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HomeMy WebLinkAbout0035 LAKE DRIVE Dili A r 4f n i a x 4 n ry Town of Barnstable i111C11 g Post,This Card So That rt is Uis�ble'From.the Street aApproved PlansMust be Retained okn lob and#his Card Mustbe Kept an MAM Posted Until Final In"spection�Has Been Made r 1639 z c, ". $ u. k „` r t Per it — h Where a Certificate of Occupancy,Fi"s Required,such Bu�ldmg'shall Not be Occupied unt�lfa Final Inspection has been made Permit No. B-18-3446 Applicant Name: LEVINE, ROBERT G& PATRICIA D Approvals Date Issued: 11/02/2018 Current Use: Structure Permit Type: Building-Deck Expiration Date: 05/02/2019 Foundation: Location: 35 LAKE DRIVE,CENTERVILLE Map/Lot: 230-052 Zoning District: RD-1 Sheathing: Owner on Record: LEVINE, ROBERT G& PATRICIA D Contractor Name: Framing: 1 Zl/oli Address: 35 LAKE DRIVE Contractor License: 2 CENTERVILLE, MA 02632 § a Est Project Cost: $0.00 Chimney: Description: repair&replace existing deck with new materials lowering existing PerrnitFee: $110.00 dec 4"-6:to allow proper depth below the current siding-,doors., Insulation: P P P g Fee Paid..: $110.00 / Repair a damaged 6'8"x6'anderson sliding door remove existing Date 11/2/2018 Final: jacuzzi from deck Project Review Req: LEDGER ATTACHMENT TO HOUSE TO MEET MINIMUM ,�¢ ? `} - Plumbing/Gas .REQUIREMENT LOAD REQUIREMENTS> Rough Plumbing: . Building Official Final Plumbing: ` Rough Gas: f Final Gas: This permit shall be deemed abandoned and invalid unless the work authonzedJby this permit is commenced within sik Ynonths afterissuance. Electrical All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of an building and structure"s shall be.in com lance with the local zonin b laws and codes. Service: g Y g p g` Y , This permit shall be displayed in a location clearly visible from access street or road and shall bemaintained open for public inspection for the entire duration of the work until the completion of the same. _ Rough: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Final: Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing Low Voltage Rough:. 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Low Voltage Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Health 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Final: 7.Final Inspection before Occupancy Fire Department 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). 0 . Application Number.....)„*.d:...:.... `. .... s ;�. /� * BUILDING I LD I NG D Permit Fee...........X40...'.............Other Fee........................ NAM �F 63¢ OCT 1 1� �f 20 Total Fee Paid..................................................................... TOWN OF BARNSr�a Permit Approval BUILDING PERMIT .. :.: �arc C L........os. .,. APPLICATION Section I- Owner's Information and Project Location f Proj ect Address 95 4 4 K 6 a;U V6 Village C C-iy re0-Vi L,L45:� Owners Name 906et (9. l-'e i f'i c" Owners Legal Address City L'&Vrr2. VICL.F— State —zip owners Cell# 5-0 V- q4 3—079Y E-mail 6-/e vines �eoix T Section 2-Use of Stractnre t Use Group ❑ Commercial Structure over 35,000 cubic feet " Comni`ezciah Structure'under"35,000 cubic feet Two Family Dwelling Section 3-'hype of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure' ❑ Change of use ❑ Demo/(entire structure) ' ❑ Finish Basement ❑ Family/Amnesty' ❑ Fire Alarm Rebuild Decks Apartment ❑ Sprinkler System ❑ Addition [] Retaining wall ❑ Solar ® Renovation ❑ Pool ❑ Insulation Other—Specify Section 4 -Work Description tLem;k A-45AAP4cA—E A�5xl5'r7116, ,PC-Ck- v�/��t �e vrfAer4,t- S/7dih4, tfXAS,► iQ0—P IA C-4/Yt9 kC( doy 0,• N V M. ' T sict-Tmdafed:7J9=18 • Application Number....................................... .. ...... Section 5—Detail Cost of Proposed Construction OM --- Square Footage of Project Age of Structures U4 7 years Dig Safe Number # Of Bedrooms Existing "/Vk Total#Of Bedrooms(proposed) 110 MPH Wmd Zone Compliance Method [jJ MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics ❑ Wiring ❑ 0i1 Tank Storage ❑ Smoke Detectors ❑ Plumbing [] Gas o ❑ Fire Suppression ❑ Heating System Masonry Chimney ❑Add/relocate bedroom Water Supply 1� Public ❑ Private Sewage Disposal ❑ Municipal ® On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: 6A' 67-A^oO I am using a crane ❑ Yes No Section 7—Flood Zone Flood Zone Designation AlavC Within or adjacent to a wetland, coastal bank? Yes ❑ No Section 8—Zoning Information Zo ' 'ct Proposed Use Lot Area Sq.Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard R Proposed Side-Yard wed, ..:, _ ,, sed' Has this property had relief from the Zoninj Board in the past, E] Yes3 No , . Last imdated 2J9201 S alze �7,iue 1 rr„20 1` ' 1 /qtt Ccy,e ru era i CG.Ce 4q /�c✓cbo�i 1',oad �!0 r w ule Date 0260/ C, 6. w1a 5,9 ioo.00 Aloccy I 2- � 1� 8 .�' G.4 14' / _._ atom Z -168 �� ,t, i -z' !003�z II �® -98 [ id r S TP/ �O 1000 G,¢ i r1 _ _ _L � i V ov 10,260.:5 c , rZ' BUILDING IJ �T C-' ,?d:'.: 1zA 7s !3 8.0. got 30 dk. Ind. �o 31 OCT-1B 2q. ! �Septrc ,Ps2 5,«I Q A TOWN O�BARIVSTALL No. b ed w o rtv, 2 r��o Y'-i,Ce No 'Sccte J vspo�u.0 r2o L s4t�,b�t,�,atecl how 220 �!? rul .✓o GNf►cJ�._ i �e�.C.I';bi,, a tGea i 68 4 � 168 �-- !000 2-9- � 4 r�G 8 1 .� �U 2 �.torae 110 ' v ♦ 's __l. .. S/wltc ����77.f n of 1-an l .rn Coite�w•t,GCe, Ma. ot 87euu tot 23 a, dl-wv)n art plan Ailed •rn book 122 pace 89 ; r twa l i on.,j cue nom water -ound on tot, and cd.� - (Made 4-18-89 C. -at . I ar1e ed Z e: 7 oc, o PhenaouzP�r r, 1 etc 2 rtitn e/c , - S S.d � 1 i i ! a.a:2�c � <tc:,vu1 I Pit OF SS � OF g;aU•,e; J4HH. N MILNE CD y A7J��_ O.0 ; a13v5_ O.n V 6 NO.3249� qZl a TES L NAI /OroA 1AN05 4 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 Lezibly Name(Business/Organization/Individual): �(? � zrp.44(//f& Address: City/State/Zip: eew�-wvt `lam M. Phone#: t—,S0 r'y93 '10'y4y Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. 0 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 mein an capacity. employees and have workers' Y P tY• 9. ❑Building addition [No workers'comp.insurance comp.insurance.t required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no I�CQ I9 employees. [No workers' 13.[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. tt:ontractors 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 isproviding workers'compensation insurance for my employees. Below is thepolicy andjob site information. n/ Insurance Company Name: Al�•i' Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip- Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. . I do hereby ce lunder �the,pains and penalties of perjury that the information provided above is true and correct Si afore: ` �,�(,F Date:Ze Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 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'bdsiness 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-contractor(s)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 Departme nt 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.mm.gov/dia 01269861 Hyannis Shepley Account: LEVROB 0010 216 Thornton Drive Branch: HYA Hyannis, MA 02601- Phone: (508)-862 6200 Phone: ( 1- Fax: 1 1- - BILL TO: SHIP TO: Robert G Levine Dba Lake Drive RGL Real Estate Management 35 Lake Drive 35 Lake Drive Centerville MA Centerville MA 02632 Page 1 of 2 PO REF .. .:: .. .. . JOB EXP DEL:V DATE;: 1C,/17/18 .ALES :.H..yN Counter TYPE:_WH .``SHIP.VIA FR..T TERM::::: ACTIVATION DATE 10/17/1 GENTSJ:Romkey QUOTEb FOR ::Robert Levin CLOSE DATE 11/16/1 Trim Rhodes QUOTED BY. Jromkey: AUTH`C.HG Robert Levine 508-493 0794 iANTITX::.: UaIVt :::::.;:::.: 1T �1l� CPTIQN ' tIC>„fU31Uf AIIM4E3ET.;:: . ................... ... .:..........::...:.::::... . ............. ..... .. ::....:........ ... :::. 2 PC 2X10-20' PT, #1 SYP MCA Ground Contact 54.95/PC 109.90 Treated *End Sealer Must Be Used With This Product!Use Item # 3540243 - Woodlife Copper Coat 30 PC 2X8-10' PT, #1 SYP MCA Ground Contact 16.26/PC 487.80 Treated *End Sealer Must Be Used With This Product!Use Item # 3540243 -Woodlife Copper Coat 5 PC 2X8-20' PT, #1 SYP MCA Ground Contact 33.68/PC 168.40 Treated *End Sealer Must Be Used With This Product!Use Item # 3540243 - Woodlife Copper Coat ..............__............__.............. 28 EA LUS28Z Simpson 2x8/10 Single Hanger 1.74/EA 48.72 Z-Max (50/ 8 PC 1 9/16" X 8' Plastic Ledger Cap D[ep 5.53/PC 44.24 40/Ctn 41 PC 5/4X6-20' Azek Decking, Slate Gray SE 75.71/PC 3,104.11 1 BOX AZ30OSGCOL COLLATED`Cortex Slate Gray 276.85/BOX 276.85 (300SgFt) Concealed fastening system for.Azek dec.k.s screws, collated ..................:...-___..._...... plugs, and setting tools are include d°i'n°every box" 1 BOX AZ100SGCOL COLLATED Cortex Slate Gray 106.60/BOX 106.60 (100SgFt) Concealed fastening system for Azek decks screws, collated plugs, and setting tools are included in every box 1 PC 2X12-12' PT, #1 SYP MCA Ground Contact 37.24/PC 37.24 Treated *End Sealer Must Be Used With This Product!Use Item # 3540243 - Woodlife Copper Coat ............................................... ................................................................ ................................................................. ................................................................ ................................................................. .....................................—...............-....... 01269661 Hyannis Shepley Account: LEVROB 0010 216 Thornton Drive Branch: HYA Hyannis, MA 02601- Phone: ( )- - Phone: (508)-862-6200 Fax: ( 1 BILL TO: SHIP TO: Robert G Levine Dba Lake Drive RGL Real Estate Management 35 Lake Drive 35 Lake Drive Centerville MA Centerville MA 02632 Page 2 of 2 PO REF JOB.... ... ... _ _. .. .... _. .... _ .. ..... .. EXP DELV DATE: 10/17/18SALES HYN Counter TYPE:`W - SHIP:VIA. FRT TERM:`: ACTIVATION DATE 10%]7/1 GENTSJRomkey; ........O.........-U.......O. UOTED FOR. `:Robert Levin CLOSE;DATE 11/16/1 Trim Rhodes.: QUOTED BY: Jromkey: AUTH CHG Robert Levine 508-493-079.4 ::.>:;:.;::X X.......:. :...:.... ...:. tANTl1'Y' UC)M ;:. 1:.. } RTEq►N.........:;;..::.;.. . ..::: .Mur::: SUBTOTAL 4,383.86 MA Sales Tax 6.25% 273.99 This is an estimate only and not a guarantee of total job cost.This estimate based on the information provided to us and its accuracy is dependent on the accuracy and depth of that information. We ask that you review quantities and specifications contained herein with us prior to ordering so that we may supply you with complete correct materials. This estimate is good for 30 days from the date of activation shown on the quote. Any special order items are non returnable without prior approval and may be subject tohandling charges if return is allowed:: Accepted under the conditions outlined above. by: Date L / PAYMENT TERMS: 5/10 NET 25 Total $4,657.85 Andersen. Andersen Windows -Abbreviated Quote Report Project Name: Own Home (Slider) Quote#: 2493 Print Date: 10/17/2018 Quote Date: 10/16/2018 iQ Version: 18.1 Dealer: Shepley Customer: Robert Levine- RGL Real Estate 216 Thornton Drive Billing Hyannis, MA Address: 508-862-6200 Phone: Fax: Sales Rep: Candice Giantonio Contact: Created By: CLG Trade ID: 093969 Promotion Code: Item Qty Item Size(Operation) Location Unit Price Ext. Price 0000 1 $ 0.00 $ 0.00 RO Size= N/A Unit Size= N/A Not Applicable Andersen A Series Frenchwood Gliding White Exterior Unfinished Cherry Interior HP low E4 Glass No Grilles Top Hung Gliding Screen No Hardware Quoted Bright Brass Hinges "`Hinged door please confirm wall depth Currently 2 x 4 ""Please confirm all sizes and specs prior to ordering— Quote#: 2493 Print Date: 10/17/2018 Page 1 Of 3 iQ Version: 18.1 Item Qty Item Size(Operation) Location Unit Price Ext. Price 0001 1 FWGD6068(SR) $ 2773.72 $ 2773.72 RO Size=6'0"W x 6' 8" H Unit Size=5' 11 1/4"W x 6'7 1/2" H ~ A Series Unit,Assembled,4 9/16" Frame Depth, Gray Sill, SR Handing, White/Cherry, Unfinished, High Performance Low-E4 Tempered Top Hung Gliding Insect Screen Track, SR, White Top Hung Gliding Insect Screen, SR, White Viewed from Exterior U-Factor:0.30, SHGC:0.27 Subtotal $ 2,773.72 Total Load Factor Tax(6.250%) $ 173-- Customer Signature 0.753 Grand Total Is 2,947.08 Dealer Signature **All graphics viewed from the exterior ** Rough opening dimensions are minimums and may need to be increased to allow for use of building wraps or flashings or sill panning or brackets or fasteners or other items. MAsk to see if all of the products you purchase can be upgraded to be ENERGY STAR®certified. MMMMM This image indicates that the product selected is certified in the US ENERGY STAR®climate zone that you have selected. Data is current as of April 2018.This data may change over time due to ongoing product changes or updated test results or requirements. Ratings for all sizes are specified by NFRC for testing and certification.Ratings may vary depending on the use of tempered glass or different grille options or glass for high altitudes etc. Nexia is a registered trademark of Ingersoll Rand Inc. Project Comments: Quote#: 2493 Print Date: 10/17/2018 Page 20f 3 iQ Version: 18.1 Item Qty Item Size(Operation) Location Unit Price Ext. Price **Per MA Building Code (Sec. R612.1)windows and doors shall be installed and flashed in accordance with manufacturer's installation instructions. **7 WEEK LEAD TIME Once Ordered- No Changes- No Cancellation Items Are Special Ordered& Non-Returnable *Please Varify all rough openings and handings* *All Graphics viewed from the exterior* Quote#: 2493 Print Date: 10/17/2018 Page 3Of 3 iQ Version: 18.1 Application Number........................................... Section 9—.Construction Supervisor Name /�� (�p�Ml _ Telephone Number - 70- yR 3• 0199 ( Address 15", kh kw City 6'' 4oi11-Ak, State�_Zip 01V AP License Number IA' License Type Expiration Date Contractors Email ,p —/eyl4 m efgs T.0e t Cell# --j0 Ff — 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.Attach a copy of your license. Signature, Date I Section 10 —Home Improvement Contractor Name Telephone Nwnber Address City State Zip Registration Number 'on Date I understand my responsibilities un lh6 rules and regulations for Home Improvement Contractors in accordance with 780 ' CMR the Massachusetts S uilding Code. I understand the construction inspection procedures,specific inspections and documentation re y 780 CMR and the Town of Barnstable.Attach a copy of your H.LC... Signature Date Section 11 —Home Owners License Exemption Home Owners Name: Telephone NumbV- Cell or Work Numbe} 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 re ' ed b 78 the Town of Barnstable. Signature Date APPLICANT SIGNATURE Signature Date /0l z/r L�v�� Print Name ����� �, Telephone Numbed-,,0 Fr- Yg,� E-mail permit to: T 11 mnni 0 Section 12-Department Sign-Offs Health Department ® Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required ❑ Fire Department TI Conservation' ❑ '` ;.�'Y.k . 4 4 For commercial work,please take your plans directly to the fire deparbnent for approval. • �` . era ... , ,,, �. .,• , � Section 13-Owner's Authorization as Owner of the-subject property hereby authorize 5p Ir aAO to act on my-behal. in all matters relative to work authorized by this building permit application for: �3'S�,a arc eLoo <`/Q- , 111�¢ • D�(.�� (Address of j ob) ' l© 10 Signature of Owner date Ol0�OA.Z' 6- Print Name �; '`` �'1,� yr ~^� �•.�'.. . '. S. _ .. - S t t `• ._'hid .s , . • . 4r. r• ♦ r ram. .Y 5 1 p. ` - • ! ` • 5 {. ems` • }' �`, .. •• '� - Last=&L-Q:2/ 2018 JV? Town of Barnstable R�ECE�iP�T KAW 200 Main Street; Hyannis MA 02601 508-862-4038 Application for Building Permit Application No: TB-17-4056 Date Recieved: 11/21/2017 Job Location: 35 LAKE DRIVE,CENTERVILLE Permit For: Building-Insulation-Residential Contractor's Name: WILLIAM J MCCLUSKEY State Lic. No: CSSL-102776 Address: West Yarmouth, MA 02673 applicant Phone: (508) 398-0398 (Home)Owner's Name: LEVINE, ROBERT G & PATRICIA D Phone: (508)493-0794 (Home)Owner's Address: 35 LAKE DRIVE, CENTERVILLE,MA 02632 Work Description: Add R-38 fiberglass,and R-35 cellulose to the attic. Add 2" rigid insulation to the common wall. Air seal the attic plane with expanding'foam. General weatherization. Total Value Of Work To Be Performed: $3,600.00 Structure Size: 0.00 0.00 a 0.00 ` Width Depth Total Area' I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a.sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: William McCluskey 11/21/2017 (508)398-0398 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $3,600.00 Date Paid Amount Paid Check#or CC# . Pay Type Total Permit Fee: $85.00 11/21/2017 $35.00 )DM-XXXX-XXXX- Credit Card 0299 Total Permit Fee Paid: $85.00 11/21/2017 �v $50.00 t)DM-XXXX XXXX- mm Credit Card I 0299 I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map z3 d Parcel 052. Application 4 uco Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Fm Pt 'L 5 f�1"r Project Street Address�3�/ !�zf Village Owner_BA 1_7 eat ZeeZ2`®ee Address Telephone C�4 �, � f' 4- Permit Request �4,0�0 �x /,c/14"Z49 ,LX Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation ���d, d Construction Type�U3r��✓�D� 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: ❑ /L o On Old King's Highway: ❑Yes JYNo Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other ®gyp J' At/� Basement Finished Area(sq.ft.) TOggasem"bri#�r hed Area (sq.ft) W N Number of Baths: Full: existing new OFeq f: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION 1 (BUILDER OR HOMEOWNER) Name �' �'�" ��� U �� Telephone Number ��` Address � , zl/ffe4rll CiZ License# 6 07 Home Improvement Contractor# Email IIG �/C�Cl��/�y1�1,�, i6l /�`� Worker's Compensation ALL CONSTRUCTION DEBRIS RESU � G FROM THIS PROJECT WILL BE TAKEN TO 6v SIGNATURE DATET,�G FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. SME T� Town of Barnstable Regulatory Services Richard V.Scali,Director Building Division Tom Perry,Building Commissioner 200 Main Street,Ifyannis,MA 02601 ,,%wwAown.barnstable_ma.us Office: ,S08-8624038 'Fax.. 508-790-6D0 Property Owner Must Complete and Sign This Section If Usin. A Builder 1 2LLJ4/'_k' �&Mgl 3,as Chimer of the subject properly hereby au4horim (/ LY to act on my behalf; in all matters relative to work authorized by this building permit application for: (Address off ob) Pool fences and alarms are the responsibIty of the applicant;. Pools are not to be filled or utilized before fence is installed and all finJ- inspections are performed and accepted_ inanature odf(0)wrn e Signature of Applicant �00 zet/ik-te, Print Nme - Punt Name `; E0E,0V-E a D MAY - 2 2016: Q:FORMS:O�+T'F RPFRJd 1SSIONPWLS i i. Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-100988 Construction Supervisor ' `3 HENRY E CASSIDY 8 SHED ROW -- WEST YARMOUTH 2' , l� Expiration: Commissioner 11/11/2017 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 153567 Type: Private Corporation Expiration: 12/15/2016 Tr# 259188 CAPE COD INSULATION, INC HENRY CASSIDY 18 REARDON CIRCLE 30, YARMOUTH, MA 02664 r'Update.Address and return card.Mark reason for change. SCA 1 2OM-05/11 Address Renewal Employment Lost Card ' �e�omur�ao�acue�r.�G�o�Cc/�l�uiJ«c�ccaeG�i _ `as\ .Office of Consumer Affairs&Business Regulation License or registration valid for individul use only UVOME IMPROVEMENT'CONTRACTOR before the expiration date, If found return to: egistration: 1:53567 Type: Office of Consumer Affairs and Business Regulation xpiration; ;.;121;1:5I20fl6 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 CAPE COD INSULAt.0R;INC HENRY CASSIDY 18 REARDON CIRCLE` g SO.YARMOUTH,MA 02664 Undersecretar Y N. valid wi ut sign e Tfie Commonwealth of Massachusetts Department of Industrial Accidents r .-- Office of Investigations 600 Washington Street r Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit; Su-ilders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl � r - Name (Business/Organization/Individual): Address: v. "'09Q, 0 FA L'461 b City/State/Zip:'�� ; AVVIAP) 'b 'l " Phone #: Are you an employer? Check th appropriate box; Type of project (required): 1, ,1 am a employer with 4. ❑ 1 am a general contractor and I employees(full and/or part-time), have hired the sub-contractors 6, ❑ New construction 2,❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp, insurance comp, insurance.$ ❑ g ❑ �required,] 5. oration and its 10.❑ Electrical repairs or additions .We are a co 3,❑ [ am a homeowner doing all wo officers have exercised theirrk l l,❑ Plumbing repairs or additions myself, [No workers' comp, right of exemption per MGL 12,7 Roof repairs insurance required,] t Ic. 152, §1(4), and we have no employees. [No workers' 13. ] Other ia comp, insurance required,] l *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affi6'dVit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. insurance Company Name: O,� ', �✓�J� �/��1� ,�'�� Policy # or Self ins, Lic, #: d.dr " I Expiration Date: �/ ' ��✓ Job Site Address:��.L,��L& dlf '�/ie City/State/Zip: d �- 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 insura coverage verification. I do hereby certify d the pal an penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: Official use only. Do not write in this area, to be completed by city or town official. City or Town; Permit/License# Issuing Authority (circle one); 1. Board of Health 2, Building Department 3. City/Town Clerk 4. Electrical Inspector 5, Plumbing Inspector 6. Other Contact Person: Phone#: CAPECOD-27 TQUIRK ACORO' CERTIFICATE OF LIABILITY INSURANCE DATD/YYYY) `-� 4/27/22712016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT - NAME: Rogers&Gray Insurance Agency,Inc. PHONE FAx 434 Rte 134 A/c No Ext: A/c N. (877)816-2156 South Dennis,MA 02660 E-MAIL RESS:mail@rogersgray.com INSURER(S)AFFORDING COVERAGE NAIC p INSURER A:Peerless Insurance Company INSURED INSURER B:Safety Insurance Company 39454 Cape Cod Insulation,Inc.: INSURER C:Endurance American Specialty Ins.Co. 18 Reardon Circle INSURERD:Atlantic Charter Insurance Group South Yarmouth,MA 02664 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE - POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MMIDD/YYYY MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE FFIOCCUR CBP8263063 04/01/2016 04/01/2017 "PREMISES Eaoccurrence $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PELT RO- FLOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 B ANY AUTO 6232707 COM 01 04/01/2016 04/01/2017 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per accident $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 C EXCESS LIAB CLAIMS-MADE R/O EXCl 0006635000 04/01/2016 04/01/2017 AGGREGATE $ DED I X I RETENTION$ 10,000 Aggregate $ 2,000,000 S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY TATUTE ER D ANY PROPRIETOR/PARTNER/EXECUTIVE YIN WCE00431901 06/30/2015 06130/2016 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Workers Compensation includes Officers or Proprietors. Additional Insured status is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Bill Swanson Builder THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 50 Camelot Lane ACCORDANCE WITH THE POLICY PROVISIONS. Brewster,MA 02631 AUTHORIZED_REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Assessor's office(1 st Floor): °1�0 �O C^ SERIC SV$W MUST BE Assessor's map and lot number o*�l J �,NS.'. LMO CE Y�E To Board of Health 3rd floor : / 07 `� ) Sewage Permit number 0/ r S 1:1 e ,,, tiR®MIWGIV AL CODE AND = 33MUSTAMLE i Engineering Department(3rd floor): rasa House number I I " SUM, REd'aULATEON-�.,s °o i63q. ®� 1 Definitive Plan Approved by Planning Board 19 DNA °\ ' APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING - *.INSPECTOR APPLICATION FOR PERMIT TO rYXl o d-f' TYPE OF CONSTRUCTION -A y 19 ?9 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies.for a permit according to the following information: Location �J� L a�',r D Y ll/>° <' �h Y1- 1 Or Proposed Use 81, a l r Ow e /Il h o Zoning District I�ff�l5LL Fire District l v Name of Owner U r!f k. (:f o Address 39 LA)rGr 01v e r- 6C/- 7-,-V,4 � Name of Builder f?a6 -ei-T )`(;z, eJ/Ai Address A r� !/Ch v P �5/z'F-v/��P /r✓-2ss Name of Architect V -e J_- Address Number of Rooms 3 '(Isom s 66,ex Wz2v �J ra9�Foundation 60rI Ck r Exterior OOol 5 Ii iti 4/ems" Roofing ASA a�J Floors wo o d of#1 G�Y 1��7� Interior Heating Plumbing 1 8� �X 15 �a� 0 Pe oa Fireplace IS I/h Approximate Cost Lird'+� �hC:L Gars�,1 Area /'� 7 .5f 6C- 2, S9 Fj Diagram of Lot and Building with Dimensions Fee g5°°- INY ; 112, a� oc-K OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Construction Supervisor's'License o D COUMBE, 17lZABETH No 32915 Permit For Add To & Remc,del Single Family Dwellinq Location 35 Lake Drive Centerville Owner Elizabeth Eoumbe Type of Construction Frame Plot Lot Permit Granted May 22 , 19 Q 8 Si Date of InspectionGj�G 19 O P ate Completed I/��.y� 19 C. IL Assessor's office(1st Floor): a1�O !® r^t) �! JOB TN a Y � Assessor's map and lot number oF >o�o Board of Health(3rd floor):f r, Sewage Permit number Z BA LYSTaBLL, i Engineering Department(3rd floor): rasa House number �o�16S9'a�®� t— Definitive Plan Approved by Planning Board 19 Y o ypr APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR "APPLICATION FOR PERMIT TO &/ fi! O J-e � 2 TYPE OF CONSTRUCTION �p o �D W r�l ►11 Q d 19 D i TO THE INSPECTOR OF BUILDINGS: ' The undersigned hereby applies for a permit according to the following information: Location Proposed Use �Ylr. 2 I r p w e 01/ho ,'Zoning District J7`e 3' � ® � Fire District i "'Name of Owner t'� � o'v Address 39 L,4 k1f l,/-t v r- CPh[f/-vi Name of Builder t>1 e�► �'�� 71 z'�P�i6u Address r#4 ye, P OS/t"i V111,- 19_ZS5, Name of Architect U Ly h A-- Address . 3 ' ors s UYhrPx wa (�ara Foundation Number of Rooms � »� w 4 P Exterior 4` UyC�, ~ `S�/�' Q Roofing Floors y r7— Interior Heating X r" Plumbing l & , 1 �� /��Ord° f t t Fireplace pp ' P / o roximate Cost ,�y 1 i� � A Area 10 6 d.• y . Diagram of Lot and Building with Dimensions Fee r' exy x6 GI i hj sA s IT f?v a d' OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Construction Supervisor's License OF 1 COUMBE, ELIZIiBETH A=230-052 No 32915 Permit For Add To & Remc)de 1 Single Family Dwelling s Location 35 Lake Drive Centerville Owner Elizabeth Coumbe Type of Construction Frame I Plot Lot Permit Granted May 2 2 , 19 89 Date of Inspection 19 Date Completed 19 v i - v t - i 5 PERMIT COMPLETED 11ML L IR 4. 1 A f,C Ca1)e ,('alze Hai c�e Sec�Ce 1" 20.' \Jnd �nrirceeai+:c' 4q /4a,bot /?,oad � 0 ' w-i_cle date ' 20 89tRgasani4,, ('icy. 02601 _ 5.9 a o.oo '��4Y . I - ' J/2 ' it0� ` f I =168 a�. �Z, zz z I ®Z {100%UIF 'E I �- �- z i a Lot 4 - - ��-/ ; /vJ Cam. ` , _' f o ; ;:� , �'V "'� .c'o :23 it i- 10,260.S 3_ is 4 wyed 7.7 1z: rot 30 a tk.. ¢kd. .c'o-t 31 F . I- 1- Septic �p� J)izpo� r�o Y' f f�b,--x t ed w w 220 rp Lrr2c/ n/o Ce,��v� !r s y` 1000 2-9 �1 'x s ` .c iV 4to e apaai-ty r� v � � S 9 , �,_L :__�_f Skp-t lP�-oi .Cana ilk CeN,telw�,.GCe, lP9a -o,t tZ, abeth C. Coumbe lan l�ei�u� tot 23 a�. alzown on f' book. 122 pac�,e 89 feat Pit #1�-728! £Cevc�tiov� aloe Jaom waste t �ound on tot,"anrl _' a.'- Plade 4-18-89 bus -- - - -- --- -- e• -- - ' 'at�c eneowzte%.ed �cte: -?Ic�eyrt ;'.ran�,taZe r�3oa�rcZ oo 2 rvin pea, 1 AA � p2 - ! 5.4 � L .. ! .... OF S9 OF G JOHN H. Jam. o RNEY; y 1 " MILNE Fr r No..2490 N ' rER G\��� �sJ�9EC/S1ER�SJJ``s:. p wnrER ! vler6� _Z.t NAL E� roAL LAND Centerville, MA 322 s -1- " F 7T/Robert G. Levine Deck Al 7 ll, i I I , v �- { i III r r i � of rn. t h I �= 1 r i lii I ii I i I ili r 'i r �i � r � r � III I •�" -1 t � t .. 1 1 , ., 1 1.'. -i, , � t �` F - `. _ _ ` f "- + i` } -. � �� � 1 I 1 � f i. _ 1 , {` _ `f._ 1 i __- PlA 1 e , i i Ill ; J j i I i LL , I 1 I I A � a 6 ♦ Zo z�B r,� i 1o��� ��: