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x TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
co, 017ol�L
Map Parcel Application o 6 ce
l
Health Division �a r Date Issued ! -2—
Conservation Division Application Fee
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation/ Hyannis v T P
Project Street Address I S
Village (I&(A e J�_\1*I ���
Owner S; Lzy-?_ V\. Address 1 1-3 Lt,( -0- Elt
TelephoneD�
Permit Request 11Ze_#��.,_ --;^�� 1- - �Lis- I V, IA4 III
J JJ re \
C LV0 qzA t 3 v a a� n wr c S�� ►�-� Ote �� . (Cd 1J`t1e'G ® k )
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District lood Plain Groundwater Overlay
'Project Valuation'427,
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 ❑ 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 e
Total Room Count (not including baths): existing new First Floor Room Count : r.
a
c>
Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other =
Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove- Yes,LJ No
Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑exiting ❑new size_
1'1
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 f Proposed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name 1 C. Telephone Numbel
Adress 23 4 nr Q S L� r..Q License #
Gt t'd' /lam Home Improvement Contractor# 00 _5 6)
Worker's Compensation # UW C1 Z o
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
Iry Gie
l J— 2 7o,
SIGNATURE - DATE
FOR OFFICIAL USE ONLY
' APPLICATION#
• .,DATE ISSUED
MAP/PARCEL NO.
ADDRESS t VILLAGE _
f
OWNER f
DATE OF INSPECTION: i
FOUNDATION
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION,PLAN NO.
r
. die Cazrzmarrwea�tJi of h�assaaliuset
'De
partmerztaffn ialAcddenfa
Coke of Fnve�tzgmdorrs
.600 Waskbttan,t&eet`
_ BastorS h�4 02 ZZI
wtfmm.mrrss gav1kHaApp
' .Workers' Compensafian�'�nce A�.davit:I�'nildersTCa�ntrac�rs/�eciri�(Pfi�tabers •
,icmt Juformation Please Print L
MUT
Name(Busa�ssrp ( e
A dd'e55:
Are Yo an employer? Check the appropriate bow
�' Type of project(regIIired):; `
1.L am a MMpkT r v Z U" 4. i] I am a� T am actor and I
employees(fan and/or park J. have hoed the sub:cauiract= 6 ❑New cawt,,,ct;�,T,
2.❑ I am a'sole or p�m listed on�•atmhed g}r�t' ff-Ung
sh#and have no employees These sub-contractors have "
�Ye and have workers 8' Demolition
for me�any capacity. es. � - .
[No workers' cam.ins�ce . c�... ce.$ 9. [] mg ad�ion
req�ed-] 5. ❑ We are a•cmpotdian and its 10-[]MWtrioal repass or ad o
3,❑ I am a homeowner dig aII•work officers have Wised$ieir
11.❑PhMbf ep
myself [No was' camp. " 69'bt bf e pet MQ, r airs.or add ons
insurance required]t C. 152, §I(4), and we have no I2.[]Rnpfrepairs
emP�m• [Nb�' . 13.El Other
comp•insurance required]
*A-y applicant ftm±eb=h bax#1 mpst also fm out thc sccfian belaw showing ffici�warkeae compcos
who submit a�on pofiey i ion .
t Someo4vasubmitthis aindaxiE i- c $ey am doing aU work and fhm hut outside e
Coahactms fat check fzis bcm must ati mbed m ad&f m l sheet M2��.�submit anew affidavitmdicafing y�
�loyees 1£fhe sob coatractos have showing
oats°of�e S,h.r,,,,},-LInm and statr whether ornot those eofifies haze
®P�-,�y MMetprmddt th,workz�s'comp,poliC3,TT
F arrr ¢n earplayea that is providnrg tNor3cers'aornpensrffian insurance far zay employees Belaw is the pafzcy and job site
infarn atio c,
Insm-anm Cinnpany Name:
Policy#or Self ins.Lic.# ` _
E anDafn:
Job S`tr Address: J` �
Attach a copy of the workers' compensation policy"daclara6nn I'
P '( Qw�g Ply nrmiher and expiration date).
Failure•tD,secure °average as required under Seadm 25A ofMGL c. 152 can lead to ffie ' o
fine up to$1,500.00 and/or one-yew as AP O WeII as•ciyfl s of coal pena}t;Ps of a
of up to $250-DO a day against fhe violator, Be advised that a penalties in the form of a STOP WORK ORI?ER and a�fine
hive DIA fin�rem�„re co copy'of this sta-te�may be forwarded to the Office of
verificafion
I cLo her Mn a pan of'PmjW y that the irzfarmadan provided jr6ov4 is ue and rrecG
�i�atare: Date:
Phone# 9� 7
4zcial use array. Do rcat write m this areg to be completed by crty ar-town a�zrsal
City or Town: Permitllacense# .
Issrring Ax&oritp(circle one):
1.Board of Heath_2.l3m'Id>ag Degai•{ment 3 C ylTUVM Clerk 4.IlecirieaI Iuspec r 5.Plirmh'
6.. Other . mg Impector .
Contact Person: Phone#:
Client#:33723 CAREF
ACORD,. ' CERTIFICATE 'OF LIABILITY INSURANCE DATE(MWDDNYYY)
THIS CERTIFICATE IS ISSUED AS A MATTER.OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
9712011
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 CONTACI
Herlihy Insurance Agency, Inc. NAME:
PHONE 508 756-5159
51 Pullman Street A/c No Ext: (AIC,No: 508 751-5747
E• L
Worcester, MA 01606 ADDRESS:
508 756-5159 CUSTOMER ID9:
INSURED INSURER(S)AFFORDING COVERAGE NAIC#
Care Free Homes Inc INSURERA:Interguard Insurance Company
239 Huttleston Avenue INSURERB:Safety Indemnity Insurance Comp
Fairhaven,MA 02719 INSURER C:
INSURER D
INSURER E:
INSURER F: -
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS-SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR I DDL UBR
LTR TYPE OF INSURANCE NSR D - POLICY NUMBER INO�DD EFF POLICY EXP YYY) - - LIMITS
GENERAL LIABILITY
EACH OCCURRENCE $.
COMMERCIAL GENERAL LIABILITY DAM R D
PREMISES Ea occurrence $
CLAIMS-MADE El OCCUR MED EXP(Any one person) $
PERSONAL&ADV INJURY $
GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER:
pRa PRODUCTS-COMP/OP AGG $
POLICY LOC
$
B AUTOMOBILE LIABILITY 6213850 07/01/2011 07/01/201 COMBINED SINGLE LIMIT -
ANY AUTO (Ea accident) $1,000,000
ALL OWNED AUTOS BODILY INJURY(Per person) $
X SCHEDULED AUTOS BODILY INJURY(Per accident) $
X HIRED AUTOS PROPERTY DAMAGE
(Per accident) $
X NON-OWNED AUTOS
UMBRELLA LIAB OCCUR -
EACH OCCURRENCE $
EXCESS LIAB 171 CLAIMS-MADE - - -
AGGREGATE $
DEDUCTIBLE - -
RETENTION - ..
A WORKERS COMPENSATION CAWC244O43 WC STATU OTH-ANY $AND EMPLOYERS'LIABILITY -Y/N 09/01/2011 09/01/201 X O
OFFICER/MEMBER EXCLUDED ECUTIVE® N/A - E.L.EACH ACCIDENT $1,000,000
(Mandatory in NH) - -
Ifyes,descrlbeunder E.L.DISEASE-EA'EMPLOYEE $1,000,000
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1 000,000
r i
DESCRIPTION OF OPERATIONS'/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) - -
CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Town of Barnstable THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
ACCORDANCE W&H THE POLICY PROVISIONS.
Building Department
367 Main Street AUTHORIZED REPRESENTATIVE
Barnstable, MA 02601
019 - G09 AIb6Rb CORI:rORATION..All rights reserved.
ACORD 25(2009109) 1 of 1 The ACORD name and logo are registered ma of ACORD "
#S48858/M48747 PB2
Massachusetts -Department of Public Safety
Board of B4ilding Regulations and:Standards
Construction Supei isor
License: CS-095228
DANA J PICK,` -
.19 I3ANILETST j
Fairhaven M�. 0211,I y
Expiration
Commissioner 03/22/2014
cJ/ze�pa»vr�aooacuea�C�o��czoacac�ccdeC� ------- ---------
Mee of Consumer Affairs&Business Regulation License or registration valid for individul use only
ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
° Office of Consumer Affairs and Business Regulation
egistration _1005Q3;;, Typ0 10 Park Plaza-Suite 5170
Ex iration
P 6/�9/2014 '?. Supplement °and Boston,MA 02116
CARE FREE HOMES I.NC
DANA PICKUP JR
239 Huttleston ave
Fairhave.'n, MA 02719 Undersecretary Not valid without signs re
04/27/2012 14:02 FAX lg�001
OFFICE(508)9974111 MA.Rullder's Lip.#021990
FAX:(609)0974207 A6CA R E F R E E Kwu improvementTOLLFRWE T�1t11 meS gnc• Co �� se
wwVLoarrhw lommon"ny oom 289 HIITTLESTON AYt= (RT 6) • FAIRHAVEN,MA 02719 911"E79 U.
NAME 4tava R Aline Rrnwn DATE_Alx iA 2ni p
ADDRESS 173 1 eke F117abWb nriva C mtf;rWlh-AAA zip co Z-c-�z
ADDRESS OF JOB carnw
HOME PH:,cing_sgn_lim CELL PH: EMAIL: G��I .Otis
Jos DE80RIP11oN
Re lace all rotted wood and rotted sills on front of house.
i9F wood fQF paint,
Apply 2 costs to all exterma him.
w v 2 Ar 1G
I ++M--
Remove small fear Ianding and stairs.
Build new landin flush with existina lar er dack
VT
x 6-
10 year workmanship .
Fred Homes haridles 40 perms S.
ns Sri 7-V [ ,--,
iLr77r—
C., Ca 5- err,*
I
"P 1,af 2
u4iz-rizutz 14:uZ N'AX f 002
Uiogr INcrie9,(if needed)
G � 90i
C111,�
tkSI+/C 14 W IL-L- SC D fr-ecAl /fe
M.pG.C-T`, /1,ti c Q tJ
Scheduled Start Scheduled Completion 1-2 waaks
A Replacement of missing or rotted lumber Is not included unless sp'edfied,
S.All start&compMon dates are approximate and could Change due'to weather conditions.
ffA C.Stripping of roof includes removal of up to two(2)layers of shingles,each additional layer to be charged @ 0 �z
rsk A.Replacement of rotted roof boards/plywood to be oharged(� 0 _- ft7.
E)dsting chimney flashing will be reused;replacement,I ASWssary,is not included.
F.Care Free Homes,Inc.is not responsible for moldlmlldew,oonditions that are pre-existing or a result from leaks not brought to the
attention of C.F.H., Inc.promptly.
The Company hereby proposes to furnish labor and material to cDmpiete the above work for the amount heroin.Fulfillment of this
order is contingent,however,upon the want of strlkesfires and natural disasters,the ability to obtain materials,or any.other
condition beyond the control of the Company.
Cost Of Project$ PAYMENT TERM on nnim n
f S 5o 1<6A -7a A c. Ar7—
1.You,#W Owner,may eanvel this tmnsaation at any time p iorto midnight the third businoos day after the date of this transaattan,
2.You,the Owners,agree to pay any and all expenses Inourred by Care Free Homes,Inc.in collecting money due under this cxrrid act j
and enforcing the terms of this contract,including but not limited to,reasonable attorney's fees,interest and court costa. I
DO NOT SIGN THIS CONTRACT 1F THEM ARE ANY BLANK SPACES
i
CARE FREE HOMES, INC.
ACGEPTE j
By; Buyer witnMedpaa cl"W t C, [g -
receipt of fully Completed
CARE FREE HOMES,INC. copy+of IN&Agreement Owner �
AM owdractors and subcontractors shall be Muistered by the director and any inqulres about a oontractor or subcontractor relating
to a registration should be directed to:
Dirmtor,Home improvemont Contractor Regigtrdon
One Ashburton Place,Room 1301
Boston,NIA 02108
Tat(Btt)727-OW
pop 2 ate
$ _
I � �
{ I
' i V,„..\/��! / 'I. `�.�'-f Chuv\.
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( TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel Z Application #
Health Division Date Issued Z'
Conservation Division QX- Application Fee
Planning Dept. Permit Fee u
Date Definitive Plan Approved by Planning Board o '711 di 2—
Historic - OKH _ Preservation / Hyannis _
Project Street Address
Village
Owner .� All- Address
Telephone b�
Permit Request (�I L if 6�Q(ti- Lu I `
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation —Construction Type
r
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
DwellingType: Single Family � Two Family ❑ Multi-Family # units)
Y 9 (
Age of Existing Structure Historic House: ❑Yes U o On Old King'stH ghway: 14 Yes==Y No
Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other
Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft)a
Number of Baths: Full: existing new Half: existing new-
Number of Bedrooms: existing —new a ;v
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
k. (BUILDER OR HOMEOWNER)
}
Name Telephone Number
Address 2 'O 1� License #
`i zG_yC AQA 04 Home Improvement Contractor#
Worker's Compensation #' C•�ti� 2 y Ll 0 L/
ALL CONSTRUCTIO DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ®" ✓ d a-�
SIGNATURE TE
FOR OFFICIAL USE ONLY :..
;r APPLICATION#
DATE ISSUED
MAP/PARCEL NO.
1
• i
1
ADDRESS VILLAGE
i
OWNER
' DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
t
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
,•s
ASSOCIATION PLAN NO.
r
r
The Commonwealth of Massachusetts .
Department of IndustHal Accidents
Office of Investigations
' 660 Washington Street
Boston, AL4 02111
www massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le 'bl
'Name(Business/Organization/Individual):
Address:
City/State/Zip: Phone#:
Are pl an employer?Check the appropriate bog: . r
general contractor and I Type of project(required);
1. I am a employer with_2 4. ❑ I am a g
employees(full and/or part-time),* have hired the sub-contractors 6. ElNew construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet, 7. ❑ modeling
ship and have no employees These sub-contractors have g, ❑Demolition
working for me in any capacity. employees and have workers'
[No workers' comp.insurance comp, insurance.$ 9. ❑Building addition
required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3.❑ 1 am a homeowner doingall work officers have exercised their
11.❑.Plumbing repairs or additions
myself.[No workers' comp. right of exemption per MGL
insurance required]t c. 152, §1(4), and we have no 12.❑Roofrepairs
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.
(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 ispro 'ding workers'compensation ' urance for my employees.- Below is thepolicy andjob site
information.
Insurance Company Name:
Policy#or Self-ins. Lic.#:
/ Expiration Date:
Job Site Address: ( ity/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 e DIA for insura4and
cation.
I do hereby cer under th ains rjury that the information provided abo a is ue and correct
Si ature:
Phone#• ,�
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/Ucense#
Issuing Authority(circle one):
1:Board of Health 2.Building Department 3. City/Town CIerk 4.Electrical Inspector. 5.PlumEInspector
6.Other
Cont#ct Person: Phone#:
Client#:33723 CAREF
ACORD. CERTIFICATE OF LIABILITY INSURANCE Dsin"7 o��"'
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 INSUR D BY 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 WAIVE ,subject Co—
'
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
Herlihy Insurance Agency, Inc. NAME:
PHONE 508 756.5159
51 Pullman Street ac No Ext; (A/C
,No: 508751-5747
E- L
Worcester,MA 01606 ADDRESS:
50$756-5159 CUSTOMER ID#:
INSURED INSURER(S)AFFORDING COVERAGE NAIC#
Care Free Homes Inc INSURERA:Interguard Insurance Company
239 Huttleston Avenue INSURERB:Safety Indemnity Insurance Comp
Fairhaven,MA 02719 INSURER C:
INSURER D:
INSURER E:
INSURER F: . `
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR DDL UBR
LTR TYPE OF INSURANCE NSR D. POLICY NUMBER POLICY EFF POLICY EXP ,.
GENERAL LIABILITY
MWDD MM/DD LIMITS
EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY DAMA D
PREMISES Ea occurrence $
CLAIMS-MADE OCCUR MED EXP(Any one person) $
PERSONAL&ADV INJURY $
GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER:
PRO PRODUCTS-COMP/OP AGG $
POLICY LOC
g AUTOMOBILE uasiun Is
6213850 07/01/2011 07/01/201 COMBINED SINGLE LIMIT
ANY AUTO (Ea accident) $1 000 000
ALL OWNED AUTOS BODILY INJURY(Per person) $
X SCHEDULED AUTOS BODILY INJURY(Per accident) $
X HIREDAUTOS PROPERTY DAMAGE $
(Per accident)
X NON-OWNEDAUTOS
$
UMBRELLA LIAB OCCUR
EXCESS LIAB CLAIMS-MADE EACH OCCURRENCE $`
DEDUCTIBLE
AGGREGATE $ATE $
RETENTION
A WORKERS COMPENSATION CAWC244043 we sTATu AN orH- $
AND EMPLOYERS'LIABILITY Y/N 09/01/2011 09/01/201 X W s
OFFICER/MEM ER EXCLUDED?ECUTNE® N/A E.L.EACH ACCIDENT $1,000,000
(Mandatory in NH)
if yes,descrlbBunder E.L.DISEASE-EA EMPLOYEE $1,000,000
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1 000,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required)
CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Town Of Barnstable THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
ACCORDANCE.WITH THE POLICY PROVISIONS.
Building Department
367 Main Street AUTHORIZED REPRESENTATIVE
Barnstable, MA 02601
ITI V v_
r�
)I@199MG09 A66Rb CORFrORATION.All rights reserved.
ACORD 25(2009109) 1 of 1 The ACORD name and logo are registered ma&b of ACORD
#S48858/M48747 P62 �:
04/27/2012 14:02 FAX z 001
OFFICE(508)NT4111 MA.BulhUpr's Lio.0029$80
FAX(508)9974297 C A R E F R E E Home Improven"m .
TOLL FRWE T�f111 BM am es' Inc. � 00#! 6W MA.License
w*,moar ftw om m ponyoom 289 HUMESTON AVE.(RT 8) • I�AIRHAVEN,MA 02719 I�1�78 R1
MANE gi8va&AMA Rmwn DATE Art 1 a 2ni P
ADDRESS-I Za I eke R17abilb nr#va+ Gontgali faa MA ZIP COD Z_C 32
ADDRESS OF JOB gwmaa
HOME PH:-sm_sFn_iim CELL PH: EMAIL:
rar�sol�canaYcvm - - �-��
JOB DESCRIPTION
Replace all rotted wood and ratted sills on front of house.
Remove sma rear Wnding and starts. 0Ar
Buildnew.landk),gi flush with existinCl fart er deck
�s A'. E
NoT Aie, ®F
11)year workman5hip
Fred Homes haMles all permits.
7-RK--4 C- C
.j5/u 6 7-) 7-0 T
(5 s 6v-r-,
P*1 orz
04/27/2012 14:02 FAX121002
Diag—INatee:(if needed)
Cats C r fz C
Scheduled Start 4 WAekq Scheduled Co
mplefian
A Replacement of missing or rotted lumber Is not included unless specified.
B.All start&completion dates are approximate and could change due'to weather conditions.
/fA C.Stripping of roof includes removal of up to two(2)layers of shingles,each additional layer to be charged(t 0 ftz
rtk Q, Replacement of rotted roof Nmrds/plywood to be oharged
OE_ Using chimney flashing will be reused;replacement,if.necess",is not included.
F.Care Free Homes, Inc.is not respdnsibbe far mokVmildew conditions that are pre-eAsting or a result from leaks not brought to the
aftention ofC.F.H., Inc. promptly. xGEPt' 16�
The Company hereby proposes to furnish labor and material tv complete the above work for the amount herein.Fulfillment of this
ordor is contingent,however,upon the want of strikes,fires and natural disasters,the ability to obtain materials,or any other
condition beyond the control of the Company.
Cost of ProJvot 5 PAYMENT TERM$an Wan^
�,57"a�d,.2.. �•ci�ct-. .��/�'�G% �r2 C�D�c,Ar,/4`� G�t77s�
�ir+i`f rD a�uo�c rs 1�c12/dam � Date
-Ta 4 c c.
9.You,the Owner,may cancel this ftn"66611 at nny time prior to midnight the third business day after the dale of GIs transaof ion.
2.You,the Owners,agree to pay any and all expenses roar red by Care Free Horses,Inc.in collecting money due under this oontmot
and e*rdnD the terms of this contract,including but not limited to,masonable attorney's fees,interest and court costs. I
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES �
CARE FREE HOMES, INC.
ACCEPTfI:
BY: 9uyeradmowledpea. ownMr
reoW of fully wmpleted
CARE FREE HOMES,INC. copy of tHs Agreement owner
All Wntractors and subcontractors shall be registered by the director and any inquires about a contractor or subcontractor relating
to a registration should be directed to:
Dlrectar,Home Improvement Contractor Registration
Oils Ashburton Place,Room 1601
Baton,1%0210
"ibi:(617)727-8fi9t3 f.
"2af2
Massachusetts -Department of Public Safety
Board of B4ilding Regulations and Standards
Construction SuperN'isor
License: CS-095228 '
`� � r S"
DANA J PICI�3�
.19 HAMLETSST.
Fairhaven MyA, 02719 y
.. c
'-�,.. .
Expiration
Commissioner 03/22/2014 I
--
-Office of Consumer Affairs&Business Regulation License or registration valid for individul use only
ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
egistratton `100503 , Typos; 10 Park Plaza-Suite 5170
9Exp1ratiQ_MA6/,19/20_-1'4 Supplement and Boston,MA 02116
CARE FREE HOMES INC 1
DANA PICKUPJR ,F r
239 Huttleston ave
{.-..r.^
Fairhaven, MA 02719 i
Undersecretary Not valid without signa re
saw
re-use eXl5t. shower
exist_ vwndow {rotate J8O degrees)
new window elec. panel
file
cab.
CLbs.
new-wall: 2x3 new wall
studs 51deway5.
Ref. CL05Ef' new to]let
heaves
KITCHEN , W.
s
re=use vanity =`
exist. counte HALL BATH 1 �.AU N D.
D.
I
raise floor to
match house �.
RRY CORDON PROPOSED PLAN ate: 4-23-12
ARC�I1ECfiU. At DEIGN Brown Residence /saT�,�, �'�• .
t e
ol &15
�:
It Vi,
, �,�
YOU WISH TO OPEN A BUSINESS? ,
For Your Information: Business Certificates cost $30.00 for 4 years. A Business Certificate ONLY REGISTERS THE BUSINESS
NAME in town (which you must do by M.G.L.- it does not give you permission to operate.) You must first obtain the necessary
signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1st FL., 367 Main Street,
Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law.
r 3 ' Fill in please: Date: ;L—/3 - C39
APPLICANT'S NAME: 6ra.�-s
a YOUR HOME ADDRESS: a-7/ P ✓6
BUSINESS TELEPHONE # HOME TELELPHONE #:
NAME OF CORPORATION: '
NAME OF NEW BUSINESS_1j/-4 y /S44Aro S S _TYPE OF BUSINESS -X 66 K 6"74.C_—s 16A4."'✓d
IS THIS A HOME OCCUPATION? x YES NO 63
ADDRESS OF BUSINESS/734+4- p� 'nC-<F&LIfILC�� MAP/PARCEL NUM13ER 2-z6.`' 7 -'(Assessing)
When starting. a new business .there are several things you must do to be in compliance with the rules and regulations of the Town of ,
Barnstable. This form is to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. (corner of Yarmouth Rd.
& Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in town.
1. BUILDING CO ISSI NER'S OFFICE
This individual has een4n d ny ermit requirements that pertain to this type of business.
1.
P
Au orized Signa_ e** MUST COMPLY WITH TION
COMMENTS. RULES AND REGULATIONS. FAILURE TO
r COMPLY MAY RESULT IN FINES.
2. BOARD OF HEALTH
This individual hates beenormed off per r uirements that pertain to this type of business.
Authorized Signature**
COMMENTS:
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual s een inf rrrred of t e is s ng uirements that pertain to this type of business.
Authorized Signature*
COMMENTS:
Town of Barnstable
oFzIH*E r�
Regulatory Services
ti Thomas F. Geiler,Director
Building Division
aAaxsTAare.
mass 8 Tom Perry,Building Commissioner
Ep Mpt16 200 Main Street, Hyannis,MA 02601 r
Office: 508-862-4038 Fax: 508-79016230
Approved:c2ini
Fee:
M Permit#:. ,
HOME OCCUPATION REGISTRATION
Dater
/ —. �rL�s S � d 3
Name:J C'� u t�20W� -0 6 R//4 / i f4 Y (5 6,�m Phone#: 5 6
Address: l ! �/� �C Z,4/3 Lr7( 0-Z _village,:: �f_c ?�—•2 ✓�C C -
Name of Business: (/ 15(--Al
Type of Business:,8 8 d g b L''es P AA 9:/4^<<cMap/Lot: Z ZC 7
INTENT: It is the.intent of this section to allow the residents.of the Town of Barnstable to operate a home occupation
within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity
shall not be discernible from outside the dwelling. there shall be no increase in noise or odor;no visual alteration to the
premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;
and no increase in air or groundwater pollution.
After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the
following conditions:
u The activity is carved on by the permanent resident of a single family residential dwelling unit,located within
that dwelling unit.
C Such use occupies no more than 400 square feet of space;
a There are no external alterations to the dwelling which are not customary in residential buildings, and.there is
no outside evidence of such use.
• No traffic will be generated in excess of normal residential volumes.
9 The use does slot involve the production of offensive noise,vibration,smoke,dust or other particular matter,'
odors,electrical disturbance,heat,glare,humidity or other objectionable effects.
There is no-stomge•or:use of toxic or hazardous materials,or flammable or explosive materials,in excess of
normal household quantities.
• Any need for parking generated by such use shall be melon the same lot containing the Customary Home
Occupation,and not within the required front yard.
• There is no exterior storage or display of materials or equipment.
• .There is no commercial vehicles related to the Customary Home Occupation, other than one van or one
pick-�up-guek-aot-=to•exceed•one torr.:capacity,and one trailer not to exceed 20 feet in length and not to _ ... .. _ -
exc-eed 4 tires,parked on the same lot containing the Customary Home Occupation.
• No sign shall be displayed indicating the Customary Home Occupation.
C If the Customary Home Occupation is listed or advertised as a business,the street address shall not be
included.
• No person shall be employed in the Customary Home Occupation who is not a permanent resident of the
dwelling unit. .
I,the undersigned,have re. d agree with the above restrictions for my home occupation I am registe
ring. q
Apph Date: l L ` b / 2-6 a /,..
The Town of Barnstable
Department of Health, Safety and Environmental Services
�„AM UL % Building Division
039. a�0� 367 Main Street,Hyannis MA 02601
�c Mop
Office: 508-790-6227 Ralph M.Crossen
Fax: 508-790-6230 Building Commissioner
Home Occupation Registration 3
Date: F�
Name: S'Mj e ¢A ',A Lke Rrrn W n Phone#: 4 17 co- OS 3S".
Address: Village• Or- y i I le _ .
Type of Business: Map/Lot: Pay f�
INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation
within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the
activity shall not be discernible from outside the dwelling there shall be no increase in noise or odor;no visual
alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal
residential volumes;and no increase in air or groundwater pollution.
After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the
following conditions:
• The activity is carried on by the permanent resident of a single family residential dwelling unit,located
within that dwelling unit.
• Such use occupies no more than 400 square feet of space.
• There are no external alterations to the dwelling which are not customary in residential buildings,and
there is no outside evidence of such use.
• No traffic will be generated in excess of normal residential volumes.
• The use does not involve the production of offensive noise,vibration,smoke,dust or other particular
matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects.
• There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess
of normal household quantities.
• Any need for parking generated by such use shall be met on the same lot containing the Customary Home
Occupation,and not within the required front yard.
• There is no exterior storage or display of materials or equipment.
• There is no commercial vehicles related to the Customary Home Occupation,other than one van or one
pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to
exceed 4 tires,parked on the same lot containing the Customary Home Occupation.
• No sign shall be displayed indicating the Customary Home Occupation.
• If the Customary Home Occupation is listed or advertised as a business,the street address shall not be
included.
• No person shall be employed in the Customary Home Occupation who is not a permanent resident of the
dwelling unit.
I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering.
Applicant: �(�P�� _ ,Cy Date: 5
Homeoc.doc
_ � ) Map = ! t0' Parcel D�'1i Permit# b
House# 173
Date Issued
,.-Board of Health(3rd floor)(8:15 -9:30/1:00-4-M) e
-EonsmvatiaT-Office(4th floor)(8:30- 9:30/1:00-2:00) - APPLICANT MUST OBTAIN A SEWER
CONNECTION PERMIT FROM THE
-Pi ifig Dept.(1st floor/School ENGINEERIN MOR TO
or/School Admin. Bldg.) town CT t
Definitive Plan Approved by Planning Board 19 ;
BARNSTABLE.
9.
TOWN OF BARNSTABLE
Building Permit Application
ro( 4
ject Street Address 11 bti kyj 0 , &,V Ijoel! `
Village" ' `�.1'(p✓I/ lel
Owner ,P✓�/ ANk V YV WY• Address ,��j W'd�'if� t1v �h 7/j!,l,�na'9✓yrl�/
Telephone Eq- #- pfkc
Permit Request G?r / — � �. hu
Gi�NIOY ' IAl(�llowli �ri0 AGrt%� , 1�6i�''�'JI ��j ;1►� -F ltr G�bil'EO�i
First Floor square feet Second Floors square feet
Construction Type U/
Df�l f)Irn.el
Estimated Project Cost $ h Q 0p
Zoning District Flood Plain Water Protection
Lot Size Grandfathered 14 Yes ❑No
Dwelling Type: Single Family 1;' Two Family ❑ Multi-Family(#units)
Age of Existing Structure I Historic House ❑Yes ;i(No On Old King's Highway ❑Yes J$(No
Basement Type: ❑Full )(Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) N t,*' Basement Unfinished Area(sq.ft) OPP
Number of Baths: Full: Existing !i New' Half: Existing — New
No. 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 14 No Fireplaces: Existing New Existing wood/coal stove ❑Yes No
Garage: ❑Detached(size) i Other Detached Structures: ❑Pool(size)
❑Attached(size) ❑Barn(size)
❑None ❑Shed(size)
❑Other(size)
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes %No If yes, site plan review#
Current Use Proposed Use
Builder Information
Name �/ � �t �� Telephone Number
Address 10 (A-A✓W (r*1&? License# 0
Nit A-Am , M4- p 4lq I/ Home Improvement Contractor# �
Worker's Compensation# -7i 0:1
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
r�eyy bq6hn�n1�d1�x1 �� ( MQrI
SIGNATURE t DATE �q
BUILDING PERMIT NIED FO HE FOLLOWING REASON(S)
t ,
FOR OFFICIAL USE ONLY ' -
PERMIT NO.
DATE ISSUED
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER
DATE OF-'INSPECTION:
FOUNDATION
FRAME {Yt
INSULATION
FIREPLACE P
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH { FINAL - ^
GAS:` Y i-Q s OUGH FINAL
- C^tail�•'E•+ � S _ r
FINAL BUILDIN`0 cr
m� .
DATE CLOSI (AJT
€ i catCC v
t
v
ASSOCIATION_P!'AN NO. t
1.
w •
oFzt+e rgyy
The Town 'of Barnstable
WXN6reat.&
��. �0�' Department of Health Safety and Environmental Services
ArEo�" Building Division
367 Main Street, Hyannis MA 02601
Office: 508-790-6227 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
For office use only ,
Permit no. 0
Date - -�
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization,
conversion, improvement, removal, demolition, or construction of an addition to any pre-existing
owner occupied building containing at least one but not more than four dwelling units or to
structures which are adjacent to such residence or building be done by registered contractors, with
certain exceptions,'along with other requirements.
Type of Work: Est. Cost ' Q4t7
Address of Work: �� % L*1� *N*A V 6 �f' n4w*
Owner's Name &,Le, � /11i��i �✓����
Date of Permit Application:
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
Job under$1,000.
Building not owner-occupied
Owner pulling own permit
Nonce is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner:
(LAM Nm
Date Contractor Name Registration No.
OR
Date Owner's Name
ry
The Commonwealth of Massachusetts
.� Department of Industrial Accidents
-:..- Ofriee 0f/n0eslM 1199fts
�y^ 600 Washington Street
Boston,Mass. 02111
Workers' Coin ensation Insurance Affidavit
name:
location:
city phone#
❑ I am a homeowner performing all work myself.
❑ I am a sole ro rietor and have no one workin in any ca acity
I am an employer providing workers' compensation for my employees working on this job.
coin an name.: bil � �
address �� ' ai�.U�✓ :;;
city O�l�v phone
insurance co. ct�/ G O �ul'` l�(�l olicv#
❑ 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:
company name: -
address:- _, .
.:
city phone*.
ohcv
insurance co #
_
cbm any name:
address:
city-
insurance co. .
xxx
Fafiure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a
copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct
Signature IAAJ / Date �/*q
Print name ` d ► Ut/ �d� Phone# --------------
--------------------------
---------------------------
official use only do not write in this area to be completed by city or town official
city or town: permit/license# ❑Building Department
❑Licensing Board
❑check if immediate response is required ❑Selectmen's Office
❑Health Department
contact person: phone#; ❑Other
(revised 9/95 PJA)
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees. As quoted from the "law", 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 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal
of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has
not produced acceptable evidence of compliance with the insurance coverage required. Additionally,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 in the workers' compensation affidavit completely,by checking the box that applies to your situation and
supplying company names, address and phone numbers along with a certificate of insurance 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 listed 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. Please
be sure to fill in the peimit/license number which will be used as a reference number. The affidavits may be retuunod in
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.
The Department's address,telephone and fax number:
The Commonwealth Of Massachusetts
Department of Industrial Accidents
Office of Investigadons
600 Washington Street
Boston;Ma. 02111
fax#: (617) 727-7749
phone#: (617) 727-4900 ext. 406, 409 or 375