Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0068 HAWSER BEND
.� $ �'�aw5�t- ��nG� r .. ,.. � L .i � .. n .... r.. _.. n ` 'i y � - � �p y .. L . . t ry_. a ... � y .. � .. - _ i, a ,. n .. t - J a ... :. - �' ^�' t e .. {. �, � r u' .. .. - a . �.. 9 .R �. .. e � _ � o � � � -- �.. 0 v s a � .. �. �. v. .: .. �� .. n a .. rp ... ., a 9 n_ e �, � 4 '� a � .- � -' � - .= � � w ... � .. _ e _ � R � e_ .�. � N � ._ r �.. a �. 0 9. .. a n o e '. � r .. c Y .. f � � _ , .. - � n - - - - a - �. ^.. .. .. _ � .� ,. - :. .. e ... „. .. .:. � ,. � :. ®•.t _� 3 .. a .; O.. '. e, � t e .. n Y F _ ,' ._ o �' .� _. e� .. - . �,.. _ :. a <..� ., � .� ai r � n- a�' - h ., -._ u ;. c ... o �. ..._ i � T e a u � W... ... � � �F i } a a z � A ,. '� .� o - fr � o ,• ,. '.. ,. a. ., � y �,. _ - a e `,. , ati .� � _... �, T— � d. � � � � y e a � � � � �; �. o a .. i _., -, a ,, a, .. � -� e ., ;. a s ° , T Town of Barnstable Post This Card So That it is Visible From theaStYeet Approved"Plans Must beRetained on;lob and this Card Mustbe Kept PostedUShed nti1 Final Inspection Has Been Made : ® ¢• x63P ti u' 6 st1. all® s Where a Certificate'of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made Registration Number: B-197-3869 Applicant Name: TREMBLAY,JEROME C& MARYANN L Approvals Date Issued: 11/15/2019 Current Use: Structure Permit Type: Building-Shed-Residential-200 sf and under Expiration Date: 05/15/2020 Foundation: Location: 68 HAWSER BEND,CENTERVILLE Map/Lot: 192-091 Zoning District: RC Sheathing: Owner on Record: TREMBLAY,JEROME C&MARYANN L Contractor Name ,';a framing: 1 Address.: 68 HAWSER BEND Contractor License 2 Est Project Cost: $0.00 CENTERVILLE, MA 02632 Chimney: Description: 8x12 Shed Permit Fee: $35.00 Insulation: Fee Paid $35.00 Project Review Req: .Date �� 11/15/2019Final: any- . .Plumbing/Gas x d, RougK Plumbing: - ;. Building Official" Plumbing: Final This permit shall be deemed abandoned and invalid unless the work authorizedHby this permit is commenced within sa mo�"nths-after;,issuance. p ,� . s All work authorized b this permit shall conform to the approved application andahetapproved construction documents-•for which this permit has been granted.. y p , Rough Gas: All construction,alterations andchanges of use of any building and structures shall be in compliance with the local zoning by-law 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. y I applicable natures b "the 9611din and':FiriMff c alsare 1ovid�M161,1 this'permit. Electrical i M The Certificate of Occupancy will not be issued until all app cab e signatures ya g K p III a f'`� �" Minimum of Five Call Inspections Required for All Construction Work. Service.. 1.Foundation or Footing 2.Sheathing Inspection y Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection final: 5.Prior to Covering Structural Members(Frame Inspection) _ _ 6.Insulation Low Voltage Rough: 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A)., Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: Town of BarnstableBuilding g" .< ii- g ,s ✓ is ; �uw« Post This Card So That rt is Uisible4From the Sheet Approved Plans Must be Retained on Job andthis CardMust,be Kept Permit M" Posted Until Final Inspectwn Has Been Madeyg aW163 here a Certificate of Occupancy-;is Required,such Building shall Not be Occupied until a F nallnspect�on has been made r: i Permit NO. B-19-3870 Applicant Name: HOMEOWNER IS APPLICANT Approvals Date Issued: 11/15/2019 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 05/15/2020 Foundation: Location: 68 HAWSER BEND,CENTERVILLE Map/Lot: 192-091 Zoning District: RC Sheathing: Owner on Record: TREMBLAY,JEROME C&MARYANN L Contractor Narre:'-` ,HOMEOWNER IS APPLICANT Framing: 1 Address: 68 HAWSER BEND Contractor License: EXEMPT 2 CENTERVILLE, MA 02632 - Est. Project Cost: $2,000.00 Chimney: � . Description: Siding and Windows(4) = Permit Fee: $35.00 Insulation: Fee Paid? $35.00 Project Review Req: .Date... , 11/15/2019 Final: Plumbing/Gas Rough Plumbing: 1- zu_. `,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. 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 str`actures 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 inspectio k,n for the entire duration of the Final Gas: work until the completion of the same. 34 ,. £ 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 g 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 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 �. All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: Application nu �rj....�........................................... Fee ......... v` .:.. .. ................. � Building Inspectors Initials....... . .. .................. � Date Issued....4 .�. L. Map/Parcel......1.. ..oq .,1.......................... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOW S/DOORS/TENTS/STOVES/WEATHERIZATION • PROPERTY INFORMATION Address of Project: 'J;/f ZJ/6WS 4/4 6 ElV b C E-/)]�� 1//L L J�' 69.2 632 NUMBER -� STREET VILLAGE Owner's Name: J2,,fO 9- /165AG 4A y Phone Number 2 7'L P Email Address: f !J FYI D8®`I' Y I/W Cell Phone Number 5-06-,2 71 6/00 Project cost$�2 . Check one Residential ommerpo OWNER'S AUTHORIZATION o T As owner of the above property I hereby authorize /- to make application f building permit in dance with 780 CMR y Owner Signature: Date: . AT, TYPE OF WORK Siding IZ Windows (no header change)# Insulation/Weatherization ❑ Doors(rio header change)# Commercial Doors require an inspector's review ❑ Roof(not applying more than 1 layer of shingles) Construction Debris will be going to -�r6 i //L) CZE BA RA26 T14,61-6 10(M-ho t CONTRACTOR'S INFORMATION- Contractor's Home Improvement Contractors Registration(if applicable)# (attach copy) \Construction,Supervisor's License# �� .��t��. . ,� � (attach copy) - .. Email of Contractor ` Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY.IS IN A HISTORIC DISTRICT. YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. �` . . APPLICATION NUMBER............................................................ *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread"Sheet of each tent must be attached..Provide.a site plan with'the location(s) of each tent Fuel source being used LP tank 20 lbs. or>Yes No ,if yes, a gas permit is required. Natural Gas Yes • No ,if yes,a gas permit is required: Iffood is being served at.your eventplease obtain'a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. k *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION. Homeowner's Name: ,_TER01yE 7A_ a/ fQ L A Y Telephone Number ;?—.1' 7 y(/©0 Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and th o n of Barnst - Signature Date APPLICA14T9S SIGNATURE Signature Date ..� All permit plications are subject to a buil ing official's approval prior to issuance. ♦ � .lr -The Commonwealth of Massachusetts Department of Industrial Accidents 7. Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leibly Name(Business/Organization/Individual): Address: /D ,j2�{ J 6 City/State/Zip: Z Phone#: ©$'—.Z7V-0 j©() Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. New construction employees(full and/or part-time).* have hired the sub-contractors 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, Q Demolition workingfor me in an capacity. employees and have workers' Y P h'• 9. ❑Building addition [No workers' comp.insurance -comp• insurance.t f �,r�uired.J 5. ❑ We area corporation and its - 10.❑Electrical repairs or additions 3.[Q4 am a homeowner doing all work officers have exercised their 1,1.❑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. 13.❑Other y1 dU,D042, ' employees. [No workers' r comp. insurance required.] �9 6 *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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: 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 c under the pa' a ad pen ti of perjury that the information provided above is true and correct Si afore: - - Date: /ts Phone#: W_ Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: r J Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such'employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter 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(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to cant'workers'compensation insurance. If an LLC or LLP does have employees,a policy`is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts, Department of Industrial Accident Office of Investigations 600 Washington.Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 www,mass.gov/dia Town of Barnstable SHE ro Building Department Services Brian Florence,CBO t _ . • Building Commissioner �prE 16!19. 0��� 200 Main Street, Hyannis,MA 02601 ICA www.town.barnstable.ma us Office: 508-862-4038 Fag: 508-790-6230 PmzmrN FEE: $35.00 SOU REGISTRATION RESIDENTIA-L ONLY 200 square feet or less I,,ocation of shed(address), V"illage F �� Property owner's name Telephone number cn; ZLQ A X Size of Shed Map/Parcel# g e Date Hyammis Main Street Waterfront Historic District? ,/V Old King's Highway Historic District Commission jurisdiction?. W6 Yon must file with Old King's Highway Conservation Commission(signature is required) Sign off bo'nrs for Conservation 8:00-9:30&3:304:30 i PLEASE NOTE:.IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FARM MUST B]� ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:08/6/17 I` .5. ' �' � . a .+ ` - ` ��l try � � r .. �r� J'` .ei `"' .. r - „' y AA � _ j.� L, a �* ,` �. � y ;�.. ,�,',,r+ � l,,.F � L' � r� i-,f" ~^S f � . � / ' �. r' R � aY tir ia� LegenOild . �,., . �;r ,.. . r ❑Parcels Town Boundary {+ r++f + { Railroad Tracks ID Buildings Painted Lines - 192089 r� j Parking Lots 791 f Ll Paved + - 192090 i 1 Unpaved #8.2 _ Driveways E3 Paved 192098 unpaved 90 Roads C I Paved Road ! Cl Unpaved Road Bridge r 13 Paved Median f+ �/ Streams_ 1 2088 Marsh #. 5 !!+ Q Water Bodies . f r #68 r r F 1 2091 - 178 1192087 j 920 - #5d 19209 #ti6 i Map printed on: 9/2/2017 This map is for illustration purposes only.It is not Parcel lines shown on this map are only graphic Town of Barnstable GIS Unit adequate for legal boundary determination or representations of Assessor's tax parcels.They are Feet regulatory interpretation.This map does not represent not true property boundaries and do not represent 367 Main Street,Hyannis,MA 026oi 0 42 83 an on-the-ground survey.It may be generalized,may not accurate relationships to physical objects on the map 5o8-862-4624 r reflect current conditions,and may contain such as building locations. , Approx. Scale: 1 inch= 42 feet cartographic.errors or omissions. gis@town.barnstable.ma.us tf Ln N.7.m W-Mm.ru N .-,, Ln Certified Mail Fee f� $ Extra Services&Fees(check box,add lee as appropriate) 0 ❑Return Receipt(hardcopy) $ ❑Return Receipt(electronic) $ t*--` lPstfnglk'9 0 Certified Mall Restricted Delivery $ 0 ❑•Adult Signature Required $ []Adult Signature Restricted Delivery$ O Postage Q Total Postage and Fees \ �V IL Se o O Street a M1t G®, P ---- Ciy S-------Z � ��� Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail ■A unique identifier for your mailpiece. associate for assistange To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this delivery. LISPS(ID-postmarked Certified Mail receipt to the ■A record of delivery(including the recipients retail associate. signature)that is retained by the Postal Service' Restricted delivery service,which provides for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent Important Reminders. Adult signature service,which requires the ■You may purchase Certified Mail service with signee to be at least 21 years of age(not First-Class Mail®,First-Class Package Service®, available at retail). or Priority Mail®service. Adult signature restricted delivery service,which" ■Certified Mail service is not available for requires the signee to be at least 21 years of age international mail. , , Iand provides delivery to the addressee specified. ■Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent with Certified Mail service.However,the purchase (not available at retail). of Certified Mail service does not change the ■To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of mailing,it should bear a certain Priority Mail items. USPS postmark.If you would like a postmark on ■For an additional fee,and with a proper this Certified Mail receipt,please present your endorsement on the mailpiece,you may request Certified Mail item at a Post Office'for the following services: postmarking.If you don't need a postmark on this -Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece. electronic version.For a hardcopy return receipt, complete PS Form 3811,Domestic Return Receipt•,attach PS Form 3811 to your mailpiece; IMPORTANT.Save this receipt for your records. PS Form 3800,April 2015(Reverse)PSN 7530-02-000.9047 7y, i ■ Complete items 1,2,and 3. 7A. Signature "-" ❑Addressee so that we can return the card to you. ■ Attach this card to the back of the mailpiece, B. Received by(Printed Name) C. Date of Delivery or on the front if space permits. 1. Article Addressed to: D. Is delivery address different from item 1? ❑Yes If YES,enter delivery address below: ❑No II I III 3. Service Type ❑Priority Mail Expresso ❑Adult Signature ❑Registered MaiITM I'll ill I H I III 11111111 III 11111111 III Adult Signature Restricted Delivery ❑Registered Mail Restricted Certified Mail® ehvery 9590 9402 3630 7305 4658 42 ❑Certified Mail Restricted Delivery eturn Receipt for ❑Collect on Delivery Merchandise 2. Article Number(Transfer from service label) ❑Collect on Delivery Restricted Delivery 0 Signature Confirmationm Insured Mail ❑Signature Confirmation 1 0 0 0 0 0 0 6 7 5 7 2 5 6 D '€> Insured Mail Restricted Delivery Restricted Delivery 01 _ , . ., . . . . (over$500) PS Form 3811.Uuly 2015 PSN 7530-02-000-9053 Domestic Return Receipt USPS TRACKING# 1 First=Crass Mail` Postage&Fees Paid USPS Permit No.G-10 9590 9402 3630 7305 4658 42 United States *,Sender:Please print your name,address,and ZIP+4®in this box* Postal Service f TOWN OF BARNSTABLE BUILDING DIVISION 200 MAIN ST HYANNIS, MA 02601 �f. . _ �Y°�= 1r►ll�ij�ilF.f1°il.iF1�9�If��',�1��1�l1liFlri.�1�1��iFFF��i.# #r��il� Town of Barnstable Building Department Services Brian Florence, CBO DST Building Commissioner BARNSTABLE 200 Main Street Hyannis, MA 02601 �MNSKI -WER"E•`°""'•"""""'s NOASIONS MILLS•OSLEM1VIOF•KFSf&WNSiMLE - 1639-2014 " www.town.barnstable.ma.us �g . Office: 508-862-4038 Fax: 508-790-6230 Notice of Building Code Violation(s) and Order to Cease, Desist and Abate: Maryann L and Jerome C Tremblay and all persons having notice of this order: As property owner or tenant of the property located at 68 Hawser Bend, Centerville,Assessors Map 192 Parcel 091 and known as residential structure,you are hereby notified that you are in violation of 780 CMR,the Massachusetts State Building Code Chapter 1 Section(s)R105.1 and are ORDERED this date 10/23/2019 to: ABATE all functions associated with the following violation(s)on or at the above mentioned premises: Summary of Violation: On 10/22/2019 the Building Department observed violation(s)of 780 CMR of the Massachusetts State Building Code Chapter 1 Section(s)R105.1; specifically,the installation of new windows, siding and the removal of front steps. Summary of Action to Abate Violation: In order to abate this violation and to avoid further enforcement action by this office, commence immediately upon receipt of this notice the following action: apply for and obtain a building permit for work described above and any other work which require a building permit. And, if aggrieved by this notice and order; to show cause as to why you should not be required abate the violation in this notice,you may file a Notice of Appeal(specifying the grounds thereof) with the State Building Code Appeals Board within(45)days of the receipt of this order and in accordance with MGL c. 143 § 100. If; at the expiration of the time allowed, action to abate this violation has not commenced, further action as the law requires may be taken. By Order, *efr Lauzon Chief Local Inspector (508) 862-4034 Jeffrey.lauzon@town.barnstable.ma.us f a>'G 5/�zfiY Towxa of Barnstable ',Pemrit Expires 6 nu date ts a Regulatory Services Fe -^ BAmkSTABL& 1�� Thomas F.Geffer,Director Buiading Division Tom Perry,CBO, Bolding Commissioner ` 200 Main Street,Hyannis,MA 02601 wwa%.town b=table.rm.us Office: 508-862-4038 Fax:508-790-6230 EXPRESS PERIVIIT APPLICATION - RESIDENTIAL ONLY Not Valid n*hour Red X-Press Imprint Map/parcelNumiber _y Property Address & Aa w (Residential V a1m of W ork S /// V Minimum fee of S35.00 for wort:tinder S6000.00 Owner's Name&:Address Contractor's Name ,— l� Te]ephone Number p� . Home Improvement ComractorLicense T ,`I(ifapplicable) !p� 3 Fina G6��CDn� fi{C �,'1((4�P�� Cd Construction Supervisor's License-(ifapplicable) _ W orkman's Compensation Insurance ElCheck one: PRESS ama sole proprietor V6', • amthe Homeowner r have Worker's mpensationInsu ance MAY _ 8 , Insurance Company Name f J J(�,I L (.� C� 0 I Workman's Comp.Policy# W �Q�`d�hes Copy of Insurance Compliance Certificate must accompany each permit. . 6@I T � lj` Permit Request(check box) �e-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to , ❑Re-roo£(hurricane nailed)(not stripping. Goi-a over existing layers of root) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-VaIL e (maxim um.35)t ofwindows n ofdoots: t ❑ Smoke/Carbon Monoxide detectors 4 floorplans marked with red S and inspections required. Separate Electrical&FIre Permits required. 'Where required:Issuance ofthis perm$does not exempt con3pliancemirb offiertown depamn=regulatnns,ie.Historic.Conservation,etc. ***Note: PropertyOwnert ns1 sign Property OwnerLetterofPermission. A copy of tote Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: y C\Users\decoM'AppD=,LocaPJ2icroso$1w iad—s\Temporary IsvaaaFsles\Cocx Revised 061313 eflt0vrlook\$276BDNjA1EkPRESS_doc Tie Commonwealth Of kfassachzcsetfs Depart-rnent of Industrial Accidents Office O' !'Invesngations P 600 Washington Street B0stOi2, !l�lA Q2I1.1 - w}.w.mass,govldiu. WorkWs compeusation Insurance Affidavit:Builders/Contracto.s/Electrieians/Plum ere . Applicant Tnfox-xnation" Please Print Legibly Name (Easiness/Organi.zatioWIndi-y-iduai): M L Address: r City/State/zip: K 17 M)q Od b 35 Q I Are you an employer?Check the appropriate box: Type of project(required.): a employer vaitlij 4.❑ I ate;.a general contractor and I have 6. employees(full and/or sat-time' hired the sub-c Aicu'corstrnction p" 1 o- tractors.listed on ne 2. the ^t,ed.,siie ?, Rcmode>i et.+ ❑ b I am a sole proprietor or partnership These sub-coutractots have 8, Demolition " and have no employees working for employees and have workers'comp. 9. Building adttitioit mein any capacity.[No workers' insurance. comp insurance mquireL] 5. We are a corporation and itc 10 ❑Electrical repairs or additions n officers have exercised their right of 11-Q Plumbing repairs or additions 3. �—! I am a homeowner doing all work exemption per MGL c.152§(4),and 12.Q Roof repairs" myself.[No workers'comp, we have no employees.[No workers' insurance required.]i comp.insurance required.] 13-❑ Othew M.ny applicant that checks-pox rl must also Ell,out the section Mow showing their workers'.compenrtionpolicy l onr�tiol.t Homeowners who submit:his affidavit indicating dzey are dosrg all work and then hi a outsid =ttactorsmimsubinirp new aflidavir indicating each #Coaaactots that check this box must attach ut additional sheet showing the name of the sub-conrracte.s and state whether or not those enik es have�»ployaes_;f the sub-con=tors have t=ployees,they must provide.the ;vorkers'comp.policy number. I ant an employer that is propiding workers'compensation insurance for my employees.BeIoty is the policy and job site information Tnstmance Compaay Name: Policy Y or Self-ins.Lic.it t1V 00"/q 30 Q I res / Expiration Date. ,! Job Site Adds: ( 2 City/State/ ip: ilttach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). , rat'.ure to secure coverage as requited Lmder Section 25A of MGL c.152 can lead to the imposition of criminal one-yea impriso zmetzt,as well es civil.penalties in the form of a STOP WORK ORDER snd a fine of up to$256 00 ay a f'wc up to$1,500.00 and'or that a copy of this state-went r=y be forwarded to the Office o Investigations of flit DI,A for inszuxnce coverage V M-Mcazicng [ e °la[or.Be advised .16 hereby certify the 'r enalties of perjury that the information Drloydzd above is true and correct. Signature: Date: IMM11- Phone#: 02 Official use only.Do not write in this area,to be completed by city or town official I. City or Town; Pernnit/License n Issuing Authority(circle one): t 1.Board of Health 2.Building Department 3.Citv/Town Clerk 4.Electrical 7� 6.Other pector 5.Plumbing Inspector Contact Dersvtt: Phone : r ��- - FRASCON-01 PAAS ;._._ CERTIFICATE OF LIABILITY INSURANCE DATE(MMUDDIYYW) 9ll912013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the 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 508)676-0309 CONTACT . Viveiros Insurance Agency,Inc. NAME: Ashle Paiva PHVN375 Airport Road C o Ex': 508-676-0309 127 WC.No): 508-3249147 Fall River,MA 02720 ADDRESS:APaiva@Viveirosinsurence.com INSURER(S)AFFORDING COVERAGE NAIC S INSURER A:Granite State Insurance Co INSURED Fraser Construction LLC INSURERS: PO Box 1845 INSURER C: COtuit,MA02635 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TM LTR TYPE OF INSURANCE POLIIN R WVD POLICYNUMBER MIDD MM1DD EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ UA CLAIMSMADE OCCUR MED EXP(Anyone person) $ PERSONAL&ADV NJURY $ GENERAL AGGREGATE S GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP.AGG $ POLICY I PRO- LOC AUTOMOBILE LIABILITY ccideSN;EBODLY nt) UMI $ ANY AUTO INJURY(Perperson) $ ALL OWNED SCHEDULED AUTOS AUTOS ILYINJURY(Peracddent) $ HIRED AUTOS NON-OWNED AUrOS accldert)PROFl=HlYUA A $ $ UMBRELLALIAB OCCUR EXCESS LIAB HCLAIMMADES EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY WC STATU OTH. A ANY PROPRIETOR/PARNERfm-XECUTIVE YIN WC009930601 TOR LIMITS ER OFFICEWMEMBEREXCLUDED- ❑ NIA 9/26/2013 9/26/2014 E.L.EACH ACCIDENT $ 500,000 (Mandatory In NH) Ir Yes.descdbeunder E.L.DISEASE-EA EMPLOYEE $ 500,000 DESCRIPTION Or OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,It more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable Building Division THE EXPIRATION DATE .THEREOF. NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis, MA 02601- AUTHORIZED REPRESENTATIVE O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 11 Massaeliusetts -iJcJ)AItment of Public Safety i Boafct of Building Requlatlons and Stanclarcis i Cn list ructtnn Saperrisnr i License; CS-091668 s t ' FAN C FRASRR` i ic�-'o:• i 1041-WRVN VEW FAw 1-ALmoYJ �• _ rbo 1 Commissioner 06/07/2015 L.1- Office,of Consumer Affairs and Business Regulation' I Park Plaza _ - Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 112536' TYPe: DBA FRASER CONSTRUCTION CO. Expiration: 31231201s T' 237059 DEAN FRASER P.O. BOX 1845 COTUIT, MA 02635 Update Address and return card.Mark reason for change. S(;A> > zr�r.<-rn:, ['j Address 0 Renewal Employment Lost Card _ Offiec of CausamerAffaim&Susi$ps Regulation License or registration valid for individul use only IMPROVEMENT CONTRACTOR before the expiration date. If found return to: 112538 Type: Office of Consumer Affairs and Business Regulation H esiistration: l ':ExPiration: 323=15 DBA 10)Park Plaza-Suite M70 Boston,MA 02116 FRASER Bost CONSTRUCTION CO. - DEAN FRASER 104 TUUINN VIEW FAME r / E FALMOUTH,MA 02536 Undersecrcnry NOtvalid w' ithout signatlrre F . _ Fraser Construction LLC ,- 31 Bowdoin Rd. Mashpee, MA 02649 d . Email: info@fraserconstructioncapecod.com www.fraserconstructioncapecod.com FAXX'f_-5b8-428 0 T2&/ PHONE 1-508-428-2292 HILL#112536 CS#97668 RE-ROOFING PROPOSAL DATE: April 4, 2014 PHONE: 508-771-0889 NAME: Josephine Roberts EMAIL: MAIL ADDRESS: CJ JOB ADDRESS: 68.Hawser Bend Centerville, MA 02632 FRASER CONSTRUCTION hereby proposes to perform the following services in a neat, professional like manner in accordance with the manufacturer's specifications and local building code. -Remove and Haul away all of the old roofing material -Re-nail all plywood sheathing as needed. Fraser Construction will include a 4 Star Upgraded warranty with the selection of any 30 year shingles or any Lifetime shingles. 4 Star Warranties have a 50 year Non-Prorated Coverage in case of any warranty repair, labor and materials, shingle tear-off and disposal fees: CertainTeed SureStart Plus- The extra measure of protection when a credentialed company installs an Integrity Roof System. ASK ITS ABOUT OUR OVERIFEEAD CARE CLUB! i Supply and Install - CERTAINTEED LANDMARK ARCHITECTURAL ASPHALT SHINGLE - Lifetime, Limited Transferable Warranty - Class A- Fire Rated - 240 lbs. per square - Two Piece multi-layered Laminated Fiber Glass Construction - Durable, Beautiful Color Blended Line to match any trim or siding color - Manufactured with Self-Adhesive Strips and fastened with six nails in common bond, large nailing area - 10 year warranty against Algae containment causing discoloration and streaking - 15 year wind-resistance warranty up to 130 MPH Color: <JP !i,2. Initial tO, * Price includes re-flashing chim ey Lead and adding soffit plates for increased ventilation * Customer is eligible for a 2% Military Discount and 2% Senior Disc With the discounts the total for the job would be $ tc), zG�'c�sl.'A iSc1.1 Roofing Product & Installation Details Supply & Install - (Soffit Venting) Hick's Ventilated Drip.Edge or S" Aluminum Drip Edge with existing soffit vents. Smart vents over white drip edge. Protection against damage to the roofing materials and structure. The most effective system is a balance of air intake and exhaust that creates a uniform flow of air through the attic. This system creates a condition in which the roof temperature is equalized from top to bottom, supplying a uniform air flow along the entire underside,of the roof deck. Supply & Install- Ice & Water shield Waterproof Underlayment System (3ft. on eves and valleys, 18" on rakes, walls, and skylights) Ice and Water Shield is.a self-adhering roofing underlayment used on critical roof areas such as eaves, rakes, ridges, valleys, dormers and skylights to protect roofing structures and interior spaces from water penetration caused by wind-driven rain and ice dams. Supply & Install - Surround Underlayment (A Typar Brand) A smart alternative to felt, it is watefs toughest opponent, creating a secondary water barrier that reduces the incidence of leaks caused by storm damage, wind-driven rain, ice dams and worn roofing materials. It is a waterproof, synthetic polymer material that will protect your home against moisture intrusion. Supply & Install - CertainTeed Swift Start With self- adhering asphalt starter course on all eves, and rake edges. CertainTeed requires this product for Integrity Roof Systems and upgraded wind warranties. Supply & Install -Aluminum & Neoprene Soil Pipe Flashing Supply & Install-CertainTeed Ridge Vent High performance ridge vent with external baffle. Supply & Install -Pre-Cut CertainTeed Hip & Ridge shingles Shingle Ridge meets the hip and ridge accessory requirements for the CertainTeed Integrity Roof System which is comprised of underlayment, shingles, accessory products and ventilation all working together.,The Integrity Roof System is designed to provide optimum performance--no matter how bad the weather conditions are. (As recommended by CertainTeed) 8 Clean & Remove -Debris from work area daily. PAYMENTS ARE DUE IMMEDIATELY AFTER JOB DOMPLETIoN. 1/3 initial payment, remainder to be paid upon completion Payments accepted are: CASH- CHECK -MASTERCARD -VISA-AMERICAN EXPRESS *Any payments not immediately paid upon job completion will be charged 0.005%for every day after the given 5 day grace period upon day of job completion. Possible Extra-After the shingles are removed from the roof, we will lift one sheet of plywood to make sure that the insulation is not up against the plywood sheathing preventing ventilation from the eaves to the ridge. If it is, ventilation panels will be installed by; removing the plywood sheathing, installing the panels, turning the plywood over and then re-installing the plywood. If needed, this would be charged for as an extra at the rate of$6.00 per panel including Materials & Labor. There are 6 Panels per sheet of plywood. Possible Extra-Any rotted or otherwise deteriorated trim boards, plywood sheathing, lead flashing, or other carpentry needing replacement will be done and charged for as an extra at the rate of$75.00 per hour, plus 20% mark-up materials. FRASER CONSTRUCTION Warranties the labor.for LIFETIME of roof. FRASER CONSTRUCTION Warranties the shingles against Blow-Offs for 15 years. CERTAINTEED Warranties the shingles and labor 100% through the Sure Start Warranty duration. CERTAINTEED Warranties the shingles to be ALGAE resistant for the duration of the Sure Start Warranty depending on the shingle that was purchased. Any deviation or alteration from above specification will be executed upon written orders and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays are beyond our control. Owner should carry fire, tornado and other necessary insurance upon the above work. We, if not accepted within thirty days may withdraw this proposal. FRASER CONSTRUCTION, LLC: Carries Workman's Compensation and Public Liability Insurance on the above work, certificate available upon request. . l i DATE OF ACCEPTANCE: Ll 9 l Homeowner . Fraser Construction, LLC .1C.1'. �1 EC 28 AIN C"E SAVE . Weatherization 508-398-0398 December 14,2011 Town f o Barnstable Thomas Perry CBO Building Commissioner 200 Main St. Hyannis,MA 02601 RE: Building Permits Dear Mr. Perry, This affidavit is to certify that all work completed for permit application#201101729, Status A, Parcel 192091 at'68 Hawser Bend, Centerville, Permit type: RADD, and issued on 5/03/2011 has been inspected by a certified Building Performance Institute (BPI) Inspector. R-30 Cellulose insulation was added to the attic.Walls were dense packed with R-13 cellulose insulation. Basement sill was insulated with R-19 fiberglass batts. Basement perimeter was wrapped with R- 5 reinforced foil or vinyl faced ductwrap.All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey 0 i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 9 Parcel ° I Application # 11 Q)9 Health Division Date Issued 5 3 Conservation Division Application Fee v Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Village C e A+e-c`y \ �o SQ� °Owner UoSP AAP, Telephone 0 Permit Request Re-+-ram; sc��};Ajn - &U 6oif j+ ye_yAts ' �awrid�¢,it5n ih \wLse-yr e✓ i at, AeaLl .Z ��M Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation�700,6 A onstruction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ,�g Two Family ❑ Multi-Family (# units) Age of Existing Structure 19 7-7- Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: mull ❑ 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 3 new First Floor Room Count Heat Type and Fuel: ❑ Gas Oil ❑ Electric ❑ Other Central Air: ❑Yes p No Fireplaces: Existing New Existing wood/coal stove;- 0 Yes=❑ No r_a J Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑,existing ❑.new size_ Attached garage:&existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ rn Commercial ❑Yes ❑ No If yes, site plan review # Current Use JR e- 51 e-il t1\ac.-) Proposed Use J�� ►�t �-�"cc\ APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name a W,lxm ncaosvlal� �� �' Sme Telephone Number S O- 318 - 0 S 9 - Address �x ,n A�11 �� License # ZC to a � Ir O'�b 6 �I Home Improvement Contractor# ` 3 011 Worker's Compensation # 7 q� D 15 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO)�L OV±k SIGNATURE �\\ - DATE g i 4 FOR OFFICIAL USE ONLY i APPLICATION# � Y DATE ISSUED MAP/PARCEL NO. r , ADDRESS VILLAGE OWNER h y i k; DATE OF INSPECTION: FOUNDATION .�d r FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL k l 1' PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT i ASSOCIATION PLAN NO. gj�C0RP,t00PR-A'-JT10N' T�f on all fines t sir tt.F::.zcr;rrcc?/}ut;C�.c)r HOME OWNER WEATHERIZATION WORK PERMIT&FUEL RELEASE: PLEASE HLL OUT-AND SIGN THIS.FORM IF YOU ARE THE APPLICANT HOME OWNER. I -Sr :PH e A:► E-. Nv6CP T 5 hereby consent to and agree that weatherization work maybe done by the Weatherization Programs of Housing Assistance Corporation ( herein after referred as "Agency") on the property located at: The weatherization work done will be based on programmatic priorities and availability of funding and it may include all or some of the following measures: Weather-stripping&caulking of windows and doors,insulation of attics, sidewalk &basements, attic and other ventilation measures and possibly replacement of badly deteriorated windows.In consideration of the weatherization work to be done at my home I agree to the following: 1. I give permission to the "Agency" its agents and employees to travel onto or across said property with such equipment and materials as may be necessary to perform weatherization work on said property. 2. The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the weatherized unit on an ongoing basis for no more than five (S)pears after the weatherization work is completed. I have read the provisions of this agreement as listed and freely give my consent. Home Owner. (Signature) _ - ,.._. ' '. :•��; Date- / 4 Agent: (signature) Date; Z HAC a .PP roved Weatherization Co an �P Y —� Caliber Building&Remodeling . Cape Cod Insulation Cape Save Creswell Construction Frontier Energy Solutions Lohr& Sons Peter Smith Resolution Energy Rock Solid Construction All Cape Insulation 'J The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers 1i Applicant Information Please Print Legibly Name(Business/Organization/Individual): M Irkrzt CM6, � Address: to N ca'Ylz a=_ City/State/Zip: - Ay ®uTt,lAft 68A gone#: g- 0 3 Are you an employer? Check the appropriate box: Type of project(required)- 1.[K I am a employer with t ok 4. ❑ I am a general contractor and I employees(full and/or part-time). have hired the sub-contractors 6. ❑New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling These sub-contractors have ship and have no employees. 9. E3 Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers' colinp. insurance comp.insurance.$ required.] 5. We are a corporation and its 1013 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I IQ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12:[3 Roof repairs insurance required.]' c. 152, §1(4),and we have no employees. [No workers' 13.0 Other (IS- 0t CA'Of) comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: r(WT(s �J Lk A--Pj cc Policy#or Self-ins.Lic.#: U3 G j '3- 6!� ( Expiration Date: Z. „6 1 Job Site Address:�jg 1 T�t,l1�S�'f (gfl a L n city/state/zip: G dyille r 0&b (1 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 certify under the pains gnd penalties 9f perjury that the information provided above is true and correct. { Y Signature: Date: A Phone#: � — Official use only. Do not write in this area,to be completed by city,or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: i 0 AC4 � DATEi��DD�YYYi CERTIFICATE OF LIABILITY INSURANCE 11/1/2010 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(fes)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 endorsements). PaoollcER I CONTANAME; Shannon Sperrazza. ;PHONE strategies Company VV 'FAX jAIC.WI.(781)463-4620 _ ... ... 15 Pa:cella Park Drive aDDaEss:®aperrazza@risk-etrategi®s,com Suite 240 I PRODUCEERR ID S.fJ0018476 I_CUSTON Random MA 02368 � INSURER(S)AFFORDING COVERAGE INSURED �1NSURERA:Seneca Specialty Insurance Cc I INSURER a Xeating Groulp Ins Services Michael McCluskey, DBA: Cape Save INSURERC:Chartis Insurance 7 C Huntington Ave INSURER D INSURER E: — South Yarmouth MA 02644 INSURERF: COVERAGES CERTIFICATE NUMBER.CL1011132675 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 y CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, I EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE POU Y EFP I POLICY EXP —{ LTR; POLICY NUMBER MW MI14JDO/YYYY ' UMITS GENERAL LIABILITY EACH OCCURRENCE :$ 1,000,000 i COMMERCIAL GENERAL LIABILITY II PREMISE$(Ea ooaurence) $ 50,000 A CLAIMS-MADE I X OCCUR )3AG1802608 '10/16/2010'10/16/2011 M EXP(A,,Y one person) $-� 10,000 r-- PERSONAL&ADV INJURY $ 1,000,000 1 GENERAL AGGREGATE $ 11 000,000 z,GEN'L AGGREGATE LIMITAPPUES PER: ; ;PRODUCTS-COMPIOP AGG ;$ 1,000,000 X POLICY -PRO- LOC AUTOMOBILE LIABILITY I i,COMBINED SINGLE LIMIT $ 1,000,O00 6208200 llj6/2010 11/6/2011 I(r Eaacculent) ANY AUTO BODILY INJURY(Per person) S ALL OWNED AUTOS I'--- —__ % ;SCHEDULED AUTOS f• I BODILY INJURY(Per accidera)s$ li— I PROPERTY DAMAGE X HIRED AUTOS I (Per accident) $ X'14ON-OWNED AUTOS I $ X USIIBRELLA t UlB OCCUR ( EACH OCCURRENCE EXCES$UAa - CLAIMS-MADE I f AGGREGATE S;S 1,000,000 1 DEDUCTIBLE B i RETENTION $ I 023578601 �0/16/201010/16/2011; $ i AND EMPLOYWORKERS�r L{aJ31L Y U N i MPENSATIOIN �ticha®1 McCluakey l X �TORY LIM TS' ER i ANY PROPRIETORtPARTNEWEXECUTIVE I its excluded from coverage' -' OFFICERIMEMBER EXCLUDED? j N I A I y E.L.EACH ACCIDENT ;$ 500 000 (Mandatory in NH) 9930951 10/21/2010;10/21/2011' L' W8yyaas desorbeunder I j I j E.L.DISEASE-EAEMPLOYE6 S 500I000 ARIPTfDN OF OPERATIONS below i E.L.DISEASE-POLICY LIMIT i$ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES(Attach ACORD 101.Additional Remarks Schedule,if more space is required) Issued as evidence of insurance. Contractors-Executive supervisors or Executive superintendents. CERTIFICATE HOLDER CANCELLATION (SOS)790-2425 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Housing Assistance Corp ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Ruth 460 West Main street AUTHORIZED REPRESENTATIVE Hyannis, MA 02601-3698 Michael Christian/3M5 d" = -_ - `-• `<<r= r_:._ ACORD 26(2009109). m 1988-2009 ACORD CORPORATION. All rights reserved. INS026(2oams) The ACORD name and logo are registered marks of ACORD au. Xe57'7 +.� �' �' ' i31 ?` i' `d% v e:•' ' iiyc. td`v�"�?� � _ ; Office of Consumer Affai s and Business Regulation ;E 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 164432 Type: Supplement Card CAPE SAVE Expiration: 1 0/6120 1 1 WILLIAM MUCCLUSLEY .......... ... .. 8201 S. HQURD CT ..................__.._.._._..._.._...... ... CHAPEL HILL, NC 27516 Update Address and return card.Mark reason for change. ' Address ? Renewal .. Employment F ; Lost Card :+.. .,%1%i' t!'G•.Ift.7�.�e;:%taiXs�.I.dl r:��,_.�1C.7�Sl;�a2{!:�CC'.S s" Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ' 3»HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 164432 Type; Office of Consumer Affairs and Business Regulation Y 10 Park.Plaza-Suite 5170 Expiration:. ,10/6l2011 Supplement Card Boston,MA 02116 CAPE SAVE s . � WILL.IAM MUCCLUSLEY: .7C HUNTING AVE.. �s'�'`��^:- Gar r, S•YARMOUTH,MA 02664 --- , —__ Undersecretary Not valid wit ou signature - it t+� �.I�t+•art, 1)e Ii itrme art of 1 lIbI4 eti,tt f3�at►41 +t Boildin, 13e irl;�ttr�tt. ai�tl �t:talc!i:GIs .seense: CS SL 102776 Restricted to: IC - �S: NIILIJAM MC CLUSKY 37 NAUSET ROAD w; WEST YARMOUTH, MA 02673 Eq)tt boor 6/2812013 6 02f25/2023 09:_3 919K12955 PAGE 01i01 CME 1 SAS Weafherlz"WVon 508-398-039 August 22, 2010 To Whom It May Concern: William J. McCluskey is an employee of Cape Save. He is authorized to negotiate contracts and building permits for our.company. Michael IMcCluskey Cape save—owner 929-593-5939 cell X Huntingto n.Avenup,South Yarmouth, NIA 02664 L '.16 L �oAA%L--! c'n©AA •-, r-1G �-n� 1►c = �cs.� tom✓ L% R , qF to �o`fot_ r�atuf r"c..v•.c,; - 3?,� mow. �...: .�} ?_c� ok Ip PCtr'GDLQTIOI..1 ►rGA C"f= ���u.J n4..�vt i tiJ •02 L>rS>, �' �' r�sf� 1• EXp. T/ 5 t 13A XTE P 2a049 taY rwv IC>o.C> LOAM Sd3. �55 4"pvF• •nys-; al.. -- EL- if SOX q6. SEAT IC (C 4 . +HIV, rAt4le. � = 95•0 lcc�o �a5��5 iNv. I4tV. F rzr G FIT W 170 � �r✓ASUGD �(.7 { � 5ro,��• :�5 ' CE7—Ti�=1ti-� >_t_=g(, +�.1 o S c a►.,.L c•;a C A(�C` 'dl:, !.S-l7 �la_-('r _ �''�5�•'i 7 a T1-(A7 Tf- G- FovQc rlo►.I 51aaw►.r t`A1-1 R ia V--lc vJ 1144 TI-*: 5l vc- 1...1"c-- �oT 3CO C&V 1,1P, oP +af E t,A."c G 8 2 , lwl/•�hYCr�C. �=., t.4Y� 1�G. 1ZC--C.1 S re +=p ". w c) L) V y U lz_4 T :j,t :a t7 f_!x F-! 1 t_t G�'C L;/ti yCL7 U►-J p t�.1 _I►J4C ':1.,.�1.?1�1; /�tJt ��t',�( f'1;t�. �:�rl�'�> C�, �lac�e�ln A,F•?Ilt_1GA,ti�iT �.•�- t,-,��, r•+.1; ..i;,1..6'� 111 tea` 1 C�C'A,'t1 •�L.: 'C" � ���r 1�l 6�3���. ✓. Assessor's map and lot numb :.......::..l.f�Ga ';:— PC � _ » a ai. �. c, r' 7 .�� ' SEPTIC S Sewage+ Permit number .................. ................�............. ` STEM MUST E SY r.. INSTALLED IN COMPLIANCE FYNe r' ci c� " c WITH ARTIC E 1 ATE . f1 , TOWN OF BAR�IV y � e - i89$�H9TODIiE, Cs). u 90•r''r !+ G ,.i rMi�a t : Q G69 M B U LDI N INSPECTOR v.; � �J •..f✓ jar i t:� ""i I-i , .. I. ............^................ APPLICATtO`.�1 'FOa3 :PERMIT TO �`.`.�. ... . .. ......................:.. ` TYPE OF CONSTRUCTION ................................................................................................. r r ......................... / .........1'9. � TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .......�............... ...... . .....:...... .......................... .................................................... ........................... Proposed Use ........ ....................................................................... K� ...... ... ......... Zoning District .......... .........................................................Fire District Name of Owner ... ... ..4.0 P. ....Address ............ . ....... ...................................... • Name of Builder ....................................................................Address .............................. 1/ l Nameof Architect ..................................................................Address ....................................:............................................... Number of Rooms ............................:.....................................Foundation io*' .................................................. Exterior �. .Roofing tr Floors ...........f�.r..(!�.�.... .......:....................................:.....Interior ....... .�! ... .... .............................................. Heating ........ /4......... .............................Plumbing .............. ............................................................... Fireplace ........ - -"..............:..........................................Approximate Cost .... .................................... Definitive Plan Approved by Planning Board .--------------------------------19________. Area ..4ff .......:................. Diagram of Lot and Building with Dimensions Fees ....... .. .. ........................ SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby, agree to ':conform to all the Rules and Regulations of the Town of Barnstable r"arding t above con"struction. Name .......................... .. ....... .. . .Z .................... � Cammmnide, Development � ` 19572 - one story ' ' No ---- Permit for .................................... ` - sin- - dwelling 4 - ^ � -' ^ ^-'-'-^^--^--^'-^^- +/ Hawser Band Road Location ---.c.-,,----....-...----_. . _ . Centerville ,---~.--.---.-.-....-----.-----.. ' wapmwide Development . Owner ..................................................... � | ! - frameType �f Construction -.------------.. . ~..-.--~.-.......-------.-.-.-^-.--. / . . Plot Lot ���. _ . -----....�--.. ----. ---.. . , ' ^ September 2 77 Permit Granted - --]g Date of |nupa�i�n ---19 Date Como�+�6 lA ' ---' - ^ - ` ^ ' .. . . .� ` -PERMIT REFUSED ............................................................ 19 ' . - ..........................................-....-,-----. ' ^ � . - . . ` ~ '-~---`~^^^^'~^^^'`'r-^'-^^-------- , ' ' ^ ' � , -r^'^---'-^-'-'''^^^^'~^~^^^^^'~^'~~^-- ' - - .�..--.-...-.-�.---.-.,--.^-._.—...,' . . ' - ................................................ 19 ` ' --------..--.---..........---..- ' -----------------_.--.......^.` K N ' _ Assessor's map and lot number .............. ...- 9j � . .. P c _ q- 7 7 �T Sewage -:Perm4t number ...............5...y?.................................. T"Erg°� TOWN OF BARNSTABLE I BBHBSTA 4 i M6 - ; BUvILDING INSPECTOR i i APPLICATION FORS PERMIT TO ..! r!'! J..'L..... r..R / .,,rsr !:J........................................................ s' J TYPE OF CONSTRUCTION .......:.... .. ................................................. ..................................................................... A7 ...................... .. ..........192 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a/permit according to the following information: Location - � f.......�?....�....... t ...,.�. ril......./`�td -.Y ................. -�r2 ........` ................ _ ProposedUse .................................:.......................................................................................................................................... Zoning District �' j ..........Fire District f . ' ' Name of Owner ........:..........: =!-'......,........,.......,.....c.............Address .. Nameof Builder ........................................ ..........................Address ..................................................................................... Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ..............�.................................................Foundation .......... ............ .................. .-:................................... Exterior Roofing > ...-....................................... ............................. �W. r.�f C- Floors ..........................................................................Interior .........: .. ............................... Heating f! .I. .. .............................Plumbing ..............".".�'�................................................................ ............ .......�................... Fireplace ; G-...........................................................Approximate Cost. : Gl�L ...................... .................................................................... Definitive Plan Approved by Planning Board ________________________________19________. Area ......................:. Diagram of Lot and Building with Dimensions Fee ...^''...................IF 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 ........................... / ......................,... ....;`:::..,............... Capewide Development A--192-91 No 19572 Permit for o e sto y .......... ........... ............. single family dwellin p .r Location'. A...Hawser Bend Cgnterville ................................... Owner CgPewid, ;evel92Ae ........ ................ Type of Construction ........ 1,em..................... Plot ............................ Lot ..........330............... S ptember 2 77 Permit Granted .......... .............................19 Date of Inspection ........ ...........................19 Date Completed .......... .........................19 PERMIT REFUSED ............................................. .............. 19 .. .. . .. . . .. ........ .. .. ....... ...................... ........ .. ...................................... ............................................................................... ............................................................................... Approved ................................................ 19 ............................................................................... ...............................................................................