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0428 GREAT MARSH ROAD
P Q .. o E: it , � � ., ,. 4 .. ,. ,. a � a ,.. _ � a TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel ?_ZO Application # Health Division Date Issued A hv Conservation Division Application Fee Planning Dept. Permit Fee , Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 44-� ��Z� mod/zeSi /7, Village ��� �, dr,��� Owner. OAN6W ���J7 Address Telephone Permit Request /T� e ziZa _Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation /o?4D& 41 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family d' Two Family ❑ Multi-Family (# units) C Age of Existing Structure Historic House: ❑Yes .8-No On Old King's„Highway,..:❑Yes �-No .:,. CD Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Others .:: Basement Finished Area(sq.ft.) Basement Unfinished Area (sqA) Number of Baths: Full: existing new Half: existing new,- Number of Bedrooms: existing —new ll `n Total Room Count (not including bath.): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ ~ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �� Telephone Number Address , � � g/ License Home Improvement Contractor# Ema Worker's Compensation #4 ao P ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY ,t APPLICATION# ,f DATE ISSUED MAP/PARCEL NO. Li ADDRESS VILLAGE OWNER t, DATE OF INSPECTION: FOUNDATION, FRAME INSULATION 4 FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL k.. GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT f ASSOCIATION PLAN NO. y Massachusetts -DepaPtmnt of PBblic Safety t 'Board of Building Regula;lons end Standards Construction Supervisor •� ;License: CS-100988 f, HENRY E CASS1Dil 8 SHED ROW _ �I WEST YARMOU`ft1 Expiration Commissioner 11/11/2015 Office of Consumer Affairs and Business Regulation-:: i ¢0 10 'ark Plaza - Suite 5170 Boston, Massachllsetts.0211.6 Z Iome Improvement CQAgAQtor Registration Registration: 153567 Type: Private Corporation Expiration: 12/15/2014 Tr# 233831 CAPE COD INSULATION, INC HENRY CASSIDY - _. . .. _..----- 18 REARDON.CIRCLE. _— SO. YARMOUTH, MA 02664 . w Q 'Update Address and return card.Marls reason for chaugc. sca i t, _aroi-osn i VEj Address Renewal Ej Employment [ Lost Card 4 ((uiierircirrtareall6 c C/Gl��dae�eur�t. Ofti,e of Consumer Affairs& Business Regulation License or registration valid for individul use only before the-OME IMPROVEMENT CONTRACTOR expiration date. If found return to: gistration: 153567 Type: Office of Consumer Affairs and Business Regulation xpiration: 1 /1'5/201 A Private Corporation 0 Parlc Plaza-Suite 5170' r v Boston,MA 02116 CAPE COD INSULATION"lh1 HENRY CASSIDY 18 REARDON CIRCLE � � SO.YARMOUTH, MA 02664 !a Undersecretary .' otval• witho natre . A: CAPECOD-27 ' CVANGELDER DATE(MMIDDIYYYY) CERTIFICATE. OF'LIABILITY INSURANCE .'. 4/1i2014 THIS CERTIFICATE IS+ISSUED AS A' MATTER OF INFORMATION'ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY,.OR NEGATIVELY:AMEND,,:EXTEND OR-ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE-OF_INSURANCE DOES-NOT CONSTITUTE A CONTRACT BETWEEN ,THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must.be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.-A statement on this certificate does not confer rights to the` certificate holder in lieu of such endorsement(s). PRODUCER _ - - - CONTACT. Cape Cod COmmerClal Rogers&Gray Insurance Agency,Inc. PHONENAME: FAx 434 Rte 134 Arc No Ext: JAJC,N.:(877)816-2156 South Dennis,MA 02660 E-MAIL ADDRESS: INSURER(S)AFFORDING*COVERAGE •` a •-NAIL q INSURER A:Peerless Insurance Company ,.. - INSURED INSURER B:COMMERCE INSURANCE COMPANY. Cape Cod Insulation Inc INSURER c:Evanston Insurance Company 18 Reardon.Circle INSURERD:ATLANTIC CHARTER'INSURANCE GROUP . South Yarmouth,MA 02664 INSURER Er - _ • _. INSURER F'; — COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD, INDICATED. NOTWITHSTANDING ANY REQUIREMENT,+TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO.WHICH THIS.' CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES:LIMITS SHOWN MAY HAVE BEEN REDUCED BY.PAID CLAIMS. INSR ---- —' - ADDLSUBR POLICY EFF POLICY EXP - _ - LTR TYPE OF INSURANCE WVD POLICY NUMBER MMIDDIYYYY) (MM/DDfYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE .t $ 1,000,00 CLAIMS-MADE -].00CUR CBP8263063 04/01/2014 04/01/2015 "pREMISAGEsdaoNccTure s 100,00 - -- -- MED EXP(Any one person) $ 5,00 `. PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER s GENERAL AGGREGATE $' : 2,000,000 X POLICY n JECT PRO- ❑"COC e ' PRODUCTS-COMP/OP AOG $ 2,000,00 ' OTHER AUTOMOBILE LIABILITY ':y ,+" - .- . �.$ COMBINED SINGLE LIMIT Ea accident) - B ANY AUTO 14MMBCKVMK 04/01/2014 04/01/2015 BODILY INJURY(Per person $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $' 1,000,00 ' AUTOS _ AUTOS X X NON-OWNED- PROPERTY DAMAGE• $ HIRED AUTOS AUTOS Per accident $ X UMBRELLA LIAB X, OCCUR EACH OCCURRENCE $ 1,000,00 C` Excess uae CLAIMS-MADE R/O XONJ453512 04/01I2014 64/01/2015 AGGREGATE --- - — DED X RETENTION$ 10,000 V Aggregate , ` $ .4 1,000,0001. • WORKERS COMPENSATION - i STRT' - OTH AND EMPLOYERS'LIABILITY A UTE,, " D�`.ANY PROPRIETOR/PARTNER/EXECUTIVE��Y/N WCA00525904 .• 06130/2013 .06130/2014 E L.EACH ACCIDENT '•" $ 1 i000,00 OFFICER/MEMBER EXCLUDED? NI NIA (Mandatory In NH) r E.L.'DISEASE`-EA EMPLOYEE $ 1;000,000 If yes,describe under '` .- DESCRIPTION OF OPERATIONS below <. - E.L DISEASE.-POLICY'LIMIT $- - ^ 11000,000 i^ - `r• - -DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES (ACORID 101,Additional Remarks Schedule,maybe'.attached if more spice Is required) '`> Workers Compensation includes Officers or Proprietors Additional Insured status is provided,under,the General Liability and Auto Liability when required by written contractor agreement with the Certificate Holder. CERTIFICATE HOLDER CANCELLATION K " SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BECANCELLED BEFORE EVIDENCEOF.INSURANCE ' THE EXPIRATION,,DATE THEREOF, NOTICE WILL' BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.r a AUTHORIZED REPRESENTATIVE, 011988-2014 ACORD»CORPORATION. All rights reserved ACORD 25 2014/01( ) The ACORD name and Togo are registered marks of ACORD �: ' Die Co1rrr1Y1o10Vea1th of 1't1`assuchusetrs Deparnnenr of Industrial Accidents t 0JJ1ce of Investigations bpU Washington Street Boston, MA 02111 wwlw,mass-go vIdia I �i'orkers' ortxay�ery5 altiarit= �sur4>Trace Affld4vit: Bu.itders'/Contra,ctorsi.EIeetriciaaslpitllxbbery �� l il.v:.:urrt ItY.pt�x'1Yll:Ttlti�YYa _ y Se t I.,e ito ity�St ttcrr?.i_ : -Zi, :�. 7lG rYi / Phone #: -�L� �/;7 % 2- Z1- . r tirC roe, Ua etxwp;iayier7 ChecGc the appropriate box: l .t ratrploycr tivitYa. `t� ❑ I am general contractor and I Type Of Project (required):` Clnploycc:-t (hill anclstot`.p art-ti.me). have hired tht dub contractors 6• [] New con3u-tictio❑ u sole proprietor Or partuter-. listed on the attached sheet 7. (� hemoclelixig Ship a,.ld liavc no t;niploycc5 These sub-contractors have g- E] Demolition.. working for me Tax any' capacity. employees and have workers' [Nu workers' comp. ips Trani c comp. insurance t 9. F1 Building addition rr.tluircd:] 5._[] We are a corporation and its I0.[] Electrical, repairs or additions t l lull a horneowner dolig all work 4 officers have exercised their.. 1„1;❑ plumbrnb repairs car additions nrsuranc[No ttorkcrs' comp. ghrof exemption_per MGI: 1 +] .t c. l S2; §1(t), and we have no, I ZI Roof repairs ,.[J 1 arrr u hoi ricowucr actin; as a 13.R Other. ,e! � . i� 15 employees. [No workers'' t. ;crrcrul cotltractor(refer to #4)' comp.insurance required:] 'Aity ippltcaat that chCC"t)OX Ffl must" till out the sceliou below showing their wodtcn'cotapciisndot#jiolicy infonswtion. r tl�rc,� wuax wh)xubitut this uffidttvit iutiicating they arc doing all wot wit then hire outside courractors wust subuut u uew uttidAVit iudicatirig such.. �wa4iu wry lion chca:l',this box ulttst jt'tuchcd an uddiaonul sheet showing the.auvc Of the satb-couaac:tots and Stara whether or not those cutitica havc *. :'Inp uyccx. If tlu yub-4antracrur3 havc crnploycci, chcy must provide their wurkcn'comp.policy number. /tim rxn cmtployer that is providing workers'tom ertsadoa insurance or m em to eaL Velvw is.t he alit acid 'ob site:p,. I y p y .� �' _.� atJUltrru!!Ur[, I lct;uianec l:otuptuly N:u17c: 1'011L:y rt or Self-irks. Lic. #: ,� Expiration Date. «f 1 2— Nrt:Cta A copy of tilt: workers' c0rupeusatiou policy declaration page(shoMng the policy u"wber wad expiratiou date). I a.litr`c to scant coycr--4gc as required under Section 25A of MGL c. 152 can lead to the imposition of crirniaaal penalties of a riot ul,to S 1,M.00 and/or one-yeax imprisonment, as well as civil pciialties iu the form of a STOP WORK OfWER and a hne. .i _rr UP 10 l;250.00 it tray against the violator. Be advised that a copy of this statement may be forwarded to the Office of ' n�cscigtciotta oftbc DIA for in:suz'-auce coverage verification. t ttu hereby etrtifjv�rr rrdar tftc kris end penaldei of perjury that the information provided above is•true and correct _. J, - ;it, lticlS, .,� � 7 7�%Z j 5L U(jiLiui use umly. Do riot wrir� irr tlrtyr area, to be completed by city or town official t <'ity or l'owrr Permit/License# - 115(1u,g.authority ('circle oa.e): 1. livarJ o!health. 21 Builditug Deptartmeut 3. City/Towrr Clerk 4. Eiectrical Inspector 5. Pliyt xbhig Inspector 6.Other('uutrnct Ver3ott: Pboue#; } i OWNER AUTHORIZATION FORM 1, ; L (Owner's Name) ' owner of the property located at CT (Property Address) C. 4lervi1 ICY, MA 0a6..; � (Property Address) i hereby authorize CQ $ (Subc.ntractor) ' an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. X.-Owner's Signature ` Date TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel '® Application # Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Feel c Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street&0,6AddressVillage All P� 1 Owner I1�tV` <�� Address 6-c4 Uxmk ' Iyi Telephone Permit Request fkl sokv j s M44t s-2 � v To_/l skm &c — o� 1Cw X Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain -,//��� Groundwater Overlay Project Valuatio OO Construction Type < � d' Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new sizd_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: : w Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use Q0 APPLICANT INFORMATION (BUILDER OR HOMEOWNER) NameA"..T Qv\_ �7tlPAMIA Telephone Number Address T 1 IU ,O R t�� �'` � License # Sy MA 0 2 6 , Q Home Improvement Contractor# 16�006 " Email &&Mvt qpwlx�o eeiffllt'-Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO IJ{ � wo SIGNATURE DATE �J c FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. Tfiff rx tarp, 02 - _ wfc�rs�.r .gv�rirrx - • arke& Campensaf iLmi a ,�Affi&vit Rdddersf hm-c[ars/nec-tricimn&numbers Infarmafian e e I ut b hTarn (�usiie�lonfFndidaal7: dresD�iLGf f yfatrlg= ®�/ fir ' ` Ph:Ons Are ycFu au employer?tfi:eckthC-2pprgnia� car T o ems: . �. I�xta ctmfzacEar�I : }�of� i ❑ I am a emplager * haveilFin t5E moors_ . ' `.i- ❑Ides rnncfrru f uvti o andfarFai ex�pl Yee${fall trme)- 7. F.eraode3ig 2_❑ I am a sole giag ar orgal er- Listed an the at#arhed shoe . ❑ g ship anti have.nd employees There sib-matracta&have 8. 0 Demolition � fnfine.ia ��5`- employees mdhave.Wo6mrs� _ $ Q_ �Bni1d-ing addifian . �a Wmioms, caaIIp.i'tisrr ecomp-mcrrrara� driest or additions I0 ....EL a aa_ its '. repass - �. We a�a ca and d-1 : ❑ LFratr - �_❑ I am a hamet doi�at1 vrar� offers havesprit;sed ffieir I I�Piambmg repairs ar adi£itioas =vceSf [No wcsl='�P- ofEder IA per ISO�afLepaizs . incrxAnre d-1 F c-M§I(4),aad-weEm-Sono . empltrYees a F ig-;- 4f31er. ,... m mace require ��ry�g)2xsaf that checks box-0 mnstalsn fiIl ontt se�fionbcTase ch*e�R eswo�ea�romneasahaupQSu� �ffnmeoxvne�.ahr ubmit 3vs sad.-- d3.Vy are thing_II r.--d-End tb-hr-e Mtla--contrPcm-s mmst s�I it a safd3rzt in^' sarh =Co- rsthstcheckthis b=nx=st]ache sn:at;ri, at sheetshbcffigthen�eofHewits- =A=teuhEdIerDc-=rtm&Eprtffxshsve emglQ3e - If the soircaa�c3m$hac�e�pIogrQs they�rstgmti3efh b�s'.tomg.paIicpu=bez I am a z arhpIoy� thritis pratidbmg workers'compgrmrclinn ansazrrrgcs far ray amgxEaygrs, Eelow is f3aepQltcy and jab errs �arrremlian. ti � Insurance Compan Name: ; NEcy4 orSeff-ins-Lic-#- ExgirafioaI3ate. Job Simlc,�,Sta�2�p nMtP�v,Ile At#ach a ropy of the Tmrkers°cDnrpenSation P6RC-y dsclarstian Page-(showing the poles n=bm:-and ejcp`a-ation ilste). Failm-ff to se core-covernge as,mqa rednuder Secfio@SA oEMGL.cc 152 can lead to the impasiS=of c6rniaal pmalffin of a fine up to$1_50D:OD andlar oneyearimpd=ment as wen as mil py=16 in the faEbi of a STOP-WORK GF=and a fine of up to S250-00 a day, against the:violator_"De advised fhaf a c�gg of Foie ctxtcrtcnt may be farwar-ded to fhe Office of Lavestgsiiom of the DIA ffti msmanm mvemge vazda-cmtEor-. l cfo h6crebj,.Ca&fy un2ffr th pa=urtd psraah§kT ufped4ty fleatfhe irz orrr t6wi pt,71idec£rtb.zn is frzra trnd carrecf Ilhoae# J(� c•. Qyk:ie FGsa vu£d.^. Da"t wii r in fFas area,67 ba C aRgJE Ed.by d�p or tafm raficrnL CJ1 or Towcc P�, rsff:;cense hzm� Av1-ho-rity ¢ne L Bozrd of Health 2.Ruiffing Departrfr t atpTa-wm Orrl 4_Electrical Inspector 5.Pturu fsspe�tor , q. 6. E rti Town of Barnstable Regulatory Services snxxnsi E Richard V.Scali,Director 1639. o �p 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 If Using A Builder T I � u P as Owner of the subject roe �� �/�b��iC J property rty P• v hereby authorize F to act on my behalf, in all matters relative to'work authorized by this building permit application for ' (Address of Job) '''`Pool fences and alarms are the res ons o the applicant. Pools . _ P ibltYf e are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner '"" Signature of Applicant s ' Print Name_ = Print Name . ,Date .' q u QTORMS:OWNERPERMISSIONPOOLS' ' Town of Barnstable .- Regulatory Services pp THE Tp� Richard V.Scali,Director Building Division BaRxsrnsrir. ` Tom Perry,Building Commissioner 163 ��� 200 Main Street, Hyannis,MA 02601 � a rFD www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LIC ENSE 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-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner" shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. _ The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval 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 &ReguIations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems, particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 I OTHER,CONSIDERATIONS:All home improvement contractors and subcontractors shall be registered. Any inquiries about'a contractor or subcontractor relating to:a registration should be directed.to: Registration Division,Program Coordinator One Ashburton Place Room 1301 Boston,,Ma 02108 Tel:.(617)727-3200 ext.25239 You may cancel this agreement:if it has been signed.by a.party thereto:at a place other than an address. of the seller,which may be his main off ce.or bmnch.thereof,provided you notify theseller:in writing at his main office or branch by ordinary mail posted,by telegram:sent or by delivery;not later than midnight of the third business day following the signing of this agreement. Attachment A THIS PROPOSAL IS SUBMITTED,1N DUPLICATE DO NOT SIGN.THIS`CONTRACT'IF THERE ARE ANY BLANK SPACES.` SUBMITTED: My Generation Energy,Inc. ACCEPTED.. Owner(s),' SIGNED NAME: DATE �I 6i rk x z:. t r.,,> .t• e� �e z' Y .. `4 ma`s i IC)P 7f .? .� `�,.i? .t' J. 1 s:r- '0•� -C)OW f V V{' air aS }'3�'se}:iif3z. 2w1 tP iT etl l51'.K�qSt{fuS`a tlfif!bew ofi 4i) 'lil3EitPifa�/�'3�t�3cstS}]CUrglif]: tS�� 7t?:7� aitsai735+�"t�#i i€9 S! iTit`r�a�Aa con Insurance. 1pany hasr arcr: scc d the r :e elabovel ama sole era arliff " tse` srrfe — PI�arrrT3 rainessa if �cs ti ig r i c ntractor �t��' � e 1 � s r e titre. 1 Gs? =i �TtS3t Y 1 s ,S ga L7ji u�*s 'i tad? fl Lop j wmi c�form - r f3 ffim rd:; rfOvIded the lrigttflinder.anf6 at3or I e.o a ova l a sof prbr ,biatop tw .., marrohlp aM have nd�,em, ay or-1>i9 d tic�::fi. rti r i ur9der tFrr'ilia r s t I era i es car areriurythat as true add rrtsignature f FL j7t'lM n?ML o Nt sse- Lrrr t a tasr�e far?i C i.+{iF #9L� ?.s� ta� [CTP ?vfrl�QYs 2`ark'LariCF? c1,6 CdE.. - am ail emofoY' �th pro i. w--or rs.'.:v rasa# r r a rce r_m�etrfi i y as a€xee[ £3P 1orl it =z. f�°�.�.i�t"�;� gs•�r'.<`.3 y���.'€s��7'p'{'b:-.a�Lf`t�i_�•.-,. <.. �-..�..x ��.r i� <c5 F xr•�yiy��{��:L,g�'"`��eX'..-'C;.r';.. =� ' Con8tr 1 ion S p� � r 61\e� fd.i5 -a1 Licensed D sigp:e(rrapplicable) R , ,5:_ "rrtsbe If 'fly and c m Lv r € nsIb for all E,elsh is s jismg— tH' site€�`:�:ll-be i ona b 7i � vsap swing uh all foem s do .pu u tot:8 OAR and the la w-:0s as approvedby 1i e BUTIdin �<s . Respo R15. , 53.E t c d € s the,C-Onstruction, afa e-n f the Widings arA "tees Ordy p s ar',:.t e Slate uRdi u Uode arve.,all ofher appricable ws uffhe-Corn-monwealti,ever lboug,U�e Uce s . hofde€. 1&3 The I WWI o;P-^nw vp1-aUo s > a&;i aga Wv to y his buildi a e ems} 5_2.:a15.4 Any Iicanse rho `�yiciate he Bute 8i!Ia-fJ 1 ('-O0 figi!lJ�tu���Ot vo ion or suspension:of license bar the hoard of Building Regulathris and S.4_z 8i AH..build�� $�u�sj�ll4 �e� a�f 2�2�u�i sf�3�3 ��� ;G�� .�I ±.r��a?$� jt?c0nS a,uI:�Tu 0h,reci r,sImu c5 or, a t ,0, s r t.r 'r-T d Ov l ct'dernolition,a 18 n-6 Jongor'supervisira said a ,the md s a finmediately cease i=aura : ad ah and m-t".may s bs F rTir*,3 b5 g unde h .rules and €istion' x,:ce si con structioa,supeii isors ki a=daily a with the-State Soil in,, Guda" f und4 a—nd the ns a#�:.do fns of pr cedur Ord ffsa s e �i ire aciiohs ag mfled for the by buflding offxci m, � ` .�-,°cam,, I • My Generation Energy,Inc., 3 Diamonds Path Unit 2 South,tennis,MA 02660 Phone S08-694-6884 Pv1yG�eratianEn�rgy 3 Town of rnstable Building Division 200 main Street. Hyannis, MA 02601 ATM Tomas Perms June 26, 2015 Dear her. Perry; 1. am Writing to grant permission to Unas Reuinskas to act as construction supervisor for projects under My,Generation Energy,, Inc, Please refer to Con trucddn Soper isor Ucense numl r i uN.er the Massachusetts Department of,Publ c Safety Board. of Building Regulations and Standards. If you live any Questiions, please feel free to contact me at your convenience: Authorized by F Andrew Wade: President and CEO My Generation Energy, Inc. i • f r MASSWhusefts in' i Safety Oard of Building Regulations and Standards _ UPCY Ucensez CS.-09"7 Ap y � } 87 CAMP OPECIEE CENTERVI MA LLE •' �' � r mi '� • e ACCO CERTIFICATE OF LIABILITY INSURANCE DATE( 3I24/20YYYl) 4/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER BRYDEN&SULLIVAN OF DENNIS INC N°An"1E:C PO BOX 1497 PHONE IFX Exth- A/C No SOUTH DENNIS, MA 02660 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A: LM Insurance Corporation 33600 INSURED INSURER B: BALTIC COMPANY INC tNSURERC: 87 CAMP OPECHEE ROAD CENTERVILLE MA 02632 INSURERD: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 23920429 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:--NO'P4ATHSTA::DING-tNY-REQUIREMENT;TERM-OR CONDIT;ONI OF-ANY-CONTRACT OR-OTHER DOCUMENT-WITH.RESPECT TO.%A!HICH 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. ILRSR ADOL BR POLICY EF'F POLICY EXP LIMITS TYPE OF INSURANCE POLICY NUMBER IY MIDD YY MM/DD/YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 DAMAGE TO ENT€Ff- CLAIMS-MADE OCCUR PREMISES occlln a ence S MED EXP(Any one person) S PERSONAL&ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 5 POLICY❑PRO-JEcT LOC PRODUCTS-COMP/OP AGO 5 S OTHER: COMBINED AUTOMOBILE LIABILITY Ea accident) SINGLE LIMIT 5 ANY AUTO BODILY INJURY(Per person) 5 ALL OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS AUTOS NON-OWNED PROPERTY DAMAGE S HIRED AUTOS AUTOS - (Per a adept 5 UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE 5 DED RETENTIONS 5 A WORKERS COMPENSATION WC5-31S-384924-025 3/25/2015 3/25/2016 ,/ STATUTE ER TH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETORIPARTNERIEXECUTIVE NIA E.L.EACH ACCIDENT S SOOOOO OFFICERIMEMBER EXCLUDED? .. (Mandatory in NH) E.L.DISEASE-'cA EMPLOYEE S 500000 It yes,descnbe ulxter E.L.DISEASE-POLICY LIMIT S 500000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Workers compensation insurance coverage applies only to the workers compensation laws of the state of MA. This certificate cancels and supersedes all previously issued certificates,only as they relate to workers compensation coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MY GENERATION ENERGY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 3 DIAMONDS PATH UNIT#2 ACCORDANCE WITH THE POLICY PROVISIONS. - SOUTH DENNIS MA 02660 AUTHORIZED REPRESENTATIVE OL LM Insurance Corporation 01999-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD • CERT NO.: 21920429 CLIENT CODE: 1595769 Anne Chandler 3/24/2015 12:11:44 PM (EDT) Page i of 1 _ Ofice of Consumer Affairs and Business:Regulation 10 Park Plaza - Suite 517:0 Boston, Massachusetts 0211�. Home Improvement Contractor Registration It w Registration: 1.63006. # t Type_ Private Corporation tZ Expiration:. :5/41201:7 Tr# 265414 MY GENERATION ENERGY, INC. LUKE HINKLE u: 326 YANKEE DRIVE , BREWSTER MA 02631 . Update Address,and return card. Mark reason for change:. Fj Address Renewal [I Employment Q.Lost Card. SCA 1.%. 20M-05/11. [- ^^ �//re�ornaruzr�cr<eGclf�o�'C��,crts�xc�c%�clt� Office oECommit&Affairs&Business Regulation License or registrat)on valid for!ndividul use only ME IMPROVEMENT CONTRACTOR before the expiration date'_If found return'to. gistratwn T63006 Type: Office of Consumer Affairs,and.Business.Regulation; xpiration5/4%2017 Private Corporation 10 Park Plaza Suite 51.Z0 s Boston,MA O'2116 MY GENERATION;ENE RGY, I�CLY �: LUKE HINKLE _ 326 YANKEE DRIVE x BREINSTER,MA 02631 Undersecretary Not valid,withOut'signature. t r - - P.O. Box 201 Phone: (508) 896-1513 Brewster, MA 02631 Fax: (508) 896-1783 Enwiffewrino,€ivision June 23,2015 RE: Solar Panel Installation David Pratt 428 Great Marsh Rd. Centerville,MA To Whom it May Concern, There are eight (8) solar panels currently proposed on the west facing roof and ten (10) proposed on the east facing roof of the house as shown in the attached sketches. The roof structure under the panels is supported by 2x8 roof joists and decking. The panels are to be attached to the roof through a system of racks which bolt into the rafters under the roof deck as shown in the attached, sketches. The attachments are certified by the ,manufacturer to withstand 120 mph wind on this type of roof at exposure C. The roof structure with the proposed panel placement, at the existing roof pitch subject to the Code wind Exposure C, with the roof attachments, is sufficient to withstand the loading required by the Massachusetts Building Code including the weight of the solar array and the wind loading for a 110 mph wind(also IM mph)and Exposure C which is required for this site. (Hurricane prone) Please see attached sketched and drawings. Thank you. Sincerely, Linda.J. Pinto,P.E. Oceanside Septic,Inc. I OF UNDA J. PI I OTHER CONSIDERATIONS:<All home.improvement-contractors and ubcoritractor's shallbe registered: Any,inquiries aboui a contractor or subcontractor relating to a registration should be directed to:' Registrafion Division,Program Coordinator One Ashburton Place Room-1301 Boston,Ma 02T08 Tel: (617)727-3200 exte 25239 You may cancel this agreement if it has been signed..by a party thereto"at a place other than an address of the seller,:which may be his main office or braneli thereof,provided you notify the seller.':a writing, :< at his main office or.branch by ordinary mail posted;by telegram;sent or by-deliver y. not later than midnight of the.third business day following the signing of this agreement. Attachment A. THIS,PROPOSAL'I&SUBMITTED IN DUPLICATE DO NOT SIGN THIS CONTRACT IF.THERE ARE ANY.,BLANK SPACES.` SUBMITTED: My Generation Energy;_MCI Owners) �-- SIGNED;: NAME: fT -_ iq sz�' DATE 3 David Pratt Site Photos 428 Great Marsh Road, Centerville eight solar panels located on west facing roof. _' Ten solar panels located on east facing roof. My Generation Energy Andrew Wade — Site Photos L1Y u f 1 1 � I■ M ■ •3,.tip i y I■ � � t David Pratt Site Photos 428 Great Marsh Road, Centerville Solar panel =44.1 lbs per module 18 Modules=945 lbs Inverter=4.4 lbs per module Projected Area of Array=306sf Associated hardware=4 lbs per module Added dead load=3.08 psf Total= 52.5 lbs per module Ground snow load=30 psf T1.&A$Was, j,0 2'r-12, 1 Z72 ._ A. _ -mow# ►t« �- �.� �v - + - �t gyp« tr � t� .� 10441% #1 S-9 n-9 1*2 194 22.16 7.1:63 1 t S 144 174 ` . s-6r4*Kb *2 11.2 101 1�1 11 21,E 7.2 104 11. 1. 1 2. 16141# 0-2 010 11.E 04 t 1 4.1 00.) J-r,6 !4*6 1i s�f r -3 13-6 174.0 214 twc 11 1 7 1 17-1 2. 1.0 24-2 11 wi�is' #1 44 A 214 1169 11-0"3 11+c q�•tlt' 2'; I149 14.11 ". 04 21.1. I2 I 1,364 1413 1111 10 Soo tttrbW S d-11 14.1 1 (i ` .0 1111 14.1 I116 .234 Ioteb 1 i1*9 18a4 11Et 21- 25-2 1 12.10 16.2 10.11 22.10 pttt� 1 » t S 9-$ 0.3 17-;S 1 '1$64 11.9 W2 1949 22-to a r }talae r 1 $02 11•41 01 1W 21,E 141 10.3 13.6 104 1' 2 11ru is Cro r2 104 1 21.5 104 13-b t6'O 14.2 •fir 6 9-0 1311 16- $16 31 10-3 12-6 14.6 Maximum allowable span-15'-1n Actual maximum span - 12' t My Generation Energy Andrew Wade- Roof Attachments SNAMPACK C0430SITION L F130T SN,APNRACK CHANNEL NUT X 1' S.S. BOLT AND SI ?MACK SPLIT WASHER STANDARD . . RAIL T 5 S; FLANGE NUT SNAPNRACK CO OSiT]ON • �` R013F FLASN]N .. S.S. LAG SGREV WITH FLAT VA*ER. (SEE ENGINEERM MCUMENTS FOR. $OLT ENeEOMENT RE0VlREMENTS — .5" f4N. Eta W—DNEN€f IS TYPICAU SNAPURAGK L. FOOT BASE SEAL PENETRATION AND UNBER BASE '+KITH APPRORRIATE ROOF SEALANT ROOF DECKIW2 TYP. RAFTER TYP.--= �KAtlp* rk F .11 David Pratt Site Photos 428 Great Marsh Road, Centerville eight solar panels located on west facing roof. 14 AIR 7"" Ten solar panels located on east facing roof. My Generation Energy Andrew Wade — David Pratt Site Photos 428 Great Marsh Road, Centerville .. a a �V � ,...-t+�w'w+r ,4 +ram•� •�vr�we� ,�. "� ��" - ,,.♦.�. ti,; +ry-=..-"sw., ct -'.�M-r ,Lam }"° "e"'s.'b.S.w"Wel.w, '�Yi�'.."'."e� � � '�`�.-y�,�a �r y. . F N f My Generation Energy Andrew Wade — David Pratt Site Photos 428 Great Marsh Road, Centerville i R r ��v ., �➢; i�'1�V1°� �e�lily ` � e x " �' T w ` t pt a: O - O j x - .;,,. -• c 'r3? i LA mow pr- F, , �. ,ry r '_ 4x4. y ,�• frx '' y: .„ 1 w My Generation Energy Andrew Wade — David'Pratt Site Photos 428 Great Marsh Road, Centerville Solar panel =44.1 lbs per module 18 Modules=945 lbs Inverter=4.41bs per module Projected Area of Array=306sf Associated hardware=4 lbs per module Added dead load=3.08 psf Total= 52.5 lbs per module Ground snow load=30 psf 'PAS S1 RAM RVANS F<*CL>S1MM t3114BEit SW1 sY t 4ylF'. ow. "wr i. r 'T d!„�•` T+T10 '« » '€YfiCY ,1 �s #r ►1 �� �1 Dow*$1if4AJCb 4.1 1" IS-10 213 S 1 1-:9 1 - 21. 244 014 *1 9.4 124 46.2 11,04 2240 .7-10 11.5 14•S 114 2" Oocoas i t44 b 2 11.11 Wt 1$4 21-,S 14 WN4 11-0. 1 to. Oovou 11t4mt 0 4-2 114 1.3-I1 162 $4 1Z10 14-4 lidn'f'ut $S 11-2 134 1740 2M 1+Or11 _? 1'X6 1 #: 10 214w2 Zito-Of 111 $4 12- 1 194 2d '747 It-1 14:1 1 -2 1#-11 litm-to ft' S-4 114 14,11 '114 - 10-6 04 16•3 ISO New-fir M 11+s 1341 16.2. $4, $4 1 3 k.Z. 14. 0atMpko 3-11 14.1 1" 2" )44 lb $-11 14.1 111-6 2M tv clr SOOOgm pi 1t1 9.9 1 04 214 IS,? 12.10 1,6.2 t9-2. 2-1 Oil t i i41 42' 12 i6.2 1 • 2.10' 1144, 14.S 0- �11 eralaiar 2 6-1 12-4 14- 174; 111 -$ 11-0 114 1 pr . tnr. r - 1 • 12•S 22.1 2S•` 12•±1 12 1 .1 eoara •f#f .41S4 1141 04 1 214 14, 1 •4 0-6 1 6 1 " prsco.pjl*Or 4.2 1.11 1 21-s -7'1 10.1, 1 16` ' 1�-2 lat er 64 1341 1 1fr2. S�6 $.J 16.;3 12.6 1 Maximum allowable span-15'-1" Actual maximum span — 12' My Generation Energy Andrew Wade — Roof Attachments AP ACK CCMPOSITION L F130T SKAPORACK CHAKNEL NUT 9XI' SS'. SOLTAND SN -ACK SPLIT WASHER STANDARD RAIL SSt FLANGE MIT SNNnAACK CEWDSVION ROOF FLASHING tV S.S. LAC SCREW WITH FLAT VASWR (SCE ENGINEERING DOCUMENTS FOR �._. OAT Eltr :ANENT REkl lMMENTS - P,5' MR EMONENT IS TYPICAL SNAPNRACK; L FOOT SASE. SEAL PENETPtATION An 41"ER RASE VITH . APPROPRIATE ROOF SEALANT ROOF ,DECKING TYP; RAfTE:R TYP, F Y� i I David Pratt Site Photos 428 Great Marsh Road, Centerville eight solar panels located on west facing roof. v `4: b, 1.. wt F .. ,. goo Ten solar panels located on east facing roof. My Generation Energy Andrew Wade — David Pratt Site Photos 428 Great Marsh Road, Centerville Yf ���; tiff^«�• ._ �� 2�T"1i�'��+ 'A`�i.R>� 7r� . "wrb* �'"�„� ,r�� •-w..y.�., f'. k �'�"°�,', y-sy+a,,,Y,�. 4.wy,�w.yp,,a,, � _ »ah?rMw t irdY� r, ... .,mow.... .�:, ,. +Y �i ur ` P ;..... - � k i Y' vy pA A w fi dw� �A- '.y"t .o'er; ...�.-a.. ti f ,.4— IA r � R r # � db n My Generation Energy Andrew Wade — David Pratt Site Photos 428 Great Marsh Road, Centerville 71 Y w y t i _ I it�r .� µ • �.. �� "`� 'K� t �a�' # a aa. �� ?+��$� ¢ �a��ss �� t e ���y .,l r. e •.r:. ,30 sin':. •`�", fc,�` ��":a. ,� My Generation Energy Andrew Wade David Pratt Site Photos 428 Great Marsh Road, Centerville Solar panel =44.1 lbs per module 18 Modules=945 lbs Inverter=4.4 lbs per module Projected Area of Array =306sf Associated hardware=41bs per module Added dead load=3.08 psf Total = 52.5 lbs per module Ground snow load=30 psf U 51'0) Wig 1t�trit�h .1 144 Woo tw b #11 1 174 71-) rlx.l 1 9-11 0.0 16* ! 2e"-10 7-10 11- t+$ 114 201-5 Oatow ffl4440 Q 2 11*11 W1 104' 21-S 14 10.1111 0. 1 111062 !tea Ii:r4agh 0 €r 0-0 11-$ 0-11 1 $4 1: 10.) I 1 6 I1 iox $S $4 13.6 11-to 2 -9 t4xt b 134 174 2 10 . Z441 11+ s- t $1 121$ 11" 14 17.7 11-1 144 1 2 110-11 11r. •t�r �`� '. 11 1+1�11. `. 1 +r'"1: 71ri1 7'. 1 1 +1 1 11�+ " -or it 19610 11 1340 1 2 $6 4.1 10-3 12.6 144 . 11Wrai c S, 11-0 141 1 2 P &11 14-1 1" 1r.Ir $ ft rix of 9 11-4 W 214 25 1240 1&Z I9-2 -10 140 414 110 17. 7 UM ON 0 9-S 1 -4 14-7 17 J-10 ti-40 t 15- 1 r r S S.$ 0.3 1 -1 1$ 7 #4 11.9 1 ; t 0 tNto pr �.la e• r` #4 $4 11411 1$11 411 71.E 14 1 W6 1 19ra #fr it -Cir *. $4 11w1.1 '10 14" 1-1 1 » ' 113.6 1&4 I6 & ?I-0 7 1311 16-2 124 1 Maximum allowable span-15'-1" Actual maximum span — 12' My Generation Energy Andrew Wade — Roof Attachments SNAI'i't ACK COVOSITION L FOOT Sl�A ?RA�CK CHARNEL NUT X I' S,S. 00 AND SWPNRACK SPLIT WASHER STAND ... RAIL , sz. FLANGE )4uT 4 i SNN*4ZACK CEMPOSMON ROOF m4SHIN S.S. LAG SCREN WITH FLAT VA*ER: (SEE ENGINEERM MCUME04TS FOR. BOLT EMBEDMENT REQ IREK'NTS — " �.--... I6N. EAR MENT I:S TYPICAL) SNAcK: L FOOT BASE SEAL PENETRATION AND UNDER BASE 'KITH-� APPROPRIATE ROOF SEALANT ROOF DECKIM TYP. RAFTER TYP.. bs a y r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 2� 0� 5ARNST449ication # Q,0/ Health.Division �ate;lssued rZ JZ4I16 Conservation Division Application Fee Planning Dept. Permit Fee ` Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address , y�✓aT ,���, ,�Jd Village ���i✓ �/f� Owner X/-G le l Address �u� Telephone J70 Permit Request U, �C� � �s'� ���� s Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 4- Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes �61\lo On Old King's Highway: ❑Yes �2CNo Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name /''lrt ��4&=:6J Zr T9 �/ Telephone Number rt�7�� Address 49 License# Home Improvement Contractor# /6 �� -17 Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY } APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE w� OWNER _r DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING } DATE CLOSED OUT ASSOCIATION PLAN NO. Town of Barnstable regulatory Services BA1tNb?A9I$ R1Cl1Srd V:$Csli;Director s Building DiVisiOn y Tom Perry,Building Commissioner 200 Main Street,Hyan ,:NIA 02601 wwwAdwa.barnstabie ma_US Office:.5.48462-4038 ' Fax: 508-790-6234 Property Owner Must Comp etie:and:Si'T is Section -If Us in A Ba&r _�.. z_ 0�vnerpf the:subject progeny lei�by authorize t1 to acC on:my behalf, in all matters relative to work uthorized bythis building,permit application for. . W`��2g G;Ica:� ���h P•�a,� C�,+r��A t�e- !��' (Adds oE .ob),, 3Z Pool fences and alarms are e«respons btl yof the-applicant. Pools . are not to--be"filled'Or utilized'before'fencers:. nstaned-.and a'll-final .inspections are performed and'accepteel. ' Signature of,0ovner ,Signalaue:of.Appkant i--- - z ui,Name Print_ -Name Da Q:FaRMS:OWNF,RI E MISSIONPOOLS f Massachusetts -D6partment.of public Safety Board of Building Regulations and Standards Construction Super)isor License: CS-100.9.88.. HENRY E CASSIDY' 8 SHED ROW WEST YARMOiFrH .' ✓, �r,t� Expiration Commissioner 11/11/2015 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 153567 Type: Private Corporation " Expiration: 12/15/2016 Tr# 259188 CAPE COD INSULATION, INC " HENRY CASSIDY 18 REARDON CIRCLE SO, YARMOUTH, MA 02664 Update Address and return card.Mark reason for change. A 1 0 20M-05/11. - Address Renewal ❑ Employment 0 Lost Card � m e epo1vmmo2cuea.?M,a�C�/lla�Jac���te �\ 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 xpiration: -12/15/201.6 Private.Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 4PE COD INSULATIQN,,INC _ ENRY CASSIDY , 3 REARDON CIRCLE' J.YARMOUTH, MA 02664 Undersecretary 9.Nyvalid wi ut sign e The-Commonwealth,of Massachusettsp, Department of Industrial Accidents 9 :9 ce o ati ff f Investi g ons - .600 Washington Street `Boston,MA 02111 www.mass.govIdia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbehs Applicant Information PIease Print L-e ibly.. Name usiness/Or ,(B anizatio , g n/Indtvtdual): l Address: V61 , City/State/Zip:/State/Zi VD i_ r ! ty WV WLd t�I"1�..t� ���,� Phone #: � (��} -7..��J l•�I�-� , Are you an.employer? Chek he appropriate box.: 1. I am a employer with �j y< 4. I am a general contractor and I Type of project(required): employees * hav 6. New(full and/or part-tune).:. e hued the;sub-contractors .� ❑� construction l 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, a Demolition working for me in any capacity, employees and have workers', I. [No workers' comp, insurance, comp. insurancet r 9•. 0-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. [No workers' comp. right of exemption per MGL 12. Roof repairs insurance required.] t c. 152, §1(4), and we have no p 3a. I am a homeowner acting as a, employees: [No workers'' 13. Other general contractor(refer to#4) -------1=- - comp. insurance required l Any applicant that checks box#1 must also fill out the section below showing their workers'co mpensationpolicy 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. tContraotors that check this bo)C 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 v information II 'Insurance Company Name: U/ V� Gt1'lz�G Policy#or Self-ins: Lic:#: 00 4 Expiration Dater Job Site Address: City/State/Zip; Attach a copy of the workers' compensation policy declaration page(showing the policy number and ex.piration 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 forwarded to the Office of Investigations of the DIA for insurance coverage veiificatiou. I do hereby certi un - the pains and penalties of perjury that the provided rovided above ' � Si a • u true and correct Phone Official use only. Do not write in this area, to be completed by city or town official - !� City or Town: PermitlLicense # j Issuing Authority(circle one): _ L Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: i From:Central Fax Fax:(888)507.0822 To:+15087785735 Fax: +15087785735 Page 2 of 2. 06/30/2015 9:25 AM CAPECOD-27 JFERGUSON ACORO' DATE(MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 6r30/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. if SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: Rogers&Gray Insurance Agency,Inc. PHONE FAx 877 816-2156 434 Rte 134 Alc No Ext: AIC No): ( ) South Dennis, MA 02660 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Peerless Insurance Company-see LIBERTY MUTUAL INSURED INSURER B:SAFETY INSURANCE COMPANY 39454 Cape Cod Insulation, Inc. INSURER c:Endurance American Specialty Ins.Co. 18 Reardon Circle INSURERD,ATLANTIC CHARTER INSURANCE GROUP South Yarmouth, MA 02664 INSURER E INSURER F: ' COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT,THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMIDDNYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ ''• 1,000,00 �X CBP8263063 04/01/2015 04/01/2616 'NrI`u 100 00 CLAIMS-MADE OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $' 2,000,00 X POLICY❑jECT a LOC PRODUCTS=COMP/OP AGG $ 2,000,00 OTHER: - - $ AUTOMOBILE LIABILITY - COMBID EDISINGLELIMI $ 1,000,00 B ANY AUTO 6232707 04/01/2015 04/01/2016 BODILY INJURY(Per person) $ ALLOVMMED X SCHEDULED BODILY INJURY(Per $ AUTOS AUTOS , l ) NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Peraccident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,00 C EXCESS-LIAB CLAIMS-MADE EXC10006635000 04/0112015 04/01/2016 AGGREGATE $ _ DED I X I RETENTION$ 10,000 Aggregate $ 2,000,00 WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE I ER D ANY PROPRIETORIPARTNER/EXECUTIVE WCE00431901 06/30/2015 06/30/2016 E.L.EACH ACCIDENT- $ 1,000,00 OFFICERIMEMBER EXCLUDED? a N/A (MandatoryinNH) E:LDISEASE-EAEMPLOYEE $ 1,000,00 If yes,describe Under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 3 . , DESCRIPTION OF OPERATIONS I LOCATIONS IVEHICLES (ACORD 101.Additional Remarks Schedule,may be attached If more space Is required) Workers Compensation includes Officers or Proprietors. Additional Insured status is provided under tyre General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF TAEA13OVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OFYARMOUTH HEALTH DEPT. ,THE EXPIRATION DATE .THEREOF, NOTICE WILL BE DELIVERED IN, HAZMAT LICENSE RENEWAL ACCORDANCE VUTH THE POLICY PROVISIONS. 1146 ROUTE 28 South Yarmouth, MA 02664 AUTHORIZED REPRESENTATIVE 74 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD T TOWN OF BARNSTABLE Permit No. ---- Building Inspector cash rua ----------'- '619 �+o■".► OCCUPANCY PERMIT Bond _ X Issued to Barnstable Holding Co. Address Lot lU 28 Great Marsh Road. rent.— ville Wiring Inspector � i Inspection date �^ Plumbing Inspector Inspection date Gas Inspector l Inspection date Engineering Department Inspection date Board of Health Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. bbrr ...... . .. ... ... .... .... Building Inspector �_.� ,: --- ..• r �rZ r-- � ::�"� t-, r,Y_�k,. S. +:.��.. ;� Y '.*::t �_ ,.K � �. =rye, n.'. ��..� 'O•.ew TOWN OF BARNSTABLE . BUILDING DEPARTMENT t seaaSr a : TOWN OFFICE BUILDING ru �ajr i639• `� HYANNIS, MASS. 02601 Y' MEMO TO: Town Clerk FROM: Building Department DATE: .?O jjLy /9 fi. An= Occupancy' Permit has been issued`4 r the building authorized by 2 7 10 z BuildingPermit #.,.............................�................................................................................................................. „... ...:..............�.. ...»»... issued .to /... ��f s Ys��Lt /�..�a........... Please release the performance bond. -t LoT Ia 6Ty�, o o f �.oAV 19 t s. IDS J , T$ 2 2b a' 9H, 7S' N 75 �i„L„1 7¢ /�c , �j ' e< T3�RBRRi9 o o o r u -FY Y. 1 ` , y F. fd�WToN `°t ` 20//0 k NOTE:.A•S S OF %✓ 77 9!S"o"w . 7aw,� /3klcstw S rt ROSERT ea lti iZ E g Tp ;47 , Ito. 19367 �fGI$T���/ to ;. CERTIFIED. PLOT PLAN 4. O-T '/4:' l2Ei9 T �R R 5,41 /�d ;NE CONBTRtICTOON ONLY ,EAIJE2y���� TOE :,OFF ;:FOUNDATION 19 FEET IN bA®pVE � L4W POINT` OF ADJACENT . t� •� �a �► , v iRFIOAD. �_ DATE . 3 SCALE, o / 8 G E �3l E'E /N� I CERTIFY THAT THE: : ': CLIENT.EL� 2_ ;SHOW ON THIS PLAN 1S LOCATED. 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TOWN REGULATIO;m TOWN F * "ARNSTABLE Lei V BUILDING) INSPECTOR APPLICATION FOR PERMIT TO ........e;00A.A 462.eler 6�e5_0 0-)................... II TYPE OF CONSTRUCTION ... ............................. ...... ........... S..517--A................ "/ ..........1..p...... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies f a permit ac g the following i f mati Location 14� o]3: '4 .t................. ..... ................. . . ......... 0414.. . ...... .(� -- . ProposedUse .. ...... 4...........j1!:!!::: --X... . ............................................................................................. Zoning District ...... ..........q... .....Fire .. Fire District ............. ............... .... ......................................... Name of Owner ..40.0 ..... ;e -Address ......... . Name of Builder ......1)*111),4doo**e92-.�. Address ...... .. ... . /..... . . .. . ....... Name of Architect >....Address .....ez�-_*Vot ............................... Number of Rooms ........... Ijam...............................................Foundation PAze�.......&V ........................... .. 2 //j. eov 01 Exterior ............ ..............................Roofing . ....!15" .... .......... Floors .................................................... ........Interior ..... .*!n ......... Heating .............I......................................................Plumbing ...'/ ............Az'w-:�p ............................................... .01 dc.0 .em Fireplace ........................................................Approximate Cost .......... - ... ............ Definitive Plan Approved by Planning Board --------------------------------19--------- Area ......... ...... ........... 159 - 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 ...... ....to-Wv--a— ko--e ...................................................................... 6P BARNSTABLE HOLDING CO. tooY .... Permit for ,.'DwQ.Stca ............ . .......... JC1�J.�.F. ni1.y...D�ue�� g.ti.................. Location ....Lat-10. Road `Centerville ................ ................................. .... r Owner' .Barns•table..H010j4g..CQ.................. Type of Construction ....Fr ........................... ................................................................................ Plot ............................ Lot ................................. Permit Granted .... arch 21 ' DateC9 .nspection .... a l 9�u Date Completed .. .�...z.:..........19 , op PERMIT REFUSED .........:.....................19 .................................... ........................ ................. ................... ..........Y.:.... i is r r . ............................................................................... ...........................................................:................... Approved ........:....................................... 19 r. ............................................................................... - - 1 ............................................................................... Assessor's map and lot number .......... - —'� THE Sewage Permit number ........... g ............................................ __ Z B9HB9TADLE, i House number;......Y:...`....;'......................................................... 90O AS& •� TOWN OF BARNSTABLE - BUILDING INSPECTOR r 1 APPLICATION FOR PERMIT TO .................................................................................................C::................... .... TYPE OF CONSTRUCTION ' r....................... ...................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..............J...........:............ .....................................?:........................................................................................................ ProposedUse .......... ..........:............................ :..................................................................................................................... Zoning District ........................................................... .............Fire District .............................................................................. Name of Owner ........................................G.......: ... ... .Address ............. .....:.. .......:.?.. ..........?:............`............. Name of Builder ...................! r....r..f ....'...... .. r Address .......:.:�.......... f. ........................:......'.................. Name of Architect ........................................... ? Address .............:...:.................................................................. .......... ................... ..... • r Number of Rooms Foundation . ':................................. ...:. ...Roofing ` -Exterior ................................................................................. ........................:....................................:...................... Floors ......................................................................................Interior ............................:..-...........:.....................:................... Heating ......................:.................................................Plumbing ...,.........,............................... Fireplace .......................................................................Approximate Cost .................................................................... Definitive Plan Approved by Planning Board -------------------_-----------19________. Area ............!...............t.............. Diagram of Lot and Building with Dimensions Fee �r' �-� SUBJECT TO APPROVAL OF BOARD OF HEALTH r I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. - Name .................................................................................. BARNSTABL.E HOLLAIIZ FJ. A=190-220 27629 TWO Story No ................. Permit,,for. ...,........................... ... 'to Single Family Dwelling ...................................................................... ........ Location .1.0t,.IQ ......428.-Great. .-Road .................J7en:bP.Lvi,-1.,.W........................ ............. Owner .....Barnstabli-a-Holding.-Co............. Type of Construction .....Trame......................... ............................................................................... Plot ............................ Lot ................................ March 21, 85 Permit Granted ........................................19 Date of Inspection ....................................19 Date Completed ......................................19 PERMIT REFUSED ..................................................L..... ...... I . ............. .............L ........7...... ............. ................. ............... ........................... Approved ...................................... .........�19 ...................................... ..... ..................... -A .... .... rd