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0101 PATRIOT WAY
r47a a - • to a G. g a' ° a e.P a a N T � 6 + s a ',r'- 4 ds x ' . .. a .. •. - i - ,.,,. .N .. , ....s..,_wu.:...+. _�_.,t.L_.i... •_le , . ,. � � �..s__.1..L ..u.. x., 1.....- ..-.,_ ..w.,..._ .. ,.e..r ' r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION -ARMap Parcel aa` `: �,.,T,�Q� Application Health Division .j k Date Issued h.I Conservation Division Application Fee Planning Dept. �. . Permit Fee`�✓ �'v Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address t Village C M Owner y � 1�� I tonc-►1 e,,5 Ds5 t'i At Address _� (1,Y►G Telephone_ � $ *2'1: 16 4-1 g Permit Request c 5E rA A all J 1 617F\ A �p C42rAl 1�6 ' F I Al d� 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 ❑ 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 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 ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes )i(No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name li 0CC[VAF_,1Co4,- a,.e �nc.Telephone Number yCS 3Q 63Q WAddress Y T�tll��� n License #M C. 7�6 S Yi F in e �j, �A- G���Y Home Improvement Contractor# I Email Worker's Compensation # WWC3 04 d, ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO�a SIGNATURE DATE L 0 6 O A FOR OFFICIAL USE ONLY .S. APPLICATION# K DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL i PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. I ' r � Towvn of;Barnsta'ble eato'ry Services bUMRkhAM .Scait,Director `0$ _. Budding Uivisinni T.om Ferry,wilding Commissioneir 20016inStrut,:Hyaruais IN4A:02601 w�ivw.town:barnstablemaus - Office: 50M624038 Fax.,50$7 90-6230 Property-der Must C oar ,plete an S.ign T s Section . If LJ ido,.A Builder Crystal M'endes. Ostine. I, as()Wner o ftl�e:su jnct xo erty . . ..K herebyauthoni7e j i Y-c- J:o act:on mybehA inz matters relative to work authorized by thislLi ding emnit application for. 10`1 Patriot my. Centerville; MA 02632 :(Address of J:ob) . Pool fences and alwnns arc t$e resporuIJlizy`of, e applicant. X'cx�ls are not to be Med.or uffi-ed before fenre.sss installed and all final i inspection are perf+med and ac:.c d— CrysIM Me es Os pe(Oct.10,.2015)„ Signature of 0w.ner Sipature:of Applicant Pnnt Flame: 11 not Nazzzo Date Q:FORMSiOIVNFRFFWAJSSIONK)O S �l?� �fl'��'I��2�??.•f�efrG�• d' �����.1JC�'�(�l?rLf/.lJ Office of Consumer Affairs and Business Regulation, ` 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 171380 Type: 'Corporation *-� f Expiration: 3/14/2016 Tr# 249649 CAPE SAVE INC. - . WILLIAM McCLUSKEY �` 7-D HUNTINGTON AVENUE ;� F �Y SOUTH YARMOUTH, MA 02664 - - --- - Update Address and return card.Mark reason for change. SCa,1 0 20M-05/11 E Address E] Renewal [IEmployment E3 Lost Card /fte afrvuiu�eu ud.C� ,,rkeJel/, . Office of Consumer Affairs&Business Regulation License or registration valid for individul use only 'VOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 11380 Type: Office of Consumer Affairs and Business Regulation 'Expiration::--z3?�'l-42rq-,1.6 Corporation10 Park Plaza-Suite 5170 Boston,MA 02116 I CAPE SAVE INC. X"QA WILLIAM McCLUSKEYf ' 7-D HUNTINGTON AVENUE ism SOUTH YARMOUTH,MA�02664 Undersecretary Not vali rthout signature Massachusetts Department of Public Safety Board of Building Regulations and Standards r._ r_ • a:.OiiNtFULLI a-ouiiea.Ji�DT mucf.i3nv ,a .,u-,�F•sa - - ' License: CSSL 102776 + WILLIAM J MC C` U 37'NAUSET ROAD West Yarmouth IWA tXpiration a Commissioner ;0612812017 x {.i ! ' J rr,V -'•:Ftl�'r, �y.'.�..�Rr.vy#-$.�rE r - The Commonwealth of Massachusetts, T .1A A r,a -u Department of Industrial A ten 1 Congress Streep Uite-.10.0 � - 1A P vIW� r .' to `Boston,MA 021I4-2017 �: T� a•` % , . �. }', � 1 » . iy , ,p.>3 a r• .»1 h r,,;e >��#"sg a J `�'t4F:'� '�.e s cr31r 1 I#', www massgov%dta t .' -N'o`rkers'Compensation Iniurarice Affidavit:Builderi/Contractors/Electi-icians/Pliimhe�s TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information _. Please Print Legibly ; 'Cape.Save Inc . Name(Business/Organization/Individual):. Address:77D Huntington Avenue,• City/State/Zip:South Yarmouth, MA 02664a ; • kphone#:'508 398-0398 Are you anemployer?Check the appropriate box 1 -_ Type of project(reyun-ed):: .. �_20..«,.,.. .,...., ,....,. .r...... am a em to er-it i '`em to ees full and/or t : �y, •I P..Y +Pi.y .. ( 7 New construction - 1 1 2. I am a sole pmprieior or partnership and ha' no employees working for me m r t ❑ =t:., :8. Remodeling ,. ' any capacity.[No workers'comp insurance required] •`� # ,,r ;4 1 1l r w g , �, i . 4; , I Y.; err 9 Demolition..• 3:a l am a homeowner doing all work myself:[No workers co t. -- mp.insurance'regwred:] _r s,'10[�Building addition ;4:❑I am a hoineowner'and will be hiring contractors to.conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance:or are sole i 1_[]Electrical repairs or additions - { proprietors with no employees. 12 ❑Plumbing:repairs or additions" 5.❑I am a general contractor and I.have hired sub-contractors listed on the attached sheet. r r 13.❑Roof repairs i These subcontractors have employees.and have workers'comp.insurance.. _ 14.�✓ Other.Insulation : 6.Q We area coporationand its officers have exercised their right of exemption per MGL c: t , 152,§1(4),and we have no employees.[No workers'comp.insurance required:j applicant that checks box#l.must also fill out the section below showing their workers'co 'Any PP� g compensation 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. r n +Contractors that check this box must attached an additional sheet.showing the name of.the sub-contractors and state whether or pot those:entities have employees. If the sub-contractors:have employees;theymust p4 videtheir workers'comp,policy number: ; I am an employer that is providing workers'compensation insurance for my.employees Below is the poluy and job.site —information.' . _ ._. 1--- • .. .«_. _. Insurance Company.Name.Wesco Insurance Company Se y "_09WWC3136274 /0Policy#orfisLic 12016 .• r , Job Site Address: 101 Patriot Way City/State/Zip: Centerville s Attach a copy of the workers'-compensation policy declaration page(showing the policy number and.ex iration,date). _ T _ :11 _.-I Failure to secure coverage as required underrNIGL c. 152.§25A is a criminal violation punishable by a fine up to$1,506.00 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 _T day,against the violator:A.copy-of this statement-may.be forwarded to the.Office of Investigations of the DIA`tor insurance coverage verification.. j. s * s r J do hereby certify under th pains and penalties of perjury that the information provided above is true and correct l r Signature: Date. 10/30/15 t 508:-398 0398 ; Phone#: O icial use.onl . Do'not write in this area' o be romp leted b ci or town o City or Town; ,.;n�' c r ;;� + "�.*I, '�'"s t ^t.*4j;p Permifticense Issuing Authority(Circle one): r•,, .. r.; 'C'L' i `' ^.a Fk.s ..;-.tom se,_.: i ;4 �_ y 1.Board of Health 2:Building Department3.City/Town Clerk 4..Electrical Inspector 5.Plumbing .inspector 6.Other Contact Person:.' 4 Phone#: + F , ,a►coRv® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY` 10/14/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsements. PRODUCER NAME:ONTACT Colleen Crowley Risk Strategies Company PHc No E : (781)986-4400 1 FAC No:(781)963-4420 15 Pacella Park Drive _. ADDRESS:ccrowley@risk-strategies.com Suite 240 INSURER(S)AFFORDING COVERAGE NAICf Randolph MA 02368 INSURERA:Selective Ins. of America INSURED INSURERS Allmerica Financial Alliance Ins Co 10212 Cape Save, Inc INSURER C:WeSCO Insurance Company 7 D Huntington Ave INSURER D: INSURER E South Yarmouth MA 02664 INSURERF: COVERAGES CERTIFICATE NUMBER:CL15101402127 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. LTR TYPE OF INSURANCE POLICY NUMBER MMIDD EFF MMIDD POICY EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS,-MADE �OCCUR PREMISEDAMAS occurrence $ NTED 100,000 01994480 10/16/2015 10/16/2016 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY 1K r LOC PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY Ea accident $ 1,000,000 B ANY AUTO BODILY INJURY(Per person) $ + ALL OWNED X SCHEDULED AWRA46796600 11/6/2015 11/6/2016 BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X AUTOS NON-OYNED PeraccideM)AMAGE $ . X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION$ Hil S1994480 10/16/2015 10/16/2016 $ WORKERS COMPENSATION Officers Included for X I PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVE NIA Coverage E.L.EACH ACCIDENT $ 500,000 C OFFICERIMEMBER EXCLUDED? �. WIFC3136274 4/9/2015 4/9/2016,(Mandatory in NH) i E.L.DISEASE.EA EMPLOYE $ 500,000 Mdescribe under PTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500 000 . - r DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) National Grid Corporate Services LLC d/b/a National Grid, Action Inc, Colonial Gas Company and NStar Electric are all included as Additional Insureds with respects to the General Liability coverage of Named Insured as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Housing Assistance Corporation THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 460 West Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE Michael Christian/CLC � <�' J`'==� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(201401) Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fag: 508-398-0399 12i2i15 DEC 16 2015 . �/� ���gR1V S Thomas Perry B To I TABLE Town of Barnstable Building Division 200 Main St. Hyannis,MA 02601 RE: Insulation Permit 201507376 # Dear Mr. Perry This affidavit is to certify that all work completed for 101 Patriot Way, Centerville has been inspected by a third party Certified Building Performance Institute(BPI) Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey oF�tiir Town of Barnstable �'� 11 q 39S *Perms .y # Erpires 6 mm1 jronr issue dare Regulatory ,services Fee aaaysrsat s. #.ass. 1619- � Thomas F. Geiler, Director rr BillId;ng Division Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.bamstable.ma.us Office: 5 08-8 62-403 8 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY ax 508-790-6230 Nat Valid Wthorrt RedX-Press Imprint Map/parcel Number ouo Pro rty Addressr� e , Residential Value of Work 3 Minimum fee ofS35.00 for work under S6000.00 n Owner's Name d Address � O; �l N C, &jm e- Contractor's Narne >J J FEU 6;S Te ephone Number Cfa� �> A — Home Improvement Contractor License#(if applicable) f g93 la r Constr ction Supervisor's License#(if applicable) ® O oX-kPERMIT Workman 's Compensation Insurance Check one: AUG 4. 7 2011 ❑ am a sole proprietor ❑ I am the Homeowner TOWN OF BARNSTABLE EY I have Worker's Compensati n Insuranc Insurance Company Name �/ C / C Workman's Comp. Policy# IYC / Copy of Insurance Compliance Certificate must accompany each permit. 'ermit Request (check box) ❑ Re-roof(hurricanenailed) (stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of root) V.. Replacem e-side f-p #of doors _l ent Windows/doors/sliders. U-Value V (maximum .35)#of windows _ *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 require . NATURE: PFILES\FORMSIbuildingpertnii formslEXPRESS.doc The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: L�S fC e 6 �elp City/State/Zip: (a_� b ✓3 31 Phone Are you an employer? Check the appropriate b Type of project(required): `r I am a employer with 4. 1 am a general contractor and I 1 —`— * have hired the sub-contractors 6. ❑N construction employees(full and/or part-time). 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'comp. Building addition [No workers' comp. insurance ,,. comp. insurance. 5. We are a corporation and its 10.❑ Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work officers have exercised their I 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 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 1Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic. #: 0 lwvj3 6 .0)--- Expiration Date: f Jam" Job Site Address: a 7 City/State/Zip: ��' 6 �fc Attach a copy of the workers' compensation polic.744laration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u e pains and penalties o erjury that the information provided above is true and corr ct Si ature: Date: Phone#: `J�b [ t1' Official use only. Do not write in this area, to be completed by city or town oJYkiaL City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: i a-" OZe Of;; e of Consumer Aft Irs& Ba iaess Reblliaaioi3 „SOME IMPROVEMENT GONT4;^TOR Registration: .126893 Type: Expiration: `8I312012 Suppler, C The Home Depot At-Home Services DARREN DEMERS :: : 2690 CUMBERLAND PARKWA1 S -- ;4"1'L N , GA 30339 Undersecretary T.,icense or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 :ard Boston,MA 02116 Not valid without signature CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYY)(Y) 12128/2010 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Vieira Insurance Agency,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 65 Alden Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Fairhaven MA 02719 INSURERS AFFORDING COVERAGE NAIC# INSURED Douglas Szynal dba Szynal Property Services INSURER A: Essex Insurance Company 24 Logan Unit N504 INSURER B Granite State Ins Co INSURER C: New Bedford MA 02740 INSURER D: INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTOTHE INSURED NAMEDABOVE 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 BYTHE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD'L POLICY EFFECTIVE POLICY EXPIRATION OF INqt]RANrr POLICY NUMBER LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 ' A COMMERCIAL GENERAL LIABILITY 3DE9446 11/22110 11122/11 DAMAGE TO RaENTED occur $100,000 CLAIMS MADE �OCCUR MED EXP An one person) 5,000 PERSONAL 8 ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. , PRODUCTS-COMP/OP AGG $1,000,000 17 POLICY PRO- LOC JFCT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea acciderd) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY (Per accident) $ NON-OWNED AUTOS , PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ EANY AUTO OTHER THAN EA ACC $ AUTO ONLY: qGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WC STATU- I X OTH- AND EMPLOYERS'LIABILITY B ANY PROPRIETORMARTNER/EXECUTIVE YIN WC 002-25-3582 1112312010 11123/2011 E.L.EACH ACCIDENT $100000 OFFICER/MEMBER EXCLUDED? N❑ . (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $100000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS additional insured:THD At Home Services Inc and the Home Depot are included as Additional Insured with respects to General Liability Insurance CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THD At-Home Services Inc DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL_DAYS WRITTEN dba The Home Depot at Home Services NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 2690 Cumberland Parkway IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR Suite 300 REPRESENTATIVES. Atlanta GA 30339 AUTHORIZED REPRESENTATIVE ' ACORD 25(2009101) O 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and hgo are regiptered marks of ACORD . //t.P':4-^O,Ixt;lltlltU�CSLtFf (1��., �ZCIJ•:12Cf7-Cli��3 y Office of Con.uincr Affairs&Bifsiness egufation Licedse or registration valid for iudividul use only i ' y HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Is � Office of Consumer Affairs and.Business Regulatior a 3 Registration 146142 TYpe 10 Park Plaza-Suite 5170 `5 ? Expiration: 312 912 0 1 3 DBA Boston,htA(121!6 4 Si PROPER PROPERTY SERVICE' ` s is DOUGLAS SZYNAL 24 LOGON ST UNIT 80 - NEW BEDFORD,MA 0274ff CnttCrscncraiy IV alict'wil utsignatu� ' �� ��, sro ..`t 4��;•>i'.s� a,g:4�, """"L,..-.......mow _�,..„ ' _ la���}cs �a rtf�.%s=.'f � 45 tt 3s`rislts ""•i 1.� }>i7 a; 4 C C''a 5iL !"iat:jh r 24 Gr�A*r ? `t tiF fit 5;', 4 HOME IMPROVEMENT CONTRACT PLEASE READ THIS � '` Sold,Furnished and Installed by: Branch Name: Boston Date: t THD At-Horns Services,Inc.. d/tr/a The Home Depot At-Fiorue,Services 34-IA Greenwood Street,Unit 2,Worcester,MA OI_CiO% Toll Free(800)657-5182;Pax(508)756-8823 Branch Nomaber:.31.... Federal ID#75-2698460;ME i.ic#C 02430;RI Q u_Lie#I C>' 5522:MA Home Improvement Contractor Reg.#126893' Installation Address: (/ - itY State ....'Lip_ Purchaser(s): r Work Phone: Home Phony. Cell Pbon_e: Home Address: (If different from Inge Address) City State 4 Zip. E-mail Address(to irereave project communications and Homt Depot updates): ❑I DO NOT wish toieceive any marketing emails from The Home Depot Project Information: Undersigned("Customer"),the owners of the property located at the above installation address,agrees to buy, and THD At-Home Services,Inc.(`"The Home Depot)agrees to furnish,deliver and arrange for the installation("Installation")of all materials described on the below and on the referenced Spec Shcet(s),all of which arc incorporated into this Contract by this reference,along with any applicable State Supplement and Payment Summary attached hereto and any Change'Orders(collectively, "Contract"): Job#: am—a Rom) Prodocls S Sheet(s)#: Project Amount ' ❑Roofing Siding Windows ❑Insulation / Gu mrs/covers Eurry Doors_❑ 4 Roofing ❑Siding ❑ ws Windo Insulation ❑Gutters/Covers QEntry Doors ❑ ❑Root➢ng []Siding Windows ❑Insulation ❑Gutters/Covers ❑Entry Dom❑ $ ---- ]Roofing Siding ❑Windows []Insulation ❑Gutters/Coven MEntry Doors ❑ $ Mittitimin 25%Depusit of Conhud Amount due upon exmition ord&conim-i Maine Purchasers.may not deposit molt than one4hird of the Contract Amount. Iota!Contract Amount $ Customer agrees that, immediately upon completion of the work for each Product,Customer will execute a Completion Certificate (one for each Product as defined by an individual Spec:Sheet)and pay any balance due. As applicable,each Customer under this Contract agrees to be joirirly and severally obligated and liable hereunder. The Home;Depot reserves the right to issue a Change Order or terminate this Contract or any individual ProdUCt(5)included herein,at its discretion,if The Houle Depot or its authorized service provider determines that it cannot perform its obligations due to'a structural problem with the home,environmental hazards such as mold,asbestos or lead paint,other safety concerns,pricing errors-or because work required to complete the job was not included in the Contract. Payment Summary: The Payment Summary# W,5:42 SZ , included as part of this Contract, sets forth the_uttat Contract amount and payments required for the deposits and final payments by Product(as applicable). NOTICE TO CUSTOMER You are entitled to a completely fiiled-in copy of the Contract at the time you sign. Do not sign a Completion Certificate(note: there is one Completion Certificate for each listed Product as defined by individual Spec Sheets)before work on that Product is complete. In the event of tennination of this Contract,Customer agrees to pay The Home Depot the Costs or materials,labor,expenses and services provided by The home Depot or Authorized Service Provider through the date of termination,plus any other amounts set forth in this Agrcement or allowed under applicable law. THE HOME DEPOT MAY WiTIMOLD AMOUNTS OWED TO THE BIOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acceptance and Authorization: Customer agrees and understands that this Agreement is the entire agreement between Customer and The Home Depot with regard to the Products and lnstallation services and supersedes all prior discussions and agreements,either oral or written,relating to said Phiducts and Installation.This Agreement cannot he assigned or amended except by a writing.signed by Customer and The Home Depot.Customer acknowledges and agrtcs that Customer has read,understands,voluntarily accepts the terms of and has received It Copy of this Agreement. gAcy: � Subs Si nature X r `7L / Sales C nsu[rant's Signature Date TT X Tel m Custoer's Signature Date Sales Consultant License No. CANCELLATION: CUSTOMER MAY CANCEL THIS (�s apiilicat,)o> AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING THIS AGREEMENT, THE STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE, NOTICE:ADDf TONAL TIERMS AND CONDITIONS ARE.STATED ON THE REVERSE SIDF.AND ARE PART OF THIS CONTRACT 12.27-10 C-SC White-Branch File 'Yellow-Customer Td WUg?:L 600? Z 'qa� TZ i i?9�80S: 'Ohl Xd� pp6w2[; WON-1 s z Town of Barnstable t.. -Permit� Ezptres 6 pths from issue dnt� . Regulatory Services '. Fee KAM Thomas F.Geiler,Director i63q. �� Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-740-6230 EXPRESS PERMIT APPLICATION = RESIDENTIAL ONLY Not Valid without Re¢X_-Press Imprint Map/parcel Number I,702 Property Address 6 mn aa . [Residential Value of.Work Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Name Telephone Number- Contractor's e �3 �fo7p 3 Home Improvement Contractor License#(if applicable) /!V.5— Construction Supervisor's License#(if applicable) ! = PERM I orkman's Compensation Insurance • ®� RESS Check-one:. MAR 2 �10 I.am a sole proprietor ❑ I am the Homeowner w ❑ I have Worker's Compensation Insurance TOWN OF-BARNSTABLE Insurance Company Name 'z ✓n v4. niS. Workman's Comp.Policy# e9m) "6 3 i O Copy of Insurance Compliance Certificate must accompany each permit. ' . .f Permit Request(check box) a roof(stripping old shingles) Ali construction'debris will be taken to 'AI e 1,fd ❑Re-roof(not stripping. Going over _ existing layers of roof) .. ' ✓ "� [Fife-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.44)#of windows '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 required. SIGNATURE: C:\Users\decollikWppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\4STGU5Q0\EXPRESS.doc Revised 090809: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 000 Washington'Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / Please Print Legibly Name(Business/Organization/Individual): ' � t:w•eo fww arl L Address: plo� so",- � City/State/Zip: 1(e rAA QU32 Phone#: Are yo 'employer?Check the appropriate box: Type of project(required): 1. I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. [Zodeling ship and have no employees These sub-contractors have g. ❑Demolition workingfor me in an capacity. employees and have workers' Y P h'• 9. ❑Building addition [No workers' comp.insurance comp.insurance.: required.] 5. ❑ We are a corporation and its ME.]Electrical repairs or additions officers have exercised their 11.[]Plumbing repairs or additions 3.❑ I am a homeowner doing all work ❑ g P 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 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: 6,Lt"'► y 3 L'O Expiration Date: Policy#or Self-ins:Lic.#: �Q'1� �.J 6 J Job Site Address: !? d4�2u City/State/Zip: Attach a copy of the workers'compensation placy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the,form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pat and penalties of perjury that the information provided above is true and correct Si ature: Date: Phone#: Ask- Official use only. Do not write in this area,to be completed by city or town ofjMaL 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#: SPECIALIZING IN ALL FORMS OF ROOFING A SIDING doyle-thomas@comcast.net (508) 328-1635 P.O. BOX 168 Fully Licensed & Insured CENTERVILLE, MA 02632 LIC# 145954 Doyle and Thomas Inc.Proposes to perform the following Work.- Location of proposed work: Mr: Mike Doherty 4. 110 Patriot Way t Centerville, MA 02632 Date on which construction should begin:' March 2010 The homeowner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that cannot be avoided by the contractor shall not be.co. nsidered as a violation of this contract. The contractor agrees thatwhen such delays become known to the contractor,the contractor will advise the homeowner,as soon as possible. The homeowner hereby acknowledges that in certain remodeling work,the demolition process may reveal defects in the existing structure which must be'repaired,creating additional work which may need to be carried out in order to complete the work described in this contract. In such case the homeowner agrees that the duration of.the work and the schedule date of completion may differ,and that such variation is not to be`consideredf a violation of this contract.: The total cost for labor and materials under this contract: $6,500.00 the above proposal includes James Hardie plank siding and six tubes of color adhesive ` In the event that the homeowner agrees and authorizes said replacement or restoration,then in addition to the above contract price,the homeowner agrees to compensate the contractor for any repairs or restoration at the hourly rate of,$45.00 for a carpenter.and$30.00 for a carpenters laborer, plus the cost of materials. -Siding area to be papered with t' k house wrap Install of James Hardie lank siding in accordance with the best practices and installation ~ P g manual. -Install of aluminum coil stock on all areas in accordance with installation and warranty Thank you for Giving us the Opportunity to Help You Improve Your,Horne' r. . practices. a -Contractor is responsible for all materials needed to complete the project as discussed. -Contractor to install PVC blocking for all.electrical and plumbing extrusions as discussed.: -Contractor will provide a container on site;for all debris. ; , -James Hardie install expert to warranty product and install as discussed at completion. NOTICE EQUIRED BY LAW t With the agreement of the'contract 1/3 of estimate is due: Further payments under this contract are as follows:. 3 1/3 of the estimate due at the`half;and remainder due at completion,of the job. , r Balance of all materials and labor'shall be payable in'full upon,completion of work described m this contract. Payment as agreed upon,shall be.made when due. `Any payments which are delayed shall be subject to a finance charge of 1;5%per month: The contractor warranties,theirworkmanship completed.under this contract for a period of five years from the date of completion. x - During the stated warranty:period the contractor shall be responsible for the service of the repair or adjustment, but the contractor shall not be responsible for the normal.maintenance, repair due to abuse, misuse,and or normal wear and tear,which shall be the responsibility of the homeowner.. All warranties for the materials supplied by the contractor shall be passed directly to the homeowner. The homeowner may be required to register,'or mail in such warranty card or evidence of ownership in order to activate such warranties:: Homeowner failure shall not.create any responsibility for the contractor under warranty provisions;the choice of repair of replacement shall be atthe , discretion of the contractor-, Thehomeowner acknowledges that the form,content, a'nd notices.contained in this contract are intended to comply with the applicable portions of the Mass. General Law Chapter 142A, and regulations promulgated thereunder. In the.event of'any instance of non-compliance;only such r portion shall.be invalid and the remainder-of this contract`shall be in full force'effect.. In`addition„any such portion not in compliance shall be'read and interpreted so as'to have its;intended meaning to the maximum extent allowed under such law and regulation: r 7 Signed as a sealed instrument on this date Date: Homeowy ' ' ,Contra or ®URUG-03-2009 12:09 From:MARK SYLUTA INS 5084209227 To: 15087906230 P.1/1 ACORD, CERTIFICATE OF LIABILITY IN URANCE DATE, 08/03/2009TI Pl g ' .. Sefial# 103646 THIS CERTIFICATE IS ISSUFb AS A MATTER OF INFORMATION ®® MARK SYLVIA INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 771 MAIN STREET ALTER THE COVERAGE AFFORQFQ BY THE POLICIF- fiI-OW- OSTERVILLE,MA 02065 TEL: 600428,4440 FAX: 608-420.9227 INSURERS AFFORDING COVERAGE NAICfF INpUI?EI) INSURER A FARM FAMILY CASUALTY INSURANCE CO DOYIL�8 THOMAS CONSTRUCTION INC- INSURER B; j P0.BOX 168 INSURER C-' CENTERVILLE, MA 02632 INSURER D: INSURER U COVERAGES 'THE POLICIES OId;INGURANCE LISTED BELOW HAV@ 84'EN ISSUED TO THE INSURED NAMED ABOVE FOR THG POLICY PERIOD INDICAT4'D.NOTWITHSTANDING F OS D OR ANY REQUIR4MLNT,TERM OR CONDITION OP ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY 1S MAY'PFR1'AIN,THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, exCLUSIONO AND CONDITIOON✓OF UCH POLICIES,AGGRLGAT6 LIMITS SHOWN MAY HAVE BEEN REDUCED 13Y PAID CLAIMS INS NO I F' T P L Y X T N LWITa TYpq Of°INBURANCq POLICY NUMDRR EACH OCCURR014ca 5 1 000 Q00 Qu gRAL 41A51CITY A X COMM TRCIAL OCNLrRAL LIABILITY 2001 XO465 07/21f2009 0721/2010 A O fl. 'fr.D s 50,000_ 6LAIMQ7 MARS a OCCUR MED FIXP (Anyone mroan) S - 5,000 PRRMONAL A ADV INJUI?Y 6 QQNr3RAL AOOROGATC S 2,000,000 OEN'L AQCIRtl0AT0 LIMIT APPL•IFS KA PRODOCTS-COMPIOP Arc S 2,000,000 X. POLICY OP LOC ............... AUTOMO[JILE LIABILITY COM13INED SINGLF LIMIT Q ANY AOTO (Eo aaoidanq ALL OWNED AUTOS DODILY INJURY y f1CHHDULCO AUTOO (For Poleon) HIRQD:AUT03 DODILY INJURY y .: NON-OWNED AU,PI'06 (Par enaidonl) PppOPDRTY OAMAGEE $ - (pp,�eoarAoniJ I....... DARAQI LIABIU'fY AUTO QNI.Y-IIA ACCIMCNT S ANY AUIq OTHER THAN F'A ACC S AUTO 014LY AOO 8 L'XCO66lUM®RDLLA LIABILITY rACI'l OCCURRENCE t OCGUI% CLAIMS MADLY AOGIRQGATE 6 DQDUCT1130 y "irirreNTION S G uIQRKnR'3 COMPENSATION AND 2001 W6390 07/01/2009 07/01/2010 777 RMPLOY17R6'LIABILITY : DL EACH AOCIOrRNT 6 SOO 000 ANY PRQPRIGTOR/PARTNamexECUTIVE OPFICERIMEM110 IrXCLUOGD?' F:L 00r ASR...f A rmpl.OYCG 6 500,000_. Yes Ilyan+dobarlDeundad 15 (ILIA':PROVIEIO S below GI.OIGE1ARP-POI,.ICY LIMIT G 500,000 rz9 DE150RIPTION OP OPHRATION61LOCATIONANUHIC4Uall3XCLU61ON6 ADDIJO BY FaNDORBOMCNTr®PUCIAL PROYIBIOP46 " r� CAR.P.ENTRY r —e; THE.WORKERS COMPENSATION POLICY GOES NOT PROVIDE COVERAGE FOR TROY A THOMAS, SHAWN DOYLE�t I'-7 f CERTIFICATE HOLDI2R CANCELLATION .......... ... ..... SHOULD ANY OF ThtF AOOVC DLESCRIDCD POLICIDB 00 CANC2LLL'D SeFORIBTHH D(I>IRATION TOWN OF BARNSTABL F DATE THG COP THE!ISSUING INSURER WILL fINPEAvoR TO MAIL DAYA WRITTEN NOTICC'O 'HIJ CERTIFICATE H01,DCR NAMED TO THO LEFT,BIJ1'FAILURE TO DO SO SHALL BUII:OING DEPARTMENT ATTN SALLY HYANNIS, MA 02601 IMPO N 01LIG1ATION DR LIApW' P ANY INO UPON TI IG INBUIiGR,ITS AGGN'fG OR FAX; 508-790-6230 JSD Rm ,rr T T AUT RIZ L' V ACORD 28,(2001/08) O A RD CORPORATION 1009 . IVlassachusetts- Department of Public Safeti ` Board of Buildin- Re, lations and Standards -Construction Supervisor Specialty License License: CS-SL 99913 Restricted to:. RF U TROY :.THOMASk. r 499 NOTTINGHAM;DRIVE y CENTERYIgj:g MA%02632 Expiration: 4/13/2012 C'�inuuissiuncr!' Tr#: 99913. _ Ar , ✓ ' Boar o w mg egu atio s an tandar s ` License or registration valid for individul use only . a• HOME IMPROVEMENT CONTRACTOR before,the expiration date. If found return to: . r Board of Building Regulations and Standards Registration, 145954 a One Ashburton PlaceRm 1301 Expiration 3/15/2011 Tr#'262668 c_ Boston,Ma.02108 I ulq Type DBX DOYLE#THOMA SCONST TROY THOMAS X } 499 NOTTINGHAM DRY l :j ^/ 'WoMa "without signature CENTERVILLE,MA 02632.E Administrator Town of Barnstable erml a ob 30( (5-6° Regulatory Services ate:. pFTME Tok� Thomas F.Geiler,Director Building Division sa MASS.ce. Tom Perry, Building Commissioner y Mass. g 039. 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 TOWN OF BARNSTABLE . SOLID FUEL STOVE PERMIT Owner: P S �1 Phone: M1 II Install at: IA)o A-1 Village: o���►'V� ��. Map/Parcel: Date: Stove A. New Use CZ B. Type: Radiant/ culatirig ;, a�7; C. Manufacturer: Q� Lab. No. D. Model No. Chimney A. New/Existing. If existing,please note date of last cleaning) U B. Flue Size C. Are other appliances attached to Flue? D. Pre-fab Type and Manufacturer E. Masonry: Line nlined Hearth A. Materials: B. Sub Floor Construction: Installer Name: Address: Phone: Location of Installation: H.I.0 Registration# Constructio=Suisor#OR checkeowner Installing, no license.required APPLICANTS SIGNATURE I APPROVED BY: Please make checks payable to the Town o Barnstable *This constitutes an official stove permit after inspection,photographed, and approved by the Building Inspector Qforms:stove Rev 103107 4 .. .• t,. • t Y Net i � l f 1 •. w s t 101 Patriot Way, Centerville 3/5/08 Assessor's Office(1st`floor) Map Parcel r(4ermit Conservation Office(4th floor)(8:30 S9:30/1:00-2:00) .Z q ,i • ,�Date Issued Board of Health t(3rd floor)(8:15 9:30/1:00-4:45)-7 — 7� " tF19ee � pYSTE MUST BE (l� Engineering Dept. (3rd floor) House# ' Z INSTAL`�® �fA$��CE NM e + r Lcd: x TOWN OF BARNSTABLE nn Building Permi1t/Application Project Str ddre /G/ (rR f✓lI bf kl l�y 1 Village �G✓1 v'U 1 N1 Owner )1 /A r Q Address .... Telephone " Permit Request add S I t'� 0�0r _ s First Floor gY X 3�_ square feet Second Floor ►'��� square feet Estimated Project Cost $ ,��+ Zoning District Flood Plain Water Protection Lot Size +3 Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Lom Q Proposed Use -m Construction Type kp dd Commercial Residential Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure ��� Basement Type: Finished Historic House Unfinished Old King's Highway Number of Baths . No.of Bedrooms A v ee Total Room Count(not including baths) c�:�cL S�'k First Floorjc�� Heat Type and Fuel r1eC,+r\Z Central Air Fireplaces 6-1 e Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds Other Builder Information Name Telephone Number Address License# 1 Home Improvement Contractor# '► Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) + FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED - MAP/PARCEL NO. ADDRESS~ ?' ` VILLAGE OWNER { DATE OF INSPECTION: , I FOUNDATION FRAME 1 r1i -V Ii r INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING:W Mti ROUGH FINAL GAS: ROGH FINAL - ! FINAL BUILDPIgi Pe DATE CLOSED QUT3 ,r)•' s , x. ASSOCIATION PLAN NO. a r ax, - a- s _ � Oi - v, t >< s � ti. - - - c f f f i f j _ I II,`I I I �f i . i ` y [, TOWN OF BARNSTABLE 20839 e Permit No - =— Building Inspector saua�n Cash mum OCCUPANCY PERMIT Bond -_X__— 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 Banner Home Corp. Address 76 West plain St., Hyannis lot #13 101 Patriot Way, Centerville Wiring Inspector �.�=* Inspection date Plumbing Easpecto + Inspection date Gas Inspector ` Inspection date Engineering Depar".ent � / ' �,� Inspection date-e/ - f 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. JI ..................... �.�.. ............, 19 ..... . ....... MBuilding�Inspector_.._.�..._. 'z - • .' ar a .✓' "+; 4• ,,xa • •L ir: }} F yy k K1. 1 / s A 3 ^T�� F S,F_37-1 .., ..s.lr..wa,..—..,: ..,,..,— .. 2U±• ��1P>f, �N - ar '�u, �fY`'+; ,��� �e 114 f r iv t c r + aP s tt 1-4 it t b s g I'tr.iiti'� rrt io 44, /,{ •' �t.� f, � mot: h G4 tl ; 0 SW A A _ VV�. • ,. r 5. i � • 4 �F 1, i' x.•r + CERTIF16 ,PLOT PLAN r 3' i Lo-T 3 PAT*- OT Y NEW CONSTRUCTION ONLY. ; TOP OF FOUNDATION IS FEET .IN ABOVE LOW POINT OF ADJACENT t 2, 1 ��� f,/� a�a',>gj �+l' e ' ROAD. SCALE : /.,/ -Sv DATE : //�i 7/7 M EL DREDGE ENGINEER/NG_C0. IN�C we-Rnic2 I CERTIFY THAT THE F°V^!4D.471 CLIENT SHOWN ON 4-HIS PLAN IS LOCATED, i EGISTERED`I REGISTERED JOB NO AND,4 r CIVIL LAND ON THE D AS INDICATED ENGINEER I SURVEYOR DR. BY: �_ A`�:' . CONFORM 'THE ZONING LAWS pz �_._—_ K — O F B A R N S T E , ASS. 33 NO. MAIN ST 712 MAIN "')T. CH. BY r'� ���`' 2G 7 i S0. YARMOUTH, MASS. HYANNIS, MASS. SHEiE.T_1. OF / -DATE-- - R-EG. -LAN.D - RVEYOW", - ter• MUS.. ' p ., �9 ?a SEPTIC SYSTE :1 a'<_ ro ssessW s ma and lot number ... . .. -e- ee ' ALLED �♦ fl,3ST IN COP�I SewagePermit number .......................................................• t''ilTy ARTICLE II S1 o 101 r�"f ITARY COD` AN a LE• ' Housenumber ........................................................................ LATIO�JS. oA639. 0� 0 mxf a` T0WN 'OF 'BAR.NSTABLE ts AsPECTOR APPLICATION FOR PERMIT TYPE OF CONSTRUCTION ............ C' .'a�...... :.. ..... . ..r................................................................. .. . .`..................19.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ........ .. ProposedUse .......... .) ��`-- ...................................:...................................................•....:................ Zoning District .....................�C ............... Fire District .. ���� � 1• Name of Owner�� ��w..� ,,. !!1. —.....Address .. .... Name of Builder ..................... ......................Address iv1 .,.................................. Nameof Architect ...................... i...........................Address ..............................!./ ..................................... Number of Rooms .............. .... .. 1� .............................Foundation .... 1... ..... Exterior ...�.... ( . ..................Roofing r ...............:.........:.. 11 t.,/,•,. Q.... . ..... .. Floors «< ...... '�.���..!�?.�°.k--...............Interior RAHeating Q..� ll ....... V...!1......Plumbing .. --t 1C. ..... �-....�VQ........................ Fireplace , v®/.Q�...............................:....A roximate Cost . v Definitive Plan Approved by Planning Board ------_-------------------------19________. Area ........... .......+�.'. • Diagram of Lot and Building with Dimensions Fee CV2 SUBJECT TO APPROVAL OF BOARD OF HEALTH - A� I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable re rding the above construction. Name• Banner Home Corp. �Nd ... Permit for ........ ............ .................. Location ............2,Q1..FAtri.Q1..Way.................. ............................ ......................... Owner ............ ................. Type of Construction .............frame................... ................................................................................ Plot ............................ Lot ................#13......... A Permit Granted ..........November...2.0......19 78 ................. /�/ ? S, Date of Inspection ....................................19 Date Completed . ....... .......19 PERMIT REFUSED: ................................................................ 19 ............................................................................... ................................................................................ r Ord ............................................................................... ................................................................................ Approved ................................................. 19 ............................................................................... ...............................................................................