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0234 LONG BEACH ROAD
u , 4. , _ w , d F;, ri 4 a n _ ♦z r_ 1, t o s f �s w Application number... ............. Date Issued.........YJ....................I...............n............. K-PRENN , MAti$A, s6 � Building Inspectors Initials..... ............ . ...... AUG Q 8 208 Map/Parcel........... � 00 I bARNS MU. TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: :)3 !Z � �� C_�4�P.�-`i vie NUMBER STREET VILLAGE Owner's Name: /i/4S Oh Phone Number Email Address: Cell Phone Number b 21eelo Project cost $ b Check one Residential) Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize D c, ��w P_ r— to make application for a building pe t 'fi accordance with 780 CMR Owner Signature: Date: TYPE OF WORK ®, Siding ❑ Windows (no he change)# ❑ Insulation/Weatherization ❑ Doors (no header change) # Commercial Doors require an inspector's review 113"Roof(not applying more than 1 layer of shingles)Construction Debris will be going to s rQ f`le CONTRACTOR'S INFORMATION Contractor's name co ti l o l�ru �r� Home Improvement Contractors Registration(if applicable)# 1 "702eo (attach copy) Construction Supervisor's License# G 5 D 7d?7 (attach copy) Email of Contractor R jo ��/v�?`. l'�,s,,/, h Phone number 5'0 f Yt 1' ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF TH,k, OBJECT PROPERTY/S IN A HISTORIC DISTRICT, YOU MUST OBTAIN H/STORIC.APPROVAL BEFOREA'PERMIT CAN BE ISSUED. i APPLICATION NUMBER.............................................�...:.....a. v *For Tents Only* 4 Date Tent(s) will be erected Removed on number of tents total Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper: Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at yourevent please obtain a Health Department approval between the hours of 8:00am-9.30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number; I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date PLICAlyTSSIGNA=T.URE Sigature f ,. Date d, All permit applications are subject to a building official's approval prior to issuance. I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly ��dme(B usiness/Organization/Individual): Address: /b ®s er /-A*i C' ty%S"ta a/Z " �� m� / I'hope# SrJ ,�.7 7 Are you 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 part-time).* have hired the sub-contractors 6. ❑New construction 2.KI am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g• ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp.insurance comp.insurance.: 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.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.ZRoof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.[ Other RO� 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 Insurance #Cttompany,Name: ' �cPoy f Sf xpiration Date: Jo to tlddress tx. 2 4Gi E'tic City/State/Zip: (fe'77er C1 /`E Attach a copy of the workers' compensa ion 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 certi under the pains and penalties of perjury that the information provided above is true and correct Sig afore: Date: «M Pl one. Official use only. Do not write in this area,to be completed by city or town official „ City or Town: Permit/Liceme# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other.legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a 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,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es).and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill'in the permit/license number which will be used ass-a reference number.-In addition,an applicant that must submit multiple permittlicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address;telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 021.11 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax##617-727-7749 www.mass.gov/dia • i �i I f=��cp�am7rcor�r«alC�r a�!?�r!cu�ac�zudeG'Z,t I� Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR I t TYPE:'Individual Registration Expiration 170900 01/10/2020 I I ROY TOLLIVER D/B/A ROY TOLLIVER CONSTRUCTION SERVICES f ROY H.TOLLIVER r 3512 MAIN ST#12 BARNSTABLE,MA 02630 j. Undersecretary Commonwealth of Massachusetts '.t®' Division of Professional Licensure Board of Building Regulations and Standards Constructiorl'Sdpervisor .i CS-078724 Expires: 05/06/2020 •'y I II t. ROY H TOLLIVER PO BOX 396 ARST-ONS-NFFLL-S 4-- Registration valid for individual use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 L 9 Fd - r' it Not valid without signatur°e . Construction Supervisor Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license , /Y Call(6171 727-3200 nr vieit w ----IA-1 f a Town of Barnstable *Permit# ,6 - �d Tres 6 mo hs rom iss e e P Building Department Services Vese_ v snxrSTABr,E,A: Brian Florence,CBO A1163¢ A,�o Building Commissioner Fc Ma• 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Ju 1 2C" Office: 508-862-4038 rol4JAj Fax: 508-790-6230 F � , pp .� EXPRESS PERMIT APPLICATION - RESIDENTIAL ONL4 Not Valid without Red X-Press Imprint Map/parcel Number - �- _` - ( * Property Address 3�z G h- / �, Ca/ Residential Value of Work$ 7 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address_04rn y 0,.1 2.3`j �Gvts I3r-<64 lz=d Contractor's Name r_e f6�z Telephone Number .S®f Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) Vrkman's Compensation Insurance n ✓� Check one: ❑ I am a sole proprietor ❑ I am the Homeowner have Worker's Compensation Insurance Insurance Company Name AV Workman's Comp.Policy# ��C �z Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ide Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows ZZ- #of doors: *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is equired. SIGNATURE: Q:IWPFILESTORWbuilding permit forms\EXPRESS.doc 08/16/17 Town of Barnstable Regulatory Services Richard V.Scali,Director 6 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I Arnold Mason ,as Owner of the subject property hereby authorize Fenton Builders Inc. to act on my behalf, in all matters relative to work authorized by this building permit application for: 23 Long Beach Rd,Centerville Ma (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. Signature of Own Jr Signature of Applicant Pk-0 b, ��� Alec Peters Print Name GQ� Print Name 12- 12.9 ( )l-� Date ACORN® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11/06/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or 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: AP INTEGO INSURANCE GROUP PHONE FAX A/C No Ext: A/C No): 375 Woodcliff Drive E-MAIL Suite 103 ADDRESS: Fairport, NY 14450 INSURERS AFFORDING COVERAGE NAIC# INSURER A: INSURED INSURERB: NorGUARD Insurance Company 31470 Fenton Builders, Inc. INSURER C: PO Box 441 INSURERD: Marstons Mills, MA 02648-0441 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LT POLICYNUMBER MM/DDIYY MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 0 CLAIMS-MADE OCCUR DAMAGETORENTED 0 PREMISES Ea occurrence $ MED EXP(Any one person) $ 0 PERSONAL&ADV INJURY $ 0 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 0 PRO- 0 POLICY JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS ONLY AUTOS ( ) HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER LOTH- AND EMPLOYERS'LIABILITY Y/N STATUTESTATUTEIAER ANYPROPRIEfOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 50Q 000 B OFFICER/M EMBER EXCLUDED? NI NIA FEWC857829 09/15/2017 09/15/2018 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE /, C/L ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street • Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Fenton Builders Inc. Address: PO Box 441 City/State/Zip: Marstons Mills Ma 02648 Phone #: 5082217403 Are you an employer? Check the appropriate box: Type of project(required): 1. I am a employer with 4 4. a am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2. I am a sole proprietor or partner- listed on the attached sheet. 7. ✓ Remodeling ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp. insurance comp. insurance. required.] 5. We are a corporation and its 10. Electrical repairs or additions III officers have exercised their 3. I am a homeowner doing all work 11. Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. Roof repairs insurance required.] t c. 152, §1(4),and we have no 13. Other employees. [No workers' comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 3 f 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. Insurance Company Name: NorGuard Insurance Company Policy#or Self-ins.Lic.#: FEWC857829 Expiration Date: 9/15/2018 Job Site Address: 234 Long Beach Rd City/State/Zip: Centerville, Ma 02601 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 and penalties of perjury that the information provided above is true and correct. Sirtature: /�. �� �� Date• 1/8/2018 Phone#: 508-221-7403 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#: i ACOKO® DATE(MM/DD/YYYY) AC� CERTIFICATE OF LIABILITY INSURANCE 12/06/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT - NAME; Rogers and Gray Processing ROGERS & GRAY INSURANCE AGENCY INC (PA . E t: (508)398-7980 MC No): E-MAIL l mai ro ers r ADDRESS: @ 9 9 ay.com 434 ROUTE 134 INSURERS AFFORDING COVERAGE NAIC# SOUTH DENNIS MA 02660 INSURERA: HARTFORD UNDERWRITERS INS CO 30104 INSURED INSURER B: TOLLIVER ROY INSURERC: INSURER D: P O BOX 396 INSURER E: MARSTONS MILLS MA 02648 INSURERF: COVERAGES CERTIFICATE NUMBER: 219712 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. ILTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM/DDPOLICY/YEYYY MMIDD//YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE FOCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO- POLICY❑JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY Per accident $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 A OFFICERIMEMBEREXCLUDED? N/A N/A N/A 6S60UB2E67661217 01/23/2017 01/23/2018 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance. The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. TOLLIVER ROY has elected coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Alec Peters Fenton Builders ACCORDANCE WITH THE POLICY PROVISIONS. 70 Rosa Lane AUTHORIZED REPRESENTATIVE Marstons Mills MA 02648 'D— Daniel M.Cr J y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 1/1QF2018 r Permit Form AW RJbRPi3TatI19J�. t. a k. N r• MewPermit V I a Main Streer, Hyannis Mk,,0260.1 _ 50 Z alec@fentonbuildersinc.com (Business) O G4 LC c G� 15 s�� zZ�l vSG Project #: TB-18-80 Location: 234 LONG BEACH ROAD, CENTERVILLE Status: Pending Balance Due: $0.00 - PERMIT INFORMATION Occupancy Type Building Type Date Submitted Date Issued Permit For Residential Single Family 1/9/2018 Building - Siding/Windows/Roof/Doors Project Cost Permit Fee Additional Fee Total Fee Total Paid k 35000.00 $178.50 $0.00 $178.50 $178.50 Work Description i Removing 12 rotted windows and replacing with matching new. Removing rotted exterior trim and replacing with new AZEK trim. No changes in design. j Removing sidewall and replacing with new cedar shingles. - OWNER APPLICANT MASON, ARNOLD Z & LEVITTS, JOAN MASON TR Roy Tolliver 20 LAURUS LANE 106 Rosa Lane NEWTON MA 02459 Marstons Mills MA 02648 CONTRACTOR ROY H TOLLIVER Marstons Mills CS-078724 05/06/2018 hftps://portal.viewpermit.com/Secured/Permitview.aspx?enc=+iG90KJTlw7ouCV WZ041z30+OgYHzO4Vj9vFBfNf8gGSAkw7Tu 1 XUveD3JUbGYFI 1/2 �-n- •5 Town of Barnstable ` Regulatory Services t Richard V.Scali,Director 639.6 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder E I Arnold Mason ,as Owner of the subject property y Fenton Builders Inc. to act on m , . hereby authorize y behalf, in all matters relative to work authorized by this building permit application for: 2m Long Beach Rd,Centerville Ma (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. Signature of Own r Si ature of App 'cant n p �� Alec Peters Pfrinnt `Gt Name Print Name Z 12X Date ti H IM-AON,(zmod qe'�71f'ma eve&4 Massachusetts Department of Public Safety office of Consumer Atfairs & Business Re gulation Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR TYPE: Individual License: CS-078724 Re istration I.. Expiration Construction Supervisor 170900 01/10/2020 ROY TOLLIVER �1 _m_. ROY H TOLLIVER A. D/B/A ROY TOLLIVER CONSTRUCTION SERVICES P.O BOX # 396 ` - MARSTONS MILLS M ROY H. TOLLIVER 3512 MAIN ST #12 BARNS TABLE o MA 02630 Undersecretary Expiration Co ',mission*r 06/06/2018 7A TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Y Map2 Parcel p on # Health Division Date Issued Ca?) Conservation Division IC Application Fee r Planning Dept. Permit Fee 4. Date Definitive Plan Approved by Planning Board 00 pE(L T-F Historic - OKH _ Preservation / Hyannis Project Street Address 7`f L�&41tf1 � Village Owner Address Telephone P-= 0 372 Permit Request �� %�1� 8 ( f �� � �r R ZZ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation o v 0 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Pl_� Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes � On Old King's Highway: Li Yes 2.w` Basement Type: a cull ❑ 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 om Count "ga Heat Type and Fuel: Vas ❑ Oil ❑ Electric ❑ Other Central Air: Voles ❑ No Fireplaces: Existing New Existing woo /coal stc OyYes ❑;SNo 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 0 Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION a S ,(BUILDER OR HOMEOWNER) Name /?zVOIJ041C, Telephone Number Address License # C 99 7) 11 Z 24✓GII 'gaV A ©p2 Home Improvement Contractor# Email 144 It Il9 if 12 M Worker's Compensation # Ao*"/X ALL1CONSTRUCTION DEB IS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE — DATE /19712 or ll` FOR OFFICIAL USE ONLY i APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER { DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT - ASSOCIATION PLAN NO. The Commonwe h of—Vassachusetts De rteut ref lidmftid-Aeeidents 600 Wasfi higton Sheet BostanAM 02111 wnw.mass.go )4dia Workers' CompensafianIusarance Affidavit:Builders/Con"ctorsMectricianslPluwbers Applicant Infarmafion / Please Print Legibly Name ghmine 0rpuizafim&dividna1}�� w f Mr Lo�1i!�r 41 Address: , -0 .13 6 � Cray/Stat&Zip: 7T ci rd f rnhaneg: Are you an employer?Check the appropriate b - T • of project 4_ I ayrx a. contractor aaci I � �o3 (�r ���- 1_❑ I am a employer with 6_ New employees{felt and/orpaxt-ime.}* have hired the sub_contracfAm. 2_❑ I am a sole grogrietar or partner- listed on the attached sheet~ y- ❑Remodeling ship aced have no employees These sub-contractors have g- Demoliti.0a working for me in any capacity_ employees and have workers' 9- ❑Building addition [No wotkus'counp_insurance omp-Insurance_ required] 5_ We are a cotporatiemand its 10-.�Electrical repairs or additions required] 3_❑ I am a homemmaer doing all work officershn-e exercised their I I_Q Plumbing repairs or additiem myself[No workers'comp- right of exemption per MOL 12-[:]Roof repairs muan.ce requited-]t c_152,§1(#),and we have no employees-[No worbars' 13_�Other Comp_insurance regU ire _] *l ay s pl ut&at checks box 91 mast also fill out the sectioa below shnwi g Dinh woa eie compensation polity informadrn�. Homeowners who sabmd this affidavit m&artmg dLey are doing all seal[and Olen hug outside!coat Extors meal sabmA a new affidavR mrrr_si ing sarb- tmctnrs that check this box muest attached as additional sheet dow-ng the name of&e sub-amift-Alm and state whether ormt these entities have employees ifthe mTlN oatmcttns have employees,they must ptuvi,de their warlers'comp.paHcg n mber d am an efrtptoyer#Faatispt�r► g tt�orkers'cottrpartsatian arrsrtrrttgr far rrz}*snzplvyerccs HdDw is fire policy an.d,}ob site informadom bisurance Company Name: NHcy#or Self Ens.Uc-4. -- Expiration Date: Job Site Address: CEtylStatelzip. Attaelt a copy of the workers'compensatitm policy declaration page(showing the policy number and ezpa-ation date). Failure to secure coverage as required under Section 25A of MGL c_ 152 can bead to the imposition of criminal penalties of a fine up to$1,50D.M andlor one year itmprisomnent,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 scat mient may be forwarded to the Office of Jirvestigations of the DIAL for inmrance coverage verifltmtion- I da h under the pruns ain penahies:f`pedwy lhatthe irt,f otwiatian prinidid abiwe is.hua and correct Siena A bate_ 42 Ph,,m uuse on F in this area, City or Town:. PerenitUcease# Issuing Authority(tdrele one): 1.Board of Re dtb. 2.Building Department 3.CitylT awn Clerk 4.Electrical Inspector 5.P'himbing Inspector 6.Other Contact Person: Phone#: 6 y 3 . Y, Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto this statute,an employee is defined as"_..every person in the service of another under any contract of hire, express or implied, oral or written." 'I An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer;or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also sus 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 applicant who has not produced acceptable evidence of compliance with the insurance.coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its'political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants. Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their cerdificate(s) of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required_ Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit 'I he afhda:�rit 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 obr,ain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant- Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one a,�davit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filed out each year_Where a homeowner or citizen is obtaining a license or permit not related to any business or commercial venture (Le.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit- The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commanwealth of Massachusetts Department of Indnstdal Accidents Ofirme of kve'stigatians GGG Washlngtan Street Bastau,IAA 02111 Tel.14 617-727-4900 W 406 or I-&97 MASWE Revised 4-24-07 Fax# 617-727-7-149 v .mas�-gov/dia Office of Consumer Affairs and Business Regulation 10 Park Plaza = Suite 51.70 Boston; Massachusetts 02116 Home Improvement Contractor Registration 5 = Registration: 177936 Type: LLC - t r r1 Expiration: 2/25/2016. Tr# 249400 j RED`BROOK MASONRY LLC. JAMES LAVELLE ' 3� P.O: BOX 554 BUZZARDS BAY, MA 02532 - '1x } y y Update Address and return card.Mark reason for change. Address Renewal Employment ❑ Lost Card t J. SCA 1 G 20M-05/11 �1 e �pomvrrcoasu eaCC�o�Caac�uaeGZa- License or registration valid for individul use only Office of Consumer Affairs&Business Regulation before the expiration date. If found return to: OME IMPROVEMENT CONTRACTOR I . ' e: Office of Consumer Affairs and Business Regulation egistration '�77936 Type: 10 Park Plaza-Suite 5170 . xpiration r 2/25/2016, LLC, Boston,MA 02116 3 RED BROOK MASONRY LLC, ;,' i 1 JAMES LAVELLE 623 HEAD OF THE BA`Y RD ���- ,iyy�J� T If BUZZARDS BAY, MA 02532 Undersecretary Not valid.with signature I IM Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor) & 2 Family License: CSFA-098472 JAWS M 11AVEaE `_• , 623 Head Of The Bay V2, Buzzards Bay AIR.0253 Expiration Commissioner 03/08/2016 Afft RED BROOK MASONRY LLC PO Box 554 Buzzards Bay,MA 02532 (508)759-4 13 AM Construction Supervisor#: 95573 MA Home Improvement Contractor#: 150047 Contractor Insured PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT; Arnold Mason same 234 Long Beach Rd. Centerville MA 02632 Date of Proposal: 10/07/2014 (Proposal Expires 30 Days after date above) PROPOSAL We hereby propose to furnish the materials and perform the labor necessary for the completion of. To demo and dispose of existing timber wall and replace with Ideal Stonewall retaining concrete block. Granite grey color.Wall constructed to be same height as original 5'. Conform to engineering plan by Coheeset engineering Bridgewater Ma. Obtain building permit. To remove and replace bushes and ornamental grass as needed.Homeowner will remove and replace flower as needed.Contractor not responsible for bushes or grass that die during construction and replanting. Work to be performed October&November 2014 All material is guaranteed to be as specified,and the above work will be performed in accordance with the. drawings and specifications submitted(if any)and to the description set for above in.a professional manner for the sum of. $25,000.00 - PAYMENT SCHEDULE:$10,000.00 deposit $7,500.00 beginning of second week of work. $7,500.00 completion.. ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the work as specified.Payment will be made as outlined above: JAMES LAVELLE v " ignature: } ON BEHALF OF: Obrook Masonry/ervices ON BEHAL OF CUST R Date: �O 1 Date: Q PROJECT f r ADDRESS: , PERNIIT DATE: o � t: P 1 LARGE ROLLED PLANS INo Box SLOT - Data entered in -MA . pTogTam on ;BY.. C - x q/wpfiles/farms/archive: rIL (:�-o 11 wbo(l TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION w ' WVq Map Parcel Application # Health Division 'Date Issued l v Conservation Division r tdkvk� , Application Fe Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis U Project Street Address Village Owner Address. Telephone Permit Request ( � ��� '� V1� + k '. �J it Square feet: 1 st floor: existing proposed 2nd floor, existing proposed Total new A. Zoning District Flood Plain 4R Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered:,�`0 Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Z Two Family ❑ Multi-Family(# units) Age of Existing Structure VmwD" Historic House: ❑Yes eNo On Old King's Highway: ❑Yes -Flo Basement Type: ❑ Full ❑ Crawl ❑Walkout Other '1 'fBA'(� Basement Finished Area (sq.ft.) -(J" Basement Unfinished Area (sq.ft) Number of Baths: Full: existing_ new Half: existing t' new -7; --: Number of Bedrooms: $ _ existing�ew p _ Total Room Count (not including baths): existing new First Floor Room Count': Heat Type and Fuel: O Uas ❑ Oil ❑ Electric ❑ Other Central Air: Q'Iees ❑ No Fireplaces: Existing New Existing wood/coal stove;: ❑Yes d No Detached garage: ❑ existing ❑ new size Pool: ❑ existing ❑ new size _ Barn: ❑ existing OJnew.�,size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes aAu No If yes, site plan review # Current Use � 'Dcmu Proposed Use P�(,�A GDwrt APPLICANT INFORMATION (BUILDER OR HOMEOWNER) - 1 Name � 1� � Telephone Numberjl �-'1�-I Addresses License # ko1A Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE 3&QU UalV7--, DATE ( L-01 I 5 y , FOR OFFICIAL USE ONLY APPLICATION# GATE ISSUED' ti. ,. - 12, <MAPJ PARCEL NO.: , ADDRESS VILLAGE ` F : OWNER f i DATE OF INSPECTION: t ,` FOUNDATION.; ® 113 fit. r' FRAME u f ,--INSULATION. ' FIREPLACE ELECTRICAL: ROUGH -J"-FINAL PLUMBING: ROUGH + FINAL ' GAS . 'V ROUGH =- « ? FINAL_ FINAL.BUILDING DATE CLOSED.OUT ASSOCIATION PLAN IVO. Y 4 F The Commonwealth of Massachusetts Department of Industrial A ccidents �. Office of 111uestigations 600 Washington Street t Boston, MA 02111 • �yy www.mass.gov/dia ;; Workers', Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Businessiorganization/Individual): / V oto Address: IL;y City/State/Zip: C0TrQNWC AW, Phone #: Are you an employer?Check the appropriate box: Ty pe of project (required): I.❑ I am a employer with 4. �,I am a general contractor and I0 New construction * have'hired the sub-contractors..eirip7oyees(full and/orpart-time).2.❑ I ama sole proprietor.or partner- listed on the attached sheet. . Remodeling ship and have no employees These sub-contractors have • Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers' comp. insurance comp. insurance. required.) 5. We are a corporation and its 10.❑ Electrical repairs or additions 3.91 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 bave no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box f!1 must also fill out the section below showing their workcrs'compensation policy information. t Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating.such: lContraetors 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, lam an employer that is providing workers'compensation insurance foamy employees. Below is the policy and jab site information. Insurance Company Name: Policy# or Self-ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing th.e 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 Ogee of Investigations of the DIA for insurance coverage verification. I do hereby eerli tinder the pains and penalties ofperjury that the information provided above is true and correct. i ature: arc.t S Phone'# ,-7 t- Official use orrly. Do not write in this area, to be completed by city or town officiaL City or Town: Permit/License.# Iiming Authority (circle one): 1'.Board of Health 2. Building Department 3, City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector .6:Other Contact Person: Phone#: hformatzon and bstructzons Massachusetts General Laws chapter 152 requires a)) employers to provide workers' compensation for their employer-.`.-, Pursuant to this statute, an etnplo))ee 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 ore em )o er, Of the foregoing engaged in aloint enterprise, and including the legal representatives of a deceased p Y receiver or trustee of a❑ individual, partnership, association or other legal entity, employing employees, Howevcr the owner of a dwelling house having not more (ban three apartments and who resides therein, or the occupant of the t employs ersons to do maintenance, conslniclion or repair work on such dwelling house dwelling house of another emy w p h p to er.' or on Lbe grounds or building appurtenant thoreto shall not because of such employment be deemed to be an emp Y MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to cons truct'buildhigs in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally MGL chapter 152 §25C(7) stales "Neither the commonwealth nor any ofits political subdivisions shall cater,into any contract for Iheperfofrhance ofpublic-iwork until acceptable evidence ofcompliancc wit-h the insurance requirements of this chapter have beenpresented to the contracting authority.' Applicants Please fill out.the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if Dccessary,supply sub-contractor(S)name(s), addresses)and phone numbers)along with their cerlificate(s) of insurance, Limilcd Liability Companies (LLC)or Limited Li.ability Partnerships(LLP) with no employers other than the members or partners, are not required to cary workers' compensation insurance. if an LLC or LLP does have employees a policy is required. Be advised that this affidayil may be submitted to the Department of IndustriaJ Should Accidents for confirmation of insurance coverage. Also be sure to sign and date th-e offrdaOt• The affidavit be returned to the city or town Lhat•the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a,workers' compensation policy,please call the Department at the number listed below. Self-inswed companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly, The Department has provided a space al the bottom of the affidayil for you to fill out in the event the Office of Investigations has to contact you regarding the appli cant. Please be sure to fill in the prnni0Jiccnse number which will be used as a.reference number. Ln addition an applicant that must submit multiple permiULicense applications in any given year, need only submil one afJaavit indicatjng current policy information ()'f necessary)abd under"Job Site Address" Lhe applicant should write"a1)]o.'cat'ons in _(city or rra town)."'A copy of the affdavit that has been officially stamped or r;arkcd by the city or townY be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavi tjnust be filled OL,i each r commerci a] venture year. Where a home owner or citizen is obtaining a license orpermit not related to any I)LlSineSSO ( � g cense of p rn i e. a do li ermit to bum leaves etc.) said person is NOT required to complete this alf•fidayl. The Office of lnvesligatjons wou i e o ri�adyQ_ L� ^nrr;,tinn and should youhave any questions, please d0'not bcsilaie to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts, ' Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02 111 Te). 617-727-4900 ext 406'or 1-877-MASSAFE Fax # 617-727-7749 Revised 1-24-07 www.mass.gov/dia r i T r Town of Barnstable CA , 0 Regulatory Services Thomas F. Geiler,Director '`'`SS. Building Division Torn Perry, Building Commissioner 200 Mairi.Street; Hyalmis, MA.0260I www.town-barnstable-ma.us Office: 508-862-403 8 Fax: 508-790-5230 EYOTiED?MER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: LE�U/ VI V{�G number -&p ( street village name horrzphhlonnee# work phone# CURRENT MAILING ADDRFSS: city/town state ;rip 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 sup eryi.S or_ DEFINMON OF BO)YMOwNER „ Persoa(s)who owns a parcel of land on which he/sbe 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 structzrs. A person who constnlcts more than one home in a two-year period shall not be.considered a bomeowner, 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 CDIMpliance with the State�Building Code and other applicable codes, bylaws, rules and regulations. The undersigned "homeowner"certifies that.he/sbe understands the Town of Barnstable Building Department minimum inspection procedures and'Tc:#rements and that he/she will comply with said procedures and ' x } Signer 'rc Homcownc7 Approval of Building Ot5cial f Note: Three-family dwellings containing 35,000 cubic feet or larger wi11 be required to comply with the State Building Code Section 127.0 Construction Control. - HOMEOWKER'S EXEMPTION The Code states that "Any homeowner performing work for which a building pemvt is requirrd shall be exempt from the provisions of this section•(Scetian IDMA -Licensing of ct=tryetion Supervisors);provided that if rhghomeowner engages a pason(s)for hint to do such work that such HDTneDWner shall act as supervisor." Many hnmcown=who use this rxcnrption arc unaware that they an assuming the responsibilities of a supervisor(sec Appendix Q, Rules&Rcgularions for Licensing Construction Supervisors,Scction 2:15) This lack of awareness bfien results in serious problems,particularly w es ; 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 enure that the homeowner is fully aware of hisAcr Yie ponnbilitirs,many communities require,u part of the permit application., that the homeowner certify that he/she understands the responnbilitics 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 forrr✓ccrtification for use in your community. Q:forrns;homccxcmpt , R Town of Barnstable Regulatory Services ` LiR?f6?ASLE, F ' uAss g Thomas F. Geiler,Director Building Division Tom Perry, Building Commissioner 200 Main Sheet, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A wilder, L I , as Owner of the subject.property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for. -�' (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. Q:FORMS:O WNEKPERMISS101� I - 44 � pFtHE l Town of Barnstable u7 �� Department of Health,Safety,and Environmental Services • snxxsrAtm Conservation Division ArEo��p't A 200 Main Street,Hyannis MA`02601 Office: 508-862-4093 Robert W.Gatewood FAX: 508-778-2412 Conservation Administrator MINOR ACTIVITY REGISTRATION o(01� �Uo COCA- 22� Property Owner Telephone number Mailing address Project location' Map/Parcel# Project description The following minor activities will be reviewed,under Art.27,by Conservation staff instead of the Conservation Commission,as long as they are constructed at least 60' from a wetland resource area or top of a coastal bank. , * Pathways 4' in width * Fencing that does not create a barrier to wildlife movement,6"above grade. * Conversion of lawns to decks,sheds,or patios that are accessory to single family homes, as long as: -house existed prior to August 7,1996 -alteration within the buffer zone is less then 250 sq.feet. -sedimentation and erosion•controls are used during construction * Stonewalls(this does not include stonewalls for retaining wall purposes,grading and/or fill) t gnature Date to Review by Date _GIS Plan Attached(fee charged for plan) { QNNFiles/Form/MinorAct Assessor's office(1st Floor): �� % Assessor's map and lot number 2 U THE tof. . w� � +._-A kl'l l hVgt Conservation , t Boar of Health(3rd floor): f Sewage Permit number E4ineering Department(3rd floor): p_ °►j�i°70'`��� House number .�' S li._ orrr Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ;. TYPE OF CONSTRUCTION i1 19 9! TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: ( f Location �3q AIA ., ss, Proposed Use e,& Zoning District Fire District /`� r 414 1A Y r Name of Owner r.A J) 0 A Address .�i �a �, I"�A P r-c Name of Builder 4^-RIP a�y. ,' /r#,'�, ( r�i7. Address M) tlP/`r . r; / //�. /c). + r�, C b��. y - Name of Architect 41, CIA o 414 Address /V Number of Rooms/ L Foundations r / 1 Exterior / �' �' �' Roofing .S,r> �r Floors Interior P�1/4 7 �` Heating .f Plumbing Fireplace �/ ��� Approximate Cost l P/ 606 r' Area JC Diagram of Lot and Building with Dimensions Fee G� OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules'and Regulations of the Town of Barnstable regarding the above construction. Name Construction Supervisor's License 7 7�C� MASON, ARNOLD A=205-001 No 34688 Permit For Expand Exist. Room S; ng1P Family Dwelling Location 234 Long Beach Road - 4 Centerville Owner Arnold Mason Type of Construction Frame ' i Plot Lot Permit Granted November 12, 19 ' 8 9 f Date of Inspection 19 Date Completed 19 PERMIT COMPLETED S Assessor's office(1st Floor): �Z d �' 04/ /J SEPTIC �P�STEW''. ',I)t: `�B Assessor's p and lot number_ y¢��gg �a�r.� �g � of Ywt r n INSTALLEDs� J"�4.s-�� �E Conservation:. '✓'1�� IalNcy cl1 WITH TITLIF Board f Health(3rdfloor): J D ^(� • IMBLE Sewa a Permit number l f /�..: T lU � rrua Engineering Department(3rd floor): (f T'OWINa PF'r-" ���5 °o s639. HOUC number 1 -/7_�j ti�S �o wsr Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING I SPECTOR APPLICATION FOR PERMIT TO h��,Oejj� coxl"`� I q ka 41 60111 7� TYPE OF CONSTRUCTION 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following info mation: Location G17S d- / 1 Proposed Use Zoning District ( Fire District. .� Name of Owner / !'A n / ( l GI BS on- Address Name of Builder Address/"P 10 Name of Architect 'ch Address d �l I/ / Number of Rooms N�/� Foundation_ 41/14 Exterior �e-- C Q dA I Roofing Floors T j /2� Interior )VIaS f r' Heating A on Plumbing Fireplace / Approximate Cost r7 1�an Area f� Diagram of Lot and Building with Dimensions F D OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Construction Supervisor's License 12 q 7 7 Tto For— ASON, ARNOLD r No 3 4 648 8 Permiffor EXPAND EXIST.' ROOM Single Family Dwelling Location- 234 Long Beach Road ' Centerville Owner '+ 'Arnold- Mason Type,of,ConstructiorC Frame , r Al ! e ,r Plot e Lot Permit Granted November 12 , ; 19 91 J Date of Inspection 19 ` Date,:Comptgted /� 1 19 a i • ` r ,e j Assessor's offioe (1st floor): _ Assessors map and lot number ........... . Q F THE T Board of Health (3rd floor): d Sewage Permit number ....... i?iCvMbzr !vk • • Z BAHdST11DLE, i Engineering Department (3rd floor):. �639. 0� R House number ...................................................7...................... �'0$aVAY a` APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00.2:00 P.M: only ®WN OF IBARNSTABLE "" BUILDING INSPECTOR APPLICATION FOR PERMIT TO !✓1. .. .,r1lV ..;1..1!s� ... A C�:. ��....... ....... ! � TYPE OF CONSTRUCTION ..........M/.lC�.... ............................................................ ................... ........... Ite...... .......... 19.. - TO- THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a pperrm{it according to the following information: Location .....(�'a ...1/ ....?�:% � ! .I..... t .l ......... % !vI.1,%1�11.[. ......................................................... ProposedUse ...... ................................................................................................................................. Zoning District ..........................................Fire District .... :..... Name of Owner 1'`.FN.t.�!!/9..�.�.�U�.:..!'I!)1.,�/.�l..Address J0.1....�t!.l!/�.� .../..4/c................. Nameof Builder ....................................................................Address ..........................,......................................................... /� Name of Architect ...l .�C1r+�.1 .G % ��.. . .. /.. ..Address ... • !....C ........ ... yltf. ,.. .,.. % 2�� ��`� Numberof Rooms .... �.........................................«..+.�1L�...Foundation .. ... ... ........ ... . .................................................... Exterior Von?.��Iw6an� l If uvc>...zv...........Roofing ... ....�I���i����............................... Floors ...!/1/,e 9. ......................................................................Interior ..... l00?..? /PIS?.............................................. � . ����Heating �. ..... ................PIumbing P� Fireplace ..( 1. ...................................................................Approximate Cost ...... ............................................. Definitive Plan Approved by Planning Board ________________________________19-------- , Area ....... f�..✓�" .-J,............ a Diagram of Lot and Building with Dimensions Fee ... SUBJECT TO APPROVAL OF BOARD OF HEALTH ��" n 1 t OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. ....te Construction Supervisor's License .. .,,. �a . MASON, ARNOL/D� & ,RUTH A=205-601 . 30676 permit for ,REMODEL & ADD TO No .............. Single Family Dwelling........... 234 ~Lo.n VBeach Road 't: 1 Location ................: � -- Centerville ............................................................................... Owner .......Arnold & Ruth Mason ................................................. Type of Construction .Frame .............................. Plot ............................ Lot ................................ April 28 , 87 Permit Granted ............I...........................19 Date of Inspection ....................................19 I Date Completed ...........................:..........19 G , �r LAwnNCE LRM L READY MIXED CONC CO. BCOX 6146, F UTH, M SACHUS TS 0 41 (617)548-6611 ..... .. .. . . ........ o Serving Eastern and Southeastern Massachusetts as well as Cape Cod for your ready mixed needs. 0 T o 0 W-Assessor's offioe (1st floor); q,`T IC SYSTEM MUST'SE oFTNE>o Assessors map and lot number ....+ :Q,.�J. : .�� ..Q ............ . .. Board of Health (3rd floor): I ALLE® IN COMP�LIANC d�P ♦� Sewage Permit number ....... f�. ... ITI TITLE 5�. 1+r!.N`.l!.:... .... .:'.�1GGOM�1' Z BASa9TADLE, i u Engineering Department (3rd floor): :A10 MEIIITAL ®E AE't +o "b House number 7 . 7+°0WN REGULATI®I o�ot+a�a� ;.APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only A P P R O V E D >a8 le Conservation N OF B A R N S T A B L E z ILDING INSPECTOR � � gnea Date ... ...7D APPLICATION FOR PERMIT TO .�l'.LDI�J. ... ..... .. ,! Cry i. WQU. � \%.11.11 J.TYPE OF CONSTRUCTION ......... .... ..................................................................................... i ........... I......... .......... .. - TO THE INSPECTOR OF BUILDINGS: The undersigned hereby Aa�pplies for a permit according to the following information: Location .....(.,� ....(/l/[V .... .... * .........� YV.!' Y/........................................................ ProposedUse ..... J� ........................................I....................................................................................... Zoning District ................................Fire District ....-:..� /"�!" r....... .... ............................................ Name of Owner ............. .. ..Address ..I�O..1...AA,9 &0 MlF................ Name of Bwilderd.. .............�....,..... ...... �.�. dress `�, I 1 Name of Architect ..�V�4. !��1!.If�GI....VU�/�!U ... /..>./� .Address ...�. ... U I. .... .. ...... CWq— Number of Rooms ....1�.........................................Q! - ...Foundation �. .................... .V.Vt/ul.�.Exterior ..c t!N �U!'�/t ... OUP...........Roofiing ... �Q1 ..sftw i�7—,s..............................I Floors ....W100P...................................................�....................Interior .....WO r?..5NPS W/Heating ....... ................Plumbing ....�..... y� .. Fireplace ..................................................................Approximate Cost .................................................... Definitive Plan Approved by Planning Board _____________________________19________ . Area ....... ../.16L".4.......... Di gram of Lot and Building with Dimensions Fee .V........ ..... ..................... SUBJECT TO APPROVAL OF BOARD OF HEALTH n OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of t n of Barnstable egarding the above construction. Nme .. ................... I •t�.ru•.. .h %5 ATM U(, f Construction Supervisor's License ..�.....�0., •• MASON, ARNOLD & RUTH 'EMODFL & ADD TO ti ..30616.. Permitrfor ...,. ;............................ Single Family lgweiling ...............................Long B�ach Road ... ... .......... Location ..................,.... ........ ................................ Centc8r'ill .............................4. ......................................... ^, Owner .,,Arnold & Ruth iiason {y Type of Construction. ...... me...................... + c3 1.0 . _ Plot ... .................... Lot ................................ Perm Granted ......April 8.'..........:19 a 7 ., 1 4 r ^•Date ofInspection ....................................19 J, Date Completed ......................... ' FOUNDATION & RENOVATIONS ` TOWN OF BARNSTABLE TM�> Permit No. ......346:8..5..&..,34688 . BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash 6�9• HYANNIS,MASS.02601 Bond ......N1A.... C } CERTIFICATE OF USE AND OCCUPANCY Issued to Arnold L. Mason Address 234 Long Beach Road Centerville, Mass. USE GROUP FIRE GRADMG OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING;SHALL. NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING, INSPECTOR UPON,SATISFACTORYXOMPLIANCE,:WITH TOWN, 4, REQUIREMENTS AND IN ACCORDANCE WITH.SECTION 119.6 OF THE MASSACHUSETTS'STATE BUILDING CODE: July .?Z f... t9 9.2 �LLe ,,Buil diri g Inspector a ' i Assessor's office(1st Floor): Assessor's map and lot number ���� 11 • Board of Health(3rd floor): _ INSTALLS ILIA,� Sewage Permit number �i/-,)-�� Engineering Department(3rd floor): ` C°® MAS s•rsnta House number Definitive Plan Approved by Planning Board 19 °MCI r APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN - OF BA.RNSTABLE BUILDING INSP CT0R APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION , �Gt2�Gy✓l 19 q l TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location Proposed Use 1Gedrr�r?i1 �C Zoning District t D Fire District J Name of Owner �i�l 2. d�rJ2i Address 2-3:1 7z-e4,- Name of Builder Address Name of Architect Address J4-11z�e 2e2v� Number of Rooms Foundation Exterior Roofing Floors Interior Heating— Plumbing Fireplace ��2�0 � � Approximate Cost �QC� Area/9t' 6 Diagram of Lot and Building with Dimensions Fee $tea OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regacding,th oye constructio Name Construction Supervisor's License ag — r 7" MASON, ARNOLD L. 1 a No 34685 Permit For Expand Foundation f•: Sinal e Fami 1 U Durg1 1 i nq Location 234 Long RPac-h RnaCI ' Centervi11P Owner Arnold 7 . Mainn Type of Construction F r a m e r A ; i Plot Lot . ., ,,f Permit Granted November 9 91it , r Date of Inspection 19 Date Completed 19 f i j } ~/ /{ �oftNtTo` �� D DARNST� Z s 9 367 MAIN STREET HYANNIS, MASSACHUSETTS 02601 COMMONWEALTH OF MASSACHUSETTS WETLANDS PROTECTION ACT AND REGULATIONS, G.L. 131, Sec. 40, 310 CMR 10.00 AND TOWN OF BARNSTABLE ARTICLE XXVII EMERGENCY CERTIFICATION FROM: Barnstable Conservation Department TO: Norman Hayes, Forest & Env. Services Arnold. Z. Mason (Name of.applicant) (name of property owner) P.O.. Box 281 W. Barnstable, MA 02668 234 Long Beach Rd. , Centerville (address) (address) DATE: Nov. 1,. 1991 LOCATION: 234 Long Beach Rd. , Centerville FINDINGS: l.) The Barnstable Conservation Dept. hereby certifies. pursuant to 310 CMR 10.06 that the work described below is necessary for the protection of the health and safety of the Citizens of the Commonwealth and will be performed by or has been ordered to be performed by an agency of the Commonwealth or a subdivision thereof. 2.) A site inspection was performed on Oct. 31, 1991 3.) The agency ordering or performing the emergency work is the Barnstable B1da, inspector's Dept. (name of agency) . (Not the Commission unless work is on land owned or controlled by them.) 4.) Describe below, the work which is allowed to proceed under this certification. No work beyond that necessary to abate the emergency may be so certified. Foundation repair work to raise the dwelling above the flood elevation Recent storm related damage necessitates this action. Construction shall conform to the requirements of the State Bldg. Code and the Town of Barnstable Zoning Ordinance for construction within the coastal floodplain. Work shall ensue only after consulting with the Building Commissioner. 5.) The above described work shall be completed by Nov. 30, • 1991 (date).. (Work performed under on Emergency Certification shall not exceed 30 days from the date of the certification unless the Commissioner of DEQE so approves.) ISSUED BY Kendall T. Ayers, Conservation Agent Signature FOUNDATION & RENOVATIONS _ " TOWN OF BARNSTABLE permit No .4 ° • BUILDING DEPARTMENT Cash 'r ■,,. TOWN OFFICE BUILDING HYANNIS,MASS.02601 Bond CERTIFICATE OF USE AND OCCUPANC t ye Issued to Arnold L. Mason Address 234 Long Beach Road Centerville, Mass. USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIE ' SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH, TOWN. REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS TAT BUILDING CODE a July 21.c. 19...... ....... .....:�� . .. �- x h Building InspectoF s • .A.TITAU-Z : The Town. of Barnstable � rur. -Inspection Department ee� i0jp, o" per►Y`%� 367 Main Street, Hyannis, MA 02601 508-790-6227 Joseph D.DaLuz Building Canmissioner TO: Kendall Ayers, Conservation- Agent FROM: Alfred E. Martin, Building Inspector A RE: A=205-001 234 Long Beach Road, 'Centerville Arnold Mason An inspection of the foundation and piers beneath the Mason residence reveals extensive damage from recent storms. The owners of the property are aware of .the serious. safety hazard and emergency repairs should be started immediately. R. i a x< 293 Washington Street Norwell MA 02061 a October 17,1991 Barnstable Building Inspector 617 659 7981 367 Main Street Barnstable Town Offices Hyannis, Mass. 02601 Re Mr : Arnold Mason Residence 234 Long Beach Road Centerville, Mass. Dear Sir, This letter is to report our observations and understandings of the conditions at the Mason Residence as observed on October 9, 1991. The purpose of the site visit was to observe the site with the specific intent of designing a new foundation for the building to elevate the first floor from elevation 6 to elevation 12 (elevation 12 is the 100 year flood elevation in the FEMA flood hazard area. ) The foundation was observed by crawling through hatches in the first floor of the structure into to a crawl space of 18 to 24 inches in height. The floor consisted of a sand bottom with various foundation styles under the house. These included portions of the perimeter foundation which varied from cast in Engineers place concrete to cinder block and mortar to cinder block laid Environmental up dry to areas of some cinder blocks set in sideways possibly Scientists to allow seepage into the crawl space, to cinder block with a mortar parge or in other areas an asphalt water proofing. GIs Consultants Further their are several support piers spotted under the building consisting of cinder blocks or concrete piers. Landscape Further , there were no anchor bolts observed securing the Architects structure to the foundation. Planners Surveyors This foundation is a composite of many styles and due primarily to the masonry style of the foundation and lack of anchor bolts, is not considered to provide adequate protection against possible movement of the structure during severe floods. BSC will be designing a new foundation under an agreement with Mr . Mason in the immediate future. We have just completed our field survey and expect to be working closely with the contractor . on behalf of Mr. Mason we request, under section 10 . 06 of CMR 310, a permit to modify the foundation by raising the structure , removing the old foundation and installing an new cast in place concrete foundation providing a first floor elevation at elevation 12. 05. Sincerely, The BSC Group Inc q p David J. Crispin PE Associa e �x ell" op,VI DANIEL S.GREENBAUM Commissioner i GILBERT T.JOLY Regional Director s. November 13 , 1991 Arnold Z. Mason RE: BARNSTABLE--Wetlands 234 Long Beach Road Emergency Certification Centerville, Massachusetts 02632 Revocation 234 Long Beach Road Dear Mr. Mason: Please be advised .. that the Department of Environmental Protection, upon its own initiative, and in accordance with the General Laws, Chapter 131, Section 40, and the Regulations at 310 CMR 10. 06 (5) , is revoking the Emergency Certification issued by the Barnstable Conservation Commission on November 1, 1991, for the repair of the foundation a•t the above-referenced location. The Department's reason for the revocation is as follows: f The work exceeds that which is authorized by the "Emergency Regulations in the Aftermath of Hurricane Bob, 310 CMR 10. 61. 11 Please be advised that these regulations allow` repairs of foundations where the damage is less than 50% of the pre-storm market value of the house or stabilizing and shoring up of foundations only to the extent' necessary to prevent imminent harm to the structure and where the damage is greater than 50% of the pre-storm market value of the structure. Complete restoration or replacement requires the filing of a Notice of Intent pursuant to 310 CMR 10. 05 (4) . No work as proposed in the Emergency Certification may go forward until such time as a Notice of Intent has been filed and a valid Final Order of Conditions has been issued. Recycled Paper - M _2_ Should you have any questions concerning the Department's action, please contact Lealdon Langley at (508) 946-2800. Very truly yours, El zabeth A. Kouloheras, Chief Wetlands Section K/LL/jt CERTIFIED MAIL #P622 583 070 RETURN RECEIPT REQUESTED cc: Barnstable Conservation Commission Norman Hayes Forest and Environmental Services P.O. Box 281 West Barnstable, MA 02668 4 t , Recommended Hoistway Construction Elevation ` T PROPOSED RESIDENTIAL ELEVATOR rar�so<eaaa dote q�i(ci w,e rasa omx Rj CUSTOM Elevator Model k RR-I I-950WD-40x54 overhead winding drum residential r,J uicneva W"",u,°P rev] d WISIIMT ta+'�>• � Elevator with a 10"cement concrete pit,fully insulated 2x6 wood frame enclosing walls, d u"�'r na�w,r me«rwlrtfl,o.r machine room within the existing residence interior within 10'0"?of the elevator shaft, Q 3 door opening landings built in full compliance with the Commonwealth of 3 .� ly. III lla'm.'00Nf01'�1101i'Fs,� Massachusetts Elevator Code. 4 IIIII I� I I;ii� r. 5 ! 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