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0031 HENRY F LORING ROAD
ntq Town of Barnstable Building .,,�<. 9 .r Post.Th�s.Card,So Thatnrt s,V�s�ble>From the Street Approved Plans;Must be,Retam'ed on 1oba'nd this Card Must bey Kept <n,,. UAFEL wgs Posted,Un 'Finall spectio Has 6 en Made t � fM° #' 'x sb39 Permit Where a Certificate of Occupancys Requedi such Buildmg shall Not be'Oc pied until a Final In„Specton'has been made E Permit NO. B-19-2681 Applicant Name: ERICSSON HOME IMPROVEMENT INC Approvals Date Issued: 08/20/2019 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 02/20/2020 Foundation: Location: 31 HENRY F LORING ROAD,'CENTERVILLE Map/Loft 172 182 2oning District RC Sheathing: s, Owner on Record: BARTLETT,CHRISTOPHER W&DONNA M toritractor, ame:' .,ERICSSON HOME IMPROVEMENT Framing: 1 Address: 31 HENRY F CORING ROAD " INC 2 CENTERVILLE, MA 02632 '= Contractor License:; 196089 Chimney: Description: DOOR AND SIDING ' EstA Project Cost: $6,000.00 Permit Fee: $35.00 Insulation: Project Review Req: - Fee Paid: $35.00 Final: Date: 8/20/2019 IT Plumbing/Gas Rough Plumbing: -: Official Final Plumbing: ' Building This permit shall be deemed abandoned and invalid unless the work authho ized'by this permit is commenced within six months after Rough Gas:issuance. g All work authorized by this permit shall conform to the approved application and the,,approved construction documents for which tFiis permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zonirig'by lawsarid codes. Final Gas: 14 This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for publcrospecfiign for the entire duration of the work until the completion of the same. ` Electrical _ Service: The Certificate of Occupancy will not be issued until all applicable signatures by�the Bu mg and FireOfficials are provided on this permit. Minimum o Rough: f Five Call Inspections Required for All Construction Work.' 1.Foundation or Footing ,. _ _ ._F •� M._� 2.Sheathing Inspection final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: S.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT z� l...Application number.................. ................ Q, Fee ................................. ............................... KM Building Inspectors Initials...........r�... 3 2 d 2019 Date Issued..................�/a0/�9.................. i 0WN 0, 6ARNSTAPLF Map/Parcel...... .. ....... 1.&a......................... TOWN OF BARNSTABLE A EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: 3' . HQ5Nty NUMBER STREET VILLAGE Owner's Name: Phone Number• 7 2 -q-43 Z. Email Address: Cell Phone Number 5L 72�IL13 2 Project cost$ C.000 Check one Residential /---- ^Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize 'can Tc5/Y� to make application for a buil ' g mit ' accordance with 780 CMR Owner Si e: . Date. TYPE OF WORK es—siding ❑ Windows no header char e # ❑ Insulation/Weatherization ( change) .i Doors(no header change)# / Commercial Doors require an inspector's review ❑ Roof(not applying more than 1 layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name ��C�c-::>AJ,-, %VA2-6 Home Improvement Contractors Registration(if applicable)# 1'76a 8 9- (attach copy) Construction Supervisor's License# /0 0 (attach copy) Email of Contractor Phone number 5 & 33269�� ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR/F THE SUBJECT PROPERTY IS/N A HISTORIC DISTRICT. YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NU.MBER...................................................... *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. - If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3.30 pm-4.30pm. Commercial events may require Fire Department approval *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: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date. APPLICANT'S SIGNATURE Signa Date /3-464aT. �s All permit applications are subject to a building official's approval prior to issuance. 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 Applicant Information Please Print Legibly Name(Business/Organization/Individual): -7` Address: `47 City/State/Zip: Phone#: 5708 -�02 6`35 q 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 employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2,Z'I am a sole proprietor or partner- 7 listed on the attached sheet.; 7. ❑Remodeling ship and have no employees These sub-contractors have �8. ❑Demolition workingfor me in an capacity. employees and have workers' Y P tY• t 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 I I:❑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' 112F t er-SYY1 66e_3— comp.insurance required.] 5/ODi41){, '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.#: �e2' /B 942 Expiration Date: Job Site Address: 400x,.6. 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 certify under the pains and penalties o perjury that the information provided above is true and correct C� <, Sit?nature• � ���"`./ Date: 7- Phone#• Q/ ,-32 6 957 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#: 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 carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to 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 Accidents 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 �"E Town of Barnstable Building Department Services ` RARNSTAI .XAM ' Brian Florence,CBO �1 Building Commissioner 200 Main Street,Hyannis;MA 02601 www.town.banutable.maus Office: 509-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section - If Using A Builder I5&7-47-T ,as Owner of the subject property hereby authorize iS A Pt $6b U 70—/ czsf to act on my behalf in all matters relative to work authorized by this building permit application for. . In ^�G k� ���.�1�'Ile T9- (Address of Job) i '**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 inspection are performed an accepted. ature of Owner Signature of Applicant 74 7 Print Name Print Name Date Q:FORMS:OWNERPERNSSIONPOOIS Rev:09/16/17 Town of Barnstable Building Department Services Brian Florence,CBO ' Building Commissioner , 200 Main Street, Hyannis,MA 02601 MAW � www.town.barnstable.maus Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMMON Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home p # wont phone# CURRENT MAU NG ADDRE c /town state zip code The current exemption for"ho�meown "was exten to include owner-occupied dwellings of six units or less and to allow homeowners to engage an indiv fit for who doe not possess a license,provided that the owner acts as supervisor. ON OF HOMEOWNER , Person(s)who owns a parcel of land on which resides m intends to reside,-on which there,is,'or is intended to be,a one or two- family dwelling,attached or detached structures ssory to such use and/or farm'st<vctures: A`person who constructs more than one home in a two-year period shall not be cons, a meowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she be ble for all such work Rerforrucid under the building ' (Section 109.1.1) The undersigned"homeowner"assumes reap ibility for co Lance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies he/she understands the wn of Barnstable Building Department minimum inspection procedures and requirements and that he✓ a w,ll comply with said pro s and requirements. Signature of Homeowner i r Approval of Building Official ! Note: Three-fam,ly dv�e gs containing 35,000 cubic feet or larger will be to comply with the State Building Code Section 127.0 Construction Co 1. HOMEOWNER'S EXEMPTION The Code states tha : "Any homeowner performing work for which a build' permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervis );provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervis Many homeowners who use this exemption are unaware that they are assuming th responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15),This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as,part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. on the last page this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPMM\FORMS\building permit forms\EXPRESS.doc 08/16/17 •P } Office of Consumer Affairs&Business Reg ulation 1 HOME IMPROVEMENT CONTRACTOR Corooration + io I Re Ez it i-- - - 06/30/2021 i T INC ERICSSON HO, i I � IERICSSON TOR 47 SEARS ST C REVERE,MA 02151 Undersecretary 4 - k , Commonwealth of Massachusetts Division of Professional L,icensure lugBoard of Building Regulations and Standards Con structip, s;�Oktioe r Specialty •CSSL-100546 � �E empires: 06/1812020 ERICSSON TORRES ' P.O.BOX 673% 4 SOUTH YARMO4TH MA266t'` 11��15'S':L•111� Commissioner Commonwealth of Massachusetts �►�" G�►�13 U Sheet-Metal Permit Map��1 Parcel Date: E r q Permit#dD 1 3 0,3V Estimated Job Cost: $ 11, 0 0 Permit Fee: $ �� Plans Submitted: YES VN0 Plans Reviewed: YES NO Business License# Applicant License# 41 Business Information: Property Owner/Job Location Information: Name: Of�e—L N Ale-,� Street: -7 0 Md_t ( 3 J47 Street. c�� W-n(W Ci ty/Town: 1 r l je Nk city/Town: Telephone50? L4 (O (CS Telephone: D8- L4 ;;eg 'K-09 o- Photo I.D. required/Copy of Photo I.D. attached: YES NO J-1/M-1-unrestricted license WES S P�Riwtr J-2/M-2-restricted to dwellin s 3-stories or less and commercial up to 10,000 sq. ft. /°Z'- to s }ess Residential: 1-2 family Multi-family Condo/Townhouses LOWiV Commercial: Office Retail Industrial Educational 46 • I Fire Dept. Approval Institutional_ Other Square Footage: under 10,000 sq. ft. _K_ over 10,000 sq. ft. Number of Stories: Sheet metal work to be completed: New Work: Renovation: HVAC Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: Ale wY �/ i•'J S ��� �(' _ 3 parr ��ic q y1 .57��Gla�a7 C w! G �. Si�E •IOG� I I i i t fNSURANCE COVERAGE: have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes❑ No ❑ you have checked Yes, indicate the'type of coverage by checking the appropriate box below: liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ )WNER'S INSURANCE WAIVER: 1 am aware that the licensee does not have the insurance coverage required by Chapter 112 of the lassachusetts General Laws,and that my signature on this permit application waives this requirement Check.One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent y checking this box❑, I hereby certify that all of the details and informat'on I have submitted(or entered)regarding this application are true and -curate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be i compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation: YES NO ;R Progress Inspections Date► '' Comments • Final Inspection -� Date "Comments Type of License: [Master le ❑ Master-Restricted yfTown ❑Joumeyperson Signature of Licensee rMit ❑Joumeyperson-Restricted License Number. / Check at www.mass.gov/dnl r)P.Hnr SinnafiirP of Permit Aooroval The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations . 600 Washington Street Boston,MA 0211-Z www.mass.gov/din Workers' Compensation Insurance Affidavit: Builders/Contractors/Elect ricians/Plnnlbers A:ppficant Information Pleas a Print Leeibly Narae(Bnsmes&/OrganizatimOmdividnal): •Address: City/State/Zip: :��e C�l(� G i PhoneA: Are you an employer? Check the appropriate box:. - I�C I am a employer with_ 4• [] I am a general con7sheet* Type of project(required): employees(full and/or part-brae)•* have hired the gub= 6 ❑New construction . 2.❑ I am a'sole proprietor or partner- listed on the-attached [7. Remodeling ship and have no employees - These sub-contractors have working for me in any capacity, employees and have workers' &' Demolition [No workers' comp,insurance cdmp..instuance.t' 9• ❑Building addition 3.❑ required_] 5. 0 We are a'corporation and its 10.0 Electrical repairs or additions I am a homeowner doing all work officers have exercised their 11.[]Plumbing myself [No workers' camp, right of exemption per MGL repairs or additions . insurance required.]t c. 152, §1(4), and we have no 12•[] Roof repairs employees. [No workers' 13.'Z Other comp.insurance required.] Any applicant that checks box#1 must also fM 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 subaut a new affidavit indicating such. #Contractrns that check tbis box must attached an additional sheet showing the name of the sub-contractors and state whether arnot those employees. If the sub-cont actors have employees,they must provide their workers'camp.policy entities have number. I an employer that is providing workers inffoo rmation. 'compensation insurance for my employees. Below is thepolicy and job site Insurance Company Name: Policy#or Self-ins.Lic. 1 Xp' � 1 Z.O � Expiration Date: lob 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 imp osition of fine up to$1,500.00 and/or one-year criminal penalties of a Yl? o�en 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 co investi lions of the DIA for inmirance covera e verification PY of this Statement may be forwarded to the Office of I do hereby certi trader thepains-and enald o er•u that the information provided above is true and correct f.P 1 r1' SiPma-ttffe.ds-s-v- G - - ^ I Date: Phone#: Q �., `7 Dffccial use only. Do not write in this area, to be completed.g • - ., mP by city or town official .. City or Town: Perini t/License# Lssuing Authority .circle one): �. .1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: 7 - Phone#: VF,RIEDELI 8 foy Plumbing * Heating"* Air Conditioning (� Quality Service Since 1932 PIOP y..d SAL ied e 11 778 Main Street Osterville, MA 02655 www.carlriedell.com ESTABLISHE g3� (508) 428-6365 Fax (508) 420-0180 PHONE DATE TO: Donna Bartlett 508-428-8090 4/9/2013 31 Henry F. Loring Road. JOB NAME/LOCATION Centerville,MA 02632 3 ton attic installed a/c system JOB NUMBER JOB PHONE F .. .r Dick Mohre s. i� ..�an�,x�ld. 5 I ry ` f•� �r � .'- °^r.�S, �,»�` ,a .r.". � ,w ,�a� "��'�' �d }�.�,, �:,Yi;; Riedell will install an "American Standard" 3 ton attic installed a/c system that will provide total cooling comfort in your home.An "American Standard" 3 ton air handler along with insulated duct work will be installed in attic area supplying a/c to living area via ceiling diffusers. Riedell will install a 3 ton 13 seer "American Standard" condenser outside of home on a supplied precast pad. Refrigerant lines will be piped from air handler to condenser to complete system. Riedell will conceal exposed refrigerant lines with attractive slim duct cover. System will be wired by Riedell. Riedell will charge, start and test system for proper operation. *System components* "American Standard" **Rated 16 SEER 13 EER -Condenser 3 ton attic installed -Air handler split a/c system -Line set 4A7A5036 condenser -Pad TAM7AOC36H air handler -Aux pan 15 seer -Drain R-410A refrigerant -Insulated duct work -Slim duct cover *10 year warranty on compresser&parts -Wiring after equipment is registered within 60 days of installation *Homeowner responsible for any electrical upgrades if needed. #AHRI 4385749 *If new sub panel is needed, add $400.00 We Propose hereby to furnish material and labor—complete in accordance with the above specifications,for the sum of: Eleven Thousand Eight Hundred Seventy Nine and 55/100 Dollars dollars($ 11,879.55 Payment to be made as follows: A deposit of$4,752.00 with signed proposal is requested. Payments are due as work progresses and balance is due upon completion. All material is guaranteed to be as specified.All work to be completed in a professional manner according to standard.practices.Any alteration or deviation from above specfea- Authorized bons involving extra costs will tie executed only upon written orders,and will become an extra Signature charge over and above the estimate.All agreements contingent upon strikes,accidents or delays beyond our control.owner to carry fire,tomado,and other necessary insurance.Our Note:This proposal may be workers are fully covered by Workers Compensation insurance. withdrawn by us if not accepted within 30 days. Acceptance of Proposal—The above prices,specifications and conditions are satisfactory and are reby accepted.You are author to do the work Signature t --� as specified.Payment will be 06 s outlined above. gnature Date of Acceptance: CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 04/30/2012 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 A Erica H O'Connor t HART INSURANCE AGENCY,INC. NAME: 243 MAIN STREET PHONE (508)759-7326 FAx (508)759-7366 PO,BOX 700 EMAIL AIC No BUZZARDS BAY,MA 025320700 ADDREs : INSURERS)AFFORDING COVERAGE NAIC p ARBELLA PROTECTION IN CO INSURED Carl F Rledeil&SOn Inc INSURER A: 41360 778 Main St INSURERS: AR13ELLA INDEMNITY INSURANCE COMPANY 10017 Osterville,MA 02655 INSURER c: - INSURER D: 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 INSR PAID CLAIMS.. ADDL SUER LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY E%P A GENERAL LIABILITY MMIDDIYYYY LMMIDDIY`1rYYl LIMITS 8500033836 05/01/2012 05/01/2013 tR � CCURRENCE $. 1,000,00 COMMERCIAL GENERAL LIABILITY - O RENTED ,jgag urr dui300.00 CLAIMS•MADE OCCUR - An one arson) $ 5.0AL&ADVINJURY. $ 1,000,00 ^2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY P"O LOG PRODUCTS-COMPIOP AGG $ 2,000,000 JFCTB AUTOMOBILE LIABILITY 00831400003 05/01/2012 05/01/2013 $ a - E MBcI_'n'l SINGLE—LIMIT LIMIT 1,000.00 ANY AUTO ALL OWNED SCHEDULED _ BODILY INJURY(Per person) $ AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS - NON-OWNED AUTOS PROPERTY DAMAGE $ Pe e c nt A UMBRELLA LIAe $ OCCUR 4600033836 65/01/2012 05/01/2013 EXCESS LIAB .EACH OCCURRENCE :0TH. $ 1,000,000 _ CLAIMS•MADE '— --ED RETENTION$___- AGGREGATE B WORKERS COMPENSATION 0054000511AND EMPLOYERS'LIABILITY 05/01/2012 O5/01/2013 WC STA7U- $ANY PROPRIETOR/PARTNER/EXECUTIVE YIN . (MandatoryOFFICER/M In H)EXCLUDED? ❑ N/A E.L.EACH ACCIDENT $ SOO,OO (Mandatory In uno ' If yes,describe under Y E.L.DISEASE=EA EMPLOYEE $ 500,00 DESCRIPTION OF OPERATIONS below " E.L.DISEASE-POLICY LIMIT $ 500.00 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,11 more apalEe G nqutrad) - CERTIFICATE HOLDER CANCELLATION PROOF OF INSURANCE 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 ACORD 25(2010105) ©1988-2010 A( CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CC36f MON+NWEALTil OF MASS ACHUSETTS SHEET METAL WORKERS 115 A MASTER—UNRESTRICTED ISSUES THE AL30VE LIGF-NSE ro: CARL A PIEDELL R CARL F RIEDE:LL. AND SONS ` ?78 MAIN ST OST1_RVILLE MA 02655-201. 1 tit 09/28/13 5 059.8 BUL IL= C�NS'AC'H. iSET I S' DRIVER'S 1r�a r LICENSELJqA i _- 4I55 -9a END '4d NUMBER y ', Il 07.26 2010 NONE: .S2578595U' 4b E%P ;n r09-05C�2015 .0910504974 q - ys�rdt11�l3�TT'12 REST 1 SEX.M is t j lrnaD," NONE ;R'IEDELL z EARL A787�, 115 LUMBERT MILL RD CENTERVILLE,MA 02632.31425 s DD 07.274010 Rev 07•15-2009 F. W. Webb - WebbConnect Online Ordering System Page 1 of 1 ' Webb+ 11 tumat AROMW ORNOQUQWAR FRO HWLQ%*MM% For WebbConnect II support please contact your local F.W.Webb branch or F.W.Webb sales person Return to Heat Calc User Menu Building Information Rooms Name Bartlett Click on room label to edit Location 31 Henry F Loring, Label Exterior height floor Centerville MA Wall Length sq.ft. Upper design 91 Room#1 181 8 1217 temp. 1st flr. Lower design -10 temp. Add a New Room Room temp. 71 Leeway as % 10 Number of 5@400 people Ground temp. 50 Cooling air. 50 Warming air 120 Change Information Calculation Building Rooms Gain BTU 38450 Label Gain Gain Loss Loss Base Loss BTU 40442 BTU CFM BTU CFM Board Gain CMF 1282 Uir , 36450 1215 40442 764 70 Loss CFM 764 Base Board 70 Tonnage 3.2 Back to Login I Current Order Pad I All Order Pad Entries I Order/Quote/AR Info Home I About F.W.Webb I Products I Locations I Programs I Services I News • O Co ri ht 1999-2012 F.W.Webb.All Rights Reserved. pY 9 9 http://w6bbconnect.fwwebb.com/bin/f wk?wc.hc.room.process 4/16/2013 TT L /tisT C'E/vT -L ��C /Yl, CANER4 y�lz- Tch� y � . i _ 8 4 L wiNG t t I OF1HE Tp� Town Of Barnstable *Permit# -� Expires 6 n:o" isfrom issue.date Regulatory Services Fee BARNSTABLE, i 639. ,�� Thomas F. Geiler, Director prED MAt A Building Division Tom Perry,CBO, Building Commissioner 200 Main'Street, Hyannis, MA 02601 www.town.barnstab l e.ma.us Office:' 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Cniprinl Map/parcel Number_____ e�? v Property Address j1 ���Na L 0)'t'/�tj �(/� C e,/V1e n /� C,5 residential Value of Wort. , ,C Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address �4t,�,i6IOA4' L�� c' CeNjej-VI,1Je 026, 3 C'ontrac[or's Name \®tom ��N L Telephone Number 401`'C21-Cq00. l Ionic Improvement Contractor License#(if applicable) Construction Supervisor's License# (if applicable) � go ❑Workman's Compensation Insurance Check one: PERMIT ❑ 1 a sole proprietor ❑ Atlarn the Homeowner WI have Worker's Compensation Insurance f,�AY 200a Insurance Company Name c�inl f�utv4teW ARNSTf�B}-E Workman's Comp. Policy # Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) Ve Replacement Windows/doors/sliders. U-Value MS'' (maximum .44) Ip GU IV potv- *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. Q.'•.WTI-II.1-SMF IZMS\building permit forms\EXPRESS.doc Revised 100608 I r p 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 ApRUcant Information Please Print Legibly Name (Business/Organization/Individual): / 'l 0-uW A S C_ Address: ./ 3 7 City/State/Zip:_ WOV/1)S 6 C�, 1" o ' g f Phone#: 7/ -.h y0 Are you an employer? Check ❑ am a general contractor and I the appropriate box: Type of project(required): 1.91 un a employer with I F�'"0 4. construction employees(full and/or part-time).* have hired the sub-contractors 6. �reinodeling 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. shipand have no employees These sub-contractors have 8. [J 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 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions, myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]' c. 152, §1(4),and we have no employees. [No workers' 13.0 Other 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. /� / e - F Insurance Company Name: Gt C ,' 1 'l U T v al. Policy#or Self-ins.Lic.#: a S k7 Expiration Date: d / Job Site Address: O� j'/lo� 1C City/State/Zip: 'e1V1`e�9/)/le- 44-.0'd,AI 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 and penalties of perjury that the information provided above is true and correct Date Signature: . -Phone#: _ 61 �, Official use only. Do not write in this area,to be completed by cioy or town official. City of 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#• f 31 Customer Name: 9DAW4'9�X.Gt+e flh�i�r�j]ear Built: Rercw-al by Andemn of RI&Cape Cod Rene`�f�{'ai I Sales Agreement Address: AkAIAy F Customer 1D#--. 113?Bark East Drive - m �Y�t1d�rS�R. City,State,Zip: �rt/ Pf2 f1i/l[ C. (03�Otder Numb, Woonsocket,i2I 02895 / SS 'I pDgT W tMDDW REPLACERIEHT ms Arder Cbmpany Phone-Horn. F b_ 7 C1 !L� Juan—#RI 12259-,IV.A 119353- Phone-Work ry 1/7�' S'��� Pager of 3 Dace CT0562725 Email: UNIT5 TeclmIca]memwe GRILLES Dlmemions e ems ^ d i 1 „a E� a .0 c�X» -r6•e •s'r L ' -S a a S N 0.� Room �' it rd-• ry ok dE 1 ea c?, s€ §a og a �'• k 7 onz Desviption 41 'a � � ®m dx '^ si= rYSk 5Z ms _ �S ark �£ � da �° 5 _ xi �� �,"a, m j $PRICES �•c �L- J�$ Nd w i �s Cm _ ink _n ,n'6 a cp +7g c96 7g SF Cy v g �`o N -59 2 I ae a mr: 3 X Q� o eua V N4 h a~ ye m I. E u7 3 .3 caofe'-n. -1 0 - D".14 a t- G-F36 n 3 7 -3 L91 6S r ,/ -3 �-3 0 ! Sf ah S coc C-6-( n 3 Z 3 2- _S co &6 - SW 3 (v !:r W1. utA 'A '3 o I - 5r.4 14� ct3L 0 SIO 6L 7 3 Proposal:wettlseabo„ev,i„ aoa mbep ro,ata,00�r„rteeina,�a�,�,er,�zt,e MisceflaneousCraditsorEx�ens«ees Sub Totalq. 1) P pa eMMethod PI"' r r3o y=.oei.ns m p c�ewl>�m,a x�,rty nnar,�,mao�rrz., (Staining.Sthap,Rnt Repair. sc>mo an. ) Sub Total raadd.w¢o Q Deseaipdpn I Notes/ f �} $Price S r Cfteek •/w �G 7 D Aodemen Selee ro igs:uo'e ii[J1nl�ffW /—LI �'o`J' Q.I � l• 5O Subtotal Wl ram ❑ tj.r ti�� Q �7�, CnsnomerAceentaace•XaaxietKrbya�r�o,rizedcof'rhzttwroaoa�utddoaa=��aro�m,.p�a�c O%�/,J � �tT•L�`✓1 � `� 'f'f— t'O 1/�'u+W"•'� MLSL M CredtLSEXpeI1SE5 I�III gscanmrfnrwhirh r'Le naasig�ed agora m paytiv:ama�oree><ea a.:lm agrremrnrand amorang m rl,r.srnla he><of � Financing (p.s0 See Reverse Side for Terms and Conditions of Sale.Xou,the buyer,may cancel Ali,414rP" �-f Total ❑ this transaction at any time ppnnoz to midnight of the thud buaness day after the date of this trap .'on. ea Sce attached notice of cancellation far an Sales Tax oMe detail.* cxpU=Ltio of bis • t. - Total Misullanmus Cndio or F-p-n<cs Aarprtd (tarry ovcrtow ton,;--arditI p—mlwnn atri&) .. Work Permit Cost '�°°�lONer iran°klWdxE Due er Appmra. a (Please dtrle as ttunapply} .Srzepad Sp-.W Order Notes Total Amount of Agreement ��j 1 ltst[o Door storm oast �v Be~ Bmyaom Due Rroewal by Andersrn Mamger 5gpawe Deposit Required / 000 spedwlgtw,daw .tw Wlmirla stmnlrtg ar Renewal EyMGnrxrt Xe-4.Mrelnnallatlea Aemeratet et—wH d 1,11 ep�ld � Batanee Due on totltpletian '� lFaPaing tMich euy does nvt guarantee the oiwlMew meaings ere .any mwxn da )Y nxdadKmmtlrMlMod thotml5�nelwtndaw whe/the reswnamfiy of is dsrwaed during hstalladon tsv wtSoxrFlem iiill6 aaggRalnF[n an165 �(�y}�S DrWr naN lTlb the Ub101Rer lllti55 aP��r?PPr;a sperlssatynoAd ahoee. twtalleE adserm.noted andeend robe joba I' Friu indudet iaboy materials,InsmUetion. At the ad o1 the job all ownurlam dehru MII De rnturrd ad—ill rlmn yournew windows and trmoval,and dis sal of rod— lecod. Customer/+q>a., Customer (t(i'J Customer ram,y their t Tatim xea. White-Aeneual by Andersen Yellow•installation Pink•Homeowner - p° P rbP irvtlals: vv�" lnitiair vv InitiaLs: V� •I�„a-mlh.A—r-J.,sa,r.nl br A+devnlrgsan valen,Ja or+.edn�rn c,.�msr,.eame n.e,o..re,�,.,w,}p�.n.,w.l�m s�,�as-Toox . Flom. shalom Robnsurl. HLuite;insorance At:Hiuritar Insurance,Inc. F.a,,101 To:Demise Gtu11e Date 1)[29fUd I I:to AM I'agc. �C a ,� aJ� Dt9/29/08 M 000rryY 1') ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID :a MCIONA-1 PRODMER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Hunter Insurance, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 389 Old River Road, P.O. Box 1 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Manville RI 02838-00.01 i Phone: 401 769-9500 Fax:4U1-76J 9502 !INSURERS AFFORDING COVERAGE NAIC9 I Z PER A. 3a t1on.! a.M9 ;rsa ursnc• o Moon Associates Inc. DBA Gutter Helmet H B�.ccn JRutu�l lnalit RnG� co. DBA Renewal by Andersen of RI ... DBA Gutter Helmet Roofing IrrA>TEt7L`_.... t. 1137 Park East Drive , PJ�.C>t:(h t, Woonsocket RI 0289ri � _...: _.._.v_._..__......_.. ...,_._ _____:__._ __... _..__.. 1 -._...... .. ..._..._. 4 tNi}1.d7rzJ't ti COVERAGES : rr Q,i.,IA.IC tI-,i tF I I$WAlleE LISTEi011.1.CAN ItAVELa!rE?Iirir4 It-D I(I II fE 04:11.9&7 t 1AIMCD A03rt;;.F00'IhE'POi. Y FT,!1:S!Ni ACM EVI f.h.) ;fi;S D I�l A,d.ir^; .T ^ -:JF-t:r.;A rlt+t l:tJ::N1.1ki:tA,';!'i .C.v$rt1l;;!n c.J AtJY!'ryrttf2/'e�'ia'i Url+t.ti Cti:>•t.�,*C`Nt�yln+rq i(PVMK:II THISCf'QT1FWATErAAY t;i;: t r;,:F'i-AItJ.Ti+is RJ;;:.dllJk:L.-)0+01.k0 By(S4,"C4.iftl'a"L>F..L:r.Ft!t'.�t�G1�;kCt.�l�..a 4.t-��Cf r;J Ni_1.1��:1'Eh`h,-Ca t>J_Li.l;:ztt}t<,..A10 l�tw�y,:i!Ii0`hf:i s.�=�rklt t _.:•,IL: ss..a.j},;�I E1it,91 SkffV4,1 WNv it-V.'F f}.,.;N f:(..>-EEa hY PAt'i;.l C.L3JF:: - - i'GC(Cr'EFFELRTVE__)PC�CILi"1kFI�rinof I L'rn IrlsiaCi TYPE OF U1611R A th:F f r,�t h:V N11k:BER DATE FMt•UD(iJl1'! I DATE(IMM00WO t - LtMfts j £NER-AL.LIABILITY .._._.. ._.__....._..___�.�`t'.--__`..^•'—•--r i ; ; lrF,•_rtlxr7bi E 3 1000000 Tvwsnr> irTR-N, .n A i Y. i -,a r f:.rr J_u!l.its(31 ITY MPS26619 }. 09/16/08 09/16/09 �r(C!.(e5J�(La uzi I F 500000 i t L<t. FTP .w'rr It F of r f i f 1 0 0 0 0 tz +rut z 4 tN,RUJ{ j41000000 t f fF F 1 .�.(-,w ATF is 2000000 '..NIL .r:; i LuA•Ef lr .:.�i�1.rS!-f r: i -_i tf C1+ h,7:� dL4S-K.I R. ..»f j 'rOQ0000 j AUTOMOSILF.Lt nn.tt°r wu;; � areil.cf it $ 1000000 A I ! � I,�FJY A,1Ttr Hl d6tz19 09/16/08 L 09�/16/09 �i a2 .f hiSt is i 47NAED IVAr.S I filli't.J !ia s t y _ ! IF R I(At vJaE —} �....�t_-___....__...---•--.._...._. ,tai r OtAN i:la t<.'II:C�M r t G 62AGE LIkFStLiIY [ t .4tir Liti:I T} RT){ Al AA C f S Ftc-(RC, sv,i> 'i IEY.CESSAMBRELLAL(A2MJFt E:J:CttivcLunf.Nr iS1000000 1r:)n:L,_:.v d: CUS26619 09/16/08 f 09/16/09 id>�ttf. I f I Lx..n : fsLf j S r tit; r(I .N $10000 i ._. ...t...-...- i.....,...... _ .._ _ .-�....__.,......._..__..._.�. __ ............._-+-. Y UfiHERS C:ihiF[iN2ATI 7N AtJD � �)i>¢JYLir'trY� -I', _ £MPL11 rER5 LIABILITY �-' Ei I 2$58t5 10/01/0$ 1 10/01%09 �E t th s+ACc, rJr 1500000 lt.L flif-EASE tP.Zmi L'5500000 et;c;I vi I J p ry (Att<-aA,, Kt YLt• I3500000 r L.SCRIPrut1 OF 0rCAA1N5F4fi i i.0C„TONS f VDV1( U-S I EXCLUSIONS FF?5,irilotis CERTIFICATE HOLDER CANCELLATION BUILDIN SHOULD ANY OF THE ABOVE DESCRI13ED POLICIES BE CANCELLED BEFORE THE E%PIRA"ON DATE 11HEREOF,THE!SSW10 IN URt;R V I t.ENDEAVOR TO M.y(L 10 0AY9 wRITTCF+ Building Cont. Reg. Board NOVICE TO THE CERTIFICATE Hr-LOER uAWD To DIE LCirf.HUT FAILURE TO GO Wit]t H:.Lt. Dept: of Administration One Capitol Hill 1MPCeG£NO GBLIG1iTi rJ OR Ll Fsttr r C1F fh KUJf 1FF'i3N THE it'JStj7if?R,t7S r{;{tJi�ciFt Providence R1 02908 f�EFRicsEriTAT7VE ACORD 25{?001109) _�~ C>ACORD CORPORATION 191I9 a„�lE6••(�C1NTt//J9(7J2Gf���£7�VvtlTd:SQC� License or registration valid for individul use only - Board of Building Regulations and Standards before the expiration date.,If found return to: HOME IMPROVEMENT CONTRACTOR Board of Building Regulations and Standards One Ashburton Place Rm 1301 - Registration: 119535 y Expiration: 7/2412009 Tr## 130185 ' Boston,Ma.02108 Type:•Private Corporation MOON ASSOC INC ,.JAMES*MOON 1137 PARK EAST DR. Not valid ithout signature WOONSOCKET,RI 02895 Administrator: a l,i�°„ic:ileF, its l�cl3:.N.Csr�x at=l3 f}tshiic �:::ft:t� 'Restricted to: RF,WS t3tt.ti it ! l tiiltiita_ R *theft; ld '< ? IA- Nlationry only RF- hoof Covering aetct �. vS 3z. 840YVS=Windows and Siding Mesa _tee fol RE,tNS SF- Solid Fuel aumiug Devices: ` DM I inolition'only JAME5 MOON ' 4&PAINE ROAD Failure to poswss a current edition of the GUUl Ertl-At'1D, ! Q28t 4' ,Massachusetts State Building Code is cause for revocation of this license. Referto, G6VdW.Mass.GovIDPS1212012 . ' 1'•Ittat:l..,Ir,1, �.-�-- 0 A 414 3 r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION M p7 Parceh IlY02 Application#C;V©r0/ 0:� Health Division Conservation Division ,� Permit# Tax Collector Date Issued .� Treasurer Application Fee ��� Planning Dept. Permit Fee3Sr u Date Definitive Plan Approved by Planning Board 6���04 Historic-OKH Preservation/Hyannis 'tz::�Project_Stree-fAddres--�3 / Pn rV ri ns EA kvillagec'N D e n re ru i I SC__ Owner ��nf I S ke', Ar),k (�'�� Addr_e-ss--3 TeI,L ephone. g UJa c� �3 D Permit'Request Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay c!P_roject=VaIuatio--_��(�b O �� Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. - _.r Dwelling Type: Single Family Y' Two Family ❑ Multi-Family(#units) Age of Existing Structure s' 4 V-5 Historic House: ❑Yes On Old King's Highway: U.-Yes z0 No Basement Type: 2Full ❑Crawl ❑Walkout ❑Other t T- 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 iI ❑Electric ❑Other Central Air: ❑Yes Fireplaces: Existing Z S New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:®'exexisting ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# _ Recorded❑- - - - T Commercial ❑Yes ❑No If yes, site plan.review# Current Use Proposed Use CB_UILDER INFORMATION-" cam\ Name I)OVrAc�, Telephone Number Addressl \AkA f!j E k-4_)f 41� RA License# Ce rn-i--eNt1<C f MA- Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 'SIGNATURE.` V r"DATE - - '"� FOR OFFICIAL USE ONLY a PERMIT NO. DATE ISSUED ' MAP/PARCEL NO. s ADDRESS VILLAGE OWNER r DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL s s r PLUMBING: ROUGH FINAL Ir i GAS: ROUGH FINAL FINAL BUILDING Y DATE CLOSED OUT ASSOCIATION PLAN NO. • i i The Commonwealth ofMassachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Bostoy; M4 02111 - www.mass.gov/dia* Workers' Compensation Insurance Affidavit:Builders/Contractors/Electridans/Plumbers Applicant Information Please Print LegibIy Name-pwauess/organization/lndivi duQ. l�J lti Y�y�� d—C 1/�i�� S+��� f:�U c4'1 r+I Address: 1�P �( �► r �d ( , �, �.ck City/State/Zip: P,n-c-�N I �— l/y 6)03�\ Phone#; s b C U Are you an employer? Check the•appropriate�bo Type of project(require): 1.❑ I am a employer with 4. am a general contractor and I 6. ❑New construction employees(fall and/or part-time). art time). have lured the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet,t 7. ❑ Remodeling ship and have no employees These sub-contractors have SS ❑ Demolition working for me in any capacity. workers' comp.insurance. 9. ❑ Building addition o*=kers' Gomp.insurance 5. ❑ We are a corporation and its [No 10,[3 Electricalrepaas or additions required.] officers have exercised their 3.❑ I am a houieownez doing all work right of exemption per MGL l l.❑Phunbing repairs or addition myself,[No workers' comp, c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t , employees.(No workers' 13.[D Other cep.insurance required.] *Any applicant that checks box#1 mist also U out the section below showing than workers'wwansadon policyFaforinatian: ` t Homeowners who submitois affidavit indicating they are doing aU work eadtheu hire outside coatraotors most submit anew affidavit indicating suoh iContractai that check this boa must attached en additional sheet showing the name of the snb,00atraLtm and their workers'0MM._pcHQy iafaxmstioa. I am an employer thai is provtdtng workers'compensation Insurance for.my employees. Below Is the polky and job ob site Information. j Insurance Company Name: pQv�y#or Bei".Lic.##: �' Doti: Job Site Address:- City/State/z* Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required node=Section 25A of MGL c. 152 rmi lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year in4nisonmen%as well as civt 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 he y ce under the pn'O d penalties of perjury that the information provided above is true and correct Phone#: it�a�use oy. e e t es ,to be complewi , City or Town: PermftJLicens Issuing Authority(circle one): 1.Board of health 2.Building Department. 3.City/T1 own Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other 1 Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensationfortbeir 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,,offal or written." An employer is defined as."an individual,partnership,association,corporation dr 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 apartinents 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 orbuilding appurtenant thereto shall not because of such employment be deemed tobe 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 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 cuter 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 checlemg the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited LiabMty Partnerships(LIP)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 time 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 member listed below. Self-insured companies should enatm their self-insurance license number on-the appropriate line. City or Town Oftldals . Please be sure that the affidavit is complete and printed legibly: The Department has provided a space at the bottom. off dMavit iia you to fill outan the event the Office of Investigations has to contact you regarding the applicant ire to fill in the ern*11icense number which wM be used as a reference number. In addition,'an appliraaxt , Pleasebes p that must submit multiple permiAicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Jot.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 applicantas proof that•a valid affidavit is on file for future permits or licenses. Anew affidavit mnstbe filled out each year.Where a j ome owner or citizen is obtaaming a license or permit notrelated to any business or commercial venture (Le.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 camber: The Commonwealth of M- MuChSettS Department of Industrial Aceidmts Of am af layesupfim 600 Washington Street Boston,IVlA 02111 Tel. #617-727-4900 exit 406 or 1 077MASSAFE ' Fax�617-72?-7749 Revised 5-26-05 c-w- i mass.gov/dia ...r.aw wvv ay.vv cm avvv•rvvaaav .. iuw annava n�raw •nwr ...-...,..�.. ._ Board of-Building e�uiations -R One Ashburton PT ace, m 130'1 ; ` Boston, Ma 02108-'t 518 Wcentie; CONSTRUCTION SUPERVISOR LICENSE Birthdate: OW14/iS70 Number. CS cT3865 Expires:03114/2OO5 Restricted 70: iG JAM R MCCTPJ.TFi 204 C%tANVIEW RD BRBWS'1'BR, MA 02631 159e7 IKeep top for rec.bt and change of address notification. 071ze -e60M'1r"40- 6v _ Board of Building R*latfons and Standards One Asbbnrton Place_Room 1301 r Boston.'Nf assg4usetts 02108 liome 1=0vemehf4atractor Registration mm Registration: 13205 -' -� TYps: Private Carporation McGRA rH POST BEAM CO. 11 Ell -- JAMES WGRATH 259 QUEEN ANNE RD. 0 Af' HARWICH,MA 02646 ' f�r1, tom' Update Adlr=tied rcram eas*Mark I==for cbang'L Cj Addreso ❑ tttuewat 0 Empigwxt Last Card Boar#of HuHd1nW P $Astt9ea and St"dsrds Licenas or regfstratim vsltd for lndh4duWre oaiy HOME IMRROVEMENTCONTRAGMR bsfortth6e:pinttfasdat6lffauu0.rcttttnta: R pietrs tong 936 Board of Batldiog Kegutaticts and Standards 9'''{{� y� OntA:bburton PlaccRcn 1301 .�{'RON�K••i. r?OaB � BOSCO%lt'ia.a2208 cbrponktrw McGEL4Yti POST d.BEA JAMES htsGtiATM .' t f% 259W1FENANNERISt' HARwtCH,MA 02 S r(JnytntscrKor Not valid wahout fignsture {p� Contact Person: phone#: Departtoetrt of Industrial.4 cciden ts Office ofrnvestigafiorJs ` '600 N�asfsixg>'oncteet Boston,l A 02111 Wairkers'Compiias.,tion bmrkna Amdavit:Builders/ContractorstMect Ci2wMluinbers' . ' MmUcant�.� TD fo-rzb ation ,• . � • Ptea e Print b! Dame(hLSbuss1�r �►;&�: ' karbal a Address: �„ ady tate.7jp: r-- l xe-you au etnplaytr?•Check'tbt•App7aprlate box: ' 1 ark a c�gloyrr vntb 4-0 I am'a gc is W cotitractor aridI• Type of irrojat(CCqu►rtX : ' • tMPloya=(W andYor par * have-hfi cd'the sub-coattac= tS a Ncw'cousajc 0a 2.❑ I am a aoteprpp��orpaf c r- listed on the attached Sh=t.#' •7. 0 Itamodclinj ship aad:aavc sib calpioy�. Tbc a sub-=tracrvrs I12'vp 8. Q p trob wor><ang for me;im 2ny capacity. WWI, , �P.iasdraucc. WO zyarkt:rs' •i>zttu�acc S: We ar a S. Q Buhdiq aWdot �� � c cvrporattoa and its - r -1 of xrcrs 11sve excused Abcir 10 D Elcctlfcai'rcpkirs or sddid= ° J 3.[� I art a'pg 4aq►iacr doing XV work right ot'ox=Vtf=pa MGL 11.[]Phlmb*rcpaus ar additiat:ss mYsclL [l`fo 4irorkcts ro •t~ 15�, 1)(41 sdd we have go . : iaswra CC requix d j.t cuvldyoes. (No workers` •12'0 Aofrcp2hm Jj cort�.ioswsa roq d.) 13.E Qfte + �Arb1i vute6-4u.box11, 1 ourtbe sec�oabe]ba�p t1T:Ocxorviiasi�hotbirri/�is" � �j "• '! I�0af10rs'ooa"ptas�tic��4 �rammt , 1 � •..— r�l at ea0ai�iayarz�t:lt arostc:nd Then tare outside ca rr bid dta;t 04 box tint attaehad at�dditiortal sheet diow�ltra name otthe{ub-Eon���sRhau`t�tc+v t�dsYit md4�t s++rh mf dtut�trolioK;i+oor}ppoticr Pj�`�: isp+�pt►�diirg tvctt'ItBrs'tcMttepa:tsariort uUtFranee ors sm `o �t lire a and f I Y P Y .Srfo POW fab site tl `, Just aura C41npauyNatnt: !W 3 1 Poiicy#or self-iris.Lk#: F;t�) S f/ �,� ' ,I ..r� � x�irati m D, {.il .Job.S:teAddrrss. . •GQty/St�e/Zip: • Attach a copy of ibt WrktW eompetisatfdu*policy dtelatatian gage(showing tote 'oli as r C p cY nutviber Aud expEmtin` } PaihiFe•to secure•c�vera a date). Be �Quir�cd undef Scedon 25A of MGL r 152 r�u lead to tba position off a ' —,r✓ two-up to$1,500:. smdlgr out�year ' E . vrt?pr tsomaent;as�vcll as civr�pcmlties is the' Qf a I� 14aS of a "j ofttp 10 MOM a day agak�t•tbt:V`Iolat*r. Bc adviscd'that,a copy of this stattatt�t SMP WORk O'RDE� ud s firic r: Investigations Of t§e D1.A far insucauce Coven age vtxi�catiop, �y be folwardat,tt:l�e 0�19Cc of• ' e do k"b}r urrdtf fhe ' + � Pee o irf •t at the ftrjorntafion prauided al ore •d'carr If . U dal ATO 04". DO not wale fn MZ area,to bs caarFldEd by city or town a teal �� t3ty di T•owfo:� � ► • Permit/idceast# . Issuing Autbor.ty(tlr&one): , 1.1ibard of bTu:th Z.Building DepttirtMeat 3.Cjty/7own Gitrtc 4.Eleciricat 6.Otber 1'ssspectar S.PlamDlag rupcctar Ceiritaet persona: Phone�: Date: 6/6/2006 Time: 11:53 AM To: Q 9,1,5087717070 R&G Ins. Agoy. Page: 001 Client# 20245 MCGRPOS --A'CORD- CERTIFICATE OF LIABILITY INSURANCE osrosws Y��' PRODUCER I THIS CERTIFICATE IS ISSUED AS AMATTER OF INFORMATION Rogers&Gray Ins.Agency,Inc ONLY AND CONFERS NO RIGHTS UPON THECERTIFICATE 434 Route 134 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O.Box 1601 South Dennis,MA 02660-1601 INSURERS AFFORDING COVERAGE NAIC# INSURED dNsURER.k St.Paul Travelers Insurance Company McGrath Post&Beam Corp INSURER& American Home Assurance dba Pine Harbor Wood Products INSURERC_. 259 Queen Anne Rd INSURER D. Harwich,MA 02US INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQU IREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR NOD1POLICY EFFECTIVE POLICY EXPIRATION LTR N$RG TYPE OF INSURANCE POLICY NUMBER DATE MM1DDfY. DATE(MWOWYYI LIMITS A GENERAL LIABILITY. ISM03MBOOTIL06 01131/06 01/31M7 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TORENTED $1Q0 OOO CLAIMS MADE OCCUR LIED EXP(Anyone person) $5 000 PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE $2 OOO 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMWOP AGG s2,000,000 X POLICY P C LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS - ., (Per per on) HIRED AUTOS BODILYINJURY $ NON-OWNED AUTOS (Per acclderd) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANYAUTO - .OTHER THAN EAACC $ AUTO ONLY: AGG $ EXCESSAIMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE. AGGREGATE. $ DEDUCTIBLE $ RETENTION $ $ B WORKERS COMPENSATION AND WC6707802 07/08/05 07/08/06 X WC STATUj r,...T 07H FR EMPLOYERS'LIABILITY 07108/06 07/08107 E.L.EACH ACCIDENT $100,000 ANY PROPRIETORIPARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-FA EMPLOYEE $100 000 If yes,describe under SPECIAL PROVISIONS bet— E.L.DISEASE-POLICY LIMIT $5QO,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS Re: Donna&Christopher Bartlett, 31 Henry F.Loring Rd.,Centerville,MA CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL A 0 DAYS WRITTEN Building Dept NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SOSHALL 200 Main St IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTSOR Hyannis,MA 02601 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001MB)1 of 2 #22568 DMW 0 ACORD CORPORATION 1988 PINE HARBOR WOOD PRODUCTS 326 Yarmouth Rd. 259 Queen Anne Rd. Hyannis, MA 02601 Harwich, MA02645 WOOD PIkODUCTS PINE RkRBOR (508) 771-5007 (508)430-2800 Fax(508) 771-7070 Fax(508)430-1115 Its all about the wood Sales 1-800-368-SHED www.pineharbor.com Customer Service 1-866-SHEDKIT SOLD BY DATE INSTALLATION DATE 20tj�r 'JAME ,Act'.lzz� 4DDRESS PHONE#'S (71C DESCRIPTION AMOUNT A ;IZE 1-sa k ;TYLE zz ;HINGLE A )PTIONS LEFT GABLE RIGHT GABLE f e/c 7-7 &0— X: FRONT SUBTOTAL 12 TAX BACK DELIVERY TOTAL 4 'HECK # CASH DEPOSIT VIC/VISA OTHER BALANCE Permits & sitework are the responsibility of the homeowner. Please check with your local building department regarding permit requirements, setbacks and other -regulations that may apply. nge, postpone or cancel a delivery we require at least a 5 day notice. Q i yew. C. ,NATURE Town of Barnstable P��FTHE Tp�� y Regulatory Services sAaxszAs , ; Thomas F.Geiler,Director 9 MASS. 039• A.� Building Division rfD MP't Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 1 l n 'Q JOB LOCATION: 3 1 Tse if�) �tr 1 h r, 1�ti l `e Vl number_ Gstr.f village "HOMEOWNER,�Uoyw t_ a h rd" Mo rir. (�,141-e-+r q 2)9-- U ��✓1�' 6 -- natrt` homphone# work phone# CURRENT MAILING ADDRESS: City/town state "°" �-—I code - The current exemption.for"homeowners"was extended to include owner-occupied dwellings of six units.or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department um inspection procedures and requirements and that he/she will comply with said procedures and req ' ements. CiSignature of Homeowner � Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. . HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt °FT Town of Barnstable Regulatory Services WABIX Thomas F.Geiler,Director �'ArEnr 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 IMTROVEMENT 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. yP S � ted Cos/ �o ® �, U T ofWo`rk: YAP Address-of Work: 3 I \ en✓h E _ L6 r i Vic, �� �P ✓1 T�°�I) I� Owners Name:1'�h y\k -N- C k/i S—k-1) h,-/' Date of Application_: (♦p (� 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 Z�er.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: Date Contractor Name Registration No. O Date Owner's Name Q;fomislomeaffidav 1 53.40' 30.00' gi ��0 J DECK -_- 8, �z L LOT 124 g� 4 �- LOT 122 RES. ZONE.- 'RC" This MORTGAGE INSPECTION plan is For FLOOD ZONE. Bank Use Only , TOWN: -CFdVTERVILLE _ __ REGISTRY OWNER: CHRISTOPHER _W._& DAiVA_M.-BARTLETT DEED REF: _ 47741LA-e__ ----BUYER: REFIN,ALVCE ----------- I _____ _ - --------- DATE: _6OZ02 ______-_____ PLAN REF: _30 Z,,? SCALE: 1"= 30___F �'. HEREBY CERTIFY TO _PLouT MORT�Ac co_____ YANKEE, SURVEY ___THAT THE BUILDING `�H OF � CONSULTANTS SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS �``� � SHOWN AND THAT ITS POSITION DOES _ _ CONFORM i PAUL( ys TO THE ZONING LAW SETBACK REQUIREMENTS OF THE � A. In 40B (SUITE 1) TOWN OF __-BARIMSTARI_E-------------AND THAT MERt7HEW c^ INDUSTRY ROAD No• g� a IT DOES_ NOT _ LIE WITHIN THE SPECIAL FLOOD HAZARD 9�cr Quo y� MARSTONS MILLS, MA. 02648 AREA AS SHOWN ON THE H.U.D. MAP DATED 8��9�85 _ �s„ 1[ SOQ. TEL: 428-0055 Co unit -Panel FAX' 420-5553 250001 0015 C ik _ __}}??i,o f__ THIS PLAN NOT MADE FROM AN I TRUMENT P UL A. REATHEti4. PLS -- SURVEY .NOT TO BE USED FOR FENCES ETC. 24115 DPG 'Mum. «'` >>:< <LT' > 82 .. .:.::: ..:::::::.....::::... GLORIA .............:..........................................::.................... .fix...... .: .:..... ::...................:...::::::::.::::::::.:. JEAN 0 NEILL .............:::.:.::::..:.. ` x:.HENRYF. LORING RD. 4............ .. ............... .. N... ..... '.. .............................::::.::::::.::::.::::.:::::::.::...::.::::::::.::::.::::......:..................................:.>.:::::::. ...:.:.:::..:. ...:::.... ...... ..:: NEIGHBOR ...:.:. ....::::::: H :..:::. EQUIPMENT-BOAT-TRUCKS ETC.0 RUNNING U BUSINESS.G U N S ESS xx NMI WILL a'7 a� l :... l R)72 182 . A P P R A I S A L D A T A KEY 102668 ONEILL, JEAN G LAND BLD/FEATURES BUILDINGS NUMBER ZN/FL=RC 28, 000 91, 400 1 A-COST 119,400 B-MKT 90, 500 BY 00/ BY ML 9/92 C-INCOME PCA=1011 PCS=00 SIZE= 1454 JUST-VAL 119,400 LEV=300 CONST-C 0 ----COMPARISON TO CONTROL AREA 37AC ----------------------------- NEIGHBORHOOD 37AC CENTERVILLE PARCEL CONTROL AREA TREND STANDARD 101 10 LAND-TYPE 280001 LAND-MEAN +0% 1194001 96618 IMPROVED-MEAN -50 250 ] FRONT-FT ] 100 DEPTH/ACRES TABLE 02 1000] LOCATION-ADJ APPLY-VAL-STAT 1 LNR] LAND LFT/IMP]ADDS/SB/FEAT STR] STRUCTURE ARR]AREA-MEASUREMENTS NOR] NOTES COM] MARKET INC] INCOME PMR] PERMITS GRR] GRAPHIC FUNCTION- [ ] STRUCTURE-CARD NO- [0 0 0] DATA- [ ] XMT [?] s 4172 182 . P E R M I T [PMT] ACTION[R] CARD [000] KEY 102668 000000001 PERMIT-NO MO YR TYPE VALUE CK-BY MO YR %CMP NEW/DEMO COMMENT 3 [ ] [R172 182 . ] LOC10031 HENRY F LORING ROA CTY110 TDS] 300 CO KEY] 102668 ----MAILING ADDRESS------- PCA11011 PCS100 YR100 PARENT] 0 ONEILL, JEAN G MAP] AREA] 37AC JV] MTG] 9201 31 HENRY F LORING RD SP1] SP21 SP31 UT11 UT21 .40 SQ FT] 1454 CENTERVILLE MA 02632 AYB11978 EYB11978 OBS] CONST] 0000 LAND 28000 IMP 91400 OTHER ----LEGAL DESCRIPTION---- TRUE MKT 119400 REA CLASSIFIED #LAND 1 28, 000 ASD LND 28000 ASD IMP 91400 ASD OTH #BLDG (S) -CARD-1 1 91, 400 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE #HN 31 TAX EXEMPT #SN HENRY F LORING RD CENT RESIDENT'L 119400 119400 119400 #DL LOT 123 OPEN SPACE #RR 0692 0206 1314 0102 COMMERCIAL #SR PRINCE HINCKLEY ROAD INDUSTRIAL *M-792 84P-0374-E1 EXEMPTIONS SALE110/85 PRICE] 127500 ORB14774/192 AFD] I LAST ACTIVITY] 07/22/86 PCR] Y � � — nz toe rAssessor,s map and lot numbe ...............11. *. `' SEPTIC, SYSTEM MUST BE :µR'. INSTALLED IN! COMPLI ANCE Sewage*Permit number .................. .......... �I T TW A4TICL�= II S FiTP St SANITARY COOE :AINID TOWN HE AORLE TOWN' OF BARN9T Z B)BB.STOIILE, i ° DY`� `� = D;UIjLDI, G,, INSPECTOR 9 \e r4-1 APPLICATION FOR PERMIT TO ....... .................................................................................. TYPE OF CONSTRUCTION • ... .... ................ .................................................. .ry` •fit' i.�' } ••_ ' ........................19.... .J� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies fo a permit accord* to the following information: Location .. .. .. ,.�....X7 /6/ .................................. ProposedUse�. ...............•.. ........................................................................................................................................................ ZoningDistrict ....................................... ..............................Fire District ..... ..................................................... Nameof Owner ..... ..........Address ...... ........ ...... ............. ........................................... Nameof Builder ....................................................................Address ................................................... ............................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ........!q.....................................................Foundation .....&rao ........................................................... Exterior ...... . .... ...................................................Roofing .............. .... .. ..... ........................................ 04 Floors ..........a ...........................................................Interior ......... "� W.. &A10.................................... Heating .... ....1.. .............................................................Plumbing .................................................................................. Fireplace ...... ..... .. .... ... .. .. Approximate Cost ........b. Definitive Plan Approved by Planning Board _""__"""_"""__"""""""_"- """_19""_""""" Area .....�: o.................... Diagram of Lot and Building with Dimensions Fee ® ... SUBJECT TO APPROVAL OF BOARD OF HEALTH �� ood? De'--- I hereby ,agree to conform to all the Rules and Regulations of the Town of Barnstable regar g the above construction. Name ...."...............................4e� I Small, Alan E. 173 \ \ �' �� one story r��, ------ Perm� for .-----------.. ~w � single family dwelling ' ^ ------.—.---..--------------.. , /r 3l F �orinm Iow�d - ` Location ---.�����.—.�--..^'..�------'. � �m���zn,�llm ' —.~------~------..---------- ~, ° . ' Alan E. Small Owner --.---_—,—.-------.--~--- � - Type ofConstruction .. ...... rap�....................... � —/.---------.—.—...~...---.-----. ' 7" ` . �pk, ���� . -----..---.. b� ----------. �a� 3 �� ' Permit Granted ......... ..". . .. ' lg ' ' ' --'r/--_ ' . Date of Inspection . lV ' ^ Date Coimplet�cl '... - X9 ' / � . ` . � �ERMIT REFUSED ^^.......................................................... l� ` ' ��/ ' ~ i —. ~'—.—'.--.'..—,---.--.-------...�.. —..�~......._. -..----...—._—.----.---~..--....... .---....—,...,.~..—'.....—.~.—.......,�. . . . Approved ---------------- lg ' ' -------.------.—.,...—.—~.~.--. ' ' ' ` --------------------.—.—~..., ' Small, Alan E. A=172-182 ,uf 20173 one story IVo. ................. Permit for .................................... single family dwelling } Location ........31 Henry F. Loring Road t ........................................................ Centerville ............................................................................... Alan E. Small Owner .................................................................. ` frame X` Type of Construction ................................................................................ 4123 iPlot ............................ Lot ................................ May 3 78 Permit Granted ........................................19 t Date of Inspection ....................................19 Date Completed ..............I........................19 PERMIT REFUSED ................................................................ 19 n . .... �14 it.L .................... ............V ...................................................... i .............................................................:................. . ............................................................................... Approved ................................................ 19 ............................................................................... ............................................................................... % - Y z .t;41t t.., `•'t�,N/ 1 -, ,%tL/ .m t J ��0"!,r+o,F1 V, . 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IJ UO Tb Q.r lt= 'M►wJ.L, Ln� f;IWi 'a..M L : ri ti TOWN OF BARNSTABLE _ 2(�, •e Permit No. __.. s �u Building Inspector Cash �t1,000.00 S S/-E rua -----------_--- <b OCCUPANCY PERMIT Bond ---_---------- "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Address Wiring Inspector 's Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. ...................................................... 19......_. .................................................................................................................. Building Inspector FRAMING: (Full Dimension Pine CHATHAM LOFT � • 2"x 4"Rafters @ 2'on centers �T 1``� OD (zx6 for 12'shed widths) POST and BEAM SHED • 2"x 4"Loft Joists @ 4'on center WOOD PRODUCTS (Zx6 for 12'shed widths) Mall about the wood" 4"x 4"Top Plate Beams 4"x 4"Center Support Posts • 4"x S"Comer Posts are 6Y'tall L • g"x 4"Comer Braces • .2"x 4"Wall Purlins QI l '� !j • 2"x 4"Door and Window frames �i /8" 00 flo o d D C �. X P�5 �i- (Pressure Treated is optional) • 2"x 6"PT Floor Joists @ 16"o.c. (2x8 PT for 12'shed widths) • Rough Pine Trim(primed pine or _7 red cedar is optional) • 8"x 8"Aluminum Louver Vents • Standard Board and Batten Siding — clapboards or white cedar shingles are optional E 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/rz,and including a ¢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 floor space. This design adds New England character! + r_ PIS CAR WOOD PRODUCTS Its Il a about the wood.�,� • cV CHAM,4M LOFT 914M - lO (Elevations Scale: 114 = 1) LEFT REAR 74' 10 o f FRONT HA" F FLOOR FRR,MING SPECIFICA77ONS (2.x 8 Pressure Treated @ 16" :.�IGffT f