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I ;, , �,;, ,1, r�, � I,., � "�',­`�,�',':i_'�'i,:�"e""�'"""""jL`,"I'- , - 11 , I l ... 11 �. 9 ,�I,,­l - k, , ­,1 R11111,I�,��I - � '-"I(,,--,., '_,., _�l­�, I'll, 11 4-�l-1��- �� �� , , , "",,'' �c'I,��,',Il� � �' _� ., A ­­1 �"R � I � , -�� . ,,,,I r,�Z, ,,y 7, , L I I - � - , ,_': . � " 1, I o , ",,,, � , , ­­,,�� ,11� ­J1 1: "I � 11 I _L 1, -, .1L � " ��, ­ ,I]l _ �, , z j , 41,"', - 1��.�. ­ D ,,���i__ ­i S_ �� -�11�,l� 1��,!,,,��Z�� ��I� ! � i ah,& Town of Barnstable Buildin PThis Card$o That,it is Visible Fro PlansrMust be Retained onJob aril this Card Must be Kept } 't63 Posted"Until Final Inspection Has Been Made. i C p y Required such Building"shall Not be Occupied until ar in Inspection has been made Where a Certificate of 0ccu anc is Re Permit No. B-19-165 Applicant Name: Michael McMahon Approvals Date Issued: 01/18/2019 Current Use: Structure Permit Type: Building-Insulation Residential Expiration Date: 07/18/.2019 Foundation: Location: 31 HAWSER BEND,CENTERVILLE Map/Lot: 192-085 Zoning District: - RC. Sheathing: Owner on Record: BRUNELLE,HAROLD S& DEBRA i Contractor Nzime:l MICHAEL T MCMAHON Framing: 1 1 }� Address: 31 HAWSER BEND Contractor License: CS-068111 2 CENTERVILLE MA 02632 - � -." Est. Project Cost: $8;677.00 Chimney: Description: Weatherization,weatherstripping,_air sealing, blown cellulose Permit Fee: $94.25 #, Insulation: Fee Paid:, $94.25 Project Review Req: k , Date- 1/18/2019 Final: Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months"after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the approved construction documents for which thi s 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. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work 1.Foundation or Footing Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final`: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection S.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing;and Mechanical Installations. Health 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 0 r_�, L-17r—1_3 sue. Town of Barnstable Building sw�srAsrx�rt PosfiThis Card So That it is'Visible From the Street-Approved Plans`Must be Retained on Job and this Card Must be Kept MASS. Posted Until Final Inspection Has Been Made.`. arna�" Where a Certificate of Occupancy.is Required,such Building shall Not be Occupied until a Final Inspection has n bee made rermit Permit No. B-18-269 Applicant Name: JAMES S PEACOCK Approvals bate-Issued: 02/06/2018 Current Use: Structure Permit T e' Building Addition Alteration -Residential Expiration Date: 08/06/2018 Foundation: Yp g ,/ Location: 31 HAWSER BEND, CENTERVILLE Map/Lot: 192-085 Zoning District: RC Sheathing: Owner on Record: BRUNELLE, HAROLD S& DEBRA Contractor Name: JAMES S PEACOCK Framing: 1 Address: 31 HAWSER BEND Contractor License: CS-094500 2 CENTERVILLE, MA 02632 L f �._ Est. Project Cost: $ 10,000.00 Chimney: I Description: REFIT KITCHEN - DEMO EXISTING KITCHEN, PULL 8'OF SHEETROCK Permit Fee: $ 101.00 ON OUTSIDE WALL AND REINSULATE Insulation: Fee Paid: $ 101.00 !� Project Review Req: Date: 2/6/2018 Final: a Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: This permitshall be deemed.abandoned and invalid unless the work authorized by this permit is commenced within six moriths after issuance. .All work authorized by this permit shall conform to the approved application and the approved construction documents for.which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building.and structures shall be in compliance with the local zoning by-laws and codes. 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 Final Gas: work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work:, Service: 1.Foundation or Footing = Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health 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 Map Parcel 02) ? Application Q Health Division Date Issued Conservation Division �� ti �� Application,F 'CO Planning Dept. �J �� P� Permit Fee Date Definitive Plan Approved by Planning Board Z�l Historic - OKH Preservation/Hyannis Protect Street Address 31 i4a wser j3� ' Village _l_v l if V c Owner HQY-o Id i- Dtbra_- Sr u ne I ft, Address i.-me-r L3 e kid - Telephone 5-0 (Q`{ f3 _ �_q 3 G Qev�4e r l i I le, , M & b (o Permit Request U I Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District. Flood Plain Groundwater Overlay Project Valuation 0,a Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing U new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ . Commercial ❑Yes ❑ No If yes, site plan review# Current Use a,2z� kcn:a A Proposed Use �. APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Scoff 19P_0k_WC_ Telephone Number 5 DP, L./a ' -7CacoCJ Address R C) ax 17 I License# C S� 06)Ll 5 CEO (:)S�T►�' V I I if N 7A ©QV 5- Home Improvement Contractor# 1571 i Email SLc>tj-_i? to e on ve r I?Lyi, nc+ Worker's Compensation # WC 005_J� 5 9(cq ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 7©0 Y) D� \ Ot V Mo Lt SIGNATURE DATE I � �/ FOR OFFICIAL USE ONLY APPLICATION # - DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT - ASSOCIATION PLAN NO. Town of Barnstable ' Regulatory Services BAANBTABM '• MAS& Richard V.Scali,Director �;;;q. t+� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, 1 J , as Owner of the subject property hereby authorize IScott Peacock to act on my behalf, in all matters relative to work authorized by this building permit application for: 31 Hawser Bend,Centerville (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Si ature of Applicant �b►�-- 1� r��1 l� Sco. Pew(,L Print Name Print Name Date Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-094500 Construction Supervisor JAMES S PEACOCK PO BOX 171 OSTER111LLE MA 02655 r-jZ;:^ `"-- Expiration: Coirmissioner 07/22/2018 - nTLrCi:iClc�..JC Office of Consumer Affairs&Business Regulation License or registration valid for individual use only � (?HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: - ! Registration: }_51853 Type; Office of Consumer Affairs and Business Regulation i 10 Park Plaza-Suite 5170 Expiration: ::.717/201.8 Private Corporation Boston,NIA 02116 SCOTT PEACOCK BUILDINGS&REMODELING INC JAMES PEACOCK 1 1046 MAIN STREET SUITE OSTERVILLE,MA 02655 Undersecretary Not valid without signature r ® CERTIFICATE OF LIABILITY INSURANCE FDATE(MMIDDNYYY) 1 07/102017 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 endorsement(s). PRODUCER CONTACT NAME Germani Insurance Agency PHONE x • (508)428-9194 908 Main Street E-MAIL F No: (50828-3068 ESS• CertS@germaniinsurance.Com INSURERS AFFORDING COVERAGE NAIC: Osterville MA 02655 INSURER A: SAFETY INS CO 39454 INSURED INSURER B: Granite State-AIU Holdings 000000 Scott Peacock Building 8�Remodeling,Inc, INSURERC: P.O.BOX 171 INSURERD: INSURER E: Osterville MA 02655 1 INSURERF: 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. IN LTR TYPE OF INSURANCE U POLICY NUMBER (MOLI p EFF POLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s 1,000,000 CLAIMS MADE ®OCCUR QA GE OR PREMIS Me oaaorence S MED EXP(Arty one person) ' s A SMA0022118 07/052017 07105/2018 PERSONAL&ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: POLICY❑PRO GENERAL AGGREGATE S Z,000,000 OTHER: JEC- LOC PRODUCTS-COMP/OP AGG S S AUTOMOBILE LIABILITY COMBINED SINGLE UMM S ANY AUTO Ea _-1Iyd t OWNED SCHEDULED BODILY INJURY(Per person) S AUTOS ONLY AUTOS BODILY INJURY(Per armdenl) S HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per ccidenS UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE S I DE1 I JR—Em"oNS S WORKERS COMPENSATIONIN PER OTH AND EMPLOYERS'LIABILITY STATUTE B ANY AFFICER/MEMBER PAREXCLUDED? CU IVE Y� NIA EL EACH ACCIDENT S 500,000 WC 005-81-5464 06/22/2017 06222018 (Mandatoryfyes.d be andn NH) EL DISEASE-EA EMPLOYE S 500,000 If yes.describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT S 500.000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101.Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Scott Peacock Building I£Remodeling Inc ACCORDANCE WITH THE POLICY PROVISIONS. PO BOX 171 Osterville,MA 02655 AUTHORIZED REPRESENTATIVE Fax: Email: ©1988 2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD fir ���"¢+tc:�.• v+=aJy^x-r•s a.�Pi. � v lr ss�r;�i"5 I pleas Elm i� fP.f U FE 1�Fg° aJL/��'i�[`C:C•L`C-ice, Al", d.i .e:} ���-•=`}mil�C��-i f:� j�"� (� z T a s plo-e€ ❑ a�-r--,ca�c�a�2 S at project ' ���C�a�£Io€pa�.��. bye 3vszt€fae ssi�-cc��� 6- ❑�e�canst�-�_ '.❑ _ a sale ar art y - iswd on.A a atac-hpd sj - 2g 3e=ddj,3g suit and fiqa~;a T-hEo--- x-cansracicn-,-.M c �F w.S'SC 3ti ' laF2P.r 3 d-f-, rN�fir"coon_ comp-Tinsa Q..[�BniFau s adz3 . T 5_Q �i e ara a tospas ioaa all mescal repa sflrar`sa` �s � y,,�,,�,,,�9 ❑R X p3iE3 ar MdCj6oM ir-,m�e-'e ail d,3 E c-152-61(W).ao&well37em�a t—El--Roarxepaim + �„T�,.+;*gsL=-ran'nszitamc�i*�� a. " * s^f..-^Qirili"m,�'t-*tst-`I� f nfiLL SIID-C �a3 R g ormmfmxve FaY�s-- eSiuj23..'T'^n-fir�3ei,8�aTa �a i &air sa,5EEW ten. aQtlCi mm�ircr - 71I dPi 2iPFB IlF�2S u3' Q'Fw*p--s;c0mp'?EFIfLu,&rurf mr. g�3 �� E DSP SiBF3kIG�'GSk[E1D37iZ ?rZul Di7itC£ILm / c iCc I ' J lob am�..d&—.ss: �� J ��l [A)�521� G-e kd L',��Sia��_.�s}_ I�C,�/ t_e`acb � r Eli'cLt;sG� 'Cam$ rs F s 1 Po ao�pala.gde-• �Ez( EGa�Fi:Fpa,ce $eTaa¢ l i o3trIafe�. nr ra se scan:a zs usd d�Sec 25A of cauleadiaEz°.impo tint:ofc aipeual es ova fmeup`D$L-500OQan3{ar Sasweg,as`�pE in fa�zaiQS't TGFK OM3ERzndzi~> a�rp s ( �a rioIatl� $e surssrc a eap rs aii �ss beam dr,&diafaa OM a az 1T•:F,.S'ota�'.L'�G�^iaE����' �i�etc,-rnwC:GiTc�aEea�w^a3srm . 1 a ftEr r c ctt _ mas s ar' gn s fiToraffilvzpmr Sbmg.'a;fnm d W"erti -Ilr Da C az a ow-m- se= CIE Eimer E.'�E_f �`feLi3l�T3l�E� F 3._ c oZo �� �t� 'Town of Barnstable *Permit# ,O Expires 6 months from issue d e Regulatory Services Fee + BAENSTABLE, " � MAC Thomas F:Geiler,Director 059. prfD MP't a . Building Division , Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma:u Office: 508-862.4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION 'RESIDENTIAL ONLY alid without Red X--Press Imprint Map/parcel Number / Property Address E/Residential Value of Work 7 I _ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address I G Iry l � 4- rvlv�` e A� �V/�� �rrc4 hliSe24�elephoneNumber qO Contractor s Name r-(� _ Home Improvement Contractor License#(if applicable) I 0 3 2-"�,l Construction Supervisor's License#(if applicable) ® I l aansP ' Compensation Insurance Check one: X PRESS PERMIT , ❑ I am a sole proprietor �am the Homeowner I have Worker's Compensation Insurance MAY U 2 2013 Insurance Company Name P'f r" 0?J Q.fl Workman's Comp.Policy#^ r �O l J ��a- `� y TOWN OF BARNSTABLE 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) FT Re-side i, #of doors . [replacement Windows/doors/sliders.U-Value 0 a 3 o (maximum.35)#of windows, 1 Cr ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and.inspections required. Separate.Electrical&Fire Permits required. - - * th other town department.regulations,i:e.Historic,Conservation,.etc.. Where.re uued: Issuance of this ermit does not exem t com Hance wi , 9 p p , p **.*Note: Property,Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. . SIGNATURE: ' , Q`.1WPFR:ES\FORMS\building permit formsTmRESS.doc: The Commonwealth of Massachusetts Print Form r� Department of Industrial Accidents Office of Investigations . I Congress Stree4 Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance .Affidavit: Builders/Contractors/Electricians/Plumbers Auulicant Information f Please Print Legibly Name(Business/Organization/Individual): 5 e-ro 1 Ngl 6yila /- INN LLe- Address' _,� /7�D l6Al lLO City/State/Zip: L/Ne®ly �' v�86S Phone#: ��a l �a — goo Are you an employer?Check the appropriate box: Type of project(required): 1.EWI am a employer with 4'- 4. ❑ I am a general contractor and 1 employees(full and/or part-time).* have hired the sub-contractors 6: ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached'sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity- employees and have workers' . 9. ❑ Building addition [No workers' comp.insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152,�§1(4),and we have no ? . employees. [No workers' 13.[�6ther .comp. insurance required.] 1 *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. //►► Insurance Company Name: Policy#or Self-iris.Lic.#: Z,�. 02 6 g .35-9 300( ' Expiration Dater � �/ l 3 Job Site Address: City/State/Zip:: (� jU Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c..152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby tern der the airs and enalties o e 'u Y that the in ormation provided above is true and correct Signature: Phone#: _L 6 Off cial use only. Do not write in this area,to be completed by city or town official - , City or Town: Permit/License# Issuing Authority(circle one): 1.Board.of Health 2.Building Department 3. City/Town Clerk .4.Electrical Inspector 5.Plumbing Inspector. 6.Other . Contact Person: Phone#: N Client#:30124 SOUTNEW AC®R®T. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 1/02/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Anita Little Willis of New Jersey,Inc. a1CC IN Ext:856 914-4660 AIC No): 856 914-1881 1015 Briggs Road E-MAIL PO Box 5005 ADDRESS: Anita.Little@willis.com INSURER(S)AFFORDING COVERAGE NAIC I1 Mount Laurel,NJ 08054 INSURER A:Selective Insurance Co of the S 39926 INSURED INSURER B:Argonaut Insurance Co. 19801 Southern New England Windows LLC INSURER C:Beacon Mutual Ins.Co. 24017 D/B/A Renewal by Andersen 1137 Park East Drive INSURER D: , Woonsocket,RI 02895 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES'LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR. INSR WVD POLICY NUMBER MMIDDIYYYY) (MMIDDNMI LIMITS A GENERAL LIABILITY Y S202945900 8/10/2012 08/10/2013 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY AMA�E 7O RENTED REMISES Ea occurrence $50 000 CLAIMS-MADE a OCCUR MED EXP(Any one person) s5,000 PERSONAL&ADV INJURY $1,000 000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 PR POLICY 'r 0 LOC $ A AUTOMOBILE LIABILITY S202945900 8/10/2012 08/10/201 COMBINED SINGLE LIMIT Ea accident 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident A X UMBRELLA LIAB OCCUR S202945900 8/10/2012 08/10/2013 EACH OCCURRENCE s5,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $5 000 000 DED I I RETENTION$ $. B WORKERS COMPENSATION AIC927698352394 8/2112012 08/211201 WC sTAru- OTH- AND EMPLOYERS'LIABILITY C ANY PROPRIETOR/PARTNER/EXECUTIVE� 6802$ 8/21/2012 08/21/201 E.L.EACH ACCIDENT $1 OOO OOO OFFICER/MEMBER EXCLUDED? N N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1 000 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 FF DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Cert holder is included as additional insured regarding work performed by the named insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25.(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S213748/M213024 AXL Southern New England Windows d.b.a Renewal by Andersen of SNE Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Superrisnr L License: CS-095707 BRIAN D DENNISON f 7 LAMBSPOND EIRCL s Charlton MA 01507 ; l Expiration Commissioner 09/08/2014 CJ/,die f (d&` R m1ati Office of Consumer A airs Business egu anon 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 173245 T9pe: Supplement Card SOUTHERN NEW ENGLAND WINDOWS LL Expiration: 911912014 DENNISON BRIAN 1137 PARK EAST DRIVE WOONSOCKET,RI 02895 _ ' - Update Address end return eard.Mark reason for change. - sc.1 0 auwsrti Address ❑Renewal Employment ❑Lost Card f e oIC a Alfaln&Bmloeu Regulation License or registration valid for Individul use only ME IMPROVEMENT CONTRACTOR before the expiration date.If found return to: C04"Expiration: Office of Consumer Affairs and Business Regulation eglstradon: 173245 �:. 10 Park Plens-Suite 5170 gM9/2014 Supplement t:ard Boston,MA 02116 , SOUTHERN NEW ENGLAND WINDOWS U.C. RENEWAL BY ANDERSON DENNISON BRIAN 1137 PARK FAST DRIVE �' •a� r��� - il�. WlOONSOCKET,RI 021195 Undersecretary Not valid without signature - " f t MnWcenx.#178YAi,4 �!'�ittISEIT. RENEWAL�BI' ANDERSElV� ,^wipeowui`nacnrrrv,�, c,�;,y, 26A1bronRoad •,'l3ncoin,'.RI04865; I�d'firm•#i.ag7r Pho�ie'866 SfjS 223,5�Bax 40.16S3; tiU2 i7GtIa41Tn tiP C,145S6B§0+ Sogtbera I,letir 1r�and M�iedowto,Li.0 d%b%a. Rtaeat,by, -en of Sonthe p New Epgipa8•i ;CUSTOM WINDOWAND,DOOIt REMODI?.I:iNO,AGREENIENTa 'q,Bi,YlrtE�INi11M_ __---.,V—Y v ... 3 ..--. � i,t71�0� � �•' gk *t.J.sara_eEd cy.Soeaana:216_evds< - �EI`inlllddiett, tis ='F' HomeTdapAmnNuinbe,•.. `',Y1kiFk;tdaplioneNumber: . ...a +' $uyer{s)jiereby jcfintly.grtd ytverall)agreet to purchase the-gtuducttaiidYoreryicec,of$ouhem�Ncw En�9and11�'indows L1 C�tilba Renewal .by Andersen of Southern Neti�.>;ngiand('Qontract9r') in_accor�ance`�wttli,��re,tierrr�`s'wed"corld�iio"'r�slde�crib�ion the fnitran�l'tti�r� tse�gT+� ,�thtcagne>nent�ttd!on tfie attaehed spe©8t�4on sheets {cdllectrvely,thiss"Agt'e�ment')___ " � Total'JohAmbui,e , '" ! ' toed aprnng,l?ao r (�edioe of Payment 0 t iedc t DiCa� nanced Iv j + oa Reoeftd 346 De $ r , P ) 1 :GnzdrtCar�arearcepte�fordeposiconly' mai6mum>.Il3yafthe,, 8atatce at Stare of job(339b) iV G t i 4 " 6dmated.Complehon:Daer P^Dj�c Doti{f ye�'see C�e®t CadRoyirieittmi) alpttng this ' AF eem Srsrt of.Job and 0k, #L x FBaknee on Subsraritlal Balante.t+n 5ubatanual'Compledon,of Job raririot be m'ada by aedk , pS� :CompleEiop of job�H%j. - � must be,fide Df+persg ',d eNk 6k;dredc.or p`sh:; I� ''•Bn Gas ecad thas�d amd4^staatls'tltat ikhas- .' �- 'yeti( )agrees� Agr�cett►eti f coiRsf.titcFs the entar,c tmd�tandang between the partaes,and that there are no verbal tmderstsandange chanPM.-AW of the terms of"Agreement,Bbyes(s)acimowh dges that Baryer(s), Agae meat,aanderstands tLe terms of+thus Agreement,and;Jhas,teceavedTa compb tedt;sigaed,sad dated; :copy of thh;_greement,auclttdmg the two atxa eS1I!foaces of CaaFe atron,.on tb'e dgtc'SFst written above and(2j was ora�Qy; iialotmgdofB>syeer'srightfocantaeT*bAgreemeat DO NOT•SICNTm,qO.NTRACTIF ANYBLANICSPACE$q .,( l*land sans Q ty)Wbfice to Buye w eR Dleoh o Cdt alga this Agsee of if any of ►e spaces'ln€aaded for tine agreed terms'. to the extent of t4ea avaalsble lofo�rmadoa are t {2)Yon are entitled tv a copy of than Agaemeatat the eam'e you saga t� :.it {3j Xau may i1t dtny tutte•pay ,th'e fall u�patd balsace dne wades tills A$secacent,°and is�danag yo>.,may be'eatatled�co:t i,,fecelve; patrdal, ebate o£-the Ba+aice and(tnsaraprce'charges,(4)The selQer tis aw right to adawfnllyenter your,premiseBa. or ixiinmat say breach of:flat peace to repossess goods ptttcLased under this Areemeni (5)�'on may cancel thae.Agreemeat` if at ' h",'a b p eta sagoed sit the walla o9ice or s brand oifiae of the seller, rovided you.ao tafy the seBei•.aft his* her- Za office,oi bract h office shiiwn m daeAgreemeat by segaste`red or ceetafia whscb shA bie -'S-red sot Istee than aaulmgiux ,;of the third calendar day after the day an a+r6ach ih4'boyer sins the Agreement,e>relndiag.Sunday and aruy holfilay oa which' a regalar maa`l delrveaae++q are:not maa9e See tote aci:ompangrng aotace of tieaceUatioai€orm fos an eiplaaatum of bnger's eights:. Buyer{s)�eeetva�the consum'eL education matcnals pcUvided°by the Rliode isiand�Go�t)raetors kleg�st'AUon�Bo'£(d ��uyn�°�tmbAlt�'= ., IRen�ewah p" of Sodthern,New England' '8uyer(B)� ,� ' Buyer(sj u sStgiiattireo,,mdddtManage'r.; t :f ``— Sigria re ", %tut apse cif lirorlu t ManagefA""' _ ifPnn Nainc priftf me "" . a - 1 r YOU, THE Bi3YER(Sj, MAX CANCEL TIiIS TRANSe1CTION AT,ANY 1R11SLf PRIOR'TO MNNIOHI' OIi THE T>filItD'+ a$tTSINESS i3AX'AF1'Ei3 THE DATE.OF 7W TRA[VSAC"TIOTiJ $$E"I HR AZTIiC:HED NOTf�:E QF CiiNCELI.ATIOIV FOIt1MIS` .e JFOR'AN V PLANi►TION OF TM$PICH7: _ _ � ` M�T�E9•_ .ALS?N L t� �, ��T'dO:T'IGF�OFCANCELLA'1nON'� ` Date ofTransactionaYtiu maycancel i,f 1Date:of,TraWttion You{triay caiacel #tis,transactionry�itliou nny gnalty ar obligation;within' , thisti!ansaction,without anyapennity or:obligatiory witfiiti athree bysiness;d'sys front the above datR It you cancfJ;ally i titRee•business; from'the,alsove date;If Jrtw ancel nary+ i rproperty traded:iiy any payments%nLade by you uriderbthe 'l property#railedi airy payinehts rttmde;lbJrayoii under rite Contract or Sale;.an- arty negotiable instrument executed ,I Contract or Sate,ant!'any negotiable instrument esoecgtet by you;w111 be es turned wi�in ten btttsinessl days following by,yoU viiill be;.t+eturned Within ten"busulessi&y'd,fo11"nY•, irecei' *"the Seiler df youF cancellation lnotice,Arad any.a� (receipptt dY the'Seller df youh•2aiicellatlan noo1ce,andY: *,security interest arising ;out of.the tranon,will be seeu" ey Interest,ansutg eliit-Of,.,the}psiyn,grill tie:.. canceled:lf you tatiicel. it must M$ avaflable to the Sellt r,'l eaiaeeled.Hyo1%e�rieel,you must makgilabte to;the Seil®r< at hour residence;In ail scan ally as good candkion:as vrhen ! at youh residence,in substantially as good eetitdition Whep i received;any goods deltve to you under,this Contract or l received;anytg�6ods tletWer ed`to you uhderthrs Contract or^� •"Ste,or you may,tf yea wish,compy with th'e'inatrut Lions of °� Sale, you may,if vita wish,comply,wldi`the&lstrpctions of' ape _S A Boot at lbe Ziie'Seller ee$aediiig the:return shipmentof fire goods st ills; the Seller re rdm the rely shi Meat of rite • +, l �oods Seller's use and risk if.* do frisks the s avaihible Sellers use and risk.if u do mates the, available", g�oodd «t to the Seller and file Seller does not ph:k sm up within to the'Sec and'tlte Seller dyes trot pick them:up,wilAtin I.twenty d' of rite date or,csnceilation,you ihaSf retain or,) 4wentjr days of ifte date of t�ncella4ton.yqu rnfay detain or,, .di oihe goods•without anyifurther.iibligation'1(you�,l ,dispdse of'the,gouds,Without any fiitlhe'r obligation.If you ,q 'fat to rrlaloe tfie goods available to the Seller.or`if you agree•.I 'fail to turtles rite goods avai(able to Vie Setter,or 16 u ageee c :to return the to theSSeller and,fail'+bo do so,tfien;tl ttp return tke.'goods'ta the'Seller,and falllta do ao, 4o, ��„you remain Ii lah a fot;Iierioiwmance ob all obligations> er+:� you remai�t IUable for perft►rmatice of a11_obllgatiifns under, the Contract.To:cancel flat transaction,,mall on'deliver ,the Contiaft To iia icell this tranmction, mail or delhrer,. ajsigned'and dated'topy,4f thke tancellatign notice or any e!! a signed Tend datedi cgp�r,`o#,this tanitlation�noEiee or arty ' othgr writtenot3ce,or send a t:6elegrarrl to Renewal othel^writbeti•g4ticcr,or 1 seiii a telegraiti i to Renewal e of 5oi them New 0 &ntl at 1137 Par*;East Dr, ,1 Andeisen!d Sout4teMI En d at,J'137:Park East Ors And T g� R1 12g95 N.Oj to ERTHAN MIONIGFR OP "jt YVoonsoc et,R162895 OT 11�►RERTHAN MIDNIGHT,OF r�... q F W 1 ANCELTHIS7RANSACTION" 3'{ 1 HEREB(CA t CEl:THISTRANSACTIO,N:,, I y r •. 7rtimtttanN lt4t-F. rF .-- ���/�-�. ' .. +»iLt�Mt n�Tl°•^„•.' 1 'a t: ' I° 1llCiW�itB,Y uiu „tsananra ■}����p�..��� �.�y� �� ¢t F MA LiCemri717 i;G5. 7ll1�, 1.7Gf Ml - aA il"J'IJCitri.?f4�34954; tarn��waucw:.4n 4ca i`, LW Yiim bi297 ,. 26,Atbion Rbad''t,LYnt:oln W 9?86S'_ - �l'hone_86¢563:2235�Fax A01 633 6¢02', +srdcrni Yux ipYNu-oSC�b:�c . _. 5PEbIF.iCATIbN$HEET�R y �7' . 30 _ The l3; a r(s)lrsted'above lieie ;it4 aeovrdarYce with the pnces r y by Jomtll*and severally a§ee topurchase the goodsand/or servtoes list and teims desai on the;SpeYYScation Sheet,'and<the fnord and the reverse of th :ncoompairyutg`tUS1+OM WINDOW.AND DOOR'; 4 RFA?IODELIIVG AGlt£EMENT;;of w)uciY'tltu S�e:i6cst,o.Y 3s,a part. . - ,_.,� . - 4°�VIIVDOW DEfAII.S:r fContracfor wrU:Ihstall a Total windows ut Qwner's home,usingrt}ie f,lmwit)g mdrvidua7 gYtanhtieS _ rouble Hung(D$), Equ sash O,rattage sash(t/S top,2I9l�ottom)„Oi'onel sash(2/3 top J%3,bottoliU -Casement(�,- e_ left' viewed$+om exterior).,t- "' Double�Caseaterttr(CDW]" • . _ . -',Casetnettt/Pictitte%Casement(CPVV1❑'�l 1 I�t,or�Q'1:2:1 a2 Life Glid>i<g Window(GW),' �" r L. Glider%FicLre!Ghder(Gpvv) ❑ Ii 1 or d1 21•; Window(AW) I'ictur�e�Wi;tdow(E'►Nj liaq of Bow W.utdaw Faho Dogrs.(see sepatalyey�°f Sp'. P. tibn ShCCE Y ❑IQo Qty of I Vf dDWs(Mbe Qn$t0M 15t Replab +' 3 Yea[] _ Qty of Sills to tie replaced by Conteti?r /!;+'�/ os •9,i Q Yes ' No Wutdows t_o fieNew CorishttctitrY frYtmeS Gncludes ne'iv rt¢eno7&axtenor cashgsli 4 yr: Pine '-,lYtauttenYce free mat [ i liactory apphed 9U8 FLbrexiidkewld 5 Glazing to be. +HP d t�+ r�t.�, ff` ,please specsfy_A � '� `-- 6 Exteriea cDlortobe to(�Sand Q CarLyas(�. a Urteelaroniy.''[]Cocoa,Bean'❑73ark+Bronee❑Forest Green 7 lritet oroolor tq, 1Vlute,0 Sand Q`Ganvas`Q T e,p - 'e.❑Maple.,[j l'Jaf<, NY�e Ittt' color ran only t whrte,;Wood orseatsne ae extenor: WooLjgnlerrors need tq be(ifyshed by,Owner: 8 Haidware.; te'Q•StottC_C] SS}Q?Bt4s>''DYi+ f#i+rtB. 9 ❑Yes r No;install Lids with le Hur{g,Winflo�vs a " ` l0 Screens wmdowsiohave lialf,orQ lta<lscreaa to be„ []'N»riun!!riuQr7fuScaie' 11 Wudow a g9lie(sy'` .[J No,tryes Qj Gnie Glass tree,` /yat�emo able lrltero(ryW ooA mn+�[Ii�l)yDtvr�ed lgfit erns Ye�1 r i r yr r E7 ­ `ssooftADpITiO uwbxrt DE12 CIl'es Oys' wGl in F�tterYOY ngs qty of Y Ycnittgy' _ jp?tne�!MatrltenaY!eF fr ec mgterl8l. 14 l7Ygs ntradlor will mctall new paint ready ors n ready meiile YSr outstdc slops Sty of openings - Intenor ops gty of olfenit{gs - * Exterior sto gE of openings 't C7 Rite MdititCttahce�ftee material I B OYes o, Contractor will wrap extenorfcasm_gs with.al mutum coil sfoclr of+ color'' _ �"' Wreppntg may,lx mcp7iF d v6Yth storm wmd6w oval,removaltof stout windows,Krill leave screw Holes m rasri4q tt lti No Contractor Lvtll Insulate,caulkAndpseal:win Ws;V 6 3,paint systen►to prevraittwater and RiCippltration- ' 1 J No `Clean up'all job ref tcx4 c�ebr is Ificwding ca , ndows will tic removet� Vaeuutri�tttghtiy' I$ , es (3No�ll+lurttted:vuarranty shall bdissued to Owner; poq tlotrtplgtiort of the".job and.paytnent fri tLll I9_ wY ©Nq BY3ildins Petmit.=Conteactor will secgri, aitd aft necg,�ary perm"lts. '""c.:.:��stl��^*+f.�:�:+fit All L urrent promotions and ht'i'kounts.liave n'apphed td:the dboye egreeinent amount'-any fiiturc dllicoLlnts oE: sales are not applicable to this,ngrdem;nt' . t 2 I Owner r8 s>tvarP that'Coatractor does not"do any,poi ling. Owner]nrtials i?2 »Owner ts.resjmnsible'Forthe�emoval and=�eanstallaton., a;,y. Isurtg.dlatm systeigs. Owner'to caU;atarm eo. YS�Oryner»responsible for the re tn`oval and installation o anywindaw L4 bwncr is i�wn3,ible fur the ienioval apti,eY:uLatallatton wmilow ti�att`nenri&;Maelcets: r z 'l7i�es ❑No,'Owner&grew to bI.pre�nt on the final day f tnstalle(tton for lrnal mspectlon,aryd t6,deliver fihdl ayment', ,20 foof�xra em 3liaff Be dear arided unh7 the Yavnfi�Ct r5 fileter!to the saps fatiwn of qll parhe It ra gg&w and".understood by pnQ betwe t the paegrea thrs Sp Y ficatloq Sheet,along twith the ClfS4OM WI VDOW' pND DC71tlEiViOD6111VG AGREEMENT,eonstitates?the eptirC,!!t)de�+stfndtgg�betvZeeh'theiparfie"s,and.flare ar'e'>fo verbal!, anderstandrggii�changt�g yr rnbdifyii►g any of the terms !lhrs SpecificahQrl S1►eet tnAy riot be chtged or ltaRterms modi6eA'+ or varied rn anywayurileas sack cbanges,itte to wr►ttng drsine °by both+tlie Bnyer(ii;)and Cogtraptor;Bnyer(s)Itentby` acttiiavviedgfi 3hat Bnyer(s)hae'read thys'Speci$cption$h - ,kettY:vvill y�ndtxsen of,_So tent iYe}q,"'` Suitt y.s BnyerC a�!!�►j l Y. t > � l den wa -__- _ .•. Il WIhj6W PMCEM6NT'.apArt ienCOnipaoy Phdmv caetom�,. e� rrX6 `�u�iG, i :�VorWcetl', C?5�7� ' ,�orrrt�vjrlG NrA`.D26 'R- { EeBiDayio ', IMI +T FEW °TfI tF< : Product 1Vlaaa - • FsG$tali Dabe:= ,Branch.•• , 'Totd.taf;; c�$api/$ow8�'. #.of D y Window Colo tieP y -77 ' ED . . . to VA - N0-` •�1E, Opmti�B�a�7�y � v ' 'LOc+�Pn i{`�Bt �t`.SC.�tII1 _+;�'olorlN. '"ODT' 1 4 j ITO + F i • li " + y •'SYwraa°iu6WYn8wi`Yitl{i4{�iVii6Y i - , '• _ ' c (All v f - ! _ it • t � � L GOw{t2 QfN G r'Q�✓L - ��{ :u�27�f�+�+G '('�! Vic°_ � /3��''•� ,,���'►-//j�'�i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application# 00 Health Division Conservation Division - h1t(,, Permit# Tax Collector Date Issued Treasurer Application Fee Planning Dept. Permit Fee A3$�U0 Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address Village 0<,r\-�,C.oAj_ Owner �arn�,J Er Ln C_,l Address �3 ]![ALQ Se/ '��e llC Telephone �� t/9 Permit Request 12-X ) Le 2" ,7a%9 ��1�C� Sep- co 3 n::A� . Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatiorw r y�® Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of EzistinOtructurel 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 9 9 Number of Bedrooms:;' existing new Total`Room-Count(n of 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 Q:new size12XI Other: Zoning Board of Appeals Authorization ❑- Appeal# Recorded❑ Commercial_❑-Yes`Q No, 'if yes;site plan`review# �Current Use Proposed Use � c, nBUILDER INFORMATION �\ Namee D ✓ �z�r4' P'MdUC�-3 Telephone Number A�7SZ�3 � uc� �c�f-� i Q� License#rt� O Home Improvement Contractor# l 3 Z 5 Worker's Compensation# (k) C CQ-?o�&02 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO Q� P)nry .0r), SIGNATUR - DATE (5�, b) 6 0 G, 7 FOR OFFICIAL USE ONLY i PERMIT NO. r . DATE ISSUED MAP/PARCEL NO. I ADDRESS' i VILLAGE • OWNER DATE OF INSPECTION: , FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL Ili PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING I DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations i; 600 Washington Street Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ` Please Print Legibly Name(Business/Organization/Individu��u--o— k4pv&ry Address:ZIS-q � City/State/Zip: � i i fl)1 , nZ(o qS ' Phone c4,50 'Z -61) Ar you an employer? Check the-appropriate bog: Type of project(require): 1. am a employer with 4. ❑ I am a general contractor and I 6, New construction employees(fall and/0 part-tim rs e).* have hired the sub-contracto ; ❑ r 2.❑ I am a sole proprietor or partner- listed on the attached sheet t Remodeling ship and have no employees These sub-contractors have 8: ❑ Demolition working for mein any capacity. workers' comp,insurance. 9. ❑ Building addition (No workers' pomp.insurance 5. ❑ We are a corporation and its required,] officers have exercised their 10,❑ Electrical repass or additions 3.❑ I am a homeowner doing aII work right of exemption per MGL I LEI Plumbing repairs or additions myself.[No workers' comp, c. 152, §1(4),and we have no 12:❑ Roof repairs insurance required.] t t; employees.(No workers' 13 ❑ Other comp.insurance required.] . *Any applicant that checks box#1 must also fill,out the section below showing their workers'eompensatioa policy information: t Homeowners wbo subaut this affidavit indicating they are doing all work andthen hire outside coatractors must submit anew affidavit indicating such %Contractors that check this box must attached an additional sheet showing the name ofthe sub•contraators and their workers'comp,policy infoixnativn. ram an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name �Mqan Policy#or Self-ins,Lie.#:�.I d b)l80L Expiration Date: Job Site Address,31 Wef �nd city/State/Zipi f--__(y iKe, (nA Iota& Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to seoare 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 oi'a STOP WORK ORDER and a fine of up to$250,00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby ce under the pains enaldes f perjury that the information provided above t. �e is true and correct Si atmr Date: /%! cp Phone#. Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority (circle one): 1.13o2.Pd of health 3.Building Department 3.Cityl—lown Cleric 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: T Informa' ti®n and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,.aial or written." An employer is defined as."an individual,parmership,association, corporation or other legal.entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the . receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to bean 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 it business or to construct buildings In the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s),address(es)and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies(LLQ or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure.to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of . Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies flionld eater their self-insurance license number on the appropriate line. City or Town Officials . Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom. of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permitllicense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job.Site Address"the applicant should write"all locations in , (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that-a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year.Where a dome owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would ble to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel T 617-727-4900 ext 406 0r 1-o77-MAS3AF Revised 5-26-05 -Fax 1617-727-7749 www.mass.gov/dia t Town of Barnstable Regulatory Servides • y Thomas F.Geiler,Director .A`'� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMXNT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c.142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, -improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. l - Type of Work:f 2—x)b ��a� L�V�e Estimated Cost �e Address of Work:(; Owner's Name:Liam, Date of Application: Al J c`0,61--a I hereby certify that: Registration is not required for the following reason(s): OWork excluded by law ❑Job Under$1,000 ElBuilding not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: 13 Date C 0 01, Registration No. OR Date Owner's Name QIbmisllomeaffidav j °ft�E' ti Town of Barnstable °t Regulatory Services srai.E,� Thomas F.Geiler,Director 4''°lfDrr►o�"`� Building Division. Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.b arnstabl e.ma-us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section. If Using A Builder as Owner of the subject property hereby authorize z= to act on my behalf, in all matters relative to work authorized.bythis building pemlit application for. (Address of Job) Signature of Owner Date Print Dame 1 Q:F0RMS:0WNERPERMMS10N t' . i•aiw atuu'+t/a� n vva• a nv.r ...«•• •• .- vV♦ivI rvNV iv.vV {'fiO iVVV•fV Va1iV Board of-Bui{diNzace epmilati�nS One Ashburton t Boston, Ma 02108-1618 License; CONSTRUCTION SUPERVISOR LICENSE Number. CS C73865 Expires-03ti4/2008 Restricted To; 10 TAMES R MCGRJ:.T3I _ - 204 CRANVTRW RO BR] WSTRR, MA 02631 _ � 15987 Tr.nos iKeep top for rscatat and change of address notification. �z� _e���� eoBoard of Building Regina One Ashburton Place W Room 1301 ' Boston.MassWlusetts 021.08 j Home jjnprovemenf a> gtractor Registration: 7 ' — —� ffegistration: 132935 a C..r..�-:�:�. i TV=. Pdvata Corporation f C,,.,:.� 1 y�.. =f,. t. �F+=a�'t:n: 1f1r�1/7iiFl� McGF rH POST BEAM CO. i DAMES WGRA CH 259 QUEEN ANNE RD. x2. HARWIt:H.MA 02645 P.° ;•t Update'AdJress and return card.Mark reasan for change. Addres:: 0 Itenew2l 0 EmploywAt Lost Cud $oatkeE Balldiag pagrtattaes and Standsrds Lice=or registration vall¢for individuture agiy HOML M ARROVEMENT CONTRltMR befonthe ezpirstloa date. lrfautukrrtuta to: Board arBalldibg Regulatiais end Standards itepiatra ion,ti g36 OncAsbburtou PlaceRm 110i ��R"F"�ic'°m:. :200B BoStOny lMla.0:206 . McGRATH POST&W A-tp c JAMES I.ScCRItTH�' 4 r'; 259 OuEEN ANNE HARWECH,MA 02645 Not valld without%Igm Lure �• fl Contact Person: Phone#: i .)7eparlmerrt oflndustrialAccidents •-•-- �___. _-- '. � - Uff cs oj'1'nvastigatiorrs • . , 600 Wostrfngton Sheet "Boston,MA 0.2111 w ww rrrasagoWhi Nair ers' Camp eusatlon xnsrrr,�uotcj A ridavit: T3uild'ers/C6:atractorsMectrici2usfPluibbers' • �p�ica�t�'�f ol�rilat�on ., , Please Print I.e kY N"3me(�usirt�sslC3t$anizaISpdiyidttal): Pint Address:_ KL . ^• aty/Stat ip: rnae#:ul -T .. Are ou an gnplaper?•Chrck the•appYopriato box: T'pe of prelect(t•equireo- 1. I ara a r�ploycr with 4.. ] 1 ania general contractor aid I csngloYms(full androrpart-tune}.* h&vc-hircd'ihc sub-CDUtfaci 6. Q Ncw construction 2.❑ I am a sotcpiopric or orpaiIncr 'listod on the attached sheet P 7. Q,Ramadchn# ship and:iavc m ralpIoyccs Tbcsc sub-contractor$kavp B, �cmolitian wotl<aag for mc.•np any capacity. warkcrs' cam,.itlStiMD= 9 (�Building adElidolt [No workers' comp iurur tcc �: [) We arc a carpotation acid its r '�•l o> bave exercised their YQ.(�Eloctrical'rcOirsor:ddi&w 3.[ I aui a'bq=gowacr doiag alt work right of cx=jp ioa pct MGL Y t.❑Flumbmg TcpaIIs ar adtliliohs Myself•(Nt WO&M'co' c. 157, J)( ] 4 ,aJad we havo ado 110 instu`alaeeragniraj.t enVldyoes. (Noworkeas' {tbofrepairs coin,imsttlanr�rcQd•]' I3.0 Other `AiW-0plia�r zb"abacb box-#1 h"atso 01 outtbc scCdon bd5w Ebor ai tbea t�crlrers'oQ - t Sri/+ho a '..imt tbi: 6: t oidicatbc6 tYiayasr:dofn`at work ind then bits Mttidc Gooftcd rr�e(dtet:t txx attxbad arc�dditiotiai sheet s)w aha same of the ors mhst iRixm`t.uciv iffidatdt L wrh . dub-toaharaat3,md dua,kodcr � �' Gon: 1`wrt,av�employe.:tkbt iF prpy�iji+Fg.H'QIIGdrS'edm,pe:rs�rian iresurerree jor rrty MP`oJ,adf- .8dow is eke par4 axd fob ee Fnfvnrrrrcfi'ot� . Jwwvncc COmpanyNamc: Policy#or Self-ins.Lie.#: (;t��', E a 7f� 1 L}7_-:__. tx?iia lion D — .Job.SitcAddttn: : A ttach a copy of ibe workers'eompctrsation policy declarafion page(skowing the polls,nttrnber jwd cxph•xfian date]. I'aihi;e•to scats'()3v=&c as Tequircd updef Sat:tion 25A of MGL c.152.cau lead to the mbposition of ' Ewe up to$I,500 tad tqr ova year i?tip7Tsc)asacnt;as well as cif penalties is the'Zi t pf a �Inm;l pmaltw of a Of Up to UkOO a day agaigSt the violator. Bc afi+iscd'that,a STOP Wt]R OM)W a fine copy of this stat=mt may be forward Slie otcx of Investigar;ons crf the DYA far insucaAce cavcragc vcricatiop, do her4by rfi m►dtr tlta p pelt o rrf tat the fnjotnt atiarr prouidtd al o�z istftre altcfcarreet O icid nsa anti: Do nqt tnr;iie In fkii area,to bs coarpfetsd by till or town 00teal ' City di Toft:- ' Per'mltli,i ce45e# Issuing Author.ty(tfr&one): . 1-Ebai•d oTl3c2:th 7.Building Departe"cni 3.Cityli'ovm-Clerk 4.Ele-irks!ruspeetor S.PIa0ltg6.Otbcr m Lrstpcctar Contact Persou: Phone#: FRAMING• `� 'C. - (Full.Dimension Pine) CHAT_ HAM LOFT * 2"x 4"Rafters @ 2'on centers .PI-NE IIAMkjIX c(zx6ifor—i2i2'shed.widdi0=I WOOD PRODUCTS - POST and BEAM SHED . 2"x 4"Loft Joists @ 4'on centers It, till about the wood"'� (2x6 for 12'shed widths) - 4$)x 4"Top Plate Beams • 4"x 4"Center Support Posts • 4"x 5"Corner Posts are 6Y'tall r • 3"x 4"Corner Braces • 2"x 4"Wall Purlins h. 2"x 4"Door and Window frames • 5/8"CDX plywood flooring (Pressure Treated is optional) 2"x 6"PT Floor Joists @ i6"o.c. (2x8 PT for IZ'shed widths) • Rough Pine Trim(primed pine or k red cedar is optional) • 8"x 8"Aluminum Louver vents Standard Board and Batten Siding ..° — clapboards or white cedar shingles are optional ROOFING• • 5/8"CDX roof sheathing • Choice of shingles and colors • FREE Pressure Treated Ramp NOTES: ° • Stock and Custom doors and windows are available • Concrete Block or optional Sonotube footings are available With a roof pitch of ro%2,and including a 4 foot storage loft, this is the perfect style for the `pack rat". The loft provides storage space for small and seasonal items such as beach chairs and hoses, while maintaining optimal wall and f loor space. This design adds New England character! t C��� � �� � � � � I� �� � �� S`�c� V'�(C���►. � Tie �, � � e �, `� I _. _ _.zr. / � �1 .. f TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel �� Permit# - o Health Division - 1!! s l�-� `�Yy 3 Date Issued Conservation Division /Z�60"L Application Fee ® Tax Collector / Permit Fee t 6 8 Treasurer 0..-2 IUa�e:SWd(a�I $,rk, �4 t,Mw�be gcu_fjgk�, SEPTIC SYSTEM MUST EM Planning Dept. I Iv� `o �fcltr p IlSTALLED Ild COMPLIANCE Date Definitive Plan Approved by Planning Board V1llTfl TITLES fly-sue/de C4. ENVIROPIEWAL CODE ANG Historic-OKH Preservation/Hyannis TOWN REGUW.IONS Project Street Address 31 Hawser Pend Village Centerville Owner Harold Frunel].e Address 31 Hawser Fend , Centerville Telephone ( 508 )790-5936 Permit Request 5 ' 6" x 8 'h" Bathroom Px1 Ont;son Change windows Reroof Construct 1.6 ' x 19 ' Deck Square feet: 1 st floor: existing proposed 4 6 2nd floor: existing proposed Total new Zoning District PC - Flood Plain Groundwater Overlay Project Valuation �.,�)D,nD D Construction Type Wood Residential Lot Size 25 ,630 f t• Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ® Two Family ❑ Multi-Family(#units) Age of Existing Structure 110 yrs Historic House: ❑Yes 0 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 a new Half: existing 1 new Number of Bedrooms: existing new n Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ®Gas ❑Oil ❑ Electric ❑Other FF!W 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:C3 existing ❑new size 2—car Shed:❑existing ❑new, size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes 0 No If yes,site plan review# Current Use R e s i d n ; a 1 Proposed Use g e c�i dent i a - BUILDER INFORMATION Name F-J.Jai,timer, Builder, Inc . Telephone Number ( 508 )778-4911 Address 48 no,-nry r.P.ne , N1,^nn e License# 003251 Home Improvement Contractor# 13.0609 Worker's Compensation# 500067201.2002 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Macorn rr s Durn s,ter SIGNATURE DATE -- i FOR OFFICIAL USE ONLY PERMIT NO. j r DATE ISSUED ' F MAP/PARCEL NO., ADDRESS `�+ ___.- VILLAGE OWNER t- r DATE OF INSPECTION: FOUNDATION FRAME �� `� i 7 1 "ZYS INSULATION r FIREPLACE ELECTRICAL: ROUGH FINAL • PLUMBING: ROUGH' i FINAL GAS: ROUGH ' FINAL J FINAL BUILDING i •• 2 wx 5, ? c"l DATE CLOSED OUT ASSOCIATIOMPLAN NO. r` t � i f j t t� J ,%,eF�n/ �rtq [..y` cu ir-Ff �� S!DE�-/,�t6 L_t_..c_.��-j%n��'..._ . .._._c_�_'y�/![1.�•' ; 14 aFTI� �TJ3� .�.��UfP-E'/NET1�`S ='�' T� �'G�C-�' !`. - =�� r -�.,z'.�7� �"2 3�,,�-• �,-+ram witft�:ti/ 7 Ocav�c�?i JA Of JAWS A- V MOORE N / �{Q 33253 Is � f °*'THE T Town of Barnstable ' Regulatory Services * sai 'MASS. i Thomas F.Geiler,Director y Mass. � qje •i639 ♦0 rf 639 Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements. I(,Y.1Q Type of Work: b" EjK9;KSIUN �N6,0 40oF, Der k_. Estimated Cost LLD idoo Address of Work: ?Jl &W 5t r 0-4<W f l It— Owner's Name: �V&V l k Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000. ❑Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: it 1111 'v E.J �1aV_tru 1 IoC�a Dat Contractor Nam Registration No. OR Date Owner's Name Q:forms:homeaffidav I ' I i I , �Y46 w 77 I. � �- - - - v -c V _ - I� , , •�" � iT i I i� I I M— o InTo If NI �#ox3G-'�.Ta4 — - - -•.� ARPROVED BY: DRAWN BY ry — T REVISED . _-. �j.•�' _ . .-._ DRA, MBER_..._..._ 1 IT 77 LEI i , -, -T.-cas rnura I � , I . z _ F At— of IT Im _ I -- - - -- t .ff A _� The Commonwealth of Massachusetts <� = Department of Industrial Accidents ( - o ce of/naestiffatians 600 Washington Street Boston,Mass. 02111 —" Workers' Compensation Insurance Affidavit name: . .J �J ��T� I�t-L►r1' E.l C . j location: city phone# i ❑ I am a homeowner performing all work myself. ❑ I am a sole ro rietor and have no one workin in anv capacity ❑ I am an employer providing workers' compensation for my employees working on this job. j company name. :'>'.... Jam'I 1 � 'LC� ft.� address.: . : _..cttw 6W:A I S i ' Jhone: � i insurance co. I= . . :.. olicv# I am a sole proprietor, general contractor, or homeowner(circle one) and have lured the contractors listed below who have the following workers' compensation polices: comyanvname. address. phone#. >. :.. insdrance.ca ohcv# canmanv name: > .. address: city: " phone#. insurance co..: olicv# Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify r to ins and penalties of perjury that the information provided above is truo and c rrect Signature Date Print name F-1 , I C�7 lW r Phone# official use only. do not write in this area to be completed by city or town official city or town: pernutilicense# ❑Building Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other (raised 9/95 PIA) 9,4e WL,/!I%Cadzimea Board of Building Regulations and Standards One Ashburton Place - Room 130.1 Boston, Massachusetts 02108 Home Improvement.Contractor Registration Registration: �,0 :0 Typ /Private Corporation Expira'Lnr: l /2002 E J JAXTIMER, BUILDER, INC. ERNEST JAXTIMER --'----- ----- 48 ROSARY LN _ = ----=---'---...-- -------� ___ _._...---- HYAN N I S, MA 02601 Update Address and return card.mark reason for change J Address .. Renewal Employment --,i Lost Card, Board of Building egulations One Ashburton Place, Rm 1301 Boston, Ma. 02108-1618 Y License: CONSTRUCTION SUPERVISOR LICENSE Number: CS 003251 Expires:01/14/2004 Restricted TO: 00 ERNESTJ JAXTIMER 48 ROSARY LANE HYANNIS, MA 02601 . Tr.no: 14213 Keep top for receipt ind change of address notification. RESIDENTIAL BUILDING PERNIIT FEES APPLICATION FEE New Buildings,Additions $50.00 -5 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= S x.0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0031= plus from below(if applicable) ACCESSORY STRUCTURE>120 sq.ftt >l20 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf-1500 sf .100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS Open Porch x$30.00= S (number) Deck l u 1 q 1 x$30.00= �6 (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool .$60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee C� projcost Engineering Dept.(3rd floor) Map Parcel Pgmit# House# f� Date Issued Board of Health(3rd floor)(8:15 -9:30/1:00-4:30)-��-•�= ✓ e Jar Conservation Office(4th floor)(8:30- 9:30/1:00-2:06) SySMU&w 5_OS Planning Dept.(1st floor/School Admin. Bldg.) Tef n Approved by Planning Board 19 �- _ pjJr y ltNSTABLI TOWN OYBARNSTABLE Building Permit Application Address S/ Village Owner,ZVL,41 Z f 4//&-171�> Address Telephone 796 ^�SCM36 Permit Request First Floor square feet Second Floor square feet Construction Type ^ oL Estimated Project Cost $ ,©z-)6 Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family 0"" 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 No.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 Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use Builder Information Name '_1 �2 Telephone Number ���-w'�✓� Address /j License# 2- 2Z/ �� sue! !� Home Improvement Contractor# Ioo Worker's Compensation#09 ,.B&j A NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO &0oo, SIGNATURE DATE - -,1 —®27��� BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) } FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED i MAP/PARCEL NO. t t ADDRESS 4 ( VILLAGE OWNER i T , DATE OF INSPECTION: r FOUNDATION i = FRAME INSULATION " FIREPLACE ELECTRICAL: ROUGH. FINAL PLUMBING:-- "' ROUGH FINAL - GAS: a x' ROUGH FINAL FINAL BUI:LI?NG` tea>, .Y. DATE CLOSED OUT ' ASSOCIATION PLAN NO. I: 4iOME .IMPROVEMENT CONTRACTORS REGISTRATION ' Board of Building Regulations and Standards t •One Ashburton Place — Room 1301 :Boston, Massachusetts 02106 j HOME IMPROVEMENT CONTRACTOR "L_-------- -------- -'-" Reg=stration 100740 Expiration 06/23/98 Type — PRIVATE CORPORATION HOME IMPROVEMENT CONTRACTOR Registration 100740 CAPIZZI HOME IMPROVEMENT, INC. Type - PRIVATE CORPCRATION Thomas Capizzi , Sr . Expiration W"'23I98 1645 Newton Rd , t o Cotuit MA 02635 CAPIZZI HOME UPROVEMENT, INC Thosas Capizr_, Sr. Newton Rd. AOMINISTWJOR Cotuit MA 02635 DEPARTMENT ONE ASK3UR COSTUN,�:: ��..�'�. . . • 'RUC.TiON='SUPERVISOR LICENSE 4 f, Expires: . 1900 , A ►S�X��,GA�IZ�IaJR:' :� ;. • ZNSTABI V,hA 02668 r - • y it H: 1,Ea,_�4 rid •� - The Conintonti'C'alth of1fassachusetts ...-.: Deportment of hidttstrial Accidents Office of[Mvestigations 1 \_.,=!a:.':=r, ' hll0 li itslrin,�ton Street ., \ Boston,Maas. 02111 Workers' Compensation Insurance Affidavit A Itcan inf name: � 2 2 1 location eih </��7Y//.%J /'`/ d Iry �5� —phone# I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity =:._- _.c •.....a6;.. �ru..:ux�'.+::�r�-.t5�= - .v_: z�.rh..g�..sY"u``�' �^• '�s::::.,s:...:_—:,st .r_o....,.�':i^��;`�. I am an employer providing workers' compensation for my employees working on this job. co p nnv na in e: address: city Phone#: insurance co. . .:- .s 'r.".�'.' .—...:�� 4t-'.e:n'^'£`"''�_..e_+�_J t'.r,.+.. ,.e...r:y <. �q�«+C^.+.s+<... ak_ra.a..,e+�... ...�.c.�-u.t^` ..'.ter... ..+.•.r. :«. I am a sole proprietor, beneral contractor,or homeowner(circle one)and hav:hired the contractors listed below who have the following workers' compensation polices: company name: address: cite: phone#: insurance co. # a._�a_._-........c _.rs_ _.... :vti•.mar~i.-s:a:_._::ti.S_��t:r�::L•at+i�:i:�.:'� c ie:;.•c�°_�,��:x'S�es'•�.--_•_d-�:.�.., ,.....,,,._�. '�.,��•y-�,,. .'t•_: company name: address: city: phone#: insurance co. _polio'# t,tiac6 additional slicer if ricccssa e —rc;_.ate �e z rz -, «; ""—�%"§' ".•, =n�n" �""1+ - s"_ �*, H , t' _.,�'-- - .�.usr la -'..x+ ..:ir2-a: �asl�'.r�'.ti.:s:.d•.. t;:r..a.., `xa,�.1 'd;.. ...=ds.i.'i.+..:.�'s Failure to secure coverage as required under Sectionr25A of NIGL 152 can lead to the imposition c`criminal penalties of a fine up to S1,i00.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a rite of S100.00 a day against me. I understand thai a cope of this statement may be forwarded to the Office or Investigations of the D1A for coverage verification. t do hereby certijrr der pains and pe Ities ojperjuiy that the information provided cove is true and correct. . Si_naturc Date Print name /'C �� �� P-none ""- .. official use only dt�n t write in this area to be completed by city or town official r cih or town: permit/liccnsc a; t l►3uilding Dcpartmcnt k.. OLicensing Board i ❑check:if immcdiale response is required OSelectmen's Officc C]Ilcalth Department contact person; phone#; nOther �,� �...,.....- .....r,•Y._�. .. ..,_;_.. ._.,.C.-_�!-�•.�-::-Rwr!f�a?-.. .�r. iv-r_.;—�..-r-•"-......,.:... _..a•. .,-.�e��'.',-=a' I reciu:;nn I'lA l table - - . .. The To" of Barns . U"& Department of Health Safety and Ennronmental Serer. es - Building Division Ma 367 Maier SUMO HYaams MA 02601 Ralph Ca= a Ogg Mg-790-.62V BM1 Commission: Fad 308-775-3344 For affiae use only Permit no. Date 2=Zz--2 L AFFIDAVIT TO _ HOME IIIZPROVEMENTp�,rO�CAIIONW SUppLEMEn requires that the reconstruction,alterations;renrnration,repair; ° MGL c 14ZA a��o� n' � i fGL c e 'rzmo%al, demolition. or consauction of an addition to'nay j at least one but not mom than four dwelling units or to which are adlacrat building containing registered aomtmetors,with certain moons.along with oth' to such residence or building be done by test ` . et' �- Cost 'w-; - Type of Work:.. . Address of Work- �� •G"`� Oaaer.Name, Date of permit Application: I hem certify that: f , Registration is not required for the following rrason(s): Work excluded by law Job uadct S1,000 Building not owner-Occupied p�rcca paiTsng°wu pazzzu " . Notice is hereby gh-ea that: . OWNERS PULLING THER OWN PEpjUT OR DEALING VJ MUMCI�C CESS ,iOC.� VOR APPLICABLE EONS VaRO�r WORK DO NOT 8A ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c 142A r - SIGNED UNDER PENALTIES OF PERTQRY I hereby apply for a permit as the agars of the owzucr- 0® 7 ,,�z7 Na Date ¢Ga,-� OR j�a-,�`r,, -��• ,, ©;i�� . o�..;�r� �/�/tea _ Assessor's map and lot.number ........ ................... ........: SEPTIC SV STEM MUST BE o S •y -�'^-� INSTALLED IN COMPLIANCE Sewage Permit number............... E�IVi13tJ�1 WITH TITLE 5 MENTAL CODE AND Qy�FTNEr TOWN OF ,BARNg "A t Io S F-i' SS i BAHHSTABLE, i 9 " q BUILDING INSPECTOR 'E0 MA( APPLICATION FOR PERMIT TO L�� GL . TYPE OF CONSTRUCTION 2.4)a'KIA.... ...................: i /..►!` ?!...... . 7..................19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .....Z14.. ................... h�?��1..�tl- '`E' ................. ., ................................... ProposedUse ..... 1 ! .................... ....'............... .... ... .......................................................................................... Zoning District f� ........................................................................Fire District ...... ?^:. .......................................... Name of Owner .....�' C/....... ?�t' v?!vic'?✓.........Address .............................1. .�L1 `?z!..f�� .? c�............ 7 Name of Builder ...(, r..:.....`..` .(.Fv'i!i, '!, ............................Address �h,�...... �:`>?,., ....P.: :. ..: .. .. ...A....... r Nameof Architect ............l. .................................................Address .......................................................... �................................................Foundation ......:%.... ................................................... Number of Rooms ............... . -61 Exterior ...... ...f/.... .... .....'.. ..C... / G :.................. ........... .................Interior_.._..,,. Heating .......Plumbing .......t .. .0 ..................................... N ....................... Fireplace ........ .................................................................:....Approximate Cost .......... Q ,Q...'.... ................................ Definitive Plan Approved by Planning Board _--------------------------------- ________. Areal. ............................ Diagram of Lot and Building with Dimensions . Fee .......✓..�.............. .......... SUBJECT TO APPROVAL OF BOARD OF HEALTH Lj t I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above y construction. 0 Name .. -� `.... .. ... :�4 t SKINNER,; GEORGE ' 23948 ADDITION .. Permit for .......Sirag.7.e.•F alai I-Y.::D.We-1.1 ng.............. Location 2.,.. L............................................................... t#21 Hawser Bend Rd. �.� Centerville :0.01 " .................. .................... -, Owner . George Skinner - -- ' . ........... - .__ r Frame . Type of Construction .. .. ... •p k n! Plot '........................... Lot ................................ . il 82 Permit Granted.. Date of Inspection ....................................19 i Date Completed. '-21P". .19' ! -• s PERMIT REFUSED ! _ .........................r.................................. 19 ............r ................ ................................. .............e� .. ..................................................... - I►/ ell Approved ...:........................................ 19 /- ..... ..... ................ ..... - t .......................................................... ................. . G , Assessor's map and lot number .................... t Sewage Permit number ...........................................:............... i' THE T� TOWN OF BARNSTABLE Z B)HBSTADLE, i "6 BUILDING INSPECTOR /oj�,0 MFy a� s APPLICATION FOR PERMIT TO ......................................... ..... ............................................................................. TYPE OF CONSTRUCTION .................. ..... . ..................... �. ...............19....... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for. a permit according to the following infoorrlmationn-:- Location .....,, !%. (.:....../ :. ...�3.?. ..................(;;,P �C'�.�-c.� � f.... `............................................. ProposedUse ..........................................................................................................°..................................................................... Zoning District ............`................................................fi=:..,......Fire District ......`-`�:. '�....�p.'?............................................ Name of Owner ....( > rl P� I.. ..t..✓-..Q'il:�.........Address .............................!'z<.tt.......�u...... ....... ............... Name of Builder f . f J w �� '( -�' le., .... ... .:... �?:^.�'....................................Address ....:................. � ...... ......:............. � Nameof Architect ............. ...?........1.....................................Address .................................................................................... �................................................Foundation XrrfC_i Number of Rooms ................. .............................................................................. Exlerior / .. Roofing / � .........�../. .......\....'.... N-'l'. ............... ............ ` .•......... Floors 2!� !1 Interior )-r lCJ ........:....................................................... .............................................................. C Heating /� �ii1� .,lrr�c� -y ........................................................... ......... ......................................................................Plumbing .................................................................................. .............................Approximate Cost .........t�`-nn/�Fireplace .................................................... pp ....................................?................. Definitive Plan Approved by Planning Board ________________________________19________ . Area ../�o ........................................ Diagram of Lot and Building with Dimensions Fee -�............................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH o � I' y F I hereby agree to conform to all the Rules 'and Regulations of the Town of Barnstable regarding the above construction. t'` Name{.. .... /lit u,.I............................ li .......... .... .. J SKINNER, GEORGE A=192-85 23948 ADDITION No ................. Permit for .................................... Single Family Dwelling ............................................................................... Lot #21,31Hawser Bend Rd. Location ................................................................ Centerville ............................................................................... Owner .,George Skinner ........................................... Type of Construction .......Fr. ...ame .. ............................. ............................................................................... Plot ............................ Lot ................................ Permit Granted ,,...April 9, 82 Date of Inspection ....................................19 Date Completed ......................................19 R PERMIT REFUSED { ................................. .�.z:..................... 19 r0� /0. ................................................................................ ............................................................................... Approved ................................................. 19 / Sip ............................................................................... ............................................................................... ■ ..n ■ ■ ■. ■ ■■■ .. ■ ■ .■■ NOON■ ■■■ ■ NE.■..■■■ ■. ■ ..EEi �. . . ON. .. .: . ■EN■.m H■m■: .. .!.■E'::n C ■':E ...N : C:■iEs:.0.' ■.s.■CC�. ■ ■. ■. ■■H■NN ■ : ' ': ' " E■ InM No ■■o . . ■ E IM N■N■■ :■ :...:■ ■C M OMEN so M .NNE�iEEE.n .. . .Fill MEN: : N■■ E . ..:■ : .::■■. . 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C:N � � _ ■ ■ �■■�i�o.■::C■No■n:■■:■ ■ ■E■■■n E.■ ■ ■ NOON E■NE■E■E■E■i ■■n■E.■ ■:: CNOE. ■ ■■ .:■ ■C.N::■■:E..No■m■■■■.■NHEE ■H■.EN .■E ■N ■N NOON. ■ .■ NONE IN ..NN .N..... ..C■E�i..: ::_■■ oN ■:■:o:EE .■ .Nm■m�n.i.:�i■■ COONn■. N�i n: ■ oo ■ NN■ E. :mn■■■ONEo■■■m..�i�E■■EOE■m■ . 5�i�. E.■� ..■: . .�■_■ ■.■�■C..E■■N■.MMw■EE ...■ M so IN C■ ii■ ■ . E■NN ._. _ m�i■o■ ■ ■oC■NoiN.■N ■ ■N■ •• ■:.: ■ : iiMM OO ■CON o.w■ ■:oC.wno n■ : ■ ■.N ■ ■ ■ ■■ :. ■�:.�:NEm■m.■■iim■®■ ■■E : H■■:.: ■� ■ ■ �� ...E ■■Nm■N■m.. .■ICON ■om�liN ■■m ■ ■■ ■■ ■: E ■®■. ■ :■ENE■O■ ■ ■:■ .■E MINN ■■. :..:C:. ■:■.: ■� ■: : ■IEEE MINN .■N■.■■NN ■ NEON m■. ■ ■o E! ■ .■ ■n ■C■ IN MEN ■ ■ ■■mmmo■■■ n.o■ of ■ ■ ■- . C ■.■ : ; ■:Co C En■ C.:.■■■N:..■:C.■:C. ■ E ■ ■ rx. . Assespr's a and lot number G���'�/✓ £ v SEPTIC SYSTEM MUST BE ,} INSTALLED IN COMPLIANCE r r� � .. \:ITH A^.TICLI= I I STATE Sewage Permit number. ............... .. ..... ... SA ITK Y CODE AND TOWN r °*TNE,°�4 TOWN OF, BARNSA 'E 1111ARBST11IILE; "AG` 1639. BUILDING INSPECTOR O IV?N n, ; ti p' r APPLICATION 'FOR PERMIT TO .. .. . ......... V/ c� TYPE OF CONSTRUCTION .... % .........I............................................. ........................................ N` .................................. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..... ............. ��:...C.�................................................................... ProposedUse .. . .....-1!t��`. ........................................................... . ............................:...............:.......... ZoningDistrict ............ ...........................................................Fire District ...................................................:. Nameof.Owner .�^ Tr / .. .....:.....�.................. ...........Address �... .. ..... .......... ... ..... ...... .................... .... Name of Builder ."..'� ....Address .4 col. .. ....... ............................... .. ......... . Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ..................................................................Foundation .............................:... .............................................. Exierior .......... ...............................Roofing .................................................................................... FloorsInterior .................................................................................... Heating ..................................................................................Plumbing ................................................................. Fireplace ..................................................................,...............Approximate Cost .........J Definitive Plan Approved by Planning Board ----------------------•---------19________. Area. .......................................... Diagram of Lot and Building. with Dimensions _ .Fee ............................................. . SUBJECT TO APPROVAL OF BOARD OF HEALTH 1 hereby .agree.to conform to all the Rules and Regulations of the Town o arnstable regarding the above construction. Name . ............ .................................................. Skinner, George .4S7 18427 swimming pool .................. Permit for•.................................... .................................................... Location .......3.1..Hawser...Bend........................... . .. .............. ........ Centerville ................................................................................. Owner ..........!Rep:rge Skinner ............................................ Type of Construction ...................... ................. ...............'!.................................................................. Plot ............... ............ Lot ................................. Permit Granted ........Ju.ne...2.....................19 76 Date of Inspection 06...... ...........19 Date Completed ......19— PERMIT REFUSED 11............................................................... 19 ............................................................................. .............................................................. ............................................................................... 7........................................................................ ,'Approved ............................................. 19 ...................................................................... ............................................................................... Assessor's map and lot number Sewage Permit number ....:............... °`?"ET°�° TOWN OF BARNSTABLE BARNSTABLE, i t "6 9 BUILDING INSPECTOR a• r _ C't APPLICATION FOR PERMIT TO ......... •�X• . 1�)�. rx;.ryrcr,..r� ........................ , / ? ............. TYPE OF CONSTRUCTION .....v:{�y ?c ,I........................................................`....V..................:........ ..................................G TO THE INSPECTOR OF BUILDINGS: The undersigned ��hereby applies for a permit according to the following information: Location ...:�.�... !� i�r.!....� .... �` ............�L�..........................................:........................ ProposedUse .. .s ..... {"� -` ...................................................................................................................... Zoning District .....................................Fire District . ................................... .............................................................................. Name of Owner ..;...:... ,�+ ....? " ....Address �.. • !�!-dt-�� d-sue �.. ... Name of Builder .3.'.. . +,.. .....................Address �!.� i`--'� �`�''1'Cc Nameof Architect ..................................................................Address ..........................................:......................................... Numberof Rooms ..................................................................Foundation ..................... Exlerior ....................................................................................Roofing .................................................................................... Floors ......................................................................................Interior .................................................................................... Heating ..................................................................................Plumbing ...................................................:..............................Fireplace ..................................................................................Approximate Cost ..... ............................................ Definitive Plan Approved by Planning Board --------------------------------19________ . Area .:........................................ Diagram of Lot and Building with Dimensions Fee. ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of'Barnstable regarding the above construction. Name .s ... ' cad.. ... •.-�-c.%........... Skinner, George A=192-85 18427 swimming pool No ................. Permit for .................................... . ............................................................................... Location ............3 1...Hawser Bend .... ............. .... .... Cente le ...................................... . ................................ Ge rge Skinner. Owner .................................................................. Type of Construction .......................................... ................................... ....................................... Plot .................... Lot ................................. Permit Grant ec!L--J�une 2......... -6 ..................... .........19 7 Date of Inspection ..................... ....19 Pate Co'mpleted ............... 19 .............. PERMIT REFUSED ..... 19 .............................�. .............................................. . ............... ............ ................ !h ?z.........................14.:;7................ ........... ........................... ................................................... Approved ................................................ 19 ............................................................................... ............. ............................................................. Assessor's office(1st Floor): �.,. PT& YSTEM = f T Assessor's map and lot numbers a .. ,r I6i9S LL ® 9Kq COPOP�.If' NIC-r7 Conservation(4th Floor): Y - `� b�-fi 3 g� - WITH TITLE 5 Board of Health(3rd floor): t t asanr►ncc ; Sewage Permit number 0- y `ice F �����'� ��� � �� 1•, rua TOWN Engineering Department(3rd floor) �o air House number y Definitive Plan Approved by Planning Board ',, 19 . APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1y00'-2:60 P.M. F TOWN 4 OF BARNSTABLE SUILDIENG ; INSPECTOR APPLICATION FOR PERMIT TO Xd/�C.a A161W /Z X !!Z 2k��/C TYPE OF CONSTRUCTION / ,plt//'�f�/� !y/�X.r� ���{QG.4�✓�l �C3�,��yt/G ' .9 aG 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for permit according to the following information: Location .3Z Proposed Use Zoning District. f``� Fire District Name of Ownereew �'7,��3, ��//�(I�GL� Address 3 ���Y✓ �LC�� 10 Name of Builder Z Awm:4E- A414MI A- Address i-iyr 026 X- Name of Architect Address Number of Rooms Foundation Exterior Roofing Floors Interior Heating Plumbing Fireplace Approximate Cost Ila as Area eli 0— Diagram of Lot and Building with Dimensions Fee z 7 Gr J OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name � i , � B Construction Supervisor's License O Al4Af _ BRUNELLE, HAROLD 31 HAWSER BEND, CENTERVILLE No � Permit For INSTALL DECK. r, S. F. D. Location Owner i Type of Construction n Plot Lot Permit Granted 19 Date of Inspection: Frame 19 'Insulation 19 Fireplace 19' - Date Completed 19 - • �fr • - - i COMMO , _ TH OF MASSACHUSETTS h -�w - _ N SYAF.irT" , s ca a soSTON M S��AGHUSETTS c, III WORD. CObeENSAnON INSURANCE AFFIDAVIT •. picalsedplermiII4 with a principal place of usinesslresidenee at: erebr ccrofjr•under the pain:and penalties of perjury doh . � ` -orb. 1 am an employer providing the following workea'comper:aaon coverage for my em 10 es workin on fib. " P y _ 8 u Cp 3 0 insurance Company _._ ...._ ... __. 1 am a sole proprietor and have no one working forme. I am a sole rieao prop r-general eontae=or or homeowner(carer oar)and have hired the`• whp have the Mowing wodcers''co :•, _ , _ eontaaoa listed beau► o have _ Mpentiti011 1n4umriLt Name d Conaactor __ _ . ...... . .. . ........ Iasn nee Company/policy Number Name of Contractor • Iniura�l�.C.onap�yAPolicy Number _ flat-.' t Name of Contactor . Iruuraaac CompUy/Pohey Number •___.D 1 am a homeowner per6cmin all the wodt myselii ~ NOTFs !laic In aware that while homeowoee who employ persons to ao maiateaallm eoastr a ain or air woo dwe?ling of net more thaw three uniti io which the 6omcowow"nsi"won io uada f eP do oa: tm ippwTsaaar thereto ars flat Seoertlly considered to be employers under the�oricers'Gsmpeasatioa Act(GL C ISL so&10)).appliation by a homeo m fora liceasa or permit may e+riaeaa the!e=a1 snots eras eraploysr tinder the Worltsts`Com a•Aet. _ pessatto rf s I underttaftd chat a top. of tltls:fsamont wr71 tos RorMardsd m t!u 1�eparmsGc o�ladusarlal Aeddeao•O(!1a ofLuuranoe for!sauces;! , Mt:::icstion and that failure to sum a"WW ai•requked land-�Sicdon 25 of M%'1S2 c�GsI kid ur tliAc'itttpoeitior'of corsuonS of a 6ne of up m it 500.00 and/or iiopri:onasen of up to one yew iad dQ penaloeCk the forts of s Slop aDork Older sze a fine of S 190.00 a flay!gaka me. _ Signed this day of ri-�Oe-A 19 Lic:i Termlaec Li=or/Fermiaor DEPARTMENT OF PUSUC SAFETY COMMONWEALTH 1010 COMMONWEALTH AVE.OF (I l MA88ACHUSETTB BOSTONF MASS.02215 � y 1 ENCLOSE CHECK OR,MOt ORD L I QENSE I 'k 10/31/1994 CONSTR. SUPERVISOR FOR REQUIRED FEE, EXPIRATION DATE r SI. ` MADE PAYABLEJO d EFFECTIVE DATE LIC-NO. RESTRICTIONS "COMMISSIONER OF PUBLIC SAFE 00 11/01/'1991 057032 DO NOT SEND CASH THOMAS X CAP I Z Z I JR 644 STRAWBERRY HILL RU4 PHOTO 11"TTNO OPR ONLY) FEE: CENTERV I LLE MA 02632 - - r , I NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY I' - e HEIGHT: STAMPED •OR•SIGNATURE OF THE COMMISSIONER 1963THIS " CAR DOCUMENT MUST BE SIGN.NAME IN FULL-ABOVE SIGNATURE LIN. { TARRED ON THE WHEN ENG G- / 1 F LICENSEE ' THE HOLDER WHEN ENGAG� I OTHERS•RIGHT THUMB PRINT EO IN THIS OCCUPATION cq Twn + 2DOM-2-87-81.29 APPR AUTH. Jl • 4 • 1. • DEPARTMENT OF Pusuc SAFETY n -- » n COMMONWEALTH im COMMONWEALTH AVE _ OF �f1 MASSACHUSETTS �STON,MASS.02216 ENCLOSE CHECK OR MONEY ORDER LIt_ENSE FOR REQUIRED FEE, EXPIRATION DATE CONSTR. UFERVISGR\� MADE PAYABLE TO •;,` �°� .a f TSB EFFECTIVE DATE LIC-NO. RESTRICTIONS g F "COMMISSIONER OF PUBLIC SAFETY" , >�S J o9/=a?/199'2 046189 g =� UU ` (DO NOT SEND CASH).' t^ % ��,!'•'�: CARREO ON THE PERSON OF 0- .. %• `f„ll,:v THE NOLOER WHIN fNWO• - ( c� COfrM15510NER I .. �B MINT ED VI IE OCCUPATION 200M•2$7$11 - .. '� _ PLOT PLAN. f r FOR LOT ,try Indicate location of garage or acc ssm bulldiag - •'' `, Additions with dashed lint: ------ . -- -- Sewerage cWposa (ccsspoolj.l�. . W+rll Abuttor's Lot./ , Rear Yard r u this is a a'�a a o caa!aer lot. s writs in nazoe of street. Sideyasd HOUSE Sideyard other µtcet. • � { ea � • � 111 r•;'r � • Set.Badc y -�# � � - � �.Pik t,_ ^rf `'`• e ) .. `" r ` '; .,,-. c. ` S , L `� / MM�M-M--�M-M-MM-M��M-M•1*M--w-A- h'1. 1.. (Name of rt"q, *��rX ,\,. �/�r.''''�� i^'a � � .� � q t .� � .. � � 9 b•,.. $ � r v' f.4� i�� 77- Wormatioa Supplied by _._..._..- "{i'�x ��p��—e .w9� Pit, �'�,' � fi,� d .•St: -t' ��t, :` � 'ti��� �t i y+ ,.✓� " . L� �'��� �'� ')� d }�'�,i � x M r i•,i'} a ,,y '•,.. '� t ,V:�� t`k a + � �r'p *a + t d y h ft Y l •Yhi�' f yfi � .0 � X n c 4� a rod {) J1 x�,°d'n.- ' :R.t.#.2'aM1 .v4'+:.eri nss...�at t ., .wi ,: ".M:a .• .,. ... .., I4, ._.«a+..r�i'r kr .w:W-+,.:'i� smart"k nk�:y1:Y ,.. i oaIMP•AK)VEMEII CONT TOR I t rs o Wildln .04 A_ ehhui toy BoetOl has"chuaetts 02 17� :. -''3"�:;s rs"b�•4 ��-n' - -S �j.ta Y � � T�s: _ � IMPROVEMEN COKTRA�CTOM� •' -'� �' - Rssiatratifan 10074 -== Expiratioi 06E23/ E=_J {~• e'er ' _- = '1 Type±— PRIVATE CORPORATION-- r _ tWepw It COKTRACTO=;: •_ i = Cap i z z f Homer Impr'oveme nt; Inc. - oil 1 - PRIYATf C9RPOwATIO .` Thomas Capizzi. Sr.- i E4irrttee =1N23/9i�-A. - 1645 Newton Rd.- . Cotu i t MA 02635 • - r Cipist Novo Iwrowoe*, lw.-- - • . . . Thou$ CAFItt[, Sr. �c�.oR equo Nevtol Rt. AD ".locN� . � ram~'" . .. : . , _ _ _ .. ' �X� .9�sigrAeR•�3�i�. s~). 0dF 8 .. - lib '�i oTll�,�►�+ Mae 0* MAVA •a , �.r u C r . ;+ r • • „ ' .V.'..; ems+ F fii Fj A r }F i� ��� �;i r Yss x _ •� +f Y 1 3 V4� ,� � + •�� � ti• � 1 y R � $ 1 of mr rqw The Town of Barnstable �1, _ l �-�, :c_•;. �`_, I 1 I i f'Ufllllt'I1113� I1'lCl'� it )uilc�I tb llivision 367 Main Street,Hyannis MA 02601 Office: 508 790-6227 Ralph Cwssen Fax: 508775-3344 Building Commissioner For office use only Permit no. Date AFFIDAVIT HOME 1WROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c.I42A requires that the-reconstruction,alterations,renovation,repair,modernization,oomrersion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwvelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. / l 1 Type of Work: <AWAA-e-P7/lflG A2 k 4t Est.Cost Address of Work: 3/ r Owner Name: Date of Permit Application:_ /a I hereby cenifv that: Registration is not required for the following reason(s): Work excluded by law. Job under S 1,000 Building not owirer-occupied Ovmer pulling own permit Notice is hereby given that: OWNTERS PULLING THEIR OWN PER,%, OR DEALING%��UT'REGISTERED CON- RACTORS FOR APPLICABLE HOME IMPROVE!,1,:-NTT NvORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARAVTY FUND UNDER NIGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hcrcb\-apple for a permit as the agent of the ou�,cr: AGO 7 90 Date Contractor name Registration No. OR Date Owner's name TH CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND COERS NO RIQHTS UPON THE CERTIFICATE MOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR AL POLICIES BELOW. TER THE COVERAGE AFFOIiOiD;0Y TliE NORCROSS & LEIGHTON 437 STATION AVE COMPANIES AFFORDING COVERAGE S YARMOUTH MA 02 6 6 4-0 5 7 9 coMPANNr ...................................... ........... .. ....... .... MARYLAN.D CASUALTY .................I......I. ........._................................ .... .............. COMPANY Trm Y B MARYLAND CASUALTY .. ... ... ...... .... .... ............ .......... COMPANYLA P C CAPIZZI HOME IMPRVMT ... , . . 1645 NEWTOWN RD COMPANY D COTUIT MA 02635 LaITrw AETNA LIFE CASUALTY COTS Y E LaTof A�►GE>i _ TH18 IS TO CERTIFY THAT THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWRHSTANON 4 ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CiR'TW4CATE MAY BE ISSUED OR.MAY PERTAIN. THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED ME96W IB 46UOJGG'TO ALL Tft TERMS, EXGLISIONB AND CONDITIONS OF OUCH POLICIES. LIMITS SHOWN MAY HAVE UEN REDUCED BY PAW CLAWL ........................................................................................................................................ LFFECTIVI POLICY O TYPI a PC&=pLMfill nY h . "n m EXPIRATION � IHHHMOOJYY) ...000 AAL LblfrNf111 ERA1318 8 0 5 8 4 01 9 4 4 0 l 9 5 N)iN{RAL AQQPAUTI 611. 0 0 0,,0 0 0 X COMMIWAML QDdWAL UASLITY PROGYGTIYCAMPIOP AQ. •1, 0 0 0 N,0 0 0 CLAM MARS X 000U0.. PEIwowIL a ADV.INJURY *1 a 0 0 0 k 0 0 0 .OwNEIra a CO STPACM&PRO. - LnCH OCCURRi". •1, 990 , O.O.P. PIRA DAMMM Wly OM n► A 5,0, 0 0 0 WED.EXPENtie(Aft Wo pamn) 65 0 0 0 , �AUTOMwLa uAWTx CA 9 9 6 4 5 0 8 7 4 01 9 4 4 01 9 5 coMNunrp slHwLa ANY ANlfO LNwrt AiL D M®ADO♦ BODILY INJURY X WAWAAD MIM IPW o«.al► +10.0..A,9,0.0. `l. HWlfra AUTOB eoolLv INJuRr h0*OlNl"AUTos i0010Mw 0 0 0 0 0 0 . . N)ARAN LWLRY ......... PRDPiRTY oAHIALiB • OO O - •500, a►cw uAlm" LACH OocURRYNCi a OTHER TAW UMBRELLA FORM aanum Q01/BMAT" C2 3 9 5 3 0 21 CAA 4 01 9 4 4 01 9 5 X STATUTORY UMITB 0"AGGIOBNT $10 0,.0 0 0 AIo awArL-p"Y LwIT 65004000 .... MIwWVMW LMMRY DIYeABe-eACH eMPLOYee `H 10 0 0 0 0 vttiw - BBBORrn"or OPBIInnoIlBAocA mw HOME IMPROVEMENT CONTRACTOR ^> SHOULD ANY OF THE ABOVE DESCRIBHA POUCIES Bfi CANCELL`sD BEFORE THL EIIPWAT►ON DATE THEREOF, THE ISSUING COMPANY WILL 6N06AVOR TL MAIL 10 DAYS WRITTEN NOTICE TO THfi CERTIFICATE MOLDER NAM60 TO TML LfiPT, BUT PAILUPA TO MAIL BNGM NOT" SHALL IMPOY6 NO 9B614ATION OI, LL24M OF ANY KIND UPON THE COMPANY, ITS ANTS OR R6PRBGIINTAVIV01L AIrTHIOR�BBPIrBLNTATnn NQ R1lSS i LELQjT . LK Robert H Lei$hLi. Ip RATION Iti ACOHD 25-5 190 72 Assessor's map and lot number ................................45..... SEPTIC SYSTEM MUST INSTALLED IN COMPLIANCE YvITH A';TICLE II STATE Sewage Permit number ...... ....;....................................... AND TOWN SANITARY CODE A TOWN OF BAR.NSfABLE ypi THE?� •�._ BAWSTd➢LMAM 1639. S, y®Ili.. O GM Or BY i��Y • �,Co.M .. `c�ct �t. ..... �. ................ ......APPLICATION FOR PERMIT TO .................. ... Y.. ... TYPE OF CONSTRUCTION ......... k?.' `4.1..Q,A.� �"� rRov4 .: .............../.... ...l-Z............197-3. TOi THE'INSPECTOR OF BUILDINGS: _ The undersigned hereby applies for a permit according to the following information: �S���c�/V /I �a 1 � a Location ..Ira.i... .1.:. �h➢1.G1„EI.N!?. .t`1017. tr,��t �`.c !~kfS6 �t�E;t�IIYS.:!Q.�� b?�oy�Sto.N.??.�) !.R. aQ.�.. � .q Proposed Use ..................... <v n.(;z,..... .... 1i....V.—.; !!k. 1'1�(,.. ... .�.D. C ......ONL�......... ZoningDistrict .............. ........................................................Fire District .............................................................................. Name of Owner ..ailQ.Y. Xuwmaatl............Address ��..C11Q�, 1 � ?-ti.. .•• `''°` M Nameof Builder ....................................................................Address .................................................................................... Nameof Architect :.................................................................Address .................................................................................... • Number of Rooms ........... Foundation �c. ........................................................... �eea. .�.......... ........... ; Exterior ...................k-k� .................................................Roofing ............�..°��� l ,:.V.............................................. Floors `.; .�...............................................Interior ...........�.> {. .....`!W.�!r 1. ..~ Heating �� ��- lam•.............................Plumbing ..............:, ....z�.Z. .�1 .......................................... .......................................... Fireplace .........................�;�...............................................Approximate Cost ......«t'•oc�............................................ . Definitive Plan Approved by Planning Board ________________________________19________. Area S.� .......................................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HE H 700 ®� aa 9� 4.j `C.Ap � v — a = L) VV �1 < qj oe � w � w I hereby agree to conform to all the Rules and Regulations 0 the T� �afnw arnsta egarding the bbove construction. p.....Name .......... . . .�..�... ....eai.l... ................. L Bay C010ny Builders Corp. No .....16571 Permit fo I r .....1 1 2...st-0.. ..... single family dwelling ............ ............. ....................g........ ..... .......... ...... -3 61711 S Locatio . ......Hawser...Bend...Road..................... ............. ........ ........ ....................... ... .......... ................................ Owner ........Pay..95?.lqwAl4:m.Cqm, Type of Construction .............fraMo.................. ................................................................................ Plot ............................ Lot ...............k2i........... Se Pber 9 73 Permit Granted .........21?9....... ......... . ..........Date of Inspection ....if...... ..........19 0:/-T Date Completed ........... .....Y...................19 PERMIT REFUSED ...................................... ......................... 19 ............ ...................................................... ................................................................................ ............................................................................... ............................................................................... Approved ................................................ 19 ............................................................................... ............................................................................... 3C �a Ca n Crosb Rd N Ben chm ark Set BULKHEAD COR/TOP CONC, Pen Ln EL.=101.85 (Assumed) X 98 88 Posth,' P�qN Bk? C°''ed �o�Q'0 0 y t°st� m° P Oµce< ZA/V Bk 36 �a °o i° MOsth 3,i ` 7 ��°� `µ`es a �D `� PG' PG' Sp, ep" �Z o ?1 o cce�o S�P g mm° a LOCUS 24 t Al i _.3o 90 LOCUS MAP X 98.11 NOT TO SCALE O � EXISTING LEACH PITS 00 SHE LOT 21 TO BE PUMPED, FILLED W/ ^�O O SAND & ABANDONED �)99,08 + 9Q.35 �r + 98.29 1 N \ PROPOSED S.A.S. TRENCHES of Io 137.>' PROVIDE INSPECTION edge 30 F PORT ON EACH TRENCH \ 99.21 98.78 + . + 98,64 C_ --99------� :f- 98,48 EXISTING SEPTIC TANK ` \'�g� LOT 22A X 98.32 (TO REMAIN) TOP OF TANK, EL.=99.77 INV.(OUT)=98.44f(VERIFY) 19. _ - --__ 99.72 \��I \+y96.90 98, 4 100-- edge o 9--- r,,. SHED II. 100.24 i/ \\I - \�.\ 99.14 + 1 � 100.83 0 SHRUBS __ -x 100,77 ` N '0I i 1 Lj + u� _x 9914 I 100,54 100,54 100.33 :� Ln j HI j SHR. 101.03 X ` cv Tp T l I I DECK HOLLY: n c w TREES:`Z LJ 72 i j II Na0 0,3 x 99,7H 1 co _Z0 �G1 FLAGN 0 1 GARAGEHUSE # 1) 15# T.0.F.=101.85E DECK/ N .N-_ 1,12 101.08 9 " y0 100.43 i 101.14 `n ; PA l/ED � ~ 100,12 °� 99,99 d , 0 DRI VEWA Y ST NE II f V j LO S 21 & 22A DRI WA Y I AP 192-085 I 25,630±S.F. L=92.71 ' R=521 .81 ' --� L= ' 50.02 CD I (D 100.59 --FENCE R==;521.81 ' I - x � of pavement 100,32 100,2d1 edge 100.50 100.28 100.58 100.19 GENERAL NOTES: HA WSERBEND OWNER OF RECORD 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL BRUNELLE, HAROLD S BOARD OF HEALTH AND THE DESIGN ENGINEER. & DEBRA 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS 31 HAWSER BEND OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE LOCAL RULES AND REGULATIONS. gF MAS CENTERVILLE, MA 02632 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR Q� s9�TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE LEGEND �� yG DESIGN ENGINEER. o PETER T. s EXISTING CONTOUR 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING - 98 FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN o MCENTEE N ENGINEER BEFORE CONSTRUCTION CONTINUES. v CIVIL x 100.98 EXISTING SPOT GRADE 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. No. 35109 Wcw, EXISTING WATER SERVICE 6 THE CONTRACTORTHE DESIGN NORR IS OWNERTTOENOTTIFYIBLE FOR THE FAILURE THE LOCAL BOARD OF OF R£GI5IERE ���� -- C ' EXISTING GAS SERVICE HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. FSS 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. a TEST PIT 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. I / I(U BENCHMARK 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS uG AGREED UPON BYOWNER AND CONTRACTOR OR AS OTHERWISE PROPOSED SEPTIC SYSTEM UPGRADE PLAN DIRECTED BY THEE APPROVING AUTHORITIES.10. IT SHALL BE THE RESPONSIBILITY THE CONTRACTOR TO VERIFY 3 1 1 HAWSER BEND, CENTERVILLE. MA THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS Prepared for: Capewide Enterprises, P.O. Box 763, Centerville, MA 02632 IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). Engineering by: SCALE DRAWN JOB. NO. 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE Engineering Works Inc. 1"=20' P.T.M. 235-10 INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. (508) 477-5313 11/6/10 P.T.M. 1 Of 2 ij LEFT REAR RIGHT FLOOR FRAMING = 2 x 8 Pressure Treated @ 16" ac. 16' PIS R N 0 WOOD PRODUCTS It's all about the wood""' a The CAPE CODDER SHED 12' x 16' (Scale: 114" = 19 UUULJHLI FRONT 99