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0153 LONG BEACH ROAD
�.,� �M ,: D� � �' . rr,. � . .. z . _ .. ;� o , , o , . � u �. ..< :: '. .. .. ... .. �. - ,. r �f' .. .. .. n _ �' y Y ,. .. :� .. .. - _ ° .. � .. ,. c �' � � .. .. ,. e .. �_ - 4 .. ..� o� .. .. R E. i� - .. .. .. ., _._—i-- ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application.# SRO Health-Division Date Issued. Conservation Division Application Fee Planning Dept. Permit.Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Str et Ad"ej;,3 W r a Village 4 g Owner Address Telephone Permit Request /� (Jaqua / Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation °� Construction Type j fir, 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 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: L1,existing `0 new8 size_ Attached garage: ❑ existing D new size _Shed: ❑ existing ❑ new size _ Other:' C3 Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes L No If yes, site plan review# Ln n Current Use Proposed Use R� APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name vV v Telephone Number Address �` License # �V VHome Improvement Contractor# Email Worker's Compensation # uvJ d ALL CONSTRUCTION DEBRIS RESULTING FRO THIS PROJECT WIL BETAKEN TO Wy Q, SIGNATURE f E f Z l6 FOR OFFICIAL USE ONLY `APPLICATION # DATE ISSUED j MAP/ PARCEL NO. t ADDRESS VILLAGE OWNER t DATE OF INSPECTION: t FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL rL FINAL BUILDING I i DATE CLOSED OUT I ASSOCIATION PLAN NO. t L . .-�---fir-'•" • ..�..,a � � �'. : .. Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS•100966 Construction Supervisor. ! HENRY E OAS•SIDY��\ ` 11, 0 SHED ROW WEST YARMOUY`H 2 Expiration: Commissioner '1111112017 CST� �p�2~11U0ea1V9_cy/(' Office of Consumer Affairs and Business Regulation 19 Park Plaza Suite\S 170 ° F Boston, Massachusetts 02116' Home Improvement C66rtxetor Registration Registration: 153567 t TYpe Private Corporation Expiration:'! p 12/15/2016 Tr# 259188 CAPE COD INSULATION, INCH HENRY CASSIDY 18 REARDON CIRCLE 30. YARMOUTH, MA 02664 %'UpdW.Address and return-card, Marlc reason for change. - (] sca +, 2oM•osru Address Q Renewal Employment U f,ost Catrtl ,���rr�� w " ...................".. •.... ................... • -orke of";onsumcrArrnirs& Dusincss Regulntion License or registration valid for Indlvidul use only } OME IMPROVEMENVQQNTRACTOR before the'exnlratlon date.'If found return to;' ogistration: '1`59b67 µ Type: office of Consumer Affairs and Business Regulation xpiration:; Private Corporation 10 Park Plaza•Suite 5170 r v .��., Boston,MA 02116 CAPE COO WSULATI FI,INC'.,•' HENRY CASSIDY 18 REAROON CIRCLE' 50.YARMOVTH,MA0204 Undcrsocretnry N valid WI lit sign e- '�' ,. The Commonivealtlt of1►4 s�chusetts DepartmRnI of inrlustrl'rcl Accidents I Congress Street, Suite 100 Boston, MA,02114.2017, l 11'�urkcrs' Compensation TnsurtinceA da�vlt; $illia O ' TO BE FILED WITH THE ADDIICRnt InformI PERMITTING AUTHOR yctrlclans/Plumbers, n Name(Business/Orgenization/individual)' l _ P asa rint Le 1bty Address. �� . • �y�r �2�D . _._._,_�_. C1ty/State/Zip __ G' • �/ Arc you an employer? cck the appropriate boxy Phoney #: ���.••-`� , I.(�}am a employer with empl . oyees(full and/orperl•time).+ ' 'Type of protect(required) 2.�1 am a$ole prop(lotor or pannorshrp and have no employees working forma in any capacity.(No workers'pomp. insurance required.) �' Q New construction J.�I am a homeowner Join all ► $•"(� Remodeling work ork myself. f. Y o wor (N keys comp.insurance required.)► � .9. Q Demolition a Q I sm a homeowner and will be hiring contractors to conduct all work on m ensure that all h no employees. nether have workers'compensation insurance or arorsole 10 Q Building addition P rtY 1 will proprietors with no employees. . l l.(T] Electrical repairs or additir:;r.•.. S.Q I am a general contractor and I have hired the subcontractors listed on Uie attached She These sub•conlractpra,have employees and have workers'comp.In I listed on 110 i e1, 12'�plumbing repairs or addi(w,,-,- 6 Q 13,We are a corporation and its oPfieors have ozonised theirright of exemption per MGL�, 1Q Roof repairs 15 ¢1(4),and we have no ompioyoos (No workers'comp,insurance required.) 4.�Dther � /,� ' 'Any applicant That chock box NI muss also fill ou!ehe section below showing their workers'compansatto 'Homeowners who submrflhis aftidavtt indicating they are doing all work end than hire outside co IConractors That check This box must attached noddditional sheet showing the name of the sub•co "policy information. ';�----•- - omployees. If the subcontractors have employees,they must provide Showing workers'comp. o.c noo of s muse submit a now affidavit indicating such. ntractors and state whether or not those entities have /ant tin employer t/aat is pro vlrlArB workers'compensation lnsnrance or Y number. information. � ✓ � errrpigyees, Below Is the poltY rrnrle o Insurance Company Name- / b site Policy Y or Self ins. r�ry/ Expiration Date:. 'Job 8ile,Address: (/ Attach a copy of the workers' con pansatlon olic P y declaration a Cih'/state/Zi (� w � Failure ri secure coverage as required under,MQL c, t52, 25A is a Page (showing the pollcybumber•and cxplratio d�tc,;, and/or one-year imprisonment, as tivall as civil penalties in the form of i STOP yyp § criminal violation punishable by a fine up to$1,SOG GU day rage against the violator. A copy d'f,tl;is statement may be forwarded to the Office o ORAE coverage verification. R and a fine of up to$250 Uu a Investigations of the DIA for insurance !rio hereby certy urrrler the palnsFanrl per.:altles ofperfrc Vaal l _ i natur . ��" ty le lttortntatlon Provlrlerl rrboue true anri correct. . . Ph n a d . . � f��'. . OfJlclal use only. Dogtrot write In this area, to be coinpleterl by city or tows a ._ fflcla L ,. ---•---, City or Tow 0n; � • � � Issuing Authority(circle one); Permlt/Llcease h, � I I. Board of Health 2,.Building Departmeaf 3. City/Towa 6. 01her Clerk q, Ele etrlcAl Inspector S, Plumblog Inspector Contact Aerson; . rI Phone M. ;! CAPECOD-27 CLEDDUKE ACORO" CERTIFICATE OF LIABILITY INSURANCE DATE(MMI°D/YYYY) 7/112016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE'COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE.DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. if SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the Certificate holder in lieu of such endorsement(s). PRODUCER CONTACT- NAME: Barbara DeLawrence Rogers&Gray Insurance Agency,Inc. r PHONE 434 Rte 134 AX c No.Ext• Alc No): South Dennis,MA 02660 E-MAIL RESS:bdelawrence@rogersgray.com INSURERS AFFORDING COVERAGE NAIC q INSURER A:Peerless Insurance Company INSURED- INSURER B:Safe Insurance Company 39454 Cape Cod Insulation,Inc. INSURER C:Endurance American Specialty Insurance Company 41718 18 Reardon Glrcte INSURERD:Atlantic Charter Insurance Corn pany44326 South ymor uth,,MA•62664 wsuliER E INSURER F: COVERAGES CERTIFICA :1=NUMBER: REVISION NUMBER:. THIS IS TO CERTIFY THAT THE POLIGIE$ OF INSURANCE-.LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NY INDICATED. NOTWITHSTANDING AREQUIREMENT,-TEf2TlA OR,CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY.'PEI2TAIN, THE,:INSUi2ANG. AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUC.H:FOLICIES.LIMITS'SHOWN•MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRADDL SUB LTR TYPE OF INSURANCE INS POLIGY.NU BER MMIDDIYYYY MVOL P MIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE D OCCUR CBP8263,063 04/01/2016 04l01/2017DAMAGE TO RENTEff• PREMISES Ea occurrence $ 100,000 i MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN%AGGREGATELI.ITAPP� PER: . GENERAL AGGREGATE $ 2,000,000 X POLICY a:� LOC ; PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: •'' .'. ••.. .• •.. $ AUTOMOBILE LIABILITY mCOMBINED SINGLE LIMIT $ 1,000,000 B ANY Aura 6232' 7 COM 01 0410112016 04'/.01/2017 BODILY INJURY(Per person) $ ALL OWNED" SCHEDULED AUTOS x AUTOS BODILY INJURY(Per aeGdenq $ NO.-OWNED . X HIRED AUTOS .. U?VOS PR PER MAGE $ eraccident) X UMBRELLA LIAR X OCCUR : BACH:000URRENCE $ 2,000,000 (; EXCESSUAB cLAIMSMADE EXC1.0006635001 04/01/2Q16 04l01/2Q17�` ncGRE g7E $ OED I X I RETENTIONS 1A1000 :-Aggregate $ 2,000,000 ,. WORKERS COMPENSATION AND EMPLOYERS'LIABILITY STAT N 11T ER D Y)' OFFICERIMEMSEREEXCLUDED?EOUTIVE ❑ NIA! CE00431902 06/30/2016 '0613012017 `'fi;y;EgCHACCIDENT:..; $ 1,000,000 it(Mandatory beund EMI'LOXE $ 1,000,000 lI es,describe under -. - yy ���� �. E.L.DISEASE-E' DESCRIPTION OF OPERATIONS below' E L.D 1,000,000 . ISEA.E-r L'ICY LIM IT.:';$= DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLE'§(ACORD 101,Additional Remarks Scheduto,.may be;attadhbd'i(°more space Is required) Workers Compensation Includes Officers or Proprietors. Additional Insured status is provided under the General Liability and Auto Liabllity4hen required by written contract or agf®Ament with the Certificate Holder. CERTIFICATE HOLDER _ CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE a -> I(g$. U THE EXPIRATION ,DATE THEREOF, NOTICE WILL BE DELIVERED IN �11,, nTerce Park SDutJ$�h ACCORDANCE WITH THE POLICY PROVISIONS. atham,MA 0265l�`+:, AUTHORIZED REPRESENTATIVE .. 4 ©1988.2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014/01) The ACORD name and logo are registered marks of ACORD t• , 4 • .. �- _::� t� -•' - qp s�7 ri•.�ti;` _ III tal.sr-- wt r''i' � nos•.h it• •.`.� ,� .. ' • r.per�' '' e t•ic5"►- IX } i TOWN OF BARNSTABLE BUILDING PERMIT A$PLICATION ee� I �. Map Parcel s d'� nipr,Y � ;E�';�.��,�(r� Application/Joc2�� Health Division _ Date Issued �2-l }� ; Si _ t Conservation Division Application Fee Planning Dept. Permit Fee 2� o Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 1 S Village C r^a%a V i d 2 Owner ®r Ne 4s o Address ( 5 3 L-Qv Q\A e0,A Telephone Permit Request o Pe-nnLo� y_,- clime ri , A_,0A !-7"iJe 0„ra-1! w ;it have- 3 AovbleVkvng ws'djpc,05 ;"4ttA� of 0 , r lk-e- we> ��l��ltiew c,��➢( ►'! I V\ove_ d®or I'QX (JIke Square feet: 1 st floor: existing l�dproposed 2nd floor: existing proposed Total new ;-6 6-7 Zoning District Flood Plain Groundwater Overlay Project Valuatio#sow Construction Type KP_yy,,ojkc1 Lot Size 3 AeR> Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure 19 3 . Historic House: ❑Yes ONo On Old King's Highway: ❑Yes 1'�No Basement Type: ❑ Full ❑ Crawl ;Walkout ❑ Other Basement Finished Area (sq.ft.) 0 Basement Unfinished Area (sq.ft) 6;1 Number of Baths: Full: existing new Half: existing f new Number of Bedrooms: j existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: 4 Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes g No Fireplaces: Existing A New Existing wood/coal stove: ❑Yes %I No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: 0 existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: ?pasem.e4 dale Car Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ANo If yes, site plan review# Current Use S i %kf �c 1��y res Je t-,e Proposed Use APPLICANT INFORMATION 11 a . (BUILDER OR HOMEOWNER) ctG�rM - — _ - -- - - � �1os`�e e� Name Telephone NumberJO`6 Address 7 76 Ma►ut S License # `a 655 Home Improvement Contractor# Email C�,A' o W� VVO '5t- -Q.or- L-\o wn e5.Le IVVorker's Compensation # W oo -51 60�2 3a-a 4,1A p � vc� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TOeJyto�rP vti v SIGNATURE DATE 3—� �— , FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER i DATE OF INSPECTION: FOUNDATION FRAME C�) e7 j g 15,E INSULATION 1 FIREPLACE -<< ELECTRICAL: ROUGH FINAL f, PLUMBING: ROUGH FINAL r GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. I 04/23/2015 13:30 617-726-3089 INR / NEP 'PAGE 01/01 Complete Home Group, LLC Estimate Hostetter Homes 770.B1 Main Street Osterville, MA 02655, Phone: 508-428-2828 Fax: 508-428-1974 Name/Address; Ship Orr 153 Long Beach Road Centerville,MA 02632 1/23/2015 108 Payment to be made as follows: A deposit of$10,000.00 with signed proposal is 0.00 requested. Payments.are due as work progresses and balance is due upon completion. ° Acceptance of.Proposal: The above prices,specifications and conditions are satisfactory and are hereby accepted. ed. You are authorized to do the work as specified. Payment will be made as outlined above. Date of Acceptance: CR� �/.C— Acceptance Signature: - Note: This proposal may be withdrawn by us if not accepted within 30 days. t Total, � - $51,574.05MINIBOOM _ Page 3 f _ The Co=wnwed th of Massachusett- aepmftentofl7Zl uYft atAcd&= Office ofinvestigations ' 600 Washington Street Boston,MA 02111 ivwW_mass govl&a Workers' Compensation Tnsurance Affidavit:BOders/Contra.ctors/Electricians/Plmnbers Applicant Information, Please Print Le "b Name(Bnsmmvorganizaiirm/rndivirinan, ? l�dl.u. Address: V " Zip: A� �' d 1� p a� Phone#: Sod ` 2 � 2-4�an employer?Check the appropriate boz Typeofproject(required): a employer with— 4. ❑I am a general contractor and employees(fall and/or part-time)- have hired the sub-contractors 6• ❑N construction 2•❑ I am a sole proprietor or partner- listed an the attached sheet 7_ Remodeling s and have no em to ees These�-m�ac� have �P P Y and have workers' 8' �Demolition - wori�g for me in any capacity, employees [No workers'comp,insurance comp-iusurance t 9. ❑Building addition ed] 5. We are a corporation and its 10_❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions Myself [No woi3cers'comp. right of exemption per MGL insurance require J t c: 152, §I(4),and we have no I2.0 Roof repairs employees.[No workers' I3.❑Ofiiez- comp-insurance required"] *Any applicantthat checks box 41 mast also a oaf the section below showing thou workcs'compensation policy information_ t Homeowners who submit this affidavit indicating they arc doing all work and thin hire outside contractors must sobna a new affidavit indicating such_ $Contractors that chock this box mast attached an additional sheet showing the nave of the soh-contractors and state whether or not those stirs have employers If the sub-oprtractors bavc employees,they raast provide their workers'comp.policy mrmber, I am an employer that is providing Workers'cornperrsadOn Lisurance for my employees, Below is the poUg anti job site information, Insurance Company Name: A/�C�Lt/ L Policy#or Self-ins.Lic.# _ e a 3 S "6 6-,D--93 e2- a.aLl Expiration Date Job Site Address: 153 6oZb3 Attach a copy of the workers' compensation po&cy declaration page(shoving the policy number and expiration date). Faffi re to secure coverage as required uades Section25A ofMGL c,152 can lead to the imposition of criminal penalties of a fine up to$1,50.0.00 and/or one-year imprisonment;as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to$250.00 a day against the violator_ Be advised that a copy of this statemeEt may be forwarded to the Office of Investigations of the DIA for insurance coverage verific a ion_ I do hereby certify the parnr and penaXes ofperjury that the information provided abovee is rice and correcf S Date: -C6 — Phone# 6 Ojfzcw use only. Do not Write in this area to be completed by city or town og"zcW City or Town: PermittlLicense# Issuing Authority(circle one): L Board of Health 2.BuildnngDepa.rtment 3,City/Town Clerk 4,Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Taformation and Instructions Massachusetts Gelieral Laws chapter 152 requires all employers to provide workers'compensation for their employees. Purmiant7to this statute,an employee is deed as"_:every person in the service of another under any contract ofhu[e, express or implied,oral or wriftem_" An employer is defined as"an individual,padnership,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 - dwelIing 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 Iocal 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 applicantwho 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 ofpublic work until acceptable evidence of compliance with the in c»r a6- requirements of this chapter have been presented to the contracting authority." : Applicants Please fill out the workers'compensation affidavit completely,by checking he boxes that apply to your situation and,if necessary,supply sob-contractors)name(s), address(es)and phone number(s) along with their certifrcate(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 affidayitmaybe submitted to the Deparfinent of Industrial Accidents for confirmation of is�c-e 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 Iaw 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 t . 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 permitllicense number which will be used as a reference number. In addition, an applicant that must submit multiple permitlIi.cense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"to applicant sho��Id 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 etn.)said person is NOT required to complete this affidavit The Office of Investigations would ae to than 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: -T'he CQII' Qnwealth of MassachusffM Department cif Industrial Accidents office of kvestigatio-m GGOashirtQn Stet BaAoii,MA 02111 Td,9 617 727-49W e�xt 4.06 or I-977-MASSAFE Fay#617-727-7749 Revised 424 07 w .mass_ga Wdia i Massachusetts - Department or Public Safety Board or Building Begulations and Standards ('nn�lru�•linn tiuper•�Lnr . License: CS-094302 ADAM HOSTETT,'R <-S 770 SUITE A MAIN OSTERVILLE MA 02� Expiration Corn►nrssioner ' 121�2/2015 i Office ofConsinncrAffairs&Business Regulation License or registration valid for individul use only aFiOME IMPROVEMENT CONTRACTOR Uefore the expiration date. If found return to: 'egistratlon: 178455 Type: Office of Consumer Afrairs and.Business Re6ulatioa ,//ExpiratioLLC 10 -Suite 5170r1nza „y Boston,MA 0211 COMPLETE HOME,GROUP LLC:. Ii ARAM HOSTETTER 770 ALMAIN ST IOSTERVILLE,MA 02655 `� — ---•---�______.:� .•._—._._ i Underseci ctary Not valid without sigoaturc T 4 LMG 4/842015 8:41:33 AM PAGE 3/008 Fax Server I IAcv V CERTIFICATE OF LIABILITY INSURANCE F °'"�`" i 4/312015 THIS CERTIFICATE IS ISSUED AS A MATTERI,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(Tes)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 MARK SYLVIA INSURANCE AGENCY 404 MAIN STREET 's. No CENTERVILLE,MA 02632 f ' j Aq:0FVMCOVER4GE rwc� ustFta: Liberty Mutual Rre Insurance 23035 COMPLETE HOME GROUP LLCM: 770 B1 MAIN STREET OSTERVILLE MA 02655 oRERn: i fE: COVERAGES CERTIFICATE NUMBER: 24136425 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSLRED NAMED ABOVE FOR THE PCUCY PERIOD INDICATED. ND'TMIITHSTANDING ANY FECUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIIA THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND OONDMOI L OF SUCH POLICIES.LIMITS SHOWN NAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPEOFQVSURFIPR:E butm POUCYN NBM UNITS 0OMMERMALGENERRI.UABILrY WHOCCl1RRENCE $ CLAQuS�uIADE OCCUR Eaamrren $ I M®EXP me $ PEF19C�11U.&ADVINAIl9Y $ C3ENLAGWMk"TELWAPPI.IESPER: 1 CeaiALAt3GRBy4TE $ ❑M ❑ PR00lM-CCNP/OPMn $ ` ODM $ 1 AVrOMLEUMUTY $ ANYAM BCOLYINIURY(PaW=) $ ® 8MLY1N1URY(P6racddert) $ NONCYOM FIREDALITOS I aeo $ { $ ' ems' °UAB OOCIA EACH OCCLFfE CE $ E1�UA8 CLAIMSMADE AC3GF1g,ATE $ OED RETBNnms $ AWORMiSCMVENUMM WC2-31S$02632-M 3f"W15 3/23/L016 ANYPRDPF3,FmEVPAfiT OE'DO?EGIli1VE Y/N ELEACHAOCIDENr $ 100000 o�1�wnI�ERExa�IDmt Y N/A Y"M 4 EL Dffik E-EP,&P $ 1DD0000 MFnCN0F0PER4110Sbd= ELDL1EkE-POLICYUMrr $ 100000 i i DESCRM0NOFOPFRATM/LOOiM&S/VEHCLEE(AD=101,AddEtlmdFkmm S&Ad^May beaI ITnn apmeIsregiired) Workers compensation insurance coverage applies only to the workers compensation laws of the state of MA. This certificate cancels and supersedes all previously issued certificates,only as they relate to workers compensation coverage. i i i I CERTIFICATE HOLDER I CANCELLATION TOWN OF BAR N S TAB LE SHOULD ANY OFTHE ABOVE DESCRIBED POLIES BE CANCELLED BEFORE THE EMRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BUILDING DEPARTMENT 200 MAIN STREET ACCpppApOVCYPRO HYANNIS MA 02601 w AnmHORZ® ,AmE Liberty Mutual Fire Insurance 019811-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD CEFX NO.: 24136425 CLEWr OME: 059552 Anne handler 4/3/2015 3:13:56 1M (EUr) Page 1 of 1 4 i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map v Parcel ;ppDlia2i16n # Health Division Date Issued f`��<�`� Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address 1�3 Z0^46- AeAy 7VAD Village �✓ �vtz�.� Owner Akl� -Ow &1-2_ Address ( Q4tC AU Telephone Permit Request &g0-ru EXr5T1r, IG- Wce- , K vT Alif C- .-tT St1Q-,erC-1- F9,0N1 2-2 � To 0 t tEGIG W Zip- R�1'LT" b�✓ SArt © i /LW 1j S7 'S 1 z� �a c�77{ SSA E or- Square feet: 1 st floor: existingi000 proposed 2nd floor: existing /©oo proposed � Total new O Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type oon A-ZE( Lot Size / Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. DwellingType: Single Family CY Two Family ❑ Multi-Family # units Yp 9 Y Y Y ( ) � o Age of Existing Structure IT Sd 5 y Historic House: ❑Yes ❑ No On Old King�!�Highway:�;Ql Ye S'- 0 ..;9 Basement Type: O'Full ❑ Crawl ❑ Walkout ❑ Other ,A Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ftj t°°°� Number of Baths: Full: existing new d Half: existing nevi 4' Number of Bedrooms: S existing O new Total Room Count (not including baths): existing _new First Floor Room Count Heat Type and Fuel: JrG' as ❑ Oil ❑ Electric ❑ Other Central Air ❑Yes 2 o Fireplaces: Existing New Existing wood/coal stove: ❑Yes U'No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: N_)-VE- t11VbEt2 Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ i Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER-OR-HOMEOWNER)-- � i Name S`T �� Bl�l rl 4�A�1 gFWSTelep hone Number S Address 17-b Mom/ !I O �,R iW4 License #('7S` Home Improvement Contractor# �J oZ/a4 Worker's Compensation # 0 8`7g 1 edo:�A ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# z DATE ISSUED C MAP/PARCEL NO. t ADDRESS VILLAGE OWNER f DATE OF INSPECTION: FRAME A i NSULATION-a 4' FIREPLACE ELECTRICAL: ROUGH FINAL . PLUMBING: ROUGH FINAL i GAS: ROUGH FINAL r FINAL BUILDING- ✓ , J `f` DATE CLOSED OUT ASSOCIATION PLAN NO. b • - i' The Commonweakh of Mazssra?chusetts x Delrarftent of Industrial'A€ciders 6 Orke of Investigations 600 Washington.Sbwet Boston,MA 02111 . rwvtiv rraamgovIdia Workers' Compensation Insurance Affidavit:-Buidersl'ContrachmvEkvteician&4%mbers Applicant Information - Please Print Lexib Name Aye lz 7tpp i VV�F 14PAm -rc�� Address 2e -1�4- S' cZRf i UUUCI - 026s ` Citylstate zip:- Phone##_ So Lfa`as' 4s Are you an employer?Check the appropriate boz; Type of project(required): 1 IJ 1 am a employer with �. 4. ❑ I am a Viral contractor and I . :employees(foil and/or part-t>me)- s have hired the snob-c�txactors b ❑New oemstructiomm 2.❑ I am a sole proprietor.or partner listed on the attached sheet. 7- ❑Remodeling ship and have no employees These sob-contractors hate 9. ❑Demolition woddng fir me in c employees and have viols' any 9- El Budding addition [No warleers'coffip.insurance' - cam-�►u`ate�-I mod] 5.❑-We are a corporation and its 10.❑Electrical repairs or additions ❑ I am a homeowner doing all work officers have exercised their I LE J Plumbing repairs or additions myself[No wcrke[s'c5omp- right of exemption per MGL. 12.❑ of repairs insurance required,]1 c.152,§1(4} and we have no employees-[No wmims' - 13. a COther f �"��Gt comp-insurance required:] *Any applitm that checks box N mmu also fill out the section below showing them wotketa'cormpensedou policy infortut®alL ?Romeowmers who submit this affidavit mdwAtmg they are doing all wank and dum hue outride couttactms irm submit a now affidavit indicating such_ komttecbm that check this bur nmst attached em additional sheet showing the name of die sub-cantiactm and state whether or not dwse eatities Dave emphtyees. If the sub-contrmms base employes,they must paavide their wmkers'Camp.policy utmber., lam an employer that is prpvittatig workgn'con scrim iusurance for tray a ng doyam Below is thepacy andyob site information. LAC,, Insurance Company Name: _ S y/ d- S k cw Policy#k or self-ices.Lic.9: Expiration Date: Job Site Address: �; 1��z City/StateJZip:C�i�/TLt/L:l L Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure bo secure coverage as required undue.Section 25A of MGL c 152 can lead to the imposition of criminal pennies 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 CORDER 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. Ida hereby certa under thepains and penalties ofpedury that the hiformartion ptrowFdad brute is bsre and correct S e_ , Phone 0_ Sea �a Official um only. Do not write is this area,to be completaad by city or totem ofrciat City or Town: Permit/License# s Issuing Authority(circle one): I.Board of Health 2.Ru lding Department 3.Cityfrown Clerk 4.Electrical napector S.Plumbing laspeetor 6.Other Contact Person: Phone 9: ACC 0 CERTIFICATE DATE(MMIDDNYYY) 16-- • OF LIABILITY INSURANCE 12/03/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,iEXTEND 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 Mark Sylvia Insurance Agency,LLC NAME: Sarah 404 Main Street PHONE 508 957-2125 FAX,No 508 957-2781 E-MAIL ADDRESS:mark marks IViainsurance.com Centerville, MA 02632 INSURERS AFFORDING COVERAGE NAIL# INSURER A:.Montpelier US Iris Co FINSURED INSURER B:Travelers Insurance CO. ay Management Trust ain Street INSURER Cle,MA 02655 INSURER o INSURER E INSURER F COVERAGES CERTIFICATE NUMBER:" REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES.OFINSURANCE 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 AODL SUER LTR TYPE OF INSURANCE POLICY EFF POLICY EXP POLICY NUMBER MMIDD/YYYYI I IMMIDDIYYYYI LIMITS A GENERAL LIABILITY MP0006001012633 12/4/2013, 12/4/2014 EACH occuRRENce $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 CLAIMS MADE ❑X OCCUR MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY $._ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X1 POLICY JFCTPRO- RO El LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE^ $ DED RETENTION$ $ B WORKERS COMPENSATION UB-7B15805A 3/23/2013 3/23/2014 WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN. X , ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED a ER N/A E.L.'EACH ACCIDENT $ 500,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 500000 If yes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule;ifrhore'space Is required) , Residential Carpentry CERTIFICATE HOLDER CANCELLATION (508)790-6230 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable THEW EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ,.ACCORDANCE WITH THE POLICY PROVISIONS. ` Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Massachusetts - Department of Public Safety Board of Building Regulations and Standards C'nn�trurtirin Sulrcr-�ialr- - License: CS-094302 ADAM HOSTETTR 770 SUITE A MAIN OSTERVILLE MA 029 ^ J.•G..- � � 'i n, Expiration Commissioner 12/22/2015 i r I e ]�\ Offict of Consumer Affair& Busloess Regulation Liceasc or registration valid for,indivlilul use only �iOME IMPROVEMENT CONTRACTOR befort the expiration date. If found return to: . �j}!egistratlon: 152124 Type: Office of Consumer Affairs and Business Regulation l�xplratlon: 8/2/2014. DBA 10 Park Plaza-Suitt 5170 �;f Boston,MA 02116 x a' WEST BAY MANAGEMENT TRUST . ADAM HOSTETTER 770 A MAIN ST. -- OSTERVILLE,MA 02655 >. Undersecretary Not valid without signalurr y + IARNSUBLE • Town of.Barnstable Regulatory Services Richard V.Scali,Interim Director . . Building Division Thomas Perry,CB0 Building Commissioner 200 Main Street, .Hyannis,AM 62601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If UsirigA Builder I as Owner of the pro sub l P p e tty 1.7 hereby authorize `,6� X5T'FTrEf—to act on my behalf,. in all matters.relative to work authorized by this building,permit application for )S3 loe* OL'�IGt (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. T:\KEVIN D\Building.Chanps\EXPRESS PERMMEXPRE AOC Revised 061313 �-T Tl�j � -------------- :_-. 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Y � .•''-Y _ � p i r r �ry T T� r —tr r a � - i 2. "r 1 T Yr ♦ . f- r . I !L { !1- T -n r r t Y f..t T T f r ♦ r ,2� t T , + ♦ ry t I r • r f Y T r 4 s ' T •' t. r -. }—..T _ t -� --t— T--7'--, �"1'~��,-- r - �. _-� — r- - - j----r �- �~ - �._—r--'7 -- r---t----; -t T.-._ t. _ 7. .. r •�'�'� � T - r—-t ��, r t • ,. Y T {r r -7 r r -'t T r r - T , r e •_c_r - , - ♦ r , 1 , - , , , - Y ;r , ` t t a - � �_ r< �� o ayT' .-a , r , , y, � • r � t � ( f- - *'• - r T - _ • i Town of Barnstable *Permit J Fapires 6 mont. a to Regulatory Services Fee + 1ARNSTASLE, MAM 9 059. Thomas F.Geiler,Director rz- ��fDMAra 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 �j Not Valid without Red X-Press Imprint Map/parcel Number ` p,G� �Q Property Address G 0 PJ 6Ct.Ge, ❑Residential Value of Work l�f 000 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address _ 5 kip OA-79-• Contractor's Name &A`'1, Telephone Number 9 Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor AUG 21 2012 ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance company Name TOWN OF BARNSTABLE Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) XRe-roof(hurricane nailed)(stripping old shingles).All construction debris will be taken to j S� ❑Re-roof(hurricane nailed)(not stripping. Going over" existing layers of roof) ❑ Re-side #of doors El Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner niu Property Owner Letter of Permission. A copy of the me Im rovement Contractors License&Construction Supervisors License is required. SIGNATURE: C:\Users\decollik\AppData\Local\Microso Windows\Temporary Intemet Files\Content.outlook\DDV87AAZ\EXPRESS.doC Revised 072110 the Commonwealth of Massachusetts Deparhnent of Indusftial Accidents , Office of Investigations 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Appficant Information Please Print Legibly Name(Businesslorganization/Individual): , i � Address: City/stat Zip: �' Jc,t Phone# Are you an employer?Check the appropriate oz: Type of project(repaired): 1.[ I am a employer with f' 4. ❑ I am a general contractor and I employees(full and/or part�ime). 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 8_ ❑Demolition working for me in any capacity_ employees and have wodcers' [No workers'comp.insurance comp.insurance./ 9. ❑Building addition ❑ We are a corporation repa required] 5: oration and its 10.❑Electrical rs or additions t 3.❑ I am a homeowner doing all work officers have exercised their I L❑Plumbing repairs or additions myself. [No workers'camp. right of exemption per MGL 12.[ Roof repairs insurance required]T c. 152, §1(4),and we have no employees.[No workers' 13.0 Other comp.insurance required] •Auy applic>ffr that checks boa#1»met also fill out the section below showing duo wocken'compensation policy information. T Homeowners who submit this af5datzt indicating they are doing all woA and then hire oatade caotrictors tmtst submit a new affidavit indicating such_ :Cootractors thst check this box must attached an addiriaoal sheet showing the name of the sub-coxctractm aad state wbetbu or not those entities base empkayees. If the sub-contractors have employees,they must provide their workers'comp.policy number_ I am an employer that is providing workers'compensalion insurance for my employees. Below is the policy and job site information Insurance Company Name: �� Policy#Or Self ins.Lc.#: (r ,L) Expiration Date: In Job Site Address: l �� J. n Z�1-1-- City/State/Zip:riefr., " ,JILAZ /1q.- Attach a copy of the workers'compensation policy declaration page(shoring the policy number and expiration date). Failure to secure coverage as required under Section 25A of bfGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year impiisoument as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the-violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification- 1 do hereby certify u the pains and penalties ofpetjury that the information provided above is true and correct Si �, -•.~ Date: Phone'W: O,Oicial use only. Do not write in this area,to be completed by city or town official. City or Town: PermidUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 6 w V. �, OIDUM Yv1 CERTIFICATE OF-LIABILITY Y ItdS�lR�I��E' , " . . 0412512 T}{#S ICATf ES Ut AS lt'@tATTEi?.'Df INFORMAMN.ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS I ETf CATS 130ES *<OZ AF'tAih�ATIktELY Ott NEGATIVELY Atiftl;NO, EXTEND OR ALTER THE`COVERAGE AFFORDED BY THE POLICIES OW 7'!BE #S'C TE.Of UpAt -DOj:t NOT C{I€wr.WTE'A CONTftACT BETVkIEEfii THE ISSUING 11!ISURER(S), AUTHORIZED. RTtVE Amu THE cERTtricATE HOWER r; Ii the l�k4er ks aR ADEItTi INAL MSUREA the{ IG3+Cses}must gR d. If SUBROGATION IS WAIVED.subJmt to tiYE;�l�[f49'BYi £s1;{fit8 tfOl ',J,vvft8'n peft� r!aqulm'if,efldOfSQfllfant::A Et2tgRlERt ontlijB CeftIRCAte d06S Rflt cflttfer T9g19tS20 th8 . ply. Eft . ..�a. iiF S. 2I =LLc • J.., F� ra�K#Eo, �5 78-0440.. �FM t ��d_Z4-$��7 �i3t'4u�.'"3�—� r , {N. F. f•1'�4� marX�Qin8tk5Yi+rieinsuran._ ee.con''— - , IL+t44l2, r �` [NSUF R 9 FFOR"P txlitEAAifE NAIC S.' s % H _ INSURER A:MoRIIIBftet US W Ca . ftraul R B�Travelers:tnsuraere Ca 'M I -- V pay�m T-m r msurtef+c ash _ v - r artsua�c: a INSURER E: - - tOtl E= GE ci3T1FtCA fE tR= REVISION NUMBER: THIS E TIIY:T?fAT-ME OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TD THE INSURED NANIED ABOVE FOR THE POLICY PERIOD , tNf.It TSIT:?RTIFY 7`RNUt AStY REQU TEPA OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VNTH RESPECT TO WHICH TMIS GILD t AlE Y 155t3Et3 Oti MAY P RTA+I THE INSURANCE AFFORDED BY THE:POLICIES DESCRIBED HERfIN IS SU64CCT TO All THE TERMS r'3CC'Lt3�AI�iD CMoTem.S 32ICI-t epa.lClES..umn Sl 4�JVfI MAY HAVE 9EETI REDUCED BY PAID CLAIhdS. .: L ;TYP;=OF� 90f.iCTtrtIStEEA N UAIf1 ' I�may, r �tD4&$4$ F 92f4rzDt1 ,2I.t (312 �cHOCcttRREntcF 9 9 064440 " r- Coco exP IAny ono ponon�. -s 50,044 xy } 1004,404 ©ENERRLAGGREGATE ,S D44 Q{1Q GaM A tRE A-MLw- AP -PER I+1FtOP ACC�G b pi;00U6T5•GO Loo (;p �3RHGLE.LIM6T BODILYINJURY(per persm) 6 t "f AUTO BODILY'IIdJURY IPm aasd*t*:S AikbMWED •,„. r. .. r �i PROPERTY OAMA E S •. e , i3CBI�i t . EACM OCCURRENCE 5 AOO}R ATE I a 1116 ZR15845A , 3f23=12 3t23M Z . X fin+ r >e fa YIN E L EACH acCroENT s BD4,4aD Ah7- �T: flfA E.E..019EAS—EABMPLOYE S 54O.00t} ( fn K,r - ; e SERSE•POLICY UMR 8 �,, E,L:OI .D04 s 4 , ^ , r - :. i fiI�CIES{&KariltaAO'F.AQtlt�rsariT�st}lYs.3ehrdtrta,f[i®DPeaPa�vhrequ3rsAl »' �fl "�E33fz4SfdN2 _ c 3cr r � c +. CANCELLATION ' A _SHOULu A1VIr of T H9 ABOVE MCRMEO t+al iclEs s6 GANcrr1aE10 BEFORE r THE EXPIRATION DATE THEREOF, 'NOTICE WILL 13E 0$CNERED IpI r+.4fiO,ItEr Rt?}' ?dfxe ` * = PiGCORRANCE WITH THE POLICY PROVISIOH3'. 3� e Os Im , 6 r r ALINWE¢FDRt3'+Pf TATtVE_ ,a i �- '+ �} . o w 1988.2fl18 ACORQ CORPORATION All 69110"srfrved ..- Af tD 25(M'II I The ACORDatrama and,logo ace flt9lstared m .af ACSRO �=. Massachu rct -T3ett<rtat�int.itf Puh{ie ?ait^t� lie Board?ii Stt'sli ins=Rc: I�x�sm and tits"0314 Got bjwtjan Sugeiwtso� License License_ CS 9-4-Y-2 a Af)AM NOST.E T TEF2 d . 770 SUITE A MAIN ST OS Et�Vlt t MA,02666. Expiratiaa: . 12-42f'3 7378 Y a FCC • Af • - `' ' 1 .. t`r a • -1 f - f { • - - •t •�. ` .•-' '� .. � , • { ' - • x IFS , - • y , t - * rao �rrraoruoecrt .o�C�/lao�nc/cc�e/la License or registration valid for individul use only. b Of®ce of Consumer Affairs&Business Regulation before the expiration date. If found return to: -- ME IMPROVEMENT CONTRACTOR Office of'Consumer Affairs and Business Regulation T e. • _ YP n: e istratio 52,24 1 • _ , � g Park Plaza-Suite 5170 •e 10 xpiration: 8/2/2014 DBA Boston,MA 02116 :Y ANAGEMENT TRUST WEST BAY M ;W S 7. ADAM HOSTETTER 770 A MAIN ST. OSTERVILLE,MA 02655 Undersecretary- Not valid without signature ' F�♦: Or - �IKE� Town of Barnstable s Regulatory Services I'E Thomas F.Geiler,Director 163 Building Division Tom Perry,Building Commissioner';.. 200 Main Street,Hyannis,MA 02601 :wwwaown.barnstable.ma.us Office: 508-862-403 8 Fax 508-790-623 0 Property Owner Must Complete and Sign This Section If Using A Builder I, , as Owner of the subject property hereby authorize 10 +� to act on my.behalf in all matters relative to work authorized by this building permit: (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. cz, U ignature of Owner. Signature of Applicant l+r'ek� Print Name Print Name Date Q:FORMSDVINERPERMISSIONPOOLS 6/2012 _ DIME Town, of Barnstable Regulatory Services snxivsrABM « Thomas F.Geiler,Director nsnss. p 1639. Building Division TED MA't A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.t.own.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street. village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include_owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to-do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certifi cad on for use in your community. Q:forms:homeexempt II - - - Barnstable *Permit CFTHE Tp�, Town Of 1 " e ]'expires 6 onthsfrom issue date Fee �e 1' v� Regulato -Y Services gARNSTABLE, Thomas F.Geiler,Director aL+ss. 9cb t 1639� Building Division pEDM pa TomPerry, Building Commissioner C, 200 Maio Street, Hyannis,MA 02601 - Office: 508-862-4038 Fax: 508-790-6230 SS PERMIT APPLICATION - RESIDENTIAL ONLY EXpRE Not.Valid without RedX Press,Impnnt Map/parcel Number Property Address S� �A)6 w0^ 0 J '/2 — value of Work i Residential 0wnerIs Name&Address Telephone Number f Contractor's Name ' if a licable) � 5°z l a` . Home Improvement Contractor License#( applicable)— ][3f a licable) C J ` Construction Supervisors License#(i PP �Workn=,s Compensation Insurance Check one: AUG- 2011 I am a sole proprietor am the Homeowner ' TOWN OF BARNSTAKE have Worker's Compensation Insurance Insurance Company Name -Policy# � U2� ��� workrn n s Comp. Y . � check box) ! Permit Request( - [] d shingles). All construction debris will be taken Re-roof(stripping ol to Re-roof(not stripping- Going ova existing layers of roof) Eyke-side [] ws. U-Value Replacement Windo (maximum.44) [Other(specify) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. Signature Q:Forms:expmtrg Revised121901 oFZHer Town of Barnstable ti Regulatory Services ,, , unnRNsuule 'rllonlas F. Geller,Director` 9 MASS. tbs9• a Building Division �PlED MPy Tom Perry,Building Commissioner 200 Nlain Street, Hyannis, MA 02601 jyNyly.town.barnstablc:ma.us Fax: 508-790-6230 Office: 508-862-4038 Pro perty p e I owner-Must Complete and Sign This Section If Using ABuilder- as Owner of the subject property ------------- -! to act on my behalf, hereby authorize in al l matters relative to work authorized by this building permit application for: (Address of Job) to Signature of Owner O,ZI : Pruit Narne a 1 in`a forpennitplease complete the If Property owner is pp y n Home owners License Exemption Fol-in on the reverse side. I Q:FO RM S:OwN, ERPERMisSION I The Commonwealth of Massachusetts sa Department of Industrial Accidents Office of Investigations U9 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): y�l�Sl C7 `� (lf ���J� �i'_C�S Address: City/State/Zip: 0,-) SS Phone #: Are an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 4. ❑ I am a general contractor and I employees(full and/or p -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 8. ❑ Demolition working..for me in any capacity. employees and have workers' 9. Buildingaddition [No workers' comp. insurance comp. insurance.$ ❑ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 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 employees. [No workers' 13. 0ther "(4 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 is providing workers'compensation insurance for my employees. Below is the policy and job site information. t Insurance Company Name: SGU �. Policy#or Self-ins.Lic.#:_ 0 Expiration Date: Job Site Address:_ ZaA. 55?960 i�p City/State/Zip: r6Jf671J,l LL;'E A pa-bS3 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains a d pen s of perjury that the information provided ab ve is true and correct. Si ature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: . Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ��M.�,-y� TT 03/23/2011 THIS CERTWICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RKWS UPON THE CERTIFICATE HOLDER, CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLIO II BEI-O`W.. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHOR REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER ' IMPORTANT: If th•c•+tIIoate holder Is an ADDITIONAL INSURED,the Poky(les)must be endorsed. If SUBROGATION IS WAIVED,aut�ect the tames and condtCorla of th•pollg,Certaln POkiss My mq�an w1doreerna* A st/tsm•Trt On thls certlflute does not confer r%hts to coMAcot•holder In lieu of•Uth endorsem• tl PRODUCER I Mark Sylvia Ins,ur/nce Agwcy 771 Main Street rrroNc 508 8-ow (5D61420-9227 Ostervils,MA 026b5 +�1eLaCER - OWRnrMerk W.SYtvla MfURED 11DURf71`f�COYER/1GEAPOLICY West BAY Management Trust tNSURM A: IMo sb tl$bM CO 770A Main Street rNSUnEA e: �o Inwrance Co Osty-''Ve,MA M55 r seauigR c _ URilt O Ilk"VA E: V F; COVERAGES CERTIFICATE NUMBER: REVISM NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NALMED ABOVE FOR TINDICATED. NOTI/NTHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHEA DOCUMENT WT}r RESPE 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 NO UMIT3 SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. lTR TYPE OF MsuwlCE ►OL C7 NUM/� a" • LJMITH A ° tIAa+Lm MP0008p0IOO5153 12/a2010 1214/Zp11 iACHOCCURRENCE I 1,D00, X CCMMFRCIAL OENEAAL UASrLrTY - 00 DCwuSAVJX X❑OccUR R,A •. I too, WED EXP an ps 1 I 5,00 PERSONAL fa AM INJURY- f 1 000 GENERAL AG tECATE a 2,000.00 NL ACGRi(LATE LMITAPOVES PER. X PO I "0 LO PROO TS•COUP!OF ACG S 2,000, f" - AUTOMM"UAQIUTI' - COMBINED SINCLb LIMIT ANY AUTO (Era foe*") I ALL OKr1ED AUTOS a00ILY INJURY(P.r o•no'+) SCNIOLIUED AUTOS . /OOILY NtJURY(►w xcld") I HWAO ALTOS PROF"E RTY OALIA A S (Pynaekstr� NDWOwrt:O AUTOS - . I' UM/R/uA ILIA _ f OCcurt excessLas iACH OCCURRENCE f CLArMSiUDE I 06OVCTIeIJs A Rf"Tf. . _ 1 3 B IMOItlfiRaCOtlF'6N•ATION 3021209 - I AJaOE>1rFlo•�lrLJAaILRY 3/2 1 3Q3Q01Z %Ci A DTI+ ANY PROPMETOPLPARTN6'"XICUn V@ rN RYJ.IMLIB. X OSFICiRAreWGREACCUl0i07 NI rumda A E.L HA t0 M� f SOO.000 w y in _ .OLSEASE•EA E7aPLG�E I o adw E.L "°a �°a MT1pM8 Nero. 5000 coo EL aeEASE•Palo uwlT s 500,000 OESCRIrn'D"Of O►ENAno"1 LOCA nON!/V"K&M(A WA ACORD IOTA Aral Rofflu"P:Aeft%.Nnwre%NCeA rsgdnel LondwApe gardening. Paint'n9,CArpamr, CERTIFICATE HOLD ER _ (SOEµ2D.1974 CANCELLATION 770A Main Realy Co Inc SHOULD ANY Of T�DA OVE DUCRINO POUC3E!Bts CANCELLED aCFOAE 770A Main Sheet THe UPIRATIONF T'rERFOF, NOTICE WLL EIE DELIVFAE'J Nr Osterv+ae.MA 02t355 ACCORDANCE YMT POLICY Pf10VISKJN9. . AUT).OMMO RBRESORAr" ACORD 25(200#Mg rks of 0C R1) D CORPORATION. All rights reserved. The ACORD name and logo ary regbpKod rrrarks of ACORD Uilrartnrrnt ul I'll Ill ii �,.itit% ® tiu:rrrl ul l3uilrlin_ Ri ulati"n. :tn tnil.iI I I N Con _or Lac -.sc License: CS 94302 .1 Restricted to: 00 ADAM HOSTETTER =1,7 . 770 SUITE A MAIN ST f-\ OSTERVILLE, MA 02655 Eilru,r!wm. 12:2212011 ( nnuj..h n r-- Tr-, 13857 - £t a, ,� �. r .{ .ti� s �""�. T � t,"^3 r, •s • s�4t _ • e r'f=. i ~ 1p 64 tr hr Ol .,✓/fig -•� r� ;-; � .."Y`�"�r•,s+➢„^'�. '. "^ rceaConsumerAffairs ,...ate •T`v`—,.�..•^•.,.. :' .. &Business Regulation 1 HOME IMPRO�fEMEN Licepse or registration valid for mdwidul use r ReglstraUon =� ONTRACTOR _ `% before the ez ' t �� Explratton $l26221,4 ` ` �TYpe t` �r �Office of ✓r'p►ation date =If found return to ' ' 12% r Consumer K E ' 1 DBA u cry . Affairs and B J ' Iu Park PI r asiness Regulation i;' ,WEB BAY MAN R r "i" ' 4 fir 4 i., z Suite 5170 k x r1 z Boston,% MA 02116 > rC 1/ ..•-a t xa!` L frog �'s �—� _i t 'ADAM HOSTETTE �y s a } ,, 770 A MAIN 5T " r r �cry `'���,�. ,•, . �Yr z � x� -� .� /. r � ,, . ,, f >: � �x4 j_; F Wv� �10aerSeCfeta u�1 ,q" �'" . �p.xr ; " �',S,a' 'NOt valld wthout, signatures i �e auk men SyU s t a �t} s - � iv. %''t c :: � �, t +..'*•",y"*�-:n ,.,,,s.�' 7.{7',7w`+ 1 qA to µx i,�c' �y ' •�, - J " i` �`..✓ 1. "...i.�,., a t N • x • 1 // �.. -�Assessor's map and lot number r a:a..........rr�� .. (�, ` �� `� Sewage Permit number rr ...r t'cf►{�!� Ci v s *THE r TOWN OF BARNSTABLE Z 89H.H9TSItLE, i "b 9 BUILDING 'INSPECTOR APPLICATION FOR PERMIT TO .... ......................>>. . . , . ....................................................................................... LAY TYPE OF CONSTRUCTION ......yy�'�-�*,. ......... ............................................................................. !�. ..... ........19.Z.;— E TO THE INSPECTOR OF BUILDINGS: (/ The undersigned hereby applies for a permit according to the following information: Location .. ,1.,?+ �.....1 � � na ....... / , . ��. ................................................................... ProposedUse (l... _ ,f:,,......... -!/ ;,� ............................................................. ................................... ....... Zoning District ......... ..... . +`� , ..'!..�..........................................Fire District .��a.,��,,;,,,��v........... �Q;'►.!...a Name of Owner A (z/. ..... 1�:...................Address iI+��r �. ... ���/�.. ..ti� ... Name of Builder .�. . Address ........._ ........ `/ t, Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ..................................................................Foundation .............................................................................. Exterior .........................Roofing ......, �'a"! ............................................................. Floors ......................................................................................Interior .................................................................................... Heating ..................................................................................Plumbing ................................................................................. Fireplace ............................. ....................................................Approximate Cost ...Z � — Definitive Plan Approved by Planning Board __ ___________________19________. Area Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF_HEALTH—.....-.--__— . i GIF 3 - I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. . f.................r................- 9�. `......?................ Name Orr, Dr. Robert A=205.29F ' Cente ll � Dr Rmmerc fr ,, - -� -_ction ---- � � � . Permit" Granted uo/e of Inspection � Date � - Completed , . . - PERMIT- R-EFU/SED lq - � � --------- ................................................. ------' -~--' � x^ ---- � ' .. . � -'--- F ---~' ' `.^ . Approved _--------------.. lV . ^ ---------------'----------- � .............................. ................................................ � ' | | � ^