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Home My WebLink About0060 LAKE ELIZABETH DRIVE Goo e — {4 t a 4 i 0 ,I Town of Barnstable *Permit 90— Ez�tres 6 months rom issue date Regulatory Services Fee f snartsr,+sr� ® y C� 0 td,+es. Richard V.Scali,Director �9�' �-�-/ i639' "'�` Building Division �� Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 � �, www.town.bamstable.ma.us Office: 508-8624038 ;�•�508-790-6230 t EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint ; Map/parcel Number Property Address E L/Z ❑Residential Value of Work$ �: o7e O Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 3 u t e C 7 /-/k K 6 �L f�fi B %f/ �, C ,fyTcRIV/L LZE t Contractor's Name M A-Z(<, U L 1-1 a Telephone Number So r,Z;?(cF 51;1 Home Improvement Contractor License#(if applicable) 1 7;jf/ Email: /►t//L /N Ba F/iv G®6/ldor¢/[,Cps Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor . ❑ I am the Homeowner [qjh'have Worker's Compensation Insurance Insurance Company Name y Workman's Comp.Policy# O &^ ? Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to- enfto Ed Dom P 2le-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 required. SIGNATURE: Q:\WPFIL.ES\FORMS\building permit forms\EXPRESS.doC 01/25/17 ' k r 1 27w Coznrrrowwe i ofMassadiusetts Department ccideids Q -rice Ofrwis rgatic is Briton,AM 02111 1'VFV14LIf 0Mgf)PMlt i ,6 Wiarkers' Campensafima Insmuce Af ffiLvait BuilderslCtintra.dursMecf ricians(Phmihers APPHczntWwnmffiM Please Pyin � Name �itgf�tatef -.• Phc��'`-�o�-�a[ &'�. , _ � ' Are yo:q an employer?.Cheekthe appropriate bra= ' Type of project(reT&ed): L am a employer v:fih 4_ ❑I am a general aonfrsctor and I 6. ❑New ccnsftucfii on employees(full andforpait-time)-* 1Ive12uedfhe Bair-contactars 10 lam a sole proprietof or partnee- rist-ed as file attached sheet. ' 'i. ❑Remodeling sliip and have no employees . T these pub-cofl4ractors bade S_ De naliffoa' , wading fornn is any - employees=dhace#oAmrs' - ' 9. Budding comp_n=iznBudding addition. requRed j _ 0 .fie are a cotpata5tfln an d its M❑Eleofkal repairs or addigons I❑ I m a homemmer doing au vrordc off cols leave e�rcised their 11 E]Plumbingrepaiss-or additions see€ o w&kere �bt of exempf ion per MGL ' ry ,�nce egair.edji c.152,§1(4k and weha�veno 13-El01ther Ro of pairs -e employees-(Nowos�rs' 13_❑�?11ier ,¢ camp-mmmanm mquired-)' 'Aay apgff��ac cTaedcs bwal ti also fllrntha se�tioabe]aa siruivag ties arorlces'�ompeIIsatiaupoT3tgin `oeat fiSamevarnerswbosabert�risof s r t}iryar {iaiRga]Fsca¢iEaaait6m]�xeaa der,.,,r,nrn,.znms#MffinitanewaffidaestmdicabnflMcb fCaa�n63�s2 checYih.Ez bins mmt at�hea sa additirmal sS�i sLousag fl�enam.�of tl�e svb-ca�scfio-is imel she�irl�eth�r.arnotrhnse e�itiesha�, - empluyees.IfthesvHtaatradaesha�a empioft�zs,they�stpmy�de their scarkra'ramp.palm mmebet law an euzpfayer float ispraia fig;markm"campmsd an inmarance f'or uzy aitrvkyves Below is MapaTicy artd jah s&a inf�orauetiarL r Insaradce Companyy.Name: F C Po-ficy or Self-ins.I.ic_ ' 7 �� ?.r3/ 7 7 FpiratfauDate: P Job R,_,A,ddse= 6 0 C/� iC 'Et--/ Z, � `�/ (� Cityl5#zwze p: e- 61V 2.I�' Z-L 4f . Aftach a copy of the workers'compensation.policy-declaratioa page(showing the policy number and ezpiration hate).:° Faiinre to secure coverage as requiredunder Section 25A of MCL c_152 can lead to the imposition of csiminal peaa%t- of a tine up to$l,50D 4U and/or one gear imprison mea( as well as avil peaaSties is vie fora of a STOP WORK ORDERand a ffm of up to$250_DO.a day a&- iost tFie violator_ Be adsise:d 91 a copy of tbis slntementmaybe fxvarded to the Office of Inveslfgadons of the DFA.for insurance coverage vedff -- on- 'lifafferehycerhyyumdLtrtkapainsandpa=WesofFe :ry th&t a&forma6wj.provi&d aboiw 15 hiss mid correct 0,U`tsid use wily. D�a Fiat write�fl�ai sa,tfr be corugLetesd b�city alto mu rn�j`rc�L CRY or€'awac Fery tTice:nse Issuing A -thorr€ty(drde rune): L Sward of Health 1.Building De mtr e t 3.City1rown Clerk 4 Electrical Iuspecter..5.Plambing Inspector' - 6.Other Con-tact Person: Phone#: 6 Taformation a)ac ustructions Massachn•`sefns GC]3=Bl Laws W�=,an�DY=to sae WO)5 is � ensatzon for fb=earploYI-' :, par, n this fe, Iaye�is defined as�:eveaYpmson iu die seavice of mother uud��Y °fhnr� express or bap]ied,"oral or assoc afion,anpora#ion or other legal Mdffy,or any two or more . An Moyer is defined.as an me iffiA partner, I er,or$ie of the foregoing=Pged.in a Joint ,and including$le Iega1��*p��tT4es of a deceased oy asSDCI±iDU.or other legal entity,�°y�=PIDY�- However the or 1xu�stee of an imdividaal,p�IA or the o of the- owner of a dweIlingh=mhavmg-notm°reth=tk=agmfinents and�ho residEsfbe�em, dweIImg licese of anof=who eEploys pets®s to do ao ce,con*uct icm or repay woik on such dwelling house , or on.the gmYmds or budding appurEen.a�thereto sballnotbecause of such employmeutbe deemed to be employer°' MGL cater 152,§25C(6)also status that'every stye nr IDNa t lka n-mg agency shaII withhold fhe issuance or to operate a T3=kess or fn construct bindings in the comm Duwealth for any reneYYal of a$cease or permit wh fba nzsuraace covxage requh� aWnotpr°drced acceptable evidnce°fcomplance _pplicn ,asabgpt=152,§25CM stem 'V6Ihe the a$ nor�y ofifs political subdvisions S w orally,M eni F-r into any contract for the perfoumme ofpnbho work�Z acceptable evidence of camp liaacewith$ie insuz-mce. rev offlais cbaptrshavelieen present�dtn the c-onfrag.a3f3i0riCy:' Please fill o� fiie Workeas'compeusafion affidavit com�gletely,by r1,�me boxes�aPFIY�yots situation and,if . �ontractor(s)n e(s), addresses)andFhone n .berCs)along withtheir certffias)of necessary:supply s �no employees other the ism-ance. L=atE dL�?�Y C°mFHMeS LC)orLmattd.LiabilityPatumship (IMP) members or partners,are not rbq�d fn easy worlo'rs' "Pensafion msarmce- if an LLC or LLP does have employees,apolicy is required. Be a.dvisedthatfi3is affidayitmaybe mbmifind to the Department of Industrial =PlO Accidufs for confrmzation of ins�dnce cflverag. ATso Be since to sigre and datE-the affidavit The affidavit should be•rcb=ed to the city or town fit the apPficaii°n for the permit or license is being requesiz not the D epartment of Dial Ard�,� g��yon�e ate•gnes-1i®s regarding the law or ifyon are Mpfi-ed to obtain.a workers' compensation policy,please cO the Department at file n=be�z listed beIO'W Self-insured companies should enter their self-msm-an=license giber on fine apj iai a line. City ar Tower Offid2-TS Please be sore that tho affidavit is coml p ete and prided legibly. The Deparim.ent has provided a space 2t the boffnm offjne affidav for YOU to bIl out in.the event trim Office ofIuves[ig� has In contact you regardingt-be applicant Pleasebesinato Ell,inthepeanit/licrosen berwhichwEIbousedasareferencenumber: In.addition,anapplicant fat must submit multiple pennitlIiceinse BPP"te ors in a�givenye�,need only submit one affidavit indicating cva�:nt and under"lob 55e Address"the applicaat should write-au locatiams in (�Y policy intonation[if necessary) or town)»A copy oft he-affidavitt3�a thus tie officially stamped orma�edbyALe city or town may beprovided to the applicant as proofthat a valid affidavit is on file for fat=-pezm ts or licenses Anew affidav moist be wed out each year.'gdhem a home owner or citizen is obtaining a license or permit not re7ated?n any business,or commercial vie - ( D.a dog liceuse or pemoit to b=leaves etc.)said person is NOT xrqu tn complete this affidavit The Office of lnycsdo'sJ:iDns worlldlrke to;dack you m advance fur your cooperaiiaa and should you have any qumstiDng, please do nothesifafe to give'M a calL -M5 Deparfmmf s address,telephone and fax ntmb=-- + T3 C�DMM t at*of Massa�uRe t, -TeL,617- -49W cEgt4-G6 m l477 MASU2E Fax#Q7-727-7 Kevised424-07 94WIRR. Insurance. Contactor acknowledges and agrees that Customer,or Owner shall not be obligated to cap ryany',,insurance in connection with the Work fAthe benefit of the Contractor. u Contractor's Ins s all! times Contractor shall at alli tmes m�intair Rnd keep in full force and effect, at its expense,Py and all insurance coverage which is prudent, necessary or desirable for the protection of th_...interests of Contractor. Contractor shall furnish to Customer certificates of insurance for the following types of insurance. a. Comm.- vial General Liability Insurance; b• Worker Compensation Insurance to cover full liability under the Workers' Compensation Laws. IN WITNESS WHEREOF, the parties hereto have executed this Contract as of the day and year first above written. t Customer a � Contractor Company By. Y � _ Print: Juli Gav tt !Mark Mullin Mullin Roofing & Siding, Inc.' 7 Connemara Way, W. Yarmouth MA 02673 508 221 8591 Address: 60Lake Elizabeth Dr. Centerville, MA Date: 7-21-17n Y-a; Date:.7-21-17 Phone number j401-529-7465 License No.'CSL 104076 HIC 167281 Email address:,,JUlppv@comcast.net Email address mullinroofing@gmail.com 1 f CERTIFICATE OF LIABILITY INSURANCE DWON% ATE(MM�D17117 ) TWQJQERTIFICATE 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 and endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsements. PRODUCER CONTACT NAME: MARGARET J GRASSI INS PHONE FAX 1188 MAIN ST (A/C,No,Ext): (A/C,No): E-MAIL W WAREHAM,MA 02576 ADDRESS: 797MR INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: AMERICAN ZURICH INSURANCE COMPANY MULLIN ROOFING AND SIDING INC INSURER B: INSURER C: INSURER D: 7 CONNEMARA WAY INSURER E: WEST YARMOUTH,MA 02673 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 ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ rGENW'L MMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE OCCUR. REMISES(Ea occurrence) MED EXP(Any one person) $ ' PERSONAL&ADV INJURY $ GGREGATE LIMIT APPLIES PER: ENERAL AGGREGATE $ LICY PROJECT❑LOC PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND X WC STATUTORY OTHER EMPLOYER'S LIABILITY YIN UB-71-1931848-17 02/25/2017 02/25/2018 LIMITS ANY PROPERITOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT. $ lOO,000. OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE 1$ 100,000 It Dyes, IPTI N OF O E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONSISPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. I CERTIFICATE HOLDER CANCELLATION FAIRVIEW MILLWORK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED 49 WHITES PATH IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPR TA " SOUTH YARMOUTH,MA 02664 ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 1988=2010 ACORD CORPORATION. All rights reserved. �1. ,.�.;;k R ✓'� M��.� r�w,r�',:::;. ....' ..«. • ,.,, ,'�3�r r'..,:fl'N!1" A�4''I;'R,r n,r �i' >a- 't �=�€ -„�,� r � �:.,.. �.. ^u ...c ,,..:, 5�., 1 •rn"�P -., �� _ ,s&;.. kC.>.�{ r 1 p rT•�`�..:....-„ d - :., S. .,.r t � r i�,� J.. .u:t' ,t. ,?x.::r.rUS ,:�'r, i+ t��T�' -t':.f� •...,., �. .�,a ``� •,.y::1,:.r ,1,k,.rr� }'�:.�.t. `'��,..:�, .lts'}kf€��P•�f�''f.'�{J_ � :.. ud .r. ,}. �,/ r x'�` �. .�t a'�: �-k ,s�«.� -- �` 1 t ,.r,vr, �""{_,. r;. fi�� 'n-?a ,�:r. �.,r�-N-.._'.:a,•� •-. �...� -x fR�• .�h'' i r��,,;•c ,r t:. - r�, � [ruse onh .�beforef . �.,r�� i��:,�,• .��:�#, :. ;� r' •_ < t I'rr3 � ,ortncii�idua. Q€fice of Consurt et' ffami, Re istratton ya f Y 8► Mint- St gulahon g � rTM_.>?°`x r_+.•s_...:r,,v, `+.arw<r.rrEMEN� - .,•E+t',t.M%,::,�!dA(»xrml, 111 �uli*: ��..:+ •a-s.. Z a _ r �� ound , • H0ME IMPR MTO CONTRA II TOR '::i . �I� ezp �<Q �'Re: �strat� n�� ` n.. ,., ,t.� � , t. „ r ,, u ;: •�I�,�, � '� O,ff ce o "Co�nsum _ �_ - �'.� , , ,r r ,d,1... � ,..a � ,h rX N``� �Re.�.. a,fe,,��,N;!�{p,#CMgf' � }I'... ��:" 1, i 1"' �. � € d eS«. 'i'�'D` R....•�,� -m i. .- "!�.r,., --_-°--"'--''•' `t, :!> Ir;: s` .r#,+ ' [; MU�LIfV RO.OFING��i°TdD�S[D1 ,_, j+,... .��...:. 'p „ � _ .__. w ,'•�1',,. - i f �:.r �'x;qr� ,., „1 "�."'�;.:« ��•-.: ..-. 'x Ir.,,, 1•� r.u# �, {r ,.x a��'hM.r�.s ''a ,.z_. „<q..;r<„ '� ��,,�n•�,Nk _ x� — lo;,., {��}yII , �,:n�:--�*• .,_: - ,:. .' .t�.'.',«+.. I k t i��,..: f'1;.1,44rr.�i;p,.r• �� fi _ __ ,a s.W�l'<F„��ti�,;rtJ+ n"+ �,P,71��. f�3xr�:-a„A,.. •.,:�� .:� � sw�U;y, :�«� .,r ,;�,B. (a N„I,'!, y;l� _ '.1:• !a}i,.'r,*✓• i "lf'IA j Cm4 Wyk d.P ym - i, i'i �illl IlBi• e,.:, ,~4, ij_.I: ,A€1 r6!��'��:,1+5 hk 4 a•d n. 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'.' ,i#I 'I 1•€��. + u- � i, - i 'tfr�Il_I�•• �� #�`,j+r+ISS.,{AI4 1. 1 �SC,L ""'�n 4: �' � - i'I r „I r i�,.,,.� ,� a u'" ,,,.. .� i _ ,N Sa,.� 5.i 1 .I;' 1 �I•ihN 1„ t + ,; �� , '"6 I�i,��l;'a +I� UiR i I �. �'.,r „ N �,.4 r •,��+.,a � '+xt ', '' �l� �i�p -�1 I�I .i I{{"+, ?iH: 4�. ,' $,.,, krSt,i1. 11 1 f�L,.w;i Y , _ z r tt bf11EMARAAAAAFA s � M� WEST�VA UBU_THHF. MA Q2 3 �� .,di'rtr1 y *q,11 +, tl+ k{,�tqw'�-•n ""+`m.ysy.,i _ - $ - �' m' I thy. s n �� .��"'�''q�'ra'``^s�+ .:c' Y .. � "r• �,}'` uk B>u y� .��,4� �yi�� a u,1� �d�:nte ��rt ,�'''h � yGtw3,�:�s �� tea« •�^c� a�a�� b y+sag �S '�� ;I �n� R "#�sC� �}y>a'`„�1""'t��# hl .tN 'LY'E1�` w.w�' '�,• ' ��`' �<F ,"`�i` � 9�07�20�17�,.r �rN�`� } ��A_,�r k� =�� Cs��m��ss�o� � . H,, ��.•�"� �� Y�.�� ,� r�� k�r;�41 A. F T„E T Town of Barnstable# � Expires 6 months jro n issue Regulatory Services Fee a s BABNSTABLE. MASS. Richard V. Scali,Director ( 9�ATE0 �a,•�1639. 0K 1 lI�II`l Building Division . Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY n G !� Not Valid without Red X-Press Imprint Map/parcel Number Property Address lf&4E 4 t'7-.07' ��"/'tom e5 [:] Residential Value of Work$,XQ06 . Minimum fee of$35.00 for work under$6000.00 , Owner's Name&Address 52 Contractor's Name ,4!/� Telephone Number ? :y&2—AN),6(:o Home Improvement Contractor License#(if applicable) a y 7I _ Emaili¢ Construction Supervisor's License#(if applicable) 7-;;L Mcnrififf ❑Workman's Compensation Insurance Ir Check one: SEP 16 2014 ❑ I am a sole proprietor JC C ❑ VW I am the Homeowner T0` 0C BARNSTABLL I have Worker's Compensation Insurance UU I�! f Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) O Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors:' ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *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 required. SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 c� a� ��om��xozzx�e�tlt o��assr�ehr�se�s Department a flixdkstrial Accidents Office 0frMWSdgUd0T1S 600 Was igton Street Rastan, 0211I _ i-m1iJ inasmgawdia Wurk.ei-s' Compensaf QnL1 =—aCe Affidavit:B13EildersfCantractors/FIec-tric6ns/ umbers Applicant Infarmatacm Please Prat Lp,,gibfy on/Ivianatj= � '� GAG t�Gy�S 7/!��Y�i it. � �L/CGf Tic Name(I3usi��l0�ganizaii O�G3J cityfs�.��_�•�7��evi�-lames Phan� 7 Areyau axe employer?Check the appropriateboD; Ty. of o-et-t r d- 4_ I am a �er-al ctmfracttx and I PT � (t�}au-e }- L I am a ci ployer witl�� ❑ $. 6- ❑New consbbi oa e=loyees{full andlorpart-time}* havel the sub-conbmdors. ?-❑ I�rn a sole proprietor or Partner- ILded on tbee attached stet 7- ❑Remodeliag ship---,A hai�e no employees T71zse_sub coafractorg have g_ ❑Demolition: warp¢ �m e trt any Capacity Ea3plra yeses and have raari�ers' Y � � 4_ ❑Building adclifion moo•wo=lrPas' co ��r.*�r�e comp-insurance I 10_. Electrical repairs cs o dditioias ]_.❑ '��e a�?a cozporatio�and its ❑ rarrs 3_❑ I=a hom er doing all tv officers have exercised ffieir I I_.❑Plumbing repaum or additions right of etir, fioaper MGL �jrseIf �2,To ivcra�'comp- 17.❑Roo ofrepaTm Lot Tr co 152, q 1(4} and we Est e no employees_[No Workers' 13_.0 other Comp_insurance squired-j -Any Savo f *i.tLchecksboxr1mastslsaullou tlesEcaonbe- shalingiaeirwoseismscoirne3sstortpoll i t rite _ 9 Aim n s tx h � - n — hwts sariLx � - 1r d C �cic3rs d—� ch--a this bcx must TftachsA aic:QiiuonsI shezt shvccmg th—.nsm of 6e szxr-ccntl sand stxtE�chetec oenoz t sg Wives Iayeys_ ?i>-, b contactors hsre emg�Icryr��the3 n�ui prmide titer r ork s'comg.poLcy alms: �cxian erap!6ye'-z'tirrrtisprmddirr�tt�or�zrs'ta�furtiii.narrrttrruzc�fortfr� err.pl��. IletotFisf€tzpo7i�rutdjobs�i� 2r2f Ot`tl�A�O.YL Ias7=ce Compare{Name 0r1*7--e e �,,o Ze, e .�/LsCi/�'9i�•l� �G��Q^y Policy-Cr self iag-Litt JobSitz Address_ 6C L�4-/K ��9s� r/Ltd CifyFStafelzig= Attach a copy of the workers'compensation poll . �r V ge .slrowing the polio ,,,.be,artd i cp ration dxtc}. 40 Failure to sure cayerage as mgjmmdnuder Secisoa 25 k of MGL cc 152 cau lead to the imposition ofrn irial penalties of a fine up to S 150a_E3a andlor one-year inapriw.rI eat as welt as eital pena%Cs in the fora of a STOP WORK ORDER and a Ene, of up.to$250-00 a-day against the violator- Be advised that a copy of this sta temeut maybe forwarded to:die Office of Isvesrdgado--s of fhee DIA far in smanct coverage veriEcadon- Ida hgre6yc,r fy undff thspdns gird enaL es of uiy that the ircjarrnatzan prcniLzdaNweis hiss anrf carrecf- si�sttxre: %�%til��GC� Date: 5/ 0 4d y F]ffu fzd nse-only. D47 rr¢t wri,&in thii;area,tabg campfeted by city or town officiaL City or"Fowu: PeruritUceuse it Issrzing Aatharity(Prole one}; I.Board-of Health 2.Building Department I Cityffawn Clerk 4_Electrical L3spector 5.Plumbing hispector 6.Other Cost7kct Person: Phone 9-- 6 r A Information and Instructions f. Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto 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 sacs dwelling house . or on the grounds or building appur tenant thereto shall not because ofsuch emplo _enf be deemed to be an employer." =_ MGL chapter 152, §25C(6)also stcys that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to cperate a business or to construct buildings in the comron r<.alth fo,-arr; applicant who has not produced acceptable evidence of compliance with the irssurauce.cover:,_,,::required.- Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the ptE o—ante of public work until acceptable ev iderice of compLiapce ,loth the iasuTance 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 aDply.to yr,L)r sit anon aud,if necessary,supply sub-contractors)nzne(s), address(cs) and phone ,2L)=:bti(s) along witlh u1e7 C:er`iii'c;_G-(_) of insurance. Limited Liability Ccmpamies(LLC)or Limited Liability Pay-tnez;}hip (7�LP)vr7uno e,_nrloy- ou_er 1-the members or partners,are not re,� fed to carry workers' compensation fist,ante_ if as L"L.0 or LL1'does have employees, a policy is required_ fie advised that`his affidavit may be to ttie Depar-w ent of indu-su;al Accidents for conf-.irraation ofnia -ante coverage. Also be sure to sign and date the a;,ada; t_ The,,afl=da=r t shoiLld be returned to the city or town that the application for the permit or license is being requested, n of the l cparbnent of Industrial Accidents. Should you rave any questions regarding the 1anv or if you are regakcr:d to ob-t-yin a workers' compensation policy,please call lihP Depa tueat of the number listed below. Self:ins---Ted comr,a ics s?could enter. ;weir sell-insurance license number on.u;e 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 L the event the Office of Investigaions has to contact you re2ardi;g the applicant Please be sure to fill in the permitlLccnse number which will be used as a reference number. In ad.dit:ica,a ,applicant that must submit multiple peimi!License applications in any given year,need only submit one affidavit indicaiing c»rrent policy information (ifnecessary) and under"Job Site Address"the applicant should v,,rite"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 uZe applicant as proof that a valid affi6a,, t is on file for future pc=its, or licenses_ A new a davit lnt,et be filled out each year_Where a home owner or cilazzen is obtaining a license or permit not related to any business or commerci�l venture (i_e.a dog license or permit to bum leaves etc.)said person is NOT requ?red to complete this aflidw,A- 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 w mber- h�,-CoDananwaTx oiMassadausi D,-_Dafine t of Industdal A.Gci:dP.n Q Zee of%VCSft tl al3 i 6QG Wash gtoa Stce�, Revised 4-24-07 Fax,"617-727-��t4 viww nass-govfdi a r r - THE Tp Town of Barnstable Regulatory Services x � x �anxxsiE�* Richard V.Scali,Director �Arf1639- A Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property b.ereby authorize ,�G,/.L� S�y TO 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 before fence is installed and all final - inspections are performed and accepted. ignature of Owner Ignature of Applicant i SI-9-u 2C� Print Name Print Name Date Q:FORMS:O WNIFRPERMIS SIOI\IPOOLS Town of Barnstable Regulatory Services �oFE rgcy Richard V.Scali,Director ° Building Division � BARN LF_ x Tom Perry,Building Commissioner MASS v� 1639. $ 200 Main Street, Hyannis,MA 02601 ATED �a www.town.barnstablema.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 andlor 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"bomeownee'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 Tovm 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 shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,RuIes &Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems, particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFIJ.ES\FORMS\building permit fonns\EXPRESS.doc Revised 061313 Ago CERTIFICATE.OF LIABILITY INSURANCE. UATE(MM;°°"'"') 16� osI2v201a 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 endorsement(s). PRODUCER CONTACT Larry Cowan' Cowan Insurance Agency,Inc: PHONE 978 372.1451 FAXING 978 5214669 359 Main Street MAIL . la cowaninsurance.com Haverhill MA 01830 INSURERISi AFFORDING COVERAGE NAIC p " IN RERA• Associated Employers Insurance Com all INSURED .. .. INS RERB:" Cape Cod Construction Services Inca t INSURER c - 163 Tem Lana - - INSURER D Centerville MA 02632 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 ADDL SUB -POLICY NUMBER POLICY EFF POLICY EXP LIMITS _ - GENERAL LIABILITY - - - .EACH OCCURRENCE-. "- $. . T TO ED R EN .. COMMERCIAL GENERAL LIABILITY DAMAGE $ ESEMISES CLAIMS-MADE OCCUR MED EXP(Ani one arson $ PERSONAL&ADV INJURY GENERAL AGGREGATE.i $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED"SINGLE LIMIT ANY AUTO i. BODILY INJURY(Per person) $ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) HIRED AUTOS AU7 SEO PROPERTY OAM(Per accident) AGE $ , UMBRELLA LIAR OCCUR, EACH OCCURRENCE '. $ EXCESS LIAB CLAIMS-MADE AGGREGATE: $ . . DIED RETENTION WORKERS COMPENSATION X WC$TATU OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTN WCC5011292012014 0812512014 08125I2015 E.L.EACH ACCIDENT . $1000 000 A OFFICERJMEMBER EXCLUDED9; N J A (Mandatory In NH) - E.L.DISEASE-EA EMPLOYEE.$J,000,000 If es,describe under •„ •- D S TI N F OPERATIONS 1 E.L.DISEASE-POLICY LIMIT $1 000 000:, DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES(Attach ACORD 101,Addidonal Remarks Schedule,lf more apace la required) Attn.Tom Palanza • Residential construction management CERTIFICATE HOLDER CANCELLATION Palanza Group SHOULD ANY OF THEABO,VE DESCRIBED POLICIES BE CANCELLED BEFORE 'THE •EXPIRATION DATE, THEREOF,'NOTICE'WILL"BE DELIVERED IN 625 North Main Street ' - ACCORDANCE WITH THE POLICY.PROVISIONS. . Mansfield,MA 02048-1430 AUTHORIZE REPRE NTATIVE 01988-2010 ACORD CORPORATION. All rights reserved:' ACORD 25(2010/05) The ACORD name and logo are reg6tered marks of ACORD -- Massachusetts -Department of Public Safety Board of Building.Regulations and Standards ; a Construction Supervisor , License: CS-072866; �l. DAVID A SAURO� 163 TERN LANE;' - CENTERVILLE MA ry 0 piration Ex -Commissioner V1 e �pomvn�zoaacue(>��i.o�C �aa�ccoe� Office'of Consumer Affairs& Business Regulation R i NTRA CTOR` O ME IMP ROVEMENT EN T CO . egistration: 170471 Type:. Expiration 1.01.27/2015 Private Corporab< CAPE COD CONSTRUCTIONSERV{ICES, INC i DAVID SAURO 163 TERN LANE gig _ CENTERVILLE,MA 02632 'Undersecretary, _ p. r . i Map o�„Z Parcel 1 Permit# 1 �� Conservation Office(4th floor)(8:30- 9:30/1:00- 2:00). Date Issued 3 Board of Health(3rd floor)(8:15 -9:30/1:00-4:45) Fee - ozs. 0 d ` Engineering Dept. (3rd floor) House# �r ✓� tME 1p;- • BARNSTABLE. ' MABS 19 oe 9. rFD AAO�� TOWN OF BARNSTABLE . •,; Building Permit Application PItSAddress a I'S � �, Oro lixab�fh on v bras , >�sVillage 1 i/ t✓. l ATe \-Ap V,%(L ' Owner Dry V I d an d To I/C. a'✓! Address // Ore wn G Xylam ,( Telephone Permit Request l )d 0 l tf and o o r- .-frParrmrn4 -A First Floor square feet Second Floor square feet Estimated Project Cost $ 41�00 � Zoning District Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use &s/'d rti�/-Q� Proposed Use Construction Type Commercial Residential Dwelling Type: Single Family S Two Family Multi-Family Age of Existing Structure 4 - Basement Type: Finished Historic House Aa Unfinished CS Old King's Highway A) e Number of Baths oZ No. of Bedrooms Total Room Count(not including baths) (0 First Floor Heat Type and Fuel "— Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds Other h Builder Information Name h T Toro he,Ili _n e ` Telephone Number, )b4 #77— I : rJJ Address d. soy J b� License# o 12o l q !7 �I L 1 T a b ram. Home Improvement Contractor# Worker's Com sation &IEXIS7TING,7 - 060 � NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BU T)SHO AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRU TION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO F v� `Star kdrq yu s SIGNATURE DATE //0 J/ BUILDING PE IT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PJ- MIT NO. D ISSUED M P/PARCEL NO. i ADDRESS - VILLAGE - OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION - FIREPLACE , ELECTRICAL: ROUGH FINAL _ PLUMBING: ROUGH - FINAL GAS: ROUGH FINAL c FINAL BUILDING DATE CLOSED OUT. o \�'�`�.• - r ASSOCIATION PLAN NO. ? ' i `•"�' - The Commonwealth of Atassacliusctts F i�.i '�•�T=�11 pepartment of IndusVial Accidents H- �i•:�` 60110kylungran Street •:��`;.sue Boaron,Masi 02111 Workers'Compensation_ Insurance.AMdavit _ -.� :ADnlicant infertnatien� '•7 Please PRiNT`lp i�11iP t��s��=��rise: a s=s�� namer location• � - - � ciri• phone# ❑ 1 am a homeowner performing all wort:myself. ❑ I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation foamy employees working on this job. lfvllnv Taro�rdj Inc.add r— h10 e il i i - dtxLa,5'h ram. a5 �� 6� 7 _I , ` � �r�run Al�r ha�c�efs # �4C' p - U .- �• »... .- :«.._....-_-,r ,.,,.,....-+�as�--moo ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices.• :. town Inv nnmer address ' cih• phone#! lesurnare rn_ RRltca•# ' i:_.�::' . ,•,er:T:�•. �..._ rprarne:.-.a�'?rriC'E':�.'�^'s�'9F��+ �t7�� _ .A43!�'t•�'�S •r.��r�rrr�.�. comnanv na p. address- eiri•• r Rhone#s iesnrance re_ .. neiicv# •• - 4 tfae6 additlonal•sheet itceeenarr,-�••�:-'.i•:c-�,.;.•+•wrr...�.�•_-�.�.� ,�,.t:.- - ..r.�•�. _�x-- -- ---- --- •r""" - Failure to secure coverage as required under Section 25A of 11IGL I52 can Ind to the imposition otcriminal penalties of s fine up to dI300A0 and/or une years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day q*ast me. 1 understand that a cop}•of this statement maybe forwarded to the OMee of lavesti0adoas of the DIA for eorerap verfo atiaL I do ltor r crrrij nder rile pains a penahl ojp ' rl that the injonsWon prorided above is true sad eott� Sigtrature ate �ou Print name JosephC rQ hr `l one# V 3 omcial use onh do not write in this area to be.compieted by city or town otQt ai city or town: permMieeose 0 nBuildia0 Departm`cut oUccusinp Board:- 13 check if immediate response is required QSeieetmea's OBice ONealth Department contact person• phone#; nUther___ Information and Instructions ! Massachusetts General Laws chapter 152 section 25 requires all employers to prow►idc•workers* compensation for their employces."-As quoted from the"law",an empinree is defined as every person in the service of another under any contract of Hire. express or implied, oral or written. An enrplgrer is defined as an individual. partnership,association.corporation or other :,-gal entity, or any two or more the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the mcciver 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 c. dwelling house of another who employs persons to do maintenance,construction or repair wort: on such dwelling Itou: or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter t52 section 25 also states that every state or local licensing agency siiall withhold the issuance or rene+val of a license or permit to operate a business or to construct buildings in the comm on++•calth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally. 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 ha been presented to the contracting authority. �' :r '«!. � .�}..:iT;'is•: �.i .�! •�f•,•1:. ,1�i •�'.ti.:J• !"�'f• ��'!�r 4.••.µ.w.�"'7T:.W v�A l:•r.^.:. .r4. ,t. '..�. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names. address and phone numbers as all affidavits 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 Iisted below. City or Towns 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. Plea: be sure to fill in the permittlicense number which will be used as a reference number. The affidavits may be returned tc the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions please do not hesitate to give us a call. ::.«cif. 'i.:.:.iw+:..'...•�;.:�:1.'.:�...�+. 77-7. .•.. .w!•,••,•1Y: . . :�i,.i r._t'i`..••:1 .:77ia.•.:.7. �:••!1. 1.•,i,.. -«.*�-::..r.. .•.`.r..-i.r.: The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of investigations 600 Washington Street _ Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 7274900 ext. 406, 409 or 375 - dt��o • The Town of Barnstable 3S Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 . Ralph Crosser Office: 508-790-6n7 Building Commission, F= 508-775-3344 „ For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,'renovation,repair,modernization,conversion, impmvernent,.removal, demolition, or construction of an addition to any pmmisdn owner occupied building containing at least one but not more than four dwelling units or to structures which arc ac4acent to such residence or building be done by registered contractors,with certain a=Pdons, along with other rooremcats. �� d �jf �oy )�Ocrff�VO)��Est. Cost " ��° b0Type ofWork:w'n D Address of Work: Cra v�Ili a 5 s OR•ner.Name• Da vid an d rya i//f Date of Permit Application: 1 Q 7 p �k— I hereby certify that: Registration is not required for the following rzason(s): Work excluded by law Job under SI.000 Building not owner occupied Owner pulling own permit Notice is hereby given that: CONTRACTORS OWNERS PULLING THEIR OWN PERMIT OR DEALING W1MNUNItEGi51'EftED LESS TO THE FOR APPLICABLE HOME IMPROVEMENT WORK DO OT HAVE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Date ntrac for name Registration No. Owner's name MAY — 2 - 96 THU 14 : 08 JeTAPAEEUUI & S0V4S P . 01 v CONTRACTORS P.O. BOX 564 MASHPEE a MASSACHUSETTS 02649 TE+EPHONE(108)477.1342 FAX(608)477.060e May 2;j 1996 To: To wn of Barnstable Attentions Louise - Building Inspectors Office 508-790-6230 Re: Gavvitt Residence E�#60_Latke Elizabeth Drive Attached please find our Construction and Remodeling licenses as required. Could you please call and let me know when I can pick up the permit? Thank you for your help and cooperation! ! ! : Dianne Haroules I , .. /�^ Q � a > vff._ v' DATE{MMlPDNY) A' .�..K $ zl5 t « tR:..' � �.; mml-.• THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION PRODUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE MARK SYLVIA AGENCY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 770 A MAIN ST ALTER THE COVERAGEFFO Y THE POLICIE.sOW OSTERVILIE,MA02855-1913 COMPANIES AFFORDING COVERAGE 508-428-0440 COMPANY FARM FAMILY MUTUAL INSURANCE COMPANY A INSURED COMPANY CRAIG V GONSALVES g EASTERN CASUALTY INSURANCE CO DBA CRAIG GONSALVES MASONARY CO rCOMPANY 113 SETUCKET MA l C SOUTH DENNIS MA 02660-2614 CO MPANY D xry. x r :r.. .fn:. ni; i K xi£c.,i'x N ne IR i°-. ?n1; x.�.. r.y:.: ,h7��3:K r r; i•},)r ;:�•. �9s,., r<d:. �': r�,�trr:•nr:'` > i 3�illx ��I .xe. g .i<�.#... �r#:e.,us.,.,Z,�: � +,, Ixixir}» .� .,� 4:, ::.x,'xcy�. gg� $$ } ..........:r. gg •sS yts;} 4��'�{>�' �� K;i� ;jspn•3,9��1: �r '.Er'�x�:a��•$Rh,k}.A.»:e�:If.:."..:.�..��r;r.Rar:;;:'`,E�. •„$2;cv,°:�n��#:.............7.t;ex,��?»;e+>t�:x+;::^x?rna.<Tls...!..�::f�o?s ?i...,Rr....,........,a :.�.. 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 B Y 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. CO POLICY EFFECTIVE POLICY EXPIRATION LIMITS lTR TYPE OF INSURANCE POLICY NUMBER DATE(MMIDDJYY) DATE(MMIDINYY) GENERAL LIABILITY GENERAL AGGREGATE R - COMMERCIAL GENERAL LIABILITY PRODUCTS-COMPIOP AGG $ 1 CLAIMS'MADE F I OCCUR PERSONAL&ADV INJURY $ 07,NER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ FIREDAMACE (Anyone fire) $ —" --' MED EXP(Anyone person) $ AUTOMOBILE LIABILITY ; COMBINED SINGLE LIMIT $ ANY AUTO ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS � -(Par per son) - - i MIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS jeer axidant) PROPERTY DAMAGE q GARAGE LIABILITY AUTO ONLY.EA ACCIDENT $ OTHER THAN AUTO ONLY ANY AUTO EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY I EACH OCCURRENCE $ UMBRELLA FORM AGGREOATE $ OTHER THAN UMBRELLA FORM $ WG'TAT1Y OTH• B WORKER'$COMPENSATION AND BUREAU FILE#360132Y 3-15-96 3.15-97 T°RvurnlTs EN ". EMPLOYERS'LIABILITY EL EACH ACCIDENT $ 1 OO THE PRCPRIErQfv INCL POLICY 0TOSEASSIGNED EL DISEASE-POLICY LIMIT $ 500 PARTNERSJEKECVTIVE OPPICERB ARE: �C EXCL EL DISEASE.EA EMPLOYEE $ 100, OTHER I A CONTRACTORS 12001X0207 k 05-25-96 05-25-96 �300,000 A OCCURRENCE ADVANTAGE SPECIAL DESCRIPTION OF OPERATION$kOCATION$IVEHICLESiSPECIAL ITEMS MASONRY Ib•,xrk: j%..ii x�Ke,�inl�x� r�} err. s=��{ :'y y{ > xi�{x�`:' ,5,�� 9 r?S. k:S� �:liyr� ii�S�;tr. :a�:�. •�a:' �S,� o� r�>�� K.I:r!I'.. 0;i•%uS'�x:K`�i�_ �R��,'ro-yA:.....i ,,,cn::��A R�'..uL,.ga:yy� i'4.,'I i�k'ib3E:3:3�3i:dx�K%• .er:xs:a!53�i3::R$:r:;�r:�i I iao:c>.........,� ...?°.:�:�r.; >.e>:. ........... :.... ..3:)..... .... .. VSHOULD ANY OF THE ABOVE DESCRIBED POLICIES Be CANCELLED BEFORE THE TOWN OF BARNSTABLE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL BUILDING DEPT. o DAYS WRITTEN NOTIeETO THE CERTIFICATE HOLDER NAMED TO THE LEFT, HYANNIS, MA. D2601 BUT FAILURE TO MAIL SUCH NOTICE SMALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY ITS AGENTS OR REPRESFNTATIVES, FAX#' 780-6230 AUTH I ED R E TAT :,e� x• two+' Maki, , :u'+u E,ie ?`#.�k d '&;� tLyY ':,rry.i R.°. s+''°` s^. ays a,; r3,�?• 'c �# . MAY — 2 - 96 THU 1 4 : 09 J TARABELL I & SOtAS P _ 03 a �� HOME IMPROVEMENT CON I n6f -10PS REGISTRATIO14 Board of Building Regulations and Standards One Ashburton Pjao.o ROOM 1301 Boston, Massachusette 02108 HOME IMPROVEMENT CONTRACTOR Registration 1096S2 Expiration 09/21/96 Type - PRIVATE CORPORATION HOME IMPROVEMENT CONTRACTO$ TARABELLI, INC. i Registration 10942 JOSE:PH R. TARABELLI TYPO - PRIVATE CORPORATIOP PO BOX $64/6 SLICE WAY Expiration 09/21/96 MASHPEE MA 02649 J. TARABELLI, INC. JOSEPH R. TARABELLI ti; BOX 5r,4A SLICE VAY AP"N19MATOR MASNPEE MA 02449 I 2 - 9G 7 " U 14 : 0a -T . TARABEL- L- I & SONS p 02 111M)RIMENT OF runt ONE ASIMURION pit 1:3()l PfY',TnN, PIA In CONSTRUCTO'N j. I SUPEfVVj9,R I.ICFNe)F, Number : Fxp i Pirthdate: cs 017259 07/21/1997 0 7 P I/'t 9:3.1, Restricted To, 00 JOSEPH R TARARELLI .... BOX 564 llptadl bottom, fold v-911 or, back, ital 116 OP6,19 Kenr tor, iorl. em10001.. s . c �zos�xxx�zstx�lei��ee LOCUS _ Scale J" = 1000' CL m J/ C C�iJ� • i hg mach u"ne propo"dl NOTES Property Lines from Barnstable Assessor Maps 8 Plot Pion by Property Dofa 40 • ;;.�, ;: ��;,� r Top o.from aurora Fels: �9; l996 ,,' •� Wetland flags delineoted by Native cpes Aug. 26, 1995 located Lands - _ - 9 aol . Feb. 29, !995 -25�D4f Q006 DGornrn. Panes . . F se cm W Bolt en HY& w clad. 8.94' tww 1 'a �\, OCEAN STREET -