner Name as of SHANAHAN,BRIAN W&KAM MapMlockit of G/S MAPS IM117 L TRS 171/107/ 32 GOFF TERRACE Property Address 24 GOFF TERRACE CENTERVILLE,MA.02632 Co-Owner Name BKS FAMILY TRUST Village:Centerville Town Sewer At Address:No GIS Zoning Value:RC Assessed Values 2018-MaplBloc-Mot:171 1 1071-Use Code:1010 2018 Appraised Value 2018 Assessed ValuePast Comparisons Building $111,500 $111,500 Year Assessed Value Value: Extra $20,300 $20,300 2017-$246,400 Features: 2016-$244,100 2015-$242,900 2014-$242,900 Outbuildings:$2,300 $2,300 2013-$243,000 2012-$244,500 2011-$251AW Land Value: $116,000 $116,000 ' 2010-$251,700 2009-$276,600 2018 Totals $250,100 $250,100 2008-$282,300 tt f 2007-$281.800 Tax Information 2018-Map/Slock/Lot:171/107/-Use Code:1010 —_ - - Taxes C.O.M.M.FD Tax(Commercial) $0 C.O.M.M.FD Tax(Residential $402.66 Fiscal Year 2018 TAX RATES HERE Community Preservation Act Tax $72.10 Torn Tax(Commercial) $0 9 Town Tax(Residential) $2,403.46 $2,878.22 Sales History-"Map/Block/Lot:171/107/:Use Code:1010 History: Owner: Sale Date Book/Page. Sale Price: SHANAHAN,BRIAN W&KATHY L TRS2011-08-31 25653/126 $235000 h4://www.townofbamstable.us/Assessing/propertydisplaysereenl 8.asp?ap-0&searchparce... 3/5/2018 oF1HE rqk, Town of Barnstable *Permit# Expires 6 months from issue date yT Regulatory Services Fee • anxxsrnsM ! ,0$ Richard V. Scali,Interim Director �{ ArED MA'i& X PR Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 NOV 2 7 2013 www.town.bamstable.ma.us Office: 508-862-4038 TOW 8W)*NS7AE1L6 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL Not Valid without Red X--Press Imprint Map/parcel Number [-7 1//U 7 Property Address 2,4 (ro f-F Tcrf-"e Gen,+e,_ 1 Residential Value of Works$ y /©4000 I Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address pr6c.n �k��4-teeth 1Z?2 6-of f T erro-ce Cen�ertii f to F Mq 026 3 2_ Contractor's Name N.CV, A&hQhan Telephone Number �6 '3(a 0 7 Home Improvement Contractor License#(if applicable) fSB LI J Email: bw 5kiiahc,n coiner4-f -ae Construction Supervisor's License#(if applicable) 3 a ql [Workman's Compensation Insurance Ch k one: 7I am a sole proprietor ' ❑ I am the Homeowner ❑ I have Worker's Compensation Insurancer Insurance Company Name .A 4f I Unto, Fire Inc Co.o F OSAII) ' Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side j Replacement Windows/doors/sliders.U-Value =1,R (maximum.35)#of windows /® #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A coLed. ome Improvement Contractors License&Construction Supervisors License is eq SIGNATURE: QAWPFILESTORMSUildi g permit forms\EXPRESS.doc Revised 061313 .C\ �/!G! ff'l'%l1I/L f/t((JECllC71 G I./�L.ECJ.K(Crt l('I JfS i „,. Office of Consumer Affairs&Business RegalstiOB ¢ . OME IMPROVEMENT CONTRACTOR Zg istration: 156211 Type: piration 6/12/2015 individual ` r BRIAN SHANAHAN , License or registration valid for individul use only BRIAN SHANAHAN before the expiration date. If found return to: 32 GOFF TERRACE Office of Consumer Affairsnd Business Regul_aton - (�ENTERVILLE,MA 02632 IIBdersecTeta :.,10-Park Plaza-Suite 5-170 r3 Boston,MA 021161 } I+ *Notithout signature I Massachusetts -Department of Public Safety Board of BuildingRegulations and Standards g n s Construction Supenisor "J I r k`' License: CS-003247 a ,1. V I♦ J '� I, BRIAN W SHANAJUN 32 GOFF TER CENTERVILLE MA } y"`!ir5• Expiration Commissioner 11/03/2015 ' I 11/19/2013 17:18 5083982224 PL&B INS PAGE 01 �C R FICATEF LIABILITY INSURANCE olalD ATE(MNPDDAYYY� � C E TI BvSO Z 11 19 13 TIJIS CERTIFICATE 15 0SUED AS A MATTER OF INFpRtMIATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Cluett Commercial Ina. Agenw HOLDER.YK5 CERTIFICATE DOES NOT AMEND,EXTEND OR 9 Pembroke street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Kingston Mh 02364 Phone*781-rs82-1600 rax:781-585-4180 INSURERS AFFORDINDCOVERAGE NAIC# INSURED INSUPERAI• p;sJOnl1 W A& K24 luomean INSURER& Brian . Sbapahan ConatrucUon INSURERC: 32 ft Terrace INSURER D: Centerville MA 02632 INSURER E: COVERAGES i THE POUCIB OIt INSURANCE LIS'EED 9ELOW NAv6 CdEEN(PPXD TO THE INSURED NAMED ASMIE FOR THE W=Y PERIOD wOTCATED.NOTIMYWSTANDING ANY REDUIRMENT.TERM OR CONDITION OF ANY CONTRACT OR on mR DOCLIMEN'VMH FMPECT TO WHICH TY93 GURT1ACAtE MAT 9E 1SOM OR MAY PERTAUL THE INSURANr E AFFORDED BYTHE POLICIES DESORM HEREIN 16 SUBJECT TO ALL THE TEAMS,E=USIONSAKD CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SNOWN MAY HAVE BEEN REDUC.'EO BY PAID CLAIMS, POLICY EFFECTM POLICY EMRATION � LTR NOW TYPE OFINBURANCE POLMY f4vmo>wR DA MID CATS LIMITS 0ENO"LIABILITY EACH OCCURRENCEUA E COMMERCIAL GENMA LIABILRY PREMISES xtvetleE 6 G CLAIMSMADE IDGCCVR MED[J[P{PnYaesePerw^} S PFRSONAL R AOV IN.NRY I GENERAL AGGREGATE I% OWL AGGREGATE;UMITAPPUESPER- PRODuGTS-COMPAOPAGG i PMICY jECT LOC AVTCMWLE LIABILITY COMBINED SINGLE L9611T ANYALITO Meecddsnl a ALL CINHED AUTOS 900AY RMURV SCHEOULEO AUTOS IPA pereera s I HCREb AU T4S GOLLY KNITY 6 ! Nra16DVAMAUMS {!R"aa*bra} i (par Fa dom) LSE s GARAGE LIABILITY AUTO ONLY.EAACCMNT S ANY AUTO OTHER THAN EA ACC S Ar1Tp O�-Y: AGG S EXCESS AUN51119 ALIMIA Y EACHOCCURRENCB S OCCUR CLAIMS MADE AGGREGATE s 5 D®vcneLE 3 RETENTION S S >eis peaATM TO S loll eR AND EMPLOYERW L IAXI L"y Yin T A ANYPRoaRIETOfWARTNERnD cuTNl wC961933�_ 01/03/13 01/03/14 ELEACHACCIDEWT $1000000 oFFIe>�excuroEoo LJ (I RapIQylnNH} E.I..OtSEASE.2AEMPLOY B 101)0000 N s� �a.PRavrawNsa�r� � ELDrsEAse-POLICYLUNtT s 1000000 OnM VE$WPT"OF OPMA'nONS I LOCAnONSAVENICLES I EXCLUMONS ADDED BY ENDDRWMTI SPECIAL PROVISIONS e . CERWICATE HOLDER CANCELLATION • BHOULD ANY OF THE ABOVE CE CKMO POLICIES BE CANCELLED 8EF!M WE b7LPlR IM r DATE THEREOF,THE ISSUING INSURWt WILLENWAVOR TO FLAIL 10 DAYa WTIl7TLEY F' NOTIGB TO YK CM71FICATP HOLM NAM®TO THr;LEFT,Wr FAILURE TO DO SO SHN..LL 01508E NO 09LICAMN OR LIANLITV OF ANY KM UKN THE MURML ITS AOEM OR Town of Barnstable REPRESENT TIVE& zoa rrala street - avTN rATlvt: Hyannis NA 02601 ACORD zs(=Viol) ®lose- righft L> orwd. The ACORD mm and lop are ri gI2tBr&d manta of ACORII The Commonwealth of Massachusetts Ir Print Form Department of Industrial Accidents - Office of Investigations hf ' I 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):Brian W.Shanahan — Address:32 Goff Terrace City/State/Zip:Centerville, MA 02632 Phone #: 508-360-3567 Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 3 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g• ❑ Demolition workingfor me in an capacity. employees and have workers' Y P h'• 9. ❑ Building addition [No workers' comp. insurance comp. insurance. . required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no windows,door' employees. [No workers' 13.❑✓ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name:Nat'l Union Fire Ins.Co.of Pittsburgh Policy#or Self-ins.Lic.#:WC009619339 Expiration Date:1/03/2014 Job Site Address: 24 Goff Terrace City/State/Zip:Centerville, MA 02632 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. Idoherelycertiffwunderth ains and enalties ofperjury that the information provided above is true and correct. Signature* -- -- — — Date Zt da 3 J Phone#:508-360- 567 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#: FVE r � Town of Barnstable Regulatory Services �1ARMASS& Eg Thomas F. Geiler,Director 1639. rEo,�,ia Building Division Tom Perry,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 Jf Using A Builder I, r V/u V 1 g �`�-� , as Owner of the subject property hereby authorize a n L5�0^C,4u to act on my behalf, in all matters relative to work authorized by this building permit �Qd✓uc � C-Pn 'fP��l�� (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Si tore of dwner SW ature of Applicant hp Q1 Print Name Print Name 1/Jd-7ldcf Date Q:FORM&OWNERPERMISSIONPOOLS 62012 Town of Barnstable 0 Regulatory Services * '"R'STS. Thomas F.Geiler,Director S'^ i6 k39_ `�� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMBOWNER": _ name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINTTION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or Iarger will be required to comply with the State Building Code Section 127.0 Construction Control_ HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulaijons for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. C:\Users\d(-wllik\AppData\Local\l�licrosof?\\6lindows\Temporary Intemet Files\Content.Outlook\QRE6ZUBN\EXPRESS.doc Revised 053012 t ,,AFT"E TOwti Town of Barnstable *Permit#, b 4,/ eZ�] t ,►e�. : Regulatory Services �''r`s 6 inont1"fro"'issue dare NAM � ' =639• `0� Thomas F.Geiler,Director Fee �S. d rED�,�► . Building Division Tom perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 X-PRESS PERM ace: 508-862-4038 'T u 508-790-6230 SUN :O 6.•2006 EXPRESSPERMIT APPLICATION - RESIDENTIAL ONIrY"N OF BARNSTABL Not Valid without Red X-Press Imprint E arcel Number G ' ty Address �J:r• , ` sidential Value of Work :w 1 lYjinimum fee of$25.00 for work under$6000.00 's Name&Address h CtP r"'V tctor's Name Telephone Number Improvement Contractor License#(if applicable) Q -7 / ruction Supervisor's License#(if applicable) od(/ '?, :;?-S' Compensation Insurance Check one: El I am a sale proprietor ❑ I am the homeowner • Qq have Worker's Compensation Insurance w ante Company Name g moan's comp.Policy# y51 o q Ans i of Insurance Compliance Certificate must be on rile. dt Request(check box) I<Re-roof(stripping old shingles) All construction debris will be taken to El Re=ioof(not stripping. Going over existing layers of roof) Re-side ❑ Replacement Windows. U-Value (maximtiixx A4) 'Where.required: Issuance of this pcnrsit dots not exempt cotrt¢Iiance with other town department regulations,i.c.Historic.Conservation,etc. ***Note: Property Owner must sign property Owner Letter of Permission. ome Im rovement Co tr ctors License is required. tatnre . nns:expmtrg so063004 Department of Industrial Accidents y� Office of Investigations ' a 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Naive (Business/Organization/Individual): Address: f Q 31 City/State/Zip: .. ®S:[Er V 1 ��� M Pr Oolb Phone#: Are you an employer? Check the-appropriate box: Type of project(required): 1. I am a to er with 4. El am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6• El New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet $ ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in an capacity. Workers' comp. insurance. Y P tY• 9. .❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its officers have exercised their 10.❑ Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4), and we have no 12.0 Roof repairs insurance required.].t employees. [No workers' 13 �JOther rQ. rbC� comp,insurance required.] f *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 arc doing all work and then hire outside contractors must submit a new affidavit indicating such t ontractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.-policy_information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance ConpanyName: 1� Policy#or Self-ins.Lic.#: 1 MGSbVA-0 Expiration Date: 010 Job Site Address: ''t L71)��� 1 � �� C ►'y l� L- City/State/Zip:_ 6�il jn 0 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 here Y-certify under the ins nd penalties of perjury that the information provided above is true and correct. SiFilatliie: Date: Ph one#: 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 S..Plumbing Inspector 6..other Contact Person: Phone#: v°f e�giti Town of Barnstable ° Regulatory Services asAss Thomas F. Geller,Director f Building Division Tom Perry, Building Commissioner 200 Main Street, Iiyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property O�vvner Must Complete and Sign This Section If Using A Builder I, 1,mti 0 k a S as Ownez of the subject property hereby authorize � 7 CA ZX o act on mg behalf, in all matters xela.tive to work authorized by this building permit application for: (Address of Job) S" /37 / � Signature of Ownex Date Print Name WORMS:OWNMERMISSION S _r 1 fie v Board of Building RegulatKbn`-s an tan arcs One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement'.Contractor Registration Registration: 103714 Type: Private Corporation I � f,1r Expiration: 7/9/2006 PAUL J. CAZEAULT & SONS, INC.J Paul Cazeault 1031 MAIN ST OSTERVILLE, MA 02658 l Update Address and return card.Mark reason for chang DP3-CAI G 5OM-04/04-G101216 I3 Address 0.1tenciyal I] Employment Lost Card ./�tCVO'!!LJ)idl+(!/CQtiCI6 O�✓tl, ad �la _... ....-__—.._ . . hoard of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR License ur rc kiralieu valid for indiviiWI MC uuh' Roflistration:. 103714 helure the expiration dale. Il found rcluro Io: Expiration:: 7/9/2006 Board ul lluildiu};Kc}ulaliuus:uul SLuidanls Onc Ashburton Place Run 1301 ;Typo:' Pnvalo Corporation Ituslun,Ma.02108 PAUL J.CAZEAU•LT;&.80NS,.1N6' .,_._------......_._. ...__,.__. - __- Paul Cazeault 1031 MAIN ST i _ p_ i �/Le �amvnro�u o�./�aoaac�u�velta I'� BOARD OF BUILDING REGULATIONS OSTERVILLE,MA 0265U Administrator :fin':: License: CONSTRUCTION SUPERVISOR rl� Number:,,CS 026325 Birthdate 10/20/1959 l Expires 10/20/2007 Tr.no: 7696.0 Restricted:s;00 PAUL J CAZEAULT' 1031 MAIN ST OSTERVILLE, MA 02655 C Commissioner vJ i cnvi��c, tw1 uroao — -----......_...._.__ Administrator_.__,.. Board of Building egulations One Ashburton Place, Rm 1301 Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 10/20/1959 Number: CS 026325 Expires: 10/20/2007 Restricted To: 00 PAUL J CAZEAULT 1031 MAIN ST OSTERVILLE, MA 02655 Tr.no: 7696.0 Keep top for receipt and change of address notification. DPS-CA1 0 SOM-04/05-PC8698 DATE(MM\DIAYY) P 9I�i�' _... .. Dt;-23-05 PRODUCER .TKIS CERTIFICATE IS ISSUED •AS A mATTF_R:QF INFOa"-;LOSL:` DOWLING 1, 0 NEIL INS ACC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 222-1WEST MAINHOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR PO BOX 1990 STREET ALTER THE COVERAGE AFFORD EDB:YTHEPOLICIESBELOW-. ' HYANNIS MA 02601 COMPANIES AFFORDING COVERAGE 22 LGR COMFA`Y, INSURED A TRAVELERS PROPERTY CASUALTY COMPANY OF AME.RICA _ COMPANY PAUL.J- CAZEAULT G SONS INC. B 1031'14A'IN STREET. OSTERVILLE MA 02655 COMPANY C COMPANY ;COVER• GES::<::.::::.. . . ....:::::..v:;:a;=:sa;;:;;.<..::;.::;<; z:s THIS 1S TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO'TFIE INSURED NAMED ABOVE FOR THE`POl'ICY}PERIOt1' INDICATED, NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY-HAVE BEEN REDUCED BY PAID CLAIMS.' T TYPE OF INSURANCE POLICY EFFECTIVE POLICY EXPIRATION LTA POLICY NUMBER LIMITS DATE.LF.•.UD\YY) DATE(MU%U0%YY)• OENERAL LIABILITY GENERALAGGITEGATE S CUMMEHGtAI GEhtI1ALiU1NIUlY ' MHUUUCI`J-{',UAAi'IUWA(jG. S CLAIMS MADE a OCCUR. PERSONAL 8 AOV,INJURY ' - q GhiN!~H'S 3 t bN7RAt TORS Pg67. rACH OCCURRGNCG nnE DAMAGE(Any one fire) q MED..EXPENSE(Any one person) _, AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE q 'ALL OWNED AUTOS LIMIT SCHEDULED AUTOS BAPILY INJURY (Per Person) q HIRED AUTOS NON-OWNED AUTOS BODILY INJURY 3 (Per Accident) GARAGE LIABILITY PROPERTY DAMAGE q - ' ' � . ANY AUTO AU10 ONLY:EA ACCIDENT' f- � - OTHER THAN AU70 ONLY. EACH ACCIDENT, g EXCESS LIABILITY AGGREGATE _ UN,ORE LIA FORFd EACH OCC111RENCE . q AGGREGATE q OTHER THAN UMBRELLA FORM A WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY (UB-0095B69—A-05) 03-10-05 08-10-06 STATUTOflYIIMITS THE PROPRIETOR! Y EACH ACCIDFNT g i;�� �� PARTNERS/EXECUTIVE INCL -OFFICERS ARE: ExcL DISEASE-POLICY LIMIT 11 500`000 1, DISEASE-EACH EMPLOYEE q 100,000 TII I., R� -CCLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE IIOLDGR AFFECTING WORKGR3 COMP COVE g F.IC(QT .HOL :.>:. R� RAGE. ........:. d1NGECd:DI,l SHOULD ANY OF THE ABOVE DESCRIBED POLICIES`BE CANCELLED BEFORE THE ` r Paul J.Cazeault$Sons I EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL Roofing,'mc. 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR 1031 Mat:i Street LIAWLITYOFANY-KINuUPGNT1iECOtr"A'f,�TSIw,FiiispViRgppE"TA,TIYFS.. Ostervilla, MA 02655 AUTHORIZED REPRESENTATIVE •� fir? �r :a p M �.: ;`� bRII�Ct3EtPdE;A71Qf�i�i993� AGOR ) CERTIFICATE OF LIABILITY INSURANCE , /18/M/LID/Y)YY) o5/leros PRODUCE_,= THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dow'ng& O'Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 222 West Main St.PO Box 1990 Hyannis, MA 02601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Western World Paul J. Cazeault&Sons Roofing, Inc. 1031 Main Street INSURER B: IU Osterville, MA 02655 NSRER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE MM/DD/YY DATE MMlDD/Yl' LIMITS A GENERAL LIABILITY NPP1012091 04/30/06 04/30/07 EACH OCCURRENCE $1 000 000 DAMAGE TO RENTED A X COMMERCIAL GENERAL LIABILITY NPP925580 04/30/05. 04/30/06 SE $50 000 CLAIMS MADE a OCCUR MED EXP(Any one person) $2 500 X BI/PD Ded:1,000 PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE $2 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-7 COMP/OP AGG $1 000 000 POLICY PRO- JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS SCHEDULED AUT BODILY INJURY Os (Per person) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $NY AUTO A OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND WC STATU- OTH. EMPLOYERS'LIABILITY IR ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? If yes,describe under E.L.DISEASE-EA EMPLOYEE $ SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF,OPERATIONS I LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Insurance coverage is limited to the terms, conditions,exclusions,other limitations'and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived, or extended the coverage provided by the policy provisions.Certificate of insurance for workers (See Attached Descriptions) ' CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL If) DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE LS1 © ACORD CORPORATION 1988 Assessor's map and lot number .......................................... Sewage Permit number .......................................................... 'THE.r TOWN OF BARNSTABLE Z BA"S'TABLE, i "b BUILDING INSPECTOR APPLICATIONFOR PERMIT TO ............................................................................................................................. TYPEOF CONSTRUCTION ..................................................................................................................................... r ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....................................................................................................................................................................................... ProposedUse ............................................................................................................................................................................. ZoningDistrict ........................................................................Fire District .............................................................................. ..Name of Owner ......................................................................Address .................................................................................... Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms I.........` :...T.........Foundation .............................................................................. Exterior ....................................................................................Roofing .................................................................................... Floors ......................................................................................Interior .................................................................................... Heating ..................................................................................Plumbing .................................................................................. Fireplace ..................................................................................Approximate Cost .................................................................... Definitive Plan Approved by Planning Board _______________________________19 ________ . Area Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .................................................................................. Guertin, Daniel R A=11:1D 17986 1 1/2 story, No ................. .Pe?mit for .................................... single family .dwelling ................................................................. Location Goff......off.`Terrace ...T.........erra..c.e............................ .. .... .. Centerville ............................................................................. Daniel R. Guertin, Owner .................................................................. Type of Construction ..... ................frame..................... .................................. ..................................... 2# 1 Lot ............. ................... Plot ................... 0!C;�tpo/r 9 Permit Granted .................. .. .............19 75 Date.of Inspection ....................................19 Date Completed ......... .............................19 RMIT RE $R..... .. .............. 19 ................ ... ................ ............................ ............... ............... ......... .../....... ...... ............................................. ................. 1b)74 Approve n.,. ....................... ......... 19 ......... . ......... .............. ............ 9j.�e'.P......................................... q 1 '1 osTM]r� TOWN OF BARNSTABLE Permit No.� -----.--------------------- Building , Bung Inspector -------_ --- • Cash I __ Bond ----------- / _ rua A 00''t0 V0�\ OCCUPANCY PERMIT No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor ]] first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Address Inspection date Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department THIS PERMIT L NOT BE AND THE BUILDING SHALL NOT BE IED UNTIL SIGNED BY THE L BUILDING INSPECTOR UP CTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. ........................................ .............................�..... _................_.�._. ._ ...................................................... 1 ..._._ Building Inspector I 42737 Q C .L oT Z/ I i514 7 Q' LL/1.l�lLi.lT�oyV. I_y°af 5� E .L. _ y r ' I1 i5 9e� i - e . r f•,,.. Y y -0 ?�..� or "t � /.. ...J_. J .. � S•Car las r op Scale. . " _ 401 BUILDING LOCATigN'eLAN ; t C�,v:7JFi T r {'011 i i Being Lot # 21 as shown on I, !hereby certify that a plan entitled subdivision y th� existing foundation i plan of section 2 Lumbert Iodation is dbi-`I-ea(:bs Mills in, Centerville, t shown and does conform 1Barnsta Y-b; -Mass. , by Newell; wi h the building setback, B. Snow R.L:84 v3uzzards ' i--- re uirements of the Town i o€� e ., Bay Ma s s.- , �4t�d�.�etb.• . of Barnstable. 1�97�,.__�� recorded Barnstable' Registry of deeds in book i' Thomas q,'. y - 1AcxSON 275 page 55• t( No.9§37 Oct. 1975 �V � t i { �4utivEigned ..A,j _ '"i BuilderL Yarmo= Port Homes G� 4.) ^--r11 U c JimmyLane I Yarmq kth, Mass. ' 4sessA-map!and'lot number 1.1.... .. 2 .... f ��, �C' /!iL'— T r r+ Sewage•rf ermit number '' n r f� yOFTMEtp�• J TO :11' N" OF-�BA r T� ,r AB� � , G� �P o� RNSTAuBLE� d n Ti i13 13AHb3TAlms, i y 0 MASS. r ! 4' G1639* yPY `00 wi . BIUIL,DING,,-* IHSPECT0R A., ml APPLICATION'FOR'PERMIT TO`C11 .. ./us.T.iE' (' o TYPE OF CONSTRUCTION ...................... �...Q .... .. /S 'j� /�................ L..... _ ^.a .... t d 9, The undersigned hereby-applies for .a permit accordin'g•'to the following`mformatlon , / Location .. . ....... ... .... ...... Proposed Use ........ V".t..� L.J..44t. ...................::.... ................................................... Zoning District ......................: :.:..� 5............... ...... Fire,C�istrit� . .§aP Vi4L,a' hr2✓1CL; /`f F Name of Ownerli ..i LHI. y-� .Acpress. ® 1 ...... .. .... �cc�J� u6N1s _ �d i Name of Builder .. - Q� ....Address ........•. ry III.... ............................. .` -............... .. s ►� Name of Architect .. ..�:.1,�.1'.: .. ............. ...........Addres �C s !�.Ud�.....Q..... �...�-5.......!v.�.�.r............"............. Number of Rooms ...............%5..... ..../......FAT(i......Foundation .......,� �UIJ 2 r_ ....................... .. ... .......................... Exlerior ... -:�.`.. .............................................................Roofing OZ.'.#.... ..C.J�.. .! ..1...:................. Floors •- z C i 1 U.P ........................................Interior ......v.f. I ............................... ..Heating Plumbing Fireplace ...........Ai.s. .. Approximate Cost ............. ®.� . .. ® ........... � Definitive Plan Approved by Planning Board ___�__ __�o_________197- rea .........f�/?F�... c Diagram of Lot and Building with Dimensions • Fee .............. .... .................. SUBJECT TO APPROVAL OF BOARD OF HEALTH Zp ` 1 �.4 i 21 LO - 2- z . f iD 151117 S9 � i' hereby agree to conform to all. the Rules and Regulations o T wn of Barns r rding. the above construction. ,✓ Nam ` ti Easton, Eleanor 7/13/81 ' 1 1/2 story , No 17986.... Permit for ........' 1 Allp single family dwelling .............................................................. Location Goff Terrace ! , f�` �•-�, r 1— , Centerville � ........................Daniel R. �uertin..._.. .1.� ...�A t Owner . - \ Type .'of Construction ,.......,frame '........... ....... ir ► .. ............................ .................. ...... Plot ..f......:..... ....... .. Lot ..................... ...... ctober 9 75/ Q r -, `, Permit Granted .........Q e 19 � y •�" - 3 .-Date.of Ins ection /7,f-b ...................... / r p ......... ...� Date Completed �ci��. 19 g ' ' . PERMIT'REFUSED - ...................................................... Vr .............. . .�'.::!li!. . ^.c.1..I/ ' " C. .r. ......................... ............. ........� .. Approved ................................................ 19 t �� `' •-1 c '' ........................................................................... u F+ i ' 1