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0082 GREELY AVENUE
�� �r.�� love , Town of Barnstable E zBuilding . V "v �. rw�. h,M `.1 d' .."v �.P� ,' n l .i - oP PostThis Card SaThat�t is bleFrom.theStreet-A raced.Plans•Must-beSRetamed on Job:and;this Gard<Must 6er.Kept v Pp M1tNSCAg1JC: '� z� "�. ,.': �. � ':- -�...��-:" � ' � ,•� �" '� '`u �§= �r -a_ � ,�' 16 Posted Until Final inspection Has Been Made / £� . 4 _ = Permit • �Wher a Certificate of Occu anc. rRe aired;such Bulldrn shalt Not;be,Occupietluntil afinal Inspecttort has been made Permit No. B-18-1974 Applicant Name: SOUTHERN NEW ENGLAND WINDOWS LLC. Approvals Date Issued: 06/22/2018 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 12/22/2018 - Foundation: Location: 82 GREELY AVENUE,CENTERVILLE Map/Lot 245 017 Zoning District: RD-1 Sheathing: Owner on Record: RUSH,GEORGE JR&MARIA TRS �Cnt cto�r Name BRIAN D DENNISON Framing: . 1 Contractor.Ucense CS-095707 Address: P O BOX 631 2 WEST HYANNISPORT, MA 02672 Est Pr'Op t Cost: $5,264.00 Chimney: Description: replace 1 door-waste management t Pe mit Fe: $35.00 A � g Insulation: Project Review Req: _ Fee Paid $35.00 Date 6/22/2018 Final: r � _ Plumbing/Gas E Rough Plumbing: T Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six ont 4fter"issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and'the'approved construction documentor whictthi"s permit has been granted. Y s Final Gas: All construction,alterations and changes of use of any building and structures shalMet in compliance with the local zon ng by�a sand codes. This permit shall be displayed in a location clearly visible from access street or& d and shall be maintained open for public Inspect on for the entire duration of the work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures b,,the Buildingand�F re Officia s are proukided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work. L ' 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 r t Application number......../.........�.. . ................. �{ S , [N Date issued............ .� �(�. ................ s�srasi.E. �. KAS& U 2010 �� 1639. ®� JUN Building Inspectors Initials.... ..... ........................ CFO MI►'��' TO �I�� ��� � HNS N, Map/Parcel.......... . 5.......... .. ......... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION. PROPERTY INFORNUTION Address of Project: G reef y �4P k1 I/L-v i;S C. r � NUMBER / STREET VILLAGE Owner's Name:/�a�i �hyS�1 Phone Number s 08 -7 76--v Email Address: Cell Phone Number Project cost$ 5 , Z 60 Check one Residential V Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: S e 061-A"- Date: TYPE OF WORK F--�s iding 0 Windows(no header change)# 0 Insulation/Weatherization Doors (no header change)# Commercial Doors require an inspector's review L-] Roof(not applying more than 1 layer of shingles) Construction Debris will be going to GJas4c-r7ana�e,y-yA-1 - Z,�-IcolrI L CONTRACTOR'S INFORMATION Contractor's name I�t Gn `r7R n��so✓� - sov���n d,J Fr,s(rva n c ow S Home Improvement Contractors Registration(if applicable)# 17 3 2-q (attach copy) Construction Supervisor's License# 01 S-7 01 (attach copy) Email of Contractor Phone number 1/01 z 2 8 - 900 ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS.IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER............................................................ 4r *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one:this event is a:-for profit non-profit event Check one:Food served Yes No Flame Spread Sheet of each tent must be attached.Provide a site plan with the location(s) of each tent if food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3.30 pin-4.30pnL Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES x Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles:front back left side right side " HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures;specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date PLI C!-�la g' �S SIGNA RE • Date Signature All permit applications are subject to a building official's approval prior to issuance. ' - RI i.ranse#360T9 f�enewal RENENVAL•BY . 'iT RSE�T 111 ram+ ^+ _ tt.4 Lcensc xl TS24r �PyAndersen. w CT L¢arue..0634oa5 t, `WINDOW REPLACEMENT m,todeicsCm�rasy 1.0-Rescrvoir Road 'Smithfield.R102971 ;=Mead tlrm�123T Phonc 866.563 223 Fax 401 643 6602 Federal Tax lu f 96-os6663o Sontheia Now England Windows,LLC d/b/a a Renewal 6y Andersen of Southern-New England , . / ( /A7 {� CUSTOM WINDOW( AND C_DOOR REMODELING AGREEMENT, C; e ` + :&ryer(s)Name:'^�T V -1 lT `.� t./R -/`/ ; 'Date ofAgreement O —/ Buyers)SveetAddress,Cfry State.and 11 Code I P.O..Box - �' t k�T ,r t�-IZ•-�L LJ Y R V { � F • E•MailAddresF [+"' Home Telephone.NumberIMF -,. 'WorkTelephone Number: k T r.., Buyer(s)hereby jointly and severall_agrees to puichase the.products and%or services of Southern Neil,England lVtndo%vs.LLC d/b/a Renewal by Andersen of Southern New England("Contractor`);'ti.accordancc witki theaerms and conditions-described on the front and the ie��erse of this agreerrierit and on the anachedspecification sheet(s)(collectieely;this'Agreemene,),�,i,, _ "r", O'Historie D Condo" b]Ifok? 'f6mijob Amount Estimated Starting-Date p �x Method of Payment ck , D Cash' Q Financed Deposit Received(33%): a .. [ Credit Cards are accepted fbr deposit only=maximum 113 of-the Balance at Sort of job(33%) �� project cost(Pfease see Credit Card Payniertt Form.)By signing this " . r Esumaced Completion Agreement,you acknowledge thitthe Balance at Scart of Job.and the Balance on Substantial r+/U ��'✓�V w/�/ Balance on Substantial Completion of Job cannot be made by credit' Completion of job(33%). 'card and must be made by'personal check,bink•check,cr cash. Buyer(s)'agrees and understands that this Agreement constitutes the entire understanding between the parties,and that any of the terms of Agreement.rBnyer(s) acknowledges that Bnyer(s) there are no verbal understandings changing (1)has read this Agreetnent,understands the terms of,this Agreement,"and has received a completed,signed,and dated copy of this Agreement,including[he two attached Notices of Cancellations on the date`first written-above and(2)-was orally informed of Buyer's right to cancel this Agreement:DO NOT SIGN THIS CONTRACT:IF THERE ARE'ANY BLANK SPACES. (Rhode Island Soles t?xly)Notice to Buyer-(I)Do not sign this Agreement if any of,the spaces-intended for the agreed terms to the extent of then available infor`mation.are left blank.(2),You are entitled to a copy of this Agreement at the time yousign it(3)You mayat anytime pay off the full unpaid balance due under this Agreement,and inso:doing you may.be entitled to receive a partial rebate of the' finance and insurance charges.(4)The seller has no right to unlawfully enter your premises e or commit any breach of the peace to repossess goods purchased under.this Agreement.(5)You may cancel this Agreement if it has not been signed at the-main office or a branch office of the seller,'provided you notify the seller at his or her main office or branch office`sliown in the Agreementby registered or certified mails whickshall be posted not later than midnight of the third calendar diy after the.day on which the buyersigns the Agreement,excluding Sunday and any,holiday of i which regular y not made.See the accompanying notice of cancellation form for an explanation of buyer'!rights: Bu e s received the consume education materials provided by the eRhode Island Contractors Registration Board. (Br A, "Imdialrj '�) t Re n Andersen of Southern New England 13uyer(s) Bu e s ' Y y � ) B` arkAO- w ' Y. Si ature f Product Manager g" g rSignature $ Signature. " ?" w Print Name of Product Manager k -.-Print - ` g Print Name"= YOU, THE BUYER(S), MAY.CANCEL THIS'TRANSACTION AT-ANY TIME PR16R,T0LMIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION.SEE,THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT. NOTICE OF CANCELLATION NOTICE OF CANCEL eTION s.F Date of Transaction l*q "i/Q t, .You may':cancel "t Date ofTransaction You,may cancel -this�iransaction,without any-penalty or obligation;within this transaction,without'any penalty or,obligation,within three business days from the.above date.If you cancel,any .;! three business days from the"above date.if you cancel,any. ,property traded'in,'any payments made by you under the i property traded in,any payments made by.you'under the Contract or Sale,and any negotiable instrument executed 1 Contract or Sale,and any negotiable instrument executed by you will,be returned within1en business days following,,j by you will be returned'within tewbusiness days following receipt by the Seller of your cancellation notice,and any�( receipt by the Seller of your cancellation notice,"and any security interest:arising out of.the.--transaction will'be." security interest:arising out,of the. transaction^will- be -pcan_celed.lf you cancel,you must make available to the Seller -canceled.If you cancel,you must make available to the Seller at your residence,in-substantially at good condition.as when-l -at'your residence,in substantially as good condition as when- received;any goods delivered to you under this Contract or a :received,any goods delivered to you under this Contract or " Sale;or you may,,if you wish,comply with the instructions of i, Sale;or you may,if.you wish,comply with the instructions of the Seller regarding the return shipment of the goods at the. the Seller regarding the return shipment of the goods atthe' Seller's exppeense and risk.If you do make the goods available _ :Seller4-ekknseand-rlsk.ff'- do'make'the g'o'ods a`vaila�Ie ;to the,Seller and;the Seller-does not pick, em',up w' ithin 81 -,to the Seller and the'Seller does.not'pickthem up within: - twenty days 'of the date of cancellation;you may retain or, twenty days of the,date of cancellation,.yolt'may'retain`or, ;dispose"of the goods without any further obligation.'If you I dispose of the goods without any further obligation.,lf.youl fail to make the goods.available to the Seller,or if you agree' I fail to make the goods available to the Seller,or if you agree `.'to return the goods to the Seller and fail to do so„then'"j, to.retum,the goods to the Seller and fail rto_do so,then you remain liable for performance of all.obligations under I you;remainrliable for.performance of all'obligatioris under the Contract.To cancel this transaction,:mail or deliver" the Contract.;To cancel this transaction;mail or deliver. a signed'and.dated,copy of this cancellation notice-or.anyI h_a signed and"dated copy of this cancellatiom notice or:any other written,notice, or send a telegram to :Renewal,by d; other written notice,or send a7telegram to Renewal b Andersen:of Southern New England at 10 Reservoir Road, ) .Andersen of,Southem New Engl'and.'atJO Reservoir Ro C S 'thfie RI 0291.7,NOT LATER_THAN'MIDNIGHT OF'I Smithfield,RI 02917,.NOT LATER THAN MIDNIGHT,a • (Date) & s i. HEREBY CA CELTHISTRANSACTION$' a�` (Date) i' 'I HEREBYyCANCELTHISTRANSACTION. r t s ti aurer'a slynatun_ Print Name Data- _ "13uyer4.111lpsature - y Print Name' u Dau -RhA Copy:White Buyer Copy:Yellow er Co 'Pink f Office of Consumer Affairs a'nd Business Reg7alation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02.116 Horne Improvement Contractor Registration Registration: 173245 Type: Supplement Card SOUTHERN NEW ENGLAND WINDOWS LL Expiration: 9/19/2018 BRIAN DENNISON 26 ALBION RD :..- . LINCOLN, RI 02865 Update Address and return card.Mark reason for change. Address _ Renewal — Employment = Lost Card -Office of Consumer Affairs&'Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: Office of Consumer Affairs and]Business Regulation Registration: 7 Type: IlQ park Plaza-Suite 5g70 Expiration: 9;79;2018 Supplement Card Poston.MA 02116 ILITHERN NEW ENGLAND WINDOWS LLC. :NEWAL BY ANDERSON IIAN DENNISON ALBION RD ✓ ' JCOLN, RI 02865 L ndersecreian Not valid without signature WX �L=.�..7� ...a i.2 fiVey tai 'Rec; �f. el[V7:� CF~i vi i ^ �i v.J CS-0951 BRIAN DO DENNISON LAMBS BOND CIRCI_E 0�ARLTON IMIA 01507 _.. The Commonwealth of Massachusetts , Department of Industrial_Accidents 0 1 Confess Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. Alicant formation TO BE- FILED W ITH THE PERMITTING AUTHORITY. In ' Please Print Legibly ' Name (Business/0rganizaiion/lndividual): ` � e� .� atw� Address: City/State/Zip:L p Phone 1,1: Are you sn emplover?Check the appropriate box: iI am a employer with Zf7 7" Type of project(required): P employee{fup and/or part-time).* �.❑I am a sole proprietor or partnership and have no employees woTidne for me in 7..❑New construction any capacity.[No workers'comp...insurance reo,ii*e— 8. D Remodeling I am z homeowner doing all work myself.[No workers'comp.insurance reodi ed 1' 9. ❑Demolition 4-.0 I am 2 homeowner and wal be hiring contractors to conduct all work on mproperty. I will 10 Building addition I ensure that aL c } contractors either have workers Compensation insurance or are sole proprietors with no employees- i 1.❑Electrical repairs or additions 5-❑lam 2 general contractor and I have hired the sub contractors listed on the attached sheet 1` Plumbing repairs or additions These sub contractors have employees and have worker'comp.insurancE= 13-Roof repairs 6.❑We are a corporation and its officer have exercised their right of exemption per MGL c. t 4 [y0ther Oct.�',o door 152§1(4),and we have no employees.[No workers'comp.insurance required.l t ' � L re Plc«� �fi Am applicant that checks box ttt must also fill out the section below showing their worker'compensation police rnforma*uor, t Homeowners who submit this affidavit indicating they are doing all work and then him outside contactors must submit a new affidevit indicating such !Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and stare 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 policJ and job site information. Insurance Company Name: F Ire Ine/)S I-O Policy 4 or Self-ins.Lic.*.--4)C� Z Expiration Date: / 1 J Job Site Address: 2— City/State/Zi i Attach a copy of the workers'compensation policy declaration page(showing the policypnumbe�and eapiratiot Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation ptltiishable by a fine up to$1,500.00 and/or one-year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator-A copy of this statement may.be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under th ains and penalties of perjury that the information provided above is true and correcL Si ature: Date: _ — Phone#: 40 ai- ZZ. [Official use only. Do not write in this area;to be completed by city or town of City or Town: Permit/License 4 Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityaown Clerk 4.Electrical Inspector. 5.Plumbing Inspector 6.Other Contact Person: Phone#� i 4llla� CERTIFICATE OF LIABILITY INSURANCE DATE(MMDD"`''") THIS CERTIFICATE IS IS ER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS SUED AS A MATT 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). 3RODUCER CONTA CoBiz Insurance,Inc.-CO NAME: 1401 Lawrence St, Ste. 1200 PHONE No .303-988-0446 Denver CO 80202 E-MAIL FA/`c Ng-303-988-0804 D : COMail cobizinsutance.com INSU S AFFORDING COVERAGE NAIC B NSURFJ] ESLERCO-01 INSURER A:Acadia Insurance Com an 31325 Southern New England Windows, LLC. INSURER B:Tremens Insurance Company of WA,D.C. 21784 dba Renewal by Andersen of Southern New England iNsuRER c:Homeland Insurance Company of New York 34452 10 Reservior Rd INSURER D: Smithfield RI 02917 INSURER E: INSURER F: OVERAGES CERTIFICATE NUMBER:1252851165 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ITSRR ADDL SUBR TYPE OF INSURANCEPOOLLIICY EFF POOUC FJ(P im POLICY NUMBER LIMITS A X COMMERCIAL GENERAL LIABIIJTY I CPA3158728 1/12018 1/72075 DDNYYYJ EACH OCCURRENCE $1,pOD,000 CLAIMS-MADE X OCCUR I DAMAGET RENTED PREMISES Fa oceurtence $30D,000 i MED EXP(Arry one person) $10,000 i I - PERSONAL&ADV INJURY $1,00D.000 GENL AGGREGATE LIMIT APPLIES PER: i GENERAL AGGREGATE $2,000.0D0 PRO- X POLICY EllJECT LOC PRODUCTS-COMPIOP AGG $2.000,DOD OTHER: i A AUTOMOBILE LIABILITY N CPA11511721 111201E 7 112016 Ea COMBINED SINGLE LIMIT X accident $•OOD DOG ,ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED I AUTOS ALTOS I BODILY INJURY(Per accident) $ X HIRED AUTOS X AAUTO-0WNED i PROPERTY DAMAGE Per acciderd $ A i X UMBRELLA LIAR I X $ OCCUR CPA375872E I 117207E 1/1207t3 EACH OCCURRENCE $10.ODD.000 EXCESSIJAB CLAIMS-MADE AGGREGATE $10,000.000 DIEDX RETENTION$ � 6 COMPENSATION WCg31587p9 2p V12018 1h1201c X PER AND E OTH AND EMPLPL OYERS iT/ �,LIABIL 1 N_ I STATUTE � ER ANY PROPRIETORIPARTNERIDIFCUMVE OFFICER/MEMBER OCCLUDED? ❑ NIA- F-L EACH ACCIDENT $1,000,000 (Mandatory in NH) M yes describe under E.L DISEASE-EA EMPLOY $1,000,000 DESCRIPTION OF OPERATIONS below E-L DISEASE-POLICY LIMIT $1.000.000 C Pollution ade Po 7930073340000 1/1/2016 1/12015 Each Occurrence $1,000,D00 Claiution U e Policy Retroactive Date 06202013 Dea ble 51,000.0m 1, 00 m ,000 )ESCRIPTON OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) :ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. For Informational Purposes AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD a Town of Barnstable *Permit# 91=9 Expires 6 mo s om issue date Regulatory Services Fee Thomas F. Geiler,Director Building Division X.PRESS PERM Tom Perry,CBO, Building Commissioner . JUL 1 9.2006 0 V 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us TOWN OF BARNSTABLE Office: 508-862-403.8 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number r"L4,�5 C Property Address (O&T-;LW KX JE, . � CZ-1 9-re-sidential Value of Work. Q Minimum fee of$25.00 for worl�under$6000.00 Owner's Name&Address -Cck—r Gy, (Lczs# k�,j- s Contractor's Name, .Q U' • 11Ji..-3 —74 [ UL I-�elephone Number 95?Je-n —14S1 Home Improvement Contractor License#(if applicable) Construction Supervisor's License#,(if applicable) ( kod) ❑Workman's Compensation Insurance Check one: 6 ❑ I am a sole proprietor '' ❑ I the Homeowner !have Worker's Compensation Insurances Insurance Company Name hagL- C j 8MZ) Workman's Comp.Policy# �� �J DD gG,!e;P-�G I acy!< Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to CPIWL6,b L, ❑Re-roo :(not stripping, Going over existing layers of roof) e-side ❑ Replacement Windows. U-Value (maximum.44) *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. Home Improvement Contractors License is required. SIGNATURE: `�-`'�• Q:Forms:expmtrg Revise0714o5 r Board of Su 11 dii�ig egnS andvSdu�r�4 HOME IMPROVEMENT CONTRACTOR Registrat'ri. 1149 j7xd+ujqual _ JOHN P. DUN — = John Dunn � - 80 MARIE AN IV TE CENTERVILLE, MA 02' yeY Deputy Administrator Ili . � - DgTE AACORD CERTIFICATE OF LIABILITY INSURANCE TM 12/29�/2004 �' PRODUCER (781)344-3200 FAX (781)344-1425 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION " ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATEx= Malcolm & Parsons Ins. Agcy. Inc HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR # 6 Freeman St. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 527 Stoughton, MA 02072 - ` INSURERS AFFORDING COVERAGE NAIC# INSURED John Dunn INSURER A: Associated Employers Insurance DBA: John Dunn INSURER B: P.O. BOX 924 INSURER C: Centerville, MA 02632-0924 INSURERD: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDIN 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. INSR DD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED. $ CLAIIVS MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ KEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO- LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY (Per person) $ SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS -(Per accident) —...• PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY _ AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ HAUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR F1 CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ qYr' RETENTION $ r , WORKERS COMPENSATION AND WCC5004658012005 09/29/20 09/29/2006 O STATIT O FIR t' EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE r:. OFF 11, Icl_R _EMBER EXCLUDED? . . E.L.DISEASE-EA EMPLOYE $ 500,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER Fat DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS a; CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 2 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, " $ BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENT VES. f��;�x Construction r= AUTHORIZED REPRESENTATIVE I-rving Parsons 26,1(2001/08) FAX: (508)539-4900, ©ACORD CORPORATION 1988 r � _..��....._....._ ,�/tG LJVI/t//�V I•Il Viir�Ir J Department.of Industrial Accidents •. _ - Office of Investigations 600 Washington Street Boston,MA 02111 www.mass:gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ]Please Print Legs•bly Name (Business/or,gan17ation/Individual):!:::�&O� Address: .4D *IM4 A*-O `Pall.- City/State/Zip: 0001"no-V(� kfP—,. Phone#: SLF-r Q-)i— 49Q,6'-- Are you an employer? Check the-appropriate bog: Type of project(required): 1.❑ I am a emplo er with�_ 4. ❑ I am a general contractor and I 6. ❑New construction employeesnd/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or p amer- listed on the attached sheet 7. ❑ Remodeling ship and have no employees These sub-contractors have 8: ❑ Demolition workers' co insurance. working for me in any capacity. mP• 9. ❑ Building addition [No workers' pomp.insurance 5. [:] We area corporation and its 10.❑ Electrical repairs og additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL l l.❑ Plumbinirepairs o. additions myself.(No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t . employees.[No workers' 13.❑ Other (L2 S e6t k-Co comp.fionmce required.] *Any applicant that cbecim box#1 must also fill out the section below abowing 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 mew affidavit indicating such tCont wtors-tbat.cbeckthis box must attached an additional sheet showing the name of the sub•contrabtors and their workers'comp.policy inforrnatlon. I am an employer that is providing workers'compensation insurance for.my employees. Below is the policy and job site information. Insurance Company Name: -as Policy#or Self-ins, Lie.#: S� Expiration Date: G p. ftA< Job Site Address:Ca CARELL/ 'tylState/Zip: - 60�0 Attach a copy of the workers' c napensation policy declaration page(showing the policy number and expiration date). Failme 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$1,50%00 and/or one-year impiisomaent, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Si: at Date: '1 Phone Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority (circle one): 1.Board of Realth 3.Building Department 3.City/Town Clerk 4.Electrical Inspector.5.Plumbing Inspector 6. Other Phone#: Contact Person: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as'_'...every person in the service of another under any contract of hire, � express or implied,oral or written." . An employer is defined as "an individual,partnership, association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the . receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or.on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the comtnomarealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), address(es)and phone numbers)along with their certificate(s) of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The-affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials . Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom. of the affidavit for you to fill out in the event the Office of Investigations has to contactyou regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that,a valid affidavit is on file for fixture permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture . (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call, The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel, t 617-727-4900 ext 406'or 1-877-MASSAFE Fax#617-727-7749 Revised 5-26-05 www.mass.Dov/air E Town of Barnstable Regulatory Service's Thomas F.Geiler,Director M;+h r Building Division. Tom Perry, Building Commissioner 200 Main Street, Iiyannis,MA b2601 www.town.b arnstable.ma.us 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using ABuilder I, Cog, 2� , as Owner of the subject property hereby authorize' "vim IJ to act on M7 behalf, in all matters relative to work authorized by this building permit application for. a"CL AV c (Ad&css of Jo ) A-1 Signature of er nate GZ 0,Zp Print Name pORMS:OWNMERMISSION Town..of.Bansable:: rer # 83 tip Expires 6 months frowissue date. . Regulatory Services Fee.. 9tb 16.9. �0�p Thomas F.Geiler,Director ArfD MA't A Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 �y.-PRESS PERMIT Office: 508-862-4038 A R Fax: 508-790-6230 IT EXPRESS PERT APPLICATION - RESMENTL ONL MI Y ?003 Not Valid without Red X--Press Imprint TOWN OF BARfVS7ABLE Map/parcel Number 4 y 6-6 Property Address 1� 1`f-Q\ rl� ❑Residential Value of Work c�k� Owner's.Name&.Address �e��Q( 'Z5 b Ili 1S Contractor's.Name 10Amy-- ,�� v� Telephone.Number b8� �-Aaj) (,c�t j Home Improvement Contractor License#(if applicable) Consftction Supervisor's.License.#(if applicable) p 1z ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner have Worker's.Compensation Insurance. Insurance Company Name C�106,� m Workman's.Comp.Policy# 6 E A 9 2jS l.9 InA 11 (n--) `\b 9, Permit Request(check box) El"Re-roof(stripping old shingles) All construction debris will be taken to bs 0 A,!nA4, ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property O must sipProperty Owner Letter of Permission. H e Imp em t ntractors License is required. Signature Q:Fomis:expmtrg Revised 121901 MARK 14ERBST 35 Peep Toad Rd. Centerville MA 02632 (508) 420-6216 PROPOSAL SUBMITTED TO: WORK PERFORMED AT: George Rush 82 Greely Ave Centerville MA SAME We herby propose to furnish the materials and perform the labor necessary for the completion of the following; Ncw R_Qf remove existing shinzIcs Install 8"drip edge Install ice & water shield at edge & in valley areas Install 151b.=felt p�zer Install 30vr, Architect shingles to match rear addittion Counter aash skylight&chimng.32 wlice & water shield Replace lum ing boots cut ridges install cobra vent All debs_cleaiydaily Price incUAY material,labor &dump fees All material is gaarnateed to be as specified, and above work to performed in accordance with specifications submitted for above, and completed in a substantial pp.,,���� workmanlike manner for the sum of - ( �f -0 � ✓-Y-A 0)'with payments as follows;112 @start w/material on site, balance l due in full upon completion * Any allteration(s) from above involving extra costs will be added under written agreement, and become an a ra charge over and above signed estimate/agreement RESPECTFULLY S M Signature ACCEPTANCE OF PROPOSAL The above prices specification & conditions are satisfactory,we herby accept you are authorized to do the work, aA4 payments will be as specified above. Signature(s) Date: * This proposal may be withdrawn by said company if not accepted within 30 days J G� . • 1 } � � ✓fie i�omvmonurea�a�✓l�Gaaaac�ivael�a Board of Building Regulations and Standards HOME IIV"EMrmfff CONTRACTOR Reg ` i�rr fi16480 * - ionf3004 ividual MARK HERBST ; MARK HERB T � S ' 35 PEEP TOAD RD. i r" CENTERVILLE,MA 02632 Administrator C'1ie �oyrvnzovzurea/ o� aaaae�ivaetya . I BOAR0.0F BU9LDING REGULATIONS x�Licentse ypNSTRUCTION SUPERvjIS®Ft Numbe 048546 Birlwate0471953 -W C _ EX i / 73 704 Tr.no: 2926 ReS'tricted'�� Y ;' MARK D HERBST; Kl§=�, i 35 PEST TOAD CENTERVILLE, MA OZ63 ' Adrnnistraio� i • - r U Parcel ermit# Conservation Office(4th floor)(8:30-9:30/1:00-2:00), (6 Date Issued Boar&of Heah(3rd floor)(8:15 9:30/1:00-4:45) 7Lf Fee Engineering Dept.(3rd floor) House# w. . �` �.IMF rq� Defi ' ' 19 i�STAL'LED IN C � E WITH TITL • TOWN OF BARNST� N��NT��co����I® Building Permit Application TOWN REGULATIONS Pro' reet Address 8� 6lie e fLE3- 4 U Village 012� R40'r i t i e Owner ��Deg Address Telephone 75'd 7J5 wiOche •t,r".l 12aogt . keokcc wf44 & .44)_6 0q0, Permit Request PH • � J/ First Floor square feet Second Floor square feet Estimated Project Cost $ co Zoning District Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type Commercial Residential Dwelling Type: Single Family ✓ Two Family Multi-Family Age of Existing Structured Basement Type: Finished Historic House /���— Unfinished Old King's Highway z Number of Baths No.of Bedrooms rr Total Room Count(not including aths) First Floor Heat Type and Fuel G!J Central Air OVd Fireplaces Y6�5 Garage: Detached Other Detached Structures: Pool Attached p? Barn None Sheds Other // r Builder Information Name Pt L�1 Ae 0 Eei,Jlg_5 1_-i Telephone Number( �� y�fr?sR 7 Address 16 Peep 7D&O License# 0 c7 A,3-5— I C e h)r?,e J[1 t`e_ W,4 OA6.3 2 Home Improvement Contractor# /0 6 a 0 g Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 7 Q) 1q40 F1 L SIGNATURE DATE ` It -3 qi- BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) v FOR OFFICIAL USE ONLY PERMIT NO. � + : : DAL ISSUED _ MAP/PARCEL NO. A&RESS VILLAGE i OWNER DATE OF INSPECTION: FOUNDATION , FRAME INSULATION - i FIREPLACE • . ELECTRICAL: ROUGO FINAL _ PLUMBING: ROUGi FINAL GAS: ' ROUG r rn FINAL FINAL BUILDING i DATE CLOSED OUT ASSOCIATION PLAN NO. = t ' 3 + ' 1 r 1 S Ci- 0 Poo wt:. do to r a - (yam ♦ ro SlicQi�y GtJi�+�O k� CSX(,1rlr.J 2" --- -- ;IA 11 /I1t A M n A Z r �D Q � C � S� IL ' FL Oa Tcj _ Q v of v A--r/U a WAc L� � • BGhrt�1+l� �Laa� Su4t3 618d 6-rt Ai6 f,ac The' own of Barnstable 2r�r� s S'�cria �1 .. ���b�3s4.pr�; A��°y yr/.�'.'�• °}� ���,}}r a,�y `�"it f��,r{�"�S�kl i'.,._ n flow t = �a 6dtf:WE Ak • 1 1 1 �1 �gam: . - 1 DEPARTMENT OF PUBLIC SAFETY V' 1 } 1 LICENSE 1 ' i; , rl 191 07126/1953 i •1 1 0 1 RICHAR I ENGSKI a i PEEP TOADR CENTERVILLE, MA 02632 -' �+`. `' `t. `.gip.-.'�,,,' '_"_r,:: The Town of Barnstable ' M ,$ Department of Health Safety and Environmental Services BuiIding Division 367 Main Strut,Hyannis MA 02601 Office: 508 790-6227 Ralph Crossett Fax: 508 775-33" Building Commis For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c 142A requires that the-noonstruction,alterations,renovation,repair,modernization,conversion, improvement,.removal, demolition. or construction of an addition to any ping owner occupied building containing at least one but not more than four dwelling units or to str C=cs which are adjacent to such residence or building be done by registered contractors,with certain cwTdons,along with other requirements. Type of Work: e w►D�� X 206`kk Est Cost 000, 10 AddrmsofWork: G 2ee � -y , v�t-S Owner.Name: -e pag f 47 Date(of Permit Application: — k I hereby certify that: Registration is not required for the following rason(s): Work excluded by law Job under SI,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEiR OWN PERMIT OR DEALING WTTTIUNREGISrEIIED CONTRACTORS FOR APPLICABLE HOME IMPROVEMDM WORK DO NOT HA ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY7E&IIGI, c SIGNED UNDER PENALTIES OF PERJUR I hereby apply for a permit as the agent of the owner. 13 etc h � �SGvs,�r' ���a�q Date Contractor name Regtst:auon No. OR n,,e Owner's name tt - The Coninionit'eaftit of Massachusetts _ -- • i# ��` �_•.�•,� De partntent of Industrial Accidents >� 600 If asltini;on' t Street qyy\f'; Boston.Mass. 011ll Workers' Compensation Insurance.Afiidavit lAnnlica—n nformatio'n:- Please PRINT Ohl 17 '7 7 name_ ��C 4 A-e-0 J Earl 0 f a location- / L°P po/�:o y2� r .it, ❑ I am a homeowner performing all work myself. (� I am a sole proprietor and have no one working in any capacity ❑ I am an employer providing workers' compensation for my employees working on this job. enmeant•name: address! ° cih•• nhone#: insarnnce co. nolicv# s•'v• ❑ 1 am a sole proprietor,general contractor,or homeowner(citete one)and have hired the contractors listed below who have the following workers' compensation polices: comnany name• address• cog: phone#� insur•nnee co uglier# I:���'�:� `�-��.;;-•- - ::. �.s,.rnr..•e:.:.a.•e.r=-+r.•;•--r_.ts;eKr".�Fr53=.,_ .:>�-- - ----- '�3'"":s �►�'•_*T!�- .9,431s!.r-••:-.*fir ctimpan� name• address city: phone#: ineurnnra on Imliev# .Attach additioital'sheet if rise r:•. Y: wry <z_t !-�+ a� ±—` • }'� 'w .';�, Failure to secure coverage as required under Section'3A of 51GL 153 can lead to the imposition of erimiwl penalties of a floe up to S1.500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a line of S100.00 a day against me. I understand that a Copy of this statement may be forwarded to the O ice of Investigations of the D1A for coverage verilieation. !do hereht• •unr/r lie pains a pe !ties of peduq•that the information provided above is true and correct aa Si_enature Print name ��L/I IJ�Q , �0,10SC.i Phone# ���— YL? d J of I use only do not write is this area to be completed by city or tows otRcial city or town: permit/ticease# riBuilding Department Licensing Board ' O check if immediate response is required QSeleetmen's Office (311ealth Department contact person: phone#;. nOther Irmsad3,ns PJA) __ I information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law",an empint�ee is defined as every person in the service of another under any contract of hire.express or implied. oral or written. An einplitrer is defined as an individual, partnership,association. corporation or other :L-gal entity, or am-two or more o� the ford=oing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual , partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling House or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 1'52 section 25 also states that every state.or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally.neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter hav been presented to the contracting authority. .. y � Applicants n affidavit corn letel , b checking the box that applies to your situation and Please fill in the workers' compensation P Y Y g supplying rcompany names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested. a not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required ' lease call the Department at the number listed below. • rs compensation policy, P to obtain a workers' p P ) P ...... ^armor' .a a.+.i. ti:w•pr-_ - 55<'K1 '" _ -.. City or Towns s Please be sure that the affidavit is complete and printed legibly. The Department has provided a Pace at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. .�.,e....,.....-,.., �+r !'�'?!!!.�s'". =:i :�:.� •i:..... .�ee�.•ne,;..«•f:if�es,_ 4�•.:i •.,,`^^77 -'..'v.++'�' :tea:+- :w�%�:•'�.-` •r The Department's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents �. Office of Investigations 600 Washington Street -- Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 7274900 ext. 406, 409 or 375 Assessor's map and lot,,number ........................ 7-:........ 76 SEPTIC SYSTEM MUST BE INSTALLED 'IN COMPLIANCE Sew,age Permit number ............................................ Sea ...... 9 •• ` WITH ARTICLE II STATE SANITARY CODE AND TOWN a, �QyoFTFIE'Tp�y� TOWN OF BARNSI •TASLE ii i DARISTAM, i MML 9 BUILDING INSPECTOR °moo MPY a' — r f APPLICATION FOR PERMIT TO ..!6jQL. Q.......ois° ...rA!' Znj....lf"R/�i, ..f'.. f�4f9.�r .............. TYPE OF CONSTRUCTION .....&jp.o.d.....tfia.#*7 .......................................................................................... r, /.. ...�02........................19..(4. r TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies fora permit , ,according tJo the following information: j Location ......... A.�=�'.l y.......Aoff...........W e.�:,l ./4.,IA,1!!!�5...��7,�....ff!//��5. .......................................... ProposedUse ......5,(f.&..... !A%............................................................................................................................... Zoning District ...... .. ..1......................................................Fire District ..�. �!!/.��1...�. S �i��C ..... ...... .. .................. Name of Owner .............Address .Q x.&v... �e?7.,llr��Lsl.�Y...�.. !//�f............. ..................Address Name of Builder .��I',�!U.�.��/.�,��.....,� .................................................................................... Nameof Architect ..............................................Address .......... /��71 ....................................................... Number of Rooms ....Foundation ....A"i.s a�'..... 4.vc�� ...............................:.............................. ......................................... Exterior ... ....:!. 1..fP 7.....................Roofing ..../.gj,04e.ezo.... .............................. Floors ....��'�i•.�°�.��R/..�................................................Interior ....... . .....�`'' Heating ...... .� L.. .......4.r. ..........................................Plumbing .icr.0Z e :....... ...-.................................................. Fireplace Approximate Cost ......... /........................ . ... .............. �._. ................ y !. Definitive Plan Approved by Planning Board __ _� 3-- 19 Area ..5 !°��!....za.. .•.•...•.... _--. Diagram of Lot and Building with Dimensions Fee r SUBJECT TO APPROVAL OF BOARD OF HEALTH 1� 1 (Ac �yr7 V� I aj Fla®a • �� `'2 y 3 �,' 4' a S. /91 J� I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. . ....................... 18548 Fran-Cal/Realty Trust 245-17 Sewage 335 L$SAV No ... Permit for F'Fan-Cal Realty,,,.. ... Trust ............................................................................... lUl/S G Location Armigly..AYA........................................ ...................W#,...l Qr.t............................. Owner .................. Type of Construction ........Womd..F.r.ame........... ................................................................................ Plot ............................ Lot ................................ Permit Granted .........July. 30 .........19 76 .. ............. / II Date of Inspection ...... q Date Completed ...........17,4�. ............19 ........... ... PERMIT REFUSED ............................................................... 19 .............................................................................. .......................................................... .................... I......................................................................... ............................................................................... Approved ................................................. 19 ................................. ............................................................................... r ...^^a..r..._.-mom." •v..�.±�..vw+.�.w-...,.. ,r...�.�,��,,.,q"'w�.,_r3,.,..rJ"''w '?„ .>rti"Y'u`a.:.�'.,Y^+�.�..-an�.ci.;ire..�.�.x"�_{,..«,.•�:,.•TY,._h:=......^r.^•^-.-�i`.`�, �°`•�"Sr•^i(-'^�+.^+.ter Assessor's map and lot number ....r�'.................................... ���.. Sewage Permit number .......................................................... r QyOfTHE r TOWN OF BARNSTABLE BARNSTLBLE, i "b 9 BUILDING INSPECTOR APPLICATION FOR PERMIT TO ..��t✓. ....... .... % ......................... TYPE OF CONSTRUCTION ..... '' ��r'�`r r 49t+ !`/`../o?•........................,9.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .........�-rl�..�'....A, ......4/,4r:...........f!�.�P':..� .....��;x4:T�^".r`.>...?�!1'� a...�11�!��............................................. r' ProposedUse ...... ..I;, A;-�`�.....r `�:.::..:.'.......................................................................................................I......................... 1 ........................................Fire District .. ii Zoning District ................................ ................................................................... Name of Owner Y,t?A�-� � Lim../1". !�i'u .............Address 1�u1.' /5,�! C �rr'31.�1�.-, j�O�•� ..y.......................... ........... .................................................... Nameof Builder ...............I.._ .... .............................Address .................................................................................... i Name of Architect t' /�!r�ifi' ............................................Address - 'r� ..,:....... ........ .................................................................................... Number of Rooms .....Foundation .. ` r Exterior J ✓/1. , `- "f' Jdl/h,6,f eS ,1� <- '•w f/ � .Y�. r�>-..�............................ .............................Roofing s Floors .....r..:. . .�f � . » .Interior .........`..!...._..I. J r.C ............................................ T Heating ..'.�..............!..y�..........................................Plumbing ............... %..`. .`...................:..................................... Fireplace Approximate Costj � f:....................... Definitive Plan Approved by Planning Board ___ !'►r- ________ �l 19.2__ Area.......,. . 4-0 Diagram of Lot and Building with Dimensions Fee 5.................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH ' F J¢,n �p R 4frA I 7 7� ,�q, - to rh r I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. /,.,, a. r .......................... ... .. 18548 Fran-Cal 941 Realty Tr t 245-17 Sewage 335 No P�A§...... Permit for ...FrannCa ...Realty T ust .......................................................... .................... Location V-_GreeLy.. a_...... ........................ Owner ..ErannCa.l..Rea. ty.-T-rust.................. -a Type of Construction .... ..f-Wod...Frame............. ....................................... ........................................ Plot ......................... . Lot ................................ Permit Granted Wy.........30........19 76 Date of Inspectifn �**....................................19 Date Completed\...t,.._..._,,............................19 P MIT REFUSED ... ........! .. ... ................. 19 ..................... ......................................................... ..........;.. .... . .. ............. . .... .. .. .. ......... . ....... ........d...... ........................................... ...........................( 10 ..................................f................ Approved ....................... ... .................... 19 ............................................................................... .................... ................................................. iE 3 � � 141 0 35'� - � ?ao PoSED �AD A►Ti o►J 4 20 o72 S q,FT. � h � x W i P,eo�bsEO ADDiTiQiJ ' N 4 CE2T��Fa p�oT r''L qi✓ LcC/tTio.`/ — I-1Y,4 IA11-Tpoe7 /y955. 3e>' D47`-' �-�(y. /2 l97(, pL�+N Fo/G 2on�gGb P. B�/t2o v�,S AND REd4CDED in/PZQN Bl�. 302 PG b l , {{x' `,`y• E27*F y 7fl47 oW �� , .sHaw ni oN �1is PL4ni /s Go c�TEc x t. oN`' Tiy€ G,e ouND AS S/�ow�+I . eon/Fa�� 1 4'. y`ati N^y- .0 Icy T THE Zonvi�vG (�//�S of /} or �R.A�✓` G /Ze,40- � T3LusT �Ti.OV6X T l i 2 i`I76 LgAIv s()/Z✓ o/Z V Assessor's map and lot number .........................................I.. - THE t0� Se0age Permit number ........,!� Z 3)►H39TAXLE, i H9usenumber ......................................................................... rMAM 000�2639 0m� Mix TOWN OF BARNSTABLE BUILDING INSPECTOR W:V APPLICATION FOR PERMIT TO ....:..............z / fit? !( !. *.............................................................................. TYPE-OF CONSTRUCTION .............0 rti.?".�.....?F:.... F,;b n`� .��`► `�...... ............................................... .. ~— .......... K4.7.......................19A .. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location t�-� 'J. .............C�J 5 ���.1 n t' /'�aR ! � .................. ..... ..o. ..... k!�J .................... ..................................................... .......Proposed Use .....5 fa,!.!. ! +..t?+ . . ........ ......................... ...................................................................................... Zoning District ......620 ......................................................Fire District .... ..�l,rpPu/h � ./. - c��fl.:."............... Name of Owner - :.....7r ...........................Address ...... c ... ......u.�P Name of Builder ............. "z `...............................Address .............. !'9vc:... ... Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms 4 �..................................................................Foundation .............................................................................. Exterior ............................�.,..............................................Roofing .................................................................................... Floors .............................. .�...................................................Interior ... ............................................................................ Heating ..................................Plumbing Fireplace ..:.................. "....'. pp................... .....................................Approximate Cost ................ Definitive Plan Approved by Planning Board ---------------_---------------19________ . Area ��`'....x..s'`"'...................... as Diagram of Lot and Building with Dimensions Fee .... .... ..... .................. SUBJECT TO APPROVAL OF BOARD OF HEALTH f �i f I hereby agree to conform to all the Rules and Regulations of the-Town of Barnstable regarding the above construction. / t Name ... �.... r!... ...................................................... C.A.D. Realty Trust A=245-17 i ` 22416 r rivate ' No Permit for P swisraning pool ............................................................................... Location 82.Greely.,Ayenue ......... West t Owner ..............C. A. D. Realty„Truss,,,., .... .... ..... .... Type of Construction .......................................... ................................................................................ Plot ............................ Lot ............................... Permit Granted ........E�Ugust..7...............19 80 Date of Inspection .. ...............................19 Date Completed ......................................19 PERMIT REFUSED .................................................. ......... 19 ... ... .. .. .. .. ...... ...... .... .. ......... ............................ ........................................... Approved ................................................ 19 ............................................................................... .............:................................................................. Assessor's map and lot `number OF7HEr0 SEw6ge Permit number SEM r.-.. � / GtiI E i• �� "'� TADL , Hofse number' C HASB pp a63q. \ TOWN OF SARNSTA 1jK BUILDING , INSPECTOR APPLICATION FOR PERMIT TO .............. .1v �n..e?. ........... o o:.�........................:................................. t TYPE OF CONSTRUCTION ......:.......VZ?!. AA'C.....�'....�F!,6 � I!`k s5:...............:............................................ f c ............4 7.......................19.F TO THE INSPECTOR OF BUILDINGS: The undersigned 'hereby applies for a permit accordiin�g-to the following inform a tion: Location ...... ... K ....19.0 c.............�!`J a 5.1,.,..lT-z q- ........ .................................. .. ...... .........Pro Proposed Use .ti f........ . ........ Zoning District ...... (.....................................................Fire District c . . II Name of Owner ..... :...... ......................:....Address ....�:a...��� ���i!..�v.�.......�eS.�..l���'6��5/%�{ Name of Builder ................, w. .....:.............................Address .................�`.�-�`i�........................................ ............. Name of Architect ........:.......................... ....Address Number of Rooms -^ ..................................................................Foundation .....................................................:........................ Exterior ..........................-.--............................................Roofing .................................................................................... Floors ............................. .--..................................:...........Interior ... -..�.--........................................................... Heating .................................Plumbing ........ .......:................................................. Fireplace ..:.........:............::.......................................................Approximate Cost ................. ................................. 'Definitive Plan Approved by Planning Board _------------------_-----------19_____*__ . Area ...K.. ........................ Diagram of Lot and Building'with Dimensions Fee ........ SUBJECT TO APPROVAL OF BOARD OF HEALTH ` F r 0 -I I hereby agree to conform to all the Rules and Regulations of9thn f Ba table regarding the above construction. Name ... ..................................... ........ C,A.D. Realty Trust 224�1v— ' private swiming No ...... 400. Permit for .................................... ...... pool , ..................................................................... Location ..........82...........Gree..l...y...............Avenue........................West- ...... .................... .................... C.A.D. Realty Trust Owner .................................................................. Type of Construction .......................................... ............ ................................................................... Plot ............................ Lot ................................. Permit Granted .............August..7..........19 80'. Date of Inspection ....................................19 Date Completed ....... 9 :r4d PERMIT REFUSED -� ................................................................ 19 ............ .... ............ ........ m ................................................ . ........... ................................................. ........ ...... ........................................................... App ................................................ 19 ............................................................ Asessors,,map and. lot number ...! ' � . `.' _/�; GFt .e'tA, fi Y d fC . ... ..... . ........ ..... ; 1 :18T B • r, / - -'7� i gO d TA IN COMPLIAN- , Sew age"Permit number ...a��.'..... ..a.�:....�: /.::,.7.::.... W H 471GLE 'll-'STAT9 S Lu t �FTNETD y TOWN OF BARNST ' � tME TIQWN 9 MAB6� , . ;=,RUILDING - INSPECTOR,�p i.6.39• ;00 r�: tO:MpY 1. ev APPLICATION FOR!PERMIT TO .............. ........................... ............../.... .....................:........ ' TYPE OF CONSTRUCTION ..(!4d.��. .�iP��t�..........5!Vr�.l C... .�fl!1rl f!.. ...... ./�d". ........... i `j M ......................... . 7.......19�J... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....t �� ... .Al -.......... � :... �'1. o!!N S. d&�...................................................................... ProposedUse 51 6.-I e... A�-07.1.1�.......����.................................................................................................... Zoning District ...... .�..�..�....................................................Fire District .... Name of Owner .. .'. !a.!...... /4//. ...//C:!!' ....Address ..........................................................toloo:a .............. Name of Builder �� Address ���''G � / ..................................... ............................ .............................. ... .. .............................................. Nameof Architect ...............,` ........................::.........Address . �.................... .......................................... Number of Rooms ...:.......... ..................................:............Foundation ...Aq�w.....h?°`�lZ:e Exterior ...(0.!d.....s. d. (w.c............................................Roofing ..... .......5!l.l.waln .......................... Floors ... .............................Interior Heating �+ .. ✓.......5�. .......�T 5....................Plumbing ............ ...�"v��.........I:...... ......134A'.......� s Fireplace ........... .A........................................ Approximate Cost .......... /................... C ............................ . Definitive Plan Approved by Planning Board ---,C/__!__/ ------------------19_ �i Are ?5-e.0..................... Diagram of Lot and Building with Dimensions f `7G'� a'D'�- Fee 1-1 SUBJECT TO APPROVAL OF BOARD OF HEALTH Jd-$ / I A,Rv( ely 60, I hereby agree to conform to all the Rules and Regulations of the Town of Ba nsta le regarding the above construction. Name ... ........................................... _ Fran-Cal Realty Trust ~ , 18053 one story, No ---.--�Permitfor .................................... ` � ' single fami1y.'dwelline . .�.--~.-�....�--,-'.------..�------.. . . . ` ^ Avenue ` ' ^ Location !w.-.����.��--------------. . . ' ' . J+ ' ,------._. , Fran-Cal Realty Trust � Owner -_-------''�---.' frameTy f .- 'Construction ---------.^---- � -- . °� - ^ ` -.~-,,,�:--.-.---..---------.--... ` . . ' Pk, -.� ---..--.. Lot ---.��------ . ' ^ 5 ' ' -^ - Permit n�6 - - - ~~ - ~~ ' ' Date of |n .�-'�]g�~ ^ I Dote Completed . ............................... . PERMIT REFUSED --.--,---------.r------'.'19� ` . ' . ' � -.....-.-----.----------..------. .' . ' . . ^ ~`—'^^-�`z�------------------' ' � . , -.-`..�.�.^....�-.------.-~--,`-..�....-. - `.......................................................... .� / . ~' +`---'_-------_-. 19 . ' 'Approved . - .......... ...... ............................................................ � . `.---~-------------.-..�....-.'-... ^ - 3 � �Ve- 4a�,^i;E't e .211033 SQ. FT, v Ak i 0t 2 C'E�T/f=/EQ PLo T PL A ,LoC.4T/o,N — /-�yANN�S�Do�T, MASS: SLAG F- ��40 DATE 1Vo V. /¢ ' l�L�N /?EF tL9ND Shown/ on/ .9 P&'4AI .Cv 2 AA-04Av- GAG R&-Al-7y T�sT � Rwo P.�'Co�Dt'D iN l�LAN DAC, z99 ' : Pa,. 30 I C"ri,cy TNAr T s EE)\IVARD :51-1oWN oN TNi.S AL4^/' /Cr L�.9 7`E4) E. 6?Ro4.1,+%/D AS S/,/o WA/. K LLEY R� of• 4,v Z) 7*4-7- T T.�/E Zon�i.s/G L.q ws of Tf�E Div-,CAL �'C.9L TtvS7= .PSG. LA�vD '`Y C-%ssessgr's map and lot number ....1. .r`:'..... .11 Sewage Permit number .. 'Z�. ....... 17r 7j ' yoGt"ET TOWN OF BARNSTABLE i BAUSTIU E, • 1639.DM B,UI,LDING - INSPECTOR' O'E• PY p'' APPLICATION. FOR',PERMIT TO A-.)!l ....................................................................................................... TYPE OF CONSTRUCTION ......�•)riry YP171/Ii ..........5irur � ... �...r... �7 ,� ...........!<�I.�.............. ...., ...................................... .......19.......... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following y-information: Location ....�-�Je? G� .. ! �°............�/�zn.7., !"�f,�1,�F,�;;H;f 5...��rt,/........................................................................... ProposedUse ..... fir - aa..... ,.."r1�? /lt!....... r :..................................................:................................................. Zoning District ......R.. ........................................#...............Fire District .... ;wv;P.!/ •. /�'A �, i� l5 .�a X J o Name of Owner ..�.. .,.:. ....`�... �' Address ................... Name of Builder " (�cv`,��-�2 ......Address uirwc. o ........................................... r............................... Name of Architect ................. K"..................................Address "'S Number of Rooms ,� ..........................Foundation ...1... a. u� ... ......................... ............47..................... /��1 R:.: .......... /. .. Exierior ../;A?cX; ti.... f fi� 1t�' ._57_4!.9:4 ���w��r�� '� .............�................................... ......Roofing .......... . ....,...`', .......... ......... ................................ ,Floors !r •iP/ �f+r< ...........Interior . SAG Heating .....................Plumbing ........................ ............... s Fireplace ............ �...............................................................Approximate. Cost Definitive Plan Approved by Planning Board 19__�'__77 Area 29..gk :o................... a � Diagram of Lot and Building with Dimensions i n�� °�`L``� "� " Fee ..:........................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH f a0 i W r Thereby agree to conform to all the Rules and Regulations of the Town of Bar st ble regarding the above construction. Name .. ..... .............................................. Fran-Cal Realty Trust A=245-17 , 1 18052 one story,No ................. Permit for .................................... 74 single family dwelling ............................................................................... Location D Gre..e..1...y......Ave. n'ue........................... . ... ...... ........ West HyInnisport ........................................ ...................................... Fran-Cal �ealty Trust Owner .................................................................. Type of Construction ....i........f.r.ame................... ............................. ..................................... Plot ............................ Lot ................................ November 75 Permit Granted ........................................19 Date of Inspection ............ ...19 Date Completed ............... .....................19 PERMIT REFUSED ......................................1................?.. 19 ..................................... ............ .... .. .. ....................... .. .............. ....... I ...... . ............................. ............................................................................... 2- Lodll Approverld' ....................... ........................ 19 .............. ......... .... .... .................................... con 40 ................. .. .................................... y1 4 Q 3 CE,�r'eA G SQ. oce r/h/EO PZor PLAN .Ce�'f!T/o N - HyA�vNispo,zr MA55: SCAG E- / 4o DA7E No V. /¢ /9 7,:f PZgAy REF LAND Shown/ oA/ .9 ALA.v CoZ .cWA/- C44 �NALTf/ PLAN ,DEC, Zf pG, 30 4f 6 � i��• 44 . S cs�erl c-y 7i/,9T 7-/V6 ��NDAT7o.V U ED\YARD S/-6WA/ oA/ TNi.S PL4AI /.3 4*C-97-6-,t) r OA/ THE G,,F-b D AS S,416 wA/ KELL�,EY v, E"R �/E�Eo/✓ A.vD 7*47 /T Co C7c 5 ?--7S r Q, T. T/v/E ZpA//n/G Z4 W.S o,-- 77-4E' °«t�Y� T wti of A64eA/S7P4BGE' A/-C'.9 - Z S - A! � G .MCA � T�2u r �E'7'�'rio �`� FEE Q TOWN OF BARNSTABLE, MASS. a 10K ra? Hgeo UTHIS IS TO CERTIFY THAT A PERMIT IS HEREBY GRANTED TO R Ri _................................................................................................_..»......................_..._.......................................... ............................................-............................................. _..._ (PROPERTY OWNER) ........................................................................................)ADDRESS) w3 To ..................._................... 14^' sb (BUILD) (ALTER) (REPAIR) IUA aV2 .............................................................................................................................._.........._........_.._.............................. ............................................................_...................._........ _._._ _ '� G 49. (TYPE OF BUILDING) (APPROXIMATE SIZE) CCC000 w o 4 LOCATION ...............__.............._...................................................................__..._ ............................................................................_................................ _� _-- G y (STREET AND NUMBER) (VILLAGE) cS NAME OF BUILDER OR CONTRACTOR _...._........_.............._.................._....................................................................._........................_............. _ ..._ A � APPROXIMATE COST —__.................. (u lu boas 1 HEREBY AGREE TO CONFORM TO ALL THE RULES AND REGULATIONS OF THE TOWN 6.y� OF BARNSTABLE, REGARDING THE ABOVE CONSTRUCTION. o PQ c a h 6) )OWNER) (CONTRACTOR) J o O U .t..............._........_........._......�_......................._..........._....................................................................................... sa s BUILDING INSPECTOR Subject to Approval of Board of Health. ?M@ropy TOWN OF 8ARNSTABLE roe" ""• ,. d ®.e BABHSTABLE, o ASSESSORS' OFFICE y MASS. pp i 6g q. $�0 Ar�0MAY&` 367 MAIN STREET, HYANNIS, MASS. 02601 775-1 120 BOARD OF ASSESSORS DIRECTOR OF ASSESSING MARY K. MONTAGNA - ROBERT D.WHITTY ' EDWIN F.TAYLOR ALFRED B.BUCKLER � 7 G f