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0427 NOTTINGHAM DRIVE
7r I,j PT UP M .MIT w P h� %'AS �gj T� g ,i�j 5l K, !V ;g ti, W W M -�V g� WIN Ar 1A NAM" Ell! 14 "M 1, Hum la-, ....... ,vffi HIS, ,pi'f 's A I emggg 6fi- g) r? ng F;� 0, i,Y1 t,$WV1 "A WON R",V ti . .... 1"" `511 AV 10e ""A It 1"', wV 41 f -g a yNT S psi EMU YAQ .7 4� "7W 21,U X.0 *�g 0 AW. 10 I Iwo; N 411, 15 ,1 P ®r _10�1,g V mot vivo All QTPA", KIM Wool NAMIFArn pvi 0,1A, -1. 1 M I XLI;1, -, `� ""'!-�,.�;.,.,,, -saw" PTI �,%N nh Alamos woupy—anygy A."', P 5N 140was Rom '57 "WO-3 Svc T� "?��l M off met ""PUNT. Tub MAN man, bu 'tt ViT usawng TWOM U AN Q lo I A. Aq' i VX� Er "Mum �,q XIT,_Vi". I r. , __. ., 'I; ��;l OEM " M t !i. rv, AIMS,qwg"M.�wwn 47 IN get 'A' q, w 'WPM 505 R, ,j �AIU by �,,l 1!"�qu ............ -!?— Application number.........................fL` Y. jl P Date Issued.....Q.....J.. ....................................... $ARN1sTABLE, a MASS. , 0118 Building Inspectors Initials....:............... . WN .....clt,,�iAA O Map/Parcel.....�.`� . ...� 5..........................O�. 8,AHNSAB' LF .... TOWN OF BARNSTABLE � . E3'EDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION. PROPERTY MORMATION Address of Project:._�/a 7 A/o r,ha�►, C'--7 r,-✓;!l o NUMBER STREET VILLAGE Owner's Name: her-r _ F,+Za'era ( CI Phone Number 7 7q-,.-7 ,7 7- Email Address: _c 1,7 +Zeco,,.,ca S4 Cell Phone Number Project cost$ .q 3 P O -- Check one Residential 4 Commercial OAR'S AUTHORIZATION As owner of the above property I hereby authorize . to make application-for a building permit in accordance with 780 CMR Owner Signature: Sep �-f(a`�n C�cs+,-{YG c-� Date: v TYPE OF WORK 0 Siding FI Windows(no header change)# Insulation/Weatherization EEI'Doors(no header change)# I Commercial Doors require an inspector's review v Roof(not applying more than 1 layer of shingles) t Construction Debris will be going to _ was4e=/''1GiIa e��P� - of s CONTRACTOR'S INFORMATION Contractor's name fi(*;an `7�n�t,'so Sov rn -�J� Fri levy S Home Improvement Contractors Re istration' if a'applicable)# !7 3 2.�[5 (attach co P i (� PP ) PY) Construction'Supervisor's License# yl S�70' (attach copy) Email of Contractor Phone number=l 01- Z. Z R - goo ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF TIME SUBJECT PROPERTY lS I!v , A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. `` All APPLICATION NUMBER............................................................ *For Tents Only' 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 pf food is being served at your eveni please obtain a Health Departnmeut approval betwea the hours of 8:00am 79.30 am or 3.30 pm-4:30pm. Commercial events may require Fire Department approval *WOOD/COAL/PELLET STOVES x• '. Manufacturer# Model/I.D. Fuel Type - Testing Lab Offsets from combustibles: front back left'side right side HOMEOWNER'S LICENSE EXEMPTIOW . Homeowner's Name: Telephone Number ' Cell or Work number I understand my responsibilities mender 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 PUCATT'S SIGNATURE Signature Date F Fl- /k All permit applications are subject to a building official's approval prior to issuance. I ' r, �R'epnewal Agreement Document and Payment Terms Jlll lde�$en' dba:Renewal By Andersen of Southern New England Robert Fitzgerald ���� Legal Name:Southern New England Windows,.LLC, 427 Nottingham Dr.. ���i RI#36079,MA#173245,CT#0634555, Lead Firm#1237 Centerville,MA 02632 wiNnow qE MCENIENT 10 Reservoir Rd I Smithfield,RI 02917 - - H:7742282077 - Phone:866-563-2235 I Fax:401-633-6602 1 sales®renewalsne.com Buyer(s)Name: Robert Fitzgerald Contract Date: 07/26/18 . Buyer(s)Street Address: 427 Nottingham Dr. Centerville:,.MA 02632. Primary Telephone Number: 7742282077. .: : Secondary.Telephone Number ciairefitz7@.comcatt.net Primary Email: . Secondary Email , Buyer(s)hereby jointly and severally agrees to purchase the products and/or services.of Southern New England Windows,LLC d/b/a Renewal By Andersen of Southern New England("Contractor"),in accordance with the terms and conditions described in.this Agreement Document and Payment Terms,any documents listed in the Table of Contents,and any other document attached to this Agreement Document,the terms of which are all agreed to by the parties and incorpporated herein by reference(collectively,this "Agreement"). , Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under.this Agreement. Total Job Amount: $4,380 By signing this Agreement;you acknowledge that the Balance Due;and the Amount Financed must be made-by personal check;bank check,credit card,or cash. Deposit Received: P Balance Due: $2,921 . Estimated Start: Estimated Completion:, Amount Financed: $U 8 to 10 weeks 8 to 10 weeks Method of Payment: Cash/Check We schedule installations based on the date of the signed contract and secondarily on the date in which:we complete the technical measurements.The installation date that we are providing at this time is only an estimate.We.will communicate an official date and time at a later date:Rain and extreme weather are the most common causes for delay. Notes: Depo paid by check, Bal to be paid by check;-Tax Centerville/Barnstable Buyer(s)agrees and understands that this Agreement constitutes:the entire understandings between the parties and that there are no verbal . understandings changing or modifying any of the terms of this Agreement.No alterations to or deviations from this Agreement will be valid without the signed,written consent of both the Buyer(s) and Contractor.Buyers)hereby acknowledges that Buyer(s)1).has:read this Agreement, understands the terms of this Agreement;and has received a completed,signed,and dated copy of this Agreement,'including ' the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO BUYER:Do.not sign this contract if blank.You are entitled to a copy of the contract at the time you sign. YOU,THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT. OF 07/30/2018 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT.. Legal Name:Southern New England Windows,LLC dba:Renewal y Aid rsen of Southern New England Buyers) Signature of Sales Person Signature Signature Cory Scanlon Robert Fitzgerald Print Name of Sales Person Print Name Print Name UPDATED: 07/26/18 Page 2 / 10 I 0 gee of Consumer Affairs and Business Re lation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 173245 Type: Supplement Card SOUTHERN NEW ENGLAND WINDOWS LL Expiration: 9/19/2018 BRIAN DENNISON 26 ALBION RD LiNCOLN; RI 02665 Update Address and return card.Mark-reason for change. Address _ Renewal - Employment — Lost Card 9ffice of Consumer.Affairs 8 business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: Office of Consumer Affairs and]Business Regulation Registratiort: 173245 T ype: 10 Park Plaza-Suite 5170 Expiration: gj79/2018 Supplement Card Boston.MA 021116 1UTHERN NEW ENGLAND WINDOWS LLC. :NEWAL BY ANDER.SON IIAN DENNISON ram` ALBION RD 4COLN, RI 02865 �-Uodersecreiary Not valid without signature u u, d .3t i L., :le`w'G 0S--095707 BR,:_M D DENNISON `..AMBS POND CIRC E I The Commonwealth of Massachusetts ' Department of Industrial_Accidents 1 Conr ess Street,Suite 100 Boston,M,q 02114-2017 www mass.gov/dia Workers' Compensatibn Insurance Affidavit:]Builders/Contractors/Electricians/Plumbers., TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information . Please Print Le ' 1 Name (Business/Organizanon/individual): ` e Address: �L�lp� City/State/Zip: Phone ,Q/ _ 2�8— Ego Are you an employer?Check the appropriate box Type of project(required):(required): i,XI am a employer with !0 temploym.(full and/or part-time)-* -7 F. ❑New construction 20 I am a sole proprietor or partriership and have no employees working for me in any capacity.(No workers'comp..insurance required.] &- D Remodeling 3.0 I am a homeowner doing all work myself jNo workers'comp.itrsrtrance regrriredl; 9• D Demolition 4.D I am a homeowner and wr71 be hiring contractors to conduct all work on my I will 10❑Building addition ensure that aL contractors either have workers`co property. 1 compensation i>lsur2nce or are sole proprietors with no employees. 11.❑Electrical repairs or additions 5.D I am a general contractor and I have hired the subcontractors listed on the attached sheet IL.[]Plumbing repairs or additions These sub-contractors h2ve employees and have wonder.'comp.tnsurancE= . 13_DRoof repairs 6.D We are s corporation,and its officers have exercised their right of exemptior,per MGL c. L-j4•dOther -6 p 1516)(4),and we have no employees.[No workers'comp.insurance required.] _e /gcP/�'1 e�l� on 'Airy applicant that checks box i91 must also fill out the section below showing the c workers'compensation policy informs rr t Homeowners who submit this affidavit indicating they are doing all work and then hire outside cont actors must submit a new 25d2vit indicating such !Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the sub-contractws have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my emplovees. Below is the policy and job site information Insurance Company Name: `Ire pie l)$ 11is. Policy*or Self-ins,Lic.;`: �,(���3/EQ2"7 Z q Z ExpirauoL Date: Job Site Address Y Z 7` �1 �i �--- City/State/Zip: -� 'tl Attach a copy,of the workers'compensa on policy declaration page(sbowing the policy number and ea anon date). Failure to secure coverage as required under MGL c. 152:§25A is a criminal violatioL punishable by 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 s day against the violator.A copy of this statement may be forwarded to the Office of Investigations of ibe DLA for insurance coverage verification. • I do hereby certify under A aims andpenalties ofperjug that the information provided above is true and correct Signature. Date: - Phone : CIO I- ZZ g —i qe . Official use only. Do not write in this area.to be completed by c3'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. b.Other Contact Person: Phone : f 4r°��® CERTIFICATE OF LIABILITY INSURANCE DATE(MIMIDD"""' 12/29/2017 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). 'RODUCEACONT A COB¢Insurance, Inc.-CO NAME: 1401 Lawrence St, Ste. 1200 PHONE 303-988-0446 Denver CO 80202 E-MAIL aC No•303-988-0804 DDRE : COMaiI cobizinsurance.com INSURER(S)AFFORDING COVERAGE NAIC CURED ESLERCO-01 INSURER A:Acadia Insurance ComDanv 31325 Southern New England Windows, LLC. INSURER a:Firemens Insurance Com an of WA,D.C. 21784 jba Renewal by Andersen of Southern New England iNsuRER c:Homeland Insurance Company of New York 34452 10 Reservior Rd INSURER D: Smithfield RI 02917 INSURER E: INSURER F: :OVERAGES CERTIFICATE NUMBER:1252851165 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. .TTR TYPE OF INSURANCE ADDL SUER POLIO Ew MOLIC EXP YYYJ LIMITS \ A COMMERCIAL GENERAL L1i im Ana POLICY NUMBER IMMIDDIYYYYI 1BILITY CPA3158728 111201E 111201E EACH OCCURRENCE $1000,000 CLAIMS-MADE X OCCUR DAMAG T RENTED PREMISES Ea occurrence $30D,DD0 MED EXP(Any.one person) $10.DDD PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2.000,000 X POLICY D JECT .17 LOC OTHER: PRODUCTS-COMP/OP AGG $2.000.D00 $ A I AUTOMOBILE LIABILITY N CPA-1158728 111/201E 111201E COMBINED SINGLE L1MT X Ea accident $1 0D0 0W ANY AUTO i ALL OWNED i SCHEDULED BODILY INJURY(Per person) $ AUTOS ALTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED i PROPERTY DAMAGE AUTOS Per accident $ A � )( UMBRELLA LIA6 N OCCUR CPA315872f 1/12016 111201E EACH OCCURRENCE &1D.ODO,DDO EXCESS LIAR CUR AGGREGATE $10.0M.0DD DED I X I RETENTION$ E WORKERS AND COYERS'LIABILITY YIN OMPENSATION WCA315S/2520 V1201e 111201E X SPER TATUTE ERA ANY PROPRIETORIPARTNERMXECUTIVENB OFFICER/MEER EXCLUDED? NIA I E.L.EACH ACCIDENT $1,000,000 (Mandatory in NH) F yes describe under E.L.DISEASE-EA EMPLOYEE$1,o00,D00 DESCRIPTION OF OPERATIONS beim, EL DISEASE-POLICY LIMT $1,100.000 C Mubs M Li;tebiPd 79MO73340000 1n201e 111201E I Each Occurrence $1,000;ODO Claimade icy Retroactive Date 06202013 Made $1p 00 D rESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule.-may be attached'rf more space is required) ;ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. For Informational Purposes AUTHORIZED REPRESENTATIVE 74 ©1988-2014 ACORD CORPORATION. All rights reserved. ',CORD 25.(2014/01) The ACORD name and logo are registered marks of ACORD Town of Barnstable *Permit# Expires 6 onths rsue date yT latory Services Fee RMWffrABM i ♦ Q � MAMS& ,a 0 0D 0 o omas F.Geiler,Director p 1639. 1 , tFp Building Division 1G Tom Perry,CBO, Building Commissioner eet,Hyannis,MA 02601 ::gw. own.bamstable.ma.us Office: 508-862 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address A p7l_\� e4 vv�` 'Z Residential Value of Work s 5 C� Minimum fee of$35.00 for work under$6000.00 T Owner's Name&Address r .1�01 Ve Contractor's Name . v ��e_ Telephone Number t;O_SL!J -3'�(a( Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) OAS Q'J"` ®Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ® I have Worker's Compensation Insurance Insurance Company Name j V����rS Workman's Comp.Policy# V - Ro% — 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`�Z_j;)t.-k o ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows ❑ 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 the Ho e I rovement Contractors License&Construction Supervisors License is required SIGNATURE: Q:\WPFILES\FORMS\building permit formsU2RESS.d c Revised 053012 I Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor _. License: CS-035037 DEAN F STANLE 359 CAPTAIN LI3V321 Centerville MA 0 .A iar.�` Expiration Commisssionne'r' 01/19/2016 - .- -- Q9L09 Toorr�nzaraurea�G�o�C/�aaoac/u�el ' License or registration valid for individul use only Office of Consumer Affairs&Busi ess Regulation g Y 3 ME IMPROVEMENT CONTRACTOR before the expiration date..,If found return to: II UVepi stration 132149 Type: Office of Consumer Affairs and Business Regulation iration 11128/2014 Individual 10 Park Plaza-Suite 5170 _ Boston,MA 02116 DEAN F.STANLEY t ` r r DEAN STANLEY 359 CAPT.LIJAH RD _ `CENTERVILLE, MA 02632 ' s I Undersecretary I Not valid without signature h► The Corr moms=eaUh,of M'erssadjusetts Dgwrtment of Indushial Accidents r— ' (?,ice of, Investigations - 600 Washington Street K-, Boston,AL4 02111 r vl ww.massg . ov1dia Workers'=Compensation Insurance.off davit: Bui]ders/Contractors/E�lectiicians/Pbimbers Applicant Information \ Please Print L . 'bh Name(Budwss/organizahonIIndividuat): \2 Addlt's5: CityfStatelZip:�� �� e` Pl.cyne# A ` -_ Are you an employer?Check the appropriate box:: . Type of project(required): 1. I am.a contractor and I �I am a employer with_i _ ❑ � G. 0.New construction employees(full and/or part-time).* have hired the sub-contractors 1❑ I am a sole proprietor or partner- listed on the attached sheet, 7- ❑Remodeling ship and have no employees Thy sub-contractors have g_ ❑Demolition working for me in any capacity. employees and have wo&ers' (No workers'comp.insurance comp.insurance.) 9. Building addition 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 1 L.Q Plumbing repairs or additions myself. [No workers'comp- right of exemption.per MGL 12.❑Roof repairs insurance required.]T c. 152, §1(4),and we have no employees.(No workers' 13.❑Other comp_insurance required.] •Any applicant that checks box#1 roust also fal out the section below showing their workers'compensation policy inf mnstiou. i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating surlh FContracmrs that check this boas.nest attached am additional sheet showing the mime of the sub-coact ors and stare wbe*er or not those entities have employees. Ifthe sub-comtmaon:have employees,they must provide their Wwkers'comp.policy number. I aria an employer that is providing workers'compensation insurance for Hiy amplo wA Below is tine poh(y and join site informadom Insurance Company Name: Policy 4 or Self-ins-Lic.#: U Ak Cow QC Ft " V5 Expiration Date: \(�> — V-� I i a� Job Site Address: JA \� cityfstatelzip:a 'te%(yL, 1\t Attach a copy of the workers'compensation p 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 fora.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 t i _render t_ nd ah es of perjury that the information provide is trine and correct Si Date: t0 Phone official um only. Do not write in this area,to be completed by city or Mom offi ciat City or Town: Permit/Ucense# Issuing Authority(circle one): 1..Board of Health 2.Building Department 3.Cityfroom Clerk 4.Electrical Inspector s.Plumbing Inspector 6.Other Contact Person: Phone#» 6 rp OF tHE lO�Y • BARNSfABLE. « "�: ,�� - Town of Barnstable AT fD MA'I A Regulatory Services Thomas F. Geiler, Director Building Division Thomas Perry,CBO 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 l 1 _e r 4' ; 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 -ah 7 / 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:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 070110 °FIME ram,; Town of Barnstable P� k°^ Regulatory Services BARNSrABLE, ' Thomas F.Geiler, Director 9 MASS. �OrFv3yro`m Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.ba rnsta ble.ma.us Office:. 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be, a one or two- family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws, rules and regulations. The undersigned "homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and.requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 15,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section .109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 070110 DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE FICATE 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 and endorsement A statement.on this certificate does not confer rights to the Certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME: 27JDD PHONE FAX (AIC,No,EXt): (AIC,No): NORTHWOOD ESHBAUGH INS A 540 MAIN STREET E-MAIL HYANNIS,MA 02601 ADDRESS: 73K6G INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA INSURED DEAN F STANLEY BUILDING CONTRACTOR INC INSURER B: INSURER C: INSURER D: 359 CAPT-LUAHS ROAD INSURER E: CE.ITERVILLE,MA 02632 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:THAT THE-OR POLICIES F INSURANCE CONTRACT OR-UTHER-DOCUMENT-WITH-RESPECT-TO.WNICH?TH1S"CERnFICATE MAY-BEISSUEO OR 1i"PPERTAIN.-T.HE INSURANCE-_. _.----- AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR ADD SUB POLICY EFF DATE POLICY EXP DATE UMrrs LTR TYPE OF INSURANCE L R POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) EACH OCCURRENCE Is GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED S CLAIMS MADE 0 OCCUR. PREMISES(Ea occurrence) ED EXP(Anyone person) Is ERSONAL&ADV INJURY Is GEN'L AGGREGATE LIMIT APPLIES PER: ENERAL AGGREGATE is POLICY F-1 PROJECT LOC RODUCTS-COMP/OP AGG I$ AUTOMOBILE LIABILITY COMBINED SINGLE Is ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY Is(Per person) SCHEDULE AUTOS BODILY INJURY Is . HIRED AUTOS (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) EACH OCCURRENCE Is UMBRELLA LIAB OCCUR EXCESS LIAB CLAIMS-MADE AGGREGATE is Is DEDUCTIBLE I$ RETENTION S A WORKER'S COMPENSATION AND we sTATurORY OTHER EMPLOYER'S LIABILITY YIN UB 4869P061-13 10/05I2013 10/OS/2014 X uMITS _ ANY PROPERITORIPARTNERAD ECUTIVE O NIA E.L.EACH ACCIDENT Is 100,000 OFFICENMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE I s 100,000 (Mandatory in NH) If yes,describe under EL DISEASE-POLICY LIMIT I$ 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIRESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIPICATE.HOLDER CANCELLATION KEVIN ELLEN ROCHE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED 101 SHORE DR IN ACCORDANCE WITH THE POLICY.PROVISIONS. AUTHORIZED REPRESENT VE MASHPEE,MA 02649 `�"�. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. v �IIq)1� MAP 148 PARCEL 24 TOWN OF BARNSTARE MAP LU ADAPT l48 F{i : PARCEL 426 ,23 2� PARCEL 23 O b IVI-SaON MAP 148 Nu. PARCEL 25 0. r 0.35 AC.f vt�• ' oEc� 0 o 26' ..... ..'.'.'.. EpP "`�o 10 �pP MAP 148 PARCEL 27 �0 CERTIFIED PLOT PLAN oCE #1 4-2,3 PREPARED EXCLUSIVELY FOR THE PURPOSE OF OBTAINING A BUILDING PERMff, NOT FOR ANY OTHER USE LOCATION 427 NOTTINGHAM DRIVE, CENTERVILLE, MA SCALE : 1" = 30' DATE : 8-13-2014 PREPARED FOR: REFERENCE : MAP 148 PARCEL 25 DE P �ANLEY _NtI HEREBY CERTIFY THAT THE STRUCTURE '{ SHOWN ON THIS PLAN IS LOCATED ON THE DANIEL 'GROUND AS SHOWN HEREON. A f c� OJALA off 1 362-4541 4 ra f.5 Na. 08-362-9880 <a� q ) ,So downcape.com 9 S wa cape eedineeried,im. civil engineers loud surveyors ------------ ------------- -------- --- 939 Moln Street (Rte 6A) YARmoumpORT MA o2675 DATE REG. LAND SURVEYOR 3. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION OF 2 q Map I Parcel V ' '{ Application # I Health Division Date;, Date Issued �l Conservation Divisions Application Fee -::,u Planning Dept. 'F" ^� Permit Fee ed < � Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address ' Village �eNr 0—IN"p t A5-5 �- Ownerl6a� �:�Zge�c`� Address y� Telephone Permit Request \ �. S i 2 tt1,(` t Square feet: 1 st floor: existing\a`b 0 proposed 2nd floor: existing a proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation V1,co VQ Construction Type woo '4�A-M 2- Lot Size •r✓ Grandfathered: RYes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 12� Two Family ❑ Multi-Family (# units) Age of Existing Structure '31 Historic House: ❑Yes allo On Old King's Highway: ❑Yes ❑ No Basement Type: .Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing t new C"� Half: existing \ new Number of Bedrooms: `s existing 4 new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ` 4 Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes *,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 . A new size _Shed:3&existing ❑ new size _ Other: %xZD, Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes A-No If yes, site plan review # Current Use t \� `i m � ` Proposed Use ki" ��e �.,A- APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name • S� rl Telephone Number Address '3 5 \ C- V� License# O'S C7 U Home Improvement Contractor# Email SH '� � y)��oo . Co Worker's Compensation # 'y►$ �y�\�\3 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO�A_ -P uJ ec�lC-A SIGNATURE DATE �`a FOR OFFICIAL USE ONLY APPLICATION# I DATE ISSUED i MAP PARCEL NO r ADDRESS VILLAGE OWNER f r i DATE OF INSPECTION: FOUNDATION 0' '7D2-1)/N PP-00% FRAME PLY Q0:1b 8113 K c INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL P GAS: ROUGH FINAL FINAL BUILDING r DATE CLOSED OUT ASSOCIATION PLAN NO. r 4 2 1e Commornwalth of Vassachuseffs De partrtrertt of�axdrrstizal Accidents - tie of bnvesfigations 600 Washir gtan&reet Boston,,MA 02LII wn7v.7tz ass,gouldia Workiets' CompensatianL urance 4ffitdavit:Builders/ContractorsMectricians/Mumbers AppEcant Infarmation 1 Please Print Le-gibly Name ahminewOrganh atim&dividual): �'• -�'1� ±mac\�e Address: 3tS CA � f� Ci /State/ - ,"-,\� oaCoI2 Phone ���5 -'`�` -jcEfo tY � �P" �. --lire_ an.an_employer?Checktl�apPropriatebaz �_- �;_._._T of o'ect r ape- pr I (egurretl):��__._ I_[ I am a employer with 4_ ❑ I am s.get>eral confractor and I 6_ []New employees(Bill andlorpart.#ime}* ha e �sub`con tractors 2.-❑ I am a sole proprietor or partner- listed on the attached sheet 7- ❑Remodel slnp and have no employees These salt'-Contractors have g_ ❑Demolition working for mein any capacity_ employees and have workers' 9_ ❑Building addition [No workers'comp.irmn—dare Comp_insurauce_l required] 5-❑ We area corporation and its 10_❑Electrical repairs or additions 3_❑ I am a homeowners doing all work officers hai-e exercised their 11_0 Plumbing repairs or additions `myself [No workers'Comp- right of exemption per MGL 12_.❑Roof repairs insurance requirel]t e.1.52,§1(4} and we have no employees-[No urorkeas' 13_❑Other comp-insurance required.] *Any ap Uomt that cbedes boa Wl=A also fill out the sectioa belaw showing Their woAers'compensation paliep:n� rn 1-Homeowners who submit this sffidavit indicating tfiey are damg all warm and then him outside contractors= submit a new;affidacit mX�stina and lauutcsctors test check this b(M must attached on additional sheet shmeing the name of @ie 9b-Mnft3C "and state whether or not tense polities have mployees Ifthe mVcontmctoss have employees,they must provide their warkers'comp.policy number I am an employer that isproiid&W workers'comperrantion insurance for my employees. Belot`is the pone}and}ob sits informadom Iusarance Company Name: Policy#or Self-ins-LiC_k` U (�oq_�� �J Expiration Date: C> Job Site At9d ess: �FoL �c9�� e. Citv/StaWZip: Attach a copy of the workers'compensation p lies ded2ration page(showing the policy number atnd expiration date). Failure to secure coverage as requiredunder 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%il 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 Imiestigations of the DIA for iumn-ance coverage verffication_ 1 I do herebyk inrder t an enalfies ofpetjury tftatifte information pratided above is h7Le and correct Signature: Bate: Phone 9 01uial use only. DJ a not write in this area,to be completed by city or town offrciaL Citv or Town:. PermitUcense# Issuing Authority(circle one): - L Board of Health 2.BnTding Department 3.Citsll'own Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone ff: 6 4 � Information an Instructions Massachusetts General Laws chapter 152 requires all employe to provide workers'compensation for their employees. Pursuanfto this statute,an employee is defined as"_..every pe on in the service of another under any contract of hire, express o lied, oral or written." An employer is defined as an individual,partnership,associ ion,corporation or other legal entity,or any two or more of the foregoing en aged in a joint enterprise,and including e legal representatives of a deceased employer;or the receiver or trustee o individual,partnership,association other legal entity,employing employees. However the owner of a dwelling ho e having not more than three ap eats and who resides therein,or the occupant of the - dwelling house of anoth who employs persons to do main nance,construction or repair work on such dwelling house or on the grounds or buil ' appurtenant thereto shall not ause of such employment be deemed to be an employer." MGL chapter 152, §25C(6)als states that"every state or oral licensing agency shall withhold the issuance or renewal of a license or permit operate a business or construct buildings in the commonwealth for ally applicant who has not produced cceptable evidence o compliance with the insurance.coverage required." Additionally,MGL chapter 152, §2 (7)states"Neither e commonwealth nor any of its political subdivisions shalt enter into any contract for the perform ce of public wor until acceptable evidence of compliance v,rith the insurance requirements of this chapter have been p sented to the c tracting authority." Applicants Please fill out the workers' compensation affida it corn letely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),addre (es and phone number(s)along with their certi.ficate(s)of insurance. Limited Liability Companies(LLC)or L ed 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 a vit may be submitted to the Department of InduzLriai Accidents for confirmation of insurance coverage. Al o b sure to sign and date the affidavit 'l'he affidavit should be returned to the city or town that the application for e p it or license is being requested,not the Department of Industrial Accidents. Should you have any questions gardia the law or if you are required to obtain a workers' compensation policy,please call the Department at th number ed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be are that the affidavit is complete and printt I legibly. The De eat has provided a space at the bottom of the affidavit for you to all out in the event the Offi of Investigations h to contact you regarding the applicant Please be sure to fill in the permit/licease number whi will be used as a re mce number. In addition,an applicant that must submit multiple pennit/license applications any given year,need o submit one affidavit indicating current policy information (if necessary)and under"Job Site ddress"the applicant sho d write"all locations in (city or town)."A copy of the affidavit that has been officially ped or marked by the cr or town maybe provided to the applicant as proof that a valid affidavit is on file for fu e permits or licenses. A ne affidavit must be.'filled out each year.Where a home owner or citizen is obtaining a li use or permit not related to any iness or commercial venture - us a dog license or permit to bum leaves etc.)said p on is NOT required to complete affidavit. The Office of Investigations would Ike to thank you 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 Ma ssachusets Il pait meat of Industual Accidents Office of kvestigaiims 600 Washington Street Bostou,MA G2111 Tel A 617-727-4900 W 406 or 1-a MASWE Revised 4-24-07 F�ix#617-727-7749 w .mass-govfdia �'ME r° Town of Barnstable Regulatory Services awxw rE 0 /"`�y Richard V.Scali,Director �E16 9. A Building Division Tom Perry,Building Commissioner j 200 Main Street,Hyannis,MA 02601 +j www.town.barnstable.ma.us Office: 508-862-4038 Fax: r 508-790-6230 A i Property Owner Must - Complete and Sign This Section f If Using A Builder f II �C n I, OYj / �i p( ��/ ,as Owner of the subject property t , hereby authorize Z�e zt-6 Z�C6 L to act on my behalf, in all matters relative to work authorized by`this building permit application for: (Addre44 of Job)` Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or' utilized before fenceiis installed and all final inspections are performed and accepted. Signature of-0,Vne'f Signature of Applicant Print Name Print Name , Date Q:FORMS:O WNERPERMIS SIONPOOLS Town of Barnstable :t� Regulatory Services �oFztte roty,� Richard V.Scali,Director P U� Building Division t =ARNSTABrE Tom Perry,Building Commissioner mass. 1639• ��� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 5 8-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTI Please Print DATE: JOB LOCATION: numbe street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: \6ire sta zip code The current exemption for"homeoxtended to include owner cc u ied dwellings of six units or less and to allow homeowners to engage an individuo does not possess a lice se,provided that the owner acts as supervisor. DEFINITION OF HO OWNER Person(s)who owns a parcel of lane/sheresides or intends o reside,on which there is, or is intended to be,a one or two- family dwelling,attached or detachaccessory to such use d/or farm structures. A person who constructs more than one home in a two-year period shall not be considere homeowner. Suc "homeowner" shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall responsible f all such work performed under the building ermit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for co ce with the State Building Code and other applicable codes, bylaws,rules and regulations. _ The undersigned"homeowner"certifies that he/she unders the To of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply ' said proc es and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings con ' ' g 35,000 cubic feet or larger will be require o comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any ho eowner performing work for which a building permit i equired shall be exempt from the provisions of this section(Se on 109.1.1-Licensing of construction Supervisors); provi that if the homeowner engages a person(s)for hire to do s work,that such Homeowner shall act as supervisor," Many homeowners w use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,RuIes & gulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious proble , particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the un ' ensed person as it would with a licensed Supervisor_ The homeowner acting as Supervisor is ultimately responsib To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the Iast page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS,doc Revised 061313 } V�ZP� Office of Consumer Aft'airs&Busidess�lat on��i _ License or registration valid for individul use only m_ rgME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:` istration 132149 Type: i Office of Consumer Affairs and Business Regulation piration: 11128/201,4 Individual i 10 Park Plaza-Suite 5170 e = r j DEAN F. Boston,MA 02116 STANLEY .l DEAN STANLEY x a 359.CAPT.LIJAH RD CENTERVILLE,MA.02632-,..:-- Undersecretary ' { Not valid without signature --- Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supersis0r s License: CS-035037 f IS DEAN F STAN�JA E - 359:CAPTAIN Centerville MA1632� �r0A Expiration 01/19/2016 commissioner 1LITY INSURANCE DATE(MM/DD/YYYYI MISS ERTIFICATE 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 and endorsement. A statement-on this certificate does not confer rights to the certificate holder in lieu of such endorsemenUs). PRODUCER CONTACT NAME: 27JDD PHONE FAX NORTHWOOD ESHBAUGH INS A (A/C,No,Ext): (A/C,No): 540 MAW STREET HYANNIS,MA 02601 E-MAIL ADDRESS: 73K6G INSURER(S)AFFORDING COVERAGE INAMIC INSURED INSURER A: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA DEAN F STANLEY BUILDING CONTRACTOR INC INSURER B: INSURER C: 359 CAPT LIJAHS ROAD INSURER D: INSURER E: CENTERVH LE,MA 02632 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 X4Y CONTRACT OR-0THER-DOCUMENT-WITH-RESPECT-TO:WHICH-T}IIS-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 - ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MMI)DIYYYY) - (MMIDDIYYYY) 'LIMITS GENERAL LIABILITY EACH OCCURRENCE Is COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR. DAMAGE TO RENTED $ REMISES(Ea occurrence) MED EXP(Anyone person) I$ GEN'L AGGREGATE LIMIT APPLIES PER PERSONAL&ADV INJURY I$ GENERAL AGGREGATE �$ POLICY PROJECT LOC PRODUCTS-COMP/OP AGG I$ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE I§ LIMIT(Ea accident) ALL OWNER AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY• I$ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE Is EXCESS LIAB 8 CLAIMS-MADE AGGREGATE Is DEDUCTIBLE I$ RETENTION $ IS A WORKER'S COMPENSATION AND WC STATUTORY 10THERI EMPLOYER'S LIABILITY YIN UB-4869POBI-13 1D/05/2013 10/05/2014 X LIMITS ANY PROPERITOR/PXCLUDE/EXECUTIVE OFFICER/MEMBER EXCLUDED? NIA E.L.EACH ACCIDENT Is 100,000 Mandatory in NH) (f yes,describe under E.L.DISEASE-EA EMPLOYEE I$ 100,000 I � - DESCRIPTION OF OPERATIONS.below _ EL DISEASE-POLICY LIMIT I$ 500,OOD DESCRIPTION,OF OPERATIONS/LOCATIONSNEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE.HOLDER CANCELLATION KEVIN ELLEN ROCHE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 101 SHORE DR BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY.PROVISIONS. MASHI'EE,MA 02649 AUTHORIZED REPRESENT VE ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. MORTGAGE INSPECTION PLAN APPLICANT: FITZGERALD TOWN: CENTERVILLE 123• LOT 64 f� cr LOT 63 •o o —_==#427=_--=— - ,- ----_---- --_- -r =_____ LOT 65 YYY v • , � 7 O �.. { x J. LC'YLE755 1' \ ; 41. a> O FLOOD PANEL: 250001 0015 C FLOOD ZONE: "C" DATE MAP REVISED: 8/19/1985 I HEREBY CERTIFY THAT THIS MORTGAGE INSPECTION PLAN HAS BEEN PREPARED FOR: DATE:. 10/4/12 SCALE: 1" = 30' DAVID C. NUNHEIMER DEED REF: 20670-112 PLAN REF: 252-32 THE LOCATION OF THE DWELLING SHOWN DOES NOT FA-L UTHIN A SPECIAL FLOOD HAZARD ZONE, PER TAPED INSPECTION THE DWELLING APPEARS TO CCiNFORM TO THE LOCAL ZONING BYLAWS IN EFFECT THE STRUCTURES SHOWN ON THIS MORTGAGE INSPECTION PLAN ARE LOCATED BY TAPE SURVEY AT THE TIME OF CONSTRUCTION WITH RESPECT TO HORIZONTAL DIMENSIONAL SETBACK REQUIREMENTS ONLY. NO INSTRUMENT SURVEY WAS PERFORMED AND LOCATIONS SHOWN ARE APPROXIMATE OR IS EXEMPT FROM VIOLATION ENFORCEMENT ACTION,UNDER MA GENERAL LAWS CHAPTER 40A AN INSTRUMENT SURVEY IS NECESSARY FOR PRECISE DETERMINATION OF BUILDING LOCATIONS SECTION 7. REFERENCE DEED SUBJECT TO AND VA7H THE BENEFIT OF ALL RIGHTS, RIGHTS OF WAY, AND ENCROACHMENTS, IF ANY EXIST, EITHER WAY ACROSS PROPERTY LINES, YANKEE LAND EASEMENTS• RESERVATIONS AND RESTRICTIONS OF RECORD, IF ANY THERE SHALL BE,AND INSOFAR SURVEY COMPANY INC. SHALL NOT BE HELD LIABLE FOR DAMAGES RESULTING FROM ANY USE AS THE SAME ARE OF LEGAL FORCE AND EFFECT. OF THIS PLAN FOR PURPOSES OTHER THAN MORTGAGE INSPECTION. TELEPHONE: 508-428-0055 YANKEE LAND SURVEY COMPANY, INC FAX: 508-420-5553 119 ROUTE 149, Marstons Mills, MA 02648 yankeesurvey@comcast.net Iwww.yankeesurvey.net 1 82267 JM Rem- DETECTORS REVIEWED AB E UILDING DEPT. 7i�� _-. FIRE DEPARTMENT DATE —`--- � "-T- - BOTH SIGNATURES ARE REQUIRED FOR PERMITTING / — �+• v* al*.vvH wet r r r'f—II .o ... ...I I t-1'1�.11tiTtoN tvacstrnoNG�^.�a•) la-z I - P66Nc5.= , c j � �>6�� I II U Y II I � -��5 - • S� e'nct i •-DIY—r �' ' �:o• w�aee � � e.L• �tip' ..- .._-_. � . 1.P� r,.�a.cc-E-tir..SYef:tu=-.mew _ DeripN awe�.o 774-23&0773 • ANT cmmrow acamo-xarcox aJnyn we;eA.dw;Jfoape rfsxezaap . edxc meoevLSTsexxs t'rR f " Afvcm w eey.q,xnmm yx'y7,x�e n Iro vn Nv,eza,.• hlsssach Setts Checklistfdr COmoHance(rmC!mvE )'. 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FlnviFnmlvp :. am .mt B� JanCB' a` p�[G' .I�.;,•c ,o uei s,m _ JOYtb611T hb (Nd RmNeMa)(FlO.t�1 _ Ym. ,OE 'eaN SW W1IDpU N1 PLAT¢ e I m .i9Y'. .. Ydpry � 416 19g..I-1m ead�Ebak'. }�:}�q n°.a'm.. Besm [altiv(FmcMIM .Sfm aim vUgm 4"' -t.Pµ. Z .IaU m'1.Op•.ms 6w YaS dne bmbJ°IDt.(aemoUN 693' 39D t�. BVUJNY4WotTaO ' ' :''., � 'Ra✓vlrlabo' .' - �.:�T.. "AMB .8 9T0 � , ' ' NyLTDa vyTx '.' Wtiv06NrLN FanN ., pd ,m n'•6pUCaN -' B� ]-Dfl] 3 lne 5}B.. " ::,' R✓M e,vWa�d aDbfC ec 4lpptl A•tbB . • •.�, •°°m h�imt wbvvN•>+eMenO m m -f- 1. .9 3-9"tl0 -9 141..: 89A. - "t' .T,� 1 N.a. .� G.m.✓.✓I :�' im 'a.eidpeatle'm"m .. b... saaz a- 5 66p: . eW bm®wswpmelaama• . ,Dope Mewl btmaewlao.MWClwlm m tm� a•mwpd•mN e' u n n. n eD IY'' 45ae10 i Isu vb N 4 �volere Teep✓1Pxtle `,ad n A A �• n Bo�°�wrm°°em w ANCNDa-L aro 9 SABLE 9: WALL OPZNINCsS-IdEADERS' wroe�°pww. IN w PAT ✓ABNna' LOAD B�IgRaNCs-WALLS �Y(r;.. - 6,We•P•�Wmv4'ae - ,m B' -Ut4MN/ e.•dro Aw.•Aw. . se WavbvUB frawmreznmemd vanes n) r.e�e•mB :. _ - fe•t;� xe man T•E6✓.IPMb •d•.•�n.••n.•• �nv.• .•nv. �/, , Mmhnp hA•� � _ Fmi6X•Ulnnx .. WDveGDva1PaM1 B0 ,m 4eapd netl,, •n+..•nv.�_ _ _ '•n�'� .:' . O�t•r)lun l•. ,Da Cneptl Cove -.. - ' APA �ppp, ` Nm N.Aa. ry.).Cvmsvn mbmrct.,°eve MdasnefeDWepppin✓apumn•d;aXelk ec lw Uumm,.T+p.�wU. _ ' and ed m,.nm _ a .Boxmegwinrom 0•✓apuNynAl . . < wIL UnmeTewheM•a.•Bm yWnfmnelb mr�mynxtr•UUmmaa .... :: � ... . " emmeMmevyml m9�.l®W'ro tle ap•NIYe'vm+miralbmq De n0a10N0 wbo Wvwfo' ,.`,: ..'. .'. .. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map . Parcel 02-5 Application #c20 6 9Sa Health Division Date Issued Conservation Division Application Fee S� Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board 2,11 13 Historic - OKH _Preservation / Hyannis Project Stre%Address Village C& &f IIXZ Owner &64-, Fltzww_a(,/� Address Telephone Permit Request IICG WM air -wx1g4 d• Diuit Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 'Z " br Construction Type t�� Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Famil Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including bath 3): 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 ❑ new size _Shed: ❑ existing ❑ new size _ Other:v C= o Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ " ' o Commercial ❑Yes ❑4o If yes, site plan review# Current Use Proposed Use zii APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name aw, 00't ��ld � Telephone Number j 77,� a Address ZV�Arhp_ License # 10 �0. cw'� G'!'V t r d� Home Improvement Contractor# 5 b Worker's Compensation # oZs"90 I ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 4,10 VWm SIGNATURE DATE �� 'yfr" FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED � MAP/PARCEL NO. y 'f ADDRESS VILLAGE f OWNER { DATE OF INSPECTION: FOUNDATION 4 '4 FRAME 4; INSULATION +` FIREPLACE ELECTRICAL: ROUGH FINAL s: , PLUMBING: ROUGH FINAL 4 GAS: ROUGH FINAL 's FINAL BUILDING y DATE CLOSED OUT _ 1y ASSOCIATION PLAN NO. E 'r • I - �ia 1 - Massachusetts- Depar-trnent of Public S:rfet%, Board"of Buil(linr Regulations and Standards: Qonstruption Supervisor License s.�' • Licen CSC 100988 HENRY CASSIDY n. 8 SHED ROW WEST.'JARMOUTH; MA 02673 Expiration: 11/11/2013 ('uumi�siine.r Tr#: 7620 =7j C�/� Office of Consumer Affairs and Business Regulation y 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 153567 Type: Private Corporation Expiration: 12/15/4 Tr# 233831 CAPE COD INSULATION, INC ----- -- -. -_ . .........._ HENRY CASSIDY 18 REARDON CIRCLE --- --- - ---- -- - SO. YARMOUTH, MA 02664 Update Address and return card. Mark reason for change. �] Address ❑ Renewal Employment L Lost Card SCA 1 0 20M-05l11 Ya�r.�wr�.rca�rlC/r.,r,`C�7xa,crc> coetl� valid for individul use only w\. Office of Consumer Affairs& Business Regulation License or registration y -_ OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 153567 Type: Office of Consumer Affairs and Business Regulation 'piration: 12/15/2014 Private Corporation 10 Park Plaza-,Suite 5170 n Boston,MA 02116 CAPE COD INSULATION;INC, HENRY CASSIDY • 18 REARDON CIRCLES S0.YARMOUTH,MA 02664 AbiwithoUndersecretary Ws4natkre The Commonwealth of Massachusetts Print-Forrn Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/Organization/Individual): el w7u la h d Address: JU &Vdal, C�tVU�j City/State/Zip: Ua MA- Phone #: Are you an employer? Check tile appropriate box: Type of project(required): l. I am a employer with M 4. ❑ I am a general contractor and 1 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 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 l.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs 9n', insurance required.] t c. 152, §1(4), and we have no 1.3. Other We���GV 1�i Tl employees. [No workers' comp. insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy infonnation. 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. ��� L n Insurance Company Name: �� L L'�tf V IW, (UV t. 1 &�C/ Policy#or Self-ins. Lic. #: WG�OD l ��I �DI Expiration Date: Job Site Address: 2� l�o Uk� VV,- City/State/Zip:& 1* ff- Attach a copy of the workers' compensatil 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of - Investigations of the DIA for insurance coverage verification. I do hereby cer Wer the ains nd enalties o er'ury that the in ormation provided above is true and correct. Si nature: Date 77 Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority (circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: No, Gllent#:4507 COIN UL ACORD,,. CERTIFICATE OF L A-131 T' Y INSURANCE 11-IN h1-1-001y yI THIS CEk'f11=ICAl t- 13 ISSUED AS A MgTI Eli OF INFOIIMA'I1CiN C'IIvLY AND CGNFER3 NO RIGHTS UPON T11G l:Et:TIFIGATE Hl)LDCrRA1T1Uls, CERTIFICATE DOES NQ-('APFIRMATIVEL_Y OR NEGATIVELY AtVik,W,EXTEND OR ALTER THE COVL'-RAGE AFFORDED UY TI-11:POLICIES "L1 L L)VV I HIS CERTIFICATE OF INSURANCE DOES NCIT CONST(I Litt:A 4DNTRACT BETWEEN-'.HE($;WING IN'WRI=;R(S), RFPRE4LiN rA rIVE Crit PRCIDUCIFR, AND THE CERTIFICATE IiOLOklt. AU ftl()ItIGL L) Ifv'PORTANT It( carUfl[atu hulrlclr i;an AbUITIDNAL INSUh tll htl 1011CN(ies)must be ID<lulyed.If SUF]R(1GATION I:)WAIVED sliblu,a to Ills(t,l,l,a trlid cQlItll(IUll s or tho PUllcy,CallaIEI 11011Cleli I114Y lu+{„1,.,WI glldortililllgliL A 641(wildnl Q11(hIs cortrllcvW,`(kwtl Not 4t111141 IIUIIl7 tl1(llc Lliltlllt.,�lu 11OWW 61 NA-Au 1.11;+U411 CI}(tUf9t<I11CN((y), - -- NAhiF: - - uf1(:r, &Gray Ins. -SO. L)cjrlrlrs TRMT7Mat ret)4it YuuN! _ aagNe 4J1 I:outv 14 uc Rv eu1:008 760�IG02 �� N„ 11/! Olti-21�b __... :illultl UnnNlr:, MA 11261iU-1(iU'I 5lkf:1?t1-1;)1{l) Nuurtl°hlulwruNnlNucovt NA(If -I ...NA)(0 IN°11RER PeUI05S Itlsuranct) ' E wsuRERO, vanztorl INeurNncu CO111)4f, Cape Loci Insul�atlnn Inc _ I Y ly;Yal mouth po"i,j NsIJRERC:Atlantic C11Eirter Insufaitc: Ilyalltlits, MA 02ti01 y INytIRrRQ Garnitforce Inwur111ce C'ofYlpany 317�•I "OuRr.R E _ _.- +wrn t r )vl ,tAl t 4L:RrIhlCAIkNl1M13ER flil, IS I0 t(l llll rliAl (FlI WOLIL.tES OF INtiU lttVl`rtQNNt114111LR NANI C t l51 pn t,Cl li_HAVE BEEN 1660EP TO-1 HE INSURL•D Nt MFM ADOVL FOR I lIL I OLII l`Phi;liHi ulrvlhU. N 1VdI1rr.;tANuuvt PINY Nt(l UIRENII"NT i1RNl OR Li?r)L1)IOr NT IOF ANY CONTRACTOR OTHER DOCUME WITHG(ESNGCT 'r0 WtllCtl ule; XCI- 611.ruL;. tvlA�' FSr IS Uf U OR MAY PERTAIN, THE INSUhzANi:r ;lrr�)ROE0 BY TH1 POLICIES DESCRIBED HEREIN IS SLIDJL.CC TO AL-I., 111E. Tr:rtr,15, ClU ION'i ANO C ONDLIIONS OF SUCH POLICIES, LIMITS SHOWN ly,,+y hWli 2UN REDUCED BY PAID CLAIMS, Err IYYh OF INWHANCE AOOL WhR - - PgLICY CFF()P{ .I�.I 46.TrIivIC hN(IlMUaAllIA...1nt,y-S.-IlLµ L/kIt-L AI U._lL.ku 1,.Ail 1,3IG 1L-P,L_ C_rtG-P8,.26P3O0L6-lc3 r. IM4_M1y0 1_D././_2.Y_.Y Y1Y2 (MN4MnluOg.CI-12Yt0iY(V�.1 I' CPLoE1RUE,AUhryC�,fDEl,H1�'FU1•;1OCCURRENCE, C I- Cl>_a_AUS<N•. IR NGI;3REMLl.tiN_C(I_9r_-)rM P q I IAd 1 1 U-00I' Q0.00 0.U- 0_ _U.0 (AWNlt-NGLAL GI-NI-RAI LIABILITY �IM-dA 1 I01)11UUCLAIMti " - ' --- -- OCCUR .._rr (Ally ojlOWLr tr ON011 I�Rd'PIALaADVIN)UNY s1000OUI $;000,01M 12MMBCKvwn 4)0912012 04)011201: 000(100 BODILY INJURN'(P.,All ININeu UICU U)0J BODILY INJURY(fa,A at) Y,X rrti(EU AulU X NUUTN0-0VVNEI) ,--`---- A PROPERT'OANIAOIT0 . 1t,LLJtGtilUtllllL_._... augur . XONJRSU51 141U`1/20'12 041011201' ucllDc uILNkNc F1 000 000 cMl k�l LIAU _..._..� 1 LAWI&MAQE .. --- gcgrer_cAle1 UUU UUU nll X nrlrlvuurl ,IUUUQ - rtuiintnt l U41rtNHA11UN u - T RNUtMRLOYtt13 IIADILIrY WGAOQd15;1t1<' - 6/3012012 U619Q1')Q'i' k wc'sT1YIriN�j•} 11Clil AIJ+'I Il(1N}21L��yvr 4N)'MuH/'KRGV rIVk YIN. _ fi'rLliNlttil kI2C G- 4[ h N)A [L CA01ACC-10-N1 _ .�1,UUU�000 Ihlu IU.W.y m NNi `_N • -.._ -`- r vu ,luoenco„1I . - E t DItiCAszr_.Icil crNhl_ovc:c 1'I uUU UQl) r,+r IPnoN or.)Nc•:I:A no vs ucluw e G.L.Dlt;CAsc•PouC VI-Ir.Nr y'I UUU UUU 11c"W 1IVION 01,O('L-0(0.J IONS I LOCAI IONS t VL14iCLE4(Akl-h ACORU 101,AdUI I,:-1,.,,,,,w�pVhyuuly,l(IllPro VP8gV 10 re(ItIIItiU) "Workers Currlp Hrfonnatiorl `" Ilulutlutl Otticerti Cyr proprietors CurUrlcace I IuIJ4r i inciudet! xf�j LIn ijdditional insurad widot Gonaial LiUoility w11011 roqulrod by wrltton.. contract Or agreement, ChhTiHItA 1 E t1UL ta! ft CANCELLATION c apo GO" Imiulatioli'llic �, � - SHOULD ANY DF THEABOVE OE3CRWIU U POLIC.jIiS LIE 4ANGY,111.11 PhI QliL: „ THE EXPIIIATION DATE THEREOF, NO'r'IC:E WILL lye orLIVLke0 IN ACCORDANCE WITH THE POLICY FROVI3ION3. _ .' w„ - .`. .. ,. AUllIDRIZLBRkPRE$EN1A'IIV@ •� - .. .._---- ...._ , a 10 za coRD A (]Rh htA' L fa 111.N,All tI�hIJ n`aurvuti. M.LN(t,z;l pu luluti -1 Of'1 1-11e ACORU tialna;Ind logo aru royjisierud marks ofACORD ?fSfl3d4�1/M8384t1• : MkY Energy rZy I t am � cis to A y � � d �" r1 mass save PARTICIPATING Savings through energy efficiency CONTRACTOR PERMIT AUTHORIZATION FORM I, Robert Fitzgerald ,owner of the property located at: (Owner's Name,printed) 427 Nottingham Dr Centerville (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain.a building permit to perform insulation and/or weatherization work on my property. X Owner's Signature 01/18/13 Date FOR CSG OFFICE USE ONLY Conservation Services Group has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participatini Contractor Date Rev. 12132011 fA OF BARNSTABLE CAPE Cdb N S U L A T I Q;iJJ A ► 12 ,F $. ! g FIBERGLASS SEAMLESS SPRATFOAM .SUSPENDED BAITS GUTTERS INSULATION 1-800-696-661W I- Town of Barnstable Regulatory Services Building Division 200 Main St Hyannis, MA 02601 Date: i0h-3 Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed& completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute (BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address Village I A)o 111n �4m 7 c'74�1 Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings ( ) 04 ) Slopes ( ) ( ) ( ) ( ) ( ) Floors Walls ((�� ( ) ( ) ( ) ( ) ( ) At J ea L Sincerely hECasJr, President ion, Inc. ' Town of Barnstable Permit# ESS PERMIT _ ]Expires 6 months from issue ate- egulatory Services Fee aAntvsresi s. MASS. OCTThomas F.Geiler,Director 1639. .0 1 2012 o►�d" e Ib� Building Division IG TOWN OF BARNSTAR-1Rerry,CBO, Building Commissioner 06 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us` Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY. f Not Valid without Red X-Press Imprint Map/parcel Number. / / D d Property p ny Address 4d7 /J`v7trivJc;��c Residential Value of Work $! �' .G'J Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address aos"- ^ FITz-(4Lc R L0 Contractor's Name `—l'-�JAL S 4 LI)AA Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# 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) ❑ Re-side. #of doors Replacement indow doors liders.U-Value a (maximum.35)#of windows 1 •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 66ma quired, . SIGNATURE: C:\Users\decollikAAppData\Lbcal\Microsoft\Windows\Temoorary'Intemet Files\Content.Ontlook\DDV87AAZ\E)PRESS:doc Revised 072110 i The Commonwealth of Massachusetts Departmewt of Industrial Accidents Office of Investigations 600 Washington Street Boston,ALA 02111 ivmv.njass.gov/dia Workers' Compensation Insurance Affidavit: Btdlders/Contractors/ElectricianslPlumbers Applicant Information Please Print Legibly Name(Bt>sme&orgmizationllndividoat): -7RD M I S 14 L 0-u h Address f6[v City/State/Zap: WWems IiH WOX Phone#: 77<<-e3&-60 41r Are you an employer?Check the appropriate box: T of project 4. am a general contractor and I 3'� P Ject(required): 1.El I am a employer with ❑ I g 6. ❑New construction employees(full and/or part-time)-* have tired 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 g. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance: comp-insurance 10_ Electrical or additions required.] 5. ❑ We are a corporation and its ❑ rep 3.❑ I am a homeowner doing all worts officers have exercised their 11.❑Plumbing repairs oradditions myself[No workers'oomp- right of exemption per MGL 12.❑Roof repairs insurance required.]I c. 152,§1(4X and we have.no employees-[No workers' 13 A Other /)vier comp-insurance required.] •Any applicant that checks bog#1 unit also fill out the section below,shomng theh workers'compensation policy information_ T Homeovmus who submit this affidimm indisatmg they are doing all work and then hire outside contractors I submit a new affidavit'indicating such BCouvactors that check this box must attached an additional sheet showing the name of the sub-conrzztois and state whetIlu or not those eatities have employees. If the sab-coaumots have employees,they must.provide their.workers'comp.policy number. I am an employer that is providing workers'coagwnsaiion insurance for my engdoyees Below is tyre policy aril job site information Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Bate: Job Site Address: 4P A)drrjmrn#m Dt't, CwreeVluoF Ml- City/state/Zip: 0?-&3 3- 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 23A 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 farm 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 liereby ce y under tkepnains d penalties of perjury that the information protdded above is tare and correct Signature: dY�l - (.� Date: Phone 9: 774-936 -Lao Zr Official use only. Do not write in this area,to be completed by city or totwr 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#: • BARNSrABM 3 9. Town of Barnstable Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO 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 as Owner of the subject property hereby authorize alml--s 1-0-lu S to act on my,behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of OwnZ D 24 Print Name r If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\DDV87AAZ\ENPRESS.doc Revised 072110 <Iassachusetts- Department of Public Safety 9 Board of Building- Re and Standards Construction Supervisor License License: CS 86040 THOMAS A LONG 166 KNOTTY.PINE LANE CENTERVILLE, MA-02632 Expiration: 8/29/2013 ('onunissibner Tr#: 20517 r 6/7 Coominzoouuec� i a�✓lLaa6ac�urGelZ6 - Office of Consumer Affairs&Business Regulation i License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration:4- 142393 Type: Office of Consumer Affairs and Business Regulation Expiration: 4'/1/2 014 Individual 1 10 Park Plaza-Suite 5170 . Boston;MA 02116 THOMAS A LONGi J;_ (- THOMAS LONG ` ! ��nc Y 166 KNOTTY PINES\LANE��_ �� — CENTERVILLE,MA 02632�= Undersecretary Not valid without signature v i Un}oas atharMse stipulated herein,any notice requlrod to be pf re i In this ngreomont shall be In miting arxi shall be l' -.--• —.--..G..��.w.y...o.o.......own nunuv a4 aron uuwoaa aai rvtut rItl[HI(i. I The Initiated Mara sitachad horate,If any,are Incorporated herein by reference. 34.Additional Exhibit A-Deod Exhibit 6-._ Exhibit C PrOvie10119 Addendurn A ` Addendcen B partlee acknoMedgo script of. MA LIconsoo-Consumer(Agency)Disclosure Environmental Disclosures Lead Paint Property Notifirailon Gatti flcat!on Sellers Statement of Property Condition Designated Agent Cor:sent/Notipcatlon(if appticable) Dual Agont ConsentlNoti0cation(if applicable) This Is a cash trunaactlon Bullet will correct Issues with septic to satisfy Title V reouiramenta puver aGM2Wj29m septic syatam}e a fgllod system acid elssgfflUji all respon9lW}ly to install i»system. Sir llks._gbIlmur ri)Sr Wan Is subloct to Seller's satcj �gyl+�yy o�yidflan shop sale approval phi,} } rav dc>t3sobilgat�tha Sellar !?ntipg Y.1u114g.Lo_ql4 L of$ prornissory notes and waives all(Uture datklancv I bllity A faxed signature on this document ehail have the saute effect fie delivery of a signed original.The patty fuxing this clorutnent agrees to mail of deliver the original forthwith, NOTICE: This is a legal document that creates binding obligations,If not undetsiood,consult an attorney. SELLER SELLER v ----- Date 9%0 -... ash. E3UYER ate BUYER Date W4170 BUYER �S INt� SELLEr7S Inhale,and Sala 3-20r0 Cop4r10h*20M Wins raver Redly Grmp.LLC. Pegs 6 of 8 T� SHED REGISTRATION NOZ f ip,,\& -IAM -pp,, CEtiTETZ\(1L.Le location of shed(address) �� VAU E. H A LLO 2A4U property owner's name; size of shed I signature date Old King's Highway Historic District Commission jurisdiction? /1/0 THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN shed 7' 3'9 FooI d �0 7L G- 0 c 0 Dcck 0 M a )` Dwe ///"I N J i E h ; ; A/O 111 G 1'1 a jyi v 1-11 V Ce .. S// THIS STRUCTURE Cd IS NOT/0 IS (FL 000 ZONE ' '"• ) � , , � �t ._ �: !;>.:%I L LOCATED IN A FLOOD ZONE ACCORDING TO •'.' - NATIONAL FLOOD INSURANCE MAP,DATED B n (��•� .�f J ,`f � NOTE: THIS PLAN WAS PREPARED IN ACCORDANCE WITH JOB NO THE PROCEDURAL AND TECHNICAL STANDARDS FOR MORTGAGE LOAN INSPECTIONS AS PROMULGATED IN THE MORTGAGE COMMONWEALTH OF MASSACHUSETTS REGULATIONS 250 CMP., .SEL :,nrE '?,On� �n� nnc4clrgE,�t:cnrrS: cE Cr�nnp►► cn 1 OQ lnIPF(;TInN FROM ASSESSORS OR DEED INFORMATION, APPARENT of. Land In OCCUPATION LINES, OR FROM PHYSICAL EVIDENCE, AND / HAVE NOT BEEN VERIFIED BY AN ACTUAL SURVEY. THE STRUCTURE(S) APPEAR(S) TO BE LOCATED APPROXIMATELY AS DEPICTED. UNDER NO. CIRCUMSTANCES IS THE SCALE., DATE: INFORMATION HEREON TO BE USED TO DETERMINE PROPERTY LINES, FOR CONSTRUCTION OR RECORDING PA�� � ���a i'r C PURPOSES, OR FOR DEED DESCRIPTIONS,IF ACTUAL LOCATION OF PROPERTY LINES OR IMPROVEMENTS IS..... _ CLIENT' )10- Z%�!'!�°1! NEEDED,` NOTIFY SOUTH SHORE'SURVEY`CONSULTANTS SOUTH SHORE SURVEY FOR A FULL SURVEY. CONSULTANTS THE STRUCTURES APPEAR TO CONFORM TO ZONING BY- 18 STRAWBERRY HILL RD. LAWS AT THE TIME OF CONSTRUCTION. PLYMOUTH, MA 02360 Assessors map and lot numb .............................. l` Z `O THE Sewage Permit number 6 s.. . 9HHSTADLE, number• ......� :7.. .... .... ............:.... .....ho . .. ... ... i 1639 �a MPY a\ TOWN OF , BARNSTABLE BUILD G INSPECT R H d - v APPLICATION FOR PERMIT TO . . .... ..... . ........ ..............z.. ...... ....................................... TYPE OF CONSTRUCTION ............... . .... ........... .. :... 6/0 4 ................. .... L.... .19.J. TO THE INSPECTOR OF BUILDINGS: The undersigned.hereby applies foor�la permit according to the follow"ing nn�form/ation: Location _!/ jrra, l... ... !. ��/.. 1� . .,. ..l� G! g ...:...... ProposedUse ......... <h . ....... .,l yl/ ....:...... ................................. :............................. Zoning District ...... ..................................................... / . ....Fire District .... `...........................................:....................... Nome'of Owner .,,(•/64�,71V C ►,,,:,... L�' 4.�>1 ddress .`, .l V � !<�i /..'1.. ..Z ............. Name of Builder" ... X4,4/& .........Address . . �'/•�����✓�����Z!��3........................ Name of Architect ... .............................. • Address Number of Rooms .........�/Y.'�:.............................................Foundation ................................................. y Exterior .........:..........................................................................Roofing ..................................................................:................. E Floors '.............Interior ......................................................................... .............................................................:...................... i w Heating ..................................................................................Plumbing ................y:...............:..........:.......... ......................... Fireplace Approximate Cos, , .) ................................................. Definitive Plan Approved by Planning Board -----------______-----------19_______. Are Diagram of Lot and Building with Dimensions Fee �!. "V SUBJECT TO APPROVAL OF BOARD OF HEALTH + r • 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 .:. . ... ...1.. ....... ... . .... . ..... ............ N PETERS, HELENE L. No ...24.435y Permit for RemQ .�,. .G. Z qe c, Single Family Dwelling U s .......... + ............................................................ z sri ... , 4..27. ...Nottingh. . . am...Drive. ......... Locatio . .. .. .. ....... ....... ....... ... .. ....... - .. Centerville r , Owner Helene L. Peters- Type of Constructions Frame .+ -', i •. Plot ........... .........:... Lot .......................... +° May',_11, 8 2 Permit'Gran.ed ..................................:......19 z Date of Inspection..... ............. .........19 Date Completed ................... `� ...19 !r r a•""' .r TOWN OF BARNSTABLE -_-------____ �.. •. Permit No. - ------------- � e � Building Inspector 1 711IST&U Cash —- — ■Yl eO''10 yPY 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 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. .....................................................1 19......_ _ ..............................................................................._......._.... _ ._._. Building Inspector � . . . � ' ` ' . . , . . ' � . � ' - � � ` . . � . . ` d lot numbDe .111.f.—�p IA-1,04.- 1W, 1ssor's map an -X......... 60 THE SEPTIC SYSTEM MU MARONMENTAL CODE TOWN OF BARNSrABE BULDING I ECTOR APPLICATION 'FOR PERMIT TO ...... TO THE INSPECTOR OF BUILDINGS: The undersigned her6by applies for a permit according to the folloWL'ing t0for ation- .........& Location ....�Z. 6j.....P.O. 6h. ........... . ..........A.4a.,�w................................. Owner -A Name of* .... . ....�&M...................Address ...... ............................ Name of Builder Address Exierior ...................................Roofing .....a-y.. ................................................. Floors ..... n erior ....A .. ........................... P-d.... ................................................... SUBJECT TO APPROVAL OF BOARD. OF HEALTH ' | hereby agree to conform to all the Rules and Regulation s of above construction. ~ U � '~7'' �'—~~------'—''`�~-----''~ � ° / ' � � ------------ TERS, HELENE 22511 permit for One Story - Single Family ........ ... .................. Location, .Lot...#.64 427 Nottingjama..Dr ve Centerville ......................................... .}. ................................ Owner f..'rHelene••Peters....... Type �Ff Construction YP i _ f- ............................................................................. Plot ............................ tot ................................ Permit Granted SeT)tember-,17 ^ 80 ..:..................................!.l 9 r s Date of Inspection ...............................:.-.19 -^- Date Completed /row............ ' . ......19 TO PERMIT REFUSED °. >....................................... 19 "�'Ce W...........- . `tt -a ......................................... Approved. " ................ ......................................... ..... .... - s, . . : , . t . � , ,. - M. / ' ° • ` IVI' , '� ,SL.. `�� ; . l^ ,. LY,s AA w•S .T _ ' ) ,_y • ) ` •^a 2. '18, ��T? +'.'- �•- +.. f•'.. hx -'�. y, sy _ t.'•`•f, Nj} � � F..'l.% _ �l/�-+.F' �"Tr ('iu. ' 'M,.r.-a.'� +S' ems,. ;�y f 1 t. \.`w ,�. 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V.A,' f f-/._._ G R �,U 1�!' i-! ,/G1 S )S:T-l G J �/\, ,,f{,E fC�O,ti' /I ,,'`i"N •<.."'"`�,�°�°, . F ' --" :a F� �L �'�� - _ ,�..• f o- �*1'-! D 4--//� !- %'7- z Q��S ,-I - . G'°Onr'F O J`'1 �:��'�� ' v>is��"f N, /�—�-• , —. -- € — w F. - 7 C.?m T`1{� C/! D / ems SE7" 1 C ,�. ".�EG�u/�E- �4k V , )��' — �' {< i x ii.4` �•4. ce MAN o'F THE T h%w 0"'= r���; :t , ' �r `° _ _' _ _ r .1 - — , w �S B� ' _- . �,'�_� ,,- , - , s t V � Z�.�T '. B C3 7 R D O� - N E,�1 L T;/--/ ,� i- G ',i s v,�`v E y o g�`� r�Pr"�,e o vE D` ' '1 G`j N 7" j T- • _ M r4 , . . < �♦ , 100 --EXISTING CONTOUR N EXISTING LEACH PIT x 100.98 EXISTING SPOT GRADE ® Ge CONTRACTOR SHALL LOCATE,, PUMP, FILL WITH SAND AND ABA'INDON W EXISTING WATER SERVICE c,O°t Ftd eotr\�t Rd P 1 G EXISTING GAS SERVICE N Pre 5• Pr °s° °o Benchmark Set EXISTING SEPTIC TANK //, -OVERHEAD WIRES L T. OUTSIDE COR./STOOP ,��0' (To REMAIN) ® °.0°t Ra �° i TOP OF TANK, EL.=101.0.1E TEST PIT pre EL.=103.2 (Assumed) INV.(0UT)=99.68E 5 BENCHMARK .° s N 58'40'00" E wy J`c W\ -a ---o-- stoc ade ?�ence LEGEND Merdeh d cr of 1'23.20' e(no N 101.29 o Ros LOT 64 101.80 Co. `o f~13.2' APN 148-025 -- ,- 19 `Y=- LOCUS r 15,400±S.F. / - r T `� a + L 0 101,g3 N LOCUS MAP TP�1 I• I NOT TO SCALE yr� I� O :..y p 102,3�.\ 1-.101,37 uj �a <TP-2�-_ Q� ., sHED GENERAL NOTES: 102.5 c f 102 38 102 07 + 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED 8Y THE LOCAL =- 102.03+ x x STUMP\� �_ rL BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS cQ 102,66 , �� OF THE STATE ENVIRONMENTAL CODE, TITLE.V, AND ANY APPLICABLE C14 'W / I DECK- LOCAL RULES AND REGULATIONS. ',� ,._� ��;•- i :I N ,. p PATI x 102,32 �\ �,: fV 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR o o 102.45= 102•D1 o TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE • - I Io 0o DESIGN ENGINEER. •V d ' N ry Nw» 101,74 4• ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING rn FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN Z + 102, 0 EXISTING ENGINEER BEFORE CONSTRUCTION CONTINUES. II 6 J� HOUSE (#427) I # 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. i I x 02,47 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF II T.O.F.=102.88E THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR. PROPER INSPECTIONS DURING CONSTRUCTION. ' At� o ? 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 10z,23 I 102,01 \•' \� OF Mq s 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S.. I / �Q� S9Cy 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS Off\ \\ (102.21 S �'� o PETER T. G� AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE // McENTEE DIRECTED B`Y THE APPROVING AUTHORITIES. _ ALK CD CIVIL 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY No. 35109 THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING 101,95 ?% CONSTRUCTION. STE��`� + 102,15 101:49 �. 0 SS G� 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS PAVED r- ' OL59. IN THE AREA BENEATH AND FOR 5' ON ALL. SIDES OF THE S.A.S. AND x 101.84 DRIVEWAY �.•� REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 10L47 10 ,79 x 0 1 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE (I 01.7px 0I123.20' 4 \0 v� I INSPECTED'-BY HEALTH DEPARTMENT PRIOR' TO BACKFILL. S L5S•40'00" W 1 IS NOT TO CONSIDERED A PROPERTY SURVEY,PURPOSES ONLY AND 3 THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PU S 0 �100,29• • . . . . . BE.CO LINE 100.38 100-190-------- ---39 84 - 904 --- -------- - ----`------10o- _-----1_ \�o OHW o0,44 PROPOSED SEPTIC SYSTEM UPGRADE PLAN 99;14 99,12 catchloasin 99,14 edge of pavement 99.740 427 NOTTI:NGHAM DRIVE, CENTERVILLE, MA ., .. .,, 99.07 Prepared for: D. A Brown,. Inc., P.O. Box 145, Centervllae, MA::02532 OWNER OF RECORD Engineering by: SCALE DRAWN JOB. NO. NOTTINGHAM DRIVE ii OBRIEN, KELLY A Engineering Works, Inc. 1"=20' P.T.M. 271 2 %FITZGERALD ROBERT T & CLAIRE 9 g 11 ELMFIELD ROAD 12, West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. 3 FRAMINGHAM, MA 01701 (508) 477-5313 12/6/12 P.T.M. 1 Of 2 i