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Town of Barnstable *Permit#;;�LL
Expires 6 months from issue date
XoPES PERMIT Regulatory Services Fee .�y
Thomas F.Geiler,Director
JUL - 6 2007 Building Division
Tom Perry,CBO, Building Commissioner /
TOWN OF BARNSTABLE 200 Main Street,Hyannis,MA 02601 7/17/6�
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
`� Not Valid without Red X-Press Imprint
Map/parcel.Number ! l I �
Property Address t V1 r^
Z 00
[V�Residenri _al Value of Work Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address r'QnC1<- TC)L$48.cb
TContractor's Name 1Inc • Telephone Number 0`$'_&4GL- 0114qq 5
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable)
VWorkman's Compensation.Insurance
Check one:
❑ I am a sole proprietor
I am the Homeowner
I have Worker's Compensation Insurance
Insurance Company Name Q(`� .1.1��{t e l��(�.�'�Tc�' lnk1 . LSO.
Workman's Comp.Policy# LJCC,rho RA54p i rg 6r-0
Copy of Insurance Compliance Certificate must be on file.
Permit 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. U-Value �.?J (maximum.44)
'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: erty Owner must 1. P perty Owner Letter of Permission.
0-
Impro en ontra ors License is required.
SIGNATURE:
Q:Forms:expmtrg
Revise071405
Date: :/3/2007 Time: 3:59 PM To: H 9,15083626115 Dowling ✓t O'Neil Page: 001-002
Client#:9742 2BAKERAS
ACORM CERTIFICATE OF LIABILITY INSURANCE o5fo�"""
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Dowling&O'Neil Insurance ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
Agency HOLDER.
THE COVERAGE AFFORDED BY THE POLICIES BELOW.
973 lyanough Rd., PO Box 1990
Hyannis,MA 02601 INSURERS AFFORDING COVERAGE NAIC it
INSURED INSURER A Harleysville Worcester Insurance Co.
Baker&Associates,Inc. INSURER a Associated Employers Insurance Compa
P O Box 923
INSURER C:
Centerville,MA 02632-0071 INSURER D.
INSURER E
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY RECIUIREMENT,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.
LT TYPE OF INSURANCE POLICY NUMBER DATE fROMMY1 DATE(MWDOjYYj POLY EFFECTIVE POLICY EXPIRATION UNITS
A GENERAL LIABILITY CB831748 "19107 "1901 EACH OCCURRENCE $1 W0 000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $100 000
CLAIMS MADE a OCCUR MED EXP(Any one person) $5 000
X PD Ded:250 PERSONAL a ADV INJURY $1 000 000
GENERAL AGGREGATE $2 WO 000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $2 000 WO
POLICY PRO- LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
ANY AUTO (Ea a ciderd) $
r
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Par persmr) $
HIRED AUTOS
BODILY INJURY $
NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE $
(Per accident) -
GARAGE LIABILITY AUTO ONLY-FA ACCIDENT -$
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR ❑CLAIMS MADE AGGREGATE $
DEDUCTIBLE $
RETENTION $ $
_ B WORKERS COMPENSATION AND WCC5002454012007 "23107 042M X I WC STATU- OTR
EMPLOYERS'UASI ITY -
ANY PROPRIETOWPARTNERIEXECUTIVE E.L.EACH ACCIDENT $1 OO OOO
OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $100 000
If yes,describe under
SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500 000
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Insurance coverage is limited to the terms,conditions,exclusions,other
limitations and endorsements. Nothing contained in the certificate of
insurance shall be deened to have altered,waived,or extended the
coverage provided by the policy provisions.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Town of Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL _—U_ DAYS WRITTEN
Thomas Perry NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO SHALL
200 Main Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR
Hyannis,MA 026M REPRESENTATIVES.
AUTHORIZED RESENTATN
C.-27
ACORD 25(2001108)1 of 2 #47454 JV a ACORD CORPORATION 1988
The Commonwealth of Massachusetts
' Department of Industrial ial Accidents "
Office.of Investigations' ' "
600 Washington Street
Boston,MA 02111
www.massgov/dia
Workers' Complensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information i Please Print Legibly
Name (Business/Organization/Individual): �Q �' `►' A4bC_,(D(,- IQ.+C,�:, e
Address:
City/State/Zip: AA(a-3a Phone#:
Are ou an employer? Check the,appropriate box:. Type of project(required):
1.9J I am a employer withrJ 4. ❑ I am a general contractor and I 6. ❑New construction
employees(full"and/or part-time)-* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet.$ 7• ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp.insurance. 9. ❑ Building addition
o workers' insurance 5. ❑ We are a corporation and its
� comp. 10.❑ Electrical repairs or.additions
required.) officers have exercised their
3.❑ I am a homeowner doing all work right of exemption per MGL ME] Plumbing repairs or.additions
,152 4
myself."[No workers'-comp. � c. §1O,and we have no 12.❑ Roof repass
insurancerequired.]t employees. [No workers' 13.[ Other .
comp.insurance required:]
'Any applicant that checks box#i must also fill out the section below showing their workers'compensation policy information:
Homeowners_who submit this affidavit indicating they are doing all work and then hire outside contractors must.submit a new affidavit indicating such.
ContractDrs that check this box.must attached an additional sheet showing the name of the subcontractors and"their workers'comp.policy information.
am an employer that is providing workers compensation insurance for my employees.'Below is the policy and job site
nformation.
nsurance Company Name: ► U)o f-
?olicy#or Self-ins.Lic. #: 1OCC SOo ag S 401 60-1 Expiration Date: AIa l�a
lob Site Address:?J(9� ►"1 City/State/Zip:
kttach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
aihire to.secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
ine 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
)f up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of
nvestigations of the DIA for insurance coverage verification.
'do hereby u d the pains a pen ties of perjury that the information provided above is true and correct.
>' ature:. Dater S
'hone#: 5�U' _ c9a'
Of,j`icial use only. Do not write in this area,to be completed by city.or town official
City or Town: Permit/Lkense#
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#:
Board of Building Regulations and Standards License or registration and for indh idol oot onk
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found reUtr�T to:
Registration: 118494 Board of Building Regulations and Standards
Expiration: 2/1l2009 Tr1t 126302 One Ashburton Place Rm 1301
Boston,Ma.02108
Type: DBA
BAKER CUS I OM ALUM 8 VINYL INC. f Y } }
-f—
MARK BAKER
� ! r
521 SHOOT FLYING HILL RD.
CENTERVILLE,MA 02632 Adminisaator Not valid without signature
...�� C!C✓iJFa)7�72fll+eU.{��L !/f c_'IGX.:k3�Li'f2f14£�F
Board of Building Regulations and Standards
r.
Construction Supervisor license
t_tP": CS 74.417
Birtht4ate. :1/6/1973
EX15irdtiOttr V6120Q9 Tr* 8139
Restrtatton. 00
BRETT J BUSSIERE'`
111 WAREHAM LAKE SMORE C
EAST WAREHAM,MA 02538 Commissioner
ofE Town of Barnstable
Regulatory Services
Thomas F.Geiler,Director
Building Division.
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA b2601
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, V-ray)G IS �)o UZ ,as Owner of the subject property
hereby authorize Le t `J to act on my behalf,
in all matters relative to work authorized by this building permit application for.
c�
( ss of Job)
Signature of Vwner Date
Print Name
yd
sor's Office(1st floor) Map /"71 :Parcel 0 c?'b Permit#
Conservation Office(4th floor)(8:30-9:30/1:00-2:00),. Date,ssu
Tec'� Q" ®a� QI J
, �.
B and of Health(3rd floor)(8:15 -9:30/1:00-4:45)
Engineering Dept. (3rd.floor) House# ;j�� d rnE rq
Planning Dept. (1st floor/School Admin. Bldg.) ,
RNSTABLE. `
Definitive Plan Approved by Planning Board 19 a 9.
TOWN OF BARNSTABLE
Building Permit Application
Pr 'ect t t ddress `
Villa PIA VC?0 V�� 1; )l
Owner iiVl r 6`�o v ddress �.G G\y; �_ ��►�- �1�t 4 /�.�
Telephone
Permit Request ® ' ZForp
P
First Floor square feet
Second Floor square feet
Estimated Project Cost $ ��6 a
Zoning District Flood Plain Water Protection
q
Lot Size Grandfathered ?
Zoning Board of Appeals Authorization Recorded
Current Use Proposed Use
Construction Type
Commercial Residential
Dwelling Type: Single Family Two Family Multi-Family
Age of Existing Structure Basement Type: Finished
Historic House Unfinished
Old King's Highway
Number of Baths No.of Bedrooms
Total Room Count(not including baths) First Floor
Heat Type and Fuel Central Air Fireplaces
Garage: Detached Other Detached Structures: Pool
Attached Barn
None Sheds
Other
( Builder Information
Name Telephone Number 1 °2. T�
Address License#
V41 v 04 a • Home Improvement Contractor#
Worker's Compensation#
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRUCTION D BRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
� S
SIGNATU DATE /0 /G
BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S)
FOR OFFICIAL USE ONLY
PERMIT NO.
DATE ISSUED
f
MAP[PARCEL NO.
ADDRESS ' VILLAGE s
OWNER
DATE OF INSPECTION: —
. ,
FOUNDATION 1 ,
FRAME
INSULATION
FIREPLACE `
r r _
ELECTRICAL: ROUGH FINAL
PLUMBING,:,, ROUGH FINAL '
GAS: 7 "�n t ROUGH FINAL
FINAL BUILDING `
DATE CLOSED OUT
ASSOCIATION PLAN NO. '
, i
The Town of Barnstable
• s�vern�. •peg Department of Health Safety and Environmental Services
Building Division
367 Main Street,Hyannis MA 02601
Ralph Crosses
Office: 508 790-6n7 Building Commissioner
Fa= 508 775-33"
For office use only
Permit no.
i
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the"n=nstrnction,alterations,renovation,repair,modernization,conversio
improvement,.removal, demolition, or construction of an addition to any owner occupied
building containing at least one but not more than four dwelling units or to structures which are adjacent
to such residence or building be done by registered contractors,with certain exceptions, along with other
requirements.
Type of Work: !� ��u Est. Cost 2:r-q
Address of Work:
Oaner.Name:
Date of Permit Application: D
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
Job under S1,000
Building not owner-occupied
Owner pulling own permit
Notice is hereby given that: CONTRACTORS
OWNERS PULLING THEIR OWN PERMIT OR DEALING WtfHt RECi
FOR APPLICABLE HOME IMPROVEMENT W���NOT 142A HAVE
ACCESS
TO THE
ARBITRATION PROGRAM OR GUARANTY FUND
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner:
Date Contractor name Registration No.
OR '
Date Owner's name .
90 model.-.Barnstable
*.rHE
TOWN OF BARNSTABLE
AW ABLL
11639.Ar BUILDING . INSPECTOR
em
Build One Family Dwelling
APPLICATION FOR PERMIT TO ....................................................... ....... ...............
W
TYPE OF CONSTRUCTION .................00d Frame...................................................................................
.................................
............ ..........1923
... .4 ...
TO-Ti-LE INSPECTOR OF BUILDINGS:j
The undersigned. hereby applies for a permit according to the following information:
•
Location ..... ....... .......................
.............
...................................................
Proposed Use Ae.s.ide.n.ti.al...................................................................................................................I...........................
.. .. . ....... .. .... .....
RD-A Centerville-Osterville
ZoningDistrict ........................................................................Fire District ..............................................................................
st I ' .
Name of Owner ...I..N..........orme.....................Homes.............nc....................Address ......Ashley... . Dr.. C.ent.ervi .le................
. ....
.. ....... ..... ..... .. .. ....... ............ .....
Name of Builder Normest Homes Inc', same
....................................................................Address ....................................................................................
Nameof Architect .......ARPB................................................Address ....................................................................................
Number of Rooms ..................6.............................................Foundation ......Po.ure.d...C.onc.ret.e.................................
... .... ....... .. .. ....... ....... ..
Exterior .........411pa..........................................................Roofing ...Asp .lt........................................ .......................... ....... .. ..
Floors .........C.arp.e.t.............................................................Interior .Dr. ywall....... . . ...........
.. ....... .. .. .. ............... .. .................................. ..........
Warm-Air 2 baths
Heating ..................................................................................Plumbing ..................................................................................
$ 20#000i--- -
Fireplace ..........Y!�§�...............................................................Approximate Cost ....................................................................
Definitive Plan Approved by Planning Board -------------—--------------19---------
Diagram of Lot and Building with Dimensions CAM ly
SUBJECT TO APPROVAL OF BOARD OF HEALTH /440
e,
13,1
too
f Loi
N\
C,)
j a:
x
co 4 Z
co La
40
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
.............................
Normest Homes Inc.
No . 16018•. one story
Permit for ....................................
single family dwelling i
Locatio`n��..Nottingham Drive
....................................
Centerville I
a
i
Owner ............Normest Homes Inc. a
......................................................
t1�
Type of Construction frame lr
.........................................
.............................................................o................
Plot ................:. ...................
......... Lot
I � V
Permit Granted March 21 ?3
19
Date of Inspection .. ...... . .. .......
Date Completed .....
.�.... ........19 i
PERMIT REFUSED '
................................................................ 19
I
............................................................................... ,I
a
...............................................................................
Approved ................................................ 19
...............................................................................