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0107 HIGHLAND DRIVE
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Richard V.Scali,Director IUD Building Division Paul Roma,Building Commissioner, 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS P RWT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number (� J Property Address�_®`Z l-� i °(� N lq-%) D Residential Value of Work$ rJ�(p® 00 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address .S C Pt k1 &j4 kL iA t ek L A oa :D 6-aLN1dr_ WA Contractor's Name J.s E a c; Telephone Number,�pP ,411 J Home Improvement Contractor License#(if applicable). 3 3 Email: ? Construction Supervisor's License.#(if applicable) D E3Workman's Compensation Insurance Check one: a !t ►:r4� ❑ I am a sole proprietor Ili a ee,• ❑ I am the Homeowner MQ� 2 O 20�1 I have Worker's Compensation Insurance fit-T C ` Insurance Company Name l t af,L4L4 M u �� (, OWN. Workman's Comp.Policy# We a 3 I S• 3 aq7 D Copy of Insurance Compliance Certificate must accompany each permit. Permit Reques (check box) x LkRe-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to �j -pijl 144 ❑Re-roof(hurricane nailed)(not stripping. Going over -existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows '#of doors: " "Where required: Issuance of this permit does not exempt compliance with other town department regulations;i.e.Historic,Conservation,etc. ***Note:. Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is re uired. ,. SIGNATURE: , QAWPFILESTORNIMbuilding permit fomisTYPRESS.doC 61/25/17 The Commonwealth ofAfassachusetts DepartmentoflndustrialAccidents Office of Investigations 600 Washington Street Boston, MA 02111. _ - www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers Applicant Information Please Print Lenbly Name(Business/Organization/Individual):J SON C+ e, - Address: Q.3 City/State/Zip: - S 2) Phone p9 L/OQ 3 4 l L Are you an employer? Check the appropriate bog: Type of project(required): 1.['I am a employer with I 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- Listed on the attached sheet_ 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition workingfor me in an capacity. employees and have workers' Y aP tY- # 9. ❑Building addition [No workers' comp.insurance comp.insurance. 10.❑Electrical repairs or additions required.] 5. ❑ We are a corporation and its eP 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions } myself{No workers'comp. - right of exemption per MGL 12.❑<aof repairs insurance required_]-t c. 152, §1(4),and we have no employees,[No workers'" 13.❑Other comp.inmrarce required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating inch. $Conhacxors 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 then-workers'comp.policy uuunber. r am an employer that is providing workers'compensation insurance for my employees. Be—row is the policy and joh site information. - Insurance Company Name: Policy#or.Self ins.Lic.#: �.i.t. �, 3lS 3y,3,97 03 (o Expiration Date: 1 Job Site Address: U>1 J 0A (N bi _DL City/State/Zip �� ��L��a , 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 riff under he pains and penalties of perjwy that the information provided above is true and correct Simatvre: Date: l�' Phone 4- x oij7 al use only. Do not write in this area to be completed by city or town ojTxiaL City or Town: PermitUcense# Isguing Authority(circle one): 1.Board of Health 2.Building Department 3.City/rown Clerk 4.EIectrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Town of Barnstable Regulatory Services MAM Richard V.SW4 Director - �� ' Building Division. Pahl Roma,Building Commissioner , 200 Main Street,Hyannis,MA 02601 www.town.barnstable-mans Office: 508-862-4038 ; Fax: 508-790-6230 Property.Owner Must . Complete and Sign This Section If Using A Builder L G D,rL aAig t41 6 LLA ' ,as Owner of the subject property 3' hereby authorize 3t),T �:,, -�„ to act on my behalf in all matters relative to work authorized by this,building permit application for. (Address of Job) - **Pool fences and alarms are the responsibility,of the applicant Pools are not to be filled or utilized befort fence is installed and all final inspections are performed and accepted: Signature-of Owner S. a of Applicant je h. Print Name' Print Name Date `QYORMS:OWNERPERMISSIONPOOIS Town of Barnstable �~ Regulatory Services t, oIF Richard V.Scali,Director Building Division t t Paul Roma,Building Commissioner 639. ��� 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: JOB LOCATION: number street village "HOMEOWNER": - name home phone#: work phone# CURRENT MAILING ADDRESS: city/town state zip 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 minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature 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 shalFact 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 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:\WPFII.ES\FORMS\building permit fbrms\EXPRESS.doc 0620/16 t From: Nadine McMahon nadine@vokeyinsurance.com, Subject: Certificate-Town of Barnstable Date: March 16,2017 at 9:28 AM To: jayjacinto7l @gmail.com Hi, Attached is a copy of the certificate I faxed to the Town of Barnstable. Let me know if you have trouble opening the attachment. Thanks, Nadine McMahon Mark T Vokey Insurance Agency PO BOX 1247 - 28 Village Landing West Chatham, Ma. 02669 (p) 508-945-3535 (f)508-945-9368 ACORV CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY 0311612017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THI CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIE BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZE REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: N the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject t the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to th certificate holder in lieu of such endorsements. PRODUCER - NAME Craig Voke CRAIG S.VOKEY, DBA MARK T.VOKEY INSURANCE PHONE (508)945-3535 1FAX No: no°o ess: craig voke insurance.com P.0 BOX 1247 INSURERS AFFORDING COVERAGE NAICM WEST CHATHAM MA 02669-1247 INSURERA: LIBERTY MUTUAL FIRE INS CO 23035 INSURED •_ INSURERS: JOSEPH JACINTO INSURERC: DBA SEASIDE ROOFING AND SIDING INSURERD; 23 RIDGEWOOD RD INSURER E: ORLEANS MA 02653 INSURER F: COVERAGES CERTIFICATE NUMBER: 134617 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIO1 INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THI; CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM; EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN5R TYPE OF INSURANCE DL SUBR - POLICY E POLICY E%P LTR POLICY NUMBER MMIDDIYYFF (MMIDDIYYYVI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $DAMAGE TO RENTED CLAIMS-MADE OCCUR - PREMISES Ea acc rrenee $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY LOC PRO. JECT - PRODUCTS-CO MPfOP AGG $ _ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $. ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident $ AUTOS AUTOS ) NON-OWNED PROPERTY DAMAGE $ HIREDAUTO$ AUTOS - (Per ent $ UMBRELLALIAB HOCCUR EACH OCCURRENCE. $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DIED RETENTION$ $ WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY YIN A OFFICERIMEMO RE CLUDED7ECUTtVE WA NIA NIA WC231S342974036 04/26/2016 04/26/2017 E.L.EACH ACCIDENT $ 100,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 100,000 If yes,desenbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 I NIA' DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If Moro spate is required) Workers.Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits h employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/Iwdlworkers-compensationrinvestigationsl. - _ Sole proprietor has not elected coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED Ip ACCORDANCE WITH THE POLICY PROVISIONS. Town of Barnstable Building Division 200 Main Street AUTHORIZED REPRESENTATIVE _• f Hyannis MA 02601 Daniel M.CIA",CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserve ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD r �5 !G'�97r� �r�rK'CFll�i f���tr�uf�rr.3C(�' ' ( '4 office of Consumer.Affairs&Busi ess Regulation _ OIVIE IMPROVEMENT CONTRACTOR registration. ,138539 Type, r+► t, +y, tpiration:, 4/11/2017; DBA 74 SEASIDE ROOFING NdrSIDING" 4 sr .JOSEPIl' JACINTO � b-z 41 j .123 RIDGE RD j rA .�• ORLEANS,,MA 02653 Under ecretflry (.. Massachusetts Department of Public Safety. i Board of Building Regulations and Standards" ' License: CSSL-099163 construction Supervisor Specialty 4 Y;{ JOSEPH J JACINTO h1 23 RIDGEWOOD.ROAD } . t `ORL"EANS MA 02653 -' `sue n ' -+I tit •x � iZOK l� Expiration: ( fit. Commissioner 10/07/2017 Cape Save Inc. t�: F� � ,WI ft ' E to k r 7-1) Huntington Avenue South Yarmouth, MA 02C6;4 }� - Tel: 508-398-0398 Fag: 508-398-0399 rR�m4� wf 9/29/14 r Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main St.Hyannis,MA 02601 a ' RE: Building Permits Dear Mr. Perry, This affidavit is to certify that for 107 Highland Dr,Centerville: No work performed. Please close permit. All work performed meets or exceeds Federal and State Requirements. Sincerely, d William McCluskey A TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map q Parcel cS Application # Health Division Date Issued Conservation Division Application Fee - Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board �k .S//3 /3 '—(� Historic OKH _ Preservation / Hyannis (��/// Project Street Address / y / �� y �i�l ✓P Village' V i ` Owner ��� u �� /� elr Address a D Telephone ,0 U 1 0122 6 a Permit Request Ai,!d' wt ¢ �/�C �Qy e w, � ft ffcj, vJ e ��.s w let -/-o , Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay 'Project Valuatior4o?3 00 — Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ;7--Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) - Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other w Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing vyogd/coal si&e: C�Yes -0 No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: existing 0 rRm size_ Attached garage: ❑ existing. ❑ new size _Shed: ❑ existing ❑ new size _ Other. N � x Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ CO rM Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name w r f/16 G CI ' � e Telephone Number_�T g —J �� 03 Fb Address C A-9 I OA) JVf License # / 0) / J yy ma � Home Improvement Contractor# 0 13 60 00)60 / Worker's Compensation # -rk/C __�iS 376 y ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO YAM y14fh SIGNATURE DATE J y.. F FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. yt ADDRESS VILLAGE OWNER - J f ' DATE OF INSPECTION: " { ,-FOUNDATION, i, FRAME :r INSULATION ^^^ FIREPLACE i x ELECTRICAL: ROUGH FINAL ' yt PLUMBING: ROUGH FINAL R GAS: ROUGH FINAL-- FINAL BUILDING ' 'r 4r DATE CLOSED OUT ASSOCIATION PLAN NO. Y+ I Building Permit Authorization I, Jean Bannister;: as owner hereby give my permission to Cape Save, Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Office: 508-398-0398 to take all necessary steps to obtain a building permit to perform work at my property located at . 107 Highland Dr- Centerville, MA 02632 Signed Date ti i til:issachusetts- Dt-partment of Public Safety Board of Buildim-, Regulations and Standards J Construction Supervisor Specialty License License: CS SL 102776 Restricted to: IC WILLIAM MC CLUSKY 37 NAUSET ROAD r WEST YARMOUTH, MA 02673 Expiration: 6/28/2013 ( nnn�issiuuer Tr=: 102776 t �11 ' % ' ✓..Crer`/.l`1�Cfri� �✓✓Cf Q" =�Q Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 2� ... Boston,Massachusetts 02116 , Home Improvement Contractor Registration - Registration. 171380 Type: Corporation Expiration: 3/1412014 T►# 222184 CAPE SAVE INC. WILLIAM MCCLUSKEY . 7-D HUNTINGTON AVENUE - - SOUTH YARMOUTH, MA 02664 Update Address and return card.IMark reason for change. Address 7 Renewal ^ Employment = Lost Card Ps-CA1 0 501e,04104-G10121e J/eafznzc3zr�alflz,ofl::ltuJel License or registration valid for individul use only Office of Consumer Affairs do BJsiness Regulation b Y I40ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration: 171380 Type: 7 Expiration: 3/14/2014 • . Corporation i0 Park Plaza-Suite�170 Boston,hL4,02116 CAPE SAVE INC... WILLIAM MCCLUSKEY;'_ 7-D RUNTINGTON AVENUE _ SOUTH YARMourH.MA 02664 iinderseeretarp loot valid w (i signs The Commonwealth of Massachitsetts s Deparhnent of Industrial Accidents office of Investigations = - a -- t� Congress Street, Suite 10 `r 02114-2017 Boston,MA www.mass.gov/daa Workers Co''inpen sation Insurance Affidavit: builders/Contractors/E1 Tease ]Print Legibly A licant Information Name (Business/organization/Individual): Cape Save Inc. Address: 7D Huntington Ave Phone#: 508-398-0398 City/State/Zip: South Yarmouth, MA 02664 Type of project(required): Check the appropriate box: Are you an employer? 4 1 am a general contractor and 1 6 New construction I.[✓� 1 am a employer with k 3- have hired the sub-contractors employees(full and/or part-time).* listed on the attached sheet. '7, � Remodeling 2.❑ I am a sole proprietor or partner- These sub-contractors have 8. Demolition ship and have no employees employees and have workers' 9 Building addition working for me in any capacity. comp. insurance.} [No workers' comp. insurance 10.❑ Electrical repairs or additions 5. We are a corporation and its Plumbing repairs or additions required.] officers have exercised-their 11.❑ • I am a homeowner doing all work right of exemption per MGL 12.❑ Roof repairs myself. [No workers' comp., c. 152, §1(4), and we have no 13 0✓ Other Insulation insurance required.] employees. [No workers' comp. insurance required.] rm kers'compensation lic Any applicant hat check box#I must affidavitalso fill ndicatingt the thev are doing all work and hen hireow showincy their ion betr outside contractors motcct submoi a new affidavit indicating such. 'Homeowners who submit this Conn•actots that check this boa must attached an additional sheet shop+ping 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. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and jab site information. Insurance Company Name: Technology Insurance Company Policy# or Self-ins. Lic.#: TWC3353968 Expiration-Date: 04/09/2014 ----t-an P� (� j Job Site Address: �-���� S� lQ.���l�,�ity/State/Zip: ckl1�ll _ 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 S 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. 1 do Irerehy certify under the pains and penalties o per p that the information provided above is true and correct. Sianature - - Date Phone#: 508-398-0398 Official use only. Do.not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of health 2.Building(Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: AC®O DATE(MMIDDrrrrO � CERTIFICATE OF LIABILITY INSURANCE 4/9/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements). PRODUCER NAMEa Colleen Crowley Risk Strategies Company AHC` E : (781)986-4400 FAX,N :(781)963 44zo 15 Pacella Park Drive EJyIAIL Uot Suite 240 INSURER(S)AFFORDING COVERAGE NAIC# Randolph MA 02368 INSURERA:SeleCtive Insurance INSURED INSURERR:Safety Insurance. CCMpanY 33618 Cape Save, Inc - INSURER C:Technology Insurance Company - 7 D Huntington Ave INSURERD: INSURERE: South Yarmouth MA 02644 INSURERF: COVERAGES CERTIFICATE NUMBER:CL134960509 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. INTR TYPE OF INSURANCE 0�SL16 WVD POLICY NUMBER MMIDD YY POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY. DAMAGE To RE TE PREMISES Ea occurrence $ 100,000 A CLAIMS-MADE a OCCUR 5199448001 0/16/2012 O/16/2013 MED EXP(Any one person) $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY P C JET LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 B ANY AUTO BODILY INJURY(Per person) $' ALL OWNED SCHEDULED 6208200 1/6/2012 1/6/2013 BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS N NON-OWNED PROPERTY DAMAGE $ AUTOS Peracadent X Undennsured motorist BI s 6t $ 100,000 A X UMBRELLA LIAB IN OCCUR 199448001 0/16/2012 0/16/2013 EACH OCCURRENCE $ 1,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION$ $ - C WORKERS COMPENSATION Officers Excluded from X T RY S TTU O H- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/E>ECUTIVE Coverage E.L.EACH ACCIDENT $ 500 000 OFFICER/MEMBER EXCLUDED? Q NIA /9/2013 /9/2014 (Mandatory In NH) 3353968 E.L.DISEASE-EA EMPLOY EMPLOYg4$ 500,000 If yes.describe under DESCRIPTION OF OPERATIONS below - E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) - - Issued as evidence of insurance. Issued as evidence of insurance. National Grid Corporate Services LLC d/b/a/ National Grid, Action Inc., Colonial Gas Company and NStar Electric are listed as additional insureds as respects General.Liability as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Cape Light Compact ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 427/SCH 3195 Main. Street AUTHORIZED REPRESENTATIVE _ Barnstable, MA 02630 mi chael Christian/CLC -��'Y�" ='� ACORD 23(2010105)' ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).0f The ACORD name and logo are registered marks of ACORD Town of Barnstable *Permit# ��o OF ZM400it E rp� Expires 6 months from issue date ,,,STAe Regulatory Services Fee v� MAS& $ Thomas F.Geiler,Director j°lFt)t,9't Building Division Elbert C Ulshoeffer,Jr. Building Commissioner 367 Main Street. Hyannis,MA 02601w Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION Not Valid without Red X-Press Imprint Map/parcel Number / -/o 0 15 Z Property Address Ul C,If oP " Commercial Value of Work tesidential OR ❑ ial Owner's Name&Address U—f/W 19 A NIV iSTLA OD 7 H16-,q41Wb D A, CZA17%P-V L&L %otc l)R4 Telephone Number Contracm 's Name— Home,Movement Contractor License#(if applicable) U 6 0 lO 1 Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner a[ -have Worker's Compensation Insurance Insurance Company Name Ll umr AL L Workman's Comp. Policy# l �, 3! i- 011/0 437� Cal �r IT t��`� Permit Request(check box) MAY 1 3 2002 Re-roof(stripping old shingles) 'TOWN OF BARNSTABLE ❑Re-roof(not stripping. Going over . existing layers of roof) y ��t3tL�s 77isPasA"L ❑ Re-side CJIC,47- To Covrf->?tr� 3603ov,T./_ ❑ Replacement Windows. U-Value (maximum.44) ❑ Other(specify) *Where required: Issuance of this permit does not exempt compliance with other town department regulations.i.e.Historic.Conservation.etc. Sisnature cxpmtrg Assessor's map and lot number .......................................... it Sewage Permit number .......................................................... �pFTNET0�1 TOWN OF BARNSTABLE i BARa9TADL i lotN** BUILDING INSPECTOR APPLICATIONFOR PERMIT TO ............................................................................................................................. TYPEOF CONSTRUCTION ..................................................................................................................................... ' ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....................................................................................................................................................................................... ProposedUse ............................................................................................................................................................................. ZoningDistrict ........................................................................Fire District .............................................................................. Nameof Owner ......................................................................Address .................................................................................... Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ..................................................................Foundation .............................................................................. Exierior ....................................................................................Roofing .................................................................................... Floors ......................................................................................Interior .................................................................................... Heating ..................................................................................Plumbing .................................................................................. Fireplace ..................................................................................Approximate Cost .................................................................... Definitive Plan Approved by Planning Board -----------______-----------19________. Area .......................................... Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .................................................................................. Kirk, Edward A=190-53 ' No •19305 Permit for .•••• two s tory......................... single family dwelling ............................................................................... Locati$n .. I Highland Drive ....... ................................................... Centerville .................................................................... Owner Edward Kirk .................................................................. Type of Construction frame...... .................................... ....................................... Plot ............................ L'bt ................#10................ June 16 77 Permit Granted .......................:.�............19 Date of Inspection ......................... 19 Date Completed ; ....................................19 PERMIT REFUSED .............. .�. . �-j,�l�........... 19 .....................................\....................................... ........................................... ................................. ............................................................................,... Approved ..............................,.................... 19 ............................................................................... ............................................................................... Assessor's map a d Slot number ......A...d..t�.'.! ....:..........» F?HE T « • � s �O Off♦ Q Sewage Permit number ...........7.:... L?. .......................... —`/ ,,:, Z MARNSTADLE, i House number ....�4 .; 10 7 90 rasa .................................... p 1639. \0� TOWN OF BARNSTAPLE 4 BUILDING INSPECTOR ` APPLICATION FOR PERMIT TO ?.....DaN��...� ...oP,� rC 4. ....... .............................. J. TYPEOF CONSTRUCTION ....... ..............................................................................................:.............. ................................. ..........19:� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...4t ....... . 1t,'�..... � ?�tt "b�'�� ' ............� `� .ec1 -`+� ...1k"... '€<" Tt.C ....`�' t ProposedUse ........ � �t1��� !r . ....................................................................................................t........................... Zoning District :.............. .............................................Fire District .....Q-t— ............................... Name of Owner ' ' Yc� Al`,A� ...Address ....�.�-�'. l...!"41 p` Name of Builder llor�l�`.3 ......•; P•�C� 5.. Alddress ..................i.J...... ..:?.?...... Nameof Architect ................0./ .....................................Address .................................................................................... Number of Rooms ......................................................Foundation .... ........ Exterior .........� ` ..................................... Roofing ...... ..:..`...... ... tat'" c Floors ................................................Interior» ............................... .................................................. S �4 Heating ........... ..........................................Plumbing ...................e.............................................................. Fireplace ................ !i ....................................................Approximate Cost .........�7- K........................................ ' 3 Definitive Plan Approved by Planning Board -------------------_-----------19--------. Area -... ....... .'............. Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH \� • �x�ST�ti � CC VC. r 10 a 0 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS 1 hereby agree to'conform to all the Rules and Regulations of the Town of Barnstable relgarding_the above construction. Names: .......... / ..........:........ Construction Supervisor's License .................................... Bannister, Miss Jean A=190-053 No 31219 permit for ,, rebuild deck & ............ ......................... add room ............................................................................... Location 107 Highland Drive .................. Centerville ........................................................................ Owner Miss Jean Bannister .................................................................. Type of Construction frame ................................................................................. Plot ............................ Lot .......10..................... Permit Granted ..... .........19 87 Date of Inspection ....................................19 Date Completed ......................................19 C' AFL ASSeSSOr'S map and lot riumber ......�.../. .. .OJ 3THE � Sewage Permit number .........T.7....... 0..5........... .......... r d�Q ♦� k i TtiTTTLE 5 /D-7 i� l��ty L �o®�p�v H9HBn9aTg LE, i House number ....... ...............:................`....<................... ' 6� 9� `i� 1639. TOWN -'.0F BA1� TABLE , BARNS TABLE INSPECTOR APPLICATION FOR PERMIT TO ...�� �4�..... r �. .../ �1�.... - `� -\.... C.� ............ TYPE OF CONSTRUCTION ..... .........:..... :....................... ........................... ...........................i ..........19 � TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for ra permit according to the following information: C LOT /dD Location .... <? .o..... `�i�+13......1�',�JA �4 �.............. � .. �9 �!At �... ! �R. ...��� � ... � Proposed Use l �r�e� .�... .................................................................... Zoning District ............... ........_.............................................Fire` District ....��L�f. ►t� ................................... Name of Owner ?. ��. .�c� �l ..�ti F ,; �kS._Address ..:.L�®j... � sue E_ I. �i4Name of Builder ..."�`� v �rS Address �5 C-t•�LJ ��1a15�` L Nameof Architect ................ .l... ....................................:Address ..............................................................:.........:........... Number of. Rooms ........Foundation .... Cie � Q � .C,J.............. ............. ................. �. ....... ... Exterior .........9794a4' .....................:................::Roofing ......it?� ........ .......................................... �� Y� :...'......Interior ......c�...!. ..� YOC�' .......................................... Floors .................... .1N�'.3.a............................ // Heating ............ ��..... .Z:®..........................................Plumbing .............�a...�....................... . ........................... Fireplace ................ .� .............'. .................... Approximate Cost .........Q..K:................................... Definitive Plan Approved by Planning Board _________________________'____19________. Area a....O...... . .�. .. -Diagram of Lot 'and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF-HEALTH k CIO a c,� S a� O 1�2. E� � OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable.re rdaa he above construction. Name ...... .... .. .................. Construction Supervisor's License .. ` /....... ' Bannister, Miss Jean No .... Permit for ........rebuild d.e.c.k..& add room ................................................................................ 107 Hig��-2RA..PKive Location ...................... ...................... Centerville ............................................................... Owner .............Miss...Jean Bannister............. Type of Construction ............f.r.ame.................... ................................................................................. P16t ........... ................. Lot................................. 'Permit Granted ...... ...-19 87 Date of Ihspection ....................................19 Date Co'mpleted .19 1.9 essc 's map and lot number ..�:... Q: :...1�,........ , '' SEPTIC SYSTEM .MUST BE _ „ d DIN COMPLIANC INSTALLED B` Sewa e' Permit number . :. . g TICLE II STATE � WITH A SANITARY CODE AND TOWN Q�oFTHEro� TOWN OF 'BAKN`S ' ' A'RU • � 86SHSTADLS • ' Olt ING INSPECTOR . zS APPLICATION.FOR PERMIT ,TO ...CS?X1eS. 71 ..:IZRUS. .............:....................................................................... c _ TYPE OF CONSTRUCTION ...Z 0.0>$..Fr. ................................................................................... June96 ..................... .. ..................r9. . ... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..Zot..JQ.s..Highland Drive.,...Centervil;le..................................................... .............................. ProposedUse ...Residence.................................................:...................................................... ...................................... ZoningDistrict ....................................................................:...Fire District .............................................................................. Name of Owner ..Edwar.d I�r.k .............Address Name of Builder ...s7 MQISA K.•....ft? :th............................Address .....13AMWit.able...................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ........6.......................................................Foundation j?.01A '.e.d...CQ.11Q. :Ito....:.............................. Exterior ......Qe.dfix............................. ... ..........................Roofing ..........ADP?Ilaa.t........................................................ Floors .......C=pet;LDg.....................................:.................Interior ...........DXY.Wal)........................................I................ Heating ...MU...by...Oil...:..................................................Plumbing .:................................... ....... Fireplace ...........2....................................................................Approximate Cost ....33.9,100.0......................................... .. ... -----19------ Definitive Plan Approved by Planning Board -----------___—________ __. Area ..........�� ...Sr....'.... - se Diagram of Lot and Building with Dimensions Fee :5""� 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 L J9.,r::N.r�. ... .. . .. _ CN\ K Kirk, Edward / 19.305 two story f 1`l0 ...... .......Permit for ................................. single fainily dwelling ..................� Hrighland Drive....,................... r _-. - r Locatp��........................................... ............. r Centerville ..... .g" ...................................... x Owner ............Edward Kirk........................................................ t Type of Construction frame ................ .... ......... .� Ptot ...............�:. ... .. Lot ......... 10....... z c June 16 77 r� Permit Granted:.'.......... ..........................19 - - Date of Inspection I ..... ,...... ® ' y ..Date :Completed"'.... �7........19 -PERMIT.REFUSED ................................ � :.................... 19 .. n ................... .............. ................................... .............................................. .................... ....... :. ......................... ` ... ................... ....... ...... .... ......... . . Approved ' CQ } ... .� .�................................. r J � ~ LOT q sy "® ,/iv Or iAl v ry b L o T /a t 0 19a-50 ' Si,I 6t.E ✓.,______fE�r AFSo�E L�D.aD i v L-) PL O r PI- A Al L 0.CA 7- 0A/ C'�N rj j/jam �_' ,� fP4AN 1 C/r 1, �y6G" LOT /D AS SNoc,1N oN Y ��jr.. I .NE,eE BY CE�T/F Y T�"!A T Tf�6 EXi57 i � ✓r .v /NG FOUAIDA7,,0,/.1-0CA710M 1,5COZ E As SNOWAI AA/0 _�G`�_. _CONFOZiV*rl7',,q TEE $UnD/NG S-ETl3.4E"C'72E9UlQEMit/7 OF TINE N/N .mil L- of I_ a Gv/ccnw sr y', ;R.�o u 7 71 L Kllff l- 337` _