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",t'a1 �' t " n4l � 1 :)i a p&t [[ P 'it' y*7° t, fA' � f,f',ii er :1-q. y,,,Wy 'I :".1 P 1 n p tr" H;y� o-9 , ,k., 1 x n ,1 r S 1 k. ,p x U r b ra " , 4� 1 11, 1{ , z �f, a t t � v4 �� a �� ;' x y f S , �, ,� ,�p�u 150 P ,, ar ,i: a s p f., a� 11 p.. 'PW �. '. R " $1, ;� , 1, ai. 0 tl'. 7. T. 1 .,� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel L �" Application #r,2 Health Division Date Issued Conservation Division Application Fee 5-0' 160 Planning Dept. Permit Fee 3 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address kn 4 Village C_p.l 4er y le Owner Currn Ct1 Cr,►�,Z Address 5aMC Telephone S O 8 05 6 1 Permit Request C e LA O i-0 . fi V1S ` r cis on C Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 637-00 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes 0 No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ..J Yes= ] No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new Sze_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: a Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ � a Commercial ❑Yes A No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION _ (BUILDER OR HOMEOWNER) Name i 1 m Nict � C e SRYt �C. . Telephone Number 508 396 03 H r Address �" �fy�11T,�n!'�d h Aff' . License # -X-C 10 ' Home Improvement Contractor# �� 8 Email Worker's Compensation # (n!W�C/3 13 6 9� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO 1 o,rnnolk4 SIGNATURE DATE 5 S FOR OFFICIAL USE ONLY 5 APPLICATION# DATE-ISSUED MAP/PARCEL NO. I ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. r 4 The Commonwealth of Massachusetts Department of Industrial Accidents f d 1 Congress Street,Suite 100 Boston,MA 02114-201.7 C www.mass.gov/dia , N orkers'Compensation:Insurance Affidavit:Builders/Contractors/Ele.ctrieians/Plumbers. TO BE FILED WITH THE:PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Qrganization/Indiyidual):Cape.Save Inc, Address:7-D Huntington Avenue City/State/Zip:South Yarmouth,:MA 02664 Phone#:508-398-0398 Are you an employer?Check the appropriate box: Type of project(required): 1.[E].I am a employer with 20 -- employees(full and/or part-time).* - 7, I)leW COIIStruCtiOII, 2. I l am a sole proprietor or partnership and have no employees working for an + ❑ - 8: �Remodeling any capacity.F4o workers'comp.insurance required.) _ 9. ❑Demolition 3.❑I am a homeowner doing ail work myself[No workers'comp.insurance required]t : „ [] 4.❑I am a homeowner and will be hiring contractors to conduct all work on.my property: I-wilt 10 Building addition i ensure that all contractors either have workers'compensation insurance or are sole 11., Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or.additions 5.a 1 am a general contractor and I,have hired the sub-contractors'listed on the attached sheet. 13QRoof repairs These sub-contractors have employees and have workers'comp..insurance t 6.❑We are a corporation and its officers have exercised their right of exemption,per MGL.:c: 14.[ ,Other Insulation 152,§1(4),and we have no,employees.[No workers'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 indicatim:such. - Contractors that check this box must.attached an additional sheet showing the name:of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers':comp.policy number; I am an employer that is providing workers'compensation insurance for my employees. Below.is the policy and job site information. Insurance Company Name:Wesco Insurance Company Policy#or Self ins.Lic.#:WWC3136274 Expiration Date:04/09/201:6 Job Site Address: 6 Knotty Pine Lane City/State/zip: Centerville Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration:date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,5:00:00 and/or one-year imprisonment,as well:as civil penalties in the:form_of a:STOP WORK ORDER and:a..fine of up..ta$25000.a. day against the violator.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:th pdins and:penalties of perjury that the information provided above is true and correct. Si ature> Date: 5/5/2015 Phone#;508-398-0398 Official use only. Do=not write::in this area,to be completed by city or town officialrt City.or Tovrn; - Permit/License I filling Autliorlty(circle:one): I..l3oard of Health 2 Building Department 3.City/Town Clerk 4.ElectricaLInspector 5.Plumbing Inspector =fr.Other Contact Person:... ' Phone*: Acv r� HATE cMMmDmvry CERTIFICATE O LI/4BILITY INSURANCE 3/24/2015 THIS CERTIFICATE IS ISSUED AS A.MATTER OF INFORMATION ONLY AND.CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY Oft 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.CERTIFICATEROLDER JIWPO.RTANT: If the.certificate balder Is an Af)t?ITIONAL INSURED,the poBc1+( )must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may requlre an:endorsement. A statement on thl"s.certlflcate does not confer rights to the certificate holder in lieu,ofsuch endorsement 5.PRODUCER. NAME: Colleen Crowley Risk strategies Company PHONE, (781)986;=�400 Fa /C No:jU1)963-A420 15 Paae3la Park Brve IAnnR ecrowley@risk-strategies.com Suite 240 INSURERS AFFORDING COVERAGE NAIC f. �aadol.Ph �1�1A t323S INSURERA::�e1 tiVO `Ias. Or Ame ica INSURED _ .�. _ _ INSURERS Allat�erica finaualal Alliance 0212 Cape Save, Iac INsuRERc'Wesco xasurance Company 7 D Huntington. Ave. . :> _ ..., INSURER D. ` INSURERE saut l ++���� 'gam. uth, ' C7ES UGC +I INSURERF: COVERAGES CERTIFICATE NUMBER:C"532,491501 REVISION NUMBER: TliL"S TO GEfiTfFY THAT T•Hf i OCICIES OF INS{fiANCE tLf55TED BEtOW'HAVE SEEN ISSUED TO THE'.iNSURfD"NA'MED ABOVE EbR TFiE;'POLICY"PER'IOD INDICATED. NOTWITHSTANDING ANY R.EQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH'RESPtCT TO W iCH YHtS CERTIFICATE MAY BE ISSUED'OR MAY:PERTAIN,THE INSURANCE AFFORDED BY THE i POLICIES DESCRIBED.HEREIN;.IS SUBJECT TO ALL THE TERMS, EXCLUS40NS.P�iD CONDITIONS OF SUCH POLICIES.LIMITS SHOUYiV NI4Y HAVE BEEN REDUCEt1 BY PAID CLAIMS: SR LTR TYPE OF INSURANCE POLICY NUMBER. 0�ICY EFF POLICY EXP LIMITS GENERAL LIABILITY CHOCcxRRENCE t 1,000."000 X COMMERCIAL GENERAL LIABILITY tJ tD PREMISES a oocwrenc $_ 100,000 A CLAIMS-MAbE OCCUR 199C480 O/16/2014 0/161.2015 MED EXP(Any one perm) $ 1-0,000 p�RsaNnti 8 AD,v IN as?Y S: ` 1,;000,000 GENERAL AGGREGATE $' 2,000,000 GEN'L AGGREGATE LIMIT APPUES PER: PRODUCTS,-COMPIOPAGG -$ 2,000,Poo POLICY X PRO- X LOC AUTOIMOBILE LIABILITY Ee aatiYdent T .000 000 $ ANY AUTO BODILY INJURY(Per pen:on) AUTOS YMED �TOESUL� 46796600 1/6/2014, 1/6/.2015 BODILY INJURY(Per accident) $ 0. x HIRED AUTOS X .A�0 PROPERTYDfiivIAL;E X. $ X UMBRELLA LIAB X OCCUR EXCES9;LIA8 CLAIMS-MADE EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DED RETENTION 911 51994480 0/16/2034 0/I5/2035 -C "RKERBC9MFENKR9N ffia�rs IrL+Laded for wcsrAru AND.EMPLUYERS'LIABILITY X TH ANY PROPRIETOR/PARTNERIENECUIIVE YIN OV r1age r OFFICEPJMEMBER EXCLLOED? ® N f A El.EACH ACCIDENT $ _50O 000 (Mandatory In NH) 7'3136�T4 1*1/201'5 f91zCY1b E.L.DiSEFaSE-54EM=LIIY $. 5E}t? (}0f} Dyes, ON, under I. DESCRIPTION:OF OPERATIONS below E:L.DISEASE-POLICY LIMIT $ 500,000 46 DESCRIPTION OF oPERAT10N81 LOCATIONS i VEHICLES(AttachA66RD.IOI,Additional I�marks s.hadulo,'If more apace to required) Issued as ev1denc® of insurance ,;, Thiel.seh Engineering, Inc, is listed a"s additional insured as. respects•General Liabi la ty',as re guired.by' written Ci?Ihtrract n. , t CERTIFICATE HOLDER CANCELLATION M4gng capel gkttasamgaat BHOIfLD'ANY-dI THE"ABOVE DESCRIBED`iy Ue1J19 BE CANCELLED BEFORE THE 'EXPIRA.M.ON DATE THEREOF, NOTICE WILL Be "DELIVERED IN Cape Light comact ACCORDANCE W"THE POLICY PROVISIONS. Attn: Margaret Song. ._ Ro wx 427/"4(rtF AUTHORIZEDREPRESE;wkTwe 3195 Main Street Barnstable, 1q� ©2.p chael- Christian/CLC.. �- AC®RD'2$(ZD 10/45j ®198&2&0AMRD CQFIP GRATIt?Rt. RII rights reserved. INSo25(2otoos).ot The ACORD name and>.Iogo are registered marks:of ACORD Housing_ Assistance Corporation Cape Cod HOME OWNER WEATHERIZATION WORK PERMIT& FUEL RELEASE: PLEASE FILL OUT AND SIGN THIS FORM IF YOU ARE THE APPLICANT HOME OWNER. A I ` � tr )` __,. hereby consent to and agree that weatherization work may be done by the Weatherization Program of Housing Assistance Corporation ( herein after referred as Agency" ) on the property located at: The weatherization work done will be based on programmatic priorities and availability of funding and it may include all or some of the following measures: Weather-stripping & caulking of windows and doors, insulation of attics, sidewalls & basements, attic and other ventilation measures and possibly replacement of badly deteriorated windows. In consideration of the weatherization work to be done at my home I agree to the following: 1. I give permission to the "Agency" its agents and employees to travel onto -or across said property with such equipment and materials as may be necessary to perform weatherization work on said property. 2 . The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the weatherized unit on an ongoing basis for no more than five (5) years after the weatherization work is completed. I have read the provisions of this agreement as listed and freely give my consent. fi Home Owners (Signature) Date: 'VA A Agent: (signature) Date: �— l c Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 171380 Type: Corporation Expiration:- 3/14/2016 Tr# 249649 CAPE SAVE INC. WILLIAM McCLUSKEY ---_.� 7-D HUNTINGTON AVENUE SOUTH YARMOUTH, MA 02664 — ----- - # � .. Update Address and return card.Mark reason for change. Of Address Renewal Employment Lost Card SCA 1 C. 20M-05111 r' (rnirrmu rrur�a�t�n � rrr�rtr efn . Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OWME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration �,171380 Type: Office of Consumer Affairs and Business Regulation �R - y"Expiration:g--3LI,41.2G.16. Corporation 10 Park Plaza-Suite 5170 . Boston MA 02116 CAPE SAVE INC. WILLIAM McCLUSKEY 7-D HUNTINGTON AVENUE' Goa SOUTH YARMOUTH, MA 02664 Undersecretary Not vali rthout signature Massachusetts -Department of Public Safety Board of Building Regulations and Standards '^ Construction Supervisor Specialty License: CSSL-102776 1 Is W ILLIAM J MC C-LUS 1' 37 NAUSET ROAD West Yarmouth MA 02673: Expiration Commissioner ' 06/28/2015 ' Cape Save Inc. � ,. 7-D Huntington Avenue NSTA U South Yarmouth, MA 02664, ;;�,N � E "E €1 t`7 Tel.- 508-398-0398 Fax: 508-398-0399 177 5/29/15 Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main St. Hyannis,MA 02601 RE: Building Permit#201502572 TO: Building Inspector(s), This affidavit is to certify that all work completed for 6 Knotty Pine Lane, Centerville has been inspected by a third party Certified Building Performance Institute (BPI)Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey IA) INE TOWN OF BARNSTABLE ARNiTABLL M9-Ar 1 BUILDING INSPECTOR a APO' ...... ....... ,,In Z....17.A........... APPLICATION FOR PERMIT TO ..... ........................ TYPE OF CONSTRUCTION ............ .......— ........ ................................................... /* / 7 ........................ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .......................... LA WC; .......... .......T k 4 C--' C a v ................................................................. .. .. ....�.A\A............................... ProposedUse ............... ........................................................................................................................... Zoning District ......................0.............................................F i re District C q4j!: 1, V)."...L.r ...... ......... .. .. ... ...... .............. 41 ? Q Name of Owner W...................................Address .....4 .................................. ..........g5.. 4 4-149 Nameof Builder ..........0.......w.... ...................................Address ....... ......................................................... t ( Ole Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ..................................................................Foundation ......... ..................................................... Exterior ............ ................................................Roofing ........ ................. ... .. .... .... .. Floors ........... P.e........................................................Interior ...... ......4-kJ..A..e_ (— ............................................. /K/7- Heating ........ 7.....LI/A.7-!�.fQ.....................................Plumbing ...... 7- OJS ............................................ .............................. Fireplace ............ G , - r—lg..............................................................Approximatt- Cost .......... ...........0.................................... Difinitive Plan Approved by Planning Board -------------------------------- Diagram of Lot and Building with Dimensions P e- 7� M O 0 N P E W KI llf-:_ LLJ (D A LL- Ul) Md 0 CL < A PPfzox.45- - 1- < L --1 M < 0 C) > Q CL r, U) N L W LL CL U) < -D Y �. �.Zm ®�W� ' � /S U) < (D 2f Ld U Uj 0 10 < a. I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ........................ ..... ..................... George, Forrest W. No ..15685... Permit for .....one. story„_....... single„family dwelling..................... Location .......6,Knotty,, Pine„Lane...............„ ......................Centerville................................ Owner .........Forrest W. George.............. Type of Construction ........... rikI e..................... ................................................................................ E Plot ......................... .. Lot ........... $.............. November 17 72 Permit Granted ...................... .................19 Date of Inspection ...' Date Completed .` ........ ....................�119 C �Sr�L� PERMIT REFUSED I ................................................................ 19 ............................................................................... ................................................... ......................... ............................................................................... ............................................................................... ; Approved ............................................... 19 ........................................... ................................ i ...............................................................................