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HomeMy WebLinkAbout0138 LUMBERT MILL ROAD n s , I t - own of Barnstable. *Permit# Expires 6 non issue date v7 °� egulatory Services Fee ¢Ill anati�raBt:e, = '�'t.. 2 1 t.so�a N Richard V.Scali,Director Ok 8ANIV A8L[ Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY lbG — I(� Not[valid without Red X-Press Imprint Map/parcel Number © p Property Address Q $��, k]A 06 esidential Value of Work$ 41 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address e If Contractor's Name � i c`� �- Telephone Number 509 " ` Q"Q "L_45� Home Improvement Contractor ense#(if applicable)�n � Email: /y► /�� C��', t.Q, 1 trl Construction Supervisor's License#(if applicable) C-S /O caLa t 0 Workman's Compensation Insurance ` Check one: ❑ I am a sole proprietor ❑ I am the Home o er I have Worker's C,mpensation Insurance Insurance Company Name 5n(D 0_.C.2 Workman s Comp.Policy# V✓ 60 n 6 C)d q , .0 1 7 Copy of Insurance Compliance Certificate must accompany each permit. o ' Permit R st(check b ) Re-roof(hurrlcan naI (stripping old shingles) All.construction debris will be taken to '_2 . ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side /� [Replacement Windows/door iders U-Value V �� (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. "Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of a Home Improve ent C tractors License&Construction Supervisors License is required. , SIGNATURE: - C:\Users\Decollik\AppData\Loca]\Microsoft indows\Temporary Internet Fi1es\Content.0utI6ok\2PI01 DHRTXPRESS.doe Revised 040215 j ,i Massachusetts Department of Public Safety lug Board of Building Regulations and Standards License: CS-102260 Construction Supervisor Construction Supervisor . Restricted to: t x Unrestricted-.Buildings of any use group which contain MICHAEL S MEAGHER JR, less than 35,000 cubic feet(991 cubic meters)of 97 EMERALD LANESw� enclosed space. MARSTONS MILLS MA102648 P"J;Z CA,:g Expiration: Commissioner 11/05/2018 Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. DPS Licensing information visit: WWW.MASS.GOV/DPS ��n,�nrwrNoaxrueall�o�C�iUGrrQJ�rclrrJeC�rt - • _-_ Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR • TYPE:Individual � Registration Expiration 162938 04/26/2019 Registration valid for Individual use only tr MEAGHER CONSTi�UGTI before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park PI -Suite 5170 !r Boston, 02116 MtCHAEL.MEAGHER�R.: 776 MAIN STREET OSTERVILLE,MA 02655 Undersecretary ; t valid without signature The Conintortwealth of Massachusetts Depart#tle7it of Ijuhrstrial Accidents 016ce o•f Investigations , 600 Washington,Street Boston,AM 02111 e~c.mass.gor?ldia W,arkers' Compensation Insarance Affidavit-'Builders/Contractors/Electricin mbers ApIlicant Information Please Print Legib Name(BuisioessPowniaati Address: GitylStatef 5p: Phone 4- Are you an employer?Check the appropriate box: Type of project(required): 4. ❑ 1 am a general contractor and I 1. d atn a tplo urith 6. ❑New construction employees(full andtar pact-timej_s have hired the sub-contractors ?_ 2.El am a sale proprietor of partner listed on the attached sheet. ❑Remodeling ship and have no employeesThese sub-contractors have g- ❑Demolition working for me in any capacity. employees and luaus workers' g ❑Building addition o workers'comp.insurance cam'insurance.X [T 5. ❑ we are a corporation and its lU_❑Electrical repairs or additions required_j officers have exercised their 11,❑Plumbing repairs`or additions 3_❑ I am s [No w homeowner s'co all work right.of exemption pet MGL 12_❑Roof myself[No workers comp- c. 152,§1(4),,and we have no repairs insurance require&] employees- o wo ims' fl3-P10tther comp.insurance required.) S •lusty applic�tt ahat checks bm#1 a mst also fal OW the section below sliowimg dheir mr�ets'compezbsation policy infot�tioa ��l� HoMeovnws who submit this affsdat�mdi-=g they am doing alt wok and then hire ot�ete tontracnus mast submit a new affidavit imdic such =watts€tots dw check this must attached un addisiooal sheet sbowing the ume of the sole-c cWrs sad state whethw of no those eoait�s have ��� employees. if the sub-convadossbare employees,they.=w provide Chest workers'comp.policy numher- I aman entphUmr that is p°aajding tIorkers conrpensaatiml i araance for my employees. Below is the polio,and job sib informadOat, lmuuance Company Dame: �J• Policy,i#or Self ins.lie.#: L C C `Soo, 5<<a 61 iration Date: � a 3 IlSQ p- l V� Job Site Address: 3 o l�� �� Gitya' tatePZip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure covwage as required under Section 25A of MGL c. 152 can Head to the imposition of criminal penalties of a fine up to$1,500-00 andlor one-year imprisonment,as well as ci ml penalties in the form of a STOP WORK ORDER and a tine of up to$250.00 a day a the violator. Be advised that a copy of this statement may be forwarded to the Office of lnirestigations of the P!L!b±umHWce covecag erifsca I do hereby certify t paints aaa Pepin ' o f vary that the iuf oruaae dan ided a bmre is tme and correct 5i tore: • Dat t ao 1 Phone#: Wc Offlcial aa"onty. Do not Mite in this area,to be completed by ch)or towns of dial City or Tour Per�tfLicense# lssniaig Authority(circle ones: 1.Board of Health Budding Department 3.cityfrown Clerk 4.Electrical Inspector S.Plumbing Inspector + 6.Other Contact Persons ' Phone#: Client#: 16665 2MEAGHERCO ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATD/YYYY) 6/22/202/2017 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(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 NCONTACT AME; Dowling&O'Neil Dowling&O'Neil Insurance Agency PH(AI O No Ell:508 775-1620 973 Iyannough Rd,PO Box 1990 n oREss: coi@doins.com ac No: 5087781218 Hyannis,MA 02601 INSURER(S)AFFORDING COVERAGE NAIC# 508 775-162620 INSURER I A:aGM Insurance Company 14788 INSURED Meagher Construction Inc. ss INSURER B:Aoclated Employers Insurance Company 11104 INSURER C: Timothy Meagher INSURER D 776 Main Street Ostervifte,MA 02655 INSURER E: � INSURER F: . COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR ADDL UBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE I g wvn POLICY NUMBER MM/DD MM/DD LIMITS A GENERAL LIABILITY MPT125OG 10/16/2016 10/16/2017 EAApCMMHHqOEECTCURRENCE• $1000000 X COMMERCIAL GENERAL LIABILITY' PREMISES EaEN°nCe $500 000 _t_ CLAIMS-MADE a OCCUR MED EXP(Any one person) $10,000 r PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $2,000,000 POLICY 7JR� LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) HIREDAUTOS NON-OWNED PROPERTYDAMAGE $ AUTOS Per accident $ UMBRELLA LIAR H OCCUR EACH OCCURRENCE, $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION WCC50050654422017A 6/23/2017 06/23/2018 X WC STATU- E0 AND EMPLOYERS'LIABILITY YIN N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $100 000 OFFICER/MEMBER EXCLUDED? � N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $100 000 If yes,describe under DESCRIPTION OF OPERATIONS below' E.L.DISEASE-POLICY LIMIT 1000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements.' Nothing contained in the certificate of Insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. - CERTIFICATE HOLDER CANCELLATION Town of Barnstable } SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE. WILL BE DELIVERED IN Building Dept. ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE C. ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2110101) 1 of 1 The ACORD name and logo are registered marks of ACORD { #S 192660/M 192659 CBD 9AaN8�A@d� Town of Barnstable Regulatory Services Richard V.Scab,Director Building Division Thomas Perry,CBQ Building Commissioner 200 Main Street, Hyannis,MA 02601 s www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must , Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) � d a Zignatureof Owner Date Print Name, If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\UsmU)ecolliklAppData%ocallMicrosoft\WindowslTempormy lntemetFilesWonterrt.0ut1ook12PIOIDHR\EXPRESS.doe $ Revised 040215 Q Town of Barnstable *Permit# &&3 �ok:; Expires 6 months fro Issue date Regulatory Services Fee 6-2 Thomas F.Geiler,Director X-PRESS PERMIT � ,o(,3I66 Building Division OCT 1Tom Perry,CBO, Building Commissioner 1 2006 200 Main Street,Hyannis,MA 02601 VVV TOWN OF g www.town.bamstable.ma.us Dffice: 508-862-403$ARIVSTABLE . Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint /� (� ll� Vparcel Number i (,� )erty Address t 3q> L-Mbo"4 Will y ,A Zesidential Value of Work -80 Minimum fee of$25.00 for work under$6000.00 ier's Name&Address ;tractor's Name a0olvr lout 2 `I/tr.Ocf'bos 2lrvt evt`� Telephone Number ne Improvement Contractor License#(if applicable) 14A -7 tsfr���rvisor�sL icense-#(I�appiieable) Vorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ Lam the Homeowner I have Worker's Compensation Insurance trance Company Name Q my� _L"l;-e. S -k— L VL5 Co rkman's Comp.Policy# W GZ—7 q 4 J q(o iy of Insurance Compliance Certificate must be on file. nit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders. U-Value �J (maximum.44) *Where required: lssuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Prope wner must sign Property Owner Letter of Permission. A py, . the Home Improvement Contractors License is required. NATURE: l�C� ,=:expmtrg se061306 06/23/1999 20:13 6106883280 PAGE 01 ,41 �a � i ✓!xe 1�omvnwauaeaCCfz o�✓ saclZuae�ta Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration;:,149752 Exp raiaon 2l6/2008 TYPe .DBA CALIBER HOME IMPROVEMENT STEVEN WHITE 1232 ORLEANS ROAD, HARWICH,MA 02645 Administrator Department of Industrial Accidents Office of Investigations 600 Washington Street " y� Boston, MA 02111 www.mass.gov/dia - Workers' Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers kpplicant Information Please Print Legibly -dame (Business/Organization/Individual): 1 . VrLe_ VVtptr cQQA41 1 .address: 14'7c-et,Woc�� U '� ;ity/State/Zip: G�co�to��=5 r' ( Phone #: SD re y an employer? Check the appropriate box:. Type of project(required) I am a e to er with 4,_El I am a general contractor and I mP Y � - 6. ❑ ew construction - employees(full and/or part-time).* - - have hired the sub-contractors n - I am a sole proprietor or partner- listed on the attached sheet. $�� _7.., Remodeli_ g - ship and have no employees These sub-contractors have 8: ❑ Demolition _ workingfor me in an capacity. workers' comp. insurance. Y P t}'• 9."❑ Building addition [No workers' comp. insurance 5 ❑ We are a corporation and its officers have exercised their 10.❑ Electrical repairs or.additions required.] _ - 3] I am a homeowner doing all work right of exemption per.MGL 11.❑ Plumbing repairs or additions myself o workers' co- c. 152, 1(4), and we have no Y mP § 12:❑ Roof repairs - - insurance required.] t employees. [No-workers' . ... . -, comp. insurance required.] 13.❑ Other :y applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: 't .)meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ntractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. man employer that is providing workers'compensation insurance for my employees. Below is the policy and job site 'ormation. - urance Company Name: .icy#or Self-ins.Lic. #: 2-1 Expiration Date: - i Site Address: 12i L fw�,_6 .. �_At. ��. City/State/Zip: fit -y i (C F1 , :act a copy of the workers' compensation policy declaration page(showing the policy:-number and expiration date): lure-to secure coverage as required under Section 25A of:MGL c..:152 can lead to the imposition of criminal penalties of a up to$1,500,00 and/or one-year imprisonment, as well-as civil penalties'',in the form:of a STOP.WORD ORDER and a time .ip to$250.00 a day_against the violator:.Be advised that a copy of this statement may-be-forwarded to the Office of - .estigations of the DIA for insurance coverage verification. - 9 hereby ce=_une pains and penalties of perjury:that the information provided above is true and correct - attire: Dater 'l t O . )ne#: 5_0�'-a � Official use only. Do not write in this.area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town.Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Iassachusetts General L s: aws chapter 1525equires all employers to provide workers' compensation for their employee arsuant to this statute, an employee is defined as"...every person in the service of another under,any contract of hire, _ rpress or implied,oral or written." --. .n employer is defined as an individual,partnership, association, corporation or other legal-entity,or any two or more f the foregoing-engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the ;ceiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the: - wner of a dwelling house having not more`than three apartments and who resides therein, or the occupant of the _.. welling house of another who employs persons to do maintenance,construction or repair..work`on such dwelling house r on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer.' 4GL chapter 152;§25C(6)also states that"every state or local licensing agency shall withhold the ssuance or, ; enewal of a license or permit to operate a business or to construct buildings in the commonwealth for any.,.,,. Lpplic - 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 _ Inter into any contract for the performance of public work until acceptable evidence of compliance.with the insurance equirements of this"chapter have been presented to the contracting authority." kpplicants 'lease`fill out the workers'-compensation affidavit completely,by checking the boxes that apply to your situation a_nd,if iecessary,supply sub-contractors)name(s),address(es)and phone number(s) along with their certificate(s) of nsurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the nembers or partners; are not required- to carry workers' compensation insurance. If an LLC or LLP does have -rnployees,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 [ndustrial.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: perms cense numbei-which will be used as a reference number.'In addition, an applicant:N that must submit multiplepermit/license applications many given year,need only submit one affidavit indicating,current - policy information(if necessary)and under"Job-Site.Address"the applicant should. "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 -roof thata valid-affidavit is on file for future.permits or licenses -A new affidavit must be filled out each_ year.'Wher e 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 Itle to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. Ile Department's address,telephone and.fax number:- _ The Commonwealth of Massachusetts Department of Industrial.Accidents Office of Investigations 600 Washington Street ° Boston, MA 02111: Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 :wised 5-26-05 www.mass.gov/dia From:Faxserver02 (508)945-4048 'To:Fax#15087905230 Cate:10111f2006 Time:10:59:46 AP4 Page 2 of 2 DATE(MMIDOWYN) ACORDN CERTIFICATE OF LIABILITY INSURANCE 10/11/2006 PRODUCER (S08)945-0393 FAX (508)9145-4048 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Eldredge & Lumpkin Ins. Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 697 Main Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Chatham, MA 02633 INSURERS AFFORDING COVERAGE NAIC# INSURED Steven WRite, _ INSJRERA: National Grange Mutual Ins Co—_ 14788 DBA: Caliber Home Improvement INSURERB: Granite State Ins, Co.-ARWC _ 13102 147 Ridgewood Ave INSURERC: Hyannis, MA 02601 INSURER D: I NSURERE COVERAGES THE POLICIES 0=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,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS" INSR DD T TYPE E OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POL1TCYIMEXPIRATIMlDOON LIMITS _ GENERAL LIABILITY MP027360 09/15/2006 09/15/2007 EACH OCCUP-REWOE $ - 500,00 COMVERCIAL GENERAL LIABILI'-Y DAMAGE TO RENTED $ S00,0O CLAIMS MADE F-1 OCCUR MED EXP(Any one pErson) $ 10,000 A PERSONAL 3 ADV INJURY $ 500,00 GENERAL AGGREGATE S 110001000 GEN'LAGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOPAGG S 1,000,000 POLICY 7 7fi0 17 LOC AUTOMOBILE LIABILITY COMBINED SING-E LIMIT S ANY AUTO (Ea accidcrt; ALL OWNED AUTOS BODILY INJURY $ ECHEDULEO AUTOS (Per pa•scn) HIRED AUTOS BODILY INJURY $ _ NON-ONNEO AUTOS (PersmdDll) PROPERTY DAMAGE $ y---- (Per-accidall) . GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER' EA ACC S AUTO ONLY: AGG $ ' EXCESSrUMBRELLA LIABILITY EACH OOCURRrNCE is OCCUR D CLAWS MADE AGGREGATE $ $ DEDUCTIBLE I $ RLTLNTION $ $ ITORY WORKERS COMPENSATION AND WC2794396 09/20/2006 09/26/2 007 X 'NCsTATU crH- EMPLOYERS'LIABILITY , B ANY PRO-RIETOR/PARTNERIEXECVTIb'E. E.L-EACH ACCICEN' S 100,OO OFF CERA151ASER EXCLUDED? E L.DISEASE-EA EMPLOYEE S 100,000 it yes,ALROV1510NS below describe under SPECI El CISCASE-POLICY LIMIT S 500,000 S OTHER DESCRIPTION OF OPERATIONS/LOCATIONS J VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS CERTIFIQATE HQLDgg CAhIQELLAjION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL Joan Carson 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Mary Jo Thomas an Ca BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY te 138 Lumbert Mill Rd OF ANY KIWORIN THE INSURER. GEIL S OR REPRESENTATIVES. Centerville, MA AUTHORIZ REPRE ACORD 25(2001108) OACORD CORPORATION 1988 Assessor's map and lot'number . . . -- . ,SEPTIC SYSSewage ermit numberTEM MUST BE P ' ..... ..iGv,��.7............... .................4.............. ,i.; INSTALLED IN COMPLIANCE FTBEr c; TOWN OF BALRWl T OWN REGULATIONS. H>HHSTADLE, i a y l b` BU-IL01NG INSPECTOR �O 39• `0� �� . ONLD PYa. G t APPLICATION:FOR PERMIT TO ..........�?.. TYPE OF CONSTRUCTION ....:..... Q........EaP I. ...................... c. .........SJ..v ` ...... ...I.,. .19.22 it TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .......L.ca...#q............ .�1�.f` T........;`'..�.�- ......�<, f .l�. ..'"..0 1�5,:1K:.R.1�.�.�--�-.L............ ProposedUse ................... r L............................. . ........................................... ................................................ Zoning District ...............................Fire District .............................................................................. iAo Name of Owner .Z!EFE.Rlf . .........1Z.Vi . --........Address .............LA.. ............................................. Name of Builder ...........Address ............ .��.� c�?. .l.ekL:......................... . Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ...............�6...............................................Foundation ®u c.e ........... ....... .....:.............................................. Exterior ........... (7�I-BR ......:agI. .....................Roofing ........ .OT L .................................................. Floors `°..........���:��..�................................................Interior ......�.��..�..�pf.w-:.................... Heating �.. AJA ............................................................Plumbing .................................................................................. Fireplace ............ E.c�............................................................Approximate Cost 6 6 �-iOC� V • Definitive Plan Approved by Planning Board -----------_------_-----------19________, y N Area . ...................... s� Diagram of Lot and Building with Dimensions ` Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH I!" 1 OV I hereby agree to conform to all the Rules and Regulations of the Town of.Barnstable regarding the above construction. Name ..... .:............ VVV Smith, Jeffrey 19411 y No ................. Permit for.............2..stor........ single family dwelling ............................................................................... Location Lumbert Mill Road , Centerville ' r ............ .............................................................. Owner Jeffrey Smith - Type ofConstruction .............frame � ............... ... ........... ............ ............ ......................... Plot. ........................... Lot .......... #9.............. 'l. u 'Permit Granted IN, July 19 19 77 Date of Inspection ...� ill 7 Date Completed . . ..� ..............19 T PERMIT'REFUSED - .............. 19 .. .................. . .p............ .e ................................ ........................... T :; ......................... ................................... ........: . .................................................................. r Approved ......................................... ..... 19 ........................................................................... �- ^~ � Assessor's map and lot number TOWN OF BARNSTABLE TAM �`��\�J��APPLICATION FOR PERMIT TO ---.---------------------.---.....—.---.----.—.. - ` TYPE OF CONSTRUCTION __ ...... � ___._____,_____________.. ^ ` | ........ ...... ......... .... . {i.l~~7'� TO THE INSPECTOR OF BUILDINGS: ' The undersigned hereby applies for o permit according to the following information: Location .............. ......�+.Ll............L.\.\��.F\\�.��.-�,,,.�~\.!./..L-_...\.����.r�__.(�..��.L\.-T�Ec.�� .[.\[.L_|^. __._. ^ Proposed Use [. Fk�rT'|.��)__________________________________~________ Znni ng District . .\ ......................................... District ---.--------------_—______ Nome Owner --T\� ����(�F�.�/---5`�A.\.— .��--..A66,eo ---- .............................................. Noma of Dvi|6a, ' `�8���' ..��......S�\ i-T.�f---..A66,eu ----' .k\ .�-�A ---------.. Name of Architect ----------.—.----------.A66reuu --------------------.-------.. . ;� � \Nom6er of Rooms -----L ---------------.Foundohon . .......T ---------------__ Exterior ---''—�/�.�����>—..�\�lU�`.�`L\�-------RooGng --. dJ�\ l�---------------.— ' Floors ---'\.' -T---------------.|nK��r -- �f.. _______________. Heating .......T—\\���............................................................Plumbing ..-------.—.--.r,,,____.______.. ` Fireplace ---_ .��-------------------.ApproximonaCos -- ..C� ___________ Definitive Plan Approved by Planning Board lR----. Area . ' Diagram of Lot and Building with Dimensions ' Fee .....~~ ............................... ^ ' SUBJECT TO APPROVAL OF BOARD OF HEALTH ^- /~^� _ � . � ~ . � ` . . . ' ^ . � - ' I hereby agree to conform to all the Rules and RoQw|oUono of the Town of Barnstable regarding the above construction.-- -~ ) ' Name ..-u.....-..—...—..~—L---. ---------~ Smith, Jeffrey A=168-, ' //S T 19411 1 1/2 story No ................. Permit for .................................... single family dwelling .............,3� Lambert Mill Road.........•...•..• Location ................................................................ Centerville ............................................................................... Owner Jeff.rey. ..Smith .................................. . .... ........... frame Type of Construction .......................................... ............................................................................... Plot ... Lot ...........#9................. Permit Granted July 9 77 Date of Inspection Date Completed ......... .. .......................19 PERMIT REF ED ..................................................... ....... 19 .......... �..�. `................ Approved ........................................:....... 19 ............................................................................... �4 W. q SILL L-E.V..-- _ - «.rt7c3U� GOAD L 0CA r/O/v : C' n/T SCALD r� l U '-ZD,.4T& pGAN 2�F� i2Cn/CE : PSG/n/f LCST AI {` --,5-. I .NE,eEOY CE.271FY' THA T 7,y�E EXI.sr- y' q iN r` G F0UVDA7-10&1 LOC-47T1Q,v 15 0OZZ4 Co,.",-O,e"y wlrq ~��$��`��^. ° Tt>!E SC//LD/NG SETL•3AC.L�,�'EQUiPEM�t/f Of 7 46 TOWN .. �.r�tl. a f f t.a� � i,F ,,•+r �---.�--�'"c'��.t, {x�✓,,?-„��..'".'��..� r 9 !�/7GL0lt/ST. Y.42Mt7uT�/GOQT MA. %ES7 L/OL L S IaO(:r,> A 14 vV n / TD P/T� / ✓v - • r /8. 3 i /6 do , N Its Ei►.5� !y Ao ,v W f46v, 6. 3 vo /�/4Paz f G_— c 0Li rE:2 J ► 2- 6� TEST DGwE w x T 7 T-��7- t TEST Ho.T� 3C- /A/ 5 TALC E %� 2 le ZVC 4roA?. /QES UL T Assessors`offioe Nst floor) Assessor':, map and lot number .....�11;110f.- .�........... SEPTIC SYSTEM MUST BE Q�pf TNFBoard of TOE` Sewage Permit(3rd floor):umber............. �.-... .o. ..... (INSTALLED IN COMPLIANCE g � •E: VViTH TITLE 5 Z BasaSTADLE, . Engineering Department (3rd floor): 8 KA I k�e9 CNMENTAL CODE A`d���V '°o +�639• \0� House number ..:.............................. ....�.�....:..�................. '°� d• REGULATiOWS 0vo 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 .....ZW409.......... TYPE OF CONSTRUCTION ...4,"—A.C.V.........s 7K2.7�(� ............. &1. X ........4-.Iff P............................. ...................19L1../ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according /to/the following information: r p Location .......13..9 ......4.P/./.,3&F- �.........&.14.6........13.d....................C.. �/Y/�!tV qC ................ ProposedUse .....(.1. .6f.N `.i..7-/A4 ..............................................................:.......................................I......................... ZoningDistrict ........................................................................Fire District ................................................................................ u Name of Owner :� .......:....c.�/..l.�I�L....................Address 1r3..�...�...4)1X8V�S../rG 4.&R-.....Op, Name of Builder . ......smatfte.....C i............Address .... Name of Architect .........1 /. l.(-r�b -.........f� .S...Address .................................................................................... Numberof Rooms .................................................................Foundation .............................................................................. Exterior ....................................................................................Roofing .................................................................................... Floors ......................................................................................Interior .................................................................................... Heating ..................................................................................Plumbing ........................................... Fireplace ..................................................................................Approximate Cost ....1.,.)1-4 .00.......................................... x/� 17 Definitive Plan Approved by Planning Board --------------------- -------19-------- . Area /.�?Q„�i ........ .. Diagram of Lot and Building with Dimensions fee SUBJECT TO APPROVAL OF BOARD OF HEALTH 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 . • . . .... ............................................. i Construction Supervisor's License .40.lP.. 613......... Smith, Jeff No3070.3......... Permit for ...................................swinmin g pool. ...... . ......................................................................... LA ation ...........138 Lumbert Mill Road ..................................................... ..........................Centerville.............................. Jeff Smith Owner .................................................................. Type of Construction swimming pool swimming......................... ...................... ........................................................ Plot ....................... ..... Lot ................................ .-Permit Granted ..........My..5..........1;1.......19 87 Date of inspection ........................ .............19 Date Completed .......................................19 CU M U ir Assessor's offioe (1st floor): o, _ THE Assessor's map and lot number .....��,1/�'. ........... .� Board of Health (3rd floor): WP o w � Sewage Permit number ...........,7 .:...y .7..... .. ' ' .:"" Z BAH39TLBLE, i Engineering Department (3rd floor): +ao NAB& 1639. 0� j House number .................................:�..............rg E� i......... �c maY APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE�S$ . BUILDING INSPECTOR y r,- APPLICATION FOR PERMIT TO .....eiJ4P........../+ P X.. /�. �� ,.. TYPE OF CONSTRUCTION -lg�. ..........� C ......... P/&.r��:........ ./. �.............................. 7!�7..a5...-----.... •---- .....19 . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to/the following information: ��! p Location ......1..:—f.....14.4 . 1630.1 1,. .........$.../?1�-(.........�� .....................��/`//,�!L��L�� ................................... Proposed Use � � � • p ......................6......... ZoningDistrict ...................................................�./....................Fire District .......................................�..r................................... Name of Owner Zf—!�............:5.&/.7/7....................Address J� ��.. .�� �V Name of Builder R.tq..Y.........5P.1#�.. jV.... A...........Address Name of Architect ......... 1.McT"t .........�� .— ....Address ..................... Numberof Rooms .."..............................................................Foundation ....................................... Exlerior .......................`............................................................Roofing .................................................................................... �F Floors .....................................................................................Interior Heating ..................................................................................Plumbing .................. .................................................. Fireplace .............:....................................................................Approximate Cost .... ................................\........ Definitive Plan Approved by Planning Board _____________________________19_______ . Area ...'X.:l:.!o...:....... Diagram of Lot and Building with Dimensions Fee SUBJECT TO .APPROVAL OF BOARD OF HEALTH 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 .C.. L ..<! ............................................ Construction. Supervisor's License ......... J Smith,,- Jeff A=168-115 No 30703 Permit for swimming pool ............ .................................... r .................................................................. Location 138 Lumbert Mill Road .................................................... Centerville ............................................................................... Owner Jeff Smith .................................................. Type of Construction ....,swimming pool ............................................................................... Y Plot ............................ Lot ............................. 1 . Permit Granted ..........11FU..S..................19 87 't Date of Inspection ....................................19 Date Completed ......................................19