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A i'b A ,� , �I- F � ��, !.,. .., _ I , , �­ 1 QJ"i jj:n,�,, , F��, : -" � ��':,�,,,_,�,,"�f �­�,� ­", ��__`;_.'_ , !:�411"�A'Y"11'111', , � __ �:t:,�_o_2,�,.,�", � - �l �.i:;. ;40 I , Vol whia i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel O i3 Application #0) Health Division Date Issued P�S /q Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Village z��- 1ZL,� Owners V2 Address Telephone 4_z F 1!9 1g l 3 Permit Request lZ �' .l,Q�ei� 1Z�f'z' G'/�9�✓ / /`��� ,J'� a�® � � Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type—/ Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ANo On Old King's Highway: ❑Yes RNo Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing U new size _Shed: ❑ existing ❑ new size — Other;_ ..._._ d� _ _* _ - .10, Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use - --- Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name4wz C'e./ ��d� �f��/ Telephone Number Address �� �� � ��� License # Home Improvement Contractor# 5 3"5 G Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED i4.• MAP/PARCEL NO. e' t �r ADDRESS VILLAGE OWNER r:. t DATE OF INSPECTION: ,FOUNDATIONo -i, ,: ajI C =t FRAME INSULATION•Ul l! . -;IA F &, -, FIREPLACE ELECTRICAL: ROUGH FINAL ,f PLUMBING: ROUGH FINAL c, GAS: ROUGH FINAL FINAL BUILDING' DATE CLOSED OUT ASSOCIATION,PLAN NO. E OWNER AUTHORIZATION FORM( (Owner's Name) owner of the property located at'._ L) �[ (Property Addr , (Pr perty Address) Chereby authorize •(Subcon r or) an authorized subcontractorfor ASE Engineering,to act on my behalf to obtain a building permit and to perforrn work on my property. er's Signature t Date. Commonwealth ofMassachusetts 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/Organizadon/Individual): �• � �, Jam' �� �o Address: City/state/Zip: ��- Are you an employer? Check the appropriate box: L q I am a employer with 4. ❑ I am a general contractor and I Type of project(required): employees (full and/or part-time).* have hired the sub-contractors . 6• ❑New construction 2.❑ 1 am a sole prbprietor 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' I 9. Building [No workers' comp, insurance comp. insurance. ❑ g addition required:] %5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have'exercised their . I LF1 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL insurance required. t C. 152, 1 4 and we have 12.❑ Roof repairs � § ( )� a no 3a.❑ I am a homeowner acting as a employees. [No workers' 13.0 Otherl,i- general g contractor(refer to#4) .comp.insurance required ]. . An applicant y pp cant that checks box#1 must also fill out the s- ection below showing their workers'compmsatio0olicy 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. tcontractors that check this box must attached an additional sheet showing the name of the sub-contactors and state whether or not those entities have employees. if the sub-contractors have employees,they must provide their workers'comp.policynumber. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. 'Insurance Company Name: Policy#or Self-ins. Lic. #: /�C.9�i Expiration Date: Job Site Address:' ,(`o Y, q �,A„ ! Z ., �,.._City/State/Zip: i Attach a copy of' f the workers' compensation policy declaration page(showing the policy number and expiration date). I 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 u!�W the p�and penalties of perjury that the information provided above istrue and correct Sizna Date: 4 ;?.T `74-' Phon #: Offlcial 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): L Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical)inspector 5. Plumbing Inspector 6..Other Contact Person- Phone#• V , x REY CAPECOD•27 KLIGETT CERTIFICATE OF LIABILITY INSURANCE DATE(MMIODIYYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER 1THIS 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 pollcy(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 Ileu of such endorsement(s), ;000CER CONTACT r 1 ers&Gray Insurance Agency, Inc, NAME: Barbara DeLawrence NE Rt8 134 PHONE � F�--_._._. uth Dennis,MA 02500. E•MMAIL—' AIC No; 877U 816.2166 DD ES: bdelawrence ro ers ra .cam — INSVRER(SI AFFORDING COVERAGE NAIC H INSURER A:Peerless Insurance Company R D INSURER 8:COMMERCE INSURANCE COMPANY Cape Cod Insulation Inc INSURER 0:Evanston Insurance Company 18 Reardon Circle South Yarmouth, MA 02664 INSURER D:ATLANTIC CHARTER:INSURANCE GROUP _. INSURER E INSURER F 7 ERAGES CERTIFICATE N UMBER; REVISION NUMBER; I DIIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD ICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS R;TIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT,TO ALL THE TERMS, C USIONS AND CONDITIONS OF SUC__H POLICIES.LIMITS SHOWN MAY-HAVE BEEN REDUCED BY PAID CLAIMS. ....__.•---'TYPE OF INSURANCE POLICY NUMBER MO ICDY EYF MMIpC1YEXP — X COMMERCIAL GENERAL LIABILITY LIMITS ' I EACH OCCURRENCE ' $ 11000,000 l CLAIMS-MADE L X� OCCUR CBP8263663 0001l2014 04/01/2015 TO �Nrt 6— z P EMISE�(Ea occurrence) $_ 100,000 MED EX P Any one person) $ _ 6,000 G N'L A PERSONAL&ADV INJURY $ 1,000,000 � GGREGATE LIMIT APPLIES PER; NERAL AGGREGATE $ _ 2,00.0,000 POLICY l PRO. GE I J£CT LOC OTHER PROOUCTS_COMPIOP AGG $ 2,000 000 AUTOMOaILE LIABILITY $ Coll E SINGLE LIMIT _LE'acci an $ 1,000,000 I ANY AUTO 14MMBCKVMK 04/01/2014 04/01/2015 BODILY INJURY(Par person) $i ALL OWNED SCHEDULED _ !.. AUTOS X AUTOS60DILY INJURY(Par accidarn) $ HIRED AUTOS X NON•04VN£D F A_TOS PROPERTY pAMAGE_— --"� e Per accide I $ ` )( UMBRELLA LIAR X OCCUR - $ Excess uaa CLAIMS•MADE XONJ463514 04101/2014 04/01l2016 EACH OCCURRENCE $ 1,000,000 DED X RETENTION 10,000 AGGREGATE WORKERS COMPENSATION A gregate $ 1,000,000 AND EMPLOYERS'LIABILITY PER OTH• ANY PROPRIETORIPARTNERIEXECUTIVE YIN WCA00525904 „ 06130l2014 06/30/2015 TA TE ER OFFICERIMEMBER EXCLUDED? N I A (Mnndalory In NH) E•L.EACH ACCID� ENT g — 1,000,000 II Yes,describe under , E.L.DISEASE•EA EMPLOYEE $ 11000,000 c On SCRIPTION OF OPERATIONS below 1 1 E.L.DISEASE•POLICY LIMIT $ 1000,000 , 9RIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORO 101,Additional Remarks Schedule,may be attached If more apace Is required) ~ kerb Compensation Includes Officers or Proprietors, 110 a(Insured status Is provided under the General.Liability and Auto Liability when required by written contract or agreement with the Certificate Holder, *Massachusetts -Depattm$nt of P biic Safety° 136ard of Buildirjg Regulations nii Standards F Constniction Supenisor License: CS-100988 HENRY E CASSIVY 8 SHED.ROW A WEST YAI2MOU`171-1 2` Expiration-, Cammissianer 11/11/2015 Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 =° Boston, MassachLisetts 021161 Home Improvement Cod for P .�;, G Registration , Registration: 153567 Type:. Private Corporation Expiration: 12/15/2014 Trf# 233831 CAPE COD INSULATION, INC HENRY CASSIDY " 18 REARDON CIRCLE SO. YARMOUTH, MA 02664', „ I Ir Update Address and return card. Mark reason for change. •.I-] Address D Renewal U-Employtnent Lost Card '�i;,/(�c.norrrcuru cacrll� c�'G�?'I�tJJccc�udelG Uffitc ul l'unsuuaer Affairs 8 Business Regulutiu„ License or registration valid for individul use.onfy , OME IMPROVEMENT CONTRACTOR , before the expiration date. If found return to: f egistration: 153567 Type: Office of Consumer Affairs and Business 12ebulation• xplration: 12/15/2014 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 r APE COD INSULATION,,,I(�lC,r _ IENI�Yi CASSIDY _ 8 REARDON CIRCLE -� 0 YARMOUTH, MA 02664A(v — j Undersecretary ' itho t nat re r� ;1 SHED REGISTRATION location of shed(address) Gf 2� property owner's name size of shed Z' ;i-gn �7 ature date Old King's Highway Historic District Commission jurisdiction? THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN t, tea. ----- . '''• ' tom•.. 1, »�;"- `� �' _�. ,3 528 / i 3 3.�% o �• 53.9 i 53. 2611� } 52e3 34 5 " 1 y 5 1.9 ', y 46. ,< 51.7 I 102 �\4� i _� \ ` •e TOWN OF BARNSTABLE Permit No. -----------------------_--------- { »n..� Building Inspector rua Cash ---------------------- --- OCCUPANCY PERMIT Bond ---- ------------_---_---- "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Address i'+BTS 1 f7ItS i it l l.; Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. .........................................._................................................................. Building Inspector Assessor's map and lot number .,! /....�..../•. ..• SEPTIC SYSTEM MUST BE c��Jy c G INVALLED W COMPLIANCE Sewage Permit number ............................... WITH TITLE oFTHETo, TOWN OF BAR =kE - � :. Z B9BBSTOBLE, i "6 0 M a' �BUILDIN-11G INSPECTOR PY APPLICATION FOR PERMIT TO ... .. ...... I .... TYPE OF CONSTRUCTION ......... ' . // A .....b.. �.��.........................19 TO—THE INSPECTOR`OF-FBUILDINGS: The undersigned hereby applies for a permit according to the fo lowing 'nformbti Location ..... .. ! ......Q..G.T...... f ......s ..!................ .. . �.1.. `.. ........................... .................... Proposed Use .ti. /"... p,6..1 ...... ...... .. .. ....... ......... ..... Zoning District .......I4. .C.....�.......... .......... . ........................Fire District ................. .. .. . QA. Name of Owner ... . .. ... ........................... Address ..................................... . .Name of Builder .........`.........................................................Address 1 ` ..............1..`. l� ..........!Name of Architect ......................... ...........:..........Address .................................... ..................................:.. I t� Number of Rooms ........�...................................................Foundation ....1.d..... .4(A...................................................... Exterior .... k...........................Roofing ....... s..P..L .. ................................................ Floors ..... ..... . ................................................................Interior ....... /Z:�`..�J.���.1. � . .. ..... ...................................................................... .. zk.\ ...............Plumbing � Fireplace ...Approximate Cost of ct--5-o /.............................. ........................ �� Definitive Plan Approved by Planning Board -------- ----�-'-.-----___19-2—L. Area ........!.....�.goC)......................... Diagram of Lot and Building with Dimensions Fee J � SUBJECT TO APPROVAL OF BOARD OF HEALTH 47,,Ll-,A I hereby agree to conform to all the Rules and Regulations of the Town of Barnstabl re rdin he above construction. Name .. ti DELANEY, JOHN r' No 2.2. $.Q.... Pelmit for•Bui1d..1...Sto.ry......... ingle,•Fam . ,1'..AY,���,�.�.1�g.............. _. Location ..Jaat...U-16...4.4.4..Nn t tin.gham...Dr Centerville Owner John...Delaney.............................. ' Type of Construction Frame ................................................................................ y Plot ............................ Lot ................................ I } June 19, : gp 1 Permit Granted .............. ..........I...............19 - Date of'Inspection ... .. ...I .�........:19 Date Completed .�o. . .. ...... 19 i } PERMIT REFUSED k .....M....................................... Q, ...._ . •/ .» a. Appteved ................................................ 19 - r � .......... ............................. y. .. x .. - > - _ - . _ -1 .. _ .. - t• f : % . V V /-,/ , / .r _. 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