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0022 HARRISON ROAD
.. � � o E ,. _ u i �l � � _ 0 L � � ,. i _ _ v ° � v .. - 67pi 1 ,. o 4 � ,. .., i e .. .. n - .. - �. �. .. .. .. - a .. � k - .... - � .� .z 3 o, - � e <. Vie Town of Barnstable rw *..„ �*, -mats,Atg ,gip€. ,-,;_ �, 1B .. Post This Card So That"�t i"s,VisifileFromahe,Street,rA rovetl"Plans Must be Retained on Job and"this Card Must be Ke t + anx�xswBa.e, ` 8 rei �; ,x. pp r ;x ap''L.K `` p ;:.: - � M" ¢ Posted UntilFinal I'nspecfion Has;Been�Made .163p eoNuc+"° . Where a Cer �ficate;of Occu ane as Re, u red such-Buildm shall-Not be Occu red until a Final.lns ection has been made ay� it Permit No. B-18-1251 Applicant Name: Cape Cod Docks, Inc. Approvals Date Issued: 05/18/2018 Current Use: Structure Permit Type: Building,t Dock Expiration Date: 11/18/2018 Foundation: T . Location: 22 HARRISON ROAD,CENTERVILLE Map/Lot 229 070 Zoning District: RD-1 Sheathing: Owner on Record: BISHOP,JEFFREY G&PAMELA C : �' Contractor Name Cape Cod Docks, Inc. framing: 1 - k k'' va _. Address: 3 PINE HILL ROAD sXContractor License. 156836 2 SOUTHBOROUGH, MA 01772 \ stPctE " Cost: $ 1,344.00 Chimney: Description: To install an aluminum framed,seasonal float with gangway Permit Fee: $ 107.85 Insulation: ' Fee d= Project Review Req: � € � �- �Pai $ 107.85 Date Y"" 5/18/2018 Final: 77 z Plumbing/Gas r � Rough Plumbing: Bui[din Official g Final Plumbing: ' Rough Gas: This permit shall be deemed abandoned and invalid unless the work authorized-byAhis permit is commenced within six months after§issuance. g All work authorized by this permit shall conform to the approved applcat an and theapproved construction documents":for which this permit has been granted. All construction,alterations and changes of use of any building and structures»shall be in compliance with the local zoning;by laws)and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street�or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. y Electrical �.�.,: The Certificate of Occupancy will not be issued until all applicable signtKures by theBuilding a ds Fire Officials are prov,ded on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work ): w a' Rough:a �F 1.Foundation or Footing _ .a, �,,,,� ....�r. •aP3M g 'r 2.Sheathing Inspection Final' 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation 7.Final Ire pection before Occupancy Low Voltage Final: 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 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION a � � JIMap Parcel V9 � lication ^ Health Division :0� - : 3� Date Issued 76onservation Division _ 1 I : Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board ��� /fit✓ Historic - OKH _ Preservation/ Hyannis Project Street Address �& ,qrr0 Sd ed Village �i'f et y, l e_ 'mots- Owner L0/.41'P C1k'k_D Address 07d #grr150t7 kead Telephone M rMG A, - '7Y- Y 70- 1&0 Permit Request 0 l n 4f 0 alfi0lr�l V M Pik M erg �QS0n1 r 1 7 e.14 W 1,H, qtf0 1 f4A V, Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 3 Vi 00 Construction TypeSeA50n 40 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 a No If yes, site plan review# Current Use I D 4I L5 S 1h e, 1n/i H,-r- Proposed Use To a e e,e/S S fh e W of er a- k 'APPLICANT INFORMATION J (BUILDER OR HOMEOWNER) U s Name t aw r en e e ae w" e Coy( Ntl s jn( _ Telephone Number �� 77 1 I f[ Address x3 N04 Ifela-,ff License # Home Improvement Contractor# Email SPrV/cF,(?1W .lid 0 Worker's Compensation # ALL CONSTRUCTION DEBRIS S G FROM THIS PROJECT WILL BE TAKEN TO S Tk �a deaf e e � �d cSe- �hv►rS SIGNATURE ATE 1 FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. k 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. r The Cu2n ommarkit off Massachrrseas Deparhamt eflud--m3hid Accidents ti e Of InvMtkafians 600 Wks-hingtow Mreet Boson,MA 02111 wnv1v.1naSs.gOWdia W-arkers' CompensafianInsurance. idavit:$ui.Tders/ContractorsMectrici-anMumbers AppIkant Information Please Print Lefibly Dame Ousineasl onlh&id=Q:Cap e C.�W Do Address: City/StateMp: We 0 &.rmo o�ti Pi7a.PA 3 Phone 9-7 S o �-� �d- Y JL( _ Are you an employer? Check the appropriate box: Type of proiect(r e5quire4: LK I am a employer with_1 4. ❑ I=a general contractor and I 6. El N constnzcSion erployees(fnli andlor part-time3* have b red the sub-conbractors 71❑ I am a sole proprietor or partner- listed on the attached sheet `- ❑Remodeling ship and have no employees These sub-contractors have g- ❑Demolition wow for mein any capacitic employees and have workers' [No workers'comp.ina,xanre comp.insurant�$ �_ ❑Building addition regnirt:d] 5.[] We are a corporaticnand its ' 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers ha-m tmercised fhek 1 L❑Plumbing repairs or additions myself.[No workers'comp- right of exemption.per MOL 17 inc�xanreregniied]$ c.15Z§1(41 and we hime no ❑Roafrepairg employees-WC,WMIM g' I3 M Other 5e asonA l P � comp-insurance req*ed.] in hOtt iT,r * "11tryagxp at that checks box-91r�ttalso fill out the sectionbelaxshowingrheatvofikesTconpensatiom policy infMr�mt ffomevwners arba sabaut ibis affidxvi i indicating they am doing off tick xnd then him Outside eontasetors n=submit a naw rf idxdt ind3rsfin smrh- tDS that check ibis box must soothed=additions!sheet dwwhag the name of the smlr-boas amd state whether Donut thnse wakes have -vluyees If the-Ta-cnutaacram have empIbyees,they must provide tize?r work-e comp policy number I am art ernpl�+yer€Fiat ispt`91'[�xcg n�orlrers'canrlxerrsYrhon arrsrrrarrcrx far rtr r Rrrrpinye�cs� Beiaty is the pogcy and' bit, information_ Insmauce CompanyNwne: r ll1 bl et su_t'�t C.-O M fi Policy# or self ins_Lima 0 5 y I q b()73//V�;/ q /7 Expiration Bate:A Job SiteAd&mss:AA /I am 5a•i7 goa-W City/Statel -rQ.47 r�I l% Ma.OZt' Ef#aeh a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure cm-erage as required under Section 25A of MGL c. 152 can lead to the imposition of'erimrmal penalties of a fine up to S 1,500-00 andlor one—yearmVrtmament as well as civil penalties in the fanm of a STOP WORK ORDEP,and a fine of up to$250-00 a day against the violator- Be advised that a copy of this statement may be fiorwarded to the Office of Im estigatims of fhe DIA fnr coverage verifficdtitrrL Ida hereby fy under pains ar d pen ss of p erfruy t3tatflrs irrf or afron prm*idRd abmrc is tizra and correct Siena Bate: fil T / Phone#: sv. 775` Giffzcial arse only. Da not mite in this area,tot be completed by city,or town officurL City or Town:. � Perm tUcense# Issuing Authority(circle one): 1.Board of Ilealtbt 2.Building Department I dAyfFawn Gerk 4.Electrical Inspector S.Plumbing inspector 6.Other Contact Person: t Phoine#: DATE(MwDDIYYY1r) .� CERTIFICATE OF LIABILITY INSURANCE 0411e120,6 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTA T Karen McHugh Arthur D.Calfee Insurance Agency,Inc. 508-540-2609 FAx PHONE. .508-457.1715 www.cafeeinsurance.com EXA . karen calfeeinsumnce.com 336 Gifford Street INSURERISI AFFORDING COVERAGE NAIL# Falmouth MA 02540 INSURER : Continental Casualty INSURED INSURER Cape Cod Docks,Inc. INSURER C: 23 Bog Road INSURER D: INSURER E West Yarmouth MA 02673.1426 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY 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 - DfYYYYI TYPE OF WSURANCE ADOLSUBR POLICY NUMBER POLK Y EFF POLICY EXP LIMITS -- GENERAL LIABILITY EACH OCCURRENCE $1000 000. A X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED opwrrancal $1 000 CLAIMS-MADE Fx-1 OCCUR ML9783328 10I3012017 1013012018 MED EXP(Any one $10 000. x includes Marine Liability PERSONAL&ADV INJURY $1000 000. GENERAL AGGREGATE $2,000,000. GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $2,000,000. X POLICY PRO LOC I I $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS_ $ X UMBRELLA LIAB OCCUR EACH OCCURRENCE 1000 000. A EXCESS UAB CLAIMS-MADE EX 0124303(bumbershoot) 1013012017 10/30/2018 AGGREGATE $1000 000. X DED I X I RETENTION 10 000. WORKERS COMPENSATION X WC STATU OTH- AND EMPLOYERS'LIABILITY A ANY OFFICER/MEMBER ER/MEMBER EXCLUDED ECUTN N� NIA 6S590-0731 N31-A-17 0711112017 0711112018 E.L.EACH ACCIDENT $100 000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE 100 WO tf ,describe under o IP ION OF OPERATION_$below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Addidanai Remarks Schedule,If more space Is roqulred) carpentry,pile driving,excavation,boat building includes USLBH CERTIFICATE HOLDER CANCELLATION Lorraine Rizzo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 22 Harrison Road ACCORDANCE WITH THE POLICY PROVISIONS. Centerville,MA 02632 AUTHORIZED REPRESENTATIVE ',) y{ <I(MM> 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Bwatisr UL 639. Town of Barnstable Regulatory Services Richard V.Scali,Interim 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 L LOrYa(n e let z ) ,as Owner of the subject property hereby authorize ��s. �� to act on my behalf, in all matters relative to work authorized by this building permit application for: 'J r (Address of Job) �7i2( Signature of Owner' ate O ffd r fi e Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. TAKEVIN MBuilding Changes\EXPRESS PERMMEXPRESS.doc Revised 061313 r Office of Consumer Affairs and Business Regulation 10 Park-Plaza---Suite 5170 Boston, Mas achusetts 02116 Home Im rovemeffContractor Registration p , � - Type: Corporation Registration: 156836 CAPE COD DOCKS,INC. Y at 23 BOG RD Expiration: 08/08/2019 r WEST YARMOUTH,MA 02673-1426 SCA 1 0 20M-05!11 Update Address and return card. Mark reason for change. A, Office ` auriicr iironr�//I n�'C3/fr�rsuct/taac(!; - - Office of Consumer Affairs&Business Regulation 2 HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only JYPE:Coruoration before the expiration date. If found return to: RRigistration ExpirationOffice of Consu A a and Business Regulation ;• 156636 08/08/2019 10 Park Plaza- uite 5170 C . —`APE COD DOCKS,INC.��: ��• ston,MA 09, 6 w LAW RENCE D.DEMEFtS'a"• •23 BOG RD WEST YARMOUTH,MA 02673-1426 Undersecre tary Not valid without signature t r ` N W W n O O O O O Massachusetts Department of Public Safety Board of Building;Regulations and Standards ' License: CS-092954 :3 Construction Supervisor LAWRENCE D DEMERS. s 919 OLD BASS RIVER',RO,ADi DENNIS MA 02636V-4 Y 1- ri!L,?'Gti' Exliiration:: Commissioner t=. 01/31/2019 i ` L t} ' Construction,Supervisor `{�.. s-•�Restricte'd to: I :.� ;Unrestricted;Buildings of any use group which contain y' less Man wG _-=�eaal sed space. / 14 //11 '�_ ✓�'� i �� Sir r w i Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. DPS Licensing information visit: WW W.MASS-GOVIDPS Fwd: Forms A&B for Conservation- lorraine-rizzo42@gmail.com- Gmail Page 2 of 2 Scan.pdf Open with Town of Barnstable F Conservation Commission i 200 Main Street .e» Hyannis Massachusetts 02601office,50s.162.W3 FAX sarM.241: Form A ForSE3. �5 L��r - ° ALL PARTIES WVOLVED WITH THIS PROJECT MU$T$dGN THIS STATEMENT I The undersigned confirm that they have read and uadetstend the Noliee of intern Order of Conditions,and approved plans for the project,The undersigned also understand that subsequent Order revisions shall require advance approval by the Conservation Commission. Pl ski name on this line_ Pkaso Milt name on this line. a a �oPrii�ne KIZ7v 3 zc !g' � Return this form to: Barnstable Conservation Commission 200 Main Street, Hyannis,MA 02601 Fax:508-778.2412 mtn 2fa2 Town of Barnstable Conservation Commission to200 Main Street Hyannis Memehusetts 0280, off"'sos-e0+03 FAX tas.rw2412 Form B For SE3-?,�2 el Below please find the names,ad supervisor and aeet dreg es, and business telephone numbers of the pt Dject with the Order 0fi-dlt3ons'for;6E3.jsuphorvt r who am p°reible for ensuring on-site compliance https://mail-google-com/mail/u/0/ z��ai�n1 Q Town of Barnstable Conservation Co mmission 200 Main Street Hyannis Massachusetts 02609 oWWW sos-gam FAX: SM77&2412 Form B For SE3- 2 Below please find the names,addresses,and business telephone n supervisor and alternate project supervisorumbers of the project who are responsible for ensuring on-site compliance with the Order of Conditions for SE3-5 Project Supervisor Alternate Project Supervisor Name 'L 1! E /Mee I�.0 -r Cu e �'Mks: �c�t� _ Name 2 60 Address Wei' Ygem Gyrs� Ygv��t� �7u U?67 3 114-d2*73 Address d 9-77� 7iI 5'05- 77�- 7r Business Telephone# Business Telephone# s a' 3/4 Property Owners i ature Date print Name �' ti% , .. h er� o v piicant s Signature(if different) Date Print Name Return this form to: Barnstable Conservation Commission 200 Main Street Hyannis,MA 02601 TOWN OF BARNSTABLE BUILDING PERMIT APPUiCATION Map t Parcel lv V j/ Application # s 7W Health Division 1 -p Date Issued h&j* _V 0 Conservation Division M4R24 Z Application Fe wN of q 016 Planning Dept. E q Permit Fee Date Definitive Plan Approved by Planning Board �STge� Historic- OKH _ Preservation / Hyannis fyyiAO:l , 5F�37-- Project Street Address �Y�2_� ©tilaP Village Owner m,4ee.ca_A. Address ZZ 4A�21�SaK3 Telephone Permit Request Q aXQ P��Ti�- +��oJ���.1 p+� �sr �id-t�l_ Q 1���� �4 ►�I owl 3Eae.�►.�6� ��l�C. Z'►Js-c�.u� >~i2�,►J u.1- D Dore-S( �N-rc�2.uo�2� nt c�.1 .woe_ . .K.�sG. 1�-n�2.�o� D cne�s. Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation I 0 600-oo 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 4new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number '-I"l 4-- 2qtb Address 1-7 'f—mu, 'w yck- e Ib License # 1 �c7• �Ag,WDCT-4, A Home Improvement Contractor# k 1O,9 4g Email AdvVN ;�&:) �e�.gn3 NL Worker's Compensation # ALL ONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE" / V DATE FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME eO� Vl; I d if4c4 - INSULATION A( f/13�6 FIREPLACE -�LLECTRICAL: ROUGH FINAL "PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ' FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO: Office of Consumer Affairs and Business Regulation b 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 , Ilome Improvement Cootractor Registration �1 Registration: 173808 Type: LLC. Expiration: 11/15/2016 Tr# 258974 -DAVID RICARDI DESIGN, LLC. lIY; DAVID RICARDI k kJ i f P.O. BOX 1051 €AST DENNIS, MA 02641 s •-Update Address and return card.Mark reason for change. Y- TsCA 1 0 20M-05/1 i � — _''—� ❑ Address Renewal Employment Lost Card Tpo:nayruracoecccc��yUVLtc35icc�uJel� - License or registrationv 'and for individul use only ffice of Consumer Affairs&Business RQgulationY ME IMPROVEMENT ONTRACTOR before the expiration date. If found return to: gistration: 173808 Type: Office of Consumer Affairs and Business Regulation 9piration: LLC 10 Park Plaza-Suite 5170 ' Boston MA 02116 DAVID RICARDI DAVID RICARDI 1582 MAIN STREET — EAS-r DENNIS,MA 02641' ' 'Undersecretary Not valid without signature r> �1\ r j; Unrestricted-Buildings of any use group which -- !�! Massachusetts Department of Public Safety contain less than 35,000 cubic feet(991M )of Board of Building Regulations and Standards enclosed space. Construction Supervisor License:CS-095M CHRISTOPHER t; ter. 17 STIR BROOIX R SOUTH Y! Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. ,�si' For DPS Licensing information v>sit:- www.Mass.Gov/DPS °- �,,`,�, �"�' �� Expiration Commissioner 08120/2016 �� rpommaru o�C�aaaac,�uee� Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVE ENT CONTRACTOR before the expiration date. If found return to: egistration• Type: Office of Consumer Affairs and Business Regulation Expiration: Individual 10 Park Plaza-Suite 5170 Boston,MA 02116' CHRISTOPHER A V, '7 CHRISTOPHER YI r 17 STILL BROOK RD"^L,sW yew a SOUTH YARMOUTH,AAA26164 Undersecretary Not valid without signature � T Town. of Barnstable . Regulatory Services r IZiAzrd V.SMX4 DhwtDr Buldrag Division TmnPerry,E-1d u Commoner 200 Mam S'ir=f;Hy=xir,,MA 02601 www tDWnl rnstable uza.Bs Office: 509-862-4038 F= 50&790-6230 Property Owner Must Complete and Sign This Section- If Us ing A Builder c �, ✓��1�. f 4,A At A as Owner of the subject property ben:I�y audiosizeze G 1�Q1�Co Qom- t tJG fis� -r to act o=L ray behalf, a in aI1=tbm mhlive to woik antbo&-ed bytbis building peanit appEcatioa for. (Add=ss of Job) -Pool fences and alarms are the responsibility of tU.e applicant Pools are nottto be filed or iii zed before fence is installed and all find ' inspections.are performed and accepted. - Sim of Owner Signature of AppTim= ✓l�l�a r c cI r PrinrName Pant Name c,.,: ► �-r- ,,,��,+ter, , Dam . .F0RM5:0 Dols Town of Bamstable Regulatory Se deer RwImrd V.Scafi,Du-wfnr , t BuRding Division. t = Tom Petry,Sm7dmg Commissioner 200 Main Street'; Hp-azffis,MA 02601 O$ce: 509-96Z--038 Fay 508-790-6230 - HOM Xj?RaMLUMD=RXIIDT,T DATE JOB LOCA=OK- f nnmbcr,' . 'gpI�1ED�JlgR": h®ephnne# wo3cpbone 7 . CURRENT.LJ ILITGADDRESS_ _ ---T— ¢� zip code t m fion for`homeowners"was mdtr ndedto mclpde owns'-occ�ied dweIImes of SIX ffiits or Iess and to anOW The`�""-�'•' crap - ho does not ossms a hcens yided fTiatti�c ow=acts as supervisor. for hirew �r-st� cos to a an md- aT p bomeo�un .fig . D8mmmN OF HOWNTM m P ersan(s)who ownsa parcel of Imcl on which.helshe resides or intends to reside,on which.th=is,or is intruded to be,a one or two- family dwelling,aid or deiarhed stract n-m accessory to such use and/or farm structnw, A person who constucts afore filan one home in atwo-ycarpexiodshallnotbe=iddrredAhamcaxnez Such Inommownee.shall snbmitto fhe Building Official an afoml acxptabletothmBmI[FmgOfUiaLthathelshe shall beresnons-Ila for all mmhwaikp-ea2mmedunderthzbm7dmgoeimit (Section 109.L1) e midmigned`homeownee-aMM3et msponsshs�-y for compliance wiatbn Stare Bufldmg Code sad other appEmbla codes, bylaws tales and rmg.mU �sns_ - 7bC nndcrs9gned`homzownce=f3f s fhathelshe ids tb'Town ofBazns[ab�e Bmildmg Depadmmt mmimmn inspection pm=dnms ancIrt:quhx=mrmts andfathdsbe will complywiffi said procedmrs and requaemeds. side ufHo®eati4nec . Appnml onr@crm905ci21 Note_ Tree-family swellingsconf$mmg35,000cubicfedorlargerwMberDTi=dta fywrthth eSiamBui7dmgCode Seddonf27.0 Canstrnction Caatml. . Hon�owru+��s max The Code d-afes that aAuy homeowner performing work for which a buBdiag permit is regm be exempt shall p from fhe provisions of this secfina(Section 109-U-Liram-mg of construction Supervisors);provided ffiat if the homeowner engages a person,(;)for lice to do such work,that such Homeowner shall act as supervisor." Many homeflwn=who use ffiis c=mptoa are rinaware ffiat fficy are as=raing file responsibiTttiies of m supervisor (see Appendix Q,Rnles&1?eguTafmns for Licsing Constrmcton SiTervisors,Section 2I3) This lark of awareness offru resRliv in serious problems,parficnlarty when fhe hbmeo wn=him maH=nsedpexso= In tkS case,=Board cannot proceed,zgahast the=H='wed person as if waIIld with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible To _ffxat as art of ffie COMM Ste hamcawtrcr is aware of hislher respanssr�rTrtr'es,many �Q� P permit applir-p nn,$rat the homeowner certify that hefshe miners[uds&e mponsi-biTifies of a Supervisor. Oa the Iastpage Of this issue is a form carrenfiy used bp,several to nm Yon may caret amend and adopt sack a formIcertificafiDn.for mein your mmmmxitj. p�ir�siE�*srFce��� Rzvised 06 U 13 . ,27ze Comraorrivealth of- assadiusetts Deparaneut qf&dussfria1Accidents - @}dice grrmcidgations 600 Washbiegion Street _ Boston,41A 02111 witu mass g-ovIdin Worlmrs' CampensatiunInsurance Affidavit SuildersICanfractarsMec ricianslPiumbers Applicant Infurmatian Please Pxiiuf DIY. Naxne Addre City/Sta-& '_--0. ,prr2.tbtWtU Phase Are you an employer?Check the appropriate box: Type of project(regnireg- I.❑ I am a employer with 4 KJ1 am a general contractor and I 6. ❑New constructim t employees(full an&or part-time).* have hired the sub contractors 2.❑ I am a sole proprietor arpartner- listed onthe attached sheet'` ?- ❑Remodeling ship and have no employees These sub-caa ractors have g- ❑Demolition w a for me in anycapacity. employees and have workers' [No Wod irnc�x rs, comp- ance comp-Msurart1 9. ❑Building addifiarp' required-] 5. ❑ We are a corporation and its 10❑Electrical repairs or adc5 iom officers have exercised their 3.❑ I an a hotneoumcer doing all work 1 L❑Plumbing repairs or additions myself[No workers'camp- rim of exemption per MGL 12.❑Roo€repairs i*+surancerequired_j i c.152, §1(4�and we have no employees.(No workers' 13.0 Other coraq-insurance required.] *A¢yappfieaatd=trIMCUboxRuaut also fill oni the section below showkjffiegsuodgerecampeasatioo policy infmustion. ' Hameawnas who submit dtis af5davt mxffcxtmg they aredaig all wa l sad then Its outside caafisctorsoust submit a new affidnk indic=ng such__ fCcn=ctm ff=cbecY thk bax must attached mr.additiansl simet shmrmg the nasae of ilia sub-coataacmrs zmd=a whether or not those entiffeshnve eop9oyem 1€thesub-coz=,c cusbace emplopeer.,theymasrpmuide their workeW comp.policy--ber- I am an empLopr float ispro%iding workers'cangW.Isatiall hwArancefor my eirrp£ojrees-Below is i£iepo£iry and jab site . informQlian. � Insurance Company Name: U?19-T_V_Wa Chi Sr vTjNam. iJSt9 � Policy#or Self-ice I.ic. ` Rxpiration Date_ Job sate Address=22- 4—.� . T CstylStawzt p. Attach a copy of the corkers'coanpensationpolicy declaration page(showing the policy number and expiration date). Failure to secare coverage as require3 under Section 25A o€MGL c 152 can lead to the imposilioa of crimimal penalties of a fine up to S U00 O0 andlar one-year impiOnffl d as well as civil peaslties,in the fona of a STOP WORK ORDMand a fsne of up to$250-00 a day abaiast the violator_ Be adtdsed drat a copy of this statemed may be fi xvnded is the Office of Investigation of the DIA for insnrancer coverage verificaticm.-. Ida lrMR cc fy ndsr ihapons and afties ofperjuty that the uufarma#imspmi&&albmw is b`w and correct:L4V ' Simaature: Piiaae �Z�— 260 Offidal use only. Do fiat wrke in flds area,to be crrinp£eted by city ortown offi a£. 8 City or Town: PernAtUcense# Issuing Anthoritp(circle one): L Board of Health 1 ceding Department 3.CStyffown Clerk 4.Electrical Inspector S.Plumbing Inspector CL Other Contact Person: Phone#: formation and Inst-ucfions M ssa_chusetts General Laws chapter 152 regcirm all employers to provide workers'compensation for their employes. p this statz3tM,an employee is defined as.".m=y person in.the service of another under any confraot ofhae, express or implied,oral or " An MpproyEr is defined as-an indiyidnA partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged is a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an mfvidnal,partnership,association or other legal entity,employing employees. However the owner of a dweIlmg house having not more than three apartments and who resides therein,or the occ¢pant of the - dwPT�house of another who employs persans to do mice,contraction or repair wow on such dwelling house or on the grounds or buMmmg appurfP therein sbaH notbecanse of such employment be deemed to be an employer." MI GL chapter 152,§25C(6)also gtafns that"every state or local Reensing agency shall withhold ffie issuance or reriewil of a liceirse 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 cove.)age requi Fed." Additionally,MGM chapter 152,§25CM states"Neither the conunonwean nor any ofi is Political subdivisions shall eotm inter any contract for the p erfomzauce ofpubhc work u3tI acceptable evidence of compliance Tii i the h s,rrmce-. requirements of this cbapterhavebeen presented to the contracting anfliozity." Applicants , PIease fill out the workeas'compensation affidavit completely,by checldag,he boxes that apply to your situation and,if necessary:supply sob-cont=tor(s)name{s), address(es)and phone m¢nber(s) along with their certificates)of ;n cm a„ce. Limited Liability Companies(LLC)or ISmited Liability Partumm'hips(LLP)with no employees other than the members or partners,are not required to carry workers' compensation iosenance_ If an LLC-or LLP does have employees, a.policy isrmpiL . Be advisedthAthis affidaThmaybe suhmiLt-_d to the Department of Industrial Accidents for confamafion of files nce coverage- Also be sure to sign and date the affidavit The affidavit should be mtumed to the city or town that the application for the permit or license is being requested,not the Department of- Industrial Aecidemjs_ Should you have any questions regarding the law or if you are regoaed to obtain a workms' compensation policy,plmse call the Deparbnenf at the number listed below Se rn e lf-insd companies shonId entLr their self-insar� ce license=mber a a the apprupriafr line. City or Town Officials Please be sore that the affidavit is complete and prhdrd.legibly. The Department has provided a space at the bottom of the affidavit for you to fill orrt in the event the Office of Investigations has to coact you regarding the applicant- Please b e sure iD fill.in the pen>iIlicense number which will be used as a reference ruinber. Tn addition,an applicant that must submit miuh ple,permWlicrose applications in any given year,need only.sobmit one affidavit indicating current p olicy info=ation'(if necessary)and under"Job Site Address"the applicant should w31Ee"all locations in (city or town)_"A copy ofthe affidavit:that has been officially stamped or marked bythe,city or town may be provided to the applicant as proof that a valid affidavit is on file for futz'e Pmmits or licenses_ A new affidavitmust be filled out each yea i.Where a home owner or citizen is obt daaing a license or permit not related to any business or conzme ial veniire Le. a dog license or permit to bum Ieaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you is advance for your coopeaation and should you have any questions, please do not hesifate to give us a call tot hone and fax number: The I}epartrnemt's address, eP . ' . The CGMMMWwla of I\assachu,& # ' ,Dega fmmt cif lndn 0zial AGcidenta, itee of Sagatio= Bastr MA 0�11k Tf,-L 4 617 727-49W cxt 406 or 1-&77-MASSAFF Fax#617` 27 774 Revised¢24-D7 .gpgIdia. DAVIRIC-01 CNELSON A R� CERTIFICATE OF LIABILITY INSURANCE F 3�11 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($),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pocky(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsmnent(s). PRODUCER Rogers&&dray Insurance Agency,Inc. -RUN—E FAX cT Csilta Nelson,CI3R,CPIA,MIS,ABC,AIN8 434 Rte 134 No (877)816-2156 South Dennis,MA 02600 A maIOf Jemoray.com INSURER(S)AFFORDING COVERAGE NAB# INSURER A:Sentinel Insurance Company Ltd INSURED INSURER s:Hartford Casual4f Insurance Company David Ricardl Designs LL.0 INSURER c,. PO Box 1051 NSURER D: East Dennis,MA OZ641 -INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED 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. LTR TYPEOFINSURANCE INSD POLICY NUMBER I AAFMN Ywffl &0OLMOM I LIMITS A X COMMERCIAL GENERAL LLUUTY EACH OCCURRENCE $ 4,000 lm CLAIMS41►DE 0 OCCUR 08MNMON 10106=15 10106=6 >+�A18ES Ea ooaurT $ +11000 MEDEXP WW a,eyeson) s 10,000 PERSONAL&ADV INJURY $ 1,000,0 Gall.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,00Q0 X POLICY JECaT ❑LOc PRODUCTS-COMWOP AGG $ 2,000,000 OTHER: s AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANYAUTO BODILY INJURY(Per pmw) $ ALL A SCHEDULED BODILY INJURY(�eo1denA $ HIREDAUTCB,R AUTOVOIED PR $ $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ ECCESS I" CLAIM&MADE AGGREGATE $ DED RETENTION$ t tNORI(ERS COMMN8A ftONTH- AND EfIIPLOYERS?LIABILITY $TAT TE ER _._ B ANY PROPRETORIPARTNERfEXEC uTiVE YIN 6WECCU3392 10/04/2015 10/04/2016 E.L LI►at ACCIDENT I3 100,0 OFFIC RnUMBEREXCLUDED? N N1A (Mandawry br NN1 E.L.DISEASE-EA EMPLOYEE $ 100100 UNye daea�a under af�RlP A OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 60010 DESCMPTIOM OF OPE§tAn Ns r LOCATIONS r VENMEs IAA 101,1ldd wW RmwM Schedule,rnr be atWchad I mare*pawls r"Pa redl CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE n of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOTownTo Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPRESEWATIVE 0 IM-2014 ACORD CORPORATION. AU rights reserved. . Y.y.� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map I Parcel Application # Health Division Date Issued d0ig3I/YZ_2P� Conservation Division Application Fee Planning Dept. Permit Fee`U 1 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Village Owner (Z-41 t-t rl Y'- F!" Address 7-z �s© Telephone Permit Request Den'!- Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation iW 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_ i Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: va Z Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ ti Commercial ❑Yes ❑ No If yes, site plan review # � Current Use Proposed Use i a� rn APPLICANT INFORMATION ` BUILDER OR HOMEOWNER) Name v i ✓1G�12- i / p Y et t a�(� le hone Number ,23- ` Address I 'T1U-- y� � License # `� ;, 9� T Home Improvement Contractor# <,3 0 Email dGi l91-A e-5 1414tci Worker's Compensation # ALL CON TRUCTION DEBR ESULTING FROM THIS PROJECT WILL BE TAKEN TO ,5 SIGNATURE DATES FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. - ADDRESS VILLAGE OWNER k DATE OF INSPECTION: FOUNDATION FRAME ��,4 �dc po�oz f� /Z INSULATION SVA13 ig 0 7 xdti - FIREPLACE r ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. .7he Commarrivealth of-Vassa+hrisetts Departrrrezrt of Industrial Accide rds -- O -ce o,f Im estrgations 600 Washington,:Street Boston,, 3PLi 021.I1 wipiv.masygovfdia _ Workers' Compensatian Insurance Affidavit:Bidldei�Contrac-tGrs.1EIecfricianslPh mbers Applicant Inf6rination I� Flea se Print I.e 'bI 1�a=(9 SEE , 3IIT2aflnnlfnr� n }: A i �!/i�L f City/Statc(Ap_ 50 Y 00-r►A 4Monew 7- lei®— 16ga Are you an employer?Check the appropriate =: Type of project(required): I_❑ I am a rrmplayer with I am a general contractor and I employees(full andlor part-time).* have hired the sub-contractors 6. New construction 2-_❑ I am a sole proprietor or partner- listed on the attached sheet I. ❑Remodeling s� and hmre no employees. These stib-contractors have �P $_ El Demolition working for me in any capacity employees and have workers' [No workers' comp.insurance comp.msurant•�$ g. ❑Ruifding addition required_] We are a corporation.and its 10,..D Electrical repairs'or additions 5. ❑ rP, 3.❑ I am.a homeoumer doing all work officers have exercised their 11-❑Flumbingrepairs or additions mys elf- o work ' right of exemption per MGL � ers �P- 12.❑IZoofrepaus i„urance required.]i c.152,§1(4X and we have no employees.[No workers'a 13.❑Other comp_insurance required.] *Any app5c=ffiatchedubox AE1►mu-t also filloutthe sectionbelowshuwmg the vAmkes'compensatwapolicy inhmadmL Mmeowners wbo submit dcis af5da%if indicating they are daiag all Waal and then lace outside contaactors amct snbaait anew affidavit IndicLung such fC'antaactors that check ibis box must attached an additional sheet showing the name of the sub-contractors.and state whether.ar not["hose eafdtks have employees.I€the sub-ccm-t ctors have emplUee%they=stpmvide their workers'comp.policy number. I atn aft settplo}�rr flerrt isprarzdirig markers'canrpertsrrii�ae insurance farm}*¢irrplay�ees $eloav Z/- Insurance Company Nance: � -i�l� •�—��ji.112�/.��1� � Policy 4'or Self-ins.I.ic. 6 0� Ekpiiatioa Date: Job Site Address: 'Z7,- 4A9VZ L<,M City/State/Zio:.. Aftach a copy of thework-ers'compensationpolicy declaration page(showing the policy number and empiration date). Failure to secure coverage as required.under Section 25A of MGL c 157-can lead to the imposition of criminal penalties of a . fine up to$1,500.00 andfor one-yearimprisonn�ent,as well as civil peualties.in 1he form of a STOP WORK ORDERand.a fine of up to$250-00 a day against the violator. Be adsised that a copy of•this statement maybe forwarded to the Office of Investigations ofthe DIAL for insurance coverage ver^iffcation. - I da hereby catltfir under the AR 'i,/andpena a. gerjnr;�fJiat flee ia}at�rtrrfiorr prm rler£a b i�bwe trl corre ct Sionature. lV Date. Phone 6 �D 1 t� Official use azzly. ,Do not,Fate in this.area,ter be campleted by city ortown official City or Tva u.• PermritUcense 4 Issuing Authaiity(carte one): 1.Board•of$ealth 2.Building Department 3.Ci.tylrown Clerk 4.Eiectrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions - Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their empIoyees_ pursm-int-tD this ate,an employee is defined as-"every person in the service of another under aay corffract of hire, express or implied,oral or wrifinn." An employer is defined as"air individnal,partnership,associafian,corporation or other legal entity,or any two or more Of the foregoing engaged is a joint mtL- rise,and including the Iegal 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,consUudtion or repair work on such dwelling house or on the grounds or building appzntenart thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also sites 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 is the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance-coverage required." Additionally;MGL chapter 152,§25C(7)sfatts`Neither the commgawealth nor any ofits political subdivisions shall enter into any contract for the p erfon an ce 0fpnblic work until acceptable evidence of compliance with the iusarace. rez Ereni(mts of 11b chapter have been presented in the contranti g anthoiityf - Applicants Please fill out the workers'compensation affidavit completely,by checking&e boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), addresses)and phone numbers) along with their certifa-cate(s)of 7n.suxance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not rbecd ed to carry workers' compensation i r=ance. If an LLC"or LLP does have employees, a policy is required. Be advised that this a$dayit maybe submitted to the Department of Industrial Accidents for conf=- ation of fi sa:ran ce coverage. Also he sure to sign and date-he affidavit Them affidavit should be retnmed to the city or town that the application for the permit or license is being requested,not the D epartmeat of Industrial Accidents. Should you have any questions regarding the law or if you are req�ed to obtain a workers' compensation policy,please call the Dep artment at the number listed beIow self-insured companies should enter their s elf-i-n mzan ce license number on the appropriate line. City or Town 0 fa-dals t - Please be sure that the affidavit is complete and pried.Iegibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill is the pennincense number which will be used as a reference namber. In addition,an applicant that must submit multiplepermitlIicmse applications in any given year;need only submit one affidavit indicating cuu:eat policy in.fomation Cif necessary)and under"Job site A(ness"the applicant should mite "all locations in (cr. or town)."A copy of the•affidavit that has been officially stamped or marked by the city or town maybe provided to the applicant as proof that a valid affidavit is on file for fatare permits or licenses_ A new affidavit must be,filled out each year. here a home owner or citizen is is obtaining a license or permitnot ielated to any business or commercial al venfiise (ie. a dog license or permit to bum leaves eta.)said person is NOT required to complete Ibis affidavit The Office of Investigations would Irke to thank you is 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: Thje CaxMonweala of Ma ssachusztt-, ' Depaxtmet cif InduStdal ACCWents Woe 4f kve&tiotio.a,,� 6��Stan�`iz�t Bostou,MA()�I 11 Tf,-1.:g 617-727 4 M Qxt 4-06 air 1--9 MASSAFF, Fax 9 617` 27 7749 Revised424-07 ,€.mas gavidia. L - DAVIRIC-01 MVAUGHAN CERTIFICATE OF LIABILITY INSURANCE DATE( 16 10/12122/2016 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 policy(ies)must have ADDITIONAL INSURED provisions or 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 endorsements. PRODUCER CWCT Rogers&Gray Insurance Agency,Inc. PHONE FAX 434 Rte 134 (A/C,No,Ext c,No:(877)816-2156 South Dennis,MA 02660 ' mail@rogersgray.com INSURER 3 AFFORDING COVERAGE NAIL# INSURER A:Sentinel Insurance Company,Ltd. 11000 INSURED INSURERS:Hartford Casualty Insurance Company 29424 David Ricardi Designs LLC INSURERC: PO BOX 1051 INSURER D: East Dennis,MA 02641 INSURER E: INSURER F: - COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED 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. iMMMOMOM LT R TYpE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ❑X OCCUR 08SEANW5605 1010512016 1010512017 DAMAGE SETo RENTED $ 1,000,000 MED EXP(Any oneperson) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑Ypef LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO BODILY INJURY Per arson $ OWNED SCHEDULED AUTOS ONLY AUTOS Ep BODILY INJURY Per accident $ AUTOS ONLY AUTOS ONLY Parr.I'dent � $ r UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ DED RETENTION$ B WORKERS COMPENSATION PTATUTE ERER E57 AND EMPLOYERS'LIABILITY YIN S ANY PROPRIETOR/PARTNER/EXECUTIVE OSWECCU3392 10/04/2016 10104/2017 100,000 OFFICERIMEMBER EXCLUDED? ❑N NIA E.L.EACH ACCIDENT $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT 500,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD i Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massaghusetts 02116 Home Improvemet�ntractor Registration Type: LLC z u Registration: 173808 David Ricardi Designs Llc. M ; Expiration: 11/14/2018 P.O. BOX 1051 - East Dennis, MA 02641 �"�---SCA 1 Ca 20M-05111 Update Address and return card. Mark reason for change. V/ce�ancorcortcvecch�o��icaaac%nael/a ~- Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only c ,Type: LLC before the expiration date. If found return to: Office of Consumer Affairs an ulation Healatratlon 1 0 10 Park Plaza-Suite 51 t� i12808 11/14/2018 s ,! 3, Boston,MA 02116 David Ricardi i'es L,,. David Ricardi 4,0 Iy 1582 Main Streot k East Dennis,MA-0264�;1`r Undersecretary Plot valid wt ognature Town of Barnstable y of Regulatory Services $� p Richard V.S=Ii Director BuRdmg Division 'romPerry,Bm-Irlin Casssi0ner 200 Main Sftee�Hym=i4 MA 02601 WWW-towna) us office: 508-862-4038 Fag: 508-790-6230 1 . Property Owner Must Complete and Sign This Sect on If USing A Builder Lo Vl.AVU Le - �zzd I A Ai ck .,as Owner of the subject property he=byaudio&;e CA- V L VAC (E rit , f to act on mybehA in all»`tPm relative to work authorized bptbis bwIdiag p=mit application for-' , (Add=s of job) '-Pool fences and`alarm are the responsibillyof the applicant Pools are not to be Elachr uilized before fence is installed and all final ' inspections are performed:and accepted ; Sim= of Owner P Y Signature of Applicant /(-12-20, CAn3 &,pA Pzi=N Pert Name Q�xass:owrr��ssmr�oors ' Massachusetts Department of Public Safety Board of Building R Unrestricted-Buildings of any use group which ng Regulations and Standards contain less than 35,000 cubic feet(991m)of License: CS-095633 s Construction Supervisor ` enclosed space. CHRISTOPHER A VINCENT + ' 17 STILL BROOK ROAD SOUTH YARMOUTH�i .02664 '► ' y "•: Failure to possess a current edition of the Massachusetts VA t` state Building Code is cause for revocation of this license. Expiration: For DPS Ucensing information visit: www.Mass.Gov/DIES Commissioner 08/20/2018 �:%�c L•c'•ntrnaattu�q���G�C✓�L!1J,1('iC�tlSn(!i y�yn. _ Office of Consumer Affairs&Business Regulation License or registration valid for individul use only «� -- 4HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: _ egistration 182000 Type:. Office of Consumer Affairs and Business Regulation Expiration .6ht/2017 Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 C.A.VINCENT INC 21- y t-, ,,. CHRISTOPHER VINCENTig� 'mot 17 STILL BROOK Rb7"-- -� SOUTH YARMOUTH,MA 02664 Undersecretary __ Not valid without signature Town of Barnstable *Permit# ~� 6 nran?hs rom issue date Regulatory Services FapiresFee D = t3nnrtsrns�. v tKnss.i639' Richard V.Scali,Director �� �D MP.I A 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 Map/parcel Number Not Valid without Red X-Press Luprint Z Z.�— d 7 U / Property Address Residential Value of Work$ 0-tom —— Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 117AI-c t G i3elis°r d-1 aepy-ri3 o n Rol �Pn fP/`�ISM 0� 6 3 L Contractor's Name a AfE '1/1 ( /JrSo/( . Telephone Number N0( Q 0 Home Improvement Contractor License#(if applicable) /73 2 4 S Email: Construction Supervisor's License#(if applicable) (26 S 7 O 7 Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ m the Homeowner I have Worker's Compensation Insurance OCT 1 9 �llb Insurance Company Name Con f'� �ie,,I �Z_a S f'1 L\14 t1��l SIABL Y uu G Workman's Comp.Policy# Yv 3/562O F 1 Copy of insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side [Replacement Windows/doors/sliders.U-Value - 3 U (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property kOwner must sign Property Owner Letter of Permission. A copy cKthe Home Improvement Contractors License&Construction Supervisors License is require t\, SIGNATURE: C:\Users\Decollik\AppData\Local\Ivlicrosoft\Windows\Temporary Internet Files\Content.Outlook\2P]OIDHR\EXPRESS.doe Revised 040215 IrT-^---�.• j"'f� ,JT d[4trsc+aKit? t. RenewalRENEWAL ri�r t�tur Ksr�,�r L4.;'V,, V• tbyAndersen. 26 i\Iburn Ili):tt ISncnln tot f118(i3 (/� (j [/���' wmaow otrt�ct«[�r r1+.�rc:e+ f fthnne FiIsG.St>tii.�23�•I'ttx 1pL6a3,_rft4t2 Southern New Eugland Windows,LI,C d/b/a Renewal by Andersen of S(ruther`n New England 1 CUSTOM WINDOW AND DOOR REMODELING AGREEMENT GIs)UrwAddremCuySan.eodTIPCode IPQ,Bax GMO Addre rvt.noer: ,E2.Ca v�.�/z�d�i_ �oTalePhwe Ntanbv�l� . liuyrrr5;hetrby jointly and severally agrees to purchase the products and✓or artvu es of Southern iVew lingland Wnt ours,IJAI'd1bla ltrnrttA by Andersen of Southern New England('G�,uitt�['tctr"),in accordant r.Wid-,the to"rms trod conditions c"�Iihril oil the frtsttt and the re%east of th6 agrectnent an(l un the auathed aleecilic.ttio)n shect(s}(o ullertivt ly,this`i\Arrrenrant"J. Ct Historic la Condo 0 HOA? Method of PaymenL'.r J C�.heck ash r,financed Total Job Amount: �.�. 5 Estimated Starting Dac�e..S Deposit Received(33%):— )r0 / Credit Cards are accepted for deposit only—maximum 1/3*(the Balance a[Start of job(3396: protect cost.(Please see Credit Cant Payment form)By slptix>S this i ) �� Esumacad Comp1-79- Complerjon Agreement,you acknowledge that the Balance at Start of job and du Balance on Substantial / Balance on Substanthf Completion of Job cannot be made by credit )� ` card and;oust be mada ay personal ch4tft,bank check,or cash. of Job(33%):_0o.'te. Buyer(s) agrees and understands that this Agreement constitutes the entire understanding between the parties, and that there are no verbal understandings changing any of the terms of this Agreement.Buyer($) acknowledges that Buyer(s) (1)has read this Agreement;understands the terms of this Agreement,and has received a eomplrted,Signed,and dated copy of this Agreement,including the two attached Notices of CAncellation,on the date first written above tind(2)Haes orally, informed of Buyers right to cancel this Agreement.DO NOT SIGN THIS CONTRACT IFTI IERE ARE ANY BLANK SPACES. (Rhode Island Sales Only)Notice to Buyer:(1)Do not sign this Agreement if any of the spaces intended for the agreed terms to the extent of then available information are left blank.(2)You are entitled to a copy of this Agreement at the time you sign it.(3)You may at any time pay off the full unpaid balance due under this Agreement,and in so 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 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 shown in the Agreement by registered or certified mail,which shall be posted not later than midnight of the third calendar day after the day on which the buyer signs the Agreement,excluding Sunday and any holiday on"which regular mail deliveries are not made.See the accompanying notice of cancellation forth for an explanation of buyer's rights. Buye.nsl received the consumer education materials provided by the Rhtxle Island Contractors kcgistraiion Board. f1?urrra Inihals) Renewal Andersen of Southern New England Buyer(s) Buyer(s) Stgna u f car t\ r er / Signature Signature ws/a 6AW>* a- Print Name(if Pruduct',Manager Print Name Print Name YOU, THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANY TIME:PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT. - - - - - - - - - - - - - - -ac• — — — — — — —i- - — — — — — — — — —CA—NC— — — - - — — —x NOTICE OF CANCELLATION K NOTICE OF ELL—ATION Date of Transaction _ You may cancel I Date of Transaction You may cancel this transaction,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 I three business days from the above date.If you cancel,any property traded in,any payments made by you under the property traded in,any payments made by you under the Contract or Sale,and any negotiable instrument executed I Contract or Sale,and any negotiable instrument executed by you.will be returned within ten business days following I by you will be returned within ten business days following receipt by the Seller of your cancellation notice, and any I 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 canceled.If you cancel,you must make available to the Seller I canceled.If you cancel,you must make available to the Seller at your residence,in substantially as good condition as when t at your residence,in substantially as good condition as when received,any goods delivered to you under this Contract or f received,any goods delivered to you under this Contract or Sale;or you regarding the wish oomph,with the instructions of Sale;or you may,if You wish comply with the instructions of the Seller regarding the return shipment of the goods at the I the Seller regarding the return shipment of the goods at the Sellers expense and risk, you do make the goods available dI( Seller's expense and risk.If you do make the goods available [o the Setter and the Seller does not pick them up within. twenty days of the date of cancellation,you may retain or I I dispose of the g to the Seller and the Seller does not pick them up within nods without any further obligation.If pV l twentyjdays of the date of cancellation,you may retain or fail to make the goods available to the Seller,or if you a agree goods without any further obligation.If you Y dispose of the to return the goods to the Seller and tail to do so,then you oods available to the Seller,or if you agree remain liable for g I fail to make the g performance of all obligations under the 1 to return the goods to the Setter and fail to do so,then you Contract.To cancel this transaction,mail or deliver a signed t remain-liable for performance of all obligations.under the and dated copy of this cancellation notice or an other copy g t Contract:To canCoftthis cancellation nhis transaction, tottce l or deliver any signed her t written notice,or send a telegram to Renewal byAany. o her I and dated.co I, Southern.New England at 26Albion Road;lincol n RI written notice,or send a telegram to Renewal by Andersen of j NOT CATER THAN MIDNIGHT OF 65, I Southern NeH,Engfand at 26 Albion Road,Lincoln,RI 02865, (Date) �1 NOT LATER THAN MIDNIGHT OF lHEREBYCANCEL THIS TRANSACTION.. I (Date) I_HEREBY CANCEL THIS TRANSACTION. _ Massachusetts. Department of Public Safety Board of Building Reguiations and Standards License: CS-095707F t " I-onstrUCition Supervisor BRIAN D DENNISON sx 7 LAMBS POND CIRCLEy CHARLTON MA 01607 u f (`✓C,.� CA, .. Expiration: Commissioner 09108120 8. 1�' f28 /y 3/G14Lfy9I LGPLG `L C fL :1l1CLGi7i/J1FiGY 'Fig - Office of Consumer Affairs and Business Regulation 10 Park,'Plaza-Surte 51.70 Boston, Massachusetts 02116 Home Improuem tractor Registration Registration: 173245 Type: Supplement Card ^ Expiration: 9/1912018 SOUTHERN NEW ENGLAND WINDOVWLS6:� BRIAN DENNISON +- 26 ALBION.RD r = 3 LINCOLN; RI 02865 —S 54�- *; ! �,•,�' ti Update Address and return card.Mark reason for.change. srA zor,�adrr --I Address I]Renewal 1=i Employment Lost Card %:��m Tp,rnvneangrca�(l of(1ft rr:Fri/rr�J}!: .. '. - "s\ fGce ofCoosumer:\tfairs Xi Busiocss-RegWation Registration.valid for individual use only before the �OME IMPROVEMENT CONTRACTOR expiration.date.If found return to: Office of Consumer Affairs and Business Reyrulalron =Registration 173245, Types 10 Park Plaza-Suite 5170 Expiration g119/PA98`. " Supplement Card - "Boston.NLA 92116 - SOUTHERN NEW Ef,4 ND.WINDOWS LLC. RENEWAL BY ANDER6 47;'- ' BRIAN DENNISON • . 26 ALBION RD �—� _ LINCOLN,RI.02865 C.Ubdersecremry Not valid without signature The Conrtrronivealth of Massachusetts - Department oJIndrrstrial Accidents. I Congress Street, Sitite 100 Boston, iiL4 02114-2017 ivwiv.mass govIdia Workers' Compensation Insurance Affidavit:BuilderslContractorslEleetricianslPiumbers. TO BE FILED NVITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly LtaIlle (Business�Organization individual): il . . Address: ' - Z City/State/Zip: 1. J J�dv Phone#r: i Are you an employer''Check the aappropriate box: T}oe of project(required): 1.N I am i employer with 2'{J-t-mployees(full and/or part-tune)." 7. New construction 1 am a ah proprietor or partnership, have no employces working for me in 3. Remodeling anv capacity.(`o worker;comp.insurance required 9. ❑Demolition 3.F7 1 am a homeowner doing all work rnyseft:[No work8ff canp:insurance required.]' 10 0 Building addition =t.❑t am a homeowner and will b: hiring contractors to conduct all:work on my property. I will ensure that all contractors either have workers'compensation trsurance or are sole 11.0 Electrical repairs or additions proprietor.,with no cmpinyees. 12.]Plumbing repairs Or additions 5.17 1 am a-tncrai contractor and i have hired the sub-contractors listed on the attached sheet. 13_ Roo f repairs i hest sub-contractors have employees and have%vorlkers7 comp.insurance.' �/ 11. Other k/t n G d 1 n.❑We are a corporation and its officers have exercised their right of etemptiun per LtGL c. I(4),, p required.] r1af '.1 e"I -5 •trd:ve have no employes.(\to Lvorer'eau .insurance rcr uircd. r? � 'Any applicaric that checks box=1 must also till out the section belo:.showing their%workers•compensation policy information. Homeowner.who submit this affidavit indicating they are doing all:work and then!tire outside contractors must submit a new,affidavit indicating such. .Conmctors that check this box must attached an additional sheet showing.the name or-the sub-contractors and state whether nr not those crtdties have cmployees If the sub-contractors have employees they must provide their /tor era'comp.policy nambcr. u lam air etrrployei-that is providing rvorkers'cotrrperrsation insurance for wry enrployees. Below is the policy arid job sit,;- Insurance Company Name: �� f11 Policv j or Self-ins.Lie.7: � �.� D Expiration Date: jA Job Site Address. Z Rot rr Spvi 2c� City/State/Zip: 1'I Attach a copy of the workers' compensation policy declaration page(showing the policy number and expi ation date). Failure to secure coverage as required under tvIGL c. 1521,ti25A is a criminal violation punishable by a fine up to 51,500.00 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 DLA for insurance coverage venncation. 1 do hereby c•er• • inde`flee p lrs and penalties of perjruy that tire ittfor nrgtiorr provided above is true and correct. Signature: , Date: Phone 7 '� Official use only. Do trot write in this urea,to be completed by city or rowrr official. City or Town: Permit/License R issuing kuthority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: f SOUTNEW-01 UOLLINGER GATE(MMIDDIYYYY) � LIABILITY INSURANCE6/29/201.6 CERTIFICATE ®F Lt 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 ISSWINGINSURER(S),AUTHORIZED REPRESENTATIVE OR PRODU.6ER,AND THE'CERTIFICATE HOLDER. IMPORTANT: If the: certificate holder isan ADDITIONAL.INSURED,the policy(ies).must be endorsed: if SUBROGATION IS WAIVED,subject to Ithe 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 fieu of such endorsement(s)6 coNTACT PRODUCER NAME:. CoBiz Insurance,Inc.-CO PH ME AIC No 303 988..-0446 FAX No:(303)988-0804 Qenv®ram,CO 80202 nDDExt REss:CoBizlnsutanc" cob¢insurance.com INSURER( AFFORDING COVERAGE NAtC# n+suRERA:Continental Western Insurance Company 110804 INSURED INSURERS: Southern New England Windows LLC INSURERC: i DB/A Renewal by Andersen INsuRERD: . 26 Albion.Road Lincoln,RI 02865 INSURER.E i INSURER:F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW-HAVE BEEN ISSUED TO THE INSURED N WED.ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING:ANY REQUIREMENT, TERM OR CONDIMON 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. lJ EFF I PAD " LIMITS NSRLTR.I TYPE OF INSURANCE. I POLICY NUMBER MM(DD ;� X COMMERCIAL GENERAL LIABILITY INSD I IM1IVTCPA3136O8O I EACH OCCURRENCE 'S 1,000,00 ! 07/01/2014 OT/01/2017;PREMISES EaOcamence 13 100,0 j J CLAIMS-MADE 7 OCCUR 10�000 ( MED EXP(Any one person) I S i' } ;PERSONAL BADVINJURY S _ 11000,000 1 2 000 000 i GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE i S ` ik " i EEaaccieM iS 2,000,000 PRODUCTS-COMP/OP AGG POLICY L C' 2,000,000E OC MPLOE OTHER: COMBINEDINLE LIMIT tl 1'O00,001 1 AUTOMOBILE LIABILITY A ANY AUTO ; iCPA3136080 ' 0T/01/2096 07/01/2017i,_------ INJURY(Per person) .S.. ALL AUTOS OWNED i AUTOSULED �i BODILY INJURY(Per acddent)I a -� NON-0WNED PROPERTY DAMAGE S HIRED AUTOS I AUTOS ( (Per aerJdan! i, i ' UMBRELLA LIAR X OCCUR I I I EACH OCCURRENCE I S S,OOQ,00 A EXCESS LIAB CLAIMS-MADE! ICPA3136080 07101/2016!07/0112017 i AGGREGATE I S Aggregate i S 5,000,00 OED X RETENTIONS ®1 L:N: COMPENSATION I STATUTE I ERA YERS LIABILITY Y 1 N WCA3136081 107/01/2016 07/011201T E.L.EACH ACCIDENT $ 1,000,000 AIETOR/PARTNERIEXECUTIVE �LN I A I I - 1,000,000 EMBER EXCLUDED? E.L DISEASE-EA EMPLOYE S "tn NH) 1,000,00 ibe underEASE-POLICY L1MnON OF OPERATIONS belowred I { DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,AddMonal Remarks Schedule may be attached If more apace to+eyul I CANCELLATION CERTIFICATE HOLDER SHOULD.ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHOR®REPRESENTATIVE -- - ©t988-2014 ACORD CORPORATION. Ali rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD c9 ✓2-�7/t VE r Town-of Barnstable *Permito .— _ ®S ,n Expir nt from issue date I Regulatory Services Feel saxxsrnsi.E. � ` ` MAS& ,pp 03201 1639. Q 3 ZO�c Richard V.Scali,Director ice" J RFD MA'1 A i e. TOWN OF BARNSTABLE Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230. EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY 4� Not Valid without Red X-Press Imprint Map/parcel Number q (} Property Address 2 1 6 h Pj Z,l V_` []/Residential Value of Work$__ ��o ZO Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 1 r f�Iti t Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) l S'Z 5. Email: ` Construction Supervisor's License#(if applicable) �� orkman's'Compensation Insurance Check one: ` ❑ I am a sole proprietor ❑ Iiall the Homeowner M-fhave Worker's Compensation Insurance Insurance"Company Name v Workman's Comp.Policy# 1 Copy of Insurance Compliance Certificate must accompany each permit. ' Permit Request eck box) e-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 ❑ Replacement Windows/doors/sliders.,U-Value (maximum.32)#of windows #of doors: x ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required: *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. r copy of the Home Impr ve ent Contractors License&Construction Supervisors License is required. SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRES . Revised 040215 Client#: 33723: CAREF �a E-OF: LIABILITY INSURANCE �iCORD C`ERTIFICAT = _ TM THIS CERTIFICATE ISISSUED AS A„MATTER OF,,INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTiF TE-DOES NOT AFFIRMATIVELY OR NEGATNELY AMEND EXTEND OR ALTER THE .COVERAGE AFFORDED BY THE POLICIES BBELOW THIS CERTIFICATE;OF INSURANCE DOES NOTCONSTITUTE ACONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR<PRODUCER,AND THE CERTIF b, HOLDER." IMPORTANT If Ahe certificate holder.is an ADDITIONAL INSURED,the pohcAN y(les)¢mustbe-endorsed.If SUBROGATION IS WAIVED,.subjeet to W5 01Mteens arid the policy,certain policies may require an encJorsement A statement on this certificate does not confer nghts io the 4 _ G xcertlficete holder In lieu of such endorsement(s): y PRODUCER: NAME } - Pat Boss-.. WN He tihy Insurance Group Inc. PHONE 508,756-5159 FA't 508-751747 -51 PUliman Street N C No AIC No PIN ADDREss lTicates@herlihygroup.com y Worcester,MA":01606 U MER 508 756 5159 C STO ID� ~ : ;'INSURER(S)AFFORDING COVERAGE NAIL$ INSURED lNsuRERa Liberty Mutual Insurance Co. ,Care.Free Homes Inc INSURERS EastGuard'Insurance Company _ �39 Huttleston Avenue x INsuRER;c Safety Insurance Company �K Fairhaven,MA 02719 ON (NSURER-0 RF INSURE COVERAGES CERTIFICATE NUMBER _ REVISION NUMBER THIS`IS TO CERTIFY.THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE`INSURED;NAMED ABOVE FOR THE POLICY.PERIOD y INDICATEDN0TINITHSTANDING ANY REQUIREMENT,-TERM ORCONDITION OFANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH:THIS ' CERTIFICATE MAY BEi1SSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBEDHEREIN IS SUBJECT TO ALL THE TERMS IXCLUSIONS ANDCONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAYHAVE BEEN;REDUCED BY PAID CLAIMS. NN a IYFE OFINSURANCE B :::POLICY NUMBER MMIDD EFF_ _POp EXP LINBTS s GENERAL LIABILITY WE A BKS56134197, "W16,0910112016 EACH OCCURRENCE S1 OOO OWN 4 X COMMERCIAL GENERAL LIABILITY ' DAMAGE 7 PREMISES Ea occurrence $300,000 OR Q AIMS A9ADE OCCUR MED EXP(Any one person) $15 OOO x PERSONAL&ADV INJURY $1 OOO OOO � ry4 _ ti, � ��x . .. k S r GENERAL AGGREGATE $2 OOO O,OO x GEN L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG r $2 OOO OOO r P_OLJCY s:,PRO LOC wr: k $ AUTOMOBILEIIABIUTY 6213850 07/01/2015 07/01/201 COMBINED SINGLE LIMIT (Ea accident) $1 OAim ANY AUTO - �, 00 ' BODILY INJURY(Per person) $ ,ALLOWNEDAUTOS` s BODILY INJURY(Per accident) $ X SCHEDULED AUTOS': N PROPERTY DAMAGE ` X HIRED AUTOS (Per accident) $ za 0, RX NON-0WNEDAUTOS " $ r .. r . $ UMBRELLA LIAB OCCUR a EACH OCCURRENCE - $ Ni fi EXCESS LJ 4B CLAIMS MADE a AGGREGATE $ a DEDUCTIBLE $ RETENTION _=: $ " /2015 e rATu IER TH-sWMOSCOMPENSATON 45 09/01BILIT A CA CAWC6030 A Y/N ANY PROPRIETORIPARTNER/IXECUTIVEa y EL.EACH ACCIDENT $1 OOO OOO - �I a OFFICER/MEMBER EXCLUDED? NIA { (Mandatory ImNH)...: EL DISEASE-EA EMPLOYEE $1,000000 n-yes;describe under DESCRIPTION OF OPERATIONS below 5 _ E.L.DISEASE-POLICY LIMIT $1 OOO O0O 9%Ai Al DESCRIPTION of OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Rema►ks Schoilule M more space 1s requirod) k. RM CERTIFICA HOLDER'. CANCELLATION 10 Da s'for Non-Payment r # � SHOULD*ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, LLBE NOTICE WI DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. Building Department W> 367`Mairt Street AUTHORED REPRESENTATIVE Barnstable,MA 02601 w m 988 2069 ORD CORPORATION.All rights reserved a �"RACORD 25 2009%09 re g g isti( ) 1 of 1 The ACORD name and to o are ki"marks of ACORD { #S845901M84576..: JXC ti 4. Ile Commomvealth of-Vassachusetts Dequarament of 1•ndustrial Accidents ' - 1 Office of Investigations 600 Washblgtort Street f, ev y Boston,MA 02111 IVIVI}Mass.govIdirr NTorkers' Campensat an Insurance Affidavit:BuilderslCantractars/EIectticianslPlumbers Applicaimt InfarmatiGn. Please Print IegibI' Name(Busi mssforgariutionFlnt dnal�. �� � , Address I ; City/Stater: Phone 4`7 7�l Are yo employer?Check the appropriate btu: Type of project(required}: 1_ I am a employer with 9iU 4. ❑I am a general contractor and I 6. ❑New construction employees(full and/or part-time)-* 'have hires;the sub-contractors M/ 2.El am a sole proprietor•or partner- listed on the attached sheet - ,_, g ship and have no employees. These sub-contractors have g- ❑Demolition to aiid have waders' wot�g forme in any capacity. _ � 9- ❑Building addition [No vu orb 'comp.insurance cam-ttlsuranml required-] S. We area corporation and its 10_❑Electrical repairs or additions 3.❑ I am.a hameoumer doing all work officers have exercised their 1L❑Plumbingrepairs or additions f o workers' right of exemption per MGL -7 myself-[N. tong_ I .❑I�oofrepairs . insurance required_]1 c.152, §1(4h and we have no ' employees-[NO workers' 13_❑Other camp-insurance required.] *Anvappticanidustched1sboar#1— also Slloutthesectioubelowsbowingtheirworkers'campensa&npoEr-yinformation_ l omeoavaers who submit this dfidatrt Micadng tbay are doing all work ant tbea hire outside contractors aamst submit a new affidavit indicating sacb. fCantectors$oat check This boat must attached an additional sheet shoaeing the name of the sub-cnntracwrs and state whether or not those entities bsvg employees.Ifthezub-caata=isbaveemployw%thejrn=srprn-idetheir workers'rnmp.policynmaber. I am att errtplayvr flerrtis prmariitt warkers'cotrrgpwa rdan insurance for my emplayees Below is fitepoticy and job srte informadom , Insurance.Company Name: t 'Policy#cr Self-ins.Lic.#: Expiration Date: < / Job Site Address: ,Z %1v&a f rll�- � City/State/zrp: t ; Attach a copy of the corkers'coampensationpolicy declaration page(shoving the policy number and expiration date). Failure to secure:coverage as required.under Section 25A of MGL c 152 can lead to the imposition of criminal penalties of a fine up to$1,500 00 and/or one-year-imprisournpak as well as trail pertalties.in the form of a STOPWORF ORDER and s fine of up to$250-00 a day against the violator. Be advised that a copy ofthis statement maybe forwarded to the Office of 1MVestrgati0n9 a DIA for insuranc vTTrage vedficatiam- I Ao Irene c fi�r a the is t ury�f)tatflte irrfotnnafionpt m i&d abmv' 6 u8 and correct Date: v Phone ik Official use tartly. Do not write in this area,to be completed ap,cio or town official City or Town: Permit!kense# Lssuing Authority(circle one): , 1.Board of Health 3.Building Department 3.Cityrrown.Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other• Contact Person: Phone it: 6,. Information and Instructions Massachusetts Gc=al Laws chapter 152 requires all empIoymz'to provide workers'compensation for their employees. Pmsrumtto this sfmute,a a.eplayse is deemed as."_.every person in the service of another under any contract of hire, express or implied,oral or wriftnm- An err plvyer is defined as"an individual,paztnership,associab one corporation or other legal entity,or any two or more of the foregoing Peed in a joint a tcrprise,and including the legal representatives of a deceased employes,or the receiver or trustee of an individual,partnership,association or other Iegal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occ¢pant of the - dwwelling house of another who employs persons to&mar t=z ce,construction or repair work ou such dweIiing 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 is the commonwealth for any applicant who has not produced acceptable evidence of compliance with the iasnrance.coverage required." Additionally,MCrL chapter 152, §25C(7)states-Neither the commonwealth nor army of its political subdivisions shall enter into any contract for the perfomaaace ofpubho woi3c until acceptable evidence of complianeewith the insurance._ reTLdrements of this chapter have keen presented to the contracting Mithozity" Appl3c Mts Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your sitnation and,if necessary,supply sub-contractor(s)name(s), addresses)and phone numbers)along with their cerffficate(s) of insurance. Limited Liability Companies(LLC)or Limited Liabr-Iity Partnerships(LLP)with no employees other than the members or partners,are not requied to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is regnired. Be advised that this aflidayh maybe submit-d to the Department of Industrial Accidents for conf>zmation of insurance coverage. Also be sure to sign and date the affidavit The,affidavit should be retrmmed to the city or town that the application for the permit or license is being regnest A not the DePar[meaf of Industrial Accidents. Should you have any questions regarding the law or if you air required to obtain a workers' compensation policy,please call the Department at the mmniber listed below. Self-mitred companies should enter their self-;r,rrr a ce license number on the appropriate line. City or Town Officials . f Please be sine that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in.the event the Office of Investigations has to contact you regarding the applicant. Please be sur-e to fill in the peffiit/licrose number wl ch will be used as a reference number. In addition,an applicant that must submit multiple pemNlicensa applibations in any given year,need only submit one affidavit indicating current policy in�nnation(if necessary)and raider"Job Site_4ddrese the applicant sho11Id write"all locations in_' (city or tiowa)_"A copy of the-affidavit that has beea officially stamped or marked by the city or town maybe provided to the ' applicant as proof fad a valid affidavit is on file for ft>jan-e permits or licenses A new affidavit must be filled Olt each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial ventage (Le. a dog license or permit to bum leaves etc.)said person is NOT reqaired to complete this affidavit The Office of Investigation 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 Deparianenfs address,telephone and fax nmober_ The C_GMMMWVIattIr of Massachimfis ' D epattment of Industdal Accidents �e of�.�e�Cig�tZop.� 600.WasbiVGIL St ;Qostml�MA Gil I I Fax#617-727 77� Revisett424U7 ww .ma4;-gavIdia NOV. ID. LUI y,UUAIVI NO. 7)O( r. L OFFICE-(608)9974111 �i MA_Builder's Lic.021330 FAX:(506)997-1297 CARE F != E Ham6 Improvement TOLL FREEL 1-800-4014111 g p Inc. Contractor%License WrcBSITE: Om es 11 LLB! 9100603 MA. www.carefraehOln escompany,aam 239 HUTTLESTON Alit,(RT 6) • FAIRHAVEN,MA D2719 #16179 R-i. NAME 1 ne B _ DATE 818115 14 a•n ADDRESS 223imtda Road.0 ryilfe.MA Zip CODE Wsrrf So ft ADDRESS OF JOB 222 Road, .MA HOME pH: - S DELL PH, 1'7— / c 7 EMAIL: rnliancar vprizan net _ JOB DESCRIPTION r Remove and Re lace Existing Roof Tear Of exlsling goof (up tp 218�yets and haul away y "' Installa t ec ura t g es as o —tnsta'M$ While 8rip edge along gnttk5lall GAF er6 , ner-tiGh:FF@IesIn —Justalt �.5.lbs-F�►>:.�apea " nd�rallelts Install GAF7imbedi0g), eTime Shina _ InslaA Ridge vent Alan eak Ste Flash Ctimin�s —'"'�"' Install New Vent Boats and Collars on all exfsting Vents - ---- Inmail Hip afid Ridge Cap f-90 t pFN6•eveF*Ill- w, _ �CiiiU.71p Fxletin9 C:��Hnr llalnndl C�41em _ ,.• Install New-K'3NhiW K"Stvke Getters and do uts t�lh Hidden F�suserg�nd .p Ahrm t PAF t�•,a �tX [�y5te!n Total Cosl:S 5,925.01) (includes 25%discount) '�ota Combined roofing an gutters 18,945_UQ — --- ......... Price efr+ttoti -fin ►rrjrtd uWmft"1TevL11)I_' ta111- - I�dH f!�BFl�fi�H98V2I of an a.,b.e_:...-_._c___1•afn9£Qumpslem -_ tSweep b ter�ov�adl ails aad fas papa 1 of 2 Nov.,16. 1015 9; 01AM No. 5561 P 3 x Scheduled Start Scheduled Completion A.Replacement of missing or rotted lumber is not included unless specified. B,All start R completion dates are approximate and could change due to weather c riditions. C.Stripping of ro6F includes removal of up to two(2)layers of shingles,each additional layer to be charged Q $,74 ft?_ D,Replacement of rotted roof boardslplywood to be changed @ $3.50 V. E.Exisfing chimney Dashing will be reused;replacement,if necessary,is not included. F.Care tree Homes;Inc.fs not responsible For moldlmildew conditions that are pre-existing or a result from leaks riot brought to the attentoo of C.FH.,Inc,promptly- The Company hereby proposes to furnish labor and material to complete the above work for the amount herein,Fulfillment of this order is contingent,however,upon the want of strikes,fires and natural disasters,the ability to obtain materials,or any other condition beyond the control of the Company. Cost of Proreet S 18,945-00 _ PAYMENTTERM4 Upon Completion 1.You,the Owner,may cancel this transactioni at any time prior to midnight the third business day after the date of this transaction. Z.You,the Owners,agree to pay any and all expenses incurred by Care Free Homes,Inc.in collecting money due under this contract and enforcing the terms of this contract,including but not limited to,reasonable attorney'*fees,interest grid court costs, DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES CARE FREE HOMES,INC. ACCEPTED, .� Buyer acknowledges Owrier ` - `✓• 7G BY;e, reoeipt of tuity mmpieied - GAR REE HOMES,INC. copy ofihis Agreerrenl Owner Ail contractors ands ntractors shall be registered by the director and any inquires about a contractor or subcontmdnr relating to a registration should a directed to: Director,dome improvement Contractor Registration One Afturlon Piace,Room 1301 Boston.IVIA O't108 Tel:(617)727$598 page z or2 • a H � Vhe Wpa�nrreonwealM,VbI&Ijac eoe I - ffice#Y oatsumerAffalrg• Misipess Rt ulatr ie i yLi.P- or�-*lost*ibn Va��t� Or i lyf3iYiduP Useionl ME IMPROVEMENT CONTRACTOR.. before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation i egistration- 100503TYPR 3 10'Park Plaza-Suite 5170 VExpiration,_6 9/2016 Supol pentBoston,MA 0211 s. �� CARE FREE HOMES It`fr�� ��al 11` I 71) DANA PICKUP JR V i 239 Huttleston ave FaithaVen,MA 027. -r Undersecretary Not1d4.9�0. .:Sig uT;: - 9LOZ2Z/£0 ,• jauctiss wok 614a0 VL1i aansgne3 fed aoasaialnH 6£Z VxVG 8ZZ96t-S0 :asuaol- josi,i:radnS uopjnlasuo3 Sp,41' 'pL S4Pue uol;eln6a. 6u/ESF ng�o„p�eo� . AlaleS b!Ignd to;uawpedaa- s 'asn Besse 1 S. CAPE INSULATION Z "EPP9 AN IIYY4Y4Y1 Sf.NIffS SPRAT fOAN SYSPSNPSP p � g -� - YArts 4urts4s ,nsuulwn cqunoi +6 jt j x o 1-800-696-6611 Town of Barnstable 2,2,11 Regulatory Services Building Division .' 200 Main St , Hyannis, MA 02601 Date,- Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. perforated &. completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute (BP•1) inspector. All work preformed meets or exceeds Federal & State Requirements, Property Owner Property Address Village XAM4a a- NA 1Say It o �K�ricv�`�e I11SUlation Installed: Fiberglass Cellulose R-Value `Restricted Unrestricted Ceilings L Slopes Floors Walls Sincerely Hie L Cas y Jr, President i' Cod .I elation, Inc. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 070 _ Application #. / q S f! Health Division Date Issued Conservation Division Application Fee 6 Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH — Preservation/ Hyannis Project Street Address ,r � �� �/�✓d/2 lSb� /z d Village Owner 14 agrlee lZe Address .� Telephone Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Typef�-LIIW.17_1o� Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family I Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes 21(No On Old King's Highway: ❑Yes G/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 RoDm Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other - Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood foal stov.Pr ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size — Barn: ❑ xisting c@ nevg? size Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size — Other: {' Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan.review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name g:� 46ti_/ e Y' Ism' Telephone Number — Address dX",Z// �! License# /6 Z9 9 Home Improvement Contractor# /� 5 Worker's Compensation #1/1:�/�TD��9GJ ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE `a FOR OFFICIAL USE ONLY c APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER :k DATE OF INSPECTION: 0FOlJ1VDAT.ION FRAME -,INSULATION..«n�. :- FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT '' ASSOCIATION PLAN NO. f OWNER AUTHORIZATION FORM (Owner's Nam ) owner of the property located at (Property Address) CID a 1 3 (Property Ad ess) t hereby authorize 0 CO A CA. I N (Subcontra;1SE or) an authorized subcontractor for Engineering,to act on my behalf to obtain a building permit and to perform work on my property. Owner's Signature x Date T .; The Commonwealth of Massachusetts + Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 ` - •www,mass.gov/did ' Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organizadon/Indivi Address:l City/State/Zip: �-f- Axe you an employer? Check the appropriate box: [] I am a am a employer with 4. •general contractor and I Type of project(required); � employees (full and/or part-time),* have hired the sub-contractors 6, ❑ New construction 2.❑ 1 am a sole prbprietor or partner- listed on the attached sh"t, 7, ❑ Remodeling ship and have no employees These sub-contractors have g• ❑ Demolition working for me in any capacity, employees and have workers' [No workers' comp, insurance comp, inrance,t 9, Building addition su required:] S. ❑ We are a corporation and its 10,❑ Electrical repairs or additions 3,❑ I am a homeowner doingall work officers have exercised their . 11.❑ Plumbing repairs or additions myself. [No workers' comp, right of exemption per MGL 12 ❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no / 3a.❑ I am a homeowner acting as a employees, [No workers' general contractor(refer to #4) comp,insurance required,] *Any applicant that cbecks box#1 must also fill out the section below showing their workers'co i t g mpcnsaaortpolicy information. Homeowners who submit this affidavit indicating they arc doing•all work and then hire outside contractors must submit a new affidavit indicating such, I tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employe",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: ,I /-lw/ l—�� Policy#or Self-ins. Lic.#;_/2C,9a1 y � Expiration Date: Jla Job Site Address:� ��, � / p6y ,�� �etii��Y`��i�'ity/State/Zip: 7 - Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date): Failure to secure coverage as required under Section 25A of MGL c, 152 can lead to the imposition of criminal penalties of a fine up to $1,500,00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250,00 a day against the violator. Be advised that a copy of tbis statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify un the pains and penalties of perjury that the informatlon provided above is true and correct Sigpa Date: Phone'# O,Q9eial use only, Do not write in this area, to be completed by city or town ofcia' City or Town; Permit/License # Issuing Authority (circle one); I. Board of Health 2. Building Department 3, City/Town Clerk 4, Electrical Inspector 5. Plumbing Inspector 6, Other Contact Person: Phone#: CAPECOD-27 KLIGETT CERTIFICATE OF LIABILITY INSURANCE 0ATE(MMIDDnYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RI12014 GHTS 611312014 UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed, If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement, A statement on this certificate does not confer rights to the certificate holder in lied of such endorsement s). 'RODUCER ogers E,Gray Insurance Agency, Inc, NCAMeAcT Barbara DeLawrence 34 Rte 134 PHONE outh Dennis, MA 02660 IAIC No ExtL_ A/C No; 877 8I6.2156 ADDAIES °bdelawrence ra ers ra ,con INSURERS AFFORDING COVERAGE _ NAIC N IS RkA INSURER A;Peerless Insurance Company INSURER a:COMMERCE E INSURANCE COMPANY _ Cape Cod Insulation Inc INSURER Ca Evanston Insurance Company 1 18 Reardon Circle South Yarmouth, MA 02664 INsuRERD;ATLANTIC CHARTER INSURANCE GROUP INSURER E; - O BRACES INSURER F; T — CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NREVISION A 0 p A NUMBER: THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS C R;TIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, E C USIONS AND CONDITIONS OF SUCH H POLICIES,LIMITS SHOWN MAY-HAVE BEEN REDUCED BY PAID CLAIMS. Z — TYPE OF INSURANCE POLICY EFF POLICY EXP X COMMERCIAL GENERAL LIABILITY POLICY NUMBER M/DD/YYYY M / I — LIMITS S 1 CLAIMS-MADE X OCCUR CBP8263063 EACH OCCURRENCE C-� 64/01/2014 04/0112015 TO�ENiL -- $-- 1,000,000 1 PREMISES(Ea occurrence) _ $ 100,000 — _..G. . _ ----- MEp EXP(Any one parson) $ -_—^61000 G N'L AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURYT_ $ 1,000,000 POLICY ha PRO- JECT LOC GENERAL AGGREGATE $_ _2,00.0,000 OTHER PRODUCTS^COMP/OP AGG $ 2,000,000 AUTOMOBILE LIABILITY — $ —' Y COMBINED SING E LIMIT ANY AUTO 14MMBCKVMK 9K-11 danl $ _ 1,000,000 04/01I2014 04/01/2016 BODILY INJURY(Per person) $ " � ALL OWNED X SCHEDULED - AUTOS AUTOS HIRED AUTOS X NON•OWNED. BODILY INJURY(Par accident) $ AUTOS ? PROPERTY DAMAGE Per accident $ X UMBRELLA LIAR X OCCUR $ EXCESS LIAR_ CLAIMS-MADE XONJ453514 EACH OCCURRENCE $ 1,000,000 DED X RETENTION 10,000 04/01/2014 041101/2016 AGGREGATE WORI(ERS COMPENSATION Aggregate AND EMPLOYERS'LIABILITY OTH• qNY PROPRIETOR/PARTNER/EXECUTIVE Y/N WCA00625904 STATUTE ER,_ OFFICER/MEMBER EXCLUDED? N/A 06/30/2014 06/30/2015(Mandatory In NH)It t E.L..EACH ACCIDENT $_ _ 1,000,000 0Y SCes,describe underRIPTION OF OPERATIONS below E.L.DISEASE•EA EMPLOYEE $ 1,000,00 , i ! E.L.DISEASE POLICY LIMIT $ 1,000 QQQ RIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached It more apace Is required) ero Compensatlon Includes Officers or Proprietors, ;lot al Insured statue Is provided under the General Liability and Auto Llabiilty when required by written contract or agreement with the Certificate Holder, TIFICATE HOLDER CANCFI I ATIr)N L ( 1,k r 1, 4 Massachusetts -Depatytm`p'nt of Plibliic Safety � Ap2rd of Building Regula;eons nd Standards I CunstnictionSupcnisul License: CS-100988 pfl� 4 �k 11-1ENRY .R CASS � A •1 8 SI-LED,ROW WL,ST YARMOU'1'11 T1r I � ✓,, , J>,,6G�-,'. „ "'�' Expiration Commissioner .y 11/11/2015 'l��s�uz ("�%���, 1�Cz'yy7/YyLGLy1rG C/�L t;v ���/ .�.� •����' %, :�,, . ', __ _.::� yea- ` � ��a:�.�•�c������F��l�� r Of'Iice of Consumer Affairs and Business Regulation 10 Park Plan Suite 5170 Boston,.MassachLjsetts 02116 .I-Iome Improvement Cgw�t�ac�tor Registration Registration; 153507 Type; Private Corporation ^if rr Expiration; 12/15/ TIFF 233831 CAPE COD INSULATION, INC HENRY CASSIDY :::I:::, <;�:.::...: _ _....---•._.__._............................. . ...... ...__... • a.' 18 REARDON CIRCLE S0. YARMOUTH; MA 02664 ' e U dato Addross Sind roturll clird, tyl irk rca.ion I'or l'haiigC, t , Adtlross Renewal EJ Elliplo,ymcrlt Lust Card � '�i4 is�l(�LGNl.•Y/l,t.r/6lUtl[lt/l!'G G�I�Z("((GdJttCf(CGJ(4C� - � .. - fir. Utrice"I'Consanlar Affairs�It Business Rcgulnriu„ License or registration valid for individul usu only ? ;.FOME IMPROVEMENT CONTRACTOR beforu the expiration data. It'found rufurn to; agistratton; 153,�67 Type; Office of Consumer Affairs and Business Rogullition Lxplratlon: 12/170/2014 Private Corporatioll 10 Park Plaza-Suite 5170 'r? ' f` .:.:• Boston;MA 02116 t(OD INSULAI'LON,;;10JCj. , IIRY CASSIDY • `I ,. !tA''DON CIRCLE r YA'NIOU11-1, MA 02664 Glndcrsecreta — — - - y of Yal' withu i [lilt Ile , "b Assessor's ;map;, and lot'number .v ; ......... �� Ga�� 7 1 c. 5Er'Tl•C SYS t Kyl 1, r ` R.f ' GGG�1,Q r f INSTALLEn lid C(� LIA�lC� ewage^Kermit number ..� ,ARTICLE :II STt''�T r - _ - •, f KITH � TOWN �+ SAN ITARY:CODE A a� THE T , TOWN OF BARNSTATBIK' .o BARISTAEILE, O '� MP' UILDING INSPECTOR ;r.. . t7' Ct t-� v rJ Cr Aj- APPLICATION'FOR PERMIT To ..... .. .. .......... ' TYPE OF CONSTRUCTION .. I......:�.���. . . Tf7M.�.� !!v. .�� .........:..... iru ...... ................ 745.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a-�p(ermit according' to the fall owing information- Location ........ ....... ................................................................. ........................ ProposedUse 54 ... �1� --. . . ................................................................................................. ZoningDistrict .........................................................................Fire District ................................:............. Name of Owner . :. ...Address ............ � .....M.!.......... �............. Name of Builder ... ...............:.....Address . .................................. Name of Architect ........ Address ....................... ............................ ...............eoV-?� Number of Rooms ..........tlly (`(........................................Foundation .......0 ....... Exterior .........VIf .................................... .Roofing, ........................................................ Floors. ...... ..............................................................:.Interior ......%. ................. Heating n !U.'"?!'........:.....:.........................................Plumbing .......rs.. ..................... Fireplace ............. ..............................................Approximate Cost ...... ............................................................JC 12. Definitive Plan Approved by Planning Board ________________________________19________. " Area ....._.................f......._..... Diagram of Lot and Building with Dimensions Fee .. SUBJECT TO APPROVAL' OF- BOARD OF HEALTH , 1/0vel Ila ti6 hA Gon(,eq�ecf I hereby agree to conform to all the Rules and Regulations of t e To n of Barnstabl re arding the above construction. Name .................................................................................. Leary, Mr. & Mrs. Joseph 180 ��` �,� add deck to PermNo , for a: .................................. <. single fainiay dwelling Location .............2-2 Harrison Road...............•...• -N r......... ... .Centerville Mr....&..Mrs. Jose. h' .Lear......... ._,_: _ � �• � -� - Owner .... P Y _ Type.of Construction ........frame....................... ............... ...................................... ..................... g of .... .� ... ....... ,. Lot ............. ..... ..... Permit Granted�.......De btex...I: ....19 75 —r F Date ofilnspection .�.. 77.... .77......... . 19 - Date Comple ec! t..�O ..................... "J 9 iA s -PERMIT"REFUSED ...................................................... �19 ........................................ ' .............. ....Yam.................... ...... ........ t - Approved .............................................. 19 4/................................................................... �.. y .................... ......................................................... - . b Assessor's map'and lot number l wage Permit number .. ��^ O. THE r TOWN OF, BARNSTABLE BA"STAKE, i - °o D AMB 39- BUILDING , INSPECTOR APPLICATION•FOR PERMIT TO .. f.t��.f� ................ ..".. ..�?.....�.1�....... ....�l.t?............. ................... • TYPE OF CONSTRUCTION !]K-/. -)WA,I/C ; 6'JGt :� / U t ..... .. . ................... - o:V....... TO THE .INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: E Location .....2 ........��► .......!•`i... ...c.................:........ Lr-�' ..:.............�.......... ProposedUse ...�? �... !. ::.....` .!( ... i ....... ................................................................................................. ZoningDistrict ........................................................................Fire District .........�...p.............`....p... .......................................... M����4-f in�SYl % ...Addressl�Aa17 N FT//.• ZV7� Name of Owner ......I... ....... ... Name of Builder *- .P ;��� ...................Address -;q CAt���,�1L% A" `� �71�'l A�� (YA E �G1-& y ................................... . ..............;.................... Name of Architect ....... �' a................................................,115��'� Address ............... T `� ................ ............,........... p Number of Rooms. �br► K'.......................................Foundation ....... � ................... .... .................................... ............... Exterior 1 ...........................................................:goofing .......... .......... ..................................... Floors ..............................................Interior Heating ......................................................Plumbing ....... Sv..!..?.............................................................. Fireplace .............► :-''............................:................Approximate Cost ...... . ?" �_. Definitive Plan Approved by Planning Board -----------_______-----------19--------. Area f if,�............................. Diagram of Lot and Building with Dimensions Fee . �..................:.......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH t . e 4aVae Al , YAOi4 '� t- f �on�Ied --- � r I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ................................................................................... Leo Z. ,, Mr. & Mrs. Joseph A A=229-70 No 1800" add d k t ................. Permit for .................t....... single family dwelling ............................................................. ...... . ....... A...d dwelling I c .A k .2 t 2 9 70 0 ... ..... . ...... 22 Harrison Roa Location ............................................... . .............. Centerville . .............................. Le ry Owner ...Mr.....&...Mr.s.....Jo.seph.........Leary .... .. .... . . .... . ...... . .....*...... 'f / ., Type of Construction ............Tp!��..................... ............................ Plot ................. ....... //Lt ................................ Permit Granted ....... 1 ac lb er.. ...........19 75 Date of Inspection ........................ ..........19 Date Completed ......................................19 PERMIT-REFUSED .............. ................................................ 19 .......... ......................... ............................................ . ...... ....................................................................... ............................................................................... ............... ............. ..... ................................. 7k Approved ............................ ......... 19. ............................................................................... ................................................................................ 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IT IS THE RESPONSIBILITY OF THE GENERAL CONTRACTOR TO VERIFY ALL EXISTING CONDITIONS AND -------------- DIMENSIONS AS THEY RELATE TO NEW CONSTRUCTION. REPORT TO THE ENGINEER ALL OBSERVATIONS STUD WALL AND ANY DISCREPANCIES BEFORE PROCEEDING WITH WORK. - -- -- ------ ------ ------- BELOW(TYP.) 3. IT IS THE RESPONSIBILITY OF THE GENERAL CONTRACTOR TO PROVIDE FOR A SAFE AND EFFICIENT METHOD OF SHORING AND/OR BRACING THE STRUCTURE DURING ALL CONSTRUCTION PHASES. SUBMIT AN OUTLINE OF PROPOSED PROCEDURE TO THE ENGINEER BEFORE CONSTRUCTION COMMENCES. ---------- STUD WALL 11. DESIGN LOADS BELOW"P.) 1. FLOOR LIVE LOAD(PER IBC 2009) EXIST.WOOD ROOF a. DWELLING AREAS...................................................................... 40 PSF T RUSSES (TYPICAL) -- b. SLEEPING AREAS...................................................................... 30 PSF ---- -- A RIDGE 2. ROOF LIVE LOAD(PER IBC 2009) a. GROUND SNOW LOAD,Pg ......................................................... 30 PSF* b. SNOW EXPOSURE FACTOR, Ge................................................ 1.0 a c. SNOW LOAD IMPORTANCE FACTOR, Is................................... 1.0 vi d. THERMAL FACTOR, Ct................................................................ 1.1 ------------------------ MODIFIED FOR SNOW DRIFT PER IBC 2009 EXIST.WOOD 101 HEADER(TYP.) r -it UJI 3. WIND LOAD(PER IBC 2009) - ------in, a. BASIC WINDSPEED(V)............................................................... 110 MPH 21 b. WIND LOAD IMPORTANCE FACTOR, Iw..................................... 1.00 7r RIDGE 9: co I c. WIND EXPOSURE CATEGORY................................................... c --------------al d. MAIN WIND FORCE RESISTING 21 SYSTEM DESIGN METHOD................................................. METHOD 2(PER ASCE 7-05) ujl e. COMPONENTS AND CLADDING LOADS.................................... PER IBC 2009 EXIST. STUD WALL BELOW i/l TO BE REMOVED(TYPICAL) A STUD WALL BELOW(TYP.) (SEE WALL REMOVAL NOTE) -------- ............ ...... ....... .......... ...................... ...... .......... JAMIE L. yG BOULAY CIVIL No.,50330 EXIST.WOOD /ST HEADER(TYP.) AREA OF WORK Sr OIV4 SHOWN ON PLAN PARTIAL ROOF FRAMING PLAN I- IMPORTANT WALL REMOVAL NOTE SCALE: 4"= 1-0" CONTRACTOR SHALL FIELD VERIFY EXISTENCE OF CONTINUOUS NOTES: TRUSS BOTTOM CHORD PRIOR TO REMOVING WALL DOCUMENT CONDITIONS DISCOVERED AND REPORT FINDINGS TO ENGINEER I. COORD.ALL FINISH DETAILS WITH EXISTING FIELD CONDITIONS. PRIOR DEMOLISHING WALL. IF BOTTOM CHORD IS FOUND TO BE 2. COORD.ALL DIMENSIONS WITH EXISTING FIELD CONDITIONS. DISCONTINUOUS AND/OR ANCHORED TO WALL,THEN DETAILS KEY PLAN 3. COORD.ALL FLOOR ELEVATIONS WITH EXISTING FIELD CONDITIONS, SHALL BE PREPARED BY THIS OFFICE TO PROVIDE NECESSARY 4. (V.I.F.)-INDICATES DIMENSION/CONDITION TO-VERIFY IN FIELD" BEAMS/POSTS TO SUPPORT DISCONTINUOUS BOTTOM CHORDS I NO SCALE SHEET CONTENTS: AS SCALE: NOTED SHEET NUMBER RIZZO/BENSER RESIDENCE ConsulUng DATE: 03-20-2016 22 HARRISON ROAD .0 . SftftuWE.*="&pmjed Management Sff4m DRAWN BY: si CENTERVILLE, MA 02632 NmtmQx"Sft0-Fa0RkffMA0V20 JLB Ph:(500)567-0113-www.bou*=wmgcom PROJECT NUMBER: 2016-0143 ] f BUILDING DEPT MAR 2 4 �416 '-OWN �F.gggNSTRS�E it l TOWN OF BARNSTABLE DA..V R CARD aeman 1582 Main Street East Dennis, MA 02641 ' Designed for Rizzo/Benser Residence 22 Harrison Road Centerville..MA ph.508-619-7384 fx.508-619-7385 9 06tt /(, 52Wtl 312�. 224,t .w..:.,q.•,.ri��:.ri�r.<.iw,rw.'•af�°�'vu?sekrf-.x: ,..-,. ,r+ti.r�. ,.s _,k xr:C.n_U�'^-eL>+k-r?`.*�";�'r `:.Z?;T?a8 e<... ,ss;:3 r.-4-.,v._ -.''- . -� i. V^ .-.%� �. 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DESIGN•BUIW•INSTAU DESIGNED BY: - fine h+tcbeo and bate,cabinetry COOK TOP HOOD EMU Phom 30s:bi9. 84 Fax sos:bi9. ss DATE: APPROVED BY OVEN COMPCTR _ S1NK david@davidricarfiidesigns_com•davidrtardidesigns:aom` - . LEGEND s� `> 100' BUFFER ZONE ', C), / \ :'. tit •. EDGE OF WATER FLAGS ADD ARTICULATING RAMP AS NECESSARY TO MEET I ` GRADE , ! LAMP POST Q,U BUOYANCY CALCULATION WATER SHUT-OFF FLOATING DOCK CONSTRUCTED WITH 2" X 8" FRAMING AND 5 4" X 6" " " " GAS VALVE ------ � �; SMTrSDA�.F RD. S.l r, / 24 X36 X16 FLOAT (2 F COMPOSITE DECKING IS CALCULATED AS FOLLOWS: PER GANGWAY SECTION s:ns<s-�;v;i7.-f ----"`� `••� , DOCK: 8X12=96 SF X 31 LBS/SF=2976 LEIS SEWER MAN—HOLE USE (6) MODEL DF-24036-20 FLOATS (24"X36"X20" WITH 524LBS OF UTILITY POLE BUOYANCY EACH) BY DOCK BUILDER SUPPLY (HTTP:WWW.DOCKBUILDERS.COM) WHICH YIELD A TOTAL BUOYANCY OF LOCUS MAP 3144 LEIS OR USE EQUAL FLOATS ® N90'00'00W CATCH BASIN N.T.S. �._ 42.74' GANGWAY: 3X20=60 SF X 25 LBS/SF=1500 LEIS i ELM TREE ��aoNMFN Green Seal Environmental, Inc._4 Y f USE (4) MODEL DF-24036-16 FLOATS (24"X36"X16" WITH 442LBS OF �X' Est. � 114 State Road, Building B BUOYANCY EACH) BY DOCK BUILDER SUPPLY h z GREEN 19Sagamore Beach, MA 02562 (HTTP:WWW.DOCKBUILDERS.COM) WHICH YIELD A TOTAL BUOYANCY OF PINE TREE Tel: 5 1768 LEIS 08S OR USE EQUAL FLOATS o m ( )888-6034 1997 Fax: (508)888-1506 I (0 OAK TREE � www.gseenv.com I BUSH These drawings are the property of the Design Engineer, Green Seal 3—FT SPLICE PLATE Environmental, Inc. Unauthorized reproduction for any purpose is an WITH 5/8" GALV. CARRIAGE infringement upon copyright laws. Violators will be subject to prosecution. ` BOLTS, TYP. BOTH SIDES FLOWER PLANTINGS Dimensions are as indicated. Use of this plan constitutes acceptance of terms and conditions set forth in *BOLTS ARE REMOVABLE accompanying project documentation. TO FACILITATE SEASONAL IV MAIL BOX DOCK REMOVAL It is the responsibility of the user to confirm discrepancies with the Engineer ',.... prior to use. ` l POST & RAIL FENCE REVISIONS NO. DATE COMMENT VINYL PICKET FENCE L. LOT 9 I 17,500 S.F. 1\:N1111111111UIIIIIIIIII �► i. 5N, CHAIN LINK FENCE 2"X6 PT FRAMING s� + I ,�r`.�alr.l��aal"11;.. •`,� 1�1 ,�.1,,,,,,� .o o STREET SIGN \ \ i.u,lauuanua I-I 1 I ,r; au ua,m"°",, + - GENERAL NOTES: LOCUS: #22 HARRISON ROAD, BARNSTABLE, MA 02632 0 1 OWNER: LORRAINE RIZZO ��ai ADDRESS: 163 BEECH STREET, ROSLINDALE, MA 02131 010 ro° 5/4X6" COMPOSITE r J DECKING, OR EQUAL �.•o� > Yi,I_l \ ao 0�5` l DEED REF: BOOK 10123 PAGE 342 e o�'too, �� ' 6" TO 8" ROUND \ \ ;niuniuilulul,lll,llw \� ` ` ,1,11111111 - ATTACH GANGWAY TO DOCK PT TIMBER PILING, PLAN REF: BOOK 114 PAGE 97 WITH (2) GANGWAY TYP OF 5 STRINGER HINGES BwmMablO Bldg.AQPt. r 10" GALV. LOOP STRAP W/ J" GALV. THROUGH BOLTS. LA ";.1,, ;r r;' t is I\ • i 'irJi l i ' i 1 - � 1 l ;`, O c' '" ' LOCUS: 22 HARRISON ROAD o�� MAP 229, PARCEL 070 2"X8" PT FRAMING 24"O.C. vF CAD 5 F6 in ALL DISTURBED AREAS \ lW. BARNSTABLE TO BE RESTORED TO 4 EXISTING WOOD DOCK TO BARNSTABLE F - BE REMOVED MASSACHUSET' 1 S CONDITIONS (TYP) �.: FLOATING GANGWAY ' (SEASONAL) PROPOSED EROSION F' 5/4X6" COMPOSITE NOTES CONTROL (TYP) DECKING, OR EQUAL 1 FLOATING DOCK p (SEASONAL) 1. DOCK PILING TO BE INSTALLED BY 5. ALL PRESSURE TREATED LUMBER JETTING OR DRIVING AND IS SHALL BE PRESERVED WITH v PERMANENT. AMMONIACIAL COPPER QUATERNARY g �' ---� PREPARED FOR: (ACQ) OR APPROVED EQUAL. LIMIT OF WORK 2. ALL HARDWARE FASTENERS SHALL BE GALVANIZED OR STAINLESS 6 THIS PLAN IS `0 BE USED FOR STEEL p /� -y ONLY, LO RRA I 1 p V E p 111%LO 3. DOCK AND GANGWAY ARE FOR PERMITTING ON LONG POND SEASONAL US ONLY ANNUALLY 7. WETLAND RES"'URCE AREAS INSTALLED IN APRIL AND REMOVED DELINEATED B" GREEN SEAL 422 HARRISON ROAD • DOCK PLAN IN NOVEMBER. ENVIRONMEN7t+_ LLC ON OCTUBER 2, 2A7 BARNSTABLE, MA 02632 SCALE}"=1' 4 THUS PLAN UNDERGROUARE ND UB SEDSUPON SHOWN ON VISIBLE ABOVE GROUND UTILITIES 8• HORIZONTAL 0".TUM IS BASED UPON �� VIEW DRAWING TITLE: AND RECORD INFORMATION OF PL 114 PG 97 IN FEET. VERTICAL BELOW GROUND UTILITIES AND ARE DATUM IS BASED UPON NAVD 88 IN I 10 20 APPROXIMATE ONLY. CONTRACTOR FEET. METERS IS RESPONSIBLE FOR TAKING ALL FEET TYPES OF WATTLES NECESSARY PRECAUTIONS BEFORE • e COIR (COCONUT FIBER) BEGINNING ANY EXCAVATION. 0 20 40 60 ®OCK STAKE WATTLES COMPOST (DIIGSAFE 1-888-344-7233) GRAPHIC SCALE 1" 20' CONTINUOUSLY WITH TWO Y STRAW RECONSTRUCTION 1"x1"x36" WOODEN 0 DIAMETER BASED MAINTAIN 5' STAKES 4' MAX O.C. FLOW/MANUFACTURER SEDIMENTATION (TYP.) MINIMUM DIAMETER 12 IMPACT CALCULATION TABLE PLAIm STORAGE ZONE RECOMMENDATIONS FOR SLOPES AREAS OF IMPACT TEMPORARY PERMANENT OF b14S GREATER THAN 4:1 WATTLE r 100—FOOT BUFFER NONE NONE M 2 MIN. 50—FOOT BUFFER NONE NONE � STUARTAR BANK NONE NONE C VIIL u DATE: p ILAND UNDER WATER 1 7.1 (SF) 7.1 (SF) o No.40697 Q October 19, 2017 i ❑ 9o,��saIs ����`` CAD TECH: S A ARI 6" MAX. Z I 2" MIN. TRENCH VEGETATION CLEARING f�> • rt j ' I CHECKED BY: 50—FOOT BUFFER NONE J DP SECTION PLAN 100—FOOT BUFFER NONE ENGINEER: THE PURPOSE OF THIS PLAN IS TWO SDC DOCK DIMENSIONS PROPOSED DOCK LEN(LTM 8 (TM A. TO RESOLVE A 'NOTICE OF VIOLATION" AND ENFORCEMENT ORDER SCALE: NOTED WATTLES SLOPE PROTECTION DATED AUGUST 8, 2017 FOR VIOLATION OF THE CHAPTER SCALE.' IVTS GANGWAY 20 (LF) 3 (L.F) 91—WATERWAY LAW AS IT RELATES TO AN UN—PERMITTED DOCK. SHEET: 1 OF 1