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0020 GREELY AVENUE
o . �� Q n. .. .. � , � -, dti a a y - .. � � s' Cape Save Inc. , 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fag: 508-398-0399 June 23,2016 l�s Thomas Perry CBO - Town of Barnstable Building Division , 200 Main St. .. Hyannis,MA 02601 RE: Insulation Permit#B-16-1068 Dear Mr. Perry f This affidavit is to certify,that all work completed for 20 Greely Avenue,West Hyannisport has been inspected by a third party Certified Building Performance Institute (BPI).Inspector. All work performed meets or exceeds Federal and State Requirements. a Sincerely, William McCluskey. k TOWN OF,BARNSTABLE BUILDING PERMIT APPLICATION Map a�►6 a� Parcel � Application Health Division BUILDING pEPT. Date Issued." S !o Conservation Division APR 28 2016 Application Fee Planning Dept. -� TOWN OF gp,RNSTABL'E : Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 0%0 Gc•P P_ Village Owner &Z w ,o n j 3 Address sce Telephone 5 Q� jai Permit Request Al `t�-"�� c a -'o +ke 0-41 r ki r Sea 1, A441111 � iai .01 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 3 (7 0 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Y p 9 9 es ❑ 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) — - - 1 ,11 Name W I� 1� M /�Pe_ Telephone Number A 0398 Address + n Aire. License# 1 XtAA1A41 �( 19 '1 Home Improvement Contractor# 44 3 a Email Worker's Compensation # wC O � 55 ` o 4bo ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION # 9 r DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE s OWNER } DATE OF INSPECTION: r FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL "GAS: ROUGH FINAL q FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. �I . i ° egaoY- Se ? ces _ ,Richard v.scan,Director R Win Division �om 'erry t&di _.Cola s 9ner 208-Main Slr�II�annis,�1+.EA b2601 VAVW acitsfabli:u us Office 508 $62=4Q38 Fax 50 =79Q 623t. Prapezty .'Owner bus Ccrn�g�e�e:axad S�gx�7.`�s Sect�cix� 4 fuze aui4:?? . ` 6 {- ca act oz3n myehaIf in.0 matters'rel2fXue m t�arr�ed by this buildiag<permit a pluation for AID ry y' taal fe�zcs a se the iesonsat cif Abe plzcanti I'nos; are nottc :beiilec orus7led bef` reenensaale€t a�tdal ivas�ectxo�s are pe�frned and aceep�erL. 5 ,r'"�-$jgnat�u�e;of .r` S �e.o���lpplicaut �ir�xt,Nanae PnntiNan to wowsow�:z�_ ssxor>Pao . ACOR& '1 w DATE(atMioomvY) CERTIFICATE OF LIABILITY INSURANCE 4/12/2016 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,poilcy(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.conferrights to the certificate holder In lieu of such endorsements. PRODUCE : NAME: Risk Strategies Company Risk Strategies Company �� E (781)986-4400 JFWAX No):cTei>963-4420 15 Pacella Park Drive ',)ASS:randolphcld®risk-stratagies.com suite INSURER(S)AFFORDING COVERAGE NAIC= Randolph NA 02368 _ P INsuRERA:Selective Ins., of .America INSURED _ msuRERB Allmerica Financial aAlliance Ins Cc 10212 Cape Save, Inc INSURERC:Star Insurance CO . 7 D Huntington Ave INSURER D: - + INSURER E: .South Yarmouth,: ' MA '02664 INSURERF: i• COVERAGES CERTIFICATE NUMBER:CL1641211275 REVISION NUMBER: ''# THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR.THE.POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE..INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ICYEFF - LICYEX - - - .L7TZ: TYPE OF.INSURANCE POLICY.NUMBER_ i. MM MMIDOlYYYY LIMITS .'. . X COMMERCIAL GENERAL LIABILITY - . EACH OCCURRENCE $ ,` 1,000,000 DAMAGE TO RENTED A CLAJMS-MADE �OCCURt PREMISES Ea occurrence)$ 100,000 X 31999400 a ,r �i0/16J2oiS 10/16/2016 MED:EXP-An one: arson $. 10,00.0, _ - .. ,, .'p �• �``r... PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: c., GENERAL AGGREGATE $ 2,00.0,006 PR0 - w. t' �� • POLICY�.�� �_LOC ' � PRODUCTS-COMP/OP , OTHER: $ AUTOMOBILE.LIABILRY - s I OM IMI, $ , •s 1,0.00'.000 r -Ea accident ANY AUTO �: BODILY INJURY(Perperson) $" B ALLOVVNE3 SCHEDULED, w '•� f AUTOS X AUTOS AgHA467966.00- 11/6/2015x 11/6,/2016 BODILY INJURY.(Pet aocident) $ NON=OVWEp PROPERTY DAMAGE Xs HIRED AUTOS X AUTOS _ - '' Peraccident $. X UMBRELLA LIAR X OCCUR -EACH OCCURRENCE $ ' 1,600,060 EXCESS LIAR GLAims-MADE i,, t+° }- +7Ti AGGREGATE DED I X RETENTION:$ EVIL 61494430,' $ WORKERS COMPENSATION h - Officers Included for {, { l.f y,. ,X r PER .OTH- - +., 1 STATUT AND EMPLOYERS'IJABILITY E ER YIN '. ... . OFFICERIMEMBER:EXCLUDED? gJTIVE ®NIA Coverage. E.L EACH ACCIDENT $ 500 000 ANY PROPRIETORIPARTNERIEXE C (Mandatory In NH). IRC005540700 4/9/2016 4/9/2017< E.L'DISEASE'-EA EMPLOYE $ .,4I , 500,000 DESCRIP e161 i ON OF OPERATIONSb d� 5.__ w s .k E.L.DISEASE:POLICY LIMIT $ ._u+' 500 0.00 DESCRIPnON OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,.Additional Remarks Schedule;maybe attached If,more space.Is required} • - National Grid Corporate Services LLC d/b/a National Grid, Action Inc, Colonial. Gas Company and NStar Electric are all included as Additiorial Insureds I., with respects to the General Liability coverage of.;named insured as required by - • •k, _ : , written Contract., , CERTIFICATE HOLDER CANCELLATION e SHOULD ANY OF THE ABOVE DESCRIBEDVOLICIES BE CANCELLED BEFORE Housiiag Assistance Corporation .'''I' *'_ � THE EXPIRATION DATE THEREOF, NOTICE VILE'BE DELIVERED IN' ACCORDANCE WITH THE POLICY PROVISIONS.`M Cape Light Compact • •Barnstable County `€ 460 West blain Street - + AUTHORIZED REPRESENTATIVE Hyannis, M 02601 -Michael Christian/CLC 01089-2014 ACORD CORPORATION. All rights roserved. ACORD 25(2014101) The ACORD name and logo are;registered marks of ACORD tNS025(zoi4o1) The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 M www massgovLdia NiA'orkers'Compensation Insurance Affidavit:Builders/Contractois/ElectricianslPlumbers. TO BE FILED WITH THE:PERMITTING AUTHORITY. Apalicant Information Please Print Legibly Name (Business/Organization/Individual):Cape Save Inc Address`:7-D Huntington Avenue City/State/Zip:South Yarmouth,MA 02664 Phone#:508 398-0398 Are you an employer?Check the appropriate box: Type of Project(required): 1. ✓ I am a employer with_.. .15 em to ees full and/or art-time " ❑ p y ( p ) 7. New construction 2.❑I am a sole proprietor or partnership and have.no employees working forme in 8; Remodeling any capacity.[No workers'comp.insurance required:] 3.M I am a homeowner doing all.work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 4:❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will. 10 0 Building addition ensure that all contractors either have workers'compensation insurance:or are sole I L E]Electrical repairs or additions proprietors with no employees. 12.❑Plumbing.repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp..insurance.� 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[R]Other hisulatlori 152,§1(4),and we have no employees..[No workers'comp.insurance required:] *Any applicant that checks.box#1-must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submita new affidavit indicating such. *Contractors that check this box'must Attached an additional sheet showing the name of the tors and state whether or not those:entities have employees. lfthe sub-contractors have employees,they must provide their,workers'comp,policy number. I am an employer that:is providing workers'compensation insurance for-my employees. Below is the policy and job site information. Insurance Company Name Star Insurance Co. Policy#or Self ms.tic:# .WC085540700 Expiration.Date: 4/9/2017 Job Site Address: 20 Greely Avenue City/State/zip: West Hyannisport Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the.form of a STOP WORK ORDER.and a fine of up to$250.00 a day against the violator.A copy of this statement.may be forwarded to the Office of Investigations of the DIA for insurance . coverage verification. Ldo hepeby.eertify under th pains andpenalties of perjury that the'information provided above is true and.correct Si ature• Date: 4/28/16 Phone#:508-398 0398 Official use only. Do not write in this area,to be completed by city or town official City or Town; Permit/License# Issuing Authority(circle one): 1 Board of Health 2.Building Department 3.City/Town Clerk 4..Electrical.Inspector 5,Plumbing Inspector 6.Other Contact Person:. Phone#: _. Office of Consumer Affairs and Business;Regulatioh- e. 51`'70: Boston,;Massachusetts Horne Improvernent;Contractor Reglstratlor F 1m . } -� Registration 171380;" - Type .Corporation 3- y : ,Z,• Expiration 3/14/201"8 Ti# 419291 CAPE SAVE.INC. WILLIAM 'MCCLUSKEY 7-D HUNT'INGTON AVENUE: y { SOUTH=YARMOUTH MA 02664 3 R Update Address and return card Mark reason for`change: Address D;Renewal Employment C L'ostCard:: I SCA 1 Q 20M-05/11 . /re oerj AlaazcoercBl &si �eiulation ti License or re istration valid for and vidul use onl Offiee of Goosumer Affairs&Business Regulation g y y� HOME IMPROVEMENT CONTRACTOR before the expiration date If found>return. o: Registration:., .171380 Type; Office of Consum er Affairstand Business Regulation ,P1 Expiration 3/14/2018 Corporation 10 Park Plaza-Suite 5170" ` l3oston,MA 02116" GAPE SAVE INC .J "{ 6 WILLIAM-McCLUSKEY } 7=1)HUNTINGTON AVE46Em {. SOUTH YARMOUTH,MAA2664 Undersecretary Not valid'MALAsignature . Massachusetts=Department of Public Safety Board of$uiiding Regui,ations and:Standards <.mnaw il'Llfin Supei v»ur uucCiucr �tvsx���s^.um.arr License: CSSL 162776 WILLIAM JMC Ctu s 37:NAUSET ROADWoo West Yarmouth NIA `✓,�....�11 c,:>r,��� Expiration Commissioner 06128/2017 k • r The Commonwealth of Massachusetts Department of Industrial.Accidents r d I Congress Street,Suite 100 Boston,MA 02114-2017 ` www massgovldia R'orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual):Cape Save Inc Address:7-D Huntington Avenue City/State/Zip:South Yarmouth, MA 02664 Phone#:508-398 0398 Are you an employer?Check.the appropriate box: Type Of project(required): LE I am a employer with. 15 employees(full and/or part-time)-! 7. E]New construction 2.M I am a sole proprietor or partnership and have,no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 31-1 I am a homeowner doing all work myself.[No workers'comp:insurance required.]t . 9. ❑Demolition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Q Building addition ensure that all contractors either have workers'compensation insurance or are sole I I.Q Electrical repairs or additions proprietors with no employees. 12.E:]Plumbing repairs or additions 5.�1 am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance. 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c_ 14.[R]Other Insulation 152,§1(4),and We have no employees.[No workers'comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities.have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insuaance Company Name: 'Star Insurance Co. Policy#or Self-ins.Lic.#: WC085540700 Expiration Date: 4/9/2017 Job Site Address: 78 Stoney Cliff Road City/State/Zip: Centerville Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certifyunder th pains andpenalties of perjury that the information provided above is true and correct: Signature: Date: 4/27/16 Phone#:508-398-0398 Official use only. Do not write.in this area,to be completed by city or town official City or Town; Permifticense# Issuing Authority(circle one): 1.Board of Health,2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map �L Parcel A3 0 TO"NNI 01 BARKTADhfion Health Division , Q�ate Issued All 5- Conservation Division 0 Application Fee Planning Dept. Permit Fee -".H>FI'MN;4nsi2Y.x.','F:>P vmANMucusuaaR3eaW Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address c� -e-J Ce 1 Village N k. Owner n� Address Q"� �o�. -�3 W• }� , anl►� bC-y' Telephone 5 $ �- 8 0 �- Ia Permit Request m� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 3 6 0 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑ Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes 'hkNo If yes, site plan review # Current Use Proposed Use - - --- - APPLICANT INFORMATION (BUILDER OR HOMEOWNER) ' Name wA111 C IV45 G,t � Telephone Number sot Address �'' D On License # ZC 10 bYkrMdAA1 m A o 6 Home Improvement Contractor# Email Worker's Compensation # Wwc ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE { 3 0 Ir re FOR OFFICIAL USE ONLY A' APPLICATION# DATE ISSUED MAP/PARCELNO. 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. I The Commonwealth of Massachusetts - Department of Industrial Accidents d 1 Congress Street,;Suite 100 , Boston,MA 02114-2017 �eJ- www massgov/dia - - Workers'Compensation Insurance Affidavit:Builders/Contractors/Electneians/Plumbers. ' TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Hanle(B Cape:Save Inc P usiness/Organization/Indivdual): Address:7-D Huntington Avenue City/State/Zip:South Yarmouth,MA 02664 Phone#:508 398 0398 Are you an employer?Check the appropriate box: Type of project(required): 1.E].I am a employer with 20 employeei full and/orpart-time),* ], Q NeW COrishllcti0n r 2. I am a sole proprietor or partnership.and.have no employees working for in 0 . •8; �Remodeling . . any capacity.[No workers'comp.insurancerequired.] ' 9. ❑Demolition " 3.F1 I am a homeowner doing all work myself:[No workers'comp.insurance required.]t 10 4.�I am a homeowner and will be hiring contractors to conduct all work on my property..I will 0 Building:addition ensure that all contractors either have workers'compensation insurance or are sole I I.0 Electrical repairs or additions proprietors with no'employees. 12.❑Plumbingrepairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13:❑Roof repairs These sub contractors have employees.apd.havemorkers'comp.insurance 6. We are a corporation and its officers have exercised theirri right of exemption 14•❑✓ Other Insulation rP g P• Per MGL c: 152,§l(4),and we have no employees.[No workers'comp.insurance required:) *Any applicant that checks box#1•must also fill<out the section below showing their:workers'compensation'policy information. t Homeowners who submit:this affidavit indicating-they are doing all,work.and then hire outside contractors must submit anew affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those:entities have employees. If the sub-contractors have employees,they must provide their workers'comp:policy number:. I am an employer that:is providing workers'compensation insurance for my employees. Below is the policy and job.site information. Insurance Company Name-Wesco Insurance Company Policy#or Self-ins.Lic:#:WWC31:36274 Expiration Date:04/09/2016 Job Site Address: 20 Greely Avenue City/State/Zip: Hyannis Port Attach a copy of the workers'compensation policy declaration page(showing the policy number and:expiration date). Failure to secure coverage as required'under.MGL..c.152,§25A is a criminal violation punishable by a fine up to.$1,500.0.0 . and/or one-year imprisonment,;as well.as civil::penalties:in the form of a STOP WORK ORDER and a fine of up to.$250M..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 cel.16 Under.th pains andpenaldis ofperjuryahat the information provided above:is true and correct Si ature: Date: 9/30/2015 Phone#:508-398-0398 Official use only. Do not-write in this area,to be completed by city or town Official City or Town, Permit/License# fi Issuing.Authority(circle on - _ 1.Board of Health 2:Bt ilding_Department 3.City/Town Clerk 4.Electrical Inspector 5..1'lumbing.Inspector 0.Other F Contact Persori:. Phone#: DATE(MMIODiYYYYj CERTIFICATE OF LIABILITY..]NSURA - IYCG 3/24/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORNIATiON ONLY,AND:CONFERS NO RIGHTS:UPON THE CERTIFICATE HOLDER: THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OWALTER 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.* U the;certificate haidei is an ADDITIONAL INSElRED,the poticyllesj InOst be endorsed. If SUBROGATION Ia WAIVED, subject to the tenns:and conditions of the policy,certain policies may require an:`endorsefnent:A statement on this.certificate does not confer rights to the certificate hoiden in lieu of such endorsements. . PRODUCER CONTACT. NAME: Colleen Crowley Risk Strategies Comrpaay ` PHONE (781)986-4400I FA c o:(781)963-4420' 15 Pacella Park Drive w ccrowley@risk-strategies.com. Suite 240 INSURE S AFFORDINGCOVERAGE NAICt taar3ol _ 3�tA Q23tS8 _ INSURERA:SeleatiVe 'ZUS Off' America INSURED ... : . _ - .. IrsURERa A11MCIxica rinaaeial AllianCe 10212 Cape Save, sac INSURER -wesco, =IISuraLC@, aIi , 7 D Ruatiagton Ave I :.. INSURERD; :.. INSURER E: South Y3niet th WK 62694 IISUREFtF: COVERAGES CERTIFICATE NUMBER:CL1$32491501 ;,; REVISION:NUMBER: T#iS I$TO'CERTIfY THAT TWE POLICIES OF'INSURANCE LISTED BELOW•HAVVE SEEN ISSUED TO THE TNSURED AAMED ABOVE rOR TH'E'POLICY PERiOD MDICATED. NOTWITHSTANI*G ANY REQUIREMENT,TERM OR CONDITION OF ANl!CONTRACT OR OTHER ➢OCUMENT:WiTH'RESPECT Tb Vi�iICH 7H(S CERTIFICATE MAY BE ISSUED.OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN:IS SUBJECT TO-ALL THE TERMS, EXCLUSIONS AND CONDITIONS QF SUCH POLICIES.LIMrrs SHOWN MAY HAVE BEEN RED BY PAID CLAIMS. 7TR TYPE OF INSURANCE POLICY NUMBER ` POLICY EFF POLICY EXP IDD MMI, D -tlMrrS .. GENERAL LIABILITY EACH OCCURRENCE 1,000,000 X COMMERCUU.GENERALLl BILITY EN PREMISES Ea oxumence $ 100,000 +� CLAIMS`MADE �X ,j C 1994480 0/16/2018 0/16%2015MED ,(Any one person) $ 10,000 PERSONAL a,- V INmRY r, 1,000 Q.OQ GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATELIMITAPPLIESPER.. PRODUCTS-COMPlOP:AGG' $ 2,000,000 POLICY X PRO- X -LOC $ AtJiOtdOBU E LIABILITY O(Ea BIN accident : 1,0001002 B. ANY AUTO BODILY INJURY(Per.pemon) $ AAUTOSS WNED r__1 AUTO ULED _ 6746600. ... �1/6/2014 1/6/2015 BODILY INJURY(Pei soddent) $ - HIREOAUTOS X NON--D _ PERTY't3?MAG£ AUTO& $ X UMBRELLA LIAR; X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS UAB CtAIMSfinADE AGGREGATE $ 1,000,00o Om RETENTi0N 6I 19 448Q. = o/i�f2o a 0/x:$/2Q1S C wroRK RSCQMr&M1IQN £fie �s YACl udsd fo'r VC STATU OTH- $MID EMPLOYERS'LIABdITY X ANY PROPRIETORPARTWJwE)ECUTIVE YIN overage Y R _• OFFICEPJMEMBER E UDED?? N-lA E.L.EACH ACCIDENT $ 500 000 (Mandatory in NH) 136274 j9f2b15 /9/'2016 ' if yyas,describe under E:L.DISEASE-EA EMPLOYEE DESCRIRTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $' 500,00 DES&UPTiON OF OPERATIONSI LOCATIONS I VEHICLES tAMa6 ACORD tot,Addi(fonal Remarks Schedule if more space is regWred) Issued as :evidence o€;;insurance.:.;. : Thielsch Engineering, Tr> , ,is listed as. additional .insured.as, respects-General Liakiility•as .reguired.,hy written contract y CERTIFICATE HOLDER CANCELLATION IIbSt?IIg�i'apE i�htn t.Qrt� SHOULD ANY OF THE iABOVE'DESCRtBED 00LiC1ES SE C3►IYCEL LED BE€ORE THE EXPIRATION DAYS THEREOF NOTICE WILL 13E DELIVERED W Cape Light Compact ACCORDANCE WITH THE POLICY PROVIMONS. Atta.0 Margaret �O MIX 4V SCK _ 'AUTHORI2ED.REPRESENrATiYE_ 3195 Main Stre6t Barnstable, MA >02b30: chael Clirsta anJCI,C AGORD 15' (2d1DItIS) ©198E-ai�ItlACt3R0 CORPORATIU fee AI; All rigl±ts artrait. iNS025(2o(omp.1 . The ACORD name and Logo ace registered marks of ACORD � . Uou4f,Batoosw E'; � �• -, �tichartT'V.Scat,D�r�igr' raftg 7DI stun 1 Twt 1w.xp; 3tuldjng Gommissianer 200 Main S6rei�IIyannis,A+i'A 02601 wtt�v.t9Wn�3ar tstabte_ma us Office 508 862 038 Fax 508-790-�23:0: ]Progeny Ovvner`�Vtust: oarpee;and S. gx '1" s Secxoa If C7sina,A.1 �deft as9v*.of tl a sab�ec prop�r�g heZe aut pnx to aet an anybeh2A iu all:maters: lave to tvv'., :utl�orized b tis kniiang, eruv�aplicaia4fo 6-7 oolfezices an;d alarms a he-itspons p of e, plica Fc� are z�otto bed arutliebefore�erc� msaalled and xzisj�ections axe;geFad:=d accepee .- Aft i•' $ tug of - r- - `�� �P .; ..; i Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Co tractor Registration Registration: 171380 Type: Corporation ,_; ' • z Expiration: 3/14/2016 Tr# 249649 CAPE SAVE INC. WILLIAM McCLUSKEY £ 7-D HUNTINGTON AVENUE : $ r, SOUTH YARMOUTH, MA 02664 --- ---__. Update Address and return card.Mark reason for change. SCA i Co 20M-05/11 E] Address Ed Renewal Q Employment E] Lost Card fa r-rie�iu>r�u�eul,G e;ackljeM • 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: e istration: ' Office of Consumer Affairs and Business Regulation 9 171380 Type: g Expiration 3%142046 Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 CAPE SAVE INC. WILLIAM McCLUSKEY T 7-D HUNTINGTON AVENUE' -_ SOUTH YARMOUTH,MA 02664 Undersecretary Not vali ithout signature i ' Massachusetts -Department of Public Safety Board of'8uiiding Regufa ions and.5tandards LHuui iiEi�irrt.�u�iEi v�+OT aueCiiier sir ..�.yy - License: CSSL 102776 WELL J MC 37 NAUSET ROAD West Yairmouth NA Expiration Commissioner 06/28/2017 - Town of Barnstable *Permit Re ulato ServicesMA ~�ee 6 g ry snaxsresr.E, ; - e 1659. m�' Thomas F.Geiler,Director Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY 1 /,�/ / Not Valid without Red X-Press Imprint reMap/parcel Number 7 / Property AddressO Q L [residential Value of Work Minimum fee of$35.00 for work under$6000.06 Owner's Name&Address ( 1C) A . 1J "uUt" �. Contractor's Name t Telephone Number�� t. t�bV D Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) Y�Workman's Compensation Insurance -PRESS PERMIT Check one: ❑ I am a sole proprietor _ AUG.14 20 ❑ I am the Homeowner R I have Worker's Compensationlnsuranc - Insurance Company Name TOWN OF BARNSTABLE Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each.permit. Permit Request(check box) N5,Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping.'.Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows ❑ Smoke/Carbon Monoxide detectors floor plans marked with red S and inspections required. . Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. . ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&'Construction Supervisors License is, efluired. SIGNATURE: Q MPFILEWORMSI ilding permit formsTYPRESS.doc, Revised 053012 r _y t - 7he Commonn+ealth of Massachusdft iJearhnent o, Industrial Accidmft lOffce oflnmtigations 60O F3'ashinglon Street Boston,MA 02111 n :nra. govldia Workers' Compensation Insurance Affidavits Biers/ContractarsJE triciansdPlumbers Applicant Information Please Print I.embly Name e ,o�gantonftndi�;dnaU= �.���� Address City{stawzip: 1-- mil`( - 6 D Are you an employer?Ckec)Otb appropriate boa: Type of project{required}: am a contract d 1or an 1_❑ I atn a employer with 4- ❑ I 6. ❑New consh�uction employees(full and/or part-time)-* have hired the sub-condwtors 2.❑ I am a sole proprietor os parker listed on the attached sheet. 7- &Remodeling ship and have no employees. These sub-contractors have g_ ❑Demolition employees and have woriCers' working for me irr any capacity c ;���I 9- ❑Building addition o worfaers .insurance camp. lo. Electrical or additions required-] �- �W e are a corporatit�n and its ❑ officers have exercised their 3.❑ I am a how daiirg all work.. 1 I.0 Plumbing repairs or additions self ' right of exemption per MGL �' . �.o workers �F- 12.❑Roof repairs msurance requited_]L c.152,§1(4),and we have no employees-[No workers': 13:0 other comp insmance required] 'Aiay appHcamt shot checks boa#1 mast also fill out the section below showing their waders'camrpensation policy infurmaric m I Howeovuaers aim sob.,this affidavit im&catmp,d ey are doing all wa¢lc and d m hoe outside contrucurs mmst seta a a new affidavit indicating such_ lCautractors that check this bobs must,attached as additional sheet showing the name of the sub-camttactoas and state whether ornot those entities have emphryees.. Ifthe sub-conua mbave employee%tlte}mnaprovide the'sr`amt}ers?comp.pohcyDug- -Taman emptoysr that ispm iaw worke s'compensation imurance for my engAPI em Below is the poficy surd job.sate informatio+x. Insurance Company Name: Policy#or Self--iris.Uc. 'Expiration Date: Job Site Address: 6 ok Tcitylstatel7�ip: Attach a copy of the workers'compen lion.policy dedara.gn page showing the policy number and motion date). Failure to secure coverage as required unifier Section 25A of MGL c- 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or onie=year impriso t,'as w, ell as civil penalties in 1he farm of.a STOP WORK ORDER and a fine ofup to$250,00 a day against the violator. Be advised that a copy of this stated may be f wmarded to the Office of Investigations of the DIA for insurance coverage v e ifiratien:. I do herby certify thepains andpena ofpej:uty thattha in formafian proAd d a ' true and carrect 1 r Date: Phone Of fiat am onl,I. Do not write in this area,to bs completed by city or town affidat City or Tow PermitUcense Twuina Authority(drde.one)r: 1.Board of Health 2.Building Department 3.Ctyfforsn Clerk 4..Electrical Inspector 5.Plumbing Lispector 6.Other, Contact Person:: Phone#: 6 c * BARNSTABLE. MA 33. g rnstable i639 . . Town of Ba ArfDN1°�A Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder �C KQ Z�'te z,L�' J , as Owner of the subject property hereby authorize 10 CX5--e, l S to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) IX Sig7— re of Owner Date r.. Z i Print ame If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\DDV87AAZ\EXPRESS.doe Revised 072110 AC40RV CERTI ICATE OF LIABILITY INSURANCE °"'�`M""°°""YY' a3f142012 THIS CERTIFICATE IS ISSUED AS A MA ER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CE�yTIFICATE DOES NOT AFFIRMA71VE Y OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSUF NCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND E CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is h ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,c ain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorse nt(s). PRODUCER CONTACT NAME: Mash USA ImA --- --.._.-_.._..........--- —. .. . 100 North Tryon Street,Suite 32000 PHOT F C No). Charlotte,NC 28202M E-MAIL ACrc For questions contact certrequesf@lonaes. ADDRESS: INSURERS AFFORDING COVERAGE NAIC f 47095-CASUA-ONLY--12-13 INSURER A:Seirinsured INSURED INSURER e:National Union Fire Ins Co Pibburgh PA 19445 Lowe's Companies,Inc.0 New Hampshire Insurance and Subsidaries0 INSURER C: P Company 23841 PO Box 10000 INSURER D:Illinois National Ire Co 23817 Mooresville,NC 28115 INSURER E:Illinois Union Insurance Co 47960 INSURER F: Steadiest Insurance Company 1 126387 COVERAGES CERTIF ATE NUMBER: ATL-002938178-13 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF NSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOU EMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PER IN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH PO IES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE LTR I POLICY NUMBER MIDDIYYY MIDDIYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ A X COMMERCIAL GENERAL LIABILITY Self-Insured 04M 2012 04fOVM13 DAMAGE 1MISES Eaoccurrence) $ CLAIMS-MADE D OCCUR MED EXP(Any one person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ GENL AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMPIOP AGO $ POLICY' PRO- JECT LOC $ AUTOMOBILE LIABILITY arc d t I' 5,000,000 8 X ANYAUTO CA4695536(ADS) 04/012011 04101 00 BODILY INJURY(Per person) $ L; ALL OWrHED SCHEDULED AUTOS AUTOS CA4895537(MA) 04/012012 ON0112013 BODO.Y IN URY(Per accident) $ BNON-OVvNED CA4695536 A) ON01O2 ON0121 PROPERTY DA_M-A_GEHIREDAUTOS AUTOS (Per amid $ $ X UMBRELLA LIAB N OCCUR EACH OCCURRENCE $ 5,000.000 F EXCESS LIAR CLAIMS-MADE IPR3792301-00 041012011 04011 014 AGGREGATE $ 5,000,000 DIED I RETENTION$ $ WORKERS COMPENSATION -" X WC STATU- I OTH- AND EMPLOYERS LIABILITY C ANY PROPRIETORIPARTNERIEXECUTIVE YIN WC019736883(AOS) 04I0WW2 ONOV2013 2,000,000 C OFFICER/MEMBER EXCLUDED? a NIA WC019736865 ON0MO12 ON012013 E.L.EACH ACCIDENT $ (Mandatory in NH) E1.DISEASE-EA EMPLOYEE $ _ 2,000,000 D if yes,describe under WC019736864(WI) 041012012 0410=3 2,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Excess WC XWC1192490(AOS) 041012012 041012013 WC:S'faVEL$3mil;xs$2mil SIR B Excess WC XWC1192491(FL) _ 04/012012 ONOU2013 WC:StdEL$3mil;xs$2mit SIR DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES ach ACORD 101,Additional Remarks Schedule,it more space Is required) Endenre ofooverage. Lowe's self insures for physical damage r, erage to renled and leased vehicles. CERTIFICATE HOLDER CANCELLATION Loos Companies,In&0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE andsubsidiaries0 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 10000 ACCORDANCE WITH THE POLICY PROVISIONS. M9oresft NC 28115 AUTHORIZED REPRESENTATIVE of Mash USA Inc. Diana Bentley 01988.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) Thi I ACORD name and logo are registered marks of ACORD ..:.:� ? , i' a ai t p 3r, .': a t , Office of Cow Affam and Rusnesss IZegulati®n 10 Park Plam-Suite 5170 } Bost Massachusetts 0 B 115 l�s 5 Home krovement Con=tnr Registration ._ Repfsflration:'163649 Type: LLC Expiialion: 7AM13 TrS 213195 KATSIKIS&DIMOPOULOS LLC - - r JAMES KATSUGS - -- T i 945 MAIN ST W LMINGTON,MA 01887 y aid n to m card.Atark remou for changr- sca`i 6' OSIf� t• a L� ❑ iAddrem ❑Renew2l ❑Employm®t ❑lAstCard C nSie �oealO P 9tftr c:. F ioemse or - Y"fop indie it we onl y mE twgaollC�m r CoHTRAc=R before t$e expiraffion&k--Yf fond a stm W-- a Tgpac DfTiceofCoa=P epA�andB Rmubtion' •.'�J�i3.-:: t� - ''Y8 ParltE�-SY�me 5fl70 Boston,li9A 02116 KATSUKfS 1.DlMO _ t . ''JAMES KATSiKiS. 945 MAIN ST42 WIUdIINGTON,ApAdif3B7'R � �i dwithoatsigga3oure 5 E .�.' . bla�3chmaKts-Deprrtment of Public Safct}• Board of Building Rctmlatiunc and Standard+ • + Construchon Supernsor License -.MYWES S KATSIMS K 9 BAUARDVALE RD r'` e" APIDOVER.MA 01810 Expiration• 717=3 • ��1 �I �'� (ltmmiau+ner� Try: 17529 f' t. + , � ` 1r i+� AEI., 5 j t. Z T [ ''. ' •r + .. r .. ' - • i v ✓lie �ia.�vrreauuPa o�✓�aaoac�ucoelZa `? Office of Consumer Affairs&Business Regulation. License or registration valid for individul use only OMEJIIRPFLOVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registratwn 1.4 (88 10 Park Plaza-Suite F-170 Expiration ;10%18/2013 Supplanle e ' d Boston,MA 02116 tint) L.V.jH'S HOMES-;CENTERS INC, . MELISSA WILLIAMS 136 TURNPIKE RD SULTE 100' � •� -- jgg SOUTH BOROUGH MA 01772 /t/—!t; Not valid without signature Undersecretary � f s and lof• number / ... :'(1� ........1A r U" P�rssess map SEPTIC SYSTEM MUST BE 7G INSTALLED IN COMPLIANCE Sewage Permit number ......_....................7.0......................... V11TH ARTICLE II STATE SANITARY CODE AND TOWN �QyoFTHE.T°�, TOWN OF BARNS'���WE _ _ ro � �r I STABLE, i 1639. BUILDING INSPECTOR \e0 �'0 MPY a• APPLICATION FOR PERMIT TO ..46V1..4..4.................... .... ......... ....1.....7.:..... ..........4F....4..................... TYPEOF CONSTRUCTION .....lI.V.C�.-W..... .................................................................................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: s Location ..(.lrfQ,4.c�-Y...�j E ......... ........................................... ProposedUse /I ESI,QF:vG ...-..D�F.... !P �s..? ................................................................................. RZoning District ..... ..-J................... . . ........... Fire District .... TE I/lLL ERv�4. .: Name of Owner ./..L.1 ^'L..V........../.J..lf �vl�Lt�!.1.�.....Addres . -... .. ... l..!.�.a. i" SRO Name of Builder ,11..5'Sv:c/gTES 10'1 CAddress ..4?9!K..... :a./.......4 Name of Architect Address . Numberof Rooms .........0...................................................Foundation ................................................... Exterior ...G' /,w ... .�f{. G � ..........................Roofing .. ?S/. , Sr?�fe7................................... Floors ..<A�7... .........'..............................................Interior. ..... �1` FT./G�� ................................................ Heating!Y. ... ......Gr"/r�:S..t.................................Plumbing ...... .............................................. ............... ............ Fireplace ..1.........../�!/!¢.S�Iy .........................••Approximate Cost .0 ....................................... .. ... Definitive Plan Approved by Planning Board _______________________________19-------- . Area ` ��.... . . . ./........ ... . . . ... Diagram of Lot and Building with Dimensions Fee ......... .... ............................... SUBJECT TO APPROVAL OF BOARD OF HEALTH �z r r I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. � Nazuksnio, A. @" J. 18669 one story, � �No .................. Permit for .................................... � single � ��m�l�� . ` � ' t , . ` Greely Avenue ^ Locohon --...---------_. .......rt � . ............. Owner ��^ �� ,J^ �� ` --- .. � ' �nv�����------ frame / Type of Construction -------------- � , ' ---^----------------------'' / | Plot ---------. Lot _--'------' � \ ' i � | � ` ) September l� �� - Permit Granted ........ � ^ Dote of |nopection?I. ..........YP ^ Dote Completed ..��/�.!�..�./�------l9 ' \ r / . � ' PERMIT REFUSED ^ ' | ----...`--'---.---------.. 19 ' ' --------.---------------..�—. ) ` . ^----.--.---------------.---. . ----.—.---------,~--,.--..---. � , - . '~'-----'--------^--^^--~—'^^^''' ' ' Approved ................................................ lQ ' � � —..-----_------'_.—....—.------. ' � � -----------.------.------~.— ' � ' | � ^ � �. - M�Y.'• 7fI r. e f -V • � Assessor's. map and lot number /{ ....: ..t,+ Sewage Permit number ..........:r:'............. '.-:�.................. y�fTHErO�y TOWN • OF BARNSTABLE I BABBSTABLE, i "b 9 BUILDING INSPECTOR APPLICATION FOR PERMIT TO � ........................ .. `.r...... .......:...........................�. :.. ... .....:-.....':'........... TYPE OF CONSTRUCTION ......`... ....... .. ....:..r". ...................... ........................................................... f, .......l: ........ '"... ...............19'f . TO THE'-LNSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location •� ''........... !... .......° :........................ ..................................... ProposedUse .................................... .................................... ........A.:..` ............................... ....................................... , Zoning District ..:.................................... 7 ..Fire District .. t` r ° "....:.......f..........`.?..?i;C..! ...... Name of Owner =t - '.; +K.:.:..'.:.:.....Address T �f .............. ......... ............ ....... .......... .. • - :d .v ...........Y I f...... .. Name of Builder .` ..... `...:..'' `:...........:.... ':...:�:'.�'...... : :Address ... ............................'...:. .....'................... ..... �°...r Name of Architect w Address ...................................................................................:. Number of Rooms ..............Foundation • '....................... Exterior i ... - .r.. ...Roofing ..• !r . ................................... t' .........................................................:....................... ...........:..........:...........::...... .. .. Floors' .... • •' " ' ' .Interior .. - ••. ..........................................:............................................................................... :................ Heating ::.. �..'..;.....'+ .�..... ..:........ Plumbing ... r_ :.... w :. -........ ........ .... ...... . ...... ....... .......... ... . t' f Y Fireplace .. " r...�.� ......Approximate Cost .. Definitive Plan Approved by Planning Board ------------------------------ t •' . --�9-------. Area ............:................... ......... Diagram of Lot and Building with Dimensions Fee f '.................7.......................;.. SUBJECT TO APPROVAL OF BOARD OF HEALTH 4 ��'` % r I hereby agree to conform to all the Rules and Regulations of the Town of.Barnstable regarding the above construction. ' 1 - Name ........:........................:.:........................................:.':r Kazukonis, A. & J. -A-246r-� No 18669 Permit for ....one story, single family-dwelling ................................................................................ Location ......G...........reel Avenue ............................................. �. West H�annisport ......................... Owner ........A. & J. Kazukonis .......................................................... Type of Construction frame ................................................................................ Plot ............................ Lot ... o' ..... Permit Granted ............. B.ptnvn.b..Pr...1.0.19 76 Date of Inspection ....................................19 Date Complete ...............................19 RM T RE USED ....... ....... .. L.......... 19 ..... ......X............. ..............................................I............ ............... 1 R �� Approved ........... !.I.,... �, :............ 19 ......... . �� ..... `�........ ......... ............ ............................... Assessor's map and lot number p THE i' SevYage Permit number ...../ fM, ,. .. ... . g/� �J ' jam SEPTIC SYSTEM INSTALLED III W • LE, i House umber ................ ......... t��............................... 9 ♦��E�P� �O 1639ZZ �0 EWRONME CO N t Q W O W N OF B A R N S T ATM NGUTATIONS } BUILDING INSPECTOR 6 F APPLICATION-'FOR PERMIT TO t. a TYPE OF CONSTRUCTION �IIQQ !'a r►c.! .............................................:................................. ...... TO THE INSPECTOR OF ,,BU,ILDING$..: The undersigned hereby applies for a permit according to the following information: Location ...:1 T. . .....t„?/. ,ex/y.... ./..��..fie................................. . . ....................... ... ProposedUse ......... ............................. ...................................................................................... .................... ZoningDistrict ........ .�......./....... ./ ........................Fire District ................................/................/.l................................. Name of Owner ..../....1 ntAP.,l. .....14.AAq.!3L.S............Address .C�Gti�.U...(.��.. �2...N... ....FY Name of Builder .../✓..Q.w ..a.s....G(1, .....:..........Address .,Wl J'!.4.1 d.Qr ...�d... . ...... ...'..4 ...... .............. .Name of Architect ..................................................................Address ...................................................................................... Numberof Rooms ..................................................................Foundation ............................................................................... . Exierior ....................................................................................Roofing ............................:.................................. ..................... Floors ............................................................Interior .:.............................................:.................................... Heating ......................Plumbing ........... - Fireplace ..................................................................................Approximate Cost ...//l/J '.f..l.............. ...................... .......... fff � Definitive Plan Approved by Planning Board --------------------------------19--------. Area .....- ....Q... Diagram of Lot and Building with Dimensions Fee �-- SUBJECT TO APPROVAL OF BOARD OF HEALTH • 0 �'FLY I hereby agree to conform to all the Rules and. Regulations of the T n of Barnstable regarding the above construction. Name .... .. ........... ........................ Kazukonis, Anthony s. 21982 Addition No ................. Permit for .................................... Dick to Dwelling ............................................................................... Greely Avenue 4 ............................ ....................... ...................................C7- .... Owner ..... Anthony Kazultonis Frame Type'of Construction .......................................... ...................................................................... Plot ......................... Lot ................................ Permit.Granted .....February 12,...................................19 80 Date of Inspection ....................................19 Date Completed .................A...19 PERMIT REFUSED ............... ......at...................................... 19 M .......................I......................... M. S. .............................................. .............................................. ni CX 0 Apprdvel...........(,;)................................. 19 C,1 ................M...... .0. ................................................... .. ............................................................................... ii Assessor's reap and lot number .............. " E _ Sewage.. Permit number .....I�����'.-�c^���....:�f.;/.�7„/„/, •J % �" d�' ,. °� „� BARNSTADLE, • House dumber ...........: ... ................................. MA86 l ,� •, ��MAY A`' TOWN OF BARNSTABLE 4. t Ll BUILDING INSPECTOR r . � APPLICATION FOR PERMIT TO ::. TYPE OF CONSTRUCTION ..... .).,n„�?r,. t.... l.!?,!? .�!.............................................. .....................19 1 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit /according to the following information: Location .... .............?..:'............: ..... tyF'....................:........:... ProposedUse .....r.. % .... ....................................................................................................................... ........... ........... a ZoningDistrict ........................................................................Fire District .............................................................................. Name of Owner ...... a�7`,r?.: 'f....f t�. ..+�. ::'=." I. ............Address f t,u � � �.. ?f�+ .. ` .... �.! F........................ Name of Builder ............:..^..,9. F....'"..r.':.... ,..: ................Address .Z! ...7 �t�r:a.:: .......t�........�7 r.... ............... I , Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ..................................................................Foundation ....................................................:......................... Exterior ................................................Roofing Floors ...........................................................Interior .................................................................................... .......................... Heating ..................................................................................Plumbing ................................................................................... Fireplace ..................................................................................Approximate Cost . : //.rat'.............................................. 1 ........ � . Definitive Plan Approved by Planning Board ___-----------------------------19________. �� , ....o ............. AreaA Diagram of Lot and Building with .Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH 12 1 ` I 7 a c. I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above a construction. Name .. 4................. .................................................... (/ n ni ' Anthony Kazukonis Ow/nnr ---------------------- . Frame ' Type ofConstruction -------------- ' ` ' . � Plot ............................ Lot ...... ' ` V = ~ , Permit. ~....~~ . ` ; | --- Completed ................./..................19 ' ' | PERMI/ITRIEFUS.ED ' � lA � -----..--.--. —' . . � ~.. —. '/1� -------' ' ` ......................�......................................................... v � .__------------.i---.--.'---'' � ---------'------~----'----^— Approved l ................................................ lQ � ----------------------~---' - � -------`--------------'---- � | � | r f ��PTi'r (F,EET� .SOIL CON1>/T/ON$ •S, vA�"� 21 d i { /91VTHOW1 W ,9No 77-1-;WET R. 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